Outcome Of Glaucoma Surgery Research Articles

Predicting Glaucoma Surgical Outcomes Using Neural Networks and Machine Learning on Electronic Health Records.

To develop machine learning (ML) and deep learning (DL) models to predict glaucoma surgical outcomes, including postoperative intraocular pressure, use of ocular antihypertensive medications, and need for repeat surgery. We identified glaucoma surgeries performed at Stanford from 2013-2024, with two or more postoperative visits with intraocular pressure (IOP) measurement. Patient features were identified from the electronic health record (EHR), including demographics, prior diagnosis and procedure codes, medications and eye exam findings. Classical ML and DL models were developed to predict which glaucoma surgeries would result in surgical failure, defined as (1) IOP not reduced by more than 20% of preoperative baseline on two consecutive postoperative visits, (2) increased classes of glaucoma medications, and (3) need for additional glaucoma surgery or revision of original surgery. A total of 2398 glaucoma surgeries of 1571 patients were included, of which 1677 surgeries met failure criteria. Random forest performed best for prediction of overall surgical failure, with accuracy of 75.5% and area under the receiver operator curve (AUROC) of 76.7%, similar to the deep learning model (accuracy 75.5%, AUROC 76.6%). Across all models, prediction performance was better for IOP outcomes (AUROC 86%) than need for an additional surgery (AUROC 76%) or need for additional glaucoma medication (AUC 70%). ML and DL algorithms can predict glaucoma surgery outcomes using structured data inputs from EHRs. Models that predict outcomes of glaucoma surgery may one day provide the basis for clinical decision support tools supporting surgeons in personalizing glaucoma treatment plans.

Three-component tear substitute as preoperative support in glaucoma surgery

This study investigates the effect of preoperative preparation with the three-component tear substitute Stillavit on the outcomes of glaucoma surgery in patients on long-term topical glaucoma therapy. The study included 63 patients (63 eyes) with glaucoma, among them 30 (30 eyes) were women and 33 (33 eyes) were men. Group 1 consisted of 33 patients (33 eyes) receiving long-term topical antihypertensive therapy with preservatives and tear substitute Stillavit 3 times a day for 1 month as preoperative preparation. Group 2 included 30 patients (30 eyes) receiving similar antihypertensive therapy who were not prescribed preoperative medications. All patients underwent a comprehensive ophthalmological examination and computer tomography of the filtering blebs (FB) on Visante system (Carl Zeiss Meditec, Germany) before surgery, as well as 1 week, 1, 3, and 6 months after surgery. Mean intraocular pressure (IOP) elevation at 6 months postoperatively was significantly higher in the group that did not undergo preoperative preparation with a tear substitute, compared to the group of patients who received the tear substitute Stillavit preoperatively. According to anterior segment optical coherence tomography, a greater number of favorable diffuse FB were noted in the group that received the tear substitute Stillavit in preparation for surgery - 87.9%, while in group 2 (without preparation) - 66.7%. Odds ratio calculation between the two groups revealed that preoperative preparation with the tear substitute Stillavit reduced the odds of IOP elevation to 20 mm Hg or higher at 3 months postoperatively by more than 10 times. The use of tear substitute Stillavit in preparation for anti-glaucoma surgery reduces the chances of IOP elevation in the early postoperative period by more than 10 times, which may indicate a reduction in the rate of FB scarring due to the beneficial effect of the drug's components on the precorneal tear film.

Genome-wide RNA sequencing of ocular fibroblasts from glaucomatous and normal eyes: Implications for glaucoma management.

