Previous Glaucoma Surgery Research Articles

Investigation of Endothelial Cell Density after PreserFlo Implantation Compared to Contralateral Eyes without PreserFlo Implantation - A Retrospective Analysis.

Loss of corneal endothelial cells after glaucoma surgery can lead to corneal decompensation and reduced vision. This loss may be accelerated by drainage implants like PreserFlo, which allow controlled subconjunctival filtration. In a retrospective analysis, we examined its impact on corneal endothelial cell density (ECD). Data from medical records for 94 eyes were retrospectively analyzed. This included 47 PreserFlo-operated eyes and 47 contralateral control eyes. Inclusion criteria were open-angle glaucoma, laser trabeculoplasty as the only prior glaucoma surgery, and a contralateral control eye without any previous glaucoma surgeries and without any relevant diseases. Only standalone procedures and pseudophakic eyes were considered. We included 48 eyes at 2 weeks (24 operated, 24 control eyes), 72 at 3 months (36 each), 34 at 1 year (17 each), and 36 at 3 years (18 each). Preoperatively, the 47 eyes that were planned for surgery had a mean ECD of 2141 ± 527 cells/mm², and the 47 control eyes had an ECD of 2114 ± 561 cells/mm². Two weeks postoperatively, ECD decreased by 5.4% in the operated eyes and increased by 1.1% in the control eyes. After 3 months, endothelial cell loss (ECL) was 3.6% (operated) and 1.9% (controls). After 1 year, ECL was 11.7% (operated) and 5.6% (controls); after 3 years it was 7.6% (operated) and 2.9% (controls). No significant differences in ECL dynamics between the operated and control eyes were detected by the analysis of variance. Although there was a trend to accelerated ECL in operated eyes compared to controls, this difference was not significant. Overall, the Preserflo procedure appears safe as regards to its influence on endothelial cell count.

Efficacy of the Direct Anterior Chamber Air Replacement Method During Descemet Stripping Automated Endothelial Keratoplasty.

This study aimed to describe a novel technique of direct anterior chamber (AC) air replacement (DACAR) for the management of Descemet stripping automated endothelial keratoplasty (DSAEK) in postvitrectomized eyes and eyes with previous glaucoma surgery. DACAR was performed after a corneal donor graft was transplanted through a wound using the pull-through technique. DACAR involves stabilizing the graft with forceps while introducing air into the AC via an infusion cannula to ensure complete air exchange. The air was maintained in the AC at all times using a vitrectomy machine. The air pressure was maintained at 30 mm Hg for 15 minutes. The DACAR technique was performed in 34 patients, and conventional pull-through technique DSAEK was performed in 32 high-risk patients. The DACAR group had shorter DSAEK surgical procedures (P = 0.009) and a lower incidence of corneal graft detachment in the early postoperative period (P < 0.001) than the conventional DSAEK group. DACAR is performed in patients having previously undergone vitrectomy or glaucoma surgery to prevent corneal graft detachment during the early postoperative period and to reduce the length of surgery.

Effectiveness and safety of VISULAS® green selective laser trabeculoplasty: 12 months retrospective data

To report the safety and effectiveness of selective laser trabeculoplasty (SLT) using the SLT mode of the VISULAS® green laser in patients with primary open-angle glaucoma (POAG). Twelve months results are presented. Retrospective extension in 4 German centers of an initially prospective interventional multicenter 3-month clinical investigation using the VISULAS® green SLT (Carl Zeiss Meditec AG, Jena, Germany) in patients with POAG who either needed treatment escalation or commenced treatment and had an IOP ≥ 17mmHg at baseline, with no previous glaucoma or other ocular surgery. Non-overlapping laser spots (100) were applied in a single session to 360° of the trabecular meshwork (TM). Glaucoma medications were not changed up to the 3-month visit. From 3 to 12 months, patients were managed according to routine standard of care. Outcome measures included IOP reduction, further glaucoma interventions, and adverse events from baseline to month 12. 25 eyes of 25 POAG patients (mean age 65.8 ± 8.5; modified intention to treat – mITT –group) were included in the extension study. Six eyes (24%) underwent additional glaucoma treatment or changed glaucoma therapy; the remaining 19 eyes (76%) had stable glaucoma therapy (SGT group) with no further glaucoma intervention or change in glaucoma medications (mean number of preoperative glaucoma medications: 2.3 ± 1.34). In the SGT group, mean baseline IOP (mmHg) was reduced from 20.0 ± 2.11 at baseline to 17.4 ± 3.25 and 16.2 ± 1.83 at 6 to 12 months, respectively (p < 0.0001): 52.6% had ≥ 20% IOP reduction at 12 months. Potential device- or procedure-related adverse events were mild to moderate and resolved without sequelae. SLT performed with the VISULAS® green laser reduced IOP in eyes with POAG up to 12 months with no relevant safety issues. The results are comparable to other reported SLT studies.

