Included Intraocular Pressure Research Articles

Outcomes of primary trabeculectomy with mitomycin-C for primary angle closure glaucoma among supervised trainees in a tertiary eye center in Manila.

To evaluate efficacy and safety of trabeculectomy with mitomycin C (trab-MMC) for primary angle closure glaucoma (PACG) performed by ophthalmology trainees. This was a six-year retrospective study of patients with primary trab-MMC with PACG performed by ophthalmology trainees in a tertiary urban eye center. Outcomes included intraocular pressure (IOP), number of medications, and complications. There were 120 PACG eyes that underwent trab-MMC performed by trainees. The mean follow-up duration was 28.6 ± 20.8 months. At 24 months, postoperative IOP decreased from 32.1 ± 12.0 mm Hg to 14.8 ± 6.9 mm Hg (p<0.0001) with decrease in glaucoma medications [0 (0), 0-2; p<0.0001]. Half of surgeries, 64/120 (53.8%) utilized MMC-onlay and the other half, 55/120(46.2%) received MMC sub-tenon injection. Half 60/120 (50.4%) utilized releasable sutures. Majority 55/120 (46.2%) utilized conjunctival closure near the corneal limbus while 34/120 (28.6%) used a conjunctival skirt. Cumulative complete surgical success rates were 63.3%, 55.83%, and 42.5% at 6, 12, and 24 months, respectively. Most complications were minor, including high IOP (25.0%), bleb leaks (13.3%), and cystic blebs (15.0%). Bleb needling was the most common (24.2%) post-op surgical intervention. Among supervised ophthalmology trainees in the Philippines, trab-MMC for PACG was effective in lowering IOP long term and decreasing glaucomamedications, and surgical success rates were generally comparable with trainee studies from first world nations. Complications were minor and not sight threatening.

Safety and efficacy of bilateral simultaneous XEN implant surgery: a pilot study.

To evaluate the efficacy and safety of the bilateral simultaneous XEN (BISIXEN) surgery in open-angle glaucoma patients. Retrospective analysis of a prospective data base conducted on uncontrolled glaucoma patients who underwent BISIXEN surgery. Primary endpoint measure was the incidence of sight-threatening complications. Secondary endpoints included intraocular pressure (IOP) reduction and in number of required antiglaucoma medications. Ten patients (20 eyes) were included in the analysis. Median (95% confidence interval) follow-up was 12.0 (7.0-12.0) months, with 14 eyes having a follow-up of 12months. No sight-threatening complications, such as endophthalmitis, retinal detachment, corneal decompensation, or intraocular hemorrhages were observed in any eye of study sample. Mean IOP decreased significantly from 25.2 (21.5-28.9) mm Hg at baseline to 15.1 (13.4-16.8) mm Hg at the last follow-up visit (p = 0.0001). Mean number of antiglaucoma medications was significantly reduced from 2.9 (2.5 to 3.3) drugs at baseline to 0.40 (0.00-0.70) at the end of the study (p < 0.0001). At the last study visit, 14 (70.0%) eyes had an IOP ≥ 6 and ≤ 18mm Hg without treatment. Two eyes needed surgical revision and three ones needed a new glaucoma surgery: two underwent Ahmed valves (one eye with aniridia and the other previously operated on) and one underwent non-penetrating deep sclerectomy. Bilateral simultaneous XEN implantation may be a feasible strategy in those patients with high anesthetic risk.

Comparison of Surgical Outcomes of Sponge Application versus Subconjunctival Injection of Mitomycin-C during Combined Phacoemulsification and Trabeculectomy Surgery in Asian Eyes.

