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Glaucoma treatment options vary with patient needs
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KOLOA, Hawaii — Phacoemulsification can be combined with other approaches, ranging from canal procedures to cilioablative procedures, to treat glaucoma, according to a speaker here.
“I see three important primers that I consider for every patient,” Thomas W. Samuelson, MD, said at Hawaiian Eye 2017. These are safety, efficacy and risk-benefit ratio.
Thomas W. Samuelson
“But also I want to know, especially if I’m combining with phacoemulsification, how quickly is the patient going to be able to see better compared to cataract surgery alone, for example?” he said.
Samuelson cautioned that his approaches are based on anecdote and opinion until further data are available.
He said phacoemulsification alone can benefit untreated ocular hypertension patients or suspects to a degree.
For those who are already receiving glaucoma treatment, he prefers to combine phaco with one of four general approaches: canal procedures, supraciliary procedures, transscleral procedures or cilioablative procedures.
Samuelson said he prefers canal procedures when he wants to maximize safety. When quick visual recovery is the goal, he gravitates toward iStent (Glaukos) implantation specifically.
When he wants to maximize safety while improving effectiveness, even if visual recovery takes longer, he chooses gonioscopy-assisted transluminal trabeculotomy. He prefers a supraciliary approach when he seeks improved efficacy and is willing to increase risk a bit while still achieving better safety than a transscleral approach.
To address patients who are progressing quickly and have high preoperative IOP, Samuelson chooses a transscleral approach. – by Joe Green
Reference:
Samuelson T. Combined glaucoma surgery 2017: Which patients? Which procedures? Presented at: Hawaiian Eye; Jan. 14-20, 2017; Koloa, Hawaii.
Disclosure: Samuelson reports consulting fees from and ownership interests in AqueSys/Allergan, Belkin Laser, Equinox, Glaukos, Ivantis and Transcend; consulting fees from Aerie Pharmaceuticals, Alcon Surgical, Abbott Medical Optics, Akorn, AcuMEMS, Bausch + Lomb/Valeant, Endo Optiks, Santen, Shire and Vindico/SLACK Incorporated; and being a researcher for Santen.