Molteno aqueous shunt as a primary surgical intervention for uveitic glaucoma: long‐term results

Purpose: To evaluate the efficacy of Molteno aqueous shunt as a primary surgical treatment in uveitic glaucoma. Methods: Nonrandomized, interventional, retrospective clinical study. The intraocular pressure (IOP), survival rate and complications were analyzed in 30 patients with uveitic glaucoma treated with Molteno implant. Results: The mean follow‐up time was 59.3 ± 18.4 months. Preoperatively, the mean ± SD IOP was 32.8 ± 7.5 mmHg (range 20–48), and the mean number of medications was 3.1 ± 0.6. The mean IOP decreased significantly (p < 0.001) to 17.7 and 15 mmHg at 3 and 6 months postoperatively. The mean number of medications decreased statistically significantly (p < 0.001) from the preoperative number 3.1 to 1.9 three months postoperatively. The number of medications continued to decrease significantly up to 3 years postoperatively. The qualified success rate (Kaplan–Meier estimate) was 97%, 93%, 90% and 85% at 1, 2, 3 and 4 years, respectively. Two patients failed because of hypotony, two patients developed conjunctival erosion and one patient had corneal decompensation. Conclusions: Molteno aqueous shunt as the first glaucoma procedure decreased IOP effectively in uveitic glaucoma. Even after 4 years, the survival estimate was quite high. The IOP decreased continuously during the first year after the surgery, and the medication was slowly tapered even up to 3 years postoperatively. It is suggested that it may be possible to postpone further surgical intervention during the first postoperative year after Molteno implantation even if the IOP is not quite optimal.     

Diode laser trans-scleral cyclophotocoagulation for glaucoma following silicone oil removal

Purpose : To evaluate the effect of trans‐scleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in eyes with medically uncontrolled secondary glaucoma persisting after intravitreal silicone oil removal. Methods : Clinical records of 21 eyes of 21 patients who underwent TSCP for medically uncontrolled glaucoma persisting after the removal of intravitreal silicone oil, injected during vitreoretinal surgery for proliferative vitreoretinopathy (PVR), were reviewed retrospectively. Diode laser contact TSCP was applied at a power setting of 1.5–2.5 W, for a maximum duration of 2 s, and a total of 40 spots (10 spots each quadrant). All the patients were evaluated for visual acuity, IOP and number of medications used. Results : The patients were followed up for a mean ± SD period of 39.9 ± 4.27 weeks (range 36–48 weeks). The IOP was found to have decreased significantly from a pretreatment value of 34.5 ± 5.37 mmHg (range 24–44 mmHg) to 20.47 ± 4.49 mmHg at 6 months of follow up (range 12–30 mmHg, P < 0.01, Student’s paired t‐test). The total number of glaucoma medications being used reduced from 3.38 ± 0.5 to 1.08 ± 0.80 postoperatively (P < 0.01, Wilcoxon’s rank sum test). There was no significant difference in the visual acuity before and after the procedure. Thirteen eyes required a second sitting of TSCP, and five of these required a third sitting. For a successful outcome (IOP < 24 mmHg), a mean of 1.56 sittings (range 1–3 sittings) per eye were needed. Conclusion : Patients with medically uncontrolled glaucoma persisting after intravitreal silicone oil removal can be treated with TSCP; however, the reduction of IOP is variable. The IOP usually falls after a mean of 2–3 sittings of TSCP.     

Baerveldt glaucoma implants in the management of refractory glaucoma after vitreous surgery

