Mean Intraocular Pressure Reduction Research Articles

Outcomes of Phacoemulsification With or Without Kahook Dual Blade Goniotomy for Glaucoma Patients with Cataract.

This meta-analysis examines the comparative efficacy of phacoemulsification with and without Kahook Dual Blade Goniotomy in individuals with glaucoma and cataract, aiming to elucidate optimal surgical approaches for coexisting conditions. The purpose of this current study is to compare the effect of combining Kahook Dual Blade (KDB) goniotomy with phacoemulsification versus phacoemulsification alone on intraocular pressure (IOP) and medication reduction in patients with glaucoma and cataract. We conducted a systematic review and meta-analysis utilizing computer databases, including Embase (OVID), MEDLINE (OVID and PubMed), CINHAL (EBSCO), and the Cochrane Library (Wiley). We included studies examining the IOP-lowering effect of KDB goniotomy combined with phacoemulsification and studies that examined the IOP-lowering effect of phacoemulsification alone in patients with open angle glaucoma or ocular hypertension. The mean reduction of IOP and the reduction in topical glaucoma eye drops after surgery were determined. A total of 26 studies were included reporting on 1659 patients, 684 patients underwent phacoemulsification alone and 975 underwent combined phacoemulsification and KDB goniotomy. A 9.62% IOP reduction from baseline occurred following phacoemulsification as a solo procedure compared to 22.74% following combined KDB goniotomy with phacoemulsification. Similarly, the combination of the procedures caused a significant drop in the mean number of glaucoma eye drops used (mean reduction=1.35, 95% CI [1.08, 1.61]) compared to phacoemulsification alone (mean reduction=0.36, 95% CI [0.06, 0.66]). Funnel plots suggested the absence of publication bias. Both phacoemulsification alone or combined with KDB goniotomy result in a significant decrease in post-op IOP and topical glaucoma eye drops. The combination of these two procedures outperforms phacoemulsification alone in terms of both parameters.

One Year Outcomes of Preserflo Microshunt for Primary Open Angle Glaucoma: A Systematic Review and Meta-analysis.

This systematic review and meta-analysis concludes that the PreserFlo Microshunt glaucoma drainage device significantly reduces intraocular pressure in primary open-angle glaucoma patients at 12 months post insertion. A systematic review and meta-analysis on the effect of the PRESERFLO™ MicroShunt (PF-MS) on intraocular pressure (IOP) at 12 months has been conducted. The Pubmed/MEDLINE, Embase, CENTRAL, Google Scholar, Scopus and Web of Science databases were searched. Inclusion criteria required a diagnosis of open-angle glaucoma, PF-MS insertion, and examination of IOP over time. Meta-analyses were conducted on the primary outcome of IOP and the secondary outcome of glaucoma medication regime. Adverse events were also noted. Fourteen studies were identified for inclusion in the meta-analyses, of which none had a high risk of bias. The meta-analyses found a significant mean reduction in IOP of 9.07mmHg (95% CI 7.88 - 10.25; P<0.0001) and a significant mean reduction in mean glaucoma medication requirement of 2.37 medications (95% CI 2.15 - 2.60); P<0.0001). Hypotony and hyphaema are common early complications. The PF-MS device significantly reduced both IOP and glaucoma medication requirement at 12 months post insertion in individuals with open-angle glaucoma without a significant adverse event burden. Further research is required to determine the economic and environmental effects of widely implementing the PF-MS device into clinical practice.

Micropulse Transscleral Cyclophotocoagulation in Non-Incisional Eyes with Ocular Hypertension and Primary Open-Angle Glaucoma.

