Retinal oxygen saturation before and after glaucoma surgery

PURPOSE

This study compared retinal vessel oxygen saturation before and after glaucoma surgery.

METHODS

Retinal oxygen saturation in glaucoma patients was measured using a non-invasive spectrophotometric retinal oximeter. Adequate image quality was found in 49 of the 108 consecutive glaucoma patients recruited, with 30 undergoing trabeculectomy, 11 EX-PRESS and eight trabeculotomy. Retinal oxygen saturation measurements in the retinal arterioles and venules were performed at 1 day prior to and at approximately 10 days after surgery. Statistical analysis was performed using a Student's t-test.

RESULTS

After glaucoma surgery, intraocular pressure (IOP) decreased from 19.8 ± 7.7 mmHg to 9.0 ± 5.7 mmHg (p < 0.001). Although oxygen saturation in retinal arterioles remained unchanged before and after surgery (104.7 ± 10.6% before and 105.4 ± 9.3% after surgery, p = 0.58), the oxygen saturation in the venules increased from 54.9 ± 7.4% to 57.4 ± 5.7% (p = 0.01).

CONCLUSION

Intraocular pressure (IOP) decreases caused by glaucoma surgery had an effect on the retinal venous oxygen saturation.

Intermediate-term and long-term outcome of piggyback drainage: connecting glaucoma drainage device to a device in-situ for improved intraocular pressure control

IMPORTANCE

This study provides results of a treatment option for patients with failed primary glaucoma drainage device.

BACKGROUND

The study aimed to describe and evaluate the long-term intraocular pressure control and complications of a new technique joining a second glaucoma drainage device directly to an existing glaucoma drainage device termed 'piggyback drainage'.

DESIGN

This is a retrospective, interventional cohort study.

PARTICIPANTS

Eighteen eyes of 17 patients who underwent piggyback drainage between 2004 and 2013 inclusive have been studied. All patients had prior glaucoma drainage device with uncontrolled intraocular pressure.

METHODS

The piggyback technique involved suturing a Baerveldt (250 or 350 mm) or Molteno3 glaucoma drainage device to an unused scleral quadrant and connecting the silicone tube to the primary plate bleb.

MAIN OUTCOME MEASURES

Failure of intraocular pressure control defined as an intraocular pressure greater than 21 mmHg on maximal therapy on two separate occasions or further intervention to control intraocular pressure.

RESULTS

The intraocular pressure was controlled in seven eyes (39%) at last follow-up with a mean follow-up time of 74.2 months. The mean preoperative intraocular pressure was 27.1 mmHg (95% confidence interval 23.8-30.3) compared with 18.4 mmHg (95% confidence interval 13.9-22.8) at last follow-up. The mean time to failure was 57.1 months (95% confidence interval 32.2-82), and the mean time to further surgery was 72.3 months (95% confidence interval 49.9-94.7). Lower preoperative intraocular pressure was associated with longer duration of intraocular pressure control (P = 0.048). If the intraocular pressure was controlled over 2 years, it continued to be controlled over the long term. Two eyes (11%) experienced corneal decompensation.

CONCLUSIONS

Piggyback drainage represents a viable surgical alternative for the treatment of patients with severe glaucoma with failing primary glaucoma drainage device, particularly in those at high risk of corneal decompensation.

Evaluation of EX-PRESS glaucoma implant in elderly diabetic patients after 23G vitrectomy

PURPOSE

The most frequent qualifications for pars plana vitrectomy (PPV) in diabetic patients include recurrent hemorrhage into the vitreous body chamber and vitreoretinal proliferation, also with traction retinal detachment. The aim of this study was to evaluate the effectiveness of EX-PRESS implant for the treatment of secondary glaucoma in elderly diabetic patients following PPV 23G with silicon oil or SF6 gas endotamponade.

MATERIALS AND METHODS

This retrospective analysis comprised 18 patients (19 eyes). We applied EX-PRESS implants in 9 patients with neovascular glaucoma (NVG) and in 10 patients with non-NVG. All patients had earlier history of diabetes and vitrectomy 23G for diabetic complications. Intraocular pressure (IOP) was measured and compared before; 7 days; 1, 3, 6, and 12 months; and a year after the surgery.

RESULTS

Application of the implant exhibited a lowering effect on IOP. After 1 month, 53% of patients had IOP values beyond 22 mmHg, while 86% after 1 year.

