Uncontrolled Open-angle Glaucoma Research Articles

Hematoma endocapsular: complicación inusual tras facoemulsificación y esclerectomía profunda no perforante

Case reportA 68-year-old male with a cataract and uncontrolled primary open angle glaucoma with maximal tolerated medication underwent non-penetrating deep sclerectomy combined with phacoemulsification surgery in right eye. There were no complications during the procedure, but shortly after the surgery, he lost visual acuity after a Valsalva manoeuvre due to an endocapsular haematoma. Neodymium:YAG laser posterior capsulotomy was performed for the treatment of an unresolving endocapsular haemorrhage at the third month of the follow-up, with immediate visual improvement and optimal control of intraocular pressure. DiscussionTo the best of our knowledge, this is the first reported case of endocapsular haematoma as a complication of non-penetrating glaucoma surgery that has been successfully solved by a YAG capsulotomy.

Combined Technique for the Application of Micropulse Cyclophotocoagulation in Patients with Uncontrolled Glaucoma: Cyclo Mix.

PurposeTo describe the outcomes of a combined technique (Cyclo Mix) in uncontrolled glaucoma cases.Materials and methodsRetrospective study. The Supra 810 nm subliminal laser (Quantel Medical, Cournon d'Auvergne, France) was used. A combined technique was performed using the subliminal mode (Subcyclo) in one hemifield (power of 2,000 mW, a duty cycle of 35%, and 80–150 seconds), and the continuous wave mode (Thermo Cyclo) on the other hemifield (power of 1,000 mW, exposure time of 2 seconds per spot). The primary endpoint was the probability of surgical failure. Mean intraocular pressure (IOP) change, best-corrected visual acuity (BCVA), number of glaucoma eye drops, and complications at 6 months postoperatively were secondary outcomes.ResultsTwenty-three eyes from 13 patients were included. Mean age was 61.4 ± 16.7 (range: 18–78 years), and 69% were female, with a baseline IOP of 20.3 ± 5.9 (range: 13–38 mm Hg). The cumulative probability of failure was 18 and 22% on days 90 and 180, respectively. Mean IOP reduction was −25.6 ± 20.9% at 6 months. The number of glaucoma eye drops was reduced to 1.2 ± 1 (p = 0.0024) at 6 months. No statistically significant change in the mean BCVA compared with baseline at 6 months was found (p = 0.84), and no severe complications were reported.ConclusionCyclo Mix seems to be a safe therapy that effectively reduces the IOP and glaucoma medications in eyes with uncontrolled open-angle glaucoma for up to 6 months.How to cite this articleWaldo L-G, Julio H-Q, Jennifer C-V, et al. Combined Technique for the Application of Micropulse Cyclophotocoagulation in Patients with Uncontrolled Glaucoma: Cyclo Mix. J Curr Glaucoma Pract 2020;14(3):93–97.

The Effect of High-Intensity Focused Ultrasound on Aqueous Humor Dynamics in Patients with Glaucoma

To investigate the effects of high-intensity focused ultrasound (HiFU) on aqueous humor dynamics in patients with glaucoma. Comparative, nonrandomized, interventional study. Adult patients with a diagnosis of open-angle glaucoma or ocular hypertension with suboptimal intraocular pressure (IOP) control despite maximum medical treatment who required further IOP optimization. All patients underwent comprehensive ophthalmic examination before aqueous humor dynamics study measurements, including fluorophotometry and digital Schiøtz tonography. All patients received 6 seconds of HiFU therapy. Aqueous humor dynamics studies were repeated 3 months after the treatment (patients had 4-week washout from their glaucoma medication before their aqueous humor dynamics study measurements at baseline and the 3-month visit). Intraocular pressure, facility of topographic outflow, aqueous flow rate, and uveoscleral outflow. Thirty eyes of 30 patients were included in the study. At the 3-month postoperative visit, the mean postwashout IOP was reduced by 16% (31.7±5.3 vs. 26.6±4.8 mmHg, P= 0.004), and aqueous flow rate was decreased by 15% (2.07±0.73 vs. 1.77±0.55 μl/min, P= 0.05) from baseline. Neither the tonographic outflow facility nor the uveoscleral outflow was significantly different from baseline. There is a 20% risk of treatment failure (those who needed further glaucoma surgical intervention) within 1 month after a single HiFU treatment (n= 6). Only 25 patients (80%) were able to undergo post-treatment washout measurements, and in these eyes, only 26.6% of eyes achieved >20% IOP reduction at 3 months compared with baseline. We investigated the aqueous humor dynamics effects of a cyclodestructive procedure and specifically HiFU in patients with uncontrolled open-angle glaucoma on maximum tolerated medical therapy. High-intensity focused ultrasound reduced IOP 3 months postoperatively by 16% and aqueous flow decreased by 15% without any significant effect on tonographic outflow facility and uveoscleral outflow.

