History Of Trabeculectomy Research Articles

Outcomes of Medical and Surgical Management in Aqueous Misdirection Syndrome.

To report the outcomes of medical and surgical management in patients diagnosed with aqueous misdirection syndrome (AMS). A retrospective chart review of all cases diagnosed with AMS at a single tertiary care eye center during the period from 2014 to 2021. Outcome measures were anatomical success (deepening of the anterior chamber (AC)), functional success (improvement in visual acuity), and treatment success (control of intraocular pressure (IOP)). A total of 26 eyes with AMS from 24 patients were included. The patients were followed for a mean duration of 24 ± 18 months. Although some patients initially responded to medical and laser therapy, all but one (3.8%) eventually required surgery during the first 3 months after presentation. The mean duration from presentation until surgery was 45.9 ± 45.8 days (range: 2-119 days). The majority of cases (69.2%) were managed by pars plana vitrectomy. At the last follow-up visit, anatomical success was achieved in 20 (76%) eyes, 15 (57%) eyes had a final visual acuity that was either similar to or better than baseline, and successful control of IOP was achieved in 17 (65%) eyes. Univariate analysis revealed that a history of trabeculectomy as a cause of AMS was a risk factor for treatment failure (OR, 7.8; 95% CI, 1.16-52.35; P, 0.02). Our findings indicate that medical and laser management of AMS provide temporary control, and almost all patients eventually require surgery within the first 3 months. A history of trabeculectomy was found to be a risk factor for treatment failure.

Traumatic Posterior Chamber Intraocular Lens Dislocation into the Subconjunctival Space

Purpose: Here we report a case of posterior chamber intraocular lens (IOL) dislocation into the subconjunctival space (pesudophacocele) following ocular trauma.Case summary: A 66-year-old male presented with ocular pain and decreased vision in the right eye following trauma with a metallic rod. The patient had a history of trabeculectomy, glaucoma drainage device implantation, transscleral cyclophotocoagulation, and cataract surgery for uveitic glaucoma and a cataract in the right eye. On examination, vision was hand movement, the intraocular pressure was 3 mmHg, and subconjunctival hemorrhage and hyphema were observed. After the resolution of hemorrhage, uveal tissue prolapse was seen nasally behind the corneal limbus and the IOL was found to be dislocated into the nasal subconjunctival space. There were no changes in the filtering bleb and tube compared to the pre-trauma status. The IOL was removed through a conjunctival incision because the patient refused any active treatment.Conclusions: Pesudophacocele developed in a patient who had a history of glaucoma and cataract surgery in the injured eye. The IOL could not be assessed immediately after the trauma because of subconjunctival hemorrhage and hyphema. When the status of IOL is unclear or suspected to be dislocated after trauma, the possibility of pseudophacocele should be considered, in addition to the dislocation into the vitreous cavity.

PREVALENCE, CHARACTERISTICS, AND OUTCOMES OF RHEGMATOGENOUS RETINAL DETACHMENT IN EYES WITH TRABECULECTOMY OR GLAUCOMA DRAINAGE DEVICES.

To describe the prevalence, management, and outcomes of rhegmatogenous retinal detachment (RRD) after incisional glaucoma filtering surgery. All patients with a history of trabeculectomy or glaucoma drainage device surgery who were subsequently diagnosed with an RRD from January 1, 2016, to January 1, 2021, at the Wills Eye Hospital were identified. Forty-six eyes met the inclusion criteria. The mean age was 60.7 ± 19.6 years, and 15 patients (32.6%) were female. Of all eyes, 34 (73.9%) were diagnosed with primary open-angle glaucoma. The mean time from most recent incisional glaucoma surgery to RRD diagnosis was 1,133 ± 1,644 days. There were 19 eyes (41.3%) with preoperative proliferative vitreoretinopathy (9 eyes [19.6%] with Grade C proliferative vitreoretinopathy) and 35 eyes (76.1%) had macula-off RRD at the time of presentation. At RRD presentation, 4 eyes (8.7%) had concomitant endophthalmitis, 5 (10.9%) had concurrent choroidal detachment, and 2 (4.7%) had concurrent vitreous hemorrhage. Primary vitrectomy was performed in most (91.3%) cases. Silicone oil tamponade was often required (71.1%). The single surgery success rate was 65.2% (30 of 46). The mean preoperative logarithm of the minimum angle of resolution visual acuity was 1.72 ± 0.78 (Snellen acuity 20/1,050), and the mean final postoperative logarithm of the minimum angle of resolution was 1.59 ± 0.89 (20/778, P = 0.2853). Of glaucoma surgeries performed, the 5-year prevalence of RRD was 0.71% (26 of 3,664, 95% Poisson confidence interval 0.48%-1.04%). The 5-year prevalence of RRDs after trabeculectomy or glaucoma drainage device was 0.71%. Most patients presented with macula-involving detachments, often with proliferative vitreoretinopathy. Anatomical and visual outcomes were poor.

