Uncontrolled Primary Open-angle Glaucoma Research Articles

Effectiveness and safety of XEN63 in patients with primary-open-angle glaucoma

This paper evaluates the effectiveness and safety of XEN63 stent, either standalone or in combination with phacoemulsification, in patients with primary open-angle glaucoma (POAG). Eighty eyes from 80 patients with medically uncontrolled POAG were assigned to undergo XEN63 implant. The primary outcome was the surgical success, defined as an intraocular pressure (IOP) lowering from preoperative values ≥ 20% and an IOP absolute value between 6 and 18 mmHg, with or without antiglaucoma medications. Forty-three (53.7%) eyes underwent XEN63-standalone and 37(46.2%) eyes a XEN63 + Phacoemulsification procedure. Success rate was 68.8% (55/80) eyes in the overall study sample, 69.8% (30/43) eyes in the XEN63-standalone group; and 67.6% (25/37) eyes in the XEN63 + Phaco group (p = 0.6133). Preoperative IOP was significantly lowered from 22.1 ± 4.9 mmHg and 19.8 ± 3.7 mmHg to 14.7 ± 5.3 mmHg and 13.8 ± 3.4 mmHg in the XEN63-standalone and XEN63 + Phaco groups, respectively (p < 0.0001 each, respectively); without significant differences between them at any of the time-points measured. Preoperative number of ocular-hypotensive drugs was significantly reduced from 2.3 ± 0.8 to 0.3 ± 0.7 drugs, from 2.5 ± 0.7 to 0.3 ± 0.7 drugs; and from 2.0 ± 0.8 to 0.3 ± 0.7 drugs, in the overall, XEN63-standalone, and XEN63 + Phaco groups, respectively. Regarding safety, 3(42.5%) eyes had transient hypotony at some point during the study, although only in one (1.2%) eye was clinically significant. Four (5.0%) eyes underwent a needling, 4 (5.0%) eyes underwent surgical-bleb-revision, 1 (1.2%) eye required a device replacement and 1 (1.2%) eye a device removal due to maculopathy. XEN63, either alone or in combination with phacoemulsification, significantly lowered IOP and reduced the number of ocular hypotensive medications. The rate of ocular hypotony was relatively high, although it was clinically relevant only in one eye.

Safety and Efficacy of Hydrus and I-Stent inject combined with Phacoemulsification in Primary Open Angle Glaucoma Patients: 2 year follow up study

Aims: To compare the safety and efficacy of phacoemulsification combined with two individual kinds of trabecular bypass micro-stent device insertion. This study compares Phacoemulsification with Hydrus stent versus phacoemulsification combined with I-Stent inject W in patients with medically uncontrolled primary open-angle glaucoma (POAG). Material and Methods: A retrospective comparative case series. Results: Eighty eyes of 75 patients with 2 years completed follow-up after combined phacoemulsification with trabecular by-pass stent (s) were included. Forty eyes of 37 patients had Hydrus stent (Hydrus Group-PH) and the other 40 eyes of 38 patients had I-stent inject W (I-stent Group-Pi) insertion combined with phacoemulsification and intraocular lens implantation. Patient demographics and preoperative characteristics of the two groups studied are comparable. A post-operative decrease of 20 percentage or more in the IOP was achieved in 33 eyes (82.5%) in PH group and 30 eyes (75%) in Pi group (p=0.57). The Hydrus group (PH) had a post-operative reduction in the mean number of medications in 22 eyes (55%) in comparison to 18 eyes (45%) in the I-stent group (Pi). Second stage trabeculectomy was avoided in 31 eyes (77.5%) in the Hydrus group and 27 eyes (67.5%). There was no significant difference in rate of complications between two groups. Conclusion: Both Hydrus stent and I-stent inject W combined with phacoemulsification and intra-ocular lens implantation, are efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). The reduction in the mean IOP and in the mean number of post-operative glaucoma medications was higher for the patients in Hydrus stent group than in I-stent inject W group.

