One-year outcomes of stand-alone ab externo SIBS microshunt implantation in refractory glaucoma

2020 ◽  
pp. bjophthalmol-2020-317299
Author(s):  
Georges M Durr ◽  
Matthew B Schlenker ◽  
Saba Samet ◽  
Iqbal Ike K Ahmed
Keyword(s):  
Primary Outcome ◽  
Vision Loss ◽  
Filtering Surgery ◽  
Choroidal Detachment ◽  
Refractory Glaucoma ◽  
Surgical Success ◽  
Hypotony Maculopathy ◽  
Moderate Disease ◽  
One Year

Background/AimsDetermine the efficacy of stand-alone implantation of the ab externo SIBS or poly(styrene-block-isobutylene-block-styrene) microshunt with mitomycin C in glaucomatous eyes, refractory to previous subconjunctival filtering surgery, over 1 year of follow-up.MethodsConsecutive retrospective cohort of patients with intraocular pressure (IOP) above target and previous subconjunctival filtering surgery, who received the microshunt between July 2015 and April 2019. Primary outcome was a complete success, with failure defined as IOP <6 mm Hg with vision loss, >17 mm Hg or <20% reduction in IOP without medications. Secondary outcomes included thresholds of 6 to 14 mm Hg and 6 to 21 mm Hg for both complete (no medications) and qualified (with medications) success as well as qualified success for thresholds of 6 to 17 mm Hg. Risk factors for failure, IOP, medications and complications were also assessed.Results85 eyes of 79 patients with a preoperative median IOP of 22.0 mm Hg (IQR 18.0–29.0) on four (IQR 3–4) medications were included. Postoperative median IOP was 13.0 mm Hg (IQR 10.0–17.0) on zero (IQR 0–2) medication at 1 year. 61.0% achieved complete success and 79.7% achieved qualified success. Mild-to-moderate disease was associated with failure (adjusted HR 2.37; 95% CI 1.23 to 4.59). Needling was performed in 11.8%, and 8.2% underwent anterior chamber reformation. Complications were transient, consisting of hyphaema, choroidal detachment and hypotony maculopathy, with 7.1% of patients undergoing reoperation.ConclusionsIn a group of high-risk eyes that had already failed at least one subconjunctival filtering surgery, the SIBS microshunt demonstrates reasonable surgical success over 1-year follow-up, with relatively few complications.

scholarly journals Intraluminal stenting versus external ligation of Ahmed glaucoma valve in prevention of postoperative hypotony

2021 ◽  
Vol 14 (10) ◽  
pp. 1560-1564
Author(s):  
Dina Abd Elfattah ◽  
◽  
Tharwat Mokbel ◽  
Hisham Elsorogy ◽  
Abd-Elmonem A. Elhesy ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Primary Outcome ◽  
Ahmed Glaucoma Valve ◽  
Refractory Glaucoma ◽  
Group 2 ◽  
One Year ◽  
Prevention Methods ◽  
Age Range ◽  
Group 1

AIM: To compare intraluminal stenting and external ligation of Ahmed glaucoma valves (AGV) for refractory glaucoma management and postoperative hypotony prevention. METHODS: This randomized prospective blind study included 30 eyes of 25 patients (age range: 44-56y) with refractory glaucoma. This study was conducted from September 2018 to January 2020. The study included two groups, AGV with intraluminal stenting group (n=15 eyes) and AGV with external ligation group (n=15 eyes). Follow-up period was one year postoperatively. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications. IOP?≤?21 mm Hg without medications indicated complete success while IOP?≤?21 mm Hg with medications indicated qualified success; and IOP<6 mm Hg was defined as hypotony. RESULTS: After a year of follow-up, IOP was significantly reduced in the intraluminal stenting group than in the external ligation group (11.67±0.89 vs 14.2±4.0 mm Hg, respectively, P=0.024). Postoperative hypotony was more common in the external ligation group (2 cases, 13.33%) than in the intraluminal stenting group (1 case, 6.67%). CONCLUSION: Application of intraluminal stenting or external ligation during AGV surgery usually prevents postoperative hypotony (transient and persistent) that occurs in conventional AGV surgery.

scholarly journals Diabetic Retinopathy and Risk of Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3733-3736
Author(s):  
Ka-Ho Wong ◽  
Katherine Hu ◽  
Cecilia Peterson ◽  
Nazanin Sheibani ◽  
Georgios Tsivgoulis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diabetic Retinopathy ◽  
Primary Outcome ◽  
Vision Loss ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Increased Risk