CONCLUSION

The implant can be used to treat both NVG and non-NVG in diabetic patients following PPV.

α5β1-Integrin inhibitor (CLT-28643) effective in rabbit trabeculectomy model

PURPOSE

Glaucoma filtration surgery (GFS) fails due to fibrosis. The α5β1-integrin plays a pivotal role in fibrosis, angiogenesis and inflammation. This is the first experiment evaluating the prevention of fibrosis after GFS by a specific small molecule α5β1-integrin inhibitor (CLT-28643).

METHODS

Twenty-four rabbits received trabeculectomy on their right eyes. The rabbits were randomized into three groups of eight eyes each. CLT-28643 was given as a single subconjunctival injection intraoperatively to two of the right eye groups followed by postoperative vehicle eye drops (CLT+ group) or CLT-28643 eye drops 4 times daily (CLT++ group). A third group received mitomycin-C (MMC) intraoperatively (sponge application, 0.04%, 2 min) followed by vehicle eye drops postoperatively. The control-surgery group consisted of 12 left eyes having trabeculectomy with no adjunctive therapy. The remaining 12 left eyes formed the untreated group. Clinical assessment included intraocular pressure (IOP) measurement, slit-lamp examination (including bleb survival and morphology) and bleb photography. The rabbits were killed after four weeks for histology.

RESULTS

Both CLT-28643-treated groups showed significantly prolonged bleb survival, and better bleb score compared to the control-surgery group. At end of the study, most functioning blebs were found in the MMC group (MMC group 75%; CLT+ group 12.5%, CLT++ group 25%; CLT+ group 12.5%, control-surgery group 0%). CLT-28643 was non-toxic and well tolerated.

CONCLUSIONS

This rabbit GFS study indicates that inhibition of α5β1-integrin by the novel α5β1-integrin antagonist CLT-28643 significantly improved the outcome. The effect of a single intro-operative application of CLT-28643 seems to be inferior to 0.04% MMC.

Aqueous shunt implantation in glaucoma

Aqueous shunts or glaucoma drainage devices are increasingly utilized in the management of refractory glaucoma. The general design of the most commonly-used shunts is based on the principles of the Molteno implant: ie. a permanent sclerostomy (tube), a predetermined bleb area (plate) and diversion of aqueous humour to the equatorial region and away from the limbal subconjunctival space. These three factors make aqueous shunts more resistant to scarring as compared to trabeculectomy. The two most commonly used shunts are the Ahmed Glaucoma Valve, which contains a flow-restrictor, and the non-valved Baervedlt Glaucoma Implant. While the valved implants have a lower tendency to hypotony and related complications, the non-valved implants with larger, more-biocompatible end plate design, achieve lower intraocular pressures with less encapsulation. Non-valved implants require additional suturing techniques to prevent early hypotony and a number of these methods will be described. Although serious shunt-related infection is rare, corneal decompensation and diplopia are small but significant risks.

Clinical evaluation of a trabecular microbypass stent with phacoemulsification in patients with open-angle glaucoma and cataract

Purpose

To evaluate the safety and efficacy of the iStent trabecular microbypass stent in combination with cataract surgery in patients with open-angle glaucoma (OAG).

Methods

Retrospective, consecutive case series from October 2012 to December 2015 with no exclusion criteria. The series comprised of 350 eyes with OAG and cataract. Data were collected both preoperatively and postoperatively at day 1 week 1, months 1, 3, 6, 12, 18, and 24. Data included intraocular pressure (IOP), number of glaucoma medications, visual acuity, the incidence of postoperative IOP pressure spikes of greater than ≥15 mmHg at any time point, and need for additional surgery.

Results

The mean preoperative IOP was 19.13±6.34 mmHg. At 2 years postoperation, mean IOP was 15.17±3.53 mmHg (P<0.0001). The mean number of glaucoma medications was 1.19±1.00 preoperatively and 0.61±0.96 (P<0.0001) at 2 years postoperation. At 1 day postoperatively, 31 eyes (12.4%) experienced an IOP increase of 15 mmHg above their baseline IOP that responded to topical therapy. Two patients required additional tube shunt surgery.

Conclusion

The insertion of the iStent trabecular microbypass stent in combination with cataract surgery effectively lowers IOP in OAG patients. The magnitude of IOP reduction was more significant in patients with higher preoperative pressure. Medication use was also significantly reduced postoperatively. The safety profile appears favorable with a low rate of IOP spikes and only two eyes (<1%) requiring additional surgery.

