AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwe...AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.展开更多
AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract...AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.展开更多
Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visua...Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.展开更多
An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of ban...An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.展开更多
As a non-penetrating glaucoma surgery(NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm’s canal. Ab interno canaloplasty(ABiC), which can reconstruct the natur...As a non-penetrating glaucoma surgery(NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm’s canal. Ab interno canaloplasty(ABiC), which can reconstruct the natural outflow pathways of aqueous humor in mild-tomoderate primary open angle glaucoma(POAG) patients, is a new minimally invasive glaucoma surgery(MIGS) procedure improving from traditional canaloplasty. Canaloplasty can reduce intraocular pressure(IOP) with high efficiency and security. There are no complications such as scar formation and encapsulation for this no-bleb canaloplasty.展开更多
Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory glaucoma....Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.Methods:A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees.Data was collected at baseline and postoperatively at day 1,week 1,and months 1,3,5,and 12.Primary outcome was mean IOP change.Secondary outcomes included change in number of glaucoma medication classes and visual acuity.Safety outcomes included needling rates.Surgical success was defined by achieving≥20%reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.Results:At baseline,28.6%(8/28)of the subjects had prior failed incisional glaucoma surgery in a study population that was 54%African-American,with 78%with severe glaucoma(average mean deviation of−14.58 dB).Thirteen subjects terminated their clinic visits before their 12-month postoperative visit,leaving 15 subjects for end point analysis.Average IOP went from 21.6 mmHg(range 12.0–31.0,SD 6.6)at baseline to 12.5 mmHg(range 7.0–19.0,SD 3.6),a 42.1%reduction(p<0.007).All subjects decreased the number of medication classes they were taking with an average reduction of 3.8(range 2–5,SD 0.9)to 1.3(range 0–3,SD 1.0)classes,or a 65.8%decrease(p<0.006).Crude surgical success was 80.0%for the 15 subjects that followed up at 12 months.The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4%(95%CI:44.7–85.8%).Regardless of the length of follow-up,21.4%(6/28)met failure criteria:3 subjects failed because they required secondary surgical intervention,and the other 3 did not have adequate IOP reduction.Initial bleb needling rate was 28.6%(8/28)and repeat was 17.9%(5/28).Conclusions:Compared to the reported literature with experienced ocular surgeons,ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP,topical medication reduction,surgical success,and needling rates at 12-month follow-up.展开更多
文摘AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.
文摘AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.
文摘Dear Editor, I am Dr.Daniela Alvarez-AscenciofromtheGlaucoma Department at Asociacion Para Evitar la Ceguera (APEC)in Mexico City, Mexico. I write to present a successful case of cyclodyalisis repair in a direct visualization technique that was performed on a patient after a microincisional glaucoma surgery (MIGS) complication.
文摘An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.
文摘As a non-penetrating glaucoma surgery(NPGS), canaloplasty aims to reconstruct the physiological outflow of aqueous humor by dilating the Schlemm’s canal. Ab interno canaloplasty(ABiC), which can reconstruct the natural outflow pathways of aqueous humor in mild-tomoderate primary open angle glaucoma(POAG) patients, is a new minimally invasive glaucoma surgery(MIGS) procedure improving from traditional canaloplasty. Canaloplasty can reduce intraocular pressure(IOP) with high efficiency and security. There are no complications such as scar formation and encapsulation for this no-bleb canaloplasty.
基金This study was sponsored by Allergan,Inc.through an investigator-initiated research grant.
文摘Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.Methods:A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees.Data was collected at baseline and postoperatively at day 1,week 1,and months 1,3,5,and 12.Primary outcome was mean IOP change.Secondary outcomes included change in number of glaucoma medication classes and visual acuity.Safety outcomes included needling rates.Surgical success was defined by achieving≥20%reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.Results:At baseline,28.6%(8/28)of the subjects had prior failed incisional glaucoma surgery in a study population that was 54%African-American,with 78%with severe glaucoma(average mean deviation of−14.58 dB).Thirteen subjects terminated their clinic visits before their 12-month postoperative visit,leaving 15 subjects for end point analysis.Average IOP went from 21.6 mmHg(range 12.0–31.0,SD 6.6)at baseline to 12.5 mmHg(range 7.0–19.0,SD 3.6),a 42.1%reduction(p<0.007).All subjects decreased the number of medication classes they were taking with an average reduction of 3.8(range 2–5,SD 0.9)to 1.3(range 0–3,SD 1.0)classes,or a 65.8%decrease(p<0.006).Crude surgical success was 80.0%for the 15 subjects that followed up at 12 months.The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4%(95%CI:44.7–85.8%).Regardless of the length of follow-up,21.4%(6/28)met failure criteria:3 subjects failed because they required secondary surgical intervention,and the other 3 did not have adequate IOP reduction.Initial bleb needling rate was 28.6%(8/28)and repeat was 17.9%(5/28).Conclusions:Compared to the reported literature with experienced ocular surgeons,ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP,topical medication reduction,surgical success,and needling rates at 12-month follow-up.
