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Gedde SJ, Vinod K, Bowden EC, Kolomeyer NN, Chopra V, Challa P, Budenz DL, Repka MX, Lum F. Reporting Clinical Endpoints in Studies of Minimally Invasive Glaucoma Surgery. Ophthalmology 2024:S0161-6420(24)00456-1. [PMID: 39127407 DOI: 10.1016/j.ophtha.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) refers to a group of procedures generally characterized by an ab interno approach, minimal trauma to ocular tissue, moderate efficacy, an excellent safety profile, and rapid recovery. The number of MIGS procedures continues to increase, and their use has become widespread among glaucoma and cataract specialists. Standardization of the methodology and reporting of clinical endpoints in MIGS investigations enhances interpretation and comparison across different studies. The assessment of surgical interventions should not only consider statistical significance, but also whether the outcome is meaningful to patients. Minimal clinically important difference (MCID) is defined as the smallest change in a treatment outcome that is considered beneficial for an individual patient and prompts a change in their clinical management, and expert consensus is an accepted approach to determine the MCID. The American Academy of Ophthalmology's Glaucoma Preferred Practice Pattern Panel is an expert panel that develops guidelines identifying characteristics and components of quality eye care. The panel recommends that the cumulative probability of surgical success at 2 years with Kaplan-Meier survival analysis be used as the primary efficacy endpoint in MIGS studies. The panel suggests that surgical success for standalone MIGS be defined as intraocular pressure (IOP) ≤ 21 mmHg and reduced ≥ 20% from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The proposed MCID for the cumulative probability of success of standalone MIGS at 2 years is 50%. The panel recommends that surgical success for MIGS combined with cataract extraction with intraocular lens implantation (CE-IOL) be defined as a decrease in glaucoma medical therapy ≥ 1 medication from baseline without an increase in IOP, or IOP ≤ 21 mmHg and reduced ≥ 20% from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The suggested MCID for the cumulative probability of success for CE-IOL/MIGS at 2 years is 65%.
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Affiliation(s)
- Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York
| | - Eileen C Bowden
- Mitchel and Shannon Wong Eye Institute, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Natasha N Kolomeyer
- Wills Eye Hospital, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vikas Chopra
- Doheny and Stein Eye Institutes, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Pratap Challa
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Donald L Budenz
- Department of Ophthalmology, University of North Carolina, Chapel Hill, North Carolina
| | - Michael X Repka
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California.
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Noh SH, Smith AK, Fox AR, Gustafson KM, Kwan CC, Lin KY, Mosaed S. Comparison of Superior versus Inferior Canaloplasty and Trabeculotomy Using the OMNI Surgical System. Clin Ophthalmol 2024; 18:1871-1878. [PMID: 38948344 PMCID: PMC11214751 DOI: 10.2147/opth.s461830] [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: 02/05/2024] [Accepted: 05/17/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose To compare outcomes of ab-interno canaloplasty and trabeculotomy of the superior versus inferior angle. Patients and methods This was a prospective, non-randomized, interventional comparison study done at the Veteran Affairs Hospital in Long Beach, California. All patients underwent cataract surgery with intraocular lens implantation combined with ab-interno canaloplasty and trabeculotomy with the OMNI Surgical System (SightSciences, Menlo Park, CA, USA), either superiorly or inferiorly. Pre- and post-operative intraocular pressure using Goldmann applanation tonometry and best corrected visual acuity were obtained and compared using paired t-tests. Patients were excluded if they had any prior intraocular surgery or prior laser trabeculoplasty procedures. Results 38 eyes from 29 patients were analyzed. 19 eyes were included in the superior group and 19 eyes in the inferior group. Mean pre-operative IOP in the superior group was 17.6 ± 5.2 mmHg and in the inferior group was 17.6 ± 4.6 mmHg (p > 0.99). At 12 months, mean postoperative IOP for the superior group decreased 24% to 13.3 ± 2.8 mmHg while the inferior group decreased 26% to 13.1 ± 2.2 mmHg (p = 0.92). Mean preoperative medications in the superior group were 2.2 ± 1.3 and in the inferior group was 2.4 ± 1.3 (p = 0.88). At 12 months, this decreased to 1.3 ± 1.5 post-operatively in the superior group and 2.2 ± 1.6 post-operatively in the inferior group (p = 0.64). Conclusion There was no statistical difference in efficacy between superior versus inferior canaloplasty/trabeculotomy with OMNI. Therefore, surgeons can perform the procedure in the direction that is most comfortable for them without affecting outcomes.
