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Background: Glaucoma is one of the major causes of irreversible blindness in the world, with trabeculectomy still being the primary surgical modality for the management of glaucoma. Glaucoma drainage devices (GDDs) have been conventionally used for the treatment of refractory glaucoma and are found to be beneficial in eyes with prior unsuccessful filtration surgeries and primary choice of surgery in certain glaucoma. Aurolab aqueous drainage implant (AADI) is a nonvalved device useful in refractory glaucoma to achieve low intraocular pressure (IOP). The device has been commercially available in India since 2013 and is like the Baerveldt glaucoma implant in design and function. AADI being the most economical and effective GDD in controlling IOP is becoming a popular choice among ophthalmologist in developing countries. AADI surgery has steep learning curve due to large end?plate surface area which needs a rigorous conjunctival dissection, muscle hooking, meticulous plate fixations, and careful tube ligations and insertion. There are different techniques of performing AADI surgery, but the authors have tried to simplify the complex surgery for easy and catchable learning of the procedure by novice surgeon with their experience and have elaborated a step?wise most effective way of performing surgery. Purpose: This video?based skill transfer depicts steps of AADI surgery with compilation of various modifications and authors’ tips and tricks to novice surgeons. Synopsis: This video depicts detailed steps of AADI surgery with micro?points and authors experience. Video also shows various tailor?made modifications of surgical techniques for different case scenarios. Highlights: Steps of AADI surgery, modifications, and surgical pearls.
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Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.
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Objective@#To describe a novel glaucoma drainage device fashioned from a scleral buckle and nasolacrimal silicone tube. @*Method@#This is a case report and a description of a surgical technique.@*Results@#A 6-year-old boy with congenital glaucoma who underwent 2 failed filter surgeries had medically uncontrolled intraocular pressures (IOP). Due to limited funds for a second glaucoma drainage device, the author utilized a portion of a scleral buckle and nasolacrimal silicone tube – the same raw materials used in the Schocket implant – to fashion a novel, non-valved glaucoma shunt that was implanted in the patient’s eye. Post-operatively, IOP was 8-10mmHg. This was sustained for 12 months without the need for supplemental anti-glaucoma medications. Postoperative complications included tube migration resulting in localized corneal decompensation and cataract formation. @*Conclusion@#The alternative GDD made from a portion of a scleral buckle and silicone tube may be an effective and economical alternative to the GDDs available in the market.
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Purpose: This study was conducted to assess the intraocular pressure (IOP) control and postoperative complications following a non?valved glaucoma drainage device (GDD) surgery in refractory glaucoma. Methods: This was a prospective interventional study conducted on patients with glaucoma refractory to maximal medications or failed surgical treatment who underwent Aurolab aqueous drainage implant (AADI; Aurolabs, India) surgery. Primary outcome measures were IOP control, postoperative complications, and reduction in the number of antiglaucoma medications (AGM). Results: Thirty-four eyes were analyzed and the mean follow?up was 16.06 ± 5.63 months. The preoperative median (Q1, Q3) IOP was 31 mmHg (28, 36.5) which decreased to 12 mmHg (12, 14) at 6 months postoperatively. The median (Q1, Q3) number of AGMs decreased from 3 (3, 4) to 0 (0, 1). Significant complications like implant extrusion and tube exposure were noted in two eyes. The total success and failure rates at 6 months were 91.1% and 8.8%, respectively. Conclusion: AADI is effective in achieving target IOP and significantly reduces the use of AGMs with good safety in the short term. Long?term follow?up studies are needed to assess long?term IOP control and cost?effectiveness.
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Objective@#We described an adjustable traction technique for glaucoma surgeries that provided adequate visualization of the surgical field.@*Methods@#A prototype device was designed to provide good exposure of the surgical site by using a peripheral lamellar trans-corneal suture capable of applying and sustaining tension. Adjustments to the amount of traction required were made through the device.@*Results@#The device was used in 9 cases of glaucoma surgeries: 5 trabeculectomies and 4 glaucoma drainage device implantations. No significant complications were observed.@*Conclusions@#The device was easy to use and allowed more flexibility for the surgeon.