A First-in-Human Study of the Efficacy and Safety of MINIject in Patients with Medically Uncontrolled Open-Angle Glaucoma (STAR-I)

To describe the safety and efficacy of a novel, supraciliary, microinvasive glaucoma surgery drainage system, MINIject (iSTAR Medical, Wavre, Belgium), in the study. Prospective, multicenter, interventional, single-arm trial. Twenty-six patients with primary open-angle glaucoma uncontrolled with 1 or more intraocular pressure (IOP)-lowering medications. Using an ab interno approach, 25 eyes were implanted successfully in a stand-alone procedure with a 5-mm long device made of biocompatible STAR material, which is soft and flexible silicone in a microporous, network design. Intraocular pressure, medication use, and other ocular parameters were evaluated before surgery, 1 day, 1 and 2 weeks, and 1, 3, and 6 months after surgery. Intraocular pressure reduction at 6 months compared with baseline analyzed using a paired t test. Safety evaluation entailed tabulation of the nature and frequency of adverse events. Mean baseline diurnal IOP was 23.2 mmHg (standard error, 0.6 mmHg) using a mean ± standard deviation of 2.0±1.1 IOP-lowering medication classes. During the 6-month follow-up period, mean IOP ranged from 10.0-16.3 mmHg (mean reductions, 6.9-13.2 mmHg or 31.0%-56.8%). Six months after surgery, mean diurnal IOP was 14.2 mmHg (standard error, 0.9 mmHg), equivalent to a reduction of 9.0 mmHg or 39.1% (P < 0.0001). The mean ± standard deviation number of IOP-lowering medications was 0.3±0.7. Of 24 patients seen at 6-month follow-up, 21 (87.5%) were medication-free and 23 (95.8%) achieved a minimum 20% IOP reduction from baseline. There were no serious adverse events related to the device or procedure, and no additional glaucoma surgery was required. Frequently reported events included anterior chamber inflammation (n= 8), IOP elevation (n= 6), of which 1 event was an IOP spike per protocol, visual acuity reduction (n= 3), and hyphema (n= 3), all of which resolved. There was no change to mean central or peripheral corneal endothelial cell density. No device-related adverse events were reported. The MINIject glaucoma drainage system significantly lowered IOP and eliminated the need for medication in most patients 6 months after surgery when implanted in a standalone procedure. There were no serious ocular adverse events.

Ologen Implant Application in Subscleral Trabeculectomy versus Non-Penetrating Deep Sclerectomy in Management of Primary Open Angle Glaucoma: A Prospective Randomized Study

Background: trabeculectomy and deep sclerectomy (DS) aim to lower intraocular pressure (IOP) in cases of medically uncontrolled primary open angle glaucoma (POAG). The application of Ologen implant is thought to increase the success rate of both procedures. Objective: to compare the application of Ologen implant in trabeculectomy versus deep sclerectomy in patients with uncontrolled POAG. Patients and Methods: this was a follow-up randomized clinical comparative trial included 30 eyes of 26 patients with uncontrolled POAG. They were randomly assigned to two equal groups (n=15 eyes): group (A) underwent trabeculectomy and group (B) underwent deep sclerectomy. Both procedures were augmented with Ologen implant. All patients were subjected to full history taking and complete ophthalmologic examination. Postoperatively, patients were followed up at 6 months. Outcome and complications were assessed. Results: both groups experienced significant reduction in IOP after 6 months postoperative; preoperative and postoperative values were 22.8±3.73 mmHg and 11.07±2.63 mmHg, respectively in group (A) and 20.13±2.26 mmHg and 13.53±2.61 mmHg, respectively in group B, P≤ 0.01. The complete success was 93.0% in group (A) and 80.0% in group (B), (P= 0.475). Group (A) had significantly higher frequency of postoperative complications compared to group B (P≤ 0.01). Conclusion: the application of Ologen implant in both trabeculectomy and deep sclerectomy is effective for IOP reduction and it resulted in better operative success in patients with POAG. Also, deep sclerectomy using Ologen implant is a good and safe alternative to trabeculectomy in patients with POAG, but our obtained results need to be supported by subsequent studies.

