ABSTRACT
Purpose: To analyze the ocular surface changes in eyes after the withdrawal of anti?glaucomatous drugs when non?penetrating deep sclerectomy (NPDS) is performed. Methods: Thirty?one patients (33 eyes) diagnosed with glaucoma that underwent NPDS were included in this prospective study. The control group included 33 eyes. Four variables were studied using Keratograph 5M (K5M): ocular hyperemia (OH), non?invasive tear film break?up time (NI?BUT), lower tear meniscus height (LTMH), and meibography. LTMH was also measured using the anterior segment module of a Spectralis Fourier?domain optical coherence tomography (FD?OCT) instrument. Moreover, an evaluation of corneal and conjunctival staining was performed. In the glaucoma group, five visits were carried out: pre?surgery, 1 week after surgery, and 1 month, 3 months, and 6 months after surgery. In control groups, examinations were performed in only one visit. In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ?25) before and 6 months after surgery. Results: Before NPDS, eyes showed worse objective data than healthy control subjects (P ? 0.049). In this group, a significant improvement was observed in questionnaire responses (P < 0.001), LTMH?FD?OCT (P = 0.037), LTMH?K5M (P = 0.025), K5M?OH (P = 0.003), NI?BUT (P = 0.022), and conjunctival and corneal staining (P < 0.001). No significant differences were observed between groups in FD?OCT and K5M LTMH, NI?BUT, corneal?conjunctival staining, nor in the most OH sector values at 6 months (P ? 0.62). Conclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawal of the topical anti?glaucomatous treatment had a beneficial effect on the subjects
ABSTRACT
El tratamiento del glaucoma se realiza con el objetivo de disminuir los niveles de presión intraocular, único factor tratable hasta el momento, y debe ser individualizado. Se presenta un paciente masculino de 54 años de edad, de piel mestiza, intelectual, con antecedentes de aparente salud y diagnóstico de glaucoma desde hace 10 años. Se realizó trabeculectomía con antimetabolito (mitomicina C) en el ojo izquierdo en el año 2012 por daño glaucomatoso avanzado. En el año 2016 acudió a nuestra consulta y refirió mala visión y descontrol de la presión intraocular de ambos ojos. Se constataron cifras muy elevadas de presión intraocular en ambos ojos, superiores a 30 mmHg; en el ojo derecho la unidad de visión con su mejor corrección y un daño campimétrico muy avanzado limitado a una isla de visión central con caída hasta los 5° centrales, y el ojo izquierdo no alcanzaba la percepción luminosa. Después de combinar 3 líneas farmacológicas con la dosis máxima, los valores de la presión intraocular no eran protectores. Surgió la disyuntiva entre realizar una cirugía filtrante, temiendo al riesgo quirúrgico elevado y tratándose de un ojo único, o no practicar cirugía alguna y solo continuar con el tratamiento farmacológico a pesar de no conseguirse valores de presión intraocular meta. Se decidió realizar esclerectomía profunda no penetrante con antimetabolito (mitomicina C al 0,02 por ciento). No se presentaron complicaciones asociadas y se consiguió el descenso de la presión intraocular a 24 mmHg, por lo que al mes de la cirugía se realizó goniopuntura. Se obtuvo la presión intraocular objetivo, sin progresión del daño glaucomatoso y hubo conservación de la agudeza visual(AU)
Treatment for glaucoma is aimed at reducing the levels of intraocular pressure. This is the only factor that may be treated so far, and it should be individualized. A case is presented of a male 54-year-old mulatto patient, intellectual, with a history of apparently good health who was diagnosed with glaucoma ten years ago. Trabeculectomy with antimetabolite (mitomycin C) was performed on the patient's left eye in the year 2012 due to advanced glaucomatous damage. In the year 2016 the patient attended our service and reported poor vision and uncontrolled intraocular pressure in both eyes. Very high intraocular pressure values above 30 mmHg were confirmed in both eyes. In the right eye the vision unit with its best correction, and very advanced campimetric damage limited to a central vision island with a fall to 5° central, whereas the left eye did not achieve light perception. After combining 3 drug lines at their maximum dosage, intraocular pressure values were not protective. The dilemma arose whether to perform filtration surgery, fearing the high surgical risk, being as it was a single eye, or not to perform any surgery and just go on with the drug treatment despite not having achieved target intraocular pressure values. It was decided to perform non-penetrating deep sclerectomy with antimetabolite (0.02 percent mitomycin C). No associated complications occurred and intraocular pressured fell to 24 mmHg. Therefore, goniopuncture was performed one month after surgery. The target intraocular pressure was obtained without glaucomatous damage progression and visual acuity was preserved(AU)
Subject(s)
Humans , Male , Middle Aged , Trabeculectomy/methods , Mitomycin/therapeutic use , Intraocular Pressure/drug effects , Glaucoma/diagnosis , Glaucoma/therapyABSTRACT
@#AIM: To study the changes in higher-order aberrations following non-penetrating deep sclerectomy surgery augmented with sub-Tenon injection of mitomycin C(MMC)in patients with open angle glaucoma<p>METHODS: Twenty eyes from 20 patients were enrolled in the study. There were 10 eyes with primary open angle glaucoma(POAG)and 10 eyes with secondary open angle(SOAG; pseudoexfoliation). Patients underwent non-penetrating deep sclerectomy surgery augmented with sub-Tenon injections(0.2 mL of MMC 0.02%)before surgery. All patients were evaluated in terms of corneal total higher-order aberrations <i>via</i> i-Trace analyzer before surgery and 1mo and 3mo after surgery. The intraocular pressure(IOP), best corrected visual acuity(BCVA), and bleb morphology were evaluated at each visit. The success rate of surgery was categorized as complete, relative, or failure.<p>RESULTS: The IOP before surgery was 24.05±3.07 mmHg with a mean of 2.85±0.67 medication, which reached to 12.30±3.32 mmHg with 0.70±0.98 medication at the 3mo follow-up. The reduction in IOP was significant at all periods of the follow-up(<i>P</i><0.001). The values of total higher-order total(HOT)root mean square(RMS)and total ocular spherical-like aberrations significantly increased at 1mo follow-up after surgery and decreased over the course of 3mo. Trefoil and total ocular coma-like aberration changes were not statistically significant at all periods after surgery. The HOT RMS, coma-like and spherical-like corneal increased significantly 1mo after surgery and decreased at the 3mo follow-up. Corneal trefoil changes were not statistically significant after surgery compared to preoperative state. Patients age and IOP did not have a significant effect on changes in HOT and corneal HOT aberrations.<p>CONCLUSION: Corneal and ocular higher-order aberrations increased within 1mo after deep sclerectomy surgery and then decreased over a 3mo period, which showed no statistically significant change compared to preoperative state. The BCVA and spherical equivalent(SE)of the patients shown no statistically significant differences compared to the preoperative state at the 3mo follow-up.