To investigate the safety and effectiveness of micropulse transscleral cyclophotocoagulation (MPTSCPC) in non-incisional eyes with ocular hypertension (OHT) and early, moderate, and severe primary open-angle glaucoma (POAG). Retrospective cohort study of eyes that underwent MPTSCPC from 2016 to 2019 at an outpatient clinic in Canada. Eyes were excluded if any incisional procedures, except cataract surgery, were performed prior to MPTSCPC treatment. Laser power ranged from 900 to 2500mW. A total of 153 eyes from 93 patients were included (OHT n=22; early POAG n=46; moderate POAG n=35; severe POAG n=50). The baseline IOP was 18.37 ± 4.76mmHg in the total cohort. All cohorts experienced a significant mean IOP reduction by final follow-up (total p<0.001; OHT p=0.003; early POAG p<0.001; moderate POAG p=0.022; severe POAG p=0.015). Overall, 52.9% of eyes achieved an IOP reduction of ≥20% from baseline to final follow-up (OHT 59.1%; early POAG 58.7%; moderate POAG 45.7%; severe POAG 50.0%). There was worsening in best-corrected visual acuity in the total cohort (mean difference=0.11 ± 0.36 logMAR, p=0.11), mostly attributable to cataract progression (34.1% of phakic eyes) and ocular surface disease (7.2%). The number of topical medications and drug classes remained unchanged in the total cohort (p=0.425 and p=0.791, respectively). Twenty-two eyes (14.4%) required retreatment, which provided an additional IOP reduction of 1.26mmHg (p=0.344). By final follow-up, 8 eyes (5.2%) required escalation to incisional procedures. MPTSCPC is a safe and effective adjunct IOP-lowering treatment in non-incisional eyes with OHT and POAG.

Outcomes of iStent inject combined with cataract surgery in Asian eyes: Australian data from the Fight Glaucoma Blindness international registry.

To analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification. This is a multi-centre, observational study of glaucomatous Asian eyes that have undergone iStent inject implantation combined with cataract surgery. Patient data were extracted from the Fight Glaucoma Blindness! Registry. Outcome measures included those of IOP reduction, glaucoma medication reduction, and adverse events including the need for secondary surgery. 123 eyes of 86 patients with a mean age of 68.4 ± 9.3years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12months 30.8% of eyes demonstrated a reduction in IOP greater than 20%, the mean IOP reduction was 12.5% with an additional reduction of 0.7 glaucoma medications. 40% of eyes were using no medications at 12months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window. iStent inject implantation combined with phacoemulsification in Asian eyes showed a reduction of IOP and glaucoma medication use in a real-world clinical setting. The safety profile of the device is good with minimal adverse outcomes, however, a subset of patients required secondary procedures within the 12 month follow up.

A Randomized, Controlled Comparison of NCX 470, a Nitric Oxide-Donating Bimatoprost, and Latanoprost in Subjects with Open-Angle Glaucoma or Ocular Hypertension: The MONT BLANC Study

PurposeTo compare intraocular pressure (IOP)-lowering efficacy and safety profile of NCX 470, a nitric oxide (NO)-donating bimatoprost, to latanoprost in subjects with glaucoma or ocular hypertension. DesignProspective, phase 3, randomized, adaptive dose-selection, double-masked, parallel-group trial. Methods: Participants691 subjects with open-angle glaucoma or ocular hypertension and unmedicated IOP of IOP ≥26 mmHg at 8AM, ≥24 mmHg at 10AM, and ≥22 mmHg at 4PM in the study eye. Study Procedures: Subjects were randomized to treatment with NCX 470 0.065%, NCX 470 0.1%, or latanoprost 0.005%. To identify the final NCX 470 dose, an interim analysis was performed after at least 30 subjects in each group had completed the Week 2 visit. Enrolled subjects were randomized to this final NCX 470 dose, 0.1%, or latanoprost for 12 weeks. Main outcome measure: We evaluated non-inferiority followed by superiority of NCX 470 versus latanoprost, based on IOP reduction from baseline at 8AM and 4PM at 2 weeks, 6 weeks, and 3 months. ResultsNCX 470 0.1% was the final dose and 661 subjects were analyzed that received NCX 470 0.1% (n=328) or latanoprost (n=333). At baseline, the mean (SD) IOP at 8AM and 4 PM was 28.3 (2.0) mmHg and 25.5 (2.5) mmHg, respectively, in the NCX 470 0.1% group, and was significantly reduced at all on-treatment time points, with reductions ranging from 8.0-9.7 mmHg (p<0.0001 at each time point). Likewise, mean (SD) baseline IOP at 8AM and 4PM was 28.2 (2.0) mmHg and 25.4 (2.4) mmHg, respectively, in the latanoprost group and was significantly reduced at all on-treatment time points, with reductions ranging from 7.1-9.4 mmHg (p<0.0001 at each time point). At the 3-month visit, mean IOP reductions were greater with NCX 470 0.1% than latanoprost 0.005% at all 6 time points and significantly greater (p<.05) at 4 of the 6 time points. Noninferiority versus latanoprost was established at all 6 timepoints. The most common adverse event was conjunctival/ocular hyperemia and was more common in the NCX 470 group compared to latanoprost; 8 NCX 470 and 6 latanoprost subjects discontinued due to adverse events. ConclusionThe NO-donating prostaglandin analogue NCX 470 0.1% was well-tolerated and lowered IOP more than latanoprost in subjects with open-angle glaucoma or ocular hypertension at all 6 time points. With a dual mechanism of action that enhances both uveoscleral and trabecular outflow, NCX 470 could become an important first-line therapy for IOP reduction in glaucoma.

