1
|
Maheshwari D, Pillai MR, Kanduri S, Nair IJ, Kader MA, Ramakrishnan R. Comparative study of surgical outcomes of twin-site phacotrabeculectomy with mitomycin C in primary open-angle glaucoma versus primary angle-closure glaucoma. Indian J Ophthalmol 2023; 71:3528-3533. [PMID: 37870019 PMCID: PMC10752304 DOI: 10.4103/ijo.ijo_324_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: 02/02/2023] [Revised: 06/19/2023] [Accepted: 07/10/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose To compare the surgical outcomes of twin-site phacotrabeculectomy with Mitomycin C (MMC) in primary open-angle glaucoma (POAG) versus primary angle-closure glaucoma (PACG). Methods Prospective, comparative, observational study. Patients with visually significant cataract and primary glaucoma were divided into two groups: POAG and PACG. They underwent twin-site phacotrabeculectomy with MMC and followed up on days 1, 15, 1 month, 6 months, and 12 months. Baseline and follow-up visits were compared to find the differences in intraocular pressure (IOP), antiglaucoma medications (AGM), success rates, anterior chamber depth (ACD), and axial length (AXL). Results There were 50 eyes each in POAG and PACG groups. Mean IOP reduction from baseline to 12 months (21.22 ± 6.0 to 11.40 ± 2.8-POAG group vs 24.16 ± 7.6 to 12.42 ± 3.2-PACG group) was statistically significant in both groups (P < 0.001), but no significant difference between groups (P = 0.095). There was a statistically significant decline in the number of AGM in POAG [1.66 (0.7) to 0.38 (0.7), P < 0.001] and PACG [2.10 (0.7) to 0.70 (0.8), P < 0.001]; the decline was more in POAG (P = 0.012) at last visit. Probability of overall (complete and qualified) success at 12 months postop was 72.0% [95% confidence interval (CI): 57.4-82.4] in PACG and 84.0% (95% CI: 70.5-91.7) in POAG group. There was a significant increase in ACD and a decrease in AXL in both groups (P < 0.001). More interventions were required in the PACG group (38, P = 0.012). Conclusion Phacotrabeculectomy with MMC causes a significant reduction in IOP and improvement in biometric parameters in both POAG and PACG. Patients with PACG required more postoperative interventions, while a lesser number of antiglaucoma medications were needed in POAG patients.
Collapse
Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | | | - Swathi Kanduri
- Department of Glaucoma, Aravind Eye Hospital, Tirunelveli, Tamil Nadu, India
| | - Indu J Nair
- Department of Retina, Chaithanya Eye Hospital and Research Institute, Trivandrum, Kerala, India
| | | | | |
Collapse
|
2
|
Maheshwari D, Segi A, Shinde SR, Kader MA, Rengappa R. Surgically induced astigmatism following single site and twin site phacotrabeculectomy augmented with mitomycin C. Eye (Lond) 2022; 36:1100-1105. [PMID: 34117400 PMCID: PMC9046193 DOI: 10.1038/s41433-021-01601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine difference in surgically induced astigmatism (SIA), post-operative intraocular pressure (IOP) and axial length (AL) between single site and twin-site phacotrabeculectomy augmented with Mitomycin C (MMC). DESIGN Prospective interventional randomised controlled study. METHODS In a prospective interventional comparative study, eligible patients were scheduled for phacotrabeculectomy. They were randomised to either group A: single site or group B: twin-site phacotrabeculectomy with MMC 0.2 mg/mL. Axial length was measured by using Zeiss IOL master I, pre-operatively and at 1, 3, 6 and 12 months post-operatively. Corneal topography was performed using Bausch and Lomb Orbscan I pre-operatively and at 3, 6 and 12 months post-operatively to analyse surgically induced astigmatism. Vector analysis was used to analyse the surgically induced astigmatism. RESULTS One hundred and eight eyes of which 55 patients in group A, and 53 patients in group B were enroled for vector analysis. The mean preoperative astigmatic vector power was +0.89 ± 0.4 D and +0.97 ± 0.5 D in group A and B respectively. The mean post-operative astigmatic vector power was +0.78 ± 0.4 D in group A and +0.96 ± 0.5 D in group B at the end of 12 months. Corneal topography showed post-operative superior flattening (51.8% at 3 months and 55.4% at 12 months) in group A (P = 0.072) compared to superior steepening (59.6% at 3 months and 61.5% at 12 months) in group B (P = 0.977). CONCLUSIONS The two commonly used techniques of combined cataract and glaucoma surgery proved to be efficacious without significant difference in surgical induced astigmatism.
Collapse
Affiliation(s)
- Devendra Maheshwari
- grid.413854.f0000 0004 1767 7755Glaucoma Clinic, Aravind Eye Hospital, Tirunelveli, India
| | - Ashwin Segi
- grid.413854.f0000 0004 1767 7755Glaucoma Clinic, Aravind Eye Hospital, Tirunelveli, India
| | - Sarika Ramugade Shinde
- grid.413854.f0000 0004 1767 7755Glaucoma Clinic, Aravind Eye Hospital, Tirunelveli, India
| | - Mohideen Abdul Kader
- grid.413854.f0000 0004 1767 7755Glaucoma Clinic, Aravind Eye Hospital, Tirunelveli, India
| | - Ramakrishnan Rengappa
- grid.413854.f0000 0004 1767 7755Glaucoma Clinic, Aravind Eye Hospital, Tirunelveli, India
| |
Collapse
|
3
|
Yilmaz Tugan B, Yuksel N, Kesim E, Subasi S. Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study. Int Ophthalmol 2022; 42:1737-1747. [PMID: 35083598 DOI: 10.1007/s10792-021-02169-2] [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: 06/14/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy. METHODS 96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5-18 mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5-18 mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan-Meier survival analysis. RESULTS The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9 years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7 years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258). CONCLUSIONS Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.
Collapse
Affiliation(s)
- Büşra Yilmaz Tugan
- Department of Ophthalmology, Kocaeli University Hospital, Kocaeli University Medical Faculty, Kocaeli, Turkey.
| | - Nursen Yuksel
- Department of Ophthalmology, Kocaeli University Hospital, Kocaeli University Medical Faculty, Kocaeli, Turkey
| | - Enes Kesim
- Ophthalmology Clinic, Tuzla State Hospital, Istanbul, Turkey
| | - Sevgi Subasi
- Department of Ophthalmology, Kocaeli University Hospital, Kocaeli University Medical Faculty, Kocaeli, Turkey
| |
Collapse
|
4
|
Senthil S, Deshmukh S, Turaga K, Pesala V, Bandela PK, Ganesh J, Garudadri C, Bharadwaj S. Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy. Indian J Ophthalmol 2021; 68:609-614. [PMID: 32174580 PMCID: PMC7210854 DOI: 10.4103/ijo.ijo_588_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies. Methods Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery. Results Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months. Conclusion The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups.
Collapse
Affiliation(s)
- Sirisha Senthil
- VST Glaucoma Center, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Sanket Deshmukh
- GMRV Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Kiranmaye Turaga
- GMRV Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Veerendranath Pesala
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Praveen K Bandela
- Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | - Jonnadula Ganesh
- VST Glaucoma Center, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| | | | - Shrikant Bharadwaj
- VST Glaucoma Center, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India
| |
Collapse
|
5
|
Gedde SJ, Vinod K, Wright MM, Muir KW, Lind JT, Chen PP, Li T, Mansberger SL. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Ophthalmology 2021; 128:P71-P150. [DOI: 10.1016/j.ophtha.2020.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
|
6
|
Gil-Carrasco F, Alvarez-Ascencio D, Tolosa-Tort P, Alvarez-Padilla M, Jimenez-Roman J, Castillejos-Chevez A. Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up. ACTA ACUST UNITED AC 2020; 96:202-209. [PMID: 33342630 DOI: 10.1016/j.oftal.2020.09.018] [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: 05/22/2020] [Revised: 09/02/2020] [Accepted: 09/05/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. METHODS Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. RESULTS The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (-0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was -0.92 medications (-3.38; +1.54) for the MMC group and -1 medication (-3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917). Both the PVP and MMC groups showed an initial reduction in number of medications until month 12 and a relatively linear increase towards month 36. A longer follow-up may be warranted to reveal differences in the number of medications between the two exposure groups. Postoperative complications were less frequent in the PVP group. CONCLUSIONS The use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.
