Drainage Implants Research Articles

Primary implantation of glaucoma drainage device in secondary glaucoma: Comparison of Aurolab aqueous drainage implant versus Ahmed glaucoma valve.

Glaucoma drainage devices are invaluable in the management of secondary/ refractory glaucomas. This study aimed to compare the efficacy and safety of Aurolab Aqueous Drainage Implant (AADI) and the Ahmed Glaucoma Valve (AGV) in filtration-surgery-naïve secondary glaucoma eyes. For this purpose, a retrospective, comparative review was conducted on patients with secondary glaucoma (open and closed) who underwent primary tube procedures, either AADI or AGV. The primary outcome measure was intraocular pressure (IOP), and secondary measures included best-corrected visual acuity (BCVA), number of antiglaucoma medications (AGMs), and complications. This study included 59 eyes in the AADI group with a mean follow-up of 20.3 ± 12.9 months and 61 eyes in the AGV group with a mean follow-up of 19.8 ± 11.8 months. Preoperative IOP, AGM use, and BCVA did not significantly differ between the groups. However, at the last visit, both IOP and AGM use were significantly lower in the AADI group (12.9 ± 3.7 mmHg and 0.6 ± 0.9 vs. 15.7 ± 2.7 and 1.8 ± 1.0 respectively, all p < .001). Moreover, the AADI group exhibited a significantly higher rate of complete success (57.6%) compared to the AGV group (14.7%, p < .001); corresponding qualified success was 91.5% and 80.3%. Serious complication rates were comparable between the two groups. In conclusion, toth AADI and AGV procedures effectively reduced IOP and the need for AGMs. However, the reductions were significantly greater in the AADI group, which also showed a higher rate of complete success. Considering its affordability, AADI could have a substantial positive impact, particularly in resource-constrained settings.

Volume and Structure of the Population’s Need for High-Tech Ophthalmological Care in Azerbaijan

Purpose. Determine the volume and structure of high­tech ophthalmological care in Azerbaijan.Materials and methods. Materials from medical histories of patients hospitalized at the National Center of Ophthalmology named after Academician Z. Aliyeva (12 882 cases) for 2019 (from January 1 to December 31) were used. The need of hospitalized patients for high­tech ophthalmological care was determined in accordance with the list of types of high­tech medical care. The volume of demand of the population of Azerbaijan for GPs by type of indications and interventions was established per 100 thousand population with the determination of the average error of the indicator.Results. 14.5 ± 0.3 % of ophthalmological patients received high­tech ophthalmological care. The main types of high­tech ophthalmological care necessary to meet the needs of the population are transpupillary, microinvasive energetic optical­reconstructive and endovitreal 23.25 gage surgery for vitreoretinal pathologies of various origins (75.3 % of all types of operations; 16.63 ± 0.44 operations per 100 thousand population). The second place in the structure is occupied by complex surgical treatment of glaucoma, including microinvasive energy optical­reconstructive and laser surgery with possible implantation of silicone valve or metal drainage (11.3 % of all operations; 2.48 ± 0.17 operations per 100 thousand population).Conclusions. In Azerbaijan, the leading reasons for providing high­tech ophthalmological care are: cataracts complicated by lens luxation, glaucoma, pathology of the vitreous body, retina and choroid (27.0 % of all reasons; 5.96 ± 0.26 cases per 100 thousand population); retinal detachment and tears, tractional retinal detachment, other forms of retinal detachment in adults and children, complicated by pathology of the cornea, lens, vitreous body (22.1 % of all cases, 4.89 ± 0.24 cases per 100 thousand population). The most common type of hightech ophthalmological care is transpupillary, microinvasive energetic optical­reconstructive and endovitreal surgery for vitreoretinal pathologies of various origins (75.3 % of all types; 16.63 ± 0.44 cases per 100 thousand population).

