scholarly journals Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

2020 ◽  
Vol 258 (12) ◽  
pp. 2775-2780 ◽  
Author(s):  
Yousef Al Yousef ◽  
Alicja Strzalkowska ◽  
Jost Hillenkamp ◽  
André Rosentreter ◽  
Nils A. Loewen
Keyword(s):  
Intraocular Pressure ◽  
Second Generation ◽  
Nearest Neighbor ◽  
Exact Matching ◽  
Close Match ◽  
Istent Inject ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
Ab Interno

Abstract Purpose To achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject) with ab interno trabeculectomy (T, Trabectome) by exact matching. Methods Fifty-three IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline intraocular pressure (IOP), the number of glaucoma medications, and glaucoma type, and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. Results A total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3 ± 5.1 mmHg and glaucoma medications of 2.7 ± 1.2 in each. IOP in IS2 was reduced to 14.6 ± 4.2 mmHg at 3 months and in T to a minimum of 13.1 ± 3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8 ± 9.0 mmHg and in T 14.2 ± 3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p < 0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0 ± 1.5 in IS2 and to 1.5 ± 1.4 in T. Conclusion T resulted in a larger and sustained IOP reduction compared with IS2 where a rebound occurred after 6 months to slightly above preoperative values.

scholarly journals Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

2020 ◽  
Author(s):  
Yousef Al Yousef ◽  
Alicja Strzalkowska ◽  
Jost Hillenkamp ◽  
André Rosentreter ◽  
Nils A. Loewen
Keyword(s):  
Time Course ◽  
Second Generation ◽  
Nearest Neighbor ◽  
Exact Matching ◽  
Close Match ◽  
Istent Inject ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
Ab Interno

AbstractPurposeTo achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject)with ab interno trabeculectomy (T, Trabectome) by exact matching. In a similar study, IS1 (1st generation iStent) had shown a loss of effect at 6 months.Methods53 IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline IOP, the number of glaucoma medications, and glaucoma type and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification.ResultsA total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3±5.1 mmHg and glaucoma medications of 2.7±1.2 in each. IOP in IS2 was reduced to 14.6±4.2 mmHg at 3 months and in T to a minimum of 13.1±3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8±9.0 mmHg and in T 14.2±3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p<0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0±1.5 in IS2 and to 1.5±1.4 in T.ConclusionT resulted in a larger and sustained IOP reduction compared to IS2 where a rebound occurred after six months to slightly above preoperative values. This time course fits bioreactivity data of the IS1.

scholarly journals Two-Year Data Comparison of Ab Interno Trabeculectomy and Trabecular Bypass Stenting Using Exact Matching

2018 ◽  
Author(s):  
Hamed Esfandiari ◽  
Kenneth Taubenslag ◽  
Priyal Shah ◽  
Swati Goyal ◽  
Adam J. Weiner ◽  
...  
Keyword(s):  
Nearest Neighbor ◽  
Primary Outcome Measure ◽  
Exact Matching ◽  
Close Match ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
The Mean ◽  
Ab Interno

Purpose: To create a highly balanced comparison of ab interno trabeculectomy (Trabectome, AIT) and trabecular bypass stenting (iStent, TBS).Setting: Eye and Ear Institute, Pittsburgh, Ross Eye Institute, Buffalo, and Glaucoma Associates of Texas, Dallas, USA.Design: Retrospective Exact Matching analysis.Methods: AIT and TBS patients were included from three large glaucoma practices. The primary outcome measure was the unmedicated IOP &le; 21 mmHg at 2-year follow-up visit. A secondary measure was unmedicated IOP reduction &ge; 20% at 2 years. Patients were matched by baseline IOP, the number of glaucoma medications and glaucoma type using Exact Matching and by age using Nearest Neighbor matching. Patients without a close match were excluded. All surgeries were combined with phacoemulsification. Results: 154 AIT and 110 TBS eyes were analyzed. 48 AIT patients were exactly matched to 48 TBS patients. Both groups had a baseline IOP of 15.3&plusmn;3.1 mmHg. At 24 months, the mean IOP was 13.9&plusmn;3.3 for AIT versus 16.8&plusmn;2.8 mmHg for TBS (p=0.04), while the number of medications was 0.7&plusmn;1.0 for AIT versus 1.7&plusmn;1.2 for TBS (p=0.04). The proportion of subjects achieving IOP &le; 21 mmHg without medications at 24 months was 53% in AIT versus 16.6% in TBS (P &lt; 0.05). At 24-month follow up 17.6% of patients in AIT had &ge; 20% IOP reduction without medication versus no patient in TBS. Conclusions: An Exact Matching comparison of AIT and TBS demonstrated greater IOP reduction with fewer medications in AIT.

