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Leinonen S, Harju M, Hagman J, Honkamo M, Marttila L, Määttä M, Saarela V, Vaajanen A, Vesti E, Komulainen J. The Finnish current care guideline for open-angle glaucoma. Acta Ophthalmol 2024; 102:151-171. [PMID: 38174651 DOI: 10.1111/aos.16612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
This article is an English translation of the 4th Finnish Current Care Guideline for diagnostics, treatment and follow-up of primary open-angle glaucoma, normal-tension glaucoma and pseudoexfoliative glaucoma. This guideline is based on systematic literature reviews and expert opinions with Finland's geographical and operational healthcare environment in mind.
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Affiliation(s)
- Sanna Leinonen
- Tays Eye Centre, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Mika Harju
- Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Juha Hagman
- Seinäjoki Central Hospital, Seinäjoki, Finland
| | | | | | | | | | - Anu Vaajanen
- Mehiläinen, Helsinki, Finland
- Terveystalo, Helsinki, Finland
| | - Eija Vesti
- Turku University Hospital and Turku University, Turku, Finland
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Yang Q, Zhang T, Wu Y, Liang Q, Zhao W, Liu R, Jin X. Progress in the Application of Microneedles in Eye Disorders and the Proposal of the Upgraded Microneedle with Spinule. Pharm Res 2024; 41:203-222. [PMID: 38337104 DOI: 10.1007/s11095-024-03658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In the local administration methods for treating eye diseases, the application of microneedles has great potential due to the shortcomings of low efficacy and significant side effects of local administration preparations. This article provides ideas for the research on the application of ophthalmic microneedle in the treatment of eye diseases. RESULTS This article analyzes the physiological structures of the eyes, ocular diseases and its existing ocular preparations in sequence. Finally, this article reviews the development and trends of ocular microneedles in recent years, and summarizes and discusses the drugs of ocular microneedles as well as the future directions of development. At the same time, according to the inspiration of previous work, the concept of "microneedle with spinule" is proposed for the first time, and its advantages and limitations are discussed in the article. CONCLUSIONS At present, the application of ocular microneedles still faces multiple challenges. The aspects of auxiliary devices, appearance, the properties of the matrix materials, and preparation technology of ophthalmic microneedle are crucial for their application in the treatment of eye diseases.
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Affiliation(s)
- Qiannan Yang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Tingting Zhang
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yujie Wu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qianyue Liang
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Wanqi Zhao
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Tianjin, 301617, Jinghai District, China
| | - Rui Liu
- College of Pharmaceutical Engineering of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 10 Poyang Lake Road, West Zone of Tuanbo New City, Jinghai District, Tianjin, 301617, China.
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Haihe Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, 301617, Tianjin, China.
- Tianjin Key Laboratory of Intelligent and Green Pharmaceuticals for Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Xin Jin
- Military Medicine Section, Logistics University of People's Armed Police Force, 1 Huizhihuan Road, Tianjin, 300309, Dongli District, China.
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Bolek B, Wylęgała A, Rebkowska-Juraszek M, Wylęgała E. Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results. Biomedicines 2024; 12:186. [PMID: 38255291 PMCID: PMC10813537 DOI: 10.3390/biomedicines12010186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/29/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND this study aimed to assess the effectiveness and safety of phaco-endocyclophotocoagulation (phaco-ECP) in patients with glaucoma over five consecutive years. METHODS Thirty-eight patients (38 eyes) with primary and secondary glaucoma were enrolled to undergo phaco-ECP (Endo Optiks URAM E2, Beaver-Visitec International, Waltham, MA, USA). The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use, and visual acuity after phaco-ECP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as a cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and in the first week and 1, 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months postoperatively. RESULTS The mean ± SD values of IOP preoperatively, at 12, 24, 36, 48, and 60 months postoperatively were 22.6 ± 6.7 mmHg, 15.9 ± 3.9 mmHg (p < 0.001), 15.9 ± 2.9 mmHg (p < 0.001), 15.6 ± 2.7 mmHg (p < 0.001), 15.5 ± 3.8 mmHg (p < 0.001), and 15.2 ± 2.6 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 32.7%. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. The qualified success rate was 40.6%. All patients at the 60-month follow-up visit required the use of antiglaucoma medications-none of the patients achieved complete success. During the follow-up period, nine patients (28.3%) that required retreatment due to nonachievement of the target IOP were considered failures. Six patients (15.8%) were lost from the follow-up. A total of 23 patients were evaluated 60 months after their phaco-ECP. Complications directly associated with the procedure, such as corneal edema (25.6%), IOP spikes (20.5%), IOL dislocation (2.6%), and uveitis (12.8%), were observed in our patients. Hypotony was not observed in any of our patients. CONCLUSIONS The phaco-ECP procedure was effective, well-tolerated, and safe for reducing IOP in glaucoma patients with cataracts over a long-term follow-up. Randomized, larger-scale studies are required to validate the results obtained.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, 40-760 Katowice, Poland
