Ab interno supraciliary microstent surgery for open-angle glaucoma

Sandhu, Amanjeet; Jayaram, Hari; Hu, Kuang; Bunce, Catey; Gazzard, Gus

doi:10.1002/14651858.cd012802.pub2

Cited by 11 publications

(5 citation statements)

References 32 publications

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“…Evidence from the NMA showed a similar effect (0.2 drops; 95% CI, −0.1 to 0.6 drops; 95% PI, −0.5 to 0.9 drops) (Figure 2). Sandhu et al reported a change of −1.2 drops after combined cataract extraction with CyPass vs −0.7 drops after cataract extraction alone, but this effect was not statistically analyzed. No significant difference was seen in mean change in IOP-lowering drops when ab interno trabeculotomy with Trabectome plus cataract extraction was compared with trabeculectomy plus cataract extraction.…”

Section: Resultsmentioning

confidence: 99%

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Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma

et al. 2021

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IMPORTANCE Glaucoma affects more than 75 million people worldwide. Intraocular pressure (IOP)-lowering surgery is an important treatment for this disease. Interest in reducing surgical morbidity has led to the introduction of minimally invasive glaucoma surgeries (MIGS). Understanding the comparative effectiveness and safety of MIGS is necessary for clinicians and patients. OBJECTIVE To summarize data from randomized clinical trials of MIGS for open-angle glaucoma, which were evaluated in a suite of Cochrane reviews. DATA SOURCES The Cochrane Database of Systematic Reviews including studies published before June 1, 2021. STUDY SELECTION Reviews of randomized clinical trials comparing MIGS with cataract extraction alone, other MIGS, traditional glaucoma surgery, laser trabeculoplasty, or medical therapy.DATA EXTRACTION AND SYNTHESIS Data were extracted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines by one investigator and confirmed by a second. Methodologic rigor was assessed using the AMSTAR 2 appraisal tool and random-effects network meta-analyses were conducted. MAIN OUTCOMES AND MEASURESThe proportion of participants who did not need to use medication to reduce intraocular pressure (IOP) postsurgery (drop-free). Outcomes were analyzed at short-term (<6 months), medium-term (6-18 months), and long-term (>18 months) follow-up.RESULTS Six eligible Cochrane reviews were identified discussing trabecular bypass with iStent or Hydrus microstents, ab interno trabeculotomy with Trabectome, subconjunctival and supraciliary drainage devices, and endoscopic cyclophotocoagulation. Moderate certainty evidence indicated that adding a Hydrus safely improved the likelihood of drop-free glaucoma control at medium-term (relative risk [RR], 1.6; 95% CI, 1.4 to 1.8) and long-term (RR, 1.6; 95% CI, 1.4 to 1.9) follow-up and conferred 2.0-mm Hg (95% CI, −2.7 to −1.3 mm Hg) greater IOP reduction at long-term follow-up, compared with cataract surgery alone. Adding an iStent also safely improved drop-free disease control compared with cataract surgery alone (RR, 1.4; 95% CI, 1.2 to 1.6), but the short-term IOP-lowering effect of the iStent was not sustained. Addition of a CyPass microstent improved drop-free glaucoma control compared with cataract surgery alone (RR, 1.3; 95% CI, 1.1 to 1.5) but was associated with an increased risk of vraision loss. Network meta-analyses supported the direction and magnitude of these results. CONCLUSIONS AND RELEVANCEBased on data synthesized in Cochrane reviews, some MIGS may afford patients with glaucoma greater drop-free disease control than cataract surgery alone. Among the products currently available, randomized clinical trial data associate the Hydrus with greater drop-free glaucoma control and IOP lowering than the iStent; however, these effect sizes were small.

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Section: Resultsmentioning

confidence: 99%

“…Cochrane Eyes and Vision formed a consortium in 2015 to conduct a suite of Cochrane systematic reviews of randomized clinical trials (RCTs) (Cochrane reviews) of MIGS procedures . Authors of these reviews harmonized their protocols so that findings from individual reviews could be compared and summarized in an overview.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma

et al. 2021

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“…This will then translate to more reliable data on which to base health economic studies-preferably by independent authors. Though the HMS shows promise and was cost-effective in our model, prior experience with MIGS devices 50,51 shows that long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

