Comparison of the Clinical Efficacy of Draining Autovalve Limbosclerectomy and Trabeculectomy in the Treatment of Primary Open-Angle Glaucoma with Long-Term Follow-Up

Purpose: to evaluate the immediate and long-term hypotensive efficacy, the number of complications, and the clinical benefits of a draining autovalve limbosclerectomy (DALS) performed using a kit of disposable instruments in patients with POAG of various stages in comparison with trabeculectomy (TE).Patients and Methods. The study is based on the analysis of the clinical and functional condition of 127 eyes of 127 patients with primary open-angle glaucoma (stage I POAG was detected in 2 eyes, stage II in 30 eyes, stage III in 88 eyes and stage IV in 7 eyes). Patients were divided into groups: the main group—76 people who underwent DALS using a set of disposable instruments, and the control group—51 people who underwent TE. The average age of patients is 68.9 ± 10.3 years. Before and within 24 months after surgery, all patients underwent standard diagnostic examinations. The initial level of IOP against the background of the maximum antihypertensive mode varied from 24 to 50 mm. Hg. According to gonioscopy, the angle of the anterior chamber was open in all cases (III–IV degree). Patient exclusion criteria: history of laser or surgical treatment of glaucoma, cataract treatment.Results. After 24 months of follow-up after DALS, the level of IOP in patients with stage I–II of POAG was 14.19 ± 1.83 mm Hg and with III–IV stage of POAG 14.95 ± 2.15 mm Hg, compensation was achieved in 88.2 % of patients without the use of antihypertensive drops. After TE, compensation was received in 72.6 % of patients, the IOP level was 16.9 ± 2.21 and 17.78 ± 2.31 mm Hg. respectively (p < 0.01). After DALS surgery, a decrease in the number of complications was revealed in comparison with TE: a decrease in сiliochoroidal detachment by 9.1 %, hyphema by 2.5 %, ophthalmic hypertension in the early p/o period by 3.2 %, cystic changes in the filtering bleb by 7.1 %.Conclusion. The standardized DALS operation using a disposable tool kit is a new highly effective and safe method for the surgical treatment of glaucoma. DALS may be the operation of choice in the treatment of POAG of all stages.

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Analysis of changes in structural and hemodynamic parameters of the retina and foveolar avascular zone in patients with primary open-angle glaucoma and diabetes mellitus observed in long-term follow-up

National Journal glaucoma ◽

10.53432/2078-4104-2021-20-3-59-77 ◽

2021 ◽

Vol 20 (3) ◽

pp. 59-77

Author(s):

A. Zh. Fursova ◽

Y. A. Gamza ◽

O. G. Gusarevich ◽

A. S. Derbeneva ◽

M. V. Vasilyeva ◽

...

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Stage I ◽

Hemodynamic Parameters ◽

Open Angle ◽

Avascular Zone ◽

Long Term Follow Up ◽

Group 3

PURPOSE. To study the changes in structural and hemodynamic parameters of the retina and foveolar avascular zone (FAZ) over time in patients with primary open-angle glaucoma (POAG) and diabetes mellitus (DM) observed in long-term follow-up.MATERIALS AND METHODS. The study included 258 patients (258 eyes) divided into five groups: group 1 — 58 patients (58 eyes) with stage I POAG and DM; group 2 — 50 patients (50 eyes) with stage I POAG; group 3 — 50 patients (50 eyes) with stage III POAG and DM; group 4 — 50 patients (50 eyes) with stage III POAG; group 5 — 50 patients (50 eyes) with DM. Patients underwent comprehensive ophthalmological examination, spectral domain optical coherence tomography (SD-OCT), optical coherence tomo-graphy angiography (OCT-A) of the macular region. The follow-up lasted 24 months.RESULTS. Analysis of the initial parameters in groups of patients with comorbidities showed the lowest values compared to controls, which were progressively worsening. MD in the group with DM + stage I POAG had reliably decreased after 12 months (by 5.05%), after 24 months by 12.12% (p≤0.05). The speed of GCL+IPL loss in groups 1 and 3 during the first year of observation was almost equal for initial and advanced glaucoma — 1.35 (-2.03%) and 1.32 (-2.36%) µm/year, but in group 3 the loss had doubled after two years (2.48 (-4.44%) and 1.41 (2.12%) µm/year). Deterioration of hymodynamic parameters in the macular region in groups 1 and 3 was noted primarily in the inner sectors (whole image vessel density in parafovea (PF wiVD) -0.79% during the first, and -2.57% during the second year in initial glaucoma, -0.6% and -1.24% in advanced, whole image vessel density in parafovea (PF wiVD) -0.2% and -1.22%, -0.66% and -1.56%, respectively). Parameters of FAZ had changed significantly after 2 years in patients with stage I POAG and DM: its area size had increased by 10.2%, perimeter by 4.49%, circularity index had decreased by 3.17%.CONCLUSION. Comorbidity of POAG and DM is accompanied by development and quick progression of significant changes in structural and hemodynamic parameters of the retina as observed by this long-term follow-up.

