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El Sayed YM, Mettias NM, Elghonemy HME, Mostafa YSE. Phacoemulsification with gonioscopy-assisted transluminal trabeculotomy versus phacoemulsification alone in primary angle closure glaucoma: A randomized controlled study. Acta Ophthalmol 2024; 102:e195-e203. [PMID: 37435985 DOI: 10.1111/aos.15733] [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: 01/05/2023] [Revised: 05/26/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE To assess the safety and efficacy of combining phacoemulsification with gonioscopy-assisted transluminal trabeculotomy (GATT) compared to phacoemulsification alone in the management of primary angle closure glaucoma (PACG). METHODS Prospective, institutional study in which eyes requiring surgery for PACG were randomized to undergo phacoemulsification followed by GATT (phaco-GATT group) or phacoemulsification alone. Success was defined as having a final IOP of 6-20 mmHg with no subsequent glaucoma surgery or vision-threatening complications. RESULTS Thirty-six eyes underwent phaco-GATT with 360° angle incision and 38 eyes underwent phacoemulsification alone. IOP and glaucoma medications were significantly lower in the phaco-GATT group at 1, 3, 6, 9 and 12 months. The success rate in the phaco-GATT group was 94.4% after 12.16 ± 2.03 months, with 75% of eyes being off medications compared to 86.8% after 12.47 ± 4.27 months in the phaco group, with 42.1% off medications. (p = 0.008). Hyphema and fibrinous anterior chamber reaction were the most common complications in the phaco-GATT group and resolved with conservative treatment or required YAG capsulotomy. Although this delayed visual rehabilitation in the phaco-GATT group, it did not affect the final visual outcome with no significant difference in the final best-corrected visual acuity between both groups (p = 0.25). CONCLUSION Combining phacoemulsification with GATT in PACG yielded more favourable outcomes in terms of IOP, glaucoma medications and surgical success. Although the postoperative hyphema and fibrinous reaction may delay visual rehabilitation, GATT further lowers the IOP by breaking residual peripheral anterior synechiae and removing the dysfunctional trabeculum circumferentially, while avoiding the risks inherent in more invasive filtering procedures.
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Song Y, Zhang H, Zhang Y, Tang G, Wan KH, Lee JWY, Congdon N, Zhang M, He M, Tham CC, Leung CKS, Weinreb RN, Lam DSC, Zhang X. Minimally Invasive Glaucoma Surgery in Primary Angle-Closure Glaucoma. Asia Pac J Ophthalmol (Phila) 2022; 11:460-469. [PMID: 36179337 DOI: 10.1097/apo.0000000000000561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/24/2022] [Indexed: 02/05/2023] Open
Abstract
Primary angle-closure glaucoma (PACG) is responsible for half of the glaucoma-related blindness worldwide. Cataract surgery with or without trabeculectomy has been considered to be the first-line treatment in eyes with medically uncontrolled PACG. While minimally invasive glaucoma surgery has become an important surgical approach for primary open-angle glaucoma, its indications and benefits in PACG are less clear. This review summarizes the efficacy and safety profile of minimally invasive glaucoma surgery in PACG to unfold new insights into the surgical management of PACG.
