Number Of Topical Antiglaucoma Medications Research Articles

One-year outcome of goniotomy with Kahook Dual Blade in primary open-angle glaucoma patients

Objectives: The objective is to describe a -year outcome of goniotomy using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with primary open-angle glaucoma (POAG) either as a standalone or plus phacoemulsification (phaco). Material and Methods: We reviewed 12 eyes of 9 patients who had goniotomy with KDB either as a standalone or combined with cataract surgery by phaco from April 2017 to July 2018 at Eye Foundation Hospital, Ikeja, Lagos. The patients were followed for a minimum of 12 months. Results: The mean age of the patients was 66.4 ± 8.8 years. The mean pre-operative intraocular pressure (IOP) for all eyes was 18.58 ± 5.42 mmHg. After 12 months of follow-up, the mean IOP was 14.27 ± 5.22 mmHg, representing a drop of 4.31 mmHg (23.2%) from baseline. For the Phaco+KDB group, the mean IOP changed from 19.25 ± 4.56 mmHg to 15.0 ± 6.03 mmHg for the same period, representing a reduction of 4.25 mmHg (22.1%) from baseline, and for the KDB as a standalone, the mean IOP change was 4.25 mmHg (24.6%) from baseline (17.25 ± 7.45 to 13.0 ± 3.83 mmHg). For all eyes, the mean number of topical antiglaucoma medications dropped by 0.88 (36.4%) from 2.42 ± 0.90 to 1.54 ± 1.51, whereas for the Phaco+KDB group, the topical antiglaucoma medications were reduced by 1.17 (46.8%) from 2.50 ± 0.93 to 1.33 ± 1.50. However, there was no change in the number of topical antiglaucoma medications in the KDB group after 12 months of follow-up (2.25 ± 0.96 to 2.25 ± 1.50). Transient hyphema in one and posterior capsular opacity (PCO) were the only recorded post-operative complications. Conclusion: KDB, either as a standalone or with phaco, recorded at least a 20% reduction in IOP after one year of follow-up in these series.

Early and Late Complications of Ahmed Glaucoma Valve Implant in a Real-World Situation

Purpose: To determine the early and late complications of Ahmed Glaucoma Valve (AGV) implant surgery. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology department of MTI-Hayatabad Medical Complex Peshawar, from May 2018 to February 2023. Methods: All the patients between May 2018 and February 2023 who underwent AGV implant were included in the study. Data included patient's age, gender, indications for surgery, type of AGV implant used, length of follow-up period, intraocular pressure (IOP), number of topical glaucoma medications used, early and late complications, and the final outcome. Continuous variables (duration of follow-up, best corrected visual acuity, IOP, and number of topical anti-glaucoma medications) were represented in means and standard deviations. Paired t-test was applied for comparison of means between baseline and last follow-up data. A p-value of < 0.05 was considered statistically significant. Results: A total of 28 eyes were included. Mean age of the patients were 28.75 ± 20.5 years. Duration of follow-up was 213.96 ± 169.33 days. There were 53.85% females. Commonest indication was congenital glaucoma 7 (25%). Majority, (n = 18, 64.3%) of the eyes had previous cataract surgeries followed by glaucoma, 13 (46.4%). The commonest early post-operative complication was hyphema (25%) and commonest late complication was hypertensive episode 32.1%. Majority of the eyes 23 (82.1%) did not require any further intervention for these complications. Conclusion: Majority of AGV complications are self-limiting, necessitating just conservative therapy. However, serious complications might happen that could lead to blindness, therefore the surgeons should have strategies for treating or preventing them.

Micropulse vs. continuous wave transscleral cyclophotocoagulation in neovascular glaucoma.

