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.

The role of mitomycin C and porcine extracellular matrix in phacotrabeculectomy

2020 ◽  
pp. 112067212094433 ◽  
Author(s):  
Momen Mahmoud Hamdi ◽  
Islam Mahmoud Hamdi
Keyword(s):  
Extracellular Matrix ◽  
Intraocular Pressure ◽  
Mitomycin C ◽  
Low Dose ◽  
Open Angle Glaucoma ◽  
Group Iii ◽  
Group I ◽  
Pressure Lowering ◽  
The Mean

Purpose: To compare between mitomycin C alone, porcine extracellular matrix alone, and combined low dose mitomycin C with porcine extracellular matrix in term of efficacy and safety in phaco-trabeculectomy surgery. Study design: Prospective comparative. Methods: Sixty eyes of 60 patients complaining of primary open angle glaucoma and cataract, undergoing phaco-trabeculectomy, were distributed into three groups: group I: surgery was augmented with mitomycin C, group II with porcine extracellular matrix, and group III with porcine extracellular matrix combined with low dose mitomycin C. Intraocular pressure was evaluated, postoperatively, at day 1, week 1, and 1, 3, 6, 9, and 12 months. Bleb vascularity, pre- and post-operative intraocular pressure lowering medications, success of IOP control and complications were also evaluated. Results: After 12 months, the mean preoperative intraocular pressure (mm Hg) improved from 30.85 ± 4.7, 33.8 ± 4.2, and 31.05 ± 5.4 mm Hg, in groups I, II, and III respectively, to 13.8 ± 4.7 (55.2%), 15.2 ± 4.8 (55%), and 13 ± 4.9 (58.1%) ( p > 0.05). Success of IOP control, postoperative IOP lowering medications and complications were comparable ( p > 0.05). Bleb vascularity was significantly different ( p < 0.05). Conclusion: Mitomycin C, porcine extracellular matrix and their combination are equally effective in phacotrabeculectomy.

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 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.

Trabeculectomy with OloGen versus Mitomycin C for the Treatment of Silicone Oil-Induced Glaucoma

2021 ◽  
Author(s):  
Hisham Samy Shalaby ◽  
Noureldin Hussein Hashem
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Silicone Oil ◽  
Success Rates ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Pressure Lowering ◽  
Group A ◽  
Group B

Abstract Aim To compare the intraocular pressure-lowering effect and success rate of trabeculectomy with OloGen to that of trabeculectomy with mitomycin C (MMC) in cases of silicone oil-induced glaucoma. Materials and Methods Forty eyes of forty patients with elevated intraocular pressure (IOP) after vitrectomy and silicone oil injection (followed by silicone oil removal) were assigned to two groups. Group A included 20 cases who underwent trabeculectomy with OloGen, while group B cases contained 20 cases undergoing trabeculectomy with MMC. The follow-up period was 24 months. Patients enrolled had IOP > 21 mmHg despite being on antiglaucoma medications. Results The mean postoperative IOP reduction was lower in group A than in group B at all follow-up visits, but this difference was not statistically significant (p > 0.05). Moreover, group A and B patients were found to be similar as regards the need for postoperative antiglaucoma medications on all follow-up visits. The Kaplan-Meier survival analysis curves for the two groups revealed slightly higher success rates in group B than in group A. However, these differences were not statistically significant for both qualified success (IOP ≤ 21 mmHg with or without antiglaucoma medications) and complete success (IOP ≤ 21 mmHg without antiglaucoma medications). There was no significant difference in the postoperative complication rate between the two groups. Conclusion OloGen implant lowers IOP to a similar extent as MMC when combined with trabeculectomy for the treatment of silicone oil-induced glaucoma, and with comparable success rates. The rate of postoperative complications is similar for OloGen implantation and MMC.

scholarly journals Biodegradable 3D-Porous Collagen Matrix (Ologen) Compared with Mitomycin C for Treatment of Primary Open-Angle Glaucoma: Results at 5 Years

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Fei Yuan ◽  
Lei Li ◽  
Xiuping Chen ◽  
Xiang Yan ◽  
Liyang Wang
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Collagen Matrix ◽  
Open Angle ◽  
Significant Difference ◽  
The Difference ◽  
Rate Of Success

