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Tatry M, Bastelica P, Brasnu E, Buffault J, Hamard P, Baudouin C, Labbé A. [Glaucoma surgeries: Long-term results - A review]. J Fr Ophtalmol 2024; 47:104098. [PMID: 39208602 DOI: 10.1016/j.jfo.2024.104098] [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: 07/19/2023] [Revised: 08/12/2023] [Accepted: 08/31/2023] [Indexed: 09/04/2024]
Abstract
The surgical treatment of glaucoma has been and is still based on filtering surgeries, commonly used for about half a century. The safety and efficacy of these techniques have been well described, as it has also been done for cyclophotocoagulation and valves or tubes, indicated in France mostly for refractory glaucoma. Minimally invasive glaucoma surgeries have emerged in recent decades, increasing the number of therapeutic options, and allowing treatment decisions to be as patient-centered as possible. Most of these techniques have now been studied for more than five years. Since glaucoma is a chronic, progressive optic neuropathy, the sustainability of each surgery's results is essential. The amount of available data concerning long-term efficacy and safety of glaucoma surgeries is increasing, so we have decided to describe it through this review of the literature.
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Affiliation(s)
- M Tatry
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France.
| | - P Bastelica
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France; Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, Paris, France
| | - E Brasnu
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France; Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, Paris, France; Inserm 1423, IHU FOReSIGHT, hôpital national de la vision, centre d'investigation clinique, Paris, France
| | - J Buffault
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France; Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, Paris, France; IHU FOReSIGHT, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France; Inserm 1423, IHU FOReSIGHT, hôpital national de la vision, centre d'investigation clinique, Paris, France
| | - P Hamard
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France
| | - C Baudouin
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France; Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, Paris, France; IHU FOReSIGHT, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France; Inserm 1423, IHU FOReSIGHT, hôpital national de la vision, centre d'investigation clinique, Paris, France
| | - A Labbé
- Service 3, IHU FOReSIGHT, hôpital national de la vision des 15-20, Paris, France; Institut de la Vision, IHU FOReSIGHT, Sorbonne Université, Paris, France; IHU FOReSIGHT, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France; Inserm 1423, IHU FOReSIGHT, hôpital national de la vision, centre d'investigation clinique, Paris, France
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Chihara E, Hamanaka T. Historical and Contemporary Debates in Schlemm's Canal-Based MIGS. J Clin Med 2024; 13:4882. [PMID: 39201024 PMCID: PMC11355781 DOI: 10.3390/jcm13164882] [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: 07/28/2024] [Revised: 08/15/2024] [Accepted: 08/17/2024] [Indexed: 09/02/2024] Open
Abstract
Glaucoma is one of the primary causes of blindness worldwide. Canal opening surgery, a type of minimally invasive glaucoma surgery (MIGS) applied in cases of mild to moderate glaucoma, has gained increasing popularity in recent years due to its efficacy in reducing the intraocular pressure, its safety profile, the simplicity of its technique, and the reduced likelihood of compromised vision. Nevertheless, the existing body of histopathological studies remains insufficient for a comprehensive understanding of post-surgical wound healing. Consequently, debates persist among researchers regarding the mechanism through which Schlemm's canal opening surgery reduces the intraocular pressure, as well as the surgical techniques that may impact the outcomes and the factors influencing surgical success. As the history of MIGS is relatively short and lacks sufficient systemic reviews or meta-analyses evaluating the influence of individual factors, this review was conducted to illuminate the disparities in researchers' opinions at the current stage of research.
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Affiliation(s)
- Etsuo Chihara
- Sensho-Kai Eye Institute, Minamiyama 50-1, Iseda, Kyoto 611-0043, Japan
| | - Teruhiko Hamanaka
- Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo 150-8935, Japan;
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Kanda S, Fujishiro T, Karakawa A, Nakagawa S, Ishii K. Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection. J Cataract Refract Surg 2024; 50:713-717. [PMID: 38532268 DOI: 10.1097/j.jcrs.0000000000001447] [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: 12/17/2023] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy. SETTING Hospital. DESIGN Single-center, retrospective, case-control. METHODS The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes. RESULTS 52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups. CONCLUSIONS AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.
