scholarly journals Glaucoma Surgery Calculator: Limited Additive Effect of Phacoemulsification on Intraocular Pressure in Ab Interno Trabeculectomy

PLoS ONE ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. e0153585 ◽  
Author(s):  
Ashley E. Neiweem ◽  
Igor I. Bussel ◽  
Joel S. Schuman ◽  
Eric N. Brown ◽  
Nils A. Loewen
Keyword(s):  
Intraocular Pressure ◽  
Glaucoma Surgery ◽  
Additive Effect ◽  
Ab Interno Trabeculectomy ◽  
Ab Interno

scholarly journals Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

2020 ◽  
Vol 258 (12) ◽  
pp. 2775-2780 ◽  
Author(s):  
Yousef Al Yousef ◽  
Alicja Strzalkowska ◽  
Jost Hillenkamp ◽  
André Rosentreter ◽  
Nils A. Loewen
Keyword(s):  
Intraocular Pressure ◽  
Second Generation ◽  
Nearest Neighbor ◽  
Exact Matching ◽  
Close Match ◽  
Istent Inject ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
Ab Interno

Abstract Purpose To achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject) with ab interno trabeculectomy (T, Trabectome) by exact matching. Methods Fifty-three IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline intraocular pressure (IOP), the number of glaucoma medications, and glaucoma type, and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. Results A total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3 ± 5.1 mmHg and glaucoma medications of 2.7 ± 1.2 in each. IOP in IS2 was reduced to 14.6 ± 4.2 mmHg at 3 months and in T to a minimum of 13.1 ± 3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8 ± 9.0 mmHg and in T 14.2 ± 3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p < 0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0 ± 1.5 in IS2 and to 1.5 ± 1.4 in T. Conclusion T resulted in a larger and sustained IOP reduction compared with IS2 where a rebound occurred after 6 months to slightly above preoperative values.

scholarly journals Angle stability and outflow in excisional ab interno trabeculectomy with active versus passive chamber management

2017 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Susannah Waxman ◽  
Xiaobo Xia ◽  
Robert N Weinreb ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Glaucoma Surgery ◽  
Training Model ◽  
Training System ◽  
Angle Stability ◽  
Ab Interno Trabeculectomy ◽  
The Right ◽  
Ab Interno

Purpose: To compare the intraoperative angle stability and the postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork. The newer device has an active aspiration and irrigation port while the older requires viscoelastic to maintain the anterior chamber. We hypothesized that anterior segment optical coherence tomography (ASOCT) allows quantifying the intraoperative behavior in a microincisional glaucoma surgery (MIGS) pig eye training model. Methods: Twelve freshly enucleated porcine eyes were measured with ASOCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle in degrees. The right and left eye of pairs were randomly assigned 24 to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, 25 respectively. The aDBG had an irrigation and aspiration port while the pDBG required surgery 26 under viscoelastic. We performed the procedures using our MIGS training system with a 27 standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining 28 canalograms with fluorescent spheres. Results: In aDBG, the nasal angle remained wide open during the procedure at above 90° and 30 did not change towards the end (100±10%, p=0.9). In contrast, in pDBG, ACD decreased by 31 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% 32 (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG 33 and the pDBG (p=0.513). The average increase for the aDBG in the superonasal and inferonasal 34 quadrants was between 27 to 31% and for the pDBG between 15 to 18%. Conclusion: ASOCT demonstrated that active irrigation and aspiration improved anterior 36 chamber maintenance and ease of handling with the aDBG in this MIGS training model. The 37 immediate postoperative outflow was equally good with both devices.

scholarly journals Primary Outcomes of Combined Cataract Extraction Technique with Ab-interno Trabeculectomy  and Endoscopic Cyclophotocoagulation  in Patients with Primary Open Angle Glaucoma

2020 ◽  
Author(s):  
Juan Carlos Izquierdo ◽  
Josefina Mejias ◽  
Laura Cañola ◽  
Natalia Agudelo ◽  
Barbara Rubio
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Surgical Success ◽  
Corrected Visual Acuity ◽  
Ab Interno Trabeculectomy ◽  
The Mean ◽  
Best Corrected Visual Acuity ◽  
Ab Interno

Abstract Background: Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. Methods: A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. Inclusion criteria: 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP <14 mmHg either with no medications (complete success) or with medications (qualified success). Results: A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0±3.7 mmHg and postoperatively was 11.6±1.9 mmHg and 11.4±1.8 mmHg (P<0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9±1.4 to 0.56±1.05 at 9 month follow-ups (P<0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months.Conclusions: In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.

Ab interno trabeculectomy with the dual blade in juvenile open-angle glaucoma

2019 ◽  
pp. 112067211989244
Author(s):  
Albert S Khouri ◽  
Yan Zhu ◽  
Hadeel Sadek
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Purpose: To introduce the use of the Kahook Dual Blade in the treatment of juvenile open-angle glaucoma. Patients and methods: A 14-year-old male was presented with juvenile open-angle glaucoma in the left eye. Ab interno trabeculectomy was performed using a dual-blade device. Results: Intraocular pressure was reduced from 28 to 15 mmHg in the left eye after 18 months. There were no complications. Conclusion: Dual blade ab interno trabeculectomy is a promising alternate to goniotomy in the treatment of juvenile open-angle glaucoma.

scholarly journals Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up

2020 ◽  
pp. bjophthalmol-2020-315954
Author(s):  
Eamon Sharkawi ◽  
Daniel Josef Lindegger ◽  
Paul H Artes ◽  
Lydia Lehmann-Clarke ◽  
Mohamad El Wardani ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Success Rate ◽  
Outcome Measures ◽  
Complication Rate ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Polypropylene Suture ◽  
Pseudoexfoliative Glaucoma ◽  
Ab Interno