Purpose. To evaluate the effectiveness and safety of the Ologen as an aid for trabeculectomy performed for primary open-angle glaucoma compared with mitomycin C.Methods. In this prospective, randomized, parallel assignment, comparative study, 31 eyes of 21 primary open-angle glaucoma patients were allocated for trabeculectomy with the Ologen implant; another 32 eyes of 23 patients were treated with trabeculectomy augmented with mitomycin C. The patients were followed up for 5 years and evaluated for intraocular pressure, rate of success, status of the bleb, and adverse events.Result. The mean postoperative intraocular pressure was statistically different at 3 m, 6 m, 1 y, 3 y, and 5 y follow-up. The rates of both complete successP=0.017and overall successP=0.031in the Ologen group were significantly higher than those in the mitomycin C group. The difference of the bleb extent and vascularity was statistically significant in both groups. There was no significant difference in postoperative complication.Conclusions. Ologen provides higher rates of surgical success compared with mitomycin C for patients with primary open-angle glaucoma undergoing trabeculectomy. It may be a new, safe, simple, and effective therapeutic approach for treating primary open-angle glaucoma.

scholarly journals Intraocular Pressure Control after Trabeculectomy with Adjunctive Use of Mitomycin-C versus Bevacizumab: A Hospital Based Study

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
P S Mahar ◽  
Sobia Tabassum ◽  
Mujahid Inam ◽  
Muhammad Faaz Malik ◽  
Tauseef Mahmood
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Pressure Control ◽  
T Test ◽  
P Value ◽  
Open Angle ◽  
One Year

Purpose:  To compare the control of intra ocular pressure (IOP) after trabeculectomy with adjunctive use of Mitomycin–C (MMC) versus Bevacizumab. Study Design:  Quasi experimental study. Place and Duration of Study:  Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Karachi, from August 2017 to August 2019. Methods:  One hundred and six patients of either gender, fulfilling the inclusion criteria were planned for trabeculectomy with adjunctive use of Mitomycin-C (MMC) or Bevacizumab. Each group consisted of 53 patients (53 Eyes). The patients diagnosed with Primary Open Angle Glaucoma (POAG) with IOP ? 21 mm Hg and not controlled with topical anti-glaucoma medication were selected. Data were analyzed by using SPSS Version 22.0. Independent sample t test was used to check significance between two drugs. Paired sample t test was used to check significance of pre and post-operative IOP. Results:  Mean age of patients was 56.67±7.34 years. Mean preoperative IOP was 31.51 ± 9.66 mm Hg in MMC group and 29.21 ± 7.69 mm Hg in Bevacizumab group. At first postoperative day, mean IOP after use of MMC was 14.75 ± 9.46 mm Hg and for Bevacizumab was 15.07 ± 6.47 mm Hg (p-value 0.001). Similarly, at one year follow-up, mean IOP for MMC group was 11.26 ± 2.31 mm Hg and for Bevacizumab was 11.73 ± 2.12 mm Hg(p-value 0.001). Conclusion:  There was significant reduction in IOP in both MMC and Bevacizumab groups. However, the difference between the two groups was not statistically significant at mean follow-up of one year. Key Words:  Primary Open Angle Glaucoma, Mitomycin–C, Intraocular Pressure, Bevacizumab, Trabeculectomy.

scholarly journals Effect of Intraoperative Use of Topical Mitomycin C on Intraocular Pressure in Patients with Pterygium Excision

1970 ◽  
Vol 12 (3) ◽  
pp. 144-148
Author(s):  
Pir Salim Mahar ◽  
Nabeel Manzar ◽  
Khabir Ahmed
Keyword(s):  
Intraocular Pressure ◽  
Mitomycin C ◽  
Ciliary Body ◽  
Case Series ◽  
Topical Administration ◽  
Significant Decline ◽  
Paired Student ◽  
Pressure Lowering ◽  
Pterygium Excision

Aim: To determine the effect of intraoperative adjunctive topical mitomycin C on intraocular pressure in patients undergoing pterygium excision.Methods: This was a descriptive interventional case series of 102 patients (118 eyes) with different grades of pterygium treated from 1995 to 2008. All patients underwent pterygium excision with intraoperative mitomycin C 0.2 mg/mL administered for 1 to 5 minutes. Changes in intraocular pressure were recorded on days 1 and 7, and at 3 months. Data were analysed using proportion, group means, standard deviations, analysis of variance, and paired Student t test.Results: There was no significant decline in intraocular pressure throughout the follow-up period (p = 0.435, Student t test). At 3 months postoperatively, 109 eyes (92.4%) had no changes in intraocular pressure >5 mm Hg, of whom 78 (72%) experienced minimal changes that were not statistically significant.Conclusions: Intraoperative topical administration of mitomycin C has a minimal effect on lowering intraocular pressure in patients with pterygium. These results do not support the trans-scleral effect of mitomycin C on the ciliary body as an intraocular pressure–lowering mechanism in glaucoma filtering surgery.

