Higher Preoperative Intraocular Pressure Research Articles

Role of lens extraction and laser peripheral iridotomy in treatment of glaucoma.

Lens extraction in people with coexisting cataract and open angle glaucoma is associated with a reduction in intraocular pressure (IOP). In primary angle-closure glaucoma (PACG), lens extraction and laser peripheral iridotomy (LPI) can be used to open the anterior chamber angle, increase the outflow through the trabecular meshwork and reduce the IOP. The present review will summarize the recent available literature regarding the role of both interventions for the treatment of glaucoma. Recent articles have confirmed the effect of cataract surgery as an IOP-lowering procedure in people with coexisting cataract and glaucoma, and highlight that the most important predictor for a greater decrease is a higher preoperative IOP. The probability for achieving a significant IOP reduction is highest in PACG and pseudoexfoliation glaucoma. Clear lens extraction (CLE) is associated with better clinical and quality of life outcomes than laser peripheral iridotomy (LPI) in patients with early or moderate PACG and those with primary angle closure and IOP over 30 mmHg. There is no high-quality evidence to support LPI in the treatment of pigmentary glaucoma. Evidence from the assessed period supports the IOP-lowering effect of cataract surgery in people with coexisting cataract and glaucoma. CLE is an option in the initial treatment of some patients with PACG as its superiority has been demonstrated against LPI.

Comparison of Outcomes between Endoscopic and Transcleral Cyclophotocoagulation.

Importance: Traditionally cyclophotocoagulation has been reserved as a treatment of last resort for eyes with advanced stage glaucoma, but increasingly it is offered to eyes with less severe disease. Endoscopic approaches in particular are utilized in increasing numbers of patients despite only a small number of publications on its results. Objective: The purpose of this study was to compare the efficacy and safety of endoscopic and transcleral cyclophotocoagulation (ECP and TCP) procedures in eyes with refractory glaucomas. Design, Setting, and Participants: A chart review was performed on consecutive patients who underwent ECP and TCP at a tertiary ophthalmology care center between January 2000 and December 2010. Cases with fewer than 3 months of follow-up or that had concurrent pressure reducing procedures were excluded. The main outcome measures examined were intraocular pressure (IOP), number of glaucoma medications, best corrected visual acuity (BCVA), additional glaucoma procedure required, and complications. Main Outcomes and Measures: Forty-two eyes (42 patients) that underwent ECP and forty-four eyes (44 patients) that underwent TCP were identified. The TCP group had a statistically higher mean age (71.2 ± 16.7 vs. 58.1 ± 22.9 years, respectively), larger proportion of neovascular glaucoma (40.9% vs. 16.7%), worse initial BCVA (logMAR 2.86 vs. 1.81), and higher preoperative IOP (45.3 vs. 26.6 mmHg) than the ECP group. At 12 months follow-up, the mean IOP difference between groups was not statistically significant, although the change in IOP from baseline to 12 months was greater for the TCP group (p = 0.006). The rates of progression to no light perception (NLP) and phthisis bulbi were significantly higher amongst TCP eyes than ECP eyes (27.2% vs. 4.8%, p = 0.017, and 20.5% vs. 0%, p = 0.003, respectively). Of these eyes that progressed, a majority had neovascular glaucoma (NVG). Corneal decompensation was the most frequent complication following ECP (11.9%). Conclusions and Relevance: In patients with preoperative BCVA of 20/400 or better, overall complication rates (cystoid macular edema, exudative retinal detachment, inflammation, cornea decompensation) were higher after ECP than with TCP. In refractory glaucomas in a real world setting (not a trial), TCP was more frequently used in ischemic eyes. TCP was associated with a higher rate of progression to phthisis bulbi and loss of light perception than ECP. However, ECP was associated with a clinically significant rate of corneal decompensation. These outcomes likely were related to the severity of underlying ocular diseases found in these eyes.

