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Erol MA, Demirdizen DÖ, Şimşek T, Yıldırım N. Comparison of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve implantation. Indian J Ophthalmol 2024; 72:S404-S408. [PMID: 38389261 PMCID: PMC467012 DOI: 10.4103/ijo.ijo_772_23] [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: 03/21/2023] [Revised: 11/12/2023] [Accepted: 11/18/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE To compare the efficacy and complications of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve (AGV) implantation. METHODS This retrospective study included 44 refractory glaucoma patients (44 eyes) who underwent AGV implantation from 2017 to 2020 in the Ophthalmology Clinic of Eskişehir Osmangazi University Hospital and attended regular postoperative follow-ups. The patients were divided based on whether they underwent Tenon duplication technique (group 1: n = 20) or dura mater covering technique (group 2: n = 24) during surgery. The patients' age, gender, systemic diseases, glaucoma type, pre-op intraocular pressure (IOP), and ocular surgeries were recorded. The groups were compared for IOP level control, early and late complications, postoperative antiglaucomatous medication requirements, glaucoma surgery requirements, presence of postoperative hypertensive phase (HP), and surgical success which was defined as an IOP ≥5 and ≤21 mmHg, with or without antiglaucoma medication. RESULTS By the end of the mean follow-up (22.6 ± 10.6 months), the success rates were 95% (group 1) and 96% (group 2). The groups showed no differences in postoperative complications, postoperative antiglaucomatous drugs' onset time, additional glaucoma surgery, need for needling, presence of HP at 6 months postoperatively, and relationship between the glaucoma type and success rates ( P values: 0.86, 0.9, 0.48, 0.12, 0.36, and 0.8, respectively). The IO P values at the last follow-up were 15.2 ± 4.1 in group 1 and 14.7 ± 4.8 in group 2. The IOP reduction rates showed no significant differences. CONCLUSION Since success and complications are similar in both Tenon duplication and dura mater covering technique, unique grafting materials may not be needed in AGV implantation surgery, except in special cases.
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Affiliation(s)
- Mehmet Akif Erol
- Department of Ophthalmology, Kırklareli University Faculty of Medicine, Kırklareli, Turkey
| | - Duygu Ören Demirdizen
- Department of Ophthalmology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Tülay Şimşek
- Department of Ophthalmology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Nilgün Yıldırım
- Department of Ophthalmology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Pfeiffer V, Gubser PA, Shang X, Lincke JB, Häner NU, Zinkernagel MS, Unterlauft JD. Functional and Morphological Outcomes after Trabeculectomy and Deep Sclerectomy-Results from a Monocentric Registry Study. Diagnostics (Basel) 2024; 14:101. [PMID: 38201410 PMCID: PMC10802181 DOI: 10.3390/diagnostics14010101] [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: 11/23/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study was to compare the effectiveness of trabeculectomy (TE) and deep sclerectomy (DS) in lowering intraocular pressure (IOP) and thereby preserving visual field and peripapillary retinal nerve fiber layer (RNFL) tissue in primary open-angle glaucoma (POAG) cases. IOP, number of IOP-lowering medications, visual acuity, mean defect of standard automated perimetry, and mean peripapillary RNFL thickness were retrospectively collected and followed up for 3 years after surgery. TE was performed in 104 eyes and DS in 183 eyes. Age, gender, laterality, IOP, number of medications, visual acuity, perimetry mean defect, and peripapillary RNFL thickness were equally distributed at baseline. Mean IOP decreased from 23.8 ± 1.4 mmHg and 23.1 ± 0.4 mmHg to 13.4 ± 0.6 mmHg (p < 0.001) and 15.4 ± 0.7 mmHg (p = 0.001) in the TE and DS groups, respectively. Mean defect remained stable (TE: -11.5 ± 0.9 dB to -12.0 ± 1.1 (p = 0.090); DS: -10.5 ± 0.9 dB to -11.0 ± 1.0 dB (p = 0.302)), while mean peripapillary RNFL thickness showed further deterioration during follow-up (TE group: 64.4 ± 2.1 μm to 59.7 ± 3.5 μm (p < 0.001); DS group: 64.9 ± 1.9 μm to 58.4 ± 2.1 μm (p < 0.001)). Both TE and DS were comparably effective concerning postoperative reduction in IOP and medication. However, glaucoma disease further progressed during follow-up.
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Affiliation(s)
| | | | | | | | | | | | - Jan Darius Unterlauft
- University Eye Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; (V.P.); (P.A.G.); (X.S.); (J.-B.L.); (N.U.H.); (M.S.Z.)
