Mean Number Of Glaucoma Medications Research Articles

Evaluating the Effectiveness of Ahmed Glaucoma Valve Implantation in Reducing Intraocular Pressure in Refractory Glaucoma in the Saudi Arabian Population at a Tertiary Care Centre

Objectives: To assess the efficacy of Ahmed glaucoma valve implantation (AGVI) in lowering intraocular pressure (IOP) in patients with refractory glaucoma. Methods: In this retrospective study, we analyzed the medical records of 60 patients who received AGVI for refractory glaucoma. Data collected included demographics, type of glaucoma, preoperative and postoperative IOP, number of glaucoma medications, and any surgical complications. Success was defined as achieving an IOP <21 mmHg at the final follow-up visit. Results: At the final follow-up (mean duration of 11.6 months), AGVI achieved successful IOP control (IOP of <21 mmHg) in 40 eyes (66.7%). The mean number of glaucoma medications decreased significantly from 2.95 preoperatively to 1.98 postoperatively (p < 0.001). Neovascular glaucoma (NVG) had a lower success rate compared to other types of glaucoma. Prior glaucoma surgery was associated with a higher risk of failing to reach target IOP, although this trend was not statistically significant (p = 0.108). Conclusion: AGVI implantation effectively lowered IOP in patients with refractory glaucoma, especially in the short term. However, long-term success rates were lower, and NVG showed less favorable outcomes. AGVI is a valuable option for managing refractory glaucoma, but careful patient selection is essential. Further research is needed to evaluate long-term efficacy and refine treatment strategies.

Intraocular Pressure-Lowering Effect of Intraocular Lens Refixation in Patients with Elevated Intraocular Pressure Due to Intraocular Lens Subluxation.

Background and Objectives: To evaluate the surgical outcomes of intraocular lens (IOL) refixation with vitrectomy in patients with elevated intraocular pressure (IOP) due to IOL subluxation. Materials and Methods: Patients with elevated IOP due to IOL subluxation who had undergone IOL refixation with vitrectomy between 1 June 2013 and 31 December 2023 were retrospectively evaluated. The primary outcome measure was surgical success or failure. Surgical success was defined as a reduction of ≥20% in the preoperative IOP or IOP ≤ 21 mmHg (criterion A), IOP ≤ 18 mmHg (criterion B), or IOP ≤ 15 mmHg (criterion C). Reoperation, loss of light perception, and hypotony were considered as surgical failure. The IOP, number of glaucoma medications used, postoperative complications, and visual acuity were evaluated as the secondary outcomes. The surgical outcomes were compared between the glaucoma and ocular hypertension (OH) groups. Results: At 12 months postoperatively, the probability of success was 72.5%, 54.1%, and 28.4% using criterion A, B, and C, respectively, and the mean IOP and mean number of glaucoma medications used had decreased significantly (p < 0.01 and p = 0.03, respectively). Furthermore, the cumulative success rate was significantly higher in the OH group than in the glaucoma (100% vs. 47.4%; p < 0.01) when using criterion A. Additional glaucoma surgery was required only in the glaucoma group. Conclusions: IOL refixation surgery significantly decreases the IOP and number of glaucoma medications required in patients with elevated IOP due to IOL subluxation. Thus, IOL refixation surgery alone without glaucoma surgery might be effective as the primary procedure in such patients.

Long-term Outcomes of Combined Phacotrabeculectomy Surgery in a Singapore Tertiary Hospital

PurposeTo describe the long-term outcomes of phacotrabeculectomy from a tertiary glaucoma service in Singapore. DesignRetrospective case series. MethodsSeven hundred ninety-six eyes of 698 patients who underwent phacotrabeculectomy surgery at the Singapore National Eye Centre between 2005 and 2007 with a minimum follow-up of three years were included. The primary outcome measure was intraocular pressure (IOP). Secondary outcomes included best-corrected visual acuity (BCVA), number of glaucoma medications, and surgical complications. ResultsThe mean age was 69.5 years, 51 % were male, and 86 % were Chinese. Most eyes had primary glaucoma (90.6 %). The mean follow-up duration was 9.4 years. The overall success rate at three years was 97 % if surgical success was defined as IOP ≤ 21 mm Hg, 92 % if IOP ≤ 18 mm Hg, 66 % if IOP ≤ 15 mm Hg. By Kaplan–Meier survival analysis over 13 years, the cumulative success rate fell from 98.1 % to 89.1 % if IOP ≤ 21 mm Hg, 98.1–76.9 % if IOP ≤ 18 mm Hg, 98–50.3 % if IOP ≤ 15 mm Hg. The postoperative IOP improved significantly at all time points (P < 0.05) and 72 % had at least 20 % IOP reduction. There was a slight improvement in postoperative BCVA (P < 0.05). The mean number of glaucoma medications was reduced postoperatively (P < 0.001). There were no significant risk factors for surgical failure. ConclusionsPhacotrabeculectomy was found to be safe, resulting in clinically significant IOP lowering for 13 years with reduced dependency on glaucoma medications and improved BCVA.

Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-Analysis.

Transscleral cyclophotocoagulation (TS-CPC) and endoscopic cyclophotocoagulation (ECP) were effective in reducing intraocular pressure (IOP) and glaucoma medications in childhood glaucoma. To report the outcomes of continuous wave TS-CPC and ECP in childhood glaucoma. We performed a systematic search of relevant databases. We collected data on age, follow-up duration, type of glaucoma, previous surgical interventions, preoperative and postoperative IOP, preoperative and postoperative number of glaucoma medications, adverse events, number of sessions, and success rates at different time points. The main outcome measures are the amount of IOP and glaucoma medication reduction. We included 17 studies studying 526 patients (658 eyes); 11 evaluated the effectiveness of TS-CPC (268 patients, 337 eyes), 5 evaluated ECP (159 patients, 197 eyes), and one study compared both techniques (56 patients, 72 eyes for TS-CPC vs 43 patients, 52 eyes for ECP). The median duration of follow-up was 28 months in the TS-CPC group and 34.4 months in the ECP group. The mean number of treatment sessions was 1.7 in the TS-CPC and 1.3 in the ECP. In the TS-CPC group, the mean IOP was significantly reduced from 31.2 ± 8 to 20.8 ± 8 mm Hg at the last follow-up ( P < 0.001). The mean number of glaucoma medications was reduced from 2.3 ± 1.3 to 2.2 ± 1.3 ( P = 0.37). In the ECP group, there was also a significant reduction in the mean IOP from 32.9 ± 8 mm Hg with a mean of 1.7 ± 0.7 glaucoma medications to 22.6 ± 9.8 mm Hg ( P < 0.0001) on 1.2 ± 1.1 medications ( P = 0.009) at the last follow-up. Both TS-CPC and ECP were effective in reducing the IOP and glaucoma medications in childhood glaucoma. Multiple treatment sessions were required.

One-Year Outcomes of the PAUL Glaucoma Implant Compared With the Ahmed Glaucoma Valve for the Treatment of Silicone Oil Glaucoma.

Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures. To evaluate the outcomes of the PAUL glaucoma implant (PGI) and Ahmed glaucoma valve (AGV) in patients with secondary glaucoma caused due to silicone oil emulsification. A retrospective examination was conducted using the medical records of 36 patients who developed secondary glaucoma due to silicone oil emulsification after vitreoretinal surgery and then underwent PGI and AGV implantation surgery. The main outcome measures in the PGI and AGV groups were intraocular pressure (IOP) and its change, the number of antiglaucoma medications, and postoperative complications during the 12-month follow-up period. IOP of <6mm Hg is used to define hypotonia. There was no statistically significant difference among the patients who underwent PGI and AGV surgeries in terms of IOP averages, both preoperatively and postoperatively on day 1, week 1, month 1, month 3, month 6, and month 12 ( P > 0.05). Before PGI and AGV implantation, the mean IOP was 40 ± 13mm Hg and 39.3 ± 10mm Hg, and the mean number of medications was 3.8 ± 0.4 and 4 ± 0, respectively. At the end of the 12-month follow-up period, the mean IOP was 13.5 ± 2.2 ( P < 0.001) mm Hg and 14.9 ± 4.2 ( P < 0.001) mm Hg, whereas the mean number of glaucoma medications decreased to 1.7 ± 1.3 ( P < 0.001) and 1.9 ± 1.8 ( P < 0.001) in the PGI and AGV groups, respectively. Surgical success was achieved in 17 of 18 eyes (94%) in the PGI group and 16 of 18 eyes (89%) in the AGV group. Although the outcomes were similar in both the PGI and AGV groups, complications requiring medical and surgical intervention were less common in the PGI group. Longer-term studies with a larger sample size are needed to demonstrate the superiority or equivalence of these procedures.