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Affiliation(s)
- Satoru Kanda
- From the Saitama Red Cross Hospital, Cyuo-ku, Saitama-shi Saitama, Japan (Kanda, Karakawa, Nakagawa, Ishii); Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan (Kanda, Fujishiro, Karakawa, Nakagawa, Ishii)
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Ye W, Fu L, Li J, Zhu S, Zhang S, Gu J, Jiang Y, Liang Y. Surgical Outcomes of Penetrating Canaloplasty in Patients with Uncontrolled Posner-Schlossman Syndrome: A Prospective Study. Ocul Immunol Inflamm 2024; 32:609-615. [PMID: 36892932 DOI: 10.1080/09273948.2023.2182794] [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: 12/12/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
PURPOSE To evaluate the surgical outcomes in patients with Posner-Schlossman syndrome (PSS) at one year. METHODS A prospective interventional study in PSS patients with penetrating canaloplasty. Main outcome measure was success rate (6 mmHg≤ intraocular pressure (IOP) ≤ 21 mmHg) with or without medications. RESULTS Thirteen eyes in 13 patients with PSS underwent complete catheterization. The mean IOP and medications (Meds) were reduced to 16.1 ± 4.8 mmHg on 0.5 ± 1.0 Meds at 12 months. Complete and qualified success rates were 61.5% and 84.6% at 12 months. The postoperative recurrent rate of PSS was 69.2%, the mean peak IOP during attacks and episodes were decreased to 26.7 ± 8.3 mmHg and 1.7 ± 2.0 times respectively. Transient IOP spike (61.5%) and hyphema (38.5%) were the two most common postoperative complications. CONCLUSION Penetrating canaloplasty achieves a high success rate in PSS without serious complications.
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Affiliation(s)
- Wenqing Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lin Fu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinxin Li
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shuqing Zhu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaodan Zhang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Juan Gu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yi Jiang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuanbo Liang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
- Institute of Glaucoma, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ansari E. Five-year outcomes of ab interno Xen 45 gel stent implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:1263-1269. [PMID: 37955701 DOI: 10.1007/s00417-023-06294-9] [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: 01/07/2023] [Revised: 08/06/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To assess the safety and 5-year efficacy of ab interno XEN 45 gel stent implantation with phacoemulsification in primary open-angle glaucoma (POAG). METHODS Single-centre, single-surgeon, retrospective case note review of consecutive OAG patients who underwent ab-interno gel stent placement combined with phacoemulsification. Surgeries were performed between 2/01/2014 and 2/01/2016. PRIMARY OUTCOME MEASURES mean reduction in intraocular pressure (IOP) and change in number of ocular hypotensive medications from baseline (follow-up range 1-7 years; mean 54 months). SECONDARY OUTCOME MEASURE change in visual field mean deviation (VFMD) from baseline. Safety data included intraoperative and post-operative complications and adverse events. Failure was defined by IOP reduction < 20% despite maximum medical therapy, the need for further laser or surgical intervention. At 5 years, 75% of eyes were free from failure (95% CI 64 to 83%). RESULTS Ninety-one eyes were analysed. Mean (SD) IOP and medications decreased from 20.2 (6.4) mmHg and 2.9 (1.0) at baseline to 15.4 (3.6) mmHg (p < 0.001) and 1.5 (1.4) medications at 5 (p < 0.001) years. Baseline mean VFMD (SD) was - 10.3dB (8.5) reducing to - 10.9(8.2) (p < 0.01) at 5 years. Two (2%) eyes had intraoperative complications, 4 (4.3%) experienced post-operative AEs, and 13 (14%) required secondary surgical intervention (SSI). CONCLUSION The gel stent combined with phacoemulsification was effective in reducing IOP and medications over 5 years, with an acceptable safety profile. Visual field change was clinically acceptable through the study period.
