1
|
Tatti F, Tronci C, Lixi F, Demarinis G, Kuzmich S, Peiretti E, Fossarello M, Giannaccare G. No Changes in Keratometry Readings and Anterior Chamber Depth after XEN Gel Implantation in Patients with Glaucoma. J Clin Med 2024; 13:2537. [PMID: 38731065 PMCID: PMC11084149 DOI: 10.3390/jcm13092537] [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: 03/17/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Background: This study aimed to compare keratometry and anterior chamber depth (ACD) changes after XEN implantation in primary open-angle glaucoma (POAG) cases over a 3-month follow-up period. Methods: Twenty patients with POAG who underwent XEN63 implantation, either standalone or combined with cataract surgery, were included. Preoperative data, including best-corrected visual acuity (BCVA), refraction, gonioscopy, ophthalmoscopy, intraocular pressure (IOP) evaluation, and axial length, were collected. Corneal topography and ACD measurements were assessed preoperatively and at postoperative days 1, 7, 15, 30, 60, and 90. Each patient's eye that underwent XEN surgery was included in the study group, with the fellow eye serving as a control. Results: In the study group, there was a significant decrease in IOP after XEN stent implantation at all investigated time intervals (p < 0.05). However, changes in mean ACD did not show statistically significant differences at any follow-up examination in both the study and control groups. Additionally, keratometry readings revealed no significant changes in total astigmatism or steep keratometry values in either group. Conclusions: XEN implantation in POAG cases resulted in a significant decrease in IOP over the 3-month follow-up period. However, there were no significant changes observed in mean ACD or keratometry readings, indicating stability in these parameters post-XEN implantation. These findings suggest that XEN implantation may be an effective option for IOP reduction without affecting corneal curvature or ACD in POAG patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, 09124 Cagliari, Italy; (F.T.); (C.T.); (F.L.); (G.D.); (S.K.); (E.P.); (M.F.)
| |
Collapse
|
2
|
Karapapak M, Olgun A. Comparison of GATT versus micropulse transscleral diode laser cyclophotocoagulation combined with GATT in patients with advanced glaucoma. Eur J Ophthalmol 2024:11206721241247440. [PMID: 38602018 DOI: 10.1177/11206721241247440] [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: 04/12/2024]
Abstract
PURPOSE To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) versus micropulse transscleral diode laser cyclophotocoagulation(MP-TDLC) combined with GATT in the treatment of advanced glaucoma. METHODS This retrospective comparative study study included 82 patients (82 eyes) with a diagnosis of advanced glaucoma: 36 patients underwent GATT, and 46 underwent GATT + MP-TDLC. Intraocular pressure (IOP) changes in patients who underwent GATT and GATT MP-TDLC were analyzed retrospectively at regular intervals during the 6-month follow-up period. RESULTS For the 82 patients included in this study, the mean ± SD IOPs before the procedures were 27.2 ± 8.5 mmHg in the GATT group and 26.6 ± 6.9 mmHg in the GATT + MP-TDLC group (p = 0.866), and the numbers of glaucoma medications used were 3.41 ± 0.5 in the GATT group and 3.36 ± 0.4 in the GATT + MP-TDLC group (p = 0.605). The mean IOP after GATT was 13.6 ± 3.9 mmHg at day 1, 13.9 ± 3.7 mmHg at week 1, 14.6 ± 4.0 mmHg at month 1, 15.3 ± 4.3 mmHg at month 3, and 14.7 ± 3.3 mmHg at month 6. In the GATT + MP-TDLC group, the postoperative day 1, week 1, month 1, month 3, and month 6 IOP values were 12.4 ± 2.5, 11.8 ± 1.8, 12.1 ± 2.0, 11.8 ± 1.09, and 11.8 ± 1.5 mmHg, respectively. CONCLUSION GATT was found to be effective in the treatment of patients with advanced glaucoma, and results closer to the targeted low teens IOP values were obtained with GATT + MP-TDLC.
Collapse
Affiliation(s)
- Murat Karapapak
- Department of Ophthalmology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Olgun
- Department of Ophthalmology, West Eye Hospital, Erbil, Iraq
| |
Collapse
|
3
|
Swaminathan SS, Jammal AA, Medeiros FA, Gedde SJ. Visual Field Outcomes in the Primary Tube Versus Trabeculectomy Study. Ophthalmology 2024:S0161-6420(24)00207-0. [PMID: 38582154 DOI: 10.1016/j.ophtha.2024.03.026] [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: 12/11/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024] Open
Abstract
PURPOSE To describe visual field outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study. DESIGN Cohort analysis of a prospective multicenter randomized clinical trial. SUBJECTS A total of 155 eyes from 155 subjects randomly assigned to treatment with tube shunt surgery (n=84) or trabeculectomy with mitomycin C (n=71). METHODS The PTVT Study was a multicenter randomized clinical trial comparing the safety and efficacy of trabeculectomy and tube shunt surgery in eyes without prior intraocular surgery. Subjects underwent standard automated perimetry (SAP) at baseline and annually for five years. SAP tests were deemed reliable if the false positive rate was ≤15%. Tests were excluded if visual acuity was ≤20/400 or loss of ≥2 Snellen lines from baseline were attributed to a non-glaucomatous etiology. Linear mixed-effects models were used to compare rates of change in SAP mean deviation (MD) between the two treatment groups. Intraocular pressure (IOP) control was assessed by percentage of visits with IOP <18 mmHg and mean IOP. OUTCOME MEASURES Rate of change in SAP MD during follow-up. RESULTS A total of 730 SAP tests were evaluated, with an average of 4.7 tests per eye. The average SAP MD at baseline was -12.8±8.3 dB in the tube group and -12.0±8.4 dB in the trabeculectomy group (p=0.57). The mean rate of change in SAP MD was -0.32±0.39 dB/year in the trabeculectomy group and -0.47±0.43 dB/year in the tube group (p=0.23). Eyes with mean IOP 14-17.5 mmHg had significantly faster rates of SAP MD loss compared to eyes with mean IOP <14 mmHg (-0.59±0.13 vs. -0.27±0.08 dB/year, p=0.012) and eyes with only 50-75% of visits with IOP <18 mmHg had faster rates than those with 100% of visits with IOP <18 mmHg (-0.90±0.16 vs. -0.29±0.08 dB/year, p<0.001). Multivariable analysis identified older age and worse IOP control as risk factors for faster progression in both treatment groups. CONCLUSIONS No statistically significant difference in mean rates of visual field change was observed between trabeculectomy and tube shunt surgery in the PTVT Study. Worse IOP control was significantly associated with faster rates of SAP MD loss during follow-up. Older patients were also at risk for faster progression.
Collapse
Affiliation(s)
- Swarup S Swaminathan
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Alessandro A Jammal
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Felipe A Medeiros
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL.
| |
Collapse
|
4
|
Steiner S, Resch H, Kiss B, Vass C. PRESERFLO™ Microshunt: 1-Year Results of a 25-Gauge vs. 27-Gauge Needle Tract. J Clin Med 2024; 13:1979. [PMID: 38610744 PMCID: PMC11012831 DOI: 10.3390/jcm13071979] [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: 01/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness and safety of the PreserFlo™ microshunt (PMS) using a 25-Gauge vs. 27-Gauge needle tract. Methods: This is a prospective postoperative examination of 60 glaucoma eyes that received a PMS. The main outcome measures were intraocular pressure (IOP), glaucoma drug score (GDS), Kaplan-Meier success rates, complications, and secondary intervention rates. Two subgroups were formed for data comparison: 27-Gauge (27G), and 25-Gauge (25G). Success was defined as IOP < 18 mmHg together with ≥20% IOP reduction with medication allowed (qualified success = QS18) or not (full success = FS18). Results: IOP and GDS were reduced from baseline to the 1-year study visit as follows: All eyes from 23.4 ± 8.6 mmHg (3.1 ± 0.9) to 15.1 ± 5.9 mmHg (0.8 ± 1.1); 25G from 24.2 ± 7.3 mmHg (3.0 ± 0.8) to 12.7 ± 2.7 mmHg (0.5 ± 0.8); and 27G from 23.1 ± 9.2 mmHg (3.1 ± 1.0) to 16.2 ± 6.7 mmHg (0.9 ± 1.2). IOP at one year was lower in the 25G group compared to the 27G group (p = 0.035). Bleb needling was required in eight (13.3%) eyes and open bleb revisions in three (5.0%). Transient hypotony occurred in 21% and choroidal effusion in 8% of all eyes. Choroidal effusions were more frequent in the 25G group (21%) compared to the 27G group (2%, p = 0.031). One-year success rates were significantly higher in the 25G group compared to the 27G group for both QS18 (25G: 67.9% vs. 27G: 35.7%, p = 0.002) and FS18 (25G: 63.6% vs. 27G: 29.2%, p = 0.007). Conclusions: The PreserFlo microshunt is an effective and safe glaucoma surgery with a low rate of bleb revisions or needlings. We show that the 25G needle tract might be more efficient for IOP control at the cost of increased IOP-related complications compared to 27G.
Collapse
Affiliation(s)
- Stefan Steiner
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| | - Hemma Resch
- Department of Ophthalmology, Sanatorium Hera, 1090 Vienna, Austria
| | - Barbara Kiss
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens Vass
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| |
Collapse
|
5
|
Gepstein R, Laytman Klein T, Naftali Ben Haim L, Belkin A. Uveitic Flare-Ups After Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Uveitic Glaucoma. Ocul Immunol Inflamm 2024:1-7. [PMID: 38470999 DOI: 10.1080/09273948.2024.2316760] [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: 06/21/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE To assess the risk of gonioscopy-assisted transluminal trabeculotomy (GATT) inducing an uveitic flare-up in patients with uveitic glaucoma (UG). METHODS This retrospective study included consecutive UG patients who underwent GATT at a single medical center between June 2020 and September 2022. The main outcome measure was the occurrence of a surgery-related uveitic complication defined as either an uveitic flare-up defined by the Standardization of Uveitis Nomenclature (SUN) criteria, or the appearance of cystoid macular edema (CME) from 2 weeks to 3 months after surgery. RESULTS A total of 25 eyes of 22 patients were included in the study. Age ranged from 10-78 and 64% were women. The most common uveitic etiologies were juvenile idiopathic arthritis (JIA, 24%) and herpetic infection (24%). A total of 48%of the patients were on systemic immunosuppressants prior and unrelated to surgery. Eight eyes (32%) had severe glaucomatous damage prior to surgery, and 20% of the patients had undergone previous glaucoma surgery. Two cases (8%) demonstrated uveitic flare-up in the early postoperative period: a case of mild anterior chamber reaction and a case of CME with persistent edema prior to surgery. Average intraocular pressure (IOP) was reduced from 26.7 mm Hg on four medications to 12.2 on 1.1 after 1 year. One patient required reoperation for IOP control. CONCLUSIONS With careful pre and postoperative care, GATT seems to be a low-risk procedure for uveitic flare-ups in patients with UG.