A Randomized Controlled Trial Comparing Outcomes of Cataract Surgery in Nanophthalmos With and Without Prophylactic Sclerostomy

To prospectively evaluate visual outcomes and complications during and after cataract surgery with or without prophylactic sclerostomy in nanophthalmic eyes with visually significant cataract. Randomized controlled trial. Sixty nanophthalmic eyes of 60 patients with visually significant cataract were randomly assigned to cataract surgery alone (control group, n= 31) or cataract surgery with concomitant prophylactic sclerostomy (sclerostomy group, n= 29). Surgery was performed using phacoemulsification or manual small-incision cataract surgery (SICS) based on the LOCS III grading score. Group differences in intraoperative and postoperative complications were analyzed and risk factors assessed. Fewer complications were noted in eyes receiving sclerostomy (5/29, 17.2%) as compared to control group eyes (12/31, 38.7%), though differences were marginally significant (P= .065). Four control group, but no sclerostomy group, eyes developed postoperative uveal effusions (P= .04). In multivariable models, sclerostomy decreased the odds of an intraoperative or postoperative complication by 80% (odds ratio [OR]= 0.2, 95% confidence interval [CI]= 0.04-0.92, P= .039); SICS was associated with a significantly higher risk of complications as compared to phacoemulsification (OR= 5.95, 95% CI= 1.49-23.73, P= .012), while high preoperative intraocular pressure (OR= 4.54, 95% CI= 0.99-20.9, P= .052) and greater lens thickness (OR=3.38, 95% CI= 0.88-12.91, P= .075) demonstrated a marginally significant association. Cataract surgery in eyes with nanophthalmos is associated with a high risk for vision-threatening complications. Performing a simultaneous prophylactic sclerostomy with cataract surgery reduces complication rates, particularly uveal effusions. Cataract surgery at earlier stages by phacoemulsification may be more beneficial than undergoing manual SICS.

Early Trabeculotomy Ab Externo in Treatment of Sturge-Weber Syndrome

To evaluate the intermediate-term efficacy and safety of trabeculotomy in infant Sturge-Weber syndrome (SWS). Retrospective cohort study. All SWS-induced glaucoma patients less than 12months of age who underwent trabeculotomy at our Ophthalmology Department from August 2011 to March 2017 were reviewed. Baseline demographics, intraocular pressure (IOP), cup-to-disc ratio (C/D), and cornea diameters were noted before surgery. The IOP, success probabilities, and medication usage were recorded during follow-up until the last visit. Overall, 34 eyes (32 patients) were included, with a median surgery age of 3months and a median follow-up time of 15.5months. The mean preoperative IOP, asymmetry between 2 eyes, cornea diameter, and median C/D were 21.5 ± 6.6mm Hg, 10.1 ± 4.9mm Hg, 12.6 ± 0.7mm, and 0.65 (interquartile range [IQR]: 0.55, 0.80), respectively. The IOP was significantly reduced from the preoperative baseline at 1week, 3months, 6months, 1 year, and 2 years after the surgery (P < .05). At the last follow-up, the cumulative proportions of overall and complete success were 86.6% and 66.0%, respectively. Complications included a transient shallow anterior chamber. Thirty of the 34 eyes had intraoperative hyphema, 27 of which lasted less than 3days. No other complications were noted during the follow-up. Compared to previous studies with a later diagnosis of glaucoma in SWS patients, better outcomes were achieved with an early diagnosis of glaucoma in SWS patients. Early trabeculotomy ab externo was safe and led to good intermediate-term surgical outcomes for early-onset glaucoma in SWS patients. Higher preoperative IOP and corneal edema were associated with a greater risk of surgery failure.

Intraocular pressure change after phacoemulsification in angle-closure eyes without medical therapy

To evaluate the intraocular pressure (IOP) change and associated factors 6months after phacoemulsification in eyes with primary angle-closure suspect (PACS) and eyes with primary angle closure (PAC) that had no medical therapy. Singapore National Eye Center, Singapore, Singapore. Retrospective case series. Patients with PACS or PAC (with corrected distance visual acuity <20/40) who had uneventful phacoemulsification were recruited.Patients were excluded if they were on IOP-lowering medications within 6months preoperatively and postoperatively. Preoperative gonioscopy, A-scan biometry, anterior segment optical coherence tomography, and automated refraction were reviewed. Factors related to the percentage of and absolute IOP change were assessed using multiple linear regression analyses after adjusting for age, sex, and diagnosis. The study evaluated 85 patients (85 eyes; 52 PACS, 33 PAC) after 7 eyes (1 PACS, 6 PAC) were excluded because of poor quality imaging. Overall, IOP decreased by 19.9% from the preoperative mean of 16.1mm Hg±3.1 (SD) to 12.9±2.7mm Hg. The IOP change between the PACS group (-3.3±2.8mm Hg; -20.6%) and the PAC group (-3.2±4.7mm Hg; -19.6%) was similar (P>.05). In multiple linear regression analyses, a higher preoperative IOP (β=0.68, P<.001) and fewer clock hours of peripheral anterior synechiae (PAS) (β=-0.30, P=.03) predicted a greater absolute change in and percentage of reduction in IOP, respectively. The mean IOP reduction 6months after phacoemulsification was 20%. Less IOP reduction was observed in the presence of lower preoperative IOP and more extensive PAS.

