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1.
Eye (Lond) ; 37(8): 1608-1613, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-35945340

RESUMO

OBJECTIVES: To describe the efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma. METHODS: This retrospective multicentre case series reports on 40 eyes with severe or refractory open-angle glaucoma that underwent standalone or combined KDB goniotomy and were followed for 12 months post-operatively in the United-States, Mexico and Switzerland. Surgical success was defined as an intraocular pressure (IOP) reduction ≥20% from baseline at 12 months, with fewer medications than preoperatively. Mean IOP and antiglaucoma medication reduction, probabilities of achieving an IOP ≤16 or 18 mmHg, and adverse events were also analysed. RESULTS: Mean IOP decreased from 18.1 ± 5.0 mmHg at baseline to 14.8 ± 3.7 mmHg at 12 months (18.2% reduction, P < 0.001). Concomitantly, the mean number of glaucoma medications decreased from 2.5 ± 1.4 to 1.7 ± 1.2 (32% reduction, P = 0.002). The proportion of eyes achieving an IOP reduction of more than 20% from baseline was 37.5% (n = 15) at 12 months. At 12 months, 67.5% and 82.5% achieved a medicated IOP ≤ 16 and ≤18 mmHg, respectively. No severe complications were reported. CONCLUSION: Excisional goniotomy with KDB achieves a statistically significant IOP and antiglaucoma medication reduction in severe or refractory glaucoma over a period of 12 months. While its efficacy decreases with time, its favourable safety profile makes it a potentially useful primary or adjunctive procedure in high-risk eyes.


Assuntos
Glaucoma de Ângulo Aberto , Glaucoma , Hipotensão Ocular , Trabeculectomia , Humanos , Trabeculectomia/métodos , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular , Agentes Antiglaucoma , Tonometria Ocular , Resultado do Tratamento , Glaucoma/cirurgia , Glaucoma/etiologia , Hipotensão Ocular/etiologia , Estudos Retrospectivos
2.
Eur J Ophthalmol ; 30(1): NP11-NP15, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30328376

RESUMO

PURPOSE: To describe the case and the follow-up of an inadvertently damaged XEN gel implant during needling procedure. METHODS: Case report. RESULTS: A 60-year-old African American patient underwent an uncomplicated combined phacoemulsification with the insertion of a XEN gel implant. Two months postoperatively, a needling procedure was required. During the needling procedure, a fragment of the XEN gel implant was inadvertently damaged. One month postoperatively, the intraocular pressure was still controlled and the bleb was functioning well. CONCLUSION: This case report reveals a previously unreported complication concerning XEN gel implant. It is important for the surgeon to pay attention during needling procedure, especially if there is a subconjunctival hemorrhage impairing the view, to defer the procedure until good visibility exists.


Assuntos
Agulhamento Seco/efeitos adversos , Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Complicações Intraoperatórias , Falha de Prótese/etiologia , Angiofluoresceinografia , Glaucoma de Ângulo Aberto/diagnóstico por imagem , Glaucoma de Ângulo Aberto/fisiopatologia , Gonioscopia , Humanos , Pressão Intraocular/fisiologia , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Facoemulsificação , Stents , Tomografia de Coerência Óptica , Tonometria Ocular , Resultado do Tratamento
4.
J Glaucoma ; 27(10): 849-855, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29979337

RESUMO

PURPOSE: The purpose of the study is to describe short-term efficacy and safety of goniotomy with trabecular meshwork excision using the Kahook Dual Blade (KDB, New World Medical Inc., Rancho Cucamonga, CA) in patients with severe or refractory glaucoma. METHOD: Retrospective multicentric case series of 53 eyes with severe or refractory glaucoma as defined by ICD-10 conducted in the United States, Mexico, and Switzerland. Primary efficacy outcome was a ≥20% decrease in intraocular pressure (IOP) from baseline at 6 months. Secondary efficacy outcome measures were probability of achieving an IOP≤14 or 18 mm Hg at 6 months and the mean IOP change from baseline at 6 months. Medication use required to obtain target IOP at last follow up and adverse effects were analyzed. RESULTS: The proportion of eyes achieving an IOP reduction of >20% from preoperative baseline at 6 months was 57.7% (n=30). The mean IOP decreased from 18.4±6.1 mm Hg at baseline to 13.9±3.5 mm Hg at month 6 (23.9% reduction; P<0.001). At 6 months, 63.5% and 92.3% achieved an IOP≤14 and ≤18 mm Hg, respectively, and the mean number of glaucoma medications was reduced by 1.2±1.3 (36.6%) compared with baseline (P<0.001). The most common adverse event was hyphema (n=29, 34.9%) with spontaneous resolution in all cases. No severe complications were reported. One case presented with uncontrolled IOP and required glaucoma drainage device surgery at 1 month. CONCLUSIONS: Goniotomy with trabecular meshwork excision using the KDB could be an alternative surgery for severe or refractory glaucoma, significantly reducing IOP and medication use at 6 months, with a low rate of complications.


