Trends in operating room-based glaucoma procedures at a single eye center from 2016-2020.

AIM: To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016-2020. METHODS: A retrospective search of all glaucoma procedures performed at our institution were performed. Data were analyzed by calculating the absolute numbers and relative weightage of each procedure per year. RESULTS: The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y, and 55% were women. From 2016 to 2019, the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460, although it decreased slightly in 2020 (n=1393), probably due to the COVID-19 pandemic. The number of trabeculectomies did not change significantly in 2016 (n=161) to 2018 (n=164) but decreased in 2019 (n=139) to 2020 (n=121), indicating a reduction in its relative weightage among glaucoma procedures (from 21.50% to 8.69%). The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased (50 and 58 respectively in 2019), except in 2020. The number of transscleral cyclophotocoagulation procedures was relatively stable, increasing until 2017 (n=218) and then decreasing. Cataract surgeries with or without glaucoma procedures accounted for a large number of the total surgeries, increasing from 247 (32.97%) in 2016 to 967 (69.42%), among which cataract extraction combined with goniosynechialysis was the most frequent. CONCLUSION: The overall increase in the number of operating room-based surgical procedures is significant. Trabeculectomy is one of the most commonly performed procedures, despite the relative decline in its weightage. Other procedures, including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries, are gaining greater acceptance. Notably, lens-related surgery plays an important role in glaucoma management.

Changes to glaucoma surgery patterns during the coronavirus disease 2019 pandemic: a shift towards less invasive procedures.

PURPOSE: The aim of the study was to compare the quantity, type of glaucoma surgeries, and the disease stage before and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This was a retrospective, single-centre consecutive case series that included medical records of patients who underwent glaucoma surgery at the University Hospital in Bialystok between 4 September, 2018, and 3 March, 2020 (pre-pandemic group) and compared it with patients treated between 4 March, 2020, and 4 September, 2021 (pandemic group). Adult patients with primary or secondary open-angle or closed-angle glaucoma who underwent surgery were included in this study. Finally, 534 operated eyes (362 and 172 eyes operated on before and during the pandemic, respectively) were examined. RESULTS: The number of glaucoma surgeries dropped by 50% during the pandemic compared to a similar pre-pandemic period, with a significant difference in the kind of procedure between the two groups (p < 0.001). The most common procedures in the pre-pandemic group were Ex-Press implantation (33.7%) and trabeculectomy (31.5%). Within the pandemic group, half of the eyes underwent trabeculectomy (50.0%), followed by Preserflo microshunt (11.6%), iStent (8.7%), and transscleral cyclophotocoagulation (TSCP) (8.7%). A significant difference in the average intraocular pressure was revealed among patients who qualified for surgery. CONCLUSION: The COVID-19 pandemic is associated with a decrease in the number of extended antiglaucoma procedures and an increase in the number of short procedures performed, such as TSCP and minimally invasive glaucoma surgery.Key MessagesOur study has shown the negative impact of the COVID-19 pandemic in reducing the number of antiglaucoma procedures.The number of glaucoma surgeries dropped by 50% during the pandemic compared to those in a similar pre-pandemic period, and the type of performed procedures has changed.The COVID-19 pandemic is associated with a decrease in the number of combined antiglaucoma procedures, in opposite: the number of minimally invasive glaucoma surgeries increased due to safety reasons.

Can SLT safely delay surgery in presurgical primary open angle glaucoma?

Purpose : Selective laser trabeculoplasty (SLT) has been widely used as both a primary and adjunct treatment in glaucoma. Glaucoma surgery was significantly affected during the Covid-19 pandemic due to reduced theatre and clinic capacity. We looked at SLT as a temporary alternative to safely delay surgical intervention in presurgical primary open angle glaucoma (POAG). Methods : This is a retrospective study that included 104 patients who had a diagnosis of POAG and received SLT treatment, with at least 1 year follow-up. Primary outcomes included: reduction in intraocular pressure (IOP), and number of glaucoma medications (NGM). The endpoint was defined as time to be listed for glaucoma surgery. All eyes that had progressive or advanced visual fields and were on 2 or more medications were included. Eyes with previous glaucoma filtration surgery or argon laser trabeculoplasty, diagnosed with normal tension glaucoma or that had significant angle closure disease (peripheral anterior synechiae >180) were excluded. Results : The mean patient age was 73.4 ± years. At baseline, the mean IOP and NGM were 20.5 ± 4.9 and 2.8 ± 0.9 mmHg, respectively. At 12 months, the mean IOP was 16.5 ± 3.3 mmHg and the NGM was 2.7 ± 1.0. The IOP reduction was 3.7 ± 5.8 mmHg (14.5%, p<0.01) at 12 months follow-up, 3.4 ± 4.7 mmHg (15.5%, p<0.01) at 24 months follow-up, 3.7 ± 5.2mmHg (15.2%, p<0.01) at 36 months follow-up and 2.5 ± 5.9 mmHg (10.1%, p=0.04) at 48 months follow-up. No surgical intervention was needed in 96% of eyes within the first year of SLT. There was no significant difference in the NGM pre- and post- SLT. Conclusions : With the current pandemic limiting the surgical capacities of eye hospitals, SLT can safely delay the need for glaucoma surgery for at least 1 year by reducing the IOP. This is particularly apparent in elderly patients or those poorly compliant to medical therapy. In addition, this could increase ophthalmology clinic capacity by reducing the number of post-operative follow ups.

Minimally Invasive Glaucoma Surgery WetLab: A Follow-Up Needs Assessment Survey for Ophthalmology Residents

Purpose : In 2012 Saheb and Ahmed found that minimally invasive glaucoma surgeries (MIGS) lower intraocular pressure, decrease dependence on medications, and have an excellent safety profile. In 2017 75.5% of glaucoma surgeries performed in the US on Medicare patients 65 years or older in the US were MIGS. A 2020 study surveyed US program directors and found that both didactics and wet labs are used for resident training in MIGS. However, 37% of program directors did not feel that the experience was adequate for independent practice and only 27% felt that MIGS should be an ACGME requirement.<span style='font-size:10.8333px'> </span>Since 2017 Loyola's citywide annual microsurgical wet lab for six Chicago residencies has focused on hands-on training in MIGS to meet the increasing interest amongst residents. During COVID-19, Loyola continued to host our annual wet lab, providing MIGS training virtually. The purpose of this study was to assess residents' perspectives of their current MIGS training and how residents' perspectives have changed since 2017. Methods : In 2017 and 2020 respectively, 31 and 44 residents of 6 Chicago programs attended our wet lab. Residents were given a pre-wet lab survey regarding their interest in MIGS and training satisfaction. The data collected was anonymous and de-identified. In 2017 data was collected in-person on iPads using RedCap software and in 2020 the data was collected remotely using Qualtrics data collection platform. In both wet labs residents performed various MIGS and intraoperative gonioscopy. Results : In 2017 and 2020 respectively, 77% and 81% of residents reported that they were interested or very interested in MIGS. In 2017 32% of residents were satisfied by their MIGS training. In 2020, still only 25% of residents were satisfied by their current MIGS training. Conclusions : Despite widespread use of MIGS in the US and growing interest amongst graduating ophthalmologists, there continues to be a gap between resident interest in MIGS and satisfaction with training during residency. Over the four years, this gap has remained unchanged. A MIGS-based hands-on wet lab experience is one way to improve MIGS training for residents and close the gap between interest and satisfaction with current MIGS resident training.