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Throw Away The Script - Outpatient Surgery Magazine - February 2019

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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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 F E B R U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 2 5

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