Average Preoperative Intraocular Pressure Research Articles

A A Retrospective Non-Randomized Case Study Analysis of Mitomycin-C Efficacy in Patients Undergoing Combined Phacotrabeculectomy at a Tertiary Care Hospital in Salem, India

Glaucoma and cataracts, which are major contributors to worldwide blindness, frequently occur together, requiring phacotrabeculectomy as the primary therapeutic approach. This study conducted a retrospective analysis of cases to evaluate the efficacy of Mitomycin-C (0.2mg/ml for 3 min) in phacotrabeculectomy, which is a combination surgical treatment that involves trabeculectomy and phacoemulsification. The study was conducted over six months, from January 2022 to June 2022, in a tertiary care hospital in Salem. An analysis was conducted on the records of 60 patients who underwent phacotrabeculectomy and met the inclusion criteria. The study included 60 patients, with 28 (47%) being men and 32 (53%) being females; of these, 22 (37%) underwent surgery on their right eye, while 38 (63%) underwent surgery on their left. Most patients belonged to the age bracket of 51-65 years. The grading of cataracts identified many forms, such as Nuclear Sclerosis (NS-1: 3%, NS-1 and PSC: 10%, NS-2: 17%, NS-2 and PSC: 23%, NS-3: 7%, PSC: 13%). The most prevalent type, affecting the majority (27%) of the population, was Senile Immature Cataract (SIMC). The average preoperative intraocular pressure was 22.4 ± 1.52 mmHg, and after the surgery, the pressure reduced dramatically to 13.20 ± 1.42 mmHg. The difficulties associated with blebs are resolved on their own. After the operation, there was an improvement in visual acuity. The average values increased from 0.86 ± 0.15 before the surgery to 0.22 ± 0.26 on day 1, 0.20 ± 0.23 on day 7, 0.19 ± 0.23 on day 14, 0.18 ± 0.19 on day 30, and 0.18 ± 0.19 on day 45. A paired t-test demonstrated a statistically significant difference (p=0.02) in postoperative visual acuity between day 1 and day 45. The study's findings indicate that Mitomycin-C is efficacious in phacotrabeculectomy, resulting in decreased intraocular pressure and enhanced visual acuity, with no notable problems. The findings provide valuable insights into managing concurrent glaucoma and cataracts, presenting a viable strategy in tertiary care settings.

A comparative study of ultrasound cycloplasty and endoscopic cyclophotocoagulation in the treatment of secondary glaucoma

To compare the clinical efficacy of ultrasound cycloplasty (UCP) and endoscopic cyclophotocoagulation (ECP) in the treatment of secondary glaucoma. In a 12-month prospective single-center study, 22 patients with secondary glaucoma were treated by high-intensity focused ultrasound (HIFU), and 23 patients with secondary glaucoma were treated by a semiconductor laser. At the final follow-up, the two groups’ surgical outcomes were compared. A complete success was defined as an intraocular pressure (IOP) reduction of at least 20% from baseline and an IOP of > 5 mmHg and ≦ 21 mmHg, while a qualified success was defined as an IOP reduction of at least 20% from baseline and an IOP of > 5 mmHg. The secondary outcome was the average IOP, number of drugs, and complications at each follow-up compared with the baseline. The average preoperative IOPs in the UCP and ECP groups were 36.4 ± 9.5 mmHg (n = 2.3 drops, n = 0.2 tablets) and 34.5 ± 11.7 mmHg (n = 2.0 drops, n = 0.3 tablets), respectively. In the last follow-up, the success rate of UCP was 54% (with a decrease of 32%) and that of ECP was 65% (with a decrease of 35%), and the P-value between the two groups was > 0.05. However, there was a difference in the average IOP between these two groups 1 day and 1 week after the operation, and the IOP reduction efficiency in the ECP group was better. However, the amount of drug used after these two surgeries was significantly reduced. There were fewer postoperative complications in the UCP group (18 cases) than in the ECP group (35 cases). Both UCP and ECP can effectively reduce IOP in secondary glaucoma, and ECP has a better effect at the early stages. However, UCP has higher safety and tolerance for patients.

