Glaucoma surgery

” The risk of glaucoma surgery should not exceed the disease risk, Thomas Samuelson, University of Minnesota, Minneapolis, US, told delegates during his presentation, “Intracanalicular & Suprachoroidal Devices.” Dr Samuelson, the current president of the American Society of Cataract & Refractive Surgery, gave his presentation during the ESCRS Main Symposium: Glaucoma for the Cataract Surgeon at the 36th annual ESCRS Congress in Vienna. “Micro-incisional glaucoma surgery (MIGS) allows us avoid high-outflow, low-resistance surgical options like supraciliary or transscleral methods that may ‘steal’ flow from physiological pathways and suffer surgical complications,” he said. “The Level 1 evidence that cataract surgery lowers IOP in most patients with elevated IOP is undeniable, which is the foundational basis of combined surgery of phacoemulsification and MIGS,” said Dr Samuelson. This evidence comes from the five prospective, randomised MIGS trials in which the control (phaco) arm significantly lowered IOP. However, the addition of the MIGS procedure to cataract surgery must be safe. “Latrogenic vision loss keeps me awake at night,” he said. And it must be synergistic with phaco, which enhances physiological outflow through the trabecular meshwork. “Remember, in mild-to-moderate disease, the trabecular meshwork is moderately dysfunctional, but not completely shot. Why abandon it?” he asked. And although MIGS can be very successful, Dr Samuelson reminded delegates to be willing to admit when it’s time to move on to a more aggressive approach.