scholarly journals Current surgical methods for advanced glaucoma

2013 ◽  
Vol 154 (52) ◽  
pp. 2052-2058
Author(s):  
Gábor Holló
Keyword(s):  
High Pressure ◽  
Intraocular Pressure ◽  
Surgical Treatment ◽  
Glaucoma Surgery ◽  
Pressure Level ◽  
Filtering Surgery ◽  
Glaucoma Drainage Devices ◽  
Surgical Methods ◽  
Advanced Glaucoma ◽  
Target Pressure

The author summarizes the most effective types of glaucoma surgery in advanced glaucoma. In high pressure advanced glaucoma a low target intraocular pressure is to be set. The most effective method of reaching this target pressure level is mitomycin C trabeculectomy combined with effective pre- and postoperative antiinflammatory treatment. However, in several cases glaucoma filtering surgery gradually fails due to increased episcleral fibrosis. In these cases use of long-tube glaucoma drainage devices is recommended. In Hungary use of the Ahmed implant has provided favourable clinical outcome even in the most complicated, high pressure, advanced glaucoma cases. Modern types of surgical treatment of advanced glaucoma need to be known by non-ophthalmologist physicians for more than a decade. This may help them to propose the optimal treatment modality to their glaucoma patients. Orv. Hetil., 2013, 154(52), 2052–2058.

scholarly journals A New Angle on Angle Surgery

2017 ◽  
Vol 11 (01) ◽  
pp. 40
Author(s):  
Rhys Davies ◽  
Mei-Ling Cheng ◽  
Andrew J Tatham ◽  
◽  
◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
High Risk ◽  
Visual Loss ◽  
Glaucoma Surgery ◽  
Filtering Surgery ◽  
Advanced Glaucoma ◽  
Outflow Pathway ◽  
Tube Shunt ◽  
Aqueous Outflow ◽  
Ab Interno

Glaucoma surgery has long relied on ab externo techniques such as augmented trabeculectomy and tube-shunt procedures. While these have excellent potential to lower intraocular pressure (IOP), they are associated with risks, including hypotony, and are therefore conventionally reserved for those with advanced glaucoma or at high risk of visual loss. Traditional filtering surgery attempts to bypass the eye’s physiological outflow pathway, however new minimally invasive glaucoma surgery (MIGS) procedures have recently been introduced that focus on the angle structures as a target for improving aqueous outflow. There are a growing number of ab interno MIGS procedures that utilise the natural drainage pathways of the eye in the management of glaucoma. This article examines the progress so far and describes how the angle has become a viable target for glaucoma surgery.

scholarly journals Cataract Surgery Combined with Trabecular MIGS (Minimally Invasive Glaucoma Surgery)

2020 ◽  
Author(s):  
Marina Aguilar González ◽  
Jorge Vila Arteaga ◽  
Jose Marí Cotino
Keyword(s):  
Intraocular Pressure ◽  
Minimally Invasive ◽  
Cataract Surgery ◽  
Excimer Laser ◽  
Aqueous Humor ◽  
Trabecular Meshwork ◽  
Glaucoma Surgery ◽  
Minimally Invasive Glaucoma Surgery ◽  
Advanced Glaucoma ◽  
Physiological Approach

Cataract surgery decreases significantly and with maintained effect intraocular pressure (IOP) in both normal eyes as in eyes with glaucoma. In patients with cataracts and glaucoma, it can be performed, isolated or in combination with other techniques, such as the following: minimally invasive glaucoma surgery (MIGS) in patients with mild/moderate glaucoma that do not require a high tensional decrease; and conventional glaucoma surgery techniques in patients with advanced glaucoma. Although lower than with conventional techniques, MIGS trabecular surgery has a good IOP lowering effect and provides some of the following advantages: a more physiological approach; little traumatic; without bleb; and it does not limit other techniques in the future. Different techniques that combinated or not with cataract surgery facilitate the exit of aqueous humor through the trabecular meshwork (TM) have been described. Our aim in this chapter is to review the newest of them, such as the following: iStent; ELT (Excimer Laser Trabeculostomy); kahook; ABiC; and OMNI.

scholarly journals Drainage devices in refractory glaucoma surgery

2019 ◽  
Vol 12 (3) ◽  
pp. 85-93
Author(s):  
S. I. Anisimov ◽  
S. Yu. Anisimova ◽  
L. L. Arutyunyan ◽  
A. P. Voznyuk
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Glaucoma Surgery ◽  
Long Term Results ◽  
Refractory Glaucoma ◽  
Eye Tissues ◽  
Surgical Methods ◽  
Methods Of Treatment ◽  
Fibroblastic Activity