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Affiliation(s)
- Yunhe Song
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Yingzhe Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei, China
| | - Kelvin H Wan
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, China
| | - Jacky W Y Lee
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Nathan Congdon
- Orbis International, New York, NY
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou University Medical College, Shantou, Guangdong, China
| | - Mingguang He
- Centre for Eye Research Australia Ltd, University of Melbourne, Australia
| | - Clement C Tham
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment And Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, The Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla
| | - Dennis S C Lam
- C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
- C-MER International Eye Research Center of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Dai Q, Fu L, Liu XY, Pan WH. Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation: phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis. Int J Ophthalmol 2021; 14:1548-1552. [PMID: 34667731 DOI: 10.18240/ijo.2021.10.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis (Phaco-CTR-IOL-OE-GSL) for treating secondary angle-closure glaucoma induced by traumatic lens subluxation. METHODS A retrospective and descriptive study was performed on patients with lens subluxation, angle closure, goniosynechia, and evaluated intraocular pressure (IOP) that cannot be controlled with medication, who underwent Phaco-CTR-IOL-OE-GSL. The postoperative best-corrected visual acuity (BCVA), IOP, range of goniosynechia and complications were retrospectively observed. RESULTS Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included. The follow-up period was 51.1±8.6mo. The preoperative range of zonule rupture was 158.2°±33.0°, and the range of goniosynechia was 220.0°±92.5°. The baseline BCVA was 0.9±1.0 logMAR, IOP was 30.7±17.3 mm Hg, and number of anti-glaucoma medication was 3.2±1.1. Mild intraoperative hyphaemia with 8 eyes (88.8%) in the anterior chamber, and was absorbed two days postoperatively. One eye (11.1%) had postoperative ciliary body detachment and was recovered after five days of topical drug treatment. BCVA was 0.2±0.2 logMAR at 3mo postoperatively. The average IOP at the last follow-up was 16.7±2.0 mm Hg, and no anti-glaucoma medications were used. The average range of recurrent goniosynechia was 54.9°±33° at the final postoperative gonioscopic examination. CONCLUSION Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation. The use of an endoscope provides a more direct and clear examination for GSL, and 360° dissection is easily achieved.
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Affiliation(s)
- Qi Dai
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Lin Fu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xin-Yi Liu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Wei-Hua Pan
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Long-term outcomes of trabeculectomy with ologen implant versus combined viscotrabeculotomy-synechiolysis in uncontrolled uveitic glaucoma. Int Ophthalmol 2021; 42:411-421. [PMID: 34609670 DOI: 10.1007/s10792-021-02057-9] [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: 04/18/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare trabeculectomy with Ologen implant(Trab-Ologen) to combined viscotrabeculotomy-synechiolysis(VTS) in uncontrolled uveitic glaucoma (UG). PATIENTS AND METHODS A retrospective chart review of 47 patients subjected to VTS(24 eyes) or Trab-ologen(23 eyes) at Mansoura Ophthalmic Center between 2010 and 2016. The patients were evaluated on day 1, week 1, months 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48. RESULTS The mean ± standard deviation age of patients in the Trab-ologen and VST groups were 38.29 ± 12.5 and 38.91 ± 11.8 years (p = 0.86), respectively. Juvenile Idiopathic arthritis (controlled on methotrexate) was the most common associated systemic disease (3 patients in each group). The mean ± standard deviation of the intraocular pressure (IOP) and IOP-lowering medications preoperatively and at the end of follow up in the Trab-ologen and VST groups were 33.1 ± 2.6 mmHg, 33.2 ± 2.6 mmHg (p = 0.91), 3.4 ± 0.5, 3.4 ± 0.5 (0.90) and 15.4 ± 1.2 mmHg, 13.0 ± 0.9 mmHg (p < 0.001), 0.6 ± 1.1, 0.7 ± 1.2 (p = 0.72), respectively. IOP control was better in the Trab-ologen group till the 30th month when it becomes better in the VST group till the end of follow-up. The most notable complication was a minimal self-limiting hyphema in the VST group. Success rates at the end of follow-up in the Trab-ologen and VST groups were 83% and 78%, respectively. CONCLUSIONS Trabeculectomy with ologen implant and visco-trabeculotomy-synechiolysis were equally effective in lowering IOP in uncontrolled UG. There was no statistically significant difference in the success rates between the 2 procedures.
