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Strzalkowska A, Hoffmann EM, Strzalkowski P, Stingl JV, Pfeiffer N, Schuster AK. [Real-world outcomes of glaucoma surgical procedures for open-angle glaucoma]. DIE OPHTHALMOLOGIE 2023; 120:1107-1116. [PMID: 37880486 DOI: 10.1007/s00347-023-01941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
This article provides an overview of real-world outcomes in glaucoma surgical procedures. While randomized clinical trials provide valuable insights, they do not fully reflect real-world clinical practice. Real-world studies enable the evaluation of outcomes in uncontrolled settings and play a crucial role in counselling and decision-making for glaucoma treatment. By examining real-world data the article aims to identify rare adverse events that may go unnoticed in controlled clinical trials. The focus is on assessing the effectiveness and safety of glaucoma surgical procedures beyond the controlled trial setting.
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Affiliation(s)
- Alicja Strzalkowska
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Esther M Hoffmann
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | | | - Julia V Stingl
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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The case for standalone micro-invasive glaucoma surgery: rethinking the role of surgery in the glaucoma treatment paradigm. Curr Opin Ophthalmol 2023; 34:138-145. [PMID: 36373756 PMCID: PMC9894157 DOI: 10.1097/icu.0000000000000927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW To highlight progress in glaucoma therapy challenging the traditional medication-first approach and present evidence supporting early standalone surgery in the era of micro-invasive glaucoma surgery (MIGS). RECENT FINDINGS Medical therapy is limited by well documented poor adherence that compromises the quality of intraocular pressure reduction. Results from modern clinical trials demonstrate advantages of selective laser trabeculoplasty and MIGS procedures in terms of both IOP control and progression risk. SUMMARY The MIGS options for pseudophakic or precataractous patients are limited by regulatory rules that require the performance of some procedures only at the time of cataract surgery. These include the iStent/iStent Inject and the Hydrus implants. Nonbleb-forming procedures currently available for standalone use in eyes with mild-moderate primary open-angle glaucoma include gonioscopy-assisted transluminal trabeculotomy (which lowers IOP by 28-61% and medication use by 38-73% in various studies), trabecular ablation with the Trabectome (23-39% and 21-43%, respectively), excisional goniotomy with the Kahook Dual Blade (15-36% and 15-40%, respectively), ab interno canaloplasty (35% and 57%, respectively), and combined canaloplasty and trabeculotomy using the OMNI system (39-40% and 64-73%, respectively). For patients who would benefit from early standalone surgery, these procedures offer meaningful reductions in both IOP and medication burden.
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Barkander A, Economou MA, Jóhannesson G. Kahook Dual-Blade Goniotomy with and without Phacoemulsification in Medically Uncontrolled Glaucoma. Clin Ophthalmol 2023; 17:1385-1394. [PMID: 37204995 PMCID: PMC10187655 DOI: 10.2147/opth.s409375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023] Open
Abstract
Purpose To evaluate the 2-year efficacy and safety of Kahook dual-blade (KDB) goniotomy in patients with medically uncontrolled glaucoma. Methods This was a retrospective case-series study of 90 consecutive patients with primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEXG) that underwent KDB goniotomy alone (KDB-alone group) or KDB goniotomy in combination with phacoemulsification (KDB-phaco group) during 2019-2020. All patients were uncontrolled on three or more medications. Surgical success was defined as an IOP reduction ≥20% and/or a reduction of one or more medications at 24 months. We also report IOP levels and number of medications from baseline to 24 months, as well as the need for further glaucoma interventions. Results At 24 months, mean IOP had reduced from 24.8±8.3 to 15.0±5.3 mmHg in the KDB-alone group (P<0.001) and from 22.3±5.8 to 13.9±3.0 mmHg in the KDB-phaco group (P<0.001). Medications had reduced from 3.5±0.6 to 3.1±0.9 in the KDB-alone group (P=0.047) and from 3.3±0.5 to 2.3±1.1 in the KDB-phaco group (P<0.001). An IOP reduction ≥20% and/or a reduction with one or more medications was achieved by 47% of eyes in the KDB-alone group and by 76% of eyes in the KDB-phaco group. Eyes with PEXG and POAG responded equally well to the success criteria. During the 24-month follow-up, additional glaucoma surgery or transscleral photocoagulation was performed in 28% of eyes in the KDB-alone group and in 12% of eyes in the KDB-phaco group. Conclusion In patients with medically uncontrolled glaucoma, KDB had a significant IOP-lowering effect after 24 months, but success rates were higher when KDB was performed in combination with cataract surgery compared to stand-alone treatment.
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Affiliation(s)
- Anna Barkander
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
- Correspondence: Anna Barkander, Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, SE-901 85, Sweden, Tel +46 63 15 30 00, Email
| | - Mario A Economou
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Ophthalmology, Capio Sophiahemmet Hospital, Stockholm, Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
- Department of Ophthalmology, University of Iceland, Reykjavik, Iceland
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Feinberg L, Swampillai AJ, Byles D, Smith M. Six year outcomes of combined phacoemulsification surgery and endoscopic cyclophotocoagulation in refractory glaucoma. Graefes Arch Clin Exp Ophthalmol 2022; 261:1339-1347. [PMID: 36482212 DOI: 10.1007/s00417-022-05906-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/13/2022] [Accepted: 11/08/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study is to describe the 6-year results of combined phacoemulsification surgery and endoscopic cyclophotocoagulation (Phaco-ECP) surgery in patients with uncontrolled glaucoma and no previous glaucoma surgery. METHODS This is a retrospective case series of 84 eyes. The primary outcome measure was intraocular pressure (IOP) reduction 6 years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 6 years. Failure was defined as IOP higher than 21 mm Hg or lower than 6 mm Hg or IOP not reduced by 20% from baseline at the 1, 2, 3, 4, 5, or 6-year time points or further laser or other surgery to reduce IOP at any timepoint. RESULTS There was a statistically significant decrease in mean IOP from 18.9 mmHg pre-operatively to 13.7, 12.8, 13.0, 12.7, 12.5, and 12.3 mmHg at the 1, 2, 3, 4, 5, and 6 years post-operatively respectively (p < 0.001). Fifty-seven (68%) reached criteria for failure by 6 years. In 36% of cases, this was due to inadequate IOP control, whereas 32% required further laser or surgery. When we excluded patients who only had selective laser trabeculoplasty rather than further surgery, the failure rate reduced to 51%. Eleven percent had a post-operative complication, 2.4% requiring further surgical intervention. CONCLUSIONS At 6 years postoperatively, combined phaco-ECP achieved a significant reduction in IOP in patients with uncontrolled glaucoma and no previous drainage surgery. Significant complications were uncommon, but 68% was classified as surgical failures by the six year point.
