5 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 1 9
Traditional glaucoma surgeries are effective, but
they are also highly invasive, carry risks and have
long recovery periods. However, we're now able to
treat some forms of mild-to-moderate primary open-
angle glaucoma (POAG) during cataract surgery
through the use of Micro-Invasive
Glaucoma Surgery (MIGS). The goal of
MIGS is to lower intraocular pressure
(IOP) with a less invasive and safer
method than implanting a drainage
device or performing a trabeculectomy.
MIGS is not used for advanced glauco-
ma, but it's good for a lot of patients I
take care of who are on drops for glau-
coma and are presenting for cataract
surgery. We continue to see evolution
and new products in this area.
Within the past year, the FDA has
approved 2 MIGS stents that go into
Schlemm's canal, the drainage system
of the eye, and expand its width. As a
result, these canal-based trabecular
microbypass stents — Ivantis's Hydrus
Microstent and Glaukos's iStent inject
— improve the outflow of aqueous
fluid in order to reduce IOP, supple-
menting the IOP relief provided by the
concurrent cataract surgery. After the
stent is implanted, I monitor the
patient's IOP to make sure it's work-
ing properly.
The first generation of the iStent
works well, but has a steep learning
curve and can be technically challenging
to insert. Getting the right angle and depth of inser-
tion can be difficult. With the second generation,
iStent Inject, you implant 2 devices, potentially get-
ting more IOP lowering. I have found them easier to
insert as well.
Ivantis
Hydrus Microstent
ivantisinc.com
Glaukos
iStent inject
glaukos.com
• RELIEVING PRESSURE Dr. Bailey gets hands-on with iStent inject.
Joe
Paone
