Moderator
Arsham Sheybani, MD, ABO
Panelists
Michael S. Berlin, MD, MSc
Maria S. Romero, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Nader Nassiri, MD
Co-Authors
Kourosh Sheibani MD, MSc, Maryam Yadgari MD, None, Sara Kavousnezhad BSc
Purpose
To evaluate the effect of early posttrabeculectomy bleb leakage on trabeculectomy surgery outcomes and success rate.
Methods
The present prospective cohort study was conducted on 203 eyes of 203 patients who underwent trabeculectomy at Torfeh and Imam Hossein Medical Centers, Tehran, Iran, between 2016 and 2021. Patients were divided into two groups: those with early bleb leakage (within the 1st month of surgery) and those without bleb leakage. The success rate of surgery was compared 12, 18, and 24 months after surgery in the two groups. The average intraocular pressure (IOP) and the need for medications in patients 1, 3, 6, 9, 12, 18, and 24 months after the trabeculectomy were also compared.
Results
Bleb leakage was detected in 33 eyes during the 1st month after a trabeculectomy (16.3%). The mean decrease in IOP in the group with leakage was significantly lower than in patients without leakage at 1, 6, 9, 12, 18, and 24 months after surgery (P < 0.05). The need for antiglaucoma medication was significantly higher among patients with bleb leakage at 3 months (P = 0.04) and 9 months (P = 0.047) after surgery (P < 0.05). The success rate at 12, 18, and 24 months after surgery was significantly lower in the group with leakage than the group without.
Conclusion
The results of our study suggest that early posttrabeculectomy bleb leakage negatively impacts surgery success. Furthermore, IOP reduction was lower in patients with early leakage.
Presenting Author
Sue L Choi, BSc
Co-Authors
Claire Wright MD, Brooks Walker MD, Elliott Kanner MD, Emily Kim BSc, Nikolas Hopkins MD, Brian Jerkins MD
Purpose
To evaluate the effect of micropulse transscleral cyclophotocoagulation (MP-TSCPC) on visual acuity and visual field outcomes in glaucoma patients.
Methods
A retrospective review of patients who underwent MP-TSCPC between June 2018 and December 2021 at a single institution. All types and severities of glaucoma were included, without exclusions based on prior incisional glaucoma surgery or lens status. Pre-operative logMAR best corrected visual acuity (BCVA) was compared to post-operative logMAR BCVA at 1-3 and 4-6 months using a paired t-test. Visual field progression, defined as a mean deviation decrease of ?2 dB, was assessed using reliable Humphrey Visual Field (HVF) tests. The average time to visual field (VF) progression and the proportion of eyes without VF progression were measured.
Results
A total of 299 eyes were included. No significant change in BCVA from preoperative baseline was observed at 1-3 months postoperatively (p>0.05). However, at 4-6 months postoperatively, BCVA differed significantly (p<0.01) with="" a="" mean="" logmar="" difference="" of="" 0.096,="" equivalent="" to="" about="" snellen="" line.="" when="" stratified="" by="" bcva="" 0/400="" and=""><20 00,="" a="" significant="" difference="" was="" seen="" at="" 4-6="" months="" postoperatively="" from="" baseline="" in="" eyes="" with="" bcva=""><20 00=""><0.05). among="" 90="" eyes="" with="" reliable="" hvf="" testing,="" the="" average="" time="" to="" visual="" field="" progression="" of="" db="" was="" 595.7="" days="" (19.9="" months).="" during="" the="" study,="" 19="" eyes="" (21.1%)="" showed="" no="" vf="">
Conclusion
MP-TSCPC appears to be a safe and effective treatment option in glaucoma management, particularly in preserving visual function, as it did not negatively impact postoperative visual acuity. MP-TSCPC may have contributed to some degree of visual field preservation, with 21% of patients showing no visual field progression during the study period.
