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Peng X, Ling Q, Duan X. Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a meta-analysis. BMC Ophthalmol 2024; 24:381. [PMID: 39198787 DOI: 10.1186/s12886-024-03651-y] [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: 06/21/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024] Open
Abstract
OBJECTIVE Trabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma. METHODS A systematic literature search was performed for studies comparing trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The endpoint was the surgically induced astigmatism assessed 6 months after operation. We conducted this meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis). RESULTS Five eligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.40, 95% CI = 0.19 to 0.61, P = 0.02). CONCLUSION Our results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism. TRIAL REGISTRATION NUMBER CRD42024517708.
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Affiliation(s)
- Xiangting Peng
- Aier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, China
| | - Qiying Ling
- Aier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, China
- Changsha Aier Eye Hospital, No.188 South Furong Road, Changsha, Hunan, 410015, China
| | - Xuanchu Duan
- Aier Eye Hospital, Jinan University, Guangzhou, Guangdong Province, China.
- Changsha Aier Eye Hospital, No.188 South Furong Road, Changsha, Hunan, 410015, China.
- Aier Glaucoma Institute, No.188 South Furong Road, Changsha, Hunan, 410015, China.
- Hunan Engineering Research Center for Glaucoma with Artificial Intelligence in Diagnosis and Application of New Materials, Changsha, Hunan, 410015, China.
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Ye W, Li J, Zhang S, Zhu S, Xie Y, Le R, Zhou W, He M, Wang N, Liang Y. Efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for primary open-angle glaucoma: A randomized controlled trial. Acta Ophthalmol 2024. [PMID: 39166845 DOI: 10.1111/aos.16750] [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: 03/12/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE To report the 2-year efficacy and safety of penetrating canaloplasty versus ab externo canaloplasty for the treatment of primary open-angle glaucoma (POAG). SETTING A single surgical site in China. DESIGN This was a prospective, randomized controlled trial. POAG patients were randomly assigned to the penetrating canaloplasty or ab externo canaloplasty group. METHODS This study enrolled POAG patients who underwent penetrating canaloplasty or ab externo canaloplasty randomly. Surgical success, intraocular pressure (IOP), number of glaucoma medications, and surgical complications were evaluated until 24 months post-operatively. Surgical success was defined as 6 mmHg ≤ IOP ≤21 mmHg with an IOP reduction ≥20%, which included qualified success (with or without medications) and complete success (without medications). RESULTS A total of 52 eyes (45 patients) were randomly assigned to one of two groups: the penetrating canaloplasty group (PCP, n = 26) or the ab externo canaloplasty group (CP, n = 26). The probabilities of qualified success and complete success were 92.3% and 76.9%, respectively, in the PCP group and 64.1% and 52.1%, respectively, in the CP group at 24 months (p = 0.013, p = 0.042, log-rank test). The mean IOP decreased from 30.8 ± 10.7 and 28.6 ± 11.8 mmHg to 14.1 ± 3.3 mmHg in the PCP group and 22.1 ± 13.6 mmHg in the CP group at year two (p = 0.007). The PCP group also received fewer medications (0.2 ± 0.5) than did the CP group (0.7 ± 1.2) at year two (p = 0.038). Post-operative complications were similar, and the most common complications were transient IOP elevation and hyphema in the PCP group (42.3%, 46.2%) and the CP group (38.5%, 23.1%) (p > 0.05). CONCLUSIONS Compared to ab externo canaloplasty, penetrating canaloplasty had a greater surgical success rate and better IOP reduction with a comparable rate of complications.
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Affiliation(s)
- Wenqing Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jinxing Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shaodan Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Shuqing Zhu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanqian Xie
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Rongrong Le
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Weihe Zhou
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Mingguang He
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Ningli Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Li Z, Wang A, Zhu M, Zhou N, Liu L, Li Q, Kuang G. CO 2 laser-assisted sclerectomy surgery for secondary open-angle glaucoma after vitrectomy. Front Med (Lausanne) 2024; 11:1429791. [PMID: 39139788 PMCID: PMC11319287 DOI: 10.3389/fmed.2024.1429791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024] Open
Abstract
Purpose To explore the efficiency and safety of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with glaucoma secondary to vitrectomy. Methods This retrospective study consisted of 16 eyes from 16 patients with glaucoma secondary to vitrectomy who underwent CLASS and were followed up for 12 months. Main outcome measures included preoperative and postoperative intraocular pressure, best corrected visual acuity (BCVA), number of anti-glaucoma medications, and postoperative surgical success rate and complications. Results The postoperative IOP and number of anti-glaucoma medications used at all follow-up time point were significantly lower than those preoperatively. The difference in BCVA was not significant before and after surgery. The main complicatios were peripheral anterior synechiae (PAS) and scleral reservoir reduction, which were controlled after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 2 (12.50%) patients underwent re-operation. The complete and total success rates at 12 months were 68.75% and 87.50%, respectively. Conclusion CLASS is a safe and effective procedure for Chinese patients with glaucoma secondary to vitrectomy. PAS and scleral reservoir reduction is a major contributor to postoperative IOP elevation, and trabecular minimally invasive perforation with the Nd:YAG laser is effective in lowering IOP and increasing scleral cistern volume.
