scholarly journals Comparison of Postoperative Hyphemas between Microhook Ab Interno Trabeculotomy and iStent Using a New Hyphema Scoring System

2021 ◽  
Vol 10 (23) ◽  
pp. 5541
Author(s):  
Akiko Ishida ◽  
Sho Ichioka ◽  
Yuji Takayanagi ◽  
Aika Tsutsui ◽  
Kaoru Manabe ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Blood Cells ◽  
Scoring System ◽  
Multivariate Analyses ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Slit Lamp ◽  
Layer Formation ◽  
The Difference ◽  
Ab Interno

We have been using our in-house scoring system of hyphemas, i.e., Shimane University RLC postoperative hyphema scoring system (SU-RLC), which we designed to classify postoperative hyphema. SU-RLC classifies the severities of hyphemas based on three factors, i.e., red blood cells (RBCs) (R) 0–3, layer formation (L) 0–3, and clot (C) 0–1, by slit-lamp observation. To test the clinical usefulness of the SU-RLC for quantifying the postoperative hyphema severity, the SU-RLC scores were compared between eyes that underwent different minimally invasive glaucoma surgery (MIGS) procedures, i.e., Tanito microhook ab interno trabeculotomy and cataract extraction (TMH-CE) (n = 64 eyes of 64 subjects; mean age ± standard deviation, 72.4 ± 8.1 years) and iStent-CE (n = 21 eyes of 21 subjects; 76.1 ± 10.6 years). Compared to the iStent-CE, higher hyphema scores with the TMH-CE were found for the R scores on postoperative days 1, 2, and 3; for the L score on postoperative day 1; and for the C score on postoperative day 2. The sums of the R, L, and C scores (RLC) on postoperative day 1 were 3.2 ± 1.1 with the TMH-CE and 1.1 ± 1.3 with the iStent-CE; the scores reached almost 0 by 2 weeks in both groups. Significant differences in the RLC scores between the surgical groups were found on postoperative days 1, 2, and 3. Multivariate analyses showed that the TMH-CE rather than iStent-CE was associated with higher R, C, and RLC scores; anticoagulant/antiplatelet use was associated with higher R score; and myopia was associated with a higher C score. In the TMH-CE group, myopia was associated with a higher C score. In the iStent-CE group, anticoagulant/antiplatelet use was associated with higher R and RLC scores; and higher postoperative 1-day intraocular pressure was associated with a higher C score. The SU-RLC successfully detected the difference in hyphema severity between different MIGS procedures; thus, we concluded that our classification system may be feasible to evaluate hyphemas after glaucoma surgery.

One-year results of gonioscopy-assisted transluminal trabeculotomy: Evaluation of prognostic factors

2020 ◽  
pp. 112067212090871 ◽  
Author(s):  
Mehmet Ozgur Cubuk ◽  
Erkan Unsal
Keyword(s):  
Intraocular Pressure ◽  
Success Rate ◽  
Open Angle Glaucoma ◽  
Multivariate Logistic Regression Analysis ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Multivariate Logistic Regression ◽  
Surgical Success ◽  
Corrected Visual Acuity

Purpose: To present the results and complications of gonioscopy-assisted transluminal trabeculotomy in adults with open-angle glaucoma using our different approaches during and after surgery. Method: A retrospective comparative study was designed. Patients with regular 12-month follow-up history were included. Two groups were defined: group 1 comprised patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy surgery alone; group 2 included patients with open-angle glaucoma who underwent combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction. A 30% reduction in preoperative intraocular pressure or postoperative intraocular pressure below 18 mm Hg was considered as surgical success. The success rate, alteration in intraocular pressure, alteration in best-corrected visual acuity, alteration in the need for antiglaucomatous medications, surgical complications, and the need for additional glaucoma surgery were evaluated and compared between the groups. Multivariate logistic regression analysis was used to show the association between the surgical success and possible prognostic factors. Results: A total of 37 eyes fulfilled the inclusion criteria and were analyzed in this study. An overall mean decrease in intraocular pressure of 11.3 ± 9.3 mm Hg was shown at 12 months (p < 0.001). The medication-free surgical success rate was 37.8% (14/37), and the surgical success rate with medication was 91.8% (33/37) at 12 months. Surgical outcomes were similar between patients who underwent gonioscopy-assisted transluminal trabeculotomy alone and those who had combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction (p > 0.05). The most common postoperative complication was hyphemia (89.1%). There were no complications that threatened best-corrected visual acuity. Multivariate logistic regression analysis revealed one significant association between the presence of blood in Schlemm’s canal and surgical success (odds ratio = 1.47; 95% confidence interval = 1.25–1.68; p = 0.047). Conclusion: This study showed that the gonioscopy-assisted transluminal trabeculotomy procedure is an effective and minimally invasive form of glaucoma surgery. Its effect was related to intraoperative blood in Schlemm’s canal.