Combined non‐penetrating deep sclerectomy with phacoemulsification versus non‐penetrating deep sclerectomy alone

Aims/Purpose: To compare the intraocular pressure after two surgical techniques: combined non‐penetrating deep sclerectomy with phacoemulsification (Phaco‐NPDS) and non‐penetrating deep sclerectomy (NPDS) alone.Methods: It is a retrospective study including thirty‐two patients with primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) who were not controlled with medication. They were assigned to Phaco‐NPDS (twenty‐two eyes) or NPDS (twenty eyes). Complications in surgery were noted and also, they were followed up after the surgery and intraocular pressure (IOP) was measured at one day, a month, six months and a year after the surgery. Moreover, best corrected visual acuity (BCVA) and the number of the anti‐glaucoma medications at the end of the postoperative medication was measured.Results: Mean IOP in the Phaco‐NPDS group decreased from 24.55 ± 5.8 mmHg to 17.31 ± 2.1 mmHg and in the NPDS group from 26.05 ± 4.1 to 15.6 ± 2.3 mmHg one day after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p &lt; 0.05). There was no significant IOP difference between Phaco‐NPDS and NPDS patients postoperatively (p &gt; 0.05). The mean number of glaucoma medications decreased from 3.31 ± 1.4 to 0.68 ± 0.2 and from 3.2 ± 1.3 to 0.3 ± 0.5 in the Phaco‐NPDS and NPDS groups, respectively. The decreases in the mean number of the anti‐glaucoma medications at the end of the postoperative, 24‐month follow‐up period were found to be statistically significant for both Phaco‐NPDS and NPDS groups (p &lt; 0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco‐NPDS group (p &lt; 0.05).Conclusions: Phaco‐NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco‐NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG.

Efficacy and Safety of an Adjustable Glaucoma Drainage Device (eyeWatch System) for Refractory Glaucoma: A 2-Year Prospective Study.

In this study, we report a 2-year follow-up after implantation of an adjustable glaucoma drainage device combined with a novel orbital filtering plate. The IOP was efficiently controlled postoperatively with limited complications and an excellent safety profile. To report the clinical results at 2 years after implantation of an eyeWatch (eW) system, which comprises an adjustable glaucoma drainage device (eW implant) combined with a novel orbital filtering plate (eyePlate), in refractory glaucoma. Monocentric, prospective, noncomparative clinical trial. Patients suffering from refractory glaucoma after several failed surgeries were operated using the eW system. The primary outcome was the success rate, defined as an IOP ≤18mmHg and reduction of more than 20% from baseline, IOP ≥6mmHg. Secondary outcomes were mean IOP, visual acuity, the number of antiglaucoma medications, and the number and type of complications. Forty-two eyes from 42 patients were included. The mean follow-up time was 22.0±4.0 months. The mean baseline IOP decreased from 23.2±7.2mmHg before surgery to 11.9±4.4mmHg at 12 months ( P <0.001) and 11.5±3.0 at 24 months. The mean number of glaucoma medications decreased from 2.9±0.9 before surgery to 0.7±0.9 at 12 months ( P <0.001) and 1.0±0.9 at 24 months. The qualified success rate was 93% at 12 months and 90% at 24 months whereas the complete success rate was 46% and 40% at 12 and 24 months, respectively. Complications occurred in 7 patients. Implantation of the eW system effectively lowered IOP and reduced glaucoma medications for a 2-year period in patients who had previously failed glaucoma surgery. Persistent hypotony was not observed and the number of complications was low.

Comparative Effectiveness and Safety of Two Different Trabecular MIGS Devices With and Without Ab Interno Canaloplasty in Patients with Primary Open-Angle Glaucoma.

This study compared outcomes of the iStent inject trabecular micro-bypass system versus the Hydrus Microstent in patients with primary open-angle glaucoma (POAG). Forty subjects (80 eyes) with POAG were included in this single-center, retrospective, contralateral-eye analysis. All patients underwent phacoemulsification with either iStent inject or Hydrus implantation in one eye and the other device in the contralateral eye, with ≥ 3-month follow-up. In 58 eyes (27 iStent inject, 31 Hydrus) the surgery also included ab interno canaloplasty (ABiC). Twelve-month outcomes included intraocular pressure (IOP), medications, and adverse events. Subgroup analyses were completed for iStent inject versus Hydrus, and with versus without ABiC. At 12months versus baseline, mean IOP reduced from 16.8 ± 3.7 to 13.6 ± 2.9 (p = 0.003) in iStent inject eyes, and from 18.1 ± 4.5 to 14.9 ± 3.2mmHg (p = 0.003) in Hydrus eyes (between-group IOP reduction p = 0.582). Mean number of glaucoma medications reduced from 1.23 ± 0.97 to 0.30 ± 0.76 (p < 0.001) in iStent inject eyes and from 1.20 ± 1.02 to 0.39 ± 0.72 (p = 0.001) in Hydrus eyes (between-group medication reduction p = 0.943). At 12months, 82.6% of iStent inject eyes and 73.9% of Hydrus eyes were medication-free versus 20.0% preoperatively in both groups (p < 0.0001 both groups). There were no statistically significant IOP or medication differences between iStent inject and Hydrus pre- or postoperatively, both in the overall cohort and in the with/without ABiC subgroups. Outcomes also were similar between eyes with/without ABiC in the overall cohort and in the iStent inject/Hydrus subgroups. There were no adverse events in the iStent inject group; two eyes in the Hydrus group had device-related complications requiring five additional surgeries (one Hydrus repositioning, one Hydrus exchange, one Hydrus removal, two goniotomies). In this contralateral-eye comparison of iStent inject versus Hydrus, the groups had similar IOP and medication outcomes, regardless of stratification by ABiC completion. Eyes receiving Hydrus had more complications and subsequent surgeries.