A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives.

Selective laser trabeculoplasty (SLT) has been widely used in the clinical management of glaucoma, both as primary and adjunctive treatment. As new evidence continues to arise, we review the current literature in terms of indications and efficacy, surgical technique, postoperative care, repeatability, and complications of this therapy. SLT has been shown to be effective in various glaucomas, including primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG), steroid-induced glaucoma, pseudoexfoliation glaucoma (PXFG), and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes. Relatively high preoperative intraocular pressure (IOP) may predict surgical success, while other parameters that have been studied do not seem to affect the outcome. Different techniques for performing the procedure have recently been explored, revealing that minor modifications may lead to a more favorable or safer clinical outcome. The utilization of postoperative medications remains controversial based on the current evidence. A short-term IOP increase may complicate SLT and can also persist in certain cases such as in exfoliation glaucoma. The efficacy and safety of repeat SLT are shown in multiple studies, and the timing of repeat procedures may affect the success rate.

Short-Term Clinical Results of Ab Interno Trabeculotomy Using the Trabectome with or without Cataract Surgery for Open-Angle Glaucoma Patients of High Intraocular Pressure.

Purpose. To assess the safety and efficacy of Trabectome procedure in patients with preoperative intraocular pressure (IOP) of 30 mmHg or higher. Methods. All patients who had underwent Trabectome stand-alone or Trabectome combined with phacoemulsification were included. Survival analysis was performed by using Kaplan-Meier, and success was defined as IOP ≤ 21 mmHg, 20% or more IOP reduction from baseline for any two consecutive visits after 3 months, and no secondary glaucoma surgery. Results. A total of 49 cases were included with an average age of 66 (range: 13–91). 28 cases had Trabectome stand-alone and 21 cases had Trabectome combined with phacoemulsification. Mean IOP was reduced from a baseline of 35.6 ± 6.3 mmHg to 16.8 ± 3.8 mmHg at 12 months (p < 0.01∗), while the number of medications was reduced from 3.1 ± 1.3 to 1.8 ± 1.4 (p < 0.01∗). Survival rate at 12 months was 80%. 9 cases required secondary glaucoma surgery, and 1 case was reported with hypotony at day one, but resolved within one week. Conclusion. Trabectome seems to be safe and effective in patients with preoperative IOP of 30 mmHg or greater. Even in this cohort with high preoperative IOP, the end result is a mean IOP in the physiologic range.

Clinical Analysis of Ocular Parameters Contributing to Intraoperative Pain during Standard Phacoemulsification.

Purpose. To study the correlation between ocular parameters and subjective pain that patients perceived during phacoemulsification. Methods. Medical records of 142 patients who underwent standard phacoemulsification under topical anesthesia between March and August 2016 were retrospectively reviewed. The pain during phacoemulsification and 1 h after surgery was assessed and compared using a visual analog scale. In addition, demographic data, preoperative biometric parameters, and intraoperative surgical parameters were recorded. Results. Mean age of patients was 67.49 ± 12.50 years. The mean pain score was 2.26 ± 0.85 during phacoemulsification and 0.40 ± 0.69 postoperatively. Intraoperative pain was significantly associated with higher preoperative intraocular pressure (β = 0.220, P = 0.016), greater anterior chamber depth (β = 0.210, P = 0.028), and greater axial length (β = 0.181, P = 0.043). Conclusions. To reduce the subjective pain when patients have high preoperative intraocular pressure, large anterior chamber depth, or great axial length, supplementary procedures may be required.

Selective laser trabeculoplasty for early glaucoma: analysis of success predictors and adjusted laser outcomes based on the untreated fellow eye.

