Editorial

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Open AccessEditorial

Advances in Glaucoma Surgery

by Karl Mercieca and Michele Figus

J. Clin. Med. 2023, 12(3), 828; https://doi.org/10.3390/jcm12030828 - 20 Jan 2023

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Abstract

Glaucoma is one of the leading causes of irreversible sight loss worldwide, with a prevalence of 64 [...] Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

Research

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11 pages, 580 KiB

Open AccessArticle

XEN^®-63 Compared to XEN^®-45 Gel Stents to Reduce Intraocular Pressure in Glaucoma

by Charlotte Evers, Daniel Böhringer, Sara Kallee, Philip Keye, Heiko Philippin, Timothy Piotrowski, Thomas Reinhard and Jan Lübke

J. Clin. Med. 2023, 12(15), 5043; https://doi.org/10.3390/jcm12155043 - 31 Jul 2023

Cited by 2 | Viewed by 714

Abstract

The XEN^® gel stent reduces intraocular pressure (IOP) in glaucoma. XEN^®-45 is widely used; the newer XEN^®-63 has a larger lumen targeting potentially lower IOP outcomes. We retrospectively compared the first 15 XEN^®-63 cases to 15 [...] Read more.

The XEN^® gel stent reduces intraocular pressure (IOP) in glaucoma. XEN^®-45 is widely used; the newer XEN^®-63 has a larger lumen targeting potentially lower IOP outcomes. We retrospectively compared the first 15 XEN^®-63 cases to 15 matched XEN^®-45 controls. With a preoperative IOP of 18.1 ± 3.9 mmHg (mean ± SD) and a final IOP of 9.1 ± 2.0 mmHg, XEN^®-63 implantation resulted in an IOP reduction of 44.6 ± 16.5%. Similarly, with a preoperative IOP of 18.3 ± 4.5 mmHg and a final IOP of 10.3 ± 2.1 mmHg, XEN^®-45 implantation resulted in an IOP reduction of 40.1 ± 17.2%. The median follow-up period was 204 days (range 78–338 days) for the XEN^®-63 group and 386 days (range 99–1688 days) for the XEN^®-45 group. In total, 5/15 eyes of each group underwent open conjunctival bleb revision within the period of observation. Three eyes of the XEN^®-63 group had secondary glaucoma surgery. One eye in the XEN^®-63 group and three eyes in the XEN^®-45 group required a restart of antiglaucomatous medication. In conclusion, both stents effectively lower IOP and medication. XEN^®-63 achieved a slightly lower IOP over a short follow-up. Complication and revision rates were similar. Full article

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14 pages, 6036 KiB

Open AccessArticle

Long-Term Outcomes of the PRESERFLO MicroShunt Implant in a Heterogeneous Glaucoma Cohort

by Jens Julian Storp, Friederike Elisabeth Vietmeier, Ralph-Laurent Merté, Raphael Koch, Julian Alexander Zimmermann, Nicole Eter and Viktoria Constanze Brücher

J. Clin. Med. 2023, 12(13), 4474; https://doi.org/10.3390/jcm12134474 - 04 Jul 2023

Cited by 4 | Viewed by 1935

Abstract

The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A [...] Read more.

The Preserflo MicroShunt represents a novel glaucoma treatment device, necessitating long-term follow-up data to accurately assess its efficacy. The aim of this study is to report real-world data of a heterogenous glaucoma cohort who received Preserflo implantation at a specialized glaucoma clinic. A total of 160 eyes of 160 patients who underwent Preserflo MicroShunt implantation were retrospectively enrolled in this study. Patient characteristics, as well as success and failure rates, were assessed. The numbers of adverse events and revision procedures were recorded, along with any reduction in supplementary medication. The progression of intraocular pressure (IOP) was assessed over the course of 12 months, and fluctuations were analyzed. The overall success rate was 61.9% (complete success: 51.3%, qualified success: 10.6%). Revision surgery was performed in 25% of cases. Excessive hypotony occurred postoperatively in 54.4% of patients and regressed after 7 days in 88.8% of all cases. Median IOP decreased from 22 (interquartile range (IQR): 17–27) mmHg preoperatively to 14 (IQR 12–16) mmHg at 12 months postoperatively (p < 0.01). The median number of antiglaucomatous agents decreased from three to zero at latest follow-up. The Preserflo MicroShunt achieved a noticeable reduction in IOP over the course of 12 months in glaucoma patients, irrespective of disease severity or disease subtype. The frequency of postoperative adverse events and number for revision surgeries over the course of the follow-up period were low. Full article

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11 pages, 956 KiB

Open AccessArticle

Plasma Rich in Growth Factors as an Adjuvant Agent in Non-Penetrating Deep Sclerectomy

by Pedro P. Rodríguez-Calvo, Ignacio Rodríguez-Uña, Andrés Fernández-Vega-Cueto, Ronald M. Sánchez-Ávila, Eduardo Anitua and Jesús Merayo-Lloves

J. Clin. Med. 2023, 12(10), 3604; https://doi.org/10.3390/jcm12103604 - 22 May 2023

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Abstract

Background: The purpose of this study is to evaluate the utility and safety of plasma rich in growth factors immunosafe eye drops (is-ePRGF) in the postoperative treatment of non-penetrating deep sclerectomy (NPDS). Methods: This is a case–control study in patients with open-angle glaucoma. [...] Read more.

