Non-penetrating Trabecular Surgery Research Articles

Non-penetrating filtration surgery versus trabeculectomy in postoperative astigmatism: a meta-analysis

ObjectiveTrabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma.MethodsA systematic literature search was performed for studies comparing trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The endpoint was the surgically induced astigmatism assessed 6 months after operation. We conducted this meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis).ResultsFive eligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.40, 95% CI = 0.19 to 0.61, P = 0.02).ConclusionOur results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism.Trial registration numberCRD42024517708.

Health Informatics Analysis of Long-Term Therapeutic Effect of Non-Penetrating Trabecular Surgery Based on Ultrasound Biomicroscopy

Health Informatics Analysis of Long-Term Therapeutic Effect of Non-Penetrating Trabecular Surgery Based on Ultrasound Biomicroscopy

Non-penetrating trabecular surgery versus trabeculectomy for the treatment of open angle glaucoma-Meta analysis

Non-penetrating trabecular surgery versus trabeculectomy for the treatment of open angle glaucoma-Meta analysis

Clinical observation on continuous 24-hour intraocular pressure curve after non-penetrating trabeculectomy with Mitomycin application

Objective To analysis the continuous 24-hour intraocular pressure (IOP) curve in patients with primary open-angle glaucoma (POAG) after non-penetrating trabecular surgery (NPTS) with Mitomycin application.Methods Twenty-six eyes of 26 patients with POAG that underwent non-penetrating trabeculectomy with Mitomycin application were studied.All patients were followed up for 1 year.24-hour IOP monitoring,intraocular pressure,mean IOP,differential pressure,visual acuity,filtering bleb and visual fields were observed.Results Preoperative mean IOP was (25.2 ± 3.4) mmHg (1 mmHg =0.133 kPa),the peak IOP was (34.7 ± 4.3) mmHg,the valley IOP was (15.5 ± 3.1)mmHg,the IOPfluctuation was (19.2 ±3.3) mmHg.Postoperative mean IOP was (15.1 ±2.5) mmHg,the peak IOP was (19.7 ± 3.6) mmHg,the valley IOP was (10.4 ± 2.8) mmHg,the I0P fluctuation was (9.3-± 2.2) mmHg.There was significant difference between the preoperative items and the postoperative items in the 24-hour IOP curve.Conclusion Non-penetrating trabecular surgery with Mitomycin application is a safe and effective method of treating the primary open-angle glaucoma. Key words: Trabeculectomy, non-penetrating ; Mitomycin; Intraocular pressure curve, 24-hour

Meta analysis of non-penetrating trabecular surgery versus trabeculectomy for the treatment of open angle glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration's RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P<0.00001). There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92, P<0.00001). Difference in the success rate was also found between the two surgeries (Z=3.82, P=0.0001). It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

Mid-Term Results of Filtering Surgery in Corticosteroid-Induced Glaucoma Patients

Aim: To analyze the mid-term effect of filtering surgery in patients with corticosteroid-induced glaucoma (CIG). Methods: This case-series study consisted of 20 eyes of 15 corticosteroid-induced glaucoma patients who received trabeculectomy or non-penetrating trabecular surgery (NPTS) from March 2005 to March 2008. Both preoperative and postoperative intraocular pressure (IOP), cup -disk ratio, Humphrey visual fields, number of glaucoma medications were recorded. Characteristics of postoperative blebs were analyzed with Ultrasound biomicroscope (UBM), and slitlamp. Bleb grading and Ultrasound biomicroscope were performed on all glaucoma surgery eyes at a single final time point. Results: 14 eyes were performed trabeculectomy, 6 eyes were performed NPTS. Mean IOP before and after trabeculectomy were 30.5±13.1 and 11.4±3.8 mmHg (p<0.01), respectively. Mean IOP before and after NPTS were 20.3±4.7 and 12.2±3.1 mmHg (p<0.01), respectively. The mean vertical cup-disk ratio (VCDR) was 0.54 before surgery compared with 0.55 just after surgery. No significant changes were found in visual fields before and after surgery (P=0.06). According to the outcome of final IOP, success rate was 100%. Based on slit-lamp and Ultrasound biomicroscope evaluation of the bleb, 90% of blebs were functional and 10% were non-functional. Conclusions: The mid-term glaucoma management in CIG patients undergoing surgery indicated a successful outcome in final IOP and fairly good prognosis for visual function, without antiglaucoma medication.

