Mean Preoperative Intraocular Pressure Research Articles

Long-term effectiveness and safety of XEN45 in open-angle glaucoma patients.

To investigate the long-term effectiveness and safety of XEN45 implant, either alone or in combination with phacoemulsification, in eyes with open-angle glaucoma (OAG). Retrospective and single center study conducted on consecutive OAG patients who underwent a XEN45 implant between February-2017 and December-2021. The primary endpoint was the mean intraocular pressure (IOP) lowering from preoperative values. Surgical success was defined as an IOP-lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 13mmHg, without (Complete-success) or with (Qualified-success) antiglaucoma medications. A total of 158 eyes (34 (21.5%) eyes XEN-solo and 124 (78.5%) XEN + Phaco) were included. The median follow-up time was 28.5months. In the overall study population, the mean preoperative IOP was significantly lowered from 19.4 ± 6.5mmHg to 12.4 ± 5.0mmHg. The mean preoperative (95% confidence interval) IOP was significantly lowered from 21.3 (19.3-23.2)mmHg and 18.8 (17.7-20.0)mmHg to 12.0 (10.4-13.6)mmHg and 12.5 (11.6-13.5)mmHg in the XEN-Solo and XEN + Phaco groups, respectively (p < 0.0001 each, respectively). The mean number of ocular-hypotensive medications was significantly reduced in the overall study sample (from 3.4 ± 0.9 to 0.9 ± 1.3, p < 0.0001), XEN-Solo (from 3.5 ± 1.1 to 0.6 ± 1.0, p < 0.0001, and XEN + Phaco (from 3.4 ± 1.1 to 0.9 ± 1.3, p < 0.0001) groups. Eighty-four (53.2%) eyes were categorized as success, with 49 (58.3%) classified as complete success. Eighty-one (51.3%) eyes underwent needling and 15 (9.5%) eyes required an additional surgical procedure. One (0.6%) eye had endophthalmitis. XEN implant, either alone or in combination with phacoemulsification significantly lowered IOP and reduced the need of ocular-hypotensive medication, while maintaining a good safety profile.

Evaluation of Intrascleral Lakes after Phaco-Viscocanalostomy using Anterior Segment Optical Coherence Tomography

Purpose: This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary openangle glaucoma (POAG). Methods: In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup–disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. Results: A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P &lt; 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. Conclusion: This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm’s canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

LONG-TERM OUTCOME OF TRANSSCLERAL FOUR-POINT FIXATION OF AKREOS INTRAOCULAR LENS WITH CLOSED CONTINUOUS-LOOP SUTURE.

To report the long-term clinical outcomes of transscleral four-point fixation of Akreos intraocular lens using a closed continuous-loop suture technique. This was a retrospective, multicenter, interventional case series. Primary outcome measures were best-corrected visual acuity, intraocular pressure, corneal endothelial cell density, and complications with a minimum of 1-year follow-up. One hundred and ninety-two eyes of 177 patients from two surgical hospital sites were identified. The mean best-corrected visual acuity improved from 0.88 ± 0.74 logarithm of the minimum angle of resolution (Snellen 20/152) preoperatively to 0.42 ± 0.52 logarithm of the minimum angle of resolution (Snellen 20/53) postoperatively ( P < 0.001). The mean preoperative intraocular pressure was 17.51 ± 8.67 mmHg, and the mean postoperative intraocular pressure at final follow-up was 15.08 ± 4.18 mmHg ( P = 0.001). The mean corneal endothelial cell density significantly reduced from 2,259 ± 729 cells/mm 2 to 2077 ± 659 cells/mm 2 , representing a cell loss of 5.73% ( P < 0.001). The intraocular lens was fixed well during follow-up. There were no intraoperative complications noted. Postoperative complications included transient ocular hypertension in 15 eyes (7.81%), hypotony in two eyes (1.04%), retinal detachment in one eye (0.52%), and macular edema in one eye (0.52%). The transscleral four-point fixation Akreos intraocular lens using the closed continuous-loop suture technique was effective and safe with satisfactory visual acuity with a minimum of 1-year follow-up.

