New Technologies for Treating Glaucoma in Patients Undergoing Cataract Surgery

2009 ◽  
Vol 03 (02) ◽  
pp. 44 ◽  
Author(s):  
Joseph L Lin ◽  
Hylton R Mayer ◽  
◽  
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
New Technologies ◽  
Surgical Techniques ◽  
Cataract Extraction ◽  
Ocular Tissue ◽  
Effective Control ◽  
Visual Recovery ◽  
Glaucoma Drainage Implants ◽  
Low Rate

New surgical technologies, such as the ExPRESS™ shunt, iCath™ canaloplasty, Trabectome™ and endoscopic cyclophotocoagulation (ECP), have been developed to provide safe and effective control of intraocular pressure (IOP) while avoiding many of the complications associated with trabeculectomies or traditional glaucoma drainage implants. A benefit of some of the newer technologies, especially for patients for whom traditional glaucoma surgeries may not previously have been considered, is that they can be readily performed at the time of cataract extraction. Many surgeons are combining these new surgical techniques with cataract surgery because of the low rate of serious complications, limited manipulation of ocular tissue (especially the conjunctiva) and/or faster visual recovery than traditional glaucoma surgeries.

scholarly journals Femto Laser-Assisted Cataract Surgery

2020 ◽  
Author(s):  
Clemence Bonnet ◽  
Saba Al-Hashimi ◽  
Antoine P. Brézin ◽  
Dominique Monnet
Keyword(s):  
Femtosecond Laser ◽  
Cataract Surgery ◽  
New Technology ◽  
Intraoperative Complications ◽  
Surgical Techniques ◽  
Current Method ◽  
Cataract Extraction ◽  
Scientific Data ◽  
Conventional Surgery ◽  
Lens Fragmentation

Cataract is a leading cause of blindness in the world, and cataract extraction is one of the most commonly performed surgeries. Preferred surgical techniques have changed over the past decades with associated improvements in outcomes and safety. Phacoemulsification is a highly successful technique first introduced over 40 years ago. It is the current method of cataract surgery, with a very low reported rate of major complications and a frequency of overall intraoperative complications of less than 2%. Application of the femtosecond laser evolved to now assist in cataract surgery and has been termed FLACS (femtosecond laser-assisted cataract surgery) and occurs in three steps: corneal incisions (including optional limbal relaxing incisions to reduce astigmatism), anterior capsulotomy, and lens fragmentation. The remaining surgical steps still require the surgeon’s hands. The FLACS technique may have some advantages compared with conventional phacoemulsification. It remains however unclear whether FLACS is globally more efficient and safer than conventional surgery. The popularity of FLACS may also be limited by its higher cost compared with conventional surgery. The potential advantages of laser-assisted surgery are yet to be determined as FLACS technology is relatively new and in continuous evolution. This chapter reports scientific data as well as our own experience with this new technology. All the platforms currently available are described.

scholarly journals Evolution of cataract surgery: Smaller incision - less complications

2012 ◽  
Vol 69 (5) ◽  
pp. 385-388 ◽  
Author(s):  
Vladimir Draganic ◽  
Miroslav Vukosavljevic ◽  
Milorad Milivojevic ◽  
Mirko Resan ◽  
Nenad Petrovic
Keyword(s):  
Cataract Surgery ◽  
Surgical Techniques ◽  
Visual Outcome ◽  
Cataract Extraction ◽  
Extracapsular Cataract Extraction ◽  
Corneal Incision ◽  
Visual Rehabilitation ◽  
Operative Trauma ◽  
Iol Implantation

Background/Aim. Cataract surgery has become one of the safest procedures in medicine thanks to advances in technology and surgical techniques. Although minimal, we still witness different complications. The aim of this study was to compare visual outcome and complication rate in different techniques of cataract surgery, ie in cataract surgeries with various corneal incision width. Methods. The study included 3,457 consecutive patients, ie 4,670 eyes that had undergone cataract surgery. The used surgical techniques were: extracapsular cataract extraction, phacoemulsification/ forceps IOL implantation, phacoemulsification/ injector IOL implantation, microincision cataract surgery (MICS). Patient follow up was 6 months. Patients were evaluated for: visual aquity, corneal astigmatism, cellular reaction in the anterior chamber, IOL position. Results. Uncorrected visual aquity 30 days postoperatively was ? 0.5 in 30% of the eyes - ECCE; 54.7% of the eyes - phacoemulsification/forceps IOL implantation; 63.0% of the eyes - phacoemulsification/injector IOL implantation; 5/8 of the eyes - MICS. Endophthalmitis was detected in 0.15% of the eyes - ECCE and 0.1% of the eyes - phacoemulsification/forceps IOL implantation. In eyes with phacoemulsification/injector IOL implantation or microincision cataract surgery (MICS) there were no cases of endophthalmitis. After a 6-month period intraocular lens were dislocated in 7.2% of the eyes - ECCE, and 0.6% of the eyes - phacoemulsification/PMMA IOL. There was no IOL dislocation in other surgical techniques. Conclusion. Shorter corneal incision implies less complications, less operative trauma, faster visual rehabilitation and better visual outcome.

