Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors

2019 ◽  
Vol 30 (2) ◽  
pp. 350-359 ◽  
Author(s):  
Alessandro Rabiolo ◽  
Alessandro Marchese ◽  
Paolo Bettin ◽  
Davide Monteduro ◽  
Mario Galasso ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Glaucoma Surgery ◽  
Safe Procedure ◽  
Success Rates ◽  
Criterion A ◽  
Hypotony Maculopathy ◽  
Primary Surgery ◽  
Complete Failure ◽  
Needle Revision

Purpose: To evaluate the efficacy and safety of needle revision and examine factors predictive of failure. Methods: In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure. Results: The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively. Conclusion: Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

scholarly journals Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

2020 ◽  
Author(s):  
Adonis El Salloukh ◽  
Abdus Samad Ansari ◽  
Alexander Chiu ◽  
Divya Mathews
Keyword(s):  
Surgical Intervention ◽  
Glaucoma Surgery ◽  
Lower Percentage ◽  
Visual Field Defects ◽  
Success Rates ◽  
Uveitic Glaucoma ◽  
Optic Nerve Damage ◽  
Primary Surgery

Abstract Background Uveitic glaucoma commonly leads to more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). Methods Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopinture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classed as a failure. Results A total of 16 patients with uveitic glaucoma were reviewed. Complete Success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. Conclusion There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

scholarly journals Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adonis El Salloukh ◽  
Abdus Samad Ansari ◽  
Alexander Chiu ◽  
Divya Mathews
Keyword(s):  
Surgical Intervention ◽  
Glaucoma Surgery ◽  
Lower Percentage ◽  
Visual Field Defects ◽  
Success Rates ◽  
Uveitic Glaucoma ◽  
Optic Nerve Damage ◽  
Primary Surgery

Abstract Background Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). Methods Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure. Results A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. Conclusion There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

scholarly journals Intraocular pressure control after trabeculectomy in the patients with primary open angle glaucoma and pseudoexfoliative glaucoma followed up for 3 to 5 years

2019 ◽  
Vol 76 (8) ◽  
pp. 822-829
Author(s):  
Vesna Maric ◽  
Vujica Markovic ◽  
Marija Bozic ◽  
Ivan Marjanovic ◽  
Paraskeva Hentova-Sencanic ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Survival Curve ◽  
Pressure Control ◽  
Safe Procedure ◽  
Open Angle ◽  
Success Rates ◽  
Pseudoexfoliative Glaucoma ◽  
Significant Difference

Background/Aim. Trabeculectomy is a safe procedure which effectively reduces the intraocular pressure (IOP). IOP is the most frequent indicator of success after glaucoma surgery. The aim of this work was to evaluate the long-term pressure control in primary open-angle glaucoma (POAG) and in pseudoexfoliative glaucoma (XFG) after primary trabeculectomy without the use of mitomycin-C (MMC), 3 to 5 years after trabeculectomy. Methods. This study involved a retrospective evaluation of 332 consecutive patients (352 eyes), 174 patients (188 eyes) with POAG (mean age of 64.0 ? 8.6 years) and 158 patients (164 eyes) with XFG (mean age of 70.7 ? 8.9 years) who underwent primary trabeculectomy between January 2007 and December 2009 at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. A successful control of IOP was defined as achieving IOP ? 21 mmHg without medication (complete success), or with a single topical medication (qualified success). Results. According to the type of glaucoma POAG/XFG preoperative IOP was 28.4 ? 6.3/30.4 ? 8.4 mmHg, respectively (p = 0.311) and last postoperative IOP was 16.9 ? 5.2/18.7 ? 5.9 mmHg, respectively (p = 0.681). According to the Kaplan-Meier survival curve, the complete success in the group with POAG in 1, 3 and 5 years were 85%, 75% and 58% and in the group with XFG were 82%, 70% and 56%, respectively. There was no statistically significant difference in the complete success rates between the patients with POAG and XFG. Conclusion. The primary goal of surgery was to achieve a sufficiently low IOP without additional medication, thus preventing progression of glaucomatous damage. In our study, the complete success in the group with POAG was achieved in 75% and 58% of the patients in the period of 3 and 5 years after surgery, respectively and in the group with XFG complete success was achieved in 70% and 56% of the patients respectively.

