XEN® 45 en el manejo quirúrgico del glaucoma en fases tempranas: estudio nacional de consenso según metodología Delphi / XEN-45 in the management of Early Glaucoma Surgery: A National Delphi Consensus Study

Antecedentes y objetivo: Las recomendaciones sobre el manejo general del glaucoma y el uso de cirugías mínimamente-invasivas y microincisionales en fases tempranas son limitadas. El objetivo de este estudio fue establecer un consenso sobre el manejo del glaucoma, centrándose en el implante XEN 45 (AbbVie Inc., North Chicago, IL, EE. UU.). Métodos: Se utilizó un método Delphi. El comité científico dirigió el estudio, identificó el panel de expertos y participó en la elaboración del cuestionario. Se invitó a 51 expertos a completar, en una escala Likert de 9 puntos, un cuestionario de 89 ítems que cubría 3 bloques temáticos. Se realizaron 2 rondas Delphi. Se logró consenso si≥66,6% de los expertos llegaron a un acuerdo o desacuerdo. Resultados: Los panelistas acordaron 84 ítems relacionados con la calidad de vida, el algoritmo terapéutico y el perfil del paciente, y el manejo quirúrgico pre y postoperatorio. Los panelistas consideraron el implante XEN idóneo para tratar el glaucoma en diferentes etapas y para diferentes perfiles de pacientes: pacientes jóvenes/ancianos/con comorbilidades-significativas, glaucoma-miópico, pacientes con fracaso quirúrgico previo y con postoperatorio complejo. El implante XEN se consideró un paso terapéutico previo a la cirugía filtrante clásica y una posible primera opción quirúrgica en pacientes ancianos con comorbilidades y presión intraocular descontrolada. El implante XEN permite al paciente retomar sus actividades diarias más rápidamente que las cirugías filtrantes convencionales y reducir y/o eliminar los tratamientos tópicos. Conclusiones: Este consenso según la metodología Delphi proporcionó una serie de recomendaciones generales para el tratamiento del glaucoma, incluidas aquellas relacionadas con la calidad de vida del paciente, el algoritmo terapéutico y el perfil del paciente, y específicas con respecto al uso del implante XEN.(AU)

Background and objective: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. Methods: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. Results: Panelists agreed on 84 items related to the patients’ quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. Conclusions: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.(AU)

XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study.

BACKGROUND AND OBJECTIVE: Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant. METHODS: A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement. RESULTS: Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments. CONCLUSIONS: This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Glaucoma avanzado. Guía de práctica clínica / Advanced glaucoma. Clinical practice guideline

objetivo Realización de una guía de práctica clínica actualizada que sirva de orientación para la detección, el manejo y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Métodos Tras la definición de los objetivos y alcance de la guía se constituyó el grupo de trabajo que formuló las preguntas clínicas estructuradas siguiendo el formato PICO (Patient, Intervention, Comparison, Outcomes). Se realizó una revisión de la literatura publicada hasta el momento, incluyendo guías de práctica clínica internacionales, utilizándose las herramientas AMSTAR-2 (Assessment of Multiple systematic Rewiews) y «Risk of Bias» de Cochrane para la evaluación de la calidad de la información de forma independiente por, al menos, 2 revisores. El nivel de evidencia y la elaboración del grado de recomendación se establecieron siguiendo la metodología del Scottish Intercollegiate Guidelines Network (SIGN). Resultados Se presentan recomendaciones con sus correspondientes niveles de evidencia que pueden ser de utilidad para la detección, el seguimiento y el tratamiento de pacientes con glaucoma avanzado en la edad adulta. Conclusiones A pesar de que la evidencia científica existente es escasa y el nivel de evidencia para muchas de las preguntas planteadas no es muy alto, esta guía de práctica clínica ofrece una revisión actualizada de las recomendaciones existentes para el manejo del glaucoma avanzado en el adulto (AU)

Objective To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. Methods After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR-2 (Assessment of Multiple systematic Rewiews) and Cochrane «Risk of bias» tools by at least 2 reviewers, recommendations were formulated following the Scottish Intercollegiate methodology Guideline Network (SIGN). Results Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. Conclusions Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma (AU)

Advanced glaucoma. Clinical practice guideline.

