Postoperative Ocular Hypotony Research Articles

Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison.

PurposeTo assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone.Methods In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg intraocular pressure (IOP) 21 mmHg, and IOP reduction 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA).Results The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 2.4 mmHg at baseline to 14.1 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 2.0 mmHg and 13.9 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 0.3 versus 2.0 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 14.3 versus 17.9 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 0.85 logMAR and changed to 0.55 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 1.07 and 0.63 0.97 logMAR, respectively (P = 0.668).ConclusionWe observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

Surgical outcomes of membrane-tube-type glaucoma shunt device in indigenous West Africans.

PurposeThe aim of this study was to report the safety and efficacy of the membrane-tube (MT)-type glaucoma shunt device (Finetube MT) in the management of refractory glaucoma in indigenous West Africans.MethodsThe Finetube MT was implanted into 25 eyes of 25 West African patients with refractory glaucoma. These patients had inadequate intraocular pressure (IOP) control despite maximum tolerable IOP-lowering medications with or without previous ocular surgeries. IOP, postoperative complications, interventions, visual acuities, and the number of IOP-lowering medications were analyzed preoperatively and postoperatively.ResultsThe mean (standard deviation [SD]) age of the patients was 49.7 (20.9) years. The mean (SD) follow-up duration was 21.0 (10.6) months. Postoperatively, the mean (SD) IOP reduced from a preoperative value of 38.1 (10.3) mmHg to 14.5 (4.6), 16.1 (7.8), and 14.7 (3.0) mmHg at 1, 2, and 3 years postoperatively, respectively, representing 61.9%, 57.7%, and 61.4% reduction from baseline (P<0.01). The mean (SD) number of IOP-lowering medications reduced from 4.1 (1.0) to 0.6 (0.9) at 1 year and 0.9 (1.1) at 2 years after the operation (P<0.01). Using an IOP level between 6 and 21 mmHg and reduced by ≥20% from baseline, the cumulative survival rate (standard error) was 96.0% (3.9%) at 6 months, 89.0% (6.0%) at 18 months, and 81.3% (10.6%) at 3 years after the operation. There was no postoperative ocular hypotony, tube occlusion, or device exposure.ConclusionThe Finetube MT may effectively control IOP with minimal risk of postoperative complications in indigenous West Africans.

Membrane-tube-type glaucoma shunt device for refractory glaucoma surgery.

To evaluate the safety and efficacy of a novel membrane-tube (MT)-type glaucoma shunt device for refractory glaucoma surgery. The device consists of an expanded polytetrafluoroethylene membranous reservoir, as well as a silicone tube (300-μm external and 200-μm internal diameter) with an intraluminal stent. We named the device "Finetube MT". The Finetube MT was implanted into 44 glaucomatous eyes that had insufficient intraocular pressure (IOP) control despite medical treatment or previous trabeculectomy. The membranous reservoir was placed underneath the Tenon's capsule, with each end located below the recti muscles; the tube was placed in the anterior chamber through a partial-thickness scleral track. We investigated the baseline and post-operative IOP values, the number of IOP-lowering medications used, and complications. The mean age of the subjects was 51.6 ± 17.2years, and the mean follow-up duration was 22.5 ± 12.0months. One year after the surgery, the mean IOP had decreased from 32.8 ± 12.2mmHg to 16.9 ± 6.4mmHg (48.5% reduction; p < 0.01), and the mean number of IOP-lowering medications used had decreased from 2.5 ± 0.8 to 1.1 ± 0.9 (p < 0.01). We considered the surgery as a success when the IOP was between 6 and 21mmHg, and had been reduced by ≥ 20% from baseline; by this standard, the success rate was 92.4% after 1year, and 85.0% after 3years. Neither postoperative ocular hypotony-related complications nor tube exposure occurred in any case. The Finetube MT showed promising surgical outcomes as a treatment for refractory glaucoma, with minimal risk of postoperative ocular hypotony or tube-related complications.

Novel membrane-tube type glaucoma shunt device for glaucoma surgery.

The background of this study is to introduce the surgical technique and outcomes of a novel membrane-tube (MT) type glaucoma shunt device (MicroMT), which was developed to achieve safer and more predictable intraocular pressure (IOP) control compared with conventional trabeculectomy. This is a retrospective, non-comparative, interventional case series study. The MicroMT was implanted in 43 glaucomatous eyes with insufficient IOP control despite medical treatment. The MicroMT consists of an expanded polytetrafluoroethylene membrane and a silicone tube with an intraluminal stent, which allows aqueous drainage from the anterior chamber to the lamellar scleral flap. The intraluminal stent prevents excessive aqueous drainage and allows additional IOP reduction through retraction or removal of the stent. The main outcome measures of this study are IOP changes and complications. The mean (SD) IOP decreased from a preoperative value of 22.5 (6.9) mmHg to 11.1 (3.6) mmHg 3 years after the operation (50.7% reduction from baseline; P < 0.01). Intraluminal stent removal 4 weeks after the operation induced an additional 40.2% IOP reduction (P < 0.01). When success was defined as an IOP between 6 and 21 mmHg, and an IOP reduction of ≥20% from baseline, the success rate was 89.5% at 3 years after the operation. No postoperative ocular hypotony (IOP <6 mmHg) or tube-related complications occurred. MicroMT implantation is a novel therapy that may reduce IOP safely and effectively, with no apparent risk of postoperative ocular hypotony. Glaucoma surgery using this device may be a good alternative to conventional glaucoma surgery.

