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Prinz J, Fuest M, Kuerten D, Walter P, Cursiefen C, Prokosch V. Factors influencing the outcomes of trabeculectomy, conventional canaloplasty, and mitomycin C augmented canaloplasty. Graefes Arch Clin Exp Ophthalmol 2025; 263:807-817. [PMID: 39460785 PMCID: PMC11953112 DOI: 10.1007/s00417-024-06656-x] [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: 07/01/2024] [Revised: 08/22/2024] [Accepted: 09/27/2024] [Indexed: 10/28/2024] Open
Abstract
PURPOSE To compare the efficacy, safety, and factors influencing the outcomes of trabeculectomy (TE), conventional canaloplasty (cCP), and mitomycin C augmented canaloplasty (mCP) in glaucoma patients. METHODS Intraocular pressure (IOP), the number of IOP-lowering eye drops, and surgery-related complications were evaluated at baseline and through 18 months postoperatively. Correlations between patients' demographic data, ophthalmic and non-ophthalmic conditions, outcomes and complications were evaluated. RESULTS 171 patients were included. IOP and IOP-lowering eye drops were significantly (p < 0.001) reduced 18 months after TE, cCP, and mCP. At the 18-month follow-up, IOP and IOP-lowering eye drops were significantly lower following TE than cCP (p < 0.001, p = 0.010, respectively) and mCP (p = 0.010, p = 0.014). At the 18-month follow-up, complete success rates were significantly higher after TE compared to cCP and mCP for IOP ≤ 21, 18, and 16 mmHg (p < 0.001). Qualified success rates for IOP ≤ 16 mmHg were higher following TE than cCP and mCP (p = 0.023). In the TE group, clinical hypotony at any postoperative follow-up was positively correlated with previous intravitreal anti-vascular endothelial growth factor (VEGF)-therapy (p < 0.001), leukaemia (p = 0.002), and a spherical equivalent < -3 dioptres (p < 0.001). There were no significant correlations in the cCP and mCP groups. CONCLUSION TE, cCP, and mCP led to a significant reduction in IOP and IOP-lowering eye drops during 18 months of follow-up. At 18 months of follow-up, IOP and IOP-lowering eye drops were significantly lower following TE compared to cCP and mCP. Anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment in the TE group. KEY MESSAGES What is known • Trabeculectomy (TE) is considered the gold standard in the surgical management of glaucoma. However, TE involves extensive postoperative management and might be associated with severe surgery-related complications. What is new • In this study, intraocular pressure (IOP) and IOP-lowering eye drops were significantly lower following TE compared to conventional canaloplasty (cCP) and mitomycin C augmented canaloplasty (mCP) at a follow-up of 18 months. • In patients undergoing TE, anti-VEGF-therapy, cystostatic therapy in leukaemia, and a spherical equivalent < -3 dioptres were significantly correlated with postoperative hypotony, macular folds, and choroidal detachment.
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Affiliation(s)
- Julia Prinz
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, 50937, Cologne, Germany
- Department of Ophthalmology, RWTH Aachen University, 52074, Aachen, Germany
| | - Matthias Fuest
- Department of Ophthalmology, RWTH Aachen University, 52074, Aachen, Germany
| | - David Kuerten
- Department of Ophthalmology, RWTH Aachen University, 52074, Aachen, Germany
| | - Peter Walter
- Department of Ophthalmology, RWTH Aachen University, 52074, Aachen, Germany
| | - Claus Cursiefen
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, 50937, Cologne, Germany
| | - Verena Prokosch
- Department of Ophthalmology, Faculty of Medicine and University Hospital of Cologne, 50937, Cologne, Germany.
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Yadgari M, Hassanpour K, Vafaei F, Firoozian N, Yazdani MO, Khorrami Z, Hooshmandi S. Sequential Serous Choroidal Detachment in Subjects Undergoing Bilateral Trabeculectomy. J Ophthalmic Vis Res 2024; 19:421-432. [PMID: 39917457 PMCID: PMC11795004 DOI: 10.18502/jovr.v19i4.13881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/24/2024] [Indexed: 02/09/2025] Open
Abstract
Purpose This study aims to assess the incidence of serous choroidal detachment (SCD) in the second eye of patients undergoing bilateral trabeculectomy (BT) and evaluate its impact on the clinical outcomes and failure rate of trabeculectomy in the second-operated eyes. Methods This retrospective case-control study analyzed 90 eyes of 45 patients who underwent BT. Surgical success was defined as maintaining intraocular pressure (IOP) between 5 and 21 mmHg, requiring no additional glaucoma surgery, and exhibiting a visual acuity of at least light perception. Relevant patient data, such as age, glaucoma type, systemic diseases, preoperative and postoperative IOP, and complications, were extracted from medical records. Results The mean age of patients was 59.8 ± 11.1 years. The five-year cumulative probability of success in the first- and second-operated eyes was 61.0% and 67.6%, respectively (log rank = 0.085, P = 0.77). Among the participants, 28.9% experienced SCD, and 76.9% of those who had SCD in the first-operated eye developed the same condition in the second eye as well (P < 0.001). In the first-operated eyes, the five-year cumulative probability of survival was 71.7% without SCD and 35.0% with SCD (log rank = 2.59, P = 0.107). Conclusion The occurrence of SCD in the first eye following trabeculectomy may indicate a predisposition to its development in the second eye during BT. Furthermore, the surgical success rate of the second-operated eye is comparable to the outcomes of the first eye undergoing BT.
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Affiliation(s)
- Maryam Yadgari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Vafaei
- Basir Eye Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nina Firoozian
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Oraee Yazdani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Khorrami
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadid Hooshmandi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ansari E. Five-year outcomes of ab interno Xen 45 gel stent implantation. Graefes Arch Clin Exp Ophthalmol 2024; 262:1263-1269. [PMID: 37955701 DOI: 10.1007/s00417-023-06294-9] [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] [Received: 01/07/2023] [Revised: 08/06/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND To assess the safety and 5-year efficacy of ab interno XEN 45 gel stent implantation with phacoemulsification in primary open-angle glaucoma (POAG). METHODS Single-centre, single-surgeon, retrospective case note review of consecutive OAG patients who underwent ab-interno gel stent placement combined with phacoemulsification. Surgeries were performed between 2/01/2014 and 2/01/2016. PRIMARY OUTCOME MEASURES mean reduction in intraocular pressure (IOP) and change in number of ocular hypotensive medications from baseline (follow-up range 1-7 years; mean 54 months). SECONDARY OUTCOME MEASURE change in visual field mean deviation (VFMD) from baseline. Safety data included intraoperative and post-operative complications and adverse events. Failure was defined by IOP reduction < 20% despite maximum medical therapy, the need for further laser or surgical intervention. At 5 years, 75% of eyes were free from failure (95% CI 64 to 83%). RESULTS Ninety-one eyes were analysed. Mean (SD) IOP and medications decreased from 20.2 (6.4) mmHg and 2.9 (1.0) at baseline to 15.4 (3.6) mmHg (p < 0.001) and 1.5 (1.4) medications at 5 (p < 0.001) years. Baseline mean VFMD (SD) was - 10.3dB (8.5) reducing to - 10.9(8.2) (p < 0.01) at 5 years. Two (2%) eyes had intraoperative complications, 4 (4.3%) experienced post-operative AEs, and 13 (14%) required secondary surgical intervention (SSI). CONCLUSION The gel stent combined with phacoemulsification was effective in reducing IOP and medications over 5 years, with an acceptable safety profile. Visual field change was clinically acceptable through the study period.
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Affiliation(s)
- Ejaz Ansari
- Maidstone & Tunbridge Wells Hospitals, Kent, UK.
- Institute of Medical Sciences, Canterbury Christ Church University, Kent, UK.
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Strzalkowska A, Hoffmann EM, Strzalkowski P, Stingl JV, Pfeiffer N, Schuster AK. [Real-world outcomes of glaucoma surgical procedures for open-angle glaucoma]. DIE OPHTHALMOLOGIE 2023; 120:1107-1116. [PMID: 37880486 DOI: 10.1007/s00347-023-01941-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/27/2023]
Abstract
This article provides an overview of real-world outcomes in glaucoma surgical procedures. While randomized clinical trials provide valuable insights, they do not fully reflect real-world clinical practice. Real-world studies enable the evaluation of outcomes in uncontrolled settings and play a crucial role in counselling and decision-making for glaucoma treatment. By examining real-world data the article aims to identify rare adverse events that may go unnoticed in controlled clinical trials. The focus is on assessing the effectiveness and safety of glaucoma surgical procedures beyond the controlled trial setting.
