What's New In Glaucoma Surgery [OD CE 2 credit hours] - PPT Slides and Videos
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Transcript of What's New In Glaucoma Surgery [OD CE 2 credit hours] - PPT Slides and Videos
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Dr. David Richardson, MD. is a Board-Certified
Ophthalmologist in San Marino, CA. He is
among an elite group of eye surgeons in the
country performing the highly specialized
canaloplasty procedure. In fact, patients have
travelled half way around the world to have
canaloplasty done by Dr. Richardson.
- Medical Director, San Marino Eye
- Vice Chief of Staff, SGVMC
- Harvard Medical Scholar
- USC Magna cum laude
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At the end of the presentation audience
participants should be familiar with the main
benefits and risks of currently available
glaucoma treatments as well as have an
awareness of the most promising potential
future surgical glaucoma treatments.
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Non-invasive Minimally Invasive Penetrating
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Shunt Enhance Ablate
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Non-invasive (Enhance)
• Laser Trabeculoplasty
Penetrating (Shunt)
• Trabeculectomy
• Glaucoma Drainage Devices
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Minimally Invasive
• Cyclophotocoagulation (Ablate)
• Trabectome (Ablate/Enhance)
• iStent (Enhance)
• Canaloplasty (Enhance)
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For open angle glaucoma
Performed in 1 or 2 sessions
May result in microscopic scars
May limit future surgeries
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Photo credit: ellex.com
Primary open angle glaucoma
Can be performed after ALT
Less traumatic compared to ALT
Less damage to the eye tissue
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Photo credit: iridex.com
Micro-pulses
Less damage and scarring
Minimal inflammation and post-operative
IOP elevation
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Fistula
Bleb dependent
Bleb failure
Lifetime risk of infection
Lifestyle Limitation
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Photo credit: www.ahmedvalve.com and www.amo-inc.com.
Non-Valved vs. Valved
Movement of the implant
Infection
Scarring
Double Vision
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For mild to moderate glaucoma
Done with cataract surgery
Modest or unpredictable
IOP Reduction
Photo credit: endooptiks.com
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For ocular hypertension or mild open
angle glaucoma
Done with cataract surgery
Limits future surgeries
Expensive
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For ocular hypertension or mild open
angle glaucoma
Done with cataract surgery
Limits future surgeries
Expensive
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One Year Results (IOP < 22mmHg):
- Cataract surgery alone: 50%
- iStent plus CE/IOL: 72%
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Two Year Results (IOP < 22mmHg):
- Cataract surgery alone: 61%
- iStent plus CE/IOL: 71%
NOT statistically significant!
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“Non-Penetrating”
No Hole. No Bleb
Lower IOP. Fewer Drops
Safer than traditional surgeries
Pro-Active Lifestyle
Photo credit: ellex.com
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Trabecular Microbypass Stents
Suprachoroidal Implants
• Ab Externo
• Ab Interno
Subconjunctival Implants
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For those with mild, controlled glaucoma
undergoing cataract surgery
As long as an eyelash, “scaffolding device “
Done with cataract surgery
Promising
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modest IOP lowering
medication reducing (at best)
benefits are time-limited
very high rate of failure
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• Soft, silicon material with micropores
• Few post-operative complications
• No long-term complications
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PES and titanium
Implanted alone or at the time
of cataract surgery
IOP reduction of at least • 20% (12 mos.)
• ~50% (18 mos. )
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Relatively fast, safe and effective
Can be placed prior to or after most
other glaucoma surgeries
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Shunt restricts flow reducing risk of hypotony
Essentially a modified trabeculectomy
Requires bleb to work
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Stent designed to reduce risk of hypotony
IOP reduction of 31-42% at 12 months
Essentially an ab-interno trabeculectomy
Still requires a bleb to achieve IOP lowering
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Comprehensive: treats trabecular
meshwork, Schlemm’s canal and collector
channels
Better aqueous outflow
No permanent implant or stent
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Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 70 20.3 ± 5.8 2.4 ± 0.9
1 Month 47 14.3 ± 3.7 0.5 ± 0.9
3 Months 23 13.0 ± 3.6 0.5 ± 0.9
6 Months 4 12.3 ± 3.8 0.5 ± 1.0
Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)
Ab-Interno Canaloplasty Case Series
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Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 54 20.2 ± 6.3 2.3 ± 0.9
1 Month 33 13.3 ± 3.1 0.0
3 Months 17 12.5 ± 2.1 0.0
6 Months 3 11.0 ± 3.5 0.0
Source: Mark J. Gallardo, MD (El Paso Eye Surgeons, PA)
Ab-Interno Canaloplasty Case Series (With No Medication)
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Exam n Mean IOP (mm Hg) ± SD Mean Medications (n) ± SD
Baseline 18 25.2 ± 6.4 2.1 ± 1.0
12 Months 16 16.8± 4.9 0.5 ± 0.6
18 Months 16 15.5 ± 4.2 0.8 ± 0.8
24 Months 14 18.1 ± 5.4 1.0 ± 1.0
30 Months 11 15.5 ± 3.5 0.8 ± 0.9
36 Months 13 16.2 ± 3.3 1.1 ± 0.8 Source: R.A. Lewis, K. von Wolff, M. Tetz, N. Koerber, J.R. Kearney, B.J. Shingleton, T.W. Samuelson. Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm’s canal using a microcatheter to treat open-angle glaucoma. J. Cataract Refract. Surg., 37 (2011), pp. 682-690.
Three-Year Treatment Outcomes – Ab-Externo Canaloplasty w/o Suture
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