Long-term Outcomes of Mitomycin-C Trabeculectomy in Exfoliative Glaucoma Versus Primary Open-Angle Glaucoma

Abstract Background The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up. Methods This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events. Results A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease. Conclusions Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

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Comparison of ab externo trabeculotomy in primary open-angle glaucoma and uveitic glaucoma: long-term outcomes

Clinical Ophthalmology ◽

10.2147/opth.s102414 ◽

2016 ◽

pp. 929

Author(s):

Bogomil Voykov ◽

Antony William ◽

Martin Spitzer ◽

Deshka Doycheva ◽

Spyridon Dimopoulos ◽

...

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Long Term Outcomes ◽

Uveitic Glaucoma

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The long-term outcomes of four alternative treatment strategies for primary open-angle glaucoma

Acta Ophthalmologica ◽

10.1111/j.1755-3768.2011.02318.x ◽

2012 ◽

Vol 90 (1) ◽

pp. 20-31 ◽

Cited By ~ 20

Author(s):

Aukje van Gestel ◽

Carroll A. Webers ◽

Johan L. Severens ◽

Henny J. Beckers ◽

Nomdo M. Jansonius ◽

...

Keyword(s):

Alternative Treatment ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Treatment Strategies ◽

Open Angle ◽

Long Term Outcomes

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Long-term Follow-up of Initial Trabeculectomy With Mitomycin C for Primary Open-angle Glaucoma in Japanese Patients

Journal of Glaucoma ◽

10.1097/01.ijg.0000212202.57029.45 ◽

2006 ◽

Vol 15 (3) ◽

pp. 195-199 ◽

Cited By ~ 57

Author(s):

Takashi Shigeeda ◽

Atsuo Tomidokoro ◽

Yi-Ning Chen ◽

Shiroaki Shirato ◽

Makoto Araie

Keyword(s):

Mitomycin C ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Japanese Patients ◽

Open Angle ◽

Long Term Follow Up

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Study of intraocular pressure and ways to prevent its increase in patients with primary open-angle glaucoma in long-term periods after phacoemulsification

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2019-2-82-86 ◽

2019 ◽

pp. 82-86

Author(s):

E.L. Sorokin ◽

◽

N.V. Postupaeva ◽

Keyword(s):

Intraocular Pressure ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle

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Problems of treatment of primary openangle glaucoma in combination with thrombosis of the central retinal vein

GlaucomaNews ◽

10.25276/2227-8281-1-65-69 ◽

2020 ◽

pp. 65-69

Author(s):

T.E. Lipatkina ◽

◽

Е.V. Karlova ◽

A.V. Zolotarev ◽

◽

...

Keyword(s):

Macular Edema ◽

Primary Open Angle Glaucoma ◽

Antihypertensive Drugs ◽

Open Angle Glaucoma ◽

Vascular Wall ◽

Open Angle ◽

Retinal Edema ◽

Long Term Preservation ◽

Central Retinal Vein

Patients with primary open-angle glaucoma (POAG) and ophthalmic hypertension have an increased likelihood of developing occlusions (thrombosis) of the central retinal vein. Different groups of antihypertensive drugs differ in their mechanism of action and may affect concomitant ocular pathology, in particular, retinal edema, which occurs, for example, in occlusion of the central retinal vein. Used in most patients with glaucoma, prostaglandin analogs can contribute to the long-term preservation of macular edema due to the effect on the permeability of the vascular wall. Preparations of other pharmacological groups, reducing the production of aqueous humor, on the contrary, may contribute to its regression. Therefore, the question of choosing a drug for antihypertensive therapy in patients with primary open-angle glaucoma and concomitant macular edema is relevant and is for further study.

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Cellular and plasma fibronectin in the aqueous humour of primary open-angle glaucoma, exfoliative glaucoma and cataract patients

Eye ◽

10.1038/eye.1998.224 ◽

1998 ◽

Vol 12 (5) ◽

pp. 886-890 ◽

Cited By ~ 21

Author(s):

Minna Vesaluoma ◽

Päivi Mertaniemi ◽

Sari Mannonen ◽

Ilkka Lehto ◽

Risto Uusitalo ◽

...

Keyword(s):

Aqueous Humour ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Plasma Fibronectin ◽

Exfoliative Glaucoma ◽

Cataract Patients

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Plasma levels of sirtuin and adiponectin in patients with primary open-angle glaucoma, exfoliative glaucoma, and healthy controls

European Journal of Ophthalmology ◽

10.1177/11206721211065216 ◽

2021 ◽

pp. 112067212110652

Author(s):

Aysun Yucel Gencoglu ◽

Murat Irkec ◽

Sibel Kocabeyoglu ◽

Z. Gunnur Dikmen ◽

Jale Karakaya ◽

...

Keyword(s):

Plasma Levels ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Healthy Controls ◽

Plasma Samples ◽

Open Angle ◽

Control Subjects ◽

Healthy Control ◽

Exfoliative Glaucoma ◽

Chi Square Analysis

Purpose To compare plasma levels of sirtuin 1 (SIRT1) and adiponectin (APN) in patients with primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG), and healthy control subjects. Methods This prospective case-control study collected plasma samples from 118 participants. All subjects underwent a comprehensive ophthalmologic examination before the acquisition of a plasma sample. Plasma samples were obtained from 40 POAG, 38 XFG, and 40 healthy control subjects without any evidence of systemic or ocular disease. Serum SIRT1 and APN levels were estimated by an enzyme-linked immunosorbent assay, ELISA (Elabscience, Houston, USA) method. Statistical analysis of results relied on Kolmogorov-Smirnov, Kruskal-Wallis, Chi-square, analysis of variance (ANOVA) tests, and linear regression analysis, where appropriate. Results A significant decrease in SIRT1 levels was observed in POAG patients compared to healthy controls (p = 0.004, Dunn's test). In contrast, no difference was detected between XFG and POAG patients or healthy controls (p = 0.32 and p = 0.34, respectively, Dunn's test). There was no significant difference in plasma APN levels between the three groups under investigation (p = 0.59, ANOVA). Conclusion Alterations in serum level of SIRT1 may suggest a possible role in POAG via potential effects in neuroprotection and oxidative stress.

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