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Chan W, Zhang C, Mittal A, Fink A, Michalovic S, Weiner A. Effect of Preoperative Trabecular Meshwork Pigmentation and Other Eye Characteristics on Outcomes of Combined Phacoemulsification/Minimally Invasive Glaucoma Surgery. Ophthalmol Glaucoma 2024; 7:271-281. [PMID: 38185378 DOI: 10.1016/j.ogla.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To investigate associations between pigmentation of the trabecular meshwork (PTM) and other preoperative eye characteristics and outcomes of minimally invasive glaucoma surgery combined with phacoemulsification (Phaco/MIGS). DESIGN Retrospective interventional case series. PARTICIPANTS Academic glaucoma clinic patients with symptomatic cataract and glaucoma treated with combined Phaco/MIGS. METHODS Analyzing preoperative PTM, intraocular pressure (IOP), IOP-lowering medications and visual acuity (VA) data in relation to Phaco/MIGS outcomes. MAIN OUTCOME MEASURES Pigmentation of the trabecular meshwork and other preoperative eye characteristics in relation to Phaco/MIGS success defined as postoperative IOP between 5 and 21 mmHg and IOP reduction of ≥ 20% and/or a reduction of ≥ 1 IOP-medications compared to baseline, and final IOP, IOP-lowering medications and VA. RESULTS A total of 265 eyes (172 patients, mean age, 73.5 [standard deviation, 10.0], range 35-95 years, male 40.0%) were identified and categorized with high PTM (108 eyes, 40.8%) or low PTM (157 eyes, 59.2%). The high PTM group, compared with the low PTM group, demonstrated higher preoperative IOP (16.7 [standard error 0.4] vs. 15.2 [0.4] mmHg, P = 0.009), included more eyes with primary open-angle glaucoma (POAG, P = 0.03), fewer eyes with normal-tension glaucoma (NTG, P = 0.01), and fewer eyes with mild stage glaucoma (P = 0.001). Compared to baseline, final IOP decreased by 6.5 [2.4]% and 13.4 [3.0]% (P = 0.075) to 13.5 [0.3] mmHg and 13.6 [0.4] mmHg (P = 0.77) in the low and high PTM groups, respectively, and IOP-lowering medications decreased by 34.6 [4.9]% (n = 116) and 18.1 [7.3]% (n = 85), respectively (P = 0.062). Surgical success was 59.9% and 58.3%, respectively (P = 0.87). It was positively associated with higher preoperative IOP (hazard ratio 1.08 [95% confidence interval 1.04-1.12] P < 0.0001) and higher number of preoperative IOP-medications (1.20 [1.05-1.37] P = 0.007), negatively associated with history of selective laser trabeculoplasty (SLT, 0.40 [0.23-0.68] P = 0.0009) and longer axial length (0.87 [0.80-0.94], P = 0.0006), but was not associated with PTM. CONCLUSIONS Higher PTM was associated with POAG rather than NTG, with more severe glaucoma and higher preoperative IOP, but not with Phaco/MIGS success. Surgical success was positively associated with higher preoperative IOP and number of IOP-medications and negatively associated with history of SLT and longer axial length. These findings may help guide glaucoma surgeons in surgical planning and patient counseling. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Weilin Chan
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Charles Zhang
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Abhiniti Mittal
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Andrew Fink
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Sharon Michalovic
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Asher Weiner
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York.
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Okada N, Hirooka K, Onoe H, Tokumo K, Okumichi H, Kiuchi Y. A Retrospective Study of Risk Factors Affecting Long-Term Outcomes Following Ab Interno Trabeculotomy and Goniotomy Concomitant with Phacoemulsification. Clin Ophthalmol 2023; 17:3563-3568. [PMID: 38026588 PMCID: PMC10676688 DOI: 10.2147/opth.s436594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To examine the potential risk factors affecting the long-term outcomes following a combination of phacoemulsification with ab interno trabeculotomy with the microhook (μLOT-Phaco) and goniotomy with the Kahook Dual Blade (KDB-Phaco). Methods For 12 months, we retrospectively examined a total of 100 eyes of 100 patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG) who had previously undergone surgery between December 2016 and December 2020. Patients with a preoperative intraocular pressure (IOP) ˂12 mmHg were excluded. Probability of success was calculated using the Kaplan-Meier method, with surgical failure defined as an IOP >18 mmHg, <20% IOP reduction or additional glaucoma surgery. The Cox proportional hazards model was used to examine the potential risk factors for failure, which included age, gender, type of glaucoma, surgical techniques, preoperative IOP, number and type of preoperative IOP-lowering medications, preoperative visual field mean deviation (MD) value, and axial length. Results For the 51 males and 49 females, mean preoperative age was 74.4 ± 9.0 years, with μLOT-Phaco performed in 44 and KDB-Phaco in 56 subjects. The type of glaucoma was POAG in 68 and EG in 32 eyes. Preoperative IOP was 20.5 ± 6.7 mmHg, while postoperative IOPs were 14.4 ± 4.2 mmHg, 13.7 ± 2.8 mmHg, and 14.6 ± 3.9 mmHg, respectively (P < 0.001). Significant decreases from the preoperative number of IOP-lowering medications (3.1 ± 1.2) were observed at 12, 24, and 36 months, respectively (1.2 ± 1.3, 1.6 ± 1.3, and 2.1 ± 1.4 (P < 0.001)). Probability of success at 12, 24, and 36 months postoperatively was 52.0%, 49.6%, and 47.7%, respectively. Lower preoperative IOP was shown to be a potential risk factor for surgical failure. Conclusion Long-term follow-ups showed IOP decreased in μLOT-Phaco and KDB-Phaco patients. Results suggest that patients with higher preoperative IOP may have better postoperative outcomes.
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Affiliation(s)
- Naoki Okada
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
| | - Hiromitsu Onoe
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
| | - Kana Tokumo
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
- Hiroshima Eye Clinic, Hiroshima, Japan
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Chan PPM, Larson MD, Dickerson JE, Mercieca K, Koh VTC, Lim R, Leung EHY, Samuelson TW, Larsen CL, Harvey A, Töteberg-Harms M, Meier-Gibbons F, Shu-Wen Chan N, Sy JB, Mansouri K, Zhang X, Lam DSC. Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges. Asia Pac J Ophthalmol (Phila) 2023; 12:537-564. [PMID: 38079242 DOI: 10.1097/apo.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.
