Number Of Hypotensive Medications Research Articles

Clinical Impact of the Use of Ologen in Filtering Surgery Performed in Uncontrolled Glaucoma.

Introduction: To compare the efficacy and safety of trabeculectomy with a collagen matrix implant (Ologen®) versus trabeculectomy with mitomycin C (MMC) versus trabeculectomy with both Ologen® and MMC (OLO + MMC). Methods: This non-randomized study included 119 eyes of 101 patients with uncontrolled open-angle glaucoma who underwent trabeculectomy, either alone or combined with phacoemulsification. The data were initially recorded following a standard surgical protocol, using an electronic database with structured fields. The patients were divided into three groups: 44 received trabeculectomy with adjunctive MMC (MMC group), 34 received surgery with Ologen® (OLO group), and 41 received surgery with both Ologen® and MMC (OLO + MMC group). The main outcome measures were the change in intraocular pressure (IOP), change in number of medications needed, complete success rate (defined as IOP ≤ 20 mmHg and at least 20% IOP reduction without hypotensive medications), rate of complications, and rate of postoperative interventions. The follow-up period was 36 months. Results: IOPs significantly decreased (p = 0.01) in all groups across all study visits, decreasing from 19.8 ± 4.6 mmHg to 12.7 ± 4.2 mmHg in the MMC group, from 20.5 ± 4.7 mmHg to 13.9 ± 3.5 mmHg in the OLO group, and from 23.5 ± 6.1 mmHg to 13.1 ± 3.5 mmHg in the OLO + MMC group. After correcting for the baseline IOP, only the first two postoperative visits (first week and first month) showed a significantly greater IOP reduction in the OLO + MMC group. The number of hypotensive medications was significantly reduced from 3.1 ± 0.6 to 0.56 ± 1.1 in the MMC group, from 2.9 ± 0.4 to 0.83 ± 1.1 in the OLO group, and from 3.0 ± 0.6 to 0.45 ± 0.95 in OLO + MMC group, with no statistically significant differences among the groups (p = 0.57). The complete success rates were 63.6% in the MMC group, 67.6% in the OLO group, and 80.5% in the OLO +MMC group, with no statistically significant differences between the groups (p = 0.21). Suture release was significantly more frequent in the MMC group (86.1%) than in the OLO group (62.1%) and in the OLO + MMC group (45.9%; p = 0.02). Bleb needling, with (33.3%; p = 0.005) or without (66.7%; p = 0.0001) 5-fluorouracil injection (5-FU), was significantly more common in the MMC group. The highest complete success rate (61%) was observed in the OLO + MMC group. Conclusions: The use of Ologen® and mitomycin C provided similar surgical IOP reduction in glaucoma surgery compared with either MMC or Ologen® alone, but significantly reduced the need for postoperative interventions.

Plasma rich in growth factors as an adjuvant agent in non‐penetrating deep sclerectomy

AbstractPurpose: To evaluate the utility and safety of plasma rich in growth factors (PRGF) eye drops in the postoperative treatment of non‐penetrating deep sclerectomy (NPDS).Methods: Retrospective case–control study, including open‐angle glaucoma patients. Cases were consecutively recruited, and used topical PRGF for 4 months after NPDS. Historical controls were patients who had undergone the same technique immediately before the start of the study (without PRGF). Prior to surgery, intraocular pressure (IOP), the number of topical hypotensive medications, and visual field mean deviation (MD) were registered. Postoperatively (1 week, 3 and 6 months), those three variables were also analysed, as well as complications, manipulations and reinterventions.Results: Preoperatively, the PRGF group (n = 37) and the control group (n = 49) were similar in age (70.9 ± 10.0 vs. 71.5 ± 10.7 years; p = 0.68), IOP (23.0 ± 9.0 vs. 20.6 ± 10.2 mmHg; p = 0.26), MD (−15.0 ± 8.8 vs. −15.9 ± 7.8 dB; p = 0.76) and the number of hypotensive medications (2.8 ± 0.9 vs. 2.7 ± 0.8; p = 0.40). IOP significantly decreased at all follow‐up visits in both groups, compared to preoperative values. That reduction was greater at 6 months with PRGF (p < 0.01): 10.9 ± 4.3 mmHg (−52.6%) versus 15.0 ± 8.0 mmHg (−27.2%). In the final analysis, the number of drugs similarly reduced in both groups (p = 0.32). MD showed no significant differences. Surgical complications were observed in 12 control eyes (25%) and 5 eyes (14%) treated with PRGF (p = 0.06). No complications related to the use of PRGF were identified. The needling rates were 9.4% and 5.9% in PRGF and controls, respectively (p = 0.58). Three eyes (6.3%) required further glaucoma surgery in the control group, and 1 (2.7%) in the PRGF‐group (p = 0.78). The final complete success rate was higher with PRGF: 83.8% vs 60.4%.Conclusions: Postoperative PRGF reduced IOP and complications rate in the mid‐term after NPDS, thus it may be considered as a possible safe adjuvant agent to achieve surgical success.

