Goniotomy with a single-use dual blade: Short-term results Greenwood, Michael D.; Seibold, Leonard K.; Radcliffe, Nathan M. ...
Journal of cataract and refractive surgery,
September 2017, 2017-09-00, 20170901, Letnik:
43, Številka:
9
Journal Article
Recenzirano
Odprti dostop
To evaluate the intraocular pressure (IOP)–lowering efficacy and safety of a single-use dual blade (Kahook) in patients with mild to end-stage glaucoma.
International multicenter ophthalmic care ...centers.
Prospective interventional case series.
Consecutive patients with glaucoma who had phacoemulsification plus goniotomy with the single-use dual blade were enrolled in this study. Each center collected deidentified clinical data, including preoperative and postoperative IOP, medication use, adverse events, and whether additional surgery was required during a 6-month follow-up.
Of the 71 eyes included in this study, 70% had primary open-angle glaucoma. Other diagnoses included angle-closure, pigmentary, pseudoexfoliative, and normal-tension glaucoma. Sixty-five percent of eyes were classified as having mild to moderate glaucoma and 35%, severe glaucoma. The mean baseline IOP decreased from 17.4 mm Hg ± 5.2 (SD) to 12.8 ± 2.6 mm Hg 6 months postoperatively and the hypotensive medication use decreased from 1.6 ± 1.3 to 0.9 ± 1.0, respectively (P < .001 and P = .005, respectively). The most common observation was blood reflux during surgery (39.4%).
Single-use dual blade goniotomy plus phacoemulsification resulted in a significant and sustained reduction in IOP and a decrease in glaucoma medications after 6 months of follow-up.
A healthy corneal endothelium is required for corneal clarity. Both the glaucoma disease state and its various forms of treatment can have adverse effects on the corneal endothelium. Both the ...presence of glaucoma and the magnitude of intraocular pressure (IOP) elevation are related to endothelial cell loss (ECL). Topical medical therapy, laser procedures, and both traditional surgeries—trabeculectomy and tube-shunts—and newer minimally invasive glaucoma surgeries have variable effects on ECL. This review will summarize the reported effects of glaucoma and its treatment on ECL. Concerns for corneal endothelial cell health should be part of the decision-making process when planning glaucoma therapy for lowering IOP, with added caution in case of planned device implantation in eyes with pre-existing ECL and low endothelial cell density (ECD) at high risk for corneal endothelial decompensation.
Introduction
To describe the 12-month efficacy and safety of goniotomy performed using the Kahook Dual Blade (KDB) in combination with cataract surgery in eyes with medically treated open-angle ...glaucoma (OAG).
Methods
This was a prospective, interventional case series conducted at seven centers in North America. Consecutive patients with medically treated OAG and visually significant cataract underwent phacoemulsification combined with goniotomy (PE + goniotomy) using KDB. Indications for glaucoma surgery included reduction of intraocular pressure (IOP) and reduction of IOP-lowering medications. De-identified data were collected and included pre-, intra-, and postoperative data on IOP, the use of IOP-lowering medications, and adverse events through 12 months of follow-up.
Results
Among 52 eyes undergoing surgery, mean IOP was reduced from 16.8 ± 0.6 mmHg at baseline to 12.4 ± 0.3 mmHg at month 12 (
P
< 0.001), a 26.2% reduction. Mean IOP across time points ranged from 12.4–13.3 mmHg during follow-up. The mean number of topical IOP-lowering medications was reduced from 1.6 ± 0.2 at baseline to 0.8 ± 0.1 at month 12 (
P
< 0.05), a 50.0% reduction. At month 12, 57.7% of eyes had IOP reduction ≥ 20% from baseline, and 63.5% were on ≥ 1 fewer IOP-lowering medications. In subgroup analysis, 84.6% of eyes with lower mean baseline IOP were using ≥ 1 fewer medications at month 12, and 100% of eyes with higher mean baseline IOP had IOP reductions ≥ 20%. The most common postoperative adverse events were pain/irritation (
n
= 4, 7.7%), opacification of the posterior lens capsule (
n
= 2, 3.8%), and IOP spike > 10 mmHg (
n
= 2, 3.8%).
Conclusion
PE + goniotomy using the KDB significantly lowers both IOP and dependence on IOP-lowering medications in eyes with OAG. Adverse events were not sight-threatening and typically resolved spontaneously.
