Microstent preferred for combined phaco and angle surgery
NEW ORLEANS — Combined phacoemulsification and angle surgery with a microstent improves safety and clinical outcomes in glaucoma surgery, a speaker told colleagues here.
Ike K. Ahmed, MD, FRCSC, elucidated three surgical pearls for the combined procedure during Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting.
“Phacoemulsification is a platform for improving aqueous outflow,” Ahmed said. “The premise of microstenting is really based on safety, establishing and re-establishing physiologic outflow and, of course, utilizing flow to prevent hypotony. ... This is designed to be a very complex procedure with rapid visual recovery and postoperative recovery.”
Ike K. Ahmed
Identifying important aqueous outflow structures is critical to success, Ahmed said.
Microstents placed in the trabecular meshwork and Schlemm’s canal should be targeted to aqueous veins because most critical outflow is in the vicinity of these veins and collector channels. Episcleral venous structures and the plexus around the limbus should be studied to identify the aqueous veins, Ahmed said.
Secondly, thorough gonioscopy, patient positioning and microscope tilt are critical to proper visualization of important angle structures. Patient movement may skew navigation and proper positioning of implants. A cohesive ophthalmic viscosurgical device optimizes the view of critical structures, Ahmed said.
Lastly, proper surgical technique is critical to minimize trauma to outflow structures and maximize outflow. Ahmed advised surgeons to avoid superficial placement of microstents within the inner wall and trabecular meshwork layers. Hand position and grip through a clear corneal incision are critical to safety and outcomes. Additional viscoelastic can help maximize visualization, Ahmed said.
Disclosure: Ahmed has no relevant financial disclosures.