Eyeworld

EW MEETING REPORTER January 2011 127 which showed glands "that weren't supposed to be there, and that tipped us off right away that there was a tumor somewhere in the body," he said. A later endoscopy found Stage IV B esophageal adenocarcinoma at the entrance of the stomach and esophagus "that we picked up just by looking at the iris," he said. "While this may be an unusual case, be aware that iris tumors are out there and you have to keep metasta- sis in mind." Editors' note: Dr. Lee has no financial interests related to his comments. Premium glaucoma surgery: Tools to evolve your practice In the Premium Glaucoma Surgery session, LTC (Ret.) Herbert P. Fechter, M.D., associate professor, Uniformed Services University, Bethesda, Md., implored the audi- ence to find an alternative to tra- beculectomy, the so-called "gold standard" of treatment for glaucoma surgeons. "As you all know, about a third of trabeculectomies eventually turn into a flat, scarred bleb with a pres- sure of 27," he said. "Another third of them turn into elevated vascular blebs with a pressure of 6. "This is what people call 'beauti- ful glaucoma surgery,'" he contin- ued, while showing photos of one horrific-looking bleb after another. "And this is why many of you in this room don't do glaucoma sur- gery. It's too much of a heartache to have to deal with patients with a time bomb sitting on top of their eye. There must be an alternative to trabeculectomy. We need to move the filtering bleb away from the lim- bus. We need to achieve a more reli- able pressure control. We need fewer early and late complications. We need better compliance." The session highlighted a num- ber of alternatives to trabeculectomy including canaloplasty, filtration de- vices, and tubes. "Canaloplasty is technically more difficult than a trabeculec- tomy," said Steven R. Sarkisian Jr., M.D., clinical professor of ophthal- mology, University of Oklahoma, Norman. "I like canaloplasty a lot, and I'd say the more you do it, the faster you get and the more you enjoy doing it." Dr. Sarkisian saves this proce- dure for early glaucoma and the younger end of the patient spec- trum. "Perhaps there are fewer occlu- sions of the collector channels with a better chance of success," he said. "Often these younger folks don't need a pressure in the single digits or low teens, and you don't want to touch their lenses." Editors' note: Dr. Fechter has no finan- cial interests related to his comments. Dr. Sarkisian has financial interests with Alcon, Optous Inc. (Roseville, Calif.), and iScience (Menlo Park, Calif.). continued on page 128

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