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Affiliation(s)
- Stephanie H Noh
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, 90822, USA
| | - Andrew K Smith
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, 90822, USA
| | - Austin R Fox
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, 90822, USA
| | - Kevin M Gustafson
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, 90822, USA
| | - Changyow C Kwan
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, 90822, USA
| | - Ken Y Lin
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
- Department of Biomedical Engineering, UC Irvine, Irvine, CA, 92617, USA
| | - Sameh Mosaed
- University of California, Irvine School of Medicine, Irvine, CA, 92617, USA
- Gavin Herbert Eye Institute, Department of Ophthalmology, UC Irvine, Irvine, CA, 92617, USA
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Dickerson JE, Harvey AE, Brown RH. Ab Interno Canaloplasty and Trabeculotomy Outcomes for Mild, Moderate, and Advanced Open-Angle Glaucoma: A ROMEO Analysis. Clin Ophthalmol 2024; 18:1433-1440. [PMID: 38803557 PMCID: PMC11129760 DOI: 10.2147/opth.s464233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose To determine if there was an association between severity of glaucoma and intraocular pressure (IOP) and medication (med) outcomes for patients in the ROMEO (Retrospective, Observational, Multicenter Evaluation of OMNI) study. Setting Eleven ophthalmology practices in 8 US states. Design Post-hoc analysis of all eyes enrolled and treated with ab interno canaloplasty and trabeculotomy in the retrospective, multicenter ROMEO study. Methods Eyes were grouped according to visual field mean deviation (MD): mild (MD better than -6 dB), moderate (MD between -6 and -12 dB), advanced (-12 dB or worse). IOP and med outcomes at 12 months were compared across groups. Least squares regression was used to assess the relationship of MD with month 12 IOP. Outcomes for 1st and last MD deciles were compared as a sensitivity analysis. Results One hundred and twenty-seven eyes were available for analysis including 79 mild, 42 moderate, 6 advanced. Most eyes had a reduction in IOP at Month 12 (70%) with most at 18 mmHg or less. Percentage IOP reduction was similar across the groups (mild 16.9%, moderate 18.6%, advanced 18.0%) with mean month 12 IOP between 14 and 16 mmHg. Medications were also reduced in all three groups; -0.8 (mild, P < 0.001), -0.55 (moderate, P < 0.05), and -1.0 (advanced, P = 0.139, ns). Regression analysis revealed no relationship between month 12 IOP and MD. Med reductions were observed for all groups with a reduction of 1 or more medications seen in (%, 95% CI) 69%, 59-79 (mild), 50%, 35-65 (moderate), and 60%, 21-99 (advanced). Secondary interventions tended to have greater incidence with worse MD likely reflecting lower desired IOP targets. Conclusion Analysis of data from the ROMEO study suggests that similar meaningful IOP and med reductions can be expected across the range of disease severity studied.
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Affiliation(s)
- Jaime E Dickerson
- Sight Sciences, Inc., Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | - Reay H Brown
- Sight Sciences, Inc., Menlo Park, CA, USA
- Atlanta Ophthalmology Associates, Atlanta, GA, USA
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Mueller A, Malley CE, Berzack S, Israilevich R, Ruiz-Pelaez J, Brink M. Canaloplasty and Trabeculotomy Combined With Phacoemulsification for Primary Angle-Closure Glaucoma: A Single-Surgeon Case Series. Cureus 2024; 16:e60549. [PMID: 38887363 PMCID: PMC11181254 DOI: 10.7759/cureus.60549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
PURPOSE To evaluate the outcomes of combined canaloplasty and trabeculotomy with phacoemulsification for primary angle-closure glaucoma (PACG). METHODS In this retrospective, consecutive, single-surgeon case series, we analyzed the pre- and postoperative measurements of PACG patients who had the procedure. Adverse events were recorded. The main outcomes were mean intraocular pressure (IOP) in each quartile of the follow-up year and the number of IOP-lowering medications the patients were on by the end of each quartile compared to their baseline values. RESULTS A total of 46 eyes from 39 PACG patients were included. The preoperative IOP and glaucoma medications taken were 19.33±6.03 mm Hg and 1.80±1.39, respectively (N=46). Postoperative IOP means (mm Hg) in the subsequent four quartiles were 14.00±3.33 (N=44), 13.44±2.83 (N=32), 14.38±2.39 (N=16), and 14.92±2.90 (N=13) (p<0.0001). The mean number of meds was 0.32±0.80, 0.22±0.42, 0.59±0.80, and 0.08±0.28 in each respective quartile (p<0.0001), while the median was 0 across all quartiles. CONCLUSIONS Combining the OMNI surgical system with phacoemulsification led to substantial reductions in mean IOP and the number of IOP-lowering medications when compared to baseline measurements.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Claire E Malley
