Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

PURPOSE. To study the changes in structural and hemodynamic parameters of the retina and foveolar avascular zone (FAZ) over time in patients with primary open-angle glaucoma (POAG) and diabetes mellitus (DM) observed in long-term follow-up.MATERIALS AND METHODS. The study included 258 patients (258 eyes) divided into five groups: group 1 — 58 patients (58 eyes) with stage I POAG and DM; group 2 — 50 patients (50 eyes) with stage I POAG; group 3 — 50 patients (50 eyes) with stage III POAG and DM; group 4 — 50 patients (50 eyes) with stage III POAG; group 5 — 50 patients (50 eyes) with DM. Patients underwent comprehensive ophthalmological examination, spectral domain optical coherence tomography (SD-OCT), optical coherence tomo-graphy angiography (OCT-A) of the macular region. The follow-up lasted 24 months.RESULTS. Analysis of the initial parameters in groups of patients with comorbidities showed the lowest values compared to controls, which were progressively worsening. MD in the group with DM + stage I POAG had reliably decreased after 12 months (by 5.05%), after 24 months by 12.12% (p≤0.05). The speed of GCL+IPL loss in groups 1 and 3 during the first year of observation was almost equal for initial and advanced glaucoma — 1.35 (-2.03%) and 1.32 (-2.36%) µm/year, but in group 3 the loss had doubled after two years (2.48 (-4.44%) and 1.41 (2.12%) µm/year). Deterioration of hymodynamic parameters in the macular region in groups 1 and 3 was noted primarily in the inner sectors (whole image vessel density in parafovea (PF wiVD) -0.79% during the first, and -2.57% during the second year in initial glaucoma, -0.6% and -1.24% in advanced, whole image vessel density in parafovea (PF wiVD) -0.2% and -1.22%, -0.66% and -1.56%, respectively). Parameters of FAZ had changed significantly after 2 years in patients with stage I POAG and DM: its area size had increased by 10.2%, perimeter by 4.49%, circularity index had decreased by 3.17%.CONCLUSION. Comorbidity of POAG and DM is accompanied by development and quick progression of significant changes in structural and hemodynamic parameters of the retina as observed by this long-term follow-up.

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Long-Term Follow-Up of Argon Laser Trabeculoplasty in Uncontrolled Primary Open-Angle Glaucoma

Ophthalmologica ◽

10.1159/000310104 ◽

1990 ◽

Vol 200 (4) ◽

pp. 181-188 ◽

Cited By ~ 7

Author(s):

M. Amon ◽

R. Menapace ◽

U. Radax ◽

A. Wedrich ◽

Ch. Skorpik

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Argon Laser ◽

Open Angle ◽

Argon Laser Trabeculoplasty ◽

Laser Trabeculoplasty ◽

Long Term Follow Up

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Surgical stimulation of uveoscleral outflow is an alternative to cyclodestructive procedures

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-1-9-13 ◽

2021 ◽

Vol 21 (1) ◽

pp. 9-13

Author(s):

