Combined Surgery in the Treatment of Patients with Cataract and Primary Open-angle Glaucoma

2012 ◽  
Vol 06 (04) ◽  
pp. 218
Author(s):  
Giovanni Taibbi ◽  
Gianmarco Vizzeri ◽  
◽  
Keyword(s):  
Cataract Surgery ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Ageing Population ◽  
Efficacy And Safety ◽  
Combined Surgery ◽  
Operative Complications ◽  
Significant Cataract ◽  
Ab Interno

Cataract and glaucoma are the two leading causes of blindness worldwide and frequently co-exist in the ageing population. No uniform recommendations can be proposed when the two conditions are associated. In the presence of a visually significant cataract and uncontrolled glaucoma, clinicians should consider performing combined cataract surgery and trabeculectomy. Numerous phacotrabeculectomy techniques have been proposed. However, in the absence of strong evidence in support of a specific technique, surgeons’ preference and experience may dictate the choice. Unless contraindicated, mitomycin-C should be considered in all combined procedures. In addition, novel and minimally invasive glaucoma surgical procedures, such as ab interno trabeculotomy, have recently emerged and gained in popularity. In general, these procedures have shown the potential to be combined with phacoemulsification to further lower intraocular pressure (IOP) with relatively few post-operative complications. However, available data suggest that these techniques seem unlikely to be able to achieve a degree of IOP reduction comparable with that of trabeculectomy. Rigorous studies are necessary to better understand the long-term efficacy and safety profile of these novel procedures, when performed alone or in combination with cataract surgery.

scholarly journals Long-term medication reduction in controlled glaucoma with iTrack ab-interno canaloplasty as a standalone procedure and combined with cataract surgery

2021 ◽  
Vol 13 ◽  
pp. 251584142110457
Author(s):  
Mahmoud A. Khaimi
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Target Range ◽  
Open Angle ◽  
Significant Difference ◽  
The Mean ◽  
Ab Interno

Purpose: To evaluate the long-term effectiveness of iTrack (Nova Eye Medical, Fremont, USA) ab-interno canaloplasty performed as a standalone procedure, or combined with cataract surgery, in reducing antiglaucoma medication dependence and maintaining intraocular pressure within target range in patients with controlled primary open-angle glaucoma. Methods: This is a retrospective, single-center, case series study of patients who underwent iTrack ab-interno canaloplasty as a standalone procedure ( n = 34) or in combination with cataract surgery ( n = 11). Eyes with controlled mild or moderate glaucoma (intraocular pressure ⩽17 mmHg) were included; those with prior glaucoma surgeries were excluded. The primary outcome was the mean reduction in glaucoma medication and the secondary outcome was the maintenance of controlled intraocular pressure postoperatively. Results: A total of 35 patients (45 eyes) with a mean age of 73 ± 9.7 years were included in the study. For all eyes, a significant decrease (61%) in the mean number of medications was seen at 36 months (1.89 ± 0.93 versus 0.60 ± 0.82; p < 0.001), with 56% (14/25) of eyes medication free. No significant difference was observed in the reduction of medication use whether iTrack was performed with or without cataract surgery at 12 and 36 months. Mean baseline intraocular pressure of 14.42 ± 2.2 mmHg for all eyes was maintained at the 12-, 24-, and 36-month follow-up visits (14.6 ± 3.65, 15.06 ± 2.26, and 14.19 ± 2.91, respectively), with no significant difference between the two groups ( p = 0.08). Conclusion: The iTrack ab-interno canaloplasty significantly reduced medication dependency and maintained intraocular pressure within target range in patients with controlled mild or moderate primary open-angle glaucoma, while showing a good safety profile, both as a standalone procedure or in combination with cataract surgery.

scholarly journals Ab interno trabeculotomy combined with cataract extraction in eyes with primary open-angle glaucoma

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095744
Author(s):  
Yuan-Zhi Chen ◽  
Ai-Ping Song ◽  
Wen-Yan Jin ◽  
Xiao Yang ◽  
Guang-Fu Dang
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Cataract Extraction ◽  
Open Angle ◽  
Efficacy And Safety ◽  
Corrected Visual Acuity ◽  
Postoperative Time ◽  
Best Corrected Visual Acuity ◽  
Ab Interno ◽  
Time Point