Neovascular glaucoma (NVG) is a refractory form of glaucoma, associated with important morbidity, for which no consensus exists regarding the optimal choice of therapy. The primary aim of our study was to compare the performances of micropulse transscleral cyclophotocoagulation (MP-TSCPC) and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) in the treatment of neovascular glaucoma (NVG). A total of 24 eyes for MP-TSCPC and 22 eyes for CW-TSCPC, all with NVG were included. The procedures were performed using either the Iridex Cyclo G6 (IRIDEX Laser System), the MP3, or the G-Probe devices. Intraocular pressure (IOP), visual acuity (VA), the mean number of antiglaucoma medications, and postoperative complications were monitored. The minimum follow-up was 12 months. The success rate at 12 months was 54.5% in the CW-TSCPC group and 33.3% in the MP-TSCPC group. The mean IOP at baseline was 35.82 mm Hg for CW-TSCPC and 34.71 mm Hg for MP-TSCPC. The change from baseline in IOP at 12 months was 11.95 mm Hg in the CW-TSCPC group and -8.04 mm Hg in the MP-TSCPC group. There was a significant difference in the occurrence of serious complications (worsening of VA, hypotony, and phthisis bulbi) between the two methods, with CW-TSCPC associated with more important adverse effects (P=0.045). There was a decrease in the number of topical antiglaucoma medications in both groups: in the MP-TSCPC group from a mean number of 2.6 at baseline, to 1.7 at 3 months, followed by a slight increase to 2.1 at 12 months and in the CW-TSCPC group from 2.8 at baseline, to 1.4 at 3 months and 1.9 at 12 months. Our study concluded that both MP-TSCPC and CW-TSCPC could manage NVG, but, while CW-TSCPC revealed higher IOP control in the long term (which did not reach statistical significance), it also had a significantly lower safety profile.

Ocular surface disease in glaucoma patients on topical medications and its relation to duration of treatment and number of medications

Background: Topical antiglaucoma medications can alter the tear film and lead to ocular surface disease (OSD). Aim: This study was done to check for the presence of OSD in patients of glaucoma on topical antiglaucoma medications and to analyze the severity of OSD with duration of treatment and number of topical antiglaucoma medications. Setting and Design: This is a prospective observational study in a tertiary care hospital. Materials and Methods: The study was undertaken in 54 eyes of 54 glaucoma patients taking antiglaucoma medications for at least 6 months and control group of 54 subjects. All the participants were assessed for OSD by ocular surface disease index (OSDI) questionnaire, Schirmer's 1 test, and tear break up time test (TBUT). Statistical Analysis: Mean and percentage were used to analyze the variables. Comparison analysis was done with analysis of variance test. P < 0.05 was considered significant. Results: The prevalence of OSD in patients of glaucoma on topical antiglaucoma medications was found to be 74%, 69%, and 83% based on OSDI questionnaire, Schirmer's test, and TBUT test, respectively. There was increase in severity of OSD with increased duration of treatment and increase in number of topical antiglaucoma medications. Conclusion: Most patients of glaucoma on topical antiglaucoma medications were having OSD. Severity of OSD is directly proportional to duration of treatment and number of drugs used.

Mid-term evaluation of the safety and efficacy of the iStent trabecular micro-bypass system combined with phacoemulsification.

Micro-invasive glaucoma surgery (MIGS) and MIGS devices have been gaining increasing attention in recent years. One such device is the trabecular micro-bypass stent, or iStent® (Glaukos Corporation, Laguna Hills, USA). To evaluate the safety and efficacy of the minimally invasive ab interno surgical implantation of a trabecular bypass during cataract surgery in reducing intraocular pressure (IOP) in patients with mild and moderate open-angle glaucoma and cataracts. The study was a prospective, uncontrolled, interventional case series (a prospective study of a case series), including 54 patients with a mean age of 72 years. All subjects underwent ab interno implantation of a single iStent together with cataract surgery. The corrected distance visual acuity (CDVA), IOP, anti-glaucoma medications, visual field, and number and type of complications were investigated after surgery. The patients were followed up at 1, 7, and 30 days, and 3, 6, 12, 24 and 36 months after the operation. The mean observation time was 20 months. At baseline, CDVA was 0.5 or better in 65% of the eyes; this improved to 0.5 or better in all eyes (0.8 or better in 79%) at the end of the observation. The mean baseline IOP was 17.1 mm Hg, which fell to a mean of 15.1 mm Hg. The mean number of medicinal eye drops prescribed preoperatively was 1.7, which decreased to 0.26 at the end of the observation. Cataract surgery combined with iStent implantation seems to be an effective procedure in patients with mild to moderate open-angle glaucoma and cataracts. The insertion of 1 stent resulted in a significant decrease in IOP and a reduction in the number of topical anti-glaucoma medications needed. Based on the characteristics of the observed complications, iStent implantation can be considered a safe method.