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Glaucome , TrabéculectomieRésumé
@#AIM: To investigate the effect of conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation for neovascular glaucoma(NVG)with and without vitreous hemorrhage.<p>METHODS: In this retrospective study, 39 eyes in 37 patients who were diagnosed with NVG with and without vitreous hemorrhage(where iridotrabecular contact is more than 180°)in the ophthalmology department of Xi'an No.1 Hospital between January 2016 and December 2017 were enrolled in this study. Patients were divided into two groups, based on whether they had vitreous hemorrhage. All patients received 0.5 mg(0.05 mL)conbercept intravitreal injection. Twenty-one eyes in 20 patiants(Group 1)without vitreous hemorrhage received EX-PRESS(P50)glaucoma drainage device implantation on 4d after conbercept intravitreal injection and then received panretinal photocoagulation 2wk after implantation. Eighteen eyes in 17 patients(Group 2)with vitreous hemorrhage received vitrectomy combined with the EX-PRESS(P50)glaucoma drainage device implantation and panretinal photocoagulation on 4d after conbercept intravitreal injection. Air or silicone oil was selectively filled according to the situation during the operation. All patients were followed up for 6mo after operation.<p>RESULTS: No statistical difference was found between preoperative best corrected visual acuity(BCVA)and postoperative(6mo)BCVA in Group 1(<i>P</i>>0.05). There was statistical difference between preoperative BCVA and postoperative(6mo)BCVA in Group 2(<i>P</i><0.05). The intraocular pressure( IOP)of Group 1 at postoperative 1d, 1wk, 1, 3 and 6mo was 20.5±4.3 mmHg, 19.6±3.8 mmHg, 20.1±3.7 mmHg, 19.9±4.2 mmHg, and 19.3±2.9 mmHg, respectively. The postoperative IOP of Group 2 was 22.3±3.7 mmHg, 20.6±2.8 mmHg, 20.4±3.8 mmHg, 18.9±4.1 mmHg, and 19.3±3.4 mmHg, respectively. The postoperative IOP of every time point was significantly lower than the preoperative IOP in Group 1 and Group 2(<i>P</i><0.05). During the follow up, three eyes in three patients showed a recurrence of iris neovascularization and were given one more 0.05 mL conbercept intravitreal injection. <p>CONCLUSION: Conbercept intravitreal injection combined with glaucoma drainage device implantation and panretinal photocoagulation can effectively reduce IOP in NVG(where the iridotrabecular touch is more than 180°).
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We describe a case of 34-year-old male with post penetrating keratoplasty glaucoma, post trabeculectomy with aphakia in the only seeing eye, in which a modified surgical technique of inserting Ahmed glaucoma valve (AGV) tube in vitreous cavity was done to reduce the risks associated with pars plana incision during pars plana vitrectomy (PPV). A hybrid 20-25 gauge PPV was done concurrently, implant fixed to sclera, and tube inserted through the 25 gauge sclerotomy port in supero-temporal quadrant. Visual acuity and intraocular pressure remained stable during 1-year follow-up.
