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Dossantos J, An J. A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation. J Curr Glaucoma Pract 2024; 18:37-41. [PMID: 38585161 PMCID: PMC10997961 DOI: 10.5005/jp-journals-10078-1436] [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: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
Purpose This study seeks to highlight and explore the occurrence of uveitis with obstructive peripheral anterior synechiae (PAS) after a combined OMNI canaloplasty and Hydrus microstent implantation with phacoemulsification, particularly in a patient with a background of psoriatic arthritis. Observations A 56-year-old male with a medical history of psoriatic arthritis (in remission for 10 years) and primary open-angle glaucoma (POAG) underwent a combined OMNI canaloplasty and Hydrus microstent with phacoemulsification. The surgical procedure was uncomplicated. However, within 2 weeks postsurgery, the patient presented with severe symptoms, including uveitis, elevated intraocular pressure (IOP), and a significant reduction in best-corrected visual acuity (BCVA). This postoperative response was unexpected, especially given the lack of any past history of uveitis in the patient. The complication, potentially influenced by the patient's history of psoriatic arthritis, led to the need for additional interventions, including the implantation of an Ahmed glaucoma valve. Conclusion This case underscores the potential for postoperative complications, specifically uveitis with obstructive PAS, following combined OMNI canaloplasty and Hydrus microstent with phacoemulsification, especially in patients with a history of autoimmune diseases. Careful preoperative history, postoperative monitoring, and a nuanced approach to surgical planning are crucial. The association between systemic inflammatory conditions and ocular complications warrants deeper exploration to ensure optimal patient care. How to cite this article Dossantos J, An J. A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation. J Curr Glaucoma Pract 2024;18(1):37-41.
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Affiliation(s)
- Jason Dossantos
- Department of Ophthalmology, GW School of Medicine and Health Sciences (SMHS), Washington, DC, State of Washington, United States of America
| | - Jella An
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, State of Washington, United States of America
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Wagner IV, Ang B, Checo L, Simsek D, Draper C, Dorairaj S. Spotlight on Schlemm's Canal MicroStent Injection in Patients with Glaucoma. Clin Ophthalmol 2023; 17:1557-1564. [PMID: 37288002 PMCID: PMC10243342 DOI: 10.2147/opth.s388293] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) has revolutionized glaucoma care with its favorable safety profile and ability to delay or minimize the need for traditional, bleb-based procedures. Microstent device implantation is a type of angle-based MIGS, which reduces intraocular pressure (IOP) through bypass of the juxtacanalicular trabecular meshwork (TM) and facilitation of aqueous outflow into the Schlemm's canal. Although there are limited microstent devices on the market, multiple studies have evaluated the safety and efficacy of iStent® (Glaukos Corp.), iStent Inject® (Glaukos Corp.), and Hydrus® Microstent (Alcon) in the treatment of mild-to-moderate open-angle glaucoma, with and without concurrent phacoemulsification. This review attempts to provide a comprehensive evaluation of injectable angle-based microstent MIGS devices in the treatment of glaucoma.
