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Agnifili L, Figus M, Sacchi M, Oddone F, Villani E, Ferrari G, Posarelli C, Carnevale C, Nucci P, Nubile M, Mastropasqua L. Managing the ocular surface after glaucoma filtration surgery: an orphan topic. Graefes Arch Clin Exp Ophthalmol 2024; 262:2039-2056. [PMID: 38091058 DOI: 10.1007/s00417-023-06333-5] [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: 05/23/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Ocular surface (OS) disorders before glaucoma filtration surgery (GFS) have been considered to play a crucial role influencing the surgical outcome. Conversely, the impact of surgery itself on the OS is almost completely overlooked, though evidence suggest that ocular surface disease (OSD) may be induced in patients by GFS. This review analyzes the determinants involved in the OSD development after GFS, the clinical features and related consequences, the main diagnostic hallmarks, as well as the therapeutic strategies for its management. METHODS The PubMed database was utilized for the literature examination. Keywords that were searched included ocular surface disease, glaucoma filtration surgery, filtration bleb, post-surgical management, and quality of life. RESULTS After GFS, OSD is promoted by peri- and post-operative factors, such as the filtration bleb (FB) development, combined surgical approach with phacoemulsification, the use of antifibrotic agents and the reintroduction of antiglaucoma medications. This particular form of OSD that present similar clinical features to mild to moderate dry eye, can be named as post-glaucoma surgery-OSD (PGS-OSD). PGS-OSD may negatively affect the FB functionality, thus potentially hindering the disease control, and significantly worsen the patient quality of life (QOL). CONCLUSIONS Clinicians are encouraged to routinely include the OS evaluation after GFS and to consider proper management when the occurrence of PGS-OSD worsen the patient's QOL or exert negative effects to the FB functionality. An outline summarizing the main risk factors and the most appropriate therapeutic options to mitigate the PGS-OSD was proposed to support the routine practice.
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Affiliation(s)
- Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Michele Figus
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | | | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Giulio Ferrari
- IRCCS San Raffaele Scientific Institute, Division of Neuroscience, Cornea and Ocular Surface Disease Unit, Eye Repair Lab, Milan, Italy
- Vita-Salute San Raffaele University, Department of Ophthalmology, Milan, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | | | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Mario Nubile
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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Wagner IV, Towne C, Saade MC, Lentz PC, Rashedi A, Vasu P, Boopathiraj N, Checo L, Krambeer C, Miller DD, Dorairaj S. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024; 18:79-85. [PMID: 39144728 PMCID: PMC11320757 DOI: 10.5005/jp-journals-10078-1442] [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: 06/01/2024] [Accepted: 06/25/2024] [Indexed: 08/16/2024] Open
Abstract
Aim To review the published literature evaluating the safety and efficacy outcomes of canaloplasty performed in the treatment of glaucoma. Background Canaloplasty is a nonpenetrating glaucoma procedure involving combined 360° circumnavigation and viscodilation of Schlemm's canal. The procedure may be performed under an ab externo (with tensioning suture) or ab-interno (conjunctiva-sparing) approach. Given the wide variety of glaucoma procedure types and approaches, further investigation into the role of canaloplasty in ophthalmological practice is warranted. The objectives of this narrative review are to synthesize the existing literature in order to investigate indications, safety and efficacy outcomes, and the optimal place of canaloplasty in glaucoma treatment and management. Review of results A total of 60 articles were included in this review. Both ab externo and ab-interno canaloplasty (ABiC) were found to be significantly effective at reducing intraocular pressure (IOP) and glaucoma medication burdens in patients with mild-to-moderate open-angle glaucoma (OAG). These findings remained consistent regardless of phacoemulsification status. ABiC was found to exhibit a safety profile favorable compared to trabeculectomy and comparable to minimally invasive trabecular bypass implants. Conclusion Canaloplasty is a nonpenetrating surgical intervention that is highly effective in treating patients with mild-to-moderate OAG across a large variety of clinical scenarios. Clinical significance These findings support the clinical use of canaloplasty in ophthalmological practice, clarify its patient profile, and compare procedural outcomes to other minimally invasive glaucoma surgery (MIGS) devices on the market. How to cite this article Wagner IV, Towne C, Saade MC, et al. A Review of Canaloplasty in the Treatment and Management of Glaucoma. J Curr Glaucoma Pract 2024;18(2):79-85.
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Affiliation(s)
- Isabella V Wagner
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Caleb Towne
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Marie C Saade
- Department of Nephrology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - P Connor Lentz
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Arianna Rashedi
- Department of Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, United States of America
| | - Pranav Vasu
- Department of Medicine, Creighton School of Medicine, Phoenix, Arizona, United States of America
| | - Nithya Boopathiraj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Leticia Checo
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Chelsey Krambeer
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Darby D Miller
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, United States of America
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Prasad M, Goodman D, Xu J, Gutta S, Zubieta D, Alluri S, Siegel NH, Peeler CE, Lee HJ, Cabral HJ, Subramanian ML. Long-Term Satisfaction of Oral Sedation versus Standard-of-Care Intravenous Sedation for Ocular Surgery. Clin Ophthalmol 2024; 18:735-742. [PMID: 38476357 PMCID: PMC10929550 DOI: 10.2147/opth.s444999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose Long-term patient satisfaction may influence patients' perspectives of the quality of care and their relationship with their providers. This is a follow up to a comparative effectiveness study investigating oral to intravenous sedation (OIV study). The OIV study found that oral sedation was noninferior in patient satisfaction to standard intravenous (IV) sedation for anterior segment and vitreoretinal surgeries. This study aims to determine if patient satisfaction with oral sedation remained noninferior long term. Patients and Methods Patients were re-interviewed using the same satisfaction survey given during the OIV study. Statistical analysis involved t-tests for noninferiority of the long-term mean satisfaction score of oral and IV sedation. We also compared the original mean satisfaction score and the follow-up mean satisfaction score for each type of sedation and for both groups combined. Results Participants were interviewed at a median of 1225.5 days (range 754-1675 days) from their surgery. The original mean satisfaction score was 5.26 ± 0.79 for the oral treatment group (n = 52) and 5.27 ± 0.64 for the intravenous treatment group (n = 46), demonstrating noninferiority with a difference in mean satisfaction score of 0.015 (p < 0.0001). The follow-up mean satisfaction score was 5.23 ± 0.90 for oral sedation and 5.60 ± 0.61 for IV sedation, with a difference in the mean satisfaction score of 0.371 (p = 0.2071). Satisfaction scores did not differ between the original mean satisfaction score and the follow-up mean satisfaction score for the oral treatment group alone (p = 0.8367), but scores in the intravenous treatment group increased longitudinally (p = 0.0004). Conclusion In this study, long-term patient satisfaction with oral sedation was not noninferior to satisfaction with IV sedation, unlike our findings with short-term patient satisfaction in our original study. Patient satisfaction also remained unchanged over time for the oral treatment group, but patients in the intravenous treatment group reported higher long-term satisfaction with their anesthesia experience compared to the immediate post-operative period.