Funding
New World Medical, Inc.
To evaluate factors associated with residual astigmatism after toric intraocular lens implantation based on data from an online toric intraocular lens (IOL) back-calculator.
This was a retrospective ...data review of an online toric IOL back-calculator, which allows users to input preoperative toric planning information and postoperative lens orientation and refractive results. These data were used to determine the optimal orientation of the IOL to minimize residual refractive astigmatism. Aggregate data were extracted from this calculator to investigate factors associated with relative magnitudes of residual astigmatic refractive error after implantation of toric IOLs.
A total of 3,159 validated records with an average reported postoperative refractive astigmatism of 1.85 diopters (D) were analyzed; 566 included data allowing calculation of surgically induced astigmatism. The relative magnitude of reported residual astigmatism appeared similar whether a femtosecond laser system was used or not. Significant differences relative to the use of intraoperative aberrometry were observed, as were differences by toric calculator. Higher measured surgically induced astigmatism was most associated with higher levels of reported residual astigmatism. A significant potential decrease in the mean refractive astigmatism was expected with IOL reorientation; in 1,416 cases (44.8%), the expected residual refractive astigmatism after lens reorientation was less than 0.50 D, with a mean reduction of 56% ± 31%.
When present after cataract surgery, higher levels of residual refractive astigmatism were most associated with large differences in measured preoperative to postoperative keratometry. To a lesser degree, intraoperative aberrometry was associated with lower levels. J Refract Surg. 2018;34(6):366-371..
The 24-hour intraocular pressure (IOP) rhythm is of interest to clinicians but its overall impact on glaucomatous progression remains unclear. Recent evidence has implicated the translaminar pressure ...gradient (TLPG), or imbalance between IOP and intracranial pressure, in the development of glaucoma. Evidence suggests that retinal ganglion cell death occurs as a result of decreased axonal transport only after a sustained, elevated TLPG. We hypothesize that periodic normalization of the TLPG prevents glaucomatous damage by enabling temporary resumption of axonal transport. Temporary resumption of axonal transport allows for delivery of critical metabolic cargoes with concomitant removal of metabolic waste which prevents apoptosis of the retinal ganglion cell.
Importance
Use of the trabecular micro‐bypass stent with cataract surgery is well established to be safe and effective in primary open‐angle glaucoma. This is the first study to exclusively evaluate ...use of the device in pigmentary glaucoma.
Background
This study aimed to investigate the safety and efficacy of a trabecular micro‐bypass stent in combination with cataract surgery in pigmentary glaucoma.
Design
Retrospective, consecutive case series.
Participants
Twenty‐four eyes of 12 patients with pigmentary glaucoma implanted with one trabecular micro‐bypass stent with concomitant cataract surgery.
Methods
Baseline data was collected and compared to the following postoperative time points: 1 day, 1 week, 1 month out to 36 months (M36) after the procedure.
Main Outcome Measures
These included intraocular pressure (IOP), number of glaucoma medications and need for additional surgery.
Results
At M36 there was a 25% reduction in IOP to 14.68 ± 3.0 (P < .01) from 19.50 ± 6.7 mmHg at baseline. The mean number of glaucoma medications was 0.75 ± 1.0 prior to the surgery and 0.59 ± 0.6 (P > .05) at 36 M. At the 36 M time‐point, 95% of eyes had IOP ≤ 18 mmHg and 68% of eyes were ≤ 15 mmHg. No eyes underwent a secondary glaucoma procedure.
Conclusions and Relevance
The insertion of a single trabecular micro‐bypass stent in combination with cataract surgery effectively provides a sustained reduction in IOP up to 3 years after surgery in patients with pigmentary glaucoma. The safety profile is favourable with low rate of IOP spikes and no patients requiring additional surgery.
PURPOSE OF THE STUDY:The purpose of the study was to evaluate the safety and efficacy of the iStent Trabecular Micro-Bypass stent in pseudophakic patients with open-angle glaucoma.
...METHODS:Retrospective, consecutive case series from October 2012 to May 2015 with no exclusion criteria. The series comprised 42 pseudophakic eyes with open-angle glaucoma that were implanted with 1 iStent. Data were collected preoperatively, and postoperative data were collected at 1 day, 1 week, 1, 3 and 6 months, 1 year, 18 months and 2 years. Data included intraocular pressure (IOP), number of glaucoma medications, the incidence of postoperative IOP pressure spikes ≥15 mm Hg at any timepoint, and the need for additional surgery.
