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From the Editor: Today’s MIGS Landscape

The FDA and industry collaborate to ensure safety.

Toward the goal of safe and efficacious glaucoma interventions, we saw a significant setback this fall when Alcon voluntarily withdrew the CyPass supraciliary stent from the market. The withdrawal was based on data from the 5-year COMPASS-XT study that demonstrated that some patients with a CyPass that was not implanted deeply enough demonstrated high rates of endothelial cell loss.

It is important to put this news in the appropriate context. By any standard, the procedure was still safe, and no patients in the 5-year study required a corneal transplant of any type because of the device. However, when we are targeting mild glaucoma, our MIGS surgeries must be very close to perfect.

So what happens now? Personally, I would like to get the CyPass back in my hands in one way or another, and I am hopeful that Alcon and regulators will be able to find a pathway for this to happen. Secondly, we might see renewed attention to the corneal endothelium as a potential victim of many of our glaucoma surgeries, particularly the more invasive surgeries such as tube shunts and trabeculectomy.

One silver lining is that there appears to be a relationship between the FDA and industry that is working to ensure the safety of our patients. The COMPASS-XT study was initiated upon FDA approval of the CyPass in order to ensure patient safety, and this study led to action.

We discuss the current MIGS landscape in this issue of Glaucoma Physician, including an article on MIGS decision-making, an article discussing common myths regarding endoscopic cyclophotocoagulation, and a deep dive into the use of the newly approved Hydrus stent by Ivantis. We hope you find this issue helpful in your use of MIGS, and we invite you to visit our new website, www.glaucomaphysician.net , for articles in this issue and more. GP

On the cover: OCTA scan (Avanti RTVue XR, Optovue) of an optic nerve head vessels before (top) and 1 month after glaucoma surgery and restoration of physiologic IOP (bottom). From "Optical Coherence Tomography Angiography for Glaucoma Diagnosis and Follow-Up," page 16.