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Affiliation(s)
- Zheng Li
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Ao Wang
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Mingqiong Zhu
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Na Zhou
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Li Liu
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Qiaolian Li
- Department of Ophthalmology, The First People’s Hospital of Chenzhou, Chenzhou, Hunan, China
- Department of Ophthalmology, The Affiliated Chenzhou Hospital, Hengyang Medical School, University of South China, Chenzhou, Hunan, China
| | - Guoping Kuang
- Shenzhen Aier Eye Hospital affiliated to Jinan University, Shenzhen, Guangdong, China
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Bolek B, Wylęgała A, Wylęgała E. Microcyclophotocoagulation in Glaucoma Treatment: A Medium-Term Follow-Up Study. J Clin Med 2023; 12:4342. [PMID: 37445376 DOI: 10.3390/jcm12134342] [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: 05/22/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND This study aimed to assess the effectiveness and safety of transscleral microcyclophotocoagulation (µCPC) in patients with glaucoma for eighteen consecutive months. METHODS Sixty-one patients (64 eyes) with primary and secondary glaucoma were enrolled to undergo µCPC (diode laser FOX 810, A.R.C. Laser, Nuremberg, Germany). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after µCPC. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at the first week, and 1, 3, 6, 12, and 18 months postoperatively. RESULTS The mean ± SD values of IOP preoperatively at 1 day, 1 week, 1, 3, 6, 12, and 18 months postoperatively were 25.1 ± 8.4 mmHg, 17.3 ± 4.5 mmHg (p < 0.001), 16.5 ± 6.1 mmHg (p < 0.001), 20.5 ± 8.3 mmHg (p < 0.001), 17.1 ± 6.2 mmHg (p < 0.001), 18.0 ± 7.1 mmHg (p < 0.001), 15.8 ± 3.2 mmHg (p < 0.001), and 17.0 ± 5.9 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.5%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 38.5%. Two patients at 18-month follow-up did not require the use of antiglaucoma medications-complete success rate-3.1%. During the follow-up period, twenty-five eyes (39.1%) that required retreatment due to nonachievement of the target IOP were considered as failures. Eleven patients (12 eyes-18.8%) were lost to follow-up. A total of 26 patients (27 eyes) were evaluated 18 months after µCPC. Hypotony was observed in one patient (1.6%) and uveitis in two patients (3.1%) after the procedure. There were no other significant intraoperative or postoperative complications observed. CONCLUSIONS The µCPC is well tolerated and safe for reducing IOP in glaucoma patients in medium-term follow-up; however, success is moderate. Randomized, larger studies are needed to confirm the obtained results.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Health Promotion and Obesity Management, Pathophysiology Department, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, 40-760 Katowice, Poland
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Díez-Álvarez L, Beltrán-Agullo L, Loscos J, Pazos M, Ponte-Zúñiga B, Pinazo-Durán MD, Giménez-Gómez R, Ussa F, Pinilla LM, Jaumandreu L, Rebolleda G, Muñoz-Negrete FJ. Advanced glaucoma. Clinical practice guideline. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:18-39. [PMID: 36088247 DOI: 10.1016/j.oftale.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.
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Affiliation(s)
- L Díez-Álvarez
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain.
| | | | - J Loscos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Pazos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - B Ponte-Zúñiga
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Pinazo-Durán
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Unidad Investigación Oftalmológica Santiago Grisolía/FISABIO; Unidad de Oftalmobiología Celular y Molecular, Universidad de Valencia, Valencia, Spain
| | - R Giménez-Gómez
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Ussa
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - L M Pinilla
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Jaumandreu
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - G Rebolleda
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
| | - F J Muñoz-Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
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Bolek B, Wylęgała A, Wylęgała E. Ultrasound ciliary plasty in glaucoma treatment: A long‐term follow‐up study. Acta Ophthalmol 2022; 101:293-300. [PMID: 36448501 DOI: 10.1111/aos.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The present study aimed to evaluate the efficacy and safety of ultrasound ciliary plasty (UCP) in patients with open-angle glaucoma for three consecutive years. METHODS Sixty-one patients (62 eyes) with primary and secondary glaucoma were enrolled to undergo UCP. The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use and visual acuity after UCP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at the first week, and 1, 3, 6, 12, 18, 24, 30 and 36 months postoperatively. RESULTS A total of 41 patients (41 eyes) were evaluated 36-month after UCP. The mean ± SD values of IOP preoperatively at 1 day, 1 week, 1; 3; 6; 12; 18; 24; 30 and 36 months postoperatively were 22.7 ± 5.0 mmHg, 17.1 ± 4.2 mmHg (p < 0.001), 15.7 ± 4.8 mmHg (p < 0.001), 18.8 ± 4.8 mmHg (p < 0.001), 17.3 ± 3.7 mmHg (p < 0.001), 16.9 ± 3.2 mmHg (p < 0.001), 16.6 ± 2.7 mmHg (p < 0.001), 16.3 ± 3.0 mmHg (p < 0.001), 15.8 ± 3.4 mmHg (p < 0.001), 15.3 ± 2.1 mmHg (p < 0.001) and 16.3 ± 3.0 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 28.5%. The qualified success rate was 64.0%. All patients at 36-month follow-up visit required the use of antiglaucoma medications - none of the patients achieved complete success. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. Choroid detachment was observed in three patients (4.8%), while macular oedema was observed in three patients (4.8%) after the procedure. No other major intraoperative or postoperative complications occurred. CONCLUSION Ultrasound ciliary plasty seems to be an effective and well-tolerated method to reduce IOP in patients with refractory glaucoma. Further studies with a larger group are needed to confirm the efficacy of this procedure.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
- Health Promotion and Obesity Management, Pathophysiology Department Medical University of Silesia Katowice Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
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Xiao J, Zhao C, Zhang Y, Liang A, Qu Y, Cheng G, Zhang M. Surgical Outcomes of Modified CO 2 Laser-assisted Sclerectomy for Uveitic Glaucoma. Ocul Immunol Inflamm 2022; 30:1617-1624. [PMID: 33983863 DOI: 10.1080/09273948.2021.1924385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the clinical safety and efficacy of modified CO2 laser-assisted sclerectomy surgery (CLASS) in patients with uveitic glaucoma (UG) using primary open-angle glaucoma (POAG) patients for a comparison. METHODS This retrospective study included UG and POAG patients from the modified CLASS Study Group database. Intraocular pressure (IOP) and the number of glaucoma medications were compared between groups by the Wilcoxon test. The Kaplan-Meier method was used for survival analysis; complete success was defined as 5≤ IOP≤18 mmHg and a ≥ 20% reduction in IOP from baseline without medication. RESULTS Twenty-three and 25 eyes in UG and POAG groups were included. At the 12-month visit in both groups, the mean IOP and mean number of IOP-lowering medications were significantly reduced compared to baseline, with complete success rates of 60.9% and 64.0% in the UG and POAG groups (P = .859). CONCLUSIONS Modified CLASS yields similar outcomes for patients with UG and POAG.
