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Levin AM, Sheybani A. Glaucoma surgical procedures under development. Curr Opin Ophthalmol 2024; 35:111-115. [PMID: 38108372 DOI: 10.1097/icu.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
PURPOSE OF REVIEW Rapid innovation in glaucoma surgery is expanding surgical options in the angle, subconjunctival space, and supraciliary space. RECENT FINDINGS Advancements in glaucoma surgery make it possible for surgeons to provide treatments with less risk. In particular, new devices and lasers are available for minimally invasive glaucoma surgeries. There are also new implants and techniques for bleb-forming glaucoma surgery. SUMMARY As glaucoma surgeons have access to an increasing number of procedures, devices, and treatments, it is important for evidence to drive decision-making.
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Affiliation(s)
| | - Arsham Sheybani
- Washington University School of Medicine, St Louis, Missouri, USA
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Nagy ZZ, Kranitz K, Ahmed IIK, De Francesco T, Mikula E, Juhasz T. First-in-Human Safety Study of Femtosecond Laser Image-Guided Trabeculotomy for Glaucoma Treatment: 24-month Outcomes. OPHTHALMOLOGY SCIENCE 2023; 3:100313. [PMID: 37363134 PMCID: PMC10285639 DOI: 10.1016/j.xops.2023.100313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 06/28/2023]
Abstract
Purpose Pilot study to evaluate adverse events and intraocular pressure (IOP)-lowering of a novel, noninvasive glaucoma procedure, femtosecond laser, image-guided, high-precision trabeculotomy (FLIGHT). Design Prospective, nonrandomized, single-center, interventional, single-arm clinical trial. Participants Eighteen eyes from 12 patients with open-angle glaucoma. Methods Eighteen eyes from 12 patients underwent FLIGHT, creating a single channel measuring 500-μm wide by 200-μm high through the trabecular meshwork and into Schlemm's canal. Adverse events, IOP, and other parameters were evaluated out to 24 months. Main Outcome Measures Outcomes were the rates and types of adverse events and the rate of postprocedure best-corrected visual acuity loss (≥ 2 lines) compared with baseline. Efficacy outcomes were reduction in mean intraocular pressure (IOP) with respect to baseline and the percentage of eyes with a ≥ 20% reduction in IOP. Results Eighteen eyes from 12 patients were enrolled in the study; 11 patients (17 eyes) returned at 24 months. There were no serious adverse events related to the laser treatment. Well-defined channels were clearly visible at 24 months by gonioscopy and anterior segment OCT, with no evidence of closure. At 24 months, the mean IOP was reduced by 34.6% from 22.3 ± 5.5 to 14.5 ± 2.6 mmHg (P < 5e-5), with an average of 2.0 ± 1.2 hypotensive medications compared with 2.2 ± 1.1 at baseline (P = 0.22). Fourteen out of the 17 study eyes (82.3%) achieved a ≥ 20% reduction in IOP at 24 months when compared with baseline. Conclusion The FLIGHT system demonstrated a favorable safety profile in this initial pilot study, with no device-related serious adverse events. The channels appeared patent at 24 months, indicating medium-term durability. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Zoltan Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kinga Kranitz
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Iqbal Ike K. Ahmed
- John Moran Eye Center, University of Utah, Salt Lake City, Utah
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Ticiana De Francesco
- John Moran Eye Center, University of Utah, Salt Lake City, Utah
- Clinica de Olhos De Francesco, Fortaleza, Brazil & Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil
| | - Eric Mikula
- ViaLase Inc., Aliso Viejo, California
- Department of Ophthalmology, University of California, Irvine, Irvine, Califorania
| | - Tibor Juhasz
- ViaLase Inc., Aliso Viejo, California
- Department of Ophthalmology, University of California, Irvine, Irvine, Califorania
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California
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Chan PPM, Larson MD, Dickerson JE, Mercieca K, Koh VTC, Lim R, Leung EHY, Samuelson TW, Larsen CL, Harvey A, Töteberg-Harms M, Meier-Gibbons F, Shu-Wen Chan N, Sy JB, Mansouri K, Zhang X, Lam DSC. Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges. Asia Pac J Ophthalmol (Phila) 2023; 12:537-564. [PMID: 38079242 DOI: 10.1097/apo.0000000000000646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
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.
