Treatment Of Refractory Glaucoma Research Articles

Adjunctive use of netarsudil 0.02% in the treatment of refractory glaucoma: a one year analysis

PurposeThis study evaluates the long-term adjunctive use of netarsudil ophthalmic solution 0.02% in lowering IOP in patients with refractory glaucoma.MethodsThis retrospective chart review study was conducted at a tertiary care center. Patients who were prescribed add-on netarsudil therapy and on ≥ 3 topical glaucoma medications from 01/01/2018 to 08/31/2020 were reviewed. 47 patients (69 eyes) met the inclusion criteria. Baseline IOPs prior to the addition of netarsudil were compared to IOPs measured at 3-, 6-, and 12-month intervals. Any patients with inadequate follow-up or who had glaucoma surgery after netarsudil initiation were excluded.ResultsMedian baseline IOP (± SD) was 21 ± 5.8 mmHg (median of 2 visits prior to initiation of netarsudil). At 3-month follow-up, 64 eyes had a median IOP of 16 ± 6.7 mmHg (p < 0.01). At 6-month follow-up, 56 eyes had a median IOP of 18 ± 4.6 mmHg (p < 0.01). At 12-month follow-up, 44 eyes had a median IOP of 15 ± 6.8 mmHg (p < 0.01). At the conclusion of the study, 64% of eyes reached 1 year follow-up due to several reasons.ConclusionsPatients with refractory glaucoma showed statistically and clinically significant IOP reductions on netarsudil. IOP reduction was stable long-term with the largest decrease in IOP seen at 12 months. Although some patients will still go on to require further laser or incisional surgery, for most patients netarsudil is an effective treatment for adjunctive use in refractory glaucoma.

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.

Repeated micropulse cyclophotocoagulation in the treatment of refractory glaucoma. A clinical experience

Purpose: to analyze the results of repeated micropulse transscleral cyclophotocoagulation (mTSCPC) in the treatment of refractory glaucoma (RG).Material and methods. We examined 74 patients aged 73.2 ± 6.3 years with developed (13), advanced (48) and terminal (13) stages of refractory glaucoma before and within 15 months after the first mTSCPC (SUPRA 810, Quantel Medical, France) using standard laser parameters — 100 J. According to indications, the repeated mTSCPC was performed for 17 patients. Of these, 4 patients had the second procedure three months after the first procedure, 10 patients — 6 months after it, and 3 patients, 9 months after the first procedure. The repeated mTSCPC was performed with an impact energy higher than the first one — 125 J.Results. After the first procedure, the hypotensive effect was held in 57 patients with RG (77.0 %) up to 15 months of the follow-up. The repeated mTSCPC given to 17 patients made it possible to reduce intraocular pressure (IOP) by 38.5 % for the developed RG stage, by 33.9 % for the advanced stage, and by 21.4 % at the terminal stage (p &lt; 0.05) by 6–12 months of follow-up. The hypotensive effect was held in 13 out of 17 patients by the end of the follow-up.Сonclusion. Single and repeated mTSCPC with laser energies of 100 J and 125 J are effective and safe techniques of RH treatment. Possibly, it is worth revising the basic parameters of the mTSCPC procedure from 100 to 125 J to achieve a longer and at the same time safe hypotensive effect in patients with RG.

Long-term Efficacy and Safety of Micropulse Transscleral Cyclophotocoagulation in the Treatment of Refractory Glaucoma

Objective: To evaluate the long-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in refractory glaucoma. Materials and Methods: The present study was a prospective non-comparative interventional study. Patients diagnosed with refractory glaucoma were included for MP-TSCPC. The success rate was defined as an intraocular pressure (IOP) of 6 to 21 mmHg or a reduction of IOP by 20%. The percentage of IOP reduction, number of glaucoma medications, visual acuity (VA), additional procedures, and complications were evaluated. Results: Twenty eyes of 14 patients were included. The mean follow-up time was 28.1±19.5 months and up to 48 months. The mean preoperative IOP was 22±10.4 mmHg. The success rate of MP-TSCPC was 43.8% at 36 and 48-months follow-ups. The cumulative proportional success was 47.6% at 48 months with a median survival time of 36 months. IOPs showed significant reduction at 1-week follow-up (P &lt;.05) and were reduced 48.7% at 48 months. The overall number of glaucoma medications (p=0.25) and VA (p=0.23) showed no difference compared to baseline. Fifty percent of eyes required an additional procedure to control IOP. Complications included one case of corneal decompensation and three cases (15%) of cataract progression. Conclusion: MP-TSCPC demonstrated a high success rate in short-term follow-up, then showed a moderate success rate at intermediate and long-term follow-ups in refractory glaucoma. The treatment should be used with caution in cases with a history of multiple ocular surgery to avoid long-term adverse effects. Keywords: Glaucoma; Intraocular pressure; Laser coagulation; Laser therapy

