Early experience with the novel glaucoma shunt device: Paul glaucoma implant in the Indonesian populations / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the safety and efficacy of Paul glaucoma implant(PGI)in the short-term follow-up period and share first experience with this novel aqueous shunt in Indonesian populations.METHODS: A total of 21 patients(22 eyes)with PGI implants from April 2022 to December 2022 and with at least a complete 2mo follow-up were retrospectively analyzed. The primary outcome measure was failure, defined as intraocular pressure(IOP)out of the target range of 21 mmHg or less than 20% reduction from baseline for 2 consecutive visits, other glaucoma surgeries required, or removal of the implant.RESULTS: The follow-up period was 2 to 6mo. The mean IOP reduction was 52.27±22.94%, with a range of 9% to 90%. The complete success rate was 59%, and patients with or without a history of glaucoma surgery had 50% and 59% of complete success rates, respectively. Complications of the surgery were diplopia(n=2), early hypotony(n=1), hyphema(n=1), and exposed tube(n=2).CONCLUSION: The complete success of the PGI implantation was 57%. No serious postoperative complications were found in our cases. One case of hypotony resolved in the early postoperative period.

Pars plana Aurolab aqueous drainage implantation for refractory glaucoma: Outcome of a new modified technique

Purpose: To report the outcomes of pars plana insertion of Aurolab aqueous drainage implant (AADI) in adults with refractory glaucoma by the novel technique of making scleral tunnel instead of patch graft to cover the tube to prevent its migration. Methods: A retrospective study was done between April 2016 and April 2018 on patients with ?12 months of follow?up. The main outcome measure was a surgical failure at 12 months. The failure was defined as intraocular pressure (IOP) >18 mmHg or IOP ?5 mmHg on two consecutive follow?up visits after 3 months, reoperation for glaucoma, loss of light perception vision, or implant explantation. Alternate definitions of failure including IOP >21 and IOP >15 mmHg were also considered. Results: The study included 32 eyes of 32 patients. The mean age was 46.2 ± 17.5 years. The most common etiology is traumatic glaucoma (12 eyes, 37.5%). The mean preoperative IOP and anti?glaucoma medications were 43.3 ± 10.3 and 3.4 ± 0.5 mmHg, respectively; both the parameters at the final follow?up were reduced to 15.2 ± 8.1 and 1.6 ± 0.5 mmHg. The Kaplan–Meier survival estimates demonstrated that the cumulative probability of failure was 15.6% (95% CI; 6.8–33.5%) at 3 months, 18.7% (95% CI; 8.9–37.0%) at 6 months, and 25.0% (95% CI; 13.4–43.8%) at 12 months. Conclusion: Pars plana AADI implantation with a newer modification technique is a useful procedure in reducing IOP and the number of anti?glaucoma medications in the eyes with refractory glaucoma. The visual acuity may be stabilized with the concurrent treatment of posterior segment pathology

Assessment of the differences in the short-term clinical outcomes of superotemporal and inferonasal Baerveldt glaucoma implantation surgeries performed <i>via </i>the pars plana route / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate and discover whether different insertion areas for Baerveldt glaucoma implant(BGI)surgery produce different outcomes in terms of the reduction of intraocular pressure(IOP). <p>METHODS: This retrospective study involved the review of cases of patients admitted at Toho University Sakura Medical Center, who underwent BGI surgery <i>via</i> the pars plana route for the treatment of neovascular glaucoma. The patients were divided into two groups: the superotemporal insertion group \〖18 eyes in 16 subjects(13 males, 3 females; mean age 62.9±14.4a)\〗 and the inferonasal insertion group \〖17 eyes in 15 subjects(11 males, 4 females; mean age 56.9±10.7a)\〗. The patients were followed up and re-evaluated at 12mo. The IOP reduction rate 12mo after surgery relative to preoperative IOP was compared between the two groups.<p>RESULTS: The mean preoperative IOP was 31.1±10.0 mmHg and postoperative IOP was 14.4±4.5 mmHg in the superotemporal group, whereas for the inferonasal group, the mean preoperative IOP was 34.9±9.7 mmHg and postoperative IOP was 15.9±3.7 mmHg. The IOP reduction rate of the superotemporal group was(50.0±19.0)% and that of the inferonasal group was(51.2±16.3)%. There was no significant correlation between the two groups(Student's<i> t</i>-test, <i>P</i>=0.590).<p>CONCLUSION: There was no difference in the short-term clinical outcomes between superotemporal and inferonasal BGI performed <i>via</i> the pars plana route.

Intraocular Pressure Change after Glaucoma Implant Surgery with Releasable suture

PURPOSE: To find the factor that affects the long-term intraocular pressure after glaucoma implant surgery with releasable suture. METHODS: We retrospectively reviewed the medical records of the 33 patients (36 eyes) who had undergone glaucoma implant surgery with our own expanded-Polytetrafluoroethylene (e-PTFE) membrane-tube implant with temporary closure of the tube by releasable suture. Data such as timing of suture release, IOP's before and after surgery and the amount of pressure change during follow-up were collected, and we tried to find the factor that influenced the IOP at the last visit. RESULTS: The preoperative IOP was 43.2+/-14.6 mmHg and the suture was released at day 17.9+/-9.5 after surgery. The IOP just before the release of suture was 33.5+/-17.1 mmHg. The pressure was dropped to 15.1+/-13.7 mmHg, measured at 30 minutes after the release of the suture. The IOP was stabilized to 14.9 +/-9.5 mmHg at 12.2+/-7.0 days after the release. The average follow-up was 32.8+/-26.3 months and the IOP at the last visit was 17.3+/-10.5 mmHg. Four eyes (11%) had hypotony (IOP less than 8 mmHg) before release of the suture, thirteen eyes (41%) showed hypotony 30minutes after release, and three eyes(8%) showed hypotony at the last visit. Multiple linear regression analysis revealed that the IOP at 30 minutes after release of the suture had a positive correlation with the IOP at the last visit (r=0.642,p=0.000). CONCLUSIONS: In the membrane-tube implant surgery for the refractory glaucoma, the releasable suture echnique is helpful to prevent the early postoperative hypotony. By measuring early post-release IOP after implant surgery with releasable suture technique, we might predict the behavior of long term IOP change; the lower post-release IOP, the better long-term pressure control.

