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Tatti F, Tronci C, Lixi F, Demarinis G, Kuzmich S, Peiretti E, Fossarello M, Giannaccare G. No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma. J Clin Med 2024; 13:2537. [PMID: 38731065 PMCID: PMC11084149 DOI: 10.3390/jcm13092537] [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: 03/17/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient's eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy; (F.T.); (C.T.); (F.L.); (G.D.); (S.K.); (E.P.); (M.F.)
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Nakakura S, Oogi S, Terao E, Nagata Y, Fujisawa Y, Dote S, Ueda K. Changes in Ocular Biometry Following PreserFlo MicroShunt Implantation and Trabeculectomy: A Prospective Observational Study. Cureus 2024; 16:e56188. [PMID: 38487650 PMCID: PMC10940033 DOI: 10.7759/cureus.56188] [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] [Accepted: 03/13/2024] [Indexed: 03/17/2024] Open
Abstract
Background This study aimed to evaluate postoperative changes in ocular biometry following initial PreserFlo MicroShunt implantation and trabeculectomy. Methodology This prospective, observational study analyzed 27 cases of PreserFlo MicroShunt implantation and 29 cases of trabeculectomy performed by a single surgeon. Visual acuity, intraocular pressure, corneal curvature, central corneal thickness, anterior chamber depth, and axial length were assessed at baseline and postoperatively at one day, one week, two weeks, one month, two months, three months, and six months. Patients requiring additional surgery and those with missing data were excluded. Consecutive data were compared with the baseline values using multiple comparisons. Results In both groups, intraocular pressure was significantly decreased from baseline at all postoperative time points (all p < 0.01). Visual acuity decreased in both groups at one day and one week postoperatively. Corneal curvature remained unchanged in both groups throughout the six-month follow-up. Central corneal thickness increased at one day and one week postoperatively in the PreserFlo group, but not in the trabeculectomy group. Anterior chamber depth exhibited a significant decrease at one week postoperatively in both groups. Axial length significantly decreased postoperatively until three months in the PreserFlo group and at all postoperative time points in the trabeculectomy group. Conclusions Ocular biometry following PreserFlo and trabeculectomy had a similar tendency postoperatively.
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Affiliation(s)
| | - Satomi Oogi
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
| | - Etsuko Terao
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
| | - Yuki Nagata
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
| | | | - Saki Dote
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
| | - Kanae Ueda
- Ophthalmology, Saneikai Tsukazaki Hospital, Himeji, JPN
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Xia J, Guo S, Hu F, Fan L, Yu L, Ye J. Changes in Corneal Higher-Order Aberrations and Ocular Biometric Measurements after Phacoemulsification Combined with Goniosynechialysis in Primary Angle Closure/Glaucoma Patients. J Ophthalmol 2024; 2024:5833543. [PMID: 38250183 PMCID: PMC10798839 DOI: 10.1155/2024/5833543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/24/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
Purpose To compare corneal higher-order aberrations (HOAs), refractive error, and ocular biological parameters before and after phacoemulsification combined with goniosynechialysis (Phaco-GSL) in primary angle closure/glaucoma (PAC/PACG) patients with different axial lengths (ALs). Methods In this prospective study, cataract patients diagnosed with PAC/PACG were categorized into two groups based on their ALs: the short AL group (AL ≤ 22.5 mm) and the normal AL group (22.5 < AL ≤ 24.5 mm). The pre- and postsurgery measurements of intraocular pressure (IOP) and best-corrected visual acuity (BCVA) were conducted at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months. Additionally, the assessments included corneal HOAs, the number of antiglaucoma medications, visual field parameters, manifest refraction, and other ocular biological parameters before surgery and at the final follow-up. Results Prior to surgery, the two groups exhibited no significant differences, except for AL, curvature value, and Z (4, 0) of the posterior corneal surface (all P < 0.01). Following surgery, BCVA improved, and IOP decreased significantly in both groups (P < 0.01). Both anterior and total corneal HOAs, along with Z (3, -3), increased in the two groups (all P < 0.05), with the normal AL group exhibiting a significantly greater increase in total cornea Z (3, -3) than the short AL group (P=0.047). The normal AL group also exhibited a slight tendency towards hyperopia (P < 0.01). Significant changes were observed in the visual field index and mean deviation in both groups (P < 0.05). Conclusions Phaco-GSL resulted in an increased corneal HOAs, particularly trefoil, with variations based on the patient's AL. Patients with normal ALs tended to shift towards hyperopia after surgery.
