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Promising Pending FDA Glaucoma Surgical Treatments
October 11, 2019
So we’ve gone through the treatments that are currently available and FDA approved – the risks and the benefits and the appropriateness of each one but now let’s take a look at the promising treatments. The ones that are not yet FDA-approved and some of these are actually approved in Europe. We do have some early results, not just a FDA study results. So, we can categorize these into a couple of separate categories. One is what we call Trabecular Microbypass Stents. And actually iStents would fit in this category. It’s going to bypass the Trabecular Meshwork, creating an opening between the anterior chamber and Schlemm’s canal. Suprachoroidal implants – we’ve not talked about this yet because we don’t have anything that’s available that does this but it turns out that when you perform surgery on the eye or you have trauma to the eye and the iris and the ciliary body separates then you get what’s called a “cleft”, the pressure drops – usually drops, in single digits. The problem, of course, is that these things usually heal or you actually try to get them to heal because you can’t get your patients in single digits for too long. The pressure shoots way up into the 40’s or 50’s or 60’s. So attempts in the past to surgically create clefts have not been very successful because they’ve been very hard to titrate. So, there are now stents that have been created to essentially find a way to get the fluid down into the Suprachoroidal Space where there’s actually a (almost like) vacuum pulling the fluid out. So, there’s a negative pressure in that space and it can be very effective in terms of lowering the pressure but how do you control it? How do you titrate it? And then the Subconjunctival Implants. Subconjunctival implants are essentially methods of trying to get a better, more controllable, safer Trabeculectomy. In my way of thinking these are actually the least exciting but it’s a step. A step in the right direction.