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Affiliation(s)
- Leo Feinberg
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, Devon, UK.
| | - Andrew J Swampillai
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - Daniel Byles
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, Devon, UK
| | - Michael Smith
- West of England Eye Unit, Royal Devon University Healthcare NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, Devon, UK
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Lima FLD, Diniz-Filho A, Suzuki ER. Procedimentos Minimamente Invasivos para Glaucoma: uma revisão atualizada da literatura. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Outcomes of Prolene Gonioscopy-assisted Transluminal Trabeculotomy in Primary Open-angle Glaucoma and Pseudoexfoliative Glaucoma: A Comparative Study. J Glaucoma 2022; 31:751-756. [PMID: 35696703 DOI: 10.1097/ijg.0000000000002063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/15/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Gonioscopy-assisted transluminal trabeculotomy (GATT) provides greater intraocular pressure (IOP) reduction in pseudoexfoliative glaucoma (PXG) than in primary open-angle glaucoma (POAG) in the first years of surgery; however, the difference between groups equalizes in the long-term. PURPOSE To compare outcomes of GATT in eyes with POAG and PXG. METHODS Single-center, retrospective, comparative case series. A total of 202 eyes (91 eyes of POAG; 111 eyes of PXG) were included. GATT was performed as a standalone procedure or in combination with cataract extraction (CE). Outcome measures were change in IOP and number of medications at all time points (1, 3, 6, 9, 12, 18, 24, and 36 mo after surgery), success rate (IOP reduction ≥20% from baseline or IOP between 6-21 mmHg, without further glaucoma surgery), and complication rate. Cumulative success probabilities were compared using Kaplan-Meier survival analyses. RESULTS The mean IOP decreased by 8.8 mmHg (34.4%) in the POAG group with a mean decrease of 2 glaucoma medications at final visit. In the PXG group, the mean IOP decreased by 12.8 mm Hg (44.6%) on 2.3 fewer medications. Mean IOP reduction was significantly higher in PXG than POAG at all time points up to 2-year visit (P<0.05 for all), after which the difference was not significant. Cumulative success probability during the first year was significantly higher in PXG (97.6%) than in POAG (86.8%) (P=0.01); no significant difference was found at 2-year (P=0.07) and 3-year visits (P=0.24). CONCLUSION GATT was safe and effectively reduced the IOP and medication burden in patients with POAG and PXG. In the first year following GATT, a significantly higher success rate was noted in PXG compared to POAG, however, in subsequent years, the success rate was similar at ~ 75%.
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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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Okuda M, Mori S, Takano F, Murai Y, Ueda K, Sakamoto M, Kurimoto T, Yamada‐Nakanishi Y, Nakamura M. Association of the prolonged use of anti-glaucoma medications with the surgical failure of ab interno microhook trabeculotomy. Acta Ophthalmol 2022; 100:e1209-e1215. [PMID: 35080795 DOI: 10.1111/aos.15090] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/03/2021] [Accepted: 12/29/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE This study examined the perioperative factors affecting surgical success in ab interno microhook trabeculotomy (μTLO). METHODS A total of 146 consecutive patients who underwent μTLO were included in this retrospective study. We performed Cox proportional hazard modelling by setting surgical success at 1 year as an objective variable. The explanatory variables included age, sex, glaucoma type, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation (MD) of the Humphrey visual field test, duration of glaucoma drug use, antithrombotic drug use, combined cataract surgery, incision range and diabetes mellitus. Additionally, we performed 1:1 matching using propensity score analysis and compared the perioperative parameters between durations of glaucoma drug use of <4.5 years and ≥ 4.5 years (50 patients each). We defined surgical success as satisfaction of all three criteria: IOP 5-21 mmHg, IOP reduction of ≥20% from the preoperative IOP and no additional glaucoma surgery. RESULTS The Cox proportional hazard model revealed that a longer duration of anti-glaucoma medication was significantly associated with surgical failure. Propensity score matching analysis showed that the <4.5-year users of anti-glaucoma drugs had significantly higher success rates than the ≥4.5-year users (72% versus 52%; p = 0.04). CONCLUSIONS The prolonged use of multiple glaucoma drugs adversely affected the outcome of μTLO at least at 1 year postoperatively.
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Affiliation(s)
- Mina Okuda
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Sotaro Mori
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Fumio Takano
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yusuke Murai
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Kaori Ueda
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Mari Sakamoto
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Takuji Kurimoto
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Yuko Yamada‐Nakanishi
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery Kobe University Graduate School of Medicine Kobe Japan
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Non-inferiority of Microhook to Trabectome: Trabectome vs. ab interno Microhook Trabeculotomy Comparative Study (TramTrac Study). Ophthalmol Glaucoma 2021; 5:452-461. [PMID: 34839035 DOI: 10.1016/j.ogla.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To elucidate the non-inferiority of ab interno microhook trabeculotomy (μTLO) using a recently developed reusable stainless spatula-type microhook device to incise the trabecular meshwork to trabectome (TOM) in terms of the 1-year postoperative outcomes of Japanese patients with glaucoma by means of propensity score analyses. DESIGN A multicenter retrospective cohort study. PARTICIPANTS We enrolled 553 and 392 patients who underwent TOM and μTLO, respectively, between January 2014 and March 2020 at 10 facilities. METHODS Logistic regression analysis was conducted to calculate the propensity score, which indicates the likelihood of treatment assignment (TOM or μTLO). We set the following factors as outcome-related covariates: age, sex, facility, glaucoma disease types, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation of the Humphrey visual field test and antithrombotic drug use, the presence or absence of combined cataract surgery, and incision range of trabecular meshwork (one or two quadrants). We analyzed four different methods (matching, inverse probability of treatment weighting (IPTW), stratification, and regression adjustment) using the propensity score. We set 15% as the non-inferiority margin based on previous trabectome meta-analysis results. MAIN OUTCOME MEASURES The primary outcome was surgical success at 1 year postoperatively. We defined surgical success as satisfying all three criteria: (1) IOP within 5-21 mmHg; (2) IOP reduction of ≥20% from preoperative IOP; and (3) no additional glaucoma surgery. RESULTS The 95% confidence interval of risk difference of surgical failure in μTLO in reference to TOM was -12.1 to +9.5% in matching, -12.7 to +11.1% in IPTW, -12.2 to +7.0 in stratification, and -9.7 to +8.1% in regression adjustment, all of which fell within the predetermined non-inferiority margin of 15%. CONCLUSIONS Surgical success of μTLO at 1-year postoperatively was not inferior to that of TOM.
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Characteristics of glaucoma patients with intraocular pressure elevation early after trabectome surgery. Graefes Arch Clin Exp Ophthalmol 2021; 260:537-543. [PMID: 34468832 DOI: 10.1007/s00417-021-05355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To analyze the rate and time of occurrence of intraocular pressure (IOP) elevation early after trabectome surgery (TOM) and the characteristics of glaucoma patients recovering from IOP elevation. METHOD Four hundred sixty eyes of 460 glaucoma (191 primary and 269 secondary open-angle glaucoma) patients who underwent TOM were evaluated. IOP elevation early after TOM was diagnosed when IOP increased by more than 5 mmHg over baseline within 1 week to 3 months. If the IOP decreased with the administration of anti-glaucoma eye drops alone, patients were classified as recovered. If the IOP did not decrease despite additional anti-glaucoma eye drop use, patients were classified as non-recovered. The rate and time of occurrence of IOP elevation early after TOM were investigated. Demographic and ocular variables related to recovery and non-recovery were identified by multivariate logistic regression analysis. RESULTS Of the 460 patients, IOP elevation early after TOM occurred in 102 (22.2%). IOP elevation occurred most frequently at postoperative week 1. Of the 102 patients with IOP elevation, 55 (53.9%) recovered and 47 (46.1%) did not. A large hyphema size the day after surgery was associated with increased likelihood of recovery from IOP elevation (odds ratio [OR], 6.6). A history of past selective laser trabeculoplasty (SLT; OR, 0.10) and high baseline IOP (OR, 0.86) were associated with reduced likelihood of recovery from IOP elevation. CONCLUSION IOP elevation early after TOM occurred most frequently at postoperative week 1. Patients with a large hyphema size, no history of SLT, and a lower baseline IOP recovered from IOP elevation early after TOM. A large hyphema the day after surgery suggested an increased likelihood of recovery from IOP elevation.
