Surgical Treatment Of Glaucoma Research Articles

A Detailed Study of Glaucoma in Adults, Its Pathogenesis, Diagnosis and Management

As the second most prevalent cause of blindness in the world, after cataracts, glaucoma diagnosis and treatment are crucial topics for general physicians to know. Glaucomas can often be categorised based on three key factors: the extent to which the anterior chamber angle is open or closed, the intensity of the onset (acute or chronic), and the underlying cause (primary or secondary). Most cases of glaucoma are primary, indicating the absence of any comorbidities. Nevertheless, secondary glaucomas may arise from a range of visual illnesses as their root cause. Individuals who are susceptible to developing chronic glaucoma should undergo regular eye examinations in order to detect the condition at an early stage and prevent the progressive deterioration of vision that may occur prior to diagnosis. Glaucoma leads to impairments in both central and peripheral vision fields due to damage to the optic nerve and the retinal nerve fibre layer. All current treatments, including drugs, lasers, and procedures, aim to reduce intraocular pressure (IOP) because it is the only factor that can be changed and is crucial in the progression of the condition. Pharmacotherapy is the usual first-line treatment, although its effectiveness is constrained by noncompliance, adverse effects, and cost. While laser and surgical methods offer the ability to effectively lower intraocular pressure (IOP) for extended periods and at a lower cost compared to medicine, they come with increased risks during the process and a higher likelihood of treatment not being successful. Various modern minimally invasive glaucoma operations have replaced conventional incisional therapies because they offer improved safety and reduced efficacy decreases. While the long-term success of minimally invasive glaucoma surgeries still needs to be determined by large-scale randomised trials, these methods have greatly transformed the surgical treatment of glaucoma.

Association Between Greater Social Vulnerability and Delayed Glaucoma Surgery

PurposeTiming of surgical intervention in glaucoma is crucial to preserving sight. While ocular characteristics that increase surgical risk are known, the impact of neighborhood-level social risk factors such as the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI) on time to glaucoma surgery is unknown. The objective of this study was to evaluate the association between SVI or ADI scores and the timing of glaucoma surgical intervention. DesignRetrospective cohort study. MethodsAdult subjects with open-angle glaucoma were identified from the Bascom Palmer Glaucoma Repository using International Classification of Disease-10 codes. Subject demographics, ocular characteristics, and standard automated perimetry (SAP) data were extracted. Geocoded data were obtained using subject residences and American Community Survey data. Univariable and multivariable time-to-event survival analyses using accelerated failure time (AFT) models were completed to evaluate whether geocoded SVI and ADI scores accelerated or delayed time to glaucoma surgery from initial glaucoma diagnosis in the electronic health record. ResultsA total of 10,553 eyes from 6,934 subjects were evaluated, of which 637 eyes (6.0%) from 568 subjects (8.2%) underwent glaucoma surgery. Mean age was 68.3±13.5 years, with 57.9% female, 21.5% Black, and 34.5% Hispanic subjects. Mean follow-up time was 5.0±2.1 years, with time to surgery of 3.2±1.9 years. Multivariable AFT models demonstrated that higher mean intraocular pressure (time ratio (TR) 0.27 per 5 mmHg higher; 95% CI: 0.23-0.31, p<0.001), faster SAP rate of progression (TR 0.74 per 0.5 dB/year faster; 95% CI: 0.69-0.78, p<0.001), moderate (TR 0.69; 95% CI: 0.56-0.85, p<0.001) or severe baseline severity (TR 0.39; 95% CI: 0.32-0.47, p<0.001), and thinner central corneal thickness (TR 0.85 per 50µm thinner; 95% CI: 0.77-0.95, p=0.003) all accelerated time to surgery. In contrast, overall SVI delayed surgery (TR 1.11 per 25% increase; 95% CI: 1.03-1.20, p=0.006). Specifically, SVI Themes 1 (TR 1.08; 95% CI: 1.01-1.17, p=0.037) and 4 (TR 1.11; 95% CI: 1.03-1.19, p=0.006) were significant. Patients from the most deprived neighborhoods (highest national ADI quartile) had a 68% increase in time to surgery compared to the least deprived quartile (TR 1.68; 95% CI: 1.20-2.36, p=0.002). ConclusionsResidence in areas with higher SVI or ADI scores was associated with delayed glaucoma surgery after controlling for demographic and ocular parameters. Awareness of such disparities can guide initiatives aimed at achieving parity in health outcomes.