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Affiliation(s)
- Junyan Xiao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anyi Liang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Qu
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Gangwei Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhang L, Yao Y, Lin Q, Li Y, Zhang J. Clinical application of the CO2 laser in Ab externo Schlemm's canal surgery. Front Med (Lausanne) 2022; 9:974056. [PMID: 36052326 PMCID: PMC9424721 DOI: 10.3389/fmed.2022.974056] [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: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aimed to investigate the clinical application of laser as a knife in Ab externo Schlemm's canal (SC) surgery and compare the efficacy and safety of the CO2 laser with the conventional procedure using a surgical knife. Methods Patients who underwent either canaloplasty or trabeculotomy with CO2 laser system which was used to locate and ablate the outer wall of SC at the time interval between May 2020 and May 2021 were identified, their medical files were reviewed, and their results were compared with conventional surgery group who underwent canaloplasty or trabeculotomy with conventional surgical knife at the same time period. The following datas were conducted and compared: age, sex, intraocular pressure (IOP), number of drugs, best-corrected visual acuity (BCVA), mean deviation and pattern standard deviation of visual field examination, SC opening related complications. Results A total of 49 patients (49 eyes) were included in this study, including 23 in the Laser surgery group and 26 in the conventional surgery group. Time for SC opening was 49.33 ± 25.23 s and 116.50 ± 31.79 s for laser surgery group and conventional surgery group, respectively. This difference between the two groups was statistically significant (P < 0.01). Hemorrhage occurred in five eyes during ablation for the laser surgery group and in 24 eyes for the conventional surgery group. In addition, anterior chamber penetration occurred in two cases for the laser surgery group and in six cases for the conventional surgery group. The success rate of identifying and opening outer wall of SC was 91.30% (21 eyes) for the laser surgery group and 76.92% (20 eyes) for the conventional surgery group. The difference between preoperative and postoperative intraocular pressure for each group was statistically significant (P < 0.01), and there were no statistically significant differences across the two groups in terms of postoperative IOP (P = 0.238) and BCVA (P = 0.389). Conclusion Compared with the conventional procedure using a surgical knife, CO2 laser-assisted ablation of the outer wall of SC was less time-consuming and less technically challenging. CO2 laser-assisted ablation also resulted in fewer complications. Furthermore, it had a shorter learning curve and a higher success rate of identifying and opening SC.
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Affiliation(s)
- Liu Zhang
- Department of Glaucoma, Fuzhou Eye Hospital, Fuzhou, China
| | - Yihua Yao
- Department of Ophthalmology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qingxia Lin
- Department of Glaucoma, Fuzhou Eye Hospital, Fuzhou, China
| | - Yanhong Li
- Department of Glaucoma, Fuzhou Eye Hospital, Fuzhou, China
| | - Jianhui Zhang
- Department of Glaucoma, Fuzhou Eye Hospital, Fuzhou, China
- *Correspondence: Jianhui Zhang
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9
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Chen M, Li Y, Cheng B, Zhang Q, Liu X, Wang K. CO 2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:902716. [PMID: 35665343 PMCID: PMC9160387 DOI: 10.3389/fmed.2022.902716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Bilateral congenital ectropion uveae (CEU) is rare syndrome, usually accompanied by refractory glaucoma. Proper and timely treatment was very important for the prognosis. The report aims to compare the long-term outcomes and complications between the two eyes after different approaches of surgery in a case of bilateral CEU with advanced glaucoma. Case Presentation The patient was a 20-year-old male with bilateral CEU and glaucoma. The intraocular pressure (IOP) was 48 mm Hg in the right eye (OD) and 52 mm Hg in the left eye (OS). The vertical cup-to-disc (C/D) ratio was nearly 1.0 in both eyes. Despite maximum medical therapy, the target IOP could not be achieved. Therefore, CO2 laser-assisted sclerectomy surgery (CLASS) was performed in OS, and the IOP was remarkably decreased. 1 month after the surgery, the IOP rebounded slightly and was controlled with a fixed-combination anti-glaucoma medicine. 3-month postoperatively, a YAG laser goniopuncture (LGP) was performed to enhance the IOP-lowing effect and the anti-glaucoma agent was discontinued. An ab externo microcatheter-assisted trabeculotomy (MAT) was performed in OD, and the IOP was also significantly decreased. During the follow-up period, the IOP was well controlled for both eyes without any medication. Shallow anterior chamber and complicated cataract developed in OS after CLASS, and there was no obvious late complication in OD after MAT. Conclusions To our knowledge, this was the first attempt to perform two different surgeries, CLASS and MAT, in both eyes of a single patient presented with bilateral CEU with glaucoma. Our results showed that the IOP was lower after CLASS, but there were potential complications such as shallow anterior chamber and complicated cataract. MAT could achieve a moderate IOP-lowing effect but had a higher safety. CLASS and MAT may be considered effective surgical options for the management of such patients.
