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Kitahara J, Kakihara S, Mukawa S, Hirano T, Imai A, Miyahara T, Murata T. Long-term surgical results of trabeculectomy for secondary glaucoma in Val30Met hereditary transthyretin amyloidosis. Sci Rep 2023; 13:12755. [PMID: 37550352 PMCID: PMC10406936 DOI: 10.1038/s41598-023-40029-4] [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: 03/24/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023] Open
Abstract
This study reports the long-term results of trabeculectomy (LEC) for secondary glaucoma in hereditary transthyretin (ATTRv) amyloidosis patients and its correlation with prior vitrectomy. A retrospective case series was conducted involving 31 consecutive eyes of 20 ATTRv amyloidosis patients who underwent LEC between 2007 and 2020. The mean follow-up period was 73.2 ± 37.0 months (range: 20-181 months). Postoperative intraocular pressures (IOPs) were evaluated based on the following criteria: (a) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for laser suture lysis, (b) IOP between 6 and 15 mmHg without additional glaucoma surgeries, except for laser suture lysis, and (c) IOP between 6 and 21 mmHg without additional glaucoma surgeries, except for needling and laser suture lysis. Kaplan-Meier analysis revealed survival rates after LEC of 0.52 at 36 months, 0.42 at 60 months, and 0.25 at 84 months under criterion (a); 0.49 at 36 months, 0.27 at 60 months, and 0.11 at 84 months under criterion (b); and 0.76 at 36 months, 0.71 at 60 months, and 0.65 at 84 months under criterion (c). Eyes with a history of small gauge transconjunctival vitrectomy (SGTV) exhibited a tendency towards lower survival rates, although no statistically significant difference was observed (log-rank test; p = 0.193 under criterion (a) and p = 0.0553 under criterion (b)). Our findings suggest that LEC and additional needling procedures can provide some control over IOP; however, the overall postoperative outcomes of LEC for ATTRv amyloidosis remain unsatisfactory, even in the era of SGTV with reduced conjunctival scarring.
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Affiliation(s)
- Junya Kitahara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Shuji Mukawa
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Microhook ab interno trabeculotomy for secondary glaucoma in patients with hereditary transthyretin amyloidosis. Jpn J Ophthalmol 2023; 67:84-90. [PMID: 36441264 DOI: 10.1007/s10384-022-00966-5] [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: 08/09/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To report surgical outcomes of a Microhook ab interno trabeculotomy (µLOT) procedure for glaucoma secondary to hereditary transthyretin amyloidosis (ATTRv). STUDY DESIGN Retrospective case series. METHODS Medical records of patients with glaucoma secondary to ATTRv with transthyretin Val30Met variant, who underwent µLOT, were retrospectively reviewed. Surgical success was categorized according to the postoperative intraocular pressures (IOPs, mmHg) as follows: (a) 6 ≤ IOP ≤ 21; (b) 6 ≤ IOP ≤ 18; and (c) 6 ≤ IOP ≤ 15, without light perception loss or additional glaucoma surgery. Secondary outcomes were glaucoma medication scores and postoperative complications. RESULTS This study included 18 eyes (13 patients, 6 men). The mean follow-up period was 25.2±9.8 months (7-38 months). Kaplan-Meier analysis indicated success rates of (a) 1.00 at 6, 1.00 at 12, and 0.43 at 24 months; (b), 1.00 at 6, 0.93 at 12, and 0.43 at 24 months; (c) 0.94 at 6, 0.75 at 12, and 0.27 at 24 months after operation. Postoperative IOPs were significantly reduced from the baseline of 25.2±5.8 mmHg to 11.5±2.7 at 3, 12.3±4.1 at 6, and 13.8±3.9 at 12 months (Dunnett's test). Medication scores were also improved at 3 and 6 months but without a significant reduction at 12 months. There were no severe complications requiring surgical intervention except for additional glaucoma surgery. CONCLUSION µLOT for secondary glaucoma in ATTRv is safe and effective 1 year after surgery, but the effects diminish after 2 years.
