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Yu S, Xu K, Zhang C. Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy. Int J Ophthalmol 2024; 17:272-277. [PMID: 38371259 PMCID: PMC10827615 DOI: 10.18240/ijo.2024.02.07] [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: 08/06/2023] [Accepted: 11/29/2023] [Indexed: 02/20/2024] Open
Abstract
AIM To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy (MAT). METHODS Totally 10 eyes of 10 patients with primary open angle glaucoma (POAG) who underwent MAT facilitated by Usights UC100 (5 eyes) or iTrack (5 eyes) were reviewed. The success of this surgery was defined as intraocular pressure (IOP) <22 mm Hg with >30% reduction, without oral glaucoma medications, or additional glaucoma surgery. RESULTS The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group. MAT was achieved in all eyes in both groups. The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes, respectively. Both microcatheters produced a statistically significant reduction in IOP, and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo follow-up (12.58±1.52 and 14.84±1.89 mm Hg, respectively), but no statistical significance was there. No severe side effects were observed in either group. CONCLUSION MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG, and Usights UC100 is as safe as iTrack.
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Affiliation(s)
- Shuo Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ke Xu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China
- Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
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Fang L, Zhu Y, Lin S, Su Y, Chen L, Liu P, Zhong Y, Liu X. Microcatheter-Assisted Circumferential Trabeculotomy After Failed Glaucoma Surgeries in Childhood Glaucoma. Am J Ophthalmol 2023; 256:46-54. [PMID: 37516402 DOI: 10.1016/j.ajo.2023.07.019] [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: 12/26/2022] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE To evaluate the outcomes of microcatheter-assisted trabeculotomy (MAT) in childhood glaucoma (primary congenital glaucoma [PCG], juvenile open-angle glaucoma [JOAG], and secondary childhood glaucoma [SCG]) after failed glaucoma surgery. DESIGN Retrospective interventional case series. METHODS Patients with childhood glaucoma who underwent MAT after failed glaucoma surgery with at least 12 months of follow-up were evaluated. Pre- and postoperative intraocular pressure (IOP) and the number of glaucoma medications were recorded and compared. Success was defined as an IOP ≤21 mm Hg with or without glaucoma medication. Analysis of variance was used to compare the glaucoma subgroups. RESULTS Forty-five eyes (42 patients) with a median follow-up period of 19 months were included. The median age at the time of MAT was 10 (range, 0.8-33) years. The mean number of previous surgeries was 1.3 ± 0.5. The IOP had significantly reduced from baseline in all PCG, JOAG, and SCG patients (27.9 ± 4.5 vs 16.3 ± 8.0 mm Hg, P = .001; and 30.8 ± 9.4 vs 13.5 ± 3.0 mm Hg, P < .001; and 31.5 ± 7.1 vs 16.5 ± 5.3 mm Hg, P = .001, respectively). Fewer glaucoma medications were needed after MAT in all 3 groups (each P < .001). At the last visit, the total success rates in PCG, JOAG, and SCG were 93.8%, 100%, and 88.9%, respectively. No severe complications were observed. CONCLUSION MAT can effectively manage PCG, JOAG, and SCG after failed surgeries, providing successful outcomes and no serious complications. Following failed glaucoma surgeries, MAT may offer these patients with childhood glaucoma an excellent opportunity to achieve IOP control.
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Affiliation(s)
- Lei Fang
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Yingting Zhu
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Shufen Lin
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Yihua Su
- The Ophthalmology Department, the First Affiliated Hospital of Sun Yat-sen University (Y.S.), Guangzhou, China
| | - Liming Chen
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Pingping Liu
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Yimin Zhong
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China
| | - Xing Liu
- From the 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 (L.F., Y.Z., S.L., L.C., P.L., Y.Z., X.L.), Guangzhou, China.