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Affiliation(s)
- Minali Prasad
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Deniz Goodman
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jia Xu
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Sanhit Gutta
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Daniella Zubieta
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | | | - Nicole H Siegel
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Crandall E Peeler
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Hyunjoo J Lee
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
| | - Howard J Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Manju L Subramanian
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Ophthalmology, Boston Medical Center, Boston, MA, USA
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Oduneye FC, Musa KO, Agboola SA, Idowu OO, Onakoya AO. The Quality of Life of Medically Versus Surgically Treated Primary Open-angle Glaucoma Patients at a Nigerian Hospital. Middle East Afr J Ophthalmol 2022; 29:7-14. [PMID: 36685343 PMCID: PMC9846962 DOI: 10.4103/meajo.meajo_146_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/15/2022] [Accepted: 10/25/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The purpose of this study is to compare the quality of life (QoL) of medically treated versus surgically treated primary open-angle glaucoma (POAG) patients attending Lagos University Teaching Hospital, Lagos, Nigeria. METHODS The study was a hospital-based, comparative cross-sectional study. Consecutive consenting POAG participants who met the inclusion criteria were recruited until the sample size was achieved. QoL of all participants was assessed using the glaucoma QoL-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) questionnaires. Analysis was done using the IBM statistical package for the social sciences version 25.0. RESULTS The study involved 81 participants who were only on medical treatment for POAG and 81 age- and sex-matched POAG participants who had trabeculectomy surgery. Surgically treated participants had a lower mean intraocular pressure 11.68 mmHg when compared to the medically treated participants 14.82 mmHg. Medically treated participants however had a better overall mean glaucoma QoL using the glaucoma QoL-15 (medical 34.36 ± 10.4, surgical 39.11 ± 13.9 P = 0.015) and NEI-VFQ-25 questionnaires (medical 68.32 ± 15.0, surgical 62.44 ± 18.8 P = 0.029). Controlling for the severity of glaucoma using the glaucoma QoL-15 questionnaire, medically treated participants had a better QoL only among participants with severe POAG (medical 49.13 ± 5.9, surgical 54.06 ± 4.6 P = 0.003). While using the NEI-VFQ-25 questionnaire, medically treated participants had a significantly better QoL only among participants with moderate (medical 74.70 ± 6.6, surgical 67.07 ± 15.6 P = 0.012) and severe POAG (medical 54.52 ± 6.3, surgical 45.51 ± 10.0 P = 0.004). CONCLUSION The study demonstrated that although participants that had trabeculectomy had a lower mean intraocular pressure, their overall mean QoL was reduced compared to the medically treated participants.
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Affiliation(s)
- Femi C. Oduneye
- Department of Ophthalmology, Prince Abdulaziz Bin Musaad Hospital, Arar, Northern Border region, Saudi Arabia,Address for correspondence: Dr. Femi C. Oduneye, Prince Abdulaziz Bin Musaad Hospital, Arar, Northern Border, Saudi Arabia. E-mail:
| | - Kareem O. Musa
- Department of Ophthalmology (Guinness Eye Centre), Lagos University Teaching Hospital, College of Medicine of the University of Lagos, Lagos, Nigeria
| | - Sefinat A. Agboola
- Department of Ophthalmology (Guinness Eye Centre), Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatobi O. Idowu
- Product Development Clinical Science, Genentech Inc. South San Francisco, CA, USA
| | - Adeola O. Onakoya
- Department of Ophthalmology (Guinness Eye Centre), Lagos University Teaching Hospital, College of Medicine of the University of Lagos, Lagos, Nigeria
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Szurman P, Klabe K. [Modifications of canaloplasty : Strong pressure-lowering effect with a low risk profile]. DIE OPHTHALMOLOGIE 2022; 119:989-999. [PMID: 35925330 DOI: 10.1007/s00347-022-01661-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Trabeculectomy still achieves the strongest intraocular pressure (IOP) reduction of all glaucoma surgical techniques, but with the drawback of a significant risk profile. Against this background, canaloplasty has established itself as a much gentler alternative which achieves sufficient IOP reduction and enables a significant reduction in postoperative glaucoma medication. However, approximately half of patients are not completely medication free. In response, a number of modifications have been developed with the goal of further enhancing the IOP-lowering effect of canaloplasty, but without the risk of serious complications. By combining canaloplasty with the newly developed suprachoroidal drainage, a uveoscleral drainage is created in addition to the trabecular outflow improvement, which seems to have an additive effect. Thus, for the first time, an IOP-lowering effect comparable to successful trabeculectomy can be achieved. Numerous other modifications with implants also enhance the potential of canaloplasty or offer other additional benefits such as the possibility of telemetric IOP self-measurement by the patient. The additional creation of a subconjunctival drainage with or without use of cytostatic drugs also seems promising. Ab interno procedures, on the other hand, have limited pressure-lowering potential but may provide some additional benefit in mild glaucoma and in the setting of cataract surgery.
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Affiliation(s)
- Peter Szurman
- Augenklinik Sulzbach, Knappschaftsklinikum Saar, An der Klinik 10, 66280, Sulzbach, Deutschland.
