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The place of endoscopic laser cyclodestruction in the system of microinvasive glaucoma surgery. OPHTHALMOLOGY JOURNAL 2022. [DOI: 10.17816/ov104268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Glaucoma is one of the leading causes of irreversible blindness in the world. Reducing intraocular pressure is the only way to slow down the progression of glaucomatous optic neuropathy. Minimally invasive glaucoma surgery aims to provide a safer way of reduction of intraocular pressure than traditional methods, and at the same time it is capable to reduce dependence on antihypertensive therapy. Cyclodestructive high-precision method of reducing the production of aquоeus humor occupies a confident position among modern minimally invasive glaucoma surgery methods. The data obtained as a result of studying the literature confirm our idea on the endoscopic laser cyclodestruction method as a minimally invasive, safe, reliable antiglaucomatous component of the combined surgical treatment of cataract and glaucoma.
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Dubey S, Bansal T, Garg P, Hegde A, Das R, Rekha PD. Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India. Indian J Ophthalmol 2022; 70:3569-3574. [PMID: 36190048 PMCID: PMC9789827 DOI: 10.4103/ijo.ijo_656_22] [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] [Indexed: 11/05/2022] Open
Abstract
Purpose This study was done to report intermediate-term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross-sectional, longitudinal, observational study design. Methods Fifty-three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post-operative data included IOP changes during the follow-up till 1-year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction of IOP from pre-operative IOP with no additional glaucoma surgery. Results The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1-year follow-up. The AGMs reduced from 2.4 ± 1.4 pre-surgery to 1.6 ± 1.4 at 1-year follow-up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra-operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.
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Affiliation(s)
- Suneeta Dubey
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India,Correspondence to: Dr. Suneeta Dubey, Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India. E-mail: ;
Dr. Rekha PD, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore, Karnataka, India. E-mail:
| | - Tanima Bansal
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Prerna Garg
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Aparna Hegde
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India
| | - Ranajit Das
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India
| | - PD Rekha
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India,Correspondence to: Dr. Suneeta Dubey, Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India. E-mail: ;
Dr. Rekha PD, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore, Karnataka, India. E-mail:
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Kan JT, Betzler BK, Lim SY, Ang BCH. Anterior segment imaging in minimally invasive glaucoma surgery - A systematic review. Acta Ophthalmol 2022; 100:e617-e634. [PMID: 34250742 DOI: 10.1111/aos.14962] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/17/2021] [Indexed: 12/13/2022]
Abstract
Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.
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Affiliation(s)
- John Tsia‐Chuen Kan
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Sheng Yang Lim
- Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology Tan Tock Seng Hospital National Healthcare Group Eye Institute Singapore Singapore
- Department of Ophthalmology Woodlands Health Campus National Healthcare Group Eye Institute Singapore Singapore
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Szigiato AA, Touma S, Jabbour S, Lord F, Agoumi Y, Singh H. Efficacy of ab-interno gelatin microstent implantation in primary and refractory glaucoma. Can J Ophthalmol 2022:S0008-4182(22)00054-0. [PMID: 35339436 DOI: 10.1016/j.jcjo.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the outcomes of ab interno gelatin microstent implantation alone and in combination with phacoemulsification for the reduction of intraocular pressure (IOP). DESIGN Retrospective cohort study. PARTICIPANTS 141 eyes of 141 patients with any glaucoma subtype, including refractory glaucoma, operated in the Centre Hospitalier de l'Université de Montréal (CHUM) from 2015-2018. Patients were included if they were over 40 years of age and had a preoperative IOP of >18 mm Hg on maximum tolerated medical therapy. METHODS All patients received ab-interno microstent implantation (XEN-45, Allergan, Madison, NJ) with mitomycin C +/- combined phacoemulsification. The primary outcome was complete surgical success (IOP 6-18 mm Hg and <20% reduction from baseline without IOP medications or reoperations or cyclophotocoagulation); secondary outcomes included qualified success allowing for medications, percentage reduction in mean IOP and medications, and reduction in number of complications, interventions, and reoperations. RESULTS Mean follow-up was 30.5 ± 10.2 months (±SD). Mean IOP was 23.3 ± 7.0 mm Hg on 3.4 ± 0.8 medications at baseline and 13.3 ± 4.7 mm Hg on 1.9 ± 1.5 medications at 24 months of follow-up (p < 0.001). From 24-month survival analysis estimates, complete success was achieved in 34.1% of microstent eyes versus 20.7% with combined phacoemulsification (p = 0.02); 79.1% versus 75.1% achieved qualified success, respectively (p = 0.86). Cases with combined phacoemulsification had a higher rate of failure (hazard ratio [HR] = 1.6, 95% CI 1.1-2.3, p = 0.02). Needling with mitomycin-C or 5-fluorouracil postoperatively occurred in 54 eyes (38.3%). Complications included transient hypotony (10.6%), transient hyphema (6.4%), macular edema (4.3%), and microstent exposure (2.8%). There were 33 eyes (23.4%) with reoperations and 14 (9.9%) requiring subsequent cyclophotocoagulation lasers. CONCLUSIONS Microstent implantation required topical therapy in most cases 24 months following surgery in primary and refractory glaucoma and, when combined with phacoemulsification, had a higher risk of failure.
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Affiliation(s)
| | - Samir Touma
- Department of Ophthalmology, University of Montreal Hospital Centre, Montréal, Que
| | - Samir Jabbour
- Department of Ophthalmology, University of Montreal Hospital Centre, Montréal, Que
| | - Frederic Lord
- Department of Ophthalmology, University of Montreal Hospital Centre, Montréal, Que
| | - Younes Agoumi
- Department of Ophthalmology, University of Montreal Hospital Centre, Montréal, Que
| | - Harmanjit Singh
- Department of Ophthalmology, University of Montreal Hospital Centre, Montréal, Que.; Department of Ophthalmology, Queen's University, Kingston, Ont..
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Minimally Invasive Glaucoma Surgery: Where We Are, and What the Future Holds. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma. Sci Rep 2021; 11:21432. [PMID: 34728652 PMCID: PMC8563755 DOI: 10.1038/s41598-021-00808-3] [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: 03/22/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022] Open
Abstract
To compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.
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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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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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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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Intraocular Pressure After Cataract Surgery Combined With Ab Interno Trabeculectomy Versus Trabecular Micro-bypass Stent: An Intrasubject Same-surgeon Comparison. J Glaucoma 2021; 29:773-782. [PMID: 32404618 DOI: 10.1097/ijg.0000000000001547] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PRECIS Combining Trabectome or iStent with phacoemulsification equally reduces intraocular pressure (IOP) and IOP-lowering medication burden during a 24-month follow-up, with a possible advantage to the Trabectome in the early postoperative period. PURPOSE Intrasubject same-surgeon comparison between phacoemulsification combined with Trabectome (Phaco/Trabectome) versus one first-generation iStent (Phaco/iStent). SETTINGS Private glaucoma and cataract practice. DESIGN This is a retrospective interventional case series. METHODS Data collected at 3 to 4 and 20 to 24 hours and up to 30 months following Phaco/Trabectome in 1 eye and Phaco/iStent in the contralateral eye in patients with bilateral visually-significant cataract and open-angle glaucoma. Evaluations included IOP, intraocular pressure-lowering medications (IOPmeds), visual acuity, and complications. RESULTS Forty-five patients (90 eyes) were identified (age 76.5, 57 to 95 y). At 3 to 4 hours, IOP was above baseline in 12 and 13 eyes following Phaco/Trabectome and Phaco/iStent, respectively, but the degree of IOP elevation was smaller (P=0.048) following Phaco/Trabectome: 4.3 mm Hg, 2.0 to 6.6 mm Hg (95% confidence interval) versus Phaco/iStent: 8.7 mm Hg, 3.8 to 13.6 mm Hg. At 20 to 24 hours, compared with baseline, IOP was significantly lower after Phaco/Trabectome (P=0.004) but not after Phaco/iStent (P=0.14) although the rate of hyphema was higher following Phaco/Trabectome (12/45 vs. 2/45 eyes, P=0.007). IOP reduction from baseline at 3 to 4 hours was significantly larger (P=0.020) in the 21 eyes with hyphema: -3.9, -6.4 to -1.4 versus the 69 eyes without hyphema: -0.3, -2.0 to +1.4. At 1, 6, 12, and 24 months, IOP and number of IOPmeds were similar and significantly lower compared with baseline following either procedure. No complications were encountered in either group. CONCLUSIONS Combined phacoemulsification with either Trabectome or first-generation iStent similarly lowers IOP and IOPmeds burden at 1, 6, 12, and 24 months following surgery. The Trabectome may have an advantage in lowering IOP faster and lessening the degree of IOP elevations in the early postoperative period.