BackgroundTo identify success predictors and to study the role of the fellow untreated eye as a co-variable for adjustment of intraocular pressure (IOP) outcomes following selective laser trabeculoplasty (SLT) in early open-angle glaucoma (OAG) patients.MethodsA case series was carried out. Patients with uncontrolled early OAG or ocular hypertension (inadequate IOP control requiring additional treatment) underwent SLT (one single laser session) performed by the same surgeon in a standardized fashion. The same preoperative medical regimen was maintained during follow-up for all patients. Post-treatment assessments were scheduled at week 1 and months 1, 2, and 3. In order to account for possible influence of IOP fluctuation on laser outcomes, post-laser IOP values of the treated eye of each patient were also analyzed adjusting for IOP changes (between visits variation) of the untreated fellow eye (adjusted analysis). Pre and post-laser IOP values were compared using paired t-test. Factors associated with the magnitude of IOP reduction were investigated using multiple regression analysis.ResultsA total of 45 eyes of 45 patients were enrolled. Mean IOP was reduced from 20.8 ± 5.1 to 14.9 ± 2.9 mmHg at month 3 (p < 0.001). Adjusted success rate (defined as IOP reduction ≥ 20%) was 64% and mean percentage of IOP reduction was 23.1 ± 14.3% at last follow-up visit. Considering unadjusted post-laser IOP values, it was found a 20% greater absolute IOP reduction (median [interquartile range] 6 mmHg [4–7] vs 5 mmHg [3–7]; p = 0.04), with a success rate of 76%. Although baseline IOP was significantly associated with both adjusted and unadjusted post-laser IOP reduction, a stronger association was found when unadjusted IOP values were considered (p < 0.001 and R 2 = 0.35; p < 0.001 and R 2 = 0.67, respectively). Age, mean deviation (MD) index, central corneal thickness and type of glaucoma were not significant predictors (p ≥ 0.150).ConclusionsIn this group of patients with early OAG or ocular hypertension, our short-term results confirmed SLT as a safe and effective alternative for IOP reduction. Although better outcomes were found in eyes with higher preoperative IOP, this effect was mitigated when results were adjusted to the fellow untreated eye (to the influence of between visits-IOP fluctuations).

Treatment Outcomes and Prognostic Factors of Selective Laser Trabeculoplasty for Open-angle Glaucoma Receiving Maximal-tolerable Medical Therapy.

To evaluate the efficacy of selective laser trabeculoplasty (SLT) for patients with open-angle glaucoma receiving maximal-tolerable medical therapy. Consecutive patients with open-angle glaucoma who were followed up for at least 1 year after SLT were retrospectively evaluated. The effectiveness was assessed using Kaplan-Meier survival analysis with 2 criteria for failure: (1) intraocular pressure (IOP) equal to or more than baseline; and (2) <20% reduction from baseline, on 2 consecutive visits. Those 2 failure criteria also included loss of light perception, reoperation of SLT, and glaucoma surgery. Influence of baseline factors on success were assessed using mixed-effects Cox proportional hazard models. Seventy-five eyes [39 primary open-angle glaucoma, 23 exfoliation glaucoma, and 13 secondary open-angle glaucoma (SOAG)] of 59 patients (21 females) aged 65.5±15.9 (mean±SD) were included. Preoperative mean IOP was 23.3±6.5 mm Hg with 3.4±1.3 IOP lowering medications. The overall success ratio at the end of study period was 45.3% by criterion 1 and 14.2% by criterion 2. The success ratio by criterion 1 and 2 was 61.1% and 21.7% in primary open-angle glaucoma, 29.3% and 14.5% in exfoliation glaucoma, and 15.4% and 7.7% in SOAG, respectively. Higher preoperative IOP and diagnosis of SOAG were significantly associated with treatment failure (P<0.01 and 0.04, respectively). One-year efficacy of SLT in controlling IOP was very limited in patients with maximal-tolerable medical therapy. Types of glaucoma and preoperative IOP were significant prognostic factors for treatment success.

Reduction of the Lamina Cribrosa Curvature After Trabeculectomy in Glaucoma.

