EyeWorld Asia-Pacific June 2011 Issue

37 June 2011 EW GLAUCOMA still trabeculectomy. “If I perform a trab, I view the EX-PRESS device as a modification,” he said. “In some cases, I’ll use it in place of a trab.” Once the iStent is approved, Dr. Mundorf may try that before a trab; “if that doesn’t work, I can always look at filters. If the iStent can get us into the mid-teen and then the disease progresses, we can still perform a trab.” Dr. Samuelson prefers canaloplasty over trabeculectomy “in phakic eyes that don’t have enough disease severity to warrant a trabeculectomy. It’s less risky, less invasive, and retains the eye’s physiologic outflow.” In pseudophakic cases or more advanced disease, “trabeculectomy or an aqueous drainage device is preferred. In early-to-moderate disease, I think it’s just a matter of time before something dethrones trab as the standard. This is part one of a two- part series. Next month: What generic prostaglandins will mean for glaucoma specialists and their patients. EW Editors’ note: Dr. Cantor has financial interests with AMO, Alcon, Allergan (Irvine, Calif., USA), and Pfizer (New York, NY, USA). Dr. Mundorf has financial interests with Allergan. Dr. Noecker has financial intersts with Alcon, Allergan, and Endo Optiks (Little Silver, NJ, USA). Dr. Samuelson has financial interests with AMO, AcuMems (Menlo Park, Calif., USA), Alcon, Allergan, AqueSys (Irvine, Calif., USA), Endo Optiks, Glaukos, iScience (Menlo Park, Calif., USA), Ivantis (Irvine, Calif., USA), Pfizer, QLT (Menlo Park, Calif., USA), and Santen (Napa, Calif., USA). Dr. Singh has financial interests with Alcon, Allergan, Bausch & Lomb (Rochester, NY, USA), iScience, Ivantis, and Transcend Medical (Menlo Park, Calif., USA). Contact information Cantor: 317-274-8485, lcantor@iupui.edu Mundorf: 704-334-3222, tommundorf@aol.com Noecker: 412-526-1757, noeckerrj@upmc.edu Samuelson: 612-813-3628, twsamuelson@mneye.com Singh: 650-575-8849, kuldev@yahoo.com Index to Advertisers Alcon Page: 33 Phone: +41-41-785-8888 www.alcon.com Abbott Medical Optics (AMO) Page: 41 Phone: +1-866-427-8477 www.AbbottMedicalOptics.com , www.WhitestarSignature.com Bausch & Lomb (S) Pte Ltd Page: 39 Phone: +65-7834-9112 Fax: +65-6286 0448 www.bausch.com Moria Page: 14 Moria SA Phone: +33 (0) 1 46 74 46 74 Fax: +33 (0) 1 46 74 46 70 E-mail: moria@moria-int.com www.moria-surgical.com Moria in China Phone: +86 21 5258 5066 Fax: +86 2 5258 5067 www.moria-surgical.com.cn Oculus Optikgeräte GmbH, Germany Oculus Asia Ltd, Hong Kong Page: 29 Phone: +852 2987 1050 Fax: +852 2987 1090 E-mail: info@oculus.hk www.oculus.de , www.oculusexperts.com STAAR Surgical Page: 17 Phone: +65 6829 2146/+65 8100 7731 E-mail: atan@staarag.ch www.staar.com, www.iclinfo.info Technolas Perfect Vision GmbH Page: 25 Phone: +65 6592 0792 Fax: +65 6250 1060 E-mail: Y.Ng@technolaspv.com , M.Soon@technolaspv.com , A.Koh@technolaspv.com www.technolaspv.com , www.intracor.net fluorescein at the slit lamp. She finds this to be a more sensitive method for detecting striae. Usually Dr. Ursea then lifts and hydrates the flap and stretches it manually. Perpetual weakness Dr. Ursea hopes that practitioners come away with the understanding that this can happen at any time down the line—at no point are they safe. “The lesson is related to the sealing of the flap the first time because surgeons think that as time passes, they are safe and there is no problem,” she said. “But in all of the reports previously and also in this particular case, the message is that if there is trauma, the flap dislocates because it is never actually 100% healed like an intact cornea that has not undergone this procedure.” Looking at the histopathology it appears to Dr. Ursea that the strength of the post-LASIK cornea is better in the periphery of the flap than in the center. “The healing in the center is not so good because there are no bridging collagen fibers,” Dr. Ursea said. “It takes about 6 months for that primitive scarring to occur.” When it does, the collagen in the flap margins tends to be stronger. Dr. Ursea stressed that LASIK is not for everyone, which she urges practitioners to keep in mind. “Depending on the lifestyle and hobbies of the patient, you might think twice about what kind of procedure to perform because this can happen at a very late stage and many years after the procedure,” she said. “Let’s say that the patient does active sports or is in the military or police enforcement where there is a chance that something may happen—you might prefer a surface procedure rather than a flap.” EW Editors’ note: Dr. Ursea has no financial interests related to her comments. Contact information Ursea: rursea@eyes.arizona.edu Stressing continued from page 25