RESUMO
PURPOSE: To describe the clinicopathological characteristics and explore the possible etiology of cornea invasion by filtering bleb (CIFB) after filtering surgery. METHODS: We reviewed 22 patients treated for CIFB between March 2005 and March 2022. The patients were followed up for more than 1 year. Slit-lamp examination, optical coherence tomography (OCT), ultrasound biomicroscopy, and histopathological examination were performed to observe the morphology of the bleb and depth of corneal invasion. Depending on the severity of the lesion, treatments consisting of local massage, acupuncture separation, or surgical resection were administered. RESULTS: The mean age of the patients was 56.3 ± 8.8 years. All patients underwent filtering surgery in the moderate or advanced stage of glaucoma. The filtering bleb was closely connected with the cornea, and its posterior boundary was locally adhered. Forward displacement of the internal opening of the filtering bleb was found in 4 of 7 surgically treated patients. OCT and pathological examination showed that the filtering blebs invaded the corneal stroma. Removal of the adhesion of the posterior boundary of the filtering bleb by different treatment methods successfully improved the patients' conditions. CONCLUSION: Filtering blebs can invade the corneal stroma. Adhesion of the posterior boundary and forward displacement of the internal opening of the filtering bleb are the possible causes of CIFB. Removal of the adhesion of the posterior boundary of the filtering bleb can halt the progression of CIFB.
Assuntos
Cirurgia Filtrante , Glaucoma , Trabeculectomia , Idoso , Humanos , Pessoa de Meia-Idade , Substância Própria/patologia , Glaucoma/cirurgia , Glaucoma/etiologia , Pressão Intraocular , Tomografia de Coerência Óptica/métodos , Trabeculectomia/métodosRESUMO
PURPOSE: To investigate the efficacy of nintedanib on preventing postoperative scar in formation following glaucoma filtering surgery (GFC) in rabbits in comparison with Mitomycin-C (MMC). DESIGN: Experimental Animal Study. METHODS: 24 New Zealand rabbits were divided randomly into 3 groups as Sham, Nindetanib and MMC(n = 8). Limbal-based trabeculectomy was performed on the right eyes of the rabbits. Left eyes that did'nt undergo surgery were included in the control group (n = 8). Following surgery, Intraocular pressures (IOP), postoperative complications and morphological changes in the bleb were evaluated. On the 28th day, eight eyes from each group were enucleated and histologically and immunohistochemically analyzed. Matrix metalloproteinase-2 (MMP-2), Transforming Growth Factor-1 (TGF-B1) and alpha-smooth muscle actin (a-SMA) were evaluated. RESULTS: It was observed that nintedanib has no side effects and reduces subconjunctival fibrosis. Postoperative IOP values in the Nindetanib group were lower than the other groups (p < 0.05). The longest bleb survival was observed in the Nintedanib group and the shortest in the Sham group (p < 0.001). Conjunctival vascularity and inflammation was reduced in the Nintedanib group compared to the Sham group (p < 0.05). The highest subconjunctival fibrosis was observed in the Sham group and the least in the Nintedanib group (p < 0.05). Although the fibrosis score was found lower in the Nintedanib group compared to the MMC(p > 0.05). α-SMA TGF-ß1, MMP-2 expressions were similar in Nintedanib and MMC groups (p > 0.05), however, it was observed that significantly decreased in both groups compared to Sham group (p < 0.05). CONCLUSION: It has been observed that Nindetanib suppress fibroblast proliferation Thus, It may be a drug that can prevent subconjunctival fibrosis in GFC.
Assuntos
Cirurgia Filtrante , Glaucoma , Trabeculectomia , Animais , Coelhos , Cicatriz/etiologia , Cicatriz/prevenção & controle , Cicatriz/patologia , Túnica Conjuntiva/metabolismo , Fibrose , Glaucoma/metabolismo , Pressão Intraocular , Metaloproteinase 2 da Matriz/metabolismo , Mitomicina/farmacologia , Inibidores de Proteínas Quinases/farmacologia , Tirosina/metabolismoRESUMO
RATIONALE: Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient. PATIENT CONCERNS: A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye. DIAGNOSES: The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations. INTERVENTIONS: Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye. OUTCOMES: The patient's visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed. LESSONS: Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.
Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Fechado , Glaucoma , Síndrome Endotelial Iridocorneana , Masculino , Humanos , Adulto , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/cirurgia , Glaucoma de Ângulo Fechado/complicações , Glaucoma/cirurgia , Cirurgia Filtrante/efeitos adversos , Pressão Intraocular , Resultado do TratamentoRESUMO
PURPOSE OF REVIEW: Glaucoma drainage device (GDD) implantation surgery is commonly performed by glaucoma specialists to treat complex and refractory glaucomas. Relative safety and efficacy data from randomized controlled trials conducted in the last two decades have sparked the interest in GDDs as possible surgical options earlier in the course of the disease than has traditionally been practiced. However, until recently, advances in the design and techniques of GDD surgery have fallen short of this increasing interest. RECENT FINDINGS: Most recently, new GDDs that possess novel design features have become available to glaucoma specialists. Two of these new devices are the Ahmed ClearPath and the Paul glaucoma implant. These devices have demonstrated promising outcomes that are comparable to those of traditional implants. Additionally, given their unique respective features, these devices may streamline surgical technique due to ease of insertion and afford better safety and efficacy outcomes in certain patients. SUMMARY: The recent introduction of new GDDs has been long awaited by glaucoma surgeons. Although early results are promising, long-term data and comparison of outcomes to those of traditional filtering surgery and commonly implanted devices are needed before these devices can be the new standard of care in glaucoma tube shunt surgery.
Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma , Cirurgiões , Humanos , Pressão Intraocular , Glaucoma/cirurgia , Implantação de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Purpose: This study was conducted to assess the outcomes of bleb needling for the treatment of failure of filtration surgeries in primary glaucoma with a follow-up of six months. Methods: This prospective interventional study included patients with primary glaucoma who underwent trabeculectomy or combined glaucoma and cataract surgery with failed or failing bleb after six weeks of surgery and less than two years. A comprehensive examination including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, gonioscopy, slit-lamp examination, and bleb morphology grading was done. Selected patients underwent a subconjunctival bleb needling with mitomycin C (MMC) (dose 0.2 mg/ml). Postoperatively, patients were followed up on the first, third, and sixth months and were assessed with respect to IOP, need for antiglaucoma medication (AGM), and complications. Results: Sixty eyes of 59 patients were included. Preoperatively, 33.3% of patients were on one AGM, whereas postoperatively at the third month 51.7% and at the sixth month 50% of patients were on no AGM. There was a statistically significant decrease in IOP (P < 0.001) from preoperative (mean: 23.8 ± 7.86 mmHg) to postoperative first month (mean: 19.8 ± 9.08 mmHg), third month (mean: 17.4 ± 5.4 mmHg) and sixth month (mean 16.6 ± 4.39). According to the defined criteria in the current study, we achieved 22 (37.9%) successes, 31 qualified successes (53.4%), and 5 (8.6%) failures. Univariate regression analysis showed a higher failure rate among younger age groups. Gender, laterality, and intraoperative complications were not significant statistically. Conclusion: Bleb needling is a safe and effective procedure for the treatment of failed filtration surgeries.
Assuntos
Cirurgia Filtrante , Glaucoma , Humanos , Estudos Prospectivos , Vesícula , Glaucoma/cirurgiaRESUMO
Glaucoma is a leading cause of irreversible blindness in the world. The reduction of intraocular pressure is the main clinical treatment. Due to the limitations of traditional filter surgery, a variety of minimally invasive glaucoma surgery (MIGS) procedures have been applied in clinical practice in recent years. Quite a few of them have been carried out in China and achieved good results. At the same time, domestic technology enterprises are actively engaged in the development, innovation and localization of the MIGS equipment. However, there are still some problems in MIGS in China, which need to be paid attention to and require corresponding clinical research, so as to make it a new highlight in the clinical diagnosis and treatment of glaucoma.
