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Einollahi N, Doozandeh A, Sharifipour F, Hassanpour K, Rezaei J, Radmehr H, Yazdani S. Failed Ahmed glaucoma valves: trabeculectomy versus repeat shunt surgery. BMC Ophthalmol 2024; 24:367. [PMID: 39179983 PMCID: PMC11342670 DOI: 10.1186/s12886-024-03610-7] [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: 04/07/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024] Open
Abstract
INTRODUCTION To investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure. METHODS This quasi-experimental study includes patients with failed AGV implants requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on conjunctival condition. The primary outcome measure was surgical success rate based on various intraocular pressure (IOP) targets and percentages of IOP reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and > 20% reduction (criterion A), IOP ≤ 15 and > 25% reduction (criterion B), and IOP ≤ 12 and > 30% reduction (criterion C). RESULTS Forty-eight eyes of 48 patients were operated and reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P < 0.001). The rate of complications was comparable between the study groups (P = 0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P = 0.07). CONCLUSIONS Trabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.
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Affiliation(s)
- Neda Einollahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Azadeh Doozandeh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Farideh Sharifipour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Javad Rezaei
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Hamed Radmehr
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran
| | - Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Paydarfard St. Boostan 9 St., Pasdaran Ave., Tehran, 16666-94516, Iran.
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Zhang JY, Qiu M. Techniques and Preferences for Nonvalved Aqueous Shunts: A Survey of American Glaucoma Society Members. Ophthalmol Glaucoma 2024; 7:82-92. [PMID: 37454974 DOI: 10.1016/j.ogla.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To assess practice patterns and opinions of glaucoma specialists regarding indications, surgical technique, and postoperative management for nonvalved aqueous shunts. DESIGN Anonymous online survey study. PARTICIPANTS American Glaucoma Society (AGS) members. METHODS An anonymous online survey was distributed to glaucoma specialists via the AGS forum from June to August 2022. MAIN OUTCOME MEASURES Survey questions and responses were assessed in 4 sections: (1) general demographics and practice patterns; (2) nonvalved tubes vs. trabeculectomy; (3) nonvalved tubes vs. valved tubes; and (4) nonvalved tube techniques. RESULTS There were 132 respondents; nonvalved tubes were reported to be performed more often than trabeculectomy by 61% of respondents within 5 years of completing training and 23% of respondents with more than 15 years since completing training. The most frequently preferred types of nonvalved tubes were Baerveldt-350 (41%), Baerveldt-250 (27%), and ClearPath-250 (18%). In patients with lower target intraocular pressure (IOP), 92% of respondents preferred trabeculectomy over nonvalved tube; 33% cited a cutoff of < 12 mmHg, and 31% cited a cutoff of < 15 mmHg. In patients with higher preoperative IOP, 50% of respondents preferred valved over nonvalved tubes; 29% cited a cutoff of > 40 mmHg, and 38% cited a cutoff of > 30 mmHg. The most frequently used ligature was 7-0 Vicryl (69%). The most frequently used strategies for early IOP lowering were fenestrations without wicks (70%) and with wicks (22%), with one 10-0 Nylon being the most used wick technique (22%). Overall, 37% of respondents use a ripcord; among ripcord users, 55% use it for hypotony prevention (3-0 Prolene most common for this purpose at 35%), and 40% use it for optional early IOP lowering (4-0 Nylon most common for this purpose at 21%). If IOP is too high at postoperative week 4, 38% of respondents do not open the tube early. CONCLUSIONS We demonstrate significant heterogeneity regarding specific indications, surgical technique, and postoperative management for nonvalved tubes. Future work is needed to identify and develop standardized guidelines alongside best practices. 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)
- Jason Y Zhang
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois; Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Mary Qiu
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois.
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LaRocca MC, Smith AK, Minckler DS, Lin KY. The Incidence of Urgent Tube Shunt Surgery for Diabetic Neovascular Glaucoma at a Tertiary Academic Medical Center. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231203865. [PMID: 37901892 PMCID: PMC10612438 DOI: 10.1177/11795514231203865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 08/23/2023] [Indexed: 10/31/2023] Open
Abstract
Background Diabetic neovascular glaucoma is a secondary glaucoma that may require immediate correction of elevated intraocular pressure to control pain and protect the optic nerve. While there is a seasonal trend to glucose levels, it is unknown if a seasonal trend exists for diabetic neovascular glaucoma. Objective This study evaluates the incidence of urgent glaucoma tube shunt implantation in diabetic neovascular glaucoma in a tertiary academic referral center in Southern California. Methods Electronic medical records were queried for urgent glaucoma tube shunt surgery from 2014 to 2021. The number of cases were separated by month of occurrence, and average hemoglobin A1c values were calculated per month. Data were analyzed via ANOVA tests and one-tailed t-tests. Results A total of 127 cases were identified. The months of March and April contained the most cases averaging 3 and 2.75 cases, respectively. April had statistically significant higher case numbers than that of other months (P = .041). ANOVA tests excluding April showed no statistically significant difference between the remaining months (P = .901). Average hemoglobin A1c values were highest in the months of April and March at 9.8 and 9.6%, respectively. Conclusion Emergency glaucoma tube shunt surgery for diabetic neovascular glaucoma occurs most frequently in April. This observation may provide insight into disease prevention through diabetes management and help improve surgical operations such that staffing and resources are allocated accordingly.