Background: The purpose of this study is to evaluate the utility and safety of plasma rich in growth factors immunosafe eye drops (is-ePRGF) in the postoperative treatment of non-penetrating deep sclerectomy (NPDS). Methods: This is a case–control study in patients with open-angle glaucoma. Group one (control) was not treated with is-ePRGF, while group two (is-ePRGF) was treated (four times a day for four months). Postoperative evaluations were performed at one day, one month, three months and six months. The main outcomes were: intraocular pressure (IOP), microcysts in blebs with AS-OCT and the number of hypotensive eye drops. Results: Preoperatively, group one (n = 48 eyes) and group two (n = 47 eyes) were similar in age (71.5 ± 10.7 vs. 70.9 ± 10.0 years; p = 0.68), IOP (20.6 ± 10.2 vs. 23.0 ± 9.0 mmHg; p = 0.26) and number of hypotensive drugs (2.7 ± 0.8 vs. 2.8 ± 0.9; p = 0.40). The IOP at six months dropped to 15.0 ± 8.0 mmHg (IOP reduction: −27.2%) and 10.9 ± 4.3 mmHg (IOP reduction: −52.6%) for group one and group two, respectively (p < 0.01). At six months, blebs with microcysts were 62.5% (group one) and 76.7% (group two). Postoperative complications were observed in 12 eyes (25%) for group one and in 5 eyes (11%) for group two (p = 0.06). No specific complications related to the use of is-ePRGF were identified. Conclusions: Topical is-ePRGF seems to reduce IOP and the rate of complications in the medium term after NPDS, so it can be considered as a possible safe adjuvant to achieve surgical success. Full article

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10 pages, 522 KiB

Open AccessArticle

Safety and Efficacy of Ab Interno XEN 45 Gel Stent in Patients with Glaucoma and High Myopia

by Matteo Sacchi, Antonio M. Fea, Gianluca Monsellato, Elena Tagliabue, Edoardo Villani, Stefano Ranno and Paolo Nucci

J. Clin. Med. 2023, 12(7), 2477; https://doi.org/10.3390/jcm12072477 - 24 Mar 2023

Cited by 3 | Viewed by 1001

Abstract

This study reports on the safety and efficacy of Xen 45 in patients with glaucoma and high myopia. It was a retrospective study including patients with high myopia (>6D) who underwent Xen implant with 2 years of follow-up. The primary outcome was to [...] Read more.

This study reports on the safety and efficacy of Xen 45 in patients with glaucoma and high myopia. It was a retrospective study including patients with high myopia (>6D) who underwent Xen implant with 2 years of follow-up. The primary outcome was to report the incidence of hypotony (IOP ≤ 5 mmHg) and hypotony-related complications. Patients with high myopia treated with mitomycin-C-augmented trabeculectomy were included as a control group. We included 14 consecutive patients who underwent Xen implant (seven eyes) and trabeculectomy (seven eyes). The mean myopia was −14.71 ± 5.36 and −15.07 ± 6.11 in the trabeculectomy and Xen groups, respectively (p > 0.05). The success rate and the mean IOP at 1 and 2 years from the intervention were statistically comparable between the two groups. The group undergoing trabeculectomy showed a higher incidence of hypotony (six eyes (85.71%) vs. two eyes (28.57%)) and hypotony maculopathy (three eyes (42.86%) vs. zero eyes (0%)) and required more postoperative procedures. Patients with high myopia were at higher risk of hypotony-related complications after trabeculectomy. The Xen implant can achieve an IOP control comparable to trabeculectomy with a significantly better safety profile and can be considered as an option for the management of patients with high myopia and glaucoma. Full article

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16 pages, 3057 KiB

Open AccessArticle

Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients

by Kazuyoshi Kitamura, Yoshiko Fukuda, Yuka Hasebe, Mio Matsubara and Kenji Kashiwagi

J. Clin. Med. 2023, 12(6), 2332; https://doi.org/10.3390/jcm12062332 - 16 Mar 2023

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Abstract

Background: The evaluation of ab interno trabeculectomy, referred to as trabectome^®, among Japanese patients is insufficient. Subjects and methods: Japanese patients who underwent trabectome^® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best [...] Read more.

Background: The evaluation of ab interno trabeculectomy, referred to as trabectome^®, among Japanese patients is insufficient. Subjects and methods: Japanese patients who underwent trabectome^® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. Results: A total of 250 eyes from 197 patients were enrolled. The trabectome^® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with the success rate. The trabectome^® alone did not show a significant reduction in corneal endothelial cells. Eyes with postoperative transient IOP elevation and removal of anterior chamber hemorrhage were 11.2% and 1.2%, respectively. Twenty-four eyes (9.6%) underwent additional glaucoma surgeries. Conclusions: The trabectome^® could be considered an effective and safe surgery. Compared to trabectome^® alone, combined cataract surgery was superior in lowering IOP and reducing glaucoma medications. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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10 pages, 725 KiB

Open AccessArticle

Clinical Outcomes of XEN45^®-Stent Implantation after Failed Trabeculectomy: A Retrospective Single-Center Study

by Constance Weber, Sarah Hundertmark, Michael Petrak, Elisabeth Ludwig, Christian Karl Brinkmann, Frank G. Holz and Karl Mercieca

J. Clin. Med. 2023, 12(4), 1296; https://doi.org/10.3390/jcm12041296 - 06 Feb 2023

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Abstract

Background: The implantation of a collagen gel micro-stent (XEN45^®) as a minimally invasive form of glaucoma surgery (MIGS) after a failed trabeculectomy (TE) may be an effective option with few risks. This study investigated the clinical outcome of XEN45^® implantation [...] Read more.

