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Serhan HA, Ba-Shammakh SA, Hassan AK, Sanvicente CT, Anter AM, Marchi MB, Stein JD, Lee RK, Sallam AB, Elhusseiny AM. Effectiveness and Safety of Trabeculectomy Versus Tube Shunt Implantation for Uveitic Glaucoma: A Systematic Review and Meta-analysis. Am J Ophthalmol 2024:S0002-9394(24)00417-3. [PMID: 39293570 DOI: 10.1016/j.ajo.2024.08.045] [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: 07/18/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/20/2024]
Abstract
PURPOSE To evaluate the effectiveness and safety of trabeculectomy compared to glaucoma drainage devices (GDDs) in managing uveitic glaucoma (UG). DESIGN Systematic review METHODS: : We searched seven electronic databases [PubMed, Scopus, Web of Science, ScienceDirect, EMBASE, CENTRAL, and Google Scholar] to compare trabeculectomy with various GDDs in UG. The primary outcome was intraocular pressure (IOP) reduction, and secondary outcomes included postoperative complications. We fitted a random effects model for meta-analysis and assessed the risk of bias using the National Institute of Health quality assessment tool. RESULTS We included eight studies; 197 eyes underwent trabeculectomy, and 277 eyes had GDDs. The mean age of participants was 48.5 years, with ∼53.5% being male in the trabeculectomy group, and 49.3% in the GDDs group. The meta-analysis revealed no significant difference in IOP reduction between trabeculectomy and GDDs (p=0.48). Subgroup analyses revealed no significant difference in IOP reduction between trabeculectomy and either the Ahmed glaucoma drainage device group (p =0.38) or the Baerveldt glaucoma implant group (p =0.90). GDDs were associated with higher rates of complications such as cystoid macular edema (CME) (15% vs. 4%, p<0.001), need for revision surgery (11% vs. 6%, P =0.04), and uveitic flare (5% vs. 0%, p =0.001). However, trabeculectomy had a higher risk of cataract progression (7% vs. 1%, p<0.001). CONCLUSION Trabeculectomy and GDDs demonstrated comparable effectiveness in reducing IOP or glaucoma medication reduction in UG. However, there are significant differences in their safety profiles; CME and revisions were higher in GDD, and cataract progression was higher after trabeculectomy.
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Affiliation(s)
- Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | | | - Amr K Hassan
- Department of Ophthalmology, Faculty of Medicine, South Valley University, Egypt.
| | - Carina T Sanvicente
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | | | - M Basil Marchi
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Joshua D Stein
- Kellogg Eye Center, University of Michigan, California, USA.
| | - Richard K Lee
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
| | - Ahmed B Sallam
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Abdelrahman M Elhusseiny
- Department of Ophthalmology, Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Almadhi N, Algorinees RM, Almohizea A, Aldihan KA, Al-Shahwan S, Al Owaifeer AM. Intermediate-Term Outcomes of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma: A Tertiary Centre Experience. Ocul Immunol Inflamm 2024:1-8. [PMID: 39024467 DOI: 10.1080/09273948.2024.2375023] [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: 12/15/2023] [Accepted: 06/26/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE To present the outcomes of Ahmed glaucoma valve (AGV) implantation in uveitic glaucoma (UG) in a tertiary eye center in Riyadh, Saudi Arabia. METHODS A retrospective review of all UG patients who underwent AGV implantation at a single, tertiary care eye center from January 2008 to December 2018. The main outcome measures were change in mean intraocular pressure (IOP), number of antiglaucoma medications, overall success rate in different follow-up periods, complete and qualified success from last follow up, and complications. The success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6- and 21-mm Hg with or without additional antiglaucoma medications and/or a minimum of 20% reduction from baseline IOP. RESULTS The study included 74 patients (86 eyes), with a mean follow-up of 4.9 ± 2.9 years. The mean IOP was 32.2 ± 8.5 mmHg at baseline and 16.3 ± 6.6 mmHg at the last follow-up (p < 0.001). The mean number of antiglaucoma medications decreased from 3.5 ± 0.7 preoperatively to 1.3 ± 1.4 at the last follow-up (p < 0.001). Overall survival rates at 1, 3, 5, and 10 years were 96.5%, 92.7%, 91%, and 56.9%, respectively. Complete and qualified success rates were 37.9% and 48.3% at the end of follow up, respectively. The rate of postoperative complications was 56%, of which 18 eyes (20%) required surgical revision. Bivariate Cox proportional hazards regression analysis did not reveal any factors significantly associated with failure. CONCLUSIONS AGV is safe and effective in providing intermediate-term IOP control in UG patients. Complications reported in our cohort were mostly transient and conservatively treated.
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Affiliation(s)
- Nada Almadhi
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Rakan Mosa Algorinees
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, College of Medicine, University of Ha'il, Ha'il, Saudi Arabia
| | - Asma Almohizea
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Sami Al-Shahwan
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Adi Mohammed Al Owaifeer
- Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Ophthalmology Unit, Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
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Glandorf K, Rothaus K, Baquet-Walscheid K, Heinz C, Heiligenhaus A. Surgical Glaucoma Treatment in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis: Results after Trabeculectomy or Ahmed Glaucoma Valve Implantation. Ocul Immunol Inflamm 2024; 32:636-641. [PMID: 36898006 DOI: 10.1080/09273948.2023.2185263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Patients with juvenile idiopathic arthritis (JIA) associated uveitis (JIAU) are at risk for secondary glaucoma, frequently requiring surgical management. We compared the success rates for trabeculectomy (TE) and Ahmed glaucoma valve (AGV) implantation. METHODS We conducted a retrospective analysis of TE (45 eyes), primary AGV (pAGV) (7 eyes), or secondary AGV (sAGV) implantation after TE (11 eyes) in JIAU at the 2-year follow-up. RESULTS All groups achieved significant pressure reduction. After 1 year, the overall success rate was higher in the Ahmed groups (p = 0.03). After adjusting the p-value according to Benjamin Hochberg, there is no significant difference between the groups in the Kaplan-Meier, despite a significant logrank test between all groups (p = 0.0194) and a better performance in the Ahmed groups. CONCLUSION Slightly better success rates were achieved with pAGV in managing JIAU patients with glaucoma refractory to medical treatment.
