Number Of Postoperative Medications Research Articles

Characteristics of Eyes Requiring Trabeculotomy for Glaucoma With Steroid Treatment: Atopic Dermatitis and Factors Affecting Surgical Outcomes.

The aim is to analyze the surgical outcomes of glaucomatous patients with steroid treatment and investigate the factors, including atopic dermatitis, associated with the surgical success rate. We retrospectively enrolled participants who required first trabeculotomy for glaucoma with steroid treatment between May 2005 and February 2018 and then compared the postoperative outcomes according to the history of atopic dermatitis or surgical procedures. Surgical success was defined as postoperative IOP ≤ 21 mmHg, ≥20% reduction from baseline, and absence of reoperation. The factors influencing the surgical success rates were investigated using mixed-effects Cox regression. The study included 70 eyes of 46 patients (18 eyes of 12 patients with atopic dermatitis). Postoperative intraocular pressure was not significantly different between eyes with and without atopic dermatitis (12 months after the surgery: patients without atopic dermatitis, 15.4 ± 3.6 mmHg; patients with atopic dermatitis, 16.1 ± 3.9 mmHg; P = 0.65). Twelve months after the surgery, the number of postoperative medications was higher in patients with atopic dermatitis than in those without (2.8 ± 1.3 vs. 2.0 ± 1.7; P = 0.060). However, no significant differences were noted in surgical success rates between patients with atopic dermatitis and those without (P = 0.54). Mixed-effects Cox regression of surgical success rate indicated that only the number of preoperative medications significantly influenced surgical success (P = 0.03). Regardless of the presence of atopic dermatitis, patients taking many preoperative glaucomatous medications might require reoperation.

Gelatin implant in the treatment of open-angle glaucoma: Safety and efficacy in real-life conditions

To evaluate the safety and efficacy of the Xen® implant for the treatment of open-angle glaucoma. Retrospective study including patients who received the Xen® implant between January 2019 and December 2020 in a university hospital. Demographic and medical data were collected using DxCare® software. The primary endpoint was a 20% reduction in intraocular pressure (IOP) at 12 months according to Société Française du Glaucome (SFG) recommendations. The secondary endpoints were decrease in glaucoma medications and incidence of adverse events. Fifty-three patients (65 eyes) were included (sex ratio 0.65, age 75.38±7.31 years). IOP decreased by 18.51% from 17.86±4.22mmHg to 14.55±2.66mmHg (P<0.05). The number of glaucoma medications was 2.16±1.01 preoperatively vs 0.49±0.94 postoperatively (P<0.05). Adverse events included 8 malpositionings, 3 of which required reoperation, 1 case of increased IOP resolved by trabeculectomy, 1 case of venous ischemia treated by photocoagulation, 3 choroidal detachments and 3 corneal ulcers. Needling was required for 18 eyes. At 12 months, the IOP was lower than previously reported in the literature (14.55 vs 15.90mmHg, P<0.05), probably due to a lower preoperative IOP. The number of postoperative medications was similar to the literature (0.49 vs 0.40, P=0.51), as was the frequency of needling (27.69% vs 32.00%, P=0.36). The frequency of malpositioning was higher (12.31% vs 7.70%, P<0.05), probably due to the management of complicated patients. The efficacy of Xen® was in line with recommendations. It would be interesting to compare the efficacy of Xen® with trabeculectomy.

Ex-PRESS® surgery versus trabeculectomy for primary open-angle glaucoma with low preoperative intraocular pressure.

To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open-angle glaucoma (POAG) with low preoperative intraocular pressure (IOP). This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤ 16mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed up for > 2years. Both surgeries significantly decreased the IOP (p < 0.001): At 2years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1mmHg, and Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2mmHg. No significant differences were observed in the postoperative IOP (p = 0.076), number of postoperative medications (p = 0.263), success rate (p = 0.900), reduction rate of ECD (p = 0.410), or difference in visual acuity (p = 0.174). The reduction rate of IOP was significantly high in the Trab group (p = 0.047). Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.

