To report the efficacy of the revision of failed ab interno canaloplasty with micro-invasive suture trabeculotomy (MIST) over a follow-up period of 24 months.
A retrospective analysis was performed ...on 23 eyes with open-angle glaucoma (OAG), on whom an ab interno canaloplasty revision with MIST was performed for glaucoma progression. The primary outcome was the proportion of eyes with a significant intraocular pressure (IOP) reduction at 12 months post trabeculotomy, defined as an IOP ≤ 18 mm Hg or ≥20% reduction in IOP without any secondary intervention (SI), and with the same or fewer number of glaucoma medications (NGM). All parameters, including best corrected visual acuity (BCVA), IOP, NGM, and SI, were evaluated at 1, 6, 12, 18, and 24 months.
At 12 months, eight out of 23 eyes (36.4%) achieved complete success, maintained in six eyes (27.3%) at 24 months. A significantly lower mean IOP was recorded at all visits 14.3 ± 4.0 mm Hg at 24 months vs 23.1 ± 6.8 mm Hg at baseline (BL) with a percent IOP change of up to 27.3% at 24 months postoperatively. NGM and BCVA did not significantly decrease from BL. A total of 11 eyes (47.8%) needed an SI throughout the follow-up period.
Ab interno trabeculotomy in patients with failed canaloplasty was not shown to be effective in providing a satisfactory control of IOP in OAG patients, possibly due to the small suture gauge used in the initial canaloplasty.
Further research is needed to optimize the surgical outcome.
Seif R, Jalbout NDE, Sadaka A,
Size Matters: Ab Interno Canaloplasty Revision with Suture Trabeculotomy. J Curr Glaucoma Pract 2022;16(3):152-157.
A 68-year-old woman presented to the ophthalmology emergency clinic with a painful left eye of a few hours' duration. One month prior, the patient had presented with a central retinal vein occlusion ...in the same eye. Examination revealed an intraocular pressure of 32 mm Hg in the left eye with 360 degree angle closure unaltered by indentation, a patent iridectomy from a previous combined phacoemulsification and trabeculectomy surgery, and no evident iris or angle neovascularization. Ultrasound biomicroscopic examination revealed a large suprachoroidal effusion with anterior rotation of the ciliary body and secondary angle closure in the left eye. The patient underwent successful pars plana vitrectomy, radial optic neurotomy, intra-vitreal triamcinolone acetonide injection, and goniosynechialysis.
The identification of modifiable risk factors for glaucoma progression is needed. Our objective was to determine whether maladaptive coping styles are associated with recent glaucoma progression or ...worse visual field mean deviation.A hospital-based case-control study was conducted in the Glaucoma Service of Maisonneuve-Rosemont Hospital in Montreal, Canada. Patients with primary open angle glaucoma or normal tension glaucoma with ≥4 years of follow-up and ≥5 Humphrey visual fields were included. Cases had recent visual field progression as defined according to the Early Manifest Glaucoma Trial pattern change probability maps. Controls had stable visual fields. The Brief Cope questionnaire, a 28-item questionnaire about 14 different ways of coping with the stress of a chronic disease, was asked. Questions were also asked about demographic and medical factors, and the medical chart was examined. Outcomes included glaucoma progression (yes, no) and visual field mean deviation. Logistic and linear regressions were used.A total of 180 patients were included (82 progressors and 98 nonprogressors). Although none of the 14 coping scales were associated with glaucoma progression (P > 0.05), higher denial was correlated with worse visual field mean deviation (r = -0.173, P = 0.024). In a linear regression model including age, sex, education, depression, intraocular pressure, and family history of glaucoma, greater levels of denial (β = -1.37, 95% confidence interval CI -2.32, -0.41), Haitian ethnicity (β = -7.78, 95% CI -12.52, -3.04), and the number of glaucoma medications (β = -1.20, 95% CI -2.00, -0.38) were statistically significantly associated with visual field mean deviation.The maladaptive coping mechanism of denial was a risk factor for worse visual field mean deviation. Further prospective research will be required to verify the pathways by which denial may exert an effect on glaucomatous visual field loss.
Aims. To describe the use of subconjunctival bevacizumab (SCB) injection in the combined cataract and glaucoma filtering surgery (GFS). Methods. Retrospective comparative case series. Thirty eyes of ...twenty-eight patients who had GFS followed by SCB injection as part of post-operative management were included (Group SCB). The types of GFS included trabeculectomy and non-penetrating glaucoma surgery (NPGS) with mitomycin-C. Outcome measures included the reduction of intraocular pressure (IOP) and medications. Age-matched patients who had the same types of surgery without SCB were selected as a control group (Group C). Results. The types of GFS were: combined cataract surgery and NPGS (SCB: 20; C: 24), phacotrabeculectomy (SCB: 6; C: 3), NPGS (SCB: 3; C: 2) and trabeculectomy alone (SCB: 1; C: 1). The average follow-up time was 16.9 (±8.2) months in the SCB group and 19.6 (±11.5) months in the controls. 1.25 mg of bevacizumab was injected on average 14.1 (range: 3–42) days post-GFS. The mean IOP decreased from 21.9 (±9.8) to 11.9 (±4.7) mmHg in the controls and from 19.6 (±8.9) to 14.0 (±4.7) mmHg in the SCB group. There was no statistically significant difference between the two groups (P=0.11). Complications included three cases of branch vein occlusion in the SCB group. Conclusions. SCB did not result in better outcome in term of IOP reduction. Clinicians should monitor its side effects in glaucoma patients.