Postoperative RNFL-Changes after Successful Trabeculectomy: 2-Year Outcomes.

The most important tool in glaucoma therapy is to lower the intraocular pressure to slow down the apoptosis of retinal ganglion cells. Trabeculectomy (TE) is considered the gold standard in glaucoma surgery. The aim of this study was to analyse the postoperative changes in retinal nerve fibre layer (RNFL) using optical coherence tomography (OCT) after TE. We examined 40 patients naïve to prior glaucoma surgery retrospectively, who received a TE for medically uncontrolled primary open-angle glaucoma (POAG). Intraocular pressure (IOP), IOP-lowering medication, mean deviation of perimetry, visual acuity and peripapillary RNFL-thickness using OCT were evaluated during the first 24 month after TE. In total 40 eyes from 40 patients were treated with TE. Mean IOP decreased from 25.0 ± 0,9 to 13.9 ± 0.6 (p < 0.01), and the mean number of IOP-lowering eye drops from 3.3 ± 0.2 to 0.5 ± 0.2 (p < 0.01). Visual acuity and mean deviation in perimetry remained stable while mean global RNFL-thickness decreased from 67.8 ± 2.9 to 63.7 ± 2.9 (p < 0.01) and 63.4 ± 2.9 µm (p < 0.01) 12 and 24 months after TE. The TE is an effective method to reduce the IOD and the amount of IOP-lowering medication. Nevertheless, a significant further loss in RNFL thickness was observed in the first 12 months after TE. Thus, RNFL changes seem to stabilise only after a protracted period.

Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report

BackgroundChoroidal effusion is a common complication of glaucoma surgery. Although most cases of choroidal effusions resolve spontaneously with observation or medical management alone as intraocular pressure normalizes, surgical drainage might be needed in severe or persistent cases. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion after Ahmed glaucoma valve implantation.Case presentationAn 85-year-old man with uncontrolled primary open-angle glaucoma and medical history of chronic kidney disease underwent uneventful Ahmed glaucoma valve implantation. On postoperative day 8, transient hypotony occurred, and large 360° peripheral choroidal detachments developed. Although the intraocular pressure increased to normal levels on postoperative day 15, choroidal effusion did not resolve. Fundus examination over 8 months showed that the large choroidal effusion persisted despite a well-controlled intraocular pressure. Laboratory test performed at preoperatively and follow-up period revealed persistently elevated potassium and creatinine levels. On postoperative 9 months, the lesion resolved spontaneously without any surgical intervention. We found that the patient’s creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved.ConclusionsConsidering the underlying medical condition may be helpful in patients with persistent choroidal effusion of an unclear etiology following glaucoma filtering surgery.

Влияние пола пациентов на изменения глазной поверхности после синустрабекулэктомии