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Affiliation(s)
- Karen Glandorf
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Kai Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
| | - Karoline Baquet-Walscheid
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Carsten Heinz
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster, Germany
- Department of Ophthalmology, University of Duisburg-Essen, Essen, Germany
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4
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Aragón-Roca D, Oliver-Gutierrez D, Banderas García S, Rigo J, Dou A, Castany M. Surgical Outcomes in Uveitic Glaucoma: Long-Term Evaluation of Trabeculectomy, Non-Penetrating Deep Sclerectomy, Ex-PRESS Shunt and Ahmed Glaucoma Valve. A 3-Year Follow-Up Study. Ocul Immunol Inflamm 2024:1-10. [PMID: 38381450 DOI: 10.1080/09273948.2024.2315194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE Uveitis can lead to secondary glaucoma, a condition with challenging management that can carry irreversible visual loss. Filtering surgery has demonstrated a higher failure rate, increased incidence of postoperative complications and reinterventions in uveitic patients. There is no consensus on the optimal surgical approach for uveitic glaucoma (UG) due to limited data comparing various intraocular pressure (IOP)-lowering surgeries. This retrospective cohort aims to assess the clinical outcomes of trabeculectomy (TBT), non-penetrating deep sclerectomy (NPDS), Ex-PRESS shunt and Ahmed glaucoma valve, providing additional insights into the long-term IOP control and safety of filtering surgeries in UG. METHODS The filtering surgery was performed on 32 eyes of 27 UG patients. Complete success was defined as IOP ≤ 18 mmHg or a 30% reduction. Qualified success allowed topical hypotensive treatment. RESULTS Complete success was 40.63% (13/32) at 12 months and 36.67% (11/30) at 36 months. Qualified success was 84.38% (27/32) at 12 months and 63.33% (19/30) at 36 months. In the survival analysis, both NPDS and Ex-PRESS demonstrated decreased failure rates compared to TBT (NPDS vs TBT: HR = 0.20, p = 0.049; Ex-PRESS vs TBT: HR = 0.28, p = 0.13). One or more reinterventions were required in 34.38% (11/32) of the eyes. NPDS had the lowest incidence of hypotony. Secondary cataract was a common complication in all groups. CONCLUSION Various filtering surgeries are safe and effective procedures for lowering IOP and reducing the requirement of topical antihypertensives in UG at 36 months. However, one-third of the patients will require another IOP-lowering procedure.
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Affiliation(s)
- David Aragón-Roca
- Ophthalmology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Ophthalmology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Jaume Rigo
- Ophthalmology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Antonio Dou
- Ophthalmology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Castany
- Ophthalmology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Halkiadakis I, Konstantopoulou K, Tzimis V, Papadopoulos N, Chatzistefanou K, Markomichelakis NN. Update on Diagnosis and Treatment of Uveitic Glaucoma. J Clin Med 2024; 13:1185. [PMID: 38592059 PMCID: PMC10931771 DOI: 10.3390/jcm13051185] [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: 01/08/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG.
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Affiliation(s)
- Ioannis Halkiadakis
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | | | - Vasilios Tzimis
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | - Nikolaos Papadopoulos
- Ophthalmiatrion Athinon, Athens Eye Hospital, 10672 Athens, Greece; (K.K.); (V.T.); (N.P.)
| | - Klio Chatzistefanou
- First Department of Ophthalmology, National and Kapodistrian University of Athens School of Medicine, Athens General Hospital “G. Gennimatas”, 11527 Athenbs, Greece;
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Tang M, Gill NP, Tanna AP. Effect of Early Aqueous Suppression After Valved Tube Shunt Surgery for Uveitic Glaucoma. Ophthalmol Glaucoma 2024; 7:37-46. [PMID: 37567499 DOI: 10.1016/j.ogla.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE To compare outcomes of early aqueous suppression (EAS) and standard therapy (ST) after Ahmed Glaucoma Valve (AGV) implantation for uveitic glaucoma. DESIGN Retrospective comparative cohort study. PARTICIPANTS All patients with uveitic glaucoma underwent AGV implantation from January 2010 to October 2020 at Northwestern Medicine. METHODS Excluding the first postoperative day 1 (POD1), only eyes with IOP 10-15 mmHg at their first visit with IOP ≥ 10 mmHg were included in the main analysis. Early aqueous suppression (EAS) was defined as initiation of ocular hypotensive therapy when IOP was first 10-15 mmHg. Standard therapy was initiation of therapy at any later time. Failure was defined as IOP > 21 mmHg, < 5 mmHg, or < 20% reduction in IOP from baseline after 3 months, for 2 consecutive study visits. Hypotony was defined as IOP ≤ 5 mmHg for ≥ 2 visits. Hypertensive phase was defined as IOP > 21 mmHg for 2 consecutive visits in the first 3 months. MAIN OUTCOME MEASURES Proportion achieving overall success; incidence of hypotony and hypertensive phase. RESULTS Twenty-eight eyes of 26 patients were in the EAS group and 20 eyes of 19 patients were in the ST group, with a mean follow-up of 17.7 and 28.2 months, respectively. Baseline IOP was similar in the EAS (31.2 ± 10.1 mmHg) and ST (34.6 ± 12.2 mmHg) groups; P = 0.18. Final IOP was lower in the EAS group (12.9 ± 4.6 mmHg) than the ST group (16.4 ± 5.7 mmHg; P = 0.02) on 2.6 ± 0.9 medications in the EAS group and 1.8 ± 1.5 in the ST group (P = 0.07). Overall success was achieved in 87% of EAS eyes and 74% of ST eyes (P = 0.43). There were no statistically significant differences in the occurrence of additional glaucoma surgery (4% for EAS, 20% for ST; P = 0.11), hypotony (7% for EAS, 0% for ST; P = 0.50), or hypertensive phase (4% for EAS, 21% for ST; P = 0.09). CONCLUSIONS EAS was associated with a lower final IOP after AGV in uveitic glaucoma eyes; however, more medications were in use at the final visit. No statistically significant differences in overall success or the incidence of adverse events were observed. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Minjia Tang
