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Laroche D, Adebayo A, Brown A, Ng C, Sakkari S. Early cataract surgery and affordable Sinskey hook goniotomy in Black and Afro-Latino glaucoma patients: a 6-month retrospective study. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1294651. [PMID: 38984135 PMCID: PMC11182272 DOI: 10.3389/fopht.2024.1294651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/18/2024] [Indexed: 07/11/2024]
Abstract
Aim The purpose of this study was to determine the real-world efficacy of early phacoemulsification cataract surgery and goniotomy with a Sinskey hook in patients with glaucoma. Methods This study was conducted at Advanced Eye Care of New York, a private practice located in Manhattan, NY. This was a single-center, retrospective study of predominantly Black and Afro-Latino patients with glaucoma. These patients underwent early phacoemulsification cataract surgery and goniotomy using an affordable and reusable straight Sinskey hook (Ambler 200-μm tip). Patients who underwent the aforementioned procedure with 6 months of follow-up were included in this study. Investigated parameters were intraocular pressure, number of medications, mean deviation on visual field test, visual acuity, adverse events, and pre/postoperative spherical refractive error. Results Among all 38 eyes that were enrolled in the study and underwent surgery (goniotomy using a Sinskey hook with phacoemulsification), mean intraocular pressure was reduced from 16.45 mmHg at baseline to 13.24 mmHg at month 6, a 19.5% reduction. The mean number of topical intraocular pressure-lowering medications used was reduced from 1.81 at baseline to 0.52 at month 6, a 71% reduction in topical medications. Conclusion Combined early cataract surgery and goniotomy performed with a Sinskey hook is an affordable microinvasive surgery and an effective way to reduce intraocular pressure and the number of ocular hypertensive medications used in Black and Afro-Latino patients with primary open-angle glaucoma.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
| | - Ayobami Adebayo
- Department of Ophthalmology, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Aaron Brown
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
| | - Chester Ng
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
| | - Soheil Sakkari
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
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Laroche D, Brown A, Sinon J, Martin A, Ng C, Sakkari S. Pilot report: objective quantification of trabecular meshwork pigmentation using densitometry and the NIDEK GS-1 gonioscope in glaucoma patients. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1322178. [PMID: 38983099 PMCID: PMC11182083 DOI: 10.3389/fopht.2023.1322178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/29/2023] [Indexed: 07/11/2024]
Abstract
In this case series, we present a methodology for a proof of principle for the development of a unique biomarker for pigmentary glaucoma to detect progression before nerve fiber layer loss. Out of the five patients in this case series, one was excluded because of an outlier due to pseudoexfoliation syndrome with excessively dense pigmentation of the trabecular meshwork. The remaining patients displayed a decreased visual field loss with increased superior to inferior trabecular meshwork ratios. This methodology, though limited due to small sample size, shows that in a limited number of patients, visual field loss is positively correlated with increased superior to inferior trabecular meshwork ratios. The next steps would be to look at patients without glaucoma and patients with pigmentary glaucoma, along with complete inter-eye comparisons for patients with unilateral exfoliation syndrome to act as controls. To our knowledge, this is a novel methodology, and if the pattern holds, it can act as proof of principle for the development of a novel early biomarker for pigmentary glaucoma to improve early intervention and delay vision loss.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, New York, NY, United States
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
| | - Aaron Brown
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine of Mount Sinai, New York, NY, United States
| | - Jose Sinon
- Department of Ophthalmology, Downstate Medical Center, New York, NY, United States
| | - Alexander Martin
- Department of Ophthalmology, Northwell Health, New York, NY, United States
| | - Chester Ng
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
| | - Sohail Sakkari
- Department of Ophthalmology, Advanced Eyecare of New York, New York, NY, United States
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Laroche D, Desrosiers A, Ng C. Short-term report of early glaucoma surgery with a clear lens extraction and an intraocular lens, OMNI canaloplasty, and a HYDRUS microstent: a case series in younger patients. FRONTIERS IN OPHTHALMOLOGY 2024; 3:1288052. [PMID: 38983083 PMCID: PMC11182160 DOI: 10.3389/fopht.2023.1288052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/29/2023] [Indexed: 07/11/2024]
Abstract