Purpose:To compare the outcomes of combined phacoemulsification–trabeculectomy surgery with intraoperative sponge-applied versus subconjunctival injection of mitomycin-C (MMC) in Asian eyes.Methods:This was a retrospective review of 95 eyes that consecutively underwent combined phacoemulsification–trabeculectomy surgery in a tertiary eye center in Singapore from January 2013 to June 2014. Data collected included intraocular pressure (IOP), best corrected visual acuity, and number of glaucoma medications. Outcome measures included postoperative IOP and complications at various timepoints up to 12 months after surgery.Results:Twenty eyes (21.1%) received 0.2 mg/ml subconjunctival MMC injection (“Group 1”) and 75 (78.9%) received 0.4 mg/ml sponge-applied MMC (“Group 2”). There was no difference between groups in demographics, IOP, and number of glaucoma medications preoperatively. There was a reduction in IOP at postoperative month (POM) 1, 6, and 12 in both the groups (POM12: Group 1, −2.8 ± 5.36 mmHg, P < 0.001; Group 2, −5.8 ± 6.29 mmHg, P = 0.054). At POM1, Group 2 showed a trend toward greater IOP reduction (−5.89 ± 7.67 mmHg vs. −1.55 ± 5.68 mmHg, P = 0.061). However, at both POM6 and POM12, there was no statistically significant difference in IOP reduction between the two groups. At POM12, complete success, defined as achieving an IOP of between 6 and 15 mmHg without the use of antiglaucoma medications, was achieved in 11 (55%) eyes in Group 1 and 48 (64%) in Group 2 (P = 0.9). There was a lower rate of postoperative hypotony in the Group 1 (0%) compared to Group 2 (8%) (P = 0.34).Conclusion:Combined phacoemulsification–trabeculectomy with subconjunctival MMC injection has comparable outcomes to that with sponge-applied MMC, with a similar reduction in IOP at 1, 6, and 12 months postoperatively and a lower postoperative complication rate.

Clinical efficacy and safety of Razumab® (CESAR) study: Our experience with the world's first biosimilar Ranibizumab.

Purpose:The aim of this study was to evaluate the efficacy and safety of Razumab (the biosimilar Ranibizumab by Intas Pharmaceuticals Ltd.) for the treatment of chorioretinal vascular diseases such as diabetic macular edema (DME), choroidal neovascular membrane (CNVM), and macular edema secondary to retinal vein occlusion (RVO).Methods:We conducted a single-center, retrospective study, including patients with DME, CNVM, and RVO, who had received treatment with Razumab® between October 2018 and September 2019. Primary outcome measures were the changes in corrected distance visual acuity (CDVA) and central foveal thickness (CFT) from baseline to 1 month and 3 months. Secondary outcome measures included intraocular pressure (IOP) at day 1, any signs of ocular inflammation or systemic adverse events during the follow-up.Results:One hundred and fifty-three eyes of 141 patients were analyzed. The indications included DME in 70 (45.8%) eyes, CNVM in 70 (45.8%) eyes, and RVO in 13 (8.4%) eyes. Mean CDVA improved from baseline (0.62 ± 0.44) to month 1 (0.45 ± 0.42) and maintained till 3 months (0.42 ± 0.44; P < 0.001). Mean CFT showed significant reduction from baseline (405.68 ± 192.422 μm) to month 1 (286.08 ± 118.36 μm) and month 3 (271 ± 104.24 μm; P < 0.001). None of the eyes recorded IOP >20 mmHg on day 1. No evidence of ocular toxicity or systemic adverse event was noted.Conclusion:Razumab® showed a rapid improvement in CDVA and CFT in most of the eyes with efficacy observed as early as 1 month and maintained till 3 months. The biosimilar Ranibizumab can be a safe and effective low-cost drug for treating macular diseases.

Comparison of Clinical Outcomes with Open Versus Closed Conjunctiva Implantation of the XEN45 Gel Stent

Purpose:To describe the efficacy and safety of open versus closed conjunctival implantation of the XEN45 Gel Stent (Allergan Inc).Design:Retrospective, multicenter study.Participants:A total of 137 patients with glaucoma who underwent XEN45 implantation via open or closed conjunctival methods. The XEN45 was implanted as a stand-alone procedure or at the time of cataract surgery by 5 surgeons.Methods:Patient demographics, diagnoses, preoperative and postoperative clinical data, outcome measures including intraocular pressure (IOP), use of glaucoma medications, visual acuity, and complications were collected. Statistical analyses were performed with P < 0.05 as significant.Main Outcome Measures:Failure was defined as less than 20% reduction of IOP from medicated baseline or IOP >21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Eyes that had not failed but required glaucoma medications were defined as qualified successes.Results:Complete success was achieved in 31% and 56% of the closed and open groups, respectively (P = 0.01). Qualified success was achieved in 53% and 71% of the closed and open groups, respectively (P = 0.06). At postoperative month 12, the open conjunctiva group was using fewer glaucoma medications than the closed group (0.9 vs. 1.8, respectively; P = 0.02). At postoperative month 12, the open group had a significantly greater percentage of IOP reduction compared with the closed group (43.1% vs. 24.8%, respectively; P = 0.02). Postoperative needling rates were higher in the closed group compared with the open group (36.1% vs. 11.8%, P = 0.001).Conclusions:Implantation of the XEN45 with opening of the conjunctiva is a safe and efficacious procedure to lower IOP with comparable success rate and lower needling rate compared with the closed conjunctiva technique. Prospective evaluation of the various methods for XEN45 implantation will allow for further comparison.

Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute.

PurposeTo report the clinical characteristics, complications, and outcomes of hyphema in patients with sickle cell trait (SCT).DesignRetrospective case series.MethodsMedical records of SCT patients (confirmed by hemoglobin electrophoresis) presenting with hyphema at the Wilmer Eye Institute over 10 years (January 2008 through December 2017) were reviewed in detail. Data were collected regarding etiology, demographics, clinical course and management. Main outcome measures included intraocular pressure (IOP) and visual acuity (VA).ResultsA total of 14 black patients (males: 57%; median age: 20 years) were included in the study with a median follow-up of 4 months (range: 1 week to 6 years). Ten patients had traumatic hyphema with a mean presenting VA of approximately 1.10 logMAR (Snellen equivalent=20/250) and a mean presenting IOP of 40 mmHg. Nine of them required medical intervention to lower IOP, and six of them ultimately required surgical intervention, primarily in the form of anterior chamber paracentesis and/or washout. The mean time to achieve IOP control was 3 days, and the mean final VA was approximately 0.10 logMAR (Snellen Equivalent=20/25). Four patients had non-traumatic hyphema with a mean presenting VA of approximately 1.8 logMAR (Snellen equivalent=20/1260) and a mean presenting IOP of 31 mmHg. Three of them required medical intervention to lower IOP, and two of them ultimately required surgical intervention. Overall, seven patients underwent anterior chamber washout, six needed an anterior chamber paracentesis to lower the IOP, two required tube shunt placement procedures and one patient underwent a trabeculectomy. The mean time to achieve IOP control was 5 days, and the mean final VA was approximately 0.80 logMAR (Snellen equivalent=20/125).ConclusionPatients with SCT are likely to develop elevated IOP in the setting of hyphema, with a majority requiring one or more surgical interventions to achieve IOP control.

Influence of Selective Laser Trabeculoplasty (SLT) on the iStent inject\xae outcomes

BackgroundTo evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in open-angle glaucoma (OAG).MethodsIn this retrospective comparative cohort outcome study, 66 patients who were treated with two iStent inject® devices were included. Patients were divided into two subgroups consisting of patients without SLT treatment prior to surgery and patients who had been treated previously with 360° SLT but without sufficient response. Outcome measures included intraocular pressure (IOP) and number of antiglaucoma medications after 6 weeks with three, six, 12, and 24 month follow-ups.ResultsMean preoperative IOP decreased from 20.4 ± 5.3 mmHg to 14.8 ± 3.0 mmHg for patients without SLT treatment prior to surgery (p = 0.001) and from 19.2 ± 4.5 mmHg to 14.0 ± 1.6 mmHg for patients with insufficient response to 360° SLT treatment (p = 0.027) at 12 months after iStent inject® implantation. No significant difference was found between the two groups (p > 0.05). The number of antiglaucoma medications did not change in both groups (p > 0.05) and showed no significant difference between the two groups (p > 0.05).ConclusionPrior SLT treatment seems to have no negative influence on the IOP lowering-effect of iStent inject® implantation in patients with OAG. It is therefore an appropriate incremental procedure with no exclusion criterion for an iStent inject® implantation.

Two-Year Multicenter Outcomes of iStent inject Trabecular Micro-Bypass Stents Combined with Phacoemulsification in Various Types of Glaucoma and Ocular Hypertension.

