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

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.

Surgical Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Patients with Open-Angle Glaucoma – A Retrospective Case Series

2021 ◽  
Vol 238 (04) ◽  
pp. 391-395
Author(s):  
Sarah Vez ◽  
Luzia Müller ◽  
Frank Bochmann
Keyword(s):  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Retrospective Case ◽  
Frequent Adverse Event ◽  
Tertiary Referral Center ◽  
Retrospective Case Series ◽  
Cantonal Hospital

Abstract Purpose To evaluate the outcome of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma (OAG). Participants and Methods A retrospective case series of patients with uncontrolled OAG treated by GATT at the cantonal Hospital Lucerne, a tertiary referral center, between October 2018 and July 2019 with a minimal 6-month follow-up period. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, and complications. Results Thirty-one eyes of 29 patients with a mean age of 70.9 years and a minimal follow-up period of 6 months were included in this study. Twenty eyes were treated for pseudoexfoliation (64.5%), seven for primary open-angle (22.6%), three for pigmentary (9.7%), and one for traumatic (3.2%) glaucoma. Twenty-six eyes had data at the 6-month follow-up and 12 eyes at the 12-month follow-up. Twenty-two eyes (70.9%) were pseudophakic prior to the operation. Mean preoperative IOP was 33 mmHg (standard deviation [SD] 8.0 mmHg). The postoperative IOP was 13.9 mmHg [SD 2.2] at the 6- and 13.9 mmHg [SD 3.1] at the 12-month follow-up. The postoperative IOP evolution translated into a 58% decrease between 6 and 12 months (p < 0.001). Thirteen patients (41.9%) were treated with oral Diamox prior to GATT. The number of antiglaucoma medications decreased from a preoperative average of 2.9 [SD 1.2] to postoperative 1 [SD 1] drug (p < 0.001). The most frequent adverse event was the occurrence of postoperative hyphema. Hyphema was observed in 21 (68.0%), 7 (22.6%), and 2 (6.4%) eyes at days 1, 7, and 30 after GATT, respectively. Intraocular hypertension over 25 mmHg was seen in eight eyes (25.8%), and in four of them, a steroid response was suspected. One patient developed an anterior uveitis and a macular edema. Conclusion GATT is an effective and safe intervention for OAG, particularly in pseudoexfoliation glaucoma (PEX). The advantages of GATT compared to filtration surgery are the low rate of long-term complications and that the intervention is feasible even when difficult conjunctival conditions are encountered.

scholarly journals Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Jea H. Yu ◽  
Chuck Nguyen ◽  
Esmeralda Gallemore ◽  
Ron P. Gallemore
Keyword(s):  
Open Angle Glaucoma ◽  
Effective Means ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Scleral Flap ◽  
Retrospective Case ◽  
Glaucoma Drainage Devices ◽  
Patch Graft

Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions.Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement.Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from39±14 mmHg to15±2 mmHg and the number of glaucoma medications was reduced from4±1to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively.Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

scholarly journals Efficacy and Safety of Timolol-Dorzolamide Fixed-Combination Three Times a Day Versus Two Times a Day in Newly Diagnosed Open Angle Glaucoma

2018 ◽  
Author(s):  
Mohammad Pakravan ◽  
Afsaneh Naderi Beni ◽  
Shahin Yazdani ◽  
Hamed Esfandiari
Keyword(s):  
Blood Pressure ◽  
Primary Open Angle Glaucoma ◽  
Fixed Combination ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Newly Diagnosed ◽  
Efficacy And Safety ◽  
The Mean

Purpose: To compare the therapeutic efficacy and safety of dorzolamide/timolol fixed-combination in newly diagnosed primary open angle glaucoma patients. Methods: In this prospective, interventional case series, newly diagnosed primary open angle glaucoma (POAG) patients that had not been treated for glaucoma were included. Patients were started on Cosopt twice a day (BID) for 1 month and then switched to three times a day (TDS) for additional 1 month. Patients underwent comprehensive ophthalmic examination, diurnal intraocular pressure (IOP), blood pressure (BP) and 24-hours heart rate (HR) measurements at baseline, month 1( BID), and month 2( TDS). IOP, systolic and diastolic pressures were measured at 8:00 AM,12:00 AM, 4:00 PM, 8:00 PM and 12:00 PM. Throughout the study, all adverse events were recorded and monitored by the investigators. Results: In 31 POAG patients that completed the study ,mean baseline IOP was 23.1&plusmn;3.15 mmHg . IOP was decreased significantly 16.5 &plusmn; 2.21 at 1 month (P &lt; 0.0001) and 13.9 &plusmn; 2.23 mmHg at 1 and 2 month follow up. (P &lt; 0.0001) IOP was significantly lower in month 2 compared to month 1 (P = 0.0004). While Cosopt BID significantly reduced the mean 24-hour systolic BP and mean 24-hour HR from baseline (P &lt; 0.0001), the mean 24-hour systolic BP and HR remained unchanged 2ith Cosopt TDS compared to BID (P = 0.62). Conclusions: Cosopt TDS has a superior IOP-lowering effect than Cosopt BID in POAG patients with comparable safety profile.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;

