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Scheres LMJ, Kujovic-Aleksov S, Winkens B, de Crom RMPC, Webers CAB, Beckers HJM. Five-year follow-up with the PreserFlo MicroShunt for open-angle glaucoma. Eye (Lond) 2025; 39:1540-1546. [PMID: 39979610 PMCID: PMC12089333 DOI: 10.1038/s41433-025-03707-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 01/29/2025] [Accepted: 02/07/2025] [Indexed: 02/22/2025] Open
Abstract
PURPOSE To report on five-year results with the PreserFlo MicroShunt (MicroShunt) for the surgical treatment of open-angle glaucoma. PATIENTS AND METHODS Retrospective case series of consecutive patients who underwent a stand-alone MicroShunt implantation at the University Eye Clinic of Maastricht. If a patient underwent the procedure in both eyes, only the first eye was included in the analysis. MicroShunt implantation was augmented with 0.2 mg/ml mitomycin-C. The primary outcome was intraocular pressure (IOP) during follow-up. Furthermore, information on IOP-lowering medication use, success rates, reoperation rates, and postoperative complications was collected. RESULTS Sixty-six eyes were included for analyses. Diagnoses included primary open-angle glaucoma (88%) and pigmentary glaucoma (12%). The majority of patients had moderate or advanced glaucoma, based on the mean deviation of the visual field examination. Mean (95% - confidence interval) IOP dropped from 21.8 (20.8-22.8) at baseline to 13.2 (11.8-14.6) mmHg after 5 years (p < 0.001). Mean number of IOP-lowering medications was reduced from 2.5 (2.2-2.9) at baseline to 0.9 (0.5-1.2), 1.0 (0.7-1.4), and 1.1 (0.7-1.5) after three, four, and five years (all p < 0.001). Needling or surgical revision was performed in twelve eyes (18%). Nineteen eyes (29%) required further IOP-lowering surgery. Postoperative complications were usually mild and self-limiting and included early hypotony, shallow anterior chamber, and hyphaema. CONCLUSIONS After five years, the MicroShunt was found to be a safe procedure, leading to a sustained reduction in mean IOP and number of IOP-lowering medications. However, almost one third of the eyes required further IOP-lowering interventions.
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Affiliation(s)
- Lotte M J Scheres
- University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands.
| | - Stefani Kujovic-Aleksov
- University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ronald M P C de Crom
- University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands
| | - Henny J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Center +, Maastricht, the Netherlands
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Savastano A, Maiola E, Carlà MM, Gambini G, Boselli F, Giannuzzi F, Rizzo C, Rizzo S. Removable regulating sutures during trabeculectomy for a safer and more effective intraocular pressure control. Eur J Ophthalmol 2025; 35:961-971. [PMID: 39140884 DOI: 10.1177/11206721241276573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
PurposeComparing the effect of standard trabeculectomy with direct sutures versus trabeculectomy with compression and everting sutures.MethodsMono-centric randomized prospective comparative study on 38 glaucomatous eyes undergoing trabeculectomy: 19 with standard fixed sutures (group A) and 19 withremovable regulating sutures (group B). Preoperatively and at day-7, 1-month, 2-months, 3-months and 6-months after surgery, we recorded best-corrected visual acuity (BCVA), intraocular pressure (IOP) and possible complications. Complete, partial success and failure rates were recorded at the end of the study.ResultsIn group B, we pulled everting sutures with the "horse bridle" technique at the 14th day, and successively removed all sutures between the 14th-30th post-operative day. At month-1, we recorded a significant IOP reduction in both groups (mean reduction of 11.5 mmHg for group A and of 14.4 mmHg for Group B, p = 0.001 and p < 0.0001, respectively). Furthermore, group B showed a significantly lower IOP than group A (-4.2 mmHg, 95% confidence interval [CI] -7.0 to -0.5 mmHg for group B, p = 0.01). At 2, 3 and 6-months, no significant IOP differences were reported between the two groups (all p > 0.05), but failure rate was higher for group A (21%) than for group B (11%). No differences in visual outcomes at any timepoints were noted.ConclusionsTrabeculectomy with removable regulating sutures showed a good safety profile, comparable to standard trabeculectomy. Moreover, we reported a lower IOP one month postoperatively, suggesting this technique may optimize early management of trabeculectomy.
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Affiliation(s)
- Alfonso Savastano
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Emanuele Maiola
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Catholic University "Sacro Cuore", Faculty of Medicine and Surgery, Rome, Italy
| | - Matteo Mario Carlà
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Gloria Gambini
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Francesco Boselli
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Federico Giannuzzi
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
| | - Clara Rizzo
- Ophthalmology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Stanislao Rizzo
- Ophthalmology Department, "Fondazione Policlinico Universitario A. Gemelli, IRCCS", 00168 Rome, Italy
- Ophthalmology Department, Catholic University "Sacro Cuore", Rome, Italy
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Abe RY, Oltramari L, Vessani RM, Schimiti RB, Magacho L, Kanadani FN, Costa VP. Trabeculectomy in Eyes With High Myopia. J Glaucoma 2024; 33:110-115. [PMID: 37671507 DOI: 10.1097/ijg.0000000000002293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
PRCIS Primary trabeculectomy was safe and effective at lowering intraocular pressure (IOP) in patients with primary open angle glaucoma and high myopia. PURPOSE To investigate the efficacy and safety of trabeculectomy in patients with glaucoma and high myopia. PATIENT AND METHODS Retrospective case-control study. Glaucomatous patients with high myopia undergoing primary trabeculectomy surgery with at least 1 year of follow-up were compared with an age-matched control group without high myopia undergoing the same procedure. Surgical success was defined as: IOP ≤ 15 mm Hg with (qualified) or without (complete) antiglaucoma medications and at least 20% reduction from baseline IOP at the end of 48 months of follow-up. RESULTS We included a total of 90 eyes from 90 patients (45 eyes with high myopia and 45 controls). Within the 90 eyes, 70 eyes underwent trabeculectomy and 20 eyes underwent combined phacoemulsification and trabeculectomy. Although patients with high myopia had higher chances for failure (37% vs. 22%) compared with controls, the difference was not statistically significant ( P =0.067). In the multivariable analysis, patients of African descent ( P =0.043) and those with juvenile glaucoma ( P =0.001) had more chances of failure, even after adjusting for myopia. There was no statistically significant difference between complication rates in both groups. CONCLUSION Trabeculectomy was effective in reducing IOP in patients with high myopia and glaucoma, without the additional risk of complications compared with a control group.
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Affiliation(s)
- Ricardo Y Abe
- Department of Opthalmology, University of Campinas-UNICAMP
- Hospital Oftalmológico de Brasília, Brasília, Distrito Federal
| | - Laura Oltramari
- Hospital Oftalmológico de Brasília, Brasília, Distrito Federal
| | - Roberto M Vessani
- Department of Ophthalmology and Visual Science, Glaucoma Service, Federal University of Sao Paulo, São Paulo
| | - Rui B Schimiti
- Department of Opthalmology, University of Campinas-UNICAMP
| | - Leopoldo Magacho
- Department of Ophthalmology, Federal University of Goiás
- VER Hospital de Olhos, Goiânia, Goiás
| | - Fábio N Kanadani
- Department of Ophthalmology, Glaucoma Institute of Belo Horizonte, Belo Horizonte, Brazil
| | - Vital P Costa
- Department of Opthalmology, University of Campinas-UNICAMP
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Lin HZ, Wang JH, Lee YC. Factors Associated with the Efficacy of XEN Gel Implant. Ophthalmol Ther 2024; 13:597-614. [PMID: 38180631 PMCID: PMC10787716 DOI: 10.1007/s40123-023-00876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Microinvasive glaucoma surgery (MIGS) is a growing trend, and XEN gel implant is one of the most effective types of MIGS. This study aimed to examine factors associated with the surgical success of XEN gel implants. METHODS This retrospective cohort study enrolled patients with glaucoma receiving XEN implantation alone or combined with phacoemulsification (PHACOXEN) with a follow-up period of more than 6 months at Hualien Tzu Chi Hospital, Taiwan. If intraocular pressure (IOP) elevated above 20 mmHg during the follow-up, needling or open revision was performed. The primary outcome measures included IOP and the number of glaucoma medications. RESULTS Male patients had lower postoperative IOP; male patients and higher preoperative IOP were associated with higher IOP change rates, and older patients had a higher chance of achieving IOP < 18 mmHg and being medication-free at months 12, 24, and 36. The Kaplan-Meier curve showed that the probability of free-of-rescue intervention over the follow-up period was not different between the XEN alone and the PHACOXEN group (P = 0.859). Both needling and open revision were effective rescue interventions, but open revision had a higher chance of achieving IOP ≤ 18 mmHg and being medication-free (P = 0.031) and required less medication afterward (P = 0.044). Older age (P = 0.013) and male patients (P = 0.022) had a lower IOP after rescue interventions. Compared with open revision, needling was associated with higher IOP (P = 0.048) and more required medications (P = 0.048). CONCLUSIONS XEN alone and PHACOXEN had comparable surgical outcomes, whereas open revision had a better IOP lowering effect than needling as a rescue intervention. Male and older patients had better surgical results in primary XEN implantations and rescue interventions.
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Affiliation(s)
- Hong-Zin Lin
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yung Road, Hualien, 97002, Taiwan, ROC
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Yuan-Chieh Lee
- Department of Ophthalmology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 707, Sec. 3, Chung-Yung Road, Hualien, 97002, Taiwan, ROC.
- Department of Ophthalmology and Visual Science, Tzu Chi University, Hualien, Taiwan.
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.
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Aoyama Y, Sakata R, Fujishiro T, Honjo M, Shirato S, Aihara M. Contributing factors for intraocular pressure control in patients with mostly normal-tension glaucoma after initial Ex-PRESS drainage device implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:191-201. [PMID: 37624385 PMCID: PMC10806052 DOI: 10.1007/s00417-023-06209-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/11/2023] [Accepted: 08/11/2023] [Indexed: 08/26/2023] Open
Abstract
PURPOSE To investigate the postoperative intraocular pressure (IOP) control and identify the factors associated with failure of initial Ex-PRESS surgery in patients with open-angle glaucoma for 3 years. METHODS A total of 79 patients with medically uncontrolled open-angle glaucoma (55 normal-tension glaucoma and 24 primary open-angle glaucoma) were enrolled. All patients underwent Ex-PRESS implantation (including combined cataract surgery). The outcome measure was the survival rate using life table analysis, the failure was defined as IOP of > 18 mmHg (criterion A), > 15 mmHg (criterion B) or > 12 mmHg (criterion C) and/or IOP reduction of < 20% from baseline (each criterion) without any glaucoma medications. The Cox proportional hazards model was used to identify risk factors for IOP management defined as the above criterion. RESULTS: The mean preoperative IOP was 19.3 ± 5.8 mmHg. At 36 months, the mean IOP was 11.8 ± 3.6 mmHg with a mean IOP change of 7.5 mmHg (reduction rate 39.0%). The cumulative probability of success was 58% (95%CI: 42-64%) (criterion A), 48% (95%CI: 37-59%) (criterion B) and 30% (95%CI: 20-40%) (criterion C). In multivariate analyses, factors that predicted poor IOP control included the intervention of bleb needling after 6 months after the surgery (HR: 2.43; 95%CI: 1.35-4.37; P = 0.032). Transient hypotony was observed in 4 patients. CONCLUSION The implementation of bleb needling after Ex-PRESS surgery in the late postoperative period was suggested to be the main risk factor for achieving lower IOP.