Glaucoma is a socially sensitive disease, being one of the leading causes of irreversible visual impairment and blindness. Refractory glaucoma is one of the most severe forms of the disease as it is resistant to conservative and surgical methods of treatment. Because of pronounced postoperative fibroblastic activity of eye tissues, leading to gross scarring and obliteration of outflow paths, modern materials and methods of drainage surgery are needed. The review presents a variety of drains used today and considers in detail their main characteristics and the biocompatibility of the material used with eye tissues. Various groups of implants are presented, whose effectiveness and safety are compared and assessed. The statistics of postoperative complications and long-term results of surgical treatment are given.

iStent inject as a reasonable alternative procedure following failed trabeculectomy?

2018 ◽  
Vol 28 (6) ◽  
pp. 735-740 ◽  
Author(s):  
Anja-Maria Davids ◽  
Milena Pahlitzsch ◽  
Alexander Boeker ◽  
Necip Torun ◽  
Eckart Bertelmann ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Wilcoxon Test ◽  
Open Angle ◽  
Istent Inject ◽  
Glaucoma Therapy ◽  
Significant Difference ◽  
Target Pressure

Purpose: The aim of this study is to assess the intraocular pressure lowering effect and the performance of the glaucoma therapy of the iStent inject in glaucoma patients with uncontrolled intraocular pressure after failed trabeculectomy. Methods: In this retrospective study, iStent inject implantation (Glaukos Corporation, Laguna Hills, CA, USA) was performed in 22 eyes of 21 subjects suffering from glaucoma (n = 18 primary open angle glaucoma, n = 3 pseudoexfoliation glaucoma, and n = 1 for secondary glaucoma) with an intraocular pressure above target pressure after failed trabeculectomy (mean = 9.6 ± 8.1 years; range: 1–35 years). The intraocular pressure and the number of antiglaucomatous medication were assessed preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1 year after surgery and compared to preoperative findings (SPSS v23.0; Shapiro–Wilk test, Wilcoxon test, Friedman test). Results: The results showed a significant intraocular pressure decrease from 22.5 ± 4.6 to 15.5 ± 3.4 mmHg after 1 year follow-up (p = 0.012). The glaucoma therapy was 2.6 ± 1.2 preoperatively and reduced to 2.25 ± 1.5 number of medications after 1 year (p > 0.05). There was no significant difference in the number of medication during the whole follow-up period (1 year, p = 0.012). No significant intra- or postoperative complications were reported. Conclusion: Minimal invasive glaucoma surgery (iStent inject) can offer an effective intraocular pressure reduction in advanced adult primary and secondary open angle glaucoma after failed trabeculectomy in a follow-up period of 1 year. Glaucoma therapy, however, needs to be maintained to achieve an individual target pressure and to prevent glaucoma progression. In addition, a failure rate of 27.3% makes it necessary to select carefully patients for this treatment option.

scholarly journals Combined Visco-Trab operation: A dual filtration pathway for management of advanced glaucoma—midterm results

2021 ◽  
Author(s):  
Tarek M. Eid ◽  
Ezz El-Din M. Ibrahim ◽  
Ahmad Zaid
Keyword(s):  
Intraocular Pressure ◽  
Visual Field ◽  
Glaucoma Surgery ◽  
Mean Deviation ◽  
Efficacy And Safety ◽  
Light Perception ◽  
Target Level ◽  
Midterm Results ◽  
Advanced Glaucoma

Abstract Purpose To study midterm efficacy and safety of combined Visco-Trab operation for management of advanced glaucoma. Methods 168 eyes of 148 patients with advanced glaucoma had Visco-Trab operation (a merge of both viscocanalostomy and trabeculectomy operations). Mean follow-up was 29.1 ± 22.2 months. Criteria of success were intraocular pressure (IOP) of 14 mmHg or less with or without glaucoma medications, with no devastating complications, loss of light perception, or additional glaucoma surgery. Results IOP, number of glaucoma drops, and visual field mean deviation were significantly reduced (11.9 ± 5.6 mmHg, 0.7 ± 1.2, and 14.2 ± 6.3 dB, compared to preoperative values of 24.4 ± 9.9 mmHg, 2.8 ± 1.4, and 17.3 ± 6.3 dB, respectively). Success was reported in 136 of 168 eyes (81%) without (100 eyes, 59.5%) or with (36 eyes, 21.5%) glaucoma medications. A functioning bleb was seen in 2/3rd of eyes; diffuse (59 eyes, 35%) and thin ischemic (54 eyes, 32%). Predictors for failure to achieve the target IOP included previous ocular (p = 0.01) or glaucoma (p = 0.04) surgery, number of preoperative glaucoma medications (p = 0.029), and severity of glaucoma (p = 0.058). Conclusion Combined Visco-Trab operation proved safe and effective, on midterm follow-up, in reducing IOP to the proposed target level in eyes with severe glaucoma via enhancing internal and external filtration.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