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Meshksar A, Razeghinejhad MR, Azimi A. Ab-interno Trabeculotomy Procedures: A Review. J Curr Ophthalmol 2023; 35:110-124. [PMID: 38250496 PMCID: PMC10795813 DOI: 10.4103/joco.joco_45_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/02/2023] [Accepted: 07/05/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To discuss the safety and efficacy of various forms of ab-interno trabeculotomy procedures. Methods A comprehensive search in PubMed and Google Scholar was done using the keywords "glaucoma", "microinvasive glaucoma surgery", "complications", "goniotomy", and "trabeculotomy". Publications discussing ab-interno trabeculotomy procedures were selected; furthermore, the relevant references in these articles were gathered and the search was updated during the article preparation. Since gonioscopy-assisted transluminal trabeculotomy was first introduced in 2014, we had no time restriction. Results Ab-interno trabeculotomy procedures, as a type of minimally invasive glaucoma surgeries, facilitate the natural trabecular outflow and lower the intraocular pressure (IOP) while preserving the conjunctiva for possible future glaucoma surgeries. It can be done alone or in combination with cataract surgery and effectively lowers the IOP and the number of antiglaucoma medications in various forms of glaucoma. Conclusion By appropriate patient selection, ab-interno trabeculotomy could be selected as a safe and effective procedure in the management of various forms of glaucoma either as an isolated procedure or in combination with cataract extraction.
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Affiliation(s)
- Aidin Meshksar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Razeghinejhad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Glaucoma Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Wang Y, Zhang W, Xin C, Sang J, Sun Y, Wang H. Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results. BMC Ophthalmol 2023; 23:89. [PMID: 36879233 PMCID: PMC9987149 DOI: 10.1186/s12886-023-02830-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery. METHODS A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success. RESULTS Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred. CONCLUSIONS GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.
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Affiliation(s)
- Yiwei Wang
- Department of Ophthalmology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.,Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Weijia Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, 100191, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, 100191, China.,Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Chen Xin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.,Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Jinghong Sang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China
| | - Yang Sun
- Department of Ophthalmology, Stanford University, Palo Alto, CA, 94303, USA
| | - Huaizhou Wang
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No.8 Chongwenmennei Street, Beijing, 100730, Dongcheng District, China.
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Outcomes of Penetrating Canaloplasty in Childhood Glaucoma. J Glaucoma 2023; 32:34-39. [PMID: 35980844 DOI: 10.1097/ijg.0000000000002111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/26/2022] [Indexed: 02/08/2023]
Abstract
PRCIS Penetrating canaloplasty was safe and effective for the management of refractory childhood glaucoma. PURPOSE The purpose of this paper is to report the safety and efficacy of penetrating canaloplasty for the management of childhood glaucoma. MATERIALS AND METHODS This single-center prospective interventional case series enrolled 50 eyes of 32 patients with childhood glaucoma between July 2017 and July 2020. Penetrating canaloplasty to create direct communication between the anterior chamber and tensioning suture-dilated the Schlemm canal was performed through a trabecular meshwork ostium in the affected eyes. Preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, and procedure-related complications were recorded. Qualified and complete success was defined as IOP≥5 and ≤21 mm Hg with or without glaucoma medications, respectively. RESULTS A total of 43 eyes (86.0%) achieved 360 degrees catheterization of Schlemm canal and completed penetrating canaloplasty. The median age at surgery was 5 years (range, 10 d-17 y, mean 6.20±5.46 y). The mean IOP decreased from 33.11±10.89 mm Hg on 2 medications (median, range: 0-5) before surgery to 13.46±4.71 mm Hg on 0 medications (median, range:0-2) postoperatively at 12 months ( P <0.001). Complete and qualified success rates were 81.08% and 89.19%, respectively, at the 12-month follow-up. Hyphema (6/43, 13.95%) and a transient shallow anterior chamber with hypotony (5/43, 11.63%) were the most commonly observed early complications. CONCLUSION Penetrating canaloplasty demonstrated good safety and efficacy in eyes with childhood glaucoma, and may be considered an option for managing refractory childhood glaucoma.