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Affiliation(s)
- Yurika Aoyama
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Rei Sakata
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
- Yotsuya Shirato Eye Clinic, Tokyo, Japan.
| | - Takashi Fujishiro
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
- Yotsuya Shirato Eye Clinic, Tokyo, Japan
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van Mechelen RJS, Wolters JEJ, Fredrich S, Bertens CJF, Gijbels MJJ, Schenning APHJ, Pinchuk L, Gorgels TGMF, Beckers HJM. A Degradable Sustained-Release Drug Delivery System for Bleb-Forming Glaucoma Surgery. Macromol Biosci 2023; 23:e2300075. [PMID: 37249127 DOI: 10.1002/mabi.202300075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/12/2023] [Indexed: 05/31/2023]
Abstract
Fibrosis of the filtering bleb is one of the main causes of failure after bleb-forming glaucoma surgery. Intraoperative application of mitomycin C (MMC) is the current gold standard to reduce the fibrotic response. However, MMC is cytotoxic and one-time application is often insufficient. A sustained-release drug delivery system (DDS), loaded with MMC, may be less cytotoxic and equally or more effective. Two degradable (polycaprolactone (PCL) and polylactic-co-glycolic acid (PLGA)) MMC-loaded DDSs are developed. Release kinetics are first assessed in vitro followed by rabbit implants in conjunction with the PRESERFLO MicroShunt. As a control, the MicroShunt is implanted with adjunctive use of a MMC solution. Rabbits are euthanized at postoperative day (POD) 28 and 90. The PLGA and PCL DDSs release (on average) 99% and 75% of MMC, respectively. All groups show functioning blebs until POD 90. Rabbits implanted with a DDS show more inflammation with avascular thin-walled blebs when compared to the control. However, collagen is more loosely arranged. The PLGA DDS shows less inflammation, less foreign body response (FBR), and more complete degradation at POD 90 when compared to the PCL DDS. Further optimization with regard to dosage is required to reduce side effects to the conjunctiva.
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Affiliation(s)
- Ralph J S van Mechelen
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, 6202 AZ, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Jarno E J Wolters
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, 6202 AZ, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Sebastian Fredrich
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, A.M. Vree G1-146, Amsterdam, 1100 DD, Netherlands
| | - Christian J F Bertens
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, 6202 AZ, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Marion J J Gijbels
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, 6229 ER, The Netherlands
- Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam Cardiovascular Sciences, Amsterdam Infection and Immunity, Amsterdam UMC, A.M. Vree G1-146, Amsterdam, 1100 DD, Netherlands
| | - Albert P H J Schenning
- Laboratory of Stimuli-responsive Functional Materials and Devices, Department of Chemical Engineering and Chemistry, Technical University of Eindhoven, Eindhoven, 5600 MB, The Netherlands
| | - Leonard Pinchuk
- InnFocus Inc. a Santen company, 12415 S.W. 136 Avenue, Miami, FL, 33186, USA
| | - Theo G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, 6202 AZ, The Netherlands
| | - Henny J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), Maastricht, 6202 AZ, The Netherlands
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Li Y, Zhao J, Yin Y, Zhang C, Zhang Z, Zheng Y. The Role of STAT3 Signaling Pathway Activation in Subconjunctival Scar Formation after Glaucoma Filtration Surgery. Int J Mol Sci 2023; 24:12210. [PMID: 37569586 PMCID: PMC10419097 DOI: 10.3390/ijms241512210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Scar formation resulting from overly active wound healing is a critical factor in the success rate of glaucoma filtration surgery (GFS). IL-6 and TGF-β have been implicated in the pathogenesis of fibrogenesis. In addition, the signal transducer and activator of transcription 3 (STAT3) can be activated by numerous cytokines and growth factors, including IL-6 and TGF-β1. Thus, STAT3 activation may integrate common profibrotic pathways to promote fibrosis. In this study, an increase in p-STAT3 was observed in activated HTFs. Inhibiting STAT3 in cultured HTFs by pharmacological inactivation reversed the fibrotic responses, such as fibroblast migration, the differentiation of resting fibroblasts into myofibroblasts and the deposition of ECM, mediated by IL-6 and TGF-β1. Moreover, the expression of suppressor of cytokine signaling 3 (SOCS3) was decreased in HTFs cultured with IL-6 and TGF-β1, and SOCS3 overexpression rescued ECM deposition, α-SMA expression and migration in IL-6- and TGF-β1-stimulated HTFs by inactivating STAT3. Finally, S3I-201 treatment inhibited profibrotic gene expression and subconjunctival fibrosis in a rat model of GFS. In conclusion, our data suggests that STAT3 plays a central role in fibrosis induced by different profibrotic pathways and that STAT3 is a potential target for antifibrotic therapies following GFS.
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Affiliation(s)
| | | | | | | | | | - Yajuan Zheng
- Department of Ophthalmology, The Second Hospital of Jilin University, Jilin University, Changchun 130041, China; (Y.L.); (J.Z.); (Y.Y.); (C.Z.); (Z.Z.)
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Liao Y, Liu Y, Gao X, Ren J, Lin H, Liu Y, Huang W, Zuo C, Lin M. Noncontact Conjunctiva: A Better Mitomycin C Application Site for Trabeculectomy. Ophthalmol Ther 2023; 12:1723-1735. [PMID: 37027100 PMCID: PMC10164217 DOI: 10.1007/s40123-023-00706-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Bleb scarring is the most important complication of trabeculectomy. Changing the application position of mitomycin C (MMC) during trabeculectomy might affect the surgery outcome. Our aim is to compare the effectiveness and safety of intraocular pressure (IOP) lowering in two different application sites of mitomycin in trabeculectomy. METHODS This retrospective trial compared the surgical outcomes of 177 eyes that underwent trabeculectomy with adjunctive mitomycin C. In 70 eyes, an MMC-soaked sponge was applied under the scleral flap without touching Tenon's capsule. In 107 eyes, an MMC-soaked sponge was applied under the scleral flap covered by Tenon's capsule. Outcome measures were the IOP, best-corrected visual acuity (BCVA), success rates, and incidence of complications. RESULTS Within both groups, a highly significant IOP reduction was seen during follow-up. The effectiveness in reducing IOP and the change in best-corrected visual acuity (BCVA) were similar between the two groups. Thin-walled blebs and postoperative hypotony were seen more often when MMC-soaked sponges were applied under the scleral flap covered by Tenon's capsule (P = 0.008 and P = 0.012, respectively). There was no significant difference in BCVA or other complications in either group. CONCLUSION Since the effectiveness of IOP reduction was similar between both groups and with a low incidence of thin-walled blebs and hypotony, the subscleral application without touching Tenon's capsule seems to be the safer application site of MMC during trabeculectomy.
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Affiliation(s)
- Yunru Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yafen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Xinbo Gao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Jiawei Ren
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Huishan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Yao Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Wei Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China
| | - Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China.
| | - Mingkai Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, No.7 Jinsui Road, Tianhe District, Guangzhou, 510060, China.
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Hong JW, Sung KR, Shin JW. Optical Coherence Tomography Angiography of the Retinal Circulation Following Trabeculectomy for Glaucoma. J Glaucoma 2023; 32:293-300. [PMID: 36730185 DOI: 10.1097/ijg.0000000000002148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
PRCIS Despite successful trabeculectomy, eyes with similar levels of peripapillary and macular vessel densities but with worse preoperative visual field mean deviations may experience functional and vascular decline after surgery. PURPOSE To evaluate the retinal microcirculation change after trabeculectomy according to glaucoma severity using optical coherence tomography angiography (OCTA). METHODS We enrolled 59 eyes of primary open angle glaucoma patients who underwent trabeculectomy. The eyes were categorized into 3 groups by preoperative visual field (VF) mean deviation (MD), group 1: MD>-12.0 dB, group 2: MD -12.0 to -20.0 dB, and group 3: MD <-20.0 dB. OCTA was performed preoperatively and 1 year after trabeculectomy. The differences in the radial peripapillary capillary vessel density (pVD) and macular VD between preoperative and postoperative assessment were analyzed and compared in each group. Factors associated with the VD change after trabeculecomy were determined using linear regression analysis. RESULTS Mean postoperative IOP and IOP reduction did not differ among the 3 groups after trabeculectomy. Preoperative pVD (37.2 vs. 36.6%, P =1.00) and macular VD (39.0 vs. 38.4%, P =1.00) did not differ between groups 1 and 2. Group 1 and 3 showed no changes in VD parameters after trabeculectomy (all, P >0.05). However, group 2 showed statistically significant decreases in pVD (36.6 vs. 32.9%, P <0.001) and macular VD (38.4 vs. 36.0%, P =0.010) after trabeculectomy. The reduction of pVD was associated with a decrease of IOP (Coefficient (β); 0.14, P =0.032) and VF MD (β; 0.15, P =0.0116) in group 2, respectively. CONCLUSION Following successful trabeculectomy surgery for uncontrolled glaucoma with similar IOP reduction, glaucoma eyes with advanced visual field loss showed reduced pVD and macular VD measured by OCT-A. These findings may be relevant to disease progression.
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Affiliation(s)
- Ji Wook Hong
- Department of Ophthalmology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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van Mechelen RJS, Wolters JEJ, Herfs M, Bertens CJF, Gijbels M, Pinchuk L, Gorgels TGMF, Beckers HJM. Wound Healing Response After Bleb-Forming Glaucoma Surgery With a SIBS Microshunt in Rabbits. Transl Vis Sci Technol 2022; 11:29. [PMID: 36018582 PMCID: PMC9428362 DOI: 10.1167/tvst.11.8.29] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The PreserFlo MicroShunt is an innovative implant for the surgical treatment of glaucoma. Although usually effective, surgeries can still fail due to fibrosis. This study was conducted to gain insight into the histological aspects of the fibrotic response and find potential targets to reduce postoperative fibrosis. Methods Fifteen New Zealand White rabbits were implanted with a microshunt and followed up for 40 days. Animals were euthanized at postoperative days (PODs) 1, 5, and 40 to collect eyes for histological evaluation. Bleb formation and ocular health were assessed by slit-lamp (SL) biomicroscopy and optical coherence tomography (OCT). Intraocular pressure (IOP) was measured using rebound tonometry. Results Blebs failed after approximately 2 weeks based on bleb survival and IOP measurements. No severe complications were observed with OCT and SL. Histology revealed a wide variety of cells, in the bleb and around the microshunt, including polymorphonuclear leucocytes (PMNs), myofibroblasts, and foreign body giant cells, at different PODs. Conclusions Implantation of a poly(styrene-b-isobutylene-b-styrene) microshunt in rabbits resulted in the occurrence of a wide variety of cells during the wound-healing response. Future research should further elucidate the potential of these (earlier often overlooked) cells to target the fibrotic response in vivo—for example, by developing novel antifibrotic drugs, methods for sustained delivery of medications, or augmenting material properties. Translational Relevance Current antifibrotic therapies aim to inhibit myofibroblasts; however, a wide variety of cells are involved in the fibrotic response. Future research focusing on these cells could offer novel methods for reducing the fibrotic response after glaucoma surgery.