Ologen Implant Application in Subscleral Trabeculectomy versus Non-Penetrating Deep Sclerectomy in Management of Primary Open Angle Glaucoma: A Prospective Randomized Study

Background: trabeculectomy and deep sclerectomy (DS) aim to lower intraocular pressure (IOP) in cases of medically uncontrolled primary open angle glaucoma (POAG). The application of Ologen implant is thought to increase the success rate of both procedures. Objective: to compare the application of Ologen implant in trabeculectomy versus deep sclerectomy in patients with uncontrolled POAG. Patients and Methods: this was a follow-up randomized clinical comparative trial included 30 eyes of 26 patients with uncontrolled POAG. They were randomly assigned to two equal groups (n=15 eyes): group (A) underwent trabeculectomy and group (B) underwent deep sclerectomy. Both procedures were augmented with Ologen implant. All patients were subjected to full history taking and complete ophthalmologic examination. Postoperatively, patients were followed up at 6 months. Outcome and complications were assessed. Results: both groups experienced significant reduction in IOP after 6 months postoperative; preoperative and postoperative values were 22.8±3.73 mmHg and 11.07±2.63 mmHg, respectively in group (A) and 20.13±2.26 mmHg and 13.53±2.61 mmHg, respectively in group B, P≤ 0.01. The complete success was 93.0% in group (A) and 80.0% in group (B), (P= 0.475). Group (A) had significantly higher frequency of postoperative complications compared to group B (P≤ 0.01). Conclusion: the application of Ologen implant in both trabeculectomy and deep sclerectomy is effective for IOP reduction and it resulted in better operative success in patients with POAG. Also, deep sclerectomy using Ologen implant is a good and safe alternative to trabeculectomy in patients with POAG, but our obtained results need to be supported by subsequent studies.

Modified viscocanalostomy in the Chinese population with open angle glaucoma: a 10-year follow-up results.

To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma (OAG). This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal (SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure (IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete (qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without (with or without) anti-glaucoma medications. The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg (mean IOP reduction of 51%) at 5y after surgery, and 15.6±2.8 mm Hg (mean IOP reduction of 49.9%) at 10y after surgery (P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5y and 0.67±0.8 at 10y postoperatively (P<0.001). The follow-up period was 104.5±37.0mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval (CI): 0.80-0.88], 73% (95%CI: 0.68-0.78), and 59% (95%CI: 0.52-0.66) after 5y, and 80% (95%CI: 0.76-0.84), 69% (95%CI: 0.64-0.74), 51% (95%CI: 0.44-0.58) after 10y, respectively. There was a relationship between age, preoperative IOP and success rate (P<0.01, P<0.05). A total of 31 eyes (31.3%) in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg (P<0.01). Neither blebitis nor endophthalmitis occurred. Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10y in Chinese individuals with OAG.

Subconjunctival draining minimally-invasive glaucoma devices for medically uncontrolled glaucoma.

