COMMENTARY

A New Angle on Glaucoma Surgery

American Academy of Ophthalmology 2013

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

Disclosures

December 11, 2013

In This Article

Who Benefits Most From Surgery?

Dr. Rhee: With respect to effectiveness, what have you seen here at this meeting, and what has been published on the safety and efficacy of some of our new procedures? Now, in the angle, we have the ab interno trabeculectomy (the Trabectome procedure) and also the iStent® (Glaukos; Laguna Hills, California), which are Food and Drug Administration (FDA)-approved in the United States. What are your thoughts on the safety and effectiveness profiles of these devices?

Dr. Patel: First of all, the benefit of these procedures is that they do not preclude any of our gold standards of care. If you have placed the Trabectome or an iStent, and for any reason in the future you need to proceed to a trabeculectomy or a glaucoma drainage device, all of those are still valid options for patients. That is of great importance, because in the future, glaucoma patients may need further surgery.

Dr. Rhee: They are very safe, as you point out. What about effectiveness? How do these procedures compare with trabeculectomy, or with the iStent, as in the study of phacoemulsification vs phacoemulsification with one iStent?

Dr. Patel: In a selected population, these devices and procedures are great. For moderate glaucoma, or patients who are on maximum medical therapy and still need a slight reduction in their pressures, these procedures are a great adjunct to cataract surgery, which can also reduce IOP alone. For severe glaucoma or other cases, such as angle closure or neovascular glaucoma, these are not going to be options. For a mild to moderate reduction in pressure, or with the desire to stop one drop or diminish the amount of medication that patients need to use, this is a great option. It can be done with cataract surgery, which will be great for comprehensive ophthalmologists as well as glaucoma specialists because they can add that to their armamentarium.

Dr. Rhee: If I am hearing you correctly, we are broadening the scope of glaucoma surgery to be done not only by glaucoma surgeons, but also by comprehensive ophthalmologists. Would you agree with that?

Dr. Patel: Yes.

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