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De Francesco T, Armstrong JJ, Hussein IM, Costa VP, Ahmed IIK. Mitomycin C 0.2 mg/ml vs. Mitomycin C 0.4mg/ml during the implantation of an ab externo SIBS microshunt: A mega-analysis. Ophthalmol Glaucoma 2024:S2589-4196(24)00085-1. [PMID: 38851392 DOI: 10.1016/j.ogla.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/18/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
PURPOSE To compare the effectiveness and adverse event profile of standalone SIBS microshunt implantation with adjunct MMC 0.2 mg/ml and MMC 0.4 mg/ml. DESIGN Mega-analysis using individual patient data from international prospective and retrospective clinical studies. STUDY POPULATION Patients with glaucoma who underwent implantation of a SIBS microshunt with MMC as a standalone procedure. METHODS A comparison of eyes that received MMC 0.2 mg/ml or 0.4 mg/ml MAIN OUTCOMES MEASURES: Primary outcome was complete success defined as the proportion of eyes at one year with all of the following: (1) no two consecutive IOPs > 17 mmHg; (2) no clinical hypotony (3) ≥20% IOP reduction from baseline and (4) no use of glaucoma medications. Secondary outcomes included IOP thresholds of 12 mmHg,14 mm Hg and 21mmHg, median IOP, number of medications, risk factors for failure, interventions, adverse events, and reoperations. RESULTS At 1 year, the complete success rate was significantly higher (71.3% vs 50.46%, p<0.001) and the median IOP significantly lower (13.0 vs. 14.2 mmHg, p<0.05) in the MMC 0.4 mg/ml group. MMC 0.2 mg/ml was found to be a significant risk factor for failure (HR 1.75 95%CI 1.14 to 2.67). Needling and surgical revision occurred at a lower rate in the MMC 0.4 mg/ml group (7% vs. 18.8%, p= 0.002 and 4.3% vs.13.7% p= 0.0087, respectively). Adverse events occurred at a similar frequency in both groups (26.6% MMC 0.2 mg/ml vs. 29.6% MMC 0.4 mg/ml, p=0.46), most of which were early and transient. CONCLUSION SIBS microshunt implantation with MMC 0.4 mg/ml resulted in a higher success rate with greater IOP reduction compared to MMC 0.2 mg/ml. Higher MMC concentration was not associated with increased serious adverse events.
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Affiliation(s)
- Ticiana De Francesco
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA; University of Campinas, Campinas, Brazil; Clinica de Olhos De Francesco, Fortaleza, Brazil; Hospital de Olhos Leiria de Andrade, Fortaleza, Brazil.
| | - James J Armstrong
- Department of Ophthalmology, Schulich School of Medicine, Western University, London, Canada
| | - Isra M Hussein
- Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Canada
| | | | - Iqbal Ike K Ahmed
- John A. Moran Eye Center, University of Utah, Salt Lake City, USA; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada
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Neubauer J, Suesskind D, Gassel CJ, Nasyrov E, Voykov B. Histopathological findings of failed blebs after microinvasive bleb surgery with the XEN Gel Stent and Preserflo MicroShunt. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06479-w. [PMID: 38625448 DOI: 10.1007/s00417-024-06479-w] [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: 10/26/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE The success of XEN Gel Stent (XEN) and Preserflo MicroShunt (Preserflo) implantation depends mainly on the development of bleb fibrosis. This study aimed to describe the histological findings of bleb fibrosis after XEN and Preserflo surgery. METHODS This retrospective study included patients with different types of glaucoma who underwent revision surgery after XEN or Preserflo implantation. The available clinical information and histological samples of removed fibrotic tissue were analyzed. RESULTS Thirty-six patients were included. Revision surgery was performed at a median of 195 (range = 31-1264) days after primary surgery. The mean intraocular pressure changed from 29.1 (± 10.3) mmHg at baseline to 18.3 (± 8.7) mmHg (- 37%; p < 0.0001) and 16.2 (± 4.2) mmHg (- 45%; p < 0.0001) after 6 and 12 months, respectively. Histological analysis revealed an increase in activated fibroblasts and macrophages in all specimens and a parallel orientation of fibroblasts in a minor part of the probe in 60% of the specimens. No pronounced inflammatory reaction in the form of lymphocytic or granulocytic infiltration was observed. The comparison of specimens from uveitic glaucoma and primary open-angle glaucoma patients revealed no significant differences. CONCLUSIONS The histological analysis of fibrotic blebs from the XEN and Preserflo implants did not show any pronounced immune or foreign-body reaction and revealed a similar histological pattern of failed blebs after trabeculectomy.
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Affiliation(s)
- Jonas Neubauer
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University, Elfriede-Aulhorn Str. 7, 72076, Tübingen, Germany.
| | - Daniela Suesskind
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University, Elfriede-Aulhorn Str. 7, 72076, Tübingen, Germany
| | - Caroline J Gassel
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University, Elfriede-Aulhorn Str. 7, 72076, Tübingen, Germany
| | - Emil Nasyrov
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University, Elfriede-Aulhorn Str. 7, 72076, Tübingen, Germany
| | - Bogomil Voykov
- Department of Ophthalmology, University Eye Hospital, Eberhard Karls University, Elfriede-Aulhorn Str. 7, 72076, Tübingen, Germany
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George J, Abouzeid H. PRESERFLO MicroShunt in Severe Myopia: A Case Report and Review of the Literature. Klin Monbl Augenheilkd 2024; 241:361-366. [PMID: 38653303 DOI: 10.1055/a-2239-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
The PRESERFLO™ MicroShunt (MP; Santen Inc., Osaka, Japan) is a minimally invasive bleb surgery (MIBS) manufactured to treat primary open-angle glaucoma (POAG), with lower postoperative adverse effects than with conventional filtering surgeries. We describe here the case study of a 58-year-old woman who presented with bilateral severe myopia with bilateral advanced POAG and unreached target pressure under quadritherapy, who was successfully managed by PM surgery. A review of the literature completes our observation. At presentation, the patient had a spherical equivalent of - 7.50 RE and - 7.75 LE with an IOP of 22 mmHg right and left eye (RLE) under quadritherapy, and with severe bilateral visual field loss, including scotomas within the central 5°. The patient presented with systemic hypertension treated with an antihypertensive drug. Two selective laser trabeculoplasties (SLT), performed 3 months apart, were first tried on the LE, without any change in IOP at 2 months. After considering the high risk of postoperative complications, a PM operation was proposed, with a targeted IOP in the mid-fifteens RLE. The patient's eyes underwent PM surgery with mitomycin C (MMC) MMC0.2 mg/mL for 3 minutes without any complications. The LE required 2 consecutive needlings with 1 mL MMC0.2 mg/mL. At 24 months after surgery, the two eyes gave successful results without the need for any additional medical therapy, and with well-functioning conjunctival blebs. The PM was an effective alternative to the gold standard trabeculectomy in our severely myopic patient. A comparative study between conventional filtering operations and this MIBS in highly myopic patients would confirm our observation.
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Affiliation(s)
- Jérôme George
- Ophthalmology, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Hana Abouzeid
- Ophthalmology, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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4
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Steiner S, Resch H, Kiss B, Vass C. PRESERFLO™ Microshunt: 1-Year Results of a 25-Gauge vs. 27-Gauge Needle Tract. J Clin Med 2024; 13:1979. [PMID: 38610744 PMCID: PMC11012831 DOI: 10.3390/jcm13071979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The purpose of this study was to evaluate the effectiveness and safety of the PreserFlo™ microshunt (PMS) using a 25-Gauge vs. 27-Gauge needle tract. Methods: This is a prospective postoperative examination of 60 glaucoma eyes that received a PMS. The main outcome measures were intraocular pressure (IOP), glaucoma drug score (GDS), Kaplan-Meier success rates, complications, and secondary intervention rates. Two subgroups were formed for data comparison: 27-Gauge (27G), and 25-Gauge (25G). Success was defined as IOP < 18 mmHg together with ≥20% IOP reduction with medication allowed (qualified success = QS18) or not (full success = FS18). Results: IOP and GDS were reduced from baseline to the 1-year study visit as follows: All eyes from 23.4 ± 8.6 mmHg (3.1 ± 0.9) to 15.1 ± 5.9 mmHg (0.8 ± 1.1); 25G from 24.2 ± 7.3 mmHg (3.0 ± 0.8) to 12.7 ± 2.7 mmHg (0.5 ± 0.8); and 27G from 23.1 ± 9.2 mmHg (3.1 ± 1.0) to 16.2 ± 6.7 mmHg (0.9 ± 1.2). IOP at one year was lower in the 25G group compared to the 27G group (p = 0.035). Bleb needling was required in eight (13.3%) eyes and open bleb revisions in three (5.0%). Transient hypotony occurred in 21% and choroidal effusion in 8% of all eyes. Choroidal effusions were more frequent in the 25G group (21%) compared to the 27G group (2%, p = 0.031). One-year success rates were significantly higher in the 25G group compared to the 27G group for both QS18 (25G: 67.9% vs. 27G: 35.7%, p = 0.002) and FS18 (25G: 63.6% vs. 27G: 29.2%, p = 0.007). Conclusions: The PreserFlo microshunt is an effective and safe glaucoma surgery with a low rate of bleb revisions or needlings. We show that the 25G needle tract might be more efficient for IOP control at the cost of increased IOP-related complications compared to 27G.
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Affiliation(s)
- Stefan Steiner
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| | - Hemma Resch
- Department of Ophthalmology, Sanatorium Hera, 1090 Vienna, Austria
| | - Barbara Kiss
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
| | - Clemens Vass
- Department of Ophthalmology, Medical University of Vienna, 1090 Vienna, Austria
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Rojo-Arnao M, Martinez-de-la-Casa JM, Albis-Donado O, Yañez-Castro G, Maroto-Cejudo R, Téllez J, Menoyo-Calatayud R. Preserflo TM MicroShunt implantation combined with Ologen TM in primary and secondary glaucoma patients in a clinical setting. Indian J Ophthalmol 2024; 72:417-426. [PMID: 38153975 PMCID: PMC11001232 DOI: 10.4103/ijo.ijo_1502_23] [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: 06/08/2023] [Revised: 09/24/2023] [Accepted: 10/18/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE This study aims to assess the effectiveness and safety of combining the Preserflo™ MicroShunt implant (MicroShunt) with a simultaneous Ologen™ implant in patients with glaucoma. METHODS We conducted a retrospective study on consecutive patients with medically uncontrolled glaucoma who underwent MicroShunt + Ologen implantation as a standalone procedure or in combination with phacoemulsification (combined procedure). Success was defined as achieving an intraocular pressure (IOP) of 6-15 mmHg at 18 months post surgery, with a preoperative IOP reduction of at least 20%, and without (complete success) or with (qualified success) the need for antiglaucoma medications. The primary endpoint was the success rate. RESULTS Forty-eight eyes from 47 patients were included, with 28 eyes (58.3%) undergoing the standalone procedure and 20 eyes (41.7%) undergoing the combined procedure. Overall, there was a significant reduction in preoperative IOP from 19.7 ± 5.8 mmHg to 11.4 ± 2.6 mmHg at 18 months ( P < 0.0001). In the standalone procedure group, preoperative IOP decreased from 21.5 ± 5.2 mmHg to 11.7 ± 2.5 mmHg ( P < 0.0001), and in the combined procedure group, preoperative IOP decreased from 17.1 ± 5.8 mmHg to 10.9 ± 2.7 mmHg ( P = 0.0002), with no significant difference between the two groups regarding final IOP. The mean number of antiglaucoma medications significantly decreased from 3.2 ± 1.1 to 0.3 ± 0.7 in the overall study population ( P < 0.0001). At 18 months, 40 eyes (83.3%) were classified as successful. Regarding safety, out of the total number of eyes, two (4.2%) experienced choroidal detachment without visual impairment, two (4.2%) had transient hyphema, one (2.1%) showed reactivation of a corneal herpetic ulcer, one (2.1%) had diplopia, and one (2.1%) exhibited a shallow anterior chamber during the first week. CONCLUSION The combination of Ologen™ and Preserflo™ MicroShunt, either alone or in conjunction with phacoemulsification, demonstrated a favorable profile in terms of IOP reduction and safety.
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Affiliation(s)
| | - José María Martinez-de-la-Casa
- Department of Ophthalmology and ORL, Faculty of Medicine, Ophthalmology Unit, Hospital Clinico San-Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clinico San-Carlos (IdISSC), Madrid, Spain
- Department of Immunology, Ophthalmology and ORL, School of Medicine, Instituto de Investigaciones Oftalmologicas Ramon Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Oscar Albis-Donado
- Glaucoma Specialist, Private Practice, Visual Sense, Mexico City, Mexico
| | | | | | - Jesús Téllez
- Department of Ophthalmology, Hospital de la Santa Creu i de Sant Pau, Autonoma University of Barcelona, Barcelona, Spain
- Departament of Ophthalmology, Grupo Admiravisión, Barcelona, Spain
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Rabiolo A, Toscani R, Sacchi M, Destefanis P, Bettin P, Ciampi C, Clemente A, Cutolo CA, Mercieca K, Iester M, Traverso CE, Di Maita M, Li Calzi G, Nucci P, Bandello F, Triolo G, De Cillà S. Risk Factors for Failure in Glaucoma Patients Undergoing Microshunt Implantation. Am J Ophthalmol 2024; 259:117-130. [PMID: 37979601 DOI: 10.1016/j.ajo.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To evaluate risk factors for failure of Microshunt in glaucoma patients. DESIGN Multicenter retrospective cohort study. METHODS The study included 220 eyes from 220 consecutive glaucoma patients undergoing Microshunt implantation at six glaucoma units. Four intraocular pressure (IOP) success criteria were defined: (A) IOP ≤21 mm Hg with ≥20% IOP reduction; (B) IOP ≤18 mm Hg with ≥20% IOP reduction; (C) IOP ≤15 mm Hg with ≥25% IOP reduction; and (D) IOP ≤12 mm Hg with ≥30% IOP reduction from baseline. Kaplan-Meier analysis was used to estimate success rates according to the criteria above, and multivariable Cox models were used to identified risk factors for failure according to criterion A. RESULTS Success rates varied based on different criteria, ranging from 43.3% to 62.5% (overall success for criteria D and A, respectively) and from 35.3% to 44.4% (complete success for criteria D and A, respectively) at 1-year follow-up. Higher intraoperative MMC concentration was associated with reduced risk of failure to maintain complete (0.4 vs 0.2 mg/mL: hazard ratio [HR] = 0.441, P < .001) and overall (0.4 vs 0.2 mg/mL: HR = 0.360, P = .004) success. For complete success, other risk factors for failure were pseudoexfoliation glaucoma/pigmentary glaucoma (HR = 1.641, P = .004), primary angle closure glaucoma (HR = 1.611, P < .001), and previous non-glaucomatous ocular surgeries (HR = 2.301, P = .002). For overall success, other risk factors for failure were lower preoperative IOP (for 1-mm Hg increase, HR = 0.934, P = .005), higher number of preoperative antiglaucoma agents (HR = 1.626, P < .001), and Microshunt combined with cataract surgery (HR = 1.526, P = .033). CONCLUSIONS This study identified risk factors for Microshunt failure, highlighting the importance of high intraoperative MMC dose and careful patient selection to optimize surgical success.