Purpose: To examine the effectiveness and safety of Baerveldt glaucoma implants in eyes with refractory glaucoma following vitrectomy. Methods: We performed a retrospective study of a non‐comparative case series of 30 eyes of 30 patients who had undergone the implantation of a Baerveldt glaucoma device. All eyes (30/30) had a minimum follow‐up of 6 months, and 16/30 (53%) had a follow‐up of 24 months. Surgical success was defined as intraocular pressure (IOP) < 22 mmHg on the last two follow‐up visits with or without glaucoma medication and a decrease in IOP of at least 20% compared to preoperative values with or without glaucoma medication. Results: The mean IOP before implantation of a Baerveldt glaucoma device was 30 mmHg [± 11.4 mmHg standard deviation (SD)] with maximally tolerated medical therapy. Six months after implantation of the Baerveldt glaucoma device, the mean IOP was 17.3 mmHg (± 6.7 mmHg SD) and the mean number of glaucoma medications had gone down from 3.0 (± 0.4 SD) to 0.3 (± 0.3 SD). Successful outcomes were found in 24 eyes (80%). Small complications occurred in six eyes (20%): transient postoperative hypotony (17%) and tube retraction (3%). Larger complications occurred in another six eyes (20%): corneal decompensation requiring keratoplasty (7%), suprachoroidal haemorrhage (3%) and persistently high IOP (10%). Conclusion: Baerveldt glaucoma devices are a valid treatment option in eyes with refractory glaucoma after vitreous surgery, although failure occurred in 20% of our patients. Transient complications occurred in 20% and severe complications in another 20%.     

Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

Purpose

To compare efficacy and safety results of an ab interno gel implant in patients with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG).

Methods

Retrospective analysis of the medical records of 110 consecutive eyes with open angle glaucoma who had received a XEN45 gel implant between March 2014 and June 2015. Intraocular pressure course, number of glaucoma medications, the need for additional intervention (including needling) and complications were evaluated until 12?months postoperatively.

Results

Data of 67 eyes with POAG and 43 eyes with PXG were analyzed. At 12?months postoperatively, the mean IOP had significantly decreased by 54.0% from preoperatively 31.85?±?8.5?mmHg to 13.99?±?2.6?mmHg in the POAG group, (p?=?0.000; Wilcoxon test), and by 55.2% from 31.63?±?9.0?mmHg to 13.28?±?3.1?mmHg in the PXG group (p?=?0.000; Wilcoxon test). The mean number of anti-glaucoma medications had significantly decreased from 3.25?±?0.8 at baseline to 0.3?±?0.7 medications at 12?months postoperatively in POAG eyes (p?=?0.000; Wilcoxon test), and from 3.05?±?1.0 to 0.3?±?0.6 medications in PXG eyes (p?=?0.000; Wilcoxon test). Hypotony (IOP?≤?6?mmHg) was observed in 2 POAG eyes (3.0%) and in 5 PXG eyes (11.7%) at 1?month but normalized in all eyes at 12?months postoperatively. Severe complications were not observed. No statistically significant differences were found between PXG eyes and POAG eyes.

Conclusion

Our data indicate that the XEN45 gel implant provides significant and comparable reduction in IOP and anti-glaucoma medication during the one-year follow-up period in POAG as well as PXG eyes. This suggests that it may be a noteworthy alternative to traditional filtering procedures in patients with POAG and PXG respectively.

     

Baerveldt implant in refractory glaucoma: long-term results and factors influencing outcome

Purpose: To evaluate the clinical outcome of patients who received aBaerveldt implant for refractory glaucoma and to identify factors which mayinfluence the outcome. Methods: Retrospective study including 51 eyesof 51 patients with medically uncontrolled glaucoma who underwent Baerveldtimplant surgery between June 1994 and December 1998. Criteria for successwere intraocular pressure (IOP) 21 mmHg and >6 mmHg, necessityof further antiglaucoma medications, absence of additional glaucoma surgeryand no loss of light perception. Results: Over a mean follow-up of 37.6(SD: ± 18.8) months, the mean intraocular pressure decreased from 34.8(±12.5) mmHg to 14.0 (±4.3) mmHg at month 60. Qualified successrate, achieved when IOP was below 21 mmHg and higher than 6 mmHg withmedications was 25/48 (52%), complete success rate (same IOP limits withoutmedication) was 14/48 (29%). Seven eyes had major complications or lostlight perception. Postoperative visual acuity improved or remained within oneSnellen line of the preoperative visual acuity in 35 patients (73%). Factorsassociated with a better prognosis were a preoperative visual acuity better than 20/400 and etiology of glaucoma. Conclusion: The Baerveldt implant iseffective in lowering intraocular pressure in most patients with refractoryglaucoma. Long-term results are promising with satisfactory IOP control.     