Outcomes of reimplantation of a new Glaucoma Drainage Device after explantation of an older implant from exposure-related complications.

To describe the clinical outcome of a series of seven eyes with an explanation of an original Glaucoma Drainage Device (GDD) arising from the complication of plate exposure and consequent reimplantation of another GDD at a second setting. This was a retrospective, interventional, and non-comparative study at two tertiary eye care hospitals in eastern and southern India. Electronic medical record data of the seven eyes where a GDD was explanted and a 2nd GDD was reimplanted over October 2010 and May 2021 was analyzed. Statistical analysis was done by SPSS (ver. 26). The first GDD survived for a mean of 168 days only till the plate got exposed and thereby got explanted. Possible predisposing factors noted were conjunctival and scleral thinning, ischemic conjunctiva, etc., The reimplantation surgery was technically easy in the absence of hypotony-opposite to what is reported in the literature. The final IOP (mean +/- SD) values (mm Hg) were 18.9 (+/-7.9), range = 10-30. The mean number of glaucoma medications reduced from 3.9 (+/-1.2; range, 2 to 5) after the explanation to 3.1 (+/-0.7; range, 2 to 4) after the 2nd GDD implantation, in the final follow-up. The second GDD was found to be stable till the last follow-up (mean = 1149 days). No other significant intraoperative or postoperative complications were seen. Reimplantation of a second GDD in a separate setting after explanations of an original implant due to exposure-related complication is both a safe and effective method.

Long-term outcomes of Baerveldt glaucoma implant surgery in Japanese patients

This study evaluated the long-term surgical outcomes of Baerveldt glaucoma implant (BGI) surgery in patients with refractory glaucoma (204 eyes/204 patients). Surgical failure was defined by: < 20% reduction in preoperative intraocular pressure (IOP), or criterion A (IOP > 21 mmHg), criterion B (IOP > 17 mmHg), or criterion C (IOP > 14 mmHg). Reoperation, loss of light perception vision, or hypotony also denoted failure. The probability of success at 5 years postoperatively using criteria A, B, and C was 72.4%, 49.7%, and 24.4%, respectively. The mean IOP decreased significantly from 32.7 ± 9.7 mmHg preoperatively to 13.1 ± 3.9 mmHg at 5 years; the mean number of glaucoma medications also decreased from 3.7 ± 1.2 to 1.8 ± 1.9 (both P < 0.01). The number of previous intraocular surgeries was significantly associated with failure in the multivariable analysis for criterion B (hazard ratio 1.30; P < 0.01) and criterion C (hazard ratio 1.19; P = 0.031). Early and late postoperative complications occurred in 82 (40.2%) and 28 (13.7%) eyes, respectively. Postoperative interventions were performed in 44 eyes (21.6%). BGI surgery resulted in significant long-term decreases in IOP and the number of glaucoma medications. BGI surgery is effective for refractory glaucoma. However, postoperative interventions due to complications are required in numerous cases.

Selective laser trabeculoplasty versus micropulse laser trabeculoplasty for intraocular pressure control in patients with primary open angle glaucoma: a 12-month retrospective comparative study.

This study was designed to compare the efficacy of selective laser trabeculoplasty (SLT) and micropulse laser trabeculoplasty (MLT) in patients with primary open angle glaucoma (POAG) requiring additional IOP control. In this retrospective, comparative study, we reviewed the charts of POAG patients requiring additional IOP lowering, who underwent either SLT or MLT and were followed for at least one year. We evaluated mean intraocular pressure (IOP), mean IOP reduction from baseline and mean number of glaucoma medications 1, 3, 6 and 12months after treatment. Success rates (success defined as IOP ≤ 21mmHg and ≥ 20% reduction from baseline IOP without additional medications, new laser session, or glaucoma surgery) at one year were also compared. A total of 98 POAG patients were included, 52 individuals in the SLT group and 46 in the MLT group. Laser treatment resulted in significant mean IOP reductions from baseline in both groups (SLT = -6.0 ± 3.3mmHg (24.9%) and MLT = -5.8 ± 2.6mmHg (23.4%)) (p < 0.001). However, there was no statistically significant difference between the mean IOP reductions in both groups (p = 0.74). At 12months, the mean number of glaucoma medications was significantly smaller in the SLT group (1.17 + 0.4) when compared to the MLT group (2.21 + 0.2) (p = 0.001). Additionally, after 12months, success was obtained in 32 (61.5%) SLT cases compared to 27 (58.7%) MLT-treated eyes (p = 1.0). MLT and SLT are both effective in controlling the IOP in POAG patients requiring additional IOP reduction. However, after 12months, SLT demonstrated a greater efficacy in reducing medication burden when compared to MLT.Trial registration: CEP/CONEP/MS Brazil 40948620.9.0000.5600.

