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Prinz J, Cursiefen C, Bachmann B, Schaub F, Walter P, Fuest M, Prokosch V. [Glaucoma drainage devices in patients following injector-assisted implantation of an artificial iris into the ciliary sulcus : Video article]. DIE OPHTHALMOLOGIE 2024:10.1007/s00347-024-02120-7. [PMID: 39320479 DOI: 10.1007/s00347-024-02120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/27/2024] [Indexed: 09/26/2024]
Abstract
OBJECTIVE OF SURGERY The aim of this surgical technique is the implantation of a glaucoma drainage device (GDD) in eyes with aphakic glaucoma following injector-assisted implantation of an artificial iris into the ciliary sulcus. INDICATIONS This atraumatic tube insertion technique can be performed during GDD implantation after implantation of an artificial iris into the ciliary sulcus. SURGICAL TECHNIQUE Following injector-assisted implantation of an artificial iris into the ciliary sulcus of eyes, the iris can shift into the chamber angle. The GDD should be positioned in the quadrant in which the iridectomy is located. Otherwise, GDD implantation is not possible due to the resistance of the artificial iris. Alternatively, the artificial iris can be easily and non-traumatically rotated in the ciliary sulcus by flushing the anterior chamber with balanced salt solution (BSS) to move the iridectomy into the desired area and position the GDD tube in the anterior chamber. A surgical video, which is available online, shows the surgical technique in detail. FOLLOW-UP After GDD, dexamethasone eye drops should be applied 8 times daily for 1 week tapering down by 1 drop per week thereafter. Antibiotic eye drops, e.g., ofloxacin eye drops, are prescribed 4 times daily for 1 week and might be discontinued thereafter. EVIDENCE To date, this is the first description of a rotation of an artificial iris located in the ciliary sulcus by irrigation of the anterior chamber during GDD implantation.
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Affiliation(s)
- Julia Prinz
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, 50937, Köln, Deutschland
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, 52074, Aachen, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, 50937, Köln, Deutschland
| | - Björn Bachmann
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, 50937, Köln, Deutschland
| | - Friederike Schaub
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, 50937, Köln, Deutschland
- Klinik für Augenheilkunde, Universitätsmedizin Rostock, 18057, Rostock, Deutschland
| | - Peter Walter
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, 52074, Aachen, Deutschland
| | - Matthias Fuest
- Klinik für Augenheilkunde, Uniklinik RWTH Aachen, 52074, Aachen, Deutschland
| | - Verena Prokosch
- Zentrum für Augenheilkunde, Medizinische Fakultät und Universität zu Köln, Uniklinik Köln, 50937, Köln, Deutschland.
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Wang X, Chen K, Yao Y, Lin Y, Yang J, Zhu Y, Zhou B. TGFβ1-Induced Fibrotic Responses of Conjunctival Fibroblasts through the Wnt/β-Catenin/CRYAB Signaling Pathway. THE AMERICAN JOURNAL OF PATHOLOGY 2024; 194:1764-1779. [PMID: 38879081 DOI: 10.1016/j.ajpath.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/29/2024]
Abstract
Conjunctival fibrosis is a common postoperative complication of glaucoma filtration surgery, resulting in uncontrolled intraocular pressure and surgery failure. Therefore, there is an urgent need to understand the molecular mechanisms underlying conjunctival fibrosis and to explore novel pharmacologic anti-fibrosis therapies for glaucoma filtration surgery. Herein, the 4-dimensional data-independent acquisition (4D-DIA) quantitative proteomic results, coupled with experimental data, revealed the activation of the Wnt/β-catenin pathway in transforming growth factor (TGF)-β1-induced human conjunctival fibroblasts (HConFs). Treatment with ICG-001, a Wnt/β-catenin inhibitor, effectively inhibited cell proliferation and migration in TGFβ1-treated HConFs. ICG-001 treatment alleviated the increased generation of extracellular matrix proteins induced by TGFβ1. In addition, ICG-001 reduced the expression level of α smooth muscle actin (α-SMA) and inhibited cell contractility in TGFβ1-treated HConFs. Proteomics data further suggested that αB-crystallin (CRYAB) was a downstream target of Wnt/β-catenin, which was up-regulated by TGFβ1 and down-regulated by ICG-001. Immunoblotting assay also indicated that ICG-001 reduced the expressions of ubiquitin and β-catenin in TGFβ1-treated HConFs, implying that CRYAB stabilized β-catenin by inhibiting its ubiquitination degradation. Exogenous CRYAB promoted cell viability, increased extracellular matrix protein levels, and up-regulated α-SMA expression of HConFs under TGFβ1 stimulation. CRYAB rescued TGFβ1-induced fibrotic responses that were suppressed by ICG-001. In conclusion, this study elucidates the regulatory mechanism of the Wnt/β-catenin/CRYAB pathway in conjunctival fibrosis, offering promising therapeutic targets for mitigating bleb scarring after glaucoma filtration surgery.
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Affiliation(s)
- Xiaohui Wang
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; the Department of Ophthalmology
| | - Kaiping Chen
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; the Department of Ophthalmology
| | - Yihua Yao
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; the Department of Ophthalmology
| | - Yijun Lin
- National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China; and the Department of Bioengineering and Biopharmaceutics
| | - Juhua Yang
- School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Yihua Zhu
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; the Department of Ophthalmology.
| | - Biting Zhou
- The First Affiliated Hospital of Fujian Medical University, Fuzhou, China; the Department of Ophthalmology.
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Holekamp NM, Yaqub M, Ranade SV, Cantrell RA, Singh S, Gazzard G. Systematic Literature Reviews Comparing the Long-Term Safety Outcomes for the Port Delivery System with Ranibizumab (PDS) Versus Other Ocular Implants. Ophthalmol Ther 2024; 13:2303-2329. [PMID: 39090513 PMCID: PMC11341515 DOI: 10.1007/s40123-024-01001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES To determine whether the types and rates of post-surgical complications associated with the Port Delivery System with ranibizumab (PDS) are comparable with those reported for other ocular implants that cross the sclera. METHODS Systematic literature reviews were conducted to determine the long-term (≥ 18-month) safety of ocular implants that cross the sclera in clinical trials and real-world studies. Complication types and rates were compared with those reported for the PDS in phase III clinical trials (Archway, Pagoda, and Pavilion). RESULTS Sixteen clinical trials (24 publications) and 43 real-world studies were identified reporting 30 complications in eyes with 15 implant types and 8 ocular diseases. Implants were associated with an acceptable, well-characterized safety profile, with most complications resolving spontaneously or with treatment. Device-related complications were reported in 0.7% (0.0-5.0%) of study eyes in clinical trials and 1.3% (0.0-14.5%) of eyes in real-world studies. Rates of conjunctival complications were 2.1% (0.0-22.8%) and 2.2% (0.9-4.6%), respectively. The overall types and rates of adverse events of special interest reported for the PDS in phase III trials (cataract, conjunctival bleb, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, endophthalmitis, implant dislocation, retinal detachment, and hyphema) were within the ranges reported for other ocular implants. CONCLUSIONS The rates of complications reported in phase III clinical trials for the PDS were within the ranges reported for other ocular implants that cross the sclera. This suggests that the long-term safety of the PDS is consistent with other ocular devices established in ophthalmology clinical practice. TRIAL REGISTRATION PROSPERO international prospective register of systematic reviews: CRD5202234129, CRD42022343129.
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Affiliation(s)
- Nancy M Holekamp
- Pepose Vision Institute, Chesterfield, MO, USA.
- F. Hoffmann-La Roche Ltd, Basel, Switzerland.
| | - Manejeh Yaqub
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | - Shrirang V Ranade
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | - Ronald A Cantrell
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Gus Gazzard
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorsfield Biomedical Research Centre, Moorfield Eye Hospital NHS Foundation Trust, London, UK
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Gao X, Lin F, Lu P, Xie L, Tang L, Zhu X, Zhang Y, Lv A, Tang G, Zhang H, Yan X, Song Y, Xu J, Huang J, Zhang Y, Hu K, Peng Y, Wang Z, Li X, Chen W, Wang N, Barton K, Park KH, Aung T, Weinreb RN, Lam DSC, Fan S, Tham CC, Zhang X. Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study. J Glaucoma 2024; 33:632-639. [PMID: 38780279 DOI: 10.1097/ijg.0000000000002443] [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: 11/07/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PRCIS The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. PURPOSE To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. PATIENTS AND METHODS A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. RESULTS A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate. CONCLUSIONS The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.
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Affiliation(s)
- Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Lin Xie
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Xiaomin Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Jiangang Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Jingjing Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Yingzhe Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Kun Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Yuying Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, CA
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
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Ahmed F, Normando E, Ahmed S, Virdee S, Al-Nahrawy A. Evaluating the Safety and Efficacy of a Novel Glaucoma Drainage Device in High-Risk Adult Glaucoma Patients: A One-Year Pilot Study. J Clin Med 2024; 13:4996. [PMID: 39274211 PMCID: PMC11396561 DOI: 10.3390/jcm13174996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/16/2024] Open
Abstract
Background: We report on the 12-month safety and efficacy outcomes of a new non-valved glaucoma drainage device, the eyePlate-300 (Rheon Medical, Lausanne, Switzerland), in managing refractory glaucoma. Methods: A retrospective review was conducted on consecutive patients over 18 who underwent glaucoma drainage device (GDD) surgery with the eyePlate-300 after a single glaucoma consultation between February 2020 and April 2021, with at least 12 months of documented post-op follow-up. Results: A total of 16 eyes from 15 patients were included. Complete success was observed in 47% of patients and overall success in 83%. The mean IOP decreased from 31.5 mm Hg to 10.7 mm Hg (67% reduction from baseline), and the number of IOP-lowering drops was reduced from 3.1 to 0.7 at one year. The mean BCVA remained stable. No additional IOP-lowering surgeries were required, and no severe sight-threatening complications were noted. Conclusions: The initial one-year results suggest that the eyePlate could be a safe and effective device for reducing IOP in an ethnically diverse refractory glaucoma population. Further follow-up is necessary to determine the long-term safety and efficacy.
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Affiliation(s)
- Faisal Ahmed
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Imperial College Ophthalmology Research Group (ICORG), Department of Surgery and Cancer, Imperial College, London NW1 5QH, UK
| | - Eduardo Normando
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Imperial College Ophthalmology Research Group (ICORG), Department of Surgery and Cancer, Imperial College, London NW1 5QH, UK
| | - Syed Ahmed
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
| | - Simrun Virdee
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
| | - Ahmed Al-Nahrawy
- Department of Glaucoma, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK
- Imperial College Ophthalmology Research Group (ICORG), Department of Surgery and Cancer, Imperial College, London NW1 5QH, UK
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Gedde SJ, Vinod K, Bowden EC, Kolomeyer NN, Chopra V, Challa P, Budenz DL, Repka MX, Lum F. Special Commentary: Reporting Clinical Endpoints in Studies of Minimally Invasive Glaucoma Surgery. Ophthalmology 2024:S0161-6420(24)00456-1. [PMID: 39127407 DOI: 10.1016/j.ophtha.2024.07.030] [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: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) refers to a group of procedures generally characterized by an ab interno approach, minimal trauma to ocular tissue, moderate efficacy, an excellent safety profile, and rapid recovery. The number of MIGS procedures continues to increase, and their use has become widespread among glaucoma and cataract specialists. Standardization of the methodology and reporting of clinical endpoints in MIGS investigations enhances interpretation and comparison across different studies. The assessment of surgical interventions not only should consider statistical significance, but also whether the outcome is meaningful to patients. Minimal clinically important difference (MCID) is defined as the smallest change in a treatment outcome that is considered beneficial for an individual patient and prompts a change in their clinical management. Expert consensus is an accepted approach to determine the MCID. The American Academy of Ophthalmology's Glaucoma Preferred Practice Pattern® Committee is an expert panel that develops guidelines identifying characteristics and components of quality eye care. The Committee recommends that the cumulative probability of surgical success at 2 years with Kaplan-Meier survival analysis be used as the primary efficacy endpoint in MIGS studies. The Committee suggests that surgical success for standalone MIGS be defined as intraocular pressure (IOP) of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The proposed MCID for the cumulative probability of success of standalone MIGS at 2 years is 50%. The panel recommends that surgical success for MIGS combined with cataract extraction with intraocular lens implantation (CE-IOL) be defined as a decrease in glaucoma medical therapy of 1 medication or more from baseline without an increase in IOP or IOP of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The suggested MCID for the cumulative probability of success for MIGS combined with CE-IOL at 2 years is 65%. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Eileen C Bowden
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Natasha N Kolomeyer
- Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vikas Chopra
- Doheny and Stein Eye Institutes, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Pratap Challa
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California.