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Nobl M, Freissinger S, Kassumeh S, Priglinger S, Mackert MJ. One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma. PLoS One 2021; 16:e0256670. [PMID: 34449795 PMCID: PMC8396760 DOI: 10.1371/journal.pone.0256670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). METHODS In this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups. RESULTS Patient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group. CONCLUSION Microshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.
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Affiliation(s)
- Matthias Nobl
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
- * E-mail:
| | - Sigrid Freissinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marc J. Mackert
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, 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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Wang Y, Liang ZQ, Zhang Y, Hennein L, Han Y, Wu HJ. Efficacy and safety of phacoemulsification plus goniosynechialysis and trabectome in patients with primary angle-closure glaucoma. Sci Rep 2021; 11:13921. [PMID: 34230569 PMCID: PMC8260581 DOI: 10.1038/s41598-021-92972-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/10/2021] [Indexed: 11/09/2022] Open
Abstract
We evaluated the efficacy and safety of combined phacoemulsification, intraocular lens implantation, goniosynechialysis (GSL), and trabectome in patients with primary angle-closure glaucoma (PACG). Twenty patients (22 eyes) of PACG treated with combined phacoemulsification, intraocular lens implantation, GSL, and trabectome between September 2017 and September 2020 were included in this case series study. The intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity (BCVA) were recorded at baseline, 1, 3, 6, and 12 months after surgery. Successful surgery was defined as IOP < 21 mmHg with or without IOP-lowering medications. IOP was decreased significantly from 22.07 ± 6.62 mmHg at baseline to 15.06 ± 3.39 mmHg at 12 months' follow-up (p = 0.001). The number of glaucoma medications was significantly reduced from 2.68 ± 1.17 preoperatively to 0.78 ± 0.73 at 12 months' follow-up (p < 0.01). The rate of successful surgery was 88.9% at 12 months. The reduction in IOP showed a positive correlation with baseline IOP (p < 0.001), and the reduction in number of glaucoma medications was positively correlated with baseline number of glaucoma medications (p < 0.001). There were no vision-threatening complications intraoperatively or postoperatively. Combined phacoemulsification, IOL implantation, GSL, and trabectome were effective and safe in PACG patients in this study. These combined surgical techniques may be useful in PACG patients, especially those with long term and extensive peripheral anterior synechiae.
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Affiliation(s)
- Yu Wang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Zhi-Qiao Liang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China
| | - Lauren Hennein
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Hui-Juan Wu
- Department of Ophthalmology, Peking University People's Hospital, Eye Diseases and Optometry Institute, Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
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Pahlitzsch M, Davids AM, Winterhalter S, Zorn M, Reitemeyer E, Klamann MKJ, Torun N, Bertelmann E, Maier AK. Selective Laser Trabeculoplasty Versus MIGS: Forgotten Art or First-Step Procedure in Selected Patients with Open-Angle Glaucoma. Ophthalmol Ther 2021; 10:509-524. [PMID: 33963524 PMCID: PMC8319229 DOI: 10.1007/s40123-021-00347-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/24/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice. Methods A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95–105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome®, NeoMedix, Tustin, USA), and 130 patients received iStent inject® implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan–Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy). Results In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome® IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject® by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome® and iStent inject® could not demonstrate a significant reduction in glaucoma therapy (Trabectome®p = 0.138, iStent inject®p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome®, 77.6% iStent inject®) and criterion B (74.5% SLT, 48.0% Trabectome®, 56.2% iStent inject®). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome®, 7.0% in iStent inject® and criterion D 3.0% in SLT, 4.3% in Trabectome®, 3.7% in iStent inject® in 3-year follow-up. Conclusion The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité – Universitätsmedizin Berlin, EA4/047/20—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00347-0.
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Affiliation(s)
- Milena Pahlitzsch
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anja-Maria Davids
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Malte Zorn
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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15
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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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16
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Arnljots TS, Economou MA. Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2021; 15:541-550. [PMID: 33603332 PMCID: PMC7884935 DOI: 10.2147/opth.s284687] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation. Materials and Methods Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving >20% IOP reduction and number of eyes with postoperative IOP <19 mmHg at last follow-up. Results A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9±6.5 (KDB-alone) to 29.5±7.6 (phaco-iStent inject) months. Pre- and post-operative IOPs were 22.2±5.8 mmHg and 15.9±4.3 mmHg (P=0.004) in the KDB-alone, 24.2±6.8 mmHg and 16.2±6.7 mmHg (P=0.001) in the phaco-KDB, 20.6±5.4 mmHg and 20.9±6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9±5.5 mmHg and 15.6±3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred. Conclusion All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.
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Affiliation(s)
| | - Mario A Economou
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Ophthalmology, Sophiahemmet Hospital, Stockholm, Sweden
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17
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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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18
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Fontana L, De Maria M, Caristia A, Mastrofilippo V, Braglia L, Iannetta D, Scarale GP. Comparison of Gonioscopy-assisted Transluminal Trabeculotomy Versus Trabeculectomy With Mitomycin C in Patients With Open-angle Glaucoma. J Glaucoma 2021; 30:101-108. [PMID: 33031187 DOI: 10.1097/ijg.0000000000001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
PRCIS Trabeculectomy (TRAB) lowers the intraocular pressure (IOP) more than gonioscopy-assisted transluminal trabeculotomy (GATT) at 18 months, with a reduction in IOP of 30% or more and a significant reduction in the number of glaucoma medications compared with baseline. PURPOSE To compare the IOP-lowering efficacy of GATT with mitomycin-C augmented TRAB in patients with uncontrolled open-angle glaucoma. METHODS Single-center, retrospective, comparative cohort study. One hundred ten consecutive patients (110 eyes) underwent GATT (n=61) or TRAB (n=49). The primary outcome measure was IOP reduction, defined as a percentage decrease ≥30% and absolute IOP≤18 mm Hg at 18 months with (qualified) or without (complete) medications. Secondary outcomes were visual field change, number of glaucoma medications, complications, and reintervention. RESULTS The mean±SD baseline IOP was 30.04±7.5 and 27.59±4.70 (P=0.072) with the mean number of medications of 3.08±0.73 and 2.92±0.91 (P=0.310) in TRAB and GATT, respectively. At 18 months, the mean±SD IOP was 15.26±3.47 mm Hg and 12.48±4.58 mm Hg after GATT and TRAB, respectively (P=0.002). The percentage of IOP lowering from baseline was 56.05±17.72 after TRAB and 42.04±15.56 after GATT (P<0.001). Percentages of complete and qualified success were 59% and 27% after TRAB and 46% and 31% after GATT (P=0.353). No change in visual field loss was observed in both groups. The mean reduction in medications was 2.3±1.4 and 2.1±1.5 in TRAB and GATT, respectively (P=0.493). The most frequent complication after TRAB was hypotony and after GATT hyphema. Reintervention occurred in 8.2% of cases after TRAB and in 14.8% after GATT (P=0.341). CONCLUSIONS IOP lowering was greater after TRAB than after GATT at 18 months with a significant reduction in the number of medications after both procedures. Complications and reintervention occurred equally in both groups but differed in type.
