Eyeworld

MAY 2013

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

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Glaucoma challenges/MIGS May 2013 Glaucoma continued from page 37 DUOVISC® Viscoelastic System is designed to give two viscoelastic materials with different physico-chemical properties that can be used differently and/or sequentially to perform specific tasks during a cataract procedure. DUOVISC® Viscoelastic System consists of VISCOAT® Ophthalmic Viscosurgical Device and PROVISC® Ophthalmic Viscosurgical Device. CAUTION: Federal law restricts this device to sale by or on the order of a physician. VISCOAT® OVD (Sodium Chondroitin Sulfate – Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: VISCOAT® OVD is indicated for use as an ophthalmic surgical aid in anterior segment procedures including cataract extraction and intraocular lens (IOL) implantation. Viscoat maintains a deep anterior chamber during anterior segment surgeries, enhances visualization during the surgical procedure, and protects the corneal endothelium and other ocular tissues. The viscoelasticity of the solution maintains the normal position of the vitreous face and prevents formation of a flat chamber during surgery. WARNINGS: Failure to follow assembly instructions or use of an alternate cannula may result in cannula detachment and potential patient injury. PRECAUTIONS: Precautions are limited to those normally associated with the surgical procedure being performed. Although sodium hyaluronate and sodium chondroitin sulfate are highly purified biological polymers, the physician should be aware of the potential allergic risks inherent in the use of any biological material. ADVERSE REACTIONS: VISCOAT® OVD has been extremely well tolerated in human and animal studies. A transient rise in intraocular pressure in the early postoperative period may be expected due to the presence of sodium hyaluronate, which has been shown to effect such a rise. It is therefore recommended that Viscoat be removed from the anterior chamber by thorough irrigation and/or aspiration at the end of surgery to minimize postoperative IOP increases. Do not overfill anterior chamber. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. PROVISC® OVD (Sodium Hyaluronate) Ophthalmic Viscosurgical Device INDICATIONS: ProVisc® OVD is indicated for use as an ophthalmic surgical aid in the anterior segment during cataract extraction and intraocular lens (IOL) implantation. Ophthalmic viscoelastics serve to maintain a deep anterior chamber during anterior segment surgery allowing reduced trauma to the corneal endothelium and surrounding ocular tissues. They help push back the vitreous face and prevent formation of a flat chamber during surgery. PRECAUTIONS: Postoperative increases in intraocular pressure have been reported with sodium hyaluronate products. The IOP should be carefully monitored and appropriate therapy instituted if significant increases should occur. It is recommended that PROVISC® OVD be removed by irrigation and/or aspiration at the close of surgery. Do not overfill anterior chamber. Although sodium hyaluronate is a highly purified biological polymer, the physician should be aware of the potential allergic risks inherent in the use of any biological material; care should be used in patients with hypersensitivity to any components in this material. Cannula assembly instructions should be followed to prevent patient injury. ADVERSE REACTIONS: Postoperative inflammatory reactions such as hypopyon and iritis have been reported with the use of ophthalmic viscoelastics, as well as incidents of corneal edema, corneal decompensation, and a transient rise in intraocular pressure. ATTENTION: Reference the Physician Labeling/Directions for Use for a complete listing of indications, warnings and precautions. © 2013 Novartis 1/13 VIS13003JAD-PI Slit lamp photograph of trabeculectomy surgery, showing the site of filtration Source: Manishi A. Desai, MD how we've advanced IOL design. It's overdue," he said. "If someone said to me, 'What's an unmet need in glaucoma surgery?' I'd say, 'Have someone redesign these fire hoses that we're sticking in the anterior chamber and putting these pieces of plastic so far back in the limbus that we have to make big incisions to do it.' There are so many potential improvements that could be made in the tube devices themselves that, to me, it's a dinosaur of an operation," he said. Dr. Gedde said that newer procedures, such as MIGS, offer additional options in glaucoma surgery beyond trabeculectomy and tube shunt surgery. "Exactly how they're going to fit into the surgical management of glaucoma I think is yet to be determined, and that may further influence some of the practice patterns we're seeing among glaucoma surgeons. It's an interesting time for glaucoma surgery, but tubes and trabeculectomy have been our mainstay, go-to operations, and I expect they're going to continue to be into the foreseeable future," he said. EW References 1. Desai MA, Gedde SJ, Feuer WJ, Shi W, Chen PP, Parrish RK 2nd. Practice preferences for glaucoma surgery: a survey of the American Glaucoma Society in 2008. Ophthalmic Surg Lasers Imaging. 2011;42(3):202-208. 2. Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the Tube Versus Trabeculectomy (TVT) Study after 5 years of follow-up. Am J Ophthalmol. 2012;153:789803. 3. Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the Tube Versus Trabeculectomy (TVT) Study during 5 years of follow-up. Am J Ophthalmol. 2012;53:804-814 4. Ramulu PY, Corcoran KJ, Corcoran SL, Robin AL. Utilization of various glaucoma surgeries and procedures in Medicare beneficiaries from 1995 to 2004. Ophthalmology. 2007;114(12):2265-2270. Editors' note: Drs. Desai and Gedde have no financial interests related to this article. Dr. Condon has financial interests with Allergan (Irvine, Calif.), Alcon, and MicroSurgical Technologies (Redmond, Wash.). Dr. Ramulu has financial interests with Tissue Bank International (Baltimore), which makes patch grafts for tube shunts. Contact information Condon: 412-359-6300, garrycondon@gmail.com Desai: madesai@bu.edu Gedde: 305-326-6435, sgedde@med.miami.edu Ramulu: 410-955-6052, pramulu1@jhmi.edu

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