In thrombocytopenia, a hemorrhagic diathesis is usually present due to a low platelet count and has been related to the development of cataracts and retinopathy. The concomitant administration of ...nonsteroidal anti-inflammatory drugs can increase the hemorrhagic diathesis. The purpose of this study was to investigate the impact of thrombocytopenia during and after intraocular surgery.
A retrospective study of medical files of patients who had undergone cataract and glaucoma filtering surgery and were diagnosed as having thrombocytopenia between 1994--1995 and 1998--1999 was conducted. Eight patients with a total of 11 surgical procedures were included in this study.
Hemorrhagic complications occurred in 2 of the 11 procedures, for an incidence of 18%. These 2 cases are described in detail.
The current study confirms that thrombocytopenia is a significant risk factor for perioperative bleeding in ocular surgery. A routine questionnaire should be completed before ocular surgery and a complete blood cell count obtained in suspect cases. Consultation with a hematologist is warranted in cases of thrombocytopenia.
Three years after receiving a Baerveldt tube implant for neovascular glaucoma, a 50-year-old man presented to the Wills Eye Hospital Glaucoma Service with pain and decreased vision in his left eye. ...On examination, a 4-0 nylon ripcord suture was seen to have migrated posteriorly through the pupil and in front of the intraocular lens. The distal end of the suture was not seen on dilated indirect ophthalmoscopic examination or by standard B-scan ultrasonography. Ultrasound biomicroscopy examination was performed, and the distal end of the suture was found to lie just anterior to the pars plana. Careful removal of the suture was performed intraoperatively through two paracentesis incisions using Kelman forceps. Posterior ripcord migration is a rare complication after glaucoma drainage implant surgery, and ultrasound biomicroscopy imaging may be helpful in determining its proper management.
To report the position of the single-piece and three-piece intraocular lenses (IOLs) following in-the-bag implantation.
Forty patients with bilateral age-related cataracts were recruited from both ...tertiary hospital and private practice in Montréal, Canada. Patients received the single-piece IOL in one eye and the three-piece IOL contralaterally. Postoperative anterior chamber depth (ACD) and iris-to-IOL distance were evaluated using a Scheimpflug imaging system.
Mean ACD was 4.21 ± 0.32 mm for the single-piece IOL and 3.94 ± 0.34 mm for the three-piece IOL. Mean iris-to-IOL distance was 0.70 ± 0.19 mm for the single-piece IOL and 0.44 ± 0.21 mm for the three-piece IOL. The difference between paired eyes was 0.26 ± 0.20 mm (P = .002) for ACD and 0.25 ± 0.21 mm (P < .001) for iris-to-IOL distance.
The single-piece IOL was positioned more posteriorly to the iris and allowed for a greater ACD than the three-piece IOL.
Abstract Background: To compare the efficacy and safety of latanoprost and timolol gel-forming solution (GFS). Methods: This was a randomized, crossover, investigator-masked, active-control study of ...patients with primary open-angle glaucoma and ocular hypertension. Patients received either once-daily 0.5% timolol GFS ( n = 40) or once-daily 0.005% latanoprost ( n = 35) for 8 weeks (period 1). Patients were then crossed over to the other medication and treated for another 8 weeks (period 2). Intraocular pressure (IOP) was determined every 2 hours from 8:00 to 20:00 at baseline and weeks 8 and 16. Safety was assessed by visual acuity, slit-lamp biomicroscopy, and adverse event reports. Results: During period 1, reduction in mean (SD) diurnal IOP was significantly greater in latanoprost-treated patients (−6.9 3.0 mm Hg) than in timolol GFS-treated patients (−5.5 2.4 mm Hg), p = 0.034. There was also a significant reduction in IOP from baseline after switching from timolol GFS to latanoprost (p < 0.001), not observed when patients were switched from latanoprost to timolol GFS. After results from each drug's treatment periods were combined between treatment arms, latanoprost reduced IOP more (−6.9 2.9 mm Hg) than did timolol GFS (−6.2 2.7 mm Hg), p = 0.018. Hyperemia was the most common adverse event in both treatment groups, with 5 incidences in timolol GFS-treated patients, and 10 in latanoprost. Interpretation: Latanoprost is more effective than timolol GFS in reducing IOP, and patients switched from timolol GFS to latanoprost have a further significant reduction in IOP.
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