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Vallée R, Meduri E, Vallée JN, Lallouette A, Haffane Z, Paillard A, Mansouri K, Mermoud A. Predictive biomarkers of intra-ocular pressure decrease after cataract surgery associated with trabecular washout in patients with pseudo exfoliative glaucoma. Sci Rep 2024; 14:13567. [PMID: 38866840 PMCID: PMC11169244 DOI: 10.1038/s41598-024-53893-5] [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: 07/28/2023] [Accepted: 02/06/2024] [Indexed: 06/14/2024] Open
Abstract
To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOPBL) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOPBL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOPBL was 0.85 and 0.94 (p < 0.0001, respectively), with IOPBL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOPBL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease.
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Affiliation(s)
- Rodolphe Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France.
- Mathematics and Applications Laboratory (LMA), CNRS UMR7348, LRCOM i3M-DACTIMMIS, University of Poitiers, Poitiers, France.
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Enrico Meduri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Jean-Noël Vallée
- Diagnostic and Functional Neuroradiology and Brain stimulation Department, 15-20 National Vision Hospital - Paris University Hospital Center, University of PARIS-SACLAY - UVSQ, Paris, France
| | - Athena Lallouette
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Zakarya Haffane
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Archibald Paillard
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Ophthalmology Department, Colorado University Medical School, Denver, CO, USA
| | - André Mermoud
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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Rasmuson E, Bengtsson B, Lindén C, Heijl A, Aspberg J, Andersson-Geimer S, Jóhannesson G. Long-term follow-up of laser trabeculoplasty in multi-treated glaucoma patients. Acta Ophthalmol 2024; 102:179-185. [PMID: 37278271 DOI: 10.1111/aos.15718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the long-term effect of laser trabeculoplasty (LTP) in patients randomized to multi-treatment in the Glaucoma Intensive Treatment Study (GITS). METHODS Patients with untreated newly diagnosed open-angle glaucoma were treated with three intraocular pressure (IOP)-lowering substances for 1 week and then 360° argon or selective LTP was performed. IOP was measured just before LTP and repeatedly during the 60-month study period. Our previous report on 12 months follow-up data revealed no effect of LTP in eyes having an IOP <15 mmHg before the laser treatment. RESULTS Before LTP, the mean IOP ± standard deviation in all 152 study-eyes of 122 multi-treated patients was 14.0 ± 3.5 mmHg. Three eyes of three deceased patients were lost to follow-up during the 60 months. After exclusion of eyes that received increased therapy during follow-up, the IOP was significantly reduced at all visits up to 48 months in eyes with pre-LTP IOP ≥15 mmHg; 2.6 ± 3.1 mmHg at 1 month and 1.7 ± 2.8 mmHg at 48 months, n = 56 and 48, respectively. No significant IOP reduction was seen in eyes with pre-LTP IOP <15 mmHg. Seven eyes, i.e., <13%, with pre-LTP IOP ≥15 mmHg at baseline had required increased IOP-lowering therapy at 48 months. CONCLUSION LTP performed in multi-treated patients may provide a useful IOP reduction that is maintained over several years. This was true on a group level when the initial IOP was ≥15 mmHg, but if the pre-laser IOP was lower than that, chances of LTP success were small.
