ABSTRACT - BOOK - 10th Icgs

th
International Congress
on Glaucoma Surgery
February 6-8, 2020 | London, England
ABSTRACT BOOK
th
on Glaucoma Surgery
FREE PAPERS - RAPID FIRE
London - February 6-9, 2020

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on Glaucoma Surgery
MID-TERM CLINICAL RESULTS OF AB INTERNO TRABECULOTOMY

USING TRABECULAR HOOKS WITH PHACOEMULSIFICATION IN
JAPANESE GLAUCOMA PATIENTS
Takashi Omoto1,2, Takashi Fujishiro1, Kimiko Asano-Shimizu1, Koichiro
Sugimoto1, Rei Sakata1, Hiroshi Murata1, Ryo Asaoka1, Megumi Honjo1,
Makoto Aihara1
1
University of Tokyo Hospital, Ophthalmology, Tokyo, Japan, 2JR Tokyo General
Hospital, Ophthalmology, Tokyo, Japan
Purpose: To evaluate mid-term clinical results of ab interno trabeculotomy

using trabecular hooks with phacoemulsification.
Methods: A retrospective chart review was performed on patients who

underwent ab interno trabeculotomy with phacoemulsification at least 1 year
ago. Changes of patients’ intraocular pressure (IOP) and medication scores
were evaluated.
Results: Thirty-three eyes of 26 patients with 21 primary open angle glaucoma,

7 exfoliation glaucoma, and 5 secondary glaucoma were included in the study.
The mean follow-up time was 18.7 ± 5.2 months. The mean preoperative IOP
and medication score decreased from 22.1 ± 6.8 mmHg and 4.3 ± 0.9 to
15.0 ± 3.4 mmHg and 2.0 ± 1.5, 14.0 ± 1.9 mmHg and 2.4 ± 1.3, 14.0 ± 2.7
mmHg and 2.6 ± 1.2, 13.9 ± 2.2 mmHg and 2.6 ± 1.4 and 14.6 ± 5.3 and 3.0 ±
1.4 at 1,6,12, 18 and 24 months, respectively. These decreases were statically
significant (p<0.01 and p<0.01), except for decrease of medication score at
24 months (p=0.067). Four eyes needed additional surgeries; implantation of
filtration device at 4 months, cyclophotocoagulation at 17 and 21 months and
trabeculectomy at 25 months.
Conclusion: Additional surgeries were needed in some cases, however, in

most cases, the lowering effect on IOP and medication scores were sustainable
during mid-term follow-up.

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INITIAL OUTCOMES OF COMBINED PHACOEMULSIFICATION WITH

ENDOCYCLOPHOTOCOAGULATION WITH AND WITHOUT AB
INTERNO TRABECULOTOMY IN OPEN ANGLE GLAUCOMA
Natalia Agudelo1, Juan C. Izquierdo1, Barbara Rubio1, Jorge Camargo1
1
Glaucoma, Oftalmosalud, Lima, Peru
Purpose: To evaluate and compare the efficacy and safety of combined

phacoemulsification (PHACO) and endocyclophotocoagulation (ECP) with
and without ab interno trabeculotomy (KDB) in patients with uncontrolled
open angle glaucoma.
Methods: Retrospective study evaluated the 12 months outcomes patients who

underwent combined PACHO+ECP+HDB (GI) vs PHACO+ECP(GII). Primary
outcome measure was mean pre and postoperative intraocular pressure (IOP);
secondary outcomes included: number of glaucoma medications, visual acuity,
report complete and qualified success, failure, and complications.
Results: A total of 46 eyes were included, basal preoperative IOP was 16.96
± 3.66 mmHg for GI and 15.64± 4.88 for GII (p = 0.122) and 11.44 ± 2.15
and 12.45 ± 1.90 respectively (p = 0.031) at 12 months followup. Complete
success: 54.5% for GI and 40.7% for GII; qualified success: 92.6% and 90.9%
respectively. Medications fell from 2.0 to 0.8 GI and 1.5 GII.
Conclusion: Patients with uncontrolled open angle glaucoma at 12 months

follow up shows reduction of IOP efficiently and safety with both procedures.
When ab interno trabeculotomy is added to phacoemulsification and ECP
mean IOP is reduced more and this difference comparing both interventions
studied is clinically significant.

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PREVALENCE OF ENDOPHTHALMITIS AFTER AQUEOUS SHUNT

IMPLANTS AND RELATED PROCEDURES IN AN EYE SERVICE
Fernanda N. Susanna1, Renata Puertas2, Suzanne Turner2, Nadine Grant-
McKenzie2, Catherine Wagland2, Maria Papadopoulos2
1
University of São Paulo, São Paulo, Brazil, 2Moorfields Eye Hospital, London,
United Kingdom
Purpose: To investigate the rate of endophthalmitis, its microorganisms, risk

factors and visual outcomes, related to aqueous shunt implant (tube) surgery
in the Glaucoma service in 5 years of laboratory electronic database.
Methods: This study was approved by the Clinical Audit Office. All eyes
with tube implant or related surgery were reviewed from 2009 to 2013.
Development of endophthalmitis was identified from the electronic database
and notes reviewed.
Results: A total of 1827 tubes, 893 revisions and 2391 removal of stent
suture (RoS) were performed. In total 6 eyes developed endophthalmitis,
all were following revision/RoS. Time till onset was 8 ± 6.7 days. The rate
of endophthalmitis was 0.67% after tube revision and 0.25% after RoS. No
microorganisms were identified in any samples.
Conclusion: Endophthalmitis is a rare complication of tube surgery, its rate

in this study was less than reported in literature and was only observed after
revision/RoS surgeries.

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COMBINED 25-GAUGE (25G) ENDOSCOPE-ASSISTED PARS PLANA

AHMED GLAUCOMA VALVE PLACEMENT AND VITRECTOMY
FOR ADVANCED GLAUCOMA WITH ANTERIOR SEGMENT
ABNORMALITIES
Taisuke Matsuda1, Sho Yokoyama1, Takashi Kojima2, Mitsunori Watanabe3,
Tatsushi Kaga1, Kazuo Ichikawa3
1
Chukyo Hospital, Department of Ophthalmology, Nagoya, Japan, 2Keio University,
Department of Ophthalmology, Tokyo, Japan, 3Chukyo Eye Clinic, Nagoya, Japan
Purpose: To report the efficacy of a combined procedure utilizing 25G

endoscope-assisted pars plana Ahmed Glaucoma Valve (AGV) placement and
vitrectomy in advanced secondary glaucoma with corneal opacity or small
pupils with fibrous changes.
Methods: This was a retrospective chart review of 19 patients (20 eyes)

who underwent AGV placement with ≥ 6 months follow-up. The majority
were diagnosed with neovascular glaucoma (n=15). All eyes underwent 25G
endoscope-assisted AGV placement with vitrectomy. Efficacy and safety were
assessed at 1,3,6,12,18, and 24 months postoperatively. Outcome parameters
included intraocular pressure (IOP), number of glaucoma medications, and
complications. Data from the most recent follow-up examination were analysed.
Results: The mean age was 55.8 ± 16.1 years, and the mean follow up duration
was 13.1 ± 5.8 months; mean preoperative and postoperative IOP were
34.9 ± 9.3 mmHg and 12.2 ± 2.2 mmHg, respectively (p < 0.001). The mean
number of glaucoma medications decreased from 4.9 ± 0.2 to 1.8 ± 1.5 after
the operation (p < 0.001). No complications occurred in 18 of 20 eyes. The
cumulative probability of success at the 2-year follow up was 95.0%.
Conclusion: The 25G endoscope-assisted pars plana AGV placement is safe

and effective for advanced glaucoma with anterior segment abnormalities.

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IMPACT OF PREOPERATIVE TOPICAL DIFLUPREDNATE ON

TRABECULECTOMY OUTCOMES: A RANDOMISED CONTROLLED
TRIAL
Jyoti Shakrawal 1, Shahnaz Anjum1, Rima Dada2, Ramanjit Sihota1,
Tanuj Dada1
1
RPC, AIIMS, Ophthalmology, 2AIIMS, Anatomy
Purpose: To evaluate the effect of preoperative topical difluprednate on

trabeculectomy outcomes.
Methods: Out of 60 primary angle closure glaucoma patients, who all meeting
inclusion criteria were randomized into two groups (30 in each group). Group
1 received preoperative 0.05% difluprednate eye drops 4 times/day and group
2 received 0.5% carboxymethylcellulose eye drops 4 times/day for 2 weeks.
All patients underwent trabeculectomy with 0.02% mitomycin-C. Primary
outcome was intraocular pressure(IOP) reduction. Qualified and complete
success was defined as IOP ≤ 12mmHg/ ≥ 6mmHg with/ without medications.
Results: Of the 60 patients enrolled, 57 completed the protocol. Two in

steroid group and one patient in placebo group dropped out. The mean age
of 60 participants was 51.6 ± 6.37 years. Both groups had comparable mean
preoperative IOP. At 6 months, intention-to-treat analysis showed a significant
difference in mean IOP between the two groups (group-1: 10 ± 1.53 mmHg,
group-2: 12.27 ± 3.05 mmHg p = 0.002). Complete success was 93.33% in
group-1 and 86.67% in group-2 at 6 months (p < 0.001). ASOCT showed
significant difference in bleb height between two groups with no significant
difference in bleb radial width at 6 months. Real-Time PCR was done to
evaluate expression pattern of genes in two groups and the genes analysed
(NFKB, MMP, CTGF, PDGF, MAPK3, Casp3) were all significantly (p < 0.01)
downregulated in steroid group.
Conclusion: Preoperative use of topical difluprednate is associated with

improved trabeculectomy outcomes in terms of IOP control, better bleb
morphology and downregulation of genes associated with extracellular matrix
deposition, inflammation and neuronal apoptosis.

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INTRACAMERAL BEVACIZUMAB VERSUS MITOMYCIN C AS

ADJUNCTS TO TRABECULECTOMY; 3-YEAR RESULTS
Gerasimos Kopsinis1, Dimitrios Tsoukanas1, Dimitra Kopsini2, Theodoros
Filippopoulos1
1
Athens Vision Eye Institute, Glaucoma Service, Athens, Greece, 2UCL Institute of
Ophthalmology, London, United Kingdom
Purpose: To compare long-term results of adjunctive intracameral injection of

bevacizumab to standard application of mitomycin C (MMC) in trabeculectomy.
Methods: Prospective, randomized study of 100 eyes with primary open-angle

or pseudoexfoliation glaucoma requiring trabeculectomy. 50 eyes received
bevacizumab and 50 eyes MMC. Complete success i.e IOP between 6 and 21
mmHg with at least 20% reduction from baseline was the primary outcome. All
patients reached 3-year follow-up.
Results: Average baseline IOP and number of medications were similar

between groups (p > 0.5). IOP and medications decreased significantly in both
groups at all follow-up points compared to baseline (p < 0.001). At last visit,
both IOP and medication requirements were not significantly different between
groups (p = 0.60, p = 0.70 respectively). However, IOP was significantly lower
in the bevacizumab group 3 and 6 months postoperatively (p = 0.01, p = 0.03
respectively). Although similar between groups at last visit, complete success
was significantly higher in the bevacizumab group at months 6 and 12 (96% vs
82% and 88% vs 72%; p = 0.03, p = 0.04 respectively) with less patients requiring
additional anti-glaucoma medications at months 6, 9 and 12 (p = 0.03, p = 0.04
and p = 0.03 respectively). Postoperative interventions and complication rates
were similar between groups.
Conclusion: Intracameral administration of bevacizumab has similar long-term

efficacy results to MMC but significantly reduces the need for IOP lowering
medications during the first year of follow-up.

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on Glaucoma Surgery
LONG-TERM EFFECTIVENESS OF ISTENT MICRO SHUNT IN PATIEN-

TS WITH PRIMARY OPEN ANGLE GLAUCOMA
Mario Montelongo, Joseph T Kavanagh, William E. Sponsel (USA)
Purpose: To examine the long-term efficacy of the iStent micro shunt in

lowering intraocular pressure (IOP).
Design: Retrospective quality assurance chart review
Methods: Inclusion: all individuals with mild to moderate primary open angle
glaucoma who had undergone phacoemulsification with intraocular lens (IOL)
implantation and subsequent iStent placement. Change in IOP was assessed
using paired t-test and a simple linear regression was calculated to correlate
number of medications prescribed based on time.
Results: 100 eyes of 61 patients were assessed (mean age 72.75; 32M 29F).
At baseline mean IOP was 18.7±0.4mmHg and patients were on a mean of
1.1 ± 0.11 IOP-lowering drop. At 1 day, 7 days and 1, 3, 6, 12, 24, 36 months
after surgery IOP dropped from the baseline value of 18.7 ± 0.4 to 16.7 ±
0.5 (-2mmHg, -11%), 17.5 ± 0.5 (-1.2mmHg, -6.4%), 16.4 ± 0.3 (-2.4mmHg,
-12%), 16.1 ± 0.5 (-2.6mmHg, -13%), 16.7 ± 0.4 (-2mmHg, -11%), 16.5 ± 0.4
(-2.2mmHg, -12%), 17.1 ± 0.5 (-1.6mmHg, -8%), 16.2 ± 0.8 (-2.5mmHg, -13%)
respectively (p < 0.05). A significant regression equation was found between
number of medications prescribed and time (F(1,5) = 78.063, p < 0.0001), with
an R2 of 0.939. Medications at 1, 3, 6, 12, 24, and 36 months changed from
baseline of 1.1 ± 0.11 to 1 ± 0.12, 1.1 ± 0.11, 0.9 ± 0.11, 1.2 ± 0.12, 1.5 ± 0.22,
and 1.7 ± 0.21, respectively.
Discussion: While the patients in this study saw a statistically significant

reduction in IOP at every time interval, it is important to note that our
population underwent phacoemulsification with IOL implantation at the time
of iStent placement. One study that assessed the effects of phacoemulsification
on IOP in healthy eyes with a mean baseline IOP of 16.2mmHg saw a
sustained reduction in IOP by 3.6mmHg (22%) up to 4 years after surgery. In
our population mean IOP remained well-controlled across all time intervals
but with a highly significant rate of medication use. While IOP remained in
mid-normal range IOP reduction (mean 10.9%) did not approach the 20%
reduction stated to be of clinical significance by European Glaucoma Society
and American Academy of Ophthalmology.

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Conclusions: iStent implantation in patients with mild to moderate glaucoma

was associated with statistically significant but not clinically significant reduction
in IOP up to 3 years post implantation, with progressive increase in topical
medication over time.

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on Glaucoma Surgery
VIDEOS

11
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on Glaucoma Surgery
V02
NOVEL TECHNIQUE FOR COMBINED TREATMENT AND

EVALUATION OF OPEN-ANGLE GLAUCOMA: AB INTERNO
ITRACK CANALOPLASTY COMBINED WITH IN VIVO TRYPAN BLUE
VENOGRAPHY
Gavin Docherty1, Matt Schlenker2, Bryce Ford1, Andrew Crichton1, Ike
Ahmed2, Patrick Gooi1
1
Ophthalmology, University of Calgary, Calgary, Canada, 2Ophthalmology, University
of Toronto, Oakville, Canada
Purpose: To demonstrate a method of visualizing aqueous outflow combined

with a minimally invasive glaucoma surgery (MIGS).
Methods: Trypan blue is injected into a Healon ophthalmic viscoelastic

cannister via a one inch-25 gauge needle. The Trypan blue is then mixed into
the Healon at various depths. A 2.2 mm clear corneal incision is then made
temporally followed by a paracentesis. Healon is used to inflate the anterior
chamber followed by nasal goniotomy. The iTrack (iScience Interventional,
Menlo Park, CA), attached to a screw-driven syringe, is inserted into the
goniotomy and advanced through Schlemm’s canal1. A small amount of trypan-
viscoelastic mixture can be injected into Schlemm’s canal allowing visualization
of the outflow pathway.
Results: The authors are evaluating the safety and efficacy of this technique
and data collection is ongoing. Currently there have been no complications
and intraocular pressure lowering is equivalent to previously described iTrack
canaloplasty.
Conclusion: Currently, we have no established clinical way to evaluate aqueous

outflow. The authors describe a technique that allows the visualization of the
aqueous outflow pathway directly during surgery. This technique may allow us
to further our understanding of the aqueous outflow system and its role in
the underlying pathophysiology of glaucoma. Further research is required to
evaluate the prognostic significance of this technique.

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on Glaucoma Surgery
V03
HEMI-GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY

COMBINED WITH DIRECT AB-INTERNO VISCOCANALOPLASTY:
DESCRIPTION AND PRELIMINARY RESULTS
Gavin Docherty1, Bryce Ford2, Andrew Crichton2, Patrick Gooi1
1
University of Calgary, Ophthalmology, Calgary, Canada, 1University of Calgary,
Ophthalmology, Calgary, Canada
Purpose: To describe a novel method of achieving intraocular pressure lowering

via gonioscopy assisted-transluminal trabeculotomy (GATT) combined with
viscocanaloplasty.
Methods: Hemi-GATT is performed in standard approach for 180 degrees.

Following this an ophthalmic viscoelastic surgical device is used to viscodilate
Schlemm’s canal and the downstream collector channels.
Results: Data collection is ongoing. Preliminary results are shown here. Sample
size of n = 10 with a mean pre-operative intraocular pressure (IOP) of 21
mmHg. Mean pre-operative number of glaucoma drops was 3 with average
daily diamox equal to 500 mg daily (3 patients). One-month post-operative
course showed a 38% reduction in IOP. No complications occurred.
Conclusion: The authors describe a novel technique that can be used in

conjunction with a validated MIGS that allows treatment of the post-trabecular
outflow system. Viscocanaloplasty represents a minimally invasive technique
that can be combined with other minimally invasive glaucoma surgeries. This
technique may prove a cost-effective way to improve treatment of glaucoma in
a minimally invasive fashion with safety and efficacy profile equivalent or better
than GATT. Preliminary results show modest IOP lowering sustained at one
month post-oeprative follow up.

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on Glaucoma Surgery
V04
USE OF THE SECOND FENTO LASER IN EYE SURGERY WITH

GLAUCOMA
Susana Perucho Martinez1, Aitor Fernandez Garcia2, Carlos Fernandez
Escamez1
1
Hospital Universitario de Fuenlabrada, Ophthalmology, Madrid, Spain, 2innova
Ocular Madrid, Ophthalmology, Madrid, Spain
In recent years, the introduction of the Femtosecond laser sparked a small

revolution in the world of cataract. This technology allows us to perform a
complete capsulorhexis, a regulated and programmable faco fragmentation
that is especially useful in patients with narrow anterior chambers. Below are
four situations in which the use of the femtosecond laser can help with surgery
in patients with glaucoma.
Case 1: Narrow chamber cataract (sub 1 mm) and contralateral miss direction.
Femtosecond is performed with a 5.2 mm capsulotomy centered on the
pupil. After, a dry central posterior vitrectomy is performed and finally a
phacoemulsification with the bevel down technique without complications.
Case 2: Cataract in a patient previously operated for trabeculectomy by GAE.
5.2 mm capsulotomy centered on pupil is performed and extended range lens
is introduced.
Case 3: Combined cataract and glaucoma surgery with Xen implant introduction.
The vacuum of the femtosecond does not cause conjunctival hemorrhages
that prevent the correct visualization of the introduction of the device.
Case 4: Glaucoma surgery by Express implant and attempted capsulotomy in a
patient with concentric contraction of the capsular bag.
Bio of the Author: Susana Perucho Martínez. Hospital Universitario de

Fuenlabrada, Madrid. Licenciada en medicina y cirugía (1995 - 2001. Doctora
en Medicina y Cirugía en el año 2007. Universidad Complutense de Madrid.
Formación MIR en Oftalmología en Hospital 12 de Octubre (2002-2006).
Subespecialidad en Glaucoma

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on Glaucoma Surgery
V05
TRAUMATIC GLAUCOMA WITH IRIDODIALYSIS

Esperanza Gutierrez Diaz1, Maria Dolores Lago Llinas1, Jose Luis Torres
Peña1, Beatriz De Lucas Viejo1, Marta Montero Rodriguez1
1
Hospital Universitario 12 de Octubre, Glaucoma, Madrid, Spain
We present a patient with a traumatic glaucoma due to angle recession

diagnosed years after the trauma with advanced glaucoma, and that had also an
inferior iridodialysis. A deep sclerectomy with MMC was performed to control
the IOP, with cataract extraction and suture of the iridodialysis as adjuvant
procedures. The procedure was uneventful, although the improvement in
visual acuity was limited by the severe glaucomatous damage. IOP after surgery
was in the high teens, and a prostaglandin analog was prescribed to maintain
the IOP in the low teens, and preserve the remaining vision. After 5 years of
follow-up, the patient remains stable and doesn’t need any more treatment.
Bio of the Author: Esperanza Gutiérrez-Diaz. Staff Physician and Chief of

Anterior Unit in the University Hospital 12 de Octubre, Complutense University
of Madrid. She specializes in glaucoma since 1990. Her main areas of interest
are glaucoma drainage devices and non-penetrating filtering surgery. She has
participated in numerous national meetings as speaker and has authored more
than 50 papers in peer-reviewed scientific journals. She has write a book about
Glaucoma Drainage Devices and several chapters of books regarding glaucoma
and examination techniques, and collaborates with several journals as reviewer.

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on Glaucoma Surgery
V06
DANGEROUS EYE: LET´S TAKE ADVANTAGE OF WHAT WE HAVE

Maria Dolores Lago Llinas1, Esperanza Gutierrez Diaz1
1
Ophthalmology, Hospital Universitario 12 de Octubre, Madrid, Spain
DANGEROUS EYE: “LETS TAKE ADVANTAGE OF WHAT WE HAVE”´

17th years old male with open angle glaucoma associated with Sturge-Weber
Syndrome.
He was performed an Ahmed valve implant with 3 years old.
Ocular examination: right eye with 0.5 visual acuity, IOP 22 mmHg with 3
glaucoma drops, an intracorneal localized tube and non-functioning valve.
We performed a surgery with tube release from the cornea, check the
valve by purging with tripan-blue. Then we made a new scleral channel to
insert the tube in anterior chamber, parallel to iris, covered the tube with
lyophilized fascia lata patch and close the conjunctiva.
Bio of the Author: Maria Dolores Lago Llinas. Academic qualification and
training in ophthalmology: Medical degree, Medicine Faculty Autonoma
University of Madrid, 1994-2001. Doctorate: Surgery Department of Autonoma
University of Madrid, 2002-2004. Research aptitude, 2005. Specialized in
ophthalmology in Hospital Universitario 12 de Octubre, Universidad
Complutense de Madrid. 2002-2006. Profesional experience: consultant in the
glaucoma Department of Hospital Universitario “12 de Octubre” of Madrid
since 2007. Book chapters and papers: first author: 6; second author: 29. Papers
in training courses: first author: 8. International congress presentations: first
author: 7. National congress presentations: first author: 38.

16
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on Glaucoma Surgery
V07
DIFFERENT SURGICAL TECHNIQUES FOR TUBE REVISION

Cynthia Yu-Wai-Man1, Sheng Lim1
1
King’s College London, Department of Ophthalmology, St Thomas’ Hospital, London,
United Kingdom
Summary: This video highlights four different surgical techniques for tube
revision.
Case 1: Tube erosion - Functional tube. Dragon technique (double tunnel)

is used to divert the tube, which is inserted into the anterior chamber at a
different position.
Case 2: Tube erosion - Non-functional tube. The tube is trimmed to the base
of the plate.
Case 3: Tube too short. A tube extender is connected to the tube end and
inserted into the anterior chamber.
CASE 4: Not enough conjunctiva

A rotational conjunctival graft is used from the inferior fornix conjunctiva.
Bio of the author

Dr Yu-Wai-Man is a Clinician Scientist and Consultant Ophthalmologist at
King’s College London. Dr Yu-Wai-Man became a Fellow of the Royal College of
Ophthalmologists (London) in 2013 and did her Glaucoma surgical fellowship
at St Thomas’ Hospital (London). She was also an NIHR Francis Crick Institute
Clinical Research Fellow at the UCL Institute of Ophthalmology (PhD 2014-
2017), and was awarded a EUREKA Fellowship in Translational Medicine in
2015. Dr Yu-Wai-Man is the Chief Investigator of clinical trials of novel targeted
therapeutics in glaucoma surgery. Her lab is focused on wound healing research
and glaucoma genetics, and is in close proximity to the NIHR BRC Genomics
facility, Advanced therapies manufacturing GMP unit and Clinical Research
facility. Over the last 5 years, she has also set up an extensive unique biobank
of ocular tissues and cell lines in glaucoma patients.

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on Glaucoma Surgery
V08
MANAGEMENT TO TRABECULECTOMY AND HYPOTONY

Nurettin Akyol1, Adem Türk2
1
KTÜ , Ophthalmology, Trabzon, Turkey, 2KTU, Opfthalmology, Trabzon, Turkey
Hypotony is intra ocular pressure 6 mmHg and if under 4 mmHg and
permenet demageoccure. Hypotony in trabeculectomy surgery may result
from various etiologies. Intraoperative, expulsive hemorrhage (supra choroidal
hemorrhage). Postoperative early and late, bleb leakage, choroidal effusion,
inflammation (blebitis and endoftalmi). Most hypotony resolve spontaneously
and medical treatment. In this video, the treatment approach of hypotony in
trabeculectomy.
To discuss the methods used in treatment of hypotonia after trabeculectomy.

The aim of this study is to present surgical treatment of blep leakage and
choroidal detachment.

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on Glaucoma Surgery
V09
BLEB RESCUE OPERATIONS

Jyoti Shakrawal1, Talvir Sidhu1, Ramanjit Sihota1, Tanuj Dada1
1
RPC, AIIMS, Ophthalmology, India
We describe different techniques for improving outcomes of bleb revision

surgery to restore bleb function. 1-Bare sclera technique for leaking, over-
hanging/over-filtering bleb. 2-Bleb-sparing-epithelial-exchange for thin,
cystic, avascular bleb. 3-Ologen implant technique for thin bleb with small
scleral necrosis. 4-Bleb repair with scleral patch along with ologen for thin
bleb with full thickness scleral defect. 5-Maumenee’s repair with pedicel
conjunctival graft for partial thickness scleral necrosis in a thin bleb.
This will be a video-assisted educational training on Bleb Rescue Operations
along with peri-operative anterior segment imaging and UBM documentation
which can have used to enhance success of bleb revision surgery.
Bio of the Author: Jyoti Shakrawal, (MD) received her MBBS degree from
SMS medical college, Jaipur and MD, ophthalmology from Dr. Rajendra Prasad
centre for ophthalmic sciences, All India Institute of Medical Sciences (AIIMS),
New Delhi. Currently pursuing senior residency at AIIMS, New Delhi. She
has completed her MD thesis on the subject ‘‘Illuminated Microcatheter
Circumferential Trabeculotomy verses Ab-externo Trabeculotomy for Primary
Congenital Glaucoma: a Randomized Controlled Trial’’ under the guidance
of Professor Tanuj Dada and has presented research poster on the same
at international ophthalmology conferences (ICGS 2016; won best poster).
She had recently presented her research paper on “Comparative evaluation
of phacoemulsification alone Versus phacoemulsification combined with
Goniosynechialysis in Primary Angle Closure Glaucoma: A randomised
controlled trial.” at 8th World Glaucoma Congress 2019. She is currently
involved in research projects on Congenital Glaucoma and Primary Angle
Closure Glaucoma.

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on Glaucoma Surgery
V10
ACUTE FLUID MISDIRECTION SYNDROME AND DIFFERENT

TREATMENT METHODS
Susana Perucho Martinez1, Aitor Fernandez Garcia2, Carlos Fernandez
Escamez1, Elena Martín Giral1, Nicolas Toledano Fernadez1
1
Hospital Universitario de Fuenlabrada, Ophthalmology, Madrid, Spain, 2Innova
The fluid misdirection syndrome is a rare clinical condition characterized by

an axially very shallow anterior chamber with the absence of suprachoroidal
effusion or hemorrhage. It usually occurs during uneventful phacoemulsification.
Faced with these situations, pars plana decompression is required. Prior to
performing a posterior decompression, the surgeon must be certain that there
is no evidence of choroidal effusion or hemorrhage. The decompression might
be done by puncture with a straight needle 3 mm from the rim and then
aspiration of retrolenticular fluid (“Chandler Maneuver”) Vitreous traction
might be a concern when performing this procedure. Furthermore, the
treatment has not always been described as successful Hence it would be
preferable to use a small-gauge trocar/cannula vitrectomy cutter (23-, 25-, or
27-gauge). The cutter can then remove retrocapsular fluid using a high cut rate
and thus be able to complete the phacoemulsification.