Treatment of chronic and extreme ocular hypotension following glaucoma surgery with intraocular platelet-rich plasma: A case report

2018 ◽  
Vol 29 (4) ◽  
pp. NP9-NP12 ◽  
Author(s):  
Omneya Abdalrahman ◽  
Alejandra E Rodriguez ◽  
Jorge L Alio Del Barrio ◽  
Jorge L Alio
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Mitomycin C ◽  
Platelet Rich Plasma ◽  
Corneal Edema ◽  
Glaucoma Surgery ◽  
Applanation Tonometry ◽  
Safe Procedure ◽  
Rieger Syndrome ◽  
Ocular Hypotony

Purpose: To report a new approach for the treatment of severe ocular hypotony secondary to glaucoma filtering surgery with mitomycin C by injecting autologous eye platelet-rich plasma (E-PRP) in the anterior chamber to block excessive diffuse filtration through an abnormally thinned sclera. Methods: A 49-year-old patient with the Axenfeld–Rieger syndrome and severe chronic hypotony and corneal edema following filtering glaucoma surgery with mitomycin C received an isolated injection of 0.3 mL of autologous platelet-rich plasma in the anterior chamber. Results: Intraocular pressure measured by Goldman’s applanation tonometry 6 h after the procedure improved to 18 mmHg. Intraocular pressure remained stable along the full follow-up period of 6 month. No filtration or hypotony or any other complications were observed. Conclusion: Intracameral platelet-rich plasma (E-PRP) injection was an effective, rapidly effective, and safe procedure for treatment of severe chronic ocular hypotony following glaucoma filtrating surgery.

Deep Sclerectomy with Mitomycin C for Glaucoma Secondary to Uveitis

2011 ◽  
Vol 21 (6) ◽  
pp. 708-714 ◽  
Author(s):  
Nitin Anand
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Cumulative Probability ◽  
Deep Sclerectomy ◽  
Retrospective Case ◽  
Uveitic Glaucoma ◽  
Needle Revision

Purpose. To report outcomes of deep sclerectomy augmented with mitomycin C (MMC) in eyes with raised intraocular pressure (IOP) secondary to uveitis. Methods. This was a retrospective case series of 26 eyes of 26 patients with uveitic glaucoma. Mitomycin C 0.2–0.4 mg/mL was applied subconjunctivally prior to scleral flap dissection for 2–3 minutes. Results. Mean follow-up was 46.5±22 months (range 12–83). Fifteen eyes (58%) had previous intraocular surgery. Preoperative IOP was 33±12 mmHg. Intraocular pressure at 1, 2, and 3 years after surgery was 13±4 mmHg, 13±4 mmHg, and 14±4 mmHg, respectively. The probability of IOP <21 and 18 mmHg with needle revision and laser goniopuncture but without medications or further glaucoma procedure was 89% and 84%, respectively, at 3 years. The cumulative probability for performing laser goniopuncture was 42% at 1 year, 50% at 2 years, and 64% at 3 years. Needle revision was performed in 6 eyes (23%). Three (12%) patients required further glaucoma surgery. The number of glaucoma medications decreased from 3.3±1.2 to 0.3±0.8 by last follow-up (p<0.001). Four eyes (15%) were on medications to control IOP Intraoperative perforation of trabeculo-Descemetic membrane occurred in 3 eyes (12%) and late iris entrapment in perforation or goniopuncture in 4 eyes (15%). Recurrence of uveitis was seen in 11 eyes (42%) with no loss in IOP control. Conclusions. Deep sclerectomy with MMC appears to be a safe and effective procedure to lower IOP in uveitic glaucoma with a low rate of complications.

scholarly journals A 2-year prospective multicenter study of ultrasound cyclo plasty for glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Giuseppe Giannaccare ◽  
Marco Pellegrini ◽  
Federico Bernabei ◽  
Lara Urbini ◽  
Fulvio Bergamini ◽  
...  
Keyword(s):  
Ciliary Body ◽  
Glaucoma Surgery ◽  
Secondary Glaucoma ◽  
Eye Drops ◽  
Safe Procedure ◽  
Efficacy And Safety ◽  
Prospective Multicenter Study ◽  
Definition Of

