SUSTAINING TARGET IOP TO PRESERVE VISION OVER A POAG PATIENT’S LIFETIME REMAINS AN UNMET NEED1

Hear it from your peers

Favorable results in glaucoma surgery today are not yet sustainable enough to meet the long-term needs of patients.

What is your experience?

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

How would a glaucoma surgical device that achieves and sustains target IOP similar to conventional filtration surgeries but with fewer complications and adverse events most change your perspective on proactive glaucoma surgery?

Graphic depicting information about MIGS

While MIGS is generally considered safe and efficient, comparative studies and data are needed to assess its long-term viability19,20

An innovative, degradation-resistant, biocompatible material could produce a new generation of surgical devices that deliver more-sustainable benefits

  • Some MIGS biomaterials provoke a strong foreign-body reaction, resulting in material degradation that sustains and intensifies the reaction21
Graphic about biocompatible flexible material and long-term sustainability
Graphic with findings based on the Tube Versus Trabeculectomy (TVT) Study

Post-op complications put trabeculectomy at risk for failure—even with intensive monitoring22,23

*Based on findings from the Tube Versus Trabeculectomy (TVT) Study. Early complications: choroidal effusion, shallow/flat anterior chamber, wound leak, hyphema, aqueous misdirection, suprachoroidal hemorrhage, vitreous hemorrhage, decompression hemorrhage, decompression retinopathy, cystoid macular edema. Late complications: persistent corneal edema, dysethesia, encapsulated bleb, choroidal effusion, cystoid macular edema, hypotony maculopathy, persistent diplopia, bleb leak, endophthalmitis/blebitis, chronic or recurrent iritis, retinal detachment, corneal ulcer, shallow/flat anterior chamber.22

Trabeculectomy failure rates increase at a rate of ~50% by 5 years post-op22,23

Trabeculectomy remains the gold standard to reach low target IOP and reduce medication burden, but failure rates increase over time.

Based on findings from the Tube Versus Trabeculectomy (TVT) Study.11,22-24

Graphic with results from Tube Versus Trabeculectomy (TVT) Study

Device innovation is needed to produce more-sustainable results to enable long-term vision preservation.

References: 1. 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. 2. Gabai A, Cimarosti R, Isola M, Battistella C, Lanzetta P. Efficacy and safety of trabeculectomy versus non-penetrating surgeries in open-angle glaucoma: a meta-analysis [published online ahead of print July 18, 2019]. J Glaucoma. doi:10.1097/IJG.0000000000001323. 3. Wang X, Khan R, Coleman A. Device-modified trabeculectomy for glaucoma (review). Cochrane Database Syst Rev. 2015;(12):CD010472. 4. Song DS, Qian J, Chen ZJ. Ologen implant versus mitomycin-C for trabeculectomy: a meta-analysis. Medicine (Baltimore). 2019;98(25):e16094. 5. Liu H, Zhang H, Li Y, Yu H. Safety and efficacy of canaloplasty versus trabeculectomy in treatment of glaucoma. Oncotarget. 2017;8(27):44811-44818. 6. Al-Haddad CE, Abdulaal M, Al-Moujahed A, Ervin AM, Ismail K. Fornix-based versus limbal-based conjunctival trabeculectomy flaps for glaucoma: findings from a Cochrane Systematic Review. Am J Ophthalmol. 2017;174:33-41. 7. Wang L, Sha F, Guo DD, Bi HS, Si JK, Du YX, Tang K. Efficacy and economic analysis of EX-PRESS implantation versus trabeculectomy in uncontrolled glaucoma: a systematic review and meta-analysis. Int J Ophthalmol. 2016;9(1):124-131. 8. Ji Q, Qi B, Liu L, Guo X, Zhong J. Efficacy and safety of Ologen implant versus Mitomycin C in primary trabeculectomy: a meta-analysis of randomized clinical trials. J Glaucoma. 2015;24(5):e88-94. 9. Liu HN, Chen XL, Li X, Nie QZ, Zhu Y. Efficacy and tolerability of one-site versus two-site phaco-trabeculectomy: a meta-analysis of randomized controlled clinical trials. Chin Med J (Engl). 2010;123(15):2111-2115. 10. Chai C, Loon SC. Meta-analysis of viscocanalostomy versus trabeculectomy in uncontrolled glaucoma. J Glaucoma. 2010;19(8):519-527. 11. 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. 12. Ederer F, Gaasterland DE, Sullivan EK; AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 1. Study design and methods and baseline characteristics of study patients. Control Clin Trials. 1994;15(4):299-325. 13. Gedde SJ, Feuer WJ, Shi W, Lim KS, Barton K, Goyal S, Ahmed IIK, Brandt J; 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. 14. Wahl J. Results of the Collaborative Initial Glaucoma Treatment Study (CIGTS) [in German]. Ophthalmologe. 2005;102(3):222-226. 15. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM. Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: a systematic review and meta-analysis. PLoS One. 2017;12(8):e0183142. 16. 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. 17. Rahmatnejad K, Pruzan NL, Amanullah S, et al. Surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. J Glaucoma. 2017;26(12):1137-1143. 18. Esfandiari H, Kurup SP, Torkian P, Mets MB, Rahmani B, Tanna AP. Long-term clinical outcomes of Ahmed and Baerveldt drainage device surgery for pediatric glaucoma following cataract surgery [published online ahead of print July 30, 2019]. J Glaucoma. doi:10.1097/IJG.0000000000001335. 19. 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. 20. Richter GM, Coleman AL. Minimally invasive glaucoma surgery: current status and future prospects. Clin Ophthalmol. 2016;10:189-206. 21. 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. 22. Gedde SJ, Schiffman JC, Feuer WJ, et al; Tube Versus Trabeculectomy Study Group. Three-year follow-up of the Tube Versus Trabeculectomy Study. Am J Ophthalmol. 2009;148(5):670-684. 23. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. II. Variations in operative technique and outcome. Eye (Lond). 2001;15:441-448. 24. 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.

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