Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

Background: Pilocarpine is commonly used after angle surgery for glaucoma despite a host of side effects and risks. We hypothesized that a pharmacological miosis during the first two months does not improve short- and long-term results of trabectome-mediated ab interno trabeculectomy. Methods: In this retrospective comparative 1-year case series, we compared 187 trabectome surgery eyes with (P+) or without (P-) 1% pilocarpine for two months. Primary outcome measures were the surgical success defined as intraocular pressure (IOP) ≤ 21 mmHg and decreased ≥ 20%, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, and IOP. Results: We categorized 86 (46%) eyes as P- and 101 (54%) eyes as P+. The mean age was 69.8±10.1 in P- and 70.5±9.4 in P+ (P=0.617) with equal gender distribution (P=0.38). The cumulative probability of qualified success at 12 months was 78.1% in the P- and 81% in the P+ (P=0.35). The IOP was decreased significantly from 20.2±6.8 mmHg at baseline to 15.0±4.8 mmHg at 12 months follow-up in P- (P=0.001) and 18.8±5.3 and 14.7±4.0, respectively (P=0.001). The medications decreased significantly from 1.4±1.2 in P- and 1.4±1.2 in P+ at baseline to 1.0±1.2 and 0.7±1.0, respectively (P=0.183). P- and P+ did not differ in IOP or medications (all P>0.05). In Multivariate Cox Regression models, the baseline IOP and central corneal thickness were associated with failure. Conclusions: Use of postoperative pilocarpine does not improve the efficacy of trabectome surgery.

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Impact of Same-Session Trabectome Surgery on Ahmed Glaucoma Valve Outcomes

10.20944/preprints201802.0017.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Tarek Shazly ◽

Priyal Shah ◽

Kiana Hassanpour ◽

Pooya Torkian ◽

...

Keyword(s):

Survival Rates ◽

Case Series ◽

Glaucoma Surgery ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Cumulative Probability ◽

Ahmed Glaucoma Valve ◽

Trabectome Surgery ◽

Hypertensive Phase ◽

One Year

Purpose: To evaluate the efficacy and survival rates of same session ab interno trabeculectomy with the trabectome and Ahmed glaucoma valve implant (AT) in comparison to the Ahmed glaucoma valve alone (A). Method: A total of 107 eyes undergoing primary glaucoma surgery were enrolled in this retrospective comparative case series, including 48 eyes which underwent AT and 59 eyes which received A alone. Participants were identified using the procedural terminology codes, and their medical records were reviewed. The primary outcome measure was surgical success, defined as intraocular pressure (IOP) > 5 mmHg, ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline at two consecutive visits after three months, no reoperation for glaucoma. Secondary outcome measures were IOP, the number of glaucoma medications, incidence of a hypertensive phase, and best corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 70% in AT, and 65% in A (p=0.85). IOP decreased significantly from 26.6 ± 10.1 mmHg at baseline to 14.7 ± 3.3 mmHg at the final follow-up in AT (p= 0.001). The corresponding numbers for A were 28.8 ± 10.2 and 16.7 ± 4.9, respectively (p= 0.001). The final IOP was significantly lower in AT (p= 0.022). The number of medications at baseline was comparable in both groups (2.6 ± 1.2 in AT and 2.5 ± 1.3 in A, p=0.851). Corresponding number at 1 year visit was 1.2±2 in AT and 2.8±1.8 in A (p=0.001). The incidence of a hypertensive phase was 18.7% in AT and 35.5% in A (p=0.05). HP resolved in only 30% of eyes. The criteria for HP resolution were fulfilled in 9 eyes (30%). There was no difference in the rate of resolution of the hypertensive phase between AT and A (33.3% and 28.5%, respectively, p=0.67). Conclusion: Ahmed glaucoma valve implant with same session trabectome surgery significantly decreased the rate of the hypertensive phase and postoperative IOP as well as the number of glaucoma medications.

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Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

F1000Research ◽

10.12688/f1000research.15244.2 ◽

2018 ◽

Vol 7 ◽

pp. 876

Author(s):

Hamed Esfandiari ◽

Nils A. Loewen ◽

Kiana Hassanpour ◽

Ali Fatourechi ◽

Shahin Yazdani ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Outcome Measures ◽

