scholarly journals Drainage surgery for primary open-angle glaucoma: past, present, future

2021 ◽  
pp. 79-85
Author(s):  
A.S. Basinsky ◽  
Keyword(s):  
Open Angle Glaucoma ◽  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Glaucoma Drainage Device ◽  
Average Decrease ◽  
Keywords Glaucoma ◽  
Limited Effectiveness ◽  
Target Values ◽  
Effective Models ◽  
Intraocular Fluid

Relevance. Despite many techniques for reducing intraocular pressure, surgical treatment of glaucoma has limited effectiveness. First, due to excessive scarring of new intraocular fluid outflow pathways and second, antifibrotics medicaments are unable to effectively control wound healing. The use of drainages reduces the risk of excessive scarring in the area of the filtration pad and forms several ways of outflow of intraocular fluid. The review presents the following sections: development history, advantages, disadvantages, surgical technique and promising directions of glaucoma drainage surgery. Purpose. Summarizing data on the possibility of drainage surgery, historical aspects, causes of scarring and methods of dealing with them. Provide data on various modern drainage devices that are used not only in Russia and their effectiveness. Material and methods. To perform the review, we searched for literature sources on the abstract databases E-library, PubMed and Scopus for the period up to and including 2018, using the keywords «glaucoma drainage surgery» (in the E-library database), «anti-glaucoma drainage» and «anti-glaucoma drainage device» (in the PubMed and Scopus databases). Abstracts of conferences were excluded from the review. A total of 40 articles related to the review topic were identified. The beginning of publications on this issue in domestic sources dates back to 1970, and in foreign sources to 1987. Results. The review presents the history of development, advantages, disadvantages of surgical techniques and promising areas of glaucoma drainage surgery. Various models of drainage devices, as well as their specific and non-specific complications are described. The effectivenes of various valves were 70%, with an average decrease in the level of IOP by at least 50% from the preoperative values. At the same time, the risk of an increase in the level of IOP above the target values is about 10% per year, which leads to the fact that after 5 years only in 50% of cases drainage devices function effectively. Therefore, studies of biomaterials, forms and techniques of drainage implantation surgery, new controlled-release antifibrotic drugs can positively affect the long-term effectiveness of glaucoma surgery. Conclusion. The data presented in the literature review allow us to identify the most effective models of drainage devices, their effectiveness, implantation techniques and possible complications. Key words: glaucoma, refractory glaucoma, glaucoma drainage surgery, drainages.

scholarly journals Ab externo implantation of the MicroShunt, a poly (styrene-block-isobutylene-block-styrene) surgical device for the treatment of primary open-angle glaucoma: a review

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Omar Sadruddin ◽  
Leonard Pinchuk ◽  
Raymund Angeles ◽  
Paul Palmberg
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Operative Management ◽  
Glaucoma Drainage Device ◽  
Outer Diameter ◽  
Open Angle ◽  
Less Invasive ◽  
Randomized Clinical Study ◽  
Suture Tension

AbstractTrabeculectomy remains the ‘gold standard’ intraocular pressure (IOP)-lowering procedure for moderate-to-severe glaucoma; however, this approach is associated with the need for substantial post-operative management. Micro-invasive glaucoma surgery (MIGS) procedures aim to reduce the need for intra- and post-operative management and provide a less invasive means of lowering IOP. Generally, MIGS procedures are associated with only modest reductions in IOP and are targeted at patients with mild-to-moderate glaucoma, highlighting an unmet need for a less invasive treatment of advanced and refractory glaucoma. The PRESERFLO® MicroShunt (formerly known as InnFocus MicroShunt) is an 8.5 mm-long (outer diameter 350 μm; internal lumen diameter 70 μm) glaucoma drainage device made from a highly biocompatible, bioinert material called poly (styrene-block-isobutylene-block-styrene), or SIBS. The lumen size is sufficiently small that at normal aqueous flow hypotony is avoided, but large enough to avoid being blocked by sloughed cells or pigment. The MicroShunt achieves the desired pressure range in the eye by draining aqueous humor from the anterior chamber to a bleb formed under the conjunctiva and Tenon’s capsule. The device is implanted ab externo with intraoperative Mitomycin C via a minimally invasive (relative to incisional surgery) surgical procedure, enabling precise control of placement without the need for gonioscopy, suture tension control, or suture lysis. The implantation procedure can be performed in combination with cataract surgery or as a standalone procedure. The MicroShunt received Conformité Européenne (CE) marking in 2012 and is intended for the reduction of IOP in eyes of patients with primary open-angle glaucoma in which IOP remains uncontrolled while on maximum tolerated medical therapy and/or in which glaucoma progression warrants surgery. Three clinical studies assessing the long-term safety and efficacy of the MicroShunt have been completed; a Phase 3 multicenter, randomized clinical study comparing the MicroShunt to primary trabeculectomy is underway. In preliminary studies, the MicroShunt effectively reduced IOP and use of glaucoma medications up to 3 years after implantation, with an acceptable safety profile. This article summarizes current literature on the unique properties of the MicroShunt, the preliminary efficacy and safety findings, and discusses its potential use as an alternative to trabeculectomy for glaucoma surgery.