Intermediate-term Result of e-PTFE Membrane Implant Surgery for Refractory Glaucomas

Recently, various tube-shunt implants have been used in treating refractory glaucomas.They have large volumed reservoir portion made of hard materials.We made a new implant with soft and freely malleable membrane[expanded polytetrafluoroethylene, e-PTFE]as a reservoir portion attached to the conventional silicone tube. Based on the encouraging result from experimental animal study, we performed a clinical trial for the membrane-tube implant.We performed Glaucoma Tube-Shunt Implant surgery using double layers of e-PTFE membrane and silicone tube with its one end fixed between the two layers.The subjects had refractory glaucomas without useful vision who visited our hospital from May 1991 to Sep.1995. There were 40 eyes of 37 patients and their mean follow-up period was 32.6 months.We could control the IOP within 6~21 mms of mercury in 26 eyes[65.0%, Success].In remaining 14 eyes, we could not control the IOP or additional surgery was needed to control the IOP or treat severe complications[35.0%, Failure].The Kaplan-Meier Survival for IOP control was 78.4% at 1 yr, 71.6%at 2 yr, and 60.3%at 3 yr.The complications were similar to those of other commercially available Glaucoma implants. This new implant is made of soft, freely malleable membrane for the reservoir portion with small volume which can be inserted with smaller incision on the conjunctiva with less complication.We have obtained comparable result from this membrane-tube implant to other implants, and it may be considered as an another substitute for the treatment of refractory glaucomas.

Lyophilized Dura Mater Patch Graft in Glaucoma Valve Implantation

This study was performed to know effectiveness and safety of cadaveric lyophilized dura mater grafts(Lyodura, B.Braun Melsungen, Germany) to cover glaucoma implant tube. Tewnty-seven eyes of 25 patients who underwent glaucoma implant surgery between April 1996 and September 1997 received a lyophilized dura mater patch graft to cover the subconjunctival portion of the tube and then followed up for clinical signs. The mean follow up visit was 10.3 months (range: 5-18 months). All eyes tolerated the lyophilized dura mater grafts well without clinical signs of graft related conjunctival, scleral, of intraocular inflammation. And no conjunctival erosion or melting of the graft was observed. The result of this study suggests that preserved dura mater is maybe a reasonable alternative to eye bank sclera for use in glaucoma implant surgery.

Experimentally designed glaucoma implant surgery with mitomycin C in rabbit

An attempt was made to observe the possibility of controlling intraocular pressure (IOP) without hypotony and ocular motility disorder by installing an experimentally designed glaucoma implant through a small conjunctival incision with the aid of a stylet and maintaining the aqueous reservoir using mitomycin C (MMC). The implant was made of silicone tube, of which one end was occluded by glue and on the same end 4 check-valve-like slits were made. Thirty-five healthy white rabbits were used and subdivided into 4 groups. In groups I to III, implants having 2.0, 2.5, 3.0 mm slit lengths, respectively, were installed with MMC application in one eye of each of the 10 rabbits. In group IV, a 2 mm slit-length implant was installed without MMC in one eye of each of the 5 rabbits. Pneumatonometry and ultrasonography were performed to check the IOP and the formation of aqueous reservoir in the implanted eyes for 8 weeks. In group I through III, there was a statistically significant 4-5 mmHg pressure-lowering effect in the implanted eyes compared to the contralateral control eyes for 8 weeks. The aqueous reservoirs were observed throughout the follow-up period. In group IV, we could observe neither a pressure-lowering effect nor aqueous reservoir formation in the implanted eyes after 2 weeks postoperatively. Hypotony did not occur in implanted eyes in any of the groups. This study shows the possibility of IOP control by installing a specially designed glaucoma implant with application of MMC.

Ultrasonographic Study of Glaucoma Implant

The fibrovascular tissues surrounding a glaucoma implant have been found to play a major role for the orbital absorption of aqueous humor following a glaucoma implant surgery. An ultrasonographic study was performed to investigate the ultrasonographic, characteristics of the tissues and its relationship with the postoperative intraocular pressure(IOP) control. Twenty-three eyes of 23 patients had undergone the e-PTFE membrane-silicone tube implantation and had been followed up for at least 6-month(mean +/- SD, 17 +/- 8.8 months). An ultrasonographic study for these eyes included such paramneters as presence of an aqueous reservoir surrounding the implant, size(height) of the aqueous reservoir and echoreHectivity from the reservoir wall tissues. The aqueous reservoir was identified in 22(96%) of 23 eyes and had a height varying from 1.0 mm to 5.5 mm. In eyes with an aqueons reservoir. 3 mm high or more, the IOPs were all 21 mmHg or less without further glaucoma medications(p=0.040, chi-square). In one eye with an obliterated reservoir on ultrasonography, the opening of the silicone tube was found to be occluded toward the extrascleral portion of the implant when reoperation was performed. The echo reflections from reservoir wall tissues were denser and higher comparing with those from the sclera of the respective eye in 7 eyes with a complete failure of postoperative lOP control(>or=30 mmHg on maximum medical theraph). These eyes also had and irregular echoreflections within the aqueous reservoir, which reflect an invasion of proliferating tissues into the reservoir.