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Maheshwari D, Pillai MR, Hm P, Kader MA, Rengappa R, Pawar N. "Long-term safety and efficacy of injection mitomycin C(MMC) versus sponge application in trabeculectomies". Eur J Ophthalmol 2024:11206721241266981. [PMID: 39094554 DOI: 10.1177/11206721241266981] [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: 08/04/2024]
Abstract
AIMS To compare the long-term safety and efficacy of subconjunctival injection mitomycin C(MMC) with conventional sponge applied MMC during trabeculectomy. METHODS AND MATERIAL Retrospective analysis of 98 eyes of 90 patients who underwent trabeculectomy with Mitomycin C were divided into two groups, group 1- sponge (n = 52) and group 2- Injection(n = 46). Follow-up data were collected on day one, day 15, one month, three months, six months, one year, two years and three years. Data from baseline and follow-up visits were analyzed and compared to study the significant difference in intraocular pressure (IOP), number of antiglaucoma medications (AGM) and best corrected visual acuity (BCVA) . P-value of <0.05 was considered statistically significant. RESULTS Mean preop IOP was 34.61 ± 13.3 mmHg in group one and 33.07 ± 9.6 mmHg in group two, which reduced to 11.43 ± 3.2 and 11.59 ± 3.2 mmHg at three years (p < 0.001 in both groups) with no significant difference between the groups. Mean number of preoperative AGM was 2.28 ± 0.8 and 2.42 ± 0.7 in group one and two respectively which reduced to 1.19 ± 1.1(p = 0.405) and 0.88 ± 0.9(p = 0.001) at three years. Complete and overall success rates (complete + qualified) were 59.3% and 78.9% in group one and 60.9% and 80.4% in group two at three years. No statistically significant difference was found in complication rates, post-operative interventions, and final visual outcome in both groups. CONCLUSIONS Subconjunctival Injection MMC was a safe and effective alternative to sponge application with comparable long term surgical outcomes.
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Affiliation(s)
- Devendra Maheshwari
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Madhavi Ramanatha Pillai
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Priya Hm
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Mohideen Abdul Kader
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Ramakrishnan Rengappa
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
| | - Neelam Pawar
- Department of Glaucoma, Aravind Eye Hospital, and Post Graduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu, India
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Yamazaki H, Tojo N, Otsuka M, Tomoko UC, Hayashi A. Comparison of corneal endothelial cell density reduction between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients at 3 years after Ex-Press® surgery. Int Ophthalmol 2024; 44:333. [PMID: 39042198 DOI: 10.1007/s10792-024-03248-w] [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: 03/11/2024] [Accepted: 07/14/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). PATIENTS AND METHODS This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3 years. We measured the CED before and after (at 12, 24, and 36 months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. RESULTS We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3 years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3 years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. CONCLUSIONS EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients.
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Affiliation(s)
- Hitoshi Yamazaki
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan.
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Ueda-Consolvo Tomoko
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan
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Nasyrov E, Gassel CJ, Merle DA, Neubauer J, Voykov B. Long-term efficacy and safety of XEN-45 gel stent implantation in patients with normal-tension glaucoma. BMC Ophthalmol 2024; 24:264. [PMID: 38902667 PMCID: PMC11191175 DOI: 10.1186/s12886-024-03522-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Minimally invasive bleb surgery using the XEN-45 gel stent has not been established for the treatment of normal-tension glaucoma (NTG). The main objective of this study was to evaluate the long-term treatment efficacy and safety of XEN-45 in eyes with uncontrolled NTG. METHODS A retrospective analysis of patients with NTG who underwent XEN-45 gel stent implantation at university hospital Tuebingen between 2016 and 2021. The primary outcome measure was surgical success after three years defined as lowering of intraocular pressure (IOP) of ≥ 20%, with target IOP between 6 and 15 mmHg. Success was complete without and qualified irrespective of topical antiglaucoma medication use. The need for further glaucoma surgery, except for needling, was regarded as a failure. The secondary outcome measures included changes in mean IOP, number of antiglaucoma medications, and needling and complication rates. RESULTS Twenty-eight eyes from 23 patients were included in the final analysis. Complete and qualified success rates were 56.5% and 75% after three years, respectively. Mean postoperative IOP ± standard deviation decreased significantly after three years from 19.3 ± 2.0 mmHg at baseline to 13.7 ± 4.2 mmHg (n = 22; p < 0.0001). The median number of antiglaucoma medications decreased from 2 (range 0-4) to 0 after three years (range 0-3; p < 0.0001). Sixteen eyes (57%) required a median of 1 (range 1-3) needling procedures. One eye required further glaucoma surgery. No sight-threatening complications were observed. CONCLUSION The XEN-45 stent is effective and safe for the long-term treatment of NTG. However, needling was frequently required to improve outcomes.
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Affiliation(s)
- Emil Nasyrov
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany.
| | - Caroline J Gassel
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - David A Merle
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Jonas Neubauer
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
| | - Bogomil Voykov
- Centre for Ophthalmology, University Hospital Tuebingen, Elfriede-Aulhorn-Str. 7, 72076, Tuebingen, Germany
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Oo HH, Hong ASY, Lim SY, Ang BCH. Angle-based minimally invasive glaucoma surgery in normal tension glaucoma: A systematic review and meta-analysis. Clin Exp Ophthalmol 2024. [PMID: 38853535 DOI: 10.1111/ceo.14408] [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: 03/16/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND This systematic review and meta-analysis quantitatively examines the efficacy of angle-based minimally invasive glaucoma surgery (MIGS) in normal tension glaucoma (NTG). METHODS A literature search was performed on Medline, Embase, PubMed, CINAHL and Cochrane Library from inception until 20 December 2022. Pilot, cohort, observational studies and randomised controlled trials including at least 5 subjects undergoing angle-based MIGS (trabecular-bypass devices, excisional trabeculotomy, goniotomy and ab-interno canaloplasty) for NTG, with or without cataract surgery, were included. Meta-analysis of continuous outcome using the meta routine in R version 2022.12.0+353 was performed to determine mean intraocular pressure (IOP) and anti-glaucoma medication (AGM) reduction post-operatively. RESULTS Of the 846 studies initially identified, 15 studies with a pooled total of 367 eyes which underwent combined phacoemulsification and angle-based MIGS were included for final meta-analysis. Outcomes of the iStent were reported in 5 studies, iStent inject in 7 studies, Hydrus Microstent in 1 study, Kahook Dual Blade in 3 studies, and Trabectome in 2 studies. There was significant reduction in both IOP and AGM post-operatively at 6 months (2.44 mmHg, 95%CI: 1.83-3.06; 1.21 AGM, 95%CI: 0.99-1.44), 12 months (2.28 mmHg, 95%CI: 1.71-2.84; 1.18 AGM, 95%CI: 0.90-1.47), 24 months (2.10 mmHg, 95%CI: 1.51-2.68; 1.26 AGM, 95%CI: 0.85-1.68) and 36 months (2.43 mmHg, 95%CI: 1.71-3.15, 0.87 AGM, 95%CI: 0.21-1.53) (all p < 0.05). Subgroup analysis on combined phacoemulsification-iStent inject surgery demonstrated a reduction in both IOP (2.31 mmHg, 95%CI: 1.07-3.56, p < 0.001) and AGM (1.07 AGM, 95%CI: 0.86-1.29, p < 0.001) at 12 months post-operatively. CONCLUSIONS Angle-based MIGS combined with phacoemulsification effectively reduces IOP and AGM in NTG eyes for up to 36 months after surgery.
