OCT 11, 2023
Investigators studied the real-world efficacy of bimatoprost sustained-release (SR) implants on IOP and other glaucoma measures in patients who had and had not received selective laser trabeculoplasty (SLT).
This retrospective case series evaluated 118 eyes (84 patients) that received a single bimatoprost SR implant. There was no medication washout. Fifty-four eyes had a history of SLT. The primary outcome was reduction in IOP and the number of glaucoma medications.
The mean pretreatment IOP was 18.5 mm Hg. At 6 months post-treatment, the mean IOP was 17.1 mm Hg, with additional lowering to 16.6 mm Hg at the most recent follow-up visit. Seven eyes had IOP spikes of ≥10 mm Hg during the follow-up period: 2 eyes improved with additional topical therapy, 3 eyes required incisional surgery, and 2 eyes had unresolved IOP spikes. One eye required implant removal due to nonoptimal placement. A statistically significant reduction in the mean number of glaucoma medications was seen at all post-treatment time points. There were no differences in response to bimatoprost SR in the eyes with a history of SLT and the eyes with no SLT history.
There were several limitations with this retrospective study. First, there was no control group. Second, the mean follow-up period for all eyes was only 27.8 weeks. Third, there was no standardized protocol for patient selection. Finally, while the authors noted that no patients in this cohort suffered corneal edema, one implant was removed due to “suboptimal placement” but no details about why this implant needed to be explanted were provided.
This retrospective study of real-world data provides valuable insight into the use of the bimatoprost SR implant outside of the clinical trial setting. Bimatoprost SR placement may be an effective, albeit short-lived, treatment modality to reduce IOP and decrease the burden of topical medications. Since this study demonstrated that the implant was still effective in eyes with a history of SLT, these 2 treatments together may offer additive IOP lowering, minimizing the negative effects of topical glaucoma medications such as ocular surface side effects, lifestyle burden, and risk of nonadherence.
Financial disclosures: Dr. Gillian Treadwell discloses no financial relationships.