Change in visual acuity 12 and 24 months after transscleral ab interno glaucoma gel stent implantation with adjunctive Mitomycin C

Abstract Purpose To determine the impact of failed ab-interno trabeculectomy on the postoperative outcome of subsequent XEN45 gel stent (Allergan, CA, USA) implantation in pseudophakic eyes. Methods In this retrospective single-center study, we included 60 pseudophakic eyes from 60 participants who underwent XEN45 gel stent implantation. Thirty eyes each underwent primary stent implantation (control group) or had previously undergone a failed ab-interno trabeculectomy (trabectome group). The groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum Intraocular pressure (IOP), preoperative medication score, cup/disk-ratio, follow-up time, best-corrected visual acuity at baseline, age, and the proportion of patients classified as primary open angle glaucoma or exfoliation glaucoma. We defined a successful surgery by the following three scores: an IOP reduction > 20% and IOP at the longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). One open conjunctival revision was allowed in all scores, and a repeat surgery was considered a failure. Results Following an average follow-up period of 22 ± 12 months, we observed a mean IOP reduction of 38%, from 23.5 ± 5.2–14.5 ± 5.0 mmHg. Comparative analyses between the groups did not reveal a significant difference in the postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate, or success rate. Conclusions Trabectome is a viable first-line procedure for medically uncontrolled glaucoma before filtering ab-interno microstent surgery is considered.

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Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma

Ophthalmology ◽

10.1016/s0161-6420(99)00725-3 ◽

1999 ◽

Vol 106 (7) ◽

pp. 1357-1362 ◽

Cited By ~ 10

Author(s):

Luciano Quaranta ◽

Roger A. Hitchings ◽

Carlo A. Quaranta

Keyword(s):

Mitomycin C ◽

Open Angle Glaucoma ◽

Open Angle ◽

Ab Interno

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Corneal Higher-Order Aberrations after Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade: Preliminary Early 3-Month Results

Journal of Clinical Medicine ◽

10.3390/jcm10184115 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4115

Author(s):

Hiromitsu Onoe ◽

Kazuyuki Hirooka ◽

Hideaki Okumichi ◽

Yumiko Murakami ◽

Yoshiaki Kiuchi

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Retrospective Study ◽

Cataract Surgery ◽

Higher Order ◽

Higher Order Aberrations ◽

Postoperative Changes ◽

The Mean ◽

Kahook Dual Blade ◽

Ab Interno

We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that underwent cataract surgery alone used as controls. Visual acuity and corneal HOAs, coma-like aberrations, and spherical-like aberrations were analyzed before and at 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence HOAs were evaluated. No significant postoperative changes were noted for corneal HOAs, coma-like aberrations, and spherical-like aberrations after cataract surgery alone. The mean corneal HOAs, coma-like aberrations, and spherical-like aberrations were 0.222 ± 0.115 μm, 0.203 ± 0.113 μm, and 0.084 ± 0.043 μm at baseline and 0.326 ± 0.195 μm (p < 0.001), 0.302 ± 0.289 μm (p = 0.03), and 0.150 ± 0.115 μm (p < 0.001) at 3 months after LOT-Phaco, respectively. Results of the analysis for risk factors suggested that a longer incision in Schlemm’s canal could influence corneal HOAs, coma-like aberrations, and spherical-like aberrations after LOT-Phaco. Although no significant postoperative changes were observed in corneal HOAs and coma-like or spherical-like aberrations after cataract surgery alone, a significant increase in corneal HOAs and coma-like or spherical-like aberrations remained after the LOT-Phaco procedure.

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Ab Interno Collagen Stent implantation as a treatment option for open angle glaucoma

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2016.0519 ◽

2016 ◽

Vol 94 ◽

Author(s):

S. Crisóstomo ◽

J. Cardigos ◽

L.M. Costa ◽

A.L. Basílio ◽

R. Anjos ◽

...

Keyword(s):

Treatment Option ◽

Stent Implantation ◽

Open Angle Glaucoma ◽

Open Angle ◽

Ab Interno

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Change in visual acuity and associated risk factors after trabeculectomy with adjunctive mitomycin C

Acta Ophthalmologica ◽

10.1111/aos.13058 ◽

2016 ◽

Vol 94 (7) ◽

pp. e561-e570 ◽

Cited By ~ 12

Author(s):

Kenji Kashiwagi ◽

Satoshi Kogure ◽

Fumihiko Mabuchi ◽

Tatsuya Chiba ◽

Tetsuya Yamamoto ◽

...