Long-term effect of canaloplasty on intraocular pressure and use of intraocular pressure-lowering medications in patients with open-angle glaucoma.

To assess the long-term safety and effectiveness of canaloplasty in reducing intraocular pressure (IOP) and use of IOP-lowering medications in eyes with open-angle glaucoma (OAG). Surgical center (Augencentrum Köln, Köln, Germany). Retrospective study. 206 eyes from 130 patients were included. Canaloplasty was performed using the VISCO360 or OMNI surgical system as a stand-alone procedure in 22 eyes and concomitantly with cataract extraction (CE) in 185 eyes with chronic OAG insufficiently controlled or intolerant to IOP-lowering medications. The number of hypotensive medications and IOP were recorded at baseline, day 1, week 1, month 1, month 3, and every 3 months thereafter, with the last follow-up visit at 36 ± 6 months postoperatively. Patients were stratified by baseline IOP (Group 1, IOP >18 mm Hg; Group 2, IOP ≤18 mm Hg). Treatment success in Group 1 was defined as a reduction in IOP and the use of IOP-lowering medications; Group 2 success was defined as maintenance of a lower IOP and a reduction in medication use. The preoperative mean IOP of both groups was 21.1 ± 8.8 mm Hg, with a mean of 2.0 ± 0.9 hypotensive medications. The primary success end point was met by 73% of patients, with a mean IOP reduction in Group 1 (131 eyes; 21.8 to 15.6 mm Hg, P < .0001) and a maintenance of IOP control in Group 2 (76 eyes; 15.4 to 13.9 mm Hg, P = .24). Medications decreased from 2.2 ± 0.9 to 0.9 ± 1.1 in Group 1 ( P = .024) and from 1.8 ± 0.8 to 0.7 ± 1.0 in Group 2 ( P = .003). Canaloplasty alone or in conjunction with CE with the VISCO360 or OMNI surgical system is a safe, tissue-sparing, and effective minimally invasive glaucoma surgery, using a clear corneal incision in phakic or pseudophakic eyes. Canaloplasty performed with both evaluated devices achieved statistically significant, consistent, and clinically meaningful reductions in IOP and use of IOP-lowering medications in adult patients with OAG. In the consistent cohort (n = 42), the IOP-lowering effect lasted up to 42 months, with ongoing data collection expected to describe long-term effectiveness of this intervention.

Порівняння гіпотензивного ефекту ендотрабекулоектомії та селективної лазерної трабекулопластики

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p &lt; 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p &lt; 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

Early Experience with the New XEN63 Implant in Primary Open-Angle Glaucoma Patients: Clinical Outcomes

The new XEN63 implant is a minimally invasive glaucoma surgery device with limited experience in real life. This retrospective study included open-angle glaucoma patients who underwent XEN63 implant, either alone or in combination with cataract surgery. Primary endpoints were the intraocular pressure (IOP) at month 3 and the incidence of serious adverse events. Twenty-three eyes of 23 patients were included. Mean age was 67.8 ± 15.3 years and 15 (65.2%) were women. Mean IOP was significantly lowered from 27.0 ± 7.8 mmHg at baseline to 12.2 ± 3.4 mmHg at month 3 (p < 0.0001). Mean IOP lowering was 40.8 ± 23.5%, with 14 (60.9%) and 16 (69.6%) eyes achieving an IOP lowering ≥30% and ≥20% without hypotensive medication, respectively. The number of hypotensive medications (NHM) was significantly reduced from 2.27 ± 0.94 drugs at baseline to 0.09 ± 0.42 drugs at month 3, p < 0.0001. Four (17.4%) eyes had hypotony (IOP ≤ 6 mmHg) at postoperative day one, which was successfully resolved without sequelae. Four (17.4%) eyes had choroidal detachment (3 at day 7 and 1 at day 15), which was successfully resolved with medical treatment, at the month 1 visit. Three (13.0%) eyes required needling (mean time for needling 35.6 ± 9.7 days). XEN63 significantly lowered IOP and reduced the NHM, with a good short-term safety profile.

