#sclerectomy

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Managing Complications in Glaucoma Surgery by Francis Carbonaro, ISBN-13: 978-3319494142 [PDF eBook eTextbook] Publisher: ‎ Springer; 1st ed. 2017 edition (March 8, 2017) Language: ‎ English 121 pages ISBN-10: ‎ 3319494147 ISBN-13: ‎ 978-3319494142 This well-illustrated book is intended as the go-to guide for the identification and management of the complications associated with specific glaucoma procedures. All of the routinely performed procedures are covered: filtration surgery, including trabeculectomy and ExPRESS shunt, nonpenetrating surgeries such as deep sclerectomy and canaloplasty, procedures involving the placement of tube shunt devices, glaucoma laser treatments, and minimally invasive glaucoma surgeries (MIGS). The book is succinct but sufficiently detailed to provide the reader with a very well informed description of possible complications and the best way to manage them, based on the evidence from recent and seminal research. The authors are recognized experts who come from a wide geographic and varied glaucoma background. The book will be ideal for all surgeons, whether new or experienced, who seek easily accessible, reliable guidance on how to manage the intraoperative and early and late postoperative complications that may arise when performing glaucoma surgery. What makes us different? • Instant Download • Always Competitive Pricing • 100% Privacy • FREE Sample Available • 24-7 LIVE Customer Support

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15 Dumb Mistakes That’ll Tank Your Glaucoma Surgery Devices Market Business

Glaucoma Surgery Devices Marketplace is segmented By Product Type (Punches, USC Marker, USC Planer, USC Electric shaver, Forceps, Others), By Surgery Type (Trabeculectomy, Tube Shunt Implantation, Cyclophotocoagulation, MIGS, Others), By End Customers (Eye Hospitals, Diagnostic Centres, Others), and Region (North United states of America, Latin America, Europe, Asia Ocean, Middle East, and Africa)– Share, Size, Outlook, and Options Analysis, 2022- 2029

Market Overview

Glaucoma Surgery Devices Market size was valued at US$ XX several in 2021 and is predicted to reach US$ XX several by 2029, growing at a CAGR of 24. 60% during the forecast period (2022- 2029).

Glaucoma is a place of ocular ailments that will induce vision loss and loss of sight by injuring the optic nerve system. The aqueous humour, fluid within the eye, usually rushes from your eye using a mesh-like channel. The issue port gets clogged, and excessive aqueous joy production may increase the intraocular pressure damaging the optic nerve system. Glaucoma usually impacts both visions, whereas it would be more alarming in one than the other.

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Marketplace Dynamics

Glaucoma surgery advancements, cool product developments, increased encounters of cases, and growing awareness about glaucoma fuel global market growth.

Glaucoma surgery advancements and the increasing hassles of glaucoma worldwide are pushing the global market growth.

Glaucoma surgery improvements fuel global market growth, like the emergence of minimally surgical glaucoma surgery (MIGS), subconjunctival MIGS, and cyclophotocoagulation. MIGS is a bunch of procedures otherwise understood as an angle-established procedure that comprises Trabecular getaway from stents, such as iStent( Glaukos) and Hydrus( Ivantis), Trabecular getting rid, such as Trabectome( MicroSurgical Technology), Kahook Dual Blade( New Community Medical), and Goniotome( MicroSurgical Technology), Trabecular unroofing, such as gonioscopic- assisted transluminal trabeculotomy, or GATT, and OMNI( Sight Sciences), Schlemm 's canal dilation via abs interno canaloplasty( Ellex), and Suprachoroidal stents.

Furthermore, the growing relationships of glaucoma globally are driving a car global market growth. Matching to the World Glaucoma Affiliation, established on prevalence studies, it is assessed that over 79. 6 million individuals had glaucoma in 2020, and it is predicted to rise to around 111. 8 million individuals by 2040. At least, 50% of people with glaucoma do not know they are affected. In a few developing nations, 90% of glaucoma is undetected.

The health problems and large are significant concerns for your glaucoma surgery devices market growth.

However, the costly glaucoma surgery will hamper global market growth during the forecast period. For instance, laser surgery is considered a poor-cost surgery and costs$ 1, 1000 to$ 2, 000, whereas an Incisional surgery will cost around$ 11, 000.

COVID- 19 Impact Analysis

During the outbreak, glaucoma management was difficult to perform, which led to switching the concentrate on tele glaucoma, like the advancements in home monitoring of intraocular pressure (IOP) and visual fields. For instance, I care USA developed the Rebound tonometer authorized for IOP measurements. Even, the Eye mate telemetric IOP detector is newly endorsed for operation in Europe and is an ongoing implantable monitoring device for patients with open-angle glaucoma.