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Affiliation(s)
- Alicja Strzalkowska
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - Esther M Hoffmann
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | | | - Julia V Stingl
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Norbert Pfeiffer
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Alexander K Schuster
- Augenklinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Remky A, Plange N. [Is mitomycin C always necessary as an adjuvant to trabeculectomy?]. DIE OPHTHALMOLOGIE 2023; 120:1063-1064. [PMID: 37682328 DOI: 10.1007/s00347-023-01915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Andreas Remky
- Augenklinik Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - Niklas Plange
- Augenzentrum am Annapark, 52477, Alsdorf, Deutschland
- Klinik für Augenheilkunde, Uniklinik der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
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XEN® implantation: an effective strategy to stop glaucoma progression despite prior minimally invasive glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2022; 261:1063-1072. [PMID: 36305910 PMCID: PMC9614765 DOI: 10.1007/s00417-022-05872-7] [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] [Received: 05/26/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The aim of this study was to evaluate whether XEN® implantation is a reasonable and safe method to lower the intraocular pressure (IOP) and amount of medication for adult primary open-angle glaucoma (POAG) over a 3-year period. The influence of the type of anesthesia, previous glaucoma surgery, and postoperative interventions on the outcome were examined. Methods In this retrospective study, 96 eyes were included. XEN® implantation was performed as sole procedure under general (n = 86) or local anesthesia (n = 10). IOP and number of glaucoma medication were assessed preoperatively: day 1, week 6, month 3, 6, 12, 24, and 36. Further outcome parameters were Kaplan–Meier success rates, secondary intervention, and complication rates. Results IOP decreased from 20.7 ± 5.1 to 12.8 ± 2.5 mmHg at the 36-month follow-up (p < 0.001) and glaucoma therapy was reduced from 3.3 ± 0.8 to 1.2 ± 1.6 (36 months, p < 0.001). Transient postoperative hypotony was documented in 26 eyes (27.1%). General anesthesia resulted in a significant improvement of the survival rate compared to local anesthesia (77% vs. 50%, p = 0.044). Prior iStent inject®, Trabectome®, or SLT laser had no significant impact, such as filter bleb revision. The number of postoperative needlings had a significantly negative influence (p = 0.012). Conclusion XEN® implantation effectively and significantly lowers the IOP and number of glaucoma therapy in POAG in the 36-month follow-up with a favorable profile of side effects and few complications. In case of IOP, general anesthesia has a significant positive influence on the survival rate, whereas prior SLT or MIGS does not have significant impact.
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Lanza M, Leone A, Scognamiglio G, Serra L, Iodice CM, Melillo P, Simonelli F. Evaluation of the Efficacy Duration of Topical Therapies in Eyes with Primary Open-Angle Glaucoma. J Clin Med 2022; 11:jcm11206166. [PMID: 36294484 PMCID: PMC9605467 DOI: 10.3390/jcm11206166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/09/2022] [Accepted: 10/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: To investigate the efficacy interval of the topical therapies available for primary open-angle glaucoma (POAG) and the ocular and systemic features potentially associated. Methods: This retrospective study included 190 patients with POAG undergoing first topical therapy, throughout a follow-up of 15 years. The patients started one topical intraocular pressure (IOP)-lowering drug within single molecules such betablockers, prostaglandin or dorzolamide, or fixed combinations such as betablockers + prostaglandin, betablockers + dorzolamide, or betablockers + brimonidine. Efficacy duration was measured as the time between the start of the therapy and the change due to IOP increase or visual field worsening. For each patient, ocular and systemic features and comorbidities were analysed to detect any significant correlation with the length of effectiveness of every drug used. Results: The molecules explored showed some discrepancies in terms of mean duration of efficacy; however, no significant differences were demonstrated (p > 0.05). Furthermore, when evaluating the overall cohort, no systemic or ocular features correlated significantly with the effectiveness of the molecules explored. However, the same analysis carried out upon stratifying the different groups according to the IOP-lowering drops they received, demonstrated that the drug efficacy could be influenced by several ocular and systemic features. Conclusion: Data observed in this study suggest that there is no difference in using one of the medications evaluated as first choice of treatment of POAG if the patients are accurately evaluated and the most recent guidelines are adopted.
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Bleeker AR, Litchfield WR, Ibach MJ, Greenwood MD, Ristvedt D, Berdahl JP, Terveen DC. Short-Term Efficacy of Combined ab Interno Canaloplasty and Trabeculotomy in Pseudophakic Eyes with Open-Angle Glaucoma. Clin Ophthalmol 2022; 16:2295-2303. [PMID: 35903750 PMCID: PMC9317358 DOI: 10.2147/opth.s367896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Adam R Bleeker
- Dean McGee Eye Institute, Oklahoma City, OK, USA
- Correspondence: Adam R Bleeker, Dean McGee Eye Institute – Oklahoma Health Center, 608 Stanton L Young Blvd, Oklahoma City, OK, 73104, USA, Tel +1 605-630-9023, Email
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Pivotal studies in glaucoma in the past 10 years. DIE OPHTHALMOLOGIE 2022; 119:137-139. [PMID: 34669019 DOI: 10.1007/s00347-021-01523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 01/25/2023]
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Lanza M, Sbordone S, Tortori A, Gironi Carnevale UA, Melillo P, Simonelli F. Evaluating Intraocular Pressure After Myopic Photorefractive Keratectomy: A Comparison of Different Tonometers. J Glaucoma 2022; 31:406-412. [PMID: 35394466 DOI: 10.1097/ijg.0000000000002023] [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: 02/08/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Abstract
PRCIS All devices evaluated in this study showed a significant underestimation in intraocular pressure (IOP) measurement after myopic photorefractive keratectomy (PRK), Goldmann tonometer more than others. Corneal biomechanics indicated a different influence on the different kinds of tonometry. PURPOSE The aim was to investigate the reliability of Goldmann applanation tonometry (GAT), rebound tonometry (RT), ocular response analyzer (ORA), Corvis ST (CST), and dynamic contour tonometry (DCT) in IOP evaluation after myopic PRK. MATERIALS AND METHODS One eye of 145 patients who underwent myopic PRK for a refractive defect ranging from -10.25 to -0.50 D (mean -4.69±2.00 D) was included in this retrospective comparative study. A complete eye visit with corneal tomography and IOP measurement with GAT, DCT, ORA, RT, and CST was performed before surgery and at 1, 3, and 6 months follow-up. Values provided by each device were tested and compared at each follow-up. Correlation analyses were run between changes in IOP and the corneal, morphologic and biomechanical parameters were measured after PRK. RESULTS GAT, DCT, ORA, RT, and CST showed a significant (P<0.01) underestimation of IOP at 6 months follow-up. GAT showed the greatest underestimation (-14.1%) and stronger correlations with corneal deformation parameter changes, whereas ORA, DCT, and RT appeared to be less conditioned by these variations. At 6 months follow-up DCT, ORA, RT, and CST provided IOP values with nonsignificant differences compared with GAT before PRK. CONCLUSIONS Each tested tonometer showed a significant IOP underestimation after myopic PRK. As this was most observed with GAT compared with all devices, we suggest DCT, ORA, RT, or CST to evaluate IOP in these patients following surgery.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Campania University "Luigi Vanvitelli", Naples, Italy
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Dias DT, Almeida I, Ushida M, Lopes FS, Kanadani FN, Gracitelli CPB, Prata TS. Subtenon triamcinolone as an adjuvant in mitomycin-C-enhanced trabeculectomy in non-inflammatory glaucomas: A randomized clinical trial. PLoS One 2022; 17:e0268623. [PMID: 35617211 PMCID: PMC9135266 DOI: 10.1371/journal.pone.0268623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP ≤ 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.
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Affiliation(s)
- Diego T. Dias
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Department, Hospital de Olhos de Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | - Izabela Almeida
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Michele Ushida
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
| | - Flavio S. Lopes
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Fábio N. Kanadani
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Tiago S. Prata
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, São Paulo, Brazil
- Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, São Paulo, Brazil
- Department of Ophthalmology, Hospital Oftalmológico de Sorocaba, Sorocaba, São Paulo, Brazil
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Hüppi R, Wagels B, Todorova M. Two-Year Outcome of Surgery in Glaucoma Patients. Klin Monbl Augenheilkd 2022; 239:435-442. [PMID: 35320867 DOI: 10.1055/a-1766-7320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the 2-year surgical treatment outcome in glaucoma patients. METHODS A retrospective, single-center, interventional study was performed on 160 eyes of 125 patients suffering glaucoma, including POAG (82 eyes), pseudoexfoliation (PEX) (59 eyes), pigment dispersion (8 eyes), and secondary glaucoma (2 eyes). Eyes with uncontrolled intraocular pressure (IOP) or signs of glaucoma progression despite medical treatment were included to undergo either trabeculectomy (TE), XEN implantation, combined TE with phacoemulsification (TE + IOL), or XEN implantation with phacoemulsification surgery (XEN + IOL). Primary efficacy outcome was the mean IOP reduction. Secondary outcome was the mean reduction in the number of medications. The data were compared at baseline vs.1 day, 1 week, and 1, 3, 6, 12, and 24 months following surgery. For statistical evaluation, ANOVA-based linear mixed-effects models were performed with SPSS. RESULTS The mean IOP reduction in a 2-year follow-up was 30.31% (22.17 vs. 15.45 mmHg, p < 0.001). The mean number of antiglaucoma medications was reduced from 2.87 to 0.58 (p = 0.001), where TE alone or combined surgeries seemed to be more effective than isolated XEN surgery. Transient IOP hypotony on the first postoperative day occurred in PEX patients following TE surgery (p = 0.024). At 6 months, PEX patients with isolated XEN surgery showed a transient IOP increase, whereas those after combined TE + IOL surgery showed the lowest IOP within the PEX group compared to other glaucoma patients (p < 0.026). CONCLUSIONS After 2 years, all performed glaucoma surgeries achieved a significant reduction in IOP and the number of antiglaucoma medications.
