Trabeculectomy With Mitomycin C in Secondary Glaucoma Associated With Behçet Disease

Early Postoperative Effect of Ripasudil Hydrochloride After Trabeculectomy on Secondary Glaucoma: A Randomized Controlled Trial

Purpose:

To evaluate the effect of Rho-associated kinase inhibitor (ripasudil hydrochloride hydrate; ripasudil) eye drops on postoperative intraocular pressure (IOP) after trabeculectomy in eyes with uveitic glaucoma.

Design:

This was a prospective, observational, controlled, and randomized study.

Methods:

Sixteen eyes of 16 patients with uveitic glaucoma who underwent trabeculectomy without mitomycin C were randomly treated without ripasudil (8 eyes) and with ripasudil (8 eyes). Postoperative IOP and surgical outcomes 3 months after surgery were compared between the two groups.

Results:

No patient discontinued treatment due to the lack of efficacy or adverse effects of ripasudil during the 3-month study period in the ripasudil group. The mean IOP (mmHg) in the control and ripasudil groups were 42.5 ± 9.8 mmHg /43.9 ± 11.7 mmHg (p = 0.82) at baseline, 14.3 ± 4.9 mmHg /9.0 ± 3.7 mmHg (p = 0.04) at 1 week, 16.3 ± 4.2 mmHg /10.6 ± 3.0 mmHg (p = 0.01) at 1 month, and 16.0 ± 3.4 mmHg /12.5 ± 2.3 mmHg (p = 0.04) at 3 months. The number of laser suture lysis procedures (2.0 ± 0.5 vs 0.4 ± 0.7), the rate of bleb revision by needling (50.0% vs 0.0%), and the mean number of antiglaucoma medications (1.6 ± 1.5 vs. 0.1 ± 0.3) after trabeculectomy were higher in the control group than in the ripasudil group (all p < 0.05). A multivariate analysis showed that the IOP reduction rate at 3 months after surgery was associated with the use of ripasudil and baseline IOP (all p < 0.05).

Conclusion:

This study demonstrated the therapeutic efficacy, safety, and tolerability of ripasudil for 3 months postoperatively. Ripasudil may effectively reduce postoperative IOP and increase the success rate of trabeculectomy in patients with uveitic glaucoma.

The Histopathology of Two Eyes Enucleated after Continuous Transscleral and Micropulse Transscleral Cyclophotocoagulation for Refractory Secondary Glaucoma

INTRODUCTION

Cyclodestructive procedures, which target the nonpigmented epithelium of the ciliary body, have been utilized to treat recalcitrant glaucoma since the early 1930s. There are now various types of cyclophotocoagulation (CPC) available. The authors provide a retrospective description that details the histopathologic findings in 2 patients who underwent CPC for uncontrolled uveitic and neovascular glaucoma (NVG) with subsequent enucleation.

CASE PRESENTATIONS

Two enucleated globes from 2 patients with secondary refractory glaucoma underwent cilioablative therapy: one with uveitic glaucoma and a remote history of micropulse transscleral CPC (MP-TSCPC) and the other with NVG and a recent history of traditional continuous transscleral CPC (CW-TSCPC). The clinical histories are summarized, and light microscopy reviewed for degree of coagulative necrosis and inflammation of the ciliary body and surrounding structures, as well as the underlying pathology of the glaucoma.

CONCLUSION

Both patients ultimately experienced pain and vision loss with either a recrudescence of elevated intraocular pressure or inflammatory hypotony and subsequently underwent enucleation of the affected eye. One globe was enucleated shortly after CW-TSCPC and found to have near full-thickness coagulative necrosis of the pigmented and nonpigmented ciliary epithelium and ciliary muscle as well as necrosis of adjacent nontarget tissues with fibrin in the anterior chamber. The second patient underwent enucleation many months after MP-TSCPC with partial healing fibrosis of the ciliary body and some remaining viable ciliary processes. The histopathologic findings post-CPC may vary based on the method used and evolve over time; additional study is needed.

Long-term outcomes of initial trabeculectomy in glaucoma associated with granulomatous and non-granulomatous uveitis

PURPOSE

To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis.

METHODS

Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy.

RESULTS

The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg ( ± 7.2) and 36.48 mmHg ( ± 11.3) to 14.00 mmHg ( ± 6.2) and 13.48 mmHg ( ± 5.7), the number of medications decreased from 3.73 ( ± 0.7) and 3.58 ( ± 0.9) to 1.00 ( ± 1.4) and 1.13 ( ± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84).

CONCLUSIONS

Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late-onset complications.

CYCLOCRYOCOAGULATION IN SECONDARY NEOVASCULAR GLAUCOMA AND OUR RESULTS

PURPOSE

To retrospectively evaluate the use of cyclocryocoagulation (CCK) in secondary neovascular glaucomas performed at the Department of Ophthalmology, Faculty of Medicine, Charles University and University Hospital Hradec Králové in the years 2016-2019.

MATERIAL AND METHODS

In a retrospective study, 30 procedures of 26 eyes of 24 patients were evaluated. All patients underwent CCK surgery. The main entry criteria were the presence of secondary neovascular glaucoma in diabetes or on the basis of occlusion of the retinal artery or vein and subsequent dispensarization of the patient in the 1st and 6th month after the operation. The parameters evaluated were: the best-corrected visual acuity (BCVA), intraocular pressure value (IOP), data of pain and change in the number of active substances of antiglaucoma therapy.

