Craven says he still can’t predict whether or not a trabecular bypass procedure is going to work. Patients who have a history of chronic steroid usage or uveitis are also good candidates for this procedure,” he says.įor patients who undergo cataract surgery, Dr. “I’ve had good success with all of the blade procedures and goniotomy procedures in high myopes, especially if they have a moderately high IOP. He says he leans towards these hybrid procedures in high myopes to avoid filtering procedures and tubes. That approach is kind of between a goniotomy/trabeculotomy, with the idea being that you remove the trabecular meshwork, expose the canal, and try to get the pressure down,” he explains.
In the future, that might be an option for us, but in the meantime, we’re left with having to remove the trabecular meshwork either through a goniotomy with some kind of a blade procedure or ab interno trabeculectomy with a catheter.
“I had a chance to do that in Saudi Arabia where it’s approved. “Some surgeons use trabecular bypass procedures off-label for these patients,” he continues. Then, I review the options and try to make a plan for the patient. “For example, I note if someone has a history of long-term steroid use or uveitis. “For people who aren’t undergoing cataract surgery, but who have elevated IOP and for whom medications aren’t working, I look at their age, refractive status, angle anatomy and ocular history,” he says. Randy Craven, MD, associate professor and director of the Wilmer Eye Institute, Johns Hopkins Medicine satellite office in Bethesda, Maryland, when evaluating glaucoma patients, ophthalmologists first need to consider whether or not they’ll be undergoing cataract surgery. It’s clear to me that each company is trying to position its device based on safety and efficacy however, the economics of the space (device cost and reimbursement) is also playing a major role that may be underrepresented in many of our discussions at meetings and in trade journals.”Īccording to E. “Now, there are a dozen different approaches and a growing body of evidence for most of the devices we use today. It used to be a discussion about iStent vs Trabectome,” says Malik Kahook, MD, a professor of ophthalmology at the University of Colorado School of Medicine. “The angle-surgery space is extremely crowded now. Here, glaucoma experts share their thoughts on how they use the available devices, and we take a look at some of the results the devices are capable of achieving. With a variety of options-and mechanisms of action-to choose from ophthalmologists can sometimes be hard-pressed to make sense of it all. (The Allergan Xen was voluntarily recalled in October 2019, and surgeons were told not to implant more of them there’s been no word when surgeons can purchase new ones to implant.) Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device (Trabectome by MicroSurgical Technology). Minimally-invasive glaucoma surgery is intended to lower intraocular pressure with less tissue disruption than traditional glaucoma surgeries.
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