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Affiliation(s)
| | - Andrew K Smith
- University of California, Irvine School of Medicine, Irvine, CA, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, USA
| | - Don S Minckler
- University of California, Irvine School of Medicine, Irvine, CA, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, USA
| | - Ken Y Lin
- University of California, Irvine School of Medicine, Irvine, CA, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, USA
- Department of Biomedical Engineering, UC Irvine, Irvine, CA, USA
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Arikan G, Gunenc U. Ahmed Glaucoma Valve Implantation to Reduce Intraocular Pressure: Updated Perspectives. Clin Ophthalmol 2023; 17:1833-1845. [PMID: 37405008 PMCID: PMC10317551 DOI: 10.2147/opth.s342721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 07/06/2023] Open
Abstract
Trabeculectomy and glaucoma drainage device implantation are the most commonly performed glaucoma surgeries worldwide. Although trabeculectomy is the gold standard, at the present time there is an increase in the use of glaucoma drainage devices. The Ahmed glaucoma valve is one of the most widely used glaucoma drainage devices worldwide. Corneal endothelial cell loss and eventually corneal decompensation is one of the serious complication of glaucoma drainage device implantation. To avoid this, drainage tube can be inserted into the ciliary sulcus instead of the anterior chamber, especially in eyes with high risk for corneal decompensation. Tube/plate exposure, hypertensive phase, endophthalmitis, cataract formation, diplopia and ocular hypotony are the other potential complications that can develop after Ahmed glaucoma valve implantation.
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Affiliation(s)
- Gul Arikan
- Dokuz Eylul University School of Medicine, Department of Ophthalmology, Izmir, Turkey
| | - Uzeyir Gunenc
- Dokuz Eylul University School of Medicine, Department of Ophthalmology, Izmir, Turkey
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Shen LL, Guo X, Johnson TV, Friedman D, Boland MV, McGlumphy EJ. Comparing Ahmed-FP7 to Baerveldt-250 and Baerveldt-350 surgical outcomes: 1-year results from a retrospective cohort study leveraging the electronic health record. BMJ Open Ophthalmol 2023; 8:e001308. [PMID: 37493661 PMCID: PMC10410868 DOI: 10.1136/bmjophth-2023-001308] [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: 04/04/2023] [Accepted: 06/08/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To compare outcomes following Ahmed-FP7 (AGI-FP7), Baerveldt-250mm2 (BGI-250), or Baerveldt-350mm2 (BGI-350) implantation. METHODS AND ANALYSIS Retrospective cohort study comprising 800 eyes from 800 individuals who underwent surgery 1 January 2016-31 December 2020 at a tertiary-care institution. Data were extracted from standardised fields in the electronic health record. Primary outcome was failure (defined as intraocular pressure (IOP) ≤5 mm Hg or >18 mm Hg or reduction <20% at two consecutive visits from month 3 onwards; or visual acuity (VA) loss ≥3 lines; or return to the operating room (OR)). Secondary outcomes were IOP, VA, number of follow-up visits and return to the OR. RESULTS A total of 523 AGI-FP7, 133 BGI-250 and 144 BGI-350 cases were analysed. The AGI-FP7 group was more likely to be younger and diagnosed with secondary glaucoma, with a higher mean baseline IOP (28.5±12.2 vs 22.0±7.7 mm Hg in BGI-250 and 23.4±9.0 in BGI-350, p<0.001). Cumulative failure rate at month 12 was 30% (AGI-FP7) vs 39% (BGI-250) vs 33% (BGI-350, p=0.159). Mean IOP at month 12 was lower in the BGI-350 group compared with AGI-FP7 (12.4±4.4 vs 14.8±5.6 mm Hg, p=0.003) but not BGI-250 (vs 13.1±4.6, p=0.710). Target IOP was achieved in 71% of AGI-FP7, 66% BGI-250, and 76% BGI-350. VA loss and rates of return to the OR did not differ between groups. Both BGI-250 and BGI-350 had more follow-up visits than AGI-FP7 (p<0.001). CONCLUSION These three glaucoma drainage devices performed similarly within 1 year, with no difference in failure rates despite differing baseline patient characteristics.
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Affiliation(s)
- Leo L Shen
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Xinxing Guo
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Thomas V Johnson
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
| | - David Friedman
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michael V Boland
- Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Elyse J McGlumphy
- Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, Maryland, USA
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Sun MT, Singh K, Wang SY. Real-World Outcomes of Glaucoma Filtration Surgery Using Electronic Health Records: An Informatics Study. J Glaucoma 2022; 31:847-853. [PMID: 36223316 PMCID: PMC9633387 DOI: 10.1097/ijg.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022]
Abstract
PRCIS Utilizing an automated pipeline for data extraction from electronic health records provides real-world information on the success of various glaucoma procedures, with tube shunt implantation associated with increased failure rates compared with trabeculectomy. BACKGROUND We aimed to evaluate the long-term survival of glaucoma surgeries using an automated pipeline for extraction of outcomes from electronic health records. METHODS A retrospective observational study from a single academic center. Patients undergoing trabeculectomy, Ex-PRESS shunt, Baerveldt, and Ahmed tube shunt insertion from 2009 to 2018 were identified from electronic health record procedure codes. Patient characteristics were identified from structured and unstructured fields using a previously validated natural language processing pipeline. RESULTS Five hundred twelve patients underwent 711 glaucoma surgeries: 287 trabeculectomies, 47 Ex-PRESS shunts, 274 Baerveldt and 103 Ahmed tube implantations. The Median follow-up was 359 days. The mean baseline IOP was 24.4 mm Hg (SD 10.9), and 73.1% were on ≥3 medications. Compared with trabeculectomy, tube shunt surgery had a higher risk of failure (Baerveldt: Hazard Ratio (HR) 1.44, 95% CI 1.02 to 2.02; Ahmed: HR 2.01, 95% CI 1.28 to 3.17). Previous glaucoma surgery was associated with increased failure (≥2 previous surgeries: HR 2.74, 95% CI 1.62 to 4.64), as were fewer baseline medications (<3 medications: HR 2.96, 95% CI 2.12 to 4.13) and male sex (HR 1.40, 95% CI 1.03 to 1.90). At 1 year, tube shunt patients had a 2.53 mm Hg ( P =0.002) higher IOP compared with trabeculectomy patients. CONCLUSIONS Baerveldt and Ahmed tube shunt implantation was associated with increased failure compared with trabeculectomy. Fewer baseline medications, previous glaucoma surgeries, and male sex were also risk factors for failure. These results demonstrate the utility of applying an informatics pipeline to electronic health records to investigate key clinical questions using real-world evidence.