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Affiliation(s)
| | - Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS di Reggio Emilia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Luca Braglia
- Clinical Trials and Statistics Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia
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19
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Tojo N, Hayashi A. The Outcomes of Trabectome Surgery in Patients with Low, Middle, and High Preoperative Intraocular Pressure. Clin Ophthalmol 2020; 14:4099-4108. [PMID: 33273806 PMCID: PMC7708680 DOI: 10.2147/opth.s285883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/12/2020] [Indexed: 11/23/2022] Open
Abstract
Background We compared the efficiency of trabectome surgery for patients with differing preoperative intraocular pressure (IOP) values in a single-facility retrospective study. We evaluated surgical outcomes based on three grades of preoperative IOP: high (hi-IOP, >26 mmHg), middle (mid-IOP, 18–26 mmHg), and low (lo-IOP, <18 mmHg). Patients and Methods We analyzed the cases of 204 eyes that underwent trabectome surgery and were followed >2 years. We defined failure as a reduction of IOP <20% or requiring additional glaucoma surgery. We used 4 cutoff values >21, >18, >15, and >12 mmHg. Other factors that may affect surgical outcomes were also investigated: age, central corneal thickness (CCT), history of selective laser trabeculotrabculoplasty (SLT), preoperative visual field, and simultaneous cataract surgery. Results Trabectome surgeries significantly decreased the IOP values from 23.0 ± 7.2 mmHg to 13.6 ± 3.6 mmHg at 2 years post-surgery. The mid-IOP group achieved significantly better surgical outcomes than the lo-IOP and hi-IOP groups with cutoff values 21, 18, and 15 mmHg. A thin CCT and simultaneous cataract surgery were significantly related to better surgical outcomes with cutoff value 21.18 and 15 mmHg. Conclusion For the patients with preoperative IOP <18 mmHg, it was difficult to decrease their IOP >20% with trabectome surgery. Patients with preoperative IOP values >26 mmHg often required additional glaucoma surgery.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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20
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El Hoffy NM, Abdel Azim EA, Hathout RM, Fouly MA, Elkheshen SA. Glaucoma: Management and Future Perspectives for Nanotechnology-Based Treatment Modalities. Eur J Pharm Sci 2020; 158:105648. [PMID: 33227347 DOI: 10.1016/j.ejps.2020.105648] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/12/2020] [Accepted: 11/13/2020] [Indexed: 12/11/2022]
Abstract
Glaucoma, being asymptomatic for relatively late stage, is recognized as a worldwide cause of irreversible vision loss. The eye is an impervious organ that exhibits natural anatomical and physiological barriers which renders the design of an efficient ocular delivery system a formidable task and challenge scientists to find alternative formulation approaches. In the field of glaucoma treatment, smart delivery systems for targeting have aroused interest in the topical ocular delivery field owing to its potentiality to oppress many treatment challenges associated with many of glaucoma types. The current momentum of nano-pharmaceuticals, in the development of advanced drug delivery systems, hold promises for much improved therapies for glaucoma to reduce its impact on vision loss. In this review, a brief about glaucoma; its etiology, predisposing factors and different treatment modalities has been reviewed. The diverse ocular drug delivery systems currently available or under investigations have been presented. Additionally, future foreseeing of new drug delivery systems that may represent potential means for more efficient glaucoma management are overviewed. Finally, a gab-analysis for the required investigation to pave the road for commercialization of ocular novel-delivery systems based on the nano-technology are discussed.
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Affiliation(s)
- Nada M El Hoffy
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt
| | - Engy A Abdel Azim
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University in Egypt
| | - Rania M Hathout
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Seham A Elkheshen
- Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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21
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Kasahara M, Shoji N. Effectiveness and limitations of minimally invasive glaucoma surgery targeting Schlemm's canal. Jpn J Ophthalmol 2020; 65:6-22. [PMID: 33150512 DOI: 10.1007/s10384-020-00781-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022]
Abstract
Glaucoma surgery is performed to lower intraocular pressure (IOP); ideally, the IOP reduction is safely maintained for an extended period of time. Although trabeculectomy was considered the gold standard for glaucoma surgery for many years because of its effective IOP reduction, yet now it is considered unsafe because of serious complications. In recent years, minimally invasive glaucoma surgery (MIGS), which emphasizes safety and can be performed rapidly, has become widespread. Because MIGS does not involve conjunctival incisions, patients can undergo future trabeculectomy. If IOP reduction can be maintained safely, the number of anti-glaucoma drops can be reduced and visual function maintained, good outcomes for patients with glaucoma. Currently, many types of MIGS approved in Japan are reported to yield relatively good results, with targets of approximately 15-19 mmHg. However, the IOP-lowering effects of MIGS are limited. In procedures targeting Schlemm's canal, it is difficult to lower IOP beyond episcleral venous pressure. In some instances, a beneficial effect cannot be achieved if function is reduced beyond the collector channel. There are many unclear aspects regarding long-term outcomes following MIGS. Notably, investigation is ongoing to determine which patients are likely to benefit most from surgery. Based on previous reports, this review describes the characteristics and results of MIGS, approved in Japan, as well as underlying factors that affect the preoperative predictions and outcomes of the surgical procedure.
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Affiliation(s)
- Masayuki Kasahara
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Esfandiari H, Hassanpour K, Knowlton P, Shazly T, Yaseri M, Loewen NA. Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison. J Ophthalmic Vis Res 2020; 15:509-516. [PMID: 33133442 PMCID: PMC7591847 DOI: 10.18502/jovr.v15i4.7789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 04/13/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. Methods In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). Results The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668). Conclusion We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Peter Knowlton
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Tarek Shazly
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.,Department of Ophthalmology, University of Würzburg, Würzburg, Germany
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23
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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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Barbosa NB, Grippo TM. Excisional goniotomy with Kahook Dual Blade in a patient with glaucoma secondary to Transthyretin Amyloidosis. Am J Ophthalmol Case Rep 2020; 19:100750. [PMID: 32514488 PMCID: PMC7267710 DOI: 10.1016/j.ajoc.2020.100750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/13/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To report for the first time the successful use of the Kahook Dual Blade excisional goniotomy technique in a patient with Transthyretin Amyloidosis. PATIENT AND METHODS The Kahook Dual Blade is a single use ab interno trabeculectomy device that removes the trabecular meshwork reducing aqueous humor outflow resistance. A patient with Transthyretin Amyloidosis underwent this procedure. RESULTS Ab interno goniotomy with Kahook Dual Blade was a successful surgical solution to reduce intraocular pressure in a patient with Transthyretin Amyloidosis secondary glaucoma controlling IOP in association with topical hypotensors for at least 6 months. CONCLUSIONS Ab interno goniotomy with Kahook Dual Blade is a surgical option for this type of glaucoma, that treats the main site of aqueous outflow resistance in this pathology with the advantage of being minimally invasive.
