Trabeculectomy with mitomycin C for glaucoma secondary to emulsified silicone oil after pars plana vitrectomy: three-years follow up

Background/Aim: To evaluate the efficacy of trabeculectomy with mitomycin C (MMC) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO) after pars plana vitrectomy. Methods: A single-center, prospective study was conducted, from December 2014 to December 2019, on 56 consecutive patients with an uncontrolled elevation of IOP after SO removal. The primary end-point was the IOP at the three-years follow-up visit. Complete surgical success was defined as an IOP ranging from 7 mmHg to 18 mmHg without glaucoma medication. Qualified success was defined as IOP ? 21 mmHg with one or two topical medications. Results: Fifty-six patients with mean (standard deviation) age of 56.6 (13.1) years had a mean baseline IOP of 42.3 (39.3 to 45.3) mmHg, which reduced to 18.6 (17.9 to 19.3) mmHg at 3 years after surgery (P < 0.0001). 17 (30.4%) eyes were classified as complete success, 21 (37,5%) as qualified success, and 18 (32.1%) as failure. In all treated patients, the number of antiglaucoma medications was significantly reduced from 2.85 (0.77) to 1.63 (0.62), p<0.0001. Conclusion: Trabeculectomy with MMC may be an option for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

Five-Year Long-Term Follow-Up of Selective Laser Trabeculoplasty in Open-Angle Glaucoma

Purpose Selective laser trabeculoplasty (SLT) is known as a safe laser therapy for an effective reduction in intraocular pressure (IOP). The aim of this study was to examine the therapeutic success of SLT in open-angle glaucoma (OAG) patients with a long-term follow-up of 5 years. Methods Forty-six eyes of forty OAG patients, some with previous intraocular surgery, underwent SLT (24 males, 16 females). Therapeutic success was categorized as: category (I) – IOP reduction ≤ 21 mmHg and > 20% compared to baseline IOP with additional glaucoma medication; category (II) – IOP reduction ≤ 18 mmHg and > 30% compared to baseline IOP with additional glaucoma medication; category (III) – IOP reduction ≤ 18 mmHg without any additional glaucoma medication at all follow-ups. Therapeutic failure was defined as the necessity of any further glaucoma surgery (IV). Results (1) SLT was well tolerated in all eyes, and no severe side effects or complications were recorded. (2) After 1-year follow-up, therapeutic success was 27% (I), 30% (II), and 3% (III). The therapeutic failure rate was 40% (IV). (3) After 2 years follow-up, therapeutic success was 7% (I), 10% (II), and 0% (III). The therapeutic failure rate was 83% (IV). (4) After 3 years follow-up, the therapeutic failure rate increased up to 100% (IV). Conclusion SLT seemed to be effective in lowering IOP in the first year in the present cohort, however, the long-term effect is low and additional local therapy or surgical interventions are necessary.

A 12-Month Retrospective Comparison of the Efficacy and Complications of Device-Based and Non-Device-Based MIGS Procedures

Background: Minimally Invasive Glaucoma Surgery (MIGS) encompasses a group of procedures designed to reduce trauma to the target tissue and reduce the incidence of complications. MIGS procedures can be divided into two overall categories: device-based procedures and non-device-based procedures. The purpose of this study is to compare the efficacy and complications of device-based and non-device-based MIGS procedures in eyes combined with phacoemulsification. Methods: 55 eyes from 36 patients with combined MIGS (iStent, GATT, ABIC, BANG, and KDB) and phacoemulsification were included. The glaucoma diagnoses included primary open angle glaucoma (POAG), secondary open angle glaucoma (SOAG), and combined-mechanism glaucoma (CMG). The efficacy of the device-based and non-device-based procedures was determined by the mean postoperative IOP and glaucoma medication reduction. Early complications included adverse events and IOP spikes. Late complications included additional surgeries. Results: At 12 months post-operatively, non-device-based eyes had a greater statistically significant reduction in IOP (3.6 ± 1.3 mmHg) when compared to device-based eyes (.07 ± 1.3 mmHg). There was not a statistically significant difference regarding glaucoma medication burden change between the non-device-based eyes (.58 ± .20, 29.7% reduction) and the device-based eyes (.76 ± .19, 31.7% reduction) (p = .52). The occurrence of hyphema was not statistically significantly greater in device-based eyes compared to non-device-based eyes with the sample sizes in this study. The difference between IOP spikes in the two groups was not statistically significant. Conclusion: Non-device-based MIGS procedures reduced the 12-month post-operative IOP more than the device-based MIGS procedures. There was not a statistically significant difference regarding glaucoma medication burden change between the study groups. Post-operative complications occurred at a similar frequency between the two groups. Clinical Impact and Implications: The results of this study can help surgeons choose the appropriate MIGS procedure for their patients depending on the efficacy and safety profile.