Rare Complication ◽

Case Series ◽

Secondary Outcome ◽

Final Visit ◽

Cumulative Probability ◽

Ahmed Glaucoma Valve ◽

Significant Difference

Background: The aim of this study was to compare the safety and efficacy of primary trabeculectomy with mitomycin C and Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC)-related glaucoma, a rare complication of an uncommon form of uveitis. Methods: In this retrospective comparative case series, 26 FHIC-associated glaucoma patients received trabeculectomy (n=12) or an AGV (n=14). Primary outcome measures were surgical success, defined as intraocular pressure (IOP) ≤21 mmHg, decreasing ≥20% from baseline, and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and IOP. Results: The follow-up was 34.0±17.7 months in patients that received trabeculectomy and 33.4±18.6 months in AGV (P= 0.837). The cumulative probability of success rate was 41.7% for trabeculectomy and 85.7% for AGV, with no significant difference in complications (P>0.05). The IOP in patients that received trabeculectomy dropped from 23.4±3.3 mmHg to 21.6±5.2 mmHg at the final visit (P= 0.041). In patients that received AGV, the IOP decreased from 24±7.8 to 17.1±2.6 mmHg (P= 0.003). The number of glaucoma medications at baseline were 3.3±0.5 in those that received trabeculectomy and 3±0.6 in those that received AGV (P=0.233), and decreased to 2.4±1.0 (P=0.008) and 1.7±0.6 (P=0.002), respectively. BCVA was equal in both groups and did not change (P>0.05). Conclusion: Primary AGV had a higher success rate than trabeculectomy, with patients also needing fewer medications for the management of FHIC-associated glaucoma.

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Fuchs heterochromic iridocyclitis-associated glaucoma: a retrospective comparison of primary Ahmed glaucoma valve implantation and trabeculectomy with mitomycin C

F1000Research ◽

10.12688/f1000research.15244.1 ◽

2018 ◽

Vol 7 ◽

pp. 876 ◽

Cited By ~ 3

Author(s):

Hamed Esfandiari ◽

Nils A. Loewen ◽

Kiana Hassanpour ◽

Ali Fatourechi ◽

Shahin Yazdani ◽

...

Keyword(s):

Success Rate ◽

Mitomycin C ◽

Outcome Measures ◽

Rare Complication ◽

Case Series ◽

Secondary Outcome ◽

Final Visit ◽

Cumulative Probability ◽

Ahmed Glaucoma Valve ◽

Significant Difference

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Coarsened Exact Matching of Trabectome Surgery Combined with Baerveldt to Baerveldt: Same Session Trabectome Negates Tube Fenestration

10.20944/preprints201811.0211.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Kiana Hassanpour ◽

Peter Knowlton ◽

Tarek Shazly ◽

Mehdi Yaseri ◽

...

Keyword(s):

Survival Rates ◽

Case Series ◽

Glaucoma Surgery ◽

Secondary Outcome ◽

Cumulative Probability ◽

Eye Drops ◽

Exact Matching ◽

Coarsened Exact Matching ◽

Significant Difference

Purpose: To evaluate the efficacy and survival rates of trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implants (BT) in comparison to Baerveldt glaucoma implant alone (B).Method: A total of 175 eyes undergoing primary glaucoma surgery (60 eyes BT and 115 B) were enrolled in this retrospective comparative case series. Participants were identified using the procedural terminology codes. Groups were then matched using Coarsened Exact Matching (51 eyes in each group). The primary outcome measure was surgical success, defined as 5 mmHg < IOP ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no reoperation for glaucoma. Secondary outcome measures were intraocular pressure, the number of glaucoma medications, and best corrected visual acuity (BCVA).Results: The cumulative probability of success at one year was 61% in BT, and 50% in B. IOP decreased significantly from 23.5±2.4 mmHg at baseline to 14.1±2.7 mmHg at the final follow up in BT (P= 0.001). The corresponding numbers for B were 23.2± 2.0 and 13.9± 1.6, respectively (P= 0.001). There was no significant difference in IOP at the final follow-up (P=0.56). The number of medications at baseline was 2.3±0.3 in both groups. However, BT needed significantly fewer drops at all postoperative time intervals and used 1.1±0.3 (BT) and 2.0±0.4 eye drops (B) at the final follow-up visit (P= 0.004). No dangerous hypotony or hypertension occurred in BT.Conclusion: Similar rates of success and IOP reduction were observed in BT and B. BT needed significantly fewer glaucoma medications. Tube fenestration was not necessary in BT resulting in less postoperative hypotony and hypertension.

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Combining Baerveldt Implant with Trabectome Negates Tube Fenestration: A Coarsened-matched Comparison

Journal of Ophthalmic and Vision Research ◽

10.18502/jovr.v15i4.7789 ◽

2020 ◽

Author(s):

Hamed Esfandiari ◽

Kiana Hassanpour ◽

Peter Knowlton ◽

Tarek Shazly ◽

Mehdi Yaseri ◽

...