Background: The implantation of a collagen gel micro-stent (XEN45^®) as a minimally invasive form of glaucoma surgery (MIGS) after a failed trabeculectomy (TE) may be an effective option with few risks. This study investigated the clinical outcome of XEN45^® implantation after a failed TE, with follow-up data of up to 30 months. Materials and Methods: In this paper, we present a retrospective review of patients undergoing XEN45^® implantation after a failed TE at the University Eye Hospital Bonn, Germany, from 2012 to 2020. Results: In total, 14 eyes from 14 patients were included. The mean follow-up time was 20.4 months. The mean time duration between the failed TE and XEN45^® implantation was 110 months. The mean intraocular pressure (IOP) decreased from 17.93 mmHg to 12.08 mmHg after one year. This value increased again to 17.63 mmHg at 24 months and 16.00 mmHg at 30 months. The number of glaucoma medications decreased from 3.2 to 0.71, 2.0, and 2.71 at 12, 24, and 30 months, respectively. Conclusions: XEN45^® stent implantation after a failed TE did not lead to an effective long-term decrease in IOP and glaucoma medications in many patients in our cohort. Nevertheless, there were cases without the development of a failure event and complications, and others in whom further, more invasive surgery was delayed. XEN45^® implantation in some failed trabeculectomy cases may, therefore, be a good option, especially in older patients with multiple comorbidities. Full article

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7 pages, 477 KiB

Open AccessArticle

Outcomes of Deep Sclerectomy for Glaucoma Secondary to Sturge–Weber Syndrome

by Faisal A. Almobarak, Abdullah S. Alobaidan and Mansour A. Alobrah

J. Clin. Med. 2023, 12(2), 516; https://doi.org/10.3390/jcm12020516 - 08 Jan 2023

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Abstract

Aims: To report the outcomes and complications of deep sclerectomy in glaucoma secondary to Sturge–Weber syndrome (SWS). Methods: The retrospective case series included patients with SWS and secondary glaucoma who underwent deep sclerectomy at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between [...] Read more.

Aims: To report the outcomes and complications of deep sclerectomy in glaucoma secondary to Sturge–Weber syndrome (SWS). Methods: The retrospective case series included patients with SWS and secondary glaucoma who underwent deep sclerectomy at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia between 2000 and 2021. The main outcome measures included intraocular pressure (IOP), the number of antiglaucoma medications, the presence of vision-threatening complications, and the need for further glaucoma surgery to control the IOP. The surgical outcome of each eye was based on the main outcome measures. Results: Twelve eyes of eleven patients were included in the study. The mean follow-up period was 83.00 months (±74.2) (range 1 to 251 months). The IOP and number of antiglaucoma medications decreased significantly from a mean of 28.75 mm Hg (±7.4) and 3.17 (±0.8) to 15.30 mm Hg (±3.5) and 0.3 (±0.7), and 18.83 (±9.3) and 1.67 (±1.7) on the 24th month and the last follow-up visit postoperatively, respectively (p < 0.01 for both). The success rate was 66.6% (8/12), while the failure rate was 33.3% (4/12) because of the uncontrolled IOP where a single repeat glaucoma surgery achieved controlled IOP. One procedure was complicated by choroidal detachment and one by choroidal effusion; both complications were resolved by medical treatments. Conclusions: Deep sclerectomy seems to be an effective treatment modality for controlling IOP and for decreasing the burden of antiglaucoma medications in patients with SWS and secondary glaucoma. Further studies are needed to confirm such a conclusion on larger number of patients with longer follow-up periods. Full article

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8 pages, 546 KiB

Open AccessArticle

Steroid Response after Trabeculectomy—A Randomized Controlled Trial Comparing Dexamethasone to Diclofenac Eye Drops

by Afrouz Ahmadzadeh, Line Kessel, Bo Simmendefeldt Schmidt and Daniella Bach-Holm

J. Clin. Med. 2022, 11(24), 7365; https://doi.org/10.3390/jcm11247365 - 12 Dec 2022

Cited by 2 | Viewed by 1261

Abstract

This prospective randomized controlled trial aimed to compare changes in intraocular pressure in three different anti-inflammatory regimens following trabeculectomy. Sixty-nine patients were randomized to receive either postoperative prophylaxis with topical preservative-free dexamethasone (DEX), diclofenac (DICLO), or their combination (DEX+DICLO). Our main outcome measure [...] Read more.

This prospective randomized controlled trial aimed to compare changes in intraocular pressure in three different anti-inflammatory regimens following trabeculectomy. Sixty-nine patients were randomized to receive either postoperative prophylaxis with topical preservative-free dexamethasone (DEX), diclofenac (DICLO), or their combination (DEX+DICLO). Our main outcome measure was an intraocular pressure (IOP) change of a minimum 4 mmHg following the withdrawal of anti-inflammatory prophylaxis 9 weeks after trabeculectomy. We found that the IOP decreased ≥ 4 mmHg in 18.6% of eyes after cessation of the topical steroid DEX (n = 3/22) and DEX+DICLO (n = 5/21), whereas a decrease in IOP was not observed in the DICLO group. In conclusion, IOP decreased in nearly 1/5 of patients after cessation of topical steroidal anti-inflammatory prophylaxis after trabeculectomy. This points toward a steroid-induced increase in IOP even after trabeculectomy. Thus, increased postoperative IOP may be related to steroid use, and the success or failure of a trabeculectomy cannot be fully evaluated before anti-inflammatory prophylaxis with steroids is stopped or changed to non-steroidal eye drops. Full article

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11 pages, 872 KiB

Open AccessArticle

Efficacy of the PRESERFLO MicroShunt and a Meta-Analysis of the Literature

by Shigeo S. M. Pawiroredjo, Wichor M. Bramer, Noemi D. Pawiroredjo, Jan Pals, Huub J. Poelman, Victor A. de Vries, Roger C. W. Wolfs and Wishal D. Ramdas

J. Clin. Med. 2022, 11(23), 7149; https://doi.org/10.3390/jcm11237149 - 01 Dec 2022

Cited by 12 | Viewed by 1781

Abstract

Background: Recent studies on the PRESERFLO MicroShunt suggest that it may be effective in lowering intraocular pressure (IOP); however, the number of studies on this device remains limited. Therefore, we assessed the efficacy of the PRESERFLO MicroShunt in patients with glaucoma and performed [...] Read more.

