scholarly journals High-Frequency Deep Sclerotomy, A Minimal Invasive Ab Interno Glaucoma Procedure Combined with Cataract Surgery: Physical Properties and Clinical Outcome

2019 ◽  
Vol 10 (1) ◽  
pp. 218 ◽  
Author(s):  
Bojan Pajic ◽  
Zeljka Cvejic ◽  
Kaweh Mansouri ◽  
Mirko Resan ◽  
Reto Allemann
Keyword(s):  
Cataract Surgery ◽  
High Frequency ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Open Angle ◽  
Custom Made ◽  
Ab Interno

Background: The efficiency and safety of primary open-angle glaucoma with high-frequency deep sclerotomy (HFDS) combined with cataract surgery has to be investigated. Methods: Right after cataract surgery, HFDS was performed ab interno in 205 consecutive patients with open angle glaucoma. HFDS was performed with a custom-made high-frequency disSection 19 G probe (abee tip 0.3 × 1 mm, Oertli Switzerland). The bipolar current with a frequency of 500 kHz is applied. The nasal sclera was penetrated repetitively six times through the trabecular meshwork and consecutively through Schlemm’s canal. Every time, a pocket of 0.3 mm high and 0.6 mm width was created. Results: Mean preoperative intraocular pressure (IOP) was 24.5 ± 2.1 mmHg (range 21 to 48 mmHg). After 48 months, the follow up average IOP was 15.0 ± 1.7 mmHg (range 10 to 20 mmHg). Postoperative IOP has been significantly reduced compared to preoperative IOP for all studied cases (p < 0.001). After 48 months, the target IOP less than 21 mmHg reached in 84.9%. No serious complications were observed during the surgical procedure itself and in the postoperative period. Conclusions: HFDS is a minimally invasive procedure. It is a safe and efficacious surgical technique for lowering IOP combined with cataract surgery.

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

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.

scholarly journals The Efficacy and Safety of High-Frequency Deep Sclerotomy in Treatment of Chronic Open-Angle Glaucoma Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Mokhtar Mohamed Ibrahim Abushanab ◽  
Ayman El-Shiaty ◽  
Tarek El-Beltagi ◽  
Shaymaa Hassan Salah
Keyword(s):  
High Frequency ◽  
Open Angle Glaucoma ◽  
Invasive Procedure ◽  
Specular Microscopy ◽  
Open Angle ◽  
Advanced Glaucoma ◽  
The Mean ◽  
A Prospective Study ◽  
Chronic Open Angle Glaucoma ◽  
Ab Interno

Purpose. Highlights the high-frequency deep sclerotomy as a competing ab interno surgery in open-angle glaucoma patients and evaluates the efficacy of high-frequency deep sclerotomy in lowering IOP of chronic open-angle glaucoma patients, in addition to the evaluation of the safety of the procedure on the corneal endothelium. Design. A prospective study. It was performed in the Research Institute of Ophthalmology, Cairo. Participants. 43 eyes were enrolled for the study. All eyes were diagnosed with chronic open-angle glaucoma. Methods. The procedure was performed using the abee® glaucoma tip of Oertli phacoemulsification machine (OS3, Switzerland) and goniolens performing nasal six pockets penetrating 1 mm deep into the trabecular meshwork and Schlemm’s canal. Patients were followed up regarding vision and intraocular pressure (IOP) for 9 months. Endothelial cell count and coefficient of variation were calculated using specular microscopy preoperatively and 9 months postoperatively. Results. The mean preoperative IOP was 31.4 ± 4.71 mmHg (range: 22 to 42 mmHg). All patients were followed up for nine months. The mean IOP was 19.06 ± 1.907 mmHg (range: 15 to 26 mmHg) by the end of the study. The reduction across the follow-ups was statistically significant (P<0.0001). The percentage of total success was 90.7% (39 eyes). Four eyes (9.3%) had IOP > 21 (failed) after surgery and continued on antiglaucoma therapy. Conclusion. High-frequency deep sclerotomy is a safe and promising minimally invasive procedure which successfully achieves a lower IOP for chronic open-angle glaucoma patients, but not adequate for advanced glaucoma patients. This trial is registered with PACTR201910823824561.

scholarly journals Long-term medication reduction in controlled glaucoma with iTrack ab-interno canaloplasty as a standalone procedure and combined with cataract surgery