Ultrasound Cyclo Plasty in Eyes with Glaucoma.

Glaucoma is a chronic disease caused by the progressive degeneration of the optical nerve fibers, resulting in decreased visual field that can lead to severe visual impairment, and eventually blindness. This manuscript describes a simple, surgeon-friendly, non-incisional technique, named Ultrasound Cyclo Plasty (UCP), for reducing intraocular pressure (IOP) in glaucoma patients. The technique determines a selective coagulation necrosis of the ciliary body; in addition, the stimulation of supra-choroidal and trans-scleral portions of the uveo-scleral outflow pathway has been recently proposed. UCP shows several technical improvements in ultrasound technology compared to previous techniques, providing more precise focusing on the target zone. The procedure is performed in the operating room under peribulbar anesthesia. Briefly, the coupling cone is put in contact with the eye and the ring probe, that contains six piezoelectric transducers which produce the ultrasound beams, is inserted inside it. Their proper centering over the ocular surface represents a crucial step for the correct targeting of the ciliary body. Sterile balanced salt solution is used to fill the empty spaces to ensure ultrasound acoustic propagation. Surgical treatment consists in the sequential automatic activation of each of the six transducers, for a total duration of less than 3 min. The patient leaves the hospital 1 h after the procedure with the treated eye patched. In the present study, 10 patients with open-angle glaucoma were followed-up during at least 12 months after the procedure. IOP was reduced at each interval compared to pre-operative, as well as the number of hypotensive medications. Twenty percent of patients did not respond to the treatment, and needed subsequent surgery to better control IOP. Treatment tolerability was good, with no cases of hypotony or phthisis. The UCP procedure is simpler, faster, safer, and less invasive than traditional cyclodestructive procedures with similar results in reducing IOP.

Outcomes of Trabeculectomy and Phacotrabeculectomy With Collagen Matrix Implant (Ologen) and Low-dose Mitomycin C: 2-Year Follow-up.

The purpose of this article is to analyze the results achieved in lowering intraocular pressure (IOP) after trabeculectomy or combined surgery (phacotrabeculectomy) with low-dose mitomycin C (MMC) using the Ologen Collagen Matrix (Ologen CM) implant. This retrospective study included 58 eyes from 47 consecutive patients with glaucoma who underwent filtering surgery alone or combined with cataract surgery. The study group included 29 eyes that underwent trabeculectomy (14 eyes) or phacotrabeculectomy (15 eyes) with low-dose MMC (0.1 mg/mL×1 min) and subconjunctival Ologen CM implant at the end of surgery. The control group included 29 eyes, 12 that underwent trabeculectomy and 17 that underwent phacotrabeculectomy, with the same MMC dose but without the collagen matrix implant. All surgical procedures were performed by the same surgeon. The follow-up period for the patients was 2 years. We found statistically significant differences between the 2 groups in the age of the patients (P=0.02). We found no statistically significant differences in the baseline IOP (P=0.37) or preoperative IOP (P=0.5), nor in the visual field damage measured with mean deviation (P=0.2). The number of hypotensive medications used preoperatively was higher in the study group (P=0.0001). At 1 and 2 years after surgery, we only found statistically significant differences in favor of the study group in patients who underwent phacotrabeculectomy (P=0.0008 and 0.02, respectivily). The Ologen CM implant can be considered as an adjunct to MMC in patients undergoing filtering surgery combined with phacoemulsification to improve postoperative IOP results over the long term.

Experience of combined laser treatment for pigmentary glaucoma

To analyze the results of combined laser treatment for pigmentary glaucoma using laser iridectomy (LIE) and selective laser trabeculoplasty (SLT). The two-stage laser treatment was performed in 12 patients (22 eyes) with pigmentary glaucoma (primary stage - 19 eyes, advanced - 3 eyes). The first stage consisted of LIE; after 5.5±2.2 months, second stage in the form of SLT took place. The follow-up was 16.8±3.2 months. In the early post-op period after LIE, P0 decreased to 14.76±0.72 mm Hg, however the intraocular pressure (IOP) gradually increased during the further follow-up. After SLT, a steady P0 decrease to 12.39±0.66 mm Hg was reached - significantly lower in comparison with the initial data (19.94±0.94 mm Hg). Moreover, significant decrease in the number of hypotensive medications used was noted by the end of the follow-up - from 1.73±0.18 to 0.86±0.15. The combined laser treatment involving LIE and SLT was effective in treating primary and advanced pigmentary glaucoma.

