New trends in glaucoma U Faridi 11th November 2016

Treatment of Glaucoma Lowering intraocular pressure (IOP) is the standard treatment of glaucoma Eye drops Laser Surgery

1. Eye drops Costly Compliance issues Allergy /intolerance Ocular surface disease 60% of glaucoma patients suffers from dry eyes

Ocular Surface Disease

2. Laser trabeculoplasty & Endoscopic cyclophotocoagulation Safe Easy to perform Works in 2/3rd of cases Limited efficacy ECP : High cost

3. Glaucoma filtration surgery (Trabs & Tubes) Pros: Achieves low IOP Cost effective Cons: Intensive post op management & slow recovery Higher complication rate Cataract formation Risk of sight loss 50% failure rate in 5 years

Tissue disruption with filtration surgery

Challenges in glaucoma management None of the glaucoma treatment is perfect and everlasting Asymptomatic patients Shared decision making Risky glaucoma surgery Drops .........................................Major surgery

Minimally invasive glaucoma surgery (MIGS) Term coined in 2009 by Dr Ike Ahmed MD, University of Toronto

5 Cardinal features of MIGS ab interno procedure Bio-compatible with minimal disruption of normal anatomy & physiology of eye High safety profile Efficient IOP lowering Quick recovery time

Drainage angle of Human eye

Various devices Schlemm’s canal drainage Suprachoroidal drainage iStent, Trabectome Suprachoroidal drainage Cypass, iStent Supra Subconjunctival drainage Xen gel stent, InnFocus microshunt

Istent

Trabectome

CYPASS

Xen Gel Implant Used in REI

Pros & Cons of MIGS Encouraging short to mid term results Cost effective High safety profile Time efficient Combine with Phaco-emulsification Less intensive post-op care Major glaucoma surgery can still be performed ? Long term results

Thanks ?