Risk factors for early-onset exfoliation syndrome

Although exfoliation syndrome (XFS) is an age-related, late-onset disease, early-onset XFS has been reported, and its associated factors remain unknown. In this study, we investigated the clinical features and risk factors of early-onset XFS. The participants were divided into two groups according to age at the time of XFS diagnosis: early-onset (< 60 years) or late-onset (≥ 70 years) group. Among the 302 eyes of 240 patients with XFS, the early-onset group included 41 eyes (14%) of 33 patients, and the late-onset group included 163 eyes (54%) of 126 patients; the mean age was 54.8 ± 5.0 and 76.6 ± 4.9 years, respectively (p < 0.001). All eight cases diagnosed with XFS at the earliest age, ranging from 36 to 52 years, underwent trabeculectomy before the diagnosis of XFS. Multivariable logistic regression analysis showed that a history of trabeculectomy (odds ratio [OR] = 11.435, p < 0.001), presence of iridectomy (OR = 11.113, p < 0.001), and longer axial length (OR = 2.311, p = 0.003) were significantly associated with the development of early-onset XFS. Collectively, patients with early-onset XFS were more likely to have undergone trabeculectomy and have more axial myopia compared with those with late-onset XFS. These findings suggest that surgical trauma compromising the blood-aqueous barrier may trigger early manifestation of XFS.

Anterior capsule sparing parsplana lensectomy in cataract with severely compromised corneal endothelium

To evaluate the results of parsplana lensectomy in the management of cataract with severely compromised or abnormal corneal endothelium. Retrospective interventional case study comprised 22 patients (9 women, 13 men; 22 eyes) with severely abnormal corneal endothelium ut still had transparent cornea. Of which 14 had history of penetrating keratoplasty, 6 had history of trabeculectomy and 2 were diagnosed with Fuch’s endothelial dystrophy. Postoperative est corrected visual acuity (BCVA), mean density of corneal endothelial cell and other complications were analyzed. Mean follow-up period was 17.2 months (ranging from 6 to 31 months). Postoperative BCVA were found to be 6/60 or below in 2 patients, 6/60-6/18 in 7 patients and 6/18-6/12 in 7 patients and 6/12 or better in 6 patients. BCVA improved in all patients after surgery, except in one patient with Fuch’s endothelial dystrophy BCVA turned worse again about five months after surgery and eventually patient developed bullous keratopathy. The mean density of corneal endothelial cells was 1018± 84/ mm (range 844/ mm to 1176/ mm) before operation and 981±93/ mm (range 853 to 1211/ mm) after operation. No significant difference in the density of corneal endothelial cells was found among the patients before and after operation (P=0.43).Pars plana lensectomy is able to decrease surgically-induced corneal endothelial damage and is safe in the management of cataract with severely compromised corneal endothelium.

Structural Confirmation of Lymphatic Outflow from Subconjunctival Blebs of Live Human Subjects.

