Resultados de una técnica quirúrgica de trabeculectomía ab-externo modificada en pacientes con glaucoma de ángulo abierto / Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma

Objetivo Evaluar la seguridad y la eficacia de una técnica quirúrgica de trabeculectomía ab-externo modificada en el control de la presión intraocular (PIO) en los pacientes con glaucoma de ángulo abierto. Método y análisis Estudio retrospectivo de corte transversal en el que se incluyeron pacientes con glaucoma de ángulo abierto sometidos a trabeculectomía ab-externo modificada como primer tratamiento quirúrgico filtrante entre enero de 2008 a marzo de 2015. En el postoperatorio se evaluó la PIO, los medicamentos hipotensores, los tratamientos adicionales y las complicaciones tempranas y tardías. Resultados Se analizaron datos de 48 ojos de 38 pacientes. La media de edad fue de 63,1 años (25 a 85 años) y el tiempo medio de seguimiento fue de 35,3 meses (rango: 1-147 meses). La PIO preoperatoria media fue de 25,21±3,48mmHg y de 15,83±4,4mmHg al final del seguimiento. Catorce ojos (29%) requirieron goniopunción con láser y 4 ojos needling (8,4%). El análisis de supervivencia de Kaplan-Meier mostró una tasa de éxito del 81,7% a los 2 años y del 54,9% del año 4 al año 12. Dos ojos presentaron desprendimiento coroideo, 3 ojos cataratas que requirieron cirugía y 5 ojos tuvieron fugas tempranas de la ampolla. Conclusiones La trabeculectomía ab-externo modificada es eficaz para el tratamiento del glaucoma de ángulo abierto con un buen control de la PIO a largo plazo y una baja incidencia de complicaciones quirúrgicas, y podría utilizarse en casos complejos seleccionados de acuerdo con los resultados obtenidos (AU)

Objective Assess the safety and efficacy of a modified ab-external trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. Methods and analysis Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. Results Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the follow-up time was 35.3 months (range of 1-147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. Conclusions This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results (AU)

Results of a modified ab-external trabeculectomy surgical technique in patients with open angle glaucoma.

OBJECTIVE: Assess the safety and efficacy of a Modified Ab-externo Trabeculectomy surgical technique in controlling intraocular pressure (IOP) in open-angle glaucoma patients. METHODS AND ANALYSIS: Patients diagnosed with primary or secondary open-angle glaucoma underwent this modified technique as the first filtering surgical treatment were included. The preoperative and final follow-up assessed IOP, hypotensive medications, the need for additional treatments, and early and late complications. RESULTS: Forty-eight eyes of 38 patients were included. The mean age was 63.1 years (25-85 years), and the mean follow-up time was 35.3 months (range of 1147 months). The mean preoperative IOP was 25.21±3.48mmHg and 15.83±4.4mmHg by the follow-up end. Subsequent laser goniopuncture was performed on 14 eyes (29%) and needling in 4 eyes (8.4%). Complete success was achieved in 18 eyes (37.5%), qualified success in 17 (35.4%), and failed in 13 eyes (27.1%). Kaplan-Meier survival analysis shows a success rate of 81.7% at two years and 54.9% from year 4 to year 12. Multivariate analysis with generalized estimating equations (GEE) shows younger age as the main predictor for failure. Two eyes had choroidal detachment, three eyes progressed to cataracts that needed surgery, and five eyes had early bleb leaks. CONCLUSIONS: This proposed technique is an effective surgical procedure for treating open-angle glaucoma with effective long-term IOP control and a low incidence of surgical complications and could be used in selected complex cases based on these results.

Duration of the hypotensive effect of prostaglandin analogues measured with the water drinking test in glaucoma patients.

OBJECTIVE: To measure the magnitude and duration of the hypotensive effect of two prostaglandin analogues in glaucoma patients using the water drinking test (WDT). METHODS: Patients received latanoprost or travoprost every 24 h and then every 48 h. Untreated WDT were performed at 7 am and with treatment 12, 36 and 44 h after the last dose; intraocular pressure (IOP) peak, fluctuation and the difference between peak and isolated IOP measurements at consultation times were calculated. RESULTS: Forty-one eyes of 21 patients with primary open-angle glaucoma were included; 22 eyes received latanoprost, and 19 received travoprost. Mean untreated isolated IOP was 17.20 standard deviation (S.D.) 3.73 and 16.95 S.D. 2.61 mmHg and peak pressure 22.45 S.D. 2.91 and 21.58 S.D. 3.79 mmHg, for the latanoprost and travoprost groups, respectively. With treatment, peak pressure was reduced by 22.64% and 20.29% at 12 h, 18.44% and 14.64% at 36 h and 16.17% and 14.46% at 44 h, respectively. The fluctuation without treatment was 4.36 and 5.11 mmHg, and with treatment at 12 h was reduced to 2.77 and 2.89 mmHg, increasing again at 36 and 44 h. CONCLUSIONS: A hypotensive effect was evident up to 44 h after the last dose of latanoprost and travoprost, similar for the two drugs and decreasing over time. IOP fluctuation was only reduced at 12 h.