Glaucoma drainage devices: Indications, intraoperative management and postoperative follow-up

Glaucoma drainage devices (GDD) are used for patients with secondary glaucoma, such as uveitic or neovascular glaucoma, which is uncontrolled under local therapy. They are also used in patients with conjunctival scarring, for example after a previous vitrectomy or after unsuccessful previous glaucoma surgery, such as trabeculectomy. They are also a treatment option for congenital glaucoma, aphakic glaucoma or for the treatment of iridocorneoendothelial syndromes. The conventional GDD were the Baerveldt, Molteno or Ahmed glaucoma implant, whereby the first two were valveless and the latter had a valve. Newer GDD include the PAUL glaucoma implant, the Ahmed Clear Path and the EyeWatch system. Hypotony is a feared complication after GDD surgery, and there are various options for avoiding it: external ligation of the tube or intraluminal suture obstruction. However, low IOP may still occur postoperatively. If early postoperative hypotension occurs in combination with a shallow anterior chamber, the injection of a viscoelastic can be helpful. Late hypotension is usually treated with permanent occlusion or removal of the tube. Furthermore, GDD erosion and migration can occur postoperatively, in such cases a surgical revision is required. Corneal decompensation can also occur after GDD; Descemet's membrane endothelial keratoplasty (DMEK) is the treatment of choice in many centers and is performed more frequently than a penetrating keratoplasty. Finally, double vision is a possible complication after GDI. Most patients have short-term, self-limited diplopia or can be adequately treated with prism glasses; a few require strabologic surgery.

Outcomes of Cataract Surgery Complicated With Zonular Dialysis: A Multicenter Comparative Study

Purpose To compare the visual outcomes, rate of cystoid macular edema (CME), and additional associated complications in eyes that exhibited zonular dialysis (ZD) during phacoemulsification to a reference group of uneventful phacoemulsification eyes. Methods A retrospective multicenter comparative database study. We pooled data from 8 United Kingdom sites between 2003 and 2015. The main outcome measures were the mean postoperative visual acuity (VA) at 12–24 weeks and the rates of CME and additional associated complications. Results We included 1074 eyes in the ZD group and 112,479 in the reference group. Logistic regression analysis showed that pseudoexfoliation was the strongest associated factor of ZD (OR: 6.1), followed by previous glaucoma surgery (OR: 4.4). Mean logMAR preoperative VA was 0.8 ± 0.6 in the ZD group vs. 0.6 ± 0.5 in the reference group (p < 0.001). Mean postoperative VA was worse in the ZD group (p < 0.001); 0.4 ± 0.6 vs. 0.2 ± 0.3 and 0.5 ± 0.6 vs. 0.2 ± 0.3 at 4–12 weeks and 12–24 weeks, respectively. At 12–24 weeks, the proportions of eyes that gained ≥0.3 logMAR units were 50% in the ZD group vs. 62% in the reference group (p < 0.001). In the ZD group, the most common intraoperative complication was vitreous loss (34.3%), followed by posterior capsular rupture (PCR) (11.1%). Postoperative CME occurred in 2.3% vs. 1.4% (p = 0.01), and 9.3% of eyes required surgery for correction of aphakia, intraocular lens decentration, or dropped lens figments removal. Conclusions The occurrence of ZD was associated with worse postoperative vision, an increased rate of vitreous loss and PCR, and a higher risk of CME.

