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Golmohammadi M, Meibodi SAA, Al-Hawary SIS, Gupta J, Sapaev IB, Najm MAA, Alwave M, Nazifi M, Rahmani M, Zamanian MY, Moriasi G. Neuroprotective effects of resveratrol on retinal ganglion cells in glaucoma in rodents: A narrative review. Animal Model Exp Med 2024; 7:195-207. [PMID: 38808561 PMCID: PMC11228121 DOI: 10.1002/ame2.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Glaucoma, an irreversible optic neuropathy, primarily affects retinal ganglion cells (RGC) and causes vision loss and blindness. The damage to RGCs in glaucoma occurs by various mechanisms, including elevated intraocular pressure, oxidative stress, inflammation, and other neurodegenerative processes. As the disease progresses, the loss of RGCs leads to vision loss. Therefore, protecting RGCs from damage and promoting their survival are important goals in managing glaucoma. In this regard, resveratrol (RES), a polyphenolic phytoalexin, exerts antioxidant effects and slows down the evolution and progression of glaucoma. The present review shows that RES plays a protective role in RGCs in cases of ischemic injury and hypoxia as well as in ErbB2 protein expression in the retina. Additionally, RES plays protective roles in RGCs by promoting cell growth, reducing apoptosis, and decreasing oxidative stress in H2O2-exposed RGCs. RES was also found to inhibit oxidative stress damage in RGCs and suppress the activation of mitogen-activated protein kinase signaling pathways. RES could alleviate retinal function impairment by suppressing the hypoxia-inducible factor-1 alpha/vascular endothelial growth factor and p38/p53 axes while stimulating the PI3K/Akt pathway. Therefore, RES might exert potential therapeutic effects for managing glaucoma by protecting RGCs from damage and promoting their survival.
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Affiliation(s)
- Maryam Golmohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Jitendra Gupta
- Institute of Pharmaceutical Research, GLA University, Mathura, India
| | - Ibrohim B Sapaev
- Tashkent Institute of Irrigation and Agricultural Mechanization Engineers, Tashkent, Uzbekistan
- New Uzbekistan University, Tashkent, Uzbekistan
| | - Mazin A A Najm
- Pharmaceutical Chemistry Department, College of Pharmacy, Al-Ayen University, Thi-Qar, Iraq
| | - Marim Alwave
- Medical Technical College, Al-Farahidi University, Baghdad, Iraq
| | - Mozhgan Nazifi
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammadreza Rahmani
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mohammad Yasin Zamanian
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Gervason Moriasi
- Department of Medical Biochemistry, School of Medicine, College of Health Sciences, Mount Kenya University, Thika, Kenya
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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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Lin WC, Chen A, Song X, Weiskopf NG, Chiang MF, Hribar MR. Prediction of multiclass surgical outcomes in glaucoma using multimodal deep learning based on free-text operative notes and structured EHR data. J Am Med Inform Assoc 2024; 31:456-464. [PMID: 37964658 PMCID: PMC10797280 DOI: 10.1093/jamia/ocad213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/16/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE Surgical outcome prediction is challenging but necessary for postoperative management. Current machine learning models utilize pre- and post-op data, excluding intraoperative information in surgical notes. Current models also usually predict binary outcomes even when surgeries have multiple outcomes that require different postoperative management. This study addresses these gaps by incorporating intraoperative information into multimodal models for multiclass glaucoma surgery outcome prediction. MATERIALS AND METHODS We developed and evaluated multimodal deep learning models for multiclass glaucoma trabeculectomy surgery outcomes using both structured EHR data and free-text operative notes. We compare those to baseline models that use structured EHR data exclusively, or neural network models that leverage only operative notes. RESULTS The multimodal neural network had the highest performance with a macro AUROC of 0.750 and F1 score of 0.583. It outperformed the baseline machine learning model with structured EHR data alone (macro AUROC of 0.712 and F1 score of 0.486). Additionally, the multimodal model achieved the highest recall (0.692) for hypotony surgical failure, while the surgical success group had the highest precision (0.884) and F1 score (0.775). DISCUSSION This study shows that operative notes are an important source of predictive information. The multimodal predictive model combining perioperative notes and structured pre- and post-op EHR data outperformed other models. Multiclass surgical outcome prediction can provide valuable insights for clinical decision-making. CONCLUSIONS Our results show the potential of deep learning models to enhance clinical decision-making for postoperative management. They can be applied to other specialties to improve surgical outcome predictions.
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Affiliation(s)
- Wei-Chun Lin
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, United States
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 545 SW Campus Dr, Portland, OR, 97239, United States
| | - Aiyin Chen
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 545 SW Campus Dr, Portland, OR, 97239, United States
| | - Xubo Song
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Nicole G Weiskopf
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, United States
| | - Michael F Chiang
- National Eye Institute, National Institutes of Health, 31 Center Dr MSC 2510, Bethesda, MD, 20892, United States
- National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD, 20894, United States
| | - Michelle R Hribar
- Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR, 97239, United States
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, 545 SW Campus Dr, Portland, OR, 97239, United States
- National Eye Institute, National Institutes of Health, 31 Center Dr MSC 2510, Bethesda, MD, 20892, United States
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Ang BCH, Lim SY, Betzler BK, Wong HJ, Stewart MW, Dorairaj S. Recent Advancements in Glaucoma Surgery-A Review. Bioengineering (Basel) 2023; 10:1096. [PMID: 37760198 PMCID: PMC10525614 DOI: 10.3390/bioengineering10091096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Surgery has long been an important treatment for limiting optic nerve damage and minimising visual loss in patients with glaucoma. Numerous improvements, modifications, and innovations in glaucoma surgery over recent decades have improved surgical safety, and have led to earlier and more frequent surgical intervention in glaucoma patients at risk of vision loss. This review summarises the latest advancements in trabeculectomy surgery, glaucoma drainage device (GDD) implantation, and minimally invasive glaucoma surgery (MIGS). A comprehensive search of MEDLINE, EMBASE, and CENTRAL databases, alongside subsequent hand searches-limited to the past 10 years for trabeculectomy and GDDs, and the past 5 years for MIGS-yielded 2283 results, 58 of which were included in the final review (8 trabeculectomy, 27 GDD, and 23 MIGS). Advancements in trabeculectomy are described in terms of adjunctive incisions, Tenon's layer management, and novel suturing techniques. Advancements in GDD implantation pertain to modifications of surgical techniques and devices, novel methods to deal with postoperative complications and surgical failure, and the invention of new GDDs. Finally, the popularity of MIGS has recently promoted modifications to current surgical techniques and the development of novel MIGS devices.
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Affiliation(s)
- Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Woodlands Health Campus, Singapore 737628, Singapore
| | - Sheng Yang Lim
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Bjorn Kaijun Betzler
- Department of Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore 308433, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Hon Jen Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Michael W. Stewart
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA; (M.W.S.)
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA; (M.W.S.)