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Quan AV, Chen J, Wang YE, Vanner EA, Grajewski AL, Hodapp EA, Chang TC. Factors Associated With Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) Complications and Failure in Children. Am J Ophthalmol 2022; 241:168-178. [PMID: 35551908 DOI: 10.1016/j.ajo.2022.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/01/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To identify the factors associated with the complications and failure of gonioscopy-assisted transluminal trabeculotomy (GATT) in children. DESIGN Retrospective case series. METHODS This study was conducted in an institutional setting in a pediatric population (aged <18 years) who had undergone GATT. Records were reviewed, and pre- and postoperative intraocular pressures (IOP), extent of angle treated, medications, complications, and failure were recorded. Failure was defined as IOP >21 mm Hg or <5 mm Hg, absence of at least 20% IOP reduction, performance of additional IOP-lowering surgery, or loss of light perception vision. RESULTS A total of 74 eyes of 57 patients were included (mean age, 7.1 years). Over a median follow-up period of 28.5 months, 36 eyes (48.6%) failed. IOP spikes occurred in 25 eyes (33.8%) and were a significant risk factor for failure (hazard ratio [HR] = 2.17; P = .0207). Postoperative hyphema was a significant risk factor for IOP spike (HR = 4.13, P = .003) but not for failure (HR = 0.7, P = .2977). The risk of IOP spike was lowest in eyes treated with nonsteroidal anti-inflammatory drugs (NSAIDs; HR = 0.27, P = .0016). The risk of failure increased significantly in eyes that received topical corticosteroids (compared to NSAIDs; HR = 5.72, P = .0005), in eyes with <360○ incisions (HR = 4.69, P < .0001), and in younger children. CONCLUSIONS GATT is a reasonably effective procedure in childhood glaucoma. Postoperatively, the use of topical NSAIDs (without corticosteroid) may decrease the risk of failure. Eyes with IOP spikes without hyphema are at the highest risk for failure.
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Affiliation(s)
- Ann V Quan
- From Scripps Health (A.V.Q.), Department of Ophthalmology, San Diego, California, USA
| | - Jenny Chen
- UC Davis Eye Center (J.C.), University of California Davis Medical Center, Sacramento, California, USA
| | - Ye Elaine Wang
- Harvard Eye Associates (Y.E.W.), Laguna Hills, California, USA
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alana L Grajewski
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth A Hodapp
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ta Chen Chang
- Bascom Palmer Eye Institute (E.A.V., A.L.G., E.A.H., T.C.C.), University of Miami Miller School of Medicine, Miami, Florida, USA.
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Shi Y, Wang H, Oatts JT, Xin C, Yin P, Zhang L, Tian J, Zhang Y, Cao K, Han Y, Wang N. A Prospective Study of Intraocular Pressure Spike and Failure After Gonioscopy-Assisted Transluminal Trabeculotomy in Juvenile Open-Angle Glaucoma: A Prospective Study of GATT in JOAG. Am J Ophthalmol 2022; 236:79-88. [PMID: 34695398 DOI: 10.1016/j.ajo.2021.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/30/2021] [Accepted: 10/09/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify risk factors for surgical failure after gonioscopy-assisted transluminal trabeculotomy (GATT) in juvenile open-angle glaucoma (JOAG). DESIGN Prospective, interventional case series. METHODS GATT was the initial surgery in 70 eyes of 70 patients with JOAG. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤21 mm Hg with at least a 20% reduction from preoperative IOP, with or without the use of antiglaucoma medication (qualified and complete success, respectively) at each postoperative visit. IOP spike was defined as IOP >30 mm Hg and an increase of at least 10 mm Hg from IOP before the spike, and then reduced to ≤21 mm Hg. RESULTS The median age at the time of surgery was 19.3 years (range, 4.9-37.5 years) with a visual field mean deviation of -17.4 ± 10.6 dB. Mean IOP decreased from 31.3 ± 9.5 mm Hg preoperatively to 15.8 ± 2.7 at 12 months postoperatively. The complete and qualified success rates were 74.3% and 91.4%, respectively. An IOP spike occurred in 52 eyes (74%), with a median spike duration of 3.5 days (range, 1-21 days). Longer duration of IOP spike (P = .009) and older age at the time of surgery (P = .025) were both associated with worse surgical outcomes. Advanced disease was associated with prolonged IOP spike (P = .007). CONCLUSIONS GATT provided excellent outcomes in patients with severe JOAG. Older age and longer duration of postoperative IOP spike are risk factors for failure. Severe cases are more likely to have longer durations of IOP spike. Frequent IOP monitoring during the early postoperative period is needed to detect IOP spikes in these patients.