Clinical study on the efficacy and safety of glaucoma drainage implants in the treatment of different types of glaucoma

Objective: To evaluate the efficacy and safety of glaucoma drainage implants(XEN-45 Gel Stent) for glaucoma treatment. Methods: A prospective study was conducted to continuously collect the clinical data of patients who were diagnosed with glaucoma and underwent XEN-45 Gel Stent implantation in the Ophthalmology Department of Peking University People's Hospital from January 2022 to August 2023. The visual acuity, intraocular pressure, number of glaucoma medications, and success rate of the patients were analyzed before and after surgery at 1 day, 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months. The differences in intraocular pressure and number of glaucoma medications among primary open-angle glaucoma, primary angle closure glaucoma, secondary glaucoma, and different implantation methods of XEN-45 Gel Stent among patients with primary open-angle glaucoma were compared. The intraoperative and postoperative complications were observed, and the risk factors for needling and surgical complete success were analyzed. Results: A total of 48 eyes from 48 patients were included in this study, comprising 27 males and 21 females, with a mean age of (54.4±18.0) years and the disease duration was 36.0(7.3, 81.0) months.There were 28 cases of primary open-angle glaucoma, 4 cases of primary angle closure glaucoma, and 16 cases of secondary glaucoma.The follow-up period was 8.0 (3.0, 12.0) months. At 12 months after surgery, the intraocular pressure decreased from 20.5 (17.0, 26.0) mmHg to (13.5±3.3) mmHg (P<0.05), and the number of glaucoma medications decreased from 3.0 (3.0, 4.0) to 0.0 (0.0, 0.0) (P<0.05). The complete success rate and qualified success rate were 73.9% (17/23) and 91.3% (21/23), respectively. The most common postoperative complications were shallow anterior chamber in 6 cases (12.5%), hypotony in 3 cases (6.3%), and blocked stent in 3 cases (6.3%). The most common postoperative treatment was needling in 27 cases (56.3%). There was no significant difference in intraocular pressure among different types of glaucoma. In the comparison of postoperative effects of different surgical implantation methods for primary open-angle glaucoma, there were no statistically significant differences in intraocular pressure and the number of glaucoma medications at other follow-up time points except 1 month after surgery (P<0.05). Univariate logistic regression analysis did not find any risk factors associated with needling and surgical complete success. Conclusions: XEN-45 Gel Stent implantation is an effective and safe surgical option for different types of glaucoma patients in China, which can significantly reduce intraocular pressure and the use of glaucoma medications and has a high success rate. However, some patients may need needling or other treatments after surgery.

New suture probe canaloplasty combined with suprachoroidal collagen implantation.

To present the modified surgery technique of new suture probe canaloplasty with a specially prepared monofilament 4.0 polypropylene suture combined with suprachoroidal drainage (ScD) and collagen sheet implantation for non-penetrating glaucoma surgery. Prospective study with a twelve months follow-up. A standard 4/0 polypropylene suture (ProleneTM by Ethicon; thickness: approximately 250m) is cut and shaped with an ophthalmic knife (MANI® Crescent Knife, Mani Inc 8-3 Kiyohara Industrial Park, Utsunomiya, Tochigi 321-3231, Japan) to create a blunt end without sharp or compressed edges. This improves suture probe canaloplasty by providing a more stable and smoother probing device. Schlemm's canal is prepared using the standard technique of canaloplasty with suprachoroidal drainage. Then, instead of using the canaloplasty microcatheter or the previously published 6/0 double-helix suture, Schlemm's canal is probed with the blunt ending of the 4/0 Prolene suture. After successful 360-degree probing, a doubled 10/0 polypropylene tension suture is threaded through the tip of the 4/0 suture. The 4/0 suture is then pulled back and the 10/0 tension sutures are tied at both ends to tension Schlemm's canal. A special collagen sheet (Ologen®) is placed in suprachoroidal space, and the scleral flap is firmly sewed. 115 eyes were included in this prospective study. In 113 cases the Schlemm's canal could completely be probed with the suture probe and canaloplasty with ScD and collagen sheet implantation succeeded. In two cases the intervention was transformed to 360-degree suture trabeculotomy due to an intraoperative cheese-wiring. Twelve months after successful new suture probe canaloplasty with ScD and Collagen Implantation the IOP had decreased by 37.1% (from 21.6 ± 6.0mmHg with 3.3 different IOP lowering eye drops to 13.5 ± 3.5mmHg with 1.0 eye drops). 16 Patients did not achieve sufficient IOP levels and underwent 360-degree suture trabeculotomy during the follow-up. One patient had to be treated with further glaucoma surgery to achieve a sufficient IOP level. Complications were hyphema, postoperative IOP elevation and transient hypotony. No serious or sight-threatening complications occurred. New suture probe canaloplasty with ScD and collagen sheet implantation yields the opportunity to conduct a cost-effective canaloplasty easier and less complicated than with the previously described method with the twisted 6/0 suture. The safety profile and IOP lowering effect is comparable. In cases where complete probing fails, there is still the opportunity to switch to suture trabeculotomy over the majorly probed part of Schlemm's canal. The pressure lowering effect of the deep sclerectomy with ScD and suprachoroidal collagen sheet implant seems to have an additional impact on the sufficient pressure lowering procedure.