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Affiliation(s)
- Alessandro Rabiolo
- From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy.
| | - Rebecca Toscani
- Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Sacchi
- Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Pietro Destefanis
- From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy
| | - Paolo Bettin
- Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Ciampi
- Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Clemente
- From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy
| | - Carlo Alberto Cutolo
- DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy
| | - Karl Mercieca
- Department of Ophthalmology (K.M.), University Hospital Bonn, Bonn, Germany; Faculty of Biology (K.M.), Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Michele Iester
- DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy
| | - Carlo Enrico Traverso
- DiNOGMI (C.A.C., M.I., C.E.T.), Università di Genova, Genova, Italy; IRCCS Ospedale Policlinico San Martino (C.A.C., M.I., C.E.T.), Genova, Italy
| | - Marco Di Maita
- Department of Ophthalmology (M.D.M.), Policlinico G.B. Morgagni, Catania, Italy
| | - Gaia Li Calzi
- Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Paolo Nucci
- Department of Ophthalmology (M.S., G.L.C., P.N.), San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Francesco Bandello
- Department of Ophthalmology (R.T., P.B., C.C., F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacinto Triolo
- Department of Ophthalmology (G.T.), Fatebenefratelli and Ophthalmic Hospital, ASST-Fatebenefratelli-Sacco, Milan, Italy
| | - Stefano De Cillà
- From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy
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Panarelli JF, Moster MR, Garcia-Feijoo J, Flowers BE, Baker ND, Barnebey HS, Grover DS, Khatana AK, Lee B, Nguyen T, Stiles MC, Sadruddin O, Khaw PT. Ab-Externo MicroShunt versus Trabeculectomy in Primary Open-Angle Glaucoma: Two-Year Results from a Randomized, Multicenter Study. Ophthalmology 2024; 131:266-276. [PMID: 37769852 DOI: 10.1016/j.ophtha.2023.09.023] [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: 06/06/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To compare the effectiveness and safety of the MicroShunt (Santen Inc) versus trabeculectomy in patients with primary open-angle glaucoma (POAG). DESIGN Prospective, randomized, multicenter trial conducted in the United States and Europe. PARTICIPANTS Adult patients (aged 40-85 years) with mild to severe POAG inadequately controlled on maximum tolerated medical therapy and intraocular pressure (IOP) ≥ 15 mmHg and ≤ 40 mmHg. METHODS Patients were randomized 3:1 to stand-alone MicroShunt implantation (n = 395) or trabeculectomy (n = 132), both augmented with mitomycin C (MMC) 0.2 mg/ml for 2 minutes. MAIN OUTCOME MEASURES The primary effectiveness end point was surgical success, defined as ≥ 20% reduction in mean diurnal IOP from baseline with no increase in glaucoma medications. Secondary end points included changes in mean IOP and medication use from baseline and the need for postoperative interventions. RESULTS At 2 years, the rate of surgical success was lower in the MicroShunt group than in the trabeculectomy group (50.6% vs. 64.4%, P = 0.005). Mean diurnal IOP was reduced from 21.1 ± 4.9 mmHg at baseline to 13.9 ± 3.9 mmHg at 24 months in the MicroShunt group and from 21.1 ± 5.0 mmHg at baseline to 10.7 ± 3.7 mmHg at 24 months in the trabeculectomy group (P < 0.001 compared with baseline in both groups). Mean medication use decreased from 3.1 to 0.9 in the MicroShunt group and from 2.9 to 0.4 in the trabeculectomy group (P < 0.001 compared with baseline in both groups). Adverse events at 2 years were generally similar in the 2 groups, except that hypotony was more common in eyes undergoing trabeculectomy (51.1% vs. 30.9%, P < 0.001). Repositioning or explantation of the implant occurred in 6.8% of MicroShunt patients. The majority of these patients had device removal at the time of subsequent glaucoma surgery. Vision-threatening complications were uncommon in both groups. CONCLUSION At 2 years, both the MicroShunt and trabeculectomy provided significant reductions in IOP and medication use, with trabeculectomy continuing to have greater surgical success. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Bonny Lee
- New York University, New York, New York
| | | | | | | | - Peng T Khaw
- NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, England; UCL Institute of Ophthalmology, London, England
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8
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Bøhler AD, Traustadóttir VD, Hagem AM, Tønset TS, Drolsum L, Kristianslund O. Hypotony in the early postoperative period after MicroShunt implantation versus trabeculectomy: A registry study. Acta Ophthalmol 2024; 102:186-191. [PMID: 37340695 DOI: 10.1111/aos.15727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE A comparison of the safety and efficacy of the MicroShunt versus trabeculectomy in the early postoperative period, with a particular focus on hypotony. METHODS In this registry study, we evaluated 200 eyes of 200 glaucoma patients who underwent filtration surgery at Oslo University Hospital between 2017 and 2021. Of these patients, 100 had a Preserflo MicroShunt (Santen) implantation and 100 had a trabeculectomy procedure. The patients were examined per standard hospital protocol after filtration surgery. Data were extracted from the 4- and 8-week visits. We defined hypotony as intraocular pressure (IOP) < 6 mmHg. RESULTS The mean preoperative IOP was 20.6 ± 7.1 mmHg in the MicroShunt group and 21.6 ± 7.1 mmHg in the trabeculectomy group, and the patients used a mean of 3.0 ± 0.9 and 3.1 ± 0.9 glaucoma medications, respectively. After 8 weeks, IOP was reduced to 10.4 ± 5.4 mmHg and 11.3 ± 4.6 mmHg, respectively (p = 0.23). During the early postoperative period, hypotony was registered in 63% of the MicroShunt patients and in 21% of the patients in the trabeculectomy group (p < 0.001); and 11% and 1%, respectively, of the patients developed choroidal detachments (p < 0.003). One patient in the MicroShunt group required reoperation due to hypotony. CONCLUSIONS In this registry study, we found that the Preserflo MicroShunt and trabeculectomy had equally satisfactory IOP-lowering effects during the early postoperative period. In this same period, a high number of patients in the MicroShunt group developed hypotony.
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Affiliation(s)
- Anders Djupesland Bøhler
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Valgerdur Dora Traustadóttir
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Marie Hagem
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Liv Drolsum
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav Kristianslund
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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9
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Oddone F, Roberti G, Giammaria S, Posarelli C, Ghirelli G, Mastropasqua L, Agnifili L, Micelli Ferrari T, Pace V, Nucci P, Sacchi M, Monsellato G, Altafini R, Scuderi G, Perdicchi A, Uva M, Carnevale C, Covello G, Maglionico MN, Fea A, Figus M. Effectiveness and safety of XEN45 implant over 12 months of follow-up: data from the XEN-Glaucoma Treatment Registry. Eye (Lond) 2024; 38:103-111. [PMID: 37414935 PMCID: PMC10764778 DOI: 10.1038/s41433-023-02642-5] [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: 09/29/2022] [Revised: 05/29/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To evaluate the 1-year effectiveness and safety of the XEN45, either alone or in combination with phacoemulsification, in glaucoma patients. METHODS This multicentre, prospective, observational study included consecutive eyes of glaucoma patients from the Italian XEN-Glaucoma Treatment Registry (XEN-GTR) who underwent XEN45 alone or in combination with phacoemulsification, with at least 1 year of follow-up. Surgical success was defined as intraocular pressure (IOP) < 18 mmHg and ≥20% reduction from preoperative IOP, over 1 year of follow-up. RESULTS Two hundred thirty-nine eyes (239 patients) were analyzed, 144 (60.2%) eyes in the XEN-solo and 95 (39.8%) eyes in the XEN+Phaco groups. One hundred-sixty-eight (70.3%) eyes achieved overall success, without statistically significant differences between study groups (p = 0.07). Preoperative IOP dropped from a median (IQR) of 23.0 (20.0-26.0) mmHg to 14.0 (12.0-16.0) mmHg at month 12 (p < 0.001), with overall 39.9 ± 18.3% IOP reduction. The mean number of preoperative ocular hypotensive medications (OHM) was significantly reduced from 2.7 ± 0.9 to 0.5 ± 0.9 at month 12 (p < 0.001). Preoperative IOP < 15 mmHg (HR: 6.63; 95%CI: 2.61-16.84, p < 0.001) and temporal position of the surgeon (HR: 4.25; 95%CI: 2.62-6.88, p < 0.001) were significantly associated with surgery failure. One hundred-forty-six (61.1%) eyes had no intraoperative complications, whereas 91 (38.1%) and 56 (23.4%) eyes experienced at least one complication, respectively early (< month 1) and late (≥ month 1), all self-limiting or successfully treated without sequelae. Needling occurred in 55 (23.0%) eyes at least once during follow-up. CONCLUSION Over 1-year follow-up, XEN45 alone or in combination with phacoemulsification, had comparable success rates and effectively and safely lowered IOP and the need for OHM.
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Affiliation(s)
| | | | | | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Pace
- Regional General Hospital F. Miulli of Acquaviva delle Fonti, Bari, Italy
| | - Paolo Nucci
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital - IRCCS Multimedica, Milan, Italy
| | | | | | - Gianluca Scuderi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, St. Andrea Hospital, NESMOS Department, University of Rome "Sapienza", Rome, Italy
| | - Maurizio Uva
- University Hospital "Policlinico Vittorio Emanuele", Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonio Fea
- Struttura Complessa Oculistica, Città Della Salute e Della Scienza di Torino, Dipartimento di Scienze Chirurgiche-Università Degli Studi di Torino, 10126, Torino, Italy
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Care Medicine, University of Pisa, Pisa, Italy
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10
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Gubser PA, Pfeiffer V, Hug S, Shang X, Lincke JB, Häner NU, Zinkernagel MS, Unterlauft JD. PRESERFLO MicroShunt implantation versus trabeculectomy for primary open-angle glaucoma: a two-year follow-up study. EYE AND VISION (LONDON, ENGLAND) 2023; 10:50. [PMID: 38124210 PMCID: PMC10734133 DOI: 10.1186/s40662-023-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND To compare the intermediate-term efficacy of PRESERFLO (PF) MicroShunt implantation with trabeculectomy (TE) in patients with primary open-angle glaucoma, focusing on longitudinal changes of functional and structural parameters. METHODS This retrospective comparative study included 104 eyes of 104 patients who underwent TE and 83 eyes of 83 patients that underwent PF implantation between January 2019 and December 2020, with a minimum follow-up of two years. Baseline and postoperative intraocular pressure (IOP), number of IOP-lowering medications, visual field mean defect (MD) and peripapillary retinal nerve fibre layer (RNFL) thickness measured using optical coherence tomography were assessed and compared between groups. RESULTS Baseline characteristics (age, sex, IOP, number of IOP-lowering medications, MD, RNFL thickness) were comparable between the two groups (all P > 0.05). During the two-year of follow-up, mean IOP decreased from 24.09 ± 1.15 mmHg and 21.67 ± 0.77 mmHg to 11.37 ± 1.13 mmHg (P < 0.001) and 15.50 ± 1.54 mmHg (P = 0.028), and the mean number of IOP-lowering medications decreased from 3.25 ± 0.14 and 3.51 ± 0.14 to 0.53 ± 0.14 (P < 0.001) and 1.06 ± 0.43 (P < 0.001) in the TE and PF groups, respectively. MD remained stable [- 11.54 ± 0.93 dB and - 11.17 ± 1.66 to - 10.67 ± 0.91 dB (P = 0.226) and - 10.40 ± 4.75 dB (P = 0.628) in the TE and PF groups, respectively] but RNFL thickness decreased continuously during follow-up [62.79 ± 1.94 µm and 62.62 ± 2.05 µm to 57.41 ± 1.81 µm (P < 0.001) and 60.22 ± 1.98 µm (P = 0.182) in the TE and PF groups, respectively]. CONCLUSION PF implantation is comparably effective in the intermediate term in lowering IOP and reducing the use of IOP-lowering medications over a two-year follow-up period. Although visual field defects were stable, RNFL continued to decrease during postoperative follow-up.
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Affiliation(s)
- Pascal Aurel Gubser
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentin Pfeiffer
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Simon Hug
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Xiao Shang
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel-Benjamin Lincke
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nathanael Urs Häner
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin S Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jan Darius Unterlauft
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Storp JJ, Schatten H, Vietmeier FE, Merté RL, Lahme L, Zimmermann JA, Englmaier VA, Eter N, Brücher VC. The Preserflo MicroShunt Affects Microvascular Flow Density in Optical Coherence Tomography Angiography. Biomedicines 2023; 11:3254. [PMID: 38137475 PMCID: PMC10741543 DOI: 10.3390/biomedicines11123254] [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: 11/01/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Intraocular pressure (IOP) lowering surgery has been shown to alter microvascular density in glaucoma patients. The aim of this study is to report changes in retinal flow density (FD) over the course of treatment with the Preserflo MicroShunt, using optical coherence tomography angiography (OCTA). 34 eyes from 34 patients who underwent Preserflo MicroShunt implantation were prospectively enrolled in this study. OCTA imaging was conducted at the superficial (SCP), deep (DCP) and radial peripapillary plexus (RPC) levels. The progression of FD and IOP was assessed at different time points from baseline to six months postoperatively for the entire patient population, as well as disease severity subgroups. The Preserflo MicroShunt achieved a significant reduction in IOP over the course of six months (median: 8 mmHg; p < 0.01). FD values of the SCP and DCP did not show significant fluctuations, even after adjusting for disease severity. FD of the RPC decreased significantly over the course of six months postoperatively from 42.31 at baseline to 39.59 at six months postoperatively (p < 0.01). The decrease in peripapillary FD was strongest in patients with advanced glaucoma (median: -3.58). These observations hint towards dysfunctional autoregulatory mechanisms in capillaries surrounding the optic nerve head in advanced glaucoma. In comparison, the microvascular structure of the macula appeared more resilient to changes in IOP.