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Affiliation(s)
- Poemen P M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, USA
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Enne Hiu Ying Leung
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Thomas W Samuelson
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | - Christine L Larsen
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | | | - Marc Töteberg-Harms
- Department of Ophthalmology, Augusta University, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Jessica Belle Sy
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Baguio General Hospital and Medical Center, Baguil City, Benguet, Philippines
| | - Kaweh Mansouri
- Glaucoma Center, Swiss Visio, Clinique de Montchoisi, Lausanne, Switzerland
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Dennis S C Lam
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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Garweg RA, Pfister IB, Schild C, Halberstadt M, Straessle K, Anastasi S, Garweg JG. IOP-lowering and drug-sparing effects of trabectome surgery with or without cyclodialysis ab interno. Graefes Arch Clin Exp Ophthalmol 2023; 261:2917-2925. [PMID: 37145333 DOI: 10.1007/s00417-023-06063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE To compare the postoperative intraocular pressure (IOP) after ab interno trabeculectomy (AIT; trabectome surgery) alone or combined with cyclodialysis ab interno (AITC). PATIENTS AND METHODS Forty-three eyes with insufficiently controlled open-angle glaucoma were included in this consecutive case series. All eyes received AIT, combined with phacoemulsification and IOL-implantation in phakic instances, with or without additional cyclodialysis ab interno. Postoperative visual acuity, IOP, number of IOP-lowering medications and complications were registered over 12 months. RESULTS A total of 19 eyes (14 patients) received AIT and 24 (19 patients) received AITC. Both groups were comparable for baseline IOP (AIT: 19.7 ± 8.2 mmHg; AITC: 19.4 ± 6.8 mmHg; p = 0.96), there was a comparable IOP reduction after 6 months (AIT: - 3.8 ± 12.3, median (interquartile range (IQR)): - 3.8 (- 7.8-4.8) mmHg; AITC: - 4.9 ± 8.3, median (IQR): - 2.0 (- 10.8-2.0) mmHg; p = 0.95) and 12 months (AIT: - 4.3 ± 6.6, median (IQR): - 4.0 (- 8.0 to - 1.0) mmHg; AITC: - 3.7 ± 6.7, median (IQR): - 1.5 (- 5.5 to - 0.5) mmHg; p = 0.49). While final visual acuity was similar between the groups, they differed regarding topical IOP-lowering medications (baseline: AIT 2.9 ± 1.2 and AITC 2.9 ± 1.2; 1 year after surgery: AIT 2.6 ± 1.5 (p = 0.16) and AITC 1.3 ± 1.3; p < 0.001)). Depending on the definition, a complete or qualified success of 33.4-45.8% was achieved in AITC compared to 15.8-21.1% in AIT. CONCLUSION The additional suprachoroidal outflow when AIT is combined with cyclodialysis ab interno (AITC) seems to result in an additional drug sparing effect for at least 1 year without critical safety signals. Thus, AITC might be further investigated prospectively prior to advocating its use in routine minimally invasive glaucoma surgery.
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Affiliation(s)
- Richard A Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Department of Ophthalmology, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Christin Schild
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | | | - Kim Straessle
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Stefano Anastasi
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Justus G Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland.
- Swiss Eye Institute, Rotkreuz, Switzerland.
- Department of Ophthalmology, University of Bern, Bern, Switzerland.
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Weber C, Ludwig E, Hundertmark S, Brinkmann CK, Petrak M, Holz FG, Mercieca K. Five-Year Clinical Outcomes of Inferior Quadrant Trabectome Surgery for Open Angle Glaucoma. J Glaucoma 2023; 32:480-488. [PMID: 36930581 DOI: 10.1097/ijg.0000000000002164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/08/2022] [Indexed: 03/18/2023]
Abstract
PRCIS This retrospective study of 264 eyes having inferior quadrant trabectome surgery confirms its safety and relative effectiveness. Most patients however still require IOP-lowering agents, and a considerable proportion may need additional glaucoma surgery. PURPOSE To report outcomes from a large single-center cohort of inferiorly-applied trabectome surgery. PATIENTS AND METHODS Retrospective review of patients undergoing trabectome surgery for chronic open angle glaucoma (COAG) at the University Eye Clinic Bonn, Germany, from 2012 to 2020. RESULTS Two hundred sixty-four eyes of 206 patients with COAG were included. The mean review period was 45.43 (range 12-101) months. One hundred five eyes (39.8%) underwent standalone surgery, of which 74 were pseudophakic and 31 phakic. The mean preoperative IOP was 17.58 mm Hg (range 12-50 mm Hg). One hundred five eyes (39.8%) developed a 'failure event' according to pre-defined criteria at a mean interval of 14.8 months postoperative. In absolute terms, 211 patients (79.9%) had a long-term IOP >14 mm Hg at 7.6 months, 174 patients (65.9%) >16 mm Hg at 10.6 months, 127 patients (48.1%) >18 mm Hg at 10.9 months, and 77 patients (29.2%) >21 mm Hg at 11.1 months. Over a five-year period, overall mean IOP remained stable at 13 mm Hg. The majority of patients were still on glaucoma drops (the mean number reduced from 2.9 to 2.7 agents). Subgroup analyses showed that a higher preoperative IOP was a positive predictor for failure, whereas combined surgery (with phaco) had better IOP outcomes (16.5 mm Hg vs. 19.3 mm Hg, respectively). Forty-one patients (15.5%) developed minor complications: 22 had high postoperative IOP within 3 months, 11 developed a self-resorbing hyphema, and 6 had fibrinous uveitis. CONCLUSIONS Trabectome surgery is a safe and relatively effective procedure for lowering IOP, but most patients still need IOP-lowering agents, and a considerable proportion may need additional glaucoma surgery within a relatively short time. Inferior quadrant treatment may result in inferior IOP outcomes when compared with nasal quadrant surgery.
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Affiliation(s)
| | | | | | - Christian Karl Brinkmann
- Department of Ophthalmology, University of Bonn, Bonn
- Department of Ophthalmology, Dietrich-Bonhoeffer Hospital, Neubrandenburg, Germany
| | | | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn
| | - Karl Mercieca
- Department of Ophthalmology, University of Bonn, Bonn
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Kitamura K, Fukuda Y, Hasebe Y, Matsubara M, Kashiwagi K. Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients. J Clin Med 2023; 12:2332. [PMID: 36983331 PMCID: PMC10055689 DOI: 10.3390/jcm12062332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The evaluation of ab interno trabeculectomy, referred to as trabectome®, among Japanese patients is insufficient. SUBJECTS AND METHODS Japanese patients who underwent trabectome® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. RESULTS A total of 250 eyes from 197 patients were enrolled. The trabectome® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with the success rate. The trabectome® alone did not show a significant reduction in corneal endothelial cells. Eyes with postoperative transient IOP elevation and removal of anterior chamber hemorrhage were 11.2% and 1.2%, respectively. Twenty-four eyes (9.6%) underwent additional glaucoma surgeries. CONCLUSIONS The trabectome® could be considered an effective and safe surgery. Compared to trabectome® alone, combined cataract surgery was superior in lowering IOP and reducing glaucoma medications.