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Affiliation(s)
| | - Tomas M. Grippo
- Grippo Glaucoma and Cataract Center, Buenos Aires, Argentina
- Hospital Aleman, Buenos Aires, Argentina
- Yale University, CT, USA
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Abstract
PRéCIS:: The preoperative factors associated with a decreased survival rate of ab interno trabeculotomy (AbIT) perfomed using a Trabectome in open-angle glaucoma were selective laser trabeculoplasty (SLT) performed previously and axial length (AL) over 23.82 mm. PURPOSE The purpose of this study was to find preoperative factors that predict outcomes of AbIT by a Trabectome. MATERIALS AND METHODS This retrospective single-center cohort study involved consecutive patients with primary open-angle glaucoma and exfoliation glaucoma treated at Helsinki University Hospital with AbIT with preoperative intraocular pressure (IOP) ≥18 mm Hg and follow-up of at least 1 year. Success was defined as lowering of their IOP by at least 20% from baseline or reduction in glaucoma medications without any rise in IOP above baseline, and no subsequent glaucoma surgery. RESULTS Of the total 72 eyes of 67 patients, 51 eyes had exfoliation glaucoma and 21 had primary open-angle glaucoma. Mean preoperative IOP was 25.2±5.3 mm Hg, with a mean of 3.2±1.2 glaucoma medications. In the multivariable model, a history of preoperative SLT and higher preoperative AL had hazard ratios of 2.99 [95% confidence interval (CI): 1.26-7.10] and 1.53 (95% CI: 1.12-2.09) with statistical significance (P=0.013 and 0.007). The statistically significant cutoff point was 23.82 mm in AL in relation to the success rate, with success times taken into account (P<0.001). AL over 23.82 mm had hazard ratio of 5.75 (95% CI: 2.57-12.87, P<0.001). CONCLUSION Previous SLT and AL over 23.82 mm reduce survival after AbIT.
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Long-term clinical results of trabectome surgery in patients with open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2020; 258:2467-2476. [PMID: 32857189 DOI: 10.1007/s00417-020-04897-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/09/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the 72-month clinical results of trabectome surgery (TOM) in patients with primary open-angle glaucoma (POAG), secondary OAG and childhood glaucoma. METHOD A total of 305 eyes from 249 glaucoma patients were analyzed in the current retrospective single-center study. Kaplan-Meier analysis was performed using three criteria: criterion A (postoperative intraocular pressure [IOP] ≤ 21 mmHg and ≥ 20% reduction from baseline IOP); criterion B (postoperative IOP ≤ 18 mmHg and ≥ 20% reduction from baseline IOP); and criterion C (postoperative IOP ≤ 16 mmHg and ≥ 20% reduction from baseline IOP). The changes in IOP, medication score, success probability, results of the multivariate analysis for success and failure risk factors, and complications were analyzed. RESULTS The baseline IOP in all glaucoma patients decreased from 29.2 ± 9.8 mmHg with a 5.3 ± 1.7 medication score to 16.4 ± 5.8 mmHg (- 43.8%) with a 4.2 ± 1.5 medication score at 72 months (p < 0.01). The success probabilities in all cases for 72 months based on criterion A, B, and C were 44%, 35%, and 17%, respectively. For criterion A, no significant differences were found in the success probability according to the glaucoma subtype for 72 months. The combined surgical procedure significantly decreased the failure risk (hazard ratio [HR]: 0.59). On the other hand, the presence of POAG (HR: 1.6) and a history of past selective laser trabeculoplasty (HR: 2.2) significantly increased failure risk. One patient (0.3%) demonstrated endophthalmitis after TOM but recovered through appropriate treatment. CONCLUSION At the 72-month time point, approximately half of the glaucoma patients maintained an IOP ≤ 21 mmHg with ≥ 20% IOP reduction. TOM is a safe surgery but may not yield sufficient IOP reduction in patients who have received SLT or have POAG.
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Sharkawi E, Lindegger DJ, Artes PH, Lehmann-Clarke L, El Wardani M, Misteli M, Pasquier J, Guarnieri A. Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol 2020; 105:977-982. [PMID: 32727734 PMCID: PMC8237193 DOI: 10.1136/bjophthalmol-2020-315954] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/13/2020] [Accepted: 07/05/2020] [Indexed: 01/04/2023]
Abstract
AIM To report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG). METHODS Prospective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate. RESULTS Mean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p<0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%. CONCLUSION At 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.
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Affiliation(s)
| | | | - Paul H Artes
- University of Plymouth, Plymouth, UK.,Southwest Eye Institute, Tavistock, UK
| | | | | | | | - Jérôme Pasquier
- Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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ElMallah MK, Berdahl JP, Williamson BK, Dorairaj SK, Kahook MY, Gallardo MJ, Mahootchi A, Smith SN, Rappaport LA, Diaz-Robles D, Lazcano-Gomez GS. Twelve-Month Outcomes of Stand-Alone Excisional Goniotomy in Mild to Severe Glaucoma. Clin Ophthalmol 2020; 14:1891-1897. [PMID: 32694910 PMCID: PMC7340474 DOI: 10.2147/opth.s256423] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/07/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To describe 12-month intraocular pressure (IOP) and medication use outcomes following excisional goniotomy (EG) as a stand-alone procedure in eyes with medically uncontrolled glaucoma. METHODS This was a retrospective analysis of data from surgeons at 8 centers (6 US, 2 Mexico). Eyes with glaucoma undergoing standalone EG with a specialized instrument (Kahook Dual Blade, New World Medical, Rancho Cucamonga, CA) for IOP reduction and followed for 12 months postoperatively were included. Data were collected preoperatively, intraoperatively, and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. The primary outcome was reduction from baseline in IOP, and key secondary outcomes included IOP-lowering medication reduction as well as adverse events. RESULTS A total of 42 eyes were analyzed, of which 36 (85.7%) had mild to severe primary open-angle glaucoma (POAG). Mean (standard error) IOP at baseline was 21.6 (0.8) mmHg, and mean number of medications used at baseline was 2.6 (0.2). At 3, 6, and 12 months postoperatively, mean IOP reductions from baseline were 4.6 mmHg (22.3%), 5.6 mmHg (27.7%), and 3.9 mmHg (19.3%) (p≤0.001 at each time point). At the same time points, mean medications reductions of 0.7 (25.8%), 0.9 (32.6%), and 0.3 (12.5%) medications were seen (p<0.05 at months 3 and 6, not significant at month 12). Six eyes (14.3%) underwent additional glaucoma surgery during the 12-month follow-up period. DISCUSSION Standalone EG with KDB can reduce IOP, and in many cases reduce medication use, through up to 12 months in eyes with mild to severe glaucoma. Statistically significant and clinically relevant reductions in IOP were seen at every time point. While the goal of surgery was not to reduce medication burden, mean medication use was significantly reduced at all but the last time point. In the majority of eyes, the need for a bleb-based glaucoma procedure was delayed or prevented for at least 12 months.
