Patient Case #2: Inflammation management in a 73-year-old patient with routine cataract surgery with MIGS

EP: 1.Patient Case #1: Inflammation management in a 68-year-old patient following routine cataract surgery

EP: 2.Takeaway points from patient case #1

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EP: 3.Patient Case #2: Inflammation management in a 73-year-old patient with routine cataract surgery with MIGS

EP: 4.Takeaway points from patient case #2

Denise Visco, MD, MBA: Our second case discussion was the 73-year-old also presenting for routine cataract surgery. However, they also have primary open-angle glaucoma, and our candidate for [microinvasive] glaucoma surgery with their cataract surgery. Unfortunately, they also have epiretinal membranes, so vitreomacular traction is an issue for them. Small pupil dilating approximately to 4.5 mm to 5 mm. This patient also wants a toric lens for uncorrected distance vision. The cylinder correction is approximately 2 diopters against the rule. The initial impression of this case with our group had many challenges. We’re concerned with the vitreomacular traction that the patient is a high risk for CME [cystoid macular edema], we know we’re going to have additional manipulation in the eye with potentially a small pupil also having to perform the MIGS [microinvasive glaucoma surgery] procedure. And, the expectation for this patient with wanting a premium procedure is also elevated. We have a heightened challenge here in delivering a great experience for this individual. The most appropriate anti-inflammatory regimen for eyes at risk for CME, as agreed by the group, [is] that patients should be getting their drops 2 to 3 days preoperatively and nonsteroidals as part of that regimen. And a significant portion of the group also felt that topical steroids were appropriate for this patient.

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