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Affiliation(s)
- Hnin Hnin Oo
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Sheng Yang Lim
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Woodlands Health, Singapore, Singapore
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
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Tokumo K, Okada N, Onoe H, Komatsu K, Masuda S, Okumichi H, Hirooka K, Asaoka R, Kiuchi Y. Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:2525-2537. [PMID: 37662650 PMCID: PMC10473402 DOI: 10.2147/opth.s419765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/10/2023] [Indexed: 09/05/2023] Open
Abstract
Purpose To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma. Patients and Methods Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ -6 dB), moderate (-6 dB > MD ≥ -12 dB), and advanced (-12 dB > MD). Survival rates were calculated by subgroup. Results A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group. Conclusion Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.
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Affiliation(s)
- Kana Tokumo
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Naoki Okada
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiromitsu Onoe
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kaori Komatsu
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shun Masuda
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Asaoka
- Seirei Hamamatsu General Hospital Department of Ophthalmology, Shizuoka, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Kiuchi Y, Inoue T, Shoji N, Nakamura M, Tanito M. The Japan Glaucoma Society guidelines for glaucoma 5th edition. Jpn J Ophthalmol 2023; 67:189-254. [PMID: 36780040 DOI: 10.1007/s10384-022-00970-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 02/14/2023]
Abstract
We are pleased to bring you the 5th edition of the Glaucoma Clinical Practice Guidelines. Clinical practice guidelines are based on evidence (scientific grounds). It is a document that presents the treatment that is the most appropriate for the patient. "Glaucoma Clinical Guidelines" was first published in 2003. This was the first guideline for glaucoma treatment in Japan. The principle of glaucoma treatment is to lower intraocular pressure. Means for lowering intraocular pressure includes drugs, lasers, and surgery; Glaucoma is a disease that should be considered as a complex syndrome rather than a single condition. Therefore, the actual medical treatment is not as simple as one word. This time we set the Clinical Questionnaire with a focus on glaucoma treatment. We hope that you will take advantage of the 5th edition.
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Affiliation(s)
- Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-31 Kasumi, Minami-ku, Hiroshima, Japan.
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Nobuyuki Shoji
- Department of Ophthalmology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Makoto Nakamura
- Division of Ophthalmology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
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Lai C, Shao SC, Chen YH, Kuo YK, Lai CC, Chuang LH. Trabeculectomy With Antimetabolite Agents for Normal Tension Glaucoma: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:932232. [PMID: 35836955 PMCID: PMC9273818 DOI: 10.3389/fmed.2022.932232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background Evidence regarding the impact on visual field (VF), intraocular pressure (IOP), and antiglaucoma medications from trabeculectomy with antimetabolites for normal tension glaucoma (NTG) is conflicting because of insufficient study sample sizes. The aim of this study is to systematically assess VF progression rate, IOP control and antiglaucoma medication use after trabeculectomy with antimetabolites for progressing NTG. Methods We searched published articles on PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from database inception to March 21, 2022. We selected studies that reported VF data before and after trabeculectomy with antimetabolite agents for NTG. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines. Data were extracted by 2 independent reviewers, and a random-effects model was employed for the meta-analysis. Study outcomes were VF progression rates measured using the pooled mean deviation (MD) slope, changes in antiglaucoma medications, and IOP. Subgroup analyses of the MD slope according to mean age (over or under 65 years), baseline MD (over or under –12 dB), and baseline IOP (over or under 15 mmHg) were performed to determine the results’ robustness. Results We included 7 retrospective observational studies (Japan: 6 studies, United States: 1 study) comprising a total of 166 eyes. Mean preoperative VF MD slopes ranged from –0.52 to –1.05 dB/year. The meta-analysis demonstrated significant MD slope improvement after trabeculectomy (pooled mean difference: 0.54 dB/year, 95% CI: 0.40 to 0.67, I2 = 9%). Mean age, baseline MD, and baseline IOP subgroup analyses revealed MD slope results were consistent with those of the main analyses. The mean IOP (pooled mean difference: –5.54 mmHg, 95% CI: –6.02 to –5.06, I2 = 0%) and mean number of antiglaucoma medications (pooled mean difference: –1.75, 95% CI: –2.97 to –0.53, I2 = 98%) significantly decreased after trabeculectomy. The most frequently reported early complications after trabeculectomy were hypotony, hyphema, and shallow anterior chamber. Conclusion This systematic review and meta-analysis indicated that trabeculectomy with antimetabolites is beneficial for progressing NTG; it preserves visual function by alleviating the MD slope and reducing antiglaucoma medication use. However, several post-trabeculectomy complications should be monitored.
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Affiliation(s)
- Chin Lai
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Hung Chen
- Department of Pharmacy, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Kai Kuo
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Hsin Chuang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- *Correspondence: Lan-Hsin Chuang,
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Ex-PRESS® surgery versus trabeculectomy for primary open-angle glaucoma with low preoperative intraocular pressure. Int Ophthalmol 2022; 42:3367-3375. [PMID: 35538255 DOI: 10.1007/s10792-022-02335-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/18/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open-angle glaucoma (POAG) with low preoperative intraocular pressure (IOP). PATIENTS AND METHODS This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤ 16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed up for > 2 years. RESULTS Both surgeries significantly decreased the IOP (p < 0.001): At 2 years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1 mmHg, and Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2 mmHg. No significant differences were observed in the postoperative IOP (p = 0.076), number of postoperative medications (p = 0.263), success rate (p = 0.900), reduction rate of ECD (p = 0.410), or difference in visual acuity (p = 0.174). The reduction rate of IOP was significantly high in the Trab group (p = 0.047). CONCLUSIONS Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.