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Oddone F, Roberti G, Giammaria S, Posarelli C, Ghirelli G, Mastropasqua L, Agnifili L, Micelli Ferrari T, Pace V, Nucci P, Sacchi M, Monsellato G, Altafini R, Scuderi G, Perdicchi A, Uva M, Carnevale C, Covello G, Maglionico MN, Fea A, Figus M. Effectiveness and safety of XEN45 implant over 12 months of follow-up: data from the XEN-Glaucoma Treatment Registry. Eye (Lond) 2024; 38:103-111. [PMID: 37414935 PMCID: PMC10764778 DOI: 10.1038/s41433-023-02642-5] [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: 09/29/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To evaluate the 1-year effectiveness and safety of the XEN45, either alone or in combination with phacoemulsification, in glaucoma patients. METHODS This multicentre, prospective, observational study included consecutive eyes of glaucoma patients from the Italian XEN-Glaucoma Treatment Registry (XEN-GTR) who underwent XEN45 alone or in combination with phacoemulsification, with at least 1 year of follow-up. Surgical success was defined as intraocular pressure (IOP) < 18 mmHg and ≥20% reduction from preoperative IOP, over 1 year of follow-up. RESULTS Two hundred thirty-nine eyes (239 patients) were analyzed, 144 (60.2%) eyes in the XEN-solo and 95 (39.8%) eyes in the XEN+Phaco groups. One hundred-sixty-eight (70.3%) eyes achieved overall success, without statistically significant differences between study groups (p = 0.07). Preoperative IOP dropped from a median (IQR) of 23.0 (20.0-26.0) mmHg to 14.0 (12.0-16.0) mmHg at month 12 (p < 0.001), with overall 39.9 ± 18.3% IOP reduction. The mean number of preoperative ocular hypotensive medications (OHM) was significantly reduced from 2.7 ± 0.9 to 0.5 ± 0.9 at month 12 (p < 0.001). Preoperative IOP < 15 mmHg (HR: 6.63; 95%CI: 2.61-16.84, p < 0.001) and temporal position of the surgeon (HR: 4.25; 95%CI: 2.62-6.88, p < 0.001) were significantly associated with surgery failure. One hundred-forty-six (61.1%) eyes had no intraoperative complications, whereas 91 (38.1%) and 56 (23.4%) eyes experienced at least one complication, respectively early (< month 1) and late (≥ month 1), all self-limiting or successfully treated without sequelae. Needling occurred in 55 (23.0%) eyes at least once during follow-up. CONCLUSION Over 1-year follow-up, XEN45 alone or in combination with phacoemulsification, had comparable success rates and effectively and safely lowered IOP and the need for OHM.
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Affiliation(s)
| | | | | | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Pace
- Regional General Hospital F. Miulli of Acquaviva delle Fonti, Bari, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | | | | | - Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Uva
- University Hospital "Policlinico Vittorio Emanuele", Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonio Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università Degli Studi di Torino, 10126, Torino, Italy
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
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XEN® implantation: an effective strategy to stop glaucoma progression despite prior minimally invasive glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2022; 261:1063-1072. [PMID: 36305910 PMCID: PMC9614765 DOI: 10.1007/s00417-022-05872-7] [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: 05/26/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to evaluate whether XEN® implantation is a reasonable and safe method to lower the intraocular pressure (IOP) and amount of medication for adult primary open-angle glaucoma (POAG) over a 3-year period. The influence of the type of anesthesia, previous glaucoma surgery, and postoperative interventions on the outcome were examined. Methods In this retrospective study, 96 eyes were included. XEN® implantation was performed as sole procedure under general (n = 86) or local anesthesia (n = 10). IOP and number of glaucoma medication were assessed preoperatively: day 1, week 6, month 3, 6, 12, 24, and 36. Further outcome parameters were Kaplan–Meier success rates, secondary intervention, and complication rates. Results IOP decreased from 20.7 ± 5.1 to 12.8 ± 2.5 mmHg at the 36-month follow-up (p < 0.001) and glaucoma therapy was reduced from 3.3 ± 0.8 to 1.2 ± 1.6 (36 months, p < 0.001). Transient postoperative hypotony was documented in 26 eyes (27.1%). General anesthesia resulted in a significant improvement of the survival rate compared to local anesthesia (77% vs. 50%, p = 0.044). Prior iStent inject®, Trabectome®, or SLT laser had no significant impact, such as filter bleb revision. The number of postoperative needlings had a significantly negative influence (p = 0.012). Conclusion XEN® implantation effectively and significantly lowers the IOP and number of glaucoma therapy in POAG in the 36-month follow-up with a favorable profile of side effects and few complications. In case of IOP, general anesthesia has a significant positive influence on the survival rate, whereas prior SLT or MIGS does not have significant impact.