Latanoprost Nonresponders with Open-Angle Glaucoma in the Japanese Population

Purpose

As some patients show little response to latanoprost, one of the most powerful topical glaucoma medications, we investigated the incidence and clinical profiles of latanoprost nonresponders (LNR) in the Japanese population.

Methods

We examined 62 glaucoma patients (62 eyes) who had received only latanoprost for more than 3 months. Their mean age was 63.8 ± 1.8 years; the mean observation period was 9.7 ± 0.4 months. At 1, 3, 6, and 12 months, their intraocular pressure (IOP) was measured, and the IOP reduction rate (RR) and the rate of LNR, defined as RR of 10% or less, were calculated. We statistically analyzed clinical factors involved in the LNR status of our study population.

Results

At 1, 3, 6, and 12 months, RR was 20.1 ± 2.0%, 18.8 ± 2.3%, 21.1 ± 2.8%, and 23.0 ± 2.6%, respectively. At the same time points, the LNR incidence was 23.1%, 28.1%, 23.5%, and 31.8%, respectively, and significantly higher in patients whose baseline IOP was less than 15?mmHg. Patient sex and age and the glaucoma type played no significant role in the LNR status.

Conclusions

The incidence of LNR in the Japanese population, including normal-tension glaucoma (NTG) patients, is higher than among European or American patients. Only low baseline IOP was a significant clinical factor among LNR.?Jpn J Ophthalmol 2006;50:153–157 © Japanese Ophthalmological Society 2006     

Intermediate-term results of the Ex-PRESS miniature glaucoma implant under a scleral flap in previously operated eyes

Background: To report the safety and efficacy of Ex‐PRESS^TM miniature glaucoma implant under a scleral flap in patients with previous ocular surgeries. Design: Retrospective, non‐comparative case series from a tertiary care hospital. Participants: Patients with previous cataract or failed glaucoma surgeries who had undergone implantation of the Ex‐PRESS^TM miniature glaucoma implant (R‐50 and T‐50), under a scleral flap, with a minimum of 1‐year postoperative follow up. Methods: For postoperative outcome, success was defined as complete if intraocular pressure (IOP) was 5–21 mmHg without medication or surgical intervention, and qualified if intraocular pressure was within the same range with glaucoma medication. To compare the outcome between patients who had previous trabeculectomy or cataract surgery the definition of success was intraocular pressure of 5–15 mmHg. Main Outcome Measures: Intraocular pressure, number of antiglaucoma drugs, visual acuity and complications. Results: One hundred eyes (100 patients; mean age: 77.4 years) with a mean follow‐up period of 27 ± 13.2 months (range: 12–66) were considered. Success was complete in 60 (60%) and qualified in 24 (24%) eyes. The mean preoperative IOP of 27.7 ± 9.2 mmHg (range: 14–52 mmHg) with 2.73 ± 1.1 drugs declined to 14.02 ± 5.1 mmHg with 0.72 ± 1.06 drugs at the last follow up (P < 0.0001). Causes of failure were uncontrolled intraocular pressure (11%), bleb needling (4%) and persistent hypotony (1%). The probability of success in the patients with previous cataract surgery and trabeculectomy at 3 years was 60.6% and 50.9%, respectively. Conclusions: The Ex‐PRESS^TM implant under scleral flap was a safe and effective glaucoma surgery in the eyes with prior ocular surgery.     

Corneal biomechanics predict the outcome of selective laser trabeculoplasty in medically uncontrolled glaucoma

Purpose

To evaluate the predictive value of clinical parameters, including biomechanical properties on the outcome of selective laser trabeculoplasty (SLT) in medically uncontrolled open angle glaucoma (OAG).

