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Tan JCK, Hashimoto Y, Gabrielle PH, Garcher CC, White A, Dunn H, Walland M, Wechsler D, Arnould L, Lawlor M. Outcomes and Baseline Predictors of Failure in Primary Standalone Xen45 Gel Stent versus Trabeculectomy for Glaucoma. Ophthalmol Glaucoma 2024:S2589-4196(24)00132-7. [PMID: 39004222 DOI: 10.1016/j.ogla.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE To compare safety, effectiveness, and baseline predictors of failure in standalone primary Xen45 gel stent (Xen) versus trabeculectomy (Trab) in glaucoma. DESIGN Retrospective study. SUBJECTS Subjects that underwent primary Xen or Trab augmented by mitomycin-C with at least 12 months follow-up. METHODS Multinational observational study of eyes in the Fight Glaucoma Blindness international registry MAIN OUTCOME MEASURES: The primary outcome was success at 12 months defined by intraocular pressure (IOP) reduction ≥ 20% from baseline and ≤ threshold IOPs of 15, 18, and 21 mmHg with (qualified) or without (complete) medications and without secondary glaucoma surgery. Multivariable mixed effects Cox regression models were used to identify risk factors for failure in each cohort. RESULTS A total of 701 eyes (Xen, 308; Trab, 393) of 596 subjects were included with baseline IOP being significantly higher (22.4 vs. 19.9 mmHg, P < 0.001) and baseline medications significantly lower in the Xen versus the Trab group (2.9 vs. 3.4, P < 0.001). Baseline visual field mean deviation was less severe in the Xen group (-9.47 vs. -13.04 dB, P < 0.001). The proportion of complete surgical success was significantly lower in the Xen versus Trab group across the 3 upper IOP limits at 12 months; 32% versus 52% at 15 mmHg, 37% versus 54% at 18 mmHg, and 39% versus 55% at 21 mmHg (P < 0.001). The incidence of postoperative numerical and symptomatic hypotony was lower in the Xen versus Trab group. In the Xen cohort, a higher failure rate was associated with Asian ethnicity (hazard ratio [HR], 1.97; 95% confidence interval (CI), 1.03-3.79) and use of oral acetazolamide at baseline (HR, 1.74; 95% CI, 1.13-2.70), whereas a lower failure rate was associated with diagnosis of ocular hypertension/open-angle glaucoma suspect (HR, 0.40; 95% CI, 0.20-0.82) and secondary open-angle glaucoma (HR, 0.46; 95% CI, 0.26-0.82). Exposure to prostaglandin analog was associated with greater failure in the Trab group (HR, 2.66; 95% CI, 1.18-6.01). CONCLUSIONS There was significantly greater complete success at 12 months across all complete success definitions for Trab compared with Xen, whereas the rate of postoperative hypotony was significantly lower in the Xen group. Asian ethnicity and use of oral acetazolamide at baseline were associated with greater failure in Xen, whereas exposure to prostaglandin analog was associated with greater failure in Trab patients. Such baseline predictors of success and failure may help guide patient selection for subconjunctival minimally invasive glaucoma surgery in patients undergoing surgical intervention. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jeremy C K Tan
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
| | - Yohei Hashimoto
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | | | - Andrew White
- Centre for Vision Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
| | - Hamish Dunn
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Walland
- Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - David Wechsler
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France; Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), Equipe d'Accueil 7460, Faculty of Health Sciences, Université de Bourgogne Franche-Comté, Dijon, France
| | - Mitchell Lawlor
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
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Mitchell W, Yang SA, Ondeck C, Stewart I, Zhao Y, Roldan AM, Halawa O, Hall N, Elze T, Miller J, Lorch A, Zebardast N. Effectiveness of Angle-Based Minimally Invasive Glaucoma Surgery after Laser Trabeculoplasty: An Analysis of the IRIS® Registry (Intelligent Research in Sight). Ophthalmol Glaucoma 2024; 7:335-344. [PMID: 38519027 DOI: 10.1016/j.ogla.2024.03.003] [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: 11/20/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Angle-based minimally invasive glaucoma surgery (ab-MIGS) has grown substantially, although long-term efficacy is poorly understood. We analyze ab-MIGS effectiveness with and without preceding laser trabeculoplasty (LTP). DESIGN Retrospective cohort