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    MIGS brings balance to combined cataract-glaucoma surgery

    The need for cataract surgery has often been the tipping point for proceeding with surgical management of glaucoma, but in 2015, surgeons are better able to tailor their intervention based on where the patient lies along the spectrum of glaucoma.

    “After the drug renaissance of the late 1990s and early 2000s, combined cataract surgery with a filtering or tube procedure began to be reserved for glaucoma patients at high risk for functional impairment,” said Thomas W. Samuelson, MD, adjunct associate professor of ophthalmology, University of Minnesota, Minneapolis, and attending surgeon, Minnesota Eye Consultants, Minneapolis. “Today, combined surgery is performed in a broader population thanks to the availability of alternatives that are far less likely to cause iatrogenic vision loss.”

    Watch as Thomas Samuelson, MD, outlines how he manages patients with cataracts and glaucoma.

    Dr. Samuelson said that while cataract surgery is not a cure for glaucoma, it is an important management option that can result in significant IOP reduction. Therefore, he considers phacoemulsification alone useful for patients needing cataract surgery who have untreated ocular hypertension or are glaucoma suspects.

    Patients with mild-to-moderate glaucoma are candidates for phacoemulsification plus “enhanced microinvasive glaucoma surgery (MIGS),” which would involve ab interno trabeculectomy (Trabectome, NeoMedix), a trabecular microbypass stent (iStent, Glaukos), or endoscopic cyclophotocoagulation plus some postoperative medication.

    Trabeculectomy or a tube procedure remains an important option to combine with phacoemulsification for patients who need cataract surgery and are at high risk for functional impairment (patients with severe glaucoma, poor compliance, extreme IOP, medication intolerance, or aggressive progression).

    Enhanced MIGS

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