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Vega-Garces M, Uppuluri S, Oydanich M, Khouri AS. Comparison of Efficacy of Micropulse and Continuous Wave Cyclophotocoagulation in Patients With Pediatric Glaucoma. J Glaucoma 2024; 33:126-131. [PMID: 37974326 DOI: 10.1097/ijg.0000000000002335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
PRCIS Both micropulse (MP-CPC) and continuous wave (CW-CPC) cyclophotocoagulation exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. OBJECTIVE To determine and compare the effectiveness and safety of MP-CPC and CW-CPC in patients diagnosed with pediatric glaucoma. METHODS A retrospective cohort study was conducted on a total of 28 patients (81 eyes) diagnosed with pediatric glaucoma either undergoing MP-CPC or CW-CPC. Intraocular pressure (IOP) measurements, number of glaucoma medications, and the onset of complications were collected at baseline, 1-month, 3-month, 6-month, and 12-month intervals. Success rate (SR) was defined as eyes achieving IOP ≤21 mm Hg and ≥5 mm Hg and a 20% reduction in IOP at the last follow-up visit. RESULTS All patients either undergoing MP-CPC or CW-CPC were matched for age (mean ± SD; 1.76 ± 1.69 vs 1.56 ± 2.49 y). Patients undergoing MP-CPC had significant decreases in IOP from baseline IOP at 1, 3, and 6 months with a 22% SR at 12 months. CW-CPC had a significant decrease in IOP from baseline IOP at all follow-ups, with a 27% SR at 12 months. At the 12-month follow-up, the CW-CPC cohort exhibited a significantly larger overall drop in IOP when compared with the MP-CPC cohort, (7.99 ± 7.95 vs 1.78 ± 6.89, P < 0.05); however, the difference in SR between treatment groups (27% vs 22%) at 12 months was not significant ( P > 0.05). Complications were minimal for both groups. CONCLUSION Both MP-CPC and CW-CPC exhibited short-term effectiveness in lowering IOP, followed by reversion to near baseline levels 12 months after laser treatment. Both MP-CPC and CW-CPC exhibited similar SR at 12 months, 22% and 27% respectively.
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Affiliation(s)
- Maria Vega-Garces
- Institute of Ophthalmology & Visual Science New Jersey Medical School, Newark, NJ
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Alhazzaa B, Alshahrani A, Aljefri S, Al Obaida I, Al Owaifeer AM, Alotaibi N, Abdalla Elsayed ME, Ahmad K, Malik R. Long-term outcomes of cyclophotocoagulation in refractory pediatric glaucoma: treatment response and success in 262 eyes. J AAPOS 2024; 28:103811. [PMID: 38219922 DOI: 10.1016/j.jaapos.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To report the surgical success and response to treatment for children undergoing cyclophotocoagulation (CPC) for refractory pediatric glaucoma. METHODS The medical records of children with a diagnosis of glaucoma who underwent a first CPC between May 2000 and May 2020 were reviewed retrospectively. The cumulative probability of success was assessed. For definition 1, treatment success was defined as IOP ≤21 mm Hg at all the visits after the first 3 months without the need for additional glaucoma surgery or repeat CPC. For definition 2, repeat CPC did not constitute failure. RESULTS Of 300 eyes that underwent CPC, we identified 262 eyes eligible for inclusion. The mean age at time of first treatment was 5.33 ± 5.03 years, with a mean follow-up of 4.3 ± 4.2 years (31 eyes having at least 10 years of follow-up). The success rates for definitions 1 and 2 were 26.7% (95% CI, 21.7%-32.4%) and 46.2% (95% CI, 40.2%-52.3%), respectively. Older age was associated with a lower risk of failure after both single CPC (HR, 0.92; 95% CI, 0.88-0.96; P < 0.001) and multiple CPCs (HR, 0.95; 95% CI, 0.90-1.00, P = 0.073). Of the 262 eyes, 107 (41%) had sustained IOP-lowering with a single treatment and 56 (21%) with multiple treatments; 35 (13%) had a transient response, and 64 (24%) had no response. CONCLUSIONS Glaucoma control through CPC often requires multiple treatments, with around a quarter of children responding suboptimally. Older children are more likely to exhibit successful IOP lowering.