Three Year Outcomes of the Paul Glaucoma Implant for Treatment of Glaucoma.

In our case series, the three-year failure for PGI implantation was 14.6%. At three years post-operatively, there was a significant reduction in mean intraocular pressure and number of glaucoma medications used. To determine 3-year efficacy and safety of the PAUL Glaucoma Implant (PGI), a novel glaucoma tube shunt in patients with glaucoma. Retrospective review of all patients who had undergone PGI implantation in a single tertiary institution in Singapore between May 1, 2017, and Jan 1, 2022. Data was extracted from electronic health records (Computerized Patient Support System 2 and Epic). Primary outcome measure was failure, defined as IOP ≥18mmHg or ≤6mmHg on 2 consecutive visits after 3 months, reoperation for IOP-related indication, explantation of implant or loss of light perception vision. Complete success was defined as the absence of failure without medications at 36 months, and qualified success similarly, but with medications. Post-operative mean IOP, mean number of IOP-lowering medications used and visual acuity were also assessed. Forty-eight eyes in 48 patients were identified. Thirty-one patients (64.6%) had primary open angle and angle closure glaucoma, and 18 (37.5%) had previous existing tube implants or trabeculectomy. At 3 years post-operatively, 7 cases (14.6%) fulfilled criteria for failure and 36 (75%) met criteria for complete success. Mean IOP at 36 months was 14.9±4.11mmHg, from mean pre-operative IOP of 20.6±6.13mmHg (P<0.001). Mean number of IOP-lowering medications used was reduced from 3.13±0.959 pre-operatively to 0.167±0.476 at 36 months (P<0.001). The most common post-operative complication was hypotony (n=17, 35.4%), of which majority were self-limiting, followed by hyphema (n=5, 10.4%) and tube exposure (n=4, 8.3%). The PGI demonstrated sustained IOP reduction and a reduction of medication burden at 3 years post-operatively.

Outcomes of gonioscopy-assisted transluminal trabeculotomy in primary congenital glaucoma treatment: a retrospective study

BackgroundThis retrospective study aimed to evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in Chinese patients with primary congenital glaucoma (PCG) and identify factors influencing surgical success.MethodsFourteen patients (24 eyes) diagnosed with PCG who underwent gonioscopy-assisted transluminal trabeculotomy were recruited, and data on intraocular pressure (IOP), antiglaucoma medication, surgery-related complications, and additional treatments were collected during preoperative and postoperative visits. Surgical success was defined as IOP ≤ 21 mmHg and a reduction of > 30% from baseline, with (partial success) or without (complete success) antiglaucoma medication.ResultsMean preoperative IOP was 30.41 ± 6.09 mmHg. At the final visit, mean IOP reduction was 16.1 ± 9.1 mmHg (52%), and 19 of 24 eyes were topical medication–free. IOP was significantly decreased at each postoperative visit compared with baseline (P < 0.05 for all time points). Cumulative proportions of complete and partial success were 79.2% and 95.8%, respectively, at three years postsurgery. Patients without prior antiglaucoma procedures, without postoperative IOP spikes, and those undergoing complete trabeculotomy exhibited improved surgical prognosis. No permanent vision-threatening complications occurred in the 24 eyes by the end of the respective follow-ups.ConclusionGonioscopy-assisted transluminal trabeculotomy emerged as a safe and effective procedure for PCG treatment, characterized by outstanding IOP reduction efficacy and high surgical success rates.