Collapse
Affiliation(s)
- Raz Gepstein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamar Laytman Klein
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
6
|
Rojo-Arnao M, Martinez-de-la-Casa JM, Albis-Donado O, Yañez-Castro G, Maroto-Cejudo R, Téllez J, Menoyo-Calatayud R. Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting. Indian J Ophthalmol 2024; 72:417-426. [PMID: 38153975 PMCID: PMC11001232 DOI: 10.4103/ijo.ijo_1502_23] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. METHODS We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. RESULTS Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. CONCLUSION The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
Collapse
Affiliation(s)
| | - José María Martinez-de-la-Casa
- Department of Ophthalmology and ORL, Faculty of Medicine, Ophthalmology Unit, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain
- Department of Immunology, Ophthalmology and ORL, School of Medicine, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Oscar Albis-Donado
- Glaucoma Specialist, Private Practice, Visual Sense, Mexico City, Mexico
| | | | | | - Jesús Téllez
- Department of Ophthalmology, Hospital de la Santa Creu i de Sant Pau, Autonoma University of Barcelona, Barcelona, Spain
- Departament of Ophthalmology, Grupo Admiravisión, Barcelona, Spain
| | | |
Collapse
|
7
|
Swampillai AJ, Nigam C, Dowse E, Lim KS. Quantification of Postoperative Inflammation in Laser and Surgical Procedures for Glaucoma with Laser Flare Photometry: A Review of the Literature. Curr Eye Res 2024; 49:225-234. [PMID: 37994868 DOI: 10.1080/02713683.2023.2282940] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE To review the application of laser flare photometry (LFP) in the objective quantification of aqueous flare (anterior chamber inflammation) post laser and surgical procedures for glaucoma. METHODS A search was undertaken using the following: PubMed (all years), the Web of Science (all years), Ovid MEDLINE (R) (1980 to 30 March 2023), Ovid MEDLINE (R) Daily Update 30 March 2023, MEDLINE and MEDLINE non-indexed items, Embase (1980-2021, week 52), Ovid MEDLINE (R) and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1980 to 30 March 2023), CENTRAL (including Cochrane Eyes and Vision Trials Register), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included "aqueous flare," "anterior chamber inflammation," "tyndallometry," "laser flare photometry" combined with "laser," "iridotomy," "trabeculoplasty," "cataract surgery," "phacoemulsification," "glaucoma surgery," "minimally invasive glaucoma surgery," "trabeculectomy," "aqueous shunt," "glaucoma drainage" and "cyclophotocoagulation." RESULTS The majority of studies utilizing laser flare photometry in grading flare have been post laser trabeculoplasty. The degree of flare produced varies according to the type of glaucoma laser or surgery performed, with filtration procedures and glaucoma drainage devices having marked and prolonged detectable levels. Aqueous flare in cyclodestructive procedures positively correlated with intraocular pressure (IOP) reduction. CONCLUSION In comparison to clinician grading, laser flare photometry provides a more objective measure of post-surgical inflammation in eyes that have undergone laser and surgery for glaucoma. Further research is warranted into how this instrument can be utilized to identify eyes at high risk of failure and other adverse outcomes after glaucoma surgery.
Collapse
Affiliation(s)
- Andrew J Swampillai
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
- School of Life Course & Population Sciences, King's College London, London, United Kingdom
| | - Chandni Nigam
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
| | - Emily Dowse
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
| | - Kin Sheng Lim
- Department of Ophthalmology, St. Thomas' Hospital, London, United Kingdom
- School of Life Course & Population Sciences, King's College London, London, United Kingdom
| |
Collapse
|
8
|
Christopher M, Gonzalez R, Huynh J, Walker E, Radha Saseendrakumar B, Bowd C, Belghith A, Goldbaum MH, Fazio MA, Girkin CA, De Moraes CG, Liebmann JM, Weinreb RN, Baxter SL, Zangwill LM. Proactive Decision Support for Glaucoma Treatment: Predicting Surgical Interventions with Clinically Available Data. Bioengineering (Basel) 2024; 11:140. [PMID: 38391627 PMCID: PMC10886033 DOI: 10.3390/bioengineering11020140] [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: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/27/2024] [Indexed: 02/24/2024] Open
Abstract
A longitudinal ophthalmic dataset was used to investigate multi-modal machine learning (ML) models incorporating patient demographics and history, clinical measurements, optical coherence tomography (OCT), and visual field (VF) testing in predicting glaucoma surgical interventions. The cohort included 369 patients who underwent glaucoma surgery and 592 patients who did not undergo surgery. The data types used for prediction included patient demographics, history of systemic conditions, medication history, ophthalmic measurements, 24-2 VF results, and thickness measurements from OCT imaging. The ML models were trained to predict surgical interventions and evaluated on independent data collected at a separate study site. The models were evaluated based on their ability to predict surgeries at varying lengths of time prior to surgical intervention. The highest performing predictions achieved an AUC of 0.93, 0.92, and 0.93 in predicting surgical intervention at 1 year, 2 years, and 3 years, respectively. The models were also able to achieve high sensitivity (0.89, 0.77, 0.86 at 1, 2, and 3 years, respectively) and specificity (0.85, 0.90, and 0.91 at 1, 2, and 3 years, respectively) at an 0.80 level of precision. The multi-modal models trained on a combination of data types predicted surgical interventions with high accuracy up to three years prior to surgery and could provide an important tool to predict the need for glaucoma intervention.
Collapse
Affiliation(s)
- Mark Christopher
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Ruben Gonzalez
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Justin Huynh
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Evan Walker
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Bharanidharan Radha Saseendrakumar
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Christopher Bowd
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Akram Belghith
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Michael H Goldbaum
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Massimo A Fazio
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Christopher A Girkin
- Department of Ophthalmology and Vision Sciences, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Carlos Gustavo De Moraes
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Jeffrey M Liebmann
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Robert N Weinreb
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Sally L Baxter
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| | - Linda M Zangwill
- Hamilton Glaucoma Center and Division of Ophthalmology Informatics and Data Science, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, CA 92037, USA
| |
Collapse
|
9
|
Pfeiffer V, Gubser PA, Shang X, Lincke JB, Häner NU, Zinkernagel MS, Unterlauft JD. Functional and Morphological Outcomes after Trabeculectomy and Deep Sclerectomy-Results from a Monocentric Registry Study. Diagnostics (Basel) 2024; 14:101. [PMID: 38201410 PMCID: PMC10802181 DOI: 10.3390/diagnostics14010101] [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: 11/23/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study was to compare the effectiveness of trabeculectomy (TE) and deep sclerectomy (DS) in lowering intraocular pressure (IOP) and thereby preserving visual field and peripapillary retinal nerve fiber layer (RNFL) tissue in primary open-angle glaucoma (POAG) cases. IOP, number of IOP-lowering medications, visual acuity, mean defect of standard automated perimetry, and mean peripapillary RNFL thickness were retrospectively collected and followed up for 3 years after surgery. TE was performed in 104 eyes and DS in 183 eyes. Age, gender, laterality, IOP, number of medications, visual acuity, perimetry mean defect, and peripapillary RNFL thickness were equally distributed at baseline. Mean IOP decreased from 23.8 ± 1.4 mmHg and 23.1 ± 0.4 mmHg to 13.4 ± 0.6 mmHg (p < 0.001) and 15.4 ± 0.7 mmHg (p = 0.001) in the TE and DS groups, respectively. Mean defect remained stable (TE: -11.5 ± 0.9 dB to -12.0 ± 1.1 (p = 0.090); DS: -10.5 ± 0.9 dB to -11.0 ± 1.0 dB (p = 0.302)), while mean peripapillary RNFL thickness showed further deterioration during follow-up (TE group: 64.4 ± 2.1 μm to 59.7 ± 3.5 μm (p < 0.001); DS group: 64.9 ± 1.9 μm to 58.4 ± 2.1 μm (p < 0.001)). Both TE and DS were comparably effective concerning postoperative reduction in IOP and medication. However, glaucoma disease further progressed during follow-up.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Jan Darius Unterlauft
- University Eye Hospital, Inselspital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland; (V.P.); (P.A.G.); (X.S.); (J.-B.L.); (N.U.H.); (M.S.Z.)
| |
Collapse
|
10
|
Wakuda H, Nakakura S, Shojo T. Comparative Analysis of Surgical Durations and Fees Across Eight Types of Glaucoma Surgery Performed by a Single Surgeon. Cureus 2024; 16:e51675. [PMID: 38313883 PMCID: PMC10838194 DOI: 10.7759/cureus.51675] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 02/06/2024] Open
Abstract
The duration of several types of glaucoma surgery and reimbursement amounts per minute of surgery remain unknown. This study compared the surgical duration of glaucoma procedures (ab interno trabeculotomy, PreserFlo, ab externo trabeculotomy, bleb revision, EXPRESS, trabeculectomy, Ahmed, and the Baerveldt implant) and their reimbursement amounts in Japan. We retrospectively analyzed 30 consecutive surgeries of each type of glaucoma surgery. The reimbursement amount per surgical hour was calculated by subtracting the implant cost from the total medical fees. Amounts were converted to dollars based on an exchange rate of 1 USD = 133 JPY. The average surgical time was as follows: ab interno trabeculotomy, 7.8 ± 2.1; PreserFlo, 13.5 ± 4.0; ab externo trabeculotomy, 15.2 ± 4.1; bleb revision, 15.6 ± 2.3; EXPRESS, 16.9 ± 2.7; trabeculectomy, 18.5 ± 3.1; Ahmed, 35.8 ± 8.2; and Baerveldt, 39.2 ± 6.2. The reimbursement amounts after implant deduction were as follows: ab interno trabeculotomy, $1,089; PreserFlo, $1,538; ab externo trabeculotomy, $1,430; bleb revision, $259; EXPRESS, $1,600; trabeculectomy, $1,774; Ahmed, $1,600; and Baerveldt, $1,765. Reimbursement amounts per minute varied, with the highest and lowest for ab interno trabeculotomy and bleb revision at $140 per minute and $17 per minute, respectively. Reimbursement amounts per minute of surgery for eight types of glaucoma surgery vary by up to eightfold.
Collapse
|
11
|
Cheema AA, Cheema HR. The Evolution and Current Landscape of Minimally Invasive Glaucoma Surgeries: A Review. Cureus 2024; 16:e52183. [PMID: 38264176 PMCID: PMC10804217 DOI: 10.7759/cureus.52183] [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] [Accepted: 01/12/2024] [Indexed: 01/25/2024] Open
Abstract
This review examines the evolution, current status, and future potential of minimally invasive glaucoma surgeries (MIGS), a significant advancement in the treatment of glaucoma, a leading cause of irreversible blindness. MIGS offer a less invasive alternative to traditional glaucoma surgeries, primarily aimed at reducing intraocular pressure, minimizing tissue trauma, and providing a safer profile. With the emergence of devices such as the Trabectome, iStent, and others, MIGS have expanded the surgical toolkit, allowing personalized, patient-centered care. Despite their advantages, MIGS face challenges such as efficacy in severe cases, long-term data, and accessibility. Ongoing research and technological innovations continue to refine their capabilities and applications, promising to further transform glaucoma management and patient outcomes. This paper provides an in-depth analysis of MIGS, reflecting on their impact and contemplating future directions in this dynamically evolving field.
Collapse
|
12
|
Botella-García J, Balboa M, Romera-Romero P, Stijnen T, Sánchez-Fortún A, Mercieca K, Loscos-Arenas J. Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery. Int J Ophthalmol 2023; 16:1806-1813. [PMID: 38028507 PMCID: PMC10626349 DOI: 10.18240/ijo.2023.11.11] [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: 01/12/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
AIM To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery. METHODS A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure. RESULTS Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively. CONCLUSION DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.
Collapse
Affiliation(s)
- Jéssica Botella-García
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- International University of Catalonia (UIC), Barcelona 08017, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
| | - Marta Balboa
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
| | - Pau Romera-Romero
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
| | - Theo Stijnen
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden 2333, The Netherlands
| | | | - Karl Mercieca
- University Hospitals Bonn Eye Clinic, Bonn, 53127, Germany
| | - Jordi Loscos-Arenas
- Department of Ophthalmology, Hospital Germans Trias i Pujol, Badalona 08916, Spain
- Department of Surgery, Barcelona Autonomous University (UAB), Barcelona 08035, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona 08916, Spain
| |
Collapse
|
13
|
Correia Barão R, Berhanu D, Bernardo Matos D, Barata AD, Sousa R, Abegão Pinto L. Bleb morphology of glaucoma drainage devices on magnetic resonance imaging. Acta Ophthalmol 2023; 101:789-796. [PMID: 37066864 DOI: 10.1111/aos.15668] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To evaluate bleb morphology features of different glaucoma drainage devices (GDD) using magnetic resonance imaging (MRI). MATERIALS AND METHODS Prospective cohort study of GDD and bleb morphology in consecutive glaucoma patients implanted with Ahmed Glaucoma Valve (AGV), Paul Glaucoma Implant (PGI), Baerveldt Glaucoma Implant (BGI) and Ahmed ClearPath (ACP) devices. Thirty-six eyes from 30 consecutive patients underwent standardized GDD implantation followed by MRI at least 1 month after surgery. Main outcomes included bleb volume and endplate position relative to the optic nerve. Secondary outcomes included intraocular pressure (IOP), medication and surgical complications during a 12-month follow-up. RESULTS Seven eyes were implanted with the AGV (19%), 5 with BGI (14%), 16 with PGI (44%) and 8 with ACP (22%). MRI scans were obtained 85 ± 66 days after surgery. Mean total bleb volume was 563 ± 390 mm3 . This bleb volume was inversely correlated with early post-operative IOP (day 7; rs = -0.3326, p = 0.0475) but positively correlated with IOP at 12 months (rs = 0.3592, p = 0.0341). No significant difference in total bleb volume was found between GDD types (p = 0.1223). A double-layered bleb was observed in 34 eyes (94%). The inferior bleb volume was significantly larger in PGI devices versus other GDD types (380 ± 205 vs. 193 ± 161 mm3 ; p = 0.0043). Distance from the endplate to the optic nerve was 9.5 ± 4.0 mm, similar across GDDs (p = 0.2519). CONCLUSIONS Double-layered blebs are a common finding with GDDs. Bleb volume showed different correlations with IOP at distinct timepoints and the PGI device formed larger blebs. A standardized GDD implantation technique ensures a safe distance from the GDD endplate to the optic nerve.