study. SUBJECTS Eyes undergoing ab-MIGS (Canaloplasty, Goniotomy, Trabectome, and iStent) with and without prior laser trabeculoplasty (< 2 years preceding MIGS) were identified in the IRIS® Registry (Intelligent Research in Sight) 2013 to 2018. METHODS Propensity score matching (PSM) was undertaken to define the following 4 cohorts: (1) standalone ab-MIGS, no prior LTP vs. (2) standalone ab-MIGS, with prior LTP; and (3) ab-MIGS + phacoemulsification, no prior LTP vs. (4) ab-MIGS + phacoemulsification, with prior LTP. MAIN OUTCOME MEASURES Failure was defined as subsequent glaucoma reoperation after ab-MIGS (either MIGS or traditional glaucoma surgery). Time-to-event outcome and incidence rates were calculated using survival analysis, and adjusted hazard ratios (aHRs) were generated using multivariate Cox proportional hazards models. Medication data were not available for analysis. RESULTS A total of 164 965 unique MIGS procedures were performed, from 2013 to 2018. After PSM, we identified 954 eyes undergoing standalone ab-MIGS and 7522 undergoing ab-MIGS + phacoemulsification. For eyes undergoing standalone ab-MIGS, those with prior LTP (n = 477) were more likely to undergo reoperation vs. those without LTP (n = 477) at 6 and 12 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53; CI, 1.15-2.04; P = 0.004). For eyes undergoing ab-MIGS + phacoemulsification, those with prior LTP (n = 3761) were more likely to undergo reoperation vs. those without LTP (n = 3761) at 12, 24, and 36 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53 CI, 1.15-2.04; P = 0.004). CONCLUSIONS Prior LTP may be associated with a higher chance of subsequent glaucoma surgery following ab-MIGS, either with or without concurrent phacoemulsification. These findings have important implications for understanding who may benefit most from ab-MIGS, and for guiding patient and surgeon treatment expectations. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- William Mitchell
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Shuang-An Yang
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Courtney Ondeck
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | | | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ana M Roldan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Omar Halawa
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Tobias Elze
- Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joan Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts.
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Nasyrov E, Gassel CJ, Merle DA, Neubauer J, Voykov B. Long-term efficacy and safety of XEN-45 gel stent implantation in patients with normal-tension glaucoma. BMC Ophthalmol 2024; 24:264. [PMID: 38902667 PMCID: PMC11191175 DOI: 10.1186/s12886-024-03522-6] [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: 07/14/2023] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Minimally invasive bleb surgery using the XEN-45 gel stent has not been established for the treatment of normal-tension glaucoma (NTG). The main objective of this study was to evaluate the long-term treatment efficacy and safety of XEN-45 in eyes with uncontrolled NTG. METHODS A retrospective analysis of patients with NTG who underwent XEN-45 gel stent implantation at university hospital Tuebingen between 2016 and 2021. The primary outcome measure was surgical success after three years defined as lowering of intraocular pressure (IOP) of ≥ 20%, with target IOP between 6 and 15 mmHg. Success was complete without and qualified irrespective of topical antiglaucoma medication use. The need for further glaucoma surgery, except for needling, was regarded as a failure. The secondary outcome measures included changes in mean IOP, number of antiglaucoma medications, and needling and complication rates. RESULTS Twenty-eight eyes from 23 patients were included in the final analysis. Complete and qualified success rates were 56.5% and 75% after three years, respectively. Mean postoperative IOP ± standard deviation decreased significantly after three years from 19.3 ± 2.0 mmHg at baseline to 13.7 ± 4.2 mmHg (n = 22; p < 0.0001). The median number of antiglaucoma medications decreased from 2 (range 0-4) to 0 after three years (range 0-3; p < 0.0001). Sixteen eyes (57%) required a median of 1 (range 1-3) needling procedures. One eye required further glaucoma surgery. No sight-threatening complications were observed. CONCLUSION The XEN-45 stent is effective and safe for the long-term treatment of NTG. However, needling was frequently required to improve outcomes.