Presenting Author
Leon W. Herndon, MD
Co-Authors
Ehsan Sadri MD, Farrell Tyson MD, Tsontcho Ianchulev MD, MPH
Purpose
To report the long-term results after uveoscleral outflow enhancement using bio-interventional cyclodialysis technique with scleral allograft reinforcement.
Methods
Homologous allograft scleral reinforcement with precision-trephined bio-tissue is used to structurally augment an interventional cyclodialysis for durable aqueous outflow. We report the 24 months results of the procedure in 31 patients
Results
Scleral allograft showed high level of biocompatibility, bio-conformity and stability as a supraciliary bio-scaffold material with no evidence of persistent inflammation or migration. The procedure was well tolerated, and OCT imaging revealed positional stability and structural similarity and conforming to the native tissues. At 24 months, there was 41% reduction from baseline in mean medicated IOP with a concurrent reduction in IOP lowering medications.
Conclusion
Scleral allograft bio-reinforcement of an ab-interno cyclodialysis provides durable functional and structural results with satisfactory interventional ocular safety profile.
Presenting Author
James S. Lewis, MD
Co-Authors
Ticiana De Francesco MD, Tsontcho Ianchulev MD, MPH, Ike Ahmed FRCSC, MD
Presenting Author
Arkadiy Yadgarov, MD, ABO
Co-Authors
Michael Patterson DO, Gautam Kamthan MD, Lautaro Vera MD, Sean Ianchulev MD
Purpose
To investigate the clinical performance of a novel gonio-intervention in patients with open angle glaucoma (OAG) undergoing cataract and uveoscleral intervention.
Methods
The C-Rex procedure is designed to improve trabecular outflow with a titratable intervention which removes the inner wall of the Schlemm�s canal for up to 360 degrees ab-interno (trabeculorehxis). We report initial surgical experience of excisional circumferential trabeculorhexis performed with the C-Rex device as an adjunct to uveoscleral outflow intervention in 18 patients with OAG.
Results
Successful flexible gonio-intervention and trabeculorhexis were performed in all 18 patients. In more than 85% of subjects, circumferential trabecular excision was achieved beyond 120 degrees. There were no serious or emergent adverse events. IOP was reduced from 21.6 mmHg to 12.1 mmHg with a concurrent reduction in medications through 12 months of follow-up.
Conclusion
Multi-interventional glaucoma surgery with excisional trabeculorhexis in addition to uveoscleral outflow enhancement can address both outflow pathways and deliver sustained and significant IOP lowering.
Presenting Author
Savak Teymoorian, MD, MBA, ABO
Co-Authors
Jasmin Kaur BSc
Purpose
The current study assessed consecutive cases of standalone travoprost intracameral implant (iDose TR) implantation by a U.S. glaucoma surgeon in patients with open-angle glaucoma (OAG) or ocular hypertension (OHT) who had undergone prior selective laser trabeculoplasty (SLT) and/or bimatoprost intracameral implant injection.
Methods
The travoprost intracameral implant (iDose TR) was approved in December 2023 for the reduction of intraocular pressure (IOP) in patients with OAG or OHT. The current non-randomized, retrospective, unmasked, consecutive study included all cases of standalone iDose TR implantation from a single U.S. glaucoma surgeon since the product�s approval. Patients had OAG or OHT and had undergone prior SLT and/or bimatoprost intracameral implant injection. IOP, medications, and adverse events were evaluated through 3 months postoperatively. Longer-term data from a larger sample size will be available by the time of the conference.
Results
All patients (n=65 eyes) were implanted with iDose TR, with no intraoperative complications. In the consistent cohort of eyes with 3-month follow-up data (n=54), mean IOP reduced from 19.6�3.8mmHg preoperatively to 13.1�2.5mmHg at 3 months (33% reduction, p=0.001). The percent of eyes with IOP ?15 mmHg increased from 11% preoperatively to 83% at 3 months (p=0.001). Mean # medications reduced from 0.28�0.71 to 0.0�0.0 (100% reduction; p=0.006). One eye was reported to have mild iritis at 1-2 weeks postoperative, and was treated with a topical prednisolone taper. No secondary surgeries occurred in any eye.
