All rights reserved. Complete surgical success was defined as freedom from repeat glaucoma sur­gery, IOP ≤18 mm Hg, and no need for glaucoma medication. Eyes with a preoperative IOP >21 mmHg were significantly more likely to undergo reoperation (p=0.038). Dr. Kahook receives royalties from and consults for Alcon, New World Medical and J&J Vision. Each center has to figure out the economic viability of each approach while, of course, always choosing what they believe is the best approach for each patient given individual surgeon experience and outcomes.”. In my practice, I’m doing more trabeculotomy/canaloplasty, because I seem to get more pressure lowering than with the devices,” he explains. “If the Hydrus did better than the single iStent, that shouldn’t be a surprise; the Hydrus accesses at least 90 degrees of the canal, so its odds of accessing one or more outflow channels is much greater.

Mean medication burden decreased by 82 percent to 0.55 ±0.79 (p<0.0001), and 61 percent of eyes were medication-free.

But for me personally, I use goniotomy or the Kahook Dual Blade in a lot of scenarios because it’s probably the most versatile procedure.

“Often, when surgeons are adept at many of these techniques, it comes down to economics,” says Dr. Kahook.

“I use the Dual Blade for my angle procedures, and sometimes combine it with endocyclophotocoagulation, which I consider a minimally invasive approach.

Study eyes were assigned randomly (1:1) to undergo standalone microin­vasive glaucoma surgery (MIGS) con­sisting of one Hydrus or two iStents.
9001 Wilshire Blvd. Required fields are marked *, Address However, hospital-based facility fees are relatively uniform across most angle procedures regardless of type. This is our best option, because there are no definitive studies comparing them to each other.”  REVIEW. Half of the eyes had a history of prior glaucoma surgery.

The retrospective study from Texas included 111 eyes of 90 patients who underwent KDB goniotomy from January to November 2016. Atlanta’s Reay Brown, MD, says he’ll use devices or other approaches when appropriate. “Some surgeons might prefer the iStent inject because it’s a ‘stealth’ device and the least-tissue-disruptive canal intervention.”, The concept that might favor an iStent approach: you put in two minimally tissue- disruptive, extremely focal stents, leaving 98 percent of the canal normal, but improved from the phaco effect.

The mean number of IOP-lowering drugs was 0.8, 1.0, 1.0, 1.0, and 1.6 at one, three, six, nine and 12 months follow-up, respectively (all p<0.001). Westlake Village, CA 91361

“If the Hydrus did better than the single iStent, that shouldn’t be a surprise; the Hydrus accesses at least 90 degrees of the canal, so its odds of accessing one or more outflow channels is much greater.

“I’ve had good success with all of the blade procedures and goniotomy procedures in high myopes, especially if they have a moderately high IOP. (Glaukos funded the article processing and provided writing assistance for the study.). Ahmed et al. Current options include canal-based stenting (iStent by Glaukos and Hydrus by Ivantis), viscodilation devices (Omni by Sight Sciences and ABiC by Ellex), excisional goniotomy (Kahook Dual Blade by New World Medical), and a cautery device … Preoperative mean IOP was 25.3 ±6.0 mmHg on a mean of 2.98 ±0.88 medications, with three-quarters of the eyes on three to five medications (no eyes were medication-free). Minimally-invasive glaucoma surgery is intended to lower intraocular pressure with less tissue disruption than traditional glaucoma surgeries. All eyes maintained or decreased their 36-month medication burden versus preoperative levels. It used to be a discussion about iStent vs Trabectome,” says Malik Kahook, MD, a professor of ophthalmology at the University of Colorado School of Medicine.
First, it provides a direct inlet into the canal because the tail end of the Hydrus resides in the anterior chamber. “Ultimately, the device that surgeons favor may depend on what long-term data shows in a large population of patients.”, Conclusion “iStent inject is to be seen even easier than the Hydrus. Sutie F