Collapse
Affiliation(s)
- Rafael Correia Barão
- Department of Ophthalmology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Visual Sciences Study Center, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - David Berhanu
- Department of Neurological Imaging, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Anatomy Institute, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Diogo Bernardo Matos
- Department of Ophthalmology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Visual Sciences Study Center, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - André Diogo Barata
- Department of Ophthalmology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Visual Sciences Study Center, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Rita Sousa
- Department of Neurological Imaging, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Luís Abegão Pinto
- Department of Ophthalmology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
- Visual Sciences Study Center, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
14
|
Savastano A, Gambini G, Carlà MM, Caporossi T, Giannuzzi F, Rizzo C, Killian R, Rizzo S. Eyewatch adjustable drainage device in vitrectomized eyes with refractory glaucoma. Eur J Ophthalmol 2023; 33:2303-2308. [PMID: 37437594 DOI: 10.1177/11206721231188153] [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: 07/14/2023]
Abstract
BACKGROUND To describe the efficacy and safety of the adjustable system eyeWatch in vitrectomized glacomatous eyes. METHODS Prospective, non-comparative, small case series of 2 patients who underwent glaucoma drainage device implant with the eyeWatch system. Intraocular pressure, number of medications and early and late complications were evaluated. RESULTS None of the operated eyes developed early or late complications. After 1 week post operatively, the IOP raised at 28 mmHg in the first eye and 25 mmHg in the second one. The eyeWatch Pen was used to open and set the device into position 3 (that means implant half opened) After waiting for 30 min, IOP was 15 mmHg and 11 mmHg, respectively. Thirty days after surgery we set the EyeWatch into position 0 (that means implant full opened) even though the IOP was under control. A new IOP measurement was done and we registered that IOP was 14 mmHg and 10 mmHg respectively, and it remained stable after six months of follow up. CONCLUSION In conclusion, in our case series the use of eyeWatch adjustable system allows a safe and gradual regulation of the flow during post-operative management also in vitrectomized eyes. Considering the percentage of hypotony related complications in vitrectomized eyes this system is an effective and safe technique to handle glaucoma in post vitreoretinal surgery eyes.
Collapse
Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| | - Clara Rizzo
- Ophthalmology Unit, Department of Surgery, University Hospital, Pisa, Italy
| | - Raphael Killian
- Ophthalmology Unit, Department of Surgery, University Hospital, Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Catholic University "Sacro Cuore", Rome, Italy
| |
Collapse
|
15
|
Tan JC, Muntasser H, Choudhary A, Batterbury M, Vallabh NA. Swept-Source Anterior Segment Optical Coherence Tomography Imaging and Quantification of Bleb Parameters in Glaucoma Filtration Surgery. Bioengineering (Basel) 2023; 10:1186. [PMID: 37892916 PMCID: PMC10604572 DOI: 10.3390/bioengineering10101186] [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: 09/13/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
This paper describes a technique for using swept-source anterior segment optical coherence tomography (AS-OCT) to visualize internal bleb microstructure and objectively quantify dimensions of the scleral flap and trabeculo-Descemet window (TDW) in non-penetrating glaucoma filtration surgery (GFS). This was a cross-sectional study of 107 filtering blebs of 67 patients who had undergone deep sclerectomy surgery at least 12 months prior. The mean post-operative follow-up duration was 6.5 years +/- 4.1 [standard deviation (SD)]. The maximal bleb height was significantly greater in the complete success (CS) blebs compared to the qualified success (QS) and failed (F) blebs (1.48 vs. 1.17 vs. 1.10 mm in CS vs. QS vs. F, one-way ANOVA, p < 0.0001). In a subcohort of deep sclerectomy blebs augmented by intraoperative Mitomycin-C, the trabeculo-Descemet window was significantly longer in the complete success compared to the qualified success group (613.7 vs. 378.1 vs. 450.8 µm in CS vs. QS vs. F, p = 0.004). The scleral flap length, thickness, and width were otherwise similar across the three outcome groups. The quantification of surgical parameters that influence aqueous outflow in non-penetrating GFS can help surgeons better understand the influence of these structures on aqueous outflow and improve surgical outcomes.
Collapse
Affiliation(s)
- Jeremy C.K. Tan
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YA, UK; (J.C.K.T.)
- Faculty of Medicine and Health, University of New South Wales, Kensington, NSW 2032, Australia
| | - Hussameddin Muntasser
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YA, UK; (J.C.K.T.)
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Anshoo Choudhary
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YA, UK; (J.C.K.T.)
| | - Mark Batterbury
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YA, UK; (J.C.K.T.)
| | - Neeru A. Vallabh
- St. Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YA, UK; (J.C.K.T.)
- Department of Eye and Vision Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L69 3BX, UK
| |
Collapse
|
16
|
Murakami K, Iida M, Shimada A, Ichioka S, Harano A, Tsutsui A, Tanito M. Dislocation of the PreserFlo MicroShunt During a Postsurgical Needling Procedure. Cureus 2023; 15:e47356. [PMID: 38022219 PMCID: PMC10659566 DOI: 10.7759/cureus.47356] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
We report a case of PreserFlo MicroShunt (PFM) dislocation following a postsurgical needling procedure. A 58-year-old woman underwent PFM implantation for exfoliation glaucoma in her left eye (OS). There were no intraoperative complications. Preoperatively, her best-corrected visual acuity (BCVA) was 0.6, and her intraocular pressure (IOP) was 25 mmHg with three antiglaucoma medications in the OS. On postoperative day 21, the IOP was 21 mmHg OS, and the filtration bleb had shrunk. A needling procedure was performed using a sharp 26-gauge needle to lower the IOP. On postoperative day 29, the BCVA was 0.02, and the IOP was 60 mmHg OS. Gonioscopy revealed no device tip in the anterior chamber, and peripheral anterior synechia was observed at the site of PFM insertion. Anterior segment optical coherence tomography showed a dislocated device in the subconjunctival space. On postoperative day 35, the dislocated PFM was removed, and a new device was inserted. Following the reoperation, no further complications were observed, and bleb formation was obtained. In conclusion, like other glaucoma filtering surgeries, PFM may require postsurgical needling procedures. Needling procedures may cause PFM dislocation and IOP rise, resulting in the requirement for further IOP-reducing procedures.
Collapse
Affiliation(s)
- Kana Murakami
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Mizuki Iida
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Ayaka Shimada
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Sho Ichioka
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Akiko Harano
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Aika Tsutsui
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, JPN
| |
Collapse
|
17
|
Kumar V, Bezzabotnov AI, Rustamova ZS, Dushina GN, Abu Zaalan KA, Shradqa ASS, Frolov MA. Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics. Vision (Basel) 2023; 7:59. [PMID: 37756133 PMCID: PMC10536777 DOI: 10.3390/vision7030059] [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: 08/02/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023] Open
Abstract
A surgical technique was developed to enhance aqueous humor (AH) flow through the non-trabecular outflow pathway by rerouting it from the anterior chamber (AC) to the suprachoroidal space (SCS) without detaching the ciliary body from the scleral spur. Medium- and long-term surgical outcomes were retrospectively analyzed in a case series of 58 glaucoma patients. At 6, 12, and 24 months, the mean IOP decreased from 27.8 ± 8.3 to 14.9 ± 5.0 mmHg, median 15.0 (25th percentile (p25)13.0; 75th percentile (p75) 18.0) and 15.2 ± 3.3 mmHg, and hypotensive medication use reduced from a median (p25; p75) of 3 (2; 3) to 0 (0; 2), 0 (0; 2), and 0 (0; 1.5), respectively. Intra- and postoperative complications were few and manageable. Following surgery, no bleb formation occurred in any of the cases (as confirmed by optical coherence tomography). Conjunctival lymphatic vessels (CLVs) developed in 50% of eyes (29/58). Clinically, they developed directly from sclera and had no connection to the surgical site. Analysis further showed that the development of CLVs and their longer visibility period had poor prognostic value for IOP control. If the fluid flow from the SCS to CLVs was resistance-free, no CLV development was evident. However, if any resistance existed in the flow, the fluid accumulated in lymphatics, resulting in their engorgement. The proposed technique was safe and effective in decreasing IOP in glaucoma patients by enhancing AH flow from the SCS to CLVs via connecting intrascleral microchannels.
Collapse
Affiliation(s)
- Vinod Kumar
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Andrey Igorevich Bezzabotnov
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Zarina Shaykuliyevna Rustamova
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
| | - Galina Nikolaevna Dushina
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Kamal Abdulmuhsen Abu Zaalan
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Ahmad Saleh Soliman Shradqa
- Centre of Eye Microsurgery “PRO Zrenie”, 1 Gorshina Str., 141407 Khimki, Russia; (A.I.B.); (K.A.A.Z.); (A.S.S.S.)
| | - Mikhail Aleksandrovich Frolov
- Department of Eye Diseases, Medical Institute, Peoples’ Friendship University of Russia Named after Patrice Lumumba, 6 Mikluho-Maklaya St., 117198 Moscow, Russia; (Z.S.R.); (G.N.D.); (M.A.F.)
| |
Collapse
|
18
|
Wiedenmann CJ, Gottwald C, Zeqiri K, Frömmichen J, Bungert E, Gläser M, Ströble J, Lohmüller R, Reinhard T, Lübke J, Schlunck G. Slow Interstitial Fluid Flow Activates TGF-β Signaling and Drives Fibrotic Responses in Human Tenon Fibroblasts. Cells 2023; 12:2205. [PMID: 37681937 PMCID: PMC10486805 DOI: 10.3390/cells12172205] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Fibrosis limits the success of filtering glaucoma surgery. We employed 2D and 3D in vitro models to assess the effects of fluid flow on human tenon fibroblasts (HTF). METHODS HTF were exposed to continuous or pulsatile fluid flow for 48 or 72 h, at rates expected at the transscleral outflow site after filtering surgery. In the 2D model, the F-actin cytoskeleton and fibronectin 1 (FN1) were visualized by confocal immunofluorescence microscopy. In the 3D model, mRNA and whole cell lysates were extracted to analyze the expression of fibrosis-associated genes by qPCR and Western blot. The effects of a small-molecule inhibitor of the TGF-β receptor ALK5 were studied. RESULTS Slow, continuous fluid flow induced fibrotic responses in the 2D and 3D models. It elicited changes in cell shape, the F-actin cytoskeleton, the deposition of FN1 and activated the intracellular TGF-β signaling pathway to induce expression of fibrosis-related genes, such as CTGF, FN1 and COL1A1. ALK5-inhibition reduced this effect. Intermittent fluid flow also induced fibrotic changes, which decreased with increasing pause duration. CONCLUSIONS Slow interstitial fluid flow is sufficient to induce fibrosis, could underlie the intractable nature of fibrosis following filtering glaucoma surgery and might be a target for antifibrotic therapy.
Collapse
Affiliation(s)
- Cornelius Jakob Wiedenmann
- Eye Center, Medical Center, Faculty of Medicine, University of Freiburg, Killianstr. 5, 79106 Freiburg, Germany (E.B.); (R.L.); (J.L.); (G.S.)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Tseng VL, Kitayama K, Yu F, Coleman AL. Disparities in Glaucoma Surgery: A Review of Current Evidence and Future Directions for Improvement. Transl Vis Sci Technol 2023; 12:2. [PMID: 37672254 PMCID: PMC10484012 DOI: 10.1167/tvst.12.9.2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/06/2023] [Indexed: 09/07/2023] Open
Abstract
There is a need to understand existing disparities in glaucoma surgery and to create strategies to eliminate these disparities. Disparities can exist in several aspects of glaucoma surgical management, including patient selection and timing of surgery, type of surgery performed, intra-operative and postoperative surgical complications, follow-up surgical care, and long-term surgical outcomes. Additionally, multiple types of disparities can exist within each of these realms, including disparities by race and ethnicity, age, gender, insurance type, people with disabilities, and other social, economic, and demographic factors. Disparities in glaucoma surgery have been examined in large scale datasets, retrospective clinical studies, and clinical trials, and several studies have identified likely racial and ethnic disparities in glaucoma surgical incidence and outcomes. We present existing literature on disparities in glaucoma surgery, analyze the advantages and limitations of various study designs for the investigation of these disparities, and propose directions for future research and interventions to identify and eliminate disparities in surgical glaucoma care.
