Long-term results of ab externo trabeculotomy for glaucoma secondary to chronic uveitis

Three-Year Results of XEN-45 Implantation for Glaucoma Secondary to Fuchs Uveitis Syndrome, Intermediate Uveitis, and Juvenile Idiopathic Arthritis-Related Anterior Uveitis

PURPOSE

To investigate the long-term outcomes of XEN-45 implantation for glaucoma secondary to Fuchs uveitis syndrome (FUS), juvenile idiopathic arthritis (JIA)-related anterior uveitis and intermediate uveitis (IU).

METHODS

This retrospective study evaluated 19 eyes with FUS, 10 eyes with JIA, and nine eyes with IU that underwent XEN-45 Gel Stent implantation. The primary outcome measure was 3-year surgical success, defined as a ≥20% reduction in intraocular pressure (IOP), with a target IOP of 6-21 mmHg. Success was considered complete when IOP control was achieved without glaucoma medication or surgery other than needling and qualified when medication and/or incisional bleb revision were allowed for IOP control. The secondary outcome measures included IOP changes and revision and complication rates.

RESULTS

The 3-year complete success rate was 49% and 67% in the FUS and IU groups, respectively, both significantly higher than the 20% rate in the JIA group (p = 0.01 and 0.02, respectively, log-rank test). The qualified success rate was also significantly higher in the FUS and IU groups than in the JIA group. Significantly more medications were reintroduced in the JIA group within the first year, and the JIA group did not achieve a significantly lower median IOP at the 2- and 3-year visits, contrary to the FUS and IU groups. The bleb revision and secondary glaucoma surgery rates were similar among all groups.

CONCLUSION

XEN-45 demonstrates a favourable safety and efficacy profile for glaucoma secondary to FUS and IU. However, its efficacy is significantly poor for JIA-related uveitic glaucoma.

Preserflo MicroShunt Implantation for Glaucoma Secondary to Viral and Juvenile Idiopathic Arthritis-Related Anterior Uveitis

PURPOSE

To investigate the efficacy and safety of the Preserflo MicroShunt (PMS) in treating glaucoma secondary to different uveitic glaucoma (UG) types in a European population.

METHODS

This study evaluated consecutive eyes with UG that received the PMS. The primary outcome measure was 12-month surgical success (≥20% IOP reduction, target IOP of 6-21 mmHg). Complete success was considered without IOP-lowering medication or additional surgery other than needling. Qualified success A was considered regardless of medication use, and qualified success B regardless of medication and/or incisional bleb revision. The secondary outcome measures included revision and complication rates.

RESULTS

Twenty-five eyes (viral group: 10 with Fuchs uveitis syndrome and six with herpetic uveitis; juvenile idiopathic arthritis (JIA) group: nine with JIA-related uveitis) were included. The 12-month complete success rate was significantly higher in the viral group than in the JIA group (69% vs 11%; p = 0.0059, log-rank test). The qualified success rates in the viral and JIA groups were 75% and 22% for category A (p = 0.029) and 94% and 56% for category B (p = 0.0237), respectively. Among the viral and JIA groups, 13% and 11% required medication, respectively. Incisional bleb revisions were conducted within 12 months in 25% and 78%, respectively (p = 0.0131, log-rank test). Complications were self-limiting, with no uveitic activity observed.

CONCLUSION

The PMS is safe and effective for glaucoma secondary to viral anterior uveitis. Conversely, it is moderately effective in eyes with JIA-related UG, with a high probability of bleb fibrosis development.

Gonioscopy-Assisted Transluminal Trabeculotomy for the Treatment of Glaucoma in Uveitic Eyes

PURPOSE

To evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in adult eyes with uncontrolled uveitic glaucoma.

METHODS

We reviewed 16 eyes from 13 patients. Surgical success was defined as intraocular pressure (IOP) reduction >20% from baseline or IOP between 5 and 21 mmHg by the 3-month visit while on a stable number or fewer IOP-lowering agents and no need for additional glaucoma surgery.

RESULTS

At 12 months, the cumulative success rate was 81%. Mean IOP was 37.8 ± 13.0 mmHg at baseline and 12.2 ± 3.0 mmHg at 12 months (68% reduction; p < .0001). The average number of glaucoma medications was 4.6 ± 1.3 at baseline and 2.2 ± 0.7 at 12 months (52% reduction; p < .0001). Transient hyphema was seen in 44% of eyes at 1 week.

