Glaucoma treatment has entered the era of minimally invasive glaucoma surgery (MIGS). In particular, surgeons now have several techniques to perform trabecular micro-bypass. Because these are new treatment options, some areas of MIGS management have yet to be fully explored. For example, after a successful trabecular micro-bypass procedure, would one type of medication be preferred over another? It is possible in the next several years that we will have at least one new medication approved that increases outflow through the trabecular meshwork pathway. As this is the very pathway that is enhanced with trabecular bypass, it could be helpful to know if these therapies will be synergistic or redundant.

Recently, Dr Sean Park and colleagues performed an investigation of the in vivo effect of pilocarpine on the Schlemm canal. Using optical coherence tomography and 3-dimensional reconstruction to measure the volume of the canal, the investigators were able to demonstrate that topical pilocarpine increased the volume of the canal by 21% in healthy eyes and by 24% in eyes with glaucoma. This study provides a methodology for evaluating the canal’s dynamic response to medications or to surgical therapy. As our therapies evolve, investigations such as this may allow us to better understand how MIGS and meds interact.

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