WRITER Dr Jason Lim

Perth glaucoma surgeon Dr Jason Lim was one of the first Australian ophthalmologists to implant the eyePlate – a non-valved glaucoma drainage implant – following its introduction into Australia. He provides a case review for mivision.

Glaucoma remains a leading cause of irreversible blindness worldwide, with lowering intraocular pressure (IOP) remaining the only proven strategy to slow disease progression. While medications, laser treatment, and trabeculectomy continue to play an important role, glaucoma drainage devices (GDDs) have become increasingly favoured for patients with refractory glaucoma and those at high risk of filtration surgery failure. Landmark studies, including the Tube Versus Trabeculectomy (TVT) and Primary Tube Versus Trabeculectomy (PTVT) trials, have demonstrated the effectiveness and durability of tube surgery, reinforcing its role in contemporary glaucoma management.1,2

As glaucoma surgery continues to evolve, innovation has focused on simplifying surgical techniques while maintaining excellent long-term IOP control. The eyePlate (Rheon Medical, Switzerland) represents the latest generation of non-valved glaucoma drainage implants, incorporating several design features aimed at reducing surgical complexity and enhancing tissue preservation.

Unlike conventional drainage implants, which often require placement beneath one or more rectus muscles, the eyePlate (Figure 1) features an ultra-thin, highly flexible silicone plate designed to conform closely to the curvature of the globe. This allows implantation using a muscle-sparing approach through a smaller conjunctival dissection. The reduced tissue manipulation aligns with the principles of minimally invasive tube surgery (MITS), a technique developed to simplify glaucoma drainage surgery while preserving conjunctival integrity for future interventions.3

Figure 2. Anterior segment photos taken day one post eyePlate surgery. A) The tube can be seen in the anterior chamber with a Prolene (in blue) suture stenting the lumen of the tube. B) The only suture seen on the surface is a 10-0 vicryl, about 5 mm posterior to the limbus.

Australian surgeons are now beginning to gain experience with this emerging technology. As a consultant ophthalmologist at Booragoon Eye Clinic in Perth, I have been fortunate to have early access to the eyePlate following its introduction into Australia. My early experience has highlighted the implant’s flexibility, ease of insertion, and reduced surgical manipulation compared with traditional drainage devices. Because of these design features, I was able to perform MITS in a particularly challenging case.

A COMPLEX CASE

The patient was an 81-year-old war veteran, whose experience in the war left him with restless leg syndrome. This made the surgery under local anaesthesia challenging due to his constant intra-operative movement. His co-morbidities made general anaesthesia highly problematic. As a result, I conducted the surgery under topical anaesthesia alone, with further intra-operative sub conjunctival top up only. My patient had previous glaucoma shunt surgery that failed due to excessive scarring and needed more definitive control of his glaucoma.

Using a smaller radial incision, I was able to fold the plate and slot it through the smaller incision away from the limbus, which was already heavily operated on (Figure 2). This technique probably wouldn’t be possible with the other current glaucoma tubes because their plates are not pliable. The outcome of this approach was that the patient’s recovery course was significantly better: he experienced less discomfort (from the absence of limbal sutures), and less risk of inflammation with a smaller wound and faster recovery. His pre-op IOP was 25 mmHg on triple glaucoma medication, and his one week postoperative IOP was 13 mmHg on no glaucoma medication. Visual acuity was 6/7.5 on day one post-op and 6/6 one week post-surgery. He was due for his one month follow-up a week after the time of writing this article.

EMERGING SOLUTIONS

For optometrists, familiarity with newer glaucoma drainage devices is becoming increasingly important. As more patients undergo tube surgery, community eye care providers play an essential role in postoperative monitoring, recognising expected bleb morphology, assessing tube position, and identifying potential complications that require timely referral.

Understanding the evolving landscape of glaucoma surgery allows optometrists to better educate patients and participate confidently in shared glaucoma care.

The eyePlate represents an exciting evolution in glaucoma drainage technology. While still very new to Australia, its innovative design, minimally invasive surgical capability, and encouraging early clinical outcomes suggest it may become a valuable addition to the glaucoma surgeon’s armamentarium. As Australian clinical experience continues to grow, these next-generation implants have the potential to further advance the surgical management of one of the world’s leading causes of irreversible vision loss.

Dr Jason Lim MBBS FRANZCO is a consultant ophthalmologist specialising in glaucoma, cataract, and general ophthalmology in Perth, Western Australia. He practises at Booragoon Eye Clinic and at Waikiki Private Hospital. AI was used to assist with writing this article.

References

1. Gedde SJ, Schiffman JC, Budenz DL, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153(5):789-803. doi: 10.1016/j.ajo.2011.10.026.
2. Gedde SJ, Feuer WJ, Brandt JD, et al; Primary Tube Versus Trabeculectomy Study Group. Treatment outcomes in the Primary Tube Versus Trabeculectomy (PTVT) study after five years of follow-up. Ophthalmology. 2022;129(12):1344-1356. doi: 10.1016/j. ophtha.2022.07.003.
3. Singh B, Swampillai AJ, Ahmed F, et al. Minimally invasive tube surgery (MITS): A novel method in glaucoma drainage device implantation. J Clin Med. 2024;13(21):6590. doi: 10.3390/jcm13216590.