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Affiliation(s)
- Bader Alhazzaa
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Department of Ophthalmology, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali Alshahrani
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Department of Ophthalmology, Armed Forces Hospitals in Southern Region, Khamis Mushait, Kingdom of Saudi Arabia
| | - Sara Aljefri
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Faculty of Ophthalmology, College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim Al Obaida
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Adi Mohammed Al Owaifeer
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia
| | - Nayef Alotaibi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Maram Ea Abdalla Elsayed
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Jeddah Eye Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; Department of Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
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Yokota C, Hirooka K, Okada N, Kiuchi Y. Risk and Prognostic Factors for Glaucoma Associated with Peters Anomaly. J Clin Med 2023; 12:6238. [PMID: 37834882 PMCID: PMC10573105 DOI: 10.3390/jcm12196238] [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: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Glaucoma secondary to Peters anomaly is an important factor affecting visual prognosis, but there are few reports on the condition. This study aimed to investigate the characteristics of glaucoma associated with Peters anomaly and glaucoma surgery outcomes. This retrospective study included 31 eyes of 20 patients with Peters anomaly. Peters anomaly was classified into three stages: Stage 1, with a posterior corneal defect only; Stage 2, a corneal defect with iridocorneal adhesion; and Stage 3, a corneal defect with lens abnormalities. The associations between glaucoma and anterior segment dysgenesis severity, visual prognosis, and glaucoma surgery outcomes were analyzed. Sixteen eyes of ten patients developed glaucoma. Stage 1 Peters anomaly had no glaucoma, 52% of Stage 2 had glaucoma, and 75% of Stage 3 had glaucoma. Of the 16 eyes with glaucoma, 11 underwent surgery. Eight of these eleven eyes achieved intraocular pressure (IOP) control. Five of the nine eyes that underwent trabeculotomy (TLO) succeeded, and none had corneal staphyloma. Three of the four eyes for which TLO was ineffective had corneal staphyloma (p = 0.0331). Patients with Peters anomaly are more likely to develop glaucoma as anterior segment dysgenesis progresses, and the effect of TLO is limited if corneal staphyloma is present.
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Affiliation(s)
- Chika Yokota
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.H.); (N.O.); (Y.K.)
- Department of Ophthalmology, Federation of National Public Service and Affiliated Personnel Mutual Aid Associations, Yoshijima Hospital, Hiroshima 730-0822, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.H.); (N.O.); (Y.K.)
| | - Naoki Okada
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.H.); (N.O.); (Y.K.)
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan; (K.H.); (N.O.); (Y.K.)
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Sesma G, Ahmad K, AlBakri A, Awad A, Malik R. Incidence and outcomes of microbial keratitis after cyclophotocoagulation to treat childhood refractory glaucoma. J AAPOS 2022; 26:124.e1-124.e5. [PMID: 35525386 DOI: 10.1016/j.jaapos.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the incidence and outcomes of microbial keratitis (MK) following cyclophotocoagulation (CPC) for treatment of refractory childhood glaucoma (CG) at a single center over a period of 6 years. METHODS In this cohort study, the medical records of children with CG who underwent CPC and subsequently presented with MK from 2014 to 2020 were reviewed retrospectively. Data were collected on age, type of glaucoma, surgeries before MK, CPC parameters, interval between CPC and MK, presenting symptoms of MK, infiltrate location, bacterial isolates, MK treatment, and outcomes. RESULTS Among the 312 children who underwent CPC during the study period, 37 eyes of 33 children had MK, with an incidence of 1.8% (95% CI, 0.3-3.2). The median interval between CPC and MK was 4 years (IQR, 2.7-7.4). CPC was repeated once in 20 eyes (54%) and twice in 4 (11%). In 20 eyes, there was no pain at MK onset. The primary isolates were Streptococcus pneumoniae (12/27 [22%]) and Staphylococcus epidermis (8/27 [30%]). MK resolved in 17 eyes (46%) after treatment; 8 eyes (22%) underwent evisceration or had phthisis, and keratoplasty failed in 6 eyes (16%). The absence of pain at presentation with MK was negatively associated with resolution (OR = 5.0 [95% CI, 1.1-23.8]; P = 0.04). CONCLUSIONS The absence of pain at MK onset may be a proxy for neurotrophic keratitis after CPC and is linked to poor response to management.