A 5-year retrospective study of intraocular pressure control after trabeculectomy: a retrospective cohort study.

The study presents a 5-year retrospective analysis of intraocular pressure (IOP) and complications after trabeculectomy. Trabeculectomy was performed using 5 mg/ml of 5-fluorouracil. A gentle diathermy was performed to secure hemostasis. Using a blade fragment of the scleral thickness, a 4×3 mm rectangular scleral flap was dissected. The central part of the flap was dissected 1 mm into the clear cornea. Before being tailed down, the patient was given topical 0.05% dexamethasone qid, 1% atropine tid, and 0.3% ciprofloxacin qid for 4-6 weeks. Patients with pain were given pain relievers, and all patients with photophobia were given sun protection. A successful surgical outcome was defined as a postoperative IOP of 20 mmHg or less. There were 161 patients over the 5-year period under review, with men constituting 70.2% of the total. Out of 275 eyes operated on, 82.9% were bilateral cases, while 17.1% were unilateral. Glaucoma was found in both children and adults aged 11-82 years. However, it was observed to predominate between the ages of 51 and 60, with males having the highest incidence. The average preoperative IOP was 24.37 mmHg, while it was 15.24 mmHg postoperatively. The complication with the highest ranking was shallow anterior chamber (24; 8.73%) due to overfiltration, followed by leaking bleb (8; 2.91%). The most common late complications were cataract (32; 11.64%) and fibrotic bleb (8; 2.91%). Bilateral cataracts developed at an average of 25 months after trabeculectomy. It was seen in patients aged 2-3 with a frequency of 9, whereas 5 years after, 77 patients had improved vision, with a postoperative visual acuity of 6/18-6/6. Postoperatively, the patients had satisfying surgical outcomes as a result of the decrease in preoperative IOP. Although postoperative complications occurred, they had no effect on the surgical outcomes because they were temporary and not optically threatening. In our experience, trabeculectomy is an effective and safe procedure for achieving IOP control.

Survival of Visual Function in Patients with Advanced Glaucoma after Standard Guarded Trabeculectomy with MMC

Surgical intervention in patients with severe glaucoma remains controversial, especially in unilateral cases with a minimally affected fellow eye. Many question the benefit of trabeculectomy in such cases due to high complication rates and prolonged recovery. In this retrospective, non-comparative, interventional case series we aimed to determine the effect of trabeculectomy or combined phaco-trabeculectomy on the visual function of advanced glaucoma patients. Consecutive cases with perimetric mean deviation loss worse than -20 dB were included. Survival of visual function according to five predetermined visual acuity and perimetric criteria was set as the primary outcome. Qualified surgical success utilizing two different sets of criteria commonly used in the literature constituted secondary outcomes. Forty eyes with average baseline visual field mean deviation -26.3 ± 4.1 dB were identified. The average pre-operative intraocular pressure was 26.5 ± 11.4 mmHg and decreased to 11.4 ± 4.0 mmHg (p < 0.001) after an average follow-up of 23.3 ± 15.5 months. Visual function was preserved at two years in 77% or 66% of eyes respectively according to two different sets of visual acuity and perimetric criteria. Qualified surgical success was 89%, 72% at 1 and 3 years respectively. Trabeculectomy and/or phaco-trabeculectomy is associated with meaningful visual outcomes in patients with uncontrolled advanced glaucoma.

Efficacy of Single-site versus Two-site Phacotrabeculectomy in Primary Open-angle Glaucoma: A Prospective Cohort Study

