ABSTRACT
IMPORTANCE: Microinvasive glaucoma surgery (MIGS) combined with phacoemulsification is increasingly utilised in glaucoma management. OBJECTIVE: To describe the postoperative outcomes of phacoemulsification alone compared to combined phacoemulsification and iStent (Glaukos, San Clemente, CA) or Hydrus (Ivantis, Irvine, CA) for open angle glaucoma. METHODS: Retrospective single surgeon comparative case series in a private practice setting. A total of 297 eyes in 190 patients (M:F = 85:105) were included consecutively from March 2011 to June 2017 with the data analysed using linear mixed models. Main outcome measures were intraocular pressure (IOP) and number of medications. RESULTS: By 6 months, all groups showed a reduction in IOP, with the combined iStent group by 4.2 mm Hg and the combined Hydrus group by 4.5 mm Hg, and this trend was sustained with follow-up to two years. All groups also showed a reduction in number of medications, with the phacoemulsification alone cases by 0.3, the combined iStent group by 0.7 and the combined Hydrus group by 1.1 medications. Both the combined surgeries had sustained reduction of number of medications with follow-up to 2 years. Postoperative complications from MIGS device insertion were uncommon and all resolved by one month. CONCLUSIONS AND RELEVANCE: The combination of phacoemulsification and a MIGS device in open angle glaucoma patients reduced the intraocular pressure and the number of medications by the first postoperative month and had longer-term effects at 2 years follow-up. If the device is inserted without intraoperative complication, the rate of significant short-term risks are low.
Subject(s)
Glaucoma Drainage Implants , Glaucoma, Open-Angle , Glaucoma , Phacoemulsification , Glaucoma/surgery , Glaucoma, Open-Angle/complications , Glaucoma, Open-Angle/surgery , Humans , Intraocular Pressure , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the effect of intravitreal bevacizumab on the macular choroidal volume and the subfoveal choroidal thickness in treatment naïve eyes with exudative age-related macular degeneration. METHODS: The macular choroidal volume and the subfoveal choroidal thickness were measured using enhanced depth imaging optical coherence tomography. After a screening examination, each patient received 3 monthly intravitreal injections of 1.25 mg bevacizumab. One month after the third injection was a final assessment. RESULTS: Forty-seven patients with a mean age of 80 ± 6.4 years were included. The macular choroidal volume decreased significantly from median 4.1 mm (interquartile range 3.4-5.9) to median 3.9 mm (interquartile range 3.1-5.6) between the baseline and final examination (difference -0.46 mm, 95% confidence interval: -0.57 to 0.35, P < 0.001). Similarly, subfoveal choroidal thickness had decreased from 157.0 µm (interquartile range 116.0-244.5) at baseline to 139.0 µm (interquartile range 102.5-212.0) at the final examination (P < 0.001). Both parameters macular choroidal volume at baseline and subfoveal choroidal thickness at baseline were not associated with the response to treatment. CONCLUSION: The macular choroidal volume and the subfoveal choroidal thickness decreased significantly after 3 monthly bevacizumab injections for exudative age-related macular degeneration.
