Mean Number Of Antiglaucoma Medications Research Articles

Comparison of Bent Ab-Interno Needle Goniectomy and Goniotomy in Primary Congenital Glaucoma: A Randomized Controlled Trial

PurposePrimary Congenital Glaucoma (PCG) is a potentially blinding disease, and the search for the best surgical option always remains. This study investigated the efficacy of Bent Ab-interno Needle Goniectomy (BANG) compared to the established standard of traditional goniotomy. DesignParallel group Randomized Controlled Trial ParticipantsInfants with PCG aged one month to one year with similar clinical features in both eyes. InterventionThe two eyes of eligible patients were randomized to either goniotomy or BANG using a 25-gauge needle bent as a reverse cystitome, and the surgeries were done on the same day in both eyes. Postoperatively each infant was followed up for a minimum period of one year. Main outcome measuresThe primary outcomes measured were intraocular pressure (IOP) control and the requirement for antiglaucoma medications (AGMs). The secondary outcome measures included corneal clarity enhancement, axial length stability, incidence of surgical complications or the need for repeat surgery. ResultsEight infants with both eyes eligible, were included. In each infant, one eye was randomized to BANG and the other to conventional goniotomy. The mean age was 7.6±3.6 months. There was no significant difference in the mean preoperative IOP (16.8 +8.87 mm Hg versus 17+6.0 mm Hg; p=0.48) in eyes randomized to goniotomy or BANG. The mean number of AGMs (1.7±1.11 versus 2+0.81 respectively; p=0.26) were similar in both groups. Postoperatively, the IOP at 6 months (14.05 + 4.1 vs 16.2+4.07; p=0.22) and one year (15.3 ± 3.4 versus 17.1 + 3.0; p=0.15) were similar in eyes that underwent goniotomy or BANG respectively. Both procedures demonstrated significant improvements in corneal clarity and maintained normal axial length growth. However, the BANG group required slightly more AGMs than the goniotomy group. There were no serious complications in either group. Both eyes of one patient required repeat surgery for IOP control and underwent a combined trabeculotomy with trabeculectomy at nine months and one year post-operatively, respectively. ConclusionsThis study indicates that goniotomy remains an effective surgical treatment for PCG. The absence of discernible superiority in IOP control or overall outcomes implies that the added complexity of excising the trabecular meshwork in BANG may not confer additional benefits over the established approach.

Intermediate-Term Outcomes of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma: A Tertiary Centre Experience

ABSTRACT Purpose To present the outcomes of Ahmed glaucoma valve (AGV) implantation in uveitic glaucoma (UG) in a tertiary eye center in Riyadh, Saudi Arabia. Methods A retrospective review of all UG patients who underwent AGV implantation at a single, tertiary care eye center from January 2008 to December 2018. The main outcome measures were change in mean intraocular pressure (IOP), number of antiglaucoma medications, overall success rate in different follow-up periods, complete and qualified success from last follow up, and complications. The success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6- and 21-mm Hg with or without additional antiglaucoma medications and/or a minimum of 20% reduction from baseline IOP. Results The study included 74 patients (86 eyes), with a mean follow-up of 4.9 ± 2.9 years. The mean IOP was 32.2 ± 8.5 mmHg at baseline and 16.3 ± 6.6 mmHg at the last follow-up (p < 0.001). The mean number of antiglaucoma medications decreased from 3.5 ± 0.7 preoperatively to 1.3 ± 1.4 at the last follow-up (p < 0.001). Overall survival rates at 1, 3, 5, and 10 years were 96.5%, 92.7%, 91%, and 56.9%, respectively. Complete and qualified success rates were 37.9% and 48.3% at the end of follow up, respectively. The rate of postoperative complications was 56%, of which 18 eyes (20%) required surgical revision. Bivariate Cox proportional hazards regression analysis did not reveal any factors significantly associated with failure. Conclusions AGV is safe and effective in providing intermediate-term IOP control in UG patients. Complications reported in our cohort were mostly transient and conservatively treated.

Paul Glaucoma Implant following Congenital Cataract Surgery in a Pediatric Cohort.