Endothelial Keratoplasty Following Glaucoma Filtration Surgery: A UK Tertiary Eye Care Referral Centre Experience.

Purpose: To compare the postoperative complications and clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with previous glaucoma filtering surgery. Methods: In this retrospective comparative case series, we analysed postoperative visual acuity and intraocular pressure, graft survival, rate of graft detachment and/or dislocation, number of rebubbling and/or graft repositioning procedures, and graft rejection or failure (primary and secondary). Results: Sixteen eyes with DMEK and 80 eyes with DSAEK with previous glaucoma surgery were studied. The results were recorded at 3 and 12 months postoperatively. No statistically significant differences in postoperative visual acuity were found between the two groups at any stage of the follow-up. Intraocular pressure was lower in the DMEK group at the follow-up stage of 3 (p = 0.0022) and 12 months (p = 0.0480). Visually significant graft detachment was recorded in 31.3% and 22.5% of DMEK and DSAEK cases, respectively (p = 0.4541). All DMEK detachments (n = 5) were managed with slit-lamp rebubbling. Out of 18 graft detachments in the DSAEK group, 2 grafts were observed due to small graft detachment, 6 large graft detachments underwent rebubbling performed in the operating theatre, and 10 eyes needed primary graft repositioning for graft dislocation. Conclusions: DMEK is a feasible option to treat endothelial failure in complex eyes with previous glaucoma surgery. In the DMEK group, visual acuity outcomes and possibly postoperative intraocular pressure control were better compared with the DSAEK group.

EndoArt®: results in patients with glaucoma drainage devices

EndoArt® (Eye Yon Medical, Ness Ziona, Israel) is anovel artificial corneal inner layer transplant and an innovative treatment alternative for patients at high risk for graft failure after posterior lamellar corneal transplantation (EK). We present the initial results of the EndoArt® implantation in patients with glaucoma drainage devices (GDD). In this study 12eyes with GDD were retrospectively evaluated. All had ahigh risk of transplant rejection in cases of EK (previous other glaucoma surgery in addition to GDD, n = 8, condition following Descemet membrane endothelial keratoplasty, DMEK, n = 9, uveitis, n = 2, or synechiae, n = 2). The EndoArt® was secured with agas bubble and one to three holding sutures. The preoperative and postoperative best spectacle-corrected visual acuity (BSCVA) and central corneal thickness (CCT) were determined. The need for additional gas injections (rebubbling) was analyzed. Octafluoropropane (C3F8) 12% was used in nine patients and sulfur hexafluoride (SF6) 20% in three patients as anterior chamber tamponade to ensure adhesion of the EndoArt®. At least one rebubbling was necessary in four eyes. The preoperative BSCVA was 1.6 (± 0.5) logMAR and significantly improved to 1.1 (± 0.6) logMAR after 12weeks (p = 0.028). The preoperative CCT was 719 µm ± 145.7, which significantly decreased to 622.4 µm ± 174.9 after six weeks (p = 0.004) and to 591.7 µm ± 190.8 after 12weeks (p = 0.096). In one eye, the prosthesis was explanted due to a suspected fibrotic remodelling of the cornea following multiple previous DMEKs. EndoArt® led to asignificant improvement in BSCVA and reduction in CCT; however, there was ahigh rebubbling rate in patients with GDD. In high-risk patients, the use of EndoArt® may be advantageous in avoiding graft failure after EK.

