Number Of Postoperative Glaucoma Medications Research Articles

Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-analysis.

To report the outcomes of continuous wave-transscleral cyclophotocoagulation (TS-CPC) and endoscopic cyclophotocoagulation (ECP) in childhood glaucoma. We performed a systematic search of relevant databases. We collected data on age, follow-up duration, type of glaucoma, previous surgical interventions, preoperative and postoperative intraocular pressure (IOP), preoperative and postoperative number of glaucoma medications, adverse events, number of sessions, and success rates at different time points. The main outcome measures are the amount of IOP and glaucoma medication reduction. We included 17 studies studying 526 patients (658 eyes); 11 evaluated the effectiveness of TS-CPC (268 patients, 337 eyes), 5 evaluated ECP (159 patients, 197 eyes), and one study compared both techniques (56 patients, 72 eyes for TS-CPC vs. 43 patients, 52 eyes for ECP). The median duration of follow-up was 28 months in the TS-CPC group and 34.4 months in the ECP group. The mean number of treatment sessions was 1.7 in the TS-CPC and 1.3 in the ECP. In the TS-CPC group, the mean IOP was significantly reduced from 31.2±8 to 20.8±8mmHg at the last follow-up (P<0.001). The mean number of glaucoma medications was reduced from 2.3±1.3 to 2.2±1.3 (P=0.37). In the ECP group, there was also a significant reduction in the mean IOP from 32.9±8mmHg with a mean of 1.7±0.7 glaucoma medications to 22.6±9.8mmHg (P<0.0001) on 1.2±1.1 medications (P=0.009) at the last follow-up. Both TS-CPC and ECP were effective in reducing the IOP and glaucoma medications in childhood glaucoma. Multiple treatment sessions were required.

Safety and Efficacy of Hydrus and I-Stent inject combined with Phacoemulsification in Primary Open Angle Glaucoma Patients: 2 year follow up study

Aims: To compare the safety and efficacy of phacoemulsification combined with two individual kinds of trabecular bypass micro-stent device insertion. This study compares Phacoemulsification with Hydrus stent versus phacoemulsification combined with I-Stent inject W in patients with medically uncontrolled primary open-angle glaucoma (POAG). Material and Methods: A retrospective comparative case series. Results: Eighty eyes of 75 patients with 2 years completed follow-up after combined phacoemulsification with trabecular by-pass stent (s) were included. Forty eyes of 37 patients had Hydrus stent (Hydrus Group-PH) and the other 40 eyes of 38 patients had I-stent inject W (I-stent Group-Pi) insertion combined with phacoemulsification and intraocular lens implantation. Patient demographics and preoperative characteristics of the two groups studied are comparable. A post-operative decrease of 20 percentage or more in the IOP was achieved in 33 eyes (82.5%) in PH group and 30 eyes (75%) in Pi group (p=0.57). The Hydrus group (PH) had a post-operative reduction in the mean number of medications in 22 eyes (55%) in comparison to 18 eyes (45%) in the I-stent group (Pi). Second stage trabeculectomy was avoided in 31 eyes (77.5%) in the Hydrus group and 27 eyes (67.5%). There was no significant difference in rate of complications between two groups. Conclusion: Both Hydrus stent and I-stent inject W combined with phacoemulsification and intra-ocular lens implantation, are efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). The reduction in the mean IOP and in the mean number of post-operative glaucoma medications was higher for the patients in Hydrus stent group than in I-stent inject W group.

One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery.

