title: Implantation of two second-generation trabecular micro-bypass stents and topical travoprost in open-angle glaucoma not controlled on two preoperative medications: 18-month follow-up.
abstract: OBJECTIVE
  Additional data are sought regarding treatment options for glaucoma, a major cause of global blindness.
  
  
  BACKGROUND
  The study assessed outcomes following standalone implantation of two second-generation trabecular micro-bypass stents and postoperative topical prostaglandin in eyes with open-angle glaucoma not controlled on two preoperative medications.
  
  
  METHODS
  The study design is a prospective, nonrandomized, open-label study at a tertiary-care ophthalmology centre.
  
  
  METHODS
  Subjects had open-angle glaucoma with preoperative intraocular pressure of 18-30 mmHg on two medications, a medication washout phase, and post-washout intraocular pressure of 22-38 mmHg. All subjects (N = 53) have been followed for 18 months.
  
  
  METHODS
  One day following implantation of two second-generation trabecular micro-bypass stents, subjects started topical travoprost. Medication washout was repeated at month 12.
  
  
  METHODS
  The main outcome measure was the proportion of eyes with intraocular pressure reduction ≥ 20% versus medicated baseline intraocular pressure with reduction of one medication at 12 months.
  
  
  RESULTS
  At 12 months, 91% of eyes achieved intraocular pressure reduction ≥ 20% with reduction of one medication. All eyes had intraocular pressure ≤ 18 mmHg with reduction of one medication, and 87% had intraocular pressure ≤ 15 mmHg. Mean intraocular pressure on one medication was ≤ 13.0 mmHg (≥ 34% reduction) through 18 months. Mean post-washout intraocular pressure at month 13 was 33% lower than preoperative unmedicated intraocular pressure. No adverse events occurred through 18 months.
  
  
  CONCLUSIONS
  In open-angle glaucoma eyes on two preoperative medications, treatment with two second-generation trabecular stents and one postoperative prostaglandin resulted in mean intraocular pressure ≤ 13 mmHg with reduction of one medication, with favourable safety. These findings show the utility of second-generation trabecular bypass with postoperative prostaglandin in patients with open-angle glaucoma.
authors.affiliation: Vance Thompson Vision, Sioux Falls, South Dakota, USA.
authors.forename: John
authors.initials: J
authors.lastname: Berdahl
authors.affiliation: S.V. Malayan Ophthalmology Centre, Yerevan, Armenia.
authors.forename: Lilit
authors.initials: L
authors.lastname: Voskanyan
authors.affiliation: Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Myers
authors.affiliation: Glaukos Corporation, San Clemente, California, USA.
authors.forename: Dana M
authors.identifier: http://orcid.org/0000-0002-1034-7732
authors.initials: DM
authors.lastname: Hornbeak
authors.affiliation: Glaukos Corporation, San Clemente, California, USA.
authors.forename: Jane Ellen
authors.initials: JE
authors.lastname: Giamporcaro
authors.affiliation: Wills Eye Hospital, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
authors.forename: L Jay
authors.initials: LJ
authors.lastname: Katz
authors.affiliation: Minnesota Eye Consultants, Minneapolis, Minnesota, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Samuelson
mesh_terms: D000287:Administration, Topical; D000959:Antihypertensive Agents / Q000008:administration & dosage; D020099:Coated Materials, Biocompatible; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D014129:Trabecular Meshwork / Q000601:surgery*; D000069557:Travoprost / Q000008:administration & dosage*; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D000959:Antihypertensive Agents; D020099:Coated Materials, Biocompatible; D000069557:Travoprost
keywords: IOP; MIGS; bypass; glaucoma; trabecular