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Zhang Y, Lai C, Zhao S, Li L, Luo X, Chen Y, Niu Y, Qin Y, Zhang H. Comparison of bleb morphologies between phacoemulsification combined with Ex-PRESS mini shunt implantation, phacotrabeculectomy and trabeculectomy alone: a two-year retrospective in vivo confocal microscopy study. BMC Ophthalmol 2024; 24:108. [PMID: 38448910 PMCID: PMC10916144 DOI: 10.1186/s12886-024-03364-2] [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: 10/21/2023] [Accepted: 02/22/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND To compare the bleb morphologies of phacoemulsification combined with Ex-PRESS implantation (Phaco-ExPRESS), phaco trabeculectomy (Phaco-Trab), and trabeculectomy (Trab) in postoperative two years. METHODS Patients with primary open-angle glaucoma (POAG) with or without cataracts were included in this study. All patients underwent surgeries of either Phaco-ExPRESS, Phaco-Trab, or Trab. The morphologic structures of the filtering bleb, including microcysts area, hyperreflective dot density, and stromal connective tissue under in vivo confocal microscope (IVCM), were compared between the three groups. The data were collected preoperatively and postoperatively at 2 weeks, 1 month, 3 months, 6 months, 12 months, 18 months, and 24 months. RESULTS Eighty-nine eyes from 89 patients were enrolled, including 32 in the Phaco-ExPRESS group, 25 in the Phaco-Trab group, and 32 in the Trab group. In a 24-month follow-up, bleb morphologies in Phaco-ExPRESS were similar to the Trab group. The area of epithelial microcysts was significantly increased in Phaco-ExPRESS and Trab groups while significantly decreased in Phaco-Trab. At postoperative 24 months, the complete success rate was 65.1% in Phaco-ExPRESS, 32.0% in Phaco-Trab, and 59.4% in the Trab group (P = 0.03). The phaco-Trab group had more postoperative anti-glaucoma medications than the other two groups (P < 0.05). CONCLUSIONS Phaco-ExPRESS group and Trab group had similar blebs morphologies in IVCM, with larger microcyst area, looser connective tissue, and less inflammation than Phaco-Trab, indicating that the function of blebs in the Phaco-ExPRESS and Trab group, was more potent than that of Phaco-Trab. All these surgical methods provided adequate IOP control, but Phaco-Trab required more anti-glaucoma medications.
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Affiliation(s)
- Yuqiao Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Chunxin Lai
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Suwen Zhao
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China
| | - Ling Li
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China
| | - Xiaoyang Luo
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanlei Chen
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yongyi Niu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Yongjie Qin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Hongyang Zhang
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou Dadao North Road, 510000, Guangzhou, China.
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Samir A, Abdelrahman Elsayed AM, Deiaeldin YA, Al-Naimy MA. The Role of Automated Peripheral Iridectomy Combined with Phacoemulsification and Mini Ex-PRESS Shunt Implantation in Patients with Chronic Angle Closure Glaucoma. Clin Ophthalmol 2022; 16:2699-2703. [PMID: 36017507 PMCID: PMC9397526 DOI: 10.2147/opth.s367509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the role of automated peripheral iridectomy as an adjunctive tool combined with phacoemulsification and ExPRESS shunt implantation in management of cases with chronic angle closure glaucoma. Setting Magrabi eye hospital. Methods This prospective study included 22 eyes of 22 patients with chronic angle closure glaucoma and cataract who underwent Ex-PRESS shunt implantation, cataract extraction and surgical peripheral iridectomy at the site of shunt implantation in the period between January 2018 and April 2020. Results After surgery, the mean IOP was 11.3±1.2 mm Hg, 14.5±1.6 mm Hg, 14.8±2.1 mm Hg, 15.3±1.9 mm Hg and 17.4±1.8 mm Hg at 7 days, 1 month, 3 months, 6 months and 12 months, respectively. All postoperative IOP was significantly lower compared with preoperative IOP (P = 0.001). There was a significant decrease in the number of medications required after surgery. The baseline mean number of medications was 3.4±0.02 (range from 1 to 4), while postoperatively the mean number of medications decreased to 0.7±0.01 at 12 months (P < 0.01). The qualified success rate was 6/22 eyes, and the complete success rate was 16/22 (72.7%) at 12 months, respectively. Conclusion The combined phacoemulsification and Ex-PRESS shunt implantation with automated peripheral iridectomy is an effective and safe procedure to treat chronic angle closure glaucoma.
