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EW FEATURE
July 2017 • MIGS roundup
Nguyen: nguyen.quang@scrippshealth.org
Sarkisian: steven-sarkisian@dmei.org
Another possible complication
is a higher IOP right after insertion,
Dr. Craven said. "This happens
in patients with more significant
glaucoma. It usually gets better with
patient observation. Use aqueous
suppressants and steroids and wait,"
he advised.
Bleeding and a low IOP are pos-
sible but are fairly uncommon, Dr.
Flowers added.
Options for cataract surgeons
Cataract surgeons should be pre-
pared to have a microinvasive
glaucoma surgery (MIGS) approach
they can use, said the surgeons in-
terviewed by EyeWorld.
"You can't afford to not have a
MIGS procedure in your armamen-
tarium," Dr. Sarkisian said. "The
learning curve for the CyPass is rea-
sonably short, and once a surgeon
has gotten over that, the opportuni-
ty to use the CyPass will avail itself
frequently."
One other advantage that Dr.
Nguyen sees is the opportunity to
intervene earlier in the course of
glaucoma and offer better IOP con-
trol, with the possibility of reducing
glaucoma medications.
"From a technical standpoint,
it's doable. If you can do phaco,
which is a relatively complex skill
to learn, you could certainly learn
this," Dr. Flowers said. The device
also now has an improved inserter,
which makes CyPass implantation
more seamless, he added.
"General ophthalmologists are
afraid of extremely low pressures,
but I haven't had that with the new
inserter," Dr. Flowers said.
One area getting mixed results is
reimbursement. Some surgeons have
had no problems, while others are
still struggling. Dr. Sarkisian's billing
team has received help from those at
Alcon to achieve reimbursement for
use of the device. EW
Reference
1. Vold S, et al. Two-year COMPASS trial
results: Supraciliary microstenting with
phacoemulsification in patients with open-an-
gle glaucoma and cataracts. Ophthalmology.
2016;123:2103–12.
Editors' note: Dr. Craven and Dr.
Sarkisian have financial interests with
Alcon. Dr. Flowers and Dr. Nguyen
have no financial interests related to
their comments.
Contact information
Craven: ercraven@yahoo.com
Flowers: bflowers@oafw2020.com
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