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Affiliation(s)
| | - Bryan Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Derya Simsek
- Department of Ophthalmology, Baskent University Medical School, Ankara, Turkey
| | | | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
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Salimi A, Kassem R, Santhakumaran S, Harasymowycz P. Three-Year Outcomes of a Schlemm Canal Microstent ( Hydrus Microstent) with Concomitant Phacoemulsification in Open-Angle Glaucoma. Ophthalmol Glaucoma 2023; 6:137-146. [PMID: 36038108 DOI: 10.1016/j.ogla.2022.08.012] [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] [Received: 05/13/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE HORIZON trials have reported the medium- and long-term outcomes of the Hydrus microstent. However, outside of randomized clinical trials, outcomes beyond 24 months have not been previously reported. Here, we examine the 3-year outcomes of the Hydrus microstent with cataract surgery outside of a randomized clinical trial setting. DESIGN Single-surgeon consecutive case series. PARTICIPANTS Glaucomatous eyes that underwent implantation of a Hydrus microstent with concomitant cataract surgery at a single ophthalmology center in Montreal, Canada. METHODS Success was defined according to the absence of specific failure criteria: (A) glaucoma reoperation; (B) selective laser trabeculoplasty; (C) intraocular pressure (IOP) < 5 mmHg, > 18 mmHg, or increase in the number of antiglaucoma medications (AGMs) used (after the first postoperative month), or loss of light perception due to glaucoma; (D) aggregation of criteria A-C. Predictors of treatment failure and postoperative changes in IOP and AGM use were assessed. Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GC-IPL) thickness, visual field mean deviation (VF-MD) and pattern standard deviation (VF-PSD), and adverse events. MAIN OUTCOME MEASURES Surgical success, predictors of treatment failure, postoperative changes in IOP and AGM use, and structural and functional markers of disease stability. RESULTS One hundred six eyes were included. The 3-year surgical success according to Criteria A to D was 86%, 83%, 91%, and 67%, respectively. Intraocular pressure decreased by 26.5% from 18.9 ± 4.8 to 13.9 ± 2.3 mmHg (P < 0.001) and AGM use reduced by 33% from 3.0 ± 1.2 to 2.0 ± 1.2 medications (P < 0.001). The postoperative improvement in BCVA was preserved (P < 0.001). The structural and functional markers of disease stability, including CDR, RNFL, and GC-IPL thickness, as well as VF-MD and VF-PSD, remained stable (P > 0.05). Postoperative adverse events were few and transient. CONCLUSIONS The 36-month results from this study show that the Hydrus microstent with phacoemulsification is safe and effective in reducing the IOP and AGM among patients with mild to severe open-angle glaucoma and can slow down the disease progression by preserving both structural and functional parameters. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Ali Salimi
- Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada
| | - Rabea Kassem
- Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada; Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada; Department of Ophthalmology, Kaplan Medical Center, Rehovot and the Hebrew University of Jerusalem-Hadassah Medical School, Jerusalem, Israel
| | | | - Paul Harasymowycz
- Montreal Glaucoma Institute and Bellevue Ophthalmology Clinics, Montreal, Quebec, Canada; Department of Ophthalmology, University of Montreal, Montreal, Quebec, Canada.
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Chee WK, Yip VCH, Tecson IO, Chua CH, Ang BCH, Kee AR, Hu JY, Kan TCJ, Yip LWL. Comparison of Efficacy of Combined Phacoemulsification and iStent Inject versus Combined Phacoemulsification and Hydrus Microstent. Clin Ophthalmol 2023; 17:1151-1159. [PMID: 37082298 PMCID: PMC10112347 DOI: 10.2147/opth.s403386] [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: 01/26/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023] Open
Abstract
Aim This study aims to compare the efficacy and safety of combined phacoemulsification with iStent inject (Phaco-iStent) and Hydrus microstent (Phaco-Hydrus). Methods This was a retrospective comparative study of patients who underwent Phaco-iStent from April 2019 to August 2020 and Phaco-Hydrus from August 2019 to December 2020 at a tertiary eye centre in Singapore. Sixty-nine Phaco-iStent eyes and 49 Phaco-Hydrus eyes were included in this study. Complete surgical success was defined as freedom from second glaucoma surgery, Intraocular pressure (IOP) of 18 mmHg or less, and discontinuation of all antiglaucoma medications. Results At 12 months, both Phaco-iStent and Phaco-Hydrus groups had comparable surgical success rate (68.1% vs 51%, p=0.061), reduction in antiglaucoma medication use (-1.3 ± 0.1 vs -1.4 ± 0.10, p=0.880) and intraocular pressure reduction (-1.1 ± 0.5 mmHg vs -1.6 ± 0.9 mmHg, p=0.323). Overall intraoperative and postoperative complications rate were similar in both groups, though hyphema was more commonly seen in early postoperative period in the Phaco-Hydrus compared to the Phaco-iStent group (8% vs 0%, p=0.028), with majority of cases resolving without any need for surgical intervention. Device obstruction was also more common in the Phaco-Hydrus group compared to the Phaco-iStent group (14% vs 4.3%, p=0.04). Conclusion Phaco-iStent and Phaco-Hydrus have similar surgical efficacy and safety profiles at 12 months.