Background: Recent studies on the PRESERFLO MicroShunt suggest that it may be effective in lowering intraocular pressure (IOP); however, the number of studies on this device remains limited. Therefore, we assessed the efficacy of the PRESERFLO MicroShunt in patients with glaucoma and performed a meta-analysis of published results. Methods: Prospective study including all patients that underwent PRESERFLO MicroShunt surgery from 2018 onwards. Sub-analyses were performed for cataract-combined procedures. To compare our results, we performed a systematic review and meta-analysis. IOP, IOP-lowering medication and surgical complications reported in the retrieved studies were assessed. Results: A total of 72 eyes underwent PRESERFLO-implant surgery (59 as standalone procedure and 13 as cataract-combined procedure). No significant differences were found in IOP and IOP-lowering medication between both groups. The mean ± standard deviation IOP and IOP-lowering medications of both groups taken together declined from 21.72 ± 8.35 to 15.92 ± 8.54 mmHg (p < 0.001, 26.7% reduction) and 3.40 to 0.93 (p < 0.001, 72.6% reduction) at 1 year follow-up, respectively. Secondary surgeries were required in 19.4% of eyes, the majority (71.4%) within 6 months. The meta-analysis including 14 studies (totaling 1213 PRESERFLO MicroShunt surgeries) from the systematic review showed a mean preoperative IOP and IOP-lowering medication of 22.28 ± 5.38 and 2.97 ± 1.07, respectively. The three-years postoperative pooled mean was (weighted mean difference, 95% CI) 11.07 (10.27 [8.23–12.32], p < 0.001) mmHg and 0.91 (1.77 [1.26–2.28], p < 0.001) for IOP and IOP-lowering medication, respectively. The most common reported complication was hypotony (2–39%). Conclusion: The PRESERFLO MicroShunt is effective and safe in lowering IOP and the number of IOP-lowering medications. Full article

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11 pages, 824 KiB

Open AccessArticle

Outcomes and Predictors of Failure of Ultrasound Cyclo Plasty for Primary Open-Angle Glaucoma

by Faisal A. Almobarak, Ahmed Alrubean, Waleed Alsarhani, Abdullah Aljenaidel and Essam A. Osman

J. Clin. Med. 2022, 11(22), 6770; https://doi.org/10.3390/jcm11226770 - 16 Nov 2022

Cited by 4 | Viewed by 1193

Abstract

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between [...] Read more.

Aims: To evaluate the outcomes of ultrasound cyclo plasty (UCP) for primary open-angle glaucoma (POAG) and identify the predictors of failure. Methods: This retrospective cohort study included patients with POAG who underwent UCP at King Abdul Aziz University Hospital, Riyadh, Saudi Arabia, between 2016 and 2021. The main outcome measures were the intraocular pressure (IOP), the number of antiglaucoma medications, and the presence of vision-threatening complications. The surgical outcome of each eye was based on the main outcome measures. Cox proportional hazard regression analysis was performed to identify the possible predictors of UCP failure. Results: Sixty-six eyes of fifty-five patients were included herein. The mean follow-up period was 28.95 (±16.9) months. The mean IOP decreased significantly from 23.02 (±6.1) to 18.22 (±7.0) and 16.44 (±5.3) mm Hg on the 12th and 24th months, respectively; the mean number of antiglaucoma medications decreased significantly from 3.23 (±0.9) to 2.15 (±1.5) and 2.09 (±1.6), respectively. The cumulative probabilities of overall success were 71.2 ± 5.6% and 40.9 ± 6.1% on the 12th and 24th months, respectively. High baseline IOP and the number of antiglaucoma medications were associated with a higher risk of failure (hazard ratio = 1.10 and 3.01, p = 0.04 and p < 0.01, respectively). The most common complications were cataract development or progression (30.8%) and prolonged or rebound anterior chamber reaction (10.6%). Conclusions: UCP reasonably controls the IOP and reduces the antiglaucoma medication burden in eyes with POAG. Nevertheless, the success rate is modest, with a high baseline IOP and number of medications. Full article

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13 pages, 1335 KiB

Open AccessArticle

Safety and Efficacy of Three Variants of Canaloplasty with Phacoemulsification to Treat Open-Angle Glaucoma and Cataract: 12-Month Follow-Up

by Aleksandra K. Kicińska, Monika E. Danielewska and Marek Rękas

J. Clin. Med. 2022, 11(21), 6501; https://doi.org/10.3390/jcm11216501 - 02 Nov 2022

Cited by 6 | Viewed by 1503

Abstract

Background: A single-center prospective randomized observational study to compare three types of canaloplasty, i.e., ab externo (ABeC), minicanaloplasty (miniABeC) and ab interno, (ABiC) combined with cataract surgery in primary open-angle glaucoma (POAG) patients over 12 months. Methods: 48 POAG patients underwent one of [...] Read more.

Background: A single-center prospective randomized observational study to compare three types of canaloplasty, i.e., ab externo (ABeC), minicanaloplasty (miniABeC) and ab interno, (ABiC) combined with cataract surgery in primary open-angle glaucoma (POAG) patients over 12 months. Methods: 48 POAG patients underwent one of three canaloplasty procedures: ABeC (16 eyes), miniABeC (16 eyes) or ABiC (16 eyes) or combined with phacoemulsification. Patients were assessed at baseline, at day 0–1–7 and at month 1–3–6–12. Successful treatment was defined as unmedicated IOP reduction ≥20%. Complete surgical success was defined as an IOP ≤ 15 mmHg without medications, and a qualified surgical success as IOP ≤ 15 mmHg with or without medications. Results: Pre-washout IOP median values (mmHg) were 17 (ABeC), 18 (miniABeC) and 17 (AbiC) and decreased at 12-month follow up postoperatively to 13 (p = 0.005), 13 (p = 0.004) and 14 (p = 0.008), respectively—successful treatment was achieved in approximately 100% of patients for ABeC and in 93.8% for both miniABeC and AbiC groups. Preoperatively, the median number of medications was 2.0 (range 1–3) (ABeC), 2.0 (1–3) (miniABeC) and 2.0 (0–4) (ABiC); 12-month post-operatively, all medications were withdrawn except in two patients (followed miniABeC and AbiC). Conclusions: The three variants of canaloplasty significantly reduced IOP and the number of medications in patients with mild to moderate POAG and gave no significant complications. Full article

