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Trabecular Bypass Surgery
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Toby Y.B. Chan, Iqbal Ike K. Ahmed
Because all of these MIGS procedures require direct visualization of the angle, they share a common series of steps and instruments: A temporal main incision (can be as small as approximately 1.6 mm) is made. If no phacoemulsification is planned as a combined procedure, one may favor a clear corneal incision over a limbal incision in order to avoid limbal vessels as minor hemorrhage may obscure the view through a goniolens.An ophthalmic viscosurgical device (OVD) is injected into the AC. A cohesive agent would be ideal in these procedures as they allow maintenance of AC during manipulation of the MIGS device as well as tamponade of any intracameral hemorrhage during the procedure (either reflux from SC or from inadvertent angle/iris trauma). One should avoid over-filling early on as it may collapse SC, resulting in more difficult entry of MIGS devices. Any large bubble or significant debris in the AC should be aspirated using a cannula to allow an unobstructed view of the angle.The microscope is tilted by about 30 degrees with the objective turning away from the surgeon and toward the angle (Figure 21.7). For ideal visualization, the patient’s head should be turned away from the surgeon (Figure 21.8). Angle of tilt should be adjusted to ensure clear view of all angle landmarks, in particular, the TM.The cornea is cleared of any debris or hemorrhage, either by irrigation with balanced saline solution (BSS) or using a surgical sponge, such as Weck-cel (Medtronic, Minneapolis, MN). Viscoelastic is then applied onto the corneal epithelium as a coupling agent for gonioscopic view (Figure 21.9).A gonio lens that allows direct gonioscopy, such as the Swan-Jacob gonioprism (Figure 21.10), is placed on the cornea. Under high magnification, a direct head-on view of the angle is obtained. The pigmented TM is used as a “landing strip” for the MIGS device.
Visual and refractive outcomes following secondary intraocular lens implantation
Published in Seminars in Ophthalmology, 2022
Marina Delgado João, Jorge Vasco Costa, Keissy Sousa, Tiago Monteiro, Nuno Lopes, Gil Calvão-Santos, Carlos Cruz, Fernando Vaz
The iris-claw IOL Artisan® Aphakia Model 205 (OPTHEC) was implanted through a 6 mm corneal incision or a 6 mm scleral tunnel (2.5 mm away from the limbus) according to the surgeon’s experience. Anterior segment surgeons used corneal incisions; posterior segment surgeons used scleral tunnels. Two paracenteses were created at the 2 and 10 o’clock positions and acetylcholine chloride 1% (Miochol-E®) was injected into the AC. A cohesive ophthalmic viscosurgical device was injected to maintain the AC formed. Then, the IOL was inserted through the main incision and was rotated into a horizontal position, and centered in the pupil. The enclavation of the iris into the IOL claw was performed using an enclavation forceps. All iris-claw aphakia IOLs were implanted in a prepupillary position. A peripheral iridectomy was created and the incision was closed with 10–0 nylon sutures. Corneal sutures were removed from the third month after the surgery onwards, according to the corneal topography.
Focusing on surgical and laser advances in glaucoma management
Published in Expert Review of Ophthalmology, 2020
Nada G. Mohamed, Timothy E. Yap, Melanie Almonte, Fernanda N. Susanna, Laura Crawley, Maria Francesca Cordeiro
A study was being conducted to assess the safety and effectiveness of the use of visco-assisted CyPass Micro-Stent implantation for the lowering of intraocular pressure in subjects who have open-angle glaucoma (Viscopass). It describes injecting 60 µL of an ophthalmic viscosurgical device (OVD) at the end of the lumen. However, no published results were found.
Comparison of the Effect of Diclofenac 0.1% and Nepafenac 0.1% on Aqueous Flare in Patients Undergoing Cataract Surgery: A Prospective Randomized Study
Published in Current Eye Research, 2020
Carlo Cagini, Adriana Pellegrino, Alessio Cerquaglia, Barbara Iaccheri, Marco Lupidi, Tito Fiore
The day of the surgery, patients were randomly assigned to one of two groups using a computer-generated randomisation list (Group A:diclofenac group; group B: nepafenac group), and all the surgical interventions were performed by the same experienced surgeon (CC), who was blinded to the treatment group assignments. Mydriasis was obtained through the use of a phenylephrine and tropicamide insert (Mydriasert, ThéaFarmaSpA, Milan, Italy) into the eyelid fornix about 60 min before surgery. Every procedure was performed with topical anesthesia (lidocaine 4%) using the Whitestar Signature phacoemulsification system (Abbott Medical Optics Inc.) and the stop-and-chop technique through a 2.2 mm temporal limbal incision. The same ophthalmic viscosurgical device (sodium hyaluronate 1.4%, Healon GV) and acrylic IOL (AR40e, Abbott Medical Optics, Inc.) were used in all patients and the duration of surgery was recorded. At the end of the surgery an intracameral injection of 0.1 mg cefuroxime solution was performed, and a fixed tobramycin 0.3% and dexamethasone 0.1% eyedrops (Tobradex, Alcon Italia S.p.A., Milan, Italy) and ofloxacin 0.5% eye-drops (Oftaquix,Santen OY, Tampere, Finland) were administered. After the discharge, all patients started treatment with ofloxacin 0.5% eye drops (Oftaquix)4 times daily for the first week, tobramycin 0.3% and dexamethasone 0.1% eye drops (Tobradex) 4 times daily for two weeks. Patients randomized to group A received preservative-free diclofenac 0.1%eye drops solution (Voltaren Oftabak®, diclofenac sodium, 1 mg/ml; Laboratoires Thea, Clermont-Ferrand, France) 4 times daily for four weeks, while patients of group B received nepafenac 0.1% ophthalmic solution (Nevanac®, nepafenac 1 mg/ml; Novartis, Basel, Switzerland) 3 times daily for three weeks. No tapering down schedule was used. All the drugs were administered according to the official Italian guidelines in terms of posology and duration of therapy. Postoperative complete evaluation with laser flare measurement and retinal tomography was performed at day 1, 15, 30 and 60 after surgery.