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PURPOSE: To evaluate the effectiveness and safety of trabeculectomy compared to glaucoma drainage devices (GDDs) in managing uveitic glaucoma (UG). DESIGN: Systematic review METHODS: : We searched seven electronic databases [PubMed, Scopus, Web of Science, ScienceDirect, EMBASE, CENTRAL, and Google Scholar] to compare trabeculectomy with various GDDs in UG. The primary outcome was intraocular pressure (IOP) reduction, and secondary outcomes included postoperative complications. We fitted a random effects model for meta-analysis and assessed the risk of bias using the National Institute of Health quality assessment tool. RESULTS: We included eight studies; 197 eyes underwent trabeculectomy, and 277 eyes had GDDs. The mean age of participants was 48.5 years, with ∼53.5% being male in the trabeculectomy group, and 49.3% in the GDDs group. The meta-analysis revealed no significant difference in IOP reduction between trabeculectomy and GDDs (p=0.48). Subgroup analyses revealed no significant difference in IOP reduction between trabeculectomy and either the Ahmed glaucoma drainage device group (p =0.38) or the Baerveldt glaucoma implant group (p =0.90). GDDs were associated with higher rates of complications such as cystoid macular edema (CME) (15% vs. 4%, p<0.001), need for revision surgery (11% vs. 6%, P =0.04), and uveitic flare (5% vs. 0%, p =0.001). However, trabeculectomy had a higher risk of cataract progression (7% vs. 1%, p<0.001). CONCLUSION: Trabeculectomy and GDDs demonstrated comparable effectiveness in reducing IOP or glaucoma medication reduction in UG. However, there are significant differences in their safety profiles; CME and revisions were higher in GDD, and cataract progression was higher after trabeculectomy.

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Background: We report on the 12-month safety and efficacy outcomes of a new non-valved glaucoma drainage device, the eyePlate-300 (Rheon Medical, Lausanne, Switzerland), in managing refractory glaucoma. Methods: A retrospective review was conducted on consecutive patients over 18 who underwent glaucoma drainage device (GDD) surgery with the eyePlate-300 after a single glaucoma consultation between February 2020 and April 2021, with at least 12 months of documented post-op follow-up. Results: A total of 16 eyes from 15 patients were included. Complete success was observed in 47% of patients and overall success in 83%. The mean IOP decreased from 31.5 mm Hg to 10.7 mm Hg (67% reduction from baseline), and the number of IOP-lowering drops was reduced from 3.1 to 0.7 at one year. The mean BCVA remained stable. No additional IOP-lowering surgeries were required, and no severe sight-threatening complications were noted. Conclusions: The initial one-year results suggest that the eyePlate could be a safe and effective device for reducing IOP in an ethnically diverse refractory glaucoma population. Further follow-up is necessary to determine the long-term safety and efficacy.

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PURPOSE: To assess the efficacy of a gelatin stent (XEN 45 Gel Stent; Allergan) implant in advanced glaucoma eyes that have failed prior aqueous shunt implantation. METHODS: We retrospectively reviewed 6 patients with refractory glaucoma, defined as persistently high IOP (> 21 mmHg) despite taking at least 3 IOP-lowering medications subsequent to undergoing a glaucoma drainage device (GDD) with or without a second GDD or cilioablative procedure. Eyes with previous failed GDD underwent subconjunctival 0.3 cc (0.4 mg/ml) mitomycin C, tenonectomy, and placement of an ab- externo XEN stent. The outcome measures included change in IOP and the number of glaucoma medications. Success was defined as patients achieving an IOP ≤ 18 mmHg with a percentage reduction of 25% or 15 mmHg and 40% mean IOP reduction from baseline while taking the same number or fewer medications. RESULTS: All six eyes with age of 77.6 ± 7.82 years who underwent XEN implantation following previous GDD surgery had primary open-angle glaucoma. The IOP decreased significantly from 32.33 ± 5.99 to 12.67 ± 3.27 mmHg (p < 0.001) with a follow-up of 13.9 ± 2 (11.7-16.7) months. Visual acuity and visual field remained stable after XEN placement. Compared to the baseline number of medications of 4.2 ± 0.8, all medication was discontinued except in one eye on two drops at the end of the follow-up. The overall surgical success rate was 100%. No complications, needling, or additional procedures were required. CONCLUSION: This study described successful implantation of the XEN stent following failed GDD. XEN Gel stent implantation associated with mitomycin C and tenonectomy can be considered a viable surgical option for patients with a history of previously failed tube shunt requiring further IOP lowering.

