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Chauhan D, Midha N, Mahalingam K, Angmo D, Sihota R, Gupta S, Chawla R, Dada T. Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma. J Glaucoma 2023; 32:1011-1017. [PMID: 38200659 DOI: 10.1097/ijg.0000000000002322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/18/2023] [Indexed: 01/12/2024]
Abstract
PRCIS In primary angle closure glaucoma (PACG), micropulse cyclophotocoagulation resulted in a significant reduction in intraocular pressure (IOP), and the number of antiglaucoma medications without any sight-threatening complications. However, the IOP lowering efficacy decreased over time. PURPOSE The purpose of this study was to evaluate the efficacy and safety of micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) in PACG. PATIENTS AND METHODS Thirty-three phakic PACG eyes with patent laser peripheral iridotomy and IOP uncontrolled on maximum tolerable antiglaucoma medications (AGMs), scheduled for trabeculectomy, were given a trial of MP-TSCPC (810 nm laser, 2000 mw power for 180 seconds, 360 degrees). The primary outcome measure was a success at 1 year with IOP ≤18 mm Hg and ≤15 mm Hg with (qualified success) or without (absolute success) AGMs after a single session of MP laser. Secondary outcome measures were changes in pupillary diameter, visual acuity, central macular thickness, and subjective pain perception. RESULTS Thirty-two out of 33 PACG patients completed 12 months of follow-up. The mean age of patients was 54.7±8.9 years; male:female ratio was 1:1. The baseline IOP was 25.7±5.3 mm Hg, which reduced to 17.9±4.6 mm Hg at the end of 12 months (P<0.0001). Twenty eyes (62.5%) achieved qualified success, and 1 eye (3.125%) had absolute success at 12 months for IOP ≤18 mm Hg; 6 eyes (18.75%) had qualified success, and 1 eye (3.125%) had absolute success for IOP ≤15 mm Hg at 12 months follow-up. A significant reduction was also observed in the number of AGMs (4.4±0.8 at baseline to 2.9±1.1 at 12 months; P <0.0001). Five eyes (15.6%) received additional treatment-3 eyes (9.4%) requiring a subsequent filtering procedure, and 2 eyes (6.2%) requiring an additional MP-TSCPC session. No significant change in pupillary diameter (P=0.489) or central macular thickness (P=0.938) was noted at 12 months. There was a transient drop of visual acuity >2 lines in 1 patient due to cystoid macular edema, and no major postlaser complications were noted. CONCLUSIONS MP-TSCPC can be used as an interim procedure to reduce IOP in PACG eyes and delay the need for invasive surgery. Most patients require continued use of glaucoma medications, and target IOPs achieved are in the high teens.
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Affiliation(s)
- Divya Chauhan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
| | | | - Karthikeyan Mahalingam
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
| | - Dewang Angmo
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
| | | | - Shikha Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
| | - Rohan Chawla
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
| | - Tanuj Dada
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences
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Vukmirovic A, Ong J, Mukhtar A, Yu D, Morgan WH. Outcomes of 45 μm gelatin stent surgery over 24-month follow-up. Clin Exp Ophthalmol 2023; 51:19-30. [PMID: 36287080 PMCID: PMC10946756 DOI: 10.1111/ceo.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 10/06/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The main objectives of this study were to determine whether known risk factors for trabeculectomy failure similarly influence gelatin stent outcomes and to identify surgical factors which may optimise success. METHODS A retrospective, observational study was conducted at a single centre in Perth, Western Australia over 24 months. Two-hundred and sixty-two eyes of 207 patients underwent XEN-45 stent surgery with various forms of glaucoma. Surgical and postoperative data on subjects undergoing XEN-45 stent surgery was collated. Intraocular pressure (IOP) reduction success was determined using three criteria: 1; IOP <18 mm Hg, 2: IOP <15 mm Hg and 3: >25% IOP reduction from baseline. Kaplan-Meier, mixed effects Cox Proportional hazard model and Chi-Square test were used to measure survival of functioning stents. RESULTS The success rates at a maximum of 2 years after surgery by criteria 1, 2 and 3 were 61.3%, 26.2% and 28.9% in primary open angle glaucoma (n = 243), 18.8%, 16.9%, 21.4% in angle closure glaucoma (n = 11), 0%, 0%, 66.7% in congenital glaucoma (n = 5) and 0% in uveitic glaucoma (n = 3). No significant reduction in success was found in those eyes that had prior ocular surgery (all p > 0.07). CONCLUSIONS Prior cataract or trabeculectomy surgery does not appear to adversely affect gelatin stent outcomes over 2 years follow up. Gelatin stent surgery appears to have less IOP reduction effect compared to trabeculectomy at 2 years.
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Affiliation(s)
| | - Jessica Ong
- Lions Eye InstitutePerthWestern AustraliaAustralia
- Ophthalmology departmentRoyal Perth HospitalPerthWestern AustraliaAustralia
| | - Aqif Mukhtar
- Lions Eye InstitutePerthWestern AustraliaAustralia
| | - Dao‐Yi Yu
- Lions Eye InstitutePerthWestern AustraliaAustralia
- Ophthalmology departmentRoyal Perth HospitalPerthWestern AustraliaAustralia
- Centre for Ophthalmology and Visual ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - William H. Morgan
- Lions Eye InstitutePerthWestern AustraliaAustralia
- Ophthalmology departmentRoyal Perth HospitalPerthWestern AustraliaAustralia
- Centre for Ophthalmology and Visual ScienceUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Angle Closure Glaucoma—Update on Treatment Paradigms. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Potop V, Coviltir V, Schmitzer S, Dragosloveanu CDM, Ionescu CI, Burcel MG, Corbu MC, Dăscălescu DMC. Ultrasound biomicroscopy in glaucoma assessment. Rom J Ophthalmol 2021; 65:114-119. [PMID: 34179574 PMCID: PMC8207866 DOI: 10.22336/rjo.2021.24] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2021] [Indexed: 12/12/2022] Open
Abstract
Ultrasound biomicroscopy (UBM) is an important tool in the diagnosis, evaluation and follow up of glaucoma patients. Even if we are dealing with a primary angle closure glaucoma (PACG) or a primary open angle glaucoma (POAG) patient, the mechanism of angle closure can be revealed by performing an UBM. The device can help differentiate between the two types of glaucoma even in patients with opaque corneas when gonioscopy cannot be performed. Knowing the type of glaucoma is vital, especially regarding an individualized treatment, since each patient is unique and needs to be treated accordingly, in order to prevent glaucomatous optic neuropathy and visual field loss. Abbreviations: AC = anterior chamber, ICE = iridocorneal endothelial syndrome, IOP = intraocular pressure, NTG = normal tension glaucoma, PACG = primary angle closure glaucoma, PC = posterior chamber, PEX = pseudoexfoliation syndrome, POAG = primary open angle glaucoma, UBM = ultrasound biomicroscopy.
