 Good morning, can you guys hear me here? Thank you for having me, it's an honor to be here. My name is Tana Ferguson, I'm a fourth year medical student from the University of South Dakota. And please note that I've slightly modified my title to off-labeled uses of the trabecular micro-bipastent in glaucoma, because I feel like it's a better descriptor of what I'm going to present today. I do not personally have any financial disclosures, but please note that Dr. Burdall is a speaker and consultant for Glaucos. So the purpose or goal of today's presentation is to present some research we've done that's evaluated various uses of the ice stent in glaucoma patients, and more specifically, some three off-label uses. So the first thing we'll talk about is the ice stent as a sole procedure in pseudophagic primary open-angle glaucoma eyes, one stem plus cataract in pseudo-exfoliation glaucoma, and the ice stent plus cataract in severe primary open-angle glaucoma. And just a quick review of the ice stent, it's a tiny L-shaped stent that serves as a patent bypass to the travecular meshwork to the Schlemz Canal, and it was approved initially by the FDA in 2012, and its indication is for use in mild to moderate primary opening glaucoma with cataract surgery, and in this population, the safety and efficacy has been well established, and it's an attractive option for surgeons because it preserves the conjectiva and leaves open the option for more aggressive or future surgery down the road. These are just our general methods. I will make note where there are differences in each of the papers. So we did a retrospective case series. We did not utilize any strict inclusion criteria such as IOP greater than 18 at baseline, or patients had to be on two-plus medications. Data was collected at baseline, typically one to two weeks before the procedure, and then we also collected data from the following time points, one day, one week, one month, all the way out to 24 months and then to 36 months in some of the papers, and all procedures were performed by one surgeon, Dr. Burrell. The primary outcome measures we looked at were intraocular pressure, number of medications, and visual acuity. I should note that for a number of medications, combination meds such as COSOP or COM again were reported as two meds. To establish a safety profile, we looked at the incidence of IOP spikes greater than 15 at any time point after surgery. We also noted any complications, and we also looked at the need for additional or secondary surgeries. Dr. Burrell's surgical approach is fairly standard. He does not use myocallar myostat. He uses a cohesive physical elastic. They received a Trimoxy injection concurrent with the procedure, and then were on topical NSAIDs for one month. And glaucoma meds are removed at or after one week if the IOP was deemed acceptable by the clinician. And then postoperative medical therapy was escalated if there was visual field changes or nerve fiber loss on OCT, or the clinician had judgment that the IOP would cause either of these parameters to progress. So the first study I'll talk about is the ICEN as a sole procedure in pseudophagic eyes with opening olgocoma. This was initially presented at the 2014 ASCRS and was published in journal glaucoma last year. It includes 60 pseudophagic eyes. The mean age was around 80, 36 female, 24 male, and 51 out of 60 eyes were moderate to severe primary opening olgocoma. The safety profile in this study, 10% of eyes experience an IOP spike greater than 15 with most of these occurring within the first week after surgery. We did not note any interoperative or postoperative complications. And six eyes did go on to have secondary surgery. Three were treated with Ahmed Tushan and three with Katie Beak Oniatomy. But all these secondary surgeries occurred more than two years after the initial procedure. So this graph illustrates the mean intraocular pressure in medications at each time point. On the far left, you'll notice is the y-axis for intraocular pressure and the far right is number of medications. So at baseline, the mean IOP was 20.32 and mean number of medications was 2.19. At 12 months, the mean IOP was reduced by greater than four millimeters in mercury and this reduction was sustained two years after surgery. And we noticed a similar trend with medication use. So in this paper, we saw sustained IOP reduction of 5.38 at 24 months to decrease dependence on drops with a 25% reduction at 24 months. We did not note any interoperative complications and six eyes did go on to require secondary procedures. Were those six eyes excluded from that graph? Yes. So actually since they were included up until the secondary procedure occurred. So in this case, they all were still included because the secondary procedures occurred more than two years after surgery. So the next paper I'll talk about is the stent with cataract surgery and pseudo exfoliation glaucoma. This was published in the June, JCRS this year. It included 115 eyes with mild to severe pseudo