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Introducción: El glaucoma es una de las entidades nosológicas con mayor prevalencia y constituye una de las principales causas de ceguera en el mundo desarrollado. La presión intraocular es el único factor de riesgo que puede ser controlado y se asocia a la presencia y progresión de la enfermedad. Objetivo: Describir la evolución de pacientes operados mediante la técnica de trabeculectomía. Métodos: Se realizó un estudio observacional descriptivo, longitudinal y prospectivo de 128 pacientes con glaucoma crónico simple operados mediante la técnica de trabeculectomía en el Centro Oftalmológico de Santiago de Cuba, desde enero del 2017 hasta junio del 2019. Para ello, se analizaron las siguientes variables: edad, sexo, color de piel, agudeza visual preoperatoria y posoperatoria, presión intraocular antes y después de la operación, así como complicaciones posoperatorias. Resultados: Predominaron el sexo masculino (69,5 %), el grupo etario de 60-69 años (44,5 %) y el color de la piel negro (53,1 %). La hipertensión arterial fue la enfermedad asociada con más frecuencia y la hipertensión ocular, el factor de riesgo fundamental; en tanto, la complicación posoperatoria principal fue el hipema. Conclusiones: Con la trabeculectomía se logró controlar la tensión ocular en la mayoría de los pacientes y las complicaciones que se presentaron en algunos de ellos no interfirieron en su evolución. Esta técnica permitió disminuir el daño irreversible que provoca la hipertensión ocular del nervio óptico y, por consiguiente, prevenir la ceguera.
Introduction: Glaucoma is one of the nosologic entities with more prevalence and constitutes one of the main causes of blindness in the developed world. The intraocular pressure is the only risk factor that can be controlled and is associated with the presence and progression of the disease. Objective: To describe the evolution of patients operated by means of trabeculectomy technique. Methods: An observational descriptive, longitudinal and prospective study of 128 patients with simple chronic glaucoma operated by means of trabeculectomy technique was carried out in the Ophthalmology Center of Santiago de Cuba, from January, 2017 to June, 2019. For this purpose, the following variables were analyzed: age, sex, skin color, preoperative and postoperative visual acuteness, intraocular pressure before and after the operation, as well as postoperative complications. Results: There was a prevalence of male sex (69.5%), 60-69 age group (44.5%) and black skin color (53.1%). Hypertension was the most frequent associated disease and the ocular hypertension was the fundamental risk factor; meanwhile, the main postoperative complication was the hyphema. Conclusions: With trabeculectomy was possible to control ocular tension in most of the patients and the complications that were presented in some of them did not interfere in their clinical course. This technique made it possible to reduce the irreversible damage caused by ocular hypertension of the optic nerve and, consequently, to prevent blindness.
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ABSTRACT Objective: To compare the hypotensive effect of SLT vs the use of latanoprost in the initial management of patients with suspected glaucoma and diagnosis of glaucoma. To evaluate the patients' quality of life using the Glaucoma Quality of Life questionnaire. Methods: Randomized controlled clinical trial conducted in the city of Cartagena, Colombia, between October 2021 to June 2023. Assignment to the SLT or latanoprost group with follow-up at days 7, 30, 90, 180, and 365 in patients diagnosed with suspected glaucoma, mild and moderate glaucoma. Results: 31 patients (60 eyes), of which 17 were men. Group SLT were 31 eyes and the latanoprost group included 29 eyes. The mean baseline IOP of the SLT group was 18.9mmHg and in the latanoprost group, it was 19.6mmHg. The mean IOP at the end of the follow-up group SLT was 13.9mmHg and for latanoprost 14.5mmHg. The IOP reduction percentage at one year of follow-up in the SLT group was 23.4% and that of the latanoprost group was 23.6% Conclusions: Selective laser trabeculoplasty with Nd-YAG laser is as effective as the use of prostaglandin analogues as initial treatment in the early stages of glaucoma. Regarding the quality of life scale, although there were no statistically significant differences in both groups, the SLT showed an increase in the difficulty perceived by the patient for activities that involve peripheral vision, which is the most affected in patients with glaucoma.