Conclusion
Standalone implantation of the travoprost intracameral implant yielded statistically significant and clinically meaningful IOP and medication reductions through 3 months in eyes with prior SLT and/or bimatoprost intracameral implant injection, with favorable safety.
Presenting Author
Eran Greenbaum, MD
Co-Authors
Avner Belkin MD, Elad Moisseiev MD, Biana Dubinsky Pertzov MD, Yaniv Barkana MD
Purpose
To compare the effect of trabecular-based (Gonioscopy Assisted Transluminal Trabeculotomy- GATT) and subconjunctival-based (Ahmed Glaucoma Valve � AGV and Preserflo Microshunt � PMS) glaucoma surgeries on aqueous humour outflow facility.
Methods
Prospective, before-and-after study. Patients with primary or secondary open-angle glaucoma who were scheduled for GATT, PMS, or AGV surgery were included in the study. Patients without glaucoma undergoing cataract extraction alone served as controls. The pre-and-post operative intraocular pressure (IOP), number of medications, and biometric data were analyzed. The outflow facility coefficient (C) measured by pneumatonography (Model 30 Classic, Reichert Technologies, Depew, NY, USA) was compared preoperatively and 1 and 3 months post-operatively.
Results
47 eyes were included: 20 in the GATT group, 12 in the PMS group, 5 in the AGV group, and 10 in the cataract extraction alone group. All GATT patients had combined cataract surgery. Preoperative C values (?l/min/mmHg) were 0.11, 0.08, 0.108, and 0.2 for GATT, PMS, AGV, and cataract alone, respectively. No significant baseline IOP or C value differences were found between groups. C values increased significantly (p<0.001) at="" month="" 3="" to="" 0.248,="" 0.27,="" and="" 0.2="" in="" gatt,="" pms,="" and="" agv="" groups.="" the="" cataract-only="" group="" showed="" no="" significant="" change="" (0.2="" to="">
Conclusion
Outflow facility increased significantly after both trabecular-based and subconjunctival-based glaucoma surgery, but not after cataract extraction alone three months after surgery. In well-selected patients, GATT was not inferior in improving outflow facility to glaucoma drainage implants.
Presenting Author
Brendan Alam, BSc
Co-Authors
Zhonghui Luo MD, PhD, Michael Lin MD, Christian Song MD, Emma Davies MD, Steven Young MD, Yuka Kiyota MD, MPH, Catherine Liu MD, Kyung Oh DO, Kanika Agarwal MD, Gustavo Lozada MBA, MD, M.Ed, Catherine Mullaly MPH, MD
Purpose
Peribulbar block is frequently employed in many ocular procedures. However, the block volume has been largely determined empirically. In order to establish an evidence-based guideline, we compared the intraocular pressure (IOP) changes of two commonly administered block volumes as well as the anesthesia effect in a prospective, randomized study.
Methods
Patients between the ages of 18 and 79 years, receiving peribulbar block prior to various ocular procedures were recruited. Any eye with a history of previous refractive, intra-ocular or orbital surgery was excluded. The volume of the peribulbar block was randomized to 4 ml (Group A and 7 ml (Group B) at a 1:1 ratio. The surgeons and patients were masked from the block volume. A single study staff performed all measurements. The intraocular pressure (IOP) immediately before, after the block and after 120-second ocular massage performed were recorded. Satisfaction rating of the anesthesia effect was collected from each surgeon immediately following the conclusion of the procedure.