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Affiliation(s)
- Jens Julian Storp
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Hannah Schatten
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
- Augenklinik Roth am St. Josef-Hospital, 53225 Bonn, Germany
| | - Friederike Elisabeth Vietmeier
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Ralph-Laurent Merté
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Larissa Lahme
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Julian Alexander Zimmermann
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Verena Anna Englmaier
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
| | - Viktoria Constanze Brücher
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany (F.E.V.); (R.-L.M.); (L.L.); (J.A.Z.); (V.A.E.); (N.E.); (V.C.B.)
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12
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Bamousa A, Dakroub M, Verma-Fuehring R, Papadopoulos K, Hillenkamp J, Loewen NA. Standard anterior peritomy versus a small posterior incision for the implantation of the PRESERFLO microshunt. Int Ophthalmol 2023; 43:5071-5078. [PMID: 37874441 PMCID: PMC10724329 DOI: 10.1007/s10792-023-02910-z] [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: 05/07/2022] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To compare two approaches for the implantation of the PRESERFLO microshunt: an anterior approach (A) with a 6-8-mm peritomy and a posterior approach (P) with a 3-mm incision. METHODS We retrospectively analyzed 126 patients who received a PRESERFLO microshunt. We compared intraocular pressure (IOP), surgical time, medication count, and postoperative complications over nine months. RESULTS The baseline IOP was similar in A (21.8 ± 8.5 mm Hg) and P (23.9 ± 8.1 mm Hg) (p = 0.08). Surgical duration was significantly shorter in P (10 ± 0.4 min) than in A (26 ± 0.8 min) (p < 0.001). Postoperative IOP levels were comparable in A (10.8 ± 5.9 mm Hg) and P (10.6 ± 4.5 mm Hg) at 30 days (p = 0.62) and throughout the study (all intra-group p-values > 0.08). The preoperative medication count was 3.2 ± 1.3 drops in A and 3.3 ± 1.0 drops in P (p = 0.4). Postoperative values were 0.2 ± 0.6 in A and 0.3 ± 0.7 in P at nine months. There were no significant differences in complications and surgical revisions between groups (p-values > 0.05). CONCLUSION Both techniques achieved satisfactory IOP and medication count reductions and had similar safety profiles, but the posterior incision technique was 2.6 times faster than the anterior incision technique.
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Affiliation(s)
- Ahmed Bamousa
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - Mohamad Dakroub
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | | | | | - Jost Hillenkamp
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany
| | - N A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
- Artemis Eye Centers of Frankfurt, Hanauer Landstr. 147, 60314, Frankfurt, Germany.
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13
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Theilig T, Papadimitriou M, Albaba G, Meller D, Hasan SM. Results of open bleb revision as management of primary bleb failure following XEN 45 gel stent and Preserflo™ Microshunt. Graefes Arch Clin Exp Ophthalmol 2023; 261:3249-3255. [PMID: 37410178 PMCID: PMC10587268 DOI: 10.1007/s00417-023-06152-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE The success of filtering surgery as in XEN-Gel-Stent (XEN) and Preserflo-Microshunt (PF) depends mainly on a functioning bleb. Primary bleb failure (PBF) is not uncommon and can be treated with needling or open bleb revision (OBR). The aim of the study is to compare surgical outcomes of OBR after XEN and PF. METHODS Eyes which received OBR as management of PBF following implantation of XEN or PF were retrospectively included. Intraocular pressure (IOP), number of IOP lowering medications (NoM), and success rates (SR) were compared between groups. Complete and qualified success were defined as IOP ≤18mmHg and a reduction of >20%, without and with medications, respectively. RESULTS 29 eyes after XEN and 23 eyes after PF were included. Six months following OBR, IOP reduced from 24.2±4.7 to 13.5±4.6 after XEN and from 27.3±8.7 to 15.9±5.8mmHg after PF (both p<0.001). NoM did not change (0.7±1.3 to 0.4±0.8 after XEN and 1.2±1.3 to 1.0±1.5 after PF, p>0.05 for both). Complete SR were higher after XEN than after PF (58.6% vs. 30.4%, p=0.04). Complications were mild and managed mainly conservatively. Additional glaucoma surgery was needed in 17% and 30% of eyes after XEN and PF, respectively (p=0.26). CONCLUSION Although OBR was effective as management of PBF following XEN and PF, SR were higher after XEN than after PF along with comparable safety profile. The change of the surgical approach from ab interno during XEN-Implantation to ab externo during OBR seems to enhance SR compared to PF, where both interventions are done ab externo.
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Affiliation(s)
- Theresa Theilig
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Menelaos Papadimitriou
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ghaith Albaba
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Meller
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Somar M Hasan
- Klinik für Augenheilkunde, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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14
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Hussein IM, De Francesco T, Ahmed IIK. Intermediate Outcomes of the Novel 63-μm Gelatin Microstent versus the Conventional 45-μm Gelatin Microstent. Ophthalmol Glaucoma 2023; 6:580-591. [PMID: 37169174 DOI: 10.1016/j.ogla.2023.05.001] [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: 03/20/2023] [Revised: 04/24/2023] [Accepted: 05/03/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To determine intermediate intraocular pressure (IOP)-lowering and adverse event profile of the 63-μm gelatin microstent (Xen63) with mitomycin C (MMC) compared with the 45-μm gelatin microstent (Xen45) with MMC. DESIGN Single center, consecutive, retrospective cohort study. PARTICIPANTS Eighty-four glaucomatous eyes (42 63-μm gelatin microstent and 42 45-μm gelatin microstent) with or without previous subconjunctival glaucoma surgery. METHODS Consecutive eyes that underwent 63-μm gelatin microstent implantation with MMC from February 2020 to June 2021 were compared with eyes that underwent 45-μm gelatin microstent implantation with MMC. Standalone and combined cases with phacoemulsification were included. MAIN OUTCOME MEASURES Primary outcome was the hazard ratio of failure of 45-μm gelatin microstent vs. 63-μm gelatin microstent eyes at 12 months, with failure defined as 2 consecutive IOPs, (1) >17 mmHg, (2) <6 mmHg with 2 lines of vision loss, or (3) <20% reduction from baseline IOP, without (complete) or with (qualified) glaucoma medications. Secondary outcomes included IOP thresholds of 14 mmHg and 21 mmHg, postoperative IOP, medications, adverse events, interventions, and reoperations. RESULTS The complete success rate was higher in the 63-μm gelatin microstent group (59.5% vs. 28.6%, P = 0.009) at the primary IOP threshold of 6 to 17 mmHg but did not differ significantly for qualified success (66.7% vs. 45.2%, P = 0.08). The crude hazard ratio of failure of 45-μm gelatin microstent relative to 63-μm gelatin microstent was 2.28 (95% confidence interval [CI], 1.21-4.32), and the adjusted hazard ratio was 7.90 (95% CI, 2.12-29.43). 63-μm gelatin microstent eyes had significantly lower mean IOP (12.7 ± 4.8 vs. 15.5 ± 5.1 mmHg, P = 0.001) and fewer medication classes (0.6 ± 1.1 vs. 1.7 ± 1.6 medications, P = 0.0005), with the degree of reduction in IOP and medication count being significantly greater in 63-μm gelatin microstent eyes. There were 28 and 21 distinct interventions in 63-μm gelatin microstent and 45-μm gelatin microstent eyes respectively, with 11.9% of eyes undergoing needling in each group. There were 34 and 19 distinct adverse events, in 63-μm gelatin microstent and 45-μm gelatin microstent eyes, respectively, most of which were early and transient. Nine Xen63 eyes (21.4%) and 6 45-μm gelatin microstent eyes (14.3%) underwent reoperation. CONCLUSIONS 63-μm gelatin microstent resulted in higher surgical success rates and fewer medications compared with 45-μm gelatin microstent. This was tempered by more postoperative interventions and adverse events, although most were transient. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Isra M Hussein
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada.
| | - Ticiana De Francesco
- Hospital de Olhos Leiria de Andrade, Fortaleza, Ceara, Brazil; Clinica de Olhos De Francesco, Fortaleza, Ceara, Brazil; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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15
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Schlenker MB, Armstrong JJ, De Francesco T, Ahmed IIK. All Consecutive Ab Externo SIBS Microshunt Implantations With Mitomycin C: One-Year Outcomes and Risk Factors for Failure. Am J Ophthalmol 2023; 255:125-140. [PMID: 37352909 DOI: 10.1016/j.ajo.2023.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/28/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE To present the effectiveness, risk factors for surgical failure, and adverse events over 12 months in a consecutive diverse cohort of glaucoma patients who underwent solo or combined ab externo SIBS microshunt with mitomycin C (MMC) with or without previous subconjunctival surgery. DESIGN Retrospective, consecutive, interventional case series. METHODS Consecutive glaucomatous eyes on maximally tolerated medical therapy received ab externo SIBS microshunt with MMC implantation as a solo or combined procedure with phacoemulsification from July 2015 to January 2020. The primary outcome was the proportion of eyes at 12-months with the following: (1) no 2 consecutive intraocular pressures (IOPs) >17 mm Hg or clinical hypotony, without (complete success) or with (qualified success) glaucoma medications; and (2) ≥20% reduction from baseline IOP. Secondary outcomes included upper IOP thresholds of 14 and 21 mm Hg with and without a 20% IOP reduction from baseline, median IOP, medications, risk factors for failure, postoperative interventions, complications, and reoperations. RESULTS A total of 436 eyes underwent surgery; 86 (20%) combined with phacoemulsification, 127 (29%) in eyes with refractory glaucoma, and 234 (51%) stand-alone procedures in non-refractory eyes. Complete success (6-17 mm Hg with no medications) was achieved in 64.0% of combined eyes, 58.1% of refractory eyes, and 74.8% of stand-alone non-refractory eyes; and qualified success rates (6-17 mm Hg with medications) were 90.7%, 84.7%, and 92.4% of eyes, respectively. At 12 months, 67% of eyes were medication free. Significant risk factors for failure included combined procedures in refractory eyes (hazard ratio [HR] = 3.2; 95% CI = 1.4-7.4), receiving <0.4 mg/mL of MMC (HR = 2.2; 95% CI = 1.6-3.1), refractory eyes (HR = 1.7; 95% CI = 1.2-2.5), combined procedures (HR = 1.6; 95% CI = 1.0-2.5), and each additional baseline medication class (HR = 1.3; 95% CI = 1.1-1.5). Postoperative complications occurred in 31% of eyes, and more often in those receiving ≥0.4 mg/mL MMC (odds ratio [OR] = 2.2, 95% CI 1.2-3.8). Needling occurred in 12% of eyes, with significantly higher frequency in refractory eyes (23%) and combined procedures (13%) compared to stand-alone (7%; P < .001). Revisions and reoperations occurred in 4% and 1.4% of eyes, respectively. CONCLUSIONS The 1-year follow-up data from this large and diverse cohort support promising rates of qualified and complete surgical success with decreased medication burden and few postoperative complications and interventions. Combined phacoemulsification, refractory glaucoma, and receiving <0.4mg/mL MMC were associated with reduced surgical success rates.
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Affiliation(s)
- Matthew B Schlenker
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada; John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA.
| | - James J Armstrong
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada
| | - Ticiana De Francesco
- John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA; Hospital de Olhos Leiria de Andrade (T.D.F.), Fortaleza, Ceará, Brazil
| | - Iqbal Ike K Ahmed
- From the Department of Ophthalmology and Vision Sciences (M.B.S., J.J.A.,I.I.K.A.), University of Toronto, Toronto, Ontario, Canada; Prism Eye Institute (M.B.S., J.J.A., I.I.K.A.), Mississauga, Ontario, Canada; John A. Moran Eye Center (M.B.S., T.D.F., I.I.K.A.), University of Utah, Salt Lake City, Utah, USA
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Abstract
Many pharmaceutical and medical device start-up companies share similar goals. Each experience is different and offers important lessons for companies seeking Food and Drug Administration approval. This article offers important advice for budding entrepreneurs as it discusses some career-altering decisions, lessons learned in the start-up world, the technology leading up to innovation, the relevant science, medicine, chemistry, and engineering, the need to develop novel biomaterials, the regulatory path, and the business process culminating in the development of a Poly(styrene-block-isobutylene-block-Styrene)-based microshunt to treat glaucoma that led to the founding of InnFocus, Inc. (Miami, FL) in 2004, and then the acquisition of InnFocus by Santen Pharmaceuticals (Osaka, Japan) in 2016.
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Affiliation(s)
- Leonard Pinchuk
- InnFocus, Inc., a Santen Company, Miami, Florida, and Department of Biomedical Engineering, University of Miami, Miami, Florida
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17
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Jamke M, Herber R, Haase MA, Jasper CS, Pillunat LE, Pillunat KR. PRESERFLO ™ MicroShunt versus trabeculectomy: 1-year results on efficacy and safety. Graefes Arch Clin Exp Ophthalmol 2023; 261:2901-2915. [PMID: 37133501 PMCID: PMC10155172 DOI: 10.1007/s00417-023-06075-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/04/2023] [Accepted: 04/15/2023] [Indexed: 05/04/2023] Open
Abstract
PURPOSE To compare the efficacy and safety of the PRESERFLO™ MicroShunt versus trabeculectomy in patients with primary open-angle glaucoma (POAG) after one year. PATIENTS AND METHODS Institutional prospective interventional cohort study comparing eyes with POAG, which had received the PRESERFLO™ MicroShunt versus trabeculectomy. The MicroShunt group was matched with the trabeculectomy group for age, known duration of disease, and number and classes of intraocular pressure (IOP) lowering medications to have similar conjunctival conditions. The study is part of the Dresden Glaucoma and Treatment Study, using a uniform study design, with the same inclusion and exclusion criteria, follow-ups and standardized definitions of success and failure for both procedures. PRIMARY OUTCOME MEASURES mean diurnal IOP (mdIOP, mean of 6 measurements), peak IOP, and IOP fluctuations. SECONDARY OUTCOME MEASURES success rates, number of IOP lowering medications, visual acuity, visual fields, complications, surgical interventions, and adverse events. RESULTS Sixty eyes of 60 patients, 30 in each group, were analyzed after 1-year follow-ups. Median [Q25, Q75] mdIOP (mmHg) dropped from 16.2 [13.8-21.5] to 10.5 [8.9-13.5] in the MicroShunt and from 17.6 [15.6-24.0] to 11.1 [9.5-12.3] in the trabeculectomy group, both without glaucoma medications. Reduction of mdIOP (P = .596), peak IOP (P = .702), and IOP fluctuations (P = .528) was not statistically significantly different between groups. The rate of interventions was statistically significantly higher in the trabeculectomy group, especially in the early postoperative period (P = .018). None of the patients experienced severe adverse events. CONCLUSION Both procedures are equally effective and safe in lowering mdIOP, peak IOP and IOP fluctuations in patients with POAG, one year after surgery. CLINICAL TRIAL REGISTRATION NCT02959242.