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Balas M, Mathew DJ. Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel) 2023; 7:54. [PMID: 37606500 PMCID: PMC10443347 DOI: 10.3390/vision7030054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - David J. Mathew
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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Yadlapalli N, Fan J, Sridhar J. Techniques to Repair Choroidal Detachments. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Pastore MR, Milan S, Agolini R, Egidi L, Agostini T, Belfanti L, Cirigliano G, Tognetto D. How Could Medical and Surgical Treatment Affect the Quality of Life in Glaucoma Patients? A Cross-Sectional Study. J Clin Med 2022; 11:jcm11247301. [PMID: 36555917 PMCID: PMC9784022 DOI: 10.3390/jcm11247301] [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] [Received: 11/14/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate and compare the visual function and the quality of life (QoL) in glaucomatous patients treated with topical medical therapy (TMT) alone, canaloplasty (CP), or trabeculectomy (TB). METHODS A total of 291 eyes of 167 patients with primary open-angle glaucoma or secondary pseudoexfoliative glaucoma in TMT or surgically treated with CP or TB were included. Eligibility criteria for surgical patients included not needing TMT after surgery. Each patient underwent a visual field assessment and peripapillary retinal nerve fiber layer (pRNFL) optical coherence tomography and filled out the Glaucoma Symptoms Scale (GSS) questionnaire and the 25-Item National Eye Institute Visual Functioning Questionnaire (25-NEI-VFQ). Comparison between the QoL level of the three groups and its correlation with optic nerve's anatomical and functional status was the primary outcome. RESULTS CP patients reported the best general vision (p = 0.01), a lower incidence of eye burning (p = 0.03), and the lowest annoyance level of non-visual symptoms (p = 0.006). QoL positively correlated with pRNFL thickness, whereas no correlation was found with visual field damage. CONCLUSION CP provides a better QoL when compared both to TB and TMT, regardless of glaucoma stage. pRNFL seems to provide additional information for predicting change in QoL.
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Affiliation(s)
- Marco Rocco Pastore
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Serena Milan
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-2243
| | - Rossella Agolini
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Leonardo Egidi
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, 34100 Trieste, Italy
| | - Tiziano Agostini
- Department of Life Sciences, University of Trieste, 34100 Trieste, Italy
| | - Lorenzo Belfanti
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Gabriella Cirigliano
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
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Koerber N, Ondrejka S. Clinical outcomes of canaloplasty via an ab-interno surgical technique using the iTrack device: a narrative review. Int Ophthalmol 2022; 43:2017-2027. [DOI: 10.1007/s10792-022-02601-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/17/2022] [Indexed: 12/03/2022]
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Teuchner B, Rauchegger T. Maculopathies in Glaucoma. Klin Monbl Augenheilkd 2022; 239:1101-1110. [PMID: 36067756 DOI: 10.1055/a-1904-8248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In the presence of glaucoma, various changes in the macula can occur during the course of the disease itself or its treatment. Maculopathies that can be observed in glaucoma include cystoid macular edema, hypotony maculopathy, and microcystic macular edema. The following article discusses the pathophysiology, causes, course, clinical presentation, and treatment of these maculopathies.
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Affiliation(s)
- Barbara Teuchner
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
| | - Teresa Rauchegger
- Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Österreich
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Patil TS, Mani B, Balekudaru S, George RJ, Lingam V. Effect of immediate shallow anterior chamber after Ahmed glaucoma valve implantation on intermediate-term intraocular pressure control. Indian J Ophthalmol 2022; 70:2915-2921. [PMID: 35918943 PMCID: PMC9672752 DOI: 10.4103/ijo.ijo_3071_21] [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] [Indexed: 12/04/2022] Open
Abstract
Purpose: To evaluate the incidence of shallow anterior chamber in the early postoperative period following Ahmed glaucoma valve (AGV) implantation and its effect on the hypertensive phase (HP), intermediate-term intraocular pressure (IOP) control, and success rate. Methods: A retrospective analysis of 369 eyes of 360 patients who underwent AGV implantation between January 2005 and January 2020 with a minimum follow-up of 2 months was performed. Twenty-six patients developed shallow anterior chamber (AC) within 8 weeks following surgery (cases). They were compared with 39 randomly selected controls (no shallow AC post AGV). HP (IOP spike >21 mmHg), use of ocular hypotensive medications, and other associations were compared. Results: Incidence of shallow AC post AGV was 7% (95% confidence interval [CI] 4, 9). The onset of shallow AC was 3 ± 2.1 days and resolved within 6 ± 4.7 days. Hypotony (12 [47%] vs. 1 [2.5%], P 0.0001) and choroidal detachment (CD; 7 [27%] vs. 3 [8%], P 0.03) were more common in cases compared to controls. The HP occurred in 11 (43%) cases versus 13 (34%) controls (P 0.4). Cases required more ocular hypotensive medications than controls at the end of 8 weeks (1.1 ± 1 vs. 0.5 ± 0.5, P 0.01). There was no significant difference in the qualified success between the groups at 1 year. Conclusion: The development of postoperative shallow AC post AGV implantation was not detrimental to IOP control at 1 year. However, there is a need to monitor the occurrence of HP in these eyes.
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Affiliation(s)
- Trupti Sudhir Patil
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Baskaran Mani
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Shantha Balekudaru
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ronnie J George
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vijaya Lingam
- Smt. Jadhavbai Nathamal Singhvi Glaucoma Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Ucar F, Yener Hİ. Can bleeding in trabeculectomy be decreased? Effectiveness of brimonidine pre-treatment. Eur J Ophthalmol 2022; 32:3476-3481. [PMID: 35164600 DOI: 10.1177/11206721221080621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the efficacy of preoperative topical brimonidine use to maintain visibility during trabeculectomy and control intraoperative bleeding and postoperative subconjunctival hemorrhage. METHODS The first group comprised 35 eyes of 34 patients administered brimonidine tartrate 0.15% (Brimogut, Bilim Ilac, Turkey) eye drops 6 and 3 min before surgery, and 33 eyes of 31 patients who received no medication for vasoconstriction formed the second group. Preoperative and postoperative photographs and operation video images were taken and vision analysis software used. Black-and-white images were obtained to identify the blood vessel and surface hemorrhage areas. The surface area of the hemorrhage was calculated by counting the black pixels with Image J software. RESULTS There was no significant difference between two groups in terms of baseline (preoperative) eye redness (p > 0.05). In the first group, the eye redness values were 344.7 ± 19.5 pixels preoperatively and 244.1 ± 23.3 pixels at the beginning of the surgery, respectively (p < 0.001). However, no significant change was observed in the second group in eye redness (348.2 ± 17.5 pixels preoperatively and 360.7 ± 26.8 pixels at the beginning of the surgery, p > 0.05). Cautery was used for an average of 11.91 ± 1.96 s in the first group and 25.57 ± 4.66 s in the second to control intraoperative bleeding (P < 0.001). CONCLUSION Preoperative topical brimonidine use in trabeculectomy surgery significantly decreased intraoperative bleeding and postoperative subconjunctival hemorrhage and facilitated bleeding control.
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Affiliation(s)
- Fikret Ucar
- Department of Ophthalmology, 590009Konyagoz Eye Hospital, Konya, Turkey
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12
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Chelerkar VJ, Agrawal D, S Kalyani VK, Deshpande M. Comparison of bleb morphology by anterior segment optical coherence tomography and clinical outcome after phacotrabeculectomy with mitomycin C or Ologen implant. Indian J Ophthalmol 2021; 69:2734-2739. [PMID: 34571624 PMCID: PMC8597473 DOI: 10.4103/ijo.ijo_3506_20] [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] [Indexed: 11/04/2022] Open
Abstract
Purpose: To compare the bleb morphology by Anterior Segment Optical Coherence Tomography (ASOCT) and clinical outcome after Phacotrabeculectomy with either mitomycin C or Ologen implant. Methods: In a prospective interventional active controlled study, 93 patients aged 18 years and above underwent phacotrabeculectomy with either mitomycin C (53 eyes) or ologen implant (40 eyes), followed up for 12 months. The primary outcome measure was to note the evolution of bleb morphology by ASOCT in the two groups over 12 months. Secondary outcome measures were mean IOP, reduction in the need for anti-glaucoma medications, and complications seen in the two groups. Results: All parameters in the two groups were comparable preoperatively (P>0.05). Best corrected visual acuity at 12 months was 0.38±0.27 in mitomycin group and 0.31±0.23 in ologen group (P=0.151). Post-operative IOP at 12 months was 14.09±3.1mmHg (95%CI 13.22-14.97) in mitomycin group, and 13.25±2.5 mmHg (95%CI 12.40-14.30) in ologen group (P=0.254).The mean number of medications was 0.36±0.68 in mitomycin group and 0.38+/-0.70 in ologen group at 12 months (P=0.91). Overall success was achieved in 98.1 % of patients in mitomycin group and 90 % of patients in ologen group at 12 months. No major sight-threatening complications were noted in any group. AS-OCT imaging at 12 months showed multiform reflectivity with multiple large cystic spaces in both groups, with good IOP control. Conclusion: Phacotrabeculectomy using Mitomycin C and Ologen implant resulted in similar morphologic and functioning blebs at one year with comparable efficacy in controlling intraocular pressure.