Is transscleral cyclophotocoagulation with diode laser (TSCPC) still a valid option for refractory glaucoma? A real-world single-centre Italian experience

Background: To describe our experience with TSCPC with diode laser for refractory glaucoma in a single centre in southern Italy. Methods: This retrospective descriptive study included 134 eyes with refractory glaucoma. Patients underwent TSCPC using a Cyclo-G6 laser method with a G-probe delivery system. Intraocular Pressure (IOP) and the number of Antiglaucoma Medications (AGM) were recorded at baseline and at 1-, 7-, 30-, 60-, 90- and 180-days post-treatment. TSCPC success rate was defined as an IOP between 5 and 21 mmHg or 30% reduction from baseline at the last visit (180 days) [26,27]. Statistical analysis was performed using Graph Pad Prism. Results: IOP decrease of 30% or more from baseline was achieved in 77.6% of eyes at day 1, 100% at 90 days and 85% at 180 days. A reduction in AGM was recorded for 85% of patients. No statistical difference in IOP reduction and number of AGM was found between female and male population at 180 days. No severe complications were reported, and minor complications occurred in 4/134 treated eyes (3%). Conclusions: In our experience TSCPC lead to an lowering of IOP in selected cases and it is still a valid option in the treatment of refractory glaucoma.

Outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma eyes

Introduction: Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) is a new treatment for glaucoma claiming to have lower levels of complications while having comparable efficacy relative to its predecessor, traditional Transscleral Continuous-wave Cyclophotocoagulation (TC-CPC).Objective: To evaluate the clinical efficacy and safety of MPTSCPC in the treatment of refractory glaucoma eyes.Methods: This uncontrolled interventional study was conducted at the Northampton General Hospital, UK. Patients who were selected to undergo MP-TSCPC due to uncontrolled intraocular pressure (IOP) or visual field progression despite maximum tolerable anti-glaucoma treatment were recruited for the study from February to September 2020. Data related to the patients were collected pre procedure and up to three months post procedure.Results: Of the 37 patients included in the study, 59.5% were females. The mean age of participants was 75.35 (SD=10.37) years. The most common types of glaucoma seen in the sample were primary open angle glaucoma and pseudoexfoliation glaucoma with 67.6% and 16.2% respectively. Mean pretreatment IOP was 26.62 (SD=8.36) mmHg. Three-month post-treatment mean IOP of 18.47 (SD=7.92) mmHg was a statistically significant (p&gt;0.001) reduction of 7.10 mm Hg. The drop in mean number of anti-glaucoma medications from 2.38 to 2.22 was not significant. Except for four patients with prolonged ocular inflammation and one patient with macular oedema, there were no significant complications following the procedure.Conclusion: MP-TSCPC is an effective and safe treatment option for refractory glaucoma over a 3 month follow up period. More extensive studies with larger sample sizes and longer follow up durations are recommended.

Structural Design and Finite Element Analysis of New Type Posterior Integral Glaucoma Valve

The treatment of refractory Glaucoma is a difficult problem in clinical ophthalmology. For refractory glaucoma patients with hyphema, shallow anterior chamber, anterior conglutination of peripheral chamber angle, corneal endothelium dystrophy or decompensated, at present, there is no effective treatment. In order to solve this problem, a new type posterior integral glaucoma valve with IOP control device was designed using medical titanium alloy, and the valve model was established by Abaqus software, and the stiffness and preload of the valve were analyzed by finite element method. The results showed that the opening and closing of the valve were controlled automatically by the pressure difference between the front and back of the valve, and the opening and flow rate of the valve increase dynamically with the increase of intraocular pressure, and finally reached the set ideal IOP value of steady state.