Background and Purpose: Diabetic retinopathy (DR) is a common microvascular complication of diabetes, which causes damage to the retina and may lead to rapid vision loss. Previous research has shown that the macrovascular complications of diabetes, including stroke, are often comorbid with DR. We sought to explore the association between DR and subsequent stroke events. Methods: This is a secondary analysis of patients enrolled in the ACCORD Eye study (Action to Control Cardiovascular Risk in Diabetes). The primary outcome was stroke during follow-up. The exposure was presence of DR at study baseline. We fit adjusted Cox proportional hazards models to provide hazard ratios for stroke and included interaction terms with the ACCORD randomization arms. Results: We included 2828 patients, in whom the primary outcome of stroke was met by 117 (4.1%) patients during a mean (SD) of 5.4 (1.8) years of follow-up. DR was present in 874 of 2828 (30.9%) patients at baseline and was more common in patients with than without incident stroke (41.0% versus 30.5%; P =0.016). In an adjusted Cox regression model, DR was independently associated with incident stroke (hazard ratio, 1.52 [95% CI, 1.05–2.20]; P =0.026). This association was not affected by randomization arm in the ACCORD glucose ( P =0.300), lipid ( P =0.660), or blood pressure interventions ( P =0.469). Conclusions: DR is associated with an increased risk of stroke, which suggests that the microvascular pathology inherent to DR has larger cerebrovascular implications. This association appears not to be mediated by serum glucose, lipid, and blood pressure interventions.

scholarly journals Transient choroidal detachment after ultrasonic circular cyclocoagulation

2019 ◽  
Vol 12 (10) ◽  
pp. e231677
Author(s):  
Tiago Morais Sarmento ◽  
Ricardo Figueiredo ◽  
João Garrido ◽  
Ana Luisa Rebelo
Keyword(s):  
Visual Acuity ◽  
Best Practice ◽  
Choroidal Detachment ◽  
Refractory Glaucoma ◽  
Corrected Visual Acuity ◽  
Retrobulbar Anaesthesia ◽  
Oral Steroids ◽  
Hypotensive Therapy ◽  
Best Corrected Visual Acuity

Two patients with refractory glaucoma followed in our ophthalmology department registered progression on left eyes (OS) despite best practice. Best corrected visual acuity (BCVA) was 9/10 and 8/10 and intraocular pressure (IOP) was above 20 mm Hg while under maximal hypotensive therapy. The procedure was performed under retrobulbar anaesthesia with second-generation EyeOp1probes. In follow-up, OS were hypotonic with registered IOP ≤5 mm Hg and revealed a 3/10 BCVA. The funduscopy showed one temporal and superior and another nasal and temporal choroidal detachments. The patients started oral steroids and interrupted all ocular hypotensive medication. After therapy, patients returned with normal rising OS IOPs and with totally reapplied choroids, accompanied by normalised BCVA. These two cases are proof of the possibility of transient choroidal detachment after a ultrasonic circular cyclocoagulation. While a very rare major vision-threatening complication, every ophthalmologist should remind it when sudden BCVA reductions occur after this procedure.

P3518Men with heart failure have higher readmission rates: a closer review of sex and gender based analyses

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Hoang-Kim ◽  
C Parpia ◽  
C Freitas ◽  
P C Austin ◽  
H J Ross ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sex Differences ◽  
Full Text ◽  
Primary Outcome ◽  
Search Strategy ◽  
Rater Agreement ◽  
Readmission Rates ◽  
Gender Based ◽  
One Year

Abstract Background There has been increased attention on reducing hospital readmission rates. However, little is known about any difference in readmission rates in heart failure by sex, although evidence exists demonstrating differences in the etiology of heart failure. As a result, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear. Purpose (1) To identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender. Methods A scoping protocol was developed using the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Our search strategy was reviewed according to the peer-review of electronic search strategy (PRESS) checklist. Full text articles published between 2002 and 2017 and drawn from multiple databases (i.e. MEDLINE, EMBASE), grey literature (i.e. National Technical Information, Duck Duck Go), and experts were consulted for additional articles. Screening criteria were established a priori. Once an acceptable inter-rater agreement was established at 80% by two independent reviewers, articles were screened for potential eligibility. A descriptive analytical method was employed to chart primary research articles. Articles were considered relevant if the cohort consisted of adult heart failure patients who were readmitted after an index hospitalization and a sex/gender-based analysis was performed. Results The literature search yielded 5887 articles, of which 746 underwent full text assessment for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies included disaggregated data for sex but no subsequent interaction was reported. Good inter-rater agreement was reached: 83% for title and abstract screening; 88% for full text review; kappa: 0.69 (95% CI: 0.526–0.851). Twelve of 34 studies included for the primary outcome reported higher readmission rates for men compared to five studies reporting higher readmission rates for women. However, there were differential readmission rates that were dependent on duration of follow-up. Women were more likely to experience higher readmission rates than men when time to event was less than one year. Readmission rates for men were higher when follow-up was longer than one year. Conclusion Sex differences in readmission rates were dependent on follow up time. Most studies used composite outcomes and had short times to event, which may mask underlying effects of sex on readmission. Acknowledgement/Funding Ontario SPOR Support Unit

