Glaucoma, new surgical technique with record instrument: less than 1 millimeter

The iStent inject W, one of the smallest implantable medical devices known to date, was presented to the press for the first time in Italy (it measures 360 μm, about a third of a millimeter). The titanium device, produced by Glaukos, already approved in the USA and in Europe for the micro invasive surgery of glaucoma, is implanted in the structure of the eye responsible for the outflow of aqueous humor, to restore its natural functionality and reduce intraocular pressure in safe and effective way. With a safety profile similar to that of cataract surgery, the implantation of the iStent inject W represents a painless, micro-invasive innovation in glaucoma therapies that can allow the interruption or reduction of drug therapies in drops. proposed, among others, by Antonio Maria Fea, Mario Sbordone and Luca Cesari, and published in Clinical Ophtalmology in 20204, highlights encouraging data on the use of MIGS – Micro Invasive Glaucoma Surgery technologies: elimination / reduction of pharmacological therapies, safety profile excellent, very short recovery times and simplified implant procedures. Even more recent observational investigations2 have confirmed the effectiveness of iStent inject® both in the short and in the long term: the follow-ups at 4 and 5 years after implantation do not detect any adverse events in the operative phase or post-operative inflammatory response and show a reduction stable eye pressure, in most cases – over 90% – without any therapy and no need for re-intervention. Visual acuity and visual field are equally stable, showing an excellent benefit / risk profile. “In Italy, drug therapy is still the first choice therapy in patients suffering from glaucoma: it is able to effectively reduce intraocular pressure but often requires the use of several active ingredients. The combination of several drugs, in addition to being not easy to handle especially for older patients, can be associated with numerous side effects (ocular inflammation, itching, vision disturbances) which tend to reduce adherence and therefore the effectiveness of therapies. Some controlled studies have shown that between 30 and 70% of patients do not adhere to the therapy and 50% abandon it after only 6 months. ” – explains Professor Antonio Maria Fea, associate professor of Diseases of the Visual Apparatus, at the University of Turin. “With some colleagues in 2020 we asked ourselves why, despite having entered the clinical practice of many countries, the use of minimally invasive surgical solutions for glaucoma is so low in Italy and we compared the literature available on the “non-medical” therapies in use. Perhaps it could be the time to welcome and recognize, even in ophthalmology, that enormous technological leap that in other specialties – eminently cardiology, oncology, gastroenterology – has allowed a real “turning point” towards the minimally invasive procedures, seizing an important opportunity to give our patients a broader and more personalized spectrum of treatments and overcoming what seems to me a “cultural” rather than a scientific resistance. ” – adds Dr. Mario Sbordone, director of the Ophthalmology department of the S. Maria delle Grazie Hospital in Pozzuoli. “The effect on the quality of life of patients that this new generation of devices generates makes the difference. About 550,000 Italian patients undergo cataract surgery every year. Between 5% and 10% of these people have or will develop glaucoma. Without increasing the operating time and with a superimposable safety profile, these patients could solve the problem of ocular pressure control with the implantation of a device for MIGS: we look to this group for a change in the management of patients with glaucoma – people with mild or moderate degrees of disease may have a quick, painless, drug-less option available. ” – concludes Dr. Luca Cesari, director of the Ophthalmology Unit of the Civil Hospital of San Benedetto del Tronto and Ascoli Piceno.