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Affiliation(s)
- Jiali Xia
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Siqi Guo
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
| | - Fei Hu
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
| | - Liqi Fan
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
| | - Ling Yu
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
| | - Jian Ye
- Department of Ophthalmology, Daping Hospital, Army Medical Center, Army Medical University, Chongqing 400042, China
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Hong ASY, Ang BCH, Dorairaj E, Dorairaj S. Premium Intraocular Lenses in Glaucoma-A Systematic Review. Bioengineering (Basel) 2023; 10:993. [PMID: 37760095 PMCID: PMC10525961 DOI: 10.3390/bioengineering10090993] [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: 07/06/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments.
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Affiliation(s)
- Ashley Shuen Ying Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Woodlands Health Campus, Singapore 768024, Singapore
| | - Emily Dorairaj
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA;
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Gambini G, Carlà MM, Giannuzzi F, Boselli F, Crincoli E, Caporossi T, Baldascino A, De Vico U, Savastano A, Rizzo S. Early post-operative anterior segment parameters modifications induced by PreserFlo MicroShunt in primary open-angle glaucoma. Int Ophthalmol 2023:10.1007/s10792-023-02697-z. [PMID: 37031312 PMCID: PMC10400679 DOI: 10.1007/s10792-023-02697-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/23/2023] [Indexed: 04/10/2023]
Abstract
PURPOSE The aim this study is to determine anterior chamber parameters variations induced by PreserFlo MicroShunt implantation, in the early post-operative days. METHODS This is a prospective observational study on 48 eyes undergoing PreserFlo MicroShunt implantation alone (n = 30) or combined with phacoemulsification (n = 18). Anterior chamber depth (ACD) and volume (ACV), central corneal thickness (CCT) and total corneal astigmatism (TCA) were evaluated pre-operatively, post-operatively at day-1 and at 1 week with the Pentacam tomography. RESULTS Intraocular pressure decreased significantly from 20.9 ± 4.0 to 8.0 ± 2.8 mmHg (p < 0.0001) and to 10.8 ± 3.7 mmHg (p = 0.0001) at day-1 and week-1, respectively. TCA varied significantly from baseline (1.5 ± 1.2 D) to both day 1 follow up (2.7 ± 1.9 D, p = 0.0003) and week 1 follow up (2.2 ± 1.6 D, p = 0.02). Nevertheless, only K1 showed a transient flattening at day 1, while K2 value didn't show any statistical variation in the early post-operative period. CCT value rose significantly at day 1 (547 ± 49 vs. 529 ± 32 µm at baseline, p = 0.04), but then returned toward pre-operative values at week 1 (537 ± 39 µm, p = 0.57). In contrast, ACD values changed insignificantly from 3.3 ± 0.9 to 3.7 ± 1.0 mm at day 1 (p = 0.21), and then stabilized at 3.4 ± 0.9 mm (p = 0.82) at week 1 follow up. ACV changed from 150.0 ± 36.2 to 159.5 ± 42.1 mm3 at day 1 (p = 0.58), and successively to 153.9 ± 37.9 mm3 at week 1 follow up (p = 0.96). The subgroup analysis in eyes undergoing standalone PreserFlo implantation didn't show significant changes in both ACD and ACV. CONCLUSION PreserFlo implantation minimizes the anterior chamber modifications generated by traditional filtering surgery, inducing low and transient corneal and biometric changes only in the very early postoperative period and insignificant changes to ACD and ACV, label of its safety and minimal invasiveness.
