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      The development of a micro‐shunt made from poly(styrene‐ block‐isobutylene‐ block‐styrene) to treat glaucoma

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          Abstract

          Glaucoma is the second leading cause of blindness with ∼70 million people worldwide who are blind from this disease. The currently practiced trabeculectomy surgery, the gold standard treatment used to stop the progression of vision loss, is rather draconian, traumatic to the patient and requires much surgical skill to perform. This article summarizes the more than 10‐year development path of a novel device called the InnFocus MicroShunt®, which is a minimally invasive glaucoma drainage micro‐tube used to shunt aqueous humor from the anterior chamber of the eye to a flap formed under the conjunctiva and Tenon's Capsule. The safety and clinical performance of this device approaches that of trabeculectomy. The impetus to develop this device stemmed from the invention of a new biomaterial called poly(styrene‐ block‐isobutylene‐ block‐styrene), or “SIBS.” SIBS is ultra‐stable with virtually no foreign body reaction in the body, which manifests in the eye as clinically insignificant inflammation and capsule formation. The quest for an easier, safer, and more effective method of treating glaucoma led to the marriage of SIBS with this glaucoma drainage micro‐tube. This article summarizes the development of SIBS and the subsequent three iterations of design and four clinical trials that drove the one‐year qualified success rate of the device from 43% to 100%. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 211–221, 2017.

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          Most cited references22

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          The Advanced Glaucoma Intervention Study (AGIS): 7. The relationship between control of intraocular pressure and visual field deterioration.The AGIS Investigators.

          (2000)
          To investigate the association between control of intraocular pressure after surgical intervention for glaucoma and visual field deterioration. In the Advanced Glaucoma Intervention Study, eyes were randomly assigned to one of two sequences of glaucoma surgery, one beginning with argon laser trabeculoplasty and the other trabeculectomy. In the present article we examine the relationship between intraocular pressure and progression of visual field damage over 6 or more years of follow-up. In the first analysis, designated Predictive Analysis, we categorize 738 eyes into three groups based on intraocular pressure determinations over the first three 6-month follow-up visits. In the second analysis, designated Associative Analysis, we categorize 586 eyes into four groups based on the percent of 6-month visits over the first 6 follow-up years in which eyes presented with intraocular pressure less than 18 mm Hg. The outcome measure in both analyses is change from baseline in follow-up visual field defect score (range, 0 to 20 units). In the Predictive Analysis, eyes with early average intraocular pressure greater than 17.5 mm Hg had an estimated worsening during subsequent follow-up that was 1 unit of visual field defect score greater than eyes with average intraocular pressure less than 14 mm Hg (P =.002). This amount of worsening was greater at 7 years (1.89 units; P <.001) than at 2 years (0.64 units; P =.071). In the Associative Analysis, eyes with 100% of visits with intraocular pressure less than 18 mm Hg over 6 years had mean changes from baseline in visual field defect score close to zero during follow-up, whereas eyes with less than 50% of visits with intraocular pressure less than 18 mm Hg had an estimated worsening over follow-up of 0.63 units of visual field defect score (P =.083). This amount of worsening was greater at 7 years (1.93 units; P <.001) than at 2 years (0.25 units; P =.572). In both analyses low intraocular pressure is associated with reduced progression of visual field defect, supporting evidence from earlier studies of a protective role for low intraocular pressure in visual field deterioration.
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            Clinical results with the Trabectome for treatment of open-angle glaucoma.

            To describe clinical results from a pilot study of a novel glaucoma surgical device. Prospective interventional case series. Thirty-seven adult Hispanic and Caucasian patients (17 male, 20 female) with uncontrolled open-angle glaucoma (OAG) in one or both eyes with or without previous surgery or laser treatment were recruited from a clinical practice in Tijuana, Mexico. Surgery was performed with the Trabectome (NeoMedix Corp., San Juan Capistrano, CA) in one eye of each patient. Goldmann applanation intraocular pressures and Snellen visual acuities were measured before and after surgery. Intraoperative and postoperative adverse events were tabulated, and numbers of preoperative and postoperative adjunctive medications were compared before and after surgery. Preoperative pressures after 1 week of medication washout averaged 28.2+/-4.4 mmHg (n = 37). Only 3 patients were not using topical medications preoperatively. Follow-up ranged between 3 months (n = 37) and 13 months (n = 11). Mean postoperative IOPs were 18.4+/-10.9 mmHg (n = 37) at 1 day, 17.5+/-5.9 mmHg (n = 37) at 1 week, 17.4+/-3.5 mmHg (n = 25) at 6 months, and 16.3+/-2.0 mmHg (n = 15) at 12 months. Visions returned to within 2 lines of preoperative levels and remained stable in all patients beyond 3 weeks postoperatively except one, not sutured at surgery, who had a late hyphema probably associated with corneal wound gaping after accidental blunt trauma. The number of adjunctive medications decreased from 1.2+/-0.6 among preoperative patients on medications (n = 34) to 0.4+/-0.6 among all patients at 6 months (n = 25). Blood reflux occurred in all eyes on instrument withdrawal after angle surgery and was present at day 1 in 22 eyes (59%) with clearing by slit-lamp examination at a mean of 6.4+/-4.1 days postoperatively. The Trabectome seems to offer a safe and effective method of lowering IOP in OAG.
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              Medical applications of poly(styrene-block-isobutylene-block-styrene) ("SIBS").

