Eyeworld

22 | EYEWORLD | SEPTEMBER 2021 ASCRS NEWS Contact Ray: hetal.ray@yale.edu Chow: jessica.chow@yale.edu The panelists in the ASCRS Journal Club pointed out that even in cases of recently diag- nosed, mild glaucoma, a percentage of patients will progress to severe disease. This is exempli- fied by the LiGHT study, in which 1.8% of ocu- lar hypertension patients required a traditional glaucoma surgery within 3 years despite no evidence of glaucomatous damage at presen- tation. 6 In the future, MIGS may be offered to ocular hypertensives as early surgical options to decrease risk of progression to advanced dis- ease. More long-term outcomes data is needed to further analyze the safety profiles among the MIGS procedures and compared to traditional glaucoma surgery. The authors published the first study of short-term reoperation rates after MIGS. True to its definition, MIGS has a favorable safety pro- file compared to traditional glaucoma surgery. The XEN group had the highest rate of reopera- tion. MIGS continues to emerge as an important surgical option for eyes with glaucoma. surgeon. Only interventions performed in the operating room were included in this study. In particular, this study excluded in-office needling and likely underestimated the rates of needling in the XEN group. This study's focus was on the 90-day postoperative period, and therefore did not offer insight into late-term complications that may occur. Other studies have also looked at longer-term outcomes following MIGS. In a retrospective study, eyes were followed 1 year after XEN implantation, and 6% had transient hypotony, 10% had 2 or more Snellen lines lost, and 16% required a second glaucoma proce- dure regardless of ab interno or ab externo approach. 3 In a prospective study of eyes with cataract and mild to moderate primary open an- gle glaucoma, Hydrus implantation reduced the probability of incisional glaucoma surgery from 3.9% to 0.6% in a 3-year period as compared to cataract surgery alone. 4 One large randomized study of 152 eyes compared Hydrus and iStent and found a statistically significant decreased reoperation rate (0 versus 3.9%) and reduced medication use in the Hydrus group. 5 Reoperation for complications within 90 days of minimally invasive glaucoma surgery Wesam Shamseldin Shalaby, MD, Joseph Bechay, BS, Jonathan Myers, MD, Daniel Lee, MD, Reza Razeghinejad, MD, Natasha Nayak Kolomeyer, MD, L. Jay Katz, MD, Aakriti Garg Shukla, MD J Cataract Refract Surg. 2021;47(7):886–891. n Purpose: To describe reoperations that occurred within 90 days of minimally invasive glaucoma surgery (MIGS) at a single institution over a 30-month period. n Setting: Tertiary care hospital. n Design: Retrospective case series. n Methods: Charts of adult patients who underwent trabecular microbypass stents, gel microstents, and goniotomy procedures (including gonioscopy-assisted transluminal trabeculotomy) from October 1, 2017 to March 15, 2020 at Wills Eye Hospital were examined. Outcome measures were unanticipated reoperations within the first 90 days after MIGS procedures and the complications that led to these reoperations. n Results: 448 MIGS procedures were performed on 436 eyes of 348 patients over a 30-month period by 6 glaucoma surgeons. Of these, 206 (46.0 %) were trabecular microbypass stents (198 iStent/iStent inject [Glaukos], 8 Hydrus [Ivantis]), 152 (33.9%) were gel microstents, 90 (20.1%) were goniotomy procedures. Combined phacoemulsification took place in 256 (58.7%) eyes. Reoperation within 90 days took place in 23/436 eyes (5.3%), including 16/152 eyes in the gel microstent group (10.5%), 4/198 eyes in the iStent/ iStent inject group (2.0%), 3/90 eyes in the goniotomy group (3.3%). Indications for reoperation were elevated intraocular pressure (IOP) in 16/23 eyes (69.6%), gel microstent tip exposure with wound leakage in 3/23 eyes (13%), and early gel microstent encapsulation without elevated IOP in 1/23 eye (4.3%). 2/23 eyes (8.7%) required reoperation for lens complications while 1/23 eye (4.3%) had elevated IOP and aphakia requiring reoperation. n Conclusion: The rate of reoperation within the first 90 days after MIGS was low. Elevated IOP and complications associated with gel microstents were the main indications for reoperation. continued from page 21

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