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Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
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Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years. Graefes Arch Clin Exp Ophthalmol 2020; 259:963-970. [PMID: 33263824 PMCID: PMC8016747 DOI: 10.1007/s00417-020-05031-w] [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: 10/08/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 10/30/2022] Open
Abstract
PURPOSE We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). METHODS A total of 5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor-matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months. RESULTS A total of 165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3 ± 5.6 mmHg, and the baseline number of glaucoma medications was 2.7 ± 1.1 in both groups. At 24 months, IOP was reduced to 15.8 ± 5.2 mmHg in AIT and 12.4 ± 4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p < 0.01) and lower in TRAB than AIT (p < 0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p < 0.01) and more infrequently in TRAB than in AIT (p > 0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT. CONCLUSION Both AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions.
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Ahmed IIK, Rhee DJ, Jones J, Singh IP, Radcliffe N, Gazzard G, Samuelson TW, Ong J, Singh K. Three-Year Findings of the HORIZON Trial: A Schlemm Canal Microstent for Pressure Reduction in Primary Open-Angle Glaucoma and Cataract. Ophthalmology 2020; 128:857-865. [PMID: 33166551 DOI: 10.1016/j.ophtha.2020.11.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report 3-year outcomes of the HORIZON study comparing cataract surgery (CS) with Hydrus Microstent (Ivantis, Inc) implantation versus CS alone. DESIGN Multicenter randomized clinical trial. PARTICIPANTS Five hundred fifty-six eyes from 556 patients with cataract and primary open-angle glaucoma (POAG) treated with 1 or more glaucoma medication, washed out diurnal intraocular pressure (IOP) of 22 to 34 mmHg, and no prior incisional glaucoma surgery. METHODS After phacoemulsification, eyes were randomized 2:1 to receive a Hydrus Microstent or no stent. Follow-up included comprehensive eye examinations through 3 years. MAIN OUTCOME MEASURES Outcome measures included IOP, medical therapy, reoperation rates, visual acuity, adverse events, and changes in corneal endothelial cell counts. RESULTS Three hundred sixty-nine eyes were randomized to microstent treatment and 187 to CS only. Preoperative IOP, medication use, washed-out diurnal IOP, and glaucoma severity did not differ between the two treatment groups. At 3 years, IOP was 16.7 ± 3.1 mmHg in the microstent group and 17.0 ± 3.4 mmHg in the CS group (P = 0.85). The number of glaucoma medications was 0.4 ± 0.8 in the microstent group and 0.8 ± 1.0 in the CS group (P < 0.001), and 73% of microstent group eyes were medication free compared with 48% in the CS group (P < 0.001). The microstent group included a higher proportion of eyes with IOP of 18 mmHg or less without medications compared with the CS group (56.2% vs. 34.6%; P < 0.001), as well as IOP reduction of at least 20%, 30%, or 40% compared with CS alone. The cumulative probability of incisional glaucoma surgery was lower in the microstent group (0.6% vs. 3.9%; hazard ratio, 0.156; 95% confidence interval, 0.031-0.773; P = 0.020). No difference was found in postoperative corneal endothelial cell loss between groups. No procedure- or device-related serious adverse events resulting in vision loss occurred in either group. CONCLUSIONS Combined CS and microstent placement for mild to moderate POAG is safe, more effective in lowering IOP with fewer medications, and less likely to result in further incisional glaucoma filtration surgery than CS alone at 3 years.
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Affiliation(s)
- Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
| | - Douglas J Rhee
- University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Gus Gazzard
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust, and Institute of Ophthalmology, University College London, London, United Kingdom
| | | | - Jeb Ong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Kuldev Singh
- Stanford University School of Medicine, Byers Eye Institute, Palo Alto, California
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Primary outcomes of combined cataract extraction technique with Ab-Interno trabeculectomy and endoscopic Cyclophotocoagulation in patients with primary open angle Glaucoma. BMC Ophthalmol 2020; 20:406. [PMID: 33036581 PMCID: PMC7545548 DOI: 10.1186/s12886-020-01643-2] [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: 03/13/2019] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. METHODS A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. INCLUSION CRITERIA 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP < 14 mmHg either with no medications (complete success) or with medications (qualified success). RESULTS A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0 ± 3.7 mmHg and postoperatively was 11.6 ± 1.9 mmHg and 11.4 ± 1.8 mmHg (P < 0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9 ± 1.4 to 0.56 ± 1.05 at 9 month follow-ups (P < 0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4 ± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months. CONCLUSIONS In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.
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Al Yousef Y, Strzalkowska A, Hillenkamp J, Rosentreter A, Loewen NA. Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching. Graefes Arch Clin Exp Ophthalmol 2020; 258:2775-2780. [PMID: 32960322 PMCID: PMC7677264 DOI: 10.1007/s00417-020-04933-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject) with ab interno trabeculectomy (T, Trabectome) by exact matching. Methods Fifty-three IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline intraocular pressure (IOP), the number of glaucoma medications, and glaucoma type, and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. Results A total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3 ± 5.1 mmHg and glaucoma medications of 2.7 ± 1.2 in each. IOP in IS2 was reduced to 14.6 ± 4.2 mmHg at 3 months and in T to a minimum of 13.1 ± 3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8 ± 9.0 mmHg and in T 14.2 ± 3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p < 0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0 ± 1.5 in IS2 and to 1.5 ± 1.4 in T. Conclusion T resulted in a larger and sustained IOP reduction compared with IS2 where a rebound occurred after 6 months to slightly above preoperative values.
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Affiliation(s)
- Yousef Al Yousef
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße, 11 97080, Würzburg, Germany
| | - Alicja Strzalkowska
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße, 11 97080, Würzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße, 11 97080, Würzburg, Germany
| | - André Rosentreter
- Department of Ophthalmology, University Witten/Herdecke, Wuppertal, Germany
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Josef-Schneider-Straße, 11 97080, Würzburg, Germany.
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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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Esfandiari H, Taubenslag K, Shah P, Goyal S, Weiner AJ, Severson ML, Weiner A, Grover DS, Bussel II, Loewen NA. Two-year data comparison of ab interno trabeculectomy and trabecular bypass stenting using exact matching. J Cataract Refract Surg 2020; 45:608-614. [PMID: 31030775 DOI: 10.1016/j.jcrs.2018.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To create a balanced comparison of ab interno trabeculectomy (AIT) (Trabectome) and trabecular bypass stenting (TBS) (iStent). SETTING Eye and Ear Institute, Pittsburgh, Pennsylvania, Ross Eye Institute, Buffalo, New York, and Glaucoma Associates of Texas, Dallas, USA. DESIGN Retrospective case series. METHODS The primary outcome measure was an unmedicated intraocular pressure (IOP) of 21 mm Hg or less and the secondary measure was an unmedicated IOP reduction of 20% or more at 2 years. Patients were matched by baseline IOP, number of glaucoma medications, and glaucoma type using exact matching and by age using nearest neighbor matching. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. RESULTS One hundred fifty-four AIT eyes and 110 TBS eyes were analyzed. Forty-eight AIT patients were exactly matched with 48 TBS patients. Both groups had a mean baseline IOP of 15.3 mm Hg ± 3.1 (SD). At 24 months, the mean IOP was 13.9 ± 3.3 mm Hg in AIT patients and 16.8 ± 2.8 mm Hg in TBS patients and the mean number of medications was 0.7 ± 1.0 and 1.7 ± 1.2, respectively (both P = .04). At 24 months, the IOP was 21 mm Hg or less without medications in 53% of AIT patients and 16.6% of TBS patients (P < .05). At that time, 17.6% of patients in the AIT group but no patient in the TBS group had an IOP reduction of 20% or more without medication. CONCLUSION An exact matching comparison of AIT and TBS showed greater IOP reduction with fewer medications after AIT.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Kenneth Taubenslag
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Priyal Shah
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Swati Goyal
- Eye Q Superspeciality Eye Hospital, Gurgaon, India
| | - Adam J Weiner
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Melissa L Severson
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York, USA