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nathan P Gill
- Department of Preventive Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Angelo P Tanna
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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7
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Triolo G, Wang J, Aguilar-Munoa S, Jayaram H, Barton K. Preserflo microshunt implant for the treatment of refractory uveitic glaucoma: 36-month outcomes. Eye (Lond) 2023; 37:2535-2541. [PMID: 36577805 PMCID: PMC10397285 DOI: 10.1038/s41433-022-02368-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To determine 36-month efficacy and safety outcomes of the PRESERFLO Microshunt implant in the treatment of refractory uveitic glaucoma. METHODS Consecutive patients with uncontrolled uveitic glaucoma despite maximum medical treatment received PRESERFLO Microshunt implant with mitomycin C (MMC) in a tertiary referral glaucoma practice. Efficacy and safety outcomes data were collected at month 6, 12, 24, and 36, postoperatively. The primary outcome was surgical success, defined as intraocular pressure (IOP) between 5 and 21 mmHg or > 20% reduction from baseline, and absence of criteria for surgical failure. Secondary outcomes were IOP, visual acuity (VA), use of glaucoma medical therapy, surgical complications, rate of reoperation for glaucoma. RESULTS 21 eyes of 21 patients were included. The mean rate of success was 0.74 (95%CI 0.48-0.88), 0.68 (0.43-0.84), 0.47 (0.25-0.67), and 0.47 (0.25-0.67, at 6, 12, 24, and 36 months postoperatively, respectively. The mean IOP decreased by 30.7% (95% CI 13.7-47.7), 26.5% (95% CI 3.2-49.8), 33.5% (95% CI 21.8-45.3), and 30.1% (95% CI 7.2-52.9) from baseline at postoperative month 6, 12, 24, and 36, respectively (p < 0.001). The mean ± SD number of glaucoma medications decreased from 4.1 ± 0.9 to 0.9 ± 1.2 at the final follow up (p = 0.0005). No sight-threatening complications were reported by 36 months. CONCLUSIONS Three-year results of the PRESERFLO Microshunt implant demonstrated favourable efficacy and safety profile in the treatment of refractory uveitic glaucoma.
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Affiliation(s)
- Giacinto Triolo
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | - Jing Wang
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | | | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
- NIHR Moorfields Biomedical Research Centre, 162 City Rd, London, EC1V 2PD, UK
- Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK
| | - Keith Barton
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK.
- Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK.
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Nüßle S, Lübke J. [Angle closure-glaucoma]. Klin Monbl Augenheilkd 2023; 240:1017-1032. [PMID: 37236235 DOI: 10.1055/a-1812-4381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Angle-closure glaucoma is a less common form of glaucoma in Europe than open-angle glaucoma. Nevertheless, the clinical picture should also be known here since it can lead to severe visual disturbances and even blindness within a short time. It is divided into primary and secondary forms and can be further categorized depending on the presence of a pupillary block. In all cases, therapy is initially based on resolving the cause of the angle-closure and treating any underlying disease that may be present. In addition, intraocular pressure reduction must be achieved. This can be effectuated conservatively or surgically. Depending on the specific subtype of angle-closure, different treatments are promising.
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San Pedro MJB, Gomez JPS, Leuenberger EU. Comparison of Short and Long-Tunnel Needle Track for Ahmed Glaucoma Valve Implantation in a Private Eye Center in the Philippines: A Retrospective Study. Clin Ophthalmol 2023; 17:1691-1699. [PMID: 37366517 PMCID: PMC10290859 DOI: 10.2147/opth.s405924] [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: 01/25/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023] Open
Abstract
Purpose This study aimed to compare the success and complication rates among patients implanted with Ahmed Glaucoma Valve (AGV) using the short and long tunnel technique through retrospective chart review. Patients and Methods We reviewed 54 charts of adult patients who underwent AGV implantation using a Short-Needle Track (SNT) or Long-Needle Track (LNT) technique. Intraocular pressures (IOP), Best Corrected Visual Acuity (BCVA) and number of medications were recorded pre-operatively, and at Day 1, 3, 7, Month 1, 3, 6 post-operatively. Treatment success, occurrence of Hypertensive Phase (HP), complication and procedures done after AGV implantation were compared between the two groups using one-tailed Z-test of proportions. Results A total of 20 (LNT) and 21 (SNT) charts were included in the study. There was no significant difference between the median postoperative IOP, BCVA, and number of anti-glaucoma medications between the two groups at each time interval. The comparison between the occurrence of HP (P = 0.435) and success rates (P = 0.476) between the two groups yielded no significant difference. Flat/shallow anterior chamber (AC) was seen exclusively in three eyes (14%) in the SNT group (P = 0.039). There was one occurrence of plate exposure in the LNT group (P = 0.149). Conclusion The LNT technique of AGV Implantation may be used as an alternative to the traditional SNT (with autologous graft). The long needle track offers the advantage reducing the risk of complications arising from shallow anterior chamber post-operatively.
