Efficacy and safety of deep sclerectomy in childhood glaucoma in Saudi Arabia

Purpose: To evaluate the efficacy and safety of deep sclerectomy in childhood glaucoma. Methods: A prospective cohort of 120 children presenting with glaucoma to King Abdul Aziz University Hospital (KAUH) was subjected to nonpenetrating deep sclerectomy surgery (NPDS). Eventually, 57 patients had macro perforation and converted to penetrating deep sclerectomy (PDS). Intra‐operative mitomycin C (MMC) 0.2 mg/ml was used in all patients. Pre‐ and postintervention glaucoma indices were assessed. Complete success rate (CSR) was identified as achieving an end‐point of intraocular pressure <21 without any antiglaucoma medications. Data were analysed to compare pre‐ and postintervention changes and to compare both procedures. Results: After follow‐up of 35.8 (34.5) months, NPDS procedure went smooth in 74 eyes of 63 patients. The complete success rate was 79.7%, whereas the overall success rate was 82.4%. Thirteen cases failed. The probability to survive was 74.6% after the 12th month. The mean intraocular pressure (IOP) went down to 11.5 ± 3.0 mmHg compared to 31.9 mmHg preoperatively. Comparing cases with NPDS to those with PDS, the magnitude of IOP reduction (15.8) was higher than that of the PDS (14.8); however, this difference was not statistically significant (p = 0.259). Apart from involuntary perforation of trabeculodescemetic window (TDW), neither intra‐operative nor early postoperative complications were observed. Conclusions: Deep sclerectomy in childhood glaucoma can effectively reduce the IOP, without the occurrence of serious complications that are commonly seen after trabeculotomy or combined trabeculotomy trabeculectomy.     

Efficacy and safety of latanoprost in eyes with uveitic glaucoma

Background  To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. Methods  Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. Results  Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 ± 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 ±0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 ± 8.4 mmHg to 18.6 ± 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 ±8.1 mmHg to 22.6 ±10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. Conclusion  Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma. The authors have no proprietary interest in any aspect of this study.     

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations

PURPOSE: Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation. MATERIAL AND METHODS: 67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test. RESULTS: After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05). CONCLUSIONS: DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.     

非穿透小梁手术联合应用丝裂霉素治疗青光眼

目的观察非穿透小梁手术联合丝裂霉素治疗青光眼的临床疗效.方法对32例41眼青光眼患者进行非穿透小梁手术,术中联合应用丝裂霉素.术前、术后1,2,8,15天,1,2,3月,以后每3月进行视力、眼压、裂隙灯显微镜、检眼镜等检查.结果术前眼压32.96 mmHg±13.02 mmHg(1 mmHg=0.133kPa),术后第1天6.59 mmHg±2.60mmHg,经3～9月随访,最后随访12.27 mmHg±3.48 mmHg,仅2眼术后前房积血,均没有出现术中术后浅前房、炎症反应等并发症.结论非穿透小梁手术联合应用丝裂霉素是一种安全、有效的抗青光眼新手术.     

Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data

BACKGROUND: If medical treatment fails in uveitic glaucoma a surgical approach should be considered. Classical trabeculectomy is known to have a less favourable outcome in uveitis. Our intention is to report the first series of uveitis patients with glaucoma resistant to medical therapy who were treated with deep sclerectomy (DS). PATIENTS AND METHODS: Fourteen eyes of 13 patients (mean age 39.0 +/- 18.5 years; range 8 to 76 years) with chronic uveitis underwent non-penetrating filtering surgery from 1995 to 2003. All patients had their uveitis controlled before and after surgery by immunomodulatory therapy. Non-penetrating filtering surgery consisted of DS with collagen implant (Staar(R)) in 4 eyes, DS with draining device (T-Flux Ioltech(R)) in 2 patients, DS without implant in 7 patients and with viscocanalostomy in 1 patient. Nine eyes (65 %) received mitomycin C peri-operatively. RESULTS: Intra-ocular pressure (IOP) was reduced from a mean pre-operative value of 42.8 +/- 13.6 mmHg to a 1-year mean post-operative value of 12.1 +/- 4.0 (71.7 % reduction). Eleven of the 14 eyes completed 12 months of follow-up, resulting in complete success in 5 (45.4 %) and in qualified success in 5 (45 %) and in failure in one patient (9.2 %), later controlled by a second operation. Anti-glaucomatous medication was reduced from a mean of 3.7 +/- 0.5 medications preoperatively to 1.2 +/- 0.8 medications (71.4 % reduction) at the 12 month follow-up. Nine of the 14 patients achieved a 24 month follow-up with a mean IOP of 14.1 +/- 3.8 mmHg and mean of anti-glaucomatous medications of 1.6. Four patients have been examined 4 years after the DS: mean IOP was 13.2 +/- 2.2 mmHg and mean medication 1.7 +/- 1.0. Post-operative complications included one case of lens opacity and 2 cases of hypotony lasting for five months and four weeks after the intervention respectively. CONCLUSION: Non-penetrating filtering surgery controlled the intra-ocular pressure in 90 % of eyes with uveitic glaucoma resistant to medical therapy at 12 months. Surgical complications were low which may explain the high success rate of the procedure, compared to classical penetrating surgery.     