Duración del efecto hipotensor de los análogos de prostaglandinas medido con la prueba de sobrecarga hídrica en pacientes con glaucoma / Duration of the hypotensive effect of prostaglandin analogues measured with the water drinking test in glaucoma patients

Objetivo Medir con la prueba de sobrecarga hídrica (PSH) la magnitud y duración del efecto hipotensor de dos análogos de prostaglandinas en pacientes con glaucoma. Métodos Los pacientes recibieron latanoprost o travoprost cada 24 horas y luego cada 48 horas. Se practicaron PSH sin tratamiento a las 7 am y con tratamiento 12, 36 y 44 horas después de la última dosis; se calcularon el pico de presión intraocular (PIO), la fluctuación y la diferencia entre el pico y las medidas aisladas de PIO en horas de consulta. Resultados Se incluyeron 41 ojos de 21 pacientes con glaucoma primario de ángulo abierto, 22 ojos recibieron latanoprost y 19, travoprost. La PIO aislada promedio sin tratamiento fue 17,20 desviación estándar (D.S.) 3,73 y 16,95 D.S. 2,61mmHg y el pico de presión 22,45 D.S. 2,91 y 21,58 D.S. 3,79mmHg, para los grupos de latanoprost y travoprost, respectivamente. Con tratamiento, la presión pico se redujo en 22,64% y 20,29% a las 12 horas, 18,44% y 14,64% a las 36 horas y 16,17% y 14,46% a las 44 horas, respectivamente. La fluctuación sin tratamiento fue 4,36 y 5,11mmHg, y con tratamiento a las 12 horas se redujo a 2,77 y 2,89mmHg, aumentando nuevamente a 36 y 44 horas. Conclusiones Se evidenció un efecto hipotensor hasta 44 horas después de la última dosis de latanoprost y travoprost, similar para los dos medicamentos y decreciente en el tiempo. La fluctuación de la PIO sólo se redujo a las 12 horas (AU)

Objective To measure the magnitude and duration of the hypotensive effect of two prostaglandin analogues in glaucoma patients using the water drinking test (WDT). Methods Patients received latanoprost or travoprost every 24hours and then every 48hours. Untreated WDT were performed at 7 am and with treatment 12, 36 and 44hours after the last dose; intraocular pressure (IOP) peak, fluctuation and the difference between peak and isolated IOP measurements at consultation times were calculated. Results Forty-one eyes of 21 patients with primary open-angle glaucoma were included; 22 eyes received latanoprost, and 19 received travoprost. Mean untreated isolated IOP was 17.20 standard deviation (S.D.) 3.73 and 16.95 S.D. 2.61mmHg and peak pressure 22.45 S.D. 2.91 and 21.58 S.D. 3.79mmHg, for the latanoprost and travoprost groups, respectively. With treatment, peak pressure was reduced by 22.64% and 20.29% at 12hours, 18.44% and 14.64% at 36hours and 16.17% and 14.46% at 44hours, respectively. The fluctuation without treatment was 4.36 and 5.11mmHg, and with treatment at 12hours was reduced to 2.77 and 2.89mmHg, increasing again at 36 and 44hours. Conclusions A hypotensive effect was evident up to 44hours after the last dose of latanoprost and travoprost, similar for the two drugs and decreasing over time. IOP fluctuation was only reduced at 12hours (AU)

Prevalence and risk factors to develop ocular hypertension and glaucoma after penetrating keratoplasty.

OBJECTIVE: To determine the prevalence and factors associated with the development of ocular hypertension and glaucoma, in patients undergoing penetrating keratoplasty, in the Eye Clinic of the city of Bogotá. METHOD: A retrospective cross-sectional study was conducted, and 130 eyes of patients undergoing penetrating keratoplasty were analyzed at the Eye Clinic in Bogotá, between January 2015 and August 2018. Demographic and clinical data were obtained, and it was determined by bivariate analysis, the association factors and the prevalence of the pathology under study. RESULTS: Prevalence of ocular hypertension was 27.69% and glaucoma 10%. Average age 48.93 ± 18.63 years; higher frequency of presentation in men (61.5%). Statistically significant association factors were male sex (PR 2.59), presence of peripheral anterior synechiae (PR 1.83), history of trauma (PR 2.16), prior PK (PR 2.10) and graft failure (PR 2.04). Post-KP glaucoma only had statistically significant association with bullous keratopathy (PR 2.76). CONCLUSIONS: Ocular hypertension and glaucoma had a high prevalence after penetrating keratoplasty, and the association factors were similar to those reported in other international studies. Knowing these factors, allows focusing surveillance and treatment in these patients to avoid blindness due to damage of the optic nerve or corneal graft.

