72-year-old female, POW#1 s/p cataract surgery with CyPass OS
Complains of mild blurry vision and difficulty reading
No associated, pain, headaches, nausea, vomiting
VA: 20/50 OD, 20/40 OS
IOP: 15 OD, 26 OS
Pupils: Surgical, irregular OD, RR OS
EOM full OU
Dilated Fundus Examination: ON: 0.8 with superior/inferior thinning OD, 0.4 sharp pink OS. Macula, vessels, periphery WNL OU.
Elevated IOP after Cataract Surgery with CyPass Implant
IOP spike from extruded CyPass implant
CyPass Implant Extrusion with Elevated Intraocular Pressure
The CyPass Implant can be classified under the new wave of Minimally Invasive Glaucoma Surgery (MIGS). It is FDA approved for concurrent use during cataract surgery for patients with mild to moderate glaucoma and is placed in the suprachoroidal space between the ciliary body and scleral spur using an ab-interno approach to enhance uveoscleral outflow of aqueous humor.
The COMPASS Trial was a two-year interventional study randomizing patients to phacoemulsification alone and phacoemulsification with CyPass microstent at 1:3 ratio. The study found that 72.5 percent of CyPass achieved a >20 percent reduction in IOP at two years and that CyPass eyes achieved a nearly 2 mmHg additional IOP reduction from baseline compared to cataract surgery alone. The most common complications in the CyPass group was hypotony (2.9 percent), iritis (8.6 percent), IOP spike > 10 mmHg over baseline (4.3 percent), and implant extrusion (1-2 percent).
Control intraocular pressure by restarting IOP-lowering drops
Use steroid drops to treat any resulting iritis
Can attempt repositioning of CyPass implant or explantation of current microstent, which carries high risk of IOP spike due to closure of the cyclodialysis cleft. Patients will often need additional surgical intervention for IOP control.
Prognosis and Future Directions
MIGS is a useful tool for managing patients with mild to moderate glaucoma and CyPass has been shown to provide increased IOP reduction compared to cataract surgery alone
Although MIGS is considered relatively safe with less side effects compared to traditional glaucoma surgery, post-operative patients still need to be monitored carefully for potential complications
More time and research will give us a better understanding of the safety profile and efficacy of these newer MIGS devices
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Alena Reznik, MD, Assistant Professor of Clinical Ophthalmology; Co-Director, Glaucoma Fellowship Program, email@example.com