非穿透小梁手术联合丝裂霉素治疗青少年型青光眼

目的观察非穿透小梁手术联合丝裂霉素治疗青少年型青光眼的临床疗效。方法对32例41眼青光眼进行非穿透小梁手术,术中联合应用丝裂霉素。术前、术后1,2,8,15天,1,2,3月,以后每3月进行视力、眼压、裂隙灯显微镜、检眼镜等检查。结果术前眼压(32.96±13.02)mmHg,术后第1天(6.59±2.60)mmHg,经3-9月随访,最后随访(12.27±3.48)mmHg,仅2眼术后前房积血,均没有出现术中术后浅前房、炎症反应等并发症。结论非穿透小梁手术联合应用丝裂霉素是一种安全、有效的抗青光眼新手术。     

Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery

AIM: To assess the efficacy and safety of non-penetrating deep sclerectomy (NPDS) with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips (modified deep sclerectomy technique, DS) and minimal use of mitomycin C in glaucoma surgery.METHODS: A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018. Best-corrected visual acuity, intraocular pressure (IOP), post-operative need for glaucoma medications, visual field mean deviation (MD), re-interventions, needling revisions and laser goniopuncture were noted. Absolute success was defined as IOP≤18 mm Hg without topical medication. Relative success was defined as the same criteria but with the addition of any antihypertensive medication. IOP over 18 mm Hg on two consecutive follow-up visits was considered as a failure.RESULTS: Fifty-two eyes of 47 patients were evaluated. Mean preoperative IOP was 25.37±6.47 mm Hg, and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo (all P<0.0001). Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo (all P<0.0001). No medications were required in 45.5% of patients after 24mo. Relative and absolute success rate at 24mo were 85.5%±5% and 48.5%±7.4%, respectively.CONCLUSION: DS is a safe and effective non-penetrating glaucoma surgery variation. It aims to retain the patency of all pathways created for aqueous humor drainage: the intrascleral bleb, the supraciliary space and the open communication between intrascleral and subconjunctival compartments.     

Efficacy and safety of ripasudil,a Rho-associated kinase inhibitor,in eyes with uveitic glaucoma

Graefe's Archive for Clinical and Experimental Ophthalmology - The purpose of this study was to describe the initial experience, efficacy, and safety of ripasudil hydrochloride hydrate...     

Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma

PURPOSE: To prospectively study and compare the effectiveness and the safety of primary deep sclerectomy with and without the use of mitomycin C in eyes with open-angle glaucoma. PATIENTS AND METHODS: A total of 90 eyes of 90 patients with primary open-angle glaucoma or pseudoexfoliative glaucoma underwent deep sclerectomy. Patients were enrolled consecutively and assigned randomly to undergo deep sclerectomy without the use of mitomycin C (DS group) and deep sclerectomy with the application of mitomycin C (DSMMC group) in a concentration of 0.2 mg/mL for 2.5 minutes, before the superficial scleral flap formation. RESULTS: The intraocular pressure was significantly decreased by 7.13 mm Hg or 27.59% in the DS group and by 11.68 mm Hg or 42.25% in the DSMMC group at the end of the follow-up period. The intraocular pressure reduction in the DSMMC group was statistically significant when compared with that in the DS group (P <0.05). The complete (IOP <22 mm Hg without medication) and qualified (IOP < 22 mm Hg with or without medication) success rates at the end of the follow-up period were 42.5% and 72.5% in the DS group and 50% and 95% in the DSMMC group. The qualified success rate in the DSMMC group was statistically significant when compared with that in the DS group. Differences in complications (choroidal detachment, hyphema, leakage) seen between the two groups were statistically nonsignificant. A hemorrhagic detachment of the Descemet membrane was observed in one eye in the DSMMC group. CONCLUSIONS: The use of intraoperative mitomycin C during deep sclerectomy significantly reduced the postoperative IOP and increased the success rate of the procedure.     

Efficacy of glaucoma drainage devices in uveitic glaucoma and a meta-analysis of the literature

Graefe's Archive for Clinical and Experimental Ophthalmology - To assess the efficacy of glaucoma drainage devices (GDD) in uveitic glaucoma and non-uveitic glaucoma, and to perform a...     

