Eyeworld

82 | EYEWORLD | DECEMBER 2022 G UCOMA and the traditional outflow pathway, facilitating outflow directly from the anterior chamber into the suprachoroidal space. Dr. Noecker said there is work being done to bring back a device that uses the suprachoroidal space. Dr. Francis also mentioned the MINIject (iSTAR Medical) and iStent Supra (Glaukos). Ciliary body procedures: These include endo- cyclophotocoagulation (ECP) and MicroPulse Laser Therapy (Iridex). These procedures, Dr. Noecker said, contribute to aqueous reduction and may increase uveo-scleral outflow. There is also some evidence that the latter may increase suprachoroidal or trabecular outflow, according to Dr. Francis. Bleb-forming "MIGS": The PreserFlo Micro- Shunt (Santen, not FDA approved in U.S.) and the XEN Gel Stent (Allergan) fall into this cat- egory. Dr. Noecker said they're not quite MIGS because they are a little more invasive with the formation of a bleb and use of mitomycin, but they are still "basically bypass procedures" that are less invasive than traditional filtering procedures. Why is categorizing helpful? Dr. Francis said that it's good to know these general categories, as well as the subtle differ- ences among the procedures within the cate- gories. First, he said, it can help you decide the procedures you want to do on a regular basis. continued from page 81 A. Canaloplasty performed with iTrack to viscodilate and open Schlemm's canal with illuminated catheter B. Hydrus in place in the canal with adjacent area of goniotomy visible (white area visible is back of Schlemm's canal) C. Endoscopic view of ciliary processes with ECP laser-treated white processes visible D. Gonioscopic view of TrabEx performing goniotomy Source (all): Robert Noecker, MD A C B D Reference 1. Riva I, et al. Canaloplasty in the treatment of open-angle glaucoma: a review of patient selection and outcomes. Adv Ther. 2019;36:31–43.

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