Ahmed glaucoma valve implantation in glaucoma surgery

Glaucoma is the leading cause of irreversible blindness worldwide. Despite the large variety of treatment methods used in glaucoma, most researchers believe that surgery is the most effective way to normalize the level of intraocular pressure and preserve visual functions. Trabeculectomy and glaucoma drainage implantation are the most commonly performed glaucoma surgeries. Although trabeculectomy is the gold standard, at present time there is an uptrend in the use of glaucoma drainage devices. Ahmed glaucoma valve (AGV) is one of the most widely used glaucoma drainage devices in the world. This review of literature presents contemporary results of AGV implantation, possible complications and ways of optimizing that technique.

Novel Biomaterials in Glaucoma Treatment.

Glaucoma is a significant cause of blindness worldwide, and its treatment remains challenging. The disease progressively leads to damage to the optic disc and thus loss of visual acuity and visual field. High intraocular pressure (IOP) is a common risk factor. There are three major methods to treat this disease: topical, laser, and surgical. None of these are completely satisfactory; therefore, alternatives using new biomaterials are being sought. Since biomaterial engineering has experienced significant growth in recent decades, its products are gradually being introduced to various branches of medicine, with the exception of ophthalmology. Biomaterials, such as glaucoma drainage implants, have been successfully used to treat glaucoma. There is significant ongoing research on biomaterials as drug delivery systems that could overcome the disadvantages of topical glaucoma treatment, such as poor intraocular penetration or frequent drug administration. This article summarizes the use of novel biomaterials for glaucoma treatment presented in the literature. The literature search was based on articles published in English on PubMed.gov, Cochranelibrary.com, and Scopus.com between 2018 and 2023 using the following term "biomaterials in glaucoma." A total of 103 published articles, including twenty-two reviews, were included. Fifty-nine articles were excluded on the basis of their titles and abstracts.

Long-term results of combined surgery in patients with cataract and glaucoma

Aim. To evaluate the efficacy and safety of femtolaser-assisted phacoemulsification in combination of cataract and glaucoma in combination with NPDS in long-term follow-up.&#x0D; Materials and methods. A retrospective analysis of the results of the surgical treatment of patients with combined pathology of cataract and glaucoma was carried out. The groups of patients differed according to the method of surgical intervention: 1) phacoemulsification with NPDS and implantation of the Xenoplast drainage (49 eyes, 43 patients); 2) femtolaser-assisted phacoemulsification with NPDS and Xenoplast drainage implantation (27 eyes, 23 patients).&#x0D; Results. Before surgery, the average values ​​of corneal-compensated intraocular pressure (IOP cc), pressure equated to Goldman pressure (IOP g) and corneal hysteresis (CH) in group 1 were 27.99.9 mm Hg. Art., 27.78.9 mm Hg. Art., 7.03.0 mm Hg. Art.; in group 2 - 25.98.4 mm Hg. Art., 24.77.7 mm Hg, 7.72.1 mm Hg Art. 5 years after the surgical treatment, the average values ​​of IOP cc, IOP g and CH of the 1st group were 17.13.8 mm Hg. Art., 14.52.8 mm Hg. Art., 8.52.6 mm Hg. Art.; 2nd group - 15.13.3 mm Hg. Art., 15.34.7 mm Hg, 8.31.0 mm Hg Art. In both groups, normalization of IOP and CH was noted in the late postoperative period.&#x0D; Conclusion. Combined phacoemulsification with femtolaser accompaniment and non NPDS with Xenoplast drainage implantation is an effective and safe way to improve visual functions and normalize IOP with subsequent stabilization of the glaucoma process in the late postoperative period.