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Affiliation(s)
- Min Chen
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuhang Li
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Bo Cheng
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Department of Ophthalmology, Fenghua People's Hospital, Zhejiang, China
| | - Qi Zhang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
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Corneal endothelial cell density loss following glaucoma surgery alone or in combination with cataract surgery: A systematic review and meta-analysis. Ophthalmology 2022; 129:841-855. [PMID: 35331751 DOI: 10.1016/j.ophtha.2022.03.015] [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: 11/16/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
TOPIC Corneal endothelial cell density (ECD) loss following glaucoma surgery with or without cataract surgery. CLINICAL RELEVANCE Corneal ECD loss may occur due to intraoperative surgical trauma in glaucoma surgery or postoperatively with chronic endothelial cell trauma or irritation. METHODS Trabeculectomy, glaucoma filtration surgery or microinvasive glaucoma surgery in participants with ocular hypertension, primary and secondary open angle glaucoma, normal tension glaucoma and angle-closure glaucoma were included. Pediatric populations and participants with pre-existing corneal disease were excluded. Laser treatments and peripheral iridotomy were excluded. Electronic databases searched in December 2021 included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and The International Prospective Register of Systematic Reviews (PROSPERO), FDA PMA and FDA 510(k). RESULTS 39 studies were included in quantitative synthesis. 12 months following suprachoroidal MIGS mean ECD loss was 282 cells/mm2 (95% Confidence Interval (CI) 220 to 345; p <0.00001; Chi2 = 0.06; I2 = 0%; 2 studies; very low certainty). Mean ECD loss after Schlemm's canal implantable devices was 338 cells/mm2 (95% CI 185 to 491; p<0.0001; Chi2 = 0.08; I2 = 0%; 2 studies; low certainty) at 12 months. When compared to phacoemulsification alone, Schlemm's canal implants combined with phacoemulsification showed statistically significant mean ECD reduction at 24 months; mean difference of ECD was -19% (95% CI -37% to -2%; p=0.03; Chi2 = 3.04; I2 = 34%; 3 studies; low certainty). Mean ECD loss was 64 cells/mm2 (95% CI 21 to 107; p=0.004; Chi2 = 4.55; I2 = 0%; 6 studies; low certainty) following Schlemm's canal procedures (without implantable devices) at 12 months. At 12 months the mean ECD loss after trabeculectomy was 33 cells/mm2 (95% CI -38 to 105, p=0.36, Chi2 = 1.17; I2 = 0%; moderate certainty). At 12 months mean ECD loss was 121 cells/mm2 (95% CI 53 to 189; p=0.0005; Chi2 = 3.00; I2 = 0%; 5 studies; low certainty) after Express implantation. When compared to control fellow eye, aqueous shunt surgery reduced ECD by 5.75% (95% CI -0.93 to 12.43; p=0.09 Chi2 = 1.32; I2 = 0%; low certainty) and 8.11% ECD loss (95%CI 0.06 to 16.16 p=0.05; Chi2= 1.93; I2=48%) at 12 and 24 months, respectively. CONCLUSIONS Overall there is low certainty evidence to suggest that glaucoma surgery involving long-term implants has a greater extent of ECD loss than glaucoma filtration surgeries without the use of implants. The results of this review support long-term follow-up (beyond 36 months) to assess ECD loss and corneal decompensation following implantation of glaucoma drainage implants.
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Xin Z, Chen J, Wang D, Wu X, Han Y. CO 2 laser-assisted sclerectomy surgery in the treatment of open-angle glaucoma in Chinese patients. Eur J Ophthalmol 2022; 32:11206721211073035. [PMID: 35018839 DOI: 10.1177/11206721211073035] [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: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of CO2-Laser Assisted Sclerectomy Surgery (CLASS) with 5-fluorouracil (5-FU) in treating open-angle glaucoma (OAG) in Chinese patients. Methods: This was a retrospective, uncontrolled, interventional case series. All patients from 2016 to 2017 who received CLASS were recruited in this study. The primary outcome was the change in intraocular pressure (IOP) and the number of IOP-lowering medications over a 12-month follow-up period. Adverse events were evaluated as secondary outcomes. Results: Data were collected from forty-two eyes of 31 patients. The average preoperative IOP was 31.33 ± 7.60mmHg. The mean percentage of IOP reduction from baseline at postoperative months (POM) 1, 3, 6, 9, and, 12 were 48.1% ± 24.6%, 51.4% ± 19.3%, 51.2% ± 17.2%, 50.9% ± 15.0%, 49.2% ± 16.3%, respectively (all P < 0.001). The number of glaucoma medications decreased from a baseline of 3.02 ± 0.81 to 0.05 ± 0.22, 0.10 ± 0.37, 0.12 ± 0.40, 0.17 ± 0.44, and 0.24 ± 0.58 at POM 1, 3, 6, 9, and 12, respectively (all P < 0.001). At POM 1, 3, 6, 9, and 12, complete success rates were 66.7%, 73.8%, 76.2%, 69.1%, and 71.4%, respectively. At POM 1, 3, 6, 9, and 12, qualified success rates were 71.4%, 82.0%, 85.3%, 83.3%, and 90.5%, respectively. Major postoperative complications include peripheral iris synechia, iris incarceration, and anterior chamber shallowing. Conclusions: CLASS with 5-FU shows safety and efficacy for decreasing IOP and the number of IOP-lowering medications over a 12-month follow-up period. It could be an alternative treatment for patients with OAG.
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Affiliation(s)
- ZhiYuan Xin
- Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jeremy Chen
- Department of Ophthalmology, 8785University of California San Francisco, San Francisco, CA, USA
| | - DaJiang Wang
- Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xing Wu
- Department of Ophthalmology, The Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Ying Han
- Department of Ophthalmology, 8785University of California San Francisco, San Francisco, CA, USA
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12
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Chen M, Gu Y, Yang Y, Zhang Q, Liu X, Wang K. Management of Intraocular Pressure Elevation After CO 2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma. Front Med (Lausanne) 2022; 8:806734. [PMID: 35004782 PMCID: PMC8740123 DOI: 10.3389/fmed.2021.806734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To report the safety and efficiency of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation. Methods: This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions. Results: The mean age of the patient was 42.6 ± 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively. Conclusion: CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.