AimLong-term data of the postoperative management following Baerveldt tube surgery (BVT) is currently limited. This study aims to evaluate the outcome and the safety profile of internal ligation suture removal after BVT surgery for refractory glaucoma.Materials and methodsA prospective, consecutive, non-comparative case series of patients previously undergoing BVT 350 mm2 surgery with 0.4 mg/mL mitomycin C (MMC), 3/0 intraluminal suture (Supramid) insertion, and 10/0 nylon external ligation suture(s). For each patient, data was collected over 12 months after internal ligation suture removal. Follow-up assessments looked at intraocular pressure (IOP), complication rate, and postoperative number of glaucoma medications. Definition of success was adopted as per the World Glaucoma Association recommendations.ResultsTwenty-four patients were included. On average, Supramid was removed at 22 ± 18.2 weeks following BVT surgery. Preoperatively, the mean IOP was 30.9 ± 12.6 mm Hg and the average antiglaucoma medications were 1.95 ± 1.13. At 12 months, the mean IOP was 15.2 ± 5.3 mm Hg and the mean number of glaucoma medications was 1.3 ± 0.2. Qualified success with IOP ≤ 21 mm Hg and IOP ≤ 15 mm Hg was achieved in 62.5% and 33.3%, respectively. Only two patients developed hypotony following Supramid removal; both resolved spontaneously within 1 month.ConclusionOur results show a good IOP reduction and safety profile at 1 year from internal ligation suture removal following BVT. A drop in IOP of approximately 50% from the preoperative IOP can be expected.How to cite this articleStringa F, Chen R, Agrawal P. One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery. J Curr Glaucoma Pract 2022;16(1):20-23.

Intraluminal stenting versus external ligation of Ahmed glaucoma valve in prevention of postoperative hypotony.

To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP≤21 mm Hg without medications indicated complete success while IOP≤21 mm Hg with medications indicated qualified success; and IOP<6 mm Hg was defined as hypotony. After a year of follow-up, IOP was significantly reduced in the intraluminal stenting group than in the external ligation group (11.67±0.89 vs 14.2±4.0 mm Hg, respectively, P=0.024). Postoperative hypotony was more common in the external ligation group (2 cases, 13.33%) than in the intraluminal stenting group (1 case, 6.67%). Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony (transient and persistent) that occurs in conventional AGV surgery.

Bleb Morphology Using Anterior-Segment Optical Coherence Tomography after Ahmed Glaucoma Valve Surgery with Tenon Capsule Resection.

Objectives To evaluate the internal morphology of blebs using anterior-segment optical coherence tomography (AS-OCT) and the surgical outcomes of Ahmed glaucoma valve (AGV) surgery with Tenon capsule resection compared to conventional AGV surgery in patients with refractory glaucoma. Patients and Methods. This randomised prospective study included 30 eyes from 30 patients (age range: 42–55 y) with refractory glaucoma from March 2018 to February 2020. The study included two groups: AGV with the Tenon capsule resection group (n = 15) and the conventional AGV surgery group (n = 15). Follow-up continued until 6 months after surgery. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications, best corrected visual acuity, visual field, and postoperative complications. The internal morphology of the blebs in both groups was evaluated at 1-day, 1-week, 1-month, 3-month, and 6-month follow-up using AS-OCT in terms of the consequent changes in bleb wall thickness, bleb wall reflectivity, and bleb cavity morphology throughout the 6-month follow-up period. Results A significant reduction in IOP was found in both groups, with a greater reduction in group I, where the mean IOP decreased from 32.73 ± 2.12 mmHg in the preoperative period to 13.33 ± 1.59 mmHg after 6 months, whereas in group II, the mean IOP decreased from 33.2 ± 2.21 mmHg in the preoperative period to 14.27 ± 1.44 mmHg after 6 months (p value <0.05). The difference between the 2 groups in terms of the decrease in IOP was insignificant except at 1 and 3 months, where there was a significant difference (p value = 0.016 and 0.01 at 1 and 3 months, respectively). The bleb analysis revealed a significant reduction in the wall thickness in both groups at 1 and 3 months, which was mostly associated with the hypertensive phase. In group I, the bleb wall thickness decreased from 754.67 ± 53.93 μm in the first postoperative day to 684 ± 81.66 μm and 671.6 ± 69.48 μm at 1 and 3 months, respectively, while in group II, the bleb wall thickness decreased from 707.13 ± 31.7 μm in the first postoperative day to 499.53 ± 99.1 μm and 506 ± 76.91 μm at 1 and 3 months, respectively. There was a significant reduction in AS‐OCT, and bleb reflectivity was insignificant throughout the follow-up period (p value >0.05). Regarding postoperative complications, the hypertensive phase occurred more frequently in group II (6 eyes, 40%) than in group I (2 eyes, 13.3%). Other complications were also reported more frequently in group II such as hypotony, shallow anterior chamber (AC), and tube exposure. Conclusion AS-OCT was beneficial in the analysis of bleb morphology after AGV surgery where there were more diffuse functioning multicystic blebs and less thinning in the bleb wall thickness during the hypertensive phase after resection of the Tenon capsule, which might be related to the less incidence of fibrosis around the surgical site.