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Purpose XEN45 Gel Stent and glaucoma drainage device (GDD) implantation is safe and effective for glaucoma treatment and should be taught during glaucoma fellowship training. However, complications may still occur, with potentially sight-threatening consequences. The purpose of this study is to describe the management of complications following a series of XEN45 Gel Stent and GDD surgeries performed over the course of glaucoma fellowship training. Methods This is a retrospective case series of XEN45 Gel Stent surgeries performed on 16 eyes and GDD surgeries performed on seven eyes. Patient demographics, disease characteristics, and complications are reviewed. The intra- and postoperative course of five select cases with complications are described in detail. Results The most frequent complications following XEN45 implantation were transient hypotony (10 eyes, 63%), reduced visual acuity (VA) (five eyes, 31%), choroidal effusion (three eyes, 19%), hyphema (two eyes, 13%), and intraocular pressure (IOP) spike (two eyes, 13%). Thirteen eyes (81%) required bleb needling, and three eyes (19%) required XEN45 replacement. Complications following GDD implantation included hypotony (three eyes, 43%), reduced VA (two eyes, 29%), choroidal effusion (two eyes, 29%), IOP spike (two eyes, 29%), implant exposure (two eyes, 29%), and shallow anterior chamber (one eye, 14%). Three eyes (43%) required revision or explantation with a secondary glaucoma surgery. One choroidal effusion following XEN45 surgery and one following GDD surgery were hemorrhagic choroidal effusions requiring surgical drainage. Conclusion Significant and potentially sight-threatening complications may occur following XEN45 Gel Stent and GDD implantation performed over the course of fellowship training. Glaucoma fellows should be ably equipped to recognize, diagnose, and manage these complications both intra- and postoperatively.

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Purpose: Insulin has been postulated as a novel and effective treatment for re-epithelialization of the ocular surface and different pathologies have been suggested as possible indications. Observations: A 69-year-old diabetic male was referred for a left non-healing conjunctival epithelial defect over the superotemporal scleral patch used in the placement of the Ahmed ClearPath. In the left eye, he was on latanoprost/timolol once daily, prednisolone 1 % once daily and tobramycin/dexamethasone ointment at night. Best-corrected visual acuity was 20/20 in the right eye and 20/25 in the left eye. Slit lamp examination of the left eye showed patches of avascular scleral tissue nasally and superiorly, conjunctival and Tenon defect over a thin avascular scleral patch graft. The patient was started on Humulin insulin 1UI/mL 6 times a day and the defect healed after 3 months of treatment. Conclusions and importance: Insulin eye drops may be used in the treatment of chronic conjunctival epithelial defects following implantation of glaucoma drainage devices.