Assessment of Ocular Surface Disease in Glaucoma Patients in Ghana.

Dry eye disease (DED) observed in this study is associated with ocular surface abnormalities as shown by specific dry eye tests. Changes in tear quality may be responsible for dry eye symptoms among the participants. This study sought to evaluate DED in glaucoma patients in Ghana. This was a hospital-based descriptive cross-sectional study involving glaucoma patients on topical glaucoma treatment for at least 6 months. The medical records of participants were thoroughly reviewed for information on demographics, ocular history, medical history, number of topical antiglaucoma medications used within the last 6 months, and any other ophthalmic medications used by the participants. An Ocular Surface Disease Index (OSDI) questionnaire was administered to each participant, after which Schirmer test and tear break-up time (TBUT) were performed on each participant in a controlled environment. A total of 100 individuals participated in the study. The mean±SD age of participants was 60.44±14.05 years. The majority (60.0%) of the participants were females and 55.0% of participants used 2 or more topical antiglaucoma medication. Of the participants, 81.0% reported subjective dry eye symptoms. Schirmer test and TBUT showed that 55.0% and 87.0% of the participants had decreased tear production and abnormal tear quality, respectively. Multiple logistic regression showed a significant association between age and abnormal OSDI (P=0.037), Schirmer test (P=0.003), and TBUT (P=0.042); the number of topical glaucoma medications and OSDI (P=0.016) and Schirmer test (P=0.009). The prevalence of DED was 23.0%. Increasing age was associated with an ∼7 times higher odds of having DED (P=0.0019), using >2 glaucoma medications with ∼4.5 times higher odds of having DED (P=0.001), 5 or more years of glaucoma medication use with ∼4 times higher odds of DED (P=0.009), and both benzalkonium chloride and sodium chlorite as preservative was associated with ∼3.5 times higher odds of DED (P=0.047). DED is prevalent among glaucoma patients in Ghana and is associated with age, duration of glaucoma medication, type of preservatives, and number of topical glaucoma medications.

EX-PRESS shunt implantation in Chinese glaucoma patients: 1-year results

Aim: To report the safety and efficacy of EX-PRESS glaucoma filtration device implantation in Chinese glaucoma patients.Methods: Records of 38 eyes from 38 Chinese glaucoma patients who underwent EX-PRESS shunt implantation between August 2012 and June 2014 with at least 1 year of follow-up were retrospectively reviewed. Main outcome measures included intraocular pressure (IOP), visual acuity, success rate, number of topical antiglaucoma medications applied, and postoperative complications.Results: The mean IOP reduced significantly from 25.8±12.4 mmHg before surgery to 15.1±6.3 mmHg at 1 year after surgery (p<0.005). Repeated measures ANOVA showed that IOP at all time points after surgery was significantly lower than IOP before surgery. 73.7% of patients achieved complete or qualified success.Conclusions: EX-PRESS shunt implantation is safe and effective in Chinese patients.

Long-term intraocular pressure after combined trabeculotomy-trabeculectomy in glaucoma associated with Sturge-Weber syndrome.

Vision loss in Sturge-Weber syndrome (SWS), a rare congenital disorder, is primarily due to glaucoma. We reviewed the data of all consecutive SWS-associated glaucoma cases in patients who had undergone combined trabeculotomy-trabeculectomy (CTT) at a tertiary glaucoma facility between January 1993 and December 2015. We analyzed the preoperative and postoperative intraocular pressure (IOP), corneal clarity, visual acuity, success rate, need for repeat surgery, and number of topical antiglaucoma medications needed at last follow-up. Twenty-six eyes of 20 patients with SWS (surgical age 0.7-96 months; mean 18.64 ± 29.74 months) had undergone primary CTT. The mean preoperative IOP was 32.76 ± 7.86 mm Hg (range 22-54 mm Hg) with medication (mean 3.11 ± 1.17; range 1-5). At the last follow-up (61-288 months); mean SD 134.73 ± 67.77 months), two eyes had IOP <6 mm Hg. Twenty-four eyes analyzed had an IOP of 13.63 ± 6.11 (mean ± SD; range 9-41) mm Hg. All these had an IOP <15 mm Hg at last follow-up except one, which had an IOP of 41 mm Hg. There was a mean reduction of 54.62% ± 31.33% in IOP from baseline. The antiglaucoma medication score at last follow-up visit was 0-3. No eye achieved predefined complete success or modified complete success. A total of 41.7% (10/24) of eyes attained both qualified and modified qualified success. Eleven eyes needed repeat surgeries. No intraoperative complications were noted. Visual acuity was below 6/60 in four eyes. Combined trabeculotomy-trabeculectomy showed promising results as a treatment for SWS-associated glaucoma in children. Long-term visual and surgical outcomes are encouraging.

