Postsurgical Intraocular Pressure Research Articles

Intraoperative Iridectomy in Femto-Laser Assisted Smaller-Incision New Generation Implantable Miniature Telescope.

In this study, we aimed to report the short-term (6 months) effects on visual functionality and safety of femto-laser assisted smaller-incision new-generation implantable miniature telescope (SING-IMT™) implanting, particularly related to postsurgical intraocular pressure increase, in patients suffering from end-stage age-related macular degeneration (AMD) and cataract. This device, designed for monocular use, aims to minimise the impact of the central scotoma by projecting the images onto a larger area of the photoreceptors surrounding the macula. In this prospective multicentric observational case series study, 6 eyes of 6 patients who underwent SING-IMT™ implantations were enrolled. At baseline and 6 months follow-up, best corrected distance visual acuity (BCDV) and best corrected near visual acuity (BCNVA), intraocular pressure (IOP), anterior chamber depth, endothelial cells count were assessed. In addition, IOP was also measured at 7, 15, 30, 45 days, and at 3 months follow-up. Finally, the incidence of complications was evaluated. At final follow-up, in the study eyes, mean BCDVA improved by +10.0 letters (6.25; 13.8) letters and mean BCNVA improved by -0.30 logMAR (-0.55; -0.20). At postoperative month 6, we reported a mean IOP decrease of 4.50 mmHg (-5.75; -0.25). Interestingly, 83.3% of patients had an increased IOP value in at least one of the first two postoperative follow-ups (7 days and 15 days). In patients in whom intraoperative mechanical iridotomy was not performed, it was necessary to perform a postoperative YAG laser iridotomy to improve IOP management. Compared to the baseline, ECD loss at 6 months follow-up was 12.6%. The SING IMT™ device was found to be effective in the distance and near vision improvement, without serious postoperative complications. We recommend intraoperative mechanical iridectomy in order to easily manage post-operative IOP and to avoid sudden IOP rise with its possible consequences. These good results can be a hope to partially improve the quality of life of patients suffering from severe end stage macular atrophy.

Development and Application of a New T-shaped Internal Trabeculotomy Hook (T-hook).

We introduce a newly designed T-shaped internal trabeculotomy hook and compare its surgical outcomes with those of Kahook dual blade (KDB) surgery. One eye each of seventeen and sixty-one patients underwent T-hook and KDB surgeries, respectively. Post-surgical intraocular pressure (IOP), medications, visual acuity, and prevalence of IOP spikes and hyphema were compared between the two cohorts. The utility of the T-hook was excellent and enabled the easy opening of the Schlemm's canal. The pre-surgical IOP of 25.6 ±7.5 mmHg in the T-hook cohort decreased to 14.1 ± 4.3 (-41.2% reduction) and 15.0 ± 3.1mmHg (-39.3% reduction) at 3 (P<0.001) and 6 months (P=0.003), respectively. Pre-surgical medications of 2.8 decreased to 2.3 and 2.0 medications, respectively, at 3 and 6 months. The best-corrected visual acuity (BCVA) improved from the pre-surgical logarithm of the minimum angle resolution (logMAR) of 0.148 to -0.012 at three months (P=0.036,). While the pre-surgical IOP of 24.9±4.3 mmHg in the KDB cohort decreased to 16.5±5.7 mmHg (-35.5%, P<0.001) and 16.1±3.4 mmHg (-33.5%, P<0.001) at 3 and 6 months, respectively. Reduction in medications at 3- and 12-month timepoints (from 2.8 to 1.7 and 1.7, respectively; P<0.001) and improvement in BCVA at three months (from 0.106 to -0.025 logMAR, P<0.001) were also significant. There was no difference between the T-hook and KDB cohorts in terms of the pre-surgical IOP (P=0.15) and post-surgical IOP at 1 (P=0.27), 3 (P=0.17), 6 (P=0.47), and 12 months (P=0.11, Mann-Whitney U-test). The prevalence of a post-surgical IOP spike in the T-hook and KDB cohorts was 41.2% and 47.5%, and that of post-surgical hyphema was 17.6% and 26.2%, respectively. The novel T-hook was easy to use and was as useful as the KDB device in performing internal trabeculotomy.

