Aqueous Angiographic Outflow Improvement after Trabecular Microbypass in Glaucoma Patients

Huang, Alex S.; Penteado, Rafaella C.; Papoyan, Vahan; Voskanyan, Lilit; Weinreb, Robert N.

doi:10.1016/j.ogla.2018.11.010

Cited by 71 publications

(63 citation statements)

References 32 publications

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“…However, eyes were used very soon after death (within 4 hours). Previous publications using AA in postmortem human eyes36,65 showed similar results to eyes from living human subjects 39,66,67. AA in feline eyes in vivo can also be performed in the future to address these concerns as well.…”

Section: Discussionmentioning

confidence: 53%

Imaging Distal Aqueous Outflow Pathways in a Spontaneous Model of Congenital Glaucoma

Snyder

Oikawa

Williams

et al. 2019

Trans. Vis. Sci. Tech.

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PurposeTo validate the use of aqueous angiography (AA) in characterizing distal aqueous outflow pathways in normal and glaucomatous cats.MethodsEx vivo AA and optical coherence tomography (OCT) were performed in nine adult cat eyes (5 feline congenital glaucoma [FCG] and 4 normal), following intracameral infusion of 2.5% fluorescein and/or 0.4% indocyanine green (ICG) at physiologic intraocular pressure (IOP). Scleral OCT line scans were acquired in areas of high- and low-angiographic signal. Tissues dissected in regions of high- and low-AA signal, were sectioned and hematoxylin and eosin (H&E)-stained or immunolabeled (IF) for vascular endothelial and perivascular cell markers. Outflow vessel numbers and locations were compared between groups by Student's t-test.ResultsAA yielded circumferential, high-quality images of distal aqueous outflow pathways in normal and FCG eyes. No AA signal or scleral lumens were appreciated in one buphthalmic FCG eye, though collapsed vascular profiles were identified on IF. The remaining eight of nine eyes all showed segmental AA signal, distinguished by differences in time of signal onset. AA signal always corresponded with lumens seen on OCT. Numbers of intrascleral vessels were not significantly different between groups, but scleral vessels were significantly more posteriorly located relative to the limbus in FCG.ConclusionsA capacity for distal aqueous humor outflow was confirmed by AA in FCG eyes ex vivo but with significant posterior displacement of intrascleral vessels relative to the limbus in FCG compared with normal eyes.Translational RelevanceThis report provides histopathologic correlates of advanced diagnostic imaging findings in a spontaneous model of congenital glaucoma.

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Section: Discussionmentioning

confidence: 53%

Imaging Distal Aqueous Outflow Pathways in a Spontaneous Model of Congenital Glaucoma

Snyder

Oikawa

Williams

et al. 2019

Trans. Vis. Sci. Tech.

Self Cite

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“…The two-stent, multidirectional design of the iStent inject is backed up by robust research in aqueous angiography and computational fluid dynamics (CFD), the most powerful tool available to assess size and flow. In a study by Huang et al, significant aqueous angiographic outflow improvement resulted after iStent inject implantation with cataract surgery [52]. The findings showed reactivation of formerly dormant outflow areas and possible access to up to 6 clock hours of collector channels for aqueous humor outflow.…”

Section: Discussionmentioning

confidence: 97%

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Manning

2019

Ophthalmol Ther

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Introduction: This real-world retrospective case series assessed 12-month effectiveness and safety following implantation of iStent Ò or iStent inject Ò trabecular micro-bypass with cataract surgery. Methods: Consecutive patients were implanted with either iStent (comprising 1 stent) or iStent inject (comprising 2 stents), together with cataract surgery. Most patients had primary openangle glaucoma. Effectiveness outcomes through 12 months included intraocular pressure (IOP) and glaucoma medications. Proportional analyses were completed for eyes achieving IOP B 18 mmHg, IOP B 15 mmHg, or IOP reduction C 20% from preoperative; and eyes on 0 medications or C 2 medications. Safety outcomes included adverse events, secondary surgeries, visual acuity, and visual fields. Results: This analysis included 137 eyes (67 iStent, 70 iStent inject) with cataract and mild to moderate glaucoma or ocular hypertension. Over 73% of eyes in both groups had early disease, and * 22% had prior glaucoma surgery. At 12 months postoperatively, mean IOP decreased from 18.4 ± 4.2 mmHg to 14.2 ± 2.5 mmHg in iStent eyes (p \ 0.0001), and from 20.4 ± 5.6 mmHg to 14.4 ± 2.1 mmHg in iStent inject eyes (p \ 0.0001). The IOP reduction was significantly greater for iStent inject eyes than iStent eyes (6.0 mmHg versus 4.2 mmHg reduction, p = 0.034). Both groups had high proportions of patients achieving the 12-month IOP endpoints, although consistently greater proportions reached these endpoints after iStent inject than iStent: 95.7% versus 92.5% had IOP B 18 mmHg, respectively; 74.3% versus 71.6% had IOP B 15 mmHg, respectively; and 68.6% versus 62.7% had IOP reduction C 20% from baseline, respectively. Mean medication burden at 12 months decreased from 1.8 ± 0.7 to 0.3 ± 0.5 medications in iStent eyes (84.0% reduction, p \ 0.0001), and from 1.3 ± 0.9 to 0.1 ± 0.3 medications in iStent inject eyes (94.7% reduction, p \ 0.0001). Significantly more iStent inject eyes were medication-free at 12 months than iStent eyes (92.9% versus 76.1% medication-free, respectively; p = 0.0068). Favorable safety included few adverse events, no secondary glaucoma surgeries, and stable visual acuity and visual fields in both groups. Conclusion: Significant and safe IOP and medication reductions were achieved through 12 months after iStent or iStent inject implantation with cataract surgery. iStent inject eyes Enhanced digital features To view enhanced digital features for this article go to