Glaucoma is a leading cause of irreversible blindness. Subconjunctival draining minimally-invasive glaucoma devices such as the Xen gelatin implant and InnFocus stent have been introduced as a treatment to prevent glaucoma progressing.These implants provide a channel to allow aqueous humour from the anterior chamber of the eye to drain into the subconjunctival space on the surface of the eye thus reducing intraocular pressure (IOP) and mimicking the mechanism of the most commonly undertaken glaucoma surgery, trabeculectomy. To evaluate the efficacy and safety of subconjunctival draining minimally-invasive glaucoma devices in treating people with open angle glaucoma and ocular hypertension whose condition is inadequately controlled with drops. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; which contains the Cochrane Eyes and Vision Trials Register; 2018, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 10 July 2018. We searched for randomised controlled trials (RCTs) of Xen gelatin implant or InnFocus MicroShunt to other surgical treatments (other minimally-invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. We also planned to include trials where these devices were combined with phacoemulsification compared to phacoemulsification alone. We planned to have two review authors independently extract data from reports of included studies using a data collection form and analyse data based on methods expected by Cochrane. Our primary outcome was mean change in IOP. Secondary outcomes included proportion of participants who were drop-free; proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less or 14 mmHg or less; and proportion of participants experiencing intra- and postoperative complications. We planned to measure all outcomes in the short-term (six to 18 months), medium-term (18 to 36 months), and long-term (36 months onwards). We found no completed RCTs that met our inclusion criteria. We found one ongoing study (NCT01881425). The study compares InnFocus MicroShunt to trabeculectomy in people with primary open angle glaucoma. The primary outcome is greater than 20% IOP reduction from baseline to 12 months' follow-up. A total of 889 people aged between 40 and 85 years have been enrolled. The estimated study completion date is November 2019. There is currently no high-quality evidence for the effects of subconjunctival draining minimally-invasive glaucoma devices for medically uncontrolled open angle glaucoma. Properly designed RCTs are needed to assess the medium- and long-term efficacy and safety of this technique.

Prospective pilot study comparing deep sclerectomy outcomes with a long-term and intense corticosteroid treatment versus a standard one

ObjectiveTo compare prospectively intraocular pressure (IOP) results after deep sclerectomy (DS) using a topical short-term corticosteroid treatment (STCT, 1 month) versus a topical long-term and intense corticosteroid treatment (LTCT, 6...

Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Glaucoma Patients Treated Previously with 360° Selective Laser Trabeculoplasty: A Randomized, Single-Blind, Equivalence Clinical Trial

The effectiveness of selective laser trabeculoplasty (SLT) was compared with argon laser trabeculoplasty (ALT) in a randomized clinical trial for patients with medically uncontrolled open-angle glaucoma who have previously received 360° SLT. An active equivalence parallel armed randomized control trial. Patients with open-angle glaucoma including pigmentary dispersion syndrome and pseudoexfoliation syndrome were enrolled into the study from 7 different sites across Canada. One setting of 180° of either SLT or ALT was assigned randomly and applied to each participant. The change in intraocular pressure (IOP) from baseline to 12 months was compared between the 2 groups. A total of 132 patients were recruited, 2 of which dropped out early in the study, leaving 130 patients who completed the study as per protocol. For those, the study's primary outcome was calculated. The IOP change at 1 year in comparison to baseline for SLT vs. ALT was found to be different by 0.33 mmHg between the 2 groups (3.16 for SLT and 2.83 for ALT) and was not statistically significant (P= 0.71) Further analysis, though, showed that SLT had a significantly lower IOP reduction at early time points: 1 week and 1 month, but this effect was lost by 3 months. Corresponding to this finding was the strong trend for ALT to fail more quickly than SLT. Although repeatable, the first repeat SLT reduced IOP to only about half compared with initial SLT treatment. The comparison at 12 months following the laser therapy showed that both modalities lowered the IOP with approximately 3 mmHg, yet essentially all of the time-to-failure analyses favored SLT over ALT. The repeat SLT effect was found to be half of the initial treatment.

360-degree suture trabeculotomy ab interno to treat open-angle glaucoma: 2-year outcomes.

