Kanaloplastik ab interno – eine minimalinvasive Alternative

2017 ◽  
Vol 234 (08) ◽  
pp. 991-995 ◽  
Author(s):  
N. Körber
Keyword(s):  
Medical Lasers ◽  
Erste Ergebnisse ◽  
Ab Interno

Zusammenfassung Zweck Beschreibung und Bewertung der Wirksamkeit der Kanaloplastik ab interno (ABiC) bei Patienten mit primärem Offenwinkelglaukom (POAG). Methoden In diese monozentrische konsekutive Fallstudienreihe wurden Patienten mit Katarakt und Offenwinkelglaukom (kombiniertes Verfahren) und pseudophake Patienten (Durchschnittsalter: 78 Jahre, Bereich: 66–90 Jahre) mit POAG aufgenommen und einer ABiC mit dem iTrack™ 250-Mikron-Mikrokatheter (Ellex Medical Lasers Pty Ltd, Adelaide, Australien) unterzogen, um den Schlemm-Kanal zirkumferenziell zu viskodilatieren und zu intubieren, ohne eine Spannnaht anzubringen. Die primären Endpunkte waren der mittlere Augeninnendruck (IOP) und die mittlere Anzahl Glaukommedikamente bis 1, 3, 6, 9 und 12 Monate nach der Operation. Ergebnisse 23 Patienten (23 Augen) wurden in die Studie aufgenommen. Der mittlere IOP ohne Wash-out sank von 18,8 ± 5,63 mmHg vor der Operation auf jeweils 14,9 ± 2,90 mmHg (n = 22), 13,82 ± 2,98 (n = 19), 14,69 ± 2,36 mmHg (n = 13), 16,0 ± 2,09 (n = 11) und 14,73 ± 2,97 (n = 11) bis 1, 3, 6, 9 und 12 Monate nach der Operation. Die mittlere Anzahl Medikamente wurde reduziert von 1,69 vor der Operation auf 0,21 bei der letzten Follow-up-Visite. Es gab eine Komplikation mit begrenzter Descemetolyse nahe dem Limbus. Schlussfolgerung Die ABiC war bei dieser Patientengruppe einfach in der Durchführung und brachte nur minimale Komplikationen mit sich. Erste Ergebnisse in dieser Studie weisen darauf hin, dass die ABiC den IOP und somit auch die Abhängigkeit von Medikamenten vergleichbar zur konventionellen Kanaloplastik senkt.

scholarly journals Impact of failed ab-interno trabeculectomy (trabectome) on subsequent XEN45 gel stent implantation in pseudophakic eyes

2021 ◽  
Author(s):  
D. Kiessling ◽  
C. Rennings ◽  
M. Hild ◽  
A. Lappas ◽  
T. S. Dietlein ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Open Angle Glaucoma ◽  
Control Group ◽  
Repeat Surgery ◽  
Medication Score ◽  
Significant Difference ◽  
Ab Interno Trabeculectomy ◽  
The Impact ◽  
Ab Interno

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.

scholarly journals One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

2021 ◽  
Author(s):  
Hiroshi Yokoyama ◽  
Masashi Takata ◽  
Fumi Gomi
Keyword(s):  
Survival Analysis ◽  
Clinical Success ◽  
Treatment Success ◽  
Medication Use ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Kaplan Meier ◽  
One Year ◽  
Ab Interno

Abstract Purpose To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group). Methods This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery. Results Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198). Conclusion S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma

2021 ◽  
pp. 112067212110104
Author(s):  
Mehmet Talay Koylu ◽  
Fatih Mehmet Mutlu ◽  
Alper Can Yilmaz
Keyword(s):  
Intraocular Pressure ◽  
Female Patient ◽  
Congenital Glaucoma ◽  
Safe Procedure ◽  
Primary Congenital Glaucoma ◽  
History Of ◽  
Kahook Dual Blade ◽  
The Right ◽  
Ab Interno

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.

