1
|
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.
Collapse
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
| |
Collapse
|
2
|
Chan W, Zhang C, Mittal A, Fink A, Michalovic S, Weiner A. Effect of Preoperative Trabecular Meshwork Pigmentation and Other Eye Characteristics on Outcomes of Combined Phacoemulsification/Minimally Invasive Glaucoma Surgery. Ophthalmol Glaucoma 2024; 7:271-281. [PMID: 38185378 DOI: 10.1016/j.ogla.2024.01.001] [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: 09/16/2023] [Revised: 12/15/2023] [Accepted: 01/03/2024] [Indexed: 01/09/2024]
Abstract
PURPOSE To investigate associations between pigmentation of the trabecular meshwork (PTM) and other preoperative eye characteristics and outcomes of minimally invasive glaucoma surgery combined with phacoemulsification (Phaco/MIGS). DESIGN Retrospective interventional case series. PARTICIPANTS Academic glaucoma clinic patients with symptomatic cataract and glaucoma treated with combined Phaco/MIGS. METHODS Analyzing preoperative PTM, intraocular pressure (IOP), IOP-lowering medications and visual acuity (VA) data in relation to Phaco/MIGS outcomes. MAIN OUTCOME MEASURES Pigmentation of the trabecular meshwork and other preoperative eye characteristics in relation to Phaco/MIGS success defined as postoperative IOP between 5 and 21 mmHg and IOP reduction of ≥ 20% and/or a reduction of ≥ 1 IOP-medications compared to baseline, and final IOP, IOP-lowering medications and VA. RESULTS A total of 265 eyes (172 patients, mean age, 73.5 [standard deviation, 10.0], range 35-95 years, male 40.0%) were identified and categorized with high PTM (108 eyes, 40.8%) or low PTM (157 eyes, 59.2%). The high PTM group, compared with the low PTM group, demonstrated higher preoperative IOP (16.7 [standard error 0.4] vs. 15.2 [0.4] mmHg, P = 0.009), included more eyes with primary open-angle glaucoma (POAG, P = 0.03), fewer eyes with normal-tension glaucoma (NTG, P = 0.01), and fewer eyes with mild stage glaucoma (P = 0.001). Compared to baseline, final IOP decreased by 6.5 [2.4]% and 13.4 [3.0]% (P = 0.075) to 13.5 [0.3] mmHg and 13.6 [0.4] mmHg (P = 0.77) in the low and high PTM groups, respectively, and IOP-lowering medications decreased by 34.6 [4.9]% (n = 116) and 18.1 [7.3]% (n = 85), respectively (P = 0.062). Surgical success was 59.9% and 58.3%, respectively (P = 0.87). It was positively associated with higher preoperative IOP (hazard ratio 1.08 [95% confidence interval 1.04-1.12] P < 0.0001) and higher number of preoperative IOP-medications (1.20 [1.05-1.37] P = 0.007), negatively associated with history of selective laser trabeculoplasty (SLT, 0.40 [0.23-0.68] P = 0.0009) and longer axial length (0.87 [0.80-0.94], P = 0.0006), but was not associated with PTM. CONCLUSIONS Higher PTM was associated with POAG rather than NTG, with more severe glaucoma and higher preoperative IOP, but not with Phaco/MIGS success. Surgical success was positively associated with higher preoperative IOP and number of IOP-medications and negatively associated with history of SLT and longer axial length. These findings may help guide glaucoma surgeons in surgical planning and patient counseling. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Collapse
Affiliation(s)
- Weilin Chan
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Charles Zhang
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Abhiniti Mittal
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Andrew Fink
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Sharon Michalovic
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York
| | - Asher Weiner
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York (SUNY), Buffalo, New York.
