1
|
Wajima R, Higashide T, Sugiyama K. Ex-PRESS shunt combined with ab-interno peripheral iridectomy: A new surgical procedure for iridocorneal endothelial syndrome. Am J Ophthalmol Case Rep 2023; 32:101887. [PMID: 38161521 PMCID: PMC10757185 DOI: 10.1016/j.ajoc.2023.101887] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/02/2023] [Indexed: 01/03/2024] Open
Abstract
Purpose Iridocorneal endothelial (ICE) syndrome may cause refractory glaucoma due to progressive synechial closure or membrane formation at the anterior chamber angle. Filtration surgeries are often required but are associated with a higher rate of surgical failure or complications than other types of glaucoma. Herein, we report a new and effective surgical procedure for glaucoma secondary to ICE syndrome: Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter. Methods Three patients with ICE syndrome who underwent surgery were included. Intraoperatively, an ab-interno peripheral iridectomy was performed using a small-gauge vitreous cutter through a corneal incision in the superior-nasal or superior-temporal quadrants to create space for the insertion of Ex-PRESS shunt free from the iris tissue. The shunt was inserted under the scleral flap. The first patient underwent combined cataract surgery, whereas patients 2 (pseudophakia) and 3 (phakia) underwent Ex-PRESS alone. Results No intraoperative complications were observed. The intraocular pressure remained stable until the final postoperative visits at approximately 7, 4, and 1 year in Cases 1, 2, and 3, respectively. Case 2, with mild preoperative corneal edema due to graft failure in Descemet's stripping automated endothelial keratoplasty (DSAEK), underwent reDSAEK 6 months postoperatively. Conclusions and importance Ex-PRESS shunt combined with ab-interno peripheral iridectomy using a small-gauge vitreous cutter may be a safe and effective surgical procedure in patients with ICE syndrome, regardless of the lens status.
Collapse
Affiliation(s)
- Ryotaro Wajima
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomomi Higashide
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| | - Kazuhisa Sugiyama
- Department of Ophthalmology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, 920-8641, Japan
| |
Collapse
|
2
|
Senthilkumar VA, Puthuran GV, Tara TD, Nagdev N, Ramesh S, Mani I, Krishnadas SR, Gedde SJ. Outcomes of the Aurolab aqueous drainage implant and trabeculectomy with mitomycin C in iridocorneal endothelial syndrome. Graefes Arch Clin Exp Ophthalmol 2023; 261:545-554. [PMID: 36038686 DOI: 10.1007/s00417-022-05811-6] [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: 02/12/2022] [Revised: 07/24/2022] [Accepted: 08/16/2022] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. MATERIALS AND METHODS This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31-83%) and 24% in the AADI group (95%CI = 11-48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16-1.40). CONCLUSION AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.
Collapse
Affiliation(s)
| | - George Varghese Puthuran
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.
| | - Techi Dodum Tara
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India.,Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Tirunelveli, India
| | - Nimrita Nagdev
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Sujitha Ramesh
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | - Iswarya Mani
- Glaucoma Services, Aravind Eye Hospital & Post Graduate Institute of Ophthalmology, Madurai, 625020, India
| | | | - Steven Jon Gedde
- Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, FL, USA
| |
Collapse
|
3
|
Deng Y, Zhang S, Ye W, Gu J, Lin H, Cheng H, Xie Y, Le R, Tao Y, Zhang W, Chen W, Tham CC, He M, Wang N, Liang Y. Achieving inner aqueous drain in glaucoma secondary to iridocorneal endothelial syndrome: One year results of penetrating canaloplasty. Am J Ophthalmol 2022; 243:83-90. [PMID: 35870489 DOI: 10.1016/j.ajo.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 11/01/2022]
Abstract
PURPOSES To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE). DESIGN Prospective, non-comparative clinical study. METHODS Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled IOP between January 2018 and April 2020. Patients were followed up at one week, month 1, 3, 6, 12 postoperatively, and semi-annually thereafter. Intraocular pressure (IOP), number of anti-glaucoma medication and surgery-related complications were recorded. Surgical success was defined as IOP ≥5 and ≤21mmHg without (complete success) or with/without (qualified success) IOP-lowering medications. RESULTS A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5±11.8 mmHg on 2.9±1.0 medications before surgery to 16.6±5.3 mmHg (P<0.001) on 0.2±0.6 medications (P<0.001) at 12 months post-operation, respectively. Hyphema (37.9%), transient hypotony (34.5%) and transient post-operative IOP elevation (≥30mmHg, 17.9%) were the most commonly observed early complications at the one week and one month visits. From one month and beyond, all treated eyes showed no obvious bleb at the operation quadrant. CONCLUSIONS Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated quite acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.