The Efficacy of Phacotrabeculectomy in Reducing Intraocular Pressure

Background: Primary open angle glaucoma and age related cataract are ocular comorbidities which can occur in some individuals at different times. Phacoemulsification is carried out for restoration of vision decreased by cataract while trabeculectomy is a procedure to decrease the intra ocular pressure. To save the time, money and stay in the hospital, phacotrabeculectomy is a single procedure which can fulfill both the restoration of vision and decrease intraocular pressure. Objectives: To determine the efficacy of phacotrabeculectomy in decreasing the intraocular pressure in patients having both primary open angle glaucoma and age related cataract.Materials and Methods: This study was conducted at the Eye department, Hayatabad Medical Complex, Peshawar, from 1st August, 2022 to 1st February 2023 after getting the permission from Ethical Committee to do this study. Patients both males and females, from 40-80 years of age, who had coexisting age related cataract (ARC) and Primary open angle glaucoma (POAG), whose intraocular pressures (IOP) was 21mm Hg or above, with and without using anti-glaucoma treatment.Patients who had secondary or rosette shaped cataract, past ocular trauma (including ocular surgery along with its intraoperative or post-operative complications) and trauma after phacotrabeculectomy procedure during the follow up period were excluded from this study.Results: All 121 patients underwent Phacotrabeculectomy. Follow up was done for 5 months. Preoperative mean intraocular pressure (IOP) was 23.53 ± 4.22SD which reduced to 12.90 ± 2.09SD postoperatively which was highly significant with p- value=0.001Conclusion: Phacotrabeculectomy reduced Intraocular pressure by &gt;10 mm Hg in our study which showed that this procedure is very effective in coexisting age related cataract and primary open angle glaucoma.Keywords: Age related cataract, Angle closure glaucoma, Combined phaco-trabeculectomy, Glaucoma, Intraocular pressure, Open angle glaucoma, Trabeculectomy.

Gonioscopy-Assisted Transluminal Trabeculotomy in Uveitis-Related Ocular Hypertension and Glaucoma.

Gonioscopy-assisted transluminal trabeculotomy (GATT) may be an effective first-line surgery for decreasing intraocular pressure (IOP) and medication burden in patients with uveitis-related ocular hypertension (OHT) or glaucoma. The purpose of the study is to determine the efficacy of GATT in lowering IOP in uveitis-related OHT or glaucoma. Retrospective case series that included patients with uveitis-related OHT or glaucoma who underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at 2 Canadian academic centres from July 2018 to May 2022. Primary outcomes were: complete (no medications) and qualified success (with medication), and failure defined as (1) IOP >21 mm Hg with maximal medical therapy, (2) the need for additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, and (4) IOP <6 mm Hg for 3 months. Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2 ± 7.3 mm Hg on 4.3 ± 0.7 classes of glaucoma drops. The average follow-up was 29.2 ± 17.6 months and 76% of eyes (n = 16) had reached at least 12 months of follow-up. At the 12-month follow-up visit, there was a significant decrease in average IOP by 9.9 ± 7.9 mm Hg (38%, P = 0.005) and a decrease of 1.9 in glaucoma medication classes ( P = 0.002). Of eyes, 14% achieved complete success, whereas 80% of eyes achieved qualified success. Six eyes failed (29%) and 5 patients (24%) required additional glaucoma surgery. The most common postoperative complication was hyphema (n = 9; 43%). This small case series suggests that GATT may be an effective first-line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-ups should be conducted to assess its long-term outcomes.

Slow coagulation versus micropulse transscleral cyclophotocoagulation for refractory childhood glaucoma.