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Affiliation(s)
| | | | | | | | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Japan
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Long-Term Clinical Results of Trabectome Surgery in Turkish Patients with Primary Open Angle Glaucoma and Pseudoexfoliative Glaucoma. BEYOGLU EYE JOURNAL 2023; 8:14-20. [PMID: 36911215 PMCID: PMC9993416 DOI: 10.14744/bej.2023.13540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 02/23/2023]
Abstract
Objectives The objectives of the study were to analyze the long-term results of trabectome surgery in Turkish patients with primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) and to characterize the risk factors for failure. Methods This single-center retrospective non-comparative study included 60 eyes of 51 patients diagnosed with POAG and PEXG, who underwent trabectome alone or phacotrabeculectomy (TP) surgery between 2012 and 2016. Surgical success was defined as a 20% decrease in intraocular pressure (IOP) or IOP≤21 mmHg and no further glaucoma surgery. Risk factors for further surgery were analyzed with the Cox proportional hazard ratio (HR) models. The cumulative success analysis was undertaken with the Kaplan-Meier method based on the time to further glaucoma surgery. Results The mean follow-up period was 59.4±14.3 months. During the follow-up period, 12 eyes required additional glaucoma surgery. The mean pre-operative IOP was 26.9±6.8 mmHg. The mean IOP at the last visit was 18.8±4.7 mmHg (p<0.01). IOP decreased 30.1% from the baseline to the last visit. The average number of antiglaucomatous drug molecules used was 3.4±0.7 (range 1-4) preoperatively and 2.5±1.3 (range 0-4) at the last visit (p<0.01). The risk factors for further surgery requirement were determined as a higher baseline IOP value (HR: 1.11, p=0.03] and the use of a higher number of preoperative antiglaucomatous drug molecules (HR: 2.54, p=0.09). The cumulative probability of success was calculated as 94.6%, 90.1%, 85.7%, 82.1%, and 78.6% at three, 12, 24, 36, and 60 months, respectively. Conclusion The success rate of trabectome was 67.3% at 59 months. A higher baseline IOP value and the use of a higher number of antiglaucomatous drug molecules were associated with an increased risk of further glaucoma surgery requirement.
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Novytskyy IY, Novytskyy MI. Efficacy of Endotrabeculectomy (Trabecula Ablation Ab Interno with the Forceps) for Open-angle Glaucoma. J Curr Glaucoma Pract 2023; 17:15-21. [PMID: 37228311 PMCID: PMC10203332 DOI: 10.5005/jp-journals-10078-1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 08/25/2022] [Indexed: 05/27/2023] Open
Abstract
Aim To investigate the efficacy of endotrabeculectomy (ETE) performed either alone or combined with phacoemulsification (phaco) in patients with primary open-angle glaucoma (POAG). Materials and methods Investigations were done in two groups. The first group (38 patients, 38 eyes) with POAG underwent ETE, and the second group of 126 patients (126 eyes) with POAG and cataracts underwent ETE and phaco. The hypotensive effect of the surgery was evaluated. Results In the ETE group, the mean intraocular pressure (IOP) was reduced from 20.25 ± 3.30 to 14.94 ± 1.95 mm Hg (26.2% reduction, p < 0.001) at 12 months. The number of medications was reduced from 2.8 ± 1.0 to 1.5 ± 1.0 (p < 0.001) at 12 months after the surgery. In the phaco-ETE group, the mean IOP was reduced from 18.24 ± 3.20 to 14.83 ± 1.71 mm Hg (18.7% reduction, p < 0.001) at 12 months. The mean number of medications was reduced from 2.2 ± 1.1 to 1.0 ± 1.0 (p < 0.001) at 12 months after the surgery. The success rate defined as a final IOP of <16 mm Hg using the Kaplan-Meier curve at 12 months was 73.8%. There were no complications that led to a constant visual decrease. Clinical significance Our study shows that ETE is technically simple, gives the ability to remove trabecula in any quadrant, and effectively reduces IOP in patients with POAG. Conclusion Endotrabeculectomy (ETE) is a safe and relatively simple procedure that significantly reduces IOP. The minimally invasive nature of the ETE allows expanding indications for combined treatment of glaucoma and cataract. How to cite this article Novytskyy IY, Novytskyy MI. Efficacy of Endotrabeculectomy (Trabecula Ablation Ab Interno with the Forceps) for Open-angle Glaucoma. J Curr Glaucoma Pract 2023;17(1):15-21.
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Affiliation(s)
- Ihor Y Novytskyy
- Department of Ophthalmology, Danylo Halytsky Lviv National Medical University (LNMU), Lviv, Lviv reg, Ukraine
| | - Markiyan I Novytskyy
- Medical Center “Microsurgery of the Eye”, Communal Municipal Clinical Hospital 8, Lviv, Lviv reg, Ukraine
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Dakroub M, Verma-Fuehring R, Strzalkowska A, Hillenkamp J, Yousef YA, Loewen NA. Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy. J Curr Glaucoma Pract 2023; 17:9-14. [PMID: 37228309 PMCID: PMC10203335 DOI: 10.5005/jp-journals-10078-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 11/29/2022] [Indexed: 05/27/2023] Open
Abstract
Aim To compare ab interno trabeculectomy by trabecular meshwork (TM) excision to plasma-mediated ablation in primary open-angle glaucoma (POAG) patients. Methods Retrospectively collected data of TrabEx+ (TEx) (n = 56) and Trabectome (T) (n = 99) patients were compared by coarsened exact matching to reduce confounding and matched based on baseline intraocular pressure (IOP) and age. The primary outcomes were IOP and the number of glaucoma medications. Complications and the need for additional glaucoma surgery were assessed. Patients were followed for up to 1 year. Results A total of 53 TEx could be matched to T. Baseline IOP was 16.5 ± 4.6 mm Hg in both; age was 73.7 ± 8.8 and 71.5 ± 9.9 years in TEx and T, respectively. TEx was taking more medications than T (p < 0.001). IOP was reduced to 14.8 ± 4.3 in TEx and to 13.4 ± 3.4 in T at 6 months, and to 14.9 ± 6.0 (p = 0.13) in TEx and to 14.1 ± 3.8 mm Hg (all p < 0.05) in T at 12 months. Medications were reduced at both 6 and 12 months (p < 0.05). No differences were seen between TEx and T at 6 and 12 months. In TEx, only one serious complication occurred, and two patients required further glaucoma surgery. Conclusion Although both groups had a baseline IOP considered low for ab interno trabeculectomy, IOP and medications were reduced further at 6 and 12 months. IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences. Both had a low complication rate. Clinical significance This study investigated subtle differences between a plasma-ablative device, the T, and an excisional device, the TEx, by applying coarsened exact matching. IOP and medications were reduced in both groups at 6 and 12 months, although IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences, with both devices having a low complication rate. How to cite this article Dakroub M, Verma-Fuehring R, Strzalkowska A, et al. Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy. J Curr Glaucoma Pract 2023;17(1):9-14.
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Affiliation(s)
- Mohamad Dakroub
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Raoul Verma-Fuehring
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Alicja Strzalkowska
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Yousef Al Yousef
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Nils A Loewen
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany; Artemis Eye Centers of Frankfurt, Hanauer Landstraße, Frankfurt, Germany
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10
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Minimally Invasive Glaucoma Surgery: Safety of Individual Devices. J Clin Med 2022; 11:jcm11226833. [PMID: 36431310 PMCID: PMC9696404 DOI: 10.3390/jcm11226833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
Primary open-angle glaucoma progression in those already on maximal medical therapy has traditionally been treated with trabeculectomy, a surgical procedure that carries a high degree of morbidity. In the last few decades, significant advances have been made in the field of minimally invasive glaucoma surgery (MIGS) devices, which aim to defer or prevent trabeculectomy via less arduous surgical techniques in certain types of glaucoma. Although reviews have been published examining the efficacy of various MIGS techniques, no article synthesises the comparative safety of all available devices. We performed a literature review examining the safety of MIGS devices. Fifteen devices were included, variously attempting to increase aqueous outflow through the trabecular meshwork or the suprachoroidal space, shunting into the subconjunctival space, or reducing aqueous production through ciliary body ablation. Notably, the earliest product attempting to increase outflow to the suprachoroidal space, Alcon's CyPass Micro-Stent, was withdrawn from the market due to concerns regarding increased corneal endothelial cell loss at five years post-implantation. All other devices were described as well-tolerated, with the most common adverse effects including hyphaema, intraocular pressure spikes, and device migration or obstruction. MIGS devices are purported to be uniformly safe, and many studies report no statistically significant increased complications beyond those associated with cataract surgery alone. It is important to note, however, the generally poor quality of current studies, with a dearth of randomised, or even prospective, data, and a large proportion of studies funded by device producers.