Xen-DS: a novel technique of ab externo Xen implantation augmented with a modified deep sclerectomy for surgical treatment of glaucoma.

The Xen gel stent is a surgical glaucoma device which creates a subconjunctival filtering bleb, which has demonstrated good intraocular pressure (IOP) lowering and safety. Nonetheless, bleb-related problems have been reported. We present a case series of ab externo Xen procedures augmented with a deep intra-scleral lake, aiming to improve both IOP-lowering and post-operative management. A retrospective review of 20 patients who underwent combined Xen gel stent implantation with modified deep sclerectomy at our institution from June to November 2022, with a 6-month follow-up period. We reviewed demographics, past ocular history, visual acuity (VA), IOP, visual fields, glaucoma medication use, complications, and perioperative information. 20 eyes of 20 patients, with a mean age of 67.45 ± 14.38 underwent surgery. Pre-operative initial IOP was 24.5 ± 7.96 mmHg, improving to 11.50 ± 2.96 mmHg at 6 months; a change of -12.89 ± 8.34 mmHg and a mean decrease of 51.13 ± 20.15% (p < 0.0001) Patients were on 3.1 ± 0.72 glaucoma medications pre-operatively, improving to 0.72 ± 1.27 at 6 months (p < 0.0001). Visual field mean deviation was -13.99 ± 9.98 dB pre-operatively and -10.27 ± 9.06 dB at 6 months, with VA of 0.287 ± 0.69 pre-operatively and 0.31 ± 0.76 LogMAR post-operatively. No patients required bleb needling. 2 patients underwent subsequent bleb revision surgery. 2 patients developed choroidal effusions, which were managed conservatively with good visual outcomes. In this preliminary study, we have found the modification of Xen gel stent implant surgery with a modified deep sclerectomy to offer good IOP lowering, with low rates of bleb needling and a good safety profile.

To discuss the minimally invasive glaucoma surgery related to trabeculotomy from the perspective of physiological function of trabecular meshwork drainage pathway

The advent of minimally invasive glaucoma surgery (MIGS) has broadened the therapeutic options for managing glaucoma. In recent years, MIGS procedures targeting the trabecular meshwork-Schlemm's canal aqueous outflow resistance site have garnered significant attention. This focus has extended to the pathophysiological changes occurring within the aqueous outflow pathway. However, questions persist regarding the efficacy of near-peripheral or peripheral trabeculotomy in achieving the anticipated reduction of outflow resistance and the suitability of MIGS surgery for patients with primary open-angle glaucoma. By integrating clinical experience with pertinent clinical research, this paper advocates for a reevaluation of MIGS procedures to aid clinicians in making informed decisions regarding various glaucoma surgical interventions.

Trends in the surgical treatment of glaucoma in recent decades

The analysis of trends in the surgical treatment of primary open-angle glaucoma (POAG) allows assessing changes in the indications for surgical treatment, the number of glaucoma surgery and their modifications, as well as the demographic characteristics of patients, duration of preoperative therapy and the effectiveness of treatment.The results indicate that over the past 20 years in the Russian Federation there was a shift towards an increasingly long-term therapeutic strategy used before the surgical stage of treatment, and, in general, a decrease in the number of performed glaucoma surgeries. There is much concern about late surgical treatment, which is confirmed by the established increase in the age of first-time operated patients, and the tendency to increase the number of operations at a far advanced stage of the disease. Most of the published studies on the postoperative hypotensive efficacy of surgery are of limited duration, which does not allow an adequate assessment of the results of treatment. Early appointment of medical hypotensive therapy after surgical intervention indicates a low interaction between outpatient and inpatient specialists, which hinders the possibility of early correction of postoperative problems. The recent increase in the number of scientific works, especially patents, focusing on the search for new technologies that can be implemented in glaucoma surgery, the development of modern drainage devices and the methods for prolonging the hypotensive effect after surgery gives a reason for optimism. The performed analysis dictates the need to develop and implement measures aimed at clearly defined indications for timely surgical treatment and creation of conditions for a complex relationship between the patient, outpatient ophthalmologist and glaucoma surgeon.