| |
Collapse
|
3
|
Garweg RA, Pfister IB, Schild C, Halberstadt M, Straessle K, Anastasi S, Garweg JG. IOP-lowering and drug-sparing effects of trabectome surgery with or without cyclodialysis ab interno. Graefes Arch Clin Exp Ophthalmol 2023; 261:2917-2925. [PMID: 37145333 DOI: 10.1007/s00417-023-06063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE To compare the postoperative intraocular pressure (IOP) after ab interno trabeculectomy (AIT; trabectome surgery) alone or combined with cyclodialysis ab interno (AITC). PATIENTS AND METHODS Forty-three eyes with insufficiently controlled open-angle glaucoma were included in this consecutive case series. All eyes received AIT, combined with phacoemulsification and IOL-implantation in phakic instances, with or without additional cyclodialysis ab interno. Postoperative visual acuity, IOP, number of IOP-lowering medications and complications were registered over 12 months. RESULTS A total of 19 eyes (14 patients) received AIT and 24 (19 patients) received AITC. Both groups were comparable for baseline IOP (AIT: 19.7 ± 8.2 mmHg; AITC: 19.4 ± 6.8 mmHg; p = 0.96), there was a comparable IOP reduction after 6 months (AIT: - 3.8 ± 12.3, median (interquartile range (IQR)): - 3.8 (- 7.8-4.8) mmHg; AITC: - 4.9 ± 8.3, median (IQR): - 2.0 (- 10.8-2.0) mmHg; p = 0.95) and 12 months (AIT: - 4.3 ± 6.6, median (IQR): - 4.0 (- 8.0 to - 1.0) mmHg; AITC: - 3.7 ± 6.7, median (IQR): - 1.5 (- 5.5 to - 0.5) mmHg; p = 0.49). While final visual acuity was similar between the groups, they differed regarding topical IOP-lowering medications (baseline: AIT 2.9 ± 1.2 and AITC 2.9 ± 1.2; 1 year after surgery: AIT 2.6 ± 1.5 (p = 0.16) and AITC 1.3 ± 1.3; p < 0.001)). Depending on the definition, a complete or qualified success of 33.4-45.8% was achieved in AITC compared to 15.8-21.1% in AIT. CONCLUSION The additional suprachoroidal outflow when AIT is combined with cyclodialysis ab interno (AITC) seems to result in an additional drug sparing effect for at least 1 year without critical safety signals. Thus, AITC might be further investigated prospectively prior to advocating its use in routine minimally invasive glaucoma surgery.
Collapse
Affiliation(s)
- Richard A Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Department of Ophthalmology, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Christin Schild
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | | | - Kim Straessle
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Stefano Anastasi
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Justus G Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland.
- Swiss Eye Institute, Rotkreuz, Switzerland.
- Department of Ophthalmology, University of Bern, Bern, Switzerland.
| |
Collapse
|
4
|
Zarei R, Azimi A, Fakhraei G, Eslami Y, Naderan M, Nouri-Mahdavi K, Caprioli J. Combined phacoviscocanalostomy versus phacoemulsification alone in patients with coexisting cataract and mild-to-moderate open-angle glaucoma; a randomized-controlled trial. Eye (Lond) 2023; 37:1390-1396. [PMID: 35752716 PMCID: PMC10170155 DOI: 10.1038/s41433-022-02152-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVE Management of concomitant cataract and glaucoma depends on the stage of glaucoma and the patient's situation. There are different surgical options for handling visually significant cataract and mild-to-moderate open-angle glaucoma (OAG). We aimed to compare the one-year results of phacoemulsification alone versus phacoviscocanalostomy in these patients. SUBJECTS/METHODS This was a parallel-arm, single-masked, randomized-controlled trial, conducted at Farabi Eye Hospital, Tehran, Iran between January 2016 and January 2018. We enrolled 89 eyes from 89 patients with mild-to-moderate primary OAG or pseudoexfoliative glaucoma (PEXG) with visually significant age-related cataract. They randomly underwent phacoemulsification alone (n = 44) or combined phaco-viscocanalostomy (n = 45). All patients had a 12-month follow-up period, and the mean intraocular pressure (IOP), the number of antiglaucoma medications, and complete and qualified success rates were compared. RESULTS After the 1st and 3rd months, the mean IOP showed significantly decreased in the phaco-visco group compared to the phaco group (P < 0001 and P = 0.004, respectively), but it was not statistically significant at 6th and 12th months (P = 0.540 and P = 0.530). The need for antiglaucoma medication and the complete and qualified success rates were significantly in favour of the phaco-visco group in all postoperative visits (P < 0.05). CONCLUSIONS Although both phacoemulsification alone and phacoviscocanalostomy procedures can be considered for patients with mild-to-moderate OAG, we found better success rates using phacoviscocanalostomy. Therefore, if the surgeon is an expert in performing this technique, this non-penetrating procedure can be applied in patients with visually significant cataract and earlier stages of OAG, especially in patients with PEXG.