Background: the effect of gender on the rate and course of ocular surface diseases (in particular, conjunctival and corneal xerosis) is fairly well known. Meanwhile, gender-dependent changes in the ocular surface after trabeculectomy have not yet been studied. Aim: to analyze the effect of gender on changes in the ocular surface after trabeculectomy. Patients and Methods: this study enrolled 443 patients (168 men and 275 women) who underwent surgical interventions for uncontrolled primary open-angle glaucoma (POAG) in 2016–2020 and were followed up for 6–24 months. Trabeculectomy was performed as the first IOP- lowering procedure in 418 patients (150 men and 268 women) and reoperation in 25 patients (18 men and 7 women). Changes in subjective symptoms (OSDI) and clinical and functional signs of dry eye syndrome (tear film break-up time/TBUT and total tear production by Schirmer's I test) characterizing the ocular surface in various surgical outcomes (complete and partial success, failure) in men and women were analyzed. Results: women have more severe subjective symptoms but not functional signs of dry eye preoperatively. They are characterized by strict adherence to treatment (manifested in lower initial IOP compared with men) but more frequent eye drop instillations and greater cumulative preservative load on the ocular surface. Gender is not an independent risk factor for surgical failure. Successful trabeculectomy results in a significant reduction in the severity of conjunctival and corneal xerosis symptoms (OSDI) for at least 2 years in both genders. Despite clear postoperative improvement, women are significantly inferior to men in this parameter at all study control points. TBUT in both men and women increases significantly during the first 6 months postoperatively, and over the next 1.5 years TBUT stabilizes at the achieved level. An increase in Schirmer's I test results in men becomes significant only at the end of the second year of follow-up. In women, a significant increase in total tear production is reported as early as 6 months after trabeculectomy and changes slightly over the next 1.5 years. Restarting IOP-lowering medications in partial success and failure of trabeculectomy eliminates the improvement of ocular surface condition achieved during the drug-free period as early as after 6 months. Conclusions: regardless of gender, successful trabeculectomy results in a significant and long-term (at least 2 years) improvement of subjective symptoms (OSDI) and functional signs (in particular, TBUT) of conjunctival and corneal xerosis. Women are characterized by a clearer improvement in the parameters studied than men. Significant gender differences are found only when comparing subjective symptoms in the first year after surgery. Restarting IOP-lowering medications postoperatively brings the parameters back to baseline levels. KEYWORDS: gender, glaucoma, trabeculectomy, ocular surface, dry eye disease, OSDI, tear film break-up time, TBUT, Norn's test, Schirmer's I test. FOR CITATION: Antonova A.V., Nikolaenko V.P., Brzheskiy V.V., Vuks A.Ja. Effect of gender on the ocular surface after trabeculectomy. Russian Journal of Clinical Ophthalmology. 2023;23(3):136–145 (in Russ.). DOI: 10.32364/2311-7729-2023-23-3-5.

Posture-induced changes in intraocular pressure after ab externo XEN45 gel-stent implantation in patients with primary open-angle glaucoma

BackgroundTo investigate posture-induced changes in intraocular pressure (IOP) after ab externo XEN45 Gel-Stent implantation in patients with medically uncontrolled primary open-angle glaucoma (POAG).MethodsThis prospective study included thirty-two eyes with POAG that underwent XEN45 Gel-Stent implantation as a standalone procedure using an ab externo approach at Chonnam National University Hospital. IOP was measured sequentially in the sitting position, supine position, and lateral decubitus position (LDP) before and at 1, 2, 3, and 6 months after surgery using an iCare IC200 rebound tonometer. In the LDP, the eye with XEN45 Gel-Stent implantation was in the dependent position.ResultsIOP at each position was significantly reduced after XEN45 Gel-Stent implantation. Posture-induced changes in IOP were maintained during the follow-up. The range of postural IOP changes was reduced at 1 month; however, no significant change was observed after that point compared with baseline levels.ConclusionsA XEN45 Gel-Stent inserted using the ab externo approach can reduce IOP in various body positions, but seems to have limited effects on posture-induced changes in IOP in patients with POAG.

High-Frequency Deep Sclerotomy as Adjunctive Therapy in Open-Angle Glaucoma Patients

