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Kaur I, Md Din N, Che Hamzah J, Yogesvaran R. Reversal of Peripheral Anterior Synechiae After Trabeculectomy With Argon Laser Synechiolysis. Cureus 2024; 16:e59668. [PMID: 38836135 PMCID: PMC11149058 DOI: 10.7759/cureus.59668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
We report a case of successful argon laser synechiolysis as a non-invasive alternative for peripheral anterior synechiae release after trabeculectomy in a young patient with steroid-induced ocular hypertension. Steroid-induced ocular hypertension is a known complication of vernal keratoconjunctivitis due to prolonged treatment with steroids. In refractive conditions, augmented trabeculectomy becomes the surgery of choice in these patients. In this article, we report successful treatment of iris tissue plugging the internal ostium with an argon laser and reinstatement of aqueous flow.
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Affiliation(s)
- Inderpreet Kaur
- Department of Ophthalmology, Hospital Canselor Tuanku Muhriz UKM (HCTM), Selangor, MYS
| | - Norshamsiah Md Din
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Jemaima Che Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | - Rupini Yogesvaran
- Department of Ophthalmology, Hospital Tengku Ampuan Rahimah, Klang, MYS
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Pastore MR, Milan S, Agolini R, Egidi L, Agostini T, Belfanti L, Cirigliano G, Tognetto D. How Could Medical and Surgical Treatment Affect the Quality of Life in Glaucoma Patients? A Cross-Sectional Study. J Clin Med 2022; 11:jcm11247301. [PMID: 36555917 PMCID: PMC9784022 DOI: 10.3390/jcm11247301] [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: 11/14/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate and compare the visual function and the quality of life (QoL) in glaucomatous patients treated with topical medical therapy (TMT) alone, canaloplasty (CP), or trabeculectomy (TB). METHODS A total of 291 eyes of 167 patients with primary open-angle glaucoma or secondary pseudoexfoliative glaucoma in TMT or surgically treated with CP or TB were included. Eligibility criteria for surgical patients included not needing TMT after surgery. Each patient underwent a visual field assessment and peripapillary retinal nerve fiber layer (pRNFL) optical coherence tomography and filled out the Glaucoma Symptoms Scale (GSS) questionnaire and the 25-Item National Eye Institute Visual Functioning Questionnaire (25-NEI-VFQ). Comparison between the QoL level of the three groups and its correlation with optic nerve's anatomical and functional status was the primary outcome. RESULTS CP patients reported the best general vision (p = 0.01), a lower incidence of eye burning (p = 0.03), and the lowest annoyance level of non-visual symptoms (p = 0.006). QoL positively correlated with pRNFL thickness, whereas no correlation was found with visual field damage. CONCLUSION CP provides a better QoL when compared both to TB and TMT, regardless of glaucoma stage. pRNFL seems to provide additional information for predicting change in QoL.
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Affiliation(s)
- Marco Rocco Pastore
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Serena Milan
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
- Correspondence: ; Tel.: +39-040-399-2243
| | - Rossella Agolini
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Leonardo Egidi
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, 34100 Trieste, Italy
| | - Tiziano Agostini
- Department of Life Sciences, University of Trieste, 34100 Trieste, Italy
| | - Lorenzo Belfanti
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Gabriella Cirigliano
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
| | - Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34129 Trieste, Italy
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Xia T, Khouri AS. Intracameral viscoelastic treatment for hypotony after glaucoma incisional surgery. Taiwan J Ophthalmol 2019; 9:292-294. [PMID: 31942439 PMCID: PMC6947745 DOI: 10.4103/tjo.tjo_31_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/28/2018] [Indexed: 12/01/2022] Open
Abstract
We report on a minimally invasive treatment of symptomatic hypotony after glaucoma surgery. Hypotony after incisional glaucoma surgery can have severe visual consequences. Refractory symptomatic hypotony often requires surgical intervention to prevent further vision loss. The clinical records of four patients in this interventional case series with symptomatic hypotony and choroidal detachments after incisional glaucoma surgery between 2013 and 2014 were reviewed. Observations were made as the cases progressed. Visual obscuration secondary to refractory hypotony was treated with an intracameral injection of high-molecular-weight ocular viscoelastic devices (HMWOVD). Postinjection, mean intraocular pressure improved from a baseline of 3.6 mm Hg to 24.0, 15.5, and 9 mm Hg at 1 day, 1 month, and 6 months' post-intervention, respectively. The mean visual acuity after injection improved from 20/274 to 20/83 at 6 months. Choroidal detachments resolved within 1 week in all patients. Intracameral HMWOVD for the treatment of symptomatic hypotony post-incisional glaucoma surgery is minimally invasive, avoided reoperation, and led to quick visual recovery.
