Refractory Glaucoma Research Articles

Surgical safety and efficacy of a multi-stent system, the comet stent, in Baerveldt glaucoma implant surgery: a prospective pilot study.

This study aimed to introduce a new technique for lowering intraocular pressure (IOP) using a multi-stent system after the implantation of a Baerveldt glaucoma implant (BGI) and evaluate its clinical effectiveness. Prospective case series. Six patients with uncontrolled refractory glaucoma were enrolled between December 2021 and May 2022. Six 6-0 nylon sutures were preoperatively inserted into the tube of a BGI. These sutures were named "comet stents" (CSs). BGI implantation was performed, and the CSs were removed one-by-one whenever the IOP rose during the follow-up period. IOP was measured 30-60min after the removal of each CS, and the reduction in IOP was recorded to assess the effect of CS removal. IOP reduction and the effect of CS removal on IOP reduction were evaluated for 6 months. The cut and trimmed stented tubes were examined with scanning electron microscopy, and the ratio of the patent cross-sectional area to the total luminal area (PCSA, %) and the luminal area occupation rate per stent (%) were calculated. The mean (±standard deviation) IOP decreased from 31.5 ± 2.8 mmHg at the baseline to 14.8 ± 8.3mmHg at 1month, 8.8 ± 4.7 mmHg at 3months, and 9.2 ± 3.4mmHg at 6months. The IOP reduction induced by CS removal ranged from 0 to 19mmHg. The mean PCSA was 52.7 ± 1.7%, and the mean luminal area occupation rate per stent was 7.9 ± 0.3%. The use of CSs is an effective technique for controlling IOP in a step-by-step manner after BGI surgery.

Ahmed to Baerveldt glaucoma drainage device exchange in pediatric patients

BackgroundThere is no consensus and few reports as to the surgical management of encapsulated Ahmed glaucoma drainage devices (GDD) which no longer control intraocular pressure (IOP), especially within the pediatric population. The purpose of this study was to report outcomes of exchanging the Ahmed GDD for a Baerveldt GDD in children with refractory glaucoma.MethodsRetrospective review of children (< 18yrs) who underwent removal of Ahmed FP7 and placement of Baerveldt 350 (2016–2021) with ≥ 3-month follow-up. Surgical success was defined as IOP 5–20 mmHg without additional IOP-lowering surgeries or visually devastating complications. Outcomes included change in best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications.ResultsTwelve eyes of 10 patients underwent superotemporal Ahmed FP7 to Baerveldt 350 GDD exchange at 8.8 ± 3.6 years. Time to Ahmed failure was 2.7 ± 1.9 years with 1-, 3-, and 5-year survival rates of 83% with a 95% CI[48,95], 33% with a 95% CI[10, 59], and 8% with a 95% CI[0, 30]. At final follow-up (2.5 ± 1.8 years), success rate for Baerveldt 350 GDDs was 75% (9 of 12 eyes) with 1 and 3-yr survival rates of 100% and 71% with 95% CI[25,92], respectively. IOP (24.1 ± 2.9 vs. 14.9 ± 3.1 mmHg) and number of glaucoma medications (3.7 ± 0.7 vs. 2.7 ± 1.1) were significantly decreased (p < 0.004). BCVA remained stable. Two eyes required cycloablation and 1 eye developed a retinal detachment.ConclusionsAhmed removal with Baerveldt placement can improve IOP control with fewer medications in cases of refractory pediatric glaucoma. However, more eyes with greater follow-up are required to determine long-term outcomes.

Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome

PurposeIridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter. MethodsThree patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone. ResultsNo intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively. Conclusions and importanceEx-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.

Glauco-Claw: A novice implant for chronic angle-closure glaucoma.

This article describes 1-year outcomes of a new intra-ocular implant, "Glauco-Claw," in refractory chronic angle-closure glaucoma (ACG). Glauco-Claw is a novice polymethylmethacrylate implant with a central ring and five claws placed circumferentially. It was placed in the anterior chamber and the peripheral iris was tucked into the claws, thus causing goniosynechialysis and preventing the reformation of goniosynechiae. It was implanted in five eyes of five patients, and they were followed up for 1 year. Target intra-ocular pressure was achieved and maintained in all the patients till the last follow-up. Two patients did not require any anti-glaucoma medication. No significant complications were observed in any patient. Glauco-Claw could be another armamentarium in the management of refractory chronic ACG.