Introduction: Glaucoma is a chronic, progressive disease of the optic nerve that can cause vision loss and blindness. High-frequency deep sclerotomy (HFDS) is a novel ab interno procedure used to lower intraocular pressure (IOP). This study aims at examining hypotensive effects of HFDS in patients with medically uncontrolled primary open-angle glaucoma (POAG). Methods: 23 patients (23 eyes) participated in this study. They were all affected by POAG and used maximum prescribed medical therapy. It is important to note that the target IOP was not detected in any study participant. The target IOP is the highest IOP value at which no new damages of the optic nerve occur. The procedure was performed with a custom-made, high-frequency dissection probe by applying bipolar current of 500 kHz. Six pockets (1 mm deep, 0.3 mm high, and 6 mm wide) were made ab interno in nasal sclera (through trabecular meshwork and Schlemm’s canal). Tobramycin/dexamethasone and pilocarpine eye drops were administered postoperatively for a month. Results: The mean value of the base IOP had been 25.6 mm Hg before the procedure. Significant complications were not recorded either during the surgery or in a postoperative follow-up period. The average IOP for our patients reduced by 8.6 mm Hg (33.6%) after a year. The mean value of the instilled anti-glaucoma eye drops had been 2.78 (SD = 0.45) before the HFDS and 0.61 (SD = 1.04) at the end of the research. The target IOP was not achieved in five cases (21.7% of our sample). Discussion/Conclusion: This study presents the data on our first surgical experience with HFDS that was conducted on 23 patients who had medically uncontrolled POAG. The results indicate that HFDS is safe and efficient in reducing IOP.

Efficacy and Safety of Deep Sclerectomy With the Esnoper Clip Implant for Uncontrolled Primary Open Angle Glaucoma: A 1 Year Prospective Study.

Deep sclerectomy (DS) with the Esnoper Clip drainage implant in patients with uncontrolled primary open angle glaucoma (POAG) achieved a complete success rate of 87.2% at the 1-year follow-up. To investigate the efficacy and safety of DS followed by Esnoper Clip implantation in patients with uncontrolled POAG. In a prospective, consecutive, interventional study, we investigated 39 eyes of 35 patients with uncontrolled POAG who underwent DS with Esnoper Clip implantation. Complete ophthalmologic examinations including corrected visual acuity and intraocular pressure (IOP), were performed preoperatively, and at 1 day, at 1 week as well as at 1, 3, 6, 9, and 12 months postoperatively. Moreover, any goniopunctures and glaucoma medications required postoperatively were noted. The mean preoperative IOP was 20.8±5.2mmHg and it decreased to 13.9±3.1mmHg at 1 year postoperatively ( P <0.001). The number of glaucoma medications decreased from 2.9±0.7 preoperatively to 0.3±0.8 after 1 year ( P <0.001). The complete success rate (IOP≤21mmHg without glaucoma medication) and the qualified success rate (IOP ≤21mmHg with or without glaucoma medication) were 87.2% and 94.9%, respectively. Goniopuncture was performed in 33.3% of cases. No significant corrected visual acuity changes were registered at the final follow-up. Perioperative complications consisted of 3 micro-perforations of the trabeculo-descemet membrane. Postoperative complications included: hyphema (6 eyes), hypotony (6 eyes), shallow anterior chamber (3 eyes), choroidal detachment (4 eyes)-all of which were resolved without surgical intervention during the first postoperative month-and conjunctival dehiscence, which required resuture (2 eyes). Deep sclerectomy with the Esnoper Clip implant was safe and effectively lowered IOP in patients with uncontrolled POAG.

Two Year Functional and Structural Changes-A Comparison between Trabeculectomy and XEN Microstent Implantation Using Spectral Domain Optical Coherence Tomography.