The effectiveness of AGV, Ex-PRESS, or trabeculectomy in the treatment of primary and secondary glaucoma: a systematic review and network meta-analysis.

In this study, we compared the efficacy of Ahmed, Ex-PRESS, and trabeculectomy to provide a reference for determining surgical schemes for glaucoma patients undergoing external drainage surgery in clinical practice. We performed a literature search for studies on the treatment of primary and secondary glaucoma with three types of external drainage surgery (Ahmed, Ex-PRESS, and trabeculectomy). As at April 24, 2021, seven electronic databases were searched for randomized controlled trials comparing any two of Ahmed, Ex-PRESS, and trabeculectomy in the treatment of glaucoma. The Cochrane tool was also adopted to evaluate the risk of bias in these trials. The relative risk (RR) with 95% confidence interval (CI), and weighted mean difference (WMD) were determined and compared indirectly using R software. A total of 14 randomized controlled trials were included in this study, involving 866 eyes of 808 patients. As for the intraocular pressure (IOP) after 3 months, trabeculectomy did not contribute to better improvement than Ahmed (WMD =0.014; 95% CI: -0.14-0.18) and Ex-PRESS (WMD =0.014; 95% CI: -0.072-0.097). However, there was a significant difference in the IOP 1 year between trabeculectomy and Ex-PRESS (WMD =0.097; 95% CI: 0.0080-0.18), with the latter achieving a favorable improvement effect. Meanwhile, the complete success (CS) of trabeculectomy was significantly lower than that of Ex-PRESS (RR =0.73; 95% CI: 0.57-0.93). In addition, Ex-PRESS was superior to Ahmed (WMD =-0.48; 95% CI: -0.89 to -0.084) in terms of a decreased number of post-operative medications. For glaucoma patients who are required to receive external drainage surgery, Ex-PRESS could achieve a significant effect on the IOP 1 year and CS, as well as a marked decrease in the number of post-operative medications used, compared with the other two types of surgery. In terms of the efficacy at least 1 year after surgery, Ex-PRESS should be one of the preferred methods for external drainage.

Comparison of Long-Term Effects After Modified CO2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

IntroductionTo compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients.This was a retrospective comparative study.MethodsA total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively.ResultsPatients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group.ConclusionsMCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

Micropulse diode laser cyclophotocoagulation in refractory pediatric glaucoma

Aim The aim of this study was to investigate the safety and long-term efficiency of high-energy-level micropulse diode laser application in the treatment of refractory pediatric glaucoma patients. Patients and methods This is a prospective, noncomparative case series study that included 90 eyes of 90 pediatric patients with glaucoma who were refractory to surgery. Micropulse transscleral cyclophotocoagulation with a high energy level was performed in all cases. The primary outcome measure was intraocular pressure reduction, whereas the secondary outcome measures were complications, number of medications, need for repeated treatment, and number of repetitions over a 24-month follow-up period. Results The mean age of the patients was 5.97±2.63 years, with 57.8% of the cases being females. Primary congenital glaucoma represented 44% of the cases. The intraocular pressure decreased from 27.44±4.3 to 12.38±1.46, 14.72±4.11, 16.96±5.57, 15.76±3.75, 15.01±1.33, and 15.07±1.31 mmHg at 1, 3, 6, 12, 18, and 24 months postoperatively, respectively (P≤0.001). Qualified success was achieved in 77.8% of the cases, whereas complete success was reported in 22.2% of the cases. One session of treatment was sufficient in 46.4% of the cases, whereas a second session was needed in 27.8% of the cases, and a third session was needed in 7.8% of the cases. Repetition of treatment was performed at 6 months in 40.6% of the cases. The number of needed sessions and the number of postoperative medications as well as the success rate did not depend on the etiology of refractory pediatric glaucoma. None of the patients lost vision or had more than two lines decrease of best-corrected visual acuity. No major complications were met. However, uveitis occurred in 25.6% of the cases and subconjunctival hemorrhage in 5.6% of the cases; both were completely treated with medical treatment. Antiglaucoma treatment was significantly decreased postoperatively from three to two types of antiglaucoma eyedrops (P≤0.001). Conclusion Micropulse transscleral cyclophotocoagulation with a high energy level is a safe and long-term effective tool to control refractory pediatric glaucoma. Neither the type nor the cause of refractory glaucoma affects the success rate of this procedure.