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Affiliation(s)
- Vasile Potop
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Valeria Coviltir
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Speranţa Schmitzer
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | - Christiana Diana Maria Dragosloveanu
- Ophthalmology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
| | | | | | - Maria Cristina Corbu
- Ophthalmology Department, Clinical Hospital of Ophthalmologic Emergencies, Bucharest, Romania
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Chiu HI, Su HI, Ko YC, Liu CJL. Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017. Br J Ophthalmol 2020; 106:362-367. [PMID: 33229342 DOI: 10.1136/bjophthalmol-2020-317303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/02/2020] [Accepted: 11/04/2020] [Indexed: 11/03/2022]
Abstract
AIMS To determine long-term outcomes and risk factors for failure after mitomycin C (MMC)-augmented initial trabeculectomy (IT) in Taiwanese patients. METHODS We reviewed medical records of patients with glaucoma undergoing IT during December 2006-December 2016. We defined complete success as an intraocular pressure (IOP) of >5 or ≤21 mm Hg or IOP reduction of ≥20% from baseline without supplemental medications and qualified success as the aforementioned IOP levels with or without supplemental medications. Kaplan-Meier survival and Cox proportional analyses evaluated success rates and risk factors for failure, respectively. RESULTS We enrolled 190 patients (237 eyes; mean age: 54.0±15.3 years; mean postoperative follow-up period: 68.4±35.1 months). Mean IOP and glaucoma medications decreased from 22.2±10.8 to 14.4±5.2 mm Hg (p<0.001) and 3.0±0.7 to 1.8±1.2 (p=0.015), respectively, at the last visit. Cumulative qualified success rates were 93.9%, 93.0%, 86.5% and 67.1% at the 1, 2, 5 and 10 years follow-up, respectively; however, only 7.7% of the eyes reached complete success at the last visit. Eyes with poor preoperative visual acuity were associated with low qualified success rates (HR=1.689, p=0.027); patients aged >70 years had higher complete success rates than did those aged ≤70 years. Five cases (2.11%) exhibited bleb-associated complications. CONCLUSION Despite satisfactory long-term success rates, most eyes needed medication for IOP control, supporting the notion of predisposed scarring vitality in patients of Chinese ethnicity following MMC-augmented trabeculectomy.
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Affiliation(s)
- Hsun-I Chiu
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - Huan-I Su
- Department of Ophthalmology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yu-Chieh Ko
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan .,Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Catherine Jui-Ling Liu
- Department of Ophthalmology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan .,Medicine, National Yang-Ming University, Taipei, Taiwan
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Bevacizumab as an Adjunct to Trabeculectomy in Primary Open-Angle Glaucoma: A Randomized Trial. J Ophthalmol 2020; 2020:8359398. [PMID: 32089872 PMCID: PMC7013315 DOI: 10.1155/2020/8359398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 12/27/2019] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare the outcomes of trabeculectomy using two different routes of bevacizumab administration as an adjunct in patients with primary open angle glaucoma. Methods Prospective, randomized, masked trial that included 180 eyes of 180 patients of documented primary open angle glaucoma were eligible for surgery. Patients were randomized to receive either a single intraoperative dose of subconjunctival bevacizumab (1.25 mg, Group I) or topical bevacizumab (5 mg/ml) for 30 days (Group II). One eye was randomly selected, if both were eligible for surgery. All patients underwent a complete ocular and systemic examination. Bleb morphology was examined and scored as per Moorfields system (MBGS) at 1, 3, 6, 12, 18, and 24 months postoperatively. Visual field, fundus photography, and disc analysis were performed. Outcome measures (at one year) included (1) comparison of bleb morphology in both groups, (2) proportion of patients achieving surgical success, and (3) side effects of treatment. Results The groups did not differ with respect to age, sex, and crystalline lens status. Group II patients had significantly lower vascularity scores for central (P=0.042) and peripheral bleb areas (P=0.042) and peripheral bleb areas (P=0.042) and peripheral bleb areas (n = 88) patients achieved average vascular scores of less than 2.5 (P=0.042) and peripheral bleb areas (n = 88) patients achieved average vascular scores of less than 2.5 (vs. 94%; P=0.042) and peripheral bleb areas ( Conclusion Topical bevacizumab gives a better vascularity profile at one year, but the studied routes appear equally safe and do not seem to affect the outcome in any other way.
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Maheshwari D, Kanduri S, Kadar MA, Ramakrishnan R, Pillai MR. Midterm outcome of mitomycin C augmented trabeculectomy in open angle glaucoma versus angle closure glaucoma. Indian J Ophthalmol 2019; 67:1080-1084. [PMID: 31238416 PMCID: PMC6611248 DOI: 10.4103/ijo.ijo_1328_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The purpose of this study is to evaluate the efficacy and safety of Trabeculectomy with Mitomycin C in Open angle glaucoma versus Angle closure glaucoma. Methods The medical records of patients who underwent Trabeculectomy with Mitomycin C were reviewed and followed for three years, divided into two groups: group 1: Open Angle Glaucoma (n = 41) and group 2: Angle Closure Glaucoma (n = 67). Success criterion was measured as Intraocular Pressure ≤21 mmHg with (qualified) or without (complete) use of Antiglaucoma medications. Results A total number of 108 eyes of 137 patients were undertaken. Mean preoperative Intraocular pressure in group 1 was 31.4 ± 10.5 mmHg and in group 2 was 33.1 ± 9.4, which reduced to 10.5 ± 3.4, 10.5 ± 2.6, 11.6 ± 3.6, 11.0 ± 2.7, 11.0 ± 2.7 in group 1 and 10.9 ± 2.8, 12.0 ± 3.8, 12.8 ± 4.9, 12.4 ± 3.9, 12.4 ± 3.7 in group 2 with P value = 0.566, 0.032, 0.168, 0.049, 0.049 at three, six months, one, two, three years, respectively, with P < 0.001 at each visit. The number of Antiglaucoma medications was reduced from 0.75 ± 0.89 to 0.43 ± 0.55 at 3 yrs (P = 0.002). At 36 months follow-up, overall, 50.0% and 48.2% of eyes achieved complete and qualified success, respectively. Sub-group analysis showed that the success rate was higher in group 1 (68.3%) compared to group 2 (55.2%). Overall, complications such as hypotony (1.8%), choroidal detachment (2.8%), encapsulated bleb (2.8%), and bleb leakage (1.8%) were encountered. Conclusion Primary Trabeculectomy with Mitomycin C is a safe and effective means of controlling Intraocular Pressure in both groups with good success and low rates of sight-threatening complications.
