Recovering Vision After Postoperative Challenges with James Murphy, MD

At the 2025 New York State Ophthalmological Society (NYSOS) Annual Meeting, James T. Murphy, MD, Scarsdale Ophthalmology Associates PLLC, presented a surgical video demonstrating his response to postoperative complications in a patient with dense cataract and pseudoexfoliation glaucoma.

The initial surgery included capsular stabilization using Ahmed segments, capsular tension ring, iris/capsular hooks, and 6-0 Prolene flange scleral fixation to secure the IOL-capsular complex. A minimally invasive glaucoma surgery (MIGS) combining canaloplasty and goniotomy was performed in accordance with the earlier generation iTrack procedure. Notably, Murphy decided to thread the 6-0 Prolene flanges posterior-to-anterior rather than the standard anterior-to-posterior to ensure that the capsular bag was stabilized to the anterior.

“The complication was that I decided to thread [the 6-0 Prolene flanges] from a posterior to anterior direction, as opposed to an anterior to posterior direction, just to make sure that the lens and the capsular bag were stabilized as anterior as possible, so that it didn’t have a hyperoptic refractive surprise,” Murphy told HCPLive. “The vision did great, she was 20/20 post op day 2 or 3.”

However, roughly a month later, the patient exhibited persistent anterior chamber inflammation; upon examination, Murphy found that the temporal flange was causing iris chafing from the posterior side. While a secondary surgery could have been attempted, Murphy instead performed a laser iridotomy over the area of iris transillumination, allowing the flange bulb to recess without further issue. Murphy indicated that the patient has had no loss of vision in 2 years since the procedure.

Looking ahead, Murphy expressed enthusiasm for emerging MIGS technologies, particularly the ELIOS excimer laser trabeculotomy system, now under Bausch & Lomb. Murphy also hopes for broader adoption of such devices by comprehensive ophthalmologists, allowing glaucoma specialists to focus on advanced disease. He emphasized the growing role of comprehensive surgeons in glaucoma care, advocating for earlier surgical intervention—even in mild cases—via MIGS, whether combined with cataract surgery or as standalone treatments.

“In a lot of ways, I almost want to encourage comprehensive ophthalmologists to take up the fight against glaucoma,” Murphy said. “And don’t ignore that mild glaucoma in one or two eye drops like that.”

References

1. Murphy, JT. Precision Vision Outcome Despite Capsule Complications and Flange Flops. Presented at the 2025 New York Ophthalmological Society Annual Meeting, May 16, 2025. New York, NY.