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Affiliation(s)
- Vidya J Chelerkar
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Dishi Agrawal
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - V K S Kalyani
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
| | - Madan Deshpande
- Department of Glaucoma, PBMA's H. V. Desai Eye Hospital, Pune, Maharashtra, India
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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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14
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The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes. J Glaucoma 2021; 29:1056-1064. [PMID: 32694285 DOI: 10.1097/ijg.0000000000001609] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PRéCIS:: This study addresses the paucity of literature examining glaucoma patients' distance from clinic on postoperative follow-up outcomes. Greater distance from clinic was associated with higher likelihood of loss to follow-up and missed appointments. PURPOSE To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. METHODS AND PARTICIPANTS Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. RESULTS In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05). CONCLUSIONS Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.
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Erichev VP, Abdullaeva EH, Mazurova UV. [Frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries]. Vestn Oftalmol 2021; 137:54-59. [PMID: 33610150 DOI: 10.17116/oftalma202113701154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To study the frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries depending on several factors. MATERIAL AND METHODS The study retrospectively analyzed 87 outpatient records and case histories of patients with primary open-angle glaucoma (POAG). All subjects had undergone standard trabeculectomy. The indication for surgical treatment was deterioration of visual function associated with increased intraocular pressure (IOP). During the follow-up, an assessment was made of intraoperative and early postoperative complications, as well as factors leading to their development. RESULTS During the observation period, the most frequently developing complications were found to be ciliochoroidal detachment - in 22 (25.8%) patients, and hyphema - in 12 (13.8%). One of the reasons for these complications is a significant, sometimes critical change in intraocular pressure when cutting open the eye. Isolated intraocular hypotension without signs of ciliochoroidal detachment was detected in 15 (17.24%) patients. Postoperative hypertension was found in 18 (20.68%) patients. Scarring of the newly created outflow tracts of intraocular fluid was the obvious cause of ophthalmic hypertension in 5 patients. In 16 (18.4%) cases, pronounced vascularization was found at the site of surgical intervention. CONCLUSION The most significant factors that have a possible impact on the outcome of glaucoma surgery - specifically, its hypotensive effect - are: age, duration of local antihypertensive therapy, comorbid somatic pathology, and the initial IOP level.
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Affiliation(s)
- V P Erichev
- Research Institute of Eye Diseases, Moscow, Russia
| | | | - U V Mazurova
- Research Institute of Eye Diseases, Moscow, Russia
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16
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Abstract
Aims and objectives This study aimed at describing the characteristics and outcomes of pediatric glaucoma patients in a university hospital in Lebanon and comparing them between primary congenital glaucoma (PCG) and secondary glaucoma. Materials and methods Sixty-four eyes of 40 pediatric glaucoma patients with a follow-up of 1 year or more were reviewed. Parameters were studied for both PCG and secondary glaucoma groups. Three major outcomes were considered: intraocular pressure (IOP) control, final best-corrected visual acuity (BCVA), and the proportion of failed angle surgeries. Results Sixty-four eyes were included divided into 29 PCG and 35 secondary glaucoma eyes, followed up for a mean of 6.6 ± 4.7 years. Eyes with PCG presented earlier, with a higher initial IOP and underwent earlier surgery than their secondary glaucoma counterparts. Although 85.9% of all eyes achieved good IOP control, 44.4% of them had a BCVA ≥20/50 with PCG having a better visual prognosis. Secondary glaucoma eyes needed more medications at the end of their follow-up. In this group, it was shown that a later age at first surgery, unilateral disease, and multiple surgeries were associated with a BCVA < 20/50. Conclusion Patients with PCG presented earlier and with a higher IOP than secondary glaucoma; they were also operated on earlier. Both groups demonstrated good IOP control at the end of the follow-up period with PCG eyes having a superior visual outcome. Secondary glaucoma eyes required a higher number of medications at their final visit. In this population, multiple surgeries, unilateral disease, and a delayed first surgery conferred a poorer visual prognosis. Clinical significance Data regarding the characteristics of pediatric glaucoma, especially in the Middle East, are scarce. Our study sheds the light on the presentation of different types of pediatric glaucoma and their outcomes namely IOP control and visual acuity. How to cite this article Dakroub M, Khair D, Noureddine B, et al. Pediatric Glaucoma in a University Hospital. J Curr Glaucoma Pract 2021;15(1):8-13.
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Affiliation(s)
- Mohamad Dakroub
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Governorate, Lebanon
| | - Diana Khair
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Governorate, Lebanon
| | - Bahaa' Noureddine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Governorate, Lebanon
| | - Christiane Al-Haddad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Governorate, Lebanon
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Costagliola C, Sbordone M, Gandolfi S, Cesari L, Furneri G, Fea AM. Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change? Clin Ophthalmol 2020; 14:2639-2655. [PMID: 32982157 PMCID: PMC7500840 DOI: 10.2147/opth.s264839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.
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Affiliation(s)
- Ciro Costagliola
- Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Mario Sbordone
- Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Luca Cesari
- UOC Ophthalmology - Area 5, Ascoli Piceno, San Benedetto del Tronto, Italy
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Terzidou C, Trivli A, Dalianis G. Stab incision mitomycin C-assisted rapid trabeculectomy: A 'SMART' trabeculectomy alternative. Exp Ther Med 2020; 20:1752-1757. [PMID: 32742404 DOI: 10.3892/etm.2020.8852] [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: 11/21/2019] [Accepted: 03/17/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to introduce a new modified trabeculectomy technique, stab incision mitomycin C (MMC)-assisted rapid trabeculectomy (SMART), which requires less surgical time and tissue manipulation. A total of 41 eyes with indication for trabeculectomy underwent glaucoma surgery with the SMART technique; superior subconjunctival injection of 0.005 mg MMC mixed with 0.1 ml lidocaine, followed by small, fornix base conjunctival opening. A stab incision was made to enter the anterior chamber 1.5 mm post-limbus using a 2.4 mm cataract knife. Double 0.75 mm punch and peripheral iridectomy were performed. A releasable suture was placed in the scleral opening, and matrix sutures to close conjunctiva. The preoperative mean intraocular pressure (IOP) was 23.8 mmHg, with a mean number of medications of 3.3. The mean follow-up duration was 27.6 months, with a range of 12-46 months. A year post-surgery, the mean IOP was 11 mmHg, with a mean number of medications of 0.7, corresponding to a reduction of 12.8 mmHg in IOP and 2.6 in the number of medications. During follow-up, additional 5-fluorouracil injections were administered when needed. In conclusion, SMART with wound modulation appears to be a safe and quick alternative to classic trabeculectomy. Few minor and no major complications were observed during the first 2.5 years of follow-up, with all eyes maintaining an IOP <15 mmHg.