Risk factors for Baerveldt glaucoma drainage implantation for uveitic glaucoma

Uveitic glaucoma (UG) is sometimes intractable, including intricate interaction between intraocular pressure (IOP) elevation associated with inflammation and side effects of steroids. Based on the Tube Versus Trabeculectomy study in refractory glaucoma results in 2012, tube shunt surgeries have been performed for UG, but few reports have focused on UG. We retrospectively examined the surgical efficacy, complications, and risk factors in 62 eyes with UG that underwent Baerveldt glaucoma drainage device (BGD) implantation at Kumamoto University. The IOPs significantly dropped, and the mean number of glaucoma medications was reduced by more than two. Kaplan‒Meier survival curves were presented under 2 conditions: an IOP reduction of 20% and 6 ≤ IOP ≤ 18 mmHg (criterion A) or 6 ≤ IOP ≤ 15 mmHg (criterion B). In criterion A, the median survival times (MST) were 124 days (complete) and 997 days (qualified). In criterion B, the MST was 129 days (complete) and 867 days (qualified). The Cox hazard proportional model found that the hazard ratio was 0.170 for a history of cataract surgery (95% CI 0.0303–0.950) and 8.669 for systemic immunosuppressive therapy (95% CI 1.810–41.51). BGD implantation is effective for treating UG, but the presence of systemic treatment and the lens status should be considered.

Impact of postoperative choroidal detachment on trabeculectomy outcomes: a four-year comparative study

BackgroundThe aim of this study was to compare trabeculectomy outcomes in patients with and without post-operative serous choroidal detachment (CD) and establish an association between CD and trabeculectomy outcomes.MethodsIn this 4-year retrospective cohort study, medical records of glaucoma patients older than 18 who underwent primary trabeculectomy with Mitomycin-C between 2012 and 2020 were reviewed. Phakic eyes without history of any other intraocular surgery and with at least one year of follow-up were included in the study. Postoperative CD was defined as clinically visible CD developed within the first postoperative week. Cases were categorized into with and without CD and trabeculectomy outcomes were compared. Comparison was carried out using postoperative intraocular pressure (IOP), glaucoma medications and surgery success. Two levels of success were defined regardless of glaucoma medications; criteria A) 5 < IOP < 19 mmHg and criteria B) 5 < IOP < 16 mmHg. In addition to the defined IOP ranges, IOP reduction less than 20% from baseline and further glaucoma surgery were also counted as surgery failures.ResultsTotal of 183 patients including 153 without CD (mean age 58.73 ± 11.40 years, mean IOP 23.7 ± 6.63 mmHg) and 30 with CD (59.00 ± 12.59 years, mean IOP 22.2 ± 3.83 mmHg) entered the study. Post-trabeculectomy mean IOPs were significantly higher in the CD group at all follow-up visits at year 1 through 4 (14.70, and 14.82 mmHg vs. 11.03, and 12.59 mmHg; p-value < 0.05). Similarly mean number of glaucoma medications was higher in the CD group at all follow-up visits (p-value > 0.001). Based on success criteria A, cumulative probability of success for patients with CD wasn’t significantly different compared to those without CD at years 1 through 4 (80.0%, and 69.6% vs. 88.2%, and 74.1% respectively; p-value > 0.05, log-rank). However, based on success criteria B, patients with CD had significantly lower cumulative probability of success at years 1 through 4 (50.0% and 8.9% vs. 79.7% and 59.8%, p-value < 0.001).ConclusionWe established that early post-trabeculectomy serous choroidal detachment is associated with adverse surgery outcomes. Lower rate of surgery success and higher mean postoperative IOP and glaucoma medications were observed in patients with post-trabeculectomy choroidal detachment and this was more pronounced in patients who required more stringent IOP control (success definition 5 < IOP < 16 mmHg).