AbstractUltrasound cyclo plasty (UCP) is a recently developed surgical technique for glaucoma allowing a selective and controlled coagulation of the ciliary body. We herein investigated the long-term efficacy and safety of UCP for the treatment of glaucoma. This prospective study included patients with primary and secondary glaucoma. All surgeries were performed using the EyeOP1 device (Eye Tech Care, Rillieux-la-Pape, France). Sixty-six patients were included, and 60 completed regularly the 2-year follow-up. Preoperative IOP was 28.5 ± 9.6 mmHg and significantly decreased to 17.0 ± 5.4 at 2 years (p < 0.001). The daily number of both hypotensive eye drops and acetazolamide tablets decreased significantly (respectively, from 2.6 ± 1.1 to 1.7 ± 1.2 and from 0.7 ± 0.8 to 0.2 ± 0.5; both p < 0.001). At 2 years, 68.1% of patients met the definition of qualified success (IOP < 21 mmHg regardless of glaucoma medications) and 10.3% of patients met the definition of complete success (IOP < 21 mmHg without glaucoma medications). No major intra- or postoperative complications occurred; however, 15 eyes required additional glaucoma surgery. These results suggest that UCP is an effective and safe procedure to reduce IOP in glaucoma patients through a 2-year follow-up period.

XEN45 real-life evaluation: Survival analysis with bleb needling and major revision outcomes

2021 ◽  
pp. 112067212110128
Author(s):  
Néstor Ventura-Abreu ◽  
Marina Dotti-Boada ◽  
María Jesús Muniesa-Royo ◽  
Jordi Izquierdo-Serra ◽  
Andrea González-Ventosa ◽  
...  
Keyword(s):  
Cox Regression ◽  
Real Life ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Life Outcomes ◽  
Kaplan Meier ◽  
Real Life Setting ◽  
Complete Failure ◽  
Poor Outcomes

Purpose: To evaluate real-life outcomes of XEN45 stent surgery including bleb needling (BN) and surgical bleb revision (SBR). Methods: Retrospective analysis of all XEN45 gel stents implanted in a tertiary glaucoma center with a minimum follow-up of 6 months. The main outcomes were intraocular pressure (IOP), the number of glaucoma medications, postoperative maneuvers like BN, and subsequent SBR. Success was defined as IOP ⩽ 18 and 20% reduction (criterion A), ⩽15 and 25% reduction (criterion B), and ⩽12 mmHg and 30% reduction (criterion C) reached with (qualified) or without (complete) medications at the last visit. Complete failure was defined as additional glaucoma surgery, loss of light perception, or sight-threatening complications. Multivariable Cox regression and Kaplan-Meier survival estimates tests were performed. Results: Fifty-eight eyes with either stand-alone or combined Phaco-XEN surgery were included. Complete success by the different definitions was 50.0% (95% confidence interval, 5.8%–84.5%) (A), 50.0% (5.8%–84.5%) (B), and 25% (0.9%–66.5%) (C) whereas qualified success was 38.3% (1.6%–80.1%), 31.7% (2.0%–71.4%), and 0%, respectively, at the 24-months visit. 30% of cases underwent BN with 5-Fluorouracil, and SBR was performed in 17.5% of eyes. Low IOP levels at 1-month and early BN were significantly associated with success. The highest chance of failure was achieved in the combined Phaco-XEN group undergoing SBR. Conclusions: In our real-life setting, the first month IOP was associated with greater success rates. Although BN obtained improved IOP values, SBR was associated with a greater bleb survival in the stand-alone XEN group. Both BN and SBR had poor outcomes in the combined Phaco-XEN group.

scholarly journals Long-Term Outcomes of Initial Trabeculectomy in Glaucoma Associated with Granulomatous and Non-Granulomatous Uveitis

2021 ◽  
Author(s):  
Faisal A. Almobarak ◽  
Ali H. Alharbi ◽  
Ibrahim Aljadaan ◽  
Hassan Aldhibi
Keyword(s):  
Intraocular Pressure ◽  
Postoperative Complications ◽  
Late Onset ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Granulomatous Uveitis ◽  
The Mean ◽  
Retrospective Comparative Study

