Eyeworld Daily News

45 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Rich Daly EyeWorld Contributing Writer Australia), Kahook Dual Blade (New World Medical, Rancho Cucamon- ga, California), and the Trabectome (NeoMedix, Tustin, California). Deciding which device to use on each patient frequently is driven by whether his or her surgical need is primarily for cataracts or for glauco- ma, Dr. Gallardo said. "If I'm taking a patient in to do cataract surgery and they are controlled on medications, these patients don't want to have an in- creased recovery," Dr. Gallardo said. For such patients, he prefers using the iStent or the ABiC and Visco360 (Sight Sciences, Menlo Park, California) "because these are the least traumatic procedures that we have for the system." Additionally, the small size of the iStent prevents it from damaging any eye structures that may need other future glaucoma surgeries. In contrast, patients with an unhealthy angle who are taking at least a couple of glaucoma medica- tions may need to start with phaco, gonioscopy, and ABiC or phaco and a suprachoroidal shunt. Surgeons implanting the iStent have obtained the best results by looking for visual cues intraoper- atively, such as blotching on the canal, that are indicators of areas of collector channels, Dr. Gallardo said. "If you target your stent implan- tation for that area you are getting maximum efficacy," Dr. Gallardo said. The worst postop complication he has found from the iStent is that it was improperly implanted and pa- tients received no benefit from it. EW Editors' note: This event was supported by an educational grant from Glaukos. The MIGS procedures are mini- mally traumatic to the target tissue, including Schlemm's canal and the supraciliary space. Additionally, MIGS procedures have a rapid recovery. "That's important because cata- ract patients have such high expec- tations," Dr. Chang said. The good safety profile of MIGS treatments is appealing and con- trasts sharply with trabeculectomies, which are performed less frequently by cataract surgeons. "Another thing that is import- ant for me is low risk because, again, I don't deal with complications of glaucoma procedures very much," Dr. Chang said about the lack of hypotony or bleb complications. Another appealing aspect is the ability to safely reduce IOP through surgery instead of through pharma- ceuticals. Specifically, if MIGS can replace some glaucoma drugs then they will reduce the systemic and ocular surface side effects of many glaucoma medications. Reducing needed glaucoma medications can reduce the signifi- cant risks that patients will not com- ply with their medication regimen. "There are a number of studies that show people are way less com- pliant than we think they are," Dr. Chang said. Among the available and coming MIGS options ophthalmol- ogists are considering are the XEN (Allergan, Dublin, Ireland), the CyPass (Alcon, Fort Worth, Texas), the iStent (Glaukos, San Clemente, California), and the Hydrus (Ivantis, Irvine, California), said Mark Gal- lardo, MD, El Paso, Texas. Dr. Gallardo has encouraged cat- aract surgeons in his town to offer the iStent to their cataract patients. Other procedures in the MIGS class include ABiC (Ellex, Adelaide, will be taking at least one ocular hypertensive medication. "The numbers are going to increase as our population ages," Dr. Chang said. Among the reasons he said cat- aract surgeons are moving to offer MIGS is the ab interno placement of many MIGS devices, which can use the same clear corneal incision creat- ed for cataract procedures. A n increasing number of cataract surgeons are adding microinvasive glaucoma surgery (MIGS) as a new way to benefit their patients. David Chang, MD, Los Altos, California, said the glaucoma focus is partially being driven by the grow- ing numbers of glaucoma patients. He noted projections that 22% of cataract patients in coming years Why MIGS is increasingly a good fit for cataract surgeons Dr. Chang describes clinical benefits that are driving more cataract surgeons to consider performing MIGS.

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