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King AJ, Hudson J, Azuara-Blanco A, Burr J, Kernohan A, Homer T, Shabaninejad H, Sparrow JM, Garway-Heath D, Barton K, Norrie J, Davidson T, Vale L, MacLennan G. Evaluating Primary Treatment for People with Advanced Glaucoma: Five-Year Results of the Treatment of Advanced Glaucoma Study. Ophthalmology 2024; 131:759-770. [PMID: 38199528 PMCID: PMC11190021 DOI: 10.1016/j.ophtha.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To determine whether primary trabeculectomy or medical treatment produces better outcomes in terms of quality of life (QoL), clinical effectiveness, and safety in patients with advanced glaucoma. DESIGN Multicenter randomized controlled trial. PARTICIPANTS Between June 3, 2014, and May 31, 2017, 453 adults with newly diagnosed advanced open-angle glaucoma in at least 1 eye (Hodapp classification) were recruited from 27 secondary care glaucoma departments in the United Kingdom. Two hundred twenty-seven were allocated to trabeculectomy, and 226 were allocated medical management. METHODS Participants were randomized on a 1:1 basis to have either mitomycin C-augmented trabeculectomy or escalating medical management with intraocular pressure (IOP)-reducing drops as the primary intervention and were followed up for 5 years. MAIN OUTCOME MEASURES The primary outcome was vision-specific QoL measured with the 25-item Visual Function Questionnaire (VFQ-25) at 5 years. Secondary outcomes were general health status, glaucoma-related QoL, clinical effectiveness (IOP, visual field, and visual acuity), and safety. RESULTS At 5 years, the mean ± standard deviation VFQ-25 scores in the trabeculectomy and medication arms were 83.3 ± 15.5 and 81.3 ± 17.5, respectively, and the mean difference was 1.01 (95% confidence interval [CI], -1.99 to 4.00; P = 0.51). The mean IOPs were 12.07 ± 5.18 mmHg and 14.76 ± 4.14 mmHg, respectively, and the mean difference was -2.56 (95% CI, -3.80 to -1.32; P < 0.001). Glaucoma severity measured with visual field mean deviation were -14.30 ± 7.14 dB and -16.74 ± 6.78 dB, respectively, with a mean difference of 1.87 (95% CI, 0.87-2.87 dB; P < 0.001). Safety events occurred in 115 (52.2%) of patients in the trabeculectomy arm and 124 (57.9%) of patients in the medication arm (relative risk, 0.92; 95% CI, 0.72-1.19; P = 0.54). Serious adverse events were rare. CONCLUSIONS At 5 years, the Treatment of Advanced Glaucoma Study demonstrated that primary trabeculectomy surgery is more effective in lowering IOP and preventing disease progression than primary medical treatment in patients with advanced disease and has a similar safety profile. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anthony J King
- Nottingham University Hospital, Nottingham, United Kingdom.
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Augusto Azuara-Blanco
- Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast, United Kingdom
| | - Jennifer Burr
- School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Ashleigh Kernohan
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Tara Homer
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Hosein Shabaninejad
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - John M Sparrow
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - David Garway-Heath
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Keith Barton
- National Institute for Health Research (NIHR) Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Tracey Davidson
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Luke Vale
- Health Economics Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
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8
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Nobl M, Freissinger S, Rudolph K, Vounotrypidis E, Kassumeh S, Priglinger S, Mackert MJ. Long-term Outcomes of PreserFlo MicroShunt versus XEN45 Gel Stent in Open-Angle Glaucoma. Klin Monbl Augenheilkd 2024; 241:805-812. [PMID: 37673088 DOI: 10.1055/a-2152-8455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To compare two glaucoma drainage devices with subconjunctival filtration (MicroShunt and XEN) for open-angle glaucoma (OAG), with respect to effectiveness and safety. PATIENTS AND METHODS This is a single center, retrospective, interventional study. In total, 106 eyes of 95 patients with OAG underwent surgery. Of these patients, 51 eyes of 45 patients received a MicroShunt implantation and 55 eyes of 50 patients received an XEN implantation. Failure was defined as an intraocular pressure (IOP) lower than 5 or higher than 17 mmHg at the end of follow-up after 2 years, the need for surgical revision, secondary glaucoma surgery, or loss of light perception. Outcome was rated as complete success or qualified success, depending on whether it was achieved with or without anti-glaucomatous medications. Postoperative complications and interventions were also documented for both groups. RESULTS In the MicroShunt group, mean IOP decreased from 20.6 ± 7.5 mmHg at baseline to 13.0 ± 3.9 mmHg (p < 0.0001) after 2 years. In the XEN group, mean IOP was lowered from 22.5 ± 7.9 mmHg to 13.5 ± 4.2 mmHg (p < 0.0001). In both groups, the mean number of medications was significantly reduced (MicroShunt 2.7 ± 1.2 to 0.9 ± 2.5; p < 0.0001 vs. XEN 3.2 ± 0.9 to 1.1 ± 1.5; p < 0.0001). In regard to success rates, 37% of MicroShunt patients achieved complete success and 57% qualified success at the end of follow-up. In the XEN group, rates were 25 and 45%, respectively. Patient demographics differed between the two groups with respect to age (MicroShunt 72.8 ± 8.7 vs. XEN 67.7 ± 9.0 years; p = 0.002). Postoperative complications were comparable between the two groups. CONCLUSION Both MicroShunt and XEN are effective in significantly reducing IOP and glaucoma medications in OAG, and with a good safety profile.
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Affiliation(s)
- Matthias Nobl
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | | | - Katrin Rudolph
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | | | - Stefan Kassumeh
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
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Rauchegger T, Krause SM, Nowosielski Y, Huber AL, Willeit P, Schmid E, Teuchner B. Three-year clinical outcome of XEN45 Gel Stent implantation versus trabeculectomy in patients with open angle glaucoma. Eye (Lond) 2024; 38:1908-1916. [PMID: 38548944 PMCID: PMC11226636 DOI: 10.1038/s41433-024-03042-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 07/07/2024] Open
Abstract
OBJECTIVE To reliably compare the three-year clinical outcome and safety of XEN45 Gel Stent implantation (XEN) vs. trabeculectomy (TRAB) in patients with glaucoma. SUBJECT/METHODS We conducted a retrospective cohort study with patients with primary open angle or pseudoexfoliation glaucoma with uncontrolled intraocular pressure (IOP) undergoing XEN or TRAB at the Innsbruck University Clinic of Ophthalmology and Optometry, Austria and analysed changes in IOP, numbers of IOP-lowering medications, and complete surgical success (i.e., IOP ≤ 18 mmHg, ≥20% IOP reduction and not requiring IOP-lowering medication) up to 36 months postoperatively. RESULTS Between 2013 and 2019, we performed XEN Gel Stent implantation in 58 eyes and trabeculectomy in 84 eyes. From baseline to 36 months, mean IOP decreased from 23.4 to 13.8 mmHg (mean reduction 35%, 95% confidence interval 23-48%, p < 0.001) in the XEN group and from 25.1 to 11.2 mmHg (mean reduction 50%, 41-60%, p < 0.001) in the TRAB group. TRAB provided higher IOP reduction than XEN Gel Stent implantation at 12, 24, and 36 months (all p < 0.05). In XEN versus TRAB, IOP-lowering medication was required by 98.3% vs. 97.6% before surgery (p = 0.781), differed significantly at month 12 (43.2% vs. 2.0%, p < 0.001)but not at month 24 or 36. Complete surgical success was achieved in 40.0% vs. 62.8% at month 24 (adjusted odds ratio 2.70; 1.04-7.00, p = 0.040) and 27.3% vs. 56.8% at month 36 (4.36; 1.25-15.18, p = 0.021). CONCLUSION Compared to XEN, TRAB was associated with lower intraocular pressure, less IOP-lowering medication, and higher probability of achieving complete surgical success over a 36-month follow-up period.
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Affiliation(s)
- Teresa Rauchegger
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sarah-Maria Krause
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Yvonne Nowosielski
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Lena Huber
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Willeit
- Institute of Health Economics, Medical University of Innsbruck, Innsbruck, Austria.
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Eduard Schmid
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Barbara Teuchner
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
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Boopathiraj N, Wagner IV, Lentz PC, Checo L, Dorairaj EA, Ahuja AS, Miller DD, Dorairaj S. 36-Month Outcomes of Ahmed ClearPath ® Glaucoma Drainage Device in Severe Primary Open Angle Glaucoma. Clin Ophthalmol 2024; 18:1735-1742. [PMID: 38912315 PMCID: PMC11193400 DOI: 10.2147/opth.s467894] [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: 03/08/2024] [Accepted: 06/12/2024] [Indexed: 06/25/2024] Open
Abstract
Purpose To evaluate the safety and effectiveness of the Ahmed ClearPath® (ACP) 250 mm2 glaucoma drainage device (GDD) in managing refractory primary open-angle glaucoma (POAG). Patients and Methods This was a retrospective case series focused on adult patients diagnosed with severe POAG who underwent implantation of an ACP GDD. Over a 36-month follow-up period, data on intraocular pressure (IOP), the number of glaucoma medications, and complications were recorded. The primary objectives were to assess the reductions from baseline in both IOP and medication usage, through 36 months. Secondary objectives included the proportion of eyes achieving an IOP reduction of ≥ 20% from baseline at 36 months. Intraoperative and postoperative complications were also assessed. Results Twelve eyes from 11 patients (mean age: 71.3 ± 14.1 years) met the inclusion criteria and were included in the study. All patients had severe POAG (n=11), with the majority being Caucasian (n=8) and female (n=10). The mean (standard deviation) IOP and number of glaucoma medications at baseline were 29 (7.6) mmHg and 3 (0.9), respectively. At 36 months, mean IOP was reduced to 10.6 (5.5) mmHg (-61.8%; p= 0.0008) and mean number of medications was reduced to 0.9 (0.9) (-71.4%; p=0.0005), with 88.9% of eyes achieving an IOP reduction by ≥20%. No vision threatening complications were observed. Conclusion To our knowledge this is the first study to report 36-month outcomes of the novel ACP device in the treatment of refractory POAG. The safety profile and efficacy of the ACP was found to be comparable to that of other commonly utilized GDD models.
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Affiliation(s)
| | | | - Paul Connor Lentz
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
- Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Abhimanyu S Ahuja
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
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Lee SY, Lee DY, Ahn J. Evaluation of machine learning approach for surgical results of Ahmed valve implantation in patients with glaucoma. BMC Ophthalmol 2024; 24:248. [PMID: 38862946 PMCID: PMC11167936 DOI: 10.1186/s12886-024-03510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Ahmed valve implantation demonstrated an increasing proportion in glaucoma surgery, but predicting the successful maintenance of target intraocular pressure remains a challenging task. This study aimed to evaluate the performance of machine learning (ML) in predicting surgical outcomes after Ahmed valve implantation and to assess potential risk factors associated with surgical failure to contribute to improving the success rate. METHODS This study used preoperative data of patients who underwent Ahmed valve implantation from 2017 to 2021 at Ajou University Hospital. These datasets included demographic and ophthalmic parameters (dataset A), systemic medical records excluding psychiatric records (dataset B), and psychiatric medications (dataset C). Logistic regression, extreme gradient boosting (XGBoost), and support vector machines were first evaluated using only dataset A. The algorithm with the best performance was selected based on the area under the receiver operating characteristics curve (AUROC). Finally, three additional prediction models were developed using the best performance algorithm, incorporating combinations of multiple datasets to predict surgical outcomes at 1 year. RESULTS Among 153 eyes of 133 patients, 131 (85.6%) and 22 (14.4%) eyes were categorized as the success and failure groups, respectively. The XGBoost was shown as the best-performance model with an AUROC value of 0.684, using only dataset A. The final three further prediction models were developed based on the combination of multiple datasets using the XGBoost model. All datasets combinations demonstrated the best performances in terms of AUROC (dataset A + B: 0.782; A + C: 0.773; A + B + C: 0.801). Furthermore, advancing age was a risk factor associated with a higher surgical failure incidence. CONCLUSIONS ML provides some predictive value in predicting the outcomes of Ahmed valve implantation at 1 year. ML evaluation revealed advancing age as a common risk factor for surgical failure.
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Affiliation(s)
- Seung Yeop Lee
- Department of Ophthalmology, Ajou University Medical Center, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, 154, Word Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Jaehong Ahn
- Department of Ophthalmology, Ajou University Medical Center, Ajou University School of Medicine, 164, World Cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea.
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Arnould L, Balsat E, Hashimoto Y, White A, Kong G, Dunn H, Fan L, Gabrielle PH, Bron AM, Creuzot-Garcher CP, Lawlor M. Two-year outcomes of Xen 45 gel stent implantation in patients with open-angle glaucoma: real-world data from the Fight Glaucoma Blindness registry. Br J Ophthalmol 2024:bjo-2023-325077. [PMID: 38789132 DOI: 10.1136/bjo-2023-325077] [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: 01/03/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To evaluate efficacy and safety outcomes of the Xen 45 gel stent implant over 24 months of follow-up. METHODS A retrospective analysis of prospectively collected data from the Fight Glaucoma Blindness observational registry. Complete success (CS) was defined as intraocular pressure (IOP) reduction ≥20% from preoperative and an IOP ≤18 mm Hg and ≥6 mm Hg with no secondary procedure at 2 years and without IOP-lowering medications. Qualified success (QS) was defined similarly, allowing the use of IOP-lowering medications. RESULTS The Xen 45 gel stent implant was implanted in 646 eyes of 515 patients. Preoperative IOP was 21.4±7.6 (mean±SD) mm Hg on 2.7±1.3 IOP-lowering medication and mean deviation was -10.2±8.4 dB. After 24-month follow-up, IOP was 16.8±7.3 mm Hg (mean reduction of 21.7%) on 1.2±1.4 IOP-lowering medications. CS and QS rates at 24 months were 26% and 48%, respectively. CS and QS were higher in the Xen stand-alone group (33% and 52%, respectively) than in the Xen+cataract group (16% and 42%, respectively). Bleb needling was performed in 28.4% of cases, and 18% underwent a secondary procedure. CONCLUSIONS The Xen 45 gel stent implant offers acceptable long-term efficacy for the treatment of open-angle glaucoma. However, there is a significant rate of reoperation and needling, and outcomes are less effective if combined with cataract surgery.
