EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/194331
October 2013 Combined glaucoma and February 2011 cataract surgery them to operate more as they do with standard surgery," he said. "You still need a little tilt, but it reduces it." Dr. Vold said he has been able to use his gonio lens in the majority if not all of his MIGS patients. However, there are a few pearls to consider: 1. If a patient has tight eyelids, consider using a triple post speculum to get the gonio lens in the eye. 2. Use firm but gentle pressure with the lens to help avoid subconjunctival hemorrhages. 3. If new to iStent use, try performing gonioscopy in a few cataract patients to become familiar with the feel of it before actually having to implant the iStent. 4. The lens packaging says that it is suitable for up to 40 uses based on the original sample testing for U.S. Food and Drug Administration approval, which ran the lens through 40 sterilization cycles. However, with proper care of the lens, it can be used much longer than that. The Ocular Hill Surgical Gonioprism When Richard A. Hill, MD, Orange County Glaucoma, Santa Ana, Calif., worked on development of the Ocular Hill Surgical Gonioprism (Ocular Instruments, Bellevue, Wash.), he said that not much attention had been given to gonio lenses. "No one was really doing angle surgery for many years except for on a limited basis, mainly goniotomy in children. I needed to develop a lens that could be used with more modern standards in mind," he said. The gonioprism has been around for about 10 years, Dr. Hill said, although some of that time it was only available overseas. The gonioprism is now commonly used both for iStent and Trabectome implantation. One advantage of the lens is a larger field of view. "The lens has a wider viewing angle and a surgical cutout. It also has a ring in the periphery used to hold and rotate the eye," he said. The lens has both left- and righthand versions. The righthand version is held in the left hand during surgery and the lefthand version is held in the right hand, according to information from Ocular Instruments. Keep in mind that if you are a righthanded surgeon, you would likely hold the lens in your left hand, or vice versa if you are a lefthanded surgeon, Dr. Hill cautioned. The lens also can be autoclaved quickly, Dr. Hill said. EW FEATURE 79 Reps from Glaukos will do a wet lab with surgeons to help them get used to the lens and shadow surcontinued on page 80 VISIONBLUE TM (TRYPAN BLUE OPHTHALMIC SOLUTION) BRIEF SUMMARY OF PRESCRIBING INFORMATION Indications and Usage VisionBlueTM is indicated for use as an aid in ophthalmic surgery by staining the anterior capsule of the lens. Contraindications VisionBlueTM 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. Precautions General: It is recommended that after injection all excess VisionBlueTM be immediately removed from the eye by thorough irrigation of the anterior chamber. Carcinogenesis, mutagenesis, impairment of fertility: Trypan blue is carcinogenic in rats. Wister/Lewis rats developed lymphomas after receiving subcutaneous injections of 1% trypan blue dosed at 50 mg/kg every other week for 52 weeks (total dose approximately 1,250,000-fold the maximum recommended human dose of 0.06 mg per injection in a 60 kg person, assuming total absorption). Trypan blue was mutagenic in the Ames test and caused DNA strand breaks in vitro. Pregnancy: Teratogenic Effects: Pregnancy Category C: Trypan blue is teratogenic in rats, mice, rabbits, hamsters, dogs, guinea pigs, pigs, and chickens. The majority of teratogenicity studies performed involve intravenous, intraperitoneal, or subcutaneous administration in the rat. The teratogenic dose is 50 mg/ kg as a single dose or 25 mg/kg/day during embryogenesis in the rat. These doses are approximately 50,000- and 25,000-fold the maximum recommended human dose of 0.06 mg per injection based in a 60 kg person, assuming that the whole dose is completely absorbed. Characteristic anomalies included neural tube, cardiovascular, vertebral, tail, and eye defects. Trypan blue also caused an increase in post-implantation mortality, and decreased fetal weight. In the monkey, trypan blue caused abortions with single or two daily doses of 50 mg/kg between 20th to 25th days of pregnancy, but no apparent increase in birth defects (approximately 50,000-fold maximum recommended human dose of 0.06 mg per injection, assuming total absorption). There are no adequate and well-controlled studies in pregnant women. Trypan blue should be given to a pregnant woman only if the potential benefit justifies the potential risk to the fetus. Nursing mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when trypan blue is administered to a nursing woman. Pediatric use: The safety and effectiveness of trypan blue have been established in pediatric patients. Use of trypan blue is supported by evidence from an adequate and well-controlled study in pediatric patients. Geriatric use: No overall differences in safety and effectiveness have been observed between elderly and younger patients. Adverse Reactions Adverse reactions reported following use of VisionBlueTM include discoloration of high water content hydrogen intraocular lenses (see Contraindications) and inadvertent staining of the posterior lens capsule and vitreous face. Staining of the posterior lens capsule or staining of the vitreous face is generally self limited, lasting up to one week. Rx ONLY Revised: July 2005 Manufactured by: © Dutch Ophthalmic Research Center International b.v. Scheijdelveweg 2, 3214 VN Zuidland The Netherlands Volk Transcend Vold Gonio Surgical Lens Source: Volk Distributed in the United States by: Dutch Ophthalmic USA 10 Continental Drive, Bldg 1 Exeter, NH 03833, U.S.A. Phone: 800-75-DUTCH or 603-778-6929 U.S. PAT. 6,367,480; 6,720,314