Abstract Purpose To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis. Methods Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy. Results The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg (± 7.2) and 36.48 mmHg (± 11.3) to 14.00 mmHg (± 6.2) and 13.48 mmHg (± 5.7), the number of medications decreased from 3.73 (± 0.7) and 3.58 (± 0.9) to 1.00 (± 1.4) and 1.13 (± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84). Conclusions Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late onset complications.

scholarly journals Twenty-Years of Experience in Childhood Glaucoma Surgery

2021 ◽  
Vol 10 (24) ◽  
pp. 5720
Author(s):  
Felix Mathias Wagner ◽  
Alexander Karl-Georg Schuster ◽  
Franz Grehn ◽  
Lukas Urbanek ◽  
Norbert Pfeiffer ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Medical Center ◽  
Glaucoma Surgery ◽  
Congenital Glaucoma ◽  
Surgical Interventions ◽  
Surgical Success ◽  
Different Types ◽  
Juvenile Glaucoma

To quantify the results of childhood glaucoma treatment over time in a cohort of children with different types of childhood glaucoma. A retrospective cohort study of consecutive cases involving children with primary congenital glaucoma, primary juvenile, and secondary juvenile glaucoma at the Childhood Glaucoma Center, University Medical Center Mainz, Germany from 1995 to 2015 was conducted. The main outcome measure was the long-term development of intraocular pressure. Further parameters such as surgical success, refraction, corneal diameter, axial length, and surgical procedure in children with different types of childhood glaucoma were evaluated. Surgical success was defined as IOP < 21 mmHg in eyes without a need for further intervention for pressure reduction. A total of 93 glaucomatous eyes of 61 childhood glaucoma patients with a mean age of 3.7 ± 5.1 years were included. The overall mean intraocular pressure at first visit was 32.8 ± 10.2 mmHg and decreased to 15.5 ± 7.3 mmHg at the last visit. In the median follow-up time of 78.2 months, 271 surgical interventions were performed (130 of these were cyclophotocoagulations). Many (61.9%) of the eyes that underwent surgery achieved complete surgical success without additional medication. Qualified surgical success (with or without additional medication) was reached by 84.5% of the eyes.

Hypotony Maculopathy

2013 ◽  
Author(s):  
Robert L. Stamper
Keyword(s):  
Structural Changes ◽  
Vision Loss ◽  
Posterior Pole ◽  
Filtering Surgery ◽  
Success Rates ◽  
Vascular Abnormalities ◽  
Hypotony Maculopathy ◽  
Higher Doses ◽  
Persistent Hypotony

Hypotony is often defined as intraocular pressure (IOP) less than 6 mm Hg. It has been reported to occur after glaucoma filtering surgery in up to 42% of cases and is usually associated with overfiltration or wound leaks. Hypotony requiring revision, however, occurs in about 4% of filtering procedures. Hypotony can follow any IOP-lowering procedure or even “simple” cataract surgery. The advent of guarded filtering surgery has reduced the rate of hypotony significantly compared to full-thickness filtering surgery. Unfortunately in the quest to increase success rates by using adjunctive antifibrotic agents, such as mitomycin-C (MMC) or 5-fluorouracil (5-FU), that prevent fibrotic wound healing, the incidence has increased again. Higher doses of and longer exposure times to MMC are associated with a greater risk of hypotony. Most cases of hypotony are transient and self-limited to a few days or weeks after surgery. Transient hypotony does not seem to have any deleterious effect on long-term visual acuity. However, persistent hypotony may result in structural changes that can become permanent. Hypotony maculopathy is one such condition manifesting from persistent hypotony that can result in permanent vision loss. Hypotony maculopathy occurs in up to 10% of filtering operations with MMC or 5-FU and in about 10% of eyes with chronic hypotony. Maculopathy associated with hypotony was first described by Dellaporta. Some years later, Gass, using fluorescein angiography, better characterized the condition. In hypotony maculopathy, the sclera and choroid develop folds in the posterior pole, which can cause significant visual disturbances. The condition is recognized by characteristic striae or folds in the macular area that do not leak or stain with fluorescein. The posterior sclera appears partially collapsed, causing the folds. The axial length of the eye may be shortened after both filtering and tube shunt surgery and more so in patients with hypotony. The loss of vision is usually gradual after the hypotony has persisted for at least a month or more. Indocyanine green angiography has revealed some vascular abnormalities including vessel tortuosity and filling defects.

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