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Affiliation(s)
- Louis Arnould
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France
- Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), (EA 7460), Dijon, France
| | - Elise Balsat
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Yohei Hashimoto
- Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Andrew White
- Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - George Kong
- Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
| | - Hamish Dunn
- Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Leo Fan
- Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
| | - Pierre-Henry Gabrielle
- Ophthalmology, Centre Hospitalier Universitaire de Dijon, Dijon, France
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, France
| | - Alain M Bron
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, France
- Ophthalmology, University Hospital, Dijon, France
| | - Catherine P Creuzot-Garcher
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, INRA Centre de Dijon, Dijon, France
- Ophthalmology, University Hospital, Dijon, France
| | - Mitchell Lawlor
- Ophthalmology, Save Sight Institute, Sydney, New South Wales, Australia
- Ophthalmology, Sydney Hospital and Sydney Eye Hospital, Sydney, New South Wales, Australia
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13
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Landers JA, Mullany S, Craig JE. Intravitreal bevacizumab improves trabeculectomy survival at 12 months: the bevacizumab in trabeculectomy study-a randomised clinical trial. Br J Ophthalmol 2024; 108:679-686. [PMID: 37541768 PMCID: PMC11137456 DOI: 10.1136/bjo-2023-323526] [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: 03/11/2023] [Accepted: 05/02/2023] [Indexed: 08/06/2023]
Abstract
AIMS To evaluate the effect of an intraoperative dose of intravitreal bevacizumab (Avastin) on surgical success following trabeculectomy with mitomycin-C (MMC) over 12 months. METHODS A single centre, parallel, double-blinded randomised, placebo-controlled trial recruiting patients requiring trabeculectomy for progressing glaucoma. Patients were randomised to intravitreal bevacizumab or placebo. MAIN OUTCOME MEASURE The primary outcome of treatment success was defined by 'complete success' when intraocular pressure (IOP) remained less than a predefined target IOP without the requirement of topical medication, or 'qualified success' where topical medication was required to meet the predefined target IOP threshold. Secondary outcomes included the need for subsequent IOP-lowering interventions, and structural parameters associated with bleb function. RESULTS From 131 patients randomised to bevacizumab (n=65) or placebo (n=66), 128 patients completed 12 months of follow-up (98%). At 12 months, success rates were higher in the bevacizumab group (complete success: 94% vs 83%; p=0.015; qualified success: 98% vs 90%; p=0.033). Within the placebo group, the requirement for topical therapy was higher at 6 months (p=0.045) and 12 months (p=0.045), and the requirement for bleb needling was higher at 1 month (p=0.035). Blebs within the bevacizumab group were larger at 1 month (p<0.001) and demonstrated less vessel inflammation (p<0.0001). CONCLUSION Bevacizumab given as a single intravitreal dose during trabeculectomy with MMC resulted in improved surgical success as 12 months. Furthermore, bevacizumab was associated with a significant reduction in the need for additional medication or further surgery to achieve target IOP. Bevacizumab was also associated with larger blebs that were less inflamed and required fewer subsequent interventions. TRIAL REGISTRATION NUMBER ACTRN12614000375651.
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Affiliation(s)
- John A Landers
- Ophthalmology, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Sean Mullany
- Ophthalmology, Flinders University of South Australia, Adelaide, South Australia, Australia
| | - Jamie E Craig
- Ophthalmology, Flinders University of South Australia, Adelaide, South Australia, Australia
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Gassel CJ, Wenzel DA, Nasyrov E, Strasser T, Voykov B. Intermediate-term impact on corneal endothelial cells and efficacy of Preserflo MicroShunt implantation in patients with open-angle glaucoma - a prospective study over two years. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06508-8. [PMID: 38771337 DOI: 10.1007/s00417-024-06508-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/22/2024] Open
Abstract
INTRODUCTION Preserflo MicroShunt is a novel microinvasive bleb forming device for the treatment of primary open-angle glaucoma. The intermediate- and long-term success and the impact of this procedure on corneal endothelial cell density remain to be investigated. METHODS In this prospective observational study, 62 eyes of 55 glaucoma patients (mean age ± SD: 67.0 ± 15.0 years) receiving a Preserflo MicroShunt were included. Corneal endothelial cell density, intraocular pressure and best corrected visual acuity were assessed preoperatively and at 3, 6, 9, 12, 18 and 24 months postoperatively. Success rates, bleb revision rates and complications were analysed. Complete success was defined as an intraocular pressure reduction of ≥ 20% and achieving a target pressure of ≤ 18, ≤ 15 or ≤ 12 mmHg without antiglaucoma medication. Qualified success indicated that the criteria were reached with or without medication. RESULTS Corneal endothelial cells showed no significant decline over 24 months (p > 0.05). Intraocular pressure showed a substantial reduction postoperatively (p < 0.001), decreasing from 29.6 ± 8,3 mmHg to 13.0 ± 4.3 mmHg after 24 months (p < 0.001). Complete and qualified success with a target pressure ≤ 15 mmHg was achieved in 52.9% and 54.6% of cases after 24 months, respectively. Best corrected visual acuity did not change after 24 months. CONCLUSION Preserflo MicroShunt had no negative side effects on corneal endothelial cells and showed favourable success rates after 2 years in patients with open-angle glaucoma.
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Affiliation(s)
- Caroline J Gassel
- University Eye Hospital Tuebingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, Tübingen, 72076, Germany.
| | - Daniel A Wenzel
- University Eye Hospital Tuebingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, Tübingen, 72076, Germany
| | - Emil Nasyrov
- University Eye Hospital Tuebingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, Tübingen, 72076, Germany
| | - Torsten Strasser
- University Eye Hospital Tuebingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, Tübingen, 72076, Germany
- Institute for Ophthalmic Research, Centre for Ophthalmology, Tuebingen, Germany
| | - Bogomil Voykov
- University Eye Hospital Tuebingen, Centre for Ophthalmology, Elfriede-Aulhorn-Str. 7, Tübingen, 72076, Germany
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Wu J, Zhou L, Liu Y, Zhang X, Yang Y, Zhu X, Bu Q, Shan X, Yin J, Weinreb RN, Zhou Q, Pan X, Huang AS. VEGF-C and 5-Fluorouracil Improve Bleb Survival in a Rabbit Glaucoma Surgery Trabeculectomy Model. Invest Ophthalmol Vis Sci 2024; 65:32. [PMID: 38771570 PMCID: PMC11114614 DOI: 10.1167/iovs.65.5.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To evaluate VEGF-C-induced lymphoproliferation in conjunction with 5-fluorouracil (5-FU) antimetabolite treatment in a rabbit glaucoma filtration surgery (GFS) model. Methods Thirty-two rabbits underwent GFS and were assigned to four groups (n = 8 each) defined by subconjunctival drug treatment: (a) VEGF-C combined with 5-FU, (b) 5-FU, (c) VEGF-C, (d) and control. Bleb survival, bleb measurements, and IOP were evaluated over 30 days. At the end, histology and anterior segment OCT were performed on some eyes. mRNA was isolated from the remaining eyes for RT-PCR evaluation of vessel-specific markers (lymphatics, podoplanin and LYVE-1; and blood vessels, CD31). Results Qualitatively and quantitatively, VEGF-C combined with 5-FU resulted in blebs which were posteriorly longer and wider than the other conditions: vs. 5-FU (P = 0.043 for longer, P = 0.046 for wider), vs. VEGF-C (P < 0.001, P < 0.001) and vs. control (P < 0.001, P < 0.001). After 30 days, the VEGF-C combined with 5-FU condition resulted in longer bleb survival compared with 5-FU (P = 0.025), VEGF-C (P < 0.001), and control (P < 0.001). Only the VEGF-C combined with 5-FU condition showed a negative correlation between IOP and time that was statistically significant (r = -0.533; P = 0.034). Anterior segment OCT and histology demonstrated larger blebs for the VEGF-C combined with 5-FU condition. Only conditions including VEGF-C led to increased expression of lymphatic markers (LYVE-1, P < 0.001-0.008 and podoplanin, P = 0.002-0.011). Expression of CD31 was not different between the groups (P = 0.978). Conclusions Adding VEGF-C lymphoproliferation to standard antimetabolite treatment improved rabbit GFS success and may suggest a future strategy to improve human GFSs.
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Affiliation(s)
- Jingyi Wu
- Shandong First Medical University, Jinan, Shandong Province, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Longfang Zhou
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Yameng Liu
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Xiaowei Zhang
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
| | - Yuanhang Yang
- Shandong First Medical University, Jinan, Shandong Province, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Xinyuan Zhu
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Qianwen Bu
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
| | - Xinmiao Shan
- Shandong First Medical University, Jinan, Shandong Province, China
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Jia Yin
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Robert N. Weinreb
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
| | - Qingjun Zhou
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Xiaojing Pan
- Eye Institute of Shandong First Medical University, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, Shandong Province, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, Shandong Province, China
| | - Alex S. Huang
- Hamilton Glaucoma Center, The Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, United States
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Llaneras CN, Quan A, Lieux C, Rivera-Grana E, Gajardo C, Duerr E, O'Brien RC, Gedde SJ, Vazquez LE. A Retrospective Comparison of Phaco-tube vs. Phaco-trabeculectomy in Glaucoma Patients. Ophthalmol Glaucoma 2024:S2589-4196(24)00072-3. [PMID: 38697359 DOI: 10.1016/j.ogla.2024.04.008] [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: 09/28/2023] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE To compare surgical outcomes of phacoemulsification combined with Baerveldt implantation (phaco-tube) or trabeculectomy with mitomycin-C (MMC) (phaco-trab) in patients without prior incisional ocular surgery. DESIGN Single-center, retrospective, comparative case series. PARTICIPANTS A total of 90 patients underwent surgical treatment, including 45 patients in the phaco-tube group and 45 patients in the phaco-trab group. METHODS Eligible patients were identified using current procedural terminology (CPT) codes, and their medical records were retrospectively reviewed. MAIN OUTCOME MEASURES The primary outcome measure was the rate of surgical failure (IOP ≤5 mmHg or >21 mmHg or reduced <20% from baseline on 2 consecutive study visits after 3 months, reoperations for glaucoma, or experienced loss of light perception vision). Patients who had successful surgical outcomes without use of glaucoma medications were classified as complete successes, while those who used glaucoma medications were classified as qualified successes. Secondary outcome measures were visual acuity (VA), visual field mean deviation (VFMD), intraocular pressure (IOP), glaucoma medication use, and complications. RESULTS The cumulative probability of failure was 6.7% in the phaco-tube group and 32.8% in the phaco-trab group after 3 years (P = 0.005; Restricted Mean Survival Time = 5.9 months, 95% CI = 1.4-10.4 months). The IOP was 13.1 ± 3.4 mmHg in the phaco-tube group and 13.3 ± 6.2 mmHg in the phaco-trab group at 3 years (P = 0.90), and the number of glaucoma medications was 2.6 ± 1.5 in the phaco-tube group and 1.7 ± 1.3 in the phaco-trab group (P = 0.015). The logarithm of the minimum angle of resolution VA was 0.39 ± 0.58 in the phaco-tube group and 0.43 ± 0.73 in the phaco-trab group at 3 years (P = 0.82), and VFMD was -18.3 ± 9.0 dB in the phaco-tube group and -14.1 ± 7.0 dB in the phaco-trab group (P = 0.16). Postoperative complications developed in 21 patients (47%) in the phaco-tube group and 15 patients (33%) in the phaco-trab group (P = 0.28). CONCLUSIONS Phaco-tubes had a significantly lower rate of surgical failure compared to phaco-trabs after 3 years of follow-up. However, phaco-trabs used significantly fewer glaucoma medications at multiple postoperative timepoints and had a higher proportion of complete success. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Cristina N Llaneras
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ann Quan
- Division of Ophthalmology, Scripps Clinic, La Jolla, California
| | - Caroline Lieux
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Erick Rivera-Grana
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Consuelo Gajardo
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Eric Duerr
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Robert C O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven J Gedde
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis E Vazquez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Figueiredo R, Barbosa-Breda J. The efficacy of adjunctive mitomycin C and/or anti-VEGF agents on glaucoma tube shunt drainage device surgeries: a systematic review. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06476-z. [PMID: 38656422 DOI: 10.1007/s00417-024-06476-z] [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: 03/23/2023] [Revised: 03/05/2024] [Accepted: 03/29/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE The effectiveness of mitomycin C (MMC) in trabeculectomy has long been established. The aim of this review is to evaluate the efficacy and safety of adjunctive agents in tube shunt drainage device surgery for glaucoma or ocular hypertension, since controversy still exists regarding their benefit. METHODS We searched CENTRAL, PubMed, Embase, Web of Science, Scopus, and BASE for RCTs, which have used adjuvant antimetabolites-either MMC or 5-Fluorouracil (5-FU)-and/or anti-vascular endothelial growth factors (anti-VEGF) agents. The main outcome was IOP reduction at 12 months. RESULTS Ten studies met our inclusion criteria. Nine used the Ahmed Glaucoma Valve (AGV) implant, while the double-plate Molteno implant was used in one study. Four studies used MMC. The remaining six studies used an anti-VEGF drug - either bevacizumab, ranibizumab or conbercept. Only one MMC-study reported a significant difference in the IOP reduction between groups at 12 months, favouring the MMC group (55% and 51%; p < 0.01). A significant difference was also reported by two out of five bevacizumab-studies, both favouring the bevacizumab group (55% and 51%, p < 0.05; 58% and 27%, p < 0.05), with the highest benefit seen in neovascular glaucoma cases, especially when panretinal photocoagulation (PRP) was also used. Neither ranibizumab nor conbercept were found to produce significant differences between groups regarding IOP reduction. CONCLUSION There is no high-quality evidence to support the use of MMC in tube shunt surgery. As for anti-VEGF agents, specifically bevacizumab, significant benefit seems to exist in neovascular glaucoma patients, especially if combined with PRP.