| | - 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, USA
| | | | - Igor I Bussel
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
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Chen DZ, Sng CCA, Sangtam T, Thomas A, Shen L, Huang PK, Cheng J. Phacoemulsification vs phacoemulsification with micro‐bypass stent implantation in primary angle closure and primary angle closure glaucoma: A randomized single‐masked clinical study. Clin Exp Ophthalmol 2020; 48:450-461. [DOI: 10.1111/ceo.13721] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/15/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Affiliation(s)
- David Z. Chen
- Department of OphthalmologyNational University Hospital Singapore Singapore
| | - Chelvin C. A. Sng
- Department of OphthalmologyNational University Hospital Singapore Singapore
- Glaucoma ServiceMoorfields Eye Hospital London UK
- Singapore Eye Research Institute Singapore Singapore
| | - Tiakumzuk Sangtam
- Department of Ophthalmology and Visual ScienceKhoo Teck Puat Hospital Singapore Singapore
| | - Anoop Thomas
- Department of Ophthalmology and Visual ScienceKhoo Teck Puat Hospital Singapore Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of MedicineNational University of Singapore Singapore Singapore
| | - Philemon K. Huang
- Department of Ophthalmology and Visual ScienceKhoo Teck Puat Hospital Singapore Singapore
| | - Jason Cheng
- Department of Ophthalmology and Visual ScienceKhoo Teck Puat Hospital Singapore Singapore
- Department of OphthalmologyUniversity of New South Wales, Liverpool Hospital Sydney Australia
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Abstract
PURPOSE The purpose of this study was to evaluate the influence of trabectome surgery on corneal endothelial cells by site. METHODS Retrospective observational study. Trabectome surgeries were performed on 159 eyes of 132 adult Japanese patients. Corneal endothelial cells were measured at the center (C), inferior (I), nasal inferior (NI), nasal superior (NS), superior (S), temporal superior (TS), and temporal inferior (TI) sectors at <1 month preoperatively and 3, 6, 12, 24, and 36 months postoperatively, for changes in corneal endothelial cell density (ECD), coefficient of variation (CV), and incidence of hexagonal cells (6A). RESULTS Mean preoperative ECD in all groups were 2401±451 (SD) cells/mm (C), 2366±450 cells/mm (I), 2397±479 cells/mm (NI), 2476±554 cells/mm (NS), 2493±596 cells/mm (S), 2464±558 cells/mm (TS), and 2329±510 cells/mm (TI). The 12-month postoperative mean ECDs were 2344±480 cells/mm (C), 2312±469 cells/mm (I), 2325±536 cells/mm (NI), 2473±517 cells/mm (NS), 2438±607 cells/mm (S), 2227±578 cells/mm (TS), and 2193±523 cells/mm (TI). There was no change in ECD in all sectors before and after surgery. ECD decreased at the TS and TI in combination with cataract surgery (2620±430 and 2445±384 cells/mm) preoperatively to 2264±501 and 2216±477 cells/mm at 12 months postoperatively. CV and 6A did not change at all sites in all surgical procedures before and after surgery. CONCLUSIONS Trabectome surgery involves minimal effects to corneal endothelial cells, although long-term prospective studies with greater sample sizes are necessary to confirm this conclusion.
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Rosdahl JA, Gupta D. Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment. Clin Ophthalmol 2020; 14:231-243. [PMID: 32158182 PMCID: PMC6986542 DOI: 10.2147/opth.s239772] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/24/2019] [Indexed: 12/05/2022] Open
Abstract
Glaucoma is a common blinding disease; while there is no cure, effective treatments include medications, laser, and incisional surgery. There is significant interest from patients and doctors to develop safer surgical options throughout the spectrum of disease, to minimize treatment burden in mild glaucoma patients and to minimize risk of complications in patients needing more aggressive treatment. Surgical procedures called Minimally or Micro-Invasive Glaucoma Surgery (MIGS) are growing in popularity. Eighty-seven prospective studies on MIGS were identified and assessed for quality. Most (74%) did not have a control group. Twelve of the highest quality were reviewed. MIGS procedures appeared to have fewer complications, and lowered intraocular pressure, and reduced medication use. Studies were limited by small sample size, narrow spectrum of glaucomatous disease, and/or conflicts of interest. There is a need for high quality, independently funded and performed, comparative studies on the MIGS to help make treatment decisions.
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Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Duke University, Durham, NC27710, USA
| | - Divakar Gupta
- Department of Ophthalmology, Duke University, Durham, NC27710, USA
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Jozic L, Magner J, Funk J, Töteberg-Harms M. Success of combined cataract extraction plus excimer laser trabeculotomy exceeds that of combined ab interno trabeculectomy with the trabectome or cataract extraction alone. Int Ophthalmol 2019; 40:529-537. [PMID: 31724109 DOI: 10.1007/s10792-019-01191-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 10/10/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine the efficacy of cataract surgery alone and combined with two minimally invasive glaucoma surgery (MIGS) procedures (phaco-ELT and phaco-aiT). METHODS Data was collected from 12/2007 to 02/2012 in this retrospective, non-randomized, comparative single surgery center study. Reduction in IOP and hypotensive medication (AGD), change in visual acuity, success rates, and complications were computed by comparing preoperative data with data at 1 year postoperatively. RESULTS A total of 245 eyes of 245 subjects were included. Study eyes underwent phaco alone (38 eye) or combined phaco-ELT (105 eye) and phaco-aiT (102 eye). Phaco alone, combined phaco-ELT, and combined phaco-aiT lowered IOP by 1.5 ± 4.0 mmHg, 4.3 ± 5.6, and 5.3 ± 4.5 mmHg, respectively (P < 0.01). Survival time of phaco-ELT outreached survival time of phaco alone and combined phaco-aiT (20.6 ± 1.0 vs. 13.2 ± 0.4 and 12.9 ± 0.6 month, respectively). No serious complications or adverse events occurred. None of the cases required a subsequent procedure within the first year to lower IOP further. CONCLUSIONS All three surgical procedures lowered IOP and reduced medication. However, the IOP-lowering efficacy of the two combined MIGS procedures exceeded the effect of phaco alone. A combined phaco and MIGS procedures seem reasonable to consider whenever a cataract surgery in an eye with glaucoma or ocular hypertension is considered. In addition, the combined MIGS procedure effectively lowers IOP whenever a target IOP in the mid-teens is sufficient. In this study, the nonthermal phaco-ELT procedure showed superior efficacy at 1 year over phaco alone and phaco-aiT in the Kaplan-Meier statistics.
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Affiliation(s)
- Lidija Jozic
- University of Zurich, Faculty of Medicine, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,nordBLICK Praxis Pinneberg, Bismarckstraße 6, 25421, Pinneberg, Germany
| | - Joachim Magner
- Qualitätsgemeinschaft Augenheilkunde Nord, Augentagesklinik Ballindamm, Ballindamm 37, 20095, Hamburg, Germany
| | - Jens Funk
- Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Marc Töteberg-Harms
- Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
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Swamy R, Francis BA, Akil H, Yelenskiy A, Francis BA, Chopra V, Huang A. Clinical results of ab interno trabeculotomy using the trabectome in patients with uveitic glaucoma. Clin Exp Ophthalmol 2019; 48:31-36. [PMID: 31505089 DOI: 10.1111/ceo.13639] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/23/2019] [Accepted: 09/07/2019] [Indexed: 12/17/2022]
Abstract
IMPORTANCE To evaluate the safety and efficacy of ab interno trabeculotomy (AIT) (trabecular ablation) with the trabectome in patients with uveitic glaucoma. BACKGROUND Traditional glaucoma filtration surgeries in the uveitic patient population come with a higher risk of complications such as failure and hypotony. DESIGN Retrospective observational cohort study. PARTICIPANTS All patients diagnosed with uveitic glaucoma were included in this study. Patients were excluded if they have less than 12 months of follow-up. METHODS All patients who received AIT alone or combined with phacoemulsification. MAIN OUTCOME MEASURES Major outcomes include intraocular pressure (IOP), number of glaucoma medications and secondary glaucoma surgery, if any. Kaplan-Meier method was used for survival analysis and success was defined as IOP ≤21 mmHg, at least 20% IOP reduction from baseline for any two consecutive visits after 3 months, no additional glaucoma medications, and no secondary glaucoma surgery. RESULTS A total of 45 eyes, 45 patients, with an average age of 52 years were included in the study. The majority were Japanese (40%) and underwent AIT alone (71%). IOP was reduced from 29.2 ± 8.0 to 16.7 ± 4.6 mmHg at 12 months (P < .01*), while the number of glaucoma medications was reduced from 4.0 ± 1.0 to 2.5 ± 1.6 (P < .01*). Survival rate at 12 months was 91%. Six cases required secondary glaucoma surgery and no other serious complication were reported. CONCLUSIONS AND RELEVANCE The trabectome AIT procedure appears to be effective in reducing IOP in uveitic glaucoma patients. Although no statistically significant difference was found in the number of glaucoma medications, a decreasing trend was found.