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Mitomycin C ◽

Associated Risk Factors

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Exact Matching of Trabectome-Mediated Ab Interno Trabeculectomy to Conventional Trabeculectomy with Mitomycin C Followed for Two Years

10.1101/2020.10.27.20165944 ◽

2020 ◽

Author(s):

A. Strzalkowska ◽

P. Strzalkowski ◽

Y. Al Yousef ◽

F. Grehn ◽

J. Hillenkamp ◽

...

Keyword(s):

Mitomycin C ◽

Nearest Neighbor ◽

Controlled Trial ◽

Exact Matching ◽

Surgical Interventions ◽

Similar Patient ◽

Nearest Neighbor Matching ◽

Ab Interno Trabeculectomy ◽

Primary Glaucoma ◽

Ab Interno

AbstractPurposeWe used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB).Methods5485 patients who underwent AIT were exact-matched to 196 TRAB patients by baseline intraocular pressure (IOP), number of glaucoma medications, and glaucoma type. Nearest-neighbor-matching was applied to age. Success was defined as a final IOP of less than 21 mmHg, IOP reduction of at least 20% reduction from baseline, and no secondary surgical interventions. Outcomes were measured at 1, 3, 6, 12, 18, and 24 months.Results165 AIT could be matched to 165 TRAB. The mean baseline IOP was 22.3±5.6 mmHg, and the baseline number of glaucoma medications was 2.7±1.1 in both groups. At 24 months, IOP was reduced to 15.8±5.2 mmHg in AIT and 12.4±4.7 mmHg in TRAB. IOP was lower than baseline at all visits (p<0.01) and lower in TRAB than AIT (p<0.01). Glaucoma medications were reduced to 2.1 ± 1.3 in AIT and 0.2 ± 0.8 in TRAB. Compared to baseline, patients used fewer drops postoperatively (p<0.01) and more infrequently in TRAB than in AIT (p>0.01). Secondary surgical interventions had the highest impact on success and became necessary in 15 AIT and 59 TRAB patients. Thirty-two challenging events occurred in TRAB and none in AIT.ConclusionBoth AIT and TRAB reduced IOP and medications. This reduction was more significant in TRAB but at the expense of four times as many secondary interventions.Key messagesDespite vastly different IOP reduction and safety profile, ab interno trabeculectomy with the Trabectome and trabeculectomy with mitomycin C are both used as primary glaucoma surgeries. Exact matching allowed us to strictly focus on identical IOP and medications to create highly similar patient pairs for a balanced comparison that cannot be accomplished short of a randomized controlled trial. We found that trabeculectomy could achieve low IOPs and independence from drops, but trabeculectomies often required postoperative interventions. Trabectome patients had a lesser reduction of IOP and drops but needed far fewer interventions.

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Efficacy and safety of single-step transepithelial photorefractive keratectomy with the all-surface laser ablation SCHWIND platform without mitomycin-C for high myopia: A retrospective study of 69 eyes

PLoS ONE ◽

10.1371/journal.pone.0259993 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0259993

Author(s):

Jean Baptiste Giral ◽

Florian Bloch ◽

Maxime Sot ◽

Yinka Zevering ◽

Arpine El Nar ◽

...

Keyword(s):