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Affiliation(s)
| | - Joao Barbosa-Breda
- Department of Surgery and Physiology, UnIC@RISE, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Ophthalmology, Centro Hospitalar E Universitário São João, Porto, Portugal
- Research Group Ophthalmology, Department of Neurosciences, KULeuven, Louvain, Belgium
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18
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El Helwe H, Samuel S, Falah H, Trzcinski J, Solá-Del Valle DA. Comparing Outcomes of Tube Versus Trabeculectomy Among Patients With Angle-closure Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00068-1. [PMID: 38636705 DOI: 10.1016/j.ogla.2024.04.005] [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: 01/15/2024] [Revised: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE Compare outcomes of tube shunt surgery (Tube) and trabeculectomy with mitomycin C (Trab-MMC) in patients with angle-closure glaucoma (ACG). DESIGN Retrospective nonrandomized comparative study. PARTICIPANTS A total of 80 eyes from 80 patients with ACG who underwent either Tube (N = 50) or Trab-MMC (N = 30) between January 2015 and January 2022 at Massachusetts Eye and Ear. METHODS Reviewed and analyzed 390 visits from patient charts. MAIN OUTCOME MEASURES Kaplan-Meier (KM) success rates, intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), adjusted hazard ratios (HRs), and complications. RESULTS Baseline demographics were similar between both groups, except for a higher proportion of patients with pseudophakia and prior incisional ocular surgery in the Tube group. The Trab-MMC procedure had significantly higher KM complete success (CS) rates than the Tube procedure, but similar qualified success (QS) rates. Under QS, the cumulative probability of survival was 87% in the Tube group and 83% in the Trab-MMC group at year 1 (P = 0.77), and 75% in the Tube group and 58% in the Trab-MMC group at year 2 (P = 0.14). Under CS, the cumulative probability of survival was 13% in the Tube group and 59% in the Trab-MMC group at year 1 (P < 0.001), and 11% in the Tube group and 41% in the Trab-MMC group at year 2 (P < 0.001). Both Tube and Trab-MMC procedures resulted in significant patterns of IOP and medication reduction from baseline up to 2 years with mean IOP reduced to 12.6 ± 5.9 mmHg on 2.8 ± 1.4 medications after Tube and 12.1 ± 6.6 mmHg on 2.4 ± 1.7 medications after Trab-MMC. Patients who underwent Trab-MMC required less IOP-lowering medications at every follow-up visit up to year 1, but a similar number at year 2. No significant differences were found in IOP reduction, BCVA, or complication rates between groups. CONCLUSIONS We demonstrate that Trab-MMC confers similar IOP reduction and QS rates to Tube placement in patients with ACG. Trab-MMC, however, demonstrated greater medication burden reduction up to 1 year, and more favorable CS rates up to 2 years, while still maintaining similar complication rates to Tube. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Hani El Helwe
- Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Sandy Samuel
- Ophthalmology Department, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Henisk Falah
- Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
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Pacovska MF, de Amorim-Cabral CLD, Teixeira EGDRM, Kasahara N. The need for more pragmatic trials in glaucoma research. Eur J Ophthalmol 2024:11206721241247428. [PMID: 38602016 DOI: 10.1177/11206721241247428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
AIM There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues in selected populations placing them in the explanatory end of the pragmatic-explanatory continuum. The purpose of this study was to assess the level of pragmatism of published randomized controlled trials in glaucoma. METHODS A PubMed search using 'glaucoma' from 1995 to 2022 and randomized controlled trial (RCT) article type was done. Each study was assessed by three independent examiners using the Pragmatic-Explanatory Continuum Indicator Summary version 2 (PRECIS-2) toolkit. Scores were calculated for each study to determine the level of pragmatism. A summed score ≥36 was indicative of a very pragmatic study. RESULTS Thirty-two different articles were included in the analysis. These papers represented 13 different landmark trials. The median PRECIS-2 score was 32 (range, 25 for the Early Manifest Glaucoma Trial (EMGT) to 34 to the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Ocular Hypertension Treatment Study). The Treatment of Advanced Glaucoma Study (TAGS), was considered very pragmatic and scored 33 points. CONCLUSION Despite the number of RCTs in glaucoma, there is still a need for more pragmatic studies.
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Affiliation(s)
- Mayara Fernanda Pacovska
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Niro Kasahara
- Department of Ophthalmology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Sao Paulo, Brazil
- Santa Casa de Sao Paulo School of Medical Sciences, Sao Paulo, Brazil
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20
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Gietzelt C, Koenig L, Adler W, Schaub F, Heindl LM, Cursiefen C, Dietlein TS, Enders P. A comparative study of cystoid macula edema following glaucoma drainage device surgery versus trabeculectomy. Int Ophthalmol 2024; 44:150. [PMID: 38503938 PMCID: PMC10950946 DOI: 10.1007/s10792-024-03068-y] [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: 06/21/2023] [Accepted: 02/16/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE To assess and compare the risk for development of cystoid macula edema (CME) after glaucoma drainage device (GDD) implantation versus conventional trabeculectomy with mitomycin (trab) for glaucoma. METHODS Retrospective review of consecutive patients receiving trab or GDD implantation between 2016 and 2018. Inclusion criteria were availability of pre- and postoperative spectral domain optical coherence tomography (SD-OCT) of the macula. SD-OCT images were evaluated for presence of CME qualitatively, central subfield thickness (CST) and macular volume (MV). RESULTS 73 eyes could be included, 42 received trab and 31 GDD surgery. Eyes receiving trab on average had 0.8 ± 0.8 previous intraocular operations, while eyes with GDD implantation had 3.1 ± 1.9 (p < 0.001). Occurrence of postoperative CME was significantly more frequent after GDD implantation (6 out of 31 (19.4%)) than after trab (2 out of 42 eyes = 4.8%), (p = 0.049). Mean preoperative CST as well as MV was comparable in both groups (CST before trab: 282.7 ± 23.0 µm, CST before GDD 284.2 ± 27.3 µm, p = 0.287; MV before trab: 7.8 ± 1.1 mm3, MV before GDD: 8.0 ± 0.8mm3, p = 0.305). Mean postoperative CST and MV were significantly higher after GDD (CST 338.5 ± 129.3 µm, MV 8.8 ± 2.6 mm3) than after trabeculectomy (CST 290.6 ± 60.2 µm, p = 0.038; MV 7.8 ± 1.2mm3, p = 0.039). CONCLUSIONS In real-life conditions, GDD surgery seems to be associated with a higher risk to develop CME when compared to conventional trabeculectomy. This information may be helpful for glaucoma surgeons to advise the patients on postoperative risks of surgery.
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Affiliation(s)
- Caroline Gietzelt
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
- Glaucoma Imaging Center, Faculty of Medicine and University Hospital Cologne, University of Cologne (GICC), Cologne, Germany.
| | - Lilo Koenig
- Glaucoma Imaging Center, Faculty of Medicine and University Hospital Cologne, University of Cologne (GICC), Cologne, Germany
| | - Werner Adler
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Friederike Schaub
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Ophthalmology, University Medical Centre Rostock, Rostock, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas S Dietlein
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philip Enders
- Department of Ophthalmology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Glaucoma Imaging Center, Faculty of Medicine and University Hospital Cologne, University of Cologne (GICC), Cologne, Germany
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21
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Rojo-Arnao M, Martinez-de-la-Casa JM, Albis-Donado O, Yañez-Castro G, Maroto-Cejudo R, Téllez J, Menoyo-Calatayud R. Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting. Indian J Ophthalmol 2024; 72:417-426. [PMID: 38153975 PMCID: PMC11001232 DOI: 10.4103/ijo.ijo_1502_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. METHODS We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. RESULTS Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. CONCLUSION The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
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Affiliation(s)
| | - José María Martinez-de-la-Casa
- Department of Ophthalmology and ORL, Faculty of Medicine, Ophthalmology Unit, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain
- Department of Immunology, Ophthalmology and ORL, School of Medicine, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Oscar Albis-Donado
- Glaucoma Specialist, Private Practice, Visual Sense, Mexico City, Mexico
| | | | | | - Jesús Téllez
- Department of Ophthalmology, Hospital de la Santa Creu i de Sant Pau, Autonoma University of Barcelona, Barcelona, Spain
- Departament of Ophthalmology, Grupo Admiravisión, Barcelona, Spain
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22
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Leinonen S, Harju M, Hagman J, Honkamo M, Marttila L, Määttä M, Saarela V, Vaajanen A, Vesti E, Komulainen J. The Finnish current care guideline for open-angle glaucoma. Acta Ophthalmol 2024; 102:151-171. [PMID: 38174651 DOI: 10.1111/aos.16612] [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: 09/19/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
This article is an English translation of the 4th Finnish Current Care Guideline for diagnostics, treatment and follow-up of primary open-angle glaucoma, normal-tension glaucoma and pseudoexfoliative glaucoma. This guideline is based on systematic literature reviews and expert opinions with Finland's geographical and operational healthcare environment in mind.
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Affiliation(s)
- Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Mika Harju
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hagman
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | | | | | | | - Anu Vaajanen
- Mehiläinen, Helsinki, Finland
- Terveystalo, Helsinki, Finland
| | - Eija Vesti
- Turku University Hospital and Turku University, Turku, Finland
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23
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Kim IJ, Wang J, Qiu M. Same-quadrant Baerveldt Glaucoma Implant-250 to Baerveldt Glaucoma Implant-350 exchange. Am J Ophthalmol Case Rep 2024; 33:101975. [PMID: 38149093 PMCID: PMC10750127 DOI: 10.1016/j.ajoc.2023.101975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/18/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose In eyes with a prior failed aqueous shunt (or "tube") requiring additional intraocular pressure (IOP) control, options include angle surgery, cyclodestruction, second tube, tube revision, or tube exchange. We present a case of a same-quadrant tube exchange of a Baerveldt-250 (BGI-250) to BGI-350. Observations The patient is a 71-year-old African American female with severe-stage primary open angle glaucoma of both eyes, and this case focuses on the right eye. This eye had prior cataract surgery with iStent, prior BGI-250 in the anterior chamber (AC), and prior iStent removal with gonioscopy assisted transluminal trabeculotomy (GATT). The visual acuity (VA) was 20/150, and the IOP was 26 mmHg on 3 IOP-lowering medications. The prior superotemporal BGI-250 had its "wings" on top of the superior and lateral rectus muscles and its tube tip in the AC. The implant was removed in its entirety including the superficial and deep layers of its capsule. The new BGI-350 was stented with a 3-0 polypropylene ripcord, ligated with a 7-0 polyglactin suture, and implanted with its wings under the rectus muscles and the tube tip in the sulcus. For early IOP-lowering prior to ligature dissolution, 2 needle stab fenestrations and an additional 7-0 polyglactin wick was used. The capsule from the prior BGI-250 was used as a patch graft for the new BGI-350. The ligature dissolved at postoperative week (POW) 6. By POW8, the IOP was 18 mmHg on 3 IOP-lowering medications and frequent topical steroid, the AC was quiet, and the ripcord was removed. A slow steroid taper finished at postoperative month (POM) 6. By POM 12, the VA was still at baseline 20/150, and the IOP was 14 mmHg on 3 IOP-lowering medications. Conclusions & importance Patients with a prior failed tube requiring additional IOP-lowering can undergo a same-quadrant tube exchange. BGI-350s may offer more IOP-lowering than BGI-250s, but the IOP-lowering achieved in this patient's case could be attributable to differences in postoperative management in addition to endplate size; longer follow-up is needed. A tube exchange offers the opportunity to reposition the tube tip from the AC to the sulcus and to use the prior tube's capsule as a patch graft for the new tube.
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Affiliation(s)
- Inae J. Kim
- The University of Chicago Department of Ophthalmology and Visual Sciences, Chicago, IL, USA
| | - Jessie Wang
- The University of Chicago Department of Ophthalmology and Visual Sciences, Chicago, IL, USA
| | - Mary Qiu
- The University of Chicago Department of Ophthalmology and Visual Sciences, Chicago, IL, USA
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Panarelli JF, Moster MR, Garcia-Feijoo J, Flowers BE, Baker ND, Barnebey HS, Grover DS, Khatana AK, Lee B, Nguyen T, Stiles MC, Sadruddin O, Khaw PT. Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study. Ophthalmology 2024; 131:266-276. [PMID: 37769852 DOI: 10.1016/j.ophtha.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To compare the effectiveness and safety of the MicroShunt (Santen Inc) versus trabeculectomy in patients with primary open-angle glaucoma (POAG). DESIGN Prospective, randomized, multicenter trial conducted in the United States and Europe. PARTICIPANTS Adult patients (aged 40-85 years) with mild to severe POAG inadequately controlled on maximum tolerated medical therapy and intraocular pressure (IOP) ≥ 15 mmHg and ≤ 40 mmHg. METHODS Patients were randomized 3:1 to stand-alone MicroShunt implantation (n = 395) or trabeculectomy (n = 132), both augmented with mitomycin C (MMC) 0.2 mg/ml for 2 minutes. MAIN OUTCOME MEASURES The primary effectiveness end point was surgical success, defined as ≥ 20% reduction in mean diurnal IOP from baseline with no increase in glaucoma medications. Secondary end points included changes in mean IOP and medication use from baseline and the need for postoperative interventions. RESULTS At 2 years, the rate of surgical success was lower in the MicroShunt group than in the trabeculectomy group (50.6% vs. 64.4%, P = 0.005). Mean diurnal IOP was reduced from 21.1 ± 4.9 mmHg at baseline to 13.9 ± 3.9 mmHg at 24 months in the MicroShunt group and from 21.1 ± 5.0 mmHg at baseline to 10.7 ± 3.7 mmHg at 24 months in the trabeculectomy group (P < 0.001 compared with baseline in both groups). Mean medication use decreased from 3.1 to 0.9 in the MicroShunt group and from 2.9 to 0.4 in the trabeculectomy group (P < 0.001 compared with baseline in both groups). Adverse events at 2 years were generally similar in the 2 groups, except that hypotony was more common in eyes undergoing trabeculectomy (51.1% vs. 30.9%, P < 0.001). Repositioning or explantation of the implant occurred in 6.8% of MicroShunt patients. The majority of these patients had device removal at the time of subsequent glaucoma surgery. Vision-threatening complications were uncommon in both groups. CONCLUSION At 2 years, both the MicroShunt and trabeculectomy provided significant reductions in IOP and medication use, with trabeculectomy continuing to have greater surgical success. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bonny Lee
- New York University, New York, New York
| | | | | | | | - Peng T Khaw
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, England; UCL Institute of Ophthalmology, London, England
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25
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Song D, Wang L. Cost-utility analysis of treating mild stage normal tension glaucoma by surgery in China: a decision-analytic Markov model. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:13. [PMID: 38347532 PMCID: PMC10863271 DOI: 10.1186/s12962-024-00523-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Many individuals suffer from normal tension glaucoma (NTG) in China. This study utilized Markov models to evaluate the cost-utility of applying many medications and surgery for mild-stage NTG when disease progression occurred at a mild stage. METHODS A 10-year decision-analytic Markov model was developed for the cost-utility analysis of treating mild-stage NTG with surgery and increased application of medication. We hypothesized that all 100,000 samples with a mean age of 64 were in mild stages of NTG. Transitional probabilities from the mild to moderate to severe stages and the basic parameters acquired from the CNTGS were calculated. Incremental cost-utility ratios (ICUR) were calculated for treating all patients with NTG by probabilistic sensitivity analysis (PSA) and Monte Carlo simulation. One-way sensitivity analysis were conducted by adjusting the progression rate, cost of medications or trabeculectomy, cost of follow-up, and surgical acceptance rate. RESULTS The ICUR of treating mild stage NTG with medication over 10 years was $12743.93 per quality-adjusted life years (QALYs). The ICUR for treating mild stage NTG patients with a 25% and 50% surgery rate with medication were $8798.93 and $4851.93 per QALYs, respectively. In this model, the cost-utility of treating NTG was sensitive to disease progression rate, surgical treatment rate, and medication costs. CONCLUSIONS According to the results of the cost-utility analysis, it was a reasonable and advantageous strategy to administer a lot of medication and surgery for NTG in the mild stages of the disease. In the model, the greater the probability of patients undergoing surgery, the strategy becomes more valuable.
