Minimally invasive glaucoma surgery: current status and future prospects

Grace M Richter, Anne L Coleman, Grace M Richter, Anne L Coleman

Abstract

Minimally invasive glaucoma surgery aims to provide a medication-sparing, conjunctival-sparing, ab interno approach to intraocular pressure reduction for patients with mild-to-moderate glaucoma that is safer than traditional incisional glaucoma surgery. The current approaches include: increasing trabecular outflow (Trabectome, iStent, Hydrus stent, gonioscopy-assisted transluminal trabeculotomy, excimer laser trabeculotomy); suprachoroidal shunts (Cypass micro-stent); reducing aqueous production (endocyclophotocoagulation); and subconjunctival filtration (XEN gel stent). The data on each surgical procedure for each of these approaches are reviewed in this article, patient selection pearls learned to date are discussed, and expectations for the future are examined.

Keywords: MIGS; Schlemm’s canal; ab interno; microincisional glaucoma surgery; suprachoroidal shunt; trabecular stent.

Figures

Figure 1
Figure 1
Trabectome handpiece showing the footplate which glides within Schlemm’s canal and the bipolar electrodes which cauterize the inner wall of Schlemm’s canal. Note: Reproduced from Francis BA, See RF, Rao NA, Minckler DS, Baerveldt G. Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma. J Glaucoma. 2006;15:68–73. Copyright © 2006. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Wolters Kluwer Health. Please contact healthpermissions@wolterskluwer.com for further information.
Figure 2
Figure 2
The first-generation trabecular iStent (A) with the self-trephining tip that is inserted into Schlemm’s canal via a sideways sliding technique, and then is maintained by the retention arches. The lumen is the portion facing the anterior chamber. The second-generation trabecular iStent inject (B), with four side ports within the Schlemm’s canal. The central lumen faces the anterior chamber. This model eliminates the need for the sideways sliding movement in the surgery technique. Note: Copyright © 2014. Dove Medical Press. Adapted from Hunter KS, Fjield T, Heitzmann H, Shandas R, Kahook MY. Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling. Clin Ophthalmol. 2014;8:499–506.
Figure 3
Figure 3
The Hydrus trabecular stent sitting within a dilated Schlemm’s canal. Note: Reprinted from Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014; 121:855–861. Copyright © 2014, with permission from Elsevier.
Figure 4
Figure 4
Demonstration of gonioscopy-assisted transluminal trabeculotomy. Notes: An illuminated microcatheter is inserted through a nasal paracentesis wound (A). After a small goniotomy wound is created, the microcatheter is inserted into Schlemm’s canal using microsurgical forceps. After being guided around 360° (B), each end of the microcatheter is externalized from the temporal wound, creating a 360° trabeculotomy (C). 1=Schlemm’s canal; 2=initial goniotomy site; 3=microsurgical forceps; 4=microcatheter; 5=distal end of microcatheter after being passed 360° around Schlemm’s canal; 6=path of microcatheter within Schlemm’s canal; 7=trabecular shelf created after this procedure; 8=trabeculotomy created when the distal end of catheter is externalized. Reprinted from Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, et al. A randomized trial of a Schlemm’s canal microstent with phacoemulsification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology. 2015;122:1283–1293. Copyright © 2015, with permission from Elsevier.
Figure 5
Figure 5
The Cypass suprachoroidal shunt in position in the suprachoroidal space with retention rings near the ciliary body face. Notes: The blue arrows demonstrate the directional flow of aqueous. Reprinted from Hoeh H, Ahmed IK, Grisanti S, et al. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery. J Cataract Refract Surg. 2013;39:431–437. Copyright © 2013, with permission from Elsevier.
Figure 6
Figure 6
Endocyclophotocoagulation being performed on a pseudophakic patient. Note: Copyright © 2015. John Wiley and Sons. Reproduced from Siegel MJ, Boling WS, Faridi OS, et al. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Experiment Ophthalmol. 2015;43:531–539.
Figure 7
Figure 7
External view of the XEN subconjunctival gel stent in place. Note: Reprinted from Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg. 2014;40:1301–1306. Copyright © 2014 with permission from Elsevier.