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@#AIM: To observe the clinical efficacy and safety of new EX-PRESS glaucoma drainage device implantation combined with ranibizumab drugs in the treatment of neovascular glaucoma(NVG).<p>METHODS: A total of 78 patients(78 eyes)who were diagnosed with neovascular glaucoma and underwent intravitreal injection of ranibizumab drugs in our hospital from June 2015 to June 2018 were selected. Sixty patients with complete follow-up data were randomly divided in the experimental group(A), 30 patients(30 eyes)underwent EX-PRESS glaucoma drainage device implantation. Postoperative complications were observed early, visual acuity and intraocular pressure were observed at 1wk, 1mo, 3mo, 6mo and 1a, and the success rate of the operation was evaluated at 6mo and 1a. <p>RESULTS:After 1wk, 1, 3mo, 25 eyes, 25 eyes and 23 eyes with BCVA <0.1 in the experimental group, the average intraocular pressure was 16.76±3.21mmHg, 15.63±2.70mmHg and 16.69±3.29mmHg, the control group was 26 eyes, 26 eyes and 25 eyes, the average IOP was 17.31±2.96mmHg, 14.44±2.53mmHg and 16.56±4.14mmHg(all <i>P</i>>0.05); 6mo after operation, 16 eyes and 16 eyes in the 1a test group with BCVA <0.1 were the average IOP 15.49±3.19mmHg, 18.52±4.03mmHg, the control group was 25 eyes and 25 eyes, the average intraocular pressure was 21.96±2.90mmHg, 28.90±4.33mmHg(all <i>P</i><0.05); the experimental group had low intraocular pressure, shallow The number of cases of anterior chamber, anterior chamber hemorrhage, inflammation, choroidal detachment were 0 eyes, 1 eyes, 2 eyes, 1 eyes, 0 eyes, while the control group were 6 eyes, 6 eyes, 5 eyes, 4 eyes, 2 eyes(<i>P</i><0.05); 6mo after operation in the experimental group, the success rate of 1a operation was 83% and 80%, while that in the control group was 60% and 53%, respectively(<i>P</i><0.05).<p>CONCLUSION: EX-PRESS glaucoma drainage implantation combined with ranibizumab drug treatment in the vitreous cavity can effectively reduce the intraocular pressure in patients with neovascular glaucoma and has the advantages of small surgical incision, simple operation, safety, fewer postoperative complications, and high success rate of surgery.
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Purpose: To report the intermediate-term safety and efficacy of Aurolab aqueous drainage implant (AADI) in patients with glaucoma. Methods: Retrospective review of patients who underwent AADI between January 2013 and December 2016. Patients aged >16 years and with a minimum follow-up of 6 months were included. Success was defined as complete when the intraocular pressure was ?6 and ?21 mmHg without antiglaucoma medication and as qualified if those requiring additional antiglaucoma medications were included. Results: The study included 55 patients (55 eyes) with a mean age � standard deviation (SD) of 47.3 � 18.1 years with a mean follow-up of 16.7 � 11.4 months. Mean intraocular pressure reduced from 30.8 � 11.1 mmHg to 13.1 � 4.7, 14.1 � 4.8, 15.7 � 2.5 (P < 0.001) mmHg at 6 months, 1 year, and 2 years, respectively. The mean number of antiglaucoma medications reduced from 3.4 � 1 to 0.8 � 1.2, 0.7 � 1.1, 0.8 � 1 (P < 0.001) at 6 months, 1 year, and 2 years, respectively. The cumulative probability of complete and qualified success was 62% and 100% at 6 months, 54% and 92% at 1 year, and 43% and 88% at 2 years, respectively. Four patients failed during the follow-up period. Postoperative complication occurred in 28 eyes (51%), of which 17 eyes (31%) required intervention. Conclusion: AADI is a safe and effective treatment for the control of intraocular pressure in patients with glaucoma.
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PURPOSE: To investigate the outflow characteristics of silicone tubes with intraluminal stents used in membrane-tube (MT) type glaucoma shunt devices. METHODS: The silicone tubes used in MicroMT (internal diameter of 100 µm with a 7-0 nylon intraluminal stent) and Finetube MT (internal diameter of 200 µm with a 5-0 nylon intraluminal stent) were connected to a syringe-pump that delivered a continuous flow of distilled water at flow rates of 2, 5, 10, and 25 µL/min. The pressures and resistances of tubes were measured at a steady flow rate with full-length, half-length, and absence of intraluminal stents. RESULTS: The mean outflow resistance of the two types of tubes ranged from 3.0 ± 1.9 to 3.8 ± 1.7 mmHg/µL/min with a full-length intraluminal stent, 1.8 ± 1.1 to 2.2 ± 1.1 mmHg/µL/min with a half-length intraluminal stent, and 0.1 ± 0.0 to 0.2 ± 0.0 mmHg/µL/min without an intraluminal stent. Theoretically, for a physiologic state with a flow rate of 2 µL/min and episcleral venous pressure of 6 mmHg, the mean pressures of tubes were expected to be 13.2 ± 3.0, 10.5 ± 2.4, and 6.4 ± 0.2 mmHg in MicroMT with full-length, half-length, and absence of intraluminal stents, respectively, and 12.5 ± 3.9, 9.6 ± 2.4, and 6.2 ± 0.2 mmHg in Finetube MT with full-length, half-length, and absence of intraluminal stents, respectively. The pressure variance also decreased with intraluminal stent retraction (p < 0.01). CONCLUSIONS: The small diameter tubes of 100 and 200 µm internal diameters, with 7-0 and 5-0 nylon intraluminal stents, respectively, used in the MT-type glaucoma shunt device showed safe and effective outflow characteristics.
