Eyeworld

EW FEATURE 128 New technology in cataract surgery • April 2016 Cucamonga, California) "allows us to have an ab interno trabeculoto- my." For those unfamiliar with it, Dr. Ahmed said the Kahook is "basi- cally a goniometry technique." Dr. Vold said the concept of ab interno trabeculotomy has garnered such attention that there's an entire session devoted to it at ASCRS Glau- coma Day prior to the ASCRS•ASOA Symposium & Congress this year. MIGS continued from page 127 WORLD CLASS OPTICS Visit Katena booth 1331 at ASCRS to discover the complete range of Sensor Medical lenses. ® 800 -225-1195 • www.katena.com • SensorMedTech.com Designed to reduce the hidden costs and delays caused by lens sterilization requirements. Superb Optics: • Excellent visualization with low distortion and high resolution • Anti-reflective coating to minimize glare and scatter • A brand new lens for every procedure Convenience and Safety: • Provided sterile and disposable – reduces the chance of cross contamination • See more patients – less downtime between procedures • Eliminate costs associated with cleaning and sterilization • Over 25 different lenses and styles available SINGLE-USE LENSES Contact us today and ask about our no-risk evaluation. AD060-16A Topical meds in the post-MIGS patient The physicians don't recommend a preop washout, but they do keep patients off glaucoma medications in the immediate postop period. Dr. Lewis withholds glaucoma drops until "1–2 months postop, depending on what their pressures are. I want to give them a couple of months off drops to see what effect they were able to achieve with the MIGS device." Dr. Ahmed agreed, saying the 2-month mark "is the new baseline for their IOPs." In cases of advanced glaucoma, Dr. Vold may initiate drops during the immediate postop period, but his goal is to eliminate drops alto- gether. With the Trabectome, Dr. Vold is a little slower to eliminate all drops "because there's sometimes a little more blood around the clots so a lot of times, I will taper their medications off over time with that procedure," said Dr. Vold, who uses pilocarpine postoperatively as well. "Postop pressures after MIGS are generally well controlled. If any- thing, MIGS help blunt the 24-hour IOP spikes after cataract surgery," Dr. Ahmed. When not to use MIGS devices As great as these devices may be, they are not appropriate for all glau- coma patients, the experts said. For example, angle-closure glaucoma is an exclusionary factor for the iStent, Dr. Vold said. Those with neovascular glaucoma are poor candidates as well. "The iStent is probably not ideal in inflammatory glaucomas, but angle-closure is an absolute contra- indication," he said. "The key to success with MIGS is patient selection. It's everything," Dr. Vold said. Patients with peripheral anterior synechiae from uveitis are usually not good candidates, Dr. Ahmed added. "Patients who have had mul- tiple surgeries and trabs or a com- promised outflow generally present with difficulty to lower IOP," Dr. Ahmed said. But in general, "our indications are expanding and our contraindi- cations are narrowing," he said, and that will continue to be the pattern as surgeons become more comfort- able with the surgical techniques and devices. EW Editors' note: Dr. Ahmed has finan- cial interests with Allergan, Glaukos, InnFocus (Miami), Ivantis (Irvine, California), and Transcend Medical (Menlo Park, California). Dr. Vold has financial interests with Allergan, Glaukos, Ellex (Adelaide, Australia), Ivantis, NeoMedix, SOLX (Waltham, Massachusetts), and Transcend Med- ical. Dr. Lewis has financial interests with Aerie Pharmaceuticals (Bedmin- ster, New Jersey), Allergan, Alcon (Fort Worth, Texas), Glaukos, and Ivantis. Contact information Ahmed: ike.ahmed@utoronto.ca Lewis: rlewiseyemd@yahoo.com Vold: svold@cox.net

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