Surgical Treatment Of Glaucoma Research Articles

SURGICAL TREATMENT OF CYSTIC FILTRATION BLEBS AFTER SINUSTRABECULECTOMY: CASES FROM PRACTICE

The article presents two similar clinical cases. Patients with complaints of bulbar conjunctiva neoplasm, which grew on the cornea, caused a pronounced feeling of discomfort and partially impaired visual functions, turned to the department of surgical treatment of glaucoma of the MNTC “Eye Microsurgery”. It should be noted that previously these patients underwent a sinustrabeculectomy at their place of residence in order to reduce intraocular pressure. After examination and additional instrumental research methods, the presence of a cystic filtration bleb was diagnosed and the area of anti-glaucoma surgery was revised with individual characteristics in each case. As a result of the treatment, a positive effect was achieved. At a repeat visit a month after surgery, patients did not complain, intraocular pressure was compensated, and there were no relapses.

Trends in glaucoma surgery in a tertiary hospital in Spain: 2010-2022.

This study aims to conduct an analysis glaucoma surgeries performed over a 13-year period at a tertiary hospital affiliated with the Spanish National Health System, with the goal of assessing temporal trends. This retrospective observational study scrutinized surgeries undertaken in the glaucoma unit of a tertiary center in Spain between 2010 and 2022. Data collected included surgical dates, procedure performed, whether it was standalone or combined, as well as patient demographics including age, sex, and type of underlying glaucoma. Surgeries on individuals under 18 years of age were excluded. An annual comparative analysis was performed to ascertain the evolving trends in glaucoma surgical interventions. A total of 12,944 surgeries were included in the analysis, comprising 9428 isolated cataract surgeries and 2975 glaucoma procedures. Trabeculectomy, glaucoma drainage devices (GDD), and cyclodestruction, collectively referred to as traditional surgery, demonstrated a decline from 93.2% to 23.6% over the study duration. Minimally invasive glaucoma surgery (MIGS) and minimally invasive bleb surgery (MIBS) demonstrated a significant increase from 3.8% in 2010 to 74.7% in 2022, relative to the total glaucoma surgeries. Furthermore, combined surgeries manifested a noteworthy increase from 39.0% in 2010 to 44.2% in 2022, with 86.4% of combined procedures in 2022 being MIGS or MIBS. In recent years, there has been a noticeable change in the trend of glaucoma surgeries, with MIGS and MIBS procedures experiencing a significant increase and becoming the most commonly performed glaucoma procedures. Consequently, traditional glaucoma surgeries have decreased in frequency.

Appropriateness and readability of Google Bard and ChatGPT-3.5 generated responses for surgical treatment of glaucoma.

To evaluate the appropriateness and readability of the medical knowledge provided by ChatGPT-3.5 and Google Bard, artificial-intelligence-powered conversational search engines, regarding surgical treatment for glaucoma. In this retrospective, cross-sectional study, 25 common questions related to the surgical management of glaucoma were asked on ChatGPT-3.5 and Google Bard. Glaucoma specialists graded the responses' appropriateness, and different scores assessed readability. Appropriate answers to the posed questions were obtained in 68% of the responses with Google Bard and 96% with ChatGPT-3.5. On average, the responses generated by Google Bard had a significantly lower proportion of sentences, having more than 30 and 20 syllables (23% and 52% respectively) compared to ChatGPT-3.5 (66% and 82% respectively), as noted by readability. Google Bard had significantly (p<0.0001) lower readability grade scores and significantly higher "Flesch Reading ease score", implying greater ease of readability amongst the answers generated by Google Bard. Many patients and their families turn to LLM chatbots for information, necessitating clear and accurate content. Assessments of online glaucoma information have shown variability in quality and readability, with institutional websites generally performing better than private ones. We found that ChatGPT-3.5, while precise, has lower readability than Google Bard, which is more accessible but less precise. For example, the Flesch Reading Ease Score was 57.6 for Google Bard and 22.6 for ChatGPT, indicating Google Bard's content is easier to read. Moreover, the Gunning Fog Index scores suggested that Google Bard's text is more suitable for a broader audience. ChatGPT's knowledge is limited to data up to 2021, whereas Google Bard, trained with real-time data, offers more current information. Further research is needed to evaluate these tools across various medical topics. The answers generated by ChatGPT-3.5™ AI are more accurate than the ones given by Google Bard. However, comprehension of ChatGPT-3.5™ answers may be difficult for the public with glaucoma. This study emphasized the importance of verifying the accuracy and clarity of online information that glaucoma patients rely on to make informed decisions about their ocular health. This is an exciting new area for patient education and health literacy.