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Affiliation(s)
- Ejaz Ansari
- Maidstone & Tunbridge Wells Hospitals, Kent, UK.
- Institute of Medical Sciences, Canterbury Christ Church University, Kent, UK.
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Lai J, Qiao Y, Tan C, Chen J. Outcomes of gonioscopy-assisted transluminal trabeculotomy in primary congenital glaucoma treatment: a retrospective study. BMC Ophthalmol 2024; 24:88. [PMID: 38408950 PMCID: PMC10898054 DOI: 10.1186/s12886-024-03351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 02/15/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND This retrospective study aimed to evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in Chinese patients with primary congenital glaucoma (PCG) and identify factors influencing surgical success. METHODS Fourteen patients (24 eyes) diagnosed with PCG who underwent gonioscopy-assisted transluminal trabeculotomy were recruited, and data on intraocular pressure (IOP), antiglaucoma medication, surgery-related complications, and additional treatments were collected during preoperative and postoperative visits. Surgical success was defined as IOP ≤ 21 mmHg and a reduction of > 30% from baseline, with (partial success) or without (complete success) antiglaucoma medication. RESULTS Mean preoperative IOP was 30.41 ± 6.09 mmHg. At the final visit, mean IOP reduction was 16.1 ± 9.1 mmHg (52%), and 19 of 24 eyes were topical medication-free. IOP was significantly decreased at each postoperative visit compared with baseline (P < 0.05 for all time points). Cumulative proportions of complete and partial success were 79.2% and 95.8%, respectively, at three years postsurgery. Patients without prior antiglaucoma procedures, without postoperative IOP spikes, and those undergoing complete trabeculotomy exhibited improved surgical prognosis. No permanent vision-threatening complications occurred in the 24 eyes by the end of the respective follow-ups. CONCLUSION Gonioscopy-assisted transluminal trabeculotomy emerged as a safe and effective procedure for PCG treatment, characterized by outstanding IOP reduction efficacy and high surgical success rates.
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Affiliation(s)
- Junyi Lai
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, 200031, Shanghai, China
| | - Yunsheng Qiao
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, 200031, Shanghai, China
| | - Chen Tan
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, 200031, Shanghai, China
| | - Junyi Chen
- Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, 83 Fenyang Rd, 200031, Shanghai, China.
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Zhang Y, Yu P, Zhang Y, Sugihara K, Zhu X, Zhang Y, Yang X, Li X, Liu Y, Zhang H, Yan X, Zhang H, Lin F, Song Y, Gao X, Yuan H, Tang G, Zhou W, Fan S, Dang G, Tang L, Chen W, Wang N, Park KH, Barton K, Aung T, Lam DSC, Weinreb RN, Xie L, Tanito M, Zeng L, Zhang X. Influence of Goniotomy Size on Treatment Safety and Efficacy for Primary Open-Angle Glaucoma: A Multicenter Study. Am J Ophthalmol 2023; 256:118-125. [PMID: 37573988 DOI: 10.1016/j.ajo.2023.08.002] [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: 05/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To compare the efficacy and safety of 120-, 240-, and 360-degree goniotomy (GT) with or without phacoemulsification with intraocular lens implantation (PEI) for patients with primary open-angle glaucoma (POAG). DESIGN Multicenter, retrospective, comparative, nonrandomized interventional study. METHODS Patients diagnosed with POAG who underwent GT with or without PEI were included, and divided into 6 groups: 1) standalone 120-degree GT (120GT); 2) standalone 240-degree GT (240GT); 3) standalone 360-degree GT (360GT); 4) PEI + 120GT; 5) PEI + 240GT; and 6) PEI + 360GT. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. Success was defined as a postoperative IOP within the range of 6 to 18 mm Hg and a 20% reduction from baseline without further glaucoma surgery. Complete success and qualified success were defined as the above without and with ocular hypotensive medications, respectively. RESULTS Three hundred eight eyes of 231 patients were included with a mean follow-up of 14.4 ± 8.6 months (6.0-48.0 months). There were no significant differences in the reductions in IOP and number of medications and cumulative survival probability for complete and qualified success rates among the 3 groups of standalone GT and PEI + GT. The 360GT group had the highest proportion of hyphema with or without PEI. CONCLUSIONS 120GT, 240GT, and 360GT with or without PEI showed similar efficacy in reducing IOP and medications used in POAG. 360GT with or without PEI was more likely to cause hyphema compared with 120GT or 240GT. 120GT with or without PEI was sufficient for treating POAG with or without cataract..