Microinvasive Glaucoma Stent (MIGS) Surgery With Concomitant Phakoemulsification Cataract Extraction: Outcomes and the Learning Curve.

To evaluate learning effects with respect to outcomes of a microinvasive glaucoma stent (MIGS) inserted during cataract surgery in glaucoma patients. Single surgeon, observational cohort study of 25 consecutive Ivantis Hydrus microstent insertions, with a minimum follow-up of 12 months. A learning curve analysis was performed by assessing hypotensive effect, adverse effects, and surgical procedure duration, with respect to consecutive case number. Success was defined with respect to various intraocular pressure (IOP) targets (21, 18, 15 mm Hg) and reduction in required antiglaucoma medications. Complete success was defined as achieving target IOP without antiglaucoma therapy. No clinically significant adverse events or learning effects were identified, although surgical time reduced with consecutive case number. Mean follow-up was 16.8 months. At final follow-up the mean IOP for all eyes was reduced from 18.1 (±3.6) mm Hg [and a simulated untreated value of 25.9 (±5.2) mm Hg] to 15.3 (±2.2) mm Hg (P=0.007; <0.0001) and the mean number of topical antiglaucoma medications was reduced from 1.96 (±0.96) to 0.04 (±0.20) (P<0.0001). Complete success (IOP<21 mm Hg, no medications) was 96% at final follow-up. Complete success (IOP<18 mm Hg, no medications) was 80% at final follow-up, but only 32% with a target IOP of <15 mm Hg (no medications). No significant learning curve effects were observed for a trained surgeon with respect to MIGS microstent insertion performed at the time of cataract surgery. Adjunctive MIGS surgery was successful in lowering IOP to <18 mm Hg and reducing/abolishing the requirement for antiglaucoma medication in eyes with open-angle glaucoma, but less successful at achieving low IOP levels (<15 mm Hg).

Medium-term Outcomes of Unsutured Scleral Flap Trabeculectomies.

To examine the clinical characteristics and medium-term outcomes of unsutured scleral flap trabeculectomies. A retrospective review of 45 patients who underwent 50 unsutured scleral flap trabeculectomies by a single ophthalmic surgeon. Information pertaining to each patient's demographic details, preoperative assessment, surgical procedure, and 2 years of postoperative management were obtained. The average age of patients was 72.4±12.5 (range, 30 to 97) years. The diagnosis was primary open-angle glaucoma in 38 (76.0%) cases. The average preoperative, 1 year postoperative and 2-year postoperative intraocular pressure (with number of topical antiglaucoma medications) were 20.8 (2.5), 13.2 (0.4), and 12.6 mm Hg (0.7), respectively. The procedure performed was a trabeculectomy alone in 32 (64.0%) cases, and combined trabeculectomy and phacoemulsification in 18 (36.0%) cases. Four were performed with mitomycin C. Three procedures (6%) had intraoperative complications (2 iris prolapses, 1 subconjunctival hemorrhage). Seven procedures were complicated by a postoperative choroidal detachment, which were managed conservatively and resolved spontaneously over time. There was 1 case (2%) of postoperative hypotony, which failed to resolve (intraocular pressure of <6 mm Hg for >3 months). The majority of unsutured scleral flap trabeculectomies had an acceptable risk profile and resulted in a decrease in the intraocular pressure at 2 years postoperatively.