RESUMO Objetivo: Comparar o efeito hipotensor da trabeculoplastia seletiva a laser versus o uso de latanoprosta no tratamento inicial de pacientes com suspeita de glaucoma e diagnóstico de glaucoma; avaliar a qualidade de vida dos pacientes por meio do Glaucoma Quality of Life Survey. Métodos: Ensaio clínico randomizado controlado realizado na cidade de Cartagena, Colômbia, entre outubro de 2021 e junho de 2023. Atribuição ao grupo trabeculoplastia seletiva a laser ou latanoprosta com acompanhamento nos dias 7, 30, 90, 180 e 365 em pacientes diagnosticados com suspeita de glaucoma, glaucoma leve e moderado. Resultados: Foram incluídos 31 pacientes (60 olhos), sendo 17 homens. No Grupo Trabeculoplastia Seletiva a Laser, foram 31 olhos, e, no Grupo Latanoprosta, 29 olhos. A pressão intraocular basal média do Grupo Trabeculoplastia Seletiva a Laser foi de 18,9mmHg e, no Grupo Latanoprosta, foi de 19,6mmHg. A pressão intraocular média no fim do grupo de acompanhamento trabeculoplastia seletiva a laser foi de 13,9mmHg e para latanoprosta de 14,5mmHg. A percentagem de redução da pressão intraocular em 1 ano de acompanhamento no Grupo Trabeculoplastia Seletiva a Laser foi de 23,4% e a do Grupo Latanoprosta foi de 23,6%. Conclusões: A trabeculoplastia seletiva a laser com Nd-YAG é tão eficaz quanto o uso de análogos de prostaglandinas como tratamento nas fases iniciais do glaucoma. Em relação à escala de qualidade de vida, embora não tenha havido diferenças estatisticamente significativas em ambos os grupos, a A trabeculoplastia seletiva a laser mostrou aumento na dificuldade percebida pelo paciente para atividades que envolvem a visão periférica, que é a mais afetada em pacientes com glaucoma.
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AIM: To investigate the application of biological amniotic membrane soaked in pirfenidone(PFD)and to evaluate its anti-scarring effect and toxic side effects on glaucoma model of rabbit eyes.METHODS: The right eyes of 72 healthy New Zealand white rabbits were randomly divided into 0.5%PFD+ biological amniotic membrane group, biological amniotic membrane group, mitomycin C(MMC)group and blank control group after the glaucoma model was established by anterior chamber injection of compound carbomer solution, and 18 rabbits in each group underwent trabeculectomy, in which the 0.5% PFD+ biological amniotic membrane group was placed with 0.5% PFD solution-soaked biological amniotic membrane under the scleral flap, and the biological amniotic membrane group was placed with normal saline-soaked rehydrated biological amniotic membrane under the scleral flap. In the MMC group, a cotton pad soaked in MMC was placed under the scleral flap for 3 min and immediately rinsed with normal saline, while the blank control group received no implant after the scleral flap was made. The intraocular pressure(IOP), filtration blebs, toxic side effects and complications were evaluated, and the histopathological changes in the filtration area were observed by hematoxylin-eosin(HE), Masson staining and immunohistochemical staining.RESULTS: The mean IOP at 14, 21 and 28 d after trabeculectomy were 0.5%PFD+ biological amniotic membrane group<MMC group<biological amniotic membrane group<blank control group(all P<0.05). At 28 d after trabeculectomy, 0.5%PFD+ biological amniotic membrane group had the best effect of anti-inflammatory hyperplasia and inhibition of collagen formation, the highest survival rate of filtration blebs, and the inflammatory reaction was mild.CONCLUSION: Biological amniotic membrane soaked in pirfenidone has more obvious anti-scarring effect on glaucoma model, with less toxic side effects and good safety.