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Wang C, Dang Y, Shah P, Esfandiari H, Hong Y, Loewen RT, Waxman S, Atta S, Xia X, Loewen NA. Intraocular pressure reduction in a pigmentary glaucoma model by Goniotome Ab interno trabeculectomy. PLoS One 2020; 15:e0231360. [PMID: 32298335 PMCID: PMC7162452 DOI: 10.1371/journal.pone.0231360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/21/2020] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. METHODS Eight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained. RESULTS After the first 90° TM excision, IOP was significantly lower in G (10.2±2.4 mmHg, n = 7) than C (20.0±2.0mmHg, n = 8, P<0.01). Outflow facility in G (0.38±0.07 μl/min/mmHg) was higher than C (0.16±0.02 μl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n = 7) was significantly lower than C (20.3±1.7 mmHg, n = 8, P<0.001), while the outflow facility in G (0.50±0.05 μl/min/mmHg, n = 7) was higher than C (0.16±0.01 μl/min/mmHg, n = 8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P = 0.20) or outflow facility (P = 0.17) further. CONCLUSIONS Excision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility.
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Affiliation(s)
- Chao Wang
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Yalong Dang
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Priyal Shah
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Hamed Esfandiari
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Ying Hong
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Ralitsa T. Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Susannah Waxman
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Sarah Atta
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America
| | - Xiaobo Xia
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Nils A. Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
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Pohlmann D, Pahlitzsch M, Schlickeiser S, Metzner S, Lenglinger M, Bertelmann E, Maier AKB, Winterhalter S, Pleyer U. Virus-associated anterior uveitis and secondary glaucoma: Diagnostics, clinical characteristics, and surgical options. PLoS One 2020; 15:e0229260. [PMID: 32092116 PMCID: PMC7039515 DOI: 10.1371/journal.pone.0229260] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/02/2020] [Indexed: 12/18/2022] Open
Abstract
In this retrospective, single-center, observational study, we compared the clinical characteristics, analyzed the glaucoma development, and the glaucoma surgery requirement mediators in patients with different virus-associated anterior uveitis (VAU). In total, 270 patients (= eyes) with VAU confirmed by positive Goldmann-Witmer coefficients (GWC) for cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubella virus (RV), and multiple virus (MV) were included. Clinical records of these patients were analyzed. Demographic constitution, clinical findings, glaucoma development, and surgeries were recorded. The concentrations of 27 immune mediators were measured in 150 samples of aqueous humor. The GWC analysis demonstrated positive results for CMV in 57 (21%), HSV in 77 (29%), VZV in 45 (17%), RV in 77 (29%), and MV in 14 (5%) patients. CMV and RV AU occurred predominantly in younger and male patients, while VZV and HSV AU appeared mainly with the elderly and females (P<0.0001). The clinical features of all viruses revealed many similarities. In total, 52 patients (19%) showed glaucomatous damage and of these, 27 patients (10%) needed a glaucoma surgery. Minimal-invasive glaucoma surgery (MIGS) showed a reliable IOP reduction in the short-term period. In 10 patients (37%), the first surgical intervention failed and a follow-up surgery was required. We conclude that different virus entities in anterior uveitis present specific risks for the development of glaucoma as well as necessary surgery. MIGS can be suggested as first-line-treatment in individual cases, however, the device needs to be carefully chosen by experienced specialists based on the individual needs of the patient. Filtrating glaucoma surgery can be recommended in VAU as an effective therapy to reduce the IOP over a longer period of time.
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Affiliation(s)
- Dominika Pohlmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Milena Pahlitzsch
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Schlickeiser
- Institute of Medical Immunology, Charité–University Medicine, Berlin, Berlin, Germany
| | - Sylvia Metzner
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Lenglinger
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Anna-Karina B. Maier
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sibylle Winterhalter
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Uwe Pleyer
- Berlin Institute of Health, Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Mosaed S. Ab interno trabeculotomy in uveitic glaucoma: Confirmation of original results with extended applications. Clin Exp Ophthalmol 2020; 48:12-13. [PMID: 32036631 DOI: 10.1111/ceo.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sameh Mosaed
- Gavin Herbert Eye Institute, University of California, Irvine, California
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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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Abstract
Surgical and laser procedures traditionally used in the management of exfoliation glaucoma (XFG) include laser trabeculoplasty, trabeculectomy, and glaucoma drainage implant surgery. Having demonstrated similar safety and efficacy in XFG compared with primary open-angle glaucoma, trabeculectomy remains the most commonly performed surgery in XFG. Recent trends in practice patterns in developed nations demonstrate a shift towards glaucoma drainage implant surgery, which is currently the procedure of choice in XFG for many, particularly in developed nations. In addition, cataract surgery alone may significantly decrease intraocular pressure in patients with XFG, may prevent glaucoma development in patients with exfoliation syndrome, and is recommended to be performed early in the course of the disease. With the relatively recent introduction of nonpenetrating glaucoma surgery and the ongoing evolution of minimally invasive glaucoma surgery, several other surgical procedures have now become part of the glaucoma surgeon's armamentarium when treating XFG, including the Ex-PRESS shunt, deep sclerectomy, viscocanalostomy, Trabectome, as well as angle procedures. These techniques have demonstrated promising results in various types of glaucoma. More research is, however, needed to establish the safety and efficacy of these procedures in XFG.
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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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Ab interno canaloplasty (ABiC)—12-month results of a new minimally invasive glaucoma surgery (MIGS). Graefes Arch Clin Exp Ophthalmol 2019; 257:1947-1953. [DOI: 10.1007/s00417-019-04366-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 04/07/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022] Open
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Marcos Parra MT, Salinas López JA, López Grau NS, Ceausescu AM, Pérez Santonja JJ. XEN implant device versus trabeculectomy, either alone or in combination with phacoemulsification, in open-angle glaucoma patients. Graefes Arch Clin Exp Ophthalmol 2019; 257:1741-1750. [PMID: 31093766 DOI: 10.1007/s00417-019-04341-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/23/2019] [Accepted: 04/26/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To compare the efficacy and safety of the XEN45 implant with that of trabeculectomy (TRAB), either alone or in combination with phacoemulsification (PHACO), in patients with open-angle glaucoma (OAG). METHODS Retrospective, single-center and comparative study conducted on OAG patients. Patients were divided into four groups: group 1 (XEN alone); group 2 (XEN+PHACO); group 3 (TRAB alone); group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN implant), while groups 3 and 4 were also combined (TRAB surgery). The main outcome measure was intraocular pressure (IOP). RESULTS Ninety-one patients (121 eyes; 65 XEN and 56 TRAB) were included. IOP reduction was - 6.7 (- 10.4 to - 3.0) mmHg, p = 0.0013; - 3.5 (- 5.0 to - 2.0) mmHg, p < 0.0001; - 8.1 (- 10.4 to - 5.9) mmHg, p < 0.0001l; and - 7.3 (- 9.3 to - 5.3) mmHg, p < 0.0001 in the XEN alone, XEN+PHACO, TRAB alone, and TRAB+PHACO, respectively. At month 12, an IOP ≥ 6 and ≤ 16 mm without treatment was achieved by 44 (67.7%) and 43 (76.8%), p = 0.2687 in the XEN implant and the TRAB surgery groups, respectively. The mean number of antiglaucoma medications was significantly reduced in all the study groups (p < 0.0001 each). Needling occurred in 20.0% (13/65) of eyes in the XEN implant group, while hyphema occurred in 30.4% (17/56) of eyes in the TRAB group. CONCLUSIONS XEN implant, either alone or in combination with phacoemulsification, significantly reduces both IOP and the number of antiglaucoma medications to a similar rate than trabeculectomy, but with a better safety profile.
