Laser Goniopuncture Research Articles

Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery.

To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery. A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure. Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively. DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.

Resultados de una técnica quirúrgica de trabeculectomía ab-externo modificada en pacientes con glaucoma de ángulo abierto

ObjectiveAssess the safety and efficacy of a modified ab-external trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysisPatients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. ResultsForty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the follow-up time was 35.3 months (range of 1-147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. ConclusionsThis proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma

ObjectiveAssess the safety and efficacy of a Modified Ab-externo Trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysisPatients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. ResultsForty-eight eyes of 38 patients were included. The mean age was 63.1 years (25–85 years), and the mean follow-up time was 35.3 months (range of 1147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. ConclusionsThis proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

Pseudophakic glaucoma and intraocular lens subluxation

Purpose. To evaluate the results of glaucoma surgery with Xenoplast drainage and fixation of IOL/capsula bag complex in patients with subluxation and luxation of this complex and secondary pseudophakic glaucoma.Materials and methods. 35 patients (35 eyes) aged 60 to 92 with secondary pseudophakic previously unoperated glaucoma, pseudophakia, zonula weakness and IOL dislocation or decentration were observed. The patients underwent phacoemulsification 6 to 12 years prior to the follow-up. In all cases IOP exceeded 28 mm Hg under 4–5 hypotensive medications a day. All patients had glaucoma surgery nonpenetrating deep sclerectomy with Xenoplast drainage implantation in the intrascleral space with simultaneous IOL/capsula bag suturing to the sclera. Anterior vitrectomy was performed if proved necessary.Results. In early post-op period, 94% of cases showed moderate hypertension of 26 to 28 mm Hg, but 2 cases showed 40 mm Hg one day after the operation. During the first month all patients received hypotensive medication: 2–3 instillations of carbonic anhydrase inhibitors. IOP normalized by the 8th week after operation. 1 to 2 months after surgery, all patients received IAG laser goniopuncture. Vision acuity was improving for 8 weeks and reached 0.1–0.8. The observation period varied between 6 months and 4 years.Conclusions. Non-penetrating deep sclerotomy with Xenoplast implantation combined with IOL/capsula bag complex fixation to the sclera in cases of pseudophakic noncompensated glaucoma normalizes IOP in the long-term post-op period.

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma.

Purpose: To report the safety and efficiency of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation.Methods: This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions.Results: The mean age of the patient was 42.6 ± 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively.Conclusion: CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.

Safety, efficacy, and timing of Nd:YAG laser goniopuncture after nonpenetrating deep sclerectomy for glaucoma: A retrospective cohort study

Neodymium-doped yttrium aluminum garnet laser goniopuncture is an adjuvant procedure for nonpenetrating deep sclerectomy. We investigated optimal laser goniopuncture timing and the effect of laser iridoplasty on success rates. This single-center retrospective cohort study compared intraocular pressure control in patients with early versus late laser goniopuncture after nonpenetrating deep sclerectomy and evaluated the effects of laser iridoplasty pretreatment. A 3-month cut-off was used to define early versus late laser goniopuncture. The primary outcome was the proportion of patients maintaining intraocular pressure control according to definitions of complete (no medications) and qualified (with medications) success at 15, 18, and 21 mmHg thresholds. Data were analyzed using right-censored Kaplan-Meier estimation and log-rank testing. A total of 124 eyes of 124 patients were analyzed. Complete success rates after 3 years were 9.2%, 14.6%, and 23.3% for early laser goniopuncture and 21.8%, 26.0%, and 55.4% for late laser goniopuncture for 15, 18, and 21 mmHg, respectively (all p < .01). Qualified success rates after 3 years were 16.6%, 24.8%, and 40.9% for early laser goniopuncture and 21.5%, 56.1%, and 69.6% for late laser goniopuncture for 15, 18, and 21 mmHg, respectively (p = .096, .0026, .0061). Late laser goniopuncture was associated with decreased risk of iris incarceration and bleb collapse. Iridoplasty pretreatment was not associated with improved outcomes. Late laser goniopuncture (3-month cut-off) was associated with better intraocular pressure control and less adverse events than early laser goniopuncture.