- Klaus Heimann Eye Research Institute (KHERI), Sulzbach, Deutschland.
| | - Karsten Klabe
- Breyer Kaymak Klabe Augenchirurgie, Düsseldorf, Deutschland
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6
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Strzalkowska A, Dietlein T, Erb C, Hoffmann EM. [Why trabeculectomy is better than its reputation]. DIE OPHTHALMOLOGIE 2022; 119:1000-1005. [PMID: 36074170 DOI: 10.1007/s00347-022-01720-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Trabeculectomy (TE) remains one of the most frequently performed glaucoma procedures. This surgery enables sufficient reduction of intraocular pressure (IOP) and freedom from using eye drops; however, complication management and time-consuming postoperative care make many ophthalmic surgeons reluctant to include TE in their treatment regimen. AIM This review presents the value of TE compared to other forms of filtering and nonfiltering glaucoma surgery. CONCLUSION The use of TE is still the most effective method for lowering IOP and in comparison to other forms of glaucoma surgery in most cases enables freedom from eye drops with a subsequent high quality of life. Postoperative complications occur more frequently, but usually heal spontaneously or can be treated adequately and safely by surgery; however, TE requires intensive postoperative care, which should not be neglected. Repeated surgery due to insufficient IOP reduction is less frequent compared to other forms of glaucoma surgery.
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Affiliation(s)
- Alicja Strzalkowska
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - Thomas Dietlein
- Medizinische Fakultät und Uniklinik Köln, Zentrum für Augenheilkunde, Universität zu Köln, Köln, Deutschland
| | - Carl Erb
- Augenklinik Wittenbergplatz, Kleiststr. 23-26, 10787, Berlin, Deutschland
| | - Esther M Hoffmann
- Augenklinik und Poliklinik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität, Langenbeckstr. 1, 55131, Mainz, Deutschland.
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Pahljina C, Sarny S, Hoeflechner L, Falb T, Schliessleder G, Lindner M, Ivastinovic D, Mansouri K, Lindner E. Glaucoma Medication and Quality of Life after Phacoemulsification Combined with a Xen Gel Stent. J Clin Med 2022; 11:jcm11123450. [PMID: 35743517 PMCID: PMC9225126 DOI: 10.3390/jcm11123450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/30/2022] [Accepted: 06/12/2022] [Indexed: 02/06/2023] Open
Abstract
Glaucoma has a significant impact on quality of life. Here, we aimed to evaluate the influence of a reduction in glaucoma medications on quality of life and patient satisfaction after phacoemulsification combined with the Xen gel stent. We carried out a cross-sectional survey of patients who underwent phacoemulsification with the Xen gel stent at the Medical University of Graz, Austria. Quality of life was assessed using the German version of the Glaucoma Symptoms Scale (GSS)—questionnaire. Patients were also asked whether the operation reduced glaucoma medications and to indicate their overall satisfaction from 1 (totally discontented) up to 10 (totally contented). Questionnaires of 80 patients were evaluated. A total of 36 patients (45.0%) reported a reduction in glaucoma medications. Three items of the GSS were significantly better in patients who needed fewer glaucoma medications after the operation (“hard to see in daylight”, 75.0 ± 31.1 vs. 57.7 ± 39.1, p = 0.035; “hard to see in dark places”, 81.1 ± 28.7 vs. 54.9 ± 41.2, p = 0.002; and “halos around lights”, 88.3 ± 25.9 vs. 68.8 ± 38.6, p = 0.002). Patient satisfaction was significantly higher when the procedure led to a reduction in glaucoma medication (8.3 ± 2.0 vs. 6.8 ± 3.1; p = 0.034). The reported quality of life and patient satisfaction were significantly better when phacoemulsification with the Xen gel stent reduced the number of glaucoma medications needed.
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Affiliation(s)
- Christian Pahljina
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Stephanie Sarny
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Lukas Hoeflechner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Thomas Falb
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Gernot Schliessleder
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Marlene Lindner
- Department of Dentistry, Medical University Graz, 8036 Graz, Austria;
| | - Domagoj Ivastinovic
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, 1006 Lausanne, Switzerland;
| | - Ewald Lindner
- Department of Ophthalmology, Medical University Graz, 8036 Graz, Austria; (C.P.); (S.S.); (L.H.); (T.F.); (G.S.); (D.I.)
- Correspondence:
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Toneatto G, Zeppieri M, Papa V, Rizzi L, Salati C, Gabai A, Brusini P. 360° Ab-Interno Schlemm's Canal Viscodilation with OMNI Viscosurgical Systems for Open-Angle Glaucoma-Midterm Results. J Clin Med 2022; 11:jcm11010259. [PMID: 35012000 PMCID: PMC8745878 DOI: 10.3390/jcm11010259] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/06/2021] [Accepted: 12/29/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose: To evaluate the effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) performed with OMNI viscosurgical system in open angle glaucoma (OAG) together or not with phacoemulsification. Setting: Two surgical sites. Design: Retrospective, observational. Methods: Eighty eyes from 73 patients with mild to moderate OAG underwent ab- interno SC viscodilation performed with OMNI system. Fifty eyes (Group 1) underwent only SC viscodilation, while 30 eyes (Group 2) underwent glaucoma surgery + cataract extraction. Primary success endpoint at 12 months was an intraocular pressure (IOP) reduction higher than 25% from baseline with an absolute value of 18 mmHg or lower, either on the same number or fewer ocular hypotensive medications, without further interventions. Secondary effectiveness endpoints included mean IOP, number of medications and comparison of outcomes between groups. Safety endpoints consisted of best-corrected visual acuity (BCVA), adverse events (AEs), and subsequent surgical procedures. Results: Primary success was achieved in 40.0% and 67.9% in Groups 1 and 2, respectively. Mean IOP at 12-month follow-up showed a significant reduction in both groups (from 23.0 to 15.6 mmHg, p < 0.001, and from 21.5 to 14.1, p < 0.001, in Groups 1 and 2, respectively). Mean medication number decreased in both groups (from 3.0 to 2.0, p < 0.001 and from 3.4 to 1.9, p < 0.001, in Groups 1 and 2, respectively). AEs included hyphema (2 eyes), mild hypotony (4 eyes), IOP spikes one month after surgery (1 eye). Twelve eyes (15.0%) required subsequent surgical procedures. No BCVA reduction was observed. Conclusions: Viscodilation of SC using OMNI viscosurgical systems is safe and relatively effective in reducing IOP in adult patients with OAG.
