APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/119916

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Page 63 of 82

April 2013 February 2011 EW GLAUCOMA 61 Highlights from the American Glaucoma Society's 23rd annual meeting T he American Glaucoma Society held its 23rd annual meeting in San Francisco, February 28-March 3. The Society was founded in 1985 with 13 charter members and has since grown to nearly 900 members. If you were unable to attend this year's AGS meeting, here is a summary of what you missed. Surgical options A video symposium co-sponsored by AGS and the American Society of Cataract and Refractive Surgery (ASCRS) started the meeting with an ambitious goal: improving your technique for challenging cases. Three challenging cases were discussed, among them a patient with a persistent bleb leak following blebitis in an eye with an EX-PRESS Glaucoma Filtration Device (Alcon, Fort Worth, Texas). Leo Seibold, MD, University of Colorado, Boulder, described a four-step procedure for EX-PRESS removal. "Start with a peritomy and blunt dissection to elevate the scleral flap," he said. "Then rotate the EX-PRESS 90 degrees to position the spur—which anchors the device intraocularly—circumlinear to the limbus. Then make a stab incision adjacent to the device overlying the spur. Finally, depress the sclera adjacent to the device to dislodge the spur and remove the device from the eye, after which the scleral flap and conjunctiva should be reapproximated with advancement as necessary." Other challenging cases included a patient with congenital glaucoma with a hazy cornea and a patient with recurrent transconjunctival tube erosion. Following a historical review of the evolution of glaucoma surgery, a series of alternatives to trabeculectomy and tube-shunt surgery were explored. Highlights here included data from a series of minimally invasive glaucoma surgery (MIGS) trials involving new and novel procedures for lowering intraocular pressure (IOP). Among these was the iStent (Glaukos, Laguna Hills, Calif.), a snorkel-shaped device inserted through the trabecular meshwork (TM) into Schlemm's canal. The FDA recently approved the device to be implanted at the time of cataract surgery. L. Jay Katz, MD, Wills Eye Institute, Philadelphia, presented by Tony Realini, MD data evaluating the efficacy and safety of implanting two devices as a standalone procedure. "One year after surgery, 92% of patients demonstrated IOP at or below 18 mm Hg on no medications," he said. "This represents a significant reduction in both IOP and medication burden through 12 months." Other investigational devices being explored include an intracanalicular stent for Schlemm's canal (Hydrus, Ivantis, Irvine, Calif.) and several shunts designed to direct fluid from the anterior chamber into the suprachoroidal space. New data from OHTS A free paper session focused on glaucoma progression, including two analyses of data from the Ocular Hypertension Treatment Study (OHTS). Linda Zangwill, PhD, University of California-San Diego, described the rate of change in structural optic nerve parameters using the Heidelberg Retina Tomograph (HRT, Heidelberg Engineering, Carlsbad, Calif.). In OHTS, there were both structural and functional endpoints, and Dr. Zangwill reported that the rate of optic nerve head rim area loss was twice as high in eyes with structural endpoints as in eyes with functional endpoints. "The rate of structural change is important but should not replace visual field testing for patients with ocular hypertension," she concluded. continued on page 62

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