scholarly journals Phaco-UCP; combined phacoemulsification and ultrasound ciliary plasty versus phacoemulsification alone for management of coexisting cataract and open angle glaucoma: a randomized clinical trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Magda A. Torky ◽  
Yousef A. Alzafiri ◽  
Ameera G. Abdelhameed ◽  
Eman A. Awad
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Open Angle Glaucoma ◽  
Surgical Techniques ◽  
Glaucoma Surgery ◽  
Median Number ◽  
Control Group ◽  
Open Angle ◽  
Link Type ◽  
A New Technique

Abstract Background Various surgical techniques have been described, to be combined with cataract surgery in glaucoma patients, aiming for an additional reduction of intraocular pressure (IOP), hence minimizing the burden of anti-glaucoma medication (AGM). Ultrasound ciliary plasty (UCP) is a recent microinvasive glaucoma surgery (MIGS) recommended for primary and refractory glaucoma. This study was conducted to evaluate the safety and efficacy of a new technique; combined phacoemulsification and ultrasound ciliary plasty (Phaco-UCP) as a primary surgical treatment for coexisting cataract and open angle glaucoma. Methods A randomized clinical trial, including 61 eyes of 61 patients with visually significant cataract and open angle glaucoma, randomized to either Phaco-UCP (study group; 31 eyes) or phacoemulsification alone (Phaco-alone) (control group; 30 eyes). Primary outcomes included reduction in IOP and/or the number of AGM. Secondary outcomes included visual acuity improvement and complications. Qualified Success was defined as an IOP reduction ≥ 20% from baseline value, with an IOP 6–21 mmHg, with no additional AGM or glaucoma surgery. Failure was defined as either < 20% IOP reduction, despite AGM use, the need of glaucoma surgeries or serious complications. Results At 18 months postoperatively, Phaco-UCP group had a median IOP reduction of 7 mmHg (Q1, Q3 = 3, 10) compared to 2 mmHg (Q1, Q3 = 2, 3) in Phaco-alone group (P < 0.001). Phaco-UCP group had significantly higher success rate at all time points reaching 67.7% at the last follow-up versus 16.7% only in Phaco-alone group (P< 0.001). The median number of AGM significantly decreased from [3 (Q1, Q3 = 2, 4), 3 (Q1, Q3 = 2,3)] respectively, (P =0.3)] at baseline to [1 (Q1,Q3 = 1, 2), 2 (Q1,Q3 = 2, 2)] respectively, (P < 0.001)] at 18 months postoperatively. No serious intraoperative or postoperative complications were encountered in either group. Conclusion Phaco-UCP is a simple, safe and effective procedure for management of coexisting cataract and open angle glaucoma. Trial registration ClinicalTrials.gov identifier, NCT04430647; retrospectively registered. June 12, 2020.

scholarly journals Two-year outcomes of the MINIject drainage system for uncontrolled glaucoma from the STAR-I first-in-human trial

