The management of glaucoma is continuously evaluated throughout the life of a glaucoma patient. Treatments are adjusted based on the progression of the disease. Effective management can significantly delay the time from one method of management to another.
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In most cases, glaucoma can be controlled with drops or laser. For some people though, the eye pressure cannot be effectively controlled, and surgical intervention is required. The traditional glaucoma surgeries (trabeculectomy and glaucoma drainage devices) are usually very effective, but they carry risks of blurred or even loss of vision, due to infection or a haemorrhage in the eye, low pressure and failure. As a result, even until today, some ophthalmologists delay glaucoma surgery, by using maximum medical treatments which can cause a number of topical and systemic side effects. This also results in worsening of their glaucoma.  However, over the past few years, there is a plethora of novel surgical procedures and devices, claiming that they can reduce the eye pressure safely with minimal risk. The term MIGS is used to include all these surgical innovative techniques. 

Why iStent

In my opinion, a MIGS procedure should satisfy the following criteria:

  • Must be a good alternative to current surgical options
  • Carry very low risk
  • Minimal additional equipment required
  • Sparing conjunctiva for future trabeculectomy or tube surgery
  • Be cost effective

The device that fulfills all the above conditions is the istent, which is usually combined with cataract surgery.

The iStent is one of the smallest medical devices that is implanted on the human body. It is a tiny one millimetre long titanium tube which safely lowers eye pressure by creating a permanent bypass in the trabecular meshwork. National Institute of Clinical Excellence have approved it. The implantation adds about 15 minutes to a cataract surgery and is performed under local anaesthesia. I will arrange to see you frequently after surgery to ensure the effectiveness of the treatment.

What is PreserFlo

The PRESERFLO MicroShunt is a small, tube-like drainage device, used to control eye pressure. It creates an escape tunnel for any excess fluid from inside the eye to safely drain into a small blister, or filtering bleb under the conjunctiva, which is the membrane that surrounds the eye. From there, the fluid is slowly absorbed into the bloodstream. The shunt is designed to stay in the eye permanently, to help keep control of the eye pressure.

The PRESERFLO MicroShunt is made of a soft, flexible biomaterial that conforms to the curve of the eye. First approved in 2002, for use in cardiology therapy, the biomaterial does not cause an immune response and should not be rejected by the body.

The operation is usually performed under local anaesthesia as a day case. The visual recovery is very quick and there is no significant discomfort.

The procedure is safe and effective, with results comparable, if not better than the traditional trabeculectomy surgery.

Why iStent

In my opinion, a MIGS procedure should satisfy the following criteria:

  • Must be a good alternative to current surgical options
  • Carry very low risk
  • Minimal additional equipment required
  • Sparing conjunctiva for future trabeculectomy or tube surgery
  • Be cost effective

The device that fulfills all the above conditions is the istent, which is usually combined with cataract surgery.

The iStent is the smallest medical devices that is implanted on the human body. It is a tiny one millimetre long titanium tube which safely lowers eye pressure by creating a permanent bypass in the trabecular meshwork. National Institute of Clinical Excellence have approved it. The implantation adds about 15 minutes to a cataract surgery and is performed under local anaesthesia. I will arrange to see you frequently after surgery to ensure the effectiveness of the treatment.

What is PreserFlo

The PRESERFLO  MicroShunt is a small, tube-like drainage device, used to control eye pressure. It creates an escape tunnel for any excess fluid from inside the eye to safely drain into a small blister, or filtering bleb under the conjunctiva, which is the membrane that surrounds the eye. From there, the fluid is slowly absorbed into the bloodstream. The shunt is designed to stay in the eye permanently, to help keep control of the eye pressure.

The PRESERFLO  MicroShunt is made of a soft, flexible biomaterial that conforms to the curve of the eye. First approved in 2002, for use in cardiology therapy, the biomaterial does not cause an immune response and should not be rejected by the body.

The operation is usually performed under local anaesthesia as a day case. The visual recovery is very quick and there is no significant discomfort.

The procedure is safe and effective, with results comparable, if not better than the traditional trabeculectomy surgery.

Experience & Expertise

I was one of the first glaucoma surgeons that started using it in the West Midlands more than 5 years ago and my personal data shows reduction of eye pressure of around 25 % in mild to moderate glaucoma in 80% of patients. Many of my patients are very pleased as their number of drops was reduced by at least one, while others avoided advanced surgery such as trabeculectomy. The risk profile of the istent is excellent, as there are no additional complications compared to cataract surgery alone. 

However, as this field is evolving rapidly, I m following the technological advances and study the data for all the other devices available. I m keen to embrace new devices, if they prove to be safe and effective. As part of the glaucoma expert communityI strive to innovate and identify which of these procedures will benefit my patients the most. 

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