111
EW GLAUCOMA
March 2017
Contact information
Panarelli: ilana.nikravesh@mountsinai.org
the intense period of postoperative
care, and the impact the surgery can
have on their vision. Patients need
to know that the surgery may not
improve their vision but actually
make it worse, for a time. Getting
to know patients and establishing a
good relationship with them is key.
"Surgery is a big 'next step,' and un-
fortunately, although we have won-
derful surgeries out there, glaucoma
surgery is fraught with issues, even
when performed perfectly. There
are postoperative complications and
other challenges that have to be
dealt with," he said.
Don't give up
Watching experienced surgeons
perform microinvasive glaucoma
surgeries (MIGS) can make it look
deceptively easy. In reality, although
MIGS promises a microinvasive
approach to surgery, minimal
damage to the targeted tissues, and
quicker postoperative recovery, no
one ever said it was going to be easy.
Dr. Panarelli thinks it is important
that young surgeons learn new and
different procedures because, with
glaucoma patients, one size doesn't
fit all. "Some people like to mas-
ter one surgery, and I think there
is some value in that, but each of
these devices is different and can be
expected to give you a different IOP
reduction and risk profile. You can
really enhance your armamentarium
if you can learn how to do multiple
new procedures. One thing you need
to be careful about is not to give
up on a procedure just because you
struggle with it the first time. There
is going to be a learning curve with
all of these procedures. But you will
get it if you do the proper didactic
and wet lab training. Watch expe-
rienced surgeons a few times to un-
derstand some of the subtle nuances
about the procedures and deal with
some of the unexpected issues that
sometimes arise in the OR, and take
your time with your first couple of
surgeries. Everyone will get better,"
Dr. Panarelli said. EW
Reference
1. Anderson DR. Collaborative normal tension
glaucoma study. Curr Opin Ophthalmol.
2003;14:86–90.
Editors' note: Dr. Panarelli has no
financial interests related to his com-
ments in this article.