ND:YAG Laser Vitreolysis as The Management of Occluded Tube After Glaucoma Drainage Device Implantation (GDD)

Introduction : Glaucoma Drainage Devices (GDD) implantation surgery can be an alternative therapy for patients with uncontrolled IOP after trabeculectomy. However, tube occlusion is a common complication of GDD implantation. Management of tube occlusion can be done using laser or with surgery. This case presents the management of vitreous occlusion of tube implant using ND:YAG laser-vitreolysis.&#x0D; Case Illustration : A 63 year-old male patient came with chief complaint of pain in his right eye. The patient had a history of cataract surgery on the right eye and was diagnosed with glaucoma. An examination showed IOP in the right eye was increased, vitreous in COA and lens was aphakic with posterior capsule rupture. The patient had undergone trabeculectomy, but IOP remained high, so an Aurolab Aqueous Drainage Implant (AADI) GDD implantation was performed. However, six weeks after the procedure, the IOP still increased, and an examination revealed vitreous occlusion of the GDD tube (Figure 1) . The patient underwent Zeiss ND-YAG laser-vitreolysis on his right eye (Figure 2) with laser spot size of 50?m and power of 2.1 MJ. Post laser IOP was decreased.&#x0D; Discussion : GDD implantation is a surgical option for primary or secondary therapy, but tube occlusion can cause implantation failure. Laser-vitreolysis is a non- invasive modality to treat tube occlusion caused by vitreous.&#x0D; Conclusion : GDD occlusion can occur due to various etiologies, but laser-vitreolysis is a non-invasive treatment option aimed at restoring tube patency and aqueous outflow.

Long-Term Surgical Outcomes of Glaucoma Drainage Implants in Eyes with Preoperative Intraocular Pressure Less than 19 mmHg.

This retrospective review reports on patients who underwent glaucoma drainage implant (GDI) surgery and had baseline intraocular pressure (IOP) of ≤18 mmHg with at least one year of follow-up. Clinical data of 67 eyes of 67 patients were collected from patients' charts, and the outcomes of GDI were evaluated until 7 years. GDI failure was defined as IOP reduction of less than 20% from the baseline at two consecutive visits three months after surgery, decline to no light perception, or if additional glaucoma surgery was performed. The average age was 65.9 ± 13.2 years. Most cases were male (52.2%), White (53.7%), and had primary open-angle glaucoma (62.7%). Forty-four eyes had prior glaucoma surgery (68.6%) and 46 (68.6%) had severe glaucoma. Though postoperative (postop) IOP changes were insignificant, the average postop number of medications dropped from 2.4 ± 1.4 to 1.9 ± 1.2 medications two years after surgery (p = 0.0451). Postop complications (23.9%) included GDI exposure (7.5%), inflammation (4.5%), shallow anterior chamber (4.5%), and strabismus (1.5%). Hypotony was observed in 4 eyes (5.9%), none of which developed hypotony maculopathy. The cumulative one-year failure rate was 56.7%, most of which were due to failure to lower IOP. In patients with baseline IOP ≤18 mmHg who had GDI surgery, though the change in IOP was not statistically significant, the number of medications dropped and visual field progression slowed in a subset of patients with adequate perimetric data. Due to a relatively high rate of complications and limited effectiveness in lowering IOP, GDI should be cautiously used in these eyes.