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Affiliation(s)
- Tian Xia
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Albert S Khouri
- Institute of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Kumar M, Parveen S, Chauhan L. Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach. Ther Adv Ophthalmol 2019; 11:2515841419854829. [PMID: 31225428 PMCID: PMC6566477 DOI: 10.1177/2515841419854829] [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: 11/02/2018] [Accepted: 05/08/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To report outcome of trabeculectomy performed by single scleral suture in Indian eyes. Methods Non-randomized, non-masked, retrospective cohort analysis. Medical records of all consecutive patients who underwent trabeculectomy between 1 January 2011 and 31 December 2016 at CL Gupta Eye Institute, Moradabad (India), were reviewed and analyzed. Trabeculectomy was performed using single scleral suture for flap closure. The suture knot was buried inside sclera. The laser lysis of scleral suture was not done. Success was defined as complete success if an intraocular pressure (IOP) was >5 and ⩽21 mmHg without any glaucoma medications or re-surgery. Qualified success was defined as IOP ⩽21 mmHg with or without antiglaucoma medications. Results Data of 98 patients was analyzed. A total of 61 (62.2%) of them underwent trabeculectomy, and 37 (37.7%) underwent phacotrabeculectomy. The probability of complete success in patient underwent phacotrabeculectomy was 86% at 3 years, and in-patient underwent only trabeculectomy was 95% at 3 years. The probability of qualified success in patient undergone phacotrabeculectomy was 91% at 3 years, and in patient undergone only trabeculectomy was 97% at 3 years. Conclusion The mean postoperative IOP was significantly less then mean preoperative IOP, at all follow-up visits. This simplified technique also resulted in high midterm success probabilities with low complication rates.
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Affiliation(s)
- Mukesh Kumar
- Consultant Ophthalmologist, Department of Glaucoma, CL Gupta Eye Institute, Moradabad, India
| | - Shafia Parveen
- Department of Optometry and Visual Sciences, CL Gupta Eye Institute, Moradabad, India
| | - Lokesh Chauhan
- Department of Clinical Research, CL Gupta Eye Institute, Moradabad, India
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Reply. Retina 2018; 38:e63-e64. [DOI: 10.1097/iae.0000000000002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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B Scoralick AL, Almeida I, Ushida M, T Dias D, Dorairaj S, S Prata T, N Kanadani F. Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017; 11:58-62. [PMID: 28924340 PMCID: PMC5577121 DOI: 10.5005/jp-journals-10028-1224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022] Open
Abstract
Aim To investigate surgical outcomes and success predictors of transconjunctival scleral flap resuturing for the management of hypotony due to overfiltration following trabeculectomy with mitomycin C. Materials and methods Noncomparative, retrospective, interventional case series in which all glaucoma patients from two glaucoma services undergoing transconjunctival scleral flap resuturing between May 2012 and July 2016 were enrolled. Included eyes had to have hypotony [intraocular pressure (IOP) < 6 mm Hg] and/or hypotony maculopathy caused by excessive filtration following trabeculectomy. Key exclusion criteria were wound/bleb leaking and postoperative ocular trauma or infection. Preoperative and postoperative IOP, best-corrected visual acuity (BCVA), fundus imaging, surgical complications, and any subsequent related events or procedures were recorded. Rates of postsurgical hypotony and/or maculopathy resolution and possible success predictors were investigated. Results A total of 22 patients (22 eyes) with a mean age of 56.4 ± 15.2 years were included. Median follow-up was 245 days [interquartilerange (IR); 120-817 days] and mean IOP was increased from 2.9 ± 1.5 mm Hg (1-6 mm Hg) to 8.5 ± 3.1 mm Hg (2-16 mm