Long-term Results of Nd:YAG Goniopuncture on Viscocanalostomy and Phacoviscocanalostomy.

Laser goniopuncture (LGP) is an effective outpatient procedure which has been shown to maintain reduced intraocular pressure (IOP) 5 years following initial laser treatment in patients who have had viscocanalostomy (VC) (with or without phacoemulsification). The purpose of this study was to establish the long term (5 y) efficacy of neodymium-doped:yttrium aluminum-garnet LGP to lower IOP following VC or phacoviscocanalostomy (PVC) in patients with glaucoma. This retrospective study analyzed patients who underwent LGP following VC±phacoemulsification between 2009 and 2012 at the Stanley Eye Unit in Abergele. Reason for further intervention included either increasing IOP outside target range or worsening visual fields. Statistical analyses were performed comparing pregoniopucture values to those taken up to 5 years later. Of the 620 VC and PVC procedures performed between 2009 and 2012, 218 eyes underwent LGP after a mean of 25 months [95% confidence interval (CI): 22.58 to 27.41] following surgery. Patients having a PVC had a longer mean time to goniopuncture compared with those who were phakic and had VC only (P<0.001). Immediately following goniopuncture IOP dropped, and a statistically significant reduction persisted at 5 year follow-up (P<0.001). Goniopuncture reduced IOP significantly from a pretreatment value of 21 to 15 mm Hg over 5 years (95% CI) (χ2F(4)=119.1, P<0.001). In total, 154 eyes (71%) were commenced on IOP-lowering medication at a mean of 14 months (95% CI: 12 to 17). At 5 years, successful IOP control was achieved in 73% (49 of 67) of eyes. There was no difference found between type of surgery and successful pressure control at 5 years (χ2(1)=2.00, P=0.16). LGP is an effective procedure which maintains a statistically significant reduction in IOP in the long term.

Laser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failure

AimsTo report the incidence, risk factors and long-term outcomes of laser goniopuncture (LGP) in patients with previous deep sclerectomy (DS).MethodsRetrospective cohort study of 1765 eyes (1385 patients) undergoing DS with...

Влияние селективной лазерной трабекулопластики на результат последующего хирургического лечения глаукомы

Treatment efficacy analysis was performed on 111 eyes of 100 patients. The effect of non-penetrating deep sclerectomy (NPDS), phaco+IOL+ab interno trabeculotomy with or without preceding selective laser trabeculoplasty (SLT) was estimated by IOP level at the moment of decompensation and by the duration of hypotensive effect after surgery. IOP decompensation after NPDS occurred in 8.09 ± 1.3 months with SLT and in 5.72 ± 0.59 months without SLT. After laser goniopuncture (LGP) the duration of hypotensive effect before hypotensive treatment was 8.83 ± 0.7 months in the first group and 10.76 ± 1.18 months in the second grouP. The duration of hypotensive effect after combined surery of glaucoma and cataract was 25.11 ± 2.82 months after SLT and 18.26 ± 1.79 months without SLT. At the moment of decompensation IOP level was almost equal in both groups: 24.57 ± 0.51 and 25.10 ± 0.59 mm Hg, respectively. The results of glaucoma surgery after SLT and without preceding laser treatment are comparable; moreover, preceding SLT may prolong hypotensive effect of glaucoma surgery. Key words: selective laser trabeculoplasty; non-penetrating deep sclerectomy; laser goniopuncture; trabeculotomy.

WITHDRAWN:Effect of Nd:YAG Laser Goniopuncture Timing on the Long-term Efficacy of Non-penetrating Deep Sclerectomy.

Ahead of Print article withdrawn by publisher.

Impact of early and delayed Nd:YAG laser goniopuncture on results of deep sclerectomy (5-years follow up period).