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Yazdani S, Doozandeh A, Sharifipour F, Hassanpour K, Pakravan M, Hajizadeh M, Esfandiari H, Mohammadi P. Capsulectomy Shunt Revision versus Repeat Shunt Implantation Following Ahmed Glaucoma Valve Failure in Refractory Glaucoma. Ophthalmol Glaucoma 2022:S2589-4196(22)00202-2. [PMID: 36257587 DOI: 10.1016/j.ogla.2022.10.003] [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: 08/13/2022] [Revised: 10/11/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate the efficacy of capsulectomy shunt revision (CSR) compared with the implantation of a second Ahmed glaucoma valve (re-AGV) in glaucoma patients with failed shunts. DESIGN Quasi-experimental study. SUBJECTS Forty-six eyes with failed Ahmed glaucoma valves (AGVs) were included in the study; 25 underwent CSR, whereas 21 underwent re-AGV. METHODS Patients were scheduled for CSR or re-AGV based on the appearance and accessibility of the existing AGV versus the feasibility for re-AGV in other quadrants. The CSR involved incision and dissection down to the thick fibrous capsule around the AGV plate, which was excised extensively. For re-AGV, the second shunt was implanted in the supranasal or infranasal quadrants. MAIN OUTCOME MEASURES Surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, IOP reduction ≥ 20% from baseline, and no reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and complications during a 12-month follow-up period. RESULTS Mean IOP was significantly lower than preoperative values at all time points in both study groups (P < 0.001). Intraocular pressure decreased significantly from 28.3 ± 5.04 mmHg at baseline to 16.4 ± 2.4 mmHg at final follow-up in the capsulectomy group (P = 0.002). Corresponding IOP values for re-AGV were 30.99 ± 6.2 and 13.6 ± 3.8 mmHg, respectively (P = 0.001). Intraocular pressure in the CSR group was higher than re-AGV during the study (P = 0.003). The cumulative probability of success at 12 months was significantly higher in the re-AGV group (87.5% vs 53.3%, P = 0.002). There was no significant difference in the number of glaucoma medications and overall complications rate between the study groups. Wound leakage was the only complication more common in the CSR group (P = 0.012). CONCLUSION In the eyes with a failed AGV, re-AGV and CSR are both effective. Implantation of a second shunt seems more effective than the surgical revision of an existing device; however, the latter procedure may be a viable option in selected cases. 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)
- Shahin Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azadeh Doozandeh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Farideh Sharifipour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pakravan
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hajizadeh
- Department of Ophthalmology, Imam Khomeini Hospital, Ahvaz Jundishapor University of Medical Sciences, Khuzestan, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Olmsted Medical Center, Rochester, Minnesota
| | - Parisa Mohammadi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Patil TS, Mani B, Balekudaru S, George RJ, Lingam V. Effect of immediate shallow anterior chamber after Ahmed glaucoma valve implantation on intermediate-term intraocular pressure control. Indian J Ophthalmol 2022; 70:2915-2921. [PMID: 35918943 PMCID: PMC9672752 DOI: 10.4103/ijo.ijo_3071_21] [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] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the incidence of shallow anterior chamber in the early postoperative period following Ahmed glaucoma valve (AGV) implantation and its effect on the hypertensive phase (HP), intermediate-term intraocular pressure (IOP) control, and success rate. Methods: A retrospective analysis of 369 eyes of 360 patients who underwent AGV implantation between January 2005 and January 2020 with a minimum follow-up of 2 months was performed. Twenty-six patients developed shallow anterior chamber (AC) within 8 weeks following surgery (cases). They were compared with 39 randomly selected controls (no shallow AC post AGV). HP (IOP spike >21 mmHg), use of ocular hypotensive medications, and other associations were compared. Results: Incidence of shallow AC post AGV was 7% (95% confidence interval [CI] 4, 9). The onset of shallow AC was 3 ± 2.1 days and resolved within 6 ± 4.7 days. Hypotony (12 [47%] vs. 1 [2.5%], P 0.0001) and choroidal detachment (CD; 7 [27%] vs. 3 [8%], P 0.03) were more common in cases compared to controls. The HP occurred in 11 (43%) cases versus 13 (34%) controls (P 0.4). Cases required more ocular hypotensive medications than controls at the end of 8 weeks (1.1 ± 1 vs. 0.5 ± 0.5, P 0.01). There was no significant difference in the qualified success between the groups at 1 year. Conclusion: The development of postoperative shallow AC post AGV implantation was not detrimental to IOP control at 1 year. However, there is a need to monitor the occurrence of HP in these eyes.