Evaluation of Blood-filling Patterns in Schlemm Canal for Trabectome Surgery.

The purpose of this study was to evaluate the association between trabectome surgery outcomes and the blood filling patterns in SC before TM ablation. This retrospective cohort study included 105 eyes of 84 Japanese primary open-angle glaucoma patients who had undergone trabectome surgery in combination with cataract surgery. Provocative gonioscopy was performed before TM ablation to classify the blood filling patterns in SC into 3 groups: no filling (group 1); patchy/irregular filling (group 2); and complete filling (group 3). The subjects were divided into 3 groups according to the blood filling patterns and the trabectome surgery outcomes were compared, including intraocular pressure (IOP), the percentage reduction in IOP, surgical success rate, and the number of glaucoma medications. Success was defined by IOP ≤15 mm Hg and a >20% reduction in IOP with/without glaucoma medication, and without additional glaucoma surgery after trabectome surgery combined with cataract surgery. Twenty-four eyes were assigned to group 1, 48 to group 2, and 33 to group 3. Between-group analyses showed no significant intergroup differences in age (P=0.213), preoperative mean deviation (P=0.505), preoperative and postoperative IOP (P=0.941 and 0.458, respectively), preoperative and postoperative number of glaucoma medications (P=0.805 and 0.077, respectively), percentage IOP reduction (P=0.256), and success rates (P=0.540). Trabectome surgery is effective for mild to moderate primary open-angle glaucoma patients, independent of the blood-filling patterns in SC before the TM ablation.

Performances of glaucoma operations with Kahook Dual Blade or iStent combined with phacoemulsification in Japanese open angle glaucoma patients

To compare surgical outcomes of phacoemulsification combined with glaucoma surgical techniques performed with either Kahook Dual Blade (KDB) or iStent for Japanese patients with either primary open angle glaucoma or exfoliation glaucoma. We retrospectively evaluated the surgical outcomes of 129 eyes of 84 Japanese patients with glaucoma who underwent KDB or 44 eyes of 34 patients who underwent phacoemulsification with iStent procedures combined with cataract surgery. The primary outcome was surgical success or failure [with surgical failure being indicated by <20% reduction from preoperative intraocular pressure (IOP) or IOP>18 mm Hg as criterion A; IOP>14 mm Hg as criterion B on two consecutive study visits; or reoperation requirement]. In addition, we assessed the number of postoperative glaucoma medications and the resulting complications. The probability of success was significantly higher in the KDB group than in the iStent group for criterion A (60.2% vs 46.4%, P=0.019). In the KDB group, the mean preoperative IOP of 19.8±7.3 mm Hg decreased significantly to 13.0±3.1 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.5±1.4 decreased significantly to 1.6±1.6 (P<0.01) 12mo postoperatively. In the iStent group, the mean preoperative IOP of 17.8±2.9 mm Hg significantly decreased to 14.3±2.3 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.2±1.1 decreased significantly to 0.9±1.4 (P<0.01) 12mo postoperatively. The overall IOP reduction percentage was higher in the KDB group (26.2%) than in the iStent group (19.0%) 12mo postoperatively (P=0.03). Hyphema occurred significantly more frequently in the KDB group (16.3%) than in the iStent group (2.3%, P=0.017). KDB and iStent procedures combined with cataract surgery both result in significant IOP and glaucoma medication reductions after the 12-month follow-up. The patients in the KDB group have a higher success rate for the target IOP of less than 18 mm Hg and a higher complication rate than those in the iStent group.

Tenon Capsule Grafting versus Autologous Scleral Graft in Ahmed Glaucoma Valve Surgery.

