Surgical Advancement of Tenon's Layer During Trabeculectomy Improves Bleb Morphology

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the "traditional" MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.

Peripheral iridectomy for glaucoma is more effective than compound trabeculectomy and significantly reduces Hcy and hs-CRP levels

OBJECTIVE

To investigate the efficacy of peripheral iridectomy and compound trabeculectomy for glaucoma and the changes in homocysteine (Hcy) and hypersensitivity C-reactive protein (hs-CRP) levels before and after treatment.

METHODS

Altogether 104 patients with primary angle-closure glaucoma who were admitted from February 2020 to January 2022 were enrolled in this study for a retrospective analysis. Among them, 49 cases treated by peripheral iridectomy were considered as the research group, and 55 treated by compound trabeculectomy were seen as the control group. The intraocular pressure (IOP), vision, anterior chamber depth (ACD), surgical efficiency and complications before and after surgery was compared between the two groups of patients. Patients' venous blood was collected before and after treatment to test the Hcy and hs-CRP levels, and the relationship between the levels and treatments was analyzed. The ROC curves of Hcy and hs-CRP diagnostic efficacy after treatment were also plotted, and the relationship between Hcy and hs-CRP and patient outcomes was tested by Pearson correlation coefficient.

RESULTS

There were no marked differences in IOP, vision and ACD between the two groups before surgery (P>0.05). After surgery, the IOP was dramatically lower, and ACD and vision were dramatically higher in the research group than those in the control group (P<0.01). Compared to the control group, the treatment success rate in the research group was markedly higher, and the incidence of adverse reactions was lower. There was no difference in Hcy and hs-CRP levels before surgery between the two groups (P>0.05). After surgery both Hcy and hs-CRP levels decreased (P<0.05), and levels in the research group were lower than in the control group (P<0.05). Patients with better outcomes had lower postoperative Hcy and hs-CRP levels (P<0.05). ROC curves of the diagnostic efficacy of Hcy and hs-CRP after treatment manifested that the areas under the curve were >0.7. Both Hcy and hs-CRP levels were found to be negatively correlated with patient outcomes by Pearson correlation coefficient (P<0.001).

CONCLUSION

The efficacy of peripheral iridotomy for glaucoma is better than that of compound trabeculectomy. Monitoring Hcy and hs-CRP levels in patients before and after surgery can effectively assess clinical outcomes as well as the safety of the procedure.