Update on laser assisted cataract surgery and managing glaucoma

Update on laser assisted cataract surgery and managing glaucoma

I recently gave a presentation over Zoom discussing a number of recently published journal articles that have altered how we manage patients with glaucoma and how I have altered my approach to laser assisted cataract surgery.

Two hundred optometrists registered for the meeting

In a future post, I will discuss these findings in greater detail

Below is this presentation which is in three parts with questions after each part.

The first part discusses the role of SLT in managing open angle glaucoma and is based on the recently published LiGHT study, the second part discusses the ZAP and Eagle studies looking at the role of iridotomies and lens surgery in managing narrow angles and the last part discusses the Femcat and related studies and I talk about how this has influenced my approach to cataract surgery

 

 

 

Welcome to our new website

Welcome to our new website

Melbourne eye centre has a new website which went live on Wednesday the 8th of January 2020

 

The old site served us well for over 17 years but was in need of modernising.

This new website makes it easier to find information about our laser eye surgery services.

We will be updating the site regularly with interesting topics on in the areas in which we specialise which is cataract surgery, refractive surgery and glaucoma surgery

As you can see, we use the term progressive eye care as our focus is on being the first and the best with the most current techniques in our areas of expertise

Xen gel stent now available in Melbourne

Xen gel stent now available in Melbourne

After a delay in getting TGA approval, the Xen Gel Sten has finally been approved for use in Australia.

The stent will get prosthesis listing in mid March and should then be available for all to use.

What is the Xen Sten?

In one of my previous postings, I wrote about the Cypass shunt, which became available in Australia late last year. The Cypass shunt is one of a number of MIGS devices of which the Xen stent also belongs.

The main differences are where the stent is placed, the main indication for its use and most importantly, the fact that the Xen stent does not require concomitant cataract surgery. This means that anyone, cataract or not can have this stent.

The Xen stent is used ab interno and unlike the Cypass which drains into the suprachoroidal space, drains subconjunctivally. In this regard, it is in essence, a filtration procedure but without the need to create a scleral flap or a conjunctival dissection.

In some regards it is also like tube surgery as there is a gel stent which drains subconjunctivally.

How is the Xen Stent implanted?

The procedure can be performed with or without cataract surgery. Through a 1.5mm clear corneal incision, the stent is introduced into the anterior chamber, across to the opposite side and inserted through scleral wall to lie externally, subconjunctivally.

Before this is done, Mitomycin C is injected at the exit site to raised the conjunctiva and create space for the stent to drain into. That is essentially all there is to it.

There have been reports of a high rate of Tenon cyst formation however this is not a great problem and can to a large extent be mitigated by needling at the time of the procedure.

Who is this for?

The ideal patient is one who is on maximally tolerated topical therapy and who has exhausted all other pressure lowering means such as SLT

A typical example would be a patient with poorly controlled pressure and possible evidence of worsening visual fields and or progressive rim loss

What is involved?

The procedure is performed as a day case under local anaesthetic. Surgical time is expected to be around 15 minutes

What is the expected outcome?

Most likely better pressure control with a likely reduction in the need for medication and even possibly, a complete cessation of all medications. Like all procedures and treatments however there will always be a spread of outcomes.

What is the cost?

This procedure is covered by Medicare and the health funds. For uninsured patients, the cost is not yet known until the actual cost of the stent is announced

First Cypass patients are implanted

First Cypass patients are implanted

Today I implanted three patients with the new Cypass shunt. All had poorly controlled glaucoma, one on four lots of medication with still a high pressure.

I will be seeing them on their first day tomorrow and it is my expectation that they will all be able to at the very least reduce their medications and at best, come off them altogether .

If this shunt works out well it may well be a replacement for a trabeculectomy in those patients who have coexisting cataract

Cypass for glaucoma during cataract surgery

Cypass for glaucoma during cataract surgery

Dr Joseph San Laureano from Melbourne Eye Centre is very excited to announce that we are now implanting the new Cypass microstent in patients who have glaucoma and are having cataract surgery.

What is the Cypass?

The Cypass microstent is a small shunt which is implanted into the supraciliary space at the time of cataract surgery which lowers the intraocular pressure by allowing drainage of aqueous. It inserted with an introducer into the area just below the scleral spur and into the supraciliary space

Who is the Cypass for?

The Cypass is currently TGA approved in Australia for patients who have glaucoma and are undergoing cataract surgery. It is also approved as a stand alone procedure but at present there is no Medicare item that will allow this.

The shunt is implanted at the end of the cataract procedure.

What will the Cypass accomplish?

The Cypass will lower the intraocular pressure to the point that medications (eye drops) may no longer be necessary. At the very least, a reduction in the number of eye drops or a better control of pressure

Is Cypass safe?

Cypass is classified as minimally invasive glaucoma surgery (MIGS) and to date there have not been any reported adverse events

What does Cypass cost?

Dr San Laureano is currently NOT charging for the Cypass. It is been implanted as part of the cataract procedure. The only requirement is that patients have private health insurance. If a non insured patient wishes to have the Cypass, it can be done at the patients cost