CONCLUSIONS

This small retrospective study suggests that GATT is effective and safe as an initial surgical treatment for medically refractory glaucoma in uveitic adult eyes.

Outcomes of Microhook ab Interno Trabeculotomy in Consecutive 36 Eyes with Uveitic Glaucoma

Microhook trabeculotomy (μLOT), recently developed by Tanito belongs to minimally invasive glaucoma surgery and contributes to intraocular pressure (IOP) control in eyes with glaucoma resistant to medical therapy. In this study, we aimed to investigate the effectiveness and safety of μLOT for uveitic glaucoma. The medical records of consecutive 36 eyes from 30 patients who underwent μLOT and were followed up over post-operative 1 year were reviewed. The surgical success (IOP = 5–20 mmHg and ΔIOP ≥ 20% with additional anti-glaucoma drugs) was achieved in 67% of eyes at post-operative 12 months. The median IOP significantly decreased from 30.5 mmHg pre-operatively to 15 mmHg at 12 months post-operatively (p = 0.001), and the median glaucoma drug score changed from 5 pre-operatively to 2.5 at 12 months post-operatively (p = 0.301). Intraocular inflammation scores at post-operative 6 weeks did not show a significant worsening as compared to pre-operatively, and 8 (22%) eyes exhibited exacerbation of inflammation during the 12-month follow-up period. Post-operative complications were confirmed in 58% of eyes, but most of them were mild and transient or successfully managed. With its favorable benefit–risk profile, μLOT would be an option worth considering as the first glaucoma surgery for uveitic glaucoma.

Long-term Outcomes of Modified 360-degree Suture Trabeculotomy for Uveitic Glaucoma Compared with Primary Open Angle Glaucoma

PRCIS

A Kaplan-Meier survival curve analysis showed no significant differences in success rates between UG and POAG 120 months after modified 360-degree suture trabeculotomy, which was effective for both groups in the long term.

PURPOSE

To examine the outcomes of modified 360-degree suture trabeculotomy in patients with uveitic glaucoma (UG) as compared to those with primary open angle glaucoma (POAG).

METHODS

This was a retrospective, non-randomized, and comparative case series study. Modified 360-degree trabeculotomy using a 5-0 nylon suture (S-LOT) was performed on 51 eyes of 51 patients (54.4±13.4 y) with UG between October 2005 and January 2012 at Hokkaido University Hospital. Age-matched patients with POAG who underwent S-LOT during the same period were enrolled as controls. Written informed consent was obtained from all patients enrolled in the present study. Surgical success was defined as an intraocular pressure (IOP) <18 mmHg with similar or lower doses of antiglaucoma medications. Kaplan-Meier survival curves of surgical failure were analyzed and compared between UG and POAG.

RESULTS

The mean follow-up periods (±SD) for UG and POAG were 104.8±44.0 and 98.1±36.3 months (P=0.23), respectively. Mean pre-operative IOP in UG and POAG were 34.9±11.0 and 25.3±9.4 mmHg (P<0.001), respectively. After surgery, mean IOP in UG and POAG decreased to 12.0±4.1 and 13.8±3.2 mmHg, respectively, at 60 months, and 12.1±5.6 and 12.4±1.8 mmHg (P=0.86), respectively, at 120 months. The Kaplan-Meier survival curve analysis showed no significant differences in success rates between UG and POAG at the end of the follow-up (Log-rank test, P=0.13). Success rates in UG and POAG were 70.0 and 62.5% at 60 months, and 67.5 and 41.2% at 120 months, respectively.

CONCLUSION

These results suggest that S-LOT is effective for UG and POAG alike.

Long-term outcomes of trabeculectomy with ologen implant versus combined viscotrabeculotomy-synechiolysis in uncontrolled uveitic glaucoma

PURPOSE

To compare trabeculectomy with Ologen implant(Trab-Ologen) to combined viscotrabeculotomy-synechiolysis(VTS) in uncontrolled uveitic glaucoma (UG).

PATIENTS AND METHODS

A retrospective chart review of 47 patients subjected to VTS(24 eyes) or Trab-ologen(23 eyes) at Mansoura Ophthalmic Center between 2010 and 2016. The patients were evaluated on day 1, week 1, months 1, 3, 6, 12, 18, 24, 30, 36, 42, and 48.