Primary open angle glaucoma is a leading cause of visual impairment and blindness which is commonly treated with drugs or laser but may require surgery. Tenon's ocular fibroblasts are involved in wound-healing after glaucoma filtration surgery and may compromise a favourable outcome of glaucoma surgery by contributing to fibrosis. To investigate changes in gene expression and key pathways contributing to the glaucomatous state we performed genome-wide RNA sequencing. Human Tenon's ocular fibroblasts were cultured from normal and glaucomatous human donors undergoing eye surgery (n = 12). mRNA was extracted and RNA-Seq performed on the Illumina platform. Differentially expressed genes were identified using a bioinformatics pipeline consisting of FastQC, STAR, FeatureCounts and edgeR. Changes in biological functions and pathways were determined using Enrichr and clustered using Cytoscape. A total of 5817 genes were differentially expressed between Tenon's ocular fibroblasts from normal versus glaucomatous eyes. Enrichment analysis showed 787 significantly different biological functions and pathways which were clustered into 176 clusters. Tenon's ocular fibroblasts from glaucomatous eyes showed signs of fibrosis with fibroblast to myofibroblast transdifferentiation and associated changes in mitochondrial fission, remodeling of the extracellular matrix, proliferation, unfolded protein response, inflammation and apoptosis which may relate to the pathogenesis of glaucoma or the detrimental effects of topical glaucoma therapies. Altered gene expression in glaucomatous Tenon's ocular fibroblasts may contribute to an unfavourable outcome of glaucoma filtration surgery. This work presents a genome-wide transcriptome of glaucomatous versus normal Tenon's ocular fibroblasts which may identify genes or pathways of therapeutic value to improve surgical outcomes.

Prediction of multiclass surgical outcomes in glaucoma using multimodal deep learning based on free-text operative notes and structured EHR data.

Surgical outcome prediction is challenging but necessary for postoperative management. Current machine learning models utilize pre- and post-op data, excluding intraoperative information in surgical notes. Current models also usually predict binary outcomes even when surgeries have multiple outcomes that require different postoperative management. This study addresses these gaps by incorporating intraoperative information into multimodal models for multiclass glaucoma surgery outcome prediction. We developed and evaluated multimodal deep learning models for multiclass glaucoma trabeculectomy surgery outcomes using both structured EHR data and free-text operative notes. We compare those to baseline models that use structured EHR data exclusively, or neural network models that leverage only operative notes. The multimodal neural network had the highest performance with a macro AUROC of 0.750 and F1 score of 0.583. It outperformed the baseline machine learning model with structured EHR data alone (macro AUROC of 0.712 and F1 score of 0.486). Additionally, the multimodal model achieved the highest recall (0.692) for hypotony surgical failure, while the surgical success group had the highest precision (0.884) and F1 score (0.775). This study shows that operative notes are an important source of predictive information. The multimodal predictive model combining perioperative notes and structured pre- and post-op EHR data outperformed other models. Multiclass surgical outcome prediction can provide valuable insights for clinical decision-making. Our results show the potential of deep learning models to enhance clinical decision-making for postoperative management. They can be applied to other specialties to improve surgical outcome predictions.

Risk and Prognostic Factors for Glaucoma Associated with Peters Anomaly.

Glaucoma secondary to Peters anomaly is an important factor affecting visual prognosis, but there are few reports on the condition. This study aimed to investigate the characteristics of glaucoma associated with Peters anomaly and glaucoma surgery outcomes. This retrospective study included 31 eyes of 20 patients with Peters anomaly. Peters anomaly was classified into three stages: Stage 1, with a posterior corneal defect only; Stage 2, a corneal defect with iridocorneal adhesion; and Stage 3, a corneal defect with lens abnormalities. The associations between glaucoma and anterior segment dysgenesis severity, visual prognosis, and glaucoma surgery outcomes were analyzed. Sixteen eyes of ten patients developed glaucoma. Stage 1 Peters anomaly had no glaucoma, 52% of Stage 2 had glaucoma, and 75% of Stage 3 had glaucoma. Of the 16 eyes with glaucoma, 11 underwent surgery. Eight of these eleven eyes achieved intraocular pressure (IOP) control. Five of the nine eyes that underwent trabeculotomy (TLO) succeeded, and none had corneal staphyloma. Three of the four eyes for which TLO was ineffective had corneal staphyloma (p = 0.0331). Patients with Peters anomaly are more likely to develop glaucoma as anterior segment dysgenesis progresses, and the effect of TLO is limited if corneal staphyloma is present.