Methods

Sixty-eight eyes from 68 patients with OAG and IOP insufficiently regulated by topical medications were enrolled. Patients’ follow-up occurred 6 and 12 months after the procedure. The recorded parameters intraocular pressure (IOP), angle characteristics, central corneal thickness (CCT) and biomechanical properties of the eyes, including corneal hysteresis CH and corneal resistance factor CRF measured with the Ocular Responses Analyzer (ORA, Reichert Ophthalmic Instruments) were tested on their predictive value of SLT-induced IOP lowering effect using correlation analyses and regression models.

Results

Mean IOP reduction 12 months after SLT was 4.2?±?5.7 mmHg (23.2 %, from baseline 18.1?±?5.2 mmHg). The preoperative IOP correlated significantly with IOP reduction (maximum Spearman’s correlation r?=?0.75, p?<?0.001). In linear regression analysis, the corneal biomechanical properties (CH and CRF) together with the baseline IOP revealed good modelling for the IOP lowering effect of SLT (R²?=?0.64, respectively).

Conclusions

In addition to the baseline IOP biomechanical properties (CH and CRF) are significant predictors of SLT induced IOP lowering effect in medically uncontrolled OAG.     

Micropulse transscleral diode laser cyclophotocoagulation in the treatment of refractory glaucoma

Background: Transscleral diode laser cyclophotocoagulation (TSCPC) is an established method of treatment for refractory glaucoma, but is associated with significant complications. This study evaluates the efficacy and safety of a new form of TSCPC using micropulse diode laser and trans‐pars plana treatment with a novel contact probe. Methods: Prospective interventional case series of 40 eyes of 38 consecutive patients with refractory glaucoma treated with micropulse TSCPC with a novel probe. Outcomes measured were success, hypotony and response rates. Results: The mean age of patients was 63.2 ± 16.0 years. The mean follow‐up period was 16.3 ± 4.5 months. The mean intraocular pressure (IOP) before micropulse TSCPC was 39.3 ± 12.6 mmHg. Mean IOP decreased to 31.1 ± 13.4 mmHg at 1 day, 28.0 ± 12.0 mmHg at 1 week, 27.4 ± 12.7 mmHg at 1 month, 27.1 ± 13.6 mmHg at 3 months, 25.8 ± 14.5 mmHg at 6 months, 26.6 ± 14.7 mmHg at 12 months and 26.2 ± 14.3 mmHg at 18 months (P < 0.001 at all time points). No patient had hypotony or loss of best‐corrected visual acuity. The overall success rate after a mean of 1.3 treatment sessions was 72.7%. Conclusion: Micropulse TSCPC is a safe and effective method of lowering IOP in cases of refractory glaucoma and is comparable with conventional TSCPC.     

Deep sclerectomy with collagen implant: medium term results

AIMS—To study prospectively the success rate and complications of deep sclerectomy with collagen implant (DSCI), a new non-penetrating filtration procedure.
METHODS—Non-randomised prospective trial involving consecutive patients. 100 eyes of 100 patients with medically uncontrolled primary and secondary open angle glaucoma. A superficial scleral flap was raised and a deep sclerectomy was performed in the scleral bed. Schlemm's canal was opened and dissection of the cornea was performed up to Descemet's membrane, at which point aqueous percolated through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed. Visual acuity, intraocular pressure (IOP) measurements, and slit lamp examinations were performed before surgery and after surgery at 1 and 7 days, and 1, 3, 6, 9, 12, 18, 24, 30, and 36 months.
RESULTS—The mean follow up period was 17.8 (SD 8.7) months. The mean preoperative IOP was 27.8 (8.6) mm Hg; the mean postoperative IOP was 5.7 (4.0) at day 1, 11.2 (4.6) at month 1, 14.0 (3.5) at month 12, and 13.0 (3.8) at month 36. Complete success rate, defined as an IOP lower than 21 mm Hg without medication, was 44.6% at 36 months. Qualified success rate, defined as an IOP lower than 21 mm Hg with medication, was 97.7% at 36 months. Early postoperative complications included hyphaema in seven patients, wound leak in 10 patients, and subtle choroidal detachment in 11 patients. Goniopuncture was performed in 41 of the patients, and 5-fluorouracil injections were made in 23 patients; cataract progression occurred in seven patients. When comparing the different types of open angle glaucoma, no difference was found in terms of reduction in IOP, number of patients requiring antiglaucoma medications, or success rate.
CONCLUSIONS—Deep sclerectomy with collagen implant appears to provide reasonable control of IOP at medium term follow up, with few immediate postoperative complications.