Intraocular Pressure Reduction and Complications Profile of Trabeculectomy with 5 Fluorouracil Versus Phaco-trabeculectomy with 5 Fluorouracil in Nigerian Glaucoma Patients

Aims: To evaluate the surgical outcome of combined phacoemulsification cataract surgery plus posterior chamber intraocular and trabeculectomy with adjunctive 5-Fluorouracil versus trabeculectomy with 5-Fluorouracil in the management of Primary open angle glaucoma. Study Design: it was retrospective comparative interventional study Place and Duration of Study: Glaucoma Unit, Eye foundation Hospital Ikeja, Lagos, Nigeria between January 2015, and December 2017 Materials and Methods: A retrospective review of consecutive 29 eyes (29 patients) who had trabeculectomy with 5-Fluorouracil compared with 26 eyes (26 patients) who had combined phacotrabeculectomy with 5-Fluorouracil from 2015 to 2017. All patients had a minimum follow up of 3 months. Results: The mean age of 54.48±14.42 years in Trabeculectomy group was significantly (p>0.001) lower than 70.76±7.22 years for the Phacotrabeculectomy group. The mean preoperative intraocular pressure (IOP) and number of glaucoma medication were similar for the two groups (19.86±9.63mmHg versus 22.23±8.99mmHg; 2.66±1.20 versus 2.73±0.72 medication, trabeculectomy versus phacotrabeculectomy respectively). The postoperative IOP and glaucoma medication after a mean follow up period of 17.11±9.81 months was not significantly different between the two groups (11.55±2.71mmHg versus 12.31±4.33mmHg, p=0.436 for trabeculectomy versus phacotrabeculectomy respectively). Both groups significantly required fewer number of antiglaucoma medication at final follow-up (1.14±0.92 vs 1.46±1.10, trabeculectomy vs phacotrabeculectomy. In the trabeculectomy group, 25 (86.2%) had IOP of ≤15mmHg with or without topical antiglaucoma drops. In the phacotrabeculectomy, 21 (80.76%) had IOP of ≤15mmHg with or without topical antiglaucoma medication (Qualified success). On the other hand, 8 (27.58%) had IOP of ≤15mmHg without topical antiglaucoma medication at the end of the follow-up in the trabeculectomy (Complete success). In the phacotrabeculectomy group, 5 (19.23%) had final IOP of ≤15mmHg without topical antiglaucoma medication. Few complications occurred in both groups. Conclusion: Phacotrabeculectomy augmented with 5-Fluorouracil gave comparable surgical success to 5-Fluorouracil augmented trabeculectomy alone.

Surgical outcomes of the Aurolab aqueous drainage implant (AADI) versus the Ahmed glaucoma valve for refractory paediatric glaucoma in Middle Eastern children

ObjectiveThe Aurolab aqueous drainage implant (AADI) has the potential advantages of less encapsulation and greater cost-effectiveness than the Ahmed glaucoma valve (AGV). The aim of this study was to compare the surgical success and outcomes of the AADI compared to the AGV in Middle-Eastern children.MethodsA comparative retrospective study of consecutive paediatric patients in a tertiary eye hospital was undertaken. Data collected included demographics, type of glaucoma, intraocular pressure (IOP), number of anti-glaucoma medications (AGMs) and any subsequent complications or further surgeries.AnalysisThe mean IOP, number of AGMs, surgical success and number of reoperations was compared for the two groups. Surgical success at each visit was defined as IOP of ≥6 mm Hg and ≤21 mm Hg or if the reduction of IOP was ≥20% reduced from baseline.ResultsA total of 126 tube surgeries (56 eyes in AADI and 70 eyes in AGV) were performed in patients aged ≤18 years from 2014 to 2019. No difference was observed in the mean IOP between the two groups except at the first month post-operative visit. After six months, the AADI group had a consistently significant lower mean number of AGMs. At last follow-up, 21 (37.5%) eyes in the AADI group were glaucoma medication-free vs 15 (21.4%) eyes in the AGV group (pp=0.047). Kaplan-Meier analysis showed equivalent cumulative probability of success at two years of 69.9% [(45.9%–84.9%)] for AADI vs 66.8% [(53.4%–77.1%])) for the AGV, respectively. Twenty-four eyes in the AGV group needed one or more subsequent surgeries, whereas 13 eyes needed one or more surgery in the AADI group.ConclusionsThis study shows an acceptable safety profile for the AADI in children, with a rate of failure that is comparable to the AGV, but less need for glaucoma re-operation or glaucoma medication in the first post-postoperative year.