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McGlumphy EJ, Mihailovic A, Ramulu PY, Johnson TV. Home Self-tonometry Trials Compared with Clinic Tonometry in Patients with Glaucoma. Ophthalmol Glaucoma 2021; 4:569-580. [PMID: 33845191 PMCID: PMC8501148 DOI: 10.1016/j.ogla.2021.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study examined characteristics of intraocular pressure (IOP) as measured during home tonometry in comparison with in-clinic tonometry in patients with glaucoma. DESIGN Retrospective cross-sectional study of glaucoma patients who completed 1 week of self-tonometry at a single academic center. PARTICIPANTS Patients with glaucoma who completed home tonometry trials with the iCare HOME tonometer (iCare USA) for any reason. METHODS Home IOP measurements were compared with in-clinic tonometry performed during the 5 visits preceding home tonometry. Maximum daily IOP was correlated to time of day. Generalized estimating equations were used to evaluate patient characteristics and clinic-derived variables that predicted differences between home and clinic IOP. MAIN OUTCOME MEASURES IOP mean, maximum, minimum, range, standard deviation and coefficient of variation were compared between clinic and home tonometry. IOP mean daily maximum (MDM) and mean daily range were calculated to describe recurrent IOP spiking. RESULTS A total of 107 eyes from 61 patients were analyzed. Mean age was 63.2 years (standard deviation [SD], 14.0 years) and 59.0% were women. Mean clinic and home IOPs were 14.5 mmHg (SD, 4.7 mmHg) and 13.6 mmHg (SD, 5.1 mmHg). Home tonometry identified significantly higher maximum IOP, lower minimum IOP, and greater IOP range than clinic tonometry (P < 0.001). Maximum daily IOP occurred outside of clinic hours (8 am-5 pm) on 50% of days assessed and occurred between 4:30 am and 8 am on 24% of days. Mean daily maximum IOP exceeded maximum clinic IOP in 44% of patients and exceeded target IOP by 3 mmHg, 5 mmHg, or 10 mmHg in 31%, 15%, and 6% of patients, respectively. Patient characteristics that predicted significant deviations between MDM and mean clinic IOP or target IOP in multivariate models included younger age, male gender, and absence of prior filtering surgery. CONCLUSIONS Self-tonometry provides IOP data that supplements in-clinic tonometry and would not be detectable over daytime in-clinic diurnal curves. A subset of patients in whom home tonometry was ordered by their glaucoma clinician because of suspicion of occult IOP elevation demonstrated reproducible IOP elevation outside of the clinic setting. Such patients tended to be younger and male and not to have undergone previous filtering surgery.
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Affiliation(s)
- Elyse J McGlumphy
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aleksandra Mihailovic
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas V Johnson
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hypotony-associated Complications After Deep Sclerectomy: Incidence, Risk Factors, and Long-term Outcomes. J Glaucoma 2021; 30:e314-e326. [PMID: 34115726 DOI: 10.1097/ijg.0000000000001882] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/25/2021] [Indexed: 11/27/2022]
Abstract
PRECIS Chronic hypotony is not uncommon following deep sclerectomy (DS), but only a minor proportion of patients develop hypotony-associated complications. Numerical hypotony does not affect the visual outcomes. This study identifies factors associated with hypotony. PURPOSE To investigate the incidence and risk factors of hypotony and hypotony-associated complications after DS. METHODS Retrospective cohort study of 1765 eyes (1385 patients) undergoing DS with or without cataract extraction between 2001 and 2020 in 2 UK centers. Chronic hypotony was defined as intraocular pressure (IOP) ≤5 mm Hg in ≥2 consecutive visits lasting >90 days or as any IOP ≤5 mm Hg associated with hypotony-related complications or requiring surgical intervention. Clinical hypotony was defined as the presence of: serous or hemorrhagic choroidal detachment, hypotony maculopathy, flat anterior chamber requiring reformation, decompression retinopathy. The incidence of hypotony was calculated with Kaplan-Meier statistics, and Cox regression was used to identify risk factors. RESULTS The median (interquartile range) age and follow-up were 76 (67 to 82) years and 45.4 (20.9 to 79.8) months, respectively. The incidence (95% confidence interval) of chronic and clinical hypotony at 5 years was 13.4% (11.5%-15.3%) and 5.6% (4.3%-6.9%), respectively. Sixteen eyes (15.7%) with hypotony-associated complications had IOP >5 mm Hg. Male sex (hazard ratio [HR]: 1.89, P=0.018), non-Caucasian ethnicity (HR: 2.49, P=0.046), intraoperative bevacizumab (HR: 3.96, P=0.01), pigmentary glaucoma (HR: 3.59, P=0.048), previous vitreoretinal surgery (HR: 5.70, P=0.009), intraoperative microperforation (HR: 4.17, P<0.001) and macroperforation (HR: 20.76, P<0.001), and avascular bleb (HR: 1.80, P=0.036) were associated with clinical hypotony. DISCUSSION Chronic hypotony is not uncommon following DS, but clinical hypotony is infrequent. Hypotony associated-complications can occur in eyes without statistical hypotony.
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Kandarakis SA, Papakonstantinou E, Petrou P, Diagourtas A, Ifantides C, Georgalas I, Serle J. One-Year Randomized Comparison of Safety and Efficacy of Trabeculectomy with Mitomycin C Sub-Tenon Injection versus Mitomycin C-Infused Sponges. Ophthalmol Glaucoma 2021; 5:77-84. [PMID: 34058431 DOI: 10.1016/j.ogla.2021.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the safety and efficacy of sub-Tenon injection of mitomycin C (MMC) with application of MMC-infused sponges during trabeculectomy. DESIGN Single-center randomized clinical trial. PARTICIPANTS A total of 56 eyes of 49 patients with open-angle glaucoma were included in this clinical trial. METHODS In this single-center randomized clinical trial, 56 eyes of 49 patients underwent trabeculectomy with MMC for primary open-angle glaucoma. Patients were randomized into 2 groups. The injection group received a sub-Tenon injection of 0.15 ml of 0.01% MMC diluted with preservative free lidocaine 2% (n = 27). In the sponges group, sponges soaked in 0.02% MMC were applied under the Tenon's capsule and the scleral flap for 2 minutes (n = 29). Intraocular pressure, endothelial cell count, best-corrected visual acuity, and number of intraocular pressure (IOP)-lowering medications were assessed before surgery and 1 week; 1, 3, and 6 months; and 1 year after surgery. Complete success was defined as IOP of 14 mmHg or less without medication. Bleb morphologic features were assessed using the Indiana Bleb Appearance Grading Scale bleb grading system. MAIN OUTCOME MEASURES Intraocular pressure reduction was the primary outcome. Bleb morphologic features and endothelial cell counts (ECCs) were secondary outcomes. RESULTS Mean IOP in the sponges group decreased from 30.5 ± 7.4 mmHg at baseline to 12.6 ± 5.9 mmHg at 1 year (P < 0.001); in the injection group, IOP decreased from 29.3 ± 6.8 mmHg at baseline to 12.7 ± 4.3 mmHg at 1 year (P < 0.001). No difference in IOP between the 2 groups was noted at any visit (P < 0.001). Surgical success was 81.5% and 82.8% in the injection and sponges groups, respectively, at 1 year. Mean ECC values were unchanged from baseline to 1 year after surgery for both groups (P = 0.444). Complication rates were similar in the 2 groups. Bleb morphologic features showed differences in the appearance and grading of the blebs between the 2 groups at 1 year, showing larger extent, lower height, and less vascularization in the injection group. CONCLUSIONS Sub-Tenon injection of MMC during trabeculectomy seems to be as safe and as efficacious as conventional application of MMC with sponges at 1 year after surgery. Bleb morphologic features show notable differences that may suggest a better long-term outcome.
