New filtering operation for open-angle glaucoma using a rolled corneo-scleral flap.

Background: To compare two-year results of a filtering trabeculotomy (FTO) to conventional trabeculectomy (TE) in open-angle glaucoma by exact matching. Methods: 110 patients received an FTO and 86 a TE. FTO avoided the need for an iridectomy due to a preserved trabeculo-descemet window anterior to the scleral flap. TE employed a trabecular block excision and iridectomy. Mitomycin C was used in both. FTO and TE were exact matched by baseline intraocular pressure (IOP) and the number of glaucoma medications. Complete and qualified success (IOP ≤18 mmHg and IOP reduction ≥ 30%, with or without medication) were primary endpoints. IOP, visual acuity (BCVA), complications and intervention were secondary endpoints. Results: 44 FTO were exact matched to 44 TE. The IOP baseline in both groups was 22.5±4.7 mmHg on 3±0.9 medications. At 24 months, complete success was reached by 59% in FTO and 66% in TE, and qualified success by 59% in FTO and 71% in TE. In FTO, IOP was reduced to 12.4±4.3 mmHg at 12 months and 13.1±4.1 mmHg at 24 months. In TE, IOP was 11.3±2.2 mmHg at 12 months and 12.0±3.5 mmHg at 24 months. Medications could be reduced at 24 months to 0.6±1.3 in FTO and 0.2±0.5 in TE. There were no significant differences between the two groups in IOP, medications, complications or interventions at any point. Conclusion: Modifying aqueous flow through a limited trabeculotomy in FTO yielded clinical outcomes similar to traditional TE but allowed to avoid an iridectomy.

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Complications Specifically Related to Canaloplasty Surgery

Complications of Glaucoma Surgery ◽

10.1093/oso/9780195382365.003.0076 ◽

2013 ◽

Author(s):

Richard A. Lewis

Keyword(s):

Open Angle Glaucoma ◽

Filtering Surgery ◽

Open Angle ◽

Schlemm’S Canal ◽

Scleral Flap ◽

Schlemm's Canal ◽

Collector System ◽

Descemet's Membrane ◽

Descemet’S Membrane ◽

Aqueous Outflow

Canaloplasty is a surgical approach for patients with open-angle glaucoma. The objective of the procedure is to enhance circumferential outflow of aqueous from Schlemm’s canal to the collector system, improving outflow without creating a filtering bleb. In the procedure, a microcatheter is threaded into the canal using a standard nonpenetrating approach and then passed for 360 degrees. A polypropylene suture is attached to the catheter. The catheter is then retracted 360 degrees during which time viscodilation is performed. The suture remains in the canal, and the ends of the suture are tied together to place constant tension upon the trabecular meshwork (TM). Theoretically, the tension results in opening of the TM, improving outflow and lowering intraocular pressure (IOP). The procedure has increased in popularity and may be a valuable option for patients with open-angle glaucoma who might be at high risk for filtering surgery complications, such as contact lens wearers, patients on blood thinners, and those patients who already failed filtering surgery in the other eye. With the increased popularity of canaloplasty, knowing how to prevent and manage complications of this procedure are crucial skills for today’s glaucoma surgeon. The notion of enhancing circumferential outflow arose from studies of an earlier nonpenetrating procedure, viscocanalostomy (see Chapter 52). In this procedure, a Descemet’s membrane window is created under a scleral flap, and the outflow system is dilated with viscoelastic for 1–2 clock hours. However, in canaloplasty, 360-degree viscodilation is performed, and a tensioning suture is left in Schlemm’s canal to promote canal distension and aqueous outflow. Passing the microcatheter and completing a successful canaloplasty requires specific steps and careful attention to detail. The procedure may be performed under local, regional, or general anesthesia. Fixation of the globe is the first step, using either a corneal or rectus suture. Then, a half-thickness, 4 mm limbus-based scleral flap is created, followed by a deeper scleral flap, which unroofs the canal. The dissection is then taken forward onto Descemet’s membrane to allow for creation of a Descemet’s window, and the deep flap is excised. Schlemm’s canal is next catheterized 360 degrees.