Goniotomy combined with giant fibrotic encapsulated bleb resection and drainage plate removal for refractory glaucoma: A case report

We report a case of goniotomy (GT) with giant fibrotic bleb resection and drainage plate removal following multiple failed antiglaucoma filtering surgeries. A 36-year-old man underwent trabeculectomy and Ahmed glaucoma valve implantation, revealing a giant fibrotic capsule with medically uncontrolled intraocular pressure (IOP) in the left eye. Removal of the drainage tube, resection of the fibrotic bleb, and a combination with GT were performed successfully, and the IOP was well controlled with a 6-month follow-up after surgery. GT may be successful for refractory glaucoma after filtering for surgical failure caused by fibrosis.

A comparative study on surgical outcomes of trabeculectomy with and without anti-metabolites in juvenile open-angle glaucoma.

To compare the surgical outcomes of trabeculectomy with and without anti-metabolites in patients with juvenile open-angle glaucoma (JOAG). This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti-metabolites (group A, n = 53 eyes) or with anti-metabolites (group B, n = 45 eyes) with a minimum of 2 years follow-up. The main outcome measures were intra-ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ≤5 mmHg or re-operation for refractory glaucoma or a complication or loss of light perception vision. The mean post-operative IOP reduced significantly from baseline at all post-operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6-44.8%] and 29.1% in group B (95% CI = 17.1-46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re-operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox-hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre-operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. : Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow-up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications.

Bilateral Fixed Dilated Pupils after MicroPulse Transscleral Cyclophotocoagulation: A Case Report and Review of Urrets-Zavalia Syndrome

MicroPulse transscleral cyclophotocoagulation (MP-TSCPC) is a relatively new procedure for treating refractory advanced glaucoma. It uses repetitive micropulses of diode laser in an "on-off" cyclic manner, delivered with the Cyclo G6 Glaucoma Laser System (IRIDEX Corp., Mountain View, CA). In this unique case, we report the only instance of bilateral Urrets Zavalia Syndrome (UZS) in medical literature following MP-TSCPC in a 33-year-old Asian female with refractory angle-closure glaucoma. The patient developed bilateral fixed dilated pupils (UZS) after the treatment. The treatment settings included 100 seconds of laser application (50 seconds superiorly and 50 seconds inferiorly). Treated areas were the superior and inferior 180 degrees of the eye, excluding the 3 and 9 o'clock positions. On the first postoperative day, vision and intraocular pressure (IOP) were stable. Six weeks postoperatively, the patient presented with fixed mid-dilated pupils bilaterally and a visual acuity (VA) of 20/200 and 20/300, despite discontinuing Atropine 1% for 42 days. The patient was given pilocarpine 2% for ten days without response; however, vision improved to 20/125 and 20/160 with refraction and a +4.50 add for near vision. One and a half years postoperatively, the patient showed spontaneous partial recovery of the fixed dilated pupils in both eyes, with sectoral paralytic iris superiorly. The overall pupils' size was smaller in both eyes compared to previous visits. This case outlines the patient's symptoms, treatment, and outcome while discussing the potential risk of UZS following MP-TSCPC in specific populations. Further research is needed to better understand and mitigate the UZS complication after MP-TSCPC.

