Eyeworld

145 EW GLAUCOMA April 2017 The pivotal U.S. XEN trial showed a reduction in IOP in refrac- tory glaucoma patients from a mean medicated baseline of 25.1 (± 3.7) said. He explained that the objective is to do an ab interno procedure: pass the stent through the angle area and under the conjunctiva. He con- tinued, "You are in a high magnifi- cation area so you have to recognize tissue and anatomy to be able to place the stent well. However, other devices that access the trabecular meshwork can be much more chal- lenging to place. The XEN is some- what less dependent on the angle anatomy than the iStent [Glaukos, San Clemente, California] or the CyPass [Alcon, Fort Worth, Texas], giving you a little bit more liberty where you place this. Postoperative care might require the surgeon to handle a wound or the bleb, to get the aqueous flow that he wants, and needling may be necessary. Like with everything else, it will take a little bit of training and some learn- ing, but I think it will become our standard of care," Dr. Lewis said. Patient selection and roll out Dr. Grover thinks that the XEN will be widely adopted, largely due to its universal applicability, particularly in patients who have run out of op- tions. "The XEN procedure is going to be the safest, most efficient, and most predictable way of creating a new drain. The patients I have lined up for the XEN are those who have failed a prior angle-based surgery or are so advanced that I know their drainage system cannot be tapped into, and so they need a new drain. These are patients who otherwise would probably get a trabeculecto- my or tube, which I can now avoid by reducing their pressure with the XEN," Dr. Grover said. Dr. Grover also participated in the U.S. trials and will be active in training doctors for XEN implanta- tion. He said the initial roll out will be with glaucoma doctors who had experience with XEN during the U.S. trials. The training plan revolves around peer training and special- ized courses. "Peer training will be important in passing on know-how, where surgeons and surgical reps are invited to the operating room to watch experienced surgeons perform implantations, so they can be talked through it and get a sense of the sur- gery. Allergan has certified surgical training reps with a good amount of experience that will be helping train U.S. doctors. Many reps have already learned from specialists in Canada and Europe. I think that the first group is going to be glaucoma specialists, who will have access to our facilities to watch and learn if they want additional training. There will be training courses and wet labs, as usual, for training purposes," he said. IRIS SPECULUM 6.7mm near-circular, dilation Engages intraoperatively with ease for marginally dilated pupils Wide, Non-Pinching Shoulders Enables Stability with Easier Rotation Visit us at ASCRS 2017 in booth 1815 Available in Single and Multi-Use DIAMATRIX Visit diamatrix.com or call 800.867.8081 additional information DOC ID 021617 continued on page 146

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