Rates of visual field change and functional progression in glaucoma following trabecular microbypass implantation of iStent technologies: a meta-analysis

Background/aimWhile intraocular pressure (IOP) remains the only modifiable risk factor for glaucoma progression, the ultimate goal of glaucoma management is to preserve patients’ functional vision and quality of life. To...

A meta‐analysis of surgical treatments for childhood glaucoma

Aims/Purpose: To assess the comparative efficacies of surgical interventions for childhood glaucoma (CG).Methods: Through electronic database searches up to August 7, 2022, randomized controlled trials (RCTs) involving surgical interventions for CG were identified. A meta‐analysis was conducted to compare the surgical interventions: Conventional partial trabeculotomy ([CPT] control), 240‐degree trabeculotomy, Illuminated microcatheter‐assisted circumferential trabeculotomy (IMCT), Viscocanalostomy, Visco‐circumferential‐suture‐trabeculotomy, Goniotomy, Laser goniotomy, Kahook dual blade ab‐interno trabeculectomy, Trabeculectomy with mitomycin C, Trabeculectomy with modified scleral bed, Deep sclerectomy, Combined trabeculectomy‐trabeculotomy with mitomycin C, and Baerveldt implant. The main outcome measures were postoperative 6‐month mean intraocular pressure (IOP) reduction and surgical success rate. The mean differences (MDs) or odds ratios (ORs) were obtained using a random‐effects model, and the efficacies were ranked by P‐score.Results: Sixteen (16) RCTs were eligible for inclusion in the analysis, involving 710 eyes of 485 participants and 13 surgical interventions, which formed a 14‐node network. IMCT was superior to CPT in both IOP reduction (MD [95% CI], −3.10 [−5.50 to −0.69]) and surgical success rate (OR [95% CI], 4.38 [1.61 to 11.96]), while the MD and OR comparing the other surgical interventions with CPT were not statistically significant. Moreover, the IMCT was ranked as the most efficacious surgical intervention for success rate (P‐score = 0.777).Conclusions: This meta‐analysis revealed that IMCT is more effective than CPT and might be the most efficacious surgical intervention for CG.

An Investigation Comparing the Efficiency of Timolol 0.5% with Brimonidine 0.2% in Managing the Increase in Intraocular Pressure Subsequent to Nd-Yag Laser Capsulotomy

Objective: Conducting a comparison between the efficacy of Timolol 0.5% eye drops and Brimonidine 0.2% eye drops in managing the elevation of intraocular pressure post Nd-YAG laser capsulotomy. Study Design: Employed a randomized controlled trial. Methodology: The research involved 80 patients (one eye per patient) aged between 45 and 70, diagnosed with posterior capsular opacification scheduled for Nd-YAG laser capsulotomy at the Department of Ophthalmology, Mathuradas Mathur Hospital (Dr. S. N. M. C.) in Jodhpur. The patients were divided into two groups, X and Y, each consisting of 40 individuals. Baseline intraocular pressure was measured using an applanation tonometer before administering eye drops. Group X received a single drop of Timolol 0.5%, while group Y received a single drop of Brimonidine 0.2% one hour prior to capsulotomy. Intraocular pressure was recorded at 1 hour and 4 hours post the laser procedure. Results: Both groups comprised 40 patients each. The baseline IOP was 16±2.16 for group X and 15±2.56 for group Y. There was no statistically significant variance between the two groups in mean IOP changes at 1 hour following Nd-YAG laser capsulotomy. However, after 4 hours, the mean reduction in IOP was -1.54 mmHg for group X and -1.85 mmHg for group Y (p&lt;0.5). Conclusion: Our study indicates that both Timolol 0.5% eye drops and Brimonidine 0.2% eye drops are similarly effective in controlling elevated intraocular pressure after Nd-YAG laser capsulotomy

Phacogoniotomy versus phacotrabeculectomy for advanced primary angle-closure glaucoma with cataract: A randomized non-inferiority trial

