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Acuff K, Wu JH, Varkhedi V, Baxter SL. Social determinants of health and health disparities in glaucoma: A review. Clin Exp Ophthalmol 2024; 52:276-293. [PMID: 38385607 PMCID: PMC11038416 DOI: 10.1111/ceo.14367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
Social determinants of health and barriers to care can significantly impact patients' access to glaucoma care and treatment, resulting in disparities within disease presentation, progression, management, and treatment outcomes. The widespread adoption of electronic health record systems has allowed researchers and clinicians to further explore these relationships, identifying factors such as race, ethnicity, and socioeconomic status to be risk factors for more severe disease and lower treatment adherence. These disparities highlight potential targets for interventions to combat these disparities and improve overall patient outcomes. This article provides a summary of the available data on health disparities within glaucoma disease presentation, progression, management, treatment, and outcomes and discusses interventions to improve care delivery and outcomes among patients with glaucoma.
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Affiliation(s)
- Kaela Acuff
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Jo-Hsuan Wu
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
| | - Varsha Varkhedi
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
- Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA
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Barquet-Pizá V, Siegfried CJ. Understanding racial disparities of glaucoma. Curr Opin Ophthalmol 2024; 35:97-103. [PMID: 37922412 DOI: 10.1097/icu.0000000000001017] [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: 11/05/2023]
Abstract
PURPOSE OF REVIEW Increased prevalence, earlier onset, and more rapid progression to vision loss from glaucoma has demonstrated racial disparity in numerous studies over decades. Precise etiologies of these important differences among patients of African and Hispanic ancestral background have not been elucidated. This review focuses on currently available epidemiologic/population, genetic, socioeconomic and physiologic studies of racial disparities in this blinding disease. RECENT FINDINGS In depth reviews of several landmark studies of glaucoma prevalence in various racial groups have highlighted potential challenges of lack of recruitment of diverse populations in genetic studies and clinical trials, challenges of racial stratification of subjects, and the impact of socioeconomic variables. SUMMARY Through a more comprehensive analysis of racial disparities of glaucoma, both clinicians and researchers may provide more effective population screening and management with a holistic approach for individualized patient care to provide improved outcomes. Future studies of interventions in sociodemographic factors and genetic/physiologic variables that influence the prevalence, access, and consequential vision loss from glaucoma will be crucial to minimize/eliminate racial disparities and improve outcomes for all.
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Affiliation(s)
- Viviana Barquet-Pizá
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Aoyama Y, Sakata R, Fujishiro T, Honjo M, Shirato S, Aihara M. Contributing factors for intraocular pressure control in patients with mostly normal-tension glaucoma after initial Ex-PRESS drainage device implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:191-201. [PMID: 37624385 PMCID: PMC10806052 DOI: 10.1007/s00417-023-06209-8] [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: 03/20/2023] [Revised: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To investigate the postoperative intraocular pressure (IOP) control and identify the factors associated with failure of initial Ex-PRESS surgery in patients with open-angle glaucoma for 3 years. METHODS A total of 79 patients with medically uncontrolled open-angle glaucoma (55 normal-tension glaucoma and 24 primary open-angle glaucoma) were enrolled. All patients underwent Ex-PRESS implantation (including combined cataract surgery). The outcome measure was the survival rate using life table analysis, the failure was defined as IOP of > 18 mmHg (criterion A), > 15 mmHg (criterion B) or > 12 mmHg (criterion C) and/or IOP reduction of < 20% from baseline (each criterion) without any glaucoma medications. The Cox proportional hazards model was used to identify risk factors for IOP management defined as the above criterion. RESULTS: The mean preoperative IOP was 19.3 ± 5.8 mmHg. At 36 months, the mean IOP was 11.8 ± 3.6 mmHg with a mean IOP change of 7.5 mmHg (reduction rate 39.0%). The cumulative probability of success was 58% (95%CI: 42-64%) (criterion A), 48% (95%CI: 37-59%) (criterion B) and 30% (95%CI: 20-40%) (criterion C). In multivariate analyses, factors that predicted poor IOP control included the intervention of bleb needling after 6 months after the surgery (HR: 2.43; 95%CI: 1.35-4.37; P = 0.032). Transient hypotony was observed in 4 patients. CONCLUSION The implementation of bleb needling after Ex-PRESS surgery in the late postoperative period was suggested to be the main risk factor for achieving lower IOP.
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Affiliation(s)
- Yurika Aoyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Yotsuya Shirato Eye Clinic, Tokyo, Japan.
| | - Takashi Fujishiro
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
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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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Katayama N, Tojo N, Otsuka M, Hayashi A. Comparison of the results of Ex-PRESS ® surgery for primary open-angle glaucoma between high and low preoperative intraocular pressure. Int Ophthalmol 2023; 43:2803-2809. [PMID: 36869980 DOI: 10.1007/s10792-023-02678-2] [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: 03/26/2022] [Accepted: 02/25/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. METHODS This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3 years were included. Patients with a preoperative IOP of ≦ 16 mmHg and > 16 mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ≦ 15 mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. RESULTS EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9 mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0 mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3 years (p = 0.0008). Success rates compared using the Kaplan-Meier survival curve were not significantly different (p = 0.449). CONCLUSIONS EXP surgery was useful for POAG patients with a low preoperative IOP.
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Affiliation(s)
- Noriko Katayama
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
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Qin ZX, Ying X, Han Q, Wang L, Tan L, Xu YF, You QX, Wu N, Liu Y. Outcomes and risk factors for failure of trabeculectomy in glaucomatous patients in Southwest China: a 325 eyes analysis. Int J Ophthalmol 2023; 16:367-374. [PMID: 36935796 PMCID: PMC10009591 DOI: 10.18240/ijo.2023.03.06] [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: 06/11/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023] Open
Abstract
AIM To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. METHODS A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. RESULTS A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg (P<0.0001) and 3.0±0.9 to 0.9±1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. CONCLUSION The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.