To compare the safety and efficacy of micropulse laser (MP-TSCP) and slow coagulation transscleral cyclophotocoagulation (TSCP) with a diode laser for reducing intraocular pressure (IOP) in patients with refractory childhood glaucoma (CG). Patients with CG and at least 12 months of medical chart data were included. Data on preoperative and postoperative outcomes were analyzed. The primary outcomes were an IOP of 6-21 mmHg and/or ≥ 20% reduction in the baseline value. A total of 17 eyes were included. The preoperative mean IOP was 28 mmHg in the MP-TSCP and 29.9 mmHg in the TSCP. The mean IOP decreased significantly to 17.26 ± 3.27 mmHg in the MP-TSCP and 14.68 ± 5.79 mmHg TSCP at the last medical record. Three anti-glaucoma meds were administered to the eyes preoperatively in both groups. A mean of 1.02 eye drops was administered to the MP-TSCP and 2.06 to the TSCP. The number of medications decreased by 2.38 ± 1.55 in the MP-TSCP and 0.82 ± 1.68 in the TSCP. The median preoperative visual acuity (logMAR) was 1.51 ± 1.06 in the MP-TSCP and 1.87 ± 0.74 in the TSCP. The variation in mean visual acuity (logMAR) was -0.027 ± 0.05 in the MP-TSCP and -0.40 ± 0.58 in the TSCP. The most frequent complication was corneal decompensation (one - MP-TSCP and two - TSCP). Both techniques were effective and relatively safe for reducing IOP. These techniques appear to extend the indications of cyclophotocoagulation in CG eyes and improve the functional prognosis.

Subscleral trabeculectomy with Ologen implant versus mitomycin C in primary infantile glaucoma

Abstract: PURPOSE: The purpose of this study is to compare the effect of subscleral trabeculectomy (SST) augmented with mitomycin C (MMC) versus Ologen implant as secondary procedures for treatment of primary congenital glaucoma. METHODS: This is a retrospective study evaluating records of 38 eyes that had undergone SST with MMC (Group M, 17 eyes) versus Ologen (Group O, 21 eyes) by the authors of the study. The study primary endpoint was set at 5–9 months postoperatively, and the secondary endpoint was the last follow-up. A successful outcome was an intraocular pressure (IOP) ≤18 mmHg for infants &lt;1 year and ≤20 mmHg for older ones. RESULTS: The follow-up duration was 1.25–51 (26.79 ± 27.583) months in Group M and 0.25–103 (22.86 ± 28.991) months in Group O (P = 0.673). The mean preoperative IOP was 28.06 ± 3.929 in Group M and 26.95 ± 6.095 in Group O (P = 0.522). A reduction of IOP was significant in Group M at all follow-up visits but starting at the 4th postoperative month in Group O. Recorded IOP in Groups M and O, respectively, was 14.9 ± 6.437 and 12.1 ± 5.043 at the primary endpoint and 22.35 ± 8.536 and 22.52 ± 10.152 (P &gt; 0.05) at the secondary endpoint. A successful outcome was achieved in Groups M and O, respectively, in 47.1% and 47.6% at the primary endpoint and in 47.1% and 52.4% at the secondary endpoint (P &gt; 0.05). Cataract, posterior synechiae, and pupillary abnormalities were insignificantly different in both the groups (P = 0.623). CONCLUSION: Ologen implant was comparable to MMC in terms of efficacy and safety. Reoperations are inadvisable before 4 months of Ologen implants.

Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy.

To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy (MAT). Totally 10 eyes of 10 patients with primary open angle glaucoma (POAG) who underwent MAT facilitated by Usights UC100 (5 eyes) or iTrack (5 eyes) were reviewed. The success of this surgery was defined as intraocular pressure (IOP) <22 mm Hg with >30% reduction, without oral glaucoma medications, or additional glaucoma surgery. The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group. MAT was achieved in all eyes in both groups. The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes, respectively. Both microcatheters produced a statistically significant reduction in IOP, and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo follow-up (12.58±1.52 and 14.84±1.89 mm Hg, respectively), but no statistical significance was there. No severe side effects were observed in either group. MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG, and Usights UC100 is as safe as iTrack.