scholarly journals 12-month interim results of a prospective study of patients with mild to moderate open-angle glaucoma undergoing combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery

2021 ◽  
pp. 112067212199823
Author(s):  
Iwona Grabska-Liberek ◽  
Patrycja Duda ◽  
Monika Rogowska ◽  
Julita Majszyk- Ionescu ◽  
Agnieszka Skowyra ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Prospective Case Series ◽  
A Prospective Study ◽  
Time Point

Purpose: To characterize clinical outcomes of combined viscodilation of Schlemm’s canal and collector channels and 360° trabeculotomy as a standalone procedure or combined with cataract surgery in eyes with mild to moderate open-angle glaucoma (OAG). Methods: In this prospective case series, the OMNI glaucoma surgical platform (Sight Sciences, Menlo Park, CA) was utilized to perform the procedure either combined with phacoemulsification or as a standalone procedure. Changes from baseline in intraocular pressure (IOP) and IOP-lowering medications were evaluated through the first 12 months of a planned 24-month follow-up period. Results: Among 17 eyes of 15 subjects, mean IOP was reduced from 20.4 mmHg to 12.7–13.7 mmHg through 12 months of follow-up ( p < 0.001 at every time point) and mean medications reduced from 2.5 to 0.1–0.6 ( p < 0.001 at every time point). IOP reductions in eyes undergoing standalone surgery were approximately 2–4 mmHg greater at each time point compared to eyes undergoing surgery combined with phacoemulsification; this may be related to a higher baseline IOP in the former eyes (22.1 vs 18.5 mmHg). Six eyes developed hyphema, of which three required washout for elevated IOP on the first postoperative day; six additional eyes had IOP elevations that resolved with medical management. Conclusion: Viscodilation of Schlemm’s canal and collector channels paired with ab interno trabeculotomy performed with a single integrated instrument (OMNI), whether as standalone or combined with phacoemulsification, effectively lowers both IOP and the need for IOP-lowering medications through 12 months of follow-up.

A standardized protocol of laser suture lysis in postoperative management in trabeculectomy with mitomycin C: One-year study

2020 ◽  
pp. 112067212090169
Author(s):  
Sofia Sousa Mano ◽  
Raquel Marques Esteves ◽  
Nuno Pinto Ferreira ◽  
Luís Abegão Pinto
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Open Angle Glaucoma ◽  
Postoperative Management ◽  
Mean Value ◽  
Early Postoperative Period ◽  
Tertiary Centre ◽  
Laser Suture Lysis ◽  
Pressure Lowering

Aim: To analyse the efficacy and safety of a standardized laser suture lysis protocol following trabeculectomy. Materials and methods: Prospective interventional study conducted at a tertiary centre, between June 2016 and July 2017. Consecutive patients undergoing primary trabeculectomy with mitomycin C (0.4 mg/mL) for open angle glaucoma were enrolled. According to study protocol, a first laser suture lysis was performed routinely when intraocular pressure was greater than 10 mmHg, starting at postoperative day 8, and a second laser suture lysis was done whenever the intraocular pressure was newly greater than 10 mmHg, with a minimum interval of 1 week after the first laser suture lysis. Primary outcome was intraocular pressure (mean value, and mean difference from baseline in percentage). Safety parameters were also analysed. Results: Thirty-three eyes of 28 patients (13 males) were enrolled with a mean age of 69.6 ± 15.1 years. Pre-operative intraocular pressure was 24.9 ± 8.6 mmHg. All eyes underwent a laser suture lysis before the 12th postoperative week, with a mean intraocular pressure–lowering efficacy of 42.4% (p < 0.01). A second laser suture lysis procedure, when performed (n = 14), had an additional intraocular pressure–lowering efficacy of 26.7% (p = 0.02). Mean intraocular pressure at 1-month follow-up was 12.9 ± 8.2 mmHg, and during this period, two cases of self-limited choroidal detachments were noticed. Ten patients needed additional bleb needling. Mean intraocular pressure at 1-year follow-up was 13.8 ± 8.0 mmHg under an average of 0.4 topical intraocular pressure–lowering drugs (p < 0.01). Conclusion: In our study, laser suture lysis was an effective tool to lower intraocular pressure during the early postoperative period, with an acceptable safety profile.