The use of collagen matrix (Ologen) as a patch graft in glaucoma tube shunt surgery, a retrospective chart review

Purpose: To determine the safety and efficacy of collagen matrix as a patch graft in glaucoma drainage surgery. Collagen matrix grafts may be advantageous because they do not need to be harvested from human donors.

Methods: An institutional, retrospective review of 43 patients with at least 12 months follow-up status post-glaucoma drainage implant surgery were evaluated for signs of tube erosion after initial placement of collagen matrix patch graft.

Results: Forty-one of 43 eyes (95.3%) required no intervention for patch graft melting with tube erosion. Average time of follow-up was 32 months (range: 12-45). Two cases had tube erosion at 4 months and 26 months post-op requiring tube revision, which was successfully revised with conjunctiva (4 month erosion) and donor sclera (26 month erosion).

Conclusion:  Our results suggest that collagen matrix patch grafts may be used successfully as a patch graft in glaucoma tube shunt surgery, and may be advantageous because they do not have to be harvested from human donors. It is possible that exposure rates may be higher after longer follow-up and with larger numbers of patients. Further research is needed to compare Ologen to traditional graft materials to conclusively determine the safety and efficacy of collagen matrix as a novel patch graft material.

Innovative approaches to glaucoma management of Boston keratoprosthesis type 1

Glaucoma remains a prevalent disorder and visual limiting factor after Boston keratoprosthesis type 1 implantation. Patients with glaucoma have worse initial and late visual acuity outcomes after otherwise successful keratoprosthesis implantation. Management of glaucoma in the setting of a keratoprosthesis is challenging because of relatively rapid progression and an inability to accurately measure intraocular pressure (IOP). In addition, there are no standard guidelines for glaucoma surveillance and monitoring after keratoprosthesis surgery. This report provides a review of the current literature and offers innovative strategies that will overcome the challenges in managing glaucoma in the setting of a Boston keratoprosthesis type 1 implant. The topics that will be discussed in this section include alternative methods for IOP measurement, rationales and surgical techniques for a pars plana tube placement for glaucoma drainage device, effective medical and laser treatment, the risk for IOP elevations after YAG laser, and practical guides to glaucoma surveillance and monitoring.

Consensual ophthalmotonic reaction in Chinese patients following augmented trabeculectomy or ExPRESS shunt implantation

INTRODUCTION

Consensual ophthalmotonic reaction (COR) was first described in 1924. Studies following monocular application of glaucoma drops and laser trabeculoplasty showed a drop in fellow eye intraocular pressure (IOP). However, studies following monocular surgery showed heterogeneous results. The purpose of this study was to investigate the COR in Chinese patients who have received monocular filtration surgery.

METHODS

A noncomparative retrospective study of 65 eyes undergoing filtration surgery in Queen Mary Hospital was conducted. The IOP was obtained at baseline and postoperative days 1, 3, 7 and 14. Patient's age, sex, type of glaucoma and surgery, preoperative medications, postoperative bleb status, and number of interventions were tabulated. The postoperative IOP measurements over both eyes were obtained, and the readings were averaged to decrease the chances of extreme readings being a one-off event and allow for regression to the mean bias.

RESULTS

COR was observed in the unoperated fellow eye. The mean preoperative IOP and averaged postoperative IOP were 17.2 ± 5.2 mm Hg and 20.1 ± 8.9 mm Hg, respectively (P < 0.04). All medications were continued in the fellow eye or even stepped up. Twenty-three percent of patients demonstrated fellow eye IOP rise >30% from baseline, while none showed IOP drop >30% from baseline.

DISCUSSION

Following monocular penetrating filtration surgery, our Chinese population demonstrated a significant fellow eye IOP increase in the early postoperative period. We should bear in mind the influence of COR and take care to measure the fellow eye IOP following monocular surgery.