To report on impact of Nd:YAG laser goniopuncture (LGP) timing on hypotensive efficacy of deep sclerectomy (DS) for open-angle glaucoma (OAG) patients. 228 patients who underwent DS followed by Nd:YAG LGP between January 2010 and December 2013, (follow up - 5 years) were enrolled into a single-center, retrospective, non-randomized, consecutive study. Subjects were divided into two groups (1 - delayed LGP, n = 116; 2 - early LGP, n = 112). Demographic variables, preoperative glaucoma medications, preceding surgeries and glaucoma severity were analyzed. Intraoperative and postoperative complications, intraocular pressure (IOP), ultrasound biomicroscopy (UBM) values were recorded. Success rate was analyzed using Kaplan-Meier curve. UBM data were the criteria for early or delayed LGP. LGP was performed 3.46 ± 1.9 (1.5-6.7) months after DS in group 1, 1.12 ± 0.08 (0.9-1.5) months in group 2 (p = 0.0001). Mean IOP before LGP in group 1 was 18.5 ± 4.7 (11.2-22.9) mm Hg; 15.7 ± 4.1 (9.1-18.5) mm Hg in group 2 (p = 0.001). Choroidal effusion occurred in 8.6% of group 1 and 3.5% of group 2 (p = 0.0001). Postoperative IOP: 15.6 ± 4.6 (group 1) and 15.7 ± 4.3 mm Hg (group 2) at 12 months (p = 0.98), 16.7 ± 4.3 and 14.9 ± 1.6 mm Hg at 24 months (p = 0.004), 16.8 ± 3.9 and 14.5 ± 3.2 mm Hg at 60 months, respectively (p = 0.0001). Complete success rates: 68.07% and 92.59% at 12 months, 40.7% and 75.8% at 24 months, 15.2% and 48.93% at 36, 48, 60 months in groups respectively (p = 0.0001). Early LGP after DS excludes TDM influence on further formation of intrascleral canal cavity and outflow pathways demonstrating pronounced hypotensive success in a long-term follow-up.

Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: a 2-year follow-up.

This study describes the imaging of the filtering area in CO2 laser-assisted sclerectomy surgery (CLASS) using ultrasound biomicroscopy (UBM) combined with the Indiana Bleb Appearance Grading Scale (IBAGS) and evaluates the mechanism by which CLASS lowers the intraocular pressure (IOP). Twenty-eight cases (28 eyes) of primary open-angle glaucoma that could not be controlled by drugs underwent CLASS. At 1, 3, 6, 12, 18, and 24 months after surgery, IBAGS was used to evaluate the external morphology of the filtering blebs, and UBM was used to describe and measure their internal structure. During the early period after CLASS, most cases showed diffuse filtering blebs with a serious degree of congestion. At the end of follow-up, most cases did not present filtering blebs. All patients showed an intact and thin trabeculodescemetic membrane (TDM) with an average thickness of 0.094 ± 0.017 mm. The scleral reservoir size gradually decreased over time and tended to stabilize after 18 months. At 3 and 6 months after surgery, 53.57% of the patients had abnormalities in the TDM area, and after laser goniopuncture treatment, the scleral reservoir became slightly larger and the IOP decreased. The TDM thickness was not correlated with postoperative IOP, and the scleral reservoir size was negatively correlated with IOP. During the early phase after CLASS, the subconjunctival and suprachoroidal pathways may be the main mechanisms lowering IOP; over time, internal drainage pathways such as the intrascleral, trabecular-meshwork, and suprachoroidal pathways play greater roles in lowering IOP.

Primary Deep Sclerectomy in Open-Angle Glaucoma: Long-Term Outcomes and Risk Factors for Failure