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Affiliation(s)
- Gloria Gambini
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy.
- Catholic University Sacro Cuore, Rome, Italy.
| | - Federico Giannuzzi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Francesco Boselli
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Emanuele Crincoli
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Antonio Baldascino
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Umberto De Vico
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Alfonso Savastano
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
- Catholic University Sacro Cuore, Rome, Italy
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Effects of Postoperative Atropine Eye Drops on Visual Quality in Patients Undergoing Trabeculectomy. J Clin Med 2023; 12:jcm12030763. [PMID: 36769412 PMCID: PMC9917408 DOI: 10.3390/jcm12030763] [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: 12/11/2022] [Revised: 01/10/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
The aim of this study was to investigate the effects of atropine on patients' perception of visual quality after trabeculectomy. Forty patients undergoing standard trabeculectomy with mitomycin C were enrolled in this prospective randomized study. All surgeries were conducted at the ophthalmology department of the University Medical Center of Mainz, Germany. All patients received the same postoperative treatment with ofloxacin and dexamethasone eye drops. Following randomization of patients into two groups of 20 patients, the intervention group also received atropine eye drops three times daily for the first 2 days after surgery to stabilize the anterior chamber. All patients completed a visual quality questionnaire before surgery and 2 and 6 weeks after surgery. Results were compared using the Wilcoxon test. After surgery, there was a reduction in visual quality in all patients. Patients who received atropine eye drops described a greater and longer-lasting reduction in visual quality than those who did not receive atropine eye drops. Trabeculectomy often leads to a transient reduction in visual quality. This reduction was greater in severity and duration in patients who received postoperative atropine eye drops. Thus, unless there is an underlying medical necessity, we would discourage the application of atropine as a standard therapy for trabeculectomy surgery.
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Refractive Changes after Glaucoma Surgery-A Comparison between Trabeculectomy and XEN Microstent Implantation. Life (Basel) 2022; 12:life12111889. [PMID: 36431024 PMCID: PMC9692314 DOI: 10.3390/life12111889] [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: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022] Open
Abstract
Best-corrected visual acuity often decreases temporarily or permanently after trabeculectomy (TE). The purpose of this study was to compare visual acuity and refractive changes after TE or XEN microstent implantation (XEN) in primary open-angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEX) cases naïve to prior glaucoma surgery over a 24-month follow-up period. We analyzed 149 consecutive glaucoma patients who received either TE or XEN because of medically uncontrollable POAG or PEX. Intraocular pressure (IOP), IOP-lowering medication use, subjective and objective refraction and best-corrected visual acuity were evaluated. In addition, surgically induced astigmatism (SIA) was calculated and compared using the vector analysis method described by Jaffe and Clayman. A total of 93 eyes (85 POAG; 8 PEX) were treated with TE and 56 eyes (50 POAG; 6 PEX) with XEN. After 24 months, the mean IOP and number of IOP-lowering medications used decreased significantly after TE (p < 0.01) and XEN (p < 0.01). In the TE group, mean best-corrected visual acuity (BCVA) changed from 0.16 ± 0.26 to 0.23 ± 0.28 logMAR (p < 0.01) after 24 months, while mean BCVA did not change significantly in the XEN group (preoperative: 0.40 ± 0.50 logMAR, postoperative: 0.36 ± 0.49 logMAR; p = 0.28). SIA was almost the same in both groups at the end of the 24-month follow-up period (0.75 ± 0.60 diopters after TE and 0.81 ± 0.56 diopters after XEN; p = 0.57). In addition, there was no significant correlation between SIA and the observed BCVA changes or SIA and IOP reduction 12 or 24 months after TE or XEN. Our results demonstrate that TE and XEN are effective methods for reducing IOP and IOP-lowering medication use. The SIA was nearly similar in both groups. The SIA does not seem responsible for the decreased visual acuity after TE.