Survival of the fittest: phacoemulsification outcomes in four corneal transplants by Dr Ramon Castroviejo

2020 ◽  
pp. bjophthalmol-2020-316435
Author(s):  
Jovany Jeomar Franco ◽  
Jose Luis Reyes Luis ◽  
Salma Rahim ◽  
Stephen Greenstein ◽  
Roberto Pineda
Keyword(s):  
Corneal Thickness ◽  
Corneal Transplantation ◽  
Case Series ◽  
Long Term Results ◽  
Retrospective Case ◽  
Term Survival ◽  
Corneal Transplants ◽  
Long Term Follow Up

AimTo evaluate and report the outcomes following phacoemulsification on four eyes, 45 years or more after corneal transplantation.MethodsA retrospective case series of four eyes in three patients (P1, P2, P3), undergoing phacoemulsification at least 45 years after corneal transplantation by Dr Ramon Castroviejo. Corneal graft survival outcome measures included central corneal thickness (CCT), best-corrected visual acuity (BCVA), corneal clarity and endothelial cell count (ECC).ResultsPhacoemulsification was successfully completed in all four cases with no instances of graft failure during the postoperative follow-up period, which ranged from 17 months to 76 months. At the conclusion of the follow-up period, all four grafts remained clear, and BCVA remained better than or similar to preoperative values. Long-term follow-up revealed no meaningful changes in CCT after phacoemulsification. All but one case experienced a decrease in ECC, with ECC values in the four cases ranging from 538 cells/mm2 to 1436 cells/mm2 at the conclusion of postoperative follow-up.ConclusionLimited data have been published on the long-term survival of corneal grafts after intraocular surgery, especially for extremely ‘mature’ corneal transplants. This case series demonstrates that with appropriate preoperative, intraoperative and postoperative measures, successful phacoemulsification can be performed in these cases with excellent long-term results.

scholarly journals Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Soosan Jacob ◽  
Michele Figus ◽  
Dhivya Ashok Kumar ◽  
Ashvin Agarwal ◽  
Amar Agarwal ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Single Step ◽  
Visual Field Defects ◽  
Open Angle ◽  
Filtration Surgery ◽  
Stab Incision

Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG).Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects). After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5–1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet’s punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured.Results. Mean preoperative IOP was27.41±5.54 mmHg and mean postoperative IOP was16.47±4.81 mmHg (n=17). Mean reduction in IOP was38.81±16.55%. There was significant reduction of IOP (p<0.000). 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered.Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18±1.88months).

scholarly journals Comparison of Using One Trabecular Microbypass Stent versus Two during Cataract Surgery at Two Sites: One-Year Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Shuo Yang ◽  
Mantapond Ittarat ◽  
Elaine Tran ◽  
Patricia Ferrell ◽  
Gloria Wang ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Palo Alto ◽  
Stent Group ◽  
Retrospective Case ◽  
Significant Difference ◽  
Stanford Versus ◽  
One Year