Long-term outcome of stab incision glaucoma surgery versus trabeculectomy surgery in the management of primary open angle glaucoma

Purpose To assess the long-term outcome of Stab incision glaucoma surgery (SIGS) and compare it with subscleral trabeculectomy (SST) in the management of open-angle glaucoma (OAG). Methods Twenty eyes of 20 OAG patients were randomly assigned into group 1: 10 patients underwent SIGS + Mitomycin C (MMC), and group 2: 10 patients underwent SST + MMC. The patients were followed-up over 2 years after surgery. Our outcome measures were: Postoperative intraocular pressure IOP, number of medications used, and postoperative complications. Results Twenty-four months postoperatively, the mean IOP was 13.78±2.05 mmHg in the SIGS group compared with preoperative IOP of 26.33±5.1 mmHg (P <0.001, paired t-test), and 14.38±4.56 mmHg in SST group compared with preoperative IOP of 30.13±7.51 mmHg (P <0.001, paired t-test). No significant differences in mean IOP between groups either preoperatively (P=0.15) or along follow-up (P=0.62 at last visit). The mean IOP drop from baseline was 12.56±5.00 mmHg (46.33±10.50%) in SIGS group and 15.75±8.22 mmHg (49.50±17.95%) in SST group (P=0.26). A significant decrease in the number of glaucoma medications was noted in the SIGSS group (P <0.001), in the SST group, the number decreased but was not statistically significant (P =0.120). Conclusion SIGS is comparable with SST in achieving long-term significant and maintained IOP reduction over up to 2 years, in addition to decreasing the number of antiglaucoma medications postoperatively. SIGS is recommended for surgical management of primary OAG as it has the advantage of being a faster, easier, less traumatic alternative to conventional SST with fewer complications.

Glaucoma Surgical Outcomes in Patients with a History of Scleritis

ABSTRACT Purpose To assess the outcomes of glaucoma surgery in patients with a history of scleritis at a tertiary medical center. Methods The retrospective case series included patients with a history of scleritis who required glaucoma surgery between 4/2006 and 8/2021. Results Two hundred and eighty-one eyes of 259 patients had glaucoma and scleritis with 28 eyes (10%) of 25 patients requiring glaucoma surgery. Post-operatively, one eye (4%) had infectious scleritis. Eleven (39%) surgeries failed: 5 tube shunts, 5 cyclophotocoagulation, and 1 gonioscopy-assisted transluminal trabeculotomy. Five (18%) eyes required tube revisions due to tube exposures without infection (3), iris blocking the tube (1), or to shorten tube length (1). Conclusions Patients with a history of scleritis have a low risk of scleritis recurrence or scleral perforation after glaucoma surgery but should be counseled appropriately on the higher risk of reoperation.

Roles of Toric intraocular Lens implantation on visual acuity and astigmatism in glaucomatous eyes treated with iStent and cataract surgery

BackgroundTo assess the efficacy of toric intraocular lenses (IOLs) in combined cataract and minimally invasive glaucoma surgery (MIGS), visual and refractive outcomes were compared between eyes implanted with non-toric and toric IOLs during iStent triple procedures.MethodsIn this retrospective study, open angle glaucoma eyes with preexisting corneal astigmatism of -1.5 diopter (D) or more and implanted with non-toric (n = 9) or toric (n = 9) IOLs were included. The main outcome measures were the intergroup difference in the uncorrected visual acuity (UCVA) and refractive astigmatism at 3 months postoperatively.ResultsPreoperatively, the logarithm of the minimum angle of resolution (logMAR) UCVAs and refractive astigmatism were equivalent between the groups. Postoperatively, the logMAR UCVA (non-toric, 0.45 ± 0.31; toric, 0.14 ± 0.15; P = 0.021) was significantly better and the refractive astigmatism (non-toric, -2.03 ± 0.63 D; toric, -0.67 ± 0.53 D; P = 0.0014) significantly less in the toric group. The toric group had postoperative improvements in the logMAR UCVA (-0.21, P = 0.020) and refractive astigmatism (+ 1.72 D, P = 0.0039). Vector analyses showed the postoperative centroid magnitude and confidence eclipses of refractive astigmatism was less in the toric group (0.47 D at 173°±0.73D) than the non-toric group (1.10 D at 2°±1.91D). Postoperatively, 78% of eyes in the toric group had 1.0 D or less refractive astigmatism compared with 11% in the non-toric group. Surgically induced astigmatism (non-toric, 0.18 D at 65°; toric, 0.29 D at 137°) did not differ between groups.ConclusionUse of toric IOLs is a reasonable option for better visual outcomes when the combined cataract and iStent surgery is performed in glaucomatous eyes with corneal astigmatism.