Fuenlabrada, Madrid. Licenciada en medicina y cirugía (1995 - 2001). Doctora
Subespecialidad en Glaucoma. Facultativo especialista de Área en el Servicio
de Oftalmología del Hospital de Fuenlabrada desde Julio 2006 hasta la
actualidad. Especialista en Glaucoma (desde 2006 hasta la actualidad). Profesara
Colaboradora de Oftalmología de la Universidad Rey Juan Carlos de Madrid
desde el año 2011 hasta la actualidad. Vocal de Tribunal de Tesis en los años
2011 - 2018. Directora de trabajos fin de Máster en la Universidad Rey Juan
Carlos, 2018.

20
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on Glaucoma Surgery
V11
MANAGING TUBE MIGRATION FOLLOWING GLAUCOMA IMPLANT

SURGERY
Surinder Pandav1, Faisal Tattaruthodi1, Madhuri Akela1, Manpreet Kaur1
1
Postgraduate Institute of Medical Education & Research, Advanced Eye Center,
Chandigarh, India
Tube migration is often encountered after tube surgery for glaucoma. Tube
migration into the anterior chamber can lead to corneal endothelial damage
whereas, retraction of tube outside the eye leads to high intraocular pressure
and failure of surgery. This video demonstrates management of anterior
migration of tube through external and internal approaches. Retracted tubes
generally require a tube extender to increase the tube length. Commercially
available tube extenders are expensive and bulky. We demonstrate a simple
technique where a silicone tube can be joined to the existing retracted tube
to gain length.
Bio of the Author: Dr. Surinder Pandav is working as Professor of

ophthalmology at PGIMER, Chandigarh, India. Dr. Pandav did Glaucoma
Research Fellowship in 2005 and Glaucoma Clinical Fellowship in 2006 at
Perth, Australia (Lions Eye Institute and Royal Perth Hospital). He was visiting
Professor at Center for Eye Research Australia, Melbourne Australia, from 2014
to 2016 where was involved in basic research on understanding functioning of
Glaucoma Drainage Devices. He was also involved in the Glaucomatous Optic
Neuropathy Evaluation (GONE) project, which is an Internet based system
for evaluation of Optic Disc Assessment Skills among ophthalmologists and
trainees. Dr. Pandav has been the President of the Chandigarh Ophthalmology
Society, General Secretary North Zone Ophthalmological Society, General
Secretary Glaucoma Society of India. He is actively involved in glaucoma
research and has published about 100 research papers and delivered over 200
talks in various conferences/ seminars.

21
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on Glaucoma Surgery
V12
CYPASS TRIMMING
Jose Luis Torres Peña1, Marta Montero Rodriguez1, Maria Dolores Lago
Llinas1, Beatriz De Lucas Viejo1, Esperanza Gutierrez Diaz1
1
We present two patients with a history of cypass implantation and reduction of

endothelial cells. For trimming, we used capsulorexis scissors. Cypass trimming
is a maneuver designed to reduce the loss of endothelial cells in susceptible
patients.
Bio of the Author: Jose Luis Torres Peña. Degree in medicine: Catholic
University of Santa Maria, Arequipa Peru, from 2004 to 2011. Resident internal
doctor of ophthalmology: University Hospital October 12 in Madrid from 2012
to 2016. Training stay in glaucoma at the Hospital October 12: from June 2016
to December 2018. Glaucoma department doctor: San Rafael Hospital, Madrid,
Spain, from January 2017 to the present. Medical Director: OftalmoVisión
Clinic, Madrid, Spain, from February 2019 to present.

22
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on Glaucoma Surgery
V13
GONIOTOME; A NEW GLAUCOMA SURGERY FOR THE EUROPEAN

MARKET
Vipul Ramjiani1, Daniel Gosling1, Graham Auger1
1
Sheffield Teaching Hospitals NHS Foundation Trust, Eye, Sheffield, United Kingdom
Summary: Goniotome +IA is a minimally invasive glaucoma procedure, a new

device in Europe. A V-shaped serrated blade removes trabecular meshwork
via an ab-interno approach, allowing direct communication with Schlemm’s
canal. The goiniotome blade is aided by irrigation and aspiration lines. This
allows for clearer angle views and maintains anterior depth intraoperatively.
The lines are connected to a phacoemulsification machine, simplifying its
implementation. This video demonstrates its use in real eyes. We summarise
our early experience and outcomes at Sheffield Teaching Hospitals NHS
Foundation Trust, United Kingdom.
Bio of the Author: Mr Vipul Ramjiani is a senior trainee working at Sheffield

Teaching Hospitals (STH) NHS Foundation Trust, United Kingdom. He will
be going on to complete a fellowship in glaucoma before a consultancy post.
He has produced this video to help with the awareness of Goniotome +IA.
The procedure is currently being performed by Mr Graham Auger, Consultant
Glaucoma Surgeon at STH. Mr Auger is the first surgeon in Europe to be
performing the procedure.

23
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on Glaucoma Surgery
V14
SEMI-OPEN SUBTENON AB INTERNO XEN STENT TECHNIQUE

Yu Xiang George Kong1,2,3
1
Royal Victorian Eye and Ear Hospital, Ophthalmology, Melbourne, Australia,
2
Mount Waverley Eye Surgeons, Melbourne, Australia, 3Monash Medical Centre,
Ophthalmology, Clayton, Australia
Semi-open XEN insertion developed by Dr George Kong aims to (1) dissecting a

potential space for filtration (2) avoid intra-tenon insertion (3) ensure adequate
tissue above stent to avoid erosion (4) avoid anterior bleb leak. Semi-open
technique involves the key steps of (1) small posterior incision ~2mm in length,
~8mm from limbus to reach subtenon space (2) dissect subtenon pocket with
thin blunt dissector (3) maintain pocket using viscoelastic (4) insertion of XEN
ab interno into pocket and (5) conjunctival closure with single 10-0 vicyl. This
technique leads to diffuse, slightly elevated blebs with less risk of obstruction
of XEN stent by tenon.
Bio of the Author: Dr George Kong is a Consultant glaucoma specialist at the

Royal Victorian Eye and Ear Hospital and Monash Hospital in Melbourne. He
received his ophthalmology training in Melbourne and subsequently received
glaucoma surgical training in Melbourne and also with Prof. Keith Martin in
Cambridge UK. He has completed a PhD on optic nerve and aging with Prof.
Jonathan Crowston. He is the co-inventor of the world’s first Apple iPad based
perimetry software and is actively involved in research into home monitoring
for glaucoma patients.

24
th
on Glaucoma Surgery
V15
PRIMARY NEEDLING IN XEN45 GEL STENT IN GLAUCOMA SURGERY

Susana Perucho Martinez1, Elena Martín Giral1, Aitor Fernandez Garcia2,
Nicolas Toledano Fernadez1, Carlos Fernandez Escamez1
1
Hospital Universitario de Fuenlabrada, Ophthalmology, Madrid, Spain, 2Innova
The XEN gel stent is a minimally invasive surgical device aimed at creating
a subconjunctival drainage of aqueous humor, thereby reducing intraocular
pressure (IOP). More important than where the implant is in the subcjunctival
space, is that the implant is completely released in that space. For this we
propose primary needling that ensures this correct position and therefore
it’s ensures the success rate of the XEN45 Gel Stent with a lower rate of
postoperative maneuvers.

Fuenlabrada, Madrid. Licenciada en medicina y cirugía (1995 - 2001). Doctora
Subespecialidad en Glaucoma. Facultativo especialista de Área en el Servicio
de Oftalmología del Hospital de Fuenlabrada desde Julio 2006 hasta la
actualidad. Especialista en Glaucoma (desde 2006 hasta la actualidad). Profesara
Colaboradora de Oftalmología de la Universidad Rey Juan Carlos de Madrid
desde el año 2011 hasta la actualidad. Vocal de Tribunal de Tesis en los años
2011 - 2018. Directora de trabajos fin de Máster en la Universidad Rey Juan
Carlos, 2018.

25
th
on Glaucoma Surgery
V16
RESTORING DRAINAGE USING A PRESERFLO MICROSHOUNT

DURING BLEB REVISION
Paolo Meier1, Tejal Magan1, Avi Kulkarni1
1
King’s College Hospital, Ophthalmology, London, United Kingdom
We describe a novel application for the Preserflo Microshunt during revision

of a leaking conjunctival bleb. A 62 year-old patient presented with a leak
from an avascular trabeculectomy bleb. Revision with excision of the avascular
conjunctiva was undertaken. To improve long-term efficacy, a Microshunt
was implanted beneath the existing scleral flap. The postoperative IOP was
consistently below 12 mmHg without glaucoma medication and with no
bleb encystment within 6 weeks following surgery. Implanting the Preserflo
Microshunt under a previous trabeculectomy flap during bleb revision ensures
good IOP control. Late failure may be less likely than if revision alone is
undertaken.
Bio of the Authors: 1. Paolo Meier MD FMH Ophthalmology FEBO

FICO, Glaucoma Fellow, King’s College Hospital, London. 2. Tejal Magan
MBBS,Specialist registrar, King’s College Hospital, London. 3. Avi Kulkarni
BSc MBBS FRCSEd (Ophth), Consultant Ophthalmologist, King’s College
Hospital, London.

26
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on Glaucoma Surgery
V17
RESCUE MICROSHUNT RESCUED

Marta Montero Rodriguez1, Jose Luis Torres Peña1, Maria Dolores Lago
Llinas1, Beatriz De Lucas Viejo1, Esperanza Gutierrez Diaz1
1
Hospital Universitario 12 de Octubre , Glaucoma, Madrid, Spain
An 18 years-old woman with advanced glaucoma diagnosed in childhood
and previous surgery with Express and Ahmed valve in both eyes. Preserflo®
Microshunt was implanted in the left eye. Two weeks later IOP was 25 mmHg.
Surgical revision showed the tube entangled in the insertion of rectus muscle
and blocked by fibrosis. After the tube was freed, good filtration was observed.
It was fixed with a 10-0 nylon suture to direct it away from the muscle and
covered by Ologen®. After 6 months, the IOP is 11 mmHg without treatment.
Preserflo may be a good alternative in operated phaquic patients. It may
maintain a good function despite slight tilt of the tube.
Bio of the Author: Marta Montero Rodriguez. Current position: Staff

physician in the Deparment of Ophthalmology at the “12 de Octubre”
Hospital, Complutense University, Madrid, Spain. Medical School: Medicine and
Surgery Bachelor, Santiago de Compostela University, Spain 1983. Graduate of
Medicine and Surgery, Santiago de Compostela University, Spain 1983. Work:
Ophthalmology Resident, Department of Ophthalmology, 12 de Octubre
Hospital, Complutense University, Madrid, Spain:1989-1992. Staff Physician,
Department of Ophthalmology at the12 de Octubre Hospital, Complutense
University, Madrid, Spain:1993-to present time. Scientific activity: Publications:
International: 11, National: 6. Book: 1, Book chapters: 1. Speaker, Symposiums
and Round Tables: 20. Clinical Trial: 3. Principal investigator in FIS: 1. Others:
Residents Tutor from 01/07/2011 to 11/06/2019.

27
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on Glaucoma Surgery
V18
AHMED DRAINAGE IMPLANTATION IN PENETRATING

KERATOPLASTY AND ANTERIOR CHAMBER RECONSTRUCTION
Tatyana Iureva1, Nadezhda Senchenko2
1
Irkutsk Branch of S. Fyodorov Eye Microsurgery National Medical Research Center
of Ministry of Health of the Russian Federation, 2nd Surgical department, Irkutsk,
Russian Federation, 2Irkutsk Branch of S. Fyodorov Eye Microsurgery National
Medical Research Center of Ministry of Health of the Russian Federation, 1st
Surgical department, Irkutsk, Russian Federation
Severe forms of the Dry Eye Syndrome is often accompanied by corneal xerosis,
trophic ulcers and perforation formation resulting into secondary glaucoma.
The treatment is problematic as hypotensive eye drops are not effective,
maximum medical therapy (MMT) aggravates xerosis of the eye surface.
Purpose: To present a clinical case of surgical treatment of secondary glaucoma

in a patient after corneal perforation with xerosis caused by target therapy
of lymphoblastic leucosis. The patient with acute lymphoblastic leukemia was
prescribed a target chemotherapy which led to clinical hematologic remission.
During the second course of chemotherapy severe form of Dry Eye Syndrome
and corneal ulcer developed. Corneal perforation, IOP elevation to 30 mmHg
occurred.The decision on combined surgery was made: penetrating keratoplasty,
reconstruction of the anterior segment, Ahmed drainage implantation. Ahmed
drainage was implanted and sutured to sclera prior to penetrating keratoplasty.
A “reverse” method of a hole formation was used for drainage implantation.
The puncture was made by an injection needle from the side of the anterior
chamber after the corneal excision. The anterior chamber was restored; the
fusion between the iris and the cornea was separated. Three months after
chemotherapy. The epithelized corneal graft was cloudy by 50%. The drainage
was correctly located in the anterior chamber. IOP was 17 mmHg without
medication.
Conclusion: The use of the proposed technique in penetrating keratoplasty

ensures correct position of Ahmed drainage providing the normal level of IOP
which is important for the engraftment of the donor cornea.

28
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on Glaucoma Surgery
V19
TIPS AND TECHNIQUES FOR MICROPULSE TRANS-SCLERAL

CYCLOPHOTOCOAGULATION
Brinda Shah1, Safaa Mahmoud1, Apurva Goray1, Paritosh Shah1
1
Yeovil District Hospital NHS Foundation Trust, Ophthalmology,Yeovil, United
Kingdom
Summary: This video demonstrates the technique of applying micropulse trans-

scleral laser cyclophotocoagulation which is proving to be a safe, non invasive
treatment for glaucoma with a quick post operative recovery. It addresses
questions regarding anaesthesia , laser settings, equipment, technique and tips
to make it a straightforward technique for a more effective treatment .We also
briefly present our post operative care regimen and results.
Bio of the Author: Ms Brinda Shah is a Consultant Ophthalmologist in Yeovil

District Hospital in Somerset ,UK, specialising in Glaucoma, having previously
completed a Glaucoma and A&E fellowship at Moorfields Eye Hospital followed
by a Research fellowship in Glaucoma at St Thomas Hospital London. She is
also the speciality lead for NIHR clinical Research network for Ophthalmology
for the South West Peninsula and is actively involved in teaching and training
at Yeovil for doctors, allied professionals, optometrists and Medical students
from Bristol Medical College.

29
th
on Glaucoma Surgery
V20
NON PENETRATING DEEP SCLERECTOMY: VISCO-DISSECTION

OF THE TRABECULO-DESCEMET’S MEMBRANE AND SURGICAL
MANEUVER TO SOLVE A POST SURGICAL INCARCERATION OF IRIS
IN THE TRABECULO-DESCEMET’S MEMBRANE
Elena Milla1, Marta Pazos1, Mª Jesus Muniesa1
1
Hospital Clínic of Barcelona. Institut Clínic d’Oftalmologia (ICOF), Glaucoma,
Barcelona, Spain
Summary: Presentation of the glaucoma surgery video of two patients with

open angle glaucoma by phaco-non-penetrating deep sclerectomy (NPDS) and
visco-dissection of the trabeculo-Descemet’s membrane (TDM). This visco-
dissection facilitates the peeling of the TDM minimizing the risk of breaking
it during surgery. In both cases, a biodegradable collagen matrix (Ologen®)
implant was used at the sub and suprascleral level as a space maintainer and
healing modulator. One of these patients presented spontaneous rupture of
the MTD one month after surgery with the iris incarcerated in the MTD,
so this patient required a new surgical intervention presented in this video.
Incarcerated iris release was performed through paracentesis and iris traction
with retinal forceps and performing an iridectomy with the help of a vitreotome
with good evolution, diffuse filtering bleb formation and good intraocular
pressure control.
Bio of the Author:

MªJesús Muniesa
Hospital Clínic of Barcelona. Institut Clínic d’Oftalmologia (ICOF), Spain,
Glaucoma Department

30
th
on Glaucoma Surgery
V21
SURGICAL TREATMENTOF GLAUCOMA AND CATARTACT IN A

PATIENT WITH IRIS COLOBOMA
Maria Dolores Lago Llinas1, Esperanza Gutierrez Diaz1
1
Ophthalmology, Hospital Universitario 12 de Octubre, Madrid, Spain
51 years old female with amblyopia in r¡ght eye. The ocular examination
showed: 0.1 visual acuity, iris coloboma, cataract, deep anterior chamber depth
and no phacodonesis. She needed 3 glaucoma drops and the optic nerve was
severe affected.We performed a combined surgery of glaucoma and cataract by
non-penetrating deep sclerectomy and phaco with tension ring. After the lens
implantation we performed an iris suture by the Siepser ab-external technique.
University of Madrid, 2002-2004. Research aptitude, 2005. Specialized in
ophthalmology in Hospital Universitario 12 de Octubre, Universidad

31
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on Glaucoma Surgery
V23
DRAINAGE OF PRE-DESCEMETIC HEMATOMA AFTER NON-

PENETRATING DEEP SCLERECTOMY
Maria Dolores Lago Llinas1, Beatriz de Lucas Viejo1
1
hospital Universitario 12 de Octubre, Ophthalmology, Madrid, Spain
76 year-old patient with atrial fibrillation treated with acenocoumarol and open-
angle glaucoma in treatment with 3 drugs. A non-penetrating deep sclerectomy
with 5-fluorouracil combined with phaco was performed. After 48 hours, the
acenocoumarol was reintroduced. Two weeks later a hematoma in the scleral
lake and upper intracorneal predescemetic space of 2.5 mm approaching
the pupillary border was observed. A surgical drainage was decided and the
procedure consisted of descematorhexis and blood drainage using a DSAEK
spatula, hyperpressure controlled with viscoelastic, achieving the evacuation of
the blood clot to the anterior chamber. In 5 months follow-up there has been
no rebleeding.
University of Madrid, 2002-2004. Research aptitude, 2005. Specialized
in ophthalmology in Hospital Universitario 12 de Octubre, Universidad

32
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on Glaucoma Surgery
V24
NON-PENETRATING GLAUCOMA SURGERY (NPGC) WITH

SPURECTOMY AND SUPRACILIARY IMPLANT
Alex Samir Fernández Santodomingo1, Miriam Rahhal Ortuño1, Emma
Marín Payá1, Jorge Vila Arteaga2
1
Ophthalmology, Hospital Universitari i Politècnic La Fe, Valencia, Spain, 2Valencia,
Hospital Universitari i Politècnic La Fe, Glaucoma, Spain
Within the glaucoma surgeries we have the Non-Penetrating Glaucoma Surgery

(NPGS), being a variety of this with spolonectomy. This technique has proven
its effectiveness in the maintenance of good control of intraocular pressure
and safety.This surgery uses the initial steps similar to NPGS, the differentiating
step is the removal of the scleral spur, with the consequent opening of the
suprachoroidal space, where we can associate it with suprachoroidal implants.
The association of spolonectomy with deep non-penetrating sclerectomy is an
effective technique that significantly reduces intraocular pressure, maintaining
this significant decrease during the first two years of surgery.
Bio of the Author: Alex Samir Fernández Santodomingo, resident of third

year in ophthalmology in Hospital Universitari i Politecnic La Fe (Valencia,
Spain). He have some participations in local and international congress with
oral presentations and posters. The most interest areas of these participations
are in glaucoma pathology and glaucoma surgery. He is currently pursuing
his doctoral thesis, investigating about the changes in suprachoroidal spaces
after glaucoma surgery. In this occasion, with a video presentation about Non-
Penetrating Glaucoma Surgery with some special variations.

33
th
on Glaucoma Surgery
V25
DEEP SCLERECTOMY COMBINED WITH OLOGEN IMPLANT AND

MITOMYCIN-C APPLICATION FOR TREATMENT OF PRIMARY OPEN
ANGEL GLAUCOMA
Mohamed Elmalah1
1
AlAzhar University Hospital in Cairo, Ophthalmology, Cairo, Egypt
Summary of the Video: The video presented the modifications of Deep

Sclerectomy with Deg-roofing of the Schlemm’s canal, associated with Ologen
implant under Scleral flap that treated during surgery by Mitomycin-C
application for 2 minutes in a concentration of 0.2% under first sclera flap
for treatment of Primary Open Angel Glaucoma patients. This operation can
be done separately or combined with Phaco- emulsification. As prescribed in
the video, the procedure is save and not associated with marked or severe
complications as with trabeculectomy, as hypotony and shallow AC. Even it can
be done suture-less. Long- term follow up for more than two years revealed
high success rate with minimal complications.
Thanks Dr Mohamed Elmalah MD, PhD

34
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on Glaucoma Surgery
V26
NON-PENETRATING GLAUCOMA SURGERY. DEEP SCLERECTOMY

WITH SPACE MAINTAINER IMPLANT
Ali Albeshri
King Khalid Eye Specialist Hospital, Riyadh, Saudi Arabia
Lately, I realized that when you have an uncontrolled open angle glaucoma it
is very useful to think about deep sclerectomy at the first place, no matter
what is the stage of glaucoma or what was the level of intra-ocular pressure.
The outcome is always promising, and has faster visual recovery. At least I can
enjoy my sleep.
Here is 45-year-old lady who is known to have advanced open angle glaucoma
in her only seeing right eye. She was uncontrolled on maximum tolerated
medications.The decision was to go for deep sclerectomy with space maintainer
implant.
The procedure started with peribulbar block and the eye prepped and draped
as usual.
Pilocarpine instilled preoperatively to constrict the pupil and stretch the iris
tissue away from the planned area of trabeculo-descemets window. 7-0 vicryl
as a tractional suture applied, then fornix-based peritomy at the 12 O’clock
was carried out. Hemostasis done gently. Then, superficial scleral flap fashioned
in a pocket-like manner. Mitomycin C 0.2mg/ml applied subconjunctivally and
undermined the flap for 2 minutes. Copious amount of balanced salt solution
used to irrigate the area, then milked out to dry the field preparing it to
the next step. Superficial flap extended to the cornel stroma for 2mm. After
that, deep flap performed meticulously, and aqueous fluid observed percolating
nicely. Deep flap excised from its base successfully. Inner wall of Schlemm
canal & juxtacanalicular trabecula are peeled off using special forceps. After we
created an incision to the supraciliary space, a space maintainer implanted to
prevent collapse of superficial flap.
Then, superficial flap repositioned and closed loosely wit 10-0 nylon. The
conjunctiva closed also with 9-0 vicryl suture. The wounds checked for leak
then subconjunctival injection of steroid and antibiotic at the end.
The day 1 post-operatively the patient was doing great and the IOP was 06
mmHg with deep AC and flat retina and she was discharged right away.

35
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on Glaucoma Surgery
V27
TRABECULAR PEELING TECHNIQUE FOR PERFORMING AB

INTERNO TRABECULECTOMY - 1 YEAR RESULTS
Ankush Mahajan1, V.k. Mahajan1
1
Mahajan Eye Hospital and Maternity Home, Ophthalmology, Jalandhar, India
Purpose : To evaluate the efficacy of a novel technique of performing ab interno

trabeculectomy either alone or when combined with phacoemulsification in
the management of glaucoma.
Methods: A retrospective study of 38 patients. the trabecular meshwork

was incised for a few clock hours at its anterior border using a 30G needle .
The trabecular tissue flap was firmly grasped with a 25G ILM peeling forceps
and pulled out creating a free flap of trabecular meshwork 3-4 clock hours
long . This flap was then repeatedly held and pulled in a tangential direction
using either ILM or a capsulorrhexis forceps to complete 120 to 360 degrees
trabeculectomy.
Results: 33 underwent combined phaco with trabeculectomy , 5 underwent

only trabeculectomy . Complete 360 degree ab interno trabeculectomy was
accomplished in 8 cases .120 degree of trabecular meshwork was peeled off
in 30 cases .The pre op IOP was 22.79±5.95 mm of Hg . The post op IOP at
1 week , 1 month, 6 month and 1 year was 15.66±4.6(n=38), 15.62±3.43(n=
34) , 16.15±3.07 (n= 27) , 16.11±2.74(n= 37) (p= 0.0001) respectively. The anti
glaucoma medication use decreased from 2.0±0.83 preoperatively to 0.2±0.6
at 1 year. Hyphema occurred in 94.74% cases but resolved spontaneously in
all.
Conclusion: This new technique of trabecular peeling is an effective method

of achieving 120- 360 degree of Ab interno trabeculectomy causing clinically
significant decrease in IOP in both open as well as narrow angle glaucoma
patients.

36
th
on Glaucoma Surgery
V28
THE ROLE OF POROUS COLLAGEN IN TRABECULECTOMY

WITHOUT SUTURING SCLERAL FLAP
Ahmed Elbably1
1
East Kent Hospitals University, Ophthalmology, Canterbury, United Kingdom
Purpose: To assess the role of porous collagen in trabeculectomy without

suturing the scleral flap.
Methods: Twenty five eyes of twenty five patients with different types of
glaucomas. Intra ocular pressure was not controlled medically. Trabeculectomy
was performed with double-layered-ologen sandwitching the scleral flap. No
scleral sutures were performed. 18 months follow up were performed.
Results: Average IOP after 18 months follow up is low teens with mild short
term complications.
Conclusion: Double-layered-porous collagen sandwitching the sutureless

scleral flap can enhance the short term results of trabeculectomy.

37
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on Glaucoma Surgery
V29
SUTURE LESS SCLERAL TUNNEL TRABECULECTOMY IN MANAGE-

MENT OF PATIENTS WITH PRIMARY OPEN ANGLE GLAUCOMA
Mohammad D.M. Arish1,2
1
Ophthalmology, Zahedan University of Medical Sciences, Zahedan, Iran, 2Edinbur-
gh. Consultant Neuro-ophthalmology, Glaucoma
To assess the effect of suture less scleral tunnel trab. In the management of
POAG patients.
Bio of the author: Fellow Of Royal College of Surgeons of Edinburgh Assistant

Prof. Zahedan University Of Medical Sciences,Member of European Glaucoma
Society.

38
th
on Glaucoma Surgery
V30
COMBINED KERATOPLASTY ,CATARACT WITH IOL AND AHMED

VALVE IMPLANTATION FOR CONGENITAL ANIRIDIA
Hani Nasr1
1
Memorial Eye Institute for Ophthalmic Research, Ophthalmology, Cairo, Egypt
Left eye underwent keratopalsty at 7 months age IOP was normal. Right eye
tension was 35 mm Hg trabeculectomy with mitiomycin failed  did another
operation trabeculectomy with trabeclotomy developed corneal opacity
with complicated cataract tension with 30 mmHg. Combined keratoplasty
I/A with PMMA IOL and Ahmed valve implantation for the right eye. Post
operative cornea is clear IOL in place IOP 10 mmHg.

39
th
on Glaucoma Surgery
V31
TUBE IN TUBE TECHNIQUE

Lina Osman1, Peter Shah2, Joseph Abbott2
1
Leicester Royal Infirmary , Ophthalmology, Leicester, United Kingdom, 2Birmingham
Childrens’ Hopsital, Ophthalmology , Birmingham , United Kingdom
Glaucoma drainage devices are widely used. Tube retraction is a recognised

post-operative complication, which can occur at any postoperative stage. It
is reportedly commoner in the paediatric population due to axial growth and
increase scarring response. Many techniques have been described for tube
extension. Chiang et al recently described the novel Tube in Tube technique.
This video shows the technique being used on two children by the same
surgeon. We include in the presentation intra-operative surgical video and
wet lab footage to highlight learning points for those new to the procedure,
as well as pro and cons of the technique. We found the technique extremely
useful and effective. It allows stable tube placement and good pressure control
and is our preferred means of tube extension.
Bio of the Authors: 1. Ms Lina Osman. University Hospitals of Leicester;

Leicester Royal Infirmary MBBS, MSc CEH, FRC Ophth.
2. Prof Peter Shah. University Hospitals Birmingham NHS Foundation Trust
BSc (Hons), MB ChB, FRC Ophth, FRCP Edin.
3. Mr Joseph Abbott. University Hospitals Birmingham NHS Foundation Trust
BM BS, BMedSci, FRC Ophth.