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Iris from Iridectomy Used as Spacer underneath the Scleral Flap: The Iridenflip Trabeculectomy Technique

Journal of Ophthalmology ◽

10.1155/2015/359450 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4

Author(s):

Veva De Groot ◽

Liselotte Aerts ◽

Stefan Kiekens ◽

Tanja Coeckelbergh ◽

Marie-José Tassignon

Keyword(s):

Open Angle Glaucoma ◽

Corneal Transplantation ◽

Case Series ◽

Postoperative Management ◽

Open Angle ◽

Scleral Flap ◽

Retrospective Case ◽

Corneal Incision ◽

Pressure Lowering

Purpose. We describe a modified trabeculectomy technique in which the iris is used to prevent fibrosis of the scleral flap.Material and Methods. A retrospective case series of patients with medically uncontrolled open angle glaucoma underwent trabeculectomy. Instead of performing a classical iridectomy, the iris was used as spacer underneath the scleral flap. Postoperative management was identical to classical trabeculectomy, with suture removal and needling if necessary. Five of the patients underwent simultaneous phacoemulsification through a separate temporal corneal incision. Patients should have two-year follow-up.Results. Data of ten patients were analysed, two had a previous failed trabeculectomy, two had LTP, and one had a corneal transplantation. In 3 patients MMC 0,1 mg/mL was used. After one and two years mean IOP was, respectively, 13,1 and 12,1 mmHg. IOP ≤ 16 mmHg was reached in 90% of patients without pressure lowering medication. No major complications were seen; no abnormal inflammatory reaction and no deformation or dislocation of the pupil occurred.Conclusion. By using the iris from the iridectomy as spacer under the scleral flap, fibrosis of the scleral flap is no longer possible. This iridenflip trabeculectomy technique gives an excellent complete success rate (IOP ≤ 16 mmHg) of 90%. A larger study is currently being done.

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Results of Rectangular and Triangular Shaped Scleral Flaps in Trabeculectomy in Terms of Control of Intra Ocular Pressure (IOP) and Complications

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v37i3.1089 ◽

2021 ◽

Vol 37 (4) ◽

Author(s):

Qirat Qurban ◽

Zeeshan Kamil ◽

Khalid Mahmood

Keyword(s):

Intraocular Pressure ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Anterior Chamber Depth ◽

Open Angle ◽

Scleral Flap ◽

Intra Ocular Pressure ◽

Group A ◽

Ocular Pressure ◽

Group B

Purpose: To compare between the results of rectangular and triangular shaped scleral flaps in trabeculectomy for primary open angle glaucoma. Study design: Quasi experimental study Place and Duration of Study: Khalid eye clinic, Karachi, from July 2018 to June 2019. Methods: This study included 24 patients of either gender and age from 40 to 65 years. Patients with a diagnosis of primary open angle glaucoma refractory to medical treatment were included by convenient sampling technique. They were divided into two groups. Group A underwent trabeculectomy with rectangular shaped scleral flap whereas Group B underwent trabeculectomy with triangular shaped scleral flap. The main outcome measures were intraocular pressure reduction, anterior chamber depth and post-operative complications. All patients were followed up for a period of two months. Results: Mean age was 52.1± 6.72 years. Mean pre-operative intraocular pressure in group A was 24.4±2.13 mmHg and 23.5±1.64 mmHg in group B. Mean post-operative IOP was 11.6±1.51 mmHg in group A and 13.4±1.67 mmHg in group B with p-value of 0.11. Pre-operative anterior chamber depth (ACD) was grade 4 both groups. It remained same in all patients of group A but two patients of group B changed to grade 3 ACD. Two patients of group B developed hypotony on the first post-operative day. They did not require revision suturing and were managed conservatively. Conclusion: Both types of scleral flap are effective in reducing IOP but rectangular scleral flap reduced IOP more as compared to triangular scleral flap but the difference was not statistically significant. Keywords: Trabeculectomy, Intra ocular pressure, Open angle glaucoma.

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Retrospective evaluation of a filtering trabeculotomy in comparison to conventional trabeculectomy by exact matching

10.1101/2020.01.17.20017913 ◽

2020 ◽

Author(s):

A. Strzalkowska ◽

P. Strzalkowski ◽

Y. Al Yousef ◽

J. Hillenkamp ◽

F. Grehn ◽

...

