Eyeworld

EW NEWS & OPINION February 2017 29 Editors' note: Dr. Panarelli has finan- cial interests with Aerie Pharmaceuti- cals (Irvine, California) and Allergan. Dr. Chang has no financial interests related to his comments. doing them in children. They may offer a safer alternative to these traditional surgeries, but it is too early to tell. Prospective, random- ized studies comparing these devices to our 'gold standard' procedures in adults are already underway." MIGS procedures that shunt aqueous to the suprachoroidal space such as the CyPass Micro-Stent (Alcon, Fort Worth, Texas) may also prove to be helpful in childhood glaucoma when Schlemm's canal- based procedures fail, but more clinical data is necessary before any definitive recommendation regard- ing the safety and effectiveness of this device in children can be made. Dr. Chang expressed a similar sentiment. "Several of the trabecular bypass implants, such as the CyPass or the XEN, may potentially offer alterna- tives to tube shunts in children who have failed angle surgery and thus decrease long-term risk of surgical complications," he said. "Overall, I think the techniques we have learned from MIGS enhance the traditional surgical paradigms in childhood glaucoma. The use of an illuminated microcatheter, which was designed for canaloplasty in adults, made trabeculotomy easier and safer. The use of an endoscope, which was designed for endoscopic cyclophotocoagulation in adults, made visualization of the angle through an opaque cornea possible," Dr. Chang said. Performing new MIGS proce- dures in pediatric cases poses tough questions, Dr. Panarelli said. "Due to the potential risks associated with repeated exposure to anesthesia and the complexity of the disease, these are situations where you want to do what works best in your hands. As more data becomes available and MIGS tech- niques and devices evolve, I am sure that my surgical armamentarium for dealing with childhood glaucoma will expand. But for now, when I am confronted with a case of congeni- tal glaucoma in a 4-month-old, I'm going to stick with performing an ab externo trabeculotomy as this has the greatest likelihood of success in my hands." EW Reference 1. Grover DS, et al. Gonioscopy assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy for the treat- ment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthal- mol. 2015;99:1092–1096. ©2017 Clarity Medical Systems Inc. PN 99-100396 Rev A 12/16 Only HOLOS IntraOp ™ Wavefront Aberrometer delivers Continuous Real-time ™ actionable data to help you con rm target refractions, deliver precise astigmatic correction, and predict IOL power using the exclusive HOLOS Barrett IOL Formula ™ . HOLOS is available now. HOLOS.com holos @ claritymsi.com Accurate IOL prediction, coming at you in real time. The New Standard in Wavefront Aberrometry • Accurate intraoperative IOL prediction with the exclusive HOLOS Barrett IOL Formula ™ • Continuous Real-time ™ feedback at 90 refractions per second • Precise guidance during toric IOL rotation for enhanced astigmatic correction The New Standard in Wavefront Aberrometry Contact information Chang: t.chang@med.miami.edu Panarelli: jpanarelli@NYEE.EDU

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