scholarly journals Outflow Enhancement by Three Different ab Interno Trabeculectomy Procedures in a Porcine Anterior Segment Model

2018 ◽  
Author(s):  
Yalong Dang ◽  
Chao Wang ◽  
Priyal Shah ◽  
Susannah Waxman ◽  
Ralitsa T. Loewen ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Segment ◽  
Structure And Function ◽  
Outflow Facility ◽  
Segment Model ◽  
Perfusion Model ◽  
Ab Interno Trabeculectomy ◽  
Anterior Segments ◽  
And Function ◽  
Ab Interno

Objective: To evaluate three different microincisional ab interno trabeculectomy procedures in a porcine eye perfusion model. Methods: In perfused porcine anterior segments, 90 degrees of trabecular meshwork (TM) were ablated using the Trabectome (T; n = 8), Goniotome (G; n = 8), or Kahook device (K; n = 8). After 24 hours, additional 90 degrees of TM were removed. Intraocular pressure (IOP) and outflow facility were measured at 5 µL/min and 10 µL/min perfusion to simulate an elevated IOP. Structure and function were assessed with canalograms and histology. Results: At 5 µL/min infusion rate, T resulted in a greater IOP reduction than G or K from baseline (76.12% decrease versus 48.19% and 47.96%, P = 0.013). IOP reduction between G and K was similar (P = 0.420). Removing another 90 degrees of TM caused an additional IOP reduction only in T and G but not in K. Similarly, T resulted in the largest increase in outflow facility at 5 µL/min compared with G and K (first ablation: 3.41 times increase versus 1.95 and 1.87; second ablation: 4.60 versus 2.50 and 1.74) with similar results at 10 µL/min (first ablation: 3.28 versus 2.29 and 1.90 (P = 0.001); second ablation: 4.10 versus 3.01 and 2.01 (P = 0.001)). Canalograms indicated circumferential flow beyond the ablation endpoints. Conclusions: T, G and K significantly increased the outflow facility. In this model, T had a larger effect than G and K.

scholarly journals Outflow Enhancement by Three Different ab Interno Trabeculectomy Procedures in a Porcine Anterior Segment Model

2018 ◽  
Author(s):  
Yalong Dang ◽  
Chao Wang ◽  
Priyal Shah ◽  
Susannah Waxman ◽  
Ralitsa T. Loewen ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Anterior Segment ◽  
Structure And Function ◽  
Outflow Facility ◽  
Segment Model ◽  
Perfusion Model ◽  
Ab Interno Trabeculectomy ◽  
Anterior Segments ◽  
And Function ◽  
Ab Interno

Purpose: To evaluate three different microincisional ab interno trabeculectomy procedures in a porcine eye perfusion model. Methods: In perfused porcine anterior segments, 90 degrees of trabecular meshwork (TM) were ablated using the Trabectome (T; n = 8), Goniotome (G; n = 8), or Kahook device (K; n = 8). After 24 hours, additional 90 degrees of TM were removed. Intraocular pressure (IOP) and outflow facility were measured at 5 µL/min and 10 µL/min perfusion to simulate an elevated IOP. Structure and function were assessed with canalograms and histology. Results: At 5 µL/min infusion rate, T resulted in a greater IOP reduction than G or K from baseline (76.12% decrease versus 48.19% and 47.96%, P = 0.013). IOP reduction between G and K was similar (P = 0.420). Removing another 90 degrees of TM caused an additional IOP reduction only in T and G but not in K. Similarly, T resulted in the largest increase in outflow facility at 5 µL/min compared with G and K (first ablation: 3.41 times increase versus 1.95 and 1.87; second ablation: 4.60 versus 2.50 and 1.74) with similar results at 10 µL/min (first ablation: 3.28 versus 2.29 and 1.90 (P = 0.001); second ablation: 4.10 versus 3.01 and 2.01 (P = 0.001)). Canalograms indicated circumferential flow beyond the ablation endpoints. Conclusions: T, G and K significantly increased the outflow facility. In this model, T had a larger effect than G and K.

scholarly journals Intraocular Pressure Reduction in a Pigmentary Glaucoma Model by Goniotome Ab Interno Trabeculectomy

2018 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Priyal Shah ◽  
Hamed Esfandiari ◽  
Ying Hong ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Ex Vivo ◽  
Pigmentary Glaucoma ◽  
Pressure Reduction ◽  
Outflow Facility ◽  
Intraocular Pressure Reduction ◽  
Ab Interno Trabeculectomy ◽  
Hematoxylin And Eosin ◽  
Anterior Segments ◽  
Ab Interno