UGH Syndrome Resolution after IOL Explantation and Concomitant Carlevale IOL Implantation

ABSTRACT Objective To examine the use of Carlevale IOL placement in patients with UGH, and to evaluate surgical outcomes. Design In this retrospective study, 28 patients with UGH syndrome that were subjected to IOL explantation and concomitant Carlevale IOL implantation were included in the study. Methods Information about VA, IOP, number of glaucoma medication, need for glaucoma surgery, presence of hemorrhage and inflammation were recorded up to 6 months after the procedure. Results We found a statistically significant increase in mean visual acuity and complete resolution of uveitis in all patients. Mean IOP and the mean number of glaucoma medications were significantly decreased postoperatively, while 14% of patients required additional glaucoma surgery. Conclusions IOL explantation and concomitant Carlevale IOL implantation may provide a viable solution for UGH syndrome resolution, increases visual acuity, and decreases the need for glaucoma medication.

Five-year outcomes of selective laser trabeculoplasty: A retrospective study.

Studies have shown the efficacy of selective laser trabeculoplasty (SLT) to lower intraocular pressure (IOP) as adjuvant therapy during short-term follow-up. However, few studies have assessed the long-term efficacy of SLT on preventing worsening Humphrey visual field (HVF) parameters and thinning of the retinal nerve fiber layer (RNFL) with continued medical therapy. A retrospective chart review was conducted of 51 eyes of 39 patients with glaucoma treated with SLT at Boston Medical Center between 2012 and 2016 with 3- and 5-year follow-up. Outcome measures included IOP, visual acuity, number of glaucoma medications, number of months to subsequent surgical intervention. HVF outcome measures included mean deviation (MD) and pattern standard deviation (PSD). Optical coherence tomography (OCT) outcome measures included RNFL mean thickness, and superior and inferior thicknesses. Twenty-five eyes received subsequent surgical intervention (mean time to intervention = 33.6 ± 20.0 months). In the eyes that did not receive another intervention, mean IOP was significantly decreased by 3.2 and 3.5 mmHg at 3- and 5-year after SLT, respectively. Mean number of glaucoma medications was significantly increased at 5-year (2.7 ± 1.6; P = 0.04), compared to pre-SLT (2.0 ± 1.1). Mean HVF MD was significantly higher at 5-year (-7.64 ± 6.57 dB) compared to pre-SLT (-5.61 ± 3.90 dB). Mean PSD significantly increased at 3-year (5.30 ± 2.91 dB) and 5-year (6.84 ± 2.62 dB), compared to pre-SLT (4.63 ± 2.70 dB; P = 0.04 and ≤0.01, respectively). On OCT, inferior quadrant RNFL thickness decreased significantly at 5-year (88.5 ± 19.3 μm), compared to pre-SLT (94.0 ± 23.2 μm). Although 51% of eyes had IOP controlled at 5-year post-SLT, mean number of glaucoma medications was significantly higher. Also, there was progression of MD and PSD on HVF and inferior quadrant thinning on OCT at 5-year. We found a significant association between age at SLT and risk of subsequent surgical intervention over 5-year follow-up. Our study adds to our understanding of long-term outcomes of adjuvant SLT for glaucoma patients receiving medical therapy.

A 2-Year, Single-Center Study to Assess the Safety and Effectiveness of the MicroShunt in Primary Open-Angle Glaucoma

Aim: The aim of the study was to assess the effectiveness and safety of the MicroShunt (formerly known as the MIDI-Arrow or InnFocus MicroShunt®), an 8.5-mm-long, 70-μm lumen-controlled ab externo glaucoma filtration surgery device made from poly(styrene-block-isobutylene-block-styrene) (SIBS), in patients with primary open-angle glaucoma (POAG). Methods: A 2-year, single-center, single-surgeon, nonrandomized, adaptive feasibility clinical study (NCT01563237) was conducted in France from June 2011 to November 2016. Eligible patients were aged 18–85 years and had POAG inadequately controlled on maximum tolerated medical therapy with intraocular pressure (IOP) ≥18 and ≤40 mm Hg. The MicroShunt was implanted ab externo with adjunctive use of mitomycin C (0.2–0.4 mg/mL applied for 2–3 min), alone or in combination with cataract surgery. The primary effectiveness endpoints were the reduction in IOP relative to the preoperative value assessed at each postoperative visit and the measurement of success at years 1 and 2. The primary safety endpoint was the incidence of all procedure- and/or device-related adverse events (AEs) during the study. The secondary effectiveness endpoint was the mean number of glaucoma medications per patient, and the secondary safety endpoint was the incidence of glaucoma reoperation. Results: Sixty-one eyes from 61 patients underwent MicroShunt implantation. Mean IOP ± standard deviation (SD) was significantly reduced from 25.7 ± 6.1 mm Hg at baseline (N = 61) to 15.8 ± 4.7 mm Hg at year 1 (n = 58) and 16.5 ± 6.0 mm Hg at year 2 (n = 52) (both p < 0.001). Overall success rates for patients achieving IOP ≥6 mm Hg and <21 mm Hg at year 1 and year 2 were 80.3% and 75.4%, respectively. Mean ± SD number of glaucoma medications per patient decreased significantly from 2.9 ± 1.1 at baseline to 0.6 ± 1.0 at year 1 (n = 58) and 1.0 ± 1.3 at year 2 (n = 52) (both p < 0.001). The most common procedure- and/or device-related AEs were investigator-reported increased IOP and hyphema. Four patients required reoperation. Conclusions: In this study, sustained reductions in mean IOP and number of glaucoma medications from baseline were observed up to 2 years post-surgery. No long-term, sight-threatening AEs were observed.