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Affiliation(s)
- Roger Hüppi
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Barbara Wagels
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Margarita Todorova
- Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Department of Ophthalmology, University of Basel, Basel, Switzerland.,University of Zürich, Zürich, Switzerland
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Wirta DL, Kuwayama Y, Lu F, Shao H, Odani-Kawabata N. Phase 2b, Randomized, 3-Month, Dose-Finding Study of Sepetaprost in Patients with Primary Open-Angle Glaucoma or Ocular Hypertension: The ANGEL Study. J Ocul Pharmacol Ther 2022; 38:240-251. [PMID: 35167779 PMCID: PMC9048176 DOI: 10.1089/jop.2021.0077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose: This phase 2b, randomized, observer-masked, placebo- and active-controlled, parallel-group, multinational (USA and Japan), multicenter study (NCT03216902) assessed the optimal dose of sepetaprost ophthalmic solution in patients with primary open-angle glaucoma or ocular hypertension. Methods: After washout, patients ≥18 years (USA) or ≥20 years of age (Japan) received once-daily sepetaprost for 3 months [0.0005% (n = 43); 0.001% (n = 43); 0.002% (n = 44); and 0.003% (n = 45)], latanoprost 0.005% (n = 44) or placebo until week 6, followed by sepetaprost 0.003% until month 3 (n = 22). Safety assessments included adverse event (AE) occurrence. Results: Baseline mean diurnal intraocular pressure (IOP) was 24.3 mmHg for latanoprost and ranged between 24.1 and 24.5 mmHg for the sepetaprost groups. Sepetaprost 0.002% had the lowest IOP at each month 3 time point (9:00 AM; 1:00 PM; 5:00 PM) of all sepetaprost concentrations (mean ± standard error: 17.6 ± 0.5; 17.4 ± 0.4; 16.7 ± 0.4 mmHg); similar values were observed with latanoprost (18.1 ± 0.6; 17.3 ± 0.5; 17.2 ± 0.5 mmHg). A positive dose–response relationship was observed with the 3 lower sepetaprost doses; sepetaprost 0.002% had numerically greater IOP-lowering effects than sepetaprost 0.003%. All sepetaprost doses had statistically significantly greater IOP reductions from baseline versus placebo at week 6 (P < 0.0001). This IOP-lowering effect was consistent between Japan- and USA-based patients. Most AEs were mild and occurred numerically less frequently with sepetaprost 0.002% (34.1%) versus latanoprost (50.0%). The most frequently reported AE was conjunctival hyperemia. Conclusion: In this study, sepetaprost 0.002% was the optimal concentration, showing comparable IOP-lowering efficacy and safety with latanoprost 0.005%. Most AEs were mild; occurrence was numerically lower with sepetaprost 0.002% than latanoprost 0.005%.
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Affiliation(s)
- David L Wirta
- Eye Research Foundation, Newport Beach, California, USA
| | | | - Fenghe Lu
- Product Development Division (FHL, HS), Santen, Inc., Emeryville, California, USA
| | - Hui Shao
- Product Development Division (FHL, HS), Santen, Inc., Emeryville, California, USA
| | - Noriko Odani-Kawabata
- Product Development Division (FHL, HS), Santen, Inc., Emeryville, California, USA.,Product Development Division (NOK), Santen Pharmaceutical Co., Ltd., Osaka, Japan
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14
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Mercieca K. [Pivotal studies in glaucoma in the last 10 years]. Ophthalmologe 2021; 118:1208-1210. [PMID: 34731277 DOI: 10.1007/s00347-021-01522-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Karl Mercieca
- Augenklinik, Universitätsklinikum Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland.
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15
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Wan-Ezatul-Arisha WM, Diana-Toh SJ, Huwaina AS, Najib MY, Azhany Y, Norsa'adah B, Liza-Sharmini AT. Visual field progression in Malay patients with primary glaucoma: survival analysis and prognostic factors. Graefes Arch Clin Exp Ophthalmol 2021; 260:2003-2012. [PMID: 34724110 DOI: 10.1007/s00417-021-05466-9] [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: 08/24/2021] [Revised: 10/05/2021] [Accepted: 10/15/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma. METHODS A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp-Parrish-Anderson scores. Kaplan-Meier survival and Cox proportional hazard regression analyses were performed. RESULTS Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively. CONCLUSION The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.
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Affiliation(s)
- Wan Masri Wan-Ezatul-Arisha
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Shi Jin Diana-Toh
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Abdul Satar Huwaina
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Majdi Yaakob Najib
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Yaakub Azhany
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Bachok Norsa'adah
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Ahmad Tajudin Liza-Sharmini
- Department of Ophthalmology and Visual Science, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia. .,Eye Clinic, Hospital Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
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16
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Kortuem C, Dietter J, Bozkurt Y, Kortuem FC, Abaza A, Wahl S, Ivanov IV, Ueffing M, Voykov B. Vessel Evaluation in Patients with Primary Open-Angle Glaucoma, Normal Tension Glaucoma and Healthy Controls. Clin Ophthalmol 2021; 15:4269-4280. [PMID: 34707346 PMCID: PMC8544789 DOI: 10.2147/opth.s320505] [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] [Received: 05/20/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare changes in central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE), arteriovenous ratio (AVR), tortuosity and fractal dimension in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and in a control group (CG) on fundus photographs. Further, to provide further evidence of vascular change in glaucoma patients using a novel method of tortuosity. Patients and Methods The primary endpoint was the change in CRAE, CRVE, AVR, fractal dimension and tortuosity of the retinal vasculature from baseline, retrospectively analyzed from 2011 to 2017 at the University Eye Hospital Tuebingen. Fundus photos of POAG (N = 49), NTG (N = 38) and CG (N = 18) were computer evaluated and analyzed in the quantities mentioned above. Results CRAE in NTG and POAG and CRVE in NTG significantly decreased (P = 0.02, P = 0.01; P = 0.03) whereas CRVE in POAG increased insignificantly (P = 0.72). In NTG, AVR decreased significantly (P = 0.05), but to a lesser extent than in POAG (P < 0.001). In CG, CRAE decreased insignificantly (P = 0.10), CRVE decreased significantly (P = 0.03) and AVR increased insignificantly (P = 0.77). In POAG tortuosity calculated using standard methods as well as our novel method, increased significantly (P = 0.015-0.04), whereas it did not occur in NTG (P = 0.18-0.57) and CG (P = 0.11-0.21). Fractal dimensions in POAG decreased significantly (P = 0.001-0.002), whereas in NTG and CG changes were insignificant (P = 0.33-0.92). Conclusion Based on a retrospective analysis of fundus photographs, specific retinal vasculature features of the retinal vasculature display significant alterations associated with NTG and POAG. The assessment of tortuosity using our novel method was consistent with previously established methods for analyzing tortuosity.
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Affiliation(s)
- Constanze Kortuem
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Dietter
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Yagmur Bozkurt
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | | | - Annegret Abaza
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Siegfried Wahl
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Iliya V Ivanov
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany.,Carl Zeiss Vision International GmbH, Aalen, Germany
| | - Marius Ueffing
- Department of Ophthalmology, Institute for Ophthalmic Research University of Tuebingen, Tuebingen, Germany
| | - Bogomil Voykov
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University Tuebingen, Tuebingen, Germany
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17
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Yohannan J, Boland MV, Ramulu P. The Association Between Intraocular Pressure and Visual Field Worsening in Treated Glaucoma Patients. J Glaucoma 2021; 30:759-768. [PMID: 34172633 PMCID: PMC8797543 DOI: 10.1097/ijg.0000000000001906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022]
Abstract
PRECIS In treated eyes with mild/suspect glaucoma, intraocular pressure (IOP) increments are associated with worsening mean deviation (MD) once IOP reaches the 20s. In moderate/advanced eyes, IOP increments are associated with worse visual field (VF) performance across the entire IOP range. PURPOSE The purpose of this study was to describe the relationship between mean treated IOP and VF worsening and understand how this relationship is affected by glaucoma severity and IOP range. METHODS A total of 1446 eyes of 869 treated glaucoma patients with at least 5 longitudinal reliable VF tests and IOP measures were included. Mixed-effects linear models were employed to understand the effect of eye-specific mean treated IOP on MD slope. Models included interaction terms to assess the differing relationships between MD slope and mean IOP by glaucoma severity (suspect/mild vs. moderate/advanced) and splines to account for the differing effects of mean IOP on MD slope at different IOP ranges (above or below 21 mm Hg). RESULTS In suspect/mild glaucoma, when treated IOP values were <21 mm Hg, a 1 mm Hg increment in IOP was not associated with an increase in the rate of VF worsening (P>0.05) but when treated IOP values rose >21 mm Hg, a 1 mm Hg increment in IOP was associated with faster VF worsening (-0.09 dB/y per 1 mm Hg increment, P<0.05). In moderate/advanced disease, a 1 mm Hg increment in treated IOP was associated with faster VF worsening both below and above 21 mm Hg, but the effect was much more pronounced in the higher range (-0.02 dB/y per mm Hg increment <21 mm Hg vs. -0.74 dB/y per mm Hg increment >21 mm Hg, P<0.05 for both). CONCLUSION IOP remained associated with VF worsening in eyes with more advanced glaucoma throughout the IOP range but was only associated with VF worsening in eyes with less severe glaucoma at higher IOP.
