Patient Selection for Trabectome ( скачать в хорошем качестве

Patient Selection for Trabectome (

Ophthalmologist ranging from the Glaucoma Specialist to the general practitioner, share their insights on the patient profile best suited for Trabectome - a micro-incisional glaucoma surgery. Here's what the Ophthalmic surgeons had to say about Trabectome (an excerpt): Dr. Brian Francis, MD, MS -- Doheny Eye Institute "I have been one of the original doctors of the Trabectome technique and I have found it to be extremely useful in managing glaucoma patients in my practice. I think it has a good wide variety of applications in different forms of opening a glaucoma. It can be performed as a stand-alone procedure in patients with high intraocular pressure. It can be performed in patients that have combined cataract procedure at the same time and has very good efficacy in both of those scenarios." Dr. Nils Loewen, MD, PhD, Director of Glaucoma -- UPMC "One question that I'm often asked by other surgeons is "what if your ideal first patient?" And I think one should not so much worry about the stage of the disease but rather have a patient with an easily identifiable mesh work, pigmented trabecular mesh work. If you don't choose such a patient, then you might have a hard time to identify the target structure when you're beginning to learn angle surgery and you might even potentially ablate the wrong tissue, bacillary band for instance, so it makes it much easier to see it nicely outlined by a little pigment. And while that is someone who has just ocular hypertension or someone with a more advanced disease, I think it doesn't really matter so much because in average these patients all end up at about fifteen millimeter mercury and still can afford an eye drop reduction or almost one eye drop reduction in average. So even if you had a patient with advanced glaucoma, you could simply continue all the drops or even add more drops if your target were ten or twelve." Harold A Ballitch II, MD, FACS -- Advanced Eye Care Center "There are a huge number of patients that are a candidate for this procedure and can benefit from it. I mean everybody always wants to flip around and say well what about the guy who's got the point nine cup and is the visual field in split fixation and media pressure effect? Well they're not a candidate. But that's not most of our practices. Most of our practices are filled with patients that maybe have small visual field of fat, cups of seven or eight, somewhere in that range. They don't need a ten target or an eight target. A target of fifteen, sixteen, eighteen is good. They're on several different medications; they're going to have cataract surgery anyway and it marries perfectly with cataract surgery. It's also great in pseudophakes. It works very well in phakic patients but if I were a novice starting out, that's not the patient I would do." Steven D Vold, MD -- Vold Vision "For me, the patients that I like to use for the Trabectome are typically patients with mild to moderate open-angle glaucoma that are on one to three medications undergoing cataract surgery. So that, to me, is the perfect patient. I am going to go in and take out their cataract; they are on multiple glaucoma medications; I can get them off their medicines. Now there are also patients that have, you know, their pressures aren't perfectly controlled, they're poorly compliant. I also think those patients are also very good candidates for the Trabectome. We can do that either as a stand --alone procedure and if they do have a cataract that is visually significant, we can take that out as well. I will tell you for me, a lot of times the driving factor actually interestingly is the cataract because they're complaining about their vision, they're on multiple medicines. I can do that, however, there are times when glaucoma drives that decision as well where they're just not well controlled or compliant and then the Trabectome would be a good choice there."