Trabekulotomie ab interno (Trabectome) – Kumulierte klinische Ergebnisse eines großen Glaukomkollektivs

To assess the outcome of routine trabectomy surgery in the treatment of primary (POAG) and secondary open angle glaucoma. 296 eyes of 296 patients with diagnosed open angle glaucoma and exfoliative glaucoma were analysed from June 2012 until June 2014. IOP readings (intraocular pressure) and the number of antiglaucoma medications was evaluated at every follow-up visit. For statistical analysis, 4 study cohorts were built (cohort 1 = trabectomy in POAG, cohort 2 = trabectomy in exfoliative glaucoma (PEX), cohort 3 = trabectomy + IOL in POAG, cohort 4 = trabectomy + IOL in PEX glaucoma). Mean IOP before trabectomy surgery was 19.8 ± 5.9 mmHg and 23.7 ± 9.5 mmHg in cohorts 1 and 2, respectively. At 1 year follow-up, IOP was reduced to normal level for cohorts 1 and 2 (14.8 ± 3.2 mmHg (p = 0.001) and 14.0 ± 3.3 mmHg (p = 0.046), respectively). The number of topical antiglaucoma medications changed to 2.1 ± 1.2 (p = 0.004) and 2.4 ± 1.2, respectively (p = 0.593) at one year follow-up, respectively, for POAG and exfoliative glaucoma. In study cohort 3 and 4, mean IOP before trabectomy surgery was 19.2 ± 4.0 mmHg and 23.2 ± 9.2 mmHg, respectively. At 1 year follow-up, IOP was reduced to normal levels in cohorts 3 and 4 (11.8 ± 3.1 mmHg (p < 0.01) and 12.6 ± 1.1 mmHg, respectively (p = 0.043)); the number of topical antiglaucoma medications changed to 2.3 ± 1.4 (p = 0.469) and 1.4 ± 0.8, respectively, (p = 0.102) at 1 year follow-up. A significant difference in IOP reduction could be demonstrated in POAG between the trabectomy + IOL group and the trabectomy cohort 1 year postoperative (p = 0.017); in the PEX trabectomy + IOL versus PEX trabectomy cohort no statistically significant difference (p = 0.678) could be demonstrated. No serious postoperative complications were recorded. Trabectomy surgery seemed to be a reliable and effective tool for the management of mild and moderate primary and secondary open angle glaucoma with uncontrolled IOP in daily routine. One year follow-up showed a significant reduction in intraocular pressure in all cohorts.

Selective laser trabeculoplasty: Results on intraocular pressure and number of topical antiglaucoma medications

PurposeTo evaluate results at one year of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) and assess if differences are related to number of topical treatments in ocular hypertension (OHT) and open angle glaucoma (OAG) patients.MethodsWe performed a retrospective chart review of 106 eyes treated by SLT. Indications for SLT treatment were insufficient IOP control, allergy, discomfort or non‐compliance to antiglaucoma treatment. Only patients with at least 1 year of follow‐up after SLT were included. IOP was measured before and at 1, 6 and 12 months after SLT. All IOP measurements were performed with Goldmann applanation tonometry.Results106 eyes of 68 patients untreated (n = 13), or treated with one (n = 25), two (n = 39) or three (n = 28) topical antiglaucoma medications were included. Mean preoperative IOP was 19.4 ± 3.6 mmHg (respectively 21.1 ± 2.7, 19.8 ± 3.1, 19.1 ± 4.2 and 18.9 ± 3.4 mmHg corresponding to the group without, one, two or three treatments) and 15.7 ± 3.1 mmHg at 12 months (respectively 16.2 ± 3.5, 15.6 ± 2.6, 15.6 ± 3.4 and 15.5 ± 2.8 mmHg for each groups) which corresponds to an average decrease of 18.3% (respectively 23.7%, 19.7%, 17.2% and 16.1% for each groups). At 1 year, 62.2% (n = 66) were responders (≥3 mmHg reduction from baseline IOP = 15.5% of IOP baseline): 92.3% without treatment (n = 12), 68% with one (n = 17), 59% with two (n = 23) and 50% with three treatments (n = 14). The average IOP of responders decreased from 20.7 ± 3.4 to 15.2 ± 2.9 mmHg (26.6%), respectively from 20.8 ± 2.6 to 15.8 ± 3.2 (25%) without treatment, from 20.6 ± 3.2 to 14.9 ± 3.7 (27.3%) with one, from 20.8 ± 4.1 to 15.5 ± 3.3 (25.1%) with two and from 20.7 ± 3.2 to 14.4 ± 2.4 mmHg (29.7%) with three treatments.ConclusionsLowering of IOP and number of responders after SLT appears to be more important un OHT and OAG patients with less topical antiglaucoma treatment.

Outcomes of Ahmed valve implant following a failed initial trabeculotomy and trabeculectomy in refractory primary congenital glaucoma.