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Abstract
PURPOSE OF REVIEW Minimally invasive glaucoma surgery (MIGS) has been shown to be safe and effective in treatment of mild to moderate glaucoma in adults, but reports in childhood glaucoma are limited. We review the available data concerning MIGS and discuss its potential role in childhood glaucoma management. RECENT FINDINGS Ab interno counterparts to circumferential ab externo trabeculotomy such as gonioscopy-assisted transluminal trabeculotomy (GATT) and Trab360 show promise in treatment of primary glaucomas as reported in a few retrospective case series. Kahook Dual Blade (KDB) and Trabectome have demonstrated mixed results in few published case reports in children. Small case series and reports suggest that the Xen gel stent can be a safer alternative to traditional filtration surgery, though data on long-term implant and bleb stability are unavailable. Newer devices are being investigated and early results are encouraging. SUMMARY GATT and Trab360 seem to be safe, effective methods of achieving circumferential trabeculotomy in childhood glaucoma. KDB, Trabectome, and Xen gel stent have shown some success in selected cases with short-term follow-up. Surgeons must determine the risks and benefits of MIGS over more established methods of intraocular pressure reduction for each individual child. Further research is needed to validate initial findings regarding MIGS in childhood glaucoma.
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Affiliation(s)
- Michelle S Go
- Department of Ophthalmology, University of North Carolina, Chapel Hill
| | - Sharon F Freedman
- Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina, USA
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Elwehidy AS, Bayoumi NHL, Abd Elfattah D, Hagras SM. Surgical Outcomes of Visco-Circumferential-Suture-Trabeculotomy Versus Rigid Probe Trabeculotomy in Primary Congenital Glaucoma: A 3-Year Randomized Controlled Study. J Glaucoma 2022; 31:48-53. [PMID: 34628421 DOI: 10.1097/ijg.0000000000001944] [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: 07/05/2021] [Accepted: 09/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to compare the long-term surgical outcomes of visco-circumferential-suture-trabeculotomy (VCST) and rigid probe viscotrabeculotomy (VT) in patients with primary congenital glaucoma (PCG). PATIENTS AND METHODS The study was conducted on 84 (47 right) eyes of 49 (32 males) children PCG to the pediatric ophthalmology unit of Mansoura Ophthalmic Center of Mansoura University, Egypt between 2015 and 2018. An initial office examination was followed by an examination under general anesthesia to establish the diagnosis of PCG. The children were then scheduled for surgery and the eyes randomly assigned to VCST or VT. Follow-up visits were scheduled at the first day, first week, first, and third months and then every 3 months for 1 year. RESULTS The mean±SD age of the study children at presentation was 4.8±2.1 and 4.9±1.7 months in the VCST and the VT groups, respectively (P=0.827). The mean±SD preoperative intraocular pressure (IOP) was 29.13±3.3 and 29.89±3.2 mm Hg in the VCST and VT groups, respectively (P=0.292) and 11.9±1.3 and 13.8±1.2 mm Hg at the end of 36 moths of follow-up (P<0.001). The IOP at all follow-up time points (except at the third month, P=0.924) was statistically significantly less in the VCST group than in the VT group (at week 1, month 1, 6, 9, 12, 18, 24, 30, and 36 the P<0.001). The cumulative probability of success was 100%, 95%, 90%, and 90%, respectively in VSCT and 100%, 72.7%, 97.7%, 90.9%, and 84% in VT at 12, 24, 30, and 36 months. CONCLUSIONS Both VCST and VT were effective and safe for lowering the IOP in PCG with VCST providing a marginal advantage over VT.