RESULTS

The mean age of patients at the time of the procedure was 62 years (range 22-85 years). The average number of procedures per eye was 1.15 out of a total of 30 procedures, 26 eyes were performed on 24 patients. The most common indication for CCK in secondary glaucoma-vascular complications in diabetes were in 21 procedures, vascular complications - after occlusion of the retinal vein or artery were in 9 cases. Two patients had both eyes operated on within one year. Three patients underwent two procedures on the same eye during the study period. One of them had two procedures on both eyes. The average value of the number of active substances of antiglaucoma drugs decreased from 3.10 to 2.87 after the 1st month (p = 0.318) and after 6 months it was 2.6 (p.

Deep sclerectomy for uveitic glaucoma: long-term outcomes

PurposeTo report long-term outcomes of deep sclerectomy (DS) in eyes with raised intraocular pressure (IOP) and glaucoma secondary to uveitis.Patients and methodsRetrospective consecutive case series of 43 eyes of 43 patients with uveitic glaucoma. Mitomycin C (MMC) 0.2-0.4 mg/ml was applied sub-conjunctivally prior to scleral flap dissection for 2-3 min in 35 eyes (81%). Combined phacoemulsification and DS was done in 4 cases (9%).ResultsMean follow-up was 68.5±33.5 months. In total, 23 eyes (53.5%) had previous intraocular surgery. Pre-operative IOP was 33.6±12.0 mm Hg. Mean IOP at one, three and five years after surgery was 15.5±5.0 mm Hg, 16.9±6.7 mm Hg and 16.4±5.2 mm Hg, respectively.The probability of IOP <22 and <19 mm Hg was 69 and 62% at 3 years and 60 and 51% at 5 years, respectively. This included eyes that had undergone needle revision and/or laser goniopuncture within that period but had not needed glaucoma medication or further glaucoma procedures. The overall number of glaucoma medications decreased from 3.0±1.2 to 0.8±1.2 by last follow-up (P<0.001). Serious complications included hypotony with macular folds in two eyes and occlusion of the trabeculo-Descemet's membrane (TDM) by iris in two eyes. Recurrence of uveitis was observed in 16 eyes. Seven eyes (16.3%) had subsequent procedures including trabeculectomy with MMC in one eye, DS with MMC in two eyes and Baerveldt tube implantation in five eyes.ConclusionsDS is a safe and effective procedure to lower IOP in uveitic glaucoma. However, as with other glaucoma procedures, a significant proportion of patients will require another IOP-lowering procedure in the long-term.

Herpetic Keratouveitis and Trabeculectomy Failure during Infliximab Therapy in a Patient with Behçet's Disease

A 51-year-old man was diagnosed with Behçet’s disease in 2001. The patient was resistant to all immunosuppressive therapies. After 6 months of infliximab therapy, he presented to our clinic with pain and blurred vision in his right eye. The visual acuity was 20/200 and the intraocular pressure was 35 mmHg in the right eye. Biomicroscopic examination revealed corneal dendritic ulcers and 2+ cells in the anterior chamber in the right eye. The herpetic keratouveitis attack was controlled with antiviral therapy but the patient needed another glaucoma surgery. Trabeculectomy with mitomycin C was performed about halfway through an eight-week interval between two doses of infliximab.

Trabeculotomy in a Behçet's Disease Patient One Week after Infliximab Administration

Purpose

To describe a patient with Behçet's disease and anterior uveitis, which was not cured by local and systemic corticosteroid treatments, who underwent trabeculotomy one week after infliximab administration.

Methods

The patient received preoperative antibiotic therapy followed by trabeculotomy one week after infliximab administration. We observed ocular findings before and after surgery.

Results

Anterior uveitis improved after infliximab administration. The elevated intraocular pressure improved after surgery and there were no intraoperative complications. Neither ocular inflammatory attacks nor infectious complications were found in the operated eye of the patient during follow-up.

Conclusion

Trabeculotomy one week after administration of infliximab appears to be safe and effective in treating secondary glaucoma associated with Behçet's disease.

Deep Sclerectomy with Mitomycin C for Glaucoma Secondary to Uveitis

Purpose.

To report outcomes of deep sclerectomy augmented with mitomycin C (MMC) in eyes with raised intraocular pressure (IOP) secondary to uveitis.

Methods.

This was a retrospective case series of 26 eyes of 26 patients with uveitic glaucoma. Mitomycin C 0.2–0.4 mg/mL was applied subconjunctivally prior to scleral flap dissection for 2–3 minutes.

Results.

Mean follow-up was 46.5±22 months (range 12–83). Fifteen eyes (58%) had previous intraocular surgery. Preoperative IOP was 33±12 mmHg. Intraocular pressure at 1, 2, and 3 years after surgery was 13±4 mmHg, 13±4 mmHg, and 14±4 mmHg, respectively. The probability of IOP <21 and 18 mmHg with needle revision and laser goniopuncture but without medications or further glaucoma procedure was 89% and 84%, respectively, at 3 years. The cumulative probability for performing laser goniopuncture was 42% at 1 year, 50% at 2 years, and 64% at 3 years. Needle revision was performed in 6 eyes (23%). Three (12%) patients required further glaucoma surgery. The number of glaucoma medications decreased from 3.3±1.2 to 0.3±0.8 by last follow-up (p<0.001). Four eyes (15%) were on medications to control IOP Intraoperative perforation of trabeculo-Descemetic membrane occurred in 3 eyes (12%) and late iris entrapment in perforation or goniopuncture in 4 eyes (15%). Recurrence of uveitis was seen in 11 eyes (42%) with no loss in IOP control.

Conclusions.

Deep sclerectomy with MMC appears to be a safe and effective procedure to lower IOP in uveitic glaucoma with a low rate of complications.