EyeWorld Asia-Pacific December 2019 Issue

able to discontinue all medica- tions while her IOP lowered in both eyes to 14 mmHg. It was also the first time in 2 years the patient was off medications. After this complicated case, Dr. Ang stated that the primary lesson he learned was that SLT could have been performed ini- tially in order to allow for MIGS options in the future. Another point Dr. Ang made was that it is important to document struc- tural and functional changes in a patient’s glaucoma condition. From this case, Dr. Ang saw a structural change in the retinal nerve fiber layer, yet there was no functional change in the visual field. Florian Kretz, MD, FEBO, presented a case on the use of iStent inject in his clinical practice. A 64-year-old female glaucomatous patient presented with stable IOP around 18 and aimed for glasses-free vision as well as a glaucoma eye-drop free lifestyle. Dr. Kretz implant- ed an iStent Inject. One day post-op results showed UCVA at –0.1 logMAR and stable IOP (<16 mmHg). Another case Dr. Kretz presented showed similar outcomes (UCVA 0.0 logMAR and stable IOP <15 mmHg) after iStent surgery on a 75-year-old male with a history of pseudo- exfoliation glaucoma. Dr. Kretz stated that iStent Inject is a good iStent inject in vivo, 2-3 clock hours apart Courtesy Glaukos option to treat cataract patients with mild to moderate glauco- ma under stable conditions. He also said that it is possible to combine this procedure with presbyopia correcting IOLs. During the discussion after the presented cases, a question arose on what the general advice and treatment management was for a glaucoma patient on three to four medications with severe red eye. The panel agreed that surgeons may first try MIGS procedures. “Many patients are old, and sooner or later will have to have cataract surgery. The opportuni- ty to do MIGS is there when you do cataract surgery,” said Dr. Ang. “If you’re experienced and competent with MIGS, then you have to bring the option to the patient. The patient in the end has to be the one deciding.” Many elderly patients may decide to continue eye drop medication despite the side ef- fects with medication noncom- pliance being a risk, while some may wish to be more aggressive in their treatment and decide to undergo surgery. Counseling plays a significant role in what the patient decides for him or herself. If the patient can tol- erate the side effects, does not wish to undergo procedures, and understands the importance of Over 15 years of Ophthalmic Education A News Magazine of the APACRS Keeping readers at the forefront of international trends in Cataract and Refractive Surgery Digital editions are now available! Asia-Pacific • China • India • Korea ASIA-PACIFIC eyeworldap.apacrs.org APACRS Secretariat Singapore c/o Singapore National Eye Centre, 11 Third Hospital Avenue, #06-20, Singapore 168751 Email: apacrs@apacrs.org Tel: (65) 6322 7468 Fax: (65)6327 8630 staying compliant with medica- tions, he or she may continue with eye drops. Ultimately, it is the patient’s decision in the end. All the surgeons in this session’s panel discussion agreed iStent inject trabecular micro by-pass system Courtesy Glaukos that MIGS is an incredibly im- portant procedure that will not only grow from here on out but will also advance outcomes for patients while becoming easier with time for surgeons to per- form.