Recurrent iris prolapse after laser goniopuncture in an open-angle glaucoma patient treated with non-penetrating trabecular surgery

Recurrent iris prolapse after laser goniopuncture in an open-angle glaucoma patient treated with non-penetrating trabecular surgery

Long-term effects of non-penetrating trabecular surgery versus trabeculectomy for treating glaucoma

To evaluate clinical outcomes of non-penetrating trabecular surgery (NPTS) and trabeculectomy surgery (TS) in the treatment of primary open angle glaucoma (POAG). It was a case-control study. A total of 63 patients (63 eyes) with POAG were observed retrospectively. Thirty one eyes and 32 eyes underwent NPTS and TS, respectively. Intraocular pressure (IOP), filtration bleb, visual field and post-operative complications were observed for 6-60 months. The CMH χ(2) test was used to analyse the difference of them. After operation, the IOP in the NPTS group were from (13.87 ± 4.88) mm Hg (1 mm Hg = 0.133 kPa) to (24.01 ± 6.55) mm Hg, the IOP in the TS group were from (11.90 ± 4.92) mm Hg to (19.10 ± 7.43) mm Hg. The IOP in the NPTS group was significantly higher than that in the TS group (F = 5.137, P < 0.05). The ratio of sustained filtration bleb of NPTS group after surgery was 25/31 (80.6%), while 6/31 were flat filtration bleb. There were statistically significant difference in the rate of disappearance of filtration bleb between these two groups (χ(2) = 8.129, P < 0.05). The difference of visual field loss postoperatively between these two groups was not statistically significant. The incidence rate of newly developed cataract after NPTS and TS was 6/31 and 12/32, respectively. The difference of rate of complication between these two groups was statistically non-significant (χ(2) = 3.797, P < 0.05). The successful rate after NPTS and TS was 61.54% (16/26) and 14.29% (4/28), respectively. The difference of successful rate between these two groups was statistically significant (χ(2) = 14.463, P < 0.05). Both NPTS and TS are effective methods for the treatment of POAG. Postoperative complications after NPTS are less than those of TS, But patients with TS could maintain a lower IOP than those with NPTS. Long-term efficacy of NPTS is uncertain, it's important to choose the suitable surgery to gain a high success rate.

Long-term effects of non-penatrating trabecular surgery treating glaucoma

Objective To evaluate the long-term clinical effect of non-penetrating trabecular surgery (NPTS)for the treatment of primary open angle glaucoma(POAG). Methods A total of 46 patients(46 eyes) with POAG were observed retrospectively. 22 eyes and 24 eyes uderwent non-penetrating trabecular surgery (NPTS) and trabeculectomy surgery(TS). Intraocular pressure (IOP), filtration bleb and visual field were ob-served. Results ①In the follow-up of 50 month, there was a significant hypertendency in post-operative intraoc-ular pressure in NPTS group. The IOP was controlled successfully in 5 eyes(22. 73%) ,and 7 eyes(31.82%) were failure in NPTS group. 11 eyes(45.83%) were success,4 eyes(16. 67%) were failure in TS group, but there were no statistically significant differences between two groups(P > 0. 05). ②The ratio of sustained filtra-tion bleb of TS group after surgery is 100% ,the ratio of sustained filtration bleb of NPTS group after surgery is 15 (68.18%), while 3 eyes(13.64%)were flat filtrtion hleb. From the time passing by, there were statistically significant differences in the disappearance number of filtration bled between two groups (P 0.05). Conclusion Long-term effects of non-penatrating trabecular surgery treating glaucoma were indefinite in some cases. It is very im-portant to choose the suitable surgery to gain high success rate. Key words: Trabecula; Micrurgy; Non-penetrating; Glaucoma

