Nonpenetrating Glaucoma Surgery Research Articles

New suture probe canaloplasty combined with suprachoroidal collagen implantation.

To present the modified surgery technique of new suture probe canaloplasty with a specially prepared monofilament 4.0 polypropylene suture combined with suprachoroidal drainage (ScD) and collagen sheet implantation for non-penetrating glaucoma surgery. Prospective study with a twelve months follow-up. A standard 4/0 polypropylene suture (ProleneTM by Ethicon; thickness: approximately 250m) is cut and shaped with an ophthalmic knife (MANI® Crescent Knife, Mani Inc 8-3 Kiyohara Industrial Park, Utsunomiya, Tochigi 321-3231, Japan) to create a blunt end without sharp or compressed edges. This improves suture probe canaloplasty by providing a more stable and smoother probing device. Schlemm's canal is prepared using the standard technique of canaloplasty with suprachoroidal drainage. Then, instead of using the canaloplasty microcatheter or the previously published 6/0 double-helix suture, Schlemm's canal is probed with the blunt ending of the 4/0 Prolene suture. After successful 360-degree probing, a doubled 10/0 polypropylene tension suture is threaded through the tip of the 4/0 suture. The 4/0 suture is then pulled back and the 10/0 tension sutures are tied at both ends to tension Schlemm's canal. A special collagen sheet (Ologen®) is placed in suprachoroidal space, and the scleral flap is firmly sewed. 115 eyes were included in this prospective study. In 113 cases the Schlemm's canal could completely be probed with the suture probe and canaloplasty with ScD and collagen sheet implantation succeeded. In two cases the intervention was transformed to 360-degree suture trabeculotomy due to an intraoperative cheese-wiring. Twelve months after successful new suture probe canaloplasty with ScD and Collagen Implantation the IOP had decreased by 37.1% (from 21.6 ± 6.0mmHg with 3.3 different IOP lowering eye drops to 13.5 ± 3.5mmHg with 1.0 eye drops). 16 Patients did not achieve sufficient IOP levels and underwent 360-degree suture trabeculotomy during the follow-up. One patient had to be treated with further glaucoma surgery to achieve a sufficient IOP level. Complications were hyphema, postoperative IOP elevation and transient hypotony. No serious or sight-threatening complications occurred. New suture probe canaloplasty with ScD and collagen sheet implantation yields the opportunity to conduct a cost-effective canaloplasty easier and less complicated than with the previously described method with the twisted 6/0 suture. The safety profile and IOP lowering effect is comparable. In cases where complete probing fails, there is still the opportunity to switch to suture trabeculotomy over the majorly probed part of Schlemm's canal. The pressure lowering effect of the deep sclerectomy with ScD and suprachoroidal collagen sheet implant seems to have an additional impact on the sufficient pressure lowering procedure.

Long-Term Astigmatism after Intraocular Pressure Sensor Implantation and Nonpenetrating Glaucoma Surgery - EYEMATE-SC Trial.

To investigate the long-term astigmatism after combined non-penetrating glaucoma surgery (NPGS) and implantation of the first miniaturized suprachoroidal intraocular pressure (IOP) sensor EYEMATE-SC. The study was conducted in five medical centers in two different countries. Retrospective multicenter clinical study. Astigmatism of patients instrumented with the EYEMATE-SC IOP sensor was assessed over a follow-up period of three years. Refraction and corrected distance visual acuity (CDVA) were obtained preoperatively, after 6 months, 1, 2, and 3 years. A canaloplasty-operated patient cohort served as control. Astigmatism was evaluated using 3-dimensional power vector analysis involving the spherical equivalent M, and the Jackson crossed cylinder projections J0 and J45. Exclusion criteria included neovascular and angle-closure glaucoma, myopia, axial length outside 22 to 26 mm, other ocular diseases, prior glaucoma surgery, other ocular surgery within 6 months (cataract surgery within 3 months) prior to NPGS, serious generalized conditions, and other active medical head/neck implants. Multivariate analysis indicated no changes in astigmatism along the observation period in both the EYEMATE-SC (n = 24) and the canaloplasty (n = 24) group (P > 0.05 or nonsignificant after Bonferroni correction). Astigmatism was unchanged between the EYEMATE-SC and the canaloplasty group at all time points (P > 0.05). CDVA didn't change along the observation period of three years in each of both groups (P > 0.05). Despite its suprachoroidal localization, the present study indicates that the miniaturized EYEMATE-SC IOP sensor doesn't negatively affect the long-term astigmatism after combined implantation with NPGS.

