glaucoma.
"External devices such as rings that sit in the sulcus of the eyelid or
drug-eluting punctal plugs are effective, less invasive treatment
options," says Jeffrey Soohoo, MD, an assistant professor of ophthal-
mology at the University of Colorado in Aurora.
He cautions that rings and plugs can cause discomfort in patients
and are at risk of falling out, which leads to retention issues. In addi-
tion, he says, injectable sustained-release drugs such as bimatoprost
SR can cause adverse ocular events and adversely impact corneal
endothelial cell health.
• Minimally invasive glaucoma surgery (MIGS). Surgical options
might never replace eye drops as the first-line treatment option, but
MIGS is forcing surgeons and their patients to consider more aggres-
sive interventions during earlier stages of the disease. MIGS —
implantation of bypass stents in the trabecular meshwork and canalo-
plasty, for example — is performed to increase trabecular outflow,
uveoscleral outflow and subconjunctival outflow, or decrease the pro-
duction of aqueous fluid.
As surgeons continue to push for a multifaceted approach to the
surgical treatment of glaucoma, fewer are performing conventional,
full-thickness filtration procedures such as trabeculectomy.
"Instead of only targeting fluid outflow through the trabecular mesh-
work, they also attempt to reduce fluid inflow," says Dr. Soohoo.
"Individually, these procedures might not result in a home run, but
together they can add up to have a significant impact on lowering
intraocular pressure."
The use of non-invasive surgery and medication delivery is getting
more refined, adds Richard Lewis, MD, a glaucoma surgeon at
Sacramento (Calif.) Eye Consultants. "There's been a great push for-
ward, and I think the next new wave will be an increase in drugs and
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