EyeWorld India December 2014 Issue

48 EWAP DEVICES December 2014 A Baerveldt implant and Ahmed valve implanted inferiorly, at varying degrees of magni cation Source: Leon W. Herndon, MD Placement of the EX-PRESS Glaucoma Filtration Device Source: Alcon by Michelle Dalton EyeWorld Contributing Writer Traditional glaucoma surgical devices still play vital role For patients with moderate to advanced glaucoma that is still progressing, traditional procedures remain necessary T raditional glaucoma surgery—trabeculectomy or tube shunts—will continue to have a place in the treatment paradigm, experts say. The advent of microincisional glaucoma surgery (MIGS) is gaining worldwide acceptance, but will not likely replace traditional devices—including the Ahmed valve (New World Medical, Rancho Cucamonga, Calif., U.S.), Baerveldt Glaucoma Implant (Abbott Medical Optics, AMO, Santa Ana, Calif., U.S.), Molteno drainage device (Molteno, Dunedin, New Zealand), or trabeculectomy with or without the EX-PRESS Glaucoma Filtration Device (Alcon, Fort Worth, Texas, U.S.)—any time soon, said Iqbal “Ike” K. Ahmed, MD , assistant professor of ophthalmology, University of Toronto, Canada, and clinical assistant professor, University of Utah, Salt Lake City, Utah, U.S. “We still perform a lot of these traditional surgeries,” he said, “because those are still the gold standard and the most powerful pressure-lowering procedures we have.” Trying to manage patients with medical therapy and laser treatment before incisional surgery is still generally the preferred approach, said Steven J. Gedde, MD , professor of ophthalmology, Bascom Palmer Eye Institute, Miami, Fla., U.S. “Traditional glaucoma surgery is usually reserved for patients who don’t have adequate pressure control despite maximum medical therapy and appropriate laser treatment and are having progressive disease or have a pressure elevation to a level where you think progression is likely to occur at a visually significant rate.” The newer surgical techniques/ devices involved in MIGS are not going to change that definition, at least not any time soon, said Thomas W. Samuelson, MD , attending surgeon and co-founder of Minnesota Eye Consultants, Minneapolis, Minn., U.S. “I perform as many filtration procedures as I do iStents [Glaukos, Laguna Hills, Calif.], which speaks to the severity of the disease that’s out there,” he said. “Unfortunately I still see a lot of patients in whom their next amount of progression could be loss of fixation.” For Dr. Ahmed, the quickest way to lower pressure is with a trab—in secondary glaucomas or where a patient has failed a trab, he will “very quickly” go to a tube shunt. Trabeculectomy and tube shunts remain “the most