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11
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Gosling D, Wang H, Auger G. Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma. J Glaucoma 2022; 31:268-273. [PMID: 35131982 PMCID: PMC8963515 DOI: 10.1097/ijg.0000000000001994] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 01/19/2022] [Indexed: 12/02/2022]
Abstract
PRCIS Irrigating goniectomy with the TrabEx+ device can lower intraocular pressure (IOP) in patients with glaucoma, as a standalone procedure or combined with cataract surgery. PURPOSE The aim was to describe the efficacy and safety of irrigating goniectomy performed using the TrabEx+ device, either as a standalone procedure or combined with cataract surgery, in eyes with medically treated open-angle glaucoma. METHODS A retrospective case series of eyes treated by a single surgeon at a single UK teaching hospital. Data was collected at follow-up visits at 1 week, 3, 6, 12, 18, and 24 months postoperatively. Primary outcomes included IOP and glaucoma medication reduction after surgery. Proportion of eyes achieving >20% IOP reduction, IOP <21 mm Hg, and no reoperation were classified as surgical success. RESULTS Seventy-three consecutive eyes of 64 patients (mean age 68.4±13.7 y) were enrolled. 62% were treated as combined procedures with cataract surgery. Overall, mean IOP decreased from 31.3±7.3 to 20.9±10.4 mm Hg at the latest follow-up (34% reduction) (P<0.001) at the latest follow-up (16.1±10.3 mo) with mean preoperative medications decreased from 2.9±1.2 to 1.9±1.3 (P<0.001). 73% met the definition of success at latest follow-up. Postoperative complications were recorded including hyphaema (17%), uveitis (3%), hypotony (1%), and persistent vitreous hemorrhage (1%). Eighteen percent required reoperation because of treatment failure. CONCLUSION TrabEx+ appears to be effective in lowering IOP and medication with or without cataract surgery. However, long-term safety and efficacy will be better understood in a prospective study with longer follow-up.
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12
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Okuda M, Mori S, Takano F, Murai Y, Ueda K, Sakamoto M, Kurimoto T, Yamada‐Nakanishi Y, Nakamura M. Association of the prolonged use of anti-glaucoma medications with the surgical failure of ab interno microhook trabeculotomy. Acta Ophthalmol 2022; 100:e1209-e1215. [PMID: 35080795 DOI: 10.1111/aos.15090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/03/2021] [Accepted: 12/29/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE This study examined the perioperative factors affecting surgical success in ab interno microhook trabeculotomy (μTLO). METHODS A total of 146 consecutive patients who underwent μTLO were included in this retrospective study. We performed Cox proportional hazard modelling by setting surgical success at 1 year as an objective variable. The explanatory variables included age, sex, glaucoma type, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation (MD) of the Humphrey visual field test, duration of glaucoma drug use, antithrombotic drug use, combined cataract surgery, incision range and diabetes mellitus. Additionally, we performed 1:1 matching using propensity score analysis and compared the perioperative parameters between durations of glaucoma drug use of <4.5 years and ≥ 4.5 years (50 patients each). We defined surgical success as satisfaction of all three criteria: IOP 5-21 mmHg, IOP reduction of ≥20% from the preoperative IOP and no additional glaucoma surgery. RESULTS The Cox proportional hazard model revealed that a longer duration of anti-glaucoma medication was significantly associated with surgical failure. Propensity score matching analysis showed that the <4.5-year users of anti-glaucoma drugs had significantly higher success rates than the ≥4.5-year users (72% versus 52%; p = 0.04). CONCLUSIONS The prolonged use of multiple glaucoma drugs adversely affected the outcome of μTLO at least at 1 year postoperatively.
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Affiliation(s)
- Mina Okuda
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Fumio Takano
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yusuke Murai
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Kaori Ueda
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Mari Sakamoto
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yuko Yamada‐Nakanishi
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
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13
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Non-inferiority of Microhook to Trabectome: Trabectome vs. ab interno Microhook Trabeculotomy Comparative Study (TramTrac Study). Ophthalmol Glaucoma 2021; 5:452-461. [PMID: 34839035 DOI: 10.1016/j.ogla.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To elucidate the non-inferiority of ab interno microhook trabeculotomy (μTLO) using a recently developed reusable stainless spatula-type microhook device to incise the trabecular meshwork to trabectome (TOM) in terms of the 1-year postoperative outcomes of Japanese patients with glaucoma by means of propensity score analyses. DESIGN A multicenter retrospective cohort study. PARTICIPANTS We enrolled 553 and 392 patients who underwent TOM and μTLO, respectively, between January 2014 and March 2020 at 10 facilities. METHODS Logistic regression analysis was conducted to calculate the propensity score, which indicates the likelihood of treatment assignment (TOM or μTLO). We set the following factors as outcome-related covariates: age, sex, facility, glaucoma disease types, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation of the Humphrey visual field test and antithrombotic drug use, the presence or absence of combined cataract surgery, and incision range of trabecular meshwork (one or two quadrants). We analyzed four different methods (matching, inverse probability of treatment weighting (IPTW), stratification, and regression adjustment) using the propensity score. We set 15% as the non-inferiority margin based on previous trabectome meta-analysis results. MAIN OUTCOME MEASURES The primary outcome was surgical success at 1 year postoperatively. We defined surgical success as satisfying all three criteria: (1) IOP within 5-21 mmHg; (2) IOP reduction of ≥20% from preoperative IOP; and (3) no additional glaucoma surgery. RESULTS The 95% confidence interval of risk difference of surgical failure in μTLO in reference to TOM was -12.1 to +9.5% in matching, -12.7 to +11.1% in IPTW, -12.2 to +7.0 in stratification, and -9.7 to +8.1% in regression adjustment, all of which fell within the predetermined non-inferiority margin of 15%. CONCLUSIONS Surgical success of μTLO at 1-year postoperatively was not inferior to that of TOM.