Engineered sensor actuator modulator as aqueous humor outflow actuator for gene therapy of primary open-angle glaucoma

Glaucoma, a blinding eye disease with optic neuropathy, is usually associated with elevated intraocular pressure (IOP). The currently available pharmacological and surgical treatments for glaucoma have significant limitations and side effects, which include systemic reactions to medications, patient non-compliance, eye infections, surgical device failure, and damage to the eye. Here, we present Sensor-Actuator-Modulator (SAM), an engineered double mutant version of the bacterial stretch-activated mechanosensitive channel of large conductance (MscL) that directly senses tension in the membrane lipid bilayer of cells and in response, transiently opens its large nonspecific pore to release cytoplasmic fluid. The heterologously expressed mechanosensitive SAM channel acts as a tension-activated pressure release valve in trabeculocytes. In the trabecular meshwork (TM), SAM is activated by membrane stretch caused by elevated IOP. We have identified several SAM variants that are activated at physiologically relevant pressures. Using this barogenetic technology, we have demonstrated that SAM is functional in cultured TM cells, and successfully transduced in vivo in TM cells by use of AAV2/8. Further, it is effective in enhancing aqueous humor outflow facility leading to lowering the IOP in a mouse model of ocular hypertension.

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.

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.

Volume and Structure of the Population’s Need for High-Tech Ophthalmological Care in Azerbaijan

Purpose. Determine the volume and structure of high­tech ophthalmological care in Azerbaijan.Materials and methods. Materials from medical histories of patients hospitalized at the National Center of Ophthalmology named after Academician Z. Aliyeva (12 882 cases) for 2019 (from January 1 to December 31) were used. The need of hospitalized patients for high­tech ophthalmological care was determined in accordance with the list of types of high­tech medical care. The volume of demand of the population of Azerbaijan for GPs by type of indications and interventions was established per 100 thousand population with the determination of the average error of the indicator.Results. 14.5 ± 0.3 % of ophthalmological patients received high­tech ophthalmological care. The main types of high­tech ophthalmological care necessary to meet the needs of the population are transpupillary, microinvasive energetic optical­reconstructive and endovitreal 23.25 gage surgery for vitreoretinal pathologies of various origins (75.3 % of all types of operations; 16.63 ± 0.44 operations per 100 thousand population). The second place in the structure is occupied by complex surgical treatment of glaucoma, including microinvasive energy optical­reconstructive and laser surgery with possible implantation of silicone valve or metal drainage (11.3 % of all operations; 2.48 ± 0.17 operations per 100 thousand population).Conclusions. In Azerbaijan, the leading reasons for providing high­tech ophthalmological care are: cataracts complicated by lens luxation, glaucoma, pathology of the vitreous body, retina and choroid (27.0 % of all reasons; 5.96 ± 0.26 cases per 100 thousand population); retinal detachment and tears, tractional retinal detachment, other forms of retinal detachment in adults and children, complicated by pathology of the cornea, lens, vitreous body (22.1 % of all cases, 4.89 ± 0.24 cases per 100 thousand population). The most common type of hightech ophthalmological care is transpupillary, microinvasive energetic optical­reconstructive and endovitreal surgery for vitreoretinal pathologies of various origins (75.3 % of all types; 16.63 ± 0.44 cases per 100 thousand population).

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.

Outcome of Glaucoma Management in Sturge-Weber Syndrome: Case Series

Objective: To report the clinical findings and outcome of treatment for developmental glaucoma from Sturge-Weber syndrome in four consecutive children managed at a child eye health tertiary facility in Ibadan, Nigeria. Methods: A retrospective case series of four children with Sturge-Weber syndrome (SWS) and developmental glaucoma who underwent surgical treatment for glaucoma over a 3-year period. Information on patients’ sociodemographic data, clinical features, and management are described. Results: Four male children, aged between 7 weeks and 11 years, with unilateral developmental glaucoma and varying extent of port-wine stain were included in the study. The primary surgery in three patients was trabeculectomy, while the fourth patient received a glaucoma drainage device. Shallow anterior chamber, choroidal effusion, and cataract were complications of glaucoma surgery observed. Secondary surgeries performed include anterior chamber reformation, suturing of leaking peritubular scleral channel, sclerotomy and fluid drainage, bleb needling, cataract surgery, and scleral buckle surgery. At the 1-year follow-up visit, one eye had complete success, one eye had qualified success, while the other two had treatment failure. Conclusion: The outcome of management of glaucoma associated with Sturge-Weber syndrome is modest. Though rare, SWS can cause significant ocular and systemic morbidity. Complications of therapy may be encountered, and multiple surgical interventions may be required for optimal management.

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.

Importance of parental compliance in postoperative rehabilitation of children with glaucoma

This study assesses the level of parental compliance with rehabilitation measures and attempts to identify the factors affecting it during the rehabilitation period of children after surgical treatment of congenital glaucoma. The study was conducted through a survey involving 62 parents of children who underwent surgical treatment for glaucoma at the ophthalmology department of the Tashkent Pediatric Medical Institute. Parents were provided with a link to the online survey after giving their consent. The questionnaire consisted of eight questions with multiple-choice answers. Analysis of the answers showed the following trends: the majority of parents had either a secondary or vocational education (59.7%); most parents lived in rural areas (64.5%); a significant portion had partial or no knowledge about the course and outcomes of glaucoma (51.6%); unreliable sources for information (45.2%); irregular adherence to the doctor's recommendations (29%); significant difficulties in following the prescribed recommendations (64.5%). It was found that the level of parental compliance with rehabilitation measures is low in a significant portion of families (37.2%) with children who underwent surgery for glaucoma. The main factors contributing to poor parental compliance include living in rural areas, insufficient knowledge about the disease, lack of strict adherence to medical recommendations, and various difficulties in implementing the prescribed recommendations (p<0.05).

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.