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Affiliation(s)
- Yu Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Ping Yu
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yingzhe Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Kazunobu Sugihara
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Xiaomin Zhu
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Zhang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao Yang
- Jinan Mingshui Eye Hospital (X.Y., X.L., S.F.), Jinan, Shandong, China
| | - Xiaoyan Li
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Yacong Liu
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Hengli Zhang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Xiaowei Yan
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Hengkai Zhang
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Fengbin Lin
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Yunhe Song
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Xinbo Gao
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Huiping Yuan
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guangxian Tang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Wenzong Zhou
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Sujie Fan
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Guangfu Dang
- Department of Ophthalmology (G.D.), The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Li Tang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weirong Chen
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China
| | - Ningli Wang
- Beijing Tongren Eye Center (N.W.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ki Ho Park
- Department of Ophthalmology (K.H.P.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keith Barton
- NIHR Biomedical Research Centre (K.B.), Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | - Tin Aung
- Singapore Eye Research Institute (T.A.), Singapore National Eye Center, Singapore, Republic of Singapore
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen) (D.S.C.L.), Shenzhen, China
| | - Robert N Weinreb
- Hamilton Glaucoma Center (R.N.W.), Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Lin Xie
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Masaki Tanito
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Liuzhi Zeng
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China.
| | - Xiulan Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), 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, Guangdong, China.
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Kono Y, Kasahara M, Sato N, Yokozeki Y, Hirasawa K, Shoji N. Comparison of Short-term Visual Acuity Changes After Trabeculotomy ab Interno Using Trabectome and Trabeculectomy ab Externo. Ophthalmol Glaucoma 2023; 6:609-615. [PMID: 37169173 DOI: 10.1016/j.ogla.2023.05.002] [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: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To compare short-term visual acuity (VA) changes after trabeculotomy ab interno (TAI) using trabectome and trabeculectomy ab externo (TAE) performed on pseudophakic eyes. DESIGN A single-center retrospective study. PARTICIPANTS Patients with pseudophakic eyes who had primary open-angle glaucoma or exfoliation glaucoma and underwent TAI or TAE alone. METHODS Changes in intraocular pressure (IOP), medication score, Snellen VA, and the number of eyes with vision loss (loss of ≥ 2 Snellen lines) were evaluated at baseline, week 1, and months 1, 3, and 6. The risk factors for vision loss at 6 months postoperatively were analyzed in both groups. MAIN OUTCOME MEASURES Visual acuity changes. RESULTS A total of 112 eyes of 112 patients were examined: 46 in the TAI group and 66 in the TAE group. Intraocular pressure was significantly lower in both groups at each visit than at baseline. The TAI group had a significantly higher mean postoperative IOP than the TAE group. Medication scores in the TAI group were significantly different after 3 months compared with baseline; however, decreased significantly at all study visits in the TAE group. The mean VA in the TAI group did not decrease significantly at each visit. In the TAE group, it decreased significantly up to 3 months but was not significantly different at 6 months. At all study visits, the number of eyes with vision loss was significantly lower in the TAI group than in the TAE group. Only 2 eyes in the TAI group (4.3%) had vision loss at 6 months, which was caused by macular edema. In the TAE group, 13 eyes (19.7%) experienced vision loss at 6 months. In all cases, the presence of preoperative split fixation [odds ratio = 7.30, P < 0.05] and the occurrence of hypotony-related complications [odds ratio = 6.76, P < 0.05] within 6 months were risk factors for vision loss. CONCLUSIONS TAI lowered IOP less than TAE; however, there was less vision loss with TAI. For eyes with a target IOP in the mid-teens, TAI can be recommended as initial surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosuremay be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Yusuke Kono