Purpose:The aim was to report the outcome of Ahmed glaucoma valve (AGV) (New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation as a surgical intervention following an initial failed combined trabeculotomy + trabeculectomy (trab + trab) in refractory primary congenital glaucoma (RPCG).Materials and Methods:Retrospective chart review of 11 eyes of 8 patients who underwent implantation of AGV (model FP8) for RPCG between 2009 and 2011. Prior trab + trab had failed in all the eyes. Success was defined as an intraocular pressure (IOP) >5 and ≤ 18 mmHg during examination under anesthesia with or without medications and without serious complications or additional glaucoma surgery.Results:The mean age at AGV implantation was 15.4 ± 4.9 months. The mean preoperative IOP was 28 ± 5.7 mmHg which reduced to 13.6 ± 3.4 mmHg postoperatively at the last follow-up (P < 0.0001). The number of topical antiglaucoma medications reduced from a mean of 2.6 ± 0.5 to 1.6 ± 0.9 postoperatively (P = 0.009). The definition of qualified success was met in 10 (90%) eyes. One eye developed a shallow anterior chamber with choroidal detachment at 1-week, which resolved spontaneously with medications. None of the eyes developed a hypertensive phase. One eye had a long tube resulting in tube corneal touch that required trimming of the tube. One eye developed tube retraction, which was treated with a tube extender. The mean follow-up was 17.9 ± 9.3 (6.2-35.4) months.Conclusion:Managing RPCG remains a challenge. AGV implant was successful in a significant proportion of cases.

The association between clinical parameters and glaucoma-specific quality of life in Chinese primary open-angle glaucoma patients

OBJECTIVE. To investigate the association between clinical measurements and glaucoma-specific quality of life in Chinese glaucoma patients. DESIGN. Cross-sectional study. SETTING. An academic hospital in Hong Kong. PATIENTS. A Chinese translation of the Glaucoma Quality of Life-15 questionnaire was completed by 51 consecutive patients with bilateral primary open-angle glaucoma. The binocular means of several clinical measurements were correlated with Glaucoma Quality of Life-15 findings using Pearson's correlation coefficient and linear regression. The measurements were the visual field index and pattern standard deviation from the Humphrey Field Analyzer, Snellen best-corrected visual acuity, presenting intra-ocular pressure, current intra-ocular pressure, average retinal nerve fibre layer thickness via optical coherence tomography, and the number of topical anti-glaucoma medications being used. RESULTS. In these patients, there was a significant correlation and linear relationship between a poorer Glaucoma Quality of Life-15 score and a lower visual field index (r=0.3, r(2)=0.1, P=0.01) and visual acuity (r=0.3, r(2)=0.1, P=0.03). A thinner retinal nerve fibre layer also correlated with a poorer Glaucoma Quality of Life-15 score, but did not attain statistical significance (r=0.3, P=0.07). There were no statistically significant correlations for the other clinical parameters with the Glaucoma Quality of Life-15 scores (all P values being >0.7). The three most problematic activities affecting quality of life were "adjusting to bright lights", "going from a light to a dark room or vice versa", and "seeing at night". CONCLUSION. For Chinese primary open-angle glaucoma patients, binocular visual field index and visual acuity correlated linearly with glaucoma-specific quality of life, and activities involving dark adaptation were the most problematic.

Endocyclophotodestruction in glaucoma patients undergoing combined surgery of pars plana vitrectomy and phacoemulsification.

BackgroundThe purpose of this trail was to assess the effect of a novel intraoperative endocyclophotodestruction method on intraocular pressure in patients undergoing combined procedure of phacovitrectomy to determine the efficacy of this combined surgical approach.Material/MethodsThe study sample included 87 subjects divided into 2 groups: Group I consisted of 52 patients who underwent intraoperative endocyclophotodestruction performed during phacovitrectomy. Group II consisted of 35 controls. The follow-up duration was 12 months. The preoperative (baseline) intraocular pressure (IOP) was determined and later assessed postoperatively at the following time points: on 1 day and at 1, 2, 3, 6, and 12 months. Other evaluated parameters were the number of topical antiglaucoma medications, and the cyclophotodestruction circumference-to-outflow resistance ratio (R).ResultsThe mean postoperative reduction of intraocular pressure was by 4.26 mmHg at 6 months and by 4.91 mmHg at 12 months. The number of topical antiglaucoma medications was reduced postoperatively from the mean preoperative value of 1.66 to 0.69 at 6 months and 1.04 at 12 months.ConclusionsThe results show a significant reduction of intraocular pressure in patients undergoing the combined triple-procedure surgery and postoperative decrease in the number of topical medications. The best outcomes in terms of IOP decrease and reduced number of medications were achieved in patients with low outflow coefficient. Endocyclophotodestruction is an alternative IOP-reducing technique to be used in patients with glaucoma who require phacovitrectomy. It is recommended for patients with low outflow coefficient in whom posterior pole abnormalities constitute the main indications for surgery.

