Inadequate Intraocular Pressure Research Articles

Effect of trabeculectomy with mitomycin C versus ologen implant in reducing intraocular pressure: A comparative study in patients with primary open-angle glaucoma

: To compare the efficacy of mitomycin C (MMC) and Ologen implant (OLO) as adjuvants in Trabeculectomy in patients with POAG in eastern India.: It was a hospital based prospective randomized parallel group comparative study from November 2019 to April 2021. Forty eyes of forty patients of POAG with inadequate intraocular pressure (IOP) control were enrolled and randomly divided them into two groups of twenty. Group A (MMC) patients underwent MMC trabeculectomy, while Group B (OLO) patients underwent OLO trabeculectomy. All the cases were followed up post-operatively for six months, and the recorded IOP of each visit was analyses using software R 4.0.3 and R-studio.: The preoperative IOP for the OLO group was 34.0 mmHg (IQR: 30.75 – 38.0), while for the MMC intervention group it was 36.50 mmHg (IQR: 31- 42). The difference in IOP between the two groups was insignificant (p= 0.24). On the first postoperative day, the IOP in the MMC group was 10.05 ± 3.65 mmHg and in the OLO group it was 10.35 ± 2.13 mmHg. Seven days after surgery, the mean IOP in MMC group was 9.45 ± 3.0 mmHg, while it was 11.50 ± 2.52 mmHg in the OLO group. One month after surgery, the mean IOP in the MMC group was 11.15 ± 4.25 mmHg, whereas it was 11.50±5.02 mmHg in OLO group. At 3 months postoperatively, the mean IOP in the MMC group was 12.25± 5.17 mmHg, while it was 12.70± 1.84 mmHg in the OLO group. Six months after surgery, the mean IOP in the MMC group was 10.50± 2.72 mmHg, whereas in the OLO group it was 13.35± 2.94 mmHg. In both the groups, there was significant reduction of IOP (p value < 0.05) observed in all postoperative visits.: In trabeculectomy surgery on POAG eyes, the MMC and OLO implants both successfully lower IOP. Between the two groups, there was no statistically significant difference in the success rate.

Longitudinal evaluation of advanced glaucoma: ten year follow-up cohort study

This study focused on patients with advanced open-angle glaucoma (OAG) and aimed to identify key factors for monitoring them. We included 127 such patients who were followed for seven years or more, undergoing annual ophthalmic examinations. Glaucoma progression was defined as a deterioration in either structure or function. The progression rates and risk factors were evaluated. The patients were divided into upper- and lower-half subgroups based on the reduction in intraocular pressure (IOP) from the baseline. Over an 11-year period, glaucoma progression was detected in 59 eyes (46.5%). The rate of change in mean deviation (MD) was − 0.43 dB/year for the entire population; − 0.67 dB/year for progressors; and − 0.20 dB/year for non-progressors. Hypertension and disc hemorrhage (DH) were more common in progressors compared to non-progressors (45.8 vs. 23.5%, 11.9 vs. 1.5%; P = 0.008 and P = 0.016). Multivariate Cox’s proportional hazard model revealed that the presence of DH and a better baseline MD were associated with glaucoma progression. Additionally, patients with a higher percentage reduction in IOP (> 20.94%) had a lower risk of progression compared to those with less reduction. Inadequate IOP reduction, better baseline MD, presence of DH, and lower central corneal thickness were identified as risk factors for progression in advanced OAG patients.

Cessation of Recurrent Bilateral Optic Disc Haemorrhages after Successful Trabeculectomy: A Case Report

Purpose: To describe a patient with primary open-angle glaucoma in whom bilateral recurrent optic disc haemorrhages disappeared permanently after trabeculectomy. Methods: A 67-old male patient was diagnosed with primary open-angle glaucoma and was followed for 10 years including best corrected visual acuity, visual field examinations, slit lamp examinations, Goldmann applanation tonometry, fundoscopy and optic disc photographs. Results: Optic disc haemorrhages were detected in 8 out of 30 preoperative visits in the right eye and in 3 out of 19 visits in the left eye. Trabeculectomy with intraoperative application of mitomycin C was performed in both eyes due to the advanced visual field loss with an inadequate intraocular pressure control despite maximum-tolerated medical therapy and because of the recurrent optic disc haemorrhages. No further optic disc haemorrhages were observed in either eye after trabeculectomy. Conclusion: Our case report demonstrates that recurrent bilateral optic disc haemorrhages can cease permanently after successful trabeculectomy.

