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Holekamp NM, Yaqub M, Ranade SV, Cantrell RA, Singh S, Gazzard G. Systematic Literature Reviews Comparing the Long-Term Safety Outcomes for the Port Delivery System with Ranibizumab (PDS) Versus Other Ocular Implants. Ophthalmol Ther 2024; 13:2303-2329. [PMID: 39090513 PMCID: PMC11341515 DOI: 10.1007/s40123-024-01001-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024] Open
Abstract
OBJECTIVES To determine whether the types and rates of post-surgical complications associated with the Port Delivery System with ranibizumab (PDS) are comparable with those reported for other ocular implants that cross the sclera. METHODS Systematic literature reviews were conducted to determine the long-term (≥ 18-month) safety of ocular implants that cross the sclera in clinical trials and real-world studies. Complication types and rates were compared with those reported for the PDS in phase III clinical trials (Archway, Pagoda, and Pavilion). RESULTS Sixteen clinical trials (24 publications) and 43 real-world studies were identified reporting 30 complications in eyes with 15 implant types and 8 ocular diseases. Implants were associated with an acceptable, well-characterized safety profile, with most complications resolving spontaneously or with treatment. Device-related complications were reported in 0.7% (0.0-5.0%) of study eyes in clinical trials and 1.3% (0.0-14.5%) of eyes in real-world studies. Rates of conjunctival complications were 2.1% (0.0-22.8%) and 2.2% (0.9-4.6%), respectively. The overall types and rates of adverse events of special interest reported for the PDS in phase III trials (cataract, conjunctival bleb, vitreous hemorrhage, conjunctival erosion, conjunctival retraction, endophthalmitis, implant dislocation, retinal detachment, and hyphema) were within the ranges reported for other ocular implants. CONCLUSIONS The rates of complications reported in phase III clinical trials for the PDS were within the ranges reported for other ocular implants that cross the sclera. This suggests that the long-term safety of the PDS is consistent with other ocular devices established in ophthalmology clinical practice. TRIAL REGISTRATION PROSPERO international prospective register of systematic reviews: CRD5202234129, CRD42022343129.
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Affiliation(s)
- Nancy M Holekamp
- Pepose Vision Institute, Chesterfield, MO, USA.
- F. Hoffmann-La Roche Ltd, Basel, Switzerland.
| | - Manejeh Yaqub
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | - Shrirang V Ranade
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | - Ronald A Cantrell
- Genentech, Inc., a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Gus Gazzard
- Institute of Ophthalmology, University College London, London, UK
- NIHR Moorsfield Biomedical Research Centre, Moorfield Eye Hospital NHS Foundation Trust, London, UK
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Van Swol JM, Walden DN, Van Swol EG, Nguyen SA, Nutaitis MJ, Kassm TM. Comparison of Repeat Trabeculectomy Versus Ahmed Valve Implantation After Initial Failed Trabeculectomy Surgery. J Glaucoma 2023; 32:744-749. [PMID: 37311016 DOI: 10.1097/ijg.0000000000002240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/06/2023] [Indexed: 06/15/2023]
Abstract
PRCIS Repeat trabeculectomy is associated with similar postoperative intraocular pressure (IOP), a lower complication rate, and a lower need for medications when compared with Ahmed valve implantation (AVI) when performed after initially failed trabeculectomy. OBJECTIVE The goal of this study was to compare the efficacy of repeat trabeculectomies and AVI after an initial failed trabeculectomy. METHODS All studies that investigated the postoperative success of patients who underwent AVI or repeat trabeculectomy with mitomycin- C after a prior failed trabeculectomy with mitomycin- C found in PubMed, Cochrane Library, Scopus, and CINAHL were included. Mean preoperative and postoperative IOP, proportions of complete and qualified successes, and proportions of complications were extracted from each study. Meta-analyses were performed to compare the differences between the two surgical approaches. Methods of measuring complete and qualified success were too heterogeneous among the included studies to allow for meta-analysis. RESULTS The literature search yielded 1305 studies, and 14 studies were included in the final analysis. Mean IOP was not significantly different between the two groups preoperatively and then after 1, 2, and 3 years. Mean number of medications between the two groups was similar preoperatively. After 1 and 2 years, the mean amount of glaucoma medications in the AVI group was approximately twice that of the trabeculectomy group; however, this relationship was only significant at 1 year of follow-up ( P = 0.042). In addition, the cumulative proportion of overall and sight-threatening complications was significantly higher in the AVI group. CONCLUSION Repeat trabeculectomy with mitomycin- C and AVI may both be considered after failed primary trabeculectomy. However, our analysis suggests that repeat trabeculectomy may be the preferred method as it provides similar efficacy with fewer disadvantages.
