It was available on the market for a short time. One of the other questions was the medication use. You can do any kind of MIGS surgery or you can stent it, open it, you can put something made of gold in there. So we mentioned this slide, I talked about the aqueous water being made and then going into the drain. It's a bridge between surgery and medical therapy that is also available now to patients. An example is mytomycin or 5-fluorouracil. The iStent inject ® W stents … This is the trabecular meshwork. ‘If my glaucoma is well managed with eyedrops, what are the advantages of having surgery despite the risks?’ And I think you kind of have just answered that. And I want you to know that at Glaucoma Research Foundation, we remain as committed as ever to helping glaucoma patients especially in these very extraordinary times. And number two, glaucoma specialists, that's all we eat, live and breathe. Tom Brunner: So what about the success rates of some of these different surgeries? Or sir, "This wave, wasn't that impressive. But I also have a frank discussion with my patient. I meet a patient for the first time. And so it's a long game, it's a marathon. I talked about the narrow-angle glaucoma. Hydrus Microstent • Open Angle Glaucoma • Stent I. Paul Singh, MD Channels: Glaucoma … This is one of my favorite pictures because it shows what's happening in front of the eye, where water is made and then it goes and it drains in the angle. And we use it on a regular basis to treat patients that have significant glaucoma. Aqueous is made right here. And in the SLT group, zero patients went on. And I'm not going to pretend it's easy because it's not fun. And what it showed over time is that even though the pressure lowering was about the same in both groups, in the medicine group, more patients went on to need cataract surgery and trabeculectomy as Tom mentioned. So if you had to do a glaucoma and a laser procedure, that would probably be one that can happen at the same time in the operating room. There are implants that are bigger, they're shaped differently. Usually you're awake when this is going on but the eye is numb. It's a nitinol stent that goes into the eye and helps open the outflow system. So let's talk about some of these surgeries that open up the drain. Can you comment on that? Now, what else can give a subconjunctival flow? So we already talked about what that angle is, it's the drainage system of the eye. Eye stents can help people with glaucoma. So you have a patient here on the left side that has, we thought, an amazing ‘wave.’ If you see that blanching, it was just tremendous evidence that the patient has an intact outflow system compared to here on the right side, where maybe this blood vessel disappears just a little bit. Because the problem as we all know is with glaucoma, there are very rarely symptoms. In recent years, some surgeons are using tube shunts or glaucoma drainage devices as first-line surgery, and forgoing standard trabeculectomy as the first surgery. Sometimes people get a little worried about having glaucoma surgery and they decide to put it off too long. We can get there with surgery. Now we have a lot of safer surgeries that have pretty good success, that have lowered our bar because of the safety to do a surgical intervention, to get patients off drops. We call that the angle. Thursday, July 4th 2019, 2:28 PM HST by Diane Ako And so you can see right here in A, with these dark arrows, this large vessel that blood is coming into the eye and then I can irrigate fluid in the eye and that whole vessel disappears or it doesn't disappear, the blood is being diluted and now it's full of clear fluid. There's about a one third chance we may have to go back in." Scarring does occur. Order booklets about glaucoma for your patients. The implant is put under the skin of the eye, connects those two chambers. So if you were somebody who needed a pressure in the single digit level, a trabeculectomy is more likely to get you there. And now we do have time for some questions. I think it's a great opportunity to address patients that don't have controlled glaucoma or have controlled glaucoma and you want to decrease their dependence on drops. It made me feel confident I am on track to control this disease." 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So something that's somewhat similar is the Kahook Dual Blade goniotomy, instead of using electrocautery just makes an incision where you can remove that strip of trabecular tissue to have direct access to the downstream pipes. And if a patient has a very poor wave, there's about a one third chance they're going to need another incisional glaucoma surgery. So it's so important to have that understanding and pick that one surgeon that you have a relationship with and the trust with because it's a leap of faith. There's certain types of lasers that help us do this. But first I would say the type of surgery is really important. Davinder Grover, MD, MPH Your browser doesn't support the HTML5 video tag. The CyPass system is a suprachoroidal shunt. The iStent® Trabecular Micro-Bypass Stent, the XEN® Gel Stent, and the Hydrus® Microstent are treatment options to reduce eye pressure for patients with both cataracts and glaucoma. 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