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Aim and background: To compare the safety and efficacy of subconjunctival gel stent implantation in the superonasal (SN) vs inferonasal (IN) quadrants in the treatment of glaucoma. Materials and methods: Patients with a history of IN (n = 29) or SN, (n = 96) gel stent placement with ≥3 months of follow-up were included. Intraocular pressure (IOP) and the number of glaucoma medications were collected preoperatively and postoperatively at months 1, 3, 6, and 12. Safety measures included the number of bleb needlings, complication rate, and additional surgeries. Results: Mean baseline IOP was 32.4 ± 11.7 mm Hg in the IN group and 21.6 ± 9.2 mm Hg in the SN group (p < 0.01). IOP was similar between groups at 3 months (IN = 15.8, SN = 15.6, p = 0.45), 6 months (IN = 17.4, SN = 15, p = 0.13), and 12 months (IN = 17.9, SN = 14.7, p = 0.15) follow-up. The number of glaucoma medications was also similar at 3 months (p = 0.31), 6 months (p = 0.24), and 12 months (p = 0.39) follow-up. Bleb needling rates were similar with 51.7% (15/29) in the IN group vs 42.7% (41/96) in the SN group (p = 0.39) and subjects requiring further surgery were 17.2% (5/29) in the IN group vs 24.0% (23/96) in the SN group (p = 0.45). Conclusion: Both IN and SN subconjunctival gel stent placements provide favorable safety and efficacy when treating open-angle glaucoma, with a meaningful decrease in medication use and IOP. Clinical significance: Implantation of the subconjunctival gel stent in the IN quadrant is an effective and safe alternative to superior implantation in refractory glaucoma. How to cite this article: Vander Zee BL, Wilson C, Berdahl JP, et al. Superonasal vs Inferonasal Subconjunctival Gel Stent Placement in Patients with Glaucoma. J Curr Glaucoma Pract 2024;18(2):63-67.

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Introduction: While the exchange of a superior valved glaucoma drainage device (GDD) for a non-valved GDD has been reported for achieving glaucoma control, inferior GDD exchange for improving the cosmetic appearance of the eyes due to poor appearance caused by encapsulated GDDs has not been previously documented. Here, we report on two patients with inferior valved GDDs who underwent an exchange for non-valved devices for glaucoma control and cosmetic improvement. Case description: We report on the case of a 23-year-old gentleman and that of an 8-year-old girl, both of whom had inferior valved GDDs with uncontrolled intraocular pressure and unsightly appearance due to encapsulated GDD plates within the palpebral aperture. Both patients were unhappy about the appearance of their eyes. In each case, improvements in both glaucoma control and cosmesis were achieved by exchanging the valved GDDs for non-valved ones. Conclusion: Exchanging a valved for a non-valved GDD might help improve the cosmetic appearance of the eyes, in addition to providing glaucoma control.

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Purpose: To evaluate the safety and effectiveness of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG). Patients and Methods: This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed. Results: Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed. Conclusion: To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.

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COVID-19 is a viral illness that can cause severe respiratory symptoms. COVID-19 has caused a worldwide pandemic that necessitated many countries to perform a national lockdown. In Jordan, a lockdown was imposed by the government. During the lockdown, the hospitals were only dealing with outpatient emergency cases, urgent referrals from primary or secondary health institutions, and inpatients whose medical conditions required keeping them admitted. Elective clinics and surgeries were canceled. At the King Abdullah University Hospital (KAUH), which is the only tertiary center in northern Jordan, we dealt with an unusual case of uncontrolled and advanced primary open angle glaucoma in a 38-year-old pregnant female patient. The patient was presented with an intraocular pressure (IOP) of 53 mmHg in the right eye and 40 mmHg in the left eye despite using dorzolamide and timolol eye drops twice daily. The angle was opened in gonioscopy. The decision was made to implant Ahmed glaucoma valves (AGV) in each eye in one session under general anesthesia which was performed successfully. At the last follow-up visit 4 years later, the IOP was maintained at 15 mmHg.