To report long-term outcomes of primary deep sclerectomy (DS) in open-angle glaucoma (OAG) and identify factors influencing surgical failure and postoperative complications. Retrospective cohort study. Consecutive OAG patients undergoing primary DS with follow-up of 1 year or more. Three intraocular pressure (IOP) success cutoffs were defined: 18 mmHg or less and 20% reduction, 15 mmHg or less and 25% reduction, and 12 mmHg or less and 30% reduction. Cox multivariable regression analysis investigated factors influencing failure and postoperative complications. The primary outcome was the success rate of DS according to the defined criteria. Secondary outcomes included IOP over time and factors predictive of failure. Five hundred thirteen eyes of 409 patients with a mean age ± standard deviation (SD) of 70.2 ± 9.8 years and follow-up of 84.1 ± 41.6 months. Mean ± SD IOP decreased from 23.5 ± 7.3 mmHg to 13.3 ± 3.9 mmHg, 12.8 ± 4.3 mmHg, and 12.4 ± 4.3 mmHg at 3, 5, and 7 years, respectively (P < 0.001). Success rates at 3, 5, and 7 years were 66.3% (95% Confidence Interval [CI] 62.2%-70.7%), 57.9% (95% CI 53.4%-62.7%), and 54.0% (95% CI 49.4%-59.1%), respectively, for IOP of 18 mmHg or less; 44.5% (95% CI 40.3%-49.1%), 34.6% (95% CI 30.4%-39.4%), and 29.8% (95% CI 25.6%-34.6%), respectively, for IOP of 15 mmHg or less; and 18.1% (95% CI 15.0%-21.9%), 11.9% (95% CI 9.2%-15.4%), and 10.0% (95% CI 7.5%-13.4%), respectively, for IOP of 12 mmHg or less. For all cutoffs, laser goniopuncture (P < 0.001), needling (P < 0.001), and postoperative antiglaucoma medications (P <0.001) were associated with increased failure. Intraoperative mitomycin C (MMC) was associated with reduced failure for IOP of 15 mmHg or less (P= 0.006) and IOP of 12 mmHg or less (P= 0.001), whereas higher preoperative IOP (P= 0.001) with increased failure for IOP of 12 mmHg or less. Deep sclerectomy is an effective, long-lasting primary surgical procedure for OAG. Intraoperative MMC enhances survival, whereas higher preoperative IOP and postoperative maneuvers are predictors of increased failure.

Comparison of early versus late laser goniopuncture following deep sclerectomy for the management of open-angle glaucoma

PurposeTo compare the outcome of early versus late Nd:YAG laser goniopuncture (LGP) after deep sclerectomy with mitomycin C (DSMMC) for open-angle glaucoma (OAG).MethodsA retrospective study of consecutive OAG eyes that...

Prospective evaluation of penetrating deep sclerectomy in advanced open-angle glaucoma: Filtration surgery adapted to resource scarcity in developing countries

Two of the hurdles that are facing ophthalmologists in developing countries are scarcity of resources and patient follow-up. Deep sclerectomy (DS) has proven less costly and more effective than topical therapies and has a more favorable safety profile than trabeculectomy. The main factors preventing its use in developing countries are the need to perform laser goniopuncture in 40-80% of cases to maintain filtration and the risk of postoperative iris incarceration. The purpose of this study is to assess the efficacy and safety profile in advanced open-angle glaucoma of a relatively new surgical technique designed to overcome this limitation: penetrating DS. This was an investigator-initiated, prospective, interventional study, conducted at a single ophthalmology center in Kinshasa, Congo. The study was conducted in full compliance with the Declaration of Helsinki. Fifty-one eyes (34patients) with uncontrolled advanced primary open-angle glaucoma (visual field mean deviation<-10 dBs) were enrolled between October 2012 and June 2016. Age, gender, comorbidities (hypertension/diabetes), best-corrected visual acuity, topical medications, medicated and unmedicated intraocular pressure (IOP) were recorded. All patients underwent penetrating DS, during which, following standard dissection of the scleral flaps, the anterior chamber was penetrated through the trabeculo-Descemet membrane and an iridectomy was performed. Patients attended postoperative appointments at months 1, 3, 6 and 12. Surgical success was defined as a 20% reduction of IOP from baseline in conjunction with a 12-month unmedicated IOP≤12mmHg. The mean age was 64.5±14.0years (44.1% female, 100% African). Mean IOP decreased from 20.2±6.1 (medicated) and 30.7±9.8mmHg (unmedicated) preoperatively to 12.1±4.1 at 12months. Concomitantly, the number of topical medications decreased from 1.5±0.7 to 0.0. Complete surgical success was achieved in 64.7%. Four eyes (7.8%) were considered surgical failures due to uncontrolled IOP. None of the eyes lost light perception or required additional surgery. A significant association between surgical failure and hypertension was observed (HR=1.49; P=0.008). There were no intraoperative complications. Postoperatively, 4bleb encapsulations (7.8%) and 1iris incarceration (2%) were observed. The present study demonstrates that penetrating DS achieved similar efficacy and safety results to traditional non-penetrating DS. In addition, it showed a lower potential for intraoperative complications, which might be associated with a more benign surgical learning curve. Finally, the rates of serious postoperative complications (iris incarceration, choroidal effusion and hypotony) were significantly lower than in DS and trabeculectomy, and this technique does not require subsequent Nd: YAG laser goniopuncture to maintain filtration, making frequent follow-up visits less critical. In view of these findings, perforating deep sclerectomy could offer a viable option for glaucoma management in developing countries as well as worldwide.