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11 pages, 2027 KiB

Open AccessArticle

Effect of Combined Surgery in Patients with Complex Nanophthalmos

by Yantao Wei, Yihua Su, Lei Fang, Xinxing Guo, Stephanie Chen, Ying Han, Yingting Zhu, Bing Cheng, Shufen Lin, Yimin Zhong and Xing Liu

J. Clin. Med. 2022, 11(19), 5909; https://doi.org/10.3390/jcm11195909 - 07 Oct 2022

Cited by 3 | Viewed by 1511

Abstract

(1) Background: To evaluate the efficacy and safety of combined surgery (limited pars plana vitrectomy, anterior-chamber stabilized phacoemulsification, IOL implantation and posterior capsulotomy, LPPV + ACSP + IOL + PC) in complex nanophthalmos. (2) Methods: Patients with complex nanophthalmos were recruited to undergo [...] Read more.

(1) Background: To evaluate the efficacy and safety of combined surgery (limited pars plana vitrectomy, anterior-chamber stabilized phacoemulsification, IOL implantation and posterior capsulotomy, LPPV + ACSP + IOL + PC) in complex nanophthalmos. (2) Methods: Patients with complex nanophthalmos were recruited to undergo LPPV + ACSP + IOL + PC from January 2017 to February 2021. Preoperative and post-operative intraocular pressure (IOP), best corrected visual acuity (BCVA), anterior chamber depth (ACD), and number of glaucoma medications were compared using the paired t-test or Wilcoxon signed rank sum tests. Surgical success rate was evaluated. Surgery-associated complications were documented. (3) Results: Forty-five eyes of 37 patients with complex nanophthalmos were enrolled. The mean follow-up period was 21.7 ± 10.6 months after surgery. Mean IOP decreased from 32.7 ± 8.7 mmHg before surgery to 16.9 ± 4.5 mmHg (p < 0.001) at the final follow-up visit, mean logMAR BCVA improved from 1.28 ± 0.64 to 0.96 ± 0.44 (p < 0.001), mean ACD significantly increased from 1.14 ± 0.51 mm to 3.07 ± 0.66 mm (p < 0.001), and the median number of glaucoma medications dropped from 3 (1, 4) to 2 (0, 4) (p < 0.001). The success rate was 88.9% (40 eyes) at the final follow-up visit. Two eyes had localized choroidal detachments which resolved with medical treatment. (4) Conclusions: LPPV + ACSP + IOL + PC is a safe and effective surgical procedure, which can decrease IOP, improve BCVA, deepen the anterior chamber, and reduce the number of glaucoma medications in patients with complex nanophthalmos. It can be considered as one of the first treatment in nanophthalmic eyes with complex conditions. Full article

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8 pages, 265 KiB

Open AccessArticle

Long-Term Changes in Corneal Endothelial Cell Density after Ex-PRESS Implantation: A Contralateral Eye Study

by Xiaotong Ren, Jie Wang, Xuemin Li and Lingling Wu

J. Clin. Med. 2022, 11(19), 5555; https://doi.org/10.3390/jcm11195555 - 22 Sep 2022

Viewed by 896

Abstract

Our purpose is to evaluate long-term changes in corneal endothelial cells after Ex-PRESS shunt implantation for the treatment of glaucoma in Chinese patients by comparison with the contralateral eye. In this retrospective observational study, glaucoma patients with a single eye undergoing Ex-PRESS shunt [...] Read more.

Our purpose is to evaluate long-term changes in corneal endothelial cells after Ex-PRESS shunt implantation for the treatment of glaucoma in Chinese patients by comparison with the contralateral eye. In this retrospective observational study, glaucoma patients with a single eye undergoing Ex-PRESS shunt implantation surgery were consecutively enrolled. For each patient, the clinical assessment, including corneal endothelial cell density (CECD) before surgery and at 6, 12 months, and at last follow-up (2.43 ± 0.63 years) after surgery was reviewed. The operated eyes were in the study group and the unoperated contralateral eyes were used as the control group to compare the CECD change. A total of 48 subjects (age, 51.02 ± 17.96 years) were included. The follow-up period was 2.08~3.17 years, with an average of 2.43 ± 0.63 years. At the last follow-up after the surgery, the CECD decrease in the operated eyes (5.0%) was similar to that in the contralateral eyes (3.2%) (p = 0.130). There were no significant differences in CECD reduction between the two groups at baseline and each postoperative follow-up (6 months, 12 months and at the last follow-up) (all p > 0.05). The average IOP reduction after the surgery was 50.8%, and the number of IOP-lowering medications was significantly reduced (p < 0.05). In addition, visual acuity showed no significant differences during follow-up (p > 0.05). In this study, we found that the CECD reduction of Ex-PRESS shunt-implanted Chinese eyes was similar to that of contralateral eyes without surgery. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

14 pages, 1287 KiB

Open AccessArticle

MicroShunt versus Trabeculectomy for Surgical Management of Glaucoma: A Retrospective Analysis

by Michael X. Fu, Eduardo M. Normando, Sheila M. H. Luk, Mira Deshmukh, Faisal Ahmed, Laura Crawley, Sally Ameen, Niten Vig, Maria Francesca Cordeiro and Philip A. Bloom

J. Clin. Med. 2022, 11(18), 5481; https://doi.org/10.3390/jcm11185481 - 18 Sep 2022

Cited by 2 | Viewed by 1605

Abstract

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints [...] Read more.