Assuntos
Cirurgia Filtrante , Glaucoma , Humanos , Glaucoma/cirurgia , Pressão Intraocular , Tonometria Ocular , Procedimentos Cirúrgicos Minimamente Invasivos/métodosRESUMO
The modern glaucoma surgeon is faced with many surgical alternatives for the management of glaucoma. In recent years, numerous techniques that make Schlemm's canal (SC) more accessible for surgery by being less invasive and surgically less challenging were introduced. Since its first introduction, canaloplasty has become a well-established method of glaucoma surgery. The aim of this paper was to present an overview of canaloplasty and its modifications, and to highlight their strong points and potential drawbacks based on available data on the effectiveness of each technique. Furthermore, it offered an overview of the development of canaloplasty over time and the clinical aspects that should be considered in patient selection. Abbreviations: ABiC = Canaloplasty ab interno, AH = aqueous humour, CSD = Canaloplasty with suprachoroidal drainage, IOP = intraocular pressure, MIGS = minimally invasive glaucoma surgery, OAG = open angle glaucoma, PEXG = pseudoexfoliation glaucoma, SC = Schlemm's canal, TDM = trabeculo-Descemet's membrane.
Assuntos
Síndrome de Exfoliação , Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Glaucoma , Humanos , Glaucoma de Ângulo Aberto/cirurgia , Cirurgia Filtrante/métodos , Pressão Intraocular , Humor Aquoso , Glaucoma/cirurgiaRESUMO
PRCIS: Utilizing an automated pipeline for data extraction from electronic health records provides real-world information on the success of various glaucoma procedures, with tube shunt implantation associated with increased failure rates compared with trabeculectomy. BACKGROUND: We aimed to evaluate the long-term survival of glaucoma surgeries using an automated pipeline for extraction of outcomes from electronic health records. METHODS: A retrospective observational study from a single academic center. Patients undergoing trabeculectomy, Ex-PRESS shunt, Baerveldt, and Ahmed tube shunt insertion from 2009 to 2018 were identified from electronic health record procedure codes. Patient characteristics were identified from structured and unstructured fields using a previously validated natural language processing pipeline. RESULTS: Five hundred twelve patients underwent 711 glaucoma surgeries: 287 trabeculectomies, 47 Ex-PRESS shunts, 274 Baerveldt and 103 Ahmed tube implantations. The Median follow-up was 359 days. The mean baseline IOP was 24.4 mm Hg (SD 10.9), and 73.1% were on ≥3 medications. Compared with trabeculectomy, tube shunt surgery had a higher risk of failure (Baerveldt: Hazard Ratio (HR) 1.44, 95% CI 1.02 to 2.02; Ahmed: HR 2.01, 95% CI 1.28 to 3.17). Previous glaucoma surgery was associated with increased failure (≥2 previous surgeries: HR 2.74, 95% CI 1.62 to 4.64), as were fewer baseline medications (<3 medications: HR 2.96, 95% CI 2.12 to 4.13) and male sex (HR 1.40, 95% CI 1.03 to 1.90). At 1 year, tube shunt patients had a 2.53 mm Hg ( P =0.002) higher IOP compared with trabeculectomy patients. CONCLUSIONS: Baerveldt and Ahmed tube shunt implantation was associated with increased failure compared with trabeculectomy. Fewer baseline medications, previous glaucoma surgeries, and male sex were also risk factors for failure. These results demonstrate the utility of applying an informatics pipeline to electronic health records to investigate key clinical questions using real-world evidence.
Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma , Trabeculectomia , Humanos , Masculino , Registros Eletrônicos de Saúde , Pressão Intraocular , Acuidade Visual , Seguimentos , Resultado do Tratamento , Glaucoma/cirurgia , Trabeculectomia/métodos , Estudos Retrospectivos , InformáticaRESUMO
Despite the well-known effectiveness of pharmacological glaucoma therapy, surgical approach remains one of the main treatment options for some forms and stages of the disease. The long-term success of glaucoma surgery depends on the intensity of local wound healing processes at the surgical site. The most common way to influence healing processes in surgical treatment of glaucoma is the use of antimetabolites. However, given the high risk of serious complications associated with their use, the search for new drugs devoid of these disadvantages continues. The aim of this review is to describe the efficacy and safety of both currently used and upcoming pharmacological ways to influence the wound healing process after glaucoma surgery in order to improve the stability of hypotensive effect.