Implantacja zastawki Ahmeda w trudnych przypadkach jaskry – technika i powikłania

Glaucoma drainage devices have an established position in the surgical treatment of glaucoma, and moreover their use has grown rapidly in recent years. The aim of the study is to discuss the technique and complications of Ahmed glaucoma valve implantation – one of the most frequently used filtering systems in the treatment of difficult cases of glaucoma. Ahmed glaucoma valve implantation is an effective and relatively safe surgical procedure. The effectiveness of the method, according to various literature reports, is estimated at approximately 45–64% in a 5-year follow-up. Traditionally, Ahmed glaucoma valve implantation has been reserved for the treatment of glaucoma refractory to multiple filtration surgical procedures. Currently, this procedure is recommended for patients with risk factors for failure of trabeculectomy with antimetabolites. The current literature shows the potential role of Ahmed glaucoma valve implantation also as a primary surgical option in selected glaucoma cases, for example in patients with a higher risk of infection.

The impact of intraocular pressure on optical coherence tomography angiography: A review of current evidence.

A scoping review of 45 peer-reviewed manuscripts involving intraocular pressure (IOP) change and concurrent optical coherence tomography angiography (OCTA) assessments was performed to aggregate knowledge, summarize major findings, and identify gaps in literature and methodology relating to the effect of IOP change on OCTA. Articles were identified through PubMed/Medline, Google Scholar, Cochrane, Web of Science, and article reference lists. A total of 838 results were identified, and 45 articles met the inclusion and exclusion criteria for detailed analysis. OCTA metrics including vessel density (VD), perfusion density, and flow density of the superficial capillary plexus and the radial peripapillary capillaries were analyzed in relation to relative temporal IOP changes. Overall, IOP changes were found to affect superficial vascular plexus (VD) measurements on OCTA, especially when IOP elevated above the physiologic normal range (10-21 mmHg). No significant association was found between diurnal IOP variation and OCTA metrics. Cataract surgery improved the whole-image signal strength and VD regardless of changes in IOP. Beta-blockers were associated with paradoxically reduced vessel density in normal tension glaucoma patients in two studies. Although glaucoma surgical intervention studies were inconsistent and limited by scan quality and low sample sizes, patients requiring glaucoma surgery exhibited attenuated postoperative superficial VD recovery despite significant IOP reductions with surgical intervention. In addition to ensuring near-perfect signal strength with minimal media opacities and controlling for high myopia, central corneal thickness, and the presence of retinopathy, clinicians should consider the statistically significant impact of IOP on OCTA metrics when interpreting results.

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).

Glaucoma surgical procedure choice in vulnerable corneal endothelium

This talk will focus on the decision making in patients with vulnerable corneal endothelium requiring glaucoma surgical intervention. The effect of glaucoma surgical procedures on corneal endothelium will be briefly analysed and conditions with vulnerable corneal endothelium and co‐existent intraocular pressure (IOP) elevation, such as Fuchs corneal endothelial dystrophy with primary open angle glaucoma or post‐keratoplasty steroid response, will be adequately described. The aim of the talk is to indicate the most appropriate glaucoma surgical interventions depending on the status of corneal endothelium and the desired IOP lowering effect, covering a wide spectrum of surgical procedures including minimally invasive interventions, such as Preserflow implantation, as well as ab interno/ab externo viscocanaloplasty or conventional procedures such as trabeculectomy or big tube implantation. Finally, the talk will highlight useful surgical tips for the abovementioned surgical procedures, and it will provide suggestions for patient selection in order to optimize clinical outcomes.