Comparison of Hypotensive Effect of Endotrabeculoectomy and Selective Laser Trabeculoplasty

2021 ◽  
pp. 19-25
Author(s):  
Olha V. Levytska ◽  
Igor Ya. Novytskyy
Keyword(s):  
Intraocular Pressure ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Hypotensive Effect ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Laser Trabeculoplasty ◽  
Significant Difference ◽  
The Difference

Hypotensive effect of endotrabeculectomy was compared with that of selective laser trabeculoplasty in patients with primary open-angle glaucoma (POAG). We evaluated 44 patients (44 eyes) with POAG. In the first group (23 patients), endotrabeculectomy (trabecular ablation through the angle of anterior chamber) was performed, and in the second group (21 patients) the patients underwent selective laser trabeculoplasty. When comparing the intraocular pressure (IOP), it was found that the difference between preoperative and postoperative IOP was significant up to 6 months of follow-up in both groups (p < 0.05), however, hypotensive effect in the first group was more pronounced (7.58 vs. 1.55 mmHg, respectively). When comparing the number of hypotensive medications used before and after glaucoma surgery, it was found that the difference in patients of the first group was significant throughout the observation period (p = 0.028), while in patients of the second group there was no significant difference from the 3rd month of observation. The number of topical drugs to reduce IOP decreased by 1.44 in the first group (p < 0.05) and by 0.33 in the second group (p = 0.109). Endotrabeculectomy, as well as selective laser trabeculoplasty, showed significant hypotensive effect in patients with POAG within 6 months of observation, however, hypotensive effect of endotrabeculectomy significantly overweighted that of SLT. Keywords: endotrabeculectomy, selective laser trabeculoplasty, intraocular pressure, primary open-angle glaucoma.

scholarly journals Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up

2020 ◽  
pp. bjophthalmol-2020-315954
Author(s):  
Eamon Sharkawi ◽  
Daniel Josef Lindegger ◽  
Paul H Artes ◽  
Lydia Lehmann-Clarke ◽  
Mohamad El Wardani ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Success Rate ◽  
Outcome Measures ◽  
Complication Rate ◽  
Case Series ◽  
Glaucoma Surgery ◽  
Polypropylene Suture ◽  
Pseudoexfoliative Glaucoma ◽  
Ab Interno

AimTo report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG).MethodsProspective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate.ResultsMean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p<0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%.ConclusionAt 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.

scholarly journals Short-Term Clinical Results of Ab Interno Trabeculotomy Using the Trabectome with or without Cataract Surgery for Open-Angle Glaucoma Patients of High Intraocular Pressure

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Handan Akil ◽  
Vikas Chopra ◽  
Alex S. Huang ◽  
Ramya Swamy ◽  
Brian A. Francis
Keyword(s):  
Intraocular Pressure ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Clinical Results ◽  
Secondary Glaucoma ◽  
Open Angle ◽  
Short Term ◽  
Safety And Efficacy ◽  
Kaplan Meier ◽  
Ab Interno

Purpose. To assess the safety and efficacy of Trabectome procedure in patients with preoperative intraocular pressure (IOP) of 30 mmHg or higher. Methods. All patients who had underwent Trabectome stand-alone or Trabectome combined with phacoemulsification were included. Survival analysis was performed by using Kaplan-Meier, and success was defined as IOP ≤ 21 mmHg, 20% or more IOP reduction from baseline for any two consecutive visits after 3 months, and no secondary glaucoma surgery. Results. A total of 49 cases were included with an average age of 66 (range: 13–91). 28 cases had Trabectome stand-alone and 21 cases had Trabectome combined with phacoemulsification. Mean IOP was reduced from a baseline of 35.6 ± 6.3 mmHg to 16.8 ± 3.8 mmHg at 12 months (p<0.01∗), while the number of medications was reduced from 3.1 ± 1.3 to 1.8 ± 1.4 (p<0.01∗). Survival rate at 12 months was 80%. 9 cases required secondary glaucoma surgery, and 1 case was reported with hypotony at day one, but resolved within one week. Conclusion. Trabectome seems to be safe and effective in patients with preoperative IOP of 30 mmHg or greater. Even in this cohort with high preoperative IOP, the end result is a mean IOP in the physiologic range.

