In an article on NZ Optics, Dr. Hussain Patel discusses recent advancements in glaucoma management, focusing on the use of stents, trabeculectomies (trabs), and tubes to improve intraocular pressure (IOP) control. Traditionally, medical therapy, including multiple eye drops, has been the standard approach to treating glaucoma. However, this can lead to issues like poor adherence, side effects, and reduced quality of life.
A paradigm shift is emerging with minimally invasive glaucoma surgeries (MIGS), which offer safer, less invasive alternatives to medical therapy and traditional surgeries. These include devices like the iStent, Kahook Dual Blade (KDB), and Preserflo MicroShunt, each targeting different aspects of the aqueous outflow pathway in the eye. These procedures are often combined with cataract surgery but can also be standalone interventions.
- iStent: A small device implanted into the trabecular meshwork to improve aqueous drainage, suitable for mild to moderate glaucoma and often paired with cataract surgery. Newer versions, like the iStent infinite, offer increased efficacy by implanting multiple stents.
- KDB: A goniotomy blade used to remove a section of the trabecular meshwork, providing drainage with minimal tissue damage, suitable for moderate glaucoma.
- Preserflo MicroShunt: A more advanced device that lowers IOP more effectively than other MIGS options, suitable for patients with more severe glaucoma and is a less invasive alternative to trabeculectomy.
While MIGS procedures are increasingly popular, traditional surgeries like trabeculectomy and tube-shunt surgeries still play crucial roles, especially in severe or complex cases of glaucoma where more aggressive IOP reduction is needed. Tube-shunts are particularly useful for patients with secondary glaucoma, offering better outcomes than trabeculectomy in certain cases. The article highlights that while these innovations reduce reliance on medications, they may not fully replace traditional surgery in all cases.