Collapse
Affiliation(s)
- F Gil-Carrasco
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - D Alvarez-Ascencio
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico.
| | - P Tolosa-Tort
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - M Alvarez-Padilla
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - J Jimenez-Roman
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| | - A Castillejos-Chevez
- Glaucoma Department, Asociación Para Evitar la Ceguera en México, IAP, Mexico City, Mexico
| |
Collapse
|
7
|
Mansoori T, Balakrishna N. Comparison of the Surgical Outcomes of Single-Site, Mitomycin C-Augmented Trabeculectomy Combined with Phacoemulsification versus Manual Small-Incision Cataract Surgery. J Curr Ophthalmol 2020; 32:329-334. [PMID: 33553833 PMCID: PMC7861104 DOI: 10.4103/joco.joco_4_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 11/04/2022] Open
Abstract
Purpose To compare the safety, efficacy, and outcome measures of a single-site, mitomycin C (MMC)-augmented trabeculectomy combined with phacoemulsification (PT) versus manual small-incision cataract surgery (MSICS) with the posterior chamber intraocular lens (PCIOL) implantation as a primary surgery in the patients with primary glaucoma coexistent with cataract. Methods From April 2015 to August 2017, medical records of all the patients who underwent combined cataract surgery with PCIOL and MMC augmented trabeculectomy were reviewed. One hundred and thirty-seven eyes met the inclusion criteria. Ninety-seven eyes which underwent PT with MMC were compared with forty eyes that underwent MSICS combined with trabeculectomy (MSICST) MMC. Outcome measures were best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of anti-glaucoma medications (AGM). Complications, if any, were noted in both the groups. Results The mean follow-up period after surgery was 18.6 ± 7.7 months (range, 12-40 months). At the last follow-up visit, there was no statistically significant difference between the groups, in terms of mean logMAR BCVA (PT: 0.22 ± 0.31, MSICST: 0.21 ± 0.33, P = 0.8), mean IOP reduction (PT: 13.9 ± 2.98 mmHg, MSICST: 14.1 ± 4.12 mmHg, P = 0.8), and mean number of AGM (PT: 0.03 ± 0.8, MSICST: 0.025 ± 0.7, P = 0.8). Complications were few and transient. One eye in the PT group was considered as a failure and had to undergo needling, repeat trabeculectomy, and later, cyclodestructive procedure. None of the eyes in the MSICST group required an additional procedure for IOP reduction. Conclusion There was no difference in the mean IOP reduction, BCVA, and mean number of AGM between the two procedures, and both appeared to be safe and effective techniques as a primary surgery in the patients with coexistent cataract and glaucoma.
Collapse
Affiliation(s)
- Tarannum Mansoori
- Department of Glaucoma, Sita Lakshmi Glaucoma Center, Anand Eye Institute, Hyderabad, Telangana, India
| | - Nagalla Balakrishna
- Department of Statistics, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| |
Collapse
|
8
|
Zhao R, Lin L, Zeng J, Duan F, Yang Y, Su SB, Lou B, Lin X. Development of a rabbit model of persistent hypotony without ciliary body injury. Exp Eye Res 2019; 190:107858. [PMID: 31669044 DOI: 10.1016/j.exer.2019.107858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/01/2019] [Accepted: 10/22/2019] [Indexed: 11/26/2022]
Abstract
In order to study the pathophysiological alterations of the ciliary body (CB) during persistent hypotony, it is necessary to develop an animal model without CB injury. In this study, we successfully established a modified model of persistent hypotony without CB injury in New Zealand rabbits. A 23-gauge pars plana vitrectomy (PPV) was performed and a trocar-formed fistula was allowed to remain in situ, to produce a continuous outflow of intraocular fluid. Both eyes underwent PPV with normal intraocular pressure (IOP); eyes with no surgical intervention were used as controls. The IOP was monitored and used to evaluate the reliability of the model. Secondary changes of hypotony were evaluated by slit-lamp biomicroscopy and B scans while morphological changes of the CB were observed by haematoxylin and eosin staining. The mean IOP in the hypotony groups were consistently lower than 6 mmHg. Furthermore, there were no significant differences in IOP between the PPV control group and normal eyes. Collectively, our data indicate that this model successfully simulates the secondary changes of hypotony, including a reduction in corneal size, corneal oedema, anterior chamber inflammation, morphological alterations of the CB, cataract, retinal detachment, and choroidal detachment. The morphological structure of the CB tissue changed dramatically after persistent hypotony, indicating that normal IOP may be required in order to maintain normal function in the CB. This model of persistent hypotony potentially represents a valuable tool for future studies aiming to investigate the pathophysiological mechanisms underlying CB dysfunction and other secondary changes that occur during hypotony.
Collapse
Affiliation(s)
- Ruijuan Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Lixia Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jieting Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Fang Duan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Shao Bo Su
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Bingsheng Lou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
| | - Xiaofeng Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
| |
Collapse
|
9
|
Pathak Ray V, Chaironika N, Gupta S, Choudhari NS. New superior modified fornix-based twin-site phacotrabeculectomy. Indian J Ophthalmol 2019; 67:1870-1872. [PMID: 31638052 PMCID: PMC6836580 DOI: 10.4103/ijo.ijo_237_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Phacotrabeculectomy is the preferred surgical management of coexisting visually significant cataract and moderate to advanced glaucoma. We report the surgical technique of a new modified fornix-based separate-site phacotrabeculectomy, with mitomycin C (MMC) application, in both primary open angle and angle closure glaucoma. In this new separate-site technique, both phaco and filtration are accommodated superiorly, side by side, hence called twin-site. This was achieved in an efficacious and safe manner with sparing of limbal stem cells without compromising safety. It is not only MMC-compatible but also has a low incidence of wound leak. The technique has no adverse consequence on the survival of the bleb, and we achieved complete success in 79.2% and total success in 93.1% in 130 eyes of 117 patients, in the intermediate term. Furthermore, the time taken for this separate-site surgical technique is comparable to published one-site procedures.
Collapse
Affiliation(s)
- Vanita Pathak Ray
- Department of Glaucoma, Centre for Sight, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Nur Chaironika
- VST Centre for Glaucoma, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Supriya Gupta
- VST Centre for Glaucoma, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| | - Nikhil S Choudhari
- VST Centre for Glaucoma, L V Prasad Eye Institute, Banjara Hills, Hyderabad, India
| |
Collapse
|
10
|
Golozar A, Chen Y, Lindsley K, Rouse B, Musch DC, Lum F, Hawkins BS, Li T. Identification and Description of Reliable Evidence for 2016 American Academy of Ophthalmology Preferred Practice Pattern Guidelines for Cataract in the Adult Eye. JAMA Ophthalmol 2019; 136:514-523. [PMID: 29800249 DOI: 10.1001/jamaophthalmol.2018.0786] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Trustworthy clinical practice guidelines require reliable systematic reviews of the evidence to support recommendations. Since 2016, the American Academy of Ophthalmology (AAO) has partnered with Cochrane Eyes and Vision US Satellite to update their guidelines, the Preferred Practice Patterns (PPP). Objective To describe experiences and findings related to identifying reliable systematic reviews that support topics likely to be addressed in the 2016 update of the 2011 AAO PPP guidelines on cataract in the adult eye. Design, Setting, and Participants Cross-sectional study. Systematic reviews on the management of cataract were searched for in an established database. Each relevant systematic review was mapped to 1 or more of the 24 management categories listed under the Management section of the table of contents of the 2011 AAO PPP guidelines. Data were extracted to determine the reliability of each systematic review using prespecified criteria, and the reliable systematic reviews were examined to find whether they were referenced in the 2016 AAO PPP guidelines. For comparison, we assessed whether the reliable systematic reviews published before February 2010 the last search date of the 2011 AAO PPP guidelines were referenced in the 2011 AAO PPP guidelines. Cochrane Eyes and Vision US Satellite did not provide systematic reviews to the AAO during the development of the 2011 AAO PPP guidelines. Main Outcomes and Measures Systematic review reliability was defined by reporting eligibility criteria, performing a comprehensive literature search, assessing methodologic quality of included studies, using appropriate methods for meta-analysis, and basing conclusions on review findings. Results From 99 systematic reviews on management of cataract, 46 (46%) were classified as reliable. No evidence that a comprehensive search had been conducted was the most common reason a review was classified as unreliable. All 46 reliable systematic reviews were cited in the 2016 AAO PPP guidelines, and 8 of 15 available reliable reviews (53%) were cited in the 2011 PPP guidelines. Conclusions and Relevance The partnership between Cochrane Eyes and Vision US Satellite and the AAO provides the AAO access to an evidence base of relevant and reliable systematic reviews, thereby supporting robust and efficient clinical practice guidelines development to improve the quality of eye care.
