Effects of Glaukos® Trabecular Stent in the Treatment of Glaucoma

2013 ◽  
Vol 07 (01) ◽  
pp. 10 ◽  
Author(s):  
Pedro Arriola-Villalobos ◽  
Laura Morales-Fernández ◽  
José M Martínez-de-la-Casa ◽  
Julián García-Feijoó ◽  
◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Experimental Studies ◽  
Glaucoma Surgery ◽  
Clinical Results ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Serious Adverse Events ◽  
Effective Option

Micro-invasive glaucoma surgery (MIGS) is gaining interest in very recent years, due to a better safety profile and good tensional results, often associated to cataract surgery. Glaukos iStent® is the only FDA-approved device for micro-invasive glaucoma surgery. It connects the anterior chamber to Schlemm´s canal by bypassing the trabecular meshwork, increasing the outflow facility. The Glaukos iStent is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate open-angle glaucoma currently treated with ocular hypotensive medication. This article summarises the results of all the clinical and experimental studies published regarding iStent effectiveness and safety. Glaukos iStent, in conjunction with cataract surgery, is a safe and effective option in the treatment of open angle glaucoma, with a significant but modest IOP drop and a significant and more clinically relevant decrease in glaucoma medications, with no serious adverse events. Some aspects concerning the number of iStent used or other indications like ocular hypertension or secondary glaucoma remain under study, although good results in both clinical situations have been published. A new model of iStent has just been developed and its first clinical results are near to be published.

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.

Outcomes of micropulse transscleral cyclophotocoagulation in primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma

2020 ◽  
pp. 112067212091423 ◽  
Author(s):  
Oya Tekeli ◽  
Helin Ceren Köse
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Pseudoexfoliation Glaucoma ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean ◽  
Glaucoma Group

Purpose: The aim of this study is to compare the outcomes of micropulse transscleral cyclophotocoagulation between primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. Methods: Outcomes of 96 consecutive patients with refractory, end-stage glaucoma treated with micropulse transscleral cyclophotocoagulation were retrospectively reviewed. Follow-up examinations were performed on a regular basis until 12 months postoperatively. Surgical successes were defined as maintaining intraocular pressure ⩽18 mmHg and ⩾20% reduction in intraocular pressure (criteria A), ⩽15 mmHg intraocular pressure and ⩾25% reduction in intraocular pressure (criteria B), and ⩽12 mmHg intraocular pressure and ⩾30% reduction in intraocular pressure from baseline (criteria C). Results: Ninety-six eyes of 96 patients (50 (52%) females, 46 (48%) males) were included. Among all eyes, 32 were primary open-angle glaucoma, 30 were pseudoexfoliation glaucoma, and 34 were other types of secondary glaucoma. The mean age was 59.37 ± 11.45 (range: 20–91) years. The mean follow-up period was 14.2 ± 3.9 (range: 12–16) months. At 12 months, the success rates of primary open-angle glaucoma, pseudoexfoliation glaucoma, and secondary glaucoma group were 68.75%, 66.6%, and 64.7% (p = 0.185) for criteria A; 56.25%, 53.3%, and 50% (p = 0.153) for criteria B; and 43.75%, 43.3%, and 38.2% (p = 0.146) for criteria C. Four patients (12.5%) in primary open-angle glaucoma group, 5 patients (16.6%) in pseudoexfoliation glaucoma group, and 14 (41.2%) patients in other secondary glaucoma group required reoperation during the follow-up (p < 0.05). Conclusion: Micropulse transscleral cyclophotocoagulation is an equally effective method of lowering intraocular pressure in patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, and other types of secondary glaucoma. The rate of reoperation was higher in refractory secondary glaucoma patients.