This case-control study aims to compare the efficacy, safety, and postoperative burden of MicroShunt versus trabeculectomy. The first consecutive cohort of MicroShunt procedures (n = 101) was matched to recent historical trabeculectomy procedures (n = 101) at two London hospital trusts. Primary endpoints included changes in intraocular pressure (IOP) and glaucoma medications. Secondary outcome measures included changes in retinal nerve fibre layer (RNFL) thickness, rates of complications, further theatre interventions, and the number of postoperative visits. From the baseline to Month-18, the median [interquartile range] IOP decreased from 22 [17–29] mmHg (on 4 [3–4] medications) to 15 [10–17] mmHg (on 0 [0–2] medications) and from 20 [16–28] mmHg (on 4 [3–4] medications) to 11 [10–13] mmHg (on 0 [0–0] medications) in the MicroShunt and trabeculectomy groups, respectively. IOP from Month-3 was significantly higher in the MicroShunt group (p = 0.006), with an increased number of medications from Month-12 (p = 0.024). There were greater RNFL thicknesses from Month-6 in the MicroShunt group (p = 0.005). The rates of complications were similar (p = 0.060) but with fewer interventions (p = 0.031) and postoperative visits (p = 0.001) in the MicroShunt group. Therefore, MicroShunt has inferior efficacy to trabeculectomy in lowering IOP and medications but provides a better safety profile and postoperative burden and may delay RNFL loss. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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9 pages, 546 KiB

Open AccessArticle

Italian Candidates for the XEN Implant: An Overview from the Glaucoma Treatment Registry (XEN-GTR)

by Chiara Posarelli, Michele Figus, Gloria Roberti, Sara Giammaria, Giorgio Ghirelli, Pierpaolo Quercioli, Tommaso Micelli Ferrari, Vincenzo Pace, Leonardo Mastropasqua, Luca Agnifili, Matteo Sacchi, Gianluca Scuderi, Andrea Perdicchi, Romeo Altafini, Maurizio Uva, Dino D’Andrea, Giuseppe Covello, Maria Novella Maglionico, Antonio Maria Fea, Carmela Carnevale and Francesco Oddone Show full author list Hide full author list

J. Clin. Med. 2022, 11(18), 5320; https://doi.org/10.3390/jcm11185320 - 09 Sep 2022

Cited by 1 | Viewed by 1481

Abstract

Background The Italian XEN Glaucoma Treatment Registry (XEN-GTR) was created to acquire a comprehensive prospective dataset that includes the patient characteristics, intraoperative variables, and postoperative management of glaucoma patients undergoing the XEN gel stent implantation. Methods This was a prospective observational, longitudinal clinical [...] Read more.

Background The Italian XEN Glaucoma Treatment Registry (XEN-GTR) was created to acquire a comprehensive prospective dataset that includes the patient characteristics, intraoperative variables, and postoperative management of glaucoma patients undergoing the XEN gel stent implantation. Methods This was a prospective observational, longitudinal clinical study involving 10 centres throughout Italy. The baseline examination included a comprehensive evaluation of demographic parameters (age, sex, ethnicity, and systemic condition), specific ophthalmological parameters, and quality of life questionnaire score collection. Results The baseline data of 273 patients were analysed. The median (IQR) age was 72 (65.0 to 78.0) years. Of the 273 patients, 123 (45%) were female and 150 (55%) were male. A total of 86% of the patients had open-angle glaucoma with a mean intraocular pressure of 24 ± 6 (range 12.0–60.0) mmHg. The mean number of medications was 2.7 ± 0.9 at baseline for the patients with a prevalence of prostaglandin analogues combined with a beta-blocker and anhydrase carbonic inhibitor (31.8%). The mean scores of the NEI-VFQ 25 and GSS questionnaires were 78 ± 18 (range 26.5–100) and 85 ± 14 (range 79–93), respectively. Combined XEN/cataract surgeries were scheduled in 73.7% of the patients. The preferred place for the XEN implant was the supero-nasal quadrant (91.6%). Conclusions Observing the baseline characteristics of the typical Italian candidates for the XEN gel implant shows that they are patients affected by POAG and cataracts, with moderate to severe glaucoma damage, all of which has an impact on their quality of life. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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14 pages, 3219 KiB

Open AccessArticle

Tube–Iris Distance and Corneal Endothelial Cell Damage Following Ahmed Glaucoma Valve Implantation

by Yitak Kim, Won Jeong Cho, Jung Dong Kim, Hyuna Cho, Hyoung Won Bae, Chan Yun Kim and Wungrak Choi

J. Clin. Med. 2022, 11(17), 5057; https://doi.org/10.3390/jcm11175057 - 28 Aug 2022

Viewed by 1313

Abstract

The most significant factor for endothelial cell loss should be readily identified, since prevention is the most crucial treatment. Here, we investigate risk factors for corneal endothelial cell density (ECD) decline following Ahmed glaucoma valve (AGV) implantation and determine the optimal cut-off values. [...] Read more.

The most significant factor for endothelial cell loss should be readily identified, since prevention is the most crucial treatment. Here, we investigate risk factors for corneal endothelial cell density (ECD) decline following Ahmed glaucoma valve (AGV) implantation and determine the optimal cut-off values. This study included 103 eyes (95 patients) with glaucoma that underwent AGV implantation between January 2006 and January 2021 at a single medical center (Severance Hospital). We conducted consecutive t-tests between two groups separated by the ECD change rate to determine the survival state of the enrolled patients. Associations were evaluated using univariable and multivariable linear regressions. Optimal cut-off values for identified risk factors were analyzed using a Cox proportional hazards model and a receiver operating characteristic (ROC) curve based on logistic regression. Mean follow-up duration was 4.09 ± 2.20 years. After implementing consecutive t-tests, only patients with an ECD change rate greater than −6.1%/year were considered to have survived. Tube–iris distance (TID) was the only statistically significant factor identified in both the univariable and multivariable linear regressions. The cut-off value determined from the consecutive Cox regression method was 0.33 mm (smallest p-value of 0.0087), and the cut-off value determined from the ROC method was 0.371 mm (area under the receiver operating characteristic curve [AUC], 0.662). Patients with short TIDs showed a better ECD prognosis following AGV surgery; we suggest optimal TID cut-off values of 0.33 mm and 0.371 mm based on the implemented Cox regression and ROC methodology, respectively. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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13 pages, 2305 KiB