The aim of this study was to analyze retinal nerve fiber layer (RNFL) thickness after trabeculectomy (TE) versus XEN microstent implantation (XEN) in primary open-angle glaucoma (POAG) cases naïve to prior incisional glaucoma surgery. We examined 119 consecutive glaucoma patients retrospectively, who received a TE or XEN for medically uncontrolled POAG. Intraocular pressure (IOP), amount of IOP-lowering medication, mean deviation of standard automated perimetry and peripapillary RNFL thickness were evaluated during the first 24 months after surgery. Fifty eyes were treated with TE and 69 eyes with XEN. Mean IOP decreased from 25.1 ± 0.8 to 13.3 ± 0.6 mm Hg (p < 0.01) and mean number of IOP-lowering eye drops from 3.2 ± 0.2 to 0.4 ± 0.1 (p < 0.01) 24 months after TE. In 69 eyes undergoing XEN, mean IOP dropped from 24.8 ± 0.6 to 15.0 ± 0.4 mm Hg (p < 0.01) and medication from 3.0 ± 0.1 to 0.6 ± 0.1 (p < 0.01) during the 24 months follow-up. Mean deviation of standard automated perimetry remained stable in TE (8.5 ± 0.7 to 8.1 ± 0.8 dB; p = 0.54) and XEN group (11,0 ± 0.5 to 11.5 ± 0.5 dB; p = 0.12) after 24 months, while mean RNFL thickness further deteriorated in the TE (−2.28 ± 0.65 µm/year) and XEN (−0.68 ± 0.34 µm/year) group. Postoperative RNFL loss develops after TE and XEN despite effective and significant lowering of IOP and amount of IOP-lowering medication. RNFL loss was more pronounced in the first year after glaucoma surgery.

Efficacy of 2% Pilocarpine on Intraocular Pressure (IOP) Lowering Effect in Uncontrolled Primary Open Angle Glaucoma (POAG) Patients with Maximal Medication

Objective: To evaluate the additive intraocular pressure (IOP) lowering effect of 2% pilocarpine eye drops in medically uncontrollable primary open angle glaucoma (POAG) patients. Materials and Methods: The present study was a retrospective study on POAG patients whose IOP were unable to be controlled with topical hypotensive agents who refused glaucoma surgery. Pilocarpine eye drops (2%) was considered as an additive treatment option. The main measurement was IOP at baseline and after adding pilocarpine eye drops (2%) at 1-, 3- and 6-months. Statistical analysis was described in terms of mean ± standard deviation (SD). Comparisons of numerical variables were done using paired t-test. A p-values of less than 0.05 was considered statistically significant. Results: Thirty-one eyes in 19 patients with open angle glaucoma were enrolled. The mean age of the patients was 62 years. Thirteen patients were male. The mean number of baseline medications was 4.0±0.3. IOP was reduced from 25.0±2.1 mmHg at baseline to 19.0±1.98 mmHg after one month, to 19.0±1.86 mmHg after three months, and to 19.0±1.73 mmHg after six months, which was statistically significant (p&lt;0.001). Conclusion: Pilocarpine eye drops (2%), when used additional with others topical hypotensive agents, was effective for IOP lowering. Patients in the present study reported reduced IOP. The efficacy of pilocarpine eye drops (2%) made it a viable treatment option, particularly for the uncontrollable open angle glaucoma patient who refused glaucoma surgery. Keywords: Pilocarpine eye drops (2%); Intraocular pressure (IOP); Medically uncontrollable; POAG

Preliminary efficacy of ab interno canaloplasty combined with micro-incision cataract surgery in primary open angle glaucoma combined with cataract: one-year results

Objective: To evaluate the preliminary efficacy and safety of ab interno canaloplasty (ABiC) combined with micro-incision cataract surgery for treating primary open angle glaucoma (POAG) combined with cataract. Methods: Prospective case series study. Patients diagnosed with POAG and concurrent cataract were enrolled to receive ABiC combined with micro-incision phacoemulsification and intraocular lens implantation in the Eye Center of the Second Affiliated Hospital of Zhejiang University School of Medicine from June 2018 to October 2019. Intraocular pressure (IOP), use of hypotensive medications, visual acuity, visual field, and optic nerve at baseline as well as at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively were assessed. Subgroup analyses were further performed to evaluate these data between controlled and uncontrolled POAG, as well as among mild, moderate, and advanced POAG. Success rate and complications were analyzed. Results: A total of 68 eyes in 42 patients completed a follow-up of 12 months. Compared to the baseline IOP under medical control [(18.25±2.65) mmHg (1 mmHg=0.133 kPa)], the mean postoperative IOP at 1 month [(14.31±3.25) mmHg], 3 months [(14.00±3.09) mmHg], 6 months[ (14.58±2.93) mmHg], and 12 months[ (14.84±2.73) mmHg] was all significantly reduced (P<0.05). The median (upper quadrant, lower quadrant) of the hypotensive medication number was 2.5 (2, 3) at baseline, which was significantly reduced to 0 (0, 1) at 1 month, and 0 (0, 0) at 3, 6, and 12 months (P<0.05). The complete success rate and qualified success rate at 12 months were 80.88%(55/68) and 89.71%(61/68), respectively. No deterioration in the visual field or optical coherence tomography scan of the optic nerve was observed at 12 months compared to the baseline status. Hyphema (26 eyes, 38.24%) and transient IOP spike (23 eyes, 33.82%) were the most common complications, but no severe case was present. Conclusion: ABiC combined with micro-incision cataract surgery is considerably effective and safe in the treatment of POAG combined with cataract in the Chinese population.

