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20 | EYEWORLD DAILY NEWS | APRIL 6, 2024 ASCRS ANNUAL MEETING DAILY NEWS The video showed Dr. Patel indenting the sclera at least 13 mm back in an attempt to visualize the plate. He continued to do this and tried to go around it to rotate it and, as the audience gasped, he said, "you see a big gape of fluid. This is the point where the globe perforates." Dr. Patel continued explaining how the video showed a red reflex and vitreous hemorrhage spreading. "This is the moment I panic." He said he began filling the eye with visco, but it was still soft. Eventually he manages to pull the plate out and puts Prolene through it. As this point, he starts to explore but the opening is so posterior he can't see it. He end- ed up closing up the eye. The patient was hand-motion after the vitreous hemorrhage. After the pressure came down the patient was back on max therapy. Once the vitreous hemor- rhage cleared, Dr. Patel said retina colleagues couldn't find anything to treat, so it had self-sealed. Another video presented in the session showed a tube shunt revision for scleral melt and exposure in a patient with a history of XEN Gel Stet (AbbVie) and MMC. Huda Sheheitli, MD, presented the case, showing how she removed the whole implant, placed scleral patches to cover the area of melt, and closed with healthy conjunctiva. The patient at 6 months was doing well with no recurrent scleral melt. When asked about a systemic workup, Dr. Sheheitli said there were a series of patients who had this problem. A different patient had a systemic workup and nothing came up. She said she thinks the melt was due to mitomycin that was injected and then washed out. "Maybe the re- current needling and the same dose of mitomycin might have caused the melt," she said. In his video presentation, James Liu, MD, showed how early visualiza- tion issues during MIGS procedures can snowball. He offered several pearls to optimize visualization as a result. Here are his "MIGS Visualiza- tion Basics": • Consider position of the patient • Consider position of the scope • Avoid nicking blood vessels • Have a light touch with the gonio- prism • Center the view • Increase magnification "The emphasis is trying to max- imize early aspects so downstream. Those tougher components are more straightforward," he said. Editors' note: The physicians have no financial interests related to their presentations. 14th annual Reay of Hope winning video unlocks 'a new fear' Dr. Patel (second from left) is voted the winner in the Reay of Hope video symposium for his case involving a globe rupture. Source: ASCRS T he Annual Video Symposium: Complications and Reay of Hope returned to Glaucoma Day for its 14th season. "I was talking to Reay Brown about the purpose of this video session and it's to help us all learn. … It's not a shock value contest," co-moderator Nathan Radcliffe, MD, said. But the audience-selected winning video had co-moderator Douglas Rhee, MD, saying "I didn't even know this was possible, so thank you for unlocking a new fear." The winning video was pre- sented by Sirjhun Patel, FRCOphth, and showed a case of globe rupture during Ahmed glaucoma valve place- ment. Dr. Patel said the case began with phaco followed by Ahmed Glau- coma Valve Model FP8 for advanced primary angle closure. The patient was count fingers in this eye. After uneventful phaco, Dr. Patel said he performed a good posterior dissection, placing a Prolene suture 10 mm back from the limbus. He then preplaced the valve, before threading Prolene through the plate, and it became visually lost. "It dives back down really posteriorly," he said, adding that he began gently by pulling the tube, worried it will come off the plate, before becoming more aggressive. "I was talking to Reay Brown about the purpose of this video session, and it's to help us all learn. … It's not a shock value contest." —Nathan Radcliffe, MD

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