Use of novel devices for control of intraocular pressure

This brief review in honor of Douglas Johnson, MD describes the rationales and initial clinical outcomes in studies to date on Trabectome®, Glaukos iStent™, iScience (canaloplasty), and Solx (suprachoroidal shunt), all newly developed surgical technologies for treatment of open-angle glaucomas. These new approaches to angle surgery have been demonstrated in preliminary case series to safely lower IOP in the mid-teens with far fewer complications than expected with trabeculectomy and without anti-fibrotics. Trabectome and iStent are relatively non-invasive, aim to improve access of aqueous to collector channels and do not preclude subsequent standard surgery. Canaloplasty, modified from viscocanalostomy, is thought to improve trans-trabecular flow. Solx potentially offers an adjustable aqueous outflow into the suprachoroidal space.