Background: The aim of this study was to evaluate the short-term efficacy and safety of the Paul Glaucoma Implant (PGI) in pediatric eyes diagnosed with glaucoma following congenital cataract surgery (GFCS). Methods: A retrospective, single-center, descriptive study was conducted on consecutive children diagnosed with GFCS who underwent PGI implantation between July 2022 and November 2023 at the University Medical Center Mainz. The primary outcome measure was the reduction in IOP at the last follow-up visit. Results: Ten eyes of nine children were included in the study. The mean follow-up time was 7.70 ± 4.22 months (4.68-10.72 months). At the end of the study follow-up, the mean (95% CI) reduction in IOP was -14.8 ± 8.73 mmHg (-8.56 to -21.04 mmHg, p < 0.001). At the last follow-up, 30.0% (3/10) of patients achieved an IOP (intraocular pressure) of ≥6 and ≤21 mmHg with a reduction in IOP of ≥25% without treatment, while 90.0% (9/10) achieved this target IOP regardless of glaucoma medication treatment. The mean number of antiglaucoma medications was significantly reduced from 3.50 (IQR = 1) to 2.0 (IQR = 2, p = 0.01), and the visual acuity logMAR improved from 1.26 ± 0.62 to 1.03 ± 0.48 (p = 0.04). Only one eye experienced numerical hypotony (4 mmHg) without choroidal detachment or anterior chamber shallowing within the first 24 h. No other adverse events were observed during the follow-up period. Conclusions: PGI implantation significantly lowered IOP and the number of antiglaucoma eye drops with a favorable safety profile in children diagnosed with GFCS, thereby achieving a high rate of qualified surgical success in the short term.

Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data.

The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2years postoperatively without the need for subsequent glaucoma surgery. A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2years. Preoperatively, the mean IOP was 26.3 ± 8.9mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3-72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2years postoperatively.

Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation.

To compare the efficacy of endoscopic cyclophotocoagulation (ECP) vs repeat transscleral cyclophotocoagulation (TCP) in eyes with persistent glaucoma despite prior treatment with TCP. This was a retrospective chart review of glaucoma patients at the American University of Beirut Medical Center over 10 years who underwent ECP or repeat TCP. We reported qualified and complete success; success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, with (qualified) or without medications (complete) and without procedure-related complications. This study included 23 eyes of 21 patients with various forms of uncontrolled glaucoma who had failed TCP. A total of 13 eyes of 12 patients underwent ECP with a mean age of 39.9 ± 23.2 years, and 10 eyes of nine patients underwent repeat TCP with a mean age of 27.2 ± 22.6 years. A significant decrease in IOP was observed from 38.5 ± 7.9 mm Hg preoperatively to 25.2 ± 8.8 mm Hg postrepeat TCP (p = 0.006) and from 33.0 ± 9.5 to 12.8 ± 3.9 mm Hg post-ECP (p < 0.001), noted at a mean follow-up time of 39.2 ± 44.4 and 41.5 ± 37.4 months, respectively. The mean number of antiglaucoma medications decreased in the two groups (from 3.8 ± 1.0 preoperatively to 1.8 ± 0.9 postoperatively for ECP and from 3.5 ± 1.3 to 3.1 ± 0.9 postoperatively for TCP); however, the drop was only statistically significant post-ECP. Qualified success was significantly higher after ECP vs repeat TCP (91.7 vs 40%, respectively). Complete success was achieved only in 1/12 (8.3%) eyes in the ECP group. Endoscopic cyclophotocoagulation (ECP) performed in glaucomatous eyes previously treated with transscleral cycloablation provided more IOP control as compared to repeat TCP by directly treating viable tissue in previously skipped ciliary processes and in between processes. In glaucomatous eyes previously treated with transscleral cycloablation, ECP attained better IOP control than repeat transscleral cycloablation. Al-Haddad C, Barikian A, Moussawi ZE, et al. Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation. J Curr Glaucoma Pract 2023;17(4):191-196.

Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting.

This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.

Ab-externo canaloplasty with and without suture in highly myopic eyes.