The anti-scar effect of two implants in the nonpenetrating trabecular surgery

目的 评价非穿透小梁手术中透明质酸钠生物胶和羊膜术后抗瘢痕化的作用.方法 原发性开角型青光眼36例(60眼)随机分为A组和B组.A组非穿透性小梁手术联合透明质酸钠生物胶组18例(30眼),B组非穿透性小梁手术联合羊膜组18例(30眼),术后随访12～24个月.主要指标视力、眼压、结膜滤过泡、前房角、并发症.结果两组患者术后1周及术后6月最佳矫正视力比较,差异无统计学意义(F=0.647,0.735,P＞0.05);术前两组眼压平均为(26.47±12.990)、(28.03±11.388)mmHg,差异无统计学意义(P＞0.05),术后1周、6月两组眼压均较术前降低(P＜0.05),术后1周、1、6、12、24月平均眼压两组之间比较差异无统计学意义(F=0.01、0.093、1.104、0.788、0.039,P＞0.05);术后1周、1月、6月、12月、24月滤过泡、手术成功率两组比较差异无统计学意义(P＞0.05).结论 非穿透小梁手术联合透明质酸钠生物胶和羊膜均可抑制术后瘢痕的形成,有效降低原发性开角型青光眼的眼压,两者疗效相当,但羊膜价格低廉、取材方便。

Preoperative Nursing of non-penetrating trabecular surgery for glaucoma

目的 做好青光眼非穿透性小梁切除术围手术期的护理,使病人有正确认识疾病的知识,遵从治疗方案,实现治疗最佳目标.方法 加强术前心理护理、术后术眼观察,做好健康宣教及出院指导.结果 有正确认识疾病的知识,遵从治疗方案,术后第4天测眼压平均(8.33±2.16)mmhg,术后3～6个月平均眼压(14.27±3.72)mmhg,无并发症的发生.结论 加强围手术期的护理观察,可促进患者对疾病认识,防止并发症的发生,提高生活质量起到至关重要的作用。

Postoperative follow-up of non-penetrating trabecular surgery with UBM

目的 研究超声生物显微镜(UBM)在非穿透性小梁切除术(NPTS)后随访的意义.方法对21例28～51岁开角型青光眼患者进行NPTS联合丝裂霉素C(MMC)及羊膜植入治疗,在术后1～18个月,UBM观察滤过泡的形态、形成液间腔的大小、剩余小梁膜的厚度及羊膜的变化.结果所有病例UBM下均形成前部的液间腔,随访18个月,其边缘逐渐钝化不规则,体积逐渐缩小,差异有统计学意义.角巩膜小梁带逐渐粗糙,其厚度测量差别较大.羊膜术后9个月左右融解,无明显后部液间腔存在. 结论 NPTS联合MMC及羊膜植入能有效降低眼压,远期效果良好.UBM适合于NPTS的随访,羊膜在NPTS中无明显的抑制纤维增生作用。

UBM in postoperative follow-up for glaucoma after NPTS

目的 观察非穿透性小梁手术联合MMC及羊膜植入治疗开角型青光眼的远期临床效果,研究超声生物显微镜(UBM)在非穿透小梁切除术后随访的意义.方法 对21例(30眼)开角型青光眼进行非穿透小梁手术联合MMC及羊膜植入术治疗,术后观察视力、眼压及滤过泡情况.分别在术后1,3,6,9,12,18月,利用UBM观察滤过泡的形态、巩膜瓣下形成液间腔的大小、剩余小梁膜的厚度及羊膜的变化.结果 患者术后眼压控制良好,手术前后眼压相比,差异有统计学意义(P＜0.01).UBM下所有病例均形成前部的透明液间腔.随访期间巩膜池前部体积无明显变化,平均宽(1.936±0.516)mm,高(0.285±0.117)mm;薄层小梁网组织平均厚度为(0.128±0.057)mm,且随访期间厚度基本无改变.羊膜在术后9月左右融解后后部巩膜池无明显透明液间腔存在.结论 非穿透性小梁手术联合MMC及羊膜植入能有效地降低眼压,远期效果良好.UBM适合于非穿透性小梁切除术的长期随访。

Reduction of intraocular pressure by laser goniopuncture after non-penetrating trabecular surgery

目的 评价激光房角穿刺治疗非穿透小梁手术后眼压升高的临床疗效和安全性.方法 以21例(23眼)开角型青光眼患者为研究对象作前瞻性研究,当非穿透小梁手术后眼压＞21 mmHg时,即在手术部位行Nd:YAG激光房角穿刺.结果 激光前平均眼压(25.1±2.4)mmHg,房角穿刺后1 h的平均眼压降至(14.2±3.9)mmHg(P＜0.01).激光后随访(10.5±4.1)个月,最后一次随访的平均眼压为(16.0±3.6)mmHg(P＜0.01).并发症为浅前房、脉络膜脱离1眼,虹膜周边前粘连1眼.结论 Nd:YAG激光房角穿刺能有效和安全地治疗非穿透小梁手术后小梁网-后弹力膜的房水低滤过状态,降低再次手术率。