40
th
on Glaucoma Surgery
V32
DRAINAGE DEVICE IMPLANTATION IN SEVERE SCLEROMALACIA

Elena Milla1, Marta Pazos1, Mª Jesus Muniesa1
1
Hospital Clinic, Ophthalmology, Barcelona, Spain
We present the case of a 58 yo lady with advanced, refractory primary open-

angle glaucoma and severe idiopathic scleromalacia that presented previous
failed trabeculectomy and endocyclophotocoagulation. Due to visual field
progression and intolerance to multiple medications she was scheduled for
drainage device implantation. Severe, extensive scleral thinning was observed
in all four quadrants. A donor scleral graft was sutured in the upper temporal
quadrant, securing the graft to the areas of relatively healthy scleral tissue. An
Ahmed valve was then sutured to the donor sclera and the tube obstructed
with occlusive 7/0 vycril peritubular suture to avoid postoperative hypotony
due to tissue debility.
Bio of the Author: Degree of Medicine and Surgery at the Faculty of Medicine
of the Central University of Barcelona in July 1991 and specialization in
Ophthalmology at Hospital de Bellvitge, Barcelona from 1991 to 1995. PhD
in Medicine at the University of Lausanne (Switzerland). Fellowship at Jules
Gonin hospital (Lausanne, Switzerland) from 1996 to 1998 in Ocular genetics.
Member of the Spanish Thematic Network of Cooperative Research in Health
(RETICS). Researcher at IDIBAPS, Hospital Clinic of Barcelona. Glaucoma
consultant at Institut Comtal d’Oftalmologia (ICO) and Hospital Clínic of
Barcelona. Director of the Genetics Unit at the Institut Comtal d’Oftalmologia,
Barcelona (www.icoftalmologia.es) from 2006 to date. Assistant Professor of
Ophthalmology at the University of Barcelona; Faculty of Medicine from 2006.

41
th
on Glaucoma Surgery
V33
EXACT POSITIONING OF TUBE IN POSTERIOR CHAMBER DURING

GLAUCOMA DRAINAGE DEVICE (GDD) SURGERY
Jose Luis Torres Peña1, Beatriz De Lucas Viejo1, Maria Dolores Lago
Llinas1, Marta Montero Rodriguez1, Esperanza Gutierrez Diaz1
1
We present a technique described by Javier Moreno-Montañés MD (Spain)

that facilitates the insertion of the tube in the posterior chamber. The tunnel
is made with a 23G needle from the inside of the globe, advancing below the
iris into the ciliary sulcus and exiting towards the sclera, and the tube is guided
by a 10-0 prolene suture double armed with straight needles passed through
the end of the tube. The advantages are the guiding of the tube that prevents
kinking or entrapments in the zonula or lens capsule, and the entrance placed
more posteriorly, which give us less extraocular portion of the tube and less
risk of exposure.
Bio of the Author: Jose Luis Torres Peña. Degree in medicine: Catholic
University of Santa Maria, Arequipa Peru, from 2004 to 2011. Resident internal
doctor of ophthalmology: University Hospital October 12 in Madrid from 2012
to 2016. Training stay in glaucoma at the Hospital October 12: from June 2016
to December 2018. Glaucoma department doctor: San Rafael Hospital, Madrid,
Spain, from January 2017 to the present. Medical Director: OftalmoVisión
Clinic, Madrid, Spain, from February 2019 to present.

42
th
on Glaucoma Surgery
V34
BAERVELDT IMPLANT COMBINED WITH VITRECTOMY IN

NANOPHTHALMOS
Esperanza Gutierrez Diaz1, Marta Montero Rodriguez1, Beatriz De Lucas
Viejo1, Jose Luis Torres Peña1, Maria Dolores Lago Llinas1
1
A 27-year-old male with nanophthalmos (axial length17 mm) and advanced

glaucoma, with previous strabismus and refractive surgery (multifocal lens
insertion in piggyback). In the right eye, an Ahmed valve was implanted but
had to be removed due to recurrent exposure. For the right eye, we choose
a Baerveldt implant due to its thin and flexible plate, which was trimmed to
adapt it to the eye size.The tube was inserted in the vitreous cavity (associated
vitrectomy), and covered with a fascia lata patch. A full-thickness sclerotomy
was also performed. After a follow-up of 18 months, IOP is controlled in the
low teens without medical treatment, and without exposure of the device.
Bio of the Author: Esperanza Gutiérrez-Diaz. Staff Physician and Chief of

Anterior Unit in the University Hospital 12 de Octubre, Complutense University
of Madrid. She specializes in glaucoma since 1990. Her main areas of interest
are glaucoma drainage devices and non-penetrating filtering surgery. She has
participated in numerous national meetings as speaker and has authored more
than 50 papers in peer-reviewed scientific journals. She has write a book about
Glaucoma Drainage Devices and several chapters of books regarding glaucoma
and examination techniques, and collaborates with several journals as reviewer.

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V35
GLAUCOMA DRAINAGE IMPLANTS: LEARNING FROM EXPERIENCE

AND TIPS FOR THE BEGINNERS
Rashmi Krishnamurthy1, Sirisha Senthil1
1
L V Prasad Eye Institute, VST Glaucoma Centre, Hyderabad, India
Glaucoma Drainage Devices (GDDs) play a significant role in the treatment

of refractory glaucomas in both children and adults. Various steps during
implant surgery including conjunctival incision and closure, implant fixation
and tube insertion may be challenging for the beginners. Additional steps
prophylactically like Pars plana vitrectomy and irido-zonulo-hyloido-vitrectomy
also is challenging in the same sitting. With experience, we have learnt few
modifications during surgery which makes it easier to learn and perform
implant surgery for beginners even in most complex situations and the same
are described in this video.
Bio of the author: Rashmi Krishnamurthy completed her basic medical

education from Vydehi Institute of Medical Sciences, Bangalore, followed
by Post graduation in Ophthalmology from Minto Ophthalmic Hospital -
Bangalore Medical College, Bangalore and Venu Eye Institute, New Delhi. She
then pursued long term Fellowship in Glaucoma from LVPEI, Hyderabad.
Rashmi is well trained in managing both adult and childhood Glaucomas. Her
other areas of interest are managing combined Surgeries, implant surgeries
and complex glaucomas. She is a member of the Glaucoma Society of India
and All India Ophthalmological Society. She has a keen interest in research and
academics and has published papers and presented at various conferences.

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on Glaucoma Surgery
V36
ANTERIOR VITRECTOMY PLUS PHACOEMULSIFICATION IN

TREATMENT OF MALIGNANT GLAUCOMA
Fei Li1, Xiulan Zhang1
1
Zhongshan Ophthalmic Center, Clinical Research Center, Guangzhou, China
A middle-aged woman with malignant glaucoma after anti-glaucoma surgery

received surgical treatment. Anterior vitreous body (AVB) was partially
removed to decrease the intraocular pressure (IOP). Then anterior chamber
was reformed with viscoelastic agent and phacoemulsification was performed
to extract the lens. Intraocular lens implantation was completed with the
insertion of capsular tension ring. Then AVB was fully removed to keep a
normal IOP. After the surgery, the patient’s anterior chamber kept deep and
IOP was well controlled. No progression was seen in the follow-up visits.
Anterior vitrectomy plus lens extraction is an effective way to treat malignant
glaucoma.
Bio of the Authors: Fei Li, MD, PhD, is currently working at Zhongshan
Ophthalmic Center. His research interests include ocular imaging, big data in
glaucoma and cognitive impairment in glaucoma.
Prof. Xiulan Zhang, MD, PhD, glaucoma specialist, is currently the director of
the Clinical Research Center at Zhongshan Ophthalmic Center. She is the
outstanding PI of State Key Laboratory of Ophthalmology in China, and was
listed as one of the TOP 100 influential people in ophthalmology in 2014. She
was awarded the Achievement Award of APAO in 2017. She is the fellow of the
AAPPO and the board member of the Asia-Pacific Glaucoma Society (APGS),
Asia Angle-Closure Glaucoma Club (AACGC) and the secretary of Chinese
Glaucoma Society (CGS). She also served as the Convener of the Glaucoma
Scientific Program of APAO Congress 2018-2019.

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on Glaucoma Surgery
E-POSTERS

46
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on Glaucoma Surgery
P002
24-MONTH OUTCOMES OF EXCISIONAL GONIOTOMY WITH THE

KAHOOK DUAL BLADE IN ANGLE-CLOSURE GLAUCOMA
Syril Dorairaj1, Mai Dang Tam2
1
Mayo Clinic, Ophthalmology, Jacksonville, USA, 2Ho Chi Minh City Eye Hospital,
Glaucoma, Ho Chi Minh City, Viet Nam
Purpose: To characterize the long-term effects of phacoemulsification

with Kahook Dual Blade (KDB)-assisted goniosynechialysis and excisional
goniotomy on intraocular pressure (IOP) and IOP medication use in eyes with
angle-closure glaucoma (ACG) and cataract.
Methods: Retrospective analysis of 42 eyes of 24 subjects through 24-months

of follow-up. IOP and medication data were collected at each follow-up visit.
Results: Preoperatively, mean (SE) IOP was 25.5 (0.7) mmHg and the mean
number of medications per eye was 2.3 (0.1). At 24-months, mean IOP was
13.5 (0.4) mmHg (-12.0 mmHg [47.1%]; p < 0.0001) and the mean number of
medications used was 0.5 (0.1) medications per eye (-1.8 medications [78%];
p < 0.0001). At 24-months, 40/42 eyes (95.2%) achieved IOP <18 mmHg, 42/42
eyes (100%) achieved IOP reduction of > 20%, 36/42 eyes (85.7%) required >1
fewer medications for IOP control, and 29/42 (69.0%) were medication-free.
No eyes required additional glaucoma surgery through 24-months of follow-
up. No vision-threatening complications occurred in any eye.
Conclusions: Phacoemulsification plus KDB-assisted goniosynechialysis/

excisional goniotomy in ACG produced statistically and clinically significant
reductions in both IOP and medication use through 24 months of follow-
up. The need for more invasive procedures (trabeculectomy or tube-shunt
implantation) was prevented or delayed in all eyes for at least 2 years. This
procedure provides a significant and sustained benefit in eyes with ACG and
cataract.

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on Glaucoma Surgery
P005
LONG-TERM EVALUATION OF ISTENT SURGERY PERFORMED ON

JAPANESE PATIENTS
Kazuyoshi Kitamura1, Kenji Kashiwagi1
1
Yamanashi university, Ophthalmology, Chuo, Japan
Purpose: To evaluate the long-term results of iStent surgery performed on

Japanese patients.
Methods: This was a retrospective nonrandomized observational study. iStent

surgery was performed on 70 eyes from 54 patients (mean age 75.5±6.92,
range 61-88, 20 males and 34 females) in Yamanashi University from April 2017
to December 2018.
Results: Primary open-angle glaucoma was observed in 47 eyes, secondary

glaucoma in 4 eyes, pseudo-exfoliation glaucoma in 12 eyes, other type of
glaucoma in 7 eyes. All surgery was performed with phacoemulsification. Mean
preoperative IOP of 16.3±4.5mmHg decreased to 13.9±3.0mmHg at 1 months,
14.2±3.1mmHg at 3 months, 14.5±2.9mmHg at 6 months, 14.4±2.4mmHg
at 12 months, respectively (P<0.05). Adjunctive medication decreased from
3.6±1.2 to 1.0±1.2 at 6 months, 1.0±1.2 at 12 months, respectively (P<0.001).
BCVA was significantly improved from 0.41±0.48 to 0.11±0.29, respectively
(P<0.001). Corneal endothelial cell density decreased from 2391.6±377.8
to 2254.9±446.7, respectively (P<0.001). 5 eyes occurred short-term IOP
elevation. 2 eyes received additional glaucoma surgery.
Conclusion: iStent surgery is safe and effective for Japanese patients.

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on Glaucoma Surgery
P006
IMPLEMENTATION OF A PILOT OPHTHALMIC-FOCUSSED

UNDERGRADUATE MICROSURGICAL SKILLS TRAINING
PROGRAMME
Daniel Wheeler1, Filippos Papadopoulos1, Mohsan Malik2, Darshak Patel3,
Meena Arunakirinathan4, Robert Petrarca5
1
GKT School of Medical Education, King’s College London, UK , 2Moorfields Eye
Hospital NHS Foundation Trust, London, UK, 3Kingston Hospital NHS Foundation
Trust, UK, 4London North West Healthcare NHS Trust, UK, 5Epsom and St. Helier
University Hospitals NHS Trust, UK
Purpose: Given a current paucity of UK undergraduate microsurgical and

Ophthalmic surgery-focussed practical courses, we introduced a novel national
course engaging medical students interested in microsurgical specialties,
particularly Ophthalmology.
Methods: Collaborating with an international eye-care pharmaceutical

company, we delivered a programme incorporating lectures covering
microsurgical techniques and ophthalmic-focussed content including anatomy,
phacoemulsification principles and procedure, and strabismus. Subsequently, 16
students utilised state-of-the-art phacoemulsification systems removing in-situ
cataracts from simulation eyes via established surgical proforma, intraoccular
lens implantation into the aphakic eyes, and microsuturing. Additionally, we
provided high-fidelity Ophthalmic surgical simulators with forceps-training and
capsulorrhexis modules, and virtual-reality headsets for anatomy demonstration.
Results: We administered pre-/post-course questionnaires to all delegates.

5-point Likert-responses demonstrated statistically significant increases across
metrics: confidence describing phacoemulsification steps; 1.75 ± 1.13 to 4.44 ±
0.63 (p < 0.0001), confidence performing basic microsurgical techniques; 2.31
± 1.14 to 3.88 ± 0.62 (p < 0.0001), and to considering a surgical career; 3.94 ±
0.93 to 4.63 ± 0.62 (p = 0.0195). Qualitative feedback included ‘an incredible,
transformative experience’. Lecture Likert-responses ranged from 4.50 ± 0.82
to 4.81 ± 0.40 and practical sessions 4.2 5± 0.86 to 5.00 ± 0.00.
Conclusion: Given these encouraging data we propose to collaboratively

expand and implement this novel educational initiative, increasing undergraduate
engagement with microsurgery and Ophthalmology.

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on Glaucoma Surgery
P007
ASSOCIATION BETWEEN MORPHOLOGICAL CHANGES IN

FILTERING BLEBS AND INTRAOCULAR PRESSURE INCREASE AFTER
PHACOEMULSIFICATION
Akiko Narita1, Tomoe Miyake1, Kae Sugihara1, Naruka Mitsui1, Seido
Okuda1, Tomoko Ishikawa1, Jiro Seguchi1
1
Okayama Saiseikai General Hospital, Ophthalmology, Okayama, Japan
Purpose: To evaluate the association between morphological changes in

filtering blebs and intraocular pressure (IOP) increase post-phacoemulsification
using three-dimensional anterior segment optical coherence tomography (3D
AS-OCT).
Methods: Thirty-three eyes of 32 patients with functioning blebs who had

undergone phacoemulsification were included. The subjects were classified
into an IOP-increase group and an IOP-stable group, according to whether they
had an IOP increase post-phacoemulsification. Pre-phacoemulsification IOP,
time interval between trabeculectomy and phacoemulsification, and changes
in 3D AS-OCT parameters, including maximum bleb height, maximum bleb
wall thickness, and the ratio of the hypo-reflective space of the bleb wall, were
compared. The subjects were also divided into a low-IOP group (<10 mmHg)
and a high-IOP group (≥10 mmHg), based on the pre-phacoemulsification
IOP, and the subjects were evaluated for changes in IOP and 3D AS-OCT
parameters.
Results: There were no significant differences in pre-phacoemulsification

IOP, time interval, and the 3D AS-OCT parameter changes between the IOP-
increase and IOP-stable groups. The low-IOP group showed a significant IOP
increase along with a significant decrease in maximum bleb wall thickness,
whereas the high-IOP group showed no significant increase in IOP despite
substantial decreases in all the 3D AS-OCT parameters.
Conclusion: Morphological changes in filtering blebs may not be a major

factor for an IOP rise after phacoemulsification.

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on Glaucoma Surgery
P008
OUTCOMES OF PHACOEMULSIFICATION COMBINED WITH TWO

ISTENT INJECT TRABECULAR MICROBYPASS STENTS WITH AND
WITHOUT ENDOCYCLOPHOTOCOAGULATION
Anca Pantalon1, Andre Diogo Barata1, Minas Georgopoulos1, Gokulan
Ratnarajan1
1
Corneo-Plastic Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, United Kingdom
Purpose: Comparison of results after combining two iStents insertion

with phacoemulsification and endocyclophotocoagulation (ICE2) vs
phacoemulsification-iStents alone.
Methods: Longitudinal study (December 2017-June 2018) in eyes with ocular

hypertension or early-to-moderate glaucoma. Level of disease, intraocular
pressure (IOP) and tolerance of glaucoma medication were considered
before surgery was planned. Best corrected visual acuity (BCVA), IOP, number
of medications were assessed at baseline, then week 1, week 5, month 3, 6,
12 post-op. Main outcome: percentage in IOP reduction at 12 months vs
medicated baseline. Secondary outcomes: absolute values of IOP/medication
reduction, BCVA and post-op complications.
Results: ICE2 group included 63 eyes and Phaco-iStent group 46 eyes. Baseline
IOP was higher in the ICE2 than phaco-istent group (19.97 ± 4.31 mmHg vs
17.63 ± 3.86 mmHg, p = 0.004) and MD 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 post-op,
IOP in the ICE2 group decreased with 35% from baseline vs 21% in the phaco-
iStent group (p = 0.03); absolute values of IOP reductions were 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 mmHg vs 14.09 ± 1.86
mmHg, 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 logMAR (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.

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on Glaucoma Surgery
P009
THREE-YEAR OUTCOMES OF COMBINED ISTENT AND CATARACT

SURGERY
Gayane Oganova1
1
S.V. Malayan Ophthalmological Center,Yerevan, Armenia, Glaucoma,Yerevan,
Armenia
Purpose: To assess safety and efficacy through 3 years following iStent

implantation with concomitant cataract surgery in patients with open-angle
glaucoma (OAG) and cataract.
Methods: 80 patients with OAG with different stages of cataract were

included in this retrospective study. Patients were taking at least 2 glaucoma
medications. Following washout of glaucoma medication, all eyes underwent
uncomplicated surgery of phacoemulsification, IOL implantation and stent
implantation. Assessments through 36 months included intraocular pressure
(IOP), best corrected visual acuity (BCVA), visual field, pachymetry and cup to
disc (C/D) ratio.
Results: At the baseline exam, unmedicated IOP ranged from 24 mmHg to

36 mmHg. At 3 years, 73% of patients had IOP ranging from 12 mmHg to
15.5mmHg, representing a greater than 18 mmHg IOP reduction from baseline
IOP. In the remaining 27% of patients, IOP ranged from 16 mmHg to 19 mmHg.
No patients restarted glaucoma medication after surgery. No intraoperative
or postoperative complications were observed; BCVA,VF, pachymetry and C/D
ratio were stable over 3 years.Three patients underwent Nd:YAG capsulotomy
for posterior capsular opacification.
Conclusion: iStent implantation with cataract surgery provides safe outcomes

through 3 years, with sustained reduction in IOP and medication, improvement
in BCVA, and stable visual fields.

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on Glaucoma Surgery
P010
GONIOSYNECHIALYSIS WITH INTERNAL LIMITING MEMBRANE

FORCEPS - A NOVEL METHOD
Thomas Sherman1, Andrew Swampillai1, Salman Waqar1
1
Derriford Hospital, Royal Eye Infirmary, Plymouth, United Kingdom
Purpose: Various surgical techniques for achieving goniosynechialysis have

been described. Here we outline our results using internal limiting membrane
peel forceps to release peripheral anterior synechiae from the angle following
temporal approach phacoemulsification.
Methods: A retrospective case notes review was performed. 13 cases of

combined cataract surgery and goniosynechialysis performed by a single
surgeon (SW) were analysed. Gonioscopy was performed using a disposable
Swan Jacobs direct goniolens. A 25 gauge internal limiting membrane forceps
(Grieshaber Revolution DSP) was advanced through the main incision
and visible synechiae were removed. We aimed for around 180 degrees of
goniosynechialsysis in the nasal angle in one sitting.
Results: The average preop vision was 0.22 logMar preop and 0.18 postop.
The mean IOP pre-operatively was 21.5 (11-33 mmHg), at the appointment
nearest to 4 weeks postop this was 18mmHg (10-23 mmHg). No patients at
this point had an IOP higher than baseline. The average number of IOP agents
patients were taking was unchanged (2). 1 patient experienced hypotony (IOP
of 4 mmHg). 3 patients developed an IOP spike of 5mmHg or more from preop
IOP. All of these resolved by 4 weeks. Average duration of follow-up was 27
weeks (4-67).
Conclusion: We describe a safe and effective method for removing peripheral

anterior synechiae with the use of ILM peel forceps.
Acknowledgement: Mr Imran Masood (Birmingham and Midlands Eye Center)

for introducing us to this technique.

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on Glaucoma Surgery
P011
AHMED-VALVE GLAUCOMA DRAINAGE DEVICE MODEL FP7

COMBINED WITH GONIOSCOPY ASSISTED TRANSLUMINAL
TRABECULOTOMY: A NOVEL TECHNIQUE FOR ADVANCED
GLAUCOMA
Gavin Docherty1, Andrew Crichton1
1
Ophthalmology, University of Calgary, Calgary, Canada
Purpose: To describe a novel surgical combination for intraocular pressure

(IOP) lowering in advanced cases of glaucoma.
Methods: We describe one case of advanced glaucoma with failed trabeculectomy

on maximally tolerated medical therapy. The authors feared a potential IOP
spike following gonioscopy assisted transluminal trabeculotomy (GATT) might
have devastating visual consequences. To help protect against an IOP spike
following GATT the authors performed a combined GATT and Ahmed FP7
glaucoma valve procedure.
Results: Preoperative IOP was 25 mmHg in the involved eye following a failed
trabeculectomy. On post-operative day one, following right eye Ahmed valve
FP7 combined with GATT, the Snellen visual acuity was 20/50 and the IOP
was 11 mmHg (Tonopen). Subsequent IOP measurements were all below 10
mmHg. At 3 months the IOP remained at 9 mmHg. No surgical complications
occurred.
Conclusions: Previous glaucoma drainage devices combined with minimally

invasive glaucoma surgeries have been described, most notably the Baerveldt
and Xen implant. Using a GATT and Ahmed glaucoma valve may present a
more cost-effective solution with less risk of post-operative complications.
Furthermore, for patients travelling from rural centres for glaucoma care this
may be a useful procedure given reduced risk of post-operative complications
and interventions when compared to trabeculectomy and Baerveldt
glaucoma drainage device. This procedure may improve chances of lowering
IOP below that of an Ahmed valve alone, while protecting against potential
post-operative IOP spikes.

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on Glaucoma Surgery
P012
OUTCOMES OF PHACOTRABECULECTOMY VS TRABECULECTOMY

IN A SINGLE SURGEON, SINGLE UNIT SETTING
Zaria Christine Ali1, Vikas Shankar2, Dawnn Khoo2
1
Manchester Foundation Trust, United Kingdom, 2East Lancashire Teaching
Hospitals, United Kingdom
Purpose: The combined procedure of phacotrabeculectomy may be viewed as

problematic as it is thought it may have greater complication rates and affect
long term outcomes. We aim to report the outcomes of phacotrabeculecomy
compared to trabeculectomy carried out by a single surgeon in a single centre.
Methods: A retrospective study was carried out. Inclusion criteria were all
patients who underwent either phacotrabeculectomy or trabeculectomy
between January 2014 and March 2018. The primary outcomes assessed were
change in IOP, number of topical medications and complication rate.
Results: 41 patients were included in the phacotrabeculectomy group and 255

patients were included in the trabeculectomy group. There was no significant
difference in age (p = 0.2732 ) or pre-operative IOP (p = 0.28) between the
two groups. There was a significant different in the mean number of drops
pre-operatively (p = 0.027) with the phacotrabeulectomy group being on
fewer drops (2.3 vs 2.5). There was no difference in the mean number of
topical glaucoma medications used post-operatively (p = 0.61). There was no
difference in post-operative IOP at 12 months (p = 0.26), 18 months (p =
0.96) or at final follow up (p = 0.86). Complication rates were 19.5% in the
phacotrabeculectomy group and 9.01% in the trabeculectomy group.
Conclusion: The change and long term control in IOP is the same
regardless of whether the patients underwent a combined procedure or
trabeculectomy alone. Although the complication rate appeared higher in
the phacotrabeculectomy group only three of these patients required any
intervention for these including one bleb revision for hypotony and kenlog
injections for macular oedema.

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on Glaucoma Surgery
P013
LASER AND SURGICAL COMBINED TECHNOLOGY IN GLAUCOMA

AND CATARACT TREATMENT
Tatiana Sokolovskaya1, Boris Malyugin1, Valeriya Yashina1
1
The S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian
Federation
Purpose: To compare phacoemulsification alone and phacoemulsification with

YAG-laser activation of trabecula (YAG-LAT) in eyes with primary open-angle
glaucoma and coexisting cataract.
Methods: The study included 70 patients (70 eyes) with initial and advanced
stages of primary open-angle glaucoma and coexisting cataract. The follow-
up period is 24 months after the treatment. The patients were divided into
two groups: combined group - 36 patients (36 eyes) who underwent YAG-
LAT and phacoemulsification and the control group - 34 patients (34 eyes)
who underwent phacoemulsification alone. YAG-LAT were realized by Tango
Laser unit (Laserex, Australia): Nd-YAG laser, 1064nm, 0.9-1.5MJ, 30NS pulse
duration, a spot diameter of 10-15µm, in the quantity of 55-70 pulses in the
lower semicircle. Phacoemulsification was carried out 30-60 minutes later. The
baseline IOP in the combined and control groups was 20.9 5 ± 2.98 mmHg and
20.50 ± 3.01 mmHg respectively. The mean medication use was 1.53 ± 0.0.65
in the combined group and 1.44 ± 0.50 in the control group.
Results: No complications were noted. At 24 months, the mean IOP was

15.21 ± 1.45 mmHg after combined treatment (p < 0.001) and 17.52 ± 1.83
mmHg after phacoemulsification alone (p = 0.001). By the end of the follow-up
period, the mean medication use decreased from 1.53 ± 0.65 to 0.64 ± 0.56
after combined treatment (p < 0.001), and increased from 1.44 ± 0.50 to 1.92
± 0.28 after phacoemulsification alone (p = 0.001).
Conclusion: Combined phacoemulsification and YAG-LAT was effective in

reducing IOP and/or medication burden in POAG patients.

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on Glaucoma Surgery
P014
BENCHMARKING POSTERIOR CAPSULE RUPTURE RATE IN

GLAUCOMA PATIENTS BEFORE AND AFTER PATIENT-SURGEON
RISK MATCH
Fernanda N. Susanna1, Renata Puertas2
1
University of São Paulo, São Paulo, Brazil, 2Moorfields Eye Hospital, London, United
Kingdom
Purpose: To investigate posterior capsule rupture (PCR) rate in glaucoma

patients before and after the implementation of patient risk and surgeon
match system.
Methods: The study included patients from the Glaucoma service between
2010 - 2017 that had phacoemulsification. Rates of PCR are analysed annually
for internal reporting use and were compared before and after implementation
of patient risk and surgeon match system.
Results: The rate of PCR was 1.75% in 2010-11, 1.04% in 2012-13, 1.30% in
2014, 0.91% in 2015, 1.01% in 2016 and 1.03% in 2017. The mean rate before
matching system was 1.36%; after intervention the PCR rate dropped to 0.98%,
showing a reduction of 27.9% in the unadjusted PCR rate.
Conclusion: The PCR rate was within national standards (1.95%) at all time.
It also concurred with the 30% reduction in National Ophthalmic Database
between first reporting in 2010 and subsequent one in 2016-2017. This shows
how a robust reporting system with feedback can aid to patient safety, boosting
performance with benchmarking.