2021 ◽  
Vol 13 ◽  
pp. 251584142110457
Author(s):  
Mahmoud A. Khaimi
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Target Range ◽  
Open Angle ◽  
Significant Difference ◽  
The Mean ◽  
Ab Interno

Purpose: To evaluate the long-term effectiveness of iTrack (Nova Eye Medical, Fremont, USA) ab-interno canaloplasty performed as a standalone procedure, or combined with cataract surgery, in reducing antiglaucoma medication dependence and maintaining intraocular pressure within target range in patients with controlled primary open-angle glaucoma. Methods: This is a retrospective, single-center, case series study of patients who underwent iTrack ab-interno canaloplasty as a standalone procedure ( n = 34) or in combination with cataract surgery ( n = 11). Eyes with controlled mild or moderate glaucoma (intraocular pressure ⩽17 mmHg) were included; those with prior glaucoma surgeries were excluded. The primary outcome was the mean reduction in glaucoma medication and the secondary outcome was the maintenance of controlled intraocular pressure postoperatively. Results: A total of 35 patients (45 eyes) with a mean age of 73 ± 9.7 years were included in the study. For all eyes, a significant decrease (61%) in the mean number of medications was seen at 36 months (1.89 ± 0.93 versus 0.60 ± 0.82; p < 0.001), with 56% (14/25) of eyes medication free. No significant difference was observed in the reduction of medication use whether iTrack was performed with or without cataract surgery at 12 and 36 months. Mean baseline intraocular pressure of 14.42 ± 2.2 mmHg for all eyes was maintained at the 12-, 24-, and 36-month follow-up visits (14.6 ± 3.65, 15.06 ± 2.26, and 14.19 ± 2.91, respectively), with no significant difference between the two groups ( p = 0.08). Conclusion: The iTrack ab-interno canaloplasty significantly reduced medication dependency and maintained intraocular pressure within target range in patients with controlled mild or moderate primary open-angle glaucoma, while showing a good safety profile, both as a standalone procedure or in combination with cataract surgery.

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

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
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.

Topical Bimatoprost Insert for Primary Open-Angle Glaucoma and Ocular Hypertension Treatment - A Phase II Controlled Study

2021 ◽  
Vol 18 ◽  
Author(s):  
Francine Rubião ◽  
Alan Cezar Faria Araújo ◽  
João Bernardo Sancio ◽  
Bárbara Silva Nogueira ◽  
Juçara Ribeiro Franca ◽  
...  
Keyword(s):  
Ocular Hypertension ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
T Test ◽  
Controlled Study ◽  
Therapeutic Drug ◽  
Eye Drops ◽  
Open Angle ◽  
Drug Concentrations

Background: The most common treatment for primary open-angle glaucoma (POAG) is the daily use of eye drops. Sustained-release drug delivery systems have been developed to improve patient adherence by achieving prolonged therapeutic drug concentrations in ocular target tissues while limiting systemic exposure. The purpose of this study is to compare the efficacy and safety of bimatoprost inserts with bimatoprost eye drops in patients with POAG and ocular hypertension (OH). Methods: We include OH and POAG patients aged between 40 and 75 years-old. Both OH and POAG patients had intraocular pressure (IOP) greater than 21 and ≤30 mmHg at 9:00 am without glaucoma medication and normal biomicroscopy. Five normal patients with IOP≤14 mmHg constitute the control group. A chitosan-based insert of bimatoprost was placed at the upper conjunctival fornix of the right eye. In the left eye, patients used one drop of LumiganTM daily at 10:00 pm. For statistical analysis, we used a two-way analysis of variance (ANOVA), Student t-test, and paired t-test. Results: Sixteen POAG and 13 OH patients with a mean age of 61 years were assessed. In both eyes, IOP reduction was similar during three weeks of follow-up (19.5±2.2 mmHg and 16.9±3.1 mmHg), insert, and eye drop, respectively; P=0.165). The percentage of IOP reduction in the third week was 30% for insert and 35% for eye drops (P=0.165). No intolerance or discomfort with the insert was reported. Among the research participants, 58% preferred the use of the insert while 25% preferred eye drops, and 17% reported no preference. Conclusions: Bimatoprost-loaded inserts showed similar efficacy to daily bimatoprost eye drops during three weeks of follow up, without major side effects. This might suggest a possible change in the daily therapeutic regimen for the treatment of POAG and OH.

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