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E-book Minimally Invasive Glaucoma Surgery

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Penilaian

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Trabecular meshwork (TM) MIGS procedures and devices are numerous. They aim to eliminate trabecular meshwork resistance in the normal physiological outflow pathway in patients with mild-to-moderate glaucoma and ocular hypertension (OHT). They are indicated in combination with cataract surgery. In patients with chronic primary angle closure, the TM outflow system has likely long-standing and irreversible damage; TM MIGS procedures or implants should be approached with caution as the drainage pathway created whether stent or trabeculotomy, may occlude with iris because of the narrow angle. In angle closure, these procedures should generally be considered only after cataract surgery and confirmation that the angle has widened sufficiently that the risk of occlusion is low. In patients with advanced glaucoma, where the maximum possible pressure lowering is often desir-able in order to minimize the risk of disease progression, TM MIGS procedures are not ideal as there is an opportunity cost in not achieving IOP control with the first surgical procedure. Other TM procedures such as ab interno trabeculotomy (AIT) or Trabectome, GATT, Kahook Dual Blade and TRAB360 cut rather than stent the TM to varying degrees. Trabectome is the earliest FDA-approved TM removal procedure. It has a disposable 19.5-gauge handpiece with irrigation, aspiration and electrocautery combined. The tip of the Trabectome removes TM tissue and coagulates at the same time. Trabectome surgery is either performed at the beginning of cataract surgery or as a stand-alone procedure [7]. The Kahook Dual Blade is a disposable knife designed to remove a strip of TM tissue via a temporal incision. With a single inci-sion, the Kahook Dual Blade and Trabectome can remove up to 120° of TM tissue, whereas GATT and TRAB360 (Sight Sciences, Menlo Park, CA, USA) can remove the entire TM tissue. GATT can be performed using either an illuminated micro-catheter (iTrack, Ellex Medical Pty Ltd., Adelaide, Australia)—designed originally for ab externo canaloplasty procedure—or a 5-0 polypropylene or Nylon suture [8]. Under direct gonioscopic view, a micro vitreoretinal (MVR) blade is used to incise the TM wall, after which the catheter or suture is advanced to cannulate Schlemm’s canal through the incision. Complete 360° catheterization of Schlemm’s canal may not be possible in all eyes. A prospective non-comparative case series has reported sustained IOP lowering for up to 2 years after GATT [9]. As 360° trabeculotomy becomes a popular first-line intervention in primary congenital glaucoma, there has been some interest in treating juvenile open-angle glaucoma with GATT as a primary surgical option.

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Ketersediaan

Informasi Detail

Judul Seri

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No. Panggil

617.7 WAN m

Penerbit

Singapore : Springer Nature., 2021

Deskripsi Fisik

203 hlm

Bahasa

English

ISBN/ISSN

9789811556326

Klasifikasi

617.7

Tipe Isi

text

Tipe Media

computer

Tipe Pembawa

online resource

Edisi

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Subjek

Ophthalmology

Info Detail Spesifik

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Pernyataan Tanggungjawab

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Versi lain/terkait

Lampiran Berkas

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