Tiny stent implants helping glaucoma patients


By Australian Hospital + Healthcare Bulletin Staff
Tuesday, 25 July, 2017


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A tiny stent, the width of a human hair, is offering a safe alternative to traditional glaucoma treatments.

Glaucoma affects over 300,000 Australians. Common treatments, although highly effective, remain invasive and prone to complications.

Most glaucoma patients begin with medical therapy, including eyedrops, followed by laser trabeculoplasty — which uses a very focused beam of light to treat the drainage angle of the eye. After that, they’ll receive either a trabulectomy (creating an opening for fluid to drain out) or a glaucoma drainage device.

Now, in a first for glaucoma treatment, the University of Michigan Kellogg Eye Center is using a tiny tube, permanently implanted in the eye, to help relieve intraocular pressure.

Known as the XEN Gel Stent, the device creates an opening between the inside of the eye and the eye’s outer layer to allow fluid to drain, potentially decreasing pressure in the eye to a normal level.

Made of a soft but permanent gelatin material, the stent is 6 mm long and about the width of a human hair. Doctors inject the stent through a small, self-sealing corneal incision using a preloaded injector.

Kellogg is among the first eye centres in the US to offer the treatment from pharma company Allergan after clinical trials showed it was safe for patients.

“Overall, this is a potentially safer alternative to traditional glaucoma filtration surgery,” said Kellogg glaucoma specialist Dr Manjool Shah. “But with any implant, there is a theoretical risk of implant exposure.”
 

Led by Dr Manjool Shah, the University of Michigan Kellogg Eye Center was one of the first eye centres in the US to implant the XEN gel stent to treat complex, open-angle glaucoma. Image credit: Michigan Medicine/Bryan McCullough.

Tiny yet powerful

Approved in November 2016 by the US Food and Drug Administration, the XEN Gel Stent represents a new way to treat glaucoma.

It is part of a growing field known as minimally invasive glaucoma surgery (MIGS) to help adults with mild to moderate glaucoma.

Since February, about one dozen XEN implant procedures have been performed at Kellogg — and the facility expects to do more — but the option isn’t suitable for everyone.

“Choosing the right candidates is a clinical decision based on a number of factors, including the type and severity of glaucoma as well as previous surgical history,” said Dr Shah.

He did add, however, “MIGS procedures are generally faster than trabulectomy and tube shunt surgeries, and shortened surgical and recovery times can be very important to patients.”

Sandra Hodel, 83, received a XEN implant at Kellogg in February after previous surgery to bring down intraocular pressure. Left untreated, such pressure can damage one’s optic nerve and cause a slow but steady loss of vision. For Hodel, this is no longer the case.

“The difference was like night and day,” she said of the short recovery period after the procedure.

Top image credit: ©iStockphoto.com/Brian Jackson

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