Development and Application of a New T-shaped Internal Trabeculotomy Hook (T-hook)

Consequences of Clot Formation and Hyphema Post-Internal Trabeculotomy for Glaucoma

PRCIS

Clot formation and hyphema following internal trabeculotomy represent distinct clinical entities. The eyes with clot formation exhibited a more pronounced postsurgical intraocular pressure spike, longer residual intracameral bleeding, and a higher risk of reoperation.

PURPOSE

The aim of this study was to investigate the consequences of clot formation and hyphema in the anterior chamber after internal trabeculotomy.

MATERIALS AND METHODS

In this retrospective interventional comparative study, we investigated the surgical outcomes of internal trabeculotomy in 142 eyes of 142 patients at Sensho-kai Eye Institute.

RESULTS

Concurrent clot formation and L≥2 hyphema (height of hyphema ≥1 mm) was observed in 22 eyes. In these cases, the postsurgical IOP was 29.3 mm Hg at 1 week, significantly higher than the 16.1 mm Hg in eyes that had L≥2 hyphema but without clot formation ( P =0.0002). However, the 1-week postsurgical IOP in L≥2 hyphema and clot (-) eyes, which measured 16.1 mm Hg was not significantly greater than that in L<2 hyphema and clot (-) eyes, which measured 18.7 mm Hg ( P =0.162). Thus, clot formation was identified as a significant factor contributing to high postsurgical IOP at 1 week. The resolution time for anterior chamber bleeding in eyes with concurrent clot formation and L≥2 hyphema was 12.3 days, longer than the 5.8 days observed in L≥2 hyphema eyes without clot formation ( P =0.016). Among the 22 eyes with concurrent L≥2 hyphema and clot formation, 8 required anterior chamber washout. Three of the 10 eyes that underwent washout necessitated additional trabeculectomy, a rate significantly higher than that in nonwashout eyes ( P <0.001).

CONCLUSIONS

After internal trabeculotomy, the sequelae of concurrent clot formation and L≥2 hyphema in the anterior chamber were more severe than those of simple hyphema without clots. Clot formation negatively affected postoperative IOP.

Trends in the National Ophthalmological Healthcare Focusing on Cataract, Retina, and Glaucoma Over 15 Years in Japan

To assess the trends in ophthalmic healthcare, especially those of cataract, vitreo-retinal diseases, and glaucoma, the national data from the Japanese Ministry of Health, Labour and Welfare, which recorded medical practices for 126.1 million citizens, were studied for 15 years. The volume and expenses of cataract surgeries increased during this period; however, non-surgical expenses decreased. As a result, the total national cataract healthcare expenses decreased over the 15-year period. The volume of vitrectomies increased from 2007 to 2013. After introduction of anti-vascular endothelial growth factor (VEGF) injections, the number of injections increased 8.4 times from 2010 to 2021, while the volume of vitrectomy and retinal photocoagulation declined after 2019 and 2017, respectively. Minimally invasive glaucoma and long-tube shunt surgeries began to increase in 2015 and 2014, respectively. This trend contrasts with the decrease in trabeculectomies after 2019. The coronavirus disease-19 pandemic caused a 30.9% decrease in ophthalmological surgery expenses in 2020. The decreases in volume and expense were greater for cataract surgeries than for other surgeries. The pandemic had a stronger impact on ophthalmological healthcare than that on general medical healthcare. Advancements in technology and methodology have led to cost savings in national cataract healthcare, vitrectomy, and retinal photocoagulation while caused increase in the volume and expenditure of glaucoma surgeries and anti-VEGF injections over a span of 15 years in Japan.

Outcomes and risk factors for Kahook Dual Blade excisional goniotomy with concomitant phacoemulsification: a multicentre Canadian study

OBJECTIVE

To assess the outcomes and failure risk factors for Kahook Dual Blade (KDB) excisional goniotomy with cataract surgery (phaco-KDB) in eyes with various glaucoma subtypes and severities.

METHODS

This multisurgeon consecutive case series included glaucomatous eyes with cataract that underwent phaco-KDB and had a minimum follow-up of 12 months postoperatively. Efficacy was assessed by absolute and qualified surgical success (defined by different criteria) and changes in intraocular pressure (IOP) and antiglaucoma medication (AGM) at the last postoperative follow-up. Safety included best-corrected visual acuity, cup-to-disc ratio, visual field mean deviation, retinal nerve fibre layer thickness, and adverse events.

RESULTS

A total of 108 eyes of 89 patients with a median follow-up of 18 months (range, 12-47 months) were included. IOP decreased by 26% from 19.1 ± 5.0 mm Hg to 14.1 ± 3.5 mm Hg (p < 0.001), AGM use decreased by 29% from 2.4 ± 1.3 medications to 1.7 ± 1.3 (p < 0.001), and 25% of eyes became free of AGMs (vs 3% at baseline). Qualified success rates achieved for IOP cutoffs of 18, 15, and 12 mm Hg were 87%, 68%, and 46%, respectively. Higher baseline IOP and postoperative incidence of IOP spikes were associated with a higher risk of surgical failure. Best-corrected visual acuity improved postoperatively (p < 0.001), and visual field mean deviation, cup-to-disc ratio, and retinal nerve fibre layer thickness remained stable. Overall, safety was favourable, and adverse events were transient and not sight threatening.

CONCLUSION

This multicentre Canadian study provides real-world data that support the safety and efficacy of phaco-KDB in reducing IOP and AGM use with no evidence of disease progression during the follow-up period.