Comparative study of the outcomes of newly developed polypropylene-based modified trabeculectomy and glaucoma shunt surgery in neovascular glaucoma.

BACKGROUND: Neovascular glaucoma (NVG) is a secondary glaucoma with a poor visual prognosis. Trabeculectomy with antifibrotic agents, glaucoma drainage devices (GDDs), and cyclo-destructive procedures are recommended in patients who are refractory to medical management. However, due to the poor success rate of conventional trabeculectomy and the higher cost of GDDs, alternative procedures need to be looked at. PURPOSE: To compare the surgical outcomes and economic aspects of a newly developed polypropylene suture bed-based modified trabeculectomy to Ahmed glaucoma valve (AGV) implantation for NVG. METHODS: It was a prospective interventional study conducted at a tertiary care center between 2018 and 2020. Consecutive patients with NVG with a minimum follow-up of 18 months were included. Surgical outcomes are mainly based on intraocular pressure (IOP) control and the cost of surgery. RESULTS: Sixty eyes were included out of which 40 (60.6%) underwent modified trabeculectomy and 20 (33.7%) underwent AGV. At the final follow-up, no significant difference (P < 0.05) was found between the surgical outcomes of both groups. The complete success rate (IOP < 21 mm Hg without antiglaucoma medications) was 60 and 65% while the qualified success rate (IOP < 21 mm Hg with antiglaucoma medications) was 30 and 25% in modified trabeculectomy and AGV groups, respectively, at final follow-up. The cost of surgery was significantly higher in the AGV group (P < 0.0001). CONCLUSION: Modified trabeculectomy as described might be a better alternative for NVG eyes.

Short- to intermediate-term surgical outcome of Keiki Mehta valve implantation in refractory glaucoma.

BACKGROUND: Keiki Mehta body pressure (BP) valve is a glaucoma drainage device that works on the simple mechanism of body pressure. PURPOSE: To evaluate the short- to intermediate-term efficacy and safety of Keiki Mehta valve implantation in treating refractory glaucoma. METHODS: This was a prospective, interventional, institution-based study. Adult patients (age >18 years) having refractory glaucoma who underwent Keiki Mehta valve implantation from May 2019 to December 2019 in a tertiary hospital in eastern India were followed up to 18 months. RESULTS: Twenty patients (20 eyes) with refractory glaucoma who underwent Keiki Mehta valve implantation were followed up on postoperative day 1 and at 1, 3, 6, 12, and 18 months postoperatively. Visual acuity, intraocular pressure (IOP), antiglaucoma medications, and success rate were measured at every visit. There was significant reduction in mean IOP from the preoperative values at every postoperative follow-up ( P < 0.05). Kaplan-Meier survival analysis demonstrated a probability of 50% complete success and 20% qualified success at 18 months. Hypotony was the most common postoperative complication. CONCLUSION: Keiki Mehta valve implantation is an effective and safe treatment for refractory glaucoma.

Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation.

Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision ("wipe-out") in the early post-operative period after glaucoma-filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco-emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra-ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre-operative and post-operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed "wipe-out". Conclusion: "Wipe-out" is a rare phenomenon after surgery in advanced glaucoma.