Outcomes of iStent versus endocyclophotocoagulation (ECP) as adjunct to cataract surgery by phacoemulsification for glaucoma patients.

PURPOSE: To compare the efficacy and safety of iStent versus Endocyclophotocoagulation (ECP) as an adjunct to cataract surgery by Phacoemulsification for treating glaucoma patients in a tertiary eye center. METHODS: Retrospective study of 67 eyes of 61 patients with glaucoma and cataract who underwent either phaco-ECP or phaco-iStent. Primary efficacy endpoint is the Intraocular pressure (IOP) reduction, while reduction of glaucoma medications is the secondary outcome. In addition to IOP and number of glaucoma medications; visual acuity, degree of disc cupping, safety profiles were all assessed at different intervals up to 12 months. RESULTS: A total of 40 eyes underwent phaco-ECP, and 27 eyes underwent phaco-iStent. Both groups were associated with a significant reduction in the number of glaucoma medications; however phaco-iStent group achieved slightly lower IOP levels than the phaco-ECP group. Furthermore, iStent inject had better control of IOP at the last follow-up compared to first-generation stents. Moreover; 2 or more stents significantly reduced IOP than single stent (p = 0.009 vs. p = 0.618, respectively). Phaco-iStent achieved a better reduction in the number of glaucoma medications for primary open-angle glaucoma (p = 0.007) compared to pseudoexfoliation glaucoma patients (p = 0.084). Complications were seen in 12 eyes (18%), of which five eyes in phaco-ECP (7.4%) and 7 eyes in phaco-iStent (10.4%), majority were mild and treated conservatively. CONCLUSIONS: Both groups had equal efficacy in reducing the IOP. However, phaco-iStent seems superior in reducing the number of glaucoma medications after 1 year of follow-up compared to phaco-ECP, particularly when 2 or more stents are used. Both groups showed an overall good safety profile.

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery.

PURPOSE: Glaucoma is a cause of comorbidity in patients receiving the Boston keratoprosthesis (KPro). The aim of this study was to report the outcomes of the Boston KPro with or without glaucoma surgery. METHODS: This was a retrospective single-center cohort study. Patients who underwent Boston KPro from March 2009 to February 2019 were included. One eye per patient (the first surgery) was included in this study. Patients were classified into 2 groups: KPro only (group 1) and KPro with any form of glaucoma procedure (group 2). Main outcome measures were Best-corrected visual acuity (BCVA), functional success (BCVA 20/200 or better), anatomical success (retention of KPro at the last follow-up), and complications. RESULTS: Seventy-one eyes were included: 27 eyes (38%) in group 1 and 44 (62%) in group 2. There was no statistically significant difference in BCVA between groups 1 and 2 at each time point. Of the eyes in group 1, 11% lost light perception vision and 4.5% in group 2 ( P = 0.293). There was no difference in anatomical success with 70% in group 1 and 77% in group 2 ( P = 0.703) at the last follow-up, with a median failure time of 18 months. The functional success was 48% for group 1 and 50% for group 2 ( P = 0.541). CONCLUSIONS: Eyes undergoing KPro with glaucoma surgery before or at the same time carry a similar functional and anatomical success to eyes without glaucoma surgery.

Outcomes of selective laser trabeculoplasty in corticosteroid-induced ocular hypertension and glaucoma.

PURPOSE: To report the outcomes of selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in patients with steroid-induced ocular hypertension and glaucoma. METHODS: A retrospective chart review of patients who underwent SLT for steroid-induced ocular hypertension or glaucoma between January 2014 and October 2018. Success of SLT was defined as ⩾20% IOP reduction from baseline without further medical or surgical intervention and/or a reduction in the number of glaucoma medications by ⩾1 from baseline while maintaining the target IOP. Main outcome measures were change in IOP from baseline and reduction in the number of medications post-laser. RESULTS: A total of 25 eyes of 17 patients were included in the study. The mean duration of follow-up was 18.8 ± 4.5 months. IOP decreased from 23.7 ± 6.7 mmHg pre-laser to 14.4 ± 3.2 mmHg post-laser, at the last follow-up visit (p < 0.001). The mean number of medications was 1.8 ± 1.6 medications pre-laser and 1.4 ± 1.3 medications post-laser (p = 0.262). The overall success rate at 12 months was 72%. No visually significant complications were encountered during the whole duration of follow-up. CONCLUSION: SLT is a safe and effective procedure that can result in well-controlled IOP in patients with steroid-induced ocular hypertension and glaucoma.

Frequency and risk factors of narrow angles in patients with pseudoexfoliation: a case-control study.

PURPOSE: To determine the frequency and risk factors of narrow angles in pseudoexfoliation (PXF) patients. METHODS: A prospective case-control study was conducted during the period from March 2017 to December 2020. Adult patients (above 40 years) presenting with PXF were consecutively enrolled (study group). Cases were matched with individuals above 40 years presenting to a comprehensive ophthalmology clinic without evidence of PXF (control group). RESULTS: We enrolled 196 PXF patients and 98 controls. The occurrence of narrow angles was 25% in the PXF group and 5.1% in the control group (P = 0.0001). Compared to controls, PXF patients were older (72.6 ± 9.6 vs. 64.4 ± 8.5, P < 0.0001) and had a lower mean ACD (2.79 ± 0.4 vs. 3.05 ± 0.4, P < 0.0001). There was no difference in AL measurements between both groups (23.3 ± 1.4 vs. 23.7 ± 1.0, P = 0.0714). After stratification by age group and gender, the risk of narrow angles was higher in PXF patients above 70 years (OR, 4.15; 95% CI, 0.91-23.87; P, 0.044). There was no gender difference in the risk of developing narrow angles. CONCLUSION: Narrow angles are more frequently encountered in PXF patients compared to controls. Advanced age (> 70 years) is significantly associated with an increased likelihood of developing narrow angles.