Collapse
Affiliation(s)
- Asieh Golozar
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Yujiang Chen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kristina Lindsley
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Benjamin Rouse
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Barbara S Hawkins
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Tianjing Li
- Department of Epidemiology, Center for Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
11
|
Demir AG, Olgun A, Guven D, Demir M, Sendul SY, Akarsu Acar OP, Kacar H. The effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage: a preliminary study. Int Ophthalmol 2018; 39:2121-2128. [DOI: 10.1007/s10792-018-1044-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/12/2018] [Indexed: 12/13/2022]
|
12
|
Nassiri N, Nassiri N, Mohammadi B, Rahmani L. Comparison of 2 Surgical Techniques in Phacotrabeculectomy: 1 Site versus 2 Sites. Eur J Ophthalmol 2018; 20:316-26. [DOI: 10.1177/112067211002000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nader Nassiri
- Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran
| | | | | | | |
Collapse
|
13
|
Anbar M, Ammar H. Effect of different incision sites of phacoemulsification on trabeculectomy bleb function: prospective case-control study. BMC Ophthalmol 2017. [PMID: 28651590 PMCID: PMC5485683 DOI: 10.1186/s12886-017-0500-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to compare superior and temporal clear corneal incisions of uneventful phacoemulsification and in-the-bag intraocular lens implantation on intraocular pressure control and the bleb morphology in eyes that have undergone previous successful trabeculectomy. Methods In this Prospective case-control study, a total of 100 eyes of 100 patients previously undergone trabeculectomy without antimetabolites, divided into two groups. Group A (temporal group) including 50 patients underwent phacoemulsification with a temporal corneal incision and group B (superior group) including 50 patients underwent phacoemulsification with a superior corneal incision. Comparisons between the two groups were performed after one year of follow-up regarding Intraocular pressure changes, bleb morphology score using the Wuerzburg bleb classification score and any added glaucoma medications. Results At the last visit, the mean intraocular pressure for the temporal group was 17.55 ± 1.47 (p = 0.51) and for the superior group was 16.90 ± 1.71 (p = 0.85); the difference between the two groups was insignificant (p = 0.21). Regarding the bleb morphology, the mean bleb morphology score in the temporal group was 10.50 ± 0.95 (p = 0.19) and for the superior group was 10.20 ± 1.06 (p = 0.01).There was an insignificant difference in the bleb grading morphology regarding both groups (p = 0.35). Conclusion Our study demonstrates that phacoemulsification whether done with a clear temporal or clear superior wound, does not affect intraocular pressure, bleb morphology or function after one year of follow-up in eyes following previous successful trabeculectomy. Furthermore, cataract surgery may be performed safely in eyes with functioning filtering blebs. Trial registration ISRCTN91835217 ‘retrospectively registered’ Date Of registration 6/6/2017
Collapse
Affiliation(s)
- Mohamed Anbar
- Sohag University, Faculty of Medicine, Sohag, Egypt. .,Ophthalmology Department, Sohag University Hospital, Sohag, 82511, Egypt.
| | - Hatem Ammar
- Sohag University, Faculty of Medicine, Sohag, Egypt
| |
Collapse
|
14
|
Combined Phacoemulsification and Ahmed Glaucoma Drainage Implant Surgery for Patients With Refractory Glaucoma and Cataract. J Glaucoma 2016; 25:162-6. [PMID: 25264992 DOI: 10.1097/ijg.0000000000000141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To examine the indications, safety, efficacy, and complications of combined phacoemulsification and Ahmed glaucoma drainage implant surgery. METHODS A retrospective case review of 35 eyes (31 patients) subjected to combined phacoemulsification and Ahmed glaucoma drainage implant surgery. Demographic characteristics of the study population, indications for combined surgery, and operative and postoperative complications were recorded. Visual acuity, intraocular pressure (IOP), and number of glaucoma medications were evaluated preoperatively and postoperatively. Complete success was defined as IOP ≤ 21 mm Hg without medication, qualified success if IOP ≤ 21 mm Hg with ≥ 1 medications, and failure if IOP>21 mm Hg or ≤ 5 mm Hg on ≥ 2 consecutive visits. RESULTS Mean follow-up was 29.5 months (range, 6 to 87 mo). The most common indication for combined surgery was a history of prior failed trabeculectomy (60%). Postoperative visual acuity improved in 30 of 35 eyes (85%) (P<0.01) regardless of the indication for combined surgery. IOP was reduced from a mean of 24.7 to 15.0 mm Hg at the last follow-up visit (P<0.01). The number of IOP-lowering medications was reduced from a median of 3.1 preoperatively to 1.7 at the last follow-up (P<0.01). Overall, there were 31 eyes (89%) classified as qualified success and 4 eyes (11%) as complete success. The most common postoperative complication was a hypertensive phase in 18 eyes (51%). CONCLUSIONS Combined phacoemulsification and Ahmed glaucoma drainage implant surgery seems to be a safe and effective surgical option, providing good visual rehabilitation and control of IOP for patients with refractory glaucoma and cataract.
Collapse
|
15
|
Rodriguez R, Alburquerque R, Sauer T, Batlle JF. The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia. J Curr Glaucoma Pract 2016; 10:7-12. [PMID: 27231414 PMCID: PMC4875729 DOI: 10.5005/jp-journals-10008-1196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/20/2015] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate and compare the safety and efficacy of combined two-site phacoemulsification and trabeculectomy surgery with mitomycin C (MMC) in glaucoma-cataract patients with retrobulbar or topical anesthesia. Patients and methods: A retrospective, nonrandomized review of consecutive phacotrabeculectomy patients with a minimum follow-up time of 6 months, no previous glaucoma surgeries, and a preoperative visual acuity (VA) greater than light perception. The main outcome measures were preoperative and postoperative VA, intraocular pressure (IOP), use of glaucoma medications, and complications. A complete surgical success required an IOP from 6 to 18 mm Hg, no visually devastating complications, no return to surgery, and no use of glaucoma medications. Qualified success allowed the use of up to two glaucoma medications. Anesthesia groups were compared by student t-tests and log rank comparison of Kaplan-Meier survival rates. Results: Eighty-seven eyes (83 patients) met inclusion criteria, with a mean follow-up of 19 ± 12 months (6-57 months). The average eye gained 3.1 ± 4.9 lines of VA, lost 4.0 ± 7.1 mm Hg of IOP, and decreased 1.0 ± 1.3 glaucoma medications. Retrobulbar and topical anesthesia groups had statistically equivalent mean changes in VA (p = 0.910), IOP (p = 0.268), and use of glaucoma medications (p = 0.964). Postoperative complication rates were also statistically similar (p = 0.580). Complete success was greater in the retrobulbar group (p = 0.006), however, qualified success was equivalent in both groups (p = 0.769). Conclusion: Two-site phacotrabeculectomy with MMC in West Indian patients is as safe and effective for glaucoma-cataract patients with topical anesthesia as it is under retrobulbar anesthesia, and without short-term losses in VA and the chance of serious complications from injection. How to cite this article: Rodriguez R, Alburquerque R, Sauer T, Batlle JF. The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia. J Curr Glaucoma Pract 2016;10(1):7-12.