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Affiliation(s)
- Ramya Swamy
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Ophthalmology, University of Maryland, Baltimore, Maryland
| | - Brian A Francis
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Handan Akil
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California.,Department of Visual Sciences, University of Liverpool, Liverpool, UK
| | - Aleksandr Yelenskiy
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Brandon A Francis
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Vikas Chopra
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
| | - Alex Huang
- Doheny Eye Institute and Stein Eye Institute, Department of Ophthalmology, Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California
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Similar Performance of Trabectome and Ahmed Glaucoma Devices in a Propensity Score-matched Comparison. J Glaucoma 2019; 27:490-495. [PMID: 29613976 DOI: 10.1097/ijg.0000000000000960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To apply propensity score matching to Ahmed glaucoma drainage implants (AGI) to trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggest that AIT can produce results similar to AGI traditionally reserved for more severe glaucoma. METHODS AGI and AIT patients with at least 1 year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, sex, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients without a close match were excluded. RESULTS Of 152 patients, 34 AIT patients were matched to 32 AGI patients. Baseline characteristics including ethnicity, IOP, the number of medications, glaucoma type, the degree of visual field loss and GI were not significantly different between AIT and AGI. AIT had a preoperative IOP of 23.6±8.1 mm Hg compared with 26.5+10.6 mm Hg for AGI. At 12 months, the mean IOP was 15.0±9 mm Hg for AIT versus 15.0±4 mm Hg for AGI (P=0.8), whereas the number of drops was 2.3±2.2 for AIT versus 3.6±1.3 for AGI (P=0.016). Only 6 AIT patients (17.6%) required further surgery within the first 12 months versus 9 (28%) for AGI. Success, defined as IOP<21 mm Hg, <20% reduction and no reoperation, was achieved in 76% of AIT versus 69% of AGI (P=0.48). Complications occurred in 13% of AGI and 0.8% of AIT. CONCLUSIONS A propensity score-matched comparison of AIT and AGI showed an equivalent IOP reduction through 1 year. Surprisingly, the AGI group required more glaucoma medications than the AIT group at 6 and 12 months.
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Kim WJ, Kim JM, Lee WH, Kim KN, Kim CS. Effect of combined goniotomy and phacoemulsification on intraocular pressure in open-angle glaucoma patients. Clin Exp Ophthalmol 2019; 47:757-765. [PMID: 30924282 DOI: 10.1111/ceo.13506] [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: 11/23/2018] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Although goniotomy is known to be successful in treating congenital glaucoma, its effect in adult glaucoma patients remains unclear. BACKGROUND To evaluate the efficacy and safety of goniotomy performed simultaneously with cataract surgery in treatment of open-angle glaucoma (OAG). DESIGN Retrospective comparative study. PARTICIPANTS A total of 76 patients with moderately controlled OAG (intraocular pressure [IOP] ≤ 21 mmHg using medications) undergoing cataract surgery. METHODS Comparison of patients who underwent the conventional goniotomy during cataract surgery (combined goniotomy group) with those who underwent cataract surgery alone (phaco group). MAIN OUTCOME MEASURES Changes in IOP and medications, and complications through 12 months. RESULTS Baseline IOP was 18.2 ± 2.4 mmHg in the combined goniotomy group and 17.4 ± 1.9 mmHg in the phaco group; number of medications was 2.6 ± 1.1 and 2.4 ± 0.9, respectively (P > 0.05). The reduction in IOP and medication use from baseline in the combined goniotomy group was significantly greater at 12 months compared to the phaco group (-3.1 ± 2.9 mmHg vs -1.3 ± 2.4 mmHg and -1.2 ± 0.9 vs -0.7 ± 0.9, respectively, both P < 0.05). The success rate was 76.7% in the combined goniotomy group and 50.0% in the phaco group at 12 months (P = 0.021). No significant complication was observed in either group. CONCLUSIONS AND RELEVANCE Combined goniotomy and cataract surgery showed a significantly greater reduction in IOP and number of medications compared to cataract surgery alone at 1 year after surgery, with similarly favourable safety profiles.
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Affiliation(s)
- Woo-Jin Kim
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea
| | - Ju-Mi Kim
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea
| | - Woo-Hyuk Lee
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea
| | - Kyoung Nam Kim
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea.,Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chang-Sik Kim
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon, Korea.,Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
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Impact of ab-interno trabeculectomy on Bruch’s membrane opening-based morphometry of the optic nerve head for glaucoma progression analysis. Graefes Arch Clin Exp Ophthalmol 2018; 257:339-347. [DOI: 10.1007/s00417-018-4187-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 02/06/2023] Open
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Esfandiari H, Shah P, Torkian P, Conner IP, Schuman JS, Hassanpour K, Loewen NA. Five-year clinical outcomes of combined phacoemulsification and trabectome surgery at a single glaucoma center. Graefes Arch Clin Exp Ophthalmol 2018; 257:357-362. [PMID: 30259089 DOI: 10.1007/s00417-018-4146-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To analyze the 5-year results of trabectome ab interno trabeculectomy of a single glaucoma center. METHOD In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) ≤ 21 mmHg, and > 20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). RESULTS The retention rate for 5-year follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4, and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR = 0.27, P = 0.001), younger age (HR = 0.25, P = 0.02), and higher central corneal thickness (HR = 0.18, P = 0.01). Exfoliative glaucoma was associated with a higher success rate (HR = 0.39, P = 0.02). IOP was decreased significantly from 20.0 ± 5.6 mmHg at baseline to 15.6 ± 4.6 mmHg at 5-year follow-up (P = 0.001). The baseline number of glaucoma medications was 1.8 ± 1.2, which decreased to 1.0 ± 1.2 medications at 5 years. CONCLUSION Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Suite 819, Pittsburgh, PA, 15213, USA
| | - Priyal Shah
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Suite 819, Pittsburgh, PA, 15213, USA
| | - Pooya Torkian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ian P Conner
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Suite 819, Pittsburgh, PA, 15213, USA
| | - Joel S Schuman
- Department of Ophthalmology, School of Medicine, New York University, NY, New York City, USA
| | - Kiana Hassanpour
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Suite 819, Pittsburgh, PA, 15213, USA.
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Moghimi S, Hamzeh N, Mohammadi M, Khatibi N, Bowd C, Weinreb RN. Combined glaucoma and cataract surgery: Comparison of viscocanalostomy, endocyclophotocoagulation, and ab interno trabeculectomy. J Cataract Refract Surg 2018; 44:557-565. [PMID: 29891153 DOI: 10.1016/j.jcrs.2018.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/01/2018] [Accepted: 03/08/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare outcomes of phacoemulsification combined with viscocanalostomy, endocyclophotocoagulation (ECP), or ab interno trabulectomy for intraocular pressure (IOP) control and safety in eyes with open-angle glaucoma and visually significant cataract. SETTING Farabi Eye Hospital, Tehran, Iran. DESIGN Retrospective case series. METHODS Medical records of patients who had combined surgery and were followed for at least 1 year were reviewed. Complete success, postoperative IOP, number of medications at each visit, and complications were evaluated and compared before and after adjustments for confounders. RESULTS Forty-six eyes had combined phacoviscocanalostomy, 35 had phaco-ECP, and 28 eyes phaco-ab interno trabulectomy. The groups were matched for baseline IOP (P = .24). At the final follow-up (mean 17.2 months ± 5.5 [SD]), the phacoviscocanalostomy group had the lowest mean IOP (13.5 ± 4.7 mm Hg, 29% decrease) (P = .01). There was no significant difference in the final IOP between phaco-ECP and phaco-ab interno trabulectomy (16.4 ± 3.9 mm Hg, 20% decrease versus 15.8 ± 4.2 mm Hg, 15% decrease) (P = .88). The reduction in the number of medications was greater with phacoviscocanalostomy (77%) than with phaco-ECP (40%) and phaco-ab interno trabulectomy (44%) (P = .01). Phacoemulsification-ab interno trabulectomy had the fewest complications. Intraocular pressure spikes were more frequent in the phaco-ECP group (20%) than in the other groups (4%) (P = .05). CONCLUSIONS All procedures significantly lowered IOP. Phacoemulsification-ab interno trabulectomy resulted in fewest complications and phacoviscocanalostomy led to the largest IOP drop and largest reduction of medications.