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Otori Y, Matsuoka T, Kumoi M, Tachibana E, Tsujino C, Matsuda S. Comparison of Surgical Outcomes Between Ab Interno Suture Trabeculotomy and Ab Externo Metal Trabeculotomy in Adult Patients with Glaucoma. Clin Ophthalmol 2021; 15:3213-3220. [PMID: 34354340 PMCID: PMC8331082 DOI: 10.2147/opth.s322166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 07/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the outcomes of ab interno suture trabeculotomy (AbI-TLO) and ab externo metal trabeculotomy (AbE-TLO) in adult patients with glaucoma aged over 40 years. Patients and Methods A retrospective chart review was conducted, including adult patients with glaucoma who underwent AbI-TLO or AbE-TLO between January 2015 and June 2019. A single surgeon (YO) performed all the operations. Eighty-one patients (81 eyes) were included in this study. Surgical success was defined as a postoperative intraocular pressure (IOP) of ≤18 mmHg and an IOP reduction of ≥20% from the preoperative IOP, without requiring additional glaucoma surgery. Success rates were assessed using Kaplan-Meier survival curves and log-rank (Mantel-Cox) tests, while risk factors were analyzed using the Cox proportional hazards model. Results Forty-nine patients who underwent AbI-TLO and 32 patients who underwent AbE-TLO were studied; the preoperative IOPs were 27.9 ± 7.3 (mean ± standard deviation) mmHg and 25.6 ± 8.1 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.217). The 12-month postoperative IOPs were 15.8 ± 4.0 mmHg and 16.3 ± 4.2 mmHg in the AbI-TLO and AbE-TLO groups, respectively (p=0.724). The surgical success rates at 12 months were 77.6% and 62.5% in the AbI-TLO and AbE-TLO groups, respectively (p=0.144). Postoperative hyphema with level formation and ocular hypertension over 30 mmHg were observed in 22.4% and 26.5% of patients in the AbI-TLO group and 18.8% and 12.5% of those in the AbE-TLO group, respectively. Stepwise multivariate Cox regression analysis showed that a longer axial length was a risk factor for surgical failure (hazard ratio: 2.030; p=0.042). Conclusion AbI-TLO and AbE-TLO had similar surgical outcomes and postoperative complications. A longer axial length was associated with an insufficient IOP reduction.
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Affiliation(s)
- Yasumasa Otori
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Takanori Matsuoka
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Miho Kumoi
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Eri Tachibana
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Chieko Tsujino
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Satoshi Matsuda
- Department of Ophthalmology, National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Phacoemulsification with Goniosynechialysis versus Phacoemulsification Alone in Angle-Closure Glaucoma: A Meta-Analysis of Randomized Controlled Trials. J Ophthalmol 2021; 2021:8831479. [PMID: 33628481 PMCID: PMC7899770 DOI: 10.1155/2021/8831479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose This meta-analysis aimed to compare the efficacy and safety of phacoemulsification with goniosynechialysis (Phaco-GSL) with those of phacoemulsification alone (Phaco-alone) in patients with angle-closure glaucoma and cataract. Methods Randomized controlled trials (RCTs) were selected through a search of electronic databases. Trial eligibility and risk of bias were assessed using Cochrane review methods. Primary measures included the intraocular pressure (IOP), number of antiglaucoma medications, peripheral anterior adhesion (PAS) extent, and their pre- and postoperative changes. For continuous parameters, we calculated weighted mean differences and 95% confidence intervals. Statistical analysis was performed using RevMan 5.3 software. Results Eight RCTs were included, where 224 and 236 eyes were in the Phaco-GSL and Phaco-alone groups, respectively. Both postoperative IOP and number of medications were not significantly different between the study groups at the six- and twelve-month follow-up. However, the 12-month postoperative PAS extent was significantly smaller in the Phaco-GSL group than in the Phaco-alone group. Similarly, changes from the preoperative to 12-month postoperative PAS extent were significantly greater in the Phaco-GSL group than in the Phaco-alone group, but IOP and the number of medication changes were not different. Conclusions Our results provide evidence that Phaco-GSL provides advantages over Phaco-alone treatment regarding PAS reduction. In terms of IOP and medication reduction, both groups were comparable. Thus, Phaco-GSL can be considered for the treatment of patients with angle-closure glaucoma and cataract due to its ease, safety, and potential benefit for the anterior chamber angle.