All Consecutive Ab Externo SIBS Microshunt Implantations With Mitomycin C: One-Year Outcomes and Risk Factors for Failure

To present the effectiveness, risk factors for surgical failure, and adverse events over 12 months in a consecutive diverse cohort of glaucoma patients who underwent solo or combined ab externo SIBS microshunt with mitomycin C (MMC) with or without previous subconjunctival surgery. Retrospective, consecutive, interventional case series. Consecutive glaucomatous eyes on maximally tolerated medical therapy received ab externo SIBS microshunt with MMC implantation as a solo or combined procedure with phacoemulsification from July 2015 to January 2020. The primary outcome was the proportion of eyes at 12-months with the following: (1) no 2 consecutive intraocular pressures (IOPs) >17 mm Hg or clinical hypotony, without (complete success) or with (qualified success) glaucoma medications; and (2) ≥20% reduction from baseline IOP. Secondary outcomes included upper IOP thresholds of 14 and 21 mm Hg with and without a 20% IOP reduction from baseline, median IOP, medications, risk factors for failure, postoperative interventions, complications, and reoperations. A total of 436 eyes underwent surgery; 86 (20%) combined with phacoemulsification, 127 (29%) in eyes with refractory glaucoma, and 234 (51%) stand-alone procedures in non-refractory eyes. Complete success (6-17 mm Hg with no medications) was achieved in 64.0% of combined eyes, 58.1% of refractory eyes, and 74.8% of stand-alone non-refractory eyes; and qualified success rates (6-17 mm Hg with medications) were 90.7%, 84.7%, and 92.4% of eyes, respectively. At 12 months, 67% of eyes were medication free. Significant risk factors for failure included combined procedures in refractory eyes (hazard ratio [HR]=3.2; 95% CI=1.4-7.4), receiving <0.4 mg/mL of MMC (HR=2.2; 95% CI=1.6-3.1), refractory eyes (HR=1.7; 95% CI=1.2-2.5), combined procedures (HR=1.6; 95% CI=1.0-2.5), and each additional baseline medication class (HR=1.3; 95% CI=1.1-1.5). Postoperative complications occurred in 31% of eyes, and more often in those receiving ≥0.4 mg/mL MMC (odds ratio [OR]=2.2, 95% CI 1.2-3.8). Needling occurred in 12% of eyes, with significantly higher frequency in refractory eyes (23%) and combined procedures (13%) compared to stand-alone (7%; P < .001). Revisions and reoperations occurred in 4% and 1.4% of eyes, respectively. The 1-year follow-up data from this large and diverse cohort support promising rates of qualified and complete surgical success with decreased medication burden and few postoperative complications and interventions. Combined phacoemulsification, refractory glaucoma, and receiving <0.4 mg/mL MMC significantly reduced surgical success rates.

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation.

The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation. Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation. Noncomparative retrospective case series including eyes with a history of corneal transplantation and subsequent XEN stent implantation by a single glaucoma surgeon in Surrey, British Columbia, between 2017 and 2022. The analysis included patient demographics, pre and postoperative intraocular pressure (IOP), pre and postoperative glaucoma medications, peri and postoperative complications and interventions, and incidence of repeat corneal transplantation and additional glaucoma procedures to control IOP. Fourteen eyes with previous cornea transplantation underwent XEN stent implantation. Mean age was 70.1 years (range: 47-85y). Mean follow-up was 18.2 months (range: 1.5-52mo). The most common glaucoma diagnosis was secondary open angle glaucoma (50.0%). There was a significant reduction in IOP and the number of glaucoma agents at all postoperative time points ( P < 0.05). IOP decreased from 32.7 ± 10.0mm Hg at baseline to 12.5 ± 4.7mm Hg at the most recent follow-up. Glaucoma agents decreased from 4.0 ± 0.7 to 0.4 ± 1.0. Two eyes required additional glaucoma surgery to control IOP, with an average time to reoperation of 7 weeks. Two eyes underwent repeat corneal transplantation, with an average time to reoperation of 23.5 months. In selected patients with previous corneal transplants and refractory glaucoma, the XEN stent was safely implanted and effectively reduced IOP in the short term.