Effect of Periocular Triamcinolone Acetonide on Prevention of Postsurgical Intraretinal Cystoid Changes after Vitrectomy with Membrane Peeling.

Newly developed intraretinal cystoid changes after vitrectomy with membrane peeling for removal of epiretinal membranes have the potential to lead to worse postsurgical results compared to patients without. The aim of the present study was to evaluate the feasibility of additional periocular application of triamcinolone acetonide as a routine adjunct at the end of vitrectomy with membrane peeling, and to compare the presence of postsurgical intraretinal cystoid changes in the first 3 months after surgery among patients with idiopathic epiretinal membranes to a historical group of patients that did not receive triamcinolone acetonide. The medical records of 41 eyes of 41patients that underwent 23 G or 25 G pars plana vitrectomy with membrane peeling for removal of epiretinal membranes and additional periocular triamcinolone acetonide application at the end of surgery were retrospectively reviewed. Optical coherence tomography findings during routine follow-ups at 3 - 5 days, 1 month, and 3 months and visual acuity at 3months after surgery were evaluated and compared to preoperative findings. Furthermore, postsurgical intraocular pressure was assessed. Periocular triamcinolone acetonide at the end of surgery was well tolerated among all patients. In total, 10% of patients had an increased intraocular pressure at least at one follow-up. Best-corrected visual acuity improved in 91% of patients with idiopathic epiretinal membranes with a mean improvement of + 3 ± 2 lines (Snellen) and was comparable to a historic group of patients (p = 0.307). Early transient macular edema could not be detected in any of the patients, while there were cases with this pathology in the historic group of patients, but neither occurrence of newly developed intraretinal cystoid changes nor macular thickness at 3 months after surgery were significantly different between patients with and without triamcinolone acetonide (p = 0.385 and p = 0.879). Periocularly applied triamcinolone acetonide at the end of vitrectomy with membrane peeling was well tolerated and showed prevention of early transient macular edema but did not prevent the development of new postoperative intraretinal cystoid changes.

Ocular Hypotension and Epiretinal Membrane as Risk Factors for Visual Deterioration Following Glaucoma Filtering Surgery.

Postsurgical hypotension at 1 week and the presence of an epiretinal membrane (ERM) were significant risk factors for the deterioration of postsurgical visual acuity (VA) at 3 and 12 months, respectively. The purpose of this study was to assess the effects of an ERM and postsurgical hypotension <6 mm Hg at 1 week on postsurgical VA loss. A total of 69 patients (69 eyes) who underwent trabeculectomy with adjunctive mitomycin C between 2017 and 2019 (mean follow-up period: 22.8 mo) were enrolled, and 14 parameters that could be associated with the deterioration of VA at 3 and 12 months were studied. There was a significant association between VA loss at 3 months and postsurgical intraocular pressure at 1 week (P=0.006 by multiple regression) and hypotony maculopathy (P=0.024 by Fisher exact test). However, this association was lost at 12 months. Instead of postsurgical hypotension, the presence of an ERM was significantly associated with VA loss at 12 months (P=0.035 by Fisher exact test, and P=0.023 by logistic regression). Postsurgical hypotension at 1 week was significantly associated with mid-term, but not long-term, postsurgical VA loss. The presence of an ERM, which was not a risk factor for mid-term acuity loss, was a significant risk factor for VA loss at 12 months.

Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery.