Objective To compare between the surgical outcomes of Tenon capsule grafting and autologous scleral graft in Ahmed glaucoma valve (AGV) surgery in the management of refractory glaucoma and prevention of tube exposure. Patients and Methods. This prospective randomised study included 30 eyes of 30 patients with refractory glaucoma, who were aged between 46 and 58 years and diagnosed with refractory glaucoma. This study was conducted in Menofia University Hospital between July 2018 and December 2019. Informed patient consent was obtained. The studied eyes were divided into two groups: the first group included 15 eyes for which AGV with Tenon capsule grafting was performed, while the second group included 15 eyes for which AGV with autologous scleral graft was performed. All patients were followed up for one year after the surgery. The outcomes were evaluated according to intraocular pressure (IOP) and the number of postoperative glaucoma medications. Visual acuity, visual field, number of postoperative glaucoma medications, and postoperative complications were followed throughout the 1-year follow-up period. Results There was a significant reduction in IOP in both groups, with more reduction in the Tenon graft group where the mean IOP after one year was 11.66 ± 0.89 mmHg, whereas in the scleral graft group, the mean IOP was 14.20 ± 4.0 mmHg (p value < 0.001). However, the difference between the 2 groups in lowering IOP was insignificant. Regarding postoperative complications, tube exposure was observed in one case in the scleral graft group with associated scleral melting and hypotony, postoperative hypotony was more in the scleral graft group with 3 cases (20%), and in the Tenon graft group, hypotony occurred only in 1 case (6.67%). In addition, less vascular blebs were seen in most cases in the Tenon graft group, while most blebs seen in the scleral graft group were vascular blebs. In addition, both groups showed stability in terms of visual acuity and visual field. Conclusion Tenon capsule grafting and autologous scleral grafting might be effective and safe techniques when applied with AGV in the management of refractory glaucoma. Tenon capsule resection with grafting showed relatively low incidence of tube exposure and hypertensive phase.

ExPress mini shunt device with trabeculectomy surgery in patients with uncontrolled glaucoma of Middle Eastern descent.

PURPOSE:The aim of this study is to assess the efficacy and safety of ExPress mini shunt in glaucoma patients of Middle Eastern descent.METHODS:This is a prospective cohort study. Uncontrolled glaucoma patients were subjected to ExPress mini-shunt implant. Pre- and post-operative glaucoma clinical indices were measured and compared. Both intra- and postoperative complications and surgical success rates were assessed. In addition to comparing a group of combined ExPress mini-shunt implant with cataract surgery versus ExPress mini-shunt implant alone.RESULTS:A total of 35 eyes of 31 patients were involved. The most common type of glaucoma was primary open-angle glaucoma in 13 eyes (37.1%). Fourteen eyes (40.0%) were combined ExPress device with cataract surgery. The mean intraocular pressure (IOP) (±standard deviation) at the last visit dropped from 24.6 mmHg (±8.3) to 13.9 mmHg (±4.5). There was a significant reduction in the number of postoperative glaucoma medications from 3.0 ± 0.5 to 1.3 (±0.7). In cases combined with cataract extraction, the patients required fewer anti-glaucoma medications. Complete success was achieved in 22 eyes (63%) and qualified success was achieved in 9 eyes (26%), whereas 4 eyes (11%) were considered a failure. The two most common complications encountered were hypotony (28.6%) and hyphema (11.4%).CONCLUSION:Among the studied population of patients, ExPress offers IOP reduction that is comparable to reported rates following standard trabeculectomy. Postoperative hyphema was encountered at a slightly higher rate.

Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients.

To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). The mean follow-up was 53.3±8.5 (range 48 to 60)mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.

A prospective comparative study between trabeculectomy versus trabeculectomy with Ologen for patients with primary open-angle glaucoma at 3-year follow-up

Background The aim of this study was to compare the outcomes of trabeculectomy with collagen implant versus conventional trabeculectomy for uncontrolled intraocular pressure (IOP). Patients and methods Sixty-eight eyes of 58 patients were randomly selected for trabeculectomy either with Ologen implant (the study group) or without implant (the control group). Preoperative history taking and examinations were carried out. Data including age, sex, glaucoma type, IOP, and numbers of postoperative glaucoma medications were collected. Postoperative IOP, number of postoperative glaucoma medications, and postoperative complications were recorded. Each patient was followed up for 3 years. Results No significant differences were observed between the two groups in terms of preoperative IOP and number of preoperative antiglaucoma medications. Postoperative IOP in the Ologen group was significantly lower than that in the control group at all follow-up visits; the mean IOP in the Ologen group was 12.88±2.37 mmHg and that in the control group was 17.26±2.72 mmHg (P=0.006). The mean number of antiglaucoma medications (0.61±0.15) in the Ologen group was significantly lower than that in the control group (1.48±0.19) at last visit (P Conclusion Trabeculectomy with Ologen showed significant advantages over trabeculectomy alone in terms of IOP. Large sample size is needed to confirm the safety and long-term outcome of trabeculectomy with Ologen.