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Affiliation(s)
- Stylianos A Kandarakis
- 1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Evangelia Papakonstantinou
- 1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros Petrou
- 1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Diagourtas
- 1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Cristos Ifantides
- Department of Ophthalmology, University of Colorado, Aurora, Colorado; Department of Surgery, Denver Health Medical Center, Denver, Colorado
| | - Ilias Georgalas
- 1st Department of Ophthalmology, "G. Gennimatas" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Janet Serle
- Icahn School of Medicine at Mount Sinai, New York, New York
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Central visual field change after fornix-based trabeculectomy in Japanese normal-tension glaucoma patients managed under 15 mmHg. Graefes Arch Clin Exp Ophthalmol 2021; 259:2309-2316. [PMID: 33929590 DOI: 10.1007/s00417-021-05215-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate how the central visual field would be changed after fornix-based trabeculectomy with mitomycin C in Japanese normal-tension glaucoma (NTG) patients monitored for more than 10 years including before surgery. METHODS This is a retrospective cohort study. We identified twenty-eight eyes of 28 NTG cases regularly monitored for more than 5 years and examined static visual field (VF) tests for more than five times before and after fornix-based trabeculectomy (including combined surgery). Based on preoperative data for 6.3 years, we evaluated postoperative changes for 6.0 years in 10-2 VF and 30-2 VF. RESULTS Six patients were male and 22 females, the mean age was 57.9 years, and the mean deviation was - 13.7 decibels. After surgery, mean IOP decreased from 13.9 to 9.0 mmHg (P ≤ 0.01), and medication score also did. The rate of 10-2 VF deterioration was significantly suppressed from - 1.0 dB/year preoperatively to - 0.4 dB/year postoperatively (P ≤ 0.01). And when 30-2 VF was divided into six relevant sectors, the rate of deterioration at cecocentral and arcuate areas of the superior hemifield was suppressed postoperatively (P ≤ 0.01 and P = 0.042, respectively). CONCLUSION Based on long-term preoperative data, a significant positive change in 10-2 VF was observed after fornix-based trabeculectomy with mitomycin C in Japanese NTG patients with a mean IOP of 13.9 mmHg. Central vision could be expected to be maintained for NTG patients even if its preoperative IOP is low after successful trabeculectomy.
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Fan Y, Tu H, Zhao H, Wei F, Yang Y, Ren T. A wearable contact lens sensor for noninvasive in-situ monitoring of intraocular pressure. NANOTECHNOLOGY 2021; 32:095106. [PMID: 33290267 DOI: 10.1088/1361-6528/abca5f] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Glaucoma is the second leading cause of blindness in the world. Intraocular pressure (IOP) is a primary indicator of glaucoma which can be measured for the treatment of the disease. This paper presents a piezo-resistive principle pressure sensor to monitor IOP continuously and non-invasively. The sensor is designed based on the Wheatstone bridge circuit and fabricated by the spray-coating method. The hybrid nanomaterials of graphene and carbon nanotubes are introduced as sensing layers which are embedded inside the soft contact lens substrate composed of flexible polydimethyl siloxane (PDMS) and parylene. The sensing performance is discussed followed by a brief description of our sensor design and fabrication. Tests on a PDMS eyeball model indicate that it has a high sensitivity of 36.01 μV mmHg-1. Also, the frequency response and the ability to track dynamic pressure change cycles are demonstrated in normal IOP variation range from 9 to 34 mmHg. It shows good repeatability and linearity, and can accurately track fluctuating IOP. Thus, this sensor, with its ease of fabrication and simple design, as well as allowance for continuous pressure measurement, offers a promising approach for IOP monitoring in clinical diagnosis of glaucoma.
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Affiliation(s)
- Yanyan Fan
- State Key Laboratory of Advanced Materials for Smart Sensing, GRINM Group Co. Ltd, Beijing 100088, People's Republic of China
- GRIMAT Engineering Institute Co., LtD, Beijing 101407, People's Republic of China
- General Research Institute for Nonferrous Metals, Beijing 100088, People's Republic of China
| | - Hailing Tu
- General Research Institute for Nonferrous Metals, Beijing 100088, People's Republic of China
| | - Hongbin Zhao
- State Key Laboratory of Advanced Materials for Smart Sensing, GRINM Group Co. Ltd, Beijing 100088, People's Republic of China
- GRIMAT Engineering Institute Co., LtD, Beijing 101407, People's Republic of China
- General Research Institute for Nonferrous Metals, Beijing 100088, People's Republic of China
| | - Feng Wei
- State Key Laboratory of Advanced Materials for Smart Sensing, GRINM Group Co. Ltd, Beijing 100088, People's Republic of China
- General Research Institute for Nonferrous Metals, Beijing 100088, People's Republic of China
| | - Yi Yang
- Institute of Microelectronics, Tsinghua University, People's Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, People's Republic of China
| | - Tianling Ren
- Institute of Microelectronics, Tsinghua University, People's Republic of China
- Beijing National Research Center for Information Science and Technology (BNRist), Tsinghua University, Beijing 100084, People's Republic of China
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Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years. Graefes Arch Clin Exp Ophthalmol 2020; 259:963-970. [PMID: 33263824 PMCID: PMC8016747 DOI: 10.1007/s00417-020-05031-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 10/30/2022] Open
Abstract
PURPOSE We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). METHODS A total of 5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor-matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months. RESULTS A total of 165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3 ± 5.6 mmHg, and the baseline number of glaucoma medications was 2.7 ± 1.1 in both groups. At 24 months, IOP was reduced to 15.8 ± 5.2 mmHg in AIT and 12.4 ± 4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p < 0.01) and lower in TRAB than AIT (p < 0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p < 0.01) and more infrequently in TRAB than in AIT (p > 0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT. CONCLUSION Both AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions.
