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The new paradigm of precision, customization and optimized safety in micro-invasive refractive cataract glaucoma surgery
Session Title: Glaucoma
Session Date/Time: Monday 07/10/2013 | 17:00-18:34
Paper Time: 18:08
Venue: Elicium 2 (First Floor)
First Author: : R.Lindstrom USA
Co Author(s): :
Provide perspective and treatment algorithms for micro-invasive glaucoma surgery (MIGS); present supportive clinical evidence related to this advanced platform to reduce intraocular pressure (IOP) and medication burden for treatment of open-angle glaucoma (OAG).
A collaborative group of visiting surgeons and staff surgeons from North America and Europe comprise the Micro-Invasive Glaucoma Surgery (MIGS) Study Group. These surgeons have traveled to one investigational site the S.V. Malayan Ophthalmological Center in Yerevan, Armenia to perform surgeries for MIGS studies of trabecular bypass and suprachoroidal stents.
The basis for using trabecular bypass stents in the MIGS algorithm is threefold: (1) 50% - 90% of resistance to aqueous is in the trabecular meshwork, (2) a single patent trabecular bypass can increase outflow facility, and (3) multiple bypass may further reduce IOP. Trabecular bypass as initial therapy has several advantages including restoration of natural physiologic outflow in OAG, titratable target IOP reduction (? 15 mmHg) with multiple trabecular bypass stents, minimal risk of hypotony (vis-ą-vis episcleral venous pressure), and sustained efficacy and safety. To further reduce IOP in refractory OAG, trabecular bypass can be used in combination with either a topical glaucoma medication or a suprachoroidal stent.
The MIGS treatment algorithm has been shown in work by Grant, Zhou, Rosenquist and Johnson, and in more work by Bahler, et al. with trabecular bypass stent technology. A large-scale prospective, randomized study of iStent (Samuelson, et al.,Craven, et al.) provided strong evidence of long-term IOP control with reduced medication burden and favorable safety in mild to moderate OAG after iStent with cataract surgery; further corroborated via studies by Fea, Neuhann, Au and Arriola-Villalobos, et al. Several studies by the MIGS study group have demonstrated sustained efficacy and safety to 18 mmHg or lower with one trabecular bypass stent and to 15 mmHg or lower with multiple stents.
Various studies have shown that OAG patients can safely achieve IOP ? 18mmHg with reduced medication burden using one trabecular bypass stent and ? 15mmHg with two stents as initial therapy. A continued standard-of-care evolution to episcleral venous target pressures via trabecular bypass combined with either one medication or a suprachoroidal stent is possible for more advanced disease.
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