PurposeTo investigate the effectiveness and safety of phacogoniotomy versus phacotrabeculectomy (PVP) among patients with advanced primary angle-closure glaucoma (PACG) and cataracts. DesignMulticenter, randomized controlled, non-inferiority trial. MethodsA total of 124 patients (124 eyes) with advanced PACG and cataracts were enrolled, with 65 in the phacogoniotomy group and 59 in the phacotrabeculectomy group. Patients were followed up for 12 months with standardized evaluations. The primary outcome was the reduction in intraocular pressure (IOP) from baseline to 12 months postoperatively, of which a non-inferiority margin of 4 mmHg was evaluated. Secondary outcomes included the cumulative surgical success rate, postoperative complications, and changes in the number of glaucoma medications. ResultsAfter 12 months, phacogoniotomy demonstrated non-inferiority to phacotrabeculectomy in terms of IOP reduction, with mean IOP reductions of − 26.1 mmHg and − 25.7 mmHg (P = 0.383), respectively, from baseline values of around 40 mmHg. Both groups experienced a significant reduction in the mean number of medications used postoperatively (P < 0.001). The cumulative success rate was comparable between the groups (P = 0.890). However, phacogoniotomy had a lower rate of postoperative complications and interventions (12.3% and 4.6%) compared to phacotrabeculectomy (23.7% and 20.3% respectively). The phacogoniotomy group reported shorter surgery time (22.1 ± 6.5 vs. 38.8 ± 11.1 min; P = 0.030) and higher quality of life (EQ-5D-5 L) improvement at 12 months (7.0 ± 11.5 vs. 3.0 ± 12.9, P = 0.010) than the phacotrabeculectomy group. ConclusionsPhacogoniotomy was non-inferior to phacotrabeculectomy in terms of IOP reduction for advanced PACG and cataracts. Additionally, phacogoniotomy provided a shorter surgical time, lower postoperative complication rate, fewer postoperative interventions, and better postoperative quality of life.

Long-Term Results of Transscleral Diode Laser Cyclophotocoagulation in Glaucoma: A Real-Life Study.

Transscleral diode laser cyclophotocoagulation is effective and safe in a large population and different types of glaucoma, but is least effective in NVG group. We aimed to investigate the clinical outcomes of transscleral diode laser cyclophotocoagulation (TDLC) in a large cohort of patients with different types of refractory glaucoma. Using patient charts, we retrospectively analyzed the success and complications of TDLC performed on eyes categorized in 6 groups: primary glaucoma (116 eyes), trauma (41 eyes), neovascular glaucoma (NVG, 84 eyes), post-vitreoretinal surgery (post-VRS, 79 eyes), penetrating keratoplasty (PK, 47 eyes), and miscellaneous (40 eyes). Failure was defined as intraocular pressure (IOP) >22mmHg or <5mmHg, the need for further glaucoma surgery, and the loss of light perception during follow-up. Overall, the mean follow-up time was 33.4±17.4 months, the mean total energy delivered was 109.2±56.5 J, and the mean IOP reduction rate was 41.8%. Total energy delivered and IOP reduction rates were similar between the groups (all P >0.05). The probability of success at 36 months was 71.5%, 70.7%, 55.9%, 77.2%, 72.3%, and 72.5% in the primary glaucoma, trauma, NVG, post-VRS, PK, and miscellaneous groups, respectively. The NVG group showed a significantly lower success rate (P=0.009) than the other groups. Significant complications consisted of phthisis bulbi in 1 eye (0.2%) in the NVG group and chronic hypotony in 7 eyes (1.7%) in the NVG (3 eyes), trauma (2 eyes), post-VRS (1 eye), and primary glaucoma (1 eye) groups. Although TDLC was found to be a safe, effective method in the long term, it was least effective in eyes with NVG.