Suture-Probe Canaloplasty as an Alternative to Canaloplasty Using the iTrack Microcatheter.

Ab externo canaloplasty using the iTrack microcatheter has been established as a safe surgical procedure to treat open-angle glaucoma. This article, however, describes the results of a novel technique using a cost-efficient suture-probe as an alternative to iTrack canaloplasty and presents 12-month follow-up results. SPCP was performed on 50 eyes of 50 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and steroid-induced glaucoma. The mean±SD preoperative IOP was 21.9±7.0 mm Hg. A suture-probe was used to dilate Schlemm canal and to place a trabecular tensioning suture. Postoperative results were noted and statistically analyzed on the day of discharge from the clinic, and at 1.5, 3, 6, and 12 months of follow-up. In all eyes, the mean postoperative IOP 12 months after SPCP was 13.7±3.0 mm Hg. The number of medications decreased from 2.8±0.9 to 0.1±0.4, and visual acuity was 0.3±0.3 logMAR. Postoperative course and complications included: hyphema >1 mm (2%); microhyphema (4%); bleb leakage (2%); bleb suture (2%); laser goniopuncture (18%); laser suture lysis (4%); scleral flap lifting (4%); and iris incarceration following laser goniopuncture (4%). SPCP is an inexpensive procedure that can achieve significant IOP reduction in patients with glaucoma. The IOP-lowering effect and low rate of surgical complications were very similar to those of iTrack canaloplasty.

Modified viscocanalostomy in the Chinese population with open angle glaucoma: a 10-year follow-up results.

To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma (OAG). This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal (SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure (IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete (qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without (with or without) anti-glaucoma medications. The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg (mean IOP reduction of 51%) at 5y after surgery, and 15.6±2.8 mm Hg (mean IOP reduction of 49.9%) at 10y after surgery (P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5y and 0.67±0.8 at 10y postoperatively (P<0.001). The follow-up period was 104.5±37.0mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval (CI): 0.80-0.88], 73% (95%CI: 0.68-0.78), and 59% (95%CI: 0.52-0.66) after 5y, and 80% (95%CI: 0.76-0.84), 69% (95%CI: 0.64-0.74), 51% (95%CI: 0.44-0.58) after 10y, respectively. There was a relationship between age, preoperative IOP and success rate (P<0.01, P<0.05). A total of 31 eyes (31.3%) in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg (P<0.01). Neither blebitis nor endophthalmitis occurred. Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10y in Chinese individuals with OAG.

Combined phacoemulsification and viscocanalostomy with Ologen implant versus combined phacoemulsification and viscocanalostomy

BackgroundTo study the efficacy of the biodegradable collagen implant Ologen® as an adjuvant in phaco-viscocanalostomy in patients with coexisting cataract and primary open angle glaucoma.MethodsThis prospective, interventional, randomized clinical study was done at Alpha Vision Center, Zagazig, Egypt. Patients with coexisting cataract and glaucoma were randomized to receive either phaco-viscocanalostomy (Phacovisco group) (39 eyes) or phaco-viscocanalostomy with Ologen® implant (OloPhacovisco group) (40 eyes). Follow-up period was 2 years. Nd:YAG laser goniopuncture was done in cases where the intraocular pressure (IOP) was elevated above 21 mmHg after discontinuation of corticosteroid eye drops at any follow-up visit.ResultsNo significant operative or postoperative complications (other than failure) were encountered in either group. At 2 years follow-up, the mean IOP level was statistically significantly decreased in the OloPhacovisco group (p = 0.02) and complete success occurred in 23 eyes (59.0%) in the Phacovisco group and in 32 eyes (80.0%) in the OloPhacovisco group. There was a statistically significant higher success rate regarding complete success in patients that received Ologen® implant (p = 0.04).ConclusionsOlogen® implant improved the success rate of phaco-viscocanalostomy. Larger studies with longer follow-up periods may be required to confirm these findings.Trial registrationThis trial was retrospectively registered on 20/12/2018 under the number (NCT03782051).