Surgical and laser interventions for pseudoexfoliation glaucoma systematic review of randomized controlled trials.

To assess the comparative effectiveness and safety of different surgical and laser techniques in people with pseudoexfoliation glaucoma (PXFG). We conducted a systematic review including randomized controlled trials (RCT) that compared any pair of surgical or laser treatment versus other type of intervention in PXFG. RCT were identified by a highly sensitive search of electronic databases and two individuals independently assessed trial eligibility, abstracted data and assessed risk of bias. We performed Bayesian Meta-Analysis when outcomes were comparable. The search strategy identified 6171 records. Six studies (262 subjects) were included. Two trials analyzed the same pair of surgical interventions comparing phacoemulsification as solo procedure or combined with trabecular aspiration and we performed meta-analysis. Other RCTs compared the following interventions: trabecular aspiration associated with phacoemulsification versus phacotrabeculectomy, non-penetrating deep sclerectomy associated or not with phacoemulsification, selective versus argon laser trabeculoplasty and one-site versus two-site phacotrabeculectomy. For IOP data, none of the trials reported a difference between pairs of surgical techniques, nor changes in visual acuity or number of post-operative medications. The overall risk of bias is moderate to high. There are no apparent differences in efficacy and safety, although with large uncertainty, between surgical or laser techniques for PXFG. Based on the low-quality evidence from the six studies included in this review, it is not possible to justify the preferential use of non-penetrating surgery, MIGS or trabecular aspiration (with or without cataract surgery) in PXFG. Further research is needed to determine the optimal management of this condition.

Effect of postoperative corticosteroids on surgical outcome and aqueous autotaxin following combined cataract and microhook ab interno trabeculotomy

To evaluate the effect of postoperative corticosteroids on surgical outcome and autotaxin (ATX) levels after microhook ab interno trabeculotomy combined with cataract surgery (μLOT-CS), prospective, consecutive non-randomized case series comparing outcomes of 30 eyes with primary open angle glaucoma was performed. The aqueous ATX, intraocular pressure (IOP) and glaucoma medications were monitored for 3 months postoperatively. An in-vivo mouse μLOT model was generated. In vitro, ATX and fibrotic changes induced by dexamethasone (Dex) treatment following scratch (S) in cultured human trabecular meshwork (hTM) cells were assessed by immunofluorescence, immunoenzymatic assay, and RT-qPCR. Postoperative ATX at 1 week and the number of antiglaucoma medications at 3 months were significantly lower in non-steroid group, and steroid use was the only variable significantly associated with postoperative medications at 3 months in multiregression analyses. In vitro, ATX activity was significantly upregulated in the Dex + S group, and αSMA was significantly upregulated in the Dex and Dex + S groups. Fibronectin and COL1A1 were significantly upregulated in the S group. μLOT-CS decreased IOP and medications in the overall cohort, and non-use of postoperative steroids resulted in a smaller number of postoperative medications. Limiting postoperative steroids in μLOT may minimize IOP elevation and postoperative fibrosis.

