Alcon tries again in Migs

Alcon’s decision to get back into the minimally invasive glaucoma surgery (Migs) market via the $475m acquisition of Ivantis is well-timed. Two months ago Ivantis put to bed a long-running patent dispute with its main rival, Glaukos, concerning its only product, the Hydrus Microstent. Like Glaukos’s iStent devices, Hydrus is an eye implant designed to lower intraocular pressure in glaucoma patients. As part of the settlement, Ivantis agreed to pay Glaukos a wince-inducing $60m in two instalments before the end of 2022, as well as a 10% royalty on Hydrus devices sold or made in the US or imported into the country up to April 2025. Presumably these obligations are now Alcon’s, and were doubtless reflected in the purchase price. Alcon’s investors must hope this deal works out better than its previous Migs acquisition. In 2018 Alcon was forced to withdraw CyPass, the implant it had obtained two years earlier by buying Transcend Medical, from the market after a long-term trial found that patients given the device suffered endothelial cell loss. Fortunately data exist to back the safety of Ivantis’s device out to five years

First premarket approvals for intraocular pressure lowering implants
Device Company US approval
FDA review
time (mths)
AquaFlow Staar Surgical Jul 2001 12.2 PMA withdrawn in July 2020, according to FDA record
iStent Glaukos Jun 2012 42.2  
CyPass Micro-stent Alcon Jul 2016 9.3 Obtained via Transcend acquisition in 2016. Voluntarily withdrawn in 2018
iStent inject Glaukos Jun 2018 6.0  
Hydrus Microstent Ivantis Aug 2018 9.3 Company acquired by Alcon for $475m in Nov 2021
Source: Evaluate Medtech, FDA. 

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