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Affiliation(s)
- Gorka Sesma
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Amani AlBakri
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulaziz Awad
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; University of Alberta, Edmonton, Alberta, Canada
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Jacobson A, Besirli CG, Bohnsack BL. Outcomes of Baerveldt Glaucoma Drainage Devices in Pediatric Eyes. J Glaucoma 2022; 31:468-477. [PMID: 34930874 PMCID: PMC9148673 DOI: 10.1097/ijg.0000000000001970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/25/2021] [Indexed: 11/26/2022]
Abstract
PRCIS In children, Baerveldt implants showed 84% success at 1 year, but decreased to 32% at 8 years. Age, race, and glaucoma type were not risk factors for failure. Concurrent intraocular surgery was associated with complications. PURPOSE Evaluate success and risk factors for failure and complications of Baerveldt glaucoma implants in children. METHODS Retrospective case series of children who underwent Baerveldt implant placement (2012-2019 by single surgeon) with ≥1 year follow-up. Ocular examination and surgical details were collected. Failure defined as intraocular pressure (IOP) <5 mm Hg or >21 mm Hg for 2 consecutive visits, need for IOP related surgery, or visually significant complication. RESULTS One hundred-six eyes of 76 patients underwent 110 Baerveldt placement at median 6.4 years. Baerveldt placement was combined with additional procedures in 49% with vitrectomy most common (30%). Success of first Baerveldt (per patient) was 64% at final follow-up (median 4.7 y). One-, 5-, and 8-year survival rates were 84%, 60%, and 32%, respectively. There was no difference (P=0.97) in survival between first Baerveldt and all Baerveldt surgeries. Failure of first Baerveldt was not associated with sex, age, ethnicity, prior IOP-lowering surgery, concurrent intraocular surgery, or glaucoma type. Complications occurred in 14% and were associated with concurrent surgery. Twenty-six percent required additional IOP-lowering surgery. At final follow-up, IOP and glaucoma medications were significantly decreased (P<0.0001). Eyes underwent an average of 3.8±2.3 ocular surgeries and 3.0±2.0 glaucoma surgeries. CONCLUSIONS Baerveldt implants showed good success initially, but survival rates declined over time. No risk factors for failure of first implanted Baerveldt were identified. Concurrent surgery was associated with complications. Majority of eyes required multiple surgeries to achieve IOP control and preserve vision.
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Affiliation(s)
- Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Cagri G. Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI
| | - Brenda L. Bohnsack
- Division of Ophthalmology, Ann & Robert H. Lurie Children’s Hospital of Chicago
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL
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6
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Khan AM, Ahmad K, Alarfaj M, Alotaibi H, AlJaloud A, Malik R. Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children. BMJ Open Ophthalmol 2021; 6:e000831. [PMID: 34786485 PMCID: PMC8587650 DOI: 10.1136/bmjophth-2021-000831] [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: 06/14/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022] Open
Abstract
Objective The Aurolab aqueous drainage implant (AADI) has the potential advantages of less encapsulation and greater cost-effectiveness than the Ahmed glaucoma valve (AGV). The aim of this study was to compare the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children. Methods A comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries. Analysis The mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline. Results A total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%–84.9%)] for AADI vs 66.8% [(53.4%–77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group. Conclusions This study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.
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Affiliation(s)
- Abdullah M Khan
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Motazz Alarfaj
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Humoud Alotaibi
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmad AlJaloud
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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7
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Muñoz-Negrete FJ, Teus MA, García-Feijoó J, Canut MI, Rebolleda G. Aniridic glaucoma: An update. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96 Suppl 1:52-59. [PMID: 34836589 DOI: 10.1016/j.oftale.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/20/2020] [Indexed: 06/13/2023]
Abstract
Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is no different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain; OFTARED.
| | - M A Teus
- Universidad de Alcalá, Alcalá de Henares, Spain; Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; OFTARED
| | - J García-Feijoó
- Servicio de Oftalmología, Hospital Universitario Clínico San Carlos, IdISSC, Madrid, Spain; Universidad Complutense, Madrid, Spain; OFTARED
| | | | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Universidad de Alcalá, Alcalá de Henares, Spain; OFTARED
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8
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Souissi S, Le Mer Y, Metge F, Portmann A, Baudouin C, Labbé A, Hamard P. An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma. Acta Ophthalmol 2021; 99:e621-e653. [PMID: 33222409 DOI: 10.1111/aos.14661] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/06/2020] [Accepted: 10/11/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Continuous-wave cyclophotocoagulation (CW-CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW-CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP-TLT) that uses repetitive micropulses of diode laser energy in an off-and-on cyclical fashion. METHODS A literature review was conducted on transscleral CW-CPC (CW-TSCPC), endoscopic CPC (ECP) and MP-TLT. Relevant series of adult and paediatric patients were included for assessing the procedures. RESULTS Regarding CW-TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow-up duration and retreatment rates. CW-CPC often needs to be repeated, especially in paediatric patients. CW-CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW-TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long-term follow-up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP-TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW-TSCPC in the medium term. CONCLUSION Although they may lead to sight-threatening complications, both CW-TSCPC and ECP seem effective. ECP appears to be superior to CW-TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW-TSCPC and MP-TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP-TLT is superior to that of CW-CPC, robust prospective comparative studies including homogeneous and well-defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.