References

    1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2081–2090.
    1. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M, Early Manifest Glaucoma Trial Group Reduction of intraocular pressure and glaucoma progression: results from the Early Manifest Glaucoma Trial. Arch Ophthalmol. 2002;120:1268–1279.
    1. Lemij HG, Hoevenaars JG, van der Windt C, Baudouin C. Patient satisfaction with glaucoma therapy: reality or myth? Clin Ophthalmol. 2015;9:785–793.
    1. Leahy KE, White AJ. Selective laser trabeculoplasty: current perspectives. Clin Ophthalmol. 2015;9:833–841.
    1. Woo DM, Healey PR, Graham SL, Goldberg I. Intraocular pressure-lowering medications and long-term outcomes of selective laser trabeculoplasty. Clin Experiment Ophthalmol. 2015;43:320–327.
    1. Gedde SJ, Herndon LW, Brandt JD, Budenz DL, Feuer WJ, Schiffman JC, Tube Versus Trabeculectomy Study Group Postoperative complications in the Tube Versus Trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804–814.
    1. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL, Tube versus Trabeculectomy Study Group Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153:789–803.
    1. Johnson M. ‘What controls aqueous humour outflow resistance?’. Exp Eye Res. 2006;82:545–557.
    1. Minckler DS, Baerveldt G, Alfaro MR, Francis BA. Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology. 2005;112:962–967.
    1. Minckler D, Mosaed S, Dustin L, Ms BF, Trabectome Study Group Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc. 2008;106:149–160.
    1. Francis BA, See RF, Rao NA, Minckler DS, Baerveldt G. Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma. J Glaucoma. 2006;15:68–73.
    1. Minckler D, Baerveldt G, Ramirez MA, et al. Clinical results with the Trabectome, a novel surgical device for treatment of open-angle glaucoma. Trans Am Ophthalmol Soc. 2006;104:40–50.
    1. Maeda M, Watanabe M, Ichikawa K. Evaluation of trabectome in open angle glaucoma. J Glaucoma. 2013;22:205–208.
    1. Francis BA, Minckler D, Dustin L, et al. Trabectome Study Group Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cataract Refract Surg. 2008;34:1096–1103.
    1. Ting JL, Damji KF, Stiles MC, Trabectome Study Group Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg. 2012;38:315–323.
    1. Damji KF, Konstas AG, Liebmann JM, et al. Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol. 2006;90:1014–1018.
    1. Ahuja Y, Ma Khin Pyi S, Malihi M, Hodge DO, Sit AJ. Clinical results of ab interno trabeculotomy using the trabectome for open-angle glaucoma: the Mayo clinic series in Rochester, Minnesota. Am J Ophthalmol. 2013;156:927–335.
    1. Jordan JF, Wecker T, van Oterendorp C, et al. Trabectome surgery for primary and secondary open angle glaucomas. Graefes Arch Clin Exp Ophthalmol. 2013;251:2753–2760.
    1. Ahuja Y, Malihi M, Sit AJ. Delayed-onset symptomatic hyphema after ab interno trabeculotomy surgery. Am J Ophthalmol. 2012;154:476–480.
    1. Luebke J, Boehringer D, Neuburger M, et al. Refractive and visual outcomes after combined cataract and trabectome surgery: a report on the possible influences of combining cataract and trabectome surgery on refractive and visual outcomes. Graefes Arch Clin Exp Ophthalmol. 2015;253:419–423.
    1. Klamann MK, Gonnermann J, Maier AK, Bertelmann E, Joussen AM, Torun N. Influence of selective laser trabeculoplasty (SLT) on combined clear cornea phacoemulsification and Trabectome outcomes. Graefes Arch Clin Exp Ophthalmol. 2014;252:627–631.
    1. Voskanyan L, García-Feijoó J, Belda JI, Fea A, Jünemann A, Baudouin C, Synergy Study Group Prospective, unmasked evaluation of the iStent® inject system for open-angle glaucoma: synergy trial. Adv Ther. 2014;31:189–201.
