A Comprehensive Approach to MIGS

ABiC™ is a new, comprehensive MIGS procedure that flushes out the natural outflow channels, without damaging tissue, and without leaving behind a stent or shunt. A restorative MIGS procedure designed to re-establish the eye’s natural outflow drainage system, ABiC™ accesses, catheterizes, and viscodilates the trabecular meshwork, Schlemm’s canal, and also the distal outflow system, beginning with the collector channels. ABiC™ is the only MIGS procedure that successfully and comprehensively addresses all aspects of potential outflow resistance. Fast and easy to perform, ABiC™ can be successfully combined with phacoemulsification in order to make the best use of time in the operating room, or performed as a stand-alone procedure.

Benefits at a Glance
1. Comprehensive: treats trabecular meshwork, Schlemm’s canal and collector channels
2. Restores natural outflow pathways with minimal tissue trauma
3. No permanent implant or stent
4. On label – patient does not have to pay additionally out of pocket
5. Patient selection criteria are similar to current MIGS procedures

Effective IOP Reduction, Reduced Medication Dependence

Based on preliminary 12-month results of a 228-eye case series by Mark J. Gallardo, MD (El Paso Eye Surgeons, PA) and Mahmoud A. Khaimi, MD (Dean McGee Eye Institute, OK), ABiC™ may offer better clinical outcomes than any other currently available MIGS procedure.

ABiC Effective Outside of Cataract Surgery
98 patients underwent ABiC™ as a stand-alone procedure.
Mean pre-operative IOP was 21.5 ± 7.4 mm Hg at baseline. At 12 months (n=14) mean IOP was reduced by 36.74% to 13.6 ± 1.20 mm Hg.*
The mean number of medications was 3.0 ± 1.0 at baseline. At 12 months the mean number of medications was reduced by 66.66% to 1.0. ± 1.0.*
ABiC Combined with Cataract Surgery
130 patients underwent ABiC™ in combination with phacoemulsification.
Mean preoperative IOP was 17.1 ± 5.0 mm Hg. At 12 months (n = 34) mean IOP was reduced to 13.1 ± 2.1 mm Hg.*
Mean number of medications was 2.0 ± 1.0 at baseline. At 12 months the mean number of medications was reduced by 50% to 1.0 ± 1.0.*
IOP Control in Uncontrolled Glaucoma Patients
161 uncontrolled glaucoma patients (> 16 IOP) underwent ABiC™.
Mean preoperative IOP was 21.6 ± 6.1 mm Hg at baseline. At 12 months ABiC reduced mean IOP by 38.88% to 13.2 ± 2.0 mm Hg (n=31).*
The mean number of medications was 2.0 ± 0.0 at baseline. At 12 months the mean number of medications had been reduced by 50% to 1.0 ± 1.0.*
Reducing the Medication Burden in Controlled Glaucoma Patients
ABiC was shown to effectively lower the medication burden in controlled glaucoma patients (<15 IOP) (n= 67).
Mean number of medications was 2.0 ± 1.0 at baseline. At 12 months medication-use was reduced by 50% to 1.0 ± 1.0 with IOP remaining stable in the low teens.*

The ABiC Difference

ABiC™ is the only MIGS procedure that successfully and comprehensively addresses all aspects of potential outflow resistance. Other MIGS procedures lower IOP by addressing different aspects of (rather than all aspects of) the ocular outflow system.

Physiological Outflow PathwayNon-Physiological Pathway
Collector ChannelsTrabecular MeshworkSchlemm’s CanalSubconjunctival SpaceSupraciliary space
ABiC YESYESYES
iStentYES
CyPass MicrostentYES
XEN Gel StentYES

The Three Simple Steps of ABiC

Step One

After Cataract surgery perform goniotomy – open the trabecular meshwork.

ABiC-step-1-website

Step Two

Prime the catheter with viscoelastic and feed it through Schlemm canal 360 degrees.

ABiC-step-2-website

Step Three

Withdraw the catheter and viscodilate the trabecular meshwork, Schlemm canal and collector channels every 2 clock hours

ABiC-step-3-website

The Importance of the Collector Channels

ABiC™ is the only currently available MIGS procedure to address blockages in the collector channels.

In a healthy eye, aqueous humor drains from the anterior chamber through progressively smaller channels of the trabecular meshwork into the circumferentially-oriented Schlemm’s canal. From Schlemm’s canal, circuitous channels, known as the collector channels, wind their way toward the surface of the sclera through the intrascleral venous plexus system, joining the episcleral vasculature, which drains into the venous system. It is important to note that the collector channels are not evenly distributed around Schlemm’s canal circumferentially and that outflow is segmental, higher in areas close to the large collector channels.

Studies undertaken in human POAG eyes by Haiyan Gong, MD, PhD (University of Boston) have shown that many of the collector channels may be blocked with herniated trabecular meshwork tissue at 0mmHg and become progressively worse as IOP rises1. This herniated tissue does not recede in POAG eyes although it does in normal eyes. Cannulating the whole of Schlemm’s canal with ABiC™, via a process of 360-degree viscodilation, may “pop” open these herniations and enable full access to collector channel ostia for the egressing aqueous. In the case of other glaucoma treatments, where only a segment of Schlemm’s canal is addressed, or where the trabecular meshwork is targeted in isolation, any herniated tissue would most likely prevent improved outflow.

Research Summary: Haiyan Gong

In POAG eyes fixed at 0 mmHg (N=5), 73 collector channel ostia regions were examined, with 51 showing herniations (70%). In POAG eyes fixed at 10 mmHg (N=2), 22 collector channel ostia regions were examined, with 21 showing herniations (95%). In contrast, in normal eyes fixed at 0 mmHg, 53 collector channel ostia regions were examined, with 8 herniations found (15%). Whilst these herniations were found to be reversible in normal eyes, they were irreversible in the POAG eyes.

  1. Source: Cha ED, Xu J, Gong H. Variations in active areas of aqueous humor outflow through the trabecular outflow pathway. Presented at ARVO 2015.

A Restorative Approach to ABiC

ABiC™ works to control IOP by a process of restoration of the natural outflow pathways: ABiC™ flushes out the natural outflow channels, without damaging tissue and without leaving behind a stent or shunt.

“Rather than trying to mechanically change or bypass the pathway of aqueous outflow, ABiC acts to restore the natural outflow process by targeting all aspects of the outflow system. That is, the trabecular meshwork, Schlemm canal, and the collector channels. This is an important distinction of the procedure — especially considering that it is not always understood where the point of maximum resistance lies. It therefore makes sense to apply a procedure that comprehensively addresses the entire outflow system.”

Mark J. Gallardo, MD
El Paso Eye Surgeons, Texas, USA