scholarly journals Ex-Press® Surgery Versus Trabeculectomy for Primary Open Angle Glaucoma with Low Preoperative Intraocular Pressure

2022 ◽  
Author(s):  
Mitsuya Otsuka ◽  
Atsushi Hayashi ◽  
Naoki Tojo
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Surgical Outcomes ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Randomized Study ◽  
Reduction Rate ◽  
Open Angle ◽  
Surgical Methods ◽  
Corneal Endothelial Cell Density

Abstract Purpose: To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open angle glaucoma (POAG) with low preoperative intraocular pressure (IOP).Patients and Methods: This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed for >2 years.Results: Both surgeries significantly decreased the IOP (p<0.001): at 2 years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1 mmHg, Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2 mmHg. No significant differences were observed in the postoperative IOP (p=0.076), number of postoperative medications (p=0.263), success rate (p=0.900), reduction rate of ECD (p=0.410), or difference in visual acuity (p=0.174). The reduction rate of IOP was significantly high in the Trab group (p=0.047).Conclusions: Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.

Clinical efficacy of osteopathic correction in the complex treatment of patients with unoperated open-angle glaucoma

2020 ◽  
pp. 97-105
Author(s):  
E. N. Simakova ◽  
O. V. Stenkova
Keyword(s):  
Intraocular Pressure ◽  
Drug Therapy ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Randomized Study ◽  
Main Group ◽  
Control Group ◽  
Open Angle ◽  
Complex Treatment ◽  
Hypotensive Drug

Introduction. Glaucoma is one of the most significant eye diseases. It is often diagnosed, not always amenable to therapy, and can lead to a complete loss of visual functions. In recent years, the method of osteopathic correction has become widespread as one of the effective methods of treatment and rehabilitation of patients with pathologies of various body systems. In the pathogenesis of glaucoma, it is customary to distinguish a dystrophic concept, which considers primary open-angle glaucoma as a result of dystrophic changes in the connective tissue, as well as in the endothelial lining of the trabeculae and Schlemm′s canal, especially destructive changes in mitochondria and the alteration of their functional activity. A vascular concept is also distinguished. According to this concept, the central link in the pathogenesis of glaucoma is circulatory disorder in the ciliary vessels, ocular artery, and major vessels of the head and neck, it can be assumed that osteopathic correction in the treatment of patients with open-angle glaucoma will be pathogenetically substantiated and will have a positive effect on intraocular pressure and trophicity of the optic nerve. The goal of research — to study the influence of in osteopathic correction on the nature of unoperated glaucoma (stage IIA) and to substantiate the possibility of using osteopathic correction in the complex treatment of patients with this pathology.Materials and methods. A prospective controlled randomized study was conducted at 52 city polyclinics, branch 3, Moscow, from January 2018 to January 2019. 40 patients (70 eyes) aged 50 to 75 years with primary open-angle glaucoma IIA stage were examined. At this stage of the disease, patients most often seek medical care and the issue of conservative management is primarily considered. All patients were divided into two groups of 20 people: the main group and the control group. The treatment in the main group included hypotensive drug therapy and osteopathic correction. Patients of the control group received only drug therapy. All patients underwent ophthalmic (visometry, tonometry, perimetry) and osteopathic examination twice: before the treatment and after 3 months.Results. For patients with primary open-angle IIA non-operated glaucoma, regional (most often regions of the head, neck, dura mater) and local (abdominal diaphragm, iliac bones, hip and knee joints) somatic dysfunctions were the most typical. In the main group a statistically significant decrease in the frequency and severity of dysfunctions at all levels was stated. Also, in patients receiving osteopathic correction, a significant decrease in the level of intraocular pressure and perimetric indices was noted. In patients of the control group, no reliable changes in these indicators were obtained.Conclusion. The results obtained indicate that osteopathic correction is clinically effective in the complex treatment of patients with primary open-angle II A glaucoma.

scholarly journals Evaluation of Outflow StructuresIn Vivoafter the Phacocanaloplasty

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Daiva Paulaviciute-Baikstiene ◽  
Renata Vaiciuliene ◽  
Vytautas Jasinskas ◽  
Ingrida Januleviciene
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Anterior Segment ◽  
Open Angle ◽  
Glaucoma Medication ◽  
Postoperative Visual Acuity

Purpose. To evaluate thein vivochanges in Schlemm’s canal (SC) and the trabecular meshwork (TM) in patients with primary open-angle glaucoma (POAG) after phacocanaloplasty using anterior segment optical coherence tomography (AS-OCT).Methods. Ten eyes of nine patients with POAG (6 men and 3 women) who underwent phacocanaloplasty. Preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), and use of glaucoma medications were evaluated. The main outcome measures were the area of SC and TM thickness assessed using AS-OCT before and 12 months after surgery.Results. We found statistically significant reduction in IOP (from 26.4 (8.6) mmHg to 12.9 (2.5) (p<0.05) mmHg), increase in VA from 0.7 (0.4) to 0.9 (0.2), and decrease in glaucoma medication from 2.6 (1.2) to 1.1 (1.3) at 12 months postoperatively. There was a significant increase in the SC area (3081.7 (842.8) μm2versus 5098.8 (1190.5) μm2,p<0.001) and a decrease in mean TM thickness (91.2 (18.6) μm versus 81.3 (15.1) μm,p=0.001) after surgery. We found negative correlations between SC area and IOP before surgery (r=-0.67,p=0.03) and also between SC area before and IOP reduction 12 months after the phacocanaloplasty (r=-0.80,p=0.005).Conclusions. Our results showed statistically significant dilation of SC area and reduction of TM thickness after phacocanaloplasty in POAG patients. The degree of SC expansion was related to the IOP decrease.