exfoliation and planted with one stent during cataract surgery. I was primarily female and the average age was 77.42. The safety profile on this paper, no significant adverse events. The IOP spike was low with only 6% experience in IOP spike greater than 15. And once again, almost all these occurred within the first week after surgery. And one patient did go on to require or undergo secondary surgery, which was a KDB, Goniotomy plus ECP three years after surgery. So here's that graph again, the mean IOP and medication use at each time point. At baseline, the mean IOP is 20 and meds are 1.41. Two years after surgery, the mean IOP was reduced by more than five and a half or approximately five and a half and medications were reduced by 50%. And this graph, I included it for this paper. It shows the postoperative IOP reduction based on preoperative IOP. So to the far left, that's the mean IOP reduction based on their last collected followup. And then so you'll note that with patients with preoperative IOP 16 to 18 the mean IOP reduction at the last followup was 3.56 in patients with preoperative IOP 22 to 24, the IOP reduction was more than double what was seen in 16 to 18. And this graded IOP response is similar to what has been shown with FACO as well. So to conclude in this population, we saw an IOP reduction of 5.49 at two years post-op. Medications were reduced by 50% and higher preoperative IOPs were assorted with a greater IOP reduction. For example, in patients with IOPs of 22 to 24 at baseline, the mean IOP reduction was 7.63. And in this population, we had an excellent safety profile, only one eye went on to undergo secondary surgery and there was a low rate of IOP spikes. So the last paper I'll talk about is the eye stent with cataract surgery and severe primary opening olgocoma. This included 97 eyes with severe primary opening olgocoma. Stage of disease was defined as optic nerve changes consistent with glaucoma and visual field changes that in this criteria was consistent with the AAL preferred practice pattern guidelines. It was a pretty even split for gender 47 female and 50 male and the average age was 74.76. For safety profile, we did not note any intraoperative or postoperative complications. Seven eyes did experience IOP spikes, which all occurred within the first week after surgery. And six eyes did undergo secondary surgery. One was three months after surgery and the rest all occurred more than two years after surgery. So once again, this is the mean IOP and number of medications at each time point at baseline. Patients were on two meds and the mean IOP was 19.67. At 12 months, the IOP was reduced to 14.13 and medications were reduced to 1.23 or like a 40% reduction. And this reduction was sustained out to two years after surgery. And for this paper, we did a three year consistent cohort for eyes that had 36 month data available to statistically compare them. So you'll note that at three years after surgery, the IOP reduction was sustained with more than a four millimeter reduction pressure. So to conclude in this paper, we saw sustained IOP reduction to 36 months, a 31% reduction in medication use at 24 months. In this paper, 90% of eyes that had preoperative IOP greater than 19 or 19 or greater had an pressure reduction at their last collected followup. And six eyes did go on to require additional surgery and there was a low rate of IOP spikes. So to conclude, the eye stents been well-established to be safe and effective in patients with mild and moderate primary opening of glaucoma in combination with cataract surgery. And these studies suggest that it's also a safe and effective option for patients with pseudo-exfoliation glaucoma and severe primary opening of glaucoma and as a sole procedure in pseudo-pagic guise. Thank you. Any questions? I think it's my understanding that it was a case by case basis. So in some cases, they were able to get them approved. I think more so early on, especially in the pseudo-pagic guise. But I can ask that and get back to you for that. And then in terms of this technique, did he do anything specific during this? It's just convenient. He doesn't do any targeting techniques like try and target blanching vessels or anything like that. Yes. It's interesting to see the response with the exfoliation patients with the combination of the stent and the cataract surgery would be interesting is to see if you have a cohort of patients who just had cataract surgery but were otherwise similarly matched to try to tease out what the effect of the cataract surgery itself was compared to cataract surgery and the stent. And that would be interesting if you've got the data to do that to compare those two. Yeah. We don't have any data for just cataract surgery and pseudo-exfoliation glaucoma. I'm sure I could retrieve it. We do have some data with just pseudo-pagic guise and pseudo-exfoliation glaucoma that were treated with a nice stent. So that could be a way of seeing the responses for just a stent. Any other questions? Thank you.