- Clinical Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Health Promotion and Obesity Management, Pathophysiology Department, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | | | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze, Medical University of Silesia in Katowice, 40-760 Katowice, Poland
- Clinical Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
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Wu TH, Yin X, Li JQ, Lu PR. Efficacy and safety of ultrasound cycloplasty for the treatment of glaucoma: a Meta-analysis. Int J Ophthalmol 2023; 16:1317-1325. [PMID: 37602344 PMCID: PMC10398525 DOI: 10.18240/ijo.2023.08.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/16/2023] [Indexed: 08/22/2023] Open
Abstract
AIM To evaluate the efficacy and safety of ultrasound cycloplasty (UCP) for glaucoma. METHODS A comprehensive search of PubMed, Embase, Web of Science, and Google Scholar databases was used to select studies met the inclusion criteria. Meta-analysis was performed by Review Manager and StataCorp LLC. RESULTS A total of 19 articles met the inclusion criteria. Overall, UCP is effective and safe in the glaucoma treatment, the risk ratio (RR) of the success rate was 2.28 (95%CI, 1.82-2.84). After UCP, patients had a significant reduction in intraocular pressure (IOP; mm Hg), the weighted mean difference (WMD) was 11.39 (95%CI, 9.88-12.90). In addition, UCP brings fewer postoperative complications with RR of 0.30 (95%CI, 0.19-0.49). Most of the complications were short-term and mild. Postoperatively, patients' use of IOP-lowering medications reduced, the standardized mean difference (SMD) was 0.78 (95%CI, 0.40-1.17). However, best corrected visual acuity (BCVA; logMAR) did not have obvious improvement after UCP, the WMD was 0.01 (95%CI, -0.06-0.09). This procedure does provide painfulness relief, with RR of 3.06 (95%CI, 1.95-4.81). CONCLUSION UCP is effective and safe for suitable glaucoma. It can effectively decrease IOP in glaucoma patients, reduce the patients' dependence on IOP-lowering medications after surgery, relief the painfulness and has fewer long-term or severe postoperative complications, but the BCVA did not improve much.
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Affiliation(s)
- Tian-Hong Wu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Xue Yin
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Jian-Qing Li
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
| | - Pei-Rong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
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Díez-Álvarez L, Beltrán-Agullo L, Loscos J, Pazos M, Ponte-Zúñiga B, Pinazo-Durán MD, Giménez-Gómez R, Ussa F, Pinilla LM, Jaumandreu L, Rebolleda G, Muñoz-Negrete FJ. Advanced glaucoma. Clinical practice guideline. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:18-39. [PMID: 36088247 DOI: 10.1016/j.oftale.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.
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Affiliation(s)
- L Díez-Álvarez
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain.
| | | | - J Loscos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitari Germans Trias i Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - M Pazos
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Institut Clínic d'Oftalmologia, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - B Ponte-Zúñiga
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Pinazo-Durán
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Unidad Investigación Oftalmológica Santiago Grisolía/FISABIO; Unidad de Oftalmobiología Celular y Molecular, Universidad de Valencia, Valencia, Spain
| | - R Giménez-Gómez
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Servicio de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Ussa
- Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Instituto de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - L M Pinilla
- Institut Català de la Retina (ICR), Barcelona, Spain
| | - L Jaumandreu
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain; Department of Ophthalmology, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - G Rebolleda
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
| | - F J Muñoz-Negrete
- Departamento de Oftalmología, Hospital Ramón y Cajal, IRYCIS, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain; Red de Oftalmología RETICS OFTARED del Instituto de Salud Carlos III (ISCII), Spain
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Basto RC, Almeida J, Roque JN, Henriques SP, Gonçalves AS, Vaz FT, Carvalho H, Prieto I. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023; 17:30-36. [PMID: 37228310 PMCID: PMC10203329 DOI: 10.5005/jp-journals-10078-1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 01/13/2023] [Indexed: 05/27/2023] Open
Abstract
Aim This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Methods Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. Results A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Conclusions Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. How to cite this article Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.