Keyword(s):

Case Series ◽

Glaucoma Surgery ◽

Secondary Outcome ◽

Cumulative Probability ◽

Eye Drops ◽

Exact Matching ◽

Significant Difference ◽

Baerveldt Glaucoma Implant ◽

One Year

Purpose: To assess the efficacy and survival rate of the Trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implant compared with the Baerveldt glaucoma implant alone. Method: In this retrospective comparative case series, 175 eyes undergoing primary glaucoma surgery (Baerveldt–Trabectome [BT] group: 60 eyes and Baerveldt [B] group: 115 eyes) were included. Participants were identified using the procedural terminology codes. Groups were then matched by Coarsened Exact Matching that resulted in the inclusion of 51 eyes in each group. The primary outcome measure was surgical success defined as 5 mmHg < intraocular pressure (IOP) ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no need to reoperation for glaucoma. Secondary outcome measures were IOP, number of glaucoma medications, and best-corrected visual acuity (BCVA). Results: The cumulative probability of success at one year was 61% in the BT group and 50% in the B group. IOP decreased from 23.5 ± 2.4 mmHg at baseline to 14.1 ± 2.7 mmHg at the final follow-up in the BT group (P = 0.001). The corresponding values for the B group were 23.2 ± 2.0 mmHg and 13.9 ± 1.6 mmHg, respectively (P = 0.001). There was no significant difference between the groups in terms of IOP at the final follow-up (P = 0.56). The number of medications at baseline was 2.3 ± 0.3 in both groups. However, the BT group needed fewer drops at all postoperative time intervals and used 1.1 ± 0.3 versus 2.0 ± 0.4 eye drops (group B) at the final follow-up visit (P = 0.004). Eyes in B with phacoemulsification had a significantly higher IOP on day 1 compared to B (23.2 ± 14.3 versus 17.9 ± 11.4, P = 0.041). During the one-year follow-up, 7 (13.7%) patients in BT group and 18 (35.2%) in B group experienced hypotony (P = 0.04). No dangerous hypotony or hypertension occurred in BT group. The mean BCVA at baseline was 0.64 ± 0.85 logMAR and changed to 0.55 ± 0.75 logMAR in BT and B groups, respectively (P = 0.663). The corresponding numbers for the final follow-up visit was 0.72 ± 1.07 and 0.63 ± 0.97 logMAR, respectively (P = 0.668). Conclusion: We observed similar rates of success and IOP reduction using BT and B techniques. BT group needed fewer glaucoma medications. Tube fenestration was unnecessary in BT group resulting in less postoperative ocular hypotony and hypertension. The results of our study indicate that additional trabectome procedure makes Baerveldt glaucoma implant safer, easier to handle, and more predictable in the most vulnerable patients with advanced glaucoma.

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Long-Term Clinical Results of Trabectome Surgery

10.21203/rs.3.rs-599761/v1 ◽

2021 ◽

Author(s):

Yasemin Un ◽

Cihan Buyukavsar ◽

Dogukan Comerter ◽

Murat Sonmez

Keyword(s):

Risk Factors ◽

Glaucoma Surgery ◽

Long Term Results ◽

Cumulative Probability ◽

Kaplan Meier ◽

Increased Risk ◽

Trabectome Surgery ◽

The Mean

Abstract Purpose: To analyze the long-term results of trabectome surgery and to characterize risk factors for failure.Method: This is a single-center retrospective study including 66 eyes of 56 patients who underwent trabectome alone (TA) or phacotrabectome (TP) surgeries between 2012-2016. Surgical success was defined as intraocular pressure (IOP) drop by 20% or IOP ≤21 mmHg and no further glaucoma surgery. Risk factors for further surgeries were analyzed with Cox proportional hazard ratio models. Cumulative success analysis of subgroups was completed with the Kaplan Meier analysis.Results: Mean follow-up period was 59.7±14.1 months. During the follow-up period, 15 of 62 (24.2%) eyes had additional glaucoma surgery. The mean preoperative IOP was 26.8±6.5 mmHg. The mean last visit IOP was 18.7±4.5 mmHg (p<0.01). IOP decreased 30.1% from baseline at the last visit. Average numbers of medications used were 3.42 ±0.76 (range 1-4) and 2.45±1.33 (range 0-4) at preoperative and last visit, respectively (p<0.01). The risk factors for further surgery requirements were higher baseline IOP (HR:1.12, p:0.01), higher central corneal thickness (CCT) (HR:1.01, p:0.04), and higher amounts of preoperative drugs (HR:2.22, p:0.08). The cumulative probability of success was 93.5%, 90.5%, 85.5%, 80.6%, and 77.4% at 3, 12, 24, 36, and 60 months, respectively. Kaplan Meier survival plots indicating the time of additional glaucoma surgery in the subgroups showed higher survival probability in primary open angle glaucoma (POAG), males, phacotrabectome cases, early stage glaucoma, and eyes without previous glaucoma surgery. Conclusion: Trabectome success ratio was 50% at 59 months. Higher baseline IOP and thicker CCT are associated with an increased risk of further glaucoma surgery.

