Eyeworld

55 EW FEATURE July 2017 • MIGS roundup According to Dr. Vinod, patients who are ideal candidates for subcon- junctival filtering procedures tend to be those with moderate to advanced glaucoma whose intraocular pres- sures are uncontrolled with medical therapy and/or have demonstrated progression or are likely to progress. "Patients must not have extensive conjunctival scarring that would limit the 'real estate' available for a subconjunctival procedure whose success relies on formation of a bleb," she said, referring to trabe- culectomy and the XEN Gel Stent. Dr. Vinod prefers trabeculec- tomy as her "go-to" surgery for patients requiring low target IOPs, such as those with normal tension glaucoma, as well as for patients without prior intraocular surgery and phakic patients with chronic an- gle closure whose anterior chambers are too shallow to accommodate a tube. Trabeculectomy remains the only available glaucoma procedure that allows titration of aqueous flow after surgery to produce a desired degree of IOP lowering, she added. She said that she will perform tube shunt surgery in patients with prior failed trabeculectomy or in pa- tients who are likely to fail primary trabeculectomy surgery (such as those with neovascular glaucoma or uveitic glaucoma), as well as in patients with extensive conjunctival scarring from previous surgery or trauma. "Of course, these are basic EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Every month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute each month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line. Poll size: 115 continued on page 56 Slit lamp picture demonstrating the XEN Gel Stent. The black arrow shows the implant in the subconjunctival space. There is a classic low diffuse bleb. Source: Davinder Grover, MD guidelines for patient selection in my practice, and one must always consider specific patient factors in order to choose the optimal surgery for a given individual," she said. Dr. Vinod said that the XEN Gel Stent is one of the newer subcon- junctival procedures, FDA approved last year, and offers the distinct advantage over trabs and tubes of being performed via an ab interno approach. "It is a gelatinous tube with a fixed length (6 mm) and inner lumen diameter (45 microns)

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