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Affiliation(s)
- Poemen P M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- University of North Texas Health Science Center, North Texas Eye Research Institute, Fort Worth, TX, USA
| | | | - Victor Teck Chang Koh
- Department of Ophthalmology, National University Health System, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Enne Hiu Ying Leung
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
| | - Thomas W Samuelson
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | - Christine L Larsen
- Minnesota Eye Consultants, Bloomington, MN, US
- Department of Ophthalmology, University of Minnesota, MN, US
| | | | - Marc Töteberg-Harms
- Department of Ophthalmology, Augusta University, Medical College of Georgia, Augusta, GA, USA
| | | | | | - Jessica Belle Sy
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
- Baguio General Hospital and Medical Center, Baguil City, Benguet, Philippines
| | - Kaweh Mansouri
- Glaucoma Center, Swiss Visio, Clinique de Montchoisi, Lausanne, Switzerland
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Dennis S C Lam
- The C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
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Papa-Vettorazzi R, Pascual L, Moura-Coelho N, Freixes S, Arrondo E. Real life experience following combined excimer laser trabeculostomy and phacoemulsification in eyes with ocular hypertension or mild glaucoma and cataract. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:521-527. [PMID: 37364679 DOI: 10.1016/j.oftale.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/05/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension (OHT). METHODS Single-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥20% from preoperative IOP, an IOP ≤ 14 mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP. RESULTS Mean follow-up was 658 ± 64 days. Mean preoperative IOP was 17.76 ± 4.88 mmHg, it decreased to 15.35 ± 3.10 mmHg at 1 year (n = 37) (p = 0.006) and to 14.00 ± 3.78 at 3 years (n = 8) (p = 0.074). Mean number of glaucoma medication requirements decreased from 2.02 ± 1.0 preoperatively to 1.02 ± 0.96 at 1 year (n = 37) (p < 0.001) and to 1.63 ± 0.92 at 3 years (n = 8) (p = 0.197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8 years after the procedure due to uncontrolled IOP. CONCLUSIONS Combined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or OHT and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery.
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Affiliation(s)
- R Papa-Vettorazzi
- Instituto de Microcirugía Ocular, Barcelona, Spain; Visualiza Clinic, Ciudad de Guatemala, Guatemala.
| | - L Pascual
- Instituto de Microcirugía Ocular, Barcelona, Spain
| | | | - S Freixes
- Instituto de Microcirugía Ocular, Barcelona, Spain
| | - E Arrondo
- Instituto de Microcirugía Ocular, Barcelona, Spain
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Klabe K, Rüfer F. [Minimally invasive glaucoma surgery-Comparison of angle based procedures]. DIE OPHTHALMOLOGIE 2023; 120:358-371. [PMID: 37010578 DOI: 10.1007/s00347-023-01844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
Surgical procedures are playing an increasing role in the care of patients with glaucoma. Within the last decade, new surgical procedures have been established, which are summarized under the term minimally invasive glaucoma surgery (MIGS). A wide variety of different procedures are aimed at the structures in the angle of the anterior chamber, such as the trabecular meshwork and Schlemm's canal, to improve the physiological outflow or to improve the alternative uveoscleral outflow. The implementation of the treatment goal differs in the individual procedures, as does the maximum pressure reduction that can be achieved. Compared to trabeculectomy with the use of cytostatic agents, the achievable pressure reduction is usually significantly lower. In contrast, the significantly lower intraoperative and postoperative complication rates are emphasized as an advantage of these procedures. With increasing clinical experience and the growth of sufficient data on these new surgical procedures, a well-founded classification in the treatment algorithm of glaucoma surgery becomes easier; nevertheless, due to the small differences with respect to efficacy and safety profile, the final decision for an individual procedure often remains dependent on the surgeon's personal preferences.
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Affiliation(s)
- Karsten Klabe
- Breyer Kaymak Klabe Augenchirurgie, Martin-Luther-Platz 22, 40212, Düsseldorf, Deutschland.
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