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Affiliation(s)
- Rita C Basto
- Department of Surgery, Ophthalmology Service, Unidade Local De Saúde Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Júlio Almeida
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
| | - Joana N Roque
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
| | - Susana P Henriques
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
| | - Ana S Gonçalves
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
| | - Fernando T Vaz
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
| | - Helena Carvalho
- Department of Social Research Methods, Instituto Universitario de Lisboa (ISCTE-IUL), CIES-IUL, Lisbon, Portugal
| | - Isabel Prieto
- Department of Ophthalmology, Professor Doutor Fernando Fonseca Hospital, Lisboa, Portugal
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Bolek B, Wylęgała A, Wylęgała E. Ultrasound ciliary plasty in glaucoma treatment: A long‐term follow‐up study. Acta Ophthalmol 2022; 101:293-300. [PMID: 36448501 DOI: 10.1111/aos.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The present study aimed to evaluate the efficacy and safety of ultrasound ciliary plasty (UCP) in patients with open-angle glaucoma for three consecutive years. METHODS Sixty-one patients (62 eyes) with primary and secondary glaucoma were enrolled to undergo UCP. The primary outcome measures were intraocular pressure (IOP) reduction, success rates, glaucoma medication use and visual acuity after UCP. An IOP reduction of 20% compared to the baseline value without re-intervention was considered a successful treatment. Complete success was defined as cessation of antiglaucoma medications. Secondary outcome measures included intraoperative and postoperative complications. Measurements were performed preoperatively and at the first week, and 1, 3, 6, 12, 18, 24, 30 and 36 months postoperatively. RESULTS A total of 41 patients (41 eyes) were evaluated 36-month after UCP. The mean ± SD values of IOP preoperatively at 1 day, 1 week, 1; 3; 6; 12; 18; 24; 30 and 36 months postoperatively were 22.7 ± 5.0 mmHg, 17.1 ± 4.2 mmHg (p < 0.001), 15.7 ± 4.8 mmHg (p < 0.001), 18.8 ± 4.8 mmHg (p < 0.001), 17.3 ± 3.7 mmHg (p < 0.001), 16.9 ± 3.2 mmHg (p < 0.001), 16.6 ± 2.7 mmHg (p < 0.001), 16.3 ± 3.0 mmHg (p < 0.001), 15.8 ± 3.4 mmHg (p < 0.001), 15.3 ± 2.1 mmHg (p < 0.001) and 16.3 ± 3.0 mmHg (p < 0.001), respectively. The mean IOP at the last follow-up was reduced by 28.5%. The qualified success rate was 64.0%. All patients at 36-month follow-up visit required the use of antiglaucoma medications - none of the patients achieved complete success. The decrease in the number of antiglaucoma medications was statistically significant at each follow-up visit compared to the baseline. Choroid detachment was observed in three patients (4.8%), while macular oedema was observed in three patients (4.8%) after the procedure. No other major intraoperative or postoperative complications occurred. CONCLUSION Ultrasound ciliary plasty seems to be an effective and well-tolerated method to reduce IOP in patients with refractory glaucoma. Further studies with a larger group are needed to confirm the efficacy of this procedure.