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Shannan Berzack
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | | | - Juan Ruiz-Pelaez
- Department of Translational Medicine, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
| | - Matthew Brink
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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Wagner IV, Towne C, Saade MC, Lentz PC, Rashedi A, Vasu P, Boopathiraj N, Checo L, Krambeer C, Miller DD, Dorairaj S. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024; 18:79-85. [PMID: 39144728 PMCID: PMC11320757 DOI: 10.5005/jp-journals-10078-1442] [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: 06/01/2024] [Accepted: 06/25/2024] [Indexed: 08/16/2024] Open
Abstract
Aim To review the published literature evaluating the safety and efficacy outcomes of canaloplasty performed in the treatment of glaucoma. Background Canaloplasty is a nonpenetrating glaucoma procedure involving combined 360° circumnavigation and viscodilation of Schlemm's canal. The procedure may be performed under an ab externo (with tensioning suture) or ab-interno (conjunctiva-sparing) approach. Given the wide variety of glaucoma procedure types and approaches, further investigation into the role of canaloplasty in ophthalmological practice is warranted. The objectives of this narrative review are to synthesize the existing literature in order to investigate indications, safety and efficacy outcomes, and the optimal place of canaloplasty in glaucoma treatment and management. Review of results A total of 60 articles were included in this review. Both ab externo and ab-interno canaloplasty (ABiC) were found to be significantly effective at reducing intraocular pressure (IOP) and glaucoma medication burdens in patients with mild-to-moderate open-angle glaucoma (OAG). These findings remained consistent regardless of phacoemulsification status. ABiC was found to exhibit a safety profile favorable compared to trabeculectomy and comparable to minimally invasive trabecular bypass implants. Conclusion Canaloplasty is a nonpenetrating surgical intervention that is highly effective in treating patients with mild-to-moderate OAG across a large variety of clinical scenarios. Clinical significance These findings support the clinical use of canaloplasty in ophthalmological practice, clarify its patient profile, and compare procedural outcomes to other minimally invasive glaucoma surgery (MIGS) devices on the market. How to cite this article Wagner IV, Towne C, Saade MC, et al. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024;18(2):79-85.
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Affiliation(s)
- Isabella V Wagner
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Caleb Towne
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Marie C Saade
- Department of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - P Connor Lentz
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Arianna Rashedi
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, United States of America
| | - Pranav Vasu
- Department of Medicine, Creighton School of Medicine, Phoenix, Arizona, United States of America
| | - Nithya Boopathiraj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Chelsey Krambeer
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
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6
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Levin AM, Sheybani A. Glaucoma surgical procedures under development. Curr Opin Ophthalmol 2024; 35:111-115. [PMID: 38108372 DOI: 10.1097/icu.0000000000001020] [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: 12/19/2023]
Abstract
PURPOSE OF REVIEW Rapid innovation in glaucoma surgery is expanding surgical options in the angle, subconjunctival space, and supraciliary space. RECENT FINDINGS Advancements in glaucoma surgery make it possible for surgeons to provide treatments with less risk. In particular, new devices and lasers are available for minimally invasive glaucoma surgeries. There are also new implants and techniques for bleb-forming glaucoma surgery. SUMMARY As glaucoma surgeons have access to an increasing number of procedures, devices, and treatments, it is important for evidence to drive decision-making.
