Becker's ASC Review

50 Executive Briefing: Executive Briefing: Minimally Invasive Glaucoma Surgery Technology Clinical Results Preliminary findings from a 70-eye case series by Mark J. Gallardo, MD (El Paso Eye Surgeons, PA) show reductions in IOP and in the number of medications similar to the results obtained with tradi- tional Canaloplasty and trabeculectomy. Importantly, ab-interno Canaloplasty may also offer better clinical outcomes than any other currently available MIGS pro- cedure. Mean preoperative IOP was 20.3 ± 5.8 mm Hg and the mean number of medications was 2.4 ± 0.9. At one, three and six months post-treatment, mean IOP was 14.3 ± 3.7 mm Hg, 13.0 ± 3.6 mm Hg and 12.3 ± 3.8 mm Hg, respectively, while the mean num- ber of medications was 0.5 ± 0.9 at one and three months, and 0.5 ± 1.0 at six months post-treatment (refer to Figure 1). Subgroup analyses were also performed including patients with (n=10) or without (n=48) previous surgery. The effect of ab-interno Canaloplasty on IOP and med- ication-use was also evaluated in pseudo- phakic patients (n=12). In patients who had not undergone sur- gery prior to treatment, mean IOP im- proved from 18.8 ± 4.7 mm Hg at baseline to 13.9 ± 3.6 mm Hg at one month and 12.2 ± 1.9 mm Hg at three months post- treatment. Six-month data for three pa- tients showed that mean IOP was 11.3± 4.0 mm Hg at this follow-up visit. The mean number of anti-glaucoma medica- tions also reduced, from 2.2 ± 0.9 at base- line to 0.4 ± 0.7 and 0.2 ± 0.6 at three and six months post-treatment, respectively. Improvements in IOP and medication- use were also observed in patients who had undergone prior glaucoma surgeries. Mean IOP and mean medication-use im- proved from 25.8 ± 8.0 mm Hg and 3.0 ± 0.8 medications pre-treatment, to 15.3 ± 4.1 mm Hg and 1.0 ±1.5 medications at one month post-treatment and 18.3 ± 7.5 mm Hg and 2.3 ± 0.6 medications at three months post-treatment. Furthermore, over 70 percent of patients were off medication entirely at one month and three months post-treatment (Refer to Figure 2). In pseudophakic patients, mean IOP improved from 21.8 ± 5.2 mm Hg at baseline to 15.1 ± 4.1 mm Hg at one month postoperative. Medication-use was also reduced, from 2.8.± 0.7 mm Hg at baseline to 0.8 ± 1.0 mm Hg at one month post-treatment. Case observation of ab-in- terno Canaloplasty also revealed that the safety profile of the procedure was similar to that of traditional Canaloplasty and the newer MIGS procedures. Ab-interno Canaloplasty: MIGS Redefined In summary, clinical evidence indicates that ab-interno Canaloplasty is safe and effective in mild-to-moderate POAG with similar IOP-lowering effects to tried and true traditional Canaloplasty. Unlike other MIGS procedures, ab-interno Canaloplas- ty ensures that all potential "blockages" in the ocular outflow pathway are addressed, including distal structures such as the col- lector channels, which have been shown to play a key role in blocking aqueous outflow in POAG eyes. Ab-interno Canalo- plasty is also fast to perform and, unlike other currently available MIGS proce- dures, preserves tissue and does not re- quire permanent placement of an implant in the eye. Furthermore, based on prelimi- nary data it may, potentially, offer better clinical outcomes than any other currently available MIGS procedure. References: Rulli E; Biagioli E, Riva I, Gambirasio G, De Simone I, Floriani I, Quaranta L. Efficacy and safety of trabeculectomyvsNonpenetrating Surgical Procedures: A Systematic Review. JAMA Ophthalmol. 2013;131(12):1573-1582. doi:10.1001/jamaophthalmol.2013.5059 Zahid S, Musch DC, Niziol LM, Lichter PR; Col- laborative Initial Glaucoma Treatment Study Group. Risk of endophthalmitis and other long-term complications of trabeculectomy in the Collaborative Initial Glaucoma Treat- ment Study (CIGTS). Am J Ophthalmol. 2013 Apr;155(4):674-680, 680.e1. doi: 10.1016/j. ajo.2012.10.017. Epub 2012 Dec 13. Brandão LM, Grieshaber MC. Update on mini- mally invasive glaucoma surgery (MIGS) and new implants. J Ophthalmol. 2013:705915. Brüggemann A, Despouy JT, Wegent A, Müller M. Intraindividual comparison of Canaloplasty versus trabeculectomy with mitomycin C in a single-surgeon series. J Glaucoma. 2013; 22(7):577-83. Klink T, Sauer J, Körber NJ, et al. Quality of life following glaucoma surgery: canaloplas- ty versus trabeculectomy. ClinOphthalmol. 2014;18;9:7-16. Nichamin LD. GlaukosiStent Trabecular Micro- Bypass. Middle East Afr J Ophthalmol. 2009; 16(3):138-40. n Ab-interno Canaloplasty: Benefits at a Glance 1. Comprehensive: treats trabecular meshwork, Schlemm's canal and collector channels 2. Opens outflow system behind the trabecular meshwork, thus ensur- ing better aqueous outflow 3. No permanent implant or stent 4. On label — patient does not have to pay additionally out of pocket 5. Reimbursement is higher than cur- rent MIGS procedures 6. Patient selection criteria are similar to current MIGS procedures 7. Easy to explain to the patient, for example: "I am going to perform circumferential angioplasty in your eye to reduce pressure" or, "We want to avoid cutting tissue or inserting devices; so let's try CP- INVISCO™ first."

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