How Medication Adherence Affects Disease Management in Veterans with Glaucoma: Lessons Learned from a Clinical Trial

Introduction: We conducted a secondary, real-world clinical assessment of a randomized controlled trial to determine how a glaucoma medication adherence intervention impacted the clinical outcomes of participants at 12 months post-randomization. Participants included veterans at a VA eye clinic with medically treated glaucoma who reported poor adherence and their companions, if applicable. Methods: The treatment group received a glaucoma education session with drop administration instruction and virtual reminders from a “smart bottle” (AdhereTech) for their eye drops. The control group received a general eye health class and the smart bottle with the reminder function turned off. Medical chart extraction determined if participants in each group experienced visual field progression, additional glaucoma medications, or a recommendation for surgery or laser due to inadequate intraocular pressure control over the 12 months following randomization. The main outcome measure was disease progression, defined as visual field progression or escalation of glaucoma therapy, in the 12 months following randomization. Results: Thirty-six versus 32% of the intervention (n = 100) versus control (n = 100) groups, respectively, experienced disease intensification. There was no difference between the intervention and control groups in terms of intensification (intervention vs. control group odds ratio: 1.20; 95% confidence interval: [0.67, 2.15]), including when age, race, and disease severity were accounted for in the logistic regression model. Those whose study dates included time during the COVID-19 pandemic were evenly distributed between groups. Conclusions: A multifaceted intervention that improved medication adherence for glaucoma for 6 months did not affect the clinical outcomes measured at 12 months post-randomization. Twelve months may not be long enough to see the clinical effect of this intervention or more than 6 months of intervention are needed.

Six year outcomes of combined phacoemulsification surgery and endoscopic cyclophotocoagulation in refractory glaucoma.

This study is to describe the 6-year results of combined phacoemulsification surgery and endoscopic cyclophotocoagulation (Phaco-ECP) surgery in patients with uncontrolled glaucoma and no previous glaucoma surgery. This is a retrospective case series of 84 eyes. The primary outcome measure was intraocular pressure (IOP) reduction 6years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 6years. Failure was defined as IOP higher than 21mm Hg or lower than 6mm Hg or IOP not reduced by 20% from baseline at the 1, 2, 3, 4, 5, or 6-year time points or further laser or other surgery to reduce IOP at any timepoint. There was a statistically significant decrease in mean IOP from 18.9mmHg pre-operatively to 13.7, 12.8, 13.0, 12.7, 12.5, and 12.3mmHg at the 1, 2, 3, 4, 5, and 6years post-operatively respectively (p < 0.001). Fifty-seven (68%) reached criteria for failure by 6years. In 36% of cases, this was due to inadequate IOP control, whereas 32% required further laser or surgery. When we excluded patients who only had selective laser trabeculoplasty rather than further surgery, the failure rate reduced to 51%. Eleven percent had a post-operative complication, 2.4% requiring further surgical intervention. At 6years postoperatively, combined phaco-ECP achieved a significant reduction in IOP in patients with uncontrolled glaucoma and no previous drainage surgery. Significant complications were uncommon, but 68% was classified as surgical failures by the six year point.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Pharmacogenetics and pharmacogenomics in glaucoma therapeutics: the way to personalized therapy.

Clinical Outcomes and Cost Analysis of PreserFlo versus Trabeculectomy for Glaucoma Management in the United Kingdom

