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Jin E, Goh CXY, Betzler BK, Heng CP, Ang BCH. Assessing the value of the water drinking test in glaucoma-a systematic review and meta-analysis. Eye (Lond) 2024; 38:2688-2700. [PMID: 38714837 PMCID: PMC11427712 DOI: 10.1038/s41433-024-03107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/08/2024] [Accepted: 04/19/2024] [Indexed: 09/28/2024] Open
Abstract
This systematic review and meta-analysis examines the relationship between intraocular pressure (IOP) parameters derived from the water drinking test (WDT) and diurnal IOP monitoring, and evaluates the reproducibility of the WDT and its association with future glaucomatous visual field (VF) loss. A literature search was performed on PubMed, EMBASE, and Cochrane Library from inception to 31 March 2023. Cohort, cross-sectional and observational studies reporting WDT results in glaucoma patients were included. Meta analysis with random-effect model was performed using "metafor" package in R version 3.2.1. 641 studies were identified on initial literature search. 38 studies (2479 subjects) were included in final analysis. Meta-analytic estimates of 5 studies (310 subjects) found strong positive correlation in peak IOP between the WDT and diurnal IOP monitoring (r = 0.92, 95% CI = 0.75, 1.08, p < 0.0001). However, there was only weak positive correlation for IOP fluctuation between both methods (r = 0.26, 95% CI = 0.06,0.47, p < 0.0001). Meta-analytic estimates of 3 studies (189 subjects) suggested a trend of the diurnal peak IOP being lower than that derived from the WDT (MD = -2.37 mmHg, 95% Limit of Agreement (LOA) =-5.58,0.84, p = 0.147). Two studies found that a higher WDT peak IOP was associated with greater future VF progression. Two studies demonstrated good reproducibility in peak IOP measurements for WDTs conducted across different days. In conclusion, there was a strong positive correlation between IOP peak measurements from the WDT and diurnal IOP monitoring in glaucoma patients. The WDT peak IOP demonstrated good reproducibility and may be associated with greater future VF progression.
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Affiliation(s)
- Eric Jin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Claire Xin Yi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Choon Pooh Heng
- Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore, Singapore.
- Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, Singapore, Singapore.
- Mayo Clinic, Department of Ophthalmology, Jacksonville, FL, USA.
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Yadav KS, Bisen AC, Ishteyaque S, Sharma I, Verma S, Sanap SN, Verma S, Washimkar KR, Kumar A, Tripathi V, Bhatta RS, Mugale MN. Solanum nigrum Toxicity and Its Neuroprotective Effect Against Retinal Ganglion Cell Death Through Modulation of Extracellular Matrix in a Glaucoma Rat Model. J Ocul Pharmacol Ther 2024; 40:309-324. [PMID: 38603587 DOI: 10.1089/jop.2023.0089] [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] [Indexed: 04/13/2024] Open
Abstract
Purpose: Glaucoma is a complex degenerative optic neuropathy characterized by loss of retinal ganglion cells (RGCs) leading to irreversible vision loss and blindness. Solanum nigrum has been used for decades in traditional medicine system. However, no extensive studies were reported on its antiglaucoma properties. Therefore, this study was designed to investigate the neuroprotective effects of S. nigrum extract on RGC against glaucoma rat model. Methods: High performance liquid chromatography and liquid chromatography tandem mass spectrometry was used to analyze the phytochemical profile of aqueous extract of S. nigrum (AESN). In vitro, {3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide} (MTT) and H2DCFDA assays were used to determine cell viability and reactive oxygen species (ROS) production in Statens Seruminstitut Rabbit Cornea cells. In vivo, AESN was orally administered to carbomer-induced rats for 4 weeks. Intraocular pressure, antioxidant levels, and electrolytes were determined. Histopathological and immunohistochemical analysis was carried out to evaluate the neurodegeneration of RGC. Results: MTT assay showed AESN exhibited greater cell viability and minimal ROS production at 10 μg/mL. Slit lamp and funduscopy confirmed glaucomatous changes in carbomer-induced rats. Administration of AESN showed minimal peripheral corneal vascularization and restored histopathological alterations such as minimal loss of corneal epithelium and moderate narrowing of the iridocorneal angle. Immunohistochemistry analysis showed increased expression of positive BRN3A cells and decreased matrix metalloproteinase (MMP)-9 activation in retina and cornea, whereas western blot analysis revealed downregulation of extracellular matrix proteins (COL-1 and MMP-9) in AESN-treated rats compared with the diseased group rats. Conclusions: AESN protects RGC loss through remodeling of MMPs and, therefore, can be used for the development of novel neurotherapeutics for the treatment of glaucoma.