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AIM: To compare the clinical outcomes of trabeculectomy combined with phacoemulsification intraocular lens implantation with suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification intraocular lens implantation for the treatment of primary open angle glaucoma(POAG).METHODS: A retrospective case-control study was conducted on 53 cases(53 eyes)with advanced-stage POAG and cataract that received surgery at our hospital from June 2021 to June 2022, among which 26 eyes underwent trabeculectomy combined with phacoemulsification and intraocular lens implantation(group A), and 27 eyes underwent suture-guided penetrating Schlemm canaloplasty combined with phacoemulsification and intraocular lens implantation(group B). The best-corrected visual acuity(BCVA), intraocular pressure, and the number of intraocular pressure lowering drugs were compared between the two groups. Furthermore, the intraoperative and postoperative complications and success rate of surgery were recorded.RESULTS: The intraocular pressure of two groups of patients at 1 wk, 1, 3 and 6 mo after surgery were lower than that before preoperatively(all P<0.017). There was a notable disparity in the frequency of anterior chamber hemorrhage between the two groups(P<0.05), but there was no significant variance in the occurrence of superficial anterior chamber and choroid detachment(all P>0.05). There was no significant difference in BCVA(LogMAR)between the two groups at 6 mo after surgery(group A: 1.29±1.19, group B: 0.78±1.01, P=0.098), and there was no significant difference in the number of anti-glaucoma drugs [group A: 0(0, 2.75), group B: 0(0, 1), P=0.209]. Additionally, there was no significant difference in the success rate of surgery between the two groups at 6 mo postoperatively(Z=0.448, P=0.654).CONCLUSIONS: Suture-guided penetrating Schlemmcanaloplasty is a safe and effective treatment for advanced-stage POAG, with a success rate comparable to that of trabeculectomy.
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@#Wound healing is a complex process that includes haemostasis and inflammation, followed by a proliferation period and repair and finally remodelling. Ocular surgeries, particularly in glaucoma cases, aim at minimal fibrosis to preserve the function of trabeculectomy as an alternative pathway for aqueous drainage. Hence, it is important to find an agent to modulate the wound healing process. This review presents compilation of wound modulation agents that have been tested in vitro, in vivo, or clinically on patients undergoing ocular surgeries, particularly for glaucoma. We identified agents into four groups, mostly for glaucoma filtration operations: anti-metabolites, anti-growth factors, mechanical barriers and rho kinases. The effect of these agents is highlighted in this review. In conclusion, despite recognized drawbacks of antimetabolites, they are still regarded as the gold standard and the most efficient treatment as anti-scarring agents use in ocular surgeries. More studies are needed to inquire agents that efficient yet has minimal adverse effects both in short and long term.
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ABSTRACT The creation of a scleral flap during trabeculectomy can be complicated by a buttonhole, partial amputation at the limbus, and extensive thinning. In some cases, the procedure must be aborted to prevent more serious postoperative complications. This report describes a technique of converting complicated trabeculectomy into ab externo cyclodialysis. A 41-year-old patient with congenital glaucoma presented with a perforated scleral wall with the choroidal tissue exposed during the dissection of the partial-thickness scleral flap. By using a Barraquer cyclodialysis spatula through the scleral perforation, the choroid was separated from the sclera up to the scleral spur over 30° into the anterior chamber. The sclera and conjunctiva/Tenon were sutured with 10-0 nylon single sutures. Two months later, the intraocular pressure was reduced to 16 mmHg with no hypotensive topical medications. This case illustrates an alternative approach to managing a flap-related perioperative complication in trabeculectomy, which yielded good early results.
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ABSTRACT Purpose: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. Methods: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. Results: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). Conclusion: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.
RESUMO Objetivo: Avaliar o efeito do tabagismo nos desfechos da trabeculectomia. Métodos: Uma revisão retrospectiva do gráfico de pacientes com glaucoma submetidos à trabeculectomia foi realizada por um único cirurgião entre 2007 e 2016. Os gráficos foram examinados para uma história documentada de condição de fumante antes da cirurgia. Variáveis pré-operatórias clínicas e demográficas e clínicas foram registradas. Os pacientes foram divididos em dois grupos de acordo com sua história de tabagismo em fumantes e não fumantes. Quaisquer Intervenções relacionadas à bolha, por exemplo, injeções de 5-fluorouracil + lise de sutura com laser, ou revisão da bolha realizada durante o período pós-operatório foram observadas. O sucesso foi definido como pressão intraocular > 5 mmHg e < 21 mm Hg sem (sucesso completo) ou com (sucesso qualificado) medicamentos hipotensores oculares. A falha foi identificada como violação dos critérios mencionados acima. Resultados: O estudo incluiu 98 olhos de 83 pacientes com idade média de 70,7 ± 11,09 anos, sendo 53% (44/83) dos pacientes do sexo feminino. O diagnóstico mais comum foi o glaucoma de ângulo aberto primário com 47 casos (47,9%). O Grupo de fumantes incluiu 30 olhos de 30 pacientes. Os fumantes, quando comparados aos não fumantes, apresentaram uma melhor acuidade visual pré-operatória significativamente pior (p=0,038), maior espessura central da córnea (p=0,047) e maior pressão intraocular pré-operatória (p=0,011). A taxa de sucesso de um ano para a cirurgia de trabeculectomia foi de 56,7% no Grupo de fumantes contra 79,4% no Grupo de não fumantes (p=0,020). O tabagismo apresentou razão de chances para falha de 2,95 95% de IC (1,6-7,84). Conclusão: Os fumantes demonstraram uma taxa de sucesso significativamente menor em um ano após a trabeculectomia em comparação com os não fumantes e uma maior necessidade de intervenções relacionadas à bolha.