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Affiliation(s)
- Ralph J S van Mechelen
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Jarno E J Wolters
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Marjolein Herfs
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Christian J F Bertens
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Ophthalmology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Chemelot Institute for Science and Technology, Maastricht, the Netherlands
| | - Marion Gijbels
- Department of Pathology, Cardiovascular Research Institute Maastricht, School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.,Department of Medical Biochemistry, Experimental Vascular Biology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Theo G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Henny J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, the Netherlands
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11
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van Mechelen RJS, Wolters JE, Bertens CJF, Webers CAB, van den Biggelaar FJHM, Gorgels TGMF, Beckers HJM. Animal models and drug candidates for use in glaucoma filtration surgery: A systematic review. Exp Eye Res 2022; 217:108972. [PMID: 35114212 DOI: 10.1016/j.exer.2022.108972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Abstract
Glaucoma, a degenerative disease of the optic nerve, is the leading cause of irreversible blindness worldwide. Currently, there is no curative treatment. The only proven treatment is lowering intraocular pressure (IOP), the most important risk factor. Glaucoma filtration surgery (GFS) can effectively lower IOP. However, approximately 10% of all surgeries fail yearly due to excessive wound healing, leading to fibrosis. GFS animal models are commonly used for the development of novel treatment modalities. The aim of the present review was to provide an overview of available animal models and anti-fibrotic drug candidates. MEDLINE and Embase were systematically searched. Manuscripts until September 1st, 2021 were included. Studies that used animal models of GFS were included in this review. Additionally, the snowball method was used to identify other publications which had not been identified through the systematic search. Two hundred articles were included in this manuscript. Small rodents (e.g. mice and rats) are often used to study the fibrotic response after GFS and to test drug candidates. Due to their larger eyes, rabbits are better suited to develop medical devices. Novel drugs aim to inhibit specific pathways, e.g. through the use of modulators, monoclonal antibodies, aqueous suppressants or gene therapy. Although most newly studied drugs offer a higher safety profile compared to antimetabolites, their efficacy is in most cases lower when compared to MMC. Current literature on animal models and potential drug candidates for GFS were summarized in this review. Future research should focus on refining current animal models (for example through the induction of glaucoma prior to undertaking GFS) and standardizing animal research to ensure a higher reproducibility and reliability across different research groups. Lastly, novel therapies need to be further optimized, e.g. by conducting more research on the dosage, administration route, application frequency, the option of creating combination therapies, or the development of drug delivery systems for sustained release of anti-fibrotic medication.
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Affiliation(s)
- Ralph J S van Mechelen
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, 6229 ER, Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), 6229 GS, Maastricht, the Netherlands.
| | - Jarno Ej Wolters
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, 6229 ER, Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), 6229 GS, Maastricht, the Netherlands
| | - Christian J F Bertens
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands; School for Mental Health and Neuroscience, Maastricht University, 6229 ER, Maastricht, the Netherlands; Chemelot Institute for Science and Technology (InSciTe), 6229 GS, Maastricht, the Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands
| | - Frank J H M van den Biggelaar
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands
| | - Theo G M F Gorgels
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands
| | - Henny J M Beckers
- University Eye Clinic Maastricht, Maastricht University Medical Center+ (MUMC+), 6202 AZ, Maastricht, the Netherlands
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12
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Ahmed T, Honjo M, Sakata R, Fujishiro T, Shirato S, Aihara M. Long-term results of the safety and effectiveness of a novel microshunt in Japanese patients with primary open-angle glaucoma. Jpn J Ophthalmol 2022; 66:33-40. [PMID: 34988757 DOI: 10.1007/s10384-021-00893-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/17/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the long-term safety and effectiveness of the Preserflo MicroShunt in Japanese primary open-angle glaucoma (POAG) patients. STUDY DESIGN Single-site, nonrandomized observational study. PATIENTS AND METHODS Eight eyes of 7 POAG patients were included. The surgical complications and interventions were monitored. The preoperative and postoperative intraocular pressures (IOPs), numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), mean deviation (MD) slope, and corneal endothelial cell density (CECD) were compared retrospectively. RESULTS The mean follow-up period was 68.9 months (range, 48-76 months). The baseline IOP of 17.9 ± 3.5 mmHg and the number of glaucoma medications of 3.5 ± 0.5 were significantly reduced at subsequent follow-up visits. At 1, 2, 3, 4, 5, and 6 years postoperatively, the IOPs were 13.8 ± 2.9, 12.8 ± 2.3, 12.1 ± 3.2, 12.6 ± 2.5, 12.3 ± 1.0, and 13.5 ± 3.1 mmHg, respectively, with the use of 1.6 ± 1.4, 1.6 ± 1.6, 1.5 ± 1.4, 1.5 ± 1.4, 1.9 ± 1.3, and 2.0 ± 1.1 medications. Postoperative transient hyphema occurred in 1 eye. Postoperative needling was required in 5 eyes, 12 times in total. No eyes showed significant VA decline, except for 1 eye with a severe central visual field defect that existed preoperatively. The preoperative MD slope of - 1.6 ± 1.2 dB/year improved significantly, to - 0.3 ± 0.2 dB/year (P = 0.023), postoperatively. The baseline CECD decreased from 2595 ± 292 to 2478.4 ± 255 postoperatively. CONCLUSION The microshunt surgical procedure is safe and effective for Japanese POAG patients.
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Affiliation(s)
- Tazbir Ahmed
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Honjo
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya-Shirato Eye Clinic, Tokyo, Japan
| | - Rei Sakata
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya-Shirato Eye Clinic, Tokyo, Japan
| | - Takashi Fujishiro
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Yotsuya-Shirato Eye Clinic, Tokyo, Japan
| | | | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Yotsuya-Shirato Eye Clinic, Tokyo, Japan.
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13
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McGlumphy EJ, Dosto NO, Johnson TV, Quigley HA. Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success. Ophthalmol Glaucoma 2022; 5:379-387. [PMID: 34995818 DOI: 10.1016/j.ogla.2021.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare electronically measured adherence with topical corticosteroid drops to outcomes of glaucoma surgery. DESIGN This prospective cohort study included eyes undergoing surgery from August 2019 to January 2021 and followed for up to 1 year. PARTICIPANTS All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had either primary open angle or angle closure glaucoma, were ≥18 years old, and underwent either trabeculectomy (with or without cataract surgery) or tube-shunt implantation. INTERVENTION Patients were instructed on use of an eyedrop monitoring device (Kali Drop®), with knowledge that it would be used to record postoperative corticosteroid instillation in real time. MAIN OUTCOMES Adherence to a regimen of corticosteroid eye drops during the first 5 postoperative weeks; achievement of target intraocular pressure (IOP) at 6 weeks, 6 months to 1 year after surgery; and bleb morphology at 1 year. RESULTS Among 90 patients, adherence was 90 ± 14% overall and 81 ± 16% during q2h dosing. Target IOP was achieved at final visit (6 months or 1 year) in 81% (59/73) without reoperation. Eyes with a higher ratio of drops taken vs prescribed were significantly more likely to achieve target IOP at 6 months/1 year (p=0.05). Total adherence was better in younger persons, eyes with less field loss, and patients of one particular surgeon (p<0.03). Percent adherence during every 2 hours (q2h) dosing was higher in eyes with higher target IOP (p=0.01). No adherence outcome was significantly related to race, sex, bleb morphology, postoperative pain, or post-operative anterior chamber inflammation. Adherence values did not significantly correlate with adherence questionnaire data (predicted mean = 70 ± 17%, actual mean = 91 ± 13% adherent, p < 0.001). CONCLUSION Adherence with frequent postoperative eye drops was high and can be successfully monitored remotely. Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03402802.
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Affiliation(s)
- Elyse J McGlumphy
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niccolo O Dosto
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas V Johnson
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harry A Quigley
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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14
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Malyugin BE, Sidorova AV, Starostina AV, Zhuravlev AS, Khaletskaya AA, Eliseeva MA, Smirnova EA. [Pharmacological modulation of wound healing in glaucoma surgery]. Vestn Oftalmol 2022; 138:136-143. [PMID: 36004602 DOI: 10.17116/oftalma2022138041136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite the well-known effectiveness of pharmacological glaucoma therapy, surgical approach remains one of the main treatment options for some forms and stages of the disease. The long-term success of glaucoma surgery depends on the intensity of local wound healing processes at the surgical site. The most common way to influence healing processes in surgical treatment of glaucoma is the use of antimetabolites. However, given the high risk of serious complications associated with their use, the search for new drugs devoid of these disadvantages continues. The aim of this review is to describe the efficacy and safety of both currently used and upcoming pharmacological ways to influence the wound healing process after glaucoma surgery in order to improve the stability of hypotensive effect.
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Affiliation(s)
- B E Malyugin
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A V Sidorova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A V Starostina
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A S Zhuravlev
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - A A Khaletskaya
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - M A Eliseeva
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
| | - E A Smirnova
- S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery", Moscow, Russia
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15
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Aqueous outflow channels and its lymphatic association: A review. Surv Ophthalmol 2021; 67:659-674. [PMID: 34656556 PMCID: PMC9008077 DOI: 10.1016/j.survophthal.2021.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/07/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022]
Abstract
The human eye has a unique immune architecture and behavior. While the conjunctiva is known to have a well-defined lymphatic drainage system, the cornea, sclera, and uveal tissues were historically considered "alymphatic" and thought to be immune privileged. The very fact that the aqueous outflow channels carry a clear fluid (aqueous humor) along the outflow pathway makes it hard to ignore its lymphatic-like characteristics. The development of novel lymphatic lineage markers and expression of these markers in aqueous outflow channels and improved imaging capabilities has sparked a renewed interest in the study of ocular lymphatics. Ophthalmic lymphatic research has had a directional shift over the last decade, offering an exciting new physiological platform that needs further in-depth understanding. The evidence of a presence of distinct lymphatic channels in the human ciliary body is gaining significant traction. The uveolymphatic pathway is an alternative new route for aqueous outflow and adds a new dimension to pathophysiology and management of glaucoma. Developing novel animal models, markers, and non-invasive imaging tools to delineate the core anatomical structure and physiological functions may help pave some crucial pathways to understand disease pathophysiology and help develop novel targeted therapeutic approaches for glaucoma.
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16
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Sihota R, Shakrawal J, Sharma AK, Gupta A, Dada T, Pandey V. Long-term perimetric stabilization with a management algorithm of set target intraocular pressure in different severities of primary angle-closure glaucoma. Indian J Ophthalmol 2021; 69:2721-2727. [PMID: 34571622 PMCID: PMC8597507 DOI: 10.4103/ijo.ijo_329_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate long-term perimetric stabilization at set Target (IOPs) in primary angle-closure glaucoma with visual field defects. Methods Two hundred forty-eight eyes, of 124 primary angle-closure glaucoma (PACG) patients on medical treatment, and 124 eyes, of 95 patients after trabeculectomy performed at least 5 years prior were evaluated. One hundred eighty-five eyes had a follow-up of ≥10 years. Target IOPs for mild, moderate, and severe glaucomatous optic neuropathy were set at ≤18, ≤15, and ≤12 mmHg, respectively. Progression was evaluated by event-based changes on guided progression analysis. Primary outcome measure was therapy required to achieve individualized Target IOP. Secondary outcome measure was assessment of perimetric change over time. Results Mean baseline IOP was 23.34 ± 6.16 mmHg in medically treated and 36.08 ± 9.73 mmHg in surgically treated eyes (P = 0.0001). All eyes with a baseline IOP of <25 mmHg were on medications alone, 65.33%, of those with a baseline IOP of 25-30 mmHg were on medications, while 34.67% required trabeculectomy. In total, 91.4% of eyes with a baseline IOP of >30 mmHg underwent a trabeculectomy for achieving Target IOP. Perimetric stabilization was achieved in 98.17% of PACG eyes. "Target" IOP was achieved for mild, moderate, and severe glaucomatous optic neuropathy, medically in 90.2, 73.9, and 29.7%, and surgery was required in 9.8, 26.1, and 70.3%, respectively. Overall analysis found that percentage reduction in IOP was significantly more after trabeculectomy than medical treatment, 64.16 ± 14.91 and 43.61 ± 13.73%, P = 0.0001. Decrease in IOP was significantly greater 5-9 years after trabeculectomy, in comparison to ≥10 years, P = 0.001. Conclusion Medications controlled IOP to "Target" in PACG eyes with mild and moderate glaucoma for over ≥10 years, when the baseline IOP off treatment was <30 mmHg. Trabeculectomy was necessary in PACG eyes having severe glaucomatous optic neuropathy, or with a baseline IOP of >30 mmHg to achieve Target IOP. These appropriate initial therapeutic interventions and Target IOPs are therefore suggested as a clinically validated algorithm of care for different severities of PACG.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Jyoti Shakrawal
- Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ajay K Sharma
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Amisha Gupta
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Service, Dr Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi, India
| | - Veena Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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17
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Mudhol R, Bansal R. Cross-linked hyaluronic acid viscoelastic scleral implant in trabeculectomy. Indian J Ophthalmol 2021; 69:1135-1141. [PMID: 33913846 PMCID: PMC8186654 DOI: 10.4103/ijo.ijo_2462_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose: Patients with glaucoma undergoing trabeculectomy develop bleb cicatrix causing poor postoperative intraocular pressure (IOP) control and low success rates. Several approaches have been explored over the years for better outcomes. This study assesses the safety, efficacy, and outcome of trabeculectomy with HealaFlow® (Anteis S. A, Geneva, Switzerland), a high-molecular-weight cross-linked hyaluronic acid viscoelastic gel, and comparing it with the antimetabolite Mitomycin-C (MMC). Methods: A prospective, interventional, case-controlled study conducted at a tertiary care hospital in Southern India on 60 eyes of patients requiring trabeculectomy divided in two groups – HealaFlow scleral implant and adjuvant low-dose MMC (0.1 mg/mL). Postoperative IOP reduction along with bleb morphology was assessed over follow-up at 1 week, 1 month, 3 months, 6 months, and 12 months. Results: Preoperatively IOP in the two groups was statistically similar. Postoperative IOP on day 1 had statistically significant reduction in both groups with greater reduction in MMC group. However, by 12 months, the IOP reduction was statistically similar in both groups, i.e., 46.24% (to 11.04 ± 2.55 mmHg) and 54.47% (to 11.99 ± 3.37 mmHg) in HealaFlow® group and MMC group, respectively (P > 0.05). The bleb morphologies were similar and complications were seen equally, which resolved by 4 weeks. A complete success rate of 89.29% and a qualified success rate of 10.71% were observed equally in both groups. Conclusion: Absorbable biosynthetic cross-linked hyaluronic acid and low-dose MMC are equally safe and efficacious in trabeculectomy with significant IOP reduction and good bleb morphology. Therefore, it is a novel substitute for MMC.