PurposeTo uncover the mechanism of subconjunctival outflow in humans.DesignCross-sectional study.ParticipantsFifteen patients receiving subconjunctival anesthesia before intravitreal injection for routine clinical care.MethodsAnterior segment (AS) OCT was performed in patients with various instances of conjunctival edema or subconjunctival fluid. Other patients received a subconjunctival mixture of 0.005% indocyanine green and 2% lidocaine. After subconjunctival injection of the tracer and anesthetic mixture, blebs and associated outflow pathways were imaged angiographically and the time for appearance was recorded. The pattern and structure of outflow pathways were studied using AS OCT. Angiographic and AS OCT results were compared with trabecular and conventional outflow imaging, which demonstrates veins.Main Outcome MeasuresOcular surface lymphangiography and AS OCT images.ResultsAnterior segment OCT of the conjunctiva in a normal eye demonstrated thin nonedematous conjunctiva with absent intraconjunctival lumens or subconjunctival fluid. Patients with a history of trabeculectomy, subconjunctival drug injection, or chemosis demonstrated thickened conjunctiva and intraconjunctival luminal pathways that contained valve-like structures. Tracer-based studies in patients demonstrated blebs with irregular subconjunctival bleb-related outflow patterns that arose in a time-dependent fashion. These angiographic pathways were luminal on OCT, sausage shaped, and contained intraluminal valve-like structures. This was in contrast to trabecular and conventional outflow imaging, where pathways were classically Y-shaped, of even caliber, and lacked valve-like structures.ConclusionsOutflow pathways were seen in patients with conjunctival edema and after subconjunctival tracer injection. These pathways were lymphatic based on pattern and structural study. Better understanding of bleb-related lymphatic outflow may lead to improved bleb-requiring glaucoma surgeries and subconjunctival drug delivery.

Effect of Cataract Surgery on Intraocular Pressure in Glaucoma Patients

Purpose: To determine the change in intraocular pressure after cataract surgery in patients diagnosed with glaucoma.&#x0D; Study Design: Interventional case series.&#x0D; Place and Duration of Study: Glaucoma Clinic. Al-Ibrahim Eye Hospital (AIEH) Karachi, Pakistan from May to October, 2019.&#x0D; Methods: Thirty-eight patients diagnosed with glaucoma and cataract and registered in glaucoma clinic were recruited for this study. Inclusion Criteria was age &gt; 41 years and patients diagnosed with primary open/closed angle glaucoma and cataract. Patients with secondary glaucoma, history of trabeculectomy and any other ocular diseases were excluded from the study. Pre-operative assessment was done for phacoemulsification. In post-operative examination, first and second follow-up IOP was measured. Data analysis was done on statistical package for social science (SPSS) version 20.0. Statistical changes were present in the form of bar chart, frequency and graphs. The mean standard deviation for pre-operative, post-operative 1st and 2nd follow-up IOP was calculated.&#x0D; Results: A total of 38 participants and 48 eyes satisfied the inclusion criteria. Out of 48 eyes, 39 (81.3%) eyes were diagnosed with Primary open angle glaucoma and 9 (18.8%) eyes with Primary Angle Closure Glaucoma. The pre-operative mean IOP was 16.56 ± 6.67 mm Hg and post-operative mean IOP at first follow-up was 13.39 ± 4.04 mm Hg. At second follow-up at one-month mean IOP was 12.14 ± 2.28 mm Hg.&#x0D; Conclusion: Phacoemulsification produces a useful decrease in IOP in glaucoma patients.&#x0D; Key Word: Glaucoma, Cataract, Phacoemulsification, Intraocular Pressure.