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Affiliation(s)
- Emil Nasyrov
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Caroline J Gassel
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - David A Merle
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Jonas Neubauer
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
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Sabharwal J, Garg AK, Ramulu PY. How much does cataract surgery contribute to intraocular pressure lowering? Curr Opin Ophthalmol 2024; 35:147-154. [PMID: 38018796 DOI: 10.1097/icu.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW To review the literature evaluating the effect of cataract surgery on intraocular pressure (IOP) in patients with glaucoma. RECENT FINDINGS Recent high-quality secondary analyses of large and primary trials continue to show IOP lowering following cataract surgery. Likewise, cataract surgery remains a key treatment for angle closure glaucoma. Some micro-invasive glaucoma surgeries (MIGS) have strong evidence to be performed at the time of cataract surgery. Data clarifying when these surgeries should be combined with cataract surgery is emerging. The mechanism underlying IOP lowering after cataract surgery remains unclear. SUMMARY Patients who are glaucoma suspects with visually significant cataracts would benefit from cataract surgery alone. Those with mild-moderate damage on 1-2 classes of medications would most likely benefit from additional MIGS. Patients with advanced disease would benefit from cataract surgery and a choice of additional surgery, which depends on disease status and patient factors. Clear lens extraction is becoming a more accepted practice as a primary procedure for patients with angle closure and high IOP or glaucoma. The role of additional MIGS in angle closure needs further study.
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Cheema AA, Cheema HR. The Evolution and Current Landscape of Minimally Invasive Glaucoma Surgeries: A Review. Cureus 2024; 16:e52183. [PMID: 38264176 PMCID: PMC10804217 DOI: 10.7759/cureus.52183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.
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Nipp GE, Aref AA, Stinnett SS, Muir KW. Glaucoma Fellows-in-Training Recent Surgery Trends. Ophthalmol Glaucoma 2023; 6:651-656. [PMID: 37336267 DOI: 10.1016/j.ogla.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/22/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE The volume of microinvasive glaucoma surgery (MIGS) has increased dramatically in recent years, from 31 059 in 2013 to 69 420 in 2018. We investigated the impact of this trend on trainees by determining the proportion of glaucoma surgeries performed by fellows-in-training comprised by MIGS, trabeculectomies, and aqueous shunts. DESIGN Retrospective analysis. PARTICIPANTS Fellows-in-training at Glaucoma Fellowship Programs certified by the Association of University Professors of Ophthalmology Fellowship Compliance Committee (AUPO-FCC) METHODS: We analyzed aggregate summaries of surgeries performed by fellows as reported to the AUPO-FCC from the academic years (AYs) beginning in 2014 through AY 2020. Each report lists the average number of procedures performed per surgery type per fellow. We combined these averages to create a sum "average number surgeries performed" across glaucoma surgeries and computed the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of surgeries performed per year. MAIN OUTCOME MEASURES Average number of procedures performed for each surgery type as well as the proportion that each surgery type (MIGS, trabeculectomies, and aqueous shunts) represented within the total average number of procedures performed per year. RESULTS Average number of MIGS performed is significantly greater in later years compared with earlier years (P < 0.001). The average number of trabeculectomies performed between AYs 2014 and AY 2020 ranged from 21.8 to 31.9 and decreased, on average, by - 0.80 year-to-year. The average number of aqueous shunts performed between AY 2014 and AY 2020 ranged from 44.7 to 49.5, with an average increase of + 0.8 year-to-year. The total average number of procedures performed (across all 3 surgical subtypes) increased on average by + 4.8 procedures each year. CONCLUSIONS Since 2014, fellows are performing increasing numbers of MIGS procedures, whereas the total number of trabeculectomies and aqueous shunt surgeries performed each year remain similar, resulting in a net increase in total number of procedures performed per fellow each year. This suggests the increase in MIGS is not associated with a substantial decline in trabeculectomies or aqueous shunts performed by glaucoma fellows. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Grace E Nipp
- Department of Ophthalmology, Duke University Medical Center, Duke Eye Center, Durham, North Carolina.
| | - Ahmad A Aref
- Department of Ophthalmology, University of Illinois College of Medicine, Illinois Eye and Ear Infirmary, Chicago, Illinois
| | - Sandra S Stinnett
- Department of Ophthalmology, Duke University Medical Center, Duke Eye Center, Durham, North Carolina
| | - Kelly W Muir
- Department of Ophthalmology, Duke University Medical Center, Duke Eye Center, Durham, North Carolina
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Laroche D, Madu CT. Preventing Blindness with Early Cataract Surgery and Micro-Invasive Glaucoma Surgery in Patients Over 50: Guidance for Patients, Physicians and World Governments in Dealing with Glaucoma. Clin Ophthalmol 2023; 17:2929-2938. [PMID: 37814637 PMCID: PMC10560466 DOI: 10.2147/opth.s422415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
Purpose To offer clinical guidance and address safety and efficacy concerns regarding the growing use of micro-invasive glaucoma surgery (MIGS) as an initial treatment for glaucoma in adult patients. Design Narrative literature review. Methods A review was conducted to assess outcomes and complications of MIGS in the treatment of glaucoma, both alone and in combination with lens replacement. These outcomes were compared with those of standard glaucoma surgery and/or glaucoma management with medication. Results MIGS are effective at lowering intraocular pressure (IOP) over long periods of follow-up. These techniques share a similarly high safety profile between one another. MIGS were found to have lower complication rates and to be more effective in reducing the total amount of medication needed to maintain control of intraocular pressure than standard surgery approaches. Conclusion MIGS techniques are growing in popularity and have been demonstrated to be a safe and effective alternative to standard glaucoma surgery. Guidance in the implementation of these procedures has been outlined.