Ocular manifestations of Sturge-Weber syndrome: pathogenesis, diagnosis, and management

Sturge–Weber syndrome has been included in the group of phakomatoses that is characterized by hamartomas involving the brain, skin, and eyes. The characteristic facial port-wine stain, involving the first branch of the trigeminal nerve and the embryonic vasculature distribution in this area, leads to several ocular complications of the anterior segment and can involve the eyelids and conjunctiva. The posterior segment of the eyes is also affected with diffuse choroidal hemangiomas. However, the most frequent ocular comorbidity is glaucoma with a prevalence rate ranging from 30%–70%. Glaucoma is related to anterior chamber malformations, high episcleral venous pressure (EVP), and changes in ocular hemodynamics. Glaucoma can be diagnosed at birth, but the disease can also develop during childhood and in adults. The management of glaucoma in Sturge–Weber syndrome patients is particularly challenging because of early onset, frequently associated severe visual field impairment at the time of diagnosis, and unresponsiveness to standard treatment. Several surgical approaches have been proposed, but long-term prognosis for both intraocular pressure control and visual function remains unsatisfactory in these patients. Choroidal hemangiomas may also lead to visual impairment thorough exudative retinal detachment and macular edema. Treatment of exudative hemangioma complications is aimed at destructing the tumor or decreasing tumor leakage.

Evaluation of the Ex-PRESS(®) P-50 implant under scleral flap in combined cataract and glaucoma surgery

AIM

To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS(®) P-50 for combined cataract surgery and glaucoma.

METHODS

Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS(®) P-50 model placed under scleral flap was performed.

RESULTS

Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P<0.001). A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control (<21 mm Hg).

CONCLUSION

Combined surgery of phacoemulsification with ExPRESS(®) P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

Gold shunt for refractory advanced low-tension glaucoma with spared central acuity

The aim of this study is to report a case of gold shunt surgery for uncontrolled, low-tension glaucoma with good central vision, after having a previously failed trabeculectomy and tube shunt surgeries. The patient was receiving maximum medical glaucoma therapy of four different types with intraocular pressure of 17 mm Hg prior to gold shunt surgery. Five years later, intraocular pressure is well controlled in the low teens without the need for ocular medications, and glaucoma is stable following gold shunt surgery.

Starflo glaucoma implant: early experience in Hungary

AIM

To present the early experience with the implantation technique, safety and efficiency of STARflo device for open angle glaucoma (OAG).

METHODS

referring intra- and postoperative clinical experience with a series of seven cases in three glaucoma centers in Hungary.

RESULTS

No intraoperative complications were observed. Postoperative inflammatory signs disappeared rapidly. The mean IOP reduction was from 27.6 ± 5.0 mmHg to 18.9 ± 3.4 mmHg (32% reduction/ patient) at six months postoperatively.

CONCLUSION

STARflo implant was safe and (except for one case with neovascular glaucoma) effective in our cases. The learning curve for experienced anterior segment surgeons was short.

Impact of treatment strategies for open angle glaucoma on intraocular pressure: the RiGOR study

AIMS

The RiGOR study's primary outcome measure was a 15% reduction in intraocular pressure (IOP) for patients with open-angle glaucoma at 1 year.

METHODS

Patients received treatment according to the ophthalmologist's usual practice.

RESULTS

A higher proportion of patients in the incisional and other surgery group achieved a 15% reduction in IOP than in the laser surgery or additional medication groups (82, 57, and 57% respectively). In multivariate regression analyses, incisional surgery patients were 2.7-times as likely as patients treated with additional medication to achieve a 15% reduction in IOP (odds ratio: 2.67; 95% CI: 2.01-3.57).

CONCLUSION

Incisional and other surgical procedures are effective treatments. There were no differences in treatment response by race or ethnicity.

Quality of life and visual acuity outcomes in the Registry in Glaucoma Outcomes Research study

AIMS

The RiGOR study evaluated the association of treatment and patient-reported outcomes for open-angle glaucoma patients.

METHODS

The Glaucoma Symptom Scale (National Eye Institute-Visual Function Questionnaire (NEI-VFQ) and visual acuity (VA) were collected as quality of life measures.

RESULTS

The proportion of patients with improvement of at least two lines of vision was highest in the incisional surgery group (14.2% compared with 9.9% for laser surgery and 10.9% for additional medication).

CONCLUSION

No clinically relevant differences were seen in benefit for the laser surgery or incisional surgery groups compared with additional medications for the Glaucoma Symptom Scale or NEI-VFQ measures or subscales. Differences in quality of life by race need to be explored in further studies.

Practice patterns and treatment changes for open-angle glaucoma: the RiGOR study

AIMS

The RiGOR study provides a current picture of the types of glaucoma treatment over 12 months.