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Affiliation(s)
- Min Chen
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuxiang Gu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yumei Yang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Shangyu People's Hospital of Shaoxing, Shaoxing, China
| | - Qi Zhang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xin Liu
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center of the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
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13
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Zhang Y, Mao J, Zhou Q, Li L, Zhang S, Bian A, Cheng G. Comparison of Long-Term Effects After Modified CO 2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma. Ophthalmol Ther 2021; 11:321-331. [PMID: 34862960 PMCID: PMC8770782 DOI: 10.1007/s40123-021-00413-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction To compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study. Methods A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively. Results Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group. Conclusions MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.
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Affiliation(s)
- Yang Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Jin Mao
- Department of Ophthalmology, Centro Hospitalar Conde de São Januário, Macau Health Bureau, Macau SAR, China
| | - Qi Zhou
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Lüe Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Shunhua Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Ailing Bian
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China
| | - Gangwei Cheng
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Dongdan Shuaifuyuan 1#, Beijing, 100730, China.
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Raja SV, Ponnat AK, Balagiri K, Pallamparthy S. Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification. Indian J Ophthalmol 2021; 69:2741-2745. [PMID: 34571626 PMCID: PMC8597511 DOI: 10.4103/ijo.ijo_3310_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/21/2021] [Accepted: 04/29/2021] [Indexed: 12/04/2022] Open
Abstract
PURPOSE To compare outcomes of laser assisted deep sclerectomy (LADS) and conventional trabeculectomy both combined with phacoemulsification. METHODS We divided 36 eyes into 2 groups, one group with LADS and the other Trabeculectomy. Patients were measured post operatively at 1, 3, 6, 9 months, 1, 2, 3 years for intraocular pressure (IOP), best corrected visual acuity (BCVA) and number of medications. RESULTS In the trabeculectomy group, after 3 year follow up, IOP was 14.67 ± 3.14, 15.27 ± 4.28 and 17.00 ± 7.79, BCVA improved to 0.17 ± 0.18, 0.24 ± 0.20 and 0.24 ± 0.27 and number of medications reduced to 0.6 ± 0.6, 1.1 ± 1.2, and 1.5 ± 1.5. Complete success rate after 3 years was 100%, 80.0% & 80.0% and Qualified success rate was 100%, 88.9% & 88.9%. In the LADS group, after 3 years follow up, IOP was 14.11 ± 3.91, 16.07 ± 5.51, 15.80 ± 6.07, BCVA improved to 0.13 ± 0.11, 0.10 ± 0.15, 0.11 ± 0.13 and medications reduced to 1 ± 1.1, 1.5 ± 1.0 and 1.8 ± 1.0. Complete success after 3 years was 85.7%, 57.1% & 57.1% whereas qualified success was 92.3%, 84.6% & 84.6%. CONCLUSION Main limitations of our study were small sample size and lack of prospective comparison. However we were able to perfom the surgery comfortably due to the relatively shorter learning curve compared to conventional NPDS.
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Affiliation(s)
- S Vidya Raja
- Glaucoma Conusltant, Aravind Eye Hospital, Madurai, Tamil Nadu, India
| | | | - K Balagiri
- Biostatician, Aravind Eye Hospital, Madurai, Tamil Nadu, India
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Pose-Bazarra S, López-Valladares MJ, López-de-Ullibarri I, Azuara-Blanco A. Surgical and laser interventions for pseudoexfoliation glaucoma systematic review of randomized controlled trials. Eye (Lond) 2021; 35:1551-1561. [PMID: 33564134 PMCID: PMC8169755 DOI: 10.1038/s41433-021-01424-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/30/2020] [Accepted: 01/18/2021] [Indexed: 01/30/2023] Open
Abstract
To assess the comparative effectiveness and safety of different surgical and laser techniques in people with pseudoexfoliation glaucoma (PXFG). We conducted a systematic review including randomized controlled trials (RCT) that compared any pair of surgical or laser treatment versus other type of intervention in PXFG. RCT were identified by a highly sensitive search of electronic databases and two individuals independently assessed trial eligibility, abstracted data and assessed risk of bias. We performed Bayesian Meta-Analysis when outcomes were comparable. The search strategy identified 6171 records. Six studies (262 subjects) were included. Two trials analyzed the same pair of surgical interventions comparing phacoemulsification as solo procedure or combined with trabecular aspiration and we performed meta-analysis. Other RCTs compared the following interventions: trabecular aspiration associated with phacoemulsification versus phacotrabeculectomy, non-penetrating deep sclerectomy associated or not with phacoemulsification, selective versus argon laser trabeculoplasty and one-site versus two-site phacotrabeculectomy. For IOP data, none of the trials reported a difference between pairs of surgical techniques, nor changes in visual acuity or number of post-operative medications. The overall risk of bias is moderate to high. There are no apparent differences in efficacy and safety, although with large uncertainty, between surgical or laser techniques for PXFG. Based on the low-quality evidence from the six studies included in this review, it is not possible to justify the preferential use of non-penetrating surgery, MIGS or trabecular aspiration (with or without cataract surgery) in PXFG. Further research is needed to determine the optimal management of this condition.