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Affiliation(s)
- Di Song
- The First People's Hospital of Huzhou, The First Affiliated Hospital of Huzhou Teacher College, Huzhou, Zhejiang, China
| | - Liwen Wang
- Department of Ophthalmology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, No. 1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang, China.
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Chopra V, Takusagawa HL, Rosdahl JA, Sit AJ, Richter GM, Ou Y, Kim SJ, WuDunn D. Aqueous Shunts with Extraocular Reservoir for Open-Angle Adult Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology 2024; 131:227-239. [PMID: 38069945 DOI: 10.1016/j.ophtha.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate the recently published literature on the efficacy and safety of the use of aqueous shunts with extraocular reservoir for the management of adult open-angle glaucomas (OAGs). METHODS A search of peer-reviewed literature was last conducted in April 2023 of the PubMed database and included only articles published since the last aqueous shunt Ophthalmic Technology Assessment, which assessed articles published before 2008. The abstracts of these 419 articles were examined, and 58 studies were selected for full-text analysis. After inclusion and exclusion criteria were applied, 28 articles were selected and assigned ratings by the panel methodologist according to the level of evidence. Twenty-five articles were rated level I and 3 articles were rated level II. There were no level III articles. RESULTS Implantation of aqueous shunts with extraocular reservoir can lower intraocular pressure (IOP) by between one-third and one-half of baseline IOP, depending on whether it is undertaken as the primary or secondary glaucoma surgery. Success rates for aqueous shunts were found to be better than for trabeculectomies in eyes with prior incisional surgery. Conversely, in eyes without prior incisional surgery, implantation of aqueous shunts was found to have an overall lower success rate as the primary glaucoma procedure compared with trabeculectomy. Although both valved and nonvalved aqueous shunts with extraocular reservoir were effective, the nonvalved device generally achieved slightly lower long-term IOPs with fewer glaucoma medications and less need for additional glaucoma surgery. Both devices slow the rates of visual field progression with efficacy comparable with that of trabeculectomy. Early aqueous humor suppression after aqueous shunt implantation is recommended for the management of the postoperative hypertensive phase and long-term IOP control. No strong evidence supports the routine use of mitomycin C with aqueous shunt implantation for OAG. CONCLUSIONS Implantation of aqueous shunts with extraocular reservoir, including valved or nonvalved devices, has been shown to be an effective strategy to lower IOP. Strong level I evidence supports the use of aqueous shunts with extraocular reservoir by clinicians for the management of adult OAG. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Vikas Chopra
- Doheny Eye Centers UCLA and Department of Ophthalmology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Hana L Takusagawa
- VA Eugene Healthcare Center, Eugene, Oregon and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
| | - Jullia A Rosdahl
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Arthur J Sit
- Mayo Clinic, Department of Ophthalmology, Rochester, Minnesota
| | - Grace M Richter
- Department of Ophthalmology, Southern California Permanente Medical Group, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California; USC Roski Eye Institute, Keck Medicine of University of Southern California, Los Angeles, California
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Darrell WuDunn
- University of Florida College of Medicine-Jacksonville, Department of Ophthalmology, Jacksonville, Florida
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Roy S, Mermoud A. Efficacy and Safety of an Adjustable Glaucoma Drainage Device (eyeWatch System) for Refractory Glaucoma: A 2-Year Prospective Study. J Glaucoma 2024; 33:132-138. [PMID: 37974333 DOI: 10.1097/ijg.0000000000002334] [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: 03/20/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
PRCIS In this study, we report a 2-year follow-up after implantation of an adjustable glaucoma drainage device combined with a novel orbital filtering plate. The IOP was efficiently controlled postoperatively with limited complications and an excellent safety profile. PURPOSE To report the clinical results at 2 years after implantation of an eyeWatch (eW) system, which comprises an adjustable glaucoma drainage device (eW implant) combined with a novel orbital filtering plate (eyePlate), in refractory glaucoma. PATIENTS AND METHODS Monocentric, prospective, noncomparative clinical trial. Patients suffering from refractory glaucoma after several failed surgeries were operated using the eW system. The primary outcome was the success rate, defined as an IOP ≤18 mm Hg and reduction of more than 20% from baseline, IOP ≥6 mm Hg. Secondary outcomes were mean IOP, visual acuity, the number of antiglaucoma medications, and the number and type of complications. RESULTS Forty-two eyes from 42 patients were included. The mean follow-up time was 22.0±4.0 months. The mean baseline IOP decreased from 23.2±7.2 mm Hg before surgery to 11.9±4.4 mm Hg at 12 months ( P <0.001) and 11.5±3.0 at 24 months. The mean number of glaucoma medications decreased from 2.9±0.9 before surgery to 0.7±0.9 at 12 months ( P <0.001) and 1.0±0.9 at 24 months. The qualified success rate was 93% at 12 months and 90% at 24 months whereas the complete success rate was 46% and 40% at 12 and 24 months, respectively. Complications occurred in 7 patients. CONCLUSIONS Implantation of the eW system effectively lowered IOP and reduced glaucoma medications for a 2-year period in patients who had previously failed glaucoma surgery. Persistent hypotony was not observed and the number of complications was low.
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Affiliation(s)
- Sylvain Roy
- Laboratory of Hemodynamics and Cardiovascular Technology, Swiss Federal Institute of Technology
- Glaucoma Center, SwissVisio, Montchoisi Clinic, Lausanne, Switzerland
| | - André Mermoud
- Glaucoma Center, SwissVisio, Montchoisi Clinic, Lausanne, Switzerland
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Hallaj S, Wong JC, Hock LE, Kolomeyer NN, Shukla AG, Pro MJ, Moster MR, Myers JS, Razeghinejad R, Lee D. Long-Term Surgical Outcomes of Glaucoma Drainage Implants in Eyes with Preoperative Intraocular Pressure Less than 19 mmHg. J Ophthalmol 2024; 2024:6624021. [PMID: 38304290 PMCID: PMC10830923 DOI: 10.1155/2024/6624021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/02/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
Background This retrospective review reports on patients who underwent glaucoma drainage implant (GDI) surgery and had baseline intraocular pressure (IOP) of ≤18 mmHg with at least one year of follow-up. Methods Clinical data of 67 eyes of 67 patients were collected from patients' charts, and the outcomes of GDI were evaluated until 7 years. GDI failure was defined as IOP reduction of less than 20% from the baseline at two consecutive visits three months after surgery, decline to no light perception, or if additional glaucoma surgery was performed. Results The average age was 65.9 ± 13.2 years. Most cases were male (52.2%), White (53.7%), and had primary open-angle glaucoma (62.7%). Forty-four eyes had prior glaucoma surgery (68.6%) and 46 (68.6%) had severe glaucoma. Though postoperative (postop) IOP changes were insignificant, the average postop number of medications dropped from 2.4 ± 1.4 to 1.9 ± 1.2 medications two years after surgery (p = 0.0451). Postop complications (23.9%) included GDI exposure (7.5%), inflammation (4.5%), shallow anterior chamber (4.5%), and strabismus (1.5%). Hypotony was observed in 4 eyes (5.9%), none of which developed hypotony maculopathy. The cumulative one-year failure rate was 56.7%, most of which were due to failure to lower IOP. Conclusion In patients with baseline IOP ≤18 mmHg who had GDI surgery, though the change in IOP was not statistically significant, the number of medications dropped and visual field progression slowed in a subset of patients with adequate perimetric data. Due to a relatively high rate of complications and limited effectiveness in lowering IOP, GDI should be cautiously used in these eyes.
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Affiliation(s)
- Shahin Hallaj
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jae-Chiang Wong
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Lauren E. Hock
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Natasha Nayak Kolomeyer
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aakriti G. Shukla
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Michael J. Pro
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marlene R. Moster
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jonathan S. Myers
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Daniel Lee
- Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Zhang JY, Qiu M. Techniques and Preferences for Nonvalved Aqueous Shunts: A Survey of American Glaucoma Society Members. Ophthalmol Glaucoma 2024; 7:82-92. [PMID: 37454974 DOI: 10.1016/j.ogla.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To assess practice patterns and opinions of glaucoma specialists regarding indications, surgical technique, and postoperative management for nonvalved aqueous shunts. DESIGN Anonymous online survey study. PARTICIPANTS American Glaucoma Society (AGS) members. METHODS An anonymous online survey was distributed to glaucoma specialists via the AGS forum from June to August 2022. MAIN OUTCOME MEASURES Survey questions and responses were assessed in 4 sections: (1) general demographics and practice patterns; (2) nonvalved tubes vs. trabeculectomy; (3) nonvalved tubes vs. valved tubes; and (4) nonvalved tube techniques. RESULTS There were 132 respondents; nonvalved tubes were reported to be performed more often than trabeculectomy by 61% of respondents within 5 years of completing training and 23% of respondents with more than 15 years since completing training. The most frequently preferred types of nonvalved tubes were Baerveldt-350 (41%), Baerveldt-250 (27%), and ClearPath-250 (18%). In patients with lower target intraocular pressure (IOP), 92% of respondents preferred trabeculectomy over nonvalved tube; 33% cited a cutoff of < 12 mmHg, and 31% cited a cutoff of < 15 mmHg. In patients with higher preoperative IOP, 50% of respondents preferred valved over nonvalved tubes; 29% cited a cutoff of > 40 mmHg, and 38% cited a cutoff of > 30 mmHg. The most frequently used ligature was 7-0 Vicryl (69%). The most frequently used strategies for early IOP lowering were fenestrations without wicks (70%) and with wicks (22%), with one 10-0 Nylon being the most used wick technique (22%). Overall, 37% of respondents use a ripcord; among ripcord users, 55% use it for hypotony prevention (3-0 Prolene most common for this purpose at 35%), and 40% use it for optional early IOP lowering (4-0 Nylon most common for this purpose at 21%). If IOP is too high at postoperative week 4, 38% of respondents do not open the tube early. CONCLUSIONS We demonstrate significant heterogeneity regarding specific indications, surgical technique, and postoperative management for nonvalved tubes. Future work is needed to identify and develop standardized guidelines alongside best practices. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Jason Y Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Mary Qiu
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois.
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30
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Song Y, Lin F, Lv A, Zhang Y, Lu L, Xie L, Tang G, Yuan H, Yang Y, Xu J, Lu P, Xiao M, Zhu X, Yan X, Song W, Li X, Zhang H, Li F, Wang Z, Jin L, Gao X, Liang X, Zhou M, Zhao X, Zhang Y, Chen W, Wang N, Tham CC, Barton K, Park KH, Aung T, Weinreb RN, Tang L, Fan S, Lam DSC, Zhang X. Phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized non-inferiority trial. Asia Pac J Ophthalmol (Phila) 2024; 13:100033. [PMID: 38383075 DOI: 10.1016/j.apjo.2023.100033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/16/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and cataracts. DESIGN Multicenter, randomized controlled, non-inferiority trial. METHODS A total of 124 patients (124 eyes) with advanced PACG and cataracts were enrolled, with 65 in the phacogoniotomy group and 59 in the phacotrabeculectomy group. Patients were followed up for 12 months with standardized evaluations. The primary outcome was the reduction in intraocular pressure (IOP) from baseline to 12 months postoperatively, of which a non-inferiority margin of 4 mmHg was evaluated. Secondary outcomes included the cumulative surgical success rate, postoperative complications, and changes in the number of glaucoma medications. RESULTS After 12 months, phacogoniotomy demonstrated non-inferiority to phacotrabeculectomy in terms of IOP reduction, with mean IOP reductions of - 26.1 mmHg and - 25.7 mmHg (P = 0.383), respectively, from baseline values of around 40 mmHg. Both groups experienced a significant reduction in the mean number of medications used postoperatively (P < 0.001). The cumulative success rate was comparable between the groups (P = 0.890). However, phacogoniotomy had a lower rate of postoperative complications and interventions (12.3% and 4.6%) compared to phacotrabeculectomy (23.7% and 20.3% respectively). The phacogoniotomy group reported shorter surgery time (22.1 ± 6.5 vs. 38.8 ± 11.1 min; P = 0.030) and higher quality of life (EQ-5D-5 L) improvement at 12 months (7.0 ± 11.5 vs. 3.0 ± 12.9, P = 0.010) than the phacotrabeculectomy group. CONCLUSIONS Phacogoniotomy was non-inferior to phacotrabeculectomy in terms of IOP reduction for advanced PACG and cataracts. Additionally, phacogoniotomy provided a shorter surgical time, lower postoperative complication rate, fewer postoperative interventions, and better postoperative quality of life.