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Purpose: To present a rare case of late-onset Pseudomonas aeruginosa orbital cellulitis following glaucoma drainage device (GDD) implantation due to suture erosion. Observations: A 65-year-old male with a history of aphakic glaucoma and two remote prior glaucoma drainage device (GDD) surgeries of the right eye presented with right orbital signs. On examination, exposed securing Gore-Tex suture material over the plate of a GDD in the inferotemporal quadrant was present. Computed tomography (CT) scan demonstrated right orbital fat stranding, lateral rectus enlargement, and an intracapsular abscess consistent with orbital cellulitis. Cultures grew Pseudomonas aeruginosa. Treatment with intravenous and topical fortified antibiotics, incision and drainage of the abscess, and removal of the inferotemporal GDD was successful in resolving the infection. At post-operative month three, the patient underwent uncomplicated transscleral cyclophotocoagulation for further intraocular pressure control. Conclusions and Importance: Orbital cellulitis is an uncommon complication of GDD implantation, and typically occurs in the early post-operative period. To our knowledge, this is the first report of late-onset orbital cellulitis resulting from Pseudomonas aeruginosa, as well as the first case of GDD orbital cellulitis related to suture erosion.

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Purpose: Tube shunts can be inserted into the anterior chamber, ciliary sulcus, or pars plana. Sulcus tube placement can be challenging. This report demonstrates three techniques for guidewire-assisted sulcus tube insertion. Observations: The first technique uses a needle inserted through a paracentesis 180-degrees across from the tube entry site and creates an ab-interno sclerotomy through which the guidewire is inserted by docking it into the needle bevel. The second technique involves inserting the guidewire into the eye via a paracentesis and using microforceps to retrieve it through a sclerotomy. The third technique uses forceps to insert the guidewire into a paracentesis 180° across from the planned tube entry site and dock it into a needle bevel that has been inserted into the sulcus. Each of these techniques provides a reliable and reproducible way to insert a tube into the sulcus. Conclusions and importance: Guidewire-assisted tube entry offers a promising solution in cases of difficult sulcus tube placement without substantial additional cost.

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PURPOSE: To assess incidence, risk factors, and treatment of retroprosthetic membrane (RPM) formation in eyes following Boston keratoprosthesis (Kpro) implantation and their correlation with glaucoma drainage device placement (GDD). METHODS: A retrospective review was performed on eyes that underwent Kpro type I or II implantation between 2005 and 2020 at a tertiary academic center. Multiple variables were collected including preoperative characteristics, presence of RPM, management of RPM, and outcomes including corrected visual acuity (VA). A Fischer's exact test was used to evaluate the significance of risk factors of RPM formation and an odds ratio was calculated for each possible risk factor. A Mann-Whitney U test was used to evaluate comparisons between outcomes and qualitative analyses. RESULTS: Of the 87 eyes identified, 37 (43%) developed an RPM within an average of 1.5 years (range, 31 days-7.5 years) following Kpro implantation. Mean follow-up duration was 4.3 years. Eyes that developed RPM had significantly worse preoperative VA compared to those that did not (logMAR 2.55 vs. 2.28, p = 0.022). The mean number of prior penetrating keratoplasty procedures trended higher in eyes that developed RPM (2.46 vs. 2.18, p = 0.44) but was not significant. GDD placement after Kpro implantation was associated with an increased risk of RPM formation (RR = 1.69 p = 0.026). Of the 37 eyes that developed an RPM following Kpro, 17 (47%) were treated with Nd:YAG laser, and four of those 17 (21%) also underwent pars plana vitrectomy (PPV). Seven of 37 eyes (19%) underwent PPV without Nd:YAG. Comparisons between RPM occurrence and final VA were not significant. CONCLUSIONS: The incidence of RPM formation following Kpro implantation was 43%. Eyes that developed RPM had significantly worse preoperative VA. GDD placement after Kpro implantation increased the risk of developing RPM. Final VA and occurrence of RPM were not significantly different between the Nd:YAG and PPV treatment groups.