To investigate whether the lamina cribrosa (LC) curvature is decreased after trabeculectomy. Thirty-nine eyes of 39 patients with primary open-angle glaucoma who underwent trabeculectomy were included. Optic nerves were scanned by using enhanced-depth-imaging spectral-domain optical coherence tomography before and after trabeculectomy. The LC curvature was assessed by measuring the LC curvature index (LCCI) in seven horizontal B-scan images in each eye. The LCCI was significantly smaller at postoperative 6 months than at the preoperative level in all seven planes (all P < 0.001). Preoperative LCCI was associated with younger age at superior midperiphery, midhorizontal plane, inferior midperiphery (all P ≤ 0.005) and higher preoperative intraocular pressure (IOP) at superior and inferior midperiphery (both P = 0.039). Younger age and larger preoperative LCCI were associated with a larger reduction of the LCCI at all three locations (P = 0.003 and 0.031 at superior midperiphery, P = 0.011 and 0.001 at midhorizontal plane, and P = 0.014 and 0.005 at inferior midperiphery, respectively), whereas the percentage IOP lowering was associated at superior and inferior midperiphery (P = 0.017 and 0.047, respectively). Lamina cribrosa curvature was reduced after trabeculectomy. This finding suggests that LC curvature may have value as a parameter relevant to optic nerve head biomechanics.

Effect of suture canalization on the treatment of primary open-angle glaucoma: 3 years clinical observation

To evaluate the safety and effectiveness of the Suture Canalization, which is a kind of Schlemm canal surgery, on the treatment of patients with primary open angle glaucoma (POAG). Retrospective cases series study. Fifty-two patients (52 eyes) with POAG were recruited from October 2007 to July 2009 from Hospital of Optometry and Ophthalmology, Wenzhou Medical University. Twenty-six patients (26 eyes) were included in the study group, who were treated with the Suture Canalization surgery with trabeculectomy. Twenty-six patients (26 eyes) were included as the control group, who were treated with trabeculectomy only. Best correct visual acuity (BCVA), intraocular pressure (IOP), bleb morphology, postoperative treatment of medicine of anti-glaucoma and complications of surgery were recorded at 1 d, 1 week, 1, 3, 6, 12, 18, 24, 30 and 36 months after surgery. After testing the normality and homogeneity of variance of the data of the multiple sets of measurement data, the variance analysis was adopted, and the t test was used in the comparison of two groups. Counting data using chi-square test, the level of variables between the groups should be compared with the rank sum test. No significant difference was found in baseline data, as well as the changes of BCVA between the study group and control group at the last visit (χ(2)=3.06, P=0.08) . Complete and qualified success was achieved in 18 (69.2%) and 23 (88.5%) cases separately in study group, 16 (61.5%) and 22 (84.6%) cases separately in control group (χ(2)=0.17, P=0.69) . There was no significant difference between two groups. IOP was decreased post-operatively: from (32.4±9.3) mmHg(1 mmHg=0.133 kPa)to (16.9±3.5) mmHg at the last visit in study group and (31.3±10.0) mmHg to (15.5±4.6) mmHg at the last visit in control group. There were significant difference between last visit and preoperative IOP between two groups (study group: t=8.12, P<0.01; control group: t=7.20, P<0.01). No significant difference was found between two groups in the decreased amplitude of IOP with treatment at the last visit (t=0.23, P=0.63), as well as the postoperative IOP at the different visits (P>0.05). 65.4% of cases in the study group and 61.5% patients in control group formed functional blebs (diffuse type and microcapsule type) at the last visit. No significant difference between the IOP of patients with functional blebs (15.5±3.5) mmHg and those with non-functional blebs (16.0±3.4) mmHg in study group at the last visit (t=-0.49, P=0.64). No serious complications during and after surgery were found in subjects of the both groups. No significant difference was present in medicine amounts at last visit between the two groups (t=2.93, P=0.09). Suture Canalization is a safe and effective surgical procedure to decrease intraocular pressure in patients with POAG, through Schlemm canal and external filtration. While it maybe not suitable to the patient with high pre-operative IOP.(Chin J OPhthalmol, 2016, 52: 416-421).