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Affiliation(s)
- Rekha Mudhol
- Department of Ophthalmology, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
| | - Rolika Bansal
- Department of Ophthalmology, KLE Academy of Higher Education and Research, Belagavi, Karnataka, India
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18
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Rao A, Gawas L. Atypical associations of viral anterior uveitis with glaucoma-a series of challenging scenarios with review of literature. Semin Ophthalmol 2021; 36:605-613. [PMID: 33734824 DOI: 10.1080/08820538.2021.1890789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report unusual associations, atypical clinical presentations, and outcomes of tailored treatment of viral uveitis and glaucoma. METHODS Patients diagnosed with viral uveitis with associated glaucoma, seen at a tertiary eye care center between 2013 and 2020, were screened. Twenty-four patients with unclassified or atypical clinical presentations of viral uveitis, atypical clinical course, or with diagnostic challenges and associated glaucoma, were included. Patients with classical features of viral anterior or posterior uveitis, other forms of autoimmune/infectious/traumatic uveitis, were excluded. RESULTS Viral re-activation causing recurrent choroidals after glaucoma filtering surgery responsive to systemic antiviral therapy, massive pigment dusting/plume as a presenting feature, multiple progressive focal anterior synechiae similar to iridocorneoendothelial (ICE) syndrome, were seen in this cohort of unusual viral uveitis in glaucoma. A high index of suspicion helped diagnose a viral etiology in cases with high intraocular pressure (IOP) after uneventful Ahmed glaucoma valve surgery (AGV) or post-YAG capsulotomy laser, presumed Posner-Schlossman syndrome with multiple recurrences or presumed steroid glaucoma. All patients responded well with anti-viral and tailored concomitant steroids, anti-glaucoma therapy with loss of visual acuity seen in one eye developing optic atrophy. CONCLUSIONS Uncommon clinical presentations or associations of viral uveitis in glaucoma should be kept in mind. A high index of suspicion and tailored prompt treatment may ensure good outcomes preventing further visual morbidity in glaucoma.
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Affiliation(s)
- Aparna Rao
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
| | - Lisika Gawas
- Glaucoma Services, LV Prasad Eye Institute, Patia, Bhubaneswar, Odisha, India
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19
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Exploiting biomaterial approaches to manufacture an artificial trabecular meshwork: A progress report. BIOMATERIALS AND BIOSYSTEMS 2021; 1:100011. [PMID: 36825164 PMCID: PMC9934513 DOI: 10.1016/j.bbiosy.2021.100011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 01/11/2023] Open
Abstract
Glaucoma is the second leading cause of irreversible blindness worldwide. Glaucoma is a progressive optic neuropathy in which permanent loss of peripheral vision results from neurodegeneration in the optic nerve head. The trabecular meshwork is responsible for regulating intraocular pressure, which to date, is the only modifiable risk factor associated with the development of glaucoma. Lowering intraocular pressure reduces glaucoma progression and current surgical approaches for glaucoma attempt to reduce outflow resistance through the trabecular meshwork. Many surgical approaches use minimally invasive glaucoma surgeries (MIGS) to control glaucoma. In this progress report, biomaterials currently employed to treat glaucoma, such as MIGS, and the issues associated with them are described. The report also discusses innovative biofabrication approaches that aim to revolutionise glaucoma treatment through tissue engineering and regenerative medicine (TERM). At present, there are very few applications targeted towards TM engineering in vivo, with a great proportion of these biomaterial structures being developed for in vitro model use. This is a consequence of the many anatomical and physiological attributes that must be considered when designing a TERM device for microscopic tissues, such as the trabecular meshwork. Ongoing advancements in TERM research from multi-disciplinary teams should lead to the development of a state-of-the-art device to restore trabecular meshwork function and provide a bio-engineering solution to improve patient outcomes.
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20
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Warjri GB, Sidhu T, Kishan A, Behera AK, Shakrawal J, Selvan H, Dada T, Pandey V, Sihota R. Achieving low target intraocular pressures in severe glaucoma. Eur J Ophthalmol 2020; 31:3068-3073. [PMID: 33289400 DOI: 10.1177/1120672120979903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to assess details of therapy required to achieve an intraocular pressure (IOP) of ⩽12 mmHg in patients with severe glaucoma of different etiologies. METHODS Patients with a follow-up of at least 1 year, who fulfilled inclusion criteria were selected, and data analyzed with respect to baseline IOP, number of medications, and/or surgeries required to achieve an IOP of ⩽12 mmHg and ⩾6 mmHg. Final IOP, visual field status and medications/surgery required were noted. RESULTS About 127 eyes of 85 patients met all criteria. There were 48 eyes having primary angle closure glaucoma (PACG), 16 eyes with primary open angle glaucoma (POAG), 17 eyes of juvenile open angle glaucoma (JOAG), and 46 eyes of secondary glaucoma. The mean baseline IOP was 33.14 ± 11.07 mmHg and final IOP 10.25 ± 1.81 mmHg. In the age group >40 years, 29.63% of patients were controlled on medication as compared to 9.09% and 5.71% in the age group of <20 years and 20-40 years (p = 0.007). With a baseline IOP of <25 mmHg, 48.65% required a trabeculectomy, whereas for 25-30, and >30 mmHg, 62.5% and 97.29% respectively, required surgery (p < 0.001).66.67% of patients having mean deviation of -12 to -16 dB (decibels) on Humphrey field analyzer (HFA) underwent surgery to achieve target IOP in comparison to 83.52% who had mean deviation greater than -16 dB (p = 0.036). CONCLUSION Only 21.26% of severe glaucoma eyes could be controlled on medications alone. A baseline IOP of >25 mmHg, age <40 years and mean deviation worse than -16 dB, had a higher frequency of trabeculectomies to achieve an IOP of ⩽12 mmHg.
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Affiliation(s)
- Gazella Bruce Warjri
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Talvir Sidhu
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Azmira Kishan
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Aswini Kumar Behera
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jyoti Shakrawal
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Harathy Selvan
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Veena Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramanjit Sihota
- Glaucoma Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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21
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Bell K, de Padua Soares Bezerra B, Mofokeng M, Montesano G, Nongpiur ME, Marti MV, Lawlor M. Learning from the past: Mitomycin C use in trabeculectomy and its application in bleb-forming minimally invasive glaucoma surgery. Surv Ophthalmol 2020; 66:109-123. [PMID: 32450159 DOI: 10.1016/j.survophthal.2020.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 12/26/2022]
Abstract
Trabeculectomy has been performed since the mid-1960s and remains the gold standard for glaucoma surgery. Newer surgical options have evolved, collectively referred to as minimally invasive glaucoma surgeries. Despite producing large intraocular pressure decreases, full-thickness procedures into the subconjunctival space may be limited by fibrosis. Mitomycin C (MMC) and 5-fluorouracil have been in use with trabeculectomy with good evidence of significantly increased success at the cost, however, of an increased risk of complications. Off-label MMC application can be found in almost all clinical trials, including in combination with minimally invasive glaucoma surgeries. We explore current evidence for MMC use in trabeculectomy and how this may differ for minimally invasive glaucoma surgery devices and analyze the range of agents and doses that are used. Although we found that most studies could not show any correlation between MMC dosage and the surgical outcome, the success rates with the Xen® microshunt seemed to be higher when using 20 mcg of MMC than when using 10 mcg. Certain important methodological considerations make this hard to confirm definitively, and other factors such as placement of the device may play a more substantial role. For the PreserFlo® microshunt, preliminary data suggest higher success rates with higher MMC dosage at the cost of higher device-related adverse events and reoperations. Although the ideal dose still needs to be established, it seems very likely that MMC provides significant improvement in outcomes in bleb-forming minimally invasive glaucoma procedures.
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Affiliation(s)
- Katharina Bell
- Experimental and Translational Ophthalmology, Department of Ophthalmology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Rhineland-Palatinate, Germany.
| | | | | | - Giovanni Montesano
- University of Milan - ASST Santi Paolo e Carlo, Milan, Italy; City, University of London - Optometry and Visual Sciences, London, United Kingdom; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, United Kingdom
| | | | | | - Mitchell Lawlor
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Sydney Eye Hospital, Macquarie St, Sydney, Australia
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22
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SPARC Levels Modulate the Capacity of Mitomycin to Inhibit the Proliferation of Human Tenon's Capsule Fibroblasts. J Ophthalmol 2020; 2020:5703286. [PMID: 32104594 PMCID: PMC7035548 DOI: 10.1155/2020/5703286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 01/01/2020] [Accepted: 01/13/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the role of SPARC in the antiproliferation effect of MMC on human Tenon's fibroblasts (HTF). Method Sixteen PACG patients aged 59 ± 10 years (31-72 years), including 6 males and 10 females, were recruited. Tenon tissue was harvested during filtering surgery. Cell density was evaluated after MMC application with different concentrations and application times, by which the optimized MMC application modality was determined. MMC, si-SPARC, or SPARC protein was used when needed to evaluate the cell densities under different conditions, by which the role of SPARC in MMC-mediated antifibrotic process was identified. Results Considering that the cell densities, as well as SPARC expression on mRNA and protein levels, are relatively stable when the MMC concentration is higher than 0.02% and exposure time longer than 90 s, we chose the MMC application pattern with 0.02% and 90 s as an optimized pattern for the downstream work. Compared to control, the si-SPARC and MMC downregulated the SPARC protein by 91% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (P < 0.01) and 65% (. Conclusion This study demonstrates that in HTF, (1) MMC downregulates the expression of SPARC in protein and mRNA levels; (2) SPARC depletion has synergistic effect on the antifibrotic effect of MMC; and (3) reactive oxygen species are the possible mediator in the antifibrotic effect of MMC and si-SPARC.
