Editors Selection IGR 21-4

Medical Treatment: Bimatoprost Implant for Glaucoma

Esther Hoffmann

Comment by Esther Hoffmann on:

90873 Phase 3, Randomized, 20-Month Study of Bimatoprost Implant in Open-Angle Glaucoma and Ocular Hypertension (ARTEMIS 1), Medeiros FA; Walters TR; Kolko M et al., Ophthalmology, 2020; 127: 1627-1641

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In this randomized phase 3 clinical trial, Medeiros and colleagues evaluated the IOP lowering efficacy and safety of a 10 and 15 microgram bimatoprost intracameral implant in open angle glaucoma and ocular hypertension patients.

First-line therapy in glaucoma is commonly topical ocular hypotensive medication. However, less than 50% of all patients take their medication regularly. Patients who do not use their prescribed medication have more severe visual field loss and progression of their disease in general. Therefore, poor adherence is a critical barrier to achieving better outcomes in glaucoma patients. While several studies on teaching, education, counseling and motivation to increase adherence have reported short-term improvement, long term effect on adherence is unknown.

The Bimatoprost implant is an intracameral biodegradable implant designed for sustained-release of bimatoprost. After implantation via a paracentesis, the implant releases bimatoprost continuously into the anterio chamber over a 90-120 day period. In this study, after a medication washout phase, patients were randomized into three groups: 10 micrograms bimatoprost, 15 micrograms bimatoprost, and timolol eye drops. Primary outcome measures were mean IOP and change over a 12-month period.

Both dose strengths of bimatoprost implant were non-inferior to timolol in IOP reduction. As well, most patients were controlled without additional medication 12 months after three administrations of bimatoprost implants. However, some patients (7 in the 10 µg bimatoprost group and 16 in the 15 µg bimatoprost group) showed corneal decompensation requiring removal of the implant.

Further investigations are needed to prove whether or not intracameral bimatoprost can be a successful option to increase adherence to glaucoma therapy long-term.

Some patients showed corneal decompensation requiring removal of the implant

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