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Harris JM, Solá-Del Valle D. Effective treatment of a normal-tension glaucoma patient with bilateral ab externo XEN Gel Stent implantation. Am J Ophthalmol Case Rep 2020; 20:100947. [PMID: 33024893 PMCID: PMC7528051 DOI: 10.1016/j.ajoc.2020.100947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/05/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose To provide the first report of effective use of bilateral XEN Gel Stent implantation using an ab externo open-conjunctival approach designed to improve bleb function and meet the uniquely low intraocular pressure requirements of a Japanese patient with normal-tension glaucoma refractory to topical medical therapy. Observations A 54-year-old phakic Japanese woman with severe normal-tension glaucoma on maximally tolerated medical therapy of four topical agents presented with above-goal intraocular pressures and new medication intolerances. She underwent bilateral ab externo open-conjunctival XEN Gel Stent implantation with tenectomy and sub-Tenon's injection of 40μg of mitomycin-C, which resulted in reduction of intraocular pressures by 41.2 and 28.6% to 10 and 10 mmHg in the right and left eyes, respectively at the most recent visit. Postoperatively, a diffuse filtering bleb with good morphology developed in both eyes. The procedure has so far allowed for complete cessation of all four topical medications for up to eight months following surgery without any serious complications. Conclusions This case illustrates the potential of Xen Gel Stent implantation through an ab externo, open-conjunctival approach to be an effective, simple alternative to trabeculectomy to meet the unique low-pressure requirements of normal-tension glaucoma patients with practical and safety benefits of a micro-invasive approach.
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Affiliation(s)
- James M Harris
- Harvard-MIT Division of Health Sciences and Technology, Harvard Medical School, 260 Longwood Ave, Boston, MA, 02115, USA
| | - David Solá-Del Valle
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA
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Thirty Years of Glaucomatous Damage with Normal Intraocular Pressure. Ophthalmol Glaucoma 2020; 3:76-78. [PMID: 32672644 DOI: 10.1016/j.ogla.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022]
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Chen MJ. Normal tension glaucoma in Asia: Epidemiology, pathogenesis, diagnosis, and management. Taiwan J Ophthalmol 2020; 10:250-254. [PMID: 33437596 PMCID: PMC7787092 DOI: 10.4103/tjo.tjo_30_20] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/22/2020] [Indexed: 12/20/2022] Open
Abstract
Normal tension glaucoma (NTG) has similar optic neuropathy as primary open-angle glaucoma (POAG), but intraocular pressure (IOP) is within the normal range. Compared with high-pressure POAG, the development of NTG is possibly a consequence of a complex interaction of several ocular and systemic factors. Recent data have shown higher translaminar pressure gradient due to impaired cerebrospinal fluid dynamics may account for the pathogenic mechanism. Insufficient blood supply and vascular dysregulation may also be the cause of the disease. In clinical evaluation, NTG is a diagnosis by excluding other nonglaucomatous optic neuropathies. NTG is characterized by larger and deeper optic-disc cupping, more central visual field defects and a higher incidence of disc hemorrhage compared with POAG. In clinical practice, controlling IOP as low as possible (with medication, laser trabeculoplasty, or surgery) is the key to manage NTG patients. In addition to IOP reduction, the control of systemic risk factors or improving ocular perfusion may be beneficial therapies. NTG is more prevalent in Asia than in the Western countries. Due to increasing old population and underdiagnoses in the clinical settings, NTG became a great challenge for ophthalmologist in Asia. Therefore, the aim of this article is to focus on the epidemiology, to update pathogenesis, diagnosis, and management for NTG.
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Affiliation(s)
- Mei-Ju Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Yuasa Y, Sugimoto Y, Hirooka K, Ohkubo S, Higashide T, Sugiyama K, Kiuchi Y. Effectiveness of trabeculectomy with mitomycin C for glaucomatous eyes with low intraocular pressure on treatment eye drops. Acta Ophthalmol 2020; 98:e81-e87. [PMID: 31344325 PMCID: PMC7003922 DOI: 10.1111/aos.14195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/29/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To examine the efficacy and safety of current trabeculectomy with mitomycin C in Japan for glaucomatous eyes with low intraocular pressure (IOP). METHODS Two hundred ninety-four eyes of 294 patients with IOP ≤21 mmHg before surgery were studied; all patients were participants in the Collaborative Bleb-related Infection Incidence and Treatment Study (CBIITS), a multicentre, prospective, cohort study conducted at 34 ophthalmological institutions throughout Japan. All eyes had an intraocular pressure ≤ 21 mmHg and had undergone trabeculectomy alone or phacotrabeculectomy. Two success criteria were used: Criterion A comprised 20% reduction of baseline IOP and Criterion B comprised 30% reduction of baseline IOP. The primary outcome was the success rate for each of these criteria. RESULTS The qualified success rates were 87.3% for Criterion A and 42.0% for Criterion B at 5 years. Mean IOP was significantly reduced, from 16.7 ± 2.7 to 11.6 ± 4.0 mmHg at 5 years after trabeculectomy (p < 0.0001); the number of anti-glaucoma medications significantly decreased from 2.7 ± 1.1 to 1.0 ± 1.2 (p < 0.0001) at 5 years after the surgery. Three or more trabeculectomies, and needling were related to increased risk of failure. Incidences of postoperative hyphema, infection, shallow anterior chamber and bleb leakage were 2.4%, 2.4%, 2.0% and 3.4%, respectively. CONCLUSIONS This study showed that trabeculectomy with mitomycin C is an effective procedure with few surgical complications for reducing IOP in patients, even if preoperative IOP was within the normal range.