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Affiliation(s)
- Sasan Moghimi
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran.
| | - Nikoo Hamzeh
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran
| | - Massood Mohammadi
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran
| | - Nassim Khatibi
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran
| | - Christopher Bowd
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran
| | - Robert N Weinreb
- From the Hamilton Glaucoma Center (Moghimi, Bowd, Weinreb), Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; Tehran University of Medical Sciences (Moghimi, Hamzeh, Mohammadi, Khatibi), Tehran, Iran
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Ahmed SF, Bhatt A, Schmutz M, Mosaed S. Trabectome outcomes across the spectrum of glaucoma disease severity. Graefes Arch Clin Exp Ophthalmol 2018; 256:1703-1710. [PMID: 29855707 DOI: 10.1007/s00417-018-4023-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/01/2018] [Accepted: 05/23/2018] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To compare the efficacy of ab-interno trabeculotomy with Trabectome® in mild glaucoma versus moderate/severe glaucoma along the spectrum of glaucoma disease severity. METHODS Subjects with at least 12 months follow-up were separated into two groups based on glaucoma severity. Severity was determined based on optic nerve cup-to-disc ratio and/or automated visual field data, with cup-to-disc ratio < 0.7 and/or visual field mean deviation ≤ 6.0 dB used to define the mild group (n = 1127), and cup-to-disc ratio > 0.7 and/or visual field mean deviation > 6.0 dB used to define the moderate/severe group (n = 1071). These groups were further subdivided into patients undergoing Trabectome with cataract surgery or Trabectome alone. Mean IOP reduction, medication usage, and success rates were compared between the two groups. Success was defined as IOP reduction of 20% or more from pre-operative IOP and IOP less than 21 mmHg with no secondary surgery throughout the follow-up period. RESULTS The mean post-operative IOP and success rates were similar between the groups. IOP reduction for the mild group was 26% (from pre-op IOP of 24 to 16.1 mmHg) and for the moderate/severe group was 24% (from pre-op IOP of 22.6 to 15.7 mmHg) at 12 Months. The overall rate of success at 12 months for the mild group was 86% and for the moderate/severe group was 83%. CONCLUSION Trabectome surgery maintains efficacy across the spectrum of glaucoma disease severity. This particular minimally invasive glaucoma surgery procedure can be an excellent choice for subjects with moderate/advanced glaucoma as well as for early glaucoma with or without cataract surgery and is applicable to a broad patient population.
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Affiliation(s)
- Sarah Farukhi Ahmed
- Gavin Herbert Eye Institute, University of California-Irvine, 850 Health Sciences Road, Irvine, CA, 92697-4375, USA. .,Irvine School of Medicine, University of California, Irvine, CA, 92697, USA.
| | - Anand Bhatt
- Gavin Herbert Eye Institute, University of California-Irvine, 850 Health Sciences Road, Irvine, CA, 92697-4375, USA.,Irvine School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Mason Schmutz
- Gavin Herbert Eye Institute, University of California-Irvine, 850 Health Sciences Road, Irvine, CA, 92697-4375, USA.,Irvine School of Medicine, University of California, Irvine, CA, 92697, USA
| | - Sameh Mosaed
- Gavin Herbert Eye Institute, University of California-Irvine, 850 Health Sciences Road, Irvine, CA, 92697-4375, USA.,Irvine School of Medicine, University of California, Irvine, CA, 92697, USA
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Ting JLM, Rudnisky CJ, Damji KF. Prospective randomized controlled trial of phaco-trabectome versus phaco-trabeculectomy in patients with open angle glaucoma. Can J Ophthalmol 2018; 53:588-594. [PMID: 30502982 DOI: 10.1016/j.jcjo.2018.01.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of ab interno trabeculectomy with the Trabectome combined with cataract surgery (phaco-AIT) versus Trabeculectomy with mitomycin C combined with cataract surgery (phaco-Trab) in open-angle glaucoma. METHODS A prospective randomized controlled trial with a single surgeon and surgical center was undertaken. Patients were recruited from July 2009 to October 2014. Primary outcomes were mean intraocular pressure (IOP) at 6 months and surgical complications. Secondary outcomes were mean IOP at 12 months, achievement of target IOP, number of glaucoma medications, and rate of secondary surgery. RESULTS The trial was ended early before achieving our intended sample size due to difficulties in recruitment and lack of clinical equipoise over time. Nineteen patients were enrolled, 10 phaco-AIT and 9 phaco-Trab. Baseline IOP was 20.0 ± 5.3 in phaco-AIT and 23.1 ± 6.4 mm Hg in phaco-Trab (p = 0.22). IOP decreased to 17.5 ± 3.8 and 16.0 ± 6.0 mm Hg at 6 months (p = 0.54), and 16.8 ± 2.7 and 17.1 ± 5.0 mm Hg at 1 year (p = 0.57), respectively. Mean number of glaucoma medications at baseline was 1.8 ± 1.3 in phaco-AIT and 1.4 ± 1.1 in phaco-Trab (p = 0.59). Mean number of glaucoma medications decreased to 0.78 ± 1.39 and 0.38 ± 0.74 at 6 months (p = 0.68), and 0.44 ± 0.88 and 0.75 ± 0.89 at 1 year (p = 0.41), respectively. Mild and moderate complications were seen in both treatment groups, but severe complications were seen only in phaco-Trab. One secondary glaucoma procedure was required in the phaco-AIT group. CONCLUSIONS Phaco-AIT achieved similar IOP lowering at 6 and 12 months compared with phaco-Trab with a similar number of glaucoma medications required at 1 year, and no serious complications were identified in the Phaco-AIT group.
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Affiliation(s)
- Jessica L M Ting
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | | | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta..
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Kinoshita-Nakano E, Nakanishi H, Ohashi-Ikeda H, Morooka S, Akagi T. Comparative outcomes of trabeculotomy ab externo versus trabecular ablation ab interno for open angle glaucoma. Jpn J Ophthalmol 2018; 62:201-208. [PMID: 29305716 DOI: 10.1007/s10384-017-0559-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare clinical outcomes between trabeculotomy ab externo (TLO) and trabecular ablation ab interno using a Trabectome (TAT) for open angle glaucoma (OAG). STUDY DESIGN Prospective and retrospective cohort study. METHODS We prospectively recruited 68 patients who underwent TAT between May 2013 and July 2015, and retrospectively recruited 59 patients who underwent TLO between April 2010 and May 2013. We included OAG patients who could be followed up for more than 12 months after surgery. Surgical outcomes were compared between groups. Kaplan-Meier analyses and Cox proportional hazards' models were used for four sets of criteria using postoperative intraocular pressures (IOP) ≤ 18 or ≤ 16 mmHg, and/or showing ≥ 20% reduction from baseline. RESULTS Mean preoperative IOPs were 22.6 ± 7.4 mmHg in the TAT group and 24.3 ± 6.6 mmHg in the TLO group. Mean postoperative IOPs in the TAT group were 15.8 ± 3.6 mmHg at 12-months, and 15.7 ± 5.5 mmHg at 36-months, and 16.0 ± 3.4 mmHg at 12 months and 15.2 ± 3.8 mmHg at 36 months in the TLO group. Postoperatively, success rates at 36-months were significantly higher in the TLO group in some criteria; IOP reductions at 1- and 2- years were significantly higher in the TLO group; these differences were not significant after adjustment with other potential prognostic factors. The number of glaucoma medications were significantly higher in the TAT group, at 2-years (P < 0.001) but not at 3-years (P = 0.22). CONCLUSION Surgical successes following TLO and TAT are not significantly different 3 years postoperatively after adjustment of potential prognostic factors.
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Affiliation(s)
- Eri Kinoshita-Nakano
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hideo Nakanishi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hanako Ohashi-Ikeda
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Satoshi Morooka
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tadamichi Akagi
- Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
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Abstract
BACKGROUND The aim of this study was to investigate the factors that influence the outcome of trabectome surgery. METHODS This was a retrospective nonrandomized study. Seventy-eight glaucoma patients (86 eyes) who underwent trabectome surgeries and were followed up for more than 12 months were included. We classified the subtypes of glaucoma as: primary open-angle glaucoma (23 eyes), pseudo-exfoliation glaucoma (58 eyes), and secondary glaucoma (5 eyes). Forty-seven eyes underwent cataract and trabectome surgeries simultaneously, and 39 underwent only trabectome surgery. We evaluated the possible influencing factors including age, sex, glaucoma index, preoperative intraocular pressure (IOP), number of medications, visual field status, central corneal thickness, type of glaucoma and operation method (trabectome only or simultaneous cataract surgeries as well). RESULTS Trabectome surgeries significantly decreased the IOP from 23.0±6.7 to 12.5±3.0 mm Hg after 12 months (P<0.001). The success rate at 12 months was 73.3%. The results showed that a low preoperative IOP, thin central corneal thickness, prior non-selective laser trabeculoplasty history, and simultaneous cataract and trabectome surgeries were factors that contributed to the success rate. CONCLUSIONS The success rate of trabectome surgery was higher for low-IOP glaucoma than high-IOP glaucoma. Trabectome could be a useful treatment for low-IOP glaucoma.
