Eyeworld

EW GLAUCOMA 76 September 2014 but conceded "the long-term safety and effi cacy isn't different from trabeculectomy." The newer Ahmed glaucoma valve modifi ed with a polyethylene shell (M4) differs from traditional drainage devices in that it's "de- signed to have fi brous tissue grow- ing on the end plates, and the blood vessels provide some great surface area for aqueous to absorb into it," but there is limited clinical experi- ence reported. All about the pressure The bottom line for these experts— target pressure is key. If that cannot be achieved with other options available, incisional surgery is the only real option. "The only way we're going to be able to get these patients low enough is with a bleb," Dr. Ahmed said. "But if the patient can tolerate a pressure in the mid-teens and is going to have cataract surgery as well, then my preference would be to try a mixed procedure, either through Schlemm's canal or in the suprachoroidal space." Procedures that retain the physiologic fl ow are preferred, and may provide enough pressure lowering that the patient only needs one medication. Dr. Samuelson often describes two scenarios to patients—one option is a more effi cacious surgery that has more risk, but is likely to allow discontinuation of all med- ications, and the second option involves a safer procedure (MIGS), but less pressure reduction likely, still requiring 1 or 2 medications. "Most of the time they take the safer option of a MIGS procedure." For those with advanced glauco- ma, however, "getting low levels of pressure is more feasible with trab- eculectomy and tube shunt surgery than these newer procedures," Dr. Gedde said. Aiming for a target pressure of 15 mmHg or even 12 mmHg is ideal, Dr. Ahmed said. "If someone is still progressing at 15 mmHg, then they need to come down to below 12 mm Hg. I'm going to get their pressure as low as I can to preserve as much vision as I can." Whether they are using a drainage device or a shunt, Dr. Samuelson recommends surgeons "be familiar with the 1 or 2 devices you like the best because one of the things that makes them effective is consistency and familiarity." EW Editors' note: Dr. Ahmed has fi nancial interests with AMO, Alcon, AqueSys, Glaukos, Ivantis (Irvine, Calif.), and Transcend Medical (Menlo Park, Calif.). Dr. Gedde has fi nancial interests with Alcon and Allergan (Irvine, Calif.). Dr. Samuelson has fi nancial interests with AMO, Alcon, AqueSys, Glaukos, Ivantis, and Transcend Medical. Contact information Ahmed: ike.ahmed@utoronto.ca Gedde: sgedde@med.miami.edu Samuelson: twsamuelson@mneye.com Traditional continued from page 75 Strength in patient care.™ Pre-Op, Transport, Surgery, and Recovery, All In One Chair. MTI's NEW 440 Mobile Quad Battery-powered Stretcher Bed provides rapid, safe, and stable transport of patients from Pre-op to OR to Post-op. • Superior Patient Accessibility • Thinnest Backrest On The Market • Revolutionary Light-weight Lithium Ion Battery • Supports Patients Over 600 lbs • Directional Steering, Dual-Wheel Caster System The MTI 440 has the thinnest backrest on the market, deep oval articulating headrest, memory foam and ultra-low entry height*, and was designed for use with Femtosecond lasers by removing either Floating Arm™ giving unparalleled patient accessibility. MTI also makes a line of fixed chair models that have many standard features with options and accessories, adapting to all your practice needs. 3655 W Ninigret Drive, Salt Lake City, Utah 84104-6572 800.924.4655 • 801.875.4999 • Fax 801.952.0548 • www.mti.net FOR MORE INFORMATION OR INQUIRIES: Call (800) 924-4655 Email sales@mti.net Visit our web site at www.mti.net/stretcherbed *Entry height of 20", low model MTI 440 MTI's Lumerus™ LED Exam Light SCAN QR CODE TO WATCH VIDEO OF CHAIR IN ACTION NEW MTI LED EXAM LIGHTS! See www.mti.net for more information. SCAN QR CODE TO WATCH VIDEO OF CHAIR IN ACTION SCAN QR CODE TO WATCH VIDEO OF CHAIR IN ACTION SCAN QR CODE TO WATCH VIDEO OF CHAIR IN ACTION Placement of the EX-PRESS Glaucoma Filtration Device Source: Alcon

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