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14
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Elhusseiny AM, Yannuzzi NA, Khodeiry MM, Lee RK, Smiddy WE. Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma. J Glaucoma 2021; 30:947-951. [PMID: 34506357 DOI: 10.1097/ijg.0000000000001938] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 02/03/2023]
Abstract
PRCIS The multiplicity of treatment options for lowering intraocular pressure (IOP) is both a blessing and a challenge. Some attention to cost-analysis might assist in choosing an optimal therapy, especially in a cost-constrained, international setting. PURPOSE The aim of this study was to quantify and to analyze the relative cost of various glaucoma surgical procedures and selective laser trabeculoplasty surgery per mm Hg IOP reduction ($/mm Hg) since standard cost-utility methods are not well suited to the study of glaucoma which characteristically only claims visual acuity in its end stages. METHODS Published glaucoma treatment studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for a given treatment modality. A US perspective was adopted, using Medicare allowable costs were used to calculate a newly introduced parameter-cost per mm Hg IOP reduction-at 1 year postoperatively. RESULTS The cost per mm Hg IOP reduction after 1 year of treatment ranged from $190/mm Hg for trabeculectomy to $1376/mm Hg for iStent. For reference, the cost of selective later trabeculoplasty surgery was $121/mm Hg. After the first year, cost/mm Hg ranged from $12 to $61/mm Hg. CONCLUSIONS Conventional glaucoma surgeries and selective laser trabeculoplasty surgery were the most cost-efficient surgical methods to lower IOP compared with the various minimally invasive glaucoma surgeries options. They may be more appropriate management when cost is an important issue.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Nicolas A Yannuzzi
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mohamed M Khodeiry
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - William E Smiddy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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15
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Characteristics of glaucoma patients with intraocular pressure elevation early after trabectome surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:537-543. [PMID: 34468832 DOI: 10.1007/s00417-021-05355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. METHOD Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. RESULTS Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. CONCLUSION IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation.
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16
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Kiessling D, Rennings C, Hild M, Lappas A, Dietlein TS, Roessler GF, Widder RA. Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes. Int Ophthalmol 2021; 41:4047-4053. [PMID: 34365554 PMCID: PMC8572817 DOI: 10.1007/s10792-021-01977-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes. METHODS In this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure. RESULTS Following an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2-14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate. CONCLUSIONS Trabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.
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Affiliation(s)
- D Kiessling
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - C Rennings
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - M Hild
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany
| | - A Lappas
- Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany
| | - T S Dietlein
- Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany
| | - G F Roessler
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany.,Department of Ophthalmology, RWTH Aachen University, Pauwelstr. 30, 52074, Aachen, Germany
| | - Randolf Alexander Widder
- Department of Ophthalmology, St. Martinus-Krankenhaus, Gladbacher Str.26, 40219, Düsseldorf, Germany. .,Department of Ophthalmology, University Hospital of Cologne, Kerpener Str 62, 50935, Cologne, Germany.
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17
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Abstract
PURPOSE Interest in micro-invasive glaucoma surgery (MIGS) has exploded over the last 8 years with an increase in MIGS procedures of at least 400% in the United States, according to Medicare data. MIGS is an umbrella term that can cover many different types of surgeries. This review focuses on peer-reviewed evidence for Trabectome®, iStent inject®, Kahook Dual Blade®, XEN® Gel Stent, and Hydrus®. METHODS We present key recent studies evaluating the efficacy and safety of MIGS in various types of glaucoma patients with different stages of disease. CONCLUSION We conclude that MIGS is generally safe and efficacious, although only some MIGS have been studied through randomized clinical trials. When comparing and contrasting the different MIGS procedures, large prospective studies are not yet the norm. High-quality large prospective studies involving MIGS will be an important next step as ophthalmologists decide how to incorporate MIGS into their surgical armamentarium.
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Affiliation(s)
- Faith A Birnbaum
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, MA United States
| | - Cameron Neeson
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, MA United States
| | - David Solá-Del Valle
- Department of Ophthalmology, Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston, MA United States
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18
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Bektas C, Aktas Z, Ucgul AY, Karamert SS. Prognostic factors affecting the surgical success of gonioscopy-assisted transluminal trabeculotomy. Indian J Ophthalmol 2021; 69:1425-1429. [PMID: 34011713 PMCID: PMC8302281 DOI: 10.4103/ijo.ijo_2035_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the prognostic factors affecting gonioscopy-assisted transluminal trabeculotomy (GATT) surgical success. Methods: Fifty-three eyes were retrospectively enrolled. Open-angle glaucoma patients with at least 6-month follow-up were included. At baseline, demographic characteristics, intraocular pressure (IOP), number of anti-glaucomatous medications (AG), and glaucoma type were recorded. Postoperatively, IOP, complications, and number of AG were noted. The effects of these parameters on surgical success were investigated. Results: The median follow-up time was 13.7 months. The mean IOP decreased from 25.6 ± 6.2 mm Hg at baseline to 14.6 ± 3.5 mm Hg at final, and the number of AG decreased from 3.2 ± 0.78 to 1.2 ± 1.3. When target IOP was considered as 18 mm Hg and 15 mm Hg, surgical success rates were 81.1% and 60.4%, respectively. When target IOP was considered as 18 mm Hg, a positive effect of the combination with cataract surgery and a negative effect of postoperative macrohyphema on success rates were observed. Other factors did not show any association with the success rates for both target IOP values when analyzed by the Cox proportional hazards regression analysis. Conclusion: Postoperative macrohyphema may affect surgical success rates negatively. The contribution of the combination with cataract surgery is controversial. Glaucoma stage does not seem to affect surgical success.
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Affiliation(s)
- Caglar Bektas
- Department of Ophthalmology, Can State Hospital, Can, 17400, Canakkale, Turkey
| | - Zeynep Aktas
- Department of Ophthalmology, Gazi University Medical School, Besevler, 06500, Ankara, Turkey
| | - Ahmet Yucel Ucgul
- Department of Ophthalmology, Training and Research Hospital, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Selin Sahin Karamert
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
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19
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Wons J, Mihic N, B Pfister I, Anastasi S, Garweg JG, Halberstadt M. Effect of Preoperative Intraocular Pressure in Patients with and without Intolerance to Their IOP-Lowering Medication on the Outcome of Trabectome Surgery. Clin Ophthalmol 2021; 15:1851-1860. [PMID: 33986587 PMCID: PMC8110264 DOI: 10.2147/opth.s303603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to compare the effect of trabectome surgery in patients with and without intolerance to their medication and with preoperatively sufficiently controlled, insufficiently controlled, and uncontrolled intraocular pressure (IOP) on the surgical outcome. Patients and Methods A total of 155 eyes (133 patients) with different forms of open angle glaucoma with or without intolerance to their glaucoma medication undergoing trabectome surgery alone (AIT) or combined with phacoemulsification (phaco-AIT) were included in this retrospective monocentric study. Patients were corresponding to IOP ≤ 18 mmHg (controlled but glaucoma progression or intolerance, group 1), 19–26 mmHg (insufficiently controlled, group 2), and ≥ 26 mmHg (not controlled, group 3), respectively. Pre- and postoperative IOP and the number of IOP-lowering medications were registered over 12 months. Surgical success was defined as a postoperative IOP of ≤18mmHg and/or reduction of the topical treatment demand after 1 year. Results Of the 155 included eyes, 79 received AIT and 76 received phaco-AIT. Sixty-nine eyes had a preoperatively sufficiently controlled IOP, 63 had an insufficiently controlled IOP, and 23 had an uncontrolled IOP. In all groups, the IOP significantly dropped by 6 and 12 months after surgery (p < 0.001). Surgical success war similar in all groups [47.8% (group 1), 38.1 (group 2) and 34.8% (group 3); p= 0.47]. The effect of AIT on IOP and glaucoma medication independent of intolerance to the anti-glaucoma medication and type of surgery (AIT/phaco-AIT). Conclusion Independently of the preoperative IOP, a satisfying surgical success was achieved using AIT. In instances that do not qualify for filtrating surgery, trabectome surgery alone or in combination with phacoemulsification thus represents a safe and effective minimally invasive glaucoma surgery technique regardless of an intolerance to the topical medication.