Extraocular muscle bridle traction suture assisted Paul glaucoma implant surgery for severe conjunctival scarring

Abstract: Glaucoma drainage device implantation can be complex and challenging, particularly in patients with conjunctival scarring. However, in this case, involving a young man with refractory glaucoma who had undergone multiple ocular surgeries, the implantation of a Paul glaucoma drainage device was successfully performed after the application of extraocular muscle bridle sutures. The patient exhibited a stable intraocular pressure ranging from 12 to 18 mmHg without antiglaucoma medication during the 3-month follow-up period. Thus, this surgical technique improves the accuracy and ease of inferior-temporal quadrant glaucoma drainage implantation, resulting in good treatment outcomes.

Efficacy of drainage implants in combined cataract and glaucoma surgery

This study evaluates the hypotensive effect and visual function outcomes of combined surgery for complicated cataract and glaucoma using the mesh drain made of digeland the xenocollagen drain. Patients in Group 1 (n=43; 48.3%) underwent combined cataract and glaucoma surgery with implantation of the digel drainage implant, while patients in Group 2 (n=46; 51.7%) underwent an identical operation with the xenocollagen implant. Preoperative tonometric pressure was 27.2±1.7 and 27.3±1.9 mm Hg; best corrected visual acuity was 0.35±0.21 and 0.33±0.18, respectively. The following surgical technique was employed. At 3.0-4.0 mm from the limbus, an intrascleral tunnel was created using a 2.2 mm sclerotome through the conjunctiva in the anteroposterior direction, exiting into the anterior chamber. Capsulorhexis and phacoaspiration were performed. The scleral tunnel was widened to 3 mm, and the intraocular lens was implanted. Penetrating basal coloboma of the iris was formed. The deep flap of the scleral tunnel was dissected from the flat part of the ciliary body and removed. The digel implant was shaped into a T-configuration, while the xenocollagen implant was used without modification. Each drainage was implanted into the intrascleral tunnel (one end directed into the anterior chamber, the other exiting the scleral tunnel). The conjunctiva was sutured with 10/0 stitches, and the paracenteses were hydrated. Over a 24-month follow-up period, the tonometric intraocular pressure in Groups 1 and 2 was 18.8 and 18.5 mm Hg, respectively, and the best corrected visual acuity was 0.51 and 0.58. The use of both drainages in the proposed combined surgery for complicated cataract and glaucoma results in similarly stable hypotensive outcomes and high visual function.

Surgical Outcomes of Ahmed Glaucoma Valve and Aurolab Aqueous Drainage Implant in Nepalese Eyes: Comparison in the First Year.

Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.

Микроимпульсная циклофотокоагуляция в комбинированном лечении неоваскулярной глаукомы

Purpose. To evulate the efficiency of micropulse cyclophotocoagulation (MP-CPC) in the combined treatment of patients with secondary refractory neovascular glaucoma with object vision. Material and methods. The study involved 30 patients (30 eyes) with neovascular glaucoma (NVG) in the stage of partial or complete blockade of the iridocorneal angle with decompensated intraocular pressure (IOP) resistant to drug therapy, who had object vision. Two study groups were formed, 15 eyes each. The first main group is represented by patients whom performed MP-CPC (Cyclo G6 Glaucoma Laser System by IRIDEX), as a stage of combined treatment before implantation of Ahmed glaucoma valve (IAGV). The second control group included patients who initially were treated by this type of drainage surgery without preliminary micropulse laser exposure. The follow-up period was 18 months. Results. The implementation of MP-CPC in the main group led to a significant decrease in IOP on the 1st day after treatment from 27.5±6.1 to 23.6±4.6 mm Hg, with the maximum attainment of normal values on the 3rd day of observation, which averaged 20.3±4.4 mm Hg. (p&lt;0.05). By the end of the 1st month, an increase in mean IOP values to subcompensated values was recorded – 24.4±6.3 mm Hg. After valve drainage implantation, by the end of the 1st month of observation, IOP in the main group was 19 (16.5; 22.0) mm Hg, and in the control group it was 24.5 (20.5; 25.8) mm Hg. (p&lt;0.05). After 18 months of the postoperative period, the level of ophthalmotonus in the main group is 15.5 (15.0; 18.2), and in the control group – 16.5 (15.0; 19.5) mm Hg. (p&gt;0.05). A significant decrease in the amounts of hypotensive drugs in the main group was revealed: 1 (0; 2) versus 2 (1; 3) in the control group (p=0.03). In both groups, there was no significant deterioration in visual functions during the entire observation period. Conclusions. MP-CPC can be considered as a preliminary stage in the combined treatment of neovascular refractory glaucoma, as it reduces the risk of preoperative ophthalmohypertension before valve surgery, leads to a significant decrease in the amounts of hypotensive drugs in the late postoperative period, thereby improving the effectiveness treatment of patients with neovascular refractory glaucoma who have object vision. Key words: micropulse cyclophotocoagulation, neovascular glaucoma, valve's Ahmed