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Shiratori N, Nakamoto K, Nishio Y, Takano Y, Arima T, Kunishige T, Suzuki H, Igarashi T, Takahashi H. Statistical Analysis of Factors Affecting Surgically Induced Astigmatism Following Trabeculectomy. Clin Ophthalmol 2022; 16:3833-3839. [DOI: 10.2147/opth.s389480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
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Volzhanin AV, Petrov SY, Safonova DM, Averich VV. [On refraction shift after trabeculectomy]. Vestn Oftalmol 2022; 138:147-155. [PMID: 36287149 DOI: 10.17116/oftalma2022138052147] [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] [Indexed: 06/16/2023]
Abstract
PURPOSE To determine the factors affecting the shift of refraction after trabeculectomy. MATERIAL AND METHODS The study included 42 patients who were examined prior to trabeculectomy and at the following timepoints: 1 week, 1 month and 3 months after surgery. Examination included tonometry with assessment of corneal biomechanical properties, keratorefractometry with vector analysis, and biometry. The obtained data was processed for regression analysis and to find the possible correlations. RESULTS All significant correlations between the measured parameters only occur on week 1. Postoperative spherical component of refraction (sphere) correlates negatively both with preoperative axial length (AL) and anterior chamber depth (ACD) (r=-0.699 and r=-0.458, p<0.05) and postoperative AL and ACD (r= -0.767 and r= -0.415, p<0.011). Dependence of sphere on AL is also expressed as a regression model. The magnitude of AL change depends on the magnitude of intraocular pressure (IOP) change (r=0.729, p<0.0001) and correlates negatively with postoperative IOP (r=-0.454, p=0.009) and baseline corneal hysteresis (CH; r= -0.482, p=0.009). Dependence of AL on IOP is also expressed as a regression model. The magnitudes of sphere and cylinder shifts correlate negatively with each other (r=-0.416, p=0.038). Keratometry reveals that the overall cylinder value correlates with the corneal cylinder, and so do the magnitudes of their shifts (r=0.589 and r=0.574, p<0.0001). Dependence of corneal hysteresis on IOP is expressed as a regression model; however, neither tonometric nor biomechanical corneal properties correlate with refraction. CONCLUSIONS Sphere correlates negatively with AL and ACD. In turn, AL is related to the reduction in IOP. This dependence is likely the most important one for the refraction shift after trabeculectomy. No correlations were found for the change of astigmatism.
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Affiliation(s)
| | - S Yu Petrov
- Research Institute of Eye Diseases, Moscow, Russia
| | - D M Safonova
- Research Institute of Eye Diseases, Moscow, Russia
| | - V V Averich
- Research Institute of Eye Diseases, Moscow, Russia
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Abstract
PURPOSE To assess biometric changes in eyes after trabeculectomy (TE) and its impact on refractive outcomes of phacoemulsification (PE) in order to determine the corrections for calculation of intraocular lens (IOL) power. MATERIAL AND METHODS The study included two groups of patients: the 1st group consisted of 116 patients who were assessed by optical biometry (IOL-Master 500) for mean biometric values before and after TE; the 2nd group included 31 patients with history of TE (study subgroup) and 47 individuals without glaucoma (control subgroup) who underwent PE with subsequent comparison of IOL calculation accuracy. RESULTS There was significant axial length (AL) shortening in the 1st group from 23.28±0.97 to 23.19±0.97 mm (p<0.001) 6 months after TE, which positively correlated (r=0.296, p=0.001) with intraocular pressure (IOP) decrease (from 25.4±5.34 to 17.2±4.42 mm Hg, p<0.001). Mean keratometry and anterior chamber depth values did not significantly change after TE. Mean IOL power calculation error after PE in the 2nd group was -0.05±0.47 D and 0.003±0.62 D for the control and study subgroups, respectively (p=0.697). However, significant impact of preoperative IOP on IOL power calculation error was discovered in the study subgroup (R2=0.526, p<0.001), but not in the control subgroup (R2=0.061, p=0.052). Based on linear regression, the expected IOL power calculation errors depending on the preoperative IOP were determined for patients with history of TE. CONCLUSION AL shortening due to decrease in IOP in patients with history of TE leads to IOL power calculation errors. Expected IOL calculation error related to preoperative IOP level was determined, which could help improve refractive outcomes of PE in patients with history of TE.