Treatment of Post-operative Inflammation following Cataract Surgery – A Review

2012 ◽  
Vol 06 (02) ◽  
pp. 98 ◽  
Author(s):  
Harminder S Dua ◽  
Richa Attre ◽  
◽  
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Cataract Surgery ◽  
Healthcare Providers ◽  
Surgical Techniques ◽  
Ocular Inflammation ◽  
Effective Control ◽  
Loteprednol Etabonate ◽  
Design Modification

Inflammation after cataract surgery, which can be persistent, remains an undesirable consequence despite many advances in surgical techniques. Although corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs) have traditionally been used to treat inflammation, prophylactically as well as post-operatively, there are no established guidelines for the treatment of inflammation induced by cataract surgery. The long-term use of corticosteroids has raised safety concerns, especially with regard to elevated intraocular pressure (IOP). This limitation of traditional corticosteroids led to the development of C-20 ester corticosteroids through retrometabolic drug design. This design modification allows the corticosteroid to be active at its site of action and then undergo predictable hydrolysis to inactive metabolites, resulting in reduced side effects. A review of studies published in the last 10 years indicates that C-20 ester corticosteroids provide effective control of post-cataract surgery inflammation without the elevation of IOP. Loteprednol etabonate ophthalmic suspension 0.5 % is the only topical C-20 ester corticosteroid approved for use in the treatment of corticosteroid-responsive inflammatory conditions including post-operative ocular inflammation. This corticosteroid, alone or in combination with NSAIDs, may provide effective and safe inflammation control, especially for high-risk patients, and may overcome concerns regarding side effects associated with traditional C-20 ketone corticosteroids. Ocular inflammation after cataract surgery presents healthcare providers with a treatment dilemma. While corticosteroids are traditionally the therapy of choice for inflammation, their long-term use for managing ocular inflammation can produce significant adverse events. This article discusses whether C-20 ester corticosteroids, alone or in combination with NSAIDs, offer effective treatment of post-cataract surgery inflammation while minimising adverse events.

Frequency of Pseudophakic Glaucoma in Patients with Cataract Surgery

2021 ◽  
Vol 15 (5) ◽  
pp. 1151-1153
Author(s):  
I. Abbas ◽  
A. M. Ahmed ◽  
S. M. Dayal ◽  
G. A. Sirhindi
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Cataract Extraction ◽  
Extracapsular Cataract Extraction ◽  
Fiber Layer ◽  
Cross Sectional ◽  
Department Of Ophthalmology ◽  
Keywords Cataract Surgery ◽  
Extracapsular Cataract Surgery ◽  
Layer Defect

Aim: To determine the frequency of pseudophakic glaucoma in patients who underwent cataract surgery. Study Design: Cross-sectional Place and Duration of Study: Department of Ophthalmology, Shaikh Zayed Hospital Lahore from 1st July 2020 to 31st December 2020. Methodology: Ninety five patients of both genders with cataract surgery were enrolled and ages between 45 to 75 years. After taking written consent detailed demographics including age, sex, body mass index, intraocular pressure, and mode of surgery were recorded. Pseudophakic glaucoma was labelled in case of cataract surgery with intraocular lens implantation and intraocular pressure >21 mmHg or more in one eye along with glaucomatous optic disc or retinal nerve fiber layer defect on optical coherence tomography (OCT). Results: There were 58 (61.05%) males and 37 (38.95%) patients were females. Mean ages of patients were 62.36±9.44 years. Sixty two (65.26%) patients had extracapsular cataract extraction and 33 (34.74%) patients had phacoemulsification. Mean intraocular pressure was 19.33±8.56 mmHg. Pseudophakic glaucoma was found in 32 (33.68%) patients. Conclusion: The frequency of pseudophakic glaucoma was high in patients with extracapsular cataract surgery. Keywords: Cataract surgery, Pseudophakic glaucoma, Intraocular pressure (IOP)

scholarly journals Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case—control Study

2017 ◽  
Vol 11 (3) ◽  
pp. 107-112 ◽  
Author(s):  
Georgios Bontzos ◽  
Michail Agiorgiotakis ◽  
Efstathios T Detorakis
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Case Control Study ◽  
Cataract Extraction ◽  
Control Group ◽  
Pressure Lowering ◽  
Long Term Follow Up ◽  
Control Study

