Eyeworld

20 | EYEWORLD | SEPTEMBER 2021 ASCRS/EYEWORLD JOURNAL CLUB ASCRS NEWS by Hetal Ray, MD, Wendy Linderman, MD, and Jessica Chow, MD period. The procedures included in the study were iStent (Glaukos), iStent inject (Glau- kos), Hydrus (Ivantis), OMNI (Sight Sciences), gonioscopy-assisted transluminal trabeculoto- my (GATT), and XEN (Allergan). The primary outcomes of the study were reoperation rates and indications within a 90-day period follow- ing MIGS procedure. Additional data included details of intraoperative and postoperative com- plications, time to reoperation, and outcomes at 1 month following reoperation. Results There were 448 MIGS procedures included in the study. Twenty-three eyes underwent reoperation. Patients who underwent reopera- tion had a mean age of 70, were predominantly female, and most often had moderate to severe glaucoma. Sixteen of the 23 eyes that underwent reop- eration had the XEN, 4 iStent/iStent inject, and 3 goniotomy/GATT/OMNI. Therefore, all types of MIGS except Hydrus were represented in the group of eyes that required reoperation, though the sample size of patients undergoing Hydrus was small (8 patients). There was a statistically significant higher rate of reoperation in the XEN group. Eleven of the 16 eyes that required reoperation after XEN were implanted in an ab interno fashion. The most common indication for reopera- tion was elevated IOP. The XEN group also had bleb-related indications for reoperation includ- ing exposure, wound leak, and early encapsula- tion. The most common reoperation performed in the XEN group was needling with an antifi- brotic agent. A few eyes required major proce- dures such as a second XEN, trabeculectomy, or glaucoma drainage device. In the iStent group, 2 eyes required IOL repositioning or secondary IOL implantation related to cataract surgery complications and 2 eyes required XEN. In the angle-based group, 3 eyes required trabeculec- tomy. In all groups, average time to reoperation was 39 days, with a range of 4 to 82 days. Postoperative results following reoperation were encouraging. Following reoperation, there Review of "Reoperation for complications within 90 days of minimally invasive glaucoma surgery" G laucoma is a leading cause of blind- ness worldwide. 1 Adequate lower- ing of IOP remains the mainstay of glaucoma treatment. Prior to 2012, surgical management of glaucoma consisted primarily of trabeculectomy and glau- coma drainage implants. Since 2012, minimally invasive glaucoma surgeries (MIGS) have been developed to lower IOP by bypassing the trabec- ular meshwork for mild to moderate glaucoma. MIGS boasts faster recovery, lower impact on leisure activities, and a greater safety profile compared to traditional glaucoma filtering surgeries. However, reported complications of MIGS include decreased vision, IOP elevation, hyphema, corneal edema, device movement, and need for reoperation. This paper is the first of its kind to describe short-term postoperative complications in eyes after minimally invasive glaucoma surgery. Design This was a retrospective case series studying postoperative complications in the 90 days following MIGS procedures. Data was collected at a single tertiary care center over a 6-month The ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the July session featured a presentation by Jake McMillin, MD, author of "Accuracy of intraocular lens calculation formulas for flanged intrascleral intraocular lens fixation with double-needle technique." The second manuscript, "Re- operation for complications within 90 days of minimally invasive glaucoma surgery" was presented by Hetal Ray, MD, resident, Yale Eye Center. To view the July Journal Club session, visit ascrs.org/clinical-education/ journal-club/schedule/july-2021. Jessica Chow, MD Residency Program Director Yale Eye Center New Haven, Connecticut Hetal Ray, MD Ophthalmology Resident Yale Eye Center New Haven, Connecticut Wendy Linderman, MD Ophthalmology Resident Yale Eye Center New Haven, Connecticut

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