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Affiliation(s)
- Zuo-Xin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Xi Ying
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Qing Han
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Lu Wang
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Lian Tan
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yu-Fei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Qiu-Xiang You
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing 400038, China
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Aoyama Y, Sakata R, Fujishiro T, Honjo M, Shirato S, Aihara M. Changes in corneal endothelial cell density after initial Ex-PRESS drainage device implantation and its relating factors over 3 years. Eye (Lond) 2023; 37:69-74. [PMID: 35001088 PMCID: PMC9829888 DOI: 10.1038/s41433-021-01888-1] [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: 06/03/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate changes in corneal endothelial cell density (CECD) after initial Ex-PRESS surgery in Japanese patients with open-angle glaucoma (OAG) followed-up for 36 months. SUBJECTS/METHODS Corneal specular microscopy was used to examine preoperative and postoperative (3, 6, 12, 24 and 36 months) CECD and CECD changes were analysed. Kaplan-Meier survival curve was used to examine CECD maintained at 95% level, and Cox proportional hazards model was used to detect the risk factors for CECD loss. Intraocular pressure (IOP) changes during the course were also examined. RESULTS A total of 79 eyes of 79 patients (standalone surgery, 24 cases; combined cataract surgery, 55 cases) were investigated. Preoperative CECD (mean ± SD) was 2521 ± 305 cells/mm² and 2429 ± 366 (P = 0.003, adjusted for Bonferroni correction), 2462 ± 332 (P = 0.002), 2457 ± 317 (P < 0.001), 2433 ± 333 (P < 0.001), and 2387 ± 352 (P < 0.001) at 3, 6, 12, 24 and 36 months, respectively. The decrease rate was calculated as 1.8%/year. Further, 95% maintenance CECD at 36 months was 50.0% (95% confidence interval, 37.1-63.0%). Both univariate and multivariate Cox proportional hazard models showed that a low preoperative CECD was a significant risk factor for CECD loss. Baseline IOP of 19.3 ± 5.8 mmHg decreased at all measurement points (P < 0.001) after surgery. CONCLUSION CECD after initial Ex-PRESS surgery in 36 months might not be clinically problematic. However, longer-term follow-up is necessary, and regular CECD measurement should be performed, especially in patients with low CECD.
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Affiliation(s)
- Yurika Aoyama
- Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
- Yotsuya Shirato Eye Clinic, Tokyo, Japan.
| | - Takashi Fujishiro
- Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, Graduate of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
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Nakakura S, Asaoka R. Comparison of surgical outcomes between initial trabeculectomy and Ex-PRESS in terms of achieving an intraocular pressure below 15 and 18 mmHg: a retrospective comparative study. EYE AND VISION 2022; 9:9. [PMID: 35227315 PMCID: PMC8885135 DOI: 10.1186/s40662-022-00279-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/29/2022] [Indexed: 12/03/2022]
Abstract
Background To evaluate the postoperative outcomes of initial trabeculectomy (Trab) and Ex-PRESS (EX) in terms of achieving an intraocular pressure (IOP) below 15 and 18 mmHg. Methods This study retrospectively analyzed 64 and 54 cases of Trab and EX, respectively, performed by the same surgeon with uniform management from April 2018 to March 2019. Surgical success was defined as 5 < IOP < 15 mmHg (criterion 1) and 5 < IOP < 18 mmHg (criterion 2) without additional glaucoma medication, needling, and bleb reconstruction 2 months after surgery. Survival analysis with Cox regression was performed to identify factors associated with postoperative outcomes. Results The Trab and EX groups had an IOP of 22.6 ± 6.2 vs. 21.8 ± 6.0 mmHg before surgery (P = 0.507), 12.6 ± 2.6 vs. 14.0 ± 4.4 mmHg (P = 0.06) at 6 months, 12.7 ± 2.3 vs. 12.9 ± 2.8 mmHg (P = 0.678) at 12 months, 13.3 ± 2.6 vs. 12.6 ± 2.8 mmHg (P = 0.260) at 18 months, and 13.2 ± 2.3 vs. 13.6 ± 2.8 mmHg (P = 0.444) at 24 months, respectively. The proportion of those with an IOP < 15 mmHg in the Trab and EX groups was 82% vs. 81% at 6 months, 68% vs. 62% at 12 months, 63% vs. 61% at 18 months, and 57% vs. 53% at 24 months, respectively. The log-rank test showed no significant difference between the groups for Criteria 1 (P = 0.755) and 2 (P = 0.138). The results of the multivariate logistic analysis identified only a high preoperative IOP as a risk factor for surgical failure (odds ratio for Criteria 1: 1.076, P = 0.009 and Criteria 2: 1.068, P = 0.048). Conclusion Postoperative outcomes of Trab and EX suggested similar ability for achieving an IOP below 15 and 18 mmHg without medications and interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-022-00279-1.
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Otsuka M, Tojo N, Hayashi A. Risk factors for Ex-Press ® surgery failure. Int Ophthalmol 2022; 43:1657-1663. [PMID: 36227402 DOI: 10.1007/s10792-022-02554-5] [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: 05/25/2022] [Accepted: 10/07/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the risk factors for Ex-Press® (EXP) surgery failure. PATIENTS AND METHODS This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed up ≥ 5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open-angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP + cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a postoperative reduction in the IOP ≥ 20% from the preoperative IOP and ≤ 18 mmHg. We determined the risk factors using multivariate cox regression models. RESULTS Performing EXP significantly decreased the IOP (preoperative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p values of the factors were age (p = 0.936), gender (p = 0.0587), hypertension (p = 0.409), DM (p = 0.967), previous glaucoma surgery (p = 0.940), type of glaucoma (p = 0.435) surgical methods (p = 0.521), CCT (p = 0.091), and preoperative IOP (p = 0.082). CONCLUSIONS No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for primary open-angle glaucoma and pseudo-exfoliation glaucoma.
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Affiliation(s)
- Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
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Ultrastructural analysis of explanted CyPass microstents and correlation with clinical findings. Graefes Arch Clin Exp Ophthalmol 2022; 260:2663-2673. [PMID: 35262764 PMCID: PMC9325823 DOI: 10.1007/s00417-022-05620-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure. Methods Nine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy. Results Fibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents. Conclusion Although MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.
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Collar B, Shah J, Cox A, Simon G, Irazoqui P. Parylene-C Microbore Tubing: A Simpler Shunt for Reducing Intraocular Pressure. IEEE Trans Biomed Eng 2021; 69:1264-1272. [PMID: 34714731 DOI: 10.1109/tbme.2021.3123887] [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: 11/06/2022]
Abstract
OBJECTIVE Current minimally-invasive glaucoma surgery (MIGS) devices promise to control elevated levels of intraocular pressure (IOP) while avoiding many of the downsides of traditional glaucoma surgery. However, there remains room for improvement in performance metrics, including drainage efficacy, device longevity, and time to implant, as outlined by benchmarks set forth by the Audacious Goals Initiative. We introduce a better shunt, which achieves similar or improved pre-clinical safety and efficacy outcomes to commercial MIGS devices, while reducing surgical profile and implantation time. METHODS We developed a parylene-based microbore glaucoma drainage device capable of modulating IOP via a minimally-invasive implantation procedure. We surgically implanted microbore tubing in five healthy New Zealand White rabbits and measured IOP levels biweekly using handheld applanation tonometry to assess device efficacy in lowering and maintaining IOP. After 6 weeks, the rabbits were euthanized and eyes were enucleated to evaluate inflammatory and histologic response to a foreign-body implant. RESULTS This device is the only one that fulfills the 10-minute benchmark for implantation time compared to other commercial MIGS devices. In 4 of 5 animals implanted, post-op IOP in the experimental eye dropped by an average of 16.17%. Histopathologic evaluation revealed localized evidence of minor inflammatory reaction and tissue irritation, as well as minimal fibrosis along the tube-tissue interface. CONCLUSION AND SIGNIFICANCE Based on these findings, this device stands as a promising platform to lowering IOP, particularly in patients with mild to moderate glaucoma requiring no need for cataract intervention, without eliciting a severe biological response.