Two-Year Performance and Safety Results of the MINIject Supraciliary Implant in Patients With Primary Open-Angle Glaucoma: Meta-Analysis of the STAR-I, II, III Trials

To evaluate the performance and safety of minimally invasive glaucoma surgery with a supraciliary drainage device (MINIject; iSTAR Medical, Wavre, Belgium) in primary open-angle glaucoma (POAG) as a stand-alone procedure. Meta-analysis. At 11 sites in Colombia, France, Germany, India, Panama, and Spain, 82 patients were treated in 3 prospective, multicenter, interventional, nonrandomized trials (STAR-I, II, III). Data were pooled in a meta-analysis of up to 2 years of follow-up postimplantation. The main outcome measures were mean relative and absolute reduction in diurnal intraocular pressure (IOP) compared to baseline. Secondary outcomes included patients with IOP ≤18 mmHg, patients with IOP reduction ≥20%, number of IOP-lowering medications, adverse events, and endothelial cell density loss. At the 2-year follow-up (n = 66), mean IOP was reduced from 23.8 ± 3.3 mmHg at baseline to 14.4 ± 4.5 mmHg (-39.3%; P < 0.0001). An IOP reduction of ≥20% was achieved in 89.4% of patients, with 84.8% having an IOP ≤18 mmHg. IOP-lowering medications were reduced from a mean of 2.4 ± 1.1 to 1.4 ± 1.4 (P < 0.0001), with 37.9% of patients being medication-free at 2 years. Mean endothelial cell density loss at 2 years was 6.2 ± 9.1% compared to baseline and no patient had a loss >30%. This meta-analysis demonstrates the favorable safety and efficacy profile of a supraciliary device implanted in a stand-alone, ab-interno procedure in patients with mild-to-moderate POAG. The data demonstrate that MINIject is a safe and effective, bleb-free treatment option for patients requiring low target IOP up to 2 years.

Short- to intermediate-term surgical outcome of Keiki Mehta valve implantation in refractory glaucoma.

Keiki Mehta body pressure (BP) valve is a glaucoma drainage device that works on the simple mechanism of body pressure. To evaluate the short- to intermediate-term efficacy and safety of Keiki Mehta valve implantation in treating refractory glaucoma. This was a prospective, interventional, institution-based study. Adult patients (age >18 years) having refractory glaucoma who underwent Keiki Mehta valve implantation from May 2019 to December 2019 in a tertiary hospital in eastern India were followed up to 18 months. Twenty patients (20 eyes) with refractory glaucoma who underwent Keiki Mehta valve implantation were followed up on postoperative day 1 and at 1, 3, 6, 12, and 18 months postoperatively. Visual acuity, intraocular pressure (IOP), antiglaucoma medications, and success rate were measured at every visit. There was significant reduction in mean IOP from the preoperative values at every postoperative follow-up ( P < 0.05). Kaplan-Meier survival analysis demonstrated a probability of 50% complete success and 20% qualified success at 18 months. Hypotony was the most common postoperative complication. Keiki Mehta valve implantation is an effective and safe treatment for refractory glaucoma.

Three-Year Efficacy and Safety Outcomes of the Second-Generation Trabecular Micro-Bypass Stents in Conjunction with Cataract Surgery in Ocular Hypertension and Open-Angle Glaucoma

Purpose: To evaluate the efficacy and safety of the iStent Inject in conjunction with phacoemulsification in patients with open-angle glaucoma. Design: Prospective, non-randomized, single-center, consecutive case series Participants: Patients with primary and secondary open angle glaucoma undergoing cataract surgery and iStent Inject Main outcomes: The primary outcome of efficacy is postoperative reduction in mean Intraocular Pressure (IOP) and number of anti-glaucomatous drop classes. A primary endpoint is the achievement of =20% IOP reduction from baseline. Secondary outcome measures include visual acuity, visual field parameters, cup-to-disk ratio, and average retinal nerve fiber layer thickness. Results: 150 eyes were included with a mean follow-up of 2.28 years (standard deviation 1.18). IOP significantly decreased at nearly all timepoints and remains significantly reduced from baseline at 36 months. IOP reduction is modest and ranges between 5.6 to 11.7 %, with IOP being stably maintained lower than baseline throughout the observation period. IOP reduction is greatest in the mild glaucoma group. The primary endpoint of an over 20% IOP reduction being achieved in overall 32% of eyes. The burden of glaucoma drops was significantly reduced by 13% at 12 months post-op (p&lt;0.005). There was no statistically significant change in visual field parameters, although they improved after cataract surgery. The rate of additional glaucoma interventions needed were very low at &lt;1%. Conclusion: The combined cataract surgery and iStent Inject procedure is safe and effective at long-term with a low rate of serious complications. It offers good visual outcomes and reasonable glaucoma control long-term.

