ABSTRACT
To compare combined viscocanalostomy-trabeculectomy [VISCO-TRAB] to trabeculectomy [TRAB] for the management of advanced glaucoma. The study cohort comprised of 18 subjects with bilateral advanced glaucoma who underwent VISCO-TRAB surgery [VISCO-TRAB group] in the right eye and TRAB [TRAB group] in the left eye. VISCO-TRAB constituted lamellar scleral flap, deep scleral flap dissection with deroofing of Schlemm's canal [SC], viscodilation of SC, penetrating trabeculectomy, peripheral iridectomy, and tight flap closure. All eyes received subconjunctival mitomycin. Success criteria included intraocular pressure [IOP] < 14 mmHg or > 30% lowering of IOP with no devastating complications. A P value less than 0.05 was considered statistically significant. Mean IOP was significantly lower after VISCO-TRAB compared to TRAB at 1 week and 3 months postoperatively [P<0.05]. No eyes lost more than two lines of Snellen acuity. There were more hypotony-related complications after TRAB than VISCO-TRAB surgery. Target IOP was achieved in 83.3% in the VISCO-TRAB group compared to 55.6% in the TRAB group. Combined VISCO-TRAB is effective in reducing IOP to the target level for advanced glaucoma with lower postoperative complications
Subject(s)
Humans , Male , Female , Trabeculectomy/adverse effects , Pilot Projects , Trabeculectomy/methods , Postoperative ComplicationsABSTRACT
Recently, primary lens extraction alone gained more acceptance as an alternative surgical approach for glaucoma management. This view was supported by the advances in phacoemulsification and intraocular lenses with greater safety and visual recovery, in addition to a substantial reduction of intraocular pressure and deepening of the anterior chamber and filtration angle. The decrease in IOP after cataract surgery in primary open-angle glaucoma [POAG] is mild, less predictable, related to baseline levels, and may return to presurgical values after an initial period of reduction. Therefore, the IOP-lowering effect of primary cataract extraction in POAG may be insufficient to achieve adequate IOP control. The IOP reduction after lens extraction is consistently greater in eyes with primary angle closure glaucoma [PACG] than in eyes with POAG. Primary lens extraction in acute PACG eliminates, or at least, reduces the risk of recurrence of acute attacks and deepens the anterior chamber and widens the angle which reduces the risk of progression of peripheral anterior synechiae and development of chronic PACG. Primary lens extraction may be more preferable to glaucoma incisional surgery in mild to moderate PACG eyes with appositional angle closure. The decision to do lens extraction as a primary treatment for glaucoma should be individualized based upon several factors other than the effect on IOP. These factors include patients' characteristics, surgeons' skills and preferences, status of glaucoma control, type of cataract and intraocular lens implanted, and potential harm of laser treatment for late capsular opacification and fibrosis
ABSTRACT
To study safety and efficacy of intravitreal Bevacizumab [IVB] injection followed by aqueous shunting tube surgery [ASTS] for management of neovascular glaucoma [NVG] with intractable high IOP. Twenty-five eyes of 25 patients with NVG and high IOP not responsive to maximally tolerated antiglaucoma medications were treated with ASTS [Ahmad valve]. Patients were classified into two groups; Group 1 [14 eyes] received IVB [1.25 mg/ 0.05ml] before ASTS. These eyes had severe retinopathy, florid NVI, dense cataract, or corneal edema that prevented proper panretinal photocoagulation [PRP] before glaucoma surgery. Group 2 [11 eyes] was treated by PRP followed by ASTS without IVB injection. Outcome measures included IOP reduction and operative complications. Mean preoperative IOP was 56.3 mmHg in group 1 and 53.3 mmHg in group 2 [p=0.8]. After IVB injection, NVI regressed markedly with media clarity and mild reduction of IOP [44.2 mmHg]. Average duration between IVB injection and ASTS was 12 days. IOP at last follow-up was 19.5 mmHg in group 1 and 17.6 mmHg in group 2 [p=0.5], with 5 eyes in group 1 and 4 eyes in group 2 on antiglaucoma drops. Post-ASTS complications were comparable between both groups. One eye in each group had one surgical intervention to treat postoperative complications. One eye in group 2 required additional glaucoma surgery. Intravitreal Bevacizumab is a useful preparatory step to safely and effectively implant an aqueous shunting tube in eyes with severe NVG and intractable IOP which cannot be treated preoperatively by PRP