Keywords: deep sclerectomy; glaucoma surgery; collagen implant     

新型青光眼引流装置——Paul青光眼植入物在印度尼西亚人群中应用的早期经验

目的：探究Paul青光眼植入物(PGI)在短期随访期间的安全性和有效性，分享新型房水引流装置在印度尼西亚人群中应用的首次经验。

方法：回顾性分析2022-04/2022-12期间使用PGI植入物的患者21例22眼，随访至少2mo。主要结局指标为手术失败，定义为眼压(IOP)超过21mmHg，或连续2次就诊较基线水平降低小于20%，需行其他青光眼手术或移除植入物。

结果：纳入患者的随访时间为2-6mo，平均IOP降低52.27±22.94%(9-90)%，总体成功率为59%，有青光眼手术史和未接受过青光眼手术的患者手术完全成功率分别为50%和59%。并发症有复视(2例)、早期低眼压(1例)、前房积血(1例)及引流管暴露(2例)。

结论：植入PGI的完全成功率为57%。未发生严重术后并发症，低眼压术后早期消退1例。     

Nonpenetrating very deep sclerectomy with hyaluronic acid implant vs trabeculectomy — a 2-year follow-up

Objective

To study and compare the efficacy and safety of nonpenetrating very deep sclerectomy (NPVDS) with the use of hyaluronic acid implant (SKGEL) to trabeculectomy (TB) in patients with with medically uncontrolled glaucoma.

Methods

Prospective, controlled study of patients with open-angle glaucoma was designed. Seventy-eight eyes of 68 patients with medically uncontrolled glaucoma were assigned either to the NPVDS or to the TB group of trial. Examinations were applied before and 7?days, 1, 3, 6, 12, 18, and 24?months after surgery.

Main outcome measure

Best-corrected logMAR visual acuity, intraocular pressure, number of additional procedures, antiglaucoma medications, number of complications.

Results

At 24?months, success rate defined as IOP?≤?21?mmHg with medication and additional procedures in NPVDS group was 92.31?%, and 94.88?% in control group (p?=?0.64). There was no statistically significant difference between intraocular pressure in NPVDS (14.56?±?4.07?mmHg ) and control (TB) (15.38?±?3.38?mmHg) group (p?=?0.34). Number of glaucoma mediations decreased from 2.18?±?0.56 to 0.54?±?0.56 in NPVDS and from 2.28?±?1.41 to 0.61?±?0.03 in TB group (p?=?0.71). Early and late postoperative complications included two cases of hyphema, two of choroidal detachment, two of filtering bleb fibrosis, four of cataract progression in the NPVDS group; and five cases of hyphema, four of choroidal detachment, one of filtering bleb fibrosis, one of blebitis, and 12 of cataract progression in the control group.

Conclusions

NPVDS is an effective surgical option for patients with medically uncontrolled glaucoma. NPVDS is associated with a lower risk of complications, and in particular cataract progression, compared to TB.

Application to clinical practice

NPVDS is a modification of NPDS devised for patients with medically uncontrolled open-angle glaucoma.     

Diode laser cyclophotocoagulation: longer term follow up of a standardized treatment protocol