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Affiliation(s)
| | | | - Edgar U Leuenberger
- Asian Eye Institute, Makati, Philippines
- Department of Ophthalmology, University of the East Ramon Magsaysay Memorial Medical Center Inc., Quezon City, Philippines
- Department of Ophthalmology, Ospital ng Makati, Makati City, Philippines
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10
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Chen RI, Purgert R, Eisengart J. Gonioscopy-Assisted Transluminal Trabeculotomy and Goniotomy, With or Without Concomitant Cataract Extraction, in Steroid-Induced and Uveitic Glaucoma: 24-Month Outcomes. J Glaucoma 2023; 32:501-510. [PMID: 36795532 DOI: 10.1097/ijg.0000000000002183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 01/22/2023] [Indexed: 02/17/2023]
Abstract
PRCIS Gonioscopy-assisted transluminal trabeculotomy (GATT) and goniotomy with Kahook Dual Blade both achieved sustained reductions in intraocular pressure (IOP) and medication burden in eyes with steroid-induced or uveitic glaucoma at 24 months. Both procedures had favorable safety profiles. PURPOSE To characterize the 24-month surgical outcomes of GATT and excisional goniotomy in eyes with steroid-induced or uveitic glaucoma. PATIENTS AND METHODS A retrospective chart review was performed of eyes with steroid-induced or uveitic glaucoma that underwent GATT or excisional goniotomy, either standalone or combined with phacoemulsification cataract surgery, by a single surgeon at the Cole Eye Institute. IOP, number of glaucoma medications, and steroid exposure were recorded preoperatively and at multiple postoperative timepoints up to 24 months. Surgical success was defined as at least 20% IOP reduction or IOP <12, 15, or 18 mm Hg (Criterion A, B, or C). Surgical failure was defined as need for additional glaucoma surgery or loss of light perception vision. Intraoperative and postoperative complications were reported. RESULTS Forty eyes of 33 patients underwent GATT, and 24 eyes of 22 patients underwent goniotomy, of which 88% and 75%, respectively, had 24-months' follow-up. Concomitant phacoemulsification cataract surgery was performed in 38% (15/40) GATT eyes and 17% (4/24) goniotomy eyes. IOP and number of glaucoma medications were reduced at all postoperative timepoints in both groups. At 24 months, GATT eyes had mean IOP 12.9±3.5 mm Hg on 0.9±1.2 medications, and goniotomy eyes had mean IOP 14.3±4.1 mm Hg on 1.8±1.3 medications. Surgical failure was 8% for GATT and 14% for goniotomy at 24 months. Transient hyphema and transient IOP elevation were the most common complications, and 10% GATT eyes required surgical evacuation of hyphema. CONCLUSIONS Both GATT and goniotomy demonstrate favorable efficacy and safety in steroid-induced and uveitic glaucoma eyes. Both procedures achieved sustained reductions in IOP and glaucoma medication burden at 24 months.
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Affiliation(s)
- Rebecca I Chen
- Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento, CA
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11
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Luo N, Liu M, Hao M, Xu R, Wang F, Zhang W. Comparison of tube shunt implantation and trabeculectomy for glaucoma: a systematic review and meta-analysis. BMJ Open 2023; 13:e065921. [PMID: 37080625 DOI: 10.1136/bmjopen-2022-065921] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma. METHODS A systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs). RESULTS Forty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures. CONCLUSION Compared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy. PROSPERO REGISTRATION NUMBER CRD42021257852.
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Affiliation(s)
- Nachuan Luo
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Miaowen Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Meiqi Hao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruoxin Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
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Manako K, Takahashi E, Saruwatari J, Matsumura T, Kojima S, Inoue T. Risk factors for Baerveldt glaucoma drainage implantation for uveitic glaucoma. Sci Rep 2023; 13:4473. [PMID: 36934114 PMCID: PMC10024771 DOI: 10.1038/s41598-023-29244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/01/2023] [Indexed: 03/20/2023] Open
Abstract
Uveitic glaucoma (UG) is sometimes intractable, including intricate interaction between intraocular pressure (IOP) elevation associated with inflammation and side effects of steroids. Based on the Tube Versus Trabeculectomy study in refractory glaucoma results in 2012, tube shunt surgeries have been performed for UG, but few reports have focused on UG. We retrospectively examined the surgical efficacy, complications, and risk factors in 62 eyes with UG that underwent Baerveldt glaucoma drainage device (BGD) implantation at Kumamoto University. The IOPs significantly dropped, and the mean number of glaucoma medications was reduced by more than two. Kaplan‒Meier survival curves were presented under 2 conditions: an IOP reduction of 20% and 6 ≤ IOP ≤ 18 mmHg (criterion A) or 6 ≤ IOP ≤ 15 mmHg (criterion B). In criterion A, the median survival times (MST) were 124 days (complete) and 997 days (qualified). In criterion B, the MST was 129 days (complete) and 867 days (qualified). The Cox hazard proportional model found that the hazard ratio was 0.170 for a history of cataract surgery (95% CI 0.0303-0.950) and 8.669 for systemic immunosuppressive therapy (95% CI 1.810-41.51). BGD implantation is effective for treating UG, but the presence of systemic treatment and the lens status should be considered.