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Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Swathi Kanduri
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohideen A Kadar
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Rengappa Ramakrishnan
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Madhavi R Pillai
- Department of Glaucoma, Aravind Eye Hospital and Post-Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Cheung CY, Li SL, Chan PP, Chan NCY, Tan S, Man X, Tham CC. Intraocular pressure control and visual field changes in primary angle closure disease: the CUHK PACG Longitudinal (CUPAL) study. Br J Ophthalmol 2019; 104:629-635. [PMID: 31391182 DOI: 10.1136/bjophthalmol-2019-314322] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/03/2019] [Accepted: 07/24/2019] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine the relationship of intraocular pressure (IOP) control with subsequent visual field (VF) deterioration in patients with primary angle closure disease (PACD). METHODS 419 PACD eyes from 240 Chinese patients were included. Mean IOP and IOP fluctuation were calculated as the average and SD divided by mean IOP, respectively, of all the IOP measured in the initial 18 months for assessment of IOP control. The relationship between IOP control and subsequent VF parameters over time was examined using linear mixed models. VF deterioration was defined as IOP control associated with decreased VF parameters over time with a p value <0.05. We calculated the average of the mean IOPs and IOP fluctuations in the cohort and used these two average values as a cut-off point to define high-threshold (≥average value) or low-threshold (<average value) for mean IOP and IOP fluctuation for each PACD eye, respectively. RESULTS Greater IOP fluctuation was significantly associated with VF deterioration, independent of mean IOP (mean deviation (MD) β=-6.36, p=0.03; VF index β=-16.41, p=0.04; and cataract-adjusted MD β=-6.96, p=0.02). In the categorical analysis, those with both high-threshold mean IOP and high-threshold IOP fluctuation had the most rapid VF deterioration, compared with eyes with low-threshold IOP fluctuation (p<0.05). Among eyes with high-threshold mean IOP, eyes with high-threshold IOP fluctuation had faster rate of VF deterioration compared with eyes with low-threshold IOP fluctuation (p=0.01). CONCLUSIONS IOP fluctuation was a significant and independent predictor for subsequent VF deterioration in eyes with PACD.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China
| | - Sophia L Li
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Poemen Pui Chan
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China.,Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China
| | - Noel C Y Chan
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Shaoying Tan
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China.,Ophthalmology, Chinese PLA General Hospital of Beijing Command Area, Beijing, China
| | - Xiaofei Man
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, Chinese University of Hong Kong Faculty of Medicine, Hong Kong, China .,Ophthalmology, Hong Kong Eye Hospital, Hong Kong, China
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Kumar M, Parveen S, Chauhan L. Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach. Ther Adv Ophthalmol 2019; 11:2515841419854829. [PMID: 31225428 PMCID: PMC6566477 DOI: 10.1177/2515841419854829] [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: 11/02/2018] [Accepted: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report outcome of trabeculectomy performed by single scleral suture in Indian eyes. Methods Non-randomized, non-masked, retrospective cohort analysis. Medical records of all consecutive patients who underwent trabeculectomy between 1 January 2011 and 31 December 2016 at CL Gupta Eye Institute, Moradabad (India), were reviewed and analyzed. Trabeculectomy was performed using single scleral suture for flap closure. The suture knot was buried inside sclera. The laser lysis of scleral suture was not done. Success was defined as complete success if an intraocular pressure (IOP) was >5 and ⩽21 mmHg without any glaucoma medications or re-surgery. Qualified success was defined as IOP ⩽21 mmHg with or without antiglaucoma medications. Results Data of 98 patients was analyzed. A total of 61 (62.2%) of them underwent trabeculectomy, and 37 (37.7%) underwent phacotrabeculectomy. The probability of complete success in patient underwent phacotrabeculectomy was 86% at 3 years, and in-patient underwent only trabeculectomy was 95% at 3 years. The probability of qualified success in patient undergone phacotrabeculectomy was 91% at 3 years, and in patient undergone only trabeculectomy was 97% at 3 years. Conclusion The mean postoperative IOP was significantly less then mean preoperative IOP, at all follow-up visits. This simplified technique also resulted in high midterm success probabilities with low complication rates.
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Affiliation(s)
- Mukesh Kumar
- Consultant Ophthalmologist, Department of Glaucoma, CL Gupta Eye Institute, Moradabad, India
| | - Shafia Parveen
- Department of Optometry and Visual Sciences, CL Gupta Eye Institute, Moradabad, India
| | - Lokesh Chauhan
- Department of Clinical Research, CL Gupta Eye Institute, Moradabad, India
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Chelerkar V, Parekh P, Kalyani VKS, Deshpande M, Khandekar R. Comparative Clinical Study of Medically Controlled Nonsevere Chronic Primary Angle-closure Glaucoma with Coexisting Cataract Surgically Managed by Phacoemulsification as against Combined Phacotrabeculectomy. Middle East Afr J Ophthalmol 2019; 25:119-125. [PMID: 30765948 PMCID: PMC6348945 DOI: 10.4103/meajo.meajo_204_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE: Comparative clinical study of medically controlled non-severe chronic Primary Angle Closure Glaucoma (PACG) with co-existing cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy. METHODS: This randomized clinical trial was conducted between December 2011 and December 2013. Patients were randomly assigned to Phacoemulsification (PE) and Phacotrabeculectomy (PT) groups for surgery. Intraocular pressure, anti-glaucoma medications, Best Corrected Visual Acuity, anterior chamber angle widening and post-operative complications in both groups were compared after 12 months. RESULTS: There were 46 eyes with PACG in PE group and 45 in PT group. The IOP at 12 months in PE group was 11.5±1.3mmHg and 11.8±1.2mmHg in PT gr. (p = 0.28). The eyes requiring single anti-glaucoma medications at 12months in PE group was 0, PT group was 1 (p = 0. 495). The post op BCVA at 12months in PE group 0.3+-0.12 and 0.33±0.15 in PT group (p = 0.22). 3 cases in PT group required additional intervention whereas no additional intervention was required in PE group and this difference was statistically significant (p = 0.116). CONCLUSION: Phacoemulsification is equally effective in terms of intraocular pressure control and visual outcome as phacotrabeculectomy with better safety and less post-operative complication.
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Affiliation(s)
- Vidya Chelerkar
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Puja Parekh
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - V K S Kalyani
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Hadapsar, Pune, Maharashtra, India
| | - Rajiv Khandekar
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Saikumar S, Anup M, Nair A, Mathew N. Coexistent cataract and glaucoma – Causes and management. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2019. [DOI: 10.4103/tjosr.tjosr_7_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Sihota R, Angmo D, Ramaswamy D, Dada T. Simplifying "target" intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian J Ophthalmol 2018; 66:495-505. [PMID: 29582808 PMCID: PMC5892050 DOI: 10.4103/ijo.ijo_1130_17] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/10/2018] [Indexed: 11/25/2022] Open
Abstract
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. "Target" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a "Target" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dewang Angmo
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Ramaswamy
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Sihota R, Midha N, Selvan H, Sidhu T, Swamy DR, Sharma A, Gupta A, Gupta V, Dada T, Chaudhary S. Prognosis of different glaucomas seen at a tertiary center: A 10-year overview. Indian J Ophthalmol 2017; 65:128-132. [PMID: 28345568 PMCID: PMC5381291 DOI: 10.4103/ijo.ijo_875_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aim: This study aims to determine treatment patterns, long-term intraocular pressure (IOP) and perimetric control in different glaucomas seen at a tertiary eye center. Settings and Design: Hospital-based, cross-sectional chart review of patients routinely following up at an outpatient glaucoma service. Methods: Patients with a follow-up of at least 10 years were evaluated. Their mean IOP, visual field (VF) status, and medications/surgery required at final assessment were noted. Statistical Analysis: Descriptive statistics (mean, standard deviation, and range) were used for all parameters. Results: A total of 230 patients met our inclusion and exclusion criteria, 79 having ocular hypertension with open angles or primary angle closure (PAC), 35 primary open angle glaucoma (POAG), 50 PAC glaucoma (PACG), 20 primary congenital glaucoma (PCG), 46 secondary glaucoma patients. Ocular hypertensives with open angles showed progression to POAG in 3.7%, those with PAC in 5.2%, at a mean IOP of 17.3 ± 3.37 mmHg and 17.13 ± 4.41 mmHg, respectively. A progression on Humphrey Field Analyzer was seen in 11% of POAG and PACG eyes at a mean IOP of 13.50 ± 5.07 and 13.09 ± 3.95 mmHg, respectively. Fifteen percent of primary congenital glaucomas (PCGs) showed a glaucomatous VF defect after 10 years. In secondary glaucoma eyes, the mean IOP at last follow-up visit was 12.38 ± 3.74 mmHg, with progression noted in 7.69% of eyes. Conclusion: This study provides evidence that routine delivery of care can provide well controlled IOP in glaucomas, both primary and secondary, and the VF stabilized in about 90% of patients over a period of 10 years, with the currently available glaucoma medications and trabeculectomy.