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on Glaucoma Surgery
P015
COMPARATIVE OUTCOMES OF AB INTERNO CANALOPLASTY VS

GOLD STANDARD TRABECULECTOMY IN UNCONTROLLED OPEN
ANGLE GLAUCOMA
Natalia Agudelo1, Juan C. Izquierdo1, Barbara Rubio1, Katia Ruiz1
1
Glaucoma, Oftalmosalud, Lima, Peru
Purpose: To compare the efficacy and safety of AB interno Canaloplasty

(ABiC) with the gold standard Trabeculectomy in patients with uncontrolled
primary open angle glaucoma (POAG).
Methods: Patients with uncontrolled POAG who received the surgical

intervention studied were included: 26 eyes underwent trabeculectomy (GI),16
eyes phacotrabeculectomy (GIII), 13 eyes ABiC (GII) and 30 eyes
phacoABiC (GIV). Outcomes measures included IOP, glaucoma medication,
visual acuity, complications and postoperative reoperations.
Results: This study included 85 eyes. Baseline IOP±SD was 22.4±8.7 mmHg
in GI, 19.6±3.8 GII (p=0.236) and at 12 months were 12.6±2.2 and 13.4±2.7
respectively (p= 0.372). Mean preoperative IOP±SD was 18.9±6.2 in GIII
and 22.0±8.3 in GIV (P= 0.266), which decreased to 14.10±4.9 mmHg and
12.10±2.1 mmHg respectively (P= 0.372) at 12 months follow up.
Conclusion: Both procedures have similar efficacy in reducing IOP, canaloplasty

and phacocanaloplasty showed more safety results, with less postoperative
visits. The trabeculectomy stand-alone procedure showed decrease in visual
acuity clinically significant.

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on Glaucoma Surgery
P016
A COMPARATIVE STUDY OF THREE SURGICAL TECHNIQUES IN

MANAGEMENT OF PRIMARY CONGENITAL GLAUCOMA
Kübra Gül Ölke1, Elif Erdem1, Inan Harbiyeli1, Meltem Yagmur1,
Reha Ersöz1
1
Cukurova University, Ophthalmology, Adana, Turkey
Purpose: To compare the outcomes of three surgical techniques in children

with primary congenital glaucoma (PCG).
Methods: This is a retrospective study of patients diagnosed with PCG (68

eyes, 45 patients) who underwent trabeculotomy, trabeculectomy or combined
trabeculectomy–trabeculotomy (CTT). The primary outcome was intraocular
pressure (IOP) in the early (1th month), mid-term (6th month), and long-term
(2th year) postoperative period.The effect of antimetabolite use and additional
surgical procedures were also evaluated.
Results: There was no difference in the effect of surgical procedures on IOP

in early period whereas the effect of CTT on trabeculotomy in the middle
period was found to be statistically significant (p = 0.013). In the long-term
period, both CTT and trabeculectomy were found statistically more effective
than trabeculotomy (p = 0.036, p = 0.029).
Conclusion: According to this study, It was seen that the CTT can effectively
reduce the intraocular pressure and control the progression of glaucoma in
cases of congenital glaucoma and needs less additional surgery than the other
techniques; It is an effective and reliable method that should be considered
first in PCG management.

59
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on Glaucoma Surgery
P017
WAVEFRONT ABERROMETRY AND HIGHER ORDER ABERRATIONS

IN PRIMARY CONGENITAL GLAUCOMA
Arjun Desai1, Subodh Lakra1, Viney Gupta1, Shikha Gupta1
1
Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Ophthalmology, New
Delhi, India
Purpose: Most primary congenital glaucoma (PCG) patients have visual

deprivation, not only because of advanced glaucoma but also due to associated
ocular changes like Haab’s-striae, astigmatism, corneal-opacity and lenticular
changes.We aim to highlight the magnitude of ocular aberrations {higher (HOA)
and lower order aberrations (LOA)}, including component contributions by
corneal and lenticular aberrations in PCG.
Methods: Cross-sectional study. Thirty-four consecutive PCG patients (12

unilateral, 22 bilateral) who were co-operative for ocular examination, were
enrolled over 6 months. 51/56 PCG eyes had undergone trabeculectomy plus
trabeculotomy and 5 were on medical therapy. Best corrected visual acuity,
cycloplegic refraction and applanation intra-ocular pressure were recorded.
Wavefront aberrometry and topography findings using iTrace (Tracey
technologies, USA) were compared with age and gender matched controls.
Results: Median age of PCG patients was 11.5 years. Total, corneal and
lenticular, HOAs and LOAs were significantly higher in PCG patients (p <
0.001), and HOAs were positively correlated. Astigmatism was predominant in
63.04% PCG patients and 82.60% controls. Amongst HOAs, coma and trefoil
contributed maximally. PCG subjects with corneal opacity/Haab’s-striae had
significantly higher HOAs than those with clear cornea; also associated with
poor vision (p:0.05). Difference in HOAs between PCG and fellow-eyes was
not significant. Lenticular aberrations contributed most in fellow eyes.
Conclusion: Increased total and higher order ocular, corneal and lenticular
aberrations comprise an important cause of poor visual quality in PCG.
Understanding the type and distribution of these aberrations can help provide
optimal visual rehabilitation and improve the quality of life of PCG patients.

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on Glaucoma Surgery
P018
LOCATING THE PATHOGENIC GENE FOR A PEDIGREE WITH

PRIMARY ANGLE-CLOSURE GLAUCOMA
Jin Yang1, Tao Liu2
1
Shaanxi Provincial People’s Hospital, Ophthalmology, Xi’an, China, 23201 Hospital,
Ophthalmology, Han Zhong, China
Objective:To collect and analyse the clinical phenotypes of a pedigree with

primary angle-closure glaucoma,and to determine the genetic characteristics
by whole-exome sequencing, so as to identify the potential causative genes.
Methods:1. Collected data of family members through field visits and field
surveys, detailed the medical history, analyzed and determined the phenotype
and mode of inheritance; 2. Selected 3 diseased members (cases group) and 2
normal members (controls group) from this pedigree,obtained their peripheral
blood, extracted blood DNA, and assessed the quality of DNA. 3. Captured
and enriched exons areas by using capture chips,sequenced all exons after the
preparation of qualified library,filtered the raw data to obtain the valid data,
then carried on the precision of bioinformatics analysis, detailed annotations
and advanced analysis, finally got the potential causative genes, and verified
these candidate gene mutations.
Results:1. A pedigree with primary angle-closure glaucoma was collected,

which had more than 20 members from 5 generations;And 15 members
existed from 3 generations. 2. DNA samples from 5 family members were
extracted for quality testing, and their quality, concentration and purity met
the requirements; 3. Completed whole exome sequencing in all of these DNA
samples,found five potential specific causative genes,including KIF5B/PCK2 /
UNC13C/DSG1 / PSEN2 respectively, and these genes were verifid eventually.
Conclusions:1. A typical PACG family was collected with clear genetic

relationship, large number of patients and prominent phenotypic characteristics;
2. Completed whole exome sequencing for this family, and 5 potential specific
pathogenic genes were finally identified, providing a basis for further elucidation
of pathogenic genes of primary angle-closure glaucoma.

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on Glaucoma Surgery
P019
RISK STRATIFICATION STRATEGY OF TREATING OCULAR

HYPERTENSION (OHT) THAT IS BASED ON ADVANCED OCULAR
IMAGING TECHNIQUE
Poemen Pui-Man Chan1, Gilda Lai1, Vivian Chiu1, Anita Chong1, Christopher
K.S. Leung1
1
Department of Ophthalmology and Visual Science, The Chinese University of Hong
Kong, Hong Kong, Hong Kong
Purpose: To investigate a treatment strategy guided by the detection

of progressive retinal nerve fibre (RNFL) thinning by ocular coherence
tomography trend-based progressive analysis (OCT-TPA) technique for ocular
hypertension (OHT) patients.
Method: OHT patients were assessed at baseline, month 4, 8 and 12. OHT
was defined as per the ocular hypertension treatment study (OHTS). The
costs of treating all patients with OHT, patients who consistently had > 15%
risk of developing glaucoma in 5 years, and patients who had progressive RNFL
thinning were hypothetically calculated.
Results: 310 OHT patients were involved. 109 patients (of 310, 35%) had a
calculated risk of > 15% and 2 patients (of 310, 0.65%) showed progressive
RNFL thinning on OCT-TPA. We assume that all OHT patients were able to
achieve a 20% IOP reduction with prostaglandin analogue alone, 1 bottle of
medication is required per month and cost approximately 155 USD per bottle.
With the assumption, the cost of treating (1) all patients with OHT, (2) patients
who have a > 15% risk of glaucoma development in 5 years, and (3) patients
who showed progressive RNFL thinning were US$ 576,600, 202,740 and 3720
in the first year, respectively. None of the patients developed glaucomatous
visual field defects.
Conclusion: OCT-TPA could guild treatment of OHT patients safely and

reduce medication costs. Randomised control trial will be required to provide
evidence for the application of OCT-TPA in OHT patients.

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on Glaucoma Surgery
P020
TREATMENT OF ENDOPHTHALMITIS AFTER BAERVELDT

GLAUCOMA IMPLANT SURGERY USING IMMEDIATE TUBE
WITHDRAWAL AND TEMPORARY SUBCONJUNCTIVAL TUBE
PLACEMANT
Mitsui Naruka1, Akiko Narita1, Kae Sugihara1, Seido Okuda1, Tomoko
Ishikawa1, Miki Nouso1, Jiro Seguchi1, Etsuo Chihara2
1
Okayama Saiseikai General Hospital, Ophthalmology, Okayama City, Japan,
2
Chihara Eye Clinic, Ophthalmology, Uji City, Japan
Purpose: To report a case of endophthalmitis secondary to tube erosion

following Baerveldt glaucoma implant surgery that was successfully treated
using prompt tube withdrawal and temporary subconjunctival tube placement.
Method: A case report.
Results: A 65-year-old male with secondary glaucoma underwent Baerveldt

glaucoma implant surgery with sclera patch graft in the inferonasal quadrant
of his right eye, which resulted in an intraocular pressure (IOP) decrease to
the low teens. Ten months following surgery, his right eye presented with a
conjunctival dehiscence over the tube along with tube exposure. Eleven days
after tube erosion, mild inflammation was found in the anterior chamber (AC)
and anterior vitreous body, with plaque surrounding the tube in the AC. He was
diagnosed with endophthalmitis secondary to tube erosion; medical therapy
was started. Two days later, the tube was removed from the AC and tucked
into the subconjunctival space. The growth of Corynebacterium species was
identified on the specimen of an AC needle aspiration. Complete resolution of
the infection was achieved 1.5 months later; thereafter the tube was reinserted
into the AC nasally and covered with donor sclera. No infection has recurred
since tube reinsertion.
Conclusion: Immediate tube withdrawal and temporary subconjunctival

tube placement may be an effective treatment for endophthalmitis following
Baerveldt glaucoma implant surgery.

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on Glaucoma Surgery
P021
BLEB COMPRESSION SUTURES IN MANAGEMENT OF

OVERFILTRATION AFTER ANTIGLAUCOMA SURGERY
Ewa Kosior-Jarecka* 1, Dominika Wróbel-Dudzińska1, Tomasz Zarnowski1
1Dep.Diagnostics and Microsurgery of Glaucoma, Medical University of
Lublin, Lublin, Poland
Purpose: The aim of the study was the assessment of efficacy and safety of
compression sutures in patients with overfiltrative hypotony after glaucoma
surgery.
Methods: The study analyses outcomes of compression sutures for 17

patients with ocular hypotony. Only patients with hyperfiltration hypotony
defined as IOP≥ 6mmHg with a reduced BCVA were included. In 13 patients
maculopathy decreasing BCVA was observed and in 4 choroidal detachments.
The compression single sutures were performed in all patients.
Results: Mean IOP before suturing was 2.3 ± 1.57mmHg and increased to 14.2
± 7.03 mmHg (p = 0.00065) in 7 days after and after one year 9 ± 4.7 mmHg
(p = 0.0117). Mean BCVA before the sutures was 0.18 ± 0.13 and increased to
0.53 ± 0.25 (p = 0.0004) in 3 months; after 6 months 0.46 ± 0.31 (p=0,005),
after one year 0,31±0,22 (p=0,025).
Conclusion: The transconjuctival compression sutures placement seems to be

efficient and safe technique for managing with ocular hypotony after glaucoma
surgery.

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on Glaucoma Surgery
P022
RECURRENT CONJUNCTIVAL EROSION AFTER AHMED VALVE:

SOLUTIONS
Sara Mora Sáez1, Mayerling Mercedes Suriano1, Irene Gregori Gisbert1,
Mireia Mascarell Vidal1, Enara Etxabe Agirre1
1
Hospital General Universitario de Castellón, Castellón, Spain
Purpose: To show the therapeutic alternatives applied in a recurrent

conjunctival erosion of an Ahmed valve tube. We present a 56-year-old male
patient with pseudophakia and ExPress® implant presenting uncontrolled IOP
with medical treatment in left eye, reason why an Ahmed valve was placed with
tube in the anterior chamber and pericardial patch covering.
Methods: Two weeks after surgery, conjunctival retraction with pericardium

exposure was observed. Suture and conjunctival autograft was performed. A
new exposure of pericardium edge appeared 1 month after. Medical treatment
was applied. The patch was cut and covered with amniotic membrane. Due to
no improvement, the implant tube was relocated in sulcus.
Results: Medical treatment, pericardium patch cutting and conjunctival closure

failed. The amniotic membrane managed to close the defect despite the fact
that after 15 days it came off. A new tube exposure was successfully treated
with retroiridian surgical repositioning.
Conclusion: The treatment for the Ahmed valve tube and pericardial patch
exposed in eyes which underwent several surgeries are a challenge. In our
patient, the technique with the best results was the repositioning of the tube.

65
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on Glaucoma Surgery
P023
INCIDENCE OF GLAUCOMA SURGERIES RELATED TO ANTI-VEGF

INJECTIONS
Natalia Maes1, John Liu2, Gavin Docherty3, Steven Schendel4
1
Glaucoma, Queen Victoria Hospital - NHS Foundation Trust, East Grinstead, United
Kingdom, 2Medicine, University of British Columbia, Vancouver, Canada, 3Glaucoma,
University of Calgary, Calgary, Canada, 4 Glaucoma, University of British Columbia,
Vancouver, Canada
Purpose: To highlight the elevated number of Glaucoma surgeries related to

intravitreal antivascular endothelial growth factor over a period of 18 months
(from January/2016 to July/2017), under the care of one glaucoma surgeon in
Vancouver.
Methods: All Glaucoma surgeries performed were retrospectively reviewed.

The patients who were undergoing Anti-VEGF treatment at the time of surgery
were. Those who developed Neovascular Glaucoma or required intravitreal
steroid were excluded. Patients’ epidemiology was collected, as well as lens
status, previous diagnosis of glaucoma, subtype of anti-VEGF and retinal disease.
The mean drops, visual acuity and intraocular pressure (IOP) before, 6 and 12
months after the surgery were also assessed.
Results: A total of 430 Glaucoma surgeries were performed. From which

121 (28.14%) were having anti-VEGF treatment. Of the cases, 41 (33.88%)
were previously known to have glaucoma or were glaucoma suspects and 80
(66.11%) did not have glaucoma or ocular hypertension before starting the
Anti-VEGF treatment. The mean IOP before surgery was 37.18 mmHg. There
was a decline of 63.28% after 12 months, leading to a final mean pressure of
13.65 mmHg.
Conclusion: A surprisingly elevated rate of Glaucoma surgeries has been

observed among patients on anti-VEGF treatment in Vancouver. To the best
of our knowledge, this inflated number of surgeries has not been reported
worldwide. Additional data on Visual outcomes and Visual Fields are being
collected.

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on Glaucoma Surgery
P024
MICROPULSE TRANSCLERAL CYCLOPHOTOCOAGULATION IN A

26-YEAR OLD FEMALE WITH BILATERAL ADVANCED GLAUCOMA
SECONDARY TO STURGE-WEBER SYNDROME
Noriell Jonathan Mamaclay1, Joel Aduan1, Joseph Manuel Cruz1
1
Quirino Memorial Medical Center , Department of Ophthalmology , Quezon City,
Philippines
Purpose: To present a case of bilateral advanced glaucoma secondary to

Sturge Weber Syndrome and highlight the use of Micropulse Transcleral
cyclophotocoagulation(MP-TSCPC) as an effective treatment option
Methods: This is a case of a 26 year old female who presented at the emergency
department with severe left eye pain and loss of vision associated with
headaches. On examination, right eye vision was counting fingers and no light
perception on the left. There was note of well-defined dusky red to violaceous
plaques with areas of telangiectasias on the forehead, bilateral malar regions,
eyelids and chin. There was note of patchy scleral pigmentation on both eyes
with dilated and tortuous episcleral vessels. IOP was 50mmHg on the right and
71mmHg on the left. Disc examination showed advanced glaucomatous optic
neuropathy on both eyes. Patient was given oral acetazolamide and topical
medications which offered relief from symptoms. On follow up visits, pressure
was still noted to be elevated. Tube surgery was offered but patient opted for
less invasive procedure. MP-TSCPC was done on both eyes, which offered
optimal IOP lowering. Patient was maintained on topical medications.
Results: Over 1 year of follow up, patient achieved stable IOP and maintained
vision on the right eye without requiring surgery.
Conclusion: This report highlights the use of MP-TSCPC as an effective

alternative to usual surgical treatment options and may also lessen the use of
topical medications.

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on Glaucoma Surgery
P025
SHORT-TERM OUTCOMES OF MICRO-PULSE TRANSSCLERAL

CYCLOPHOTOCOAGULATION IN JAPANESE REFRACTORY
GLAUCOMA
Risako Yamamoto1, Takashiro Fujishiro1, Koichiro Sugimoto1, Shotaro
Asano1, Kimiko Asano1, Rei Sakata1, Hiroshi Murata1, Ryo Asaoka1, Megumi
Honjo1, Makoto Aihara1
1
The University of Tokyo Hospital, Ophthalmology, Tokyo, Japan
Purpose: To evaluate 6 months post-operative outcome of micro-pulse

transscleral cyclophotocoagulation (MP-CPC) for Japanese refractory
glaucoma.
Methods: We retrospectively investigated patients who underwent MP-CPC

from July 2017 to November 2018 at the University of Tokyo. IOP, medication
score and complications were examined at baseline and 6 months after the
treatment. MP-CPC procedure was delivered with 2000 mW applied for 80
seconds. The duty cycle was 31.3 %, which translated to 0.5 ms of “on time”
and 1.1 ms of “off time.
Results: 33 eyes of 31 patients were enrolled in the current study. (SOAG: 11,
NVG: 7, POAG: 7, PE: 5, other: 3). The mean age of patients was 64.2 ± 16.6
years (means±SD). The mean IOP and medication score was 34.5 ± 9.8 and
4.2 ± 1.2 at baseline, respectively. The mean IOP and medication score was
19.6 ± 7.2 and 4.2 ± 3.2 at 6 months after the treatment, respectively. (P<0.01,
paired t-test with bonfferoni correction) No complications such as ocular
hypotension, choroidal detachment, expulsive hemorrhages, and phthisis bulbi
were happened. The reduction of IOP and the medication score were not
significantly different in all types of glaucoma.
Conclusion: In Japanese refractory glaucoma, MP-CPC was effective to

lower the IOP and medication score, and no significant complications were
happened.

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on Glaucoma Surgery
P026
LONG-TERM RESULTS OF SUCCESS RATE AND FACTOR

ANALYSIS OF SUCCESS AND FAILURE ON PATTERNED LASER
TRABECULOPLASTY IN REFRACTORY GLAUCOMA PATIENTS
Min Jin Kim1, Seung Joo Ha1
1
Soonchunhyang University College of Medicine, Soonchunhyang University Seoul
Hospital, Ophthalmology, Seoul, South Korea
Purpose: To assess outcomes of patterned laser trabeculoplasty (PLT) in

refractory glaucoma patients and evaluate risk factors of failure.
Methods: A retrospective study was done for 42 refractory glaucoma patients

who have undergone patterned laser trabeculoplasty over 1 year follow-up.
Complete success was defined as intraocular pressure(IOP) reduction more
than 20% without additional laser or surgery. Qualified success was defined
as cases who had to get additional lasers for target IOP. Patients’ age, sex,
systemic condition, baseline IOP, type of glaucoma, laser power, pigmentation
grade of trabecular meshwork on gonioscopy, and history of intravitreal steroid
injection were analyzed with cox regression analysis.
Results: IOP reduction of success patients were 40.5, 43.0, 45.5, 46.9, 43.6,
45.4% at week 1, and 1, 3, 6, and 12 months follow-up. Success rate of PLT
was 69.15% (29 patients). Patients who need to receive the filtering surgery
within 1 year after PLT were 13. Baseline IOP, type of glaucoma, laser power,
pigmentation grade of trabecular meshwork, and history of intravitreal steroid
injection were revealed as risk factors in univariate anaylsis. Baseline IOP(HR
= 1.071, p-value = 0.010) and pigmentation grade of trabecular meshwork (HR
= 0.348, p-value = 0.069) were statistically significant in multivariate analyses.
Conclusion: Patterned laser trabeculoplasty was effective on refractory

glaucoma patients with high pigmentation of trabecular meshwork.

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on Glaucoma Surgery
P027
CLINICAL OUTCOMES AFTER MICROPULSE TRANSSCLERA

CYCLOPHOTOCOAGULATION IN UNCONTROLLED GLAUCOMA
PATIENTS: 2-YEARS RESTROSPECTIVE STUDY
Lasmida Ruth Simatupang1, Astrianda Suryono1
1
Cipto Mangunkusumo Hospital, Ophthalmology, Jakarta, Indonesia, Ophthalmology
Department, Faculty of Medicine Universitas Indonesia
Purpose: To evaluate the use of micropulse transsclera cyclophotocoagulation

(MP-TSCPC) in patients with uncontrolled glaucoma in Cipto Mangunkusumo
Hospital.
Methods: A retrospective review was performed for all patients who

underwent a MP-TSCPC at Cipto Mangunkusumo Hospital, Jakarta, Indonesia
from January 2017 - December 2018.
Results: A total of 55 eyes were treated with MP-TSCPC in this study with
follow up to 6 months. The mean age of treated patients was 49.65 years
and 30 (54.5%) were female. Preoperative visual acuity were profound visual
impairment (1/55), near total blindness (19/55) and total blindness (35/55).
Neovascular glaucoma (21.8%) was the most common diagnosis. Pre-operatively,
mean intraocular pressure (IOP) was 46.57 mmHg and mean number of ocular
antihypertensive medications used was 2.07. Mean postoperative IOP at week
1, months 1, 3, and 6 were lowered to 33.2, 34.2, 34.0 and 31.8 respectively.
Postoperative ocular antihypertensive medication was lowered to 1.49 at the
end of month 6. Success was achieved in 63.6% patients, in which IOP between
6 and 21 mmHg or at least 20% reduction in IOP at the final follow up with
or without IOP lowering medication. Complication included hypotony in 3
patients (5.5 %).
Conclusion: Micropulse transscleral cyclophotocoagulation was effective in

lowering intraocular pressure. Patients can expect significant IOP lowering
along with reduction in number of topical glaucoma medications required for
IOP control.

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on Glaucoma Surgery
P028
EFFICACY OF SELECTIVE LASER TRABECULOPLASTY IN PRIMARY

ANGLE CLOSURE GLAUCOMA (PACG) WITH PSEUDOPHAKIA
Jyoti Shakrawal 1, Arpit Sharma1, Dewang Angmo1, Ramanjit Sihota1
1
RPC, AIIMS, Ophthalmology, India
Purpose: Evaluation of outcomes of selective laser trabeculoplasty (SLT) in

mild to moderate primary angle closure glaucoma (PACG) with pseudophakia.
Methods: 30 eyes of PACG who had underwent cataract surgery, had an
intraocular pressure (IOP) > 21 mmHg with gonioscopically visible posterior
trabecular meshwork for at least 180 degrees were enrolled. SLT was done to
the visible angle segments. Patients were followed up to 6 months.
Results: 30 eyes of 21 patients were enrolled. The mean age of the patients
was 51.72 ± 6.3 years. The mean baseline IOP was 23.2 ± 5.3 mmHg. 63.33%
of eyes had 3600 treatment. At 6 months, mean IOP was 17.3 ± 4.8 mmHg
(p = 0.001). The success rate of achieving IOP reduction of 20% or more
from baseline, or discontinuation of one or more of glaucoma medications
was obtained in 56.67% eyes at 6 months. 3 eye had a transient posttreatment
IOP spike greater than 6 mmHg. The drop in IOP was significantly more in the
eyes treated with 360 degrees SLT (5.3 mmHg) than the eyes treated with 180-
270 degrees (3.9 mmHg) (p = 0.032). The number of medications decreased
significantly from 3.8 ± 0.77 at baseline to 2.1 ± 0.81 at 6 months. No other
significant complications noted.
Conclusion: SLT can be used as an alternative procedure for mild to

moderate PACG eyes with pseudophakia in which sufficient trabecular
meshwork is visible. Long term therapeutic effectiveness needs further
evaluation.

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on Glaucoma Surgery
P031
TRANSSCLERAL CYCLOPHOTOCOAGULATION IN REFRACTORY

GLAUCOMA IN PATIENTS WITH GOOD VISION
Natalia Palarie1, Tatiana Pasenco2, Natalia Palii1
1
International Clinic, Ophthalmology, Orhei, Moldova, 2State University of Medicine
and Pharmacy “Nicolae Testemitanu”, Ophthalmology, Chisinau, Moldova
Purpose: This study was conducted to evaluate the efficacy and safety of
transscleral diode laser cyclophotocoagulation (TSCPC) in eyes with refractory
glaucoma and BCVA better than 0,3.
Methods: The study included 30 eyes with refractory glaucoma of 27 patients

treated with TSCPC. BCVA varied from 0,3 to 0,5; mean IOP prior to procedure
was 40 ± 12 mmHg. The 810nm diode laser was delivered at 1200 mW for 4
seconds over 270°-300°.The power was increased in 150 mW increments until
an audible “pop” was heard, followed by a decrease of 150 mW to complete
the treatment. A reduction in the number of antiglaucoma drops (AGD) and an
IOP of 11-21 mm Hg at the last follow-up visit was defined as success. Patients
were followed at baseline, week 1, month 1, 3 and 6.
Results: A mean of 1.3 treatments were given per eye, with 8 eyes (26%)
requiring retreatment at the 1st month of follow up. Mean IOP decreased to
26.5 ± 5.0 mmHg at 1 week, 20.0 ± 5.3 mmHg at 1 month, 18.2 ± 2.7 mmHg
at 6 months. The overall success rate was 84%. AGD were reduced from
2.0 ± 1.0 at baseline to 1.1 ± 1.2 at 1 month and 2.2 ± 1.2 at 6 months follow-
up. No patient had hypotony. 3 patients with neovascular glaucoma failed the
procedure.
Conclusions: This study suggests TSCPC as an effective, safe and rapid

method of treatment in patients with refractory glaucoma with good vision
over a 6-month period. IOP becomes stably reduced only by the 3rd month
after the TSCPC.

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on Glaucoma Surgery
P032
SMALLER ANTERIOR CHAMBER VOLUME IS ASSOCIATED WITH

HIGHER RISK OF INTRAOCULAR PRESSURE ELEVATION AFTER
LASER IRIDOTOMY: A 1-YEAR FOLLOW UP STUDY
Fei Li1, Xiulan Zhang1
1
Zhongshan Ophthalmic Center, Clinical Research Center, Guangzhou, China
Purpose: There was no data about the efficacy of volumetric parameters such
as anterior chamber volume in the follow-up of PACD patients. This study is
designed to explore the efficacy of volumetric parameters during the follow
up of PACD.
Methods: In this single-center study, PACD patients who underwent laser

peripheral iridotomy (LPI) were recruited. Anterior segment images of the
patients were captured using swept-source OCT before and at one week, one
month, three months, six months and one year after LPI. IOP elevation was
defined as IOP greater than 21 mmHg at any time point after LPI. The changes
in trabecular iris surface area, anterior chamber volume and iris volume with
time and their relationship with IOP elevation were analyzed.
Results: Ninety eyes of 81 subjects were included. ACV, IV and mean TISA750
of the four quadrants significantly increased at one week after LPI and did
not decrease during the first year. ACV and mean TISA750 were significantly
smaller in those with IOP elevation when compared to the control (coefficient
= -5.17, p < 0.001 and coefficient = -22.40, p = 0.01, respectively). Correlations
between TISA750 and IOP elevation varied across different quadrants and
were significant only in the superior and inferior quadrants (p < 0.001 and
p = 0.03, respectively).
Conclusion: ACV is a reliable and accurate parameter for the follow up of

PACD. ACV is a better representation of the status of the anterior chamber in
PACD patients than traditional angle width parameters such as TISA750.