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Fea AM, Menchini M, Rossi A, Posarelli C, Malinverni L, Figus M. Outcomes of XEN 63 Device at 18-Month Follow-Up in Glaucoma Patients: A Two-Center Retrospective Study. J Clin Med 2022; 11:jcm11133801. [PMID: 35807088 PMCID: PMC9267545 DOI: 10.3390/jcm11133801] [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: 03/29/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Glaucoma surgery has significantly evolved over the last years. This paper aims to evaluate the midterm clinical outcomes of the XEN63 device in a real-world scenario. Methods: A retrospective clinical study was conducted on consecutive patients who underwent an XEN63 implant insertion, either alone or in combination with phacoemulsification. The primary endpoint was the mean intraocular pressure (IOP) at the month 18 visit. Results: Twenty-three eyes (23 patients) were included in the analysis. The preoperative IOP was significantly lowered from 27.0 ± 7.8 mmHg to 14.1 ± 3.4 mmHg at month 18 (p < 0.0001). At month 18, 14 (77.8%) and 11 (61.1%) eyes had an IOP ≤ 16 mmHg and ≤ 14 mmHg, respectively, without ocular hypotensive medication. The mean number of ocular hypotensive medication taken was significantly reduced from 2.3 ± 0.9 drugs at baseline to 1.0 ± 1.4 drugs at month 18 (p = 0.0020). Four (17.4%) eyes had hypotony at postoperative day 1, which was successfully resolved without sequelae. Four (17.4%) eyes underwent a needling procedure and four (17.4%) eyes underwent additional surgeries. Conclusions: The XEN63, either alone or in combination with cataract surgery, significantly lowered the IOP and reduced the need for ocular hypotensive drugs over a period of 18 months.
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Affiliation(s)
- Antonio Maria Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
- Correspondence: ; Tel.: +39-349-560-1674
| | - Martina Menchini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
| | - Alessandro Rossi
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
| | - Chiara Posarelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
| | - Lorenza Malinverni
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università degli Studi di Torino, 10126 Torino, Italy; (A.R.); (L.M.)
| | - Michele Figus
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine-University of Pisa, 56126 Pisa, Italy; (M.M.); (C.P.); (M.F.)
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Marolo P, Reibaldi M, Fallico M, Maugeri A, Barchitta M, Agodi A, Parisi G, Caselgrandi P, Ventre L, Ahmed IIK. Reintervention rate in glaucoma filtering surgery: A systematic review and meta-analysis. Eur J Ophthalmol 2022; 32:2515-2531. [PMID: 35473447 DOI: 10.1177/11206721221093828] [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 Reintervention rate is an important factor impacting on patients, surgeons, and society. To date, only a few studies have focused on this topic. For this reason, a systematic review and meta-analysis was undertaken to assess the reintervention rate after glaucoma filtering surgery. MATERIALS AND METHODS Prospective studies reporting the reintervention rate after glaucoma filtering surgery and with at least 12 months of follow-up were systematically searched on PubMed, Medline and Embase databases. The primary outcome was the total reintervention rate following surgery. Secondary outcomes were: the rate of manipulation, in-clinic and in-operating room reintervention; the reintervention rate for intraocular pressure (IOP) control and for complications; demographic, clinical and surgical variables associated with reintervention rate. RESULTS Ninety-three studies with a total of 8345 eyes were eligible. The total reintervention rate was 1.84 (95% CI 1.57-2.13), with a lower rate for Baerveldt (0.53, 95% CI 0.29-0.83) and Preserflo (0.60, 95% CI 0.15-1.29), and a higher rate for Xen (4.26, 95% CI 2.59-6.31). The manipulation rate was 0.99 (95% CI 0.77-1.23), the in-clinic reintervention rate was 0.08 (95% CI 0.05-0.12) and the in-operating room reintervention rate was 0.28 (95% CI 0.22-0.35). The reintervention rate for IOP control was 1.26 (95% CI 1.04-1.51) and the reintervention rate for complications was 0.27 (95% CI 0.21-0.35). CONCLUSIONS All types of surgery presented a total reintervention rate similar to the overall findings, except studies on Baerveldt and Preserflo Microshunt, with a lower rate, and Xen, with a higher rate. None of the variables evaluated were found to be directly associated with the explored outcomes.
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Affiliation(s)
- Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, 9298University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Luca Ventre
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology & Vision Sciences, 7938University of Toronto, Toronto, Ontario, Canada
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Lim R. The surgical management of glaucoma: A review. Clin Exp Ophthalmol 2022; 50:213-231. [PMID: 35037376 DOI: 10.1111/ceo.14028] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/20/2021] [Accepted: 11/28/2021] [Indexed: 01/26/2023]
Abstract
After a long period of little change, glaucoma surgery has experienced a dramatic rise in the number of possible procedures in the last two decades. Glaucoma filtering surgeries with mitomycin C and glaucoma drainage devices remain the standard of surgical care. Other newer surgeries, some of which are minimally or microinvasive glaucoma surgeries, target existing trabecular outflow, enhance suprachoroidal outflow, create subconjunctival blebs, or reduce aqueous production. Some require the implantation of a device such as the iStent, Hydrus, Ex-PRESS, XEN and PRESERFLO, whilst others do not-Trabectome, Kahook dual blade, Ab interno canaloplasty, gonioscopy-assisted transluminal trabeculotomy, OMNI and excimer laser trabeculotomy. Others are a less destructive variation of an established procedure, such as micropulse transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cycloplasty. Cataract surgery alone can be a significant glaucoma operation. These older and newer glaucoma surgeries, their mechanism of action, efficacy and complications are the subject of this review.
