IOP‐lowering efficacy of prostaglandin analogues adjunctive to a Supercilliary Micro‐Stent (CyPass®)

Purpose Minimally invasive glaucoma surgery (MIGS) procedures are proving to be a safe, efficacious alternative to medical management of glaucoma. Most frequently employed concomitantly with cataract surgery, they add little if any additional risk while, in many instances, decreasing or even eliminating the need for ocular hypotensive medication. The optimum target intraocular pressure (IOP) varies from patient to patient and is dependent on multiple factors including degree of glaucomatous damage, rate of progression, age and race, central corneal thickness. The purpose of this work is to investigate IOP lowering effect of PGAs added to MS in patients with mild to moderate POAG. Methods In a recent large randomized controlled trial (the COMPASS Trial; n = 505, 374 micro-stent, 131 control), the supracilliary micro-stent (MS) used in conjunction with phacoemulsification demonstrated superior IOP lowering effectiveness at 24 months compared to phacoemulsification alone (CON) and allowed 85% of patients to remain off of all ocular hypotensives. Despite this success, 8 (2%) patients in the MS group and 15 (11%) in the CON group required a prostaglandin (PGA) in addition to the MS to reach their IOP target. Mean pre-PGA IOP for MS and CON groups were 24.4 and 18.7 mmHg. Results Addition of the PGA resulted in mean percentage IOP reductions of 23% and 18.5% for the MS and CON groups respectively. Measurement of IOP post-PGA was at 24 months post-surgical visit so that the duration of treatment with the PGA was variable but was initiated over 3 months earlier, on average, in the CON group than in the MS group. Conclusions Addition of a PGA in MS patients provided IOP reductions at least as good and numerically better than for CON patients, albeit somewhat less than IOP reductions observed (~ 30%) for PGA monotherapy when used in the overall OAG population.