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Affiliation(s)
- Kiyofumi Manako
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Eri Takahashi
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
| | - Junji Saruwatari
- Division of Pharmacology and Therapeutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tomoyo Matsumura
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sachi Kojima
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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13
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Alvarez-Guzman C, Hartleben-Matkin C, Ruiz-Lozano RE, Rodriguez-Garcia A, Quiroga-Garza ME, Valdez-Garcia JE. Risk factors for secondary Glaucoma in patients with Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 2022; 12:22. [PMID: 35816207 PMCID: PMC9273804 DOI: 10.1186/s12348-022-00300-7] [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: 12/08/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/PURPOSE Identify the prevalence and risk factors for secondary glaucoma among Mexican-mestizo patients with Vogt-Koyanagi-Harada Disease (VKH). METHODS Retrospective cohort study analyzing the demographic, clinical, and epidemiological variables. Risk estimates were calculated using a Cox proportional hazards regression model. RESULTS One hundred eyes of 50 patients, 44 (88%) women and 6 men (12%) with a median age of 35.5 years (IQR 29-46) and a median follow-up time of 72 months (IQR 13.7-126.7) were analyzed. The prevalence of glaucoma was 20%, with angle-closure accounting for 70% of all cases. Significant clinical risk factors for glaucoma development were a chronic recurrent stage at presentation (RR 2.88, 95% CI 1.11-12.63, p = 0.037), ≥ 2 episodes of recurrent anterior uveitis (RR 8.52, 95% CI 2.02-35.92, p < 0.001), angle-closure disease (ACD, RR 7.08, 95% CI 2.44-20.48, p < 0.001), iris bombé (RR 5.0, 95% CI 2.10-11.90, p < 0.001), and peripapillary atrophy (RR 3.56, 95% CI 1.43-8.85, p < 0.001). Exposure to > 24 months of oral (RR 9.33, 95% CI 2.21-39.28, p < 0.001) or > 12 months of topical corticosteroids (RR 3.88, 95% CI 1.31-11.46, p = 0.007) were associated with an increased likelihood for secondary glaucoma development. CONCLUSION Glaucoma is a frequent complication of VKH, often attributed to mixed pathogenic mechanisms. Chronic disease at presentation, recurrent inflammation, angle-closure mechanisms, iris bombé, and peripapillary atrophy represent clinically significant risk factors for developing secondary glaucoma. Prompt and aggressive steroid-spearing immunosuppressive therapy for adequate inflammation control may lower the risk of glaucoma in VKH.
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Affiliation(s)
- Carlos Alvarez-Guzman
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico.,Fundación de Asistencia Privada Conde de Valenciana, IAP, Ciudad de México, México Chimalpopoca 14. Col. Obrera, CP 06800, Ciudad de México, Mexico
| | - Curt Hartleben-Matkin
- Fundación de Asistencia Privada Conde de Valenciana, IAP, Ciudad de México, México Chimalpopoca 14. Col. Obrera, CP 06800, Ciudad de México, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico. .,Instituto de Oftalmologia y Ciencias Visuales (1er Piso Ote.) Hospital Zambrano Hellion Tec Salud, Av. Batallon de San Patricio #112. Col. Real de San Agustin. San Pedro Garza Garcia, Nuevo Leon. CP, Mexico, 66278, Mexico.
| | - Manuel E Quiroga-Garza
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
| | - Jorge E Valdez-Garcia
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Instituto de Oftalmologia y Ciencias Visuales, Monterrey, Nuevo Leon, Mexico
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14
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High prevalence of angle-closure glaucoma in Vogt-Koyanagi-Harada disease. Int Ophthalmol 2022; 42:3913-3921. [PMID: 35789316 DOI: 10.1007/s10792-022-02412-4] [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: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the prevalence, clinical characteristics, and mechanisms of secondary glaucoma in Vogt-Koyanagi-Harada (VKH) disease. METHODS This retrospective, longitudinal observational study analyzed the demographic data, disease stage, glaucoma development, intraocular pressure, best-corrected visual acuity, lens status, optic nerve, gonioscopy, management, and visual outcomes of VKH disease. Clinical features were used to categorize the stage of VKH disease. VKH eyes were divided into two groups, with or without glaucoma, undergoing further analysis, including statistical analysis. RESULTS 305 eyes of 155 patients with VKH disease with a median follow-up of 22 months were included. Secondary glaucoma developed in 67 (22%) eyes, most of which (64.2%) had chronic recurrent VKH at presentation. Angle-closure was present in 55 (82.1%) of glaucoma eyes. Peripheral anterior and posterior synechiae were present in 58 (86.6%) and 51 (76.1%) eyes, respectively. Pupillary block and posterior synechiae resulted in iris bombé in 17 (25.4%) eyes with glaucoma. At the last visit, visual acuity was worse in eyes with glaucoma (p < 0.001). CONCLUSION We found that angle-closure disease is a significant cause of secondary glaucoma in VKH. Eyes with glaucoma were more likely to present in the chronic recurrent stage of the disease.
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Comparison of Surgical Outcomes between Trabeculectomy with Mitomycin C and Ahmed Valve Implantation with Mitomycin C in Eyes with Uveitic Glaucoma. J Clin Med 2022; 11:jcm11051368. [PMID: 35268458 PMCID: PMC8911249 DOI: 10.3390/jcm11051368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 02/04/2023] Open
Abstract
We compared 1-year outcomes of trabeculectomy with mitomycin C (MMC) and Ahmed valve implantation with MMC as a first surgical procedure in patients with uveitic glaucoma. A total 38 eyes of 38 patients undergoing trabeculectomy (n =16) or Ahmed valve implantation (n = 22) were included. Surgical success was defined as intraocular pressure (IOP) ≤21 mmHg, IOP reduction ≥20% from baseline, no secondary glaucoma surgery, and no loss of light perception. The main outcome measurements including success rate, IOP, and the number of antiglaucoma medications and complications were compared. The overall success rates were comparable between the Ahmed and trabeculectomy groups (81.3 vs. 81.8%, p = 0.987). The mean IOPs were similar as well (p = 0.084), though the number of antiglaucoma medications was significantly lower in the trabeculectomy group than in the Ahmed group (1.0 ± 1.2 vs. 2.2 ± 1.1; p = 0.005). A statistically significant reduction in corneal endothelial cell density was noted in the Ahmed group (p = 0.004). Both treatments offered reasonable IOP control and safety for eyes with uveitic glaucoma. However, significantly fewer antiglaucoma medications were used in the trabeculectomy group. Furthermore, our results suggest that cautious postoperative monitoring with regard to corneal endothelial cell density should be additionally performed after Ahmed valve implantation.