PurposeThe purpose of this study was to evaluate the efficacy of 360-degree suture trabeculotomy (360S-LOT) ab interno for treating open-angle glaucoma (OAG). Risk factors of surgical failure were examined.Patients and methods360S-LOT ab interno alone was performed for patients with uncontrolled OAG, and combined 360S-LOT ab interno/phacoemulsification was performed for patients with controlled OAG with a visually significant cataract between March 2014 and September 2015 at a single center. The patients were prospectively followed for 2 years. The main outcome measures included 2-year intraocular pressure (IOP), number of anti-glaucoma medications used, postoperative complications, and predictive factors of surgical failure. Kaplan–Meier analysis was performed, with surgical success (with or without medication use) defined as postoperative IOP ≤15 mmHg and IOP reduction ≥20% (criterion A) or IOP ≤12 mmHg and IOP reduction ≥30% (criterion B). Predictive factors were evaluated using Cox proportional hazard ratios.ResultsA total of 64 eyes of 64 patients were included, and 50 (78%) eyes of 64 eyes underwent a phacoemulsification combination procedure. Surgery significantly reduced IOP from 18.4 ± 2.9 mmHg before surgery to 13.4 ± 3.0 mmHg after surgery (P < 0.001). Patients used an average of 1.8 ± 1.5 medications before surgery and 1.3 ± 1.5 medications after surgery (P = 0.101). No serious postoperative complications were observed. The probability of surgical success was 49.2% and 16.0% using criteria A and B, respectively. No risk factors of surgical failure were identified.ConclusionThe 360S-LOT ab interno procedure is a favorable option for treating eyes with mild or moderate OAG.

Micropulse laser trabeculoplasty for uncontrolled open angle glaucoma in Peruvian patients

ABSTRACT Objective: We describe the pressure lowering effect of micropulse laser trabeculoplasty (MLT) in patients with uncontrolled open angle glaucoma (OAG). Design: Retrospective case series. Methods: We retrospective reviewed 30 eyes with Open angle Glaucoma (OAG) at the Vista Clinic in Lima, Peru. A single session of MLT treatment was delivered using a 532 nm Frequency doubled Nd. YAG laser to 360o of the trabecular meshwork with a power of 1000 mW, 25 % of duty cycle, and 300 ms. of exposure. The intraocular pressure (IOP) was measured at baseline and at 1 day, 1 week, 3, 6 months post-treatment and were followed up for one last control. Results: The mean baseline IOP was 15.6 mmHg and in the last control was12.8 mmHg, mean follow up time of 19 months (+/- 10 SD). The mean reduction of IOP in the first day was 1.6 mmHg (± 2.6 SD) and 1.2 mmHg (± 3.3 SD) in the last follow up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction greater than 20%. No statistical difference in relation to demographics characteristics of the patients. The greatest reduction was achieved in the first day with a median of 2.00 (P 0.001). A tendency to achieve higher reduction of IOP in patients with higher baseline IOP was found, but was not statistical significant. No adverse reactions occurred. Conclusions: Micropulse laser trabeculoplasty can temporarily be effective in reducing the IOP in some patients with uncontrolled Open angle glaucoma and appears to be safe.

Micropulse Trabeculoplasty in Open Angle Glaucoma.

Background:We report the effect of micropulse laser trabeculoplasty (MLT) in the intraocular pressure (IOP) of patients with uncontrolled open-angle glaucoma (OAG).Materials and Methods:In this retrospective review, 30 eyes with OAG were treated with a single session of MLT at the Vista Clinic in Lima Perú. We used a 532 nm frequency doubled Nd: YAG laser to 360° of the trabecular meshwork with a power of 1000 mW, 15% of the duty cycle, and 300 ms of exposure. The IOP was measured at baseline and at 1 day, 1 week, 3 months, and 6 months post-treatment and were followed up for one last control.Results:The mean baseline IOP was 15.6 mmHg and in the last control was 12.8 mmHg, mean follow-up time of 19 months (±10 standard deviation [SD]). The mean reduction of IOP in the 1st day was 1.6 mmHg (±2.6 SD) and 1.2 mmHg (±3.3 SD) in the last follow-up. The mean percentage of IOP reduction was 17.9% and 7 eyes (40%) had IOP reduction >20%. No statistical significant difference in relation to demographic characteristics of the patients. The greatest reduction was achieved in the 1st day with a median of 2.00 (P < 0.001). A tendency to achieve a higher reduction of IOP in patients with higher baseline IOP was found but was not statistically significant. No adverse reactions occurred.Conclusions:MLT slightly reduced the IOP in a few patients with uncontrolled OAG for a very short time and may not be suitable for these patients.