PLA-PEG Implant as a Drug Delivery System in Glaucoma Surgery: Experimental Study.

Excessive postoperative scarring halts the effectiveness of glaucoma surgery and still remains a challenging problem. The purpose of this study was to develop a PLA-PEG-based drug delivery system with cyclosporine A or everolimus for wound healing modulation. Methods: PLA-PEG implants saturation with cyclosporine A or everolimus as well as their further in vitro release were analyzed. Anti-proliferative activity and cytotoxicity of the immunosuppressants were studied in vitro using human Tenon’s fibroblasts. Thirty-six rabbits underwent glaucoma filtration surgery with the application of sham implants or samples saturated with cyclosporine A or everolimus. The follow-up period was six months. A morphological study of the surgery area was also performed at seven days, one, and six months post-op. Results: PLA-PEG implants revealed a satisfactory ability to cumulate either cyclosporine A or everolimus. The most continuous period of cyclosporine A and everolimus desorption was 7 and 13 days, respectively. Immunosuppressants demonstrated marked anti-proliferative effect regarding human Tenon’s fibroblasts without signs of cytotoxicity at concentrations provided by the implants. Application of PLA-PEG implants saturated with immunosuppressants improved in vivo glaucoma surgery outcomes. Conclusions: Prolonged delivery of either cyclosporine A or everolimus by means of PLA-PEG implants represents a promising strategy of wound healing modulation in glaucoma filtration surgery.

Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success

To compare electronically measured adherence with topical corticosteroid (CS) drops with outcomes of glaucoma surgery. This prospective cohort study included eyes undergoing surgery from August 2019 to January 2021 and followed for up to 1 year. All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had primary open-angle or angle-closure glaucoma, were aged ≥18 years, and underwent trabeculectomy (with or without cataract surgery) or tube-shunt implantation. Patients were instructed on the use of an eye drop monitoring device (Kali Drop), with the knowledge that it would be used to record postoperative CS instillation in real time. Adherence to a regimen of CS eye drops during the first 5 postoperative weeks; achievement of target intraocular pressure (IOP) at 6 weeks and 6 months to 1 year after surgery; and bleb morphology at 1 year. Among 90 patients, adherence was 89.7% ± 13.7% overall and 80.9% ± 15.8% during dosing every 2 hours. Target IOP was achieved at the final visit (6 months or 1 year) in 81% (59/73) without reoperation. Eyes with a higher ratio of drops taken versus prescribed were significantly more likely to achieve target IOP at 6 months/1 year (P= 0.05). Total adherence was better in younger persons, eyes with less field loss, and patients of one particular surgeon (P < 0.03). Percent adherence during dosing every 2 hours was higher in eyes with higher target IOP (P= 0.01). No adherence outcome was significantly related to race, sex, bleb morphology, postoperative pain, or postoperative anterior chamber inflammation. Adherence values did not significantly correlate with adherence questionnaire data (predicted mean= 78% ± 17%, actual mean= 91% ± 13% adherent, P < 0.001). Adherence to frequent postoperative eye drops was high and can be successfully monitored remotely. Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma.