PurposeThis multicenter study evaluated 2-year effectiveness and safety following implantation of two second-generation trabecular micro-bypass stents (iStent inject®) with phacoemulsification.Materials and MethodsThis was a retrospective study of iStent inject implantation with phacoemulsification by nine surgeons across Australia. Eyes had mild to advanced glaucoma (predominantly primary open-angle/POAG, appositional angle-closure/ACG, or normal-tension/NTG) or ocular hypertension (OHT), and cataract. Evaluations included intraocular pressure (IOP); medications; proportions of eyes with 0 or ≥2 medications, reduced/stable medications versus preoperative, and IOP ≤15 mmHg; visual acuity; cup-to-disc ratio (CDR); visual fields (VF); adverse events; and secondary surgery.ResultsA total of 340 eyes underwent surgery and had 24-month follow-up data. At 24 months, mean IOP decreased by 16% from 16.4±4.7 mmHg preoperatively to 13.7±3.1 mmHg (p<0.001), and 77% of eyes achieved IOP of ≤15 mmHg versus 49% preoperatively (p<0.001). Mean number of medications decreased by 67% to 0.49±0.95 versus 1.49±1.20 preoperatively (p<0.001), with 74% of eyes medication-free versus 25% preoperatively (p<0.001), and 14% of eyes on ≥2 medications versus 46% preoperatively (p<0.001). Medication burden was reduced or stable in 98% of eyes versus preoperative. Stratified analyses showed significant IOP and medication reductions across glaucoma subtypes (POAG, ACG, NTG, OHT): 13–22% for IOP (p<0.01 for all) and 62–100% for medication (p<0.001 for all). Favorable safety included few adverse events; stable CDR, VF, and visual acuity; and filtering surgery in only 8 eyes (2.4%) over 2 years.ConclusionThis 340-eye multicenter dataset provides robust evidence of the safety and efficacy of iStent inject implantation with phacoemulsification, with significant and sustained IOP and medication reductions through 2 years. Results were similarly favorable across glaucoma subtypes (including POAG, ACG, NTG, OHT) and were attained across various glaucoma severities, clinical sites, and surgeons, highlighting the real-world versatility and utility of this treatment modality.

IStent Trabecular Micro-Bypass Stent Implantation with Cataract Surgery in a Japanese Glaucoma Population.

IntroductionThis study assesses two-year efficacy and safety following implantation of a single trabecular micro-bypass stent (iStent®) with concomitant phacoemulsification cataract surgery in Japanese patients with open-angle glaucoma (OAG).Materials and MethodsThis retrospective, consecutive case series included eyes that underwent iStent implantation with phacoemulsification and were followed for 24 months postoperative. Efficacy and safety measures included intraocular pressure (IOP), number of glaucoma medications, adverse events, secondary surgeries, visual fields, and endothelial cell counts.ResultsOf 73 operated eyes, 53 eyes had 24 months of follow-up and are analyzed. Diagnoses included primary open-angle glaucoma (POAG, n=25), normal-tension glaucoma (NTG, n=16), and pseudoexfoliative glaucoma (PXG, n=12). At 24 months, mean IOP reduced by 18% to 13.6±3.0 mmHg versus 16.5±3.4 mmHg preoperatively (p<0.0001), and mean medication number reduced by 81% to 0.37±0.74 versus 1.96±0.98 preoperatively (p<0.0001). The percentage of medication-free eyes was 77% versus 0% preoperatively, and 81% of eyes had IOP ≤15 mmHg versus 42% preoperatively. Results were similarly favorable across glaucoma subtypes (POAG, NTG, PXG). Notably, mean IOP in NTG eyes decreased to 12.8±1.4 mmHg from 14.4±3.0 mmHg preoperatively (p=0.03), and medications decreased by 87% to 0.31±0.70 versus 2.38±0.72 preoperatively (p<0.0001). At 24 months, 81% of NTG eyes were medication-free (versus 0% preoperatively); 2 NTG eyes (13%) were on ≥2 medications (versus 100% preoperatively). Throughout the follow-up, visual fields and endothelial cell counts remained stable; 1 eye (1.9%) underwent filtration surgery.DiscussionFavorable safety and significant IOP and mediation reductions were achieved through two years following iStent implantation with phacoemulsification in a Japanese population. These gains were achieved across all glaucoma subtypes (including POAG, NTG, PXG).ConclusionThis real-world study supports the viability of iStent implantation to treat Japanese patients with glaucoma and shows that the benefits extend to those with NTG or PXG in addition to POAG.