scholarly journals Two-Year Data Comparison of Ab Interno Trabeculectomy and Trabecular Bypass Stenting Using Exact Matching

2018 ◽  
Author(s):  
Hamed Esfandiari ◽  
Kenneth Taubenslag ◽  
Priyal Shah ◽  
Swati Goyal ◽  
Adam J. Weiner ◽  
...  
Keyword(s):  
Nearest Neighbor ◽  
Primary Outcome Measure ◽  
Exact Matching ◽  
Close Match ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
The Mean ◽  
Ab Interno

Purpose: To create a highly balanced comparison of ab interno trabeculectomy (Trabectome, AIT) and trabecular bypass stenting (iStent, TBS).Setting: Eye and Ear Institute, Pittsburgh, Ross Eye Institute, Buffalo, and Glaucoma Associates of Texas, Dallas, USA.Design: Retrospective Exact Matching analysis.Methods: AIT and TBS patients were included from three large glaucoma practices. The primary outcome measure was the unmedicated IOP &le; 21 mmHg at 2-year follow-up visit. A secondary measure was unmedicated IOP reduction &ge; 20% at 2 years. Patients were matched by baseline IOP, the number of glaucoma medications and glaucoma type using Exact Matching and by age using Nearest Neighbor matching. Patients without a close match were excluded. All surgeries were combined with phacoemulsification. Results: 154 AIT and 110 TBS eyes were analyzed. 48 AIT patients were exactly matched to 48 TBS patients. Both groups had a baseline IOP of 15.3&plusmn;3.1 mmHg. At 24 months, the mean IOP was 13.9&plusmn;3.3 for AIT versus 16.8&plusmn;2.8 mmHg for TBS (p=0.04), while the number of medications was 0.7&plusmn;1.0 for AIT versus 1.7&plusmn;1.2 for TBS (p=0.04). The proportion of subjects achieving IOP &le; 21 mmHg without medications at 24 months was 53% in AIT versus 16.6% in TBS (P &lt; 0.05). At 24-month follow up 17.6% of patients in AIT had &ge; 20% IOP reduction without medication versus no patient in TBS. Conclusions: An Exact Matching comparison of AIT and TBS demonstrated greater IOP reduction with fewer medications in AIT.

scholarly journals Exact matching of trabectome-mediated ab interno trabeculectomy to conventional trabeculectomy with mitomycin C followed for 2 years

2020 ◽  
Author(s):  
A. Strzalkowska ◽  
P. Strzalkowski ◽  
Y. Al Yousef ◽  
F. Grehn ◽  
J. Hillenkamp ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Nearest Neighbor ◽  
Exact Matching ◽  
Surgical Interventions ◽  
Secondary Interventions ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
The Mean ◽  
Ab Interno

Abstract Purpose We used exact matching for a highly balanced comparison of ab interno trabeculectomy (AIT) with the trabectome to trabeculectomy with mitomycin C (TRAB). Methods A total of 5485 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. Results A total of 165 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. Conclusion Both 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.

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

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.

