The Reay of Hope session is a regular feature of ASCRS Glaucoma Day where the goal is “for us all to learn through each other’s misery,” said Nathan Radcliffe, MD, one of the co-moderators of the session.
This year did not disappoint with a case of a bent iDose (Glaukos), a case with no conjunctiva discovered when beginning a bleb-forming procedure, and a case of a flat anterior chamber and hypotony that was referred for treatment.
Source: ASCRS
The winner of the session was Jia-Yue You, MD, who presented on a case that was referred for flat anterior chamber and hypotony. This patient had a prior Preserflo MicroShunt (Glaukos) that had failed and undergone a revision as well as a temporal trabeculotomy.
When she got this patient into the OR, she sutured a leak, but even after the leak was resolved, the chamber remained flat. Dr. You started to expect a posterior pushing mechanism. She showed in the video that she started draining choroidals, which were quite large and issued a “nice gush of fluid.” After those were drained, the anterior chamber was able to be reformed with balanced salt solution.
From there, Dr. You went forward with cataract surgery, which she said was more challenging than usual. During the case, she confirmed there were no leaks in the two blebs and confirmed the iris was not stuck. She made some sclerectomies as well.
Source: ASCRS
At the end of the case, the anterior chamber was formed and the patient was 20/30 uncorrected, which Dr. You said was a great improvement over the patient’s prior hand-motion vision.
Other video cases included one by Christine Funke, MD, who presented a case of a bent iDose implant. She showed how she tried several times to insert the implant, but it wouldn’t remain within its intended space. She eventually noticed the tip was bent. “Now I’m going to take it out and say, ‘Is this really a titanium bent tip’ because how could that happen?”
She said she successfully removed the travoprost implant and implanted a new, unbent one. The lesson learned: Check my iDose before implanting, Dr. Funke said, noting that she’s discovered a second bent one, and she’s still not sure how this happened.
Arkadiy Yadgarov, MD, presented a case where the patient had glaucoma on maximum medications, pressures that were not optimal, significant cataracts, conjunctival follicles, conjunctival injections, and punctate keratopathy. He was going to give the patient a trabeculectomy but when he began his conjunctival dissection, he discovered there was no conjunctiva. He went forward with cataract surgery and inserted an AlloFlo (Iantrek), which created a large cyclodialysis cleft. “In my mind, I felt this was the only thing viable for this patient with as much disease as he had,” Dr. Yadgarov said.
Financial disclosures
Funke: AbbVie, Alcon, Glaukos, New World Medical, Nova Eye Medical, Sight Sciences, Thea
Yadgarov: AbbVie, Alcon, Bausch Health, Glaukos, Iantrek, New World Medical, Sight Sciences
You: None