Surgical management of ophthalmic abnormalities in Peters plus syndrome: case report

AbstractPurposeTo report a case of a patient with Peters plus syndrome (PPS) who underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy.MethodsA four‐year‐old female with bilateral central opacified cornea was referred to our department for corneal transplantation. Slit‐lamp examination demonstrated horizontal nystagmus, bilateral central corneal opacity and iridocorneal adhesion without lenticular involvement, which is characteristic of type I Peters anomaly. Intraocular pressure was 22 mmHg in the right eye and 26 mmHg in the left eye. Posterior segment ultrasonography showed no vitreous or retinal abnormalities. General and systemic examination revealed short stature and developmental delay without any other abnormality. The diagnosis of PPS was clinically made. The patient underwent combined synechiolysis, penetrating keratoplasty, and trabeculectomy of her left eye that was more affected.ResultsSix months postoperatively, corneal graft was clear with normal depth anterior chamber and normal intraocular pressure. For the right eye, the patient was put on antiglaucomatous eye drops while waiting for corneal transplantationConclusionsGlaucoma was proven to be a significant risk factor for graft failure and rejection after penetrating keratoplasty for Peters anomaly(1). In this case, combined surgeries were performed to allow better visual outcome and intraocular pressure control.Bibliography1. Dolezal KA, Besirli CG, Mian SI, Sugar A, Moroi SE, Bohnsack BL. Glaucoma and Cornea Surgery Outcomes in Peters Anomaly. Am J Ophthalmol 2019;208: 367–375.

Effects of Postoperative Intravitreal Injections on Outcomes of Traditional Glaucoma Surgery in Patients with Preoperative Intravitreal Injections

To compare outcomes of glaucoma drainage device (GDD) implantation and trabeculectomies with and without postoperative intravitreal injections (IVIs) in glaucoma patients with a history of preoperative IVIs. Retrospective cohort study. A total of 133 eyes of 133 glaucoma patients who underwent GDD implantation or trabeculectomy with at least 1 IVI preoperatively between January 2005 and October 2020 at Massachusetts Eye and Ear. Chart review of glaucoma patients with traditional glaucoma surgery and at least 1 IVI before surgery. All statistical analyses were conducted with R statistical programming software. Intraocular pressure (IOP), medication burden, best-corrected visual acuity (BCVA), Kaplan-Meier success rates, adjusted hazard ratios (HRs), and complications. Baseline demographics were similar between the groups with and without postoperative IVIs. The group with postoperative IVIs had a higher proportion of diabetic retinopathy and retinal vascular occlusions than the group without postoperative IVIs, which had more eyes with age-related macular degeneration. Intraocular pressure, medication burden, and visual acuity were similar between groups at all time points except for IOP at 6 weeks, which was lower in the group with postoperative IVIs. The group with postoperative IVIs had significantly more preoperative IVIs than the group without postoperative IVIs (6.6 vs. 3.3, P= 0.017). For success defined as IOP reduction ≥ 20% with 5 < IOP ≤ 21 mmHg, Kaplan-Meier analyses demonstrated similar success rates between groups with and without IVIs. When stratified by the number of IVIs, success rates for the group with 7 or more IVIs were significantly higher than the success rates for the group with 0-6 IVIs (P= 0.005). Each additional postoperative IVI resulted in a 7.2% decrease in the hazard of failure to achieve our stated success criteria. With regard to late complications, the group with postoperative IVIs had a higher incidence of vitreous hemorrhage (18.5% vs. 3.2%, P= 0.039) than the group without postoperative IVIs. A higher number of postoperative IVIs, specifically 7 or more IVIs, may be associated with improved success rates of traditional glaucoma surgery in glaucoma patients who received IVIs before surgery.

Refractive outcome of combined phacoemulsification and glaucoma surgery in patients of primary "open-angle glaucoma"

Introduction Glaucoma and cataracts are the leading causes of blindness worldwide. Treatment of either condition can influence the course of the other. Trabeculectomy induces changes to anterior chamber depth, axial length (AL), and corneal curvature, which could influence the accuracy of intraocular lens power calculations in combined surgery. Aim Assessment accuracy of intraocular lens calculation and refractive outcome after combined surgery versus cataract surgery (phacoemulsification) alone for coexisting cataract and glaucoma. Patients and methods Our study is a prospective nonrandomized comparative study of 43 consecutive patients (60 eyes) with cataract with coexisting glaucoma who had undergone phacotrabeculectomy (group 1) or phacoemulsification only (group 2). The biometry prediction error was determined for each case by the difference between the actual postoperative refraction and the preoperative predicted refraction in a spherical equivalent followed by comparative analysis of mean absolute refractive error, best-corrected visual acuity, and intraocular pressure (IOP) before and after surgery at 1, 3 months postoperatively. Results In both groups, best-corrected visual acuity was improved and IOP was decreased significantly. Mean absolute refractive error at 1, 3 months postoperatively was not significantly different between two groups (P>0.05) with more cylindrical changes and myopic shifts in group 1 due to high bleb, conjunctival or scleral suture, and changes in anterior chamber depth. Conclusion Phacotrabeculectomy may be an effective treatment with stable long-term outcomes of prediction error similar to phacoemulsification in patients with glaucoma. However, it is more effective in lowering IOP.

Frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries

To study the frequency and nature of intraoperative and early postoperative complications after glaucoma surgeries depending on several factors. The study retrospectively analyzed 87 outpatient records and case histories of patients with primary open-angle glaucoma (POAG). All subjects had undergone standard trabeculectomy. The indication for surgical treatment was deterioration of visual function associated with increased intraocular pressure (IOP). During the follow-up, an assessment was made of intraoperative and early postoperative complications, as well as factors leading to their development. During the observation period, the most frequently developing complications were found to be ciliochoroidal detachment - in 22 (25.8%) patients, and hyphema - in 12 (13.8%). One of the reasons for these complications is a significant, sometimes critical change in intraocular pressure when cutting open the eye. Isolated intraocular hypotension without signs of ciliochoroidal detachment was detected in 15 (17.24%) patients. Postoperative hypertension was found in 18 (20.68%) patients. Scarring of the newly created outflow tracts of intraocular fluid was the obvious cause of ophthalmic hypertension in 5 patients. In 16 (18.4%) cases, pronounced vascularization was found at the site of surgical intervention. The most significant factors that have a possible impact on the outcome of glaucoma surgery - specifically, its hypotensive effect - are: age, duration of local antihypertensive therapy, comorbid somatic pathology, and the initial IOP level.

The Relationship of Travel Distance to Postoperative Follow-up Care on Glaucoma Surgery Outcomes.

To investigate the relationship of patient travel distance and interstate access to glaucoma surgery postoperative follow-up visit attendance. Retrospective longitudinal chart review of all noninstitutionalized adult glaucoma patients with initial trabeculectomies or drainage device implantations between April 4, 2014 and December 31, 2018. Patients were stratified into groups on the basis of straight-line distance from residence to University of North Carolina at Chapel Hill's Kittner Eye Center and distance from residence to interstate access. Corrective procedures, visual acuity, appointment cancellations, no-shows, and insurance data were recorded. Means were compared using 2-tailed Student t-test, Pearson χ, analysis of variance, and multivariate logistical regression determined odds ratios for loss to follow-up. In total, 199 patients met all inclusion criteria. Six-month postoperatively, patients >50 miles from clinic had greater odds of loss to follow-up compared with patients <25 miles (odds ratios, 3.47; 95% confidence interval, 1.24-4.12; P<0.05). Patients >50 miles from clinic had significantly more missed appointments than patients 25 to 50 miles away, and patients <25 miles away (P=0.008). Patients >20 miles from interstate access had greater loss to follow-up than those <10 miles (t(150)=2.05; P<0.05). Mean distance from clinic was 12.59 miles farther for patients lost to follow-up (t(197)=3.29; P<0.01). Patients with Medicaid coverage had more missed appointments than those with Medicare plans (t(144)=-2.193; P<0.05). Increased distance from clinic and interstate access are associated with increased missed appointments and loss to follow-up. Glaucoma specialists should consider these factors when choosing surgical interventions requiring frequent postoperative evaluations.

Evaluación de resultado del tratamiento quirúrgico en el glaucoma avanzado

IntroductionThere is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon.The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma. MethodsThis retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months. ResultsThe mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9.Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract. ConclusionGlaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.

