Real world use of loteprednol etabonate ophthalmic gel 0.5% in cases representative of comorbid pathologies responding to minimally invasive glaucoma surgery

Figures & data

Table 1 Minimally invasive glaucoma surgical procedures^a

MIGS category/IOP-lowering mechanism	Procedure/Device	Manufacturer	FDA approval status
Increasing trabecular flow Target tissue: juxtacanicular portion of the trabecular meshwork (TM) Mechanism: increases trabecular outflow by restoring or bypassing the juxtacanalicular TM	Trabectome	Neomedix, Tustin, CA, USA	2004
	iStent	Glaukos Corporation, Laguna Hills, CA, USA	2012
	iStent inject	Glaukos Corporation, Laguna Hills, CA, USA	2018
	Hydrus Microstent	Ivantis, Inc, Irvine, CA, USA	2018
	Gonioscopy-assisted transluminal trabeculotomy (GATT): iTrack microcatheter	Ellex, Adelaide, Australia	2008
	Excimer laser trabeculotomy (ELT)	Laser probe: AIDA; Glautec AG, Nürnberg, Germany Endoscopic laser probe: AIDA; TUI- Laser, Munich, Germany	Under clinical investigation
	Ab interno canaloplasty (ABiC): iTrack microcatheter	Ellex, Adelaide, Australia	2008
	Visco 360	Sight Sciences, Menlo Park, CA, USA	IDE approval, 2016
	Kahook Dual Blade	New World Medical, Rancho Cucamonga, CA, USA	2015
	TRAB360	Sight Sciences, Menlo Park, CA, USA	2015
Suprachoroidal shunts Target: uveoscleral pathway Mechanism: increase uveoscleral outflow through the suprachoroidal pathways via placement of a stent	CyPass Micro-Stent	Alcon, Fort Worth, TX, USA	2016 (withdrawn from market, 2018)
	iStent Supra	Glaukos Corporation, Laguna Hills, CA	Under clinical investigation
Reducing aqueous production Target: ciliary body mechanism: reduce aqueous production through laser application to whiten and shrink the ciliary process	Endocyclophotocoagulation (ECP)	Curved laser endoscope probe: Endo Optiks, Little Silver, NJ, USA Diode Laser: Iridex Oculight, Mountain View, CA, USA	1991
Subconjunctival filtration Target: subconjunctival space Mechanism: creates a non-physiologic drainage route for aqueous humor from the anterior chamber to the subconjunctival space	XEN Glaucoma implant/gel	Allergan, Inc., Irvine, CA, USA Or Allergan plc, Dublin, Ireland	2016

Notes: ^aMIGS defined as any glaucoma procedure avoiding conjunctival dissection and approached via an ab interno incision (clear corneal wound).

Abbreviation: IDE, investigational device exemption.

Figure 1 iStent implanted through the trabecular meshwork into Schlemm’s canal with the assistance of a gonioprism. One can see the snorkel facing the anterior chamber allowing aqueous to flow directly into Schlemm’s canal.

Figure 2 CyPass Micro-Stent positioning within the supraciliary space, entering posterior to the scleral spur, using the approved loading device. This Cypass is fully inserted without rings showing and there is no local corneal edema.