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ABSTRACT Purpose: This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. Methods: A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning. This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. Results: The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). Conclusion: Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group.
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Purpose: To compare the surgical outcomes of trabeculectomy with and without anti?metabolites in patients with juvenile open?angle glaucoma (JOAG). Methods: This retrospective comparative case series included 98 eyes of 66 patients with JOAG who underwent either trabeculectomy without anti?metabolites (group A, n = 53 eyes) or with anti?metabolites (group B, n = 45 eyes) with a minimum of 2 years follow?up. The main outcome measures were intra?ocular pressure (IOP), number of glaucoma medications, visual acuity, additional surgical interventions, surgical complications, and risk factors for failure. Surgical failure was defined as IOP >18 mmHg or failure to reduce IOP by <30% from the baseline value or IOP ?5 mmHg or re?operation for refractory glaucoma or a complication or loss of light perception vision. Results: The mean post?operative IOP reduced significantly from baseline at all post?operative visits until 6 months and thereafter. The cumulative probability of failure at 2 years was 28.7% in group A [95% confidence interval (CI) = 17.6–44.8%] and 29.1% in group B (95% CI = 17.1–46.7%) (P = 0.78). Surgical complications occurred in 18 eyes (34%) in group A and 19 eyes (42%) in group B. Re?operations for glaucoma or complications were performed in two eyes (3.8%) in group A and two eyes (4.4%) in group B. Cox?hazard regression model revealed male gender (HR = 0.29; P = 0.008), baseline high IOP (HR = 0.95; P = 0.002), and an increased number of pre?operative glaucoma medications (HR = 2.08; P = 0.010) as significant factors associated with failure. Conclusion: Our study results on trabeculectomy in JOAG revealed a success of 71% in both groups at 2 years follow?up. There was no significant difference in success or failure rates between the two groups. The risk factors for poor surgical outcome in JOAG were male gender, baseline high IOP, and an increased number of glaucoma medications
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Background: Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow?ups and management of the blebs play a critical role in the long?term success. This video is aimed at showing the real?world management of blebs postoperatively. Purpose: This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation. Synopsis: This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed. Highlights: We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture?related complications and their management have been shown along with practical examples
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ABSTRACT Purpose: The nasal sector of the anterior chamber angle may present a higher density of collector channels, which may influence the results of angle surgeries. Considering the anatomical differences in the anterior chamber angle, we compared the results of the nasal and temporal 180° selective laser trabeculoplasty approaches for open-angle glaucoma. Methods: A retrospective chart review was conducted for patients with open-angle glaucoma (primary, pseudoexfoliation, and pigmentary) who underwent at least one 180° selective laser trabeculoplasty session between December 2016 and October 2018. The nasal (N1) or temporal (T1) sectors were chosen at the physician's discretion. Patients who did not experience decreased intraocular pressure between 3 and 6 months again underwent 180° selective laser trabeculoplasty in the opposite angle sector (T2 and N2). The main outcome measured was decrease in intraocular pressure at 6-month follow-up, after the last selective laser trabeculoplasty. A multivariable regression analysis was used to evaluate factors associated with decreased intraocular pressure after treatment. Results: The procedure was performed initially in 45 eyes (N1, 25; T1, 20 eyes) and repeated in the opposite anterior chamber angle sector in 19 eyes (N2, 11; T2, 8 eyes). Analysis of variance revealed that only the N1 approach presented a significant difference in the decrease in intraocular pressure as compared with the T1, N2, and T2 approaches (p=0.0014). The baseline intraocular pressure (p=0.021) and anterior chamber angle sector (N1; p=0.044) correlated with decreased intraocular pressure. Conclusion: Compared with the temporal approach, 180° selective laser trabeculoplasty performed initially in the nasal sector was associated with a more significant decrease in intraocular pressure. Considering the sectorial differences in the anterior chamber angle, further prospective trials are warranted to confirm our findings and provide more-efficient selective laser trabeculoplasty protocols.