Introduction: The prevalence of co-existing cataract and glaucoma is increasing in the adult population. Combined surgeries have become more popular. However, there is a conflict over which technique provides the best Intraocular Pressure (IOP) control with good postoperative outcomes. Aim: To compare the efficacy of single-site versus two-site phacotrabeculectomy with mitomycin-C in patients with Primary Open-angle Glaucoma (POAG) and cataract. Materials and Methods: A prospective cohort study was conducted in the Department of Ophthalmology, S.V. Medical College, Tirupati, Andhra Pradesh, India, over a period of one year from January 2019 to January 2020. A total of 50 cases of POAG coexisting with cataract were analysed in the present study. Twentyfive cases were included in each group (Group-1 and Group-2). Phacoemulsification and trabeculectomy were both performed through a superior scleral tunnel in the single-site approach. The two-site method combines a superior trabeculectomy with a temporal clear corneal phacoemulsification. A concentration of 0.2 mg/mL of MMC was applied in both groups for three minutes. Patients were followed-up for three months after surgery to evaluate Intraocular Pressure (IOP), the need for antiglaucoma medication, and postoperative best-corrected Visual Acuity (VA). Comparative analysis was done using the Student’s t-test, and a p-value &lt;0.05 was considered statistically significant. Results: Throughout the three-month duration, the patients were monitored. In the single-site group, the average preoperative IOP was 21.880±8.4079 mmHg, which significantly decreased to 11.16±9.95 mmHg after three months (p&lt;0.001). In the twosite group, the corresponding figures were 22.640±6.3040 and 10.8±1.19 mmHg, respectively (p&lt;0.001), with no discernible statistical distinction between the two groups (p=0.486). At the final follow-up, the number of antiglaucoma medications was 0.24±0.5 in the single-site group compared to 0.16±0.24 in the two-site group. The mean postoperative Best Corrected Visual Acuity (BCVA) did not exhibit any significant variation between the two groups. Furthermore, there was no disparity in the occurrence rate of complications between the two groups. Conclusion: Both single and two-site phacotrabeculectomy led to a significant reduction in IOP and improvement in BCVA. The final IOP was similar in the two procedures, although the twosite group needed less glaucoma medication. As both surgical procedures are equally effective, the choice of procedure remains at the discretion of the surgeon.

Increase in Intra-Ocular Pressure after Intravitreal Triamcinolone Acetonide in Non-Diabetics and Diabetic Patients

Objective: The objective of this research study was to find out the occurrence of raised IOP (Intra-ocular Pressure) following IVTA (Intra-vitreal Triamcinolone Acetonide) in the patients of diabetes and non-diabetics subjects suffering from different chorio-retinal complications. Methodology: This study was conducted in Benazir Bhutto Shaheed Teaching Hospital Abbottabad and the duration of this study was from May 2019 to April 2021. Total 237 eyes of one hundred and eighty patients were recruited with ninety patients in groups: diabetics &amp; non-diabetics patient groups, in need of IVTA. We injected the IVTA 4.0mg/0.10 milliliter and measured the IOP at 7 days, one month, 3 months and 6 months in the patients of both groups. Results: In the group of diabetics, there were 47.80% (n: 43) males and 52.20% (n: 47) female patients, whereas in the group of non-diabetics, there were 62.20% (n: 56) male and 37.80% (n: 34) female patients. The average age of the patients in the 1st group was 52.21±9.60 years and in the patients of 2nd group was 51.13±10.75 years. Average pre-operative IOP was approximately 3.60±2.80mmHg and 14.10±2.40mmHg in first and second group correspondingly. In the patients of first group, average IOP with standard deviation was 16.40±4.90mmHg, 14.60±3.60mmHg, 17.60±9.70mmHg and 15.50±7.09mmHg at 7 days, one month, 3 months and 6 months after the injection. Whereas in the patients of second group, average IOP with standard deviation was 14.80±3.33mmHg, 15.90±4.2mmHg, 15.50±4.20 mmHg and 14.10±3.20mmHg at 7 days, one month, 3 months and 6 months during the follow up period. We observed an increase in one hundred and seventeen eyes (49.0%) in the patients of both groups, with 65.0% (n: 78) eyes in first group and 33.0% (n: 39) eyes in the patients of second group. Conclusions: After injecting the IVTA, there was a clear high rise in the level of IOP in the patients of diabetes as compared to the patients who were non-diabetics. Keywords: IVTA, IOP, complications, injection, standard deviation, average, mmHg, treatment.

CO2 laser-assisted sclerectomy surgery in the treatment of open-angle glaucoma in Chinese patients.