Outcomes of Laser Goniopuncture Following Nonpenetrating Deep Sclerectomy With Mitomycin C: A Large Retrospective Cohort Study.

To report on the frequency, efficacy, and safety of laser goniopuncture (LGP) in lowering intraocular pressure (IOP) following mitomycin-C-augmented nonpenetrating deep sclerectomy (NPDS) in a large cohort of eyes. This is a monocenter database retrospective study. We reviewed records of 350 eyes that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). We recorded the incidence of LGP, the time between NPDS and LGP, IOP efficacy, and the occurrence of complications. The success of the LGP was defined by an IOP<15 mm Hg without hypotonic treatment. The mean postoperative follow-up period was 19±15.9 months after the NPDS (range, 6 to 58). LGP was performed in 125 eyes (35.7%) in a mean time after NPDS of 7.4±7.6 months (range, 1 d to 36 mo). Most LGP procedures were performed during the first year (97 eyes, 77.6%). The survival analysis using the Kaplan-Meier method showed a 50% incidence of LGP by 2 years. The mean IOP before LGP was 23.8±7.1 mm Hg. LGP resulted in immediate (day 8) and significant IOP lowering by up to 15±6.8 mm Hg. This decrease was maintained throughout the follow-up period, and the Kaplan-Meier survival success rate at 2 years was 48.9% (95% confidence interval, 39.4-60.8). The most common complication was iris incarceration, which occurred in 22 eyes of 125 LGP (17.6%). Most of the eyes that underwent NPDS may require LGP to reduce the IOP to below the target value. Most often, this procedure was performed in the first year after NPDS (77.6%). LGP lowered IOP<15 mm Hg without any hypotonic medication for at least 2 years in 50% of cases. Goniopuncture is associated with potentially significant complications, of which the most common is iris incarceration. We identified 2 predicting factors for iris incarceration: high IOP before LGP and early LGP after NPDS.

Nd:YAG laser goniopuncture as a mandatory adjuvant procedure after non-penetrating deep sclerectomy (long-term observation results)

To evaluate the effect of Nd:YAG laser goniopuncture on the long-term hypotensive effectiveness of non-penetrating deep sclerectomy. The study included 114 patients after non-penetrating deep sclerectomy (NPDS). In the control group (n=58), Nd:YAG laser goniopuncture was performed within 3.4±1.9 (1.5-6.7) months, and in the main group (n=56) - within 1.12±0.08 (0.9-1.5) months after the surgery. Ultrasound biomicroscopy (UBM) was used to evaluate the semiotics of trabecular-Descemet's membrane (TDM), intrascleral canal (ISC) and filtering bleb. The follow-up period was 5 years. According to UBM data, the thickness (0.10±0.009 mm) and density (50±6%) of TDM (p=0.0001) increased before LGP in the control group, the height of ISC decreased to 0.49±0.19 (0.20-0.40) (p=0.03), the height of UBM scan - to 1.49±0.05 (1.41-2.9) (p=0.0001); IOP (P0) was 18.48±4.7 (11.2-22.9) mmHg (p=0.001). In the main group before LGP, TDM thickness was 0.08±0.006 mm, density was 40±5%, and IOP (P0) was 15.7±4.1 (9.1-18.5) mm Hg. Complete hypotensive success was achieved in 83.6% of cases in the control group and 96.2% in the main group in 6 months; 68.07% and 92.59% in 12 months; 41.3% and 75.8% in 24 months; 15.25% and 48.93% in 36; 15% and 34.8% in 60 months after the surgery, respectively (p=0.0001, 95% confidence interval). TDM is an additional level of retention of aqueous humor and plays key role in the formation of outflow pathways after NPDS. Performing LGP in the early postoperative period is an effective and safe adjuvant option, which excludes the influence of TDM on the formation of aqueous humor outflow pathways and significantly increases the long-term hypotensive efficacy of non-penetrating deep sclerectomy.