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Wong MOM, Yu AHY, Chan CKM. Two Year Outcomes of Trabeculectomy in Cytomegalovirus Anterior Uveitis with Uncontrolled Intraocular Pressure. Ocul Immunol Inflamm 2023; 31:1490-1496. [PMID: 35914307 DOI: 10.1080/09273948.2022.2103828] [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: 12/14/2021] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To describe the two-year outcome of trabeculectomy in cytomegalovirus(CMV) anterior uveitis(AU). METHODS Records of 29 eyes of 29 consecutive CMV AU patients undergoing MMC-augmented trabeculectomy for uncontrolled IOP despite maximal tolerated topical medications were retrospectively reviewed. Treatment success was defined as IOP≤21 mmHg with same or reduced number of IOP-lowering medications compared to baseline, without systemic acetazolamide or further interventions for uncontrolled IOP. RESULTS Treatment success was 79.3% (23/29) at 24 months. Both median IOP and number of IOP-lowering medications dropped significantly from baseline (p < .01 and p < .001, all time-points, Wilcoxon sign-rank test, respectively), with 63.2% and 19.0% reduction in AU relapse/year and steroid use(p = .001 and 0.03, respectively), without sight-threatening sequelae. At 24 months, AU frequency was not significantly different between successful cases with and without ≥12-month use of topical ganciclovir (p = .51, Mann-Whitney U test). CONCLUSION MMC-augmented trabeculectomy was efficacious for IOP control in nearly 80% of CMV AU cases over two years.
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Affiliation(s)
- Mandy Oi Man Wong
- Hong Kong Eye Hospital, HKSAR, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, HKSAR, Hong Kong, People's Republic of China
| | - Amy Hiu Ying Yu
- Hong Kong Eye Hospital, HKSAR, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, HKSAR, Hong Kong, People's Republic of China
| | - Carmen Kar Mun Chan
- Hong Kong Eye Hospital, HKSAR, Hong Kong, People's Republic of China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, HKSAR, Hong Kong, People's Republic of China
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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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Özdamar Erol Y, Güngör A, Şekeryapan Gediz B. Peripapillary and Macular Choroidal Vascularity Index in Eyes with Fuchs' Uveitis. Ocul Immunol Inflamm 2022; 30:1853-1858. [PMID: 34410884 DOI: 10.1080/09273948.2021.1964031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the choroidal vascularity alterations of macula and peripapillary area in eyes with unilateral Fuchs uveitis (FU). METHODS This study included 18 eyes with unilateral FU and 18 healthy fellow eyes. The choroidal vascularity index (CVI) was analyzed, and the results were compared between eyes with FU and healthy fellow eyes (control group). RESULTS The mean subfoveal (s)CVI (%) value was significantly lower in the FU group as compared with the control group: 60.92 ± 2.63 vs. 64.01 ± 2.54, respectively (p = .001). The mean pCVI (%) values of superior and inferior quadrant were significantly lower in the Fuchs group as compared with the control group:58.87 ± 4.48 vs. 61.98 ± 3.32, respectively, in superior quadrant (p = .035); and 57.29 ± 6.65 vs. 61.44 ± 4.76, respectively, in inferior quadrant (p = .014). CONCLUSION The chronic continuous inflammation in FU causes inflammation-mediated thinning in the vascular area of the subfoveal and peripapillary choroid. The changes in the peripapillary region are remarkable in terms of the further glaucoma risk of these eyes.
