12-Month Follow Up of Combined Cataract Surgery with Schlemm's Canal Scaffolding for the Treatment of Primary Angle Closure Glaucoma

Abstract We evaluated the efficacy and safety of combined phacoemulsification, intraocular lens implantation, goniosynechialysis (GSL), and trabectome in patients with primary angle-closure glaucoma (PACG). In this prospective interventional study, twenty patients (22 eyes) of PACG treated with combined phacoemulsification, intraocular lens implantation, GSL, and trabectome between September 2017 to September 2020 were recruited. The intraocular pressure (IOP), the number of glaucoma medications, and best-corrected visual acuity (BCVA) were recorded at baseline, 1, 3, 6, 12, and 24 months after operation. IOP was decreased significantly from 20.69±6.90 mmHg at baseline to 15.83±2.79mmHg at 24 months’ follow-up (P=0.043). The number of glaucoma medications reduced from 2.76±1.14 preoperatively to 0.73±0.77 at 24 months’ follow-up (P=0.026). The qualified success rate was 86.8% at 2 years. The reduction of IOP showed a positive correlation with baseline IOP (p<0.001) and the reduction of the number of glaucoma medications was positively correlated with baseline number of glaucoma medications (p<0.001). There was no vision-threatening complication during and after operation. The combined procedure of phacoemulsification, IOL implantation, GSL, and trabectome was effective and safe for PACG patients. It may provide a new method for PACG patients especially those with long term and extensive goniosynechia.

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Long-Term Outcomes of Primary Trabeculectomy in Diabetic Patients without Retinopathy with Primary Angle-Closure Glaucoma

Journal of Ophthalmology ◽

10.1155/2017/7947854 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6

Author(s):

Jian Liu ◽

Miaomiao Zhang ◽

Bin Li ◽

Jianrong Wang

Keyword(s):

Case Series ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Control Group ◽

Diabetic Patients ◽

Surgical Success ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma

Purpose. To evaluate primary trabeculectomy with adjunctive mitomycin-C (MMC) in diabetic patients without retinopathy with primary angle-closure glaucoma (PACG). Design. This is a retrospective case series comparison. Participants. This retrospective trial compared outcomes of 88 eyes that underwent trabeculectomy in patients with diabetes mellitus (DM) without retinopathy and in 97 patients without DM. Methods. In this study, the intraocular pressure (IOP), visual acuity, visual field, and postoperative complications were compared between the two groups. Qualified surgical success is defined as an IOP between 6 and 18 mmHg with or without topical antiglaucoma medication. Results. After a follow-up of 5 years, the IOP decreased from a mean basal IOP of 27.8±7.3 mmHg to 15.0±5.6 mmHg in the DM group and from 27.3±6.0 mmHg to 12.4±5.3 mmHg in the control group. The mean number of antiglaucoma medications was 3.4±1.3 and 3.3±1.2 preoperatively (P=0.587) whereas it was 1.7±1.5 and 1.1±1.4 at the 5-year follow-up (P=0.049). The 5-year qualified surgical success rates were 42.9% and 65.4% for both groups (P=0.046; log-rank test). Encysted blebs were seen in 21 (23.9%) patients in the DM group and in 12 (12.4%) patients in the control group (P=0.041). Conclusion. PACG patients with DM without retinopathy undergoing primary trabeculectomy with MMC may have a lower long-term surgical survival rate compared with patients without DM.

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Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study

Current Journal of Glaucoma Practice with DVD ◽

10.5005/jp-journals-10028-1235 ◽

2017 ◽

Vol 11 (3) ◽

pp. 113-119 ◽

Cited By ~ 2

Author(s):

Joobin Hooshmand ◽

James CY Leong ◽

Jeremy O'Connor ◽

Ghee S Ang ◽

Anthony P Wells

Keyword(s):

Optical Coherence Tomography ◽

Cataract Surgery ◽

Anterior Segment ◽

Angle Closure Glaucoma ◽

Angle Closure ◽

Final Visit ◽

Optical Coherence ◽

Medium Term ◽

Primary Angle Closure

ABSTRACT Aim To evaluate by anterior segment optical coherence tomography (AS-OCT) the medium-term (mean duration 3.2 years) anatomical changes in the anterior chamber angle (ACA) after laser peripheral iridoplasty. Materials and methods This is a longitudinal, retrospective case series of 31 eyes of 31 patients with primary angle-closure suspicion, primary angle closure (PAC), or primary angle-closure glaucoma (PACG) who underwent laser peripheral iridoplasty. All patients had persistent iridotrabecular contact (ITC) despite the presence of a patent peripheral iridotomy (PI). An AS-OCT was performed in dark conditions before and after laser iridoplasty. Quadrants of ITC, intraocular pressure (IOP), and the AS-OCT parameters of the temporal and nasal ACAs were measured and analyzed. Results Prior to iridoplasty, the average number of quadrants of ITC was 3.3. At the first postiridoplasty visit (mean duration 6.8 weeks), this reduced to 1.7 quadrants but increased to 1.9 by the final follow-up visit (mean duration 3.2 years). Twenty-five patients (80.1%) had less ITC at the first postlaser visit increasing to 27 (87.1%) patients by the final visit. Two (6.5%) required a second iridoplasty, while 3 (9.7%) required cataract surgery. All parameters of angle width showed a statistically significant increase in magnitude. All patients maintained IOP ≤ 21 mm Hg throughout the follow-up period. Conclusion Iridoplasty is a useful adjunct in widening the ACA, particularly in those with persistent angle closure after iridotomy but with no cataract. While not successful in all patients, it can act as a temporizing measure to widen the drainage angle until such time that cataract surgery can be performed. Clinical significance Laser peripheral iridoplasty can be used as an adjunct in angle-closure glaucoma patients with no cataract. How to cite this article Hooshmand J, Leong JCY, O'Connor J, Ang GS, Wells AP. Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study. J Curr Glaucoma Pract 2017;11(3):113-119.

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