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Fathalla A, Said M, Wasfi E, Abdelazeem K, Soliman K, Masood I. Primary trabeculectomy with mitomycin C in the treatment of medically uncontrolled inflammatory glaucoma and primary open-angle glaucoma: a comparative study. DELTA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/djo.djo_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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17
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Ventura-Abreu N, Mendes-Pereira J, Pazos M, Muniesa-Royo MJ, Gonzalez-Ventosa A, Romero-Nuñez B, Milla E. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021; 15:52-57. [PMID: 34720493 PMCID: PMC8543743 DOI: 10.5005/jp-journals-10078-1306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim and objective This study aimed to evaluate the performance of and indication for different surgical techniques in the management of uveitic glaucoma (UG). Materials and methods A retrospective audit of records of all patients with UG who underwent ≥1 glaucoma surgery, between January 2007 and December 2016. The main outcomes were intraocular pressure (IOP) and the need for antihypertensive medication at each follow-up visit. The total number of surgical interventions needed to control IOP was recorded. Postoperative interventions and complications were analyzed. Results Forty eyes from 34 patients were assessed. Overall, baseline IOP was 30.7 ± 8.2 mm Hg, and postoperative mean IOP at the last visit was 16.4 ± 2.0 mm Hg, with a mean follow-up of 28 months. Antihypertensive medications were reduced from 2.8 ± 0.8 to 0.8 ± 1.2. During the follow-up, 61.8% of the eyes required only one glaucoma surgery. There was no correlation between the location of uveitis and the total number of glaucoma surgeries required. The greatest IOP reductions were in cases treated with non-penetrating deep sclerectomy (21%), Ahmed valve (23%), and cyclophotocoagulation (CPC) (51%); in cases where an Ahmed implant was the first surgical option, a 43% reduction was achieved. Conclusion Filtering procedures, glaucoma drainage devices, and CPC are all good options for IOP control in UG, but all are prone to failure over time. With respect to IOP reduction, the safety profile, and postoperative care, Ahmed implants and CPC might be the best first surgical option. Clinical significance The article highlights the versatility of the surgical techniques required to treat UG, which is one of the most difficult types of glaucoma to manage. How to cite this article Ventura-Abreu N, Mendes-Pereira J, Pazos M, et al. Surgical Approach and Outcomes of Uveitic Glaucoma in a Tertiary Hospital. J Curr Glaucoma Pract 2021;15(2):52-57.
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Affiliation(s)
| | | | - Marta Pazos
- Department of Ophthalmology, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | | | | | - Elena Milla
- Department of Ophthalmology, Hospital Clinic de Barcelona, Innove Ocular-ICO Barcelona, Spain
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Nüßle S, Lübke J. [Secondary Angle Closure Glaucoma]. Klin Monbl Augenheilkd 2021; 238:1251-1262. [PMID: 34380157 DOI: 10.1055/a-1545-9983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Secondary angle closure glaucoma is a very heterogeneous subtype of glaucoma with a variety of possible causes leading to a blockade of the regular aqueous humour flow or outflow. A distinction is made between secondary pupillary block, angle closure with "pulling" or angle closure with "pushing" mechanisms. For each of these three subgroups, there are different causes, which in turn require individual therapy. Treatment of the underlying cause should always take priority whenever possible. Reduction of the intraocular pressure is often a symptomatic therapy with surgical, pressure lowering procedures showing a limited success rate in many forms of secondary angle closure glaucoma. This article intends to provide an overview of the different causes of secondary angle closure, diagnostic approaches and targeted therapies of exemplary causes of each subgroup.From the group of secondary pupillary block, mechanical causes, iris bombé, and intraoperative air or oil input are addressed, from the group of "pulling" causes, angle neovascularization, post-inflammatory angle changes, and iridocorneal endothelial syndrome and for the group of "pushing" mechanisms, gas endotamponade, retroiridal neoplasms and aqueous misdirection syndrome.While secondary angle closure is one of the most challenging glaucoma subgroups for treatment it is crucial to know the different subgroups and their development to choose the right treatment.
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Nüßle S, Lübke J. Sekundäre Winkelblockglaukome. AUGENHEILKUNDE UP2DATE 2021. [DOI: 10.1055/a-1232-5267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungBei sekundären Winkelblockglaukomen liegt mindestens eine identifizierbare
Ursache für den Winkelblock und die Obstruktion des Kammerwasserabflusses vor.
Diese spezielle Unterform des Glaukoms ist eine besonders heterogene Gruppe an
Erkrankungen bzw. Ursachen, die sich in ihrer Auswirkung auf den
Kammerwasserfluss und in ihrer Behandlung deutlich unterscheiden. Dieser Beitrag
gibt eine Übersicht über die verschiedenen Formen des sekundären
Winkelblockglaukoms und zeigt die Ansatzpunkte für eine zielgerichtete Therapie
auf.
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20
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Kilgore KP, Wang F, Stern NC, Sabbagh N, Jamali S, White LJ, Sit AJ, Bitrian E, Roddy GW, Mohney BG, Khanna CL. Rates of Diplopia in Ahmed FP7, Baerveldt 250, and 350 Glaucoma Patients Compared With Medical Controls. J Glaucoma 2021; 30:579-584. [PMID: 34049345 DOI: 10.1097/ijg.0000000000001886] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/25/2021] [Indexed: 12/14/2022]
Abstract
PRECIS Diplopia was present in ~20% of patients with Ahmed FP7 (FP7) or Baerveldt 350 (B350), compared with 5% to 6% in those with Baerveldt 250 (B250) or controls, suggesting risk of diplopia should be included in preoperative counseling. PURPOSE The purpose of this study was to examine the prevalence of diplopia and strabismus in patients with B250, B350, or FP7 glaucoma drainage devices (GDD). MATERIALS AND METHODS In this cohort study, glaucoma patients 18 years and above who had received, or would be receiving, a B250, B350, or FP7 GDD, and medically treated controls were consecutively enrolled from August 8, 2017, through July 31, 2019. The Diplopia Questionnaire was administered ≥30 days postoperatively, and upon enrollment to the controls. All diplopic patients underwent orthoptic measurements, which were reviewed by a strabismus specialist. Patients with GDDs in quadrants other than superotemporal, multiple GDDs, or scleral buckles were excluded. Bonferroni correction was applied for pairwise comparisons. RESULTS Diplopia was reported in 23/129 (17.8%) GDD patients and 5/99 (5.1%) control patients (P=0.003): 8/35 (22.9%) FP7, 2/32 (6.3%) B250, and 13/62 (21.0%) B350, with significant differences between FP7 versus controls (P=0.014) and B350 versus controls (P=0.011). Diplopia was attributable to GDD in 2 FP7 (5.9%, 95% confidence interval: 0.7-19.2), 0 B250, and 4 B350 (6.5%, 95% confidence interval: 1.7-15.2) patients, without significant differences between the GDDs. CONCLUSIONS Patients with the larger (B350) or the higher profile plate (FP7) GDDs were more likely to experience diplopia than controls, and diplopia was attributable to the GDD in ~6% of patients with either a FP7 or a B350 GDD. Since diplopia can affect patients' quality of life, preoperative counseling for GDD surgery, particularly B350 and FP7, should include a discussion of the risk of diplopia.