E.A. Korchuganova ◽

◽

A.Yu. Kazantzeva ◽

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Secondary Glaucoma ◽

Open Angle ◽

Uveoscleral Outflow ◽

Surgical Stimulation ◽

Diode Laser Cyclophotocoagulation ◽

Stimulation Of

Aim: to assess clinical efficacy and safety of surgical scleral rejection (SSR) vs. transscleral diode laser cyclophotocoagulation (TSCPC) in primary open-angle glaucoma (POAG) and secondary glaucoma (SG). Patients and Methods: study (prospective) group included 84 patients with POAG and SG after SSR. Control (retrospective) group included 80 patients after TSCPC. In addition, the patients were distributed by age and the stage and type of glaucoma, i.e., 128 patients were diagnosed with POAG and 36 patients were diagnosed with secondary thrombotic glaucoma. Follow-up was 24 to 36 months. IOP measurements, tonography (to assess the coefficient outflow facility / COF), ultrasound biomicroscopy of the anterior segment, visual acuity measurement, and visual field testing were performed. Results: no complications after SSR were reported in patients with POAG and SG. In contrast, postoperative complications (choroidal effusion, hyphema, and uveitis) were reported in 14% of patients after TSCPC. Long-term IOP-lowering efficacy of both procedures was similar (87% after SSR and 89% after TSCPC). In POAG, greater IOP reduction was seen after TSCPC (by 39.11%) compared to SSR (by 31.58%) (p<0.05). Meanwhile, in patients with SG, treatment outcomes were similar (IOP reduced by 36.78% after TSCPC and by 35.26% after SSR). In longterm follow-up, PVF reduced by 10.76% vs. baseline after TSCPC but increased by 11.19% vs. baseline after SSR (p≤0.05). Surgery resulted in the improvement or stabilization of visual functions. Ultrasonography has demonstrated that outflow pathways (intrascleral space and filtering bleb) remain functional after SSR in long-term follow-up. Conclusion: SSR is an alternative to cyclodestructive procedures in POAG and SG. Sclera being the final point of the uveoscleral outflow is a perspective entity to develop surgical approaches to glaucoma treatment. Keywords: surgical scleral resection, uveoscleral outflow, sclera, primary open-angle glaucoma, secondary glaucoma, glaucoma surgery, transscleral diode laser cyclophotocoagulation. For citation: Korchuganova E.A., Kazantzeva A.Yu. Surgical stimulation of uveoscleral outflow is an alternative to cyclodestructive procedures. Russian Journal of Clinical Ophthalmology. 2021;21(1):9–13. DOI: 10.32364/2311-7729-2021-21-1-9-13.

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Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

Eye and Vision ◽

10.1186/s40662-021-00263-1 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Ali Salimi ◽

Harrison Watt ◽

Paul Harasymowycz

Keyword(s):

Cataract Surgery ◽

First Generation ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Long Term Outcomes ◽

Surgical Success ◽

Rnfl Thickness

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 the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Ophthalmology in Russia ◽

10.18008/1816-5095-2020-1-49-55 ◽

2020 ◽

Vol 17 (1) ◽

pp. 49-55

Author(s):

D. V. Lapochkin ◽

V. I. Lapochkin ◽

A. V. Lapochkin

Keyword(s):

Surgical Treatment ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Stage Iv ◽

Stage I ◽

Control Group ◽

Open Angle ◽

Disposable Instruments

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages.

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Long-term Follow-up of Initial 5-Fluorouracil Trabeculectomy in Primary Open-angle Glaucoma in Japanese Patients

Journal of Glaucoma ◽

10.1097/00061198-200112000-00004 ◽

2001 ◽

Vol 10 (6) ◽

pp. 458-465 ◽

Cited By ~ 22

Author(s):

Saiko Uchida ◽

Yasuyuki Suzuki ◽

Makoto Araie ◽

Takashi Shigeeda ◽

Takeshi Hara ◽

...

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Japanese Patients ◽

Open Angle ◽

Long Term Follow Up

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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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“Anti-glaucoma implant A3”: surgical technique and the long term follow-up results

Ophthalmology journal ◽

10.17816/ov2019219-24 ◽

2019 ◽

Vol 12 (2) ◽

pp. 19-24

Author(s):

Maria K. Grineva ◽

Sergey Yu. Astakhov

Keyword(s):

Surgical Technique ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Anterior Segment ◽

Advanced Stage ◽

Open Angle ◽

Fiber Layer ◽

Long Term Follow Up

The goal of our work was to study the safety profile and effectiveness of a domestically manufactured shunting device for the treatment of advanced stage primary open-angle glaucoma. This article describes the surgical technique of “Anti-Glaucoma Implant A3” implantation, as well as long term follow-up results obtained from 19 patients (20 eyes). Materials and methods. The devices were implanted in 19 patients (20 eyes) with advanced stage primary open-angle glaucoma. The diagnosis was made based on collected medical history, results of objective and instrumental test findings. All patients included in the study underwent a standard ophthalmologic examination, including: automatic refractometry, best-corrected visual acuity (BCVA) assessment, automated static perimetry, biomicroscopy of the anterior segment, indirect ophthalmoscopy with an aspheric lens, gonioscopy. Optical coherence tomography (OCT) was used to assess retinal nerve fiber layer (RNFL) thickness. Conclusion. Intraocular pressure (IOP) lowering surgical procedures using an anti-glaucoma shunting device are non-inferior by their effectiveness to trabeculectomy, and have lower complication rate.

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