Drainage
implants act as flow controllers, space maintainers, and healing modulators,
reducing the risk of scleral fibrosis.
The
suprachoroidal implantation of drainage devices improves deep sclerectomy (DS)
techniques by decreasing aqueous production by detachment of the ciliary body
or by increasing the choroidal resorption of aqueous humor.
DS
creates a trabeculo-descemet window by removing the deep scleral flap and the
corneal stroma. This allows gradual aqueous filtration through the thin
trabeculo-descemet membrane (TDM) and prevents dangerously rapid IOP decreases.
DS
preserves the integrity of the anterior chamber and has the advantage of
superior filtration control and reduced occurrence of perioperative and
postoperative complications (e.g., hypotonia, flat anterior chamber, and
choroidal detachment).
The
Esnoper Clip is a nonabsorbable foldable implant made from HEMA, a nonionic
polymer with a low tendency for protein deposits. The implant has a
double-plate design, which facilitates both trabecular and uveoscleral drainage.
It is also found to reduce fibrosis, ensuring maintenance of both the above-mentioned
spaces, thus avoiding their collapse over time.
The
implant has internal channels to facilitate aqueous humor flow through the
device and has lateral notches for non-sutured supraciliary placement.
This
implant has 2 plates, one is placed on the scleral bed and the other in the
supraciliary space. The shape of the implant has been designed to preserve the
patency of the intrascleral and suprachoroidal spaces and to maximize both
aqueous-humor drainage pathways long after surgery.
A
significant limiting factor in the long-term success of DS with uveoscleral
implants is the inflammatory potential of the suprachoroidal region, characterized
by significant cell infiltration and fibrosis.
A
study of 39 eyes by Alina-Dana Baxant, from Charles University, Prague, showed
a 87.2% success rate at one year, following DS with Esnoper Clip implantation
in patients with uncontrolled glaucoma.
REFERENCE:
Baxant
AD, Klimešová YM, Holubová L, Pluhovský P, Bartošová J, Veselý Ľ, Nemčoková M,
Rosina J, Studený P. Efficacy and Safety of Deep Sclerectomy With the Esnoper
Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective
Study. J Glaucoma. 2023 Mar 1;32(3):227-235. doi: 10.1097/IJG.0000000000002137.
Epub 2022 Oct 14. PMID: 36256952; PMCID: PMC9981320.