OBJECTIVE: To present an update clinical practice guideline that serve as a guide for the detection, evaluation and treatment of adults patients with advanced glaucoma. METHODS: After defining the objectives and scope of the guide, the working group was formed and structured clinical questions were formulated following the PICO (Patient, Intervention, Comparison, Outcomes) format. Once all the existing clinical evidence had been independently evaluated with the AMSTAR 2 (Assessment of Multiple systematic Rewiews) and Cochrane "Risk of bias" tools by at least two reviewers, recommendations were formulated following the Scottish Intercollegiate methodology. Guideline Network (SIGN). RESULTS: Recommendations with their corresponding levels of evidence that may be useful in the diagnosis, monitoring and treatment of adults patients with advanced glaucoma. CONCLUSIONS: Despite the fact that for many of the questions the level of scientific evidence available is not very high, this clinical practice guideline offers an updated review of the different existing aspects related to the evaluation and management of advanced glaucoma.

Retinal and choroidal thickness measurements in obstructive sleep apnea: impacts of continuous positive airway pressure treatment.

PURPOSE: To examine retinal and choroidal thicknesses in individuals with obstructive sleep apnea (OSA) and determine the impacts of continuous positive airway pressure (CPAP) treatment. METHODS: Prospective follow-up study conducted at a university hospital. 40 patients with OSA, 28 treated with CPAP, and 12 untreated, were enrolled immediately after diagnosis and graded according to the apnea hypopnea index (AHI) determined in an overnight polysomnography. Inclusion criteria were a new diagnosis of OSA and CPAP indicated. Participants underwent a full ophthalmologic examination including optical coherence tomography (OCT) at the peripapillary, macular, and choroidal levels and the same examination 3 months later. Outcome measures were peripapillary retinal nerve fiber layer (RNFL), total retinal (TRT), retinal ganglion cell layer (RGCL), inner plexiform layer (IPL), photoreceptor layer (PL), and choroidal thicknesses. RESULTS: At 3 months, RGCL thickness was reduced at the inner nasal macula segment in the no-CPAP group (P = 0.016). In + CPAP, increases were produced in RNFL thickness (5/6 segments) and TRT (7/ 9 segments), while choroidal thinning was observed temporally (P = 0.003). At baseline, positive correlation was detected between choroidal thickness and AHI (r = 0.352, P = 0.005) and between IPL thickness (7/9 segments) and AHI (r = 0.414, P < 0.001). CONCLUSIONS: Initial retinal and choroidal thickening was followed by RGCL thinning over 3 months. In patients receiving CPAP, we observed no thinning of any retinal layer and normalization of choroidal thickness.

Variabilidad clínica en la cirugía de la catarata / Clinical practice variation in cataract surgery

PROPÓSITO: Las tasas de la cirugía de la catarata han aumentado de forma espectacular en las últimas dos décadas. Sin embargo, las variaciones en la práctica clínica en esta cirugía no han sido estudiadas en profundidad. El objetivo de esta revisión es el análisis de dicha variabilidad, incluyendo los factores que la originan y las consecuencias sobre la calidad asistencial y la planificación sanitaria. Asimismo se resalta la importancia de reducirla y se exponen diversas estrategias que permiten su control. Hallazgos recientes: A lo largo del artículo se presentan las últimas investigaciones en las que se considera que el desarrollo y la implementación de guías de práctica clínica constituyen la mejor herramienta para estandarizar los procesos de cuidados. CONCLUSIÓN: El control del componente injustificado o no deseado de las variaciones, además de mejorar la calidad asistencial, puede suponer un importante ahorro en el gasto sanitario

PURPOSE: Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. Recent findings: The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION: Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending

[Clinical practice variation in cataract surgery]. / Variabilidad clínica en la cirugía de la catarata.

PURPOSE: Cataract surgery rates have dramatically increased in the last two decades. However, clinical practice variation in cataract surgery has not been thoroughly studied. The aim of this review is to analyze clinical practice variation, including the causes and consequences of this phenomenon. Then, its role in health care planning and health care quality is focused, emphasizing the importance of reducing it and providing several practical strategies to accomplish it. RECENT FINDINGS: The latest researches are presented in this article. They identify the development and implementation of clinical practice guidelines as the best tool to standardize care processes. CONCLUSION: Managing unwarranted or unwanted variation would improve quality of care and may lead to a significant saving in health care spending.

Implante Ex-Press (R) en glaucoma y síndrome de Sturge Weber / Ex-Press (R) implant in glaucoma and Sturge Weber syndrome

No disponible

Síndrome de Charles Bonnet, glaucoma y agudeza visual moderada / Charles Bonnet syndrome, glaucoma and moderate visual acuity

No disponible

Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins.