Two-year data comparison of ab interno trabeculectomy and trabecular bypass stenting using exact matching

2019 ◽  
Vol 45 (5) ◽  
pp. 608-614 ◽  
Author(s):  
Hamed Esfandiari ◽  
Kenneth Taubenslag ◽  
Priyal Shah ◽  
Swati Goyal ◽  
Adam J. Weiner ◽  
...  
Keyword(s):  
Exact Matching ◽  
Data Comparison ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
Ab Interno

Ab interno trabeculectomy with the dual blade in juvenile open-angle glaucoma

2019 ◽  
pp. 112067211989244
Author(s):  
Albert S Khouri ◽  
Yan Zhu ◽  
Hadeel Sadek
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Purpose: To introduce the use of the Kahook Dual Blade in the treatment of juvenile open-angle glaucoma. Patients and methods: A 14-year-old male was presented with juvenile open-angle glaucoma in the left eye. Ab interno trabeculectomy was performed using a dual-blade device. Results: Intraocular pressure was reduced from 28 to 15 mmHg in the left eye after 18 months. There were no complications. Conclusion: Dual blade ab interno trabeculectomy is a promising alternate to goniotomy in the treatment of juvenile open-angle glaucoma.

scholarly journals 12-month clinical outcomes of combined phacoemulsification and ab interno trabeculectomy for open-angle glaucoma in the United Kingdom

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252826
Author(s):  
Ejaz Ansari ◽  
Deva Loganathan
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Medication Use ◽  
Retrospective Chart Review ◽  
Mean Deviation ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Background/Objectives To describe intraocular pressure (IOP) and ocular hypotensive medication outcomes of combined phacoemulsification and ab interno trabeculectomy with the Kahook Dual Blade (KDB; New World Medical, Inc, Rancho Cucamonga, CA) in adults with cataract and open-angle glaucoma (OAG). Subjects/Methods Retrospective chart review of existing medical records. Data collected included intraocular pressure (IOP) and IOP-lowering medication use preoperatively and through up to 24 months postoperatively. Paired t-tests were utilized to compare preoperative to postoperative mean IOP and mean medications used. Results Data from 32 eyes of 26 subjects were analyzed. Subjects were predominantly Caucasian (25/26) had mean (standard error) age of 79.3 (1.2) years, and eyes had moderate-advanced OAG (mean visual field mean deviation -8.3 [1.3] dB). Mean IOP was 19.8 (0.8) mmHg at baseline and 15.5 (0.6) mmHg (p<0.0001) after mean follow-up of 11.5 (1.0) months; IOP reductions of ≥20% were achieved in 20/32 eyes (62.5%). Mean medication use declined from 2.4 (0.2) medications per eye at baseline to 0.5 (0.2) at last follow-up (p<0.0001); 23/32 eyes (71.9%) were medication-free at last follow-up. No vision-threatening complications were observed. Conclusions Combined phacoemulsification and ab interno trabeculectomy with the KDB safely provided mean IOP reductions of 21.7% and mean IOP medication reductions of 83% after mean follow-up of 12 months in eyes with moderate to advanced OAG. This procedure provides medication-independence in most eyes with statistically and clinically significant IOP reductions.

scholarly journals Intraocular Pressure Reduction in a Pigmentary Glaucoma Model by Goniotome Ab Interno Trabeculectomy

2018 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Priyal Shah ◽  
Hamed Esfandiari ◽  
Ying Hong ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ex Vivo ◽  
Pigmentary Glaucoma ◽  
Pressure Reduction ◽  
Outflow Facility ◽  
Intraocular Pressure Reduction ◽  
Ab Interno Trabeculectomy ◽  
Hematoxylin And Eosin ◽  
Anterior Segments ◽  
Ab Interno

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90&deg; of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90&deg; of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&amp;E) was obtained. Results: After the first 90&deg; TM excision, IOP was significantly lower in G (10.23&plusmn;2.39 mmHg, n=7) than C (20.04&plusmn;1.97mmHg, n=8, P&lt;0.01). Outflow facility in G (0.38&plusmn;0.07 &micro;l/min/mmHg) was higher than C (0.16&plusmn;0.02 &micro;l/min/mmHg, P&lt;0.01). After the second 90&deg; TM excision, IOP in G (6.46&plusmn;0.81 mmHg, n=7) was significantly lower than C (20.25&plusmn;1.66 mmHg, n=8, P&lt;0.001), while the outflow facility in G (0.50&plusmn;0.05 &micro;l/min/mmHg, n=7) was higher than C (0.16&plusmn;0.01 &micro;l/min/mmHg, n=8, P&lt;0.001). Compared to the first excision, excision of an additional 90&deg; did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90&deg; of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90&deg; can effectively restore outflow in pigmentary glaucoma.

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