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EW FEATURE
August 2018 • Glaucoma's armamentarium
noted that she hasn't used a XEN
in a uveitic patient, but she would
likely go straight to a tube for these
patients.
She added that neovascular
glaucoma is also a concern. "You
don't want hyphemas or fibrin
blocking stents like the CyPass or
iStent," Dr. Trubnik said, and she
thinks the same would be true for
the XEN.
Dr. Moster said that she still
finds trabeculectomy to be the "gold
standard" to help bring a patient's
pressure down to the low teens or
single digits. "There are patients
who just need that," she said. Some
patients have a lot to lose if the
pressure stays up, she said, and it's
not unheard of for the pressure to
be uncontrolled in the immediate
postop period after MIGS.
Therefore, trabeculectomies are
still Dr. Moster's go-to procedure for
the "real deal" glaucoma when pa-
tients need a low pressure and have
a lot to lose if it's not obtained.
MIGS after a failed traditional
glaucoma surgery
Dr. Moster said she has performed
MIGS after a failed traditional
glaucoma surgery, specifically using
GATT.
"I've done GATT after failed
trabeculectomies and after failed
tubes, however, the trabecular
meshwork needs to be visualized
for 360 degrees. We can then split
the trabecular meshwork in order to
lower the pressure by increasing flow
into Schlemm's canal," she said.
Dr. Moster added that MIGS
procedures have broadened the field
for juvenile glaucoma, especially
GATT. Pressures can drop from
40–50 to 12 and stay there, she said,
and this is a tremendous advantage
in young people, especially contact
lens wearers.
Though Dr. Trubnik has not per-
formed MIGS after failed traditional
glaucoma surgery, she said she has
certainly considered it.
She has had multiple patients
who had a trabeculectomy and tubes
and both were not sufficient to
control IOP. She's also had patients
where the tube eroded once or
multiple times. Dr. Trubnik said that
in these cases, she wouldn't want to
put anymore hardware on the outer
surface of the eye but would consid-
er doing a CyPass, where everything
is internal, and you don't have to
worry about the shunt or any mate-
rial being exposed. EW
Editors' note: Dr. Moster has financial
interests with Santen, Alcon, Aller-
gan, and Glaukos. Dr. Trubnik has
no financial interests related to her
comments.
Contact information
Moster: marlenemoster@gmail.com
Trubnik: valerietrubnik@yahoo.com