Prevalencia y factores de riesgo para desarrollar hipertensión ocular y glaucoma posterior a queratoplastia penetrante / Prevalence and risk factors to develop ocular hypertension and glaucoma after penetrating keratoplasty

Objetivo Determinar la prevalencia y los factores asociados con el desarrollo de la hipertensión ocular (HTO) y el glaucoma, en los pacientes sometidos a queratoplastia penetrante (QPP), en la Clínica de Ojos de la ciudad de Bogotá. Método Se realizó un estudio retrospectivo de corte transversal y se analizaron 130 ojos de pacientes sometidos a QPP, en la Clínica de Ojos de la ciudad de Bogotá, entre enero del 2015 y agosto del 2018. Se obtuvieron datos demográficos y clínicos y se determinó mediante el análisis bivariado los factores de asociación y la prevalencia de la patología a estudio. Resultados Prevalencia de HTO del 27,69% y glaucoma del 10%. Edad promedio 48,93 ± 18,63 años; frecuencia de presentación mayor en hombres (61,5%). Los factores de asociación estadísticamente significativos fueron el sexo masculino (PR 2,59), presencia de sinequias anteriores periféricas (PR 1,83), antecedente de trauma (PR 2,16), QPP previa (PR 2,10) y fracaso del injerto (PR 2,04). El glaucoma de la queratoplastia post penetrante (post-QPP) únicamente tuvo asociación estadísticamente significativa con la queratopatía bullosa (PR 2,76). Conclusiones La HTO y el glaucoma tuvieron una alta prevalencia posterior a QPP y los factores de asociación fueron similares a los reportados en otros estudios internacionales. Conocer estos factores permite enfocar la vigilancia y el tratamiento en estos pacientes para evitar la ceguera por daño del nervio óptico o del injerto corneal (AU)

Objective To determine the prevalence and factors associated with the development of ocular hypertension and glaucoma, in patients undergoing penetrating keratoplasty, in the Eye Clinic of the city of Bogotá. Method A retrospective cross-sectional study was conducted, and 130 eyes of patients undergoing penetrating keratoplasty were analyzed at the Eye Clinic in Bogotá, between January 2015 and August 2018. Demographic and clinical data were obtained, and it was determined by bivariate analysis, the association factors and the prevalence of the pathology under study. Results Prevalence of ocular hypertension was 27.69% and glaucoma 10%. Average age 48.93 ± 18.63 years; higher frequency of presentation in men (61.5%). Statistically significant association factors were male sex (PR 2.59), presence of peripheral anterior synechiae (PR 1.83), history of trauma (PR 2.16), prior PK (PR 2.10) and graft failure (PR 2.04). Post-KP glaucoma only had statistically significant association with bullous keratopathy (PR 2.76). Conclusions Ocular hypertension and glaucoma had a high prevalence after penetrating keratoplasty, and the association factors were similar to those reported in other international studies. Knowing these factors, allows focusing surveillance and treatment in these patients to avoid blindness due to damage of the optic nerve or corneal graf (AU)

Síndrome de Axenfeld-Rieger con glaucoma bilateral y descompensación de cornea en ojo izquierdo / Axenfeld-Rieger syndrome with bilateral glaucoma and corneal descompensation in left eye

Se describe un caso de síndrome de Axenfel-Rieger en un paciente de sexo femenino, con corectopia y policoria en ambos ojos, baja visión en el ojo derecho y glaucoma bilateral; en tratamiento desde 1994. Se realizó trabeculectomía del ojo derecho en dos ocasiones, obteniendo control transitorio de la presión intraocular con medicación complementaria. La presión del ojo izquierdo se mantuvo bien controlada con medicación hipotensora. Posteriormente presentó disminución de la agudeza visual en el ojo izquierdo y se diagnosticó descompensación de la córnea. Se practicó queratoplastia penetrante y pupiloplastia sin complicaciones. Más tarde desarrolló, elevación progresiva de la presión intraocular, por lo que se insertó un implante para glaucoma, logrando control adecuado de la presión. La agudeza visual del ojo izquierdo no ha logrado mejoría significativa y se mantiene en niveles subnormales