Collapse
Affiliation(s)
- Reza Zarei
- Glaucoma service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Azimi
- Glaucoma service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ghasem Fakhraei
- Glaucoma service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yadollah Eslami
- Glaucoma service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Naderan
- Glaucoma service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kouros Nouri-Mahdavi
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joseph Caprioli
- Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
5
|
Gołaszewska K, Obuchowska I, Konopińska J. Efficacy and Safety of ab Externo Phaco-Canaloplasty versus First-Generation iStent Bypass Implantation Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-Early Results. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1365. [PMID: 36674122 PMCID: PMC9859240 DOI: 10.3390/ijerph20021365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/07/2023] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
This study evaluated the early outcomes of the hypotensive efficacy and safety profile of ab externo phaco-canaloplasty versus first-generation iStent bypass implantation combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). In total, 82 patients with POAG comprising 92 eyes were divided into phaco-canaloplasty (Group PC, (n = 47) or iStent combined with phacoemulsification (Group PiS, n = 45) groups. Primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications. Secondary outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (EECD), changes in anterior chamber depth (ACD), and complication rate. The follow-up period was approximately 6 months. Preoperative IOPs were 17.30 (15.00; 19.85) mmHg and 17.50 (15.10; 20.90) mmHg in the PC and PiS groups, respectively (p = 0.876). At the end of the follow-up, IOP decreased to 15.00 (13.00; 16.00) mmHg and 15.00 (14.00; 17.00) mmHg in the PC and PiS groups, respectively (p = 0.438). Medication usage decreased from 2.08 to 0.12 and 1.40 to 0.04 in PC and PiS eyes, respectively. Most patients in both groups were medication-free at 6 months follow-up. After 6 months of observation, EECD in PC and PiS groups decreased from 2309.50 (2032.00; 2533.00) to 1966.50 (1262.00; 2353.50) and 2160.00 (1958.50; 2372.50), to1231.00 (1089.00; 2050.00), respectively (p = 0.037). Pre-surgery BCVA was 0.80 (0.50; 1.00) and 0.60 (0.40; 1.00) in PC and PiS eyes, respectively (p = 0.456). Follow-up BCVA was 0.95 (0.60; 1.00) for PC and 1.00 (1.00; 1.00) for PiS. Hyphema and corneal oedema were noted on the first day post-surgery in both groups. Subsequent complications included a transient increase in IOP in the PC group. Phaco-canaloplasty and iStent bypass implantation combined with phacoemulsification significantly lowered IOP and decreased medication burden. All eyes in both groups maintained or exhibited improved BCVA relative to baseline. Both surgeries had low postoperative complication rates and exhibited comparable safety profiles over 6-month follow-up in patients with POAG.