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The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study. Int Ophthalmol 2017; 38:2341-2347. [DOI: 10.1007/s10792-017-0732-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022]
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Tojo N, Abe S, Miyakoshi M, Hayashi A. Comparison of intraocular pressure fluctuations before and after ab interno trabeculectomy in pseudoexfoliation glaucoma patients. Clin Ophthalmol 2017; 11:1667-1675. [PMID: 28979095 PMCID: PMC5606685 DOI: 10.2147/opth.s143061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Ab interno trabeculectomy (AIT) with the Trabectome has been shown to reduce intraocular pressure (IOP) in eyes with pseudoexfoliation (PEX) glaucoma. Here, we examined the change of IOP fluctuations before and after only AIT or AIT with cataract surgery in PEX patients using the contact lens sensor Triggerfish®. METHODS This was a prospective open-label study. Twenty-four consecutive patients with PEX glaucoma were included. Twelve patients underwent cataract surgery and AIT (triple-surgery group), and 12 patients underwent only AIT (single-surgery group). In each eye, IOP fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the surgery. We compared the change of IOP fluctuation before and after operation. We also evaluated the difference in IOP changes between the triple- and single-surgery groups. RESULTS At 3 months after the surgeries, the mean IOP was significantly reduced from 23.5±6.5 mmHg to 14.6±2.8 mmHg in the single-surgery group and from 22.5±3.0 mmHg to 11.5±2.9 mmHg in the triple-surgery group. The mean IOP reduction rate was significantly higher in the triple-surgery group compared to the single-surgery group (p=0.0358). In both groups, the mean range of IOP fluctuations was significantly decreased during nocturnal periods. The mean range of 24 h IOP fluctuations was decreased in the triple-surgery group (p=0.00425), not in the single-surgery group (p=0.970). CONCLUSION Triple surgery could decrease IOP value and the IOP fluctuations to a greater extent than single surgery in PEX glaucoma patients.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Shinya Abe
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mari Miyakoshi
- 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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Ianchulev T, Ahmed IIK, Stamper RL, Chang DF, Samuelson TW, Lindstrom RL. Innovative alternatives in the surgical management of glaucoma with cataract surgery. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1362335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tsontcho Ianchulev
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, U.S.A
| | - Iqbal I. K. Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Robert L. Stamper
- Department of Ophthalmology, UC San Francisco, San Francisco, CA, U.S.A
| | - David F. Chang
- Department of Ophthalmology, UC San Francisco, San Francisco, CA, U.S.A
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Schehlein EM, Kaleem MA, Swamy R, Saeedi OJ. Microinvasive Glaucoma Surgery: An Evidence-Based Assessment. EXPERT REVIEW OF OPHTHALMOLOGY 2017; 12:331-343. [PMID: 30026790 DOI: 10.1080/17469899.2017.1335597] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction The advent of Microinvasive Glaucoma Surgery (MIGS) offers a novel approach in the treatment of glaucoma with the number of procedures developing at an exciting pace. Areas Covered MIGS procedures aim to lower intraocular pressure (IOP) via four mechanisms: (1) increasing trabecular outflow, (2) increasing outflow via suprachoroidal shunts, (3) reducing aqueous production, and (4) subconjunctival filtration. A comprehensive search for published studies for each Microinvasive Glaucoma Surgery (MIGS) device or procedure was undertaken using the electronic database PubMed. Search terms included 'minimally invasive glaucoma surgery', 'microincisional glaucoma surgery', and 'microinvasive glaucoma surgery'. A manual search for each device or procedure was also performed. After review, randomized control trials and prospective studies were preferentially included. Expert Opinion These procedures offer several benefits: an improved safety profile allowing for intervention in earlier stages of glaucoma, combination with cataract surgery, and decreased dependence on patient compliance with topical agents. Established MIGS procedures have proven efficacy and more recent devices and procedures show promising results. Despite this, further study is needed to assess the long term IOP-lowering effectiveness of these procedures. Particularly, rigorous study with more randomized control trials and head-to-head comparisons would allow for better informed clinical and surgical decision-making. MIGS offers new solutions for glaucoma treatment.
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Affiliation(s)
- Emily M Schehlein
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Mona A Kaleem
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Ramya Swamy
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Osamah J Saeedi
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
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Safety and Efficacy of Microinvasive Glaucoma Surgery. J Ophthalmol 2017; 2017:3182935. [PMID: 28512578 PMCID: PMC5420434 DOI: 10.1155/2017/3182935] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/20/2017] [Indexed: 01/27/2023] Open
Abstract
Microinvasive glaucoma surgery (MIGS) is emerging as a new therapeutic option for glaucoma patients who wish to reduce their medication burden and avoid the postoperative complications of conventional glaucoma filtration surgery. These devices differ in terms of their efficacy and safety profile. Schlemm's canal devices have the most favorable safety profile at the compromise of modest efficacy, while subconjunctival and suprachoroidal devices are potentially more effective at lowering the intraocular pressure at the expense of a higher rate of complications. This review consolidates the latest evidence on the efficacy and safety of the MIGS devices in clinical use and provides an overview on upcoming devices which would likely also become viable treatment options in the near future. These clinical data would assist a glaucoma surgeon in selecting the most appropriate MIGS device for each patient based on the glaucoma severity and patient expectations.
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Short-Term Clinical Results of Ab Interno Trabeculotomy Using the Trabectome with or without Cataract Surgery for Open-Angle Glaucoma Patients of High Intraocular Pressure. J Ophthalmol 2017; 2017:8248710. [PMID: 28484649 PMCID: PMC5412169 DOI: 10.1155/2017/8248710] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/19/2016] [Accepted: 02/19/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose. To assess the safety and efficacy of Trabectome procedure in patients with preoperative intraocular pressure (IOP) of 30 mmHg or higher. Methods. All patients who had underwent Trabectome stand-alone or Trabectome combined with phacoemulsification were included. Survival analysis was performed by using Kaplan-Meier, and success was defined as IOP ≤ 21 mmHg, 20% or more IOP reduction from baseline for any two consecutive visits after 3 months, and no secondary glaucoma surgery. Results. A total of 49 cases were included with an average age of 66 (range: 13–91). 28 cases had Trabectome stand-alone and 21 cases had Trabectome combined with phacoemulsification. Mean IOP was reduced from a baseline of 35.6 ± 6.3 mmHg to 16.8 ± 3.8 mmHg at 12 months (p < 0.01∗), while the number of medications was reduced from 3.1 ± 1.3 to 1.8 ± 1.4 (p < 0.01∗). Survival rate at 12 months was 80%. 9 cases required secondary glaucoma surgery, and 1 case was reported with hypotony at day one, but resolved within one week. Conclusion. Trabectome seems to be safe and effective in patients with preoperative IOP of 30 mmHg or greater. Even in this cohort with high preoperative IOP, the end result is a mean IOP in the physiologic range.
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Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma. J Curr Ophthalmol 2017; 29:17-22. [PMID: 28367521 PMCID: PMC5362389 DOI: 10.1016/j.joco.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 09/10/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To provide efficacy and safety of surgery with Trabectome combined with phacoemulsification in primary open-angle glaucoma. METHODS In this interventional case series, 30 consecutive eyes that have had combined phacoemulsification with Trabectome were included. The main outcome measures were change in intraocular pressure (IOP), glaucoma medication use, and the rate of complications. RESULTS Mean IOP was 18.25 ± 3.28 mmHg preoperatively which decreased to 13.50 ± 2.53 mmHg at 1 year. (P < 0.05). There was a corresponding drop in glaucoma medications from 2.52 ± 0.60 at baseline to 1.40 ± 0.53 at 12 months (P < 0.01). The preoperative BCVA (Log Mar) was improved from 0.68 ± 0.26 pre-operatively to 0.26 ± 0.19, 0.18 ± 0.13, 0.17 ± 0.13, 0.11 ± 0.12, at 5 days and 2, 6, and 12 months, respectively (P < 0.01). The only frequent complication was transient blood reflux resolving spontaneously within a few days. No vision-threatening complication occurred. CONCLUSION Combined phacoemulsification and Trabectome significantly lowered IOP and medication use, with early visual rehabilitation in the majority of patients.
