NEW MIGS DEVICE

One-year results with a new suprachoroidal stent called the iStent Supra (Glaukos) indicate that the device can bring about a satisfactory reduction of IOP and a reduced requirement for medication in open-angle glaucoma patients resistant to hypotensive topical therapy, said Anselm Jünemann MD at the XXXI Congress of the ESCRS in Amsterdam. In the prospective trial, 73 patients with elevated IOP resistant to treatment with two medications underwent ab interno implantation of a single iStent Supra suprachoroidal stent through a 1.0mm temporal clear corneal incision under topical anaesthesia and under gonioscopic view, said Dr Jünemann, University Hospital, Erlangen, Germany.

All had a preoperative IOP between 18.0 mmHg and 30.0 mmHg, on two medications, and between 22.0 mmHg and 38.0 mmHg after medication washout. Their mean preoperative medicated diurnal IOP was 20.4 mmHg, and their unmedicated baseline IOP was 24.8 mmHg (SD 1.7). All were prescribed travoprost postoperatively, which they were to discontinue if their IOP fell below 6.0 mmHg.

Among 42 eyes with 12 months of follow-up, mean IOP decreased by 47 per cent compared with baseline values and remained at 13.2 mmHg or less throughout one year of follow-up. In addition, 98 per cent of eyes met the primary efficacy endpoint of a reduction of 20 per cent in IOP with one medication. The IOP reduction in the remaining patient was 18.2 per cent. Furthermore, all eyes met the secondary efficacy endpoint of IOP less than 18.0 mmHg on one medication and 90 per cent achieved IOP 15.0 mmHg or less on one medication. After a medication washout at 13 months' follow-up, mean IOP was still only 16.8 mmHg and it reduced back down to 12.3 mmHg among 32 eyes that reached 18 months of follow-up.

iStent Supra on finger
Courtesy of Anselm Jünemann MD

The implantation procedures were performed without complications in all eyes. There was transient hypotony with IOP less than 5.0 mmHg in two eyes at one week. One of those eyes had a choroidal attachment which resolved by three months and the two eyes had best-corrected visual acuities of 20/20 and 20/22, respectively. There were no other postoperative sequelae.

Best-corrected visual acuity improved or stayed the same as preoperative BCVA in 40 of 42 patients. However, one patient had a reduction in BCVA from 20/22 preoperatively to 20/50 at 18 months postoperatively due to pre-existing cataract.

“The results of this study suggest that the iStent Supra implanted as a sole procedure with postoperative travoprost is feasible, safe and capable of significant reduction in IOP and medication burden in open-angle glaucoma patients previously uncontrolled on two topical hypotensive medications,” Dr Jünemann concluded.