Транссклеральная диод-лазерная циклофотокоагуляция в микроимпульсном режиме у пациентов с рефрактерной глаукомой

The aim of the work was to study clinical efficacy of micropulsed transscleral diode laser cyclophotocoagulation (MTDСFC) in patients with refractory glaucoma. Material and methods. After careful standard ophthalmologic eye examination, 60 patients underwent mTDGFC to compensate the intraocular pressure (IOP) and stabilize the visual and functional indices. Results. Immediately on the next day after the procedure a brightening of the cornea and a decrease of the degree of perilymphalic congestion were observed. IOP level decreased from 42.0 ± 1.2 to 20.97 ± 1.12 in 47.6% of cases, and in a year – to 18.85 ± 0.7. In 40% of cases (n = 24) the visual acuity improved from 0.03 ± 0.01 to 0.06 ± 0.05 which was statistically significant (p &lt; 0,05). In 16.7% of cases (n = 10) there was an increase in the visual field boundaries by an average of 5 degrees. In 15 eyes (25.0%) it became possible to observe fundus. An important advantage of mTDFC was a 52.4% decrease in the number of hypotensive drugs used by the end of follow-up: from 3.0 ± 0.5 to 1.0 ± 0.5 drugs (p &lt; 0.05). In the early postoperative period subconjunctival hemorrhages in 5 (8.3%) patients, hyphema 1 mm in 1 (1,7%) patient were among the available complications; they dissolved after hematase and dexamethasone injection. Conclusions. mTDFC should be performed in patients at earlier stages of refractory glaucoma, providing compensation for varying degrees of elevated IOP. This procedure contributes to the elimination or significant reduction of pain syndrome, which preserves eye function, improves patients'quality of life, and is an alternative to laser treatment of refractory glaucoma. Keywords: refractory glaucoma, surgical treatment, laser cyclophotocoagulation, micropulse cyclophotocoagulation, transscleral cyclophotocoagulation

Cyclophotocoagulation - current applications and practical aspects

Despite the advent of a large variety of minimally invasive glaucoma surgery (MIGS) techniques cyclophotocoagulation (CPC) remains a popular treatment option to lower intraocular pressure (IOP) in glaucoma patients. Guidelines for glaucoma treatment point to the rather unphysiological mode of action and, thus, recommend CPC mainly for refractory glaucoma and/or eyes with limited visual potential. The primary target of CPC is the pigmented secretory ciliary body epithelium resulting in a decreased production of aqueous humor. In addition, an increase of aqueous outflow may contribute to the IOP lowering. CPC is generally considered a low risk intervention. However, macular edema, prolonged intraocular inflammation, vision loss, hypotony, pain or phthisis occur at considerable rates. Over the past decades new promising modes of cyclophotocoagulation have evolved aiming at reducing the risk of adverse effects and improving the efficiency. This article provides an overview of the different currently available cyclophotocoagulation modes: Besides the classic transscleral continuous-wave cyclophotocoagulation it covers endoscopic cyclophotocoagulation, micropulse transscleral laser treatment and transscleral controlled cyclophotocoagulation. Various practical aspects of the treatment in light of the current literature are being discussed.

Feline leishmaniosis with focus on ocular manifestation: a case report

BackgroundIn Europe, feline leishmaniosis is commonly caused by Leishmaniainfantum. There is little knowledge regarding pathogenesis, ocular manifestations and long-term follow-ups in cats with leishmaniosis.FindingsA 6-year-old female, spayed European Shorthair cat was imported from Spain to Germany 2 years prior to its first clinical presentation. The cat showed lethargy, weight loss, ulcerative lesions on the front limbs and high-grade chronic uveitis. The diagnosis of L. infantum infection was based on the cytological finding of amastigotes in skin lesions, positive qPCR of EDTA-blood and positive PCR of a cyto-brush sample from the conjunctiva. Supportive findings included positive serology by IFAT, serum protein capillary electrophoresis with peaks in alpha2- and gamma-globulin sections and marked elevation of SAA. Enucleation had to be performed on day 288 on both eyes because of blindness, glaucoma and high-grade uveitis. Histologically, high numbers of Leishmania spp. amastigotes were found in histiocytes. IFAT and PCR were positive in the aqueous humor in both eyes, respectively. Feline leukemia virus antigen and feline immunodeficiency virus antibody testings were positive. Hematological and biochemical results revealed mild leukocytosis with lymphocytosis, monocytosis and eosinopenia as well as marked elevation of SAA and hyperglobulinemia. The cat was treated with allopurinol, responded well and was still alive at follow-up on day 288 after first presentation. However, enucleation was necessary because of refractory glaucoma and uveitis. ConclusionFor the first time, ocular evidence of Leishmania IgG antibodies was demonstrated in the aqueous humor of both eyes in cats. There is limited knowledge about the pathogenesis, treatment options and outcomes in cats infected with L. infantum. This case report supports the hypothesis that immunosuppression increases the risk of clinical signs of leishmaniasis in cats. Alpha2- and gamma-globulin peaks in serum protein capillary electrophoresis are supportive criteria for the diagnosis of L. infantum infection. SAA is valuable for monitoring. Regarding ophthalmology, uveitis and glaucoma may have a poor prognosis. Graphical abstract