scholarly journals Combining Ab Interno Kahook Trabeculectomy with Gonioscopy-Assisted Transluminal Trabeculotomy Reduces Intraocular Pressure

2019 ◽  
Vol 184 (11-12) ◽  
pp. 934-936
Author(s):  
Jared R Widder ◽  
Joseph W Schmitz
Keyword(s):  
Intraocular Pressure ◽  
Surgical Technique ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Active Duty ◽  
Pharmacologic Therapy ◽  
Open Angle ◽  
Elevated Intraocular Pressure ◽  
Kahook Dual Blade ◽  
Ab Interno

Abstract Minimally invasive glaucoma surgery (MIGS) provides a safe option for individuals with mild to moderate open-angle glaucoma to reduce their need for pharmacologic therapy or more extensive ab externo surgeries. In this report, we describe a surgical technique using both the Kahook Dual Blade and Gonioscopy-assisted transluminal trabeculotomy (GATT), to treat a 23-year-old active duty female with idiopathic uveitis and subsequent corticosteroid-induced glaucoma who presented with consistently elevated intraocular pressure (IOP) measurements despite maximal pharmacologic interventions. This combination was effective in consistently lowering intraocular pressure for at least 12 months in a young, phakic, active duty patient with uveitis and steroid-responsive open-angle glaucoma.

scholarly journals 360° Ab-Interno Schlemm’s Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma—Midterm Results

2022 ◽  
Vol 11 (1) ◽  
pp. 259
Author(s):  
Giacomo Toneatto ◽  
Marco Zeppieri ◽  
Veronica Papa ◽  
Laura Rizzi ◽  
Carlo Salati ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Open Angle Glaucoma ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Open Angle ◽  
Schlemm’S Canal ◽  
Schlemm's Canal ◽  
Primary Success ◽  
Group 2 ◽  
Ab Interno

Purpose: To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification. Setting: Two surgical sites. Design: Retrospective, observational. Methods: Eighty eyes from 73 patients with mild to moderate OAG underwent ab- interno SC viscodilation performed with OMNI system. Fifty eyes (Group 1) underwent only SC viscodilation, while 30 eyes (Group 2) underwent glaucoma surgery + cataract extraction. Primary success endpoint at 12 months was an intraocular pressure (IOP) reduction higher than 25% from baseline with an absolute value of 18 mmHg or lower, either on the same number or fewer ocular hypotensive medications, without further interventions. Secondary effectiveness endpoints included mean IOP, number of medications and comparison of outcomes between groups. Safety endpoints consisted of best-corrected visual acuity (BCVA), adverse events (AEs), and subsequent surgical procedures. Results: Primary success was achieved in 40.0% and 67.9% in Groups 1 and 2, respectively. Mean IOP at 12-month follow-up showed a significant reduction in both groups (from 23.0 to 15.6 mmHg, p < 0.001, and from 21.5 to 14.1, p < 0.001, in Groups 1 and 2, respectively). Mean medication number decreased in both groups (from 3.0 to 2.0, p < 0.001 and from 3.4 to 1.9, p < 0.001, in Groups 1 and 2, respectively). AEs included hyphema (2 eyes), mild hypotony (4 eyes), IOP spikes one month after surgery (1 eye). Twelve eyes (15.0%) required subsequent surgical procedures. No BCVA reduction was observed. Conclusions: Viscodilation of SC using OMNI viscosurgical systems is safe and relatively effective in reducing IOP in adult patients with OAG.

scholarly journals Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Erin G. Sieck ◽  
Cara E. Capitena Young ◽  
Rebecca S. Epstein ◽  
Jeffrey R. SooHoo ◽  
Mina B. Pantcheva ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Refractive Outcomes ◽  
University Of Colorado ◽  
Significant Difference ◽  
The Difference ◽  
Kahook Dual Blade ◽  
The University ◽  
Refractive Surprise

