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EW GLAUCOMA
January 2017
Moster: marlenemoster@gmail.com
Sheybani: sheybaniar@wustl.edu
Vold: svold@voldvision.com
iris connects to the iris root, and
the suprachoroidal devices will slide
behind the root into the space."
For suprachoroidal procedures,
the tip of the microstents are placed
at the base of the scleral spur and
then gently guided into the supra-
ciliary space between the ciliary
muscle and the scleral wall.
"No significant resistance
should be encountered if the mi-
crostent is in the correct space," Dr.
Vold said.
Dr. Grover said in-depth knowl-
edge of the angle is less crucial
for these devices than other MIGS
procedures.
MIGS before cataract
Some surgeons prefer to perform
the MIGS portion before cataract
surgery, but Dr. Bacharach said a dif-
ferentiating factor is chamber depth.
Placing the MIGS device first
offers several advantages—the
cornea is "very clear, and that im-
proves your visibility placing a stent
before the cataract is removed," Dr.
Bacharach said. But if the chamber
is shallow, placing the MIGS device
will be more challenging, and if the
MIGS procedure results in blood,
it could make the cataract surgery
more difficult as well.
"If you're doing the MIGS por-
tion before the cataract portion, do
the capsulotomy first," he said.
Doing MIGS first eliminates the
edema in the cornea, Dr. Sheybani
said.
Surgeons should easily be able
to deepen the angle before taking
the lens out, "and if you can't, you
did not select that case appropriate-
ly, and that might have been a pure
angle closure case," Dr. Sheybani
said.
Dr. Grover will use the GATT,
Trabectome and dual blade before
performing phaco, but this is not
the case with all MIGS devices.
"With both the iStent and the
CyPass, I do phaco first, but with
most other angle-based MIGS proce-
dures, I'll do phaco second," he said.
Finally, Dr. Sheybani said, start
using gonioprisms or goniolenses
on all cataract patients to gain more
experience before starting MIGS
procedures. 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