CLINICAL ASSESSMENT OF MANAGEMENT WHEN CHOOSING A METHOD OF PROVIDING CARE TO PATIENTS WITH OPEN-ANGLE GLAUCOMA

Introduction: glaucoma is an essential international social and medical problem, as it leads to irreversible blindness in patients worldwide. Organization of treatment and prevention of complications using the most effective methods is the most important task of ophthalmologists at the present stage of the fight against glaucoma.&#x0D; The purpose of the study: to evaluate the management of assistance under the monitoring program «STOP! Glaucoma» to patients with suspected glaucoma, open-angle glaucoma, and more advanced stages of glaucoma. To compare the effectiveness of therapeutic and surgical methods of glaucoma treatment.&#x0D; Materials and methods: To detect and prevent the progression of glaucoma in patients, the LLC «VISIOBUD» Clinic developed and implemented the monitoring program «Stop! Glaucoma». The main task of program was to analyze the dynamics of glaucomatous changes in the optic nerve and, based on this, to determine whether glaucoma compensation is complete and whether the patient does not need a more radical treatment method to preserve visual functions. The following methods of empirical research were used: systematic approach - to determine the research elements between which there are relationships of objects and their properties; observation - to identify signs and external manifestations of facts; comparison – to determine similarities and differences and identify regularities; measurement; monitoring.&#x0D; Results: In the course of the study, the dynamics of changes in intraocular pressure in patients who follow the annual monitoring program «Stop! Glaucoma» in the clinic of LLC «VISIOBUD». 4 groups of patients (116 patients – 156 eyes) were under observation. Installed that in 75% of cases, patients need surgical treatment of glaucoma to preserve their visual functions. Surgical treatment of patients with open-angle glaucoma effectively preserves vision in 89% of cases.&#x0D; Conclusions: Timely detection, monitoring, and treatment of initial signs of open-angle glaucoma and symptoms of its progression affects the preservation and prolongation of visual functions in patients. In the long term, surgical treatment of glaucoma is more cost-effective, as the need to use expensive hypotensive drops is significantly reduced (by 2.5 times).

Efficacy of anti-vascular endothelial growth factor and mitomycin C on wound healing after trabeculectomy in glaucoma patients: A meta-analysis.

Trabeculectomy is the main surgical treatment for glaucoma, but scar formation during wound healing may lead to surgical failure. In this study, we evaluated the efficacy of anti-vascular endothelial growth factor (anti-VEGF) and mitomycin C (MMC) on wound healing after glaucoma surgery. We have been looking for Pubmed, Embase and other databases. The last time we looked at an electronic database was August 2023. A case control study was conducted to compare the use of anti-VEGF and mitomycin C for the treatment of glaucoma. We used the Cochrane standard methodology for collecting and analysing the data. Based on the criteria of inclusion, we have determined 369 related papers and selected seven eligible trials for data analysis. Three hundred and twenty-six cases were treated with trabeculectomy, of which 166 were injected with anti-VEGF and 160 were given MMC for trabeculectomy. In six trials, anti-VEGF and MMC were not found to have any statistical significance on postoperative wound leakage after surgery (OR, 1.55; 95% CI, 0.71, 3.35 p = 0.27). The three trials showed that anti-VEGF and MMC did not differ in terms of reducing postoperative wound hypotony after surgery (OR, 0.78; 95% CI, 0.20, 3.11 p = 0.73). Five trials demonstrated that anti-VEGF and MMC were not associated with a lower incidence of shallow anterior chamber (OR, 1.17; 95% CI, 0.5, 2.76 p = 0.71). There is no significant difference in the effect of anti-VEGF and MMC on wound healing after glaucoma surgery. A multicentre randomized controlled trial with a larger sample size is needed to confirm this study.

Acute glaucoma attack in a patient recovered from coronavirus infection (case report)

The prevalence of ophthalmic manifestations in COVID-19 ranges from 2 to 32%. The most common ophthalmic disease associated with COVID-19 is viral conjunctivitis, but there are also reports of cases with episcleritis, uveitis, occlusions of the central retinal artery and vein, retinopathy, glaucoma, dry eye syndrome, as well as rare neuroophthalmological manifestations such as diplopia, ophthalmoplegia and nystagmus. This study reports a case of bilateral acute angle-closure glaucoma attack in a patient recovered from severe COVID-19 pneumonia.PURPOSE. To determine the causes of bilateral acute angle-closure glaucoma attack associated with COVID-19 pneumonia, and to evaluate the effectiveness of laser iridotomy and transciliary drainage of the posterior chamber of the eye.METHODS. Bilateral acute angle closure glaucoma attack was observed in a female patient recovered from COVID-19 pneumonia. Low hypermetropia and co-existing cataract were diagnosed in both eyes. In order to normalize the IOP and restore visual acuity, laser iridotomy was performed in both eyes, followed by surgical treatment of glaucoma with transciliary drainage of the posterior chamber in both eyes. After that the patient underwent phacoemulsification with implantation of intraocular lenses (IOL) in both eyes.RESULTS. Laser iridotomy and transciliary drainage of the posterior chamber was performed in both eyes. The target IOP without topical therapy and stabilization of glaucoma were achieved in both eyes. The second step was phacoemulsification with implantation of IOL, which significantly improved visual acuity of both eyes.CONCLUSION. COVID-19 can lead to vision loss and disability, therefore IOP should be monitored in patients that remain in prone position for ventilation for extended periods of time and receive systemic steroid medications. This is especially relevant for patients with a predisposition to glaucoma or with diagnosed glaucoma.