Early results of micropulse transscleral cyclophotocoagulation for the treatment of glaucoma

2019 ◽  
Vol 30 (4) ◽  
pp. 700-705 ◽  
Author(s):  
Alexander T Nguyen ◽  
Jessica Maslin ◽  
Robert J Noecker
Keyword(s):  
Intraocular Pressure ◽  
Continuous Wave ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Angle Closure ◽  
Secondary Outcome ◽  
Early Results ◽  
Pressure Lowering ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean

Purpose: To describe our clinical experience with the efficacy and safety of micropulse transscleral cyclophotocoagulation as a treatment for glaucoma. Methods: In this retrospective case series, we reviewed the charts of 95 consecutive patients with various glaucoma subtypes who underwent micropulse transscleral cyclophotocoagulation. Patients were offered micropulse transscleral cyclophotocoagulation if they had perimetric glaucoma refractory to intraocular pressure–lowering topical medications and who were poor candidates for traditional filtering surgery. Eligible patients were treated with the Micropulse P3 device (IQ 810 Laser Systems; Iridex, Mountain View, CA, USA) at 2.0–2.5 W for a duration of 90 s per hemisphere at a 31.3% duty cycle. If a retreatment was needed, the power was increased to up to 3.0 W with other parameters remaining the same. Patients were considered successfully treated if their intraocular pressure was lowered by at least 20% compared to their baseline. The main outcome measure was post-operative intraocular pressure; secondary outcome measures included the number of adverse events and complications that occurred with treatment. Results: The glaucoma subtypes treated included primary open-angle glaucoma (n = 51), exfoliation glaucoma (n = 24), chronic angle-closure glaucoma (n = 15), and congenital/juvenile glaucoma (n = 5). The mean pre-operative intraocular pressure was 25.1 ± 5.3 mm Hg and the mean post-operative intraocular pressure at 12 months was 17.5 ± 5.1 mm Hg (p = 0.004). The mean number of intraocular pressure–lowering medications used preoperatively was 3.0 ± 1.1; the mean number of medications used at the 12-month post-operative visit was 1.4 ± 1.0 (p = 0.03). Success with one treatment was achieved in 73 (76.8%) of patients. With multiple treatments, all patients had significant intraocular pressure–lowering compared to baseline. The maximum number of treatments received by any single patient was 5. There were no instances of prolonged intraocular inflammation or long-term hypotony. Conclusion: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficacious treatment for glaucoma. Given its improved safety profile compared to continuous-wave transscleral cyclophotocoagulation, it deserves consideration as a primary procedure.

scholarly journals Intraocular Pressure-Lowering Potential of Subthreshold Selective Laser Trabeculoplasty in Patients with Primary Open-Angle Glaucoma

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Hong Yang Zhang ◽  
Yong Jie Qin ◽  
Yang Fan Yang ◽  
Jian Gang Xu ◽  
Min Bin Yu
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Initial Energy ◽  
The Other ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Pressure Lowering ◽  
Laser Flare

Purpose.To compare the efficacy of subthreshold and conventional selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in the patients with primary open-angle glaucoma (POAG).Methods.Fifty-two eyes from fifty-two POAG patients were randomized into two groups, one group treated with subthreshold SLT using two-thirds of the conventional energy and the other one treated with the conventional energy. IOP was measured with the Goldmann tonometer and the anterior chamber inflammation was determined using laser flare meter.Results.The initial energy dosage used in subthreshold SLT group was significantly lower than the amount of the energy used in conventional SLT group (0.4±0.1 mJ versus0.6±0.1 mJ,P=0.030). The total energy dosage was also significantly lower in subthreshold SLT group compared to the other group (37.6±3.3 mJ versus51.8±5.7 mJ,P=0.036). However, the level of inflammation in aqueous humor, amount of reduction in IOP, and the success rate in controlling IOP was the same in both groups.Conclusion.The efficacy of subthreshold SLT group in reducing IOP in POAG patients is comparable to the efficacy of conventional SLT group.

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