Collapse
Affiliation(s)
- Raquel Rodriguez
- Medical Director, Department of Glaucoma, Oftalmologia, Santiago, Dominican Republic
| | - Rachel Alburquerque
- Member, Department of Glaucoma, Elias Santana Hospital, Santo Domingo, Dominican Republic
| | - Tripper Sauer
- Resident, Department of Ophthalmology, Elias Santana Hospital and Centro Laser, Santo Domingo, Dominican Republic
| | - Juan Francisco Batlle
- Medical Director, Department of Ophthalmology, Elias Santana Hospital and Centro Laser, Santo Domingo, Dominican Republic
| |
Collapse
|
16
|
Cillino S, Casuccio A, Di Pace F, Cagini C, Ferraro LL, Cillino G. Biodegradable collagen matrix implant versus mitomycin-C in trabeculectomy: five-year follow-up. BMC Ophthalmol 2016; 16:24. [PMID: 26946419 PMCID: PMC4779569 DOI: 10.1186/s12886-016-0198-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 02/28/2016] [Indexed: 01/10/2023] Open
Abstract
Background Clinical studies comparing trabeculectomy augmented with Ologen implant (OLO) versus trabeculectomy plus mitomycin-C (MMC) show contradictory results. To obtain long-term data, we report an extended 5-year follow-up trial evaluating the safety and efficacy of OLO as adjuvant compared to low-dosage MMC in trabeculectomy. Methods Forty glaucoma patients (40 eyes) assigned to trabeculectomy with MMC or Ologen. Primary outcome: target IOP at ≤21, ≤17 and ≤15 mmHg; complete and qualified success endpoint rates. Secondary outcomes: visual acuity (VA), mean deviation (MD), bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain OCT (SD-OCT) bleb examination; number of glaucoma medications; frequency of postoperative complications. Results The mean preoperative IOP was 26.7(±5.2) in MMC and 27.3(±6.0) in OLO eyes. Mean 60-month percentage reduction in IOP was significant in both groups [40.9 (±14.2) and 42.1(±13.3) P = 0.01], with an endpoint value of 15.2 (±3.2) and 15.8 (±2.3) mmHg in MMC and OLO, respectively. Complete success rates at ≤ 21 mmHg target IOP were 65 % and 70 %, at ≤17 mm Hg 60 % and 55 %, and at the ≤15 mm Hg target IOP 35 % and 45 % in MMC and OLO, respectively. The Kaplan–Meier curves did not differ both for complete and qualified success at any target IOP, with no significant endpoint intergroup difference at ≤ 15 mm Hg (log-rank P = 0.595).The intergroup MBGS scores differed due to reduced central and peripheral vascularity in MMC group (P = 0.027; P = 0.041). SD-OCT analysis denied differences in bleb height between MMC vs OLO (140.5 ± 20.3 μ vs 129.2 ± 19.3 μ respectively; P =0.079). Mean antiglaucoma medications were significantly reduced (P < 0.0005) from 2.5 (±0.3) to 1.2 (±0.4) in MMC and from 2.6 (±0.2) to 1.4 (±0.3) in OLO group, with no intergroup differences (P = 0.08). Six (30 %) cystic thin avascular blebs without oozing were recorded in the MMC group and 2 (10 %) in the OLO group, without intergroup difference (P = 0.235). Conclusions Our extended follow-up results confirm that Ologen implant yields efficacy and long-term success rates quite similar to MMC, with at least equivalent safety. Electronic supplementary material The online version of this article (doi:10.1186/s12886-016-0198-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Salvatore Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo (Italy), via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| | - Alessandra Casuccio
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Via del Vespro 127, I, 90127, Palermo, Italy.
| | - Francesco Di Pace
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo (Italy), via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| | - Carlo Cagini
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, Piazza Menghini 1. S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - Lucia Lee Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo (Italy), via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| | - Giovanni Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo (Italy), via Liborio Giuffrè, 13, 90127, Palermo, Italy.
| |
Collapse
|
17
|
Coleman AL, Lum FC, Velentgas P, Su Z, Gliklich RE. Practice patterns and treatment changes for open-angle glaucoma: the RiGOR study. J Comp Eff Res 2015; 5:79-85. [PMID: 26691017 DOI: 10.2217/cer.15.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The RiGOR study provides a current picture of the types of glaucoma treatment over 12 months. METHODS Patients were identified and enrolled at the time of decision to proceed with laser surgery procedure or other procedure such as incisional surgery or drainage device implantation, or initiation of a new or additional course of therapy with medication for glaucoma treatment. RESULTS The most frequent type of treatments were prostaglandin analogues (60%) among patients with additional medication, selective laser trabeculoplasty (87%) among patients with laser surgery and trabeculectomy (57%) among patients with incisional surgery. CONCLUSION For 36% of patients, a treatment cascade involves two or more therapies over a year. This demonstrates the complex nature of open-angle glaucoma treatment.
Collapse
Affiliation(s)
- Anne L Coleman
- Jules Stein Eye Institute, David Geffen School of Medicine & Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.,H Dunbar Hoskins Jr, MD Center for Quality Eye Care, Foundation of the American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109, USA
| | - Flora C Lum
- H Dunbar Hoskins Jr, MD Center for Quality Eye Care, Foundation of the American Academy of Ophthalmology, 655 Beach Street, San Francisco, CA 94109, USA
| | - Priscilla Velentgas
- Outcome DEcIDE Center, Quintiles Real World & Late Phase Research, Cambridge, MA, 02139
| | - Zhaohui Su
- Outcome DEcIDE Center, Quintiles Real World & Late Phase Research, Cambridge, MA, 02139
| | - Richard E Gliklich
- Massachusetts Eye & Ear Infirmary & Harvard Medical School, Boston, MA 02114, USA
| | | |
Collapse
|
18
|
Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study. Eye (Lond) 2015; 29:1495-503. [PMID: 26337945 DOI: 10.1038/eye.2015.163] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/27/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. METHODS Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline. RESULTS Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. CONCLUSIONS This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.
Collapse
|
19
|
Abstract
PURPOSE This study was designed to evaluate the refractive outcomes of combined cataract extraction and glaucoma surgery. DESIGN Retrospective case series. METHODS A retrospective chart review of patients undergoing simultaneous cataract extraction with trabeculectomy or glaucoma drainage device surgery was performed. The main outcome measure evaluated was whether or not spherical equivalent of -1.00 to +0.50 D was achieved at 3 to 6 months postoperatively. Secondary outcomes included: reduction in intraocular pressure, amount of cylinder induced by combined surgery, and individual patient characteristics that may have affected refractive outcome. Outcomes were compared with an age-matched and sex-matched control group of patients who had uncomplicated cataract surgery during the same time period. RESULTS Forty-three eyes of 36 patients underwent combined cataract extraction and glaucoma surgery. A refractive outcome of spherical equivalent between -1.00 and +0.50 D was achieved in 32 of 43 eyes (74%) at 3 to 6 months after surgery. Logistic regression analysis found a 1.14 increased risk of the refraction being outside this defined refractive range in older compared with younger patients (by year, 95% CI, 1.04-1.27). Type of lens implant used, type of glaucoma surgery, and preoperative best-corrected visual acuity did not significantly affect refractive outcome. In a subset of 22 eyes with available preoperative keratometry measures, a mean 1.31 D (SD=0.86; range, 0.26 to 3.76) of corneal astigmatism was induced by combined surgery. In comparison, a matched control group who had cataract surgery alone achieved target refractive outcome in 34 of 40 eyes (85%, P=0.001) and had a trend for less induced cylinder (0.99, SD=0.72, P=0.11). CONCLUSIONS Favorable refractive outcomes were achieved in the majority of patients despite the potential alteration of preoperative measurements and introduction of error into lens selection when using a combined approach. There does not seem to be a difference in the refractive outcome with regard to the type of glaucoma surgery performed. Control patients who had cataract surgery alone had a higher percentage of achieving target refractive goal and less induced cylinder.