METHODS

Patients were identified and enrolled at the time of decision to proceed with laser surgery procedure or other procedure such as incisional surgery or drainage device implantation, or initiation of a new or additional course of therapy with medication for glaucoma treatment.

RESULTS

The most frequent type of treatments were prostaglandin analogues (60%) among patients with additional medication, selective laser trabeculoplasty (87%) among patients with laser surgery and trabeculectomy (57%) among patients with incisional surgery.

CONCLUSION

For 36% of patients, a treatment cascade involves two or more therapies over a year. This demonstrates the complex nature of open-angle glaucoma treatment.

Trabeculectomy versus canaloplasty (TVC study) in the treatment of patients with open-angle glaucoma: a prospective randomized clinical trial

Purpose

To compare the outcomes of canaloplasty and trabeculectomy in open‐angle glaucoma.

Methods

This prospective, randomized clinical trial included 62 patients who randomly received trabeculectomy (n = 32) or canaloplasty (n = 30) and were followed up prospectively for 2 years. Primary endpoint was complete (without medication) and qualified success (with or without medication) defined as an intraocular pressure (IOP) of ≤18 mmHg (definition 1) or IOP ≤21 mmHg and ≥20% IOP reduction (definition 2), IOP ≥5 mmHg, no vision loss and no further glaucoma surgery. Secondary endpoints were the absolute IOP reduction, visual acuity, medication, complications and second surgeries.

Results

Surgical treatment significantly reduced IOP in both groups (p < 0.001). Complete success was achieved in 74.2% and 39.1% (definition 1, p = 0.01), and 67.7% and 39.1% (definition 2, p = 0.04) after 2 years in the trabeculectomy and canaloplasty group, respectively. Mean absolute IOP reduction was 10.8 ± 6.9 mmHg in the trabeculectomy and 9.3 ± 5.7 mmHg in the canaloplasty group after 2 years (p = 0.47). Mean IOP was 11.5 ± 3.4 mmHg in the trabeculectomy and 14.4 ± 4.2 mmHg in the canaloplasty group after 2 years. Following trabeculectomy, complications were more frequent including hypotony (37.5%), choroidal detachment (12.5%) and elevated IOP (25.0%).

Conclusions

Trabeculectomy is associated with a stronger IOP reduction and less need for medication at the cost of a higher rate of complications. If target pressure is attainable by moderate IOP reduction, canaloplasty may be considered for its relative ease of postoperative care and lack of complications.

Evaluation of Adenovirus-Mediated Down-Regulation of Connective Tissue Growth Factor on Postoperative Wound Healing After Experimental Glaucoma Surgery

PURPOSE

This study was aimed to determine whether adenovirus-mediated down-regulation of connective tissue growth factor (CTGF) can modulate postoperative scarring in a rabbit receiving simplified glaucoma surgery.

METHODS

In vitro studies were performed using a replication-deficient recombinant adenovirus that transcribes a small interfering RNA (siRNA) specific to the CTGF gene under the control of the modified CMV promoter. Primary tenon cells from a New Zealand White rabbit were transduced with 10-100 plaque-forming units (pfu) per cell of the viral vector. Seventy-two hours later, CTGF expression was analyzed by Western blot analysis. In vivo studies were conducted using 10 New Zealand White rabbits, which underwent simplified glaucoma surgery and received a postoperative subconjunctival injection of 5 µl suspension of adenovirus carrying shRNA for CTGF (2 × 10(11) pfu/ml) in the right eye, and the same amount of null virus in the left eye. Eyes were enucleated 5 d after the surgery, and immunohistochemical and histological examinations of the surgical outcome were performed.

RESULTS

Western blot analysis showed that CTGF was depleted to less than 10% of its original level in cells transduced with the adenovirus expressing CTGF-specific siRNA. This demonstrates RNA interference (RNAi)-mediated CTGF inactivation in vitro. Immunohistochemical analysis also showed that CTGF was significantly depleted in eyes transduced with the adenovirus expressing CTGF siRNA. This demonstrates RNAi-mediated CTGF inactivation in vivo. In addition, less scar tissue was observed on histological evaluation in the transduced eyes, demonstrating that inhibition of CTGF expression can modulate the wound healing process after surgery.

CONCLUSIONS

Down-regulation of CTGF is effective in inhibiting postoperative scarring in vivo. This suggests that RNAi with CTGF siRNA may potentially pave the road for a novel therapeutic strategy to improve glaucoma surgery results.