Hg) at the last follow-up visit (p < 0.01). Approximately 75% of the cases (16 out of 22) had an IOP between 7 and 18 mm Hg at the end of the follow-up period. Median BCVA (log MAR) at last follow-up visit [0.1 (IR; 0.0- 0.3)] was significantly better than preoperative BCVA [0.4 (IR; 0.11.0); p < 0.01]. Hypotony resolved in 81% of the cases, while maculopathy resolution was found in 85% of the cases. Time interval between trabeculectomy and flap resuturing was the only factor significantly associated with patient’s IOP at last follow-up visit (R2 = 0.23; p = 0.036). Success rates (IOP > 6 mm Hg at last follow-up visit) were halved in those left untreated for more than 6 months. No serious adverse event was recorded. Conclusion Our findings support the use of transconjunctival scleral flap resuturing as an effective and safe alternative for hypotony management due to overflitration following trabeculectomy. As time interval seems to influence the odds of hypotony resolution, early intervention is recommended. How to cite this article Scoralick ALB, Almeida I, Ushida M, Dias DT, Dorairaj S, Prata TS, Kanadani FN, Hypotony Management through Transconjunctival Scleral Flap Resuturing: Analysis of Surgical Outcomes and Success Predictors. J Curr Glaucoma Pract 2017;11(2):58-62.
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Affiliation(s)
- Ana Luiza B Scoralick
- Staff specialist, Department of Ophthalmology, Instituto de Olhos Ciencias Medicas, Belo Horizonte, Brazil
| | - Izabela Almeida
- Postgraduate Student, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil
| | - Michele Ushida
- Staff specialist, Glaucoma Unit, Hospital Medicina dos Olhos, Osasco, Brazil
| | - Diego T Dias
- Postgraduate Student, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil
| | - Syril Dorairaj
- Assistant Professor, Department of Ophthalmology, Mayo Clinic, Jacksonville Florida, USA
| | - Tiago S Prata
- Associate Professor, Department of Ophthalmology, Glaucoma Service, Federal University of Sao Paulo, Brazil; Glaucoma Unit Hospital Medicina dos Olhos, Osasco, Brazil; Department of Ophthalmology Glaucoma Service, Sorocaba Ophthalmology Hospital, BOS Sorocaba, Brazil
| | - Fábio N Kanadani
- Associate Professor, Department of Ophthalmology, Instituto de Olhos Ciencias Medicas, Belo Horizonte, Brazil
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Fakhraie G, Mohajernezhad-Fard Z, Moghimi S, Vahedian Z, Eslami Y, Zarei R. Lens Extraction for Management of Coexisting Cataract and Post-filtering Surgery Ocular Hypotony. J Ophthalmic Vis Res 2016; 10:385-90. [PMID: 27051482 PMCID: PMC4795387 DOI: 10.4103/2008-322x.176908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: To evaluate the safety and efficacy of phacoemulsification for management of post-filtering ocular hypotony. Methods: This prospective interventional case series study recruited 21 consecutive patients with an established diagnosis of ocular hypotony with or without maculopathy. Clear corneal incision phacoemulsification was done for all patients. Nineteen cases that completed a follow-up of at least 6 months were considered for final analysis. Results: Mean baseline intraocular pressure (IOP) was 2.95 ± 1.43 mm Hg, which increased to 8.84 ± 4.67 mm Hg at 6 months (P < 0.001). Hypotony was resolved in 13 cases (68%) at 6 months while 6 cases (32%) showed persistent hypotony at this time point. Postoperative IOP change at all follow-up time points was not correlated with patient age, time interval between filtering surgery and phacoemulsification, baseline IOP, baseline anterior chamber depth and IOP on the first postoperative day. Three cases (16%) showed filtering bleb failure with dramatic IOP rise around the first postoperative month and required glaucoma medication for IOP control. No significant intra- or postoperative complications were noted. Conclusion: Cataract surgery alone seems promising in resolving hypotony in patients with post-filtering ocular hypotony, and can be considered as an effective treatment modality before proceeding to more complicated procedures.