Collapse
Affiliation(s)
- Victoria L. Tseng
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ken Kitayama
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Fei Yu
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Anne L. Coleman
- Department of Ophthalmology, Stein and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| |
Collapse
|
20
|
Figus M, Sacchi M, Rossi GC, Babighian S, Del Castillo JMB, de Polo L, Melchionda E, Posarelli C. Ocular surface and glaucoma, a mutual relationship. Practical suggestions for classification and management. Eur J Ophthalmol 2023:11206721231199157. [PMID: 37649335 DOI: 10.1177/11206721231199157] [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: 09/01/2023]
Abstract
The chronic use of glaucoma medications could improve the development of an ocular comorbidity, the glaucoma therapy-related ocular surface disease. This could be related to the exposure of the conjunctiva to preservatives, but also active compounds such as prostaglandin analogues may improve the risk of ocular surface inflammation. Inflammation has a negative impact on tolerability and adherence to eyedrops and to the outcome of filtration surgery as well. A stratification of glaucoma patients based not only on visual field progression but also on glaucoma therapy-related ocular surface disease would be desirable for a strategic management. Early diagnosis, individualized treatment, and safe surgical management should be the hallmarks of glaucoma treatment. One of the main issues for the proper and successful management of patients is the right timing, effectiveness and safety for both medical and surgical treatment options leading to a precision medicine in glaucoma disease as the best modern treatment.
Collapse
Affiliation(s)
- Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Matteo Sacchi
- Eye clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | - Gemma Caterina Rossi
- Department of Surgical Science, University Eye Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- ASST Bergamo Est, Ambulatorio di Oculistica, Ospedale MO A.Locatelli, Piario, Italy
| | - Silvia Babighian
- Department Ophthalmology, Sant'Antonio Hospital, Azienda Ospedaliera Padova, Padova, Italy
| | - José Manuel Benitez Del Castillo
- Hospital Clinico San Carlos de Madrid Department of Ophthalmology, Madrid, Spain
- Universidad Complutense de Madrid, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Madrid, Spain
| | | | - Eugenio Melchionda
- UOC Chirurgica Oftalmologica e di Urgenza, Presidio Ospedaliero Oftalmico, ASL ROMA1, Roma, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
21
|
Şimşek D, Wagner I, Draper C, Şimşek T, Dorairaj S. Cyclodialysis Cleft and Hypotony Following Combined Phacoemulsification and Excisional Goniotomy with the Kahook Dual Blade. Turk J Ophthalmol 2023; 53:257-260. [PMID: 37602674 PMCID: PMC10442746 DOI: 10.4274/tjo.galenos.2023.60963] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 04/03/2023] [Indexed: 08/22/2023] Open
Abstract
A 69-year-old woman with bilateral primary open-angle glaucoma who underwent cataract extraction with intraocular lens implantation and excisional goniotomy with the Kahook Dual Blade (KDB; New World Medical, Rancho Cucamonga, CA, USA) in both eyes one year prior was referred for evaluation of significant visual acuity loss and pain in the left eye. On initial examination, intraocular pressure in the left eye was 3 mmHg and slit lamp examination revealed normal anterior chamber depth. Gonioscopy revealed a cyclodialysis cleft that was confirmed by anterior segment optical coherence tomography. Prominent chorioretinal folds suggestive of long-standing hypotony maculopathy were observed during fundoscopic examination. The cyclodialysis cleft, thought to be created inadvertently during the KDB goniotomy, resolved after three sessions of argon laser photocoagulation and the patient's symptoms and visual acuity partially improved.
Collapse
Affiliation(s)
- Derya Şimşek
- Başkent University Faculty of Medicine, Ankara, Türkiye
| | - Isabella Wagner
- Mayo Clinic, Department of Ophthalmology, Jacksonville, United States
| | - Christian Draper
- Mayo Clinic, Department of Ophthalmology, Jacksonville, United States
| | - Tülay Şimşek
- Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Türkiye
| | - Syril Dorairaj
- Mayo Clinic, Department of Ophthalmology, Jacksonville, United States
| |
Collapse
|
22
|
Richardson-May J, Alnuaimi R, Elbably A, Walker L, Thulasidharan S, Dacombe R, Jacob A. Our Experience of Deep Sclerectomy at a Tertiary Center in the United Kingdom Over 14 Years. Cureus 2023; 15:e43366. [PMID: 37701011 PMCID: PMC10494555 DOI: 10.7759/cureus.43366] [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] [Accepted: 08/12/2023] [Indexed: 09/14/2023] Open
Abstract
Background Deep sclerectomy (DS) is a non-penetrating surgical procedure for glaucoma, reducing the resistance to aqueous outflow and lowering intraocular pressure while maintaining a physiological barrier between the anterior chamber and the sub-scleral space. This offers a lower complication profile than penetrating procedures, though with less intraocular pressure (IOP) reduction. Methods We retrospectively reviewed the electronic record for all DS undertaken at our hospital (a tertiary care center) over 14 years, collecting data on demographics, diagnosis, IOP, visual acuity, complications, medications, and further procedures required. Results Eighty eyes of 69 patients underwent DS, with a mean follow-up period of 53.5 months. The mean pre-operative IOP was 23.55 mmHg (range 11-52, standard deviation 8.46); the mean final IOP was 13.61 mmHg (range 5-35, SD 4.73), with a mean reduction of 42.21%. The mean change in glaucoma medications was -1.64. 78.40% experienced a reduction in glaucoma treatment. Post-operatively, 43.80% had no complications; this improved to 85.0% when numerical hypotony and raised IOP without visual sequelae were excluded. Further procedures required included Nd:YAG goniopuncture (10%), bleb needling (13.75%) or revision (7.5%), iridectomy (3.75%), goniosynechiolysis (1.25%), and autologous blood injection (1.25%). Two eyes were converted to trabeculectomy peri-operatively, with seven overall (8.75%) requiring trabeculectomy over the course of follow-up. 3.75% underwent glaucoma drainage device implantation, and 3.75% underwent cyclodiode laser. Conclusion We have found DS to be a safe, effective procedure for selected patients where trabeculectomy has a high likelihood of failure or where a higher IOP can be tolerated.
Collapse
Affiliation(s)
- James Richardson-May
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Rawdha Alnuaimi
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Ahmed Elbably
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Lawrence Walker
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Suresh Thulasidharan
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Richard Dacombe
- Clinical Outcomes, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| | - Aby Jacob
- Ophthalmology, University Hospital Southampton National Health Services (NHS) Foundation Trust, Southampton, GBR
| |
Collapse
|
23
|
Dar N, Naftali Ben Haim L, Yehezkeli V, Sharon T, Belkin A. Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma. Indian J Ophthalmol 2023; 71:3024-3030. [PMID: 37530276 PMCID: PMC10538851 DOI: 10.4103/ijo.ijo_2769_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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/07/2023] [Accepted: 06/05/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Methods Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single-center chart review. The main outcome measure was surgical success; intra-ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ≤ of baseline on fewer medications as compared to baseline. Results Forty-seven eyes were included in the analysis. The average mean deviation was -17.5 ± 7.2 dB (range -8.0 to -33.0). The average follow-up was 6.8 months (range 3.2-22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12-40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post-operative month (P < 0.001 for both IOP and medications). At the last follow-up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. Conclusions GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post-operative management are imperative.
Collapse
Affiliation(s)
- Nimrod Dar
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liron Naftali Ben Haim
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Veronika Yehezkeli
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Sharon
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Belkin
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
24
|
Weber C, Hundertmark S, Liegl R, Jauch AS, Stasik I, Holz FG, Mercieca K. Clinical outcomes of the PAUL® glaucoma implant: One-year results. Clin Exp Ophthalmol 2023; 51:566-576. [PMID: 37160354 DOI: 10.1111/ceo.14235] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/28/2023] [Accepted: 04/22/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND To report one-year outcomes from a single-centre cohort undergoing PAUL® Glaucoma Implant (PGI) surgery. METHODS Retrospective review of patients undergoing PGI surgery at the University Eye Hospital Bonn, Germany, from April 2021 to September 2021. RESULTS Forty-five eyes of 41 patients were included. Qualified and complete success rates (95% CI) were 95.6% (88.9%-100%) and 73.3% (60%-86.7%) for Criterion A (IOP ≤ 21 mmHg), 84.4% (73.3%-93.3%) and 74.4% (51.1%-80.0%) for Criterion B (IOP ≤ 18 mmHg), 62.2% (48.9%-75.6%) and 46.7% (31.2%-62.2%) for Criterion C (IOP ≤ 15 mmHg) and 26.7% (13.3%-40.0%) and 22.2% (11.1%-33.3%) for Criterion D (IOP ≤ 12 mmHg), respectively. Mean IOP decreased from 26.1 mmHg (7-48 mmHg) to 12.0 mmHg (3-24 mmHg) (reduction of 48.83%) after 12 months with a reduction of IOP-lowering agents from 0.5 (0-3). One eye (2.2%) needed an injection of viscoelastic due to significant hypotony with AC shallowing, and four eyes (8.9%) developed choroidal detachments due to hypotony which resolved without further interventions after 6 weeks. Three patients (6.7%) developed tube exposure which required conjunctival revision with an additional pericardial patch graft. An intraluminal prolene stent was removed in 19 eyes (42.2%) after a mean time period of 8.4 months (2-12 m). Mean IOP before the removal was 21.9 mmHg (12-38 mmHg) and decreased to 11.3 mmHg (6-16 mmHg). CONCLUSIONS PGI surgery is an effective procedure for reducing IOP and pressure-lowering therapy. An intraluminal prolene stent impedes hypotony in the early postoperative phase and enables further IOP lowering without additional interventions during the postoperative course.
Collapse
Affiliation(s)
- Constance Weber
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | | | - Raffael Liegl
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Anna S Jauch
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Isabel Stasik
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| | - Karl Mercieca
- Department of Ophthalmology, University of Bonn, Bonn, Germany
| |
Collapse
|
25
|
Fea AM, Ricardi F, Cariola R, Rossi A. Hydrus microstent for the treatment of primary open-angle glaucoma: overview of its safety and efficacy. Expert Rev Med Devices 2023; 20:1009-1025. [PMID: 37752854 DOI: 10.1080/17434440.2023.2259788] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Minimally invasive glaucoma surgeries (MIGS) are now a consolidated reality in many surgical units. The Hydrus Microstent is one of several MIGS devices bypassing trabecular outflow and had excellent results over the years. This article aims to review the key features of the Hydrus Microstent in terms of design, efficacy, and safety. AREAS COVERED The present review analyses the main characteristics of the device by evaluating the technical and physical details of its functioning. The evidence that supports a clinical decision summarizes the most influential clinical trials and the most accurate systematic reviews. EXPERT OPINION The Hydrus device has been extensively studied regarding biocompatibility and outflow potential. The subsequent clinical studies have been well-built and proved that the device effectively reduces intraocular pressure (IOP) and the eyedrop load. The device covers almost a quarter of Schlemm's canal circumference, offering at least two advantages: cannulating the Schlemm's canal provides evidence that the device has been implanted correctly; covering a larger area potentially allows to target multiple collector channels or at least areas of active outflow. This scaffold may prove more effective in naïve patients or subjects who used antiglaucoma eyedrops for a limited period, as the prolonged use of hypotonic medications has been associated with the surgical failure of ab interno microhook trabeculotomy.