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Sato
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yukako Yokozeki
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kazunori Hirasawa
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
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Okuda M, Mori S, Ueda K, Sakamoto M, Kusuhara S, Yamada-Nakanishi Y, Nakamura M. Favorable effect of ripasudil use on surgical outcomes of microhook ab interno trabeculotomy. Graefes Arch Clin Exp Ophthalmol 2023; 261:2603-2610. [PMID: 37000272 PMCID: PMC10432324 DOI: 10.1007/s00417-023-06040-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE We have previously demonstrated that prolonged use of glaucoma medications was associated with a poor surgical outcome of ab interno trabeculotomy (µTLO). Given that almost all types of glaucoma eye drop either enhance the drainage through the uveoscleral pathway or reduce aqueous humor production, we hypothesized that prolonged use of these medications might cause disuse atrophy of the conventional pathway. In contrast, ripasudil increases the conventional outflow and eventually shows a favorable outcome of µTLO. This study aimed to evaluate the effect of ripasudil use on µTLO outcomes. METHOD The medical charts of 218 patients who underwent µTLO were analyzed retrospectively. We compared the 1-year outcome between ripasudil users versus nonusers by using propensity score matching. We set the covariates as age, sex, glaucoma types, preoperative intraocular pressure (IOP), the mean deviation values of visual field tests, the presence or absence of concomitant cataract surgery, trabecular meshwork incision range, the presence or absence of any glaucoma medication except ripasudil and duration of glaucoma medical therapy. Success was defined as a postoperative IOP between 5 and 21 mmHg, a ≥ 20% IOP reduction from baseline, and no additional glaucoma surgery at postoperative 1 year. RESULT Fifty-seven patients each were allocated to the ripasudil users or nonusers. The 1-year success rates were 74% in ripasudil users and 51% in nonusers (p = 0.01). Kaplan‒Meier survival curves also showed that the ripasudil users had a higher survival distribution (p = 0.01). CONCLUSION The patients who took ripasudil showed a favorable 1-year outcome of µTLO.
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Affiliation(s)
- Mina Okuda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
- Institute of Ophthalmology, University College London, London, UK
| | - Kaori Ueda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Mari Sakamoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Sentaro Kusuhara
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Yuko Yamada-Nakanishi
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017, Japan.
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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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11
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Klabe K, Rüfer F. [Minimally invasive glaucoma surgery-Comparison of angle based procedures]. DIE OPHTHALMOLOGIE 2023; 120:358-371. [PMID: 37010578 DOI: 10.1007/s00347-023-01844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
Surgical procedures are playing an increasing role in the care of patients with glaucoma. Within the last decade, new surgical procedures have been established, which are summarized under the term minimally invasive glaucoma surgery (MIGS). A wide variety of different procedures are aimed at the structures in the angle of the anterior chamber, such as the trabecular meshwork and Schlemm's canal, to improve the physiological outflow or to improve the alternative uveoscleral outflow. The implementation of the treatment goal differs in the individual procedures, as does the maximum pressure reduction that can be achieved. Compared to trabeculectomy with the use of cytostatic agents, the achievable pressure reduction is usually significantly lower. In contrast, the significantly lower intraoperative and postoperative complication rates are emphasized as an advantage of these procedures. With increasing clinical experience and the growth of sufficient data on these new surgical procedures, a well-founded classification in the treatment algorithm of glaucoma surgery becomes easier; nevertheless, due to the small differences with respect to efficacy and safety profile, the final decision for an individual procedure often remains dependent on the surgeon's personal preferences.
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Affiliation(s)
- Karsten Klabe
- Breyer Kaymak Klabe Augenchirurgie, Martin-Luther-Platz 22, 40212, Düsseldorf, Deutschland.