Modified ex-PRESS technique versus Ahmed glaucoma valve as primary glaucoma surgery for hereditary transthyretin amyloidosis glaucoma

Background To compare the efficacy of modified Ex-PRESS technique (ExP) versus Ahmed Glaucoma Valve (AGV) as primary surgery in hereditary transthyretin amyloidosis (ATTRv) secondary glaucoma. Methods Retrospective study at the national amyloidosis centre. Success was defined as an IOP ≥ 6 mmHg and ≤ 21 mmHg with no need for further glaucoma surgery or laser trabeculoplasty and without loss of light perception at the time of the last follow-up. Secondary outcomes included surgical complications, need for hypotensive drugs, and endothelial cell loss. Patients submitted to previous glaucoma surgery were excluded. Results We included 180 eyes of 150 patients, 121 in AGV and 59 in ExP group. No significant baseline differences were found between groups. At the time of last follow-up, both groups exhibited significant intraocular pressure (IOP) reduction (p < .001) and number of glaucoma medications (p < .001). Kaplan-Meyer analysis showed higher cumulative probability of success for AGV group (80.1% vs. 41.1%, p < .001) and higher mean time to failure (54.5 vs. 36.9 months, respectively, p < 0.001) at 60 months follow-up. AGV showed lower hazard (HR 0.21, 95% CI [0.111–0.407], p < .001) for failure. Conclusion AGV and ExP are safe and effective techniques in the treatment of ATTRv secondary glaucoma. However, AGV’s efficacy seems to be more durable.

Scleral bridging technique for preventing PreserFlo microshunt exposure: A case report.

The use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy. However, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery. Exfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva. We performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge. The patient had better intraocular pressure control with positive cosmetic appearance using this technique. This technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.

Ultrasonography in Detecting the Posterior Segment Pathology in Pre-Operative Cataract Patient

Background: Cataract is the leading cause of blindness globally, accounting for approximately 47.8% of blindness worldwide and 51.5% in Pakistan. The opacity of the lens in cataract patients obstructs the visualization of the posterior segment, making it challenging to predict visual outcomes post-surgery. Ultrasonography, particularly B-scan, plays a crucial role in identifying posterior segment pathologies before cataract surgery, aiding in surgical planning, and improving postoperative visual prognosis. Objective: This study aimed to evaluate the effectiveness of B-scan ultrasonography in detecting posterior segment pathologies in patients with dense cataracts, thus assisting in preoperative planning and predicting visual outcomes. Methods: This descriptive cross-sectional study was conducted at the Outpatient Department of Ophthalmology, Hayatabad Medical Complex, Peshawar, from August 15th, 2019, to February 15th, 2020. A total of 260 eyes from patients with dense cataracts were included. Patients of all age groups and both sexes, including those with traumatic and non-traumatic cataracts, were examined. Exclusion criteria included transmittable ocular surface infections, penetrating ocular trauma, previous glaucoma or vitreoretinal surgery, and siliconized eyes. B-scan ultrasonography was performed using an 8-10 MHz frequency probe. The eye globe was assessed in axial, longitudinal, and transverse positions. Data were recorded and analyzed using SPSS version 25. Ethical approval was obtained from the institutional review board, and the study adhered to the Declaration of Helsinki. Results: Out of 260 eyes examined, 97 (37.3%) were right eyes, 105 (40.4%) were left eyes, and 58 (22.3%) had bilateral involvement. Normal findings were observed in 215 eyes (67.8%), while 32.2% showed posterior segment pathologies. The most common pathology was posterior vitreous detachment (PVD), found in 24 eyes (7.6%). Retinal detachment and vitreous hemorrhage were each observed in 15 eyes (4.7%). Other findings included asteroid hyalosis (18 eyes, 5.7%), vitreous inflammation (11 eyes, 3.5%), intraocular foreign body (3 eyes, 0.9%), persistent hyperplastic primary vitreous (1 eye, 0.3%), and posterior staphyloma (2 eyes, 0.6%). Conclusion: B-scan ultrasonography is an effective tool for detecting posterior segment pathologies in preoperative dense cataract patients, significantly influencing surgical strategies and postoperative visual outcomes. Routine use of ultrasonography in cataract patients can enhance surgical planning and improve patient counseling and prognosis.

