Meeting News CoveragePerspective

Study: Suprachoroidal shunt with topical travoprost reduces IOP

WASHINGTON — Early study findings suggest that implantation of a suprachoroidal stent significantly reduces IOP and medication burden in phakic patients with open-angle glaucoma, according to a presenter here.

In this study of the suprachoroidal shunt implantation with travoprost, there were substantial reductions in pressure, with all eyes achieving a pressure of 18 mm Hg or lower at 1 and 2 years, and most eyes achieving 15 mm Hg at 1 and 2 years,” Jonathan S. Myers, MD, said at the American Glaucoma Society meeting.

Jonathan S. Myers

Myers reported results of implantation of the iStent supra (Glaukos) suprachoroidal micro-bypass stent with postoperative travoprost in 41 of 80 subjects evaluable at 2 years in an ongoing 5-year prospective, single-arm, open-label study.

“The goal of this study was to evaluate pressure reduction when you put in an iStent supra and started the patient then on topical travoprost,” Meyers said. “We also looked at medication reduction.” Primary effectiveness endpoint was IOP reduction of at least 20% at 12 months with reduction of one ocular hypotensive medication.

“The vast majority of patients achieved a 30% and even 40% pressure reduction in comparison to their unmedicated baseline,” Myers said. “So, there is strong pressure reduction with the iStent suprachoroidal shunt and topical travoprost.”

Safety profile is excellent, according to Myers, with only two cases of hypotony being reported, and those were resolved within 1 month. One patient required trabeculectomy in one eye, and subsequent data on that patient was not included in the analysis.
The iStent supra is not approved by the U.S. Food and Drug Administration.

Disclosure: Myers receives research support from Alcon and Glaukos and is a consultant and speaker for Alcon.

WASHINGTON — Early study findings suggest that implantation of a suprachoroidal stent significantly reduces IOP and medication burden in phakic patients with open-angle glaucoma, according to a presenter here.

In this study of the suprachoroidal shunt implantation with travoprost, there were substantial reductions in pressure, with all eyes achieving a pressure of 18 mm Hg or lower at 1 and 2 years, and most eyes achieving 15 mm Hg at 1 and 2 years,” Jonathan S. Myers, MD, said at the American Glaucoma Society meeting.

Jonathan S. Myers

Myers reported results of implantation of the iStent supra (Glaukos) suprachoroidal micro-bypass stent with postoperative travoprost in 41 of 80 subjects evaluable at 2 years in an ongoing 5-year prospective, single-arm, open-label study.

“The goal of this study was to evaluate pressure reduction when you put in an iStent supra and started the patient then on topical travoprost,” Meyers said. “We also looked at medication reduction.” Primary effectiveness endpoint was IOP reduction of at least 20% at 12 months with reduction of one ocular hypotensive medication.

“The vast majority of patients achieved a 30% and even 40% pressure reduction in comparison to their unmedicated baseline,” Myers said. “So, there is strong pressure reduction with the iStent suprachoroidal shunt and topical travoprost.”

Safety profile is excellent, according to Myers, with only two cases of hypotony being reported, and those were resolved within 1 month. One patient required trabeculectomy in one eye, and subsequent data on that patient was not included in the analysis.
The iStent supra is not approved by the U.S. Food and Drug Administration.

Disclosure: Myers receives research support from Alcon and Glaukos and is a consultant and speaker for Alcon.

    Perspective

    This current study in open-angle glaucoma patients not controlled on two medications preoperatively showed an IOP reduction to 18 mm Hg or less and reduction of medication through 2 years after implantation of a suprachoroidal stent and postoperative administration of travoprost. Most patients achieved IOP reduction of 30% vs. unmedicated baseline preoperative IOP. The safety profile was excellent through 2 years. These data show that, in addition to the currently available trabecular bypass stents, a suprachoroidal stent can become another microinvasive glaucoma surgery option. Stent implantation, either with trabecular bypass or through the uveoscleral outflow pathway, can provide IOP management in eyes with open-angle glaucoma. This not only relieves medication burden, but also avoids fluxes in medication effect. One may anticipate a synergistic effect of using suprachoroidal stents after trabecular bypass stents to further reduce IOP or presumptive use of trabecular bypass and suprachoroidal stents for the treatment of more advanced glaucoma, thereby increasing the potential for effective IOP control.

    • L. Jay Katz, MD
    • Wills Eye Hospital

    Disclosures: Katz is a medical monitor and consultant for Glaukos.

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