Collapse
Affiliation(s)
| | | | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, 15-089 Białystok, Poland
| |
Collapse
|
6
|
Cantor L, Lindfield D, Ghinelli F, Świder AW, Torelli F, Steeds C, Dickerson Jr JE, Nguyen DQ. Systematic Literature Review of Clinical, Economic, and Humanistic Outcomes Following Minimally Invasive Glaucoma Surgery or Selective Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma with or Without Cataract Extraction. Clin Ophthalmol 2023; 17:85-101. [PMID: 36636619 PMCID: PMC9831079 DOI: 10.2147/opth.s389406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS) are increasingly used options for mild-to-moderate open-angle glaucoma (OAG) care. While most MIGS devices are indicated for use in combination with cataract surgery only, with phacoemulsification playing a role in lowering IOP, newer technologies can also be used as standalone glaucoma surgery. Methods This systematic literature review (SLR) aimed to assess the clinical, economic, and humanistic outcomes of MIGS and SLT for the treatment of OAG and was conducted according to PRISMA guidelines. Studies that assessed MIGS or SLT in at least one treatment arm versus any other glaucoma treatment in adults with mild-to-moderate OAG were included. Clinical, humanistic (health-related quality of life [HRQoL] and patient burden), and economic data were extracted, and the methodological quality of included studies was evaluated. Results A total of 2720 articles were screened, and 81 publications were included. Fifty-eight reported clinical outcomes. The majority assessed iStent or iStent inject (n=41), followed by OMNI (n=9), gonioscopy-assisted transluminal trabeculotomy (GATT) or the Kahook Dual Blade (KDB) (n=7), Hydrus (n=6), SLT (n=5), Xen Gel Stent (n=2), PreserFlo (n=1), and iTrack (n=1). IOP reduction was observed across prospective studies, varying from -31% to -13.7% at month 6 and from -39% to -11.4% at year 1 versus baseline. Most adverse events were transient and non-serious. Limited humanistic and economic data were identified. Conclusion Given their established efficacy and safety, there is a rationale for wider use of MIGS in mild-to-moderate OAG. Of the MIGS devices, iStent and OMNI have the largest clinical evidence base supporting their sustained effectiveness.
Collapse
Affiliation(s)
- Louis Cantor
- Eugene and Marilyn Glick Eye Institute, Indiana School of Medicine, Indianapolis, IN, USA
| | - Dan Lindfield
- Royal Surrey County Hospital, Guildford, England, UK
| | | | | | - Francesca Torelli
- Valid Insight, Macclesfield, England, UK,Correspondence: Francesca Torelli, Valid Insight, Ropewalks, Newton St, Macclesfield, SK11 6QJ, UK, Tel +44 203 750 9833 Ext 703, Email
| | | | - Jaime E Dickerson Jr
- Sight Sciences, Menlo Park, CA, USA,North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dan Q Nguyen
- Mid-Cheshire Hospitals NHS Foundation Trust, Crewe, UK
| |
Collapse
|
7
|
Dakroub M, Verma-Fuehring R, Strzalkowska A, Hillenkamp J, Yousef YA, Loewen NA. Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy. J Curr Glaucoma Pract 2023; 17:9-14. [PMID: 37228309 PMCID: PMC10203335 DOI: 10.5005/jp-journals-10078-1384] [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: 12/16/2021] [Accepted: 11/29/2022] [Indexed: 05/27/2023] Open
Abstract
Aim To compare ab interno trabeculectomy by trabecular meshwork (TM) excision to plasma-mediated ablation in primary open-angle glaucoma (POAG) patients. Methods Retrospectively collected data of TrabEx+ (TEx) (n = 56) and Trabectome (T) (n = 99) patients were compared by coarsened exact matching to reduce confounding and matched based on baseline intraocular pressure (IOP) and age. The primary outcomes were IOP and the number of glaucoma medications. Complications and the need for additional glaucoma surgery were assessed. Patients were followed for up to 1 year. Results A total of 53 TEx could be matched to T. Baseline IOP was 16.5 ± 4.6 mm Hg in both; age was 73.7 ± 8.8 and 71.5 ± 9.9 years in TEx and T, respectively. TEx was taking more medications than T (p < 0.001). IOP was reduced to 14.8 ± 4.3 in TEx and to 13.4 ± 3.4 in T at 6 months, and to 14.9 ± 6.0 (p = 0.13) in TEx and to 14.1 ± 3.8 mm Hg (all p < 0.05) in T at 12 months. Medications were reduced at both 6 and 12 months (p < 0.05). No differences were seen between TEx and T at 6 and 12 months. In TEx, only one serious complication occurred, and two patients required further glaucoma surgery. Conclusion Although both groups had a baseline IOP considered low for ab interno trabeculectomy, IOP and medications were reduced further at 6 and 12 months. IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences. Both had a low complication rate. Clinical significance This study investigated subtle differences between a plasma-ablative device, the T, and an excisional device, the TEx, by applying coarsened exact matching. IOP and medications were reduced in both groups at 6 and 12 months, although IOP reduction did not reach significance in TEx at 12 months. The intergroup comparison did not reveal any significant differences, with both devices having a low complication rate. How to cite this article Dakroub M, Verma-Fuehring R, Strzalkowska A, et al. Coarsened Exact Matching of Excisional to Plasma-ablative Ab Interno Trabeculectomy. J Curr Glaucoma Pract 2023;17(1):9-14.