Results
Fifty eyes were included. Five anesthesiologists performed all the peribulbar blocks at 2 surgical centers. Six surgeons performed the intended surgeries and rated the anesthesia effects. The mean pre-block IOP (PB) was 16 � 4 mmHg; immediate after-block IOP (IAB) was 17 � 8 mmHg; immediate after-massage IOP (IAM) was 13 � 4 mmHg. There was no statistically significant raise in IOP from the block in either group, or significant differences in PB, IAB, or IAM between the two groups. However, IAM was significantly lower than IPB in both groups (pA=0.02, pB=0.02) by a paired t-test. Group B that received 7-ml block had a significantly higher satisfaction ratings by the surgeons (p=0.04).
Conclusion
A peribulbar block volume of 7 ml did not cause IOP increase more than that of 4 ml. A post-block 120-second manual ocular massage significantly reduced the IOP in both groups. Surgeon satisfaction of the anesthesia was significantly higher in the 7-ml group, which is a safe and more effective peri-bulbar block volume.
Presenting Author
Daniela B. Cabrerizo, MD
Co-Authors
Leonidas Traipe MSc, MD, Daniela L�pez MSc, Claudia Goya MSc, Remigio Lopez-Sol�s PhD, Paula Maturana MD
Purpose
To examine the safety and efficacy of Paul glaucoma implant (PGI) surgery in patients with refractory glaucoma over an 18-month period.
Methods
Retrospective study of 41 patients (45 eyes) that underwent PGI surgery. Inclusion criteria: ? 18 years old, diagnosis of refractory glaucoma and performed PGI surgery between 2022 and 2024. Outcome measures were IOP, number of drugs pre and post-operatively and complications related to the procedure. Success was defined as IOP > 5 and ? 21 mmHg and IOP reduction ? 20% without vision threatening complication, novo procedures or loss of light perception. Success was subcategorized as complete success without medication and qualified with ? 1 medication in the last follow-up. Failure was defined as IOP > 21 or ? 5 mmHg on ? 2 consecutive visits or when reoperation for glaucoma was needed.
Results
The mean preoperative IOP of 22.8 � 9.8 mmHg significantly decreased to 13.4 � 3.9 mmHg at 18 months postoperatively (p < 0.01). The average number of glaucoma medications reduce from 4.0 � 0.8 preoperatively to 1.5 � 1.0 at the last follow-up (p < 0.01). Recorded complications related to the procedure were hypertensive phase in 5 eyes (11%), choroidal detachment in 4 eyes (9%), hyphema in 2 eyes (4%), cornea decompensation in 1 eye (2%) and central retinal vein occlusion in 1 eye (2%). Overall, there were 8 eyes (17.8%) as complete success, 35 eyes (77.8%) as qualified success and 2 eyes (4.4%) as failure.
Conclusion
PGI surgery seems to be a safe and effective surgical option for managing advanced and refractory glaucoma. In this study PGI surgery demonstrated significant IOP reduction, decreased dependence on glaucoma medication, high success rate and a manageable complication profile.
Presenting Author
Nimrita Nagdev, MS, MBBS
Co-Authors
Devendra Maheshwari MD, Madhavi Pillai MBBS, DNB, Shivam Gupta MS
Presenting Author
Tal Sharon, MD, BSc
Co-Authors
Farhad Ghaseminejad MSc, Sorayya Seddigh MD, Mahadev Bhalla MD, Georgios Kontos MD, FRCOphth, MBA, Steven Schendel FRCSC, MD, Kulbir Gill FRCSC, MD
Purpose
Preserflo� microshunt (PMS) (Santen, Miami, Florida, USA), is a glaucoma drainage device, that is gaining popularity worldwide. This is a retrospective chart review aimed at assessing the efficacy and the safety profile of sectoral resection of tenon tissue during implantation of a preserflo� microshunt for the treatment of glaucoma
Methods
A retrospective chart review, including patients who underwent PMS implantation with and without primary sectoral tenectomy, between January 2022 and September 2023, at Vancouver General Hospital, Vancouver, Cananda. Primary safety outcomes were - proportion of eyes without persistent hypotony, and proportion of eyes without a need for salvage surgery. Primary efficacy outcomes were proportion of eyes with IOPs between 6 and 18 mmHg, and IOP reduction of 20% or more without (complete) or with (qualified) glaucoma medications. Secondary outcomes included number of medications needed, exposure rate, failure rate, complications, and re-operation rates.