Does the type of treatment have an influence on utility values in a glaucoma population?

PURPOSE

To assess the impact of glaucoma therapy on utility values in a glaucoma population.

METHODS

A cross-sectional study of consecutive glaucoma patients was conducted. Utility values were obtained using the time trade-off method. Visual function variables (visual acuity and mean deviation in the better eye) and sociodemographic and clinical characteristics (age, sex, race, educational level, type of glaucoma, current and past glaucoma treatments, and comorbidities) were also obtained for statistical analysis. We divided the patients into three groups: medical treatment (group 1), surgical treatment (group 2), and mixed surgical and medical treatment (group 3).

RESULTS

Mean age of the study population (n=225) was 65.7 years. After controlling for glaucoma stage (early, moderate, and advanced), the difference among the groups in mean utility values was not statistically significant. Number of medications per patient, type of medication, or type of surgical technique did not have an impact on the utility values.

CONCLUSION

Our findings suggest that the type of therapy did not affect the utility values in a glaucoma population.

One Year of Glaucoma Research in Review-2013 to 2014

PURPOSE

The purpose of this study was to provide the practicing clinical ophthalmologist with an update on relevant glaucoma literature published from 2013 to 2014.

DESIGN

This study is a literature review.

METHODS

The authors conducted a 1-year (October 1, 2013, to September 30, 2014) English-language glaucoma literature search on PubMed of articles containing "glaucoma" or "glaucomatous" with title/abstract as a filter. Medical subject headings filtered searching was not performed because of the newness of the reviewed material.

RESULTS

Literature search yielded 2314 articles, after which we excluded reviews and letters to the editor. We highlighted articles featuring new or updated approaches to the pathophysiology, diagnosis, or treatment of glaucoma and gave preference to human research.

CONCLUSIONS

This review features literature that is of interest to ophthalmologists in practice and also highlights studies that may provide insight on future developments applicable to clinical ophthalmology.

Outcome of surgical treatment of primary and secondary glaucoma in young children

PURPOSE

To describe a paediatric cohort surgically treated for primary or secondary glaucoma (PG/SG), with regard to incidences, visual outcome and control of intraocular pressure (IOP).

METHODS

All children (n = 29, 42 eyes in total) surgically treated for PG or SG at the age of 4 years or younger between January 2002 and December 2010 at Sahlgrenska University Hospital in Mölndal were retrospectively studied through medical records. Median follow-up time after initial surgery was 5.9 years (range 2.4-11.2 years).

RESULTS

The incidence of primary congenital glaucoma was 4.3 cases per 100 000 live births in the county of Västra Götaland. For glaucoma secondary to cataract surgery, the incidence was 13% with a median postoperative duration to diagnosis of glaucoma of 3.8 months (range 1.6 months to 4.3 years). Preoperative mean IOP was 31.5 (SD 8.1) mmHg, and mean IOP at last visit was 17.1 (SD 4.4) mmHg. For the entire cohort, 30% of the glaucoma eyes required more than two IOP-lowering surgical procedures during the study period. BCVA was ≥0.3 (decimal) in 45% of glaucomatous eyes at last follow-up with no statistically significant difference between PG and SG. Analysis of functional visual outcome, that is BCVA in the better eye, showed that 83% of all patients attained a BCVA of ≥0.5.

CONCLUSIONS

The incidences and outcome of surgically treated paediatric glaucoma were in accordance with previous studies. Chamber angle surgery, and if necessary, tube implantation without the use of antimetabolites, is a favourable approach leaving most sites needed for future glaucoma surgery unaffected.

A comparative study of a modified filtering trabeculotomy and conventional trabeculectomy

Purpose

The objective of the study reported here was to evaluate the outcome of a modified filtering trabeculotomy (FTO) without iridectomy in open-angle glaucoma compared with that of conventional trabeculectomy (trab).

Patients and methods

Thirty eyes of 30 patients who underwent modified FTO were prospectively followed for 1 year and were compared with 87 conventional trab patients (87 eyes), matched for age and preoperative intraocular pressure (IOP). The FTO procedure consisted of a deep sclerectomy and trabeculotomy preserving the trabeculo-Descemet membrane, without iridectomy. Main outcome measures were complete success (IOP <18 mmHg and >/=30% IOP reduction, without medication), IOP, visual acuity, medication, complications, and subsequent surgeries.