非穿透小梁手术联合应用丝裂霉素治疗青少年型青光眼

目的观察非穿透小梁手术联合丝裂霉素治疗青少年型青光眼的临床疗效。方法对32例41眼青光眼患者进行非穿透小梁手术,术中联合应用丝裂霉素。术前,术后1,2,8,15天,1,2,3月,以后每3月进行视力、眼压、裂隙灯显微镜、检眼镜等检查。结果术前眼压32．96mmHg±13．02mmHg,术后第1天6．59mmHg±2．60mmHg,经3-9月随访,最后随访12．27mmHg±3．48mmHg,仅2眼术后前房积血,均没有出现术中术后浅前房、炎症反应等并发症。结论非穿透小梁手术联合应用丝裂霉素是一种安全、有效的抗青光眼新手术。     

Combined deep sclerectomy and trabeculotomy in congenital glaucoma with complications

BACKGROUND: Lately there has been growing interest in deep sclerectomy as a therapeutic approach for the management of congenital glaucoma.In theory, its pressure-lowering effect is independent of external filtration, which minimizes the risk of failure due to conjunctival or episcleral scarring. In patients who have failed to benefit from previous filtering procedures and have refractory congenital glaucoma,deep sclerectomy could become an alternative. PATIENTS AND METHODS: A 3-year-old girl with refractory congenital glaucoma underwent deep sclerectomy in her left eye. Intraoperatively, percolation through the trabeculodescemetic window was weak, so that the procedure was supplemented by a trabeculotomy. RESULTS: By now, throughout a follow-up period of 20 months, stabilisation of disc cupping and ocular axial length has been achieved without additional glaucoma surgery or medications. CONCLUSIONS: In patients with congenital glaucoma,the combination of deep sclerectomy with trabeculotomy may provide an additional therapeutic approach whenever the prospect of success appears to be limited with deep sclerectomy alone.     

丝裂霉素C在正常眼压性青光眼深层巩膜切除术中的应用

目的：研究深层巩膜切除术中应用丝裂霉素C对于治疗正常眼压性青光眼的临床效果及影响。
　　方法：选取我院2011－12／2013－12期间收治的正常眼压性青光眼患者60例60眼,均为药物治疗效果不佳或拒绝药物治疗的患者。将所有患者随机分为两组各30例30眼。其中30例患者使用深层巩膜切除术进行治疗作为对照组,另30例患者在上述基础上使用丝裂霉素C进行治疗作为观察组。
　　结果：两组患者术后发现,观察组患者平均视力明显提高,好于对照组患者（P＜0．05）。而观察组患者功能型滤过泡形成以及前房形成人数比例明显高于对照组（P＜0．05）。术后3mo 视野变窄观察组1眼（3％）,对照组4眼（17％）,差异有统计学意义（P＜0．05）。术后3mo视野变窄观察组3眼（10％）,对照组8眼（27％）,差异有统计学意义（P＜0．05）。观察组术后远期并发症发生率为7％,明显低于对照组的17％（ P＜0．05）。术后随访1a发现,观察组复发率仅为3％,明显低于对照组的13％（ P＜0．05）。结论：正常眼压性青光眼患者在行深层巩膜切除术时,联合丝裂霉素C进行治疗,其效果显著,安全性高,术后并发症发生率低,复发率低,值得临床应用及推广。     

Comparison of deep sclerectomy with implant and combined glaucoma surgery

To evaluate the efficacy of combined glaucoma surgery, 42 glaucomatous patients were randomly divided into two groups: deep sclerectomy with implant (DS) alone was performed in 21 patients, and combined deep sclerectomy and phacoemulsification (PDS) was performed in the other 21 patients. Follow-up was carried out at regular intervals for 12 months. A comparative study on intraocular pressure (IOP) was designed. Although further study is needed, PDS appears to have better postoperative long-term results in IOP control than DS alone.     

Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma

PURPOSE: To compare the longterm results in pseudoexfoliative glaucoma and primary open-angle glaucoma (POAG) following deep sclerectomy with implant. METHODS: A total of 28 pseudoexfoliative glaucoma eyes and 27 POAG eyes were consecutively included in the study. Intraocular pressure (IOP) and number of glaucoma medications were compared before surgery and at every postoperative visit. Most patients included had very advanced glaucoma and were using multiple therapies (mean 3.3 and 3.6 in the pseudoexfoliative glaucoma and POAG groups, respectively) and the duration of the disease was more than 8 years in both groups. The definition of complete success was the achievement of IOP < 19 mmHg without therapy. RESULTS: After a mean follow-up time of 45 months in the pseudoexfoliative glaucoma group and 43 months in the POAG group, 50.0% of the pseudoexfoliative glaucoma group were considered to represent complete success compared with 33.3% of the POAG group (NS). In survival analyses controlling for covariates, it was found that patients with pseudoexfoliative glaucoma had a higher rate of success over time than POAG patients (p = 0.014). Furthermore, the duration of glaucoma prior to surgery had a negative influence on the success rate (p = 0.034). Four years after surgery, the mean IOP was 15.5 +/- 5.3 mmHg in the pseudoexfoliative glaucoma group and 13.6 +/- 3.5 mmHg in the POAG group (NS). The mean number of medications used by each group at that time was 1.7 +/- 1.5 and 1.2 +/- 1.1, respectively (NS). CONCLUSION: The present study suggests that deep sclerectomy is a safe procedure in pseudoexfoliative glaucoma. Half of the patients were regulated without therapy after 45 months.     