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Affiliation(s)
- Ridia Lim
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia.,Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Sihota R, Shakrawal J, Sharma AK, Gupta A, Dada T, Pandey V. Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma. Indian J Ophthalmol 2021; 69:2721-2727. [PMID: 34571622 PMCID: PMC8597507 DOI: 10.4103/ijo.ijo_329_21] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects. Methods Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time. Results Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25-30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. "Target" IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5-9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001. Conclusion Medications controlled IOP to "Target" in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Jyoti Shakrawal
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ajay K Sharma
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Amisha Gupta
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Veena Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Central visual field change after fornix-based trabeculectomy in Japanese normal-tension glaucoma patients managed under 15 mmHg. Graefes Arch Clin Exp Ophthalmol 2021; 259:2309-2316. [PMID: 33929590 DOI: 10.1007/s00417-021-05215-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To investigate how the central visual field would be changed after fornix-based trabeculectomy with mitomycin C in Japanese normal-tension glaucoma (NTG) patients monitored for more than 10 years including before surgery. METHODS This is a retrospective cohort study. We identified twenty-eight eyes of 28 NTG cases regularly monitored for more than 5 years and examined static visual field (VF) tests for more than five times before and after fornix-based trabeculectomy (including combined surgery). Based on preoperative data for 6.3 years, we evaluated postoperative changes for 6.0 years in 10-2 VF and 30-2 VF. RESULTS Six patients were male and 22 females, the mean age was 57.9 years, and the mean deviation was - 13.7 decibels. After surgery, mean IOP decreased from 13.9 to 9.0 mmHg (P ≤ 0.01), and medication score also did. The rate of 10-2 VF deterioration was significantly suppressed from - 1.0 dB/year preoperatively to - 0.4 dB/year postoperatively (P ≤ 0.01). And when 30-2 VF was divided into six relevant sectors, the rate of deterioration at cecocentral and arcuate areas of the superior hemifield was suppressed postoperatively (P ≤ 0.01 and P = 0.042, respectively). CONCLUSION Based on long-term preoperative data, a significant positive change in 10-2 VF was observed after fornix-based trabeculectomy with mitomycin C in Japanese NTG patients with a mean IOP of 13.9 mmHg. Central vision could be expected to be maintained for NTG patients even if its preoperative IOP is low after successful trabeculectomy.
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Arimura S, Iwasaki K, Orii Y, Takamura Y, Inatani M. Comparison of 5-year outcomes between trabeculectomy combined with phacoemulsification and trabeculectomy followed by phacoemulsification: a retrospective cohort study. BMC Ophthalmol 2021; 21:188. [PMID: 33894759 PMCID: PMC8066976 DOI: 10.1186/s12886-021-01949-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background We aimed to compare the outcomes of trabeculectomy combined with phacoemulsification and those of trabeculectomy followed by phacoemulsification. Methods A total of 141 patients with primary open-angle glaucoma, exfoliation glaucoma, and glaucoma secondary to uveitis glaucoma who underwent trabeculectomy followed by (n = 48) or combined with (n = 93) phacoemulsification were included. We analyzed data collected from the Collaborative Bleb-Related Infection Incidence and Treatment Study, a prospective cohort study conducted in 34 clinical centers that included 1249 eyes. The main outcome was the cumulative probability of success based on intraocular pressure (IOP) within 5 years. Surgical failure was defined as a case in which additional glaucoma surgery is required or one of the following criteria are met: preoperative IOP > 21 (A), > 18 (B), or > 15 mmHg (C). The secondary outcomes were cumulative probability of success, risk factors of surgical failure, and Δ visual acuity. However, the data on phacoemulsification during the 5-year follow-up were censored. Results No significant difference was found in the cumulative probability of success as the main outcome. When the data on phacoemulsification during the 5-year follow-up were censored, the probabilities of success of trabeculectomy followed by phacoemulsification were significantly higher for criteria A (p = 0.02), B (p < 0.01), and C (p < 0.01). Lower preoperative IOP, younger age, and trabeculectomy combined with phacoemulsification were associated with poorer outcome. Trabeculectomy followed by phacoemulsification had significantly worse Δ logMAR visual acuity at 6 and 12 months (p < 0.01). Conclusion The cumulative probability of success after trabeculectomy combined with or followed by phacoemulsification remained unchanged. Combining phacoemulsification with trabeculectomy adversely affected the cumulative probability of success after trabeculectomy. The visual acuity improvements observed in the early postoperative period after combining phacoemulsification with trabeculectomy disappeared within 5 years.
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Affiliation(s)
- Shogo Arimura
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Yoshida, 23-3 Simoaizuki, Matsuoka, Fukui, Japan
| | - Kentaro Iwasaki
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Yoshida, 23-3 Simoaizuki, Matsuoka, Fukui, Japan
| | - Yusuke Orii
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Yoshida, 23-3 Simoaizuki, Matsuoka, Fukui, Japan
| | - Yoshihiro Takamura
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Yoshida, 23-3 Simoaizuki, Matsuoka, Fukui, Japan
| | - Masaru Inatani
- Department of Ophthalmology, Faculty of Medical Science, University of Fukui, Yoshida, 23-3 Simoaizuki, Matsuoka, Fukui, Japan.