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Costa VP, Leung CK, Kook MS, Lin SC, Al-Aswad LA, Araie M, Baudouin C, Coupal DJ, Fechtner R, Tee Khaw P, Khaderi KR, Khawaja A, Mattox C, Miller-Ellis E, Nagori S, Olivier M, Pfeiffer N, Serle J, Stalmans I, Varma DK. Clear lens extraction in eyes with primary angle closure and primary angle-closure glaucoma. Surv Ophthalmol 2020; 65:662-674. [DOI: 10.1016/j.survophthal.2020.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
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Elwehidy AS, Bayoumi NH, Badawi AE, Hagras SM, Kamel R. Combined phacoemulsification-viscosynechialysis-trabeculotomy vs phacotrabeculectomy in uncontrolled primary angle-closure glaucoma with cataract. J Cataract Refract Surg 2019; 45:1738-1745. [DOI: 10.1016/j.jcrs.2019.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 10/25/2022]
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Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined With Phacoemulsification for Angle-closure Glaucoma. J Glaucoma 2019; 28:643-646. [DOI: 10.1097/ijg.0000000000001256] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Razeghinejad MR, Myers JS. Contemporary approach to the diagnosis and management of primary angle-closure disease. Surv Ophthalmol 2018; 63:754-768. [PMID: 29777727 DOI: 10.1016/j.survophthal.2018.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
The primary angle-closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that, in many patients, the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle-closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle-closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand-alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management.
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Affiliation(s)
- M Reza Razeghinejad
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA; Poostchi Ophthalmology Research Center, Shiraz University of Medcial Sciences, Shiraz, Iran.
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
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Anterior Chamber Angle Assessment by Anterior-segment Optical Coherence Tomography After Phacoemulsification With or Without Goniosynechialysis in Patients With Primary Angle Closure Glaucoma. J Glaucoma 2016; 24:647-55. [PMID: 24844542 DOI: 10.1097/ijg.0000000000000061] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate changes of anterior chamber angle (ACA) by anterior-segment optical coherence tomography (AS-OCT) in patients with primary angle closure glaucoma (PACG) following phacoemulsification (phaco) with or without goniosynechialysis (GSL). METHODS Patients with PACG recruited into 2 randomized controlled trials comparing phaco-GSL versus phaco were pooled for analysis. Images of ACA were obtained by AS-OCT before surgery, and at 1 and 2 weeks, and 1, 3, and 6 months after surgery. The following parameters were analyzed: angle opening distance (AOD) at 500 and 750 μm from the scleral spur, trabecular-iris space area (TISA) at 500 and 750 μm, angle recess area (ARA) at 500 and 750 μm, and scleral spur angle (SSA). RESULTS All parameters of ACA increased significantly after phaco-GSL (P<0.001), whereas no increase occurred in the phaco group. Negatively significant correlations were found in ΔAOD500 (P<0.05), ΔARA750 (P<0.05), ΔTISA500 (P<0.05), and ΔTISA750 (P<0.05) at 1, 3, and 6 months, and ΔSSA (P<0.05) at 3 and 6 months after phaco-GSL against Δ intraocular pressure (IOP). In the phaco-GSL group, 23 of 23 eyes had IOP<21 mm Hg without any antiglaucoma medication postoperatively. In the phaco group, 12 of 20 eyes (60%) had IOP<21 mm Hg without medication, 8 of 20 eyes required medication with IOP<21 mm Hg (15%) and uncontrollable IOP (25%) after surgery. CONCLUSIONS On AS-OCT evaluation, ACA in eyes with PACG opened and widened significantly after phaco-GSL in our study. It is suggested that ΔAOD500, ΔARA750, ΔTISA500, ΔTISA750, and ΔSSA would provide valuable information to estimate the effectiveness of phaco-GSL.