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Affiliation(s)
- Yuki Yuasa
- Department of Ophthalmology and Visual ScienceHiroshima University Graduate School of Biomedical SciencesMinami‐ku HiroshimaJapan
| | - Yosuke Sugimoto
- Department of Ophthalmology and Visual ScienceHiroshima University Graduate School of Biomedical SciencesMinami‐ku HiroshimaJapan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual ScienceHiroshima University Graduate School of Biomedical SciencesMinami‐ku HiroshimaJapan
| | - Shinji Ohkubo
- Department of OphthalmologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Tomomi Higashide
- Department of OphthalmologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Kazuhisa Sugiyama
- Department of OphthalmologyKanazawa University Graduate School of Medical ScienceKanazawaJapan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual ScienceHiroshima University Graduate School of Biomedical SciencesMinami‐ku HiroshimaJapan
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Tojo N, Hayashi A, Otsuka M. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019; 13:55-61. [PMID: 31564794 PMCID: PMC6743308 DOI: 10.5005/jp-journals-10078-1252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim The aim of this study is to identify target levels of early postoperative intraocular pressure (IOP) associated with successful trabeculectomy using an Ex-Press glaucoma shunt. Materials and methods This was a retrospective single-facility study. We enrolled 158 glaucoma patients who underwent trabeculectomy with Ex-Press and were followed for >1 year, and investigated risk factors for the failure of Ex-Press surgery. We examined age, sex, central corneal thickness (CCT), number of preoperative glaucoma medications, simultaneous performance of cataract surgery, history of trabeculotomy, hypertension (HT), diabetes mellitus (DM), subtype of glaucoma, and early postoperative IOP (minimum, 2 weeks, 1 month, and 3 months). Results Ex-Press surgery could significantly decrease IOP. Success rates at 1, 2, 3, and 4 years were 91.1, 86.1, 82.5, and 78.1%, respectively. Factors significantly affecting the success rate included age, the number of preoperative glaucoma medications, and early postoperative IOP. The IOP cutoff values of minimum IOP for the success of Ex-Press surgery was 5 mm Hg. Conclusions Younger age, a high number of preoperative glaucoma medications, and high IOPs in the early postoperative period were found to be the risk factors for failure of Ex-Press surgery. Considering hypotonic complications, it is desirable to control the minimum IOP from 3–5 mm Hg within 2 weeks after surgery. According to our calculations, target IOPs at 2 weeks, 1 month, and 3 months after Ex-Press surgery should be 8 mm Hg, 10 mm Hg, and 14 mm Hg, respectively. Clinical significance We thought that Ex-Press surgery might require lower IOP in the early postoperative period than conventional trabeculectomy. How to cite this article Tojo N, Hayashi A, et al. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019;13(2):55–61.
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Affiliation(s)
- Naoki Tojo
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
| | - Mitsuya Otsuka
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Aihara M, Kuwayama Y, Miyata K, Ohtani S, Ideta R, Hashimoto Y, Sasaki N, Shirato S. Twelve-month efficacy and safety of glaucoma filtration device for surgery in patients with normal-tension glaucoma. Jpn J Ophthalmol 2019; 63:402-409. [DOI: 10.1007/s10384-019-00682-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 06/13/2019] [Indexed: 12/18/2022]
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Endothelin-1 Concentration in Aqueous Humor Predicts Postoperative Late Low Intraocular Pressure in Primary Open-angle Glaucoma After Trabeculectomy. J Glaucoma 2019; 28:633-636. [DOI: 10.1097/ijg.0000000000001254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Razeghinejad MR, Lee D. Managing normal tension glaucoma by lowering the intraocular pressure. Surv Ophthalmol 2018; 64:111-116. [PMID: 30300624 DOI: 10.1016/j.survophthal.2018.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/23/2018] [Accepted: 07/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Daniel Lee
- Wills Eye Hospital, Glaucoma Service, Philadelphia, Pennsylvania, USA.
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Outcome of Primary Nonpenetrating Deep Sclerectomy in Patients with Steroid-Induced Glaucoma. J Ophthalmol 2018; 2018:9215650. [PMID: 29850218 PMCID: PMC5904771 DOI: 10.1155/2018/9215650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/08/2018] [Accepted: 03/12/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the outcome of primary nonpenetrating deep sclerectomy (NPDS) in patients with steroid-induced glaucoma. Methods This was a retrospective interventional clinical study that included 60 eyes of 60 steroid-induced glaucoma patients that had undergone NPDS. Patients were followed up for 4 years. Data from the records was retrieved as regards corrected distance visual acuity (CDVA), intraocular pressure (IOP), visual field mean defect (dB), and number of antiglaucoma medications needed if any. Complete success of the surgical outcome was considered an IOP ≤ 21 mmHg with no antiglaucoma medications. Qualified success was considered an IOP ≤ 21 mmHg using antiglaucoma medications. Results The mean age was 21.2 ± 8.5 years (ranged from 12 to 35 years). At 48 months, mean IOP was 13.6 ± 2.8 mmHg (range 11-23 mmHg). This represented 60% reduction of mean IOP from preoperative levels. One case had YAG laser goniopuncture. Three cases required needling followed by ab interno revision. Using ANOVA test, there was a statistically significant difference between preoperative and postoperative mean IOP values (P = 0.032). Twelve, 16, and 20 patients required topical antiglaucoma medications at 24, 26, and 48 months postoperative, respectively. Conclusion Primary nonpenetrating deep sclerectomy is a safe and an effective method of treating eyes with steroid-induced glaucoma. No major complications were encountered. After 4 years of follow-up, complete success rate was 56.7% and qualified success rate was 70%.
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Harju M, Suominen S, Allinen P, Vesti E. Long-term results of deep sclerectomy in normal-tension glaucoma. Acta Ophthalmol 2018; 96:154-160. [PMID: 28834385 DOI: 10.1111/aos.13529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/09/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the long-term outcome of deep sclerectomy with and without mitomycin-C (MMC) in patients with normal-tension glaucoma (NTG). METHODS We prospectively analysed consecutive patients randomized to surgery performed either with (MMC group) or without (non-MMC) MMC. Surgery was considered totally successful if, after surgery, the preoperative intra-ocular pressure (IOP) level was reduced by 25% without medication, and a qualified success if medication was required to achieve the same limits. RESULTS A total of 37 patients were enrolled, 15 in the MMC and 22 in the non-MMC group. The median (range) follow-up was 7.9 (1.0-9.0) years, with a drop-out of three (8%) patients. The preoperative IOP was 15 (11-21) mmHg in the MMC and 15 (10-19) mmHg in the non-MMC group. At the last 6- to 9-year follow-up, IOP was significantly reduced to 9 (2-13) mmHg (p = 0.002) and 10 (5-13) mmHg (p < 0.001). The overall (groups combined) complete and qualified success rates were 50% and 71%, with no significant difference between groups (p = 0.48 and p = 0.25). Goniopuncture was performed in 87% and 100% of eyes in the MMC and non-MMC groups (p = 0.14). Needling with MMC injection was performed 0 (0-1) times in the MMC group and 0.5 (0-4) times in the non-MMC group (p = 0.056). We encountered no cases of hyphema, shallow anterior chamber, hypotony maculopathy, choroidal effusion, late bleb leakage, blebitis, endophthalmitis or malignant glaucoma. CONCLUSION In NTG, long-term significant IOP reduction can be achieved with deep sclerectomy with a low incidence of sight-threatening complications.