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23
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Kansal V, Armstrong JJ, Hutnik CM. Trends in Glaucoma Filtration Procedures: A Retrospective Administrative Health Records Analysis Over a 13-Year Period in Canada. Clin Ophthalmol 2020; 14:501-508. [PMID: 32109986 PMCID: PMC7039086 DOI: 10.2147/opth.s232873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 01/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Glaucoma surgical management has evolved significantly with the introduction of minimally invasive glaucoma surgery. Our aim was to evaluate trends in Canadian glaucoma surgery billing code usage as a surrogate index of the current impact of this new technology in Canada’s publicly funded health-care system. Methods Retrospective administrative health records analysis of all patients who underwent a publicly funded glaucoma filtration procedure from January 2003 to December 2016 in the 6 largest Canadian provinces. The frequency of glaucoma-related procedures was adjusted against primary open-angle glaucoma prevalence data. Frequency of all glaucoma filtration procedures with and without implantation of a drainage device in each province per year is reported. Results Nationwide, glaucoma filtration procedures per 1000 primary open-angle glaucoma patients per year remained constant, with increased drainage device implantation over time (P<0.0001). Ontario and Nova Scotia mirrored the overall population. British Columbia and Saskatchewan showed increased rates of glaucoma filtration surgery, with increased drainage device implantations. In Quebec, overall filtration surgery decreased, while the rate of device implantation increased (p<0.0001). Alberta showed a decline in filtration surgery and device implantations from 2003 to 2008, and then increased thereafter. Conclusion Over the study period, there was a distinct trend towards billing code usage for implanted devices. Challenges encountered during this investigation highlight the need for identifiers in provincial health databases to accommodate the introduction of novel technologies. The absence of specific billing codes for newer technologies prevents accurate analyses of impact, utilization, efficacy and cost implications in contemporary patient management.
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Affiliation(s)
- Vinay Kansal
- University of Saskatchewan, Department of Ophthalmology, Saskatoon, SK, Canada
| | - James J Armstrong
- Western University Canada, Schulich School of Medicine, Department of Pathology and Laboratory Medicine, London, ON, Canada.,Western University Canada, Schulich School of Medicine, Department of Ophthalmology, London, ON, Canada
| | - Cindy Ml Hutnik
- Western University Canada, Schulich School of Medicine, Department of Pathology and Laboratory Medicine, London, ON, Canada.,Western University Canada, Schulich School of Medicine, Department of Ophthalmology, London, ON, Canada.,Ivey Eye Institute, St. Joseph's Hospital, London, ON, Canada
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24
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Hong K, Lind J, Sheybani A. Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma: a surgery series from surgeon trainees at a tertiary teaching hospital. EYE AND VISION 2020; 7:5. [PMID: 32021876 PMCID: PMC6995155 DOI: 10.1186/s40662-019-0171-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/29/2019] [Indexed: 11/16/2022]
Abstract
Background To study the effect of an ab interno gelatin stent (XEN45 Gel Stent, Allergan Inc., Irvine, California, USA) on intraocular pressure (IOP) as placed by glaucoma fellowship trainees in eyes with refractory glaucoma. Methods A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees. Data was collected at baseline and postoperatively at day 1, week 1, and months 1, 3, 5, and 12. Primary outcome was mean IOP change. Secondary outcomes included change in number of glaucoma medication classes and visual acuity. Safety outcomes included needling rates. Surgical success was defined by achieving ≥20% reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal. Results At baseline, 28.6% (8/28) of the subjects had prior failed incisional glaucoma surgery in a study population that was 54% African-American, with 78% with severe glaucoma (average mean deviation of − 14.58 dB). Thirteen subjects terminated their clinic visits before their 12-month postoperative visit, leaving 15 subjects for end point analysis. Average IOP went from 21.6 mmHg (range 12.0–31.0, SD 6.6) at baseline to 12.5 mmHg (range 7.0–19.0, SD 3.6), a 42.1% reduction (p < 0.007). All subjects decreased the number of medication classes they were taking with an average reduction of 3.8 (range 2–5, SD 0.9) to 1.3 (range 0–3, SD 1.0) classes, or a 65.8% decrease (p < 0.006). Crude surgical success was 80.0% for the 15 subjects that followed up at 12 months. The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4% (95% CI: 44.7–85.8%). Regardless of the length of follow-up, 21.4% (6/28) met failure criteria: 3 subjects failed because they required secondary surgical intervention, and the other 3 did not have adequate IOP reduction. Initial bleb needling rate was 28.6% (8/28) and repeat was 17.9% (5/28). Conclusions Compared to the reported literature with experienced ocular surgeons, ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP, topical medication reduction, surgical success, and needling rates at 12-month follow-up.
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Affiliation(s)
- Karen Hong
- 1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO USA
| | - John Lind
- 1Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO USA
| | - Arsham Sheybani
- Barnes-Jewish Center for Outpatient Health, 4901 Forest Park Avenue, St Louis, MO 63110 USA
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25
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Sihota R, Shakrawal J, Sidhu T, Sharma AK, Dada T, Pandey V. Does TRABECULECTOMY meet the 10-10-10 challenge in PACG, POAG, JOAG and Secondary glaucomas? Int Ophthalmol 2020; 40:1233-1243. [PMID: 31942662 DOI: 10.1007/s10792-020-01289-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Evaluation of the intraocular pressure (IOP) lowering efficacy of trabeculectomies over > 10 years and their ability to stabilize glaucomatous optic neuropathy. METHODS In total, 181 eyes (136 patients), which underwent trabeculectomy (10 min surgery) at least 10 years prior and were on regular follow-up, were evaluated. Qualified/complete success was taken as criteria A: IOP ≤ 12 mmHg, B: IOP ≤ 15 mmHg and C: IOP ≤ 18 mmHg, with all > 5 mmHg, with/without medications. Target IOP in advanced glaucoma is about 10 mmHg, therefore trabeculectomy 10-10-10 challenge! RESULTS The mean age of patients was 46.32 ± 11.50 years. Absolute success was 50.27%, 54.14% and 59.66% according to criteria A, B and C at last follow-up, while qualified success was 70.11%, 81.77% and 96.13%. An IOP of ≤ 12 mmHg was noted in 34, 64.15%, PACG eyes, 14, 73.68%, POAG, 15, 65.22%, JOAG and 64, 74.42%, secondary glaucoma eyes. The reduction in IOP overall was 64.83 ± 16.80% at last review and was 59.47 ± 16.07% in PACG, 62.40 ± 17.72% in POAG, 71.89 ± 8.50% in JOAG and 67.74 ± 18.10% in secondary glaucoma eyes. "Target" IOP was achieved in 97.29% of early glaucoma, 85.71% moderate glaucoma and 70% severe glaucoma eyes. 97.24% of patients were perimetrically stable. 2.21% of eyes post-trabeculectomy had a shallow anterior chamber needing surgical intervention. Visual acuity was maintained or better in 93.92% of patients, with a cataract surgery performed in 6.63% eyes. A repeat trabeculectomy was performed in 3.31% of eyes. CONCLUSION Trabeculectomy 10-10-10 is achievable in the long term, with few complications or repeat surgical interventions in the majority of POAG, PACG, JOAG and secondary glaucomas. Therefore, trabeculectomy should not be relegated to a last resort, but should be undertaken as soon as possible, if medical therapy is inadequate, unaffordable or compliance is an issue.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Jyoti Shakrawal
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India.
| | - Talvir Sidhu
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Ajay K Sharma
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Tanuj Dada
- Glaucoma Service, Glaucoma Research and Clinical Facility, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Room No. 475, Fourth Floor, Ansari Nagar, New Delhi, 110029, India
| | - Veena Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029, India
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26
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Yu J, Qiu LX, Qing GP, Zhao BW, Wang H. Modified Cortex Mori Capsules improving the successful rate of functional filtering blebs after reclinical glaucoma filtering surgery. World J Clin Cases 2019; 7:3436-3445. [PMID: 31750327 PMCID: PMC6854417 DOI: 10.12998/wjcc.v7.i21.3436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The major reason for filtering bleb failure or scarring of the bleb site is due to excessive scarring after glaucoma filtration surgery in the clinic. Traditional Chinese medicine has preeminence in the prevention of fibrosis formation through the regulation of systemic circulation and improvement of the properties of the inflammatory cells in the blood.
AIM To examine the clinical efficacy of using the Modified Cortex Mori Capsules (MCMC; Chinese name: Jiawei Sangbaipi Capsules) in the success rate of functional filtering blebs after glaucoma filtering surgery in clinical patients.
METHODS Sixty resurgery glaucoma patients were randomly divided into two groups: 30 patients in surgery with the placebo group and 30 patients in surgery with the MCMC group. Patients took either the placebo or the MCMC 2 wk before and after surgery. Postoperative morphology and function filtering bleb, visual acuity, intraocular pressure, postoperative complications, the success rate of filtration surgery and clinical efficacy were observed.
RESULTS Fifty patients completed the study. The percentage of functional filtering blebs in the surgery plus MCMC group was 84% at 6 mo after surgery, which was higher than surgery plus placebo group (64%, P < 0.05). The surgical success rate in the MCMC and placebo groups were 79% ± 8.3% and 57% ± 10.6% respectively (P < 0.05). The visual acuity, intraocular pressure and the postoperative complications in the two groups had no significant differences.
CONCLUSION Glaucoma filtering surgery while taking MCMC not only reduced excessive scar formation and increased the success rate of functional filtering blebs but also improved the success of glaucoma filtration operations.
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Affiliation(s)
- Jing Yu
- Beijing Tongren Eye Center, Laboratory of Ophthalmology and Visual Science in Beijing, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Li-Xin Qiu
- Beijing Tongren Eye Center, Laboratory of Ophthalmology and Visual Science in Beijing, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Guo-Ping Qing
- Beijing Tongren Eye Center, Laboratory of Ophthalmology and Visual Science in Beijing, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Bo-Wen Zhao
- Beijing Tongren Eye Center, Laboratory of Ophthalmology and Visual Science in Beijing, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hui Wang
- Beijing Tongren Eye Center, Laboratory of Ophthalmology and Visual Science in Beijing, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Glandorf K, Lommatzsch C, Heinz C, Koch JM. [Trabeculectomy with Ologen® implant and bevacizumab]. Ophthalmologe 2019; 117:445-451. [PMID: 31541288 DOI: 10.1007/s00347-019-00972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Trabeculectomy is the most frequent form of glaucoma surgery. Despite the intraoperative use of antimetabolites, such as mitomycin C (MMC) postoperative scarring reactions can cause surgical failure. The subconjunctival placement of an Ologen® implant can avoid wound scarring. The additional application of bevacizumab should reduce angiogenesis and thereby scarring reactions and improve the surgical success rate. METHODS This was a retrospective single center study of patients with glaucoma after trabeculectomy with MMC. The operation was carried out either without an Ologen® implant (group 1), or with an Ologen® implant as an bevacizumab depot (group 2) or with an Ologen® implant and intrachamber injection of bevacizumab (group 3). The follow-up postoperative observation of intraocular pressure (IOP), complications, subsequent interventions and antiglaucoma treatment was performed for 12 months. RESULTS There were no significant differences between the groups with respect to IOP, complications, subsequent interventions and postoperative antiglaucoma treatment. The highest success rate (IOP after 12 months ≤15 mm Hg without treatment) was in group 1 (77.5%), followed by group 2 with 63.6% and group 3 with 57.1% (p = 0.34, χ2-test). CONCLUSION The highest success rate was achieved in group 1 with MMC but without an Ologen® implant or bevacizumab. In this study the additional use of Ologen® implants and bevacizumab in trabeculectomy was found to be a safe operation method but did not provide any additional benefits.