Clinical results of the eyeWatch system: 1-year outcomes

The eyeWatch System (EWS) (Rheon Medical, Lausanne, Switzerland) was developed as aglaucoma drainage device (GDD) to precisely control intraocular pressure (IOP) and thus prevent the development of postoperative hypotension and its complications. To report 1‑year outcomes from asingle-center cohort undergoing EWS surgery. Retrospective review of patients undergoing EWS surgery at the University Eye Hospital Bonn, Germany from May 2021 to September 2022. Atotal of 5eyes of the first 5consecutive patients treated with the EWS were included in this study. The mean preoperative IOP was 34.6 mm Hg (23-45 mm Hg) which was reduced to 12.2 mm Hg (9-18 mm Hg) with amean reduction of 60%. Local pressure-lowering therapy was reduced from 2.8agents preoperatively (1-4) to 0.6agents after 1year. All patients achieved the target IOP of below 21 mm Hg including 4patients without any medication. The complication rate was low. One patient had to undergo two surgical revisions as the IOP was elevated to over 30 mm Hg after surgery and tube exposure became apparent during the course of the follow-up so that asecond donor patch was sutured on. The same patient had an elevated IOP >30 mm Hg after acMRI examination, so that areduction of IOP by adjusting the EWS using the eyeWatch pen (EWP) was performed. IOP adjustments with the eyeWatch pen (EWP) were performed in 4 of 5patients in the first year after surgery; the mean IOP before adjustment was 21.33 mm Hg (15-37 mm Hg) which was reduced to amean of 8.58 mm Hg (4-16 mm Hg). The EWS effectively lowers IOP and the amount of necessary pressure-lowering therapy. With the EWP postoperative adjustments of IOP are possible without further invasive measures.

SUCCESSFUL RATE OF GLAUCOMA SURGERY IN SECONDARY GLAUCOMA AFTER VITRECTOMY IN KARIADI HOSPITAL SEMARANG 2020-2022

Introduction: Glaucoma is one of the most frequent complications of vitrectomy surgery. It can cause a significant rise in intraocular pressure (IOP). Glaucoma surgery can be planned in medically uncontrolled glaucoma. Trabeculectomy and Glaucoma Drainage Device (GDD) implantation are the most frequent filtering surgeries used in these cases. This study aims to define the success rate of glaucoma surgery in secondary glaucoma after vitrectomy. Methods: This study is an analytical observational study with retrospective data collection held from medical records of patients with secondary glaucoma after vitrectomy who underwent glaucoma surgery in Kariadi General Hospital Semarang from 2020-2022. Surgical success defined by postoperative IOP reduced by&gt;20% from baseline, with or without anti-glaucoma medication. Result: There were 16 eyes of trabeculectomy with 5-fluorouracil (5-FU), and 8 eyes of GDD implants. The mean preoperative IOP was 43.76+6.77 mmhg for trabeculectomy 5-FU, and 42.43+4.02 mmhg for GDD implant. IOP levels in both groups varied significantly after one day, one week, one month, and three months after surgery (p&lt;0.05). The success rate for the trabeculectomy 5-FU group was 75% and the GDD implant group was 87.5% in 3 months. There was no statistically significant difference in the success rate between the trabeculectomy 5-FU and GDD implant groups (p=0.069). The complication were 18.75% and 25% for trabeculectomy group and GDD implant group, respectively. Conclusion: There was no significant difference in the success rate between trabeculectomy 5-FU and the GDD implant group. Both groups are viable for glaucoma surgery in secondary glaucoma after vitrectomy surgery.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Influence of the postoperative restrictive methodologies and efficacy of the Baerveldt 350 implant after 12 months follow‐up