Clinical evaluation and cost analysis of mitomycin-C-augmented PreserFlo MicroShunt versus trabeculectomy. Retrospective cohort study across 3 teaching hospitals. A total of 134 consecutive eyes of 129 patients (70 undergoing MicroShunt, 64 trabeculectomy). Primary and secondary glaucoma cases with uncontrolled intraocular pressure (IOP) were included. Neovascular glaucoma and surgery combined with cataract extraction were excluded. The cost analysis used results from the clinical study to estimate operative costs (equipment and staff costs) and postoperative costs (follow-up visits, nonglaucoma medications, and postoperative procedures) per eye for PreserFlo and trabeculectomy. The primary clinical outcome measure was surgical failure (defined as IOP > 21 mmHg or < 20% reduction from baseline, IOP ≤ 5 mmHg, reoperation, or loss of light perception) or qualified and complete success (with or without medication) at 18 months. Secondary measures were IOP, glaucoma medications, visual acuity, mean deviation, time to cessation of steroid drops, complications, surgical time, follow-up visits, postoperative interventions, and reoperations. The cost analysis evaluated costs of PreserFlo compared with trabeculectomy. Baseline characteristics were similar, except for more non-White patients in the trabeculectomy group (51% Black and Asian vs. 32% MicroShunt, P= 0.02) and more cases with prior ab externo glaucoma surgery in the MicroShunt group (19% vs. 3% in the trabeculectomy group, P= 0.004). Overall, 59% of eyes had primary open-angle glaucoma. Mean follow-up was 19.9 months for both groups. At 18 months, surgical failure was 25% for MicroShunt compared with 35% for trabeculectomy (P= 0.18). Failure in MicroShunt cases was due to inadequate IOP reduction (84%) or reoperation for glaucoma (16%). Failure in trabeculectomy cases was due to inadequate IOP reduction (58%), persistent hypotony (29%), or reoperation for glaucoma (13%). Combined blebitis and endophthalmitis rate was 1.4% for MicroShunt and 3.1% for trabeculectomy. Cost analysis showed a savings of £245 to £566 per eye in the MicroShunt group, driven mostly by reduced postoperative procedures and follow-up visits. This is in contrast to prior randomized controlled trial data reporting the incremental cost of $2058 of PreserFlo over trabeculectomy. Our experience of introducing PreserFlo MicroShunt surgery showed it was safer than trabeculectomy and is a cost-saving and effective option that offers potential to free up highly limited National Health Service resources. Proprietary or commercial disclosure may be found after the references.

Cost-utility analysis of trabecular micro-bypass stents (TBS) in patients with mild-to-moderate open-angle Glaucoma in Italy

BackgroundGlaucoma is a disease characterized by progressive damage of the optic nerve. Several therapeutic options are available to lower intraocular pressure (IOP). In primary open-angle glaucoma (POAG) patients with inadequate IOP control (or controlled with multiple medical therapies or for whom medical therapy is contraindicated), the implantation of micro-invasive glaucoma surgery devices (MIGS) and concomitant cataract surgery has proved to be more effective in reducing intraocular pressure (IOP), as compared to cataract surgery alone. The objective of this study was to assess the cost-effectiveness of iStent inject® device with concurrent cataract surgery vs. cataract surgery alone, in patients with mild-to-moderate POAG, adopting the Italian National Health Service (NHS) perspective.MethodsSimulation of outcomes and costs was undertaken using a Markov model with 4 health states and one-month cycles, that is used to simulate the prognosis of these patients. Efficacy data were obtained from the randomized clinical trial (RCT). A lifetime horizon was adopted in the analysis. A discount rate of 3.5% was applied to both costs and effects. The Italian National Healthcare Service (NHS) perspective was considered, therefore only healthcare direct costs (acquisition of main interventions and subsequent procedures; medications; monitoring and follow-up; adverse events). Model robustness was tested through sensitivity analyses.ResultsResults of the base-case analysis showed that the total lifetime costs were higher in the iStent inject® + concurrent cataract surgery, compared with the cataract surgery alone group (€8368.51 vs. €7134.71 respectively). iStent inject® + concurrent cataract surgery was cost-effective vs. cataract surgery alone, with an incremental cost-effectiveness ratio of €13,037.01 per quality-adjusted life year (QALY) gained. Both one-way deterministic and probabilistic sensitivity analyses confirmed robustness of base-case results. The cost-effectiveness accessibility curve (CEAC) showed that iStent inject® + cataract surgery would have a 98% probability of being cost-effective, compared to cataract surgery alone, when the willingness to pay (WTP) is equal to €50,000 per QALY gained.ConclusionsThe results of the cost-utility analysis confirm that iStent inject® + cataract surgery is a cost-effective option for the treatment of patients affected by mild-to-moderate POAG, compared with cataract surgery alone, when evaluated from the Italian NHS perspective.