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Affiliation(s)
- Karan Singh Yadav
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Amol Chhatrapati Bisen
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Pharmaceutics and Pharmacokinetics Division, and CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Sharmeen Ishteyaque
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Isha Sharma
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Smriti Verma
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Sachin Nashik Sanap
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Pharmaceutics and Pharmacokinetics Division, and CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Shobhit Verma
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Kaveri R Washimkar
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Akhilesh Kumar
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Vineeta Tripathi
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Division of Botany, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Rabi Sankar Bhatta
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
- Pharmaceutics and Pharmacokinetics Division, and CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
| | - Madhav Nilakanth Mugale
- Division of Toxicology and Experimental Medicine, CSIR-Central Drug Research Institute (CSIR-CDRI), Lucknow, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
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Hao H, He B, Yu B, Yang J, Xing X, Liu W. Suprachoroidal injection of polyzwitterion hydrogel for treating glaucoma. BIOMATERIALS ADVANCES 2022; 142:213162. [PMID: 36279749 DOI: 10.1016/j.bioadv.2022.213162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 09/24/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
Glaucoma is the primary cause of irreversible blindness worldwide. The current treatments are primarily based on drug usage or surgical operation to reduce intraocular pressure (IOP). However, it is expensive and requires patients to insist on taking the medicine for a long time. The suprachoroidal space (SCS) is the space between the choroid and the sclera, which forms part of the uveovortex pathway in the circulation of aqueous humor. So far, it is still challenging to realize the injection of hydrogels into the SCS with long-term duration. In this work, an in situ-forming polyzwitterionic polycarboxybetaine hydrogel is designed and injected to expand SCS to increase the drainage of aqueous humor from the eye via the uveovortex pathway, thus reducing IOP for at least 6 weeks, while commercial hyaluronic acid hydrogel can only last for about 4 weeks. The clinical ophthalmological safety assessment examination shows that the treatment of polyzwitterion hydrogel is well-tolerated that leads to minimal inflammatory reaction, and histopathology assessment demonstrates that the SCS is expanded after injection of the hydrogel. Further analysis of ultrasound biomicroscopy reveals that there is a strong correlation between IOP reduction and SCS expansion. In short, the polyzwitterion hydrogel developed in this work can prolong the period of IOP reduction by expanding SCS, thus treating ocular hypertension and glaucoma without resorting to drugs or regular surgery.
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Affiliation(s)
- Huijie Hao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Binbin He
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Bo Yu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China
| | - Jianhai Yang
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China.
| | - Xiaoli Xing
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin 300384, China.
| | - Wenguang Liu
- School of Materials Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
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Romano D, De Ruvo V, Fogagnolo P, Farci R, Rossetti LM. Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments. J Clin Med 2022; 11:jcm11051238. [PMID: 35268329 PMCID: PMC8910944 DOI: 10.3390/jcm11051238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.