Aims/Purpose: To assess the clinical outcomes subsequent to the implantation of a Baerveldt 350 drainage device, utilizing different restrictive methodologies to prevent sudden postoperative hypotony (HT) (IOP &lt;6 mmHg), and their subsequent impact on the incidence of a Hypertensive phase (HP).Methods: A retrospective observational analysis of 71 consecutive eyes that had a Baerveldt 350 implanted. 50 eyes had 6 or 7/0 polyglactin tube ligation (ligature group = LG) and 21 eyes had a 3/0 polypropylene intraluminal tear cord 3/0 added to the ligation (ripcord‐ligature group = RLG), which was manually removed at the surgeon's discretion after spontaneous opening of the polyglactin. Intraocular pressure (IOP) and ocular hypotensive medication (OHM) lowering, failure rate, complete and partial success (CS and PS) and presence of HP were analysed.Results: The mean preoperative IOP was 26.14 (11.34) mmHg with 2.98 OHM for the LG and 28 (8.76) mmHg with 3.35 OHM for the RLG (p = 0.545 and p = 0.397). At the end of the follow‐up, the mean postoperative IOP was 13.35 (3.87) mmHg for the LG and 10.81(2.66) mmHg for the RLG (p = 0.01). The mean reduction of OHM was 2.25 (1.38) for the LG and 2.81 (1.6) for the RLG (p = 0.168). HP was noted in 26 patients (37.14%), 25 of them took place in the LG (50%); however, only 1 took place in the RLG (5%) (p = 0.00023). 35% of the patients who exhibited HP achieved CS, compared to 67.7% of the patients that did not show HP (p = 0.022). The survival analysis for a 12 months follow‐up period, showed that the estimate survival time for the LG was 10.97 (±0.521), and 11.64 (±0.342) for the RLG (p = 0.216). Two predictors were identified for risk of failure and CS: age of the patient before surgery (OR 0.157; 95% CI 0.029–0.865; p = 0.033) and the presence of HP (OR 3.90; 95% CI 1.189–12.794; p = 0.025). Lastly, HT was noted in 55 patients (80.9%), 45 of them took place in the LG (81.8%); however, only 10 took place in the RLG (18.2%) (Pearson Chi‐S p = 0.000225).Conclusions: Baerveldt 350 drainage device implantation has proven to be an effective procedure for glaucoma control. The use of the ripcord added to the absorbable ligature was associated with less risk of HP, and with better IOP results at the 12‐months follow‐up. Nevertheless, further research with larger population and larger follow‐up is needed to obtain robust results.

Prospective Study of Canaloplasty and Trabeculotomy Performed by Trainees.

To evaluate outcomes of new adopters of the OMNI® Surgical System (Sight Sciences, Inc.) by prospectively evaluating intermediate-term outcomes of patients operated by trainees. This was a prospective study of surgeries performed by trainees on patients with open angle glaucoma undergoing simultaneous cataract surgery and ab interno canaloplasty and trabeculotomy using the OMNI Surgical System. Pre-operative intraocular pressure (IOP) and number of glaucoma medications were recorded. Only patients with a minimum of 6-month follow up were included. Baseline IOP was used to separate subjects into two groups: Group 1 (IOP ≥18 mmHg) and Group 2 (IOP <18 mmHg). Mean decrease in IOP and medications was calculated and compared with paired t-tests for the overall sample as well as the subgroups. Success was defined as those with a ≥20% reduction from pre-operative IOP or with an IOP ≤18 mmHg and ≥6 mmHg and on the same or fewer number of medications while not requiring additional surgery. Adverse events were also recorded. Forty-two eyes of 31 patients were included. Mean pre-operative IOP was 17.2 ± 4.8 mmHg and mean number of medications was 2.4 ± 1.2. The primary endpoint was reached in 83.3% of patients at 12 months. IOP was reduced by 22.3% to 13.4 ± 2.4 (p<0.001). Mean number of medications decreased to 1.7 ± 1.6 (p<0.001). Group 1 mean IOP decreased 35.4% from 22.2 ± 4.6 mmHg to 14.3 ± 2.8 mmHg (p<0.001). Group 2 mean number of medications decreased from 2.3 ± 1.1 to 1.6 ± 1.5 (p<0.001). When operated on by the novice MIGS surgeon, the OMNI device provides effective IOP and glaucoma medication reduction with minimal adverse events. Efficacy and safety of the device in the hands of trainees was comparable to experienced glaucoma surgeons suggesting its ease of adoption.