Non-penetrating phaco-deep sclerectomy with SkGel implantation — long-term observations

INTRODUCTION. The aim of this study is to present the efficacy and safety of non-penetrating phaco-deep sclerectomy (PDS) with implantation of an absorbable sodium hyaluronate implant (SkGel/Corneal). MATERIALS AND METHODS. In a prospective case series study 219 procedures were performed on 176 subjects receiving PDS with SkGel implantation. Indications were uncontrolled primary-open angle glaucoma (POAG) and operable cataract. Data collected included best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of hypotensive medications. Follow-up examinations were performed one and seven days after procedure, then one, three, and six months after, and thereafter every six months. Complete and qualified success (without and with hypotensive medications) was assessed for IOP ≤ 18 mm Hg and IOP ≤ 12 mm Hg. RESULTS . The mean follow-up was 48.3 } 12.8 months. At 24 months, mean IOP decreased from 19.9 ± 5.0 mm Hg to 13.4 ± 3.1 mm Hg ( P < 0.001) (31.8% reduction) and to 13.3 ± 2.7 mm Hg ( P = 0.003) and after 60 months (33.2% reduction). At the 24-month follow-up, the average number of anti-glaucoma medications was reduced from 2.3 ± 0.8 to 0.62 ± 0.88 (p < 0.001). Complete and qualified success rates for IOP ≤ 18 mm Hg were 70.1% and 93.0%, respectively. Goniopuncture (23.8%), suturolysis (20.1%), and needling (18.3%) were performed. The most common complication was transient hypotony (36.07%). CONCLUSIONS. PDS with SkGel leads to an effective decrease in IOP over a long-term follow-up. The profile of the complications indicates that it is a safe procedure.

Retrospective Review of Pars Plana Versus Anterior Chamber Placement of Baerveldt Glaucoma Drainage Device

To evaluate outcomes of pars plana (PP) versus anterior chamber (AC) placement of Baerveldt glaucoma drainage device (GDD). This study is a nonrandomized, retrospective case series evaluating 63 eyes that underwent GDD insertion with Baerveldt 350 device under the supervision of 2 surgeons at 5 centers. The drainage tube was either inserted into the AC or through the PP into the vitreous cavity where eyes had been vitrectomized. Surgery was conducted between 2003 and 2010 with minimum patient follow-up of 6 months. Data on postoperative intraocular pressure (IOP), visual acuity, number of hypotensive medications, and surgical complications were recorded. Of the 63 drainage device surgeries, 34 tubes were placed in the AC and 29 were placed into the posterior segment through the PP. Preoperative mean IOP was 32.3±20.3 mm Hg in the AC group and 32.8±18.4 mm Hg in the PP group. Postoperative mean IOP was reduced at all follow-up time points in both the groups. Postoperative mean IOP in the anterior tube group was 14.0, 12.9, and 14.0 mm Hg and in the PP group was 14.2, 14.2, and 14.0 mm Hg, at the 1-, 2-, and 3-year follow-up, respectively. The qualified success rate at 2 years was 94% for the PP group and 91% for the AC group, whereas absolute success was 35% for the PP group and 27% for the AC group at 2-year follow-up. Insertion of the tube of the Baerveldt GDD into the PP is a safe and effective method for IOP control in aphakic, pseudophakic, and vitrectomized eyes where there is a need to avoid anterior tube placement such as coexisting corneal pathology. IOP control results appear comparable to conventional AC placement.

