Clear Lensectomy, Goniosynechiolysis and Hydrus Microstent in a Patient with Mixed Mechanism Glaucoma.

Abstract Purpose To report a case of a patient with mixed mechanism glaucoma and a clear lens who was successfully surgically treated with combination cataract extraction, goniosynechiolysis and the Hydrus stent. Observation A 59-year-old Afro-Latino woman with a history of mixed mechanism glaucoma. She was taking latanoprost OU QHS. Best corrected visual acuities were 20/25 OU. Her intraocular pressures were 18 mmHg OU. Anterior segment examination revealed pigment on the lens zonules, and intermittent peripheral anterior synechiae in the angle. Optic nerves revealed glaucomatous cupping OU. After discussion of the risks and benefits, she agreed to undergo combined lensectomy, goniosynechiolysis, and Hydrus stent to lower the intraocular pressure on less medical therapy. Her vision improved to 20/20 with a mean IOP in the right eye during the 6 months follow up period was 12 mmHg on no medication. Conclusion and Importance: Patients mixed mechanism glaucoma may benefit from earlier cataract extraction, goniosynechiolysis and Hydrus stent placement to lower intraocular pressure and reduce medication burden.