Uveitic Flare-Ups After Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Uveitic Glaucoma

ABSTRACT Purpose To assess the risk of gonioscopy-assisted transluminal trabeculotomy (GATT) inducing an uveitic flare-up in patients with uveitic glaucoma (UG). Methods This retrospective study included consecutive UG patients who underwent GATT at a single medical center between June 2020 and September 2022. The main outcome measure was the occurrence of a surgery-related uveitic complication defined as either an uveitic flare-up defined by the Standardization of Uveitis Nomenclature (SUN) criteria, or the appearance of cystoid macular edema (CME) from 2 weeks to 3 months after surgery. Results A total of 25 eyes of 22 patients were included in the study. Age ranged from 10–78 and 64% were women. The most common uveitic etiologies were juvenile idiopathic arthritis (JIA, 24%) and herpetic infection (24%). A total of 48%of the patients were on systemic immunosuppressants prior and unrelated to surgery. Eight eyes (32%) had severe glaucomatous damage prior to surgery, and 20% of the patients had undergone previous glaucoma surgery. Two cases (8%) demonstrated uveitic flare-up in the early postoperative period: a case of mild anterior chamber reaction and a case of CME with persistent edema prior to surgery. Average intraocular pressure (IOP) was reduced from 26.7 mm Hg on four medications to 12.2 on 1.1 after 1 year. One patient required reoperation for IOP control. Conclusions With careful pre and postoperative care, GATT seems to be a low-risk procedure for uveitic flare-ups in patients with UG.

Combined cataract and glaucoma surgery

Cataracts and glaucoma commonly co‐exist, largely due to both being associated with older age. The crystalline lens can however cause glaucoma by phacomorphic or phacolytic processes, or by contributing to pupil block leading to primary angle closure. Medical and surgical treatments for glaucoma can also result in accelerated cataract formation. Cataract surgery in patients with glaucoma provides an opportunity to reduce medication burden and improve intraocular pressure control but has a higher risk than surgery in non‐glaucomatous eyes. Special consideration should be given to those with pseudoexfoliation (e.g. zonular instability), advanced glaucoma (e.g., risk of pressure spike and wipe out) or in those with short axial length or angle closure (e.g., shallow anterior chamber and risk of malignant glaucoma). Cataract surgery in eyes with previous subconjunctival glaucoma surgery is a particular challenge as it increases the risk of wound healing and failure of the filtering procedure. This presentation will outline steps for success in cataract surgery in patients with glaucoma and will also present recent evidence regarding the efficacy of phacoemulsification combined with minimally invasive glaucoma surgery (MIGS).

Селективная лазерная трабекулопластика (СЛТ) после антиглаукомной хирургии при развитой и далеко зашедшей первичной открытоугольной глаукоме

Purpose. To study the hypotensive effect of selective laser trabeculoplasty (SLT) treatment in cases of insufficient effectiveness or reduced hypotensive effect of glaucoma surgery in patients with moderate and advanced primary open-angle glaucoma (POAG). Material and methods. A retrospective study was conducted of 32 patients (32 eyes) with POAG after previous glaucoma surgery and uncompensated intraocular pressure (IOP), who underwent SLT due to the impossibility of reoperation. Changes in IOP were studied 1 day, 1, 3, 6 and 12 months after SLT. Results. After SLT, the IOP level decreased from 24.5±4.4 to 19.3±3.8 mm Hg after 1 day (p&lt;0.001), the hypotensive effect was 5.2±5.1 mm Hg (21.2% of the baseline IOP) and did not change significantly within 3 months after laser treatment. After 6 and 12 months, a decrease in the hypotensive effect was revealed compared with the primary response 1 day after SLT (3.0±2.9 and 1.9±5.4 mm Hg, p=0.02). 12 months after SLT, the IOP level remained below the baseline IOP only in 46.9% of cases. There were no significant differences in the results of SLT at different stages of POAG, different types of glaucoma surgery, different medication regimens (p&gt;0.05), and there was no dependence on the timing after previous glaucoma surgery. Conclusion. SLT can be used after previous glaucoma surgery when IOP reduction is insufficient in patients with moderate and advanced POAG. However, the hypotensive effect of SLT in such cases is unstable, so this method of treatment should be considered only as an auxiliary one and if repeated surgery is not possible, as well as providing more frequent control of IOP in patients. Key words: glaucoma, selective laser trabeculoplasty, intraocular pressure, glaucoma surgery, ophthalmic surgery

Factors Associated with Large Cup-to-Disc Ratio and Blindness in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) Study.