Erste Ergebnisse der transperinealen Ligatur des Fisteltrakts bei rektovaginalen Fisteln

2019 ◽  
Vol 144 (04) ◽  
pp. 374-379
Author(s):  
Oliver Schwandner ◽  
Claudius Falch ◽  
Christl Reisenauer
Keyword(s):  
Chirurgische Therapie ◽  
Morbus Crohn ◽  
Postoperative Komplikationen ◽  
Erste Ergebnisse

Zusammenfassung Hintergrund Die chirurgische Therapie der rektovaginalen Fistel stellt trotz vielfältiger Operationsverfahren weiterhin eine Herausforderung dar. Es war Ziel dieser prospektiven Studie, die Ergebnisse einer innovativen Operationstechnik zu evaluieren. Material und Methoden Es erfolgte eine transperineale Ligatur des Fisteltrakts ohne Fistulektomie oder Sphinkterplastik. Es wurden ausschließlich tiefe rektovaginale Fisteln für die Operationsmethode ausgewählt. Standardisierte Ein- und Ausschlusskriterien wurden definiert. Ergebnisse Innerhalb eines 16-Monate-Zeitraums wurden an 2 Zentren 7 Patientinnen mit einer tiefen rektovaginalen Fistel über einen transperinealen Zugang operiert. Die Genese der rektovaginalen Fisteln war postpartal, operativ-iatrogen, bei Z. n. Bartholin-Abszess sowie bei Morbus Crohn. In allen Fällen konnte die Fistel identifiziert werden und zwischen einer Ligatur durchtrennt werden. Intra- und postoperative Komplikationen traten nicht auf. Nur eine Operation erfolgte unter Stomaschutz. Nach einem mittleren Follow-up von 9 Monaten kam es zu einer Heilung bei 4 von 7 Patientinnen (Erfolgsrate 57%). Schlussfolgerung Die ersten Ergebnisse einer transperinealen Ligatur des Fisteltrakts bei der rektovaginalen Fistel scheinen vielversprechend. Um den objektiven Stellenwert zu beurteilen, müssen weitere Erfahrungen, Studien mit größerer Fallzahl und Langzeitdaten abgewartet werden.

scholarly journals Erratum to: A novel technique of ab interno glaucoma surgery: follow-up results after 24 months

2010 ◽  
Vol 249 (2) ◽  
pp. 311-311
Author(s):  
Bojan Pajic ◽  
Grigoris Pallas ◽  
Heinrich Gerding ◽  
Matthias Böhnke
Keyword(s):  
Glaucoma Surgery ◽  
Novel Technique ◽  
Ab Interno

scholarly journals Five-Year Clinical Outcomes of Trabectome Surgery at a Single Glaucoma Center

2018 ◽  
Author(s):  
Hamed Esfandiari ◽  
Priyal Shah ◽  
Pooya Torkian ◽  
Ian P. Conner ◽  
Joel S. Schuman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Success Rate ◽  
Retention Rate ◽  
Case Series ◽  
Series Data ◽  
Cumulative Probability ◽  
Single Center ◽  
Trabectome Surgery ◽  
Ab Interno

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) &le;21 mm Hg, or &gt;20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0&plusmn;5.6 mmHg at baseline to 15.6&plusmn;4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8&plusmn;1.2, which decreased to 1.0&plusmn;1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

scholarly journals Suprachoroidal MIGS Devices

2020 ◽  
pp. 105-119
Author(s):  
Julian Garcia-Feijoo ◽  
Jose Maria Martinez-de-la-Casa ◽  
Lucia Perucho
Keyword(s):  
Glaucoma Surgery ◽  
Cell Loss ◽  
Term Efficacy ◽  
Suprachoroidal Space ◽  
Early Results ◽  
Outflow Pathway ◽  
Implanted Devices ◽  
Ab Interno