Efficacy and Safety of an Adjustable Glaucoma Drainage Device (eyeWatch System) for Refractory Glaucoma: A 2-Year Prospective Study.

In this study, we report a 2-year follow-up after implantation of an adjustable glaucoma drainage device combined with a novel orbital filtering plate. The IOP was efficiently controlled postoperatively with limited complications and an excellent safety profile. To report the clinical results at 2 years after implantation of an eyeWatch (eW) system, which comprises an adjustable glaucoma drainage device (eW implant) combined with a novel orbital filtering plate (eyePlate), in refractory glaucoma. Monocentric, prospective, noncomparative clinical trial. Patients suffering from refractory glaucoma after several failed surgeries were operated using the eW system. The primary outcome was the success rate, defined as an IOP ≤18mmHg and reduction of more than 20% from baseline, IOP ≥6mmHg. Secondary outcomes were mean IOP, visual acuity, the number of antiglaucoma medications, and the number and type of complications. Forty-two eyes from 42 patients were included. The mean follow-up time was 22.0±4.0 months. The mean baseline IOP decreased from 23.2±7.2mmHg before surgery to 11.9±4.4mmHg at 12 months ( P <0.001) and 11.5±3.0 at 24 months. The mean number of glaucoma medications decreased from 2.9±0.9 before surgery to 0.7±0.9 at 12 months ( P <0.001) and 1.0±0.9 at 24 months. The qualified success rate was 93% at 12 months and 90% at 24 months whereas the complete success rate was 46% and 40% at 12 and 24 months, respectively. Complications occurred in 7 patients. Implantation of the eW system effectively lowered IOP and reduced glaucoma medications for a 2-year period in patients who had previously failed glaucoma surgery. Persistent hypotony was not observed and the number of complications was low.

Оценка выживаемости трансплантата после ФЛ-ЗПК (FS-DSEK) у пациентов с глаукомой

Purpose. To evaluate the graft survival in the dynamics of the postoperative period of FS-DSEK in patients with concomitant glaucoma. Material and methods. In total 52 eyes were operated, 32 of them with glaucoma compensated by medication (1st group), 8 with glaucoma operated by implantation of the Ahmed valve model FP8 (2nd group) and 12 with glaucoma operated by microinvasive non-penetrating deep sclerectomy with implantation of collagen antiglaucoma drainage (3rd group). All patients have a follow-up of 12 months. Results. By 1 year, the «cornea + graft» complex retained its transparency in group 1 in 84.4% of eyes (27 out of 32 eyes), in group 2 in 87.5% of cases (7 out of 8 eyes), in group 3 in 75% of cases (9 out of 12 eyes). The highest percentage of endothelial cell loss at 12 months was observed in 2nd group (Ahmed valve) – 45,4±19,5%. In other groups, endothelial cell loss was 41,8±9,1% (group 3) and 39,6±15,2% (1st group). Conclusion. Clinical results show a lower percentage of graft survival after FS-DSEK in the operated glaucoma groups. Accumulation of clinical material and further study of patterns are required. Key words:posterior lamellar keratoplasty, glaucoma, femtosecond laser, endothelial corneal dystrophy

Glaucoma in Axenfeld–Rieger Syndrome. A Clinical Case

Background: AxenfeldRieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with AxenfeldRieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with AxenfeldRieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.