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Affiliation(s)
- Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Valentino De Ruvo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
- Correspondence:
| | - Roberta Farci
- Department of Health Science, University of Milan, 20146 Milan, Italy;
| | - Luca Mario Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
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Non-inferiority of Microhook to Trabectome: Trabectome vs. ab interno Microhook Trabeculotomy Comparative Study (TramTrac Study). Ophthalmol Glaucoma 2021; 5:452-461. [PMID: 34839035 DOI: 10.1016/j.ogla.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To elucidate the non-inferiority of ab interno microhook trabeculotomy (μTLO) using a recently developed reusable stainless spatula-type microhook device to incise the trabecular meshwork to trabectome (TOM) in terms of the 1-year postoperative outcomes of Japanese patients with glaucoma by means of propensity score analyses. DESIGN A multicenter retrospective cohort study. PARTICIPANTS We enrolled 553 and 392 patients who underwent TOM and μTLO, respectively, between January 2014 and March 2020 at 10 facilities. METHODS Logistic regression analysis was conducted to calculate the propensity score, which indicates the likelihood of treatment assignment (TOM or μTLO). We set the following factors as outcome-related covariates: age, sex, facility, glaucoma disease types, preoperative intraocular pressure (IOP), glaucoma drug score, mean deviation of the Humphrey visual field test and antithrombotic drug use, the presence or absence of combined cataract surgery, and incision range of trabecular meshwork (one or two quadrants). We analyzed four different methods (matching, inverse probability of treatment weighting (IPTW), stratification, and regression adjustment) using the propensity score. We set 15% as the non-inferiority margin based on previous trabectome meta-analysis results. MAIN OUTCOME MEASURES The primary outcome was surgical success at 1 year postoperatively. We defined surgical success as satisfying all three criteria: (1) IOP within 5-21 mmHg; (2) IOP reduction of ≥20% from preoperative IOP; and (3) no additional glaucoma surgery. RESULTS The 95% confidence interval of risk difference of surgical failure in μTLO in reference to TOM was -12.1 to +9.5% in matching, -12.7 to +11.1% in IPTW, -12.2 to +7.0 in stratification, and -9.7 to +8.1% in regression adjustment, all of which fell within the predetermined non-inferiority margin of 15%. CONCLUSIONS Surgical success of μTLO at 1-year postoperatively was not inferior to that of TOM.
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Ofei-Palm CNK, Tagoe NN, Jatoe D, Agyare A, Ankrah D. Cost Analysis and Rational Use of Anti-Glaucoma Therapy in a Tertiary Hospital in Ghana. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:619-627. [PMID: 34239312 PMCID: PMC8259729 DOI: 10.2147/ceor.s311058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Glaucoma is the leading cause of irreversible blindness worldwide. In Ghana, 19.4% of all blindness recorded is due to glaucoma. Reducing intraocular pressure medically (using eye drops) is the evidence-based therapeutic option. Objective To determine the rational use and undertake cost analysis of anti-glaucoma drugs among patients attending clinic at the Lions International Eye Centre (LIEC), Korle-Bu Teaching Hospital. Methods In this cross-sectional study, we reviewed all prescriptions presented to the pharmacy unit from 01/12/2015 to 31/03/2016. The dispensed drops were classified, and all anti-glaucoma drugs were identified. This was followed by cost analysis. Results A total of 588 prescriptions were captured, 27.3% (161/588) contained an anti-glaucoma medication. The mean number of anti-glaucoma medications was 1.71 of which 52.7% was prescribed to females. Prostaglandin analogs (PGA) were the most prescribed (37% (102/276)), followed by beta blockers (25.4% (70/276)), carbonic anhydrase group of medicines (16.3% (45/276)), combined beta blockers (11.2% (31/276)), alpha agonists (8.7% (24/276)) and miotics (1.4% (4/276)). The median (IQR) cost of anti-glaucoma therapy per prescription per month was GHC 65.00 (GHC38.5-GHC140) about [US$16.25 (US$ 9.6–US$35)]. Azopt (Brimonidine) was the most expensive with daily treatment cost of GHC 5.8 (about US$ 1.45), whilst the least expensive drug with a daily treatment cost of GHC 0.14 (about US$ 0.035) was timolol eye drops. Conclusion Prostaglandin analogs though expensive remain the most preferred treatment for managing glaucoma at the Korle-Bu Eye Centre in Ghana. This may adversely affect treatment among the poor since prostaglandins analogs are currently not covered by insurance.