Repeat glaucoma surgery: modern view of the problem

Glaucoma surgery is the most effective way to achieve target levels of intraocular pressure. However, it has significant advantages and disadvantages. The main disadvantage is the temporary nature of its hypotensive effect. The onset of surgical failure can occur at various times after the intervention. A correct assessment of the operation timing and risk factors for excessive scarring, as well as correct perioperative therapy, can prolong the effectiveness of the surgery and reduce the number of repeat operations.With a wide choice of surgical treatment methods, trabeculectomy remains the most frequently performed intervention. Its effect is better understood and can be considered more controllable. If the surgical treatment of glaucoma is ineffective, it is possible to prescribe a "restart" therapy, activate previously formed outflow tracts, and perform a second intervention. The development of needling technology makes it possible to delay repeat interventions, prolonging the hypotensive effect of the initial operation.

Sulcus Tube Internal Needle Guidewire Technique for Glaucoma Drainage Device Placement: Improving Surgical Ease and Precision.

Despite the rise of micro-invasive glaucoma surgery(MIGS), glaucoma drainage device implantation continues to be a mainstay among glaucoma surgical treatment options. Anterior chamber tube placement, while effective in reducing intraocular pressure(IOP), poses corneal endothelial risks. Ciliary sulcus tube placement shows promise in reduced corneal endothelial cell loss, but proper sulcus placement can be challenging. Our study describes the initialsafety and effectiveness results using a novel sulcus tube internal needle guidewire (STING) technique for glaucoma drainage device insertion into the ciliary sulcus. We retrospectively reviewed the charts of all consecutive patients who underwent the STING technique using the Ahmed ClearPath, Ahmed Glaucoma Valve, or Baerveldt glaucoma implant with at least 6 months of follow-up. Demographic characteristics, type of glaucoma, previous medical and surgical treatment, pre- and postoperative IOP, pre- and postoperative medications, complications, and success rates were recorded. Out of nine eyes, seven resulted in qualified success (77.8%). Preoperative mean IOP was 23.8 ± 6.3 mmHg, and postoperative IOP decreased significantly to 14.9 ± 3.7 mmHg (p = 0.008). The average number of preoperative medications per patient was 4.4 ± 0.7, while the average number of postoperative medications per patient was reduced significantlyto 3.6 ± 1.0 (p = 0.039). The STING technique is a novelmethod for placing a glaucoma drainage device into the ciliary sulcus, leading to IOP lowering with minimal complications. The STING technique is designed to improve surgical ease and increase anatomical precision of sulcus tube placement. Video available for this article.

Incident glaucoma and ocular hypertension after periocular and intravitreal steroid injections: a claims-based analysis

Background/aimsThis study aims to determine the incidence and risk of open-angle glaucoma or ocular hypertension (OHT) following ocular steroid injections using healthcare claims data.MethodsWe retrospectively reviewed deidentified insurance claims data...

Efficacy of Continuous-Wave Transscleral Cyclophotocoagulation Post-Pars Plana Vitrectomy in Glaucoma Patients: A Retrospective Study from Poland.