RESUMO Objetivo: O setor nasal do ângulo da câmara anterior pode apresentar maior densidade de canais coletores, o que pode influenciar no resultado de cirurgias angulares. Considerando as diferenças anatômicas no ângulo da câmara anterior, comparamos os resultados das abordagens de trabeculoplastia seletiva a laser nasal e temporal de 180 graus no glaucoma de ângulo aberto. Métodos: Revisão retrospectiva de prontuários de pacientes com glaucoma de ângulo aberto (primária, pseudoexfoliação e pigmentar), que realizaram pelo menos uma sessão de trabeculoplastia seletiva a laser de 180 graus entre dezembro/2016 e outubro/2018. O setor nasal (N1) ou temporal (T1) foi escolhido a critério do médico. Os pacientes que não apresentaram diminuição da pressão intraocular (PIO) entre 3 e 6 meses foram retratados com trabeculoplastia seletiva a laser de 180 graus no setor de ângulo oposto (T2 e N2). O principal resultado medido foi a diminuição da pressão intraocular no 6º mês de acompanhamento após a última trabeculoplastia seletiva a laser. Uma análise de regressão multivariável avaliou os fatores associados à redução da pressão intraocular após o tratamento. Resultados: O procedimento foi realizado inicialmente em 45 olhos (N1=25, T1=20 olhos), e repetido no setor ângulo da câmara anterior oposto em 19 olhos (N2 = 11, T2 = 8 olhos). Os testes ANOVA mostraram que apenas a abordagem N1 apresentou diferença significativa na diminuição da pressão intraocular em relação a T1, N2 e T2 (p=0,0014). A pressão intraocular basal (p=0,021) e o setor ângulo da câmara anterior (N1; p=0,044) se correlacionaram com a diminuição da pressão intraocular. Conclusão: A trabeculoplastia seletiva a laser de 180 graus realizado inicialmente no setor nasal foi associado a uma diminuição mais significativa da pressão intraocular em comparação com a abordagem temporal. Considerando as diferenças setoriais no ângulo da câmara anterior, mais estudos prospectivos são necessários para confirmar nossos achados e fornecer protocolos para trabeculoplastia seletiva a laser mais eficientes.
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ABSTRACT Purpose: To compare viscotrabeculotomy with anterior chamber irrigation to Ahmed glaucoma valve implantation for secondary glaucoma following silicone oil removal. Methods: A prospective study was conducted on 43 vitrectomized pseudophakic eyes with persistent glaucoma after silicone oil removal. Patients were randomized to either viscotrabeculotomy with anterior chamber irrigation or Ahmed glaucoma valve implantation. All patients were examined on day 1, week 1, and months 1, 3, 6, 9, 12, 18, and 24 postoperatively. Postoperative complications were noted. Success was defined as an intraocular pressure between 6 and 20 mmHg and with an intraocular pressure reduction of >30% compared with the preoperative intraocular pressure. Results: There were 22 eyes in the viscotrabeculotomy with anterior chamber irrigation and 21 eyes in the Ahmed glaucoma valve implantation group. The mean preoperative and postoperative intraocular pressure in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 35.5 ± 2.6 mmHg and 35.5 ± 2.4 mmHg and 16.9 ± 0.7 mmHg and 17.9 ± 0.9 mmHg respectively (p˂0.0001). There was a statistically significant intraocular pressure reduction at all follow-up time points compared to preoperative values (p˂0.0001) in both groups. The unqualified success rate in the viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation groups were 72.73% and 61.9%, respectively. A minimal self-limited hyphema was the most common complication. Conclusions: Both viscotrabeculotomy with anterior chamber irrigation and Ahmed glaucoma valve implantation are effective in lowering the intraocular pressure in glaucoma after silicone oil removal with viscotrabeculotomy with anterior chamber irrigation providing greater reduction, higher success rates, and minimal complications.