Purpose: To investigate whether microsurgical excision of trabecular meshwork (TM) in an ex vivo pigmentary glaucoma model can normalize the hypertensive phenotype. Methods: Eight eyes of a porcine pigmentary glaucoma model underwent 90° of microsurgical TM excision with an aspirating dual-blade (Goniotome (G)). 24 hours later, an additional 90° of TM were removed. Anterior segments with sham surgeries served as the control (C). Outflow facility and intraocular pressure (IOP) were analyzed. Histology with hematoxylin and eosin (H&E) was obtained. Results: After the first 90° TM excision, IOP was significantly lower in G (10.23±2.39 mmHg, n=7) than C (20.04±1.97mmHg, n=8, P<0.01). Outflow facility in G (0.38±0.07 µl/min/mmHg) was higher than C (0.16±0.02 µl/min/mmHg, P<0.01). After the second 90° TM excision, IOP in G (6.46±0.81 mmHg, n=7) was significantly lower than C (20.25±1.66 mmHg, n=8, P<0.001), while the outflow facility in G (0.50±0.05 µl/min/mmHg, n=7) was higher than C (0.16±0.01 µl/min/mmHg, n=8, P<0.001). Compared to the first excision, excision of an additional 90° did not change of IOP (P=0.20) or outflow facility (P=0.17) further. Conclusion: Excision of 90° of TM in a pigmentary glaucoma model using an aspirating dual-blade decreased IOP and increased outflow facility. Translational Relevance: Microsurgical TM excision over 90° can effectively restore outflow in pigmentary glaucoma.

scholarly journals Outflow enhancement by three different ab interno trabeculectomy procedures in a porcine anterior segment model

2018 ◽  
Vol 256 (7) ◽  
pp. 1305-1312 ◽  
Author(s):  
Yalong Dang ◽  
Chao Wang ◽  
Priyal Shah ◽  
Susannah Waxman ◽  
Ralitsa T. Loewen ◽  
...  
Keyword(s):  
Anterior Segment ◽  
Segment Model ◽  
Ab Interno Trabeculectomy ◽  
Ab Interno

scholarly journals Comparison of a second-generation trabecular bypass (iStent inject) to ab interno trabeculectomy (Trabectome) by exact matching

2020 ◽  
Vol 258 (12) ◽  
pp. 2775-2780 ◽  
Author(s):  
Yousef Al Yousef ◽  
Alicja Strzalkowska ◽  
Jost Hillenkamp ◽  
André Rosentreter ◽  
Nils A. Loewen
Keyword(s):  
Intraocular Pressure ◽  
Second Generation ◽  
Nearest Neighbor ◽  
Exact Matching ◽  
Close Match ◽  
Istent Inject ◽  
Nearest Neighbor Matching ◽  
Ab Interno Trabeculectomy ◽  
Trabecular Bypass ◽  
Ab Interno

Abstract Purpose To achieve a highly balanced comparison of trabecular bypass stenting (IS2, iStent inject) with ab interno trabeculectomy (T, Trabectome) by exact matching. Methods Fifty-three IS2 eyes were matched to 3446 T eyes. Patients were matched using exact matching by baseline intraocular pressure (IOP), the number of glaucoma medications, and glaucoma type, and using nearest neighbor matching by age. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. Results A total of 78 eyes (39 in each group) could be matched as exact pairs with a baseline IOP of 18.3 ± 5.1 mmHg and glaucoma medications of 2.7 ± 1.2 in each. IOP in IS2 was reduced to 14.6 ± 4.2 mmHg at 3 months and in T to a minimum of 13.1 ± 3.2 mmHg at 1 month. In IS2, IOP began to rise again at 6 months, eventually exceeding baseline. At 24 months, IOP in IS2 was 18.8 ± 9.0 mmHg and in T 14.2 ± 3.5 mmHg. IS2 had a higher average IOP than T at all postoperative visits (p < 0.05 at 1, 12, 18 months). Glaucoma medications decreased to 2.0 ± 1.5 in IS2 and to 1.5 ± 1.4 in T. Conclusion T resulted in a larger and sustained IOP reduction compared with IS2 where a rebound occurred after 6 months to slightly above preoperative values.

scholarly journals Angle stability and outflow in excisional ab interno trabeculectomy with active versus passive chamber management

2017 ◽  
Author(s):  
Chao Wang ◽  
Yalong Dang ◽  
Susannah Waxman ◽  
Xiaobo Xia ◽  
Robert N Weinreb ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Glaucoma Surgery ◽  
Training Model ◽  
Training System ◽  
Angle Stability ◽  
Ab Interno Trabeculectomy ◽  
The Right ◽  
Ab Interno

Purpose: To compare the intraoperative angle stability and the postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork. The newer device has an active aspiration and irrigation port while the older requires viscoelastic to maintain the anterior chamber. We hypothesized that anterior segment optical coherence tomography (ASOCT) allows quantifying the intraoperative behavior in a microincisional glaucoma surgery (MIGS) pig eye training model. Methods: Twelve freshly enucleated porcine eyes were measured with ASOCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle in degrees. The right and left eye of pairs were randomly assigned 24 to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, 25 respectively. The aDBG had an irrigation and aspiration port while the pDBG required surgery 26 under viscoelastic. We performed the procedures using our MIGS training system with a 27 standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining 28 canalograms with fluorescent spheres. Results: In aDBG, the nasal angle remained wide open during the procedure at above 90° and 30 did not change towards the end (100±10%, p=0.9). In contrast, in pDBG, ACD decreased by 31 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% 32 (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG 33 and the pDBG (p=0.513). The average increase for the aDBG in the superonasal and inferonasal 34 quadrants was between 27 to 31% and for the pDBG between 15 to 18%. Conclusion: ASOCT demonstrated that active irrigation and aspiration improved anterior 36 chamber maintenance and ease of handling with the aDBG in this MIGS training model. The 37 immediate postoperative outflow was equally good with both devices.