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PURPOSE: To describe the incidence, risk factors, clinical characteristics, and long-term outcomes of a hypertensive phase (HP) after glaucoma drainage device (GDD) implantation. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes that underwent implantation of their first GDD from January 2010 to October 2020 at a tertiary care center. METHODS: Hypertensive phase was defined as intraocular pressure (IOP) >21 mmHg occurring at 2 consecutive visits in the first 90 days after the date of surgery for Ahmed Glaucoma Valve (AGV) or in the first 90 days after tube opening for Baerveldt Glaucoma Implant (BGI). Generalized estimating equations and Fisher exact tests were used to evaluate risk factors for HP and risk factors for failure of GDD surgery after occurrence of a HP. MAIN OUTCOME MEASURES: Incidence and risk factors for HP. Overall surgical success rates, defined as the absence of failure criteria: IOP >21 mmHg, ≤5 mmHg, or <20% reduction below baseline IOP after 3 months for 2 consecutive visits, with or without adjunctive ocular hypotensive therapy; additional glaucoma surgery; or loss of light perception. RESULTS: Among 419 eyes of 360 patients that underwent GDD implantation, 42 (10.0%) eyes developed HP. Onset of HP was 20.8 ± 10.5 days after AGV and 11.7 ± 20.3 days from the date of tube opening after BGI. Mean IOP during HP was 26.5 ± 3.2 mmHg with peak IOP of 30.0 ± 5.9 mmHg. Median follow-up duration was 21.5 months after onset of HP. Younger age and neovascular glaucoma were significant risk factors for HP occurrence in a multivariable model. Resolution of HP occurred in 32 eyes (76.2%) after a mean duration of 48.0 ± 53.0 days. Additional surgery with a second GDD or cyclophotocoagulation was performed for 12 eyes (28.6%). The overall success rate among eyes with a HP was 52.6% at 2 years, which was significantly lower than that observed among control eyes that did not experience HP (76.3%), P < 0.01. CONCLUSIONS: The incidence of HP was 10.0%. Younger age and neovascular glaucoma were significant risk factors for HP in the multivariable model. The risk of surgical failure after HP is significantly higher compared to eyes that did not experience HP. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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INTRODUCTION: To describe the use and technique of a Tenon's transposition flap without overlying conjunctiva to cover bare sclera following bleb excision and tube shunt implantation. PRESENTATION OF CASE: A 76-year-old man with severe stage primary open-angle glaucoma in both eyes presented with a nonfunctioning trabeculectomy with a thin-walled, cystic bleb overhanging the cornea. A Baerveldt-350 Glaucoma Implant in the ciliary sulcus was recommended for further lowering of intraocular pressure, along with concurrent excision of the bleb due to patient dissatisfaction with the cosmesis of the bleb and to prevent future bleb-associated complications. Conjunctiva could be closed without tension over the new tube entry site; however, a defect remained at the prior trabeculectomy site. A Tenon's transposition flap without overlying conjunctiva was created to cover this site. By postoperative week 6, new conjunctiva had grown over the Tenon's transposition graft, appearing as if there had never been a bleb. DISCUSSION: This case illustrates the use of a Tenon's transposition flap to cover bare sclera following bleb excision. This technique proves valuable when conjunctiva is limited, offering an alternative when adjacent conjunctiva cannot be mobilized. CONCLUSION: In cases requiring non-water-tight coverage of bare sclera with limited available conjunctiva, a Tenon's transposition flap can be used, permitting new conjunctiva to safely grow over bare Tenon's. This technique is useful during a variety of scenarios, including tube shunt and trabeculectomy revisions, where conjunctival closure may be difficult.

