New Treatments In Glaucoma
With new research and advancements in technology becoming available each and every day, we strive to offer the newest, safest and most efficient instruments and procedures to our patients. Here are a few recent developments in the world of glaucoma treatment that we are happy to offer at Minnesota Eye Consultants.
The XEN Gel Stent is a new procedure that is most analogous to a Trabeculectomy/ExPress Shunt. It is, however, much more refined and less invasive than Trabeculectomy. The XEN Gel Stent is ideal for patients with more advanced glaucoma and can be used as a standalone procedure independent of cataract surgery. Like Trabeculectomy, the XEN Gel Stent forms a filtration bleb, intended to significantly reduce and sustain the patient’s intraocular eye pressure. Although this treatment does have a slower visual recovery than the iStent procedure, it likely lowers pressure more effectively (although there are no comparative studies). The pliability and softness of the gel stent allows it to conform to the tissue within the eye and minimize complications related to synthetic materials. The XEN Gel Stent has been approved in Europe and in Canada for many years and has been used extensively in these regions of the world.
The MicroPulse laser treatment is a non-invasive therapy that delivers repetitive, low-energy laser ‘micropulses’ above and below the iris, with the goal of lowering the patient’s eye pressure. This treatment is performed within the OR so anesthesia can be administered during the procedure. Some perks to using this laser system is that the procedure is repeatable and the patient’s downtime after is minimal. Most patients do not experience pain after the therapy, but may be asked to wear a patch for the remainder of the day.
GATT is a modified Trabeculectomy – a glaucoma procedure commonly performed at Minnesota Eye Consultants. A Trabeculectomy creates a new drainage system from the eye’s natural tissue for the aqueous humor (the transparent fluid within the eye that can cause high pressures) to exit, while the GATT procedure aims at enhancing the patient’s own natural drainage system. Through a small incision, a tiny catheter is placed and rotated around the Schlemm’s canal 360 degrees. This minimally invasive surgery treats patients with open angle glaucoma and is performed within our Ambulatory Surgery Centers.
The Kahook Dual Blade (KDB) is an ophthalmic blade that makes parallel incisions in the trabecular meshwork and inner wall of the Canal of Schlemm. Incisions created with this device precisely remove tissue from the meshwork and as a result, help reduce intraocular pressure behind the eye. On the day of the procedure, the surgeon will determine whether or not this innovative surgical tool will be beneficial during the surgery. Currently, this device is available at our Ambulatory Surgery Centers.
Sources: medgadget.com, glaucomaassociates.com, www.eyeworld.org, www.kdbcert.com, iridex.com and aquesys.com
The CyPass microstent is an incredibly small device used to create a new channel for fluid to flow out of the eye, ultimately reducing eye pressure for glaucoma patients. This implant is used during Cataract and Glaucoma surgery. The FDA approved CyPass in 2016 based on favorable two-year safety and effectiveness data. Since approval, CyPass has been implanted in tens of thousands of eyes worldwide and has become a popular surgical treatment for the management of glaucoma.
While the Cypass device was approved based on two-year data, the FDA required a follow up “post-approval” study to provide additional safety data. The 5-year safety data are now available, and the results were recently released. While the effectiveness results remain favorable, some patients had an accelerated loss of corneal endothelial cells, the very delicate cells that line the inside of the cornea. Some patients were found to be at higher risk than others, and the risk was closely correlated to the position of the CyPass within the eye. Fortunately, no eye has had any serious consequence so far, however, all eyes that have received CyPass will require ongoing monitoring.
Based on this new information, Alcon has decided to voluntary withdraw CyPass from the global market while it investigates the significance of these findings.
What should you do if you have the CyPass Microstent implant?
We recommend you schedule an appointment for an examination which can determine your risk. The vast majority of patients will simply need monitoring, for example, a yearly exam. For most patients, this can be part of your routine follow up. Your surgeon will determine if you are in a low risk group or a higher risk group. If you are in the low risk group, your follow up will be very similar to your pattern in terms of exam frequency. If you are in a higher risk grouping, you may need more frequent follow up. Again, this recommendation will be based on the position of the CyPass within your eye.
Should the CyPass Device be removed?
An independent group of national glaucoma and cornea experts recommend that CyPass not be removed. Some patients may require device trimming, but the majority will need monitoring without any additional intervention.