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Ngai P, Kim G, Chak G, Lin K, Maeda M, Mosaed S. Outcome of primary trabeculotomy ab interno (Trabectome) surgery in patients with steroid-induced glaucoma. Medicine (Baltimore) 2016; 95:e5383. [PMID: 27977576 PMCID: PMC5268022 DOI: 10.1097/md.0000000000005383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To determine the efficacy and safety of Trabectome surgery on patients with steroid response, ranging from ocular hypertension refractory to maximal medical therapy to the development of steroid-induced glaucoma.A nonrandomized, nonblinded, retrospective study of 20 subjects with steroid response was conducted. All 20 eyes underwent Trabectome surgery alone. Nine subjects had steroid response with unremarkable visual field, 3 had mild steroid-induced glaucoma, and 8 had advanced steroid-induced glaucoma. Outcome measures included intraocular pressure (IOP), number of glaucoma medications, need for secondary glaucoma surgery, and steroid regimen. Mann-Whitney U test was used to compare postoperative IOP and number of medications to preoperative IOP and number of medications. Kaplan-Meier was used for survival analysis, and success was defined as: IOP reduced by 20% or more on any 2 consecutive visits after 3 months; IOP ≤21 mm Hg on any 2 consecutive visits after 3 months; and no secondary glaucoma surgery.The average preoperative IOP was 33.8 ± 6.9 mm Hg and average preoperative glaucoma medication usage was 3.85 ± 0.75 medications. At 12 months, the IOP was reduced to 15.00 ± 3.46 mm Hg (P = 0.03) and glaucoma medication was reduced to 2.3 ± 1.4 (P < 0.01). The survival rate at 12 months was 93%. At 12 months, 10 patients were continued on their preoperative steroid treatments, 5 were on tapered steroid treatments, and 5 had ceased steroid treatments entirely. One patient required secondary glaucoma surgery (glaucoma drainage device). No other complications were noted.The Trabectome procedure is safe and highly effective for steroid-response glaucoma, even in the context of continued steroid treatment.
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Affiliation(s)
- Philip Ngai
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Grace Kim
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Garrick Chak
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | - Ken Lin
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
| | | | - Sameh Mosaed
- University of California, Gavin Herbert Eye Institute
- University of California, Irvine School of Medicine, Irvine, CA
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Manabe SI, Sawaguchi S, Hayashi K. The effect of the extent of the incision in the Schlemm canal on the surgical outcomes of suture trabeculotomy for open-angle glaucoma. Jpn J Ophthalmol 2016; 61:99-104. [PMID: 27848108 DOI: 10.1007/s10384-016-0487-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 09/25/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the relationship between the extent of the incision in the Schlemm canal during suture trabeculotomy (S-LOT) for open-angle glaucoma and the associated reduction in intraocular pressure (IOP). METHODS Forty-eight consecutive eyes (primary open-angle glaucoma: 28; exfoliation glaucoma: 20) scheduled to undergo S-LOT were studied. A 320-degree opening in the Schlemm canal was planned when total circumferential cannulation had been achieved, and the remaining 40-degree region under the scleral flap was not incised. When the cannulation was incomplete, the canal was incised up to the point reached by the cannula, and the extent of the incision was measured. Logistic regression analysis was performed to identify potential predictors of surgical success (IOP ≤ 15 mmHg). RESULTS A 320-degree incision was achieved in 23 eyes, and the mean extent of the incision was 275 ± 52.3°. The mean IOP fell from 34.0 ± 8.8 mmHg at baseline to 14.5 ± 4.0 mmHg at 1 year postoperatively (P < 0.0001). An IOP reduction of ≥30% was achieved in 46 eyes. Simple correlation analysis indicated that the extent of the incision in degrees did not correlate with IOP or with the reduction in IOP at 1 year postoperatively (P = 0.7665 and 0.693, respectively). Lower preoperative IOP values and concomitant cataract extraction were found to be associated with surgical success. CONCLUSIONS The extent of the incision in the Schlemm canal during S-LOT does not correlate with postoperative reduction in IOP.
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Affiliation(s)
- Shin-Ichi Manabe
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-ku, Fukuoka, 812-0011, Japan.
| | - Shoichi Sawaguchi
- Department of Ophthalmology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ken Hayashi
- Hayashi Eye Hospital, 4-23-35 Hakataekimae, Hakata-ku, Fukuoka, 812-0011, Japan
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Assessment of Anterior Segment Measurements with Swept Source Optical Coherence Tomography before and after Ab Interno Trabeculotomy (Trabectome) Surgery. J Ophthalmol 2016; 2016:4861837. [PMID: 27795855 PMCID: PMC5066020 DOI: 10.1155/2016/4861837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/01/2016] [Indexed: 12/04/2022] Open
Abstract
Purpose. To compare the changes of anterior segment parameters, assessed by swept source anterior segment optical coherence tomography (AS-OCT) after combined Trabectome-cataract surgery and Trabectome-only surgery in open angle glaucoma patients. Methods. Thirty-eight eyes of 24 patients with open angle glaucoma were scanned with swept source AS-OCT before and 4 weeks after combined Trabectome-cataract or Trabectome-only surgery. Intraocular pressure, number of medications, and AS-OCT parameters, such as angle opening distance at 500 and 750 μm from the scleral spur (AOD500 and AOD750), trabecular-iris space area at 500 and 750 mm2 (TISA500, TISA750), angle recess area at 500 and 750 mm2 (ARA500, ARA750), trabecular iris angle (TIA), anterior chamber depth (ACD), anterior chamber width (ACW), and anterior chamber volume (ACV), were obtained before the surgery. These parameters were compared to evaluate whether the outcome of the surgery differed among the patients after the surgery. The width of the trabecular cleft was also measured for both groups. Results. The reduction of IOP and number of medications was found to be statistically significant in both groups (p < 0.001). ACD, ACV, and angle parameters such as AOD 500/750, TISA 500/750, ARA 500/750, and TIA500 showed significantly greater changes from the preoperative values to postoperative 1st month values in combined Trabectome-cataract surgery group (p < 0.05), whereas Trabectome-only group did not show statistically significant difference (p > 0.05). There was no statistically significant difference between two groups for the width of the trabecular cleft (p = 0.7). Conclusion. Anterior chamber angle parameters measured with swept source AS-OCT may be useful for evaluating glaucoma patients before and after Trabectome surgery with or without cataract surgery.
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Kurji K, Rudnisky CJ, Rayat JS, Arora S, Sandhu S, Damji KF, Dorey MW. Phaco-trabectome versus phaco-iStent in patients with open-angle glaucoma. Can J Ophthalmol 2016; 52:99-106. [PMID: 28237158 DOI: 10.1016/j.jcjo.2016.06.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/26/2016] [Accepted: 06/16/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate efficacy and safety of phaco-trabectome (PT) versus phaco-iStent (Pi) for intraocular pressure (IOP) control in open-angle glaucoma (OAG). DESIGN Retrospective comparative case series. PARTICIPANTS A total of 70 eyes of 55 patients with OAG underwent either PT surgery by a single surgeon or Pi (insertion of 2 stents) by another surgeon in Canada between January 2010 and December 2012. METHODS The medical records of consecutive adult patients who underwent either PT or Pi surgery were reviewed. All patients who satisfied both the inclusion and exclusion criteria were included in the outcomes analyses. IOP reduction, reduction in glaucoma medication, safety profile, and best-corrected visual acuity were evaluated. RESULTS Thirty-six eyes of 30 patients had PT and 34 eyes of 25 patients had Pi. Baseline IOP was higher in the PT group (20.92 ± 5.07 mm Hg) than in the Pi group (17.47 ± 4.87 mm Hg; p = 0.026). At 12 months there was no significant difference between groups in relative reduction of mean IOP (PT -5.09 ± 5.73, 24% relative reduction vs. Pi -3.84 ± 3.80, 22% relative reduction; p = 0.331) or glaucoma medication use (PT -0.49 ± 1.17 vs. Pi -0.26 ± 0.73; p = 0.168) from baseline. However, Pi had significantly fewer individual complications (PT 20 vs. Pi 5; p < 0.0001) throughout the postoperative period. CONCLUSION At 12 months of follow-up, both techniques significantly lowered IOP, but fewer complications were observed in the Pi group.
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Affiliation(s)
- Khaliq Kurji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | | | - Jaspreet S Rayat
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Sourabh Arora
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Simrenjeet Sandhu
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta
| | - Michael W Dorey
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alta.
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Abstract
Ab interno trabeculectomy is one among several recently introduced minimally invasive glaucoma surgeries that avoid a conjunctival incision and full-thickness sclerostomy involved in traditional glaucoma surgery. Ablation of the trabecular meshwork and inner wall of Schlemm's canal is performed in an arcuate fashion via a clear corneal incision, alone or in combination with phacoemulsification cataract surgery. Intraocular pressure reduction following ab interno trabeculectomy is limited by resistance in distal outflow pathways and generally stabilizes in the mid-to-high teens. Relief of medication burden has been demonstrated by some studies. A very low rate of complications, most commonly transient hyphema and intraocular pressure elevations in the immediate postoperative period, have been reported. However, available data are derived from small retrospective and prospective case series. Randomized, controlled trials are needed to better elucidate the potential merits of ab interno trabeculectomy in the combined setting versus phacoemulsification cataract surgery alone and to compare it with other minimally invasive glaucoma surgeries.