RESULTS

The mean ± standard deviation age of patients in the Trab-ologen and VST groups were 38.29 ± 12.5 and 38.91 ± 11.8 years (p = 0.86), respectively. Juvenile Idiopathic arthritis (controlled on methotrexate) was the most common associated systemic disease (3 patients in each group). The mean ± standard deviation of the intraocular pressure (IOP) and IOP-lowering medications preoperatively and at the end of follow up in the Trab-ologen and VST groups were 33.1 ± 2.6 mmHg, 33.2 ± 2.6 mmHg (p = 0.91), 3.4 ± 0.5, 3.4 ± 0.5 (0.90) and 15.4 ± 1.2 mmHg, 13.0 ± 0.9 mmHg (p < 0.001), 0.6 ± 1.1, 0.7 ± 1.2 (p = 0.72), respectively. IOP control was better in the Trab-ologen group till the 30th month when it becomes better in the VST group till the end of follow-up. The most notable complication was a minimal self-limiting hyphema in the VST group. Success rates at the end of follow-up in the Trab-ologen and VST groups were 83% and 78%, respectively.

CONCLUSIONS

Trabeculectomy with ologen implant and visco-trabeculotomy-synechiolysis were equally effective in lowering IOP in uncontrolled UG. There was no statistically significant difference in the success rates between the 2 procedures.

Rate of Complete Catheterization of Schlemm's Canal and Trabeculotomy Success in Primary and Secondary Childhood Glaucomas

PURPOSE

Despite the increasing use of microcatheters to perform 360-degree trabeculotomy, the rate of complete Schlemm's canalization in different forms of pediatric glaucoma is under-reported.

DESIGN

Retrospective institutional observational case series.

METHODS

Ocular diagnoses and surgical details of 60 pediatric patients (≤18 years old) who underwent trabeculotomy between 2013 and 2019 were collected. Surgical success was defined as an intraocular pressure (IOP) of 5-20 mm Hg and no additional IOP-lowering surgery.

RESULTS

Eighty-five eyes of 60 patients underwent trabeculotomy. For bilateral cases, the first eye to undergo surgery was included for analysis. Diagnoses included primary congenital glaucoma (PCG n = 22), juvenile open angle glaucoma (JOAG n = 16), glaucoma following cataract surgery (GFCS n = 15), and other secondary forms of glaucoma (n = 7). Canalization using a microcatheter was attempted in 52 of 60 eyes (87%) of which 21 (40%) achieved full 360-degree. Complete canalization was attained in 69% of JOAG patients, which was significantly higher than in PCG patients (22%; P = 0.007), but not GFCS (36%) and other secondary glaucoma (29%). The 5-year survival rate for all eyes was 75% with 95% confidence interval (CI), 57 to 86. Survival curves for 360-degree catheter, 270-degree to 360-degree combined catheter/Harms trabeculotome, and <180-degree Harms trabeculotome trabeculotomies were significantly different (P < 0.001) with 5-year survival rates of 100%, 69% with 95% CI, 16 to 93, and 48% with 95% CI, 29 to 64, respectively.

CONCLUSIONS

A 360-degree catheter trabeculotomy is highly effective in obtaining IOP control; however, complete canalization of Schlemm's canal is most frequently achieved in JOAG patients. Congenital anomalies or scarring from previous surgeries, which prevents full canalization, may inherently decrease success of angle surgery in other glaucoma.

Comparative outcomes of trabeculotomy ab externo versus trabecular ablation ab interno for open angle glaucoma

PURPOSE

To compare clinical outcomes between trabeculotomy ab externo (TLO) and trabecular ablation ab interno using a Trabectome (TAT) for open angle glaucoma (OAG).

STUDY DESIGN

Prospective and retrospective cohort study.

METHODS

We prospectively recruited 68 patients who underwent TAT between May 2013 and July 2015, and retrospectively recruited 59 patients who underwent TLO between April 2010 and May 2013. We included OAG patients who could be followed up for more than 12 months after surgery. Surgical outcomes were compared between groups. Kaplan-Meier analyses and Cox proportional hazards' models were used for four sets of criteria using postoperative intraocular pressures (IOP) ≤ 18 or ≤ 16 mmHg, and/or showing ≥ 20% reduction from baseline.