Primary open-angle glaucoma (POAG) disproportionately affects individuals of African ancestry. In these patients' eyes, a large cup-to-disc ratio (LCDR > 0.90) suggests greater retinal ganglion cell loss, though these patients often display varied visual ability. This study investigated the prevalence and risk factors associated with LCDR in African ancestry individuals with POAG and explored the differences between blind (>20/200) and not blind (≤20/200) LCDR eyes. A case-control methodology was used to investigate the demographic, optic disc, and genetic risk factors of subjects in the Primary Open-Angle African American Glaucoma Genetics Study. Risk factors were analyzed using univariable and multivariable logistic regression models with inter-eye correlation adjusted using generalized estimating equations. Out of 5605 eyes with POAG, 1440 eyes (25.7%) had LCDR. In the multivariable analysis, LCDR was associated with previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.04), decreased mean deviation (OR = 1.08), increased pattern standard deviation (OR = 1.06), thinner retinal nerve fiber layer (OR = 1.05), nasalization of vessels (OR = 2.67), bayonetting of vessels (OR = 1.98), visible pores in the lamina cribrosa (OR = 1.68), and a bean-shaped cup (OR = 2.11). Of LCDR eyes, 30.1% were classified as blind (≤20/200). In the multivariable analysis, the statistically significant risk factors of blindness in LCDR eyes were previous glaucoma surgery (OR = 1.72), increased intraocular pressure (OR = 1.05), decreased mean deviation (OR = 1.04), and decreased pattern standard deviation (OR = 0.90). These findings underscore the importance of close monitoring of intraocular pressure and visual function in African ancestry POAG patients, particularly those with LCDR, to preserve visual function.

Suture Fixation to Reduce Graft Detachment in Descemet Stripping Endothelial Keratoplasty.

The aim of this study was to report the outcomes of graft fixation using interrupted, full-thickness sutures on graft detachment after Descemet stripping endothelial keratoplasty (DSEK). All DSEK procedures performed at Mayo Clinic, Rochester, MN, from 2015 through 2022 were retrospectively reviewed. Risk factors for graft detachment were defined as previous incisional glaucoma surgery, previous penetrating keratoplasty, or absence of the normal lens-capsule barrier. Cases were categorized into sutured, high-risk grafts; unsutured, high-risk grafts; and unsutured, low-risk grafts. The primary outcome was graft detachment, and secondary outcomes were early graft failure and graft clarity at 12 months after surgery. Demographics between the high-risk groups were similar for sex and age at the time of surgery. Graft detachment occurred in 4 of 97 sutured, high-risk eyes (4.1%) and 24 of 119 unsutured high-risk eyes (20.2%) ( P = 0.002). In comparison, graft detachment occurred in 18 of 181 unsutured low-risk eyes (9.9%). The incidence of early graft failure was 2.1%, 5.0%, and 3.3% and late graft failure by 12 months was 9.8%, 12.8%, and 4.2%, respectively. In eyes with high-risk factors for graft detachment, suture fixation of the graft in DSEK decreased graft detachment to a rate at least as low as that in low-risk eyes.

Clinical Outcomes of Descemet's Membrane Endothelial Keratoplasty without Routine Prophylactic Peripheral Iridotomy.