Internal Revision with Bleb Needling: An Effective, Safe Option for Failing Blebs

Aim: To report the outcomes of internal revision with bleb needling in cases of failing blebs with the internal sclerostomy blocked by iris tissue.&#x0D; Methods: Prospective study of 26 eyes of 26 patients with failing blebs where target IOP was not achieved with 2 anti-glaucoma drugs and sclerostomy was blocked by iris (confirmed on gonioscopy). Patients were divided into 3 groups depending on the time from the first surgery- early (&lt;3 months), intermediate (4-12 months) and late (&gt;1 year). Patients underwent internal revision with bleb needling with either 5-Fluorouracil (5-FU) or Mitomycin C (MMC)&#x0D; Results: 26 eyes of 26 patients were included in the study. Mean age was 51.35±14.5 years. Time from the filtration surgery was early in 3, intermediate in 5 and late in 18 eyes. Mean IOP reduction at 3 months was 32±18% with maximum reduction in early group (40%). Mean IOP decreased from 24.5±3.4 mmHg to 16.2±4.3 mmHg in 5-FU group (12 patients) and 27.4±9 mmHg to 18.2±6.6 mmHg in MMC group (14 patients). Self-limiting complications were hyphema in 2 patients and subconjunctival haemorrhage in 1 patient.&#x0D; Conclusion: Internal revision with bleb needling is a safe and effective procedure for reviving failing blebs.

Combined versus standalone XEN45 Gel Stent implantation in either phakic or pseudophakic patients: a case-matched study

PurposeTo determine differing outcomes among either phakic or pseudophakic patients who received standalone XEN45 Gel Stent (Allergan, an AbbVie Company, CA, USA) implantation and patients who underwent combined surgery with phacoemulsification.MethodsThis retrospective single-center study involved 180 eyes of 180 participants who underwent XEN45 Gel Stent implantation, of which 60 eyes received combined surgery with phacoemulsification (combined group). Standalone stent implantation was performed on 60 phakic (phakic group) and on 60 pseudophakic eyes (pseudophakic group). The groups were matched in a ratio of 1:1:1 based on multiple criteria. Successful surgery was defined by three scores: IOP at the longest follow-up of < 21 mmHg (Score A) or < 18 mmHg (Score B) and an IOP reduction > 20% or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). In all scores, one open conjunctival revision was allowed, and additional repeat surgery was considered a failure.ResultsAfter an average follow-up time interval of 20.6 ± 12.6 months, there was a mean IOP-reduction by 37% among the entire cohort. Comparative analysis between the three groups did not show significant differences regarding postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate or success rate. A dysfunctional stent was detected in eight eyes (4%) during open conjunctival revision in 76 eyes.ConclusionThe clinical endpoints investigated did not differ significantly among either phakic or pseudophakic patients who received standalone stent implantation and patients who underwent combined surgery. However mean latency between primary stent implantation and first revision surgery after combined surgery was markedly shorter.

Retrospective Analysis of the Efficacy and Safety of Omidenepag Isopropyl 0.002% Ophthalmic Solution in Korean Patients

Purpose: This study aimed to analyze the clinical efficacy and safety of omidenepag isopropyl (OMDI) 0.002% in Korean patients.Methods: A retrospective study was conducted involving 306 patients diagnosed with glaucoma or ocular hypertension, who were administered OMDI 0.002% from May 2021 to June 2022. The primary outcomes were the change in intraocular pressure (IOP) at months 1, 3, and 6 compared to the baseline IOP, and the reactions to the OMDI drug.Results: Out of 235 patients who met the study inclusion criteria, the mean IOP was 16.5 ± 3.4 mmHg at baseline, 14.5 ± 3.0 mmHg at month 1, 14.3 ± 2.7 mmHg at month 3, and 14.7 ± 3.1 mmHg at month 6. The mean IOP reduction at month 6 was -1.6 ± 2.8 mmHg (p &lt; 0.001). On analyzing the IOP by types of glaucoma, the mean IOP change at the 6-month point showed statistically significant results in all types, including normal tension glaucoma, primary open-angle glaucoma, and ocular hypertension (p &lt; 0.05). The frequency of side effects in all patients was 29.8%, with the most commonly reported adverse drug reaction being hyperemia in 18.7% of the total patients. There was one case (0.4%) of uveitis after OMDI administration, but no other systemic adverse drug reactions were reported.Conclusions: Omidenepag isopropyl demonstrated a statistically significant IOP-lowering effect in Korean patients with various types of glaucoma. This suggests that OMDI could potentially serve as a first-line treatment for glaucoma.

