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10 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS Stretching forceps (Epsilon) and briefly shared another case like this that confirmed tube durability over time. Dr. Herndon also said that this technique of saving the implant is more cost effective than complete replacement. Ang Li, MD, presented a video that showed a transcorneal tube tie off for chronic hypotony due to ex- posed ripcord. Mary Qiu, MD, shared a video involving a 78-year-old pa- tient with severe POAG. This patient was pseudophakic in both eyes with a Baerveldt-350 in her right eye and a failed EX-PRESS shunt (Novartis) in her left. Dr. Qiu's video showed GATT performed in this eye. She had difficulty pulling the GATT through a couple of times, but let go in those instances and ultimately was able to complete a 359-degree trabeculotomy. Editors' note: The speakers do not have financial interests related to their comments. A SCRS Glaucoma Day concluded with the 13 th Annual Video Session: Complications and Reay of Hope. "This is where all of you get to choose the gnarliest, best, ugliest, video of the year. Thank you to our brave souls who are bearing it all for you," session moderator Manjool Shah, MD, said. The winning video was present- ed by Ari Leshno, MD, and Aakriti Shukla, MD, as a fellow/attending team. The case was called "A Hole in One." They showed a 56-year-old with moderate JOAG who was re- ferred with an IOP of 46 mm Hg, on maximum medical therapy, and prior surgical interventions. They decided to pursue trab- eculectomy. They described how during flap creation an area of weak- ness was observed on the right side of the flap. They continued placing sutures, and at one point, the stay suture detached. They replaced this suture, made multiple needle passes through the flap, and then entered the AC. They then noticed a leak on the left side of the flap, so they put a suture there. Then there was a leak on the right side of the flap, so they sutured again. Then there was a gush of fluid from the central flap, showing a hole that they speculated could have been made from multiple needle passes and stretching of the flap. They used a graft to remedy the problem, trimmed the flap, closed the perimetry, and ended up with a water-tight, sealed, elevated bleb and a deep AC. Leon Herndon Jr., MD, present- ed a video titled "Save the Implant: Transected Baerveldt Tube." The patient was a 73-year-old male who was pseudophakic, had severe pseudoexfoliation glaucoma, and a history of trabeculectomy, endo- scopic cyclophotocoagulation, and XEN Gel Stent (Allergan) in the right eye. Despite these interventions the patient had persistently high IOP (27 mm Hg on max medical therapy), and his care team decided to place a Baerveldt drainage device (Johnson & Johnson Vision). The patient's XEN was also removed. Once in the OR, under general anesthesia at the patient's request, as the Baerveldt was being prepared, the tube was transected with a Vicryl suture and fell off the surgical field. While opening a new implant would be a reasonable option, Dr. Hern- don said, there was not another one available in the ASC where he was operating, and a new implant would have been expensive. So he was forced to salvage the implant. The questions were: Is it doable? Is there an alternative tube if the main tube fell off? How to connect the tubes? "What if we can marry the Craw- ford tube with the Baerveldt tube and save this device? Here comes the Herndon tube stretching forceps," Dr. Herndon said, demonstrating this technique that connected the two tubes followed by completing the case normally. At postop day 1, Dr. Herndon said the patient was doing well with a stable tube visible in the sulcus and an IOP of 8 mm Hg. At 6 months, the tube was still stable with an elevat- ed and vascular bleb and an IOP of 10 mm Hg. At this point the patient was on dorzolamide timolol BID and latanoprost each night. In the presentation, Dr. Hern- don described the Herndon Tube C M Y CM MY CY CMY K Complicated video cases showcased at Glaucoma Day Dr. Li presents a case video of transcorneal tube tie off due to an exposed ripcord.

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