scholarly journals Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions

Eye ◽  
2021 ◽  
Author(s):  
Inês C. F. Pereira ◽  
Rosanne van de Wijdeven ◽  
Hans M. Wyss ◽  
Henny J. M. Beckers ◽  
Jaap M. J. den Toonder
Keyword(s):  
Anterior Chamber ◽  
Aqueous Humour ◽  
Alternative Pathway ◽  
Glaucoma Surgery ◽  
Future Directions ◽  
Plate Design ◽  
Glaucoma Drainage Devices ◽  
Abnormal Increase ◽  
Preventable Blindness ◽  
Glaucoma Implants

AbstractGlaucoma is a progressive optic neuropathy that is the second leading cause of preventable blindness worldwide, after cataract formation. A rise in the intraocular pressure (IOP) is considered to be a major risk factor for glaucoma and is associated with an abnormal increase of resistance to aqueous humour outflow from the anterior chamber. Glaucoma drainage devices have been developed to provide an alternative pathway through which aqueous humour can effectively exit the anterior chamber, thereby reducing IOP. These devices include the traditional aqueous shunts with tube-plate design, as well as more recent implants, such as the trabeculectomy-modifying EX-PRESS® implant and the new minimally invasive glaucoma surgery (MIGS) devices. In this review, we will describe each implant in detail, focusing on their efficacy in reducing IOP and safety profile. Additionally, a critical and evidence-based comparison between these implants will be provided. Finally, we will propose potential developments that may help to improve the performance of current devices.

scholarly journals Ologen augmentation of Ahmed glaucoma drainage devices in pediatric glaucomas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adam Jacobson ◽  
Carin Rojas ◽  
Brenda L. Bohnsack
Keyword(s):  
Intraocular Pressure ◽  
Pediatric Patients ◽  
Survival Rates ◽  
Collagen Matrix ◽  
Ahmed Glaucoma Valve ◽  
Limited Data ◽  
Conventional Surgery ◽  
Glaucoma Drainage Devices ◽  
Hypertensive Phase

Abstract Background Limited data exists on the effectiveness of the collagen matrix, Ologen, on increasing Ahmed glaucoma valve (AGV) success in childhood glaucomas. Methods Ocular examination and surgical details of pediatric patients who underwent AGV placement ± Ologen augmentation between 2012 and 2020. Complete success was defined as intraocular pressure (IOP) between 5 and 20 mmHg without glaucoma medications and additional IOP-lowering surgeries. Qualified success was defined as above, except IOP control maintained with or without glaucoma medications. Results Twenty-two eyes of 16 patients underwent AGV placement of which 6 eyes had Ologen-augmentation (OAGV) and 16 eyes had conventional surgery (CAGV). Average age was 6.4 ± 5.1 years with 4.2 ± 2.5 follow-up years. There was no difference in age, number of previous surgeries, and preoperative IOP and glaucoma medications. At final follow-up, success rate was 100% (5 eyes complete, 6 eyes qualified) in the OAGV group compared to 31% (0 eyes complete, 5 eyes qualified) in the CAGV group. One and two-year survival rates were 100% for OAGV compared to 62 and 38% for CAGV. Postoperative IOP was significantly lower at 1-month and final follow-up (p = 0.02) as was the number of glaucoma medications at 3, 6, 12-months and final follow-up (p < 0.05) in the OAGV group. Conclusions Ologen-augmentation increased the success and survival rates of AGVs in childhood glaucomas. Further, Ologen mitigated the hypertensive phase and decreased medication dependency. Longer follow-up with a greater number of eyes is required to fully evaluate the effectiveness of OAGV.

Sign in / Sign up

Export Citation Format

Share Document