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Affiliation(s)
- Trupti Sudhir Patil
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Baskaran Mani
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shantha Balekudaru
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie J George
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vijaya Lingam
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Wijesinghe HK, Puthuran GV, Ramulu PY, Ponnat AK, Reddy MM, Mani I, Krishnadas SR, Gedde SJ. Intraocular Pressure Control Following Phacoemulsification in Eyes With Pre-existing Aurolab Aqueous Drainage Implant. J Glaucoma 2022; 31:456-461. [PMID: 34628424 DOI: 10.1097/ijg.0000000000001946] [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: 05/23/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to investigate intraocular pressure (IOP) control after phacoemulsification in adult glaucomatous eyes with a functioning nonvalved Aurolab Aqueous Drainage Implant (AADI) compared with eyes that did not have cataract extraction post-AADI. METHODS In this retrospective study, we reviewed records of 47 patients (47 eyes) who had a clear corneal phacoemulsification after AADI placement with a minimum of 2 years of follow up. The control group included 89 patients (89 eyes) who had a functional AADI at 1 year, minimum of 3 years of follow up post-AADI implantation, and no cataract extraction. The main outcome measure was failure (IOP >21 mm Hg or increased by >20% from prephacoemulsification level requiring at least 1 additional glaucoma medication, IOP ≤5 mm Hg, reoperation for glaucoma, or loss of light perception vision). RESULTS The median interval between AADI and phacoemulsification was 11.5 months (range: 4 to 68 mo), and the mean follow-up time after phacoemulsification was 35.6±6.4 months. The cumulative probability of failure was 14% (95% confidence interval=6%-31%) in the phaco group and 6% (95% confidence interval=3%-13%) in the control group at 2 years (P=0.11). Mean IOP was reduced from 16.5±4.5 mm Hg preoperatively to 15.4±4.7 mm Hg at 2 years after phacoemulsification (P=0.10). Mean LogMAR visual acuity improved from 1.1±0.6 preoperatively to 0.6±0.7 at 2 years after phacoemulsification (P<0.001). CONCLUSIONS In eyes with a pre-existing AADI, phacoemulsification resulted in visual improvement without a significant rise in IOP or increased risk of AADI failure after 2 years follow up.
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Affiliation(s)
| | | | | | | | | | - Iswarya Mani
- Department of Biostatistics, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL
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Corneal endothelial cell density loss following glaucoma surgery alone or in combination with cataract surgery: A systematic review and meta-analysis. Ophthalmology 2022; 129:841-855. [PMID: 35331751 DOI: 10.1016/j.ophtha.2022.03.015] [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: 11/16/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
TOPIC Corneal endothelial cell density (ECD) loss following glaucoma surgery with or without cataract surgery. CLINICAL RELEVANCE Corneal ECD loss may occur due to intraoperative surgical trauma in glaucoma surgery or postoperatively with chronic endothelial cell trauma or irritation. METHODS Trabeculectomy, glaucoma filtration surgery or microinvasive glaucoma surgery in participants with ocular hypertension, primary and secondary open angle glaucoma, normal tension glaucoma and angle-closure glaucoma were included. Pediatric populations and participants with pre-existing corneal disease were excluded. Laser treatments and peripheral iridotomy were excluded. Electronic databases searched in December 2021 included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and The International Prospective Register of Systematic Reviews (PROSPERO), FDA PMA and FDA 510(k). RESULTS 39 studies were included in quantitative synthesis. 12 months following suprachoroidal MIGS mean ECD loss was 282 cells/mm2 (95% Confidence Interval (CI) 220 to 345; p <0.00001; Chi2 = 0.06; I2 = 0%; 2 studies; very low certainty). Mean ECD loss after Schlemm's canal implantable devices was 338 cells/mm2 (95% CI 185 to 491; p<0.0001; Chi2 = 0.08; I2 = 0%; 2 studies; low certainty) at 12 months. When compared to phacoemulsification alone, Schlemm's canal implants combined with phacoemulsification showed statistically significant mean ECD reduction at 24 months; mean difference of ECD was -19% (95% CI -37% to -2%; p=0.03; Chi2 = 3.04; I2 = 34%; 3 studies; low certainty). Mean ECD loss was 64 cells/mm2 (95% CI 21 to 107; p=0.004; Chi2 = 4.55; I2 = 0%; 6 studies; low certainty) following Schlemm's canal procedures (without implantable devices) at 12 months. At 12 months the mean ECD loss after trabeculectomy was 33 cells/mm2 (95% CI -38 to 105, p=0.36, Chi2 = 1.17; I2 = 0%; moderate certainty). At 12 months mean ECD loss was 121 cells/mm2 (95% CI 53 to 189; p=0.0005; Chi2 = 3.00; I2 = 0%; 5 studies; low certainty) after Express implantation. When compared to control fellow eye, aqueous shunt surgery reduced ECD by 5.75% (95% CI -0.93 to 12.43; p=0.09 Chi2 = 1.32; I2 = 0%; low certainty) and 8.11% ECD loss (95%CI 0.06 to 16.16 p=0.05; Chi2= 1.93; I2=48%) at 12 and 24 months, respectively. CONCLUSIONS Overall there is low certainty evidence to suggest that glaucoma surgery involving long-term implants has a greater extent of ECD loss than glaucoma filtration surgeries without the use of implants. The results of this review support long-term follow-up (beyond 36 months) to assess ECD loss and corneal decompensation following implantation of glaucoma drainage implants.