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Affiliation(s)
- Ramanjit Sihota
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Midha
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Harathy Selvan
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Talvir Sidhu
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa R Swamy
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Sharma
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amisha Gupta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viney Gupta
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chaudhary
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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15
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Baril C, Vianna JR, Shuba LM, Rafuse PE, Chauhan BC, Nicolela MT. Rates of glaucomatous visual field change after trabeculectomy. Br J Ophthalmol 2016; 101:874-878. [PMID: 27811280 DOI: 10.1136/bjophthalmol-2016-308948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/03/2016] [Accepted: 10/09/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Trabeculectomy is frequently performed in patients with glaucoma who are deteriorating, although its effects on rates of visual field (VF) progression are not fully understood. We studied the rate of VF progression post trabeculectomy comparing with medically treated patients matched for VF loss. METHODS Medical records of patients who underwent trabeculectomy alone or combined with cataract extraction were reviewed. Patients with 5 or more 24-2 VF examinations post trabeculectomy were selected. The rate of mean deviation (MD) change after surgery was calculated for each patient. These patients were pairwise matched based on baseline MD with patients with glaucoma who were treated medically and had at least 5 VF tests. RESULTS 180 surgical patients were identified and matched with 180 medically treated patients (baseline MD of -8.72 (5.24) dB and -8.71 (5.22) dB, respectively). Surgically and medically treated patients were followed for 7.4 (2.9) and 6.8 (3.1) years respectively. The MD slopes were -0.22 (0.55) dB/year and -0.08 (1.10) dB/year in the surgically and medically treated patients, respectively, and not statistically different (p=0.13, 95% CI -0.31 to 0.04). More patients in the surgical group had fast progression (rates worse than -1 dB/year) than in the medical group (17 and 7 patients, respectively, p=0.05). CONCLUSIONS Our findings suggest that most patients who undergo trabeculectomy demonstrate relatively slow rates of VF progression postoperatively, similar to patients treated medically, although some patients can continue to progress despite adequate surgical control of intraocular pressure.
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Affiliation(s)
- C Baril
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - J R Vianna
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - L M Shuba
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - P E Rafuse
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B C Chauhan
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - M T Nicolela
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
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Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study. Eye (Lond) 2016; 30:1126-34. [PMID: 27256305 DOI: 10.1038/eye.2016.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/20/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeWe aimed to assess the IOP-lowering effect of trabeculectomy with ologen in refractory secondary glaucoma following failed trabeculectomy with mitomycin C (MMC), and to compare its surgical outcome between open angle (SOAG) and angle closure (SACG) cases.MethodsThis is a prospective interventional comparative study conducted on 40 eyes (40 patients) with medically uncontrolled secondary glaucoma. Patients were divided into group A: 18 eyes (18 patients) with SOAG, and group B: 22 eyes (22 patients) with SACG. All patients underwent trabeculectomy with insertion of ologen implant. Intraocular pressure (IOP) measurement, SITA standard perimetry (Central 24-2), spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness, and anterior segment OCT for bleb morphology, were all done pre- and postoperatively. Primary outcome measures were comparing preoperative to postoperative measurements and also comparing these measurements between SOAG and SACG. All patients were examined up to 1 year.ResultsWhen preoperative IOP was compared with postoperative IOP, in each group, there was a statistically significant difference (P<0.001). IOP percentage difference was statistically insignificantly different between both groups except at 1 month. According to Moorfields bleb grading system; postoperative bleb was better than the bleb of the previously failed trabeculectomy (P<0.001), and there was a significant difference between group A and B regarding bleb area. Total success rate was 100%; in group A, complete success was 100%, while in group B it was 72.7% (P=0.016).ConclusionOur results suggest that Ologen may be a useful alternative to MMC in repeat trabeculectomy.
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17
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Baig N, Kam KW, Tham CCY. Managing Primary Angle Closure Glaucoma - The Role of Lens Extraction in this Era. Open Ophthalmol J 2016; 10:86-93. [PMID: 27014390 PMCID: PMC4780513 DOI: 10.2174/1874364101610010086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be higher than lens extraction alone.
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Affiliation(s)
- Nafees Baig
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China
| | - Ka-Wai Kam
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
| | - Clement C Y Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China; Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, People's Republic of China
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18
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Abstract
Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.
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Affiliation(s)
- Jimmy Lai
- From the Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
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19
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Caprioli J, de Leon JM, Azarbod P, Chen A, Morales E, Nouri-Mahdavi K, Coleman A, Yu F, Afifi A. Trabeculectomy Can Improve Long-Term Visual Function in Glaucoma. Ophthalmology 2016; 123:117-28. [DOI: 10.1016/j.ophtha.2015.09.027] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/17/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022] Open
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21
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Biodegradable 3D-Porous Collagen Matrix (Ologen) Compared with Mitomycin C for Treatment of Primary Open-Angle Glaucoma: Results at 5 Years. J Ophthalmol 2015; 2015:637537. [PMID: 26078875 PMCID: PMC4452460 DOI: 10.1155/2015/637537] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/07/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To evaluate the effectiveness and safety of the Ologen as an aid for trabeculectomy performed for primary open-angle glaucoma compared with mitomycin C. Methods. In this prospective, randomized, parallel assignment, comparative study, 31 eyes of 21 primary open-angle glaucoma patients were allocated for trabeculectomy with the Ologen implant; another 32 eyes of 23 patients were treated with trabeculectomy augmented with mitomycin C. The patients were followed up for 5 years and evaluated for intraocular pressure, rate of success, status of the bleb, and adverse events. Result. The mean postoperative intraocular pressure was statistically different at 3 m, 6 m, 1 y, 3 y, and 5 y follow-up. The rates of both complete success (P = 0.017) and overall success (P = 0.031) in the Ologen group were significantly higher than those in the mitomycin C group. The difference of the bleb extent and vascularity was statistically significant in both groups. There was no significant difference in postoperative complication. Conclusions. Ologen provides higher rates of surgical success compared with mitomycin C for patients with primary open-angle glaucoma undergoing trabeculectomy. It may be a new, safe, simple, and effective therapeutic approach for treating primary open-angle glaucoma.