Initial Glaucoma Medication in the Hypertensive Phase Following Ahmed Valve Implantation: A Comparison of Results Achieved Using Aqueous Suppressants and Prostaglandin Analogs

Background: To compare the effects of aqueous suppressants (AS) and prostaglandin (PG) analogs during the hypertensive phase on intraocular pressure (IOP) and surgical outcomes. Methods: In this retrospective, observational study, 66 eyes (66 patients) with Ahmed glaucoma valve (AGV) implantation were included. As evaluation items, IOP changes, number of postoperative medications, the surgical success rate, and postoperative complications were examined. Complete success was defined as IOP between 6 and 21 mmHg without medications, while qualified success was with a maximum of four medications. Results: The short-term IOP reduction following initial medication was 9.3 mmHg for AS and 4.4 mmHg for PG analogs (p = 0.016). More postoperative medications were used in PG than in AS from postoperative 3 months to 3 years (all p < 0.05). The qualified success rate with the initial medication was higher in AS than in PG (67.5% vs. 42.3% at 1 year, 80.6% vs. 37.5% at 2 years, 80.0% vs. 35.0% at 3 years, all p < 0.05). Conclusions: Association between AS used as the first medications during the hypertensive phase and better IOP control and a higher success rate was observed. The type of the initial glaucoma medication after AGV implantation could affect short- and long-term surgical outcomes.

Autologous Partial-thickness Scleral Flap and Donor Corneal Graft in Management of Tube Erosion of Glaucoma Drainage Device.

To evaluate the outcomes of autologous limbus-hinged partial-thickness scleral flap and half-moon-shaped split-thickness donor corneal allograft in management of tube erosion of glaucoma drainage device. Consecutive patients who had undergone a limbus-hinged partial-thickness scleral flap and half-moon-shaped split-thickness corneal graft were reviewed. Primary outcome was surgical success of coverage of the exposed tube without complications or additional surgeries. Secondary outcomes were visual acuity (VA), intraocular pressure, number of glaucoma medications, surgical complications, and additional surgeries. From March 1, 2016 to August 30, 2017 (18 mo), 8 consecutive cases (7 patients) of tube erosions were included for analysis. Mean follow-up and age were 16.6±5.4 months and 74.4±15.2 years, respectively. Mean number of intraocular surgeries was 4.8±1.6 (range: 3 to 6 surgeries) and intraocular glaucoma surgeries was 2.9±1.7 (range: 1 to 6 surgeries) before tube erosion. There were no intraoperative or postoperative complications or recurrence of tube erosion in any patient. Differences between the preoperative and postoperative number of medications (2.6±1.8, 2.9±1.8, respectively; P=0.171) and intraocular pressure (12.9±6.9, 10.8±3.5 mm Hg, respectively; P=0.209) were not statistically significant. Preoperative and 3-month postoperative VA were identical in all eyes except in 1 eye that the VA improved from 20/300 to 20/70 after repair. Combination of limbus-hinged partial-thickness scleral flap and half-moon-shaped split-thickness corneal allograft is a viable surgical option to repair tube erosion.

P091 STAPLED END-TO-SIDE VS. SIDE-TO-SIDE ANASTOMOSIS AFTER ILEOCECECTOMY FOR CROHN’S DISEASE: A PROPENSITY SCORE-MATCHED ANALYSIS