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Glaucome , Hydrodynamique , Pression intraoculaire , Nylons , Silicium , Silicone , Endoprothèses , Pression veineuse , EauRésumé
Purpose: The purpose of the study is to report the outcomes of simultaneous cataract extraction (CE) and a new nonvalved glaucoma drainage device (GDD), Aurolab Aqueous Drainage Implant (AADI), in eyes with cataract and refractory glaucoma. Methods: This was a non-comparative, interventional, retrospective study. Consecutive patients who underwent AADI together with phacoemulsification from June-2015 to January-2017 by a single fellowship trained glaucoma surgeon with documented 3-months of follow-up were included. The main outcomes were intraocular pressure (IOP), antiglaucoma medication (AGM), visual acuity, and complications. Results: We included 19 eyes of 17 patients with average follow-up of 14.4 ± 8.4 months. IOP and AGM reduced from 36.9 ± 11.1 mmHg and 4 ± 0.8 preoperatively to 12 ± 4.5 mmHg and 0.8 ± 1.2, respectively (P < 0.001). Complications were seen in seven eyes (36.8%). Total success was seen in 17 eyes (89.5%). None of the patients lost vision. Conclusion: Combining cataract extraction with the new non-valved Aurolab Aqueous Drainage Implant, appears to be an effective and safe technique in eyes with refractory glaucoma and cataract. Larger studies and further follow-up is recommended for such patients.
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We present a case of tube endothelial touch where a suture technique for repositioning of the Ahmed glaucoma valve was performed. Advantage of this technique is that it is minimally invasive and anterior chamber stability is maintained during the procedure.
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@#AIM:To explore the effects of EX-PRESS glaucoma drainage device implantation and trabectome on visual acuity, intraocular pressure, central anterior chamber depth(ACD)and postoperative complications in patients with primary open angle glaucoma(POAG)complicated with cataract. <p>METHODS: The clinical data of 64 patients(64 eyes)with POAG complicated with cataract in our hospital from March 2015 to January 2017 were retrospectively analyzed. Among them, 34 patients(34 eyes)were given EX-PRESS glaucoma drainage device implantation and cataract phacoemulsification(the Group A)and another 30 cases(30 eyes)were given trabectome combined with cataract phacoemulsification(the Group B). The visual acuity \〖best corrected visual acuity(BCVA)\〗, intraocular pressure, ACD and the thickness of macular ganglion cell complex(GCC)were compared between the two groups before operation and at 5mo after operation, and the differences of postoperative complications were also recorded between the two groups. <p>RESULTS: At 5mo after operation, the BCVA, intraocular pressure(IOP)was lower than that before operation(<i>t</i> <sub>Group A</sub>=39.359, 21.045; <i>t</i> <sub>Group B</sub>=23.126, 16.863; <i>P</i><0.01), and the Group A was lower than that in the Group B(<i>t</i>=9.452, 2.761; <i>P</i><0.01). There was no significant difference in the ACD level before and after operation between-groups and within-groups(<i>P</i>>0.05). At 5mo after operation, there was no significant difference in the thickness of macular GCC in the Group A compared with that before operation(<i>P</i>>0.05), but the thickness of macular GCC in the Group B was lower than that before operation(<i>t</i>=3.851, <i>P</i><0.05)and was lower than that in the Group A(<i>t</i>=2.269, <i>P</i><0.05). The incidence rate of postoperative complications in the Group A was significantly lower than that in the Group B(<i>χ</i><sup>2</sup>=7.883, <i>P</i><0.05). <p>CONCLUSION: EX-PRESS glaucoma drainage device implantation or trabectome combined with cataract phacoemulsification can receive good treatment effects in treating POAG patients with cataract, but the former one has better effects on reducing IOP and improving visual acuity than those in the latter one. And EX-PRESS glaucoma drainage device implantation can reduce the incidence rate of postoperative complications, and it is also beneficial to the reduction of retinal ganglion cells(RGCs)damage and the disease prognosis.