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Suture trabeculotomy ab interno for secondary glaucoma in Japanese patients with Val30Met hereditary transthyretin amyloidosis. Sci Rep 2022; 12:19330. [PMID: 36369333 PMCID: PMC9652217 DOI: 10.1038/s41598-022-23150-8] [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: 04/15/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022] Open
Abstract
We retrospectively evaluated surgical outcomes of suture trabeculotomy (SLOT) ab interno for secondary glaucoma in 18 eyes of 12 patients with hereditary transthyretin (ATTRv) amyloidosis with Val30Met mutation. SLOT ab interno was performed between May 2015 and January 2020. All the participants were followed up for at least 12 months. The primary outcome measure was Kaplan-Meier survival. Failure of this treatment was defined as an intraocular pressure (IOP) of ≥ 22 mmHg and a < 20% IOP reduction with or without medication or as additional operations needed to reduce IOP. The mean postoperative follow-up period was 3.5 years (1.2-6.1 years). The SLOT ab interno procedure alone was performed in 17 eyes (94%). Fifteen eyes (83%) had a 360° incision made in Schlemm's canal and 3 eyes (17%) had a 180° incision performed. Cumulative survival values were 0.83, 0.63, and 0.22 at 1, 2, and 3 years, respectively. Ten eyes (56%) needed additional surgery, such as repeated SLOT ab interno, Ahmed glaucoma valve implantation, or MicroPulse transscleral cyclophotocoagulation. Our results here, as well as our previous results with trabeculectomy, suggest that SLOT ab interno may not have a sufficiently long-term effect on secondary glaucoma because of ATTRv amyloidosis.
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Choroidal Amyloid Deposition: A Multicenter Study of Amyloid Lesions Identified in Late Indocyanine Green Angiography. Retina 2022; 42:1989-1994. [DOI: 10.1097/iae.0000000000003551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marta A, Vieira R, Figueiredo A, Reis R, Sampaio I, Beirão JM, Menéres MJ. Ahmed valve for secondary glaucoma in patients with hereditary transthyretin amyloidosis. Eye (Lond) 2022; 36:111-118. [PMID: 33627759 PMCID: PMC8727566 DOI: 10.1038/s41433-021-01443-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the surgical outcomes of patients with hereditary transthyretin amyloidosis (TTR-FAP) who underwent Ahmed glaucoma valve (AGV) implantation. METHODS A retrospective cohort study was performed on patients with a diagnosis of TTR-FAP secondary glaucoma, who underwent AGV implantation in our department, between November 2010 and July 2019. The cumulative probability of treatment success was measured with Kaplan-Meier survival analysis. The primary outcome was success, defined as intraocular pressure (IOP) ≥ 6 mmHg and ≤21 mmHg with or without medication, with no need for further glaucoma surgery and without loss of light perception at last follow-up. Secondary outcomes were postoperative IOP, number of IOP-lowering medications, and rates of complications. RESULTS The study included 114 eyes of 87 patients. The mean follow-up duration was 3.81 ± 2.11 years (y) [range, 1.00-8.28 y]. Compared to the preoperative values, the mean IOP was reduced from 28.20 ± 7.01 to 12.87 ± 3.76 mmHg at the final visit (p < 0.001), with a reduction in the number of medications from 3.89 ± 0.66 to 1.86 ± 1.43 (p < 0.001). Early and late postoperative complications occurred in 20 (17.09%) and 9 (7.89%) eyes, respectively. Kaplan-Meier analysis indicated probabilities of success of 0.98 at 1 y, 0.97 at 2 y, 0.95 at 3 y, 0.89 at 4 y, 0.77 at 5 y and 0.72 at 6 y. The linear correlation analysis showed a correlation between some characteristics of the natural history of TTR-FAP patients and AGV implantation success. CONCLUSION Although glaucoma in TTR-FAP patients is very difficult to manage, AGV implantation is an effective and relatively safe procedure.
