To review the published literature and summarize clinically relevant information about
novel, or emerging, surgical techniques for the treatment of open-angle glaucoma and
to describe the devices and procedures in proper context of the appropriate patient
population, theoretic effects, advantages, and disadvantages.
Devices and procedures that have US Food and Drug Administration clearance or are
currently in phase III clinical trials in the United States are included: the Fugo
blade (Medisurg Ltd., Norristown, PA), Ex-PRESS mini glaucoma shunt (Alcon, Inc.,
Hunenberg, Switzerland), SOLX Gold Shunt (SOLX Ltd., Boston, MA), excimer laser trabeculotomy
(AIDA, Glautec AG, Nurnberg, Germany), canaloplasty (iScience Interventional Corp.,
Menlo Park, CA), trabeculotomy by internal approach (Trabectome, NeoMedix, Inc., Tustin,
CA), and trabecular micro-bypass stent (iStent, Glaukos Corporation, Laguna Hills,
CA).
Literature searches of the PubMed and the Cochrane Library databases were conducted
up to October 2009 with no date or language restrictions.
These searches retrieved 192 citations, of which 23 were deemed topically relevant
and rated for quality of evidence by the panel methodologist. All studies but one,
which was rated as level II evidence, were rated as level III evidence.
All of the devices studied showed a statistically significant reduction in intraocular
pressure and, in some cases, glaucoma medication use. The success and failure definitions
varied among studies, as did the calculated rates. Various types and rates of complications
were reported depending on the surgical technique. On the basis of the review of the
literature and mechanism of action, the authors also summarized theoretic advantages
and disadvantages of each surgery.
The novel glaucoma surgeries studied all show some promise as alternative treatments
to lower intraocular pressure in the treatment of open-angle glaucoma. It is not possible
to conclude whether these novel procedures are superior, equal to, or inferior to
surgery such as trabeculectomy or to one another. The studies provide the basis for
future comparative or randomized trials of existing glaucoma surgical techniques and
other novel procedures.
Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All
rights reserved.