AimTo report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG).MethodsProspective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate.ResultsMean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p<0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%.ConclusionAt 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.

scholarly journals Short-Term Clinical Results of Ab Interno Trabeculotomy Using the Trabectome with or without Cataract Surgery for Open-Angle Glaucoma Patients of High Intraocular Pressure

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Handan Akil ◽  
Vikas Chopra ◽  
Alex S. Huang ◽  
Ramya Swamy ◽  
Brian A. Francis
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Clinical Results ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Short Term ◽  
Safety And Efficacy ◽  
Kaplan Meier ◽  
Ab Interno

Purpose. To assess the safety and efficacy of Trabectome procedure in patients with preoperative intraocular pressure (IOP) of 30 mmHg or higher. Methods. All patients who had underwent Trabectome stand-alone or Trabectome combined with phacoemulsification were included. Survival analysis was performed by using Kaplan-Meier, and success was defined as IOP ≤ 21 mmHg, 20% or more IOP reduction from baseline for any two consecutive visits after 3 months, and no secondary glaucoma surgery. Results. A total of 49 cases were included with an average age of 66 (range: 13–91). 28 cases had Trabectome stand-alone and 21 cases had Trabectome combined with phacoemulsification. Mean IOP was reduced from a baseline of 35.6 ± 6.3 mmHg to 16.8 ± 3.8 mmHg at 12 months (p<0.01∗), while the number of medications was reduced from 3.1 ± 1.3 to 1.8 ± 1.4 (p<0.01∗). Survival rate at 12 months was 80%. 9 cases required secondary glaucoma surgery, and 1 case was reported with hypotony at day one, but resolved within one week. Conclusion. Trabectome seems to be safe and effective in patients with preoperative IOP of 30 mmHg or greater. Even in this cohort with high preoperative IOP, the end result is a mean IOP in the physiologic range.

scholarly journals 12-month clinical outcomes of combined phacoemulsification and ab interno trabeculectomy for open-angle glaucoma in the United Kingdom

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252826
Author(s):  
Ejaz Ansari ◽  
Deva Loganathan
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Medication Use ◽  
Retrospective Chart Review ◽  
Mean Deviation ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Background/Objectives To describe intraocular pressure (IOP) and ocular hypotensive medication outcomes of combined phacoemulsification and ab interno trabeculectomy with the Kahook Dual Blade (KDB; New World Medical, Inc, Rancho Cucamonga, CA) in adults with cataract and open-angle glaucoma (OAG). Subjects/Methods Retrospective chart review of existing medical records. Data collected included intraocular pressure (IOP) and IOP-lowering medication use preoperatively and through up to 24 months postoperatively. Paired t-tests were utilized to compare preoperative to postoperative mean IOP and mean medications used. Results Data from 32 eyes of 26 subjects were analyzed. Subjects were predominantly Caucasian (25/26) had mean (standard error) age of 79.3 (1.2) years, and eyes had moderate-advanced OAG (mean visual field mean deviation -8.3 [1.3] dB). Mean IOP was 19.8 (0.8) mmHg at baseline and 15.5 (0.6) mmHg (p<0.0001) after mean follow-up of 11.5 (1.0) months; IOP reductions of ≥20% were achieved in 20/32 eyes (62.5%). Mean medication use declined from 2.4 (0.2) medications per eye at baseline to 0.5 (0.2) at last follow-up (p<0.0001); 23/32 eyes (71.9%) were medication-free at last follow-up. No vision-threatening complications were observed. Conclusions Combined phacoemulsification and ab interno trabeculectomy with the KDB safely provided mean IOP reductions of 21.7% and mean IOP medication reductions of 83% after mean follow-up of 12 months in eyes with moderate to advanced OAG. This procedure provides medication-independence in most eyes with statistically and clinically significant IOP reductions.

scholarly journals Intraocular Pressure Reduction in a Pigmentary Glaucoma Model by Goniotome Ab Interno Trabeculectomy

2018 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Priyal Shah ◽  
Hamed Esfandiari ◽  
Ying Hong ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ex Vivo ◽  
Pigmentary Glaucoma ◽  
Pressure Reduction ◽  
Outflow Facility ◽  
Intraocular Pressure Reduction ◽  
Ab Interno Trabeculectomy ◽  
Hematoxylin And Eosin ◽  
Anterior Segments ◽  
Ab Interno

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90&deg; of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90&deg; of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&amp;E) was obtained. Results: After the first 90&deg; TM excision, IOP was significantly lower in G (10.23&plusmn;2.39 mmHg, n=7) than C (20.04&plusmn;1.97mmHg, n=8, P&lt;0.01). Outflow facility in G (0.38&plusmn;0.07 &micro;l/min/mmHg) was higher than C (0.16&plusmn;0.02 &micro;l/min/mmHg, P&lt;0.01). After the second 90&deg; TM excision, IOP in G (6.46&plusmn;0.81 mmHg, n=7) was significantly lower than C (20.25&plusmn;1.66 mmHg, n=8, P&lt;0.001), while the outflow facility in G (0.50&plusmn;0.05 &micro;l/min/mmHg, n=7) was higher than C (0.16&plusmn;0.01 &micro;l/min/mmHg, n=8, P&lt;0.001). Compared to the first excision, excision of an additional 90&deg; did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90&deg; of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90&deg; can effectively restore outflow in pigmentary glaucoma.

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