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Affiliation(s)
- Mika Harju
- Department of Ophthalmology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Sakari Suominen
- Department of Ophthalmology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Pasi Allinen
- Department of Ophthalmology; Helsinki University Hospital; University of Helsinki; Helsinki Finland
| | - Eija Vesti
- Department of Ophthalmology; Turku University Hospital; University of Turku; Turku Finland
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Ho DKH, Garrick A, Aazem S, Mathews D. Effect of primary Phacoviscocanalostomy/ Viscocanalostomy on intraocular pressure of normal tension glaucoma patients: 3-year results. BMC Ophthalmol 2017; 17:201. [PMID: 29110658 PMCID: PMC5674681 DOI: 10.1186/s12886-017-0596-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the efficacy of Viscocanalostomy/Phacoviscocanalostomy (VC/PVC) in lowering intraocular pressure (IOP) in Normal Tension Glaucoma (NTG) patients. METHODS Retrospective electronic database review of patients who underwent VC/PVC for NTG between December 2009 and November 2011 at Stanley eye unit in Abergele Hospital. Goldmann applanation tonometry (GAT) was used for all IOP measurements which were taken at the time of listing for surgery and at 1 day, 1 week, 1 month, then 3-monthly up to 1 year, then half-yearly up to 3 years post operatively. Statistical analysis was performed using unpaired t-test. A P value of <0.05 was accepted as the level of significance. RESULTS Operations were performed on 94 eyes from 67 patients over the study period. The mean age at the time of surgery was 76.4 years. Pre-operative IOP was 17.75 ± 2.19 mmHg (range 12-21 mmHg). 3 year follow-up showed a mean IOP of 13.41 ± 2.22 mmHg (range 8-18 mmHg). By year 3, 17 patients needed laser goniopuncture and 25 patients needed antiglaucoma drops. IOP was reduced by 24.4% at 3 years post-surgery, which was statistically significant (p < 0.0001). CONCLUSIONS From our results, which show a 24.5% reduction in IOP at 3 years with 12% complication rate, we propose that a logical surgical management for NTG patients would be viscocanalostomy, thereby keeping trabeculectomy as an alternative.
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Affiliation(s)
- Derek Kwun-Hong Ho
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK
| | - Adesuwa Garrick
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK
| | - Seemeen Aazem
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK
| | - Divya Mathews
- Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, LL22 8DP, UK.
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Risk Factors and Long-Term Outcomes in Patients with Low Intraocular Pressure after Trabeculectomy. Ophthalmology 2017; 124:1457-1465. [DOI: 10.1016/j.ophtha.2017.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022] Open
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Naito T, Fujiwara M, Miki T, Araki R, Fujiwara A, Shiode Y, Morizane Y, Nagayama M, Shiraga F. Effect of trabeculectomy on visual field progression in Japanese progressive normal-tension glaucoma with intraocular pressure < 15 mmHg. PLoS One 2017; 12:e0184096. [PMID: 28850613 PMCID: PMC5574552 DOI: 10.1371/journal.pone.0184096] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/17/2017] [Indexed: 11/18/2022] Open
Abstract
We examined the effectiveness of trabeculectomy in decreasing the slope of mean deviation (MD) in Japanese patients with progressive normal-tension glaucoma (NTG) at low intraocular pressure (IOP) levels. The charts of patients who had undergone initial trabeculectomy with adjunctive mitomycin C for progressive NTG with medically controlled IOP < 15 mmHg in 2010–2013 were retrospectively reviewed. Seventeen eyes of 13 NTG patients who had undergone at least 5 times of visual field (VF) examinations in both of preoperatively and postoperatively with postoperative follow-up of ≥ 2 years were enrolled. Preoperative and postoperative MD slopes were compared to evaluate the effectiveness of trabeculectomy in slowing progression of VF. Mean IOP (8.1 ± 2.9 mmHg) and number of IOP-lowering medications (0.8 ± 1.5) were significantly lower postoperatively than preoperatively (13.9 ± 0.9 mmHg; P < 0.001 and 3.0± 0.4; P < 0.0001). In total, 91.7% of eyes with single-digit IOP postoperatively showed improvement in MD slope, whereas only 20.0% of eyes with IOP ≥ 10 mmHg postoperatively showed the improvement. Three eyes (17.6%) showed a decrease in visual acuity (VA) of ≥ 0.1 unit; this group had a lower mean postoperative IOP (6.0 ± 1.0 vs. 8.6 ± 3.0 mmHg; P = 0.1717) and a higher mean IOP reduction rate (56.2 vs. 38.5%; P = 0.8296) than eyes with a VA decrease of < 0.1 unit or no change. Thus, in this analysis of Japanese NTG patients with medically controlled IOP < 15 mmHg, achieving an IOP < 10 mmHg with trabeculectomy was beneficial for reducing the VF progression rate in progressive NTG at low IOP levels. However, an IOP < 7 mmHg by surgery would be required careful attention to VA decline.
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Affiliation(s)
- Tomoko Naito
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
- * E-mail:
| | - Miyuki Fujiwara
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Takako Miki
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Ryoichi Araki
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Atsushi Fujiwara
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Yusuke Shiode
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | - Yuki Morizane
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
| | | | - Fumio Shiraga
- Department of Ophthalmology, Okayama University Medical School Hospital, Okayama, Japan
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Ishida K, Moroto N, Murata K, Yamamoto T. Effect of glaucoma implant surgery on intraocular pressure reduction, flare count, anterior chamber depth, and corneal endothelium in primary open-angle glaucoma. Jpn J Ophthalmol 2017; 61:334-346. [PMID: 28374269 DOI: 10.1007/s10384-017-0512-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 03/06/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate the effect of filtering surgery using the EX-PRESS device on intraocular pressure (IOP), flare count, anterior chamber (AC) depth, and the corneal endothelium in primary open-angle glaucoma (POAG), including normal-tension glaucoma (NTG). PATIENTS AND METHODS The study comprised 63 consecutive patients with POAG or NTG. They underwent complete ophthalmologic examinations, including measurement of visual acuity (VA), IOP, flare count, AC depth, and cell density of the corneal endothelium (CE). Two outcomes were used for surgical success: outcome 1 was defined as a ≥20% reduction in the IOP from the preoperative value, with an IOP ≥ 5 mmHg but ≤18 mmHg, and outcome 2 was defined as a ≥20% reduction in the IOP, with an IOP ≥ 5 mmHg but ≤15 mmHg. RESULTS The IOP significantly decreased from 17.7 preoperatively to 12.4 mmHg postoperatively (P < 0.0001). The success rates for outcome 1 at 24 months were 81.3 and 46.7% for POAG and NTG, respectively (P = 0.0065); the corresponding success rates for outcome 2 were 79.4 and 46.7% (P = 0.0120). The flare count significantly increased on postoperative day 1 (P = 0.0002) but recovered to insignificant levels by day 3 (P = 0.0686). A transient decrease in AC depth was observed by 4 weeks after surgery (P = 0.0017). The CE changed from 2529 preoperatively to 2428/mm2 at 24 months (P = 0.0089). CONCLUSION The advantage of filtering surgery using the EX-PRESS device includes reduced inflammation, and the disadvantages include loss of the CE and reduced effectiveness of NTG.