XEN in extreme cases

AbstractPurposeThe Xen implant allows to perform a filtering procedure using a collagen tube of 6 mm in length and 45 microns of lumen usually placed in the upper nasal quadrant. Its main indication is primary open angle glaucoma, however, its versatility has allowed it to be used in other types of glaucoma cases. The aim of this communication is to present some cases in which the Xen implant has been used to treat complex situations.Methods &amp; ResultsCase 1 ‐ A 31‐year‐old woman with congenital glaucoma, a history of goniotomy and a drainage device carrier of double‐plate glaucoma who presented intraocular pressure (IOP) of 17 mmHg with maximum topical and oral treatment and severe toxic ocular disease. As the upper nasal quadrant was occupied, a XEN device was implanted in the inferior nasal quadrant. During the postoperative period, displacement of the implant towards the anterior chamber was evident, but no endothelial cell loss was observed and control of the IOP was maintained at 1 year of follow‐up with a significant reduction in medication and improvement of the ocular surface. Case 2 ‐ A 34‐year‐old man presented with contusive trauma in his left eye complicated by 2‐mm hyphema and (IOP &gt; 40 mmHg ) that could not be controlled with maximum medication. After performing a drainage of the hyphema a XEN implant was placed in the upper nasal quadrant. Since then, IOP was controlled and the visual acuity completely reestablished. Case 3 ‐ A 58‐year‐old woman with severe scleromalacia affecting all four quadrants. She had a history of trabeculectomy in the upper quadrant and a superior nasal sector of healthy conjunctiva that was normocolored and mobilizable was observed. After placing the Xen in the upper nasal sector, the patient has remained with an IOP of 16 mmHg with a beta‐blocker medication.Conclusions1. The Xen implant can be useful in the management of glaucoma in some challenging situations. 2. The inferior nasal location of the Xen is raised exceptionally. It can make it more susceptible to displacement, although this does not necessarily affect its functioning. 3. The Xen device can be useful in acute uncontrolable ocular hypertension (ex trauma) in the context of an open angle.

Effects of Baerveldt Glaucoma Implant Surgery on Corneal Endothelial Cells of Patients with No History of Trabeculectomy.

PurposePersistent corneal edema is a serious potential complication of Baerveldt glaucoma implant (BGI) surgery. A trabeculectomy reduces the density of corneal endothelial cells. We investigated the effect of BGI surgery on corneal endothelial cells of patients with no history of trabeculectomy.MethodsWe retrospectively analyzed 85 eyes of 85 patients who underwent BGI surgery and were followed-up for ≥12 months. We used new criteria for surgical failure. We defined persistent corneal edema or needed additional surgery for changing the tube position due to remarkable reduction in corneal endothelial cells as failure. We compared surgical outcomes with new criteria and the rates of corneal endothelial cell density (ECD) loss after BGI surgery between the anterior chamber insertion (AC) group (n=23) and vitreous cavity insertion (VC) group (n=63).ResultsThe mean pre-operative ECD values of the AC and VC groups were not significantly different at 2309 ± 498 and 2204 ± 556 (p=0.426). The ECD reduction rate in the AC group was significantly faster than in the VC group. The mean post-operative IOP values significantly decreased in both groups. However, the VC group’s surgical outcomes were significantly better than the AC group’s (p=0.0241) with the new criteria.ConclusionThe mean of ECD did not decrease significantly after BGI surgery in VC group patients with no history of trabeculectomy. BGI surgery insertion to the vitreous cavity was safe and had much less effect on the ECD decrease compared to insertion to the anterior chamber.

Outcomes of complex Descemet Stripping Endothelial Keratoplasty performed by cornea fellows

BackgroundA major obstacle that academic institutions face is the steep learning curve for cornea fellows initially learning to perform Descemet Stripping Endothelial Keratoplasty (DSEK). The purpose of this study is to evaluate the outcomes of complex DSEK performed by cornea fellow supervised by an attending surgeon at an academic institution.MethodsPatients who underwent a complex DSEK procedure performed by a cornea fellow during the years 2009-2013 were included. All the surgeries were supervised by the same cornea attending. All patients had a minimum follow-up of 6 months. Charts were reviewed for demographic data, intraoperative and postoperative complications and clinical outcomes. Corneal graft survival was calculated using the Kaplan-Meier analysis.ResultsFifty-seven eyes of 55 patients (mean age 77.5 ± 8.5 years) were included in the study with a mean follow-up time of 16.4 ± 15.6 months. Previous graft failure, presence of a tube and history of trabeculectomy were the leading diagnoses to define the surgery as complex. No intraoperative complications occurred. In 21.1% of cases a corneal graft detachment was documented in the first postoperative day. Mean visual acuity improved from 1.06 LogMAR (20/230) preoperatively to 0.39 LogMAR (20/50, p < 0.001) by the sixth postoperative month and to 0.52 LogMAR (20/65, p < 0.001) at the last follow-up visit. Graft failure rate was 29.8%. Kaplan-Meier analysis found a 67.2% graft survival rate at 20 months.ConclusionsComplex DSEK can be performed successfully with an acceptable postoperative complication rate by cornea fellows during their training period when supervised by an experienced attending.