To evaluate the effectiveness of ab-externo canaloplasty using the iTrack canaloplasty microcatheter (Nova Eye Inc, Fremont, California), with or without suture, in glaucoma patients with high myopia. This was a prospective, single-center, single-surgeon, observational study comparing the outcomes of ab-externo canaloplasty performed with a tensioning suture (suture group) and without a tensioning suture (no-suture group) in mild to severe glaucoma patients with high myopia. Twenty-three eyes received canaloplasty as a standalone procedure, 5 in combination with phacoemulsification. Primary efficacy endpoints included intraocular pressure (IOP) and the number of glaucoma medications. Safety was assessed based on reported complications and adverse events. Twenty-nine eyes of 29 patients with a mean age of 61.2 ± 12.3years; 19 eyes in the no-suture group and 10 eyes in the suture group. All eyes demonstrated a significant reduction in IOP 24months postoperatively, from 21.9 ± 7.22 to 15.4 ± 4.86mmHg in the suture group and from 23.8 ± 7.58 to 19.7 ± 3.68mmHg in the no-suture group. The mean number of anti-glaucoma medications reduced from 3.1 ± 0.6 to 0.4 ± 0.7 in the suture group and 3.3 ± 0.9 to and 0.2 ± 0.6 in the no-suture group at 24months. IOP was not significantly different at baseline between the 2 groups, but it was statistically different at 12 and 24months. There was no statistically significant difference in the number of medications between the groups at baseline, 12 and 24months. No serious complications were reported. Ab-externo canaloplasty performed either with or without a tensioning suture demonstrated good effectiveness in highly myopic eyes with a significant reduction in IOP and number of anti-glaucoma medications. The suture group achieved a lower postoperative IOP. However, the no-suture modification provides a similar reduction in medications with reduced tissue handling.

Evaluation of peripheral anterior synechia formation following gonioscopy-assisted transluminal trabeculotomy surgery.

To quantitatively assess the development of peripheral anterior synechia (PAS) formation rate and PAS locations on gonioscopic examination following gonioscopy-assisted transluminal trabeculotomy (GATT) surgery and investigate the surgical outcomes. A total of 35 eyes from 31 patients with open angle glaucoma who underwent GATT or combined GATT and phacoemulsification surgery were analyzed. Presence of PAS was assessed on gonioscopy in nasal, temporal, superior and inferior quadrants at months 1, 3 and 6 following surgery. Surgical outcomes were also noted. Frequencies of PAS formation were 38.3%, 25.3%, 17.0% and 19.1% at postoperative 1month, 34.0%, 26.4%, 17% and 22.6% at postoperative 3months and 32.3%, 25.8%, 16.1% and 25.8% at postoperative 6months, in nasal, temporal, superior and inferior quadrants, respectively. The highest amount of PAS involvement was 3 clock hours in the study which was identified only in nasal and inferior quadrants. Frequency of PAS formation did not significantly differ between nasal, temporal, superior and inferior quadrants at all time points (p > 0.05). No significant differences of mean IOP levels were observed between patients who developed PAS and who did not develop PAS at postoperative 1month (p = 0.72), 3months (p = 0.21) and 6months (p = 0.59). The mean IOP and mean number of antiglaucoma medications decreased from 31.5 ± 7.2mmHg and 3.6 ± 0.6 at baseline to 13.8 ± 3.1mmHg and 1.6 ± 1.3 at postoperative 6months, respectively (p < 0.001, for both). Cumulative success rate (95% confidence interval) was 74.3% (69.9-78.6%) at the end of the study. Mild to moderate degrees of hyphema occurred in all cases postoperatively. Although PAS formation was observed to be relatively higher in nasal quadrant, PAS frequency was not statistically different between the angle quadrants.

Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients.

To assess the effectiveness of XEN45, either alone or in combination with phacoemulsification, in open-angle glaucoma (OAG) patients in clinical practice. Retrospective and single-center study conducted on OAG patients who underwent XEN45 implant, either alone or in combination with cataract surgery. We compared the clinical outcomes of the eyes of thosewho underwent XEN-solo versus those who underwent XEN+Phacoemulsification. The primary endpoint was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. A total of 154 eyes, 37 (24.0%) eyes that underwent XEN-solo and 117 (76.0%) eyes that underwent XEN+Phacoemulsification, were included. The mean preoperative IOP was significantly lowered from 19.1±5.0 mmHg to 14.9±3.8 mmHg at month-36, p<0.0001. Preoperative IOP was significantly lowered from 21.2±6.2 mmHg and 18.4±4.3 mmHg to 14.3±4.0 mm Hg and 15.2±3.7 mmHg at month-36 in the XEN-solo and XEN+Phacoemulsification groups, p<0.0004 and p=0.0009; with no significant differences between them. In the overall study population, the mean number of antiglaucoma medications was significantly reduced from 2.1±0.8 to 0.2±0.6, p<0.0001. There were no significant differences in the proportion of eyes with a final IOP ≤14 mmHg and ≤16 mmHg between XEN-solo and XEN+Phaco groups (p=0.8406 and 0.04970, respectively). Thirty-six (23.4%) eyes required a needling procedure. XEN implant significantly lowered IOP and reduced the need of ocular hypotensive medication, while maintaining a good safety profile. Beyond week-1, there were no significant differences in IOP lowering between XEN-solo and XEN+Phacoemulsification groups.