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Affiliation(s)
- Melanie Jamke
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Robert Herber
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Maike A Haase
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Carolin S Jasper
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Karin R Pillunat
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
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18
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Nobl M, Freissinger S, Rudolph K, Vounotrypidis E, Kassumeh S, Priglinger S, Mackert MJ. Long-term Outcomes of PreserFlo MicroShunt versus XEN45 Gel Stent in Open-Angle Glaucoma. Klin Monbl Augenheilkd 2023. [PMID: 37673088 DOI: 10.1055/a-2152-8455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To compare two glaucoma drainage devices with subconjunctival filtration (MicroShunt and XEN) for open-angle glaucoma (OAG), with respect to effectiveness and safety. PATIENTS AND METHODS This is a single center, retrospective, interventional study. In total, 106 eyes of 95 patients with OAG underwent surgery. Of these patients, 51 eyes of 45 patients received a MicroShunt implantation and 55 eyes of 50 patients received an XEN implantation. Failure was defined as an intraocular pressure (IOP) lower than 5 or higher than 17 mmHg at the end of follow-up after 2 years, the need for surgical revision, secondary glaucoma surgery, or loss of light perception. Outcome was rated as complete success or qualified success, depending on whether it was achieved with or without anti-glaucomatous medications. Postoperative complications and interventions were also documented for both groups. RESULTS In the MicroShunt group, mean IOP decreased from 20.6 ± 7.5 mmHg at baseline to 13.0 ± 3.9 mmHg (p < 0.0001) after 2 years. In the XEN group, mean IOP was lowered from 22.5 ± 7.9 mmHg to 13.5 ± 4.2 mmHg (p < 0.0001). In both groups, the mean number of medications was significantly reduced (MicroShunt 2.7 ± 1.2 to 0.9 ± 2.5; p < 0.0001 vs. XEN 3.2 ± 0.9 to 1.1 ± 1.5; p < 0.0001). In regard to success rates, 37% of MicroShunt patients achieved complete success and 57% qualified success at the end of follow-up. In the XEN group, rates were 25 and 45%, respectively. Patient demographics differed between the two groups with respect to age (MicroShunt 72.8 ± 8.7 vs. XEN 67.7 ± 9.0 years; p = 0.002). Postoperative complications were comparable between the two groups. CONCLUSION Both MicroShunt and XEN are effective in significantly reducing IOP and glaucoma medications in OAG, and with a good safety profile.
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Affiliation(s)
- Matthias Nobl
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | | | - Katrin Rudolph
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
| | | | - Stefan Kassumeh
- Department of Ophthalmology, University Hospital of Munich, Munich, Germany
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19
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Armstrong JJ, De Francesco T, Ma J, Schlenker MB, Ahmed IIK. Ab Externo SIBS Microshunt with Mitomycin C for Open-Angle Glaucoma: Three-Year Results as a Primary Surgical Intervention. Ophthalmol Glaucoma 2023; 6:480-492. [PMID: 37044278 DOI: 10.1016/j.ogla.2023.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE To determine the effectiveness, risk factors for surgical failure, and adverse events in a large cohort of patients receiving stand-alone ab externo poly(styrene-block-isobutylene-block-styrene) (SIBS) microshunt implantation with mitomycin C (MMC) over 3 years of follow-up. DESIGN Retrospective, interventional case series. PARTICIPANTS Glaucomatous eyes on maximally tolerated medical therapy with no previous subconjunctival glaucoma surgery. METHODS Records of eyes that underwent ab externo SIBS microshunt with MMC between July 2015 and November 2017 were reviewed. Data from all follow-up visits were utilized and included intraocular pressure (IOP), medication use, postoperative interventions, complications, and reoperations. MAIN OUTCOME MEASURES The primary outcome was proportion of eyes at 3 years with (1) no 2 consecutive IOPs > 17 mmHg (or < 6 mmHg with > 2 lines of vision loss from baseline); (2) ≥ 20% reduction from baseline IOP; and (3) using no glaucoma medications (complete success). Secondary outcomes included 14 and 21 mmHg upper IOP thresholds with and without ≥ 20% IOP reduction from baseline, qualified success (with glaucoma medications), risk factors for failure, median IOP/medications, postoperative interventions, complications, and reoperations. RESULTS One hundred fifty-two eyes from 135 patients were included. Complete and qualified success was achieved in 55.6% and 74.8% of eyes, respectively. Time to first glaucoma medication use was a median of 16.9 (interquartile range [IQR], 12.1-34.1) months; however, 59.4% of eyes remained medication free at 3 years. Significant risk factors for failure included receiving < 0.4 mg/ml of MMC (adjusted hazard ratio [HR], 2.42; 95% confidence interval [CI], 1.44-4.05) and baseline IOP < 21 mmHg (adjusted HR, 1.79; 95% CI, 1.03-3.13). The most common complications were choroidal detachment, hyphema, and anterior chamber shallowing, occurring in 7%, 5%, and 5% of eyes, respectively. The needling rate was 15.1%, with significantly higher frequency for baseline IOP > 21 mmHg (HR, 3.21; 95% CI, 1.38-7.48). Revisions occurred in 7% of eyes and reoperations in 2.6%. Eyes receiving < 0.4 mg/ml of MMC underwent more revisions (odds ratio, 4.9; 95% CI, 1.3-18.3). CONCLUSIONS Three-year follow-up data from this large cohort continues to support promising rates of qualified and complete success, with decreased medication burden postoperatively and few postoperative complications and interventions. Comparisons to other filtering surgeries will further facilitate integration of the SIBS microshunt into the surgical treatment paradigm. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- James J Armstrong
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada
| | | | - Jenny Ma
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Matthew B Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada.
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Prism Eye Institute, Mississauga, Canada; John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
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20
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Balas M, Mathew DJ. Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel) 2023; 7:54. [PMID: 37606500 PMCID: PMC10443347 DOI: 10.3390/vision7030054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.
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Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - David J. Mathew
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
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21
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Tanner A, Haddad F, Fajardo-Sanchez J, Nguyen E, Thong KX, Ah-Moye S, Perl N, Abu-Bakra M, Kulkarni A, Trikha S, Lascaratos G, Parnell M, Kailani O, King AJ, Agrawal P, Stead R, Giannouladis K, Rodrigues I, Goyal S, Hysi PG, Lim S, Yu-Wai-Man C. One-year surgical outcomes of the PreserFlo MicroShunt in glaucoma: a multicentre analysis. Br J Ophthalmol 2023; 107:1104-1111. [PMID: 35365491 PMCID: PMC10359526 DOI: 10.1136/bjophthalmol-2021-320631] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/13/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy and safety of the PreserFlo MicroShunt glaucoma device in a multicentre cohort study. METHODS All consecutive patients who received the microshunt with mitomycin-C (MMC) 0.4 mg/mL from May 2019 to September 2020 in three UK tertiary centres. Primary outcome at 1 year was a complete success, with failure defined as intraocular pressure (IOP) >21 mmHg or <20% reduction, IOP≤5 mmHg with any decreased vision on two consecutive visits, reoperation or loss of light perception vision. Secondary outcomes were IOP, best-corrected visual acuity, medications, complications, interventions and reoperations. We also performed subgroup analyses for severe glaucoma and assessed risk factors for failure. RESULTS 104 eyes had 1-year follow-up. Complete and qualified success at 1 year were achieved in 51.9% (N=54) and 16.4% (N=17), respectively, and failure occurred in 31.7% (N=33). There was a significant reduction in IOP (mmHg) from preoperatively (23.4±0.8, N=104) to 12 months (14.7±0.6, N=104) (p<0.0001). Antiglaucoma medications also decreased from preoperatively (3.4±0.1, N=104) to 12 months (0.7±0.1, N=104) (p<0.0001). Multivariate analyses showed an association between higher mean deviation and failure (HR 1.055, 95% CI 1.0075 to 1.11, p=0.0227). Complications were hypotony (19.2%; N=20), choroidal detachments (10.6%; N=11), hyphaema (5.8%; N=6) and bleb leak (5.8%; N=6). Needling and 5-fluorouracil injections were performed in 12.5% (N=13) and 33.7% (N=35), respectively, and 11.5% (N=12) required revision surgery. CONCLUSION The PreserFlo MicroShunt with MMC 0.4 mg/mL showed an overall success rate of 68.3% at 1 year, and led to significant IOP and medication reduction with a low rate of adverse effects.
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Affiliation(s)
- Alexander Tanner
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fadi Haddad
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Julia Fajardo-Sanchez
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ethan Nguyen
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kai Xin Thong
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sarah Ah-Moye
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicole Perl
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Mohammed Abu-Bakra
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Avinash Kulkarni
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Sameer Trikha
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Gerassimos Lascaratos
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Miles Parnell
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Obeda Kailani
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Pavi Agrawal
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | - Richard Stead
- Department of Ophthalmology, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - Ian Rodrigues
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Saurabh Goyal
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Pirro G Hysi
- Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Sheng Lim
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cynthia Yu-Wai-Man
- Faculty of Life Sciences & Medicine, King's College London, London, UK
- Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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22
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Kuet ML, Azuara-Blanco A, Barton K, King AJ. Will the PRESERFLO™ MicroShunt impact the future of trabeculectomy practice? A UK and Éire Glaucoma Society National Survey. Eye (Lond) 2023; 37:2252-2256. [PMID: 36477732 PMCID: PMC9735154 DOI: 10.1038/s41433-022-02326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES To explore the attitudes of UK glaucoma specialists regarding the current and future practice of trabeculectomy and the novel PRESERFLO™ MicroShunt (PF-MS) device, and intentions to adopt the PF-MS into routine glaucoma surgical practice. METHODS Online survey of UK and Éire Glaucoma Society members. RESULTS 43 glaucoma consultants completed the survey. All surgeons performed trabeculectomies (median of 40 annually) and 51% undertook PF-MS procedures (median of 22.5 annually). The mean duration of surgery was reported as 48.9 (SD 13.3) and 31.2 (SD 9.9) min for trabeculectomy and PF-MS respectively (p < 0.0001). For surgeons not currently using the PF-MS, 65% planned to do so. Respondents judged completion of 35 trabeculectomies and 10 PF-MS were required to achieve basic competence. 91% of participants predicted their trabeculectomy volume would decrease and 73% expected PF-MS usage to increase. Respondents reported a median of six and four follow-ups within 3 months post surgery for trabeculectomy and PF-MS respectively (p < 0.0001). Respondents reported trabeculectomy required more post-operative interventions than the PF-MS and 81.8% judged the patient experience to be better with the PF-MS. The PF-MS was deemed suitable for early visual field loss by 72% of respondents, severe visual field loss by 35% and normal tension glaucoma by 21%. CONCLUSION The PF-MS has seen rapid adoption in the UK. Respondents predict its usage will significantly increase whilst trabeculectomies will decrease. They report the PF-MS is quicker to learn and perform, and requires less post-operative follow-ups and interventions which may facilitate a more efficient service delivery for patients requiring glaucoma surgery.
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Affiliation(s)
- Mong-Loon Kuet
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's Hospital Belfast, Belfast, UK
| | - Keith Barton
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- UCL Institute of Ophthalmology, London, UK
| | - Anthony J King
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Triolo G, Wang J, Aguilar-Munoa S, Jayaram H, Barton K. Preserflo microshunt implant for the treatment of refractory uveitic glaucoma: 36-month outcomes. Eye (Lond) 2023; 37:2535-2541. [PMID: 36577805 PMCID: PMC10397285 DOI: 10.1038/s41433-022-02368-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/26/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To determine 36-month efficacy and safety outcomes of the PRESERFLO Microshunt implant in the treatment of refractory uveitic glaucoma. METHODS Consecutive patients with uncontrolled uveitic glaucoma despite maximum medical treatment received PRESERFLO Microshunt implant with mitomycin C (MMC) in a tertiary referral glaucoma practice. Efficacy and safety outcomes data were collected at month 6, 12, 24, and 36, postoperatively. The primary outcome was surgical success, defined as intraocular pressure (IOP) between 5 and 21 mmHg or > 20% reduction from baseline, and absence of criteria for surgical failure. Secondary outcomes were IOP, visual acuity (VA), use of glaucoma medical therapy, surgical complications, rate of reoperation for glaucoma. RESULTS 21 eyes of 21 patients were included. The mean rate of success was 0.74 (95%CI 0.48-0.88), 0.68 (0.43-0.84), 0.47 (0.25-0.67), and 0.47 (0.25-0.67, at 6, 12, 24, and 36 months postoperatively, respectively. The mean IOP decreased by 30.7% (95% CI 13.7-47.7), 26.5% (95% CI 3.2-49.8), 33.5% (95% CI 21.8-45.3), and 30.1% (95% CI 7.2-52.9) from baseline at postoperative month 6, 12, 24, and 36, respectively (p < 0.001). The mean ± SD number of glaucoma medications decreased from 4.1 ± 0.9 to 0.9 ± 1.2 at the final follow up (p = 0.0005). No sight-threatening complications were reported by 36 months. CONCLUSIONS Three-year results of the PRESERFLO Microshunt implant demonstrated favourable efficacy and safety profile in the treatment of refractory uveitic glaucoma.
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Affiliation(s)
- Giacinto Triolo
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | - Jing Wang
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
| | | | - Hari Jayaram
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK
- NIHR Moorfields Biomedical Research Centre, 162 City Rd, London, EC1V 2PD, UK
- Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK
| | - Keith Barton
- Glaucoma Service, Moorfields Eye Hospital, 162 City Rd, London, EC1V 2PD, UK.
- Institute of Ophthalmology, University College London, 11-43 Bath St, London, EC1V 9EL, UK.