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Li Y, Mitchell W, Elze T, Zebardast N. Association Between Diabetes, Diabetic Retinopathy, and Glaucoma. Curr Diab Rep 2021; 21:38. [PMID: 34495413 DOI: 10.1007/s11892-021-01404-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The strength of the relationship between diabetes, diabetic retinopathy (DR), and glaucoma remains controversial. We review evidence supporting and refuting this association and explore mechanistic pathological and treatment relationships linking these diseases. RECENT FINDINGS While studies have shown diabetes/DR may increase the risk for glaucoma, this remains inconsistently demonstrated. Diabetes/DR may contribute toward glaucomatous optic neuropathy indirectly (either by increasing intraocular pressure or vasculopathy) or through direct damage to the optic nerve. However, certain elements of diabetes may slow glaucoma progression, and diabetic treatment may concurrently be beneficial in glaucoma management. Diabetes plays a significant role in poor outcomes after glaucoma surgery. While the relationship between diabetes/DR and glaucoma remains controversial, multiple mechanistic links connecting pathophysiology and management of diabetes, DR, and glaucoma have been made. However, a deeper understanding of the causes of disease association is needed.
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Affiliation(s)
- Yangjiani Li
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, 510060, China
| | - William Mitchell
- Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA
- Department of Ophthalmology, Royal Victorian Eye and Ear, Melbourne, VIC, 3002, Australia
| | - Tobias Elze
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, 02114, USA
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, 243 Charles Street, Boston, MA, 02114, USA.
- Department of Ophthalmology, Harvard Medical School, Boston, MA, 02115, USA.
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Yang S, Zhang Y, Zhang Z, Dan J, Zhou Q, Wang X, Li W, Zhou L, Yang L, Xie L. Insulin Promotes Corneal Nerve Repair and Wound Healing in Type 1 Diabetic Mice by Enhancing Wnt/β-Catenin Signaling. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:2237-2250. [PMID: 32858016 DOI: 10.1016/j.ajpath.2020.08.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 07/31/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022]
Abstract
The insulin and Wnt signaling pathways are involved in cell proliferation, tissue homeostasis, and tumorigenesis. However, their interrelationship in the pathophysiological process of diabetic corneal injury remains unclear. In this study, the role of insulin in the diabetic cornea was investigated in vitro, using cultured TKE2 cells and trigeminal ganglion neurons, and in vivo, by assessing corneal wound-healing responses in diabetic mice. A selective Wnt antagonist (XAV-939) and activator (BML-284) were used to regulate the interactions between insulin and the Wnt pathway. The results demonstrated that insulin promoted corneal epithelial wound healing and sensation recovery, whereas the expression of molecules involved in the Wnt/β-catenin pathway was also up-regulated in the injured corneal epithelium. However, XAV-939 limited the insulin-induced epithelial and corneal nerve repair. By contrast, BML-284 treatment promoted the healing of the corneal epithelium and corneal nerve repair in diabetic mice. These results indicate that insulin, via Wnt signaling, contributes to diabetic corneal epithelial wound healing and nerve injury recovery and is, therefore, a potential protective factor for diabetic corneal epithelial wounds and nerve injury.
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Affiliation(s)
- Shuo Yang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China; Eye Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, China
| | - Yangyang Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Zhaohua Zhang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Jing Dan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Qingjun Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Xiaochuan Wang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Weina Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Li Zhou
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China
| | - Lingling Yang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.
| | - Lixin Xie
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao, China.
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EX-PRESS Glaucoma Filtration Device: Management of Complications. Vision (Basel) 2020; 4:vision4030039. [PMID: 32824320 PMCID: PMC7560153 DOI: 10.3390/vision4030039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
The EX-PRESS glaucoma filtration device appears to be an effective addition to our options to treat refractory glaucoma. The possibility to create a sclerostomy without tissue excision provides a safe and reliable outflow pathway for aqueous that is standard in size, reducing much of the variability associated with a surgical procedure. Prospective randomized studies comparing EX-PRESS implantation with trabeculectomy show encouraging results. However, complications usually encountered in filtration surgery have been reported, and EX-PRESS implantation can also lead to specific device-related complications. This article reviews the most common complications associated with this procedure.
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Comparison of ExPress Implantation and Partial Deep Sclerectomy Combined with ExPress Implantation and Simultaneous Phacoemulsification. J Ophthalmol 2019; 2019:7424376. [PMID: 31885894 PMCID: PMC6915013 DOI: 10.1155/2019/7424376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/31/2019] [Accepted: 04/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background To compare the effectiveness and safety profile of ExPress implantation versus partial deep sclerectomy combined with ExPress implantation and simultaneous phacoemulsification. Patients and Methods A prospective, randomized control study with 24-month follow-up was performed. 114 eyes were included, of which 42 eyes underwent phacoemulsification with simultaneous implantation of the Ex-Press device (ExPress), and deep sclerectomy with phacoemulsification and simultaneous implantation of the Ex-Press device (DS-ExPress) was performed in 72 eyes. The main outcome measures were intraocular pressure (IOP), corrected distance visual acuity (CDVA), the number of antiglaucoma medications, and the rate of complications. Surgical success was defined as complete (without antiglaucoma medications) with IOP ≤18 mmHg in criterion A, IOP ≤16 mmHg in criterion B, and IOP ≤12 mmHg in criterion C. Satisfactory success was defined as the same IOP levels for individual criteria with a maximum of 2 antiglaucoma medications. Results Before the procedure, mean IOP in the ExPress group was 17.5 ± 4.7 mmHg; after 24 months, it decreased by 13% to 16.0 ± 3.0 mmHg (P < 0.05). In the DS-ExPress group, mean IOP reduced from 16.3 ± 4.4 mmHg to 14.3 ± 3.3 mmHg (P < 0.05), which was a 9% reduction compared to the initial value. In the DS-ExPress group, 65.9% of the patients did not use topical pharmacotherapy, and the same is true for 29.2% of the ExPress group (P=0.004). Conclusions This modification is efficient in surgical treatment of glaucoma, especially when very low postoperative IOP is needed. A less amount of antiglaucoma medicines are needed.