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Silva N, Bollemeijer JG, Ferreira A, Menéres MJ, Lemij H. Donor scleral graft vs pericardial graft vs scleral flap in tube drainage covering: advantages and disadvantages. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2026217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nisa Silva
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
| | | | - André Ferreira
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Maria João Menéres
- Ophthalmology Department, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Hans Lemij
- Ophthalmology Department, Rotterdam Eye Hospital, Rotterdam Netherlands
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Ansari E. 5-year outcomes of single iStent (G1) trabecular microbypass implantation with phacoemulsification in moderately advanced primary open angle glaucoma. PLoS One 2021; 16:e0257015. [PMID: 34529692 PMCID: PMC8445476 DOI: 10.1371/journal.pone.0257015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/23/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of combined phacoemulsification and single iStent (G1) (iStent, Glaukos Corp. San Clemente, USA), implantation in moderately advanced primary open angle glaucoma (POAG) with 5-years follow-up. Methods Retrospective, interventional case series. All subjects had POAG and underwent single iStent implantation+ phaco+IOL by a single surgeon, with 5 years follow-up. Primary outcome measures: reduction in intraocular pressure (IOP) and proportion of eyes achieving at least 20% reduction of IOP at 5 years. Secondary outcome measures: number of glaucoma drops at 1 through to 5 years; change in visual field mean deviation (MD) at year 5 compared to baseline. Results 35 eyes of 26 patients were included. Mean (sd) medicated pre-op IOP was 18.5 (3.2) mm Hg on mean (sd) 2.3 (1.0) medications. Mean IOP was reduced to 15.9 (4.5) mm Hg on 2.2 (0.9) drops, 15.0mm (4.5) mm Hg on 2.3 (0.9) drops, 15.6 (3.6) mm Hg on 2.5 (1.0) drops, 15.7 (4.43) mmHg on 2.6 (1.0) drops and 14.7 (3.02) mmHg (P<0.001) on 2.7 (1.14) drops (P = 0.06) from 1 through to 5 years. At year 5, 62% of eyes had achieved at least 20% reduction in IOP. MD reduced from -8 (8.1) dB to -10.7 (13.4) dB over 5 years (p = 0.8) at 0.54dB/ annum. One eye required filtering surgery. There were no sight-threatening complications. Conclusion This study showed sustained IOP reduction and excellent safety profile for single iStent implantation. Uniquely it provides data for a more severe stage of glaucoma, and also visual field data, which indicated no significant change through 5 years.
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Affiliation(s)
- Ejaz Ansari
- Maidstone & Tunbridge Wells NHS Trust, Maidstone, Kent, United Kingdom
- Canterbury Christ Church University, Canterbury, United Kingdom
- * E-mail:
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Chemello F, Rodella A, Barosco G, Ceruti P, Tosi R, Marchini G. Double versus single suture stenting to manage hypertensive spikes after glaucoma drainage device implantation. Eur J Ophthalmol 2021; 31:3542-3548. [PMID: 33938321 DOI: 10.1177/11206721211014386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of double compared to single intraluminal suture stenting in reducing early postoperative hypertensive spikes (HS) and hypotony after Baerveldt glaucoma implant surgery. METHODS For this retrospective study, we reviewed the medical charts of 60 patients (60 eyes) who underwent Baerveldt drainage device surgery between 2017 and 2019. Two groups were formed according to whether a single suture stent was placed within the tube (5-0 polypropylene, 30 eyes, group 1) or a double suture (5-0 and 6-0 polypropylene, 30 eyes, group 2). Intraocular pressure (IOP) was measured at baseline, at 6 h, and on postoperative days 1, 2, 5, 7, 14, 21, 30, 60, 90, 180. The occurrence of HS (IOP ⩾ 30 mmHg), anterior chamber reformation, decompressive paracentesis, anti-glaucoma medication, and adverse events were recorded. RESULTS There was a greater decrease in IOP from baseline at days 1, 2, and 21 (p < 0.05) and number of HS at 6 h (p = 0.006) and postoperative day 1 (p < 0.001) in group 2. The mean number of decompressive paracentesis, anterior chamber reformation procedures, and topical anti-glaucoma medications was the same in both groups; the need for oral acetazolamide was significantly lower in group 2 at days 1, 21, and 30 (p < 0.05). CONCLUSIONS While both stenting methods provide a gradual, controlled decrease in IOP, the double stenting technique was associated with a sooner and greater postoperative reduction in IOP and a good safety profile thanks to fewer HS in the early postoperative period and less need for oral acetazolamide.