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Affiliation(s)
| | - Feng Wang
- Departments of Ophthalmology
- Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | | | | | | | | | | | - Elena Bitrian
- Departments of Ophthalmology
- Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL
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Sinha S, Ganjei AY, Ustaoglu M, Syed ZA, Lee D, Myers JS, Fudemberg SJ, Razeghinejad R. Effect of shunt type on rates of tube-cornea touch and corneal decompensation after tube shunt surgery in uveitic glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 259:1587-1595. [PMID: 33515315 DOI: 10.1007/s00417-021-05095-2] [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: 09/13/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the effect of tube shunt type [Ahmed (AGV) versus Baerveldt (BGI)] on the frequency of tube-cornea touch and corneal decompensation after tube shunt surgery. METHODS This retrospective comparative study included 145 eyes of 130 patients with uveitic glaucoma who underwent AGV (75 eyes) or BGI (70 eyes) implantations. Electronic medical records were reviewed to document demographic factors, intraocular pressure (IOP) reduction, frequency of tube-cornea touch, corneal decompensation, and need for subsequent corneal transplantation. RESULTS The mean follow-up was 27.7±3.3 months for AGV and 32.8±3.8 months for BGI (p=0.30). Tube-cornea touch was observed in 5 eyes after BGI and 1 eye in the AGV group (p=0.08). The BGI group reported a significantly higher rate of corneal decompensation (9 versus 0; p=0.001) and transplantation (6 versus 0; p=0.01) compared to the AGV group. Previous trabeculectomy was a significant risk factor for corneal complications in eyes undergoing BGI implantation (odds ratio [OR]= 8.17, 95% confidence interval [CI]=1.78-37.45, p=0.007). CONCLUSION Similar rates of tube-cornea touch were observed in both shunt types; BGI shunts were associated with a greater incidence of corneal complications and transplantation as compared to AGV in this retrospective series of uveitic glaucoma cases.
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Affiliation(s)
- Sapna Sinha
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA.
| | - Allen Y Ganjei
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Melih Ustaoglu
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Zeba A Syed
- Wills Eye Hospital, Cornea Service, Philadelphia, PA, USA
| | - Daniel Lee
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Jonathan S Myers
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Scott J Fudemberg
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
| | - Reza Razeghinejad
- Wills Eye Hospital, Glaucoma Research Center, 840 Walnut Street, Suite 1140, Philadelphia, PA, 19107, USA
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Pinazo-Durán MD, Muñoz-Negrete FJ, Sanz-González SM, Benítez-Del-Castillo J, Giménez-Gómez R, Valero-Velló M, Zanón-Moreno V, García-Medina JJ. The role of neuroinflammation in the pathogenesis of glaucoma neurodegeneration. PROGRESS IN BRAIN RESEARCH 2020; 256:99-124. [PMID: 32958217 DOI: 10.1016/bs.pbr.2020.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The chapter is a review enclosed in the volume "Glaucoma: A pancitopatia of the retina and beyond." No cure exists for glaucoma. Knowledge on the molecular and cellular alterations underlying glaucoma neurodegeneration (GL-ND) includes innovative and path-breaking research on neuroinflammation and neuroprotection. A series of events involving immune response (IR), oxidative stress and gene expression are occurring during the glaucoma course. Uveitic glaucoma (UG) is a prevalent acute/chronic complication, in the setting of chronic anterior chamber inflammation. Managing the disease requires a team approach to guarantee better results for eyes and vision. Advances in biomedicine/biotechnology are driving a tremendous revolution in ophthalmology and ophthalmic research. New diagnostic and imaging modalities, constantly refined, enable outstanding criteria for delimiting glaucomatous neurodegeneration. Moreover, biotherapies that may modulate or inhibit the IR must be considered among the first-line for glaucoma neuroprotection. This review offers the readers useful and practical information on the latest updates in this regard.
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Affiliation(s)
- Maria D Pinazo-Durán
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO and Cellular and Molecular Ophthalmo-biology Group of the University of Valencia, Valencia, Spain; Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain.