Unusual ultrasound biomicroscopy appearance after non-penetrating trabecular surgery with SK gel implant

Unusual ultrasound biomicroscopy appearance after non-penetrating trabecular surgery with SK gel implant

The early postoperative complications and cost-effectiveness analysis of non-penetrating trabecular surgery in patients with primary open angle glaucoma

To compare the early postoperative complications of non-penetrating trabecular surgery (NPTS) and modified trabeculectomy (MT) in patients with primary open angle glaucoma, and to analyze the cost-effectiveness of NPTS to prevent adverse events as well. One hundred and forty seven consecutive cases (215 eyes) with primary open angle glaucoma from the glaucoma division, Zhongshan Ophthalmic Center, were involved. One hundred and four eyes underwent NPTS; while 111 eyes underwent MT. Visual acuity, intraocular pressure and complications occurred while staying in the hospital, were recorded. Number of need to treat (NNT) was used to analyze the cost-effective for NPTS. (1) Visual acuity decrease over 2 lines occurred in 25 eyes (24.0%) in NPTS group and 26 eyes (23.4%) in MT group. The difference of visual changes between these two groups was not statistically significant (P > 0.05). (2) One day after the operation, hypotension [IOP less or equal to 5 mm Hg (1 mm Hg = 0.133 kPa)] occurred in 39 eyes in NPTS group (38.2%), and 10 eyes in MT group (9.2%). The difference was significant (P < 0.01). On the day of discharge, the incidence of hypotension was 27.5% in NPTS group and 17.3% in MT group, respectively. The difference was still significant (P < 0.05). (3) Hyphema was found in 20 eyes (19.2%) in NPTS group and ten eyes (9.0%) in MT group. In either group, a surgical procedure was needed in two eyes to evacuate the blood. (4) Two eyes of grade II degrees and five eyes of grade I degrees shallow chamber were found in NPTS group. Five eyes of grade II degrees and five eyes of grade I shallow chamber were found in MT group. The difference of incidence of shallow chamber between these two groups was not statistically significant (P > 0.05). (5) Other complications: In the NPTS group, trabeculo-descemetic membrane rupture occurred in one eye, pupil dilated to 7 mm observed in six eyes; in the MT group, acute elevated IOP occurred in one eye, peripheral anterior synechia at inner incision occurred in one eye, hypotensive macular edema occurred in one eye. (6) The absolute risk ratio (ARR) of NPTS for adverse event was 3.0%, (NNT = 33.2), it costs additional RMB yen 116, 100 for preventing one adverse event. For serious adverse event, ARR = 1.8% (NNT = 55.5), and it costs additional RMB yen 194, 000 to prevent one serious adverse event. Although the NPTS may reduce the incidence of serious adverse event in comparing with MT, the cost of NPTS is very high, therefore, it is not an optimal procedure in China. Ophthalmologists in the general hospital should familiar with the MT procedure to save the medical expenses.

Effect of non-penetrating trabecular surgery with amniotic membrane implant on patients with juvenile glaucoma

To evaluate the effect of non-penetrating trabecular surgery (NPTS) with amniotic membrane implant in patients with juvenile glaucoma. NPTS with amniotic membrane implant was performed on 32 eyes of 26 patients with juvenile glaucoma aged between 12 approximately 28 years. Intraocular pressure (IOP) was measured pre- and post-operatively by CT-60 non-contact tonometer, intraocular irritations and the bleb appearances were recorded, and the anterior chamber angle of post-operation was observed by gonioscopy. Follow-up was (8.3 +/- 4.2) months after surgery. IOP of post-operation was significantly decreased (15.7 +/- 3.7) mm Hg (1 mm Hg = 0.133 kPa; t = 4.82, P < 0.01) compared with that of pre-operation (28.6 +/- 7.3) mm Hg. The mean number of drug usage was significantly reduced to 0.8 (t = 128, P < 0.01) after surgery when compared with 3.2 before surgery. On the last visit, the IOP was <or= 21 mm Hg in 30 eyes (93.8%), among them, there were 18 eyes (56.3%) without anti-glaucoma medication and 12 eyes (37.5%) with anti-glaucoma compounds. There was a small amount of hyphema that was absorbed in 3 approximately 5 days in 6 eyes. The gonioscopy showed that the remnant trabecular meshwork and Descemet membrane were thinner at the surgical site, and microperforation occurred in the trabecular meshwork in 5 eyes. The complications such as flat chamber, inflammation and choroidal detachment were not observed. There was no significant difference in visual acuity between pre- and post-operation. NPTS with amniotic membrane implant effectively controls elevated IOP in patients with juvenile glaucoma and reduced the number of anti-glaucoma drug usage without significant post-operative complications. NPTS with amniotic membrane implant is an effective and new method for the treatment of patients with juvenile glaucoma.