3-Year Outcomes of XEN Implant Compared With Trabeculectomy, With or Without Phacoemulsification for Open Angle Glaucoma.

Trabeculectomy (TRAB) surgery reduces the intraocular pressure (IOP) more than the XEN45 implant over 3 years. There is no difference in the number of antiglaucoma medications between the 2 procedures. The decision to perform either TRAB or XEN45 implantation must be evaluated on a case-by-case basis, taking into account the high rate of needling of the XEN45. The aim of this study was to compare the differences between the efficacy and safety of the XEN45 implant and TRAB, either alone or in combination with phacoemulsification (PHACO), in patients with open angle glaucoma (OAG) at 36 months. A retrospective, single-center and comparative study conducted on OAG patients who underwent XEN45 implantation or TRAB from 2016 to 2018. Patients were divided into 4 groups: group 1 (XEN45 alone), group 2 (XEN45+PHACO), group 3 (TRAB alone), and group 4 (TRAB+PHACO). For statistical purposes, groups 1 and 2 were combined (XEN45 implant), whereas groups 3 and 4 were also combined (TRAB surgery). IOP, number of glaucoma medications, and adverse events were evaluated. The main outcome measure was the reduction in IOP at 36 months postoperatively. One hundred thirty-four patients (134 eyes; 63 XEN45 and 71 TRAB) were included. The mean (95% confidence interval) IOP reduction at the end of the study follow-up was -6.3 (-11.0 to -1.6 mm Hg, P =0.025, XEN45 alone), -8.9 (-11.0 to -6.8 mm Hg, P <0.001, TRAB alone), -2.5 (-4.5 to -0.4 mm Hg, P =0.019, XEN45+PHACO), and -5.6 (-7.7 to -3.4 mm Hg, P <0.001, TRAB±PHACO). The proportion of patients achieving an IOP≥6 and ≤16 mm Hg without treatment at the end of the 36-month follow-up were 50.8% (32/63) in the XEN45 implant and 49.3% (35/71) in the TRAB surgery group, P =0.863. The mean number of glaucoma medications was significantly reduced in all the study groups. The needling rate was 19% in XEN45 versus 5.6% in the TRAB group ( P =0.030), and 2.81% and 36.6% of eyes in the TRAB group presented anterior chamber flattening and hyphema, respectively. TRAB surgery lowered IOP significantly more than XEN45 implant with or without phacoemulsification over 3 years and had a significantly lower need for additional needling surgery. Both procedures reduced glaucoma medications to a similar rate. These findings are relevant to the informed consent process and patient decisions for one procedure over the other.

Prospective 12-month outcomes of combined iStent inject implantation and phacoemulsification in Asian eyes with normal tension glaucoma

BackgroundGlaucoma is the leading cause of irreversible blindness. Normal tension glaucoma (NTG) is a subset of open-angle glaucoma, demonstrating glaucomatous optic nerve damage in the absence of raised intraocular pressure (IOP). NTG is more prevalent in Asian populations. While generally slow-progressing, NTG may be associated with significant central visual field loss. In recent years, minimally invasive glaucoma surgery has been added to the armamentarium of glaucoma surgery. This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject (Glaukos Corporation, Laguna Hills, CA) implantation and phacoemulsification in Asian eyes with NTG.MethodsThis is a prospective, single-centre case series of 30 eyes followed up until 12 months after surgery. Outcome measures included IOP, number of glaucoma medications, best-corrected visual acuity (BCVA) and intra and postoperative complications.ResultsMean age of subjects was 73.1 ± 6.3 years. Majority were ethnic Chinese (n = 27, 90%). Baseline medicated mean IOP was 13.8 ± 2.4 mmHg and mean number of glaucoma medications was 1.3 ± 0.7. Mean Humphrey visual field mean deviation was − 13.7 ± 7.6. The mean IOP reduction at all timepoints from postoperative month (POM) 3 onwards was statistically significant (all P < 0.05), with mean reduction of 1.2 mmHg (95% CI: 0.1–2.2, P = 0.037) by POM12. There was statistically significant reduction in mean number of medications from postoperative day (POD) 1 onwards (all P < 0.05), with mean decrease of 1.0 medication (95% CI: 0.9–1.1, P < 0.001) by POM12. By POM12, 25 (83.3%) eyes were medication-free. Three (10%) eyes had stent occlusion by iris requiring laser iridoplasty. One eye had gross hyphema which resolved on conservative management before POM1. Mean BCVA improved from the baseline 0.3 ± 0.3 logMAR to 0.1 ± 0.1 logMAR postoperatively (P < 0.001). There were no major adverse or sight-threatening events. No eyes required further glaucoma surgery during the 12-month follow-up period.ConclusionAsian eyes with NTG which underwent combined iStent inject implantation and phacoemulsification demonstrated a significant and sustained reduction in IOP and glaucoma medications, up to 12 months postoperatively.