Ab interno trabeculectomy with the dual blade in juvenile open-angle glaucoma

2019 ◽  
pp. 112067211989244
Author(s):  
Albert S Khouri ◽  
Yan Zhu ◽  
Hadeel Sadek
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Purpose: To introduce the use of the Kahook Dual Blade in the treatment of juvenile open-angle glaucoma. Patients and methods: A 14-year-old male was presented with juvenile open-angle glaucoma in the left eye. Ab interno trabeculectomy was performed using a dual-blade device. Results: Intraocular pressure was reduced from 28 to 15 mmHg in the left eye after 18 months. There were no complications. Conclusion: Dual blade ab interno trabeculectomy is a promising alternate to goniotomy in the treatment of juvenile open-angle glaucoma.

scholarly journals 12-month clinical outcomes of combined phacoemulsification and ab interno trabeculectomy for open-angle glaucoma in the United Kingdom

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252826
Author(s):  
Ejaz Ansari ◽  
Deva Loganathan
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Medication Use ◽  
Retrospective Chart Review ◽  
Mean Deviation ◽  
Open Angle ◽  
Ab Interno Trabeculectomy ◽  
Kahook Dual Blade ◽  
Ab Interno

Background/Objectives To describe intraocular pressure (IOP) and ocular hypotensive medication outcomes of combined phacoemulsification and ab interno trabeculectomy with the Kahook Dual Blade (KDB; New World Medical, Inc, Rancho Cucamonga, CA) in adults with cataract and open-angle glaucoma (OAG). Subjects/Methods Retrospective chart review of existing medical records. Data collected included intraocular pressure (IOP) and IOP-lowering medication use preoperatively and through up to 24 months postoperatively. Paired t-tests were utilized to compare preoperative to postoperative mean IOP and mean medications used. Results Data from 32 eyes of 26 subjects were analyzed. Subjects were predominantly Caucasian (25/26) had mean (standard error) age of 79.3 (1.2) years, and eyes had moderate-advanced OAG (mean visual field mean deviation -8.3 [1.3] dB). Mean IOP was 19.8 (0.8) mmHg at baseline and 15.5 (0.6) mmHg (p<0.0001) after mean follow-up of 11.5 (1.0) months; IOP reductions of ≥20% were achieved in 20/32 eyes (62.5%). Mean medication use declined from 2.4 (0.2) medications per eye at baseline to 0.5 (0.2) at last follow-up (p<0.0001); 23/32 eyes (71.9%) were medication-free at last follow-up. No vision-threatening complications were observed. Conclusions Combined phacoemulsification and ab interno trabeculectomy with the KDB safely provided mean IOP reductions of 21.7% and mean IOP medication reductions of 83% after mean follow-up of 12 months in eyes with moderate to advanced OAG. This procedure provides medication-independence in most eyes with statistically and clinically significant IOP reductions.

scholarly journals Training strategies and outcomes of ab interno trabeculectomy with the trabectome

F1000Research ◽  
2017 ◽  
Vol 6 ◽  
pp. 67 ◽  
Author(s):  
Katherine Fallano ◽  
Igor Bussel ◽  
Larry Kagemann ◽  
Kira L. Lathrop ◽  
Nils A. Loewen
Keyword(s):  
Outcome Data ◽  
Eye Model ◽  
The Us ◽  
Ab Interno Trabeculectomy ◽  
Training Strategies ◽  
And Function ◽  
High Degree ◽  
Outflow Pathway ◽  
Function Testing ◽  
Ab Interno

Plasma-mediated ab interno trabeculectomy with the trabectome was first approved by the US Food and Drug Administration in 2004 for use in adult and pediatric glaucomas. Since then, increased clinical experience and updated outcome data have led to its expanded use, including a range of glaucomas and angle presentations, previously deemed to be relatively contraindicated. The main benefits are a high degree of safety, ease, and speed compared to traditional filtering surgery and tube shunts. The increasing burden of glaucoma and expanding life expectancy has resulted in demand for well-trained surgeons. In this article, we discuss the results of trabectome surgery in standard and nonstandard indications. We present training strategies of the surgical technique that include a pig eye model, and visualization exercises that can be performed before and at the conclusion of standard cataract surgery in patients who do not have glaucoma. We detail the mechanism of enhancing the conventional outflow pathway and describe methods of visualization and function testing.

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