Fornix-Based Versus Limbal-Based Conjunctival Trabeculectomy Flaps for Glaucoma: Findings From a Cochrane Systematic Review

To compare effectiveness of fornix- and limbal-based conjunctival flaps in trabeculectomy surgery. Systematic review. Setting: CENTRAL, MEDLINE, LILACS, ISRCTN registry, ClinicalTrials.gov, WHO, and ICTRP were searched to identify eligible randomized controlled trials (RCTs). RCTs in which benefits and complications of fornix- vs limbal-based trabeculectomy for glaucoma were compared in adult glaucoma patients. We followed Cochrane methodology for data extraction. Proportion of failed trabeculectomies at 24months, defined as the need for repeat surgery or uncontrolled intraocular pressure (IOP) >22mm Hg, despite topical/systemic medications. The review included 6 trials with a total of 361 participants, showing no difference in effectiveness between fornix-based vs limbal-based trabeculectomy surgery, although with a high level of uncertainty owing to low event rates. In the fornix-based and limbal-based surgery, mean IOP at 12months was similar, with ranges of 12.5-15.5mm Hg and 11.7-15.1mm Hg, respectively. Mean difference was 0.44mm Hg (95% CI-0.45 to 1.33) and 0.86mm Hg (95% CI-0.52 to 2.24) at 12 and 24months of follow-up, respectively. Mean number of postoperative glaucoma medications was similar between the 2 groups. Mean difference was 0.02 (95% CI-0.15 to 0.19) at 12months. As far as postoperative complications, an increased risk of shallow anterior chamber was observed in the limbal-based group. Similar efficacy of trabeculectomy surgery with respect to bleb failure or IOP control was observed in both types of conjunctival flap incisions. A significant difference was detected in the risk of postoperative shallow anterior chamber, which was increased in the limbal-based group.

Comparison of the changes in corneal endothelial cells after pars plana and anterior chamber ahmed valve implant.

Purpose. To compare the changes in corneal endothelial cells after pars plana Ahmed glaucoma valve (AGV) implantation with those after the anterior chamber AGV implantation for refractory glaucoma. Methods. The medical records of 18 eyes with pars plana implantation of AGV (ppAGV) were reviewed retrospectively and were compared with 18 eyes with the anterior chamber AGV (acAGV) implant. The preoperative and postoperative endothelial cells, intraocular pressure (IOP), and postoperative complications during the follow-up in both groups were compared. Results. The average follow-up was 18 months. The postoperative endothelial cells in the ppAGV and acAGV groups were 2044 ± 303 and 1904 ± 324, respectively (P = 0.25). The average percentage decrease in the endothelial cells in the ppAGV and acAGV groups at 18 months was 12.5% and 18.4%, respectively, and showed significant difference between the 2 groups (P = 0.01). No difference in IOP control and the number of postoperative glaucoma medications was observed between the 2 groups. Conclusions. Endothelial cell damage in the ppAGV group for refractory glaucoma appeared to be lower than that in the acAGV group. Therefore, pars plana implantation of AGV may be preferred as it may have lower level of endothelial cell damage while maintaining similar level of IOP control.