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Storp JJ, Vietmeier FE, Merté RL, Koch R, Zimmermann JA, Eter N, Brücher VC. Long-Term Outcomes of the PRESERFLO MicroShunt Implant in a Heterogeneous Glaucoma Cohort. J Clin Med 2023; 12:4474. [PMID: 37445509 DOI: 10.3390/jcm12134474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/14/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A total of 160 eyes of 160 patients who underwent Preserflo MicroShunt implantation were retrospectively enrolled in this study. Patient characteristics, as well as success and failure rates, were assessed. The numbers of adverse events and revision procedures were recorded, along with any reduction in supplementary medication. The progression of intraocular pressure (IOP) was assessed over the course of 12 months, and fluctuations were analyzed. The overall success rate was 61.9% (complete success: 51.3%, qualified success: 10.6%). Revision surgery was performed in 25% of cases. Excessive hypotony occurred postoperatively in 54.4% of patients and regressed after 7 days in 88.8% of all cases. Median IOP decreased from 22 (interquartile range (IQR): 17-27) mmHg preoperatively to 14 (IQR 12-16) mmHg at 12 months postoperatively (p < 0.01). The median number of antiglaucomatous agents decreased from three to zero at latest follow-up. The Preserflo MicroShunt achieved a noticeable reduction in IOP over the course of 12 months in glaucoma patients, irrespective of disease severity or disease subtype. The frequency of postoperative adverse events and number for revision surgeries over the course of the follow-up period were low.
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Affiliation(s)
- Jens Julian Storp
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | | | - Ralph-Laurent Merté
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | | | - Nicole Eter
- Department of Ophthalmology, University of Muenster Medical Center, 48149 Muenster, Germany
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Aguilar-Munoa S, Tham YH, Barton K. A simple surgical solution for the treatment of persistent postoperative hypotony after PRESERFLO MicroShunt implantation. Eye (Lond) 2023; 37:2126-2129. [PMID: 36434286 PMCID: PMC10333267 DOI: 10.1038/s41433-022-02301-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/31/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/OBJECTIVES PRESERFLO MicroShunt implantation is a relatively new and increasingly popular treatment for recalcitrant glaucoma. Though relatively uncommon, persistent or severe postoperative hypotony may occur and its treatment presents a significant challenge. SUBJECTS/METHODS Interventional case series of the first 7 consecutive patients who underwent the insertion of a rip-cord suture to treat severe or persistent postoperative hypotony. RESULTS In 6 patients, the hypotony resolved and vision was restored. The 7th patient had suffered a severe suprachoroidal haemorrhage with a poor visual recovery and limited follow-up, so success was more difficult to assess. CONCLUSIONS Stenting the PRESERFLO MicroShunt with a rip-cord suture is a simple technique to correct persistent or severe postoperative hypotony.
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Affiliation(s)
| | | | - Keith Barton
- UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital NHS Foundation Trust, London, UK
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26
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Van Lancker L, Saravanan A, Abu-Bakra M, Reid K, Quijano C, Goyal S, Rodrigues I, Lascaratos G, Trikha S, Barwood C, Combe E, Kulkarni A, Lim KS, Low S. Clinical Outcomes and Cost Analysis of PreserFlo versus Trabeculectomy for Glaucoma Management in the United Kingdom. Ophthalmol Glaucoma 2023; 6:342-357. [PMID: 36427750 DOI: 10.1016/j.ogla.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/27/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Clinical evaluation and cost analysis of mitomycin-C-augmented PreserFlo MicroShunt versus trabeculectomy. DESIGN Retrospective cohort study across 3 teaching hospitals. PARTICIPANTS A total of 134 consecutive eyes of 129 patients (70 undergoing MicroShunt, 64 trabeculectomy). METHODS Primary and secondary glaucoma cases with uncontrolled intraocular pressure (IOP) were included. Neovascular glaucoma and surgery combined with cataract extraction were excluded. The cost analysis used results from the clinical study to estimate operative costs (equipment and staff costs) and postoperative costs (follow-up visits, nonglaucoma medications, and postoperative procedures) per eye for PreserFlo and trabeculectomy. MAIN OUTCOME MEASURES The primary clinical outcome measure was surgical failure (defined as IOP > 21 mmHg or < 20% reduction from baseline, IOP ≤ 5 mmHg, reoperation, or loss of light perception) or qualified and complete success (with or without medication) at 18 months. Secondary measures were IOP, glaucoma medications, visual acuity, mean deviation, time to cessation of steroid drops, complications, surgical time, follow-up visits, postoperative interventions, and reoperations. The cost analysis evaluated costs of PreserFlo compared with trabeculectomy. RESULTS Baseline characteristics were similar, except for more non-White patients in the trabeculectomy group (51% Black and Asian vs. 32% MicroShunt, P = 0.02) and more cases with prior ab externo glaucoma surgery in the MicroShunt group (19% vs. 3% in the trabeculectomy group, P = 0.004). Overall, 59% of eyes had primary open-angle glaucoma. Mean follow-up was 19.9 months for both groups. At 18 months, surgical failure was 25% for MicroShunt compared with 35% for trabeculectomy (P = 0.18). Failure in MicroShunt cases was due to inadequate IOP reduction (84%) or reoperation for glaucoma (16%). Failure in trabeculectomy cases was due to inadequate IOP reduction (58%), persistent hypotony (29%), or reoperation for glaucoma (13%). Combined blebitis and endophthalmitis rate was 1.4% for MicroShunt and 3.1% for trabeculectomy. Cost analysis showed a savings of £245 to £566 per eye in the MicroShunt group, driven mostly by reduced postoperative procedures and follow-up visits. This is in contrast to prior randomized controlled trial data reporting the incremental cost of $2058 of PreserFlo over trabeculectomy. CONCLUSIONS Our experience of introducing PreserFlo MicroShunt surgery showed it was safer than trabeculectomy and is a cost-saving and effective option that offers potential to free up highly limited National Health Service resources. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Lauren Van Lancker
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amrita Saravanan
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mohammed Abu-Bakra
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kyle Reid
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Claudia Quijano
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Saurabh Goyal
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ian Rodrigues
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gerassimos Lascaratos
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sameer Trikha
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Emily Combe
- FIECON, St. Albans, Hertfordshire, United Kingdom
| | - Avinash Kulkarni
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Kin Sheng Lim
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sancy Low
- Department of Ophthalmology, Guys and St. Thomas' NHS Foundation Trust, London, United Kingdom.
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Nobl M, Grün C, Kassumeh S, Priglinger S, Mackert MJ. One-Year Outcomes of Preserflo TM MicroShunt Implantation versus Trabeculectomy for Pseudoexfoliation Glaucoma. J Clin Med 2023; 12:jcm12083000. [PMID: 37109334 PMCID: PMC10141576 DOI: 10.3390/jcm12083000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/03/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
This retrospective, single-center study evaluates the safety and efficacy of PreserfloTM MicroShunt (MicroShunt) implantations compared to trabeculectomies (TETs) in patients diagnosed with pseudoexfoliation glaucoma (PEXG). A total of 31 eyes from 28 patients received a MicroShunt implantation, and 29 eyes from 26 patients received a TET. Surgical success was defined as an intraocular pressure (IOP) between 5 mmHg and 17 mmHg at the end of the follow-up period, no need for surgical revisions or secondary glaucoma surgery, and no loss of light perception. In the MicroShunt group, the mean IOP dropped from 20.8 ± 5.9 mmHg at baseline to 12.4 ± 2.8 mmHg (p < 0.0001) after one year. In the TET group, the mean IOP dropped from 22.3 ± 6.5 mmHg to 11.1 ± 3.7 mmHg (p < 0.0001) after 12 months. In both of the groups, the mean number of medications was reduced significantly (MicroShunt from 2.7 ± 1.2 to 0.2 ± 0.7; p < 0.0001 vs. TET from 2.9 ± 1.2 to 0.3 ± 0.9; p < 0.0001). Considering the success rates, 83.9% of the MicroShunt eyes achieved complete success, and 90.3% qualified for success at the end of the follow-up period. In the TET group, the rates were 82.8% and 93.1%, respectively. The postoperative complications were comparable between both groups. In conclusion, the MicroShunt implantation demonstrated non-inferiority regarding its efficacy and safety profile compared to TET in PEXG at a follow-up of one year.
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Affiliation(s)
- Matthias Nobl
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Clara Grün
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Siegfried Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336 Munich, Germany
| | - Marc J Mackert
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336 Munich, Germany
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Sharif NA, Odani-Kawabata N, Lu F, Pinchuk L. FP and EP2 prostanoid receptor agonist drugs and aqueous humor outflow devices for treating ocular hypertension and glaucoma. Exp Eye Res 2023; 229:109415. [PMID: 36803996 DOI: 10.1016/j.exer.2023.109415] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/21/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023]
Abstract
Prostaglandin (PG) receptors represent important druggable targets due to the many diverse actions of PGs in the body. From an ocular perspective, the discovery, development, and health agency approvals of prostaglandin F (FP) receptor agonists (FPAs) have revolutionized the medical treatment of ocular hypertension (OHT) and glaucoma. FPAs, such as latanoprost, travoprost, bimatoprost, and tafluprost, powerfully lower and control intraocular pressure (IOP), and became first-line therapeutics to treat this leading cause of blindness in the late 1990s to early 2000s. More recently, a latanoprost-nitric oxide (NO) donor conjugate, latanoprostene bunod, and a novel FP/EP3 receptor dual agonist, sepetaprost (ONO-9054 or DE-126), have also demonstrated robust IOP-reducing activity. Moreover, a selective non-PG prostanoid EP2 receptor agonist, omidenepag isopropyl (OMDI), was discovered, characterized, and has been approved in the United States, Japan and several other Asian countries for treating OHT/glaucoma. FPAs primarily enhance uveoscleral (UVSC) outflow of aqueous humor (AQH) to reduce IOP, but cause darkening of the iris and periorbital skin, uneven thickening and elongation of eyelashes, and deepening of the upper eyelid sulcus during chronic treatment. In contrast, OMDI lowers and controls IOP by activation of both the UVSC and trabecular meshwork outflow pathways, and it has a lower propensity to induce the aforementioned FPA-induced ocular side effects. Another means to address OHT is to physically promote the drainage of the AQH from the anterior chamber of the eye of patients with OHT/glaucoma. This has successfully been achieved by the recent approval and introduction of miniature devices into the anterior chamber by minimally invasive glaucoma surgeries. This review covers the three major aspects mentioned above to highlight the etiology of OHT/glaucoma, and the pharmacotherapeutics and devices that can be used to combat this blinding ocular disease.
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Affiliation(s)
- Najam A Sharif
- Ophthalmology Innovation Center, Santen Inc., Emeryville, CA, USA; Singapore Eye Research Institute, Singapore; Eye-ACP Duke-National University of Singapore Medical School, Singapore; Department of Pharmacology and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, TX, USA; Department of Pharmacy Sciences, Creighton University, Omaha, NE, USA; Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA; Imperial College of Science and Technology, St. Mary's Campus, London, UK; Institute of Ophthalmology, University College London, London, UK.
| | | | - Fenghe Lu
- Product Development Division, Santen Inc., Emeryville, CA, USA
| | - Leonard Pinchuk
- Ophthalmology Innovation Center, Santen Inc., Emeryville, CA, USA; Biomedical Engineering Department, University of Miami, Miami, FL, USA
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Ahmed IIK, Sadruddin O, Panarelli JF. Subconjunctival filtration in evolution: current evidence on MicroShunt implantation for treating patients with glaucoma. EYE AND VISION (LONDON, ENGLAND) 2023; 10:10. [PMID: 36859515 PMCID: PMC9979478 DOI: 10.1186/s40662-022-00322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/06/2022] [Indexed: 03/03/2023]
Abstract
BACKGROUND Although traditional surgical procedures for glaucoma (such as trabeculectomy and tube-shunt implantation) can significantly reduce intraocular pressure (IOP), they are associated with numerous complications, some of which are vision-threatening, or involve prolonged recovery or a highly intensive postoperative course. Micro-invasive glaucoma surgery (MIGS) procedures have shown better safety but reduced efficacy in achieving target IOP. Combinations of these methods have led to the development of subconjunctival micro-invasive procedures with safety comparable to traditional surgery and greater efficacy than minimally invasive methods. This review describes the use of one of these devices, the poly(styrene-block-isobutylene-block-styrene) (SIBS)-based PreserFlo MicroShunt (Santen, Emeryville, CA), in the surgical treatment of patients with glaucoma. MAIN TEXT The MicroShunt is an 8.5-mm tube made of an inert polymer with no endplate, an internal diameter of 70 μm, and fins intended to prevent peritubular flow and anchor the device within the sclera to prevent proximal migration into the eye. Following ab externo implantation, the tube provides a conduit for flow of aqueous humor from the anterior chamber into the subconjunctival/sub-Tenon space. Clinical trials to date have shown that, when paired with mitomycin C (MMC) treatment, MicroShunt implantation significantly reduced both IOP and the number of glaucoma medications. These IOP-lowering results were found both when surgery was performed alone and with phacoemulsification. The MicroShunt also showed a safety profile comparable to that of traditional filtering surgery. CONCLUSIONS The MicroShunt and other novel subconjunctival procedures have shown substantial IOP reductions while mitigating hypotony-related complications. MMC, which modulates fibrosis and scarring postoperatively, is essential to surgical success. Randomized, long-term clinical trials will further clarify the role of controlled micro-incisional device-assisted ab externo glaucoma filtering surgery in long-term glaucoma management.