Collapse
Affiliation(s)
- Antonio M Fea
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Federico Ricardi
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Rossella Cariola
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Alessandro Rossi
- Institute of Ophthalmology, Department of Surgical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
26
|
Tanito M. Nationwide Analysis of Glaucoma Surgeries in Fiscal Years of 2014 and 2020 in Japan. J Pers Med 2023; 13:1047. [PMID: 37511660 PMCID: PMC10381819 DOI: 10.3390/jpm13071047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/01/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Nationwide trends in glaucoma surgical procedures were assessed by using the NDB Open Data 2014 and 2020. In Japan, 33,340 non-laser, 54,569 laser, and 88,019 total glaucoma surgeries were performed in 2014. In 2020, 60,108 non-laser, 60,547 laser, and 120,655 total glaucoma surgeries were performed. The rates from 2014 to 2020 were 180%, 111%, and 137%, respectively. In each procedure, angle surgery (326%), tube shunt surgery (383%), ciliary coagulation (489%), and gonio-laser (225%) were remarkably increased, while iridectomy (75%) and iris laser (77%) decreased during the same period. An increase in laser surgery was seen in young age groups, namely, 55-59 years old and younger, while non-laser surgery was increased in old age groups, namely, 45-49 years old and older. In 2020, 47.6 non-laser, 48.0 laser, and 95.6 total glaucoma surgeries were performed per 100,000 persons. None of the vital statistics, including prefectural population, mean age, and rate of ≥65-year-old people, were significantly associated with the number of glaucoma surgeries. Glaucoma practice patterns changed each time a new device or procedure was introduced. The results of the current study reflected the use of new procedures, such as minimally invasive glaucoma surgery, tube shunt, selective laser trabeculoplasty, and micropulse cyclophotocoagulation.
Collapse
Affiliation(s)
- Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Shimane, Japan
| |
Collapse
|
27
|
Collotta D, Colletta S, Carlucci V, Fruttero C, Fea AM, Collino M. Pharmacological Approaches to Modulate the Scarring Process after Glaucoma Surgery. Pharmaceuticals (Basel) 2023; 16:898. [PMID: 37375845 DOI: 10.3390/ph16060898] [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: 04/16/2023] [Revised: 05/15/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Glaucoma is an acquired optic neuropathy that results in a characteristic optic nerve head appearance and visual field loss. Reducing the IOP is the only factor that can be modified, and the progression of the disease can be managed through medication, laser treatment, or surgery. Filtering procedures are used when target pressure cannot be obtained with less invasive methods. Nevertheless, these procedures require accurate control of the fibrotic process, which can hamper filtration, thus, negatively affecting the surgical success. This review explores the available and potential pharmacological treatments that modulate the scarring process after glaucoma surgery, analyzing the most critical evidence available in the literature. The modulation of scarring is based on non-steroidal anti-inflammatory drugs (NSAIDs), mitomycin, and 5-fluorouracil. In the long term, the failure rate of filtering surgery is mainly due to the limitations of the current strategies caused by the complexity of the fibrotic process and the pharmacological and toxicological aspects of the drugs that are currently in use. Considering these limitations, new potential treatments were investigated. This review suggests that a better approach to tackle the fibrotic process may be to hit multiple targets, thus increasing the inhibitory potential against excessive scarring following surgery.
Collapse
Affiliation(s)
- Debora Collotta
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy
| | - Simona Colletta
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy
| | | | - Claudia Fruttero
- Hospital Pharmacy, S. Croce e Carle Hospital Cuneo, 12100 Cuneo, Italy
| | - Antonio Maria Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, 10126 Torino, Italy
| | - Massimo Collino
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy
| |
Collapse
|
28
|
Alasbali T. Endoscopic cyclophotocoagulation for glaucoma compared to alternative procedures -A Systematic review. Oman J Ophthalmol 2023; 16:211-219. [PMID: 37602189 PMCID: PMC10433059 DOI: 10.4103/ojo.ojo_106_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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 11/05/2022] [Accepted: 03/14/2023] [Indexed: 08/22/2023] Open
Abstract
INTRODUCTION Despite many recent developments, preference in the choice of surgical treatment of uncontrolled intraocular pressure (IOP) remains a challenge. OBJECTIVE This study compares the clinical efficacy and safety of endoscopic cyclophotocoagulation (ECP) to alternative surgical procedures, for all types of glaucoma. METHODOLOGY The methodology adheres to the preferred reporting items for systematic reviews and meta-analyses guidelines for systematic review reporting. Studies reporting ECP and alternative surgeries in treating refractory glaucoma, neovascular glaucoma, aphakic glaucoma, filtering surgical failure-induced glaucoma, congenital or juvenile glaucoma, and secondary glaucoma such as uveitis glaucoma, traumatic glaucoma, secondary glaucoma postcorneal transplantation, etc. were included. The efficacy was evaluated from the number of IOP-lowering drugs, and mean change in pre- and post-IOP were the outcomes assessed in ECP and non-ECP groups in this review. Evaluations of the postoperative complications revealed the safety assessment of the procedure. RESULTS In total, 11 relevant studies were selected in this study with a total of 5418 eyes, including 763 eyes in the ECP group and 4655 in the non-ECP group. This review observed that both ECP and non-ECP procedures had been successful in reducing postoperative IOP. CONCLUSION It can be deduced from this review, that all types of glaucoma can be treated efficiently with significantly higher success rates with ECP and ECP demonstrates lowest postoperative complications when compared to non ECP procedures. This review provides updated scientific evidence which caters to support clinical decisions for surgical treatment of glaucoma.
Collapse
Affiliation(s)
- Tariq Alasbali
- Department of Ophthalmology, College of Medicine, Imam Mohammed IBN Saud Islamic University, Riyadh, Saudi Arabia
| |
Collapse
|
29
|
Jalamangala Shivananjaiah SK, Kumari S, Majid I, Wang SY. Predicting near-term glaucoma progression: An artificial intelligence approach using clinical free-text notes and data from electronic health records. Front Med (Lausanne) 2023; 10:1157016. [PMID: 37122330 PMCID: PMC10133544 DOI: 10.3389/fmed.2023.1157016] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/15/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose The purpose of this study was to develop a model to predict whether or not glaucoma will progress to the point of requiring surgery within the following year, using data from electronic health records (EHRs), including both structured data and free-text progress notes. Methods A cohort of adult glaucoma patients was identified from the EHR at Stanford University between 2008 and 2020, with data including free-text clinical notes, demographics, diagnosis codes, prior surgeries, and clinical information, including intraocular pressure, visual acuity, and central corneal thickness. Words from patients' notes were mapped to ophthalmology domain-specific neural word embeddings. Word embeddings and structured clinical data were combined as inputs to deep learning models to predict whether a patient would undergo glaucoma surgery in the following 12 months using the previous 4-12 months of clinical data. We also evaluated models using only structured data inputs (regression-, tree-, and deep-learning-based models) and models using only text inputs. Results Of the 3,469 glaucoma patients included in our cohort, 26% underwent surgery. The baseline penalized logistic regression model achieved an area under the receiver operating curve (AUC) of 0.873 and F1 score of 0.750, compared with the best tree-based model (random forest, AUC 0.876; F1 0.746), the deep learning structured features model (AUC 0.885; F1 0.757), the deep learning clinical free-text features model (AUC 0.767; F1 0.536), and the deep learning model with both the structured clinical features and free-text features (AUC 0.899; F1 0.745). Discussion Fusion models combining text and EHR structured data successfully and accurately predicted glaucoma progression to surgery. Future research incorporating imaging data could further optimize this predictive approach and be translated into clinical decision support tools.
Collapse
Affiliation(s)
| | | | | | - Sophia Y. Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, United States
| |
Collapse
|
30
|
Gedde SJ, Vinod K, Prum BE. Results from the Primary Tube Versus Trabeculectomy Study and translation to clinical practice. Curr Opin Ophthalmol 2023; 34:129-137. [PMID: 36730686 PMCID: PMC9908825 DOI: 10.1097/icu.0000000000000928] [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] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW The Primary Tube Versus Trabeculectomy (PTVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube shunt surgery and trabeculectomy with mitomycin C (MMC) in eyes without previous incisional ocular surgery. This article reviews results from the PTVT Study and suggests how they may be translated to clinical practice. RECENT FINDINGS Tube shunt surgery had a higher failure rate than trabeculectomy with MMC in the PTVT Study, and the difference was statistically significant at 1 year but not at 3 years and 5 years. Both surgical procedures reduced intraocular pressure (IOP) to the low teens throughout 5 years of follow-up. Mean IOPs were lower after trabeculectomy with MMC compared with tube shunt implantation, and the differences were statistically significant during the first postoperative year and at 3 years. The greater IOP reduction after trabeculectomy with MMC was achieved with significantly fewer glaucoma medications relative to tube shunt placement. Surgical complications were common in the PTVT Study, but most were transient and self-limited. The incidence of early postoperative complications was significantly higher after trabeculectomy with MMC than tube shunt surgery. The rates of late postoperative complications, cataract progression, and vision loss were similar with both surgical procedures. Serious complications producing vision loss and/or requiring a reoperation to manage the complication developed more frequently after trabeculectomy with MMC compared with tube shunt surgery, and the difference was statistically significant at 1 year but not at 3 years and 5 years postoperatively. SUMMARY Tube shunt implantation and trabeculectomy with MMC are both viable surgical options for managing glaucoma in patients without previous incisional ocular surgery. Results from the PTVT Study support further expansion of tube shunt use beyond refractory glaucomas.
Collapse
Affiliation(s)
- Steven J. Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kateki Vinod
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E. Prum
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia
| | | |
Collapse
|
31
|
Tanev I, Kirkova R. "Ab Interno" Surgery of the Schlemm's Canal in Postuveitic Glaucoma Patients. J Pers Med 2023; 13:456. [PMID: 36983635 PMCID: PMC10051606 DOI: 10.3390/jpm13030456] [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: 01/24/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Patients with uveitis have a higher risk of developing glaucoma not only because of the disease by itself, but also because of the ongoing corticosteroid therapy. The pathogenesis of uveitic glaucoma is characterized by a complex of biochemical and cellular processes, as well as morphological changes in the trabecular meshwork. Treatment of secondary chronic glaucoma is challenging and often requires different approaches and solutions. PURPOSE To present the "ab interno" procedure of the Schlemm's canal (SC) performed with the help of TrabEx+ (MST, Redmond, WA, USA) in postuveitic glaucoma patients. METHODS The observed group included patients with postuveitic secondary glaucoma, which consisted of 12 pseudophakic patients (12 eyes). Patients are with intraocular pressure higher than 25 mmHg and on maximal local therapy. Due to insufficient conservative control on IOP, surgical solutions are needed. We describe a new, minimally invasive surgical procedure-the technique of the operation, the postoperative results and complications. RESULTS We present the achieved intraocular pressure (on the first day, 2 weeks, 1 month, 6, 8 12 and 18 months). The morphology of the trabecular area was demonstrated by gonioscopy. The effects of the therapy on the glaucoma progression, was evaluated with perimetry and OCT. DISCUSSION The following procedure is a minimally invasive procedure and provides good control of intraocular pressure. Aqueous veins in the conjunctiva are significantly preserved compared to conventional filtration trabeculectomy. This potentially modulates the physiological outflow pathways by ablating trabeculum strip the cause of increased outflow resistance-the inner wall of the SC. CONCLUSION Removal of the inner wall of the SC, using Trabex+ (MST, Redmond, WA, USA), demonstrates promising results in the selected patients with a minimally invasive nature.
Collapse
Affiliation(s)
- Ivan Tanev
- Eye Clinic “Zrenieto”, 1000 Sofia, Bulgaria
| | - Radina Kirkova
- Department of Ophthalmology, ENT and Maxillofacial Surgery, Medical University—Pleven, 5800 Pleven, Bulgaria
- Department of Ophthalmology, IRCCS HUMANITAS Research Hospital, 20089 Rozzano, Italy
- University First Multiprofile Hospital for Active Treatment “St Joan Krastitel”, 1000 Sofia, Bulgaria
| |
Collapse
|
32
|
Wong JC, Savsani E, Mahmoudzadeh R, Salabati M, Razeghinejad R, Lee D, Shukla AG, Myers JS, Pro MJ, Moster MR, Dunn JP, Kolomeyer NN. Glaucoma Surgical Outcomes in Patients with a History of Scleritis. Ocul Immunol Inflamm 2023:1-7. [PMID: 36802353 DOI: 10.1080/09273948.2023.2177678] [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: 05/15/2022] [Revised: 01/24/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To assess the outcomes of glaucoma surgery in patients with a history of scleritis at a tertiary medical center. METHODS The retrospective case series included patients with a history of scleritis who required glaucoma surgery between 4/2006 and 8/2021. RESULTS Two hundred and eighty-one eyes of 259 patients had glaucoma and scleritis with 28 eyes (10%) of 25 patients requiring glaucoma surgery. Post-operatively, one eye (4%) had infectious scleritis. Eleven (39%) surgeries failed: 5 tube shunts, 5 cyclophotocoagulation, and 1 gonioscopy-assisted transluminal trabeculotomy. Five (18%) eyes required tube revisions due to tube exposures without infection (3), iris blocking the tube (1), or to shorten tube length (1). CONCLUSIONS Patients with a history of scleritis have a low risk of scleritis recurrence or scleral perforation after glaucoma surgery but should be counseled appropriately on the higher risk of reoperation.
