Innovative surgical approaches can have solid outcomes, notes Won Kim, MD.
Reviewed by Won Kim, MD
Microinvasive glaucoma surgery (MIGS) is already a game-changing approach, but there are some ways to raise the bar for even more innovation, according to Won Kim, MD, Walter Reed National Military Medical Center, Bethesda, MD.
Dr. Kim started to combine MIGS procedures in 2013 to see if he could maintain safety while also improving efficacy to achieve lower IOP. Here is an overview of some ways Dr. Kim has combined MIGS approaches and the results his patients have achieved.
Trabecular meshwork bypass technique with some form of ECP or micropulse: Dr. Kim has performed this approach on 31 patients. The average baseline IOP was 21.3 mm Hg on 3.3 medications compared with an average postoperative IOP of 11.8 mm Hg and 2.4 medications. Between postoperative month 1 and year 4, the IOPs have ranged between 11.3 mm Hg and 13.6 mm Hg. Four failures occurred.
Ab interno canaloplasty using a lighted microcatheter combined with a trabecular meshwork bypass technique: Dr. Kim has 19 patients who have had this combination, all of whom had severe visual field loss and four of whom had a failed prior trabeculectomy and/or tube.
The average baseline IOP was 20.2 mm Hg with three medications, compared with a range between 11.9 to 13.4 mm Hg between postoperative month 1 and postoperative year 2. At the last follow-up, the mean IOP was 11.8 mm Hg, and patients used 2.4 medications. Two failures occurred.
Two iStents, iStent Supra, Travoprost use: After observing positive results from the MIGS Study Group that were presented at the 2016 American Glaucoma Society meeting, Dr. Kim was inspired to try something similar.
Won Kim, MD
E: [email protected]
This article was adapted from Dr. Kim’s presentation at the 2019 American Glaucoma Society annual meeting. Dr. Kim has no financial disclosures.