Clinical outcomes following selective laser trabeculoplasty in Afro-Caribbean patients with glaucoma at high risk for progression

AimTo characterise clinical outcomes following selective laser trabeculoplasty (SLT) in eyes of Afro-Caribbean patients with open-angle glaucoma (OAG) at high risk for progression.MethodsIn a prospective interventional case series, patients meeting...

Tube Versus Trabeculectomy IRISⓇ Registry 1-Year Composite Outcome Analysis with Comparisons to the Randomized Controlled Trial

This study compared 1-year results for the composite treatment outcome from the Tube Versus Trabeculectomy (TVT) randomized controlled trial (RCT) to those from an IRISⓇ (Intelligent Research In Sight) Registry cohort of analogous eyes. Retrospective clinical study with comparison to an RCT. Subjects' eyes in the IRIS Registry received either a glaucoma drainage implant (tube) or underwent trabeculectomy after a previous trabeculectomy and/or cataract extraction and had data for 1-year follow-up analyses. Eyes were classified as failing if they had hypotony (intraocular pressure (IOP) ≤5 mm Hg) or inadequate IOP control (IOP >21 mm Hg or not reduced at least 20% below baseline) on 2 consecutive follow-up visits after 3 months, a reoperation for glaucoma, or no light perception vision and as successful otherwise. Failure risk was compared by treatment, demographic, and clinical variables and was compared to analogous failure risks from the TVT RCT. The TVT IRIS Registry cohort included 419 eyes, 236 tube eyes (56.3%) and 183 trabeculectomy eyes (43.7%). In this cohort, there was no significant failure risk difference (12.3% for tube eyes and 16.4% for trabeculectomy eyes, P=0.231). Comparing the studies, there was a significantly greater risk of failure in the TVT IRIS Registry tube eyes than in the TVT RCT tube eyes (3.8%; P <.001). Reasons for treatment failure included reoperations for glaucoma (none in the TVT RCT at 1 year). Our results were different from those in the TVT RCT. Possible reasons include non-Baerveldt tubes, greater severity among tube eyes, and practice patterns that reflect real-world data, which are different than those in RCTs.

Surgical Technique for Pars Plana Ahmed Glaucoma Valve Implantation in Advanced Glaucoma: The Upside-Down Technique.

Ahmed glaucoma valve (AGV) implantation using the upside-down technique resulted in an aqueous humor outflow pathway, occurring primarily on the scleral side and secondarily on the conjunctival side, and was effective in treating refractory glaucoma. To describe the AGV surgical technique, which results in changes in the primary aqueous humor outflow pathway to the scleral side (upside-down technique), and to evaluate the clinical effects and distribution of bleb fluid after surgery in patients with refractory glaucoma. In this retrospective study, the upside-down technique was used for pars plana AGV implantation in 10 eyes of 10 patients with refractory glaucoma. Surgical success was defined by complications, intraocular pressure (IOP), the glaucoma medication score, and bleb fluid distribution determined by magnetic resonance imaging. Postoperatively, there were significant reductions in the IOP and medication score at 23 and 27 months, respectively (P<0.05). Although a transient hypertensive phase was observed in 7 patients, it was controlled without ocular massage and additional surgery. A patient who had suprachoroidal hemorrhage during surgery lost light perception 7 months after the surgery, and another patient developed hypotony at 3 and 4 months after surgery, which spontaneously improved during subsequent examinations. Magnetic resonance imaging showed that the double bleb layer adjacent to the endplate tended to have more bleb fluid on the conjunctival side than on the scleral side facing the outlet (n=8; 1 to 29 mo after surgery). Pars plana AGV implantation using the upside-down technique was a relatively effective alternative to manage inadequate IOP control in patients with refractory glaucoma.