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Affiliation(s)
- Juliana Wons
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Nadine Mihic
- Department of Ophthalmology, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Stefano Anastasi
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Justus G Garweg
- Swiss Eye Institute, Rotkreuz, and Berner Augenklinik am Lindenhofspital, Bern, Switzerland.,Department of Ophthalmology, University of Bern, Bern, Switzerland
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Kiessling D, Rennings C, Hild M, Lappas A, Dietlein TS, Roessler GF, Widder RA. Predictability of ab-interno trabeculectomy success in the subsequent eye: A contralateral eye comparison study. Clin Exp Ophthalmol 2021; 49:242-250. [PMID: 33550686 DOI: 10.1111/ceo.13905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND To determine whether the outcome of the first eye may serve as a predictor for intraocular pressure (IOP)-lowering effectiveness in the second eye following bilateral ab interno trabeculectomy. METHODS This retrospective single-centre study included 168 eyes from 84 participants, who underwent combined Trabectome surgery with phacoemulsification cataract surgery in a hospital setting. The clinical endpoint was defined as either 'success' or 'failure' based on four separate scores at the longest follow-up time point: IOP at follow-up <21 mm Hg (Score A) or IOP < 18 mm Hg (Score B), without re-surgery and IOP reduction >20%; IOP ≤15 mm Hg without re-surgery and IOP reduction ≥40% (Score C); and the sole absence of re-surgery according to the discretion of the surgeon (Score D). RESULTS No significant difference was observed between the outcomes of first and second eyes. The frequency of success in the second eye after effective surgery in the first eye significantly exceeded that after prior failure. Within our analysis, the probability calculations determined a 75% chance of success following prior success for Score A. If surgery in the first eye failed, the chance of success in the subsequent eye was 37%. The corresponding probabilities were 79% and 32% for Score B, 56% and 9% for Score C, and 99% and 50% for Score D. CONCLUSION The results of our study offer a useful tool to assess the success of subsequent eye surgeries based on the outcome in the initial eye, owing to the high predictive potential.
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Affiliation(s)
- David Kiessling
- Department of Ophthalmology, St. Martinus-Krankenhaus, Düsseldorf, Germany
| | - Corinna Rennings
- Department of Ophthalmology, St. Martinus-Krankenhaus, Düsseldorf, Germany
| | - Matthias Hild
- Department of Ophthalmology, St. Martinus-Krankenhaus, Düsseldorf, Germany
| | - Alexandra Lappas
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Thomas S Dietlein
- Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
| | - Gernot F Roessler
- Department of Ophthalmology, St. Martinus-Krankenhaus, Düsseldorf, Germany.,Department of Ophthalmology, RWTH Aachen, Aachen, Germany
| | - Randolf A Widder
- Department of Ophthalmology, St. Martinus-Krankenhaus, Düsseldorf, Germany.,Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany
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Tojo N, Hayashi A. The Outcomes of Trabectome Surgery in Patients with Low, Middle, and High Preoperative Intraocular Pressure. Clin Ophthalmol 2020; 14:4099-4108. [PMID: 33273806 PMCID: PMC7708680 DOI: 10.2147/opth.s285883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background We compared the efficiency of trabectome surgery for patients with differing preoperative intraocular pressure (IOP) values in a single-facility retrospective study. We evaluated surgical outcomes based on three grades of preoperative IOP: high (hi-IOP, >26 mmHg), middle (mid-IOP, 18–26 mmHg), and low (lo-IOP, <18 mmHg). Patients and Methods We analyzed the cases of 204 eyes that underwent trabectome surgery and were followed >2 years. We defined failure as a reduction of IOP <20% or requiring additional glaucoma surgery. We used 4 cutoff values >21, >18, >15, and >12 mmHg. Other factors that may affect surgical outcomes were also investigated: age, central corneal thickness (CCT), history of selective laser trabeculotrabculoplasty (SLT), preoperative visual field, and simultaneous cataract surgery. Results Trabectome surgeries significantly decreased the IOP values from 23.0 ± 7.2 mmHg to 13.6 ± 3.6 mmHg at 2 years post-surgery. The mid-IOP group achieved significantly better surgical outcomes than the lo-IOP and hi-IOP groups with cutoff values 21, 18, and 15 mmHg. A thin CCT and simultaneous cataract surgery were significantly related to better surgical outcomes with cutoff value 21.18 and 15 mmHg. Conclusion For the patients with preoperative IOP <18 mmHg, it was difficult to decrease their IOP >20% with trabectome surgery. Patients with preoperative IOP values >26 mmHg often required additional glaucoma surgery.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Kasahara M, Shoji N. Effectiveness and limitations of minimally invasive glaucoma surgery targeting Schlemm's canal. Jpn J Ophthalmol 2020; 65:6-22. [PMID: 33150512 DOI: 10.1007/s10384-020-00781-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15-19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.
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Affiliation(s)
- Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Widder RA, Hild M, Dietlein TS, Kühnrich P, Rennings C, Szumniak A, Lappas A, Roessler GF. Trabectome, trabecular aspiration and phacoemulsification in a triple procedure for treating exfoliation glaucoma: A long-term follow-up. Eur J Ophthalmol 2020; 31:2432-2438. [PMID: 32914642 DOI: 10.1177/1120672120956505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study investigates the long-term intraocular pressure (IOP) lowering potential, risk profile and success rate of a triple procedure comprising phacoemulsification, trabecular aspiration and trabectome (Microsurgical Technology, Redmond, WA, USA) for treating exfoliation glaucoma. METHODS A total of 117 eyes of 117 patients with exfoliation glaucoma underwent a combination of phacoemulsification, trabectome and trabecular aspiration. They were followed up for up to 7 years. The success rates were designated according to criteria based on the Tube versus Trabeculectomy Study and the World Glaucoma Association guidelines: A (no resurgery); B/C (IOP < 21/18 mmHg, no resurgery, IOP reduction > 20%); D (IOP ⩽ 15 mmHg, no resurgery, IOP reduction ⩾ 40%). RESULTS The mean follow-up period was 46 months. IOP showed a 38% reduction from 24.5 ± 6.1 to 15.2 ± 3.6 mmHg (p < 0.0001). The Medication Score decreased by 23% from 2.2 ± 0.9 to 1.7 ±1.0 (p < 0.0001). The success rates were 87, 76, 74 and 38% according to criteria A, B, C and D. In eyes with an initial IOP of >30 mmHg, a 57% reduction from 34.2 ± 4.4 to 14.8 ± 3.2 mmHg (p < 0.0001) was observed, and the success rates were 91, 91, 82 and 59% for criteria A, B, C and D, respectively. DISCUSSION We conclude that the triple procedure may effectively lower IOP in patients with exfoliation glaucoma over a mean follow-up period of 46 months without significant side effects. Therefore, the triple procedure may serve as first-line surgery for patients with exfoliation and cataract, even with a high initial IOP.