Ahmed and Baerveldt Glaucoma Drainage Devices in Childhood Glaucoma: A Meta-Analysis.

The effectiveness of Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI) was comparable in the management of childhood glaucoma over the long term despite initial better success rate with BGI. There were higher tube block and retraction rates in the BGI group and higher tube exposure rates in the AGV group. To evaluate the outcomes and safety of AGV and BGI in childhood glaucoma. We performed a systematic literature review of publications from 1990 to 2022 in PubMed, EMBASE, ClinicalTrials.gov, Ovid MEDLINE, Cochrane CENTRAL, and google scholar for studies evaluating AGV and BGI in childhood glaucoma. Primary outcome measures were intraocular pressure (IOP) reduction and glaucoma medication reduction. The secondary outcome measures were the success rates and incidence of postoperative complications. We conducted a meta-analysis using a random effects model. Thirty-two studies met the inclusion criteria. A total of 1480 eyes were included. The mean IOP reduction was 15.08 mm Hg ( P < 0.00001) for AGV and 14.62 ( P < 0.00001) for the BGI group. The mean difference between pre and postoperative glaucoma medications was 1 ( P < 0.00001) fewer medications in the AGV group and 0.95 ( P < 0.0001) fewer medications in the BGI group. There was a lower success rate in the AGV versus BGI groups at 2 years [63% vs 83%, respectively ( P < 0.0001) and 3 years (43% vs 79%, respectively ( P < 0.0001)]; however, the success was higher for AGV at 5 years (63% vs 56% in the BGI group, P < 0.001). The incidence of postoperative complications was comparable in the AGV and BGI groups, with rates of 28% and 27%, respectively. The IOP and glaucoma medication reduction, success rates, and incidence of postoperative complications were comparable in Ahmed and Baerveldt groups. Most literature comes from retrospective low-quality studies on refractory childhood glaucoma. Further larger cohort studies are needed.

Micropulse Transscleral Cyclophotocoagulation Results in Secondary Glaucoma.

The aim of this study was to analyze the long-term outcome of first session of micropulse transscleral cyclophotocoagulation (MP-CPC) for refractory glaucoma developed after vitreoretinal surgery combined with silicone oil implantation. The inclusion criteria of this consecutive case series were: patients with secondary glaucoma in the refractory stage who underwent MP-CPC between 2018 and 2021, vitreoretinal surgery combined with silicon oil implantation, and at least a 24-month follow-up period after MP-CPC. Success was defined as the baseline eye pressure reduced at least 20%, and it should be ranged between 10 to 20 mmHg without further MP-CPC at the end of the follow-up. For this retrospective study, 11 eyes of 11 patients were selected. The reduction in IOP was found to be significant (p = 0.004) at the end of the follow-up time, and the success rate was 72% according to our results. The change in the number of antiglaucoma agents in the administered eyedrops was not significant compared to the baseline values. At the end of the follow-up period the change in BCVA values was not significant (p = 0.655). Our results confirm significant IOP lowering effect of this subthreshold method preserving visual performance safely even in eyes with previous vitrectomy surgery with a silicone oil implantation.

