A New Angle on Glaucoma Surgery

American Academy of Ophthalmology 2013

Douglas J. Rhee, MD; Shuchi B. Patel, MD


December 11, 2013

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Glaucoma Surgery: Evolution in the Angle

Douglas J. Rhee, MD: Hello. I am Dr. Douglas Rhee, Chair of Ophthalmology at Case Western Reserve University in Cleveland, Ohio. Welcome to Medscape Ophthalmology Insights. Joining me today is Dr. Shuchi Patel, Assistant Professor and Director of the Glaucoma Service at Loyola University in Chicago. We are here today to wrap up some of the highlights in glaucoma as presented at the American Academy of Ophthalmology (AAO) meeting in New Orleans.

Dr. Patel, there has been a lot of excitement in the world of surgery in glaucoma. Can you share with us some of your insights in regard to the devices?

Shuchi B. Patel, MD: This meeting was great. For the past few years, we have been focusing on minimally invasive glaucoma surgery (MIGS). We had some nice debates at this meeting about the different procedures and the different devices that have come out in the past few years. We started with Trabectome® (NeoMedix; Tustin, California) -- that came out about 10 years ago. It was the first step in angle-based surgery. Since then, there have been a couple new ones.

Dr. Rhee: What are some of the differences? We had endoscopic cyclophotocoagulation (ECP) in the 1990s or earlier, but then we started focusing on the angle. There has been a gradual progression. What are your comments about that?

Dr. Patel: You are absolutely correct that different procedures came out even before all these angle-based surgeries. We realized that we should be focusing on the angle because enhancing outflow will be the key to reducing intraocular pressure (IOP), perhaps more permanently, without causing some of the side effects and complications that we have seen with other procedures, including ECP. It has enhanced the procedures that are being developed.

Dr. Rhee: That’s true. The evolution in the angle is such that we are destroying less tissue but not losing any of the safety profile and also keeping the effectiveness.


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