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Evaluating the long-term efficacy of short-duration 0.1 mg/ml and 0.2 mg/ml MMC in primary trabeculectomy for primary adult glaucoma. Graefes Arch Clin Exp Ophthalmol 2015; 253:1153-9. [PMID: 25940554 DOI: 10.1007/s00417-015-3028-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/20/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To evaluate safety and efficacy of 0.1 mg/ml versus 0.2 mg/ml mitomycin-C (MMC), applied for 1 min subconjunctivally, during trabeculectomy for primary adult glaucoma in previously un-operated eyes. MATERIALS AND METHODS This is a randomised controlled, non-inferior, clinical trial consisting of 50 consecutive POAG or CPACG patients uncontrolled on maximal hypotensive therapy, meeting all inclusion criteria. Patients were randomized into two groups and underwent a standard limbus-based trabeculectomy with MMC: Group I, 0.1 mg/ml and Group II, 0.2 mg/ml. The pre-operative and post-operative intraocular pressure (IOP), bleb morphology, and visual acuity were recorded every 6 months for 2 years. Complete success (primary outcome) was defined as IOP ≤ 15 mmHg without any additional medications at the end of 2 years. RESULTS The average age of patients was 62.6 ± 9.8 years and 61.2 ± 8.1 years in Group 1 and 2, respectively; p = 0.57. The mean preoperative IOP was 22.5 ± 1.4 mmHg and 23.3 ± 1.8 mmHg; p = 0.10. The mean IOP at 2 years was 11.1 ± 1.6 mmHg and 10.8 ± 2.8 mmHg, a mean reduction in IOP of 50.6 ± 1.23 %, and 53.7 ± 2.25 % in Group I and II, respectively. The complete success was 92.0 % and 91.7 % in the two groups, respectively (p = 0.99), and there was one failure (Group II, post trauma). A wider bleb extent and larger areas of thin, transparent conjunctiva over the bleb were seen with the 0.2 mg/ml MMC group (p < 0.001) and in PACG eyes; p < 0.04. CONCLUSION A 1-min subconjunctival application of low dose 0.1 mg/ml MMC is non-inferior to 0.2 mg/ml and is probably a safer alternative, as thinning of the bleb is significantly less frequent in the long term.
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Bussel II, Kaplowitz K, Schuman JS, Loewen NA. Outcomes of ab interno trabeculectomy with the trabectome by degree of angle opening. Br J Ophthalmol 2014; 99:914-9. [PMID: 25336577 PMCID: PMC4501175 DOI: 10.1136/bjophthalmol-2014-305577] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/21/2014] [Indexed: 11/12/2022]
Abstract
Aim To analyse ab interno trabeculectomy (AIT) with the trabectome and combined phacoemulsification with AIT (phaco-AIT) by Shaffer angle grade (SG). Methods Prospective study of AIT and phaco-AIT with narrow angles of SG≤2 versus open angles ≥3. Outcomes included intraocular pressure (IOP), medications, complications, secondary surgery and success (IOP <21 mm Hg and >20% reduction without further surgery). Exclusion criteria were missing preoperative data and <1 year follow-up. Results Of 671 included cases, at 1 year AIT SG≤2 (n=43) had an IOP reduction of 42% from 27.3±7.4 to 15.7±3.0 mm Hg (p<0.01) versus AIT SG≥3 (n=271) with an IOP reduction of 37% from 26.1±7.8 to 16.4±3.9 mm Hg (p<0.01). In phaco-AIT with SG≤2 (n=48), IOP was reduced 24% from 20.7±7.0 to 15.7±3.6 mm Hg (p<0.01) versus phaco-AIT with SG≥3 (n=309) with an IOP reduction of 25% from 22.6±6.4 to 17.0±3.4 mm Hg (p<0.01). There was no difference between SG≤2 and SG≥3 in reduction of IOP or medications, complications, secondary surgery and success rates (p>0.05). Conclusions SG≤2 is not associated with worse outcomes in AIT or phaco-AIT.
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Affiliation(s)
- I I Bussel
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - K Kaplowitz
- Department of Ophthalmology, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - J S Schuman
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - N A Loewen
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Early efficacy and complications of releasable sutures for trabeculectomy in primary angle-closure glaucoma: a randomized clinical trial. J Glaucoma 2014; 23:136-41. [PMID: 23059481 DOI: 10.1097/ijg.0b013e31826981c9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the postoperative intraocular pressure (IOP) and incidence of early complications after trabeculectomy with releasable suture to standard trabeculectomy in Chinese patients with primary angle-closure glaucoma. PATIENTS AND METHODS One hundred seventy-five patients diagnosed as primary angle-closure glaucoma with 6 clock-hours or more of peripheral anterior synechia were randomly allocated to 2 treatment groups: 87 underwent standard trabeculectomy (S group: 2 interrupted permanent sutures to the scleral flap) and 88 received trabeculectomy with 2 permanent and 2 releasable sutures (R group). The postoperative IOP and complications during the first 3 months after surgery were compared. RESULTS One hundred seventy-one patients (97.7%) attended the 3-month visit. The IOP in the first week after trabeculectomy was significantly higher in the R group: day 1, 17.3±8.6 versus 12.7±6.0 mm Hg (P<0.001); day 3, 18.0±7.3 versus 12.9±6.3 mm Hg (P<0.001); day 7, 14.8±6.3 versus 12.0±4.9 mm Hg (P=0.001), but no difference was observed after the second week (P=0.659 to 0.753). The incidence of transient hypotony was higher in S group (20.4%) than the R group (9.1%) (P=0.046); hypotony recovered in 80.8% (21/26) within 1 week. There was no difference in the occurrence of shallow chamber, choroidal detachment, macular edema, additional surgery, or hyphema (P=0.56 to 1.0). CONCLUSIONS The technique of releasable sutures for trabeculectomy used in this study did not demonstrate significant advantages over standard trabeculectomy. Releasable sutures were associated with some decrease in visual acuity and increase in postoperative complaints.
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25
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Bertrand V, Fieuws S, Stalmans I, Zeyen T. Rates of visual field loss before and after trabeculectomy. Acta Ophthalmol 2014; 92:116-20. [PMID: 23551517 DOI: 10.1111/aos.12073] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the rates of change in the visual field (VF) in patients with glaucoma before and after trabeculectomy. METHODS Of 52 eyes of 52 patients with different types of chronic glaucoma who underwent first trabeculectomy were evaluated retrospectively. Pre- and postoperative-automated visual fields measured by the same technique were compared to detect differences in rates of change. Rates of VF loss before and after trabeculectomy were calculated using mean deviation (MD). Linear mixed models were used to compare the rates of change in the VF before and after trabeculectomy. RESULTS The mean follow-up period pre- and post-trabeculectomy was 3.9 years (min 0.9, max 10.7) and 3.8 years (min 2.0, max 8.0), respectively. The intraocular pressure (IOP) decreased from 18.1 mmHg (SD = 4.7) before trabeculectomy to 11.1 mmHg (SD = 2.9) at the last follow-up after trabeculectomy. The rate of MD loss was reduced with 56% on average, from -0.36 dB/year before surgery to -0.16 dB/year after surgery (p = 0.15). CONCLUSION Trabeculectomy considerably decreased the rates of change in the glaucomatous visual field.