BACKGROUND Glaucoma, a vision-threatening condition, results from optic nerve damage and affects millions of people worldwide. Often asymptomatic, it is hereditary, with risk factors like hypertension, diabetes, and steroid use. Despite its link with intraocular pressure (IOP), not everyone with high IOP develops glaucoma. After pars plana vitrectomy (PPV), patients face increased IOP risks. Traditional treatment includes pharmacotherapy, and, when ineffective, surgical interventions. Continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) is an alternative for refractory glaucoma but can have complications. Our study compares the efficacy and safety of CW-TSCPC after PPV. MATERIAL AND METHODS The study group consisted of 18 patients diagnosed with glaucoma who underwent the CW-TSCP procedure as the first-choice therapy after conservative treatment of glaucoma proved ineffective. The comparison group consisted of 12 patients who underwent the CW-TSCP procedure after conservative drug treatment and in whom surgical treatment of glaucoma had been unsuccessful. All patients had inadequate control of IOP after PPV. RESULTS Study and comparison group patients showed a decrease in IOP during the follow-up, independent of the type of endotamponade used (P<0.05). When the indication for PPV was retinal detachment hemorrhage into the vitreous chamber, a significant decrease in IOP between 0 days and 180 days was only found in the study group (P<0.05). In contrast, when the indication for PPV was the state after uveitis or proliferative diabetic retinopathy, a significant decrease in IOP was found at 180 days in the study and comparison groups (P<0.05). CONCLUSIONS The analysis showed that the CW-TSCPC procedure can be recommended as the first-choice invasive treatment in patients with increased IOP after PPV.

ALGORITHM FOR MANAGEMENT OF CHILDREN AFTER ANTI-GLAUCOMATOSUS SURGERY

The prevalence of glaucoma in children is 1:10000-1:12000. In the structure of blindness in children, the proportion of thepathology under consideration ranges from 2 to 15 %.The goal of surgical treatment of glaucoma is to achieve the target elevated intraocular pressure (IOP) without the use of medications. Early complications include shallow anterior chamber syndrome, hyphema, ciliochoroidal detachment, excessive hypotension and hypertension. The probability of these complications is quite high: according to some data it can reach 50 %, which shows the relevance of this problem.Aims. To study the frequency and nature of early postoperative complications and to analyze the results of treatment inchildren with primary congenital glaucoma.Material and methods. The total number of children was 50 (91 eyes) who underwent anti-glaucomatous surgery and earlypostoperative complications were revealed.Results. Analysis of the structure of early postoperative complications after anti-glaucoma surgery showed that on thefi rst day, the total number of patients with complications was 61.54 %. On the third day, the total number of patients withcomplications decreased to 39.56 %. Of these patients, the largest number were patients with hypotension with CCO 32.97 %, hyphema was –19.78 % in the early postoperative period and ophthalmohypertension was –17.58 %.On the seventh day, the number of complications was 9.9 % of patients who were recommended to continue conservative treatment in inpatient conditions.Conclusion. In the early postoperative period after conservative treatment, the number of complications decreased to 90.1 %. None of these patients required repeat surgery. Patients were discharged home under the supervision of a local ophthalmologist.

XEN®-45 implantation for refractory uveitic glaucoma

PurposeTo evaluate the efficacy of XEN®-45 gel stent ab interno implantation for medically uncontrolled uveitic glaucoma.MethodsRetrospective analysis of 25 eyes receiving XEN® gel stent for medically uncontrolled uveitic glaucoma from February 2019 to February 2023 with recording of intraocular pressure (IOP) values, ocular hypotensive medication, requirement for revision or secondary surgery and complications. Prerequisites for XEN® implantation were a clear cornea, an open iridocorneal angle and an unscarred, mobile conjunctiva at the implantation site. Minimum follow-up required for inclusion was 3 months. The primary outcome measure was IOP compared to baseline. Complete and qualified success were defined as final IOP of ≤ 18 mmHg without or with topical antiglaucomatous treatment, respectively. Failure was defined as IOP > 18 mmHg on two consecutive visits, IOP reduction < 20%, persisting complications from hypotony and open conjunctival bleb revision. Further glaucoma surgical intervention was defined as complete failure.ResultsMean preoperative IOP was 35.3 ± 10.9 mmHg on 2.9 ± 0.9 topical antiglaucomatous agents. 19 of 25 patients (76%) received additional oral acetazolamide. 19 eyes were pseudophakic, 5 eyes phakic and 1 aphakic.Early postoperatively, mean IOP reduced to 7.7 ± 3.0 mmHg (75.8% reduction). At final follow-up (mean 17.7 months) mean IOP was 12.0 ± 3.8 mmHg (62.5% reduction) on 0.2 ± 0.6 medications.Six eyes (24%) required bleb revision at mean 28 weeks and therefore were categorized as failure. One eye failed despite bleb revision and restart of topical ocular hypotensive medication. Three other eyes (12%) had IOP spikes with uveitis flare-ups. Transient hypotony complications occurred in 32%. At final follow-up, 18 eyes (72%) achieved complete success and one eye (4%) qualified success.ConclusionThe XEN® gel stent effectively reduced IOP in uncontrolled uveitic glaucoma, with 72% complete success. Bleb revision was required in 24%. IOP spikes occurred in 12% despite functioning blebs. Further follow-up is needed to determine long-term outcomes.

