Long-term safety and efficacy of suprachoroidal ESNOPER CLIP® implantation in non-penetrating deep sclerectomy.

PURPOSE: To evaluate the long-term hypotensive efficacy and safety of the ESNOPER CLIP® implant in non-penetrating deep sclerectomy (NPDS) in patients with open-angle glaucoma. METHODS: Patients who underwent NPDS and suprachoroidal ESNOPER CLIP® implantation were followed up for 5 years. Preoperative and postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field mean deviation (MD), number of topical hypotensive medications, and intra- and postoperative complications were registered. Surgical success was defined for different IOP thresholds (≤ 21, ≤ 18 and ≤ 15mmHg) with (qualified success) or without postoperative antiglaucoma medications (complete success). RESULTS: 132 eyes (mean age 68.8 ± 8.9 years) were included. BCVA remained similar after surgery (0.73 ± 0.27 decimal preoperatively and 0.74 ± 0.29 after 5 years, p = 0.723). IOP experienced a significant improvement compared to preoperative values (20.7 ± 8.0 vs. 13.0 ± 4.2 mmHg), with a mean number of topical hypotensive medications significantly dropping from 2.63 ± 0.82 to 0.64 ± 0.95 after 5 years. Visual field MD did not significantly change. Four microperforations were registered as intraoperative complications (3%) and 49% needed goniopuncture during follow-up. Needling rate was 26%. After 5 years, complete and qualified success rates were 58% and 88% for IOP≤21mmHg threshold, 59% and 85% for IOP≤18mmHg threshold, and 49% and 60% for IOP≤15mmHg threshold, respectively. CONCLUSIONS: NPDS with the ESNOPER CLIP® implant was associated with sustained reductions in IOP and in the use of topical medications over five years, while maintaining a favourable safety profile. ESNOPER CLIP® implant combined with phacoemulsification appears to be a safe and effective approach for glaucoma patients with a coexisting cataract. KEY MESSAGES: WHAT IS KNOWN : Non-penetrating deep sclerectomy is considered a safe and effective filtering procedure with potentially lower complication rates compared to traditional trabeculectomy. The uveoscleral Esnoper Clip implant used in non-penetrating deep sclerectomy has shown effective and safe results, although available evidence is limited to follow-ups of up to 2 years. WHAT IS NEW: This is the first study reporting 5-year outcomes of the Esnoper Clip implant, including assessment of its performance when combined with cataract surgery. Non-penetrating deep sclerectomy enhanced with the suprachoroidal Esnoper Clip implant is safe and effective in maintaining a reduction of both, intraocular pressure and the number of topical hypotensive medications, in the long term. Non-penetrating deep sclerectomy and Esnoper Clip implantation combined with phacoemulsification is a suitable approach for managing glaucoma patients with concurrent cataract.