To evaluate the efficacy and safety of CO2-Laser Assisted Sclerectomy Surgery (CLASS) with 5-fluorouracil (5-FU) in treating open-angle glaucoma (OAG) in Chinese patients. Methods: This was a retrospective, uncontrolled, interventional case series. All patients from 2016 to 2017 who received CLASS were recruited in this study. The primary outcome was the change in intraocular pressure (IOP) and the number of IOP-lowering medications over a 12-month follow-up period. Adverse events were evaluated as secondary outcomes. Results: Data were collected from forty-two eyes of 31 patients. The average preoperative IOP was 31.33 ± 7.60mmHg. The mean percentage of IOP reduction from baseline at postoperative months (POM) 1, 3, 6, 9, and, 12 were 48.1% ± 24.6%, 51.4% ± 19.3%, 51.2% ± 17.2%, 50.9% ± 15.0%, 49.2% ± 16.3%, respectively (all P < 0.001). The number of glaucoma medications decreased from a baseline of 3.02 ± 0.81 to 0.05 ± 0.22, 0.10 ± 0.37, 0.12 ± 0.40, 0.17 ± 0.44, and 0.24 ± 0.58 at POM 1, 3, 6, 9, and 12, respectively (all P < 0.001). At POM 1, 3, 6, 9, and 12, complete success rates were 66.7%, 73.8%, 76.2%, 69.1%, and 71.4%, respectively. At POM 1, 3, 6, 9, and 12, qualified success rates were 71.4%, 82.0%, 85.3%, 83.3%, and 90.5%, respectively. Major postoperative complications include peripheral iris synechia, iris incarceration, and anterior chamber shallowing. Conclusions: CLASS with 5-FU shows safety and efficacy for decreasing IOP and the number of IOP-lowering medications over a 12-month follow-up period. It could be an alternative treatment for patients with OAG.

Changes of Neuroretinal Rim and Retinal Nerve Fiber Layer Thickness Assessed by Optical Coherence Tomography After Filtration Surgery in Glaucomatous Eyes.

PurposeLowering the intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) with filtration surgery can induce morphological changes to the bulbus and structures of the retina. In this study, we have evaluated changes of Bruch’s membrane-based parameters and retinal nerve fiber layer (RNFL) derived by spectral-domain optical coherence tomography (SD-OCT) in eyes that have undergone glaucoma filtration surgery.Patients and MethodsSD-OCT imaging of the optic nerve head (ONH) and of the RNFL was performed in 54 eyes of 54 patients with medically uncontrolled POAG before and after IOP-lowering surgery (trabeculectomy or deep sclerectomy). The ONH parameter minimum rim width (MRW) and the size of the Bruch’s membrane opening (BMO-Area) were derived from 24 radial B-scans centered on the ONH.ResultsThe average preoperative IOP was 23.1 ± 7.5 mmHg. One month postoperatively, the average IOP decreased to 12.1 ± 4.6 mmHg (p < 0.01), which caused a significant increase in the thickness of neuroretinal rim. There was no significant change in the automatically detected BMO-Area (p = 0.32). The pressure-related increase in MRW correlated well with the postoperative IOP and cup-to-disc ratio (CDR). In regression analysis, the alteration in thickness of the neuroretinal rim could be well predicted in a model including CDR, change of IOP and mean deviation (MD) (R2 = 0.414, p < 0.001). RNFL showed a significant increase as well.ConclusionIOP-lowering surgery in patients with medically uncontrolled POAG causes an increased thickness of the SD-OCT derived ONH parameters. The changes of the RNFL after surgery showed no significant correlations with IOP changes. In contrast to this, highly significant correlations of MRW values with the IOP could be observed. The BMO-Area remained completely stable A preferred use of RNFL for follow-up should be discussed.

Ab Interno Canaloplasty in Open-angle Glaucoma Patients Combined With In Vivo Trypan Blue Aqueous Venography.