Clinical Study on Treatment of Refractory Glaucoma with Brinzolamide Eye Drops

Clinical Study on Treatment of Refractory Glaucoma with Brinzolamide Eye Drops

Subliminal Diode Treatment of the Ciliary Bodies by Transscleral Cyclophotocoagulation with a 31.3% Duty Cycle in the Treatment of Refractory Glaucoma: Safety and Efficacy

Micropulse Transscleral diode laser cyclophotocoagulation (MP-TSCPC) is an established method of treatment for refractory glaucoma. This study evaluates the efficacy in terms of reduction in intraocular pressure and/or treatment amount, and safety and side effects of the ciliary bodies using a subthreshold laser with a duty cycle of 31.3% with Supra 810 nm Subliminal Quantel Medical, at one year in patients with refractory glaucoma.

Occurrence of motility disorders in patients undergoing tube surgery-consecutive, retrospective follow-up case series analysis.

The two glaucoma drainage devices (GDD) Ahmed and Baerveldt tubes are most commonly used for the treatment of refractory glaucoma. We noticed a significant number of patients with postoperative motility disorders resulting in diplopia. We investigated the occurrence and patterns of postoperative motility disorders overall and between the two GDD tubes using the Hess Screen Test. Retrospective single-center matched case series of 20 patients undergoing Ahmed and 20 patients undergoing Baerveldt tube implantation with a follow-up of at least 1year. In order to investigate the dynamic of GDD-induced motility disorder over time, from 25 patients, a follow-up examination from two different time periods (3 to 6months and 12 to 24months postoperatively) was available. From these 25 patients, 12 had received an Ahmed and 13 a Baerveldt GDD. To compare the different Hess Screen Tests, we developed nine categories of possible emerging motility disorder in the operated eye as a primary endpoint: Motility restriction in up-gaze, in down-gaze, in abduction, in adduction; combined motility disorders in up-gaze and adduction, up-gaze and abduction, down-gaze and adduction, down-gaze and abduction. If there was no motility disorder, this was also separately classified. Regardless of the used device, Ahmed or Baerveldt, most patients experienced motility disorders to some extent; mainly down-gaze and adduction were affected. However not every motility disorder resulted in diplopia. Although over time a decrease in ocular misalignment was seen, the incidence of diplopia was stable. Nevertheless, only few required therapy. We noted no difference between Ahmed and Baerveldt tube implant devices. Ocular misalignment and restriction of motility is a common finding after GDD. Although not every motility disorder results in diplopia, it is frequent. Therefore, it needs to be taken into consideration in informed consent.

РАЗВИТИЕ ЦИКЛОДЕСТРУКТИВНОЙ ХИРУРГИИ В ОФТАЛЬМОЛОГИИ И ЕЁ ПРИМЕНЕНИЕ ПРИ РАЗЛИЧНЫХ ВИДАХ ГЛАУКОМЫ

Glaucoma remains a significant problem in ophthalmology. It is characterised by increased intraocular pressure (IOP), visual field loss, and optic nerve degeneration. Despite some progress achieved in the diagnosis and treatment of the disease, millions still suffer from glaucoma (currently, according to WHO, there are more than 106 million people globally), and many patients are already in the later stages. The accompanying pain syndrome sometimes forces doctors to remove the eye. In this regard, several so-called organ-preserving operations were introduced, the purpose of which is to reduce the production of intraocular fluid (IOF) and, accordingly, eliminate the pain syndrome. Glaucoma treatment includes conservative and surgical interventions. Surgical methods for glaucoma treatment aim to improve the outflow of intraocular fluid (fistulising operations) or reduce its production (cyclodestructive procedures). This paper analyses the evolution of surgical interventions to reduce intraocular fluid production by destroying the aqueous humour-producing ciliary processes. Systematic review searches were performed using Google Scholar, Pubmed, Web of Science, Cyberleninka, and Cochrane Library databases for articles published up to 2020 using keywords related to cyclodestruction (CD), cyclophotocoagulation (CPC), and treatment of refractory glaucoma (RG). Keywords: Glaucoma, cyclodestruction, cyclophotocoagulation, ciliary body, diode laser.

Technique for laser activation of scleral hydropermeability in the treatment of patients with refractory forms of glaucoma

Laser cyclodestructive interventions are considered the method of choice in the treatment of refractory glaucoma. However, the traumatic nature of cyclocoagulation makes it necessary to search for more gentle methods of laser treatment. One of the possible directions is the development of laser transscleral technologies that mainly affect the uveoscleral outflow. This article presents a new technique for laser activation of scleral hydropermeability (LASH) using pulse-periodic erbium glass (Er-glass) fiber-optics laser with wave length of 1.56 μm. The article describes the parameters of laser emission and the technique of LASH, and presents the mechanism of reducing intraocular pressure associated with increased transcleral drainage of intraocular fluid by forming new pores in the sclera. The effectiveness and safety of LASH is supported by a detailed example from clinical practice. This technology has proven itself as a possible alternative to the conventional contact transcleral cyclocoagulation.