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Affiliation(s)
- Chryssa Terzidou
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Alexandra Trivli
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
| | - Georgios Dalianis
- Department of Ophthalmology, Konstantopouleio-Patission General Hospital, Athens 14233, Greece
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Abstract
PRéCIS:: Retrospective analysis of 38 suprachoroidal glaucoma stent implantations showed sudden intraocular pressure (IOP) elevations to >30 mm Hg in 37% of eyes, 39% needing additional glaucoma surgery, and a success rate at 12 months of 24%. PURPOSE To study the efficacy and safety of suprachoroidal stent in everyday clinical practice at a tertiary glaucoma center. MATERIALS AND METHODS This retrospective single-center consecutive case series involved patients treated at Helsinki University Hospital with the CyPass Micro-Stent. Preoperative IOP was ≥18 mm Hg. Success was IOP between 6 and 18 mm Hg and lowering of IOP at least 20% from baseline without an increase in glaucoma medications over baseline or use of oral acetazolamide, and no subsequent glaucoma surgery. RESULTS Of the total 38 eyes of 33 patients, 17 had primary open-angle glaucoma, 16 had exfoliative glaucoma, 2 each had uveitic glaucoma or steroid-induced glaucoma, and 1 had pigmentary glaucoma. Median preoperative IOP was 25.8 [interquartile range (IQR), 9.7] mm Hg with a median of 3 (IQR, 2) glaucoma medications. Kaplan-Meier estimate of median survival time was 79 days (95% confidence interval, 37-121 d). Success rate at 12-month follow-up was 24%. Sudden IOP elevation to over 30 mm Hg occurred in 14 eyes (37%). Highest IOP was 68 mm Hg. IOP peaks occurred between 1 week and 8 months after the surgery. In total, 43% of those with IOP elevation to >30 mm Hg had no symptoms. After the CyPass implantation, 15 eyes (39%) needed additional glaucoma surgery within a median of 167 (IQR, 109) days. CONCLUSIONS Suprachoroidal stenting in a heterogenous clinical population resulted in a high incidence of sudden IOP peaks with a low success rate.
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Matsushita K, Kawashima R, Uesugi K, Okada H, Sakaguchi H, Quantock AJ, Nishida K. Assessment of a self-assembling peptide gel, SPG-178, in providing a clear operative field for trabeculectomy surgery for glaucoma in an animal model. Sci Rep 2020; 10:11326. [PMID: 32647319 PMCID: PMC7347556 DOI: 10.1038/s41598-020-68171-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/10/2020] [Indexed: 11/18/2022] Open
Abstract
The presence of blood during ophthalmic surgery is problematic, as it can obstruct a surgeon’s view of the operative field. This is particularly true when performing trabeculectomy surgery to enhance ocular fluid outflow and reduce intraocular pressure as a treatment for glaucoma, one of the most common vision loss conditions worldwide. In this study, we investigated the performance of a transparent, self-assembling peptide gel (SPG-178) and its ability to maintain visibility during trabeculectomy surgery. Unlike the hyaluronic acid gel commonly used in ophthalmic surgery, SPG-178 did not permit the ingress of blood into the gel itself. Rather, it forced blood to flow peripherally to the gel. Moreover, if bleeding occurred under the SPG-178 gel, perfusion with saline was able to effectively flush the blood away along the interface between the SPG-178 and the ocular tissue (in this case scleral) to clear the surgical field of view. In experimental trabeculectomy surgeries with mitomycin C used as an adjuvant, there were no differences in the postoperative recovery of intraocular pressure or bleb morphology with or without the use of SPG-178. SPG-178, therefore, when used in a gel formulation, represents a new material for use in intraocular surgery to ensure a clear operative field with likely beneficial treatment outcomes.
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Affiliation(s)
- Kenji Matsushita
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Rumi Kawashima
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Uesugi
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.,Menicon Co., Ltd., 5-1-10 Takamoridai, Kasugai, Aichi, 487-0032, Japan
| | - Haruka Okada
- Menicon Co., Ltd., 5-1-10 Takamoridai, Kasugai, Aichi, 487-0032, Japan
| | - Hirokazu Sakaguchi
- Department of Advanced Device Medicine, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Andrew J Quantock
- School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, Wales, UK
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. .,Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Osaka, Japan.
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Nguyen TDM, Mabon M, Li G. Successful posttraumatic bleb repair using amniotic membrane and corneal patch graft. Can J Ophthalmol 2019; 54:e184-e186. [PMID: 31358164 DOI: 10.1016/j.jcjo.2018.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/25/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | - Michele Mabon
- Hôpital Maisonneuve-Rosemont, Centre de santé ambulatoire, Montréal, Que
| | - Gisele Li
- Hôpital Maisonneuve-Rosemont, Centre de santé ambulatoire, Montréal, Que..
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Salama MM, Abdel-Hamid RM, El-Basty MK, El-Zawahry OM. One-Year Results of Stab Incision Glaucoma Surgery and Radiofrequency-Assisted Stab Incision in Management of Open-Angle Glaucoma. Middle East Afr J Ophthalmol 2019; 26:141-147. [PMID: 31619901 PMCID: PMC6788308 DOI: 10.4103/meajo.meajo_153_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 03/08/2019] [Accepted: 06/27/2019] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of the study is to evaluate the surgical outcome of stab incision glaucoma surgery (SIGS) and compare it with radiofrequency-assisted stab incision in the treatment of uncontrolled open-angle glaucoma. PATIENTS AND METHODS A prospective, interventional study included 50 eyes who were assigned into two equal groups: Group A underwent stab incision procedure with preoperative subconjunctival (SC) mitomycin-C (MMC) and Group B underwent radiofrequency-assisted technique without MMC. Intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP), and bleb status were evaluated up to 12 months. RESULTS Mean preoperative IOP in Group A was 26.96 ± 2.42 reduced to 13.43 ± 2.31 while in Group B was 27.20 ± 3.57 reduced to 15.48 ± 3.68 mmHg (P < 0.001) with a mean reduction of 50.61% ± 8.42% and 43.56% ± 12.83%, 12 months postoperatively in Groups A and B, respectively. Non-basal peripheral iridectomy was the most encountered intraoperative complication in 8 eyes (32%) and 9 eyes (36%) and hypotony was the most reported postoperative complication in 5 eyes (20%) and 9 eyes (36%) in Groups A and B, respectively. Flat bleb area had been reported at the end of follow-up time in 3 eyes (13%) and 7 eyes (30%) in Groups A and B, respectively. Complete success rate was 52.2% and 28.6% while qualified success rate was 28.8% and 42.9% in Groups A and B, respectively. CONCLUSION SIGS with SC MMC is an effective and safe procedure in IOP lowering, while radiofrequency-assisted stab incision had high incidence of subconjunctival scarring and ostium closure.