Clinical Outcomes of Ahmed Glaucoma Valve in Posterior Segment Versus Anterior Chamber

To compare the intermediate-term intraocular pressure (IOP) control and complication profile of the Ahmed Glaucoma Valve (AGV) implanted posteriorly through the pars plana in eyes undergoing concurrent pars plana vitrectomy (PPV) with device implantation in the anterior chamber (AC) in nonvitrectomized eyes. : We retrospectively reviewed the medical records of 31 case eyes (30 patients) with refractory glaucoma that underwent posterior implantation of AGV after complete PPV and compared them to 31 control eyes (31 patients) with refractory glaucoma that underwent implantation of AGV in the AC. Case-control patients were matched one-to-one on the basis of principal glaucoma diagnosis. All surgeries were performed at 1 institution using a silicone-plate device. Success was defined as intraocular pressure (IOP)≥ 5 mm Hg and ≤ 21 mm Hg with or without glaucoma medications at final follow-up, no additional glaucoma surgery, no removal of the implant, and no loss of light perception. The average follow-up was 20.9 months (range, 6 to 54 mo) for the posterior group and 20.5 months (range, 4 to 48 mo) for the anterior group. The reduction in IOP was similar in both groups at all postoperative time points. The number of postoperative glaucoma medications in both groups was not statistically different at final follow-up. Success rates at final follow-up were identical, 83.9% in both groups, and Kaplan-Meier survival curve analysis showed no significant difference between the 2 groups (P=0.96). Postoperative complications were similar between the 2 groups, except there were more instances of early postoperative flat AC in the anterior group than the posterior group (P=0.01). The AGV can similarly control IOP in the majority of cases, whether the tube is placed in the posterior segment after PPV or in the AC of nonvitrectomized eyes.

Surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients

PurposeTo compare the surgical outcomes of the Ex-PRESS glaucoma filtration device in African American and white glaucoma patients.DesignRetrospective comparative case series.MethodsThis was a comparative case series of 36 eyes of 36 African Americans and 43 eyes of 43 whites that underwent placement of the Ex-PRESS glaucoma filtration device under a partial-thickness scleral flap for uncontrolled glaucoma. All eyes received intraoperative mitomycin C. The primary outcome measures were intraocular pressure (IOP), number of postoperative glaucoma medications, and surgical success. Surgical success was defined as IOP between 5 and 18 mm Hg, with or without glaucoma medications, without further glaucoma surgery, or loss of light perception vision.ResultsAverage follow-up was 31.9 ± 9.8 (range, 14.6–47) months for African Americans and 30.7 ± 8.6 (range, 14.3–47) months for whites. At 33 months, surgical success was 80.0% in the African American group and 83.3% in the white group (P = 1.00). Reasons for surgical failure included increased IOP (3 eyes, 3.8%), persistent hypotony with maculopathy (1 eye, 1.3%), and further surgery (4 eyes, 5.06%). Compared with preoperative values, the mean postoperative IOP and number of glaucoma medications were significantly reduced in both groups, and no statistical difference was observed between the two groups at 33 months. Postoperative complications were similar in the two groups.ConclusionsSimilar surgical outcomes were observed in African American and white glaucoma patients after implantation of the Ex-PRESS glaucoma filtration device. This latest modification of glaucoma filtration surgery may be a better surgical option for African Americans given its potential advantages of no tissue removal, predictable outcomes related to consistent lumen size and controlled flow, fewer postoperative complications, and overall reduced inflammation.

Trabeculectomy with OloGen versus trabeculectomy for the treatment of glaucoma: a pilot study

To present the preliminary results of our study comparing the outcomes of trabeculectomy with or without OloGen implant in patients requiring glaucoma surgery for uncontrolled intraocular pressure (IOP). Forty eyes of 40 patients were assigned randomly to undergo trabeculectomy either with OloGen implant (study group) or without implant (control group). Preoperative data included age, gender, type of glaucoma, IOP and number of preoperative glaucoma medications. Postoperative IOP, number of postoperative glaucoma medications and postoperative complications were recorded. Each patient was followed up for at least 6 months. There were no significant differences between the groups in terms of age, gender, type of glaucoma, preoperative IOP and number of antiglaucoma medications. Mean IOPs for both groups were significantly lower than preoperative levels at all intervals (P < 0.05) The number of glaucoma medications used dropped from a preoperative mean of 3.5 +/- 0.7 to a 6-month postoperative mean of 0.3 +/- 0.7 (P < 0.001) in the study group and from 3.7 +/- 0.4 to 0.5 +/- 1.1 (P < 0.001) in the control group. No statistically significant differences between the two groups were observed in terms of postoperative complications. In this pilot study it appears that trabeculectomy with OloGen does not seem to offer any significant advantages compared with trabeculectomy alone. Additionally, even though there were no statistical differences between the two groups as far as complications were concerned, one eye from the study group developed endophthalmitis 10 days after surgery and two eyes presented with positive Seidel test and flat anterior chamber and required additional suturing. Studies with larger numbers of patients and longer follow-ups are required to confirm these findings and to examine the safety and long-term outcomes of trabeculectomy with OloGen.