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Affiliation(s)
- Giacomo Toneatto
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy; (G.T.); (C.S.); (A.G.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy; (G.T.); (C.S.); (A.G.)
- Correspondence: ; Tel.: +43-255-2743
| | - Veronica Papa
- Department of Ophthalmology, Policlinico “Città di Udine”, 33100 Udine, Italy; (V.P.); (P.B.)
| | - Laura Rizzi
- Department of Economics and Statistics, University of Udine, 33100 Udine, Italy;
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy; (G.T.); (C.S.); (A.G.)
| | - Andrea Gabai
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy; (G.T.); (C.S.); (A.G.)
| | - Paolo Brusini
- Department of Ophthalmology, Policlinico “Città di Udine”, 33100 Udine, Italy; (V.P.); (P.B.)
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9
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Volzhanin AV, Petrov SY, Safonova DM, Averich VV. [On refraction shift after trabeculectomy]. Vestn Oftalmol 2022; 138:147-155. [PMID: 36287149 DOI: 10.17116/oftalma2022138052147] [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] [Indexed: 06/16/2023]
Abstract
PURPOSE To determine the factors affecting the shift of refraction after trabeculectomy. MATERIAL AND METHODS The study included 42 patients who were examined prior to trabeculectomy and at the following timepoints: 1 week, 1 month and 3 months after surgery. Examination included tonometry with assessment of corneal biomechanical properties, keratorefractometry with vector analysis, and biometry. The obtained data was processed for regression analysis and to find the possible correlations. RESULTS All significant correlations between the measured parameters only occur on week 1. Postoperative spherical component of refraction (sphere) correlates negatively both with preoperative axial length (AL) and anterior chamber depth (ACD) (r=-0.699 and r=-0.458, p<0.05) and postoperative AL and ACD (r= -0.767 and r= -0.415, p<0.011). Dependence of sphere on AL is also expressed as a regression model. The magnitude of AL change depends on the magnitude of intraocular pressure (IOP) change (r=0.729, p<0.0001) and correlates negatively with postoperative IOP (r=-0.454, p=0.009) and baseline corneal hysteresis (CH; r= -0.482, p=0.009). Dependence of AL on IOP is also expressed as a regression model. The magnitudes of sphere and cylinder shifts correlate negatively with each other (r=-0.416, p=0.038). Keratometry reveals that the overall cylinder value correlates with the corneal cylinder, and so do the magnitudes of their shifts (r=0.589 and r=0.574, p<0.0001). Dependence of corneal hysteresis on IOP is expressed as a regression model; however, neither tonometric nor biomechanical corneal properties correlate with refraction. CONCLUSIONS Sphere correlates negatively with AL and ACD. In turn, AL is related to the reduction in IOP. This dependence is likely the most important one for the refraction shift after trabeculectomy. No correlations were found for the change of astigmatism.
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Affiliation(s)
| | - S Yu Petrov
- Research Institute of Eye Diseases, Moscow, Russia
| | - D M Safonova
- Research Institute of Eye Diseases, Moscow, Russia
| | - V V Averich
- Research Institute of Eye Diseases, Moscow, Russia
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10
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Byszewska A, Konopińska J, Kicińska AK, Mariak Z, Rękas M. Canaloplasty in the Treatment of Primary Open-Angle Glaucoma: Patient Selection and Perspectives. Clin Ophthalmol 2019; 13:2617-2629. [PMID: 32021062 PMCID: PMC6948200 DOI: 10.2147/opth.s155057] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023] Open
Abstract
Canaloplasty is a surgical procedure that has undergone a number of developments since its introduction in 2005. Many thousands of canaloplasties have been performed around the world since then and is, by definition, a blebless procedure. It does not necessitate the use of any antifibrotic agents and results in safe and effective IOP reductions in patients with open-angle glaucoma (OAG) with minimal complications and no bleb-related adverse events. When considering the surgical management of patients with early and medium stages of the disease, canaloplasty can be considered as a first line option. This paper will overview the theoretical effectiveness of canal surgery, the fundamental aspects of aqueous outflow resistance with particular emphasis on the role of the trabecular meshwork, Schlemm's canal, and the collector channels, and the methods available for the clinical evaluation of the outflow pathways in relation to the ocular anatomy. Further, the paper will detail the surgical technique itself and how this has developed over time together with the clinical aspects that should be accounted for when selecting patients for this surgery.
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Affiliation(s)
- Anna Byszewska
- Department of Ophthalmology, Military Institute of Medicine, Warsaw 04-141, Poland
| | - Joanna Konopińska
- Department of Ophthalmology, Medical University of Białystok, Białystok 15-276, Poland
| | | | - Zofia Mariak
- Department of Ophthalmology, Medical University of Białystok, Białystok 15-276, Poland
| | - Marek Rękas
- Department of Ophthalmology, Military Institute of Medicine, Warsaw 04-141, Poland
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Zhang J, Wang NL. Progression on canaloplasty for primary open angle glaucoma. Int J Ophthalmol 2019; 12:1629-1633. [PMID: 31637200 DOI: 10.18240/ijo.2019.10.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
Abstract
As a non-penetrating glaucoma surgery (NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm's canal. Ab interno canaloplasty (ABiC), which can reconstruct the natural outflow pathways of aqueous humor in mild-to-moderate primary open angle glaucoma (POAG) patients, is a new minimally invasive glaucoma surgery (MIGS) procedure improving from traditional canaloplasty. Canaloplasty can reduce intraocular pressure (IOP) with high efficiency and security. There are no complications such as scar formation and encapsulation for this no-bleb canaloplasty.
