Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser / Combined excimer laser trabeculostomy and phacoemulsification: one year follow-up real world data of a laser-based MIGS

Objetivos Evaluar la eficacia y posibles complicaciones de la trabeculostomía láser excímer (excimer laser trabeculostomy, ELT) una técnica de cirugía de glaucoma mínimamente invasiva (minimally invasive glaucoma surgery, MIGS) emergente de tipo láser, realizada en combinación con la cirugía de la catarata durante la práctica clínica habitual. Pacientes y métodos Estudio intervencionista, retrospectivo, en un único centro. Se recopilaron los datos clínicos preoperatorios y postoperatorios de pacientes con catarata y glaucoma de ángulo abierto (GAA) que fueron sometidos a cirugía combinada de ELT y facoemulsificación, en el día preoperatorio, a una semana, y uno, dos, tres, seis, nueve y 12 meses después de la cirugía. La variable principal del estudio fue la presión intraocular (PIO). El éxito cualificado y completo se definió como una PIO menor de 21 mmHg con una reducción del 20% o más de la PIO preoperatoria, con o sin tratamiento médico adyuvante, respectivamente. Resultados Se incluyeron 34 ojos de 29 pacientes; 29 ojos completaron el seguimiento a un año. La PIO preoperatoria media bajo medicación hipotensora fue de 20,9 ± 2,6 mmHg (± desviación estándar, DE) y disminuyó significativamente al año (16,3 ± 1,9; p < 0,0001). El número medio de medicamentos reductores de la PIO disminuyó de 1,7 ± 0,7 a 0,3 ± 0,8 (p < 0,0001) en el seguimiento de 12 meses. Al año, el 81% de los ojos estaban libres de medicación. Se obtuvo un éxito cualificado y completo en el 62% y el 58% de los ojos, respectivamente. Dos ojos presentaron hipema postoperatorio, tres ojos sufrieron un aumento transitorio de PIO y un paciente requirió de cirugía filtrante en los tres meses sucesivos (AU)

Purpose To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. Patients and methods Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. Results Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. Conclusion Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting (AU)

Combined excimer laser trabeculostomy and phacoemulsification: One year follow-up real world data of a laser-based MIGS.

PURPOSE: To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. PATIENTS AND METHODS: Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21mmHg and an IOP reduction ≥20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. RESULTS: Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9±2.6mmHg (±standard deviation, SD) and decreased significantly at one year (16.3±1.9; p<0.0001). The mean number of IOP-lowering medications decreased from 1.7±0.7 to 0.3±0.8 (p<0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. CONCLUSION: Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.

Combined excimer laser trabeculostomy and phacoemulsification: one year follow-up real world data of a laser-based MIGS. / Cirugía combinada de trabeculostomía láser excímer y facoelmusificación: datos a un año en el mundo real de una MIGS de tipo láser.

PURPOSE: To evaluate the efficacy and complication profile of excimer laser trabeculostomy (ELT), an emerging laser-based trabecular minimally invasive glaucoma surgery (MIGS), combined with cataract surgery in routine clinical practice. PATIENTS AND METHODS: Single-site, retrospective, interventional study. Preoperative and postoperative clinical data of patients with cataract and open-angle glaucoma (OAG) who underwent combined phacoemulsification and ELT were collected and analyzed at preoperative day, one week postoperatively, and after one, two, three, six, nine and 12 months. Main outcome measure was intraocular pressure (IOP). Qualified and complete success were defined as an IOP less than 21 mmHg and an IOP reduction ≥ 20% from preoperative medicated IOP with or without adjuvant medical treatment, respectively. RESULTS: Thirty-four eyes of 29 patients were included; 29 eyes completed 1-year follow-up. The mean preoperative IOP under medications was 20.9 ± 2.6 mmHg (± standard deviation, SD) and decreased significantly at one year (16.3 ± 1.9; p < 0.0001). The mean number of IOP-lowering medications decreased from 1.7 ± 0.7 to 0.3 ± 0.8 (p < 0.0001) at the 12-month follow-up. At one year, 81% of eyes were medication free. Qualified and complete success was obtained in 62% and 58% of eyes, respectively. Two eyes had postoperative hyphema, three eyes had transient IOP spikes and one patient underwent a subsequent filtering surgery at three months. CONCLUSION: Combining ELT with phacoemulsification in eyes with cataract and mild to moderate OAG significantly reduced IOP and medication use without meaningful complications after one-year follow-up in a real world clinical practice setting.

Nuevo abordaje anestésico en la cirugía de glaucoma: anestesia subtenoniana ampular y su influencia en el resultado a medio plazo / New anesthetic approach in glaucoma surgery: "Underbleb" subtenonian anesthesia and its influence in medium term outcome