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Affiliation(s)
| | - Arsham Sheybani
- Washington University School of Medicine, St Louis, Missouri, USA
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Smith AK, Kwan CC, Fox A, Noh S, Gustafson K, Lin KY, Mosaed S. Prospective Study of Canaloplasty and Trabeculotomy Performed by Trainees. Clin Ophthalmol 2024; 18:17-26. [PMID: 38192581 PMCID: PMC10771790 DOI: 10.2147/opth.s441834] [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: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose To evaluate outcomes of new adopters of the OMNI® Surgical System (Sight Sciences, Inc.) by prospectively evaluating intermediate-term outcomes of patients operated by trainees. Patients and Methods This was a prospective study of surgeries performed by trainees on patients with open angle glaucoma undergoing simultaneous cataract surgery and ab interno canaloplasty and trabeculotomy using the OMNI Surgical System. Pre-operative intraocular pressure (IOP) and number of glaucoma medications were recorded. Only patients with a minimum of 6-month follow up were included. Baseline IOP was used to separate subjects into two groups: Group 1 (IOP ≥18 mmHg) and Group 2 (IOP <18 mmHg). Mean decrease in IOP and medications was calculated and compared with paired t-tests for the overall sample as well as the subgroups. Success was defined as those with a ≥20% reduction from pre-operative IOP or with an IOP ≤18 mmHg and ≥6 mmHg and on the same or fewer number of medications while not requiring additional surgery. Adverse events were also recorded. Results Forty-two eyes of 31 patients were included. Mean pre-operative IOP was 17.2 ± 4.8 mmHg and mean number of medications was 2.4 ± 1.2. The primary endpoint was reached in 83.3% of patients at 12 months. IOP was reduced by 22.3% to 13.4 ± 2.4 (p<0.001). Mean number of medications decreased to 1.7 ± 1.6 (p<0.001). Group 1 mean IOP decreased 35.4% from 22.2 ± 4.6 mmHg to 14.3 ± 2.8 mmHg (p<0.001). Group 2 mean number of medications decreased from 2.3 ± 1.1 to 1.6 ± 1.5 (p<0.001). Conclusion When operated on by the novice MIGS surgeon, the OMNI device provides effective IOP and glaucoma medication reduction with minimal adverse events. Efficacy and safety of the device in the hands of trainees was comparable to experienced glaucoma surgeons suggesting its ease of adoption.
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Affiliation(s)
- Andrew K Smith
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Changyow C Kwan
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Austin Fox
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Stephanie Noh
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Kevin Gustafson
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Ophthalmology, Tibor Rubin Veteran Affairs Medical Center, Long Beach, CA, USA
| | - Ken Y Lin
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
- Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Sameh Mosaed
- School of Medicine, University of California, Irvine, CA, USA
- Department of Ophthalmology, Gavin Herbert Eye Institute, Irvine, CA, USA
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Greenwood MD, Yadgarov A, Flowers BE, Sarkisian SR, Ohene-Nyako A, Dickerson JE. 36-Month Outcomes from the Prospective GEMINI Study: Canaloplasty and Trabeculotomy Combined with Cataract Surgery for Patients with Primary Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:3817-3824. [PMID: 38105915 PMCID: PMC10725746 DOI: 10.2147/opth.s446486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To provide long-term intraocular pressure (IOP) and ocular hypotensive medication usage outcomes through 36 months for patients treated with canaloplasty and trabeculotomy (OMNI Surgical System) combined with cataract surgery as participants in the GEMINI study. Setting Eleven ophthalmology practices in 10 US states. Design Non-interventional 36-month extension of the 12-month, prospective, multicenter, GEMINI study. Methods GEMINI patients had visually significant cataract, mild-to-moderate glaucoma (ICD-10 guidelines), medicated IOP <33 mmHg, and unmedicated mean diurnal IOP (DIOP) (after washout) 21-36 mmHg. Patients from GEMINI were eligible for inclusion. Outcome measures were reduction in mean unmedicated DIOP, reduction in mean IOP-lowering medications, percent of eyes with ≥20% reduction in unmedicated DIOP, and percent of eyes with unmedicated DIOP ≥6 and ≤18 mmHg. Results A total of 66 patients provided consent and were enrolled. Mean (SD) unmedicated DIOP was 23.1 (2.7) mmHg at baseline, 16.7 (4.1), 16.3 (3.3) at 24 and 36 months; mean reductions of 6.2 (4.1) and 6.9 (3.4) mmHg. Twelve-month IOP at the end of GEMINI was 15.6 mmHg. The proportion of eyes with ≥20% reduction in IOP was 77% and 78% (months 24 and 36) compared to 87% at month 12 from GEMINI. About 68% of patients had an IOP between 6 and 18 mmHg at 24 months and 71% at 36 months. Mean IOP-lowering medications was 1.7 at baseline, which was reduced to 0.4 (24 months, -1.3) and 0.3 (36 months, -1.4). About 74% of patients (46 of 62) were medication free at 36 months. Conclusion GEMINI demonstrated 12-month effectiveness of canaloplasty and trabeculotomy with OMNI combined with cataract surgery for IOP and medication reduction in mild-to-moderate glaucoma. However, longer-term data is key to the decision making in the selection of a surgical treatment. This GEMINI extension demonstrates that the 12-month outcomes from GEMINI were sustained through 36 months.