Effect of intraoperative factors on IOP reduction after phacoemulsification

The purpose of the study was to determine the independent predictors of long-term intraocular pressure (IOP) reduction after cataract surgery with phacoemulsification. This is a retrospective review of uncomplicated cataract surgeries from 2006 to 2008 at the Baltimore VA Medical Center with longitudinal follow-up. Demographic, clinical, biometric, and intraoperative variables including phacoemulsification parameters were recorded. Univariate and multivariate linear regression were used to analyze the relationship between these variables and postoperative IOP, which was the outcome variable. Analysis was performed in 115 eyes of 115 patients who underwent uncomplicated phacoemulsification during the study period. There was an average postoperative IOP reduction through 12, 24, and 36months of -1.7±3.1, -1.5±3.8, and -1.3±2.6mmHg, respectively. Higher preoperative IOP (P<0.001), a more anterior relative lens position (P<0.05), and longer phaco time (P<0.05) were significantly associated with greater postoperative decrease in IOP using univariate analysis. Using multivariate analysis, preoperative IOP (P<0.001), and phaco time (P=0.038) were associated with greater postoperative IOP reduction through 24months. Phaco time is independently associated with IOP reduction after adjusting for age and preoperative IOP. Higher preoperative IOP is associated with a greater IOP-lowering effect after phacoemulsification.

Hypertensive Phase Following Silicone Plate Ahmed Glaucoma Valve Implantation.

To estimate the incidence of hypertensive phase (HP) following silicone plate Ahmed glaucoma valve implantation and to explore the risk factors for developing HP. A total of 325 eyes from 325 patients who underwent Ahmed glaucoma valve implantation for uncontrolled intraocular pressure (IOP) and were followed for at least 1 year were included. The HP was defined as IOP>21 mm Hg (with or without IOP-lowering medication) during the first 3 months after surgery. Eyes were divided into HP and non-HP development groups. Overall success was defined as reaching an IOP>5 and <22 mm Hg with (qualified success) or without (complete success) use of an IOP-lowering medication. Risk factors associated with HP development were determined by logistic regression analysis. Among 325 eyes, 101 eyes (31.1%) experienced HP. For 24 eyes (23.8%), HP had not resolved by postoperative year 1. The HP group showed a significantly higher mean preoperative IOP than the non-HP group (37.1 ± 11.4 vs. 32.3 ± 11.2 mm Hg, P=0.004). The overall success rate was not significantly different between groups (81.2%, HP group vs. 89.7%, non-HP group; P=0.111); however, the complete success rate was significantly higher in the non-HP group (26.7% vs. 43.3%, P=0.003) at postoperative year 1. HP development was positively associated with preoperative IOP (odds ratio, 1.025; P=0.023). Higher preoperative IOP was associated with the HP development. The non-HP group achieved a higher complete success rate when assessed at postoperative year 1.

Lens Position Parameters as Predictors of Intraocular Pressure Reduction After Cataract Surgery in Nonglaucomatous Patients With Open Angles.

To evaluate the relationship between lens position parameters and intraocular pressure (IOP) reduction after cataract surgery in nonglaucomatous eyes with open angles. The main outcome of the prospective study was percentage of IOP change, which was calculated using the preoperative IOP and the IOP 4 months after cataract surgery in nonglaucomatous eyes with open angles. Lens position (LP), defined as anterior chamber depth (ACD) + 1/2 lens thickness (LT), was assessed preoperatively using parameters from optical biometry. Preoperative IOP, central corneal thickness, ACD, LT, axial length (AXL), and the ratio of preoperative IOP to ACD (PD ratio) were also evaluated as potential predictors of percentage of IOP change. The predictive values of the parameters we found to be associated with the primary outcome were compared. Four months after cataract surgery, the average IOP reduction was 2.03 ± 2.42 mm Hg, a 12.74% reduction from the preoperative mean of 14.5 ± 3.05 mm Hg. Lens position was correlated with IOP reduction percentage after adjusting for confounders (P = 0.002). Higher preoperative IOP, shallower ACD, shorter AXL, and thicker LT were significantly associated with percentage of IOP decrease. Although not statistically significant, LP was a better predictor of percentage of IOP change compared to PD ratio, preoperative IOP, and ACD. The percentage of IOP reduction after cataract surgery in nonglaucomatous eyes with open angles is greater in more anteriorly positioned lenses. Lens position, which is convenient to compute by basic ocular biometric data, is an accessible predictor with considerable predictive value for postoperative IOP change.