Collapse
Affiliation(s)
- Jae-Chiang Wong
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Rowan University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Esika Savsani
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Mirataollah Salabati
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aakriti G Shukla
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael J Pro
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James P Dunn
- The Retina Service of Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Natasha Nayak Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
33
|
Lupardi E, Laffi GL, Moramarco A, Barboni P, Fontana L. Systematic Preserflo MicroShunt Intraluminal Stenting for Hypotony Prevention in Highly Myopic Patients: A Comparative Study. J Clin Med 2023; 12. [PMID: 36836212 DOI: 10.3390/jcm12041677] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Transient hypotony is the most common early complication after Preserflo MicroShunt (PMS) implantation. High myopia is a risk factor for the development of postoperative hypotony-related complications; therefore, it is advisable that PMS implantation in patients should be performed while employing hypotony preventive measures. The aim of this study is to compare the frequency of postoperative hypotony and hypotony-related complications in high-risk myopic patients after PMS implantation with and without intraluminal 10.0 nylon suture stenting. This is a retrospective, case-control, comparative study of 42 eyes with primary open-angle glaucoma (POAG) and severe myopia that underwent PMS implantation. A total of 21 eyes underwent a non-stented PMS implantation (nsPMS), while in the remaining eyes (21 eyes), PMS was implanted with an intraluminal suture (isPMS group). Hypotony occurred in six (28.57%) eyes in the nsPMS group and none in the isPMS group. Choroidal detachment occurred in three eyes in the nsPMS group; two of them were associated with the shallow anterior chamber and one was associated with macular folds. At 6 months after surgery, the mean IOP was 12.1 ± 3.16 mmHg and 13.43 ± 5.22 mmHg (p = 0.41) in the nsPMS and isPMS group, respectively. PMS intraluminal stenting is an effective measure to prevent early postoperative hypotony in POAG highly myopic patients.
Collapse
|
34
|
Zhang D, Miao JH, Suo LG, Li YN, Chen XH, Wu DF, Wu QR, Zhang C. Trends in operating room-based glaucoma procedures at a single eye center from 2016-2020. Int J Ophthalmol 2023; 16:208-214. [PMID: 36816222 PMCID: PMC9922625 DOI: 10.18240/ijo.2023.02.06] [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: 03/10/2022] [Accepted: 12/26/2022] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016-2020. METHODS A retrospective search of all glaucoma procedures performed at our institution were performed. Data were analyzed by calculating the absolute numbers and relative weightage of each procedure per year. RESULTS The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y, and 55% were women. From 2016 to 2019, the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460, although it decreased slightly in 2020 (n=1393), probably due to the COVID-19 pandemic. The number of trabeculectomies did not change significantly in 2016 (n=161) to 2018 (n=164) but decreased in 2019 (n=139) to 2020 (n=121), indicating a reduction in its relative weightage among glaucoma procedures (from 21.50% to 8.69%). The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased (50 and 58 respectively in 2019), except in 2020. The number of transscleral cyclophotocoagulation procedures was relatively stable, increasing until 2017 (n=218) and then decreasing. Cataract surgeries with or without glaucoma procedures accounted for a large number of the total surgeries, increasing from 247 (32.97%) in 2016 to 967 (69.42%), among which cataract extraction combined with goniosynechialysis was the most frequent. CONCLUSION The overall increase in the number of operating room-based surgical procedures is significant. Trabeculectomy is one of the most commonly performed procedures, despite the relative decline in its weightage. Other procedures, including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries, are gaining greater acceptance. Notably, lens-related surgery plays an important role in glaucoma management.
Collapse
Affiliation(s)
- Di Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Jin-Hong Miao
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ling-Ge Suo
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Ya-Nan Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Xu-Hao Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - De-Fu Wu
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | - Qian-Ru Wu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Institute of Ophthalmology, Capital Medical University, Beijing 100730, China
| | - Chun Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing 100191, China,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing 100191, China
| | | | | | | | | | | | | |
Collapse
|
35
|
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
|
36
|
Stingl JV, Wagner FM, Liebezeit S, Baumgartner R, Spät H, Schuster AK, Prokosch V, Grehn F, Hoffmann EM. Long-Term Efficacy and Safety of Modified Canaloplasty Versus Trabeculectomy in Open-Angle Glaucoma. Life (Basel) 2023; 13:life13020516. [PMID: 36836873 PMCID: PMC9963969 DOI: 10.3390/life13020516] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/27/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND To evaluate the long-term efficacy and safety of modified canaloplasty versus trabeculectomy in open-angle glaucoma. METHODS In total, 210 subjects with open-angle glaucoma were included. 70 were treated with Mitomycin C-augmented modified canaloplasty with enhanced subconjunctival filtration and 140 with Mitomycin C-augmented trabeculectomy. Cases were matched 1:2 by sex and age. RESULTS In canaloplasty and trabeculectomy groups, 61.4% and 57.9% of participants were female. Mean age was 60.0 ± 13.9 and 63.0 ± 12.2 years, median follow-up time was 4.6 [IQR 4.3, 5.05] years and 5.8 [IQR 5.4, 6.3]. Strict success was achieved in 20.0% and 56.4%, complete success in 24.3% and 66.4%, and qualified success in 34.3% and 73.6% (each p < 0.001). Kaplan-Meier survival analysis showed a better survival probability for trabeculectomy than for canaloplasty (p < 0.001) and Cox regression analysis revealed an HR of 6.03 (95%-CI 3.66, 9.93, p < 0.001) after canaloplasty. Trabeculectomy showed superiority in terms of IOP decrease (9.2 ± 7.9 mmHg vs. 13.7 ± 10.4 mmHg, p = 0.002), use of AGM (50.0% vs. 10.7%, p < 0.001), and the number of revision surgeries (41.4% vs. 21.4%, p = 0.004). Occurrence of complications was similar in both groups (14.5% vs. 7.5%, p = 0.19). CONCLUSIONS Trabeculectomy showed superiority in efficacy and equality in safety compared to modified canaloplasty.
Collapse
Affiliation(s)
- Julia V. Stingl
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Felix M. Wagner
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | | | | | - Helene Spät
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Alexander K. Schuster
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Verena Prokosch
- Department of Ophthalmology, University of Cologne, 50937 Cologne, Germany
| | - Franz Grehn
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Esther M. Hoffmann
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Correspondence:
| |
Collapse
|
37
|
Weber C, Hundertmark S, Petrak M, Ludwig E, Brinkmann CK, Holz FG, Mercieca K. Clinical Outcomes of XEN45(®)-Stent Implantation after Failed Trabeculectomy: A Retrospective Single-Center Study. J Clin Med 2023; 12. [PMID: 36835831 DOI: 10.3390/jcm12041296] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The implantation of a collagen gel micro-stent (XEN45®) as a minimally invasive form of glaucoma surgery (MIGS) after a failed trabeculectomy (TE) may be an effective option with few risks. This study investigated the clinical outcome of XEN45® implantation after a failed TE, with follow-up data of up to 30 months. MATERIALS AND METHODS In this paper, we present a retrospective review of patients undergoing XEN45® implantation after a failed TE at the University Eye Hospital Bonn, Germany, from 2012 to 2020. RESULTS In total, 14 eyes from 14 patients were included. The mean follow-up time was 20.4 months. The mean time duration between the failed TE and XEN45® implantation was 110 months. The mean intraocular pressure (IOP) decreased from 17.93 mmHg to 12.08 mmHg after one year. This value increased again to 17.63 mmHg at 24 months and 16.00 mmHg at 30 months. The number of glaucoma medications decreased from 3.2 to 0.71, 2.0, and 2.71 at 12, 24, and 30 months, respectively. CONCLUSIONS XEN45® stent implantation after a failed TE did not lead to an effective long-term decrease in IOP and glaucoma medications in many patients in our cohort. Nevertheless, there were cases without the development of a failure event and complications, and others in whom further, more invasive surgery was delayed. XEN45® implantation in some failed trabeculectomy cases may, therefore, be a good option, especially in older patients with multiple comorbidities.
Collapse
|
38
|
Ćwiklińska-Haszcz A, Żarnowski T, Wróbel-Dudzińska D, Kosior-Jarecka E. The Efficacy and Safety of the GATT Procedure in Open-Angle Glaucoma-6-Month Results. Int J Environ Res Public Health 2023; 20:2759. [PMID: 36768125 PMCID: PMC9914959 DOI: 10.3390/ijerph20032759] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
AIM The aim of the study was to retrospectively evaluate the efficacy and safety of GATT during a 6-month observation period. MATERIAL AND METHODS The studied group consisted of 69 open-angle glaucoma patients treated with GATT as the only procedure or in combination with cataract surgery. Patients were assessed 1 day, 10 days, 1 month, 3 months, and 6 months after the surgery via standard ophthalmic examination including VF, IOP, and BCVA. The number of medications taken daily and possible complications were checked. Two criteria of success were established (S1: IOP decrease by 30% and S2: IOP lower than 18 mm Hg). RESULTS Before the surgery, the mean IOP was 26.94 mmHg and significantly decreased after GATT to 15.59 mmHg at 6M. BCVA did not significantly differ between the visits. The mean MD did not change significantly within the 6-month observation period (-8.20 dB vs. -8.16 dB, p = 0.9824), similar to the mean VFI (64.31% vs. 63.05%, p = 0.8571). A 30% IOP decrease at 6M visit was obtained in 95.6% of patients, and 37.7% needed medications to stabilize IOP. An IOP lower than 18 mmHg at 6M was obtained in 91.3% of studied patients after the GATT procedure, and in 58.0% without additional medications. The mean number of medications received daily decreased significantly at 6M compared to preoperative results (2.59 at inclusion vs. 0.76 at 6M, p = 0.0004). The most frequent complication after surgery was hyphema, which resolved spontaneously within 10 days. CONCLUSION The 6-month observation showed that GATT is a minimally invasive glaucoma-surgery technique that enables an effective and safe IOP decrease.
Collapse
|
39
|
Carré C, Baudin F, Buteau B, Martine L, Grégoire S, Vasku G, Berdeaux O, Béduneau A, Pellequer Y, Jamoussi J, Desrumeaux C, Aho S, Bron AM, Acar N, Creuzot-Garcher C, Gabrielle PH. Effects of topical docosahexaenoic acid on postoperative fibrosis in an animal model of glaucoma filtration surgery. Acta Ophthalmol 2023; 101:e61-e68. [PMID: 35920328 DOI: 10.1111/aos.15222] [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: 03/04/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of this study was to evaluate docosahexaenoic acid (DHA) as a potential antifibrotic agent after glaucoma filtration surgery (GFS) in rats. METHODS A total of 36 10-week-old Brown Norway rats underwent GFS. Animals were equally divided into three groups: a control group, a DHA group and a mitomycin C (MMC) group. Intraocular pressure (IOP) was measured using a dynamic rebound tonometer, and a photograph of the surgical site was taken on days 1, 3, 7, 10, 14 and 17. The incorporation of DHA into fibroblasts was evaluated by gas chromatography. The expression of alfa-smooth muscle actin (α-SMA) and Smad proteins was assessed by Western blotting. RESULTS IOP decreased after surgery in animals from the three groups on day 1 after surgery. Over time, IOP remained lower in the DHA and MMC groups than in the control group (median [interquartile range] 8.0 [7.0-8.0] and 8.0 [7.3-8.0] mmHg vs. 9.0 [8.0-9.0] mmHg, respectively; p < 0.001). Bleb area in the DHA and MMC groups remained larger than that of the control group from day 7 to day 14 (3.9 [2.9-5.2] and 3.5 [2.3-4.4] mm2 vs. 2.3 [2.0-2.8] mm2 , respectively; p = 0.0021). We did not observe any change in DHA concentrations in the fibroblasts of the DHA group compared with the other groups. CONCLUSION The impact of DHA on IOP and bleb area was similar to that of MMC. The mechanisms of action of DHA in rat eye fibroblasts deserve further investigation.