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Affiliation(s)
| | | | | | | | | | - Jaime E Dickerson
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - On behalf of the GEMINI 2 STUDY GROUP
- Vance Thompson Vision, West Fargo, ND, USA
- Omni Eye Services, Atlanta, GA, USA
- Ophthalmology Associates, Fort Worth, TX, USA
- Oklahoma Eye Surgeons, Oklahoma City, OK, USA
- Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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Garweg RA, Pfister IB, Schild C, Halberstadt M, Straessle K, Anastasi S, Garweg JG. IOP-lowering and drug-sparing effects of trabectome surgery with or without cyclodialysis ab interno. Graefes Arch Clin Exp Ophthalmol 2023; 261:2917-2925. [PMID: 37145333 DOI: 10.1007/s00417-023-06063-8] [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: 11/09/2022] [Revised: 03/27/2023] [Accepted: 04/05/2023] [Indexed: 05/06/2023] Open
Abstract
PURPOSE To compare the postoperative intraocular pressure (IOP) after ab interno trabeculectomy (AIT; trabectome surgery) alone or combined with cyclodialysis ab interno (AITC). PATIENTS AND METHODS Forty-three eyes with insufficiently controlled open-angle glaucoma were included in this consecutive case series. All eyes received AIT, combined with phacoemulsification and IOL-implantation in phakic instances, with or without additional cyclodialysis ab interno. Postoperative visual acuity, IOP, number of IOP-lowering medications and complications were registered over 12 months. RESULTS A total of 19 eyes (14 patients) received AIT and 24 (19 patients) received AITC. Both groups were comparable for baseline IOP (AIT: 19.7 ± 8.2 mmHg; AITC: 19.4 ± 6.8 mmHg; p = 0.96), there was a comparable IOP reduction after 6 months (AIT: - 3.8 ± 12.3, median (interquartile range (IQR)): - 3.8 (- 7.8-4.8) mmHg; AITC: - 4.9 ± 8.3, median (IQR): - 2.0 (- 10.8-2.0) mmHg; p = 0.95) and 12 months (AIT: - 4.3 ± 6.6, median (IQR): - 4.0 (- 8.0 to - 1.0) mmHg; AITC: - 3.7 ± 6.7, median (IQR): - 1.5 (- 5.5 to - 0.5) mmHg; p = 0.49). While final visual acuity was similar between the groups, they differed regarding topical IOP-lowering medications (baseline: AIT 2.9 ± 1.2 and AITC 2.9 ± 1.2; 1 year after surgery: AIT 2.6 ± 1.5 (p = 0.16) and AITC 1.3 ± 1.3; p < 0.001)). Depending on the definition, a complete or qualified success of 33.4-45.8% was achieved in AITC compared to 15.8-21.1% in AIT. CONCLUSION The additional suprachoroidal outflow when AIT is combined with cyclodialysis ab interno (AITC) seems to result in an additional drug sparing effect for at least 1 year without critical safety signals. Thus, AITC might be further investigated prospectively prior to advocating its use in routine minimally invasive glaucoma surgery.
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Affiliation(s)
- Richard A Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
- Department of Ophthalmology, University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Christin Schild
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | | | - Kim Straessle
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Stefano Anastasi
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland
- Swiss Eye Institute, Rotkreuz, Switzerland
| | - Justus G Garweg
- Berner Augenklinik, Zieglerstrasse 29, CH-3007, Bern, Switzerland.
- Swiss Eye Institute, Rotkreuz, Switzerland.
- Department of Ophthalmology, University of Bern, Bern, Switzerland.
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Gołaszewska K, Obuchowska I, Konopińska J. First-Generation iStent Bypass Implantation versus ab Externo Canaloplasty Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-12-Month Follow-Up. J Clin Med 2023; 12:5711. [PMID: 37685778 PMCID: PMC10488869 DOI: 10.3390/jcm12175711] [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: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This prospective, non-randomized, interventional clinical study evaluated the efficacy and safety profile of first-generation iStent bypass implantation versus ab externo canaloplasty, both combined with phacoemulsification, in patients with primary open-angle glaucoma (POAG) after 12-month follow-up. A total of 138 patients with POAG and their 138 eyes (69 phaco-iStent and 69 phacocanaloplasty) were included. Postoperatively at 12 months, the mean intraocular pressure (IOP) decreased from 18.44 ± 3.88 to 15.51 ± 2.50 mmHg and from 17.20 ± 4.04 to 14.97 ± 2.37 mmHg in the phaco-iStent (PiS) and phacocanaloplasty (PC) groups, respectively (p = 0.480). In both groups, 35.7% achieved >20% IOP reduction from baseline. A total of 86% and 71.4% of the eyes were medication-free at 12 months in the PiS and PC groups, respectively. In both groups, all eyes showed improvement in best-corrected visual acuity compared with baseline and demonstrated similar safety profiles throughout the 12-month follow-up period. This study showed equal hypotensive effects of PiS and PC. Both procedures significantly reduced the IOP and the requirement for IOP-lowering medications for at least 12 months postoperatively, with no significant differences between the groups.