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Abstract
PRéCIS:: The preoperative factors associated with a decreased survival rate of ab interno trabeculotomy (AbIT) perfomed using a Trabectome in open-angle glaucoma were selective laser trabeculoplasty (SLT) performed previously and axial length (AL) over 23.82 mm. PURPOSE The purpose of this study was to find preoperative factors that predict outcomes of AbIT by a Trabectome. MATERIALS AND METHODS This retrospective single-center cohort study involved consecutive patients with primary open-angle glaucoma and exfoliation glaucoma treated at Helsinki University Hospital with AbIT with preoperative intraocular pressure (IOP) ≥18 mm Hg and follow-up of at least 1 year. Success was defined as lowering of their IOP by at least 20% from baseline or reduction in glaucoma medications without any rise in IOP above baseline, and no subsequent glaucoma surgery. RESULTS Of the total 72 eyes of 67 patients, 51 eyes had exfoliation glaucoma and 21 had primary open-angle glaucoma. Mean preoperative IOP was 25.2±5.3 mm Hg, with a mean of 3.2±1.2 glaucoma medications. In the multivariable model, a history of preoperative SLT and higher preoperative AL had hazard ratios of 2.99 [95% confidence interval (CI): 1.26-7.10] and 1.53 (95% CI: 1.12-2.09) with statistical significance (P=0.013 and 0.007). The statistically significant cutoff point was 23.82 mm in AL in relation to the success rate, with success times taken into account (P<0.001). AL over 23.82 mm had hazard ratio of 5.75 (95% CI: 2.57-12.87, P<0.001). CONCLUSION Previous SLT and AL over 23.82 mm reduce survival after AbIT.
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Long-term clinical results of trabectome surgery in patients with open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2020; 258:2467-2476. [PMID: 32857189 DOI: 10.1007/s00417-020-04897-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/09/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. METHOD A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. RESULTS The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (- 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. CONCLUSION At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG.
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Abstract
PRéCIS:: This study confirms the safety and efficacy of XEN gel stents in the management of pseudoexfoliative glaucoma 2 years after implantation, with success rates similar to primary open-angle glaucoma regardless of the definition of success. PURPOSE To compare the long-term safety and efficacy of XEN gel implant surgery (Allergan Inc., Irvine, CA) in patients with pseudoexfoliative glaucoma (PEXG) and primary open-angle glaucoma (POAG). SETTING Prospective, interventional study in a tertiary glaucoma center. METHODS A total of 110 eyes of 85 patients with POAG (57 eyes) or PEXG (53 eyes) and uncontrolled intraocular pressure (IOP) despite medical treatment underwent combined XEN+cataract surgery or standalone XEN surgery. Mean IOP, mean number of medications, needling rates, and incidence of adverse effects were compared between the 2 groups. Complete surgical success was defined as an unmedicated IOP≤12, 15, 16, or 18 mm Hg at 2 years, both with and without a 20% reduction from baseline. RESULTS Combined XEN+cataract surgery was performed in 72% of POAG and 76% of PEXG eyes (P=0.67), the remainder underwent standalone XEN surgery. Patient characteristics were similar between the 2 groups except for older age for the patients with PEXG (78.5±8.5 vs. 71.3±8.7 y; P<0.005). Mean medicated IOP were 19.8±5.8 mm Hg (POAG) versus 19.8±8.2 mm Hg (PEXG) at baseline (P=0.98), and 14.5±3.6 mm Hg (-26.8%) versus 14.2±3.8 mm Hg (-28.3%), respectively, at 2 years (P=0.75). Mean medications concomitantly dropped from 1.9±1.6 (POAG) versus 2.0±1.3 (PEXG) to 0.6±0.9 versus 0.4±0.7, respectively (P=0.29). Using the 16 mm Hg threshold, 51.4% (POAG) versus 57.1% (PEXG) eyes achieved complete success (P=0.70) at 2 years. The difference in success rates between the 2 groups was not statistically significant under any of the definitions of success. By 24 months, needling was performed in 42.8% (POAG) and 43.2% (PEXG) (P=0.64), with an average time to needling of 162.8 and 134.9 days, respectively (P=0.46). The rates of adverse effects were 30.6% (POAG) and 36.4% (PEXG) (P=0.66), and additional glaucoma surgeries were carried out in 14.3% (POAG) versus 15.9% (PEXG) (P=0.89). CONCLUSIONS The XEN gel implant as a standalone or combined procedure demonstrated similar efficacy and safety results in PEXG and POAG eyes.
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Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery. J Cataract Refract Surg 2020; 46:1422-1432. [PMID: 32657904 DOI: 10.1097/j.jcrs.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Minimally invasive glaucoma surgery (MIGS) has become a reliable standard of care for the treatment of glaucoma when combined with cataract surgery. This review describes the MIGS procedures currently combined with and without cataract surgery with a focus on visual outcomes based on the literature and the experience of the ASCRS Glaucoma Clinical Committee.
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Comparison of the short-term effectiveness and safety profile of ab interno combined trabeculotomy using 2 types of trabecular hooks. Jpn J Ophthalmol 2020; 64:407-413. [PMID: 32533393 DOI: 10.1007/s10384-020-00750-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the short-term surgical effectiveness and safety profile of ab interno trabeculotomy using 2 types of trabecular hooks. STUDY DESIGN Retrospective comparative study. PATIENTS AND METHODS A retrospective chart review was performed on Japanese open-angle glaucoma patients who underwent ab interno trabeculotomy with phacoemulsification and who had a 6-month follow-up. Trabeculotomy was performed using 2 kinds of trabecular hooks, the Tanito ab interno Trabeculotomy Micro-hook (TMH) or the Kahook Dual Blade (KDB). The patients' demographics, preoperative and postoperative intraocular pressures (IOPs), medication scores, and occurrence of complications were analyzed and compared. RESULTS Fifty-nine eyes with open-angle glaucoma were included in the final analysis. Trabeculotomy was performed using the TMH in 30 eyes (50.8%) and the KDB in 29 eyes (49.2%). Significant decreases in IOP from the baseline (P < 0.001, except for the 1-month time-point in the KDB group, when P < 0.01) after the 1-month time-point and the medication scores (P < 0.001) at all time-points were noted in both groups. However, the percentage changes in the IOP and medication scores from the baseline at each time-point did not differ significantly between the 2 groups, with the exception of the medication score at the 1-month time-point (P < 0.0283). The occurrence of postoperative complications was similar in the 2 groups. CONCLUSIONS The present study demonstrates the absence of significant differences in IOP and medication score reductions at almost all time-points between the TMH and KDB groups.