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Affiliation(s)
| | - Naa Naamuah Tagoe
- Lions International Eye Centre (LIEC), Korle Bu Teaching Hospital, Accra, Ghana
| | - Dong Jatoe
- Lions International Eye Centre (LIEC), Pharmacy Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Angela Agyare
- Lions International Eye Centre (LIEC), Pharmacy Unit, Korle Bu Teaching Hospital, Accra, Ghana
| | - Daniel Ankrah
- Pharmacy Department, Korle Bu Teaching Hospital, Accra, Ghana
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Shanmugham V, Subban R. Extraction of capsanthin from Capsicum annum L fruits and its effect on carbomer-induced intraocular pressure in Albino Wistar rats. J Food Biochem 2021; 45:e13776. [PMID: 34056744 DOI: 10.1111/jfbc.13776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/20/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
The present study was aimed to explore the antiglaucoma activity of capsanthin enriched fraction (CEF) of Capsicum annum L fruits against carbomer-induced experimental glaucoma in Albino Wistar rats. CEF was orally administered to carbomer-induced glaucomatous rats, and pilocarpine 2% eye drops were used as a standard drug. Intraocular pressure (IOP) levels were determined after oral administration of a low, medium, and a high dose of CEF (20, 40, and 80 mg/kg bwt) in glaucomatous rats. In rats with elevated IOP in both eyes, oral administration of CEF resulted in a significant reduction in IOP (p < .05) even at a low dose of 20 mg/Kg body weight. There were no treatment-related changes in histopathology, hematology, and clinical chemistry parameters. Thus, CEF when administered orally in IOP-bearing rats successfully reduced IOP without any adverse effects. PRACTICAL APPLICATIONS: Capsanthin enriched fraction can be used to prevent permanent vision loss due to age-related macular diseases and high intraocular pressure. The intraocular pressure reduction action of capsanthin can be useful in the treatment of glaucoma. The medication available to treat glaucoma are topical drugs, and for the first time, we proved the oral supplementation of capsanthin from a food source can reduce the intraocular pressure in rats.
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Affiliation(s)
| | - Ravi Subban
- Department of Chemistry, Karpagam Academy of Higher Education, Coimbatore, India
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Vera V, Ahmed I“IK, Stalmans I, Reitsamer H. Gel Stent Implantation—Recommendations for Preoperative Assessment, Surgical Technique, and Postoperative Management. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/usor.2018.11.1.38] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The surgical management of glaucoma offers the potential to lower intraocular pressure (IOP) independent of patients’ compliance with their medication regimen. Procedures such as trabeculectomy and tube shunt placement often yield large magnitudes of IOP reduction, but may be associated with short- and long-term complications. Microinvasive glaucoma surgery (MIGS) offers an alternative surgical approach that is inherently less invasive; however, most devices that fit in this category are associated with a lesser degree of IOP-lowering efficacy compared with traditional glaucoma surgeries. A newer MIGS device, a gel stent that facilitates drainage to the subconjunctival space, appears to offer similar IOP reduction to trabeculectomy, but with much less tissue manipulation; better predictability; and less sight-threatening complications, thus making it a potentially safer and more predictable surgical option in appropriate patients. The following proposed protocol, based on evidence-based practices and augmented where necessary by the opinions of experienced surgeons, provides guidance for the pre-, intra-, and postoperative management of patients receiving a gel stent implant. The goal of this protocol is to provide a framework for better patient selection and preparation, surgical pearls, and how best to assess and manage patients in the postoperative period.