Results
90 eyes of 84 patients were included � 52 in the no tenectomy group, and 38 in the tenectomy group. Mean follow-up time was 463�169 days in the no-tenectomy versus 252�57 days for the tenectomy group(p<0.001). Pre-operative IOP was higher in the no-tenectomy group (21.3�8.3 mmHg Vs. 17.5�4.3 mmHg, P=0.01), otherwise the groups were similar pre-operatively. IOP reduction was 40.3%�23.6% in the no tenectomy group and 28.3%�35.5% in the tenectomy group (p=0.06), complete and qualified success rates were 36.5% and 61.5% vs. 52.6% and 65.8% in the no-tenectomy and tenectomy groups respectively (P>0.05). Rates of hypotony, needling, open revision, device exposure and salvage therapy were similar
Conclusion
The efficacy and safety of the primary tenectomy were non-inferior to the two-layer closure protocol in our study, with a potential to reduce need for additional surgeries. Further studies are required to better understand the benefits and the risk in this technique.
Presenting Author
Robert N. Weinreb, MD, ABO
Co-Authors
Leon Herndon MD, Nathan Radcliffe MD, Sean Ianchulev MD
Purpose
To study the clinical utility of bio-interventional uveoscleral outflow augmentation in medically uncontrolled glaucoma patients.
Methods
The glaucoma intervention included micro-incisional cyclodialysis surgery followed by endoscleral bio-reinforcement using allogeneic homologous scleral bio-tissue to facilitate aqueous drainage and IOP control in patients undergoing cataract surgery.
Results
51 eyes with a baseline medicated IOP of 25.7 � 4.4 mmHg and a mean number of IOP lowering medications of 1.2 � 1.3 were included in the study. The allogeneic bio-tissue showed high level of biocompatibility and stability as a supraciliary bio-scaffold material with no evidence of persistent inflammation, migration or anterior synechia formation. OCT imaging revealed positional stability and structural similarity and conformance to the native tissue. At 12 months, there was 39.7% paired reduction from baseline in mean medicated IOP (p<0.001) with="" a="" concurrent="" 41.1%="" reduction="" in="" the="" mean="" number="" of="" iop-lowering="" medications="" from="" baseline="">< />
Conclusion
Intraocular implantation of scleral allograft for bio-scaffolding and reinforcement of the uveoscleral outflow pathway demonstrates high degree of ocular biocompatibility and tolerability.
Presenting Author
Ticiana De Francesco, MD
Co-Authors
Anna Zhang MD, Ike Ahmed FRCSC, MD
Presenting Author
Anna H. Zhang, MD
Co-Authors
Ike Ahmed FRCSC, MD, Ticiana De Francesco MD
Purpose
To determine intermediate intraocular pressure (IOP)-lowering and adverse event profile of the open (open) and closed conjunctival approaches (closed) in 63-?m Gelatin Microstent Implants after 1 year follow-up.
Methods
Retrospective cohort study of 89 glaucomatous eyes that received standalone Xen 63 Gel Implants at 6 surgical centres across 4 countries (Canada, Italy, Austria, Belgium). The primary outcome was complete success, defined as no two consecutive IOP readings >17mmHg or IOP <6mmHg with >2 lines of vision loss and at least a 20% reduction from baseline IOP on no medications. Secondary outcomes included upper IOP thresholds of 14mmHg and 21mmHg, qualified success (with medications), change in IOP, medications, complications, interventions, and re-operations. A Cox proportional hazards model was used to assess risk factors for failure.