Collapse
Affiliation(s)
- Chloé Carré
- Department of Ophthalmology, University Hospital, Dijon, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Florian Baudin
- Department of Ophthalmology, University Hospital, Dijon, France.,Équipe d'Accueil (EA 7460): Physiopathologie et Épidémiologie Cérébro-Cardiovasculaires (PEC2), Faculté des Sciences de Santé, Université de Bourgogne-Franche-Comté, Dijon, France
| | - Bénédicte Buteau
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Lucy Martine
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Stéphane Grégoire
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Glenda Vasku
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Olivier Berdeaux
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Arnaud Béduneau
- PEPITE EA4267, Labex LipSTIC, Bourgogne-Franche-Comté University, Besançon, France
| | - Yann Pellequer
- PEPITE EA4267, Labex LipSTIC, Bourgogne-Franche-Comté University, Besançon, France
| | - Jasmine Jamoussi
- PEPITE EA4267, Labex LipSTIC, Bourgogne-Franche-Comté University, Besançon, France
| | - Catherine Desrumeaux
- Molecular Mechanisms in Neurodegenerative Dementia Laboratory (MMDN), INSERM, U1198, Environmental Impact in Alzheimer's Disease and Related Disorders (EiAlz) Team, Montpellier, France.,University of Montpellier, Montpellier, France.,EPHE, Paris, France.,MMDN, University of Montpellier, INSERM, EPHE, Montpellier, France
| | - Serge Aho
- Department of Epidemiology and Biostatistics, University Hospital, Dijon, France
| | - Alain-Marie Bron
- Department of Ophthalmology, University Hospital, Dijon, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Niyazi Acar
- Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Catherine Creuzot-Garcher
- Department of Ophthalmology, University Hospital, Dijon, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| | - Pierre Henri Gabrielle
- Department of Ophthalmology, University Hospital, Dijon, France.,Eye and Nutrition Research Group, Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRAE, Université de Bourgogne Franche-Comté, Dijon, France
| |
Collapse
|
40
|
Shakya R, Ahluwalia NS, Shah C, Paul P, Jain BK, Pandit K, Gupta RKC, Ahlawat R, Choudhary P. Awareness and knowledge among paramedical staff about glaucoma surgeries and post-surgery counseling - A questionnaire based study at a tertiary eye care center in Central Rural India. Indian J Ophthalmol 2023; 71:580-584. [PMID: 36727365 DOI: 10.4103/ijo.ijo_1766_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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Purpose To determine the level of awareness and knowledge about glaucoma surgery and post-surgery counseling amongst paramedical staff at a tertiary eye-care hospital. Methods This observational cross-sectional study included a random sample of 94 hospital personnel: 37 general nurse midwives, 47 ophthalmic assistants, and 10 patient caretakers (PCTs). Participants were administered a questionnaire about glaucoma surgery and post-surgery counseling of patients. Results The study included 41 (43.6%) females and 53 (56.4%) males. The mean age of the participants was 24.85 ± 4.54 years. All participants were aware of trabeculectomy surgery in glaucoma (100%). A total of 95.7% knew that surgery helps in controlling IOP, of whom 57 (60.6%) participants got information during their course of learning. Overall 53 (56.4%) believed that surgery is done when medication failure occurs, and 58 (61.7%) knew that surgery helps in preserving vision. A total of 63 (67.0%) participants knew to counsel patients to visit an ophthalmologist when called for and take the treatment as advised, whereas 74 (78.7%) correctly said to visit an ophthalmologist immediately if pain/diminution of vision/discharge occurs. Overall, PCTs were found to be having significantly better knowledge (P = 0.01) compared to others and they also reported ophthalmologists as the chief source of information. Conclusion This study revealed that paramedical staff had an excellent awareness of trabeculectomy surgery. However, the knowledge and counseling parts of the questionnaire revealed less than satisfactory responses. So, there is a need to continuously educate paramedical staff members so that they can help in propagating information about the role of glaucoma surgery and the importance of proper follow-up.
Collapse
Affiliation(s)
- Rakesh Shakya
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Navjot Singh Ahluwalia
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Chintan Shah
- Department of Pediatric Ophthalmology and Strabismus, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Pulak Paul
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - B K Jain
- Director and Trustee, Quality Assurance, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Kushal Pandit
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Ramesh K C Gupta
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Reena Ahlawat
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| | - Priyanka Choudhary
- Department of Glaucoma, Sadguru Netra Chikitsalaya and Postgraduate Institute of Ophthalmology, Jankikund, Chitrakoot, Madhya Pradesh, India
| |
Collapse
|
41
|
Rao A, Khan SM, Mukherjee S. Causes of Immediate and Early IOP Spikes After Circumferential Gonioscopy-Assisted Transluminal Trabeculotomy Using ASOCT. Clin Ophthalmol 2023; 17:313-320. [PMID: 36711260 PMCID: PMC9879041 DOI: 10.2147/opth.s397816] [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: 11/17/2022] [Accepted: 01/05/2023] [Indexed: 01/23/2023] Open
Abstract
Purpose To report the early postoperative causes of intraocular pressure (IOP) spikes after complete circumferential gonioscopy-assisted transluminal trabeculotomy (GATT) using anterior segment optical coherence tomography (ASOCT). Methods This was retrospective interventional case series of patients who underwent circumferential GATT by a single surgeon (APR) from 2021 to 2022 at a tertiary eye care in East India and who developed IOP spikes at 1 day-2 weeks (immediate) or early (>2 weeks-2 months) after GATT. The intraocular pressure (IOP), glaucoma medications, and angle evaluation by ASOCT at 1 week, and 1 month were compared between the two groups. Results Thirty-two eyes of 32 consecutive patients, aged 40±20.1 years (20 exfoliation glaucoma, 9 juvenile open-angle, and 3 developmental glaucoma), that developed IOP spikes between immediate (n=20) or early (n=12) IOP spikes after GATT, were included. Immediate postoperative spikes were seen in 20 eyes due to retained viscoelastic (n=8), hyphema (n=8) in uncontrolled hypertension, and peripheral anterior synechiae (PAS) (n=6) of which only one eye required medication at 2 months. Causes of immediate IOP spikes on ASOCT included an inverted/reattached trabecular shelf, iris strands in eyes with abnormal iris in developmental glaucoma, and PAS in 1-2 quadrants. Causes of early IOP spikes included PAS >3 quadrants (n=8), and hyperreflective fibrotic tissue over TM (n=4) with 50% requiring medications at 2 months. The ASOCT features predicting the need for medications were PAS >3 quadrants (OR=8.4[2.2-14.3], p=0.03) and fibrotic TM closure (OR=5.4, [3.6-10.2], p=0.003). One eye with macrohyphema 3 days after surgery owing to uncontrolled hypertension (owing to the stoppage of medicines), required additional incisional trabeculectomy within 1 month of surgery. Conclusion Immediate IOP spikes are mostly self-resolving as opposed to early IOP spikes >2 weeks that require medications after GATT. Gonioscopic PAS >3 quadrants, and fibrotic TM closure were the main identifiable ASOCT causes predicting the need for medications after GATT.
Collapse
Affiliation(s)
- Aparna Rao
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India,Correspondence: Aparna Rao, Glaucoma Service, LV Prasad Eye Institute, MTC Campus, Bhubaneswar, Odisha, 751024, India, Tel +91 674 2653001, Fax +91 674 2653130, Email ;
| | - Sardar Mohd Khan
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| | - Sujoy Mukherjee
- Glaucoma Service, LV Prasad Eye Institute, Bhubaneswar, Odisha, 751024, India
| |
Collapse
|
42
|
Sterenczak KA, Fuellen G, Jünemann A, Guthoff RF, Stachs O, Stahnke T. The Antibiotic Kitasamycin-A Potential Agent for Specific Fibrosis Preventing Therapy after Fistulating Glaucoma Surgery? Pharmaceutics 2023; 15. [PMID: 36839651 DOI: 10.3390/pharmaceutics15020329] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/06/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023] Open
Abstract
One major complication after fistulating glaucoma surgeries are fibroblast-mediated scarring processes and their specific prevention is key in the development of novel pharmaceutical concepts. Within this study a possible antifibrotic potential of kitasamycin (KM) in a transforming growth factor (TGF)-β1-mediated fibroblast model was evaluated in vitro. Primary ocular fibroblasts were isolated, cultivated and a dose-response test including determination of the half maximal effective concentration (EC50) for KM was conducted. Transformation of fibroblasts into myofibroblasts was induced by TGF-β1and immunofluorescence (IF), and Western blot (WB) analyses were performed with fibroblasts and myofibroblasts. IF analyses were carried out using antibodies against α-smooth muscle actin (α-SMA) and fibronectin, and protein detection of intracellular and extracellular proteins was performed by WB. Using the dose-response test, the viability, cytotoxicity and EC50 of KM after 24 and 48 h were determined. Fibroblasts exposed to various KM concentrations showed no increase in α-SMA and extracellular matrix expression. In TGF-ß1-stimulated myofibroblasts, KM inhibited the expression of α-SMA and fibronectin in a concentration-dependent manner. These findings demonstrate that KM could impair the transformation of fibroblasts into myofibroblasts and the expression of proteins involved in fibrotic processes, representing a potential agent for specific fibrosis prevention in future therapeutic concepts.
Collapse
|
43
|
Almobarak FA, Alobaidan AS, Alobrah MA. Outcomes of Deep Sclerectomy for Glaucoma Secondary to Sturge-Weber Syndrome. J Clin Med 2023; 12:jcm12020516. [PMID: 36675444 PMCID: PMC9860536 DOI: 10.3390/jcm12020516] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
Aims: To report the outcomes and complications of deep sclerectomy in glaucoma secondary to Sturge−Weber syndrome (SWS). Methods: The retrospective case series included patients with SWS and secondary glaucoma who underwent deep sclerectomy at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between 2000 and 2021. The main outcome measures included intraocular pressure (IOP), the number of antiglaucoma medications, the presence of vision-threatening complications, and the need for further glaucoma surgery to control the IOP. The surgical outcome of each eye was based on the main outcome measures. Results: Twelve eyes of eleven patients were included in the study. The mean follow-up period was 83.00 months (±74.2) (range 1 to 251 months). The IOP and number of antiglaucoma medications decreased significantly from a mean of 28.75 mm Hg (±7.4) and 3.17 (±0.8) to 15.30 mm Hg (±3.5) and 0.3 (±0.7), and 18.83 (±9.3) and 1.67 (±1.7) on the 24th month and the last follow-up visit postoperatively, respectively (p < 0.01 for both). The success rate was 66.6% (8/12), while the failure rate was 33.3% (4/12) because of the uncontrolled IOP where a single repeat glaucoma surgery achieved controlled IOP. One procedure was complicated by choroidal detachment and one by choroidal effusion; both complications were resolved by medical treatments. Conclusions: Deep sclerectomy seems to be an effective treatment modality for controlling IOP and for decreasing the burden of antiglaucoma medications in patients with SWS and secondary glaucoma. Further studies are needed to confirm such a conclusion on larger number of patients with longer follow-up periods.
Collapse
Affiliation(s)
- Faisal A. Almobarak
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
- Glaucoma Research Chair, King Saud University, Riyadh 11411, Saudi Arabia
- Correspondence: ; Tel.: +966-11-4786100 (ext. 1426); Fax: +966-11-4775731
| | - Abdullah S. Alobaidan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| | - Mansour A. Alobrah
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh 11411, Saudi Arabia
| |
Collapse
|
44
|
Panarelli JF, Vera V, Sheybani A, Radcliffe N, Fiscella R, Francis BA, Smith OU, Noecker RJ. Intraocular Pressure and Medication Changes Associated with Xen Gel Stent: A Systematic Review of the Literature. Clin Ophthalmol 2023; 17:25-46. [PMID: 36660309 PMCID: PMC9845068 DOI: 10.2147/opth.s390955] [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: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
The Xen gel stent (Allergan Inc, an AbbVie company; Dublin, Ireland) was conceived as an option for patients requiring modest IOP reduction but for whom trabeculectomy was not yet indicated. As with any glaucoma surgery, establishing criteria for patient selection and identifying factors that contribute to a high likelihood of success are important. To help guide clinical decision-making, a systematic review of published studies on the gel stent was performed, with the goal of understanding postoperative outcomes based on clinical and patient factors. Results were organized around a series of pertinent clinical questions based on scenarios encountered in clinical practice. Criteria for including studies were intentionally broad, with the objective of simulating the diverse population of glaucoma patients encountered in real-world practice. Outcomes for IOP and medication reduction postoperatively were assessed in various analyses, including in eyes with various glaucoma types and severity; in eyes naïve to surgery as well as those with a history of prior incisional glaucoma surgery; and when surgery was performed as a standalone procedure or at the time of cataract surgery. The results of each of the various analyses were consistent in demonstrating that successful gel stent surgery achieved a postoperative IOP of approximately 14.0 mm Hg and reduction to fewer than 1 glaucoma medication. Additional data are shown on outcomes by method of implant (ab interno vs ab externo); intraoperative use of antifibrotics; and rates of needling in published studies.