Open AccessArticle

Outcomes of Deep Sclerectomy following Failed XEN Gel Stent Implantation in Open-Angle Glaucoma: A Prospective Study

by Giorgio Enrico Bravetti, Kevin Gillmann, Harsha L. Rao, André Mermoud and Kaweh Mansouri

J. Clin. Med. 2022, 11(16), 4784; https://doi.org/10.3390/jcm11164784 - 16 Aug 2022

Cited by 1 | Viewed by 1682

Abstract

Background: The purpose of this study is to evaluate the outcome of deep sclerectomy (DS) as a secondary procedure following failed ab-interno XEN gel stent implantation in patients with open-angle glaucoma. Methods: Prospective, single-center, non-randomized, interventional study. Consecutive eyes that underwent mitomycin C [...] Read more.

Background: The purpose of this study is to evaluate the outcome of deep sclerectomy (DS) as a secondary procedure following failed ab-interno XEN gel stent implantation in patients with open-angle glaucoma. Methods: Prospective, single-center, non-randomized, interventional study. Consecutive eyes that underwent mitomycin C (MMC) augmented XEN gel stent surgery, with uncontrolled intraocular pressure (IOP) or signs of disease progression, were included to undergo MMC-augmented DS. Primary efficacy outcome was surgical success, defined as complete when the unmedicated IOP was 12 mmHg or less, or 15 mmHg or less and 20% lower than at the timing of XEN failure and defined as qualified when the IOP fulfilled the same conditions with fewer medications than before deep sclerectomy. Secondary measures were mean reduction in IOP and in the number of medications, and the rates of complications. Results: Seventeen eyes were enrolled with a mean age of 72.1 ± 8.2 years (66.7% women). The mean follow-up was 20.1 ± 4.9 months, with more than 12-month data available from 15 eyes. Following DS, IOP decreased significantly from 22.6 ± 5.3 mmHg to 12.3 ± 5.5 (45.6%; p < 0.001). Antiglaucoma medications dropped from 1.1 ± 0.9 to 0.3 ± 0.7. Complete success was obtained in 40% of eyes using the threshold of 12 mmHg or less and a 20% decrease of IOP, and in 60% using the 15 mmHg or less threshold. Adverse events were observed in 20% of eyes (bleb leakage (13.3%); hypotony (6.7%)). No cases of choroidal detachment or hypotony maculopathy were reported. Conclusions: Failed XEN gel stent implantation does not seem to negatively affect the safety and efficacy of subsequent deep sclerectomy surgery. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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12 pages, 1388 KiB

Open AccessArticle

Topical Steroids and Glaucoma Filtration Surgery Outcomes: An In Vivo Confocal Study of the Conjunctiva

by Leonardo Mastropasqua, Lorenza Brescia, Francesca D’Arcangelo, Mario Nubile, Giada D’Onofrio, Michele Totta, Fabiana Perna, Raffaella Aloia and Luca Agnifili

J. Clin. Med. 2022, 11(14), 3959; https://doi.org/10.3390/jcm11143959 - 07 Jul 2022

Cited by 4 | Viewed by 1258

Abstract

(1) Background: The purpose of this study is to investigate the effects of topical steroids on conjunctiva in patients undergoing filtration surgery (FS) for glaucoma by using confocal microscopy (CM); (2) Methods: One hundred and four glaucomatous patients were randomized to fluorometholone or [...] Read more.

(1) Background: The purpose of this study is to investigate the effects of topical steroids on conjunctiva in patients undergoing filtration surgery (FS) for glaucoma by using confocal microscopy (CM); (2) Methods: One hundred and four glaucomatous patients were randomized to fluorometholone or lubricants four weeks before FS. CM was performed before treatments and pre-operatively. Dendritic and goblet cell densities (DCD, GCD), stromal meshwork reflectivity (SMR), vascular tortuosity (VT), and intra-ocular pressure (IOP) were the main outcomes. By evaluating treatments and outcomes (12-month success/failure) as categorical variables, patients were grouped into Group 1, 2, 3, or 4 (success/failure with fluorometholone, or lubricants); (3) Results: Twelve-month IOP was reduced in Groups 1 and 3 (p < 0.001). After treatments, DCD and SMR were reduced in Groups 1 and 2 (p < 0.01), and 1 and 3 (p < 0.05), respectively. Pre-operative DCD was lower in the steroid compared to lubricant group (p < 0.001), whereas SMR was lower in successful (1 and 3) compared to failed groups (2 and 4) (p = 0.004). There were no significant differences between the fluorometholone and lubricant groups for success percentages. The number of bleb management procedures and IOP lowering medications were lower in Group 1 compared to Groups 2–4 (p < 0.05); (4) Conclusions: Topical steroids mitigate conjunctival inflammation and lower the stromal density in patients undergoing FS. These modifications lead to less intensive post-operative management. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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Review

Jump to: Editorial, Research, Other

21 pages, 1705 KiB

Open AccessReview

Effectiveness and Safety of Xen Gel Stent in Glaucoma Surgery: A Systematic Review of the Literature

by Carlo Enrico Traverso, Roberto G. Carassa, Antonio Maria Fea, Michele Figus, Carlo Astarita, Benedetta Piergentili, Vanessa Vera and Stefano Gandolfi

J. Clin. Med. 2023, 12(16), 5339; https://doi.org/10.3390/jcm12165339 - 16 Aug 2023

Cited by 2 | Viewed by 1384

Abstract

Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of [...] Read more.