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Affiliation(s)
- Ghasem Fakhraie
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohajernezhad-Fard
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Sasan Moghimi
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakieh Vahedian
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yadollah Eslami
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Zarei
- Department of Ophthalmology, Glaucoma Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Jeong H, Sung KR. Augmentation of filtering blebs with viscoelastics in trabeculectomy. KOREAN JOURNAL OF OPHTHALMOLOGY 2014; 28:393-8. [PMID: 25276081 PMCID: PMC4179116 DOI: 10.3341/kjo.2014.28.5.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/20/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the clinical outcome of viscoelastics (VE, sodium hyaluronate)-augmented trabeculectomy (VAT, 66 eyes) and conventional trabeculectomy (CT, 57 eyes) for glaucomatous eyes. Methods In the VAT group, half of the anterior chamber space was filled with VE via the paracentesis site at the end of CT and a balanced salt solution was injected into the anterior chamber. This procedure induced migration of VE from the anterior chamber into the bleb space; thus the bleb was elevated with underlying VE. Follow-up examinations were performed until 1 year after surgery. Success was defined as the attainment of an intraocular pressure (IOP) greater than 5 mmHg and less than 22 mmHg. If IOP was in the range of success without antiglaucoma medication, it was regarded as a complete success. Results The mean postoperative IOP was significantly lower in the VAT group at postoperative 1 day, 1 week, and 1 month. The complete success rate was significantly higher in the VAT group (89%) than in the CT group (75%), though the qualified success rate was not different between the two groups. The number of IOP-lowering medications at postoperative 1 year was significantly higher in the CT group (1.30 ± 1.08 vs. 0.73 ± 0.98, p = 0.003). Among postoperative procedures, laser suture lysis was required less frequently in the VAT group (p < 0.001). Conclusions Placing VE within the bleb at the end of surgery may result in better IOP control and less need for IOP-lowering medication without any additional materials, cost, or time.
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Affiliation(s)
- Hyerin Jeong
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Rim Sung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Long-term results after transconjunctival resuturing of the scleral flap in hypotony following trabeculectomy. Am J Ophthalmol 2013; 155:864-9. [PMID: 23394904 DOI: 10.1016/j.ajo.2012.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 12/06/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To present the 4-year follow-up results in the surgical treatment of hypotony following trabeculectomy with mitomycin C in glaucoma patients with additional flap sutures. DESIGN Retrospective interventional case series. METHODS Since 2006, 53 patients with hypotony maculopathy attributable to overfiltration following glaucoma surgery (trabeculectomy with mitomycin C) were included in this institutional study. We were able to follow up intraocular pressure (IOP) and distance-corrected visual acuity in 33 (62%) over 4 years, whereas all were followed over 2 years. To elevate IOP, we placed tangential transconjunctival sutures through the scleral flap and connected them to the adjacent sclera in all 53 patients. RESULTS Mean IOP prior to surgery was 3.55 mm Hg (± 2.05; range 0-8 mm Hg), 20.08 mm Hg (± 12.48) on the first postoperative day, 10.69 mm Hg (± 4.73) after 1 month, 10.12 mm Hg (± 3.95) after 6 months, 10.42 mm Hg (± 4.17) after 2 years, and 9.5 mm Hg (± 3.93) after 4 years. Mean visual acuity (VA) improved from 0.8 logarithm of minimal angle of resolution (logMAR) preoperatively to 0.5 after 1 month, and remained stable after 6 months at 0.3. Macular folds resolved in all patients and choroidal detachment in 51 patients (96%) after 6 months. IOP increase and vision improvement were statistically significant (<.05). CONCLUSION Even 4 years after resuturing of the scleral flap through the intact conjunctiva, there is evidence that this surgical method is an effective and simple technique to treat hypotony maculopathy after glaucoma surgery.