Подходы к комбинированной хирургии катаракты и глаукомы в условиях слабости связочного аппарата хрусталика

Purpose. To demonstrate the effectiveness of single-step phacoemulsification of cataracts and antiglaucoma surgery in conditions of weakness of the zonular apparatus. Methods. Patient N., 67 years old, came to S. Fyodorov Eye Microsurgery Federal State Institution (Moscow) with complaints of decreased vision, increased intraocular pressure (IOP), and narrowing of the fields of view of the right eye. The diagnoses: OD Primary open-angle glaucoma 3v, Subluxation of the lens grade 1 OS Primary open-angle glaucoma 1a, OU Complicated cataract, Pseudoexfoliation syndrome. Carried out: autorefractokeratometry, visual acuity testing, computerized perimetry, biomicroscopy, gonioscopy, pneumotonometry, tonometry according to Maklakov, optical biometry. Considering the weakness of the lens zonules, the method of fixation of the intraocular lens (IOL) by optic capture technique was used. Results. Examination and evaluation one week post-operation: Visus 0.6 unc, IOP (pneumotonometry) 11 mmHg without hypotensive therapy; biomicroscopy: a calm eye with a well-expressed filtration bleb at the 12 o’clock position, well-adapted sutures, a transparent cornea of average depth, clear aqueous humor, moderate iris atrophy, round 3 mm pupil with pseudophakia at the pupil’s edge, IOL located in the capsular bag with haptics in the iridociliary groove, stable positioning. Fundus examination shows a pale optic nerve head, excavated with 0.8 cup-to-disc ratio, well-defined borders, narrowed vessels. Macular region appears normal. Conclusion. Combined cataract and glaucoma surgery in a patient with subluxated crystalline lens using the «optic capture» technique and Non-penetrating Glaucoma Surgery allowed preserving the correct and stable position of the IOL with normalization of intraocular pressure without the need for hypotensive therapy during a 1-year follow-up period. Key words: one-stage surgery, primary angle-closure glaucoma complicated by cataract, «optic capture»

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.

A clinical case of choroidal detachment as choroidal effusion in a child with Sturge-Weber-Crabbe syndrome

Choroidal effusion syndrome is a rare idiopathic condition that occurs predominantly in middle-aged man with hyperopia and is characterized by ciliochoroidal detachment (CD), followed by exudative retinal detachment. To present a clinical case of postoperative choroidal detachment in a child with SturgeWeberCrabbe syndrome after microinvasive non-penetrating glaucoma surgery.&#x0D; RESULTS: This article presents the clinical case of postoperative choroidal detachment in a child with SturgeWeberCrabbe syndrome after microinvasive non-penetrating glaucoma surgery. Against the background of the existing anomalies in the development of an optic disc after antiglaucomatous intervention for decompensated glaucoma, after the normalization of IOP, the patient developed choroid detachment with exudative retinal detachment the next day of operation. After conservative therapy involving bed rest and double instillation of mydriatics for 1 month, the situation was completely resolved and his vision was restored to 1.0.&#x0D; DISCUSSION: The atypicality of our clinical case of CD lies in the overly pronounced exudative component. In addition to the classic CD vesicles, we observed high exudative retinal detachment as well as high retinoschisis, which is extremely atypical for classical CD. Considering the characteristics of congenital syndrome, it is necessary to accurately differentiate atypical CCA from the rare choroidal effusion syndrome, which also includes CCA with retinal detachment, but does not present with retinoschisis. Against the background of conservative therapy with bed rest and two instillations of mydriatics for 1 month, the situation was completely resolved, and the patients vision was restored to 1.0. In the treatment of such patients, it is always necessary to consider their individual anatomical features as well as to understand the detailed pathogenesis of the complications that arise before rushing to repeat surgery.

EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure

Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS). Prospective, multicenter, open-label, single-arm, interventional clinical trial. Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy). An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors' IOP measurements at all postoperative visits through 12 months. Device position and adverse events. Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], -5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was -0.2 mmHg (95% CI of LoA, -4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT. The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring. Proprietary or commercial disclosure may be found after the references.

Trabeculectomy: Does It Have a Future?

The trabeculectomy (TRAB) procedure has undergone various modifications to increase the long-term surgical success and safety profiles. The main issues with TRAB include short and long-term complications, that are more common with the concomitant use of anti-fibrotic agents. While many surgeons have predicted the demise of trabeculectomy amidst newer non-penetrating glaucoma surgeries, it is still the gold standard procedure for patients with an advanced or rapidly progressing disease and for those patients who need very low intraocular pressures. This review article is unique in summarizing the evolution of trabeculectomy and its efficacy compared to neoteric shunt procedures while trying to predict if trabeculectomy has a future in the modern surgical world. We have compared the outcomes and complications of trabeculectomy to all the surgical procedures available to date and have tried to evolve an algorithm to help surgeons to decide on their preferred technique.

