devices used in combination," he says.
Dr. Sarkisian supports combining MIGS with the placement of sus-
tained-release medication implants. "That way you have the efficacy
of trabecular micro bypass with an intervention that increases
uveoscleral outflow," he explains. "Combining MIGS with sustained
release medications is where we're going to see the most promise in
reducing intraocular pressure and getting patients off topical eye
drops."
Mixed procedures are effective in reducing IOP into the mid to high
teens, but more invasive treatments — trabeculectomy, for example
— might still be necessary to drop the pressure to the low teens or
single digits, says Dr. Lewis.
"We're still striving for a medication or device that's safe, and that
can lower and maintain low intraocular pressure," he says. "That
would be a wonderful development."
Two for one
An increasing number of surgeons combine MIGS — including place-
ment of a trabecular micro-bypass stent, ab interno trabeculectomy
and canaloplasty — to reduce IOP while implanting new intraocular
IOLs.
"We're already in the eye, the incision size is the same, and the
recovery and risk profiles are similar," says Dr. Soohoo.
As surgeons become more comfortable implant-
ing stents during cataract surgery, the dual-procedure space will con-
tinue to grow, says Blake Williamson, MD, a glaucoma specialist at the
Williamson Eye Center in Baton Rouge, La. He says 20% of patients
who undergo cataract surgery have diagnosed glaucoma and would
benefit from having MIGS performed concurrently.
It's an underserved population. "We're nowhere close to that in
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