              Poly(Styrene-block-IsoButylene-block-Styrene) ("SIBS") is a biostable thermoplastic elastomer with physical properties that overlap silicone rubber and polyurethane. Initial data collected with SIBS stent-grafts and coatings on metallic stents demonstrate hemocompatibility, biocompatibility and long-term stability in contact with metal. SIBS has been used successfully as the carrier for a drug-eluting coronary stent; specifically Boston Scientific's TAXUS stent, and its uses are being investigated for ophthalmic implants to treat glaucoma, synthetic heart valves to possibly replace tissue valves and other applications. At present, researchers developing medical devices utilizing SIBS have found the following: (1) SIBS does not substantially activate platelets in the vascular system; (2) polymorphonuclear leukocytes in large numbers are not commonly observed around SIBS implants in the vascular system or in subcutaneous implants or in the eye; (3) myofibroblasts, scarring and encapsulation are not clinically significant with SIBS implanted in the eye; (4) embrittlement has not been observed in any implant location; (5) calcification within the polymer has not been observed; and (6) degradation has not been observed in any living system to date. Some deficiencies of SIBS that need to be addressed include creep deformation in certain load-bearing applications and certain sterilization requirements. The reason for the excellent biocompatibility of SIBS may be due to the inertness of SIBS and lack of cleavable moieties that could be chemotactic towards phagocytes.
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                Author and article information

                Contributors
                len@innovia-llc.com
                Journal
                J Biomed Mater Res B Appl Biomater
                J. Biomed. Mater. Res. Part B Appl. Biomater
                10.1002/(ISSN)1552-4981
                JBM
                Journal of Biomedical Materials Research. Part B, Applied Biomaterials
                John Wiley and Sons Inc. (Hoboken )
                1552-4973
                1552-4981
                18 September 2015
                January 2017
                : 105
                : 1 ( doiID: 10.1002/jbm.b.v105.1 )
                : 211-221
                Affiliations
                [ 1 ]InnFocus, Inc. Miami Florida
                [ 2 ]Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Miami Florida
                [ 3 ]Pôle Ophtalmologique de la Clinique Mutualiste Pessac CedexFrance
                [ 4 ]Centro Laser Santo DomingoDominican Republic
                [ 5 ]Anne Bates Leach Eye Hospital Miami Florida
                [ 6 ]Bascom Palmer Eye Institute, University of Miami Miller School of Medicine Miami Florida
                [ 7 ] Department of OphthalmologyUniversity of Paris Hotel‐Dieu Hospital ParisFrance
                Author notes
                [*] [* ] Correspondence to: L. Pinchuk; e‐mail: len@ 123456innovia-llc.com
                Article
                JBMB33525
                10.1002/jbm.b.33525
                5215625
                26380916
                ea5ee77f-013c-44a0-8583-d2b86ac77de3
                © 2015 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 03 August 2015
                : 14 August 2015
                Page count
                Figures: 8, Tables: 3, Pages: 11, Words: 7153
                Funding
                Funded by: Florida Lions Eye Bank, Research to Prevent Blindness
                Funded by: NIH Center Grant
                Award ID: P30‐EY014801
                Funded by: Henri and Flore Lesieur Foundation
                Funded by: InnFocus, Inc
                Categories
                Review Article
                Review Articles
                Custom metadata
                2.0
                jbmb33525
                January 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.0.0 mode:remove_FC converted:04.01.2017

                Biomaterials & Organic materials
                glaucoma,trabeculectomy,sibs,biodegradation,entrepreneurship
                Biomaterials & Organic materials
                glaucoma, trabeculectomy, sibs, biodegradation, entrepreneurship

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