scholarly journals One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256670
Author(s):  
Matthias Nobl ◽  
Sigrid Freissinger ◽  
Stefan Kassumeh ◽  
Siegfried Priglinger ◽  
Marc J. Mackert
Keyword(s):  
Postoperative Complications ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Similar Efficacy ◽  
Choroidal Detachment ◽  
Pseudoexfoliation Glaucoma ◽  
Patient Demographics ◽  
One Year ◽  
Definition Of

Purpose To compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). Methods In this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups. Results Patient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group. Conclusion Microshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.

One-year follow-up of the XEN® implant with mitomycin-C in pseudoexfoliative glaucoma patients

2018 ◽  
Vol 29 (3) ◽  
pp. 309-314 ◽  
Author(s):  
Ana Ibáñez-Muñoz ◽  
Víctor Santiago Soto-Biforcos ◽  
María Chacón-González ◽  
Oscar Rúa-Galisteo ◽  
Alexandra Arrieta-Los Santos ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Pressure Reduction ◽  
Pseudoexfoliative Glaucoma ◽  
Intraocular Pressure Reduction ◽  
Pressure Lowering ◽  
One Year

Purpose: To evaluate the intraocular pressure–lowering effect, the safety profile, and the success rate of the XEN45 Gel Stent (Allergan, Dublin, Ireland) in patients with pseudoexfoliative glaucoma. Methods: Retrospective study conducted on patients with pseudoexfoliative glaucoma, with or without cataract, who underwent XEN45 implantation surgery with subconjunctival mitomycin-C and had a minimum postoperative follow-up period of 12 months. The primary outcome measure was intraocular pressure reduction at 1 year as compared to baseline. Complete success was defined as a postoperative intraocular pressure reduction of ⩾20% from preoperative baseline at 12 months without any glaucoma medications. Qualified success was defined as a postoperative intraocular pressure reduction of ⩾20% at 12 months with medications. Results: Of the 24 screened patients, 21 eyes of 20 patients met the inclusion/exclusion criteria and were included in the study. A total of 13 (62%) eyes underwent XEN alone surgery and 8 (38%) eyes had combined XEN + cataract surgery. Mean intraocular pressure was significantly reduced from 21.1 (3.8) mmHg at baseline to 15.2 (3.9) mmHg at 1 year, p < 0.001. Mean antiglaucoma medications dropped from 2.95 (0.97) preoperatively to 1.23 (1.22) at month 12 (p < 0.001). Of the 21 eyes included in the study, 18 (85.7%) were considered as success, 6 (28.6%) as complete success, and 12 (57.1%) as qualified success. Five eyes required needling revision. Complications included uveitis, choroidal detachment, hyphema, and cystoid macular edema in 2, 1, 1, and 1 eye, respectively. Conclusion: XEN45 Gel Stent implant significantly reduced the intraocular pressure and the number of antiglaucoma medications in patients with pseudoexfoliative glaucoma.

scholarly journals Intermediate outcomes of ab externo circumferential trabeculotomy and canaloplasty in POAG patients with prior incisional glaucoma surgery

2020 ◽  
Author(s):  
Huaizhou Wang ◽  
Chen Xin ◽  
Ying Han ◽  
Yan Shi ◽  
Sarah Ziaei ◽  
...  
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Open Angle Glaucoma ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Secondary Outcome ◽  
Filtering Surgery ◽  
Intermediate Outcomes ◽  
Topical Medications

Abstract Background: To compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC). Methods : We conducted a retrospective chart review of POAG patients with failed filtering surgery and intact SC, who further received ECT and canaloplasty. The primary outcome measures were intraocular pressure (IOP) and the number of topical medications at each follow-up point.The secondary outcome compared the quantified success rate at1-year follow-up between the groups. Results: Twenty-nine eyes were recruited in the ECT group and 19 eyes in canaloplasty group. The postoperative IOP and the number of topical medications decreased significantly in both groups(p<0.001). The IOP at 3-month and 6-monthwas significantly lower in the ECT group (p=0.039, p=0.001) than in the canaloplasty group. Although the IOP at 12-mon was similar between the two groups, the number of topical medications was less in the ECP group (p=0.040). Hyphema (72.4%) and ciliary body detachment (27.6%), which mainly resolve spontaneously, were two leading complications in the ECT group. The prevalence of hyphema was higher in ECT than in canaloplasty group (p<0.001). Conclusion: For POAG with failed filtering surgery and intact SC, canaloplasty may be safer, whereas ECT presented better IOP control.