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Affiliation(s)
- K Glandorf
- Augenzentrum am St. Franziskus Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland.
| | - C Lommatzsch
- Augenzentrum am St. Franziskus Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland
| | - C Heinz
- Augenzentrum am St. Franziskus Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland.,Zentrum für Augenheilkunde, Universität Duisburg Essen, Essen, Deutschland
| | - J M Koch
- Augenzentrum am St. Franziskus Hospital Münster, Hohenzollernring 74, 48145, Münster, Deutschland
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28
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Assessing the Methodological Quality of Glaucoma Clinical Practice Guidelines and Their Recommendations on Microinvasive Glaucoma Surgery: A Systematic Review. J Glaucoma 2019; 27:e44-e49. [PMID: 29117010 DOI: 10.1097/ijg.0000000000000820] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Clinical practice guidelines (CPG) are regarded by many as critical communications providing guidance within specific medical fields. Over a decade ago, the first microinvasive glaucoma surgical (MIGS) procedures were introduced. Since then, a number of these novel intraocular pressure controlling surgical options have been approved worldwide. Governing bodies and health care administration often utilize CPGs when considering funding for newer technologies. This highlights the importance of well-written, accurate, and up-to-date CPGs in the rapidly evolving field of MIGS. If CPGs are unable to fill this role, their use in treatment decision-making is doing a disservice to patients, who will be denied currently available and potentially superior care. To determine the overall value of a CPG, the methodological quality with which it was developed, in addition to the current relevance and appropriateness of its recommendations, should be evaluated. The objective of the present study was to assess the methodological quality of currently available international glaucoma CPGs, as well as their coverage of MIGS as a surrogate marker of relevance and appropriateness to policy-makers and ophthalmologists alike. MATERIALS AND METHODS To identify potentially relevant CPGs, a predefined search strategy was used to search the following databases: Medline, EMBASE, BIOSIS, and Web of Science. All CPGs related to adult glaucoma and published in English were included. CPG methodological quality was assessed by 3 individuals using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. Studies were then assessed for coverage of MIGS devices and procedures. RESULTS Search strategy and subsequent screening identified 11 CPGs for analysis. Eight were of high quality according to the AGREE II criteria. Three included basic information on MIGS, but none provided specific recommendations regarding their indications or which patient populations would benefit most. CONCLUSIONS Many international glaucoma CPGs are of high methodological quality. However, coverage of MIGS is sparse, nonspecific and in many instances, absent. This causes CPGs to be a suboptimal source in guiding physicians and health policy-makers in areas characterized by novel and/or rapidly evolving technologies. Mechanisms to incorporate updated evidence in CPGs would have to be considered before they can be used as a source of contemporary clinical decision-making.
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Abstract
AIM To evaluate the efficacy and safety of trabeculectomy (Trab) with mitomycin-C (MMC) versus Trab with implant. METHODS Studies published in different languages were retrieved by systematically searching Embase, PubMed, Cochrane library, China Biology Medicine disc, and Google Scholar from 1966 to April 2018, as well as manually examining the references of the original articles. The outcome measures of efficacy covered intraocular pressure, glaucoma medications reductions, and success rate. Safety evaluation was measured by relative ratio of complications. RESULTS A total of 11 studies involving 443 participants were covered in this meta-analysis. The weighted mean difference (WMD) in the percentage of intraocular pressure (IOP) reduction (IOPR%) comparing Ologen group with MMC group was -3.69 (95% CI: -6.70 to -0.68) at 1 month, -2.69 (-5.17 to -0.21) at 3 months, -3.67 (-6.09 to -1.25)at 6 months, -3.24 (-6.08 to -0.41) at 12 months, 1.24 (-9.43 to 11.90) at 24 months, and 1.10 (-10.11 to 12.31) at 60 months, which showed that there was statistically significant difference at 1,3, 6, and12 months after the surgery. A significantly higher incidence of postsurgery hypotony (0.64 (95% Cl: 0.42 to 0.98)) and suture lysis (0.30 (95% CI: 0.10-0.93)) was observed in MMC group. However, there was no significant difference in the reduction in glaucoma medications, success rate, and incidence of other complications.Trab with 0.2 mg/mL MMC presented higher rates of complete success compared with Trab with 0.4 mg/mL MMC (P = .01). CONCLUSION Trab with MMC was associated with a higher IOP-lowering efficacy and a higher incidence of postsurgery hypotony and suture lysis in contrast to that of Trab with Ologen.
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30
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Lenzhofer M, Kersten-Gomez I, Sheybani A, Gulamhusein H, Strohmaier C, Hohensinn M, Burkhard Dick H, Hitzl W, Eisenkopf L, Sedarous F, Ahmed II, Reitsamer HA. Four-year results of a minimally invasive transscleral glaucoma gel stent implantation in a prospective multi-centre study. Clin Exp Ophthalmol 2019; 47:581-587. [PMID: 30578661 PMCID: PMC6767491 DOI: 10.1111/ceo.13463] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/28/2018] [Accepted: 12/19/2018] [Indexed: 11/26/2022]
Abstract
Importance The transscleral XEN Glaucoma Gel Microstent (XEN‐GGM, Allergan Plc., Parsippany, New Jersey) is implanted by a minimally invasive ab interno technique. Background The present study aims to assess the long‐term clinical outcomes in patients after XEN‐GGM implantation. Design This prospective, non‐randomized, multi‐centred study was conducted in three countries (Austria, Canada and Germany). Participants Sixty‐four consecutive eyes of 64 patients with open angle glaucoma received the XEN‐GGM (63 μm) without Mitomycin C. Thirty‐five (55%) were solo procedures, and 29 (45%) were combined with cataract surgery. Methods Visits were planned at baseline, 6 months, 1, 2, 3 and 4 years postoperatively. Main Outcome Measures The main outcome measures were mean intraocular pressure (IOP), mean number of IOP lowering medication. Secondary outcome parameters were: visual acuity, visual fields and complete surgical failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) at 4 years, postoperatively. Results Mean best‐medicated baseline IOP was 22.5 ± 4.2 mmHg and decreased significantly to 13.4 ± 3.1 mmHg 4 years postoperatively (−40%, n = 34, P < 0.001). Mean number of IOP lowering medication decreased significantly from 2.4 ± 1.3 preoperatively to 1.2 ± 1.3 (−50%, n = 34, P < 0.001) postoperatively. Visual field mean deviation showed no significant change between preoperative and postoperative examinations. Complete surgical failure rate per year was 10%. Conclusions and Relevance The XEN‐GGM resulted in lower IOP and a reduction in medications from baseline over 4 years of follow‐up. There was no detectable decrease in visual fields over the study. The surgical failure rate is comparable to other filtration surgeries.
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Affiliation(s)
- Markus Lenzhofer
- Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Inga Kersten-Gomez
- Department of Ophthalmology, University Eye Clinic Bochum, Bochum, Germany
| | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
| | - Husayn Gulamhusein
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Clemens Strohmaier
- Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Melchior Hohensinn
- Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H Burkhard Dick
- Department of Ophthalmology, University Eye Clinic Bochum, Bochum, Germany
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Lisa Eisenkopf
- Department of Ophthalmology, University Eye Clinic Bochum, Bochum, Germany
| | - Fady Sedarous
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Iqbal I Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Credit Valley Eye Care, and Trillium Health Partners, Mississauga, Ontario, Canada
| | - Herbert A Reitsamer
- Department of Ophthalmology and Optometry, University Clinic Salzburg, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology, Paracelsus Medical University, Salzburg, Austria
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Rodgers CD, Lukowski ZL, Min J, Martorana GM, Wilson MK, Schaefer JL, Levine MA, Meyers CA, Blake CR, Schultz GS, Sherwood MB. Modulating Ocular Scarring in Glaucoma Filtration Surgery Using the Epigenetic Adjunct Suberoylanilide Hydroxamic Acid. J Curr Glaucoma Pract 2019; 13:37-41. [PMID: 31496560 PMCID: PMC6710929 DOI: 10.5005/jp-journals-10078-1246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIM The aim of this study is to assess the effectiveness of suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor (HDI) with a broad spectrum epigenetic activity, in improving filtration bleb survival as an adjunct therapy to glaucoma filtration surgery (GFS) in the rabbit model. MATERIALS AND METHODS Eighteen New Zealand White rabbits underwent GFS in the left eye and were randomized to receive either a subconjunctival (SC) injection of 0.1 mL SAHA (9.25 μg/mL) or balanced saline solution (BSS) at the end of surgery, or a 3-minute intraoperative topical application of 0.4 mg/mL mitomycin-C (MMC). Bleb survival and histology were compared. RESULTS Blebs of rabbits receiving injections of SAHA survived an average (mean ± SD) of 23.2 ± 2.7 days. SAHA rabbits showed a nonsignificant improvement over rabbits that received an injection of BSS, which had a mean survival time of 19.7 ± 2.7 days (p = 0.38) according to a one-way analysis of variance (ANOVA). Eyes receiving intraoperative topical MMC survived an average of 32.5 ± 3.3 days, which is significantly longer than both the control group treated with BSS (p = 0.01) and the experimental group treated with the SAHA (p = 0.0495). SAHA was well tolerated and showed no significant avascularity, necrosis, or conjunctival thinning. CONCLUSION Although it was well tolerated, a single intraoperative injection of SAHA did not significantly prolong bleb survival in the rabbit model. CLINICAL SIGNIFICANCE Epigenetic adjuncts hold promise for improving GFS outcome; however, future studies must continue to examine different administration protocols and dosages to substantiate their efficacy. HOW TO CITE THIS ARTICLE Rodgers CD, Lukowski ZL, et al. Modulating Ocular Scarring in Glaucoma Filtration Surgery Using the Epigenetic Adjunct Suberoylanilide Hydroxamic Acid. J Curr Glaucoma Pract 2019;13(1):37-41.
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Affiliation(s)
- Cooper D Rodgers
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA; Department of Ophthalmology, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Zachary L Lukowski
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA; Department of Ophthalmology, Medical College of Georgia-Augusta University, Augusta, Georgia, USA
| | - Jeff Min
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA; Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gina M Martorana
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA; Department of Dermatology, University of Florida, Gainesville, Florida, USA
| | - Mary-Kate Wilson
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Jamie L Schaefer
- Department of Ophthalmology, West Virginia University, Morgantown, West Virginia, USA
| | - Monica A Levine
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Craig A Meyers
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - C Richard Blake
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
| | - Gregory S Schultz
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, Florida, USA
| | - Mark B Sherwood
- Department of Ophthalmology, University of Florida, Gainesville, Florida, USA
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Gedde SJ, Chen PP, Heuer DK, Singh K, Wright MM, Feuer WJ, Schiffman JC, Shi W. The Primary Tube Versus Trabeculectomy Study. Ophthalmology 2018; 125:774-781. [DOI: 10.1016/j.ophtha.2017.10.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/24/2022] Open
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Abbas A, Agrawal P, King AJ. Exploring literature-based definitions of hypotony following glaucoma filtration surgery and the impact on clinical outcomes. Acta Ophthalmol 2018; 96:e285-e289. [PMID: 29193812 DOI: 10.1111/aos.13601] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To highlight the variations in published definitions of hypotony and their impact on reported clinical outcomes. To propose a revised definition, focusing on clinically significant hypotony (CH). METHODS Literature review of hypotony definitions published between January 2010 and December 2015 was carried out. Numerical definitions for hypotony, its onset, duration and associated clinical signs were recorded. Each definition was applied to surgical outcomes data collected prospectively from a cohort of 300 glaucoma patients treated at a single centre. The sensitivity and specificity of each definition in identifying CH [defined as low intraocular pressure (IOP) with signs of maculopathy hypotony and choroidal detachment] were calculated. RESULTS A total of 128 eligible papers were identified, and 14 different definitions for hypotony were extracted. In 53 (41.4%), hypotony was not defined. In the remaining 75 (58.6%), the numerical definitions varied between 4 and 8 mmHg, and of these, 24 (32%) included the onset and duration of hypotony as part of the definition. Definition-dependent hypotony rates within the cohort varied between 1% and 59.3%. No statistical differences were found between the groups based on corneal thickness or axial length. Clinically significant hypotony (CH) was identified in 37 (12.3%), with large differences in the sensitivity and specificity among published definition. CONCLUSION Variations in defining postoperative hypotony can have a large impact on the reported success and failure rates among studies. There is a need for a more robust universal definition, focusing on clinically important signs, to allow better comparison between different treatment modalities.