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Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

Journal of Ophthalmology ◽

10.1155/2015/795357 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 25

Author(s):

Antonio Maria Fea ◽

Giulia Consolandi ◽

Marta Zola ◽

Giulia Pignata ◽

Paola Cannizzo ◽

...

Keyword(s):

Cataract Surgery ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Control Group ◽

Open Angle ◽

Long Term Follow Up ◽

Baseline Values ◽

The Mean

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone.Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment.Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p=NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p=0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p=0,005in the combined group andp=0,01in the control group).Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with:NCT00847158.

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Long-term Follow-up of Diode Laser Trabeculoplasty for Primary Open-angle Glaucoma and Ocular Hypertension

Ophthalmology ◽

10.1016/s0161-6420(93)31428-4 ◽

1993 ◽

Vol 100 (11) ◽

pp. 1614-1618 ◽

Cited By ~ 13

Author(s):

Anthony P. Moriarty ◽

J. Dominic A. McHugh ◽

Timothy J. ffytche ◽

John Marshall ◽

A.M. Peter Hamilton

Keyword(s):

Ocular Hypertension ◽

Diode Laser ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Laser Trabeculoplasty ◽

Long Term Follow Up

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To Compare the Effect on IOP Following Primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i43b32577 ◽

2021 ◽

pp. 475-480

Author(s):

Zakaullah Gopang ◽

Shabeer Ahmed Bhutto ◽

Naeem Akhtar Katpar ◽

Arslan hassan Rajper ◽

Vijay Nagdev

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Test Group ◽

Control Group ◽

Open Angle ◽

Primary Procedure ◽

Group A ◽

Group B ◽

Medical University

Objective: To determine the effect on intraocular pressure following primary Trabeculectomy with MMC 0.2% versus Trabeculectomy without MMC in Primary Open Angle Glaucoma. Study Design: This is a prospective and experimental Study. Setting: Study carried out at Ophthalmology Department, Shaheed Mohtarma Benazir Bhutto Medical University Larkana, from 01-03-2020 to 31-08-2020 (06 Months). Materials and Methods: The patients with primary open angle glaucoma were selected from glaucoma clinic after taking careful history and clinical examination. Patients selected for trabeculectomy into two groups. Group A includes 43 patients while Group B also includes 43 patients. Among Group A patients adjunctive MMC 0.2mg/ml for a period of 3 minutes was used during trabeculectomy as a primary procedure (Test Group) while Group B patients were operated without MMC 0.2% (Control Group). Follow-up period of 06 months was observed in both groups. The span of study was from 01-03-2020 to 31-08-2020. Results: The total of 86 Eyes of 86 patients of POAG were included in this study. Group A patients were operated for trabeculectomy with MMC while group B patients were operated for trabeculectomy without MMC. The mean IOP before surgery of Group-A was 25.39±2.42 mmHg while in Group-B it was 26.23±4.23mmHg. At day 1 of surgery in Group-A patients IOP was 13.20±3.05 mmHg while in Group-B patients IOP, was 14.09±4.04 mmHg. After 3 months in Group-A, IOP was 13.04±3.81 mmHg in Group-B IOP was 14.01±4.18 mmHg. Out of 43 patients in Group-A, 41(95.3%) were succeeded while in Group-B, 39(90.7%)were succeeded. Significant result was found for IOP reduction after 6 months of surgeryin group-A IOP was 13.48 + 2.86 mmHg while in group-B, IOP was 15.09 ±2.64 (P=0.754). Conclusion: Trabeculectomy with MMC as a primary procedure seems to be more effective than trabeculectomy without MMC.

