Eyeworld

127 EW FEATURE April 2016 • New technology in cataract surgery with "viscocanalostomy and com- bining a suprachoroidal stent with viscoelastic to expand the supracho- roidal space" is resulting in higher efficacy than adjuncts alone. "MIGS plus—going outside the eye—is what the Xen gel stent [Allergan, Dublin] implant does," he said. "For me the greatest efficacy in standalone MIGS procedure is the Xen." Dr. Vold said the Kahook Dual Blade (New World Medical, Rancho want to do a trabeculectomy because they'll need contacts, and they get hypotony maculopathy," Dr. Lewis said. A little induced hypotony (by gently depressing the wound) can bring blood into Schlemm's canal, making it easier to identify where the major collector channels are. "By doing that, you can easily slide the iStent in," Dr. Vold said. Surgeons should be "near a collector channel, but you're never 100% certain. You can identify the collector channels carefully by looking at the vessel exiting from the limbus," Dr. Lewis said. Implantation of the Trabectome (NeoMedix, Tustin, California) is similar to the iStent, Dr. Vold said. "With the Trabectome, I like to treat close to 180 degrees of angle with that procedure," he said. "I'll make the inner diameter of the wound a little wider than the outer, and that way I can just sweep across the angle. It's a little removal of the inner wall of Schlemm's canal and the trabecular meshwork (TM)." Other MIGS devices TRAB360 (Sight Sciences, Menlo Park, California) is a "trabeculo- tome" that can manually cut up to 360 degrees of TM, Dr. Vold said. Ab interno canaloplasty "uses the catheter developed for canaloplasty and adds the ability to viscodilate by including a viscosurgical device (OVD)," he said. Dr. Ahmed said the route taken may also dictate where other devices will shine—implanting into the TM produces modest IOP lowering, but the safety is exemplary. Working EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put EW Pulse in the subject line. Poll size: 283 iStent about to be engaged into the trabecular meshwork Source: Doug Rhee, MD continued on page 128 Intraoperative goniophotograph with Trabectome in position for canal entry Source: Ronald Fellman, MD

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