Evaluation of Blood-filling Patterns in Schlemm Canal for Trabectome Surgery.

The purpose of this study was to evaluate the association between trabectome surgery outcomes and the blood filling patterns in SC before TM ablation. This retrospective cohort study included 105 eyes of 84 Japanese primary open-angle glaucoma patients who had undergone trabectome surgery in combination with cataract surgery. Provocative gonioscopy was performed before TM ablation to classify the blood filling patterns in SC into 3 groups: no filling (group 1); patchy/irregular filling (group 2); and complete filling (group 3). The subjects were divided into 3 groups according to the blood filling patterns and the trabectome surgery outcomes were compared, including intraocular pressure (IOP), the percentage reduction in IOP, surgical success rate, and the number of glaucoma medications. Success was defined by IOP ≤15 mm Hg and a >20% reduction in IOP with/without glaucoma medication, and without additional glaucoma surgery after trabectome surgery combined with cataract surgery. Twenty-four eyes were assigned to group 1, 48 to group 2, and 33 to group 3. Between-group analyses showed no significant intergroup differences in age (P=0.213), preoperative mean deviation (P=0.505), preoperative and postoperative IOP (P=0.941 and 0.458, respectively), preoperative and postoperative number of glaucoma medications (P=0.805 and 0.077, respectively), percentage IOP reduction (P=0.256), and success rates (P=0.540). Trabectome surgery is effective for mild to moderate primary open-angle glaucoma patients, independent of the blood-filling patterns in SC before the TM ablation.

Surgical Outcomes of a Second Ahmed Glaucoma Valve Implant for the Treatment of Refractory Glaucoma.

To evaluate the surgical outcomes of a second AGV implant in Hispanic patients with refractory glaucoma. The medical records of patients who underwent a second AGV implant were reviewed retrospectively. Clinical outcome measures including intraocular pressure (IOP), visual acuity, and glaucoma medication use were collected from the preoperative visit and all follow-up visits up to 18 months after surgery. Failure was defined as one of the following: loss of light perception, sustained IOP >21 or <6 mm Hg, an IOP reduction of <20% from baseline, need for additional glaucoma surgery, including needling revision with subconjunctival adjuvant therapy, or valve extrusion. A total of 48 patients were included. In all cases, an S-2 model was implanted in the superonasal quadrant. Mean preoperative IOP was 24.3±7.9 mm Hg and was significantly reduced to 13.9±4.8 at 6 months (P<0.05), 15.4±7.2 at 12 months (P<0.05), and 12.9±2.0 at 18 months (P<0.05). Mean glaucoma medications were reduced from 2.8±1.1 preoperatively to 1.9±1.2 at 6 months (P<0.05), 2.4±1.2 at 12 months, and 2.2±1.1 at 18 months; however, the difference was no longer statistically significant after 6 months, and the success rate was 60% at the mean for survival time of 15 months (13.7 to 16.5). The findings of this study demonstrate that a second AGV can achieve a significant reduction in IOP for up to 18 months postoperatively.

Ab externo 240-degree trabeculotomy versus trabeculotomy–trabeculectomy in primary congenital glaucoma