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Affiliation(s)
- Daniel Laroche
- Department of Ophthalmology, New York Eye and Ear Infirmary, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Advanced Eye Care of New York, New York, NY, USA
| | - Chisom T Madu
- City University of New York School of Medicine, New York, NY, USA
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Iftikhar M, Dun C, Schein OD, Lum F, Woreta F. Cystoid Macular Edema after Cataract Surgery in the United States: IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2023; 130:1005-1014. [PMID: 37302490 DOI: 10.1016/j.ophtha.2023.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/13/2023] Open
Abstract
PURPOSE To determine the incidence, risk factors, and visual outcomes of cystoid macular edema (CME) after cataract surgery in the United States. DESIGN Retrospective, longitudinal, case-control study. PARTICIPANTS Patients aged ≥ 18 years who underwent phacoemulsification cataract surgery. METHODS The American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) was used to analyze patients who underwent cataract surgery between 2016 and 2019. Patients who received a diagnosis of CME within 90 days after cataract surgery were classified as cases, and the rest were classified as controls. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with the development of CME as well as poor visual outcome (defined as a best-recorded visual acuity worse than 20/40 Snellen equivalent at postoperative month 12). MAIN OUTCOME MEASURES Incidence, demographics, baseline characteristics, and visual outcomes. RESULTS Of 3.1 million cataract surgeries performed during the study period, CME was diagnosed in 25 595 eyes (0.8%), with an average onset of 6 weeks. Patients with CME were more likely to be male, to be aged < 65 years, to be Black, and to have preexisting diabetic retinopathy. Patients with CME were more likely to have a poor visual outcome (OR, 1.75; 95% CI, 1.66-1.84; P < 0.001), with a mean best-recorded visual acuity of 20/30 at postoperative month 12 (compared with 20/25 for those without CME; P < 0.001). Other factors associated with a poor visual outcome included smoking, Medicaid insurance, non-White race, and baseline ocular comorbidities such as macular degeneration and retinal vein occlusion. CONCLUSIONS Although the incidence of CME after cataract surgery is low and most eyes achieve a visual acuity of 20/40 or better, there are significant outcome disparities that warrant further exploration. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Mustafa Iftikhar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Fujita A, Hashimoto Y, Matsui H, Yasunaga H, Aihara M. Recent Trends in Treatment and Associated Costs of Primary Angle-Closure Glaucoma: A Retrospective Cohort Study. Ophthalmol Glaucoma 2023; 6:308-315. [PMID: 36252921 DOI: 10.1016/j.ogla.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/20/2022] [Accepted: 10/10/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE To describe recent trends in the treatment for primary angle-closure glaucoma (PACG) and its associated costs in a clinical setting. DESIGN A retrospective cohort study. SUBJECTS We included patients with PACG from 2011 to 2020 using a large-scale administrative claims database in Japan. METHODS We calculated the frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries, stratified by fiscal years and age groups. MAIN OUTCOME MEASURES Frequencies and costs of antiglaucoma drugs, ophthalmic examinations, and glaucoma-related surgeries. RESULTS We identified 5654 patients with PACG (15 338 patient-years). Prostanoid FP receptor agonist, nonselective β-blocker, and topical carbonic anhydrase inhibitor use decreased, whereas prostanoid EP2 receptor agonist, α-2 adrenergic agonist, Rho-associated protein kinase inhibitor, and fixed-combination eyedrops use increased. The total amount of drug per patient-year significantly decreased. In recent years, the frequency of cataract surgery increased, whereas that of laser peripheral iridotomy decreased. Visual field testing, slit-lamp examination, intraocular pressure measurement, and funduscopy were performed 0.83, 6.65, 5.15, and 4.61 times/patient-year, respectively. The total cost of drugs, examinations, and surgeries was 60 338 yen per patient-year. Patients with PACG spent more than twice the money on surgeries and examinations than they did on antiglaucoma drugs. CONCLUSION The amount of antiglaucoma drugs dispensed decreased, and the proportion of fixed-combination and newly introduced eyedrops increased. Frequency of cataract surgery increased whereas that of laser peripheral iridotomy decreased in recent years. Surgeries and examinations were the major cost drivers for PACG treatment. The current results would be valuable information for future economic analyses and policy making. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Asahi Fujita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Japan.
