The new MIGS alternatives available on the market today, are continuously proving to be a very reliable tools to managing many cases throughout the spectrum of the many manifestations of glaucoma. Furthermore, when combining old technology with new, one can further grow the therapeutic reach of both technologies, than the original spectrum of disease that they are originally meant to treat. We present the case of a 32 years old lady with Harboyan syndrome, with an uncontrolled ocular

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... n and previous failed trabeculectomy and Ahmed valve, corneal scarring with low visibility of the structures in the anterior chamber, with anterior syn-echiae on superior angle. We decided to combine new and old technology to evaluate the anterior chamber structures and modify the classic approach to an unconventional XEN45 implant, which ended in a successful therapy for the patient, with an implant in place and intraocular pressure on target. The new MIGS alternatives available on the market today, are continuously proving to be a very reliable tools to managing many cases throughout the spectrum of the many manifestations of glaucoma. Furthermore, when combining old technology with new, one can further grow the therapeutic reach of both technologies, than the original spectrum of disease that they are originally meant to treat.