Objective To investigate the efficacy and safety of ab interno trabeculotomy using the VISCO360® Viscosurgical System (Sight Sciences, Inc., Menlo Park, CA, USA) combined with cataract extraction in the treatment of primary open-angle glaucoma (POAG). Methods Patients with POAG who underwent ab interno trabeculotomy combined with cataract extraction were retrospectively analyzed. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), the number of antiglaucomatous medications, and complications were recorded preoperatively and 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years postoperatively. Results Thirty-four patients (40 eyes) with POAG were included in this study, including 20 men (22 eyes) and 14 women (18 eyes). Compared with the preoperative IOP, the postoperative IOP was significantly lower at each time point. The greatest reduction in IOP was 60.7% at 1 month after surgery. The BCVA was also significantly improved at each postoperative time point. The number of antiglaucomatous medications used by the patients was significantly lower postoperatively than preoperatively. Conclusion Ab interno trabeculotomy combined with cataract extraction is effective and safe for treatment of POAG.

scholarly journals Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Ali Salimi ◽  
Harrison Watt ◽  
Paul Harasymowycz
Keyword(s):  
Cataract Surgery ◽  
First Generation ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Open Angle ◽  
Long Term Outcomes ◽  
Surgical Success ◽  
Rnfl Thickness

Abstract Background The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up. Methods This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events. Results A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease. Conclusions Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

scholarly journals High-Frequency Deep Sclerotomy, A Minimal Invasive Ab Interno Glaucoma Procedure Combined with Cataract Surgery: Physical Properties and Clinical Outcome

2019 ◽  
Vol 10 (1) ◽  
pp. 218 ◽  
Author(s):  
Bojan Pajic ◽  
Zeljka Cvejic ◽  
Kaweh Mansouri ◽  
Mirko Resan ◽  
Reto Allemann
Keyword(s):  
Cataract Surgery ◽  
High Frequency ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Open Angle ◽  
Custom Made ◽  
Ab Interno

Background: The efficiency and safety of primary open-angle glaucoma with high-frequency deep sclerotomy (HFDS) combined with cataract surgery has to be investigated. Methods: Right after cataract surgery, HFDS was performed ab interno in 205 consecutive patients with open angle glaucoma. HFDS was performed with a custom-made high-frequency disSection 19 G probe (abee tip 0.3 × 1 mm, Oertli Switzerland). The bipolar current with a frequency of 500 kHz is applied. The nasal sclera was penetrated repetitively six times through the trabecular meshwork and consecutively through Schlemm’s canal. Every time, a pocket of 0.3 mm high and 0.6 mm width was created. Results: Mean preoperative intraocular pressure (IOP) was 24.5 ± 2.1 mmHg (range 21 to 48 mmHg). After 48 months, the follow up average IOP was 15.0 ± 1.7 mmHg (range 10 to 20 mmHg). Postoperative IOP has been significantly reduced compared to preoperative IOP for all studied cases (p < 0.001). After 48 months, the target IOP less than 21 mmHg reached in 84.9%. No serious complications were observed during the surgical procedure itself and in the postoperative period. Conclusions: HFDS is a minimally invasive procedure. It is a safe and efficacious surgical technique for lowering IOP combined with cataract surgery.

scholarly journals Two-Year Outcomes of Ab Interno Trabeculectomy with the Trabectome for Chinese Primary Open Angle Glaucoma: A Retrospective Multicenter Study

2018 ◽  
Author(s):  
Yalong Dang ◽  
Xiao Wang ◽  
Yujie Cen ◽  
Ying Hong ◽  
Ping Huang ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Glaucoma Surgery ◽  
Safe Procedure ◽  
Open Angle ◽  
Trabectome Surgery ◽  
History Of ◽  
Ab Interno Trabeculectomy ◽  
Ab Interno

To evaluate the 2-year efficacy and safety of ab interno trabeculectomy with the Trabectome in Chinese primary open-angle glaucoma (POAG) patients. This was a multicenter, retrospective study and included POAG patients with or without visually-significant cataracts. The primary outcome was intraocular pressure (IOP) reduction. Secondary outcomes included reduction of glaucoma medications, surgical complications, and success at 2-years. Success was defined as: 1) IOP &lt; 21 mmHg and at least 20% IOP reduction from baseline after 3 months at any two consecutive visits, and 2) no additional glaucoma surgery required. A total of 42 patients were enrolled; thirteen had a history of failed glaucoma surgery. Twelve patients underwent Trabectome surgery combined with phacoemulsification while the remainder underwent Trabectome surgery alone. Overall, the mean preoperative IOP was 21.4&plusmn;1.23 mmHg. The Trabectome lowered IOP to 18.5&plusmn; 0.94 mmHg at 2 years (P&lt;0.05). The number of glaucoma medications also decreased from a baseline of 2.0&plusmn;0.9 to 1.2&plusmn; 0.21 at 2 years (P=0.04). The overall success was 78%, with patients undergoing combined surgery having a higher success than those with Trabectome surgery alone (100% vs. 76%). No major complications were seen. The Trabectome appears to be an efficient and safe procedure in Chinese POAG patients in the long-term.