Abstract Background Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma. This risk is further increased with combined filtering procedures. Indeed, there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery (MIGS). Here, we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade (KDB) goniotomy. Methods Retrospective chart review of 385 glaucomatous eyes of 281 patients, which underwent either phacoemulsification alone (n = 309) or phacoemulsification with KDB goniotomy (n = 76, phaco-KDB) at the University of Colorado. The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than ±0.5 Diopter (D). Results Refractive surprise greater than ±0.5 D occurred in 26.3% of eyes in the phaco-KDB group and 36.2% in the phacoemulsification group (p = 0.11). Refractive surprise greater than ±1.0 D occurred in 6.6% for the phaco-KDB group and 9.7% for the phacoemulsification group (p = 0.08). There was no significant difference in risk of refractive surprise when pre-operative IOP, axial length, keratometry or performance of KDB goniotomy were assessed in univariate analyses. Conclusion There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.

scholarly journals An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

2019 ◽  
Vol 7 (4) ◽  
pp. 224-232
Author(s):  
Sarah H. Van Tassel ◽  
Darren Chen
Keyword(s):  
Intraocular Pressure ◽  
Cataract Extraction ◽  
Glaucoma Surgery ◽  
Surgical Approaches ◽  
Future Research ◽  
The Usa ◽  
Clinical Interest ◽  
Aqueous Outflow

Abstract Purpose of Review In this article, we review the current options for microinvasive glaucoma surgery (MIGS) combined with cataract extraction in the USA and the efficacy of the various approaches. Recent Findings MIGS is a rapidly growing area of research and clinical interest. Available surgeries aim to reduce intraocular pressure by improving aqueous outflow through the trabecular or subconjunctival pathways or by reducing aqueous production. Summary Multiple approaches to MIGS are utilized in clinical practice. On average, these surgeries are safe and modestly effective in reducing intraocular pressure. Future research will demonstrate which surgical approaches are most efficacious, whether and how to combine MIGS, and the role of MIGS in improving patient quality of life.

scholarly journals Glaucoma Surgery Calculator: Limited Additive Effect of Phacoemulsification on Intraocular Pressure in Ab Interno Trabeculectomy

PLoS ONE ◽  
2016 ◽  
Vol 11 (4) ◽  
pp. e0153585 ◽  
Author(s):  
Ashley E. Neiweem ◽  
Igor I. Bussel ◽  
Joel S. Schuman ◽  
Eric N. Brown ◽  
Nils A. Loewen
Keyword(s):  
Intraocular Pressure ◽  
Glaucoma Surgery ◽  
Additive Effect ◽  
Ab Interno Trabeculectomy ◽  
Ab Interno

Intracameral Avastin Dramatically Resolves Iris Neovascularization and Reverses Neovascular Glaucoma

2008 ◽  
Vol 18 (2) ◽  
pp. 255-262 ◽  
Author(s):  
K.V. Chalam ◽  
S.K. Gupta ◽  
S. Grover ◽  
V.S. Brar ◽  
S. Agarwal
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Outcome Measure ◽  
Glaucoma Surgery ◽  
Pressure Control ◽  
Neovascular Glaucoma ◽  
Slit Lamp ◽  
Snellen Visual Acuity ◽  
Iris Neovascularization ◽  
Biologic Effect

Purpose To report the biologic effect of intracameral bevacizumab in patients with iris neovascularization secondary to proliferative retinal vasculopathies. Methods Sixteen eyes of 15 patients with iris neovascularization associated with or without neovascular glaucoma secondary to proliferative retinal vasculopathies received intracameral bevacizumab (1.25 mg). Ophthalmic evaluations included Snellen visual acuity (VA), complete ophthalmic examination, fluorescein iris angiography, and slit lamp photography Main outcome measure was change in degree of iris neovascularization. Secondary outcomes included fluorescein iris angiographic leakage, control of intraocular pressure, and changes in VA. Results All patients with neovascularization demonstrated by slit lamp photography and fluorescein angiography (16/16 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 3 weeks after the injection. Leakage from iris neovascularization resolved in 12 of 16 (75%) eyes. In two cases recurrent leakage was seen as early as 4 weeks necessitating repeat injection. Intraocular pressure was controlled with maximum medical therapy in eight of nine eyes reducing the need for glaucoma surgery. Visual acuity improved from a median of hand motions to 20/200. Conclusions In summary, intracameral bevacizumab was effective in reversing iris neovascularization in the majority of patients. It also facilitated intraocular pressure control in patients with associated glaucoma.

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