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12 | EYEWORLD DAILY NEWS | JULY 24, 2021 ASCRS ANNUAL MEETING DAILY NEWS T he 11th Annual Complica- tions and "Reay of Hope" Video Case Presentations closed out ASCRS Glauco- ma Day with Manjool Shah, MD, winning the award. Dr. Shah presented the case of a 77-year-old patient with advanced glaucoma and an IOP of 17 mm Hg on three medica- tions. He had an exposed tube that needed revision and he was monocular. "Of course," Dr. Shah said, introducing his video called "Oh Snap!" After a lengthy discussion about the risks, Dr. Shah said the patient agreed to undergo the revision, which Dr. Shah alluded was not the complication. After getting to the tube, there was a little aqueous egress, Dr. Shah said, so his fellow went in to reform the chamber with a little viscoelastic and … pop. "You could swear you could hear it in the OR," he said, noting it was the fellow's first time in the OR with him. Descemet's membrane was completely stripped off into the anterior chamber. Dr. Shah said they went into the newly visco- elastic-formed space and did a dry aspiration technique. After assessing the space, he pointed out how you could see Descemet's coming up to the cannula. Multi- ple passes were taken in and out to clean up as much viscoelastic as possible. The viscoelastic was exchanged for air to keep the chamber formed, the tube proce- dure was finished, and the patient was supine for an hour postop in recovery. Postop day 1 the patient was hand motion only with an IOP of 4 mm Hg and Descemet's was still detached. What's next? Dr. Shah said they talked about creating venting incisions through the stromal bed and rebubbling, rebubbling alone, or even a DSEK. Observation was selected. By postop day 4, Descemet's was still detached. Postop month 2, the cornea was more compact and Descemet's was attached, but the patient's vision was still poor. Poor vision continued at postop month 6. At 1 year, the patient was 20/150 and IOP stabilized around 10 mm Hg. Brian Francis, MD, presented another case in the session. It in- volved a patient with POAG, IOP in the 20s on three medications, and a visually significant cataract. The patient had prior RK and hex- agonal cuts in the cornea. When doing the cataract surgery, there was a break in the posterior chamber but the anteri- or hyaloid was intact. Dr. Francis said he decided to use a three- piece sulcus lens but inserted it the wrong way. He flipped it in the eye, which ended up breaking the anterior hyaloid, bringing vit- reous forward. A limited anterior vitrectomy was performed. Despite these challenges, Dr. Francis decided to go forward with implanting Hydrus (Ivantis). It was going fairly well, but it didn't advance far enough. A long end was sticking out in the anteri- or chamber and facing toward the cornea. Dr. Francis used forceps to rotate it and push it into place. At this point, he was doing a little more vitreous cleanup and the patient moved. The iris began to bleed (Dr. Francis later found out the patient was on blood thin- ners). The case moved forward and the patient moved again. Fortunately, this was toward the end of the case. Ultimately, the patient did well, ending up 20/30 with a pressure in the mid-teens on one medication. Other video presentations in- cluded a case of titrated combined choroidal drainage and cataract surgery by Reza Razeghinejad, MD, and a case of accidental iris capture presented by Reay Brown, MD. Editors' note: The physicians have no relevant financial interests. 'Reay of Hope' showcases dramatic complicated case videos Dr. Shah (second from right), voted by the audience as winner of the "Reay of Hope" award, poses with moderator Thomas Patrianakos, DO, Dr. Francis, Dr. Razeghinejad, and Dr. Brown. Source: ASCRS

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