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Affiliation(s)
- Valérie Bertrand
- Department of Ophthalmology, University Hospitals Leuven, Leuven, BelgiumInteruniversity Center for Biostatistics and Statistical Bioinformatics, Catholic University of Leuven and University of Hasselt, Leuven, Belgium
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Senthil S, Rao HL, Babu JG, Mandal AK, Garudadri CS. Comparison of outcomes of trabeculectomy with mitomycin C vs. ologen implant in primary glaucoma. Indian J Ophthalmol 2014; 61:338-42. [PMID: 23571259 PMCID: PMC3759104 DOI: 10.4103/0301-4738.109520] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: To compare the safety and efficacy of trabeculectomy with Ologen implant vs. trabeculectomy with Mitomycin C (MMC). Materials and Methods: In a prospective, randomized, pilot study, 39 eyes of 33 subjects with medically uncontrolled primary glaucoma, aged 18 years or above underwent trabeculectomy either with MMC (20 eyes) or with Ologen implant (19 eyes). The primary outcome measure was cumulative success probability, defined as complete if the intraocular pressure (IOP) was > 5 and ≤ 21 mm Hg without anti-glaucoma medications or additional surgery and qualified if an IOP was > 5 and ≤ 21 mm Hg with or without anti-glaucoma medications. Results: Mean (± standard deviation) follow-up in Ologen group was 19.1 ± 8.1 months, and in MMC group was 18.0 ± 8.4 months. Mean IOP reduction at 6 months was significantly lower (P = 0.01) in the MMC group (11.9 ± 2.9 mm Hg) as compared to Ologen group (14.6 ± 2.7 mm Hg). However, at 12 months (P = 0.81) and 24 months (P = 0.32), the mean IOP was similar between the 2 groups. Complete success probability at the end of 6 months in Ologen group was 100% (95% confidence interval: 59.1 - 99.0) was similar (P = 0.53) to that in MMC group (93.8%, 95% CI: 63.2 - 99.1). The incidences of early post-operative complications were similar in the 2 groups, except hyphema, which was significantly more in Ologen group (P = 0.02). Conclusion: In this pilot study, the success of trabeculectomy and complications were similar in both Ologen and MMC groups at the end of 6 months.
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Affiliation(s)
- Sirisha Senthil
- VST Glaucoma Center, L.V Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, India
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The Singapore 5-Fluorouracil Trial. Ophthalmology 2013; 120:1127-34. [DOI: 10.1016/j.ophtha.2012.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 11/23/2012] [Accepted: 12/04/2012] [Indexed: 11/18/2022] Open
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Rong SS, Feng MY, Wang N, Meng H, Thomas R, Fan S, Wang R, Wang X, Tang X, Liang YB. Can early postoperative intraocular pressure predict success following mitomycin-C augmented trabeculectomy in primary angle-closure glaucoma. Eye (Lond) 2013; 27:403-9. [PMID: 23306726 DOI: 10.1038/eye.2012.291] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the association between early and late postoperative intraocular pressure (IOP) and determine if early postoperative IOP can predict the surgical outcome. METHODS A total of 165 consecutive patients with primary angle-closure glaucoma (PACG) undergoing primary mitomycin-C-augmented trabeculectomy underwent a comprehensive eye examination before surgery and were followed-up on days 1, 7, 14, and 30, and months 3, 6, 12, and 18. IOPs on days 1, 7, 14, and 30 were stratified into groups A (<10 mm Hg), B (≥10 and <15 mm Hg), C (≥15 and <20 mm Hg), and D (≥20 mm Hg). Differences between groups were analyzed using analysis of variance (ANOVA) and Fisher's exact test. Multivariable regression was used to exam the predictive ability of early IOP for final outcome. RESULTS The mean age was 62.5±7.9 years and 41.21% (n=68) were males. Stratified by IOP on days 1, 7, 14, and 30, respectively, mean IOPs at month 18 were different among groups A, B, C, and D (ANOVA, P=0.047, P=0.033, P=0.008, and P<0.001, respectively). Once the IOPs were settled with interventions on day 7 a higher IOP level was associated with decreasing success rate under different outcome definitions, final IOP <15 mm Hg (Fisher's exact P=0.001) and <20 mm Hg (P=0.039) without medication. Multiple regression showed early IOP predicted final IOP independently from baseline variables. A cutoff value of 13.5 mm Hg on day 7 achieved an accuracy of 80.0 and 57.1% in predicting IOP<15 mm Hg without medication and failure after surgery, respectively. CONCLUSIONS The IOP at 18 months following primary antifibrotic-augmented trabeculectomy in PACG patients is associated with and predicted by the postoperative IOPs at 1 month. Control of early IOP to 13.5 or less may provide better outcomes.
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Affiliation(s)
- S S Rong
- Tongren Eye Center, Beijing, China
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Congdon NG, Krishnadas R, Friedman DS, Goggins W, Ramakrishnan R, Kader MA, Gilbert D, Tielsch J, Quigley HA. A study of initial therapy for glaucoma in southern India: India Glaucoma Outcomes and Treatment (INGOT) Study. Ophthalmic Epidemiol 2012; 19:149-58. [PMID: 22568428 DOI: 10.3109/09286586.2012.667493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare initial glaucoma therapy with medications and trabeculectomy in southern India. METHODS Patients aged ≥ 30 years newly diagnosed with glaucoma were randomized to trabeculectomy with 5-fluorouracil or medical therapy. Subjects with best-corrected vision <6/18 due to cataract underwent phacoemulsification (phaco/intraocular lens, IOL). Intraocular pressure (IOP), vision and visual function were assessed at 12 months. RESULTS Patients assigned to medications and surgery received the expected therapy in 86% (172/199) and 64% (126/199) of cases, respectively. Forty patients (20%) assigned to surgery refused any treatment and 33 (17%) received medications. Among 199 patients randomized to medications, 52 (26.1%) underwent phaco/IOL, as did 89/199 (43.7%) of patients randomized to trabeculectomy. Baseline parameters of the two groups did not differ, nor did 1-year follow-up rates (medication 65%, trabeculectomy 58%, P = 0.15). Final IOP was lower with randomization to trabeculectomy (16.3 ± 5.1 mmHg) than medication (18.8 ± 6.7 mmHg, P < 0.0001). In regression models, randomization to trabeculectomy (P < 0.0001) was associated with lower IOP, and simultaneous trabeculectomy and cataract surgery was associated with higher IOP (P = 0.008) than trabeculectomy alone. Subjects receiving Phaco/IOL had significantly better final acuity (P < 0.0001) and visual function (P = 0.035), despite concurrent glaucoma treatment. Final visual acuity was worse in those receiving trabeculectomy in addition to cataract surgery, but this was of borderline significance (P = 0.06). CONCLUSIONS Trabeculectomy lowered IOP significantly more than medical treatment, but with slightly greater loss of visual acuity. Combined phaco/IOL and trabeculectomy improved visual acuity with substantial IOP lowering.
