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48 | EYEWORLD DAILY NEWS | MAY 18, 2020 DAILY NEWS ASCRS VIRTUAL ANNUAL MEETING between the groups, Dr. Evans said. In terms of glaucoma med- ications, Dr. Evans noted how the topical group started out by Liz Hillman Editorial Co-Director L acob Evans, MD, Madi- son, Wisconsin, presented research on intracameral injections after cataract surgery combined with iStent (Glaukos) in an on-demand pa- per session devoted specifically to looking at medications and glaucoma. As background for the research, Dr. Evans shared how cataracts and glaucoma fre- quently occur together, and he noted the difficulty associated with postop drops: compliance, higher endophthalmitis risk compared to intracamerals, corneal irritation (NSAIDs), and cost. What's more, steroid drops can cause an IOP spike. "We investigated drug de- livery of an NSAID and steroid in a way that hasn't been done before, namely intracamerally alongside an antibiotic," he said, comparing it to intravitre- al and topical delivery. The single-center retro- spective review included 615 patients who had cataract surgery and iStent (for pri- mary open angle glaucoma) from 2015–2018 with at least 3 months of follow-up. Pa- tients were divided into three groups: topical drops, anterior chamber dexamethasone-moxi- floxacin-ketorolac (AC DMK) with one topical, compound- ed drop per day, and pars plana triamcinolone-moxifloxa- cin-vancomycin (PP TMV) with one topical, compounded drop per day. Dr. Evans noted that the topical group was about 4 years older, on average, than the other two groups. There were no instances of endophthalmitis or other allergic complications in any groups. On a results slide, Dr. Evans drew viewers' attention to eyes with at least one IOP spike and eyes with multiple spikes. There was no statistical difference in either of these Papers evaluate medications and glaucoma patients J challenges with glaucoma and ocular surface disease. Patients without glaucoma who receive a limbal stem cell transplant or a keratoprosthesis, Dr. Denny noted, have a 27% risk of de- veloping secondary glaucoma. As such, Dr. Denny said many surgeons advocate for pretreating high-risk patients with prophylactic surgery. But he noted, even with a low threshold to pretreat, a quarter of eyes will go on to develop secondary glaucoma. For the most part, due to location, Dr. Denny said tubes are usually used after limbal stem cell transplant because the tube can be implanted un- der the stem cells. "These tubes are not without risks and in an effort to find a safer al- ternative, our glaucoma colleagues have turned to cyclophotocoagulation in some cases," he said, adding that this latter procedure has risks of its own. Dr. Denny and his col- leagues compared outcomes and safety profiles of cyclo- photocoagulation and tubes in patients who have had stem cell transplants. The retrospec- tive chart review included 36 glaucoma surgeries (31 eyes) with ocular surface stem cell transplants. Primary outcomes were surface failure (recurrent corneal conjunctivalization) and glaucoma failure (need for further glaucoma surgery). The glaucoma surgeries included were Ahmed FP7, Baerveldt glaucoma implant, or G-Probe cyclophotocoagulation (Iridex). He said there were no significant differences be- tween the Baerveldt and Ahmed tube groups; tubes and cyclophotocoagulation both demonstrated significant IOP reduction; the tube group had superior drop reduction; and there were trends toward greater surface failures in the tube group and more glaucoma failures in the cyclophotocoag- ulation group. While these trends were not statistically significant, Dr. Denny said further analysis showed the failures were not equivalent between groups. In the tube group, he contin- ued, every glaucoma failure required surgical repair and tube revisions resulted in three surface failures. All surface fail- ures were in the location of the tube. Conversely, most of the glaucoma failures in the cyclo- photocoagulation group were treated with repeat cyclopho- tocoagulation. None of these eyes experienced hypotony or phthisis, and only two glauco- ma failures required a tube. "I think the lack of statis- tical significance in this study fails to recognize the clinically significant differences between the groups," Dr. Denny said. "In conclusion, cyclophotoco- agulation is a safe option for the management of secondary glaucoma after limbal stem cell transplantation. CPC should es- pecially be considered in eyes with severe conjunctival dis- ease. The benefits of tubes may outweigh the risks in patients who require more substantial IOP reduction for reduced drop burden." View these presentations and more in SPS-305. Editors' note: Drs. Kilgore and Denny have no financial interests related to their presentations. continued from page 46 continued on page 52 "We investigated drug delivery of an NSAID and steroid in a way that hasn't been done before, namely intracamerally alongside an antibiotic." —Jacob Evans, MD

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