GLAUCOMA EWAP MARCH 2023 39 risk compared to standalone. In his experience, the added benefits outweigh the risk. Dr. Razeghinejad said to decrease the chance of complications and the cost, combining the MIGS procedures in one session seems to be a reasonable approach. “Because of the possibility of MIGS failure and the progressive nature of glaucoma and to avoid taking the patient back to the operating room for a filtering surgery, MIGS procedures may be combined in one session,” he said. A combined procedure may increase the chance of hyphema, which in most patients is temporary. Combining MIGS procedures that involve device implantations may hypothetically have some impact on the corneal endothelium, but we need more data, Dr. Razeghinejad said. Dr. Razeghinejad said it’s important that patients know that there is no evidence-based data on the safety and efficacy of combined MIGS, and insurance may not cover the combined MIGS. Dr. Razeghinejad added that combining MIGS does not seem to increase the chance for endophthalmitis, as the rate of endophthalmitis following MIGS has been similar to phacoemulsification. Combining MIGS with cyclodestructive procedures increases the risk of postoperative inflammation and cystoid macular edema, which could be managed with topical steroid therapy and NSAIDs in most patients, he said. EWAP Editors’ note: Dr. Murphy is Adjunct Clinical Instructor, Yale New Haven Hospital, New Haven, Connecticut, and has interests with Nova Eye Medical and Sight Sciences. Dr. Razeghinejad is Director, Glaucoma Fellowship Program, Wills Eye Hospital, Philadelphia, Pennsylvania, and declared no relevant financial interests. coverage. Eventually, she was more aggressive with treatment for this patient and added topical ganciclovir, as well as amniotic dehydrated membrane and acyclovir ointment. Two months later, she was able to get the patient back to a baseline of 20/50 vision. Dr. Chan said for the first time in history, there is an mRNA vaccine that delivers specific genetic information to host cells to produce foreign proteins, which leads to the immune system being upregulated. Inflammatory events have been reported with all of the different COVID-19 vaccines. There are still unknowns about the mechanism of action of these vaccines, she said, so it’s important for physicians to pay attention when asking patients about any inflammatory reactions and acknowledge when the last COVID-19 vaccine was. “I have counseled patients Slit lamp photo of same patient with inactive herpetic disease but extensive advancement of whorl pattern of “late” fluorescein staining, indicating progression of limbal stem cell deficiency. Source (all): Clara Chan, MD about the signs and symptoms of ocular inflammation,” she said. She recommends transplant patients get the COVID-19 vaccine series prior to their transplant and recommends a baseline prophylaxis dose in high-risk grafts. EWAP Editors’ note: Dr. Chan is Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada. She has interests with Johnson & Johnson Vision, Novartis, and Santen. Dr. Jeng is Professor and Chair, Department of Ophthalmology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. He has interests with GSK, Oyster Point Pharma, and Santen. Affect the cornea - from page 16
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