Keyword(s):

Visual Acuity ◽

Open Angle Glaucoma ◽

Open Angle ◽

Retrospective Evaluation ◽

Exact Matching ◽

Scleral Flap ◽

Primary Endpoints ◽

Secondary Endpoints ◽

Aqueous Flow ◽

Flow Through

AbstractPurposeTo compare 2-year results of a filtering trabeculotomy (FTO) to conventional trabeculectomy (TE) in open-angle glaucoma by exact matching.Methods110 patients received an FTO and 86 a TE. FTO avoided the need for an iridectomy due to a preserved trabeculo-Descemet window anterior to the scleral flap. TE employed a trabecular block excision and iridectomy. Mitomycin C was used in both. FTO and TE were exact-matched by baseline intraocular pressure (IOP) and the number of glaucoma medications. Complete and qualified success (IOP ≤18 mmHg and IOP reduction ≥ 30%, with or without medication) were primary endpoints. IOP, visual acuity (BCVA), complications and intervention were secondary endpoints.Results44 FTO were exact-matched to 44 TE. The IOP baseline in both groups was 22.5±4.7 mmHg on 3±0.9 medications. At 24 months, complete success was reached by 59% in FTO and 66% in TE and qualified success by 59% in FTO and 71% in TE. In FTO, IOP was reduced to 12.4±4.3 mmHg at 12 months and 13.1±4.1 mmHg at 24 months. In TE, IOP was 11.3±2.2 mmHg at 12 months and 12.0±3.5 mmHg at 24 months. Medications could be reduced at 24 months to 0.6±1.3 in FTO and 0.2±0.5 in TE. There were no significant differences between the two groups in IOP, medications, complications or interventions at any point.ConclusionModifying aqueous flow through a limited trabeculotomy in FTO yielded clinical outcomes similar to traditional TE but allowed to avoid an iridectomy.

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Retrospective evaluation of two-year results with a filtering trabeculotomy in comparison to conventional trabeculectomy by exact matching

F1000Research ◽

10.12688/f1000research.26772.2 ◽

2021 ◽

Vol 9 ◽

pp. 1245

Author(s):

Alicja Strzalkowska ◽

Peter Strzalkowski ◽

Yousef Al Yousef ◽

Jost Hillenkamp ◽

Franz Grehn ◽

...

Keyword(s):

Visual Acuity ◽

Open Angle Glaucoma ◽

Open Angle ◽

Retrospective Evaluation ◽

Exact Matching ◽

Scleral Flap ◽

Primary Endpoints ◽

Secondary Endpoints ◽

Aqueous Flow ◽

Flow Through

Background: To compare two-year results of a filtering trabeculotomy (FTO) to conventional trabeculectomy (TE) in open-angle glaucoma by exact matching. Methods: 110 patients received an FTO and 86 a TE. FTO avoided the need for an iridectomy due to a preserved trabeculo-descemet window anterior to the scleral flap. TE employed a trabecular block excision and iridectomy. Mitomycin C was used in both. FTO and TE were exact matched by baseline intraocular pressure (IOP) and the number of glaucoma medications. Complete and qualified success (IOP ≤18 mmHg and IOP reduction ≥ 30%, with or without medication) were primary endpoints. IOP, visual acuity (BCVA), complications and intervention were secondary endpoints. Results: 44 FTO were exact matched to 44 TE. The IOP baseline in both groups was 22.5±4.7 mmHg on 3±0.9 medications. At 24 months, complete success was reached by 59% in FTO and 66% in TE, and qualified success by 59% in FTO and 71% in TE. In FTO, IOP was reduced to 12.4±4.3 mmHg at 12 months and 13.1±4.1 mmHg at 24 months. In TE, IOP was 11.3±2.2 mmHg at 12 months and 12.0±3.5 mmHg at 24 months. Medications could be reduced at 24 months to 0.6±1.3 in FTO and 0.2±0.5 in TE. There were no significant differences between the two groups in IOP, medications, complications or interventions at any point. Conclusion: Modifying aqueous flow through a limited trabeculotomy in FTO yielded clinical outcomes similar to traditional TE but allowed to avoid an iridectomy.

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Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

Russian Osteopathic Journal ◽

10.32885/2220-0975-2019-3-4-97-105 ◽

2020 ◽

pp. 97-105

Author(s):

E. N. Simakova ◽

O. V. Stenkova

Keyword(s):

Intraocular Pressure ◽

Drug Therapy ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Randomized Study ◽

Main Group ◽

Control Group ◽

Open Angle ◽

Complex Treatment ◽

Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

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