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Affiliation(s)
- Sara Pose-Bazarra
- Ophthalmology Department, University Hospital Complex Ferrol, Ferrol, Spain
| | - María Jesús López-Valladares
- grid.411048.80000 0000 8816 6945Ophthalmology Department, University Hospital Complex Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Augusto Azuara-Blanco
- grid.4777.30000 0004 0374 7521Centre for Public Health, Queen’s University, Belfast, UK
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CO 2 Laser-Assisted Deep Sclerectomy Surgery Compared with Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results. J Ophthalmol 2021; 2021:6639583. [PMID: 33628476 PMCID: PMC7889398 DOI: 10.1155/2021/6639583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/02/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the effectiveness and safety of carbon dioxide (CO2) laser-assisted deep sclerectomy surgery (CLASS) and trabeculectomy (Trab) for treatment of primary open-angle glaucoma (POAG). Methods In this retrospective and comparative study, 77 eyes of 62 patients with POAG were studied and divided into the CLASS and Trab groups. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of medications, surgical success rate, and complications were analyzed. Results The mean follow-up periods were 27.89 ± 2.94 months and 26.11 ± 2.06 months in the CLASS and Trab groups, respectively. 30 eyes (24 patients) underwent CLASS and 47 eyes (38 patients) underwent Trab. The BCVA in the CLASS and Trab groups was recovered to baseline at postoperative 1 week and 1 month, respectively. At last follow-up visits, a remarkable reduction in the IOP and number of medications was observed in both groups, and no significant difference was found in those between the two groups. The complete success rates were 51.7% and 47.7% in postoperative 24 months in the CLASS and Trab groups, respectively (P > 0.05). There were higher rates of delayed anterior chamber formation (21.3%) and thin-wall filtrating blebs (10.6%) in the Trab group. Meanwhile, the peripheral anterior synechiae were only observed in the CLASS group, and the ratio was 30%. Conclusions CLASS is an effective and safe treatment modality for POAG, with fewer filtering bleb-related complications and quicker visual recovery in the early postoperative stage than trabeculectomy. The efficacy of lowering intraocular pressure was similar for both procedures.
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17
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Zhang Y, Cheng G. Author Response: Letter to the Editor of JOG Regarding the "Lowering of Intraocular Pressure Effects Early After CO2 Laser-Assisted Sclerectomy Correlate to Intrascleral Lake Volumes". J Glaucoma 2021; 30:e30-e31. [PMID: 33074966 DOI: 10.1097/ijg.0000000000001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yang Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Yan X, Zhang H, Li F, Ma L, Geng Y, Tang G. Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: a 2-year follow-up. Eye (Lond) 2020; 35:2283-2293. [PMID: 33139873 DOI: 10.1038/s41433-020-01235-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE This study describes the imaging of the filtering area in CO2 laser-assisted sclerectomy surgery (CLASS) using ultrasound biomicroscopy (UBM) combined with the Indiana Bleb Appearance Grading Scale (IBAGS) and evaluates the mechanism by which CLASS lowers the intraocular pressure (IOP). METHODS Twenty-eight cases (28 eyes) of primary open-angle glaucoma that could not be controlled by drugs underwent CLASS. At 1, 3, 6, 12, 18, and 24 months after surgery, IBAGS was used to evaluate the external morphology of the filtering blebs, and UBM was used to describe and measure their internal structure. RESULTS During the early period after CLASS, most cases showed diffuse filtering blebs with a serious degree of congestion. At the end of follow-up, most cases did not present filtering blebs. All patients showed an intact and thin trabeculodescemetic membrane (TDM) with an average thickness of 0.094 ± 0.017 mm. The scleral reservoir size gradually decreased over time and tended to stabilize after 18 months. At 3 and 6 months after surgery, 53.57% of the patients had abnormalities in the TDM area, and after laser goniopuncture treatment, the scleral reservoir became slightly larger and the IOP decreased. The TDM thickness was not correlated with postoperative IOP, and the scleral reservoir size was negatively correlated with IOP. CONCLUSION During the early phase after CLASS, the subconjunctival and suprachoroidal pathways may be the main mechanisms lowering IOP; over time, internal drainage pathways such as the intrascleral, trabecular-meshwork, and suprachoroidal pathways play greater roles in lowering IOP.
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Affiliation(s)
- Xiaowei Yan
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China
| | - Hengli Zhang
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China
| | - Fan Li
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China
| | - Lihua Ma
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China
| | - Yulei Geng
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China
| | - Guangxian Tang
- Shijiazhuang People's Hospital (Shijiazhuang No.1 Hospital), Shijiazhuang, China.
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Modified CO2 Laser-assisted Sclerectomy Surgery in Chinese Patients With Primary Open-Angle Glaucoma and Pseudoexfoliative Glaucoma: A 2-Year Follow-up Study. J Glaucoma 2020; 29:367-373. [PMID: 32053553 DOI: 10.1097/ijg.0000000000001460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PRECIS A modified CO2 laser-assisted sclerectomy surgery (CLASS) based on the characteristics of Chinese eyeball was carried out in Chinese patient and was confirmed to be effective and safe during long-term follow-up. PURPOSE The purpose of this study was to study the long-term efficacy and safety of modified CLASS in Chinese patients with primary open-angle and pseudoexfoliative glaucoma. METHODS We enrolled 25 medically uncontrolled primary open-angle and pseudoexfoliative glaucoma patients in this prospective, interventional case series. A combination of modified CLASS and preoperative laser iris management was administered to 29 eyes. Visual acuity, intraocular pressure (IOP), slit-lamp examinations, visual field, and gonioscopy were carried out at baseline and until 24 months postoperatively. Ultrasound biomicroscopy examinations were repeated at 3, 12, and 24 months postsurgically. RESULTS Mean patient age was 53.92±12.08 years. Mean preoperative IOP was 30.66±10.41 mm Hg; and mean postoperative IOP was 8.17±3.76, and 13.25±2.73, 13.76±2.50, and 13.76±2.50 mm Hg at 1 day, and 6, 12, and 24 months, respectively. Proportional changes in IOP from baseline at 6, 12, and 24 months was 58.33%, 56.25%, and 58.97% (P<0.001), respectively. Complete postoperative success rates at 12 and 24 months were 62.07% and 48.28%. Qualified success rates at 12 and 24 months postoperatively were both 89.66%. Number of medications administered per patient reduced from 3 at baseline to 0 at 12 and 24 months (P<0.0001). Two patients demonstrated severe peripheral anterior synechiae (6.90%). Ultrasound biomicroscopy examination revealed a severe scleral lake diminution in 1 patient (3.40%) at 12 months and 2 patients (6.90%) at 24 months. CONCLUSION Combination of modified CLASS and preventive laser iris management was effective and safe in the long-term treatment of primary open-angle glaucoma patients.