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Affiliation(s)
- Erika Rasmuson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| | - Boel Bengtsson
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
| | - Christina Lindén
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
| | - Anders Heijl
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
| | - Johan Aspberg
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Sabina Andersson-Geimer
- Department of Clinical Sciences in Malmö, Ophthalmology, Lund University, Malmö, Sweden
- Department of Ophthalmology, Skåne University Hospital, Malmö, Sweden
| | - Gauti Jóhannesson
- Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
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Abe RY, Maestrini HA, Guedes GB, Nascimento MM, Iguma CI, de Miranda Santos HD, Nasr MG, Lucena-Junior RP, Prata TS. Real-world data from selective laser trabeculoplasty in Brazil. Sci Rep 2022; 12:1923. [PMID: 35121762 PMCID: PMC8817042 DOI: 10.1038/s41598-022-05699-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Evaluate real-world data of outcomes from selective laser trabeculoplasty (SLT) performed in different regions of Brazil and investigate potential predictors of success associated with treatment. Multicenter retrospective case series with patients who underwent a primary SLT procedure. A total of 835 eyes from 835 patients were included. The mean follow-up was 916.8 ± 563.0 days. The mean age was 64.5 ± 14.9 years and 56.6% were women. We observed an intraocular pressure reduction comparing baseline to post-SLT measurements (18.4 ± 3.8 mmHg versus 14.8 ± 3.5 mmHg; P < 0.001) and mean number of glaucoma medications (1.8 ± 1.3 versus 1.4 ± 1.4; P < 0.001). We observed visual acuity loss over time (0.1 ± 0.3 versus 0.2 ± 0.3 logMAR, baseline and post-SLT, respectively, P = 0.009) and decrease in visual field mean deviation values (- 5.4 ± 5.9 versus - 5.7 ± 6.0 dB; P = 0.054) The Kaplan-Meier survival analysis showed an estimated probability of treatment success of 88% at 12 months, declining to 70% at 24 months and 54% at 36 months post-SLT. In the multivariable model, we found that a denser angle pigmentation (HR 0.69; 95% CI 0.57-0.85, P = 0.001) and corticosteroid treatment following SLT (HR 0.59; 95% CI 0.39-0.91, P = 0.018) were significantly associated with a lower risk for failure. Primary SLT achieved relatively high success rates without sight-threating complications in this real-world study with a large sample of Brazilian patients. These findings corroborate previous studies regarding SLT outcomes and may help clinicians to identify the best candidates for laser treatment.
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Affiliation(s)
- Ricardo Y Abe
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil. .,Department of Ophthalmology - University of Campinas, Campinas, Brazil.
| | | | | | | | - Camila I Iguma
- Hospital Oftalmológico de Brasília, SGAS 607 Avenida L2 Sul, Distrito Federal, Brasília, ZIP Code 70200670, Brazil
| | | | | | | | - Tiago S Prata
- Hospital Medicina Dos Olhos, Osasco, São Paulo, Brazil.,Departamento de Oftalmologia, UNIFESP/EPM, São Paulo, Brazil
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Pillunat KR, Herber R, Wolfram S, Jasper CS, Waibel S, Pillunat LE. Efficacy of Selective Laser Trabeculoplasty on Circadian Intraocular Pressure Following Trabeculectomy in Advanced Primary Open-angle Glaucoma. J Glaucoma 2022; 31:96-101. [PMID: 34919063 DOI: 10.1097/ijg.0000000000001971] [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: 08/13/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022]
Abstract
PRCIS In about 50% of post-trabeculectomy (TE) eyes, selective laser trabeculoplasty (SLT) is effective in further lowering intraocular pressure (IOP). PURPOSE To investigate the efficacy and safety of SLT in post-TE eyes, uncontrolled on maximum tolerated medication, and/or with progression of visual field loss. PATIENTS AND METHODS This retrospective study consecutively included post-TE eyes of patients diagnosed with primary open-angle glaucoma who had been treated with 360 degrees SLT and had a follow-up after 12 months. Primary endpoints were the reduction of mean diurnal intraocular pressure (mdIOP, mean of 6 measurements), peak IOP, and diurnal IOP fluctuations. Secondary outcomes were factors influencing IOP reduction, SLT success, and failure rates. RESULTS Forty-three eyes of 43 patients were included. During the first year, 10 eyes (23%) needed additional procedures to reduce mdIOP and were accounted as failures and excluded from final analysis. Of the remaining 33 eyes (77%) mdIOP [Q25, Q75] dropped from 15.2 [12.2 to 16.5] to 13.2 [11.6 to 15.3] mm Hg (P=0.027), 23 eyes (54%) showed a sufficient mdIOP reduction, 1 year after SLT. CONCLUSION SLT is effective and safe in lowering mdIOP to target IOP in about 50% of eyes after prior incisional glaucoma surgery.
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Affiliation(s)
- Karin R Pillunat
- Department of Ophthalmology, Medical Faculty Carl Gustav Carus, Technical University, Dresden, Germany
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