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.

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 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 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 A Mitomycin C-Sparing Novel Technique for Subscleral Trabeculectomy in Primary Congenital Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Ashraf Bor’i ◽  
Salah M. Al-Mosallamy ◽  
Tamer G. Elsayed ◽  
Wael M. El-Haig
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Congenital Glaucoma ◽  
Surgical Interventions ◽  
Primary Congenital Glaucoma ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Group Ii ◽  
Contralateral Eye

Purpose. To evaluate the safety and efficacy of a novel modified subscleral trabeculectomy technique in management of primary congenital glaucoma. Methods. This study included 25 infants diagnosed of having bilateral primary congenital glaucoma. For each patient, one eye was assigned to undergo subscleral trabeculectomy with trimming of the edges of the scleral bed (group I), while the contralateral eye underwent subscleral trabeculectomy with application of mitomycin C (0.4 mg/ml for 3 min) (group II). All the patients were followed up for a period of 14 ± 3 months (range 13–22 months). Results. 25 eyes were included in each group. Patients’ mean age was 2.5 ± 0.5 months (range 1.8–6.5 months). The mean preoperative intraocular pressure was 31 ± 4.9 mmHg and 32.1 ± 4.0 mmHg in group I and II, respectively. The mean postoperative intraocular pressure was 9.0 ± 1.0, 11.0 ± 3.2, 12.5 ± 0.9, 13.0 ± 2.9, and 15.5 ± 1.5 mm Hg in group I and was 10.3 ± 1.2, 12.0 ± 2.5, 13.5 ± 1.7, 15.0 ± 1.5, and 17.1 ± 2.8 mm Hg in group II at the first week and 1, 3, 6, and 12 months, respectively. There was no statistically significant difference between the mean intraocular pressure values recorded at both groups preoperatively and at each follow-up visit. Failure necessitating further surgical interventions was recorded in 4 eyes (16%) in group I as compared to 3 eyes (12%) in group II (P>0.05). Postoperative complications included mild hyphema, which occurred in one eye (4%) in group I and 2 eyes (8%) in group II, and shallow anterior chamber in 3 eyes (12%) in group I and in 2 eyes (8%) in group II. One eye (4%) in group I developed drawn-up pupil. Choroidal effusion developed in one eye (4%) at each group. Conclusion. Trimming the edges of the scleral bed adjacent to the sclera flap is a safe and effective surgical step which can be added to the subscleral trabeculectomy procedure to effectively control the intraocular pressure in patients with primary congenital glaucoma, sparing them the hazards associated with mitomycin C application.

The role of mitomycin C and porcine extracellular matrix in phacotrabeculectomy

2020 ◽  
pp. 112067212094433 ◽  
Author(s):  
Momen Mahmoud Hamdi ◽  
Islam Mahmoud Hamdi
Keyword(s):  
Extracellular Matrix ◽  
Intraocular Pressure ◽  
Mitomycin C ◽  
Low Dose ◽  
Open Angle Glaucoma ◽  
Group Iii ◽  
Group I ◽  
Pressure Lowering ◽  
The Mean

Purpose: To compare between mitomycin C alone, porcine extracellular matrix alone, and combined low dose mitomycin C with porcine extracellular matrix in term of efficacy and safety in phaco-trabeculectomy surgery. Study design: Prospective comparative. Methods: Sixty eyes of 60 patients complaining of primary open angle glaucoma and cataract, undergoing phaco-trabeculectomy, were distributed into three groups: group I: surgery was augmented with mitomycin C, group II with porcine extracellular matrix, and group III with porcine extracellular matrix combined with low dose mitomycin C. Intraocular pressure was evaluated, postoperatively, at day 1, week 1, and 1, 3, 6, 9, and 12 months. Bleb vascularity, pre- and post-operative intraocular pressure lowering medications, success of IOP control and complications were also evaluated. Results: After 12 months, the mean preoperative intraocular pressure (mm Hg) improved from 30.85 ± 4.7, 33.8 ± 4.2, and 31.05 ± 5.4 mm Hg, in groups I, II, and III respectively, to 13.8 ± 4.7 (55.2%), 15.2 ± 4.8 (55%), and 13 ± 4.9 (58.1%) ( p > 0.05). Success of IOP control, postoperative IOP lowering medications and complications were comparable ( p > 0.05). Bleb vascularity was significantly different ( p < 0.05). Conclusion: Mitomycin C, porcine extracellular matrix and their combination are equally effective in phacotrabeculectomy.

scholarly journals The Results of Trabeculectomy with Antimetabolites in Elderly Patients: A Retrospective Study

Acta Medica ◽  
2021 ◽  
pp. 1-5
Author(s):  
Özlem Dikmetaş ◽  
Sepideh Lotfisadigh, ◽  
Merve Kaşıkçı ◽  
Ali Bülent Çankaya ◽  
Sibel Kocabeyoğlu
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Mitomycin C ◽  
Open Angle Glaucoma ◽  
Success Rates ◽  
Topical Medication ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: To examine the effectiveness and results of primary trabeculectomy with 5-fluorouracil (group 1) or mitomycin-C (group 2) in elderly patients. Materials and Methods: This was a retrospective study including 67 eyes with primary open-angle glaucoma that underwent primary trabeculectomy with group 1 or group 2. Patients who were followed up for less than 1 year or were under 55 years of age were excluded from the study. Surgical success was evaluated according to a decrease in cup/disk ratio and reduction of intraocular pressure without any topical medication. Results: The mean ages of participants were 65.7 years (range 59–88) and 65.9 years (range 59–74) in groups 1 and 2, respectively. The mean preoperative and postoperative intraocular pressure values were 31.3 ± 5.7 mmHg (range 17–46) and 14.8 ± 0.4 mmHg (range 10–21) in group 1 (p < 0.001) and 31.5 ± 7.4 mmHg (range 18–52) and 14.8 ± 2.9 mmHg (range 10–21) in group 2 (p < 0.001). Conclusion: The use of 5-fluorouracil or mitomycin-C during primary trabeculectomy is associated with high postoperative success rates. There were no significant differences between 5-fluorouracil and mitomycin-C in terms of intraocular pressure reduction.

scholarly journals Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma

2020 ◽  
Author(s):  
Juan Carlos Izquierdo ◽  
Josefina Mejias ◽  
Laura Cañola ◽  
Natalia Agudelo ◽  
Barbara Rubio
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Surgical Success ◽  
Corrected Visual Acuity ◽  
Ab Interno Trabeculectomy ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Ab Interno

Abstract Background: Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. Methods: A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. Inclusion criteria: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP <14 mmHg either with no medications (complete success) or with medications (qualified success). Results: A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0±3.7 mmHg and postoperatively was 11.6±1.9 mmHg and 11.4±1.8 mmHg (P<0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9±1.4 to 0.56±1.05 at 9 month follow-ups (P<0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months.Conclusions: In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

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.

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