Tips for success
Dr. Brown provided several pearls for performing MIGS. First, he said he warns patients that the glaucoma procedure may not be possible, especially if he is worried about the case.
“I usually say there may not be enough room. This is part of the informed consent and it gives the surgeon an out,” he explained.
“It is better to have this conversation before the surgery than after. It is part of the under-promise and over-deliver approach.”
Intraoperatively, Dr. Brown uses trypan blue 0.06% dye (VisionBlue, DORC) in every MIGS case. He explained that it stains the trabecular meshwork. Therefore, it provides a “landing strip” if he is implanting a stent (Stent, Glaukos). Or, if he is implanting another device (CyPass Micro-Stent, Alcon Laboratories), it helps him to position the device so that the tip is at the desired location at the top of the meshwork.
Other tools are used whenever needed, including a pupil expansion ring, capsular tension hooks, or pars plana vitrectomy. Dr. Brown presented some intraoperative videos demonstrating challenging cases where he used these adjuncts to achieve a good outcome.
Dr. Brown receives patents/royalty from Glaukos Corp.