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Affiliation(s)
- Bartłomiej Bolek
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
| | - Adam Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
- Health Promotion and Obesity Management, Pathophysiology Department Medical University of Silesia Katowice Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, School of Medicine in Zabrze Medical University of Silesia in Katowice, District Railway Hospital Katowice Poland
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MicroPulse Transscleral Laser Therapy Demonstrates Similar Efficacy with a Superior and More Favorable Safety Profile Compared to Continuous-Wave Transscleral Cyclophotocoagulation. J Ophthalmol 2022; 2022:8566044. [PMID: 35178250 PMCID: PMC8846995 DOI: 10.1155/2022/8566044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose. The aim of this study was to compare effectiveness and safety of MicroPulse transscleral laser therapy (MP-TLT) using the original MicroPulse P3® device and continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) using the G-Probe® device in glaucoma. Methods. Spherical equivalent, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of topical or oral ophthalmic pressure-reducing medications were registered at every time point, up to the last follow-up at 12 months. A complete slit-lamp examination was conducted to record the following complications: corneal edema, persistent ocular hypotony (IOP ≤5 mmHg) on two consecutive follow-up visits, choroidal detachment, phthisis bulbi, sympathetic ophthalmia, cystoid macular edema, or other abnormal ocular findings. Success was defined as IOP between 6 and 21 mmHg and >20% reduction in IOP with or without antiglaucoma medications. Results. 47 eyes underwent MP-TLT and 150 CW-TSCPC. At 12 months, success was achieved in 88.6% in the CW-TSCPC group and 87.5% in the MP-TLT group (
= 0.883). In the CW-TSCPC group, eyes achieved a 42.4% IOP reduction (from 28.3 ± 12.3 mmHg to 15.3 ± 6.0 mmHg) and a 31.1% reduction (from 22.0 ± 7.2 mmHg to 15.7 ± 4.8 mmHg) in the MP-TLT group. Visual acuity remained primarily unaltered in both groups. Conclusion. MP-TLT was as effective in lowering IOP as CW-TSCPC and achieved comparable success. Additionally, MP-TLT demonstrated consistent and effective outcomes at every time point. The improved safety profile of MP-TLT allows the therapeutic spectrum to be broadened, granting ophthalmologists’ treatment of glaucoma in earlier stages of glaucoma than those typically treated with CW-TSCPC, i.e., early to moderate and to patients with good central-vision.
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Enrico B, Marc TH. First and second transscleral cyclophotocoagulation treatments provide similar intraocular pressure-lowering efficacy in patients with refractory glaucoma. Int Ophthalmol 2022; 42:2363-2369. [PMID: 35113312 PMCID: PMC9314293 DOI: 10.1007/s10792-022-02234-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Purpose The aim of this study is to address the safety and effectiveness of a second continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) treatment by comparing its outcome against a first CW-TSCPC treatment in the same patients with refractory glaucoma. Methods Twenty-one eyes with either primary or secondary glaucoma received a second CW-TSCPC laser session ≥ 3 months after the first treatment. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and number of topical or oral ophthalmic pressure-reducing medications were registered at every time point up to the last follow-up at 3 months. A complete slit-lamp examination was conducted to record for complications or other abnormal ocular findings. Success was defined as IOP between 6 and 21 mmHg and > 20% reduction in IOP with or without anti-glaucoma medications. Results At 3 months follow-up of the first CW-TSCPC treatment, a 24.8% decrease in IOP was observed, whereas a 45.6% IOP decrease was observed 3 months post the second CW-TSCPC treatment. Visual acuity did not decrease, and no major complications were observed post either treatment within the follow-up period. Time to failure was 79.5 ± 24.6 and 77.1 ± 29.4, respectively (P = 0.955). No serious complications were observed. Conclusion A second CW-TSCPC treatment proved to be a safe and effective treatment option when the first CW-TSCPC treatment was insufficient in maintaining the desired IOP level for a prolonged time (mean time between both sessions 6.4 ± 8.0 months).
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Affiliation(s)
- Bernardi Enrico
- Medical Faculty, University of Zurich, Zurich, Switzerland.,Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Töteberg-Harms Marc
- Medical Faculty, University of Zurich, Zurich, Switzerland. .,Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland. .,Medical College of Georgia, Department of Ophthalmology, Augusta University, Augusta, GA, USA.