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Terzidou C, Trivli A, Dalianis G. Stab incision mitomycin C-assisted rapid trabeculectomy: A 'SMART' trabeculectomy alternative. Exp Ther Med 2020; 20:1752-1757. [PMID: 32742404 DOI: 10.3892/etm.2020.8852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to introduce a new modified trabeculectomy technique, stab incision mitomycin C (MMC)-assisted rapid trabeculectomy (SMART), which requires less surgical time and tissue manipulation. A total of 41 eyes with indication for trabeculectomy underwent glaucoma surgery with the SMART technique; superior subconjunctival injection of 0.005 mg MMC mixed with 0.1 ml lidocaine, followed by small, fornix base conjunctival opening. A stab incision was made to enter the anterior chamber 1.5 mm post-limbus using a 2.4 mm cataract knife. Double 0.75 mm punch and peripheral iridectomy were performed. A releasable suture was placed in the scleral opening, and matrix sutures to close conjunctiva. The preoperative mean intraocular pressure (IOP) was 23.8 mmHg, with a mean number of medications of 3.3. The mean follow-up duration was 27.6 months, with a range of 12-46 months. A year post-surgery, the mean IOP was 11 mmHg, with a mean number of medications of 0.7, corresponding to a reduction of 12.8 mmHg in IOP and 2.6 in the number of medications. During follow-up, additional 5-fluorouracil injections were administered when needed. In conclusion, SMART with wound modulation appears to be a safe and quick alternative to classic trabeculectomy. Few minor and no major complications were observed during the first 2.5 years of follow-up, with all eyes maintaining an IOP <15 mmHg.
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Affiliation(s)
- Chryssa Terzidou
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Alexandra Trivli
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Georgios Dalianis
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
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Sihota R, Shakrawal J, Sidhu T, Sharma AK, Dada T, Pandey V. Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas? Int Ophthalmol 2020; 40:1233-1243. [PMID: 31942662 DOI: 10.1007/s10792-020-01289-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy. METHODS In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP ≤ 12 mmHg, B: IOP ≤ 15 mmHg and C: IOP ≤ 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge! RESULTS The mean age of patients was 46.32 ± 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of ≤ 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 ± 16.80% at last review and was 59.47 ± 16.07% in PACG, 62.40 ± 17.72% in POAG, 71.89 ± 8.50% in JOAG and 67.74 ± 18.10% in secondary glaucoma eyes. "Target" IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes. CONCLUSION Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Jyoti Shakrawal
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India.
| | - Talvir Sidhu
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Ajay K Sharma
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Tanuj Dada
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Veena Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Elwehidy AS, Bayoumi NH, Badawi AE, Hagras SM, Kamel R. Combined phacoemulsification-viscosynechialysis-trabeculotomy vs phacotrabeculectomy in uncontrolled primary angle-closure glaucoma with cataract. J Cataract Refract Surg 2019; 45:1738-1745. [DOI: 10.1016/j.jcrs.2019.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 10/25/2022]
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Change in visual acuity 12 and 24 months after transscleral ab interno glaucoma gel stent implantation with adjunctive Mitomycin C. Graefes Arch Clin Exp Ophthalmol 2019; 257:2707-2715. [PMID: 31494710 DOI: 10.1007/s00417-019-04452-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/13/2019] [Accepted: 08/27/2019] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To analyze changes in best-corrected visual acuity (BCVA) after implantation of the transscleral ab interno glaucoma gel stent (XEN Gel Stent; Allergan, Dublin) in patients with open-angle glaucoma. METHODS In a single-center, prospective, non-randomized study of 137 eyes with open-angle glaucoma which underwent implantation with XEN, 69 eyes underwent XEN implantation alone (group 1) and 68 eyes underwent XEN implantation and cataract surgery (group 2). BCVA (Bailey-Lovie chart, logMAR scale) was evaluated at baseline, postoperative day 1, weeks 1 and 2, and months 1, 3, 6, 12, and 24. Risk factors for decline in BCVA were analyzed in multivariate models. RESULTS Baseline BCVA in group 1 was 0.21 ± 031; the group's mean BCVA did not change at any postoperative visit, although a ≥ 2-line loss of BCVA was detected in 15% (95% CI 7-29%) and 4% (95% CI 0-20%) after months 12 and 24, respectively. Baseline BCVA in group 2 was 0.33 ± 031; vision increased significantly at months 3 (0.22 ± 0.29, p = 0.015), 6 (0.20 ± 0.26, p = 0.006), 12 (0.18 ± 0.29, p = 0.001), and 24 (0.18 ± 0.29, p = 0.005). A ≥ 2-line loss of BCVA was reported in 4% (95% CI 1-15%) and 7% (95% CI 1-24%) after months 12 and 24, respectively. CONCLUSIONS There was no deterioration of BCVA in group 1; those in group 2 had an overall significant increase in BCVA. BCVA decrease was lower than is typically reported in the literature post-trabeculectomy.