Abstract The suprachoroidal outflow pathway has the potential to reduce intraocular pressure (IOP) significantly but has been associated with sight-threatening complications including severe and prolonged hypotony. Historically, suprachoroidal devices have been implanted ab externo requiring a conjunctival peritomy and scleral flap dissection. Additionally, the long-term efficacy of previous attempts to harness this space has been disappointing due to occlusion of implanted devices by fibrosis in the suprachoroidal space. More recently, there have been a number of suprachoroidal devices that are injected ab interno., including the CyPass Micro-Stent (Alcon Laboratories Inc., Fortworth, Texas, USA), the iStent Supra (Glaukos Corporation, San Clemente, CA, USA) and the MINIject (iSTAR Medical Isnes, Belgium). These have utilized a clear corneal entry, thereby sparing the conjunctiva. Early results with these ab-interno devices showed safety and efficacy in IOP-lowering that is similar to Schlemm’s canal minimally invasive glaucoma surgery devices and procedures. Despite the ab-interno approach, their long-term efficacy also seems to be limited by fibrosis. In addition, the first commercially available ab-interno suprachoroidal device, the CyPass Micro-Stent, has been voluntarily withdrawn globally by the manufacturer in August 2018, after 5-year follow-up data demonstrated a higher level of endothelial cell loss with the device than in controls. The iStent Supra and MINIject are not yet available commercially.

scholarly journals Ab interno goniotomy with a Kahook Dual Blade in 6-month follow-up

Klinika Oczna ◽  
2020 ◽  
Vol 122 (3) ◽  
pp. 105-111
Author(s):  
Anna Majer ◽  
Magdalena Kaszuba-Modrzejewska ◽  
Marzena Petrus ◽  
Bartłomiej Kałużny
Keyword(s):  
Kahook Dual Blade ◽  
Ab Interno

scholarly journals Continuous ab interno repairing of traumatic cyclodialysis cleft using a 30-gauge needle in severe ocular trauma: a clinical observation

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Haibo Li ◽  
Jinhong Cai ◽  
Xiaofeng Li
Keyword(s):  
Ciliary Body ◽  
Ocular Trauma ◽  
Ultrasound Biomicroscopy ◽  
Bulbar Conjunctiva ◽  
Mattress Suture ◽  
The Difference ◽  
Ab Interno ◽  
Cyclodialysis Cleft

Abstract Background To investigate the efficacy and safety of continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30-gauge (G) needle. Methods Fifteen patients (15 eyes) with traumatic cyclodialysis cleft admitted to the ocular trauma department of our hospital from July 2014 to December 2018 were included in this study. After the bulbar conjunctiva corresponding to the ciliary body was incised along the corneal limbus, an incision was made along the corneal limbus on the opposite side. A 30G needle with a 10–0 suture entered the anterior chamber from the incision and passed through the ciliary body with clefts and the sclera to fixate the ciliary body on the sclera wall with continuous mattress suture. The best corrected visual acuity (BCVA) and intraocular pressure (IOP) were observed preoperatively and postoperatively. In vivo ultrasound biomicroscopy (UBM) was performed to observe closure of cyclodialysis cleft before and after surgery. Results Fifteen patients successfully underwent continuous mattress suture for repair of cyclodialysis cleft. No bleeding and suture breakage were reported during surgery. After surgery, the UBM during follow-up showed satisfactory closure of the cyclodialysis cleft. The BCVA and IOP were improved to different degrees. The difference between the preoperative IOP and the postoperative IOP (1 week) was statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 16.17 ± 4.65 mmHg, t = − 8.43, P < 0.05), and the difference between the preoperative IOP and the postoperative IOP (1 month) was also statistically significant (preoperative: 6.49 ± 0.98 mmHg, postoperative: 14.63 ± 3.63 mmHg, t = − 8.38, P < 0.05). Duration of outpatient follow-up was 3 to 12 months. No complications, including exposed knots, loose sutures, decompensation of corneal endothelium, sympathetic ophthalmia, endophthalmitis and choroidal detachment, were reported. Conclusion Continuous ab interno repairing of traumatic cyclodialysis cleft in severe ocular trauma using a 30G needle is a safe and effective procedure with simple operation, little tissue damage and few complications.

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