A comparison between 2% dorzolamide/0.5% timolol fixed combination: brand name drug to its generic counterpart regarding efficacy and side effects

Aim The aim of this study was to compare 2% dorzolamide/0.5% timolol fixed combination brand name drug (Cosopt) to its generic counterpart (Twinzol) regarding efficacy and side effects. Patients and methods The study included 92 eyes of 92 patients diagnosed with primary open-angle glaucoma and are indicated for antiglaucoma fixed combination of 20 mg/ml dorzolamide/5 mg/ml timolol). Patients were randomly divided into two groups: the first group received Cosopt, whereas the second received Twinzol. In visit, intraocular pressure (IOP) was measured and any local side effects by either eye drops was recorded. Monitoring and recording the percentage of IOP drop each month and all over the 3 months duration of follow up visits were done. Results The percentage of IOP drop for Cosopt and Twinzol after 1 month showed a significant P value of 0.032, with a mean percent reduction in IOP of 28.55%, median percent reduction of 26.92%, the minimum is 3.82% while the maximum is 62.96% for the Cosopt group, while that for Twinzol was 23.14, 21.29, 4.17, and 57.14%, respectively. On the other hand, the percentage of drop of IOP between the two groups after 3 months showed insignificant P value (0.646). IOP measurement was statistically insignificant between the two groups at 1 (0.462) and 3 months (0.639). As regards side effects; both eye drops were comparable with an insignificant P value of 0.49. Conclusion The study demonstrated a reliable efficacy and safety on using generic therapy Twinzol compared with band counterpart Cosopt.

6-Year Efficacy and Safety of iTrack Ab-Interno Canaloplasty as a Stand-Alone Procedure and Combined With Cataract Surgery in Primary Open Angle and Pseudoexfoliative Glaucoma.

Significant reductions in intraocular pressure (IOP) and the number of medications are sustained up to 6 years postoperatively for eyes that underwent ab-interno canaloplasty using the iTrack microcatheter, either as a stand-alone procedure or combined with cataract surgery. The purpose of this study was to evaluate the long-term effectiveness of iTrack (Nova Eye Medical Inc.) ab-interno canaloplasty for reducing IOP and the number of glaucoma medications in patients with primary open angle (POAG) and pseudoexfoliative glaucoma. A retrospective single-center consecutive case series. Patients were treated with either ab-interno canaloplasty performed as a stand-alone procedure or combined with cataract surgery and were followed for up to 6 years. iTrack was used to circumferentially catheterize and viscodilate the Schlemm canal over 360 degrees. Primary efficacy endpoints included IOP and number of glaucoma medications at 12, 24, 36, 48, 60, and 72 months after surgery. Twenty-seven eyes of 22 patients, with a mean age of 76.9±6.3 years, were recruited. Mean IOP was reduced significantly from 19.9±5.2mmHg (n=27) at baseline (no washout) to 14.6±3.3mmHg at the 6-year follow-up (n=18; P <0.001). The number of medications was significantly reduced from 1.9±1 at baseline to 0.9±0.9 at 6 years (n=18; P =0.005). At all time points, there was no statistical difference between POAG (n=16) and pseudoexfoliative (n=11) eyes, nor between stand-alone procedures (n=4) and those combined with phacoemulsification (n=23). At 72 months, the mean reduction in IOP was 27% while 53% in the number of medications. No serious complications were recorded. iTrack ab-interno canaloplasty performed as a stand-alone procedure or in combination with cataract surgery significantly reduced IOP and number of medications in patients with POAG up to 6 years after the procedure. To the authors' knowledge, this is the longest ab-interno canaloplasty follow-up available in the literature.