Neuroprotective Therapies for Patients With Worsening Glaucoma Despite Adequate Intraocular Pressure Lowering—Short-term Neurorecovery, Long-term Neuroprotection?

2021 ◽  
Author(s):  
Pradeep Y. Ramulu
Keyword(s):  
Intraocular Pressure ◽  
Short Term ◽  
Pressure Lowering ◽  
Neuroprotective Therapies

Conjunctival bleb compression sutures: An effective method of addressing hypotony after trabeculectomy or trabeculectomy-related procedures

2018 ◽  
Vol 28 (6) ◽  
pp. 731-734 ◽  
Author(s):  
Jonathan TS Yu ◽  
Karl Mercieca ◽  
Leon Au
Keyword(s):  
Intraocular Pressure ◽  
Topical Therapy ◽  
Case Series ◽  
Pressure Control ◽  
Posterior Flap ◽  
Anterior Flap ◽  
Pressure Lowering ◽  
Flow Through

Purpose: Over-filtration is a well-known complication of trabeculectomy and related procedures, especially with adjunctive antimetabolites. Secondary hypotony can result in reduced visual acuity and compromise long-term surgical success. Persistent hypotony requires intervention and we describe an effective adaptation of placing conjunctival compression sutures directly over the scleral flap. Methods: A retrospective consecutive case series of all patients who underwent conjunctival compression suturing from 2012 to 2014 at Manchester Royal Eye Hospital, UK. Under sub-tenon’s anaesthesia, two 9/0 nylon figure-of-eight transconjunctival sutures were placed horizontally across the bleb: the first over the anterior flap/ostium and the second over the posterior flap edge to reduce flow through the trabeculectomy flap. Results: A total of 10 patients underwent conjunctival compression suturing, and all patients had successful reversal of hypotony and symptom resolution within 1 week with corresponding clinical improvement. Intraocular pressure control was maintained without topical pressure-lowering agents in seven patients (median = 10 mmHg, range = 7–12 mmHg) with a median follow-up of 35.9 months (range = 11–61 months). Two patients required topical therapy to maintain intraocular pressure ≤ 14 mmHg and one patient’s hypotony returned after 10 months but remained untreated due to pre-existing poor vision. No patients required a return to theatre. Conclusion: This series demonstrates that conjunctival compression sutures can successfully provide long-term control of trabeculectomy-bleb-related hypotony. This technique offers an effective alternative for glaucoma surgeons in addressing post-trabeculectomy hypotony.

Does the intraocular pressure-lowering effect of prostaglandin analogues continue over the long term?

2016 ◽  
Vol 37 (3) ◽  
pp. 619-626 ◽  
Author(s):  
Caner KARA ◽  
Emine Malkoç ŞEN ◽  
Kadriye Ufuk ELGİN ◽  
Kurtuluş SERDAR ◽  
Pelin YILMAZBAŞ
Keyword(s):  
Intraocular Pressure ◽  
Prostaglandin Analogues ◽  
Lowering Effect ◽  
Pressure Lowering

scholarly journals Short-Term Changes in the Photopic Negative Response Following Intraocular Pressure Lowering in Glaucoma

2020 ◽  
Vol 61 (10) ◽  
pp. 16
Author(s):  
Jessica Tang ◽  
Flora Hui ◽  
Xavier Hadoux ◽  
Bernardo Soares ◽  
Michael Jamieson ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Negative Response ◽  
Photopic Negative Response ◽  
Short Term ◽  
Pressure Lowering

scholarly journals Canaloplasty in Pigmentary Glaucoma: Long-Term Outcomes and Proposal of a New Hypothesis on Its Intraocular Pressure Lowering Mechanism

2020 ◽  
Vol 9 (12) ◽  
pp. 4024
Author(s):  
Paolo Brusini ◽  
Veronica Papa
Keyword(s):  
Intraocular Pressure ◽  
Trabecular Meshwork ◽  
Long Term Results ◽  
Pigmentary Glaucoma ◽  
Long Term Outcomes ◽  
Pressure Lowering ◽  
Visual Field Damage ◽  
The Mean ◽  
New Hypothesis