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Hooshmand S, Voss J, Hirabayashi M, McDaniel L, An J. Outcomes of initial and repeat micro-pulse transscleral cyclophotocoagulation in adult glaucoma patients. Ther Adv Ophthalmol 2022; 14:25158414211064433. [PMID: 35187401 PMCID: PMC8852201 DOI: 10.1177/25158414211064433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Micro-pulse transscleral cyclophotocoagulation (MP-TSCPC) has continued to gain popularity as a treatment in adult glaucoma patients. Thus far there is limited evidence reporting the efficaciousness and safety of retreatment. OBJECTIVE To evaluate safety and efficacy of primary and repeat MP-TSCPC procedures. METHODS Thirty-four of 67 eyes who failed to achieve target IOP from initial MP-TSCPC underwent repeat MP-TSCPC and followed for a minimum of 6 months. All treatments were performed using the laser power of 2000 or 2250 mW, duration of 100-200 s, and a velocity 16-20 s per hemisphere swipe. Success criteria were defined as intraocular pressure (IOP) reduction of greater than 20% from baseline or any medication reduction without additional glaucoma procedures at 6 months after repeat MP-TSCPC. The 6-month success rate after repeat MP-TSCPC was also compared to that of initial MP-TSCPC in the same group of eyes. RESULTS Mean baseline IOP before the repeat MP-TSCPC was 23.0 + /- 5.3 on 3.0 + /- 1.4 medications. At 6 months, mean post-op IOP was 18.2 + /- 5.4 (21.9% reduction, p < 0.002), with mean medication staying relatively the same (p = .976). Success rate was increased from 23.5% to 44.1% with the repeat procedure compared to that of initial procedure (p = 0.123). Mean IOP reduction was also greater after repeat MP-TSCPC (18.7%, p < 0.002) when compared to initial MP-TSCPC (10.4%). No adverse events occurred. CONCLUSIONS MP-TSCPC is a safe and effective non-invasive means to lower IOP in a variety of glaucoma patients. While over 50% (34/67) of eyes required repeat MP-TSCPC, repeat treatment resulted in greater success rates and IOP reduction without any adverse events when using the total energy between 112 and 150 J.
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Affiliation(s)
- Sara Hooshmand
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Jackson Voss
- School of Medicine, University of Missouri, Columbia, MO, USA
| | | | | | - Jella An
- School of Medicine, University of Missouri, 3215 Wingate Court, Columbia, MO 65201, USA
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11
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Nagar A, Daas A, Danieliute L, Alaghband P, Yu-Wai-Man C, Amon A, Galvis E, Lim KS. Effect of high-intensity focused ultrasound (HiFU) treatment on intraocular pressure and aqueous humour dynamics: 12 -months results. Eye (Lond) 2021; 35:2499-2505. [PMID: 33159175 PMCID: PMC8377105 DOI: 10.1038/s41433-020-01260-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 10/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HiFU) is a cyclodestructive therapy for controlling intraocular pressure (IOP) in glaucoma. The mechanism of action is thought to be through destruction of the ciliary epithelium as well as increased uveoscleral outflow. We reviewed the change in aqueous humour dynamics parameters including aqueous humour flow rate, tonographic outflow facility (TOF) and uveoscleral outflow at 12 months. PATIENTS AND METHODS This is a prospective observational study. Consecutive patients with open angle glaucoma (OAG) or ocular hypertension (OHT) requiring further IOP lowering were enroled in the study between August 2016 and January 2017. Patients were commenced on medication washout period prior to baseline and twelve months' visit. RESULTS Sixteen patients (OAG) in the treatment group underwent assessment at twelve months follow up. Mean age was 63.1 ± 11 years. Eleven patients were African/Caribbean and 5 were Caucasian. Nine patients were female and 7 were male. Mean post-washout IOP was reduced by 21% (28.3 ± 5.7 at baseline vs 22.4 ± 8.4 mmHg at 12 months, p = 0.04). Aqueous humour flow rate was reduced by 16% at twelve months (2.40 ± 0.6 at baseline vs 2.02 ± 0.6 µl/min at 12 months, p = 0.0493). There was no statistically significant change in the TOF (0.12 ± 0.09 at baseline vs 0.08 ± 0.05 µl/min/mmHg at 12 months, p = 0.08) or uveoscleral outflow (0.6 ± 1.3 at baseline vs 1.3 ± 0.85 µl/min at 12 months, p = 0.15). CONCLUSION In this study, we demonstrated that the observed IOP reduction was likely due to aqueous humour flow rate reduction. The TOF and uveoscleral outflow were not detectibly changed.
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Affiliation(s)
- Anindyt Nagar
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Arij Daas
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Lina Danieliute
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Pouya Alaghband
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Cynthia Yu-Wai-Man
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
- King's College London, London, SE1 7EH, UK
| | - Andrew Amon
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Elizabeth Galvis
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK
| | - Kin Sheng Lim
- Department of Ophthalmology, St Thomas' Hospital, London, SE1 7EH, UK.