Comparison of Trabeculectomy With Ex-PRESS Miniature Glaucoma Device Implanted Under Scleral Flap

To evaluate the Ex-PRESS miniature implant (Model R 50) placed under partial-thickness scleral flap compared with standard trabeculectomy. In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) > or =5 mm Hg and < or =21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week. The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001). The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.

Nonpenetrating deep sclerectomy: a 6-year retrospective study.

Nonpenetrating trabeculectomy, also called nonpenetrating deep sclerectomy (NPDS), is a filtering surgery where the internal wall of Schlemm's canal is excised, allowing subconjunctival filtration without actually entering the anterior chamber. This, technique was developed to minimize the complications of trabeculectomy. The authors investigated its safety and efficacy in a retrospective noncomparative study. A total of 258 eyes (179 patients, mean age 61.4 +/- 11.56 years) with uncontrolled open angle glaucoma with prior medical therapy were treated. NPDS with a biocompatible collagen device (157 eyes) sutured to deep scleral bed or with the use of a 5-fluorouracil sponge (90 eyes) were analyzed. The main outcome measure was postoperative intraocular pressure (IOP) with an average follow-up of 54.4 +/- 17.07 months (range 1-85). Efficacy was determined 1 month, 3 months, and every 6 months after the procedure for 6 years. Mean preoperative IOP was 24.47 +/- 5.92 mmHg. Mean postoperative IOP was 14.44 +/- 5.31 mmHg (average lowering of the IOP was 38.94 +/- 23.81%) at 1 month, 15.16 +/- 4.57 mmHg (35.73 +/- 21.35%) at 3 months, 15.87 +/- 4.24 mmHg (32.45 +/- 20.52%) at 6 months, 16.32 +/- 4.53 mmHg (29.96 +/- 23.69%) at 12 months, 17.12 +/- 4.45 mmHg (26.51 +/- 23.93%) at 18 months, 16.77 +/- 4.44 mmHg (28.18 +/- 21.73%) at 24 months, 16.43 +/- 4.15 mmHg (28.89 +/- 23.69%) at 30 months, 16.34 +/- 4.12 mmHg (30.05 +/- 21.61%) at 36 months, 16.16 +/- 4.01 mmHg (30.06 +/- 22.55%) at 42 months, 15.71 +/- 3.74 mmHg (32.49 +/- 19.08%) at 48 months, 15.61 +/- 3.48 mmHg (31.26 +/- 21.01%) after 5 years, and 15.81 +/- 3.79 mmHg (33.73 +/- 20.9%) after 6 years. YAG goniopuncture was performed in 47.3% of cases with a mean follow-up of 12 +/- 13 months. These goniopunctures were effective in lowering IOP after a long-term follow-up (24 months). Additional 5-fluorouracil injections were used in 7% of cases. Visual field (Octopus or Humphrey mean defect and corrected loss variance or loss variance) was not modified (p < 0.01). Number of preoperative glaucoma medications was 2.01 +/- 0.58 and number of postoperative glaucoma medications was 0.85 +/- 0.92. Complications were peroperative microperforations in 27 eyes (10.5%), shallow anterior chamber in 2 eyes, hyphema in 2 eyes (0.8%), cataract in 5 eyes (2%), and dellen in 1 eye (0.4%). No cases of endophthalmitis or choroidal detachment were found. After surgery, 23 eyes (8.9%) required a new filtering surgical procedure, and diode laser cyclophotocoagulation was necessary in 2 eyes (0.8%). The probability success rate, defined as an IOP lower than 21 mmHg, was 66.46% (Kaplan Meier) at 60 months off all glaucoma medications and 80.32% with medical or new surgical treatment. NPDS appears to be an effective and safe filtering procedure for lowering IOP and could be an alternative to trabeculectomy in open angle glaucoma with the advantage of having fewer complications.