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Affiliation(s)
- Ali Abbas
- Glaucoma Unit; Moorfields Eye Hospital; London UK
| | - Pavi Agrawal
- Department of Ophthalmology; Nottingham University Hospital; Nottingham UK
| | - Anthony J. King
- Department of Ophthalmology; Nottingham University Hospital; Nottingham UK
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Miraftabi A, Nilforushan N, Darghahi M, Alemzadeh SA, Parsamanesh M, Yadgari M. Effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve implantation: a randomized control trial. Clin Exp Ophthalmol 2018; 46:750-756. [PMID: 29573081 DOI: 10.1111/ceo.13191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 02/06/2018] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Abstract
IMPORTANCE The effect of subconjunctival Bevacizumab injection on the outcome of Ahmed glaucoma valve (AGV) implantation. BACKGROUND Evaluation of efficacy and safety of subconjunctival Bevacizumab injection adjunctive to AGV implantation. DESIGN Prospective and randomized clinical trial. PARTICIPANTS Fifty eyes of 50 patients with diagnosis of glaucoma that were candidate for AGV surgery were included. METHODS In 25 eyes, conventional AGV surgery (group 1) and in 25 eyes AGV surgery with subconjunctival Bevacizumab (group 2) was performed by block randomization MAIN OUTCOME MEASURES: The primary outcome measure was surgical success. Outcome measures were compared at postoperative month 3, 6 and 12. RESULTS Mean age of patients was 58.76 ± 12.11 and 51.36 ± 15.44 years in group 1 and 2 respectively (P = 0.06). Mean intraocular pressure (IOP) at baseline was 24.88 ± 7.62 mmHg in group 1 and 27.52 ± 8.57 mmHg in group 2 which decreased to15.4 ± 4.4 mmHg in group 1 and 13.42 ± 2.9 mmHg in group 2 (P < 0.00) at last follow up. Surgical success was defined in two level: postoperative IOP ≤ 21 mmHg with at least 20% reduction in IOP (Criterion A), either with no medication (complete success) or with no more than two medications (qualified success) and criterion B with the same definition but the IOP ≤ 18 mmHg The cumulative success according to criterion A and B was 77.8%, 72.2% in group 1 and 89.5% in group 2, respectively, at the end of follow-up. CONCLUSIONS AND RELEVANCE Subconjunctival injection of Bevacizumab adjunctive to AGV implantation leads to higher success rate compared with AGV alone in one year follow-up.
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Affiliation(s)
- Arezoo Miraftabi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naveed Nilforushan
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mina Darghahi
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Parsamanesh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Yadgari
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Alwitry A, Abedin A, Patel V, Moodie J, Rotchford A, King AJ. Primary low-risk trabeculectomy augmented with low-dose mitomycin-C. Eur J Ophthalmol 2018; 19:971-6. [DOI: 10.1177/112067210901900612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amar Alwitry
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
| | - Asyia Abedin
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
| | - Vick Patel
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
| | - Jonathan Moodie
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
| | - Alan Rotchford
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
| | - Anthony J. King
- Eye, Ear, Nose and Throat Centre, Queens Medical Centre, Nottingham - UK
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Kim TJ, Kang S, Jeoung JW, Kim YK, Park KH. Comparison of 1-year outcomes after Ahmed glaucoma valve implantation with and without Ologen adjuvant. BMC Ophthalmol 2018; 18:45. [PMID: 29444665 PMCID: PMC5813372 DOI: 10.1186/s12886-018-0709-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background Many studies have investigated the clinical benefits of Ologen for trabeculectomy. However, its benefits for Ahmed glaucoma valve (AGV) implantation have not been investigated as extensively. The aim of this study was to compare the 1-year outcomes of AGV implantation with and without Ologen adjuvant for the treatment of refractory glaucoma. Methods This retrospective study included a total of 20 eyes of 20 glaucoma patients, who were followed for at least 1-year after undergoing AGV implantation. In 12 eyes of 12 patients, conventional AGV (CAGV) surgery was performed, while in 8 eyes of 8 patients, Ologen-augmented AGV (OAGV) implantation was performed. The outcomes were evaluated according to intraocular pressure (IOP) and the number of IOP-lowering medications. Complete success was defined as IOP ≤ 21 mmHg without medications throughout the 1-year follow-up period, and qualified success was defined as IOP ≤ 21 mmHg with or without medications throughout the 1-year follow-up period. Results The rate of complete success was significantly higher in the OAGV group (50.0%) than in the CAGV group (8.3%) (p = 0.035). There were no significant differences between the two groups in terms of qualified success or incidence of the early hypertensive phase. The IOP changes were similar between the groups within 1-year postoperatively, though the number of IOP-lowering medications was significantly lower in the OAGV group during the early hypertensive phase (p = 0.031, 0.031, and 0.025 at postoperative months 1, 2, and 3, respectively). When subjects were divided into groups according to the occurrence of the early hypertensive phase, the group with early hypertensive phase was more likely to use IOP-lowering medications at postoperative 6 months and 1 year (p = 0.002 and 0.005, respectively). Conclusions OAGV surgery shows encouraging results for patients with refractory glaucoma, specifically with respect to the achievement of complete success and the reduction of the number of IOP-lowering medications during the early hypertensive phase. Furthermore, our results suggest that occurrence of the early hypertensive phase is predictive of which patients will require IOP-lowering medications at postoperative 6 months and 1 year.
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Affiliation(s)
- Tai Jun Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Sohyun Kang
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
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Kenigsberg PA. Changes in Medical and Surgical Treatments of Glaucoma between 1997 and 2003 in France. Eur J Ophthalmol 2018; 17:521-7. [PMID: 17671925 DOI: 10.1177/112067210701700407] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2003 in France. Methods Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Numbers of patients treated per year were estimated from drug unit sales using defined daily doses for each drug. Results New medical treatments of glaucoma and ocular hypertension, introduced in France between 1997 and 2003, allowed treatment of 557,000 patients. In 2003, 63% of patients treated with these new medicines were receiving prostaglandins (39% latanoprost, 9% travoprost, 8% the fixed combination of latanoprost + timolol, and 7% bimatoprost), 13% brinzolamide, 13% the fixed combination of dorzolamide + timolol, and 11% brimonidine. During the same period, trabeculectomies declined by 38% (-48% in public hospitals and −32% in private clinics), while the total number of glaucoma surgeries declined by 22% (−34% in public hospitals and −14% in private clinics). Hospital days related to open-angle glaucoma surgery declined by 51%. There is a strong correlation (r2=-0.97) between the reduction of glaucoma surgery and the increase in the number of patients treated with prostaglandins during the study period. Conclusions Between 1997 and 2003, new glaucoma drugs, primarily prostaglandins, improved intraocular pressure control and delayed surgery, reducing glaucoma surgery by 22%.
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Abstract
PURPOSE To examine outcomes of trabeculectomy with mitomycin C for uncontrolled glaucoma when performed by glaucoma trainee surgeons. MATERIALS AND METHODS Retrospective case series of patients who underwent trabeculectomy with mitomycin C. Primary outcome was to assess the rate of failure, which was defined as intraocular pressure in 2 consecutive visits >18 or <5 mm Hg or intraocular pressure reduction <30% from baseline, additional glaucoma surgery, or loss of light perception. The secondary outcome was to investigate risk factors for failure and surgical complications. RESULTS One hundred forty-three eyes from 126 glaucoma patients underwent primary trabeculectomy between 2013 and 2014 at University of Campinas. Mean follow-up time was 1.47±0.96 years. Kaplan-Meier analysis showed cumulative survival rates of 70.1%, 62.5%, and 57.8%, after 1, 2, and 3 years, respectively. Multivariate analysis with generalized estimating equations revealed that neovascular glaucoma [odd ratios (OR): 5.05, P=0.043], suture lysis (OR: 8.89, P=0.011), and early bleb leak (OR: 4.63, P=0.011) were risk factors for failure. CONCLUSIONS A success rate of approximately 60% was obtained 3 years after primary trabeculectomy performed by trainees. Patients with neovascular glaucoma, who underwent suture lysis and who presented an early bleb leak had an increased risk for failure during follow-up.
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Sihota R, Angmo D, Sen S, Gupta V, Dada T, Pandey RM. The Long-term Outcome of Primary "Bleb-sparing, Epithelial Exchange" in Dysfunctional Filtering Blebs. J Glaucoma 2017; 25:571-8. [PMID: 26465075 DOI: 10.1097/ijg.0000000000000322] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the long-term outcome of epithelial peeling and conjunctival replacement as a primary procedure in dysfunctional filtering blebs, without excising the bleb. MATERIALS AND METHODS A prospective, observational case series involving 34 consecutive eyes, having prior operated trabeculectomy with a dysfunctional filtering bleb, that met the inclusion criteria and were reviewed for at least 12 months. The bleb epithelium was peeled off and replaced with the adjacent conjunctiva, without bleb excision. Patients were reviewed at 1 week, 1 and 3 months postoperatively, and thereafter every 6 months for best corrected visual acuity (BCVA), applanation tonometry, bleb morphology and leaks, the lens status, glaucoma medications, and any complications. ASOCT was performed preoperatively and at the last review. Complete success (primary outcome) was defined as an intraocular pressure (IOP) >6 and <18 mm Hg without any additional antiglaucoma medications at the last follow-up. RESULTS The average age of the patients was 36.6±20.7 years. The average time of follow-up was 23.9±6.1 months (range, 13 to 40 mo). The mean preoperative IOP was 5.8±4.2 mm Hg. Postoperatively, the IOP at 24 months was 12.6±3.9 mm Hg (P<0.0001). The bleb characteristics were graded according to the Indiana Bleb Appearance Grading Scale (IBAGS), which showed significant results in terms of the height (H), the vascularity (V), and Seidel (S) (P<0.0001). The preoperative and the postoperative BCVAs in logMAR were 0.51±0.26 and 0.37±0.21 (P=0.0001), respectively. Complete success was noted in 31/34 eyes (91.18%) and qualified success was noted in 3 eyes (8.82%). One patient developed a mild ptosis after bleb revision. CONCLUSIONS Epithelial peeling of the bleb with replacement by advancement, without bleb excision, maintains bleb function and resolves bleb dysfunction in the long term.