Ileocolic resection (ICR) is the most common surgical procedure for Crohn’s disease (CD). Anastomotic construction is most commonly achieved with stapled side-to-side (SSTS) or hand-sewn end-to-end anastomosis (ETE), with the decision often made by tissue quality, surgeon experience, and surgeon preference. Another option that combines advantages of both SSTS and ETE, and which is extensively used at our institution, is the Stapled End-to-Side anastomosis (SETS). SETS recapitulates the normal anatomy with the ileum entering the colon at a right angle, and facilitates reconstruction in the face of a lumen size discrepancy between colon and ileum. However, results after SETS have not previously been reported. Therefore, we aimed to compare short-term septic complications and long-term recurrence-free survival of CD between patients who underwent SETS vs. SSTS. This study was a retrospective analysis of a prospectively maintained database over a 5-year period. All patients who underwent resection and anastomosis for terminal ileal CD from 01/2012–12/2016 were included. Patients who had a stoma, or other type of anastomosis were excluded. Surgeries were done for 27 surgeons. The two groups were compared with univariate analysis. Recurrence (Rutgeerts>=i2 or active disease on CT/MRI) rates were assessed using Kaplan-Meier curves and a log-rank test. Cox-proportional hazard and linear regression models with propensity score inverse probability of treatment weighting were used to further evaluate postoperative outcomes and recurrence of CD. Numbers represent median or proportion as noted. A total of 383 patients were analyzed:181 underwent SETS and 202 underwent SSTS. There were no differences between the groups regarding demographics and disease characteristics, except SETS patients had less weight loss (8% vs.15%, p=0.04) and fewer phlegmons (5% vs. 10%, p=0.05). SETS operations were shorter (120 vs.133 min., p=0.02), and fewer were performed laparoscopically (46% vs. 65%, p=0.001). Patients who underwent SETS compared to STSS had surgeons with more years of experience, 23 vs.11 years, p<0.001, respectively. There was no significant difference in any short-term outcome between the two groups on univariate analysis (Fig.1). The Kaplan-Meier analysis (Fig.2) for recurrence showed no difference in recurrence rates. After inverse probability of treatment weighting using the propensity score and number of postoperative medications, there was no significant difference in any of the outcomes between the two groups. At our center, SETS and SSTS anastomoses in patients undergoing ICR for CD, after rigorous adjustment for confounders, were comparable with respect to short-term complications and long-term recurrence rates. Therefore SETS remains a viable method for reconstruction, especially in the case of bowel lumen size mismatch.

P091 STAPLED END-TO-SIDE VS. SIDE-TO-SIDE ANASTOMOSIS AFTER ILEOCECECTOMY FOR CROHN’S DISEASE: A PROPENSITY SCORE-MATCHED ANALYSIS

Ileocolic resection (ICR) is the most common surgical procedure for Crohn’s disease (CD). Anastomotic construction is most commonly achieved with stapled side-to-side (SSTS) or hand-sewn end-to-end anastomosis (ETE), with the decision often made by tissue quality, surgeon experience, and surgeon preference. Another option that combines advantages of both SSTS and ETE, and which is extensively used at our institution, is the Stapled End-to-Side anastomosis (SETS). SETS recapitulates the normal anatomy with the ileum entering the colon at a right angle, and facilitates reconstruction in the face of a lumen size discrepancy between colon and ileum. However, results after SETS have not previously been reported. Therefore, we aimed to compare short-term septic complications and long-term recurrence-free survival of CD between patients who underwent SETS vs. SSTS. This study was a retrospective analysis of a prospectively maintained database over a 5-year period. All patients who underwent resection and anastomosis for terminal ileal CD from 01/2012–12/2016 were included. Patients who had a stoma, or other type of anastomosis were excluded. Surgeries were done for 27 surgeons. The two groups were compared with univariate analysis. Recurrence (Rutgeerts>=i2 or active disease on CT/MRI) rates were assessed using Kaplan-Meier curves and a log-rank test. Cox-proportional hazard and linear regression models with propensity score inverse probability of treatment weighting were used to further evaluate postoperative outcomes and recurrence of CD. Numbers represent median or proportion as noted. A total of 383 patients were analyzed:181 underwent SETS and 202 underwent SSTS. There were no differences between the groups regarding demographics and disease characteristics, except SETS patients had less weight loss (8% vs.15%, p=0.04) and fewer phlegmons (5% vs. 10%, p=0.05). SETS operations were shorter (120 vs.133 min., p=0.02), and fewer were performed laparoscopically (46% vs. 65%, p=0.001). Patients who underwent SETS compared to STSS had surgeons with more years of experience, 23 vs.11 years, p<0.001, respectively. There was no significant difference in any short-term outcome between the two groups on univariate analysis (Fig.1). The Kaplan-Meier analysis (Fig.2) for recurrence showed no difference in recurrence rates. After inverse probability of treatment weighting using the propensity score and number of postoperative medications, there was no significant difference in any of the outcomes between the two groups. At our center, SETS and SSTS anastomoses in patients undergoing ICR for CD, after rigorous adjustment for confounders, were comparable with respect to short-term complications and long-term recurrence rates. Therefore SETS remains a viable method for reconstruction, especially in the case of bowel lumen size mismatch.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors related to hypertensive phase after glaucoma drainage device implantation.