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Affiliation(s)
- Francesca Chemello
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Anna Rodella
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Guido Barosco
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Piero Ceruti
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Roberto Tosi
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement, University Eye Clinic, University of Verona, AOUI - Borgo Roma Hospital, Verona, Veneto, Italy
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Puthuran GV, Wijesinghe HK, Gedde SJ, Tara TD, Uduman MS, Krishnadas SR, Lee Robin A, Palmberg P. Incidence and Outcomes of Hypertensive Phase Following Aurolab Aqueous Drainage Implant Surgery in Adults with Refractory Glaucoma. Am J Ophthalmol 2021; 221:75-82. [PMID: 32828879 DOI: 10.1016/j.ajo.2020.08.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the incidence and outcomes of hypertensive phase (HP) following Aurolab Aqueous Drainage Implant (AADI) (Aurolab) surgery in adults with refractory glaucoma. DESIGN Retrospective, noncomparative, interventional case series. METHODS All eyes that received the AADI and had a minimum of 2-year follow-up were identified, and data of patients who had intraocular pressure (IOP) ≤21 mm Hg at 6 weeks (ie, the time at which the tube-ligature suture dissolves) were used for statistical analysis. HP was defined as IOP >21 mm Hg during the first 3 months after the release of the tube ligating suture (with or without medications) in the absence of tube obstruction. RESULTS A total of 200 eyes were included in the study, and HP was seen in 64 eyes (32%) with a peak IOP (mean ± SD) of 29.6 ± 7.8 mm Hg and peak incidence at 2-3 months after surgery. HP resolved within 3 months of its onset in 60 of the 64 eyes (94%) with additional IOP-lowering medications. The cumulative success rates were 71.8% (95% CI = 59.3%-81.2%) in HP eyes and 76.4% (95% CI = 68.7%-82.7%) in non-HP eyes (P = .23). Unadjusted Cox proportional hazards analysis showed that eyes experiencing HP had a marginally higher risk of failure (HR = 1.16, 95% CI = 0.6-2.1), but this relationship was not statistically significant (P = .61). CONCLUSIONS A third of eyes that underwent AADI placement experienced HP. HP was successfully managed with additional IOP-lowering medications in a majority of cases and did not have a significant influence on long-term success rate.
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Affiliation(s)
| | | | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
| | | | | | | | - Alan Lee Robin
- Department of Ophthalmology, University of Michigan, Michigan, USA
| | - Paul Palmberg
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida, USA
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Koentjoro SL, Artini W, Soebijantoro I, Istiantoro VW, Rusmayani E, Sulastiwaty R, Djamal ZE, Akbar ASN, Yoserizal M. Comparison of complications after Ahmed versus Baerveldt implant in glaucoma patients: one year follow-up. Int J Ophthalmol 2020; 13:1908-1914. [PMID: 33344189 DOI: 10.18240/ijo.2020.12.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To compare surgical results of the Ahmed and Baerveldt implant procedures in glaucoma patients at 1y follow-up at Jakarta Eye Center (JEC) Eye Hospitals. METHODS This cohort retrospective study was conducted on glaucoma patients aged ≥18y who had undergone Ahmed and Baerveldt implant surgery. Intraocular pressure (IOP), visual acuity, glaucoma medication, success rate, early and late postoperative complications, and the number of resurgeries were analyzed. RESULTS A total of 351 eyes in the Ahmed group and 94 eyes in the Baerveldt group were included in this study. At 1y follow-up, the mean IOP was found to be significantly lower in the Baerveldt group (13±4.47 mm Hg) compared to the Ahmed group (15.02±5.73 mm Hg; P=0.025). Glaucoma medication was required in both the Ahmed and Baerveldt groups (58.92% vs 71.67%). Comparable success rate was found in both groups. The Ahmed group revealed a complete and qualified success of 86.82%, and failure of 13.17%. Similarly, the Baerveldt group showed complete and qualified success in 87.75% and failure in 12.25% cases. In the Ahmed group, 11.97% early complications, 26.06% late complications and 9.97% resurgeries were observed. In comparison, in the Baerveldt group, 23.40% early complications, 30.95% late complications and 11.70% resurgeries were observed. CONCLUSION Both groups of glaucoma implants show significant IOP reduction, however, the Baerveldt implant group demonstrates greater IOP reduction with more failure rates and complications than the Ahmed implant group.