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Affiliation(s)
- Nathan G Congdon
- Zhongshan Ophthalmic Center, State Key Laboratory and Division of Preventive Ophthalmology, Sun Yat Sen University, Guangzhou, PRC.
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Kayikcioglu OR, Emre S, Kaya Z. Trabeculectomy combined with deep sclerectomy and scleral flap suture tension adjustment under an anterior chamber maintainer: a new modification of trabeculectomy. Int Ophthalmol 2009; 30:271-7. [PMID: 19960232 DOI: 10.1007/s10792-009-9326-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 11/17/2009] [Indexed: 11/28/2022]
Abstract
The objective of this study was to investigate the efficacy and safety of trabeculectomy combined with deep sclerectomy in patients with primary open angled glaucoma (POAG) and to compare the results with those from conventional trabeculectomy. In the study 12 eyes of 10 patients operated with trabeculectomy combined with deep sclerectomy (Group I) and 16 eyes of 16 patients operated with conventional trabeculectomy surgery (Group II) were included. In the described form of combined deep sclerectomy with the trabeculectomy technique the superficial scleral flap was sutured with 10/0 monofilament, the number and tension of sutures were adjusted according to the outflow dynamics, under the scleral flap, of balanced salt solution (BSS) provided by an anterior chamber maintainer. In groups I and II all the patients were male POAG cases with mean ages of 60.0 +/- 19.4 and 67.0 +/- 7.1 years, respectively. The mean follow-up periods were 8.3 +/- 3.5 months for group I and 16.6 +/- 7.0 months for group II. Preoperative mean IOP were 29.7 +/- 8.3 and 29.1 +/- 12.8 mmHg mmHg, and average topical antiglaucomatous medications were 2.9 +/- 0.7 and 2.7 +/- 1.1 for groups I and II, respectively. Postoperatively mean IOP measurements were reduced in groups I and II to 10.5 +/- 2.9 vs. 9.6 +/- 4.8 mmHg at 1 week, 13.7 +/- 5.6 vs. 16.0 +/- 9.8 at 1st month, 12.3 +/- 6.4 vs. 17.3 +/- 8.0 at 3rd month, 11.0 +/- 4.1 vs. 15.3 +/- 5.8 at 6th month, 10.8 +/- 1.6 vs. 16.1 +/- 4.4 at 12th month, and 11.0 +/- 1.0 vs. 16.7 +/- 5.0 at 18th month. Statistical analysis revealed that mean postoperative IOP measurements for group I were significantly lower than for group II for all measurements except the first week (P < 0.05). At 12th month, the complete (IOP <22 mmHg without medication) and qualified (IOP <22 mmHg with medication) success rates were 83.3 and 100% for group I and 63.6 and 90.9% for group II. Postoperatively at 12th month, the mean number of antiglaucoma medications had fallen to 0.0 +/- 0.0 in group I and 0.81 +/- 1.1 in group II. Trabeculectomy surgery combined with deep sclerectomy and suture adjustment under an anterior chamber maintainer provided sufficient IOP decrease and diffuse bleb morphology. This technique could be used as a safe method for management of glaucoma.
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Affiliation(s)
- Ozcan R Kayikcioglu
- Department of Ophthalmology, School of Medicine, Celal Bayar University, 45010, Manisa, Turkey
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Moving the goal posts definitions of success after glaucoma surgery and their effect on reported outcome. Ophthalmology 2009; 117:18-23.e3. [PMID: 19896196 DOI: 10.1016/j.ophtha.2009.06.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 06/04/2009] [Accepted: 06/09/2009] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine (1) the extent to which the definition of success of glaucoma surgery varies in the literature and (2) the degree to which the reported outcome after trabeculectomy is affected by the criteria used to define success. DESIGN A systematic review of the literature and application of definitions to a retrospective cohort. PARTICIPANTS A cohort of 100 patients who previously underwent trabeculectomy. METHODS A literature search was performed of PubMed using the search term trabeculectomy for a 5-year period. Studies presenting original data relating to longitudinal intraocular pressure (IOP) control after glaucoma surgery were included. The definitions of success and failure used were documented for each publication. Each IOP-related definition of success was applied to a cohort of patients who previously underwent trabeculectomy. Success rates were derived for each published definition up to 36 months after surgery. MAIN OUTCOME MEASURES Intraocular pressure measured by Goldmann applanation tonometry. RESULTS From 100 publications meeting the inclusion criteria, 92 distinct IOP-related definitions of success were identified. Using these definitions, success rates for this series of 100 trabeculectomies varied between 36.0% and 98.0% after 3 years of follow-up. CONCLUSIONS Over a recent 5-year period, there were nearly as many different definitions of success after glaucoma surgery as publications on the subject. The definition used markedly affects the quoted success rate after trabeculectomy, making interpretation of and comparison between published results extremely difficult. Standardization of published outcome parameters after glaucoma surgery is essential to allow meaningful comparisons between different study reports. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Sharmini ATL, Yin NYS, Lee SSH, Jackson AL, Stewart WC. Mean target intraocular pressure and progression rates in chronic angle-closure glaucoma. J Ocul Pharmacol Ther 2009; 25:71-5. [PMID: 19232007 DOI: 10.1089/jop.2008.0061] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate risk factors for progression in chronic angle-closure glaucoma (CACG) patients. METHODS A retrospective cohort of patient records in East Asia were evaluated for risk factors associated with progressive optic-disc and visual-field loss. There were 101 CACG patients with 5 years of follow-up. RESULTS Seventy-one percent (71%) of patients with intraocular pressures (IOP) of >22 mmHg progressed, whereas 26% of patients with IOPs of 13-21 mmHg progressed, and 0% of patients with IOPs of <12 mmHg progressed. The mean IOP was 16.6 +/- 3.4 mmHg in the stable group and 18.8 +/- 3.5 mmHg in the progressed group (P = 0.007). The highest average peak IOP was 23.2 +/- 6.3 mmHg in the stable group and 26.5 +/- 6.5 mmHg in the progressed group (P = 0.03). Generally, patients whose standard deviation of IOP was <2 mmHg (12% progressed) were more often stable, compared to those who were >3 mmHg (33% progressed). A multivariate regression analysis was positive for mean IOP as a clinically important risk factor for progression. CONCLUSIONS IOP reduction in CACG patients may help prevent progressive visual-field and optic-disc damage.