OBJECTIVES: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. MATERIAL AND METHODS: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. RESULTS: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4 mmHg (SD2.2) and after 4 weeks 19.9 mmHg (SD2.6), (P>.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<.001). No significant differences in tear clearance, Schirmer or TFI were found (P>.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7 mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5 mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=.014). CONCLUSIONS: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI.

Aclaramiento lagrimal y sintomatología ocular en pacientes tratados con prostaglandinas sin conservantes / Tear clearance and ocular symptoms in patients treated with preservative-free prostaglandins

Objetivos: Evaluar el efecto en los síntomas de sequedad ocular y en la dinámica lagrimal que se produce al sustituir una prostaglandina con conservante por una prostaglandina sin conservante. Material y métodos: Estudio prospectivo no controlado en el que se seleccionaron 28 ojos de 14 pacientes con síntomas de ojo seco en tratamiento con latanoprost, travoprost o bimatoprost con conservante. Se evaluaron los síntomas oculares con un cuestionario validado de enfermedad de la superficie ocular y los signos mediante el test de aclaramiento lagrimal, el Schirmer y el índice de función lagrimal (TFI, TFI=Schirmer/aclaramiento). En todos los pacientes se cambió el tratamiento hipotensor a tafluprost sin conservante. Al mes, se repitieron los tests. En el análisis estadístico se utilizó el test de Wilcoxon y el coeficiente de correlación de Spearman. Resultados: No encontramos diferencias en la presión intraocular (PIO) al cambiar a tafluprost. La PIO inicial era 20,4mmHg (DE2,2) y la PIO al mes era 19,96mmHg (DE2,6) (p>0,05). La puntuación del cuestionario disminuyó de forma significativa desde 9,7 (DE3,7) hasta 5,4 (DE2,7) al mes del tratamiento (p<0,001). No encontramos diferencias significativas en el aclaramiento, en el Schirmer, ni en el TFI (p>0,05). Inicialmente, aclaramiento=0,13 (DE0,07), Schirmer=10,7mm (DE6) y TFI=80 (48-156). Al mes, aclaramiento=0,1 (DE0,07), Schirmer=9,5mm (DE3,9) y TFI=104 (48-216). Hemos encontrado una asociación significativa entre la puntuación del cuestionario y el aclaramiento al mes (coeficiente de correlación=0,62; p=0,014). Conclusiones: La sustitución de una prostaglandina con conservante por tafluprost sin conservante mejora los síntomas de sequedad ocular y sugiere una mejoría en el test de función lagrimal(AU)

Objectives: To assess the effects on dry eye symptoms and tear dynamics of switching from a prostaglandin with a preservative to a preservative-free prostaglandin. Material and methods: Fourteen patients (N=28 eyes) with open-angle glaucoma and dry eye symptons, treated with preserved latanoprost, travoprost or bimatoprost were included in this uncontrolled prospective study. Ocular symptoms were analysed using a validated ocular surface disease questionnaire and ocular signs were assessed with tear clearance, Schirmer and tear function index test (TFI=Schirmer/clearance). Patients were assigned to preservative-free tafluprost treatment, and measurements were repeated 4 weeks after change of medication. Wilcoxon test and Spearman correlation coefficient were used in the statistical analysis. Results: No statistically significant difference in intraocular pressure (IOP) was observed after switching to tafluprost. Mean IOP at baseline was 20.4mmHg (SD2.2) and after 4 weeks 19.9mmHg (SD2.6), (P>0.05). The mean questionnaire score significantly decreased from 9.7 (SD3.7) at baseline to 5.4 (SD2.7) after one month (P<0.001). No significant differences in tear clearance, Schirmer or TFI were found (P>0.05). At baseline, tear clearance=0.13 (SD0.07), Schirmer=10.7mm (SD6) and TFI=80 (48-156). After 4 weeks, tear clearance=0.1(SD0.07), Schirmer=9.5mm (3.9) and TFI=104 (48-216). A significant association between questionnaire score and tear clearance after 4 weeks was observed (Spearman coefficient=0.62; P=0.014). Conclusions: Switching from preservative prostaglandin with a preservative to preservative-free tafluprost treatment improves dry eye symptoms and suggests an improvement in TFI(AU)