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Affiliation(s)
- Jithin Yohannan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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18
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Fontana L, De Maria M, Caristia A, Mastrofilippo V, Braglia L, Iannetta D, Scarale GP. Comparison of Gonioscopy-assisted Transluminal Trabeculotomy Versus Trabeculectomy With Mitomycin C in Patients With Open-angle Glaucoma. J Glaucoma 2021; 30:101-108. [PMID: 33031187 DOI: 10.1097/ijg.0000000000001696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022]
Abstract
PRCIS Trabeculectomy (TRAB) lowers the intraocular pressure (IOP) more than gonioscopy-assisted transluminal trabeculotomy (GATT) at 18 months, with a reduction in IOP of 30% or more and a significant reduction in the number of glaucoma medications compared with baseline. PURPOSE To compare the IOP-lowering efficacy of GATT with mitomycin-C augmented TRAB in patients with uncontrolled open-angle glaucoma. METHODS Single-center, retrospective, comparative cohort study. One hundred ten consecutive patients (110 eyes) underwent GATT (n=61) or TRAB (n=49). The primary outcome measure was IOP reduction, defined as a percentage decrease ≥30% and absolute IOP≤18 mm Hg at 18 months with (qualified) or without (complete) medications. Secondary outcomes were visual field change, number of glaucoma medications, complications, and reintervention. RESULTS The mean±SD baseline IOP was 30.04±7.5 and 27.59±4.70 (P=0.072) with the mean number of medications of 3.08±0.73 and 2.92±0.91 (P=0.310) in TRAB and GATT, respectively. At 18 months, the mean±SD IOP was 15.26±3.47 mm Hg and 12.48±4.58 mm Hg after GATT and TRAB, respectively (P=0.002). The percentage of IOP lowering from baseline was 56.05±17.72 after TRAB and 42.04±15.56 after GATT (P<0.001). Percentages of complete and qualified success were 59% and 27% after TRAB and 46% and 31% after GATT (P=0.353). No change in visual field loss was observed in both groups. The mean reduction in medications was 2.3±1.4 and 2.1±1.5 in TRAB and GATT, respectively (P=0.493). The most frequent complication after TRAB was hypotony and after GATT hyphema. Reintervention occurred in 8.2% of cases after TRAB and in 14.8% after GATT (P=0.341). CONCLUSIONS IOP lowering was greater after TRAB than after GATT at 18 months with a significant reduction in the number of medications after both procedures. Complications and reintervention occurred equally in both groups but differed in type.
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Affiliation(s)
| | - Michele De Maria
- Ophthalmology Unit, AUSL-IRCCS di Reggio Emilia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Luca Braglia
- Clinical Trials and Statistics Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia
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19
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Dixit A, Ashish A, Sharma R. A comparative study on efficacy of fixed combination timolol/brinzolamide versus travoprost monotherapy in drug-naïve open-angle glaucoma patients. Ther Adv Ophthalmol 2020; 12:2515841420909666. [PMID: 32440640 PMCID: PMC7227157 DOI: 10.1177/2515841420909666] [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] [Received: 03/01/2019] [Accepted: 01/24/2020] [Indexed: 10/26/2022] Open
Abstract
Background Glaucoma is most common irreversible cause of blindness in India. First line management of open-angle glaucoma is either beta blockers or prostaglandin analogs monotherapy. Monotherapy rarely achieves target intraocular pressure within 2 years and patients are shifted to combination medications, usually fixed-dose combination. Objective To compare travoprost monotherapy and timolol/brinzolamide fixed-dose combination for their intraocular pressure lowering efficacy, their effects on hemodynamic parameters and cup disc ratio reversibility in newly diagnosed drug-naïve open-angle glaucoma patients. Material and methods In a 12-week, prospective, randomised, single-blind study, patients were randomised to receive twice daily 0.5% timolol and 0.2% brinzolamide fixed-dose combination (n = 52) or once daily travoprost 0.004% (n = 52). Intraocular pressure, blood pressure, pulse rate and cup disc ratio were compared across treatment groups over 3 months. Results Significant reduction (p < 0.001) in intraocular pressure by 27.99% and 30.49% at 12th-week visit as compared with baseline was observed in monotherapy and fixed-dose combination group, respectively. Significant changes in pulse rate (9 beats/min) and systolic blood pressure (2.35 mmHg) was observed in fixed-dose combination group. No cup disc ratio reversibility was observed at the end of study. Conjunctival hyperaemia (n = 14) and transient blurring of vision (n = 16) were most commonly reported adverse drug reaction in monotherapy and fixed-dose combination, respectively. Conclusion The 0.5% timolol and 0.2% brinzolamide fixed-dose combination produced greater reduction in intraocular pressure than those produced by 0.004% travoprost alone in drug-naïve open-angle glaucoma patients.
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Affiliation(s)
- Alok Dixit
- Department of Pharmacology, Uttar Pradesh University of Medical Sciences, Saifai, India
| | - Atul Ashish
- Department of Pharmacology, Uttar Pradesh University of Medical Sciences, Saifai 206130, Etawah, Uttar Pradesh, India
| | - Reena Sharma
- Department of Ophthalmology, Uttar Pradesh University of Medical Sciences, Saifai, India
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20
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Qassim A, Walland MJ, Landers J, Awadalla M, Nguyen T, Loh J, Schulz AM, Ridge B, Galanopoulos A, Agar A, Hewitt AW, Graham SL, Healey PR, Casson RJ, Craig JE. Effect of phacoemulsification cataract surgery on intraocular pressure in early glaucoma: A prospective multi‐site study. Clin Exp Ophthalmol 2020; 48:442-449. [DOI: 10.1111/ceo.13724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/19/2020] [Accepted: 01/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Ayub Qassim
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Mark J. Walland
- Glaucoma Investigation and Research UnitRoyal Victorian Eye and Ear Hospital Melbourne Victoria Australia
| | - John Landers
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Mona Awadalla
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Thi Nguyen
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Jason Loh
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Angela M. Schulz
- Faculty of Medicine and Health SciencesMacquarie University Sydney New South Wales Australia
| | - Bronwyn Ridge
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
| | - Anna Galanopoulos
- South Australian Institute of OphthalmologyRoyal Adelaide Hospital Adelaide New South Wales Australia
| | - Ashish Agar
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Alex W. Hewitt
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Stuart L. Graham
- Faculty of Medicine and Health SciencesMacquarie University Sydney New South Wales Australia
| | - Paul R. Healey
- Centre for Vision ResearchWestmead Institute for Medical Research, University of Sydney Sydney New South Wales Australia
| | - Robert J. Casson
- South Australian Institute of OphthalmologyUniversity of Adelaide Adelaide South Australia Australia
| | - Jamie E. Craig
- Department of OphthalmologyFlinders University, Flinders Medical Centre Adelaide South Australia Australia
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21
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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: 3] [Impact Index Per Article: 0.5] [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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22
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Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol 2019; 257:983-996. [PMID: 30758653 DOI: 10.1007/s00417-019-04251-z] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/09/2019] [Accepted: 01/11/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of an ab interno subconjunctival gelatin implant as primary surgical intervention in reducing intraocular pressure (IOP) and IOP-lowering medication count in medically uncontrolled moderate primary open-angle glaucoma (POAG). METHODS In this prospective, non-randomized, open-label, multicenter, 2-year study, eyes with medicated baseline IOP 18-33 mmHg on 1-4 topical medications were implanted with (phaco + implant) or without (implant alone) phacoemulsification. Changes in mean IOP and medication count at months 12 (primary outcomes) and 24, clinical success rate (eyes [%] achieving ≥ 20% IOP reduction from baseline on the same or fewer medications without glaucoma-related secondary surgical intervention), intraoperative complications, and postoperative adverse events were assessed. RESULTS The modified intent-to-treat population included 202 eyes (of 218 implanted). Changes (standard deviation) in mean IOP and medication count from baseline were - 6.5 (5.3) mmHg and - 1.7 (1.3) at month 12 and - 6.2 (4.9) mmHg and - 1.5 (1.4) at month 24, respectively (all P < 0.001). Mean medicated baseline IOP was reduced from 21.4 (3.6) to 14.9 (4.5) mmHg at 12 months and 15.2 (4.2) mmHg at 24 months, with similar results in both treatment groups. The clinical success rate was 67.6% at 12 months and 65.8% at 24 months. Overall, 51.1 (12 months) and 44.7% (24 months) of eyes were medication-free. The implant safety profile compared favorably with that published for trabeculectomy and tube shunts. CONCLUSIONS The gelatin implant effectively reduced IOP and medication needs over 2 years in POAG uncontrolled medically, with an acceptable safety profile. ClinicalTrials.gov registration number: NCT02006693 (registered in the USA).