Results
Complete success was achieved in 57.1% of 35 open eyes and 64.2% of 54 closed eyes (HR, 1.33; 95% CI, 0.67-2.65). Qualified success was achieved in 79.3% and 91.8% (HR, 2.82; 95% CI, 0.83-9.64). Multivariate Cox proportional analyses did not identify risk factors for failures, including open approach (HR, 1.33; 95% CI, 0.67-2.65; p=0.411), high preop IOP, poor preop vision, and disease severity. Complications occurred in 28 open and 49 eyes, most of which were transient. Open and closed had similar IOP and medication reduction at 12 months (p>0.05). One (2.9%) open and 6 closed (11.1%) eyes underwent needling (p=0.238), and 5 (14.2%) and 11 (20.3%) eyes underwent re-operations (p=0.577).
Conclusion
The standalone open conjunctiva approach demonstrated similar success rates as the closed approach in 63-?m Gelatin Microstent implantation. Both showed comparable IOP reduction from baseline at 1-year follow-up.
Presenting Author
Zain S Hussain, MD
Co-Authors
Jawad Muayad BSc, Ahmed Sallam FRCOphth, MD, PhD, Muhammad Chauhan MS, MD
Purpose
Due to rapid optometric surgical expansion in key US states, our scientific team aims to characterize use and complication rates of various laser & surgical privileges between optometrists and ophthalmologists.
Methods
This retrospective cohort analysis used a national 5% CMS Limited Dataset file 2012-2020. The rate of laser trabeculoplasties (LTP), laser peripheral iridotomies, YAG capsulotomies, and foreign body removals. Complications ranging from retinal detachments, elevated intraocular pressures, macular edema, and shifts in refractive error were analyzed. With billing modifiers, eyes undergoing greater than 1 LTP in the same eye were further compared between providers with geographical adjustment. Cox Proportional Hazards modeling and Kaplan-Meier Analysis determined factors associated with development of complications between ophthalmologists and optometrists. Significance was achieved at p< />
Results
TBD
Conclusion
TBD
Presenting Author
Lisa Renaud, MD, MSc
Co-Authors
Gavin Docherty FRCSC, MD
Purpose
This study compares the efficacy and safety of PreserFlo with donor sclera/corneal patch graft and ripcord versus PreserFlo alone.
Methods
Retrospective chart review of glaucoma cases in Kelowna, B.C., Canada, with 12 months of follow up. 312 eyes were treated total with diagnoses of primary and secondary open angle glaucoma as well as closed angle glaucoma. 239 were treated with PreserFlo Primary without a patch graft or ripcord, which 52% being female and an average age of 75 across both sexes. In 78 eyes, a scleral or corneal patch graft was placed with a ripcord. The average age was 74 across the sexes and 53% were female. The efficacy was evaluated by reduction of intraocular pressure (IOP), number of bleb needlings, and number glaucoma medication usage at 12 months post-surgery.
Results
There was a reduction in MMC administration from 70% to 24% in PreserFlo versus Patch graft group during the 12-month period. At the end of the study period, IOP was similar between the two groups (11mmHg PreserFlo and 12 mmHg Patch Graft). At end of the study period both groups were utilizing 1 glaucoma medication (PreserFlo patch 1.1 +- 1.4) (PreserFlo alone 0.9+/-1.3). The PreserFlo alone group required subsequent surgery in 28% of patients (PreserFlo revision, Trabeculectomy or Ahmed valve). PreserFlo patch group had 9 patients with choroidals over the 12-month period with 1 patient requiring surgical drainage and microshunt suture insertion. 4 had choroidals in PreserFlo.
Conclusion
Both PreserFlo groups reduced intraocular pressure and medication use for patients with moderate to advanced glaucoma by 12 months post-op. The PreserFlo patch group demonstrated favorable outcomes, with lower rates of reoperation, MMC administration, and failure rates, while effectively maintaining adequate intraocular pressure.
To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2025 Annual Meeting registration.
