Eyeworld

61 EW GLAUCOMA August 2016 Contact information Barnett: ebarnett@mcw.edu Lin: shan.lin@ucsf.edu who feel that it is thus far unprov- en. There are potential side effects related to using argon laser irido- plasty, and in my experience I don't see the necessary benefits." Dr. Lin added, "I transitioned from someone who frequently did this procedure to someone who usually observes these cases." Iridoplasty creates burns at the peripheral iris using an argon laser to shrink the iris and pull it away from the chamber angle and open it up. Dr. Lin takes a conservative approach to iridoplasty but thinks it may be warranted in some cases. He said, "The procedure is reasonable in patients who are very narrow in which all 4 quadrants look occlud- able—grade 1 or grade 0—and where there is a very high risk for an attack of glaucoma or closure despite the iridotomy. In those patients I'd consider iridoplasty. Another category would be people who are progressing and developing PAS, which pushes them into primary angle closure status. I would consid- er iridoplasty here to prevent them from progressing." Dr. Lin uses the argon laser starting at 200 mW at 0.5 s duration. He places roughly 30 500 µ spots around the peripheral iris, placing them as far into the periphery as possible. Postop care focuses on re- ducing inflammation and is carried out using 4x daily prednisolone drops for 3 to 7 days. Dr. Lin explained that irido- plasty is, unfortunately, not fool- proof. "Failure of iridoplasty, in my experience, has been in patients, for example, who have plateau iris or who have a large lens that pushes everything forward, in whom the angle remains narrow." Narrow angle detection When a patient visits him for the first time or for a follow-up visit, Dr. Lin uses slit lamp and gonioscopic examinations to rule out narrow chamber angles. If he suspects a narrow angle, he will then use ante- rior segment OCT, which he repeats on a routine annual basis in closed angle suspects for a true, objective assessment of the angle. He said, "Gonioscopy is revealing, but it requires skill and experience, since it's an indirect way of looking at the angle. Ultrasound biomicroscopy is also very helpful, for instance, if I do an iridotomy and the angle remains narrow and I want to understand the mechanism why. Its drawbacks include that it is a contact proce- dure, which is losing a little favor in the U.S. these days, and that you need an ultrasound specialist," he explained. EW Editors' note: Drs. Barnett and Lin have no financial interests related to their comments. TRUE SURGICAL SOLUTIONS Premier Edge, SOFT CELL, SOFT SHIELD and OASIS names and logos are registered trademarks of OASIS Medical, Inc. 514 S. Vermont Ave, Glendora, CA 91741. LIT-SRG-Ad1 Rev.1 www.oasismedical.com (844) 820-8940 (USA Toll Free) (909) 305-5400 Request a catalog from customerservice@oasismedical.com V I S I T O A S I S a t E S C R S 2 0 1 6 Request a Meeting: dgarcia@oasismedical.com Premier Edge ® Safety Slit Ref # PE3128–SL Chang Cannula Ref # 4036J SOFT CELL ® PVA Spears Ref # 0525 SOFT SHIELD ® Collagen Shield (dissolution times: 12 – 72hrs) Ref # 7012 OASIS ® IRIS EXPANDER Ref # 9625S There is no such thing as a routine surgery. There is always room for improvement. Prepare with confidence. APPROVED

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