2020 ◽  
pp. bjophthalmol-2020-316888
Author(s):  
Philippe Denis ◽  
Christoph Hirneiß ◽  
Georges M Durr ◽  
Kasu Prasad Reddy ◽  
Anita Kamarthy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Open Angle Glaucoma ◽  
Human Study ◽  
Drainage System ◽  
Glaucoma Surgery ◽  
Glaucoma Drainage Device ◽  
Glaucoma Medication ◽  
Registration Number ◽  
Diurnal Iop

Background/AimsThe current study evaluates the efficacy and safety of the stand-alone implantation of the MINIject (iSTAR Medical, Wavre, Belgium) supraciliary, microinvasive glaucoma drainage device in patients with medically uncontrolled open-angle glaucoma.MethodsThis prospective, multicentre, first-in-human, single-arm interventional study evaluated stand-alone, ab interno implantation in 25 patients of a 5 mm long uveoscleral device made of STAR biocompatible material, which is a soft, microporous, flexible silicone. The primary outcome was the reduction of intraocular pressure (IOP) at 6 months compared with baseline, and follow-up continued until 2 years for 21 patients. Secondary outcomes included success defined as diurnal IOP of ≤21 mmHg and >5 mmHg with an IOP reduction of 20% without (complete) or with/without (qualified) glaucoma medication.ResultsMean baseline IOP was 23.2±2.9 mmHg on 2.0±1.1 glaucoma medication ingredients and decreased to 13.8±3.5 mmHg (−40.7% reduction) on 1.0±1.3 medications 2 years after implantation. Complete success was achieved in 47.6% of patients (10/21) and qualified success in 100% of patients (21/21) at the 2-year follow-up. All patients achieved a 20% IOP reduction with 48% of patients medication-free. No serious ocular adverse events or additional glaucoma surgery were reported. Mean central endothelial cell density (ECD) mildly decreased from 2411 cells/mm2 (n=26) to 2341 cells/mm2 (n=21) at 24 months, which represents a 5% decrease for matched eyes. No patient had a ≥30% decrease in central ECD.ConclusionThis first-in-human study on the stand-alone implantation of the MINIject supraciliary drainage system shows promising IOP-lowering results and medication reduction over 24 months with few adverse events.Trial registration numberNCT03193736.

scholarly journals Comparison of Efficacy between 120° and 180° Schlemm’s Canal Incision Microhook Ab Interno Trabeculotomy

2021 ◽  
Vol 10 (14) ◽  
pp. 3181
Author(s):  
Naoki Okada ◽  
Kazuyuki Hirooka ◽  
Hiromitsu Onoe ◽  
Yumiko Murakami ◽  
Hideaki Okumichi ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Kaplan Meier ◽  
The Mean ◽  
Ab Interno

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal.

scholarly journals Association between glaucoma surgery and all-cause and cause-specific mortality among elderly patients with glaucoma: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sang Yeop Lee ◽  
Hun Lee ◽  
Ji Sung Lee ◽  
Sol Ah Han ◽  
Yoon Jeon Kim ◽  
...  
Keyword(s):  
Cohort Study ◽  
Elderly Patients ◽  
Cox Regression ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Population Based ◽  
Angle Closure ◽  
Charlson Comorbidity Index Score ◽  
All Cause Mortality ◽  
Specific Mortality

AbstractThis population-based, retrospective cohort study aimed to evaluate the association between glaucoma surgery and all-cause and cause-specific mortality among Korean elderly patients with glaucoma. A total of 16210 elderly patients (aged ≥ 60 years) diagnosed with glaucoma between 2003 and 2012 were included, and their insurance data were analyzed. The participants were categorized into a glaucoma surgery cohort (n = 487), which included individuals who had diagnostic codes for open angle glaucoma (OAG) or angle closure glaucoma (ACG) and codes for glaucoma surgery, and a glaucoma diagnosis cohort (n = 15,723), which included patients who had codes for OAG and ACG but not for glaucoma surgery. Sociodemographic factors, Charlson Comorbidity Index score, and ocular comorbidities were included as covariates. Cox regression models were used to assess the association between glaucoma surgery and mortality. The incidence of all-cause mortality was 34.76/1,000 person-years and 27.88/1,000 person-years in the glaucoma surgery and diagnosis groups, respectively. The adjusted hazard ratio (HR) for all-cause mortality associated with glaucoma surgery was 1.31 (95% confidence interval [CI], 1.05–1.62, P = 0.014). The adjusted HR for mortality due to a neurologic cause was significant (HR = 2.66, 95% CI 1.18–6.00, P = 0.018). The adjusted HRs for mortality due to cancer (HR = 2.03, 95% CI 1.07–3.83, P = 0.029) and accident or trauma (HR = 4.00, 95% CI 1.55–10.34, P = 0.004) associated with glaucoma surgery for ACG were significant as well. Glaucoma surgery was associated with an increase of mortality in elderly patients with glaucoma. In particular, the risk of mortality associated with glaucoma surgery due to neurologic causes was significant.