The impact of COVID‐19 on the wait times and severity of surgical glaucoma cases evaluated at a tertiary eye center

Aims/Purpose: COVID‐19 has caused shortages in health services worldwide. In Canada, this led to a relocation of medical staff, which paradoxically acted as potential barriers to access to care when considering the significant delays reported in elective surgeries. The purpose of this study was to assess the effect of pandemic related delays on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec, Canada.Methods: In this retrospective cohort study, 182 and 201 eyes of patients who underwent glaucoma surgery at Hôpital Saint‐Sacrement, Quebec City, between the periods of March 1 to June 30, 2019 (pre‐pandemic) and 2021 (pandemic), were included. Severity data included mean visual field deficit, intraocular pressure (IOP), number of drops, and preoperative best corrected visual acuity (BCVA). The times from referral to surgery (referral time) and from listing date to surgery (listing time) were calculated.Results: Visual field deficit was −11.6 ± 7.7 dB in 2019 versus −11.6 ± 7.5 dB in 2021 (p = 0.92). Mean preoperative IOP was 21.1 ± 9.70 mmHg in 2019 versus 20.0 ± 9.52 mmHg in 2021 (p = 0.25). The mean MAVC in the affected eye was 0.60 ± 0.72 LogMAR in 2019 versus 0.55 ± 0.73 LogMAR (p = 0.07). The mean number of preoperative drop classes was 3 ± 1 in both groups (p = 0.56). The mean number of patients referred with oral glaucoma medication increased from 45 to 70 in 2019 and 2021 respectively (p = 0.03). Time to consultation was 122 ± 120 days in 2019 versus 144 ± 136 days in 2021 (p = 0.17), whereas time to list was 48 ± 57 days in 2019 versus 38 ± 43 days in 2021 (p = 0.05).Conclusions: There were no statistically significant differences in the severity of surgical glaucoma cases operated on during the pandemic. Waiting list time decreased, possibly secondary to the prioritization of more urgent glaucoma cases over other ophthalmic surgeries. These reassuring data suggest that the barriers of the pandemic did not lead to a severe worsening of access to care for surgical glaucoma patients.ReferencesFelfeli, Tina et al. The ophthalmic surgical backlog associated with the COVID‐19 pandemic: a population‐based and microsimulation modelling study. CMAJ Open. vol.9 (4) 1063–1072. 23 Nov. 2021, https://doi.org/10.9778/cmajo.20210145

Nonsuperotemporal quadrant implantation of the Ahmed glaucoma valve using modified long scleral tunnel technique for intraocular pressure control.

As superotemporal implantation of the Ahmed glaucoma valve is not always feasible in cases of refractory glaucoma, this study examined the characteristics and surgical outcomes of cases in which the valve was implanted in a nonsuperotemporal quadrant using a modified long scleral tunnel technique. This retrospective case-control study included 37 eyes with nonsuperotemporal quadrant--Ahmed glaucoma valve implantation in Group 1 and 69 eyes with superotemporal Ahmed glaucoma valve implantation in Group 2. The demographic characteristics of these groups, surgical outcomes, including complications, further surgical interventions, and surgical success rates were compared. Surgical success was defined as an intraocular pressure not exceeding 21 mmHg, accompanied by a minimum reduction of 20% in intraocular pressure from the baseline without any additional intraocular pressure-lowering procedures, and the absence of light perception loss or phthisis bulbi. Group 1 had significantly higher numbers of eyes with secondary glaucoma and preoperative surgical procedures than Group 2 (p<0.05). Both groups had mean preoperative intraocular pressure values, and mean intraocular pressure values at the last visit of 34.2 and 27.9 months, 35.5 ± 1.5 and 35.8 ± 1.2 mmHg, and 14.5 ± 5 and 14.9 mmHg, respectively. Although both groups had 70.2% and 75.8% as their five-year cumulative probability of success, respectively, the rates of complications, revisional surgery, and additional surgical procedures did not differ significantly (p>0.05). The modified long scleral tunnel technique for Ahmed glaucoma valve implantation in nonsuperotemporal quadrants achieves intraocular pressure control and complication rates comparable to superotemporal implantation.