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12
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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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13
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Tan Q, Li J, Lin D, Zhao P. Risk factors of surgical failure in combined phacoemulsification and excisional goniotomy for angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:535-543. [PMID: 36029305 DOI: 10.1007/s00417-022-05808-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/14/2022] [Accepted: 08/10/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To evaluate the therapeutic success, and risk factors for combined phacoemulsification and Kahook Dual Blade excisional goniotomy (Phaco/KDB) in primary angle-closure glaucoma (PACG). METHODS A retrospective review was conducted on glaucoma patients who underwent Phaco/KDB between September 2019 and August 2021 at 2 ophthalmology centers. Complete success was defined as unmedicated intraocular pressure (IOP) ≤ 18 mmHg with no further glaucoma surgery, while the medicated IOP ≤ 18 mmHg was defined as qualified success with lesser medications than at baseline. RESULTS Seventy-two eyes (64 patients) with a mean age of 67.1 ± 8.1 years were included in this study, and 70.2% were female. The mean medicated baseline IOP decreased from 23.4 ± 8.1 to 16.6 ± 3.9 mmHg at an average of 11.6 ± 3.7 months of follow-up (- 29.1%; P < 0.00). Medications decreased from 2.6 ± 1.3 to 0.4 ± 0.9 (- 82.6%; P < 0.001). Complete success and qualified success were achieved in 65.3% and 79.2% of eyes, respectively. Male gender [hazard ratio (HR): 6.00 (1.57-22.9); P = 0.009] was observed a risk factor for surgical failure, whereas higher axial length (HR:0.37 (0.16-0.86); P = 0.021), and a combined circumferential goniosynechialysis procedure (HR: 0.13 (0.02-0.74); P = 0.022) lowered the risk of surgical failure. Hyphema, postoperative shallowing anterior chamber, and IOP spike were the most common complications. The cumulative survival proportion for qualified success at 12 months was 82.5% ± 0.05 (95% CI, 0.70-0.90). CONCLUSION Phaco/KDB provided acceptable therapeutic success rate and may, therefore, be recommended in patients with coexisting cataract and PACG. Identifying patients with risk factors preoperatively may help clinicians predict surgical success.
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Affiliation(s)
- Qian Tan
- Aier School of Ophthalmology, Central South University, Changsha, China.,Changsha Aier Eye Hospital, Aier Eye Hospital Group, Tianxin District, 188 Furong South Road, Changsha, 410004, China
| | - Jun Li
- Changsha Aier Eye Hospital, Aier Eye Hospital Group, Tianxin District, 188 Furong South Road, Changsha, 410004, China
| | - Ding Lin
- Aier School of Ophthalmology, Central South University, Changsha, China. .,Changsha Aier Eye Hospital, Changsha, China.
| | - Ping Zhao
- Aier School of Ophthalmology, Central South University, Changsha, China. .,Shenyang Aier Eye Hospital, Shenyang, China.
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14
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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: 5] [Impact Index Per Article: 2.5] [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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15
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Takano F, Mori S, Okuda M, Murai Y, Ueda K, Sakamoto M, Kurimoto T, Yamada-Nakanishi Y, Nakamura M. Risk of surgical failure and hemorrhagic complications associated with antithrombotic medication in glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2022; 260:3607-3615. [PMID: 35687172 DOI: 10.1007/s00417-022-05719-1] [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: 01/19/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this retrospective study was to determine the extent to which the use of antithrombotic drugs during glaucoma surgery contributes to surgical failure and postsurgical hemorrhagic complications. METHODS Glaucoma surgeries were categorized into three groups: trabeculotomy (TLO), trabeculectomy (TLE), and long-Tube shunt surgery (Tube). At 1 year after surgery, the following criteria for surgical success were met: intraocular pressure (IOP) in the 5-21-mmHg range, IOP reduction of at least 20% from the preoperative level, and no additional glaucoma surgeries. We compared the percentages of the success rates and hemorrhagic complications between antithrombotic medication experiencers and non-experiencers. Furthermore, we adjusted the preoperative factors between the two groups using a propensity score analysis in TLO and TLE surgeries. RESULTS A total of 910 glaucoma surgeries were included, with TLO, TLE, and Tube accounting for 353, 444, and 113 surgeries, respectively. Preoperative antithrombotic medications were administered to 149 patients in all glaucoma surgeries: 37 patients used only anticoagulants, 102 used only antiplatelets, and 10 used both. There was no significant difference in the success rates of any of the procedures. The hemorrhagic complications (hyphema and vitreous hemorrhage rate) were significantly higher in the patients who underwent TLE and Tube. The surgical success rates of TLO and TLE were not significantly different after the two groups were matched by propensity score. CONCLUSION The perioperative use of antithrombotic drugs did not affect success for any of the procedures. However, it increased early postoperative hemorrhagic complications for TLE and Tube.