Интраоперационная оптическая когерентная томография в оптимизации непроникающей хирургии глаукомы при имплантации различных видов дренажей

Purpose. To evaluate the role of intraoperative optical coherence tomography in non-penetrating glaucoma surgery with implantation of various types of drainages. Methods. Non-penetrating deep sclerectomy using seton type drainages (Xenoplast – 67, Hydrogel – 24, Igen – 32, Glautex – 20) was performed in 143 patients with 2–3 stages of glaucoma. The surgery was performed under the control of a Hi-R NEO 900A N / R operating microscope (Haag-Streit Surgical, Germany) with an integrated 3rd generation iOCT optical coherence tomograph. Results. During carrying out microinvasive nonpenetrating deep sclerectomy, intraoperative optical coherence tomography allows monitoring the quality of performed surgical operation in real time at all stages: assessing the thickness of the trabecula, the degree of filtration, the quality of trabeculo-descemet window peeling, the correct positioning of the drainage and the formed filtering bleb. Conclusion. The use of iOCT is a promising and necessary method for introducing into everyday technology of non-penetrating glaucoma surgery. Key words: non-penetrating deep sclerectomy, drainage of the seton type, optical coherence tomograph.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis.

To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

Safety and performance of a suprachoroidal sensor for telemetric measurement of intraocular pressure in the EYEMATE-SC trial

AimTo investigate the safety and performance of a telemetric suprachoroidal intraocular pressure (IOP) sensor (EYEMATE-SC) and the accuracy of its IOP measurements in open angle glaucoma (OAG) patients undergoing simultaneous...

Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

BackgroundUveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC).MethodsRetrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure.ResultsA total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries.ConclusionThere remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

Активация увеолимфатического пути оттока водянистой влаги при непроникающей хирургии глаукомы без формирования фильтрационной подушки: клинические случаи

The authors propose a modified technique of non-penetrating filtering glaucoma surgery for primary open-angle glaucoma (POAG) to improve the uveoscleral outflow. The study enrolled 11 patients with POAG. A novel surgical technique included two steps. The first step was modified deep sclerectomy and cyclodyalysis with collagen implant placed into the supraciliary space. The second step (after 7–10 days) was YAG laser trabeculotomy. Surgical site and adjacent areas were examined by optical coherence tomography (OCT). After 6 months, mean IOP significantly reduced by 52% (from 30.0±10.3 mm Hg to 14.6±5.0 mm Hg, р=0.0004) while the number of IOP-lowering medications reduced by 79% (from 2.9±1.0 to 0.6±0.4, р=0.000001). The aqueous humor outflow occurred through conjunctival lymphatic vessels without filtering bleb formation, as illustrated by OCT. Postoperative complications were minor and easy-to-treat. Three case reports are discussed. Keywords: open-angle glaucoma, glaucoma surgery, conjunctival lymphatics, filtering bleb, non-penetrating glaucoma surgery, uveolymphatic outflow pathway. For citation: Kumar V., Abu Zaalan K.A., Frolov M.A. et al. Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports. Russian Journal of Clinical Ophthalmology. 2021;21(2):108–115. DOI: 10.32364/2311-7729-2021- 21-2-108-115.

Hemorrhagic Descemet's Membrane Detachment in Nonpenetrating Glaucoma Surgery.

To describe 5 representative cases of hemorrhagic Descemet's membrane (DM) detachment in glaucoma surgery that had different origins, mechanisms and treatments. Clinical records of patients that had undergone a nonpenetrating glaucoma surgery, with a diagnosis of hemorrhagic DM detachment were reviewed for demographic data, clinical findings and treatment applied. Five patients with hemorrhagic DM detachment were included in this case series. They all had different causes, namely a massive hemorrhage at the end of a canaloplasty procedure, a needling maneuver, autologous blood injection, Swan syndrome, and frequent eye rubbing. Hematoma evacuation was performed in 4 eyes, 1 of them from under the scleral flap of the deep sclerectomy and 3 of them through a surgical or laser perforation in DM. Air tamponade was done in most of these cases. One of these cases required transcorneal suture fixation. One case was observed expectantly. All cases successfully recovered but peripheral corneal stain was persistent in 2 cases. Hemorrhagic DM detachment is a rare but potential vision-threatening complication in glaucoma surgery. Different mechanisms may cause the bleeding and there are several techniques available to approach this complication. Pre-Descemet hematoma should be drained to avoid permanent corneal stain and air/gas tamponade may help to prevent recurrences.