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Affiliation(s)
- Ahmed Samir
- Department of Ophthalmology, Zagazig University, Zagazig, Sharkia, Egypt
- Magrabi Eye Hospital, Jeddah, Kingdom Saudi Arabia
- Correspondence: Ahmed Samir, Tel +966 594988779, Email
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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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Corneal endothelial cell density loss following glaucoma surgery alone or in combination with cataract surgery: A systematic review and meta-analysis. Ophthalmology 2022; 129:841-855. [PMID: 35331751 DOI: 10.1016/j.ophtha.2022.03.015] [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: 11/16/2021] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
TOPIC Corneal endothelial cell density (ECD) loss following glaucoma surgery with or without cataract surgery. CLINICAL RELEVANCE Corneal ECD loss may occur due to intraoperative surgical trauma in glaucoma surgery or postoperatively with chronic endothelial cell trauma or irritation. METHODS Trabeculectomy, glaucoma filtration surgery or microinvasive glaucoma surgery in participants with ocular hypertension, primary and secondary open angle glaucoma, normal tension glaucoma and angle-closure glaucoma were included. Pediatric populations and participants with pre-existing corneal disease were excluded. Laser treatments and peripheral iridotomy were excluded. Electronic databases searched in December 2021 included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and The International Prospective Register of Systematic Reviews (PROSPERO), FDA PMA and FDA 510(k). RESULTS 39 studies were included in quantitative synthesis. 12 months following suprachoroidal MIGS mean ECD loss was 282 cells/mm2 (95% Confidence Interval (CI) 220 to 345; p <0.00001; Chi2 = 0.06; I2 = 0%; 2 studies; very low certainty). Mean ECD loss after Schlemm's canal implantable devices was 338 cells/mm2 (95% CI 185 to 491; p<0.0001; Chi2 = 0.08; I2 = 0%; 2 studies; low certainty) at 12 months. When compared to phacoemulsification alone, Schlemm's canal implants combined with phacoemulsification showed statistically significant mean ECD reduction at 24 months; mean difference of ECD was -19% (95% CI -37% to -2%; p=0.03; Chi2 = 3.04; I2 = 34%; 3 studies; low certainty). Mean ECD loss was 64 cells/mm2 (95% CI 21 to 107; p=0.004; Chi2 = 4.55; I2 = 0%; 6 studies; low certainty) following Schlemm's canal procedures (without implantable devices) at 12 months. At 12 months the mean ECD loss after trabeculectomy was 33 cells/mm2 (95% CI -38 to 105, p=0.36, Chi2 = 1.17; I2 = 0%; moderate certainty). At 12 months mean ECD loss was 121 cells/mm2 (95% CI 53 to 189; p=0.0005; Chi2 = 3.00; I2 = 0%; 5 studies; low certainty) after Express implantation. When compared to control fellow eye, aqueous shunt surgery reduced ECD by 5.75% (95% CI -0.93 to 12.43; p=0.09 Chi2 = 1.32; I2 = 0%; low certainty) and 8.11% ECD loss (95%CI 0.06 to 16.16 p=0.05; Chi2= 1.93; I2=48%) at 12 and 24 months, respectively. CONCLUSIONS Overall there is low certainty evidence to suggest that glaucoma surgery involving long-term implants has a greater extent of ECD loss than glaucoma filtration surgeries without the use of implants. The results of this review support long-term follow-up (beyond 36 months) to assess ECD loss and corneal decompensation following implantation of glaucoma drainage implants.
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Combined Phacoemulsification and Ex-PRESS Implant with Everting Suture in Primary Angle-Closure Glaucoma: Survival Analysis and Predictive Factors. J Clin Med 2021; 10:jcm10040774. [PMID: 33671999 PMCID: PMC7919368 DOI: 10.3390/jcm10040774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy and safety of combined phacoemulsification and Ex-PRESS implant with everting suture in primary angle-closure glaucoma (PACG) and to examine predictive factors of failure. Twenty-three eyes of 18 patients were enrolled. Data about time of removal of releasable sutures and traction of the everting suture and about changes in intraocular pressure (IOP) were collected, as well as comprehensive ophthalmic examinations. Success was defined by the following criteria: IOP ≤ 18 mmHg (criterion 1); IOP ≤ 15 mmHg (criterion 2); and IOP ≤ 12 mmHg (criterion 3). Success was categorized as complete or qualified, depending on whether it was reached without or with drugs, respectively. Success rate was assessed with Kaplan–Meier survival analysis with a Cox proportional hazard model to adjust for potential confounders. The lowering of IOP and the reduction of medications were statistically significant at every follow-up visit compared with the baseline (p < 0.05). The complete success rates were 87%, 70%, and 17% accordingly to criterion 1, 2, and 3; the qualified success rates were 93%, 70%, and 20%, respectively. Most of the complications resolved spontaneously and conservatively. In conclusion, combined phacoemulsification and Ex-PRESS Minishunt implant with everting suture is a safe and effective surgery, even in PACG, lowering IOP and number of medications.
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EX-PRESS Glaucoma Filtration Device: Management of Complications. Vision (Basel) 2020; 4:vision4030039. [PMID: 32824320 PMCID: PMC7560153 DOI: 10.3390/vision4030039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/18/2022] Open
Abstract
The EX-PRESS glaucoma filtration device appears to be an effective addition to our options to treat refractory glaucoma. The possibility to create a sclerostomy without tissue excision provides a safe and reliable outflow pathway for aqueous that is standard in size, reducing much of the variability associated with a surgical procedure. Prospective randomized studies comparing EX-PRESS implantation with trabeculectomy show encouraging results. However, complications usually encountered in filtration surgery have been reported, and EX-PRESS implantation can also lead to specific device-related complications. This article reviews the most common complications associated with this procedure.
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Combined Phacoemulsification With Goniosynechialysis Under Ophthalmic Endoscope for Primary Angle-closure Glaucoma After Failed Trabeculectomy. J Glaucoma 2020; 29:941-947. [DOI: 10.1097/ijg.0000000000001579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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