PurposeTo evaluate the surgical outcome of internal trabeculectomy by Kahook dual blade (KDB) with that of external trabeculotomy, each combined with phaco-lensectomy and intraocular lens implantation (Phaco).Patients and MethodsThis is a retrospective comparative study. The primary and secondary outcome measures are postsurgical intraocular pressure and postsurgical hyphema. One eye each of 76 primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEG) and ocular hypertension (OH) patients underwent external phaco-trabeculotomy, and that of 40 POAG, PEG and OH patients underwent phaco-KDB surgery.ResultsReduction of the intraocular pressure (IOP) by phaco-KDB at one and two years was 28.4 and 27.8%, respectively, and was not significantly different from that by external phaco-trabeculotomy of 32.7% (P=0.256) and 31.5% (P=0.468), respectively. Three months postsurgical IOP after phaco-KDB and external phaco-trabeculotomy was 16.1 and 15.9 mmHg, respectively. There was a significant turn back elevation of once reduced IOP to 17.1 (P=0.0207) and 17.0 mmHg (P=0.0096) at 24 months, respectively. There were no differences in success probability to achieve IOP below 17 mmHg (P=0.120), 21 mmHg (P=0.719) and >20% IOP reduction (P=0.309) with medication(s) at two years between the phaco-KDB and external phaco-trabeculotomy cohorts. Younger age was a significant (P<0.001) risk factor for failure; however, presurgical IOP (P=0.466), the type of surgery (P=0.219) and presence of postsurgical IOP spike (P=0.737) were not significant risk factors by the Cox proportional hazard model. Hyphema and spike of the IOP in phaco-KDB and external phaco-trabeculotomy cohorts were 40% and 88% (P<0.001), and 53% and 41% (P=0.238), respectively.ConclusionThe IOP reduction by the phaco-KDB was equivalent to that by external phaco-trabeculotomy up to two years. In both cohorts, once reduced postsurgical IOP tend to increase up to 24 months.

Predicting factors of ocular hypertension following keratoplasty: Indications versus the procedure.

To assess the incidence of ocular hypertension (OHTN) following penetrating keratoplasty (PKP) versus deep anterior lamellar keratoplasty (DALK) corneal transplant surgeries, and to assess the impact of indication for transplantation versus surgery type on OHTN development. A retrospective study of 76 eyes of 76 patients who underwent PKP or DALK between 1 January 2009 and 1 September 2014. Data included: preoperative intraocular pressure (IOP), indication and type of surgery, post-surgical IOP at 1 to 5, 14 to 21 days, 3, 6 months, 1 year and at the last follow up. Primary outcome was post-operative OHTN (defined as IOP >21 mm Hg). A total of 13 patients (17.1%) developed OHTN of whom 9 (20.45%) underwent PKP and 4 (12.5%) DALK (p = 0.33). OHTN occurred after an average of 16.46 ± 8.47 months (0.1-58 months). Twenty-one keratoconus patients (39.62%) underwent PKP and 32 (60.37%) underwent DALK. Patients with indications other than keratoconus all underwent PKP. Keratoconus patients were less likely to develop OHTN (9.43% vs 34.78%, p = 0.02). Among patients developing OHTN, mean age of the non-keratoconus group was significantly higher (63.25±16.7 vs 33 ± 10, p = 0.01). No significant difference in OHTN among keratoconus patients undergoing DALK versus PKP (12.5% vs 4.76%, respectively, p = 0.35) was found. PKP was associated with less OHTN in keratoconus eyes (4.76% vs 34.78%, p = 0.02). Patients who underwent keratoplasty due to keratoconus are at a lower risk to develop OHTN than those who underwent surgery for other indications.

Argon Laser Peripheral Iridoplasty and Argon Laser Pupilloplasty: Alternative Management for Medically Unresponsive Acute Primary Angle Closure.

Objective To introduce the combined laser technique, argon laser peripheral iridoplasty (ALPI) and argon laser pupilloplasty (ALPP), in the management of medically unresponsive acute primary angle closure (APAC). Design Retrospective study. Methods We retrospectively reviewed the records of 23 patients (27 eyes) with APAC, who were applied ALPI and ALPP when traditional treatment failed. The visual acuity and intraocular pressure (IOP) were monitored before surgery and at 1, 2, 12, 24, and 48 h after surgery. Additionally, the angle-opening status was monitored before surgery and 48 h after the treatment by using an ultrasonic biological microscope (UBM), and the presurgical and postsurgical cornea edema statuses were observed by using a slit lamp. We also documented the complications of laser treatment. Results For the ALPI + ALPP laser-effective group, the presurgical IOP was 52.1 ± 9.3 mmHg and the postsurgical IOP was 37.6 ± 10.9 mmHg (1 h), 28.4 ± 12.4 mmHg (2 h), 19.9 ± 9.0 mmHg (6 h), 16.8 ± 7.3 mmHg (12 h), 15.9 ± 5.9 mmHg (24 h), and 14.9 ± 5.0 mmHg (48 h), with statistically significant differences (p < 0.05) in each time point. It was observed in all the patients that the corneal edema alleviated, the angles opened, and visual acuity recovered with varying degrees at 48 h after applying combined laser treatment. For the ALPI + ALPP laser-ineffective group, further interventions were taken. Definite treatment was given in both groups to maintain the long-term IOP control. Conclusions Although the combination of ALPI and ALPP is a temporizing therapeutic strategy for APAC, it is effective in relieving pupillary block which is unresponsive to miotic agents, opening the closed angle to a certain extent, restoring the transparency of cornea, and reducing IOP to a safe level for further definitive treatment.