scholarly journals Effects of cataract surgery on short-term and long-term intraocular pressure fluctuations in non-glaucomatous and medically controlled primary open-angle glaucoma patients

2019 ◽  
Vol 72 (7-8) ◽  
pp. 202-208
Author(s):  
Bojana Markic ◽  
Milka Mavija ◽  
Sasa Smoljanovic-Skocic ◽  
Sanela-Sanja Burgic
Keyword(s):  
Intraocular Pressure ◽  
Cataract Surgery ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Pressure Fluctuations ◽  
Control Group ◽  
Open Angle ◽  
Short Term ◽  
Short And Long Term

Introduction. It has been recognized that cataract surgery leads to a reduction of intraocular pressure, both in healthy and in glaucoma patients. This prospective interventional clinical study aimed to investigate the effects of cataract surgery on intraocular pressure and its short- and long-term fluctuations in medically controlled primary open-angle glaucoma patients and non-glaucomatous patients. Material and Methods. Two groups of 31 patients (31 eyes) were studied. The observed group included patients with glaucoma and cataract, and the control group included patients with senile cataract only. The intraocular pressure was measured three times daily pre- and at 1, 3 and 6 months postoperatively. Results. In both groups, a significant postoperative reduction in both mean and maximum intraocular pressure. Six months after surgery, in the observed group the average and maximum intraocular pressure reduction levels were -2.73 ? 1.91 mmHg and -3.16 ? 2.19 mmHg, and -2.26 ? 1.71 mmHg and -2.53 ? 1.70 mmHg in the control group. In the observed group, at 3 and 6 months after surgery, a significant reduction in short-term fluctuations was observed. Six months after surgery, short-term fluctuations decreased by -1.04 ? 2.20 mmHg compared to preoperative. Postoperatively, in the observed group, long-term fluctuations of average and maximum intraocular pressure were 2.69 ? 2.15 mmHg and 2.88 ? 2.22 mmHg, respectively, and in the controls they were 2.02 ? 1.28 mmHg and 2.42 ? 1.47 mmHg, showing no significant differences between groups. Conclusion. In patients with primary open-angle glaucoma, cataract surgery results in a statistically significant reduction in both average and maximum intraocular pressure as well as of short-term fluctuations.

scholarly journals Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Antonio Maria Fea ◽  
Giulia Consolandi ◽  
Marta Zola ◽  
Giulia Pignata ◽  
Paola Cannizzo ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Control Group ◽  
Open Angle ◽  
Long Term Follow Up ◽  
Baseline Values ◽  
The Mean

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone.Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment.Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p=NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p=0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p=0,005in the combined group andp=0,01in the control group).Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with:NCT00847158.

Problems of treatment of primary openangle glaucoma in combination with thrombosis of the central retinal vein

GlaucomaNews ◽  
2020 ◽  
pp. 65-69
Author(s):  
T.E. Lipatkina ◽  
◽  
Е.V. Karlova ◽  
A.V. Zolotarev ◽  
◽  
...  
Keyword(s):  
Macular Edema ◽  
Primary Open Angle Glaucoma ◽  
Antihypertensive Drugs ◽  
Open Angle Glaucoma ◽  
Vascular Wall ◽  
Open Angle ◽  
Retinal Edema ◽  
Long Term Preservation ◽  
Central Retinal Vein

Patients with primary open-angle glaucoma (POAG) and ophthalmic hypertension have an increased likelihood of developing occlusions (thrombosis) of the central retinal vein. Different groups of antihypertensive drugs differ in their mechanism of action and may affect concomitant ocular pathology, in particular, retinal edema, which occurs, for example, in occlusion of the central retinal vein. Used in most patients with glaucoma, prostaglandin analogs can contribute to the long-term preservation of macular edema due to the effect on the permeability of the vascular wall. Preparations of other pharmacological groups, reducing the production of aqueous humor, on the contrary, may contribute to its regression. Therefore, the question of choosing a drug for antihypertensive therapy in patients with primary open-angle glaucoma and concomitant macular edema is relevant and is for further study.

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