Collapse
|
20
|
Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015; 9:6-11. [PMID: 26997825 PMCID: PMC4741140 DOI: 10.5005/jp-journals-10008-1175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/30/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the ability of phacoemulsification combined with either primary trabeculectomy (PT) or primary Ahmed glaucoma valve implantation (PAVI) to achieve target intraocular pressures (TIOP) in adults with primary open angle glaucoma. MATERIALS AND METHODS Chart review of 214 adult patients operated between January 2002 and June 2008 with a minimum follow-up of 6 months. Group 1 comprised 181 eyes of 166 patients undergoing PT while group 2 included 50 eyes of 49 patients in combination with primary AVI. Target lOPs were pre-determined for each patient and success was defined as an IOP at or lower than target with or without medications. An IOP above target, loss of light perception or need for additional procedures to lower IOP were considered a failure. RESULTS Mean preoperative IOP was 17.2 mm Hg in group 1 and 17.3 in group 2. Mean postoperative IOPs were 10.2 and 9.2 on day 1, 12.2 and 11.6 at year 1, and 10.7 in both groups at year 5. Survival rates in groups 1 and 2 were 96.7 vs 96% at 6 months, 89 vs 96% at 12 months, 83.5 vs 96% at 24 months and 79.4 vs 89.1% at 36, 48 and 72 months. Transient bleb leaks were more frequent in group 1 (26 eyes, 14.4 vs 0%, p = 0.001) and transient choroidal detachments were more frequent in group 2 (7 eyes, 3.9 vs 6 eyes, 12%, p = 0.038). CONCLUSION Midterm results for achieving target pressures using combined phacoemulsification with either PT or PAVI are comparable. The profile of complications is different for the two procedures. How to cite this article: Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015;9(1):6-11.
Collapse
Affiliation(s)
- Oscar Albis-Donado
- Department of Glaucoma, Mexican Institute of Ophthalmology Queretaro, Mexico
| | | | - Lorena Cárdenas-Gómez
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
| | - Rafael Castañeda-Diez
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
| | - Ravi Thomas
- Department of Glaucoma, Cataract, Clinical Epidemiology Queensland Eye Institute, Melbourne, Australia
| | - Félix Gil-Carrasco
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
| |
Collapse
|
21
|
Poon LYC, Lai IC, Lee JJ, Tsai JC, Lin PW, Teng MC. Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma. Taiwan J Ophthalmol 2015; 5:28-32. [PMID: 29018661 PMCID: PMC5602719 DOI: 10.1016/j.tjo.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/18/2014] [Accepted: 01/07/2015] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS This is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups. RESULTS There were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction. CONCLUSION Postoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.
Collapse
Affiliation(s)
- Linda Yi-Chieh Poon
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ing-Chou Lai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jong-Jer Lee
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jen-Chia Tsai
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Wen Lin
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chin Teng
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| |
Collapse
|
22
|
A new surgical triple procedure in pseudoexfoliation glaucoma using cataract surgery, Trabectome, and trabecular aspiration. Graefes Arch Clin Exp Ophthalmol 2014; 252:1971-5. [DOI: 10.1007/s00417-014-2795-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/06/2014] [Accepted: 08/27/2014] [Indexed: 10/24/2022] Open
|
23
|
Abstract
PURPOSE To evaluate the safety and preliminary efficacy of intraoperative mitomycin C (MMC) in conjunction with canaloplasty for the treatment of open-angle glaucoma. METHODS Observational case series. A microcatheter was used to viscodilate the full circumference of Schlemm canal and to place a trabecular meshwork tensioning suture. Low dosage MMC was applied beneath the superficial scleral flap before dissecting the second, deep scleral flap and accessing Schlemm canal. Qualifying preoperative intraocular pressures (IOPs) were at least 16 mm Hg with a historical maximum IOP of at least 21 mm Hg. Primary outcome measures including visual acuity and adverse events are reported for a 12-month postoperative period. Secondary outcome measures included IOP and glaucoma medication usage. RESULTS In 20 eyes of 20 consecutive patients, adverse events were generally transient and not sight threatening. With the use of MMC, there was an increased rate of hypotony as compared with reported results of prior canaloplasty studies. The mean logMAR best corrected visual acuity at baseline was 0.07 ± 0.12 with a mean of 0.09 ± 0.13 at 12 months (P=0.679). Mean IOP decreased from a preoperative value of 23.4 ± 4.3 mm Hg on 2.2 ± 1.2 antiglaucoma medications to 13.4 ± 4.3 mm Hg on no medications at 12 months. At all intervals, IOP and medication use results were significantly reduced versus baseline (P<0.001). CONCLUSIONS The adjunctive use of MMC in canaloplasty is safe and effective.
Collapse
|
24
|
Sałaga-Pylak M, Kowal M, Zarnowski T. Deterioration of filtering bleb morphology and function after phacoemulsification. BMC Ophthalmol 2013; 13:17. [PMID: 23617885 PMCID: PMC3638009 DOI: 10.1186/1471-2415-13-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trabeculectomy remains the most efficient method of lowering he IOP applied for the treatment of glaucoma refractory to pharmacological treatment. Cataract is concerned as the most frequent late complication of trabeculectomy. The aim of the study was to analyse the effect of phacoemulsification with posterior chamber lens implantation on the morphology and function of filtering bleb in patients after previous successful trabeculectomy. METHODS The retrospective study included 122 eyes treated for primary open angle glaucoma, 50 eyes (study group) in which, after a successful trabeculectomy with 5-Fluorouracil, phacoemulsification with posterior chamber lens implantation was performed, and 72 eyes (control group), in which only a successful trabeculectomy was conducted. The surgical success of the trabeculectomy was expressed as IOP < 17 mmHg. RESULTS In the group of patients subjected to both trabeculectomy and phacoemulsification, mean IOP was significantly higher than in the group of patients who underwent trabeculectomy after 6 months (p = 0.003), 12 months (p = 0.01) and 18 months (p = 0.007) of observation. The filtering blebs after phacoemulsification in the study group were characterized by a greater reduction, compared to those in the control group. Cox regression survival success was 75% (SE = 5.9; 95% CI: 63.4-86.6), 75% (SE = 5.9; 95% CI: 63.4-86.6), 71% (SE = 5.4; 95% CI: 60.4-81.6) in study group and 92% (SE = 1.8; 95% CI: 91.5-98.5), 92% (SE = 1.9; 95% CI: 88.3-95.7), 91% (SE = 2.0; 95% CI: 87.1-94.9) in control group after 6, 12 and 18 months, respectively. CONCLUSIONS Phacoemulsification causes a significant elevation of IOP in the eyes after previous successful trabeculectomy and deterioration of filtering bleb morphology.