A prospective comparison of continuous wave and micropulse transscleral laser cyclophotocoagulation for refractory glaucoma in African eyes

Aims: To report the efficacy of transscleral diode laser photocoagulation and compare outcomes between the continuous wave (CW) and micropulse wave (MP) protocols for refractory glaucoma in African eyes. Methods: A non-randomized prospective comparative study of patients who had transscleral diode laser photocoagulation for refractory glaucoma between January 2021 and December 2021in Eye Foundation Hospital Lagos, Nigeria was done. Results: A total of 52 eyes of 52 patients were analyzed. Mean age of patients was 66 ± 12.5 years. The mean preoperative intraocular pressure (IOP) was 31.2 ± 11.9 mmHg. Overall post-operative mean IOP was 17.9 ± 8.6 mmHg at 4 weeks, 21.0 ± 9.9 mmHg at 8 weeks and 20.6 ± 11.4 mmHg at 12 weeks. The difference between mean preoperative and postoperative IOP measured at week 12 was statistically significant (p&lt;0.001). Both continuous wave and micropulse wave protocols were effective at reducing intraocular pressures, the micropulse group had a mean difference between preoperative IOP and postoperative IOP at week 12 of 7.5 ± 6.7 mmHg (p=0.001), while the continuous wave laser group had a mean difference of 11.7 ± 13.7 mmHg (p&lt;0.001). The micropulse group achieved a higher percentage of success in 11 eyes (78.6%) compared with 24 eyes (63.2%) in the continuous wave group. This difference was not statistically significant (p=0.341). Conclusion: Both the continuous wave (CW) and micropulse wave (MP) protocols of transscleral diode laser photocoagulation were found effective at significantly reducing IOP in our study of African eyes with refractory glaucoma. Although the MP group achieved a higher percentage of absolute success, this was not statistically significant.

Phaco-goniosynechialysis versus phaco-trabeculectomy in patients with refractory primary angle-closure glaucoma: a comparative study

PurposeTo compare the effects of phacoemulsification with intraocular lens implantation (phaco) combined with goniosynechialysis (phaco + GSL) versus phaco with trabeculectomy (phaco + trab) for the management of primary angle-closure glaucoma (PACG) refractory to peripheral anterior synechiae (PAS) of over 180°.MethodsThis retrospective study followed 77 eyes of 77 patients for at least 6 months. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of glaucoma drugs, and PAS were recorded at the preoperative baseline and evaluated at each postoperative follow-up visit. The National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) was administered to patients enrolled in this study. Pearson’s correlation analysis and multivariate linear analysis were performed to identify factors influencing changes in NEI VFQ-25 scores and to identify factors associated with increases in NEI VFQ-25 scores after the operation.ResultsIn total, seventy-seven eyes were included (43 with phaco + GSL and 34 with phaco + trab). Comparing preoperative baseline and month 6 after surgery measurements revealed that both groups found significant improvements in IOP, PAS, BCVA and the number of glaucoma drugs (P < 0.05). Baseline NEI VFQ-25 scores were similar in the two groups, but there was a significant difference in postoperative NEI VFQ-25 scores (74.47 ± 10.39 in phaco + GSL vs. 69.57 ± 8.54 in phaco + trab, P = 0.048 < 0.05), and the phaco + GSL group had better scores at the time of the last follow-up. The change in preoperative scores and the number of glaucoma drugs was significantly correlated with postoperative scores in the phaco + GSL group.ConclusionPhaco + GSL treatment is as safe and effective as phaco + trab for refractory PACG patients, and patients’ subjective experience improved significantly after phaco + GSL surgery.

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.

Поиск биомаркеров диабетической ретинопатии и ее осложнений в стекловидном теле и внутриглазной жидкости

Today diabetes mellitus (DM) is one of the leading medical and social problems. Its complications lead to formidable comorbidities that significantly affect the lives of patients. At the beginning of 2021, there were more than 537 million ¹ people with DM in the world and this number is increasing every year. Diabetic retinopathy (DR) is one of the most severe complications of diabetes affecting the organ of vision. The formation of moorings on the retina, the formation of traction syndrome, hemorrhagic complications, retinal detachment and hemophthalmia, as well as neovascular glaucoma (NG) is a manifestation of the terminal stage of proliferative DR. NG is considered one of the most severe terminal forms of refractory glaucoma, which is steadily progressing, leading to disability and impaired social adaptation [1]. The main method of treating diabetic complications in the posterior segment of the eye is vitrectomy, and in the event of NG, implantation of the Ahmed valve due to the ineffectiveness of conservative therapy. At the same time, one should not forget about multiple complications both during the operation, and in the early and late postoperative periods. To date the pathogenesis of DR development remains unexplored. Apparently, it is based on hyperglycemia, chronic diffuse chorioretinal hypoxia and ischemia of the corresponding structures and tissues. These unfavorable factors trigger a pathogenetic cascade of reactions that cause the release of various angiogenic factors and cytokines. Many researchers have shown the role of the immune response in the development of proliferative DR. This was the reason for the study of the local production of various cytokines and growth factors in patients with DM, proliferative DR and NG. Keywords: diabetes mellitus, diabetic retinopathy, neovascular glaucoma, biomarker, cytokines