Ultrasound Biomicroscopy in Pseudophakic Patients with Unexplained Recurrent Hyphema or Vitreous Hemorrhage

ABSTRACTPurpose: To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. Methods: Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. Results: There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. Conclusions: UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.

Lipid corneal degeneration after trabeculectomy with mitomicin 0.02%

Um paciente com história de trabeculectomia com Mitomicina C 0,02%, sem doenças sistêmicas pré-existentes, apresentou infiltrado lipídico corneano unilateral associado à vascularização intraestromal profunda. Injeção subconjuntival de Bevacizumabe foi realizada e posterior ceratoplastia penetrante. Não houve sinais de recorrência em um ano. Degeneração lipídica da córnea após trabeculectomia com mitomicina C 0,02%

Comparison of a Remote Operating Slit-Lamp Microscope System With a Conventional Slit-Lamp Microscope System for Examination of Trabeculectomy Eyes

To compare 2-dimensional (2D) photo imaging with slit-lamp photo imaging for examination of trabeculectomy eyes, and to compare the accuracy and consistency of examination of trabeculectomy eyes with a remote operating slit-lamp microscope system (referred to as "remote slit lamp" hereafter) and a conventional slit-lamp microscope system (referred to as "slit lamp" hereafter). Thirty-five eyes of 35 patients having a history of trabeculectomy were enrolled in the study that compared 2D photo imaging with slit-lamp photo imaging for the evaluation of trabeculectomy eyes. Five ophthalmologists evaluated the 2D images and the slit-lamp images independently with masking of patient information. Evaluation scores were compared with those provided by a glaucoma specialist using the slit lamp as standard. Fifteen eyes from 15 patients having a history of trabeculectomy were enrolled in the study that investigated the accuracy and consistency of examination of trabeculectomy eyes with a remote slit lamp and a slit lamp. Central anterior chamber depth, bleb height, and bleb extent evaluated by the slit-lamp photo imaging showed significantly higher consistency with the standard than those evaluated by 2D photo imaging (P<0.05). The remote slit lamp showed good consistency of all the evaluated parameters with the slit lamp and the κ scores of all the evaluated parameters were higher than 0.8. The completion time for evaluation with the remote slit lamp and the slit lamp were 247.3±153.5 and 123.5±53.7 seconds, respectively (P<0.001). Slit-lamp photo imaging is a superior method for examination of trabeculectomy eyes compared with 2D photo imaging. The remote slit-lamp system shows similar potential to the slit-lamp system for the evaluation of trabeculectomy eyes, although the evaluation time is much longer.

Delayed Traumatic Phacocele Following Trabeculectomy

A 56-year-old woman with a history of trabeculectomy in both eyes sustained blunt trauma to the right eye at home. She initially presented with pain, loss of vision, total hyphema, and hypotony with no evidence of rupture or tissue prolapse. Prompt anterior chamber wash out revealed a partially subluxated crystalline lens behind the pupil, but the globe was intact. At 1 month postoperatively, subconjunctival displacement of the crystalline lens was detected. The patient gave a history of severe bouts of coughing and sneezing a few days earlier. During removal of phacocele, the trabeculectomy wound was intact with no evidence of leakage. A shallow concentric furrow was noticed across the flap approximately 3 mm from the limbus. It is believed that repeat trauma pushed the crystalline lens through the weakened trabeculectomy scleral flap. The wound later self-sealed.