    1. Hunter KS, Fjield T, Heitzmann H, Shandas R, Kahook MY. Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling. Clin Ophthalmol. 2014;8:499–506.
    1. Bahler CK, Hann CR, Fjield T, Haffner D, Heitzmann H, Fautsch MP. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments. Am J Ophthalmol. 2012;153(6):1206–1213.
    1. Fea AM. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial. J Cataract Refract Surg. 2010;36:407–412.
    1. Samuelson TW, Katz LF, Wells JM, Duh YJ, Giamporcaro JE, US iStent Study Group Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology. 2011;118:459–467.
    1. Craven ER, Katz LJ, Wells JM, Giamporcaro JE, iStent Study Group Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg. 2012;38:1339–1345.
    1. Fernández-Barrientos Y, García-Feijoó J, Martínez-de-la-Casa JM, Pablo LE, Fernández-Pérez C, García Sánchez J. Fluorophotometric study of the effect of the glaukos trabecular microbypass stent on aqueous humor dynamics. Invest Ophthalmol Vis Sci. 2010;51:3327–3332.
    1. Belovay GW, Naqi A, Chan BJ, Rateb M, Ahmed II. Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma. J Cataract Refract Surg. 2012;38:1911–1917.
    1. Fea AM, Belda JI, Rekas M, et al. Prospective unmasked randomized evaluation of the iStent inject (®) versus two ocular hypotensive agents in patients with primary open-angle glaucoma. Clin Ophthalmol. 2014;8:875–882.
    1. Klamann M, Gonnermann J, Pahlitzsch M, et al. iStent inject in phakic open angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2015;253:941–947.
    1. Johnstone MA, Grant WG. Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol. 1973;75:365–383.
    1. Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, et al. A randomized trial of a Schlemm’s canal microstent with phacoemulsification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology. 2015;122:1283–1293.
    1. Grover DS, Godfrey DG, Smith O, Feuer WJ, Montes de Oca I, Fellman RL. Gonioscopy-assisted transluminal trabeculotomy, ab interno trabeculotomy: technique report and preliminary results. Ophthalmology. 2014;121:855–861.
    1. Beck AD, Lynch MG. 360 degrees trabeculotomy for primary congenital glaucoma. Arch Ophthalmol. 1995;113:1200–1202.
    1. Chin S, Nitta T, Shinmei Y, et al. Reduction of intraocular pressure using a modified 360-degree suture trabeculotomy technique in primary and secondary open-angle glaucoma: a pilot study. J Glaucoma. 2012;21:401–407.
    1. Grover DS, Smith O, Fellman RL, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol. 2015;99(8):1092–1096.
    1. Berlin MS, Rajacich G, Duffy M, Grundfest W, Goldenberg T. Excimer laser photoablation in glaucoma filtering surgery. Am J Ophthalmol. 1987;103:713–714.
    1. Babighian S, Caretti L, Tavolato M, Cian R, Galan A. Excimer laser trabeculotomy vs 180 degrees selective laser trabeculoplasty in primary open-angle glaucoma. A 2-year randomized, controlled trial. Eye (Lond) 2010;24:632–638.
    1. Töteberg-Harms M, Hanson JV, Funk J. Cataract surgery combined with excimer laser trabeculotomy to lower intraocular pressure: effectiveness dependent on preoperative IOP. BMC Ophthalmol. 2013;13:24.
    1. Toris CB, Yablonski ME, Wang YL, Camras CB. Aqueous humor dynamics in the aging human eye. Am J Ophthalmol. 1999;127:407–412.
    1. Emi K, Pederson JE, Toris CB. Hydrostatic pressure of the suprachoroidal space. Invest Ophthalmol Vis Sci. 1989;30:233–238.
    1. Saheb H, Ianchulev T, Ahmed II. Optical coherence tomography of the suprachoroid after CyPass Micro-Stent implantation for the treatment of open-angle glaucoma. Br J Ophthalmol. 2014;98:19–23.
    1. Hoeh H, Ahmed IK, Grisanti S, et al. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery. J Cataract Refract Surg. 2013;39:431–437.
