Eyeworld

EW FEATURE 58 Complicated glaucoma surgery management • November 2016 AT A GLANCE • Failing to at least offer a MIGS procedure at the time of cataract surgery for a glaucoma patient is thought of as a "lost opportunity." • Surgeons differ on preference for implanting iStent before or after cataract surgery, with both options having pros and cons. • Physicians think the different MIGS devices for stemming inflow or improving outflow will be a boon for specialists, expanding options for patients and enhancing combination therapies. by Liz Hillman EyeWorld Staff Writer Jason Bacharach, MD, North Bay Eye Associates, Petaluma, Cali- fornia, said there has been a "para- digm shift in how I manage the dis- ease concomitantly." Dr. Bacharach said he will generally advise people with mild to moderate glaucoma who also have at least a moderate cataract to have microinvasive glau- coma surgery (MIGS) at the time of cataract surgery in an effort to avoid trabeculectomy in the future. "In many patients I can avoid a procedure that brings along with it life-long risks, potentially reduced visual acuity, and, if you don't deal with the cataract up front, can cause cataract progression, making Pearls, preferences, and the future of MIGS C ataract surgery in glauco- ma patients has changed dramatically within the last decade. "I think the femto- second laser has changed things. I think the MIGS procedures have changed things. I think the patient expectation level is much higher. They expect good vision no matter how badly they start off. They all expect perfect results," said Richard Lewis, MD, Sacramento Eye Con- sultants, Sacramento, California. "I think the bar is a lot higher for everything." Cataract surgery and glaucoma management Monthly Pulse Complicated glaucoma surgery management Trab360 is a MIGS procedure that can perform an ab interno trabeculotomy up to 360 degrees. Source: Arsham Sheybani, MD

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