1

Figure 4. Hydrus ® implant. Property 01 Ivantis ®, Inc

I Io.o!.-_I ~~

Figure 5. /oP (purpie) and medication use (light blue) inpatients receiving both the Hydrus ® implant and cataract surgery

concurrentlr. N=28 patients treated, with a loflow-up 0128/28 atthree months and 20/28 at six months. Property 01 Ivantis ®, Inc.

Figure 6: Stegmann ® Canal Expandervisualised in the canal 01

Schlemm, gonioscopic view

chamber, allowing for device-supportedsub-conjunctival filtration (Figure 2). Thisstent was evaluated in a study by Maris etaJ.2,who compared ExPress mini-shuntimplantation to classical trabeculectomy.While a similar postoperative intraocularpressure and surgical success ratewas achieved, the incidence of earlypostoperative hypotony and relatedcomplications was significantly lower inpatients who received the ExPressmini-shunt.

3. The iStent @ (Glaukos @)~_~~ __ ~~~TheiStent (Figure 3) is a surgical gradenonferromagnetic titanium trabecularmicro-bypass system. It is inserted abinterno, bypassing the trabecular meshwork,and is placed into Schlernm's canal. TheUnited States FDA IDE trial comparedcataract surgery plus iStent to cataractsurgery alone. The study found that 73 percent of patients who had received an iStentmaintained an intraocular press ure of 21mmHg or lower without medication at 12months' post-surgery, compared to only 50per cent of those who underwent cataractsurgery alone '.

~adeofanickel titanium shape memory alloy (Figure4). Suggested advantages of the deviceinclude excellent biocompatibility andelasticity. It is designed for insertion intoSchlernm's canal ab interno. Preliminarydata are promising thus far, as the resultsof a small cohort clinical trial indicatesignificant lowering of intraocular press ureand decreased reliance on glaucomamedications by six months' post-implant.These results were consistent and wereseen both in patients who received onlythe implant and in patients who receivedthe implant in combination with cataractsurgery (Figure 5).

EUROTIMES I Volume 16/17 I Issue 12/1

Figure 7: AqueSys ® implant

5. The Ste mann "Canal E anderThe Stegmann • implant is made by theOphthalmos • company in Switzerland. Thestent is composed of polyimide and has atube multi-fenestrated skeleton structuredesigned to expand Schlemm's canal (Figure6). Initial data suggest pressure-Ioweringeffects at least similar to the published dataof viscocanalostomy.

6. The AqueS s" implant~ioIoIii!lil!illiJii!illiliUii;tl"'iIi!iIllillllll~.ThiSis the only biological implant, designedto ren der minimally invasive surgery forsubconjunctival fenestration. The implantis composed of a collagen tube with aninner diameter of around 65mm and canbe placed with a special inserter ab interno(Figure 7). Early clinical study data ispromising.

_ The field of new glaucomadevices and surgical technology today israpidly developing and a lot of clinicalresearch is on the way. Hopefully theseinnovations will help to render safer andmore standardised surgical technologiesfor the eure of the challenging disease ofglaucoma.

AcknowledgementsSupport was provided by the Vanderbift Medical Scholars

program, Vanderbift University, Nashvifle, TN, USA

RelerencesI. Lewis RA, von Wolff K, Tetz M, Koerber N, Kearney JR,

Shingleton BJ, and Samuelson TW. Canaloplasty: Three-yearresufts 01 circumlerential viscodilation and tensioning 01Schlemm canal using a microcatheter to treat open-angleglaucoma. JCRS. Vol. 37, Issue 4, pp. 682-690, Apri/2011.

2. Maris PJ Jr, Ishida K, Netland PA. Comparison 01trabeculectomy with Ex-Press miniature glaucoma deviceimplanted under scleral ffap. J Glaucoma. 2007;16.'14-19.

3. Spiegel D, Wetzel W, Neuhann T, Stuermer J, Hoeh H, Garcia-Feijoo J, et al. Coexistent primary open-angle glaucomaand cataracl: interim analysis 01 a trabecular micro-bypassstent and concurrent cataract surgery. Eur J Ophthalmol.2009;19:393-9.