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Affiliation(s)
- Ramanjit Sihota
- *Glaucoma Research Facility & Clinical Services †Ocular Pathology, Dr Rajendra Prasad Centre for Ophthalmic Sciences ‡Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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Abstract
PURPOSE We report the first description of temporalis fascia autograft to repair a late leakage bleb with scleral defect that occurred long time after trabeculectomy with mitomycin C. PATIENT A 65-year-old woman was referred to our hospital with chronic late bleb leakage on her right eye. She had previously undergone a trabeculectomy with mitomycin C 3 years ago for a pigmentary glaucoma. Bleb leakage occurred 1½ year after the initial surgery. She underwent 2 surgical revisions consisting of a conjunctival advancement then an autologous conjunctival with partial scleral grafts without success. The initial best-corrected visual acuity of the right eye was 20/50 (Snellen scale). Slit-lamp examination revealed an avascular filtering bleb with leakage (massive positive Seidel test) and a scleral defect. The anterior chamber was deep and intraocular pressure (IOP) was 9 mm Hg.Faced with the risk of blebitis, endophthalmitis, and with the failure of the previous surgeries announced earlier, a surgical revision with autologous superficial temporalis fascia graft was decided to repair the leaking bleb. After local anesthesia, a sample of superficial temporalis fascia was harvested. The necrotic avascular conjunctiva around the bleb was dissected to separate and excise it from the sclera. The autologous fascia graft was sutured on the scleral defect with 10-0 nylon. Subsequently healthy conjunctiva was sutured above the graft. RESULTS No bleb leakage occurred postoperatively, best-corrected visual acuity improved to 20/25, and IOP remained within normal levels 6 months after surgery without IOP-lowering medication. CONCLUSIONS Superficial temporalis fascia autograft seems to be an effective, safe, and easy technique for ophthalmologists. It is a new procedure in the management of late-onset bleb leakage.
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A Pilot Study on Ocular Safety and Efficacy of Infliximab as an Antifibrotic Agent After Experimental Glaucoma Filtration Surgery. Ophthalmol Ther 2017; 6:323-334. [PMID: 28669026 PMCID: PMC5693834 DOI: 10.1007/s40123-017-0096-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Tumor necrosis factor-α (TNF-α) is a multifunctional, proinflammatory cytokine that mediates pleiotropic biological functions, especially inflammation and immunoregulation. We hypothesized that blocking TNF-α with a monoclonal antibody would decrease inflammation and subconjunctival scarring in an animal model of experimental filtration surgery. Methods In a randomized, prospective, masked-observer study, 30 New Zealand albino rabbits underwent glaucoma filtration surgery. The animals were allocated to receive either intraoperative application of infliximab (group A) or mitomycin C (MMC) at a concentration of 0.2 mg/ml (group B) or balanced salt solution (BSS, control) (group C). Different infliximab doses, namely 1.0, 2.0, 3.0, 4.0, 5.0 mg in 0.1 ml, were applied. Bleb survival and characteristics were evaluated over a 30-day period. The animals were killed on postoperative day 15 or 30. Histology of the operated eyes was performed to evaluate and grade the amount of scarring in each group. Cellular density was evaluated in each case. Results Infliximab did not appear to improve outcomes in this model of glaucoma filtration surgery. Bleb survival was significantly higher in the MMC group compared to the other groups (p < 0.001 for both comparisons). Vascularity was also significantly lower in the MMC group compared to the other groups (p = 0.018 for both comparisons). There was a significant decrease in cellular density in the MMC group compared to the control (p = 0.0352) and the infliximab group (p < 001). Conclusion Our results have shown that trabeculectomies in the infliximab group failed faster and displayed more scarring, compared to the control and MMC groups. This outcome suggests that the infliximab doses used in this pilot study resulted in a subconjunctival TNF-α concentration, which acted as a stimulator to fibroblasts.
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Fan Gaskin JC, Sandhu SS, Walland MJ. Victorian trabeculectomy audit. Clin Exp Ophthalmol 2017; 45:695-700. [DOI: 10.1111/ceo.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer C Fan Gaskin
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Sukhpal S Sandhu
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Mark J Walland
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
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Pakravan M, Esfandiari H, Yazdani S, Douzandeh A, Amouhashemi N, Yaseri M, Pakravan P. Mitomycin C-augmented trabeculectomy: subtenon injection versus soaked sponges: a randomised clinical trial. Br J Ophthalmol 2017; 101:1275-1280. [DOI: 10.1136/bjophthalmol-2016-309671] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 11/04/2022]
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Alagöz N, Alagöz C, Yıldırım Y, Yeşilkaya C, Altan Ç, Bozkurt E, Şatana B, Başarır B, Taşkapılı M. The Effect of Adjuvant Intracameral Triamcinolone Acetonide on the Surgical Results of Trabeculectomy with Mitomycin C. Turk J Ophthalmol 2017; 46:169-174. [PMID: 28058152 PMCID: PMC5200822 DOI: 10.4274/tjo.88785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/22/2015] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To evaluate the effect of adjuvant intracameral triamcinolone acetonide (TA) on the surgical results of trabeculectomy with mitomycin C. MATERIALS AND METHODS All consecutive trabeculectomy cases performed in the glaucoma clinic between July 2012 and December 2013 were retrospectively reviewed from the patient charts. Only those with follow-up of 12 months or longer were included. Patients with intraoperative intracameral TA (study group, n=19) were compared to those without TA (control group, n=21) in terms of surgical success, intraocular pressure (IOP) change, medication use and complications. RESULTS Forty eyes of 31 patients (21 male/10 female, mean age 64.2±13.8 years) were included in the study. The mean follow-up period was 20.9±5.1 months and 20.7±6.7 months in the study and control groups, respectively (p=0.830). Baseline IOP was 26.4±9.9 and 25.2±7.6 mmHg (p=0.979), and final IOP was 12.7±2.6 and 13.6±3 mmHg in both groups respectively (p=0.226). At the final follow-up, complete success was observed in 68.4% and 52.4% of the study and control groups (p=0.349) and anti-glaucoma medication was used by 31.6% (mean number of medications: 0.79±1.2) and 47.6% (mean number of medications: 1.33±1.7), respectively (p>0.05). Bleb encapsulation, leakage, suture-lysis and hypotony rates were similar in both groups (for all, p>0.05). Cataract progression was noted in six (35.3%) and in five (26.3%) of the phakic eyes in the study and control groups, respectively (p=0.720). CONCLUSION When used intracamerally, TA did not increase the complication rate in trabeculectomy surgery. Although the group that received TA showed lower IOP levels, use of fewer medications and fewer eyes requiring medication, the differences did not reach significance.
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Affiliation(s)
- Neşe Alagöz
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Cengiz Alagöz
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Yıldırım
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Ceren Yeşilkaya
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Çiğdem Altan
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | | | - Banu Şatana
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
| | - Berna Başarır
- Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey
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Outcomes of Trabeculectomy Augmented With Subconjunctival and Subscleral Ologen Implantation in Primary Advanced Glaucoma. J Glaucoma 2017; 26:8-14. [DOI: 10.1097/ijg.0000000000000537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moradi M, Derakhshandeh K, Karimian B, Fasihi M. Safety and efficacy of Intraurethral Mitomycin C Hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy. J Inj Violence Res 2016; 8:75-9. [PMID: 27093204 PMCID: PMC4967365 DOI: 10.5249/jivr.v8i2.812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/18/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evaluation of the safety and efficacy of intraurethral Mitomycin C (MMC) hydrogel for prevention of post-traumatic anterior urethral stricture recurrence after internal urethrotomy. METHODS A thermoresponsive hydrogel base consisting of 0.8 mg MMC with 1cc water and propylene glycol to PF-127 poloxamer was used in theater. 40 male patients with short, non-obliterated, urethral stricture were randomized into 2 groups: control and MMC. After internal urethrotomy, the MMC group patients received the MMC-Hydrogel while the others were just catheterized. Both groups had their catheters for at least 1 week. After surgery, they were followed up by means of medical history and physical examination, monitoring voiding patterns and retrograde urethrogram at 1 month, 6 months and 1 year after surgery. RESULTS 40 male patients between 14 to 89 years old (Mean = 54.15) underwent internal urethrotomy. The average age for the control and MMC group was 54.55±21.25 and 53.75±24.75 respectively. In a comparison of age between the two groups, they were matched (P=0.574). Stricture length was 10.7±5.9 and 9.55±4.15 mm for the control and MMC group respectively. There were no statistically meaningful differences between the two groups (P=0.485). Fifteen patients had a history of one previous internal urethrotomy which in a comparison between the two groups meant there was no meaningful difference (P=0.327). During postoperative follow up, total urethral stricture recurrence happened in 12 patients: 10 patients (50%) in control group and 2 patients (10%) in MMC group. The difference was statistically significant (P=0.001). There were no significant complications associated with the MMC injection in our patients. CONCLUSIONS Based on our results, MMC Hydrogel may have an anti-fibrotic action preventing post-traumatic anterior urethral stricture recurrence with no side effects on pre-urethral tissue. Due to our study limitations, our follow up time and the small number of patients, our results were not conclusive and further studies will be needed with a longer follow up time.
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Affiliation(s)
- Mahmoudreza Moradi
- Department of Urology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Trabeculectomy with ologen in secondary glaucomas following failed trabeculectomy with MMC: comparative study. Eye (Lond) 2016; 30:1126-34. [PMID: 27256305 DOI: 10.1038/eye.2016.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 04/20/2016] [Indexed: 11/08/2022] Open
Abstract
PurposeWe aimed to assess the IOP-lowering effect of trabeculectomy with ologen in refractory secondary glaucoma following failed trabeculectomy with mitomycin C (MMC), and to compare its surgical outcome between open angle (SOAG) and angle closure (SACG) cases.MethodsThis is a prospective interventional comparative study conducted on 40 eyes (40 patients) with medically uncontrolled secondary glaucoma. Patients were divided into group A: 18 eyes (18 patients) with SOAG, and group B: 22 eyes (22 patients) with SACG. All patients underwent trabeculectomy with insertion of ologen implant. Intraocular pressure (IOP) measurement, SITA standard perimetry (Central 24-2), spectral domain optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL) thickness, and anterior segment OCT for bleb morphology, were all done pre- and postoperatively. Primary outcome measures were comparing preoperative to postoperative measurements and also comparing these measurements between SOAG and SACG. All patients were examined up to 1 year.ResultsWhen preoperative IOP was compared with postoperative IOP, in each group, there was a statistically significant difference (P<0.001). IOP percentage difference was statistically insignificantly different between both groups except at 1 month. According to Moorfields bleb grading system; postoperative bleb was better than the bleb of the previously failed trabeculectomy (P<0.001), and there was a significant difference between group A and B regarding bleb area. Total success rate was 100%; in group A, complete success was 100%, while in group B it was 72.7% (P=0.016).ConclusionOur results suggest that Ologen may be a useful alternative to MMC in repeat trabeculectomy.
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Influence of Endothelin-1 in Aqueous Humor on Intermediate-Term Trabeculectomy Outcomes. J Ophthalmol 2016; 2016:2401976. [PMID: 26904271 PMCID: PMC4745626 DOI: 10.1155/2016/2401976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 12/15/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To investigate whether increased concentrations of ET-1 in aqueous humor of glaucoma patients influences surgical outcome of standard trabeculectomy with Mitomycin C. Methods. Retrospective chart review of 36 glaucoma patients with known ET-1 concentrations who had undergone trabeculectomy with Mitomycin C. Patients were divided into two groups based on their aqueous ET-1 concentration, a below-median (low ET-1) and an above-median (high ET-1) group. Postoperative IOP development, necessity of glaucoma medication, surgical success and complications, postoperative use of antifibrotics (5-FU), and number of additional glaucoma surgeries were compared between the groups. Results. Overall surgical success of trabeculectomy was comparable to published literature (90%, 81%, 76%, and 68% absolute success at 12, 24, 36, and 48 months after surgery). There was no difference between high and low ET-1 group in the postsurgical development of IOP, surgical success rate, or complication rate. There was no difference in postoperative scarring or indirect indicators thereof (e.g., number of 5-FU injections, needlings, suture lyses, or IOP lowering medications). Conclusion. In this set of patients, ET-1 in aqueous humor does not appear to have influenced surgical outcome of trabeculectomy with Mitomycin C. There is no indication of an increased likelihood of bleb fibrosis in patients with increased ET-1 concentrations.
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