Selective Laser Trabeculoplasty: Outcomes of Multiple Repeat Treatments

To characterize intraocular pressure (IOP) reduction, effect duration, and side effect profile of repeat selective laser trabeculoplasty (SLT) used as primary stand-alone treatment for open-angle glaucoma (OAG). The secondary aim was to investigate covariates associated with treatment response to SLT. Retrospective chart review. A total of 52 patients with treatment-naïve OAG who received 3 installments of 3600 SLT as stand-alone glaucoma therapy. When both eyes met the inclusion criteria, only right eye data were used for analysis. The study was conducted in a single specialist practice. First, second, and third SLT (SLT1, SLT2, SLT3, respectively) treatments were compared for IOP reduction and effect duration. Eyes were classified as "treatment responders" if they had ≥20% IOP reduction 4 to 8 weeks post-SLT compared with baseline. Effect duration was the interval between SLT and the time point at which the surgeon decided inadequate IOP control necessitated repeat SLT. Individuals were excluded if they underwent intraocular surgery during the study period or received treatment with adjunctive ocular hypotensive medications. Reduction in IOP post-SLT and effect duration between treatments. Mean age at SLT1 was 58 years; 50% were male, and 92% were phakic. The SLT1 and SLT3 both resulted in mean 27% IOP reduction at 4 to 8 weeks, whereas SLT2 led to 26% IOP reduction. Response rate (≥20% IOP reduction at 4-8 weeks) was 79% for SLT1, 73% for SLT2, and 81% for SLT3, but the difference was not statistically significant. Response to repeat SLT was not significantly associated with previous SLT outcome. Effect duration was 22.2 months, 33.8 months, and 28.9 months after SLT1, SLT2, and SLT3, respectively. Effect duration was significantly longer after SLT2 (P= 0.0006) and SLT3 (P= 0.0444) compared with SLT1. There was no significant association between SLT response and gender, lens status, or OAG subtype. For primary stand-alone treatment in OAG, initial and repeat SLTs produced comparable percentage IOP reduction, but repeat SLTs had longer effect duration. Intraocular pressure response to SLT was not predictive of the IOP response to subsequent, repeat SLT treatment.

A challenging case of refractory childhood glaucoma associated with bilateral congenital ectropion uveae

Congenital ectropion uveae (CEU) is a rare disorder, resulting from the proliferation of iris pigment epithelium on the anterior surface of the iris. We report the case of a 3-year-old boy, who was recently diagnosed with glaucoma, on treatment with two topical antiglaucoma medications and referred to us for further evaluation and management. His visual acuity, at presentation, was 6/7.5 (Cardiff) in both his eyes. Slit-lamp examination of both his eyes revealed the presence of ectropion uveae, with intraocular pressure (IOP) of 32 mm Hg. Gonioscopy in both eyes showed anterior insertion of iris. On Fundoscopy, both eyes showed glaucomatous disc changes. He had no systemic associations. Owing to inadequate IOP control, despite optimal medical therapy, he underwent trabeculectomy with intra-operative application of Mitomycin-C. However, the IOP reduction post-trabeculectomy was inadequate, and he subsequently required a bleb needling, which also failed. Hence, he underwent Ahmed glaucoma valve implantation in his right eye, with a favorable final outcome. IOP in the right eye was brought under control following multiple surgical interventions and additional medical treatment. CEU in children can be associated with refractory childhood glaucoma. It is important to evaluate for glaucoma in CEU cases to prevent blindness, especially in young patients and improve their overall prognosis.

Positive correlation of blood reflux in Schlemm’s canal and reduction of intraocular pressure after ab interno 360‐degree viscocanalostomy in primary open‐angle glaucoma

AbstractPurposeThe aim was to investigate the association between blood reflux in Schlemm’s canal (SC) and the reduction of intraocular pressure (IOP) after ab interno viscocanalostomy in primary open‐angle glaucoma (POAG).MethodsNon‐comparative study of consecutive patients with early to moderate POAG underwent ab interno viscocanalostomy with a follow‐up time of at least 12 months. Indications for glaucoma surgery were inadequate IOP and /or intolerance to eye drops. Through clear cornea incision, the IOP was lowered below episcleral venous pressure by aspiration of aqueous from the anterior chamber to provoke blood reflux into the SC. After a 1‐min waiting period, a goniolens was placed on the globe, and blood reflux was observed and classified into three filling patterns: no filling, partly filling and complete filling. Then, the anterior chamber was filled with viscoelastic material and ab interno viscocanalostomy was performed with a microcatheter system (Visco360).ResultsIn provocative gonioscopy, 12 eyes had no blood reflux (group 1), 19 had patchy blood reflux (group 2), and 14 had complete blood reflux (group 3). For the different reflux patterns, the preoperative IOP was 17.0 mmHg (SD ± 2.8) mmHg for group 1, 18.4 mmHg (SD ± 2.0) for group 2, and 22.2 mmHg (SD ± 2.8) for group 3. The IOP difference between preoperative and 6 months postoperative was 1.8 mmHg (SD ± 1.2) group 1, 4.9 mmHg (SD ± 0.9) for group 2, and 9.9 mmHg (SD ± 2.5) for group 3 (p &lt; 0.001). In a linear regression model, there were highly significant differences between the groups even after adjustment for preoperative IOP (p &lt; 0.001).ConclusionsBlood reflux in SC seems to be a significant positive prognostic indicator in uneventful ab interno viscocanalostomy concerning IOP reduction, possibly representing the patency of the physiologic aqueous outflow system.

