Efficacy of two trabecular micro-bypass stents combined with topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 3-year follow-up

David F Chang; Eric D Donnenfeld; L Jay Katz; Lilit Voskanyan; Iqbal Ike K Ahmed; Thomas W Samuelson; Jane Ellen Giamporcaro; Dana M Hornbeak; Kerry D Solomon

doi:10.2147/OPTH.S121041

Efficacy of two trabecular micro-bypass stents combined with topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 3-year follow-up

Clin Ophthalmol. 2017 Mar 15:11:523-528. doi: 10.2147/OPTH.S121041. eCollection 2017.

Authors

David F Chang¹, Eric D Donnenfeld², L Jay Katz³, Lilit Voskanyan⁴, Iqbal Ike K Ahmed⁵, Thomas W Samuelson⁶, Jane Ellen Giamporcaro⁷, Dana M Hornbeak⁷, Kerry D Solomon⁸

Affiliations

¹ Altos Eye Physicians, Los Altos, CA.
² Ophthalmic Consultants of Long Island, Rockville Centre, NY.
³ Department of Ophthalmology, Wills Eye Hospital, Jefferson Medical College, Philadelphia, PA, USA.
⁴ S.V. Malayan Ophthalmology Centre, Yerevan, Armenia.
⁵ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
⁶ Minnesota Eye Consultants, Minneapolis, MN.
⁷ Glaukos Corporation, San Clemente, CA.
⁸ Carolina Eyecare Physicians, Mount Pleasant, SC, USA.

Abstract

Purpose: To evaluate the long-term intraocular pressure (IOP)-lowering effect and safety parameters following treatment with two trabecular micro-bypass stents and topical prostaglandin in phakic eyes with open-angle glaucoma (OAG) not controlled on two preoperative medications.

Methods: This prospective, single-arm, unmasked study enrolled 39 qualified phakic eyes with OAG not controlled on 2 medications, preoperative medicated IOP of 18-30 mmHg, and IOP following medication washout of 22-38 mmHg. Two trabecular micro-bypass stents were implanted as a standalone procedure, and travoprost was started on postoperative day 1. Evaluations included IOP, best-corrected visual acuity, medication use, fundus and slit-lamp examinations, visual field, cup:disc ratio, central corneal thickness, and ocular complications. Data through 18 months were summarized previously. Thirty-seven of the original 39 subjects have been followed for 3 years postoperatively; follow-up is continuing for 5 years.

Results: At 3 years postoperative, 97% of eyes had achieved an IOP reduction of ≥20% from baseline with a reduction of 1 medication. Eighty-six percent of eyes had IOP of ≤18 mmHg with a reduction of 1 medication. Mean medicated IOP decreased to 14.0±2.6 mmHg on 1 medication versus 22.4±2.3 mmHg on 2 medications preoperatively. The mean unmedicated IOP decreased to 17.7±1.7 mmHg at 37 months from 25.3±1.9 mmHg preoperatively. Long-term postoperative adverse events included cataract surgery in 3 eyes due to cataract progression, and trabeculectomy in 1 eye due to uncontrolled IOP of 23 mmHg. No intraoperative or device-related adverse events occurred.

Conclusion: Significant and sustained reduction in IOP and medications with a favorable safety profile was shown through 3 years after implantation of 2 trabecular micro-bypass stents combined with postoperative travoprost in phakic OAG eyes uncontrolled on 2 preoperative medications. These findings demonstrate the long-term performance and safety of trabecular bypass stents in combination with topical prostaglandin for OAG patients.

Keywords: IOP; MIGS; glaucoma; medication; trabecular micro-bypass.