1
|
Ahmed IIK, Sheybani A, De Francesco T, Samuelson TW. Corneal endothelial safety profile in minimally invasive glaucoma surgery. J Cataract Refract Surg 2024; 50:369-377. [PMID: 37988037 PMCID: PMC10959532 DOI: 10.1097/j.jcrs.0000000000001365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/08/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To compare 5-year corneal endothelial safety of 3 minimally invasive glaucoma surgery (MIGS) devices (iStent inject , Hydrus Microstent, CyPass Micro-Stent). SETTING U.S. multicenter trials. DESIGN Post hoc 5-year analysis from prospective randomized single-masked pivotal trials. METHODS Mild to moderate open-angle glaucoma subjects received a MIGS implant with phacoemulsification (implant + phaco) or phaco alone (control). In addition, 5-year end points comparing the implant and control groups included proportion of eyes with significant endothelial cell loss (ECL) (>30% or ≥30% vs baseline) and mean endothelial cell density (ECD). RESULTS Comparable proportions of eyes in the iStent inject + phaco and control groups had significant 60-month ECL (9.4% vs 6.3%, respectively, diff: 3.2%, 95% CI, -5.0% to 11.3%, P = .77). Hydrus (20.8% vs 10.6%, diff: 10.2%, 95% CI, 3.2% to 17.2%, P = .01) and CyPass (27.2% vs 10.0%, diff: 17.2%, 95% CI, 5.6% to 28.7%, P = .02) had more eyes with ECL vs controls (iStent inject 1.49X, Hydrus 1.96X, CyPass 2.72X vs controls). Mean ECD over 60 months for iStent inject was indistinguishable vs control, whereas greater ECL was observed primarily 3 months postoperative (Hydrus) or accelerated after 2 years (CyPass). No iStent inject or Hydrus subjects developed persistent corneal edema, whereas 7 CyPass-implanted eyes developed ECL-related complications. CONCLUSIONS Through 5 years postoperative, there were no differences in proportion of eyes with significant ECL or mean ECD between the iStent inject and control groups. There was greater 5-year ECL and lower ECD in the Hydrus and CyPass groups vs controls. The Hydrus ECL rate mirrored control after 3 months; the CyPass ECL rate accelerated vs control.
Collapse
Affiliation(s)
- Iqbal Ike K. Ahmed
- From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ahmed, Sheybani, De Francesco); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Ahmed); Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri (Sheybani); Clinica de Olhos de Francesco, Fortaleza, Brazil (De Francesco); Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil (De Francesco); Minnesota Eye Consultants, University of Minnesota, Minneapolis, Minnesota (Samuelson)
| | - Arsham Sheybani
- From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ahmed, Sheybani, De Francesco); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Ahmed); Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri (Sheybani); Clinica de Olhos de Francesco, Fortaleza, Brazil (De Francesco); Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil (De Francesco); Minnesota Eye Consultants, University of Minnesota, Minneapolis, Minnesota (Samuelson)
| | - Ticiana De Francesco
- From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ahmed, Sheybani, De Francesco); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Ahmed); Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri (Sheybani); Clinica de Olhos de Francesco, Fortaleza, Brazil (De Francesco); Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil (De Francesco); Minnesota Eye Consultants, University of Minnesota, Minneapolis, Minnesota (Samuelson)
| | - Thomas W. Samuelson
- From the John A. Moran Eye Center, University of Utah, Salt Lake City, Utah (Ahmed, Sheybani, De Francesco); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (Ahmed); Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri (Sheybani); Clinica de Olhos de Francesco, Fortaleza, Brazil (De Francesco); Hospital de Olhos Leiria de Andrade (HOLA), Fortaleza, Brazil (De Francesco); Minnesota Eye Consultants, University of Minnesota, Minneapolis, Minnesota (Samuelson)
| |
Collapse
|
2
|
Coroneo MT, Graterol-Nisi G, Maver E, Gillies RM. Aqueous Humor Circulation in the Era of Minimally Invasive Surgery for Glaucoma. Ann Biomed Eng 2024; 52:898-907. [PMID: 38155316 DOI: 10.1007/s10439-023-03427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
Glaucoma surgery with implantation of aqueous humor draining microstents may compromise long-term corneal health by disrupting aqueous humor circulation. The effect of stent numbers on this circulation was interrogated to determine the number of stents associated with minimal circulation disruption. An in vitro anterior eye model perfusion system was constructed with multiple exit ports. A 3-D model of the anterior eye was imported into ABAQUS CFD, analyzes were carried out for unsteady laminar flow and solved using Navier-Stokes equations. DT Vision Foundry was used to analyze velocity contour plot images. The field variable results output for the CFD model were fluid wall shear, fluid pressure and fluid velocity. In vitro, "aqueous" fluid flow is high through a single stent and "aqueous" stagnation is greatest in the quadrants 180° away. Increasing stent port numbers, results in an exponential decrease in the stagnant flow locations. High wall shear stress was seen in the single stent model and is markedly reduced after a second and subsequent stents are introduced. We identify two factors potentially contributing to corneal compromise post glaucoma drainage surgery: aqueous humor stagnation, remote to the stent site and higher exit flows imparting increased stent exit shear stress (particularly with a single stent). With 4 stents, there is minimal disruption of anterior chamber circulation (mimicking physiological conditions). Furthermore we propose that aqueous humor circulation disruption via the usual single-exit port approach disrupts aqueous humor circulation with long-term consequences for corneal health.
Collapse
Affiliation(s)
- Minas T Coroneo
- Ophthalmic Surgeons, 2 St Pauls St, Randwick, NSW, 2031, Australia.