Results of combined endotrabeculectomy and phacoemulsification surgery

to identify indications and evaluate the efficacy of combined endotrabeculectomy and phacoemulsification surgery. A total of 172 patients (193 eyes) with open-angle glaucoma and cataract were enrolled. Group 1 included 102 patients (118 eyes), who were considered surgical candidates due to decompensation of IOP, group 2--70 patients (75 eyes), in whom IOP control could only be achieved with a multidrug regimen (two or more ocular hypotensive medications). The mean preoperative IOP measured with Maklakov tonometer was 26.4 ± 1.8 mmHg in group 1 and 20.5 ± 1.7 mmHg in group 2. In 134 eyes the extent of retention of intraocular fluid was determined intraoperatively by provoking blood reflux into Schlemm's canal. In 6 out of 134 eyes (4.5%) Schlemm's canal was not at all filled with blood, which was considered a contraindication for endotrabeculectomy. Partial filling of Schlemm's canal with blood was observed in 26 out of 134 eyes (19.4%), complete--in 102 eyes (76.1%). All but 6 patients underwent endotrabeculectomy (ab interno trabecular excision with original forceps through the anterior chamber angle) combined with cataract phacoemulsification and intraocular lens implantation. In 11 out of 126 cases, insignificant bleeding occurred during sample acquisition. No other complications were registered. Six months after the surgery, IOP was reduced by the mean of 7.0 ± 0.6 mmHg (26.5% from the baseline) in group 1 and by 2.2 ± 0.2 mmHg (10.7% from the baseline) in group 2. The number of hypotensive medications by that time has been decreased from 2.3 ± 0.3 to 0.8 ± 0.2 in group 1 and from 1.6 ± 0.3 to 0.4 ± 0.1 in group 2. Combined endotrabeculectomy and phacoemulsification surgery is a pathogenically oriented procedure, which improves ocular hydrodynamics and has a significant hypotensive effect.

Long-Term Outcomes Following Trabeculectomy Combined with 25-Gauge Transconjunctival Sutureless Vitrectomy in Uveitis Patients

Purpose: To evaluate the efficacy of combined trabeculectomy (TLE) and 25-gauge transconjunctival sutureless vitrectomy (TSV-25) for uveitis patients.Methods: Combined TSV-25/TLE was performed in 9 eyes of 6 patients with vitreoretinal complications and intractable glaucoma. Visual acuity, intraocular pressure (IOP), inflammatory control, and number of hypotensive medications were evaluated.Results: Visual acuity improved in 7 of 9 eyes and inflammation was controlled with a decreased oral anti-inflammatory agent dosage in all eyes. Mean IOP, which was 28.11 ± 4.83 mmHg preoperatively, was significantly reduced (15.77 ± 2.68 mmHg) 5 years after surgery (p = 0.008). The mean number of IOP-lowering medications was 3.33 ± 0.71 before surgery and 1.11 ± 0.92 5 years after surgery (p = 0.007). Two eyes required implant of an Ahmed drainage valve during the follow-up period.Conclusion: Combined TSV-25/TLE can be effective in managing vitreoretinal complications and elevated IOP in uveitis patients.

Use of a fibrin adhesive for conjunctival closure in trabeculectomy

To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo(®) ) used to close the conjunctiva in trabeculectomy. A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo(®) group. Two patients in the Tissucol Duo(®) group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. The use of Tissucol Duo(®) seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.

Intraocular pressure outcome after phacoemulsification and intraocular lens implantation in chronic angle closure glaucoma patients without extensive peripheral anterior synechiae

Abstract Background:Cataract extraction surgery significantly decreases intraocular pressure (IOP) in patients with various forms of angle closure glaucoma (ACG). However, most reports did not specify the circumferential extent of peripheral anterior synechiae (PAS). Objective: Evaluate IOP after phacoemulsification with intraocular lens (IOL) implantation in chronic ACG patients without extensive PAS. Materials and methods: Data of chronic ACG patients with documented peripheral PAS &lt;180 degrees and clinically significant cataract, who underwent phacoemulsification with IOL implantation at King Chulalongkorn Momorial Hospital between May 2002 and June 2007 were reviewed retrospectively. Baseline characteristics as gender, degree of PAS, IOP, and number of medications were collected. The outcomes were post-operative IOP at 6, 12, and 18 months, and number of hypotensive medications. Results: Twenty-five eyes from 25 patients (mean age: 73.0 years old) were included in this study. Twenty-three out of 25 patients were female, and 17 had PAS less than 90 degrees. Pre-operative mean IOP was 15.6 mmHg, while pre-operative median (Q1, Q3) number of hypotensive medications was 2 (1, 2). After operation, statistically significant lower IOPs were seen at all time points. Mean IOP at 6, 12, and 18 months were 12.4, 11.0, and 11.9 mmHg respectively. In addition, post-operative number of hypotensive medication was also statistically significantly less than baseline, with median (Q1, Q3) 1 (0, 1), and 20% of these eyes were medication-free. Conclusion: Phacoemulsification and IOL implantation surgery alone in chronic ACG patients without extensive PAS can significantly lower IOP up to 18 months postoperatively.