This study presents the long-term results on canaloplasty in a group of patients affected by pigmentary glaucoma, and studies the progression of the disease after surgery. Material and methods: Twenty-nine eyes of 25 patients with pigmentary glaucoma in maximum tolerated medical therapy with significant visual field damage progression underwent canaloplasty and were followed up to 11 years (mean 59.8 ± 30.1 months). All patients underwent a complete ophthalmic examination every 6 months. Results: The pre-operative mean intraocular pressure (IOP) was 31.8 mmHg ± 10.9 (range 21–70) with an average of 3.3 medications. After 1, 2, 3, and 4 years, the mean IOP was 15.9 ± 4.0, 14.4 ± 7.3, 14.1 ± 2.1, and 15.7 mmHg, respectively, with 0.4, 0.5, and 0.7 medications, respectively. Four patients underwent trabeculectomy after 3 to 30 months due to uncontrolled IOP. Gonioscopy showed a significant reduction of pigment in trabecular meshwork in all cases, starting from the sixth month. In some cases, the pigment was almost completely reabsorbed after two years, suggesting an accelerated transit and escape of the granules through the trabecular spaces. Conclusions: Canaloplasty seems to be a reasonable option in treating patients affected by progressive pigmentary glaucoma. The reabsorption of pigment granules from the trabecular meshwork could, at least in part, explain the relatively high success rate observed after this surgical procedure.

Long-term efficacy and safety of bimatoprost for intraocular pressure lowering in glaucoma and ocular hypertension: year 4

2008 ◽  
Vol 92 (10) ◽  
pp. 1387-1392 ◽  
Author(s):  
R D Williams ◽  
J S Cohen ◽  
R L Gross ◽  
C-c Liu ◽  
E Safyan ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ocular Hypertension ◽  
Efficacy And Safety ◽  
Term Efficacy ◽  
Pressure Lowering

scholarly journals A novel suprachoroidal microinvasive glaucoma implant: in vivo biocompatibility and biointegration

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Ian Grierson ◽  
Don Minckler ◽  
Marian K. Rippy ◽  
Andrew J. Marshall ◽  
Nathalie Collignon ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Time Course ◽  
Structural Changes ◽  
Ocular Tissues ◽  
Tissue Integration ◽  
Drainage Channels ◽  
Pressure Lowering ◽  
Over Time

Abstract Background A major challenge for any glaucoma implant is their ability to provide long-term intraocular pressure lowering efficacy. The formation of a low-permeability fibrous capsule around the device often leads to obstructed drainage channels, which may impair the drainage function of devices. These foreign body-related limitations point to the need to develop biologically inert biomaterials to improve performance in reaching long-term intraocular pressure reduction. The aim of this study was to evaluate in vivo (in rabbits) the ocular biocompatibility and tissue integration of a novel suprachoroidal microinvasive glaucoma implant, MINIject™ (iSTAR Medical, Wavre, Belgium). Results In two rabbit studies, no biocompatibility issue was induced by the suprachoroidal, ab-externo implantation of the MINIject™ device. Clinical evaluation throughout the 6 post-operative months between the sham and test groups were similar, suggesting most reactions were related to the ab-externo surgical technique used for rabbits, rather than the implant material itself. Histological analysis of ocular tissues at post-operative months 1, 3 and 6 revealed that the implant was well-tolerated and induced only minimal fibroplasia and thus minimal encapsulation around the implant. The microporous structure of the device became rapidly colonized by cells, mostly by macrophages through cell migration, which do not, by their nature, impede the flow of aqueous humor through the device. Time-course analysis showed that once established, pore colonization was stable over time. No fibrosis nor dense connective tissue development were observed within any implant at any time point. The presence of pore colonization may be the process by which encapsulation around the implant is minimized, thus preserving the permeability of the surrounding tissues. No degradation nor structural changes of the implant occurred during the course of both studies. Conclusions The novel MINIject™ microinvasive glaucoma implant was well-tolerated in ocular tissues of rabbits, with observance of biointegration, and no biocompatibility issues. Minimal fibrous encapsulation and stable cellular pore colonization provided evidence of preserved drainage properties over time, suggesting that the implant may produce a long-term ability to enhance aqueous outflow.

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