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma

OBJECTIVE: To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma. DESIGN: Prospective randomized trial. PARTICIPANTS: Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study. INTERVENTION: Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye. MAIN OUTCOME MEASURES: Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications. RESULTS: At 12 months, mean IOP reduction was 12.3 +/- 4.2 (sclerectomy) versus 14.1 +/- 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP 相似文献   

青光眼深层巩膜切除联合可吸收缝线植入术

目的探讨一种非穿透性深层巩膜切除术治疗开角型青光眼的新方法,观察其疗效和并发症.方法对18例(26眼)开角型青光眼采用深层巩膜切除联合可吸收缝线植入术治疗.结果术前平均眼压为(38.5±4.3)mmHg(1 mmHg=0.133kPa),随访3～14月(平均6月),术后不用任何降眼压药物,平均眼压为(17.1±5.2)mmHg,差异具有显著性意义(P＜0.05),其中术后眼压≤21 mmHg者21眼,占80.8%.术后5眼眼压＞21 mmHg(19.2%),2眼前房积血.但无浅前房、炎症反应或脉络膜脱离等并发症.结论深层巩膜切除联合可吸收缝线植入术是治疗开角型青光眼一种有效方法,但手术操作较为复杂,远期疗效有待进一步观察.     

Non-penetrating deep sclerectomy for glaucoma associated with Sturge-Weber syndrome

PURPOSE: To report the results of non-penetrating deep sclerectomy (NPDS) in the treatment of glaucoma associated with Sturge-Weber syndrome (SWS). METHODS: We carried out a retrospective case series analysis of patients who underwent NPDS for glaucoma associated with SWS between 1998 and 2003. The control of glaucoma after NPDS, the results of surgery on intraocular pressure, the need for additional medical treatment and surgical complications were studied. RESULTS: Twelve eyes of nine patients, aged 11 days to 24 years, underwent filtering surgery: nine NPDS procedures were performed and three surgical procedures had to be converted to trabeculectomy because NPDS was not technically achievable. The mean follow-up after surgery was 26.3 months (range 6-48 months). Two trabeculectomies were complicated by choroidal effusion, which resolved in both cases. Good control of glaucoma was obtained during follow-up. CONCLUSIONS: Non-penetrating deep sclerectomy is transiently efficient in the treatment of SWS-associated glaucoma. Further studies of NPDS for the treatment of glaucoma associated with SWS are warranted.     

Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma

PURPOSE: To assess the efficacy and postoperative complications of deep sclerectomy with collagen implant (DSCI), a nonpenetrating filtration procedure. SETTING: Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland. METHODS: Forty-four eyes of 44 patients with medically uncontrolled open-angle glaucoma had DSCI and a matched control group of 44 patients, trabeculectomy. A superficial scleral flap was raised and a deep sclerectomy performed in the scleral bed. Schlemm's canal was opened, and the cornea was dissected to Descemet's membrane. At that stage, aqueous filtered through the remaining trabeculo-Descemet's membrane. A collagen implant was sutured radially in the scleral bed; the scleral flap and conjunctiva were then closed. Examinations were performed before surgery and postoperatively at 1 and 7 days and 1, 2, 3, 6, 9, 12, 15, 18, and 24 months. RESULTS: The mean follow-up was 14.4 months +/- 6.3 (SD) (range 3 to 24 months). The mean preoperative intraoperative pressure (IOP) was 26.7 +/- 7.3 mm Hg. The mean postoperative IOP was 6.1 +/- 4.5 mm Hg at 1 day and 11.0 +/- 4.4 mm Hg at 1 week; it remained stable for the next 24 months. The success rate, defined as an IOP lower than 21.0 mm Hg without medication, was 69% in the DSCI group and 57% in the trabeculectomy group at 24 months postoperatively (P = .047). The number of postoperative complications was significantly lower in the DSCI group than in the trabeculectomy group. CONCLUSIONS: The success rate of DSCI may be comparable to that of trabeculectomy, with fewer complications.