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on Glaucoma Surgery
P033
MICROPULSE TRANSSCLERAL CYCLOPHOTOCOAGULATION

Rita Basto1, Joana Roque1, Susana Henriques1, Fernando Trancoso Vaz1
1
Hospital Professor Doutor Fernando Fonseca, Ophthalmology , Lisbon, Portugal
Introduction: Micropulse transscleral Cyclophotocoagulation (MPTSCPC)

allowed to target melanin in a non-destructive way in ciliary body tissues,
minimizing adjacent tissue damage. This abstract’s main purposes are to
describe the procedure and demonstrate the results from 1 year of treatment
with MPTSCPC.
Methods: A retrospective review of 26 glaucoma patients submitted to

MPTSCPC. Medical records were consulted to obtain all data.
Results: MPTSCPC was performed with peribulbar anaesthesia. The probe

used was MicroPulse P3®, with predefined parameters: 810 nm diode laser,
power of 2000 mW, duty factor of 31.3% (0.5 ms on and 1.1 ms off) and
total treatment duration of 160 seconds (80 for each hemisphere). The 3 and
9 o’clock meridians were spared, along with any area of thinned sclera. In
week one, successful reduction in IOP (> 20% and PIO ≤ 21 mmHg) was
achieved in all cases except one (96.2%). Success rate, despite always good,
decreased progressively to 76.9% at month 1 and 3 and to 73.1% at month 6.
The percentage of IOP reduction was 43.4 ± 16.2% (8.9% - 70.6%). There were
no records of serious complications. Some cases described subconjunctival
haemorrhage or light pain post-procedure.
Conclusion: MPTSCPC is an efficient and safe strategy and can be used in

all spectrum of glaucoma disease. The procedure is easily performed and can
be repeated with good results. We consider necessary a larger sample and
longer follow-up period to better understand the real impact of MPTSCPC in
glaucoma treatment.

74
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on Glaucoma Surgery
P034
ANGIOGRAPHIC BIOMARKERS OF FUNCTIONAL FILTERING BLEBS

AFTER XEN GEL IMPLANTATION FOR GLAUCOMA
Lorenza Brescia1, Luca Agnifili1, Leonardo Mastropasqua1
1
Ophthalmology Clinic, Department of Medicine and Aging Science; University G.
d’Annunzio of Chieti-Pescara, Chieti, Italy
Purpose: To evaluate and describe, using optical coherence tomography

angiography (OCTA), the angiographic biomarkers of good bleb function after
XEN gel stent implantation for glaucoma.
Methods: Forty-three consecutive patients (43 eyes) who underwent XEN

gel stent implantation, were enrolled. According to the intraocular pressure
(IOP) reduction, patients were classified into Group 1 (21 eyes; success) and
2 (22 eyes; failure). OCTA was performed to image the vascularization of
the conjunctival bleb wall. The main outcomes were: presence and number
of vessel displacement areas (NVDA), major displacement area (MDA; mm2),
non-flow whole area (NFWA; mm2), and bleb wall vessel density (BWVD; %).
Results: Mean post-operative Group 1 and 2 IOP were 16.2 ± 2.7 and 26.3 ±
2.1 mmHg, respectively. Higher MDA (0.32 ± 0.03; p < 0.05), NVDA (3.8 ± 1.3;
p < 0.001), and NFWA (1.66 ± 0.61; p = 0.001), and lower BWVD (46.19 ±
3.82; p < 0.001) was found in Group 1 compared to Group2. MDA negatively
correlated with BWVD (r = -0,437; p = 0.026) and positively with NFWA (r
= 0.712; p = 0.000); BWVD negatively correlated with NFWA (r = -0.617; or
p = 0.001). Post-operative IOP positively correlated with BWVD (r = 0.567;
p = 0.003), but negatively with NFWA and MDA (r = -0.581; p = 0.002; and
r = -0.619; p = 0.001, respectively).
Conclusions: OCTA is a useful tool to investigate the bleb wall vascular

features after XEN gel implantation. The presence of large areas of vessel
displacement within the bleb wall, along with a reduced vascular network can
be considered as angiographic biomarkers of a good bleb filtration ability.

75
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on Glaucoma Surgery
P035
GONIOTOME FIRST YEAR OUTCOMES

Daniel Gosling1, Vipul Ramjiani1, Graham Auger1
1
Sheffield Teaching Hospitals NHS Trust, United Kingdom
Purpose: Goniotome (Neomedix, California) is a new ab interno dual-blade

device, with an irrigation and aspiration feature, for the lowering of intraocular
pressure by excision of trabecular meshwork. We report the first year data on
the first European cohort treated with the device.
Methods: Data was extracted retrospectively from Medisoft for all patients
treated with Goniotome, between March 2018 and July 2019. Intraocular
pressure (IOP) and number of IOP lowering medications were recorded.
Complications are reported to indicate the safety profile. IOP was measured
with Ocular Response Analyser G3 (Reichert inc, New York).
Results: 29 eyes in 26 patients had been treated as of July 2019. Mean follow up
was 25 weeks (range 4-67). Mean pre-operative IOP was 30.6 mmHg (standard
deviation 6.6). Mean IOP reduction was 12.3 mmHg (SD 7.8) or 39% (SD 20%)
reduction from baseline. Mean number of medication classes reduced from
2.6 to 1.6. 19 eyes (66%) had IOP lowering greater than 30% and 5 eyes (17%)
were medication free. 5 eyes (17%) had significantly raised post-operative IOP
at the first post-operative visit, related to hyphaema. There were no cases of
severe vision loss. Two eyes subsequently required penetrating surgery.
Conclusion: Goniotome is an effective treatment at lowering IOP in this initial

cohort, with follow up duration of up to 1 year. The possibility of a post-
operative pressure spike may alter patient selection.

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P036
EARLY OUTCOMES OF SEMI-OPEN SUBTENON AB INTERNO XEN

STENT INSERTION COMPARED TO STANDARD TECHNIQUE
Yu Xiang George Kong1,2
1
Royal Victorian Eye and Ear Hospital, Ophthalmology, Victoria, Australia, 2Mount
Waverley Eye Surgeons, Ophthalmology, Victoria, Australia
Purpose: Novel Semi-open XEN insertion aims to (1) dissecting a potential

space for filtration (2) avoid intra-tenon insertion (3) ensure adequate tissue
above stent to avoid erosion (4) avoid anterior bleb leak. Early (6 month) post
operative outcome is reported.
Methods: Semi-open technique involves (1) small posterior incision ~2mm

in length, ~8mm from limbus to reach subtenon space (2) dissect subtenon
pocket with thin blunt dissector (3) maintain pocket using viscoelastic (4)
insertion of XEN ab interno into pocket (5) conjunctival closure with single
10-0 vicyl. Standard technique involves ab interno insertion and primary
needling. Retrospective analysis of Semi-open (n = 44) and Standard technique
(n = 25) was performed. All cases received subconjunctival injection of
mitomycin C (0.01-0.02%).
Results: The two groups had statistically similar IOP at baseline (Semi-open
21.0 ± 7.1 mmHg vs Standard 22.7 ± 8.8 mmHg), postoperative day-1 (6.8 ± 5.5
mmHg vs 7.9 ± 5.0 mmHg) and week-1 (8.6 ± 7.7 mmHg vs 9.9 ± 4.3 mmHg).
The IOP were statistically different for postoperative week-4 (10.7 ±4.1mmHg
vs 16.0 ± 7.9 mmHg, p = 0.001), 2-months (11.6 ± 3.9 mmHg vs 15.6 ± 5.7 mmHg,
p = 0.007) and 3-months (12.6 ± 5.1 mmHg vs 16.6 ± 6.2 mmHg, p = 0.05).
Similar trend was observed at 4-months (13.9 ± 5.1 mmHg vs 18.8 ± 7.0
mmHg, p = 0.06) and 6-months (9.8 ± 3.0 mmHg vs 15.1 ± 6.1 mmHg, p =
0.06). Semi-open technique had lower needling rate (14% vs 60%) but more
transient choroidal effusion (21% vs 16%). Standard technique had 2 stent
erosions and 5 revisions.
Conclusion: Early outcomes showed Semi-open achieved lower IOP compared

to Standard technique with lower needling and revision rates.

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on Glaucoma Surgery
P037
SHORT-TERM OUTCOMES AND PROGNOSTIC FACTORS OF ISTENT

IN SOUTH KOREA
Jonghoon Shin1
1
Pusan National University Yangsan Hospital, Ophthalmology,Yangsansi, South Korea
Purpose: To evaluate the intraocular pressure (IOP) reduction, success rate

and prognostic factors after trabecular micro-bypass stent implantation in
patients with open angle glaucoma.
Methods: We retrospectively reviewed 33 eyes of 33 patients with open angle

glaucoma who were followed up for more than 6 months after trabecular
micro-bypass stent implantation. Success of surgery was defined as IOP ≤ 21
mmHg and IOP reduction ≥ 20% from baseline regardless of whether glaucoma
medication was used or not.
Result: During follow-up at 6 months after trabecular micro-bypass stent

implantation, IOP was significantly decreased from 25.33 ± 9.20 mmHg before
surgery to 18.03 ± 4.64 mmHg after 6 months and glaucoma medication was
significantly decreased from 3.73 ± 0.67 before surgery to 3.43 ± 0.67 after 6
months (p < 0.001, 0.027, respectively). Success rate at 6 months was 30.7 ±
5.2%. Using multiple regression analysis of the risk factors, age was associated
with success rate (OR, 1.076; 95% CI, 0.996-1.164, p = 0.045).
Conclusions: In Koreans, trabecular micro-bypass stent implantation is

effective surgery for IOP reduction and shows a better surgical success rate
in younger patients.

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on Glaucoma Surgery
P038
EFFICACY AND SAFETY OF XEN GEL STENT AS PRIMARY SURGICAL

PROCEDURE: EARLY EXPERIENCE IN KOREA
Jaewan Choi1
1
Central Seoul Eye Center, Department of Glaucoma Service, Seoul, South Korea
Purpose: To evaluate the efficacy and safety of XEN® Gel Stent as primary
surgical procedure in Korean eyes with medically uncontrolled glaucoma.
Methods: This retrospective, open-label, single-center study analyzed 43

eyes of 39 Korean glaucoma patients who had XEN® Gel Stent implantation.
Every patient had no prior glaucoma surgery history, and required a minimum
follow-up period of 3 months for the enrollment. Intraocular pressure (IOP),
the number of glaucoma medication, and best-corrected visual acuity (BCVA)
were evaluated at baseline and at each follow-up to 9 months.
Results: Mean medicated IOP (number of medication) was reduced from 21.3
± 7.8 mmHg (3.5 ± 0.7) at baseline to 12.9 ± 6.0 mmHg (1.0 ± 1.2) at 3 months,
and 11.7 ± 4.2 mmHg (0.7 ± 1.0) at 9 months (p < 0.001). BCVA loss > 2
lines at postoperative 1 month was observed in 4.7% (n = 2). Postoperative
complications included hyphema (n = 4), cystic bleb (n = 2), cataract progression
(n = 2), choroidal effusion (n = 1), and stent dislocation (n = 1). The bleb
needling rate was 39.5% (n = 17/43), and 5 eyes required secondary glaucoma
surgical intervention due to uncontrolled IOP.
Conclusion: The XEN® Gel Stent effectively reduced IOP and the need of
medication as a primary surgical procedure in Korean patients with medically
uncontrolled glaucoma.The postoperative safety profile seems to be acceptable,
with minimal vision-threatening complications.

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on Glaucoma Surgery
P039
ONE-YEAR RESULTS FOR ISTENT INJECT FOR GLAUCOMA AND

OCULAR HYPERTENSION IN A REAL-WORLD NHS SETTING
Harikesh Kaneshayogan1, Sri Vamshi Merugamala1, Adam Booth1, Salman
Waqar1
1
University Hospitals Plymouth NHS Trust, Ophthalmology, Plymouth, United
Kingdom
Purpose: We present 1-year results of patients with all types of glaucoma and
ocular hypertension who underwent iStent Inject surgery, and aim to guide
clinicians in making an informed decision on its effectiveness, within a typical
NHS glaucoma service.
Methods: Data was collected retrospectively from a single hospital for 43

patients with a diagnosis of glaucoma or ocular hypertension who had an
iStent Inject procedure, with or without cataract surgery over a 1-year period.
The primary outcome was reduction in intraocular pressure and number of
glaucoma medications at 12 months post operatively. Other aims included
reporting complications from surgery, achieving target pressure or 20%
reduction in IOP and requirement for further pressure lowering surgery
Results: Mean IOP reduced from 20.7 mmHg preoperatively to 15.4 mmHg
(26% reduction, p < 0.0001) at 12 months. 65% achieved a drop of at least 20%
from their pre-operative IOP. Overall there was no difference in the average
number of topical antihypertensive agents pre (2.14) and post stent insertion
(2.14).
Conclusion: iStent Inject is an effective treatment modality in moderate

to severe glaucoma of varying aetiology and ocular hypertension, with a
good safety profile. Patients on maximal topical therapy and previous laser
trabeculoplasty can be counselled to expect a 20-25% reduction in post-
operative IOP reduction at 1-year, however it is difficult to recommend to
patients that they will have a significant drop reduction based on these results.

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on Glaucoma Surgery
P040
FIVE-YEAR OUTCOMES OF TRABECULAR MICRO-BYPASS STENTS

(ISTENT INJECT) COMBINED WITH TRAVOPROST IN GLAUCOMA
EYES ON 2 PREOPERATIVE MEDICATIONS
Albert Khouri1
1
Rutgers New Jersey Medical School, Ophthalmology, Newark, United States
Purpose: To assess 5-year outcomes following standalone implantation of

2nd-generation trabecular mi-cro-bypass stents (iStent inject®) combined
with topical travoprost, thereby addressing both trabecular and uveoscleral
aqueous outflow.
Methods: This 5-year prospective multi-surgeon study enrolled subjects with

OAG on 2 ocular hypoten-sive medications and preoperative intraocular
pressure (IOP) of 18-30 mmHg (medicated) and 22-38 mmHg (post-washout).
Subjects underwent standalone iStent inject implantation and started topical
travoprost one day postoperatively. Annual medication washouts were per-
formed.
Results: All 53 enrolled subjects underwent uncomplicated iStent inject

implantation and completed 5-year follow-up. At Month 60 (M60) postoperative,
mean IOP on travoprost was 12.1 mmHg, a 39% reduction vs preoperative
IOP of 19.7 mmHg on 2 medications (p<0.0001). At M61 (post-washout),
mean unmedicated IOP was 16.1 mmHg, a 35% reduction vs preoperative
washout IOP of 24.9 mmHg (p<0.0001). Mean medicated IOP remained ≤13.1
mmHg at all postoperative visits through M60. 92.5% of eyes achieved M60
IOP ≤18 mmHg and 88.7% achieved IOP ≤15 mmHg on travoprost. 4 eyes
required additional medication, but all remain-ing eyes used travoprost alone
throughout follow-up. Visual acuity, cup-to-disc ratio, and visual fields were
stable throughout.
Conclusion: In glaucomatous eyes with IOP uncontrolled on 2 medications, the

combination of standalone iStent inject implantation with topical prostaglandin
(thereby enhancing both trabecular and uveoscleral outflow) resulted in
consistent and safe 5-year IOP and medication reductions.

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on Glaucoma Surgery
P042
18-MONTH OUTCOMES OF THE OPTIMISED XEN IMPLANTATION

(OXI TECHNIQUE): A SINGLE-SURGEON INTERVENTIONAL CASE
SERIES OF 150 AB-INTERNO XEN IMPLANTS WITH AND WITHOUT
COMBINED PHACOEMULSIFICATION IN GLAUCOMA PATIENTS
Tasneem Khatib1, Symeon Nicolaou1, Asad Zaheer1, Zhiheng Lin1, Twishaa
Sheth1, Mahmoud Radwan1, Golden Ogbonna1, Chrysostomos Dimitriou1
1
Colchester Hospital, Ophthalmology, Colchester, United Kingdom
Purpose: To characterise the intraocular pressure (IOP) lowering effect, and

reduction in glaucoma medication use of an optimised Xen implantation (OXI)
technique in glaucoma patients.
Methods: Retrospective chart review of patients (150 eyes of 119 patients)

undergoing Xen implantation by a single experienced glaucoma surgeon from
June 2016 to July 2019. Diagnoses included primary open angle glaucoma
(n = 81), primary angle closure glaucoma (n = 24), normal tension glaucoma (n
= 14) and secondary glaucomas (n = 31).
Results: The OXI technique significantly lowered the IOP regardless of

glaucoma severity and subtype. The overall mean pre-operative IOP decreased
from 18 mmHg to 9.9 mmHg at month 12 and 13.2 mmHg at month 18
(p < 0.0001). The percentage of patients achieving ³ 20% reduction in IOP from
baseline while remaining medication-free was 85.7% at 12 months and 66.7%
at 18 months. Overall medication usage reduced from 2.5 pre-operatively to
0.1 at 12 months and 1 at 18 months. 23 cases (15.3%) required post-operative
bleb needling or antimetabolite injection and 12 patients (8%) required further
surgical glaucoma procedures.
Conclusion: The OXI technique is effective in reducing IOP and medication

burden at 18 months. Further data is required to assess the longer-term efficacy.

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on Glaucoma Surgery
P043
EARLY RESULTS OF PRESERFLO MICROSHUNT IN PATIENTS WITH

GLAUCOMA
Lauren Van Lancker1, Paolo Meier1, Mohammed Abu-Bakra1, Avi Kulkarni1
1
King’s College Hospital NHS Trust, London, United Kingdom
Purpose: Evaluate the efficacy and safety of PreserFlo MicroShunt in patients

with glaucoma
Methods: PreserFlo was inserted with a standard technique including mitomycin

C 0.4 mg/mL for control of intraocular pressure (IOP) in patients with
refractory glaucoma despite maximally tolerated medication. Observational
study using electronic medical records. Age range was 31-89 years. Patient
ethnicity: 8 Afro-Caribbean, 2 Asian, 12 Caucasian, 5 not stated.
Results: 27 patients had the implant. Diagnoses were: 18 primary open angle
glaucoma, 2 normal tension glaucoma, 5 secondary open angle glaucoma, 1
neovascular glaucoma, 1 congenital glaucoma. Mean pre-operative IOP was 25.6
(range 15-41) and number of glaucoma agents was 3.7. 4 eyes had had prior
non conjunctival-sparing glaucoma procedures. Mean post-operative IOP was
6 on day 1, 10 on day 7 and 13 at the date of last follow-up. Mean IOP drop was
45% and number of glaucoma agents was 0.6 at last follow-up. Mean follow-
up duration was 53 days (range 1-120). 12/27 eyes had additional procedures
(5-flourouracil or steroid injection except for one requiring anterior chamber
viscoelastic injection). Additional procedures were more common in those
of Afro-Caribbean heritage. The only significant complication was transient
clinical hypotony in one patient.
Conclusion: Early results indicate that PreserFlo MicroShunt has great efficacy
and a good safety profile. This study adds to the relatively sparse data on
outcomes in Afro-Caribbean patients.

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on Glaucoma Surgery
P044
2-YEAR OUTCOMES FOLLOWING 2ND GENERATION TRABECULAR

MICRO-BYPASS (ISTENT INJECT) IMPLANTATION WITH CATARACT
SURGERY: A MULTI-CENTRE, MULTI-SURGEON STUDY
Colin Clement1, David Manning2, Michael Shiu3, Alex Ioannidis4, Simon
Skalicky5, Todd Goodwin6, Ridia Lim1, Frank Howes7
1
Sydney Eye Hospital, Australia, 2Hunter Cataract and Eye Centre, Australia, 3Bayside
Eye Specialists, Australia, 4Vision Eye Institute, Australia, 5Eye Surgery Associates,
Australia, 6NQ Eye Specialists, Australia, 7Gold Coast Laser and Vision Centre
Purpose: To evaluate effectiveness and safety of 2nd-generation trabecular

micro-bypass stents (iStent inject®) implanted with cataract surgery. This
multi-surgeon, 2-year dataset is one of the largest yet reported, providing
useful information for the growing numbers of surgeons using iStent inject.
Methods: Multi-surgeon, multi-centre, retrospective case series. Outcomes

included intraocular pressure (IOP), medications, visual acuity, cup-to-disc
ratio, visual fields, adverse events and complications.
Results: 309 eyes underwent iStent inject implantation with cataract surgery
and completed 2-year follow-up, with most eyes having primary open-angle
glaucoma (71%), ocular hypertension/glaucoma suspect (9%), appositional angle-
closure glaucoma (8%), and normal-tension glaucoma (6%). Preoperatively,
mean IOP was 16.4 ± 4.9 mmHg on 1.47 ± 1.21 mean medications (range
0-5 medications), and 42% of eyes had prior glaucoma procedures. Two years
postoperatively, mean IOP was 13.7 mmHg (16% reduction; p < 0.0001), and
77% of eyes had IOP ≤ 15 mmHg (vs. 51% preoperatively). Mean medication
number reduced by 66% to 0.50 medication (p < 0.0001), with 74% of eyes
medication-free (vs. 26% preoperatively). Intra-operative and postoperative
adverse events were generally infrequent, mild, and resolved without sequelae.
A total of 7 eyes (all with more advanced glaucoma) had filtering surgery
during 2-year follow-up.
Conclusion: This 2-year multi-centre study showed sustained and significant

IOP and medication reductions after iStent inject implantation with cataract
surgery for glaucoma or ocular hypertension. This comprises one of the largest
real-world cohorts to-date, and confirms existing evidence of the efficacy and
safety of iStent inject.

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on Glaucoma Surgery
P045
EARLY COMPLICATIONS OF XEN GEL STENT IN KOREAN

POPULATION
Seungsoo Rho1,2
1
School of Optometry and Vision Science, Cardiff University, Ophthalmology, Cardiff,
United Kingdom, 2CHA Bundang Medical Center, CHA University, Ophthalmology,
Seongnam, South Korea
Purpose: To describe early complication cases of XEN gel stent (XEN45,

Allergan, CA, US) during the first three months postoperatively in Korean
open-angle glaucoma (OAG) population.
Methods: This single-center, retrospective study included a total of 20 eyes of

OAG with XEN gel stent implantation. Various complications were described
including hypotony (< 6 mmHg at any time point postoperatively), choroidal
detachment, corneal wound leak, implant displacement, postoperative
hyphaema, intraoperative bleb hemorrhage and etc. None of the severely
complicated cases were included.
Results: Hypotony was the most common complication of XEN gel stent
implantation (16/20, 80%). Early hypotony should be managed using intracameral
viscoelastic injection because prolonged hypotony of globe could be followed
by choroidal detachment resulting in unexpected severe vision loss. Although
the intraocular pressure (IOP) of all hypotony cases were normalized in 3 days
- 3 weeks after viscoelastic injection, two eyes showed choroidal detachment.
One case presented an IOP spike after second viscoelastic injection which
needed an I&A of residual viscoelastic in the anterior chamber. There was one
case of corneal wound leak, implant displacement and postoperative hyphaema,
respectively.
Conclusion: XEN gel stent implantation is minimally invasive in terms of the

conjunctival wound healing process and highly effective at least in the early
postoperative period in Korean OAG population. However, Korean surgeons
should be aware of the higher chance of hypotony rate after Xen gel stent
implantation than previous studies reported from other countries.

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on Glaucoma Surgery
P046
A SYSTEMATIC REVIEW AND META-ANALYSIS OF OUTCOME IN

MINIMALLY-INVASIVE GLAUCOMA SURGERIES
Marion Luise Kvasnicka1
1
Bad Homburg, Germany
Purpose: We have investigated the cumulative reported change in intraocular

pressure (IOP) and glaucoma medications using different subconjunctival and
suprachoroideal minimally-invasive glaucoma surgeries (MIGS) devices (XEN,
InnFocus, Cypass, iStent supra, STARflo, SOLX) as a solo procedure or in
association with phacoemulsification.
Methods: A systematic literature search was performed to identify randomized

control trials (RCT) and non-RCT (non randomized comparative studies, NRS,
and before-after studies) with at least 12 months of follow-up. Outcome data
regarding overall qualified response (OQR), IOP, and number of glaucoma
medications at 12 months were extracted and compared across all devises.
Results: A total of 30 studies were identified which included 2.289 eyes. MIGS
surgery seemed effective in lowering both IOP and glaucoma drug use at 12
months with a reported OQR ranging between 76.8% and 91.0%. Stratified
meta-analysis of observed mean IOP difference at 12 months revealed the
highest mean IOP reduction at 12 months for the Innfocus device (11.049),
followed by the SOLX (10.545) and XEN device (10.464). Efficacy of the
STARflo device was in a similar range (10.269), whereas iStent supra and
Cypass showed much lower IOP reduction at 12 months (8.400 and 6.718).
The change in the number of glaucoma medication was highest in the studies
which used the XEN and InnFocus device (2.449 and 2.190 contrasting the
suprachoroideal devices.
Conclusion: MIGS show in general a good safety profile and effective reduction
of IOP and glaucoma medication, however, the evidence on the efficacy of
MIGS compared to other therapies is still limited.

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on Glaucoma Surgery
P047
ONE-YEAR TREATMENT OUTCOMES OF A NOVEL GLAUCOMA

TUBE SHUNT IMPLANT FOR REFRACTORY GLAUCOMA
Victor Teck Koh1 2, Cecilia Aquino3, Giacinto Triolo2, Henrietta Ho4,
Visanee Tantisevi Tantisevi5, Prin Rojanapongpun5, Seng Kheong Fang6,
Poemen Chan7, Clement Tham7, Sheng Lim4, Paul Chew3, Keith Barton2
1
Ophthalmology, National University Hospital, Singapore, Singapore,
2
Ophthalmology, Moorfields Eye Hospital, United Kingdom, 3Ophthalmology,
National University Hospital, Singapore, 4St Thomas’ Hospital, United Kingdom,
5
Ophthalmology, Chulalongkorn University and Hospital, Thailand, 6International
Specialist Eye Centre, Malaysia, 7 Ophthalmology, Chinese University of Hong Kong,
Hong Kong
Purpose: To investigate the one-year efficacy and safety of a novel glaucoma

tube shunt, PAUL® Glaucoma Implant (PGI) in the treatment of eyes with
refractory glaucoma
Methods: This is an interventional cohort study involving 6 international

centers and 60 eyes (60 participants) between October 2017 and September
2019. The primary outcome is complete success at one-year post-operatively,
defined as intraocular pressure (IOP) not exceeding 21 mmHg (without any
IOP-lowering medications) and not below 6mmHg, did not lose light perception
vision and without further reoperations.The other outcome measures included
IOP, the number of IOP-lowering medications and complications.
Results: The mean age was 63.0 ± 12.6 years, 77.4% male and 41.9% had
secondary glaucoma. At one-year after surgery, the complete success rate was
71.0 (44/62 eyes) %. Compared to the mean pre-operative IOP (36.8 ± 11.4
mmHg), the post-operative IOP at 6 and 12 months were 14.0 ± 3.5 and 13.4
± 3.4 mmHg respectively (p < 0.001). The mean number of pre-operative and
one-year post-operative number of IOP-lowering medications were 3.4 ± 0.8
and 0.4 ± 0.7 respectively (p < 0.001). Significant post-operative complications
included hypotony requiring intracameral injection of viscoelastic gel (n = 6,
9.7%), tube shunt occlusion (n = 3, 4.8%), tube exposure (n = 2, 3.2%) and
endophthalmitis with resultant loss of vision (n = 1, 1.6%)
Conclusion: The PGI is effective and safe in lowering IOP with close to three-
quarters of the eyes with refractory glaucoma achieving complete surgical
success after one year of follow-up.

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on Glaucoma Surgery
P048
2 YEAR OUTCOMES OF THE XEN IMPLANT WITH MINIMAL BLEB

NEEDLING
Zaria Christine Ali1, Nadeem Mohsin2, Vikas Shankar2
1
Manchester Foundation Trust, Manchester, United Kingdom, 2East Lancashire
Teaching Hospitals, United Kingdom
Purpose: The Xen implant is a form of minimally invasive glaucoma surgery.

Although use of the device has increased over the past few years, there is still
limited long term data available regarding its efficacy. We aim to report the 2
year outcomes of the XEN implant with minimum bleb needling.
Methods: A retrospective study was conducted at East Lancashire Teaching

Hospital. Inclusion criteria was patients who underwent implantation with a
Xen device between May 2016 and December 2017. The primary outcome
assessed was complete success defined as when the patient was without
glaucoma medications and had an IOP of 18mmHg or less, and had a 20%
reduction in IOP compared to baseline. Qualified success was defined as the
same change in IOP but with medications.
Results: 67 patients were included. Male to female ratio was 37:30. The
majority had primary open angle glaucoma. There was a significant difference
(p < 0.001) between preoperative IOP and IOP at 24 months. Mean number
of topical medications was 2.3 pre-operatively and 1.2 at 24 months. Bleb
needling was done in 4.5% which is significantly lower than other reports. At
24 months complete success was obtained in 12% and qualified success was
achieved in 64%.
Conclusion: The XEN has good long term outcomes even with minimal
bleb needling. Patients maintained a lower IOP postoperatively with a lower
number of medications. Should their IOP rise, the patient has more treatment
options available to them compared to pre-operatively including increasing
topical medications or opting for further surgery.