Purpose The purpose of this case series is to report the surgical outcomes from the combination of a clear lensectomy, OMNI® canaloplasty, and a HYDRUS® microstent with an adjacent goniotomy. Methods This is a retrospective non-comparative single-center case series of four black patients of African descent with glaucoma who were treated with a clear lensectomy, OMNI canaloplasty, and a HYDRUS microstent with an adjacent goniotomy. The surgeries were performed by an experienced cataract and glaucoma surgeon, Daniel Laroche, MD. The parameters investigated in this study were postoperative intraocular pressure (IOP) and the mean number of preoperative and postoperative medications needed. Results The mean age of the four patients was 44.5 years. All patients had a mean postoperative reduction in IOP of 17 mmHg to 12.7 mmHg. The mean number of preoperative medications was 2.2, while the mean number of postoperative medications was 0.3. Potential complications such as hyphema, IOP spikes, or corneal edema were not seen in this series. All patients achieved a lower IOP and stable vision with less refractive error. Patients also experienced improved visual fields, clearer vision, and more open angles. Conclusion Clear lensectomy and combined microinvasive glaucoma surgery (MIGS) in patients with primary open-angle glaucoma (POAG) and narrow-angle glaucoma (NAG) results in the safe lowering of IOP. The limitations of this study include the small series size and the retrospective potential for bias. Further research with a larger series and a prospective trial with follow-up should be performed.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, Icahn School of Medicine, Mount Sinai, New York, NY, United States
- Advanced Eye Care New York, New York, NY, United States
| | - Abelard Desrosiers
- City University of New York (CUNY) School of Medicine, New York, NY, United States
| | - Chester Ng
- Advanced Eye Care New York, New York, NY, United States
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Laroche D, Madu CT. Preventing Blindness with Early Cataract Surgery and Micro-Invasive Glaucoma Surgery in Patients Over 50: Guidance for Patients, Physicians and World Governments in Dealing with Glaucoma. Clin Ophthalmol 2023; 17:2929-2938. [PMID: 37814637 PMCID: PMC10560466 DOI: 10.2147/opth.s422415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
Purpose To offer clinical guidance and address safety and efficacy concerns regarding the growing use of micro-invasive glaucoma surgery (MIGS) as an initial treatment for glaucoma in adult patients. Design Narrative literature review. Methods A review was conducted to assess outcomes and complications of MIGS in the treatment of glaucoma, both alone and in combination with lens replacement. These outcomes were compared with those of standard glaucoma surgery and/or glaucoma management with medication. Results MIGS are effective at lowering intraocular pressure (IOP) over long periods of follow-up. These techniques share a similarly high safety profile between one another. MIGS were found to have lower complication rates and to be more effective in reducing the total amount of medication needed to maintain control of intraocular pressure than standard surgery approaches. Conclusion MIGS techniques are growing in popularity and have been demonstrated to be a safe and effective alternative to standard glaucoma surgery. Guidance in the implementation of these procedures has been outlined.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Advanced Eye Care of New York, New York, NY, USA
| | - Chisom T Madu
- City University of New York School of Medicine, New York, NY, USA
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Kuerten D, Walter P, Baumgarten S, Fuest M, Plange N. 12-month outcomes of ab interno excisional goniotomy combined with cataract surgery in primary open-angle glaucoma and normal tension glaucoma. Int Ophthalmol 2023; 43:2605-2612. [PMID: 36862355 PMCID: PMC10371902 DOI: 10.1007/s10792-023-02659-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 02/19/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of excisional goniotomy performed with the Kahook Dual Blade (KDB) combined with cataract surgery in patients with pimary open angle glaucoma (POAG) and Normal Tension Glaucoma (NTG) under topical therapy. Further sub-analysis was performed to compare between 90 and 120 degrees goniotomy. METHODS This was a prospective case series of 69 eyes from 69 adults (age 78 ± 5.9 years; male = 27, female = 42). Indications for surgery included insufficient IOP control with topical medication, glaucomatous damage progression under topical therapy and reduction of medication burden. Complete success was defined as IOP lowering below 21 mmHg without the need for topical medication. For NTG patients, complete success was defined as IOP lowering below 17 mmHg without the need for topical medication. RESULTS IOP was significantly lowered from 19.7 ± 4.7 to 15.1 ± 2.7 at 2 months, 15.8 ± 2.3 at 6 months and 16.1 ± 3.2 at 12 months (p < 0.05) for POAG and 15.1 ± 2.5 to 14.1 ± 2.4 at 2 months, 14.1 ± 3.1 at 6 months and 13.6 ± 1.8 at 12 months (p > 0.08) for NTG, respectively. Complete success was achieved in 64% of the patients. IOP lowering under 17 mmHg without the need for topical medication was achieved in 60% of the patients at 12 months. In NTG patients (14 eyes) IOP lowering under 17 mmHg without the need for topical medication was achieved in 71%. No significant difference was recorded in terms of IOP lowering at 12 months in-between 90° and 120° of treated trabecular meshwork (p > 0.7). No severe adverse reactions were recorded in this study. CONCLUSION One-year results show that KDB combined with cataract surgery is an effective treatment option for glaucoma patients. IOP lowering was successfully achieved in NTG patients with complete success in 70% of the patients. In our study, no significant differences were recorded in-between 90° and 120° of treated trabecular meshwork.
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Affiliation(s)
- David Kuerten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany.