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AIM:To compare the short-term and long-term curative effect between two implantation methods for treating refractory glaucoma.METHODS:A total of 150 patients with refractory glaucoma (150 eyes) were divided into Group A (treated by implantation with Ex-press glaucoma drainage device) and Group B (treated by implantation with Ahmed glaucoma valve) according to different implantation methods.Changes of intraocular pressure and anti-glaucoma drugs at different time points, the success rate of surgery, improvement of visual acuity and complications were compared between the two groups.RESULTS:The intraocular pressure of two groups at 1d, 1wk, 3, 6 and 12mo after surgery was significantly lower than that before surgery (P0.05).CONCLUSION:The effects of implantation with Ex-press glaucoma drainage device are similar to those of implantation with Ahmed glaucoma valve in the treatment of refractory glaucoma.However, the intraocular pressure control effect of the former is better than the latter, and used anti-glaucoma drugs are fewer.
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AIM: To evaluate intraocular pressure (IOP) control and visual rehabilitation after placement of the Ex-press(R)miniature glaucoma shunt with adjunctive amniotic membrane transplantation (AMT) and mitomycin C (MMC) in patients with post-traumatic open-angle glaucoma during 2y of follow up.METHODS: This was an interventional,2-year,observational study.Eighteen eyes were prospectively observed (in 18 patients with traumatic secondary open-angle glaucoma) in which Ex-press miniature glaucoma filtration shunts were implanted with AMT and MMC.The outcome measures included intraocular pressure (IOP),best corrected visual acuity (BCVA),number of antiglaucoma medications,and complications.The progress of all patients was monitored for 24mo.RESULTS: Complete success (IOP <21 mmHg without glaucoma medications) was seen in 15 of the 17 (88.2%) eyes enrolled in the study at 24mo after the operation.IOP decreased from 36.9±4.8 mmHg preoperatively to 15.4±3.5 mmHg at 12mo and 15.5±3.5 mmHg at 24mo postoperatively.Early postoperative hypertension developed in two patients (11.1%) due to postoperative fibrosis.Most of the patients had improved postoperative BCVA values at the final follow-up visit compared to their preoperative measurements.Two patients (11.1%) developed transient hypotony.There were no complications such as hyphema,choroidal effusion,shallow anterior chamber,the device touching the iris,or extrusion of the device.CONCLUSION: The Ex-press miniature glaucoma filtration shunt with adjunctive AMT and MMC is effective and safe in cases of traumatic open-angle glaucoma.Surgical management is an appropriate surgical treatment in this series of cases.
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AIM: To observe the clinical effect of combined cataract and primary open-angle glaucoma underwent phacoemulsification and glaucoma drainage device implantation. ·METHODS: We selected in our hospital from January 2014 to February 2016, 42 cases (42 eyes) with primary open-angle glaucoma with cataract. According to random number table method, all of the patients were randomly divided into two groups, control group and study group. In control group, 21 patients ( 21 eyes ) underwent trabecular resection combined phacoemulsification;in study group patients, 21 patients ( 21 eyes ) , underwent EX-PRESS glaucoma drainage device combined phacoemulsification. Compared parameters included postoperative complications and filtering bleb, visual acuity, intraocular pressure ( IOP ) and other clinical indicators between two groups. ·RESULTS: Preoperative IOP of two groups was no significantly different (P>0. 05). Postoperative IOP at each time point was significantly lower than before treatment (P 0. 05). At 12wk after treatment, surgical success rate of study group was 95%, significantly higher than that of control group 71% (P0. 05). At 12wk after treatment, 21 patients in study group were shown as functional filtering bleb, while in the control group 18 cases was functional filtering bleb. ·CONCLUSION:Using EX-PRESS glaucoma drainage device combined with phacoemulsification in treating cataract with primary open-angle glaucoma is reliable, the curative effect is better than that by trabeculectomy combined with phacoemulsification treatment.