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on Glaucoma Surgery
P049
CAN WE REDUCE NEEDLING AFTER XEN IMPLANTATION

Claudia Quijano1, Shaista Giny1, Dan Lindfield2
1
Royal Surrey County Hospital NHS Healthcare Trust, Ophthalmology, Guildford,
United Kingdom, 2Royal Surrey County Hospital NHS Healthcare Trust,
ophthalmology, Guildford, United Kingdom
Purpose: Describe findings after subconjunctival 5FU at 3rd week post-

operatory of XEN-45 Gel Stent (XEN).
Methods: Retrospective review of 21 patients (26 eyes) that underwent XEN

implantation standalone or combined phacoemulsification followed by routine
5FU (0.1ml of 50 mg/ml) injection at 3/52 post-operatory. Data collected on
demographics, BCVA, IOP, glaucoma drops, medical interventions, conjunctival
appearance and associated complications. Patients reviewed on week 1, 3 and
months 1, 3, 6. Primary outcome was rate of needling during the firth 6 months
post-operatory. Secondary outcome was reduction in the IOP and glaucoma
drops use.
Results: A total of 26 eyes (21 patients) included. All patients received 5FU
at 3rd week. After month 1, 1 patient required needling and none thereafter.
A mean of 1.4% of needling throughout the 6 months. At month 6th IOP
was reduced to 14.8 mmHg with mean reduction of -7.9 mmHg or 34% was
achieved. At month 1 none of the patients were using glaucoma drops. At
month 3 and 6, 91 % of patients were free drops. The most frequent adverse
event was conjunctival inflammation in 38%. One patient had corneal toxicity
secondary to 5FU which resolved after 1 week.
Conclusion: Routine 5FU at 3rd week post XEN is safe and make post-
operative more predictable. Just 1.4% needed needling after routine 5FU.
Glaucoma medication usage was lower or stopped due to improved function.
No adverse events were found.

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on Glaucoma Surgery
P050
EVALUATION OF ISTENT INJECT IN PSEUDOPHAKIC EYES WITH

OPEN ANGLE GLAUCOMA : PRELIMINARY RESULTS
Vishal Vohra1, Indira Madgula1, Bhavani Karri1
1
Royal Preston Hospital, Lancashire Teaching Hospital, Glaucoma Services,
Ophthalmology Department, Preston, United Kingdom
Purpose: To evaluate the efficacy and safety of iStent inject implantation in

the treatment of progressive open-angle glaucoma (OAG) in pseudophakic
eyes.
Methods: A retrospective analysis of records of patients that underwent istent

inject implantation since March 2018 was done for intraocular pressure (IOP)
reduction and glaucoma medication load reduction. Safety outcomes included
intraoperative and postoperative complications, secondary surgeries and best-
corrected visual acuity (BCVA).
Results: Records of 55 eyes that underwent the iStent implantation were

analysed with a mean age of 77 years (51- 97). The average IOP preoperatively
in the analyzed eyes was 20.2 ± 6.4 mmHg. IOP decreased by ≥ 20% compared
to preoperative IOP in 22 eyes completing 3 months and 11 eyes completing 6
months follow up. 11 (67%) of the 17 eyes that completed 6 months follow up
revealed significantly decreased medication burden. Out of 55 eyes evaluated
9 eyes were steroid responder, 3 eyes had malpositioned stents ,5 had over
implanted stents and 1 eye had an episode of iris prolapse.
Conclusion: The early result of istent inject implant look promising with
significant reduction of IOP and medication load in eyes with coexistent
primary open angle glaucoma.

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on Glaucoma Surgery
P051
EFFECTIVENESS AND SAFETY OF THE IMPLANTATION OF

TRABECULAR MICRO-BYPASS DEVICE “ISTENT INJECT W” IN
COMPARISION WITH “ISTENT INJECT” ACCOMPANIED WITH
PHAKO SURGERY
Abdelwahhab Azzawi1
1
Staedtisches Klinikum Friedrichstadt Dresden, Department of ophthalmology
Dresden, Germany
Purpose: Retrospective study to evaluate the effectiveness and safety of the

implantation “iStent inject w” in comparison with “iStent inject” accompanied
with phako surgery.
Methods: Group1: iStent inject w (4 eyes). Group2: iStent inject (4 eyes).

Both have cataract and POAG with at least one anti-glaucoma eyedrops. We
evaluated the reduction in IOP and the eye drops with BCVA after 1 week
from the surgery.
Results: Group 1: mean IOP before the surgery was 21. Median IOP reduction
was 7.75. Median BCVA improved from 0.425 to 0.725. Group 2: median IOP
before the surgery was 20.25. Median IOP reduction was 4.25. Median BCVA
improved from 0.45 to 0.825. in both groups mean reduction of eyedrops
was 1 and no complication happened. Mild residual blood over the iris were
detected in the group1 but no Hyphema. The Blood reflux after implantation
of iStent inject w was significantly more. No Patient from both groups needed
second surgery.
Conclusions: Both iStents were safe and and effective in lowering IOP. iStent
inject w has a more hypotensive effect (p value 0.0171). Hyphema is more
probable in iStent inject w. a long follow up with a larger number of patients is
recommended. The results of this study will be updated after 3 months.

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on Glaucoma Surgery
P052
TWO-YEAR POOLED SAFETY OUTCOMES FROM THREE STUDIES

FOLLOWING MICROSHUNT IMPLANTATION IN PATIENTS WITH
PRIMARY OPEN-ANGLE GLAUCOMA (POAG)
Henny Beckers1, Juan Batlle2, Julián García-Feijoó3, Isabelle Riss4
1
University Eye Clinic, Maastricht University Medical Center +, Maastricht,
Netherlands, 2Centro Láser, Santo Domingo, Dominican Republic, 3Universidad
Complutense, Hospital Clínico San Carlos, Madrid, Spain, 4Pôle Ophtalmologique de
la Clinique Mutualiste, Bordeaux, France
Purpose: Pooled analysis of three prospective, single-arm studies to further

assess the safety of the MicroShunt (8.5-mm-long subconjunctival/Tenon’s
capsule device) in patients with POAG.
Methods: The MicroShunt was implanted ab externo (0.2–0.4 mg/mL

Mitomycin C, 2-3 minutes) in patients inadequately controlled on maximum
tolerated medical therapy (medicated intraocular pressure [IOP] ≥ 18 - ≤ 35
mmHg). Outcomes included adverse events (AEs), reoperations and needling
rates.
Results: The MicroShunt was implanted in 125 patients. Common procedure-

related AEs (≥ 5%) by Year 2 were investigator-reported increased IOP (30/125;
most treated with medication [n = 14]), transient hypotony (< 6 mmHg;
17/125), keratitis (13/125) and hyphaema (12/125); devicerelated AEs were
investigator-reported increased IOP (15/125; most treated with medication
[n = 8]). The mean resolution times for procedure- and device-related AEs
were 53 and 39 days, respectively. The majority of AEs occurred within the first
month. Nine patients had procedure-related serious AEs (SAEs) and four had
device-related SAEs. Five patients (4.0%) required reoperation (trabeculectomy
[n = 2], sclerectomy [n = 1], flap resuture [n = 1], implantation of a second
MicroShunt [n = 1]). Seven patients (5.6%) required bleb revision; 13 (10.4%)
required postoperative needling.
Conclusion: In this analysis, MicroShunt implantation was associated with low

rates of reoperations and needling events, and no long-term sight-threatening
AEs.

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on Glaucoma Surgery
P053
XEN® GEL IMPLANT IN A PATIENT WITH POSNER-SCHLOSSMAN

SYNDROME. A CASE REPORT
Enara Etxabe Agirre1, Mayerling M. Suriano1, Irene Gregori Gisbert1, Mireia
Mascarell Vidal1, Sara Mora Sáez1
1
Ophthalmology, Hospital General de Castellón, Castellón de la Plana, Spain
Purpose: To report a case of a patient with glaucomatocyclitic crises (also

known as Posner-Schlossman syndrome) with increased intraocular pressure
(IOP) which could not be stabilized with medical treatment and was treated
surgically with a Xen® Gel implant.
Methods: A 45 year-old female patient was referred to our department with

a blurry right eye. Examination revealed mild anterior chamber reaction with
small diffuse keratic precipitates and IOP of 40 mmHg. Medical treatment did
not manage to control the IOP, therefore surgery was offered to the patient
and a Xen® Gel implant was placed on her right eye.
Results: After the implant was placed the IOP lowered to 4 mmHg during the
first week, resulting in a high and diffuse filtering bleb. One year after surgery,
the IOP remains stable at 20 mmHg and a well-functioning bleb is maintained.
Conclusion: In Posner-Schlossman syndrome, sometimes medical treatment is

not sufficient to maintain normal IOP values and a surgical approach is needed.
Xen® Gel implant may be a safe and effective therapy in glaucomatocyclitic
crises when medical therapy fails to control IOP.

93
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on Glaucoma Surgery
P054
HEADS-UP GLAUCOMA SURGERY USING A 3D VISUALIZATION

SYSTEM
Kazuhiko Mori1, Yuji Yamamoto1, Morio Ueno1, Yoko Ikeda1,2
1
Kyoto Prefectural University of Medicine, Ophthalmology, Kyoto, Japan, 2Oike Ikeda
Clinic, Kyoto, Japan
Purpose: To investigate the feasibility of performing various kinds of glaucoma

surgery including gonio surgery with double-mirror gonio lens, while viewing a
three-dimensional (3D) image on a large display in a heads-up position.
Methods: In this case series, we retrospectively evaluated and share our initial
impressions of the TrueVision 3D visualization system (Ngenuity 3D visual
system, Alcon Surgical), when performing various kinds of glaucoma surgery,
such as trabeculectomy (Trab), bleb needling, goniosynechialysis (GSL), and
suture trabeculotomy / gonioscope-assisted transluminal trabeculotomy
(GATT).
Results: All glaucoma surgeries were successfully performed under the

heads-up system without any complications, not through the eye piece of a
microscope.The field of view (FOV) is broad and stereopsis is excellent for the
gonio surgery with high magnification. However, when working on the anterior
segment such as Trab or bleb needling the digital latency becomes more evident
and the surgeon’s hands should slightly slow down to compensate for this. Also,
FOV of the anterior segment is smaller with the heads-up platform compared
to the standard operating microscope. Additionally, the shared viewing ability
has helped many on the OR staff, as well as medical students and residents, to
have a better understanding of the methods and goals of surgery.
Conclusion: Heads up surgery using a 3D visualization system is suitable for

glaucoma surgeries, especially for the gonio surgery with double-mirror gonio
lens including MIGS.

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on Glaucoma Surgery
P055
MICROPULSE DIODE LASER CYCLOPHOTOCOAGULATION: INITIAL

RESULTS AND SAFETY PROFILE
Brinda Shah1, Apurva Goray1, Safaa Mahmoud1, Paritosh Shah1
1
Yeovil District Hospital NHS Foundation Trust, Ophthalmology,Yeovil, United
Kingdom
Purpose: Micropulse transscleral cyclophotocoagulation (MCP) is a non-

invasive treatment option believed to result in minimum tissue damage and is
hypothesised to increase uveoscleral outflow. We aim to assess the safety and
efficacy of MCP.
Methods: We retrospectively analysed eyes with early to advanced glaucoma

of various aetiologies undergoing MCP using the IRIDEX Cyclo G6 Laser
System with settings of 2000mw 31.3% cycles over 160-180 seconds.
Results: A total of 25 eyes, of patients aged 22 to 96 years with an average of

6.96 months follow up (3-12 months), post MCP were included; 7 of which had
secondary glaucoma. We included 8 eyes with early (MD 0-6dB), 1 with moderate
(MD 6-12dB) and 16 with advanced (MD > 12dB) glaucoma. The average mean
deviation on a 24-2 visual field was -17.02dB. The mean Intraocular Pressure
(IOP) decreased by 7.16 mmHg (29.11%) from 24.6mmHg pre operatively to
17.44 post operatively.The mean number of medications per eye reduced from
2.84 to 1.88. 3 eyes with end stage glaucoma (MD > 25dB) were noted to
have further reduced vision post laser. Laser was repeated up to three times
in 6 eyes and 7 eyes underwent further intervention due to inadequate IOP
reduction. Dry eye and anterior uveitis were the other complications seen.
No cases of hypotony, macular oedema, hyphaema, choroidal detachment or
persistent inflammation were noted.
Conclusion: MCP appears to be a safe and repeatable option not only in

eyes with advanced but also moderate glaucoma. More studies are needed to
standardise patient selection.

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on Glaucoma Surgery
P056
THE EFFECT OF GLAUCOMA ON DRIVING PERFORMANCE

Fang Helen Mi1, Boon Ang Lim1, Wei Leon Leonard Yip1
1
National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Ophthalmology,
Singapore, Singapore
Purpose: This study aims to investigate the difference in driving performance

of glaucoma patients compared to normal subjects, using a driving simulator.
Methods: This was a prospective pilot study, using a custom-built driving

simulator running on CarSim and UC-Win software. The driving proficiency
outcome measures were trajectory control, maneuvering skills, steering
control, pedals control, speed control, safety distance control and collision
risk control. Overall scores were calculated (between A to E), and C or better
was considered as pass. The Humphrey Visual Field (HVF) 24-2 test results of
glaucoma patients were collected.
Results: A total of 40 normal subjects and 17 glaucoma patients were recruited.

5 glaucoma patients (29.4%) obtained a pass score, compared to 37 normal
subjects (92.5%) (p = 0.000). There were statistically significant differences
between the mean scores of the two groups, in trajectory control (p = 0.000),
maneuvering skills (p = 0.000), steering control (p = 0.023), and speed control
(p = 0.002). However, no significant differences were noted for pedals control
(p = 0.701), safety distance control (p = 0.376) and collision risk control
(p = 0.141).There was a statistically significant inverse correlation between the
HVF mean deviation (MD) and collision risk control outcome, with Spearman’s
rho of -0.620 (p = 0.008).
Conclusion: The overall driving performances of glaucoma subjects were

worse than normal subjects in this sample group. Glaucoma patients with worse
HVF MD results performed poorer in the collision risk control outcome.

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on Glaucoma Surgery
P057
HUMAN LIMBAL MESENCHYMAL STEM CELLS AUGMENTED

TRABECULECTOMY IN HIGH-RISK GLAUCOMA: A PILOT STUDY
Rashmi Krishnamurthy1, Sirisha Senthil1, Sayan Basu2, Vivek Singh3
1
L V Prasad Eye Institute, VST Glaucoma Centre, Hyderabad, India, 2L V Prasad
Eye Institute, Virender Sangwan Chair of Regenerative Ophthalmology Director,
Center for Ocular Regeneration (CORE) Research Lead, Tej Kohli Cornea Institute
(TKCI) , Hyderabad, India, 3L V Prasad Eye Institute, Scientist Prof. Brien Holden Eye
Research Center, Champalimaud Translational Centre for Eye research Tej Kohli
Cornea Institute,, Hyderabad, India
Purpose: We performed a pilot trial to evaluate the safety and efficacy of

hlMSCs augmented trabeculectomy in high-risk refractory glaucoma.
Methods: Prospective interventional pilot study. Inclusion criteria: age > 30

years, medically uncontrolled high-risk glaucoma (diagnosis of neovascular
glaucoma, ICE Syndrome and non-resolving Acute angle-closure attack (AAC)
where the risk of failure of Mitomycin-C augmented trabeculectomy is higher
> 50%). Standard fornix-based trabeculectomy was performed. hlMSC’s were
placed after the scleral flap closure with single apical suture, around the Scleral
flap in U-shape manner using fibrin glue followed by conjunctival closure.
Primary outcome measure was intraocular pressure (IOP). Secondary measure
was bleb morphology using Anterior segment Optical Coherence Tomography
(ASOCT).
Results: We randomly assigned 5 eyes. Three eyes had neovascular glaucoma,

one had ICE Syndrome and one had AAC. Pre-operatively, mean IOP (±standard
deviation) was 41.6 (11.26) mmHg. Mean number of anti-glaucoma medication
(AGM) was 4.6 (0.5). We noted significant reductions in the mean IOPs of 14
(±6.16), 12.6 (±4.7), 9.6 (±5.54), 10 (±6.2), 12.6 (±4.6) mmHg at postoperative
day-1, day-7, month-1, month-3 and month-6 respectively. At last follow-up
(mean follow-up: 220 ± 32 days), none of the eyes needed AGM nor had any
complications. Bleb ASOCT revealed mean bleb wall thickness of 156 (±58)
microns and bleb cavity height of 108 (±32) microns suggesting adequate
functioning.
Conclusion: Human Limbal Mesenchymal stem cells as a potent anti-fibrotic

and wound modulator in MMC-trabeculectomy seems to be safe and effective
in high-risk refractory glaucomas.

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on Glaucoma Surgery
P059
HIGH-INTENSITY FOCUSED ULTRASOUND TREATMENT IN

MODERATE GLAUCOMA PATIENTS: RESULTS OF A 2-YEAR
PROSPECTIVE CLINICAL TRIAL
Yair Rubinstein1, Ari Leshno1, Alon Skaat1, Reut Singer1, Shlomo Melamed1
1
Ophthalmology, Sheba Medical Center, Tel Hashomer, Israel
Purpose: To evaluate the safety and efficacy of the Ultrasound Cyclo Plasty
(UCP) procedure using high intensity focused ultrasound (HIFU) in moderate
glaucoma patients.
Methods: Sixteen eyes treated with HIFU. A thorough ophthalmic examination

& IOP measurements were performed before the procedure and at 1 day, 1
week, 4w, 3m, 6m, 1 year and 2y. Surgical success (≥ 20% IOP reduction and
IOP ≥ 5 mmHg) was measured at the last follow-up. Secondary outcomes
were mean IOP, medications, complications, and re-interventions.
Results: IOP reduced from 27.7 ± 5.9 mmHg to 14.6 ± 4.8 (p < 0.001), 14.5
± 4.1 mmHg (p < 0.001), 17.1 ± 5.2 mmHg (p < 0.001), 17.1 ± 3.4 mmHg (p
< 0.001), 18.5 ± 3.5 mmHg (p < 0.001), 18.1 ± 3.6 mmHg (p < 0.001), 17.6 ±
4.4 mmHg (p = 0.005) at 1 day, 1w, 4w, 3m, 6m, 1y and 2y. Surgical success was
87%. Medication reduced (2.5+0.8 to 2.0+1.0) after 2y (p = 0.48). No major
complications.
Conclusion: Ultrasound Cyclo Plasty using HIFU is an effective and well-

tolerated method to reduce IOP in patients with moderate glaucoma.

98
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on Glaucoma Surgery
P060
EVALUATION OF ENDOTHELIAL CELL DENSITY AND LOSS

FOLLOWING ITRACK AB-INTERNO CANAL BASED SURGERY
David Lubeck, Paul Singh, Robert Noecker
Purpose: To evaluate stability of endothelial cell density over a three-year

period in patients who have undergone ab-interno canal based surgery using
the iTrack surgical system (Ellex, Adelaide, Australia).
Methods: Prospective, multi-center registry study with patients followed

for 36 months following iTrack ab-interno canal based surgery, either as a
standalone procedure or in combination with cataract surgery. Specular
microscopy was performed preoperatively and at 1, 6, 12, 24, and 36 months
postoperatively. Standard metrics for glaucoma surgery follow-up were also
measured including visual acuity, intraocular pressure, visual fields, optic nerve
OCT and glaucoma medication use. Endothelial cell density and loss were
analyzed at each time point. Results from patients undergoing iTrack combined
with cataract surgery were compared with results from age matched controls
who underwent cataract surgery only. Six month results are being reported.
Results: Mean endothelial cell loss 1 month following iTrack surgery was 4%,
2% as a standalone procedure and 5% in combination with cataract surgery.
Endothelial cell loss in the control group undergoing just cataract surgery was
5%. There was no additional endothelial cell loss between months 1 and 6 in
any group.
Conclusion: iTrack canal based surgery causes minimal endothelial cell loss,
comparable to cataract surgery alone. Future analyses will assess long term
endothelial cell stability.

99
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on Glaucoma Surgery
P061
GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY

(GATT): ONE YEAR FOLLOW-UP WITH EVALUATION OF SAFETY
AND EFFICACY
Natalia Maes1, Gavin Docherty2, Steven Schendel3
1
Queen Victoria Hospital - NHS Foundation Trust, Glaucoma, East Grinstead, United
Kingdom, 2University of Calgary, Glaucoma, Calgary, Canada, 3University of British
Columbia, Glaucoma, Vancouver, Canada
Purpose: To describe one year results of patients undergoing gonioscopy

assisted transluminal trabeculotomy
Methods: Retrospective review of patients undergoing GATT with one

surgeon (SS) between July 2017 and October 2018. The authors recorded
preoperative intraocular pressure, number of medications, daily diamox use
and degrees of goniotomy performed. The above information was reassessed
at post-operative day 1, post-operative week 1, post-operative month 1, 3, 6,
and 12. Data collection is ongoing.
Results: We identified 27 patients undergoing GATT with 6 months follow

up data. Patients’ ages ranged from 20-89 years, 51% identified as male.
Preoperatively patients were on a mean of 3.25 glaucoma medications.
Patients (n=18) were on an average daily dose of diamox equal to 660 mg.
Average intraocular pressure (IOP) was 28 mmHg and following GATT, IOP
was significantly lower across all follow up visits (p < 0.05). At one year follow
up the average IOP was 16 mmHg (43% reduction). No patients remained
on diamox. Average number of medications was reduced to 2.8. One patient
required a wound burp on post-operative day one for elevated IOP. The most
common significant complication was failure, requiring a second IOP lowering
surgical procedure; which occurred in 15% of the cases.
Conclusion: GATT was successful in reducing IOP and medication burden in

approximately 85% of cases. Failure to achieve adequate IOP control requiring
furhter surgical intervention occurred in 15% of patients.

100
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on Glaucoma Surgery
P064
MACULA MICROVASCULATURE CHANGES IN PATIENTS WTH

PRIMARY OPEN ANGLE AND NORMAL TENSION GLAUCOMA; AN
OCTA STUDY
Anna Dastiridou1, Maria Samouilidou1, Paraskevi Riga1, Eleftherios
Anastasopoulos1, Sofia Androudi2, Nikolaos Ziakas1
1
Aristotle University of Thessaloniki, 2nd Ophthalmology Department, Thessaloniki,
Greece, 2University of Thessalia, Ophthalmology Clinic, Larissa, Greece
Purpose: To compare the macula vascularity characteristics in patients with

primary open angle (POAG), normal tension (NTG) glaucoma and controls.
Methods: This was a cross-sectional study in an Academic Center. Patients

with POAG and NTG from the Glaucoma Clinics were recruited. The control
group comprised patients with mild cataracts or small refractive errors. OCT
scanning of the macula and the disc and 6*6 HD macula OCT angiography
imaging were performed with the RTVue XR Avanti with AngioVue software
(OptoVue Inc). Retinal nerve fiber layer thickness (NFL), macula ganglion cell
complex thickness (GCC) and macula vessel density (VD) were analysed.
Results: Seventy-six POAG, 44 NTG and 61 normal eyes were analysed. NFL
thickness was 80.19±15.02 in the POAG and 78.81 ± 15.13 μm in the NTG
group (p = 0.65). GCC thickness was 81.55 ± 15.16 μm and 79.31 ± 14.04
respectively (p = 0.59).VD was 40.82 ± 6.61 in the POAG and 39.25 ± 5.21 μm
in the NTG group (p=0.15). There was a significant correlation between VD
and both GCC and NFL (p < 0.05). VD, NFL and GCC were lower in patients
with POAG or NTG, compared to controls (all p < 0.01).
Conclusion: Macula VD is affected in patients both open angle glaucoma

groups. However, NTG and POAG eyes show similar characteristics on OCT
angiography.

101
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on Glaucoma Surgery
P066
ONE YEAR EFFICANCY AND SAFETY OF AB INTERNO

TRABECULECTOMY WITH KAHOOK DUAL BRADE IN JAPANESE
GLAUCOMA PATIENTS
Aya Suigiura1, Takashi Fujishiro1, Takashi Oomoto2, Hiroshi Murata1, Ryo
Asaoka1, Kouichirou Sugimoto1, Rei Sakata2, Megumi Honjo1, Makoto
Aihara1
1
The University of Tokyo Hospital, Opthalmology, Tokyo, Japan, 2JR Tokyo General
Hospital, Opthalmology, Tokyo, Japan
Purpose: To evaluate 1-year surgical efficacy and safety of ab interno

trabeculectomy with Kahook Dual Blade (KDB surgery) in Japanese glaucoma
patients.
Methods: A retrospective chart review was performed on glaucoma patients

who underwent standalone KDB surgery at University of Tokyo Hospital from
February 2017 to October 2018, with 12 months follow-up.The demographics,
preoperative and postoperative intraocular pressure (IOP), visual acuity (VA)
and medication score, the extent of incision, and postoperative complications
were analyzed.
Results: Thirty-eight eyes of 34 patients with 14 POAG, 1 NTG, 19 exfoliation

glaucoma, 1 congenital glaucoma and 3 secondary glaucoma were included.The
mean age was 69.8 ± 16.7 years old. The trabecular meshwork was incised in
105 ± 15.1 degrees.The IOP and medication score significantly decreased from
25.8 ± 6.4 mmHg and 4.5 ± 1.1 at the baseline to 16.9 ± 5.6 mmHg and 2.0 ±
1.7, 15.9 ± 4.3 mmHg and 2.9 ± 1.8, 15.1 ± 4.3 mmHg and 2.8 ± 1.8, and 18.4 ±
8.0 mmHg and 2.7 ± 1.7 at 1, 3, 6 and 12 months, respectively (p < 0.05, paired
t-test with Bonferroni correction).VA in all visits was not significantly different.
Hyphema was seen in 7 eyes (18.4%) on the first postoperative day. Additional
surgery was needed in 9 eyes (24%) because of insufficient IOP reduction after
the operation.
Conclusion: IOP and medication score were significantly reduced in KDB

surgery during 1-year.There were some eyes which were needed for additional
surgery.

102
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on Glaucoma Surgery
P067
MANAGEMENT OF BLEB FAILURE AFTER TRABECULECTOMY

Elif Erdem1, Inan Harbiyeli1, Anıl Uysal1, Meltem Yagmur1, Reha Ersoz1
1
Cukurova University Faculty of Medicine, Ophthalmology, Adana, Turkey
Purpose: To evaluate the surgical treatment options for the management of

bleb failure after trabeculectomy.
Methods: A retrospective chart review was performed on patient records

who underwent trabeculectomy and diagnosed bleb failure during the period
March 2012 and March 2019. Surgical procedures for bleb failure were needling,
argon laser suturolysis, bleb revision and re-trabeculectomy. Surgical timing,
intraocular pressure values and complications were recorded.
Results: Sixteen eyes of 16 patients included in this study. Mean age was
60 years (25-84 years). Mean intraocular pressure was 31 mmHg (20-50
mmHg) after trabeculectomy. Mean duration between trabeculectomy and
other surgical interventions was 4.8 months (1-24 months). Bleb revision
was most common surgical procedure (8 patients, 2 of them underwent re-
trabeculectomy finally), other surgical procedures were needling (4 patients,
1 of them need bleb revision during follow-up) and argon laser suturolysis (4
patients). Laser suturolysis was performed within one month after, needling 2
or 5 months later whereas there was no timing preference for surgical bleb
revision (varying between 1 month to 24 months). Patients were followed
mean 12 months (6-44 months) after surgical procedures. Intraocular pressure
was under control 13 of 16 patients at the end of follow-up. There wasn’t any
complications that related with surgical procedures.
Discussion: Bleb failure is one of the challenges after trabeculectomy. Decision

of surgical treatment options should be depend on particular features
of patients. Repeated or combining procedures may be need for control
intraocular pressure.