- Department of Ophthalmology, Prince of Wales Hospital/University of New South Wales, Sydney, Australia.
| | | | - Eric Maver
- Ophthalmic Surgeons, 2 St Pauls St, Randwick, NSW, 2031, Australia
| | - R Mark Gillies
- Medical Device Research Australia Pty Ltd, Sydney, Australia
| |
Collapse
|
3
|
Villarreal E, Berkowitz E, Tiosano B. XEN45 Gel Stent Combined with Healaflow Injectable Viscoelastic Implant. Case Rep Ophthalmol Med 2023; 2023:7096406. [PMID: 38033752 PMCID: PMC10686706 DOI: 10.1155/2023/7096406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/14/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose To introduce a potential solution for failed glaucoma surgeries by proposing an optional surgical procedure in conjunction with the use of Healaflow (Anteis S.A., Geneva, Switzerland) as a spacer, which may potentially reduce the failure rate. Case Presentation. We present the outcomes of a surgical procedure involving the inferonasal implantation of an ab interno XEN gel stent (Allergan, Dublin, Ireland) in a 74-year-old male patient who was experiencing uncontrolled advanced glaucoma in his left eye. It is important to note that the patient had previously undergone several glaucoma surgeries and procedures in the same eye. During this particular procedure, we utilized Healaflow as a spacer by implanting the stent within a subconjunctival Healaflow "bubble." At 6 months postoperatively, intraocular pressure remained on target. There was no need for additional topical medications, and no change in visual acuity was observed. Conclusion For patients with a history of unsuccessful glaucoma surgeries and who are unsuitable candidates for tube shunt procedures or transscleral diode cyclophotocoagulation, an alternative option involves implanting the XEN45 stent in the inferior nasal region in conjunction with the use of subconjunctival Healaflow. This combined approach may provide a potential solution for managing glaucoma in these patients.
Collapse
Affiliation(s)
- Eloy Villarreal
- Department of Ophthalmology, Hillel Yaffe Medical Center Affiliated with the Bruce Rappaport School of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Eran Berkowitz
- Department of Ophthalmology, Hillel Yaffe Medical Center Affiliated with the Bruce Rappaport School of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| | - Beatrice Tiosano
- Department of Ophthalmology, Hillel Yaffe Medical Center Affiliated with the Bruce Rappaport School of Medicine, The Technion-Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
4
|
Wagner IV, Ang B, Checo L, Simsek D, Draper C, Dorairaj S. Spotlight on Schlemm's Canal MicroStent Injection in Patients with Glaucoma. Clin Ophthalmol 2023; 17:1557-1564. [PMID: 37288002 PMCID: PMC10243342 DOI: 10.2147/opth.s388293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) has revolutionized glaucoma care with its favorable safety profile and ability to delay or minimize the need for traditional, bleb-based procedures. Microstent device implantation is a type of angle-based MIGS, which reduces intraocular pressure (IOP) through bypass of the juxtacanalicular trabecular meshwork (TM) and facilitation of aqueous outflow into the Schlemm's canal. Although there are limited microstent devices on the market, multiple studies have evaluated the safety and efficacy of iStent® (Glaukos Corp.), iStent Inject® (Glaukos Corp.), and Hydrus® Microstent (Alcon) in the treatment of mild-to-moderate open-angle glaucoma, with and without concurrent phacoemulsification. This review attempts to provide a comprehensive evaluation of injectable angle-based microstent MIGS devices in the treatment of glaucoma.
Collapse
Affiliation(s)
| | - Bryan Ang
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| | - Derya Simsek
- Department of Ophthalmology, Baskent University Medical School, Ankara, Turkey
| | | | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA
| |
Collapse
|
5
|
Abstract
OBJECTIVE To compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma. METHODS A systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs). RESULTS Forty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures. CONCLUSION Compared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy. PROSPERO REGISTRATION NUMBER CRD42021257852.
Collapse
Affiliation(s)
- Nachuan Luo
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Miaowen Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Meiqi Hao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Ruoxin Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fei Wang
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Wenxiong Zhang
- Department of Thoracic Surgery, The second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
6
|
Sonntag SR, Gniesmer S, Gapeeva A, Offermann KJ, Adelung R, Mishra YK, Cojocaru A, Kaps S, Grisanti S, Grisanti S, Tura A. In Vitro Evaluation of Zinc Oxide Tetrapods as a New Material Component for Glaucoma Implants. Life (Basel) 2022; 12:1805. [DOI: 10.3390/life12111805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/03/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
In our previous study we were able to show that zinc oxide (ZnO) tetrapods inhibit wound healing processes. Therefore, the aim of this study was to test the antiproliferative effect of two types of porous polydimethylsiloxane (PDMS)/ tetrapodal zinc oxide (ZnO-T) materials, as well as their usability for glaucoma implants. To find the best implant material, two different porous PDMS/ZnO-T materials were examined. One consisted of 3D interconnected PDMS coarse-pored foams with protruding ZnO-T particles; the other consisted of fine-pored 3D interconnected ZnO-T networks homogeneously coated by a thin PDMS film in the nanometer range. Fibroblast cell viability was investigated for both materials via MTT dye, and some implant material samples were further processed for electron microscopy. Both PDMS/ZnO-T materials showed reduced cell viability in the MTT staining. Furthermore, the electron microscopy revealed barely any fibroblasts growing on the implant materials. At the surface of the fine-pored implant material, however, fibroblasts could not be observed in the etched control samples without ZnO-T. It was found that post-processing of the material to the final stent diameter was highly challenging and that the fabrication method, therefore, had to be adapted. In conclusion, we were able to demonstrate the antiproliferative potential of the two different PDMS/ZnO-T materials. Furthermore, smaller pore size (in the range of tens of micrometers) in the implant material seems to be preferable.
Collapse
|