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Affiliation(s)
- Jun Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China.,Dalian Aier Eye Hospital, Dalian 116031, Liaoning Province, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
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Danielewska ME, Kicińska AK, Placek MM, Lewczuk K, Rękas M. Changes in spectral parameters of corneal pulse following canaloplasty. Graefes Arch Clin Exp Ophthalmol 2019; 257:2449-2459. [PMID: 31377849 DOI: 10.1007/s00417-019-04433-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To ascertain whether changes in the spectral content of the corneal pulse (CP) signal, measured in vivo in primary open-angle glaucoma (POAG) patients, indirectly reflect changes in corneal biomechanics after canaloplasty. METHODS Fifteen eyes of 15 POAG patients who underwent canaloplasty combined with phacoemulsification were enrolled. Standard ophthalmic examinations were conducted before washout, pre-operatively, at days 1, 7, and 1, 3, 6, and 12 months after surgery. Non-contact measurements of the CP signal were performed at pre-washout, pre-operatively, and at 3, 6, and 12 months post-operatively. Then, amplitudes of the CP first five harmonics associated with the heart rate were estimated. Temporal changes of all considered parameters were tested at a Bonferroni-adjusted significance level set to 0.005. RESULTS A decrease in the amplitude of the first harmonic and an increase in the normalized amplitude of the third harmonic (ACP3n) of the CP signal were noticed between the pre-washout and the pre-operative stages (p = 0.003 and p = 0.004, respectively). This corresponds to an increase in median intraocular pressure (IOP) values by 6.0 mmHg (p = 0.0045). After surgery, ACP3n reached the highest value at 3 months post-operatively, compared with pre-washout level (p = 0.0045). CONCLUSIONS Alterations in corneoscleral stiffness caused by surgery are reflected in changes in the ACP3n value. Hence, post-operative corneal biomechanics could be monitored indirectly by this supporting indicator that can be used to estimate the time at which measures of IOP are no longer biased by the changed cornea boundary conditions caused by canaloplasty. CLINICAL TRIALS REGISTRATION NCT02908633.
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Affiliation(s)
- Monika E Danielewska
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370, Wrocław, Poland.
| | - Aleksandra K Kicińska
- Department of Ophthalmology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland
| | - Michał M Placek
- Department of Biomedical Engineering, Faculty of Fundamental Problems of Technology, Wrocław University of Science and Technology, Wybrzeże Wyspiańskiego 27, 50-370, Wrocław, Poland
| | - Katarzyna Lewczuk
- Department of Ophthalmology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland
| | - Marek Rękas
- Department of Ophthalmology, Military Institute of Medicine, ul. Szaserów 128, 04-141, Warsaw, Poland
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Ondrejka S, Körber N. 360° ab-interno Schlemm's canal viscodilation in primary open-angle glaucoma. Clin Ophthalmol 2019; 13:1235-1246. [PMID: 31409962 PMCID: PMC6645607 DOI: 10.2147/opth.s203917] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/09/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the safety and effectiveness of ab-interno microcatheterization and 360° viscodilation of Schlemm’s canal (SC) using the VISCO360® Viscosurgical System in treatment of primary open angle glaucoma (POAG). Setting: Surgical center (Augencentrum Köln, Köln, Germany). Design: Retrospective analysis of 106 eyes from 71 consecutive patients. Methods: Ab-interno canal viscodilation (VISCO360®) with or without cataract extraction was performed in two groups of patients with mild-moderate POAG: Group 1 had a baseline intraocular pressure (IOP) ≥18 mmHg (n=72 eyes) and Group 2 had a baseline IOP <18 mmHg (n=34 eyes). IOP without washout was measured and number of IOP-lowering medications were documented at all visits. Effectiveness was determined by reduction in IOP and reduction in the number of IOP-lowering medications at 12±3 months from baseline. Safety was determined by the rate of adverse events (AEs) and secondary surgical interventions (SSI). Results: In Group 1, all eyes available at 12±3 months (n=72), had a 41.0% reduction in mean IOP (from 24.6±7.1 mmHg to 14.6±2.8 mmHg), 87% (n=62) of which showed an IOP reduction of ≥20% with no increase in IOP-lowering medications. In Group 2, all eyes (n=34) maintained their baseline IOP at all postoperative visits. In both groups, a significant decrease (>89%) in mean number of IOP-lowering medications was seen at 12 months with 86% of eyes completely off medication with no increase in IOP. The most common AE seen was hyphema (13%) and no eye required SSI during the study period. Conclusion: Ab-interno SC viscodilation (VISCO360) is safe and effective in lowering IOP and reducing hypotensive medications in patients with OAG.
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Affiliation(s)
| | - Norbert Körber
- Augencentrum Köln , Köln, Germany.,Eye Clinic, University Eye Hospital, Padova, Italy
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Körber N. Ab interno canaloplasty for the treatment of glaucoma: a case series study. SPEKTRUM DER AUGENHEILKUNDE 2018; 32:223-227. [PMID: 30595621 PMCID: PMC6280802 DOI: 10.1007/s00717-018-0416-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
Purpose To describe and evaluate the efficacy of ab interno canaloplasty (ABiC) in patients with primary open-angle glaucoma (POAG). Methods This single-center consecutive case series study included patients with cataract and open-angle glaucoma (combined procedure) and pseudophakic patients (mean age, 76 years; range, 66–83 years) with POAG who underwent ABiC using the iTrack™ 250-μm microcatheter (Ellex Medical Lasers Pty Ltd, Adelaide, Australia) to circumferentially viscodilate and intubate Schlemm’s canal without placement of a tensioning suture. The primary endpoints were mean intraocular pressure (IOP) and mean number of glaucoma medications at 1, 3, 6, 9, and 12 months postoperatively. Results In total, 20 patients (20 eyes) were enrolled in the study. Mean IOP reduced from 18.5 ± 3.44 mm Hg preoperatively to 14.88 ± 2.82 mm Hg (n = 17), 13.80 ± 2.05 (n = 12), 14.57 ± 2.59 mm Hg (n = 9) and 15.47 ± 2.42 (n = 6) at 1, 3, 6 and 9 months postoperatively. The 12‑month data for two patients showed that IOP had reduced from 17 mm Hg preoperatively to 16 mm Hg in one patient and from 20 mm Hg to 13 mm Hg in the other patient. The mean number of medications was reduced from 2.4 preoperatively to 0.25 at the last follow-up visit. There was one reported complication of limited descemetolysis near the limbus by the viscoelastic during the dilatation of Schlemm’s canal. No adverse events as a result of the device were reported. Conclusions ABiC was straightforward to perform in this group of patients with minimal complications. Although initial findings from this study indicate that ABiC is comparable to conventional canaloplasty in lowering IOP and medication dependency, long-term follow-up in a large patient cohort is required to confirm the efficacy of this minimally invasive glaucoma procedure.