Background : Diode laser cyclophotocoagulation (cyclodiode) is gaining acceptance as a therapy for refractory or end‐stage glaucoma. The aim of the study was to establish whether a reproducible dose–effect relationship exists following a single standardized cyclodiode treatment to lower intraocular pressure (IOP). Methods : This paper reports results from a longer‐term follow up of a trial involving the study of 30 patients with uncontrolled IOP and advanced glaucoma who were treated with a single episode of either a half or a full standardized dose of laser depending on clinical risk of phthisis and monitored for IOP control, visual acuity, postoperative inflammation and phthisis. Results : A lowering of IOP at the final follow up was achieved in 83% of patients, with a mean follow‐up time of 21 months. For patients receiving a full standardized laser dose, preoperative IOP was 49.4 ± 11.2 mmHg (mean ± SD) and postoperative IOP was 28.5 ± 20.0 mmHg (42% reduction); 45% of patients achieved IOP < 22 mmHg and 68% gained an IOP reduction > 30%. For the half treatment cases, the preoperative IOP was 29.4 ± 4.3 mmHg (mean ± SD) and the postoperative IOP was 18.3 ± 10.0 mmHg (38% reduction); 63% of patients achieved IOP < 22 mmHg and 50% gained an IOP reduction of > 30%. Of 22 sighted eyes, nine (41%) recorded no change in vision; and nine (41%) lost and four (18%) gained vision. Hypotony was seen in 4/22 (18%) of full standardized laser dose cases. Conclusion : Longer follow‐up times confirm that diode laser cyclophotocoagulation is a convenient and useful therapy in the control of IOP in end‐stage glaucoma. Response of IOP to the laser therapy is highly variable, particularly in the neovascular glaucoma group, and it does not appear to be possible to predict an IOP outcome for an individual eye. Circumferential treatments in neovascular eyes should be avoided. Prospects for long‐term vision retention in end‐stage eyes are poor, perhaps due to progression of the underlying disease.     

Deep sclerectomy: results with and without collagen implant

Purpose: To study the need, the safety and the success rate of collagen implant in eyes that underwent deep sclerectomy, a new non penetrating filtration procedure, we compared the results of deep sclerectomy with (DSCI) and without (DS) collagen implant. Methods: Of 168 patients (168 eyes) with various types of medically uncontrolled open angle glaucoma, 86 (86 eyes) underwent DSCI, and 82 (82 eyes) underwent DS. Visual acuity, slit lamp examination, intraocular pressure (IOP) measurements were performed before surgery and prospectively at days 1 and 7 and months, 1, 2, 3, 6, 9, 12, 15, 18, and 24 after surgery. Deep sclerectomy was performed according to Kozlov's original technique. The collagen implant drainage device was radially secured in the center of the deep sclerectomy dissection. Results: The mean follow-up period was 9.7 ± 6.5 months for DSCI, and 9.0 ± 4.8 months for DS. The mean preoperative IOP was 26.9 ± 8.8 mmHg for DSCI and 25.8 ± 8.5 mmHg for DS. The mean postoperative IOP and visual acuity were similar between the two groups. Complete and qualified success rates were better when the collagen implant was used (Log-Rank test: p = 0.0002 and 0.033 for complete and qualified success respectively). The need for postoperative glaucoma medications was significantly lower when the collagen implant was used (0.2 ± 0.5 versus 0.5 ± 0.7 medication per patient in the DSCI and DS respectively, Student's t test: p = 0.0038). There was significantly less bleb fibrosis when the collagen implant was used (2% and 11% in DSCI and DS respectively, p = 0.029). Conclusion: The collagen implant device is safe, increases the success rate of deep sclerectomy, and lowers the need for postoperative glaucoma medications.     

Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5 (range 48 to 60)mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

【In Press】Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5mo (range 48 to 60mo). The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

Pars plana Ahmed implantation combined with 23-gauge vitrectomy for refractory neovascular glaucoma in diabetic retinopathy

Purpose

To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR).

Methods

The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up.

Results

The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 ± 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 ± 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 ± 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 ± 0.61 to 0.96 ± 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases.

Conclusions

We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.     

XEN Implant for Glaucoma Treatment: A Review of the Literature

Purpose: The purpose of this review is to summarize current knowledge on XEN implant for the treatment of glaucoma.

Methods: A comprehensive literature review has been performed regarding XEN implant and its use on glaucoma management. Forty-two articles were checked and 37 were found to be relevant. Out of them, 21 were excluded as being case reports and reviews and the remaining 16 were eligible for the purpose of our review.