Assuntos
Cirurgia Filtrante , Glaucoma , Trabeculectomia , Cirurgia Filtrante/efeitos adversos , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Humanos , Mitomicina , CicatrizaçãoRESUMO
Purpose: Cytotoxic agents such as mitomycin C (MMC) are part of the mainstay treatment for limiting subconjunctival scarring following glaucoma filtration surgery (GFS). However, a safer antifibrotic therapy is clinically needed. The anti-scarring properties of 3',4'-dihydroxyflavonol (DiOHF) were evaluated in a mouse model of GFS and in cultured human Tenon's fibroblasts (HTFs). Methods: GFS was performed in C57BL/6 mice receiving daily intraperitoneal injections of DiOHF or vehicle or a single intraoperative injection of MMC. Eyes were harvested on day 14 for assessment of collagen deposition, expression of alpha-smooth muscle actin (α-SMA), cluster of differentiation 31 (CD31), and 4-hydroxy-2-nonenal (4HNE) in the conjunctiva/Tenon's layer. The inhibitory effects of DiOHF on transforming growth factor ß (TGFß)-induced responses were also assessed in HTFs. Results: Treatment with DiOHF demonstrated a reduction in collagen deposition at the GFS site compared to vehicle-treated mice. The degree of 4HNE-positive fluorescence was significantly reduced in DiOHF-treated eyes compared to the other groups, indicating a decrease in oxidative stress. A reduction in expression of α-SMA and CD31 was seen in DiOHF-treated conjunctiva compared to those treated with vehicle. Concordant results were demonstrated in cultured HTFs in vitro. Furthermore, treatment of cultured HTFs with DiOHF also displayed a reduction in the proliferation, migration, and contractility of HTFs. Conclusions: Treatment with DiOHF reduces scarring and angiogenesis in the conjunctiva of mice with GFS at a level comparable to MMC. The reduction in oxidative stress suggests that DiOHF may suppress scarring via different mechanisms from MMC. Translational Relevance: DiOHF may be a safer and superior wound modulating agent than conventional antifibrotic therapy in GFS.
Assuntos
Cirurgia Filtrante , Glaucoma , Animais , Colágeno/metabolismo , Colágeno/farmacologia , Modelos Animais de Doenças , Fibroblastos/metabolismo , Flavonóis , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Mitomicina/metabolismo , Mitomicina/farmacologia , Mitomicina/uso terapêutico , Cápsula de Tenon/metabolismoRESUMO
PURPOSES: To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE). DESIGN: Prospective, non-comparative clinical study. METHODS: Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled intraocular pressure (IOP) between January 2018 and April 2020. Patients were followed up at 1 week, months 1, 3, 6, 12 postoperatively, and semi-annually thereafter. The IOP, anti-glaucoma medication, and surgery-related complications were recorded. Surgical success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg without (complete success) or with/without (qualified success) IOP-lowering medication. RESULTS: A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5 ± 11.8 mmHg on 2.9 ± 1.0 medications before surgery to 16.6 ± 5.3 mmHg (P < .001) on 0.2 ± 0.6 medications (P < .001) at 12 months postoperatively, respectively. Hyphema (37.9%), transient hypotony (34.5%), and transient postoperative IOP elevation (≥ 30 mmHg, 17.9%) were the most commonly observed early complications at the 1 week and 1 month visits. From 1 month and beyond, all treated eyes showed no obvious bleb at the operation quadrant. CONCLUSIONS: Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.
Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Glaucoma , Síndrome Endotelial Iridocorneana , Trabeculectomia , Humanos , Cirurgia Filtrante/métodos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/cirurgia , Estudos Prospectivos , Vesícula/cirurgia , Agentes Antiglaucoma , Glaucoma/complicações , Glaucoma/cirurgia , Pressão Intraocular , Resultado do Tratamento , Trabeculectomia/métodos , Estudos RetrospectivosRESUMO
Propósito Conocer las cirugías de glaucoma más frecuentes entre los miembros de la Sociedad Española de Glaucoma (SEG).MétodosUna encuesta anónima de 10 preguntas fue enviada a los socios de la SEG en enero, febrero y julio de 2019 para conocer sus preferencias en las cirugías de glaucoma.Variables a estudiar Edad, tipo de glaucoma, tipo de cirugía realizada, estrategia antifibrótica usada o bien implante de las últimas 10 cirugías realizadas desde la recepción de la encuesta. La experiencia del cirujano se muestra según los años de práctica.Resultados Un total de 97 oftalmólogos repartidos por toda la geografía del país respondieron la encuesta, teniendo el 63,4% más de 10 años de experiencia. El glaucoma más frecuente intervenido fue el glaucoma primario de ángulo abierto, representando un 60,6% del total. La cirugía más realizada fue la esclerectomía profunda no perforante (EPNP) con el 37,3% de las cirugías, seguida por el 17,6% de trabeculectomía, 14,1% del microshunt de colágeno (XEN® Allergan Inc., Irvine, CA) y 10,5% de dispositivos de drenaje. Un 21,7% del total fueron reintervenciones y de estas, en el 27,3% se utilizó un dispositivo de drenaje y en el 20,3% trabeculectomía. Un 47,3% de las cirugías fueron combinadas con facoemulsificación. En un 54,8% se usó únicamente mitomicina C (MMC), en un 8,2% de los casos se usó únicamente matriz de colágeno (Ologen®, Aeon Astron Corporation, Taipei, Taiwán) y en un 13,7% la combinación de MMC y matriz de colágeno. La administración de MMC aplicada en esponja se realizó en el 79% de los casos (de estos, a concentraciones de 0,02% en el 99% y al 0,04% en el 1%) y en el 21% de los casos restante mediante inyección subconjuntival (al 0,01% en el 81% y al 0,02% en el 19% restante).Conclusiones A pesar de que el cirujano de glaucoma domina una gran variedad de técnicas quirúrgicas, la EPNP sigue siendo la técnica quirúrgica más realizada en nuestro país (AU)
Purpose To evaluate the spectrum of glaucoma surgery undertaken among members of the Spanish Glaucoma Society (SEG). Methods A 10 question web-based anonymous survey was mailed through the Annals of the Spanish Glaucoma Society to all its members on January, February and July 2019 to determine their preferred surgical approach. Main outcome measures Age, type of Glaucoma, surgery undertaken, type of anti-scarring strategy and prothesis introduced for the last 10 surgeries since the survey was received. The surgeon experience was registered in years of practice. Results A total of 97 SEG members across the country answered the survey. Sixty-two (63.4%) responders had more than 10 years of experience. Primary open angle glaucoma was the most frequent type of glaucoma (60.6%). The most popular surgery was deep-sclerectomy (37.3%) followed by trabeculectomy (17.6%) and the collagen microshunt (XEN® Allergan Inc., Irvine, CA) (14.1%). Glaucoma drainage device (GDD) was used in 10.5% of the cases. Up to 21.7% of surgeries were reinterventions, where GDD was used in 27.3% and trabeculectomy in 20.3% of the cases. Glaucoma surgery was combined with phacoemulsification in 47.3% of the eyes. Mitomycin C (MMC) was used in 54.8% of the cases, collagen matrix (Ologen®, Aeon Astron Corporation, Taipei, Taiwan) was used alone in 8.2% of the cases and in 13.7% combined with MMC. MMC was used in a soaked sponge in 79% of cases (concentrations of 0.02% in 99% and 0.04% in 1%) and in 21% of cases MMC was injected subconjunctivally (concentrations of 0.01% in 81% and 0.02% in 19%) (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Pesquisas sobre Atenção à Saúde , Padrões de Prática Médica/estatística & dados numéricos , Cirurgia Filtrante , Glaucoma/cirurgia , Competência Clínica , Pressão Intraocular , Mitomicina/administração & dosagem , EspanhaRESUMO
PURPOSE: To conduct a narrative review of research articles on the potential anti- and pro-fibrotic mechanisms of noncoding RNAs following glaucoma filtration surgery. METHODS: Keyword searches of PubMed, and Medline databases were conducted for articles discussing post-glaucoma filtration surgeries and noncoding RNA. Additional manual searches of reference lists of primary articles were performed. RESULTS: Fifteen primary research articles were identified. Four of the included papers used microarrays and qRT-PCR to identify up- or down-regulated microRNA (miRNA, miR) profiles and direct further study, with the remainder focusing on miRNAs or long noncoding RNAs (lncRNAs) based on previous work in other organs or disease processes. The results of the reviewed papers identified miR-26a, -29b, -139, -155, and -200a as having anti-fibrotic effects. In contrast, miRs-200b and -216b may play pro-fibrotic roles in filtration surgery fibrosis. lncRNAs including H19, NR003923, and 00028 have demonstrated pro-fibrotic effects. CONCLUSIONS: Noncoding RNAs including miRNAs and lncRNAs are emerging and promising therapeutic targets in the prevention of post-glaucoma filtration surgery fibrosis.