BackgroundThe aim of the study was to evaluate factors related to hypertensive phase (HP) after glaucoma drainage device (GDD) implantation.Patients and methodsRetrospective charts review of glaucoma patients who underwent GDD implantation and completed 12 months of follow-up at King Chulalongkorn Memorial Hospital since 2004 was performed. Patients were divided into two groups according to the presence or absence of HP. The data were analyzed for factors associated with HP. The surgical outcomes including surgical failure, post-operative visual acuity (VA), post-operative number of medications, post-operative intraocular pressure (IOP), and post-operative complication were compared between the two groups.ResultsSeventy-two patients were included. Most were diagnosed with secondary glaucoma (N=51, 70.8%), and Baerveldt was the most implanted GDD (N=49, 68.1%). Mean ± SD of IOP was significantly lower: 27.1±9.6 mmHg at pre-operation and 13.7±59 mmHg at 12-month follow-up (p<0.001). HP was identified in 38/72 patients (52.8%, 95% CI 40.7–64.7). Risk factor of HP was pre-operative VA equal or better than 20/70 (p=0.021, OR 7.5; 95% CI 1.4–41.4). Presence of underlying heart disease (patients in this group had taken anti-platelets) was found as a protective factor for HP (p=0.027, OR 0.06; 95% CI 0.00–0.72). It was speculated that the anti-inflammatory effect of the anti-platelets, particularly aspirin, may be responsible for controlling inflammation and retarding fibrosis formation around drainage implants. Failure rate at 12 months was 24/72 (33%). There was no difference in all surgical outcomes between the two groups. Survival analysis also showed no significant difference between HP and non-HP group.ConclusionHP commonly occurred after GDD implantation. Pre-operative VA was a risk factor for the development of HP, whereas presence of underlying heart disease was a protective factor. No association between HP and surgical outcomes was identified.

Argon laser trabeculoplasty (ALT) for advanced glaucoma: A 12 months follow‐up study

AbstractPurpose ALT has been used for lowering the intraocular pressure (IOP) for over 25 years. The aim of this study was to investigate the safety and efficacy of ALT in cases of advanced glaucoma unsuitable for surgery due to ocular or systemic conditions.Methods This retrospective observational study had the following inclusion criteria: advanced POAG with uncontrolled IOP, maximum medical treatment, previously failed ALT or filtration surgery and unsuitability for surgical intervention due to ocular or systemic comorbidities. The data collected included: pre‐ and postoperative number of medications, visual acuity (VA), visual fields mean deviation (VF MD), IOP and adverse events during the study period. All ALT treatments were carried out by the same clinician.Results A total of 40 patients (40 eyes; mean age: 79 years; range 56‐92 years) were identified. The number of medications remained unchanged in 75% patients, decreased by 2‐4 medications in 12.5% of patients and increased by 1‐2 in 12.5% of patients. Mean Log MAR VA (baseline 0.27±SD 0.45; final 0.19±SD 0.3) and the VF MD (baseline ‐9.17±SD 8.9; final ‐9.45±SD 9.3) did not change significantly over the 12 months study period (Log MAR p=0.29; VF MD p=0.18). The change in IOP was statistically significant, p=0.00018 (p&lt;0.001), with an average IOP reduction by 18.14% at 12 months. In 76% of patients the mean IOP decreased by 6 mmHg and in 47.5% of patients the final IOP was lower than 16mmHg. No adverse events were observed during the study.Conclusion ALT appeared safe and effective in lowering the IOP in cases of advanced glaucoma unsuitable for surgery.