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Affiliation(s)
- Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, China
| | - Lan Lu
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Lin Xie
- Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Huiping Yuan
- Department of Ophthalmology, the 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Jiangang Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Meichun Xiao
- Department of Ophthalmology, Fujian Medical University Union Hospital, Fuzhou, Fujian Province 350001, China
| | - Xiaomin Zhu
- Department of Ophthalmology, the Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Wulian Song
- Department of Ophthalmology, the 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang 150086, China
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province, 050000, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Zhenyu Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Xiaohong Liang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Minwen Zhou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xiaohuan Zhao
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tin Aung
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610041, China.
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan 056001, China.
| | - Dennis S C Lam
- The International Eye Research Institute, the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China.
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Gubser PA, Pfeiffer V, Hug S, Shang X, Lincke JB, Häner NU, Zinkernagel MS, Unterlauft JD. PRESERFLO MicroShunt implantation versus trabeculectomy for primary open-angle glaucoma: a two-year follow-up study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:50. [PMID: 38124210 PMCID: PMC10734133 DOI: 10.1186/s40662-023-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To compare the intermediate-term efficacy of PRESERFLO (PF) MicroShunt implantation with trabeculectomy (TE) in patients with primary open-angle glaucoma, focusing on longitudinal changes of functional and structural parameters. METHODS This retrospective comparative study included 104 eyes of 104 patients who underwent TE and 83 eyes of 83 patients that underwent PF implantation between January 2019 and December 2020, with a minimum follow-up of two years. Baseline and postoperative intraocular pressure (IOP), number of IOP-lowering medications, visual field mean defect (MD) and peripapillary retinal nerve fibre layer (RNFL) thickness measured using optical coherence tomography were assessed and compared between groups. RESULTS Baseline characteristics (age, sex, IOP, number of IOP-lowering medications, MD, RNFL thickness) were comparable between the two groups (all P > 0.05). During the two-year of follow-up, mean IOP decreased from 24.09 ± 1.15 mmHg and 21.67 ± 0.77 mmHg to 11.37 ± 1.13 mmHg (P < 0.001) and 15.50 ± 1.54 mmHg (P = 0.028), and the mean number of IOP-lowering medications decreased from 3.25 ± 0.14 and 3.51 ± 0.14 to 0.53 ± 0.14 (P < 0.001) and 1.06 ± 0.43 (P < 0.001) in the TE and PF groups, respectively. MD remained stable [- 11.54 ± 0.93 dB and - 11.17 ± 1.66 to - 10.67 ± 0.91 dB (P = 0.226) and - 10.40 ± 4.75 dB (P = 0.628) in the TE and PF groups, respectively] but RNFL thickness decreased continuously during follow-up [62.79 ± 1.94 µm and 62.62 ± 2.05 µm to 57.41 ± 1.81 µm (P < 0.001) and 60.22 ± 1.98 µm (P = 0.182) in the TE and PF groups, respectively]. CONCLUSION PF implantation is comparably effective in the intermediate term in lowering IOP and reducing the use of IOP-lowering medications over a two-year follow-up period. Although visual field defects were stable, RNFL continued to decrease during postoperative follow-up.
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Affiliation(s)
- Pascal Aurel Gubser
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentin Pfeiffer
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Hug
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Xiao Shang
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel-Benjamin Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nathanael Urs Häner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Darius Unterlauft
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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32
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Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to Topical Glaucoma Medication for Glaucoma Management. Clin Ophthalmol 2023; 17:3899-3913. [PMID: 38111854 PMCID: PMC10726774 DOI: 10.2147/opth.s439457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Topical glaucoma medications have favorable safety and efficacy, but their use is limited by factors such as side effects, nonadherence, costs, ocular surface disease, intraocular pressure fluctuations, diminished quality of life, and the inherent difficulty of penetrating the corneal surface. Although traditionally these limitations have been accepted as an inevitable part of glaucoma treatment, a rapidly-evolving arena of minimally invasive surgical and laser interventions has initiated the beginnings of a reevaluation of the glaucoma treatment paradigm. This reevaluation encompasses an overall shift away from the reactive, topical-medication-first default and a shift toward earlier intervention with laser or surgical therapies such as selective laser trabeculoplasty, sustained-release drug delivery, and micro-invasive glaucoma surgery. Aside from favorable safety, these interventions may have clinically important attributes such as consistent IOP control, cost-effectiveness, independence from patient adherence, prevention of disease progression, and improved quality of life.
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Affiliation(s)
| | | | - Arsham Sheybani
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Sheheitli H, Quan AV, Vanner EA, Parrish RK. Risk Factors for Flat Anterior Chamber Requiring Intervention After Glaucoma Drainage Implant: A Retrospective Case-Controlled Study. Am J Ophthalmol 2023; 256:39-45. [PMID: 37567432 DOI: 10.1016/j.ajo.2023.07.027] [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: 03/20/2023] [Revised: 07/24/2023] [Accepted: 07/30/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To identify risk factors for flat anterior chamber that required additional intervention in the postoperative period (90 days) after uncomplicated Baerveldt Glaucoma Implant (BGI) surgery. DESIGN Retrospective, matched case-control study. METHODS A total of 42 cases (eyes) that received BGI at Anne Bates Leach Eye Hospital between February 1, 2011, and January 1, 2019, and that developed flat anterior chamber were included. For each case, we matched 2 controls (84). Variables included sex, diagnosis, diabetes, hypertension, pre- and postoperative glaucoma medications, ocular conditions, and intraocular pressure (IOP). Multivariable conditional logistic regression determined odds ratios (ORs) for independent predictors. RESULTS Case patients were more likely to be female (69.1% case patients/41.7% controls), to have a history of taking oral carbonic anhydrase inhibitors (CAIs) at tube opening (21.4%/7.1%), to be of another race/ethnicity (11.9%/0.0%), and to have pseudoexfoliation (23.8%/6.0%), and were less likely to be using cholinergic agonists (0.0%/11.9%) at baseline and to have primary open angle glaucoma (42.9%/64.3%). Case patients had greater mean age (75.9/64.9 years), earlier tube opening time (5.6/6.2 weeks), and lower IOP after tube opening (7.2/14.4 mm Hg), but IOP before opening was higher (24.7/19.5 mm Hg). We identified 3 independent predictors: older age (10-year increase OR = 3.59, P < .0001), oral CAI use at tube opening (OR = 5.65, P = .009), and higher IOP prior to tube opening (3 mm Hg increase OR = 1.30, P = .018). CONCLUSION Risk factors for flat anterior chamber were older age, oral CAIs at tube opening, and higher IOP before tube opening. Strategies to minimize the acute IOP reduction that preceded this complication such as discontinuing oral CAI prior to tube opening may be considered.
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Affiliation(s)
- Huda Sheheitli
- From the Department of Ophthalmology (H.S.), University of Minnesota, Minneapolis, Minnesota, USA.
| | - Ann V Quan
- Department of Ophthalmology (A.V.Q.), Scripps Clinic, La Jolla, California, USA
| | - Elizabeth A Vanner
- Department of Ophthalmology/Bascom Palmer Eye Institute (E.A.V., R.K.P.II), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Parrish
- Department of Ophthalmology/Bascom Palmer Eye Institute (E.A.V., R.K.P.II), University of Miami Miller School of Medicine, Miami, Florida, USA
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Zhang Y, Yu P, Zhang Y, Sugihara K, Zhu X, Zhang Y, Yang X, Li X, Liu Y, Zhang H, Yan X, Zhang H, Lin F, Song Y, Gao X, Yuan H, Tang G, Zhou W, Fan S, Dang G, Tang L, Chen W, Wang N, Park KH, Barton K, Aung T, Lam DSC, Weinreb RN, Xie L, Tanito M, Zeng L, Zhang X. Influence of Goniotomy Size on Treatment Safety and Efficacy for Primary Open-Angle Glaucoma: A Multicenter Study. Am J Ophthalmol 2023; 256:118-125. [PMID: 37573988 DOI: 10.1016/j.ajo.2023.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE To compare the efficacy and safety of 120-, 240-, and 360-degree goniotomy (GT) with or without phacoemulsification with intraocular lens implantation (PEI) for patients with primary open-angle glaucoma (POAG). DESIGN Multicenter, retrospective, comparative, nonrandomized interventional study. METHODS Patients diagnosed with POAG who underwent GT with or without PEI were included, and divided into 6 groups: 1) standalone 120-degree GT (120GT); 2) standalone 240-degree GT (240GT); 3) standalone 360-degree GT (360GT); 4) PEI + 120GT; 5) PEI + 240GT; and 6) PEI + 360GT. Data on intraocular pressure (IOP), the number of ocular hypotensive medications, and complications were collected and compared. Success was defined as a postoperative IOP within the range of 6 to 18 mm Hg and a 20% reduction from baseline without further glaucoma surgery. Complete success and qualified success were defined as the above without and with ocular hypotensive medications, respectively. RESULTS Three hundred eight eyes of 231 patients were included with a mean follow-up of 14.4 ± 8.6 months (6.0-48.0 months). There were no significant differences in the reductions in IOP and number of medications and cumulative survival probability for complete and qualified success rates among the 3 groups of standalone GT and PEI + GT. The 360GT group had the highest proportion of hyphema with or without PEI. CONCLUSIONS 120GT, 240GT, and 360GT with or without PEI showed similar efficacy in reducing IOP and medications used in POAG. 360GT with or without PEI was more likely to cause hyphema compared with 120GT or 240GT. 120GT with or without PEI was sufficient for treating POAG with or without cataract..
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Affiliation(s)
- Yu Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ping Yu
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Yingzhe Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Kazunobu Sugihara
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Xiaomin Zhu
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yao Zhang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao Yang
- Jinan Mingshui Eye Hospital (X.Y., X.L., S.F.), Jinan, Shandong, China
| | - Xiaoyan Li
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Yacong Liu
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Hengli Zhang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Xiaowei Yan
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Hengkai Zhang
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Fengbin Lin
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Yunhe Song
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Xinbo Gao
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Huiping Yuan
- Department of Ophthalmology (Hengkai Zhang, H.Y.), The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Guangxian Tang
- Department of Ophthalmology (Hengli Zhang, X.Y., G.T.), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China
| | - Wenzong Zhou
- Cangzhou Aier Eye Hospital (Y.L., W.Z.), Aier Eye Hospital Group, Cangzhou, Hebei, China
| | - Sujie Fan
- Department of Ophthalmology (X.L.), Handan City Eye Hospital (The Third Hospital of Handan), Handan, Hebei, China
| | - Guangfu Dang
- Department of Ophthalmology (G.D.), The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Li Tang
- Department of Ophthalmology (Yao Zhang, L.T.), West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Weirong Chen
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China
| | - Ningli Wang
- Beijing Tongren Eye Center (N.W.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ki Ho Park
- Department of Ophthalmology (K.H.P.), Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keith Barton
- NIHR Biomedical Research Centre (K.B.), Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | - Tin Aung
- Singapore Eye Research Institute (T.A.), Singapore National Eye Center, Singapore, Republic of Singapore
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen) (D.S.C.L.), Shenzhen, China
| | - Robert N Weinreb
- Hamilton Glaucoma Center (R.N.W.), Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
| | - Lin Xie
- Department of Ophthalmology (X.Z., L.X.), The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Masaki Tanito
- Department of Ophthalmology (K.S., M.T.), Shimane University Faculty of Medicine, Izumo, Japan
| | - Liuzhi Zeng
- Department of Ophthalmology (P.Y., L.Z.), Chengdu First People's Hospital, Chengdu, Sichuan, China.
| | - Xiulan Zhang
- From the State Key Laboratory of Ophthalmology (Yu Zhang, Yingzhe Zhang, F.L., Y.S., X.G., W.C., Xiulan Zhang), Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, Guangdong, China.
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Jayaram H, Kolko M, Friedman DS, Gazzard G. Glaucoma: now and beyond. Lancet 2023; 402:1788-1801. [PMID: 37742700 DOI: 10.1016/s0140-6736(23)01289-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 09/26/2023]
Abstract
The glaucomas are a group of conditions leading to irreversible sight loss and characterised by progressive loss of retinal ganglion cells. Although not always elevated, intraocular pressure is the only modifiable risk factor demonstrated by large clinical trials. It remains the leading cause of irreversible blindness, but timely treatment to lower intraocular pressure is effective at slowing the rate of vision loss from glaucoma. Methods for lowering intraocular pressure include laser treatments, topical medications, and surgery. Although modern surgical innovations aim to be less invasive, many have been introduced with little supporting evidence from randomised controlled trials. Many cases remain undiagnosed until the advanced stages of disease due to the limitations of screening and poor access to opportunistic case finding. Future research aims to generate evidence for intraocular pressure-independent neuroprotective treatments, personalised treatment through genetic risk profiling, and exploration of potential advanced cellular and gene therapies.