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Long-Term Follow-Up of Argon Laser Trabeculoplasty in Uncontrolled Primary Open-Angle Glaucoma

Ophthalmologica ◽

10.1159/000310104 ◽

1990 ◽

Vol 200 (4) ◽

pp. 181-188 ◽

Cited By ~ 7

Author(s):

M. Amon ◽

R. Menapace ◽

U. Radax ◽

A. Wedrich ◽

Ch. Skorpik

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Argon Laser ◽

Open Angle ◽

Argon Laser Trabeculoplasty ◽

Laser Trabeculoplasty ◽

Long Term Follow Up

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DEVELOPMENT OF PRIMARY OPEN-ANGLE GLAUCOMA AND DELETION POLYMORPHISM OF THE GLUTATHIONE-S-TRANSFERASE GENES

EUREKA Health Sciences ◽

10.21303/2504-5679.2020.001289 ◽

2020 ◽

Vol 3 ◽

pp. 27-32

Author(s):

Artem Burdei

Keyword(s):

Null Allele ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Stage Iv ◽

Null Alleles ◽

Control Group ◽

Open Angle ◽

Glutathione S Transferase ◽

Deletion Polymorphism ◽

Gstt1 Gene

The aim of the research. To investigate the association of the development of primary open-angle glaucoma with deletion polymorphism of glutathione-S-transferase genes. Materials and methods. Under our observation there were 172 patients, residents of Ukraine with primary open-angle glaucoma I–IV stages. Analysis of the deletion polymorphism of GSTM1 and GSTT1 genes was performed by real-time polymerase chain reaction using unified TaqMan Mutation Detection Assays Life-Technology (USA) test systems. Statistical analysis of the obtained data was performed using the MedStat package and the statistical package MedCalc v.15.1 (MedCalc Software bvba). Results and discussion. The detection of null alleles of the GSTM1 gene was observed in 39 % of patients in the control group, in patients with POAG a significant increase in the frequency of deletion polymorphism to 50–56 % was observed with the progression of the disease in stages II-IV. In patients with stage IV disease, the effect of the zero GSTM1- null allele on POAG course was determined (χ2=3.97; p=0.047), and the null allele of GSTM1 doubled the probability of developing the disease (OR=2.01; 95 % CI=1.01–4.01) in patients of group 4 compared with control. The null allele of the GSTT1 gene in the control group was found in 31 %, an increase in the frequency of the GSTT1-null allele was also observed in the second and fourth stages of POAG from 41 % to 54 %. Statistically significant differences of GSTT1 gene allele frequencies were determined between the control group and all patients with POAG (χ2=4.43; p=0.03), between the control and the 4th group (χ2=7.64; p=0.01), and between the 1st and 4th groups (χ2=5.52; p=0.02). An association with the development of POAG (χ2=4.43; p=0.03) was determined for the deletion polymorphism of the GSTT1 gene when comparing the control group with the data of all patients with POAG (1–4 groups). At stratification by stages of POAG (that is, by groups of patients), an association with the development of POAG was determined only in patients of group 4 (χ2=7.64; p=0.01) compared with the control group. Conclusions. The association of the null allele of the GSTT1 gene with POAG was established (p=0.03). The presence of the GSTT1-null allele significantly increased the risk of developing POAG (OR=1.75; BI=1.04–2.96) compared with the control group. The presence of null alleles (GSTM1-null and GSTT1-null) of the GST deletion polymorphism significantly increased the risk of stage IV POAG (OR=2.01; BI=1.01–4.01 and OR=2.66; VI=1.32–5.37, respectively) compared with the control group, which indicated the effect of zero alleles on the rapid progression of the disease.

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Comparison of the Effectiveness of Antiglaucomatous Surgeries with Various Glautex Drainage Models

Ophthalmology in Russia ◽

10.18008/1816-5095-2019-1s-91-95 ◽

2019 ◽

Vol 16 (1S) ◽

pp. 91-95 ◽

Cited By ~ 1

Author(s):

I. I. Khusnitdinov ◽

A. E. Babushkin

Keyword(s):

Surgical Treatment ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Hypotensive Effect ◽