RESULTS:The mean preoperative IOP was 20.26±6.00 mm Hg. At 1 year postoperatively, the mean IOP was 16.34±3.78 mm Hg (P<0.01). At 2 years postoperatively, the mean IOP was 13.62±4.55 (P<0.01). The mean number of glaucoma medications was 1.95±1.01 preoperative and 1.69±1.28 (P>0.05) at 1 year postoperatively. Postoperatively, 3 eyes (7%) experienced an IOP increase of 15 mm Hg above their baseline IOP that responded to topical therapy. In total, 96% of patients with an IOP≥19 mm Hg achieved a reduction in IOP at their last collected follow-up.
CONCLUSIONS:The insertion of the iStent Trabecular Micro-Bypass stent effectively lowers IOP in pseudophakic patients with open-angle glaucoma. Although medication use was not significantly reduced postoperatively at 1 year, 80% of patients either experienced a reduction or no change in medication use. The safety profile appears favorable with a low rate of IOP spikes and only 1 patient requiring additional surgery.
To evaluate the safety and efficacy of the iStent trabecular microbypass stent in combination with cataract surgery in patients with open-angle glaucoma (OAG).
Retrospective, consecutive case series ...from October 2012 to December 2015 with no exclusion criteria. The series comprised of 350 eyes with OAG and cataract. Data were collected both preoperatively and postoperatively at day 1 week 1, months 1, 3, 6, 12, 18, and 24. Data included intraocular pressure (IOP), number of glaucoma medications, visual acuity, the incidence of postoperative IOP pressure spikes of greater than ≥15 mmHg at any time point, and need for additional surgery.
The mean preoperative IOP was 19.13±6.34 mmHg. At 2 years postoperation, mean IOP was 15.17±3.53 mmHg (
<0.0001). The mean number of glaucoma medications was 1.19±1.00 preoperatively and 0.61±0.96 (
<0.0001) at 2 years postoperation. At 1 day postoperatively, 31 eyes (12.4%) experienced an IOP increase of 15 mmHg above their baseline IOP that responded to topical therapy. Two patients required additional tube shunt surgery.
The insertion of the iStent trabecular microbypass stent in combination with cataract surgery effectively lowers IOP in OAG patients. The magnitude of IOP reduction was more significant in patients with higher preoperative pressure. Medication use was also significantly reduced postoperatively. The safety profile appears favorable with a low rate of IOP spikes and only two eyes (<1%) requiring additional surgery.
Defocus Curve of Emerging Presbyopic Patients Shafer, Brian M; Puls-Boever, Keeley; Berdahl, John P ...
Clinical ophthalmology (Auckland, N.Z.),
01/2023, Letnik:
17
Journal Article
Recenzirano
Odprti dostop
To create a defocus curve of emerging presbyopic patients of various age groups.
Single site private practice in Sioux Falls, South Dakota.
This was a non-randomized, prospective study. All subjects ...were enrolled from healthy volunteers.
Subjects aged 37-9, 40-42, 43-45 and 46-48 that have 20/20 best-corrected distance visual acuity (BCDVA) were included. Binocular visual acuity at different defocus steps ranging from +0.5 D to -3 D was measured in each age group. Defocus curves were generated from the mean logMAR visual acuities at each defocus step, by age group.
Of the 60 subjects, 23.3% of subjects were between the ages of 37-39, 26.7% were between the ages of 40-42, 25% of subjects were between ages 43-45, and 25% were between the ages of 46-48. Visual acuity significantly decreased from plano to -3 D defocus steps in all groups (p < 0.0002, p = 0, p = 0 and p = 0). The 46-48-year-old group had worse visual acuity compared to the other three groups from the -1.0 to -2.0 D defocus steps (p = 0.037, p = 0.022 and 0.017, respectively). Starting at a near point of 40cm, the 37-39 group had the best logMAR vision and the 46-48 group had the worst vision (p = 0.001).
The defocus curves of emerging presbyopic individuals demonstrate a decreasing visual acuity at near defocus steps that decreases with age. Defocus curves at different age ranges can help doctors explain various presbyopia treatment options in terms of near point capabilities at various ages.
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