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Affiliation(s)
- Ana Marta
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Rita Vieira
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Ana Figueiredo
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Rita Reis
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - Isabel Sampaio
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal
| | - João Melo Beirão
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
| | - Maria João Menéres
- grid.5808.50000 0001 1503 7226Department of Ophthalmology, Centro Hospitalar e Universitário do Porto, Oporto, Portugal ,grid.5808.50000 0001 1503 7226Instituto de Ciências Biomédicas Abel Salazar, Oporto, Portugal
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Kakihara S, Hirano T, Imai A, Miyahara T, Murata T. Comments on pupillometry: An objective test to assess endocular hereditary transthyretin amyloidosis. Eur J Ophthalmol 2021; 32:NP332-NP333. [PMID: 34169778 DOI: 10.1177/11206721211028047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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Kakihara S, Hirano T, Imai A, Kurenuma T, Chiku Y, Murata T. Micropulse laser trabeculoplasty under maximal tolerable glaucoma eyedrops: treatment effectiveness and impact of surgical expertise. Int J Ophthalmol 2021; 14:388-392. [PMID: 33747814 DOI: 10.18240/ijo.2021.03.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/30/2020] [Indexed: 02/08/2023] Open
Abstract
AIM To evaluate the effectiveness of micropulse laser trabeculoplasty (MLT) for eyes with open angle glaucoma (OAG) under maximal tolerable glaucoma eyedrops and to assess the effect of expertise performing MLT on its clinical effectiveness. METHODS Medical records of 42 consecutive eyes of 34 patients diagnosed with OAG who underwent MLT were retrospectively reviewed. The effectiveness was determined using the Kaplan-Meier survival analysis. Failure was defined as an intraocular pressure (IOP) reduction of <20% from baseline, an IOP >21 mm Hg during two consecutive follow-up visits, or surgical intervention for OAG. To determine the impact of MLT surgical expertise on clinical effectiveness, the eyes were divided into two groups according to whether the procedure was conducted by an experienced specialist (defined as a glaucoma specialist who had conducted at least ten MLT procedures) or a less experienced glaucoma specialist. The difference in expertise was determined using a log-rank test. RESULTS MLT was conducted by three glaucoma specialists. The overall survival rates were 0.76, 0.48, and 0.44 at 1, 3, and 6mo, respectively. The survival rates for MLT performed by a less experienced glaucoma specialist were 0.62, 0.31, and 0.25 (n=21 eyes) at 1, 3, and 6mo, respectively, whereas the survival rates for MLT performed by an experienced glaucoma specialist were 0.90, 0.64, and 0.64 (n=21 eyes) at 1, 3, and 6mo, respectively. The log-rank test showed a significant difference in the survival curves of the two groups (P=0.0061). CONCLUSION The 6-month effectiveness of MLT for controlling IOP is relatively limited in eyes with OAG using maximal tolerable glaucoma eyedrops. However, its effectiveness may be improved if performed by a glaucoma specialist with sufficient MLT experience.
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Affiliation(s)
- Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Taihei Kurenuma
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Yoshiaki Chiku
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan
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Kakihara S, Hirano T, Matsuda Y, Takano D, Imai A, Miyahara T, Murata T. Deposits on Retinal Surface Seen on OCT in Ocular Amyloidosis. Ophthalmol Retina 2021; 5:1005-1008. [PMID: 33422693 DOI: 10.1016/j.oret.2020.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/26/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the tomographic features in patients with hereditary amyloidosis transthyretin (hATTR). DESIGN Retrospective case series and analysis of B-scan OCT images. PARTICIPANTS A total of 120 patients (240 eyes) diagnosed with hATTR. METHODS We performed a retrospective review of the treatment history and retrospective analysis of the OCT images of patients with hATTR. The parameters analyzed were the age at which the last OCT was performed, presence of ocular amyloidosis, history of pars plana vitrectomy (PPV), systemic treatment, and genetic mutations. Two independent evaluators evaluated the OCT images for characteristic needle-shaped pattern deposits on the retinal surface, and a third evaluator resolved any differences in their evaluations. MAIN OUTCOME MEASURES The frequency of characteristic needle-shaped deposits on the retinal surface seen on OCT. RESULTS The mean age at the time of the last OCT was 56.5 ± 14.9 years. Ninety-nine patients had gene encoding transthyretin (TTR) with the Val30Met mutation, and 21 patients had other mutations. Of 240 eyes, 128 had signs of ocular amyloidosis. Fifty of 73 eyes (68.5%) with a history of PPV for vitreous opacities exhibited characteristic deposits on OCT. Four of 31 eyes with vitreous opacity but without a history of PPV showed deposits on the retinal surface. No eyes without a history of vitreous opacities revealed the characteristic needle-shaped deposits. CONCLUSIONS Characteristic needle-shaped deposits on the retinal surface seen on OCT are significant because they are seen in most of the vitrectomized eyes presenting with ocular amyloidosis.
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Affiliation(s)
- Shinji Kakihara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
| | - Takao Hirano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yorishige Matsuda
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Daiki Takano
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Akira Imai
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Teruyoshi Miyahara
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshinori Murata
- Department of Ophthalmology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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