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Affiliation(s)
- Wai Kitt Chee
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vivien Cherng Hui Yip
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Correspondence: Vivien Cherng Hui Yip, Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, Tel +65 62566011, Email
| | - Ivan O’Neill Tecson
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chun Hau Chua
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Ae Ra Kee
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jeremy Youwei Hu
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Tsia-Chuen John Kan
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Leonard Wei Leon Yip
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Creagmile J, Kim WI, Scouarnec C. Hydrus Microstent implantation with OMNI Surgical System Ab interno canaloplasty for the management of open-angle glaucoma in phakic patients refractory to medical therapy. Am J Ophthalmol Case Rep 2022; 29:101749. [PMID: 36544749 PMCID: PMC9762144 DOI: 10.1016/j.ajoc.2022.101749] [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] [Received: 03/03/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose To report a series of 8 phakic eyes of 8 patients with open angle glaucoma with uncontrolled intraocular pressure on maximum tolerable medical therapy receiving Hydrus Microstent implants combined with concomitant OMNI Surgical System ab interno canaloplasty. Observations 8 phakic eyes underwent Hydrus Microstent implantation with OMNI Surgical System ab interno canaloplasty. 2 patients underwent concurrent Kahook Dual Blade goniotomy and 1 patient underwent a concurrent micropulse transscleral cyclophotocoagulation. 6 out of 8 eyes achieved successful intraocular pressure reduction. Only 1 achieved success without the need for additional medical therapy. 1 required Neodymium-doped yttrium aluminum garnet laser to clear iris obstruction of the Hydrus inlet and 1 required selective laser trabeculoplasty for additional intraocular pressure lowering. 2 out of 8 eyes required subsequent incisional glaucoma surgery for unacceptable intraocular pressure levels despite maximum tolerable medical therapy. Conclusions and Importance The Hydrus Microstent combined with OMNI Surgical System ab interno canaloplasty can safely and successfully reduce intraocular pressure in phakic patients with open-angle glaucoma with uncontrolled intraocular pressure on maximum tolerable medical therapy with a low complication rate and rapid visual recovery.
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Affiliation(s)
- Jack Creagmile
- Corresponding author. 1301 U St Nw apt 609, Washington DC, 20009, USA.
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Elksne E, Mercieca K, Prokosch-Willing V. Canaloplasty with mitomycin C after previous combined cataract surgery and Schlemm's canal microstent implantation. Eur J Ophthalmol 2021; 32:712-716. [PMID: 33706574 DOI: 10.1177/11206721211000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a 56-year-old male with primary open-angle glaucoma who underwent mitomycin C augmented canaloplasty enabling filtration in the right eye after cataract surgery combined with a Schlemm's canal microstent 3 years previously. He showed progressive glaucomatous optic neuropathy and was highly myopic (axial length 32.05 mm, spherical equivalent -18.75 dioptres in the right eye). Augmented canaloplasty was performed uneventfully and 360° catheterisation was achieved followed by the placement of a 10-0 polypropylene suture in Schlemm's canal. Intraocular pressure (IOP) in the first post-operative day was reduced from 19 to 6 mmHg. At 1-month follow-up IOP was 12 mmHg off glaucoma medications. The presence of a minimally invasive glaucoma surgery (MIGS) device did not hinder successful catheterisation of Schlemm's canal. Significant reduction of IOP was obtained in the early post-surgical period. No intra-operative complications were registered and only transient hyphema in early post-operative period was reported. This augmented canaloplasty could be an effective alternative to trabeculectomy even after Schlemm's canal microstent implantation.