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Affiliation(s)
- Soufiane Souissi
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Yannick Le Mer
- Department of Vitreoretinal Surgery Adolphe de Rothschild Foundation Paris France
| | - Florence Metge
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | - Alexandre Portmann
- Department of Pediatric Ophthalmology Adolphe de Rothschild Foundation Paris France
| | | | - Antoine Labbé
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
| | - Pascale Hamard
- Department of Ophthalmology III Quinze‐Vingts Hospital Paris France
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9
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Jacobson A, Rojas C, Bohnsack BL. Ologen augmentation of Ahmed glaucoma drainage devices in pediatric glaucomas. BMC Ophthalmol 2021; 21:72. [PMID: 33546636 PMCID: PMC7863366 DOI: 10.1186/s12886-021-01827-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/20/2021] [Indexed: 12/18/2022] Open
Abstract
Background Limited data exists on the effectiveness of the collagen matrix, Ologen, on increasing Ahmed glaucoma valve (AGV) success in childhood glaucomas. Methods Ocular examination and surgical details of pediatric patients who underwent AGV placement ± Ologen augmentation between 2012 and 2020. Complete success was defined as intraocular pressure (IOP) between 5 and 20 mmHg without glaucoma medications and additional IOP-lowering surgeries. Qualified success was defined as above, except IOP control maintained with or without glaucoma medications. Results Twenty-two eyes of 16 patients underwent AGV placement of which 6 eyes had Ologen-augmentation (OAGV) and 16 eyes had conventional surgery (CAGV). Average age was 6.4 ± 5.1 years with 4.2 ± 2.5 follow-up years. There was no difference in age, number of previous surgeries, and preoperative IOP and glaucoma medications. At final follow-up, success rate was 100% (5 eyes complete, 6 eyes qualified) in the OAGV group compared to 31% (0 eyes complete, 5 eyes qualified) in the CAGV group. One and two-year survival rates were 100% for OAGV compared to 62 and 38% for CAGV. Postoperative IOP was significantly lower at 1-month and final follow-up (p = 0.02) as was the number of glaucoma medications at 3, 6, 12-months and final follow-up (p < 0.05) in the OAGV group. Conclusions Ologen-augmentation increased the success and survival rates of AGVs in childhood glaucomas. Further, Ologen mitigated the hypertensive phase and decreased medication dependency. Longer follow-up with a greater number of eyes is required to fully evaluate the effectiveness of OAGV. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-01827-4.
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Affiliation(s)
- Adam Jacobson
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Carin Rojas
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48105, USA
| | - Brenda L Bohnsack
- Division of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Box 70, Chicago, IL, 60611, USA. .,Department of Ophthalmology, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave, Chicago, IL, 60611, USA.
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10
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Muñoz-Negrete FJ, Teus MA, García-Feijoó J, Canut MI, Rebolleda G. Aniridic glaucoma: An update. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2021; 96:S0365-6691(20)30428-7. [PMID: 33531163 DOI: 10.1016/j.oftal.2020.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023]
Abstract
Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is not different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Universidad de Alcalá, Alcalá de Henares, España; OFTARED.
| | - M A Teus
- Universidad de Alcalá, Alcalá de Henares, España; Hospital Universitario Príncipe de Asturias, Alcalá de Henares, España; OFTARED
| | - J García-Feijoó
- Servicio de Oftalmología, Hospital Universitario Clínico San Carlos. IdISSC, Madrid, España; Universidad Complutense, Madrid, España; OFTARED
| | - M I Canut
- Clínica Barraquer, Barcelona, España
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Universidad de Alcalá, Alcalá de Henares, España; OFTARED
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