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Yi QY, Cai B, Huang J, Chen LS, Han Y, Bai ZS. Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope: A modified technique of ciliary body photocoagulation. Indian J Ophthalmol 2019; 67:515-519. [PMID: 30900585 PMCID: PMC6446639 DOI: 10.4103/ijo.ijo_65_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study aimed to investigate the efficacy of cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope in treating refractory glaucoma. Methods: Eleven patients (11 eyes) with refractory neovascular glaucoma were treated with ciliary body photocoagulation. Preoperative and postoperative corrected visual acuity, intraocular pressure (IOP), ophthalmofundoscopy, B-ultrasound and ultrasound biomicroscopy, optical coherence tomography, and fundus fluorescein angiography were performed. Results: Preoperative IOP ranged from 45 to 58 mmHg (mean 51.9 mmHg). At postoperative 1, 3, and 6 months, the IOPs ranged between 16 and 33 mmHg (mean 27.1 mmHg), 14–28 mmHg (mean 20.6 mmHg), and 14–28 mmHg (mean 18.5 mmHg), respectively. IOP at the last follow-up (range 7–12 months) was 15–24 mmHg (mean 18.8 mmHg). An average of 63.8% decrease in postoperative IOP was found in these patients with no associated complications. The postoperative fibrotic exudate, anterior chamber hyphema, and exudative choroidal detachment were all well-managed and resolved. No patients experienced intraocular lens deviation or dislocation, hypotonia oculi, atrophy of eyeball, retinal detachment, endophthalmitis, or sympathetic ophthalmia. Conclusion: Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope is a safe and effective technique for the treatment of neovascular glaucoma.
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Affiliation(s)
- Quan-Yong Yi
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Bin Cai
- Ningbo Central Blood Station, Ningbo, Zhejiang, China
| | - Jiang Huang
- Department of Ophthalmology, The Second Affiliated Hospital of Soochow University, China
| | - Li-Shuang Chen
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Yin Han
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
| | - Zhi-Sha Bai
- Department of Ophthalmology, Ningbo Eye Hospital, Ningbo, Zhejiang, China
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Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2019; 257:983-996. [PMID: 30758653 DOI: 10.1007/s00417-019-04251-z] [Citation(s) in RCA: 131] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of an ab interno subconjunctival gelatin implant as primary surgical intervention in reducing intraocular pressure (IOP) and IOP-lowering medication count in medically uncontrolled moderate primary open-angle glaucoma (POAG). METHODS In this prospective, non-randomized, open-label, multicenter, 2-year study, eyes with medicated baseline IOP 18-33 mmHg on 1-4 topical medications were implanted with (phaco + implant) or without (implant alone) phacoemulsification. Changes in mean IOP and medication count at months 12 (primary outcomes) and 24, clinical success rate (eyes [%] achieving ≥ 20% IOP reduction from baseline on the same or fewer medications without glaucoma-related secondary surgical intervention), intraoperative complications, and postoperative adverse events were assessed. RESULTS The modified intent-to-treat population included 202 eyes (of 218 implanted). Changes (standard deviation) in mean IOP and medication count from baseline were - 6.5 (5.3) mmHg and - 1.7 (1.3) at month 12 and - 6.2 (4.9) mmHg and - 1.5 (1.4) at month 24, respectively (all P < 0.001). Mean medicated baseline IOP was reduced from 21.4 (3.6) to 14.9 (4.5) mmHg at 12 months and 15.2 (4.2) mmHg at 24 months, with similar results in both treatment groups. The clinical success rate was 67.6% at 12 months and 65.8% at 24 months. Overall, 51.1 (12 months) and 44.7% (24 months) of eyes were medication-free. The implant safety profile compared favorably with that published for trabeculectomy and tube shunts. CONCLUSIONS The gelatin implant effectively reduced IOP and medication needs over 2 years in POAG uncontrolled medically, with an acceptable safety profile. ClinicalTrials.gov registration number: NCT02006693 (registered in the USA).
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Sarkisian SR, Mathews B, Ding K, Patel A, Nicek Z. 360° ab-interno trabeculotomy in refractory primary open-angle glaucoma. Clin Ophthalmol 2019; 13:161-168. [PMID: 30666087 PMCID: PMC6333157 DOI: 10.2147/opth.s189260] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the safety and efficacy of microinvasive glaucoma surgery (MIGS) with 360° ab-interno trabeculotomy using the TRAB360 device as a stand-alone procedure in patients with refractory primary open-angle glaucoma (POAG) and preoperative IOP ≥18 mmHg. Setting This study evaluated patients treated in a tertiary-referral clinical practice setting. Design This study is a retrospective analysis of 81 eyes. Methods Patients with refractory open-angle glaucoma underwent stand-alone 360° ab-interno trabeculotomy using the TRAB360 device. Effectiveness was determined by reduction in medicated IOP and the use of medications from baseline. Safety was determined by the rate of adverse events and secondary surgical interventions. The time points assessed were baseline and postoperative day 1, week 1, and months 1, 3, 6, and 12. A subgroup analysis was performed on eyes with medicated preoperative IOP values of ≥25 mmHg. Results The reductions in IOP from 1 day to 12 months postoperatively were statistically significant compared to baseline values. The mean reduction in IOP at 12 months was 7.3±6.7 mmHg from baseline. At 12 months, 59% eyes achieved ≥20% reduction in IOP and IOP <18 mmHg with the same or fewer numbers of IOP-lowering medications compared with those at baseline. The mean number of IOP-lowering medications was reduced from 1.7±1.3 at baseline to 1.1±1.0 at 12 months. At 12 months, 67% of eyes with preoperative IOP values of ≥25 mmHg achieved ≥20% reduction in IOP and IOP <18 mmHg with the same or fewer numbers of IOP-lowering medications compared with those at baseline. The most common adverse event for all eyes was mild, transient hyphema (57 eyes). During the first year after the procedure, 20 (25%) eyes were considered failures since they required reinterventions. Conclusion Trabeculotomy using the TRAB360 device resulted in significant IOP reductions up to 1 year with a favorable safety profile. The device is an effective stand-alone MIGS procedure for patients with refractory POAG.
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Affiliation(s)
- Steven R Sarkisian
- University of Oklahoma College of Medicine, Dean McGee Eye Institute, Oklahoma City, OK, USA,
| | | | - Kai Ding
- University of Oklahoma, Oklahoma City, OK, USA
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Wang Q, Zhang QE, Nauheim J, Nayak Kolomeyer N, Pro MJ. Fornix-Based Trabeculectomy Conjunctival Closure: Winged Sutures versus Modified Wise Closure. Ophthalmol Glaucoma 2019; 2:251-257. [PMID: 32672547 DOI: 10.1016/j.ogla.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/25/2019] [Accepted: 04/30/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare the midterm safety and efficacy profile of winged sutures versus modified Wise closure for fornix-based trabeculectomy. DESIGN Retrospective comparative study. PARTICIPANTS Consecutive cases that underwent fornix-based trabeculectomy by a single surgeon between January 5, 2015, and May 8, 2017. METHODS Potential cases were identified using the Current Procedural Terminology code, and their charts were reviewed thoroughly. Only 1 eye per patient was included. Demographic and clinical data were collected. MAIN OUTCOME MEASURES Primary outcomes were bleb leak and subsequent surgical revision rates. Secondary outcomes included intraocular pressure (IOP), number of glaucoma medications (NGM), visual acuity (VA), and other complications. RESULTS A total of 313 patients were identified, 157 with winged sutures and 156 with modified Wise closure. Baseline demographic and clinical characteristics were similar between the 2 groups. Twenty-six cases (16.6%) of winged sutures and 10 cases (6.4%) of modified Wise group developed bleb leak (P = 0.007), but only a total of 10 eyes needed bleb revision (P = 0.336). Other complications were similar in rates between the groups (P > 0.05). At 6 months, the modified Wise group had significantly greater IOP reduction (-3.10±1.29 [standard error], P = 0.016). Number of glaucoma medications reduction and VA evolution were similar between the 2 groups (P > 0.05). CONCLUSIONS Fornix-based trabeculectomy with either closure technique was effective in lowering IOP and NGM with comparable safety profile at 6 months. Furthermore, modified Wise closure provided larger IOP reduction and lower bleb leak rate, suggesting a potential superiority to winged sutures. Our study was limited by mitomycin C (MMC) delivery method change near the time of conjunctival closure change, although MMC delivery methods did not show significance in any outcome model.