Furthermore, the consistency of trabeculectomies declined within the COVID- 19 outburst to a certain degree because of the range of postoperative visits and procedures required, because of this, the traditional and micro pulse diode laser, glaucoma draining devices, deep sclerectomy, and Preserflo seem to resort as they might require less intensive postoperative medical care. The need to minimize patient contact during surgery and aid postoperative supervision to downsize the risk of COVID- 19 transmission has immensely influenced the choice of surgery type offered after the outburst with an inclination to lower postoperative follow-up, interventions, and not as long surgical time, containing significantly influenced the glaucoma surgical device market.

Portion Analysis

Typically, minimally Surgical Glaucoma Surgeries (MIGS) are required to grow at the speediest CAGR throughout the forecast period (2022- 2029)

Minimally Surgical Glaucoma Surgeries (MIGS) is awaited to dominate the worldwide market within the forecast period (2022- 2029). Since other operations have a lengthy report on likely complications, there is a heightened reliance upon minimally invasive glaucoma operations because they supply equivalent IOP- lowering abilities when compared with traditional incisional surgeries using a greater safety profile. Furthermore, the approval for minimally surgical glaucoma surgery devices ensures the dominance of MIGS over the global market, for example, on November 17, 2021, iSTAR Medical received European market approval for glaucoma implant MINIject. Also, on August 03, 2022, the Circumstance. S. Fda(FDA) granted endorsement to Glaukos Corporation for it is iStent infinite, a trabecular small-bypass system meant for utilization in a standalone method to lessen elevated intraocular pressure( IOP) in patients with principal open-angle glaucoma out-of-hand by previous medical and surgical treatment.

Physical Analysis

southwest American region hosts the biggest share of the glaucoma surgery devices market.

North America rules the global glaucoma surgery devices market. It is predicted to dominate throughout the forecast period (2022- 2029) owing to the existence of a bulk of market players holding a larger share of the global market through different market methods such as product launches, verifications, acquisitions, expansions, Etc in this area. Such as, on August 08, 2022, Corza Medical, a leading global manufacturer of ground-breaking surgical technologies in the us, acquired Barron Precision Instruments, expanding its stock portfolio of ophthalmic surgery products, in March 7, 2022, Alcon, a U. S. based ophthalmic devices company launched its Clarion IOL Portfolio in the U. S i9000. strengthening its hold over the ophthalmic market also, on January 10, 2022, Alcon acquired Ivantis, Inc., adding Hydrus Microstent, a minimally invasive glaucoma surgery (MIGS) device designed to lower eyesight pressure for open-perspective glaucoma patients in connection with cataract surgery. Also, the high incidences of glaucoma among the American population are fueling the dominance of this region over the global market, for illustration, CDC states that over 3 million Americans have glaucoma rendering it one of the foremost factors behind irreversible blindness in the Unified States and costing the Circumstance. S. economy$ 2. 86 thousand each year in direct costs and productivity losses. Also, it is predicted that glaucoma will affect those over 6. 3 several Americans by 2050.

Affordable Landscape

Industry expanding innovation upon glaucoma surgery devices obligates industry players to remain competitive to help keep an area available on the market, the glaucoma surgery products market Corza Medical, Alcon, Inami& Co., Ltd., Katalyst Medical, Lumenis, Millennium Surgical, Moria Medical, Zabbys, Johnson& Johnson and Allergan are fundamental players. These types of key players hold most of the market share through improvements, product launches, collaborations, acquisitions, and alliances. For example, on Sept 16, 2021, Johnson& Manley Vision, a portion of the Johnson& Manley Medical Devices Companies, collaborated with Black EyeCare Perspective, a not necessarily- for-profit business.

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Micro Perforating Deep Sclerectomy: A New Modification of Non Penetrating surgeries to Improve results and Flatten learning Curve-Juniper Publishers

Introduction

The High intra ocular pressure (IOP) is the only risk factor that we can control in glaucoma treatment, and it has been shown that reducing this pressure will stop or reduce glaucoma progression. Usually, when the patients diagnosed, wesill start treatment with drops that reduce aqueous humor production or increase its out flow in the trabecular mesh work in order to reduce the pressure inside the eye. But sometimes, this reduction is not enough and we can´t reach to our planified Target Intraocular pressure and it´s necessary to plan a surgical procedure that could reduce this pressure even more too finally achieve our intended IOP.

Glaucoma surgery has multiple variations but the gold standard procedure is still the trabeculectomy, creating a pathway from the anterior chamber, to the subconjunctival space by a scleral ostium and and peripheraliridotomy. This surgical technique is usually not very difficult to perform, but the chances of having surgery or post operation complications are very high, specially, those related to ocular hypotension due to unexaggerated and not controlled out flow. Another usual problem is when we try to control or reduce the out flow, and we perform really small ostiums or very tight sutures in the scleral flap and we get a poor result in the reduction of the intraocular pressure.