Collapse
Affiliation(s)
- Monika Sałaga-Pylak
- Chair of Ophthalmology, Medical University of Lublin, Chmielna Str No 1, 20-079 Lublin, Poland
| | | | | |
Collapse
|
25
|
Dietlein T, Widder R, Jordan J, Jonescu-Cuypers C, Rosentreter A. Kombinierte Katarakt-Glaukom-Chirurgie. Ophthalmologe 2013; 110:310-5. [DOI: 10.1007/s00347-012-2765-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
26
|
[Combined glaucoma cataract surgeries]. J Fr Ophtalmol 2012; 35:555-60. [PMID: 22921041 DOI: 10.1016/j.jfo.2012.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 06/05/2012] [Indexed: 11/22/2022]
Abstract
The combined cataract-glaucoma surgery is a procedure gaining a higher role in the surgical treatment for patients having both cataract and glaucoma. Both these pathologies are strongly related to the age. A good knowledge of surgical indications and techniques, complications and postoperative follow-up can improve the outcome of this surgery, which is considered to be the best technique in the treatment of combined cataract and glaucoma. The combined glaucoma and cataract surgery enables us to lower the intraocular pressure and gain in visual acuity in one surgery, with the treatment of two distinct disorders. This kind of surgery requires a close follow-up to spot and manage the post-operative complications.
Collapse
|
27
|
Venkatesh R, Sengupta S, Robin AL. Mitomycin C-Augmented Trabeculectomy Combined With Single-Site Manual Small-Incision Cataract Surgery Through a Tunnel Flap Technique. ASIA-PACIFIC JOURNAL OF OPHTHALMOLOGY (PHILADELPHIA, PA.) 2012; 1:142-6. [PMID: 26107330 DOI: 10.1097/apo.0b013e3182553545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to analyze short-term outcomes of mitomycin C-augmented trabeculectomy combined with manual small-incision cataract surgery (MSICS/Trab). DESIGN This was a retrospective, noncomparative single-center case series. METHODS Records of eyes that underwent MSICS/Trab with mitomycin C performed between January 2006 and May 2007 were reviewed. Manual small-incision cataract surgery was done through a superior scleral tunnel; a Kelly punch was used for the trabeculectomy through the tunnel flap, and after a peripheral iridectomy, the scleral tunnel was opposed with two 10-0 nylon sutures. RESULTS Of the 103 patients, 64 (62.1%) had primary open-angle glaucoma (POAG), 23 (22.3%) had secondary open-angle glaucoma (SOAG), and 16 (15.5%) had chronic angle closure glaucoma (CACG). The minimum follow-up was 6 months, and mean follow-up was 12.6 months. Demographics and mean intraocular pressure (IOP) at the time of surgery (30.4 ± 10.3 mm Hg) were comparable in all 3 groups. Significant visual improvement and reduction in IOP levels from baseline were observed at 6 months (16.64 ± 4.75 mm Hg) irrespective of the type of glaucoma (P = 0.035). Subgroup analysis showed a significant difference in IOP levels of CACG group compared with the SOAG group (P = 0.035) at 6 months. However, no statistically significant difference was observed in IOP comparisons between POAG and CACG groups or POAG and SOAG groups. CONCLUSIONS Mitomycin C-augmented MSICS/Trab appears to be safe and effective technique in tackling coexistent cataract and glaucoma in developing world.
Collapse
Affiliation(s)
- Rengaraj Venkatesh
- From the *Glaucoma Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India; and †Bloomberg School of Public Health and the Wilmer Institute of Johns Hopkins School of Medicine, Baltimore, MD
| | | | | |
Collapse
|
28
|
Li T, Vedula SS, Scherer R, Dickersin K. What comparative effectiveness research is needed? A framework for using guidelines and systematic reviews to identify evidence gaps and research priorities. Ann Intern Med 2012; 156:367-77. [PMID: 22393132 PMCID: PMC3804310 DOI: 10.7326/0003-4819-156-5-201203060-00009] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The authors developed and tested a framework for identifying evidence gaps and prioritizing comparative effectiveness research by using a combination of clinical practice guidelines and systematic reviews. In phase 1 of the project, reported elsewhere, 45 clinical questions on the management of primary open-angle glaucoma were derived from practice guidelines and prioritized by using a 2-round Delphi survey of clinicians. On the basis of the clinicians' responses, 9 questions were classified as high-priority. In phase 2, reported here, systematic reviews that addressed the 45 clinical questions were identified. The reviews were classified as at low, high, or unclear risk of bias, and evidence gaps (in which no systematic review was at low risk of bias) were identified. The following comparative effectiveness research agenda is proposed: Two of the 9 high-priority questions require new primary research (such as a randomized, controlled trial) and 4 require a new systematic review. The utility and limitations of the framework and future adaptations are discussed.
Collapse
Affiliation(s)
- Tianjing Li
- Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
| | | | | | | |
Collapse
|
29
|
Buys YM, Jin YP, Sheng L, Yan P, Yuen D, Gdih GA. Author reply. Ophthalmology 2011. [DOI: 10.1016/j.ophtha.2011.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
30
|
Cillino S, Di Pace F, Cillino G, Casuccio A. Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial. Eye (Lond) 2011; 25:1598-606. [PMID: 21921953 DOI: 10.1038/eye.2011.219] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
AIM To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy. METHODS This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at ≤21, ≤17, and ≤15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications. RESULTS The mean preoperative IOP was 26.5 (±5.2) in MMC and 27.3 (±6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 (±3.5) and 9.2 (±5.5) mm Hg, respectively (P=0.009). The IOP reduction was significant at end point in all groups (P=0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan-Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (P<0.05). SD-OCT analysis of successful/unsuccessful bleb in patients with or without complete success at IOP ≤17 mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted. CONCLUSIONS Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate.
Collapse
Affiliation(s)
- S Cillino
- Department of Experimental Biomedicine and Clinical Neuroscience, Ophthalmology Section, University of Palermo (Italy), Palermo, Italy.
| | | | | | | |
Collapse
|
31
|
Gdih GA, Yuen D, Yan P, Sheng L, Jin YP, Buys YM. Meta-analysis of 1- versus 2-Site Phacotrabeculectomy. Ophthalmology 2011; 118:71-6. [DOI: 10.1016/j.ophtha.2010.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/09/2010] [Accepted: 04/05/2010] [Indexed: 10/19/2022] Open
|
32
|
|
33
|
Rosdahl JA, Chen TC. Combined cataract and glaucoma surgeries: traditional and new combinations. Int Ophthalmol Clin 2010; 50:95-106. [PMID: 20057299 DOI: 10.1097/iio.0b013e3181c5563a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Jullia A Rosdahl
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
| | | |
Collapse
|
34
|
Soro-Martínez MI, Villegas-Pérez MP, Sobrado-Calvo P, Ruiz-Gómez JM, Miralles de Imperial Mora-Figueroa J. Corneal endothelial cell loss after trabeculectomy or after phacoemulsification, IOL implantation and trabeculectomy in 1 or 2 steps. Graefes Arch Clin Exp Ophthalmol 2009; 248:249-56. [DOI: 10.1007/s00417-009-1185-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 08/18/2009] [Accepted: 08/20/2009] [Indexed: 12/13/2022] Open
|
35
|
Mokbel TH, Ghanem AA, Moawad AI, Nafie EM, Nematallah EH. Comparative study of phacoemulsification-subscleral trabeculectomy versus phacoemulsification-deep sclerectomy. Saudi J Ophthalmol 2009; 23:189-96. [PMID: 23960859 DOI: 10.1016/j.sjopt.2009.10.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 08/15/2009] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To compare the surgical outcomes of phacoemulsification-subscleral trabeculectomy versus phacoemulsification-deep sclerectomy with intraoperative mitomycin C in open-angle glaucoma. METHODS The study was conducted on 40 chronic primary open-angle glaucomatous eyes with senile cataract. They were divided into two groups: group I (n = 20): eyes undergoing phacoemulsification with subscleral trabeculectomy, and group II (n = 20): eyes undergoing phacoemulsification with deep sclerectomy. Intraoperative mitomycin C (0.4 mg/ml for 3 min) was applied in both groups. Postoperative intraocular pressure (IOP), complications, glaucoma medications, visual outcomes, and the bleb appearance were assessed for 12 months. RESULTS The mean postoperative IOP was significantly lower (P < 0.05) in both groups in all time intervals in comparison to their preoperative values. The mean postoperative IOP was 14.1 ± 5.4 mmHg in group I, and 14.8 ± 3.1 mmHg in group II. No major complications were encountered in either procedure, but complications such as shallow anterior chamber, hypotony, and delayed bleb leaks were common in group I, whereas intraoperative perforation of Descemet's membrane occurred in group II. No significant difference in visual acuity improvement, visual field changes, and surgical success outcome were found between both groups. CONCLUSION There was no significant difference in IOP reduction, surgical complications and visual outcomes between subscleral trabeculectomy, or deep sclerectomy with intraoperative mitomycin C in combination with phacoemulsification and intraocular lens implantations in patients with primary open-angle glaucoma.
