Saturday, March 25, 2023

CILIOSCLERAL INTERPOSITION (CID) DEVICE

 


  • Ciliatech, a France based company has developed a novel glaucoma implant.
  • Known as the cilioscleral-interposition (CID) device, it is a unique non-resorbable glaucoma implant.
  • It is a single-piece implant, made from 26% hydrophilic acrylic, which ensures long-term biocompatibility.
  • It consists of a specifically designed 6mm long, 4 mm wide, and 200µm thick plate.
  • The device’s two faces and edges are designed with grooves and corrugations to maximize the outflow from the anterior chamber and its circulation to the choroid and the sclera-conjunctival vessels.


OCT image of CID implant


  • Spares the conjunctiva, which is only incised over the scleral incision site.
  • Incurs no Endothelial Cell Loss (ECL): the implant does not enter the anterior chamber of the eye, as the wall that separates the anterior chamber from the supraciliary space is not cut: there is zero risk of altering the corneal endothelium.
  • Generates very low post-operative inflammation; the surgical technique and the implant do not provoke ciliary body reaction: the anatomical compartments of the anterior segment are not modified, resulting in fewer adverse events and thus better patient post-operative comfort.
  • Does not create a bleb: scleral incisions are sutured watertight to maintain the outflow under the sclera. As such, the surgical technique and the implant cannot generate a subconjunctival bleb and its associated complications (heavy post-op monitoring, cyst, fibrosis, use of antimetabolites, etc.).
  • ‘No loss of chance’: should a second surgery be needed, CID surgery preserves the eye anatomy (anterior segment and conjunctiva); another interventional act (laser, stent, trabeculectomy or GDD) can be performed without difficulty.
  • Two cohorts of 20 and 22 patients in Yerevan, Armenia, living with open angle glaucoma, participated in the studies. They were operated on with one of the first versions of Ciliatech’s implant (SV13) in a monocentric study.
  • Based on internal data: interim results at 12M / 6M follow-up SAFARI 1 / SAFARI 2 studies respectively, the implant achieves an IOP in the mid to low teens (15 mmHg and lower).
  • There is significant IOP reduction >33%.
  • Medication reduction >90% at 12 months was also reported in the studies.
  • No treatment failure (no reoperation) at 12 months in 42 patients: 89% of patients were medication free.
  • Spares the anterior chamber and the ciliary muscle root.
  • Removes a local obstacle to uveoscleral outflow. This allows aqueous humour resorption at the supraciliary and suprachoroidal spaces.




 

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