Eyeworld

Dr. Sarkisian, Dr. Grover, and Dr. Teymoorian discuss real-world data for bimatoprost 10 mg intracameral implant for sustained drug delivery to treat glaucoma. Source: ASCRS "Beyond the 3 months that you saw before, if you follow them out to about a year, the pressure reduction stayed to about a year," he said. Dr. Sarkisian's data also saw a continuation of IOP lowering out to a year, and 65% of his patients remained off medications, which was the goal of the bimatoprost implant. Looking at a subset of patients who had pressures more than 21 mm Hg preop, Dr. Sarki- sian said they also had a significant medication reduction a year postop. "That's exciting to see," Dr. Sarkisian said. The year or two you get in reducing the drop burden, Dr. Teymoorian said, how much is that earlier intervention going to pay off at the end of the disease? "We don't have studies to state that, but if you can treat a little more consis- tent pressure reduction because glaucoma studies show we need to get the pressure down but also keep the pressure down. If we can keep the pressure down earlier in the game so it's not such a gap and you're not down as much by the time the fourth quarter hits, how much did we actually win?" Real-world administration Dr. Grover shared that he administers the bimatoprost im- plant at the slit lamp, saying he finds it more intuitive there. Dr. Teymoorian said he does almost all of his at an ASC. "To me, I think it's nice to get a warm blanket, it's sterile. They never see me coming at them. We're usually talking about what they are doing after lunch. If you distract them, it seems to make it more streamlined. I get asked if I need to take them to the ASC on a different day, and I say, 'They didn't go to the pharmacy, instead they're going to go to the surgery center.'" Dr. Sarkisian said he performs the procedure in the office. "I have two afternoons a week where I do lasers and Durysta, and I bounce between the laser room and the Durysta room, and it makes it very easy," he said. Postop, the physicians said they tell patients to stop their drops and see them after a month to determine how they're doing. "You may think it might not work as well with patients who are on two drops, but I think this starts to highlight that patients just don't get their drops in," Dr. Teymoorian said, adding later "what matters is the pressure is low, the patient is happy, we're happy." Dr. Teymoorian shared data on whether SLT affects this implant. Out of 197 eyes, 103 (52.3%) did not have SLT; 94 eyes (47.7%) had SLT before and/or after the bimatoprost implant (66 SLT before, 12 SLT after, 16 SLT before and after). Patients, in total, went from a mean IOP of 16.6 mm Hg to 12.8 mm Hg at month 3 after receiving the bimato- prost implant. For those who had not had SLT in the 6 months pri- or, IOP went to 12.7 mm Hg. Mean topical IOP-lowering medications went from 1.4 at baseline in all eyes to 0.2 at 3 months postop. The drop numbers were the same in the group that did not have prior SLT. Dr. Teymoorian also not- ed the reduction in IOP that was maintained from about a week postop through 3 months. He said that there were no significant corneal issues observed. Dr. Sarkisian presented his real-world findings in a patient population that had a large number of Native Americans. His consecutive retrospective study included 156 patients, 14% of whom were Native American. Eighty- three percent were pseudophakic. The study looked at two groups—patients who had an IOP over 21 mm Hg where the goal was to lower IOP and those who were under 21 mm Hg where the goal was to get patients off topical medicine. This allows for a real-world report of treatment goals because if we were to average these two groups, the results are no longer meaningful, Dr. Sarkisian said. At 6 months, eyes with baseline IOP ≥21 mm Hg had a significantly lower mean IOP (19.85±8.01 versus 26.25±4.84 mm Hg; p<0.0001) and mean number of IOP-lowering medications (1.04±1.44 versus 1.38±1.50; p=0.048) compared with baseline. One year after implantation, 73.58% of eyes had a ≥20% reduction in IOP, 41.51% were medication-free, and 30.19% were receiving at least one fewer medication. Among eyes with baseline IOP <21 mm Hg, there was a significant reduction in the mean number of IOP-lowering medicines by month 6 (0.61±1.03 versus 1.93±1.21 at baseline; p<0.0001), with no change in IOP. At 12 months, 24.27% of eyes had a ≥20% decrease in IOP, 43.69% of eyes did not require any medications, and 63.11% had at least one fewer medication compared with baseline. Looking at the Native American subgroup, Dr. Sarkisian noted similar baseline IOP. IOP lowering after the bimato- prost implant was similar among the total population and the Native American subgroup. In a Q&A with the audience, the presenters were asked how long the IOP-lowering effect would last. Dr. Teymoorian said he followed some patients in his study out as far as 11–13 months, finding that IOP of all eyes (those with and without SLT) was 13.3 mm Hg at this timepoint. Copyright 2024 ASCRS. All rights re- served. The views expressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS and in no way imply endorsement by EyeWorld and ASCRS. Sponsored by

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