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Gonioscopy
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Ronald L. Fellman, Davinder S. Grover
The importance of gonioscopy is at an all-time high because of new surgical treatment modalities for glaucoma. Leading the way is minimally invasive glaucoma surgery (MIGS) and laser trabeculoplasty, which remains a close second. These new surgical procedures require that eye surgeons are intimately familiar with angle anatomy in order to successfully place new devices and/or perform canal surgery (Figure 5.1). The desire to improve the patient’s inherent outflow system and avoid bleb surgery has created a renaissance in gonioscopy. A vast knowledge of working angle anatomy is a prerequisite in order to correctly diagnose the type of glaucoma and determine if the patient is a MIGS candidate. Fortunately, there has been a commensurate level of innovation in the field of gonioscopy with new and improved surgical goniolenses and gonioprisms designed to magnify and improve intraoperative visualization of the angle.
XEN Implant for Glaucoma Treatment: A Review of the Literature
Published in Seminars in Ophthalmology, 2019
Aikaterini Chatzara, Irini Chronopoulou, George Theodossiadis, Panagiotis Theodossiadis, Irini Chatziralli
Minimally invasive glaucoma surgery (MIGS) are surgical interventions for lowering IOP, with an ab-interno approach, minimal trauma with very little or no scleral dissection, minimal or no conjunctival manipulation, good safety profile and rapid recovery.6,7 Specifically, Lavia et al. performed a meta-analysis, showing a decrease in IOP and a reduction in glaucoma medication after MIGS surgery without serious complications.7 It has also to be mentioned that MIGS procedures can be performed along with phacoemulsification for synchronous treatment of glaucoma and cataract and there is limited data for standalone techniques.8 Although MIGS is currently indicated for mild-to-moderate glaucoma or for patients who are intolerant to standard medical therapy and despite increasing interest on MIGS,9 there is inadequate data for the efficacy of MIGS compared to other therapies and large non-comparative or randomized controlled trials are warranted.7,10
XEN Gel Implant: a new surgical approach in glaucoma
Published in Expert Review of Medical Devices, 2018
Ankita Chaudhary, Lauriane Salinas, Jacopo Guidotti, André Mermoud, Kaweh Mansouri
Minimally invasive glaucoma surgery (MIGS) encompasses the recent glaucoma microstent surgeries meeting the criteria of minimal tissue disruption, ab-interno implantation, short surgical time, IOP reduction, simple instrumentation, and fast postoperative recovery. MIGS has generally been confined to mild-to-moderate glaucoma cases, often in combination with cataract surgery, and not in more severe glaucoma patients (especially if they have undergone previous glaucoma surgery) [22]. XEN Gel Implant is one of the MIGS alternatives. The ab-interno placement of the implant lowers the IOP using a minimally invasive procedure, minimum conjunctival tissue disruption, restricted flow to avoid hypotony, and long-term safety. While other MIGS devices target Schlemm’s canal and the suprachoroidal space, the XEN subconjunctival implant is the world’s first ab-interno MIGS approach to subconjunctival outflow. This review discusses in detail the XEN Gel Implant starting with a short description of a few other MIGS implants to familiarize the readers with the amount of research occurring in surgical aspects of glaucoma.
Efficacy and Safety of High-Energy Selective Laser Trabeculoplasty for Steroid-Induced Glaucoma in Patients with Quiescent Uveitis
Published in Ocular Immunology and Inflammation, 2021
Junyan Xiao, Chan Zhao, Anyi Liang, Meifen Zhang, Gangwei Cheng
Glaucoma is a common and sight-threatening complication of uveitis.1–3 The mechanisms underlying intraocular pressure (IOP) elevation are diverse and complicated in uveitic glaucoma (UG). Uncontrolled inflammation may lead to partial or complete obstruction of aqueous outflow path resulting from trabeculitis, inflammatory obstruction of the trabecular meshwork (TM), extensive anterior synechia and acute angle closure due to pupil block. Management of UG is challenging, as it requires careful diagnosis and adequate control of both IOP and inflammation.4 Steroid-induced glaucoma is also a common condition and was reported to represent up to one-third of all UG cases.5 In addition, inflammatory mechanisms and steroid-induced changes may be involved simultaneously or sequentially, and it is often difficult to determine which mechanism is predominating and which should be addressed.6 Even for UG patients with definite pathogenesis, it is sometimes difficult to make a treatment decision if IOP could not be controlled by medications. While traditional trabeculectomy is currently the main procedure performed in UG,7 a poor success rate has been reported if it is performed without antiproliferative agents or is accompanied by complications.6 In addition, conventional procedures are associated with a higher rate of postoperative complications in UG than primary glaucoma.8–10 Minimally invasive glaucoma surgery (MIGS) might be a safer alternative than penetrating surgeries, however, further evaluations are needed as postoperative inflammation recurrence is also a major concern.11