scholarly journals RISK FACTORS FOR THE OCCURRENCE OF PRIMARY OPEN-ANGLE GLAUCOMA IN PATIENTS WITH DIABETIC RETINOPATHY AND TYPE 2 DIABETES

2021 ◽  
Vol 77 (3) ◽  
pp. 37-46
Author(s):  
K. A. Gudzenko ◽  
S. Yu. Mogilevskyy ◽  
М. L. Kyryliuk ◽  
D. S. Ziablitsev
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Duration Of Diabetes

The aim of this work was to identify risk factors for the occurrence of primary open-angle glaucoma in patients with diabetic retinopathy and type 2 diabetes mellitus by conducting a regression analysis of the mutual influence of these diseases. We examined 649 patients (649 eyes), among whom 301 patients (301 eyes) had diabetic retinopathy and glaucoma; 164 patients (164 eyes) had diabetic retinopathy only; 81 patients (81 eyes) had only glaucoma and 103 patients (103 eyes) did not have these diseases (control). The construction of logistic regression models was carried out in the GLZ module of the Statistica 10 software (StatSoft, Inc. USA). It was found that the development of primary open-angle glaucoma directly depended on the duration of diabetes and the intraocular pressure level, and vice versa — on visual acuity (p < 0.001). The development of diabetic retinopathy did not depend on the presence of glaucoma, but it was directly dependent on the blood content of glucose and glycated hemoglobin. Men had a lower risk of developing diabetic retinopathy than women(OR = 0.800; 95% CI 0.76-0.84). Also, men had a lower risk of glaucoma (OR = 0.95; 95% CI 0.94–0.96). Stratification by stages of diabetic retinopathy showed the effect of intraocular pressure, decreased visual acuity and glaucoma stages on the development of proliferative diabetic retinopathy (p < 0.001). Increased intraocular pressure was an independent factor in the development of retinopathy. The development of glaucoma of the initial stage was directly influenced by an increase of blood glycated hemoglobin and by the stage of diabetic retinopathy. The occurrence of stage 2 glaucoma was influenced by the duration of diabetes and visual acuity, stage 3 glaucoma — by visual acuity, and stage 4 glaucoma – by the age and duration of diabetes. Independent risk factors for glaucoma were duration of diabetes, increased intraocular pressure, and low visual acuity. When stratified by stage, there was no evidence of a reduction in the risk of developing diabetic retinopathy and glaucoma in men. Thus, the features of the mutual influence of the development of diabetic retinopathy and primary open-angle glaucoma in type 2 diabetes mellitus have been established.

scholarly journals Outcome of Conventional Trabeculectomy in Terms of Intraocular Pressure and Visual Acuity in Primary Open Angle Glaucoma

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Erum Shahid ◽  
Uzma Fasih ◽  
Arshad Shaikh
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Tertiary Care Hospital ◽  
Open Angle Glaucoma ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Open Angle ◽  
Retrobulbar Anaesthesia

Purpose:  To determine the outcomes of conventional trabeculectomy in terms of decrease in Intra Ocular Pressure (IOP) and improvement in visual acuity in patients of primary open glaucoma, coming to a tertiary care hospital. Study Design:  Retrospective case series. Place and Duration of Study:  Ophthalmology department of a tertiary care hospital from January 2017 to December 2018. Methods:  Patients undergoing trabeculectomy for Primary open angle glaucoma were included. Patients with repeated trabeculectomy, failed argon laser trabeculoplasty, advance cataract, corneal opacities and absolute glaucoma were excluded. All the trabeculectomies were done under retrobulbar anaesthesia after taking all aseptic measures. Primary outcome measures were preoperative and postoperative visual acuity, intraocular pressure, number of antiglaucoma medications and failed or successful trabeculectomy. Results:  Total 52 patients underwent trabeculectomy. There were 36 (69.2%) males and 16 (30.8%) females. Mean age was 56.73 years ± 10.9 SD. Mean preoperative IOP was 30.96 ± 6.71 mm Hg, post operatively IOP at 1 year it was 15.6 ± 4.2 mm Hg. P value was <.000. Mean number of antiglaucoma medications was 3.03 and 1.19, pre and post-operatively respectively (p value <.000). Improvement in visual acuity after trabeculectomy was seen in 32 (61.5%) patients. Complete Surgical success was seen in 28 (53.8%) and qualified success in 21 (40.4%) patients. Failed trabeculectomy was seen in 3 (5.8%) patients. Conclusion:  Conventional trabeculectomy is effective in lowering IOP in primary open angle glaucoma patients. It maintains IOP within normal range with and without anti-glaucoma medications at 1 year follow-up. Trabeculectomy significantly reduces number of anti-glaucoma medications. Key Words:  Intraocular pressure, Primary open angle glaucoma, Trabeculectomy.

