In March 2020, the U.S. Food and Drug Administration approved Durysta, the first sustained-release bimatoprost implant for lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG) and ocular hypertension. As with any new treatment, it’s important that you understand what Durysta is, how it works, and what the benefits and potential risks are of this new form of glaucoma treatment.*

What is the benefit of sustained-release medication?

Studies have shown that 30-80% of glaucoma patients do not follow their treatment regimens as directed. 

There are many reasons for this, among them: 

• Forgetfulness  
• Difficulty administering the drops 
• Inconvenience of frequent administration 
• Poor understanding of the disease 
• Medication costs and side effects 

As a sustained-release implant, Durysta can take most of that responsibility off of your shoulders.

How does the Durysta implant work?

The implant is shaped like a rod and is biodegradable and intracameral (placed in the eye cavity). The rod contains 10 micrograms (μg or mcg) of bimatoprost, a prostaglandin analog that decreases your intraocular pressure (IOP) by increasing fluid drainage. As a minor procedure, the implantation can take place in your doctor’s office. 

The time-release mechanism was designed to last four to six months, but the clinical trials showed that the effects often lasted longer than projected. Forty percent of patients in phase I (1) and phase II (2) studies did not require additional IOP-lowering treatment for at least one year following a single implant.

How safe is the procedure?

The implant has proven safe enough to gain approval for single-dose use. Based on results of phase I and II studies, there were no reported cases of:

• Endophthalmitis, 
• Cystoid macular edema 
• Eyelash growth 
• Iris hyperpigmentation
• Eyelid retraction 

There are, however, risks of possible side effects. Differences between the group that received the implant and the group that received topical bimatoprost included:

• Thirty-five percent (35%) of implant patients experienced conjunctival hyperemia versus 29% of topical patients. After the first two days, however, the implant group had lower rates of hyperemia
• The implant group experienced slightly higher rates of nonspecific adverse events, including eye pain, eye irritation, lacrimation, and conjunctival hemorrhage. 
• Reduction in endothelial cell density at two years was slightly higher in the implant group. 

Despite these minor risks, doctors, such as Natasha Nayak Kolomeyer, M.D., are hopeful about the implant’s use and excited about the further innovations the technology makes possible. 

“Sustained-release medication is a burgeoning field,” wrote Kolomeyer, “and I am optimistic it will transform our treatment paradigm for glaucoma and reduce the burden on our patients.” 

*Nayak Kolomeyer, N. (2020, May 14). Top 7 Things to Know About First Sustained-Release Glaucoma Medication. American Academy of Ophthalmology. https://www.aao.org/young-ophthalmologists/yo-info/article/top-7-things-to-know-about-first-sustained-release