Aqueous misdirection syndrome following ab interno gelatin stent can be managed successfully with anterior vitrectomy approach.

INTRODUCTION: Minimally invasive glaucoma surgery (MIGS) is a relatively new surgical technique available to glaucoma surgeons. The ab interno gelatin XEN stent (XEN®45, Allergan Inc., CA, USA) drains aqueous into the subconjunctival space and is theoretically less invasive than trabeculectomy and therefore carries less risk. Aqueous misdirection syndrome (AMS) is a rare but well-recognised complication of any intraocular surgery. Only four cases have been reported following XEN stents but their management and outcome was not discussed. We present a case of AMS following XEN implantation including management and outcome. CASE PRESENTATION: A 78 year old lady with an axial length of 21.27 mm and a previous episode of acute angle closure glaucoma was treated with laser peripheral iridectomy and, later, clear crystalline lens extraction. However, she continued to have high intraocular pressure (IOP) and a shallow anterior chamber. Despite medical therapy, she developed worsening glaucoma.She had XEN implantation to her right eye with no intraoperative complication. Unfortunately, she developed signs of AMS. Medical and laser zonulohyaloidectomy failed to resolve the condition. She then had surgical iriodozonulohyaloidectomy and anterior vitrectomy which resolved the AMS. DISCUSSION: Management of AMS has been well documented. However, incidence following novel surgical techniques, such as XEN implantation, is not well reported. We have shown that AMS following XEN can be successfully treated using an anterior approach.

Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation.

AIM: Comparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone. METHODS: This is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle glaucoma. Level of disease, intraocular pressure (IOP) and tolerance of glaucoma medication were considered before planning surgery. Best-corrected visual acuity (BCVA-logMAR), IOP (mm Hg), number of medications were assessed at baseline, week 1, week 5, month 3, 6, 12 postop. MAIN OUTCOME: percentage (%) in IOP reduction at 12 months vs medicated baseline. SECONDARY OUTCOMES: absolute values of IOP/medication reduction, BCVA and postop complications. RESULTS: The ICE2 (two iStents-cataract extraction-ECP) group included 63 eyes and Phaco-iStent group included 46 eyes. Baseline IOP was higher in the ICE2 than phaco-iStent group (19.97±4.31 mm Hg vs 17.63±3.86 mm Hg, p=0.004) and mean deviation was lower (-7.20±2.58 dB vs -4.94±4.51 dB, p=0.037). Number of medications were comparable at baseline: 2.22±1.06 (ICE2) vs 2.07±1.02 (phaco-iStent), p=0.442. At month 12 postop, IOP in the ICE2 group decreased 35% from baseline vs 21% in the phaco-iStent group (p=0.03); absolute IOP reduction was significantly lower than baseline in each group (p<0.001), yet final IOP was lower in the ICE2 group than phaco-iStent group (13.05±2.18 mm Hg vs 14.09±1.86 mm Hg, p=0.01). Similar results were found for glaucoma medication (1.24±1.05 in ICE2 group vs 1.39±1.03 in phaco-iStent group, p=0.01). Final BCVA was 0.11±0.18 (phaco-iStent group) vs 0.08±0.08 (ICE2 group), p=0.309. Safety outcomes were comparable between groups. CONCLUSION: ICE2 procedure offers better results in IOP/medication reduction at 12 months than phacoemulsification-iStents alone.