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Affiliation(s)
- Iqbal Ike K. Ahmed
- grid.223827.e0000 0001 2193 0096John Moran Eye Center, University of Utah, Salt Lake City, UT USA ,grid.17063.330000 0001 2157 2938University of Toronto, Toronto, ON Canada ,grid.477184.9Prism Eye Institute, Mississauga, ON Canada
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Short-term safety and efficacy of Preserflo™ Microshunt in glaucoma patients: a multicentre retrospective cohort study. Eye (Lond) 2023; 37:644-649. [PMID: 35277663 PMCID: PMC8916945 DOI: 10.1038/s41433-022-01995-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 02/03/2022] [Accepted: 02/16/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/AIMS To evaluate 1-year success rates and safety profile of Preserflo™ Microshunt in glaucoma patients. METHODS Retrospective multicentre cohort study of 100 consecutive eyes (91 patients) from four tertiary-referral glaucoma centres. Four intraocular pressure (IOP) criteria were defined: A: IOP ≤ 21 mmHg+IOP reduction ≥20% from baseline; B: IOP ≤ 18 mmHg+IOP reduction ≥20%; C: IOP ≤ 15 mmHg+IOP reduction ≥25%; D: IOP≤12 mmHg+IOP reduction ≥30%. Success was defined as qualified or complete based on whether reached with or without medication. Primary outcome was success according to the above criteria. Secondary outcomes included: IOP, best-corrected visual acuity (BCVA), medication use, complications, postoperative interventions, and failure-associated factors. RESULTS Qualified and complete success rates (95% CI) at 12 months were 74%(66-83%) and 58%(49-69%) for criterion A, 72%(63-82%) and 57%(48-68%) for B, 52%(43-63%) and 47%(38-58%) for C, 29%(21-40%) and 26%(19-36%) for D. Overall median (interquartile range (IQR)) preoperative IOP decreased from 21.5(19-28) mmHg to 13(11-16) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.79). Preoperative median (IQR) number of medications decreased from 3 (2-3) to 0 (0-1) at 12 months. Twelve eyes underwent needling, five surgical revision and one device removal due to corneal oedema. There were no hypotony-related complications. Non-Caucasian ethnicity was the only risk factor consistently associated with increased failure. CONCLUSIONS Preserflo™ Microshunt is a viable surgical option in glaucoma patients, with reasonable short-term success rates, decreased medications use, excellent safety profile, smooth postoperative care, and rapid learning curve. Success rates for the most stringent IOP cutoffs were modest, indicating that it may not be the optimal surgery when very low target IOP is required.
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31
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Scheres LMJ, van den Biggelaar FJHM, Winkens B, Kujovic-Aleksov S, Müskens RPHM, de Waard PWT, de Crom RMPC, Ernest PJG, Pijl BJ, Ramdas WD, van Rijn LJ, Tan A, Dirksen CD, Beckers HJM. Effectiveness and cost-effectiveness of MicroShunt implantation versus standard trabeculectomy for open-angle glaucoma (a SIGHT study): study protocol of a multicentre randomised controlled trial. BMC Ophthalmol 2023; 23:43. [PMID: 36721130 PMCID: PMC9887798 DOI: 10.1186/s12886-022-02734-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/10/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Trabeculectomy is the "gold standard" initial surgical procedure for open-angle glaucoma worldwide. During the last decade, the introduction of less invasive procedures, including new bleb-forming surgery such as the MicroShunt, has altered the approach of glaucoma management. At present, there is insufficient evidence comparing the effectiveness between these procedures nor versus trabeculectomy. Furthermore, there is no data available on patient impact and cost-effectiveness. This study aims to address this gap in evidence and establish whether MicroShunt implantation is non-inferior compared to trabeculectomy with regard to effectiveness and whether it is cost-effective. METHODS A multicentre, non-inferiority, randomised controlled trial (RCT) studying open-angle glaucoma with an indication for surgery will be conducted. Patients with previous ocular surgery except for phacoemulsification are excluded, as are patients with ocular comorbidity compromising the visual field or requiring a combined procedure. After informed consent is obtained, patients will be randomly allocated to the intervention, a PRESERFLO™ MicroShunt implantation, or the control group, trabeculectomy, using block randomisation (blocks of 2, 4 or 6 patients). In total, 124 patients will be randomised in a 1:1 ratio, stratified by centre. The primary endpoint will be intraocular pressure (IOP) one year after surgery. Secondary outcomes include IOP-lowering medication use, treatment failure, visual acuity, visual field progression, additional interventions, adverse events, patient-reported outcome measures (PROMs), and cost-effectiveness. Study outcomes will be measured up to 12 months postoperatively. DISCUSSION This study protocol describes the design of a multicentre non-inferiority randomised controlled trial. To this date, cost-effectiveness studies evaluating the MicroShunt have not been undertaken. This multicentre RCT will provide more insight into whether MicroShunt implantation is non-inferior compared to standard trabeculectomy regarding postoperative IOP and whether MicroShunt implantation is cost-effective. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: NCT03931564 , Registered 30 April 2019.
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Affiliation(s)
- Lotte M. J. Scheres
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Frank J. H. M. van den Biggelaar
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Bjorn Winkens
- grid.5012.60000 0001 0481 6099Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences (FHML), Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Stefani Kujovic-Aleksov
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands ,Department of Ophthalmology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Rogier P. H. M. Müskens
- grid.4494.d0000 0000 9558 4598Department of Ophthalmology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Peter W. T. de Waard
- grid.414699.70000 0001 0009 7699Department of Glaucoma, Rotterdam Eye Hospital, Rotterdam, The Netherlands
| | - Ronald M. P. C. de Crom
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands ,Department of Ophthalmology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Paul J. G. Ernest
- Department of Ophthalmology, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Benjamin J. Pijl
- grid.413649.d0000 0004 0396 5908Department of Ophthalmology, Deventer Hospital, Deventer, The Netherlands
| | - Wishal D. Ramdas
- grid.5645.2000000040459992XDepartment of Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Laurentius J. van Rijn
- grid.509540.d0000 0004 6880 3010Department of Ophthalmology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Annelie Tan
- grid.10419.3d0000000089452978Department of Ophthalmology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Carmen D. Dirksen
- grid.412966.e0000 0004 0480 1382Department of Clinical Epidemiology and Medical Technology Assessment, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Henny J. M. Beckers
- grid.412966.e0000 0004 0480 1382University Eye Clinic Maastricht, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
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Gassel CJ, Dzhelebov DN, Voykov B. Detailed intraocular pressure curve by telemetric tonometry with an implanted pressure sensor before and after PreserFlo ® MicroShunt implantation: a case report. Ther Adv Ophthalmol 2023; 15:25158414221149927. [PMID: 36714382 PMCID: PMC9875318 DOI: 10.1177/25158414221149927] [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: 08/30/2022] [Accepted: 12/16/2022] [Indexed: 01/24/2023] Open
Abstract
Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo® MicroShunt to significantly reduce IOP fluctuations.
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Affiliation(s)
| | | | - Bogomil Voykov
- Centre for Ophthalmology, University Eye
Hospital, Eberhard Karls University of Tübingen, Tübingen, Germany
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33
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Shen R, Li VSW, Wong MOM, Chan PPM. Pediatric Glaucoma-From Screening, Early Detection to Management. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020181. [PMID: 36832310 PMCID: PMC9954748 DOI: 10.3390/children10020181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/10/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Pediatric glaucoma (PG) covers a rare and heterogeneous group of diseases with variable causes and presentations. Delayed diagnosis of PG could lead to blindness, bringing emotional and psychological burdens to patients' caregivers. Recent genetic studies identified novel causative genes, which may provide new insight into the etiology of PG. More effective screening strategies could be beneficial for timely diagnosis and treatment. New findings on clinical characteristics and the latest examination instruments have provided additional evidence for diagnosing PG. In addition to IOP-lowering therapy, managing concomitant amblyopia and other associated ocular pathologies is essential to achieve a better visual outcome. Surgical treatment is usually required although medication is often used before surgery. These include angle surgeries, filtering surgeries, minimally invasive glaucoma surgeries, cyclophotocoagulation, and deep sclerectomy. Several advanced surgical therapies have been developed to increase success rates and decrease postoperative complications. Here, we review the classification and diagnosis, etiology, screening, clinical characteristics, examinations, and management of PG.
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Affiliation(s)
- Ruyue Shen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Venice S. W. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Mandy O. M. Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
| | - Poemen P. M. Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong, China
- Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, The Prince of Wales Hospital, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-5807
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Burgos-Blasco B, García-Feijóo J, Gines-Gallego C, Perucho-Gonzalez L, Fernandez-Vigo JI, Martinez de la Casa JM, Saenz-Frances F, Morales-Fernandez L, Mendez-Hernandez CD. Efficacy and safety of the PreserFlo implant with mitomycin C in childhood glaucoma after previous failed glaucoma surgeries. Graefes Arch Clin Exp Ophthalmol 2022; 261:1349-1357. [PMID: 36536223 DOI: 10.1007/s00417-022-05939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study aims to evaluate the efficacy and safety of the PreserFlo MicroShunt (Santen, Osaka, Japan) in lowering intraocular pressure (IOP) in childhood glaucoma patients with previous failed glaucoma surgeries. METHODS This is a prospective case review of consecutive PreserFlo procedures performed in childhood glaucoma patients after failed surgeries. Age, sex, diagnosis, and previous glaucoma surgeries, as well as visual acuity, IOP, and treatment in the preoperative visit and all follow-up visits were collected. Outcome measures included IOP reduction from baseline, mean IOP change from baseline at month 6, medication use at 6 months, complications, adverse events, and need for further procedures. RESULTS Fourteen patients were included, 8 (57%) males and 6 (43%) females; the mean age was 27.5 ± 13.5 years. Nine patients (64%) had at least two trabeculectomies, and 6 patients (43%) had at least one trabeculectomy and a glaucoma drainage implant. The mean IOP change from baseline was 11.3 ± 4.9 mmHg at 12 months. At 12 months, 12 patients (86%) presented ≥ 20% IOP lowering from baseline, and 11 patients (79%) presented ≥ 30%. The mean medication count decreased from 3.9 ± 0.7 (baseline) to 0.7 ± 1.3 (12 months). No intraoperative complications were reported. No adverse events were noted. No secondary filtration surgery was required, although bleb needling was required in one case, 1 month after the surgery. CONCLUSIONS PreserFlo with MMC can be used successfully to treat uncontrolled IOP in childhood glaucoma cases with previous failed surgeries. Larger studies with longer follow-up are needed to further explore the role of the device in resistant childhood glaucoma cases.
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Affiliation(s)
- Barbara Burgos-Blasco
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain.
| | - Julian García-Feijóo
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
- Departamento de Inmunología, Oftalmología Y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Gines-Gallego
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Lucía Perucho-Gonzalez
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Jose Ignacio Fernandez-Vigo
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Jose María Martinez de la Casa
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
- Departamento de Inmunología, Oftalmología Y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Federico Saenz-Frances
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Laura Morales-Fernandez
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
| | - Carmen Dora Mendez-Hernandez
- Servicio de Oftalmología, Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Hospital Clinico San Carlos, Madrid, Spain
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Pawiroredjo SSM, Bramer WM, Pawiroredjo ND, Pals J, Poelman HJ, de Vries VA, Wolfs RCW, Ramdas WD. Efficacy of the PRESERFLO MicroShunt and a Meta-Analysis of the Literature. J Clin Med 2022; 11:jcm11237149. [PMID: 36498729 PMCID: PMC9738249 DOI: 10.3390/jcm11237149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/16/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Recent studies on the PRESERFLO MicroShunt suggest that it may be effective in lowering intraocular pressure (IOP); however, the number of studies on this device remains limited. Therefore, we assessed the efficacy of the PRESERFLO MicroShunt in patients with glaucoma and performed a meta-analysis of published results. Methods: Prospective study including all patients that underwent PRESERFLO MicroShunt surgery from 2018 onwards. Sub-analyses were performed for cataract-combined procedures. To compare our results, we performed a systematic review and meta-analysis. IOP, IOP-lowering medication and surgical complications reported in the retrieved studies were assessed. Results: A total of 72 eyes underwent PRESERFLO-implant surgery (59 as standalone procedure and 13 as cataract-combined procedure). No significant differences were found in IOP and IOP-lowering medication between both groups. The mean ± standard deviation IOP and IOP-lowering medications of both groups taken together declined from 21.72 ± 8.35 to 15.92 ± 8.54 mmHg (p < 0.001, 26.7% reduction) and 3.40 to 0.93 (p < 0.001, 72.6% reduction) at 1 year follow-up, respectively. Secondary surgeries were required in 19.4% of eyes, the majority (71.4%) within 6 months. The meta-analysis including 14 studies (totaling 1213 PRESERFLO MicroShunt surgeries) from the systematic review showed a mean preoperative IOP and IOP-lowering medication of 22.28 ± 5.38 and 2.97 ± 1.07, respectively. The three-years postoperative pooled mean was (weighted mean difference, 95% CI) 11.07 (10.27 [8.23−12.32], p < 0.001) mmHg and 0.91 (1.77 [1.26−2.28], p < 0.001) for IOP and IOP-lowering medication, respectively. The most common reported complication was hypotony (2−39%). Conclusion: The PRESERFLO MicroShunt is effective and safe in lowering IOP and the number of IOP-lowering medications.
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Affiliation(s)
- Shigeo S. M. Pawiroredjo
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Wichor M. Bramer
- Medical Library, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Noemi D. Pawiroredjo
- Faculty of Science, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Jan Pals
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Huub J. Poelman
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Victor A. de Vries
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Roger C. W. Wolfs
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Wishal D. Ramdas
- Department of Ophthalmology, Erasmus Medical Center, University Medical Center, 3000 CA Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-10-7033691; Fax: +31-10-7035105
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Majoulet A, Scemla B, Hamard P, Brasnu E, Hage A, Baudouin C, Labbé A. Safety and Efficacy of the Preserflo ® Microshunt in Refractory Glaucoma: A One-Year Study. J Clin Med 2022; 11:jcm11237086. [PMID: 36498660 PMCID: PMC9739914 DOI: 10.3390/jcm11237086] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the safety and efficacy of Preserflo® microshunt implantation in eyes with refractory glaucoma. Methods: In this retrospective study, a cohort of patients who underwent Preserflo® microshunt implantation between April 2019 and August 2020 for refractory glaucoma were evaluated. At the time of surgery, all eyes had uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy and at least one previous failed glaucoma filtering surgery. The primary outcome was a complete success, defined as postoperative IOP ≤ 21 mm Hg with an IOP reduction ≥ 20% and no repeat filtering surgery. The secondary outcome was qualified success, defined as a complete success with the use of antiglaucoma medications. The rates of needling, bleb repair, and postoperative complications were also recorded. Results: Forty-seven eyes with a mean preoperative IOP of 30.1 ± 7.1 mm Hg and a mean of 3.4 ± 1 glaucoma medications were included. The mean number of previous surgeries prior to microshunt implantation was 2.3 ± 1.3. After 1 year, the mean IOP was significantly reduced to 18.8 ± 4.6 mm Hg, with the mean number of medications significantly reduced to 1.4 ± 1.2. Complete success was achieved in 35% of eyes, and a qualified success in 60% of eyes. A decrease in IOP of at least 30% was found in 55% of eyes. Needling or bleb repair was performed in 49% of eyes. Complications were minimal and transient, except for one eye which presented with tube extrusion, and another eye with a transected tube. A repeat glaucoma surgery had to be performed in 17% of eyes. Conclusions: The Preserflo® Microshunt provided moderate success but a significant reduction in IOP, with a good safety profile after one year of follow-up in eyes at high risk for failure of filtering surgery.
