Effectiveness of CyPass in eyes with mild to moderate glaucoma in an urban population

Abstract

Purpose : To evaluate the effectiveness of the CyPass microstent to reduce intraocular pressure (IOP) and to reduce the number of IOP lowering medications in patients with mild to moderate glaucoma.

Methods : Adult patients with mild to moderate glaucoma from 2017 to 2019 were included in this retrospective study. Each patient had their visual acuity (VA), IOP, and number of IOP lowering medications recorded at 1, 3, 6, 12, and 24 months post-operatively. Patients with advanced glaucoma, defined as a Mean Deviation on visual field greater than -10.00dB, and patients with low tension glaucoma, defined as IOP below 18, were both excluded. Post-op success criteria stated IOP must be below 21 and number of IOP lowering medications had to decreased by at least 1. Patients who had additional glaucoma surgery after CyPass insertion, had an increase in IOP lowering medications from baseline, had hypotony for at least 2 consecutive visits, sight threatening complications, or had loss of light perception (LP) were considered failures. Criteria for success was analyzed by a Kaplan-Meier survival curve.
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Results : This study included results from 30 eyes in 28 patients. Of the eyes followed 29 underwent combined CyPass insertion with Cataract Extraction and Intraocular Lens insertion, and one eye underwent isolated CyPass insertion. Our subjects were 82% African American. Mean age 71.89 ± 8.11 years, mean pre-OP IOP was 22.4 ± 7.2 mmHg, and mean pre-OP number of IOP lowering medications was 2.1 ± 1.3. For our success criteria the Kaplan-Meier analysis showed cumulative success rates of 67.5% at 6 months, 55% at 12 months, and 50% at 24 months. Mean pre-OP number of IOP lowering medications at 2.1 ± 1.3, was decreased to 0.6 ± 0.9 at 6 months (p<0.0001), 1.3 ± 1.5 at 12 months (p= 0.03), and 1.6 ± 1.8 at 24 months (p=0.32). Mean pre-OP IOP at 22.4 ± 7.2 mmHg was decreased to 15.7 ± 4.3 at 6 months (p=0.0001), 17.4 ± 4.3 at 12 months (p=0.003), and 16.1 ± 3.5 at 24 months (p=0.005).

Conclusions : Prior to being removed from commercial market, the CyPass microstent was successful at lowering patient’s mean number of IOP lowering medications as well as mean IOP. Supraciliary shunt procedures can be an effective surgical treatment in patients with mild to moderate glaucoma.

This is a 2020 ARVO Annual Meeting abstract.

 

Success Criteria – Post-Op IOP < 21 and decreased IOP lowering medications by at least 1

 

Pre-Op and Post-Op Measurements