by Mark Gallardo, MD
Mark Gallardo, MD, discusses strategies to determine which microinvasive glaucoma surgery (MIGS) device is the best fit for a specific patient. During his presentation, Dr. Gallardo also shares his personal data and advice on using the iStent Trabecular Micro-Bypass Stent (Glaukos).
WASHINGTON — For patients with highly aberrated corneas due to pellucid marginal degeneration, penetrating keratoplasty or previous refractive surgery, toric lenses can have optimal results, according to a speaker here.
Goniotomy With a Single-Use Dual Blade
Neda Shamie, MD, describes a prospective, interventional case series which assesses the safety and efficacy of goniotomy with a single-use dual blade. One of the authors of the paper, Nathan Radcliffe, MD, highlights key findings and summarizes the short-term results of this study.
Abstract: Preservatives used in topical glaucoma medications have a plethora of well-described toxic effects on the ocular surface. Such ocular toxicity is manifest clinically as ocular surface disease (OSD) and has been confirmed in epidemiologic, prospective clinical trials and studies in which patients are switched from preservative-added to preservative-free topical therapy. Such toxicity has implications not only for tolerability, but also for adherence and persistence with therapy that is known to be poor in glaucoma. Glaucoma medication is now widely available in preservative-free formulations, and the question arises as to which patients should receive preservative-free glaucoma therapy in preference to preservative-added medication. A case can be made for several subpopulations of patients who might particularly benefit from preservative-free medication: patients with existing OSD, older patients, younger adult patients, female patients, pediatric and juvenile patients, patients who work in air-conditioned environments or who use electronic screens frequently, patients with medical risk factors for OSD, patients in whom trabecular surgery may become indicated in the future, contact lens users, perhaps patients with Asian ethnicity and patients with severe or treatment-refractory glaucoma. Whilst arguments could be made for selecting patients for preservative-free medication on the basis of their existing risk of OSD, collectively, these patients form a significant proportion of the glaucoma patient population as a whole and, in the absence of any cost premium or positive indication for preservative-added medication, preservative-free glaucoma medication for all patients seems an appropriate strategy.
Publishing date: April 2018
Author(s): King C (1), Sherwin JC (1), Ratnarajan G (2), Salmon JF (1)
1 Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
2 QVH Eye Unit, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK.
BACKGROUND/AIMS: To determine the mortality within 20 years of diagnosis of chronic open-angle glaucoma (COAG) and visual acuity and visual field progression of a cohort followed for 20 years.
Live surgery is great, but sometimes it’s complicated… I share my top tips
By I. Paul Singh
Most know me as an ophthalmic surgeon. But outside the clinic I play keyboard in a band, and the experience has really influenced my surgical skills. Not only has it helped me strengthen the ability of my non-dominant hand, it has helped me when it comes to performing live surgeries.
Pretty much every surgeon, whether doing live events or presenting on the podium, gets a little nervous. Me too – I’m not immune to a bit of stage fright! Performing live on stage with my band and talking to the audience has definitely helped me learn that your approach is what matters.
Kerry Solomon, MD, shares advice on how to incorporate the iStent Trabecular Micro-Bypass Stent (Glaukos) into a refractive cataract surgery practice and what criteria he uses to evaluate MIGS devices.
Glaukos announced that its travoprost intraocular implant with the iDose delivery system continued to provide sustained reduction in IOP in a 12-month interim cohort of patients in its US investigational new drug phase 2 clinical trial, according to a company news release. Implanted during a microinvasive procedure, the iDose Travoprost is filled with a special formulation of travoprost and is designed to continuously elute therapeutic levels of the medication from within the eye for extended periods of time. When depleted, the iDose Travoprost can be removed and replaced in a similar procedure.
oin ophthalmologists from 109 countries (and counting) who have already registered to attend the 36th World Ophthalmology Congress® (WOC2018) of the International Council of Ophthalmology 16–19 June in Barcelona, Spain. The WOC is the longest continuous medical meeting in the world and addresses all subspecialties and related interests in ophthalmology.
Latanoprostene bunod (LBN) is a topical ophthalmic therapeutic for the reduction of intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension (OHT). LBN is composed of latanoprost acid (LA) linked to a nitric oxide (NO)-donating moiety and is the first NO-releasing prostaglandin analog to be submitted for marketing authorization in the United States. The role of latanoprost in increasing uveoscleral outflow of aqueous humor (AqH) is well established. Herein, we review findings from nonclinical studies, which evaluated the role of NO in the IOP-lowering efficacy of LBN. Pharmacokinetic studies in rabbits and corneal homogenates indicate that LBN is rapidly metabolized to LA and butanediol mononitrate (BDMN). NO is subsequently released by BDMN as shown by increased cyclic guanosine monophosphate (cGMP) levels in (1) the AqH and iris-ciliary body after administration of LBN in rabbits and in (2) human trabecular meshwork (TM) cells after incubation with LBN. LBN reduced myosin light chain phosphorylation, induced cytoskeletal rearrangement, and decreased resistance to current flow to a greater extent than latanoprost in TM cells, indicating that NO released from LBN elicited TM cell relaxation. LBN also lowered IOP to a greater extent than latanoprost in FP receptor knockout mice, rabbits with transient OHT, glaucomatous dogs, and primates with OHT. Along with results from a Phase 2 clinical study in which treatment with LBN 0.024% resulted in greater IOP-lowering efficacy than latanoprost 0.005%, these data indicate that LBN has a dual mechanism of action, increasing AqH outflow through both the uveoscleral (using LA) and TM/Schlemm's canal (using NO) pathways.
Neurotrophic keratopathy – the loss of corneal sensation – has a poor prognosis with limited available treatment options
Current techniques for corneal neurotization can restore corneal sensation, but may be associated with significant morbidity
I describe two minimally invasive techniques for corneal neurotization: using a cadaveric nerve graft and an endoscopic approach
More ophthalmologists learning – and performing – these minimally invasive procedures may help more patients before devastating and irreversible damage occurs.
Elizabeth Yeu, MD, discusses how the iStent Trabecular Micro-Bypass Stent (Glaukos) has given her the opportunity to provide an option at the time of cataract surgery that could prevent the progression of a patients' glaucoma. In this article, she describes her experiences with the iStent, which makes this option possible via microinvasive glaucoma surgery (MIGS).
Bhavana Sharma,1 Aditi Dubey,2 Gaurav Prakash,3 Rasik B Vajpayee4–6
1Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, India; 2Department of Ophthalmology, Gandhi Medical College, Bhopal, India; 3Cornea and Refractive Surgery Services, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates; 4Vision Eye Institute, Melbourne, VIC, Australia; 5Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia; 6North West Academic Centre, University of Melbourne, Melbourne, VIC, Australia
Abstract: Surgical management of keratoconus (KC) has undergone a paradigm shift in the last two decades and component corneal transplantation technique of deep anterior lamellar keratoplasty has established itself as a modality of choice for management of advanced cases of KC. Every now and then, new minimalist modalities are being innovated for the management of KC. On the same lines, a new technique, Bowman’s layer transplantation, for surgical management of moderate to advanced KC has been reported in recent years. The procedure has shown to be beneficial in reducing ectasia in advanced KC with minimal intraoperative and postoperative complications. In this review, we intend to describe available information and literature with reference to this new surgical technique – Bowman’s layer transplantation.
Keywords: keratoconus, Bowman’s Layer, keratoplasty, post PRK haze, component keratoplasty
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