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Vijaya L, Manish P, Ronnie G, Shantha B. Management of complications in glaucoma surgery. Indian J Ophthalmol 2011; 59 Suppl:S131-40. [PMID: 21150025 PMCID: PMC3038515 DOI: 10.4103/0301-4738.73689] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Surgical option for glaucoma is considered when other modalities are not working out to keep the intraocular pressure under control. Since the surgical procedures for glaucoma disrupt the integrity of the globe, they are known to produce various complications. Some of those complications can be vision-threatening. To minimize the morbidity, it is very important that one should know how to prevent them, recognize them and treat them. The objective of this article is to provide insight into some of those complications that will help the ophthalmologists in treating glaucoma patients in their clinical practice.
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Affiliation(s)
- Lingam Vijaya
- Smt Jadhavbai Nathmal Singhvee Glaucoma Services, Sankara Nethralaya, 18 College Road, Chennai 600006, India.
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Suominen S, Harju M, Ihanamäki T, Vesti E. The effect of deep sclerectomy on intraocular pressure of normal-tension glaucoma patients: 1-year results. Acta Ophthalmol 2010; 88:27-32. [PMID: 19775310 DOI: 10.1111/j.1755-3768.2009.01623.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To study the intraocular pressure (IOP)-reducing effect of deep sclerectomy on normal-tension glaucoma (NTG) patients. METHODS We retrospectively analysed 21 eyes of 18 consecutive NTG patients who had undergone deep sclerectomy with mitomycin-C and a collagen implant. RESULTS Median (range) preoperative IOP was 15.1 mmHg (9.3-20.8) and median follow-up time 13 months (12-18). At the 1-year follow-up visit, median IOP was significantly (P < 0.001) reduced to 10.5 mmHg (4-15) with median IOP reduction from preoperative values of 37% (12-78). Laser goniopuncture was performed in 10 eyes (48%) 1-16 months postoperatively. After 13 months' follow-up, a complete success at 20%, 25% and 30% IOP reduction levels was achieved in 67%, 62% and 52% of eyes, respectively. Few complications were encountered, but these included reduced visual acuity, problems with conjunctiva, microperforation, hyphaema, Dellen formation and encapsulated bleb. We encountered no complications related to postoperative hypotony. CONCLUSION Deep sclerectomy with a collagen implant and mitomycin-C was a safe and effective method for reducing IOP in NTG patients during 1-year follow-up.
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Affiliation(s)
- Sakari Suominen
- Department of Ophthalmology, Helsinki University Central Hospital, Finland.
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Utility of Bleb Imaging With Anterior Segment Optical Coherence Tomography in Clinical Decision-making After Trabeculectomy. J Glaucoma 2009; 18:492-5. [DOI: 10.1097/ijg.0b013e31818d38ab] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Eha J, Hoffmann EM, Wahl J, Pfeiffer N. Flap suture--a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol 2008; 246:869-74. [PMID: 18389274 DOI: 10.1007/s00417-007-0694-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 08/07/2007] [Accepted: 09/12/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy, papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC. METHODS In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included. Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera. Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging of the posterior pole were performed. RESULTS Before surgery (flap suture), the mean IOP was 2.8 mmHg (+/-1.1; range from 1 to 4 mmHg). It was 24.9 +/- 11.7 mmHg (range; 9-48 mmHg) on the 1st postoperative day, 15.7 +/-8.1 mmHg (range; 5-35 mmHg) on day 7, 11.1 +/-4.1 mmHg (range; 5-20 mmHg) 1 month after surgery, 9.3 +/-3.9 mmHg (range; 2-20 mmHg) after 3 months, and 9.6 +/-4.2 mmHg (range; 2-20 mmHg) after 6 months. The best corrected mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively. Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up. CONCLUSION Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided.
