EyeWorld Asia-Pacific September 2019 Issue

34 EWAP SEPTEMBER 2019 SECONDARY FEATURE T hough MIGS is generally considered safer than traditional glaucoma procedures, complications can still occur. Two surgeons discussed potential complications, how to speak to patients about them, and how to remedy these situations. Jacob Brubaker, MD One point that Dr. Brubaker said he is sure to mention to patients is that sometimes these devices are not effective for some people. It’s important to make sure patients are aware upfront that the collector systems may not function in a particular individual. “We’re not aware of that until we’re doing surgery,” he said. As a result, a common “complication” may Li ̅>Ì ˆÌ½Ã ÕÃÌ iÃà ivwV>VˆœÕà ˆ˜ some patients. Dr. Brubaker said that one of the most common surgical complications that can occur is bleeding. This is more likely with trabecular bypass ablating procedures. In procedures like the Kahook Dual Blade (KDB, New World Medical) or gonioscopy-assisted transluminal trabeculotomy (GATT) or OMNI Glaucoma Treatment System (Sight Sciences), there is a common hyphema risk, he said. Depending on how much you excise, with KDB, you may have around a 5–10% chance that there will be a little hyphema, he said. Dr. Brubaker has seen hyphema in some iStent (Glaukos) cases that may take up to 2–4 weeks to resolve. by Ellen Stodola EyeWorld Senior Staff Writer / Meetings Editor AT A GLANCE • Þ«…i“> >˜` Lœœ` ÀiyÕÝ >Ài two complications that can occur with MIGS procedures. These tend to resolve on their own. • More serious complications can include cyclodialysis or Descemet’s detachment. • Other MIGS “complications” could be connected to gaining familiarity with the procedures or the devices being less ivwV>VˆœÕà ˆ˜ ܓi «>̈i˜Ìð Complications in MIGS Contact information Brubaker: jacobbrubaker@me.com Patrianakos: tpatrianakos@yahoo.com This article originally appeared in the July 2019 issue of EyeWorld . It has been UNKIJVN[ OQFKƂGF CPF CRRGCTU JGTG YKVJ permission from the ASCRS Ophthalmic Services Corp. Intraoperative hyphema during insertion of an OMNI Glaucoma Treatment System. Source: Thomas Patrianakos, MD Dr. Brubaker also noted that although the CyPass (Alcon) is no longer being implanted, it could be associated with such issues as hypotony, myopic shifts, uveitis, and endothelial cell damage. Rare complications such as iridodialysis, cyclodialysis, or Descemet’s detachment can occur, Dr. Brubaker said. Descemet’s detachment may be seen more commonly with incisional procedures. The trabecular meshwork may be more adherent to the endothelium, he said, and it could detach as you ablate or remove it. It’s important to recognize this early and cut it rather than continuing to pull. Though many associated MIGS complications will resolve on their own, Dr. Brubaker said they may need some sort of intervention. If there is cyclodialysis or iridodialysis, that will often need repair, he said. Hyphema will usually resolve on its own. Thomas Patrianakos, MD MIGS in general is meant to be safer and have fewer complications than traditional }>ÕVœ“> wÌÀ>̈œ˜ ÃÕÀ}iÀÞ] À° Patrianakos said. He stressed that these procedures are not complication-free, but they don’t see complications as frequently. "˜i œv ̅i wÀÃÌ ˆÃÃÕiÅi discussed was gaining familiarity with the procedure. Since they’re all relatively new, these procedures are either self-taught or someone from the industry works with surgeons to train them on the product. Training may also include watching videos. “Being familiar with intraoperative gonioscopy is essential to minimize complications,” Dr. Patrianakos said, adding that being familiar with angle structures is also important. To make these procedures safer and have a better target in terms of outcomes, make sure you have a clear view of the angle before proceeding with any of the devices that use gonioscopy, he said. One cause of complications in - «ÀœVi`ÕÀià ˆÃ Lœœ` ÀiyÕÝ° “If your view is not crystal clear, then you’re not going to be able to perform the procedure correctly,” he said.