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Affiliation(s)
- Qianqian Wang
- Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, University of Montreal Hospital Center, Montreal, QC, Canada.
| | - Qiang Ed Zhang
- Wills Eye Hospital, Philadelphia, Pennsylvania; Vickie and Jack Farber Vision Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jennifer Nauheim
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Natasha Nayak Kolomeyer
- Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael J Pro
- Wills Eye Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Elving-Kokke KH, Sas-Meertens MAV, de Beer FM, van Rijn LJ, de Boer JH, Visser ES. The treatment of ocular hypotony after trabeculectomy with a scleral lens: A case series. Cont Lens Anterior Eye 2018; 42:123-126. [PMID: 30442515 DOI: 10.1016/j.clae.2018.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 10/07/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Ocular hypotony after trabeculectomy may be treated medically, surgically and with a tamponade. Three cases are reported in which a scleral lens was applied to treat ocular hypotony after mitomycin C (MMC) augmented trabeculectomy. METHODS In this retrospective case series the records of three eyes of three patients who developed ocular hypotony after they had undergone trabeculectomy augmented with MMC were evaluated. The patients were between 11 and 69 years of age and the intraocular pressure (IOP) after surgery ranged between 3 and 6 mmHg. All three patients showed a negative Seidel test; one had suspected hypotonic maculopathy and one had a collapsed anterior chamber. After unsuccessful treatment with large bandage lenses all three patients were subsequently fitted with a scleral lens. The scleral lens was fitted to fully cover and compress the bleb. Scleral lenses were worn continuously with a check-up after one night of wear and subsequent check-ups when needed. One patient continued to wear the scleral lens for a further 6.5 months on a daily wear basis. RESULTS In all three eyes the IOP was higher after wearing the scleral lens. Two patients stopped wearing the scleral lens after the IOP was stable. One patient developed a cataract; the cataract surgery was combined with a bleb revision and scleral lens wear was therefore discontinued. DISCUSSION The scleral lens might be a useful tool in the treatment of ocular hypotony after trabeculectomy augmented MMC surgery. The effect of the scleral lens on the ocular pressure is unpredictable. Caution is advised in vulnerable corneas due to risk factors such as hypoxia and infection. Further research is warranted to establish the safety of the procedure, the patient selection and the overall success in a larger patient group.
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Affiliation(s)
- K H Elving-Kokke
- Visser Contact Lens Practice, Sint Annastraat 93, 6524 EJ Nijmegen, the Netherlands.
| | - M A V Sas-Meertens
- Visser Contact Lens Practice, Sint Annastraat 93, 6524 EJ Nijmegen, the Netherlands.
| | - F M de Beer
- Visser Contact Lens Practice, Sint Annastraat 93, 6524 EJ Nijmegen, the Netherlands.
| | - L J van Rijn
- Amsterdam UMC, location Vumc, po box 7057, 1007 MB, Amsterdam, the Netherlands.
| | - J H de Boer
- UMC Utrecht, Heidelberglaan 100, 3585 CX Utrecht, the Netherlands.
| | - E-S Visser
- Visser Contact Lens Practice, Sint Annastraat 93, 6524 EJ Nijmegen, the Netherlands.
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Karimi A, Lindfield D, Turnbull A, Dimitriou C, Bhatia B, Radwan M, Gouws P, Hanifudin A, Amerasinghe N, Jacob A. A multi-centre interventional case series of 259 ab-interno Xen gel implants for glaucoma, with and without combined cataract surgery. Eye (Lond) 2018; 33:469-477. [PMID: 30356133 DOI: 10.1038/s41433-018-0243-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/29/2018] [Accepted: 09/28/2018] [Indexed: 11/09/2022] Open
Abstract
AIMS To assess the efficacy of Xen in reducing intraocular pressure (IOP) in varying glaucoma subtypes. To assess the effect of combined phacoemulsification. To determine the frequency of complications and explore further bleb management needed. METHODS Retrospective case note review of all patients undergoing Xen implantation across four centres from August 2015 to May 2017. RESULTS In total, 259 consecutive surgeries of 226 patients were reviewed. IOP reduced from 19.3 (SD ± 6.0) mmHg preoperatively to 14.2 (SD ± 4.4) at month 12 and 13.5 (SD ± 3.3) at month 18 (p < 0.0001). Medication usage reduced from 2.6 (±1.1) preoperatively to 0.8 (±1.0) at month 12 (p < 0.0001) and 1.1 (±1.3) medications at month 18 (p < 0.0001). Simultaneous phacoemulsification did not alter outcomes as Xen IOP was 14.3 (SD ± 4.7) mmHg and Phaco-Xen was 13.8 (SD ± 2.6) mmHg at month 12 (p = 0.5367). Xen appears to be effective in previous failed filtration surgery. Adverse events included: IOP spikes of ≥30 mmHg in 33 (12.7%) cases, secondary filtration surgery required in 24 (9.3%) cases; implant exposure in 6 (2.3%) cases; persistent hypotonous maculopathy in 5 (1.9%) cases; persistent choroidal effusions in 4 (1.5%) cases; a cyclodialysis cleft secondary to implant insertion in 1 (0.5%) case; and 1 (0.5%) case of endophthalmitis post-implant bleb resuturing. In all, 40.9% of cases required postoperative bleb needling or antimetabolite injection. CONCLUSIONS Xen reduces IOP and medications at 18 months. Adverse events are uncommon. Careful postoperative surveillance and low threshold for bleb management is needed. Xen is safe and effective in mild to moderate glaucoma.
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Affiliation(s)
- Ayesha Karimi
- Royal Surrey County Hospital, Guildford, GU2 7XX, UK.
| | - Dan Lindfield
- Royal Surrey County Hospital, Guildford, GU2 7XX, UK
| | | | | | | | | | - Pieter Gouws
- Conquest Hospital, Saint Leonards on Sea, East Sussex, TN37 7RD, UK
| | | | | | - Aby Jacob
- University Hospital Southampton, Southampton, SO16 6YD, UK
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Janani MK, Jaichandran V, Madhavan HNR, Vijaya L, George RJ, Ambastha PS, Manu A, Malathi J. Effect of Lignocaine Concentration on Human Fibroblasts Growth in Eyes Undergoing Trabeculectomy: An in vitro Study. Biomed Hub 2018; 3:1-10. [PMID: 31988963 PMCID: PMC6945966 DOI: 10.1159/000491074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 06/19/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose To evaluate the effect of lignocaine on growth and apoptosis indication of primary human Tenon's capsule fibroblast (HTFs) in an in vitro model. Patients and Methods Tenon's capsule tissue obtained from patients undergoing trabeculectomy were grown in cell culture medium. The effect of different concentrations of lignocaine (0.5, 1.0, 1.5, and 2%) on the morphology and growth of the fibroblasts was studied using microscopy, cell viability, and proliferation assay, and apoptosis was detected using the FITC Annexin V Apoptosis Kit. Results Morphological changes similar to those of apoptotic cells, including cytoplasmic vacuolation, shrinkage, and rounding were visualized in the cells treated with concentrations greater than 1.0% (i.e., 1.5, 2.0%). Though proliferation inhibition was found with all four concentrations (0.5–2.0%), the viability of cells decreased from 1.0% lignocaine. Conclusion 0.5% lignocaine prevents proliferation of fibroblasts without causing apoptosis in vitro.