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Affiliation(s)
- Judith Eha
- Department of Ophthalmology, Johannes Gutenberg-University, Langenbeckstr. 1, 55101 Mainz, Germany.
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Veneziale RW, Bral CM, Sinha DP, Watkins RW, Cartwright ME, Rosenblum IY, Treinen KA, Kishnani NS, Nelson J, Chen Z, Faha B, Maneval D, Munger RJ, Cai XY, Cullen C, Arezzo JC. SCH 412499: biodistribution and safety of an adenovirus containing P21(WAF-1/CIP-1) following subconjunctival injection in Cynomolgus monkeys. Cutan Ocul Toxicol 2007; 26:83-105. [PMID: 17612977 DOI: 10.1080/15569520701212167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Monkey studies were conducted for the preclinical safety assessment of SCH 412499, an adenovirus encoding p21, administered by subconjunctival injection prior to trabeculectomy for postoperative maintenance of the surgical opening. Biodistribution of SCH 412499 was minimal and there was no systemic toxicity. Findings included swollen, partially closed or shut eye(s) and transient congestion in the conjunctiva. A mononuclear cell infiltrate was present in the conjunctiva, choroid and other ocular tissues, but completely or partially resolved over time. Electroretinograms and visual evoked potentials revealed no adverse findings. Thus, the findings are not expected to preclude the clinical investigation of SCH 412499.
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Affiliation(s)
- Robert W Veneziale
- Drug Safety, Schering-Plough Research Institute. Lafayette, New Jersey 07848-0032, USA.
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Edmunds B, Thompson JR, Salmon JF, Wormald RP. The National Survey of Trabeculectomy. III. Early and late complications. Eye (Lond) 2002; 16:297-303. [PMID: 12032721 DOI: 10.1038/sj.eye.6700148] [Citation(s) in RCA: 188] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE There is a considerable body of literature relating to trabeculectomy, however there are no data representative of the national experience of trabeculectomy in the United Kingdom (UK). The Department of Health funded a national survey of trabeculectomy to establish current practice patterns and the outcome of trabeculectomy in the National Health Service (NHS). In this paper we present the reported complications of first-time trabeculectomy from a nationally representative cohort of patients with chronic open angle glaucoma. METHODS Cross-sectional study of consultant ophthalmologists performing trabeculectomy in the NHS. Participants recruited their four most recent consecutive first-time trabeculectomy cases with chronic open angle glaucoma according to study eligibility criteria and data were collected by self-administered questionnaire. FOLLOW-UP one year post-trabeculectomy. MAIN OUTCOME MEASURES occurrence of early and late complications. RESULTS Clinical outcome data were available for 1240 (85.3%) of cases. Early complications were reported in 578 (46.6%) cases and late complications in 512 (42.3%) cases. Some cases had more than one complication. The most frequent early complications were hyphaema (n = 304, 24.6%), shallow anterior chamber (n = 296, 23.9%), hypotony (n = 296, 24.3%), wound leak (n = 216, 17.8%) and choroidal detachment (n = 175, 14.1%). The most frequent late complications were cataract (n = 251, 20.2%), visual loss (n = 230, 18.8%) and encapsulated bleb (n = 42, 3.4%). The occurrence of most complications was not associated with a consultant's specialist interest, level of activity, type of hospital or region. Encapsulated bleb was reported more frequently in a university hospital setting. CONCLUSIONS The complication rates reported in this paper represent the national experience of first-time trabeculectomy for open angle glaucoma in the UK. These are similar to previous published studies and highlight in particular, the impact of trabeculectomy on visual acuity in the first year following surgery. This survey provides valid and clinically relevant data on the complications of trabeculectomy for the production of guidelines and standards for audit at regional, local and individual level.
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Affiliation(s)
- B Edmunds
- Royal College of Ophthalmologists, London, UK.
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Cooper R. Surgical management of the glaucomas. AUSTRALIAN AND NEW ZEALAND JOURNAL OF OPHTHALMOLOGY 1999; 27:353. [PMID: 10571397 DOI: 10.1046/j.1440-1606.1999.00234.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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