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Affiliation(s)
| | | | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, 15-089 Białystok, Poland; (K.G.); (I.O.)
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11
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Dickinson A, Leidy L, Nusair O, Mihailovic A, Ramulu P, Yohannan J, Johnson TV, Kaleem M, Rachapudi S, An J. Short-Term Outcomes of Hydrus Microstent With and Without Additional Canaloplasty During Cataract Surgery. J Glaucoma 2023; 32:769-776. [PMID: 37310992 DOI: 10.1097/ijg.0000000000002245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/06/2023] [Indexed: 06/15/2023]
Abstract
PRCIS Compared with phacoemulsification and microstent alone, we observed that phacoemulsification with combined microstent and canaloplasty resulted in a significantly greater reduction in glaucoma medications while maintaining similar rates of intraocular pressure reduction and low complications. PURPOSE The purpose of this study was to compare the outcomes of phacoemulsification combined with Hydrus Microstent (Alcon Inc.) implantation alone or in combination with canaloplasty (OMNI Surgical System, Sight Sciences Inc.). MATERIALS AND METHODS Retrospective study of mild-to-moderate primary open angle glaucoma patients who underwent phacoemulsification with microstent alone (42 eyes of 42 patients) or in combination with canaloplasty (canaloplasty-microstent, 32 eyes of 32 patients). The mean number of ocular hypotensive medications and intraocular pressure were assessed preoperatively and postoperatively at 1 week and at 1, 3, and 6 months. Complications and secondary surgical interventions were recorded. Outcomes measures included the percentage of unmedicated eyes and surgical success at 6 months. Surgical success was defined as reaching the target intraocular pressure without medications or secondary surgical interventions. RESULTS Mean intraocular pressure at 6 months was 14.1±3.5 mm Hg (13% reduction) after microstent alone and 13.6±3.1 mm Hg (17% reduction) after canaloplasty-microstent. Mean medications at 6 months were 0.57±0.9 (67% reduction) after microstent alone and 0.16±0.4 (88% reduction) after canaloplasty-microstent ( P< 0.05). At 6 months, 64.3% of microstent alone and 87.3% of canaloplasty-microstent were off all medications ( P =0.02). Success probabilities at 6 months were 44.5% for microstent alone and 70.0% for canaloplasty-microstent ( P =0.04). No secondary surgical interventions occurred in either group. CONCLUSIONS Microstent combined with canaloplasty resulted in a significantly higher rate of medication-free status compared with microstent alone through 6 months.
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Affiliation(s)
- Anna Dickinson
- Eastern Virginia Medical School, Norfolk, VA
- Johns Hopkins University School of Medicine
| | - Luke Leidy
- Eastern Virginia Medical School, Norfolk, VA
- Johns Hopkins University School of Medicine
| | - Omar Nusair
- Johns Hopkins University School of Medicine
- Northeast Ohio Medical University, Rootstown, OH
| | - Aleksandra Mihailovic
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Pradeep Ramulu
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Jithin Yohannan
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Thomas V Johnson
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Mona Kaleem
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
| | - Sruti Rachapudi
- Johns Hopkins University School of Medicine
- University of Texas Medical Branch School of Medicine, Galveston, TX
| | - Jella An
- Johns Hopkins University School of Medicine
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University Faculty of Medicine, Baltimore, MD
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12
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Yadgarov A, Dentice K, Aljabi Q. Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:2609-2617. [PMID: 37674592 PMCID: PMC10478966 DOI: 10.2147/opth.s422132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Patients and Methods Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Results Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Conclusion Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.