Transition to nonpenetrating trabecular surgery: sclerotrabeculectomy

A transition from trabeculectomy to nonpenetrating trabecular surgery (NPTS) is proposed under the name of sclerotrabeculectomy. The technique, which is aimed at facilitating the transition to NPTS, is a modification of both penetrating and nonpenetrating techniques. Sclerotrabeculectomy uses a more superficial sclerokeratectomy than NPTS to avoid the risk of perforation. A minitrabeculectomy with cross-linked hyaluronate implant insertion in the sclerokeratectomy site is performed, with several sutures placed in the superficial flap. The sclerokeratectomy site is filled with cohesive viscoelastic substance to avoid a flat or shallow anterior chamber. Using this technique, it is possible to move to NPTS by finding the pre-Descemet’s plane in front of the scleral spur and removing the external trabeculum. In case of accidental microperforation of Descemet’s plane, the operation is finished as a standard sclerotrabeculectomy with no risk to the patient’s eye. A safe transition can thus be achieved. Initial clinical results demonstrate excellent lowering of intraocular pressure without significant complications.

NEW PERSPECTIVES IN SELECTIVE TRABECULAR SURGERY

Enormous progress has been made in understanding the complexity of the underlying causes of chronic open-angle glaucoma; however, indisputable concepts for effective treatment are still rare. To date, conventional filtering surgery remains the mainstay of surgical therapy in the management of glaucoma not controlled by medication. 25 Unfortunately, treatments involving full-thickness filtration are scarcely selective, as healthy structures not primarily involved in the disease process are subject to surgical intervention. The application of adjunct antimetabolites for inhibition of undesired episcleral fibroblastic proliferation dramatically increased the success rates for filtering procedures but had the disadvantage of exacerbating serious side effects, such as flat anterior chambers, prolonged postoperative hypotony, and late endophthalmitis from infected filtering blebs. 27,45 Microsurgery on Schlemm's canal and the human aqueous outflow system for controlling intraocular pressure (IOP) in chronic open-angle glaucoma have been evolving over the past few decades. Theoretic considerations indicate that production of approximately 10 to 15 fistulae, each 10 μm in diameter, between the anterior chamber and Schlemm's canal should restore normal outflow facility in open-angle glaucoma. 9 The basis for most of the current approaches to microsurgery of Schlemm's canal is the finding by Grant 10 that the largest proportion of resistance to outflow is located within the trabecular meshwork, namely, the cribriform layer and can be eliminated by incising the trabecular meshwork and entering the canal of Schlemm. If one agrees that the site of the pathologic resistance to aqueous humor outflow is this tissue, then partial removal, taking the utmost possible care not to damage the surrounding chamber angle structures, could be a new alternative in antiglaucomatous surgery. This sort of selective nonpenetrating trabecular surgery would be equivalent to internal filtration surgery without transscleral drainage of aqueous humor into the subconjuntival space and would thereby reduce the incidence of postoperative complications typically associated with filtering procedures. This review discusses different internal trabecular microsurgical techniques that are designed to facilitate outflow along its natural pathway. Each new technique is described in detail, newly developed instrumentation is discussed, and the presumed mechanisms of action are outlined. The reader must understand, however, that none of these new microsurgical procedures threaten to replace conventional filtering approaches, as they are still in the experimental phase and under careful clinical evaluation, and there is plenty of room left for further refinements and developments. We hope this article gives us impetus to the search for alternative strategies in antiglaucomatous surgery and focuses attention more closely on the diseased target structure in chronic open-angle glaucoma: the trabecular meshwork.