Results: There was a significant reduction in intraocular pressure as well as in the number of medications needed in glaucoma patients treated with XEN implant either alone or combined with cataract surgery. In addition, combination of XEN implant with Baerveldt tubes has been shown to be beneficial in cases of refractory glaucoma, although complications may be present in this technique. Moreover, uveitic glaucoma may be a potential application of XEN implant.

Conclusions: XEN implant devices have been developed as a surgical alternative for glaucomatous patients and are expected to play an important role in the management of glaucoma in the future.     

Endoscopic cyclophotocoagulation for the treatment of glaucoma: an Asian experience

Background: To describe the efficacy and safety of endoscopic cyclophotocoagulation in Asian patients with glaucoma. Methods: Retrospective case series. Consecutive cases of endoscopic cyclophotocoagulation performed by one surgeon during the study period were included. Patients' records were reviewed for clinical and demographic factors, treatments, intraocular pressure (IOP), visual acuity and any complications. Results: Twenty‐nine eyes of 29 patients were treated. Their mean age was 73.6 ± 9.4 years. The mean follow‐up duration was 15.9 ± 8.9 months. Eleven patients had primary open‐angle glaucoma, two normal tension glaucoma, six chronic angle‐closure glaucoma, five neovascular glaucoma, four secondary open‐angle glaucoma and one secondary angle‐closure glaucoma. Twenty patients had endoscopic cyclophotocoagulation combined with cataract surgery. Mean pretreatment IOP was 21.8 ± 6.6 mmHg. Mean post‐treatment IOP at 18 months (n = 17) was 16.2 ± 4.1 mmHg (P = 0.02) and 17.9 ± 4.9 mmHg (P = 0.18) at 24 months (n = 10). The mean number of anti‐glaucoma medications pretreatment was reduced from 2.0 ± 1.0 to 0.9 ± 0.9 at 18 months post‐treatment (P = 0.04) and 1.2 ± 0.8 at 24 months (P = 0.13). The overall success rate based on IOP reduction of 20% or greater at last follow‐up was 48.3%. Visual acuity was reduced in five eyes. Complications included one case each of hyphaema, bullous keratopathy, transient pigment dispersion and iris burn. Conclusion: Endoscopic cyclophotocoagulation may have a treatment role in Asian patients with glaucoma. The success rate appears poorer than previously reported in Caucasian populations. The treatment effect appeared to wane between 18 and 24 months post‐treatment.     

Comparison of the Additive Effects of Nipradilol and Carteolol to Latanoprost in Open-Angle Glaucoma

Purpose

To compare the effects of nipradilol and carteolol on intraocular pressure (IOP) when added to latanoprost treatment for glaucoma patients.

Methods

Fifty patients with primary open-angle glaucoma were treated with latanoprost 0.005% once daily for 3 months. Then they were assigned to one of two groups randomly. One group received nipradilol 0.25% twice daily (nipradilol preceding group; n = 25), and the other carteolol hydrochloride 2% twice daily (carteolol preceding group; n = 25), for 3 months in addition to latanoprost. Then, nipradilol and carteolol were switched, and the subjects were treated for 3 more months. One eye was selected randomly for analysis.

Results

In the nipradilol preceding group, IOP was 21.4 ± 2.3?mmHg (mean ± SD) at baseline, and 16.8 ± 1.9?mmHg at the end of latanoprost monotherapy (P < 0.01). The addition of nipradilol decreased IOP to 15.8 ± 1.7?mmHg, and the change to carteolol, to 15.3 ± 2.0?mmHg. In the carteolol preceding group, IOP was 21.2 ± 2.0?mmHg at baseline, and 17.0 ± 2.1?mmHg at the end of latanoprost monotherapy (P < 0.01). The addition of carteolol decreased IOP to 15.4 ± 1.8?mmHg, and the change to nipradilol, to 16.3 ± 1.9?mmHg. Additional IOP reduction was greater with carteolol than with nipradilol (cross-over analysis of variance; P = 0.0005).

Conclusions

Both nipradilol and carteolol have additive effects when used in combination with latanoprost. Carteolol, however, may have a more potent effect than nipradilol. Jpn J Ophthalmol 2006;50:33–37 © Japanese Ophthalmological Society 2006