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13
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Klabe K, Rüfer F. [Minimally invasive glaucoma surgery-Comparison of angle based procedures]. DIE OPHTHALMOLOGIE 2023; 120:358-371. [PMID: 37010578 DOI: 10.1007/s00347-023-01844-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
Surgical procedures are playing an increasing role in the care of patients with glaucoma. Within the last decade, new surgical procedures have been established, which are summarized under the term minimally invasive glaucoma surgery (MIGS). A wide variety of different procedures are aimed at the structures in the angle of the anterior chamber, such as the trabecular meshwork and Schlemm's canal, to improve the physiological outflow or to improve the alternative uveoscleral outflow. The implementation of the treatment goal differs in the individual procedures, as does the maximum pressure reduction that can be achieved. Compared to trabeculectomy with the use of cytostatic agents, the achievable pressure reduction is usually significantly lower. In contrast, the significantly lower intraoperative and postoperative complication rates are emphasized as an advantage of these procedures. With increasing clinical experience and the growth of sufficient data on these new surgical procedures, a well-founded classification in the treatment algorithm of glaucoma surgery becomes easier; nevertheless, due to the small differences with respect to efficacy and safety profile, the final decision for an individual procedure often remains dependent on the surgeon's personal preferences.
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Affiliation(s)
- Karsten Klabe
- Breyer Kaymak Klabe Augenchirurgie, Martin-Luther-Platz 22, 40212, Düsseldorf, Deutschland.
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14
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Longo R, Ghinelli F, Torelli F, Mader G, Masseria C, Patel C, Franic DM, Dickerson J, Nguyen D, Cantor L. OMNI® surgical system versus iStent inject® with concomitant cataract surgery for the treatment of mild-to-moderate primary open-angle glaucoma in the United States: a cost utility analysis. EXPERT REVIEW OF OPHTHALMOLOGY 2023. [DOI: 10.1080/17469899.2023.2193685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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15
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Canaloplasty and trabeculotomy with the OMNI® surgical system in OAG with prior trabecular microbypass stenting. Int Ophthalmol 2022; 43:1647-1656. [PMID: 36229561 PMCID: PMC10149460 DOI: 10.1007/s10792-022-02553-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/07/2022] [Indexed: 10/17/2022]
Abstract
Abstract
Purpose
Evaluate effectiveness and safety outcomes for patients treated with canaloplasty and trabeculotomy previously treated with a trabecular microbypass stent (TBS).
Methods
Retrospective, multicenter, IRB approved study. Patients treated with TBS (iStent/iStent inject, Glaukos) and subsequently with OMNI surgical system (OSS) (Sight Sciences). From 5 practices in 5 US states. Open-angle glaucoma (OAG), minimum 3 months follow-up after OSS surgery, Pre-OSS IOP ≥ 17 mmHg on ≥ 1 medication. No glaucoma procedures between TBS and OSS. Endpoints: proportion with ≥ 20% reduction in IOP, IOP between 6 and 18 mmHg, mean IOP, change in IOP, mean number of medications. Adverse events and secondary surgical interventions (SSI). Mann–Whitney rank sum test compared pre-OSS IOP and medications with follow-up.
Results
Twenty seven patients. Average age (SD) 72.2 (10.8), 22/27 primary OAG (82%), mean MD − 6.2 (7.0) dB. Mean IOP before OSS 22.3 (4.3) mmHg on 2.2 (1.3) medications. At last follow-up (mean 11 months) IOP was 17.2 mmHg on 1.8 medications, − 5.1 mmHg (− 23%, p < .001), − 0.4 meds (− 18%, p = .193); ≥ 20% IOP reduction (41%), IOP ≤ 18 (56%). Adverse events were non-serious. Hyphema > 1 mm (3, 11%), BCVA decrease (4, 15%), IOP spike (2, 7%). SSI (4, 15%) had higher pre-OSS IOP (23.4 mmHg) and worse MD (− 9.6 dB).
Conclusion
Patients uncontrolled by medication and a prior TBS would once have been candidates for trabeculectomy and tube shunts. OSS offered a minimally invasive option that provided IOP control and avoidance of traditional surgery for the majority over follow-up averaging 11 months and up to 42 months.