A New and Easier Approach to Preserflo MicroShunt Implantation.

PRESERFLO™ MicroShunt is a new minimally invasive glaucoma surgical (MIGS) device, implanted with an ab externo approach, which drains the aqueous humor to the subconjunctival space. It has been designed as a safer and less invasive approach for treating medically uncontrolled primary open-angle glaucoma (POAG) patients. The classic way of MicroShunt implantation involves different key steps, which includes creating a small scleral pocket with a 1mm blade; passing a 25-gauge (25G) needle through the scleral pocket into the anterior chamber (AC); and subsequently flushing the stent with a 23-gauge (23G) thin-wall cannula. However, sliding the needle into the scleral pocket can create false passages, thus making the device’s threading more difficult. The purpose of the current paper is to propose a simplified implantation approach. Our method proposes to make the scleral tunnel by using directly the 25G needle and, at the limbus, this 25G needle is used to slightly depress the sclera and enter into the AC. The MicroShunt is subsequently assembled on a 23G cannula mounted on a 1mL syringe. The syringe can then be used to flush the device. Outflow can thus be confirmed immediately by seeing drops of aqueous humor leaking from the external opening of the stent. This new approach may have different potential advantages, such as better control of the site of entry, avoids wrong passages, reduces or eliminates the risk of aqueous humor sideway flow, facilitates a parallel path to the iris plane, and it is faster.

Long-term results of micropulse laser trabeculoplasty with 577-nm yellow wavelength in patients with uncontrolled primary open-angle glaucoma and pseudoexfoliation glaucoma.

Our aim was to evaluate the long-term results of micropulse laser trabeculoplasty (MLT) with 577-nm yellow wavelength in the treatment of glaucoma. We reviewed the medical records of 51 patients (51 eyes) with uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma who underwent 180° MLT for the first time. The success of MLT was defined as an IOP reduction of ≥ 20% and IOP < 21mmHg after treatment. If the number of medications was increased or further laser trabeculoplasty or glaucoma surgery was required after treatment, the case was considered unsuccessful. The mean duration of patient follow-up was 18.39 ± 12.17months (range 3-52months). Patients included in the study used 2-4 types of antiglaucoma eye drops (mean 3.43 ± 0.7). The mean number of MLT spots was 65.54 ± 6.19, and the mean energy level was 750.98 ± 101.73mJ. The decrease in intraocular pressure compared to baseline measurements was: 16.72 ± 11.87%, 15.07 ± 13.76%, 12.63 ± 14.29%, 16.66 ± 19.32%, and 16.75 ± 19.78% during follow-up at 3, 6, 12, 24, and 36-48months. Successful response was achieved in 35.41%, 36.95%, 34.21%, 40%, 41.17%, and 42.85% of patients during 3, 6, 12, 18, 24, and 36-48months of follow-ups, respectively. Of the 51 eyes studied, 12 patients (23.5%) underwent post-MLT glaucoma surgery, and 7 patients (13.7%) had cataract surgery, whose follow-up data were subsequently censored. The reduction of intraocular pressure showed a significant correlation with baseline intraocular pressure, while age and laser power showed no correlation (p > 0.05). MLT is a novel treatment option for patients with glaucoma with favorable long-term outcomes and a good safety profile.