Micropulse trans-scleral cyclophotocoagulation: treatment outcomes of refractory glaucoma in Malaysia

Introduction: A more novel form of cycloablation, micropulse cyclophotocoagulation (MPCPC), has gained popularity in recent years due to its proven efficacy in lowering intraocular pressure (IOP) as well as higher safety profile compared to conventional trans-scleral cyclophotocoagulation.&#x0D; Purpose: The aim of this study was to investigate the treatment outcome of MPCPC as an adjunctive treatment for refractory glaucoma.&#x0D; Study design: Retrospective interventional case series.&#x0D; Materials and methods: Subjects were patients with refractory glaucoma and glaucoma progression; with or without prior glaucoma surgery, who were not keen or not suitable for glaucoma surgery. Outcomes were IOP-lowering effect and reduction of glaucoma medications at 6 months follow-up. Treatment success was defined as either achieving IOP &lt; 21 mmHg or IOP reduction of 20% from baseline IOP.&#x0D; Results: The median age of patients was 57.5 years. A total of 34 eyes of 24 patients were treated with MPCPC with a mean follow-up period of 6 months. The majority of our patients (79%) experienced mild to moderate pain during the procedure. The median IOP prior to MPCPC was 30 mmHg and was significantly reduced at 1 week (17.5 mmHg), 1 month (17.5 mmHg), 3 months (21.0 mmHg), and 6 months (21.0 mmHg), with a 19.2% IOP reduction at the last follow-up. There were no cases of hypotony. The reduction in the number of glaucoma medications was not statistically significant. Our treatment success rate after a mean of 1.1 treatment sessions was 53% (16 out of 34 eyes).&#x0D; Conclusions: Our study showed that MPCPC offers good IOP-lowering efficacy and patient tolerability in the treatment of refractory glaucoma. Larger, prospective, comparative studies are needed to determine a standardized MPCPC treatment protocol with high success and low complication rates.

Микроимпульсная циклофотокоагуляция в лечении рефрактерной глаукомы у детей

Микроимпульсная циклофотокоагуляция в лечении рефрактерной глаукомы у детей

Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study.

Cyclocryotherapy and transscleral cyclophotocoagulation are commonly used procedures for the treatment of refractory glaucoma, but still with many complications. Ultrasound cyclo plasty (UCP) is a novel technique that determines a selective and more precise coagulation necrosis of the ciliary body to reduce intraocular pressure (IOP), but its efficacy and safety have been less investigated in Chinese population. This study aimed to evaluate the clinical efficacy and safety of UCP in Chinese patients with refractory glaucoma. We designed a prospective, before-after study involving 36 eyes of 36 patients with refractory glaucoma that underwent uneventful UCP. Mean IOP, mean IOP reduction and subjective pain scale scores before and after UCP were compared to evaluate the efficacy of UCP in these patients. Procedural success defined as no abnormality of the treatment sites, and complications were recorded, along with confirmation of the safety of UCP. The 36 UCP patients had a mean IOP of 53.61 ± 12.4mmHg and a mean VAS score of 5.69 ± 3.02 preoperatively. Successful operation was achieved in 28 patients, with a success rate of 77.8%. In the follow-up observation at day 1, day 7, and month 1, 2, 3 and 6 postoperatively, both mean IOP and mean VAS score were significantly lower than those before operation (both P < 0.0001). The median baseline IOP reduction ranged from 22 to 36%. The mean reduction was 42.5% in 36 patients when taking IOP at the last follow-up visit as the last. No significant changes in visual acuity were achieved in 4 patients after UCP, and no adverse outcomes were present in other patients after timely treatment of complications such as conjunctival hyperemia, subconjunctival hemorrhage, or hyphema. UCP is a novel yet reliable option for Chinese patients with refractory glaucoma since its high efficacy and safety.