Changes in intraocular pressure after cataract surgery: Analysis of the Swedish National Cataract Register Data

To analyze changes in intraocular pressure (IOP) after cataract surgery based on data from the Swedish National Cataract Register (NCR). Ophthalmic surgery units in Sweden. Prospective database study. Data for 2012 through 2014 were obtained prospectively from the NCR. The outcome register of the NCR has collected data on IOP before and a mean of 37.7 days ± 29.1 (SD) after cataract surgery since 2012. The analyses were based on 20 437 cataract extractions reported during 1 month each year to the outcome registry of the NCR. Cataract surgery was found to reduce IOP by a mean of 1.46 mm Hg, which was statistically significant (P < .001). A larger IOP reduction was seen in cases with a higher preoperative IOP (r = 0.557, P < .001). Older patients and shorter eyes had a greater IOP reduction after surgery (P < .001 and P = .001, respectively). Women had a greater IOP reduction than men (P = .04) When high IOP was given as an indication for surgery, the IOP reduction after cataract surgery was 5.50 mm Hg compared with a reduction of 1.40 mm Hg in patients for whom this indication was not given (P < .001). Patients with glaucoma or pseudoexfoliation (PXF) had a more pronounced IOP reduction than patients without these diagnoses (P < .001). Cataract surgery had an IOP-lowering effect, in particular in older patients, women, short eyes, eyes with high preoperative IOP, and eyes with glaucoma or PXF. No author has a financial or proprietary interest in any material or method mentioned.

Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma

PurposeTo compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). MethodsThis is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups. ResultsThere were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction. ConclusionPostoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.

Trabectome Patient Selection, Preparation, Technique, Management, and Outcomes

Ab internotrabeculectomy with the Trabectome® (NeoMedix, Tustin, CA, US) is a minimally invasive glaucoma surgery that has the capacity to significantly lower intraocular pressure (IOP) with a highly favorable safety profile compared with traditional glaucoma surgeries. Since the first results were reported in 2005, mostly for primary open-angle glaucoma, the indications have since expanded to include secondary open- and closed-angle glaucoma. Exclusion criteria are active neovascular and uveitic glaucoma, and glaucoma due to increased episcleral pressure. On average, IOP is typically lowered by 30–40 % into the midteens, while decreasing the number of medications by one. Postoperative IOP can be estimated using a calculator. Patients with a higher preoperative IOP have the largest IOP reduction. Transient hyphema is a common postoperative observation. In this article, we will review surgical technique, patient management, postoperative care, and outcomes.

Risk Factors for Decompression Retinopathy After Glaucoma Surgery

To evaluate the risk factors for decompression retinopathy after glaucoma surgery. We reviewed the medical records of patients who underwent a trabeculectomy or Ahmed valve implantation and divided them into 2 groups by the development of decompression retinopathy. Various factors were compared between the 2 groups, including age, sex, glaucoma type, previous intraocular surgery, preoperative and postoperative intraocular pressure (IOP), refractive error, axial length, anesthesia, and systemic risk factors such as history of diabetes, hypertension, medication, and a laboratory examination including hemoglobin, hematocrit, platelet, prothrombin time (PT), and activated partial thromboplastin time (aPTT). The proportion of eyes with decompression retinopathy was 3.05% (21 of 688 eyes), and 50 control eyes were selected randomly. No significant differences were observed between the 2 groups in age, systemic disease, glaucoma type, anesthesia, or the incidence rate of postoperative hypotony. Preoperative maximum IOP and the change of IOP was higher (P=0.016, 0.019), PT and aPTT was prolonged (P=0.001, 0.006), and hemoglobin and hematocrit level was lower in patients with decompression retinopathy (P=0.005, 0.002). Preoperative maximum IOP and hemoglobin showed a significant association with the development of decompression retinopathy in a multivariate analysis (P=0.031, 0.040). No significant difference was observed between the 2 groups for IOP and visual acuity 6 months postoperatively. Patients with high preoperative IOP and hematologic abnormalities have a higher risk for developing decompression retinopathy. Surgeons should carefully assess the potential risks and pay close attention to sufficiently decrease IOP preoperatively.

Dynamics of outflow easiness coefficient after angular-suprachoroidal drainage in patients with primary glaucoma

Dynamics of outflow easiness coefficient after angular-suprachoroidal drainage in patients with primary glaucoma