So there are many options to develop a surgery that can provide good intraocular pressure reduction with fewer complications than the penetrating procedures like trabeculectomy or valve implants. The development of Non penetrating Deep Sclerectomy became one of the most promising of this new surgical techniques. It is described as a good option for open angle glaucoma, especially if the target IOP, is not very low, or when the risk of hypotonic is high (phakic, nanoftalmos, Hypermetropia). This technique consist carving a first superficial scleral flap of about 4 or 5 mm wide and 1/3 of scleral thickness, then its carved a second Deep scleral flap is about 3 to 4 mm and almost 2/3 of scleral thickness arriving just choroid darkness. This Deep flap goes forward until we see the change of the scleral fibers when the scleral spur is located, then we find the external Wall of Schlemm's canal, Schwalbe´s line and continue forward at least one or two millimeters into clear corneal stroma. At this moment an anterior chamber paracentesis can be done to avoid prolapse of schlemm´s cannel tissue or the perforation of this very thin tissue that remains between anterior chamber and the outside, that we call trabeculo-Descemet membrane. These cond deepest flap is cutted and then next step is to remove that schlemm´s cannel outer Wall and at that moment we will see a continue controlled filtration or aqueous humor, without collapsing or abrupt compression of the anterior chamber.

This technique has shown good results in intraocular pressure reduction, compared to trabeculectomy, with an important difference in the incidence of complications related with hypotonic (atalamy, cataracts, endothelial damage, hypotonic aculophaty, retinal detachment, choroidal effusion or detachment) or to the communication of the outside environment with the inside of the eye (Endophthalmitis).

This is a safe, effective technique but with a very high learning curve, especially at the moment of the second Deep flap carving when the trabeculo-descemetic membrane is created, the perforation of this very thin tissue is a common complication and usually learning specialists try to avoid it by not going very Deep, over the choroidal plane and that is a reason, why the surgeons can´t get the correct plane, that will guarantee and adequate aqueous filtration trough the trabeculode scemtic membrane into the scleral lake as a decompression chamber, sub conjunctival space. The use of laser goniopunctures were needed to get the IOP lowering effects pected.

This was our main problem when we tried to learn and teach this technique in Bolivia, we had to convertion to trabeculectomy due to perforation or not enough IOP lowering effect.

The solution was to perform the surgery with the same steps as the original but when we found the remaining tissue was too thick to achieve a good filtering function, the risk of perforation trying to go deeper, we used a 30 gauge needle to perform about 5-10 micro perforations in the trabeculode scemetic like membrane we created, turning this membrane into a net like tissue that kept the resistance of the aqueous out flow, avoiding fast decompression problems. And hypotony problems in the post operation period without requering an extra procedure like yag laser goniopunctures or surgery revision.

Results

66 cases have been conducted from which (9.09%) should have been turned into trabeculectomy by perforation of the trabecular descemetic membrane. On a 3-year average follow-up, a 17+-3 IOP was obtained during the first year in 54 patients (81,8%) in 50 (75,7%) after 2 years, and in 48 patients (72,7%) after 3 years of control, and them education had to be restarted in the rest. Out of the operated patients, only 7required a new surgical procedure (Ahmed valve implant) on the 3rd year of the follow-up. No cases of hypothonia, at halamia, choroid detachment or end ophthalmitis were reported 3 years after the control.

Discussion

On our first years of experience with the non penetrating Deep sclerectomy, we found our selves continuosly with the situation of membrane perforation, or a thickker, non functioning membrane created. We need to turn many surgeries into big trabeculectomies, that increased the incidence of hypontony related complications in the post operatory time or if we were conservative, filtering surgeries that worked bad or didn´t work at all, needing new medications, new surgeries, oryag laser retreatment.

Turning Non Penetrating Deep sclerectomy surgeries into Micro Perforation Deep Sclerectomy give us a safe, effective option, that we used a lot in the beginning, with practice and gaining experience. We need to use less over time, once having dominated the surgery planes we needed to reach, when the learning curve was passed.

Its is a good option for learning residents or experienced surgeons who want to start with the Non penetrating surgeries to reduce the chances of complications and increse effectiveness of the filtering technique, until they achieve the needed practice to perform a perfect flaps carving and reaching a trabeculo-decement level needed to really reduce IOP.

Learning non penetrating surgeries, allows Glaucoma surgeons to identify and reach schlemm´s channel, and that opens options for other Glaucoma surgeries, like visco canalostomy, canaloplasty, ortrabeculotomy.

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