scholarly journals Ultrasound Cyclo Plasty for Treatment of Surgery-Naïve Open-Angle Glaucoma Patients: A Prospective, Multicenter, 2-Year Follow-Up Trial

2021 ◽  
Vol 10 (21) ◽  
pp. 4982
Author(s):  
Michele Figus ◽  
Chiara Posarelli ◽  
Marco Nardi ◽  
Ingeborg Stalmans ◽  
Evelien Vandewalle ◽  
...  
Keyword(s):  
Focused Ultrasound ◽  
Vision Loss ◽  
Open Angle Glaucoma ◽  
Mean Value ◽  
Piezoelectric Transducers ◽  
High Intensity Focused Ultrasound ◽  
Filtering Surgery ◽  
Open Angle ◽  
History Of

Background: The purpose of this prospective study was to evaluate the efficacy and safety of the Ultrasound Cyclo Plasty (UCP) procedure using high-intensity focused ultrasound in surgery-naïve open-angle glaucoma patients. Methods: prospective, non-randomized, single-arm, multicenter clinical trial. Sixty-six eyes with primary open-angle glaucoma, intraocular pressure (IOP) ≥21 mmHg and with no history of filtering surgery were enrolled. Patients were treated by UCP with a therapy probe comprising six piezoelectric transducers, consecutively activated for 8 s each. Complete ophthalmic examination was performed before the procedure, 1 day after the procedure, and 1, 3, 6, 12, 18 and 24 months after the procedure. Primary outcomes were complete success (defined as IOP lowering from baseline ≥20% without additional glaucoma medications) and vision-threatening complications. Secondary outcomes were the presence of complications and the reduction of the number of medications used. Results: IOP was significantly reduced after one procedure (p < 0.05), from a mean pre-operative value of 24.3 ± 2.9 mmHg (n = 2.3 hypotensive medications) to a mean value of 15.9 ± 3.6 mmHg (n = 2.2 hypotensive medications) at 2 years (mean IOP lowering of 33%). Surgical success was achieved in 74% of eyes. Notwithstanding side effects such as transient anterior chamber inflammation, refractive error changes, transient hypotony and macular edema, no major intra or post-operative complications such as phthisis, induced cataract, neovascularization or significant vision loss were observed. Conclusions: Ultrasound Cyclo Plasty is a valuable, effective and well-tolerated procedure to lower IOP in patients with open-angle glaucoma without previous filtering surgery.

scholarly journals Intermediate Outcomes of ab Externo Circumferentialtrabeculotomy and Canaloplastyin POAG Patients with Prior Incisional Glaucoma Surgery

2020 ◽  
Author(s):  
Huaizhou Wang ◽  
Chen Xin ◽  
Ying Han ◽  
Yan Shi ◽  
Sarah Ziaei ◽  
...  
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Open Angle Glaucoma ◽  
Retrospective Chart Review ◽  
Glaucoma Surgery ◽  
Secondary Outcome ◽  
Filtering Surgery ◽  
Intermediate Outcomes ◽  
Topical Medications

Abstract Background: To compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC).Methods: We conducted a retrospective chart review of POAG patients with failed filtering surgery and intact SC, who further received ECT and canaloplasty. The primary outcome measures were intraocular pressure (IOP) and the number of topical medications at each follow-up point.The secondary outcome compared the quantified success rate at1-year follow-up between the groups. Results:Twenty-nine eyes were recruited in the ECT group and 19 eyes in canaloplasty group. The postoperative IOP and the number of topical medications decreased significantly in both groups(p<0.001). The IOP at 3-month and 6-monthwas significantly lower in the ECT group (p=0.039, p=0.001) than in the canaloplasty group. Although the IOP at 12-mon was similar between the two groups, the number of topical medications was less in the ECP group (p=0.040). Hyphema (72.4%) and ciliary body detachment (27.6%), which mainly resolve spontaneously, were two leading complications in the ECT group. The prevalence of hyphema was higher in ECT than in canaloplasty group (p<0.001). Conclusion: For POAG with failed filtering surgery and intact SC, canaloplasty may be safer, whereas ECT presented better IOP control.Translational Relevance:

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