CyPass Micro-Stent


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**As of 29 August 2018, the CyPass Micro-Stent has been withdrawn from use globally by Alcon due to concerns regarding its long term effect on the cornea. It is no longer available for implantation in Australia and worldwide until further notice. You can read the press statement by Alcon here.

More information regarding the risk of corneal endothelial cell loss is available from the Alcon presentation at the September 2018 ESCRS Meeting in Vienna.**


WHY IS CYPASS MICRO-STENT IMPLANTATION NECESSARY?

The CyPass Micro-Stent is implanted at the same time as cataract surgery for patients who have both cataract and glaucoma. The aim of the iStent Inject is to decrease the eye pressure so that you can reduce the number of pressure-lowering eye drops you use. In some cases, it may be possible for you to stop your pressure-lowering eye drops completely.

The lens is the middle window inside the eye that focuses light entering the eye. As you age, your lens becomes gradually more cloudy – this is called a cataract. As the cataract progresses, you may experience worsening vision and increasing glare. During cataract surgery, the cloudy lens inside your eye is removed and replaced with an artificial clear lens implant. The lens implant remains in the eye permanently.

(Image adapted from the internet)

Fluid in the eye (aqueous) is produced by the ciliary body, and drains out through the trabecular meshwork (drainage pathway) in the drainage angle. Sometimes the trabecular meshwork no longer copes, preventing aqueous from draining out easily. This causes pressure to build up in the eyeball. When the pressure in the eye is too high, it can cause optic nerve damage and permanent vision loss - this is called glaucoma.

(Image adapted from the internet)



WHAT DOES THE CYPASS MICRO-STENT DO?

The CyPass Micro-Stent is one of the glaucoma surgery techniques called minimally invasive glaucoma surgery (MIGS). In contrast to traditional glaucoma surgery, MIGS is quicker and easier to perform and has less risk of complications, but has reduced overall pressure control.

(Image adapted from the internet)

The CyPass Micro-Stent is made of polyamide and measures 6.35 mm long. The stent is implanted in the suprachoroidal space (space between the wall and inner lining of the eye). This creates an opening in the suprachoroidal space, and allows aqueous to drain out in a controlled manner, thereby reducing eye pressure.

There is no change to the way the cataract surgery is performed. The stent is implanted into the eye after the lens implant has been inserted into the eye. This adds around 5 minutes to the overall cataract surgery time.



WHAT ARE THE POTENTIAL RISKS?

The CyPass Micro-Stent is inert, well accepted by the eye, and safe for Magnetic Resonance Imaging (MRI). Apart from the usual risks associated with cataract surgery, additional risks specific to the CyPass Micro-Stent are usually self-limiting and not sight-threatening. These include:

● Bleeding into the eye. This is common and the amount of blood may initially
   be alarming. However this generally settles over a few days without the
   need for additional treatment.
● Initial low eye pressure. This is common and the pressure usually
   increases gradually after a few weeks. Your vision may be slightly blurry
   until the eye pressure stablizes.
● Stent implantation issues, such as implantation at a non-ideal location,
   depth or angle. Rarely, the stent may become dislodged from its
   implanted position. No harm or damage will be caused to the eye, so
   usually no additional procedure is needed to reposition or remove the stent.
   However, you may need to restart your glaucoma eye drops.
● Failure to work. It is possible that the CyPass Micro-Stent may not work
   in your eye despite successful and uncomplicated implantation. Sometimes
   the stent works well initially, but the pressure gradually increases over time.
   If this occurs, you may need to restart your glaucoma eye drops.
● Problems with the cornea (the clear front window of the eye). Five-year data
   has shown that the CyPass Micro-Stent can result in increased loss of
   corneal endothelial cells (innermost layer of cells lining the cornea). This
   may result in the cornea becoming cloudy, which may require treatment
   with a corneal transplant if severe.

**As of 29 August 2018, the CyPass Micro-Stent has been withdrawn from use globally by Alcon due to concerns regarding its long term effect on the cornea. It is no longer available for implantation in Australia and worldwide until further notice.**



WHAT SHOULD I EXPECT?

(Image adapted from the internet)

CyPass Micro-Stent implantation (in combination with cataract surgery) is a hospital-based day case procedure performed under local anesthetic. The operation is usually performed one eye at a time.

Before and during surgery:

All the instructions before and after surgery are the same as for cataract surgery. All the precautions and surgical steps taken are the same as for cataract surgery. The following are the extra steps that will occur during CyPass Micro-Stent implantation:

● You will be asked to rotate your head to one side. Please remain still during
   the procedure.
● A contact lens will be placed on your eye.
● The stent will be implanted. You should not feel any pain during stent
   implantation.

After surgery:

After cataract surgery and CyPass Micro-Stent implantation, a pad and shield will be placed over your eye. The pad and shield can be removed the next day, and you can start your normal postoperative eye drops, usually a steroid (Prednisolone or Dexamethasone) and an antibiotic (Chloramphenicol) 4 times daily for 3 to 4 weeks.

You will usually be reviewed the day after surgery to check the positioning of the stent and your eye pressure. The reduction in the eye pressure with the CyPass Micro-Stent is usually immediate, so you should stop your usual pressure-lowering eye drops after surgery.

Over the next few days, you may experience blurriness, discomfort, sensitivity to light, and blood around the eye. This will gradually improve with the eye drops. As with routine cataract surgery, it can take a week or two before you notice any improvement in your vision.

Please contact the clinic immediately if you experience pain or a sharp drop in vision.




Learn more about cataract surgery

Learn more about the techniques of cataract surgery

Learn more about the steps involved in cataract surgery

Learn more about what to expect with cataract surgery

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