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Affiliation(s)
- Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; UCL Institute of Ophthalmology, London, UK; National Institute for Health and Care Research Moorfields Biomedical Research Centre, London, UK
| | - Miriam Kolko
- Copenhagen University Hospital, Rigshospitalet, Glostrup, Denmark; University of Copenhagen, Department of Drug Design and Pharmacology, Copenhagen, Denmark
| | - David S Friedman
- Massachusetts Eye and Ear Hospital, Glaucoma Center of Excellence, Boston, MA, USA; Harvard University, Boston, MA, USA
| | - Gus Gazzard
- Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK; UCL Institute of Ophthalmology, London, UK; National Institute for Health and Care Research Moorfields Biomedical Research Centre, London, UK.
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36
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Zhang X, Lin F, Li F, Lee JWY, Tham CC. Minimally Invasive Glaucoma Surgery: A New Era in Glaucoma Treatment. Asia Pac J Ophthalmol (Phila) 2023; 12:509-511. [PMID: 38079261 DOI: 10.1097/apo.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Fei Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jacky W Y Lee
- The C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Lam Kin Chung, Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
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37
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Lin F, Nie X, Shi J, Song Y, Lv A, Li X, Lu P, Zhang H, Jin L, Tang G, Fan S, Weinreb RN, Zhang X. Safety and Efficacy of Goniotomy following Failed Surgery for Glaucoma. J Glaucoma 2023; 32:942-947. [PMID: 37725785 DOI: 10.1097/ijg.0000000000002301] [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: 03/15/2023] [Accepted: 08/09/2023] [Indexed: 09/21/2023]
Abstract
PRCIS Goniotomy (GT) is an alternative surgery for patients with prior failed surgery for glaucoma. PURPOSE To evaluate the efficacy and safety of GT in patients with prior failed surgery for glaucoma. MATERIALS AND METHODS A prospective, observational multicentered study was performed for patients who underwent GT with prior single or multiple surgery for glaucoma. Outcome measures included intraocular pressure (IOP) change, best-corrected visual acuity change, ocular hypotensive medication use, and occurrence of adverse events through 12 months. Complete success was defined as a postoperative IOP within 6-18 mmHg and a 20% reduction from baseline without ocular hypotensive medications. Qualified success was the same as the definition of complete success, except for postoperative use of medication. Logistic regression models were used to investigate the potential factors for surgical success. RESULTS A total of 38 eyes of 34 patients were included. Twenty-three eyes had only 1 prior surgery, 13 eyes had 2 prior surgeries, 1 eye had 3 prior surgeries, and 1 eye had 4 prior surgeries. At month 12, there was complete success in 42.1% of the eyes and qualified success in 78.9% of the eyes. Preoperatively, the mean IOP was 29.4±6.9 mmHg and the median number of glaucoma medications used was 3.0 (2.0, 4.0); this decreased to 16.7±3.6 mmHg (43.2% reduction; P <0.001) and 2.0 (0.0, 3.0) ( P <0.001) at month 12, respectively. The most common complications included hyphema (13.2%), IOP spike (7.9%), and corneal edema (5.2%). Older age significantly contributed to surgical success. CONCLUSIONS GT seems to be a safe and effective procedure for patients with prior failed surgery for glaucoma.
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Affiliation(s)
- Fengbin Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Xin Nie
- Department of Ophthalmology, Chongqing General Hospital, Chongqing
| | | | - Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou
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38
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Abstract
Many pharmaceutical and medical device start-up companies share similar goals. Each experience is different and offers important lessons for companies seeking Food and Drug Administration approval. This article offers important advice for budding entrepreneurs as it discusses some career-altering decisions, lessons learned in the start-up world, the technology leading up to innovation, the relevant science, medicine, chemistry, and engineering, the need to develop novel biomaterials, the regulatory path, and the business process culminating in the development of a Poly(styrene-block-isobutylene-block-Styrene)-based microshunt to treat glaucoma that led to the founding of InnFocus, Inc. (Miami, FL) in 2004, and then the acquisition of InnFocus by Santen Pharmaceuticals (Osaka, Japan) in 2016.
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Affiliation(s)
- Leonard Pinchuk
- InnFocus, Inc., a Santen Company, Miami, Florida, and Department of Biomedical Engineering, University of Miami, Miami, Florida
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39
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Sakamoto T, Nisiwaki H. Factors associated with 1-year outcomes and transient intraocular pressure elevation in minimally invasive glaucoma surgery using Kahook Dual Blades. Sci Rep 2023; 13:15206. [PMID: 37710010 PMCID: PMC10502046 DOI: 10.1038/s41598-023-42575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 09/12/2023] [Indexed: 09/16/2023] Open
Abstract
In this retrospective case-control study, we aimed to investigate the mid- to long-term outcomes and factors involved in minimally invasive glaucoma surgery using the Kahook Dual Blade. Of the 229 cases since 2018 in which the dual blades were used for glaucoma surgery at the Tenri Hospital, 133 eyes of 98 patients who followed up for more than 3 months were included. Intraocular pressure (IOP), number of drops score, and need for reoperation were evaluated on day 1 and at 1, 3, 6, 9, and 12 months postoperatively. Intraocular pressure spikes occurred in 25 patients postoperatively (18.8%), occurring at approximately 4.5 days (1-10.25). The preoperative number of eye drops used and ocular axial length were found to be associated with the occurrence of spikes (OR = 1.45, 95% CI 1.02-2.06; P = 0.025 and OR = 1.41, 95% CI 0.98-1.25; P = 0.072, respectively). At the 12-month mark, no significant relationship was found between the presence of spikes or incisional extent scores and the amount of change in IOP and number of drops scores. Patients with severe visual field impairment, high preoperative IOP and drop scores, and long ocular axial length may require more frequent follow-ups after surgery to check for spikes.
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Affiliation(s)
- Tomoaki Sakamoto
- Department of Ophthalmology, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 632-8552, Japan.
| | - Hirokazu Nisiwaki
- Department of Ophthalmology, Tenri Hospital, 200 Mishimacho, Tenri, Nara, 632-8552, Japan.
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40
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Li R, Zhang K, Lu Z, Mou D, Wang J, Li H, Fan S, Wang N, Liu H. Cost-utility analysis of commonly used anti-glaucoma interventions for mild-to-moderate primary open-angle glaucoma patients in rural and urban China. BMJ Open 2023; 13:e073219. [PMID: 37673456 PMCID: PMC10496665 DOI: 10.1136/bmjopen-2023-073219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023] Open
Abstract
OBJECTIVE An increasing number of studies have explored the clinical effects of antiglaucoma surgical procedures; however, economic evidence was scarce. We aimed to compare the cost-effectiveness between maximal medical treatment (MMT) and commonly used surgical procedures (trabeculectomy, Ahmed glaucoma valve implantation, gonioscopy-assisted transluminal trabeculotomy and ab interno canaloplasty). DESIGN AND SETTING A Markov model study. PARTICIPANTS A hypothetical cohort of 100 000 patients with mild-to-moderate primary open-angle glaucoma (POAG). OUTCOMES Data were obtained from public sources. The main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs). Sensitivity analyses were conducted to verify the robustness and sensitivity of base-case results. MAIN RESULTS Both cumulative costs and QALYs gained from surgical procedures (US$6045-US$13 598, 3.33-6.05 QALYs) were higher than those from MMT (US$3117-US$6458, 3.14-5.66 QALYs). Compared with MMT, all surgical procedures satisfied the cost-effectiveness threshold (lower than US$30 501 and US$41 568 per QALY gained in rural and urban settings, respectively). During the 5-year period, trabeculectomy produced the lowest ICUR (US$21 462 and US$15 242 per QALY gained in rural and urban settings, respectively). During the 10-year-follow-up, trabeculectomy still produced the lowest ICUR (US$13 379 per QALY gained) in urban setting; however, gonioscopy-assisted transluminal trabeculotomy (US$19 619 per QALY gained) and ab interno canaloplasty (US$18 003 per QALY gained) produced lower ICURs than trabeculectomy (US$19 675 per QALY gained) in rural areas. Base-case results were most sensitive to the utilities and costs of initial treatment and maintenance. CONCLUSIONS The long-term cost-effectiveness of commonly used surgical procedures could be better than the short-term cost-effectiveness for mild-to-moderate POAG patients in China. Health economic studies, supported by more rigorous structured real-world data, are needed to assess their everyday cost-effectiveness.
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Affiliation(s)
- Ruyue Li
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Kaiwen Zhang
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Zhecheng Lu
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Dapeng Mou
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Jin Wang
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Huiqi Li
- School of Medical Technology, Beijing Institute of Technology, Beijing, China
| | - Sujie Fan
- Handan City Eye Hospital, Handan, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
| | - Hanruo Liu
- Beijing Institute of Ophthalmology, Beijing, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing, China
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Atik A, Martin K, Fahy E, Green C, Mennemeyer ST. Re: Van Lancker et al.: Clinical outcomes and cost analysis of PreserFlo versus trabeculectomy for glaucoma management in the United Kingdom (Ophthalmol Glaucoma. 2023;6:342-357). Ophthalmol Glaucoma 2023; 6:e3-e4. [PMID: 37277022 DOI: 10.1016/j.ogla.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/31/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Alp Atik
- Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
| | - Keith Martin
- Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia; Centre for Eye Research Australia, Melbourne, Australia
| | | | - Catherine Green
- Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Stephen T Mennemeyer
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
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Myers JS, Lamrani R, Hallaj S, Lee D, Wong JC. 10-Year Clinical Outcomes of Tube Shunt Surgery at a Tertiary Care Center. Am J Ophthalmol 2023; 253:132-141. [PMID: 37072075 DOI: 10.1016/j.ajo.2023.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To report 10-year clinical outcomes of tube shunt (TS) surgery at a tertiary care center. DESIGN Retrospective cohort study. METHODS Eyes were included that underwent a first TS surgery between January 2005 and December 2011 at a tertiary referral eye hospital and with at least 10 years of follow-up. Demographic and clinical data were collected. Failure was defined as reoperation to lower intraocular pressure (IOP), IOP > 80% of baseline for two consecutive visits, or progression to no light perception. RESULTS Eighty-five eyes of 78 patients were included in the Study Group; 89 eyes were selected as a Comparison Group. Mean follow-up was 11.9 ± 1.7 years. Fifty-one valved (60%), 25 non-valved (29%), and nine unknown (11%) TS were placed. At the final visit, mean IOP was reduced from 29.2 ± 10.4 mmHg on 3.1 ± 1.2 medications to 12.6 ± 5.8 mmHg on 2.2 ± 1.4 (p<0.001 for each). Forty-eight eyes (56%) failed; 29 eyes (34%) underwent additional glaucoma surgery; eight eyes (10%) progressed to no light perception; and 34 eyes (40%) also required TS revision. Best corrected visual acuity (BCVA) logMAR (minimal angle of resolution) worsened from 0.8 ± 0.7 (20/125) to 1.4 ± 1.0 (20/500) at the last visit (p<0.001). Average visual field MD was -13.9 ± 7.5 dB at baseline and -17.0 ± 7.0 dB at last follow-up (P=0.0605). CONCLUSIONS Many eyes maintained IOP control 10 years following TS, but 56% met failure criteria, 39% had substantial vision loss, and 34% underwent additional surgery. Outcomes did not differ with TS model. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Jonathan S Myers
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA (J.S.M, D.L).
| | - Ryan Lamrani
- Eastern Virginia Medical School, Norfolk, VA, USA (R.L)
| | - Shahin Hallaj
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W)
| | - Daniel Lee
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA (J.S.M, D.L)
| | - Jae-Chiang Wong
- From Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA (J.S.M, S.H, D.L, J-C.W); Rowan University School of Osteopathic Medicine, Stratford, NJ, USA (J-C.J)
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43
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Armstrong JJ, De Francesco T, Ma J, Schlenker MB, Ahmed IIK. Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma: Three-Year Results as a Primary Surgical Intervention. Ophthalmol Glaucoma 2023; 6:480-492. [PMID: 37044278 DOI: 10.1016/j.ogla.2023.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To determine the effectiveness, risk factors for surgical failure, and adverse events in a large cohort of patients receiving stand-alone ab externo poly(styrene-block-isobutylene-block-styrene) (SIBS) microshunt implantation with mitomycin C (MMC) over 3 years of follow-up. DESIGN Retrospective, interventional case series. PARTICIPANTS Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery. METHODS Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 and November 2017 were reviewed. Data from all follow-up visits were utilized and included intraocular pressure (IOP), medication use, postoperative interventions, complications, and reoperations. MAIN OUTCOME MEASURES The primary outcome was proportion of eyes at 3 years with (1) no 2 consecutive IOPs > 17 mmHg (or < 6 mmHg with > 2 lines of vision loss from baseline); (2) ≥ 20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21 mmHg upper IOP thresholds with and without ≥ 20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, postoperative interventions, complications, and reoperations. RESULTS One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (interquartile range [IQR], 12.1-34.1) months; however, 59.4% of eyes remained medication free at 3 years. Significant risk factors for failure included receiving < 0.4 mg/ml of MMC (adjusted hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.44-4.05) and baseline IOP < 21 mmHg (adjusted HR, 1.79; 95% CI, 1.03-3.13). The most common complications were choroidal detachment, hyphema, and anterior chamber shallowing, occurring in 7%, 5%, and 5% of eyes, respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP > 21 mmHg (HR, 3.21; 95% CI, 1.38-7.48). Revisions occurred in 7% of eyes and reoperations in 2.6%. Eyes receiving < 0.4 mg/ml of MMC underwent more revisions (odds ratio, 4.9; 95% CI, 1.3-18.3). CONCLUSIONS Three-year follow-up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden postoperatively and few postoperative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- James J Armstrong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada
| | | | - Jenny Ma
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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Traverso CE, Carassa RG, Fea AM, Figus M, Astarita C, Piergentili B, Vera V, Gandolfi S. Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature. J Clin Med 2023; 12:5339. [PMID: 37629380 PMCID: PMC10455777 DOI: 10.3390/jcm12165339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of glaucoma has undergone continuous advances in recent years, XEN-gel-stent has been introduced as a safer and less traumatic means of lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). This study aimed to review the effectiveness and safety of clinical data on XEN-stent in OAG patients with a Synthesis-Without-Meta-analysis (SWiM) methodology. A total of 339 studies were identified following a literature search adhering to PRISMA guidelines and, after evaluation, 96 studies are discussed. XEN63 and XEN45 device data were collected both short and long term. In addition, this document has evaluated different aspects related to the XEN implant, including: its role compared to trabeculectomy; the impact of mitomycin-C dose on clinical outcomes; postoperative management of the device; and the identification of potential factors that might predict its clinical outcomes. Finally, current challenges and future perspectives of XEN stent, such as its use in fragile or high myopia patients, were discussed.