Assuntos
Cirurgia Filtrante , Glaucoma , MicroRNAs , RNA Longo não Codificante , Vesícula , Cicatriz/genética , Fibrose , Cirurgia Filtrante/efeitos adversos , Glaucoma/genética , Glaucoma/cirurgia , Humanos , MicroRNAs/genética , RNA Longo não Codificante/genéticaRESUMO
PURPOSE: Reintervention rate is an important factor impacting on patients, surgeons, and society. To date, only a few studies have focused on this topic. For this reason, a systematic review and meta-analysis was undertaken to assess the reintervention rate after glaucoma filtering surgery. MATERIALS AND METHODS: Prospective studies reporting the reintervention rate after glaucoma filtering surgery and with at least 12 months of follow-up were systematically searched on PubMed, Medline and Embase databases. The primary outcome was the total reintervention rate following surgery. Secondary outcomes were: the rate of manipulation, in-clinic and in-operating room reintervention; the reintervention rate for intraocular pressure (IOP) control and for complications; demographic, clinical and surgical variables associated with reintervention rate. RESULTS: Ninety-three studies with a total of 8345 eyes were eligible. The total reintervention rate was 1.84 (95% CI 1.57-2.13), with a lower rate for Baerveldt (0.53, 95% CI 0.29-0.83) and Preserflo (0.60, 95% CI 0.15-1.29), and a higher rate for Xen (4.26, 95% CI 2.59-6.31). The manipulation rate was 0.99 (95% CI 0.77-1.23), the in-clinic reintervention rate was 0.08 (95% CI 0.05-0.12) and the in-operating room reintervention rate was 0.28 (95% CI 0.22-0.35). The reintervention rate for IOP control was 1.26 (95% CI 1.04-1.51) and the reintervention rate for complications was 0.27 (95% CI 0.21-0.35). CONCLUSIONS: All types of surgery presented a total reintervention rate similar to the overall findings, except studies on Baerveldt and Preserflo Microshunt, with a lower rate, and Xen, with a higher rate. None of the variables evaluated were found to be directly associated with the explored outcomes.
Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Estudos Prospectivos , Resultado do TratamentoRESUMO
PURPOSE: Open-angle glaucoma (OAG), accounting for 90% of all glaucoma cases, is a progressive optic nerve neuropathy. It may lead to irreversible loss of visual field and complete blindness. When conservative treatment becomes insufficient to stop OAG progression, a surgical intervention is considered. Currently, canaloplasty procedure is being introduced instead of conventional trabeculectomy for invasive OAG treatment. The aim of the study is to asses safety and efficacy of canaloplasty. METHODS: This prospective study included 67 eyes that received 360° canaloplasty with placement of a tensioning suture. Primary OAG (n = 35), secondary OAG in pseudoexfoliative syndrome (n = 13), and pigmentary glaucoma (n = 19) patients were included. Control check-ups were conducted pre-operatively and in a 18-month follow-up time. Study endpoints involved reduction in IOP values and in the number of glaucoma medications after the intervention. RESULTS: The intervention led to a significant 38% reduction in IOP value from the preoperative baseline to 18 months after the intervention. The number of medications decreased significantly by 89%. At 18 months postoperative, 79% eyes did not require any glaucoma medications. The incidence of complications after canaloplasty was low, and none of the adverse effects were vision threatening. A surgically-induced astigmatism was the most frequent complication. Pigmentary glaucoma patients were the most beneficial subgroup, with 50% reduction in IOP, the highest success rate, and 98% reduction in the number of medications used. CONCLUSION: This study proved that canaloplasty is an efficient and safe procedure in OAG eyes.
Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Cirurgia Filtrante/métodos , Seguimentos , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Humanos , Pressão Intraocular , Estudos Prospectivos , Resultado do TratamentoRESUMO
Glaucoma, a degenerative disease of the optic nerve, is the leading cause of irreversible blindness worldwide. Currently, there is no curative treatment. The only proven treatment is lowering intraocular pressure (IOP), the most important risk factor. Glaucoma filtration surgery (GFS) can effectively lower IOP. However, approximately 10% of all surgeries fail yearly due to excessive wound healing, leading to fibrosis. GFS animal models are commonly used for the development of novel treatment modalities. The aim of the present review was to provide an overview of available animal models and anti-fibrotic drug candidates. MEDLINE and Embase were systematically searched. Manuscripts until September 1st, 2021 were included. Studies that used animal models of GFS were included in this review. Additionally, the snowball method was used to identify other publications which had not been identified through the systematic search. Two hundred articles were included in this manuscript. Small rodents (e.g. mice and rats) are often used to study the fibrotic response after GFS and to test drug candidates. Due to their larger eyes, rabbits are better suited to develop medical devices. Novel drugs aim to inhibit specific pathways, e.g. through the use of modulators, monoclonal antibodies, aqueous suppressants or gene therapy. Although most newly studied drugs offer a higher safety profile compared to antimetabolites, their efficacy is in most cases lower when compared to MMC. Current literature on animal models and potential drug candidates for GFS were summarized in this review. Future research should focus on refining current animal models (for example through the induction of glaucoma prior to undertaking GFS) and standardizing animal research to ensure a higher reproducibility and reliability across different research groups. Lastly, novel therapies need to be further optimized, e.g. by conducting more research on the dosage, administration route, application frequency, the option of creating combination therapies, or the development of drug delivery systems for sustained release of anti-fibrotic medication.
Assuntos
Cirurgia Filtrante , Glaucoma , Animais , Fibrose , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Pressão Intraocular , Camundongos , Mitomicina , Modelos Animais , Preparações Farmacêuticas , Coelhos , Ratos , Reprodutibilidade dos TestesRESUMO
After a long period of little change, glaucoma surgery has experienced a dramatic rise in the number of possible procedures in the last two decades. Glaucoma filtering surgeries with mitomycin C and glaucoma drainage devices remain the standard of surgical care. Other newer surgeries, some of which are minimally or microinvasive glaucoma surgeries, target existing trabecular outflow, enhance suprachoroidal outflow, create subconjunctival blebs, or reduce aqueous production. Some require the implantation of a device such as the iStent, Hydrus, Ex-PRESS, XEN and PRESERFLO, whilst others do not-Trabectome, Kahook dual blade, Ab interno canaloplasty, gonioscopy-assisted transluminal trabeculotomy, OMNI and excimer laser trabeculotomy. Others are a less destructive variation of an established procedure, such as micropulse transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation and ultrasound cycloplasty. Cataract surgery alone can be a significant glaucoma operation. These older and newer glaucoma surgeries, their mechanism of action, efficacy and complications are the subject of this review.
Assuntos
Cirurgia Filtrante , Implantes para Drenagem de Glaucoma , Glaucoma , Trabeculectomia , Cirurgia Filtrante/métodos , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Trabeculectomia/métodos , Resultado do TratamentoRESUMO
The mutual relationship among medical therapy, ocular surface (OS) and filtration surgery (FS) represents one of the most crucial issues in glaucoma management. As the long-term use of intraocular pressure-lowering medications significantly affect the OS health, patients with an uncontrolled disease frequently undergo glaucoma surgery in less-than-ideal conditions. As we known, OS changes strongly affect the post-operative bleb filtration capability. Therefore, improving the OS conditions before proceeding with FS is needed. Currently, given the rapid diffusion of new surgical procedures, this need is even more perceived. Nevertheless, despite surgeons retain the OS preparation of primary importance, and recognize the OS disease (OSD) as the only modifiable risk factor for filtration failure, there is no agreement on which strategies should be preferred to prepare patients. This is largely due to the lack of validated guidelines, which forces clinicians to adopt personal approaches based on evidence derived from low-quality studies. In this review, we provided an overview of risk factors involved in the FS failure, with particular attention to those depending on OS changes, and how OSD negatively affects the aqueous humor resorption after surgery. Moreover, we reported the most exploited measures to mitigate the OSD before surgery, the possible reasons underlying the absence of shared approaches, and the upcoming area of intervention to preserve the OS health during glaucoma management. Finally, based on the current evidence, we proposed a pre-operative outline reporting the main risk factors that should be considered before surgery, and the therapeutical options available to improve the OS.
