OCT 2013

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

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October 2013 Microinvasive glaucoma surgery "Then I find it is better to move quickly," he said. "Once you get the tip underneath the trabecular meshwork, you insert it relatively rapidly by flattening the angle of attack and it allows for good seating of the stent." Then, as recommended by the Glaukos team, Dr. Solomon suggested doing a little bit of seating of the heel of the iStent by pushing toward the trabecular meshwork. "Tap it in place once it's seated to make sure that it's oriented," Dr. Solomon said. In addition, he urged practitioners to make sure that the opening of the iStent isn't angled. "With dilation on occasion you can get occlusion of the iStent with the iris if there is a posterior angulation, so make sure that it's perpendicular to the trabecular meshwork," he said. Meanwhile, after insertion, Dr. Lewis said that a small amount of bleeding is very common, which can sometimes obscure the device. "It's important to use a little bit more viscoelastic after you put it in and make sure that you're comfortable with where it is," Dr. Lewis said. "If not, nudge or reposition it." Overall, Dr. Lewis sees this as an exciting time. "There's a lot of data suggesting that more than one stent is better than one by itself—we're getting better pressure reduction," he said. "I think we're heading into an era where, as my friend Reay Brown (MD) says, glaucoma is going to become a surgical disease." Dr. Solomon is also excited. "The outcomes are good, and the procedure is relatively straightforward and easy," he said. "I think that we're going to see the adoption rate rise rapidly." Ultimately, he thinks this will make for a new wave of microinvasive surgery that allows practitioners to achieve their pressure reduction goals without inconveniencing patients further. In the long run, he thinks that it will have a positive impact on the cost of healthcare for everyone. EW Editors' note: Dr. Lewis has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Glaukos, Ivantis (Irvine, Calif.), and Aquesys (Irvine, Calif.). Dr. Solomon has no financial interests related to this article. Visit us at AAO Booth 1052 EW SECONDARY FEATURE Contact information Lewis: 916-649-1515, rlewiseyemd@yahoo.com Solomon: 301-464-1885, jdsolomon@hotmail.com 85

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