RESUMO Objetivo: Comparar a viscotrabeculotomia com irrigação da câmara anterior com o implante de válvula de glaucoma de Ahmed para glaucoma secundário após remoção de óleo de silicone. Métodos: Foi realizado um estudo prospectivo de 43 olhos pseudofácicos vitrectomizados com glaucoma persistente após a remoção de óleo de silicone. Os pacientes foram randomizados para viscotrabeculotomia com irrigação da câmara anterior ou implante de válvula de Ahmed. Todos os pacientes foram examinados no primeiro dia, na primeira semana e 1, 3, 6, 9, 12, 18 e 24 meses após a cirurgia. Observaram-se complicações pós-operatórias. O sucesso foi definido como uma pressão intraocular entre 6 e 20 mmHg e uma redução da pressão intraocular >30% em comparação com a pressão intraocular pré-operatória. Resultados: Foram designados 22 olhos para o grupo da viscotrabeculotomia com irrigação da câmara anterior e 21 olhos para o grupo do implante de válvula de Ahmed. A pressão intraocular média pré-operatória foi de 35,5 ± 2,6 mmHg para o grupo da viscotrabeculotomia com irrigação da câmara anterior e pós- e de 35,5 ± 2,4 mmHg no grupo do implante de válvula de Ahmed. e Os valores pós-operatórios foram de 16,9 ± 0,7 mmHg e 17,9 ± 0,9 mmHg para esses mesmos grupos, respectivamente (p<0,0001). Ambos os grupos tiveram uma redução estatisticamente significativa da pressão intraocular em relação aos valores pré-operatórios (p<0,0001) em todos os momentos do acompanhamento. A taxa de sucesso não qualificado nos grupos da viscotrabeculotomia com irrigação da câmara anterior e do implante de válvula de Ahmed foi de 72,73% e 61,9%, respectivamente. A complicação mais comum foi o hifema, autolimitado e mínimo. Conclusões: Tanto a viscotrabeculotomia com irrigação da câmara anterior quanto o implante de válvula de Ahmed são eficazes na redução da pressão intraocular no glaucoma após injeção de óleo de silicone, mas a viscotrabeculotomia com irrigação em câmara anterior proporcionou maior redução da pressão intraocular e maiores taxas de sucesso, com complicações mínimas.
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Purpose: To explore the visual field (VF) changes two years following augmented trabeculectomy. Methods: A retrospective study of patients who underwent augmented trabeculectomy surgery with mitomycin C by a single surgeon at East Lancashire Teaching Hospitals NHS Trust over 3 years. Patients with a minimum of two years postoperative follow?up were included. Baseline characteristics, intraocular pressure (IOP), VF, number of glaucoma medications, and complications were recorded. Results: In total, 206 eyes were included, 97 (47%) patients were female, and the mean age was 73.8 ± 10.3 (range 43 to 93) years. One hundred thirty?one (63.6%) eyes were pseudophakic before trabeculectomy. The patients were divided into three outcome groups according to VF outcome. Seventy?seven (37.4%) patients had stable VF, 35 (17.0%) patients showed VF improvement, and 94 (45.6%) had VF deterioration. The overall mean preoperative IOP was 22.7 ± 8.0 mmHg and postoperative IOP 10.4 ± 4.2 mmHg, with a reduction of 50.2% (P < 0.001). In total, 84.5% of postoperative patients did not require glaucoma medications. A higher number of patients with postoperative IOP ?15 mmHg had deteriorating VF (P < 0.001). Based on preoperative MD distribution, VF improvement or stability was more achievable with patients with a preoperative VF defect up to ?12 dB (n = 41, 59.4%) and in those with greater than ?24 dB (n = 25, 64.1%). Conclusion: Trabeculectomy continues to be an effective means of lowering IOP in patients with uncontrolled glaucoma and is important in stabilizing or improving visual fields. We recommend early trabeculectomy to prevent further VF deterioration. This may help in maintaining VF for driving status and, thus, quality of life
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Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti?glaucoma medication use and compare it with the age?matched normal population. Methods: Objective clinical evaluation was done by tear film break?up time (TBUT) and Schirmer’s test (ST) in the three groups– trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ?10), chronic anti?glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty?six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.