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Refractory glaucoma is one of the main blinding diseases in ophthalmology.Glaucoma drainage device implantation has become one of the main methods of refractory glaucoma.It has been widely used in clinic because of its advantages of safety,effectiveness and less complications.After a large number of clinical applications and innovative development of minimally invasive glaucoma surgery,glaucoma drainage device implantation shows its good treatment prospects.In this paper,the structural features of glaucoma external drainage device (Molteno,Schocket,Baerveldt,Human aqueous drainage,Krupin,Ahmed,Joseph,Whites,Optimed drainage device) and microin vasive glaucoma surgery (MIGS) (Ex-PRESS drainage device,Xen Gel Stent,CyPass Micro-Stent,Ab interno trabeculectomy trabectome,Hydrus Schlemm canal scaffold,iStent trabecular micro-bypass stent,SOLX Gold Shunt) were summarized.The drainage device implantations for glaucoma in the role of the refractory glaucoma were reviewed.
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@#AIM: To explore the efficacy of Ex-press glaucoma drainage device on open-angle glaucoma. <p>METHODS: We collected the clinical data of those patients who were diagnosed as open angle glaucoma and had undergone Ex-press glaucoma drainage device implantation or trabeculectomy in the Second Hospital of Anhui Medical University from January 2014 to May 2016. The data of patients was collected and used to make a comparison involving sex, ages, best corrected visual acuity(BCVA), intraocular pressure(IOP), the amount of corneal endothelium cells and complications before and after operations. <p>RESULTS: There was no significantly different(<i>P</i>>0.05)between the Ex-press group and trabeculectomy group on postoperative BCVA at 6mo. Both groups had obvious effects on the drop of IOP after operations(<i>P</i><0.001), but there was no difference between the two groups at any time after operations. Ex-press group had no significant difference at 6mo while it had in the trabeculectomy group about the amount of corneal endothelium cells comparing with preoperative. The incidence rate of overall complications about Ex-press group and trabeculectomy group was 15% and 43% respectively, it had a significant difference between two groups(<i>P</i><0.05). <p>CONCLUSION: The Ex-press glaucoma drainage device had similar efficacy with lower complication rate and smaller influence of corneal endothelium cells comparing with trabeculectomy.
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Objective@#To identify the risk factors for conjunctival tube erosion (CTE) in eyes implanted with Ahmed® glaucoma valve (AGV) device@*Method@#This is a retrospective study conducted at a private eye institution. Medical records of patients who underwent AGV implantation surgery from January 2004 to December 2013 were reviewed. Eyes with at least 24 months of follow-up and complete records were included. Several variables from the pre-, intra-, and postoperative periods were collected. The primary outcome was development of CTE after AGV surgery. Univariable logistic regression and multivariable analysis were employed.@*Results@#Forty-six (46) eyes of 45 patients were included in the study. The mean follow-up was 50.2 months (range: 24-140 months). Eight (8) eyes developed CTE (17.4%). Univariable logistic regression analysis identified female gender (P =0.064), presence of diabetes (P =0.083), prior intraocular surgeries (P =0.09), and postoperative use of antiglaucoma medications (P =0.086) to be marginally significant risk factors for CTE. On multivariable analysis, only female gender (OR=15.4, P =0.033) and diabetes (OR=14.1, P =0.031) were found to be significantly associated with CTE.@*Conclusion@#Risk factors for CTE following AGV implantation include female gender and presence of diabetes.