Intermediate-term outcome of Aurolab aqueous drainage implant in refractory glaucoma.

The purpose of the study was to evaluate the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) in terms of intraocular pressure (IOP) lowering from baseline levels, the number antiglaucoma medications (AGMs) in the postoperative phase, and the rate of complications. It was a retrospective interventional case series. All patients who underwent AADI surgeries with sulcus fixation from March 2018 to September 2018 at a tertiary eye care hospital in North India with a minimum follow-up of 1 year were recruited for the study. A standard AADI technique was employed. The primary outcome measures were the postoperative IOP, the requirement of AGMs, and early and late postoperative complications. A total of 20 patients were recruited in the study. The mean follow-up period was 25.25 ± 3.76 months. The mean IOP reduced from 33.20 ± 7.95 mmHg to 19.45 ± 9.19 mmHg at day 1, 13.62 ± 3.92 mmHg at 6 months, 12.78 ± 3.36 mmHg at 1 year, and 13.0 ± 2.53 mmHg at 2 years postoperatively (P < 0.001). The mean number of AGMs also reduced from 3.7 ± 0.97 to 0.35 ± 0.81 at 6 months, 0.42 ± 0.83 at 1 year, and 0.26 ± 0.73 at 2 years postoperatively (P < 0.001). Early postoperative complications, such as hypotony and hyphema, were seen in 5 (25%) patients, although none of them was sight-threatening. Late postoperative complications, such as hypertensive phase and persistent fibrinous membrane, were also seen in five eyes. The study assessed the clinical outcomes, safety profile, and long-term AGM requirement with AADI and found it to be a good viable surgical option in refractory glaucoma.

Surgical outcomes of trabeculectomy augmented with sub-Tenon injected mitomycin C.

Recently, trabeculectomy with mitomycin C (MMC) where MMC is applied by injection into the Tenon layer has attracted close attention. However, the data on efficacy and safety of this technique is still limited and more clinical studies are needed. Therefore, the work is aimed at comprehensive evaluation of the effectiveness of trabeculectomy using MMC applied by intra-Tenon injection. A set of 50 eyes in 50 patients underwent trabeculectomy using MMC at concentration of 0.4 mg/ml in a total volume of 0.05 ml. The primary end point was to control intraocular pressure (IOP) on postoperative days 1, 8, 30 and 90 and subsequently at 6 and 12 months after surgery. The secondary end point was to evaluate the changes in various corneal parameters prior to and 90 days after surgical procedure. The mean preoperative IOP was 32.34 ± 9.45 mmHg. After surgery, the mean IOP significantly decreased to 17.52 ± 4.58 mmHg at the 90-day follow-up, and to 18.14 ± 3.74 and 19.30 ± 3.82 mmHg at 6 and 12 months after the procedure, respectively. The mean BCVA values remained unchanged compared to baseline (0.77 ± 0.23) to the 90-day follow-up (0.80 ± 0.23). The mean number of anti-glaucoma medications significantly reduced from 3.50 ± 0.74 to 0.58 ± 1.03 postoperatively. Similarly, the mean corneal hysteresis and ACD of the eye as well as CECD were significantly changed postoperatively. Trabeculectomy using MMC applied by injection is a safe and effective surgical method for the treatment of primary and secondary forms of open-angle glaucoma. It has a significant hypotonising effect and allows a complete discontinuation of antiglaucoma drugs (Tab. 3, Fig. 3, Ref. 58).

Short-term outcomes of micropulse transscleral cyclophotocoagulation as a primary versus additional therapy in eyes with uncontrolled glaucoma.

To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP-TSCPC from April 2020 to December 2020 were recruited in this study. A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP-TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP-TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. MP-TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision-threatening complications with invasive surgery.

Outcomes and Predictors of Failure of Ultrasound Cyclo Plasty for Primary Open-Angle Glaucoma.