Recanalization of Xen45 gel stent implant occlusion using 10 − 0 nylon suture in refractory glaucoma: a case report

BackgroundXen Gel Stent implant is a new minimally invasive surgical treatment for glaucoma that has been proven effectiveness and safety profile. However, it may also lead to some complications. Xen Gel Stent occlusion is a relatively rare complication reported less frequently and has limited treatment experience. In our case report, we proposed a novel surgical treatment using a 10 − 0 nylon suture to successfully recanalize the occluded Xen45 Gel Stent.Case presentationA 16-year-old female patient had bilateral juvenile glaucoma for the past 5 years. Her right eye had undergone three glaucoma surgeries but failed. At a presentation to our hospital, the right eye’s intraocular pressure (IOP) was 30 mmHg despite applying four different active principles. Xen45 Gel Stent implant was chosen for treatment, but six days after implantation, the IOP rose to 40 mmHg as a result of an anterior chamber tip occlusion of the Xen45 Gel Stent. Nd: YAG laser shockwave therapy was attempted but failed. The patient eventually had to return to the operating room for a revision procedure. The Xen45 Gel Stent was recanalized from the ab externo by making an L-shaped conjunctival incision at the fornix base and threading a 10 − 0 nylon suture through it. The IOP was successfully controlled in the 11-month follow-up without medication.ConclusionIf postoperative occlusion arises after Xen45 Gel Stent implantation, surgery using 10 − 0 nylon suture to recanalize Xen45 Gel Stent should be considered as a relatively safe, effective that does not require removal of Xen45 Gel Stent.

Topical hypotensive therapy preceding surgical treatment of glaucoma

PURPOSE. To analyze specific clinical and epidemiological parameters of patients with primary open-angle glaucoma (POAG) who were admitted for surgical treatment to the ophthalmological hospital of a multi-specialty in-patient medical center in the period of 2021–2022 years.METHODS. The retrospective elective study analyzed data from 95 patients (95 eyes) with different stages of primary open-angle glaucoma (mean age 73 [67; 80] years old) who were hospitalized for surgical treatment of the disease in 2021–2022. In addition to standard ophthalmological examination, several clinical and epidemiologic characteristics were analyzed in detail, including the prevalence of prescriptions for antiglaucoma hypotensive drugs. Comparison of the obtained results with the data of similar procedures performed in the period from 2005 to 2016 was carried out.RESULTS. The number of main comorbid somatic diseases was on average 3 (2; 4), and comparison of conditions by disease stage revealed no significant differences (p&gt;0.05). Mean duration of the disease (according to anamnesis) was 8 (4; 13) years and was longer in comparison with similar results from 2005–2006 presented in a previous study. The period preceding the first surgical intervention was 5 (2; 10) years and was statistically significantly longer in those with moderate stage of POAG (9 [3; 14] years) compared to those with early stage of POAG (4 [3; 5] years, p&lt;0.05) and advanced stage of POAG (6 [0; 10] years, p&lt;0.04). The average number of drugs at the time of hospitalization for surgical treatment has increased significantly in comparison with the data of the early-mid 2000s and amounted to 4 (3; 4) units (stage I glaucoma — 3 [3; 4]; stage II — 4 [3; 4]; stage III — 4 [3; 4] units), with no statistically significant difference (p1,2=0.64; p1,3=0.21; p2,3=0.42, respectively).CONCLUSION. Unwarranted long-term use of a large number of antiglaucoma drugs ("maximal medication therapy adherence") is a significant problem in modern glaucomatology and can evidently affect future prognosis of the disease.