Glaucoma Surgery - STRETCH Study Explained
Intravitreous HPMC for Hypotony: Promise, Caution, and the Pakistani Context
A recent innovation being discussed widely in ophthalmology circles across the world is the use of intravitreal HPMC in selected cases of hypotony. A study named as STRETCH was started in Moorfield Hospital UK. This particular study shows the possible solution in the treatment of hypotony as this condition has already limited options of treatment.
However, when we look at this innovation in the context of Pakistan, the situation may become complicated if caution is not exercised.
We have already seen a similar story unfold with Anti-VEGF therapy. For nearly ten years, Anti-VEGF was cheaply available and widely used by eye doctors in Pakistan. The drug came from a single source and was prepared in a controlled environment. Over time, however, uncontrolled sales began. The medication was sold without proper storage or sterile conditions. As a result, some patients suffered severe complications, including blindness. This led the government to introduce strict legislation. Today, the affordable option is no longer available, and only FDA-approved, expensive medications can be offered. The financial burden now lies entirely on the patient.
This experience should serve as a clear warning.
Before intravitreal HPMC is adopted for the management of hypotony, its careful and restricted use must be clearly understood. It should only be used in selected cases and within a strictly controlled environment. Avastin story teaches us many things that storage, handling and supply of HPMC should be carefully managed.
The study also emphasize that HPMC treatment is not a single dose treatment. 10-13 injections are needed in carefully selected patients. So the safety, sterility and handling of these injections is very imporatnt at each dose.
inclusion criteria for HPMC :
- Low IOP for three months.
- IOP less than 6.5mmHg.
- A structural change should be evident.
- Eye have visual potential.
The limitations of this study is that the sample size of this study is small and the patients are followed up for only 11 months so more long term studies are needed to reach concrete solutions.
Finally , intravitreal HPMC is a innovation in the treatment of hypotony, but how, who and how much should be carefully regulated in Pakistan. Whereas, in the past the Govt bodies failed to implement their own regulations where patient can be ultimately be at the loss.