The influence of selective laser trabeculoplasty on the success of trabeculectomy.

PURPOSE:The purpose of this to investigate whether selective laser trabeculoplasty (SLT) has any effect on the success of trabeculectomy.PATIENTS AND METHODS:Thirteen-one eyes of 29 primary open-angle glaucoma patients who underwent SLT before trabeculectomy and 29 eyes of 27 patients with the same inclusion criteria which underwent trabeculectomy without prior SLT in the Sifa University and in the Batigöz Eye Hospital in January 2012 and November 2012 were reviewed. All patients underwent trabeculectomy for uncontrolled open-angle glaucoma with the same technique. The results were evaluated 3, 6, 12, 18, and 24 months later after surgery. The statistical analysis was performed with the Mann–Whitney U-test. Fisher's Exact Chi-square test was used to compare the continuous and categorical variables.RESULTS:The mean intraocular pressure (IOP) before surgery was 24.1 ± 1.9 in the SLT-performed group and 26.7 ± 1.6 in the non-SLT-performed group. Twenty-four months later, the mean IOP was 15.1 ± 1.2 in the SLT-performed group and 15.4 ± 1.4 in the non-SLT performed group. There was no difference in the IOP drop after trabeculectomy between the two groups (P = 0.531).CONCLUSIONS:SLT has no influence on trabeculectomy success.

Two-year Results After Deep Sclerectomy With Nonabsorbable Uveoscleral Implant (Esnoper-Clip): Surgical Area Analysis Using Anterior Segment Optical Coherence Tomography.

To report 2-year results of deep sclerectomy (DS) with mitomycin C and the uveoscleral implant Esnoper-Clip (AJL Ophthalmics, Álava, Spain), a nonabsorbable hema implant, and the morphologic analysis of the surgical area with anterior segment optical coherence tomography (AS-OCT). In total, 41 eyes of 41 patients with medically uncontrolled open angle glaucoma who underwent DS with the uveoscleral implant were included in this prospective interventional study. Patients were recruited and selected sequentially. All patients were followed at least for 12 months and 36 of them for 24 months. Absolute success was defined as intraocular pressure (IOP)≤18 mm Hg and ≥20% of IOP reduction without topical medication. Relative success was defined with the same criteria but with the addition of any antihypertensive medication. Primary outcomes were IOP decrease in the postoperative stage. Secondary outcomes were number of medication, best-corrected visual acuity changes, rate of goniopuncture, needle revision, and AS-OCT analysis of the bleb area. AS-OCT analysis, using Visante OCT, was performed at 1, 12, and 24 months. Absolute success rate was 68.3% at 12 months and 61.1% at 2 years. Relative success was 78.0% and 71.4%, at 12 and 24 months, respectively. A significant IOP decrease was observed, from 27.3±6.3 to 14.9±4.4 mm Hg at 12 months and 15.3±5.2 mm Hg at 24 months (P<0.001). There was also a significant reduction in the number of medications, dropping from a mean of 2.5 to 0.28 one year and 0.36 two years after the surgery (P<0.001). Main postoperative complications were transient: 4 eyes with seidel phenomenon at 24 hours (10.3%), 3 hyphema (7.7%), and 1 choroidal detachment (2.6%). Mean intrascleral space height, measured by AS-OCT, was 0.78 mm and it showed a significant positive correlation with IOP at 12 months. Neodymium-doped yttrium aluminium garnet laser goniopuncture was performed in 25 eyes (61%) at 12 months and in 27 (66.8%) by 24 months. DS with the uveoscleral implant is a safe and effective procedure to lower IOP in open angle glaucoma patients. IOP reduction is maintained over 2 years and is correlated to the postoperative height of the intrascleral bleb. Supraciliary implantation reduces intrascleral lake dependency, being a simultaneous drainage alternative to the subconjunctival pathway.

