Eyeworld

EW INTERNATIONAL 116 March 2017 upon a unified definition of MIGS. It was characterized as an ab interno procedure, with minimal tissue in- teraction (wound healing), effective IOP reduction, and high safety. The adequate IOP reduction for MIGS was set at a middle reduction of 20% or more of the midday IOP without medications; and/or a reduction of at least 3 mm Hg. "There is a therapeutic dilemma, however, in this definition, regard- ing the target pressure concept be- cause patients who have raised IOP of short duration, or slowly rising early IOP need a higher target IOP than patients who have advanced, long-standing, fast-rising IOP, who require a lower target IOP. Many factors play into deciding the target pressure for a patient," he explained. Dr. Jünemann believes that patients with advanced long-stand- ing or quickly-rising IOP are still best served by trabeculectomy. Apart from the Xen gel stent, which has been shown to be effective in increasing filtration of aqueous, tra- beculectomy is likely to still be the surgeon's best choice. "An experienced surgeon can create a good filtration bleb and tenon suture, making this an ex- cellent, effective pressure-relieving surgery. The XEN bleb is much like the trabeculectomy bleb. However, the advantages of trabeculectomy over the XEN MIGS stent is that it is performed reliably from the outside of the eye allowing us to reliably surgically define a drainage shaft. By continuing to perform trabeculecto- my, our young surgeons stay in prac- tice, sew and suture, and continue to learn more about the eye tissues, through surgery. After all, experience is not inherited," he said. EW References 1. Neuhann TH. Trabecular micro-bypass stent implantation during small incision cataract surgery for open-angle glaucoma or ocular hypertension: Long-term results. J Cataract Refract Surg. 2015;41:2664–71. 2. Kass MA, et al. The Ocular Hypertension Treatment Study: A randomized trial de- termines that topical ocular hypotensive medication delays or prevents the onset of primary-open-angle glaucoma. Arch Ophthal- mol. 2002;120(6):701–13. 3. Ahmed IK, et al. Prospective evaluation of microinvasive glaucoma surgery with trabec- ular microbypass stents and prostaglandin in open-angle glaucoma. J Cataract Refract Surg. 2014;40:1295–1300. 4. Wellik SR, Dale EA. A review of the iStent trabecular micro-bypass stent: Safety and efficacy. Clin Ophthalmol. 2015;9:677–684. 5. Voskanyan L, et al. Prospective, unmasked evaluation of the iStent Inject System for open-angle glaucoma: Synergy Trial. Adv Ther. 2014;31:189–201. 6. Pfeiffer N, et al. A randomized trial of a Schlemm's canal microstent with phacoemul- sification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology. 2015;122:1283–93. 7. Hoeh H, et al. Initial clinical experience with the Cypass Micro-Stent: Safety and surgical outcomes of a novel supraciliary microstent. J Glaucoma. 2016;25:106–12. 8. Sheybani A, et al. Phacoemulsification com- bined with a new ab interno gel stent to treat open-angle glaucoma: Pilot study. J Cataract Refract Surg. 2015;41:1905–09. Editors' note: Dr. Jünemann has finan- cial interests with Alcon, Allergan, and Glaukos. Contact information Jünemann: anselm.juenemann@med. uni-rostock.de Lebitis with large avascular area after mitomycin C-augmented trabeculectomy Optimal bleb formation after mitomycin C-augmented trabeculectomy Source (all): Anselm Jünemann, MD Trabeculectomy continued from page 114

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