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Affiliation(s)
- Alexandre Majoulet
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
| | - Benjamin Scemla
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UVSQ, Paris Saclay University, 91190 Gif-sur-Yvette, France
| | - Pascale Hamard
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
| | - Emmanuelle Brasnu
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
| | - Alexandre Hage
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UVSQ, Paris Saclay University, 91190 Gif-sur-Yvette, France
| | - Antoine Labbé
- Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, INSERM-DHOS CIC 1423, 75012 Paris, France
- Department of Ophthalmology III, Quinze-Vingts National Ophthalmology Hospital, IHU FOReSIGHT, 75012 Paris, France
- Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, UVSQ, Paris Saclay University, 91190 Gif-sur-Yvette, France
- Correspondence: ; Tel.: +33-1-40021308; Fax: +33-1-40021399
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Minimally Invasive Glaucoma Surgery: Safety of Individual Devices. J Clin Med 2022; 11:jcm11226833. [PMID: 36431310 PMCID: PMC9696404 DOI: 10.3390/jcm11226833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 10/30/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022] Open
Abstract
Primary open-angle glaucoma progression in those already on maximal medical therapy has traditionally been treated with trabeculectomy, a surgical procedure that carries a high degree of morbidity. In the last few decades, significant advances have been made in the field of minimally invasive glaucoma surgery (MIGS) devices, which aim to defer or prevent trabeculectomy via less arduous surgical techniques in certain types of glaucoma. Although reviews have been published examining the efficacy of various MIGS techniques, no article synthesises the comparative safety of all available devices. We performed a literature review examining the safety of MIGS devices. Fifteen devices were included, variously attempting to increase aqueous outflow through the trabecular meshwork or the suprachoroidal space, shunting into the subconjunctival space, or reducing aqueous production through ciliary body ablation. Notably, the earliest product attempting to increase outflow to the suprachoroidal space, Alcon's CyPass Micro-Stent, was withdrawn from the market due to concerns regarding increased corneal endothelial cell loss at five years post-implantation. All other devices were described as well-tolerated, with the most common adverse effects including hyphaema, intraocular pressure spikes, and device migration or obstruction. MIGS devices are purported to be uniformly safe, and many studies report no statistically significant increased complications beyond those associated with cataract surgery alone. It is important to note, however, the generally poor quality of current studies, with a dearth of randomised, or even prospective, data, and a large proportion of studies funded by device producers.
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Khawaja AP, Stalmans I, Aptel F, Barton K, Beckers H, Klink T, Marchini G, Martínez de la Casa J, Simonsen JH, Töteberg-Harms M, Vass C, Abegão Pinto L. Expert Consensus on the Use of the PRESERFLO™ MicroShunt Device in the Treatment of Glaucoma: A Modified Delphi Panel. Ophthalmol Ther 2022; 11:1743-1766. [PMID: 35797005 PMCID: PMC9437199 DOI: 10.1007/s40123-022-00529-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The implantation of the PRESERFLO™ MicroShunt (PMS) device has been shown to significantly lower increased intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). However, guidelines on best practice for patient selection and pre-/peri-/postoperative care management are lacking. The aim of this modified Delphi panel was to achieve expert consensus on the role of the PMS to treat patients with glaucoma in Europe. METHODS Twelve European glaucoma surgeons experienced with the PMS procedure participated in a three-round modified Delphi panel. A targeted literature review and expert steering committee guided round 1 questionnaire development. Consensus was set at a pre-defined threshold of at least 70% of panellists selecting 'Strongly disagree'/'Disagree' or 'Strongly agree'/'Agree' for six-point Likert scale questions, or at least 70% selecting the same option for multiple-choice questions. Questions not reaching consensus were restated/revised for the next round, following guidance from free-text responses/scoping questions. RESULTS Consensus was achieved for 60.3% (n = 38/63), 60.0% (n = 18/30), and 100.0% (n = 11/11) of Likert/multiple-choice questions in rounds 1, 2, and 3, respectively. There was agreement that the PMS procedure is effective at reducing IOP in patients with high-tension POAG (greater than 21 mmHg). Although surgical techniques may vary slightly, consensus was reached on several points, including the importance of posterior application of mitomycin C (MMC). Panellists agreed that the PMS postoperative follow-up appointment schedule is reasonably predictable and mostly characterised by fewer visits than with trabeculectomy, particularly in the early phase. Although panellists agreed that combined cataract/PMS surgery and the use of non-MMC wound-healing modulators/antifibrotics during the procedure are possible, further data are needed to determine efficacy. CONCLUSION The expert consensus reached in this panel will help inform best practice guidelines in the treatment of patients with glaucoma in Europe. Panellists also highlighted key areas for future research to improve understanding of the PMS in the treatment algorithm of glaucoma.
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Affiliation(s)
- Anthony P Khawaja
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK.
| | - Ingeborg Stalmans
- Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
- Research Group Ophthalmology, Catholic University KU Leuven, Leuven, Belgium
| | - Florent Aptel
- Clinique Universitaire d'Ophtalmologie, CHU de Grenoble-Alpes, Grenoble, France
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Henny Beckers
- University Eye Clinic, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thomas Klink
- Herzog Carl-Theodor Eye Hospital, Munich, Germany
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement, Eye Clinic and UOC Oculistica, University Hospital and AOUI, Verona, Italy
| | | | - Jan H Simonsen
- Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark
| | - Marc Töteberg-Harms
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Clemens Vass
- Department of Ophthalmology and Optometry, Medical University Vienna, Vienna, Austria
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Holland LJ, Kirwan JF, Mercieca KJ. Effect of COVID-19 pandemic on glaucoma surgical practices in the UK. Br J Ophthalmol 2022; 106:1406-1410. [PMID: 33931388 PMCID: PMC8098230 DOI: 10.1136/bjophthalmol-2021-319062] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIM The aim of the study was to examine the effect of the COVID-19 pandemic on glaucoma surgical practices within the UK. METHODS A cross-sectional online survey was distributed to all consultant glaucoma specialists who are on the UK and Eire Glaucoma Society contact list. Participants were asked specific questions regarding preferences in glaucoma surgical practices and whether these had changed subsequent to the onset of the COVID-19 pandemic. RESULTS Trabeculectomy was the procedure of choice for 61 (87%) glaucoma specialists. A total of 51 (73%) respondents reported performing minimally invasive glaucoma surgery (MIGS) procedures before the COVID-19 pandemic. The most commonly performed MIGS procedure was the iStent inject (51%), followed by XEN 45 (36%) and Preserflo (17%). Forty-three (61%) respondents reported modifying their glaucoma surgery practice subsequent to the onset of the COVID-19 pandemic. Of the glaucoma specialists who modified their surgical practices, 21 (43%) specifically reduced the number of trabeculectomies performed. In combination, diode laser (both micropulse and conventional trans-scleral cyclodiode) was the most common alternative procedure. Glaucoma drainage devices, deep sclerectomy and Preserflo were also commonly chosen alternatives. CONCLUSION Although trabeculectomy remains the most commonly performed established glaucoma surgery, it is being performed with reduced frequency during the COVID-19 pandemic due to the number of postoperative visits and procedures required. Alternatives such as conventional and micropulse diode laser, glaucoma drainage devices, deep sclerectomy and Preserflo appear to be the favoured alternative procedures.
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Affiliation(s)
| | - James F Kirwan
- Ophthalmology Department, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Karl J Mercieca
- Glaucoma Unit, University Hospital Eye Clinic, Bonn, Germany
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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MicroShunt versus Trabeculectomy for Surgical Management of Glaucoma: A Retrospective Analysis. J Clin Med 2022; 11:jcm11185481. [PMID: 36143128 PMCID: PMC9505905 DOI: 10.3390/jcm11185481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17–29] mmHg (on 4 [3–4] medications) to 15 [10–17] mmHg (on 0 [0–2] medications) and from 20 [16–28] mmHg (on 4 [3–4] medications) to 11 [10–13] mmHg (on 0 [0–0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group (p = 0.006), with an increased number of medications from Month-12 (p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group (p = 0.005). The rates of complications were similar (p = 0.060) but with fewer interventions (p = 0.031) and postoperative visits (p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss.
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Lima FLD, Diniz-Filho A, Suzuki ER. Procedimentos Minimamente Invasivos para Glaucoma: uma revisão atualizada da literatura. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Posarelli C, Figus M, Roberti G, Giammaria S, Ghirelli G, Quercioli P, Micelli Ferrari T, Pace V, Mastropasqua L, Agnifili L, Sacchi M, Scuderi G, Perdicchi A, Altafini R, Uva M, D’Andrea D, Covello G, Maglionico MN, Fea AM, Carnevale C, Oddone F. Italian Candidates for the XEN Implant: An Overview from the Glaucoma Treatment Registry (XEN-GTR). J Clin Med 2022; 11:jcm11185320. [PMID: 36142967 PMCID: PMC9500791 DOI: 10.3390/jcm11185320] [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: 08/09/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Italian XEN Glaucoma Treatment Registry (XEN-GTR) was created to acquire a comprehensive prospective dataset that includes the patient characteristics, intraoperative variables, and postoperative management of glaucoma patients undergoing the XEN gel stent implantation. Methods This was a prospective observational, longitudinal clinical study involving 10 centres throughout Italy. The baseline examination included a comprehensive evaluation of demographic parameters (age, sex, ethnicity, and systemic condition), specific ophthalmological parameters, and quality of life questionnaire score collection. Results The baseline data of 273 patients were analysed. The median (IQR) age was 72 (65.0 to 78.0) years. Of the 273 patients, 123 (45%) were female and 150 (55%) were male. A total of 86% of the patients had open-angle glaucoma with a mean intraocular pressure of 24 ± 6 (range 12.0–60.0) mmHg. The mean number of medications was 2.7 ± 0.9 at baseline for the patients with a prevalence of prostaglandin analogues combined with a beta-blocker and anhydrase carbonic inhibitor (31.8%). The mean scores of the NEI-VFQ 25 and GSS questionnaires were 78 ± 18 (range 26.5–100) and 85 ± 14 (range 79–93), respectively. Combined XEN/cataract surgeries were scheduled in 73.7% of the patients. The preferred place for the XEN implant was the supero-nasal quadrant (91.6%). Conclusions Observing the baseline characteristics of the typical Italian candidates for the XEN gel implant shows that they are patients affected by POAG and cataracts, with moderate to severe glaucoma damage, all of which has an impact on their quality of life.
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Affiliation(s)
- Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
- Correspondence: ; Tel.: +39-050997675
| | - Michele Figus
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | | | | | | | | | | | - Vincenzo Pace
- Ospedale Generale Regionale F. Miulli di Acquaviva delle Fonti, 70021 Bari, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. D’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, University of Milan, 20162 Milan, Italy
| | - Gianluca Scuderi
- Ophthalmology Unit, NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00189 Rome, Italy
| | - Andrea Perdicchi
- Ophthalmology Unit, NESMOS Department, S. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome La Sapienza, 00189 Rome, Italy
| | | | - Maurizio Uva
- Azienda Ospedaliera Universitaria, “Policlinico Vittorio Emanuele”, P.O. Gaspare Rodolico, 95123 Catania, Italy
| | | | - Giuseppe Covello
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Maria Novella Maglionico
- Department of Surgical, Medical, Molecular Pathology and of Critical Area, University of Pisa, 56124 Pisa, Italy
| | - Antonio Maria Fea
- Ophthalmic Eye Hospital, Department of Surgical Sciences, University of Turin, 10122 Turin, Italy
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Saeed E, Zalewska R, Konopińska J. Early Complications and Results of Preserflo MicroShunt in the Management of Uncontrolled Open-Angle Glaucoma: A Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148679. [PMID: 35886531 PMCID: PMC9315655 DOI: 10.3390/ijerph19148679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023]
Abstract
We analyze the surgical outcomes and early complications with their management of the Preserflo MicroShunt (Santen Pharmaceutical Co., Ltd., Osaka, Japan) at six-month follow-up. The study is conducted between March 2021 and May 2022. Best-corrected visual acuity (BCVA) logMAR, intraocular pressure (IOP), and changes in glaucoma medications are assessed. Thirty eyes of 30 patients (22 women [73.3%] and 8 men [26.7%]) are included. They are augmented with mitomycin C (MMC) 0.5 mg/mL (8 subjects) or MMC 0.2 mg/mL (22 subjects) intraoperatively. BCVA is significantly higher one day after the treatment than before the treatment (MD with 95% CI = 0.05 (<0.01; 0.30); p = 0.045) when analyzing all patients. Such dependency is not observed when analyzing only patients treated with MMC 0.2 or 0.5 mg/mL (p > 0.050 for both analyses). No other statistically significant differences are detected in the level of BCVA before and after treatment. Among the patients, overall IOP is significantly lower at each time point after treatment than before surgery (p < 0.001 for all analyses). Among patients augmented with MMC 0.2 mg/mL, the IOP level is also significantly lower at each time point after treatment than before treatment (p ≤ 0.001 for all analyses). The same differences are observed among patients with MMC = 0.5—the IOP level is significantly lower at each time point after treatment than before treatment (p < 0.050 for all analyses). Five subjects (16.7%) require anti-glaucoma medications three months after the procedure. Early complications (hypotony, choroidal effusion, keratitis, hyphema, and bleb fibrosis) are observed in 46.7% of cases. Our early results show that Preserflo MicroShunt is safe and effective for lowering IOP; however, it is not free from transient complications.
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Burgos-Blasco B, García-Feijóo J, Perucho-Gonzalez L, Güemes-Villahoz N, Morales-Fernandez L, Mendez-Hernández CD, Martinez de la Casa JM, Konstas AG. Evaluation of a Novel Αb Εxterno MicroShunt for the Treatment of Glaucoma. Adv Ther 2022; 39:3916-3932. [PMID: 35797002 PMCID: PMC9402735 DOI: 10.1007/s12325-022-02230-1] [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: 04/21/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
The surgical management of glaucoma has been revolutionized by the introduction of minimally invasive glaucoma surgery (MIGS). The various MIGS options aim to meaningfully lower intraocular pressure with a better safety profile than traditional glaucoma surgery. The key clinical attributes and the emerging potential of an ab externo MicroShunt (PreserFlo™) are reviewed in the context of published evidence and clinical experience. This novel MicroShunt consists of an 8.5-mm-long tube that is implanted in the eye via an ab externo approach enabling aqueous humor drainage into the sub-Tenon’s space through the formation of a bleb, similar in appearance to that created by trabeculectomy. The efficacy and safety of this procedure, the concomitant use of antimetabolites, the impact of tube positioning, and its future value in clinical practice are critically reviewed. Recent evidence has demonstrated the MicroShunt to be less effective than traditional filtration surgery, but with a significant improvement in safety. Cumulative data suggest that the new implant provides tangible clinical benefits to selected patients with glaucoma in need of further intraocular pressure (IOP) lowering. Future research should delineate the precise role of this and other MIGS options in the rapidly evolving glaucoma treatment algorithm.