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Affiliation(s)
| | | | | | - Lingam Vijaya
- Department of Glaucoma, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | - Ronnie Jacob George
- Department of Glaucoma, Vision Research Foundation, Sankara Nethralaya, Chennai, India
| | | | - Abhijeet Manu
- Birla Institute of Technology & Science, Pilani, India
| | - Jambulingam Malathi
- L&T Microbiology Research Centre, Vision Research Foundation, Chennai, India
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Alejandre-Alba N, Gutierrez-Contreras R, Dorronsoro C, Marcos S. Intraocular Photobonding to Enable Accommodating Intraocular Lens Function. Transl Vis Sci Technol 2018; 7:27. [PMID: 30324000 PMCID: PMC6183327 DOI: 10.1167/tvst.7.5.27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/13/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose Accommodating intraocular lenses (A-IOLs) require capturing the ciliary muscle forces. Prior work demonstrated strong photo-initiated bonding between strips of capsular bag and poly(2-hydroxyethyl methacrylate); (pHEMA) polymer in an extraocular setting. We demonstrate that photobonding can be achieved intraocularly. Methods Phacoemulsification was performed in porcine eyes (<24 hours postmortem). A commercial intraocular lens (IOL; pHEMA-MMA material) was inserted in the capsular bag. Surface contact between the lens and capsular bag was ensured by continuous air infusion into the anterior chamber of the eye, which provided sufficient pressure at the interface, as well as oxygen. The capsular bag and IOL then were stained with 0.1% photosensitizer Rose Bengal (RB) solution. A fiberoptic probe connected to a diode-laser (532 nm) was used to locally irradiate the capsular bag-IOL interface intraocularly. The bonding breaking load was evaluated in a uniaxial stretcher. Results Photobonding occurred in the 0.8 to 1.6 W/cm2 irradiance range and 2.5 to 7 minutes irradiation time. Average forces of 0.12 N stretched but did not break the bond. These forces, applied uniaxially, are higher than the summed net accommodating force of the ciliary muscle along the entire equator (0.08 N). In two cases, the zonulae broke before the bonded region. Conclusions Photobonding between the capsular bag and IOL polymer can be achieved intraocularly, in a procedure compatible with standard cataract surgery. This technique will enable the mechanisms of A-IOLs not to rely on capsular bag integrity or natural haptic fibrosis. Translational Relevance Intraocular photobonding holds promise to enable operation of A-IOLs to restore accommodation in presbyopia, affecting 100% of the population >45 years old. Intraocular bonding of polymer material to ocular tissue also may find other applications in ophthalmology.
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Affiliation(s)
- Nicolas Alejandre-Alba
- Department Ophthalmology, University Hospital Fundación Jiménez-Díaz, Madrid, Spain.,Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Rocio Gutierrez-Contreras
- Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Carlos Dorronsoro
- Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Susana Marcos
- Instituto de Óptica "Daza de Valdés", Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
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Vera V, Ahmed I“IK, Stalmans I, Reitsamer H. Gel Stent Implantation—Recommendations for Preoperative Assessment, Surgical Technique, and Postoperative Management. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/usor.2018.11.1.38] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The surgical management of glaucoma offers the potential to lower intraocular pressure (IOP) independent of patients’ compliance with their medication regimen. Procedures such as trabeculectomy and tube shunt placement often yield large magnitudes of IOP reduction, but may be associated with short- and long-term complications. Microinvasive glaucoma surgery (MIGS) offers an alternative surgical approach that is inherently less invasive; however, most devices that fit in this category are associated with a lesser degree of IOP-lowering efficacy compared with traditional glaucoma surgeries. A newer MIGS device, a gel stent that facilitates drainage to the subconjunctival space, appears to offer similar IOP reduction to trabeculectomy, but with much less tissue manipulation; better predictability; and less sight-threatening complications, thus making it a potentially safer and more predictable surgical option in appropriate patients. The following proposed protocol, based on evidence-based practices and augmented where necessary by the opinions of experienced surgeons, provides guidance for the pre-, intra-, and postoperative management of patients receiving a gel stent implant. The goal of this protocol is to provide a framework for better patient selection and preparation, surgical pearls, and how best to assess and manage patients in the postoperative period.
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Eyepass Glaucoma Implant in Open-Angle Glaucoma After Failed Conventional Medical Therapy: Clinical Results of a 5-Year-Follow-up. J Glaucoma 2017; 26:328-334. [PMID: 28355172 DOI: 10.1097/ijg.0000000000000618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE STUDY The purpose of the study was to evaluate the long-term safety and intraocular pressure (IOP) lowering effect of the Eyepass glaucoma implant (GMP Vision Solutions, Inc.). PATIENTS AND METHODS The prospective study included 15 patients (16 eyes) with primary open-angle glaucoma who underwent an implantation of the Y-shaped Eyepass glaucoma implant. This shunt diverts aqueous from the anterior chamber directly into Schlemm's canal to increase outflow and to lower the IOP. IOP, visual acuity, potential complications and the number of antiglaucomatous medications were monitored over a period of 5 years. RESULTS The implant was successfully inserted in 14 of 16 eyes. Mean IOP was reduced from 26.4±8.1 mm Hg (SD) to 16.4±5.3 mm Hg (P=0.032) at the end of the follow-up. Mean number of antiglaucomatous medications dropped from 2.1±1.2 (SD) to 0.9±1.2 (SD). In 5 cases, no pressure-lowering medications were necessary 5 years after surgery. Mean best-corrected visual acuity did not change significantly (P>0.05). In all cases, filtering blebs were observed and sustained using antimetabolites. The most common complication was temporary ocular hypotony. Two patients required a revision surgery due to implant malposition. CONCLUSIONS The Eyepass glaucoma implant seems to be a safe and effective treatment option for patients with primary open-angle glaucoma. The use of this device resulted in a significant decrease of IOP.
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Ramakrishna S, Nelivigi S, Sadananda AM, Ganesh S. Study of efficacy and timing of laser suture lysis in reducing intraocular pressure after trabeculectomy with mitomycin-C. Oman J Ophthalmol 2016; 9:144-149. [PMID: 27843228 PMCID: PMC5084496 DOI: 10.4103/0974-620x.192264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Laser suture lysis is used to enhance filtration after trabeculectomy. Aims: The aim of this is to evaluate the change in intraocular pressure (IOP) after laser suture lysis after trabeculectomy with mitomycin-C and to correlate the efficacy of suture lysis in relation to the time of lysis. Settings and Design: Prospective interventional study of seventy eyes of seventy patients. Subjects and Methods: Trabeculectomy with mitomycin-C was performed for 352 patients with glaucoma. Laser suture lysis was carried out when indicated for seventy patients during 2nd–8th week posttrabeculectomy. Primary outcome measures were IOP at immediate postsuture lysis, 1, 2, 4, 6, and 8 weeks, 3 and 6 months following laser suture lysis. For the purpose of statistical analysis, patients were divided into three groups depending on the week of suture lysis as <3 weeks, 3rd–5th week, and >5 weeks posttrabeculectomy and 21 mmHg was used as the cutoff for the achievement of target IOP. Statistical Analysis Used: Descriptive statistical analysis has been carried out. Significance is assessed at 5% level of significance. Student's t-test (two-tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups. Chi-square/Fisher exact test has been used to find the significance of study parameters on categorical scale between two or more groups. Results: On immediate postsuture lysis, 62 patients (88.6%) had IOP of <21 mmHg which increased to 68 patients (98.6%) at the end of 6 months postsuture lysis. When laser suture lysis was performed during 3rd–5th week posttrabeculectomy, 34 patients (73.9%) achieved the target IOP. Conclusions: Laser suture lysis during 3rd–5th week posttrabeculectomy with mitomycin-C is an effective and safe technique for reducing IOP.