Although topical medical therapy and selective-laser-trabeculoplasty represent the treatments of choice to reduce intraocular pressure, many patients do not achieve adequate glaucoma control; therefore, they require further options and eventually surgery. Trabeculectomy is still considered the gold standard, but the surgical management of glaucoma has undergone continuous advances in recent years, XEN-gel-stent has been introduced as a safer and less traumatic means of lowering intraocular pressure (IOP) in patients with open-angle glaucoma (OAG). This study aimed to review the effectiveness and safety of clinical data on XEN-stent in OAG patients with a Synthesis-Without-Meta-analysis (SWiM) methodology. A total of 339 studies were identified following a literature search adhering to PRISMA guidelines and, after evaluation, 96 studies are discussed. XEN63 and XEN45 device data were collected both short and long term. In addition, this document has evaluated different aspects related to the XEN implant, including: its role compared to trabeculectomy; the impact of mitomycin-C dose on clinical outcomes; postoperative management of the device; and the identification of potential factors that might predict its clinical outcomes. Finally, current challenges and future perspectives of XEN stent, such as its use in fragile or high myopia patients, were discussed. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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15 pages, 3021 KiB

Open AccessReview

Advances in Canaloplasty—Modified Techniques Yield Strong Pressure Reduction with Low Risk Profile

by Peter Szurman

J. Clin. Med. 2023, 12(8), 3031; https://doi.org/10.3390/jcm12083031 - 21 Apr 2023

Viewed by 1392

Abstract

For decades, trabeculectomy (TE) was considered the gold standard for surgical treatment of open-angle glaucoma owing to its powerful intraocular pressure (IOP)-lowering potency. However, owing to the invasive nature and high-risk profile of TE, this standard is changing, and minimally invasive procedures are [...] Read more.

For decades, trabeculectomy (TE) was considered the gold standard for surgical treatment of open-angle glaucoma owing to its powerful intraocular pressure (IOP)-lowering potency. However, owing to the invasive nature and high-risk profile of TE, this standard is changing, and minimally invasive procedures are becoming more preferable. In particular, canaloplasty (CP) has been established as a much gentler alternative in everyday life and is under development as a full-fledged replacement. This technique involves probing Schlemm’s canal with a microcatheter and inserting a pouch suture that places the trabecular meshwork under permanent tension. It aims to restore the natural outflow pathways of the aqueous humor and is independent of external wound healing. This physiological approach results in a significantly lower complication rate and allows considerably simplified perioperative management. There is now extensive evidence that canaloplasty achieves sufficient pressure reduction as well as a significant reduction in postoperative glaucoma medications. Unlike MIGS procedures, the indication is not only mild to moderate glaucoma; today, even advanced glaucoma benefits from the very low hypotony rate, which largely avoids a wipeout phenomenon. However, approximately half of patients are not completely medication-free after canaloplasty. As a consequence, a number of canaloplasty modifications have been developed with the goal of further enhancing the IOP-lowering effect while avoiding the risk of serious complications. By combining canaloplasty with the newly developed suprachoroidal drainage procedure, the individual improvements in trabecular facility and uveoscleral outflow facility appear to have an additive effect. Thus, for the first time, an IOP-lowering effect comparable to a successful trabeculectomy can be achieved. Other implant modifications also enhance the potential of canaloplasty or offer additional benefits such as the possibility of telemetric IOP self-measurement by the patient. This article reviews the modifications of canaloplasty, which has the potential to become a new gold standard in glaucoma surgery via stepwise refinement. Full article

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Other

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11 pages, 3207 KiB

Open AccessCase Report

Descemet’s Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review

by Marta Orejudo de Rivas, Juana Martínez Morales, Elena Pardina Claver, Diana Pérez García, Itziar Pérez Navarro, Francisco J. Ascaso Puyuelo, Julia Aramburu Clavería and Juan Ibáñez Alperte

J. Clin. Med. 2023, 12(17), 5461; https://doi.org/10.3390/jcm12175461 - 23 Aug 2023

Viewed by 662

Abstract

This article presents three cases of Descemet’s membrane detachment (DMD) occurring during ‘ab externo’ phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of [...] Read more.

This article presents three cases of Descemet’s membrane detachment (DMD) occurring during ‘ab externo’ phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm’s canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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6 pages, 1640 KiB

Open AccessCase Report

XEN Gel Stent for Conjunctiva with Minimal Mobility Caused by Scleral Encircling: A Case Report

by Yuri Kim, Myungjin Kim, Dai Woo Kim and Seungsoo Rho

J. Clin. Med. 2023, 12(13), 4293; https://doi.org/10.3390/jcm12134293 - 27 Jun 2023

Viewed by 803

Abstract

This case report describes the successful use of a XEN gel stent for controlling intraocular pressure (IOP) in a patient who had previously undergone scleral encircling for rhegmatogenous retinal detachment. The patient had very limited mobile conjunctiva due to scarring caused by the [...] Read more.

This case report describes the successful use of a XEN gel stent for controlling intraocular pressure (IOP) in a patient who had previously undergone scleral encircling for rhegmatogenous retinal detachment. The patient had very limited mobile conjunctiva due to scarring caused by the earlier surgery, which limited their options for glaucoma surgery. The XEN gel stent, a minimally invasive glaucoma surgery (MIGS) procedure that does not require opening the conjunctiva, was implanted in the subconjunctival space using an ab interno approach. Postoperative blebs were imaged using anterior segment optical coherence tomography, and IOP was monitored over six months. This study found that the XEN gel stent effectively controlled the IOP, and there were no complications during or after surgery. This case report may expand the indication for the XEN gel stent, which could be considered a viable option for patients who have undergone scleral buckling and have limited mobile conjunctiva. Full article

(This article belongs to the Special Issue Advances in Glaucoma Surgery)

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