Eyeworld

28 | EYEWORLD | JULY 2023 ASCRS NEWS by Ellen Stodola Editorial Co-Director About the physicians Daniel Chang, MD Cataract and Refractive Surgeon Empire Eye and Laser Center Bakersfield, California Francis Mah, MD Scripps Clinic La Jolla, California Cathleen McCabe, MD Medical Director The Eye Associates Bradenton, Florida Marlene Moster, MD Wills Eye Hospital Philadelphia, Pennsylvania glaucoma surgery, or in a standalone procedure, intended to measure IOP. Next, Dr. Moster discussed goniotomy. The goal of goniotomy is to open the trabecular meshwork to expose Schlemm's canal and col- lector channels and improve aqueous drainage, she said, but goniotomy opens only the anterior wall of Schlemm's canal. There are a number of goniotomy options available, mostly focused on opening the anterior wall of Schlemm's canal. "We do not manipulate the back wall," Dr. Moster said. The surgical solution she shared to raise the bar and push GATT to the next level is the T-Rex Duo (Iantrek), made of nitinol with firm elastic memory. This opens the inner wall and the back wall of Schlemm's canal. It offers better access to the collector channels to maxi- mize outflow with both walls open. Last, Dr. Moster discussed her love/hate relationship with tube shunts, suggesting the evolution of potentially changing the material that tube shunts are made of and/or making them thinner. The first new option in develop- ment is the VisiPlate (Avisi Technologies), which is ultra-thin and can bend without fracturing. It is made from non-fibrotic materials, and the multichannel design creates outflow redundan- cy with no hypotony. The surface area main- tains the drainage space. Dr. Moster said this is made from the thinnest freestanding material in the world. She also highlighted the Gore GDI concept that is 10 times thinner than current drainage devices. The reservoir is within the plate, cells cannot grow into the reservoir, and it's very permeable to aqueous. Cathleen McCabe, MD, gave the cataract presentation. She discussed complex cataract surgery and shared a case of zonulopathy. She noted the importance of having a toolbox for complex cataract surgery. Her patient was a 62-year-old active patient who had a 1-week history of poor vision after being hit in the eye with a tennis ball. The vision fluctuated when the eye moved, and the patient was referred for surgical treatment. No zonules were visible when Dr. McCabe took the patient for surgery, and there was no vitreous. She stressed the im- portance of figuring out a plan in advance. She put in a 23-gauge trocar to perform an anterior vitrectomy through the pars plana, but Lindstrom Lecture and symposium recap M arlene Moster, MD, delivered the 2023 Richard L. Lindstrom, MD, Lecture, titled "Glaucoma Surgery: Taking it to the Next Level." When it comes to glaucoma, Dr. Moster said there are two groups: the "real deal" glaucoma, patients who are going blind, and what she called glaucoma "light," where they're not going blind. The MIGS pipeline is robust for mild to moderate glaucoma, but for more severe patients, the options are still trabeculectomy or tubes. She highlighted four problems and new surgical interventions and innovations to improve outcomes. The first problem she discussed was compli- ance, saying that many patients don't take their medicines and don't understand their medi- cines. The potential solution she suggested is a new concept in a drug-based delivery system that simultaneously combines cataract surgery and glaucoma medication for a long duration of action (SpyGlass Pharma). Dual pads of drugs are securely placed on the haptics of a monofo- cal acrylic IOL. Standard phaco is used, and the dual drug pads slowly elute medication for 3 years after surgery, Dr. Moster said. If approved, this new drug-based delivery system would be accessible to all ophthalmologists, including the 75% of cataract surgeons who are not currently utilizing MIGS. Enhanced drug delivery systems such as this will go a long way to alleviate com- pliance issues and improve patient outcomes, she said. The next problem that Dr. Moster addressed was intraocular pressure, specifically its fluctua- tion over time. The potential solution is a surgically placed intraocular pressure sensor (Injectsense) that is capable of 24/7 pressure readings with reliable accuracy. It is meant to be placed in the eye during a 5-minute office procedure and is self-sealing. It is rechargeable once a week and can last decades. Dr. Moster noted that there have been rare complications with minimal immune response. The physician can retrieve IOP data through the cloud to modify treatment. She also mentioned a similar option that is an RFID-powered micro-sensor (Implandata) located in the suprachoroidal space, inserted in combination with phaco,

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