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Bolek B, Wylęgała A, Wylęgała E. Assessment of Scleral and Conjunctival Thickness of the Eye after Ultrasound Ciliary Plasty. J Ophthalmol 2020; 2020:9659014. [PMID: 33029390 PMCID: PMC7532393 DOI: 10.1155/2020/9659014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Accepted: 08/27/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE This study aims to assess scleral and conjunctival thickness using optical coherence tomography after ultrasound ciliary plasty (UCP) procedure with reference to scleral marks appearing in the area where the ultrasound energy was applied. MATERIALS AND METHODS Seventy-eight patients with primary and secondary refractory glaucoma participated in this study. Complete ophthalmic examinations including measurements of scleral and conjunctival thickness were performed preoperatively and at 1 week, and 1, 3, 6, 12, 18, and 24 months postoperatively. The parameters were determined using the Swept Source OCT with anterior attachment. Thirty-eight patients (58 scleral marks-23 superior and 35 inferior) fulfilled the inclusion criteria and completed the follow-up period of 24 months. RESULTS The mean ± SD scleral and conjunctival thickness in superior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 684.57 ± 83.58 μm, 771.78 ± 112.03 μm (p < 0.001), 771.74 ± 100.12 μm (p < 0.001), 731.38 ± 83.92 μm (p=0.012), 719.52 ± 73.20 μm (p=0.037), 702.91 ± 66.50 μm (p=0.247), 694.13 ± 72.22 μm (p=0.482), and 699.35 ± 70.68 μm (p=0.200), respectively. The mean ± SD scleral and conjunctival thickness in inferior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 816.86 ± 79.30 μm, 936.37 ± 107.33 μm (p < 0.001), 946.00 ± 130.40 μm (p < 0.001), 896.63 ± 123.40 μm (p < 0.001), 877.69 ± 114.38 μm (p=0.003), 843.03 ± 71.55 μm (p=0.021), 811.86 ± 68.91 μm (p=0.731), and 805.03 ± 69.52 μm (p=0.248), respectively. The transient thickening of the sclera was observed after the procedure; however, after 12 months postoperatively, the parameters returned to the initial value and no significant difference was noted. CONCLUSION The sclera thickness increases after UCP. However, with time the thickness reduces to its initial value with no significant difference. Clinical implication of the scleral changes lasts shorter than the measured significant difference in scleral thickness.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, District Railway Hospital, Katowice, Poland
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van Setten GB. Survival of the best? - Why some surgical techniques such as deep sclerectomy 'fail'. Acta Ophthalmol 2020; 98:e659-e661. [PMID: 32162484 DOI: 10.1111/aos.14383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Sohajda Z, Széll N, Revák Á, Papp J, Tóth-Molnár E. Retinal Nerve Fibre Layer Thickness Change After CO2 Laser-Assisted Deep Sclerectomy Surgery. Clin Ophthalmol 2020; 14:1749-1757. [PMID: 32612350 PMCID: PMC7323794 DOI: 10.2147/opth.s247595] [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: 02/08/2020] [Accepted: 04/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The goal of our study was to investigate changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), and retinal nerve fibre layer thickness (RNFLT) after CO2 laser-assisted deep sclerectomy (CLASS). Methods We carried out uncomplicated CLASS surgeries and a 12-month follow-up on 22 open-angle glaucomatous (OAG) eyes of 22 patients. IOP, BCVA, and RNFLT with spectral-domain optical coherence tomography (SD OCT) were recorded before and 1, 3, 6, 12 months after surgery. Results Mean age of patients was 68.1 years. IOP decreased from preoperative 28.45±5.99 SD mmHg (mean±standard deviation) to 15.09±2.40 mmHg (p=0.00039) at 12 months after surgery. BCVA-change from preoperative 0.34±0.38 SD (LogMAR) to 0.37±0.41 SD (LogMAR) was not significant (p=0.2456). RNFLT-change from preoperative 60.50±18.15µm to 59.63±17.52 µm at 12 months postoperatively was not significant (p=0.056). Qualified success rate of CLASS surgery was 72.7%, whereas complete success rate was 64% at 1 year postoperatively. Conclusion Successful CLASS surgery efficiently reduced IOP. At postoperative 12 months, RNFLT and BCVA were not reduced significantly. There was no significant glaucomatous progression after surgery encountered in respect of investigated parameters.
