EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/194331
78 February 2011 Combined glaucoma and cataract surgery October 2013 EW FEATURE Meeting MIGS challenges with unique approaches by Vanessa Caceres EyeWorld Contributing Writer Tried-and-true and newer devices, techniques aim for a better view E veryone wants a better view—a better view for successful microinvasive glaucoma surgery (MIGS), that is. 0.06% TRYPAN BLUE OPHTHALMIC SOLUTION TM VisionBlue is indicated for use as an aid in ophthalmic surgery by staining the anterior capsule of the lens.1 TM VisionBlue is intended to be applied directly on the anterior lens capsule, staining any portion of the capsule which comes in contact with the dye. It is recommended that after TM injection all excess VisionBlue be immediately removed from the eye by thorough irrigation of the anterior chamber. The dye does not penetrate the capsule, permitting visualization of the anterior capsule in contrast to the non stained lens cortex and inner lens material.1 TM Rx Only Please see adjacent page for brief prescribing information. D.O.R.C. International B.V. Scheijdelveweg 2 3214 VN Zuidland The Netherlands Phone: +31 181 45 80 80 Fax: +31 181 45 80 90 E-mail: sales@dorc.nl VisionBlue is contraindicated when a non-hydrated (dry state), hydrophilic acrylic intraocular lens (IOL) is planned to be inserted into the eye because the dye may be absorbed by the IOL and stain the IOL. Adverse reactions reported following TM use of VisionBlue include inadvertent staining of the posterior lens capsule or vitreous face. Staining of the posterior lens capsule or vitreous face is generally self limited, lasting up to one week. ORDER INFORMATION TM VisionBlue is available in sterile packs of 10 syringes of 0.5ml/box Dutch Ophthalmic USA 10 Continental Drive Bldg 1, Exeter, NH 03833, U.S.A. Phone: or Call: (800) 75-DUTCH or (603) 778-6929 E-mail: sales@dutchophthalmicusa.com +1 800-75-DUTCH +1 603-778-6929 Fax: +1 603-778-0911 E-mail: sales@dutchophthalmicusa.com 1 Melles GJR, de Waard PWT, Pameyer JH, Houdijn Beekhuis W, Trypan blue capsule staining to visualize the capsulorhexis in cataract surgery. J Cataract Refractive Surgery 1999; 25:7-9 As surgeons adapt to MIGS procedures like the iStent Trabecular Micro-Bypass Stent (Glaukos, Laguna Hills, Calif.) and the Trabectome (NeoMedix, Tustin, Calif.), a perennial challenge is positioning of the patient to achieve the best view and angle for a MIGS procedure. This can require inconvenient tilting of the patient's head and movement of the surgical microscope. Surgeons say there is potential to improve this currently cumbersome process. Here's a perspective on three different approaches that involve the use of gonioscopic lenses—or endoscopic imaging—to implant the iStent or Trabectome. Each approach aims for better visualization and more user-friendly positioning for the surgeon. The Volk Transcend Vold Gonio (TVG) Surgical Lens Commercially available for about a year now, the Volk Transcend Vold Gonio Surgical Lens (Volk Optical, Mentor, Ohio) was designed by Steven D. Vold, MD, Vold Vision, Fayetteville, Ark. The lens comes with a few advantages, Dr. Vold said. "First, it has a modified Thornton ring attached to the lens to hold the eye in place AT A GLANCE • Implantation of devices such as the iStent Trabecular Micro-Bypass Stent and the Trabectome have surgical positioning challenges. • Certain gonioscopic lenses aim to help surgeons work around surgical challenges associated with MIGS. • The use of an endoscope is another approach to achieve better visualization before MIGS. so if the patient moves around a little, you still have full control of the eye," he said. "Second, the lens floats. For novice gonioscopists, it's easy for them to compress the cornea and the view gets harder to see." The capacity to float helps to ensure a better view for surgeons, he said. The lens has an ambidextrous handle, so both right- and lefthanded surgeons can use the same lens. Dr. Vold cited one more advantage of the lens. "One can minimize the amount of microscope tilt. For people who are more petite or don't have the longest arms, this allows Triple continued from page 77 Dr. Sarkisian warns that the triple procedure is still in its early phases, and advises surgeons be "cautiously optimistic." However, he has been excited about the many patients on whom he has performed ICE, who otherwise may have gotten their cataract surgery combined with a filtering surgery. He does advise surgeons be methodical about OVD removal, and recommends his patients take acetazolamide the evening after surgery and the morning after with food "so I can be fairly confident there's not going to be a pressure spike." To date, Dr. Parekh is "delighted" because the minimally invasive procedure has created no additional pain or discomfort and his patient satisfaction level is extremely high—especially for those who are completely drop-free. "There's not much downside to this procedure, and the upside is potentially fantastic," he said. EW Editors' note: Dr. Mayer has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y.). Dr. Parekh has no financial interests related to this article. Dr. Sarkisian has financial interests with Aeon Astron (Amsterdam), Alcon (Fort Worth, Texas), Endo Optiks, Ivantis (Irvine, Calif.), iScience (Menlo Park, Calif.), Glaukos, InnFocus (Miami), New World Medical (Rancho Cucamonga, Calif.), Sight Science (Sylmar, Calif.), and Transcend Medical (Menlo Park, Calif.). Dr. Radcliffe has financial interests with Allergan (Irvine, Calif.), Alcon, and Glaukos. Contact information Mayer: hmayer@edow.com Parekh: parag2020@gmail.com Radcliffe: nmr9003@med.cornell.edu Sarkisian: steven-sarkisian@dmei.org