Purpose. To compare IOP and ocular hypotensive medication reduction of using one trabecular microbypass stent versus two in patients with open-angle glaucoma. Setting. Palo Alto Veterans Affairs (VA) Hospital and the Byers Eye Institute at Stanford University, Palo Alto, California, USA. Design. Retrospective case series. Methods. A chart review included patients who underwent trabecular microbypass implantation with cataract surgery in 2015-2017, with at least one-year follow-up. Subjects were divided into two groups by location (always one stent at Stanford versus two stents at the VA). Primary outcome measures included IOP and medication reduction at baseline and 12-month follow-up. Results. 132 subjects (166 eyes) were included. The preoperative IOP was 16.3±3.4 mmHg on 2.6±1.1 medications in the one-stent group (N=85) and 17.5±3.1 mmHg on 2.7±0.6 medications in the two-stent group (N=81). There was no significant difference between the two groups (p=0.06). At the 12-month visit, there was a 13.37%±2.93 reduction in IOP in the 1-stent group (p≤0.001) and 13.49%±2.69 in the 2-stent group (p≤0.001); both were not significantly different from each other (p=0.074). At 12 months, there was also a 14.5% reduction in medication use for the 1-stent group and 15.3% reduction in the 2-stent group, both statistically significant from baseline, (p=0.022 and p=0.037, respectively). Conclusions. Implantation with either one or two stents during cataract surgery in patients with glaucoma demonstrated similar IOP and med reduction in both groups between the two sites.

scholarly journals Brimonidine-associated uveitis – a descriptive case series

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Susanne Hopf ◽  
Karl Mercieca ◽  
Norbert Pfeiffer ◽  
Verena Prokosch-Willing
Keyword(s):  
Anterior Uveitis ◽  
Open Angle Glaucoma ◽  
Descriptive Analysis ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Topical Steroids ◽  
Retrospective Case ◽  
Root Cause ◽  
Clinical Records

Abstract Background Anterior uveitis secondary to topical brimonidine administration is rare and not well-defined. In glaucoma patients using brimonidine, one must consider this phenomenon to avoid mis-diagnosis and over-treatment with topical steroids which in turn may increase intraocular pressure (IOP). This is the largest case series including the longest patient follow-up in the current literature. Methods Sixteen patients (26 eyes) with consultant diagnosed brimonidine-associated anterior uveitis in a tertiary referral glaucoma clinic presenting between 2015 and 2019 were included in this retrospective case series. Clinical records were taken for descriptive analysis. Main outcome measures were the key clinical features, and disease course (therapy, IOP control, patient outcome). Results Key features were conjunctival ciliary injection and mutton fat keratic precipitation in all eyes. The findings were bilateral in 10 patients. Time between initiation of brimonidine treatment and presentation was 1 week to 49 months. Glaucoma sub-types were mostly pseudo-exfoliative and primary open angle glaucoma. Brimonidine treatment was stopped immediately. Additionally, topical corticosteroids were prescribed in 18 eyes and tapered down during the following 4 weeks. Thirteen eyes did not need surgical or laser treatment (median follow-up time 15 months). No patient showed recurrence of inflammation after cessation of brimonidine. Conclusions This type of anterior uveitis is an uncommon but important manifestation which should always be considered in glaucoma patients on brimonidine treatment. Although treatable at its root cause, problems may persist, especially with respect to IOP control. The latter may necessitate glaucoma surgery after the resolved episode of the uveitis.

scholarly journals Primary open-angle glaucoma with retinal vein occlusion: a retrospective case series

2019 ◽  
Vol 1 (1) ◽  
pp. 50-59
Author(s):  
Muhamad Amin Ramli ◽  
Sarah Murniati Che Mat ◽  
Azhany Yaakub ◽  
Embong Zunaina ◽  
Liza Sharmini Ahmad Tajudin
Keyword(s):  
Retinal Vein Occlusion ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Systemic Hypertension ◽  
Open Angle ◽  
Retrospective Case ◽  
Asian Patients ◽  
Vein Occlusion ◽  
End Stage

Glaucoma is a known risk factor for retinal vein occlusion (RVO). There are many reported studies among primary open-angle glaucoma (POAG) patients with RVO in Caucasians. Our objective was to report the natural course of RVO in Asian patients with POAG. A retrospective record review was conducted between January 2015 and December 2016 involving five POAG patients who developed RVO while attending regular follow-up at the Hospital Universiti Sains Malaysia glaucoma clinic (Malaysia). Three readings of intraocular pressure (IOP) were taken as pre-RVO IOP. IOP at presentation of RVO was also recorded. Clinical data including RVO management and complications were documented. All POAG patients were at the severe and end stage of the disease. None of them achieved target pressure. Median IOP at presentation was 26 ± 3.8 mmHg (SD) and the majority were asymptomatic. Systemic hypertension was present in all patients. There was deterioration of visual acuity and increased number topical medication post RVO presentation. Vigilant monitoring of IOP is important in POAG patients with systemic hypertension to prevent RVO, given that RVO in POAG is like robbing someone blind twice.  

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