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24
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Genaidy MM, Zein HA, Eid AM. Combined phacocanaloplasty for open-angle glaucoma and cataract: 12 months results. Clin Ophthalmol 2017; 11:2169-2176. [PMID: 29263645 PMCID: PMC5726364 DOI: 10.2147/opth.s143756] [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] [Indexed: 11/23/2022] Open
Abstract
Purpose of the study To evaluate efficacy, safety, and success rates of canaloplasty combined with phacoemulsification and intraocular lens implantation in patients with open-angle glaucoma (OAG) and visually significant cataract. Patients and methods A prospective interventional noncomparative case series carried out in Minia University Hospital from April 2015 to October 2016 on 20 eyes of 18 patients who had visually significant cataract and primary OAG. All the cases had combined phacocanaloplasty. Preoperative best-corrected visual acuity, intraocular pressure (IOP), and number of antiglaucoma medications were collected and compared to postoperative levels, and complications rates were recorded. Results 20 eyes of 18 patients (5 males and 15 females), with a mean age 57.6 years (range 48–69 years), underwent phacocanaloplasty. Preoperative mean IOP was 25.20 ±1.009 mmHg. Postoperative IOP decreased to a mean of 14.20±0.9, 14.85±0.8, and 15.85±0.7 mmHG at 3, 6, and 12 months, respectively, with 37% reduction from preoperative IOP level at one year follow-up visit (P=0.0005). The number of antiglaucoma medications dropped from mean of 1.55 preoperatively to 0.35 postoperatively. LogMAR of best-corrected visual acuity improved from 0.6950±0.07 preoperatively to 0.3670±0.056, 0.3460±0.056, and 0.03370±0.052 at 3, 6, and 12 months postoperatively (P=0.0005). Complications were limited to mild hyphemia (one case), mild corneal edema (one case), and mild inflammatory membrane (one case) that resolved in the first week after surgery. Conclusion Canaloplasty combined with clear corneal phacoemulsification and intraocular lens implantation may be a safe and effective procedure to lower IOP in adult patients with OAG and visually significant cataract.
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Affiliation(s)
| | - Hosny Ahmed Zein
- Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed Mostafa Eid
- Department of Ophthalmology, Faculty of Medicine, Minia University, Minia, Egypt
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25
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The Effects of Phacoemulsification on Intraocular Pressure and Topical Medication Use in Patients With Glaucoma: A Systematic Review and Meta-analysis of 3-Year Data. J Glaucoma 2017; 26:511-522. [PMID: 28333892 DOI: 10.1097/ijg.0000000000000643] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE For patients with comorbid cataract and primary open-angle glaucoma (POAG), guidance is lacking as to whether cataract extraction and traditional filtering surgery should be performed as a staged or combined procedure. Achieving this guidance requires an evidence-based understanding of the effects of phacoemulsification alone on intraocular pressure (IOP) in patients with POAG. For this reason, a systematic review and meta-analysis was undertaken to synthesize evidence quantifying the effect of phacoemulsification on IOP and the required number of topical glaucoma medications in patients with cataract and POAG. MATERIALS AND METHODS Database searches were last run on August 15, 2016 to identify potentially relevant studies. Identified articles were screened for relevance and meta-analysis was used to compute postoperative mean and percentage reduction in IOP (IOPR%) as well as mean difference in topical glaucoma medications. RESULTS The search strategy identified 1613 records. Thirty-two studies (1826 subjects) were included in quantitative synthesis. A 12%, 14%, 15%, and 9% reduction in IOP from baseline occurred 6, 12, 24, and 36 months after phacoemulsification. A mean reduction of 0.57, 0.47, 0.38, and 0.16 medications per patient of glaucoma medication occurred 6, 12, 24, and 36 months after phacoemulsification. CONCLUSIONS Phacoemulsification as a solo procedure does lower IOP in patients with POAG, and reduces dependency on topical glaucoma medications. These effects appear to last at least 36 months with gradual loss of the initial effect noted after 2 years. Certain populations appear to experience much greater reductions in IOP than others and future work to identify these high responding patients is needed.
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26
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Aptel F, Bron AM, Lachkar Y, Schweitzer C. Change in Visual Field Progression Following Treatment Escalation in Primary Open-angle Glaucoma. J Glaucoma 2017; 26:875-880. [PMID: 28834827 DOI: 10.1097/ijg.0000000000000748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the effect of treatment escalation on the rate of visual field progression in patients with primary open-angle glaucoma (POAG). PATIENTS AND METHODS Multicenter database study. We reviewed the electronic records of 171 patients with POAG under medical hypotensive treatment who underwent 5 consecutive visits 6 months apart before and after medical treatment escalation or additive laser trabeculoplasty. We calculated the rate of visual field progression (mean deviation change per year) before and after treatment escalation. RESULTS The mean duration of follow-up was 5.1±0.5 years and the mean number of visual field examinations was 10.2±0.2. In 139 eyes with medical treatment escalation, the rate of progression was significantly reduced [from -0.57 to -0.29 dB/y; P=0.022; intraocular pressure (IOP) reduction 11.1%]. In detail, the rate of progression was significantly reduced after escalation from mono to dual therapy, dual to triple therapy, and from mono to triple therapy (-0.35 to -0.24 dB/y, P=0.018; -1.01 to -0.48 dB/y, P=0.038; -1.04 to -0.35 dB/y, P=0.020, respectively). In 32 eyes with additive laser trabeculoplasty, the rate of progression was significantly reduced (-0.60 to -0.24 dB/y; P=0.014; IOP reduction 9.4%). CONCLUSIONS Medical treatment escalation or additive laser trabeculoplasty significantly reduced the rate of visual field progression in POAG. Larger IOP reduction has a greater probability of reducing glaucoma progression.
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Affiliation(s)
- Florent Aptel
- *Department of Ophthalmology, University Hospital of Grenoble, Grenoble †Department of Ophthalmology, University Hospital of Dijon, Dijon ‡Institut du Glaucome, Fondation Hôpital Saint-Joseph, Paris §Department of Ophthalmology, CHU Bordeaux ∥Bordeaux Population Health Research Center, Team LEHA, University Bordeaux, Inserm, Bordeaux, France
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Schehlein EM, Kaleem MA, Swamy R, Saeedi OJ. Microinvasive Glaucoma Surgery: An Evidence-Based Assessment. EXPERT REVIEW OF OPHTHALMOLOGY 2017; 12:331-343. [PMID: 30026790 DOI: 10.1080/17469899.2017.1335597] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Introduction The advent of Microinvasive Glaucoma Surgery (MIGS) offers a novel approach in the treatment of glaucoma with the number of procedures developing at an exciting pace. Areas Covered MIGS procedures aim to lower intraocular pressure (IOP) via four mechanisms: (1) increasing trabecular outflow, (2) increasing outflow via suprachoroidal shunts, (3) reducing aqueous production, and (4) subconjunctival filtration. A comprehensive search for published studies for each Microinvasive Glaucoma Surgery (MIGS) device or procedure was undertaken using the electronic database PubMed. Search terms included 'minimally invasive glaucoma surgery', 'microincisional glaucoma surgery', and 'microinvasive glaucoma surgery'. A manual search for each device or procedure was also performed. After review, randomized control trials and prospective studies were preferentially included. Expert Opinion These procedures offer several benefits: an improved safety profile allowing for intervention in earlier stages of glaucoma, combination with cataract surgery, and decreased dependence on patient compliance with topical agents. Established MIGS procedures have proven efficacy and more recent devices and procedures show promising results. Despite this, further study is needed to assess the long term IOP-lowering effectiveness of these procedures. Particularly, rigorous study with more randomized control trials and head-to-head comparisons would allow for better informed clinical and surgical decision-making. MIGS offers new solutions for glaucoma treatment.
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Affiliation(s)
- Emily M Schehlein
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Mona A Kaleem
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Ramya Swamy
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
| | - Osamah J Saeedi
- University of Maryland School of Medicine, Department of Ophthalmology and Visual Sciences, 419 W Redwood Street, Suite 420, Baltimore, MD 21201
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Wagdy FM. Canaloplasty versus Viscocanalostomy in Primary Open Angle Glaucoma. Electron Physician 2017; 9:3665-3671. [PMID: 28243422 PMCID: PMC5308510 DOI: 10.19082/3665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 08/17/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The purpose of this study was to compare the efficacy and safety of canaloplasty versus viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication. METHODS Canaloplasty surgery was applied for thirty eyes of thirty patients (45-55 years) with a mean age of 48 years (Group A) and viscocanalostomy surgery was applied also for thirty eyes of thirty patients (43-54 years) with a mean age of 46 years (group B). All patients were with uncontrolled primary open angle glaucoma by maximally tolerated medical therapy. RESULTS Intraocular pressure (IOP) in both surgeries was significantly reduced through follow up period (p < 0.0.001). Complete success was 86.6% in group A and 80% in group B. Visual field deterioration was in 2 cases (6%) in group A and in 4 cases (13%) in group B. Low incidence of postoperative complications was reported as Descemet's membrane detachment (3% in group A and 8% in group B), ocular hypotony (2% in group A and 4% in group B) and hyphema (3% in group A and 5% in group B). CONCLUSION Canaloplasty was more effective and safer than viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication.
