1. New trends in glaucoma
U Faridi
11th November 2016

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

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

4. Ocular Surface Disease

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

6. 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

7. Tissue disruption with filtration surgery

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

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

10. 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

11. Drainage angle of Human eye

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

13. Istent

14. Trabectome

15. CYPASS

16. Xen Gel Implant Used in REI

17. 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

18. Thanks ?