Main Group ◽

Control Group ◽

Open Angle ◽

The Third ◽

Total Failure ◽

The Absolute

Purpose: comparative study of trabeculectomy results with various models of domestic “Glautex” drainage in the surgical treatment of primary open angle glaucoma (POAG). Patients and methods. The results of surgical treatment of 98 (105 eyes) patients with POAG aged 50–83 years who underwent trabeculectomy with various Glautex drainage models were analyzed. There were 43 men (43.9 %) and 55 (56.1 %) women. The second (II) stage of POAG was diagnosed in 49 eyes (46.7 %), the third (III) stage in 56 (53.3 %). All patients were divided into 3 groups. The first (main) group consisted of 34 (37 eyes) patients who underwent trabeculectomy in combination with the implantation of Glautex DDA drainage model. The second (main) group included 29 (30 eyes) patients with trabeculectomy and implantation of the SDA model of this drainage. The third group was the control group and consisted of 35 (38 eyes) patients with the classical method of surgery without using any drainage. Results. There was a significant 71.7 % decrease in IOP compared with baseline data in the 1st patients group after antiglaucomatous surgery, 72 and 74 % decrease was in the 2nd and 3rd groups respectively (p < 0.05). An increase in IOP was noted predominantly in the control and in the second study group within 1 month of follow-up. Normalization of ophthalmotonous pressure was achieved by using needling in 13.3 % (4/30) patients in the second group, in 7.9 % (6/38) cases in the control group. The absolute hypotensive effect in the 1st group was noted in 75.7 % of cases; the relative hypotensive effect was in 8.1 %; total failure was in 16.2 %. In the 2nd group the absolute hypotensive effect of the surgery was in 73.3 % of 30 cases, the relative was in 6.7 %, total failure was in 20 %. In the control group (38 eyes), absolute success was in 63.1 %, the relative hypotensive effect was in 13.2 %, and the total failure was in 23.7 %. Conclusion. Trabeculectomy with Glautex drainage and with various models in case of primary open-angle glaucoma provided a sufficiently high relative hypotensive effect in 82 % of cases in a year after the surgery. The achieved surgery outcomes with this drainage in the studied periods did not depend on applied model: DDA or SDA (83.8 and 80 % respectively), but was higher than the classical trabeculectomy (76.3 %). However, in case of the SDA model, needling was required in 13.3 % of cases in the early postoperative period.

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Surgical stimulation of uveoscleral outflow is an alternative to cyclodestructive procedures

Clinical ophthalmology ◽

10.32364/2311-7729-2021-21-1-9-13 ◽

2021 ◽

Vol 21 (1) ◽

pp. 9-13

Author(s):

E.A. Korchuganova ◽

◽

A.Yu. Kazantzeva ◽

Keyword(s):

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Secondary Glaucoma ◽

Open Angle ◽

Uveoscleral Outflow ◽

Surgical Stimulation ◽

Diode Laser Cyclophotocoagulation ◽

Stimulation Of

Aim: to assess clinical efficacy and safety of surgical scleral rejection (SSR) vs. transscleral diode laser cyclophotocoagulation (TSCPC) in primary open-angle glaucoma (POAG) and secondary glaucoma (SG). Patients and Methods: study (prospective) group included 84 patients with POAG and SG after SSR. Control (retrospective) group included 80 patients after TSCPC. In addition, the patients were distributed by age and the stage and type of glaucoma, i.e., 128 patients were diagnosed with POAG and 36 patients were diagnosed with secondary thrombotic glaucoma. Follow-up was 24 to 36 months. IOP measurements, tonography (to assess the coefficient outflow facility / COF), ultrasound biomicroscopy of the anterior segment, visual acuity measurement, and visual field testing were performed. Results: no complications after SSR were reported in patients with POAG and SG. In contrast, postoperative complications (choroidal effusion, hyphema, and uveitis) were reported in 14% of patients after TSCPC. Long-term IOP-lowering efficacy of both procedures was similar (87% after SSR and 89% after TSCPC). In POAG, greater IOP reduction was seen after TSCPC (by 39.11%) compared to SSR (by 31.58%) (p<0.05). Meanwhile, in patients with SG, treatment outcomes were similar (IOP reduced by 36.78% after TSCPC and by 35.26% after SSR). In longterm follow-up, PVF reduced by 10.76% vs. baseline after TSCPC but increased by 11.19% vs. baseline after SSR (p≤0.05). Surgery resulted in the improvement or stabilization of visual functions. Ultrasonography has demonstrated that outflow pathways (intrascleral space and filtering bleb) remain functional after SSR in long-term follow-up. Conclusion: SSR is an alternative to cyclodestructive procedures in POAG and SG. Sclera being the final point of the uveoscleral outflow is a perspective entity to develop surgical approaches to glaucoma treatment. Keywords: surgical scleral resection, uveoscleral outflow, sclera, primary open-angle glaucoma, secondary glaucoma, glaucoma surgery, transscleral diode laser cyclophotocoagulation. For citation: Korchuganova E.A., Kazantzeva A.Yu. Surgical stimulation of uveoscleral outflow is an alternative to cyclodestructive procedures. Russian Journal of Clinical Ophthalmology. 2021;21(1):9–13. DOI: 10.32364/2311-7729-2021-21-1-9-13.

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Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

Eye and Vision ◽

10.1186/s40662-021-00263-1 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Ali Salimi ◽

Harrison Watt ◽

Paul Harasymowycz

Keyword(s):

Cataract Surgery ◽

First Generation ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Open Angle ◽

Long Term Outcomes ◽

Surgical Success ◽

Rnfl Thickness

Abstract Background The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up. Methods This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events. Results A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease. Conclusions Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

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