103
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on Glaucoma Surgery
P068
NEW SUTURING TECHNIQUE IN TRABECULECTOMY

Mohsen Afroozifar1, Mohammad Pakravan2, Shahin Yazdani2
1
Khodadoust Eye Hospital, Glaucoma, Shiraz, Iran, 2Shahid Beheshti University of
Medical Sciences, Ophthalmology, Tehran, Iran
Purpose: Comparison of trabeculectomy in patients who operated by

new suturing techniqe of Dr. Afroozifar (A.F. Suture) and the conventional
trabeculectomy.
Methods: 18 patients with closed angle glaucoma who underwent conventional

phaco-trabeculectomy (group A) compared with 12 patients treated with
phaco-trabeculectomy using new suturing technique (A.F. Suture) (group B) for
4.5 years. Results compared based on post-operative mean ocular pressure,
need for releasable suture removal, need for re-opening the trabeclectomy
path(needling), need for choroidal tap. Pre-operation mean ocular pressure
in group A was 28.3 mmHg with a mean of 3.3 drops and mean pre-operation
ocular pressure in group B was 30.2 mmHg with average of 3.8 drops. mean
age of the first group was 65.6 years and the mean age of the second group
was 67.8 years.
Results: After 4.5 years, mean ocular pressure in group A was 14.4 mmHg
with a mean of 1.5 drops and mean ocular pressure in group B was 12.7 mmHg
with an average of 1.2 drops In 65.6% of group A, releasable suture removal
was required, only in 13.9% of group B needed to remove releasable sutures.
12.8% of group A, need to use needle to open the trabeculectomy duct, but
only 1.3% of group B needed to use needle to open the trabeculectomy duct
and choroidal tap in both groups was only one patient.
Conclusion: New suturing technique of Dr. Afroozifar (A.F. Suture) creates a

better trabeclectomy outlet and better result in trabeculectomy.

104
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on Glaucoma Surgery
P069
THE TENON’S LAYER REPOSITIONING APPROACH OF

TRABECULECTOMY - A LONGITUDINAL CASE SERIES OF A MIXED
GROUP OF GLAUCOMA PATIENTS
Liam Yin Nam Wong1, Poemen P.M. Chan1 2, Tommy C.Y. Chan1, Gilda Lai1,
Nafees Baig1,3
1
The Chinese University of Hong Kong, Department of Ophthalmology & Visual
Sciences, Kowloon, Hong Kong, 2Hong Kong Eye Hospital, Kowloon, Hong Kong,
3
Caritas Medical Centre, Department of Ophthalmology, Kowloon, Hong Kong
Purpose: To investigate the effectiveness and safety of a Tenon’s layer

repositioning approach of trabeculectomy.
Methods: A prospective case series of 30 eyes of 30 Chinese patients with

mixed types of glaucoma who underwent fornix-based trabeculectomy
combined with intraoperative mitomycin C application. During conjunctival
flap closure,Tenon’s layer was separated and anchored on to the scleral surface,
followed by conjunctival closure as a separate layer. All patients were followed-
up for 1 year. Assessments, including intraocular pressure (IOP), vertical cup-
disc ratio (VCDR), best-corrected visual acuity (BCVA) and visual field (VF),
were performed before and after operation. Qualified and complete success
were defined as IOP ≤21mmHg in two consecutive visits with or without
medication, respectively.
Results: 21 eyes (70%) and 28 eyes (93.3%) achieved complete and partial
success at one year, respectively.There was significant reduction of IOP (28.5 ±
9.6 to 15.5 ± 2.6 mmHg, p < 0.001) and medication use (4.4 ± 0.9 to 0.8 ± 1.2
bottle per eye, p < 0.001). There were no significant changes to BCVA, VCDR
and VF indices. No wound leaks were identified throughout the study. Other
postoperative complications, including 2 eyes (6.7%) with transient hypotony
and 1 eye (3.3%) requiring cataract surgery, were of relatively low rate.
Conclusion: The Tenon’s layer repositioning approach of performing

trabeculectomy appears to be a safe and efficacious procedure for patients
with mixed types of glaucoma.

105
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on Glaucoma Surgery
P070
SHORT-TERM RESULTS OF COMBINED PHACOEMULSIFICATION

AND AB INTERNO TRABECULECTOMY IN THE UNITED KINGDOM
Deva Loganathan1, Ejaz Ansari1
1
University of Kent, Canterbury, United Kingdom
Purpose: To describe short-term outcomes of combined Phacoemulsification

and Ab Interno Trabeculectomy with the Kahook Dual Blade (KDB; New World
Medical, Inc, Rancho Cucamonga, CA) in adults with cataract and open-angle
glaucoma (OAG).
Methods: Retrospective chart review of existing medical records. Data

collected included intraocular pressure (IOP) and IOP-lowering medication
use preoperatively and through up to 9 months postoperatively. Paired t-tests
were utilized to compare preoperative to postoperative IOP and medication
use values.
Results: Data from 32 eyes of 32 subjects were analyzed. Subjects were

predominantly Caucasian (31/32) had mean (standard error) age of 80.0 (1.2)
years, and had moderate-advanced OAG (mean cup-disc ratio 0.75 [0.03],
mean visual field mean deviation -8.3 [1.2]). Mean IOP was 19.8 (0.8) mmHg
at baseline and 15.8 (0.6) mmHg (p < 0.0001) at last follow-up (mean 5.8 [0.3]
months); IOP reductions of > 20% were achieved in 17/32 eyes (53.1%). Mean
IOP medication use declined from 2.4 (0.2) medications per eye at baseline
to 0.06 (0.04) medications per eye (p < 0.0001) at last follow-up; 30/32
eyes (93.8%) were medication-free at last follow-up. No vision-threatening
complications were observed.
Conclusions: Combined phacoemulsification and ab interno trabeculectomy

with the KDB safely provided mean IOP reductions of ~20% and mean IOP
medication reductions of ~98% after mean follow-up of ~6 months in eyes
with moderate to advanced OAG. This procedure provides medication-
independence in most eyes with statistically and clinically significant IOP
reductions in the short-term.

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on Glaucoma Surgery
P071
COMPARISON OF CORNEAL ENDOTHELIUM ANALYSIS

BEFORE AND AFTER SURGERY IN PATIENTS UNDERGOING
TRABECULECTOMY WITH MITOMYCIN-C
Ibrahim Inan Harbiyeli1, Oguzhan Oruz1, Elif Erdem1, Meltem Yagmur1, T.
Reha Ersöz1
1
Cukurova University, Faculty of Medicine, Department of Ophthalmology, Adana,
Turkey
Purpose: To evaluate the possible effects of trabeculectomy on endothelial cell

survival and to reveal the pre-postoperative factors associated with endotelial
cell loss after trabeculectomy.
Methods: This prospective cross-sectional study involved 25 eyes of 22

glaucoma patients who underwent trabeculectomy with mitomycin-C between
December 2017- May 2019. Baseline patient data included age, gender, type
and duration of glaucoma, number of topical/oral medications, preoperative
intraocular pressure, lens status and preoperative analysis of central corneal
endothelium with non-contact specular microscopy (Cellcheck, Konan Medical,
Inc.). Postoperative data included duration of follow-up, all medications,
complications, additional interventions and postoperative analysis of
endothelium.
Results: The mean age of 22 patients (6 female, 16 male) was 55.2 ± 18.6 years.
The mean follow-up period was 8.5 ± 8.1 months. Preoperative endothelial cell
density was 2598.2 ± 203.6, this value changed as 2430.1 ± 359.3 postoperatively
and this difference was statistically significant (p: 0.05). Coefficient of variation
and hexagonality values did not differ significantly after trabeculectomy
(p > 0.05 for both). There was no significant effect of demographic and clinical
parameters on endothelial cell survival and morphology (p > 0.05 for all).
Monthly endothelial cell loss (cell loss / month) were similar between patients
with a follow-up ≤ 6 months and patients with longer follow-up (p > 0.05).
Conclusion: Endothelial cell loss may develop after trabeculectomy therefore

periodic evaluation of endothelial cells during postoperative follow-up may be
helpful in predicting postoperative corneal complications. Larger case series
with longer follow-up are required to reveal demographic and clinical factors
that may have an impact on endothelial survival after trabeculectomy.

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P072
TRABECULECTOMY FAILURE RATES BETWEEN PHAKIC AND

PSEUDOPHAKIC PATIENTS WITH OPEN ANGLE GLAUCOMA
Sónia Torres-Costa1, António Melo1, Sérgio Estrela-Silva1, Fernando Falcão-
Reis1, João Barbosa Breda1,2
1
Centro Hospitalar Universitário de São João, Ophthalmology, Oporto, Portugal,
2
KULeuven, Research Group Ophthalmology, Department of Neurosciences, Leuven,
Belgium
Purpose: To evaluate whether previous clear-cornea phacoemulsification

affects the surgical outcomes of trabeculectomy in open angle glaucoma
(OAG) patients.
Methods: Retrospective cohort study comparing phakic and pseudophakic

eyes at 1 and 2 years of follow-up. The primary outcome was the probability
of surgical failure. Failure was defined as IOP > 21 mmHg or reduced < 20%
from baseline, IOP ≤ 5 mmHg, need for further glaucoma surgery, phthisis or
loss of light perception vision due to glaucoma. Secondary outcome measures
included: visual acuity, postoperative hypotensive medications, needlings,
intraoperative and postoperative complications and need for further glaucoma
surgery.
Results: In total, 87 eyes from 87 patients (63 phakic and 24 pseudophakic)

were included. Patients in the pseudophakic group were significantly older
than those in the phakic group, 76 vs 66 years (p < 0.001). No other statistically
significant differences between groups were found at baseline. The probability
of surgical failure in the phakic vs pseudophakic group was 22% (12 in 54) vs
37% (7 in 19) at 1 year and 22 % (11 in 50) vs 37.5% (6 in 16) at 2 years. No
significant differences of surgical failure between phakic and pseudophakic eyes
were found at 1 and 2 years.
Conclusion: Prior clear-corneal phacoemulsification may not significantly

increase the rate of trabeculectomy failure.

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on Glaucoma Surgery
P073
VISUAL FIELD CHANGES FOLLOWING TRABECULECTOMY: A

RETROSPECTIVE STUDY
Mubashir Siddiqui1, Tawfeeq Hakim1, Pornjittra Rattanasirivilai1, Vikas
Shankar1
1
East Lancashire Hospitals NHS Trust, Ophthalmology, Burnley, United Kingdom
Purpose: This study aims to determine whether trabeculectomy surgery in

glaucoma patients would lead to an improvement in visual fields.
Methods: We retrospectively looked at patients with a diagnosis of primary

open angle glaucoma (POAG) who underwent trabeculectomy surgery
in one or both eyes from April 2015 to March 2018. Out of a total of 340
surgeries, 40 were trabeculectomies with phacoemulsification while 300
were just trabeculectomies. 36 cases were selected at random where 7 were
trabeculectomies with phacoemulsification while 29 were just trabeculectomies.
The pre-op, 6-month post-op, 1-year post-op and 2-year post-op visual field
results were recorded. Improvement was defined as an increase in mean
defect (MD) and pattern standard deviation (PSD) value by > 0.50 DB while
deterioration was defined as a decrease by > 0.50 DB. Any change in the values
between those two parameters was considered stable. The patients who
showed stability or improvement in their visual fields from pre-op to post-op
were divided into mild, moderate and severe visual field defect. Their pre-op
and post-op intra-ocular pressure (IOP) was recorded and the percentage
change in IOP was calculated.
Results: Out of 36 trabeculectomies, 16 (44%) showed an improvement, 13

(36%) showed a deterioration while 7 (19%) remained stable. The average
reduction in IOP from pre-op to post-op was 14 mmHg which was a 59%
decrease.
Conclusion: Trabeculectomy in POAG patients is known to stabilise visual

fields. However, these results show that some patients can show improvement,
which will prove to be invaluable when consenting patients for trabeculectomies.

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on Glaucoma Surgery
P075
A DECADE OF DIFFERENCE: A 10-YEAR COMPARISON OF

TRABECULECTOMY SURGERY
Haaris Shiwani1, Salman Naqvi2, Cristina Cristian2, Leon Au2, Anne F.
Spencer2, Cecilia H. Fenerty2, Karl J. Mercieca2
1
Royal Lancaster Infirmary, University Hospitals Morecambe Bay Foundation Trust,
Lancaster, United Kingdom, 2Manchester Royal Eye Hospital, Manchester University
NHS Foundation Trust, Manchester, United Kingdom
Purpose: Trabeculectomy techniques have evolved significantly over the

decades.We compare 2-year outcomes obtained from primary trabeculectomy
in two cohorts, ten years apart, performed at a large UK teaching eye hospital.
Methods: Retrospective descriptive analysis of clinical records for patients

undergoing trabeculectomy at Manchester Royal Eye Hospital from 1st August
2004 to 31st July 2005 (cohort 1, C1) and from 1st August 2014 to 31st July 2015
(cohort 2, C2). Pre-defined IOP success rates and survival curves were applied.
Results: 186 cases were analysed; 52 from C1, 134 from C2. Mean pre-operative
IOP was 24 ±10 mmHg (mean ±SD) in C1 and 21 ± 7 mmHg in C2 (p = 0.01).
37 patients (80%) achieved absolute IOP success in C1 compared to 95 (75%)
in C2 at two-year follow-up (p = 0.63). Intra-operative 5-fluorouracil (5-FU)
was used in 62% of cases in C1; mitomycin C (MMC) was used exclusively in
C2 (p < 0.0001). Post-operative antimetabolite injections were required in
56% versus 28% of patients in C1 and C2 respectively (p = 0.0006) whereas
theatre needling rates were not statistically different (35% versus 31% for C1
and C2) (p = 0.80).
Conclusion: MMC has replaced 5-FU as the intra-operative antimetabolite

with resulting similar IOP success rates but a lower degree of post-operative
antimetabolite administration. MMC use did not result in increased post-
operative complications.

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on Glaucoma Surgery
P076
COMPARATIVE EVALUATION OF TRABECULECTOMY VERSUS

TRABECULECTOMY COMBINED WITH DEEP SCLERECTOMY- A
RANDOMIZED CONTROL TRIAL
Arpit Sharma1, Ramanjit Sihota1, Shikha Gupta1, Dewang Angmo1, Tanuj
Dada1
1
Dr Rajendra Prasad Centre for Ophthalmic Sciences, Ophthalmology, New Delhi,
India
Purpose: To evaluate the efficacy of deep sclerectomy combined with

trabeculectomy as compared to trabeculectomy alone in primary open angle
glaucoma.
Methods: Trial conducted at the tertiary eye care center, out of 68 patients
with moderate to advanced glaucoma (Hodapp-Parish-Anderson classification),
35 were operated for trabeculectomy alone (Group 1) and 33 operated for
trabeculectomy with deep sclerectomy (Group 2). Subconjunctival Mitomycin
C 0.1 mg/ml for 1 minute was used in both groups. Kaplan–Meier plots were
constructed to assess time to failure. Outcome measure included reduction in
intraocular pressure (IOP) by absolute and qualified success criteria (less than
or equal to 15 mm Hg without medication and with medication respectively).
Results: Mean postoperative IOP at 9 months was 12.8 ± 2.2 mmHg in the
Group 1 and 11.4 ± 1.3 mmHg in Group 2 (p .003). Significantly higher absolute
and cumulative success (absolute plus qualified success) was achieved in the
Group 2 (57.5% and 87.8%, respectively), when compared to Group 1 (31.42%
and 51.42% respectively), (p .012 and .001 respectively). On bleb Ultrasound
Biomicroscopy at 9 months, suprachoroidal flow was noted more frequently in
Group 2 (6.5%) vis-à-vis Group 1 (0%) (p .23). Median, minimum and maximum
height of the intrascleral lake (mm) in Group 1 and Group 2 at 9 months was
0.02, 0.01, 0.2 and 0.01, 0.01, 0.3 respectively (p .4).
Conclusion: Combination of trabeculectomy with deep sclerectomy lead to

significantly lower IO, improved success rate in terms of IOP control.

111
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on Glaucoma Surgery
P078
LONG TERM OUTCOMES OF TRABECULECTOMY IN

UNCONTROLLED ADVANCED OPEN ANGLE GLAUCOMA PATIENTS
Anca Pantalon1, Dorin Chiselita1
1
”Sf. Spiridon” University Hospital, Ophthalmology, Iasi, Romania
Purpose: Trabeculectomy success in advanced uncontrolled open angle

glaucoma (OAG) eyes.
Methods: A retrospective cohort study in OAG cases. Indications for

trabeculectomy were: uncontrolled IOP, progressive disease, general status/
life span of the patients, status of the fellow eye. Clinical parameters included:
demographics, best corrected visual acuity (BCVA), type of glaucoma, baseline/
final IOP, number of medications, intra/postop complications. Complete
success, was defined if medicated IOP < 21 mmHg; whereas qualified success
was defined for unmedicated IOP < 21 mmHg. Failure was declared if eyes
lost light perception or if medicated IOP ≥ 21 mmHg, respectively IOP ≤ 5
mmHg. Statistical analysis included odd ratio (OR) calculations and Kaplan-
Meier survival analysis. p ≤ 0.05 was significant.
Results: 165 eyes were selected and followed-up for 24.34 ± 13.67 months;
mean age was 64.72 ± 14.6 years, baseline BCVA = 1.38 ± 1.09 logMAR. Initial
IOP was 34.54 ± 12.31mmHg, under 3.16 ± 0.89 topical medications. After
trabeculectomy, postop IOP dropped to 12.33 ± 8.81 mmHg (p < 0.001 vs
baseline). Effect of trabeculectomy was sustained at the last available visit
(IOP = 15.52 ± 8.45 mmHg), with an overall IOP reduction of 43.66% from
baseline. Reduction in postop medication was also notable (0.5 ± 1.01, p =
0.000). Overall success of trabeculectomy was 84% at 12 months, 77% at 24
months and 51% after 36 months. Success of trabeculectomy was influenced
by sex, male patients having better chances to “survive” OR = 2.1, 95%, [CI] =
1.13-3.10, the number of 5FU postop injections OR = 1.8, [CI] = 0.88-2.7 and
tenonectomy OR =1.19, [CI] = 0.2-2.06.
Conclusion: Success in trabeculectomy was achieved in a high proportion of

cases (> 75%) at 12 and 24 months; male patients, tenonectomy or anti-fibrotic
treatment (5FU injections) were related to a better surgical outcome.

112
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on Glaucoma Surgery
P079
CORNEAL BIOMECHANICAL BEHAVIOR AFTER GLAUCOMA

SURGERY
Vassilios Kozompolis1
1
Democritus University Thrace, Ophthalmology, Alexandroupolis, Greece
Purpose: The purpose of this study is to assess how the corneal biomechanical
properties are affected after two antiglaucoma procedures (trabeculectomy
and the insertion of the Ex-PRESS mini shunt).
Methods: Thirty eyes were included in the study. Eighteen eyes had an Ex-
PRESS shunt inserted (Group 1) and 12 had trabeculectomy (Group 2). IOP,
CH, CRF were recorded preop and postoperatively. The follow up period was
12 months.
Results: In both Groups CH increased at all time points compared to baseline

values. In Group 1 from preop 7.98 to 8.89 at 12 months. In group 2 from 8.15
preop to 9.25 at 12 months. CRF was also increased at all time points from
preoperative 9.99, to 11.85 at 12 months in Group 1 and from 10.35 preop to
12.05 at 1 year. No difference between the two groups was recorded, but CH
and CRF postop increased more in PEXG.
Conclusion: Both surgical techniques have shown to cause a decrease of

IOP and an increase of the CH and CRF postoperatively more pronounced in
PEXG eyes.

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on Glaucoma Surgery
P080
USE OF INTRACAMERULAR BEVACIZUMAB IN TRABECULECTOMY,

ADVANTAGE OR NOT?
Maria Elisa Luís1, Diogo Hipólito-Fernandes1, Rita Serras-Pereira1, Catarina
Xavier1, Nuno Moura-Coelho1, Maria Reina1, Joana Cardigos1
1
Centro Hospitalar Universitário de Lisboa Central, Ophthalmology, Lisbon, Portugal
Purpose: To evaluate morphological and imaging characteristics of filtration

blebs in non-neovascular glaucoma patients undergoing trabeculectomy
combined with intracamerular bevacizumab injection.
Methods: Cross-sectional study of 17 eyes submitted to trabeculectomy

abexterno combined with 50µL bevacizumab (1.25 mg / 0.05 ml) intracamerular
injection and 17 eyes undergoing trabeculectomy abexterno without
bevacizumab. Filtration blebs were evaluated according to the Moorfields Bleb
Grading System (MBGS) classification and invivo confocal microscopy (ivCM).
Results: Mean follow-up time was 6.5 ± 5.0 months for study group and
17,6% were non-functional blebs. According to MBGS classification, 46% of
study blebs were cystic, while 50% of control blebs were diffuse. ivCM showed
a mean number of intraepithelial cysts of 31.7 for study blebs and 12.9 for
control blebs (p < 0.05). A difference in cysts density between the 2 groups
were also observed (mean 206.9 for study group and 83.4 for control group)
(p < 0.05). A higher vascularisation were detected in study group. 60.5% of
study blebs and 50% of control blebs presented a loose or mild connective
tissue on ivCM, respectively.
Conclusion: The use of bevacizumab in neovascular glaucoma is well described

in the literature, but the results in non-neovascular cases still lacks consistent
outcomes. Our study shows a higher number of intraepithelial cysts and cysts
density in bevacizumab group, which is usually associated with better bleb
function. Larger studies are needed.

114
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on Glaucoma Surgery
P081
LONG-TERM CHANGES OF THE CORNEAL ENDOTHELIAL CELL

DENSITY AFTER EX-PRESS® DRAINAGE DEVICE IMPLANTATION FOR
JAPANESE GLAUCOMA PATIENTS
Yurika Aoyama1, Rei Sakata1, Takashi Fujishiro1, Megumi Honjo1, Shiroaki
Shirato2, Makoto Aihara1
1
University of Tokyo hospital, Ophthalmology, Tokyo, Japan, 2Yotsuya Shirato Eye
Clinic, Ophthalmology, Tokyo, Japan
Purpose: To investigate the changes of corneal endothelial cell density (CECD)

after initial EX-PRESS® drainage device implantation surgery (EX-PRESS) for
Japanese open angle glaucoma (OAG) patients.
Methods: We retrospectively investigated the CECD after EX-PRESS of OAG

patients who were followed up for three years and well-controlled under the
target IOP. Pre (baseline) and postoperative (3, 6, 12, 24 and 36 months) CECD
were examined by corneal specular microscopy, and the changes of CECD
were analyzed.
Results: Thirty eyes of 30 patients (mean age 67.5 ± 15.2 years; male 21, female
9) including 14 eyes with stand-alone surgery and 16 eyes with combined
surgery were included. The types of glaucoma were 13 POAG, 14 NTG, 2
pseudo-exfoliation glaucoma, and 1 secondary glaucoma. The mean CECD was
2535 ± 173 (mean ± SD) at the baseline and 2458 ± 189, 2515 ± 197, 2480 ±
234, 2429 ± 253 and 2414 ± 286 cells/ mm² at 3, 6, 12, 18, 24 and 36 months,
respectively. The reduction rate of CECD after the surgery from the baseline
was 3.0, 0.8, 2.2, 4.2, and 4.8%, respectively. Statistically, CECD in all subjects
significantly decreased after the surgery only at 24 months, and CECD of triple
surgery decreased at 6 and 36 months (p < 0.05, paired t-test). However, there
was no differences among CECDs of the 6 post-operative points, and stable
for 3 years.
Conclusion: CECD transiently decreased after EX-PRESS surgery, but stable

for 3 years. Ex-PRESS surgery was clinically safe for CECD in post-operatively
well-controlled patients.

115
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on Glaucoma Surgery
P083
EFFECT OF MODIFIED POST-SURGICAL CARE ON OUTCOMES OF

AHMED GLAUCOMA VALVE (AGV) AND BAERVELDT GLAUCOMA
IMPLANT (BGI) SURGERY FOR NEOVASCULA GLAUCOMA (NVG)
Mayumi Minami1, Etsuo Chihara1
1
Sensho-kai Eye Institute, Ophthalmology, Uji, Japan
Purpose: To report postoperative care techniques and outcomes of AGV and

BGI for NVG.
Methods: We retrospectively reviewed the medical records of NVG patients

who underwent AGV (19 eyes) BGI (39 eyes) between 2001 and 2019.We used
modifications such as absorbable suture to ligate tube, combination of the stent
and ripcord, stepwise release of ligation, and massage, and the outcome was
compared with that of the Ahmed Baerveldt Comparison study (ABC study).
Main outcome measures were IOP, visual acuity (VA), rate of failure.
Results: The mean follow-up period was 54.7 ± 48.5 months in AGV and 33.7 ±
23.2 months in BGI. Baseline IOP in AGV and BGI cohorts were 37.4 ± 16.5 and
37.0 ± 11.1 mmHg (p = .90), which lowered to 14.6 ± 2.6 and 13.0 ± 4.0 mmHg (p
= .08)at 5 years. Baseline logMAR VA in AGV and BGI cohorts were 1.39 ± 0.90
and 1.43 ± 1.01 (p = .86), which changed to 1.46 ± 0.62 and 0.86 ± 1.03 (p = .20) at
5 years. Even though we enrolled only NVG, the cumulative probability of failure
at 5 years were 33.9% in AGV and 35.0% in BGI (p = .80), which was comparable
or even better than the probability of 44.7% and 39.4% in the ABC study.
Conclusions: Modified techniques might have contributed to better outcome

after long tube surgery for NVG.

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on Glaucoma Surgery
P084
COMPARISON OF MITOMYCIN-C USE AS AN ADJUNCTIVE THERAPY

IN BAERVELDT TUBE SURGERY
Anindyt Nagar1, Lina Danieliute1, Henrietta Ho1, Ian Rodrigues1
1
Guy’s and St Thomas’ Foundation Trust, Ophthalmology, London, United Kingdom
Purpose: To investigate outcomes of glaucoma patients undergoing Baerveldt

tube surgery with/without Mitomycin-C (MMC).
Methods: Retrospective, single centre analysis of 24 consecutive patients who

underwent Baerveldt tube surgery with or without MMC. The decision to use
MMC was the surgeons choice.
Results: 24 eyes with a mean age of 64.6 years and mean follow up of 11.5
months. Subconjunctival application of sponges soaked in 0.4mg/ml MMC for
5 minutes were used in 14 (58%) eyes. 30% had secondary glaucomas and
50% prior conjunctival involving glaucoma surgery. Of the 10 eyes in the non-
MMC group only 20% had prior conjunctival involving glaucoma surgery and
10% had secondary glaucomas. The MMC group had a 40% reduction in mean
intraocular pressure (IOP) from 23.9 mmHg to 14.3 mmHg (p < 0.005) and
60% reduction in IOP lowering medications from 3.9 to 1.5 (p < 0.005). The
non-MMC group had a 44% reduction in IOP from 24.5 mmHg to 13.7 mmHg
(p = 0.01) and a non-significant 19% reduction in medications from 3.6 to 2.9
at latest follow-up (p = 0.10). Reduction in IOP was similar in both groups
but the MMC group had a significantly greater reduction in the number of
IOP lowering medications at latest follow-up (p = 0.02) with 29% drop free
compared to none in the non-MMC group. Both groups had a similar low
number of complications.
Conclusion: Baerveldt tube surgery with adjunctive MMC resulted in similar

post-operative IOP as non-MMC, however this was achieved using significantly
fewer IOP lowering medications, despite a higher proportion of patients with
secondary glaucomas and previous glaucoma surgery.

117
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on Glaucoma Surgery
P085
NASAL AHMED GLAUCOMA VALVE IMPLANTATION A FINAL

SOLUTION TO SUPERIOR TEMPORAL QUADRANT FAILURE
Carolina Madeira1, Gonçalo Godinho1, António Melo1, Fernando Falcão-
Reis1, Sérgio Silva1
1
Department of Ophthalmology, Centro Hospitalar de São João, Porto, Portugal
Purpose: To evaluate the long-term efficacy and complications of inferior (IN)

and superior (SN) nasal Ahmed Glaucoma Valve (AGV) implantation in patients
with refractory glaucoma.
Methods: Retrospective review of clinical records of 10 eyes of 10 patients

who underwent uneventful SN or IN AGV implantation with a minimum follow-
up of 2 years. An operation was defined as successful when (1) postoperative
IOP remained between 5 and 21 mmHg and was reduced 30% compared to
baseline, with or without medication, (2) there was no loss of light perception
or vision-threatening severe complications, and (3) no additional filtering or
aqueous drainage surgery was required.
Results: The current study included 10 eyes of 10 patients with uncontrolled

IOP despite maximum tolerated medical therapy. Pre-operative mean IOP was
28 (19-40) mmHg. The superotemporal (ST) quadrant wasn’t available for valve
implantation in any of these eyes. Patients underwent SN (n = 5) and IN (n = 5)
AGV implantation. Median follow-up period was 3 [2-12] years. Postoperative
IOP at the end of follow-up was 12 [6-34] mmHg. Success rate was 90%.
One patient with a SN AGV presented with a vision-threatening complication:
wound dehiscence, exposure of the patch graft and endophthalmitis.
Conclusion: AGV implantation in the nasal quadrants seems to be an effective

option for IOP control in patients with refractory glaucoma, when the ST
quadrant is not available, the nasal location is an effective option.