One-year results of gonioscopy-assisted transluminal trabeculotomy: Evaluation of prognostic factors

2020 ◽  
pp. 112067212090871 ◽  
Author(s):  
Mehmet Ozgur Cubuk ◽  
Erkan Unsal
Keyword(s):  
Intraocular Pressure ◽  
Success Rate ◽  
Open Angle Glaucoma ◽  
Multivariate Logistic Regression Analysis ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Multivariate Logistic Regression ◽  
Surgical Success ◽  
Corrected Visual Acuity

Purpose: To present the results and complications of gonioscopy-assisted transluminal trabeculotomy in adults with open-angle glaucoma using our different approaches during and after surgery. Method: A retrospective comparative study was designed. Patients with regular 12-month follow-up history were included. Two groups were defined: group 1 comprised patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy surgery alone; group 2 included patients with open-angle glaucoma who underwent combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction. A 30% reduction in preoperative intraocular pressure or postoperative intraocular pressure below 18 mm Hg was considered as surgical success. The success rate, alteration in intraocular pressure, alteration in best-corrected visual acuity, alteration in the need for antiglaucomatous medications, surgical complications, and the need for additional glaucoma surgery were evaluated and compared between the groups. Multivariate logistic regression analysis was used to show the association between the surgical success and possible prognostic factors. Results: A total of 37 eyes fulfilled the inclusion criteria and were analyzed in this study. An overall mean decrease in intraocular pressure of 11.3 ± 9.3 mm Hg was shown at 12 months (p < 0.001). The medication-free surgical success rate was 37.8% (14/37), and the surgical success rate with medication was 91.8% (33/37) at 12 months. Surgical outcomes were similar between patients who underwent gonioscopy-assisted transluminal trabeculotomy alone and those who had combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction (p > 0.05). The most common postoperative complication was hyphemia (89.1%). There were no complications that threatened best-corrected visual acuity. Multivariate logistic regression analysis revealed one significant association between the presence of blood in Schlemm’s canal and surgical success (odds ratio = 1.47; 95% confidence interval = 1.25–1.68; p = 0.047). Conclusion: This study showed that the gonioscopy-assisted transluminal trabeculotomy procedure is an effective and minimally invasive form of glaucoma surgery. Its effect was related to intraoperative blood in Schlemm’s canal.

Comparison of Hypotensive Effect of Endotrabeculoectomy and Selective Laser Trabeculoplasty

2021 ◽  
pp. 19-25
Author(s):  
Olha V. Levytska ◽  
Igor Ya. Novytskyy
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Significant Difference ◽  
The Difference

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p < 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p < 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

scholarly journals Bilateral Pseudoexfoliation Deposits on Intraocular Lens Implants

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Elena Bonafonte Marquez ◽  
Sergio Bonafonte Royo
Keyword(s):  
Cataract Surgery ◽  
Intraocular Lens ◽  
Rare Case ◽  
Open Angle Glaucoma ◽  
Secondary Glaucoma ◽  
Pseudoexfoliation Syndrome ◽  
Open Angle ◽  
Common Cause

We present a rare case of bilateral pseudoexfoliative deposits on both intraocular lens (IOL) implants in an 83-year-old woman with no other associated pathology, 5 years after cataract surgery. Pseudoexfoliation syndrome is the most common cause of secondary open-angle glaucoma worldwide and these deposits are usually found on the natural lens. The fact that pseudoexfoliative deposits have been found on IOL implants implies the need for a thorough examination in pseudophakic patients, for it could be the only sign of secondary glaucoma.

scholarly journals Modern view of using gonioassociated trabeculotomy

2021 ◽  
pp. 77-82
Author(s):  
R.R. Fayzrakhmanov ◽  
◽  
M.E. Kalinin ◽  
M.M. Shishkin ◽  
O.A. Pavlovskiy ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Review Literature ◽  
Secondary Glaucoma ◽  
Maximum Effect ◽  
Open Angle ◽  
Minimally Invasive Glaucoma Surgery ◽  
Minimal Trauma