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Affiliation(s)
- Eva Elksne
- Department of Ophthalmology, Riga Stradins University, Riga, Latvia
| | - Karl Mercieca
- Department of Ophthalmology, Manchester University Hospitals NHS Trust, Manchester Royal Eye Hospital, Manchester, UK
| | - Verena Prokosch-Willing
- Department of Ophthalmology, University Medical Center of Johannes Gutenberg University Mainz, Mainz, Germany
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Laroche D, Nkrumah G, Ng C. Real-world efficacy of the Hydrus microstent in Black and Afro-Latinx patients with glaucoma: a retrospective study. Ther Adv Ophthalmol 2020; 12:2515841420964311. [PMID: 33150299 PMCID: PMC7580146 DOI: 10.1177/2515841420964311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/18/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose: The purpose was to determine the real-world efficacy of phacoemulsification cataract surgery and Hydrus microstent in Black and Afro-Latinx patients with glaucoma. Methods: A retrospective noncomparative single-center study of 76 Black and Afro-Latinx patients with glaucoma who underwent phacoemulsification cataract surgery and Hydrus microstent placement for treatment of glaucoma at single practice. Investigated parameters were intraocular pressure (IOP), number of medications, mean deviation on visual field test, and visual acuity. Patients were also subgrouped into mild, moderate, and advance glaucoma for further analysis. Results: We reviewed a total of 76 patients who had 6 months of follow up in the study. The mean number of medications decreased significantly from 2.6 ± 1.5 preoperatively to 0.72 ± 1.4 in 6 months (p < 0.0010), while IOP decreased from 14.7 ± 3.7 to 13.9 ± 4.3 (p = 0.25). At 6 months, 55 patients (74%) of all patients were medication free (n = 27, 84.4% mild glaucoma; n = 17, 70.8% moderate glaucoma; n = 10, 50% advance glaucoma). There was significant improvement in visual acuity (p < 0.00010) and stabilization of mean deviation on visual field test (baseline −9.2; 6 months −9.1; p = 0.22). The most common adverse effect was a transient IOP spike and transient corneal edema (n = 6, 7.9%; n = 6, 7.9%, respectively) with spontaneous resolution in all cases. No sight-threatening complications were reported at 6 months. Conclusion/clinical relevance: This 6-month retrospective study demonstrated the efficacy of phacoemulsification cataract surgery and Hydrus microstent in reducing the medication burden while maintaining lower IOP in Black and Afro-Latinx patients with glaucoma.
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Affiliation(s)
- Daniel Laroche
- Advanced Eyecare of New York, 49 West 127th Street, New York, NY 10027, USA
| | - Gideon Nkrumah
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chester Ng
- Advanced Eyecare of New York, New York, NY, USA
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Dick HB, Schultz T, Gerste RD. Miniaturization in Glaucoma Monitoring and Treatment: A Review of New Technologies That Require a Minimal Surgical Approach. Ophthalmol Ther 2019; 8:19-30. [PMID: 30725339 DOI: 10.1007/s40123-019-0161-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/13/2018] [Indexed: 11/26/2022] Open
Abstract
In the management of glaucoma, recent and upcoming innovations have the potential to contribute to both the efficacy of intraocular pressure (IOP) monitoring and the number of available treatment options. These new devices and procedures have two things in common: they are part of the trend in medicine towards miniaturization, and they require a limited surgical procedure to become effective. This review focuses on the Eyemate (Argos) intraocular sensor, which offers a new way to reliably measure 24 h IOP, and on intraocular sustained release systems for pharmacological glaucoma therapy. It also briefly reflects on the miniature implants currently used in minimally invasive glaucoma surgery (MIGS).
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