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Affiliation(s)
- Zoltán Sohajda
- University of Debrecen, Kenézy Hospital Department of Ophthalmology, Debrecen, Hungary
| | - Noémi Széll
- University of Debrecen, Kenézy Hospital Department of Ophthalmology, Debrecen, Hungary
| | - Ágnes Revák
- University of Debrecen, Kenézy Hospital Department of Ophthalmology, Debrecen, Hungary
| | - Júlia Papp
- University of Debrecen, Kenézy Hospital Department of Ophthalmology, Debrecen, Hungary
| | - Edit Tóth-Molnár
- University of Szeged, Department of Ophthalmology, Szent-Györgyi Medical and Pharmaceutical Center, Szeged, Hungary
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Abstract
PRéCIS:: The ultrasound ciliary plasty (UCP) procedure affects corneal parameters, although the effect is transient. Ultrasound energy affects the sclera, leading to induced astigmatism. The area of energy application correlates with the astigmatism axis. PURPOSE To assess the postoperative corneal topography for 1 year after UCP. MATERIALS AND METHODS In total, 78 patients with primary and secondary refractory glaucoma were enrolled in the study. The primary outcome measures were the corneal parameters obtained with anterior segment swept-source optical coherence tomography. Intraocular pressure, number of antiglaucoma medications, and best-corrected logMAR visual acuities were analyzed as secondary outcome measures. Measurements were performed preoperatively and at 1 week, and 1, 3, 6, and 12 months postoperatively. A total of 39 patients (39 eyes) completed the follow-up period of 12 months. RESULTS There was a significant difference in the anterior/posterior steep/flat keratometry and anterior/posterior astigmatism values immediately after UCP. However, 3 months postoperatively these parameters returned to their initial values and there were no significant differences noted. The mean±SD values of anterior astigmatism preoperatively and at 1 week, and 1, 3, 6, and 12 months postoperatively were 1.12±0.66 D, 2.17±0.91 D (P<0.001), 2.05±0.93 D (P<0.001), 1.55±0.75 D (P=0.004), 1.31±0.70 D (P=0.024), and 1.20±0.73 D (P=0.406), respectively. The astigmatism axis tended to approach 90 degrees meridian with a significant difference 1 week postoperatively. Central and minimal corneal thickness remained unchanged, whereas the intraocular pressure and the number of antiglaucoma medications decreased significantly. CONCLUSIONS UCP influenced the corneal topography parameters in the immediate postoperative period; however, with time, all parameters returned to their initial values.
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Ye X, Qi Y, Deng J, Yang Y, Mo T, Xu M, Liu W. Scleral concave pool trabeculectomy combined phacoemulsification in primary open-angle glaucoma with cataract. BMC Ophthalmol 2020; 20:222. [PMID: 32517766 PMCID: PMC7285585 DOI: 10.1186/s12886-020-01500-2] [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: 11/29/2019] [Accepted: 06/02/2020] [Indexed: 11/21/2022] Open
Abstract
Background To investigate the safety and efficacy of scleral concave pool trabeculectomy (SCPT) combined phacoemulsification for eyes with coexisting cataract and primary open-angle glaucoma (POAG). Methods This was a retrospective, controlled, interventional pilot case series. Thirty patients (30 eyes) were diagnosed with coexisting cataract and POAG between May 2015 and April 2018. Fourteen eyes underwent SCPT combined phacoemulsification were set as the study group, and 16 eyes received conventional phacotrabeculectomy were set as the control group. All patients were followed up for at least 6 months. The preoperative to postoperative changes in IOP, glaucoma medication requirements, BCVA, blebs functions, and adverse events were recorded. Results The groups were matched for baseline age, BCVA, IOP and types of IOP-lowering medications (all P > 0.05). At 6-month visit, there were no significant difference between control and study group in the improvement of BCVA (0.22 ± 0.24 versus 0.18 ± 0.26, P = 0.718), reduction of IOP (− 11.21 ± 8.61 mmHg versus − 9.19 ± 9.18 mmHg, P = 0.540) and the number of eyes that needed IOP-lowering medications (2 versus 3, P = 0.743). At the last visit, the rate of forming functioning blebs was significantly different between the study and control groups, (92.9% versus 68.7% respectively, P = 0.007). In the study group, 5 eyes developed hypotony, and 1 eye showed limited choroidal detachment, whereas in the control group 1 eye developed malignant glaucoma. All adverse events were successfully managed. Conclusion The SCPT combined phacoemulsification seems to be a safe and effective alternative to conventional phacotrabeculectomy for patients with POAG and visually significant cataract in the short-term.
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Affiliation(s)
- Xiangxiang Ye
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yongjun Qi
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China.
| | - Jianhua Deng
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Yang Yang
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Ting Mo
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Mao Xu
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
| | - Wanjun Liu
- Guangdong Hospital of Traditional Chinese Medicine, Zhuhai, China
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The CLASS Surgical Site Characteristics in a Clinical Grading Scale and Anterior Segment Optical Coherence Tomography: A One-Year Follow-Up. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:5909827. [PMID: 29861883 PMCID: PMC5976922 DOI: 10.1155/2018/5909827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/26/2018] [Accepted: 04/16/2018] [Indexed: 11/23/2022]
Abstract
Purpose We combined a clinical grading scale and swept source anterior segment OCT to describe the successful and failed CLASS. Material and Methods 23 patients in the successful group and 17 patients in the failed group were compared in terms of the IBAGS grades and AS-OCT findings at one, three, and twelve months postoperatively. Results The majority in the successful group presented shallow blebs (91%, 57%, and 52% at 1M, 3M, and 12M, resp.). 59% of the failed group presented no bleb (H0 E0) from the early postoperative period with the rate increasing to 88% at 3M and 100% at 12M. The scleral lake was detected in all the successful patients. The successful group showed significantly higher rates of TDM integrity (P < 0.001), IF (P < 0.001), and SCF (P < 0.05), but there were no significant differences in the rates of microcysts between the groups (P > 0.05). We found a significant decrease in the SL anteroposterior extent (P=0.003) and SL height (P < 0.001) over time, with no significant correlation between the above parameters and IOP. Conclusions The subconjunctival bleb may be a sign of the successful CLASS when it matches the AS-OCT findings of TDM integrity, maintained scleral lake, and intrascleral fluid. A validated OCT pixel intensity measurement is required to evaluate the bleb reflectivity.
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