Visual Acuity ◽

Laser Ablation ◽

Mitomycin C ◽

High Myopia ◽

Photorefractive Keratectomy ◽

Efficacy Rate ◽

Care Hospital ◽

Case Series Study ◽

Surface Laser ◽

Rate Frequency

Background Studies suggest that transepithelial photorefractive keratectomy (TransPRK) with the all-surface laser ablation (ASLA)-SCHWIND platform is effective and safe for both low-moderate myopia and high myopia. In most studies, mitomycin-C is administered immediately after surgery to prevent corneal opacification (haze), which is a significant complication of photorefractive keratectomy in general. However, there is evidence that adjuvant mitomycin-C induces endothelial cytotoxicity. Moreover, a recent study showed that omitting adjuvant mitomycin-C did not increase haze in low-moderate myopia. The present case-series study examined the efficacy, safety, and haze rates of eyes with high myopia that underwent ASLA-SCHWIND TransPRK without adjuvant mitomycin-C. Methods All consecutive eyes with high myopia (≤-6 D) that were treated in 2018–2020 with the SCHWIND Amaris 500E® TransPRK excimer laser without adjuvant mitomycin-C in a tertiary-care hospital (France) and were followed up for 6 months were identified. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and spherical equivalent (SE) were recorded before and after surgery. Postoperative haze was graded using the 4-grade Fantes scale. Efficacy rate (frequency of eyes with 6-month UCVA ≤0.1 logMAR), safety rate (frequency of eyes that lost <2 BSCVA lines), predictability (frequency of eyes with 6-month SE equal to target SE±0.5 D), efficacy index (mean UCVA at 6 months/preoperative BSCVA), and safety index (BSCVA at 6 months/preoperative BSCVA) were computed. Results Sixty-nine eyes (38 patients) were included. Mean preoperative and 6-month SE were -7.44 and -0.05 D, respectively. Mean 6-month UCVA and BSCVA were 0.00 and -0.02 logMAR, respectively. Efficacy rate and index were 95.7% and 1.08, respectively. Safety rate and index were 95.7% and 1.13, respectively. Predictability was 85.5%. Grade 3–4 haze never arose. At 6 months, the haze rate was zero. Conclusions ASLA-SCHWIND TransPRK without mitomycin-C appears to be safe as well as effective and accurate for high myopia.

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Reduction in Ocular Hypotensive Eyedrops by Ab Interno Trabeculotomy Improves Not Only Ocular Surface Condition But Also Quality of Vision

Journal of Ophthalmology ◽

10.1155/2018/8165476 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Kenji Kashiwagi ◽

Mio Matsubara

Keyword(s):

Visual Acuity ◽

Ocular Surface ◽

Surface Condition ◽

Tear Film ◽

Film Stability ◽

Corneal Epithelial ◽

Surface Conditions ◽

Trabectome Surgery ◽

Before And After ◽

Ab Interno

Purpose. To investigate the effect of ab interno trabeculotomy using the Trabectome surgical system on tear film stability and functional visual acuity (FVA). Patients and Methods. Adult glaucoma patients who underwent Trabectome surgery alone or Trabectome surgery combined with phacoemulsification with intraocular lens insertion were included in this study. Corneal epithelial defects, tear film breakup time (TBUT), tear meniscus height, tear film spreading grade, tear interferometry grade, and FVA were assessed before and after surgery in addition to routine ophthalmic examinations. Changes in ocular surface conditions and visual acuity as a result of the Trabectome surgery were investigated. Results. Thirty eyes of 22 patients with a mean age of 72.2 ± 7.9 years, including 8 males and 14 females, were enrolled. The Trabectome surgery significantly reduced the intraocular pressure (IOP) from 20.3 ± 5.2 to 15.0 ± 3.3 mmHg (P<0.001) and the number of different types of ocular hypotensive eyedrops used from 3.2 ± 0.7 to 1.1 ± 0.7 types (P<0.001). The surgery significantly improved corneal epithelial defects, the tear spreading grade, the tear interferometry grade, and FVA. The surgery also improved the visual maintenance ratio among all enrolled patients, including those who underwent Trabectome surgery only. Conclusion. Trabectome surgery may be beneficial not only for IOP reduction but also for improving ocular surface conditions and FVA.

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Combined AB Externo and AB Interno Revision of Failed Filtering Blebs with Adjunctive Mitomycin C

European Journal of Ophthalmology ◽

10.5301/ejo.5000349 ◽

2014 ◽

Vol 24 (2) ◽

pp. 196-201

Author(s):

Leopoldo Magacho ◽

Rajesh K. Shetty

Keyword(s):

Mitomycin C ◽

Ab Interno

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Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent

Journal of Clinical Medicine ◽

10.3390/jcm10102129 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2129

Author(s):

Yuji Takayanagi ◽

Sho Ichioka ◽

Akiko Ishida ◽

Aika Tsutsui ◽

Masaki Tanito

Keyword(s):

Visual Acuity ◽

Cataract Surgery ◽

Corneal Endothelial Cell ◽

Efficacy And Safety ◽

Fellow Eye ◽

Corrected Visual Acuity ◽

Corneal Endothelial Cell Density ◽

Anterior Chamber Flare ◽

Best Corrected Visual Acuity ◽

Ab Interno

The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.

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