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Gillmann K, Mansouri K. Minimally Invasive Glaucoma Surgery: Where Is the Evidence? Asia Pac J Ophthalmol (Phila) 2020; 9:203-214. [PMID: 32501895 PMCID: PMC7299223 DOI: 10.1097/apo.0000000000000294] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The last decade has witnessed an unprecedented growth in glaucoma treatment options through the introduction of minimally invasive glaucoma surgeries (MIGS). The aim of the present review is to provide an understanding of the currently available MIGS and to examine what data are currently available to guide treatment choice. DESIGN Meta-analysis and systematic review of randomized and non-randomized control trials. METHODS Out of 2567 articles identified, a total of 77 articles were retained for analysis, including 28 comparative studies and 12 randomized control trials. Overall, 7570 eyes were included. When data permitted, the weighted mean difference in intraocular pressure reduction was calculated for comparison purposes. RESULTS Weighted mean intraocular pressure reductions from all analyzed studies were: 15.3% (iStent), 29.1% (iStent inject), 36.2% (ab interno canaloplasty), 34.4% (Hydrus), 36.5% (gonioscopically-assisted transluminal trabeculotomy), 24.0% (trabectome), 25.1% (Kahook dual blade), 30.2% (Cypass), 38.8% (XEN), and 50.0% (Preserflo). CONCLUSIONS One of the advantages of the heterogenous range of available MIGS options is the chance to tailor therapy in an individualized manner. However, high-quality data are required to make this choice more than an educated guess. Overall, this review confirms the efficiency of assessed MIGS compared with standalone phacoemulsification, but it highlights that only few studies compare different MIGS techniques and even fewer assess MIGS against criterion standard treatments. Current evidence, while non-negligible, is mostly limited to heterogenous nonrandomized studies and uncontrolled retrospective comparisons, with few quality randomized control trials. We suggest that future research should be comparative and include relevant comparators, standardized to report key outcome features, long-term to assess sustainability and late complications, and ideally randomized.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA
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Can a contact lens sensor predict the success of trabectome surgery? Graefes Arch Clin Exp Ophthalmol 2020; 258:843-850. [PMID: 31900641 DOI: 10.1007/s00417-019-04576-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/25/2019] [Accepted: 12/18/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE We examined whether a contact lens sensor (CLS) is useful for the postoperative evaluation of trabectome surgery. We investigated the correlations between the outcomes of trabectome surgery and the output of a CLS. METHODS We examined 24 consecutive eyes of patients with pseudo-exfoliation glaucoma. In each eye, the intraocular pressure (IOP) fluctuations over 24 h were measured with the SENSIMED Triggerfish CLS before and at 3 months after the trabectome surgery. We divided the patients into success (n = 12 eyes) and failure (n = 12 eyes) groups; success was defined as a postoperative IOP level ≤ 21 mmHg plus an IOP reduction ≥ 20% relative to the preoperative IOP value with or without anti-glaucoma medications. We investigated CLS parameters that correlate with surgical outcomes by performing a Cox hazard regression analysis. We determined the maximum value, minimum value, and range of IOP fluctuation as CLS parameters. RESULTS The mean follow-up period was 38.0 ± 3.0 months. The success rate was 50%. The postoperative range of IOP fluctuation during the nocturnal period with the CLS was significantly correlated with the surgical results (p = 0.024). CONCLUSIONS A smaller range of IOP fluctuation was significantly correlated with better surgical outcomes. We were able to predict the surgical success after trabectome surgery at 3 months using the CLS. Thus, CLS results could be a new surgical evaluation parameter.
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An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
In this article, we review the current options for microinvasive glaucoma surgery (MIGS) combined with cataract extraction in the USA and the efficacy of the various approaches.
Recent Findings
MIGS is a rapidly growing area of research and clinical interest. Available surgeries aim to reduce intraocular pressure by improving aqueous outflow through the trabecular or subconjunctival pathways or by reducing aqueous production.
Summary
Multiple approaches to MIGS are utilized in clinical practice. On average, these surgeries are safe and modestly effective in reducing intraocular pressure. Future research will demonstrate which surgical approaches are most efficacious, whether and how to combine MIGS, and the role of MIGS in improving patient quality of life.
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Surgical Outcomes and Quality Assessment of Trabeculectomy: Leveraging Electronic Health Records for Clinical Data Visualization. J Glaucoma 2019; 28:1023-1028. [PMID: 31658225 DOI: 10.1097/ijg.0000000000001386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PRéCIS:: This electronic medical record-based study demonstrates 1 approach to monitor clinical outcomes for individual physicians performing trabeculectomy. PURPOSE The purpose of this study was to develop an interactive data visualization platform for evaluating trabeculectomy outcomes and monitoring clinical care quality. PATIENTS AND METHODS This is a retrospective electronic health record study in a glaucoma division of an academic medical center. We included 633 patients who underwent trabeculectomy between July 2016 and December 2018. Data were collected for intraocular pressure (IOP), vision loss, number of follow-up visits, and return to the operating room within the initial 3 months. Regression analyses were used to assess factors associated with these study outcomes. Risk of IOP ≤5 mm Hg was assessed using survival analysis. An interactive data visualization platform was created. RESULTS A total of 429 trabeculectomy and 204 combined surgeries were analyzed, with preoperative IOP of 21.9±9.4 and 19.4±6.9 mm Hg, respectively. Mean pressure declined by 53% and 41% (P=0.001) by 3 months. Risk of pressure ≤5 mm Hg was higher in white patients and those who underwent trabeculectomy alone. At 3 months, patients on average had 5 clinic visits; 5.5% required additional surgical procedures, and 18% experienced loss of at least 3 lines of best-recorded (not best-corrected) vision. Returning to the operating room was significantly associated with an increased number of clinic visits (coefficient=3.94) and higher odds of vision loss (odds ratio=11.12). CONCLUSIONS Over the initial 3 months after trabeculectomy, additional surgeries are rare, while a significant proportion of patients lost vision, and this was strongly associated with a need to return to the operating room. Interactive electronic health record data visualization can be a useful tool for monitoring clinical outcomes.
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Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019; 13:453-464. [PMID: 30880906 PMCID: PMC6402616 DOI: 10.2147/opth.s181444] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Merve Inanc
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Ufuk Elgin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Avar M, Jordan JF, Neuburger M, Engesser D, Lübke J, Anton A, Wecker T. Long-term follow-up of intraocular pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the Trabectome. Graefes Arch Clin Exp Ophthalmol 2019; 257:997-1003. [PMID: 30739156 DOI: 10.1007/s00417-019-04259-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The minimally invasive ab-interno trabeculectomy (AIT) via electro-ablation with the Trabectome has been on the European market since 2009. Many studies have proven the safety and efficacy of the procedure. Up until now, studies investigating the long-term effect of AIT have been sparse. In this study, we present long-term results of AIT in patients with primary and secondary open-angle glaucoma. METHODS In a retrospective monocentric study, the data of all the patients having undergone the procedure in 2010 at our institution were recorded. Data was collected during routine examinations at our institution. In total, 81 eyes of 74 patients (46 patients with primary open-angle glaucoma (POAG), 28 patients with pseudoexfoliative glaucoma (PEXG)) were included. At every examination, the intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the number of IOP-lowering medication was registered. Statistical analysis was done using the Kaplan-Meier analysis or Dunnett's t test, respectively. RESULTS For both groups (POAG and PEXG), we found a significant lowering of the IOP (28% for POAG and 26% for PEXG) and a significant reduction of the number of IOP-lowering medication (32% for POAG and 29% for PEXG) after a median follow-up period of 3.5 years. CONCLUSION In patients with open-angle glaucoma and especially pseudoexfoliative glaucoma, ab-interno trabeculectomy is an effective surgical procedure to significantly lower the intraocular pressure on a long-term basis.
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Affiliation(s)
- Markus Avar
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | | | | | - Diana Engesser
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Lübke
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Anton
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Wecker
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Ophthalmic practice Dr. Wecker, Heilbronn, Germany
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