| | - Yohei Hashimoto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan; Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, the University of Tokyo, Japan
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Patterson I, Avdagic E, Qiu M. Safety and Efficacy of Resident-Performed Gonioscopy-Assisted Transluminal Trabeculotomy. J Glaucoma 2023; 32:313-319. [PMID: 36634018 DOI: 10.1097/ijg.0000000000002171] [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: 02/28/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
PRCIS GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature. PURPOSE Report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) performed by PGY-3 and PGY-4 residents. METHODS A retrospective chart review was performed for patients undergoing resident-performed GATT. Eyes with previous traditional glaucoma surgery (trabeculectomy or aqueous shunt) or neovascular glaucoma were excluded from this analysis. The primary aim was to assess whether resident-performed GATTs demonstrated success rates comparable with the GATT literature. Surgical success was defined as intraocular pressure (IOP)<21 mmHg, and an IOP reduction of 20% from baseline, and no subsequent IOP-lowering surgery. The secondary and tertiary aims were to describe complication rates and operating times for resident-performed GATTs, respectively. RESULTS A total of 50 eyes from 40 patients with various types of glaucoma were included. Eyes either underwent resident-performed GATT-alone (N=9) or GATT+cataract extraction with intraocular lens implantation (CEIOL) (N=41). The surgical success rate at 6 months was 71% for GATT-alone and 42% for GATT+CEIOL. Three eyes required subsequent IOP-lowering surgery. The hyphema rate was 16% at postoperative week 1 and 6% at postoperative month 1. The IOP spike (>30 mmHg) rate was 18%. Mean surgical time for both GATT-alone and GATT+CEIOL was longer for PGY-4s than for PGY-3s, attributable to less attending assistance during PGY-4 cases and more resident-performed cataracts in PGY-4 GATT+CEIOL cases (85%) compared with PGY-3 cases (35%). CONCLUSIONS GATT can be performed efficaciously and safely by PGY-3 and PGY-4 residents, with clinical outcomes and complication rates that mirror those of attending-performed GATT cohorts from the literature.
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Affiliation(s)
- Ian Patterson
- Department of Ophthalmology and Visual Science, The University of Chicago Medicine, Chicago, IL
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Lee CS. American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry and the IRIS Registry Analytic Center Consortium. OPHTHALMOLOGY SCIENCE 2022; 2:100112. [PMID: 36246182 PMCID: PMC9560568 DOI: 10.1016/j.xops.2022.100112] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Leung DYL, Tham CC. Normal-tension glaucoma: Current concepts and approaches-A review. Clin Exp Ophthalmol 2022; 50:247-259. [PMID: 35040248 DOI: 10.1111/ceo.14043] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/19/2022]
Abstract
Normal tension glaucoma (NTG) has remained a challenging disease. We review, from an epidemiological perspective, why we should redefine normality, act earlier at lower pre-treatment intraocular pressure (IOP) level, and the role of ocular perfusion pressures, noting that perfusion is affected by defective vascular bed autoregulation and endothelial dysfunction. The correlation of silent cerebral infarcts (SCI) and NTG may indicate that NTG belongs to a wider spectrum of small vessel diseases (SVD), with its main pathology being also on vascular endothelium. Epidemiological studies also suggested that vascular geometry, such as fractal dimension, may affect perfusion efficiency, occurrence of SCI, SVD and glaucoma. Artificial intelligence with deep learning, may help predicting NTG progression from vascular geometry. Finally, we review latest evidence on the role of minimally-invasive glaucoma surgery, lasers, and newer drugs. We conclude that IOP is not the only modifiable risk factors as, many vascular risk factors are readily modifiable.
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Affiliation(s)
- Dexter Y L Leung
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Lam Kin Chung . Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
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