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Junoy Montolio FG, Müskens RP, Jansonius NM. Influence of glaucoma surgery on visual function: a clinical cohort study and meta-analysis. Acta Ophthalmol 2019; 97:193-199. [PMID: 30288923 PMCID: PMC6586003 DOI: 10.1111/aos.13920] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/18/2018] [Indexed: 12/01/2022]
Abstract
Purpose To determine the cost (loss of visual function associated with the procedure) and benefit (long‐term preservation of the visual field) of glaucoma surgery. Methods We included 100 patients who underwent glaucoma surgery (Baerveldt glaucoma implant [BGI], n = 61; trabeculectomy [TE], n = 39). Preoperatively, the median (interquartile range [IQR]) standard automated perimetry mean deviation (MD) was −12 (−16 to −6) dB. We analysed the change in visual acuity (BCVA) and MD due to the procedure and, in a subset with at least 5 years of perimetric follow‐up both pre‐ and postoperatively (n = 20), the change in rate of progression (ROP; time rate of change in MD). For the surgery‐induced change in ROP, we also performed a meta‐analysis including the current and previously published studies. From the surgery‐induced decrease in MD and change in ROP, we calculated the average postoperative duration needed for the benefit to surpass the cost. Results Mean (standard deviation) MD decline was 1.3 (2.7) and 1.0 (2.3) dB for BGI (p < 0.001) and TE (p = 0.009), respectively; no significant surgery‐induced changes in BCVA were found (p = 0.08 and p = 0.12, respectively). In our study, surgery was associated with a non‐significant deceleration of ROP (from −0.37 [0.52] to −0.15 [0.48] dB/year; p = 0.23). The meta‐analysis, based on eight studies, showed an overall surgery‐induced change in ROP of 0.44 (95% confidence interval 0.25 to 0.64; p < 0.0001) dB/year. Conclusion Glaucoma surgery significantly reduces the progression velocity in glaucoma. On average, the benefit of glaucoma surgery surpasses the cost after approximately 1.5 years.
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Affiliation(s)
- Francisco G. Junoy Montolio
- Department of Ophthalmology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Rogier P.H.M. Müskens
- Department of Ophthalmology University Medical Center Groningen University of Groningen Groningen The Netherlands
| | - Nomdo M. Jansonius
- Department of Ophthalmology University Medical Center Groningen University of Groningen Groningen The Netherlands
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Riva I, Roberti G, Oddone F, Konstas AG, Quaranta L. Ahmed glaucoma valve implant: surgical technique and complications. Clin Ophthalmol 2017; 11:357-367. [PMID: 28255226 PMCID: PMC5322839 DOI: 10.2147/opth.s104220] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Implantation of Ahmed glaucoma valve is an effective surgical technique to reduce intraocular pressure in patients affected with glaucoma. While in the past, the use of this device was reserved to glaucoma refractory to multiple filtration surgical procedures, up-to-date mounting experience has encouraged its use also as a primary surgery for selected cases. Implantation of Ahmed glaucoma valve can be challenging for the surgeon, especially in patients who already underwent previous multiple surgeries. Several tips have to be acquired by the surgeon, and a long learning curve is always needed. Although the valve mechanism embedded in the Ahmed glaucoma valve decreases the risk of postoperative hypotony-related complications, it does not avoid the need of a careful follow-up. Complications related to this type of surgery include early and late postoperative hypotony, excessive capsule fibrosis around the plate, erosion of the tube or plate edge, and very rarely infection. The aim of this review is to describe surgical technique for Ahmed glaucoma valve implantation and to report related complications.
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Affiliation(s)
- Ivano Riva
- IRCCS "Fondazione GB Bietti per l'Oftalmologia", Rome, Italy
| | - Gloria Roberti
- IRCCS "Fondazione GB Bietti per l'Oftalmologia", Rome, Italy
| | | | - Anastasios Gp Konstas
- 1st University Department of Ophthalmology, Glaucoma Unit, AHEPA Hospital, Thessaloniki, Greece
| | - Luciano Quaranta
- Department of Medical and Surgical Specialties, Section of Ophthalmology, University of Brescia, Brescia, Italy
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Kashiwagi K, Kogure S, Mabuchi F, Chiba T, Yamamoto T, Kuwayama Y, Araie M. Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C. Acta Ophthalmol 2016; 94:e561-e570. [PMID: 27156361 DOI: 10.1111/aos.13058] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/15/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the 5-year incidence of visual impairment after mitomycin C-augmented trabeculectomy (MMC trabeculectomy) and the risk factors for visual impairment. METHODS This is a multicentre prospective observational cohort study. Among glaucoma patients registered in the Collaborative Bleb-related Infection Incidence and Treatment Study performed in Japan, the patients with eyes meeting the following qualifications were included: eyes with primary open-angle glaucoma; eyes with primary angle-closure glaucoma; eyes with exfoliative glaucoma; eyes with ≥3/60 in blindness analysis; and eyes with ≥20/60 in low-vision analysis and visual acuity loss analysis. The patients were followed at 6-month intervals for 5 years. The entry data and follow-up data were analysed to determine the incidence of blindness (<3/60), low vision (≥3/60 and <20/60) and visual acuity loss (≥0.2 logMAR) during the follow-up period. Risk factors for visual impairment were also analysed. RESULTS A total of 694 eyes of 694 or 559 eyes of 559 glaucoma patients were subjected to the blindness analysis or the low-vision and visual acuity loss analysis, respectively. Visual acuity significantly deteriorated (p < 0.0001): 12.2% (95%CI: 9.8-14.7%) of the patients became blind; 12.1% (95%CI: 9.4-14.9%) were judged to have low vision at the final examination; 28.3% (95%CI: 24.5-32.0%) were judged to have visual acuity loss. Glaucoma subtypes, poor preoperative visual function and postoperative complications are the main risk factors for visual impairment. CONCLUSIONS Visual acuity was significantly reduced after MMC trabeculectomy in 5 years, and we identified several risk factors associated with this complication.