STARflo-a suprachoroidal drainage implant in glaucoma surgery

The STARflo Glaucoma Device (iSTAR Medical, Wavre, Belgium) offers anew approach to bleb-free filtering surgery in which the intraocular pressure (IOP) is lowered by supporting outflow of the aqueous humor into the suprachoroidal space. On the basis of acase series of 9patients with open-angle glaucoma (OAG) unmanageable by drug-based treatment, intra- and postoperative experiences with the implant are presented. The implant, the implantation procedure, and the first results 6months postoperatively are described. No intraoperative complications were observed. Postoperative complications such as increased astigmatism or ocular hypotony were rare and transient. After 6months there was an IOP reduction from 29.1 mm Hg± 6.1 mm Hg with 2.7± 1.1 local IOP-lowering medications to 16.1± 4.1 mm Hg (IOP reduction of 44.7%) with additional 2.0± 0.8 local IOP-lowering medications. The new STARflo Glaucoma Device shows promising results in reducing the IOP of medically uncontrolled OAG. Further investigations concerning the long-time efficacy of the implant and additional IOP-lowering medication are still ongoing.

Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens.

The purpose of the study was to investigate results of selective laser trabeculoplasty (SLT) performed directly on the sclera without a gonioscopy lens. Interventional case series, prospective, randomized, masked, controlled clinical trial. Setting: Meir Medical Center, Kfar-Saba, Israel. Adults with uncontrolled primary open angle or pseudoexfoliation glaucoma randomized into 2 groups. The controls underwent conventional SLT with 100 spots delivered using a gonioscopy lens for 360 degrees of the trabecular meshwork. The study group underwent irradiation using the same parameters with the laser applications administered on the perilimbal sclera. Study visits: 1 hour, 1, 7, 30, 60, 180, and 365 days postprocedure. Intraocular pressure (IOP) and side effects. Thirty adults were randomized into 2 groups. The mean (±SD) pretreatment IOP was 20.21±3.19 mm Hg for the study group (n=14) and 21.14±2.98 mm Hg for the controls (n=14; P =0.43), dropping to 15.50±3.77 and 15.00±4.08 mm Hg (P =0.74) after 6 months and to 16.00±3.31 and 14.00±2.45 mm Hg (P =0.22) after 12 months. The average IOP reduction after 6 and 12 months was 23.4% and 20.83% for the study group and 27.1% and 33.77% for the controls (P=0.528). Success (a decrease of ≥15% at 6 months with no additional medications, laser, or glaucoma surgery) was achieved in 12 (85.7%) study patients and 9 (69.2%) controls (P=0.385). Complications were mild and transient (n=30), although significantly higher in the controls (n=15; P <0.0001). SLT applied directly to the perilimbal sclera may be as efficacious as the conventional procedure for 1 year.

Canaloplasty versus Viscocanalostomy in Primary Open Angle Glaucoma.

IntroductionThe purpose of this study was to compare the efficacy and safety of canaloplasty versus viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication.MethodsCanaloplasty surgery was applied for thirty eyes of thirty patients (45–55 years) with a mean age of 48 years (Group A) and viscocanalostomy surgery was applied also for thirty eyes of thirty patients (43–54 years) with a mean age of 46 years (group B). All patients were with uncontrolled primary open angle glaucoma by maximally tolerated medical therapy.ResultsIntraocular pressure (IOP) in both surgeries was significantly reduced through follow up period (p < 0.0.001). Complete success was 86.6% in group A and 80% in group B. Visual field deterioration was in 2 cases (6%) in group A and in 4 cases (13%) in group B. Low incidence of postoperative complications was reported as Descemet’s membrane detachment (3% in group A and 8% in group B), ocular hypotony (2% in group A and 4% in group B) and hyphema (3% in group A and 5% in group B).ConclusionCanaloplasty was more effective and safer than viscocanalostomy in management of uncontrolled primary open angle glaucoma (POAG) with medication.

Micropulse laser trabeculoplasty as an adjuvant treatment for uncontrolled open angle glaucoma

Micropulse laser trabeculoplasty as an adjuvant treatment for uncontrolled open angle glaucoma

The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma

The Effectiveness of Selective Laser Trabeculoplasty in Patients with Medically Uncontrolled Open-angle Glaucoma