Clinical Scorecard: Decision-Making on Implantable Drug Delivery

At a Glance

Key Highlights

• Implantable drug delivery systems improve adherence by providing steady IOP control without daily eye drops.
• Durysta (bimatoprost implant) is FDA-approved for single administration, eluting drug over 3-4 months, placed at slit lamp.
• iDose TR (travoprost implant) is FDA-approved for up to 3 years of drug release, implanted surgically with a titanium anchoring canister.

Guideline-Based Recommendations

Diagnosis

• Confirm diagnosis of ocular hypertension or open-angle glaucoma prior to implantation.
• Perform comprehensive ophthalmologic exam including corneal, anterior chamber, and angle assessment with gonioscopy.

Management

• Consider implantable sustained-release therapies to improve adherence in patients struggling with topical drops.
• Durysta implant can be administered once at the slit lamp; iDose TR requires surgical implantation.
• Implants may be placed as stand-alone procedures or combined with cataract or minimally invasive glaucoma surgeries.

Monitoring & Follow-up

• Monitor for corneal endothelial cell loss, especially with repeated Durysta implants.
• Assess for signs of iritis or intraocular inflammation post-implantation.
• Regular follow-up to evaluate IOP control and implant position.

Risks

• Potential corneal endothelial cell loss, particularly with repeated Durysta dosing.
• Iritis reported in <5% with Durysta and ~6.2% with iDose TR slow-eluting implant.
• Risks of infection, inflammation, iris chafing, implant malposition, and need for explantation.
• Patients should be counseled on possibility of future interventions and ongoing glaucoma management.

Patient & Prescribing Data

Adults with OHT or OAG who have difficulty adhering to topical IOP-lowering medications

Implants reduce the burden of daily drops, provide steady drug release, and may delay or reduce need for topical therapy; Durysta approved for single use, iDose TR for up to 3 years

Clinical Best Practices

• Use wide beam and low magnification during Durysta implantation at slit lamp to maintain broad field of view.
• Stabilize globe with gentle countertraction using cotton-tipped applicator soaked with proparacaine.
• Pause briefly before withdrawing Durysta injector to allow implant to settle and avoid displacement.
• For iDose TR implantation, ensure clear view of angle and position implant in superior quadrant away from cornea and iris.
• Reposition malpositioned iDose implants carefully to avoid damage to drug-encasing membrane.
• Counsel patients clearly that implants are not a cure but a means to reduce or delay topical drop use.
• Prepare to explant implants if complications arise and inform patients about this possibility pre-procedure.

References

• Glaucoma Adherence and Persistence Study
• ARTEMIS Phase 3 Trials of Durysta
• Phase 3 Trial of iDose TR
• Spyglass Pharma Drug-Eluting IOL Platform Study