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Purpose: To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Methods: Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A? trabeculectomy and group B? medication + minor surgery. Results: A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Conclusion: Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.
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Purpose: Consensual eye intra?ocular pressure (IOP) increase has been reported following ipsilateral glaucoma surgery. The study evaluated the need for increase in anti?glaucoma medications (AGM) ± glaucoma surgery to control the IOP in consensual eye following unilateral glaucoma surgery. Methods: Data of 187 consecutive patients who underwent either trabeculectomy or AGV implant were collected. Index (IE) and fellow eye (FE) IOP (baseline, follow?up day 1, week 1, months 1 and 3), acetazolamide and AGM use, FE surgery, glaucoma status, and relevant ophthalmological data were collected. Results: A significant increase from a baseline IOP of 14.4 mmHg was noted at week 1 (15.8 mmHg, p?0.005) and month 1 (15.62 mmHg, p?0.007) in FE (n?187). Among the 61 patients (33%, n?187) who needed additional intervention to reduce FE IOP, 27 (14.4%) underwent FE trabeculectomy. In the IE trabeculectomy group (n?164), significant increase in FE IOP was noted in week 1 (15.87 mmHg, p?0.014) and month 1 (15.61 mmHg, p?0.02), and in the IE AGV group (n?23) at day 1 (15.91 mmHg, p?0.06). Pre?operative acetazolamide resulted in significant increase in FE IOP at week 1 and month 1. Maximum increase in FE IOP of nearly 3.5 mm Hg was noted when IE IOP was persistently <5 mmHg at one month following surgery. Mean FE IOP remained elevated at all visits. Conclusion: An increase in fellow eye IOP needing any additional intervention in a third and surgical intervention in nearly a sixth meant that FE IOP be strictly monitored and addressed following unilateral glaucoma surgery
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Objetivo: Evaluar la seguridad de facoemulsificación asociada a la trabeculectomía gonioasistida modificada con tijeras. Métodos: Estudio experimental de intervención en 103 ojos (103 pacientes) con glaucoma primario de ángulo abierto. Se realizó facoemulsificación y trabeculectomía gonioasistida modificada con tijeras (51 ojos, casos) y facoemulsificación- trabeculectomía estándar (52 ojos, controles). En los casos se requirió tijera y pinza vítreo-retinal y se resecó trabéculo por abordaje interno. Se evaluó la agudeza visual, el astigmatismo inducido, la pérdida de células endoteliales y la aparición de complicaciones quirúrgicas en ambos grupos a los tres meses de seguimiento posoperatorio. Resultados: La AVSC se incrementó en ambos grupos a los tres meses postoperatorios. Sin embargo, fue mayor para la FACO-TGAM (0,81 ± 0,16vs. 0,71 ± 0,16), con diferencias significativas (p= 0,002). El astigmatismo inducido fue significativamente mayor en el grupo control (0,53 ± 1,14Dvs.1,8 ± 1,20D (p< 0.001). Las complicaciones quirúrgicas posoperatorias fueron más frecuentes en el grupo control (57 por ciento vs. 73 por ciento p= 0,14). La pérdida de células endoteliales no mostró diferencias significativas (p= 0,82). Conclusiones: La recuperación visual y el menor número de complicaciones ubican la facoemulsificación y trabeculectomía gonioasistida modificada con tijeras como técnica de elección para el tratamiento de pacientes con catarata y el glaucoma primario de ángulo abierto(AU)
Objective: To evaluate the safety of phacoemulsification associated with modified gonio-assisted trabeculectomy with scissors. Methods: Experimental intervention study in 103 eyes (103 patients) with primary open-angle glaucoma. Phacoemulsification and modified gonioassisted trabeculectomy with scissors (51 eyes, cases) and standard phacoemulsification-trabeculectomy (52 eyes, controls) were performed. In the cases, scissors and vitreoretinal forceps were required and trabeculum was resected by internal approach. Visual acuity, induced astigmatism, loss of endothelial cells and the appearance of surgical complications were evaluated in both groups at three months postoperative follow-up. Results: The uncorrected visual acuity increased at three postoperative months in both groups, however it was higher for the PHACO-TGAM (0.81 ± 0.16 vs 0.71 ± 0.16); with significant differences (p = 0.002). Induced astigmatism was significantly higher in the control group (0.53 ± 1.14 D vs. 1.8 ± 1.20 D, (p < 0.001). Postoperative surgical complications were more frequent in the control group (57 percent vs 73 pèrcent, p = 0.14), the endothelial cell loss did not show significant differences (p = 0.82). Conclusions: the visual recovery and the lower number of complications place phacoemulsification and modified gonio-assisted trabeculectomy with scissors as the technique of choice for the treatment of patients with cataract and primary open-angle glaucoma(AU)