Atik

Rhodes

Samuels

et al. 2022

Journal of Glaucoma

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Précis: Hydrus microstent (HMS) implantation at the time of cataract surgery appears to be cost-effective in mild-to-moderate glaucoma. However, long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness. Purpose: The aim was to assess the societal cost-utility to the US Medicare system of implanting HMS with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma. Patients: Markov model cohort of patients with mild-to-moderate open-angle glaucoma and visually significant cataract. Methods: Patients received HMS during cataract surgery versus cataract surgery alone, in a deterministic model over a 2-year horizon using TreeAge software. Both arms received additional ocular hypotensive agents to control intraocular pressure. Treatment effect of HMS was measured as mean number of ocular hypotensive medications and intraocular pressure, which directly impacted transition probabilities. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. One-way sensitivity and probabilistic sensitivity analyses were conducted on device efficacy and longer time horizons. Results: At 2 years, HMS with cataract surgery in mild glaucoma had an incremental cost-utility ratio of USD 38,346.43 per utility gained, compared with cataract surgery alone. Probabilistic sensitivity analysis was cost-effective in 61.4% of iterations for HMS+cataract surgery. The probability of side-effects with eye drops, utility decrement with side-effects, cost of the HMS and real-world efficacy rate had the greatest impact on model outcomes. HMS must be 85.60% as effective as published data to maintain cost-effectiveness at a willingness-to-pay threshold of USD 50,000. The incremental cost-utility ratio of HMS with cataract surgery in moderate glaucoma was USD 42,895.38. Conclusions: HMS implantation during cataract surgery appears to be cost-effective for patients with mild-to-moderate glaucoma. Nevertheless, more long-term safety and efficacy data are required.

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“…Alcon, Fort Worth, TX, USA) nach FDA(Food and Drug Administration)-Zulassung 2016 (CE-Zulassung bereits 2008). Die Studienergebnisse zeigten eine vielversprechende Drucksenkung zwischen 20 und 30 % bei gleichzeitiger Medikamentenreduktion über 2 bis 3 Jahre [61][62][63]. Allerdings zeigte sich in der COMPASS XT-Folgestudie nach 5 Jahren ein signifikanter Hornhautendothelzellverlust bei einer anterioren Stentimplantation [64].…”

Section: Suprachoroidale Drainageunclassified

“…B. Hornhautendothelschaden) notwendig sind. Es konnte gezeigt werden, dass MIGS-Verfahren mit unterschiedlichen Wirkmechanismen mit einer additiven Wirkung kombiniert werden können [71][72][73][74][75][76]. Möglicherweise können hieraus -auch in Kombination mit in naher Zukunft verfügbaren implantierbaren medikamentösen Slow-Release-Systemen -neue Glaukomtherapien entwickelt werden, die eine vergleichbare IOD-Senkung wie fistulierende Operationsverfahren bei gleichzeitig deutlich reduziertem Operationsrisiko ermöglichen.…”

Section: Suprachoroidale Drainageunclassified

„Minimally invasive glaucoma surgery“ – Kammerwinkelbasierte Verfahren im Vergleich

Klabe¹,

Rüfer²

2023

Ophthalmologie

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ZusammenfassungIn der Versorgung von Patienten mit einer Glaukomerkrankung spielen operative Verfahren eine zunehmende Rolle. Innerhalb der letzten Dekade haben sich neue chirurgische Verfahren etabliert, die unter dem Begriff „minimally invasive glaucoma surgery“ (MIGS) zusammengefasst werden. Eine große Vielfalt von unterschiedlichen Operationen zielt dabei auf die Strukturen im Kammerwinkel, sei es das Trabekelmaschenwerk und den Schlemm-Kanal zur Verbesserung des physiologischen Abflusses oder auch die Verbesserung des alternativen uveoskleralen Abflusses. Die Umsetzung des Therapieziels unterscheidet sich bei den einzelnen Verfahren ebenso wie die maximal erreichbare Drucksenkung. Im Vergleich zur Trabekulektomie mit dem Einsatz von Zytostatika ist die erzielbare Drucksenkung in der Regel deutlich geringer. Als Vorteil dieser Verfahren werden hingegen die signifikant geringeren intra- und postoperativen Komplikationsraten betont. Mit zunehmender klinischer Erfahrung und dem Anwachsen von suffizienten Daten dieser neuen chirurgischen Verfahren fällt eine fundierte Einordnung in den Behandlungsalgorithmus der Glaukomchirurgie leichter. Dennoch bleibt die letztendliche Entscheidung für einen einzelnen Eingriff aufgrund der geringen Differenzen hinsichtlich Wirksamkeit und Sicherheitsprofil häufig an die persönlichen Präferenzen des Chirurgen gebunden.

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Ab interno supraciliary microstent surgery for open-angle glaucoma

Abstract: Ab interno supraciliary microstent surgery for open angle glaucoma.

Cited by 11 publications

References 32 publications

Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma

Minimally Invasive Glaucoma Surgical Techniques for Open-Angle Glaucoma

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

„Minimally invasive glaucoma surgery“ – Kammerwinkelbasierte Verfahren im Vergleich

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