Eyeworld Daily News

EW SHOW DAILY 44 Meeting Reporter Sunday, April 15, 2018 by Vanessa Caceres EyeWorld Contributing Writer Davinder Grover, MD, Dallas, shared the case of a 63-year-old male patient with primary open angle glaucoma who is relatively well controlled on one medica- tion. A particular patient who fits this description had unsuccessful selective laser trabeculoplasties a few years back. The patient also traveled a lot and scuba dived. The XEN was implanted in both eyes, and at the last postop visit, his IOPs were 15 and 16 mm Hg. Although the patient still has to use timolol, he is happy with his outcome, Dr. Grover said. The panelists recommend starting with easier, ideal patients for MIGS before moving on to more challenging cases. • Focus on getting stent place- ment right, advised Arsham Sheybani, MD, St. Louis. That said, if your initial placement during surgery is not ideal, you can still adjust it. • Expect a learning curve—but don't get overwhelmed by it. "This surgery is not easy, but it's doable," Dr. Grover said. • Give it a month. As you assess the success of MIGS with XEN during follow up, Dr. Ahmed said that a positive outcome at 1 month usually means long-term future success. EW Editors' note: This event was supported by an educational grant for Allergan. A lthough nearly 75% of attendees at the "50 Shades of Subconjunctival MIGS" program on Friday evening perform both cataract and glaucoma surgery, 69% of them do not yet perform sub- conjunctival MIGS. However, they plan to do so in the next 12 months, prompting their interest in microin- vasive glaucoma surgery (MIGS). With program chair Ike Ahmed, MD, Toronto, Canada, panelists shared pearls to make MIGS patient selection and management easier, particular for the XEN Gel Stent (Allergan, Dublin, Ireland). Use of MIGS has enabled com- prehensive ophthalmologists to perform surgery earlier and provide an option for patients who have trouble with medication use, said panelist Inder Paul Singh, MD, Racine, Wisconsin. Once MIGS is learned, it helps improve OR patient flow and helps surgeons perform more efficient surgeries. Although the percentage of surgeons using MIGS has grown from 16% in 2014 to 36% in 2017 according to the ASCRS Clinical Sur- vey, there are still many questions about how to best use this approach, Dr. Ahmed said. Here are several of the tips shared about MIGS during the session. • Consider MIGS if a patient has trouble with eye drop com- pliance. Research shared at the session shows that 27% of patients on one glaucoma medication and 37% on two or more medications are not compliant. "I think it's higher than that," said panelist Jacob Brubaker, MD, Sacramen- to, California. He likened it to flossing the week before a dentist appointment; glaucoma patients are probably more compliant with medication use around the time of appointments so their IOP seems good. It's the rest of the time that IOP is not as optimal. In the right patients, MIGS can help cut down on eye drop compliance issues. • Start with easy patients. As an example of an ideal patient, Making subconjunctival MIGS easier and more successful Dr. Grover shares pearls and experiences with subconjunctival MIGS.

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