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Affiliation(s)
- Sara Listyani Koentjoro
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Widya Artini
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Iwan Soebijantoro
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Vira Wardhana Istiantoro
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Emma Rusmayani
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Rini Sulastiwaty
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Zeiras Eka Djamal
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Arini Safira Nurul Akbar
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
| | - Muhammad Yoserizal
- Glaucoma Division, Jakarta Eye Center Hospital, West Jakarta, Special District Region of Jakarta 11520, Indonesia
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Liu Y, Huang L, Zhao Q, Liu Q, Stamper RL, Han Y. Short-term Postoperative Visual Acuity Decrease and Recovery after Ahmed Tube Shunt Procedure for Glaucoma. Ophthalmol Glaucoma 2020; 3:384-392. [PMID: 32980043 DOI: 10.1016/j.ogla.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To elucidate the vision loss and recovery course after the Ahmed tube shunt procedure 6 months postoperatively. To identify risk factors associated with significant vision loss. DESIGN Retrospective chart review. PARTICIPANTS One eye of all adult patients who underwent an Ahmed glaucoma valve procedure from January 2008 to December 2017 with a minimum 6-month follow-up. METHODS Patients' preoperative and postoperative corrected visual acuity (CVA) were documented for 1 week, 1 month, 3 months, and 6 months postoperatively. MAIN OUTCOME MEASURES Preoperative and postoperative CVA at various time points were compared using repeated-measures analysis of variance. The proportions of patients with mild (<3 lines of Snellen CVA loss), moderate (3-5 lines, inclusive), and severe (>5 lines) vision loss were calculated and compared using a chi-square test. Logistic regression analysis was conducted to identify risk factors associated with a loss of 3 or more lines of CVA 6 months after surgery. RESULTS A total of 375 patients were included, whose mean preoperative CVA was 0.76. At 1 week postoperatively, mean CVA worsened to 0.96 (P < 0.05), but recovered back to preoperative level by the third postoperative month (P > 0.05). In terms of any vision loss, 55.6% of patients had worse CVA than preoperation at 1 week postoperatively, including 23.5% who had 3 or more lines of vision loss; these proportions decreased to 39.2% (P < 0.001) and 9.3%, respectively, by 6 months postoperatively. The most common causes of significant vision loss were preexisting ocular conditions and cataract progression. Postoperative antimetabolite injection was associated with a lower risk of 3 or more lines of CVA loss 6 months postoperatively (odds ratio, 0.44; P = 0.023). CONCLUSIONS After the Ahmed tube shunt procedure, the worst CVA occurred at 1 week postoperatively and mean CVA returned to the preoperative level by month 3 postoperatively. Approximately 40% of patients had any CVA loss compared with preoperation, and 9.3% of patients had 3 or more lines of CVA loss at month 6 postoperatively. Postoperative antimetabolite injection was associated with a lower risk of 3 or more lines of postoperative vision loss.
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Affiliation(s)
- Yingna Liu
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Lijuan Huang
- The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian Province, China
| | - Qian Zhao
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong Province, China; Department of Biomedical Data Science, Stanford University, Palo Alto, California
| | - Qian Liu
- Henan Eye Institute, Henan Eye Hospital, Henan Provincial People's Hospital and Zhenzhou University People's Hospital, Zhengzhou, Henan Province, China
| | - Robert L Stamper
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California.
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Costagliola C, Sbordone M, Gandolfi S, Cesari L, Furneri G, Fea AM. Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change? Clin Ophthalmol 2020; 14:2639-2655. [PMID: 32982157 PMCID: PMC7500840 DOI: 10.2147/opth.s264839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.
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Affiliation(s)
- Ciro Costagliola
- Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Mario Sbordone
- Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Luca Cesari
- UOC Ophthalmology - Area 5, Ascoli Piceno, San Benedetto del Tronto, Italy
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Ferguson TJ, Mechels KB, Dockter Z, Bleeker A, Ibach M, Schweitzer J, Berdahl JP. iStent Trabecular Microbypass Stent Implantation with Phacoemulsification in Patients with Open-Angle Glaucoma: 6-Year Outcomes. Clin Ophthalmol 2020; 14:1859-1866. [PMID: 32669832 PMCID: PMC7337430 DOI: 10.2147/opth.s247910] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose To investigate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in eyes with primary open-angle glaucoma (POAG). Setting Private practice; Sioux Falls, South Dakota. Design Retrospective, consecutive case series. Methods This case series included eyes implanted with a single trabecular microbypass stent in combination with phacoemulsification in patients with mild to severe POAG. Data were collected preoperatively and at day 1, week 1, month 1, and up to 6 years postoperatively. Primary outcome measures included mean intraocular pressure (IOP) and number of glaucoma medications. Safety was noted by assessing the incidence of IOP spikes and need for additional surgery. Results The study comprised 411 eyes. Mean IOP was reduced to 14.9±4.2 mmHg compared to 18.8±5.6 mmHg at baseline at 6 years postoperative. The mean number of medications was reduced to 1.2±1.0 from 1.4±1.1 at baseline. In eyes with severe stage of disease, there was a mean IOP reduction >6 mmHg at 6 years postoperative. Eyes with baseline IOP ≥18 mmHg achieved a more robust reduction in IOP. Fifteen eyes underwent a secondary glaucoma procedure. There were no intra- or postoperative complications. Conclusion Trabecular microbypass stent implantation in combination with cataract surgery provides a sustained IOP reduction in eyes with mild-to-severe POAG. The degree of IOP reduction was more significant in eyes with higher baseline IOP and severe stage of disease.
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Affiliation(s)
| | | | - Zachary Dockter
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Adam Bleeker
- University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
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Sunaric Megevand G, Bron AM. Personalising surgical treatments for glaucoma patients. Prog Retin Eye Res 2020; 81:100879. [PMID: 32562883 DOI: 10.1016/j.preteyeres.2020.100879] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 02/06/2023]
Abstract
Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.
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Affiliation(s)
- Gordana Sunaric Megevand
- Clinical Eye Research Centre Memorial Adolphe de Rothschild, Geneva, Switzerland; Centre Ophtalmologique de Florissant, Geneva, Switzerland.
| | - Alain M Bron
- Department of Ophthalmology, University Hospital, Dijon, France; Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université Bourgogne Franche-Comté, F-21000, Dijon, France
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20
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Lee JC, Evers BM, Cavuoti D, Hogan RN, Kooner KS. Polymicrobial infection confined to Ahmed glaucoma shunt. Am J Ophthalmol Case Rep 2020; 18:100596. [PMID: 32195438 PMCID: PMC7076141 DOI: 10.1016/j.ajoc.2020.100596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/28/2022] Open
Abstract
Purpose To present a case of a unique complication of an Ahmed glaucoma shunt. The pathological and immunohistochemical findings will also be discussed. Observations A 58-year-old woman with glaucoma secondary to Marfan syndrome and cataract surgery developed exposure of an Ahmed glaucoma tube, intraluminal white inflammatory material, and low-grade endophthalmitis five years after insertion. The patient was treated with topical and oral antibiotics and successfully underwent removal and replacement of the shunt. Pathologic analysis of the intraluminal contents revealed a bacterial infiltrate of mixed morphology. Conclusions and Importance Concurrent tube exposure, intraluminal exudates, and endophthalmitis is a rare but potentially serious complication of glaucoma drainage device surgery. When this complication is encountered, prompt medical and surgical intervention is necessary to prevent significant vision loss. Ultimately, the glaucoma shunt may be revised, replaced, or removed altogether from the eye.