Sulcus Tube Internal Needle Guidewire Technique for Glaucoma Drainage Device Placement: Improving Surgical Ease and Precision.

Despite the rise of micro-invasive glaucoma surgery(MIGS), glaucoma drainage device implantation continues to be a mainstay among glaucoma surgical treatment options. Anterior chamber tube placement, while effective in reducing intraocular pressure(IOP), poses corneal endothelial risks. Ciliary sulcus tube placement shows promise in reduced corneal endothelial cell loss, but proper sulcus placement can be challenging. Our study describes the initialsafety and effectiveness results using a novel sulcus tube internal needle guidewire (STING) technique for glaucoma drainage device insertion into the ciliary sulcus. We retrospectively reviewed the charts of all consecutive patients who underwent the STING technique using the Ahmed ClearPath, Ahmed Glaucoma Valve, or Baerveldt glaucoma implant with at least 6 months of follow-up. Demographic characteristics, type of glaucoma, previous medical and surgical treatment, pre- and postoperative IOP, pre- and postoperative medications, complications, and success rates were recorded. Out of nine eyes, seven resulted in qualified success (77.8%). Preoperative mean IOP was 23.8 ± 6.3 mmHg, and postoperative IOP decreased significantly to 14.9 ± 3.7 mmHg (p = 0.008). The average number of preoperative medications per patient was 4.4 ± 0.7, while the average number of postoperative medications per patient was reduced significantlyto 3.6 ± 1.0 (p = 0.039). The STING technique is a novelmethod for placing a glaucoma drainage device into the ciliary sulcus, leading to IOP lowering with minimal complications. The STING technique is designed to improve surgical ease and increase anatomical precision of sulcus tube placement. Video available for this article.

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.

Early Outcomes of Combined Phacoemulsification and Ab Interno Tanito Microhook Trabeculotomy in Open-Angle Glaucoma

To study the early postoperative efficacy and safety of an Ab Interno microhook trabeculotomy (microLOT) combined with cataract surgery in patients with open-angle glaucoma. This prospective, randomized, interventional study was conducted on consecutive patients with visually significant cataract and mild-moderate open-angle glaucoma. One hundred fourteen patients were included for analysis. The patients were randomized to undergo microhook trabeculotomy with phacoemulsification (group 1) or phacoemulsification alone (group 2). All patients were evaluated on postoperative day 1, 15, and 30, as well as 3, 6, and 12 months postoperatively. A P value < 0.05 was considered statistically significant. Baseline and follow-up visits were compared to determine significant differences in the number of antiglaucoma medications (AGMs), intraocular pressure (IOP), and best-corrected visual acuity. There were 57 patients in each group. The baseline characteristics were similar between the 2 groups, except the number of AGMs, which was greater in group 2. The mean preoperative IOP for group 1 (phaco-microLOT) was 26.5 mmHg ± 5.2 and group 2 (phaco-alone group) was 25.3 mmHg ± 3.1 which decreased to 12.5 mmHg ±3.6 (P < 0.001) and 20.0 mmHg ± 2.7(P < 0.001) at 12 months, respectively. Logarithm of the minimum angle of resolution visual acuity improved from 0.48 (interquartile range [IQR], 0.30-0.60) preoperatively to 0.00 (0.00-0.18) postoperatively (P < 0001) in group 1 and improved from 0.30 (IQR, 0.30-0.48) to 0.00 (0.00-0.00) in group 2 (P < 0.001). In group 1, the mean (standard deviation [SD]) AGM used preoperatively was 0.6 (0.9) which was significantly reduced to 0.2 (0.5) at 12 months postoperatively, whereas in group 2, at 12 months, the mean (SD) AGM used was reduced from 1.4 (0.6) to 1.1 (0.9). In group 1, 90.3% of eyes achieved complete success at the end of 1 year. The most common complication was hyphema, noted in 4 patients with 1 eye requiring an anterior chamber washout. Ab interno microhook trabeculotomy (microLOT) combined with phacoemulsification in patients with open-angle glaucoma is an efficacious procedure with relatively minimal complications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Efficacy and safety of ab-externo radiofrequency sclerostomy in management of open-angle glaucoma