To demonstrate canalogram patterns observed when trypan blue tracer is combined with oculoviscoelastic device during ab interno canaloplasty, and discuss surgical results and potential implications for diagnosis, prognosis, and treatment. This is a retrospective small case series study. The authors performed this procedure on 5 patients with informed consent with 4 to 18 months of follow-up. All procedures have been complication free. The average preoperative intraocular pressure was 16.4 mm Hg with an average number of topical glaucoma medications being equal to 3.6. Postoperatively, the average intraocular pressure for the group was reduced to 13 mm Hg with a concurrent drop in the average number of topical medications used equaling 1.8. Currently, there are limited practical options to evaluate the patency of the aqueous outflow system in our patients. The primary purpose of this paper is to describe canalogram patterns observed during ab interno canaloplasty with trypan blue. This technique may allow us to further our understanding of the aqueous outflow system and its role in the underlying pathophysiology of glaucoma. Further research is required to evaluate the prognostic and diagnostic significance of this technique.

Second-Generation Trabecular Micro-Bypass (iStent inject) with Cataract Surgery in Eyes with Normal-Tension Glaucoma: One-Year Outcomes of aMulti-Centre Study.

PurposeThe efficacy and safety of the trabecular micro-bypass stents (iStent and iStent inject) have been well documented in various open-angle glaucoma subtypes. However, their outcomes remain understudied in normal-tension glaucoma (NTG). The present study aimed to assess the 1-year outcomes related to the implantation of two second-generation trabecular micro-bypass stents (iStent inject) concomitant with cataract surgery (CE-TMS), exclusively in eyes with NTG.MethodsThis multi-center, consecutive case series included eyes with cataract and normal-tension glaucoma that underwent CE-TMS to reduce intraocular pressure or glaucoma medication use. The 12-month efficacy measures included change in average intraocular pressure (IOP) and medication burden. Safety included change in best-corrected visual acuity, cup-to-disc ratio, visual field mean-deviation and retinal nerve fiber layer thickness. Intra- or postoperative adverse events were noted.ResultsA total of 62 eyes with mild-to-severe NTG and average preoperative IOP of 15.82 ± 2.94 mmHg on 1.50 ± 1.28 glaucoma medications were included. Postoperatively, IOP declined by 22% from 15.82 ± 2.94 mmHg to 12.32 ± 2.58 (p < 0.001), all eyes had IOP ≤ 18 mmHg (versus 74% preoperatively), and half had IOP ≤ 12 mmHg (versus 15% preoperatively). Medication burden decreased by 70% from 1.50 ± 1.28 to 0.45 ± 0.86 (p < 0.001), and 73% of the eyes were medication-free (versus 23% preoperatively). Safety was favorable, with no evidence of sight-threatening adverse events.ConclusionImplantation of iStent inject (two second-generation trabecular micro-bypass stents) combined with cataract surgery is efficacious in reducing IOP and medication burden with a favorable safety profile in eyes with mild-to-severe NTG.

How to Predict Intraocular Pressure Reduction after Cataract Surgery? A Prospective Study

ABSTRACTPurpose/Aim: To evaluate the best formula to predict intraocular pressure (IOP) reduction after cataract surgery.Materials and methods: In this prospective longitudinal study, we included consecutive patients with or without glaucoma, either with open or with narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Clinical factors and anterior segment parameters measured with optical biometry and optical coherence tomography were evaluated as preoperative predictors for IOP reduction at 6 months postoperatively. To find the best combinations of predictors, model selection was conducted using least absolute selection and shrinkage operator regression with cross-validation.Results: A total of 156 eyes from 109 patients were enrolled. The mean age of the patients was 74.89 (±8.54) years and the average preoperative IOP was 15.6 (±3.68) mmHg with 0.7 (range 0–4) glaucoma medications. The mean IOP reduction after phaco was 3.1 (±2.49) mmHg at postoperative month 6. After multivariate analysis, preoperative IOP (β = 0.49 [0.4–0.59] P < .0001), gonioscopy score (β = −0.14 [−0.23 to −0.06] P = .0001), anterior chamber depth (β = −0.85 [−1.64 to −0.07] P = 0.033), lens thickness (LT) (β = 0.87 [0.12–1.62] P = .024), and angle open distance 750 (β = −2.2 [−3.96 to −0.44] P = 0.014) were associated with IOP reduction. The best formula to correlate with IOP reduction was −4.76 + (0.46 × preoperative IOP) – (0.42 × LT) – (0.1 × gonioscopy score) – (0.66 × glaucoma status).Conclusion: Different formulas were developed and were able to improve the predictive value of the preoperative IOP. When used in combination, these formulas may help the clinician to know how much IOP reduction to expect after cataract surgery at 6 months postoperatively.

Surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy and cataract surgery.

Purpose:To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery.Methods:A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications.Results:The average preoperative visual acuity of the patients was logMAR 1.57 ± 1.2, and the average postoperative visual acuity was logMAR 0.39 ± 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 ± 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 ± 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 ± 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 ± 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 ± 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony.Conclusion:Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.

Results of CO2 laser-assisted sclerotomy surgery (CLASS procedures) in eyes with primary open-angle glaucoma

Purpose This study aimed to examine the effectiveness of CO2 laser-assisted sclerectomy surgery (CLASS) in eyes with primary open-angle glaucoma (POAG) showing progression in spite of maximal local antiglaucomatous therapy. Materials and methods Patients with progressive POAG received CLASS treatment. We performed CLASS on 15 eyes (eight males and seven females). The primary endpoint was the change in the intraocular pressure (IOP), and additionally best spectacle-corrected visual acuity (BSCVA), C/D ratio (cup-to-disc), as well as use of antiglaucomatous drops were also investigated. Following the preoperative assessment, measurements were performed at 6-month follow-up. Results The average preoperative IOP was 26.13 ± 6.79 mmHg that dropped to 9.57 ± 4.09 mmHg at 1 day. IOP was stable at 1 month, 3 months, and 6 months. The BSCVA decreased to the 1-day and 1-week follow-up but returned to its original value to the 1-month check-up. Preoperatively, all patients were on maximal antiglaucoma drop therapy, after CLASS none of the patients needed antiglaucomatous treatment at 1 month. However, at 3 months, one of them needed antiglaucoma drops. C/D ratio showed non-significant changes. Conclusions CLASS procedure was found to be effective in decreasing IOP in POAG patients whose IOP was not compensated with maximal antiglaucomatous local therapy; patients needed significantly less local therapy following the CO2 laser surgery.

High intensity focused ultrasound cyclodestruction versus cyclodiode treatment of refractory glaucoma: A retrospective comparative study

To compare the efficacy of two cyclodestructive treatments for refractory glaucoma: High Intensity Focused Ultrasound (HIFU) cyclocoagulation and transscleral diode laser cyclophotocoagulation (cyclodiode). A retrospective comparative single centre study including all patients who underwent cyclodestruction for refractory glaucoma by either HIFU cyclocoagulation or cyclodiode. "Refractory glaucoma" was defined as an uncontrolled high IOP despite medical treatment and at least one filtering surgery. Uncontrolled high IOP was defined as an IOP≥16mmHg. The diagnosis of glaucoma was confirmed by automated visual field (VF) testing and peripapillary RNFL scans using a time-domain ocular coherence tomography device. Treatment success was defined as: postoperative IOP between 5mmHg and 21mmHg and IOP reduction greater than or equal to 20% as compared to preoperative values. Among the 99 eyes of 86 patients included in this study, 29 eyes were treated by cyclodiode and 70 eyes by HIFU. Median follow-up was 3 months (IQR 3-6) for the cyclodiode group and 6 months (IQR 3-8) for the HIFU group. Average preoperative intraocular pressure (IOP) was 34.3±11.1mmHg (cyclodiode group) and 23±6.8mmHg (HIFU group). The treatment success rate at last follow-up was 52% [34-70] for the cyclodiode group and 25% [15-35] for the HIFU group (P value=0.01). Kaplan-Meier survival analysis showed that the mean estimated time to failure was 5.9 months (4.4-7.5) for the cyclodiode group and 3.7 months (2.8-4.7) for the HIFU group (log-Rank test, P=0.02). A 2-line visual acuity loss was observed for 31% of the patients treated by cyclodiode and 17% for those treated by HIFU. In the cyclodiode group 4 cases of hypotony were reported vs. none in the HIFU group. The success rate was significantly higher for cyclodiode treatment as compared to HIFU cyclodestruction when treating refractory glaucoma. However, significantly fewer complications were observed with HIFU cyclocoagulation as compared to cyclodiode.