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Humans , Trabeculectomy/methods , Phacoemulsification/methodsABSTRACT
Background: The introduction of mitomycin C (MMC) as an adjunct to trabeculectomy was a major advance in the ability to improve the Intra ocular pressure lowering efficiency of the procedure. The time tested traditional way of administration of MMC is via a sponges soaked in it, duration and concentration varies depending on risk of failure. A subconjunctival injection of MMC instead of these sponges is recently being used as a promising alternative. Purpose: Here is the video demonstrating the 2 possible ways to prepare and apply MMC during a trabeculectomy surgery. Synopsis: Intraoperative injection of MMC in trabeculectomy has several advantages over conventional method ofsponge application. A large MMC treatment area produces more diffuse and elevated blebs. Large-area MMC application also seems to increase long-term success without increasing the complication rates in trabeculectomies. Direct and diffuse application of MMC by injection may promote less scarring and vascularization of the bleb. To achieve the same surface area of exposure with sponges, i.e.achieved with injection, the surgeon must use multiple sponges, all of which must be carefully collected thereafter. The injection method,therefore,eliminates the risk of retained sponges. Highlights: injection of MMC may be as safe and as effective as conventional sponge application of MMC with comparable estimated complete treatment success with relatively lower complication rates
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The purpose of this article is to evaluate the effectiveness of collagen crosslinking of filtering blebs with 0.1% riboflavin stimulated with ultraviolet A radiation in a case of a thin-walled filtering bleb with leakage following an episode of late blebitis. The time to cessation of the bleb leakage was studied, as well as the intraocular pressure, the visual acuity, and the presence of adverse effects during 4 years of follow-up after treatment. A single session of crosslinking was effective in resolving the leakage of the filtering bleb. There were no adverse effects. The intraocular pressure and the visual acuity remained stable after 4 years of follow-up. Collagen crosslinking with 0.1% riboflavin stimulated with ultraviolet A radiation may prove to be a simple, painless, non-invasive, and repeatable treatment of the leaking bleb with the aim of strengthening the collagen fibers of the conjunctiva and avoiding more invasive surgical treatments.
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Objective:To investigate the curative effect of endoscopic cyclophotocoagulation combined with trabeculectomy for primary open angle glaucoma.Methods:From January 2020 to May 2021, 30 eyes of 30 patients with advanced primary open angle glaucoma with cataract who underwent endoscopic cyclophotocoagulation combined with trabeculectomy in the Municipal Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The preoperative best corrected visual acuity, preoperative intraocular pressure (IOP) and numbers of anti-glaucoma medication were recorded. IOP, numbers of anti-glaucoma medication at 1 day, 3 months, 6 months and 1 year after operation, postoperative complications, the numbers of absolute success and qualified success were recorded.Results:All cases were followed up for 1 year. The best corrected visual acuity improved by more than one line in 26 eyes at 1 year after operation. Preoperative visual acuity was maintained in 3 eyes visual acuity decreased in 1 eye. The IOP and numbers of anti-glaucoma medication at 1 day, 3 months, 6 months and 1 year after operation were significantly different from those before operation ( P<0.01). At 1 year after operation, 8 patients were qualified successful and 17 patients were absolutely successful. Early hyphema in 30 eyes, transient ocular hypertension in 3 eyes ciliary body detachment in 0 eyes, corneal edema in 9 eyes, and anterior chamber exudation in 8 eyes. Conclusions:In this small sample size of study with follow-up for 12 months, the results showed that endoscopic cyclophotocoagulation combined with trabeculectomy in the treatment of advanced open angle glaucoma has good preliminary efficacy and safety. However, a large sample of cases is still needed to further study its long-term safety and efficacy.