OBJETIVO: Presentar una nueva variante de anestesia subtenoniana, en el área quirúrgica de la futura ampolla de filtración y su influencia en el éxito quirúrgico a medio plazo. MATERIAL Y MÉTODOS: Estudio retrospectivo de 97 cirugías (esclerectomía profunda no perforante -EPNP- o Faco EPNP) realizadas en pacientes con glaucoma crónico simple, comparando aquellas realizadas bajo nuestra técnica de anestesia subtenoniana anterior modificada «subampular» (ASA) frente a otro grupo control bajo anestesia peribulbar (AP) (n = 58 vs. 38). Se contrastaron la PIO, número de fármacos antiglaucomatosos y porcentaje de éxito total y parcial a 1, 3, 6, 12, 18 y 24 meses tras la cirugía. RESULTADOS: Ambos grupos fueron comparables en términos de edad, sexo, tipo de cirugía, número de fármacos y PIO preoperatoria. La PIO en el grupo intervenido bajo ASA descendió de forma similar respecto al grupo control sin diferencias significativas salvo en los 24 meses, donde la PIO fue 2mm menor (14,83 ± 2,87 vs. 17,61 ± 4,27 [p = 0,009]). Esto sucedió tanto para EPNP como para la FACO-EPNP. El número de fármacos postoperatorios fue algo menor a los 3, 6, y 18 meses, pero no estadísticamente significativo. El éxito total a los 24 meses fue mayor en el grupo de ASA respecto al control AP (62,5% vs. 51,6) al igual que el éxito parcial (100% vs. 71%). CONCLUSIÓN: Nuestra nueva técnica anestésica ASA no influye negativamente en el control tensional a medio plazo de la cirugía no perforante, sino que incluso podría contribuir al éxito quirúrgico a más largo plazo

PURPOSE: To present a new anterior subtenonian anesthesia approach in the area of the future filtration bleb and its influence on medium term surgical success. MATERIAL AND METHODS: Retrospective study of 97 surgeries, deep sclerectomy (DE) or phaco-deep sclerectomy (PHACO-DS), were performed in patients with open angle glaucoma (OAG) comparing our modified "underbleb" subtenonian anesthesia (USA) (n = 58) versus a control group under peribulbar anesthesia (PA) (n = 38). Main outcomes were intraocular pressure (IOP), number of antiglaucomatous drugs and total and qualificated success, compared during 1, 3, 6, 12, 18 and 24 months follow up after glaucoma surgery. RESULTS: Both groups were comparable in terms of age, gender, surgical technique, number of antiglaucoma drugs and preoperative IOP. The IOP in the USA group decreased as in PA control group without statistical significant differences except at 24 months, where the IOP was 2mm lower (14.83 ± 2.87 vs. 17.61 ± 4.27 (P = .009). This happened for both, DS and PHACO-DS surgeries. The number of postoperative drugs was lower at 3, 6, and 18 months but without statistically significant diferences. Total success rate at 24 months was higher in the USA group respect AP control group (62.5% vs. 51.6) as well as partial success (100% vs. 71%). CONCLUSION: Our new USA anesthetic technique does not have a negative impact in DS medium-term surgical success, even it could contribute to a longer-term improvement

New anesthetic approach in glaucoma surgery: "Underbleb" subtenonian anesthesia and its influence in medium term outcome. / Nuevo abordaje anestésico en la cirugía de glaucoma: anestesia subtenoniana ampular y su influencia en el resultado a medio plazo.

PURPOSE: To present a new anterior subtenonian anesthesia approach in the area of the future filtration bleb and its influence on medium term surgical success. MATERIAL AND METHODS: Retrospective study of 97 surgeries, deep sclerectomy (DE) or phaco-deep sclerectomy (PHACO-DS), were performed in patients with open angle glaucoma (OAG) comparing our modified "underbleb" subtenonian anesthesia (USA) (n=58) versus a control group under peribulbar anesthesia (PA) (n=38). Main outcomes were intraocular pressure (IOP), number of antiglaucomatous drugs and total and qualificated success, compared during 1, 3, 6, 12, 18 and 24 months follow up after glaucoma surgery. RESULTS: Both groups were comparable in terms of age, gender, surgical technique, number of antiglaucoma drugs and preoperative IOP. The IOP in the USA group decreased as in PA control group without statistical significant differences except at 24 months, where the IOP was 2mm lower (14.83 ± 2.87 vs. 17.61 ± 4.27 (P=.009). This happened for both, DS and PHACO-DS surgeries. The number of postoperative drugs was lower at 3, 6, and 18 months but without statistically significant diferences. Total success rate at 24 months was higher in the USA group respect AP control group (62.5% vs. 51.6) as well as partial success (100% vs. 71%). CONCLUSION: Our new USA anesthetic technique does not have a negative impact in DS medium-term surgical success, even it could contribute to a longer-term improvement.

[Hemilaryngectomy of the supracricoid: experience of 58 cases. (Follow-up study for 5 years)]. / Hemilaringectomía supracricoidea: experiencia en 58 casos (seguimiento mayor de cinco años).

In the supracricoid hemilaryngectomy the wing of the thyroid and its internally related structures are resected. This is widely used in T2 glottic tumour. Some writers describe its use in limited ventricularis lesions. We have frequently used this technique in both types of lesions. In this paper 58 cases of patients operated on between 1974 and 1986 are reviewed, giving a follow-up period of more than five years. The results obtained, both oncological and functional, are good enough to make this technique basic in the treatment of laryngeal cancer.

[Partial horizonto-vertical laryngectomy: experience of 44 cases (follow up of more than five years]. / Laringectomía parcial horizontovertical: experiencia en 44 casos (seguimiento mayor de cinco años).

The horizontal-vertical partial laryngectomy combines supraglottic and hemilaryngeal excisions of one side of the larynx and is indicated, as first choice, in the supraglottic tumours with unilateral glotoaryntenoid involvement. We have followed this theory and practice since 1974, and have studied 44 patients operated on using this technique up to 1986, who have now (1992) been followed up for more than five years. Analysis of the results shows the number of patients alive and free of tumour, and the number of decannulations, to be sufficiently high for the recommendation of this technique in the treatment of such tumours.