Effect of phacoemulsification on intraocular pressure in patients with primary open angle glaucoma and pseudoexfoliation glaucoma.

To compare the effect of phacoemulsification on intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). A retrospective comparative case series conducted at the Glaucoma Department at the Association to Prevent Blindness in Mexico. The study enrolled consecutive patients having phacoemulsification with intraocular lens (IOL) implantation and a diagnosis of POAG or PXG. Data about IOP values and number of glaucoma medications used was collected at baseline, 1, 3, 6 and 12mo postoperatively. The study enrolled 88 patients (88 eyes). After phacoemulsification, there was a statistically significant reduction in IOP values and glaucoma medications use compared to baseline in both POAG and PXG patients (P<0.001). In the POAG group, a 20% decrease in IOP values was evidenced, and a 56.5% reduction in the number of medications used at the one-year follow-up. The PXG group showed a 20.39%, and a 34.46% decrease in IOP and number of medications used, respectively. A significant difference in the mean ΔIOP (postoperative changes in IOP) was evidenced between groups (P=0.005). The reduction of the postsurgical IOP mean values in both groups, the POAG group showed a greater reduction in IOP values compared to the PXG group. In both types of glaucoma, phacoemulsification cataract surgery can result in a significant IOP reduction (20%) over a 12mo follow-up period. The number of medications used is also significantly reduced up to 12mo after surgery, especially in the PXG group.

Nd:Yag laser goniopuncture for deep sclerectomy: efficacy and outcomes.

To report on the safety and efficacy of Nd: YAG laser goniopuncture (LGP) for postsurgical intraocular pressure increase after deep sclerectomy (DS) in a consecutive cohort of open-angle glaucoma patients. This case series included 56 eyes from 49 consecutive patients who underwent LGP between November 2008 and March 2015. Prior to LGP, patients had undergone DS augmented with mitomycin C and injectable cross-linked hyaluronic acid implant between October 2008 and May 2014. Demographic variables, type of glaucoma, prior phacoemulsification, intraocular pressure (IOP), best-corrected visual acuity, execution of post-LGP maneuvres, and post-LGP complications were analyzed. The success rate of the procedure was analyzed using the Kaplan-Meier survival curve. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model in order to highlight variables associated with a failure to achieve surgical success. Mean IOP was 23.0 mmHg prior to LGP, and 12.5, 11.8, and 10.5 mmHg at 6, 12, and 24 months after LGP respectively. Post-laser IOP was significantly lower than pre-laser IOP at every time point. For an IOP ≤ 15 mmHg, success rates were 85 % at 6 months, 76 % at 1 year, and 62 % at 2 years. Thirty-eight eyes underwent prophylactic iridotomy and iridoplasty prior to LGP. Iris prolapse into the trabeculo-descemetic window following LGP occurred in 6/18 eyes (33.3 %) of the non-pretreated and in 1/38 eyes (2.6 %) of the pretreated group. One case of choroidal detachment and one delayed suprachoroidal hemorrhage occurred after LGP execution in two non-pretreated eyes. LGP is a relatively safe and effective complementary adjunct to deep sclerectomy that makes it possible to further lower IOP and avoid additional filtering surgery. Prophylactic iridotomy and localized iridoplasty may permit the frequency of post-LGP complications to be reduced.

Effect of bilateral sequential cataract extraction on intraocular pressure in non-glaucomatous Asian eyes

Background/aimsTo determine the effect of cataract extraction on intraocular pressure (IOP) of both eyes in patients undergoing sequential cataract extractions.MethodsRetrospective review of 116 consecutive treatment-naive non-glaucomatous patients who underwent sequential...