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AIM: To compare the surgical outcomes of glaucoma drainage device implantation (GDI) and trans-scleral neodymium:YAG cyclophotocoagulation (CPC) in the management of refractory glaucoma after Descemet-stripping automated endothelial keratoplasty (DSAEK). METHODS: This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery (15 with GDI and 14 with CPC). The main outcome measures were intraocular pressure (IOP), glaucoma surgery success rate (defined as IOP of 6-21 mm Hg without additional anti-glaucoma operation), number of glaucoma medications, endothelial graft status, and best-corrected visual acuity (BCVA). RESULTS: The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries, both for the GDI and CPC groups. Both groups showed significant IOP reduction after glaucoma surgery. The GDI group presented a significantly higher success rate in IOP control than the CPC group (60% vs 21.4%, P=0.03). Both procedures significantly decreased the number of glaucoma medications (P=0.03). Forty percent and 57% of cases in the GDI and the CPC group, respectively, experienced endothelial graft failure during follow-up (P=0.36). Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group. CONCLUSION: Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK. GDI is preferable to CPC in refractory glaucoma cases after DSAEK, as it manifests a significantly higher success rate for IOP control, similar endothelial graft failure rate, and relatively preserves BCVA than CPC.

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PURPOSE: To compare glaucoma tube outcomes of wet age-related macular degeneration (AMD) eyes receiving anti-VEGF injections versus dry AMD eyes and no anti-VEGF. DESIGN: Retrospective clinical cohort study. PARTICIPANTS: Patients with wet AMD and a history of anti-VEGF within a year prior or after stand-alone glaucoma tube surgery and eyes with dry AMD and no history of anti-VEGF with at least 6 months of follow-up. Eyes with neovascular glaucoma or anti-VEGF for reason other than wet AMD were excluded. METHODS: A Kaplan-Meier analysis compared survival for wet versus dry AMD eyes. Failure was defined as intraocular pressure (IOP) > 21 mmHg or < 20% IOP reduction from baseline or IOP ≤ 5 mmHg for 2 consecutive postoperative visits starting at month 3, additional glaucoma surgery, or no light perception. Complete success was defined as no failure or medications at final follow-up. Hypertensive phase was defined for valved tubes as IOP > 21 mmHg within 3 months of surgery after a reduction to < 22 mmHg during the first postoperative week. Intraocular pressure, percent reduction in IOP, number of glaucoma medications, and early (< 1 year) and late (> 1 year) complications were compared through 5 years. MAIN OUTCOME MEASURES: Survival analysis, IOP, number of medications. RESULTS: Baseline IOP, number of medications, or tube type were not significantly different between wet (n = 24) and dry AMD eyes (n = 54). No wet AMD eyes failed versus 10 (18%) dry AMD eyes (P = 0.03). Five-year survival was estimated as 100% for wet AMD and 72% for dry AMD (P = 0.04). Wet AMD eyes had lower IOP (10.6 vs. 12.7 mmHg, P = 0.05), greater IOP reduction (60% vs. 49%, P = 0.04), fewer medications (1.2 vs. 2.1, P = 0.02), and more complete success (50% vs. 15%, P = 0.001) at final follow-up (32 vs. 36 months, P = 0.42). Fewer wet than dry AMD eyes experienced hypertensive phase (0/10 [0%] vs. 4/10 [40%], P = 0.04). There were no significant differences in early or late complications. CONCLUSIONS: Exposure to anti-VEGF may influence postoperative wound healing and capsule formation which may improve glaucoma tube surgical outcomes. Prospective data is needed to consider perioperative administration of anti-VEGF for glaucoma tube surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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PURPOSE: To assess the effect of lens status and cataract surgery on glaucoma drainage device (GDD) efficacy. DESIGN: Retrospective cohort study. PARTICIPANTS: Two hundred and forty-three eyes of 216 patients that underwent GDD implantation with ≥1 follow-up visit within 3 years postoperatively. Exclusion criteria included GDD combined with other ophthalmic procedures. 90%-94% of GDDs were Ahmed implants; 83%-90% had adjunctive mitomycin-C. METHODS: Outcomes were compared between phakic eyes (group A), eyes phakic at time of implantation but subsequently underwent cataract surgery within 3 years (group B), and pseudophakic eyes (group C). Outcomes were measured at 1, 3, 6, 12, 24, and 36 months after tube shunt implantation. Multivariable regression models were performed, adjusting for baseline characteristics. MAIN OUTCOME MEASURES: Intraocular pressure (IOP) after GDD implantation. Secondary outcomes included change in visual acuity (VA), number of glaucoma eye drops, and rate of failure, defined as additional glaucoma surgery, vision decrease to no light perception, or IOP persistently ≤ 5 mmHg or > 21 mmHg or not reduced from baseline by 20%. RESULTS: There were 65 eyes in group A, 52 in group B, and 126 in group C. Within group B, cataract surgery was performed at a mean of 1.3 ± 0.7 years after GDD implantation. There were no statistically significant differences in mean IOP or medications between the 3 groups at all time points up to 3 years postoperatively. Significant improvement in VA was noted in groups A and B compared to group C at 6 months, 1 year, and 2 years after implantation; however, by postoperative year 3, change in VA was similar across groups. There were no significant differences in the failure rate amongst groups (P = 0.68). IOP and medications up to 12 months after cataract surgery were similar compared to preoperative baseline. Group B had significantly more short-term (P = 0.02) and long-term (P < 0.001) postoperative complications than groups A or C, driven primarily by hypotony. CONCLUSIONS: There were no differences in IOP, glaucoma medications, or rate of failure 3 years after GDD implantation based on lens status or after undergoing subsequent cataract surgery. These results may inform the management of patients with co-existing glaucoma and cataract. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Purpose: We describe a rare case of tube obstruction caused by intraocular lens (IOL) capture following a PreserFlo MicroShunt (PMS) surgery and its subsequent management. Observations: Tube obstruction was noted following PMS implantation at 8 days postoperatively. The intraocular pressure (IOP) increased to 42 mmHg because of tube occlusion that was caused by iris and IOL capture at the tip of the tube. The occlusion was released surgically to free the lumen, and the IOP rapidly decreased to 14 mmHg. Conclusions and importance: IOP elevation due to tube obstruction caused by iris and IOL capture after PMS surgery was resolved by surgical intervention without tube reinsertion. Extra care is required regarding the IOL position in relation to the PMS tube when hypotony occurs in the early postoperative period.

