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Subspecialties Glaucoma

Improved Recovery, Reduced Risks

At a Glance

  • Almost every type of surgery requires preoperative protocols, which should be regularly adjusted to be effective; one such protocol for glaucoma procedures is a filtering bleb
  • Steroids are regularly used before bleb surgery, and topical glaucoma medications are usually withheld or replaced with preservative-free glaucoma drops
  • Ocular surface disease and lid margin issues should be resolved well ahead of surgery; procedures should be delayed if the patient is still suffering from red eye or other symptoms.

Regardless of the surgical operation, preoperative protocols have an essential role in helping us prevent infection, reduce pain and bleeding, and lower the risk of inflammation. Sometimes the steps are developed in the course of the procedure’s investigational process, other times we learn as we go and publish our results – and, often, we do both. For nearly every surgery, we continually adjust protocols based on new data or new drugs, working to incrementally improve our outcomes. Over time, the well-honed, evidence-based protocols become more effective and reliable. One example is the protocol for glaucoma procedures that involve a filtering bleb. Bleb procedures include traditional trabeculectomy and tube shunt surgeries, both of which are ab externo procedures that permit the aqueous to drain from the anterior chamber to the subconjunctival space. Another newer bleb procedure is the XEN Gel Stent (Allergan), a MIGS device that also creates drainage to the subconjunctival space with a stent implanted through an ab interno approach. XEN has a similar pressure-lowering effect with fewer risks than trabeculectomy and tube shunt (1), which can cause loss of best-corrected visual acuity, hypotony, choroidal effusion, cataract, and flattening of the anterior chamber (2-5).

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About the Author

Ike Ahmed

The 2014 Binkhorst Medal recipient, Ike Ahmed is a world-renowned ophthalmologist in the fields of glaucoma, complex cataract surgery and IOL complications. The man who coined the term “MIGS” – micro-invasive glaucoma surgery – he and his peers have opened a new flank in the battle to reduce intraocular pressure, ushering in a new generation of surgical approaches and devices. Based in Ontario, Ike is chief of ophthalmology at Trillium Health Partners, Mississauga, Ontario, Canada.

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