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Affiliation(s)
| | | | | | | | - Matthew J Nutaitis
- Department of Ophthalmology-Glaucoma, Medical University of South Carolina, Charleston, SC
| | - Tala M Kassm
- Department of Ophthalmology-Glaucoma, Medical University of South Carolina, Charleston, SC
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Dawson EF, Rosenberg NC, Meyer AM, Culpepper BE, Bolch CA, Wilson MK, Nguyen PT, Rodgers CD, Smith RJ, Blake CR, Sherwood MB. Comparison of Outcomes of Glaucoma Drainage Implant Surgery With or Without Prior Failed Trabeculectomy. J Glaucoma 2021; 30:585-595. [PMID: 33867503 DOI: 10.1097/ijg.0000000000001852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
PRECIS A comparison of 186 glaucoma patients with mixed diagnoses who underwent nonvalved glaucoma drainage device (GDD) implant surgery showed similar long-term intraocular pressure (IOP), medication, and visual acuity (VA) outcomes between those with prior failed trabeculectomy surgery versus those without. PURPOSE The purpose of this study was to evaluate whether prior failed trabeculectomy adversely affects the outcome of glaucoma tube surgery. PATIENTS AND METHODS A total of 186 eyes of 186 patients who underwent a nonvalved GDD implant surgery by a single surgeon between 1996 and 2015 at a University practice were included. Patients were of mixed diagnoses and over 18 years old. Before the GDD surgery, 65 had a previous failed glaucoma filtering surgery and 121 had no prior glaucoma surgery. Demographic information, preoperative and postoperative IOP, medication, VA, and complications were collected from chart review. RESULTS No significant difference was noted in mean IOP and mean medication use (13.0 and 12.6 mm Hg on 2.0 and 1.7 medication classes at 5 y postoperatively, respectively), mean VA and change in VA from baseline, or numbers of complications (P>0.05), between eyes that had a prior failed filtration surgery and those that had not. Kaplan-Meier plots for failure over 5 years using a lower limit of <5 mm Hg and an upper limit of ≥18, ≥15, or ≥12 mm Hg did not show a significant difference between groups. Subanalyses were performed to examine only primary glaucoma eyes and results were similar. Further group subanalyses comparing those with baseline IOP ≥25 or <25 mm Hg, age 65 and above or below 65 years and those specifically with Baerveldt 350 mm2 implants also did not show significant differences. CONCLUSION Prior failed filtration surgery does not appear to affect the outcome of future GDD surgery.
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Affiliation(s)
- Emily F Dawson
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Nicole C Rosenberg
- Department of Ophthalmology, University of Florida, Gainesville, FL
- The Edward Via College of Osteopathic Medicine, Spartanburg, SC
| | - Alissa M Meyer
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | | | | | - Mary K Wilson
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Phuong T Nguyen
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Cooper D Rodgers
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Ryan J Smith
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Charles R Blake
- Department of Ophthalmology, University of Florida, Gainesville, FL
| | - Mark B Sherwood
- Department of Ophthalmology, University of Florida, Gainesville, FL
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Vanner EA, Sun CQ, McSoley MJ, Persad PJ, Feuer WJ, Lum F, Kelly SP, Parrish RK, Chang TC, Gedde SJ. Tube Versus Trabeculectomy IRIS Ⓡ Registry 1-Year Composite Outcome Analysis with Comparisons to the Randomized Controlled Trial. Am J Ophthalmol 2021; 227:87-99. [PMID: 33657420 DOI: 10.1016/j.ajo.2021.02.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE This study compared 1-year results for the composite treatment outcome from the Tube Versus Trabeculectomy (TVT) randomized controlled trial (RCT) to those from an IRISⓇ (Intelligent Research In Sight) Registry cohort of analogous eyes. DESIGN Retrospective clinical study with comparison to an RCT. METHODS Subjects' eyes in the IRIS Registry received either a glaucoma drainage implant (tube) or underwent trabeculectomy after a previous trabeculectomy and/or cataract extraction and had data for 1-year follow-up analyses. OUTCOME Eyes were classified as failing if they had hypotony (intraocular pressure (IOP) ≤5 mm Hg) or inadequate IOP control (IOP >21 mm Hg or not reduced at least 20% below baseline) on 2 consecutive follow-up visits after 3 months, a reoperation for glaucoma, or no light perception vision and as successful otherwise. Failure risk was compared by treatment, demographic, and clinical variables and was compared to analogous failure risks from the TVT RCT. RESULTS The TVT IRIS Registry cohort included 419 eyes, 236 tube eyes (56.3%) and 183 trabeculectomy eyes (43.7%). In this cohort, there was no significant failure risk difference (12.3% for tube eyes and 16.4% for trabeculectomy eyes, P = 0.231). Comparing the studies, there was a significantly greater risk of failure in the TVT IRIS Registry tube eyes than in the TVT RCT tube eyes (3.8%; P <.001). Reasons for treatment failure included reoperations for glaucoma (none in the TVT RCT at 1 year). CONCLUSIONS Our results were different from those in the TVT RCT. Possible reasons include non-Baerveldt tubes, greater severity among tube eyes, and practice patterns that reflect real-world data, which are different than those in RCTs.