Glaucoma filtering surgery in the elderly over eighty years old: an analysis of postoperative risks

Aim of this retrospective study was to identify the postoperative complications following trabeculectomy with mitomycin C in patients aged 80 years or older at the time of surgery. Additionally, the corresponding risk factors for postoperative complications were analysed. During a defined period between 2005 and 2009 all trabeculectomies in this age group at the Department of Ophthalmology, University of Cologne were identified. Second eye surgery and re-trabeculectomies in the same eye were excluded from data collection. Postoperative ocular hypotony (< 6 mmHg) and hypertony (> 20 mmHg), bleeding, corneal erosion, re-surgery and prolonged postoperative duration of hospital stay were defined as complications. One hundred and twenty eyes of 120 patients were included. The mean age was 83.4 years, 62.5 % patients were female. Eighty nine percent of the eyes were pseudophakic, the mean visual field defect was - 17.3 dB, the mean preoperative intraocular pressure under pressure-reducing medication was 24.1 mmHg. Considering the perioperative complications there was no significant difference depending on the age (80-85 years, n = 79 and > 85 years, n = 41), depending on the type of anesthesia (general, n = 80 and local, n = 40) or depending on antiplatelet (APT)/anticoagulative (ACT) therapy (APT, n = 55 and ACT, n = 16). The postoperative duration of the hospital stay showed significant correlations with the occurrence of corneal erosions, postoperative ocular hypertony, loss of anterior chamber and choroidal detachment. The postoperative risks of antiglaucomatous filtering surgery did not increase with age or comorbidity. However, even minor perioperative complications had direct implications on the duration of the hospital stay.

OUR FIRST EXPERIENCE OF THE APPLICATION OF EX-PRESS SHUNT IN COMBINATION WITH HEMOSTATIC SPONGE IN OBSTINATE GLAUCOMA SURGERY

On the clinical case the article presents our first experience of the use of Ex-Press shunt in combination with hemostatic sponge in obstinate (resistant) glaucoma surgery, which requires a special approach to the choice of means and methods of treatment because of the low efficiency of conventional methods. The technology of the surgery distinguishes with its minimal invasiveness, absence of necessity in scleroticectomy or iridectomy, provides reliable and consistent normalization of intraocular pressure. Good conditions for the formation of a consistent filtering bleb are created in combination with the use of gelatinous hemostatic sponge, because the processes of formation of conjunctival and scleral as well as scleral adherences in the area of surgical interference are prevented. The use of a sponge reduces the possibility of haemorrhagic intraoperative and postoperative complications, and significantly reduces the period of post-operative ocular hypotony.

Évaluation de la vitrectomie transconjonctivale 20-gauge sans suture

To evaluate the safety and efficacy of 20-gauge transconjunctival sutureless vitrectomy for a variety of vitreoretinal conditions. This study was a retrospective clinical case series examining 29 eyes of 29 patients treated with 20-gauge transconjunctival sutureless vitrectomy. The main outcome measures included intraocular pressure, visual acuity, surgical time, and intraoperative and postoperative complications. The mean follow-up duration was 5.7 months. There were only two cases of postoperative ocular hypotony (6.9%) and one suspect case of endophthalmitis. Mean overall acuity improved from 0.495 logMar at baseline to 0.29 logMar (p=0.002) and mean total operative time was 19 min. We observed no cases of retinal detachment. Twenty-gauge transconjunctival sutureless vitrectomy is an effective surgical technique, but other studies are needed to confirm its safety and its value in other indications.

Ocular hypotony after the use of indocyanine green for epiretinal membrane surgery

Purpose: To report the occurrence of transient ocular hypotony after indocyanine green (ICG)-assisted macular surgery for removal of the epiretinal membrane (ERM).Materials and methods: This was a retrospective review of 122 eyes of 118 patients who underwent vitrectomy for idiopathic ERM. The ICG staining technique was used in 71 eyes without fluid–air exchange (FAX) and in 15 eyes with FAX. Detailed eye examinations, including intraocular pressure (IOP) measurement, were performed before and after surgery.Results: We observed postoperative transient ocular hypotony with choroidal detachment in 8 of 71 eyes (11%) in the ICG (+)/FAX (−) group, and no ocular hypotony was seen in the ICG (+)/FAX (+) group (15 eyes) or in the ICG (−) group (36 eyes). The median best corrected visual acuity (BCVA) in the ICG(−)group was only significantly better than in the ICG (+)/FAX (−) with hypotony at 1 week after surgery (p = 0.046). However, there was no statistically significant difference in BCVA at 3 and 6 months after surgery among the groups (p > 0.05).Conclusion: ICG staining of the internal limiting membrane (ILM) supports complete ERM removal because of enhanced visualization of the border between the ILM and the ERM. However, it should be cautioned that postoperative ocular hypotony may occur in some cases of ICG-assisted macular surgery. Therefore, informed consent with careful follow-up is required when ICG-assisted surgery is performed.