Clinical Ophthalmology (May 2020)
Circumferential Viscodilation Ab Interno Combined with Phacoemulsification for Treatment of Open-Angle Glaucoma: 12-Month Outcomes
Abstract
Nathaniel Tracer,1 Jaime E Dickerson Jr,2,3 Nathan M Radcliffe4 1NYU School of Medicine, New York, NY, USA; 2Sight Sciences, Inc, Menlo Park, CA, USA; 3North Texas Eye Research Institute, UNTHSC, Fort Worth, TX, USA; 4Mt Sinai School of Medicine, New York, NY, USACorrespondence: Nathan M RadcliffeMt Sinai School of Medicine, New York Eye Surgery Center, 1101 Pelham Parkway North, New York, NY, USATel +1 718 519 1000Email [email protected]: To evaluate reduction in intraocular pressure (IOP) and medications for open-angle glaucoma (OAG) patients 12 months post-ab-interno circumferential viscodilation (VISCO360, Sight Sciences, Menlo Park, CA) in conjunction with cataract surgery.Setting: Surgical center (New York, United States).Design: Retrospective study of all OAG patients treated with 360-degree ab-interno viscodilation with cataract surgery by a single surgeon (NR) having 12 months of follow-up. Eyes were stratified by baseline IOP. Group 1: ≥ 18 mmHg (n=111). Group 2: < 18 mmHg (n=69).Methods: IOP was measured using Goldmann applanation tonometry. Medications, the number of medication-free eyes in each group at 12 months, and adverse events (AE) are reported. Analysis includes descriptive statistics and t-tests evaluating change from baseline.Results: Groups 1 and 2 had mean baseline IOP of 22 and 14.3 mmHg. Medication use was 0.9 and 1.1 for Groups 1 and 2. At 12 months IOP for Group 1 was reduced 22% to 17.2 mmHg (p< 0.0001) on 1.0 medications (p=0.7). IOP for Group 2 was similar to baseline (15.4 mmHg) but with a reduction in medications to 0.6 (p< 0.05). The proportion medication free at 12 months was 32% and 47% for Groups 1 and 2 versus 34% and 26% at baseline, respectively. There were few AE (hyphema 1.7%, IOP elevation > 10 mmHg > 30 days post-op 1.1%, mild inflammation < 1%) and no secondary surgical interventions excepting a single paracentesis, one-day postoperative.Discussion: Treatment goals for the two groups differed. Pressure reduction (Group 1) or medication reduction (Group 2). Viscodilation achieved significant IOP reduction in Group 1 and medication reduction in Group 2 with many patients (both groups) medication free at 12 months. AE were infrequent and transient.Conclusion: Circumferential ab-interno viscodilation can be combined with cataract surgery and provide an IOP lowering and medication reduction benefit sustained for at least 12 months, for many patients with OAG.Keywords: viscodilation, MIGS, open-angle glaucoma, glaucoma surgery, VISCO360, canaloplasty, OMNI