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Affiliation(s)
- D F Belov
- Saint Petersburg Multifield Hospital No. 2, St. Petersburg, Russia
| | - V P Nikolaenko
- Saint Petersburg Multifield Hospital No. 2, St. Petersburg, Russia.,Saint Petersburg State University, St. Petersburg, Russia
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Long-term comparison of postoperative refractive outcomes between phacotrabeculectomy and phacoemulsification. J Cataract Refract Surg 2019; 44:964-970. [PMID: 30115297 DOI: 10.1016/j.jcrs.2018.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare long-term postoperative refractive outcomes between phacotrabeculectomy and phacoemulsification, both with posterior chamber intraocular lens implantation. SETTING Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, South Korea. DESIGN Retrospective comparative study. METHODS Postoperative refractive outcomes were compared between patients with cataract and coexisting primary or secondary open-angle glaucoma (OAG) who had phacotrabeculectomy (combined group) and patients with cataract with or without coexisting OAG who had phacoemulsification alone (phaco-only group). The refractive prediction error, mean absolute error, and median absolute error were compared between groups. Subgroup analysis based on preoperative axial length (AL) was performed (medium >22.0 to <24.5 mm; medium-long ≥24.5 to <26.0 mm; long ≥26.0 mm). RESULTS The combined group comprised 51 eyes and the phaco-only group, 74 eyes. The mean interval between surgery and refraction measurement was 14.70 months ± 10.80 (SD) (median 13.0 months) and 4.81 ± 4.97 months (median 2.0 months), respectively. Postoperatively, there was no statistically significant between-group difference in the following mean values: refractive prediction error, -0.05 ± 0.64 versus -0.04 ± 0.52 (P = .905); mean absolute error, 0.46 ± 0.44 versus 0.38 ± 0.36 (P = .258); median absolute error, 0.32 (interquartile range [IQR], 0.17, 0.67) versus 0.28 (IQR, 0.13, 0.54) (P = .297). Subgroup analysis also did not show significant differences between the 2 groups (all P > .05). CONCLUSION The long-term postoperative refractive outcomes of phacotrabeculectomy and phacoemulsification alone were not significantly different in eyes with OAG, regardless of preoperative AL.
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Miraftabi A, Lotfi M, Nilforushan N, Abdolalizadeh P, Jafari S. Ocular biometric changes after Ahmed glaucoma valve implantation. Eur J Ophthalmol 2019; 31:120-124. [PMID: 31752527 DOI: 10.1177/1120672119889528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the ocular biometric changes after uneventful Ahmed glaucoma valve implantation. METHODS Patients with refractory glaucoma who were candidate for Ahmed valve surgery were prospectively included in this study. Patients with a history of any kinds of corneal surgery were excluded. Refractive status, intraocular pressure, axial length, anterior chamber parameters including anterior and posterior mean keratometry, central corneal thicknesses, and anterior chamber depth, anterior chamber volume, and anterior chamber angle were evaluated at baseline and 1 and 3 months after surgery. RESULTS A total of 20 eyes from 20 patients were included. Mean intraocular pressure at baseline was 33.4 ± 12.3 mm Hg that significantly decreased to 14.6 ± 6.2 mm Hg at 1 month and 13.5 ± 4.3 mm Hg at 3 months after Ahmed glaucoma valve implantation (p < 0.001). Mean number of medications was 3.6 ± 1.3 at baseline which significantly decreased to 1.0 ± 1.3 at 3 months after Ahmed glaucoma valve implantation (p < 0.001). Axial length decreased significantly from 23.69 ± 1.95 to 23.47 ± 1.91 mm (p < 0.001) at month 3. There were no significant changes in other parameters such as mean spherical equivalent, anterior chamber volume, anterior chamber angle, anterior chamber depth, and keratometry at the end of month 3 after surgery (p > 0.05 in all). CONCLUSION Ahmed glaucoma valve implantation had a significant effect on axial length at 3 months after surgery but its effect on keratometry and other anterior chamber parameters was not significant.