Frequency of Dry Eye in Glaucoma Patients Using Topical Anti-Glaucoma Therapy

Aim: To determine the prevalence of dry eye in glaucoma patients using topical anti-glaucoma therapy. Study Design: Descriptive observational study Place and duration of study: Department of Ophthalmology, Shalimar Medical & Dental College Lahore from 1st November 2020 to 30th April 2021. Methodology: Ninety patients of both genders were enrolled. Detailed demographics of enrolled cases age, sex and body mass index were recorded after taking informed written consent. Patients using topical anti-glaucoma therapy for more than 8 months and having symptoms of stinging and burning sensations itching, watering, irritation, due to regular use of topical antiglaucoma drugs were presented. Basal Schrimer’s test and tear film break-up time test was used to measure the frequency of dry eye syndrome as mild, moderate and severe. Results: There were 60 (66.7%) females and 30 (33.3%) patients were males. Mean age of the patients were 45.61±7.66 years with mean BMI 26.24±8.71 kg/m2. We found that 40 (44.4%) patients had burning and stinging sensations, itching found in 21 (23.3%), dry eye sensations were found in 16 (17.8%) patients and watering and irritation found in 13 (14.4%) .According to tear film break-up time test 20 (22.2%) cases did not show dry eye syndrome and 19 (21.1%) patients were normal in Basal Schrimer’s test. Conclusion: Use of topical anti-glaucoma medication resulted in dry eye syndrome as well as a decrease in the tear film's stability. Keywords: Anti-glaucoma therapy, Basal Schrimer`s test, Tear film break-up time, Anti-glaucoma therapy, Dry eye syndrome

Effective treatment for secondary angle-closure glaucoma caused by traumatic lens subluxation: phacoemulsification with capsular-tension-ring implantation combined with ophthalmic endoscope-controlled goniosynechialysis

AIM: To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis (Phaco-CTR-IOL-OE-GSL) for treating secondary angle-closure glaucoma induced by traumatic lens subluxation. METHODS: A retrospective and descriptive study was performed on patients with lens subluxation, angle closure, goniosynechia, and evaluated intraocular pressure (IOP) that cannot be controlled with medication, who underwent Phaco-CTR-IOL-OE-GSL. The postoperative best-corrected visual acuity (BCVA), IOP, range of goniosynechia and complications were retrospectively observed. RESULTS: Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included. The follow-up period was 51.1±8.6mo. The preoperative range of zonule rupture was 158.2°±33.0°, and the range of goniosynechia was 220.0°±92.5°. The baseline BCVA was 0.9±1.0 logMAR, IOP was 30.7±17.3 mm Hg, and number of anti-glaucoma medication was 3.2±1.1. Mild intraoperative hyphaemia with 8 eyes (88.8%) in the anterior chamber, and was absorbed two days postoperatively. One eye (11.1%) had postoperative ciliary body detachment and was recovered after five days of topical drug treatment. BCVA was 0.2±0.2 logMAR at 3mo postoperatively. The average IOP at the last follow-up was 16.7±2.0 mm Hg, and no anti-glaucoma medications were used. The average range of recurrent goniosynechia was 54.9°±33° at the final postoperative gonioscopic examination. CONCLUSION: Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation. The use of an endoscope provides a more direct and clear examination for GSL, and 360° dissection is easily achieved.

Ocular Surface Disease Signs and Symptoms of Glaucoma Patients and Their Relation to Glaucoma Medication in Finland

Purpose: To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. Methods: A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name and type of used antiglaucoma drugs.Results: Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer’s test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs and symptoms.Conclusion: Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.