118
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on Glaucoma Surgery
P086
INTRALUMINAL STENT CHOICE FOR THE BAERVELDT GLAUCOMA

IMPLANT
Lina Danieliute1, Anindyt Nagar1, Henrietta Ho1, Ian Rodrigues1
1
Guy’s and St Thomas’ NHS Foundation Trust, Ophthalmology, London, United
Kingdom
Purpose: Flow restriction is critical in preventing early hypotony with the

valveless Baerveldt glaucoma implant (BGI). We compared outcomes of BGI
surgery using 3-0 Supramid® and 4-0 Prolene sutures as intraluminal stents.
Methods: Consecutive patients operated by a single surgeon were

retrospectively reviewed. Failure was defined as post-surgery intraocular
pressure (IOP) > 21 mmHg, or < 20% reduction from pre-operatively. 4-0
Prolene was the surgeon’s standard intraluminal stent and 3-0 Supramid® was
used if the patient was within a clinical trial.
Results: 24 patients (12 in each group) were included. Mean age was 64.6
years and mean follow-up 11.5 months. With 3-0 Supramid, mean IOP reduced
from 23.3mmHg to 14.8 mmHg (p < 0.001) and mean number of IOP-lowering
medications reduced from 3.5 to 2.5 (p = 0.026). With 4-0 Prolene, IOP reduced
from 25.0mmHg to 13.1 mmHg (p < 0.001) and IOP-lowering medications
reduced from 4.0 to 1.8 (p < 0.001). 25% with Supramid were classified as
failures compared to 8% with Prolene stents. Post-operatively, laser suturelysis
of ligating sutures were required in 41% with Supramid and 67% with Prolene
stents (p = 0.41), however significantly more patients required removal of
Supramid (100%) compared to Prolene stents (17%), p < 0.001. One patient in
the Prolene group had early overdrainage with hypotony, requring an additional
ligation suture.
Conclusion: Final IOP and number of IOP-lowering medications were similar

when using 3-0 Supramid® and 4-0 Prolene intraluminal stents in BGI surgery.
However this was achieved with significantly less frequent intralumial stent
removal when using 4-0 Prolene which can therefore be considered a safe and
effective alternative intraluminal stent.

119
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on Glaucoma Surgery
P087
OUTCOMES OF COMBINED BAERVELDT GLAUCOMA IMPLANT

AND TRABECULECTOMY WITH MITOMYCIN C IN PATIENTS WITH
ADVANCED GLAUCOMA
Henrietta Ho1, Saurabh Goyal1
1
St Thomas’ Hospital, Ophthalmology Department, London, United Kingdom
Purpose: To describe our surgical experience with combined Baerveldt

glaucoma implant (BGI) and trabeculectomy with mitomycin C (MMC), and
present our clinical outcomes.
Methods: Consecutive eyes with advanced glaucoma (mean deviation (MD)

<-12dB) and uncontrolled intraocular pressure (IOP) or progression on
maximal medical treatment were recruited. All patients were deemed to be at
high risk of trabeculectomy failure. Data was prospectively collected. Mean IOP
reduction, use of ocular hypotensive medications and surgical complications
were recorded.
Results: 28 eyes of 25 patients were included. Most patients had POAG

(89.3%), and a mean age of 61.7 ± 12.4 years and mean preoperative MD of
-20.9 ± 7.2 dB. The mean duration of follow-up was 26.1 ± 13.5 months. Mean
medicated IOP was 22.6 ± 7.9 mmHg at baseline, 14.3 ± 4.8 mmHg at 1 month
post-operatively, 12.1 ± 4.8 mmHg at 3 months post-operatively and 11.0 ±
3.2 mmHg at last follow-up (p < 0.001). Mean number of medication reduced
from 3.5 ± 0.6 to 1.3 ± 1.4 (p < 0.001). Complications included one eye with
endophthalmitis, two eyes with late hypotony (> 6 months post-operative) and
one eye with exotropia. No eyes lost light perception in this cohort.
Conclusions: Our surgical technique of combined BGI with trabeculectomy

significantly lowered IOP and reduced medication use to provide good early
and intermediate IOP control in eyes with refractory advanced glaucoma.

120
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on Glaucoma Surgery
P088
OUTCOMES AND RISK FACTOR FOR FAILURE AFTER AQUEOUS

SHUNT IMPLANTS - ANNUAL REVIEW OF ONE SERVICE RESULTS
AND BENCHMARK
Renata Puertas1, Fernanda N. Susanna2, Ameet Shah1, Fabiola Murta1,
Vaneeta Sood1, Ashkan Khalili1, Keith Barton1
1
Moorfields Eye Hospital, London, United Kingdom, 2University of São Paulo, São
Paulo, Brazil
Purpose: Report annual benchmark exercise of aqueous shunt implants

(tubes) outcomes and risk factors for failure over 4 years.
Methods: Retrospective cases series: Annual reporting of outcomes of tube

implants. A total of 332 eyes were included in this study. The main outcomes
were intra-ocular pressure (IOP), loss of visual acuity (VA), number of
medications and failure/visually threatening complications at 1-year follow-up.
Results: Surgical success rate was 93% at a mean follow-up of 13.3 months.
Compared to preoperative IOP (25.8 ± 7.9 mmHg), the mean postoperative
IOP was significantly lower (14.4 ± 5.5 mmHg, p < .00001) on significantly
fewer ocular hypertensive medications (from 3 ± 1 to 1.4 ± 1.3, p < .00001).
There were 2 (0.6%) cases of loss of light perception.
Conclusion: Annual reporting of tube implant within a service provides an

exceptional tool for monitoring outcomes in line with major literature. It
allows to monitor safety as well as new trends in surgical technique.

121
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on Glaucoma Surgery
P089
EFFICACY AND SAFETY OF THE AB-INTERNO XEN GEL STENT

AFTER FAILED SHUNT SURGERY IN ADVANCED GLAUCOMA
PATIENTS
Eran Berkowitz1, Beatrice Tiosano1
1
Ophthalmology, Hillel Yaffe Medical Center, Hadera, Israel
Purpose: To assess the efficacy and safety of the Xen gel stent in reducing
intraocular pressure (IOP) in eyes with prior failed shunt surgeries and
determine the frequency of complications.
Methods: Retrospective case review of all patients with prior shunt surgeries
who had undergone Xen surgery from May 2017 to April 2019.
Results: Seven surgeries were reviewed. Average IOP was reduced from 24.5
mmHg to 10.8 mmHg. Medication usage was reduced from an average of 3.5
to 0.5. Adverse events included: numerical hypotony in 2 cases , one requiring
anterior chamber reformation. Postoperative bleb needling was required in
three cases.
Conclusion: The Xen Gel Stent reduces IOP and the number of medications
in eyes with failed shunt surgeries. Detailed preoperative conjunctiva, sclera,
angle assessment and preparation, together with a targeted stent placement,
are required.

122
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on Glaucoma Surgery
P090
COMPREHENSIVE BIOINFORMATIC EVENT SIMULATION STUDIES

ON WOUND HEALING IN TRABECULECTOMY BY UTILIZING
FUNCTIONAL GENE ASSOCIATION AND CELLULAR EVENT
ANALYSIS: A FOCUS ON GENE MODULATION TO IMPROVE
SURGICAL OUTCOMES
Rayees Sofi1, Anoop Sainulabdeen2, Muneeb A. Faiq2 3, Muzafar Pandit4
1
Government Medical College, Ophthalmology, Jammu and Kashmir, India, 2New
York University (NYU), School of Medicine, NYU Langone Health, New York, NY,
USA, Ophthalmology, New York, USA, 3Dr. Rajendra Prasad Center for Ophthalmic
Sciences, All India Institute of Medical Sciences, New Delhi, India, 4All India Institute
of Medical Sciences, New Delhi, India
Purpose: Success of trabeculectomy is profoundly hampered by postoperative

fibrotic scar formation. Although mitomycin C (MMC) is currently used to
prevent scar formation but it often leads to complications. With this premise,
we aimed at identifying the molecular and genetic signatures that could be
employed to improve surgical outcomes.
Methods: We did comprehensive data mining using databases, search engines,

meta-analyses, repositories, individual studies, and Human Metabolome
Database. A perioperative and postoperative chronology of molecular events
that enhance fibrotic scar formation (α-Nodes) and those that inhibit (β-Nodes)
was constructed. Disgenet, Metacore, Genespring, Cytoscape, Netpath, Cell
Collective and E-cell were used for analysis and event simulation in Tenon’s
capsule, episclera and subcunjunctival areas.
Results: 209 genes belonging to 24 pathways were identified. Simulation

yielded 12 cellular events relevant to fibrotic scar formation viz. surgical trauma,
fibrinogen/fibronectin/plasminogen release, fibrin-fibronectin matrix induction,
infiltration of proinflammatory cells, induction of angiogenesis, lymphocyte and
fibroblasts infiltration/activation, T-cell activation/cytokine release, fibroblast
proliferation, fibrin-fibronectin matrix dissolution, fibrovascular granulation
and scar formation. Pathway enrichment was carried (FDR < 0.001) which
identified 19 genes (CTGF, ROCK1, MMP9, PDGF, IL1B, FAS, IL1A, NGF1,
BCL2L1, NTRK1, NFKB1, CASP3, TP53, TGF-β, TNF-α, XIAP, BAD, VEGF and
MAPK3) and 1731 interactions. Functional annotation revealed that MMP9,
CASP3, BCL2L1, TGFβ, TNF and VEGF expression signature modulates fibrosis
around Tenon’s capsule, episclera and subcunjunctival areas.

123
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on Glaucoma Surgery
Conclusion: This is the first bioinformatic study that identifies the gene
expression signature that could be regulated to improve surgical outcomes in
trabeculectomy.

124
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on Glaucoma Surgery
P092
5-FLUOROURACIL VS MYTOMICIN-C IN BLEB REVISION

Fernando Trancoso Vaz1, Rita Basto1, Joana Roque1, Susana Henriques1
1
Hospital Professor Doutor Fernando Fonseca, Ophthalmology, Lisbon, Portugal
Introduction: Subconjunctival antifibrotic injection allows to restore the

bleb’s filtration function without further destruction of the conjunctiva.
The aim is to compare the efficiency between 5-fluorouracil (5-FU) and
mytomicin-C (MMC) in postoperative bleb revision.
Methods: A retrospective comparative review was made with 53 patients,

divided into two groups: 34 eyes injected with 5-FU (50 mg/mL) and 19 injected
with MMC (0.04 mg/mL).
Results: Successful reduction in IOP (> 20%) was achieved in 88.7% of all
cases, with no difference between groups (p = 0.113). Absolute success (IOP
≤ 21 mmHg with no medication) tended to be higher in the MMC group, with
significance (p = 0.013) only after 3 months of follow-up (14.7% in 5-FU group
and 52.6% in MMC group at 3 months, 24.2% and 50.0% at 1 year). Failure (IOP
> 21 mmHg) tended to increase in 5-FU group, with no cases of failure with
MMC and 20.6% with 5-FU after 6 months. Repeated injection was performed
in 41.2% of eyes in 5-FU group, compared to 15.8% with MMC. The need for
a new surgery was similar (38.2% in 5-FU and 36.8% in MMC). There was no
statistical difference in the complication rates between groups.
Conclusion: Antifibrotic injection is safe and an effective intervention to

rescue filtration blebs. MMC seems to be more effective than 5-FU, without
significant increase in complications. Patients receiving MMC had a shorter
follow-up period which may justify the higher MMC success rate and the lower
need for re-intervention.

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on Glaucoma Surgery
P093
PROLONGATION OF IMMUNOSUPRESSANTS DELIVERY FOR

WOUND HEALING MODULATION IN GLAUCOMA SURGERY:
EXPERIMENTAL IN VITRO STUDY
Viktoriia Germanova1, Elena Karlova2, Andrey Zolotarev2, Aleksandr
Korigodskiy3
1
Samara State Medical University, Ophthalmology, Samara, Russian Federation,
2
Eroshevskiy Eye Hospital, Glaucoma, Samara, Russian Federation, 3HiBiTech,
Moscow, Russian Federation
Purpose: To develop a method to prolong delivery of selective

immunosupressants in the surgery area for wound healing modulation in
glaucoma interventions.
Methods: We analyzed the ability of poly(lactic-co-glycolic) acid glaucoma

drainage samples to cumulate cyclosporine A (CsA) from solutions with
decreasing drug concentrations from 50,0 to 1,0 mg/ml for 5-60 minutes. Other
drainage samples were enriched with everolimus with the help of ultrasound.
Then drainage samples were lyophilized and amount of incorporated
immunosupressants was evaluated by means of chromatography-mass
spectrometry. The dynamics of immunosupressants desorption was analyzed
in vitro: drainage samples enriched with CsA and everolimus were placed in
containers with 9 ml balanced salt solution and kept at constant temperature
37 C° in a shaker (50-100 rpm). At specific times from 12 hours to 14 days
drainage samples were removed from the solutions and residual content of the
drugs was evaluated by means of chromatography-mass spectrometry.
Results: poly(lactic-co-glycolic) acid glaucoma drainage turned out to be a good

substrate for enrichment with both immunosupressants. It incorporated 3.87
µg of CsA and 240 µg of everolimus. Drainage samples released therapeutic
concentrations of CsA for 7 ± 0.5 days and everolimus for 12.0 ± 0.8 days.
СOnclusion: We developed a method to maintain therapeutic concentrations

of CsA and everolimus in vitro in close to real conditions for a period of time
long enough to overlap the moment when T-cells and macrophages reach their
peak amount and trigger fibroblast proliferation. Implantation of glaucoma
drainages enriched with selective immunosupressants can potentially modulate
wound healing in glaucoma surgery.

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on Glaucoma Surgery
P094
RESCUE OF A NON-FUNCTIONING XEN®

Mireia Mascarell Vidal1, Mayerling M. Suriano1, Irene Gregori Gisbert1,
Enara Etxabe Agirre1, Sara Mora Saez1
1
Ophthalmology, Hospital General de Castellón, Castellón, Spain
Purpose: Expose the rescue maneuver used to recover an old Xen® device
surgery.
Methods: It is decided to make a surgical revision of the failed Xen®.

Conjunctival dissection was performed in fornix-based, visualizing the
subconjunctival portion partially sectioned. The functionality of the device
was tested by introducing Vision Blue® in the anterior chamber. We performed
partial tenectomy and mitomycin 0.02% was applied.
Results: After 3 months of follow-up, the intraocular pressure was stable in

13mmHg without medical treatment and with filtering bleb grade 3.
Conclusion: Surgical revision is an effective option for restoring Xen® function.

It is a fragile implant, which can fracture during surgical revision, which, in our
case, probably favoured the release of the nonfunctioning obstructed end, thus
restoring drainage. Mitomycin and tenectomy can prevent reobstruction.

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on Glaucoma Surgery
P095
ACUPUNCTURE EFFECTS ON PRIMARY OPEN ANGLE GLAUCOMA

Siham Fahmy1
1
Military Hospital, Traditional Chinese Medicine Departement, Cairo, Egypt
Background: Glaucoma is the second leading cause of irreversible blindness.

Open angle glaucoma is more common affects African people. Over 8.4million
of glaucoma patients are bilaterally blind rising to 11.1million by 2020.
Purposes: To determine the therapeutic efficacy of acupuncture therapy

on intraocular pressure and visual field in primary open angle glaucomatous
patients.
Methods: Fifty one eyes with Primary open angle glaucoma participated in this
study. Their age ranged from 40 to 80 years, IOP ranged from 20 to 45 mmHg,
these eyes were divided randomly into two groups; Acupuncture group: This
group consisted of twenty six eyes whose received acupuncture therapy and
Control group: This group consisted of twenty five eyes whose did not receive
any kind of acupuncture therapy. Both groups received their standard topical
antiglaucoma medications. Assessment depended on two aspects: IOP which
was measured by Goldman Applanation Tonometry and Visual field which was
measured by Octopus Perimetry.
Results: There were a significant decrease in IOP in the acupuncture group

compared to control group where the level of significance was (p<0.05) with
76.9% stabilization of visual field in the acupuncture group compared to 8% in
control group.
Conclusion: Acupuncture can be considered as additional to standard

antiglaucoma medications and effective for POAG in reducing IOP and stabilize
visual field.

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on Glaucoma Surgery
P096
CLINICAL EVALUATION OF BLOOD-FILLING PATTERNS IN

SCHLEMM’S CANAL FOR TRABECTOME SURGERY
Kae Sugihara1, Akiko Narita1, Naruka Mitsui1, Seido Okuda1, Tomoko
Ishikawa1, Miki Noso1, Jiro Seguchi1
1
Okayama Saiseikai General Hospital, Department of Ophthalmology, Okayama,
Japan
Purpose: To assess the relationship between blood-filling patterns in

Schlemm’s canal and surgical results after Trabectome surgery combined with
phacoemulsification.
Methods: A retrospective cohort study. 105 eyes of 95 primary open

angle glaucoma (POAG) patients who had undergone Trabectome surgery
combined with phacoemulsification were included. Provocative gonioscopy
was performed at the beginning of the surgery to classify the blood-filling
patterns in Schlemm’s canal: no filling (grade 1), incomplete filling (grade 2), and
complete filling (grade 3). Subjects were classified into 3 groups according to
the grade of the blood-filling patterns in Schlemm’s canal in order to compare
the clinical data, including age, visual field mean deviation (MD), intraocular
pressure (IOP), number of glaucoma medications, IOP reduction, and surgical
success rate. Surgical success was defined as an IOP ≤15 mmHg and ≥ 20%
reduction in IOP.
Results: Mean pre-operative IOP of 17.1±3.6 mm Hg significantly decreased to

13.3±3.1 mm Hg at 1 year after surgery. There were no significant differences
between the three groups in age (p = 0.523), MD (p = 0.356), pre- and post-
operative IOP (p = 0.941 and 0.483, respectively), pre- and post-operative
number of glaucoma medications (p = 0.805 and 0.079, respectively), percentage
IOP reduction (p = 0.284), or surgical success rate (p = 0.468).
Conclusion: Trabectome surgery is an effective procedure for POAG patients

regardless of the blood-filling patterns in Schlemm’s canal.

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on Glaucoma Surgery
P097
A RARE CASE OF GLAUCOMA IN FAMILIAL AMYLOIDOSIS

POLYNEUROPATHY DUE TO TRANSTHYRETIN VARIANT,
P.GLU74GLY
Selina Khan1, Rani Sebastian1, Demetrios Manasses1
1
Bristol Eye Hospital, Ophthalmology, Bristol, United Kingdom
Purpose: We present a complex case of glaucoma due to Transthyretin-related

Familial Amyloidosis Polyneuropathy (TR-FAP), p.Glu74Gly. To-date, this is the
only case reporting management of TR-FAP glaucoma with a combination of
glaucoma tube surgery, cyclodiode laser and the latest systemic gene therapy
Partisiran®.
Methods: Retrospective case note review was undertaken.
Results: A 50-year-old gentleman presented to eye casualty with a painful

left eye and misty vision. Examination revealed raised pressure of 51mmHg,
corneal oedema and open angles on gonioscopy. He was subsequently treated
for unilateral glaucoma secondary to TR-FAP. This became refractory to topical
intraocular pressure (IOP) lowering medication. As both of his brothers had
previously underwent unsuccessful trabeculectomy surgery for TR-FAP related
glaucoma, it was decided he should undergo Baerveldt tube implantation with
Mitomycin C 0.4 mg/ml. Over the course of 6 months, the IOP in the left
eye increased from 3 mmHg to 44 mmHg. Cyclodiode laser to 270 degrees
was performed and for over 1 year his pressure has remained successfully
controlled at 12mmHg. He is also treated systemically with Partisiran®, a
rubonucleic acid interfence molecule, which has been shown to prevent the
formation of Transthyretin protein by the liver.
Conclusion: This case highlights the importance of integrating novel gene

therapy interventions with established models of glaucoma treatment for
optimised clinical outcomes.

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P098
BURDEN AND QUALITY OF LIFE AMONG PRIMARY CAREGIVERS OF

GLAUCOMA PATIENTS
Deeksha Rani1, Vivek Gupta1, Arjun Desai1, Tanuj Dada1
1
Dr. R P Center for Ophthalmic Sciences, AIIMS, New Delhi, India
Purpose: To assess caregiver burden among primary caregivers of glaucoma

patients at a tertiary hospital in North India
Methods: Fifty primary caregivers of 50 patients with glaucoma were enrolled.

Participants completed 12-item Zarit Burden Interview (ZBI) to assess
caregiver burden, Caregivers Congenital Glaucoma QOL Questionnaire
(CarCGQol) for quality of life (QOL) and Patient Health Questionnaire-9
(PHQ9) for depression.
Results: Patients included 15 congenital, 15 primary open angle (POAG), 6

primary angle closure (PACG) and 14 secondary glaucoma. Caregivers were
aged 41.2 ± 14.7 years, 74% were females and 44% were (grand)parents. High
caregiver burden (ZBI score ≥ 17) was observed in 46% (95% CI: 31.8, 60.7),
and moderate depression (PHQ9 score ≥ 10) in 34% (95% CI: 21.2, 48.8)
caregivers. Median rasch-scaled CarCGQol score was -0.25 logits (inter-
quartile range: -0.91, 1.2) among congenital glaucoma caregivers which is
worse than other studies from India and Iran. Adjusting for caregiver’s sex, age
and patient’s sex, high caregiver burden was associated with PACG diagnosis
(b = 4.49, p = 0.02), and patient age < 20 years (b = 4.6, p = 0.02). Patient age
< 20 years (b = 6.7, p = 0.01) was also associated with moderate depression.
Conclusion: Glaucoma is associated with high caregiver burden, poor QOL,

and depression in primary caregivers. Glaucoma management must include
psychosocial interventions, meditation and mindfulness-based stress-reduction
techniques for caregivers to help overcome this high burden.

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on Glaucoma Surgery
P099
EVALUATION OF RETINAL NERVE FIBER LAYER AND CANGLION

CELL-INNER PLEXIFORM LAYER LOSS IN PATIENTS WITH PRIMARY
OPEN ANGLE GLAUCOMA
Asaad Ghanem1
1
Mansoura Ophthalmic Center, Ophthalmology, Mansoura, Egypt
Purpose: This is study aims to compare the rates of Peripapillary retinal

nerve fiber layer (RNFL) and macular retinal ganglion cell-inner plexiform
layer (GCIPL) changes in patients with POAG with control subjects by Swept
Source OCT.
Methods: This was a comparative cross-sectional study included 40 eyes with

POAG and 40 eyes of 40 control subjects. After detailed eye examination
and measurement of intraocular pressure, Visual field examination by using
Humphery (2003 Carl Zeiss Meditec), Germany. ALL subjects were scanned
using swept source Optical Coherence Tomography device (Triton, Topcon,
Tokyo, Japan), imaging OCT to measure Macular GC-IPL thickness , Peripapillary
RNFL thickness.
Results: The mean age of the patients with POAG was 58.20 ± 9.12 years;
26 eyes (65.0%) were male and 14 eyes (35.0%) were female. The average age
of control subjects was 54.10 ± 9.11 years; 14 eyes (35.0%) were male and
26 eyes (65.0%) were female, average of VFMD was -11.30 ± 6.88dp, average
Spherical equivalent(SE) was -3.43 ± 1.08, average CMT was 164.3 ± 16.62
and average IOP was 15.25 ± 1.33 in patients with POAG, whereas average of
VFMD was-0.97 ± 0.39, average SE was -3.23 ± 1.04, average CMT was 170.6
± 9.21 and average IOP was 13.20 ± 1.18 in control subject.
Conclusion: Evaluation of RNFL and Ganglion Cell-Inner Plexiform Layer by

Swept-source OCT showed significant differences between the normal and
glaucomatous eyes.

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P100
ENDOTHELIN-1 AND NITRIC OXIDE LEVELS IN PATIENTS WITH

GLAUCOMA
Asaad A. Ghanem1
1
Ophthalmology, Mansoura Ophthalmic Center, Mansoura University, Mansoura,
Egypt
Purpose: To investigate the levels of endothelin-1 (ET-1) and nitric oxide

(NO) in the aqueous humor and plasma of human eyes with different types
of glaucoma: primary openangle glaucoma (POAG) and chronic closed-angle
glaucoma (CCAG).
Methods: Patients were classified into 3 groups: groupI comprised 35 patients

with POAG, groupII comprised 25 patients with CCAG, and 30 patients with
senile cataract (groupIII) were used as a control group. Aqueous humor and
corresponding plasma were analyzed for ET-1 and NO concentrations by ELISA.
Bonferroni correction for multiple comparisons was performed.
Results: ET-1 and NO were significantly elevated in the aqueous humor of

patients with CCAG and POAG compared to the corresponding value in
patients with cataract (p < 0.001). ET-1 and NO concentrations in the aqueous
humor were more marked in CCAG than in POAG. NO levels were correlated
with ET-1 in the aqueous humor of patients with glaucoma (p < 0.001).
Conclusion: Increased concentrations of ET-1 and NO in aqueous humor may

be useful with POAG and CCAG. In addition, ET-1 and NO may have useful
metabolite levels in the aqueous humor of POAG and CCAG patients as a
result of glaucoma damage and may not be a cause of it.

133

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FREE PAPERS - RAPID FIRE

London - February 6-9, 2020

MID-TERM CLINICAL RESULTS OF AB INTERNO TRABECULOTOMY

Purpose: To evaluate mid-term clinical results of ab interno trabeculotomy

Methods: A retrospective chart review was performed on patients who

Results: Thirty-three eyes of 26 patients with 21 primary open angle glaucoma,

Conclusion: Additional surgeries were needed in some cases, however, in

London - February 6-9, 2020

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Purpose: To evaluate and compare the efficacy and safety of combined

Methods: Retrospective study evaluated the 12 months outcomes patients who

Conclusion: Patients with uncontrolled open angle glaucoma at 12 months

London - February 6-9, 2020

PREVALENCE OF ENDOPHTHALMITIS AFTER AQUEOUS SHUNT

Purpose: To investigate the rate of endophthalmitis, its microorganisms, risk

Conclusion: Endophthalmitis is a rare complication of tube surgery, its rate

London - February 6-9, 2020

COMBINED 25-GAUGE (25G) ENDOSCOPE-ASSISTED PARS PLANA

Purpose: To report the efficacy of a combined procedure utilizing 25G

Methods: This was a retrospective chart review of 19 patients (20 eyes)

Conclusion: The 25G endoscope-assisted pars plana AGV placement is safe

London - February 6-9, 2020

IMPACT OF PREOPERATIVE TOPICAL DIFLUPREDNATE ON

Purpose: To evaluate the effect of preoperative topical difluprednate on

Results: Of the 60 patients enrolled, 57 completed the protocol. Two in

Conclusion: Preoperative use of topical difluprednate is associated with

London - February 6-9, 2020

INTRACAMERAL BEVACIZUMAB VERSUS MITOMYCIN C AS

Purpose: To compare long-term results of adjunctive intracameral injection of

Methods: Prospective, randomized study of 100 eyes with primary open-angle

Results: Average baseline IOP and number of medications were similar

Conclusion: Intracameral administration of bevacizumab has similar long-term

London - February 6-9, 2020

London - February 6-9, 2020

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Purpose: To examine the long-term efficacy of the iStent micro shunt in

Design: Retrospective quality assurance chart review

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London - February 6-9, 2020

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HEMI-GONIOSCOPY-ASSISTED TRANSLUMINAL TRABECULOTOMY

Purpose: To describe a novel method of achieving intraocular pressure lowering

Methods: Hemi-GATT is performed in standard approach for 180 degrees.

Conclusion: The authors describe a novel technique that can be used in

London - February 6-9, 2020

USE OF THE SECOND FENTO LASER IN EYE SURGERY WITH

In recent years, the introduction of the Femtosecond laser sparked a small

Bio of the Author: Susana Perucho Martínez. Hospital Universitario de

London - February 6-9, 2020

TRAUMATIC GLAUCOMA WITH IRIDODIALYSIS

We present a patient with a traumatic glaucoma due to angle recession