Suture Pull-Through Insertion Techniques for Descemet Stripping Automated Endothelial Keratoplasty in Chinese Phakic Eyes: Outcomes and Complications

PurposeTo investigate the outcomes and complications of suture pull-through insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK) in Chinese phakic eyes.Patients and MethodsRetrospective case series. Included in the study were all Chinese patients with phakic eyes who underwent DSAEK at Peking University Third Hospital from August 2008 to August 2011. All ocular diseases of the patients were recorded. Distance visual acuity (DVA), near visual acuity (NVA), intraocular pressure (IOP), anterior chamber depth (ACD), central corneal thickness (CCT), and corneal endothelial cell density (ECD) were compared prior to and 12 months after DSAEK. The DSAEK success rate, endothelial cell loss (ECL), complications, and prognosis were analyzed. All patients had at least 12 months of follow up.ResultsTwenty-one eyes of 16 patients were included (11 males and 5 females). Ages ranged from 2 to 47 years with an average age of 29.8 years. The average follow up was 15.4 months (ranging from 12 to 36 months). Diagnoses included 7 eyes (4 patients) with corneal endothelial dystrophy and 14 eyes (12 patients) with bullous keratopathy. Presurgical DVA and NVA (LogMAR) were 1.7±0.7 and 1.2±0.4; postsurgical DVA and NVA were 0.8±0.6 and 0.7±0.5; Z = −3.517, −2.764; P<0.001 and P = 0.006 respectively. Presurgical IOP was 15.8±3.7 mm Hg; postsurgical IOP was 15.2±2.6 mm Hg; Z = −0.505, P = 0.614. Presurgical ACD was 3.00±0.74 mm; postsurgical ACD was 2.72±0.59 mm; Z = −0.524, P = 0.600. Donor ECD was 2992±163 cells/mm2, ECD was 1836±412 cells/mm2 with a 12-month postsurgical ECL of 39%. Success rate was 86%. Surgery complications included pupillary block-induced hypertension in 5 eyes (24%), graft detachment in 3 eyes (14%), and graft dislocation in 1 eye (5%).ConclusionsDSAEK on Chinese phakic eyes can significantly improve DVA and NVA by preserving the patient’s own crystalline lens. DSAEK is an optional surgery for patients who need to preserve accommodative function. More attention should be given to postsurgical pupillary block-induced hypertension.

NON PENETRATING DEEP SCLERECTOMY AND TRABECULOTOMY FOR GLAUCOMA

ABSTRACT Purpose: The purpose of this paper is to show the efficacy and safety of controlling intraocular pressure by combining a non-penetrating deep sclerectomy procedure with trabeculotomy, and analyze its results and complications. Design: Surgical cases. Material and Methods: Intraocular pressure equal to or less than 16 mmHg with or without medication was considered a success. Between August 2005 and October 2008, 61 eyes were operated, presenting open-angle glaucoma without intraocular pressure control with maximum medication. 28 patients underwent non-penetrating deep sclerectomy with trabeculotomy and the others received combined phacoemulsification and intraocular lens implant. Average age was 68 years, with a range between 48 and 86. Sex distribution was 22 men and 39 women. Average pre-surgical intraocular pressure was 21.75 mmHg, with standard deviation +- 5.45 and a range between 14 and 45 mmHg. Average follow-up was 22.55 months with a range between 1 and 40 months. No antimetabolites, viscoelastics or devices were employed to improve the results. Results: Average latest post-surgical intraocular pressure was 12.79 mmHg, standard deviation +-4.31 with a range between 9 and 40 mmHg. The difference between pre- and post-surgical measures was 8.96 mmHg. Average success was 88.52% (54 eyes). The failure rate was 11.47% (7 eyes). Intraocular pressure was controlled in 51 eyes (83.60%) without medication and in 10 eyes (16.39%) with medication. 35 cases had hyphema between 1 to 12 days post-surgery, resolved without consequences. Conclusions: Combining non-penetrating deep sclerectomy with trabeculotomy showed better results than each one separately, resulting in an alternative procedure for surgical treatment of open-angle glaucoma.