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“…The CFD models estimated that a single stent (either iStent or iStent inject) was completely capable of conducting all 2.5 μL/ min of aqueous humor production [47]. Huang et al confirmed these findings in an aqueous angiography study of patients undergoing iStent inject implantation with cataract surgery, showing that aqueous outflow patterns improved and formerly dormant outflow areas were reactivated, thereby increasing the span of collector channels for outflow [50].…”

Section: Discussionmentioning

confidence: 99%

Second-generation trabecular micro-bypass stent implantation: Retrospective analysis after 12- and 24-month follow-up

Neuhann¹,

Neuhann²

2020

Eye and Vis

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Background: The study aimed to investigate the 24-month safety and efficacy of implantation of two secondgeneration iStent inject trabecular micro-bypass stents with concomitant cataract surgery. Methods: This consecutive case series included 164 eyes of 109 patients implanted with the iStent inject® device with concomitant cataract surgery. The series was comprised of eyes with primary open-angle glaucoma (n = 84), pseudoexfoliation glaucoma (n = 42), normal-tension glaucoma (n = 18), and ocular hypertension (n = 20). All 164 eyes reached 9-14 months of follow-up ("12-month consistent cohort"), with a subset of 88 eyes reaching 21-26 months of follow-up ("24-month consistent cohort"). Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intra-or postoperative complications, the need for secondary procedures and corrected distance visual acuity. Comparisons of change in continuous (e.g., IOP) and categorical (e.g., proportions of eyes on zero medications) measures between baseline and postoperative times were made with the paired t-test and McNemar's chi-squared test, respectively. Results: At 12 months postoperatively, IOP was reduced by 25.5% (from 20.0 ± 5.5 mmHg to 14.9 ± 2.0 mmHg; p < 0.001); at 24 months postoperatively, IOP was reduced by 26.6% (from 20.3 ± 6.1 mmHg to 14.9 ± 1.9 mmHg; p < 0.001). At 12 months postoperatively, mean number of glaucoma medications was reduced by 85.0% (from 2.0 ± 1.0 to 0.3 ± 0.8 medications; p < 0.001); at 24 months postoperatively, mean number of medications was reduced by 81.0% (from 2.1 ± 1.1 to 0.4 ± 0.8 medications; p < 0.001). After 12 months, 96.3% of eyes had an IOP ≤ 18 mmHg and 58.5% of eyes had an IOP ≤ 15 mmHg, with 81.1% of eyes free of any medication, compared to 1.8% of eyes medication-free in the 12-month cohort at baseline. After 24 months, 98.9% of eyes had an IOP ≤ 18 mmHg and 53.4% of eyes had an IOP ≤ 15 mmHg, with 72.7% free of medication compared to 1.1% of eyes medication-free in the 24-month cohort at baseline. Overall, a high safety profile was observed with no significant postoperative complications. Conclusions: The insertion of iStent inject (comprised of two second-generation trabecular micro-bypass stents) with cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden up to 24 months postoperatively.

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Aqueous Angiographic Outflow Improvement after Trabecular Microbypass in Glaucoma Patients

Cited by 71 publications

References 32 publications

Imaging Distal Aqueous Outflow Pathways in a Spontaneous Model of Congenital Glaucoma

Imaging Distal Aqueous Outflow Pathways in a Spontaneous Model of Congenital Glaucoma

Real-world Case Series of iStent or iStent inject Trabecular Micro-Bypass Stents Combined with Cataract Surgery

Second-generation trabecular micro-bypass stent implantation: Retrospective analysis after 12- and 24-month follow-up

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