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Affiliation(s)
- María Teresa Marcos Parra
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain.
| | - Javier Alejandro Salinas López
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Noelia Soledad López Grau
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Ana María Ceausescu
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
| | - Juan José Pérez Santonja
- Ophthalmology Department, Hospital General Universitario de Alicante, Alicante, Pintor Baeza, 11, 03010, Alicante, Spain
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Avar M, Jordan JF, Neuburger M, Engesser D, Lübke J, Anton A, Wecker T. Long-term follow-up of intraocular pressure and pressure-lowering medication in patients after ab-interno trabeculectomy with the Trabectome. Graefes Arch Clin Exp Ophthalmol 2019; 257:997-1003. [PMID: 30739156 DOI: 10.1007/s00417-019-04259-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The minimally invasive ab-interno trabeculectomy (AIT) via electro-ablation with the Trabectome has been on the European market since 2009. Many studies have proven the safety and efficacy of the procedure. Up until now, studies investigating the long-term effect of AIT have been sparse. In this study, we present long-term results of AIT in patients with primary and secondary open-angle glaucoma. METHODS In a retrospective monocentric study, the data of all the patients having undergone the procedure in 2010 at our institution were recorded. Data was collected during routine examinations at our institution. In total, 81 eyes of 74 patients (46 patients with primary open-angle glaucoma (POAG), 28 patients with pseudoexfoliative glaucoma (PEXG)) were included. At every examination, the intraocular pressure (IOP) was measured using Goldmann applanation tonometry and the number of IOP-lowering medication was registered. Statistical analysis was done using the Kaplan-Meier analysis or Dunnett's t test, respectively. RESULTS For both groups (POAG and PEXG), we found a significant lowering of the IOP (28% for POAG and 26% for PEXG) and a significant reduction of the number of IOP-lowering medication (32% for POAG and 29% for PEXG) after a median follow-up period of 3.5 years. CONCLUSION In patients with open-angle glaucoma and especially pseudoexfoliative glaucoma, ab-interno trabeculectomy is an effective surgical procedure to significantly lower the intraocular pressure on a long-term basis.
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Affiliation(s)
- Markus Avar
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | | | | | - Diana Engesser
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jan Lübke
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexandra Anton
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Wecker
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Ophthalmic practice Dr. Wecker, Heilbronn, Germany
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Grisanti S, Grisanti S, Garcia-Feijoo J, Dick HB, Munoz-Negrete FJ, Arrondo E, Ianchulev T. Supraciliary microstent implantation for open-angle glaucoma: multicentre 3-year outcomes. BMJ Open Ophthalmol 2018; 3:e000183. [PMID: 30687782 PMCID: PMC6326317 DOI: 10.1136/bmjophth-2018-000183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective To describe the safety and effectiveness of CyPass supraciliary microstent implantation alone in eyes with open-angle glaucoma (OAG) followed up for up to 3 years. Methods and analysis This registry study included subjects with primary or secondary OAG who underwent CyPass Micro-Stent implantation alone at 12 sites in four European countries to reduce intraocular pressure (IOP) and/or use of IOP-lowering medications. The primary safety outcome was the incidence of adverse events. Secondary efficacy outcomes included mean changes from baseline in IOP and IOP-lowering medications. Eyes were subgrouped into those with low (< 21 mm Hg) and high (> 21 mm Hg) baseline IOP. Results This study included 225 eyes of 178 patients, with mean baseline IOP of 22.6 ± 6.7 mm Hg and a mean 2.2 ± 1.2 medications per eye. Common ocular adverse events included device obstruction (10.2%), IOP elevation > 10 mm Hg during follow-up (8.9%), retinal complications (4.4%) and loss of > 2 lines of best-corrected visual acuity (2.7%). Seventy-one eyes (31.6%) required secondary glaucoma surgery, with trabeculectomy (33 eyes) and second microstent implantation (13 eyes) being most common. At months 6–36, mean IOP reductions ranged from 4.4 to 5.1 mm Hg (15.8%–19.5%) and mean medication reductions from 0.2 to 1.2 (9.1%–54.5%). Mean IOP reduction was greater in eyes with higher than lower baseline IOP. Both subgroups showed reductions of 0.5–1.0 medication at 12–18 months. Conclusion CyPass microstent implantation demonstrated a safety profile consistent with other minimally invasive glaucoma surgeries and effectively lowered IOP for up to 3 years in eyes with OAG.
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Affiliation(s)
- Swaantje Grisanti
- Klinik fuer Augenheilkunde, Universitaetsklinikum Schleswig-Holstein, Luebeck, Germany
| | - Salvatore Grisanti
- Klinik fuer Augenheilkunde, Universitaetsklinikum Schleswig-Holstein, Luebeck, Germany
| | | | - H Burkhard Dick
- Center of Vision Science, Bochum University Eye Hospital, Bochum, Germany
| | | | - Elena Arrondo
- Instituto de Microcirugia Ocular (IMO), Barcelona, Spain
| | - Tsontcho Ianchulev
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, USA
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Dang YL, Wang X, Dai WW, Huang P, Loewen NA, Zhang C. Two-year outcomes of ab interno trabeculectomy with the Trabectome for Chinese primary open angle glaucoma: a retrospective multicenter study. Int J Ophthalmol 2018; 11:945-950. [PMID: 29977805 DOI: 10.18240/ijo.2018.06.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 04/28/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open angle glaucoma (POAG) patients. METHODS This was a multicenter, retrospective, observational study and included POAG patients with or without visually-significant cataracts. The Chinese patients were enrolled from three glaucoma centers and a group of comparable Japanese POAG patients was analyzed from our international Trabectome database. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2y. Success was defined as: 1) IOP≤21 mm Hg and at least 20% IOP reduction from baseline after 3mo at any two consecutive visits; 2) no additional glaucoma surgery required. RESULTS A total of 42 Chinese POAG patients from three glaucoma centers were enrolled. Twelve patients underwent Trabectome surgery combined with phacoemulsification and intraocular lens implantation while the remainder underwent Trabectome surgery alone. Thirteen patients had a history of failed glaucoma surgery and were considered as complicated cases. In China data, the mean preoperative IOP was 21.4±1.23 mm Hg. The Trabectome lowered IOP to 17.9±1.8 mm Hg at 2y (P=0.05). The number of glaucoma medications also decreased significantly from a baseline of 2.0±0.9 to 1.1±0.8 at 2y post-surgery (P=0.04). The overall 2-year success rate was 78%, with patients undergoing combined surgery having a higher success rate compared with those undergoing Trabectome surgery alone (100% vs 76%). In Japan data, the mean preoperative IOP was 20.8±7.7 mm Hg. The Trabectome lowered IOP to 12.20±2.0 mm Hg at 2y. The number of glaucoma medications also decreased significantly from a baseline of 2.1±0.9 to 3.4±0.6 at 2y post-surgery. In all patients, no major complications were seen. CONCLUSION Surgery with the Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.