| | - Francisco J Muñoz-Negrete
- Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain; Ophthalmology Department at the University Hospital "Ramón y Cajal" (IRYCIS) and Surgery Department at the Faculty of Medicine, University Alcala de Henares, Madrid, Spain
| | - Silvia M Sanz-González
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO and Cellular and Molecular Ophthalmo-biology Group of the University of Valencia, Valencia, Spain; Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain
| | - Javier Benítez-Del-Castillo
- Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain; Department of Ophthalmology at the Hospital of Jerez, Jerez de la Frontera, Cádiz, Spain
| | - Rafael Giménez-Gómez
- Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain; Department of Ophthalmology at the University Hospital "Reina Sofia", Córdoba, Spain
| | - Mar Valero-Velló
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO and Cellular and Molecular Ophthalmo-biology Group of the University of Valencia, Valencia, Spain
| | - Vicente Zanón-Moreno
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO and Cellular and Molecular Ophthalmo-biology Group of the University of Valencia, Valencia, Spain; Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain; International University of Valencia, Valencia, Spain
| | - José J García-Medina
- Ophthalmic Research Unit "Santiago Grisolía"/FISABIO and Cellular and Molecular Ophthalmo-biology Group of the University of Valencia, Valencia, Spain; Researchers of the Spanish Net of Ophthalmic Research "OFTARED" of the Institute of Health Carlos III, Net RD16/0008/0022, Madrid, Spain; Department of Ophthalmology at the University Hospital "Morales Meseguer" and Department of Ophthalmology at the Faculty of Medicine, University of Murcia, Murcia, Spain
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Kesav N, Palestine AG, Kahook MY, Pantcheva MB. Current management of uveitis-associated ocular hypertension and glaucoma. Surv Ophthalmol 2020; 65:397-407. [DOI: 10.1016/j.survophthal.2019.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
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Ahmed Versus Baerveldt Glaucoma Drainage Device in Uveitic Glaucoma: A Retrospective Comparative Study. J Glaucoma 2020; 29:750-755. [PMID: 32590449 DOI: 10.1097/ijg.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRECIS Baerveldt glaucoma drainage device demonstrated a greater reduction in intraocular pressure (IOP) than Ahmed in patients with uveitic glaucoma. The most common cause of failure was uncontrolled IOP in Ahmed and hypotony in the Baerveldt group. PURPOSE To compare the efficacy and safety of Ahmed and Baerveldt glaucoma drainage devices in uveitic glaucoma. MATERIALS AND METHODS The retrospective comparative study included patients with uveitic glaucoma who underwent Ahmed or Baerveldt glaucoma drainage device implantation with a minimum follow-up of 3 months. Success was defined as IOP ≥6 and ≤21 mm Hg and >20% reduction on 2 consecutive visits after the third month with (qualified success) or without (complete success) medications and no further glaucoma surgery or loss of vision. IOP, number of medications, visual acuity, complications, and interventions were compared between groups. RESULTS In total, 137 eyes of 122 patients (67 Ahmed, 70 Baerveldt) were included. The preoperative IOP and number of medications in the Ahmed group (32.7±10.3 mm Hg; 4.1±1.3) were similar to Baerveldt (32.1±10.2 mm Hg; 4.3±1.3; P=0.73, 0.35). These at the last follow-up were (18.1±9.8 mm Hg; 2.1±1) in Ahmed and (12.7±6.9 mm Hg; 1.3±1.3) in Baerveldt groups (P=0.04, 0.01). The Baerveldt had greater IOP reduction (60.3% vs. 44.5%) and complete success rate (30% vs. 9%) with higher complication rate (51.4% vs. 20.9%) (all P≤0.05). The de novo glaucoma reoperation rate was 19% in the Ahmed group and 4% in the Baerveldt group (P=0.006). Hypotony resulted in failure in 7 eyes (10%) in the Baerveldt group and none in the Ahmed group (P=0.013). CONCLUSIONS Higher complete success rate and significantly greater reduction in mean IOP and number of medications were observed in the Baerveldt group, but with a higher rate of complications including hypotony.
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Factors Predictive of Remission of Chronic Anterior Uveitis. Ophthalmology 2020; 127:826-834. [PMID: 31932091 DOI: 10.1016/j.ophtha.2019.11.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To estimate the incidence of medication-free remission of chronic anterior uveitis and identify predictors thereof. DESIGN Retrospective cohort study. PARTICIPANTS Patients diagnosed with anterior uveitis of longer than 3 months' duration followed up at United States tertiary uveitis care facilities. METHODS Estimation of remission incidence and identification of associated predictors used survival analysis. MAIN OUTCOME MEASURES Incidence of medication-free remission. For the primary analysis, remission was defined as inactive uveitis while off treatment at all visits spanning an interval of at least 90 days or-for patients who did not return for follow-up after 90 days-remaining inactive without receiving suppressive medications at all of the last visits. Association of factors potentially predictive of medication-free remission was also studied. RESULTS Two thousand seven hundred ninety-five eyes of 1634 patients with chronic anterior uveitis were followed up over 7936 eye-years (4676 person-years). The cumulative medication-free, person-year remission incidence within 5 years was 32.7% (95% confidence interval [CI], 30.4%-35.2%). Baseline clinical factors predictive of reduced remission incidence included longer duration of uveitis at presentation (for 2 to 5 years vs. less than 6 months: adjusted hazard ratio [aHR], 0.61; 95% CI, 0.44-0.83), bilateral uveitis (aHR, 0.75; 95% CI, 0.59-0.96), prior cataract surgery (aHR, 0.70; 95% CI 0.56-0.88), and glaucoma surgery (aHR, 0.63; 95% CI, 0.45-0.90). Two time-updated characteristics were also predictive of reduced remission incidence: keratic precipitates (aHR, 0.36; 95% CI, 0.21-0.60) and synechiae (aHR, 0.62; 95% CI, 0.41-0.93). Systemic diagnosis with juvenile idiopathic arthritis and spondyloarthropathy were also associated with reduced remission incidence. Older age at presentation was associated with higher incidence of remission (for age ≥40 years vs. <40 years: aHR, 1.29; 95% CI, 1.02-1.63). CONCLUSIONS Approximately one third of patients with chronic anterior uveitis remit within 5 years. Longer duration of uveitis, younger age, bilateral uveitis, prior cataract surgery, glaucoma surgery, presence of keratic precipitates and synechiae, and systemic diagnoses of juvenile idiopathic arthritis and spondyloarthropathy predict reduced remission incidence; patients with these factors should be managed taking into account the higher probability of a longer disease course.
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Efficacy of Goniotomy With Kahook Dual Blade in Patients With Uveitis-associated Ocular Hypertension. J Glaucoma 2019; 28:744-748. [DOI: 10.1097/ijg.0000000000001298] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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