Comparison of ultrasound cycloplasty and transscleral cyclophotocoagulation for refractory glaucoma in Chinese population

BackgroundTo compare the efficacy and safety of focused ultrasound cycloplasty (UCP) and transscleral cyclophotocoagulation (TSCP) in the treatment of refractory glaucoma in a Chinese population.MethodsWe retrospectively compared twenty-eight eligible patients with refractory glaucoma, who were divided into the UCP group and TSCP group. Patients in these two groups underwent a corresponding procedure from June 2018 to February 2019. The intraocular pressure (IOP), visual acuity, the number of anti-glaucoma agents used and complications were reviewed and compared between groups. Proper statistical methods were selected according to comparison models under IBM SPSS 25 software.ResultsAfter the 12-months follow-up, postoperative IOP and number of anti-glaucoma agents used in the two groups were both reduced than the baseline level, and the differences were statistically significant (P < 0.05). There were no significant differences in IOP, number of anti-glaucoma agents and the best-corrected visual acuity between the two groups at each follow-up time point (P>0.05). In terms of complications, the pain at 1 day after surgery in the UCP group was significantly milder than that in the TSCP group (P < 0.05). And there were no significant differences in other complications between the two groups (P > 0.05).ConclusionsBoth UCP and TSCP are safe and effective methods for the treatment of refractory glaucoma. Nevertheless, pain is less severe after UCP.

Клиническая оценка результатов микроимпульсной лазерной циклофотокоагуляции в лечении рефрактерной глаукомы в первые сутки после операции

Клиническая оценка результатов микроимпульсной лазерной циклофотокоагуляции в лечении рефрактерной глаукомы в первые сутки после операции

Evaluation of ciliary body by ultrasound bio-microscopy after trans-scleral diode cyclo-photocoagulation in refractory glaucoma.

To evaluate the morphological changes of the ciliary body after diode laser trans-scleral cyclo-photocoagulation using ultrasound bio-microscopy in refractory glaucoma. This prospective, interventional, non-comparative, non-randomized, longitudinal study was performed on 40 eyes with refractory glaucoma, during the period between February 2016 and March 2018. All patients were treated with single session diode laser trans-scleral cyclo-photocoagulation. The intraocular pressure was obtained over a period of 3 months after the operation and morphological changes of the ciliary body were observed using ultrasound bio-microscopy. Trans-scleral cyclo-photocoagulation has achieved a reasonable success in reducing intraocular pressure to less than 22 mm Hg without increasing the number of glaucoma medication. The overall success rate was 40%, as the intraocular pressure decreased from a baseline mean value of 54.70 ± 12.27 to 42.45 ± 9.85 mm Hg 1 week after operation, 33.50 ± 8.00 mm Hg after 1 month, and 25.60 ± 6.62 after 3 months of operation. Ultrasound bio-microscopy detected reduction in the length and width of ciliary processes in addition to the ciliary muscle thickness of the treated quadrants. Intraocular pressure was more correlated to the width of the ciliary processes. Trans-scleral cyclo-photocoagulation is a rapid and effective procedure in treatment of refractory glaucoma with intraocular pressure reduction. Ultrasound bio-microscopy is a promising twin tool for cyclo-destructive procedures to detect ciliary body changes and can be used as a guide for re-treatment procedures.

Efficacy of transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma: a retrospective study

Efficacy of transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma: a retrospective study

Современный взгляд на циклодеструктивные операции при глаукоме

The main purpose of glaucoma treatment is to reduce the intraocular pressure (IOP) to a target level. One of the pathogenetically justified method of treatment for various types of glaucoma, first of all its refractory forms, is the surgery on the ciliary body. A purpose of such manipulations is to suppress excessive formation of aqueous humor. Previously, diode laser cyclophotocoagulation was widely used, which is mainly applied in terminal glaucoma. Technological innovations have led to the development of perspective, more safe, and less destructive methods of cyclodestructive anti-glaucomatous operations, such as micro-pulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation, and ultrasound cyclodestruction. During micro-pulse cyclophotocoagulation, the effect of laser energy occurs by short pulses at rest intervals, which significantly reduces the absorption of energy by surrounding tissues and their associated damage. With endoscopic cyclophotocoagulation, the epithelium of the ciliary processes is directly coagulated, which makes it possible to dose laser energy under visual control. Ultrasonic cyclodestruction causes a coagulation necrosis of the ciliary processes with a very insignificant collateral damage of surrounding tissues. Today these surgical techniques are becoming more relevant in the treatment of refractory glaucoma in order to preserve visual functions. This review is an analysis of modern literature, reflecting the efficacy and safety of cyclodestructive operations with sufficiently high visual functions.