This prospective study aimed to compare the surgical outcomes of ab externo 240-degree trabeculotomy and trabeculotomy-trabeculectomy in managing primary congenital glaucoma (PCG). The study included 30 eyes of 30 patients aged less than 3 years who were diagnosed with PCG and was conducted in Menofia University Hospital between November 2018 and January 2020. The studied eyes were divided into two equal groups. Ab externo 240-degree trabeculotomy and combined trabeculotomy with trabeculectomy with MMC were performed for groups I and II, respectively. Post-operative measurements included intraocular pressure (IOP), optic disc changes, alteration in corneal clarity and transverse corneal diameter, as they are needed for antiglaucoma therapy. Post-operative complications were followed up for 1-year. There was significant reduction in IOP in both groups during the follow-up period. The reduction was higher in group I, where mean preoperative IOP was 28.20 ± 1.74 mmHg. The IOP in the group II was 28.07 ± 3.51 mmHg. The mean IOP decreased to 13.93 ± 1.8 mmHg and 14.60 ± 1.24 mmHg in groups I and II, respectively, after 1 year (P < 0.001); however, the difference between the two groups was not significant. Regarding post-operative complications, post-operative hypotony was more common in group I. Other complications such as shallow anterior chamber, choroidal detachment and blebitis occurred more frequently in group II. However, post-operative hyphema was more common in group I. Corneal clarity improved significantly in both groups, but more so in group I, where an improvement was seen in 13 cases (86.6%), compared to 11 cases in group II (73.3%). Ab externo 240° trabeculotomy and trabeculotomy-trabeculectomy are effective techniques in primary congenital glaucoma with more reduction in IOP in Ab Externo 240° trabeculotomy. Ab externo 240° trabeculotomy provided more better surgical outcome with limited complications, especially those related to bleb formation.

Efficacy and safety of Bujing Yishi tablet for glaucoma with controlled IOP: study protocol for a multi-centre randomized controlled trial

BackgroundAs an irreversible, intractable disease with vision loss, glaucoma leads to permanent and progressive damage of visual function. Lowering high intraocular pressure (HIOP) is the first choice for treating glaucoma; however, the control of HIOP is not enough to prevent progressive vison loss. Currently, the therapies to treat glaucoma with controlled IOP (GPCI) are unsatisfactory. Chinese medicine is effective for improving visual function in patients with GPCI. Bujing Yishi tablets (BJYSP) have been the standard preparation for treating GPCI in our hospital for decades. However, no rigorous randomized controlled clinical studies have investigated its effects and safety.MethodsThis study will be a 6-month, multicenter, stratified trial following a prospective, randomized, open-label, blinded endpoint (PROBE) protocol. A total of 216 eligible GPCI patients aged 18–75 years will be stratified according to the early, moderate, and advanced stages of glaucoma. After stratifying, the participants will be randomly assigned to the BJYSP group or control group at a ratio of 1:1. Following randomization, participants in the BJYSP group and control group will receive BJYSP and mecobalamin tablets, respectively, for the same 6-month period. The primary outcomes will include the best-corrected visual acuity (BCVA), visual field assessment, visual evoked potential (VEP) test, and Heidelberg retina tomography II (HRT II); the secondary outcomes will include intraocular pressure (IOP) and Traditional Chinese medicine (TCM) clinical symptom scales. The primary and secondary outcomes will be measured at baseline and 8, 16, and 24 weeks thereafter. Safety assessments will also be evaluated at baseline and 12 and 24 weeks thereafter.DiscussionThis study will be a standardized, scientific, clinical trial designed to evaluate the therapeutic effects and safety of BJYSP as a novel therapeutic strategy for improving visual function in patients with GPCI.Trial registrationChinese Clinical Trial Registry, ChiCTR1800016431. Registered on 1 June 2018.

IStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma: early clinical experience

BackgroundRetrospective, consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world, clinical setting.MethodsThe series included 56 eyes implanted with the iStent inject device with phacoemulsification. The series consisted of eyes with primary open-angle glaucoma (n = 52) and pseudoexfoliative glaucoma (n = 4). Primary outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes ≥10 mmHg and ≥ 15 mmHg.ResultsIOP was reduced by 21% to 14.7 ± 2.9 mmHg (p < 0.01) at 6 months postoperative from 18.7 ± 5.8 mmHg at baseline. Preoperatively, the mean number of glaucoma medications was 1.5 ± 0.9 and reduced by 39% to 0.9 ± 1.2 (p < 0.01) at 6 months. At 6 months, 68% of eyes had an IOP ≤15 mmHg, increased from 30% at baseline. 55% of eyes were medication-free at 6 months, up from 18% at baseline. There were no severe postoperative complications. No eyes underwent an additional glaucoma procedure.ConclusionsImplantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative. The safety profile is excellent.

Trabecular microbypass stent implantation in pseudoexfoliative glaucoma: long-term results.