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BACKGROUND: Determine outcomes of concurrent strabismus surgery with placement of a glaucoma drainage device (GDD) in children. METHODS: Retrospective review of pediatric patients who underwent simultaneous lateral rectus (LR) muscle surgery with superotemporal GDD placement. Strabismus and GDD success were defined as residual horizontal misalignment < 10 prism diopter (PD) and intraocular pressure (IOP) < 21 mmHg, no visually devastating complications, and no additional IOP-lowering surgeries. RESULTS: Fifteen eyes of 13 patients (69% male) underwent LR surgery (14 recessions, 1 resection) for exotropia or esotropia simultaneous with GDD placement (13 Baerveldt, 2 Ahmed) at 8.34 ± 5.26 years. Preoperative visual acuity (VA) in operative eye (0.89 ± 0.54) was worse than non-operative eye (0.23 ± 0.44, p = 0.0032). Preoperative horizontal deviation was 38.3 ± 9.4 PD and LR recession was 7.4 ± 1.1 mm. At final follow-up, VA in operative eye (0.87 ± 0.52) was unchanged from preoperative (p = 0.4062). Final IOP was significantly decreased (12.4 ± 4.7 mmHg vs. 31.1 ± 11.4 mmHg, p = 0.0001) as was number of glaucoma medications (2.7 ± 1.7 vs. 1.1 ± 1.3, p = 0.0037). Five (38%) and 9 patients (69%) met criteria for strabismus and GDD success, respectively. Two eyes required tube revision and endoscopic cyclophotocoagulation and 2 eyes had additional strabismus surgery. CONCLUSIONS: Concurrent strabismus and GDD surgery decreased horizontal deviation and obtained IOP control. It is important to consider correction of strabismus at time of GDD placement to maximize visual development and improve cosmesis in children with glaucoma.

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This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.