Microdevice for aqueous humor drainage Maldonado Bas - Pförtner

A microdevice for the treatment of refractory glaucoma is presented. The underlying concepts, its mechanisms of action and the surgical technique for implanting are explained and the results are analyzed. The microdevice was developed and the surgeries were performed at the Maldonado-Bas Eye Clinic (Cordoba, Argentina), under the rules established in the protocol approved by the provisions of the National Administration of Drugs, Food and Medical Technology 430/7. File No.:1-47-25-649-07-1. In a prospective study, following the protocol, 16 eyes with refractory glaucoma were included and operated. Intraocular pressure <21mmHg with or without additional medication was considered successful. The follow-up was one year. Averages, percentages and their 95% confidence bands were calculated. Analysis of variance for repeated measures was used to compare averages. The average preoperative intraocular pressure was 32.81 mmHg, SD ± 10.94 mmHg in a range of 14 to 50 mmHg. The average post-surgical intraocular pressure at one year was 12.43 mmHg, SD ± 2.85 mmHg in a range of 7 to 19 mmHg. The difference between the pre-and post-surgery average intraocular pressure was 20.38 mmHg. The number of successes was 14 eyes (87.5%, confidence interval (CI) 95% 61.6% - 98.6%). The number of failures was two eyes (12.5%, CI 95% 1.43% - 38.4%). The results show that the microdevice is successful for the treatment of refractory glaucoma.

Different modes of intraocular pressure reduction after three different nonfiltering surgeries and trabeculectomy

To study the mode of intraocular pressure (IOP) reduction based on correlation with the preoperative IOP after filtering and nonfiltering surgeries. Pre- and postsurgical IOPs at 6 months were compared in one eye of each of 789 subjects with primary open-angle glaucoma, pseudoexfoliation glaucoma, or ocular hypertension who underwent trabeculectomy with adjunctive mitomycin C alone (Lectomy-MMC) (n = 145), phaco-viscocanalostomy (Phaco-VCS) (n = 320), phaco-trabeculotomy ab externo (Phaco-lotomy) (n = 116), or phacoemulsification aspiration and intraocular lens implantation alone (PEA+IOL) (n = 208). The correlation between the preoperative and 6-month postoperative IOP was not significant in eyes that underwent Lectomy MMC (r = -0.026, P = 0.7552, IOP reduction 51.9%), but was significant in eyes treated by Phaco-VCS (r = 0.409; IOP reduction, 24.8%) or PEA+IOL alone (r = 0.294; IOP reduction, 9.9%), and was marginal in eyes treated by Phaco-lotomy (P = 0.062; r = 0.174; IOP reduction, 24.1%). Among the four cohorts studied, the variation in the 6-month postoperative IOP was the largest after Lectomy-MMC. After glaucoma surgery, there are two modes of IOP reduction. The postoperative IOP after Lectomy MMC did not correlate with the preoperative IOP, whereas the postoperative IOP levels after Phaco-VCS, Phaco-Lotomy, and PEA+IOL correlated with preoperative IOP levels. We may be able to predict postsurgical IOP after nonfiltering surgery.

Kanaloplastik

Canaloplasty provides a new option in non-penetrating glaucoma surgery. The aim of this study is to examine its early postsurgical safety and efficacy. This was a retrospective study of canaloplasties performed at our institution in 2009 (n=46, 13 of which were combined with cataract surgery). The mean follow-up was 6.0±3.4 months. The most important parameters examined were intraocular pressure (IOP), number of topical medications, postoperative complications, and required additional surgery. Mean presurgical IOP: 18.2±5.8mmHg on a mean of 2.3±1.2 applied topical medications. Mean postsurgical IOP: 12.3±5.1mmHg at 3 months, 11.7±3.0mmHg at 6 months, and 12.6±2.4 mmHg at 12 months. Number of postsurgical medications: 0.8±1.1at 3 months, 1.2±1.3at 6 months, and 1.0±1.1 at 12 months. The most frequent postoperative complications were transient hypotension (32.6%), bleb leakage (26.1%), and microhyphema (23.9%). Revision surgery was required in 8.7% of all patients. Canaloplasty showed a good IOP-reducing effect. Complications occurred mostly temporarily and were of a controllable nature.