Evaluation of intraocular pressure in the first 24 hours after micropulse laser trabeculoplasty in eyes with pseudoexfoliation glaucoma

To evaluate the immediate 24-hour effect on intraocular pressure (IOP) of a single session of micropulse laser trabeculoplasty (MLT) in patients with pseudoexfoliation glaucoma (PEXG). In this single-center, one-arm, prospective study, patients with PEXG on prostaglandin analogue monotherapy with inadequate IOP control were treated with 360-degree 532nm MLT. Intraocular pressure was evaluated at 1, 4, 8, 12 and 24hours after MLT. Twenty-three eyes of eighteen patients (10 male, 8 female) were enrolled in the study. The mean age of the patients was 71.83±6.51 years, and the mean IOP prior to MLT was 20.61±1.8mmHg. The mean IOP was reduced by 2.17±3.31mmHg, 2.69±3.85mmHg, 0.87±3.02mmHg, 2.13±2.8mmHg and -0.87±3mmHg at 1, 4, 8 and 24hours after MLT, respectively. At 4 and 12hours after MLT, the mean IOP was statistically significantly lower compared to the pre-MLT IOP (P=0.043 and P=0.021 respectively). No eye experienced an IOP spike≥5mmHg during the first 24hours after MLT. Treatment with MLT in PEXG eyes did not result in any significant, potentially dangerous IOP spikes during the first 24hours after MLT.

XEN implant in primary and secondary open-angle glaucoma: A 12-month retrospective study.

The aim of this study was to compare the efficacy and safety of the XEN45 gel stent implant in patients with primary open-angle glaucoma or secondary open-angle glaucoma. This is a retrospective, single-center, and comparative study conducted in consecutive primary open-angle glaucoma or secondary open-angle glaucoma patients, who underwent a XEN45 implant, alone or in combination with phacoemulsification. The primary end point was the intraocular pressure at the end of the follow-up period. Complete success was defined as an intraocular pressure reduction of ⩾20% from baseline to month 12 without antiglaucoma treatment. Of the 69 patients (74 eyes) who were screened, 68 patients (73 eyes) were included in this study. In the overall study population, XEN gel stent significantly reduced intraocular pressure from 22.3 (21.0-23.5) mmHg at baseline to 15.3 (14.3-16.3) mmHg, p < 0.0001. As compared to baseline, mean intraocular pressure reduction was -7.3 (-9.7 to -5.0) and -6.6 (-8.4 to -4.8) mmHg in the primary open-angle glaucoma and secondary open-angle glaucoma groups, respectively, p = 0.6357. At month 12, 53 (72.6%) eyes were classified as success. The mean number of antiglaucoma medications was significantly reduced in both groups (p < 0.0001, each). Complications included anterior chamber flattening (one eye), XEN implant extrusion (four eyes), one of whom had an endophthalmitis that required vitrectomy, and one eye underwent a trabeculectomy due to inadequate intraocular pressure control. XEN gel stent, either alone or in combination with phacoemulsification, provided a significant reduction in both intraocular pressure and medical antiglaucoma treatment, but with some safety concerns, in a cohort of patients with open-angle glaucoma (primary or secondary).

Smaller-incision Revision of Trabeculectomy With Mitomycin: Long-term Outcomes and Complications.