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A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

International Journal of Otolaryngology ◽

10.1155/2010/643123 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Samantha Anne ◽

Lawrence M. Borland ◽

Laura Haibeck ◽

Joseph E. Dohar

Keyword(s):

Outcome Measures ◽

Pediatric Patients ◽

Conscious Sedation ◽

Treatment Plan ◽

Tertiary Care ◽

Case Series ◽

Diagnostic Information ◽

Secondary Outcome ◽

Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

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The Management of Otitis Media with Early Routine Insertion of Grommets in Children with Cleft Palate—A Systematic Review

The Cleft Palate-Craniofacial Journal ◽

10.1597/07-219.1 ◽

2009 ◽

Vol 46 (1) ◽

pp. 30-38 ◽

Cited By ~ 50

Author(s):

Sirisha Ponduri ◽

Rebecca Bradley ◽

Pamela E. Ellis ◽

Sara T. Brookes ◽

Jonathan R. Sandy ◽

...

Keyword(s):

Systematic Review ◽

Language Development ◽

Cleft Palate ◽

Cohort Studies ◽

Outcome Measures ◽

Case Series ◽

Secondary Outcome ◽

Speech And Language ◽

Historical Cohort ◽

Speech And Language Development

Objective: To determine whether early routine grommet insertion in children with cleft palate has a beneficial effect on hearing and speech and language development compared with conservative management. Design: Systematic review of randomized controlled trials, controlled clinical trials, case series, and prospective and historical cohort studies. Main Outcome Measures: The main outcome measure was the effect of early routine grommet placement on the degree of conductive hearing loss. Secondary outcome measures included differences in hearing level, possible side effects, speech and language development, and quality of life. Results: We identified 368 citations for review. From a review of the titles, 34 potentially relevant papers were selected. Of these, 18 studies met our inclusion criteria, including eight case series, six historical cohort studies, three prospective cohort studies, and one randomized trial. Most studies were either small or of poor quality or both. The results of the studies were contradictory, with some studies suggesting early placement of grommets was beneficial and others reporting there was no benefit. Conclusions: There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.

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Five-Year Clinical Outcomes of Trabectome Surgery at a Single Glaucoma Center

10.20944/preprints201804.0248.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Priyal Shah ◽

Pooya Torkian ◽

Ian P. Conner ◽

Joel S. Schuman ◽

...

Keyword(s):

Risk Factors ◽

Success Rate ◽

Retention Rate ◽

Case Series ◽

Series Data ◽

Cumulative Probability ◽

Single Center ◽

Trabectome Surgery ◽

Ab Interno

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, or >20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0±5.6 mmHg at baseline to 15.6±4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8±1.2, which decreased to 1.0±1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

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Independent assessment and outcomes of 196 short-tapered stems short-term follow-up and review of the literature

Journal of Orthopaedic Surgery ◽

10.1177/2309499018812236 ◽

2018 ◽

Vol 26 (3) ◽

pp. 230949901881223 ◽

Cited By ~ 5

Author(s):

Sam Nahas ◽

Akash Patel ◽

Nicola Blucher ◽

Vikas Vedi

Keyword(s):

Outcome Measures ◽

Case Series ◽

Outcome Data ◽

Secondary Outcome ◽

Complication Rates ◽

Short Term ◽

Safe Alternative ◽

Term Outcome ◽

Patient Reported

Background: Longer term outcome data are now becoming available for short-tapered femoral stems for cementless total hip arthroplasty. The shorter stem has a metaphyseal fit, loading the bone in this area, leading to physiological bone remodelling. It is also bone preserving, as it is 35 mm shorter. It may be easier to insert through a smaller incision and potentially reduce complication rates. We present a retrospective single surgeon case series of 196 patients (>53% follow-up over 5 years). All patients had the cementless ‘Microplasty Taperloc’ (Biomet). Primary outcome measures were femoral component revision rates. Secondary outcome measures included complications, patient-reported functional outcome scores (Oxford hip) and radiographic evidence of loosening. Methods: Patients were identified using electronic software. All were routinely followed up and assessed in clinic since implant introduction in 2009. Oxford hip scores were routinely obtained. A surgeon who had not carried out the procedure independently assessed radiographs. Results: One hundred ninety-six patients were identified. The revision rate was 0.5% due to an intraoperative peri-prosthetic fracture of the femur identified on post-operative radiograph. The complication rate was 2%, attributable to: subsidence of the prosthesis (one hip), post-operative dislocation (two hips), one of which required acetabular revision. Oxford hip scores increased on average from 21 to 45 (pre- to post-operatively). There were no signs of radiographic loosening. Conclusion: The results show that using the short-tapered stem is proving so far to be a reliable and safe alternative to its longer counterpart, with low complication rates in the short term.

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