EyeWorld Asia-Pacific December 2012 Issue

47 EWAP DEVICES December 2012 solution, Bausch + Lomb, Rochester, NY, USA) to bring the pupil down and hyperinflates the anterior chamber with viscoelastic. Surgical pearls offered by Dr. Vold include pressing on the posterior lip of the wound to help bring blood into Schlemm’s canal, which can help surgeons more easily identify the proper location for the iStent placement. It also is important to document the pigmentation of the trabecular meshwork before operating in order to best account for individual anatomic variations among patients. Additionally, Dr. Vold suggested a soft approach. “When you insert it, it’s a movement with your fingers, not your wrist,” he said. “You don’t want to have big movements, you want to have complete control.” The device should enter at a slight angle and slide gently. If faced with strong resistance, then reposition it and try again, he said. Finally, tap the end of the iStent to ensure it is seated properly. “A little blood reflux through the stent is often a good thing because it lets you know that you are in the right spot,” Dr. Vold said. Coming micro-trend Surgeons anticipate that the iStent is likely only the first so- called microincisional glaucoma device to which U.S. surgeons will have access in the coming years. For instance, Dr. Craven has clinical experience with the Hydrus Intracanalicular Implant (Ivantis, Irvine, Calif., USA), which is an even more Schlemm’s canal- based device than the iStent. The intracanalicular scaffold for the treatment of primary open-angle glaucoma recently began FDA clinical trials. “The intriguing thing about the Hydrus is that the concept of the device came from cardiovascular CALENDAR OF MEETINGS 2013 DATE MEETING VENUE March 30-31 2nd Biennial Scientific Meeting of INASCRS www.inascrs.org Jakarta, Indonesia April 19-23 ASCRS-ASOA Symposium & Congress (ASCRS-ASOA) www.ascrs.org San Francisco , USA June 27-29 28th Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) http://www.congre.co.jp/jscrs2013/english/contents/greeting.html Tokyo, Japan July 6-8 2013 Indian Intraocular Implant & Refractive Surgery Convention (IIRSI) www.iirsi.com Chenai, India July 11-14 26th APACRS Annual Meeting – A Global Focus on the Anterior Segment www.apacrs.org Singapore October 5-9 XXXI Congress of the ESCRS www.escrs.org Amsterdam, Netherlands November 16-19 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago,USA surgery with a stent that dilates the canal some,” Dr. Craven said. “Again, not sure yet if that is good; it may be. Time will tell on that.” The Hydrus 3-clock hour nitinol scaffold is designed to potentially restore aqueous outflow for even more collector channels and aims to lower the intraocular pressure even more than a single iStent, Dr. Vold said. A very different approach is taken by the CyPass (Transcend Medical), which taps into the supraciliary space and lowers intraocular pressure by increasing uveoscleral outflow. Enrollement for its pivotal FDA clinical trial is targeted for completion by the end of the year, Dr. Vold said. “It is using an outflow system apart from the meshwork and the canal,” Dr. Craven said. Also in FDA trials is the iStent Supra, which is another device that bypasses the trabecular meshwork and aims to enhance the suprachoidal drainage to the scleral space. But the immediate future of U.S. micro-incisional glaucoma surgery will be dominated by the iStent, said the surgeons. “For now, we know the iStent offers a safe option for patients undergoing cataract surgery,” Dr. Craven said. EWAP Editors’ note: Dr. Vold has financial interests with Glaukos, Transcend Medical, AqueSys (Irvine, Calif., USA), Ivantis, NeoMedix (Tustin, Calif.), iScience Interventional (Menlo Park, Calif., USA), and SOLX (Waltham, Mass., USA). Dr. Lewis has financial interests with AqueSys, Glaukos, and Ivantis. Dr. Craven has financial interests with Glaukos, Transcend Medical, and Ivantis. Dr. Bacharach has financial interests with Glaukos. Contact information Bacharach: jb@northbayeye.com Craven: ercraven@yahoo.com Lewis: rlewiseyemd@yahoo.com Vold: svold@cox.net