CURRENT CHALLENGE: PREDICTABLY ACHIEVING LOW TARGET IOP WITH A BETTER SAFETY PROFILE1

Hear it from your peers

Current glaucoma surgery methods can be effective, but variability of results remains an issue.2-4

What is your experience?

Answer a question and see how your response matches up with your peers’

What would having a glaucoma device that delivers IOP reductions approaching that of trabeculectomy with fewer complications and a more-predictable post-op regimen mean the most for you as a surgeon?

MIGS has not yet shown the efficacy to reach low target IOP similar to that of trabeculectomy3,5-8

  • MIGS is considered safe and efficient but has yet to harness the full IOP-lowering potential of the subconjunctival space to consistently reach low target IOP and reduce medication load like trabeculectomy.3,5-8
  • There are no comparative data demonstrating that an ab externo MIGS via the subconjunctival approach can predictably achieve lower target IOP like trabeculectomy.7,9
Graphic illustration depicting findings from the TVT Study and the COMPARE Study

*Not a head-to-head comparison. Based on findings from the TVT Study and the COMPARE Study.5,8

Graphic depicting post-trabeculectomy success rates

Based on findings from the TVT Study.9

Based on follow-up time and the criteria used to define successful outcomes.10

Trabeculectomy success rates can be as low as 47% in 5 years.10,†

Intensive post-op follow-up is frequently necessary following trabeculectomy4,11

Up to 1 year following trabeculectomy11

  • 63% of patients required post-op interventions
    • These included bleb interventions such as laser suture lysis (29%), 5‑fluorouracil injection (21%), removal of releasable suture (18%), and needling (14%)
  • A total of 6% of patients required re-operation to manage post-op complications
Graphic depicting bleb intervention findings

§Based on findings from Gedde 2018.11

A minimally invasive device that can reach target IOP approaching that of trabeculectomy but with more-predictable post-op is needed to empower proactive surgery.

References: 1. Amoozgar B, Wei X, Lee JH, et al. A novel flexible microfluidic meshwork to reduce fibrosis in glaucoma surgery. PLoS One. 2017;12(3):e0172556. 2. Nilforushan N, Yadgari M, Astaraki A, Miraftabi A. Comparison of the long-term outcomes of resident versus attending performed trabeculectomy. J Current Ophthalmol. 2017;29:169-174. 3. Bloom P, Au L. “Minimally invasive glaucoma surgery (MIGS) is a poor substitute for trabeculectomy”—the great debate. Ophthalmol Ther. 2018;7(2):203-210. 4. King AJ, Rotchford AP, Alwitry A, Moodie J. Frequency of bleb manipulations after trabeculectomy surgery. Br J Ophthalmol. 2007;91(7):873-877. 5. Ahmed IIK, Fea A, Au L, et al. A prospective randomized trial comparing Hydrus and iStent microinvasive glaucoma surgery implants for standalone treatment of open-angle glaucoma: the COMPARE Study [published online ahead of print April 26, 2019]. Ophthalmology. doi:10.1016/j.ophtha.2019. 6. Ayyala RS, Jewelewicz D, Bottorff J, De La Rosa S, Al-Dujali L, Morgan MG. Xen Gel Stent early results: safety and efficacy in the short term. Paper presented at: American Glaucoma Society Annual Meeting; February 28 to March 4, 2018; New York, NY. 7. Agrawal P, Bradshaw SE. Systematic literature review of clinical and economic outcomes of micro-invasive glaucoma surgery (MIGS) in primary open-angle glaucoma. Ophthalmol Ther. 2018;7(1):49-73. 8. Gedde SJ, Schiffman JC, Feuer WJ, et al; Tube Versus Trabeculectomy Study Group. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) Study after five years of follow-up. Am J Ophthalmol. 2012;153(5):789-803.e2. 9. Lee RMH, Bouremel Y, Eames I, Brocchini S, Kaw PT. The implications of an ab interno versus ab externo surgical approach on outflow resistance of a subconjunctival drainage device for intraocular pressure control. Transl Vis Sci Technol. 2019;8(3):58. 10. Bhatia J. Outcome of trabeculectomy surgery in primary open angle glaucoma. Oman Med J. 2008;23(2):86-89. 11. Gedde SJ, Feuer WJ, Shi W, et al; Primary Tube Versus Trabeculectomy Study Group. Treatment outcomes in the primary Tube Versus Trabeculectomy Study after 1 year of follow-up. Ophthalmology. 2018;125(5):650-663.

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