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16
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Novack GD. Eyes on New Product Development. J Ocul Pharmacol Ther 2022; 38:469-470. [PMID: 35925754 DOI: 10.1089/jop.2022.29094.gdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, California, USA.,Department of Ophthalmology, University of California, Davis, School of Medicine, Sacramento, California, USA
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17
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Murphy III JT, Terveen DC, Aminlari AE, Dhamdhere K, Dickerson Jr JE. A Multicenter 12-Month Retrospective Evaluation of Canaloplasty and Trabeculotomy in Patients with Open-Angle Glaucoma: The ROMEO 2 Study. Clin Ophthalmol 2022; 16:3043-3052. [PMID: 36128338 PMCID: PMC9482782 DOI: 10.2147/opth.s384105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose Twelve-month safety and effectiveness results for canaloplasty combined with trabeculotomy using the OMNI surgical system in pseudophakic eyes or combined with cataract surgery in mild-to-moderate open-angle glaucoma (OAG). Setting Sixteen centers in 11 US states (AL, AR, CA, CT, KS, LA, MO, NY, SD, TN, TX). Design Retrospective, case series, open-label. Methods A total of 136 eligible patients from 20 surgeons: mild-to-moderate OAG (visual field mean deviation (MD) not worse than −12 dB), 12-month follow-up, preoperative medicated IOP >18 mmHg and ≤36 mmHg on ≤5 medications. One eye per patient enrolled. Endpoints included proportion with ≥20% reduction in IOP or IOP between 6 and 18 mmHg (inclusive) and on the same or fewer medications without secondary surgical intervention (SSI) (primary success), mean IOP, change in IOP, ocular hypotensive medication use, and proportion of patients with a 20% or greater reduction in IOP at 12 months. Safety: adverse events (AE) and best corrected visual acuity (BCVA). Results Primary success was met by 71%. Mean IOP was reduced (22.3–15.9 mmHg, p < 0.0001). Medications went from 1.9 ± 1.3 to 1.3 ± 1.2 (p < 0.001). AE were mild and as expected for angle surgery. The most frequent AE were BCVA loss (6%), mild inflammation (4%), IOP elevation (3%), and clinically significant hyphema (3%). There were 4 (3%) SSI. Conclusion The OMNI system provides effective IOP reduction, sustained IOP control, and meaningful medication reduction for up to 12 months postoperative. The present study confirms and extends the results from ROMEO.
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Affiliation(s)
| | | | | | - Kavita Dhamdhere
- Clinical Research, Sight Sciences, Menlo Park, CA, USA
- Mahatma Gandhi Medical College and Research Center, Wardha, India
| | - Jaime E Dickerson Jr
- Clinical Research, Sight Sciences, Menlo Park, CA, USA
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
- Correspondence: Jaime E Dickerson Jr, Email
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18
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Novack GD, Williams KD. The genus decision: Potential impact on ophthalmic pharmaceuticals. Ocul Surf 2022; 26:342-344. [PMID: 35985608 DOI: 10.1016/j.jtos.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Gary D Novack
- Department of Ophthalmology & Visual Sciences, University of California, Davis, USA; PharmaLogic Development Inc., San Rafael, CA, USA.
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Novack GD. Eyes on New Product Development: Long-Acting Ocular Drug Delivery Technologies Addressing Unmet Needs in Ophthalmology. J Ocul Pharmacol Ther 2022; 38:373-375. [PMID: 35763404 DOI: 10.1089/jop.2022.29093.gdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gary D Novack
- PharmaLogic Development, Inc., San Rafael, California, USA.,Department of Ophthalmology, University of California, Davis, School of Medicine, Sacramento, California, USA
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20
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Beres H, Scharioth GB. Canaloplasty in the spotlight: surgical alternatives and future perspectives. Rom J Ophthalmol 2022; 66:225-232. [PMID: 36349177 PMCID: PMC9585494 DOI: 10.22336/rjo.2022.44] [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] [Accepted: 09/15/2022] [Indexed: 11/21/2022] Open
Abstract
The modern glaucoma surgeon is faced with many surgical alternatives for the management of glaucoma. In recent years, numerous techniques that make Schlemm's canal (SC) more accessible for surgery by being less invasive and surgically less challenging were introduced. Since its first introduction, canaloplasty has become a well-established method of glaucoma surgery. The aim of this paper was to present an overview of canaloplasty and its modifications, and to highlight their strong points and potential drawbacks based on available data on the effectiveness of each technique. Furthermore, it offered an overview of the development of canaloplasty over time and the clinical aspects that should be considered in patient selection. Abbreviations: ABiC = Canaloplasty ab interno, AH = aqueous humour, CSD = Canaloplasty with suprachoroidal drainage, IOP = intraocular pressure, MIGS = minimally invasive glaucoma surgery, OAG = open angle glaucoma, PEXG = pseudoexfoliation glaucoma, SC = Schlemm's canal, TDM = trabeculo-Descemet's membrane.
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Affiliation(s)
- Hanga Beres
- Aurelios Augenzentrum Recklinghausen, Germany
,“George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureş, Romania
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