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Affiliation(s)
- Carlo Enrico Traverso
- Eye Clinic, IRCCS San Martino Polyclinic Hospital, 16132 Genoa, Italy;
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16126 Genoa, Italy
| | | | - Antonio Maria Fea
- Department of Surgical Sciences, University of Turin, 10122 Turin, Italy;
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Carlo Astarita
- AbbVie S.r.l., 04011 Campoverde, LT, Italy; (C.A.); (B.P.)
| | | | | | - Stefano Gandolfi
- Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy;
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Lazcano-Gomez G, Antzoulatos GL, Kahook MY. Combined Phacoemulsification and STREAMLINE Surgical System Canal of Schlemm Transluminal Dilation in Eyes of Hispanic Patients with Mild to Moderate Glaucoma. Clin Ophthalmol 2023; 17:1911-1918. [PMID: 37425029 PMCID: PMC10329431 DOI: 10.2147/opth.s409164] [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: 03/01/2023] [Accepted: 06/08/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To characterize clinical outcomes of transluminal dilation of the canal of Schlemm using the STREAMLINE Surgical System combined with phacoemulsification in eyes of Hispanic patients diagnosed with mild to moderate primary open-angle glaucoma. Methods This was a prospective analysis of all cases performed and followed up to 12 months. All eyes underwent medication washout preoperatively. Reduction in intraocular pressure (IOP) from unmedicated baseline, as well as medications from pre-washout baseline, were analyzed at postoperative Day 1, Week 1, and Months 1, 3, 6, 9, and 12. Results All 37 patients were Hispanic, 83.8% were female, and mean (standard deviation) age was 66.0 (10.5) years. Mean medicated preoperative IOP was 16.9 (3.2) mmHg using a mean of 2.1 (0.9) medications, unmedicated baseline IOP (after washout) was 23.2 (2.3) mmHg, and mean IOP at every postoperative study visit was significantly lower (p<0.0002). Mean IOP from month 1 through the first postoperative year ranged from 14.7-16.2 mmHg, representing a reduction of 7.0-8.5 mmHg (30.7-36.5%). At month 12, 80% of all eyes (28/35) and 77.8% of medication-free eyes (14/18) had IOP reduction ≥20% from unmedicated baseline, and 51.4% of eyes (18/35) were medication-free. Mean medication use was significantly reduced (by 59.9-74.6%, p<0.0001) at every postoperative study visit. The only adverse event occurring in >1 eye was high IOP (n=4) which was responsive to topical medical therapy; no adverse events were attributed to the transluminal dilation procedure. Conclusion Transluminal dilation of the canal of Schlemm using the STREAMLINE Surgical System combined with phacoemulsification safely and effectively reduced both IOP and dependence on IOP-lowering medications in a Hispanic population diagnosed with POAG and should be considered at the time of phacoemulsification in Hispanic patients who have a need for IOP reduction, medication reduction, or both.
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Affiliation(s)
- Gabriel Lazcano-Gomez
- Department of Glaucoma, Clinica Laser y Ultrasonido Ocular, Puebla City, Puebla, Mexico
- Hospital Angeles Puebla, Puebla City, Puebla, Mexico
| | | | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Coulon SJ, Vanner EA, Gedde SJ. Outcomes of Glaucoma Reoperations in the Primary Tube Versus Trabeculectomy Study. Ophthalmol Glaucoma 2023; 6:422-431. [PMID: 36828230 PMCID: PMC10440285 DOI: 10.1016/j.ogla.2023.02.003] [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: 11/16/2022] [Revised: 02/09/2023] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To describe the incidence and outcomes of reoperations for glaucoma in the Primary Tube Versus Trabeculectomy (PTVT) Study. DESIGN Cohort study of patients in a multicenter randomized clinical trial. PARTICIPANTS The PTVT Study enrolled 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery. METHODS Randomization assigned 125 patients to placement of a tube shunt (350-mm2 Baerveldt glaucoma implant) and 117 patients to trabeculectomy with mitomycin C (MMC, 0.4 mg/ml for 2 minutes). Data were analyzed from patients who underwent additional glaucoma surgery. MAIN OUTCOME MEASURES Outcome measures included intraocular pressure (IOP), use of glaucoma medications, visual acuity, surgical complications, and failure (IOP > 21 mmHg or reduced by <20%, IOP ≤ 5 mmHg, additional glaucoma surgery, or loss of light perception vision). RESULTS Additional glaucoma surgery was performed in 21 patients in the tube group and 12 patients in the trabeculectomy group in the PTVT Study, and the 5-year cumulative reoperation rate for glaucoma was 18.0% in the tube group and 10.4% in the trabeculectomy group (P = 0.15). Follow-up (mean ± standard deviation [SD]) after additional glaucoma surgery was 35.1 ± 17.7 months in the tube group and 30.1 ± 17.6 months in the trabeculectomy group (P = 0.44). At 3 years after glaucoma reoperation, IOP (mean ± SD) was 15.5 ± 4.8 mmHg in the tube group and 16.6 ± 7.3 mmHg in the trabeculectomy group (P = 0.71). The number of glaucoma medications (mean ± SD) after 3 years of follow-up was 2.1 ± 1.7 in the tube group and 1.7 ± 1.0 in the trabeculectomy group (P = 0.58). The cumulative probability of failure at 3 years after a glaucoma reoperation was 37.8% in the tube group and 21.3% in the trabeculectomy group (P = 0.47). CONCLUSION No significant difference in the rate of reoperation for glaucoma was observed after tube shunt implantation and trabeculectomy with MMC in the PTVT Study. Similar surgical outcomes were observed after additional glaucoma surgery, irrespective of the initial procedure to which the patient was randomized. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Sara J Coulon
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
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Akai R, Yunoki T, Otsuka M, Hayashi A. Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon. Ophthalmic Plast Reconstr Surg 2023; 39:357-360. [PMID: 36735298 DOI: 10.1097/iop.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma. METHODS Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis. RESULTS The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively ( p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries ( p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03-40.26; p = 0.04). CONCLUSION Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.
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Affiliation(s)
- Ryota Akai
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Van Lancker L, Saravanan A, Abu-Bakra M, Reid K, Quijano C, Goyal S, Rodrigues I, Lascaratos G, Trikha S, Barwood C, Combe E, Kulkarni A, Lim KS, Low S. Clinical Outcomes and Cost Analysis of PreserFlo versus Trabeculectomy for Glaucoma Management in the United Kingdom. Ophthalmol Glaucoma 2023; 6:342-357. [PMID: 36427750 DOI: 10.1016/j.ogla.2022.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Clinical evaluation and cost analysis of mitomycin-C-augmented PreserFlo MicroShunt versus trabeculectomy. DESIGN Retrospective cohort study across 3 teaching hospitals. PARTICIPANTS A total of 134 consecutive eyes of 129 patients (70 undergoing MicroShunt, 64 trabeculectomy). METHODS Primary and secondary glaucoma cases with uncontrolled intraocular pressure (IOP) were included. Neovascular glaucoma and surgery combined with cataract extraction were excluded. The cost analysis used results from the clinical study to estimate operative costs (equipment and staff costs) and postoperative costs (follow-up visits, nonglaucoma medications, and postoperative procedures) per eye for PreserFlo and trabeculectomy. MAIN OUTCOME MEASURES The primary clinical outcome measure was surgical failure (defined as IOP > 21 mmHg or < 20% reduction from baseline, IOP ≤ 5 mmHg, reoperation, or loss of light perception) or qualified and complete success (with or without medication) at 18 months. Secondary measures were IOP, glaucoma medications, visual acuity, mean deviation, time to cessation of steroid drops, complications, surgical time, follow-up visits, postoperative interventions, and reoperations. The cost analysis evaluated costs of PreserFlo compared with trabeculectomy. RESULTS Baseline characteristics were similar, except for more non-White patients in the trabeculectomy group (51% Black and Asian vs. 32% MicroShunt, P = 0.02) and more cases with prior ab externo glaucoma surgery in the MicroShunt group (19% vs. 3% in the trabeculectomy group, P = 0.004). Overall, 59% of eyes had primary open-angle glaucoma. Mean follow-up was 19.9 months for both groups. At 18 months, surgical failure was 25% for MicroShunt compared with 35% for trabeculectomy (P = 0.18). Failure in MicroShunt cases was due to inadequate IOP reduction (84%) or reoperation for glaucoma (16%). Failure in trabeculectomy cases was due to inadequate IOP reduction (58%), persistent hypotony (29%), or reoperation for glaucoma (13%). Combined blebitis and endophthalmitis rate was 1.4% for MicroShunt and 3.1% for trabeculectomy. Cost analysis showed a savings of £245 to £566 per eye in the MicroShunt group, driven mostly by reduced postoperative procedures and follow-up visits. This is in contrast to prior randomized controlled trial data reporting the incremental cost of $2058 of PreserFlo over trabeculectomy. CONCLUSIONS Our experience of introducing PreserFlo MicroShunt surgery showed it was safer than trabeculectomy and is a cost-saving and effective option that offers potential to free up highly limited National Health Service resources. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Lauren Van Lancker
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amrita Saravanan
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mohammed Abu-Bakra
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kyle Reid
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claudia Quijano
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Saurabh Goyal
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ian Rodrigues
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gerassimos Lascaratos
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sameer Trikha
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Emily Combe
- FIECON, St. Albans, Hertfordshire, United Kingdom
| | - Avinash Kulkarni
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kin Sheng Lim
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sancy Low
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Hung A, Williams AM, Newman-Casey PA, Muir KW, Gatwood J. Cost-Utility Analysis of a Medication Adherence-Enhancing Educational Intervention for Glaucoma. Ophthalmol Glaucoma 2023; 6:395-404. [PMID: 36707031 PMCID: PMC10366331 DOI: 10.1016/j.ogla.2023.01.006] [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: 09/12/2022] [Revised: 12/27/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To evaluate the cost utility of a glaucoma medication-enhancing intervention compared to standard of care over a lifetime from the United States Department of Veterans Affairs (VA) payer perspective. DESIGN Model-based cost-utility analysis of a glaucoma medication-enhancing intervention from a randomized clinical trial. SUBJECTS Veterans with glaucoma, or suspected glaucoma who were prescribed topical glaucoma medications, had their visual field assessed within the last 9 months, and endorsed poor glaucoma medication adherence. METHODS Veterans were randomized either to a behavioral intervention to promote adherence or to a standard of care (control) session about general eye health. A decision analytic model was developed to simulate lifelong costs and quality-adjusted life years (QALYs) for an intervention tested in a randomized clinical trial at a single VA eye clinic. Costs included direct medical costs that the VA payer would incur, as informed initially by the clinical trial and then by published estimates. Health-state quality of life was based on published utility values. Scenario analyses included addition of booster interventions, a 3% decline in chance of staying medication adherent annually, and the combination of the two. Analyses were also conducted in the following subgroups: those with companion versus not, and those with once-daily versus more than once-daily dosing frequency. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratio (ICER). RESULTS Compared to standard of care, the intervention dominated resulting in lower costs ($23 339.28 versus $23 504.02) and higher QALYs (11.62 versus 11.58). Among the 4 subgroups, the intervention dominated for 3 of them. In the fourth subgroup, those with more than once-daily dosing, the ICER was $2625/QALY. Compared to standard of care, an intervention with booster interventions led to an ICER of $3278/QALY. Assuming both a 3% annual loss in chance of continuing to be adherent and addition of booster interventions, the ICER increased to $71 371/QALY. CONCLUSIONS From a VA payer perspective over a lifetime, the glaucoma medication-enhancing behavioral intervention dominated standard of care in terms of generating cost savings and greater QALYs. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Anna Hung
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Duke-Margolis Center for Health Policy, Durham, North Carolina.
| | - Andrew M Williams
- Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina; Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Kelly W Muir
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, North Carolina; Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina
| | - Justin Gatwood
- College of Pharmacy, The University of Tennessee Health Science Center, Memphis, Tennessee
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Arikan G, Gunenc U. Ahmed Glaucoma Valve Implantation to Reduce Intraocular Pressure: Updated Perspectives. Clin Ophthalmol 2023; 17:1833-1845. [PMID: 37405008 PMCID: PMC10317551 DOI: 10.2147/opth.s342721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023] Open
Abstract
Trabeculectomy and glaucoma drainage device implantation are the most commonly performed glaucoma surgeries worldwide. Although trabeculectomy is the gold standard, at the present time there is an increase in the use of glaucoma drainage devices. The Ahmed glaucoma valve is one of the most widely used glaucoma drainage devices worldwide. Corneal endothelial cell loss and eventually corneal decompensation is one of the serious complication of glaucoma drainage device implantation. To avoid this, drainage tube can be inserted into the ciliary sulcus instead of the anterior chamber, especially in eyes with high risk for corneal decompensation. Tube/plate exposure, hypertensive phase, endophthalmitis, cataract formation, diplopia and ocular hypotony are the other potential complications that can develop after Ahmed glaucoma valve implantation.
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Affiliation(s)
- Gul Arikan
- Dokuz Eylul University School of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Uzeyir Gunenc
- Dokuz Eylul University School of Medicine, Department of Ophthalmology, Izmir, Turkey
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