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Affiliation(s)
- Ahmed S Elwehidy
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura
| | - Nader H L Bayoumi
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Dina Abd Elfattah
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura
| | - Sherein M Hagras
- Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura
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Zhang W, Wang Y, Xin C, Sun Y, Cao K, Wang H, Wang N. Ab Interno vs. Ab Externo Microcatheter-Assisted Circumferential Trabeculotomy in Treating Patients With Primary Open-Angle Glaucoma. Front Med (Lausanne) 2021; 8:795172. [PMID: 34988099 PMCID: PMC8720850 DOI: 10.3389/fmed.2021.795172] [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: 10/14/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Circumferential trabeculotomy have evolved from ab externo to ab interno approach. Both procedures may lower IOP, but it is unclear which maybe a superior approach.Purpose: To compare the outcomes of ab interno and ab externo circumferential trabeculotomy in patients with primary open-angle glaucoma.Design: Retrospective, comparative case series.Participants: Primary open angle glaucoma patients undergoing ab interno (40 patients in Group 1) or ab externo (54 patients in Group 2) circumferential trabeculotomy, with about one half of them having prior incisional glaucoma surgery.Methods: Outcomes including intraocular pressure (IOP), glaucoma medications and surgical complications were analyzed.Main Outcome Measures: IOP, medications and surgical success defined as an IOP of ≤ 21 mmHg and a reduction of IOP ≥20% from baseline (criterion A) or IOP ≤ 18 mmHg and a reduction of IOP 20% from baseline (criterion B) with (qualified success) or without (complete success) medications.Results: At 1 year, IOP decreased by 37.1% (26.0–14.8 mmHg) in Group 1 and 39.5% (28.5–15.1 mmHg) in Group 2. Medications decreased from 3.5 in Group 1 and 3.6 in Group 2 pre-operatively to 0.6 ± 1.0 and 0.3 ± 0.6 post-operatively, respectively. Success rates did not differ significantly between groups based on criterion A (complete and qualified success: 68.7 and 81.9% in Group 1, and 75.3 and 90.4% in Group 2, respectively) or criterion B (complete and qualified success: 58.2 and 79.3%in Group 1, and 69.5 and 88.4% in Group 2, respectively). For eyes with prior filtration surgeries, the mean percent reduction of IOP (41.7 ± 32.7% in Group 1, 39.7 ± 27.8% in Group 2, P = 0.724) and the mean medication reduction (2.9 ± 1.6 in Group 1, 3.4 ± 1.0 in Group 2, P = 0.454) were not significantly different.Conclusions: Ab interno circumferential trabeculotomy achieved comparable outcomes to ab externo trabeculotomy and may be an effective surgical option for patients with primary open-angle glaucoma.