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Affiliation(s)
| | - Catherine Q Sun
- Bascom Palmer Eye Institute, Miami, Florida, USA; University of California San Francisco, San Francisco, California, USA
| | - Matthew J McSoley
- Bascom Palmer Eye Institute, Miami, Florida, USA; University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Scott P Kelly
- American Academy of Ophthalmology, San Francisco, California
| | | | - Ta C Chang
- Bascom Palmer Eye Institute, Miami, Florida, USA
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Tekeli O, Elgin U, Takmaz T, Ekşioğlu Ü, Baş Z, Yarangümeli A, Karakurt A, Evren Kemer Ö, Mumcuoğlu T, Aktaş Z, Akman A, Bayer A. Characteristics of uveitic glaucoma in Turkish patients. Eur J Ophthalmol 2020; 31:1836-1843. [PMID: 32799547 DOI: 10.1177/1120672120950932] [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] [Indexed: 01/24/2023]
Abstract
PURPOSE To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases. METHODS This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results. RESULTS During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes. CONCLUSION UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.
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Affiliation(s)
- Oya Tekeli
- Ophthalmology Department, Ankara University Medical School, Ankara, Turkey
| | - Ufuk Elgin
- Ulucanlar Training and Research Hospital, Ankara, Turkey
| | - Tamer Takmaz
- Atatürk Training and Research Hospital, Ankara, Turkey
| | - Ümit Ekşioğlu
- Ankara Training and Research Hospital, Ankara, Turkey
| | - Zeynep Baş
- Ophthalmology Department, Ankara University Medical School, Ankara, Turkey
| | | | | | - Özlem Evren Kemer
- Ophthalmology Department, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Tarkan Mumcuoğlu
- Ophthalmology Department, Gülhane Training and Research Hospital, Ankara, Turkey
| | - Zeynep Aktaş
- Ophthalmology Department, Gazi University Medical School, Ankara, Turkey
| | - Ahmet Akman
- Ophthalmology Department, Başkent University Medical School, Ankara, Turkey
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Surgical Outcomes of a Second Ahmed Glaucoma Valve Implantation in Asian Eyes with Refractory Glaucoma. J Ophthalmol 2020; 2020:8741301. [PMID: 32280538 PMCID: PMC7125488 DOI: 10.1155/2020/8741301] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
Results The cumulative failure rates were 9.5%, 20.0%, 32.5%, and 46.0% at six months, one year, two years, and three years of follow-up. At final follow-up, complete success and qualified success rates were 23.8% and 33.3%, respectively; mean IOP and number of medications decreased by 5.6 mmHg (23.9%) and 1.7 mmHg (54.8%), respectively, from preoperative baseline (P < 0.01). More common postoperative complications included hypertensive phase (38.1%), corneal decompensation (23.8%), and tube exposure (14.3%). Conclusion An additional AGV implant had good short and modest long-term effectiveness in reducing IOP following a failed glaucoma tube shunt in Asian eyes, with the mentioned common postoperative complications to be actively monitored and managed.
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Abstract
AIMS To assess the efficacy and safety of the Xen gel stent in reducing intraocular pressure (IOP) in eyes with prior failed trabeculectomy and to determine the frequency of complications and further intervention. METHODS Retrospective case note review of all patients with prior trabeculectomy undergoing Xen surgery across 5 centers from August 2015 to May 2017. RESULTS In total, 17 surgeries were reviewed. IOP reduced from 21.5 (±2.4) mm Hg preoperatively to 13.6 (±3.4) mm Hg at month 12 (P<0.05). Medication usage reduced from 2.8 (±0.6) preoperatively to 1.0 (±1.3) at month 12 (P<0.05). Adverse events included: numerical hypotony (IOP<6 mm Hg) in 4 cases (23.5%) that all resolved spontaneously, IOP spike of ≥30 mm Hg in 2 (11.8%) cases and transient occlusion of the implant by iris in 1 (5.9%) case. Secondary filtration surgery (Baerveldt tube implantation) was required in 2 (11.8%) cases. Postoperative bleb intervention was required in 9 cases (52.9%), usually in the first month after surgery. CONCLUSIONS Xen reduces IOP and number of medications in eyes with failed trabeculectomy. Detailed preoperative conjunctival assessment and targeted stent placement is required. Prospective data and follow-up beyond 12 months are required but Xen seems a viable, effective, and safe option after failed trabeculectomy.
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Davids AM, Pahlitzsch M, Boeker A, Torun N, Bertelmann E, Maier-Wenzel AK, Hager A, Gonnermann J, Klamann M. iStent inject as a reasonable alternative procedure following failed trabeculectomy? Eur J Ophthalmol 2018; 28:735-740. [PMID: 29592533 DOI: 10.1177/1120672117747010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE: The aim of this study is to assess the intraocular pressure lowering effect and the performance of the glaucoma therapy of the iStent inject in glaucoma patients with uncontrolled intraocular pressure after failed trabeculectomy. METHODS: In this retrospective study, iStent inject implantation (Glaukos Corporation, Laguna Hills, CA, USA) was performed in 22 eyes of 21 subjects suffering from glaucoma (n = 18 primary open angle glaucoma, n = 3 pseudoexfoliation glaucoma, and n = 1 for secondary glaucoma) with an intraocular pressure above target pressure after failed trabeculectomy (mean = 9.6 ± 8.1 years; range: 1-35 years). The intraocular pressure and the number of antiglaucomatous medication were assessed preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery and compared to preoperative findings (SPSS v23.0; Shapiro-Wilk test, Wilcoxon test, Friedman test). RESULTS: The results showed a significant intraocular pressure decrease from 22.5 ± 4.6 to 15.5 ± 3.4 mmHg after 1 year follow-up (p = 0.012). The glaucoma therapy was 2.6 ± 1.2 preoperatively and reduced to 2.25 ± 1.5 number of medications after 1 year (p > 0.05). There was no significant difference in the number of medication during the whole follow-up period (1 year, p = 0.012). No significant intra- or postoperative complications were reported. CONCLUSION: Minimal invasive glaucoma surgery (iStent inject) can offer an effective intraocular pressure reduction in advanced adult primary and secondary open angle glaucoma after failed trabeculectomy in a follow-up period of 1 year. Glaucoma therapy, however, needs to be maintained to achieve an individual target pressure and to prevent glaucoma progression. In addition, a failure rate of 27.3% makes it necessary to select carefully patients for this treatment option.
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Affiliation(s)
- Anja-Maria Davids
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Boeker
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Annette Hager
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Gonnermann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Klamann
- Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Fatehi N, Morales E, Parivisutt N, Alizadeh R, Ang G, Caprioli J. Long-term Outcome of Second Ahmed Valves in Adult Glaucoma. Am J Ophthalmol 2018; 186:96-103. [PMID: 29199011 DOI: 10.1016/j.ajo.2017.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the long-term outcomes of second Ahmed glaucoma valve (AGV) implants in eyes with glaucoma. DESIGN Retrospective interventional case series. METHODS Patients with sequential second Ahmed valves implanted in the same eye from 1994 to 2016 were included. Success was defined with 3 criteria: (1) intraocular pressure (IOP) ≤ 21 mm Hg and IOP reduction of 20%; (2) IOP ≤ 18 mm Hg and IOP reduction of 25%; and (3) IOP ≤15 mm Hg and IOP reduction of 30%. The primary analysis was the 5-year Kaplan-Meier survival rate for each criterion. Failure was established when the success criterion was not met at 2 consecutive visits at least 3 months after the surgery. Loss of light perception, requirement for additional glaucoma surgery, hypotony maculopathy, and serious complications were also considered failures. RESULTS One hundred ten eyes from 104 patients were included with a mean follow-up of 5.0 years (interquartile range [IQR] 1.6-7.33 years). The median (IQR) age at the second AGV was 68.0 (53.5-77.9) years. The median (IQR) time between surgeries was 2.1 (0.7-4.0) years. The 5-year Kaplan-Meier survival rates were 57%, 51%, and 30% for criteria 1, 2, and 3, respectively. CONCLUSION A second AGV is effective in reducing IOP in patients who require additional IOP lowering after a first AGV. The success rates are comparable to primary AGV implantation, and to trabeculectomy in eyes with a previously implanted glaucoma drainage device. A second AGV is a viable option in eyes with inadequate IOP levels after a primary AGV.
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