scholarly journals Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Jea H. Yu ◽  
Chuck Nguyen ◽  
Esmeralda Gallemore ◽  
Ron P. Gallemore
Keyword(s):  
Open Angle Glaucoma ◽  
Effective Means ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Scleral Flap ◽  
Retrospective Case ◽  
Glaucoma Drainage Devices ◽  
Patch Graft

Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions.Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement.Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from39±14 mmHg to15±2 mmHg and the number of glaucoma medications was reduced from4±1to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively.Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

The efficacy of Ex-PRESS glaucoma drainage device implantation in the treatment of open-angle glaucoma

2021 ◽  
Vol 63 (3) ◽  
Author(s):  
Shouxiang NI ◽  
Zongbao GAO ◽  
Deshui RAN ◽  
Chunming ZHAO ◽  
Qiao LI
Keyword(s):  
Open Angle Glaucoma ◽  
Glaucoma Drainage Device ◽  
Open Angle ◽  
Drainage Device ◽  
Device Implantation

Complications Common to Nonpenetrating Surgeries

2013 ◽  
Author(s):  
Andrew C. Crichton
Keyword(s):  
Glaucoma Surgery ◽  
Outer Wall ◽  
Glaucoma Drainage Device ◽  
Deep Sclerectomy ◽  
Success Rates ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Descemet's Membrane ◽  
Descemet’S Membrane ◽  
Controlled Flow

Nonpenetrating glaucoma surgery encompasses techniques that involve a deep dissection to the level of Descemet’s membrane, allowing aqueous seepage. The major techniques covered by the term “nonpenetrating surgery” are deep sclerectomy with or without implant and viscocanalostomy. In large meta-analyses comparing nonpenetrating procedures to trabeculectomy, trabeculectomy resulted in lower intraocular pressures (IOP) but a higher risk of postoperative complications. Although nonpenetrating surgery is successful in lowering IOP, the amount of IOP lowering is typically not as low as can be achieved with trabeculectomy. Consequently, patient selection with regard to the target IOP is important in the decision of whether or not to perform a nonpenetrating procedure. The goal of nonpenetrating procedures is to lower IOP with fewer complications than are seen with trabeculectomy. The complications that can occur can be easily understood and predicted by an understanding of the techniques and modifications, as well as knowledge and mechanisms of the adjustments that can be used postoperatively to enhance success. After appropriate anesthetic, the techniques involve a deep dissection in the sclera to the limbus. In the case of deep sclerectomy, after the initial half-thickness flap is fashioned, a second deeper flap is created and excised. This dissection is taken to the level of Descemet’s membrane, allowing controlled flow of aqueous. A fine forceps may be used to strip the outer wall of Schlemm’s canal, further enhancing the flow. The space created by the excision can then be filled with an implant, such as collagen (AquaFlow™ Collagen Glaucoma Drainage Device; STAAR® Surgical Company, Monrovia, California) or hyaluronate (SK Gel®; Corneal Laboratories, Paris, France). For viscocanalostomy, Schlemm’s canal is identified and dilated by using viscoelastic. With deep sclerectomy, intraoperative or postoperative antimetabolites may be used to try to increase success rates by limiting the inflammatory response. Goniopuncture to the Descemet’s window is often required postoperatively (in up to 67% of cases) to enhance flow and lower IOP. The available evidence on complications of nonpenetrating glaucoma surgery is relatively sparse and may be challenging to interpret. Comparative studies between trabeculectomy and nonpenetrating surgery would seem to show fewer complications in the nonpenetrating group.

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