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Affiliation(s)
- Norbert Körber
- Augencentrum Köln-Porz, Josefstraße 14, 51143 Cologne, Germany
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Canaloplasty versus Nonpenetrating Deep Sclerectomy: 2-Year Results and Quality of Life Assessment. J Ophthalmol 2018; 2018:2347593. [PMID: 29682338 PMCID: PMC5845501 DOI: 10.1155/2018/2347593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 01/24/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose To compare phacocanaloplasty (PC) and phaco-non-penetrating deep sclerectomy (PDS). Methods 75 patients with uncontrolled glaucoma and cataract were randomized for PC (37 eyes) or PDS (38 eyes). Intraocular pressure (IOP) and number of medications (meds) were prospectively evaluated. Follow-up examinations were performed on days 1 and 7 and after 1, 3, 6, 12, 18, and 24 months. Surgical success was calculated. Complications and postoperative interventions were noted. Quality of life (QoL) was analyzed. Results Preoperatively, mean IOP and meds were comparable (P > 0.05). After 24 months, IOP significantly decreased in PC from 19.4 ± 5.9 mmHg (2.6 ± 0.9 meds) to 13.8 ± 3.3 mmHg (0.5 ± 0.9 meds) and in PDS from 19.7 ± 5.4 mmHg (2.9 ± 0.9 meds) to 15.1 ± 2.9 mmHg (1.1 ± 1.2 meds). Statistically lower IOP was observed in PC in the 6th month and persisted until 24 months (P < 0.05). No difference was found in meds (except for month 18, in which less drugs were used in PC (P = 0.001)) or success rates (P > 0.05). The most frequent complication in PC was transient hyphema (46%), in PDS bleb fibrosis (24%). PC patients during postoperative period required only goniopuncture (22% of subjects), whereas PDS patients required, in order to maintain subconjuctival outflow, subconjunctival 5-fluorouracil injections in 95% of cases (median = 3), suture lysis (34%), needling (24%), and goniopuncture (37%). NEI VFQ-25 mean composite score for PC was 78.04 ± 24.36 points and for PDS 74.29 ± 24.45 (P = 0.136). α Cronbach's correlation coefficient was 0.913. Conclusions PC leads to a more effective decrease in IOP than PDS in midterm observation with similar safety profiles. PDS patients required a vast number of additional procedures in contrast to PC patients, but this fact did not influence QoL.
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Khaimi MA. A retrospective analysis of the use of loteprednol etabonate ophthalmic suspension 0.5% following canaloplasty. Clin Ophthalmol 2018; 12:319-329. [PMID: 29491705 PMCID: PMC5815503 DOI: 10.2147/opth.s153912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background While loteprednol etabonate (LE) suspension 0.5% is approved for the treatment of postoperative ocular inflammation, there have been no reported studies of its use in glaucoma patients undergoing canaloplasty. Methods This was a retrospective medical chart review conducted at a single US center. Data were collected on patients with glaucoma who underwent canaloplasty with or without cataract surgery, and were prescribed LE suspension 0.5% postoperatively. Outcomes evaluated included postsurgical inflammation (anterior chamber [AC] cells and flare), intraocular pressure (IOP), number of IOP-lowering medications, and postsurgical complications. Results Data were collected on 204 patients (262 eyes) with a mean (SD) age of 71.6 (11.3) years. The most frequent LE dosing regimens at day 1, week 1, and month 1 postsurgery were QID (92.3%; 241/261), TID (52.6%; 133/253), and QD (65.5%; 78/119), respectively. Inflammation (AC flare and cells), mostly mild, was noted in 33.2% (86/259) of eyes on postoperative day 1 and 8.6% (21/244) of eyes at month 1. Mean IOP and mean number of IOP-lowering medications were significantly reduced from baseline (P<0.001) at all time points postoperatively. Complete (no IOP-lowering medication) or qualified (use of ≤2 IOP-lowering medications) surgical success was achieved in 78.8% and 90.6% of eyes, respectively, at month 6 and 63.4% and 92.7% of eyes at month 36. The most frequently observed postoperative complication was hyphema in 48.7% (126/259) eyes at day 1, which decreased to 0.4% (1/244) of eyes by month 1. IOP ≥30 mmHg was noted in 13 (5.3%) eyes at postoperative week 1 and rarely thereafter, and no patient discontinued therapy because of an IOP increase. Conclusion These real-world data suggest that canaloplasty with or without cataract surgery managed postoperatively with LE suspension 0.5% is effective and safe in the glaucoma patient.
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Szurman P, Januschowski K, Boden KT, Seuthe AM. Suprachoroidal drainage with collagen sheet implant- a novel technique for non-penetrating glaucoma surgery. Graefes Arch Clin Exp Ophthalmol 2017; 256:381-385. [DOI: 10.1007/s00417-017-3873-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/11/2017] [Accepted: 12/11/2017] [Indexed: 10/18/2022] Open
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Mursch-Edlmayr AS, Mojon DS, Ring M, Laubichler P, Luft N, Priglinger SG. Comparison of deep sclerokeratodissection, a new variant of nonpenetrating glaucoma surgery, with deep sclerectomy. Indian J Ophthalmol 2017; 64:914-918. [PMID: 28112133 PMCID: PMC5322707 DOI: 10.4103/0301-4738.198863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the safety and efficacy of deep sclerokeratodissection (DSKD), a new nonpenetrating technique in glaucoma surgery. MATERIALS AND METHODS Retrospective comparison between patients treated with DSKS or deep sclerectomy (DS) between 2013 and 2014. In DSKD, the first and only flap is dissected directly into clear cornea with unroofing Schlemm's canal. Beside routine clinical follow-up (visual acuity, intraocular pressure [IOP] readings, slit lamp and fundus examination), postoperative ultrasound biomicroscopy (UBM) investigation and quality of life (QoL) assessment were performed. Statistically significant differences were determined by parametric or nonparametric tests, depending on normality. RESULTS Twelve (38.7%) DSKDs and 19 (61.3%) conventional DS' were included in this analysis. IOP decreased significantly from 21.5 ± 9.2 mmHg to 6.2 ± 5.4 mmHg on day 1, 13.4 ± 7.7 at 1 month, 12.0 ± 4.1 at 3 months, 12.5 ± 3.1 mmHg at 6 months, and 13.4 ± 4.3 mmHg at 12 months (P < 0.01). No significant difference in the IOP was observed between the two groups at any follow-up (P > 0.1). There was no significant difference in intra- and post-operative complications, the morphology of the surgical site in the UBM as well as in the QoL assessment. CONCLUSION The results indicate that DSKD is a safe and efficient new variant of nonpenetrating glaucoma surgery. IOP can be lowered as effectively compared to conventional DS, with a similarly low rate of complications. Further reports are necessary to confirm these results.
