EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
July 2012 Pseudoexfoliation February 2011 EW FEATURE 37 "His pressure is high, his targets are low, and his CCs are 500," Dr. Reynolds said. "I don't have enough faith in canaloplasty in an eye like this to get him at target. I feel like it's in this guy's best interest that I do a guarded trabeculectomy." Pearls for combination therapy Dr. Samuelson recommended inject- ing an antimetabolite, which he mixes himself. "By injecting it with a 30-gauge needle, I know exactly how much I am administering, and it standard- izes the procedure," he said. "I tend to use the EX-PRESS, which also standardizes the size of the opening to 50 µm." The antimetabolite is a 50/50 mixture of 0.4 mg per ml mitomycin and 1 or 2% lidocaine with epineph- rine. Dr. Samuelson takes 0.3 cc of each, mixes them together, and places them in a syringe. He then injects 0.2 cc of the mixture with a 30-gauge needle about 10 mm posterior to the limbus into the subconjunctival space and then massages the medicine toward the limbus before moving onto the procedure. "No rinsing or irrigating is necessary," Dr. Samuelson said. Adding antimetabolites to filtra- tion surgery helps reduce the iatro- genic risk of bleb-related infections such as endophthalmitis. He added that the early post-op care, the first 3 weeks to a month after a trabeculectomy, is just as critical as the intraoperative portion of the procedure. He lengthens the time a patient uses a topical steroid to 3-4 weeks. Dr. Brown advised taking the cataract out of these types of patients as soon as possible. "If you're following the patient yourself, try to be proactive in re- moving the cataract," he said. "Take it out as soon as it's reasonable, so it's out of the picture. That's a good idea with PEX in general because PEX is a higher risk cataract opera- tion, and all of the risks you en- counter are going to be increased when the cataract is more dense." Dr. Brown admitted his attitude about combined surgery is likely to change very soon with the approval of more MIGS devices, which are designed to be used in conjunction with cataract surgery. Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Established Anterior Segment Ophthalmologists Mid-career is perhaps the most challenging period for today's ophthalmologist. The clinical and technological changes have never come faster and the regulatory concerns have never been greater. ASCRS' Annual Sympo- sium and Winter Update offer the education and networking needed to help your practice excel, and our ASCRS MediaCenter provides targeted online content addressing the issues most pressing to you. ASCRS' monthly Journal of Cataract and Refractive Surgery reports on all aspects of anterior segment surgery, and our meetings are focused, well-organized, and highly interactive. eyeCONNECT, ASCRS' online clinical service, lets you share questions and answers with like-minded peers in a private and supportive environment. ASCRS' commitment to fostering excellence through collaborative exchange is unmatched by any other ophthalmic organization. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org An ASCRS Membership For every stage of your career "MIGS surgery will open the door, and it will revive even some- one like me, who is anti-combined," Dr. Brown said. EW Editors' note: Drs. Brown and Reynolds have no financial interests related to this article. Dr. Samuelson has finan- cial interests with Alcon and Abbott Medical Optics (Santa Ana, Calif.). Contact information Brown: 404-252-1194, reaymary@comcast.net Reynolds: 208-373-1200, adamreynolds@cableone.net Samuelson: twsamuelson@mneye.com