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Affiliation(s)
| | - Julián García-Feijóo
- Servicio de Oftalmología, Hospital Clínico San Carlos; IdISSC, Madrid, Spain.,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Carmen D Mendez-Hernández
- Servicio de Oftalmología, Hospital Clínico San Carlos; IdISSC, Madrid, Spain.,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Jose M Martinez de la Casa
- Servicio de Oftalmología, Hospital Clínico San Carlos; IdISSC, Madrid, Spain.,Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Anastasios G Konstas
- 1st and 3rd University, Departments of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece. .,Department of Ophthalmology, 1st University, AHEPA University Hospital, 1 Kyriakidi Street, 54636, Thessaloniki, Greece.
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45
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Brandt JD. Use of a Novel Microshunt in Refractory Childhood Glaucoma: Initial Experience in a Compassionate Use/Early Access Cohort. Am J Ophthalmol 2022; 239:223-229. [PMID: 35346624 DOI: 10.1016/j.ajo.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE In patients with refractory childhood glaucoma, treatment options include trabeculectomy or large glaucoma drainage devices (GDDs) with attendant short- and long-term risks. A novel polymer-based microshunt is under review by the US Food and Drug Administration (FDA) for use in adults. The device is attractive for children given the long-term stability of the polymer and the small conjunctival incision required for implantation. This early clinical series explores the safety and efficacy of this device in patients with refractory childhood glaucoma who would otherwise undergo trabeculectomy or implantation of a GDD. DESIGN Prospective single-center case series under FDA compassionate use investigational device exemption. METHODS FDA and institutional review board approvals were obtained to treat ≤20 children using this investigational device under the compassionate use pathway. Single eyes in patients with refractory childhood glaucoma were treated surgically with the microshunt. Patients with ≥1 year of follow-up are reported. RESULTS Twelve eyes of 12 children (15 months to 14 years if age) with mean preoperative intraocular pressure of 22.72 ± 4.8 mm Hg on 3.3 ± 0.65 medications were treated beginning in December 2019. No intraoperative complications occurred. Among eyes with ≥1 year of follow-up (range 12-23 months), 9 were successfully controlled. In this group, preoperative intraocular pressure 21.6 ± 4.9 mm Hg dropped 45% to 11.9 ± 3.8 mm Hg at 1 year; 7 patients were taking no medications at 12 months, and 2 required 2 medications (fixed-combination dorzolamide-timolol). Three eyes failed, requiring additional surgery. CONCLUSION These early data suggest that the device is safe and appears effective in patients with refractory childhood glaucoma. A prospective, multicenter pivotal trial is planned.
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Efficacy and Safety of the Preserflo Microshunt With Mitomycin C for the Treatment of Open Angle Glaucoma. J Glaucoma 2022; 31:557-566. [PMID: 35583510 PMCID: PMC9232283 DOI: 10.1097/ijg.0000000000002052] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 05/02/2022] [Indexed: 01/31/2023]
Abstract
PRCIS The Preserflo Microshunt (PSM) is a safe and effective glaucoma microfiltering implant that significantly reduces the intraocular pressure (IOP), either alone or in combination with phacoemulsification, during the first year after surgery. PURPOSE The purpose of this study was to assess the safety and efficacy of the PSM for the treatment of open angle glaucoma with 0.2 mg/mL mitomycin C, either alone or in combination with cataract surgery. METHODS A retrospective, open-label study of 64 eyes with primary open angle glaucoma that underwent PSM implantation and were followed up for at least 9 months. Success was defined as IOP 6-17 mm Hg and a reduction of at least 20%, complete without hypotensive medication, and qualified with medication. Safety was assessed by the incidence of adverse events. Secondary endpoints included mean hypotensive medications, visual acuity, and incidence of needling and surgical revision. RESULTS A total of 51 eyes underwent PSM alone and 13 underwent PSM+phacoemulsification. In the overall population of the study, the mean IOP was significantly reduced from 22.03±0.7 mm Hg at baseline to 12.7±0.4 mm Hg at the final visit, P <0.0001 (mean follow-up: 11±1.4 mo). The IOP was significantly reduced in both groups ( P <0.0001). Ocular hypotensive medication was reduced significantly from 2.7±0.7 to 0.2±0.5 ( P <0.0001). No significant differences were found in IOP-lowering medication between groups (PSM alone, 0.2±0.08; PSM+phacoemulsification, 0.1±0.1; P =0.2). At the final visit, 70.3% were considered as complete success and 12.5% as qualified success. The most common adverse event was clinical hypotony (7.8%) followed by hyphema (4.7%), and anterior chamber reformation (1.6%). Overall, 1.6% required needling and 15.6% surgical revision to restore the flow. CONCLUSION Glaucoma surgery with the PSM and mitomycin C was efficacious and safe in the short term, either alone or in combination with cataract surgery, and may be considered a surgical option for lowering IOP in primary open angle glaucoma.
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Iris Obstruction Following PRESERFLO™ Microshunt Implantation and Surgical Management. J Glaucoma 2022; 31:e72-e74. [PMID: 35513896 DOI: 10.1097/ijg.0000000000002049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/27/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To present a case of lumen obstruction after implantation of microshunt with subconjunctival drainage and subsequent management. CASE REPORT A 56-year-old male with primary open angle glaucoma underwent uneventful PRESERFLO™ MicroShunt implantation in both eyes. Five months after surgery the patient presented with an intraocular pressure of 26▒mmHg in the right eye due to iris obstruction. RESULTS The iris fibers were severed and removed surgically to free the lumen. Follow-up showed a normalised intraocular pressure of 10▒mmHg and a free lumen. CONCLUSION Uncontrolled intraocular pressure due to iris obstruction following PRESERFLO™ Microshunt was addressed by surgical removal of iris fibers at the lumen entrance without the need for tube repositioning.
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Pillunat KR, Herber R, Haase MA, Jamke M, Jasper CS, Pillunat LE. PRESERFLO™ MicroShunt versus trabeculectomy: first results on efficacy and safety. Acta Ophthalmol 2022; 100:e779-e790. [PMID: 34331505 DOI: 10.1111/aos.14968] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/21/2021] [Accepted: 06/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To report efficacy and safety outcomes of the PRESERFLO™ MicroShunt compared with trabeculectomy, the current gold-standard treatment for advanced glaucoma, in the early and intermediate postoperative period. METHODS Institutional prospective interventional cohort study of primary open-angle glaucoma (POAG) patients scheduled for the PRESERFLO™ MicroShunt. The comparison group were POAG patients who had had received trabeculectomy and were matched for age, known duration of disease, number and classes of intraocular pressure (IOP)-lowering medications to ensure a similar conjunctival condition. The study is part of the Dresden Glaucoma and Treatment Study (DGTS), was not randomized, but used a uniform study design, with the same inclusion and exclusion criteria as well as standardized definitions of success and failure. MAIN OUTCOME MEASURES mean diurnal IOP (mdIOP, mean of 6 measurements), diurnal peak IOP, diurnal IOP fluctuations, glaucoma medical therapy, success rates, visual acuity, visual fields, surgical complications and interventions, and severe adverse events. RESULTS Fifty-two eyes of 52 patients, 26 in each group, were analysed. At 6 months, median [Q25, Q75] mdIOP was 10.8 [9.5-12.2] mmHg in the microshunt and 10.3 [7.6-11.8] mmHg in the trabeculectomy group. Reduction in mdIOP (p = 0.458), peak diurnal IOP (p = 0.539), and median diurnal fluctuation (p = 0.693) was not statistically significantly different between groups. The rate of interventions was statistically significantly higher in the trabeculectomy compared with the microshunt group (p = 0.004). None of the patients experienced severe adverse events. CONCLUSION Both procedures are equally effective and safe in lowering mdIOP in patients with POAG. Because the microshunt is less invasive with less follow-up and interventions needed postoperatively, it might be recommended earlier in the treatment of glaucoma.
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Affiliation(s)
- Karin R. Pillunat
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
| | - Robert Herber
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
| | - Maike A. Haase
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
| | - Melanie Jamke
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
| | - Carolin S. Jasper
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
| | - Lutz E. Pillunat
- Department of Ophthalmology Medical Faculty Carl Gustav Carus Technische Universität Dresden Germany
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Marolo P, Reibaldi M, Fallico M, Maugeri A, Barchitta M, Agodi A, Parisi G, Caselgrandi P, Ventre L, Ahmed IIK. Reintervention rate in glaucoma filtering surgery: A systematic review and meta-analysis. Eur J Ophthalmol 2022; 32:2515-2531. [PMID: 35473447 DOI: 10.1177/11206721221093828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Reintervention rate is an important factor impacting on patients, surgeons, and society. To date, only a few studies have focused on this topic. For this reason, a systematic review and meta-analysis was undertaken to assess the reintervention rate after glaucoma filtering surgery. MATERIALS AND METHODS Prospective studies reporting the reintervention rate after glaucoma filtering surgery and with at least 12 months of follow-up were systematically searched on PubMed, Medline and Embase databases. The primary outcome was the total reintervention rate following surgery. Secondary outcomes were: the rate of manipulation, in-clinic and in-operating room reintervention; the reintervention rate for intraocular pressure (IOP) control and for complications; demographic, clinical and surgical variables associated with reintervention rate. RESULTS Ninety-three studies with a total of 8345 eyes were eligible. The total reintervention rate was 1.84 (95% CI 1.57-2.13), with a lower rate for Baerveldt (0.53, 95% CI 0.29-0.83) and Preserflo (0.60, 95% CI 0.15-1.29), and a higher rate for Xen (4.26, 95% CI 2.59-6.31). The manipulation rate was 0.99 (95% CI 0.77-1.23), the in-clinic reintervention rate was 0.08 (95% CI 0.05-0.12) and the in-operating room reintervention rate was 0.28 (95% CI 0.22-0.35). The reintervention rate for IOP control was 1.26 (95% CI 1.04-1.51) and the reintervention rate for complications was 0.27 (95% CI 0.21-0.35). CONCLUSIONS All types of surgery presented a total reintervention rate similar to the overall findings, except studies on Baerveldt and Preserflo Microshunt, with a lower rate, and Xen, with a higher rate. None of the variables evaluated were found to be directly associated with the explored outcomes.
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Affiliation(s)
- Paola Marolo
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Matteo Fallico
- Department of Ophthalmology, 9298University of Catania, Catania, Italy
| | - Andrea Maugeri
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Martina Barchitta
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Antonella Agodi
- Department of Medical and Surgical Sciences and Advanced Technologies "G.F. Ingrassia", 9298University of Catania, Catania, Italy
| | - Guglielmo Parisi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Paolo Caselgrandi
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Luca Ventre
- Department of Surgical Sciences, Eye Clinic Section, 60265University of Turin, Turin, Italy
| | - Iqbal Ike K Ahmed
- Department of Ophthalmology & Vision Sciences, 7938University of Toronto, Toronto, Ontario, Canada
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Saletta G, Alexoudis A, Gkatzioufas Z, Grieshaber M, Papazoglou A, Tschopp M, Töteberg M, Gugleta K. Retrospective Analysis of 12 Months Glaucoma Implant Efficacy: XEN45 and PreserFlo Microshunt. Klin Monbl Augenheilkd 2022; 239:429-434. [PMID: 35472784 DOI: 10.1055/a-1766-6444] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Several new implant devices have recently been introduced to glaucoma surgery using various techniques for reducing intraocular pressure (IOP). Two implants introduced during the past couple of years, XEN45 and PreserFlo Microshunt, are both designed to control subconjunctival filtration. There are two Swiss multicenter studies that collected the data retrospectively to analyze the efficacy and safety of these two devices separately. In this study, we report the analysis of the combined data subset from the University Hospital of Basel. SUBJECTS AND METHODS The XEN45 implantation technique was introduced to Basel University Hospital in 2016 and PreserFlo Microshunt in 2018. Sixty operated patients, thirty in each group, were operated on by one surgeon, clinically followed up, and their data retrospectively analyzed from medical records. Only standalone procedures, without combined phacoemulsification, were considered in this analysis; the lens status, however, was neither an inclusion nor an exclusion criterion. Further inclusion criteria were the diagnosis of open-angle glaucoma, no previous glaucoma surgery, other than laser trabeculoplasty, and complete medical records during the 12 months of follow-up. IOP reduction during a 12-month postoperative period was the primary outcome measure as well as the number of IOP reducing drugs. The number of subsequent surgical interventions and complications/adverse events are descriptively reported. RESULTS Patient age, gender, ophthalmological diagnosis, and initial preoperative IOP were well balanced between the two groups. Postoperative IOP course was comparable between the two methods for the first 12 months. IOP measurements were taken preoperatively and then on the first postop day, week 1, month 1, and months 3, 6, and 12 for the PreserFlo Microshunt vs. XEN45 (mmHg): 23.6 vs. 24.9, 9.0 vs. 8.9, 11.4 vs. 10.6, 13.0 vs.18.3, 16.8 vs.15.1, 15.9 vs.15.0, and 15.4 vs.14.5, respectively. IOP reducing medications were also comparable between the two groups. The study showed that subsequent interventions were more frequent in the XEN45 (13) than in the PreserFlo Microshunt group (7). CONCLUSION Both methods demonstrate satisfactory IOP control within a 12-month postoperative period with practically no serious adverse events/complications, but with relatively high numbers of subsequent interventions (needlings), particularly in the XEN45 group.
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Affiliation(s)
- Giulia Saletta
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
| | - Antonios Alexoudis
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland.,Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Zisis Gkatzioufas
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
| | | | - Anthia Papazoglou
- Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Markus Tschopp
- Department of Ophthalmology, Kantonsspital Aarau AG, Aarau, Switzerland
| | - Marc Töteberg
- Department of Ophthalmology, Universitätsspital Zürich, Zürich, Switzerland
| | - Konstantin Gugleta
- Department of Ophthalmology, Universitätsspital Basel, Basel, Switzerland
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