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Abstract
PURPOSE To evaluate outcomes of trabeculectomy bleb needle revision with 5-fluorouracil augmentation performed in the operating theater. METHODS Retrospective study of all patients undergoing trabeculectomy bleb needle revisions in the operating theater performed by a single surgeon in a metropolitan hospital in Australia. A total of 51 needle revisions were performed on 33 eyes over a mean follow-up time of 1.81±1.56 years. RESULTS A total of 29% achieved intraocular pressure (IOP) ≤20 mm Hg off all glaucoma medications, and an additional 39% achieved qualified success with the addition of glaucoma medications, giving overall success of 68%. Analyzing success rate for target IOP≤16 mm Hg, 24% achieved target off all glaucoma medications, 35% achieved qualified success with the addition of glaucoma medications, giving an overall success rate of 59%. There was a statistically significant improvement in IOP, as compared with preoperative levels, at all timepoints postoperatively (P<0.05). However, number of glaucoma medications remained unchanged (P>0.05) contributing to the high percentage of qualified successes. Visual acuity remained unchanged and there were no major postoperative complications. The Kaplan-Meier survival shows a survival rate of 60% with IOP≤20 mm Hg and 40% for IOP≤16 mm Hg at 5 years. CONCLUSIONS Trabeculectomy needle revision is a useful option for the management of elevated IOP in the presence of a failed or failing trabeculectomy bleb. However, as with trabeculectomy, there tends to be a failure rate over time. This often leads to reinstitution of glaucoma medications and/or further needle revisions to maintain IOPs at target level. The procedure itself is minimally invasive with an acceptable safety profile.
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Castañeda-Diez R, Prado-Larrea C, Silva-Romano SK, García-Huerta M, Domínguez-Dueñas F, Jiménez-Román J. Cirugía de catarata con láser de femtosegundo en glaucoma. REVISTA MEXICANA DE OFTALMOLOGÍA 2016. [DOI: 10.1016/j.mexoft.2015.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Intraocular Pressure Following Phacoemulsification and Endoscopic Cyclophotocoagulation for Advanced Glaucoma: 1-Year Outcomes. J Glaucoma 2015; 24:e157-62. [PMID: 25646714 DOI: 10.1097/ijg.0000000000000228] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate changes in intraocular pressure (IOP), vision, and medications at least 1 year after phacoemulsification combined with endocyclophotocoagulation for advanced glaucoma and cataract. METHODS A retrospective chart review was conducted on patients with advanced glaucoma who underwent phacoemulsification combined with endocyclophotocoagulation at King Khaled Eye Specialist Hospital between 2005 and 2012. Data were collected on patient demographics, type of glaucoma, IOP over time, best-corrected visual acuity, number of glaucoma medications, comorbidities, and previous surgeries. Absolute success was defined as IOP≤15 mm Hg without medication and qualified success was IOP≤15 mm Hg with medications. Statistical significance was indicated by P<0.05. RESULTS The study sample comprised 104 eyes (104 patients). Mean follow-up was 17.3±1.8 months. Mean IOP decreased from 17±1.4 mm Hg preoperatively to 14.7±1.3 mm Hg at the last postoperative visit. Absolute success was achieved in 11.9% (95% confidence interval, 5.6-18.2) of the eyes. Qualified success was achieved in 72.3% (95% confidence interval, 63.5-81.0) of the eyes. Best-corrected visual acuity improved by ≥2 lines in 76 (73%) eyes. Eyes with primary open-angle glaucoma had the higher absolute and qualified success rates compared with primary angle-closure and pseudoexfoliation glaucoma (P>0.05). Only 48 (46%) patients required >3 medications for IOP control compared with 78 (75%) patients before surgery. CONCLUSIONS At ≥1 year postoperatively, the absolute success rate of treating advanced glaucoma by endocyclophotocoagulation and phacoemulsification was low. However, medication burden was reduced. Owing to the significant variation in the success rate based on the type of glaucoma, patients with advanced glaucoma should be carefully selected and counseled.
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Lanza M, Iaccarino S, Mele L, Carnevale UAG, Irregolare C, Lanza A, Femiano F, Bifani M. Intraocular pressure evaluation in healthy eyes and diseased ones using contact and non contact devices. Cont Lens Anterior Eye 2015; 39:154-9. [PMID: 26481062 DOI: 10.1016/j.clae.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/30/2015] [Accepted: 10/02/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze and compare intraocular pressure (IOP) values measured in healthy subjects (HS), keratoconus (KC) patients and patients that underwent myopic photorefractive keratectomy (REF), using Goldmann applanation tonometry (GAT), dynamic contour tonometry (DCT), ocular response analyzer (ORA) and Corvis ST (CST). METHODS The study included 76 eyes of 76HS, 15 eyes of 15 KC patients and 18 eyes of 18 subjects that underwent REF. Each participant underwent a complete ophthalmic evaluation, IOP measurement with GAT, DCT, ORA and CST. RESULTS HS showed a mean GAT value of 15.62±2.33 mm Hg, a mean DCT value of 17.44±2.51 mm Hg, a mean ORA value of 15.99±3.58 mm Hg and a mean CST value of 17.24±3.44 mm Hg. KC showed a mean GAT value of 15.07±1.83 mm Hg, a mean DCT value of 17.01±1.96 mm Hg, a mean ORA value of 13.58±2.99 mm Hg and a mean CST value of 14.37±1.89 mm Hg. REF showed a mean GAT value of 14.06±1.51 mm Hg, a mean DCT value of 15.12±2.34 mm Hg, a mean ORA value of 16.85±2.4 mm Hg and a mean CST value of 15.57±1.77 mm Hg. CONCLUSION Our data suggest that ORA and GAT could be used interchangeably in HS; GAT, ORA and CST could be used interchangeably in KC patients and that GAT provides lower IOP values compared to the other devices in eyes previously submitted to myopic PRK.
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Affiliation(s)
- Michele Lanza
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy; Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy.
| | - Stefania Iaccarino
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Luigi Mele
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
| | - Ugo Antonello Gironi Carnevale
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
| | - Carlo Irregolare
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Alessandro Lanza
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
| | - Felice Femiano
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
| | - Mario Bifani
- Dipartimento Multidisciplinare di Scienze Mediche, Chirurgiche e Odontoiatriche, Seconda Università di Napoli, Napoli, Italy
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Paletta Guedes RA, Paletta Guedes VM, Freitas SM, Chaoubah A. Does the type of treatment have an influence on utility values in a glaucoma population? Clin Ophthalmol 2015; 9:1645-50. [PMID: 26379421 PMCID: PMC4567237 DOI: 10.2147/opth.s92653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To assess the impact of glaucoma therapy on utility values in a glaucoma population. METHODS A cross-sectional study of consecutive glaucoma patients was conducted. Utility values were obtained using the time trade-off method. Visual function variables (visual acuity and mean deviation in the better eye) and sociodemographic and clinical characteristics (age, sex, race, educational level, type of glaucoma, current and past glaucoma treatments, and comorbidities) were also obtained for statistical analysis. We divided the patients into three groups: medical treatment (group 1), surgical treatment (group 2), and mixed surgical and medical treatment (group 3). RESULTS Mean age of the study population (n=225) was 65.7 years. After controlling for glaucoma stage (early, moderate, and advanced), the difference among the groups in mean utility values was not statistically significant. Number of medications per patient, type of medication, or type of surgical technique did not have an impact on the utility values. CONCLUSION Our findings suggest that the type of therapy did not affect the utility values in a glaucoma population.
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Affiliation(s)
- Ricardo Augusto Paletta Guedes
- Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil ; Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil ; Santa Casa de Misericórdia Hospital, Juiz de Fora, MG, Brazil
| | - Vanessa Maria Paletta Guedes
- Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil ; Paletta Guedes Ophthalmological Center, Juiz de Fora, MG, Brazil ; Santa Casa de Misericórdia Hospital, Juiz de Fora, MG, Brazil
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Khandelwal RR, Raje D, Rathi A, Agashe A, Majumdar M, Khandelwal R. Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction. Eye (Lond) 2014; 29:363-70. [PMID: 25502867 DOI: 10.1038/eye.2014.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 09/30/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To determine the efficacy of safe surgery system trabeculectomy combined with manual small incision cataract surgery/phacoemulsification in primary glaucoma coexistent with cataract. METHODS This is a retrospective analysis of 105 cases who underwent single-site combined surgery between January 2008 and December 2009. Safe surgery system trabeculectomy with diffuse and posterior application of mitomycin C was performed in all cases. Cataract extraction was done either by Manual Small Incision Cataract Surgery (MSICS) or phacoemulsification. Main outcome measures were success rate of trabeculectomy, as determined by four different IOP goals and incidence of postoperative complications. Analysis was performed using R-2.15, and the significance was tested at 5% level. RESULTS The minimum follow-up period was 12 months. The overall success rates (with or without medication) when safe surgery system trabeculectomy was combined with MSICS were 91, 70, and 51% for IOP ≤18, ≤15, and ≤12 mm Hg, respectively, and target IOP was achieved in 72% cases. The mean IOP reduction was 43.8% with MSICS and 42.08% with phacoemulsification. The surgical outcome was not significantly different for both techniques. Postoperative complications were infrequent and comparable. CONCLUSION The Safe Surgery System Trabeculectomy combined with cataract surgery offers excellent IOP control with minimal postoperative complications. It offers an effective and improved solution for primary glaucoma coexistent with cataract found in developing countries.