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Affiliation(s)
- Arezoo Miraftabi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Lotfi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naveed Nilforushan
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Jafari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Sieck EG, Capitena Young CE, Epstein RS, SooHoo JR, Pantcheva MB, Patnaik JL, Lynch AM, Kahook MY, Seibold LK. Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy. EYE AND VISION (LONDON, ENGLAND) 2019; 6:28. [PMID: 31548974 PMCID: PMC6751845 DOI: 10.1186/s40662-019-0153-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy. METHODS Retrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone (n = 309) or phacoemulsification with KDB goniotomy (n = 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D). RESULTS Refractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group (p = 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group (p = 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses. CONCLUSION There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.
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Affiliation(s)
- Erin G. Sieck
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Cara E. Capitena Young
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Rebecca S. Epstein
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Jeffrey R. SooHoo
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Mina B. Pantcheva
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Jennifer L. Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Malik Y. Kahook
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
| | - Leonard K. Seibold
- Department of Ophthalmology, University of Colorado School of Medicine, 1675 Aurora Court F731, Aurora, CO 80045 USA
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Update on the Use of Premium Intraocular Lenses in Glaucoma. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Suture Removal After Trabeculectomy With Fornix-based Conjunctival Flap Leads to Faster Visual Recovery but Not Reduced Astigmatism. J Glaucoma 2019; 28:392-397. [PMID: 30855411 DOI: 10.1097/ijg.0000000000001232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PRéCIS:: The closing limbal suture after trabeculectomy with a fornix-based conjunctival flap plays no critical role in the development of corneal astigmatism and intraocular pressure (IOP). A standard removal is not recommended. PURPOSE To investigate the effect of removal of the conjunctival suture after trabeculectomy with fornix-based conjunctival flap on corneal astigmatism, visual acuity, and IOP. METHODS Eighty-seven cases of trabeculectomy with mitomycin C with a fornix-based conjunctival flap performed in the eyes of 82 patients (5 patients underwent bilateral trabeculectomy) were enrolled in a prospective randomized study. All surgeries were conducted by the same surgeon (J.W.) in the Ophthalmology Department of the University Medical Center of Mainz, Germany. All eyes received a corneal-conjunctival, continuous, mattress, interlocked suture for closing the conjunctiva at the limbus. After randomization, in 46 cases the suture was removed 6 weeks postoperatively; in 41 patients, the suture was left in place. All patients were examined preoperatively, and at 6 weeks, 3 months, 6 months, and 12 months after surgery. Astigmatism was measured using objective refraction and corneal topography, IOP and visual acuity were also assessed. Results were compared using a Wilcoxon test or Mann-Whitney U test for single time-points. RESULTS During follow-up, no significant differences between the 2 study groups regarding refractive or topographic values were found. Patients in the suture removal group had a significantly higher visual acuity than controls at 3 months, 6 months, and 1 year after surgery. IOP was similar in both groups throughout the study. CONCLUSIONS Removal of the conjunctival suture in trabeculectomy with a fornix-based conjunctival flap leads to a faster rehabilitation of visual acuity but does not significantly affect corneal astigmatism or IOP.
