Ab-Externo XEN Gel stent implantation effectively treated refractory glaucoma with prior failed shunt tube.

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.

Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification.

Aim and background: Combined endocyclophotocoagulation and phacoemulsification (ECP/Phaco) are uncommonly associated with complications. We present the first case of a rare complication following ECP/Phaco. Case description: A 72-year-old patient with dense nuclear sclerotic cataracts and primary open-angle glaucoma (POAG) underwent bilateral surgery uneventfully. He experienced a brief episode of postoperative elevated intraocular pressure (IOP), but only one eye with a lower baseline IOP developed a dilated pupil. No pupillary response was observed after applying 4% pilocarpine. The fixed mydriasis persisted without reaction to light or near stimulus, and the best-corrected vision (BCVA) was 20/30 in the affected eye. Conclusion: This case reports a possible rare complication when undergoing ECP/Phaco therapy. The pathogenesis of Urrets-Zavalia syndrome is unknown, but we hypothesized that eyes with more pronounced increases in IOP from baseline may be more susceptible to ischemic injury to the pupillary sphincter, resulting in a chronically dilated pupil. Clinical significance: Even a modest transient rise in postoperative IOP in a glaucomatous eye with normal baseline IOP could result in a chronically dilated pupil. How to cite this article: Cheng AMS, Vedula GG, Kubal AA, et al. Urrets-Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification. J Curr Glaucoma Pract 2024;18(1):28-30.

Cocaine-assisted epithelial debridement for the treatment of anterior basement membrane dystrophy.

PURPOSE: To describe a method of epithelial debridement with the adjunctive use of topical cocaine for the treatment of symptomatic anterior basement membrane dystrophy (ABMD). METHODS: Retrospective consecutive chart review. Symptomatic patients with ABMD were treated with 4% topical cocaine followed by epithelial debridement. Preoperative and postoperative best-corrected visual acuities (BCVA), topography, subjective symptoms, complications, and evidence of disease recurrence were recorded. RESULTS: Thirty-three eyes of 27 patients were included. The average follow-up duration was 5 years (range, 1.3 months to 8 years). Fourteen patients (17 eyes) presented with recurrent erosion symptoms (group 1) and 13 patients (16 eyes) presented with reduced visual acuity from irregular astigmatism (group 2). Only 1 patient from group 1 experienced symptomatic recurrence of the corneal erosion. In this group, BCVA improved from a mean of 20/45 preoperatively to 20/38 at the last follow-up visit. In group 2, BCVA improved from a mean of 20/63 preoperatively to 20/32 at the last follow-up visit. No major recurrences were noted at the last follow-up visit in this group. No residual effect from the application of cocaine was noted in any of the eyes. Significant postoperative corneal haze occurred in 1 eye. CONCLUSIONS: Topical cocaine-assisted epithelial debridement offers a simple and inexpensive method for treating patients with ABMD who experience recurrent corneal erosions and/or irregular astigmatism resulting in decreased visual acuity.