Ab Externum Canaloplasty – An Overview

Canaloplasty is a non-penetrating glaucoma surgery used to treat patients with open-angle glaucoma. It was developed as an alternative method to traditional glaucoma surgery and is one of the recent techniques of non-penetrating glaucoma surgery. Studies have shown its efficacy and safety in the reduction of intraocular pressure, having a lower rate of intraoperative and post-operative complications compared to trabeculectomy. A combination of canaloplasty with phacoemulsification represents a good option for patients with concomitant cataract. Canaloplasty appears to be a good alternative for the treatment of open-angle glaucoma.

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante

Case reportA 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure. DiscussionTo the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.

Outcomes of 360° suture trabeculotomy after unsuccessful canaloplasty.

Canaloplasty is a well-established non-penetrating glaucoma surgery. Unsuccessful outcomes can be enhanced by micro-invasive 360° suture trabeculotomy (360°trabeculotomy), analyzed in this study. This retrospective study included twenty eyes of 19 patients, mean age 59.7±17.2 years, with primary open-angle glaucoma (POWG n = 14), pseudoexfoliation glaucoma (PEX n = 3), juvenile glaucoma (n = 2) and aphakic glaucoma (n = 1), who underwent micro-invasive 360° trabeculotomy after unsuccessful (intraocular pressure (IOP) >21 mmHg under maximum glaucoma eye drop therapy (Meds)) canaloplasty. IOPs, Meds, complications and failure rates (IOP >21 mmHg at two consecutive follow-ups) were evaluated. Complete success (no Meds) and qualified success (with Meds) rates for IOP levels ≤21 mmHg and ≤ 18 mmHg at the last follow-up were evaluated. IOPs and Meds were significantly reduced from before to 1 week (10.3±3.1 days) after 360° trabeculotomy (IOP, 28.3±6.0 mmHg to 15.8±4.5 mmHg; p < 0.001; Meds, 3.1 ± 1.2 to 1.0 ± 1.2; p < 0.001). IOPs (p = 0.37) and Meds (p = 0.33) did not decrease further from 1 week until the last follow-up (18.3 ± 8.2 months (IOP, 14.4±3.8 mmHg; Meds, 1.5±1.3)). Complete and qualified success was 25% (5/20) and 70% (14/20) for IOP ≤21 mmHg, as well as 25% (5/20) and 60% (12/20) for IOP ≤18 mmHg. Four eyes had postoperative hyphema, which resolved after a mean period of 4.0 ± 2.2 days. Five failures occurred after a mean of 40.6 ± 51.9 days after 360° trabeculotomy. All failures underwent trabeculectomy. Eyes that needed early (≤3 months post canaloplasty) 360° trabeculotomy showed higher IOPs before (p < 0.001) and lower (p = 0.03) IOPs 2 months post 360° trabeculotomy than eyes with late (>3 months) 360° trabeculotomy surgery. 360° trabeculotomy is a safe, micro-invasive, simple and successful method to enhance failed canaloplasty.

Progression on canaloplasty for primary open angle glaucoma.

As a non-penetrating glaucoma surgery (NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm's canal. Ab interno canaloplasty (ABiC), which can reconstruct the natural outflow pathways of aqueous humor in mild-to-moderate primary open angle glaucoma (POAG) patients, is a new minimally invasive glaucoma surgery (MIGS) procedure improving from traditional canaloplasty. Canaloplasty can reduce intraocular pressure (IOP) with high efficiency and security. There are no complications such as scar formation and encapsulation for this no-bleb canaloplasty.

Catheter-independent suture probe canaloplasty with suprachoroidal drainage.