The Norwich Trabeculectomy Study: Long-term Outcomes of Modern Trabeculectomy with Respect to Risk Factors for Filtration Failure

Objective: The aim of the study was to evaluate the long-term outcomes of a large series of ‘modern’ trabeculectomies with specific respect to traditional risk factors for failure. Methods: 636 consecutive ‘modern’, augmented ‘safe-technique’ trabeculectomies performed over an 11-year period (1998-2008) were assessed in a single centre, observational, cohort study. Traditional risk factors for failure (previous surgery, long-term exposure to topical medication, young age, secondary glaucoma and trainee surgeon) were assessed using various success outcome criteria. Success survival was defined with respect to various intraocular pressure (IOP) targets, using criteria for both complete and two categories of qualified success. A multivariate logistic regression analysis was performed to account for the significant number of patients with more than one risk factor. Results: The mean follow-up period was 65.5 (± 35.7) months. At final follow-up the mean IOP for all eyes was reduced from 23.4 (± 6.2) mmHg pre-operatively to 11.9 (± 4.2) mmHg (p<0.001) and the mean number of topical anti-glaucoma medications was reduced from 2.3 to 0.4 (p<0.001). Complete success rates were 65% (IOP ≤ 15 mmHg, no medications) and 71% (IOP ≤ 21 mmHg, no medications) at final follow-up. Qualified success rates varied from 78% to 97%, depending on IOP threshold. Outcomes for the various risk factor groups were compared with a ‘risk-free’ control group. Overall, traditional risk factors for failure did not significantly influence outcome for the various success criteria, but surgery performed by trainee surgeons had less satisfactory outcomes compared to surgery performed by a more senior surgeon. Clinic-based post-operative interventions were more frequently required in eyes with ‘traditional’ risk factors for failure. Conclusions: In a large cohort of mainly Caucasian patients, appropriately augmented, ‘modern’, ‘safetechnique’ trabeculectomy was highly successful and, together with ‘modern’ post-operative management, appeared to annul the effect of most ‘traditional’ risk factors for failure such as previous surgery, long-term exposure to topical medication, relative youth and secondary glaucoma.

Manchester iStent study: early results from a prospective UK case series

To evaluate the 6-month efficacy and safety of the iStent microtrabecular bypass stent in patients with open-angle glaucoma. A prospective, uncontrolled, interventional case series. Forty-four eyes with open-angle glaucoma were reported. All subjects underwent ab interno implantation of a single iStent together with (n = 40) or without (n = 4) cataract surgery. Patients were assessed at postoperative week 1, months 1 and 3, and quarterly, thereafter. Data collected included visual acuity, intraocular pressure measurement using Goldmann tonometry, number of glaucoma medications, and number and type of complications. The mean age of the sample was 76.8 years. The mean duration since glaucoma diagnosis was 5.3 years (standard deviation 2.9 years). The mean visual acuity was 0.53 logMAR at baseline that improved to 0.23 at 6 months postoperatively. The mean baseline intraocular pressure was 21.1 mmHg, and this decreased significantly to 16.7 mmHg at 6 months (P < 0.01). The mean number of drops prescribed preoperatively was 2.3, which decreased to 0.6 at 6 months (P < 0.01). Sixty-six per cent of patients were drop-free at 6 months. One patient developed an hyphaema following surgery; no other adverse events were recorded. The iStent proved to be a safe and effective treatment for patients with open-angle glaucoma over our 6-month follow up period. Insertion resulted in a significant decrease in intraocular pressure as well as the number of topical antiglaucoma medications required for adequate intraocular pressure control.