Glaucoma is a multifaceted disease which result in damage to the optic nerve and vision loss. The most common type is open-angle glaucoma with less common types including closed-angle glaucoma and normal-tension glaucoma. Open-angle glaucoma develops slowly over time and there is no pain. Side vision may begin to decrease followed by central vision resulting in blindness if not treated.The origins of therapeutic trials to control intraocular pressure (IOP) go back several centuries, however the wide diversity of different approaches shows the poor efficiency of them. 




                                     A normal range of vision






              The same view with advanced vision loss from glaucoma




Glaucoma drainage devices are designed to divert aqueous humor from the anterior chamber to an external reservoir, where a fibrous capsule forms about 4-6 weeks after surgery and regulates flow. These devices have shown success in controlling intraocular pressure (IOP) in eyes with previously failed trabeculectomy and in eyes with insufficient conjunctiva because of scarring from prior surgical procedures or injuries. They also have demonstrated success in complicated glaucomas, such as uveitic glaucoma, neovascular glaucoma, and pediatric and developmental glaucomas, among others.

ESNOPER scleral implant is an implant with recognized effectiveness that may be placed either in the scleral bed or in the suprachoroidal pouch.




· Lateral notches: they allow fixation in suprachoroidal pouch thus there is no need of suture, skipping a surgical step, reducing time in the operating room and also additional cost (suture).

· The new design doesn’t complicate or represent a disadvantage to those surgeons that implant sutured to the lateral scleral steps. Moreover, it can be advantageous because prevents sliding of the suture through implant sides.

· With the new design the suprachoroidal implantation step is simplified, allowing more surgeons to practice this technique and choosing this implant.The ESNOPER CLIP is a non-reabsorbable implant whose double-plate design provides two drainage channels: Trabecular (intraescleral and supraciliary) and uveoscleral. For implantation, the notched plate is inserted in the suprachoroidal space and the upper plate is positioned on the scleral bed.



ESNOPER CLIP implant is an evolution of ESNOPER that arises after the surgical experience of its location in the lateral scleral bed and also in when it is hosted in a part of the suprachoroidal pouch. When surgeons implanted ESNOPER V-2000 in the supraciliary space trying to avoid suture and enhancing the conventional trabecular and the uveoscleral outflow pathways, they realized that with the implant just a single plate acted more in either direction, but not in both at the same time. Uveoscleral ESNOPER CLIP implant has the same indication as ESNOPER implant, it is also designed to be used in glaucoma surgery in Non-Penetrating Deep Sclerectomy technique (NPDS) to enhance even more the uveoscleral outflow pathway. This implant comes from the union of the two possible locations of ESNOPER implant in the sclera: If ESNOPER was placed over the scleral bed, trabecular outflow pathway was enhanced, which is the classical aqueous humor draining, and in order to use the uveoscleral outflow the suprachoroidal pouch was made where one of the sides of ESNOPER was anchored. With the new ESNOPER CLIP implant it is intended to use both pathways, the uveoscleral inserting a plate in the suprachoroidal pouch and the other plate is placed over the scleral bed, as it was performed with the original ESNOPER.

Thank to this new implant uveoscleral outflow is enhanced, which is responsible between 10% and 30% of the drainage and is pressure-independent, what allows working in lower pressures than the episcleral venous pressure. On the other hand, aqueous humor flows directly though ciliary body and from the iris root to the suprachoroidal space.

In this pathway the ciliary muscle plays a key role in such a way that its relaxation undergoes an increase in the space between its muscle bundles, helping aqueous humor drainage. From this point it flows through the sclera towards episcleral space. Actually, placing the implant in a supraciliary level gives a small cyclodialysis that provokes relaxation of muscle fibers and increases aqueous humor drainage trough uveoscleral outflow pathway.
With this design different draining pathways are enhanced in order to make aqueous humor flow in different levels: TRABECULAR (INTRASCLERAL AND SUPRACILIARY) AND UVEOSCLERAL.

The material used to manufacture these implants is HEMA. The raw material for the production of Esnoper V-CLIP is Hydroxyethylmethacrylate (HEMA) pellets provided by our regular supplier for medical and implantable plastic polymers Benz Research. This material contains a 25% of water on its composition, what is suitable to produce lenses or other flexible intraocular devices such as this implant. It is a 100% acrylic polymer, a hydrogel with excellent mechanical and optical features. The excellent mechanical properties make this material suitable for this type of implant because allows an easy insertion due to his perfect folding and unfolding during surgery.




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