To introduce the novel technique of suture probe canaloplasty with suprachoroidal drainage (SCD) as a catheter-independent and cost-saving method to perform non-penetrating glaucoma surgery. Prospective interventional study with a 12-month follow-up. A standard 6/0 polypropylene suture is twisted in a special manner to create a double helix with a small loop at its end. Then canaloplasty with SCD is performed, but instead of using the standard canaloplasty catheter, Schlemm's canal is probed with the twisted suture. After 360° probing, a 10/0 polypropylene suture is thread through the loop and the twisted 6/0 suture is pulled backwards through Schlemm's canal. The 10/0 suture in Schlemm's canal is tied firmly and hyaluronic acid is injected into the suprachoroidal space. In total, 74 eyes that underwent suture probe canaloplasty with SCD were included. In 57 cases, probing of Schlemm's canal with the twisted 6/0 suture succeeded. Seventeen eyes had adhesions in Schlemm's canal which made probing with the suture impossible so that the surgeon switched in 12 cases to microcatheter-guided canaloplasty with SCD. While this was successful in five further cases, the adhesions seemed surely not be overcome and SCD with collagen sheet implantation was directly performed. In four additional cases after successful probing, the suture cut through trabecular meshwork; hence a 360° suture trabeculotomy was performed. After successful suture probe canaloplasty with SCD, intraocular pressure (IOP) decreased by 39.2% (from 19.8 ± 4.3mmHg with 3.4 ± 0.7 different IOP-lowering eye drops to 12.0 ± 1.9mmHg with 0.6 ± 0.9 eye drops). Three patients did not achieve sufficient IOP levels and, therefore, underwent 360° suture trabeculotomy during follow-up. No serious or sight-threatening complications occurred. Suture probe canaloplasty + SCD yields the opportunity to conduct canaloplasty with SCD more cost-effectively with a safety profile and IOP-lowering effect comparable to conventional canaloplasty. In cases where probing with the suture fails. there still remains the option to use a conventional microcatheter or to switch to SCD with collagen sheet implantation.

Recent Advances in the Surgical Management of Glaucoma in Exfoliation Syndrome.

Surgical and laser procedures traditionally used in the management of exfoliation glaucoma (XFG) include laser trabeculoplasty, trabeculectomy, and glaucoma drainage implant surgery. Having demonstrated similar safety and efficacy in XFG compared with primary open-angle glaucoma, trabeculectomy remains the most commonly performed surgery in XFG. Recent trends in practice patterns in developed nations demonstrate a shift towards glaucoma drainage implant surgery, which is currently the procedure of choice in XFG for many, particularly in developed nations. In addition, cataract surgery alone may significantly decrease intraocular pressure in patients with XFG, may prevent glaucoma development in patients with exfoliation syndrome, and is recommended to be performed early in the course of the disease. With the relatively recent introduction of nonpenetrating glaucoma surgery and the ongoing evolution of minimally invasive glaucoma surgery, several other surgical procedures have now become part of the glaucoma surgeon's armamentarium when treating XFG, including the Ex-PRESS shunt, deep sclerectomy, viscocanalostomy, Trabectome, as well as angle procedures. These techniques have demonstrated promising results in various types of glaucoma. More research is, however, needed to establish the safety and efficacy of these procedures in XFG.

Self-engineered Acry C plants in nonpenetrating glaucoma surgery.

BACKGROUND:Analysis of safety and efficacy of self-engineered polymethylmethacrylate (Acry C) implants in nonpenetrating glaucoma surgery (NPGS) for control and maintenance of intraocular pressure (IOP) in primary open angle glaucoma (POAG) patients.MATERIALS AND METHODS:This was a hospital-based randomized study. Fifty eyes of 50 POAG patients were divided into 3 groups based on preoperative IOP range. NPGS was done with polymethylmethacrylate implants made from haptics of intraocular lenses. All patients were followed up after 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months. Preoperative IOP range was from 25.62 ± 1.72 to 41.66 ± 1.15 mmHg. Postoperative success was defined as IOP <21 mmHg at 1 month in the absence of additional antiglaucoma medication or other treatment.RESULTS:A significant reduction in IOP was observed postsurgery in all three groups, changing from a preoperative mean of 25.62 ± 1.72 mmHg, 34.38 ± 2.27 mmHg, and 41.66 ± 1.15 mmHg to a postoperative mean of 13.27 ± 2.13 mmHg, 16.50 ± 2.74 mmHg, and 17.66 ± 1.52 mmHg, respectively (P < 0.001) at 12 months. No significant difference was seen with change in position of the implant, i.e., convexity facing limbus or fornix. No intraoperative complications were observed. The main postoperative complication was failure of filtration in 1 case (3.44%) from Group 1, 5 cases (27.78%) from Group 2, and all 3 cases (100%) from Group 3 at 1 month postoperatively. Thus, 9 eyes (41%) required postoperative antiglaucoma medications following which the IOP was controlled.CONCLUSION:NPGS with Acry-C implants is a safe and cost-effective (<1 US dollar) procedure for control of IOP in POAG patients especially those with moderately elevated IOPs.