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Hasan S, Theilig T, Unterlauft JD. Comparing the efficacy of trabeculectomy and diode laser cyclophotocoagulation in primary open-angle glaucoma. Int Ophthalmol 2019; 39:2485-2496. [PMID: 30830546 DOI: 10.1007/s10792-019-01093-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim was to compare the postsurgical outcomes of trabeculectomy (TET) and transscleral cyclophotocoagulation (CPC) in a similar cohort of eyes diagnosed with primary open-angle glaucoma (POAG). MATERIALS AND METHODS For this monocentric non-randomized retrospective comparative trial, the records of eyes which underwent TET or CPC between 2013 and 2016 at our institution for the treatment of POAG were reviewed. Parameters analyzed before surgery as well as 1 and 2-3 years afterwards were visual acuity (VA), intraocular pressure (IOP), mean defect (MD) of the visual field, number of glaucoma medications and the objective refraction using which the surgically induced astigmatism (SIA) was calculated. RESULTS In total, 51 eyes of 51 patients underwent TET and 45 eyes of 45 patients underwent CPC. Mean VA dropped in both groups on the last follow-up after surgery (TET-group: 0.17 ± 0.17 to 0.23 ± 0.28 logMAR, p = 0.01/CPC-group: 0.22 ± 0.22 to 0.26 ± 0.27 logMAR, p = 0.01). In the TET- and CPC-groups IOP decreased significantly (TET: 24.9 ± 6.4 to 14.9 ± 3.1 mmHg, p = 0.001/CPC: 23.0 ± 6.5 to 16.0 ± 4.1 mmHg, p = 0.001) although more pronounced and less depending on IOP-lowering medication in eyes after TET. MD remained stable after TET (7.4 ± 4.8 and 8.1 ± 4.9 dB, p = 0.1) but further deteriorated in eyes after CPC (9.0 ± 4.9 and 10.7 ± 4.6 dB, p < 0.001). SIA was comparable in both groups on the last follow-up (TET: 0.83 ± 0.69 D; CPC: 0.91 ± 0.65 D, p = 0.6). CONCLUSION The IOP reduction achieved without medication was more pronounced in the TET-group compared with the CPC-group. Visual field remained stable in the TET-group, while further deteriorating in the CPC-group during follow-up. Eyes undergoing CPC had a higher demand for additional medication to reach comparable success rates as TET. Due to this performing TET is favorable over CPC in POAG eyes.
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Affiliation(s)
- Somar Hasan
- University Eye Hospital, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany.,Department of Ophthalmology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Theresa Theilig
- University Eye Hospital, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany
| | - Jan Darius Unterlauft
- University Eye Hospital, University of Leipzig, Liebigstrasse 10-14, 04103, Leipzig, Germany.
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Stabilization Time of Anterior Segment Parameters After Trabeculectomy Surgery. Eye Contact Lens 2018; 44 Suppl 2:S396-S399. [PMID: 29944511 DOI: 10.1097/icl.0000000000000525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the postoperative changes in the anterior segment parameters by Scheimpflug imaging method in patients undergoing trabeculectomy surgery. METHODS This prospective study included 38 phakic eyes of 38 patients with primary open-angle glaucoma who underwent trabeculectomy. Anterior chamber angle (ACA), anterior chamber depth (ACD), anterior chamber volume (ACV), and central corneal thickness (CCT) of the eyes were measured by performing Scheimpflug imaging in preoperative (baseline) and postoperative periods (1st week and 1st, 3rd, and 6th months after the surgery). RESULTS Significant differences were observed in all the anterior segment parameters during the postoperative period (P<0.001 for ACA, ACD, and CCT; P=0.001 for ACV). Compared with preoperative values, ACA, ACD, and ACV values decreased and CCT value increased in the 1st postoperative week (P<0.001 for all the parameters). Compared with the 1st postoperative-week values, ACA, ACD, and ACV values significantly increased and CCT value significantly decreased in the 1st postoperative month (P=0.002 for ACV; P<0.001 for ACA, ACD, and CCT). However, no significant differences were observed between the baseline and 1st postoperative-month values (P>0.05 for all the parameters). Moreover, the changes in the anterior segment parameters were not statistically significant after the 1st postoperative month. CONCLUSIONS Our results showed that the changes in the anterior segment parameters observed in the early postoperative period after trabeculectomy returned to their baseline values after approximately 1 month after the surgery and remained stable thereafter.
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