Using MIGS: Not just for glaucoma specialists

摘要

GONIOSCOPY’S ROLE IN SELECTIONFor many non-glaucoma specialists, in-office gonioscopy is not commonly employed in practice. Given that many MIGS procedures involve complex bimanual maneuvers in the anterior chamber angle, a thorough and detailed preoperative examination with slit-lamp gonioscopy is an essential skill for all of us to brush up on. Gonioscopy allows you to not only differentiate between primary open-angle glaucoma (POAG) and narrow-angle glaucoma (and its variants) but is also crucial in the decision-making process, which includes whether a MIGS procedure(s) may be appropriate for a given patient.For example, a patient with a healthy angle with good visualization of anatomical landmarks (especially the trabecular meshwork [TM]) may be better suited for TM-preserving MIGS procedures, such as trabecular micro-bypass stent (iStent, Glaukos) or ab-interno canaloplasty (ABiC). A patient with poor angle anatomy (eg, peripheral anterior synechiae) may be a better candidate for tissue-destructive procedures (eg, ab-interno goniotomy [Kahook Dual Blade, or KDB, New World Medical], Trabectome [NeoMedix]) or procedures not involving the angle at all (eg, endoscopic cyclophotocoagulation [ECP]). MIGS surgeons should gain an intimate understanding of the angle prior to surgery lest they chose a surgical procedure that may be challenging or ineffective on the day of surgery.I have made this mistake, and now I make sure that I have performed in-office gonioscopy prior to choosing a MIGS procedure.