Study of the effectiveness of osteopathic correction in the complex treatment of patients with operated primary open-angle glaucoma

2021 ◽  
pp. 66-76
Author(s):  
O. V. Zubkov ◽  
E. A. Smirnova ◽  
V. V. Kramar ◽  
O. I. Kurbatov
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Surgical Treatment ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Pain Syndrome ◽  
Open Angle ◽  
Complex Treatment ◽  
Fiber Layer ◽  
Complex Therapy

Introduction. Glaucoma is a chronic eye disease characterized by a constant or periodic increase in intraocular pressure, a decrease of visual fields and visual acuity, and by a special form of optic nerve atrophy with excavation in the disc area. The reflection of this slowly fl owing atrophy is a disturbance in the visual field and a complete irreversible loss of visual function. The prevalence of the disease increases with increasing age. The main methods of treatment are medical and surgical. Non-penetrating operations are recognized as the safest methods of surgical treatment of glaucoma. The most common complications of such operations include: detachment of the choroid, small anterior chamber syndrome, hyphema, cicatricial changes in the filtration cushion. Based on the analysis of literature data, it can be assumed that the inclusion of osteopathic correction in the complex therapy of patients with operated glaucoma can increase the effectiveness of therapy.The aim of the research was to study the clinical efficacy of osteopathic correction in the complex treatment of patients operated on primary open-angle glaucoma.Materials and methods. The study involved 20 patients (20 eyes) aged 70 to 75 years with developed and advanced stages of primary open-angle glaucoma, who underwent surgical treatment. The main (10 people) and control (10 people) groups were formed by simple randomization. Participants in the main group received standard medical therapy and osteopathic correction, while participants in the control group received only medical therapy. Changes in the following clinical parameters were evaluated: visual acuity, visual fi eld, intraocular pressure, thickness of the retinal nerve fiber layer, and severity of pain syndrome. Indicators were recorded at the beginning of the study (2 weeks after surgery) and at the end of the study (2–3 months after surgery).Results. Patients receiving osteopathic correction as part of the complex therapy after surgery of primary openangle glaucoma are characterized by a statistically significant (p<0,05) decrease in the severity of pain syndrome, an increase in the magnitude of the visual field and of the thickness of the retinal nerve fiber layer.Conclusion. The obtained results suggest the effectiveness of the inclusion of osteopathic correction in the complex treatment of patients with operated on primary open-angle glaucoma. It is recommended to continue the study with a larger sample size.

scholarly journals Comparison of the Effect of Trabeculectomy in Controlling Intraocular Pressure in Pseudo-Exfoliaiton and Primary Open Angle Glaucoma Patients

2019 ◽  
pp. 1-7
Author(s):  
S. Kavuncu ◽  
H. H. Erbil
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Study Groups ◽  
First Year ◽  
Open Angle ◽  
Significant Difference ◽  
The Mean

Objective: The aim of this study is to compare the efficacy of the trabeculectomy in controlling intraocular pressure in patients with primary open-angle and pseudo-exfoliation glaucoma. Materials and Methods: The medical data of a sum of 69 eyes of which 36 (52,2%) with primary open angle glaucoma (POAG) and 33 (47,8%) with pseudo-exfoliation (PEG), who have medically uncontrolled glaucoma and had undergone primary trabeculectomy in Göztepe Education and Research Hospital were evaluated in this retrospective study. Postoperatively, data at the first day, at the first month, and at the last examination evaluated in the study. Success of the surgery is defined as measurement of intraocular pressure under 21 mmHg with (incomplete success) or without (complete success) additional medications following the end of the first year follow-up examinations. Results: POAG group consists of 36 patients of which 16 male, 20 female and PEG group consists of 33 patients of which 21 male and 12 female. The mean age was 67.2±9.1 (42-80) years in POAG group and 70.7±6.6 (55-80) years in PEG group. There was no statistically significant difference between POAG and PEG groups in visual acuity, mean intraocular pressure, c/d ratio and the number of antiglaucomatous medications preoperatively and postoperatively (p>0.05). There was a statistically significant difference in groups between post and preoperative values in visual acuity, mean intraocular pressure, c/d ratio and the number of antiglaucomatous medications (p<0.05) Success of the trabeculectomy was 41,7% (complete success), 41,7% (incomplete success) and remaining 16,6% was unsuccessful, in POAG group and success rate in PEG group was 51.5%, 27,3% and 21,2% respectively. There was no statistically significant difference between groups (p=0.738). Conclusion: Trabeculectomy is an effective surgery in lowering intraocular pressure in both of the study groups equally.

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