Advancements should take glaucoma surgery to the next level


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Moster MR. Glaucoma Surgery: Taking it to the next level. Venue: American Society of Cataract and Refractive Surgery Congress. May 5-8, 2023. San Diego.

Disclosure:
Moster has not reported any related financial disclosures.


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Important points:

  • Marlene R. Moster, MD, discusses four new glaucoma surgery innovations.
  • Motivation and collaboration should lead to better results with fewer complications.

SAN DIEGO — Future surgical innovations could help take glaucoma treatment to the next level, according to lecturers here.

“I want to share with you what is coming and what the progress is that will raise the bar for us to reach the next level.” Dr. Marlene R. Moster, In a speech by Richard L. Lindstrom, M.D., Ph.D., at a conference of the American Society for Cataract and Refractive Surgery.

Marlene R. Moster, MD

To address patient compliance issues, new concepts include long-acting drug delivery systems that combine cataract surgery with glaucoma medications. In the SpyGlass drug delivery platform, dual pads of drug tactilely anchored to acrylic IOLs slowly elute drug over 3 years post-ultrasonic phacoemulsification.

“This data has been validated both in vivo and in vitro, and if approved, this new drug-based delivery system could be used by all ophthalmologists, including 75% of cataract surgeons not currently using MIGS. It will be available,” Moster said. .

Another issue is the variation in IOP over time and the need to monitor the patient’s blood pressure throughout the day and night.

“One possible solution is a surgically placed intraocular pressure sensor that can measure pressure 24/7 with reliable accuracy,” she said.

Injectsense’s 4 mm sensor is inserted into the eye during a 5-minute consultation. It can be used for decades by charging once a week. A doctor can retrieve her IOP data through the cloud and change treatment at any time.

Implandata has already received the CE mark for microsensors that measure pressure and are placed in the suprachoroidal space during cataract surgery, glaucoma surgery, or sole surgery. The patient can check her IOP at any time with a remote control that recharges the sensor and downloads her IOP data to a cloud-based platform, allowing the doctor to change treatment as needed.

A third area in need of improvement is goniotomy, which is often performed in conjunction with cataract surgery.

Iantrek’s T-Rex Duo opens the inner wall of Schlemm’s canal by blunt 360° resection and scrapes open the posterior wall to improve access to collector channels and maximize flow when both walls are open. increase. Attaching a robotic arm to the device could improve the accuracy down to 1 μm.

“Precise access to this canal will allow cataract surgeons to better manipulate the hardware to access Schlemm’s canal more precisely, allowing both walls to be opened at the same time,” Moster said. said.

Finally, Moster discussed taking tube shunts to the next level.

“One possible solution is to change the shunt tube material,” she says. “The second is to make it much thinner than what we are currently using.”

The VisiPlate (Avisi Technologies) is an ultra-thin 5 μm thick shunt designed to avoid occlusion and reduce pressure below 14 mm Hg without causing hypotension. It is covered with a nonfibrous material that limits cell adhesion and has multiple outflow channels that cause diffuse subconjunctival blisters in the lower part.

“The VisiPlate is very strong. You can twist it, turn it, and it won’t crack,” Moster said. “It is the thinnest self-supporting material in the world so far.

Another new tube is the Gore GDI Concept. It is made from a material called ePTFE and is ten times thinner than the Ahmed Tube Shunt. It is designed for rapid tissue ingrowth at the top, but cells cannot enter the reservoir.

“So it’s very permeable to water, which is exactly what we were looking for,” she said.
“Inspiration from ophthalmologists and collaboration with scientists and technicians will result in fewer complications and better outcomes for everyone,” Moster said. “With further research and innovation, we are fully confident that we will win.”



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