Assuntos
Glaucoma/cirurgia , Malha Trabecular/cirurgia , Trabeculectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tonometria Ocular , Trabeculectomia/instrumentação , Resultado do Tratamento
5.
J Glaucoma ; 27(3): 297-301, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29303876

RESUMO

PURPOSE: The purpose of this article is to present a case of ocular decompression retinopathy (ODR) occurring after uncomplicated deep sclerectomy with Mitomycin C using optical coherence tomography angiography (OCTA). PATIENT AND METHOD: This is a single case report. RESULTS: A 55-year-old man with traumatic glaucoma in the right eye complained of blurred vision. Visual acuity was 20/25 and intraocular pressure (IOP) was 50 mm Hg. Deep sclerectomy with Mitomycin C was performed. On the first postoperative day, best-corrected visual acuity (BCVA) was light perception and IOP was 6 mm Hg. At 3 months follow-up, BCVA was 20/40 and IOP was 14 mm Hg. Fundoscopy showed multiple diffuse round retinal hemorrhages over the posterior pole, in all quadrants. On OCTA (RTVue XR Avanti; Optovue Inc., Fremont, CA), hemorrhages were present in superficial and deep retinal layers, with a normal vascularization in the en face image. BCVA improved to 20/32 at postoperative month 4 with reduced but persistent retinal hemorrhages. CONCLUSIONS: ODR is a rare complication of filtering surgery. To the best of our knowledge, this is the second reported case of ODR occurring after deep sclerectomy and first description using OCTA. OCTA showed superficial and deep retinal hemorrhages with a normal vascular configuration. High-preoperative IOP seems to be the most important risk factor for this complication.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Traumatismos Oculares/cirurgia , Angiofluoresceinografia/métodos , Glaucoma de Ângulo Aberto/cirurgia , Doenças Retinianas/diagnóstico por imagem , Esclerostomia/efeitos adversos , Tomografia de Coerência Óptica/métodos , Ferimentos não Penetrantes/cirurgia , Alquilantes/administração & dosagem , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Doenças Retinianas/etiologia , Esclera/cirurgia , Tonometria Ocular/efeitos adversos , Acuidade Visual
6.
Expert Rev Med Devices ; 15(1): 47-59, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29258404

RESUMO

INTRODUCTION: Glaucoma is a leading cause of blindness worldwide. Intraocular pressure (IOP) lowering is the only effective treatment strategy. Traditional glaucoma surgeries are generally considered to be unpredictable and associated with a high rate of complications. This has led to the development of a novel XEN Gel Implant, a type of minimally invasive glaucoma surgery (MIGS), lowering the IOP without extensive surgical dissection. AREAS COVERED: A literature search was undertaken on PubMed using the terms XEN glaucoma, gelatin microstent, and MIGS. All the articles and case reports on XEN Gel Implant and selected articles on MIGS were studied and reviewed. We have discussed the results of most studies on XEN Gel Implant related to its efficacy, safety and success. EXPERT COMMENTARY: The XEN Gel Implant effectively lowers IOP and medication use, with a favorable safety profile. Long-term data on its success and cost-effectiveness are lacking. The studies have shown it to be without any serious adverse events and to have good safety profile encouraging future research on this novel implant. There is a need to correctly identify selection criteria for patients, who would benefit the most from the XEN Gel Implant.


Assuntos
Glaucoma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Oftalmológicos/instrumentação , Stents , Materiais Biocompatíveis , Colágeno , Gelatina , Géis , Glaucoma/diagnóstico , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular , Tonometria Ocular , Resultado do Tratamento
7.
J Glaucoma ; 27(1): e11-e13, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29088056

RESUMO

Minimally invasive glaucoma surgery includes different devices which provide a less invasive and safer means of reducing intraocular pressure. The XEN Gel Stent (Allergan Inc., CA) is an ab interno procedure which creates a subconjunctival drainage pathway. It is a new surgical device and there is a paucity of data on complications and their management. We report a clinical case of a leaking bleb after XEN surgery managed by bleb revision, conjunctival suturing, and XEN replacement.


Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma de Ângulo Aberto/cirurgia , Idoso , Catarata/complicações , Túnica Conjuntiva/cirurgia , Síndrome de Exfoliação/fisiopatologia , Síndrome de Exfoliação/cirurgia , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Facoemulsificação , Reoperação , Falha de Tratamento
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