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Affiliation(s)
- R R Khandelwal
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - D Raje
- MDS Bioanalytics, Nagpur, India
| | - A Rathi
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - A Agashe
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - M Majumdar
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
| | - R Khandelwal
- Department of Ophthalmology, NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital, Nagpur, India
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Lanza M, Iaccarino S, Cennamo M, Irregolare C, Romano V, Carnevale UAG. Comparison between Corvis and other tonometers in healthy eyes. Cont Lens Anterior Eye 2014; 38:94-8. [PMID: 25467287 DOI: 10.1016/j.clae.2014.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 10/31/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the agreement of intraocular pressure (IOP) values in healthy eyes among Goldmann applanation tonometer, dynamic contour tonometer, ocular response analyzer and Corvis. Additionally, to study the relationship between their differences with central corneal thickness (CCT) and corneal curvature (CK). METHODS Seventy-six eyes of 76 healthy subjects were examined. Every subject underwent a complete ophthalmic evaluation, a Pentacam scan and three consecutive IOP measurements with each instrument (DCT, GAT, ORA and CST). IOP measurements provided by each device were compared with each other and the differences between them were correlated with morphological parameters obtained by Pentacam (CCT and CK). Statistical analysis was performed using SPSS software, version 18.0. RESULTS The mean age of enrolled subjects was 36.8 ± 10.6 years old. The mean IOP measurements that were obtained with GAT, DCT, ORA and CST was 15.62 ± 2.33 mmHg, 17.44 ± 2.51 mmHg, 15.99 ± 3.58 mmHg and 17.24 ± 3.44 mmHg respectively. The mean CCT was 543.63 ± 36.15 μm, the mean CK was 43.35 ± 1.23 D. GAT and ORA provided IOP values not showing a statistical difference; CST and DCT IOP measurements did not show a statistical difference whereas CST provided statistically higher IOP values both than GAT and both ORA. CONCLUSIONS According to our data, CST produces IOP values that are notably higher than GAT measures; therefore they cannot be used interchangeably. If CST should be used as the next gold standard, higher IOP values will come to be considered normal.
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Affiliation(s)
- Michele Lanza
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Seconda Università di Napoli, Napoli, Italy; Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy.
| | - Stefania Iaccarino
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Michela Cennamo
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Carlo Irregolare
- Centro Grandi Apparecchiature, Seconda Università di Napoli, Napoli, Italy
| | - Vito Romano
- Multidisciplinary Department of Medical, Surgical and Dental Sciences, Seconda Università di Napoli, Napoli, Italy
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Castañeda Díez R, Jiménez Román J, Iriarte Barbosa MJ. Concepto de sospecha de glaucoma de ángulo abierto: definición, diagnóstico y tratamiento. REVISTA MEXICANA DE OFTALMOLOGÍA 2014. [DOI: 10.1016/j.mexoft.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
PURPOSE To assess and compare the impact of medical and surgical glaucoma treatments on patients' health-related Quality of Life (QoL). MATERIALS AND METHODS We used the 25-question version of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) for this cross-sectional study. Patients were divided into 3 groups: 1 (medical treatment); 2 (surgical treatment), and 3 (medical and surgical treatment). Comparisons among groups were carried out for demographic and clinical characteristics and for the NEI VFQ-25 scores. RESULTS Of the 240 invited patients, 225 were enrolled for this study. Groups were homogenous for age, sex, race, type of glaucoma, and level of education. The mean overall score was 78.46, 65.85, and 60.51 for groups 1, 2, and 3, respectively (P<0.001). Type of therapy, visual acuity, and comorbidity were associated with QoL scores. When controlled by glaucoma stages, surgery had a negative impact on the QoL only in early glaucoma. CONCLUSIONS Glaucoma surgery is associated with a lower QoL in patients with early glaucoma due mainly to the psychological burden. In moderate and advanced glaucomas, the QoL scores did not differ between the surgical and the medical therapy groups.
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Aptel F, Chiquet C, Romanet JP. Intraocular pressure-lowering combination therapies with prostaglandin analogues. Drugs 2012; 72:1355-71. [PMID: 22686588 DOI: 10.2165/11634460-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Intraocular pressure (IOP) reduction is currently the only therapeutic approach demonstrated to preserve visual function in patients with glaucoma. The first line of glaucoma treatment consists of topical IOP-lowering medications, usually initiated as monotherapy. A significant proportion of patients require more than one medication to reach a target IOP at which optic nerve damage will not progress. As prostaglandin analogues (PGAs) are the most effective class for reducing IOP, one of the other commonly used classes (β-adrenoceptor antagonist [β-blocker], carbonic anhydrase inhibitor or α(2)-adrenoceptor agonist) is frequently combined with a PGA. In the last decade, the use of fixed combinations containing two medications in a single bottle has steadily increased. Fixed combinations have the potential to simplify the dosing regimen, increase patient adherence, avoid the washout effect of the second drop on the first medication instilled, decrease exposure to preservatives and, sometimes, reduce the cost of treatment. Clinical trials have evaluated PGA-based fixed combinations versus unfixed combinations (individual components administered concomitantly) or versus individual monotherapies; however, any advantage that the fixed combinations may have in terms of IOP-lowering efficacy is still debated. For these reasons, the PGA-based fixed combinations are not approved by regulatory authorities in some countries, such as the US. We review the published studies evaluating the efficacy and tolerability of the IOP-lowering unfixed and fixed combination therapies with PGAs. Regarding unfixed combinations, the review shows that α(2)-adrenergic agonists-PGA and carbonic anhydrase inhibitor-PGA combinations seem to be at least as effective at reducing IOP as the β-blocker-PGA combinations. As for the fixed combinations, the review shows that the three PGA-timolol fixed combinations are more effective than their component medications used separately as monotherapy and are better tolerated than the three respective prostaglandins. The three PGA-timolol fixed combinations are less effective at reducing IOP than the unfixed combinations but are better tolerated. The advantage of the fixed combinations in terms of patient adherence and persistence is supported by a very small number of studies and remains to be more accurately determined. Most studies, but not all, seem to show that PGA-timolol fixed combinations are more effective than other available β-blocker fixed combinations (dorzolamide-timolol fixed combinations) at reducing IOP and are similarly tolerated.
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Abstract
PURPOSE To estimate the outpatient clinic burden and surgical workload related to glaucoma in Lagos, Nigeria. METHODS A multicentre study involving the 2 tertiary eye institutions, 7 secondary eye centers with eye care facilities, and the largest private eye hospital in Lagos state, Nigeria. Data on outpatient department (OPD) visits were collected over a 4-week period, using a specially designed tally sheet. Theater records were examined in each hospital over a 1-year period (2009) for the number and types of glaucoma surgeries performed. RESULTS A total of 6240 patients visited the OPD over the 4-week period, out of which 1577 (25.3%) were glaucoma patients. OPD visit per ophthalmologist were 274, 323, and 61, whereas glaucoma visits per ophthalmologist were 75, 70, and 23 in the tertiary, secondary, and private centers, respectively. Glaucoma surgeries constituted 8.6% of total surgeries (n=4050). Trabeculectomy with intraoperative 5-fluorouracil was the most common procedure (81.0%). Number of glaucoma surgeries per ophthalmologist per month in the tertiary, secondary, and private centers were 0.5, 0.9, and 1.4, respectively. Overall number of glaucoma surgery per ophthalmologist per month was 1. CONCLUSIONS Glaucoma visits constitute a significant proportion of eye clinic visits in Lagos state, Nigeria, and therefore, necessary manpower, infrastructure, and equipments should be mobilized for its optimal management. Also, there is a relatively low output of glaucoma surgeries that needs to be further investigated and appropriate measures taken to manage it.
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Bonilla R, Loscos J, Valldeperas X, Parera MÀ, Sabala A. Supraciliary hema implant in combined deep sclerectomy and phacoemulsification: one year results. Open Ophthalmol J 2012; 6:59-62. [PMID: 22798971 PMCID: PMC3394410 DOI: 10.2174/1874364101206010059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 06/20/2012] [Accepted: 06/20/2012] [Indexed: 11/22/2022] Open
Abstract
We present the combined surgery of non-penetrating deep sclerectomy with insertion of the implant in the supraciliary space as an effective and safe surgery for patients with both cataract and primary open angle glaucoma. This study included 20 eyes of 16 patients who were followed up during 12 months. We found a significant intraocular pressure reduction, changing from a preoperative mean of 23 ± 5 mmHg to a postoperative mean of 18 ± 3 mmHg (p<0.002). Similarly, a significant reduction in the number of glaucoma drugs needed was observed, varying from 2.5 ± 0.9 drops per patient to 0.7 ± 0.9 (p<0.0002) at the end of the study. We also report a significant improvement in best-corrected visual acuity, from 5/10 ± 2/10 to 8/10 ± 2/10 (p<0.006), one year after the combined surgery. The only intraoperative complication observed was the microperforation of the trabeculo-descemetic membrane (TDM) and postoperative complications were iris incarceration, seidel test positivity and microhyphema. All these complications resolved successfully.