Bleb Analysis Using Anterior Segment Optical Coherence Tomography and Surgical Predictors of XEN Gel Stent.

PurposeTo determine the early predictors of surgical success 6 months after XEN surgery among clinical parameters, including anterior segment optical coherence tomography (AS-OCT).MethodsA total of 31 eyes with medically uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma was enrolled retrospectively. Using AS-OCT, XEN tip location was categorized into intraconjunctival, intratenon, or uviform at day 1 and blebs were classified into no or low, high sparse, high thick, cystic, or mixed walls at month 6. Using slit-lamp photography, blebs were classified into no or low, localized avascular, diffuse avascular, localized vascular, or diffuse vascular blebs at month 6. Surgical success was defined as an intraocular pressure (IOP) of less than 14 mm Hg.ResultsIntraconjunctival and intratenon locations of the tip mostly created a high sparse wall, whereas the uviform type mostly created no or low wall and no or low bleb. The uviform type was linked to pseudoexfoliation glaucoma. A high sparse wall and diffuse avascular bleb showed a lower mean IOP than a high thick wall and localized vascular bleb. In the multivariate analysis, female sex and IOP at week 1 were early predictors of surgical success (8.45 times and 33.1% per 1 mm Hg-decrease, respectively).ConclusionsBleb evaluation using AS-OCT is valuable to correlate tip location and bleb morphology with clinical profiles, considering that a lower early postoperative IOP is linked to surgical success.Translational RelevanceBleb analysis using AS-OCT on day 1 could help to predict bleb morphology after 6 months, which is important to maintain the functioning bleb in the longer term.

Retinal Pigment Epithelium Tear after Glaucoma Surgery

Retinal pigment tear (RPE) is a very rare complication of glaucoma filtering surgeries. The right eye of a 65-year-old woman underwent an Ex-Press shunt implantation to treat uncontrolled primary open-angle glaucoma. On day 3, the intraocular pressure (IOP) was 5 mmHg with an over-filtering bleb. Wide-field fundus color and autofluorescence images showed peripheral choroidal detachment, RPE detachment (arrow), RPE tear, and macula-off exudative retinal detachment (Fig A-B). Additional sutures were placed on the scleral flap to achieve an increase in IOP.

Clinical outcomes of viscocanalostomy and phacoviscocanalostomy in primary open angle glaucoma: Two years follow-up.

To compare the outcomes of phacoviscocanalostomy and viscocanalostomy in patients with primary open angle glaucoma. This non randomized, prospective comparative study included 168 eyes of 168 patients with primary open angle glaucoma (POAG). Phacoviscocanalostomy was performed in 94 eyes with POAG and cataract and viscocanalostomy was performed in 74 eyes with POAG. Preoperative and postoperative intraocular pressures (IOP), number of antiglaucoma medication, intraoperative and postoperative complications were recorded throughout the follow-up period. The mean follow-up after surgery was 20.13 ± 7.9 months. Mean IOP decreased significantly 1 month after surgery in both groups (p < 0.001) and remained significantly lower from its preoperative value at all follow-up visits. The postoperative mean IOP at the last follow up in phacoviscocanalostomy and viscocanalostomy was 14.98 ± 4.8 mmHg and 16.84 ± 5.0 mmHg, respectively (p = 0.001). Complete success rate in phacoviscocanalostomy and viscocanalostomy groups was 83.1% and 56.8%, respectively (p = 0.008). Qualified success rate was achieved in 89.4% eyes in the phacoviscocanalostomy group and 83.8% of viscocanalostomy group (p = 0.534). The Best corrected visual acuity (BCVA) in phacoviscocanalostomy group improved significantly post-operatively (p = 0.001). Postoperative antiglaucoma medication in both groups were significantly less than the preoperative values (p = 0.001). Both Phacoviscocanalostomy and viscocanalostmy are effective procedures in the control of IOP in patients with POAG with and without cataract. Higher complete success rates and BCVA were achieved in phacoviscocanalostomy. Therefore, phacoviscocanalostomy and viscocanalostomy are recommended in eyes with medically uncontrolled primary open-angle glaucoma with and without coexisting cataract.

Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma

To compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.

Mid-term results of patterned laser trabeculoplasty for uncontrolled ocular hypertension and primary open angle glaucoma.

To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population. A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values. From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%). Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.

Posture-induced Changes in Intraocular Pressure After Trabeculectomy in Patients With Primary Open-angle Glaucoma.

Trabeculectomy can effectively reduce posture-induced changes in intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). The purpose of this study was to investigate posture-induced changes in IOP after trabeculectomy in patients with medically uncontrolled POAG. This was a prospective, consecutive study. Thirty-seven eyes of 37 patients with POAG were included. IOP was measured before trabeculectomy and 1, 2, 3, and 6 months postoperatively with patients in the sitting position, supine position, and lateral decubitus position (LDP) sequentially using iCare IC200 rebound tonometry. In the LDP, the eye scheduled for trabeculectomy was in the dependent position, the contralateral unoperated eye was a control eye. The central corneal thickness, axial length, and anterior chamber depth were measured using partial coherence interferometry. In the sitting, supine, and LDP, the IOP was significantly reduced at every time point during the follow-up. Although the posture-induced changes in IOP persisted during the follow-up, the range of IOP changes in the sitting and supine positions, sitting and LDP, and the supine and LDP were significantly reduced after than before trabeculectomy. The central corneal thickness did not change significantly after trabeculectomy. Trabeculectomy can effectively reduce posture-induced changes in IOP in patients with POAG.

Changes of Neuroretinal Rim and Retinal Nerve Fiber Layer Thickness Assessed by Optical Coherence Tomography After Filtration Surgery in Glaucomatous Eyes.

PurposeLowering the intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) with filtration surgery can induce morphological changes to the bulbus and structures of the retina. In this study, we have evaluated changes of Bruch’s membrane-based parameters and retinal nerve fiber layer (RNFL) derived by spectral-domain optical coherence tomography (SD-OCT) in eyes that have undergone glaucoma filtration surgery.Patients and MethodsSD-OCT imaging of the optic nerve head (ONH) and of the RNFL was performed in 54 eyes of 54 patients with medically uncontrolled POAG before and after IOP-lowering surgery (trabeculectomy or deep sclerectomy). The ONH parameter minimum rim width (MRW) and the size of the Bruch’s membrane opening (BMO-Area) were derived from 24 radial B-scans centered on the ONH.ResultsThe average preoperative IOP was 23.1 ± 7.5 mmHg. One month postoperatively, the average IOP decreased to 12.1 ± 4.6 mmHg (p < 0.01), which caused a significant increase in the thickness of neuroretinal rim. There was no significant change in the automatically detected BMO-Area (p = 0.32). The pressure-related increase in MRW correlated well with the postoperative IOP and cup-to-disc ratio (CDR). In regression analysis, the alteration in thickness of the neuroretinal rim could be well predicted in a model including CDR, change of IOP and mean deviation (MD) (R2 = 0.414, p < 0.001). RNFL showed a significant increase as well.ConclusionIOP-lowering surgery in patients with medically uncontrolled POAG causes an increased thickness of the SD-OCT derived ONH parameters. The changes of the RNFL after surgery showed no significant correlations with IOP changes. In contrast to this, highly significant correlations of MRW values with the IOP could be observed. The BMO-Area remained completely stable A preferred use of RNFL for follow-up should be discussed.