Collapse
Affiliation(s)
- Yuxuan Deng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Shaodan Zhang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wenqing Ye
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Juan Gu
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Haishuang Lin
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Huanhuan Cheng
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China; Wuhu First People's Hospital, Wuhu, Anhui, China
| | - Yanqian Xie
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Rongrong Le
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Yan Tao
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Wei Zhang
- Biomedical Informatics and Statistics Center, School of Public Health, Fudan University, Shanghai, China
| | - Wei Chen
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mingguang He
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | | | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases; The Eye Hospital of Wenzhou Medical University; Glaucoma Research Institute of Wenzhou Medical University, Zhejiang, China.
| |
Collapse
|
4
|
Rodrigo-Rey S, Bolívar G, Paz J, Teus MÁ. Ex-PRESS® implant as the first surgical option in the iridocorneal endothelial syndrome. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2021; 96:430-433. [PMID: 34340781 DOI: 10.1016/j.oftale.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
Our purpose is to report the intermediate-term results of the Ex-PRESS® implant as the first surgical option in patients with Iridocorneal Endothelial (ICE) Syndrome. We describe two patients diagnosed from ICE syndrome with medically uncontrolled glaucoma and finally treated with an Ex-PRESS® implant, associating a cataract surgery in one of them. Three years after surgery, intraocular pressure remains stable without any additional medical antiglaucomatous treatment, with a well-located implant surrounded by a diffuse filtering bleb and no sight-threatening adverse events have been documented. In addition, no progression of the disease has been registered. This report encourage the Ex-PRESS® implant to be considered the first surgical option in this patients as it allows a permeable ostium in spite of the progressive synechial angle closure typical of the ICE syndrome.
Collapse
Affiliation(s)
- S Rodrigo-Rey
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain.
| | - G Bolívar
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain
| | - J Paz
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain
| | - M Á Teus
- Ophthalmology Department, Universitary Hospital «Príncipe de Asturias», Alcalá de Henares, Madrid, Spain; University of Alcalá, School of Medicine, Alcalá de Henares, Madrid, Spain
| |
Collapse
|
5
|
Abstract
Our purpose is to report the intermediate-term results of the Ex-PRESS® implant as the first surgical option in patients with Iridocorneal Endothelial (ICE) Syndrome. We describe two patients diagnosed from ICE syndrome with medically uncontrolled glaucoma and finally treated with an Ex-PRESS® implant, associating a cataract surgery in one of them. Three years after surgery, intraocular pressure remains stable without any additional medical antiglaucomatous treatment, with a well-located implant surrounded by a diffuse filtering bleb and no sight-threatening adverse events have been documented. In addition, no progression of the disease has been registered. This report encourage the Ex-PRESS® implant to be considered the first surgical option in this patients as it allows a permeable ostium in spite of the progressive synechial angle closure typical of the ICE syndrome.
Collapse
|
6
|
Surgical outcomes of Ahmed glaucoma valve implantation in patients with glaucoma secondary to iridocorneal endothelial syndrome. Eye (Lond) 2020; 35:608-615. [PMID: 32367005 DOI: 10.1038/s41433-020-0912-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To evaluate the long-term outcome of patients with iridocorneal endothelial (ICE) syndrome who underwent Ahmed glaucoma valve implantation surgery for uncontrolled glaucoma. METHODS Eighteen patients who suffered from unilateral ICE syndrome with uncontrolled glaucoma and subsequently underwent Ahmed aqueous shunt surgery at Zhongshan Ophthalmic Center between January 2008 and December 2016 were reviewed. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, further surgical interventions, and surgical complications. RESULTS The mean IOP was reduced from 34.8 ± 10.6 mmHg on 3.6 ± 0.5 medications to 17.4 ± 4.9 mmHg (t = 6.791, P = 0.000) on 1.6 ± 1.1 medications (Z = -3.545, P = 0.000) at the last follow-up (42.0 ± 19.3 months). Five eyes (27.8%) achieved complete success, nine (50.0%) achieved qualified success, and the remaining four (22.2%) were considered failures. Survival was 94.4% at 1 year, 88.1% at 2 years, and 73.5% at 3 years. Four cases displayed a flat anterior chamber and were treated with a single anterior chamber reformation surgery with no recurrence. No other complications related to the glaucoma drainage implants occurred in this series. CONCLUSIONS Ahmed glaucoma valve implantation appears to be a safe and effective method for treating glaucoma secondary to ICE syndrome. Postoperative shallow anterior chamber and hypotony may occur but responds well to the treatment. Early consideration may be given to aqueous shunt surgery in patients with glaucoma secondary to ICE syndrome when trabeculectomy fails.