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Affiliation(s)
- Jessica C Lee
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Bret M Evers
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.,Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Dominick Cavuoti
- Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - R Nick Hogan
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.,Department of Pathology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA
| | - Karanjit S Kooner
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.,Department of Ophthalmology, Veterans Affairs North Texas Health Care System, 4500 S Lancaster Rd, Dallas, TX, USA
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Sheybani A, Scott R, Samuelson TW, Kahook MY, Bettis DI, Ahmed IIK, Stephens JD, Kent D, Ferguson TJ, Herndon LW. Open-Angle Glaucoma: Burden of Illness, Current Therapies, and the Management of Nocturnal IOP Variation. Ophthalmol Ther 2019; 9:1-14. [PMID: 31732872 PMCID: PMC7054505 DOI: 10.1007/s40123-019-00222-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 12/19/2022] Open
Abstract
Glaucoma is a chronic, debilitating disease and a leading cause of global blindness. Despite treatment efforts, 10% of patients demonstrate loss of vision. In the US, > 80% of glaucoma cases are classified as open-angle glaucoma (OAG), with primary open-angle (POAG) being the most common. Although there has been tremendous innovation in the surgical treatment of glaucoma as of late, two clinical variants of OAG, normal-tension glaucoma (NTG) and severe POAG, are especially challenging for providers because patients with access to care and excellent treatment options may progress despite achieving a “target” intraocular pressure value. Additionally, recent research has highlighted the importance of nocturnal IOP control in avoiding glaucomatous disease progression. There remains an unmet need for new treatment options that can effectively treat NTG and severe POAG patients, irrespective of baseline IOP, while overcoming adherence limitations of current pharmacotherapies, demonstrating a robust safety profile, and more effectively controlling nocturnal IOP. Funding The Rapid Service Fees were funded by the corresponding author, Tanner J. Ferguson, MD.
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Affiliation(s)
- Arsham Sheybani
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Malik Y Kahook
- Department of Ophthalmology, University of Colorado Health Eye Center, Aurora, CO, USA
| | - Daniel I Bettis
- Department of Ophthalmology, Carver College of Medicine, Iowa City, IA, USA
| | | | | | | | | | - Leon W Herndon
- Duke University School of Medicine, Duke Eye Center, Durham, NC, USA
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22
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Boote C, Sigal IA, Grytz R, Hua Y, Nguyen TD, Girard MJA. Scleral structure and biomechanics. Prog Retin Eye Res 2019; 74:100773. [PMID: 31412277 DOI: 10.1016/j.preteyeres.2019.100773] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
As the eye's main load-bearing connective tissue, the sclera is centrally important to vision. In addition to cooperatively maintaining refractive status with the cornea, the sclera must also provide stable mechanical support to vulnerable internal ocular structures such as the retina and optic nerve head. Moreover, it must achieve this under complex, dynamic loading conditions imposed by eye movements and fluid pressures. Recent years have seen significant advances in our knowledge of scleral biomechanics, its modulation with ageing and disease, and their relationship to the hierarchical structure of the collagen-rich scleral extracellular matrix (ECM) and its resident cells. This review focuses on notable recent structural and biomechanical studies, setting their findings in the context of the wider scleral literature. It reviews recent progress in the development of scattering and bioimaging methods to resolve scleral ECM structure at multiple scales. In vivo and ex vivo experimental methods to characterise scleral biomechanics are explored, along with computational techniques that combine structural and biomechanical data to simulate ocular behaviour and extract tissue material properties. Studies into alterations of scleral structure and biomechanics in myopia and glaucoma are presented, and their results reconciled with associated findings on changes in the ageing eye. Finally, new developments in scleral surgery and emerging minimally invasive therapies are highlighted that could offer new hope in the fight against escalating scleral-related vision disorder worldwide.
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Affiliation(s)
- Craig Boote
- Structural Biophysics Research Group, School of Optometry & Vision Sciences, Cardiff University, UK; Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Newcastle Research & Innovation Institute Singapore (NewRIIS), Singapore.
| | - Ian A Sigal
- Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh, USA
| | - Rafael Grytz
- Department of Ophthalmology & Visual Sciences, University of Alabama at Birmingham, USA
| | - Yi Hua
- Laboratory of Ocular Biomechanics, Department of Ophthalmology, University of Pittsburgh, USA
| | - Thao D Nguyen
- Department of Mechanical Engineering, Johns Hopkins University, USA
| | - Michael J A Girard
- Ophthalmic Engineering & Innovation Laboratory (OEIL), Department of Biomedical Engineering, National University of Singapore, Singapore; Singapore Eye Research Institute (SERI), Singapore National Eye Centre, Singapore
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