To evaluate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in pseudoexfoliative glaucoma (PXG). Private practice, Sioux Falls, South Dakota, USA. Retrospective, consecutive case series. Eyes with a preoperative diagnosis of PXG implanted with a single iStent trabecular microbypass stent with concomitant cataract surgery were included. Performance outcome measures included intraocular pressure (IOP) and number of glaucoma medications. Safety outcomes included intraoperative or postoperative complications and the need for secondary procedures. The series included 117 eyes. IOP was reduced by 25% to 15.3 ± 3.7 mm Hg at 5 years postoperatively from 20.5 ± 6.6 mm Hg at baseline. The statistically significant (P < .01) 36% reduction in medication use through 36 months was not sustained, and medication use was unchanged from baseline (1.4 ± 1.0) at 5 years postoperatively (1.3 ± 1.1) (P > .05). At 5 years, 52% of eyes had an IOP of 15 mm Hg or lesser, increased from 22% at baseline. There were no severe postoperative complications; 5 eyes (4%) underwent an additional glaucoma procedure. Implantation of a trabecular microbypass stent with concomitant cataract surgery provided a sustained reduction in IOP up to 5 years postoperatively. The long-term safety profile of the device in this population was excellent with a low rate of postoperative IOP spikes and low percentage of eyes undergoing a secondary procedure.

Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome.

To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = -3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.

A novel ophthalmic viscosurgical device-free phakic intraocular lens implantation makes myopic surgery safer

PurposeTo assess the efficacy and safety of a novel ophthalmic viscosurgical device-free (OVD-free) method for posterior chamber phakic intraocular lens (PIOL) implantation in myopic eyes.MethodsIn this retrospective cohort study, the medical records of myopic eyes that underwent PIOL (Implantable Collamer Lens, ICL) implantation for myopia correction at the Eye Hospital of Wenzhou Medical University between May 2015 and March 2017 were reviewed. A total of 49 eyes with complete data that met follow up requirements (2 h, 1 day, 1 week, 3 months postoperatively) were recruited. Based on the surgical techniques used, the eyes were divided into the OVD-free method group and the standard method group. The clinical data, including intraocular pressure (IOP), corrected distance visual acuity (CDVA) and spherical equivalent (SE), at each follow-up were collected for comparison. Endothelial cell loss and complications were also investigated.ResultsTwenty-one eyes received the standard method, and 28 eyes received the OVD-free method. A rise in IOP > 22 mmHg at 2 h was noted in 14 eyes (66.7%) in the standard group and none (0%) in the OVD-free group (p < 0.001). The rise in IOP from baseline was significantly higher at 2 h in the standard group (10.5 ± 5.2 mmHg vs. 2.2 ± 3.3 mmHg, difference: 8.3, 95% CI 5.8 to 10.8; p < 0.001). There was a significant difference in the time course of LogMAR CDVA changes between the two groups (p = 0.047). The LogMAR CDVA was significantly better in the OVD-free method group compared to the standard group at 1 day (− 0.076, 95% CI − 0.134 to − 0.018; p = 0.012), 1 week (− 0.071, 95% CI − 0.135 to − 0.007; p = 0.03), but not at 3 months (− 0.046, 95% CI − 0.107 to 0.015; p = 0.134). There was no significant difference in the time course of SE changes between the two groups (p = 0.471; p = 0.705). In the OVD-free group, mean endothelial cell loss was 4.6% at 3 months (2522 ± 281 vs. 2407 ± 226 cells/mm2, difference: -115, 95% CI − 295 to 65; p = 0.187). No complications were reported in both groups except for the early IOP elevation in the standard group during the observation period.ConclusionsThe OVD-free method is safe and efficient for ICL implantation. It can be a safer method of ICL implantation compared to the standard method in that it completely eliminates ophthalmic viscoelastic devices-related complications without causing additional complications.