Collapse
|
7
|
Colás-Tomás T, López Tizón E. Ex-PRESS mini-shunt implanted in a pregnant patient with iridocorneal endothelial syndrome. Eur J Ophthalmol 2019; 30:NP25-NP28. [DOI: 10.1177/1120672118820508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: The failure rate of both filtration surgery and of aqueous shunt implantation is higher for iridocorneal endothelial syndrome than in other scenarios, due to the continuous proliferation of abnormal endothelial cells over the trabecular meshwork and the filtration area and also due to the more pronounced cicatrizing response shown by these young patients. We present the first case ever described in the literature of a pregnant patient with iridocorneal endothelial syndrome and uncontrolled ocular hypertension who was implanted an Ex-PRESS mini-shunt. Clinical case: A 35-year-old female presented with diminution of vision in the left eye for 2 months. She was 20 weeks pregnant. Her visual acuity was 20/20 in right eye and 20/25 in left eye, and intraocular pressure was 11 mmHg in right eye and 34 mmHg in left eye. Slit lamp biomicroscopic examination revealed no alterations in right eye, whereas left eye showed corectopia and uveal ectropion, stroma of iris’ sectoral atrophy and moderate corneal epithelial edema. Gonioscopy showed some anterior iris synechiae in left eye. Fundus evaluation was normal. Based on clinical features and examination, the diagnosis of left eye iridocorneal endothelial syndrome with decompensated intraocular pressure was made. She was prescribed topical timolol (0.5%) and dorzolamide. As a result of uncontrolled intraocular pressure and the impossibility to prescribe other hypotensive treatment available due to her being pregnant, it was decided to perform surgery in left eye using an Ex-PRESS mini-shunt and Ologen®; 6 months post surgery, intraocular pressure was 9 mmHg with no need for hypotensive treatment. The cornea was transparent, and the patient maintained her left eye visual acuity. Conclusions: Ex-PRESS mini-shunt can be considered a surgical option for iridocorneal endothelial syndrome. Its composition allows the ostium to remain open and the device triggers a milder postoperative inflammatory response. In our particular case, taking into account that the subject was a young, phakic, pregnant woman, whose intraocular pressure had to be closely controlled and we had to ensure that her postoperative care included as few drugs and as few reoperations as possible, we thought that using this device was the most appropriate option.
Collapse
|
8
|
Feng B, Tang X, Chen H, Sun X, Wang N. Unique variations and characteristics of iridocorneal endothelial syndrome in China: a case series of 58 patients. Int Ophthalmol 2017; 38:2117-2126. [PMID: 28993974 DOI: 10.1007/s10792-017-0712-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 09/16/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Iridocorneal endothelial (ICE) syndrome is a rare condition, and unique characteristics in Chinese patients can make diagnosis difficult. Our purpose was to describe the clinical characteristics and variations of ICE syndrome in 58 consecutive Chinese patients. METHODS The clinical data of consecutive patients with ICE syndrome who were seen between 2008 and 2011 at the glaucoma clinic of our ophthalmology department were retrospectively reviewed. The diagnostic criteria for ICE syndrome were a "hammered-silver" appearance of the corneal endothelium and specular microscopy showing ICE cells characterized by the absence of a hexagonal appearance, dark areas within the cells, and a light-dark reversal pattern. The general characteristics of the cornea, iris, pupil, and anterior chamber angles were compiled and examined. RESULTS Fifty-eight patients with ICE syndrome were identified: 26 had Chandler's syndrome (CS), 23 Cogan-Reese syndrome, and nine progressive iris atrophy (PIA). The incidence of glaucoma was 98%. Twenty-three (39.7%) patients had atypical ICE syndrome. Intraocular pressure was relatively high in 13 patients with slightly damaged irises, while the corneal endothelium remained relatively intact. Slit lamp examination showed an intact iris in ten patients (17.2%), with massive deposition of black pigment in the anterior chamber angle. In the 25 patients in whom the anterior chamber angle was only partially closed, 80% of the anterior chamber angles were hyperpigmented. CONCLUSIONS CS is the most common variation of ICE syndrome in Chinese patients, and PIA is the least common. A slight change or an intact iris under slit lamp examination is a characteristic of ICE syndrome.
Collapse
Affiliation(s)
- Bo Feng
- Beijing MEM Eye Care System, No. 65-2, Fuxing Road, Beijing, 100036, China
| | - Xin Tang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China.
| | - Hong Chen
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Xia Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, No. 1 Dongjiaominxiang Street, Dongcheng District, Beijing, 100730, China
| |
Collapse
|