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Tojo N, Hayashi A, Otsuka M. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019; 13:55-61. [PMID: 31564794 PMCID: PMC6743308 DOI: 10.5005/jp-journals-10078-1252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim The aim of this study is to identify target levels of early postoperative intraocular pressure (IOP) associated with successful trabeculectomy using an Ex-Press glaucoma shunt. Materials and methods This was a retrospective single-facility study. We enrolled 158 glaucoma patients who underwent trabeculectomy with Ex-Press and were followed for >1 year, and investigated risk factors for the failure of Ex-Press surgery. We examined age, sex, central corneal thickness (CCT), number of preoperative glaucoma medications, simultaneous performance of cataract surgery, history of trabeculotomy, hypertension (HT), diabetes mellitus (DM), subtype of glaucoma, and early postoperative IOP (minimum, 2 weeks, 1 month, and 3 months). Results Ex-Press surgery could significantly decrease IOP. Success rates at 1, 2, 3, and 4 years were 91.1, 86.1, 82.5, and 78.1%, respectively. Factors significantly affecting the success rate included age, the number of preoperative glaucoma medications, and early postoperative IOP. The IOP cutoff values of minimum IOP for the success of Ex-Press surgery was 5 mm Hg. Conclusions Younger age, a high number of preoperative glaucoma medications, and high IOPs in the early postoperative period were found to be the risk factors for failure of Ex-Press surgery. Considering hypotonic complications, it is desirable to control the minimum IOP from 3–5 mm Hg within 2 weeks after surgery. According to our calculations, target IOPs at 2 weeks, 1 month, and 3 months after Ex-Press surgery should be 8 mm Hg, 10 mm Hg, and 14 mm Hg, respectively. Clinical significance We thought that Ex-Press surgery might require lower IOP in the early postoperative period than conventional trabeculectomy. How to cite this article Tojo N, Hayashi A, et al. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019;13(2):55–61.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Twenty-Four-Hour Contact Lens Sensor Monitoring of Aqueous Humor Dynamics in Surgically or Medically Treated Glaucoma Patients. J Ophthalmol 2019; 2019:9890831. [PMID: 30809389 PMCID: PMC6369465 DOI: 10.1155/2019/9890831] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
Aim This study assessed the 24 h circadian rhythm of intraocular pressure (IOP) using a contact lens sensor in three groups of patients with open-angle glaucoma. Methods This study was a monocentric, cross-sectional, nonrandomized, prospective, pilot study. Eighty-nine patients were enrolled: 29 patients previously underwent an Ex-PRESS mini glaucoma device procedure (Group 1), 28 patients previously underwent Hydrus microstent implantation (Group 2), and 32 patients were currently being treated medically for primary open-angle glaucoma (Group 3). Circadian rhythm patterns were considered with five circadian indicators: fluctuation ranges, maximum, minimum, acrophase (time of peak value), and bathyphase (time of trough value). A two-tailed Mann–Whitney U-test was used to evaluate differences between groups. Results All subjects exhibited a circadian rhythm and a nocturnal pattern. The signal fluctuation range was significantly smaller in the surgical groups than in the medically treated group (Group 1 vs. Group 3, p=0.003; Group 2 vs. Group 3, p=0.010). Subjects who underwent the Ex-PRESS procedure (Group 1) exhibited significant differences compared with the drug therapy group (Group 3) with regard to the minimum value (p=0.015), acrophase (p=0.009), and bathyphase (p=0.002). The other circadian indicators were not significantly different among groups. Conclusions Patients who underwent IOP-lowering surgery had an intrinsic nyctohemeral rhythm. Both surgical procedures, Ex-PRESS and Hydrus, were associated with smaller signal fluctuations compared with medical treatment.
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Omatsu S, Hirooka K, Nitta E, Ukegawa K. Changes in corneal endothelial cells after trabeculectomy and EX-PRESS shunt: 2-year follow-up. BMC Ophthalmol 2018; 18:243. [PMID: 30200927 PMCID: PMC6131764 DOI: 10.1186/s12886-018-0913-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background To compare trabeculectomy and EX-PRESS device implantation procedures for treating glaucoma and evaluate changes in corneal endothelial cell density (CECD). Methods This study prospectively evaluated changes in the CECD in 60 eyes of 60 patients who underwent trabeculectomy and 50 eyes of 45 patients who underwent EX-PRESS device implantation. Baseline patient data recorded included age at surgery, sex, type of glaucoma medications, and lens status. Using a noncontact specular microscope, corneal specular microscopy was performed preoperatively at the central cornea and then at 6, 12, 18 and 24 months after surgery. CECD before and after surgery was compared using a paired t-test. Results There was a significant decrease in the IOP and number of antiglaucoma medications in both groups after the surgery. The mean CECD in the trabeculectomy group was 2505 ± 280 cells/mm2 at baseline, while it was 2398 ± 274 cells/mm2 (P < 0.001), 2349 ± 323 cells/mm2 (P < 0.001), 2293 ± 325 cells/mm2 (P < 0.001), and 2277 ± 385 cells/mm2 (P = 0.003) at 6, 12, 18, and 24 months, respectively. However, the CECD in the EX-PRESS group was 2377 ± 389 cells/mm2 at baseline, while it was 2267 ± 409 cells/mm2 (P = 0.007), 2292 ± 452 cells/mm2 (P = 0.043), 2379 ± 375 cells/mm2 (P = 0.318), and 2317 ± 449 cells/mm2 (P = 0.274) at 6, 12, 18, and 24 months, respectively. Conclusions As compared to trabeculectomy, EX-PRESS device implantation appears to be a safer procedure with regard to the endothelial cell loss risk.
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Affiliation(s)
- Saki Omatsu
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
| | - Eri Nitta
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kaori Ukegawa
- Department of Ophthalmology, Kagawa University Faculty of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
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Tojo N, Hayashi A, Otsuka M. Factors influencing the filtration-bleb volume after Ex-PRESS ® surgery. Clin Ophthalmol 2018; 12:1675-1683. [PMID: 30233131 PMCID: PMC6134405 DOI: 10.2147/opth.s172400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESS® surgery. Methods This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESS® surgeries and were followed up for >2 years were analyzed. We used anterior segment optical coherence tomography to measure the bleb volume, and compared the volume at 1 year with that at 2 years after surgery. We also examined potential influencing factors, including age, number of medications, central corneal thickness, type of glaucoma, preoperative intraocular pressure (IOP), postoperative IOP, reduction ratio of IOP, history of trabeculotomy, and operation method (Ex-PRESS® surgery only or simultaneous cataract surgery). Results Ex-PRESS® surgeries significantly decreased the IOP from 26.3±9.7 mmHg to 11.6±3.7 mmHg after 24 months (P<0.001). The success rate at 2 years was 81.2% (IOP ≥21 mmHg or ≥20% reduction from the baseline IOP). The results showed that age, postoperative IOP, glaucoma type, and simultaneous cataract surgeries influenced the filtration-bleb volume. Conclusion Advanced age, higher postoperative IOP, pseudo-exfoliation glaucoma, and simultaneous cataract surgeries were all found to decrease the volume of the filtration bleb.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan,
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Abstract
RATIONALE Neovascular glaucoma (NVG) is one of the most aggressive types of glaucoma, and its abnormal fibrovascular tissue growth on the iris and trabecular meshwork may create difficulties to control the intraocular pressure (IOP) and perform the operation such as trabeculectomy. PATIENT CONCERNS Ex-PRESS glaucoma shunt has been introduced to serve as one alternative operation for glaucoma, and is thought to have the potential advantage of being less traumatic than traditional trabeculectomy. The purpose of our study is to evaluate the efficacy and safety of primary Ex-PRESS implantation in eyes with NVG. DIAGNOSES AND INTERVENTIONS This was a retrospective study of four patients with NVG in whom primary Ex-PRESS implantation was performed between January 2012 and October 2016. OUTCOMES After a mean follow-up of 20.8 ± 8.9 months (range, 15-34 months), three of four NVG patients (75.0%) receiving primary Ex-PRESS implantation had postoperative IOP under 21 mmHg without any antiglaucoma medication control at the last follow-up, but shunt reposition had been performed due to failed blebs or recurrent NVG. Besides, the best corrected visual acuity at the last follow-up was stabilized or improved in three of four NVG patients (75.0%), accompanied with the regression of iris neovascularization. Only one patient had self-resolved postoperative hyphema; otherwise, there were no other perioperative complications. LESSONS Primary Ex-PRESS implantation might constitute a safe and alternative treatment for patients with NVG. In spite of the possible reoperations, the final outcomes were still shown effective after shunt reposition.