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Affiliation(s)
- Swati Ramakrishna
- Department of Glaucoma, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | - Sirish Nelivigi
- Department of Glaucoma, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
| | | | - Sri Ganesh
- Department of Glaucoma, Nethradhama Superspeciality Eye Hospital, Bengaluru, Karnataka, India
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Gigon A, Shaarawy T. The Suprachoroidal Route in Glaucoma Surgery. J Curr Glaucoma Pract 2016; 10:13-20. [PMID: 27231415 PMCID: PMC4875730 DOI: 10.5005/jp-journals-10008-1197] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022] Open
Abstract
Glaucoma surgeries targeting the uveoscleral drainage pathways have been drawing more attention lately. Among all the available techniques, procedures focusing on the supra-choroidal space seem particularly promising, by making use of a presumably efficient and secure outflow route and avoiding subconjunctival filtration blebs. The purpose of this review is to assess the efficacy and the security of the different suprachoroidal drainage implants, namely the CyPass Micro-Stent, the iStent Supra, the SOLX Gold Shunt, the Aquashunt, and the STARflo Glaucoma Implant. Most clinical studies seem to currently point toward the direction that there are actual benefits in suprachoroidal surgeries by avoiding bleb-related complications. Nevertheless, even suprachoroidal implants may be subject to scarring and failure. More data are still needed, especially concerning long-term effects, although the approach does seem appealing. How to cite this article: Gigon A, Shaarawy T. The Suprachoroidal Route in Glaucoma Surgery. J Curr Glaucoma Pract 2016;10(1): 13-20.
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Affiliation(s)
- Anthony Gigon
- Medical Student (Final Year), Department of Ophthalmology, Geneva University Hospital Geneva, Switzerland
| | - Tarek Shaarawy
- LecturerDepartment of Ophthalmology, Geneva University Hospital Geneva, Switzerland
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Kyei S, Koffuor GA, Ramkissoon P, Owusu-Afriyie O. Anti-glaucoma potential of Heliotropium indicum Linn in experimentally-induced glaucoma. EYE AND VISION 2015; 2:16. [PMID: 26605369 PMCID: PMC4657293 DOI: 10.1186/s40662-015-0027-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/08/2015] [Indexed: 01/06/2023]
Abstract
Background Heliotropium indicum is used as a traditional remedy for hypertension in Ghana. The aim of the study was to evaluate the anti-glaucoma potential of an aqueous whole plant extract of H. indicum to manage experimentally-induced glaucoma. Methods The percentage change in intraocular pressure (IOP), after inducing acute glaucoma (15 mLkg−1 of 5 % dextrose, i.v.), in New Zealand White rabbits pretreated with Heliotropium indicum aqueous extract (HIE) (30–300 mgkg−1), acetazolamide (5 mgkg−1), and normal saline (10 mLkg−1) per os were measured. IOPs were also monitored in chronic glaucoma in rabbits (induced by 1 % prednisolone acetate drops, 12 hourly for 21 days) after treatments with the same doses of HIE, acetazolamide, and normal saline for 2 weeks. The anti-oxidant property of the extract was assessed by assaying for glutathione levels in the aqueous humour. Glutamate concentration in the vitreous humour was also determined using ELISA technique. Histopathological assessment of the ciliary bodies was made. Results The extract significantly reduced intraocular pressure (p ≤ 0.05–0.001) in acute and chronic glaucoma, preserved glutathione levels and glutamate concentration (p ≤ 0.01–0.001). Histological assessment of the ciliary body showed a decrease in inflammatory infiltration in the extract and acetazolamide-treated group compared with the normal saline-treated group. Conclusion The aqueous whole plant extract of Heliotropium indicum has ocular hypotensive, anti-oxidant and possible neuro-protective effects, which therefore underscore its plausible utility as an anti-glaucoma drug with further investigation.
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Affiliation(s)
- Samuel Kyei
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu- Natal, Durban, South Africa ; Department of Optometry, School of Physical Sciences, University of Cape-Coast, Cape-Coast, Ghana
| | - George Asumeng Koffuor
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu- Natal, Durban, South Africa ; Department of Pharmacology, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Ramkissoon
- Discipline of Optometry, School of Health Sciences, College of Health Sciences, University of KwaZulu- Natal, Durban, South Africa
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Nugent RB, Lee GA. Ophthalmic use of blood-derived products. Surv Ophthalmol 2015; 60:406-34. [PMID: 26077627 DOI: 10.1016/j.survophthal.2015.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/23/2015] [Accepted: 03/25/2015] [Indexed: 12/23/2022]
Abstract
There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.
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Affiliation(s)
| | - Graham A Lee
- City Eye Centre, Brisbane, Queensland, Australia; Department of Ophthalmology, University of Queensland, Brisbane, Queensland, Australia.
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Jeong H, Sung KR. Augmentation of filtering blebs with viscoelastics in trabeculectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:393-8. [PMID: 25276081 PMCID: PMC4179116 DOI: 10.3341/kjo.2014.28.5.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/20/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. Methods In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. Results The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). Conclusions Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.
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Affiliation(s)
- Hyerin Jeong
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Arslan S, Aydemir O, Güler M, Dağlı AF. Modulation of postoperative scarring with tacrolimus and octreotide in experimental glaucoma filtration surgery. Curr Eye Res 2012; 37:228-33. [PMID: 22335810 DOI: 10.3109/02713683.2011.635404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The purposes of this study were to investigate the effects of topically administrated Tacrolimus and Octreotide on modulation of postoperative scarring in experimental glaucoma filtration surgery and to compare the antifibrotic properties of these agents with mitomycin-C (MMC). MATERIAL AND METHODS A total of 28 New Zealand rabbits weighing 2.5-3 kg were randomly divided into a surgical control (SC) group and three experimental groups. Standard filtration surgeries were performed on the right eyes of all the rabbits. The rabbits in the SC group received only vehicle after the surgeries, whereas the rabbits in the three experimental groups were treated either with 0.4 mg/mL MMC during the surgery (MMC group) or with 0.3 mg/mL Tacrolimus drop four times a day (TT group) or with 10 µg/mL Octreotide drop three times a day (OT group) for 14 days. The animals were killed on day 14, eyes were enucleated and histologically and immunohistochemically analyzed. RESULTS In SC group mean fibroblast, mononuclear cell number and fibroblast growth factor-β (FGF-β), transforming growth factor-β (TGF-β) immunostaining intensity was higher than all treatment groups. In OT group mean fibroblast number was lesser than MMC (p < 0.01) and TT (p < 0.05) group. In TT group mean fibroblast number was lesser than MMC group (p < 0.05). Mean mononuclear cell number was similar between MMC, OT and TT groups (p > 0.05). In MMC, OT and TT groups mean TGF-β and FGF-β immunostaining intensity was similar (p > 0.05). CONCLUSIONS Topically administration of Tacrolimus and Octreotide effectively reduced the subconjuntival scarring response 2 weeks after experimental glaucoma filtration surgery.
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Affiliation(s)
- Sermal Arslan
- Department of Ophthalmology, School of Medicine, Fırat University, Elazig, Turkey
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