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Affiliation(s)
- Yasemin Özdamar Erol
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Anıl Güngör
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
| | - Berrak Şekeryapan Gediz
- Department of Ophthalmology, University of Health Science, Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
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Wong MOM, Yu AHY, Chan CKM. Efficacy and safety of oral valganciclovir in cytomegalovirus anterior uveitis with uncontrolled intraocular pressure. Br J Ophthalmol 2020; 105:1666-1671. [PMID: 33011687 DOI: 10.1136/bjophthalmol-2020-317044] [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: 05/27/2020] [Revised: 08/19/2020] [Accepted: 09/13/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS While cytomegalovirus (CMV) anterior uveitis (AU) patients often require glaucoma surgery, the effectiveness of systemic anti-viral in long-term intraocular pressure (IOP) control is not well established. Our study aims to identify the 2-year efficacy and safety of oral valganciclovir in CMV AU with uncontrolled IOP. METHODS In this retrospective case series, one eye from each of 17 immunocompetent PCR-proven patients with CMV AU who received a single course of oral valganciclovir for 20-148 days for medically uncontrolled IOP during 2008-2018 were identified. They were examined at baseline, week 2, months 1, 2 and 3, then every 3 months up to 2 years after commencement of valganciclovir, or until IOP-lowering procedure. RESULTS Median baseline IOP and IOP-lowering medication were 27.0 mm Hg (IQR: 22.9-31.0 mm Hg), and 4.0, respectively. IOP was significantly lower than baseline from 2 weeks to 12 months and at 21 and 24 months after starting valganciclovir (p=0.001 to 0.041, Wilcoxon sign-rank test), with 16.9-46.0% median IOP reduction. Seven (41.2%) and six (35.3%) patients had IOP≤21 mm Hg with same, or reduced, topical medications by 12 and 24 months, respectively. Median time to IOP-lowering intervention or second course of valganciclovir was 12.4 months. There was no serious medication-related adverse event. Common side effects included reduced monocyte count (9 patients) and deranged renal function/electrolytes (5 patients). IOP spike and wound leak occurred in 35.5% and 29.4% of patients, respectively, after diagnostic aqueous tap. CONCLUSION In CMV AU with uncontrolled IOP, >1/3 of the patients avoided glaucoma surgery over 2 years with a course of oral valganciclovir.
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Affiliation(s)
- Mandy O M Wong
- Hong Kong Eye Hospital, Hong Kong SAR, China .,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Amy H Y Yu
- Hong Kong Eye Hospital, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen K M Chan
- Hong Kong Eye Hospital, Hong Kong SAR, China.,Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
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A literature review on Fuchs uveitis syndrome: An update. Surv Ophthalmol 2019; 65:133-143. [PMID: 31622627 DOI: 10.1016/j.survophthal.2019.10.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/14/2022]
Abstract
Fuchs uveitis syndrome is a chronic, typically unilateral, ocular condition characterized by an asymptomatic mild inflammatory syndrome that can result in cataract and secondary glaucoma. Diagnosis is largely clinical because the etiology remains obscure. Fuchs uveitis syndrome is most likely the result of different insults or pathogenic mechanisms, including infections, autoimmune diseases, hereditary and sympathetic dysfunction. According to the infectious theory, the infection of herpes simplex virus, ocular toxoplasmosis, cytomegalovirus, rubella virus, and other viruses have been implicated in the pathogenesis of the disease. There is no indication for corticosteroid therapy in Fuchs patients, and treatment should be mostly reserved to cataract and glaucoma. Phacoemulsification with intraocular lens implantation is a safe procedure with good visual outcomes in patients with Fuchs uveitis syndrome. Glaucoma is often unresponsive to treatment and should actively be monitored both preoperatively and postoperatively in these patients. We discuss the current understanding of Fuchs uveitis syndrome from its clinical presentations through recommended management and provide a comprehensive description and the updated knowledge of its pathophysiology.
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Esfandiari H, Shazly T, Shah P, Hassanpour K, Torkian P, Yaseri M, Loewen NA. Impact of same-session trabectome surgery on Ahmed glaucoma valve outcomes. Graefes Arch Clin Exp Ophthalmol 2018; 256:1509-1515. [PMID: 29602960 DOI: 10.1007/s00417-018-3967-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/01/2018] [Accepted: 03/23/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). METHOD A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was success defined as IOP > 5 mmHg, ≤ 21 mmHg and ≥ 20% reduction of IOP from baseline at two consecutive visits after 3 months, and no need for glaucoma reoperation. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). RESULTS The cumulative probability of success at 1 year was 70% in AT, and 65% in A (p = 0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p = 0.001). The corresponding numbers for A were 27.8 ± 10.2 and 16.7 ± 4.9, respectively (p = 0.001). The final IOP was significantly lower in AT (p = 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p = 0.851). Corresponding number at 1 year visit was 1.2 ± 2 in AT and 2.8 ± 1.8 in A (p = 0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p = 0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3 and 28.5%, respectively, p = 0.67). CONCLUSION Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA.,Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tarek Shazly
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Priyal Shah
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Kiana Hassanpour
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Pooya Torkian
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA
| | - Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nils A Loewen
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, 203 Lothrop St, Pittsburgh, PA, 15213, USA.
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