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Affiliation(s)
- Teng-Chieh Yu
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
| | - Gow-Lieng Tseng
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University
| | - Chun-Chen Chen
- Department of Ophthalmology, Taipei City Hospital, Renai Branch
- Institute of Clinical Medicine, National Yang-Ming University
| | - Shiow-Wen Liou
- Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University
- Department of Ophthalmology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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Dib Bustros Y, Fechtner R, S Khouri A. Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results. J Curr Glaucoma Pract 2017; 11:42-47. [PMID: 28924337 PMCID: PMC5577118 DOI: 10.5005/jp-journals-10028-1221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 03/17/2017] [Indexed: 11/23/2022] Open
Abstract
Aim To compare the efficacy and safety of Ex-PRESS glaucoma filtration surgery to trabeculectomy in African origin patients. Materials and methods A retrospective chart review was performed on 56 African American patients undergoing Ex-PRESS glaucoma shunt (E) or trabeculectomy (T) between 2004 and 2012. Data collected included intraocular pressure (IOP) and glaucoma medication use at baseline and postoperative week 1, Month (M) 1, M3, M6, M12. Postoperative interventions including laser suture lysis (LSL) and 5FU injections were analyzed. Complete and qualified success rate, and eyes failing and requiring more surgery were determined. Means, SD, chi-square, and Student’s t-test were performed. Results A total of 56 subjects (E 28, T 28) were included in the analysis. There was a statistically significant reduction (p < 0.05) in IOP and number of glaucoma medications at all time points compared to baseline for both groups. Extent of IOP reduction between groups was not statistically significant at any time point, except postoperative week 1. Mean number of glaucoma medications between groups was not significant, except at 3 months (lower in EXP group). The cumulative number of postoperative interventions within 3 months (LSL and 5-FU) was significantly greater for the TRAB than EXP (3.89 ± 2.4 vs 2.36 ± 2.2, p = 0.007). Success rates were comparable between both groups (Table 2). Conclusion Our study is unique in patients of African origin showing statistical significance in the requirement of less postoperative 5-FU injections during the first 3 months following surgery in the Ex-PRESS group vs the trabeculectomy group. The Ex-PRESS shunt was as effective as trabeculectomy in reducing IOP and use of glaucoma medications up to 1 year. Clinical significance The possible benefit of this article is to help guiding ophthalmologists to select the type of glaucoma filtration surgery to undergo in an African American patient with glaucoma. How to cite this article Bustros YD, Fechtner R, Khouri AS. Outcomes of Ex-PRESS and Trabeculectomy in a Glaucoma Population of African Origin: One Year Results. J Curr Glaucoma Pract 2017;11(2):42-47.
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Affiliation(s)
- Youssef Dib Bustros
- Resident, Department of Ophthalmology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Robert Fechtner
- Professor and Chairman, Department of Ophthalmology, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Albert S Khouri
- Associate Professor, Department of Ophthalmology, Rutgers New Jersey Medical School, New Jersey, USA
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Lyssek-Boroń A, Wylęgała A, Dobrowolski D, Kowalczyk E, Polanowska K, Wylęgała E. Evaluation of EX-PRESS glaucoma implant in elderly diabetic patients after 23G vitrectomy. Clin Interv Aging 2017; 12:653-658. [PMID: 28435237 PMCID: PMC5391864 DOI: 10.2147/cia.s128618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The most frequent qualifications for pars plana vitrectomy (PPV) in diabetic patients include recurrent hemorrhage into the vitreous body chamber and vitreoretinal proliferation, also with traction retinal detachment. The aim of this study was to evaluate the effectiveness of EX-PRESS implant for the treatment of secondary glaucoma in elderly diabetic patients following PPV 23G with silicon oil or SF6 gas endotamponade. MATERIALS AND METHODS This retrospective analysis comprised 18 patients (19 eyes). We applied EX-PRESS implants in 9 patients with neovascular glaucoma (NVG) and in 10 patients with non-NVG. All patients had earlier history of diabetes and vitrectomy 23G for diabetic complications. Intraocular pressure (IOP) was measured and compared before; 7 days; 1, 3, 6, and 12 months; and a year after the surgery. RESULTS Application of the implant exhibited a lowering effect on IOP. After 1 month, 53% of patients had IOP values beyond 22 mmHg, while 86% after 1 year. CONCLUSION The implant can be used to treat both NVG and non-NVG in diabetic patients following PPV.
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Affiliation(s)
- Anita Lyssek-Boroń
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Adam Wylęgała
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Dariusz Dobrowolski
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec.,Department of Ophthalmology, Ophthalmology Clinic, Medical University of Silesia, District Railway Hospital, Katowice, Poland
| | - Ewelina Kowalczyk
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Katarzyna Polanowska
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec
| | - Edward Wylęgała
- Department of Ophthalmology with Pediatric Unit, Trauma Center, Santa Barbara Hospital, Sosnowiec.,Department of Ophthalmology, Ophthalmology Clinic, Medical University of Silesia, District Railway Hospital, Katowice, Poland
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Ishida K, Moroto N, Murata K, Yamamoto T. Effect of glaucoma implant surgery on intraocular pressure reduction, flare count, anterior chamber depth, and corneal endothelium in primary open-angle glaucoma. Jpn J Ophthalmol 2017; 61:334-346. [PMID: 28374269 DOI: 10.1007/s10384-017-0512-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the effect of filtering surgery using the EX-PRESS device on intraocular pressure (IOP), flare count, anterior chamber (AC) depth, and the corneal endothelium in primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG). PATIENTS AND METHODS The study comprised 63 consecutive patients with POAG or NTG. They underwent complete ophthalmologic examinations, including measurement of visual acuity (VA), IOP, flare count, AC depth, and cell density of the corneal endothelium (CE). Two outcomes were used for surgical success: outcome 1 was defined as a ≥20% reduction in the IOP from the preoperative value, with an IOP ≥ 5 mmHg but ≤18 mmHg, and outcome 2 was defined as a ≥20% reduction in the IOP, with an IOP ≥ 5 mmHg but ≤15 mmHg. RESULTS The IOP significantly decreased from 17.7 preoperatively to 12.4 mmHg postoperatively (P < 0.0001). The success rates for outcome 1 at 24 months were 81.3 and 46.7% for POAG and NTG, respectively (P = 0.0065); the corresponding success rates for outcome 2 were 79.4 and 46.7% (P = 0.0120). The flare count significantly increased on postoperative day 1 (P = 0.0002) but recovered to insignificant levels by day 3 (P = 0.0686). A transient decrease in AC depth was observed by 4 weeks after surgery (P = 0.0017). The CE changed from 2529 preoperatively to 2428/mm2 at 24 months (P = 0.0089). CONCLUSION The advantage of filtering surgery using the EX-PRESS device includes reduced inflammation, and the disadvantages include loss of the CE and reduced effectiveness of NTG.