Purpose. To evaluate the efficacy and safety profile of an innovative ab-externo technique in the management of uncontrolled open angle glaucoma (OAG) through creating filtering tracts subconjunctivally.Material and methods. This is a randomized clinical trial including 40 eyes (40 patients) divided into 2 equal groups, group (A), underwent ab-externo radiofrequency sclerostomy and group (B), underwent ab-externo radiofrequency sclerostomy with subconjunctival injection of mitomycin C. Intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP) and bleb status were evaluated for 6 months.Results. The mean preoperative IOP was 28 ± 3.5 mm Hg reduced to 21.9 ± 5.2 mm Hg (p = 0.001) in group (A) and was 29.4 ± 3.4 mm Hg reduced to 20.8 ± 6.3 mm Hg (p = 0.001) in group (B), 6 months postoperatively. Both groups showed a significant percent reduction of IOP 15.1 ± 17.3%, 27.1 ± 22.4% in groups (A) and (B) respectively with group (B) showing lower values on days 1, 7, 14, 30, 90 and 180 but was not statistically significant. The number of anti-glaucoma medications was significantly reduced in both groups. Heat radiation to the cornea from radiofrequency waves was obvious in early cases — 5 (25%) in group (A), and 3 (15%) in group (B) that was reversible within the first 3 months postoperatively. Shallow anterior chamber and choroidal detachment were the most encountered early postoperative complication, which all managed conservatively.Conclusion. Ab-externo radiofrequency sclerostomy offers a promising minimally invasive, quick and simple procedure in management of early and moderate cases of OAG with effective reduction of IOP and number of glaucoma medication.

INTRAOCULAR PRESSURE REDUCTION FOLLOWING COMBINED PHACOEMULSIFICATION AND TRABECULECTOMY SURGERY: A STUDY OF 300 CASES

Objectives: The aim of the study was to evaluate intraocular pressure (IOP) reduction following combined phacoemulsification and trabeculectomy surgery in primary glaucomapatients with cataract. Methods: A prospective, comparative study of 300 patients with primary glaucoma and cataract who underwent combined surgery phacoemulsification and trabeculectomy at our center between July 2016 and June 2019 were included in this study. Out of these, 124 patients had primary open-angle glaucoma (POAG) and 176 patients had primary angle closure glaucoma (PACG). Phacoemulsification, intraocular lens implantation, and trabeculectomy were performed in all cases. Follow-up visits were carried out at 1, 3, and 6 months after surgery. Complete ophthalmic examination was done at each follow-up visit. Results: The pre-operative mean IOP of all patients was 34.60±6.33 mmHg and mean IOP at last 6 month follow-up was 13.0±2.18 mmHg. There was a statistically significant difference between IOP at presentation and IOP at 6-month follow-up (p&lt;0.001). No significant difference in post-operative IOP in POAG and PACG patients (p&gt;0.001). Out of 300, 58 patients required anti-glaucoma medication at 1 month and this number decreased to 41 patients at 6 month follow-up. No significant intraoperative complications were noted. Conclusion: Combined phacoemulsification and trabeculectomy surgery is safe and effective in controlling IOP with minimal complications in the management of primary glaucoma patients with cataract in expert hands.