Eyeworld

World view Facing complicated glaucoma cases W ith the voluntary recall of the CyPass Micro-Stent (Alcon, Fort Worth, Texas), the glaucoma com- munity has turned its attention to the corneal endothelium, and EyeWorld has enlisted glaucoma and cor- nea experts Ramesh Ayyala, MD, and John Berdahl, MD, to teach us about the complex relationship between the cornea, particularly the corneal endothelium, and glaucoma. We learn that everything from a high IOP to a low IOP and a variety of other factors may embarrass the corneal endothelium. Both experts weigh in on combined glaucoma and corneal surgery, with Dr. Ayyala noting that ab externo canaloplasty is still a great procedure to protect the cornea because of its non-penetrating nature. While we generally consider MIGS to be very safe, bleeding is still top of mind, particularly for cataract surgeons providing premium outcomes. Because many of the aging population will be using chronic anticoagu- lation therapy, EyeWorld reached out to glaucoma experts Douglas Rhee, MD, Brian Song, MD, Richard Lewis, MD, and Steven Vold, MD, to learn more about balancing the risks and benefits of MIGS in patients treated with anticoagulants. All the surgeons agreed that communicating with the treat- ing primary care physician is important, as is a discussion with the patient about surgical risks and the risks of stopping anticoagulant medications. In cases where the risk is too high, a transscleral laser may be a viable option, although our experts also discuss a variety of other technical considerations to make high-risk surgeries safer. With so many new developments in the world of MIGS, where does endoscopic cyclophotocoagulation (ECP) fit in 2019? EyeWorld spoke with Ronald Fellman, MD, Steven Sarkisian Jr., MD, and Brian Francis, MD, about ECP and other ways to boost surgical outcomes. ECP can be used di- agnostically and therapeutically as an adjunct to both traditional and MIGS procedures. In some cases, transscleral laser such as micropulse may be used in a similar fashion. To consider the impact that ophthalmic viscoelastic devices (OVDs) have had on glaucoma surgery and the management of complications, Robert Noecker, MD, Jacob Brubaker, MD, and I spoke with EyeWorld about their developing use. Cohesive and dispersive OVDs can aid the glaucoma surgeon in traditional and MIGS procedures, both in and out of the operating room. EW Nathan Radcliffe, MD, Glaucoma editor The news magazine of the American Society of Cataract & Refractive Surgery A S C R S February 2019 Volume 24, number 2 ASCRS Executive Director Steve Speares sspeares@ascrs.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Senior Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Designer Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Editorial Production Assistant/ Social Media Coordinator Taylor Wise taylor@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. Chiles Aedam R. Samaniego Muntinlupa, Philippines Michelle Stephenson Roanoke, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Sales, Sponsorships, and Special Events ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 Jessica Donohoe jessica@eyeworld.org Shelly Dixon shelly@eyeworld.org Joe Dooley joe@eyeworld.org Molly Phillips molly@eyeworld.org Cathy Stern cathy@eyeworld.org Anne Le anne@eyeworld.org ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org Copyright 2019, ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. Letters to the editor and other unsolicited material are assumed intended for publication and are subject to editorial review and acceptance. Subscriptions: Requests should be addressed to the publisher. Annual subscription prices: Individual: 1 year, $120; 2 years, $220; 3 years, $320. Institutional: 1 year, $250; 2 years, $330; 3 years, $425. 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