The purpose of this study was to assess long-term outcomes and complications of smaller-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients. Review of patients undergoing trabeculectomy revision with MMC for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a smaller (median, 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits. Forty eyes (40 patients; mean age, 67±13 y) underwent revision; 9 revisions were combined with other surgery. Mean baseline IOP was 20.6±6.2 mm Hg on 2.6±1.4 glaucoma medications after 2.4±1.3 incisional ocular surgeries. At final follow-up (70±34 mo), 27 successful eyes (67.5%) had IOP of 9.2±2.4 mm Hg on 0.6±0.9 medications. Eleven eyes (27.5%) required reoperation for glaucoma, 7 (63%) within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 77.5%, 72.2%, 69.5%, and 69.5%, respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7±2.4 weeks (median 1). Complications included sustained hypotony (IOP, ≤5 mm Hg) in 2 eyes (1 also with corneal decompensation), 1 eye with wound leak, and 2 eyes with bleb leak (1 requiring surgical repair). Smaller-incision trabeculectomy revision with MMC resulted in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.

Micropulse laser trabeculoplasty on pseuodexfoliation glaucoma patients under topical prostaglandin analogue monotherapy: 1-year results.

To evaluate the effectiveness of a single session of micropulse laser trabeculoplasty (MLT) to lower intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PEXG). In this single-center, one-arm, prospective study patients with PEXG under prostaglandine analogue monotherapy with inadequate IOP control were treated with 360° 532-nm MLT. Patients were evaluated at 1day, 1month, 3months, 6months, and 12months post-MLT while they were treated with the same drug regimen as pre-MLT. Mean IOP reduction and percentage of IOP change during the follow-up were calculated. Cases that required any further intervention, like additional hypotensive medication, laser or surgical therapy, throughout the study period were considered failures and removed from the study. Twenty-seven eyes (27 patients, 17 male) were included in the study. The age of the patients was 72.37 ± 6.29years and the baseline IOP was 20.41 ± 1.87mmHg. Treatment with MLT resulted in significantly lower IOP at 1, 3, 6, and 12months after MLT compared to baseline (p < 0.0001 for all comparisons). By the end of the study, 52.17% of the PEXG eyes demonstrated a ≥ 20% IOP reduction compared to baseline. Four eyes (14.81%) did not respond to MLT (three eyes at 3months and one eye at 6months after trabeculoplasty) and were considered failures since they required additional intervention. Micropulse laser trabeculoplasty appears to be an effective method to lower IOP in patients with PEXG up to 12month of follow-up period. The study is registered on www.ClinicalTrials.gov with registration number NCT03483402.

Surgical outcomes of membrane-tube-type glaucoma shunt device in indigenous West Africans.

PurposeThe aim of this study was to report the safety and efficacy of the membrane-tube (MT)-type glaucoma shunt device (Finetube MT) in the management of refractory glaucoma in indigenous West Africans.MethodsThe Finetube MT was implanted into 25 eyes of 25 West African patients with refractory glaucoma. These patients had inadequate intraocular pressure (IOP) control despite maximum tolerable IOP-lowering medications with or without previous ocular surgeries. IOP, postoperative complications, interventions, visual acuities, and the number of IOP-lowering medications were analyzed preoperatively and postoperatively.ResultsThe mean (standard deviation [SD]) age of the patients was 49.7 (20.9) years. The mean (SD) follow-up duration was 21.0 (10.6) months. Postoperatively, the mean (SD) IOP reduced from a preoperative value of 38.1 (10.3) mmHg to 14.5 (4.6), 16.1 (7.8), and 14.7 (3.0) mmHg at 1, 2, and 3 years postoperatively, respectively, representing 61.9%, 57.7%, and 61.4% reduction from baseline (P<0.01). The mean (SD) number of IOP-lowering medications reduced from 4.1 (1.0) to 0.6 (0.9) at 1 year and 0.9 (1.1) at 2 years after the operation (P<0.01). Using an IOP level between 6 and 21 mmHg and reduced by ≥20% from baseline, the cumulative survival rate (standard error) was 96.0% (3.9%) at 6 months, 89.0% (6.0%) at 18 months, and 81.3% (10.6%) at 3 years after the operation. There was no postoperative ocular hypotony, tube occlusion, or device exposure.ConclusionThe Finetube MT may effectively control IOP with minimal risk of postoperative complications in indigenous West Africans.

Update on Microinvasive Glaucoma Surgery.

Update on Microinvasive Glaucoma Surgery.