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Affiliation(s)
- Kyoko Ishida
- Department of Ophthalmology, Toho University Ohashi Medical Center, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. .,Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan.
| | - Naoya Moroto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Murata
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
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Sakata R, Sakisaka T, Matsuo H, Miyata K, Aihara M. Effect of Travoprost and Nonsteroidal Anti-Inflammatory Drug on Diurnal Intraocular Pressure in Normal Subjects with Low-Teen Baseline Intraocular Pressure. J Ocul Pharmacol Ther 2016; 32:365-70. [PMID: 27294589 DOI: 10.1089/jop.2015.0159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The main purpose was to determine whether a nonsteroidal anti-inflammatory drug (NSAID) ophthalmic solution would affect the intraocular pressure (IOP)-lowering effect of a benzalkonium chloride (BAK)-free prostaglandin analog, travoprost. The secondary purpose was to confirm the IOP-lowering effect of BAK-free travoprost on the diurnal IOP. METHODS This was a prospective, randomized, double-blind, placebo-controlled 1-month trial. After baseline diurnal IOP was confirmed, travoprost was administered once daily to both eyes. Bromfenac sodium hydrate was then randomly assigned to one eye, while flavin adenine dinucleotide sodium was applied to the other eye as a control. Both solutions were administered twice daily. IOP was measured three times daily (8:00, 14:00, and 20:00). The IOP of both groups was compared using Student's t-test. The effect of NSAID on IOP was investigated by repeated measures analysis of variance (ANOVA). RESULTS Twenty-eight normal Japanese subjects (mean age, 36.6 years) completed the study. After the start of travoprost, remarkable IOP lowering was gained and it settled to 10-11 mmHg. The diurnal IOPs of the NSAID group showed similar tendencies to that of the control group (P = 0.69-1.0). In a 1-month period, the range of IOP reductions compared with the baseline IOP of both groups showed no significant difference (P = 0.76-0.92). NSAID did not have an influence on IOP (F-value = 0.0036, P = 0.95). CONCLUSIONS Although BAK-free travoprost showed a powerful IOP-lowering effect in diurnal and 1-month readings, even in eyes with an IOP of <13 mmHg, the NSAID ophthalmic solution did not affect its IOP-lowering effect.
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Affiliation(s)
- Rei Sakata
- 1 Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Toshihiro Sakisaka
- 1 Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | | | - Kazunori Miyata
- 3 Department of Ophthalmology, Miyata Eye Hospital , Miyazaki, Japan
| | - Makoto Aihara
- 1 Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
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Mastropasqua R, Fasanella V, Agnifili L, Fresina M, Di Staso S, Di Gregorio A, Marchini G, Ciancaglini M. Advance in the pathogenesis and treatment of normal-tension glaucoma. PROGRESS IN BRAIN RESEARCH 2015; 221:213-32. [PMID: 26518080 DOI: 10.1016/bs.pbr.2015.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Normal-tension glaucoma (NTG) is a multifactorial disease where mechanical stresses and vascular alterations to the optic nerve head probably represent the key pathogenic moments. Although intraocular pressure (IOP) plays a crucial role in the retinal ganglion cell loss, the IOP reduction does not necessarily reduces the disease progression. Therefore, several IOP-independent factors such as glutamate toxicity, oxidative stress, autoimmunity, and vascular dysregulation have been considered in the pathogenesis of NTG. Numerous evidences documented an impairment of the ocular blood flow, involved both in the onset and progression of the disease. The IOP reduction remains the main strategy to reduce the damage progression in NTG. Recently, new treatment strategies have been proposed to improve the control of the disease. Neuroprotection is a rapidly expanding area of research, which represents a promising tool. In the present review, we summarize the recent scientific advancements in the pathogenesis and treatment of NTG.
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Affiliation(s)
- Rodolfo Mastropasqua
- Ophthalmology Unit Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Vincenzo Fasanella
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Department of Medicine and Aging Science, Ophthalmology Clinic, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Michela Fresina
- Department of Specialist, Diagnostics and Experimental Medicine (DIMES), Ophthalmology Service, University of Bologna, Bologna, Italy
| | - Silvio Di Staso
- Ophthalmic Clinic Department of Surgical Science, Eye Clinic, University of L'Aquila, L'Aquila, Italy
| | - Angela Di Gregorio
- Ophthalmic Clinic Department of Surgical Science, Eye Clinic, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Marchini
- Ophthalmology Unit Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy
| | - Marco Ciancaglini
- Ophthalmic Clinic Department of Surgical Science, Eye Clinic, University of L'Aquila, L'Aquila, Italy.
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Van Tassel SH, Radcliffe NM, Demetriades AM. One Year of Glaucoma Research in Review-2013 to 2014. Asia Pac J Ophthalmol (Phila) 2015; 4:228-35. [PMID: 26197218 PMCID: PMC4520779 DOI: 10.1097/apo.0000000000000133] [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] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The purpose of this study was to provide the practicing clinical ophthalmologist with an update on relevant glaucoma literature published from 2013 to 2014. DESIGN This study is a literature review. METHODS The authors conducted a 1-year (October 1, 2013, to September 30, 2014) English-language glaucoma literature search on PubMed of articles containing "glaucoma" or "glaucomatous" with title/abstract as a filter. Medical subject headings filtered searching was not performed because of the newness of the reviewed material. RESULTS Literature search yielded 2314 articles, after which we excluded reviews and letters to the editor. We highlighted articles featuring new or updated approaches to the pathophysiology, diagnosis, or treatment of glaucoma and gave preference to human research. CONCLUSIONS This review features literature that is of interest to ophthalmologists in practice and also highlights studies that may provide insight on future developments applicable to clinical ophthalmology.
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