Collapse
Affiliation(s)
- Mohamad Dakroub
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Raoul Verma-Fuehring
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Alicja Strzalkowska
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Jost Hillenkamp
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Yousef Al Yousef
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany
| | - Nils A Loewen
- Department of Ophthalmology, University Eye Hospital of Wuerzburg, Wuerzburg, Germany; Artemis Eye Centers of Frankfurt, Hanauer Landstraße, Frankfurt, Germany
| |
Collapse
|
8
|
Dubey S, Bansal T, Garg P, Hegde A, Das R, Rekha PD. Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India. Indian J Ophthalmol 2022; 70:3569-3574. [PMID: 36190048 PMCID: PMC9789827 DOI: 10.4103/ijo.ijo_656_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose This study was done to report intermediate-term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross-sectional, longitudinal, observational study design. Methods Fifty-three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre-operative data included age, gender, eye laterality, specific diagnosis, number of anti-glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post-operative data included IOP changes during the follow-up till 1-year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ≤ 21 mmHg and ≥ 20% reduction of IOP from pre-operative IOP with no additional glaucoma surgery. Results The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1-year follow-up. The AGMs reduced from 2.4 ± 1.4 pre-surgery to 1.6 ± 1.4 at 1-year follow-up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra-operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.
Collapse
Affiliation(s)
- Suneeta Dubey
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India,Correspondence to: Dr. Suneeta Dubey, Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India. E-mail: ;
Dr. Rekha PD, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore, Karnataka, India. E-mail:
| | - Tanima Bansal
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Prerna Garg
- Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India
| | - Aparna Hegde
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India
| | - Ranajit Das
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India
| | - PD Rekha
- Yenepoya Research Centre, Yenepoya (Deemed to be University), Derlakatte, Mangalore, Karnataka, India,Correspondence to: Dr. Suneeta Dubey, Department of Glaucoma, Dr. Shroff’s Charity Eye Hospital, New Delhi, India. E-mail: ;
Dr. Rekha PD, Yenepoya Research Centre, Yenepoya (Deemed to be University), Deralakatte, Mangalore, Karnataka, India. E-mail:
| |
Collapse
|
9
|
McNiel CL, Sanchez FG, Rees JP, Gardiner SK, Young JW, Kinast RM, Young A, Jones EP, Mansberger SL. Intraocular Pressure and Medication Burden With Cataract Surgery Alone, or Cataract Surgery Combined With Trabecular Bypass or Goniotomy. J Glaucoma 2022; 31:423-429. [PMID: 35353775 DOI: 10.1097/ijg.0000000000002028] [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: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 11/25/2022]
Abstract
PRCIS When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden. PURPOSE To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). MATERIALS AND METHODS We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1. RESULTS All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both). CONCLUSION Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.
Collapse
Affiliation(s)
- Christopher L McNiel
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
- Department of Osteopathic Medicine, Western University of Health Sciences, Lebanon, OR
| | - Facundo G Sanchez
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Jack P Rees
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Stuart K Gardiner
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Jonathan W Young
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Robert M Kinast
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Amber Young
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Emily P Jones
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| | - Steven L Mansberger
- Legacy Devers Eye Institute and Discoveries In Sight Research Laboratories at Legacy Health, Portland
| |
Collapse
|
10
|
Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma. Sci Rep 2021; 11:21432. [PMID: 34728652 PMCID: PMC8563755 DOI: 10.1038/s41598-021-00808-3] [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: 03/22/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022] Open
Abstract
To compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.
Collapse
|
11
|
Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent. J Clin Med 2021; 10:jcm10102129. [PMID: 34069079 PMCID: PMC8157143 DOI: 10.3390/jcm10102129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.
Collapse
|