Novel Gonioscopy Score and Predictive Factors for Intraocular Pressure Lowering After Phacoemulsification.

To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery. This was a prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range, 0 to 16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP. In total, 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range, 0 to 4) glaucoma medications. The mean IOP reduction after phacoemulsification was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preoperative IOP [β=0.49 (0.41-0.58), P<0.0001], gonioscopy score [β=-0.17 (-0.24 to -0.09), P<0.0001], anterior chamber depth (ACD) [β=-0.88 (-1.64 to -0.14), P=0.02], and IOP/ACD ratio [β=0.45 (0.07 to 0.83) P=0.021] were associated with IOP reduction at 6 months. Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

Intraocular Pressure After Phacoemulsification in Open-angle Glaucoma Patients With Uncontrolled or Marginally Controlled Glaucoma and/or With Severe Visual Field Loss.

To evaluate intraocular pressure (IOP) after phacoemulsification in open-angle glaucoma (OAG) patients with uncontrolled or marginally controlled glaucoma and/or severe visual field (VF) loss. Retrospective case series of OAG patients without prior glaucoma surgery undergoing phacoemulsification. Uncontrolled or marginally controlled glaucoma was defined as IOP>21 mm Hg despite maximally tolerated medications or requiring >3 topical drugs for IOP control. Severe VF loss was defined as VF mean deviation ≤-12 dB. Eyes with postoperative IOP elevation were identified using 4 different definitions. Of 56 eyes (56 patients), 10 eyes (17.8%) had IOP elevation ≥10 mm Hg at postoperative day 1. At 1 year (N=45), the average preoperative IOP of 14.3±3.5 mm Hg decreased to 13.8±3.6 mm Hg (P=0.312), and number of medications of 3.2±1.1 decreased to 2.8±1.2 (P=0.165). Eleven eyes (24.4%) had increase in IOP of ≥3 mm Hg, whereas 14 eyes (31.1%) had decrease of ≥3 mm Hg. Nine eyes (20.0%) had higher IOP without medication changes and 9 eyes (20.0%) required additional medications or surgery for IOP control; 3 eyes (6.7%) required trabeculectomy. Higher IOP at 1 year was associated with IOP elevation ≥10 mm Hg at postoperative week 1 (P=0.020). Phacoemulsification resulted in nonsignificant 1-year IOP change in OAG patients with uncontrolled or marginally controlled glaucoma and/or with severe VF loss. Although 40% of eyes had higher IOP after phacoemulsification at 1-year postoperatively, only 6.7% required trabeculectomy.

Institution of a Surgical Curriculum for Trabecular Microbypass Stent Placement

Purpose This article evaluates whether a targeted, stepwise curriculum for microbypass stent placement leads to successful insertion of the iStent (Glaukos, Laguna Hills, CA) by resident surgeons. Participants Senior (postgraduate year 4) ophthalmology residents (9 residents) from three classes during the 2015 to 2016, 2016 to 2017, and 2017 to 2018 academic years. Design Residents participated in a three-stage surgical curriculum. First, a wet laboratory was held for residents to gain familiarity with the device and develop bimanual surgical proficiency. The wet laboratory involved several stations, with each station requiring increased dexterity for successful completion. Next, residents practiced bimanual intraoperative gonioscopy after routine phacoemulsification procedures. Finally, residents performed combined phacoemulsification and iStent insertion under the supervision of an experienced attending surgeon. Primary success was determined by correct anatomical placement of the device confirmed via subsequent intraoperative gonioscopy by the supervising surgeon. Secondary success was measured by change in intraocular pressure (IOP) and number of topical hypotensive medications used after surgery. Residents provided feedback about the effectiveness of the curriculum via an online survey. Results There were a total of 43 cases. There were no significant intraoperative complications, including hyphema. The iStent location was confirmed during both intraoperative and postoperative gonioscopy and was noted to be in appropriate position for the duration of the follow-up period (6–12 months) for all patients. Average preoperative IOP in our subjects was 17.5 ± 4.0 mm Hg and mean number of preoperative medications was 1.4 ± 1.0. At 6 months' postoperative, average IOP was 14.5 ± 2.2 mm Hg (13% reduction from baseline [±15%]). At 12 months' postoperative, average IOP was 14.4 ± 3.5 mm Hg, with a reduction of 14% (±18%). The mean number of medications at follow-up was 1.2 ± 1.1. Mean postoperative IOP at 6 and 12 months was significantly lower compared with baseline (p = 0.0002, p = 0.0001). Residents agreed that the curriculum prepared them to perform iStent insertion during residency and most residents felt prepared after residency. Conclusion This stepwise surgical curriculum for trabecular microbypass stent placement leads to successful performance of the procedure by residents and is a useful model for other residency programs.