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Affiliation(s)
- Fumio Takano
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mina Okuda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yusuke Murai
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kaori Ueda
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Mari Sakamoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuko Yamada-Nakanishi
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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16
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Marando CM, Neeson C, Solá-Del Valle D. Intracameral Antibiotics and Glaucoma Surgery. Int Ophthalmol Clin 2022; 62:125-143. [PMID: 35325915 DOI: 10.1097/iio.0000000000000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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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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18
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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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19
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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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Nakamura K, Honda R, Soeda S, Nagai N, Takahashi O, Kadonosono K, Ozawa Y. Factors associated with achieving intraocular pressure lower than 15 mmHg by Trabectome surgery in primary open-angle glaucoma. Sci Rep 2021; 11:14308. [PMID: 34253788 PMCID: PMC8275622 DOI: 10.1038/s41598-021-93711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
To assess good prognostic factors of Trabectome surgery in primary open-angle glaucoma (POAG), clinical records of patients with POAG who underwent Trabectome surgery with/without cataract surgery as the first additive therapy to eye drops between January 2015 and March 2018 were retrospectively reviewed. Overall, data of 79 eyes (79 patients; 50 men; mean age, 68.0 years) up to postoperative 24 months were analyzed. Their mean intraocular pressure (IOP) was 20.4 ± 6.0 mmHg at baseline. Forty-two eyes (53.2%) achieved an IOP < 15 mmHg and ≥ 20% reduction from baseline without additional treatments. Phakic eyes had a better survival probability than pseudophakic eyes after adjusting for age, sex, baseline IOP, best-corrected visual acuity, and eye drop score (hazard ratio 3.096; 95% confidence interval [95% CI] 1.367–7.013; P = 0.007). Phakic eyes treated with combined Trabectome and cataract surgeries (mean survival time, 22.250 months; 95% CI 17.606–26.894) had a better survival probability than pseudophakic eyes treated with Trabectome surgery only (mean survival time, 12.111 months; 95% CI 8.716–15.506; P = 0.009) after the adjustment. Among the eyes treated with Trabectome surgery only, phakic eyes required significantly less additional treatments than pseudophakic eyes (P = 0.04). Trabectome surgery may be indicated for phakic eyes with POAG in addition to eye-drop therapy.
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Affiliation(s)
- Kentaro Nakamura
- Department of Ophthalmology, St. Luke's International University and Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Department of Ophthalmology and Micro-Technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Rio Honda
- Department of Ophthalmology, St. Luke's International University and Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Shoichi Soeda
- Department of Ophthalmology, St. Luke's International University and Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Norihiro Nagai
- Department of Ophthalmology, St. Luke's International University and Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.,Laboratory of Retinal Cell Biology, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan.,Laboratory of Retinal Cell Biology, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Osamu Takahashi
- Graduate School of Public Health, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-Technology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, St. Luke's International University and Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan. .,Laboratory of Retinal Cell Biology, Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjukuku, Tokyo, 160-8582, Japan. .,Laboratory of Retinal Cell Biology, St. Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
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