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Published byDominick Strickland Modified over 6 years ago
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New trends in glaucoma U Faridi 11th November 2016
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Treatment of Glaucoma Lowering intraocular pressure (IOP) is the standard treatment of glaucoma Eye drops Laser Surgery
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1. Eye drops Costly Compliance issues Allergy /intolerance
Ocular surface disease 60% of glaucoma patients suffers from dry eyes
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Ocular Surface Disease
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2. Laser trabeculoplasty & Endoscopic cyclophotocoagulation
Safe Easy to perform Works in 2/3rd of cases Limited efficacy ECP : High cost
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3. Glaucoma filtration surgery (Trabs & Tubes)
Pros: Achieves low IOP Cost effective Cons: Intensive post op management & slow recovery Higher complication rate Cataract formation Risk of sight loss 50% failure rate in 5 years
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Tissue disruption with filtration surgery
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Challenges in glaucoma management
None of the glaucoma treatment is perfect and everlasting Asymptomatic patients Shared decision making Risky glaucoma surgery Drops Major surgery
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Minimally invasive glaucoma surgery (MIGS)
Term coined in 2009 by Dr Ike Ahmed MD, University of Toronto
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5 Cardinal features of MIGS
ab interno procedure Bio-compatible with minimal disruption of normal anatomy & physiology of eye High safety profile Efficient IOP lowering Quick recovery time
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Drainage angle of Human eye
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Various devices Schlemm’s canal drainage Suprachoroidal drainage
iStent, Trabectome Suprachoroidal drainage Cypass, iStent Supra Subconjunctival drainage Xen gel stent, InnFocus microshunt
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Istent
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Trabectome
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CYPASS
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Xen Gel Implant Used in REI
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Pros & Cons of MIGS Encouraging short to mid term results
Cost effective High safety profile Time efficient Combine with Phaco-emulsification Less intensive post-op care Major glaucoma surgery can still be performed ? Long term results
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Thanks ?
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