Collapse
Affiliation(s)
- Tahrwat H Mokbel
- Ophthalmology Center, Faculty of Medicine, Mansoura University, Egypt
| | | | | | | | | |
Collapse
|
36
|
Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes. Eye (Lond) 2009; 24:573-7. [DOI: 10.1038/eye.2009.132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
37
|
Canadian Ophthalmological Society evidence-based clinical practice guidelines for the management of glaucoma in the adult eye. CANADIAN JOURNAL OF OPHTHALMOLOGY 2009. [DOI: 10.3129/i09.080] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
|
38
|
Guide factuel de pratique clinique de la Société canadienne d’ophtalmologie pour la gestion du glaucome chez l’adulte. Can J Ophthalmol 2009. [DOI: 10.1016/s0008-4182(09)80037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
39
|
Baykara M, Timucin O. Bimanual microincisional phacoemulsification combined with viscocanalostomy plus deeper sclerectomy. Eur J Ophthalmol 2009; 19:384-92. [PMID: 19396783 DOI: 10.1177/112067210901900310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of the study was to evaluate the safety and effectiveness of a new technique, two-site bimanual microincisional cataract surgery combined with viscocanalostomy plus deeper sclerectomy (two-site bimanual MICS-VC-DS), in patients with cataract and glaucoma. DESIGN Noncomparative, interventional case series. METHODS From December 2005 to October 2007, a consecutive series of 12 patients (12 eyes) with uncontrolled primary open angle glaucoma (POAG) and cataract have undergone two-site bimanual MICS-VC-DS. Postoperative evaluation included visual acuity (VA), intraocular pressure (IOP), average retinal nerve fiber layer (RNFL) thickness measurement, and gonioscopic, biomicroscopic, and funduscopic examination. Paired-samples t test was used. A p value of <0.05 was taken as significant. RESULTS The mean duration of follow-up was 14.6 months (SD 5.8). At 9 months, mean IOP was 17.0 (SD 4), the mean IOP reduction was 13.2 mmHg (SD 5.86). At 9 months post-surgery, the complete success rate was 75%. Qualified success was achieved in 100% of patients. At 9 months, the mean number of antiglaucoma medications was 0.58 (SD 1.24) (p<0.05). Visual acuity improved by a mean value of 2.8 lines. Average RNFL thickness did not change significantly during the follow-up period (p=0.781). CONCLUSIONS Two-site bimanual MICS-VC-DS appears to be an effective and safe procedure with quick visual rehabilitation, acceptable mid-term IOP control, and the advantage of having fewer complications.
Collapse
Affiliation(s)
- Mehmet Baykara
- Department of Ophthalmology, Uludag University School of Medicine, Bursa, Turkey.
| | | |
Collapse
|
40
|
Lachkar Y. Quand proposer une chirurgie combinée ? J Fr Ophtalmol 2009; 32:226-9. [DOI: 10.1016/j.jfo.2009.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
41
|
|
42
|
Francis BA, Minckler D, Dustin L, Kawji S, Yeh J, Sit A, Mosaed S, Johnstone M. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cataract Refract Surg 2008; 34:1096-103. [PMID: 18571075 DOI: 10.1016/j.jcrs.2008.03.032] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 03/30/2008] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide an update of the short-term results of combined phacoemulsification and trabeculotomy by the internal approach with a follow-up to 21 months. SETTING Universities and private practices in the United States. METHODS This prospective interventional case series comprised 304 consecutive eyes with open-angle glaucoma and cataract having combined phacoemulsification and trabeculotomy with a Trabectome (NeoMedix Inc.). The Trabectome is designed to open a direct pathway for aqueous to flow from the anterior chamber into Schlemm canal collector channels. Under gonioscopic control, bipolar cautery was applied by a purpose-designed footplate to ablate the trabecular meshwork and inner wall of Schlemm canal. The main outcome measures were intraocular pressure (IOP), glaucoma medication use, and complications. RESULTS The mean IOP was 20.0 mm Hg+/-6.3 (SD) preoperatively, 14.8+/-3.5 mm Hg at 6 months, and 15.5+/-2.9 mm Hg at 1 year. There was a corresponding drop in glaucoma medications from 2.65+/-1.13 at baseline to 1.76+/-1.25 at 6 months and 1.44+/-1.29 at 1 year. Subsequent secondary glaucoma procedures were performed in 9 patients. The only frequent complication, blood reflux in 239 patients (78.4%), resolved within a few days. CONCLUSIONS Combined phacoemulsification and trabeculotomy by the internal approach using the Trabectome lowered IOP and medication use in the majority of patients. Complications were minimal and comparable to those in an earlier series of Trabectome-only procedures.
Collapse
Affiliation(s)
- Brian A Francis
- Doheny Eye Institute, Keck School of Medicine, and Department of Preventive Medicine and Biostatistics, University of Southern California, Los Angeles, Los Angeles, CA 90093, USA.
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Buys YM, Chipman ML, Zack B, Rootman DS, Slomovic AR, Trope GE. Prospective Randomized Comparison of One- versus Two-Site Phacotrabeculectomy. Ophthalmology 2008; 115:1130-1133.e1. [PMID: 18171584 DOI: 10.1016/j.ophtha.2007.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2007] [Revised: 08/15/2007] [Accepted: 09/12/2007] [Indexed: 11/25/2022] Open
|
44
|
Lteif Y, Berete-Coulibaly R, Labbé A, Bouassida W, Lachkar Y. [Mid-term effects of two-site phacotrabeculectomy with limbal-based conjunctival flap and microincision trabeculectomy with adjustable sutures]. J Fr Ophtalmol 2008; 31:397-404. [PMID: 18563039 DOI: 10.1016/s0181-5512(08)71434-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the midterm effects of two-site phacotrabeculectomy with limbal-based conjunctival flap and microincisinal trabeculectomy with adjustable sutures. DESIGN and method: The charts of 115 patients (188 eyes) were retrospectively reviewed. Patients had a mean age of 74.7 years and were all operated by the same surgeon between 2001 and 2003. The surgery consisted of a clear cornea phacoemulsification and a microtrabeculectomy with limbal-based conjunctival flap. The number of sutures on the scleral flap was adjusted according to the filtration. RESULTS The mean preoperative IOP was 17.7 +/- 3.94 mmHg, and the mean number of antiglaucomatous medications was 2.05 +/- 0.86. The last postoperative IOP was 13.2 +/- 2.81 mmHg with a mean of 0.8 +/- 0.8 medications. Mean follow-up was 29.8 months (1-7 years). Visual acuity improved by at least two lines in 154 eyes (81%), stabilized (+/- 1 line) in 33 eyes (17.37%), and worsened of more than two lines in one eye (1.63%). Early postoperative complications were seven Seidels (3.68%), one shallow anterior chamber (0.55%), three chorioretinal detachments (1.58%), six hyphemas (3.15%), one iris incarceration (0.55%), and eight corneal edemas (4.21%). Late complications were five cases of bleb fibrosis despite needling and 5-FU injection. We had no cases of wipe-out syndrome. CONCLUSION Our study shows the effectiveness of this special phacotrabeculectomy technique on IOP control and visual acuity improvement, with low complication incidence compared to classical phacotrabeculectomies.
