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 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 Suprachoroidal MIGS Devices

2020 ◽  
pp. 105-119
Author(s):  
Julian Garcia-Feijoo ◽  
Jose Maria Martinez-de-la-Casa ◽  
Lucia Perucho
Keyword(s):  
Glaucoma Surgery ◽  
Cell Loss ◽  
Term Efficacy ◽  
Suprachoroidal Space ◽  
Early Results ◽  
Outflow Pathway ◽  
Implanted Devices ◽  
Ab Interno

Abstract The suprachoroidal outflow pathway has the potential to reduce intraocular pressure (IOP) significantly but has been associated with sight-threatening complications including severe and prolonged hypotony. Historically, suprachoroidal devices have been implanted ab externo requiring a conjunctival peritomy and scleral flap dissection. Additionally, the long-term efficacy of previous attempts to harness this space has been disappointing due to occlusion of implanted devices by fibrosis in the suprachoroidal space. More recently, there have been a number of suprachoroidal devices that are injected ab interno., including the CyPass Micro-Stent (Alcon Laboratories Inc., Fortworth, Texas, USA), the iStent Supra (Glaukos Corporation, San Clemente, CA, USA) and the MINIject (iSTAR Medical Isnes, Belgium). These have utilized a clear corneal entry, thereby sparing the conjunctiva. Early results with these ab-interno devices showed safety and efficacy in IOP-lowering that is similar to Schlemm’s canal minimally invasive glaucoma surgery devices and procedures. Despite the ab-interno approach, their long-term efficacy also seems to be limited by fibrosis. In addition, the first commercially available ab-interno suprachoroidal device, the CyPass Micro-Stent, has been voluntarily withdrawn globally by the manufacturer in August 2018, after 5-year follow-up data demonstrated a higher level of endothelial cell loss with the device than in controls. The iStent Supra and MINIject are not yet available commercially.

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.

Pooled Data Analysis of the Ahmed Baerveldt Comparison Study and the Ahmed Versus Baerveldt Study

2020 ◽  
pp. 109-114
Author(s):  
Alan D. Penman ◽  
Kimberly W. Crowder ◽  
William M. Watkins
Keyword(s):  
Clinical Trials ◽  
Intraocular Pressure ◽  
Data Analysis ◽  
High Risk ◽  
Randomized Clinical Trials ◽  
De Novo ◽  
Glaucoma Surgery ◽  
Pooled Data ◽  
The Individual ◽  
Selection Of

Data from 2 independent randomized clinical trials, the Ahmed Baerveldt Comparison (ABC) Study and the Ahmed Versus Baerveldt (AVB) Study, were pooled for analysis to determine whether the Ahmed-FP7 or the Baerveldt BG101-350 implant was more efficacious in the treatment of refractory or high-risk glaucoma. Both devices lowered intraocular pressure (IOP) and decreased the need for glaucoma medications. The Baerveldt group had a lower failure rate, lower rate of de novo glaucoma surgery, and lower mean IOP on fewer medications than the Ahmed group. However, Baerveldt implantation carried a higher risk of hypotony. The authors recommended that the selection of a device for a patient should be based on target IOP, compliance with medications, urgency for IOP lowering, surgeon familiarity with each device, and the surgeon’s personal outcomes with the individual devices.

Trabeculectomy and Tube Shunts

2013 ◽  
Author(s):  
Darrell WuDunn
Keyword(s):  
Wound Healing ◽  
Glaucoma Surgery ◽  
Aqueous Fluid ◽  
Filtering Bleb ◽  
Schlemm's Canal ◽  
Healing Response ◽  
Subconjunctival Space ◽  
Wound Healing Response ◽  
Tube Shunt ◽  
Aqueous Outflow

Trabeculectomy surgery is the most common operative procedure for managing glaucoma. Although the techniques have evolved over the decades, the basic procedure remains the same since filtering surgery was first performed a century ago: a scleral fistula enables aqueous fluid to drain into the subconjunctival space and create a bleb. Despite the long history of trabeculectomy surgery, the mechanisms of how aqueous fluid ultimately exits the eye after trabeculectomy are still not well characterized. Aqueous tube shunts are becoming more popular among glaucoma surgeons as an alternative to trabeculectomy in eyes with previously failed blebs or in eyes at high risk for bleb failure. Although the mechanism of aqueous outflow following tube shunt implantation may be similar to the mechanism after trabeculectomy, key differences exist that may be important for future developments in glaucoma surgery. Multiple potential routes of aqueous drainage exist for both trabeculectomy and tube shunt implants. Thus, aqueous drainage can be thought of as a complex system of pathways arranged in series and in parallel. In general, fluid flowing through any system will be directed according to the resistance along each potential pathway. After glaucoma surgery, the arrangement and resistance through these pathways will depend on the wound healing response (see Chapter 3), and thus the mechanism of aqueous drainage will alter as the wound healing response evolves. However, it is likely that one or 2 main routes of drainage will dominate as the tissue reaction stabilizes. When Cairns first described the trabeculectomy procedure, he argued that aqueous humor would flow out through the cut ends of Schlemm’s canal without subconjunctival drainage. However, as the procedure is currently performed, a filtering bleb is almost always created, and a block of trabecular meshwork is not consistently excised. Thus, modern trabeculectomy is a filtering procedure in which aqueous passes through the sclera into the subconjunctival space overlying the scleral flap. The existence of a filtering bleb does not eliminate the possibility of aqueous outflow through Schlemm’s canal into the aqueous veins. Indeed, tracer studies suggest that some aqueous enters the aqueous veins.

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.

Combined Circumferential Canaloplasty and Trabeculotomy Ab Interno with the OMNI Surgical System

2021 ◽  
pp. 1-9
Keyword(s):  
Intraocular Pressure ◽  
Trabecular Meshwork ◽  
New Technology ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Surgical Device ◽  
Outflow Pathway ◽  
Consequent Increase ◽  
Surgical System ◽  
Ab Interno

In the normal eye the conventional outflow pathway is responsible for the majority of aqueous humor egress and plays a key role in the maintenance of healthy intraocular pressure. However, in the glaucomatous eye pathologic changes to the pathway in the trabecular meshwork, Schlemm’s canal, and collector channel ostia can introduce abnormal resistance to outflow with consequent increase in intraocular pressure. The OMNI Surgical System (Sight Sciences, Menlo Park, CA USA) is a relatively new surgical device and the only one that combines two ab interno minimally invasive treatments in a single procedure, canaloplasty and trabeculotomy. This new technology allows surgeons to address outflow resistance wherever it may be, both proximally (juxtacanalicular trabecular meshwork and inner wall of Schlemm’s canal), and distally (Schlemm’s canal and the collector channels). This review covers several recent clinical studies of the OMNI device with the aim of collating what is known and what remains to be learned.

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