The Effect of Tube Ligature on the Safety and Efficacy of Ahmed Glaucoma Valve Surgery.

PRECIS: In this matched case-control study, ligature of the Ahmed glaucoma valve (AGV) was associated with a reduction in the rate of postoperative complications without affecting the surgical success rate or the visual outcome following the procedure. PURPOSE: The purpose of this study was to compare the safety and efficacy of AGV surgery with and without tube ligation. MATERIALS AND METHODS: This was a retrospective, matched case-control study. A review was performed of patients who underwent AGV surgery with tube ligation between June 2015 and December 2017 (ligated AGV group). Cases were matched with controls who underwent AGV surgery without tube ligation (nonligated AGV group). Data were compared on postoperative intraocular pressure (IOP), the number of glaucoma medications, surgical success rates, complications, and vision. RESULTS: There were 49 eyes in the ligated AGV group, and 98 eyes in the nonligated AGV group. Baseline characteristics were similar between groups except for the number of glaucoma medications (3.72±0.55 in the ligated AGV group vs. 3.92±0.92 in the nonligated AGV group; P<0.01). At 18 months, IOP was 16.7±6.3 mm Hg in the ligated AGV group and 17.3±8.0 mm Hg in the nonligated AGV group (P=0.76). In addition, the mean number of glaucoma medications was 2.38±1.10 in the ligated AGV group and 1.68±1.51 in the nonligated AGV group (P=0.56). The overall success rate at 12 months was similar between groups (P=0.84). The overall rate of complications was statistically lower in the ligated AGV group (28.6%) compared with the nonligated AGV group (73.5%) (P<0.01). The mean change in logarithm of the minimum angle of resolution acuity was similar between groups (P=0.50). CONCLUSION: Tube ligation in AGV surgery may be an effective measure that reduces the rate of postoperative complications without affecting the success rate or visual outcomes of the surgery.

Selective laser trabeculoplasty in patients with angle recession glaucoma: A small case series.

PURPOSE: To describe the results of selective laser trabeculoplasty (SLT) in eyes with angle recession glaucoma (ARG). To our knowledge, this is the first report of SLT being used as treatment modality for angle recession glaucoma. Argon laser trabeculoplasty (ALT) was used for ARG but showed a little therapeutic effect. OBSERVATIONS: Retrospective case series of 4 eyes of 4 patients with history of non-penetrating injury to the eye resulted in angle recession glaucoma. All eyes underwent SLT. Post-treatment, the best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of glaucoma medications, additional need for intervention, and complications were recorded. Success of treatment was defined as an IOP reduction of 20% or reduction in medications and maintaining target IOP without further intervention during follow up period of more than 3 months.Mean patient age was 44 years (SD = 9) and 2 out of 4 were females. SLT treatment resulted in decreased IOP from 21 to 12 mmHg in one patient and from 26 to 20 mmHg with reduced medication burden in another patient and reduced medication burden in the third patient who stopped glaucoma medication with no significant change in IOP (from 10 to 14 mmHg) at last follow up visit at 45 months. Two SLT sessions failed in one patient who underwent tube surgery.In the 3 patients with successful treatment, IOP remained controlled for the duration of follow up ranging from 4 to 45 months. CONCLUSIONS AND IMPORTANCE: Predicting IOP outcomes after SLT is difficult in patients with ARG. Success was noted early in the post-treatment period and was maintained for years. Repeating SLT in a case of early failure didn't change the result and is not recommended. A larger study is required to confirm the safety and effectiveness of SLT for ARG.

Comparison of surgical outcomes between sulcus and anterior chamber implanted glaucoma drainage devices.

PURPOSE: This retrospective case-control cross-sectional study compared the outcomes of sulcus placement of glaucoma drainage devices (GDD) versus traditional anterior chamber (AC) to test the hypothesis that sulcus placement results in fewer complications whilst maintaining similar efficacy. METHODS: This study included 45 patients in the sulcus group and 60 patients in the anterior chamber (AC) group who had undergone surgery from January 2014 to December 2017. Data were collected on pre-operative demographics, operative details and post-operative intraocular pressure and complications. The IOP, number of medications and complications between the two groups was compared. A P value of <5% was considered statistically significant. RESULTS: The sulcus group had significantly lower overall complications compared to the AC group with a comparable IOP decrease between groups. There were significantly lower rates of hyphaema in the sulcus (3 cases) compared to AC group (17 cases) (P < 0.05). Severe or late complications (implant exposure, corneal decompensation, endophthalmitis, poor vision, choroidal hemorrhage and cornea edema) were significantly lower in the sulcus group [2 eyes; 4.4%] compared to the AC group [13 eyes; 21.7%] (P < 0.05). The sulcus group required fewer medications during the follow-up period. CONCLUSION: Sulcus implantation of GDD resulted in less postoperative hyphaema and severe complications compared to AC implantation. Our findings concur with the literature that sulcus implantation is safe and effective for controlling IOP for various types of glaucoma. The long-term effects of endothelial cell loss for sulcus versus AC implantation require further evaluation.