Collapse
Affiliation(s)
- Y Lteif
- Institut du Glaucome, Fondation Hôpital Saint-Joseph, Paris.
| | | | | | | | | |
Collapse
|
45
|
Cillino S, Zeppa L, Di Pace F, Casuccio A, Morreale D, Bocchetta F, Lodato G. E-PTFE (Gore-Tex) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial. Acta Ophthalmol 2008; 86:314-21. [PMID: 17995980 DOI: 10.1111/j.1600-0420.2007.01036.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy. METHODS Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin-C (TMMC), with ePTFE (TG) or with mitomycin-C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels -< or =21 and < or =17 mmHg - by Kaplan-Meier curves. RESULTS The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (+/-2.9), 16.2 (+/-2.7), 15.3 (+/-3.4) and 15.2 (+/-4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan-Meier curves relating to either the < or =21 mmHg or the < or =17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium-term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC-related complications were more frequent when MMC was applied. CONCLUSION Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony-related complications and contributes to attaining medium-term IOP control that is comparable to the low-dosage MMC.
Collapse
Affiliation(s)
- Salvatore Cillino
- Department of Clinical Neuroscience, Section of Ophthalmology, University of Palermo, Italy.
| | | | | | | | | | | | | |
Collapse
|
46
|
Cotran PR, Roh S, McGwin G. Randomized Comparison of 1-Site and 2-Site Phacotrabeculectomy with 3-Year Follow-up. Ophthalmology 2008; 115:447-454.e1. [PMID: 17825417 DOI: 10.1016/j.ophtha.2007.05.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Revised: 05/06/2007] [Accepted: 05/15/2007] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To compare intraocular pressure (IOP) control and other clinical outcomes after 1-site fornix-based and 2-site limbus-based phacotrabeculectomy. DESIGN Prospective randomized controlled trial. PARTICIPANTS A total of 90 eyes of 76 patients with cataract and glaucoma were treated. METHODS Forty-four eyes were assigned randomly to receive a 1-site phacotrabeculectomy with a fornix-based conjunctival flap, and 46 eyes were assigned randomly to receive a 2-site phacotrabeculectomy with a limbus-based conjunctival flap. All operations were performed with mitomycin C. MAIN OUTCOME MEASURES Intraocular pressure and number of antiglaucoma medications were recorded at baseline and during a 3-year follow-up period. RESULTS Mean preoperative IOP was 20.1+/-3.8 mmHg in the 1-site group and 19.5+/-5.3 mmHg in the 2-site group (P = 0.56) using a mean of 2.3+/-0.9 and 2.5+/-0.9 antiglaucoma medications, respectively (P = 0.27). After 3 years of follow-up, the mean IOP was 12.6+/-4.8 mmHg in the 1-site group and 11.7+/-4.0 mmHg in the 2-site group (P = 0.40), receiving a mean of 0.3+/-0.7 and 0.4+/-0.9 medications, respectively (P = 0.59). At the end of the study, 73% of 1-site eyes and 78.4% of 2-site eyes had IOPs of less than 18 mmHg while receiving no antiglaucoma medications (P = 0.59). Visual acuity was similar for both groups at 3 months after surgery. There were no significant differences in the need for digital pressure, postoperative bleb needling with 5-fluorouracil, or number of postoperative visits. There were 2 major complications in each group during follow-up. Early leaks of the conjunctival wound closure occurred in 6 eyes in the 1-site group and in 0 eyes in the 2-site group (P = 0.03). Operating time (in minutes) was less in the 1-site surgery group (P<0.0001). Day one postoperative IOP was higher in the 2-site group (P = 0.0.01). CONCLUSIONS One-site fornix-based and 2-site limbus-based phacotrabeculectomy were similarly effective in lowering IOP and reducing the need for antiglaucoma medications over a 3-year follow-up period.
Collapse
Affiliation(s)
- Paul R Cotran
- Department of Ophthalmology, Lahey Clinic, Burlington, Massachusetts 01960, USA.
| | | | | |
Collapse
|
47
|
Cillino S, Di Pace F, Casuccio A, Cillino G, Lodato G. Deep Sclerectomy versus Trabeculectomy with Low-Dosage Mitomycin C: Four-Year Follow-Up. Ophthalmologica 2008; 222:81-7. [DOI: 10.1159/000112623] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2006] [Accepted: 12/21/2006] [Indexed: 11/19/2022]
|
48
|
Combined cataract–glaucoma surgery using the intracanalicular Eyepass glaucoma implant. J Cataract Refract Surg 2008; 34:247-52. [DOI: 10.1016/j.jcrs.2007.09.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2007] [Accepted: 09/05/2007] [Indexed: 11/17/2022]
|
49
|
Shoji T, Tanito M, Takahashi H, Park M, Hayashi K, Sakurai Y, Nishikawa S, Chihara E. Phacoviscocanalostomy versus cataract surgery only in patients with coexisting normal-tension glaucoma: midterm outcomes. J Cataract Refract Surg 2007; 33:1209-16. [PMID: 17586377 DOI: 10.1016/j.jcrs.2007.03.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 03/19/2007] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the midterm efficacy and safety of phacoviscocanalostomy (viscocanalostomy, phacoemulsification, and intraocular lens [IOL] implantation) and cataract surgery (phacoemulsification and IOL implantation) in patients with normal-tension glaucoma (NTG) and cataract. SETTING Sensho-kai Eye Institute, Kyoto, Japan. METHODS Thirty-one eyes had phacoviscocanalostomy, and 35 eyes had uncomplicated cataract surgery only. The intraocular pressure (IOP), postoperative antiglaucoma medications, and visual outcomes were compared between groups. RESULTS The mean follow-up was 34.9 months+/-19.8 (SD) (range 7 to 78 months). At 36 months, the mean preoperative IOP and postoperative IOP were 17.2+/-1.5 mm Hg and 14.1+/-1.6 mm Hg, respectively, in the phacoviscocanalostomy group and 16.7+/-1.4 mm Hg and 15.6+/-3.4 mm Hg, respectively, in the cataract surgery only group. The differences between groups were significant at all time points (P<.05). The success probabilities of the phacoviscocanalostomy group achieving 20% and 30% IOP reductions with (or without) medications were 78.5% (67.4%) and 35.5% (37.4%) at 24 months and 58.0% (44.2%) and 28.0% (26.6%) at 48 months, which were significantly better than the probabilities in the cataract surgery only group, which were 16.0% (9.5%) and 5.7% (2.9%) at 24 months (P<.001 for each comparison, Kaplan-Meier life-table analysis with log-rank test). Based on the modified Aulhorn-Greve classification, the visual acuity and visual fields did not deteriorate in the phacoviscocanalostomy group; the visual fields deteriorated in 6 eyes in the cataract surgery only group during the follow-up (P=.024). CONCLUSION Phacoviscocanalostomy lowered IOP and maintained postoperative visual outcomes; it was safe and effective in elderly patients with coexisting NTG and cataract.
Collapse
Affiliation(s)
- Takuhei Shoji
- Sensho-kai Eye Institute, Kyoto, and the Department of Ophthalmology, Shimane University School of Medicine, Shimane, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The wound healing response is one of the major determinants of filtering surgery success. Over the last two decades, antifibrotic agents, 5-fluorouracil (5-FU) and mitomycin C (MMC), have modified the prognosis of filtering surgery, particularly in patients at high risk for failure. Nevertheless, these agents are associated with severe complications. In order to maximize their benefits and minimize the rate of complications, the use of these powerful treatments has to be carefully evaluated in relation to patient risk factors for scarring. The choice of an antifibrotic agent, mode, dose and duration of application should be made with complete knowledge of the different effects of these treatments and adapted for each patient after an exhaustive preoperative evaluation.
Collapse
Affiliation(s)
- A Labbé
- Service d'Ophtalmologie III, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | | | | |
Collapse
|