ABSTRACT Aim In this study, we reviewed demographics and biometric characteristics among patients receiving chronic β-blockers and prostaglandins (PGs) for primary open-angle glaucoma. We compared the age at the time of cataract surgery in different patient groups and in a control group which was not under any medication. Materials and methods Retrospective chart review of glaucomatous patients who underwent cataract extraction at the Department of Ophthalmology of the University Hospital of Heraklion, Crete, Greece, between January 1998 and December 2016 was done. Age at cataract surgery, axial length (AL), and preoperative and postoperative best-corrected visual acuities (BCVAs) were recorded. A cohort of patients without glaucoma who were operated for cataract extraction was also evaluated. Results In all, 320 patients were reviewed. There were significant results in mean age difference between the beta-antagonist and the PG group [3.05 years, 95% confidence interval (CI) 1.54-4.57] and between the beta-antagonist group with the patients receiving a combined therapy (3.02 years, 95% CI 1.14-4.91). No significant difference was found between the PG and the combination group. All the three treated groups had a significant lower mean age than the control group at the time of cataract surgery. Conclusion Based on our study, we concluded that there might be a possible association between chronic treatment with beta-antagonist agents and earlier cataract surgical time in the treated eye. Clinical significance Intraocular pressure control is often usually achieved using ophthalmic agents. Their topical and systemic effects should be monitored precisely. Earlier cataract formation might be an important side effect which the physician has to keep in mind before choosing the suitable medication. How to cite this article Bontzos G, Agiorgiotakis M, Detorakis ET. Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case—control Study. J Curr Glaucoma Pract 2017;11(3):107-112.

Endoscopic Goniotomy

2012 ◽  
Vol 05 (01) ◽  
pp. 33
Author(s):  
Marc Töteberg-Harms ◽  
Peter P Ciechanowski ◽  
Jens Funk ◽  
◽  
◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Trabecular Meshwork ◽  
Surgical Techniques ◽  
Filtering Surgery ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Elevated Intraocular Pressure ◽  
Excimer Laser Trabeculotomy ◽  
Over Time

Usually an elevated drainage resistance is responsible for elevated intraocular pressure (IOP) in glaucoma, while aqueous humor production is still normal. Therefore, currently there are great efforts to develop surgical techniques that enhance the conventional outflow through the trabecular meshwork and Schlemm’s canal and into the episcleral veins. One of these techniques is excimer laser trabeculotomy (ELT). ELT is easy to perform at the end of cataract surgery. The duration of cataract surgery is only prolonged by 2–3 minutes. IOP can be reduced by up to 34.7 %. It is known that the effect of IOP reduction is constant over time, unlike argon or selective laser trabeculoplasty. The procedure is also very safe. If required later, filtering surgery is not compromised because there is no conjunctival touch during ELT and therefore no scarring of the conjunctiva is induced. For a selected cohort of glaucoma patients, this procedure may avoid the need for trabeculectomy.

scholarly journals Safety and efficacy of microinvasive glaucoma surgery with cataract extraction in patients with normal-tension glaucoma

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Enchi Kristina Chang ◽  
Sanchay Gupta ◽  
Marika Chachanidze ◽  
Nathan Hall ◽  
Ta Chen Chang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Success Probability ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Normal Tension Glaucoma ◽  
Mechanisms Of Action ◽  
Safety And Efficacy

AbstractThis study assesses the safety and efficacy of microinvasive glaucoma surgery (MIGS) with cataract extraction in patients with normal-tension glaucoma (NTG). In our sample of 45 NTG patients, mean intraocular pressure (IOP) decreased from 13.7 to 12.3 mmHg at 2.5 years, and mean medication burden decreased from 2.0 to 1.1 at 1.5 years. For success defined as IOP reduction ≥ 30% from baseline IOP with medication burden reduction from preoperative levels, success probability was 5.4% at 1.5 years. For success defined as medication burden reduction with an IOP reaching goal IOP as determined by the glaucoma specialist, success probabilities were 67.2% at 1.5 years and 29.4% at 2.5 years. At the last follow-up visit, eyes with two MIGS procedures with different mechanisms of action achieved successful medication reduction 68.8% of the time versus 35.7% achieved by a single MIGS procedure (p = 0.052). At their last visit, visual acuity was unchanged or improved in all eyes (100%). MIGS with cataract surgery results in modest reductions in IOP and medication burden in NTG patients, which may lead to lower costs and better therapeutic compliance. A combination of two MIGS procedures with different mechanisms of action may potentially be more effective in reducing medication burden than a single MIGS procedure in NTG patients. Further research is necessary to ascertain whether MIGS for NTG patients may help decrease medication burden while helping achieve goal IOP.

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