- King's College London, London, SE1 7EH, UK.
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12
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Abdullatif AM, Ahmed El-Saied HM. Various modalities of cyclodestruction in non-refractory glaucoma: a comparative study. Int Ophthalmol 2021; 41:3313-3323. [PMID: 34009517 DOI: 10.1007/s10792-021-01893-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study is to study the safety and efficacy of three cyclodestructive treatments; high-intensity focused ultrasound (HIFU) cyclocoagulation versus micropulse cyclophotocoagulation (MP-CPC) versus transscleral continuous-wave cyclophotocoagulation (CW-CPC) for treatment of non-refractory glaucoma. METHODS This is a prospective comparative single-center study. Thirty non-refractory, medically uncontrolled, primary open-angle glaucoma patients with good vision were randomized to a single session of HIFU, MP-CPC or CW-CPC. Intraocular pressure (IOP) reduction, number of medications, success rate, visual acuity and complications were compared between the three groups. Success was defined as an IOP reduction of 30% and IOP between 6 and 21 mmHg with or without medications, in the absence of vision-threatening complications. RESULTS Thirty patients were enrolled in our study: 10 patients received HIFU, 10 patients received MP-CPC and 10 patients received CW-CPC. At 6 months, IOP was reduced by 31.5%, 23.9% and 19.4% (P = 0.4) achieving a success rate of 50%, 60% and 50% (P = 0.8) for continuous, micropulse and HFU groups, respectively, with reduction in the number of drops and stop of oral acetazolamide. Although the difference in the rate of complications between groups was not significant, CW-CPC group had more complications. CONCLUSIONS Cyclophotocoagulation could be an option in the treatment of non-refractory glaucoma even in patients with good visual acuity, with similar outcomes between the three types of cyclodestruction.
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Affiliation(s)
| | - Heba Magdy Ahmed El-Saied
- Department of Ophthalmology, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt. .,, Giza, Egypt.
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13
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Lenzhofer M, Hohensinn M, Hitzl W, Steiner V, Motaabbed A, Motloch K, Colvin HP, Reitsamer HA, Moussa S. Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation. Graefes Arch Clin Exp Ophthalmol 2021; 259:2351-2361. [PMID: 33797631 PMCID: PMC8352832 DOI: 10.1007/s00417-021-05157-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population. Methods Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP. Results IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months. Conclusion The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.
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Affiliation(s)
- Markus Lenzhofer
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria. .,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
| | - Melchior Hohensinn
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Veit Steiner
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Armin Motaabbed
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Karolina Motloch
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Hans Peter Colvin
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Herbert A Reitsamer
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Sarah Moussa
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburger Landeskliniken, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
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14
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Gillmann K, Mansouri K. Minimally Invasive Surgery, Implantable Sensors, and Personalized Therapies. J Ophthalmic Vis Res 2020; 15:531-546. [PMID: 33133445 PMCID: PMC7591837 DOI: 10.18502/jovr.v15i4.7792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/08/2020] [Indexed: 01/02/2023] Open
Abstract
Glaucoma management has changed dramatically over the last decades, through clinical advances and technological revolutions. This review discusses the latest innovations and challenges faced in the field around three major axes: minimally-invasive glaucoma surgery (MIGS), implantable sensors and injectable therapeutics. Indeed, the vast number of recently developed MIGS techniques has not only provided clinicians with a wide range of therapeutic options, but they have also enabled them to adjust their therapies more finely which may have contributed a more patient-centric decision-making process. Yet, despite considerable advances in the field, the wide heterogeneity in clinical trial designs blurs the surgical outcomes, specificities and indications. Thus, more high-quality data are required to make the choice of a specific MIGS procedure more than an educated guess. Beyond the scope of MIGS, the potential of IOP telemetry for self-assessment of IOP-control through implantable sensors is developing into a real option for clinicians and an empowering opportunity for patients. Indeed, providing patients with direct feedback enables them to take control and have a clearer representation of their care, in turn leading to a better control of the disease. However, there are potential issues with self-monitoring of IOP, such as increased anxiety levels induced by measured IOP fluctuations and peaks, leading to patients self-treating during IOP spikes and additional office visits. Furthermore, the advent of implantable therapeutics may soon provide yet another step towards personalized glaucoma treatment, by offering not only an efficient alternative to current treatments, but also a therapeutic option that may better adapt to patients' lifestyle. After several decades of relative stagnation through the last century, glaucoma has now entered what many view as a golden age for the specialty. Like every revolution, this one brings its fair share of uncertainty, clinical questioning and uneasy periods of adaptation to ever-changing expectations. Yet, while it is impossible to guess what the landscape of glaucoma surgery will be like in ten or fifteen years, data suggest a bright outlook both for patients and clinicians.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA
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15
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Schuster AK, Erb C, Hoffmann EM, Dietlein T, Pfeiffer N. The Diagnosis and Treatment of Glaucoma. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:225-234. [PMID: 32343668 DOI: 10.3238/arztebl.2020.0225] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/01/2019] [Accepted: 10/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Glaucoma is a group of chronically progressive disorders of the optic nerve. In this article, we present the epidemiology of and risk factors for glaucoma, as well as the diagnostic work-up and treatment options. METHODS This review is based on pertinent publications retrieved by a selective search in Medline and the Cochrane Library, supplemented by further articles chosen by the authors. RESULTS In Europe, the prevalence of glaucoma is 2.93% among persons aged 40 to 80 years. The prevalence rises with age, reaching 10% in persons over 90 years old. The available diagnostic methods include ophthalmoscopy, tonometry, perimetry, and imaging techniques. The treatment of glaucoma is focused on lowering the intraocular pressure with topical drugs, laser therapy, and glaucoma surgery. In patients with manifest glaucoma, lowering the intraocular pressure prevents the progression of visual field defects, with a number needed to treat of 7. CONCLUSION The diagnostic evaluation of glaucoma rests on multiple pillars, all of which must be considered for establishing the diagnosis and defining the desired target pressure: these are, among others, the intraocular pressure and ocular function and morphology. Individually tailored pressure-lowering treatment should be evaluated in regularly scheduled follow-up visits for assessment of function and morphology and adjusted as necessary to minimize the risk of progression.
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Affiliation(s)
- Alexander K Schuster
- Department of Ophthalmology, University Medical Center Mainz; Private Institute of Applied Ophthalmology Berlin; Department of Ophthalmology, University Hospital Cologne
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16
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Malik R, Shah A, Veeramani P, Ameen S, Bourmpaki E, Bunce C, Wormald R. Glaucoma drainage devices versus trabeculectomy for lowering intraocular pressure in people of West African origin. Hippokratia 2020. [DOI: 10.1002/14651858.cd013698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Rizwan Malik
- Glaucoma Division; King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
| | | | | | - Sally Ameen
- Imperial College Healthcare NHS Trust; London UK
| | - Elli Bourmpaki
- Research Data Management & Statistics Unit; The Royal Marsden NHS Foundation Trust; Sutton UK
| | | | - Richard Wormald
- Cochrane Eyes and Vision, ICEH; London School of Hygiene & Tropical Medicine; London UK
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17
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Tóth M, Shah A, Hu K, Bunce C, Gazzard G. Endoscopic cyclophotocoagulation (ECP) for open angle glaucoma and primary angle closure. Cochrane Database Syst Rev 2019; 2:CD012741. [PMID: 30801132 PMCID: PMC6388466 DOI: 10.1002/14651858.cd012741.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glaucoma is a leading cause of irreversible blindness. A number of minimally invasive surgical techniques have been introduced as a treatment to prevent glaucoma progressing. Among them, endoscopic cyclophotocoagulation (ECP) is a cyclodestructive procedure developed by Martin Uram in 1992. OBJECTIVES To evaluate the efficacy and safety of ECP in people with open angle glaucoma (OAG) and primary angle closure whose condition is inadequately controlled with drops. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2018, Issue 6); Ovid MEDLINE; Ovid Embase; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 12 July 2018. SELECTION CRITERIA We searched for randomised controlled trials (RCTs) of ECP compared to other surgical treatments (other minimally invasive glaucoma device techniques, trabeculectomy), laser treatment or medical treatment. We also planned to include trials where these devices were combined with phacoemulsification compared to phacoemulsification alone. DATA COLLECTION AND ANALYSIS Two review authors planned to independently extract data from reports of included studies using a data collection form and analyse data based on methods expected by Cochrane. Our primary outcome was proportion of participants who were drop-free (not using eye drops). Secondary outcomes included mean change in IOP; proportion of participants who achieved an IOP of 21 mmHg or less, 17 mmHg or less or 14 mmHg or less; and proportion of participants experiencing intra- and postoperative complications, We planned to measure all outcomes in the short-term (six to 18 months), medium-term (18 to 36 months), and long-term (36 months onwards). MAIN RESULTS We found one ongoing study that met our inclusion criteria (ChiCTR-TRC-14004233). The study compares combined phacoemulsification with ECP to phacoemulsification alone in people with primary angle closure glaucoma. The primary outcome is intraocular pressure (IOP) and number of IOP-lowering drugs. A total of 50 people have been enrolled. The study started in February 2014 and the trialists have completed recruitment and are in the process of collecting data. AUTHORS' CONCLUSIONS There is currently no high-quality evidence for the effects of ECP for OAG and primary angle closure. Properly designed RCTs are needed to assess the medium and long-term efficacy and safety of this technique.