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Affiliation(s)
- Anna Sophie Mursch-Edlmayr
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University; Ars Ophthalmica Study Center, General Hospital (AKH), Linz, Austria
| | - Daniel S Mojon
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University, Linz, Austria; Airport Medical Center Eye Clinic, Zürich, Switzerland
| | - Michael Ring
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University; Ars Ophthalmica Study Center, General Hospital (AKH), Linz, Austria
| | - Peter Laubichler
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University, Linz, Austria
| | - Nikolaus Luft
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University; Ars Ophthalmica Study Center, General Hospital (AKH), Linz, Austria
| | - Siegfried Georg Priglinger
- Department of Ophthalmology, General Hospital (AKH), Johannes Kepler University; Ars Ophthalmica Study Center, General Hospital (AKH), Linz, Austria; Department of Ophthalmology, Ludwig Maximilian University, Munich, Germany
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Zhang B, Kang J, Chen X. A System Review and Meta-Analysis of Canaloplasty Outcomes in Glaucoma Treatment in Comparison with Trabeculectomy. J Ophthalmol 2017; 2017:2723761. [PMID: 28540081 PMCID: PMC5429958 DOI: 10.1155/2017/2723761] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/01/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose. This system review studied the efficiency and safety of canaloplasty (CP) and compared the outcomes between CP and trabeculectomy (TE). Methods. Literatures were searched in PubMed and EMBASE. The meta-analysis was conducted on the postoperative outcomes in CP and then on the differences of outcomes between CP and TE. Results. In the meta-analysis, IOP decreased by 9.94 (95% CI 8.42 to 11.45) mmHg with an average AGM reduction of 2.11 (95% CI 1.80 to 2.42) one year after CP. The IOP reduction was significantly higher after TE than after CP, with an average difference of 3.61 (95% CI 1.69 to 5.53) mmHg at 12 months postoperationally. For complications, the incidence of hyphema was significantly higher in CP and the Descemet membrane detachment was just reported in CP, with an incidence of 3%. However, the incidence was significantly lower in CP of hypotony and of choroidal effusion/detachment. Meanwhile, suprachoroidal hemorrhage and bleb needling were only reported in TE. Conclusions. CP was less effective in IOP reduction than TE, but CP was able to achieve similar postoperative success rates and reduce the number of AGMs likewise. CP was also associated with lower incidence of complications. More high-quality researches are needed in the future to verify our findings in this system review.
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Affiliation(s)
- Bing Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China
| | - Jie Kang
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China
| | - Xiaoming Chen
- Department of Ophthalmology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu 610041, China
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Lin ZJ, Xu S, Huang SY, Zhang XB, Zhong YS. Comparison of canaloplasty and trabeculectomy for open angle glaucoma: a Meta-analysis. Int J Ophthalmol 2016; 9:1814-1819. [PMID: 28003985 PMCID: PMC5154998 DOI: 10.18240/ijo.2016.12.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 06/24/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma. METHODS Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction (IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events. RESULTS We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference (WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12mo was -2.33 (95%CI: -4.00, -0.66). There was not significant improvement in the complete or qualified success rate (OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction (WMD: -0.54, 95%CI: -1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result. CONCLUSION Trabeculectomy seems to be more effective in lowering IOP up to 12mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.
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Affiliation(s)
- Zhong-Jing Lin
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Shuo Xu
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Shou-Yue Huang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao Tong University, Shanghai 200025, China
| | - Xiao-Bin Zhang
- Department of Ophthalmology, Hubei University of Science and Technology, Xianning 437100, Hubei Province, China
| | - Yi-Sheng Zhong
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiao Tong University, Shanghai 200025, China
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Is there a change in the quality of life comparing the micro-invasive glaucoma surgery (MIGS) and the filtration technique trabeculectomy in glaucoma patients? Graefes Arch Clin Exp Ophthalmol 2016; 255:351-357. [PMID: 27848022 DOI: 10.1007/s00417-016-3550-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 06/21/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022] Open
Abstract
PURPOSE This study was conducted to assess the impact on the Quality of Life (QOL) of micro-invasive glaucoma surgery (MIGS: iStent, Trabectome) and a penetrating technique such as Trabeculectomy (TE). METHODS This study evaluated 88 eyes of 88 open angle glaucoma patients undergoing glaucoma surgery: 43 (mean age 72.8 ± 8.8y, female 59.5 %, male 40.5 %) Trabectome (NeoMedix, Inc., Tustin, CA, USA), 20 (mean age 68.6 ± 16.4y, female 60 %, male 40 %) iStent (Glaucos Corporation, Laguna Hills, CA, USA), and 25 TE patients (mean age 74.2 ± 9.1y female 58.3 %, male 41.7 %). The National Eye Institute-Visual Functioning Questionnaire (VFQ-25) survey was used to assess the QOL at 6 months post surgery. The following 12 QOL parameters were evaluated: general health, ocular pain, general vision, near and distance activities, mental health, social functioning, role difficulties, dependency, driving, color vision, and peripheral vision. Intraocular pressure (IOP), number of topical medications, and visual acuity (VA) were examined preoperatively, 1 day, 6 weeks, 3 months, and 6 months post surgery. Statistical data were calculated using SPSS (v20.0, SPSS, Inc.). RESULTS There was no significant difference between TE and MIGS in the quality of life 6 months postoperatively. IOP was significantly lower in TE compared to MIGS at 6 weeks and 3 months postoperatively (p = 0.046 and p = 0.046). Number of medications was significantly decreased in TE compared to MIGS (p < 0.001). A significant difference in VA between TE and MIGS could be assessed at day 1 post-op (p = 0.011). CONCLUSION In this study cohort, the QOL can be maintained by all three surgical techniques. Patients, however, need lower numbers of topical medication in TE, which would impact QOL even though it is not included in the NEI-VFQ-25. The decision of the most appropriate surgical technique should be made by including single QOL categories, IOP and glaucoma medication outcome.