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Affiliation(s)
- Weijia Zhang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yiwei Wang
- Department of Ophthalmology, Henan Provincial People's Hospital, Zhengzhou, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Xin
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Yang Sun
- Byers Eye at Stanford, Palo Alto, CA, United States
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Huaizhou Wang
- Department of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- *Correspondence: Huaizhou Wang
| | - Ningli Wang
- Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Centre, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Zhang H, Yan X, Li F, Ma L, Geng Y, Jiao K, Tang G. Microcatheter-Assisted Trabeculotomy Combined With Deep Sclerectomy and Trabeculectomy in Young to Middle-Aged Adults With Advanced Primary Open-Angle Glaucoma: 1-Year Result. Front Med (Lausanne) 2021; 8:712332. [PMID: 34540866 PMCID: PMC8446351 DOI: 10.3389/fmed.2021.712332] [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: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: We aimed to evaluate the safety and clinical efficacy of ab externo microcatheter-assisted trabeculotomy combined with deep sclerectomy and trabeculectomy (MATT-DS-Trab) in the surgical management of advanced primary open-angle glaucoma (POAG). Methods: According to the inclusion criteria, we retrospectively collected and analyzed 37 POAG cases in advanced stage who received MATT-DS-Trab. The intraocular pressure (IOP), best corrected visual acuity (BCVA), use of anti-glaucoma drugs, shape of the filtering bleb, size of the scleral lake, complications, and the surgical success rate were recorded. Results: The mean IOP was 37.50 ± 8.11 mmHg before the operation, while it depleted to 10.08 ± 2.01 and 11.43 ± 2.07 mmHg at 1 week and 12 months after the operation, respectively (both P < 0.001 compared to preoperative IOP). From none to two kinds of anti-glaucoma drugs were used 12 months after surgery on the patients, which were significantly reduced compared with that preoperatively (P < 0.001). An L-type filtering bleb was the main form at all time points after the operation. At 12 months following surgery, an F-type filtering bleb accounted for 5.41% and no E-type filtering bleb was recorded. The length and height of the scleral lake shrunk with time, but there was no statistical significance (P > 0.05). Also, there was no correlation between the size of the scleral pool and the IOP (P > 0.05). At 12 months after the operation, the complete success rates were 94.59, 83.78, and 72.97% according to standards A (≤18 mmHg), B (≤15 mmHg), and C (≤12 mmHg), respectively. Intraoperative complications were mainly anterior chamber hemorrhage, and no complications related to the filtration bleb were observed after the operation. Conclusion: Based on multichannel mechanisms, MATT-DS-Trab is able to effectively reduce IOP in advanced POAG patients, with few serious complications and a high success rate.
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Affiliation(s)
- Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Fan Li
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Lihua Ma
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Yulei Geng
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Kexin Jiao
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Shijiazhuang, China
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Shi Y, Wang H, Oatts J, Cao K, Xin C, Liang X, Tian J, Han Y, Wang N. Ab interno vs ab externo microcatheter-assisted trabeculotomy for primary congenital glaucoma with clear cornea. Clin Exp Ophthalmol 2020; 48:1201-1209. [PMID: 33058409 PMCID: PMC7756548 DOI: 10.1111/ceo.13868] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/19/2020] [Accepted: 09/25/2020] [Indexed: 11/27/2022]
Abstract
Importance This is the first comprehensive comparison between ab interno approach and ab externo approach for microcatheter‐assisted trabeculotomy in primary congenital glaucoma with clear cornea. Background Ab externo microcatheter‐assisted trabeculotomy is considered to be the gold standard for primary congenital glaucoma. The novel ab interno approach would intuitively be similar to ab externo approach for microcatheter‐assisted trabeculotomy in eyes with clear cornea; however, there is no evidence yet. Design Non‐contemporary comparison of retrospective case series. Participants Fifty‐eight and fifty‐seven consecutive primary congenital glaucoma eyes with clear corneas underwent ab interno and ab externo microcatheter‐assisted trabeculotomy, respectively. Methods Retrospective comparison of clinical outcomes. Main Outcome Measures Surgical success was defined as a postoperative intraocular pressure of ≤21 mmHg with at least a 30% reduction from preoperative IOP with or without the use of anti‐glaucoma medication (qualified and complete success, respectively). Results The qualified success rate (87.9% vs 82.2%, P = .40) and complete success rates (81.0% vs 73.3%, P = .32) were comparable between groups. Complications were minimal and comparable. Less than 360° trabeculotomy (P = .009) and a higher number of previous surgeries (P = .03) were both associated with worse surgical outcomes. Conclusions and Relevance Ab interno approach provide good and comparable outcomes as ab externo approach for microcatheter‐assisted trabeculotomy in primary congenital glaucoma eyes with clear cornea. It should be considered as the initial choice in these patients with the benefit of sparing conjunctiva. Successful trabeculotomy with either technique during the first attempt is critical to overall success and underscores the need for proficiency before independent practice.
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Affiliation(s)
- Yan Shi
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Huaizhou Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Julius Oatts
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Kai Cao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Chen Xin
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Xintong Liang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Jiaxin Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Ying Han
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
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