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were the intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Cox proportional hazard regression analysis was performed to identify the possible predictors of UCP failure. Results: Sixty-six eyes of fifty-five patients were included herein. The mean follow-up period was 28.95 (±16.9) months. The mean IOP decreased significantly from 23.02 (±6.1) to 18.22 (±7.0) and 16.44 (±5.3) mm Hg on the 12th and 24th months, respectively; the mean number of antiglaucoma medications decreased significantly from 3.23 (±0.9) to 2.15 (±1.5) and 2.09 (±1.6), respectively. The cumulative probabilities of overall success were 71.2 ± 5.6% and 40.9 ± 6.1% on the 12th and 24th months, respectively. High baseline IOP and the number of antiglaucoma medications were associated with a higher risk of failure (hazard ratio = 1.10 and 3.01, p = 0.04 and p &lt; 0.01, respectively). The most common complications were cataract development or progression (30.8%) and prolonged or rebound anterior chamber reaction (10.6%). Conclusions: UCP reasonably controls the IOP and reduces the antiglaucoma medication burden in eyes with POAG. Nevertheless, the success rate is modest, with a high baseline IOP and number of medications.

Early Postoperative Effect of Ripasudil Hydrochloride After Trabeculectomy on Secondary Glaucoma: A Randomized Controlled Trial

Purpose: To evaluate the effect of Rho-associated kinase inhibitor (ripasudil hydrochloride hydrate; ripasudil) eye drops on postoperative intraocular pressure (IOP) after trabeculectomy in eyes with uveitic glaucoma. Design: This was a prospective, observational, controlled, and randomized study. Methods: Sixteen eyes of 16 patients with uveitic glaucoma who underwent trabeculectomy without mitomycin C were randomly treated without ripasudil (8 eyes) and with ripasudil (8 eyes). Postoperative IOP and surgical outcomes 3 months after surgery were compared between the two groups. Results: No patient discontinued treatment due to the lack of efficacy or adverse effects of ripasudil during the 3-month study period in the ripasudil group. The mean IOP (mmHg) in the control and ripasudil groups were 42.5 ± 9.8 mmHg /43.9 ± 11.7 mmHg (p = 0.82) at baseline, 14.3 ± 4.9 mmHg /9.0 ± 3.7 mmHg (p = 0.04) at 1 week, 16.3 ± 4.2 mmHg /10.6 ± 3.0 mmHg (p = 0.01) at 1 month, and 16.0 ± 3.4 mmHg /12.5 ± 2.3 mmHg (p = 0.04) at 3 months. The number of laser suture lysis procedures (2.0 ± 0.5 vs 0.4 ± 0.7), the rate of bleb revision by needling (50.0% vs 0.0%), and the mean number of antiglaucoma medications (1.6 ± 1.5 vs. 0.1 ± 0.3) after trabeculectomy were higher in the control group than in the ripasudil group (all p &lt; 0.05). A multivariate analysis showed that the IOP reduction rate at 3 months after surgery was associated with the use of ripasudil and baseline IOP (all p &lt; 0.05). Conclusion: This study demonstrated the therapeutic efficacy, safety, and tolerability of ripasudil for 3 months postoperatively. Ripasudil may effectively reduce postoperative IOP and increase the success rate of trabeculectomy in patients with uveitic glaucoma.

Efficacy and safety of subliminal transscleral cyclophotocoagulation in uncontrolled glaucoma.

To determine the efficacy of subliminal cyclophotocoagulation in reducing intraocular pressure (IOP) and to assess the safety profile of the procedure. We reviewed the charts of all patients who underwent subliminal cyclophotocoagulation between August 2019 and August 2020. The IOP, number of antiglaucoma medications, and visual acuity were compared at baseline and at 6 months. The post-laser complications were noted. Paired t-test, Wilcoxon rank-sum test, and McNemar test were used for analysis. This study included 40 eyes of 40 patients. The most frequent diagnosis was neovascular glaucoma (55%), followed by primary open-angle glaucoma (17.5%). The mean IOP reduced from 32 to 21 mmHg (mean IOP reduction: 32%, 95% confidence interval [CI]: 27%-37%, P < 0.001). Mean number of antiglaucoma medications declined from 3.2 to 1.9 (P < 0.001). Use of oral acetazolamide decreased from 62% to 5% (P < 0.001). The success rate of the procedure at 6 months was 55%. One patient had unexplained visual acuity decline after the procedure. Subliminal sub-cyclophotocoagulation is effective in treating refractory glaucoma in the Indian population. It decreases the medication burden. However, subliminal lasers can also cause vision-threatening complications such as hypotony, uveitis, and optic nerve hypoperfusion. So, clinicians should be cautious when using sub-cyclophotocoagulation in patients with good vision.

Outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma eyes

Introduction: Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) is a new treatment for glaucoma claiming to have lower levels of complications while having comparable efficacy relative to its predecessor, traditional Transscleral Continuous-wave Cyclophotocoagulation (TC-CPC).Objective: To evaluate the clinical efficacy and safety of MPTSCPC in the treatment of refractory glaucoma eyes.Methods: This uncontrolled interventional study was conducted at the Northampton General Hospital, UK. Patients who were selected to undergo MP-TSCPC due to uncontrolled intraocular pressure (IOP) or visual field progression despite maximum tolerable anti-glaucoma treatment were recruited for the study from February to September 2020. Data related to the patients were collected pre procedure and up to three months post procedure.Results: Of the 37 patients included in the study, 59.5% were females. The mean age of participants was 75.35 (SD=10.37) years. The most common types of glaucoma seen in the sample were primary open angle glaucoma and pseudoexfoliation glaucoma with 67.6% and 16.2% respectively. Mean pretreatment IOP was 26.62 (SD=8.36) mmHg. Three-month post-treatment mean IOP of 18.47 (SD=7.92) mmHg was a statistically significant (p&gt;0.001) reduction of 7.10 mm Hg. The drop in mean number of anti-glaucoma medications from 2.38 to 2.22 was not significant. Except for four patients with prolonged ocular inflammation and one patient with macular oedema, there were no significant complications following the procedure.Conclusion: MP-TSCPC is an effective and safe treatment option for refractory glaucoma over a 3 month follow up period. More extensive studies with larger sample sizes and longer follow up durations are recommended.

Long-term surgical outcomes of Ahmed valve implantation in refractory glaucoma according to the type of glaucoma

BackgroundWe evaluated the long-term efficacy and surgical outcomes of Ahmed glaucoma valve (AGV) implantation in patients with refractory glaucoma by glaucoma type.MethodsIn total, 135 eyes of 135 patients diagnosed with refractory glaucoma and underwent AGV implantation between 2002 and 2018 were reviewed retrospectively. The best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of antiglaucoma medications were investigated at baseline and follow-up. The cumulative probability of qualified success according to the glaucoma type was evaluated at 12, 24, 36, and 60 months postoperatively.ResultsThe mean IOP of all patients was 35.7 ± 11.7 mmHg, which was significantly reduced 12.7 ± 7.0 mmHg at 1 week, 16.2 ± 7.5 mmHg at 2 weeks, 17.6 ± 6.8 mmHg at 1 month, 17.5 ± 6.4 mmHg at 3 months, 16.1 ± 6.0 mmHg at 6 months, 16.7 ± 8.0 mmHg at 12 months, 16.4 ± 6.6 mmHg at 24 months, 15.6 ± 5.0 mmHg at 36 months, and 15.6 ± 5.6 mmHg at 60 months after surgery (p < 0.001, respectively). The mean number of antiglaucoma medications was 3.7 ± 1.3, which significantly decreased to 0.4 ± 0.9 at 1 week, 0.3 ± 0.8 at 2 weeks, 0.7 ± 0.9 at 1 month, 1.1 ± 1.1 at 3 months, 1.4 ± 1.0 at 6 months, 1.5 ± 1.1 at 12 months, 1.6 ± 1.2 at 24 months, 1.7 ± 1.2 at 36 months, and 1.8 ± 1.3 at 60 months after surgery (p < 0.001, respectively). The mean BCVA significantly improved from postoperative 2 weeks. Although 71 (52.6%) eyes had postoperative complications, the cumulative probability of surgical success was 72.6% at 12 months, 66.7% at 24 months, and 63.7% at 36 and 60 months. According to the glaucoma type, the success rate of AGV implantation was more than 50% even after 60 months follow-up, except subgroup of neovascular glaucoma (NVG) due to retinal vein occlusion (RVO).ConclusionsAGV implantation in patients with refractory glaucoma was, after long-term follow-up, successful overall. Therefore, AGV implantation can be an effective surgical option to reduce the IOP and number of antiglaucoma medications and to improve visual acuity for various glaucoma types.

Micropulse Transscleral Cyclophotocoagulation for Glaucoma after Penetrating Keratoplasty.

