Sutie F The mean number of IOP-lowering drugs was 0.8, 1.0, 1.0, 1.0, and 1.6 at one, three, six, nine and 12 months follow-up, respectively (all p<0.001). “The physician reimbursement for 0191T (iStent and Hydrus) has been decreased by Medicare Administrative Contractors across the country. “I think the innovation represented by these new devices and procedures has sort of outstripped our ability to fully assess the effects of each one,” says Leonard K. Seibold, MD, an associate professor of ophthalmology at the University of Colorado School of Medicine. All rights reserved. Copyright © 2020 Jobson Medical Information LLC unless otherwise noted. Dr. Seibold is a consultant for New World Medical and Allergan, and has received research support from Alcon and Glaukos. 31824 Village Center Rd. Minimally-invasive glaucoma surgery is intended to lower intraocular pressure with less tissue disruption than traditional glaucoma surgeries. 1 Dr. Brown is chief medical officer of Sight Sciences. It’s certainly a quality-of-life boost. Monday—Friday: 9:00AM–5:00PM Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device (Trabectome by MicroSurgical Technology).
Data on-file, Ivantis. Hengerer FH, Auffarth GU, Riffel C, et al. 3. Download PDF. 1. • An overall safety profile that was similar to cataract surgery alone.3. “I choose angle procedures when I want low to mid-teen IOP and for patients in whom the major goal is decreasing their dependence on medications. Address: Reproduction in whole or in part without permission is prohibited. Preoperative mean IOP was 25.3 ±6.0 mmHg on a mean of 2.98 ±0.88 medications, with three-quarters of the eyes on three to five medications (no eyes were medication-free). Beverly Hills CA, 90211 “The data from the HORIZON trial, which is the pivotal U.S. trial for Hydrus, was tremendously favorable—probably the best MIGS data that we’ve seen to date, in terms of the important combination of sustained efficacy and safety. “The other big advancement in that same area has been the iStent inject because it’s a lot easier for people to put in and, with the two stents in, I think we’re seeing better pressure reduction,” Dr. Craven adds. First, it provides a direct inlet into the canal because the tail end of the Hydrus resides in the anterior chamber. (310) 482-1240. Hydrus vs iStent.
Required fields are marked *, Address Saturday: 9:00AM–12:00PM, Address: Kornmann H, Fellman R, Feuer W. Early results of goniotomy with the Kahook Dual Blade. Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device …
Postop, mean IOP was 14.9 mmHg, 13.9 mmHg, 14.1 mmHg, 14.4 mmHg, and 14.7 mmHg at one, three, six, nine and 12 months follow-up, respectively (all p<0.004).
There were no serious complications at any time point in the follow-up period. Your email address will not be published. The Hydrus also was associated with reduced need for glaucoma medication (p = .004); more Hydrus subjects were completely free of such medication by month 12 (p = .0057). Since the evidence of the iStent inject is attaining better outflow via improved access to the collector channels, surgeons may wonder about the relative merits of the iStent inject compared to the Hydrus, which should provide even greater access to the channels, at least in theory.
“I’ve had good success with all of the blade procedures and goniotomy procedures in high myopes, especially if they have a moderately high IOP. With a variety of options—and mechanisms of action—to choose from ophthalmologists can sometimes be hard-pressed to make sense of it all.
Dr. Brown emphasizes that now the various approved options are being tested. (The Allergan Xen was voluntarily recalled in October 2019, and surgeons were told not to implant more of them; there’s been no word when surgeons can purchase new ones to implant.).
Mean medication burden decreased by 82 percent to 0.55 ±0.79 (p<0.0001), and 61 percent of eyes were medication-free. The prospective HORIZON trial, sponsored by Ivantis, analyzed the Hydrus device when used in conjunction with cataract surgery, with cataract surgery alone used as a control.
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There’s room for more than one canal device, just as we have multiple IOL platforms and phaco machines. Westlake Village, CA 91361
Two eyes treated with Hydrus and one treated with iStent had BCVA loss of 2 lines or more. All participants had OAG, a Shaffer angle of grade III or IV, best-corrected visual acuity (BCVA) of 20/30 or better, and IOP of 23 to 39 mm Hg after washout of hypotensive medications.
Here, glaucoma experts share their thoughts on how they use the available devices, and we take a look at some of the results the devices are capable of achieving. “Often, when surgeons are adept at many of these techniques, it comes down to economics,” says Dr. Kahook. Each center has to figure out the economic viability of each approach while, of course, always choosing what they believe is the best approach for each patient given individual surgeon experience and outcomes.”. You can use it in different disease severities. I’ve probably done 100 of them post-approval here.
It should also be noted that the ambulatory surgery center facility fee for some Category I code procedures is not as high as the device intensive codes that are currently coupled with 0191T devices. 3-year HORIZON results. All eyes maintained or decreased their 36-month medication burden versus preoperative levels. Safety measures included frequency of surgical complications, changes in VA, abnormal slit-lamp findings, and adverse events. 2. That approach is kind of between a goniotomy/trabeculotomy, with the idea being that you remove the trabecular meshwork, expose the canal, and try to get the pressure down,” he explains.
“Some devices might have enhanced efficacy in particular situations—for example, goniotomy with angle-closure glaucoma or post failed iStent implantation—but they all work almost equally well in mild to moderate primary open-angle glaucoma when combined with cataract extraction,” he says. Ophthalmology, January 2020. The retrospective study from Texas included 111 eyes of 90 patients who underwent KDB goniotomy from January to November 2016.
So, it’s a little bewildering, but each surgeon is doing his or her own empirical testing. Conclusion The Hydrus has a lot of potential,” says Dr. Samuelson. Two iStent inject stents were implanted in 44 consecutive eyes (POAG=38, PXG=4, appositional NAG=1, secondary neovascular glaucoma=1) of 31 patients, and 33 eyes had 36-month follow-up data. “Now, there are a dozen different approaches and a growing body of evidence for most of the devices we use today. “For example, I note if someone has a history of long-term steroid use or uveitis. According to Dr. Kahook, a simple literature review shows that most angle devices, whether stent implants or goniotomy devices, produce essentially the same IOP lowering after long-term follow-up. Eyes with a preoperative IOP >21 mmHg were significantly more likely to undergo reoperation (p=0.038). “For people who aren’t undergoing cataract surgery, but who have elevated IOP and for whom medications aren’t working, I look at their age, refractive status, angle anatomy and ocular history,” he says. It’s clear to me that each company is trying to position its device based on safety and efficacy; however, the economics of the space (device cost and reimbursement) is also playing a major role that may be underrepresented in many of our discussions at meetings and in trade journals.”. “I had a chance to do that in Saudi Arabia where it’s approved.
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