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    Know your glaucoma surgery for better comanagement

    Patients are looking more to ODs to manage their glaucoma care, including postop


    MIGS and iStent

    Recent advances in micro-invasive glaucoma surgical (MIGS) techniques and devices that improve aqueous outflow have revolutionized the glaucoma treatment algorithm. (See Table 1.) The Trabecular Micro-Bypass Stent from Glaukos (iStent) is a tiny L-shaped implantable device made of titanium that is 1-mm long and 0.33-mm high.9,10 (See Figure 2.) It is approved only for use in combination with cataract surgery. The stent creates a patent bypass between the anterior chamber and Schlemm’s canal to improve aqueous outflow. It is inserted easiest inferonasally in Schlemm’s canal, where coincidentally the highest concentration of collecting channels and aqueous veins are located.9,10 The procedure is done under gonioscopic visualization before or after the cataract procedure, so visualization of the anatomy of the angle is critical.

    Related: How patients perceive their glaucoma matters

    Postoperatively, glaucoma medications are continued initially, and patients follow the same regimen of topical medications used for cataract surgery. It takes at least six weeks to reach the maximum IOP-lowering effect from iStent. Don’t be over eager in stopping glaucoma medications. Once the IOP decreases, glaucoma medications can be reduced one at a time until desired IOP goal is obtained.

    In clinical trials, 68 percent of patients undergoing a combined iStent/cataract surgery procedure achieved an IOP of 21 mm Hg or lower with no medications at one year compared with only 50 percent of subjects in the cataract surgery-alone group. This treatment difference of 18 percent was statistically (P=0.004) and clinically significant. In the study, a 20 percent IOP reduction at 12 months was observed in 64 percent of patients in the iStent group vs. 47 percent in the cataract surgery-alone group (P=0.01).10

    Next: Filtration surgery

    Elizabeth D. Muckley, OD, FAAO
    Dr. Muckley is director of optometric services at NE Ohio Eye Surgeons in Kent, OH, where she concentrates on medical glaucoma and ...


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