The main objective of the article was to assess the surgical outcome of micropulse transscleral cyclophotocoagulation in patients presenting with glaucoma after penetrating keratoplasty. We conducted a retrospective study that included 26 eyes of 26 patients who presented with glaucoma after penetrating keratoplasty, and who were treated using micropulse transscleral cyclophotocoagulation between January 2017 and December 2020. The surgeries were performed using the Iridex Cyclo G6 MicroPulse P3 Probe. The intraocular pressure, mean number of antiglaucoma medications, visual acuity, corneal status, and postoperative complications were analyzed. The minimum follow-up period was 12 months. The success rate after 12 months was 76.9%. The baseline median intraocular pressure was 29 mm Hg and decreased to 18 mm Hg after 12 months. The median number of antiglaucoma medications was also reduced from three preoperatively to one after one year. In seven cases (29.92%), the visual acuity decreased and, in four cases (15.38%), the corneal graft was not transparent. We concluded that micropulse transscleral cyclophotocoagulation is an effective and safe method for the treatment of glaucoma after penetrating keratoplasty.

Two-Year Outcome of Surgery in Glaucoma Patients.

To evaluate the 2-year surgical treatment outcome in glaucoma patients. A retrospective, single-center, interventional study was performed on 160 eyes of 125 patients suffering glaucoma, including POAG (82 eyes), pseudoexfoliation (PEX) (59eyes), pigment dispersion (8 eyes), and secondary glaucoma (2 eyes). Eyes with uncontrolled intraocular pressure (IOP) or signs of glaucoma progression despite medical treatment were included to undergo either trabeculectomy (TE), XEN implantation, combined TE with phacoemulsification (TE + IOL), or XEN implantation with phacoemulsification surgery (XEN + IOL). Primary efficacy outcome was the mean IOP reduction. Secondary outcome was the mean reduction in the number of medications. The data were compared at baseline vs.1 day, 1 week, and 1, 3, 6, 12, and 24 months following surgery. For statistical evaluation, ANOVA-based linear mixed-effects models were performed with SPSS. The mean IOP reduction in a 2-year follow-up was 30.31% (22.17 vs. 15.45 mmHg, p < 0.001). The mean number of antiglaucoma medications was reduced from 2.87 to 0.58 (p = 0.001), where TE alone or combined surgeries seemed to be more effective than isolated XEN surgery. Transient IOP hypotony on the first postoperative day occurred in PEX patients following TE surgery (p = 0.024). At 6 months, PEX patients with isolated XEN surgery showed a transient IOP increase, whereas those after combined TE + IOL surgery showed the lowest IOP within the PEX group compared to other glaucoma patients (p < 0.026). After 2 years, all performed glaucoma surgeries achieved a significant reduction in IOP and the number of antiglaucoma medications.

Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma.

Neovascular glaucoma (NVG) is a refractory form of glaucoma, associated with important morbidity, for which no consensus exists regarding the optimal choice of therapy. The primary aim of our study was to compare the performances of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) in the treatment of neovascular glaucoma (NVG). A total of 24 eyes for MP-TSCPC and 22 eyes for CW-TSCPC, all with NVG were included. The procedures were performed using either the Iridex Cyclo G6 (IRIDEX Laser System), the MP3, or the G-Probe devices. Intraocular pressure (IOP), visual acuity (VA), the mean number of antiglaucoma medications, and postoperative complications were monitored. The minimum follow-up was 12 months. The success rate at 12 months was 54.5% in the CW-TSCPC group and 33.3% in the MP-TSCPC group. The mean IOP at baseline was 35.82 mm Hg for CW-TSCPC and 34.71 mm Hg for MP-TSCPC. The change from baseline in IOP at 12 months was 11.95 mm Hg in the CW-TSCPC group and -8.04 mm Hg in the MP-TSCPC group. There was a significant difference in the occurrence of serious complications (worsening of VA, hypotony, and phthisis bulbi) between the two methods, with CW-TSCPC associated with more important adverse effects (P=0.045). There was a decrease in the number of topical antiglaucoma medications in both groups: in the MP-TSCPC group from a mean number of 2.6 at baseline, to 1.7 at 3 months, followed by a slight increase to 2.1 at 12 months and in the CW-TSCPC group from 2.8 at baseline, to 1.4 at 3 months and 1.9 at 12 months. Our study concluded that both MP-TSCPC and CW-TSCPC could manage NVG, but, while CW-TSCPC revealed higher IOP control in the long term (which did not reach statistical significance), it also had a significantly lower safety profile.