Institutional, tertiary care eye hospital. All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuchs endothelial dystrophy, using a standardized protocol between August 2016 and July 2021, were included. Previous glaucoma surgery, laser PI, aphakia, or complicated pseudophakia were excluded. Primary outcomes: Incidence of pupillary block (PB). Graft detachment (GD), rebubbling rates, uncorrected (UCDVA) and best corrected logMAR distance visual acuity (BCDVA), and endothelial cell loss (ECL) at six months. Data were analyzed using the chi-square test and stepwise backward regression analysis. Results: 104 eyes of 72 patients were included. Four eyes (3.8%) developed PB; in two of these cases, standard protocol was not followed. Overall minor GD occurred in 43.2% (n = 45); significant GD was present only in 7 eyes (6.6%). Overall slit lamp rebubbling rate was 30% (n = 35), though only four patients were rebubbled in theatre (3.8%). PB, GD, and rebubbling rates did not vary with the surgeon, surgery, or tamponade (air or SF6 gas). UCDVA, BCDVA, and ECL at 6 months were 0.29 ± 0.31, 0.20 ± 0.28, and 40.46 ± 20.36%, respectively. Conclusions: Compared to previously reported outcomes of DMEK with PI, our results of PI less DMEK using a standardized protocol have a similar incidence of pupillary block, graft detachment, and rebubbling, with comparable visual acuity and endothelial cell loss.

Новая хирургическая методика антиглаукомной операции с биодеградирующим дренажем для стабилизации гипотензивного эффекта

Purpose. To develop a modification of sinus trabeculectomy (STE) using a new biodegradable drainage in glaucoma surgery for normalizing and stabilizing aqueous humor outflow along the formed pathways. Material and methods. We observed 63 patients (63 eyes) with primary open-angle glaucoma in the advanced stages with previous surgeries. The patients were divided into groups: Group 1 (main group) – 32 patients who underwent the proposed modification of STE using a new biodegradable drainage (absorbable suture material Vicryl); Group 2 (control) – 31 patients with standard STE and implantation of ‘Xenoplast’ drainage The maximum duration of patients’ follow-up was 24 months. Results. The total number of intra- and early postoperative complications in the main group was less (25%) than in the control group (41.9%). This was especially true of a ciliochoroidal detachment, which was recorded much less frequently after STE with biodegradable drainage than after a standard operation with Xenoplast drainage implant (3.1% vs. 9.7%). 2 years after surgery in the main group, complete IOP compensation was observed in 84.4% of cases, partial – in 12.5% of cases. The unsuccessful outcome was observed in 3.1% of cases. In the control group, the corresponding results were: 70.9% and 16.1% with hypertensive failure equal to 12.9%. Conclusion. The STE modification was developed using a new biodegradable drainage (absorbable suture material Vicryl) to form a stable pathway of the aqueous humor outflow and prolong the hypertensive effect of the operation. It was found that intra- and early postoperative complications after the modified version of STE were less common than in the control group (especially ciliochoroidal detachment – 3.1 fold lower). At the same time, the hypertensive results of the proposed operation without additional drug load in patients with advanced and far-advanced stages of POAG with previous glaucoma surgeries were higher (84,4%) in the long-term follow-up than the efficacy of traditional STE with Xenoplast drainage (70,9%). Key words: primary open-angle glaucoma, surgical treatment, modification of sinus trabeculectomy, biodegradable drainage, stability of the hypertensive effect.

Intermediate Outcomes of the Novel 63-μm Gelatin Microstent versus the Conventional 45-μm Gelatin Microstent