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Affiliation(s)
- Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. .,Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Naoya Moroto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Murata
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
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Lan J, Sun DP, Wu J, Wang YN, Xie LX. Ex-PRESS implantation with phacoemulsification in POAG versus CPACG. Int J Ophthalmol 2017; 10:51-55. [PMID: 28149776 DOI: 10.18240/ijo.2017.01.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/25/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the long-term outcomes of the Ex-PRESS miniature glaucoma device implanted under a scleral flap in combination of phacoemulsification with intraocular lens implantation in primary open angle glaucoma (POAG) and chronic primary angle-closure glaucoma (CPACG). METHODS Retrospective, comparative study. A total of 60 eyes (60 patients) receiving the Ex-PRESS miniature glaucoma device implantation combined with phacoemulsification were reviewed. Thirty eyes (30 patients) had the combined procedures for POAG, and the other 30 eyes (30 patients) for CPACG. RESULTS The follow-up was 39.37±7.09mo (range 3 to 49mo) in patients with POAG and 37.10±9.26mo (range 9 to 49mo) in patients with CPACG (P=0.29). The mean change in best corrected visual acuity was 0.41 logMAR for POAG and 0.38 logMAR for CPACG at the last follow-up (P=0.22). The postoperative intraocular pressure (IOP) of the POAG group was significantly lower than the CPACG group at 1, 3, 12, and 18mo after surgery (P=0.02, 0.00, 0.04, 0.01) with similar glaucoma medications after surgery (P>0.16). At 3y after surgery, the cumulative complete and qualified success rates were 63.3% (POAG) and 53.3% (CPACG), 83.3% (POAG) and 73.3% (CPACG) (P=0.41, 0.49), respectively. The POAG group had more hypotony than the CPACG group (P=0.04). CONCLUSION The long-term outcomes show the Ex-PRESS implantation combined with phacoemulcification can effectively lower the IOP in both the POAG and CPACG groups. The POAG group seems to have lower postoperative IOP and a higher risk of hypotony.
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Affiliation(s)
- Jie Lan
- Qingdao University Medical College, Qingdao 266071, Shandong Province, China; Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Da-Peng Sun
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Jie Wu
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Ya-Ni Wang
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
| | - Li-Xin Xie
- Qingdao Eye Hospital, Shandong Eye Institute, Shandong Academy of Medical Sciences, Qingdao 266071, Shandong Province, China
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Liu B, Guo DD, Du XJ, Cong CY, Ma XH. Evaluation of Ex-PRESS implantation combined with phacoemulsification in primary angle-closure glaucoma. Medicine (Baltimore) 2016; 95:e4613. [PMID: 27603352 PMCID: PMC5023874 DOI: 10.1097/md.0000000000004613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To evaluate the safety and efficacy of Ex-PRESS (R50) implantation combined with phacoemulsification in primary angle-closure glaucoma (PACG) patients with cataract.Twenty-four eyes of 24 patients with unregulated PACG underwent combined cataract and glaucoma surgery. After phacoemulsification and intraocular lens implantation, the Ex-PRESS (R-50) was inserted into the anterior chamber under a scleral flap. The intraocular pressure (IOP), best corrected visual acuity (BCVA), number of medications, and complications were recorded preoperatively as well as postoperatively on day 7 and at 1, 3, 6, and 12 months.The mean follow-up was 16.4 ± 2.5 months (range 14-21 months) and the mean age of the patients was 64.7 ± 6.8 years (range 56-78 years). The mean IOP was 20.4 ± 5.4 mm Hg preoperatively and decreased to 10.2 ± 2.8, 13.1 ± 2.7, 14.9 ± 4.1, 14.3 ± 3.9, and 14.0 ± 3.6 mm Hg on day 7 and at 1, 3, 6, and 12 months after surgery (all P < 0.005). At 12 months, the mean BCVA was 0.62 ± 0.33 and the number of medications was 0.3 ± 0.6. Most of complications were resolved spontaneously and conservatively.The Ex-PRESS implantation combined with phacoemulsification cataract extraction is safe and effective for reducing IOP and antiglaucoma medications in PACG patients with cataract.
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Affiliation(s)
- Bing Liu
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine
| | - Da-Dong Guo
- Eye Institute of Shandong University of Traditional Chinese Medicine
| | - Xiu-Juan Du
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine
| | - Chen-Yang Cong
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine
| | - Xiao-Hua Ma
- Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
- Correspondence: Xiao-Hua Ma, Department of Ophthalmology, Shandong Provincial Hospital affiliated to Shandong University, 9677 Aotizhong Road, Jinan 250000, China (e-mail: )
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Taubenslag KJ, Kammer JA. Outcomes Disparities between Black and White Populations in the Surgical Management of Glaucoma. Semin Ophthalmol 2016; 31:385-93. [DOI: 10.3109/08820538.2016.1154163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Huerva V, Soldevila J, Ascaso FJ, Lavilla L, Muniesa MJ, Sánchez MC. Evaluation of the Ex-PRESS(®) P-50 implant under scleral flap in combined cataract and glaucoma surgery. Int J Ophthalmol 2016; 9:546-50. [PMID: 27162726 DOI: 10.18240/ijo.2016.04.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/10/2015] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS(®) P-50 for combined cataract surgery and glaucoma. METHODS Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS(®) P-50 model placed under scleral flap was performed. RESULTS Out of 40 eyes of 40 patients (55% male and 45% female) completed the study during one-year follow-up. The mean of age was 76.6±11.02y. The intraocular pressure (IOP) decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg (Wilcoxon signed ranks test, P<0.001). A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control (<21 mm Hg). CONCLUSION Combined surgery of phacoemulsification with ExPRESS(®) P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.