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Sabine Baumgarten
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
| | - Niklas Plange
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstr. 30, 52057, Aachen, Germany
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Mispositioned Hydrus Microstents: A Case Series Imaged with NIDEK GS-1 Gonioscope. J Ophthalmol 2022; 2022:1605195. [PMID: 36119138 PMCID: PMC9477617 DOI: 10.1155/2022/1605195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction. The Hydrus microstent has become a common procedure in glaucoma surgery intended to improve outcomes of cataract surgery to lower intraocular pressure. Despite proper placement, this device can subsequently be noted to not be in the proper position. In this case series, we report mispositioned Hydrus microstents in five different patients and use NIDEK GS-1 gonioscopy. Case Report. We report five different patients who had cataract surgery and who were subsequently noted to have mispositioned Hydrus stents. No stents needed to be removed. All patients had improved vision and stable visual fields, and none required secondary surgery. Management and Outcome. In each case of mispositioned stents, vision was significantly improved and there was no inflammation or other complications noted. Discussion. Hydrus stents can be noted to be mispositioned during the post-operative period after successful insertion. This can often be well tolerated requiring no further intervention.
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Clear Lensectomy with Hydrus Stent in Black and Afro-Latino Patients: A 1-Year Retrospective Study. J Ophthalmol 2022; 2022:8011745. [PMID: 36091576 PMCID: PMC9453024 DOI: 10.1155/2022/8011745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose. To determine the efficacy and safety of phacoemulsification, clear lensectomy, and the Hydrus microstent (Ivantis, Inc.) in Black and Afro-Latino glaucoma patients. Method. This is a retrospective nonrandomized study of 134 Black and Afro-Latino patients who underwent clear lensectomy with Hydrus stent implant for the treatment of glaucoma. For comprehensive analysis, patients were divided into mild, moderate, and advanced glaucoma. The evaluated parameters were reductions in the number of medications, intraocular pressure (IOP), mean deviation on visual field test, and visual acuity. Results. A total of 134 patients with 1-year follow-up were evaluated. At 1 year, the average number of medications significantly decreased from 2.5 ± 1.4 preoperatively to 0.43 ± 1.04 (
) and IOP decreased from 14.4 ± 3.9 to 13.8 ± 3.10 (
). 110 (82.1%) patients were medication-free at 1 year (n = 57, 83.8% mild glaucoma; n = 37, 92.5% moderate glaucoma; n = 16, 61.5% advanced glaucoma). There was stabilization of mean deviation on the visual field test (baseline, −8.28; 1 year, −8.28;
). The most reported adverse effects were transient IOP spike and hyphema (n = 7, 5.2%; n = 3, 2.2%, respectively); both events were self-resolving. No decline in vision or sight-threatening complications were reported at 1 year, and no additional surgeries were required. Conclusion. This 1-year retrospective study demonstrated the efficacy and safety of clear lensectomy and Hydrus stent implantation in decreasing medication burden while maintaining lower IOP in Black and Afro-Latino glaucoma patients.
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Observation of Visual Quality after Femtosecond Laser-Assisted Cataract Surgery Combined with Trifocal Intraocular Lens Implantation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1519416. [PMID: 35813423 PMCID: PMC9270113 DOI: 10.1155/2022/1519416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/31/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022]
Abstract
Objective This study is the first observation of Alcon's PanOptix trifocal intraocular lens (IOL) implanted in 55 cataract patients with femtosecond laser-assisted cataract surgery. Methods Fifty-five patients (63 eyes) with cataract were treated with femtosecond laser-assisted cataract surgery combined with trifocal IOL implantation. Visual acuity, defocus curve, higher order aberration (HOA), refractive stability, eyeglass removal rate, and satisfaction were evaluated and analyzed. Results We found that the visual acuity of patients with near, intermediate, and distance vision was better than 0.1 LogMAR at 1, 3, and 6 months after the completion of surgery. The uncorrected near visual acuity (UCNVA), uncorrected intermediate visual acuity (UCIVA), and uncorrected distance visual acuity (UCDVA) of patients at 1, 3, and 6 months after surgery were compared with those before operation, showing statistical significance. Six months after the operation, all patients' surgical eyes had a smooth transition in the defocus range from +0D to -2.5D, and the visual acuity of the surgical eyes reached a level better than 0.1 LogMAR. The statistical results of 6-month follow-up showed that the eyeglass removal rate at near, intermediate, and far distances was 100%. At 6 months postoperatively, only 1 case had nocturnal glare, which affected life; 3 cases developed glare and halo but did not affect life. The patient satisfaction rate was 98.18%. Conclusions Femtosecond laser-assisted cataract surgery with trifocal IOL implantation can remove the lens from the patient with satisfactory visual quality and significantly improve the postoperative satisfaction of the patient.
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