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Affiliation(s)
- Ya-Long Dang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Restoration of Damaged Optic Nerve, Peking University Third Hospital, Beijing 100191, China.,Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.,Department of Ophthalmology, Sanmenxia Central Hospital, Sanmenxia 472000, Henan Province, China
| | - Xiao Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Wan-Wei Dai
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Restoration of Damaged Optic Nerve, Peking University Third Hospital, Beijing 100191, China.,Institution of Population Research, Peking University, Beijing 100191, China
| | - Ping Huang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Nils A Loewen
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Restoration of Damaged Optic Nerve, Peking University Third Hospital, Beijing 100191, China
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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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Davids AM, Pahlitzsch M, Boeker A, Torun N, Bertelmann E, Maier-Wenzel AK, Hager A, Gonnermann J, Klamann M. iStent inject as a reasonable alternative procedure following failed trabeculectomy? Eur J Ophthalmol 2018; 28:735-740. [PMID: 29592533 DOI: 10.1177/1120672117747010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: The aim of this study is to assess the intraocular pressure lowering effect and the performance of the glaucoma therapy of the iStent inject in glaucoma patients with uncontrolled intraocular pressure after failed trabeculectomy. METHODS: In this retrospective study, iStent inject implantation (Glaukos Corporation, Laguna Hills, CA, USA) was performed in 22 eyes of 21 subjects suffering from glaucoma (n = 18 primary open angle glaucoma, n = 3 pseudoexfoliation glaucoma, and n = 1 for secondary glaucoma) with an intraocular pressure above target pressure after failed trabeculectomy (mean = 9.6 ± 8.1 years; range: 1-35 years). The intraocular pressure and the number of antiglaucomatous medication were assessed preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery and compared to preoperative findings (SPSS v23.0; Shapiro-Wilk test, Wilcoxon test, Friedman test). RESULTS: The results showed a significant intraocular pressure decrease from 22.5 ± 4.6 to 15.5 ± 3.4 mmHg after 1 year follow-up (p = 0.012). The glaucoma therapy was 2.6 ± 1.2 preoperatively and reduced to 2.25 ± 1.5 number of medications after 1 year (p > 0.05). There was no significant difference in the number of medication during the whole follow-up period (1 year, p = 0.012). No significant intra- or postoperative complications were reported. CONCLUSION: Minimal invasive glaucoma surgery (iStent inject) can offer an effective intraocular pressure reduction in advanced adult primary and secondary open angle glaucoma after failed trabeculectomy in a follow-up period of 1 year. Glaucoma therapy, however, needs to be maintained to achieve an individual target pressure and to prevent glaucoma progression. In addition, a failure rate of 27.3% makes it necessary to select carefully patients for this treatment option.
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Affiliation(s)
- Anja-Maria Davids
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Boeker
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Annette Hager
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Gonnermann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Klamann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 2018; 102:1342-1350. [PMID: 29567789 DOI: 10.1136/bjophthalmol-2017-311321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022]
Abstract
Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.
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Affiliation(s)
- Samir Nazarali
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraz Damji
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Dang YL, Cen YJ, Hong Y, Huang P, Wang NL, Wang C, Zhang C. Safety and Efficiency of Trabectome-mediated Trabecular Meshwork Ablation for Chinese Glaucoma Patients: A Two-year, Retrospective, Multicentre Study. Chin Med J (Engl) 2018; 131:420-425. [PMID: 29451146 PMCID: PMC5830826 DOI: 10.4103/0366-6999.225050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients. METHODS This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percentages, and complications. Success was defined as an IOP <21 mmHg and at least a 20% IOP reduction from baseline after 3 months for any two consecutive visits, without additional glaucoma surgery. The data were processed using the R Stats Package version 3.0.0. The Wilcoxon test was used to compare the postoperative IOP and the number of glaucoma medications with baselines. The Kaplan-Meier test was used to calculate the 2-year success percentage. The risk factors related to Trabectome failure were determined by logistic regression. RESULTS A total of 120 glaucoma patients were enrolled. The Trabectome efficiently reduced the IOP from a baseline of 22.8 ± 1.34 mmHg to 17.6 ± 0.96 mmHg, and the use of glaucoma medications from 2.2 ± 0.17 mmHg to 1.4 ± 0.21 in a 2-year follow-up (both, P < 0.01). The overall success percentage was 80%. No risk factor related to Trabectome failure was identified. No vision-threatening complication was observed. Ten patients, who required secondary glaucoma surgery, all reached the target IOP. CONCLUSIONS In a 2-year follow-up, Trabectome was an efficient and safe procedure for Chinese glaucoma patients.
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Affiliation(s)
- Ya-Long Dang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Yu-Jie Cen
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Ying Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Ping Huang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
| | - Ning-Li Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Chao Wang
- Department of Ophthalmology, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
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Jiang N, Zhao GQ, Lin J, Hu LT, Che CY, Wang Q, Xu Q, Li C, Zhang J. Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma. Int J Ophthalmol 2018; 11:279-286. [PMID: 29487820 DOI: 10.18240/ijo.2018.02.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/21/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma. METHODS We performed a systematic search of the related literature in the Cochrane Library, PubMed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction (IOPR%) from baseline to end-point, the percentage of number of glaucoma medications reduction from pre- to post-operation, and the secondary efficacy evaluations were performed by odds ratio (OR) and 95% confidence interval (CI) for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using RevMan software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi2 test and the I2 measure. RESULTS Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification. CONCLUSION Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.
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Affiliation(s)
- Nan Jiang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Gui-Qiu Zhao
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jing Lin
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Li-Ting Hu
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Cheng-Ye Che
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Qian Wang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Qiang Xu
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Cui Li
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
| | - Jie Zhang
- Department of Ophthalmology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
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Pelitli Gürlü V, Güçlü H, Özal A, Benian Ö, Alimgil L. Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma. Int J Ophthalmol 2018; 11:66-70. [PMID: 29375993 PMCID: PMC5767660 DOI: 10.18240/ijo.2018.01.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the long term outcome of trabeculectomy in patients with pseudoexfoliative glaucoma (PEG) and primary open angle glaucoma (POAG) in terms of surgical success. METHODS The success of the trabeculectomy was evaluated by three criteria. Criterion A: intraocular pressure (IOP) ≤21 mm Hg and decrease in IOP ≥20%; Criterion B: IOP ≤18 mm Hg and decrease in IOP ≥30%; Criterion C: IOP ≤15 mm Hg and decrease in IOP ≥50%. Patients that met these criteria without medical treatment were considered to be completely successful, while those that met these criteria with medical treatment were considered partially successful. Significance levels of differences between the POAG and PEG groups in the Kaplan-Meier survival curves were calculated with the log-rank test. RESULTS Sixty-four eyes from 64 patients with PEG and 51 eyes from 51 patients with POAG were evaluated. No significant differences were detected between the PEG and POAG groups according to full or partial success relative to each of the three criteria (A: P=0.73, 0.32; B: P=0.73, 0.31; C:P=0.90, 0.27). CONCLUSION There is no difference in the long-term success of trabeculectomy between PEG and POAG patients whose clinical characteristics are otherwise the same.
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Affiliation(s)
- Vuslat Pelitli Gürlü
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Hande Güçlü
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Altan Özal
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Ömer Benian
- Department of Ophthalmology, Ekol Private Hospital, Edirne 22030, Turkey
| | - Levent Alimgil
- Department of Ophthalmology, Medicana Private Hospital, Istanbul 34520, Turkey
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