Results of phacoemulsification in eyes with preexisting glaucoma filters

A retrospective analysis was performed on 58 eyes that had temporal phacoemulsification via a clear corneal (32 eyes) or scleral tunnel (26 eyes) approach after previous filtration surgery with a minimum follow-up of 12 months. The study analyzed best-corrected visual acuity (BCVA), changes in intraocular pressure (IOP), and changes in glaucoma medication requirements. There were no statistically significant differences between the two groups in BCVA, IOP, and postoperative glaucoma medication requirements or between patients who received mitomycin C at the time of the original filter and those who did not. The mean preoperative logarithm of the minimal angle of resolution (logMAR) equivalent BCVA for all eyes was 0.8 + 0.4, which improved to a mean of 0.4 + 0.4 postoperatively (P < .0000002). The mean preoperative IOP in all eyes was 11.8 + 4.2 mm Hg and the mean final postoperative IOP was 13. 7 + 4.6 mm Hg (P < .022). The mean preoperative number of glaucoma medications for all eyes was 0.6 + 1.1 and the mean final postoperative number of glaucoma medications was 0.5 + 0.9 (not significant). Clear corneal or scleral tunnel phacoemulsification in the setting of a preexisting glaucoma filter was associated with improved BCVA, a small but statistically significant increase in IOP, and stability in the number of glaucoma medications required for IOP control over a minimum follow-up of 1 year.—Michael D. Wagoner

Comparative Study of Silicone versus Acrylic Foldable Lens Implantation in Primary Glaucoma Triple Procedure

To compare silicone versus acrylic foldable intraocular lens (IOL) implantation in primary glaucoma triple procedure (PGTP). Prospective, randomized. A total of 79 eyes of 79 primary open-angle glaucoma (POAG) patients in need of combined surgery were randomized to a silicone IOL group (36 eyes) and acrylic IOL group (43 eyes). The study eyes underwent PGTP, which consisted of primary trabeculectomy, phacoemulsification, and posterior chamber IOL implantation. Adjunctive mitomycin C (MMC) (0.5 mg/ml for 1 minute) was used selectively only in patients with one or more risk factors for filtration failure of PGTP. Snellen visual acuity, intraocular pressure (IOP), slit-lamp biomicroscopy, and number of glaucoma medications were measured, performed, or determined preoperatively and at regular intervals postoperatively. There were no significant differences in the mean number of postoperative glaucoma medications at 1, 2, 3, 4-6, and 9-12 months and at last follow-up (P > 0.05); mean change in corrected visual acuity best attained (P = 0.315) or at last follow-up (P = 0.223) between the silicone and acrylic groups. Both groups had significant decreases in mean IOP and mean number of medications postoperatively at all times (P < 0.05). However, the postoperative IOP > 25 mmHg and IOP spike > 5 mmHg above preoperative IOP during the first month were significantly higher in the acrylic group (P = 0.026). The mean postoperative IOP at 1 month in the acrylic group was also significantly higher than the silicone group (14.1 +/- 5.0, 11.2 +/- 3.9, P = 0.005). Conversely, there were no significant differences in mean postoperative IOP at 2, 3, 4-6, and 9-12 months and at last follow-up between the silicone and acrylic groups (P > 0.05). Suture removal or release occurred significantly more frequently in the acrylic IOL group during the first month and the first 2 months (48.8% and 60.5%) than the silicone group (25.0% and 36.1%, P = 0.030 and 0.031, respectively). There were no significant differences in postoperative complications or surgical interventions between the two groups (P > 0.05). During the first year following the PGTP with selective use of MMC, there were no significant differences in the medical dependency or visual outcomes or complications between the silicone and acrylic groups. Both groups attained significant decreases in IOP postoperatively. However, the mean IOP was significantly higher in the acrylic than the silicone group at 1 month postoperatively, and postoperative IOP > 25 mmHg and IOP spike > 5 mmHg above preoperative IOP were significantly greater in the acrylic group. There were significantly more suture releases in the acrylic IOL group than the silicone IOL group in the first 2 months postoperatively.