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Myopic Patient Encounters Failed Needling

  Channels: Glaucoma | Posted 2/20/2019

Dan Lindfield, BM, FRCOphth, presents a 46-year-old myopic patient (-14.00) with an IOP of 24 mm Hg on three agents who underwent combined phacoemulsification and XEN Gel Stent (Allergan) implantation. On day 1 the patient had a postoperative IOP of 4 mm Hg. At week 1 the IOP was 11 mm Hg, and at week 3 the IOP was 13 mm Hg. By week 6 the postoperative IOP was 24 mm Hg and could not be reduced with digital ocular compression. Due to the long axial length, it was difficult to achieve the 1-2-3 positioning recommended with the stent. The length in the anterior chamber was good, but the stent was short in the subconjunctival portion due to the longer intrascleral length of the patient’s globe. Needling was attempted, but aqueous flow could not be achieved due to the stent being completely stuck down. The patient had to progress to a trabeculectomy, which functioned well.

Myopia • Needling • Trabeculectomy • XEN

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