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Affiliation(s)
- Valentín Huerva
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida 25198, Spain
| | - Jordi Soldevila
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida 25198, Spain
| | - Francisco J Ascaso
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza 50009, Spain
| | - Laura Lavilla
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, Zaragoza 50009, Spain
| | - M Jesús Muniesa
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida 25198, Spain
| | - M Carmen Sánchez
- Department of Ophthalmology, Universitary Hospital Arnau de Vilanova, Lleida 25198, Spain
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Mendoza-Mendieta ME, López-Venegas AP, Valdés-Casas G. Comparison between the EX-PRESS P-50 implant and trabeculectomy in patients with open-angle glaucoma. Clin Ophthalmol 2016; 10:269-76. [PMID: 26893540 PMCID: PMC4745960 DOI: 10.2147/opth.s94850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the EX-PRESS P-50 implant compared to standard trabeculectomy (TBC). Methods Single-center prospective randomized study; 20 eyes of 20 patients were treated with the EX-PRESS P-50 implant, and 20 eyes of 20 patients with TBC, over a 19-month period. Records of all patients were reviewed and compared. Success was defined as intraocular pressure (IOP) <21 and >5 mmHg or a decrease of 30% of IOP. Failure was defined as >21 mmHg or decline in visual acuity. Statistical analysis was made with Student’s t-test and χ2 test analyzed with SPSS version 13.0. Results The average follow-up was 8.6 months (±4.9 months) for the EX-PRESS P-50 group and 9.6 months (±5.3 months) for the TBC group. The postoperative visual acuity and IOP were not significantly different. We report more complications in the EX-PRESS P-50 group. At 3, 6, and 12 months follow-up, the control group was found to be free of complications, whereas multiple complications were observed in the EX-PRESS P-50 group at 3 and 6 months follow-up. We found no differences in either group with respect to success. Conclusion Both procedures are equally effective for the treatment of glaucoma, with 80% success in the EX-PRESS P-50 group and 72.7% in the control group.
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Affiliation(s)
- María Elena Mendoza-Mendieta
- Department of Anterior Segment, Dr Luis Sánchez Bulnes Hospital, Association to Prevent Blindness, Mexico City, Mexico
| | | | - Gerardo Valdés-Casas
- Department of General Ophthalmology, Institute of Ophthalmology, Conde de Valenciana, Mexico City, Mexico
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Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review. J Curr Glaucoma Pract 2016; 9:81-5. [PMID: 26997842 PMCID: PMC4779946 DOI: 10.5005/jp-journals-10008-1190] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/13/2015] [Indexed: 11/23/2022] Open
Abstract
Glaucoma is a multifactorial condition under serious influence of many risk factors. The role of diabetes mellitus (DM) in glaucoma etiology or progression remains inconclusive. Although, the diabetic patients have different healing mechanism comparing to the general population and it has a possible-negative role on surgical outcomes. This review article attempts to analyze the association of both diseases, glaucoma and DM, before and after the surgery. The epidemiological studies, based mainly in population prevalence analyzes, have shown opposite outcomes in time and even in the most recent articles also the association remains inconclusive. On the contrary, the experimental models based on animal induced chronic hyperglycemia have shown an important association of both diseases, explained by common neurodegenerative mechanisms. Diabetic patients have a different wound healing process in the eye viz-a-viz other organs. The healing process is more and it results in lower surgical survival time, higher intraocular pressure (IOP) levels and, therefore, these patients usually need more medication to lower the IOP. Both randomized and nonrandomized retrospective and experimental molecular studies have shown the association between DM and glaucoma. Further studies are needed to get better explanations about outcomes on more recent surgical procedures and with the exponential use of antifibrotics. How to cite this article: Costa L, Cunha JP, Amado D, Pinto LA, Ferreira J. Diabetes Mellitus as a Risk Factor in Glaucoma's Physiopathology and Surgical Survival Time: A Literature Review. J Curr Glaucoma Pract 2015;9(3):81-85.
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Affiliation(s)
- Lívio Costa
- Consultant, Department of Ophthalmology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Paulo Cunha
- Consultant, Department of Ophthalmology, Centro Hospitalar de Lisboa Central; Faculty of Medical Sciences, New University, Lisbon Portugal
| | - Duarte Amado
- Consultant, Department of Ophthalmology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luís Abegão Pinto
- Professor, Department of Ophthalmology, Centro Hospitalar de Lisboa; Institute of Pharmacology and Neurosciences, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Joana Ferreira
- Consultant, Department of Ophthalmology, Centro Hospitalar de Lisboa Central; Faculty of Medical Sciences, New University, Lisbon Portugal
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Kim YH, Sung MS, Park SW. A Case of Fibrotic Obstruction of Scleral Orifice of Ex-PRESS Shunt. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.6.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yung Hui Kim
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Sun Sung
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Woo Park
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea
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Gunenc U, Ozturk T, Arikan G, Kocak N. Long-term results of viscocanalostomy and phacoviscocanalostomy: a twelve-year follow-up study. Int J Ophthalmol 2015; 8:1162-7. [PMID: 26682166 DOI: 10.3980/j.issn.2222-3959.2015.06.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/04/2014] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the long-term efficacy and safety results of viscocanalostomy and phacoviscocanalostomy. METHODS The charts of 49 glaucoma patients who underwent viscocanalostomy or phacoviscocanalostomy surgery between February 1999 and August 2004 were reviewed retrospectively. Thirty-one eyes of 21 glaucoma patients who underwent filtering procedure with a postoperative follow-up of at least 5y were included in the study. Results of complete ophthalmologic examinations were recorded and statistically analyzed. Long-term surgical outcome was defined as an overall success when intraocular pressure (IOP) was found as ≤20 mm Hg with or without antiglaucomatous medication at the last follow-up visit, while it was defined as a complete success when IOP was measured ≤20 mm Hg without antiglaucomatous medication. RESULTS Mean age was 68.1±9.6y (range: 32-81y). Mean follow-up time was 101.5±27.3mo (range: 60-144mo). Viscocanalostomy was performed in 8 eyes (25.8%) and phacoviscocanalostomy was performed in 23 eyes (74.2%). The mean preoperative IOP was 23.1±7.6 mm Hg with 2.1±1.0 medications, while mean IOP was 16.8±3.8 mm Hg with 0.9±1.1 medication at the last follow-up visit. Both the IOP decrease and the reduction in the antiglaucomatous medication were statistically significant (P<0.001 and P<0.001). No case required further glaucoma surgery. Overall success and complete success were found as 87.1% and 51.6%, respectively. Complete success rate was statistically higher in phacoviscocanalostomy group compared with the viscocanalostomy group (P=0.031), however there was no significant difference in overall success rate between two groups (P=0.072). CONCLUSION Both viscocanalostomy and phacoviscocanalostomy provide good IOP reduction in the long-term period.