Differences between Goldmann Applanation Tonometry and Dynamic Contour Tonometry following Trabeculectomy

Background. To evaluate differences between Goldmann Applanation Tonometry (GAT) and Dynamic Controur Tonometry (DCT) following trabeculectomy. Methods. Thirty eight glaucomatous eyes with a history of trabeculectomy (Trabeculectomy group, TG), 20 eyes without a history of trabeculectomy but with a history of latanoprost use (Latanoprost group, LG), and 19 nonglaucomatous eyes (Control group, CG) were included. GAT-IOP, DCT-IOP, the difference between them (dIOP), the central corneal thickness (CCT), the axial length (AL), and the depth of the anterior chamber (ACD) were measured. Results. dIOP was significantly higher in TG (5.19 mmHg) than in LG (4.01 mmHg) and CG (1.98 mmHg). Correlations between AL and dIOP were statistically significant in both TG and LG but not in CG whereas correlations between dIOP and other clinical parameters examined were statistically not significant in all groups. Conclusions. The significantly higher dIOP in TG implies that the bio-mechanical properties of the ocular walls are altered following trabeculectomy.

Long-term results of amniotic membrane transplantation-assisted bleb revision for leaking blebs

To report long-term results of amniotic membrane transplantation (AMT)-assisted bleb revision for intractable late-onset bleb leak. Retrospective medical record review of six consecutive patients who underwent AMT-assisted bleb revision for late-onset bleb leak at the Kobe University hospital between December 2001 and March 2004. The median (range) of age was 60 (20-77) years. All patients had a history of trabeculectomy with adjunctive use of 0.4 mg/ml mitomycin C. The median (range) of interval between the prior trabeculectomy and bleb leak was 15 (4-54) months. Preoperative intraocular pressure (IOP) was lower than 10 mmHg in two cases, while it was 25 mmHg or higher in three patients, who had a localized, ischemic, thin-wall leaking bleb circumscribed with extensively scarred tissue. The median (range) of follow-up after the AMT-assisted bleb revision was 49 (41-67) months. Postoperative IOP was well controlled in all patients without medication or with a maximum of three glaucoma medications. No patients presented recurrence of the bleb leak or AMT-related complications during entire follow-up. All patients showed at final visit a diffuse bleb which extended posteriorly beyond the conjunctival incision line. AMT-assisted bleb revision successfully treated intractable late-onset bleb leak. Further comparative studies are needed to confirm the present result.

Use of Indocyanine Green During Excision of an Overhanging Filtering Bleb

We report the use of an indocyanine green (ICG) injection during the safe removal of an overhanging filtering bleb after trabeculectomy. A 63-year-old man with a history of trabeculectomy 5 years previously in his left eye complained of foreign body sensation in this eye and decreased vision from induced astigmatism. Slit-lamp examination revealed an expanding overhanging filtering bleb on the cornea. With a 30-G needle, 0.25% ICG was injected into the overhanging bleb. Use of ICG visualization of the inner space of the overhanging filtering bleb provided visualization of the border with the original bleb, allowing for safe excision of the overhanging filtering bleb without injury to the thin surface of the original bleb. Injection of ICG into an overhanging filtering bleb during excision can be useful in the prevention of damage to the original bleb.

Intraocular pressure and progression in exfoliative eyes with ocular hypertension or glaucoma.

This retrospective study was conducted in exfoliative eyes in order to study the influence of IOP and other possible factors on the conversion from ocular hypertension (OHT) to glaucoma and progression of glaucoma. 139 patients with exfoliation OHT or glaucoma with exfoliation syndrome were included (mean follow-up 5.2 +/- 3.6 years). The effects of age, gender, weighted mean IOP, maximum IOP, stage of glaucoma at the first visit, refraction, glaucoma medication, and interventions on the hazard of progression were studied by multivariate survival analysis. Conversion from OHT to glaucoma or progression of glaucoma was detected in 63 eyes (45.3%). A significant association with progression was found for age (relative risk 1.042; p-value 0.043), weighted mean IOP (1.076; <0.001), and stage of glaucoma (1.436; <0.001). History of trabeculectomy (0.360; 0.002) related to a decreased risk. The risk of conversion from OHT to glaucoma and progression of glaucoma increased in exfoliative eyes with severity of stage of glaucoma, weighted mean IOP, and the age of the patient. A history of trabeculectomy was related to decreased risk of progression.