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Affiliation(s)
- Rosa Bonilla
- Department of Ophthalmology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
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Liu L. There is insufficient evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence-based perspective--comment. Clin Exp Ophthalmol 2012; 40:647-8; author reply 648-9. [PMID: 22394453 DOI: 10.1111/j.1442-9071.2012.02786.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Töteberg-Harms M, Ciechanowski PP, Hirn C, Funk J. [One-year results after combined cataract surgery and excimer laser trabeculotomy for elevated intraocular pressure]. Ophthalmologe 2012; 108:733-8. [PMID: 21359550 DOI: 10.1007/s00347-011-2337-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Glaucoma is one of the most common reasons for blindness. Usually an elevated resistance to aqueous outflow is the reason, while aqueous humor production is still normal. Medical reduction of intraocular pressure (IOP) is the first-line therapy in most cases. The gold standard of surgical treatment is trabeculectomy (TE). But TE has a lot of postoperative complications. Therefore we prefer the combined procedure of cataract extraction plus excimer laser trabeculotomy (phaco-ELT) for a selected group of glaucoma patients. Indications are cataract together with moderately elevated IOP without medical therapy or a moderate cataract together with elevated IOP under medical therapy. PATIENTS AND METHODS During ELT, 10 pores were created over 90° of the anterior chamber angle; 28 eyes of 28 patients (10 men and 18 women) were reexamined 12 months ± 2 weeks after combined phaco-ELT. Four patients were excluded because of IOP-lowering surgery during the follow-up. IOP, best corrected visual acuity, slit lamp biomicroscopy as well as glaucoma medication history (antiglaucoma drugs, AGD) were recorded. RESULTS The mean age was 74.33±11.81 years. The diagnosis was primary open-angle glaucoma in 9 eyes, pseudoexfoliative glaucoma in 15 eyes, ocular hypertension in 3 eyes, and 1 post-traumatic secondary glaucoma. On average, phaco-ELT could reduce the IOP by 8.79±5.28 mmHg (-34.70%, p<0.001). AGD could be reduced by 0.79±1.50 (-62.70%, p=0.017) at the same time. CONCLUSION The ELT is easy to perform at the end of cataract surgery. Duration of surgery is only prolonged by 2 to 3 minutes. We found an average IOP reduction of 8.79 mmHg (-34.70%) and an average reduction of 0.79 AGD. It is known that the effect of IOP reduction is constant over time unlike argon or selective laser trabeculoplasty. If needed later on, filtering surgery is not compromised because there is no conjunctival touch during ELT and therefore no scarring of the conjunctiva. For a selected collective of glaucoma patients this procedure could be a good way to avoid trabeculectomy.
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Modèle de collaboration entre les professions en matière de soins aux patients atteints de glaucome et à ceux qui représentent des cas suspects de glaucome. Can J Ophthalmol 2011. [DOI: 10.1016/j.jcjo.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Model of interprofessional collaboration in the care of glaucoma patients and glaucoma suspects. Can J Ophthalmol 2011; 46:S1-21. [DOI: 10.1016/j.jcjo.2011.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2011] [Indexed: 10/26/2022]
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Canaloplasty: Three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg 2011; 37:682-90. [DOI: 10.1016/j.jcrs.2010.10.055] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/11/2010] [Accepted: 10/28/2010] [Indexed: 11/23/2022]
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Kozobolis VP, Glynatsis M, Labiris G, Katsanos A, Fanariotis M, Koukoula S, Alvanos S, Toufexis G. Retinal nerve fiber layer thickness in patients with exfoliation, exfoliative glaucoma, and primary open angle glaucoma. Eur J Ophthalmol 2010; 20:142-8. [PMID: 19882545 DOI: 10.1177/112067211002000120] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE to evaluate the retinal nerve fiber layer(RNFL) profile of healthy controls, persons with exfoliation syndrome (XFS), and patients with exfoliation glaucoma (XFG) and primary open angle glaucoma(POAG). METHODS One eye from each of 269 participants was analyzed. Fifty eyes were normal , 45 eyes had XFS, 89 eyes had POAG, and 89 had XFG. Glaucoma patients were divided according to the severity of the disease into mild and advanced groups. All participants underwent imaging with the GDx-VCC device. Measurements of the parameters TSNIT average, TSNIT SD, and nerve fiber indicator (NFI) were performed. Polametric RNFL thickness values were compared by means of Bonferroni-corrected t-tests. RESULTS Regarding control and glaucoma groups, statistically significant differences were identified in all GDx parameters. RNFL thickness values of the control group differed significantly from the values of the XFS group. There was no statistically significant difference between RNFL thickness values for the mild POAG and mild XFG groups or for the advanced POAG and advanced XFG groups. CONCLUSIONS Polarimetry-determined RNFL in eyes with XFS is thinner than that of healthy eyes. No differences in RNFL thickness were found when eyes with POAG and XFG of similar severity were compared.
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Fakhraie G, Lopes JF, Spaeth GL, Almodin J, Ichhpujani P, Moster MR. Effects of postoperative cyclosporine ophthalmic emulsion 0.05% (Restasis) following glaucoma surgery. Clin Exp Ophthalmol 2010; 37:842-8. [PMID: 20092592 DOI: 10.1111/j.1442-9071.2009.02134.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine if postoperative topical cyclosporine 0.05% has any beneficial effect following trabeculectomy. METHODS This was an interventional, randomized, prospective, double-masked clinical trial of 44 consecutive patients with uncontrolled glaucoma requiring filtration surgery. Ocular surface disease index questionnaire and comprehensive ocular exam, including Schirmer's tear test 1, were performed. Patients underwent routine trabeculectomy, with or without phacoemulsification. The study group (n = 22) received cyclosporine 0.05%, and the control group (n = 22) received artificial tears. Patients were evaluated at 1 and 6 months post surgery. Outcome measures were intraocular pressure, success rate, bleb appearance, ocular surface disease index, Schirmer's tear test 1 and conjunctival inflammation. RESULTS Thirty-nine patients completed the study (19 in the study group, 20 in the control group). The mean baseline intraocular pressure was 23.8 +/- 12.6 mmHg in the study group and 25.9 +/- 10.6 mmHg in the control group (P = 0.513). Mean intraocular pressure at postoperative month 6 was 14.88 +/- 6.2 and 14.62 +/- 5.46 mmHg in the study group and control group, respectively (P = 0.837). There was no statistically significant difference in the mean values of Schirmer's tear test 1 and the level of conjunctival hyperaemia between the two groups at baseline, months 1 and 6 post surgery. The treatment group had a statistically significant decrease in ocular surface disease index score at 6 months (P = 0.003), indicating less severity of dry eye symptoms and significant reduction in ocular pain. CONCLUSIONS Topical cyclosporine 0.05% had no effect on postoperative bleb function and intraocular pressure following trabeculectomy, but improved subjective ocular surface symptoms in these patients.
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Khaimi MA. Canaloplasty using iTrack 250 Microcatheter with Suture Tensioning on Schlemm's Canal. Middle East Afr J Ophthalmol 2010; 16:127-9. [PMID: 20142977 PMCID: PMC2813597 DOI: 10.4103/0974-9233.56224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Open angle glaucoma (OAG) necessitating surgery has traditionally been treated with filtering procedures using antifibrotics. Unfortunately, such filtering procedures are not without the risk of postsurgical complications. Increasing interest in blebless surgery has led to innovative surgical procedures aimed at rejuvenating the natural trabeculo canalicular outflow pathway. Circumferential catheterization with suture tensioning of Schlemm's canal has emerged as a safe and effective way to surgically treat OAG.
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Affiliation(s)
- Mahmoud A Khaimi
- Dean McGee Eye Institute, University of Oklahoma, Department of Ophthalmology, 608 Stanton L. Young Blvd, Oklahoma City, OK 73104
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Folgar FA, de Moraes CGV, Prata TS, Teng CC, Tello C, Ritch R, Liebmann JM. Glaucoma surgery decreases the rates of localized and global visual field progression. Am J Ophthalmol 2010; 149:258-264.e2. [PMID: 20103054 DOI: 10.1016/j.ajo.2009.09.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Revised: 09/14/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Incisional glaucoma surgical procedures produce greater intraocular pressure (IOP) reduction and less IOP variability than medical treatment. We sought to determine the efficacy of glaucoma surgery in decreasing localized and global rates of visual field (VF) progression. DESIGN Retrospective, interventional case series. METHODS Subjects in the New York Glaucoma Progression Study with glaucomatous optic neuropathy, repeatable VF loss, and 10 or more Swedish interactive threshold algorithm standard VF examinations were assessed for eligibility. Patients who underwent successful glaucoma surgery (not requiring further surgical intervention and IOP < 18 mm Hg) in either eye and who were followed up for at least 2 years before and after surgery were enrolled. Automated pointwise linear regression analysis was used to calculate global and localized rates of progression before and after surgery. Eyes with other ocular conditions likely to affect the VF and an insufficient number of VF to create a slope before and after surgery were excluded. Comparisons were performed within the same eyes before and after surgery (Student paired t test). RESULTS We enrolled 28 eyes of 28 patients (mean age, 61.2 +/- 14.5 years). The mean number +/- standard deviation of VF was 13.4 +/- 2.3, spanning 7.1 +/- 1.2 years (range, 4 to 9 years). Mean IOP +/- standard deviation decreased from 19.0 +/- 3.9 mm Hg before surgery to 11.3 +/- 3.7 mm Hg after surgery (40% reduction; P < .01). Mean global progression rates decreased from -1.48 +/- 1.4 dB/year before surgery to -0.43 +/- 0.8 dB/year after surgery (70% reduction; P = .01). Twelve eyes (42.8%) had at least 1 significantly progressing point before surgery, whereas only 2 (7.1%) had at least 1 progressing point after surgery. Each 1 mm Hg of IOP reduction after surgery resulted in a 0.1 dB/year decrease in the global rate of progression. CONCLUSIONS Successful IOP reduction after glaucoma surgery greatly reduces both the number of progressing points and the localized and general rates of VF progression.
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