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Affiliation(s)
- Márta Tóth
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Anupa Shah
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Kuang Hu
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Catey Bunce
- King's College LondonDepartment of Primary Care & Public Health Sciences4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Gus Gazzard
- Moorfields Eye Hospital NHS Foundation TrustNIHR Biomedical Research Centre162 City RoadLondonUK
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18
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Abstract
The first surgical modalities to reduce aqueous humor production by damaging the ciliary body date back to the early twentieth century. Until recently, however, cyclodestructive procedures (e.g., cyclocryotherapy and transscleral diode laser photocoagulation) have been reserved as last option procedures in refractory glaucoma patients with poor visual potential. Emerging technologic innovation has led to the development of promising, safer and less destructive techniques, such as micropulse diode cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cyclodestruction. Consequently, an emerging paradigm shift is under way with the selection of these surgical options in eyes with less severe glaucoma and good visual potential. Although existing evidence has not, as yet, adequately defined the role and value of these procedures, their emergence is a welcome expansion of available options for patients with moderate-to-severe glaucoma. This article reviews the pertinent evidence on both established and evolving cyclodestructive techniques and describes their growing role in the management of glaucoma.
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19
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Wang H, Li M, Zhang Z, Xue H, Chen X, Ji Y. Physiological function of myocilin and its role in the pathogenesis of glaucoma in the trabecular meshwork (Review). Int J Mol Med 2018; 43:671-681. [PMID: 30483726 PMCID: PMC6317685 DOI: 10.3892/ijmm.2018.3992] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 11/16/2018] [Indexed: 12/26/2022] Open
Abstract
Myocilin is highly expressed in the trabecular meshwork (TM), which plays an important role in the regulation of intraocular pressure (IOP). Myocilin abnormalities may cause dysfunction of the TM, potentially leading to increased IOP. High IOP is a well‑known primary risk factor for glaucoma. Myocilin mutations are common among glaucoma patients, and they are implicated in juvenile‑onset open‑angle glaucoma (JOAG) and adult‑onset primary open‑angle glaucoma (POAG). Aggregation of aberrant mutant myocilins is closely associated with glaucoma pathogenesis. The aim of the present review was to discuss the recent findings regarding the major physiological functions of myocilin, such as intra‑ and extracellular proteolytic processes. We also aimed to discuss the risk factors associated with myocilin and the development of glaucoma, such as misfolded/mutant myocilin, imbalance of myocilin and extracellular proteins, and instability of mutant myocilin associated with temperature. Finally, we further outlined certain issues that are yet to be resolved, which may represent the basis for future studies on the role of myocilin in glaucoma.
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Affiliation(s)
- Hongwei Wang
- Department of Ophthalmology, Jingjiang People's Hospital, Jingjiang, Jiangsu 214500, P.R. China
| | - Mingzhe Li
- Department of Ophthalmology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, P.R. China
| | - Zhenzhen Zhang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P.R. China
| | - Haifeng Xue
- Public Health School, Qiqihar Medical University, Qiqihar, Heilongjiang 161006, P.R. China
| | - Xing Chen
- Department of Science and Education, Jingjiang People's Hospital, Jingjiang, Jiangsu 214500, P.R. China
| | - Yong Ji
- Department of General Surgery, Jingjiang People's Hospital, Jingjiang, Jiangsu 214500, P.R. China
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