Otago Glaucoma Surgery Outcome Study: Examining the Development of Strabismus Causing Diplopia in Patients Who Have Received Molteno Implant Surgery

ABSTRACT Objective To evaluate the development of postoperative strabismus causing diplopia in patients who received Molteno implant surgery for the treatment of glaucoma. Methods The Otago Glaucoma Surgery Outcome study (OGSOS) was used to select cases who had undergone Molteno implant surgery to examine the effect on the development of strabismus causing diplopia. Information was collected on treatments provided to correct motility disturbance, and their success, in this retrospective non-comparative study. Results 32 cases (3.3%) were found to have developed diplopia following the Molteno implant surgery from a total of 977 cases. Of these, the strabismus in 23 cases was described in sufficient detail to permit clinical categorization. Most (19/23) demonstrated an exodeviation, hyperdeviation, or a combination thereof, although 2/6 cases with superonasal plate location demonstrated a hypodeviation. Diplopia generally resolved spontaneously (20/32 cases). Treatment was required in eight cases, usually conservative and successful (6/8 cases), but strabismus surgery was required in two cases, and was unsuccessful. Conclusions This study found a low incidence of diplopia developing post-Molteno implant surgery. Strabismus features suggested a restrictive etiology, and spontaneous recovery was common (62.5%). Surgical correction proved unsuccessful – confirming persistent postoperative diplopia after Molteno implant surgery to be a rare but surgically challenging complication.

Translating Minimally Invasive Glaucoma Surgery Devices.

Glaucoma is the leading cause of irreversible blindness with over 70 million people affected worldwide. The surgical management of glaucoma aims to lower intraocular pressure by increasing aqueous outflow facility. The latest manufacturing techniques have allowed for the development of a number of novel implantable devices to improve safety and outcomes of glaucoma surgery. These are collectively referred to as minimally invasive glaucoma surgery (MIGS) devices and are among the smallest devices implanted in the human body. This review discusses the design criterion and constraints as well as the user requirements for MIGS devices. We review how recent devices have attempted to meet these challenges and give our opinion as to the necessary characteristics for the development of future devices.

Glaucoma and Cornea Surgery Outcomes in Peters Anomaly

To conduct a qualitative description of corneal and glaucoma outcomes in Peters anomaly. Retrospective case series. Children with Peters anomaly who presented between 1982-2017 were included. Visual acuity, intraocular pressure (IOP), survival of corneal grafts, and success of glaucoma surgery (defined as IOP of 5-20mm Hg and no additional IOP-lowering surgery or visually devastating complications) were analyzed. Fifty-eight eyes of 37 patients (19 males) with Peters anomaly presented at 0.7 ± 1.5 years of age and had a follow-up of 10.2 ± 10.8 years. Twenty-three eyes underwent penetrating keratoplasty (PKP) with an average of 2.0 ± 1.3 grafts per eye. PKP survival at 1 year was 60% (95% confidence interval 41-75%) but decreased at 10 years to 34% (95% confidence interval 18-51%). Thirty-four eyes were diagnosed with glaucoma at 2.8 ± 6.4 years of age. Twenty eyes required glaucoma surgery, and the average number of IOP-lowering surgeries was 2.9 ± 2.0 per eye. Glaucoma drainage devices (15 eyes) had a 53% success rate. Laser cycloablation (9 eyes, transcleral or endoscopic) had a success rate of 67% with 2.0 ± 1.0 treatments per eye. Trabeculectomy with mitomycin C (8 eyes) and trabeculotomy (8 eyes) had 25% and 0% success rates, respectively. Fifteen eyes that underwent glaucoma surgery obtained IOP control, and GDD with or without cycloablation accounted for 80% of the successes. Eyes that underwent PKP did not show increased rates of glaucoma, higher IOP, or a greater necessity for IOP-lowering surgery. In Peters anomaly, PKP shows poor long-term success. In addition, >50% of eyes with Peters anomaly have secondary glaucoma that often requires multiple surgeries.

Exploring patients’ expectations and preferences of glaucoma surgery outcomes to facilitate healthcare delivery and inform future glaucoma research

IntroductionGlaucoma is a lifelong condition often requiring surgical intervention. To allow us to inform patients’ expectations of surgery effectively, it is important to understand patients’ preferences and concerns regarding outcomes...