Post-keratoplasty glaucoma—Tackling tube exposure

Glaucoma drainage implants (GDI) are sometimes used in the treatment of refractory glaucoma associated with keratoplasty. An important complication of GDI is the exposure of the drainage tube. Two patients presented after penetrating keratoplasty and Ahmed glaucoma valve, with exposure of the GDI tube following prolonged topical steroid usage. This report addresses the risk factors and early signs of tube exposure that guide its prevention and management.

Keratokonus, Sklerallinsen und Glaukom-Drainage-Implantat

Purpose. This case report describes scleral lens fitting for advanced keratoconus in combination with additional glaucoma surgery. Material and Methods. The implantation of a drainage implant was followed by the bilateral fitting of scleral lenses. For contact lens fitting, it was essential to work with a scleral lens system that allows individual zone size and edge clearance in the scleral alignment zone to prevent provocation of the postoperative area. Results. Due to the individualized design of the scleral lenses, the patient was able to wear scleral lenses again postopera- tively with successful implantation of a drainage implant. A prerequisite for this was also that the surgeon considered the necessity of a later postoperative fitting with scleral lenses when choosing the surgical method. Conclusion. Scleral lenses can also be successfully fitted in cases of complex corneal shapes and surgical procedures on the eye. This requires not only a great clinical experience in fit- ting such contact lenses, but also an individual manufacturing of the contact lenses based on the contact lens parameters specified by the contact lens specialist. Keywords drainage implant, scleral lens with peripheral torus, zone size, x-value

Pirfenidone release from ophthalmic implants – perspectives for a drug-eluting microstent for glaucoma therapy

Abstract Elevated intraocular pressure is the main risk factor for glaucoma and its adjustment to physiological levels can prevent progression of the disease. If conventional drop-based glaucoma therapy fails, surgical interventions such as trabeculectomy or the application of implants, which drain aqueous humour from the eye and thus reduce intraocular pressure, are used as final therapeutic procedures. These interventions are becoming increasingly minimally invasive and the drainage implants are getting steadily smaller, which is why these interventions are now called microinvasive glaucoma surgery (MIGS). Both, surgery and drainage implant-based glaucoma therapy are limited by wound healing processes and fibrosis that occlude the newly created drainage pathways for the aqueous humour. To suppress unwanted postoperative fibrosis coupled with an increased extracellular matrix production, cytostatics like mitomycin c or 5- fluorouracil are currently used, which are associated with side effects. Therefore, more specific antifibrotic agents are key for a durable functionality of the interventions in glaucoma therapy. In this study a specific active substance (pirfenidone, PFD) was added in a polymer matrix for controlled release. Previous studies have shown that the release of pirfenidone from a thermoplastic silicone polycarbonate elastomer, which could be used as a material for a glaucoma drainage implant, has been relatively fast. To decelerate the release the influence of the alternate polymers Poly-L-Lactide (PLLA) and Poly-D,LLactide (PDLLA) as alternative drug carriers was investigated. Furthermore, a reduction of the pirfenidone content was used to delay the release.

A comparative study on clinical outcome of conventional trabeculectomy and glaucoma drainage device in a tertiary health care center

BACKGROUND: Glaucoma is becoming a more common cause of blindness as the world's population ages. Glaucoma, the second largest cause of blindness worldwide, accounts for approximately 15% of all blindness. However, it poses an even more significant public health concern than cataracts because the blindness it produces is irreversible. This study aims to compare the clinical outcomes of traditional trabeculectomy and glaucoma drainage devices. METHODOLOGY: This is a hospital-based study of 30 patients in which we compare clinical results after conventional trabeculectomy and implantation of a glaucoma drainage device. Intraocular pressure will be measured by an Applanation tonometer and best-corrected visual acuity testing will be performed in all patients. The data will be compared, and statistical analysis will be done. EXPECTED RESULTS: Patients with Glaucoma drainage implants will have better IOP control.