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Eldaly MA, Bunce C, ElSheikha OZ, Wormald R. Non-penetrating filtration surgery versus trabeculectomy for open-angle glaucoma. Cochrane Database Syst Rev 2014; 2014:CD007059. [PMID: 24532137 PMCID: PMC11329888 DOI: 10.1002/14651858.cd007059.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glaucoma is the second commonest cause of blindness worldwide. Non-penetrating glaucoma surgeries have been developed as a safer and more acceptable surgical intervention to patients compared to conventional procedures. OBJECTIVES To compare the effectiveness of non-penetrating trabecular surgery compared with conventional trabeculectomy in people with glaucoma. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 8), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to September 2013), EMBASE (January 1980 to September 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to September 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 27 September 2013. SELECTION CRITERIA This review included relevant randomised controlled trials (RCTs) and quasi-RCTs on participants undergoing standard trabeculectomy for open-angle glaucoma compared to non-penetrating surgery, specifically viscocanalostomy or deep sclerectomy, with or without adjunctive measures. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the titles and abstracts of the search results. We obtained full copies of all potentially eligible studies and assessed each one according to the definitions in the 'Criteria for considering studies' section of this review. We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included five studies with a total of 311 eyes (247 participants) of which 133 eyes (participants) were quasi-randomised. One hundred and sixty eyes which had trabeculectomy were compared to 151 eyes that had non-penetrating glaucoma surgery (of which 101 eyes had deep sclerectomy and 50 eyes had viscocanalostomy). The confidence interval (CI) for the odds ratio (OR) of success (defined as achieving target eye pressure without eye drops) does not exclude a beneficial effect of either deep sclerectomy or trabeculectomy (OR 0.98, 95% CI 0.51 to 1.88). The odds of success in viscocanalostomy participants was lower than in trabeculectomy participants (OR 0.33, 95% CI 0.13 to 0.81). We did not combine the different types of non-penetrating surgery because there was evidence of a subgroup difference when examining total success. The odds ratio for achieving target eye pressure with or without eye drops was imprecise and was compatible with a beneficial effect of either trabeculectomy or non-penetrating filtration surgery (NPFS) (OR 0.79, 95% CI 0.35 to 1.79). Operative adjuvants were used in both treatment groups; more commonly in the NPFS group compared to the trabeculectomy group but no clear effect of their use could be determined. Although the studies were too small to provide definitive evidence regarding the relative safety of the surgical procedures we noted that there were relatively fewer complications with non-filtering surgery compared to trabeculectomy (17% and 65% respectively). Cataract was more commonly reported in the trabeculectomy studies. None of the five trials used quality of life measure questionnaires. The methodological quality of the studies was not good. Most studies were at high risk of bias in at least one domain and for many, there was lack of certainty due to incomplete reporting. Adequate sequence generation was noted only in one study. Similarly, only two studies avoided detection bias. We detected incomplete outcome data in three of the included studies. AUTHORS' CONCLUSIONS This review provides some limited evidence that control of IOP is better with trabeculectomy than viscocanalostomy. For deep sclerectomy, we cannot draw any useful conclusions. This may reflect surgical difficulties in performing non-penetrating procedures and the need for surgical experience. This review has highlighted the lack of use of quality of life outcomes and the need for higher methodological quality RCTs to address these issues. Since it is unlikely that better IOP control will be offered by NPFS, but that these techniques offer potential gains for patients in terms of quality of life, we feel that such a trial is likely to be of a non-inferiority design with quality of life measures.
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Affiliation(s)
- Mohamed A Eldaly
- Cairo UniversityOphthalmology Department, Faculty of MedicineCairoEgypt
| | - Catey Bunce
- Moorfields Eye Hospital NHS Foundation TrustResearch and Development DepartmentCity RoadLondonUKEC1V 2PD
| | - Ola Z ElSheikha
- Cairo UniversityOphthalmology Department, Faculty of MedicineCairoEgypt
| | - Richard Wormald
- Moorfields Eye Hospital NHS Foundation TrustResearch and Development DepartmentCity RoadLondonUKEC1V 2PD
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision Group, ICEHKeppel StreetLondonUKWC1E 7HT
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Sultan MB, Mansberger SL, Lee PP. Understanding the Importance of IOP Variables in Glaucoma: A Systematic Review. Surv Ophthalmol 2009; 54:643-62. [DOI: 10.1016/j.survophthal.2009.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 04/17/2009] [Accepted: 05/12/2009] [Indexed: 10/20/2022]
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