Current surgical techniques for the management of pediatric glaucoma: A literature review.

Pediatric glaucoma surgery is challenging due to its diverse and complex pathophysiology, altered anterior segment anatomy, greater potential for failure, and complications compared to adult patients. Moreover, numerous challenges are associated with long-term postoperative management. Thus, when dealing with childhood glaucoma, it is important to consider the potential complications in addition to the benefits of each intervention. The purpose of this article is to review recently published literature to shed light on the most recent surgical techniques for the safe and effective treatment of childhood glaucoma. Current literature shows that goniotomy and trabeculotomy are the first choices for the management of primary congenital glaucoma. Although older children with phakic eyes seem to benefit from trabeculectomy with adjunctive mitomycin C, it carries a long-term risk of bleb-related endophthalmitis. Glaucoma drainage devices may be preferred for patients with secondary or refractory glaucoma. However, hypotony or tube-related complications are common and encountered more often in children than in adults. Cyclodestructive procedures are also an option for cases in which filtering surgery has failed, but they can also be used as a temporizing measure to reduce the rate of complications in high-risk patients. However, their outcomes can be unpredictable, in terms of efficiency and complications. Finally, minimally invasive glaucoma surgery (MIGS) as the sole alternative treatment or as an adjunctive surgical procedure is a relatively new path for pediatric patients.

Anterior Chamber Washout During Ahmed Valve Glaucoma Surgery Reduces the Incidence of Hypertensive Phase.

Intraoperative anterior chamber (AC) washout reduces the odds of hypertensive phase (HP) by 95% compared with those not receiving washout during Ahmed glaucoma implant (AGI), suggesting AC washout is an effective prophylaxis for postoperative HP. To characterize the incidence of postoperative HP in patients receiving AC washout at the time of AGI. A total of 24 patients with medically refractory glaucoma who underwent AGI surgery at a tertiary academic medical center in Southern California from December 2018 through March 2021 were included in this retrospective comparative case series. Patients who received a pediatric implant and underwent concurrent intraocular surgery or did not complete a minimum of 6 months of follow-up were excluded. Nine patient's eyes received AC washout and 15 controls that were analyzed through 6 months postprocedure. HP was defined as intraocular pressure (IOP) above 21mmHg within 6 months postprocedure with maximum tolerated medical therapy. AC washout was performed by irrigating the AC with a 5mL balanced salt solution before placing the tube of the AGI into the AC. The rate of postoperative HP, defined as peak IOP >21mmHg, at 6 months follow-up, was observed as the primary outcome measure. Patients included in the study had a high mean preoperative IOP ( X̅ = 44.11, SD = 13.85). There were no baseline differences between the washout and control groups. The odds of HP were significantly reduced (odds ratio: 0.050; 95% CI: 0.004, 0.706; P = 0.027) for patients who underwent intraoperative AC washout compared with those who did not. Bivariate analysis of subject baseline characteristics revealed that only washout status was significantly different in subjects with HP compared with subjects without HP ( P = 0.015). A multivariate logistic regression model using washout status and autoimmune conditions as covariates was significant in predicting HP ( X2 (2) = 12.337, P = 0.002), with washout as a significant predictor when controlling for autoimmune comorbidities ( P = 0.027). AC washout significantly decreases the odds of HP after AGI surgery. AC washout with balanced salt solution adds minimal time and risks to surgery and therefore may be an effective adjunct during AGI placement.