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Mattox C. Trabeculectomy. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Physiology of vitreous surgery. Graefes Arch Clin Exp Ophthalmol 2008; 247:147-63. [PMID: 19034481 DOI: 10.1007/s00417-008-0980-7] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 10/06/2008] [Indexed: 12/11/2022] Open
Abstract
Vitreous surgery has various physiological and clinical consequences, both beneficial and harmful. Vitrectomy reduces the risk of retinal neovascularization, while increasing the risk of iris neovascularization, reduces macular edema and stimulates cataract formation. These clinical consequences may be understood with the help of classical laws of physics and physiology. The laws of Fick, Stokes-Einstein and Hagen-Poiseuille state that molecular transport by diffusion or convection is inversely related to the viscosity of the medium. When the vitreous gel is replaced with less viscous saline, the transport of all molecules, including oxygen and cytokines, is facilitated. Oxygen transport to ischemic retinal areas is improved, as is clearance of VEGF and other cytokines from these areas, thus reducing edema and neovascularization. At the same time, oxygen is transported faster down a concentration gradient from the anterior to the posterior segment, while VEGF moves in the opposite direction, making the anterior segment less oxygenated and with more VEGF, stimulating iris neovascularization. Silicone oil is the exception that proves the rule: it is more viscous than vitreous humour, re-establishes the transport barrier to oxygen and VEGF, and reduces the risk for iris neovascularization in the vitrectomized-lentectomized eye. Modern vitreous surgery involves a variety of treatment options in addition to vitrectomy itself, such as photocoagulation, anti-VEGF drugs, intravitreal steroids and release of vitreoretinal traction. A full understanding of these treatment modalities allows sensible combination of treatment options. Retinal photocoagulation has repeatedly been shown to improve retinal oxygenation, as does vitrectomy. Oxygen naturally reduces VEGF production and improves retinal hemodynamics. The VEGF-lowering effect of photocoagulation and vitrectomy can be augmented with anti-VEGF drugs and the permeability effect of VEGF reduced with corticosteroids. Starling's law explains vasogenic edema, which is controlled by osmotic and hydrostatic gradients between vessel and tissue. It explains the effect of VEGF-induced vascular permeability changes on plasma protein leakage and the osmotic gradient between vessel and tissue. At the same time, it takes into account hemodynamic changes that affect the hydrostatic gradient. This includes the influence of arterial blood pressure, and the effect oxygen (laser treatment) has in constricting retinal arterioles, increasing their resistance, and thus reducing the hydrostatic pressure in the microcirculation. Reduced capillary hydrostatic pressure and increased osmotic gradient reduce water fluxes from vessel to tissue and reduce edema. Finally, Newton's third law explains that vitreoretinal traction decreases hydrostatic tissue pressure in the retina, increases the pressure gradient between vessel and tissue, and stimulates water fluxes from vessel into tissue, leading to edema.
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Deokule SP, Molteno ACB, Bevin TH, Herbison P. Long-term results of Molteno implant insertion in cases of chronic angle closure glaucoma. Clin Exp Ophthalmol 2007; 35:514-9. [PMID: 17760632 DOI: 10.1111/j.1442-9071.2007.01530.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was undertaken to provide data on the long-term results of cases of chronic angle closure glaucoma with additional risk factors treated by Molteno implants between 1985 and 2004 at Dunedin Hospital, New Zealand. METHODS A prospective non-comparative case series followed 21 eyes (17 patients) for a mean of 5.7 years (range 1.3-16.3 years) in terms of intraocular pressure, visual acuity and subsequent procedures. RESULTS Insertion of a Molteno implant has controlled the intraocular pressure at 21 mmHg or less in 100% of cases at 5 years after surgery, the probability of control being 0.95 (95% CI 0.91-0.99). The mean number of hypotensive medications reduced from 2.04 (SD 0.92) preoperatively to 1.40, 0.64 and 0.66 at 1, 2 and 5 years, respectively. The mean visual acuity improved from 6/18 preoperatively to 6/12 at 1 year and declined to 6/13.5 at 2 and 5 years. CONCLUSION Insertion of Molteno implants was a safe and effective procedure in the management of complex cases of chronic angle closure glaucoma.
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Hong S, Park K, Ha SJ, Yeom HY, Seong GJ, Hong YJ. Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma. Ophthalmologica 2007; 221:395-401. [DOI: 10.1159/000107499] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Accepted: 12/04/2006] [Indexed: 12/11/2022]
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Post-operative complication of trabeculectomy in Ibadan, Nigeria: outcome of 1-year follow-up. Eye (Lond) 2007; 23:448-52. [PMID: 17932507 DOI: 10.1038/sj.eye.6702979] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To describe the post-operative complications reported in patients who had trabeculectomy with and without antimetabolite in UCH, Ibadan between 1999 and 2003 and the success rate achieved in term of the post-operative intraocular pressure (IOP). METHODS A retrospective study of the records of glaucoma patients who had trabeculectomy between 1999 and 2003 and had follow-up in UCH Ibadan eye clinic for a minimum of 1 year was carried out. RESULTS Seventy-six out of 171 eyes that had trabeculectomy during the period were reviewed. Mean age of patients was 49.4 years. The mean preoperative IOP was 31.8 mm Hg. Success rate of 79.4% was achieved in term of IOP control at a year of follow-up. The most frequent early post-operative complication was shallow AC (13 eyes; 17.1%) while late complication was elevated IOP (21 eyes; 27.6%). Others were encapsulated bleb 7.9% and hyphema 3.9%. There was no significant difference in the complication rate in those who had intraoperative antimetabolite (5-fluorouracil) when compared with those operated without antimetabolite. CONCLUSION Guarded filtration surgery is effective in controlling IOP. Most of the complications noted were transient and not visually threatening.
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Tham CCY, Kwong YYY, Lai JSM, Lam DSC, Ritch R. Surgical management of chronic angle-closure glaucoma. EXPERT REVIEW OF OPHTHALMOLOGY 2007. [DOI: 10.1586/17469899.2.2.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Anand A, Negi S, Khokhar S, Kumar H, Gupta SK, Murthy GVS, Sharma TK. Role of early trabeculectomy in primary open-angle glaucoma in the developing world. Eye (Lond) 2005; 21:40-5. [PMID: 16200053 DOI: 10.1038/sj.eye.6702114] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients. METHODS A total of 60 patients with moderately advanced POAG were randomised into three groups (Group I-Conventional medical management, Group II-Option for early trabeculectomy, Group III-Received an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction. RESULTS The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (P<0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction. CONCLUSION There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.
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Affiliation(s)
- A Anand
- Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi 110029, India.
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Abstract
PURPOSE OF REVIEW Trabeculectomy is an effective operation for lowering intraocular pressure. However, success is limited by complications such as infection, hypotony, and scarring. RECENT FINDINGS These complications, which are increased by antifibrotic use, can be reduced with attention to surgical technique. We highlight the benefit of sub-Tenon anaesthesia, careful choice of the surgical site, fashioning of the scleral flap to produce diffuse aqueous flow, and better intraocular pressure control, maintenance of intraocular pressure, a formed anterior chamber, with outflow control during surgery using an infusion, optimal method of antimetabolites application, new adjustable sutures, and corneal-conjunctival closure techniques. SUMMARY These techniques reduce hypotony, producing a diffuse noncystic bleb with long-term pressure control.
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Affiliation(s)
- Emma Jones
- ORB (Ocular Repair and Regeneration Biology), Divisions of Pathology and Glaucoma, Institute of Ophthalmology and Moorfields Eye Hospital, London, UK
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Walland MJ. Whither the blade? Clin Exp Ophthalmol 2004; 32:1-2. [PMID: 14746580 DOI: 10.1046/j.1442-9071.2003.00777.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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