Collapse
Affiliation(s)
- Joseph F Panarelli
- Department of Ophthalmology, New York University, New York, NY, USA,Correspondence: Joseph F Panarelli, Department of Ophthalmology, New York University, 222 E 41st St, 3rd Floor, New York, NY, 10017, USA, Email
| | | | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Nathan Radcliffe
- Department of Ophthalmology, New York Eye and Ear Infirmary, New York, NY, USA
| | | | - Brian A Francis
- Department of Ophthalmology, Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Robert J Noecker
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA,Ophthalmic Consultants of Connecticut, Fairfield, CT, USA
| |
Collapse
|
45
|
Avetisov SE, Erichev VP, Antonov AA, Poleva RP, Kozlova IV, Makarova AS. [Modern achievements in the diagnosis and treatment of glaucoma]. Vestn Oftalmol 2023; 139:96-106. [PMID: 37144375 DOI: 10.17116/oftalma202313903296] [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: 05/06/2023]
Abstract
Glaucoma is one of the most difficult and significant ocular conditions. The chronic asymptomatic course of glaucoma progression leads to irreversible deterioration of visual functions. Many aspects of its pathogenesis, the features of its clinical presentation, diagnosis and treatment have been identified in recent years. The results of diagnostic methods: tonometry, perimetry, optical coherence tomography - with glaucoma do not have high specificity due to the large diversity of the population. When determining the target intraocular pressure (IOP), we look at the indicators of the choroidal blood flow and biomechanical stress of the cornea and sclera (fibrous membrane of the eye). Studying visual functions is important in the diagnosis and monitoring of glaucoma. The creation of a modern portable device based on a virtual reality helmet allows examination of patients with low central vision. Structural changes in glaucoma affect the optic disc and the inner retinal layers. The proposed classification of atypical discs allows determining the earliest characteristic changes in the neuroretinal rim for glaucoma in cases of difficult diagnosis. The complexity of the diagnosis of glaucoma is also associated with concomitant pathologies in elderly patients. In cases with comorbidity of primary glaucoma and Alzheimer's disease the structural and functional changes revealed by modern research methods for glaucoma are explained by both the process of secondary transsynaptic degeneration and the death of neurons as a result of an increased IOP. The starting treatment is and its type are fundamentally important for preserving visual functions. Drug therapy with prostaglandin analogues contributes to a significant and persistent decrease in the level of IOP, and mainly by utilizing the uveoscleral outflow pathway. Surgical treatment of glaucoma is an effective way to achieve the target IOP values. However, postoperative hypotension affects the bloodstream both in the central and peripapillary retina. Optical coherence tomography angiography helped establishe that the strongest factor that determines postoperative changes is the difference in IOP, not its absolute level.
Collapse
Affiliation(s)
- S E Avetisov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - V P Erichev
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A A Antonov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - R P Poleva
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - I V Kozlova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - A S Makarova
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| |
Collapse
|
46
|
Khan OA, Sesma G, Alawi A, AlWazae M. Outcomes of Non-Penetrating Deep Sclerectomy for Primary Congenital Glaucoma Performed by Experienced versus Trainee Surgeons: A Cohort Study. Clin Ophthalmol 2023; 17:897-906. [PMID: 36960324 PMCID: PMC10028302 DOI: 10.2147/opth.s403016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose To compare the outcomes of non-penetrating deep sclerectomy (NPDS) for primary congenital glaucoma (PCG) performed by experienced vs trainee surgeons. Patients and Methods This retrospective cohort study was conducted in 2022 in Saudi Arabia. Consultants (Gr-1) and trainee pediatric ophthalmologists (Gr-2) performed NPDS on pediatric patients with PCG. Success was defined as an intraocular pressure (IOP) less than 21 mmHg at 6 months after surgery. Complications, glaucoma medications, and additional procedures were also observed in the two groups. Results Gr-1 and Gr-2 operated on 14 and 39 eyes with PCG, respectively. The absolute success rates were 90.9% (95% confidence interval [CI]: 73.9, 100) in Gr-1 and 96.7% (95% CI: 90.2, 100) in Gr-2 (odds Ratio=1.1; 95% CI: 0.87, 1.3; P=0.54). Survival analysis suggested that the failure rate in the first 6 months after NPDS was not significantly different between the two groups (hazard ratio=1.45; 95% CI: 0.13, 16.0; P=0.767). The complications included hypotony (2 cases), vitreous hemorrhage (1 case), and total flap penetration (1 case). Only one eye in Gr-2 needed glaucoma medication after surgery. There was no significant difference in the success rates of one surgeon before and after training (P=0.43). The age (P=0.59) and sex (P=0.77) of patients, type of surgeon (P=0.94), and preoperative IOP (P=0.59) were not significant predictors of a stable IOP at 6 months after NPDS. Conclusion At 6 months after NPDS surgery performed by experienced and trainee pediatric ophthalmologists, the outcomes (stabilization of IOP) were similar between the two groups.
Collapse
Affiliation(s)
- Omar Abdallah Khan
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Gorka Sesma
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Correspondence: Gorka Sesma, Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, Tel +966114849700, Fax +966114821908, Email
| | - Abeer Alawi
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Manal AlWazae
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
47
|
Papadopoulos K, Schröder FM, Sekundo W. Long-term surgical outcomes of two different Ahmed Valve implantation techniques in refractory glaucoma: Scleral flap vs scleral tunnel. Eur J Ophthalmol 2023; 33:297-306. [PMID: 35473453 DOI: 10.1177/11206721221097176] [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: 01/11/2023]
Abstract
PURPOSE To compare the outcomes and complications of the partial-thickness scleral flap technique to the long scleral tunnel technique in patients who underwent mitomycin C (MMC)-augmented Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS In this retrospective study, we reviewed 139 eyes of 137 patients with refractory glaucoma who underwent AGV-Model FP7 implantation. The eyes were divided into the scleral flap group (n = 74) and the scleral tunnel group (n = 65). RESULTS The mean follow-up was 57.91 ± 18.18 months for the flap and 61.18 ± 15.13 months for the tunnel group (p = 0.2499). The postoperative intraocular pressure (IOP) at 1 to 6 years was significantly lower than the baseline IOP in each group (p < 0.001). The average number of postoperative glaucoma medications decreased in the tunnel group (p = 0.0001) and in the flap group (p = 0.6194) compared to baseline. No statistically significant differences in postoperative visual acuity (p = 0.6396) and cumulative success (p = 0.054) were noted between the two groups. Conjunctival erosion or tube migration only occurred in the flap group. Significantly more reoperations were performed in the flap than in the tunnel group (p = 0.048). CONCLUSIONS Both MMC-augmented AGV tube implantation methods lowered IOP. The flap technique was associated with higher rates of postoperative serious complications and more reoperations than the tunnel technique. Previous glaucoma surgery and the technique used to implant the surgical tube proved to be significant risk factors for conjunctival erosion.
Collapse
Affiliation(s)
- Kosmas Papadopoulos
- Department of Ophthalmology, Faculty of Medicine, 61061Philipps University of Marburg, Marburg, Germany
| | - Frank Michael Schröder
- Department of Ophthalmology, Faculty of Medicine, 61061Philipps University of Marburg, Marburg, Germany
| | - Walter Sekundo
- Department of Ophthalmology, Faculty of Medicine, 61061Philipps University of Marburg, Marburg, Germany
| |
Collapse
|
48
|
Niruthisard D, Bonnet C, Tanasugarn L, Le B, Deng SX. Autologous Serum Eye Drops in the Management of Limbal Stem Cell Deficiency Associated With Glaucoma Surgery. Eye Contact Lens 2023; 49:19-24. [PMID: 36322388 PMCID: PMC9789170 DOI: 10.1097/icl.0000000000000951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Accepted: 09/11/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate safety and efficacy of autologous serum eye drops (AS) in the treatment of limbal stem cell deficiency (LSCD) associated with glaucoma surgery. METHODS Retrospective case series of eyes with glaucoma surgery-induced LSCD treated with AS. Diagnosis of LSCD was confirmed by anterior segment optical coherence tomography, in vivo confocal microscopy, and/or impression cytology. Limbal stem cell deficiency severity was staged using a clinical scoring system (2-10 points). Outcome measures were changes (≥2 points) of the LSCD score and best-corrected visual acuity (BCVA) from the baseline to the last follow-up. RESULTS Thirteen eyes of 12 consecutive patients treated with 50% AS for at least 3 months were included. The mean age was 78.9±7.5 years and the mean duration of AS use was 20.9±16.8 months. Indications of AS included LSCD progression in eight eyes (61.5%) and visual axis threatening in five eyes (38.5%). The mean LSCD score at baseline (6.7±1.6) was similar to that at last follow-up (6.5±2.2, P =0.625). Two eyes (15.4%) showed improvement, nine eyes (69.2%) were stable, and two eyes (15.4%) worsened. The mean baseline BCVA (0.89±0.64 logMAR) was similar to the mean final BCVA (1.05±0.63 logMAR, P =0.173). There were no serious adverse complications related to AS. CONCLUSION AS appears to be well tolerated and may stabilize the progression of LSCD with limited effects. A larger study is necessary to confirm the findings.
Collapse
Affiliation(s)
- Duangratn Niruthisard
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Ophthalmology, Banphaeo General Hospital, Samut Sakhon, Thailand
| | - Clémence Bonnet
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Cornea Department, Cochin Hospital, AP-HP, F-75014, Paris University, Paris, France
| | - Lokachet Tanasugarn
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Thailand
| | - Bryan Le
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Drexel University College of Medicine
| | - Sophie X. Deng
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Molecular Biology Institute, University of California, Los Angeles, USA
| |
Collapse
|
49
|
Urbonavičiūtė D, Buteikienė D, Janulevičienė I. A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment. Medicina (Kaunas) 2022; 58:medicina58121870. [PMID: 36557072 PMCID: PMC9787124 DOI: 10.3390/medicina58121870] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
Neovascular glaucoma (NVG) is a rare, aggressive, blinding secondary glaucoma, which is characterized by neovascularization of the anterior segment of the eye and leading to elevation of the intraocular pressure (IOP). The main etiological factor is retinal ischemia leading to an impaired homeostatic balance between the angiogenic and antiangiogenic factors. High concentrations of vasogenic substances such as vascular endothelial growth factor (VEGF) induce neovascularization of the iris (NVI) and neovascularization of the angle (NVA) that limits the outflow of aqueous humor from the anterior chamber and increases the IOP. NVG clinical, if untreated, progresses from secondary open-angle glaucoma to angle-closure glaucoma, leading to irreversible blindness. It is an urgent ophthalmic condition; early diagnosis and treatment are necessary to preserve vision and prevent eye loss. The management of NVG requires the cooperation of retinal and glaucoma specialists. The treatment of NVG includes both control of the underlying disease and management of IOP. The main goal is the prevention of angle-closure glaucoma by combining panretinal photocoagulation (PRP) and antiangiogenic therapy. The aim of this review is to summarize the current available knowledge about the etiology, pathogenesis, and symptoms of NVG and determine the most effective treatment methods.
Collapse
Affiliation(s)
- Danielė Urbonavičiūtė
- Medical Academy, Lithuanian University of Health Sciences, Eiveniu 2, LT-50161 Kaunas, Lithuania
- Correspondence: ; Tel.: +370-6112-7522
| | - Dovilė Buteikienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| | - Ingrida Janulevičienė
- Department of Ophthalmology, Medical Academy, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, LT-50161 Kaunas, Lithuania
| |
Collapse
|
50
|
Jayasri P, Kaliaperumal S, Behera G, Stephen M. Safety and efficacy of Aurolab aqueous drainage implant in refractory glaucoma: A prospective study. Indian J Ophthalmol 2022; 70:4212-4216. [PMID: 36453316 PMCID: PMC9940568 DOI: 10.4103/ijo.ijo_1391_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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non-valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results Thirty-four eyes were analyzed and the mean follow-up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long-term follow-up studies are needed to assess long-term IOP control and cost-effectiveness.
Collapse
Affiliation(s)
- P Jayasri
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Subashini Kaliaperumal
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India,Correspondence to: Prof. Subashini Kaliaperumal, Department of Ophthalmology, JIPMER, Puducherry - 605 006, India. E-mail:
| | - Geeta Behera
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mary Stephen
- Department of Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|