Results

In the conventional trab group, the median preoperative IOP was 23.0 mmHg (interquartile range 20.0–27.0) with 3.0 (2.0–3.0) medications, compared with 23.0 mmHg (20.0–27.0) and 3.0 (2.8–4.0) in the modified FTO group. Median postoperative IOP at 12 months was 12.0 mmHg (10.0–13.0) in the conventional trab and 11.0 mmHg (8.0–14.0) in the modified FTO group (P=0.3). The complete success rate at 1 year was 83.1% and 79.3% in the conventional trab group and modified FTO group, respectively (P=0.8). The complications hypotony (20.7%, 24.1%), choroidal detachment (2.3%, 10.3%), and bleb scarring (17.2%, 13.8%), were present in the conventional trab group and modified FTO group, respectively.

Conclusion

The outcomes of reduced IOP and medications in the FTO group were not different to those in the conventional trab group over 1 year, but some complications were more often seen with the modified FTO technique. The new filtration trabeculotomy, however, has the advantage of avoiding iridectomy, thus reducing the risk of cataract formation, and may result in the development of more favorable blebs by controlling the flow over two resistance levels.

Quality of life following glaucoma surgery: canaloplasty versus trabeculectomy

Purpose

To evaluate quality of life (QoL) with a new questionnaire after canaloplasty (CP) and trabeculectomy (TE).

Patients and methods

We assessed outcomes of surgery, rate of revision surgeries, patients’ mood, and influence of postoperative care on QoL, surgery interference with daily activities, and postsurgical complaints. Patients completed the QoL questionnaire 24 months after surgery.

Results

Patients who underwent CP (n=175) were compared to TE patients (n=152). In the CP group, 57% of patients expressed high satisfaction, while 41% of patients in the TE group said they were highly satisfied. The satisfaction difference was statistically significant (P=0.034). Significantly fewer second surgeries were needed after CP (8% CP versus 35% TE, P<0.001). Patients were more positive in the CP group (54% CP versus 37% TE, P<0.009). Stress related to postoperative care was lower in the CP group compared to the TE group (14% versus 46%). Difficulties with activities of daily living, such as reading, were much lower or even nonexistent after CP, and complaints like eye burning or stinging were significantly lower in the CP group.

Conclusions

Compared with TE, CP is associated with less QoL impairment and higher patient satisfaction after surgery. However, long-term data on intraocular pressure reduction after surgery are needed to confirm long-term patient satisfaction with this surgery.

Deep sclerectomy in normal-tension glaucoma with and without mitomycin-c

PURPOSE

To compare the outcome of deep sclerectomy (DS) with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG).

METHODS

We prospectively analysed the results of 37 eyes of 37 consecutive patients with NTG (age; mean ± SD; 64 ± 7 years) who underwent DS with a collagen implant. Patients were randomized to the MMC and non-MMC groups. Subconjunctival MMC (0.4 mg/ml for 3 min) was used intraoperatively in 15 of 37 eyes. We defined total success as 25% reduction in intraocular pressure (IOP) without medication. Follow-up time was 12 months.

RESULTS

The mean preoperative IOP was significantly reduced from 15.2 ± 2.8 mmHg to 9.3 ± 2.7 (p < 0.001) in the MMC group after 12-month follow-up and from 15.1 ± 2.9 mmHg to 11.8 ± 2.0 (p < 0.001) in the non-MMC group. At 12 months, the mean IOP was significantly lower in the MMC group (p = 0.003) compared with the non-MMC group. Total success was achieved in 10 of 15 eyes (67%) in MMC group and in nine of 22 eyes (41%) in non-MMC group (p = 0.12). The number of glaucoma medications was decreased from 2.2 ± 0.8 to 0.5 ± 1.2 in MMC group (p = 0.001) and from 2.6 ± 1.0 to 0.5 ± 0.7 in non-MMC group (p < 0.001). Goniopuncture was performed in seven eyes (47%) in the MMC group, compared with 16 eyes (73%) in the non-MMC group (p = 0.13). IOP < 10 mmHg was achieved in seven of 15 eyes in the MMC group and in two of 22 in the non-MMC group (p = 0.009). Complication rate was low, and no difference between groups was evident.

CONCLUSION

Deep sclerectomy seems to be effective and safe in reducing IOP in patients with NTG. Intraoperative use of MMC results in lower postoperative IOP 12-month postoperatively without increased rate of complications.