Eyeworld

EW GLAUCOMA 68 November 2017 many fantastic glaucoma presentations, particularly in the area of microinvasive glaucoma surgery (MIGS). Long before the iStent (Glaukos, San Clemente, Cal- ifornia) had FDA approval and MIGS revolutionized glaucoma care, Michael Berlin, MD, developed excimer laser trabeculostomy (ELT). ELT in many ways was a procedure ahead of its time: a minimally invasive, clean, and pre- cise laser trabecular bypass technique that could safely and effectively lower IOP, alone or in combination with cat- aract surgery. Dr. Berlin's dedication to the development of ELT technology has been fruitful, and at the ASCRS•ASOA Symposium & Congress we saw the pre- sentation of true long-term efficacy both with and without phacoemulsification. This data, which demonstrated more than 40% IOP lowering, not only vali- dates ELT as a treatment but also offers proof of concept for MIGS (trabecular bypass in particular) as a long-term glaucoma treatment. Dr. Berlin is to be congratulated for this body of work and for elevating the MIGS literature with his quality data. Multicenter open-label study of the performance of a new gel stent in refractory glaucoma in the United States Arsham Sheybani, MD, Davinder Grover, MD, William Flynn, MD, Kent Bashford, DO, Richard Lewis, MD, Barbara Niksch Purpose: This multicenter, single-arm, open-label, pivotal study assessed the intraocular pressure (IOP)-low- ering and complications of an ab interno placed, minimally invasive gel stent (XEN 45, Allergan, Dublin, Ireland) in refractory glaucoma over 12 months. Methods: Patients ≥45 years old with refractory glaucoma (prior failure of filtering or cilioablative procedures, or having a condition whereby ex- perience indicates a filtering proce- dure would not provide satisfactory tion and deteriorating visual fields were included in a prospective study. 46 eyes of 46 patients underwent ELT alone. 37 eyes of 37 patients with OAG and clinically signifi- cant cataract underwent combined ELT+Phaco. Peribulbar anesthe- sia, fiberoptic ELT probe traverses anterior chamber to contact TM and excise five to 10, 200-μ chan- nels into Schlemm's canal. IOP at 1 month was compared to all subse- quent follow-up visits, 3 months, 6 months, 1, 2, 3, 4, 5, 6, 7, and 8 years postop, as were number of medications, vision, complications, adverse events (ELT alone: 21/46, ELT+Phaco: 19/37). Results: At 8 years, mean IOP in the ELT alone group was 16.1 ± 3.4 mm Hg compared to a non-washed out preop IOP of 22.9 ± 5.4 mm Hg (p-value IOP <0.001, 29.7% reduc- tion). In the ELT+Phaco group, the mean IOP was 14.2 ± 3.1 mm Hg compared to non-washed out preop IOP of 25.1 ± 6.1 mm Hg (p-value IOP <0.001, 43.4% reduction). The number of glaucoma medications at 8 years for the ELT alone group was 1.2 ± 1.2 compared to 1.6 ± 0.7 at preop (p-value meds 0.152). The number of medications for the ELT+Phaco group was 1.8 ± 0.8 com- pared to 1.3 ± 0.7 at preop (p-value meds 0.087). No complications. No adverse events. Conclusion: ELT alone and ELT+Pha- co are clinically safe, effective, and long-lasting MIGS procedures that enable long-term (8 years), consis- tent, significant reductions in IOP in patients with OAG. 8 years post-ELT, a MIGS procedure with no implants, IOP lowering efficacy was equivalent to 1- and 5-year data on IOP low- ering following combined iStent + Phaco. Dr. Radcliffe: At the 2017 ASCRS• ASOA Symposium & Congress, we saw efficacy, consistency over time and safety of excimer laser trabeculo- stomy (ELT) both as a standalone procedure and combined with phacoemulsification (ELT+Phaco) in patients with open angle glaucoma (OAG) and in patients with coexist- ing OAG and surgical cataract. Methods: 83 eyes of 83 consecutive patients with OAG with uncon- trolled IOP on maximum medica- tions, increasing optic disc excava- Nathan Radcliffe, MD, highlighted the best glaucoma papers at the "Best of ASCRS" session at the 2017 ASCRS•ASOA Symposium & Congress. The papers were chosen from the Best Paper of Session winners. Here are the abstracts from the studies, with Dr. Radcliffe's comments regarding each selection. Eric Donnenfeld, MD, and Ronald Yeoh, MD, moderated the session, with panelists Reay Brown, MD, Clara Chan, MD, Boris Malyugin, MD, PhD, Kevin Miller, MD, and Vance Thompson, MD. Best of ASCRS: Excimer laser trabeculostomy MIGS procedure using no implants while lowering intraocular pressure over 8 years, alone and with phaco Michael Berlin, MD, Marc Toeteberg-Harms, MD, Lea Kleineberg, MD, Vigan Roka, MD, Richard Paul Stodtmeister, MD, Ulrich Giers, MD Purpose: To evaluate the long-term, 8-year intraocular pressure-lowering

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