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Canaloplasty: Current Value in the Management of Glaucoma. J Ophthalmol 2016; 2016:7080475. [PMID: 27239337 PMCID: PMC4867063 DOI: 10.1155/2016/7080475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 04/17/2016] [Indexed: 11/17/2022] Open
Abstract
Canaloplasty is a nonpenetrating blebless surgical technique for open-angle glaucoma, in which a flexible microcatheter is inserted within Schlemm's canal for the entire 360 degrees. When the microcatheter exits the opposite end, a 10-0 prolene suture is tied and it is then withdrawn, by pulling microcatheter back through the canal in the opposite direction. Ligation of prolene suture provides tension on the canal and facilitates aqueous outflow. The main advantage of canaloplasty is that this technique avoids the major complications of fistulating surgery related to blebs and hypotony. Currently, canaloplasty is performed in glaucoma patients with early to moderate disease and combination with cataract surgery is a suitable option in patients with clinically significant lens opacities.
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Comparison of Surgical Outcomes between Canaloplasty and Schlemm's Canal Scaffold at 24 Months' Follow-Up. J Ophthalmol 2016; 2016:3410469. [PMID: 26989497 PMCID: PMC4771907 DOI: 10.1155/2016/3410469] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/19/2016] [Accepted: 01/24/2016] [Indexed: 11/29/2022] Open
Abstract
The results of canaloplasty (CP) and Hydrus Microstent (HM) implantation were retrospectively compared at 24 months' follow-up in a cohort of subjects referred to our Institution for uncontrolled IOP in primary or secondary (e.g., pseudoexfoliative and pigmentary) open-angle glaucoma. The outcome was labelled as “complete” success, “qualified” success, or “failure” if, two years after surgery, the eyes operated on needed “no” hypotensive medications, “some” hypotensive medications, or further glaucoma surgery to attain the target IOP, respectively. Both CP and HM implant allowed significant IOP reductions, with comparable rate of clinical success and safety profile. A slightly (albeit not significant) better trend for a “complete” clinical success was observed in the CP group.
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Canaloplasty: A Minimally Invasive and Maximally Effective Glaucoma Treatment. J Ophthalmol 2015; 2015:485065. [PMID: 26495135 PMCID: PMC4606093 DOI: 10.1155/2015/485065] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
Canaloplasty is a highly effective, minimally invasive, surgical technique indicated for the treatment of open-angle glaucoma that works by restoring the function of the eye's natural outflow system. The procedure's excellent safety profile and long-term efficacy make it a viable option for the majority of glaucoma patient types. It can be used in conjunction with existing drug based glaucoma treatments, after laser or other types of incisional surgery, and does not preclude or affect the outcome of future surgery. Numerous scientific studies have shown Canaloplasty to be safe and effective in lowering IOP whilst reducing medication dependence. A recent refinement of Canaloplasty, known as ab-interno Canaloplasty (ABiC), maintains the IOP-lowering and safety benefits of traditional (ab-externo) Canaloplasty using a more efficient, simplified surgical approach. This paper presents a review of Canaloplasty indications, clinical data, and complications, as well as comparisons with traditional incisional glaucoma techniques. It also addresses the early clinical evidence for ABiC.
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Au CPY, Fardell N, Williams M, Fraser-Bell S, Campain A, Gillies M. Patient experiences in retinal trials: a cross-sectional study. BMC Ophthalmol 2015. [PMID: 26202164 PMCID: PMC4511246 DOI: 10.1186/s12886-015-0071-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Patient-centered care recognizes the obligation to understand and meet patient’s expectations. An individual’s satisfaction has been found to affect health-related decisions and treatment-related behaviours, which in turn affect medical compliance, follow-up, the success of treatment and the appropriate use of services. We studied the expectations, experiences and satisfaction of patients who participated in clinical trials for retinal diseases at the Sydney Eye Hospital. Methods The study was undertaken at the research clinic of the major public quaternary eye hospital in New South Wales, Australia. A 37-question survey was conducted on patients enrolled in or who had finished a clinical trial for macular disease in the 12 months preceding this study in November 2012. Patient satisfaction was assessed using close-ended, multiple choice questions. First, the decision making process for entering into the clinical trial was evaluated. Then the level of patient understanding and experience during the study was assessed. Finally, there was a series of questions to gauge the participants’ perception of trial outcomes and overall impression gained from the experience. Results Eighty patients completed the questionnaire. Overall patient satisfaction was high with the majority of patients stating they would recommend participation in a retinal clinical trial (94 %) and participate in a subsequent trial (78 %). Most patients rated themselves as the most important factor in making the decision to join a trial. Patients felt well informed and expectations were generally felt to be met, however 14 % did not believe that they could withdraw from the study voluntarily. The most common reasons for trial participation were to contribute to medical science and to have improved treatment outcomes. Conclusions We found that patients generally found participation in retinal clinical trials to be a positive experience. Factors contributing to dissatisfaction mainly related to inconvenience experienced by transportation and waiting times. We also found that patients felt well informed about the study, but some did not have a complete understanding of their rights, which had been communicated to them when they entered the study. There were both altruistic and self-motivated reasons behind patients’ decisions to join a retinal trial. Electronic supplementary material The online version of this article (doi:10.1186/s12886-015-0071-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cheryl Pui-Yan Au
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Nicole Fardell
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Maria Williams
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Samantha Fraser-Bell
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Anna Campain
- Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
| | - Mark Gillies
- Sydney Medical School, University of Sydney, Sydney, Australia. .,Macular Research Group, Room 116, Level 1, Save Sight Institute, Campus of Sydney Eye Hospital, 8 Macquarie St, Sydney, NSW, 2000, Australia.
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