MAY 5, 2019 | EYEWORLD DAILY NEWS | 49
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laser trabeculoplasty (SLT) in the
patient's right eye. "The pressure
was not budging," she said. That
led her to use a subconjunctival gel
stent via an ab externo approach
along with 40 mcg of mitomy-
cin-C (MMC). This helped lower
the patient's preop IOP of 18 mm
Hg lower to 8 mm Hg postop.
Arsham Sheybani, MD,
St. Louis, reported on a 74-year-
old male patient with primary
open-angle glaucoma (POAG)
with an IOP of 23 mm Hg in the
right eye and using several medi-
cations. The patient also had a pri-
mary tube shunt. The visual acuity
was 20/30, and the visual field was
progressing. "With a mild patient,
it's tough to justify trabeculectomy.
There's where devices can help,"
Dr. Sheybani said. The patient
was treated with subconjuncti-
val MIGS and MMC. By postop
month 9, the IOP was 13 mm Hg,
with no medications used.
Cataract surgeon Deborah
Gess Ristvedt, DO, Alexandria,
Minnesota, shared details on a
76-year-old male patient who had
POAG in both eyes, diagnosed in
2013, and visual acuity of 20/40
and 20/30. The patient also had
cataracts. He was on three medi-
cations. His maximum IOPs were
21 and 22, and his visual field was
worsening. For her cataract and
MIGS treatment, Dr. Ristvedt
considered an angle procedure,
aqueous suppression, or a subcon-
junctival approach but ultimately
chose subconjunctival MIGS.
Jonathan Myers, MD, Phil-
adelphia, discussed a 73-year-old
patient with OAG and age-related
macular degeneration as well as an
IOP of 32 mm Hg in the right eye
and 15 mm Hg in the left eye. The
patient, who was on maximum
medical therapy, said, "I ran out of
timolol last week."
"This is a cry for help," Dr.
Myer said, noting that comments
like that often indicate that pa-
tients are not taking medication as
they should. The patient also had
prior SLT, phaco, and an iStent
(Glaukos) in the right eye.
Dr. Myers used a XEN Gel
Stent (Allergan) ab interno with
MMC in the right eye, which
worked great for awhile. However,
the patient then had an IOP of
27 mm Hg on maximum medical
therapy with a flat bleb. He ulti-
mately performed needling, and
the patient had a buttonhole and
subconjunctival heme. Dr. Myers
used the XEN via an ab externo
approach. At the patient's last fol-
low up 3 weeks ago, his IOPs were
10 and 12 mm Hg, and he was not
on any medications.
Editors' note: This event was supported
by educational grants from Allergan and
Santen Pharmaceutical.
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