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Affiliation(s)
- Kenji Kashiwagi
- Department of Ophthalmology; University of Yamanashi; Faculty of Medicine; Chuo Yamanashi Japan
| | - Satoshi Kogure
- Department of Ophthalmology; University of Yamanashi; Faculty of Medicine; Chuo Yamanashi Japan
| | - Fumihiko Mabuchi
- Department of Ophthalmology; University of Yamanashi; Faculty of Medicine; Chuo Yamanashi Japan
| | - Tatsuya Chiba
- Department of Ophthalmology; University of Yamanashi; Faculty of Medicine; Chuo Yamanashi Japan
| | - Tetsuya Yamamoto
- Department of Ophthalmology; Gifu University Graduate School of Medicine; Gifu Japan
| | | | - Makoto Araie
- Department of Ophthalmology; University of Tokyo Graduate School of Medicine; Tokyo Japan
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Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma. J Ophthalmol 2016; 2016:2837562. [PMID: 27144015 PMCID: PMC4842060 DOI: 10.1155/2016/2837562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG). Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects). After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5–1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet's punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41 ± 5.54 mmHg and mean postoperative IOP was 16.47 ± 4.81 mmHg (n = 17). Mean reduction in IOP was 38.81 ± 16.55%. There was significant reduction of IOP (p < 0.000). 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18 ± 1.88 months).
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Wright C, Tawfik MA, Waisbourd M, Katz LJ. Primary angle-closure glaucoma: an update. Acta Ophthalmol 2016; 94:217-25. [PMID: 26119516 DOI: 10.1111/aos.12784] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 05/11/2015] [Indexed: 02/04/2023]
Abstract
Primary angle-closure glaucoma is potentially a devastating disease, responsible for half of glaucoma-related blindness worldwide. Angle closure is characterized by appositional approximation or contact between the iris and trabecular meshwork. It tends to develop in eyes with shallow anterior chambers, anteriorly positioned or pushed lenses, and angle crowding. Risk of primary angle-closure glaucoma is high among women, the elderly and the hyperopic, and it is most prevalent in Asia. Investigation into genetic mechanisms of glaucoma inheritance is underway. Diagnosis relies on gonioscopy and may be aided by anterior segment optical coherence tomography and ultrasound biomicroscopy. Treatment is designed to control intraocular pressure while monitoring changes to the angle and optic nerve head. Treatment typically begins with medical management through pressure-reducing topical medications. Peripheral iridotomy is often performed to alleviate pupillary block, while laser iridoplasty has been found effective for mechanisms of closure other than pupillary block, such as plateau iris syndrome. Phacoemulsification, with or without goniosynechialysis, both in eyes with existing cataracts and in those with clear lenses, is thus far a viable treatment alternative. Long-term research currently underway will examine its efficacy in cases of angle closure in early stages of the disease. Endoscopic cyclophotocoagulation is another treatment option, which can be combined with cataract surgery. Trabeculectomy remains effective therapy for more advanced cases.
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Prognostic factors for trabeculectomy failure in a Cuban population. ACTA ACUST UNITED AC 2015; 91:27-33. [PMID: 26616245 DOI: 10.1016/j.oftal.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 07/24/2015] [Accepted: 09/15/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify the prognostic factors for mid-term trabeculectomy failure. METHOD A prospective cohort study was conducted on 113 eyes (113 patients) that had undergone a trabeculectomy for primary open or closed angle, pigmentary, or juvenile glaucoma. Surgical failure was defined if intraocular pressure was equal or more than 18mmHg with medication (two or more drops), after 1-4 postoperative years. The relative risk was calculated and a logistic regression analysis was performed. RESULTS Previous trabeculectomy, preoperative intraocular pressure ≥ 31mmHg, black race, and advanced glaucoma increased the failure risk by 7.9 times (P=.036), 5.3 times (P=.011) and 4.7 times (P=.028, and P=.027), respectively. The addition of two or more factors increased the risk by 6.4 times (P<.001). It was not affected by age, sex, pre-operative drops, or surgical complication. CONCLUSIONS Previous trabeculectomy, pre-operative intraocular pressure ≥ 31mmHg, black race, and advanced glaucoma are prognostic factors for trabeculectomy failure, in decreasing order of their association with surgical failure. The addition of two or more factors increased the risk of failure. In those situations, the use of trans- operative anti-metabolites is suggested.