Nursing of 8 combined surgeries for the treatment of nanophthahnos

Objective To summarize the nursing experience of lamellar sclera resection combined cataract extraction combined trabeculectomy surgeries for the treatment of nanophthahnos. Methods Eight patients (8 eyes) of nanophthalmos with secondary glaucoma who were treated in the department of ophthalmology of Beijing Tongren Hospital from February 2013 to December 2015 were selected. They were all performed with lamellar scleral resection combined with cataract extraction combined with trabeculectomy surgeries. Appropriate nursing care and comprehensive nursing were timely applied in the patients with postoperative ocular complications such as postoperative exclusive hemorrhage, malignant glaucoma, shallow anterior chamber, low intraocular pressure, choroidal detachment and so on. Results All the patients were followed up for six months, The average postoperative intraocular pressure was (17.9±3.6) mmHg, which was significantly lower than the average preoperative intraocular pressure (36.0±8.4mmHg, P<0.05) . Choroidal detachment was found in one patient (one eye) one day after the operation. Fundus hemorrhage was found in one patient (one eye) two days after the operation. The symptom was improved after the treatment. The clinical care overall satisfaction was 87.5%. Conclusions Appropriate nursing care for the complications in operation and after operation applied in the patients with combined surgeries for the treatment of nanophthalmos reduces the occurrence of complications in these patients and improve the clinical therapeutic effect. Key words: Nursing care; Lamellar sclera excision; Nanophthahnos

Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant.

AimTo evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study.Materials and methodsA retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success.ResultsA total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up.ConclusionThe M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time.Clinical significanceWhile the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design.How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

Heterologous, Fresh, Human Donor Sclera as Patch Graft Material in Glaucoma Drainage Device Surgery.

To determine the safety and efficacy of fresh, human sclera allografts as a patch graft material in glaucoma drainage device (GDD) surgery. Retrospective, noncomparative, interventional, consecutive case series. All GDD cases operated between 2008 and 2013 in which fresh human corneoscleral rims were used immediately after the central corneal button was used for penetrating or endothelial keratoplasty. Surgery was performed by 2 surgeons at 2 facilities. The Ahmed Glaucoma Valve (FP-7) was used exclusively in this cohort. Sixty-four eyes of 60 patients were identified; demographic data were recorded along with intraocular pressure (IOP), medication requirements, visual acuity, complications, and subsequent interventions. Incidence of complications. IOP and medication requirements at the last follow-up. Quilified success utilizing Tube Versus Trabeculectomy study criteria. The mean age of the cohort was 66.2±19.1 years; the average preoperative IOP was 33.2±11.1 mm Hg on 4.2±1.3 IOP-lowering agents before GDD surgery. IOP decreased significantly to 14.1±4.7 mm Hg (P<0.001) on 1.6±1.2 IOP-lowering agents (P<0.001) after an average follow-up of 18.2±15.4 months. There were no cases of early or late blebitis or endophthalmitis, and there was 1 case of conjunctival erosion and tube/plate exposure (1.6%) occurring 30 days after surgery. Qualified success was estimated as 90.5% and 81% at 1 and 2 years, respectively, using Tube Versus Trabeculectomy study criteria. Heterologous, fresh, human donor sclera appears to be a safe material for GDD tube coverage. It provides a cost-efficient alternative compared with traditional patch graft materials associated with a low risk of pathogen transmission.