Purpose. Provide data on the use of gonioscopy-assisted transluminal trabeculotomy (GATT), reflecting its effectiveness and safety when using this technique in various patient models. Material and methods. To perform the review, literature sources which were searched through the PubMed and Scopus databases up to and including 2021, using the keywords "gonioassociated trabeculotomy", "minimally invasive glaucoma surgery", "primary open-angle glaucoma", "glaucoma", "secondary glaucoma". A total of 19 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 2013. Results. GATT can be used at various stages of glaucoma, but at the same time, the maximum effect of lowering intraocular pressure (IOP) is achieved in patients with an early or middle stage of glaucoma. There are also good results of using the GATT technique after vitreoretinal surgery, with the development of secondary glaucoma or ophthalmic hypertension. One of the advantages of GATT is that all manipulations are performed in the anterior chamber, which in turn makes it possible, if necessary, to perform reoperation after an unsuccessful ad-externo trabeculotomy without re-traumatizing the sclera and conjunctiva. It should be noted that the main complication in all studies is the hyphema, which is completely absorbed within a few days. Conclusion. Based on these studies, it can be concluded that the proposed GATT technique is relevant, and meets all modern standards of minimally invasive glaucoma surgery (MIGS): micro-incision, minimal trauma, is able to effectively reduce IOP, has a high level of safety and quick recovery. Key words: glaucoma, primary open-angle glaucoma, secondary glaucoma, gonioassociated trabeculotomy, minimally invasive glaucoma surgery, surgical treatment of glaucoma

scholarly journals Secondary glaucoma due to thrombosis of sigmoid and transverse sinus

2020 ◽  
Vol 17 (2) ◽  
pp. 142-146
Author(s):  
Vijaya Pai H. ◽  
Matta Rudhira Reddy
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Open Angle Glaucoma ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Secondary Glaucoma ◽  
Sigmoid Sinus ◽  
Open Angle ◽  
Relative Afferent Pupillary Defect ◽  
First Case

An 88-year-old female presented with redness in the left eye of one-month duration. On examination, the left eye showed 3 mm of proptosis with dilated and tortuous episcleral vessels and relative afferent pupillary defect. Intraocular pressure was 60 mmHg and showed open angles on gonioscopy with cup disc ratio of 0.8 in OS. A diagnosis of secondary open-angle glaucoma due to elevated episcleral venous pressure (EVP) was made. Magnetic resonance venogram revealed thrombosis of transverse and sigmoid sinus on the left side. This is the first case report of secondary open-angle glaucoma due to elevated EVP following thrombosis of transverse and sigmoid sinus.

Results of filtering bleb investigation by thermography method after glaucoma surgery

2021 ◽  
pp. 52-55
Author(s):  
N.V. Makashova ◽  
◽  
O.Y. Kolosova ◽  
Keyword(s):  
Intraocular Pressure ◽  
Correlation Coefficient ◽  
Temperature Difference ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Statistical Correlation ◽  
Ocular Response Analyzer ◽  
Open Angle ◽  
Visible Image ◽  
Filtering Bleb

Thermography is the method of noninvasive registration of visible image of own infrared radiation of the human body surface by special devices. The results of filtration bleb investigation, carried out by thermography method are presented in patients with open angle glaucoma in different terms after glaucoma surgery. Purpose. To execute an investigation of a filtration bleb in patients with open angle glaucoma in different terms after glaucoma surgery by method of thermography. Material and methods. 35 patients (35 eyes) with open angle glaucoma were examined after 1, 7 days, after 1-3-6 months after minimally invasive sinustrabeculectomy. Authors used thermal imaging Тesto 875-2i with SuperResolution technology and telephoto lens 9° x 7°. The bleb area and temperature were evaluated With IRSoft and Universal Desktop Ruler programmes. Intraocular pressure (corneal compensated) (IOPcc) was measured with Ocular Response Analyzer®, ORA. Investigation protocol included 2 groups. Group №1 - 15 patients (15 eyes) with moderate glaucoma. Group №2 – 20 patients (20 eyes) with advanced glaucoma. All patients went through glaucoma surgery, microinvasive sinustrabeculectomy. Management and recurrent examinations were carried out in 1 and 7 day after glaucoma surgery; then in 1, 3 and 6 months after surgery. Results. The IOP level was credibly lowered in all patients in all terms of management in comparison with the baseline IOP level. High statistical correlation was determined in patients of 1 group between IOPcc and the index of temperature difference (between filtering bleb and surrounding conjunctiva temperatures), correlation coefficient >0,7, in all management terms after surgery (in 1, 3, 6 months). In 2 group there was determined statistical correlation between IOPcc and index of temperature difference between filtering bleb and surrounding conjunctiva temperatures (Δ Тsc - Тfb) in 1 week, in 1 and 3 months after surgery. The same correlation coefficient was determined between filtering bleb temperature and Δ Тsc- Тfb in 6 months after surgery. Conclusion. Thermography is a safe and noninvasive method, that credibly detects temperature elevation in surgery zone, indicates IOP level raise and can predict starting of filtering bleb scarring. This method defines the necessity of needling procedure execution in different terms after surgery treatment and allows to control its effectiveness. Key words: open angle glaucoma, filtering bleb, scarring, thermography, corneal compensated intraocular pressure, Ocular Response Analyzer.

