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Shakeel Shareef, MD
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The field of angle surgery is undergoing an exponential growth with many devices targeting this surgical space. However, there are a number of common variables surgeons need to consider when performing MIGS surgery. Using a case study, Shakeel Shareef, MD, highlights the essential components of anesthesia, control, and timing, known by the acronym ACT, that are necessary to not only optimize patient safety but also build surgical confidence.
Posted: 3/04/2015
Shakeel Shareef, MD
The field of angle surgery is undergoing an exponential growth with many devices targeting this surgical space. However, there are a number of common variables surgeons need to consider when performing MIGS surgery. Using a case study, Shakeel Shareef, MD, highlights the essential components of anesthesia, control, and timing, known by the acronym ACT, that are necessary to not only optimize patient safety but also build surgical confidence.
Posted: 3/04/2015
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Shakeel Shareef
10 years ago
Jon, thank for your comments and your willingness to try the gel. Unlike phaco, with angle surgery, the entire cornea and the surrounding limbal bulbar conjunctiva is covered by a gonolens. Over 50-450 sensory trigeminal neurons transmit nerve fibers via the ophthalmic division of CN V and terminate in free nerve endings in the corneal epithelium. Additionally, it has been estimated that 33 to 71 nerve bundles in the corneoscleral limbus form the limbal plexus. Lidocaine gel has many advantages including increased efficacy due to prolonged contact time with the ocular surface, better pain control, patient cooperation, and lower tissue manipulation sensation which is needed during angle surgery. The prolonged contact time of the gel was not limited to just the cornea, but also provided better analgesia with the conjunctival nerve fibers, anatomic areas where a goniolens can come in contact within the limbal region should the patient have involuntary ocular excursions. This would also help lessen any discomfort from the Peripheral flange of the Hill Lens or the Cleat Ring on the TVG lens. Shakeel
Jonathan Ellis
10 years ago
Great idea with the lidocaine jelly instead of Healon! I've noticed many of my patients moving from a little pain right when I touch the TM with the istent. I've tried nasal subconjunctival lidocaine injections, but I'll definitely give that a try!