Visual Field Protective Effect of Erigeron breviscapus (vant.) Hand. Mazz. Extract on Glaucoma with Controlled Intraocular Pressure

Objective: To evaluate the visual field protective effect of Erigeron breviscapus (vant.) Hand. Mazz. (EBHM) extract on glaucoma with controlled intraocular pressure (IOP).Methods: Forty patients (40 eyes) with primary open-angle glaucoma, visual field defects and a postsurgical IOP of <18mmHg were enrolled. The EBHM and placebo tablets were given orally according to the randomized and double-blind principle. Two tablets (of either EBHM or placebo) were taken three times a day for a period of 6 months. Patients were examined every 2 months after treatment commenced. At the end of the study, the results were given to the drug manufacturer.Results: All patients completed the prospective, randomized, double-blind, clinical trial. No obvious adverse effects were found in patients during the treatment period. In the placebo group, no significant difference was found in mean defect (MD) or mean sensitivity (MS) between the values at pretreatment and after 2, 4, and 6 months of treatment. After 6 months of EBHM treatment, the MD was significantly decreased and the MS was significantly increased compared with pre-treatment (p < 0.05). In the patients with moderate and late glaucoma, the MD was significantly decreased and the MS was significantly increased after 2, 4, and 6 months of EBHM treatment compared with pre-treatment.Conclusion: EBHM extract may have a partial protective effect on the visual field of glaucoma patients with controlled IOP. Further studies are needed to determine the safety and effectiveness of long-term EBHM treatment.

Visual Field Protective Effect of Erigeron breviscapus (vant.) Hand. Mazz. Extract on Glaucoma with Controlled Intraocular Pressure

Objective: To evaluate the visual field protective effect of Erigeron breviscapus (vant.) Hand. Mazz. (EBHM) extract on glaucoma with controlled intraocular pressure (IOP). Methods: Forty patients (40 eyes) with primary open-angle glaucoma, visual field defects and a postsurgical IOP of <18mmHg were enrolled. The EBHM and placebo tablets were given orally according to the randomized and double-blind principle. Two tablets (of either EBHM or placebo) were taken three times a day for a period of 6 months. Patients were examined every 2 months after treatment commenced. At the end of the study, the results were given to the drug manufacturer. Results: All patients completed the prospective, randomized, double-blind, clinical trial. No obvious adverse effects were found in patients during the treatment period. In the placebo group, no significant difference was found in mean defect (MD) or mean sensitivity (MS) between the values at pretreatment and after 2, 4, and 6 months of treatment. After 6 months of EBHM treatment, the MD was significantly decreased and the MS was significantly increased compared with pre-treatment (p < 0.05). In the patients with moderate and late glaucoma, the MD was significantly decreased and the MS was significantly increased after 2, 4, and 6 months of EBHM treatment compared with pre-treatment. Conclusion: EBHM extract may have a partial protective effect on the visual field of glaucoma patients with controlled IOP. Further studies are needed to determine the safety and effectiveness of long-term EBHM treatment.

Modified Deep Sclerectomy (D-lectomy MMC) for Primary Open-angle Glaucoma

To evaluate the outcome of modified deep sclerectomy [D-lectomy mitomycin C (MMC)] for medically refractory glaucoma patients. In a retrospective comparative study, the surgical outcome in 1 eye each of 31 patients who underwent D-lectomy MMC was compared with that of 91 eyes of 91 patients who underwent trabeculectomy with adjunctive MMC. These eyes had a diagnosis of primary open-angle glaucoma or pseudoexfoliation glaucoma, a record of high intraocular pressure (IOP) exceeding 25 mm Hg, and planned for surgical intervention. In the D-lectomy MMC cases, a slit incision at the trabecular meshwork and peripheral iridectomy were created. The "lake" and trabeculo-Descemet membrane ("window") were examined by ultrasound biomicroscope, gonioscopy, and time-domain optical coherence tomography. Postsurgical IOP at 1, 3, 6, and 12 months after the D-lectomy MMC and trabeculectomy MMC were comparable (P=0.63-0.97). The filtering bleb was noted in 14 (45%) of the 31 D-lectomy MMC eyes at 3 months, and their survival was significantly less than trabeculectomy MMC subjects in which 81 of 91 eyes had the bleb at 3 months (P<0.0001). The lake was noted in 29 of 31 D-lectomy MMC eyes. The sealing of the once penetrated trabecular meshwork was complete at 3 months in 23 of 29 eyes by ultrasound biomicroscopic and/or gonioscopic examinations, whereas that was incomplete in 6 eyes. Addition of a slit incision to the trabecular meshwork and peripheral iridectomy (D-lectomy MMC) improved postsurgical IOP of the deep sclerectomy to the level comparable with trabeculectomy MMC, with a less frequency of the bleb formation.