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Affiliation(s)
- Kateki Vinod
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Weiner Y, Severson ML, Weiner A. Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy. J Cataract Refract Surg 2016; 41:2081-91. [PMID: 26703283 DOI: 10.1016/j.jcrs.2015.10.048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/19/2015] [Accepted: 03/19/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate intraocular pressure (IOP) immediately after cataract surgery with or without ab interno trabeculectomy (Trabectome) and whether trabeculectomy-related hyphema increases the risk for IOP spikes. SETTINGS Private glaucoma practice. DESIGN Retrospective interventional nonrandomized comparative chart review. METHODS Intraocular pressure was measured 3 to 4 hours and 20 hours postoperatively. RESULTS The combined group comprised 73 eyes of 73 patients and the cataract-only group, 75 eyes of 75 patients. The mean preoperative IOP was 15.8 mm Hg ± 3.6 (SD) and 14.9 ± 3.0 mm Hg, respectively (P = .09). In the combined group, the IOP decrease was significant at 3 to 4 hours (P = .0003) and 20 hours (P = .0007). In the cataract-only group, the IOP increased significantly (P < .0001 and P = .0035, respectively). The mean IOP was significantly lower in the combined group than in the cataract-only group at 3 to 4 hours (12.8 ± 5.9 mm Hg versus 19.7 ± 7.5 mm Hg) and 20 hours (12.7 ± 7.0 mm Hg versus 17.2 ± 5.9 mm Hg) (both P < .0001). Significantly fewer eyes in the combined group than in the cataract-only group had IOP spikes (overall, P = .0077; 3 to 4 hours, P = .001). Hyphema occurred in 35 eyes (47.9%) in the combined group; however, the IOP was similar with or without hyphema. Only 1 eye with an IOP spike in the combined group had hyphema. CONCLUSION Combining ab interno trabeculectomy and cataract surgery reduced short-term postoperative IOP and the incidence of IOP spikes despite the common hyphema. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Yotam Weiner
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA
| | - Melissa L Severson
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA
| | - Asher Weiner
- From the Oakland University William Beaumont School of Medicine (Y. Weiner), Rochester Hills, Michigan, Hudson Valley Community College (Severson), Troy, New York, and Ophthalmic Consultants of the Capital Region (Severson, A. Weiner), Albany, New York, USA.
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Response to "Advancing the Economic Assessment of Microinvasive Glaucoma Surgery". J Glaucoma 2016; 25:e723-4. [PMID: 27362451 DOI: 10.1097/ijg.0000000000000415] [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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Polat JK, Loewen NA. Combined phacoemulsification and trabectome for treatment of glaucoma. Surv Ophthalmol 2016; 62:698-705. [PMID: 27163670 DOI: 10.1016/j.survophthal.2016.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 03/03/2016] [Accepted: 03/17/2016] [Indexed: 11/25/2022]
Abstract
Ab interno trabeculectomy with the trabectome is a microincisional glaucoma surgery modality with an electrosurgical device to ablate the trabecular meshwork and inner wall of Schlemm canal to restore conventional outflow along its physiological route, thereby decreasing intraocular pressure. The device was approved by the FDA in 2004 and has since gained widespread use. Trabectome can be performed on its own or combined with cataract surgery for the treatment of ocular hypertension or advanced glaucoma with similar intraocular pressure reduction. It can be used after failed classical glaucoma surgeries and in narrow angles. Postoperative average intraocular pressure is independent of preoperative pressure and can be expected to be near 15 mm Hg with a theoretical minimum close to episcleral venous pressure. In combination with tube shunts, low intraocular pressures can be achieved during the hypertensive phase and long term. Although early postoperative hyphema is common, complications are rare and similar to those seen in cataract surgery, resulting in a safety profile that is favorable compared to older glaucoma surgeries. Aqueous angiography that is under development will allow anatomically targeted ablation.
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Affiliation(s)
- Julia K Polat
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Khan M, Saheb H, Neelakantan A, Fellman R, Vest Z, Harasymowycz P, Ahmed IIK. Efficacy and safety of combined cataract surgery with 2 trabecular microbypass stents versus ab interno trabeculotomy. J Cataract Refract Surg 2016; 41:1716-24. [PMID: 26432130 DOI: 10.1016/j.jcrs.2014.12.061] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the outcomes of combined cataract surgery with trabecular microbypass stents and ab interno trabeculotomy in patients with open-angle glaucoma. SETTING University of Toronto, Toronto, Ontario, and University of Montreal, Montreal, Quebec, Canada, and Glaucoma Associates of Texas, Dallas, Texas, USA. DESIGN Retrospective case series. METHODS Patients with primary open-angle, pseudoexfoliative, or pigmentary dispersion glaucoma were included. Primary outcome measures were intraocular pressure (IOP), postoperative medications, success (IOP ≤18 mm Hg, no glaucoma medications or reoperations), and postoperative adverse events. RESULTS The average patient age was 76.5 years ± 12 [SD]. Forty-nine eyes had phacoemulsification and 2 had stent implantations; 52 eyes had phacoemulsification and trabeculotomy surgery with a 12-month postoperative follow-up. The analysis of variance indicated a significant reduction in mean IOP from baseline to 12 months for stent (19.6 ± 5.3 mm Hg to 14.3 ± 3.1 mm Hg; P < .001) and trabeculotomy (20.6 ± 6.8 mm Hg to 17.3 ± 6.5 mm Hg; P < .001) and lower mean IOP at 12 months in the stent group (P = .01). The median number of glaucoma medications decreased from baseline to 12 months in both groups and was lower in the stent group at 3, 6, and 12 months. Thirty-nine percent (19 eyes) in the stent group and 14% (7 eyes) in the trabeculotomy group achieved success at 12 months (P = .006). The incidence of hyphema was lower in the stent group (P = .008). CONCLUSIONS Both types of surgery achieved a significant reduction in IOP and medication use at 12 months, with the stent group achieving higher success and a reduced incidence of postoperative hyphema. FINANCIAL DISCLOSURE Dr. Ahmed is a consultant to and investigator for Glaukos Corp., Ivantis, Inc., Transcend Medical, Inc., and Aquesys, Inc., and has received speaker honoraria from Neomedix, Inc. Dr. Saheb has received travel funding from Glaukos Corp., Ivantis, Inc., and Transcend Medical, Inc., and a research grant from Ivantis, Inc. Dr. Harasymowycz has received a research grant from Ivantis, Inc. Dr. Fellman is a consultant to Endo Optiks, Inc., and has received honoraria from Optous and research funds from Ivantis, Inc., Glaukos Corp., and Transcend Medical, Inc. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Michelle Khan
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Hady Saheb
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Arvind Neelakantan
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Ronald Fellman
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Zachary Vest
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Paul Harasymowycz
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA
| | - Iqbal Ike K Ahmed
- From the University of Toronto (Khan), Toronto, Ontario, McGill University Health Centre (Saheb), University of Montreal (Harasymowycz), Montreal, Quebec, and Credit Valley EyeCare (Ahmed), Mississauga, Ontario, Canada; the Glaucoma Center of Texas (Neelakantan) and Glaucoma Associates of Texas (Fellman, Vest), Dallas, Texas, USA.
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Akil H, Chopra V, Huang A, Loewen N, Noguchi J, Francis BA. Clinical results of ab interno trabeculotomy using the Trabectome in patients with pigmentary glaucoma compared to primary open angle glaucoma. Clin Exp Ophthalmol 2016; 44:563-569. [DOI: 10.1111/ceo.12737] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/07/2016] [Accepted: 02/21/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Handan Akil
- Doheny Eye Institute, Doheny Image Reading Center; Los Angeles California USA
| | - Vikas Chopra
- Doheny Eye Institute, Doheny Image Reading Center; Los Angeles California USA
- Department of Ophthalmology; David Geffen School of Medicine; Los Angeles California USA
| | - Alex Huang
- Doheny Eye Institute, Doheny Image Reading Center; Los Angeles California USA
- Department of Ophthalmology; David Geffen School of Medicine; Los Angeles California USA
| | - Nils Loewen
- Department of Ophthalmology; University of Pittsburgh; Pennsylvania USA
| | - Jonathan Noguchi
- University of California, San Diego School of Medicine; La Jolla California USA
| | - Brian A Francis
- Doheny Eye Institute, Doheny Image Reading Center; Los Angeles California USA
- Department of Ophthalmology; David Geffen School of Medicine; Los Angeles California USA
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