RESULTS

Mean preoperative IOPs were 22.6 ± 7.4 mmHg in the TAT group and 24.3 ± 6.6 mmHg in the TLO group. Mean postoperative IOPs in the TAT group were 15.8 ± 3.6 mmHg at 12-months, and 15.7 ± 5.5 mmHg at 36-months, and 16.0 ± 3.4 mmHg at 12 months and 15.2 ± 3.8 mmHg at 36 months in the TLO group. Postoperatively, success rates at 36-months were significantly higher in the TLO group in some criteria; IOP reductions at 1- and 2- years were significantly higher in the TLO group; these differences were not significant after adjustment with other potential prognostic factors. The number of glaucoma medications were significantly higher in the TAT group, at 2-years (P < 0.001) but not at 3-years (P = 0.22).

CONCLUSION

Surgical successes following TLO and TAT are not significantly different 3 years postoperatively after adjustment of potential prognostic factors.

Effect of Trabeculotomy on Corneal Endothelial Cell Loss in Cases of After Penetrating-Keratoplasty Glaucoma

PURPOSE

The aim of this study was to evaluate the effect of trabeculotomy (TLO) on glaucoma and endothelial cell loss after penetrating keratoplasty (PK).

METHODS

A retrospective study was conducted on consecutive patients who underwent PK and in whom more than 24 months of follow-up was available. Patients were categorized into the PK+TLO group [ie, TLO for post-PK glaucoma (n = 10)] and the PK group [PK alone (n = 73)]. Intraocular pressure (IOP) was evaluated during each follow-up examination. Central corneal endothelium images were obtained and analyzed to determine corneal endothelial cell (CEC) density.

RESULTS

The mean duration period from original PK to TLO for secondary glaucoma was 25.5 ± 34.9 months in the PK+TLO group. Mean preoperative IOP in the PK+TLO group was 35.8 mm Hg, and decreased to 17.5 mm Hg at 24 months postoperative (P < 0.01). CEC density decreased in the same manner in both groups. In the PK+TLO group, mean CEC density was 1838 cells per square millimeter before TLO and decreased to 1195 cells per square millimeter at 24 months after TLO. In the PK group, mean CEC density decreased from 1870 to 1209 cells per square millimeter at each corresponding time point.

CONCLUSIONS

TLO for post-PK glaucoma appeared to safely lower IOP, although repeated surgeries were required in some patients, and did not accelerate CEC loss.

Comparison of ab externo trabeculotomy in primary open-angle glaucoma and uveitic glaucoma: long-term outcomes

Background

The aim of this study was to compare the long-term outcomes of ab externo trabeculotomy in primary open-angle glaucoma (POAG) and uveitic glaucoma (UG).

Design

This was a retrospective single-center case series study.

Participants

Twenty eyes of 17 patients with POAG and 22 eyes of 18 patients with UG were included in this study.

Patients and methods

The medical records of all consecutive patients with POAG and UG who underwent ab externo trabeculotomy since 2004 were reviewed.

Main outcome measure

The main outcome measure was change in median intraocular pressure (IOP). Success was defined as IOP ≤21 mmHg (success 1) and IOP ≤21 mmHg and at least 25% reduction from baseline (success 2).

Results

In the POAG group, the median IOP decreased significantly from 22 mmHg (95% CI 21–25 mmHg; n=20) at baseline to 14 mmHg (95% CI 12–16; n=13) after 4 years, P<0.001. In the UG group, the median IOP decreased significantly from 27 mmHg (95% CI 24.5–30.5 mmHg; n=22) at baseline to 12 mmHg (95% CI 9–15 mmHg; n=15) after 4 years, P<0.001. Seven eyes in the UG group failed within the first year after surgery compared to none in the POAG group. Of these, four eyes had Fuchs’ uveitis syndrome and two had granulomatous uveitis. No sight-threatening complications occurred in both POAG and UG groups.

Conclusion

Ab externo trabeculotomy effectively reduced IOP in both UG and POAG groups. However, the success rates in the UG group were significantly lower due to the high failure rate in patients with Fuchs’ uveitis syndrome and granulomatous uveitis. The procedure demonstrated a high safety profile in both UG and POAG patients.