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Affiliation(s)
- Uzeyir Gunenc
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey
| | - Taylan Ozturk
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey
| | - Gul Arikan
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey
| | - Nilufer Kocak
- Department of Ophthalmology, Dokuz Eylul University School of Medicine, Inciralti, Izmir 35340, Turkey
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Gonzalez-Rodriguez JM, Trope GE, Drori-Wagschal L, Jinapriya D, Buys YM. Comparison of trabeculectomy versus Ex-PRESS: 3-year follow-up. Br J Ophthalmol 2015; 100:1269-73. [PMID: 26674779 DOI: 10.1136/bjophthalmol-2015-307161] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 11/18/2015] [Indexed: 11/04/2022]
Abstract
AIMS To compare the outcomes of Ex-PRESS versus trabeculectomy at 3 years. METHODS Consenting patients aged 18-85 years with medically uncontrolled open-angle glaucoma scheduled for trabeculectomy were included in this study. 63 subjects were randomised to undergo Ex-PRESS (32) or trabeculectomy (31). Follow-up data included intraocular pressure (IOP), glaucoma medications, visual acuity (VA), complications and additional interventions. Complete success was defined as IOP between 5 and 18 mm Hg and 20% reduction from baseline without glaucoma medications, while qualified success was with or without glaucoma medications. RESULTS Complete success at 2 and 3 years was 43% vs 42% (p=0.78) and 35% vs 38% (p=0.92) in Ex-PRESS versus trabeculectomy, respectively. Qualified success at 2 and 3 years was 59% vs 76% (p=0.20) and 52% vs 61% (p=0.43) in Ex-PRESS versus trabeculectomy, respectively. Mean IOP at 2 and 3 years was 12.5±5.1 mm Hg vs 10.3±3.7 mm Hg (p=0.07) and 13.3±4.5 mm Hg vs 11.1±4.4 mm Hg (p=0.10) for Ex-PRESS versus trabeculectomy, respectively. At 3 years, 47.6% of Ex-PRESS and 50% of trabeculectomy patients were on glaucoma medications (p=1.00). No difference in VA was found after 3 years (logarithm of minimum angle of resolution 0.43±0.4 vs 0.72±0.8 for Ex-PRESS vs trabeculectomy, p=0.11). When excluding patients who underwent reoperation VA was better in the Ex-PRESS group at 1, 2 and 3 years. There were no complications after the first year in either group. CONCLUSIONS We found no difference in success rates, mean IOP or other secondary outcomes between Ex-PRESS and trabeculectomy after 3 years of follow-up. TRIAL REGISTRATION NUMBER NCT01263561; post results.
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Affiliation(s)
- Johanna M Gonzalez-Rodriguez
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Graham E Trope
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Lilach Drori-Wagschal
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital/University of Toronto, Toronto, Ontario, Canada
| | - Delan Jinapriya
- Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, Toronto Western Hospital/University of Toronto, Toronto, Ontario, Canada
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Chan JE, Netland PA. EX-PRESS Glaucoma Filtration Device: efficacy, safety, and predictability. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:381-8. [PMID: 26366105 PMCID: PMC4562650 DOI: 10.2147/mder.s63350] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Trabeculectomy has been the traditional primary surgical therapy for open-angle glaucoma. While trabeculectomy is effective in lowering intraocular pressure, complications associated with the procedure have motivated the development of alternative techniques and devices, including the EX-PRESS Glaucoma Filtration Device. This review describes the efficacy, safety, complication rates, and potential advantages and disadvantages of the EX-PRESS Glaucoma Filtration Device. EX-PRESS implantation is technically simpler compared with that of trabeculectomy, with fewer surgical steps. Vision recovery has been more rapid after EX-PRESS implantation compared with trabeculectomy. Intraocular pressure variation is lower during the early postoperative period, indicating a more predictable procedure. While efficacy of the EX-PRESS implant has been comparable to trabeculectomy, postoperative complications appear less common after EX-PRESS implantation compared with trabeculectomy. The EX-PRESS Glaucoma Filtration Device appears to be safe and effective in the surgical management of open-angle glaucoma.
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Affiliation(s)
- Jessica E Chan
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Peter A Netland
- Department of Ophthalmology, University of Virginia School of Medicine, Charlottesville, VA, USA
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Kato N, Takahashi G, Kumegawa K, Kabata Y, Tsuneoka H. Indications and postoperative treatment for Ex-PRESS(®) insertion in Japanese patients with glaucoma: comparison with standard trabeculectomy. Clin Ophthalmol 2015; 9:1491-8. [PMID: 26316691 PMCID: PMC4547651 DOI: 10.2147/opth.s86504] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background We investigated indications and early postoperative treatment for Ex-PRESS® insertion for glaucoma by comparing postoperative outcomes with those for standard trabeculectomy. Methods Ex-PRESS insertion was performed in 21 eyes and standard trabeculectomy (TLE) in 22 eyes. Mean intraocular pressure (IOP) in the 6 months after surgery, success rate for postoperative IOP decline, postoperative complications, postoperative treatment, filtering blebs, and indications were then retrospectively investigated. Results Mean postoperative IOP did not differ significantly between the groups at any observation time for 6 months after surgery. Further, it did not differ between either the groups of patients with primary open-angle glaucoma (POAG) and neovascular glaucoma (NTG), or the patients with primary open-angle glaucoma and NTG in the Ex-PRESS group. Comparison of success rates in reduction of postoperative IOP between the groups under the following four survival conditions showed no significant differences: postoperative IOP <30% of the preoperative IOP, complete success (no additional ophthalmic solution), and qualified success (ophthalmic solution required); 5 mmHg ≤ postoperative IOP ≤21 mmHg, complete success (no additional ophthalmic solution), and qualified success (ophthalmic solution required). With regard to postoperative complications and postoperative treatment, the incidence of hyphema was significantly lower in the Ex-PRESS group, but no other significant intergroup differences were seen. The height of the filtering bleb was lower in the Ex-PRESS group. Conclusion Postoperative outcomes in the Ex-PRESS and TLE groups were comparable. The incidence of hyphema was significantly lower in the Ex-PRESS group. Ex-PRESS insertion appears to be useful in patients with NTG and in those prone to postoperative bleeding. There were no significant intergroup differences in postoperative treatment. Assessment of outcome after Ex-PRESS insertion was difficult in some patients. Postoperative treatment should be developed to suit the specific requirements of Ex-PRESS insertion.
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Affiliation(s)
- Noriko Kato
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan ; Katsushika Medical Center, Tokyo, Japan
| | - Genichiro Takahashi
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan ; Katsushika Medical Center, Tokyo, Japan
| | - Koichi Kumegawa
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan ; Katsushika Medical Center, Tokyo, Japan
| | - Yoshiaki Kabata
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan ; Katsushika Medical Center, Tokyo, Japan
| | - Hiroshi Tsuneoka
- Department of Ophthalmology, Jikei University, School of Medicine, Tokyo, Japan
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Naranjo-Bonilla P, Giménez-Gómez R, Gallardo-Galera JM. Ex-Press implant in glaucoma and Sturge Weber syndrome. ACTA ACUST UNITED AC 2014; 89:508-9. [PMID: 25086881 DOI: 10.1016/j.oftal.2014.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/18/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P Naranjo-Bonilla
- Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España.
| | - R Giménez-Gómez
- Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España
| | - J M Gallardo-Galera
- Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España
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Response to: RE: Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device. Eye (Lond) 2014; 28:1034-5. [PMID: 24810573 DOI: 10.1038/eye.2014.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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RE: Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device. Eye (Lond) 2014; 28:1034. [PMID: 24810572 DOI: 10.1038/eye.2014.87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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