scholarly journals Combining Ab Interno Kahook Trabeculectomy with Gonioscopy-Assisted Transluminal Trabeculotomy Reduces Intraocular Pressure

2019 ◽  
Vol 184 (11-12) ◽  
pp. 934-936
Author(s):  
Jared R Widder ◽  
Joseph W Schmitz
Keyword(s):  
Intraocular Pressure ◽  
Surgical Technique ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Active Duty ◽  
Pharmacologic Therapy ◽  
Open Angle ◽  
Elevated Intraocular Pressure ◽  
Kahook Dual Blade ◽  
Ab Interno

Abstract Minimally invasive glaucoma surgery (MIGS) provides a safe option for individuals with mild to moderate open-angle glaucoma to reduce their need for pharmacologic therapy or more extensive ab externo surgeries. In this report, we describe a surgical technique using both the Kahook Dual Blade and Gonioscopy-assisted transluminal trabeculotomy (GATT), to treat a 23-year-old active duty female with idiopathic uveitis and subsequent corticosteroid-induced glaucoma who presented with consistently elevated intraocular pressure (IOP) measurements despite maximal pharmacologic interventions. This combination was effective in consistently lowering intraocular pressure for at least 12 months in a young, phakic, active duty patient with uveitis and steroid-responsive open-angle glaucoma.

scholarly journals The Effectiveness of First-Generation iStent Microbypass Implantation Depends on Initial Intraocular Pressure: 24-Month Follow-Up—Prospective Clinical Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Joanna Konopińska ◽  
Milena Kozera ◽  
Paweł Kraśnicki ◽  
Zofia Mariak ◽  
Marek Rękas
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Observation Time ◽  
Open Angle ◽  
Group I ◽  
Before And After ◽  
The Mean ◽  
Group Ii

Background. Evaluation of efficacy of the iStent trabecular bypass implant in reducing intraocular pressure (IOP) depending on the value pretreatment IOP and number of medications used before surgery in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PXG) and coexisting cataract. Methods. A prospective, uncontrolled, interventional case series. 72 patients, on a mean age of 72.42 ± 9.17, were divided into two groups depending on baseline IOP: group I < 26 mmHg and group II ≥ 26 mmHg. All subjects underwent ab interno implantation of a single iStent together with cataract surgery. Best-corrected visual acuity (BCVA), IOP, number of antiglaucoma medications, visual field, and number and type of complications were examined before and after surgery. Postoperative patients were followed up at 1, 7, and 30 days and 3, 6, 12, and 24 months. All the patients were washed out preoperatively as well as postoperatively. Results. The mean observation time was 20 months. The mean preoperative IOP was 21.03 ± 1.44 mmHg in group I and reduced to mean 15.60 ± 2.12 mmHg after operation. In group II, mean IOP reduced from 26.00 ± 0.00 to 18.56 ± 1.81 (p=0.003). Mean glaucoma medications decreased from 1.35 ± 0.65 to 0.29 ± 0.52 in group I (p<0.001) and from 2.89 ± 1.18 to 1.33 ± 1.50 in group II (p<0.001). At 24 months, medication reduction was significantly greater in group I than group II (p=0.026). Conclusions. Combined cataract surgery with implantation of iStent seems to be an effective procedure in patients with mild-to-moderate open-angle glaucoma and cataract. In patients with baseline IOP < 26 mmHg, surgery reduced IOP and medication use significantly declined to 2 years, with greater reductions achieved versus patients with baseline IOP ≥ 26 mmHg. This trial is registered with NCT03807869.

Sign in / Sign up

Export Citation Format

Share Document