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Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015; 9:6-11. [PMID: 26997825 PMCID: PMC4741140 DOI: 10.5005/jp-journals-10008-1175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 12/30/2014] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the ability of phacoemulsification combined with either primary trabeculectomy (PT) or primary Ahmed glaucoma valve implantation (PAVI) to achieve target intraocular pressures (TIOP) in adults with primary open angle glaucoma. MATERIALS AND METHODS Chart review of 214 adult patients operated between January 2002 and June 2008 with a minimum follow-up of 6 months. Group 1 comprised 181 eyes of 166 patients undergoing PT while group 2 included 50 eyes of 49 patients in combination with primary AVI. Target lOPs were pre-determined for each patient and success was defined as an IOP at or lower than target with or without medications. An IOP above target, loss of light perception or need for additional procedures to lower IOP were considered a failure. RESULTS Mean preoperative IOP was 17.2 mm Hg in group 1 and 17.3 in group 2. Mean postoperative IOPs were 10.2 and 9.2 on day 1, 12.2 and 11.6 at year 1, and 10.7 in both groups at year 5. Survival rates in groups 1 and 2 were 96.7 vs 96% at 6 months, 89 vs 96% at 12 months, 83.5 vs 96% at 24 months and 79.4 vs 89.1% at 36, 48 and 72 months. Transient bleb leaks were more frequent in group 1 (26 eyes, 14.4 vs 0%, p = 0.001) and transient choroidal detachments were more frequent in group 2 (7 eyes, 3.9 vs 6 eyes, 12%, p = 0.038). CONCLUSION Midterm results for achieving target pressures using combined phacoemulsification with either PT or PAVI are comparable. The profile of complications is different for the two procedures. How to cite this article: Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015;9(1):6-11.
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Affiliation(s)
- Oscar Albis-Donado
- Department of Glaucoma, Mexican Institute of Ophthalmology Queretaro, Mexico
| | | | - Lorena Cárdenas-Gómez
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
| | - Rafael Castañeda-Diez
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
| | - Ravi Thomas
- Department of Glaucoma, Cataract, Clinical Epidemiology Queensland Eye Institute, Melbourne, Australia
| | - Félix Gil-Carrasco
- Department of Glaucoma, Association for the Prevention of Blindness, Coyoacan, Mexico
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Qing G, Wang N, Mu D. Efficacy of goniosynechialysis for advanced chronic angle-closure glaucoma. Clin Ophthalmol 2012; 6:1723-9. [PMID: 23152649 PMCID: PMC3497447 DOI: 10.2147/opth.s34035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the intraocular pressure (IOP)-lowering efficacy of goniosynechialysis (GSL) for advanced chronic angle-closure glaucoma (CACG) using a simplified slit-lamp technique. Patients and methods: Patients with CACG with one severely affected eye with best-corrected visual acuity below 20/200 and a mildly or functionally unaffected fellow eye were enrolled in this study. All patients underwent ophthalmologic examinations including measurement of visual acuity, best-corrected visual acuity, and IOP; biomicroscopy; specular microscopy; fundus examination; and gonioscopy followed by anterior chamber paracentesis and GSL for nasal peripheral anterior synechiae in the eye with severe CACG. Results: Thirty patients (18 men, 12 women) were identified as having CACG with an initial mean IOP of 47.1 ± 6.7 mmHg (range 39–61 mmHg) in the severely affected eye. One week after GSL, the mean IOP of the treated eyes decreased to 19.3 ± 2.8 mmHg (range 14–26 mmHg) without antiglaucoma medication (average decrease 27.7 ± 6.5 mmHg; range 16–41 mmHg), which was significant (P < 0.00001) compared with baseline. After an average follow-up period of 36.6 ± 1.0 months (range 35–38 months), the mean IOP stabilized at 17.4 ± 2.2 mmHg (range 12–21 mmHg). The nasal angle recess did not close again in any one of the patients during the follow-up period. The average significant (P < 0.00001) decrease in corneal endothelial cell density in the treated eyes was 260 ± 183 cells/mm2 (range 191–328 cells/mm2). Conclusions: Anterior chamber paracentesis and GSL lowers IOP in advanced CACG, though it may lead to mild corneal endothelial cell loss.
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Affiliation(s)
- Guoping Qing
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing, China; ; State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
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