One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery.

AimLong-term data of the postoperative management following Baerveldt tube surgery (BVT) is currently limited. This study aims to evaluate the outcome and the safety profile of internal ligation suture removal after BVT surgery for refractory glaucoma.Materials and methodsA prospective, consecutive, non-comparative case series of patients previously undergoing BVT 350 mm2 surgery with 0.4 mg/mL mitomycin C (MMC), 3/0 intraluminal suture (Supramid) insertion, and 10/0 nylon external ligation suture(s). For each patient, data was collected over 12 months after internal ligation suture removal. Follow-up assessments looked at intraocular pressure (IOP), complication rate, and postoperative number of glaucoma medications. Definition of success was adopted as per the World Glaucoma Association recommendations.ResultsTwenty-four patients were included. On average, Supramid was removed at 22 ± 18.2 weeks following BVT surgery. Preoperatively, the mean IOP was 30.9 ± 12.6 mm Hg and the average antiglaucoma medications were 1.95 ± 1.13. At 12 months, the mean IOP was 15.2 ± 5.3 mm Hg and the mean number of glaucoma medications was 1.3 ± 0.2. Qualified success with IOP ≤ 21 mm Hg and IOP ≤ 15 mm Hg was achieved in 62.5% and 33.3%, respectively. Only two patients developed hypotony following Supramid removal; both resolved spontaneously within 1 month.ConclusionOur results show a good IOP reduction and safety profile at 1 year from internal ligation suture removal following BVT. A drop in IOP of approximately 50% from the preoperative IOP can be expected.How to cite this articleStringa F, Chen R, Agrawal P. One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery. J Curr Glaucoma Pract 2022;16(1):20-23.

Gonioscopy-Assisted Transluminal Trabeculotomy for Glaucoma: 1-Year Outcomes and Success Predictors.

Our results suggest gonioscopy-assisted transluminal trabeculotomy (GATT) as an effective and safe option for the surgical management of open-angle glaucoma (OAG). Older age was the only risk factor for failure in our analysis. To report 12-month clinical outcomes, safety profile and success predictors of GATT in patients with OAG. A retrospective study of patients (18 y old and above) with medically uncontrolled OAG who underwent GATT as a solo procedure or combined with phacoemulsification (PHACO-GATT) between January 2018 and January 2020. Success at 12 months (primary outcome) was defined as intraocular pressure (IOP) <15 mm Hg, with an IOP reduction of at least 20%, OR a reduction of at least 2 glaucoma medications, compared with baseline. Secondary outcomes were success predictors and safety parameters. A total of 73 eyes (GATT=38; PHACO-GATT=35) from 58 patients with a mean age of 54.8±11.6 years were included. Overall, after 12 months of follow-up, the mean IOP was reduced from 24.9±8.5 to 12.1±2.1 mm Hg (P<0.001). The mean number of glaucoma medications was reduced from 3.5±0.7 to 1.2±1.2 (P<0.001). The success rate was 87% at 12 months, with no significant differences between GATT (85%) and PHACO-GATT (91%) eyes (P=0.330). Age was the only factor significantly associated with surgical success (hazard ratio=1.35; P=0.012; after adjusting for preoperative IOP and number of glaucoma medications). Patients older than 60 years had a significant greater chance of failure (hazard ratio=10.96; P=0.026) compared with those younger than 60 years. The most common postoperative complication was transient hyphema (39%; median duration, 5 d). No sight-threatening adverse event was documented. GATT was effective and safe at lowering IOP with or without cataract extraction in OAG. Patients 60 years or older had a higher risk of failure compared with those younger in age.