To determine intermediate intraocular pressure (IOP)-lowering and adverse event profile of the 63-μm gelatin microstent (Xen63) with mitomycin C (MMC) compared with the 45-μm gelatin microstent (Xen45) with MMC. Single center, consecutive, retrospective cohort study. Eighty-four glaucomatous eyes (42 63-μm gelatin microstent and 42 45-μm gelatin microstent) with or without previous subconjunctival glaucoma surgery. Consecutive eyes that underwent 63-μm gelatin microstent implantation with MMC from February 2020 to June 2021 were compared with eyes that underwent 45-μm gelatin microstent implantation with MMC. Standalone and combined cases with phacoemulsification were included. Primary outcome was the hazard ratio of failure of 45-μm gelatin microstent vs. 63-μm gelatin microstent eyes at 12 months, with failure defined as 2 consecutive IOPs, (1) >17 mmHg, (2) <6 mmHg with 2 lines of vision loss, or (3) <20% reduction from baseline IOP, without (complete) or with (qualified) glaucoma medications. Secondary outcomes included IOP thresholds of 14 mmHg and 21 mmHg, postoperative IOP, medications, adverse events, interventions, and reoperations. The complete success rate was higher in the 63-μm gelatin microstent group (59.5% vs. 28.6%, P=0.009) at the primary IOP threshold of 6 to 17 mmHg but did not differ significantly for qualified success (66.7% vs. 45.2%, P= 0.08). The crude hazard ratio of failure of 45-μm gelatin microstent relative to 63-μm gelatin microstent was 2.28 (95% confidence interval [CI], 1.21-4.32), and the adjusted hazard ratio was 7.90 (95% CI, 2.12-29.43). 63-μm gelatin microstent eyes had significantly lower mean IOP (12.7 ± 4.8 vs. 15.5 ± 5.1 mmHg, P= 0.001) and fewer medication classes (0.6 ± 1.1 vs. 1.7 ± 1.6 medications, P= 0.0005), with the degree of reduction in IOP and medication count being significantly greater in 63-μm gelatin microstent eyes. There were 28 and 21 distinct interventions in 63-μm gelatin microstent and 45-μm gelatin microstent eyes respectively, with 11.9% of eyes undergoing needling in each group. There were 34 and 19 distinct adverse events, in 63-μm gelatin microstent and 45-μm gelatin microstent eyes, respectively, most of which were early and transient. Nine Xen63 eyes (21.4%) and 6 45-μm gelatin microstent eyes (14.3%) underwent reoperation. 63-μm gelatin microstent resulted in higher surgical success rates and fewer medications compared with 45-μm gelatin microstent. This was tempered by more postoperative interventions and adverse events, although most were transient. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma: Three-Year Results as a Primary Surgical Intervention

To determine the effectiveness, risk factors for surgical failure and adverse events in a large cohort of patients receiving standalone ab externo SIBS microshunt implantation with mitomycin C (MMC) over 3-years of follow-up. Retrospective, interventional case series. Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery. Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 to November 2017 were reviewed. Data from all follow-up visits were utilized and included IOP, medication use, post-operative interventions, complications, and reoperations. The primary outcome was proportion of eyes at 3-years with (1) no 2 consecutive IOPs >17mmHg (or <6mmHg with >2 lines of vision loss from baseline); (2) ≥20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21mmHg upper IOP thresholds with and without ≥20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, post-operative interventions, complications, and reoperations. One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (IQR 12.1-34.1) months, however 59.4% of eyes remained medication free at 3-years. Significant risk factors for failure included receiving <0.4mg/mL of MMC (adjusted HR 2.35; 95% CI 1.43-3.86) and baseline IOP <21mmHg (adjusted HR 1.84; 95%CI 1.09-3.08). The most common complications were choroidal detachment, hyphema and anterior chamber shallowing, occurring in 7%, 5% and 5% of eyes respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP >21mmHg (HR 3.21, 95% CI 1.38 - 7.48). Revisions occurred in 7% of eyes, and reoperations in 3%. Eyes receiving <0.4mg/mL of MMC underwent more revisions (OR 4.9; 95%CI 1.3-18.3). Three-year follow up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden post-operatively and few post-operative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm.

Comparison of glaucoma drainage implants

Glaucoma drainage devices (tubes, GDI or GDD) are nowadays an important surgical option in the treatment of refractory glaucoma. They are frequently used in cases where previous glaucoma surgery has failed or in patients with ahistory of conjunctival scarring where other procedures are contraindicated or simply not possible. This article looks at the evolution of glaucoma drainage implants from the very beginning to the multiple designs, experiences and research studies that have made tubes an essential part of the armamentarium of modern glaucoma surgeons. The article describes the first concepts and then proceeds to the first commercialized devices which led to the widespread use of tubes such as Molteno®, Baerveldt® and Ahmed®. Finally, it looks at the innovations that have been carried out, particularly over the last decade with the advent of new tubes, such as Paul®, eyeWatch® and Ahmed ClearPath®. The factors associated with the success and failure of GDD surgery, including the indications, are different from those for trabeculectomy and increasing experience and larger amounts of data have helped glaucoma surgeons to become more comfortable with selecting the most appropriate procedure for the individual patients.