Phacoemulsification with Trabecular micro-bypass stents in complex and moderate to advanced glaucoma: 3 year outcomes

Purpose: To evaluate longer-term (3 year) outcomes in terms of safety and efficacy of two trabecular micro-bypass stents implanted in combination with cataract surgery in patients with moderate to advanced and complex glaucoma. Patients: Fifty consecutive patients with cataract and moderate to advanced primary glaucoma or significantly raised intra-ocular pressure or secondary glaucoma or those with a history of previously failed filtering surgery. Methods: Retrospective, interventional case series. Patients underwent implantation of two trabecular micro-bypass stents in combination with cataract surgery. Outcomes measures included intra-ocular pressure (IOP), number of glaucoma medications, visual field mean deviation and need for secondary surgery. Results: The mean pre-operative IOP was 24.2 ± 7.3 mmHg, the mean post-operative IOP at 36 months (M36) was 16.2 ± 4.3 mmHg (p ≤ 0.05). This was a mean reduction of 8 mmHg (33.1%). Mean medication overall reduced from 3.2 preoperatively to 2.1 at M36 (p<0.05), a reduction of 34.4%. Visual field data was available for 30 eyes. There was no significant difference in mean MD over 36 months (p=0.267). Seven eyes (14%) required conversion to filtration surgery. No intraoperative complications were noted. Nine eyes (22.0%) were off medication at M36. Conclusion: Trabecular micro-bypass implantation in combination with cataract surgery is a safe and effective option in patients with complex and advanced glaucoma and appears to stabilize visual fields.

Combined iStent® Inject Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma.

PurposeThis retrospective audit aimed to evaluate the impact of combined iStent® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields.Patients and MethodsPatients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification.ResultsForty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (–16%; p = 0.012; n = 35) and 12 months (–29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (–8%; p < 0.001; n = 57) and 6 months (–16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups.ConclusionThis audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

Short term efficacy of EX-PRESS filtration shunt implantation for open angle glaucoma.

To observe the short-term efficacy of EX-PRESS filtration shunt implantation in the treatment of open angle glaucoma, and to analyze the safety and effectiveness of the surgical method. From April 2017 to January 2018, a total of 28 eyes of 17 open angle glaucoma patients in Xiangya Hospital of Central South University were screened. Among them, 16 eyes in the experimental group were treated with EX-PRESS filtration shunt (P200)implantation, and 12 eyes in the control group underwent trabeculectomy. Related examinations were performed in 1 day before operation, 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation, which included intraocular pressure (IOP), uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA), central anterior chamber depth (ACD), trabecular iris angle (TIA), the long axis of drainage nail and corneal endothelium angle (ACA), intraoperative and postoperative complications. Visual-related quality of life questionnaire was conducted and scored in 3 months after operation. In the experimental group, the IOP in 1 day after operation, 1 week after operation and 1 month after operation was decreased significantly compared with that in 1 day before operation (all P<0.05), but the IOP in 3 months after operation was not significantly decreased compared with that in 1 day before operation (P>0.05). In the control group, the IOP in 1 week after operation, 1 month and 3 months after operation was decreased significantly with that of pre-operation (all P<0.05), but the IOP in 1 day after operation was not significantly decreased compared with that in 1 day before operation (P>0.05).The BCVA between the 2 groups was significantly different in 1 week after operation, 1 month and 3 months after operation compared with that in 1 day before operation (P>0.05). The ACD in 1 day after operation, 1 week after operation, 1 month after operation and 3 months after operation was not significantly different compared with that in 1 day before operation (all P>0.05). However, the ACD in 1 week after operation and 1 month after operation was significantly different in the control group compared with that in 1 day before operation (both P<0.05). There was no significant change in the TIA in the 2 group compared with that in 1 day before operation (all P>0.05). At different observed time after operation, there was no significant difference in the ACA (all P>0.05). The correlation analysis of Pearson showed that there was a weak correlation between the ACA and the IOP (r=0.286, P<0.05). According to the standard of surgical success defined in this study, the success rate of experimental group was 81.25%, and the control group was 83.33%. There was no significant difference in the visual-related quality of life score between the experimental group and the control group (P>0.05), but the mean value in the former was higher. As a new type of anti-glaucoma surgery, the success rate of EX-PRESS filtration shunt implantation for 3-month follow-up is equivalent to that of classic trabeculectomy. The operation process is simple, and there is no significant change in the ACD before and after the operation in the period of 3-month follow-up. The stability of the anterior chamber is better. There is no significant correlation between the relative position of the shunt in the anterior chamber and the IOP. Compared with trabeculectomy, there is no significant difference in the visual-related quality of life.