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Foulsham WS, Fu L, Tatham AJ. Visual improvement following glaucoma surgery: a case report. BMC Ophthalmol 2014; 14:162. [PMID: 25539801 PMCID: PMC4292810 DOI: 10.1186/1471-2415-14-162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 12/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background Glaucoma is a progressive optic neuropathy and a leading cause of blindness. Neural losses from glaucoma are irreversible, and so the aim of glaucoma treatment is to slow progression and minimize the risk of further damage. Functional improvement with treatment is not expected. We report the case of a patient who experienced a significant improvement in vision following glaucoma surgery and review the literature regarding this phenomenon. Case presentation A 64-year old male presented with a 13-month history of gradual vision loss in the right eye to the extent that he could only perceive hand movements. His intraocular pressure (IOP) measured 50 mmHg and he was found to have advanced primary open angle glaucoma. Medical treatment was commenced and he underwent a successful right Mitomycin C-augmented trabeculectomy. Unexpectedly he experienced marked improvement in vision post-operatively, with improvements maintained through six months of follow-up. At his most recent visit visual acuity was 6/18 in the affected eye. Although the mechanism of improved vision cannot be proven it is likely that successful lowering of IOP resulted in some reversal of retinal ganglion cell dysfunction. Important factors may have included his relatively young age, high IOP and short duration of symptoms. Conclusion Although rare, functional improvements may occur following trabeculectomy. Glaucoma surgery should be offered early to those with advanced disease, and considered even in those with reduced visual acuity.
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Affiliation(s)
| | | | - Andrew J Tatham
- Princess Alexandra Eye Pavilion and Department of Ophthalmology, University of Edinburgh, Edinburgh, UK.
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Early efficacy and complications of releasable sutures for trabeculectomy in primary angle-closure glaucoma: a randomized clinical trial. J Glaucoma 2014; 23:136-41. [PMID: 23059481 DOI: 10.1097/ijg.0b013e31826981c9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the postoperative intraocular pressure (IOP) and incidence of early complications after trabeculectomy with releasable suture to standard trabeculectomy in Chinese patients with primary angle-closure glaucoma. PATIENTS AND METHODS One hundred seventy-five patients diagnosed as primary angle-closure glaucoma with 6 clock-hours or more of peripheral anterior synechia were randomly allocated to 2 treatment groups: 87 underwent standard trabeculectomy (S group: 2 interrupted permanent sutures to the scleral flap) and 88 received trabeculectomy with 2 permanent and 2 releasable sutures (R group). The postoperative IOP and complications during the first 3 months after surgery were compared. RESULTS One hundred seventy-one patients (97.7%) attended the 3-month visit. The IOP in the first week after trabeculectomy was significantly higher in the R group: day 1, 17.3±8.6 versus 12.7±6.0 mm Hg (P<0.001); day 3, 18.0±7.3 versus 12.9±6.3 mm Hg (P<0.001); day 7, 14.8±6.3 versus 12.0±4.9 mm Hg (P=0.001), but no difference was observed after the second week (P=0.659 to 0.753). The incidence of transient hypotony was higher in S group (20.4%) than the R group (9.1%) (P=0.046); hypotony recovered in 80.8% (21/26) within 1 week. There was no difference in the occurrence of shallow chamber, choroidal detachment, macular edema, additional surgery, or hyphema (P=0.56 to 1.0). CONCLUSIONS The technique of releasable sutures for trabeculectomy used in this study did not demonstrate significant advantages over standard trabeculectomy. Releasable sutures were associated with some decrease in visual acuity and increase in postoperative complaints.
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Chua BE, Nguyen DQ, Qin Q, Ruddle JB, Wells AP, Niyadurupola N, Gupta V, Wong TT, Coote MA, Crowston JG. Bleb vascularity following post-trabeculectomy subconjunctival bevacizumab: a pilot study. Clin Exp Ophthalmol 2012; 40:773-9. [DOI: 10.1111/j.1442-9071.2012.02798.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Landers J, Martin K, Sarkies N, Bourne R, Watson P. A Twenty-Year Follow-up Study of Trabeculectomy: Risk Factors and Outcomes. Ophthalmology 2012; 119:694-702. [PMID: 22196977 DOI: 10.1016/j.ophtha.2011.09.043] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/23/2011] [Accepted: 09/23/2011] [Indexed: 10/14/2022] Open
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Walland MJ. Are failure rates of primary trabeculectomy really increasing? Clin Exp Ophthalmol 2009; 37:422-3; author reply 423-5. [PMID: 19594575 DOI: 10.1111/j.1442-9071.2009.02047.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Are failure rates of primary trabeculectomy really increasing? - response. Clin Exp Ophthalmol 2009. [DOI: 10.1111/j.1442-9071.2009.02053.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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