Efficacy and Safety of Trabeculectomy with Mitomycin C for Childhood Glaucoma: A Study of Results with Long-Term Follow-Up

OBJECTIVETo evaluate the safety and effectiveness of trabeculectomy with mitomycin C in the management of childhood glaucoma.INTRODUCTIONThe use of antifibrotic agents enhances the success of trabeculectomy performed in both adults and children.METHODSA retrospective chart review (1991–2001) of 114 patients (114 eyes) from 0–14 years of age with congenital or developmental glaucoma. These patients underwent trabeculectomy with mitomycin but had not been previously treated with any antifibrotic agent.RESULTSThe mean patient age was 57.36 +/− 51.14 months (range: 0.5–168 months). Treatment was considered successful in 63 eyes (55.26%), with a mean intraocular pressure of 12.11 +/− 3.98 mmHg. For patients categorized as successfully treated, the mean follow-up time was 61.16 +/− 26.13 months (range 12–113 months). A post-surgical intraocular pressure of < 16 was observed in 47 eyes. The life-table success rates for intraocular pressure control at 24, 36, 48, and 60 months were 90.2%, 78.7%, 60.7% and 50.8%, respectively. The cumulative probability of failure was 40.8% at 12 months. Following surgery, endophthalmitis appeared in eight eyes (4.88%) after an average 36.96 months (range: 1.7–106 months). Other complications included expulsive hemorrhage, flat anterior chamber and bleb leak.DISCUSSIONIt has been reported in pediatric patients that trabeculectomy without adjunctive antimetabolites achieves a successful outcome in 30% to 50% of cases. In our study, treatment was considered successful in 63 eyes (55.26%) within 61.16 +/− 26.13 months of follow-up.CONCLUSIONSTrabeculectomy with mitomycin is safe and effective for short-term or long-term treatment of congenital or developmental glaucoma. The frequency of bleb-related endophthalmitis was no higher in these patients than that described in adults.

180 Sclérectomie profonde non pénétrante avec trabéculotomie pour glaucome

The purpose of this paper is to show the efficacy and safety of controlling intraocular pressure by combining a non-penetrating deep sclerectomy procedure with trabeculotomy, and analyze its results and complications. Intraocular pressure equal to or less than 16 mmHg with or without medication was considered as a success. Between August 2005 and September 2006, 29 eyes were operated for open-angle glaucoma without control of the intraocular pressure in spite of maximum medication. 14 patients underwent non-penetrating deep sclerectomy with trabeculotomy and the others received combined phacoemulsification and intraocular lens implant. Average age was 71 years, with a range between 57 and 87. Sex distribution was 11 men and 18 women. Average presurgical intraocular pressure was 23.07 mmHg, with standard deviation +- 6.42 and a range between 17 and 45 mmHg. Average follow-up was 10 months with a range between 2 and 14.5 months. Pre-surgical and post-surgical intraocular pressures at 1, 2, 3, 6 and 12 months were analyzed. The surgical technic was as follows: Fornixbased conjunctival flap. Dissection of a scleral flap 4 × 3mm and 300μ thick. Paracentesis and phacoemulsification performed according to the case. Deep flap dissection unroofing the Schlemm canal and exposing the Descemet membrane. Juxtacanalicular tissue removed with forceps, and trabeculotomy performed on both sides. Sclera and conjunctiva were sutured. No antimetabolites, viscoelastics or any devices were employed to improve the results. On average, latest post-surgical intraocular pressure was 12.25 mmHg, standard deviation +/-2.03 with a range between 8 and 16 mmHg. The difference between pre- and post-surgical measures was 11.53 mmHg. Only one eye (3.45%) out of 29 did not have intraocular pressure controlled and had to undergo a trabeculectomy. Intraocular pressure was controlled in 27 eyes (93.1%) without medication and in 1 eye (3.45%) with only one drop of medication. 18 cases had hyphema between 1 to 8 days post-surgery, resolved without consequences. Combination of non-penetrating deep sclerectomy with trabeculotomy showed better results than each one separately, resulting in an alternative procedure for surgical treatment of open-angle glaucoma.