    1. García-Feijoo J, Rau M, Grisanti S, et al. Supraciliary micro-stent implantation for open-angle glaucoma failing topical therapy: 1-year results of a multicenter study. Am J Ophthalmol. 2015;159:1075–1081.
    1. Francis BA, Berke SJ, Dustin L, Noecker R. Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma. J Cataract Refract Surg. 2014;40:1313–1321.
    1. Siegel MJ, Boling WS, Faridi OS, et al. Combined endoscopic cyclophotocoagulation and phacoemulsification versus phacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Experiment Ophthalmol. 2015;43:531–539.
    1. Tan JC, Francis BA, Noecker R, Uram M, Dustin L, Chopra V. Endoscopic cyclophotocoagulation and pars plana ablation (ECP-Plus) to treat refractory glaucoma. J Glaucoma. 2015 May 14; Epub.
    1. Francis BA, Pouw A, Jenkins D, et al. Endoscopic cycloplasty (ECPL) and lens extraction in the treatment of severe plateau iris syndrome. J Glaucoma. 2015 Mar 18; Epub.
    1. Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg. 2014;40:1301–1306.
    1. Tsai JC. Medication adherence in glaucoma: approaches for optimizing patient compliance. Curr Opin Ophthalmol. 2006;17:190–195.
    1. Dreer LE, Girkin CA, Campbell L, Wood A, Gao L, Owsley C. Glaucoma medication adherence among African Americans: program development. Optom Vis Sci. 2013;90:883–897.
    1. Lacey J, Cate H, Broadway DC. Barriers to adherence with glaucoma medications: a qualitative research study. Eye (Lond) 2009;23:924–932.
    1. Friedman DS, Hahn SR, Gelb L, et al. Doctor-patient communication, health-related beliefs, and adherence in glaucoma results from the Glaucoma Adherence and Persistency Study. Ophthalmology. 2008;115:1320–1327.
    1. Kaštelan S, Tomić M, Metež Soldo K, Salopek-Rabatić J. How ocular surface disease impacts the glaucoma treatment outcome. Biomed Res Int. 2013;2013:696328.
    1. Baudouin C, Renard JP, Nordmann JP, et al. Prevalence and risk factors for ocular surface disease among patients treated over the long term for glaucoma or ocular hypertension. Eur J Ophthalmol. 2012 Jun 11; Epub.
    1. Stein JD, Kim DD, Peck WW, Giannetti SM, Hutton DW. Cost-effectiveness of medications compared with laser trabeculoplasty in patients with newly diagnosed open-angle glaucoma. Arch Ophthalmol. 2012;130:497–505.
    1. Kaplan RI, De Moraes CG, Cioffi GA, Al-Aswad LA, Blumberg DM. Comparative cost-effectiveness of the Baerveldt implant, trabeculectomy with mitomycin, and medical treatment. JAMA Ophthalmol. 2015;133:560–567.
    1. Yang HS, Lee J, Choi S. Ocular biometric parameters associated with intraocular pressure reduction after cataract surgery in normal eyes. Am J Ophthalmol. 2013;156:89–94.
    1. Mansberger SL, Gordon MO, Jampel H, et al. Ocular Hypertension Treatment Study Group Reduction in intraocular pressure after cataract extraction: the Ocular Hypertension Treatment Study. Ophthalmology. 2012;119:1826–1831.
    1. Chen PP, Lin SC, Junk AK, Radhakrishnan S, Singh K, Chen TC. The effect of phacoemulsification on intraocular pressure in glaucoma patients: a report by the American Academy of Ophthalmology. Ophthalmology. 2015;122:1294–1307.
    1. Schmidt W, Kastner C, Sternberg K, et al. New concepts for glaucoma implants – controlled aqueous humor drainage, encapsulation prevention and local drug delivery. Curr Pharm Biotechnol. 2013;14:98–111.
    1. Premarket Studies of Implantable Minimally Invasive Glaucoma Surgical (MIGS) Devices: Draft Guidance for Industry and Food and Drug Administration Staff. Rockville: Food and Drug Administration; 2015. [Accessed July 1, 2015]. Available from: .
    1. van der Merwe EL, Kidson SH. Advances in imaging the blood and aqueous vessels of the ocular limbus. Exp Eye Res. 2010;91:118–126.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit