1
|
Almobarak FA, Alrubean A, Alsarhani WK, Aljenaidel A. Ultrasound cyclo plasty in advanced glaucoma: Intermediate-term success, predictors for failure and complications. Eur J Ophthalmol 2024:11206721241235430. [PMID: 38425194 DOI: 10.1177/11206721241235430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE To report the intermediate-term success rate of ultrasound cyclo plasty (UCP), predictors for failure and complications in advanced glaucoma. METHODS This study included patients with advanced glaucoma who underwent UCP. The main outcome measures were intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of complications. Success was defined as an IOP reduction ≥30% and IOP between 6 mmHg and 18 mmHg with no vision-threatening complications. Cox proportional hazard regression analysis was performed to identify possible predictors for failure. RESULTS We included 65 eyes of 58 patients in the study. The mean IOP and number of antiglaucoma medications decreased significantly from 27.60 ± 5.5 mmHg and 3.40 ± 0.9 at baseline to 17.80 ± 8.0 mmHg (35.51% reduction) and 2.43 ± 1.3 at 12 months and 17.10 ± 8.2 mmHg (38.04% reduction) and 2.41 ± 1.5 at 24 months, respectively (p < 0.01 for both). The success rates were 66.2% (43/65) and 72.4% (21/29), while the failure rates were 33.8% (22/65) and 27.6% (8/29) at 12 and 24 months postoperatively, respectively. The cumulative probabilities of overall success were 67.7 ± 5.8% and 33.8 ± 5.9% at 12 and 24 months, respectively. High baseline IOP and history of old glaucoma surgery were associated with a higher risk for failure (Hazard ratio = 1.10 and 5.82, p = 0.03 and p < 0.01, respectively). The most common complications were anterior chamber reaction (18.5%) and cataract development/progression (15.4%). Two eyes (3.1%) developed phthisis bulbi. CONCLUSIONS Although UCP is effective in lowering IOP in eyes with advanced glaucoma, the intermediate-term success rates were moderate.
Collapse
Affiliation(s)
- Faisal A Almobarak
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Glaucoma Research Chair, King Saud University, Riyadh, Saud Arabia
| | - Ahmed Alrubean
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Waleed K Alsarhani
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Ophthalmology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Aljenaidel
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Yadgarov A, Dentice K, Aljabi Q. Real-World Outcomes of Canaloplasty and Trabeculotomy Combined with Cataract Surgery in Eyes with All Stages of Open-Angle Glaucoma. Clin Ophthalmol 2023; 17:2609-2617. [PMID: 37674592 PMCID: PMC10478966 DOI: 10.2147/opth.s422132] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023] Open
Abstract
Purpose To evaluate the long-term safety and efficacy of sequential canaloplasty and trabeculotomy combined with cataract surgery in patients with mild, moderate, and advanced open-angle glaucoma. Patients and Methods Case records of 171 consecutive patients (171 eyes) who had undergone cataract surgery followed by canaloplasty (≥180°) and trabeculotomy (≥90°) for mild, moderate, or advanced open-angle glaucoma (Shaffer grade ≥3) using the OMNI Surgical System (Sight Sciences, Inc., Menlo Park, CA) were analyzed retrospectively. Efficacy endpoints included change in mean IOP and number of medications from baseline to postoperative 12- and 24-months for the overall dataset and stratified by each stage of glaucoma. Kaplan-Meier survival analysis of success (eyes that did not require secondary surgical interventions (SSI)) by postoperative 24 months was also performed. Results Postoperatively, there was a statistically significant reduction in IOP (baseline of 17.2 mmHg on 1.3 medicines reduced to 14.3 on 0.8 medicines (12 months) and 14.0 on 0.9 medicines (24 months), p<0.001 for both time points). Eyes with advanced glaucoma (N=63) maintained significant IOP reduction (17.8 mmHg on 1.6 medicines at baseline reduced to 13.6 mmHg on 1.3 medicines (12 months) and 13.0 on 1.5 medicines (24 months), p<0.001). Kaplan-Meier analysis showed a 93.0% survival probability for the avoidance of SSI at 2 years after surgery. Conclusion Canaloplasty and trabeculotomy combined with cataract surgery provided effective IOP reduction for eyes with all stages of glaucoma at postoperative 12 and 24 months, and the procedure yielded a 93% survival rate for SSI avoidance at 2 years.
Collapse
|
3
|
Kim HJ, Sung MS, Park SW. Factors Associated with Visual Acuity in Advanced Glaucoma. J Clin Med 2023; 12:jcm12093076. [PMID: 37176517 PMCID: PMC10179664 DOI: 10.3390/jcm12093076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
This study aimed to comprehensively analyze various parameters in advanced glaucoma patients to identify the factors that can affect best-corrected visual acuity (BCVA) in advanced glaucoma. This cross-sectional retrospective study included 113 patients (mean age, 61.66 ± 13.26 years; males, 67) who had advanced glaucomatous damage (113 eyes; mean BCVA, 0.18 ± 0.38 logMAR; mean deviation of 30-2 visual field [VF], -19.08 ± 6.23 dB). Peripapillary retinal nerve fiber layer (RNFL) and total and segmented macular thickness (RNFL, ganglion cell layer (GCL), and inner plexiform layer (GCL)) were measured using Spectralis optical coherence tomography (OCT). Correlations between BCVA and OCT parameters or 30-2 VF parameters were assessed using Pearson correlation analysis. Multivariate regression analysis was performed to determine the factors associated with BCVA in advanced glaucoma patients. Peripapillary RNFL thickness, subfoveal choroidal thickness, and global macular RNFL, GCL, IPL, and total thickness were found to be significantly correlated with BCVA and central visual function. Multivariate analysis showed a significant correlation between subfoveal choroidal thickness and BCVA. In addition, central VF mean sensitivity, especially inferior hemifield, showed a significant relationship with BCVA. In conclusion, subfoveal choroidal thickness and central VF sensitivity, especially the inferior hemifield area, are factors that affect BCVA in advanced glaucoma.
Collapse
Affiliation(s)
- Hyun Jee Kim
- Department of Ophthalmology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Mi Sun Sung
- Department of Ophthalmology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| | - Sang Woo Park
- Department of Ophthalmology, Research Institute of Medical Sciences, Chonnam National University Medical School and Hospital, Gwangju 61469, Republic of Korea
| |
Collapse
|
4
|
Patil TS, Viswanathan N, George R. To compare central visual field progression using mean deviation and pointwise linear regression analysis. Indian J Ophthalmol 2023; 71:854-860. [PMID: 36872693 DOI: 10.4103/ijo.ijo_1737_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Purpose To compare central visual field progression using mean deviation and pointwise linear regression (PLR) analysis. Methods We analyzed the 10-2 Humphrey visual field (HVF) tests for moderate and advanced primary glaucoma who had undergone at least five reliable 10-2 visual field tests with a minimum follow-up of at least two years and best-corrected visual acuity better than 6/12. Regression slope less than -1 dB/year at P < 0.01 at a point was defined as an individual threshold point progression. Results Ninety-six eyes of 74 patients were included. The median follow-up duration was of 4 years (±1.97). Median 10-2 mean deviation (MD) at inclusion was -19.01 dB (interquartile range [IQR] -13.2, -24.14) and -21.90 (IQR - 13.4, -27.8) on 24-2 HVF. The median rate of MD change was -0.13 dB/year (IQR - 0.46, 0.08) for 10-2. The median rate for visual field index (VFI) change was 0.9% per year (IQR - 1.5, 0.4). Twenty-eight percent of eyes (27 eyes) showed progression. Twelve percent (12 eyes) showed progression of two or more points in the same hemifield on pointwise linear regression (PLR) analysis, and 16% of eyes (15 eyes) showed progression of one point. The median rate of MD change was significantly more in progressing eyes based on PLR analysis than eyes with no progression (-0.5 vs. -0.06 dB/year P < 0.001). One patient had likely and the second had possible progression on 24-2. In 24 eyes, event analysis did not show any change; the rest mean deviation was out of range. Conclusion Central visual field PLR analysis is useful in detecting progression in advanced glaucomatous damage.
Collapse
Affiliation(s)
- Trupti S Patil
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, India
| | - N Viswanathan
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, India
| | - Ronnie George
- Smt. Jadhavbai Nathamal Singhvee Glaucoma Services, Sankara Nethralaya Medical Research Foundation, Chennai, Tamil Nadu, India
| |
Collapse
|
5
|
Filippopoulos T, Tsoukanas D, Kandarakis SA, Salonikiou A, Georgiou M, Topouzis F. Survival of Visual Function in Patients with Advanced Glaucoma after Standard Guarded Trabeculectomy with MMC. J Clin Med 2023; 12. [PMID: 36836173 DOI: 10.3390/jcm12041639] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/14/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
Surgical intervention in patients with severe glaucoma remains controversial, especially in unilateral cases with a minimally affected fellow eye. Many question the benefit of trabeculectomy in such cases due to high complication rates and prolonged recovery. In this retrospective, non-comparative, interventional case series we aimed to determine the effect of trabeculectomy or combined phaco-trabeculectomy on the visual function of advanced glaucoma patients. Consecutive cases with perimetric mean deviation loss worse than -20 dB were included. Survival of visual function according to five predetermined visual acuity and perimetric criteria was set as the primary outcome. Qualified surgical success utilizing two different sets of criteria commonly used in the literature constituted secondary outcomes. Forty eyes with average baseline visual field mean deviation -26.3 ± 4.1 dB were identified. The average pre-operative intraocular pressure was 26.5 ± 11.4 mmHg and decreased to 11.4 ± 4.0 mmHg (p < 0.001) after an average follow-up of 23.3 ± 15.5 months. Visual function was preserved at two years in 77% or 66% of eyes respectively according to two different sets of visual acuity and perimetric criteria. Qualified surgical success was 89%, 72% at 1 and 3 years respectively. Trabeculectomy and/or phaco-trabeculectomy is associated with meaningful visual outcomes in patients with uncontrolled advanced glaucoma.
Collapse
|
6
|
Ghahari E, Bowd C, Zangwill LM, Proudfoot JA, Penteado RC, Kyung H, Hou H, Moghimi S, Weinreb RN. The Association Between Regional Macula Vessel Density and Central Visual Field Damage in Advanced Glaucoma Eyes. J Glaucoma 2022; 31:734-743. [PMID: 35654344 PMCID: PMC10695567 DOI: 10.1097/ijg.0000000000002055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Abstract
PRCIS Both macular superficial vessel density and ganglion cell complex (GCC) thickness measurement are significantly associated with regional and global 10-degree central visual field (VF) sensitivity in advanced glaucoma. PURPOSE The purpose of this study was to evaluate the regional and global structure-function relationships between macular vessel density (MVD) assessed by optical coherence tomography angiography (OCTA) and 10-2 VF sensitivity in advanced open angle glaucoma eyes. METHODS Macular OCTA and 10-2 VF sensitivity of 44 patients [mean deviation (MD) <-10 dB] were evaluated. Regional and global VF mean sensitivity (MS) was calculated from total deviation plots. Superficial and deep MVD were obtained from 3 × 3 and 6×6 mm 2 OCTA scans using 2 sectoral definitions. Spectral-domain optical coherence tomography macular GCC thickness was obtained simultaneously from the same scan as the MVD measurements. Linear regression models were used to assess the associations ( R2 ). RESULTS Lower MS was significantly associated with a reduction in superficial MVD and GCC in each region of both scan sizes for both maps. Associations were weaker in the individual sectors of the whole image grid than the Early Treatment Diabetic Retinopathy Study map. Deep-layer MVD was not associated with central MS. Although 6×6 mm 2 and perifoveal vessel density had better associations with central 10-degree MS compared with GCC thickness (eg, R2 from 25.7 to 48.1 µm and 7.8% to 32.5%, respectively), GCC associations were stronger than MVD associations in the central 5-degree MS. CONCLUSIONS Given a stronger MVD-central 10-degree VF association compared with GCC, as well as stronger GCC-central 5-degree VF association compared with MVD, MVD and GCC are complementary measurements in eyes with advanced glaucoma. A longitudinal analysis is needed to determine the relative utility of the GCC and MVD measurements.
Collapse
Affiliation(s)
- Elham Ghahari
- Viterbi Family Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, La Jolla, CA
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Sugisaki K, Inoue T, Yoshikawa K, Kanamori A, Yamazaki Y, Ishikawa S, Uchida K, Iwase A, Araie M. Factors Threatening Central Visual Function of Advanced Glaucoma Patients: A Prospective Longitudinal Observational Study. Ophthalmology 2021; 129:488-497. [PMID: 34890684 DOI: 10.1016/j.ophtha.2021.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/17/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To identify risk factors for further deterioration of central visual function in advanced glaucoma eyes. DESIGN Prospective observational 5-year study. PARTICIPANTS Advanced glaucoma patients with well controlled intraocular pressure (IOP), the mean deviation (MD) of Humphrey Field Analyzer 24-2 program (HFA 24-2) ≤ -20 decibels and best-corrected visual acuity (BCVA) ≥ 20/40. METHODS The HFA10-2 test and BCVA examination were performed every 6 months and the HFA 24-2 test every 12 months for 5 years. The Cox proportional hazards model was used to identify risk factors for deterioration of HFA10-2 and 24-2 results and BCVA. MAIN OUTCOME MEASURES Deterioration of HFA 10-2 results was defined by the presence of the same ≥ 3 points with negative total deviation slope ≤ -1 decibel/year at P < 0.01 in ≥ 3 consecutive tests, that of HFA 24-2 results as an increase ≥ 2 in the Advanced Glaucoma Intervention Study (AGIS) score in ≥ 2 consecutive tests and that of BCVA as an increase of ≥ 0.2 in the log MAR in ≥ 2 consecutive tests. RESULTS A total of 175 advanced glaucoma eyes of 175 patients (mean age, 64.1 years; mean baseline IOP, 13.2 mmHg; mean logMAR, 0.02; Mean HFA 24-2 and 10-2 MD, -25.9 and -22.9 decibels, respectively) were included. The mean IOP during follow-up was 13.0 mmHg. The probabilities of deterioration in HFA 10-2 and 24-2 results and BCVA were 0.269 ± 0.043 (standard error), 0.173 ± 0.031 and 0.194 ± 0.033, respectively, at 5 years. Lower BCVA at baseline (P=0.012) was significantly associated with further deterioration of HFA 10-2 results. Better HFA24-2 MD (P<0.001) and use of systemic antihypertensive agents (P=0.009) were significantly associated with further deterioration of HFA 24-2 results, and a greater β-peripapillary atrophy area/disc area ratio (P<0.001), use of systemic antihypertensive agents (P=0.025) and lower BCVA (P=0.042) were significantly associated with further deterioration of BCVA, respectively. CONCLUSIONS In advanced glaucoma eyes with well controlled IOP, BCVA, β-peripapillary atrophy area/disc area ratio and use of systemic antihypertensive agents were significant prognostic factors for further deterioration of central visual function.
Collapse
Affiliation(s)
- Kenji Sugisaki
- Department of Ophthalmology, International University of Health and Welfare, Mita Hospital, Tokyo, Japan; Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toshihiro Inoue
- Department of Ophthalmology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Akiyasu Kanamori
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shinichiro Ishikawa
- Department of Ophthalmology, Saga University Faculty of Medicine, Saga, Japan
| | | | | | - Makoto Araie
- Department of Ophthalmology, University of Tokyo Graduate School of Medicine, Tokyo, Japan; Sekikawa Hospital, Tokyo, Japan
| | | |
Collapse
|
8
|
Lee J, Park CK, Park HL. The Impact of Superficial Vessel Density on Glaucoma Progression according to the Stage of Glaucoma. J Clin Med 2021; 10:5150. [PMID: 34768669 DOI: 10.3390/jcm10215150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: To investigate the clinical significance of vessel density (VD) on visual field (VF) progression regarding the severity of glaucoma. Methods: A total of 130 eyes were recruited in this retrospective and longitudinal study. Superficial and deep VDs in circumpapillary and macular regions were measured via ImageJ. The rate of VF progression was defined as the mean deviation (MD) slope (dB/year). Linear regression was used to verify factors affecting deterioration of VF. The eyes with lower superficial VD were further analyzed. Results: Fifty patients with early glaucoma (EG) (MD > −6 dB) and 52 patients with moderate-to-advanced glaucoma (MAG) (MD ≤ −6 dB) were included. A faster progression rate was found in MAG (p = 0.049). Superficial VD was noticeably related to the VF progression rate in total eyes and in MAG (Both Ps ≤ 0.007, respectively). With patients in the lower half of the superficial VD, the VD was significantly associated with the rate of progression (B, 0.049, p = 0.021). This association was independent of the baseline MD and OCT parameters. Conclusion: Decreased superficial VD might conversely affect the progression of glaucoma even in MAG, which suggests superficial VD could be used as a potential marker to foresee the disease progression even in progressed eyes.
Collapse
|
9
|
Naik M, Kapur M, Gupta V, Sethi H, Srivastava K. Ripasudil Endgame: Role of Rho-Kinase Inhibitor as a Last-Ditch-Stand Towards Maximally Tolerated Medical Therapy to a Patient of Advanced Glaucoma. Clin Ophthalmol 2021; 15:2683-2692. [PMID: 34194222 PMCID: PMC8238538 DOI: 10.2147/opth.s318897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose To elucidate the use of Ripasudil in patients of advanced glaucoma on maximally tolerated medical therapy who could not be offered the option of surgery due to the global pandemic lockdown. Materials and Methods Only patients with primary open angle glaucoma (POAG), who had a cup-disc ratio (CDR) of 0.9 or a near total cupping on maximum tolerated medical therapy for at least 4 weeks and yet could not meet the target IOP were included. Target IOP was defined as ≤12 mm Hg. A total of 30 patients were enrolled. All patients in study cohort were started on E/D Ripasudil BD. Patients were followed up at 1 week, 2 weeks, 4 weeks and then monthly for 6 months for their best corrected visual acuity (BCVA), intraocular pressure (IOP), disc changes (slit lamp biomicroscopy), perimetry, and retinal nerve fibre layer analysis using optical coherence tomography (OCT-RNFL). Results Mean pre-treatment IOP on five drugs was 18.3 ± 2.1 mm Hg (range 14 to 22mmHg) on maximally tolerated medical therapy. At 1 week follow-up, mean post-treatment IOP was 15.1 ± 1.7 mm Hg (range 12 to 18mmHg) and at 2 week follow-up, mean post-treatment IOP was 12.5 ± 1.9 mmHg (range 10 to 16mmHg). Thus, target IOP ≤12mmHg was attained in 28 patients at 2 weeks. This target IOP was maintained throughout the 6 months of follow-up period. Of the 2 patients who could not meet target IOP, 1 patient needed rearrangement of their fixed-drug-combinations to achieve target IOP at 4 weeks. The second patient required unfixing of all fixed-drug-combinations to achieve target IOP at maximally tolerated medical therapy at 6 weeks. Conclusion Ripasudil not only provides a better IOP control but also has a high safety profile even when started as an add-on drug to already-existing yet inadequate maximally tolerated medical therapy.
Collapse
Affiliation(s)
- Mayuresh Naik
- Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, India
| | - Monika Kapur
- Department of Ophthalmology, School of Medical Sciences & Research, Sharda University, Greater Noid, Uttar Pradesh, India
| | - VishnuSwarup Gupta
- Department of Ophthalmology, H.I.M.S.R & H.A.H. Centenary Hospital, New Delhi, India
| | - HarinderSingh Sethi
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
| | - Kartikeya Srivastava
- Department of Ophthalmology, V.M.M.C & Safdarjung Hospital, New Delhi, 110029, India
| |
Collapse
|
10
|
Farraová P, Ondrejková M, Demianová D. TRANSSCLERAL DIODE CYCLOPHOTOCOAGULATION IN TREATMENT OF GLAUCOMA. Cesk Slov Oftalmol 2021; 76:236-242. [PMID: 33499646 DOI: 10.31348/2020/34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cyclodestructive procedures are an alternative of surgical treatment of medically refractory glaucoma. AIM To assess efficiency and safety of diode cyclophotocoagulation (CPC). METHODS Retrospective study included 81 eyes with advanced glaucoma operated with CPC for elevated intraocular pressure (IOP) from January 2017 to January 2019. CPC was performed in retrobulbar anesthesia with contact diode laser FOX (A.R.C. Laser, Germany) of wavelength 810 nm, transsclerally to the ciliary body. Energy settings: intensity 2 W, exposition time 2 s, 18 applications in arc of 360°. Decrease of intraocular pressure was investigated during month 1, 6 and 12 after CPC. Safety was evaluated according to the best corrected visual acuity (BCVA) on Snellen optotypes and number of postoperative complications. RESULTS Study on 31 eyes of 24 patients, 21 (68 %) women and 10 (32 %) men, with follow-up during more than 12 months. Mean follow-up time was 19.5 ± 6.1 (from 12 to 29) months. Average age was 75.9 ± 9.2 (56 - 93) years. Indication for CPC was primary open angle glaucoma in 15 eyes (49 %), primary angle closure glaucoma in 6 eyes (19 %) and secondary glaucomas in 10 eyes (32 %). All patients were on therapy of 4 antiglaucomatic drops and 10 of them (32 %) on acetazolamide pills. IOP before CPC was 25.4 ± 11.0 (13-56) mm Hg. After 1 year IOP decreased to 16.9 ± 6.1 (8-40) mm Hg. Best corrected visual acuity (BCVA) before CPC was 0.39 ± 0.34 (0-1), 1 year after CPC 0.36 ± 0.33 (0-1). 1 year after CPC, 11 eyes (35 %) lost 0.23 ± 0.14 rows. 6 from these (19 %) due to other acquired ocular pathologies. Hypotony occurred in 6 % and uveitis in 10 % eyes. CONCLUSION CPC is a safe and effective method of lowering IOP.
Collapse
|
11
|
Abstract
This study aimed to compare various visual function parameters for evaluating the quality of life (QOL) of patients with advanced glaucoma with low vision.In total, 44 eyes of advanced glaucoma patients with low vision were included in this cross-sectional study. A moving pattern edge band program was used to assess edge detection ability and the low vision quality-of-life (LVQOL) questionnaire was used for evaluating QOL scores of subjects. Correlation analyses between QOL scores and visual functional parameters including pattern edge band unit, visual acuity (VA), and Mean deviation (MD) of perimetry were performed. The areas under receiver operating characteristic curves (AUROCs) of diverse visual functional parameters were calculated.VA and pattern edge band unit were related to LVQOL score in all subjects. For patients with a decimal VA lower than 0.1, only the pattern edge band showed a significant correlation with the QOL associated with distant activities (P = .031). However, the MD of perimetry was not related to the QOL score. After sorting subjects into 2 groups according to the LVQOL score, VA and pattern edge band unit were significantly different (P < .01 and P = .029, respectively). The AUROC for edge detection ability using pattern edge band was higher than MD of perimetry.Assessment of edge detection ability using pattern edge band was meaningful for predicting QOL associated with visual performance in patients with far-advanced glaucoma. For these patients, edge detection could be used as an additional parameter for visual function with traditional VA and perimetry.
Collapse
Affiliation(s)
- Soo Ji Jeon
- Department of Ophthalmology, Seoul St. Mary's Hospital
| | - Younhea Jung
- Department of Ophthalmology, Yeouido St. Mary's Hospital
| | - Chang-Sub Jung
- Natural Sciences Section, Department of Medical Lifescience, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary's Hospital
| |
Collapse
|
12
|
Shin JW, Lee J, Kwon J, Choi J, Kook MS. Regional vascular density-visual field sensitivity relationship in glaucoma according to disease severity. Br J Ophthalmol 2017; 101:1666-1672. [PMID: 28432111 DOI: 10.1136/bjophthalmol-2017-310180] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/14/2017] [Accepted: 03/24/2017] [Indexed: 11/04/2022]
Abstract
AIMS To study whether there are global and regional relationships between peripapillary vascular density (pVD) assessed by optical coherence tomography angiography (OCT-A) and visual field (VF) mean sensitivity at different glaucoma stages. METHODS Microvascular images and peripapillary retinal nerve fibre layer (pRNFL) thicknesses were obtained using a Cirrus OCT-A device in 91 glaucoma subjects. The pVD was measured at various spatial locations according to the Garway-Heath map, using a MATLAB software (The MathWorks, Natick, Massachusetts). VF mean sensitivity (VFMS) was recorded in the 1/L scale. Global and regional vasculature-function (pVD vs VFMS) relationships were assessed in separate patient groups at mild and moderate-to-advanced stages of glaucoma. RESULTS The pVDs at superotemporal and inferotemporal regions were significantly associated with corresponding VFMS in mild glaucoma (p<0.05). In moderate-to-advanced glaucoma, there were significant associations between pVD and VFMS, regardless of location. The association between global pVD and VFMS was significantly stronger than that between global pRNFL thickness and VFMS in moderate-to-advanced stage glaucoma (p <0.05). CONCLUSION Global and regional pVD measured by OCT-A was significantly associated with corresponding VFMS in moderate-to-advanced glaucoma. OCT-A may be useful in monitoring glaucoma at various stages.
Collapse
Affiliation(s)
- Joong Won Shin
- Department of Ophthalmology, Asan Medical Center, Songpa-gu, Republic of Korea
| | - Jiyun Lee
- Department of Ophthalmology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Junki Kwon
- Department of Ophthalmology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Jaewan Choi
- Glaucoma Service, Central Seoul Eye Center, Seoul, Republic of Korea
| | - Michael S Kook
- Department of Ophthalmology, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
13
|
Aktas Z, Korkmaz S, Hasanreisoglu M, Onol M, Hasanreisoglu B. Trabeculectomy with large area mitomycin-C application as a first-line treatment in advanced glaucoma: retrospective review. Int J Ophthalmol 2014; 7:104-9. [PMID: 24634873 PMCID: PMC3949468 DOI: 10.3980/j.issn.2222-3959.2014.01.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 07/17/2013] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the outcomes of trabeculectomy with large area mitomycin-C (MMC) application as a first line treatment in advanced glaucoma. METHODS The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy (initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy (primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure (IOP) values, visual acuities, mean deviations, morphology and function of the blebs, necessity for anti-glaucomatous medications and surgical complications were reported. RESULTS There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg (27-68mmHg) and 29.0±4.4mmHg (21-41mmHg), respectively (P=0.001). Average preoperative mean deviations (MD) in Groups 1 and 2 were 17.4±2.8dB (13.3-23dB) and 17.9±2.4 dB (13.7-23.2dB), respectively (P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2 (P=0.005). No cystic bleb formation was observed in Group 1, whereas 4 patients from Group 2 (10.8 %) developed cystic bleb (P=0.040). No visually devastating complication has occurred in both Groups. CONCLUSION Initial trabeculectomy with large area MMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.
Collapse
Affiliation(s)
- Zeynep Aktas
- Department of Ophthalmology, Gazi University Medical Faculty, Ankara 06500, Turkey
| | - Safak Korkmaz
- Department of Ophthalmology, Duzce Ataturk State Hospital, Düzce, 81010, Turkey
| | - Murat Hasanreisoglu
- Department of Ophthalmology, Gazi University Medical Faculty, Ankara 06500, Turkey
| | | | - Berati Hasanreisoglu
- Department of Ophthalmology, Gazi University Medical Faculty, Ankara 06500, Turkey
| |
Collapse
|