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EW GLAUCOMA
December 2016
Sheybani: sheybaniar@wustl.edu
Vold: svold@voldvision.com
Dr. Grover bases his decision on
the device—the iStent (Glaukos) and
CyPass (Alcon, Fort Worth, Texas)
"can be done safely with topicals,"
and performing concomitant cata-
ract surgery also dictates his prefer-
ence for topicals.
But with other MIGS proce-
dures, including circumferential tra-
beculectomy or gonioscopy-assisted
transluminal trabeculotomy (GATT),
"patients will feel it and need a
peribulbar block," Dr. Grover said.
For the "delicate angled surgeries
that require a bit more manipula-
tion, it's key to have this done with
a peribulbar block," he said.
Drs. Bacharach, Moster, and
Sheybani prefer not to use blocks
at all once past the first few MIGS
cases. "I wanted to make sure that
patient movement and comfort were
not an issue in the first few cases,"
Dr. Bacharach explained. "Allowing
the eye to be able to move is a bene-
fit in not inducing akinesia. Patients
can maneuver their eye if surgeons
need more visibility."
Dr. Sheybani reserves blocks for
the GATT or Trab360 (Sight Sciences
Menlo Park, California) procedures.
"When you cannulate that area,
patients can become uncomfortable,
especially when you start stripping
the trabecular meshwork," he said.
He has no issues with blocks in the
first few patients undergoing a new
MIGS procedure but prefers to use
topical anesthesia.
"If you're going to do a sub-Ten-
on's on the block, when you're cut-
ting the conjunctiva down in that
intranasal quadrant, you're trying
to access the collector channel," Dr.
Sheybani added. "It's better not to
traumatize the eye."
Dr. Moster doesn't use blocks
for any kind of glaucoma surgery. "I
use the Blitz anesthesia technique,
which is a combination of intraca-
meral lidocaine, topical lidocaine
1%, non-preserved. If we're doing
a subconjunctival procedure, like
the InnFocus MicroShunt [Santen,
Osaka, Japan] or a procedure that
involves the conjunctiva, I pre-
fer subconjunctival lidocaine 1%,
non-preserved," she said.
However, "GATT goes behind
Schlemm's canal and it's crucial
the patient's eye doesn't move, so a
block or general anesthesia might be
needed," Dr. Moster said. EW
Editors' note: The physicians have
no financial interests related to their
comments.
Contact information
Bacharach: jb@northbayeye.com
Fellman: rfellman@glaucomaassociates.com
Grover: dgrover@glaucomaassociates.com
Moster: marlenemoster@gmail.com
840 Walnut Street Philadelphia, PA 19107
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