Changes in Flow Density Measured Using Optical Coherence Tomography Angiography after iStent Insertion in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma

Alnawaiseh, Maged; Müller, Viktor; Lahme, Larissa; Merté, Ralph-Laurent; Eter, Nicole

doi:10.1155/2018/2890357

Cited by 30 publications

(26 citation statements)

References 23 publications

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“…Furthermore, Alnawaiseh et al [ 31 ] demonstrated the improvement of the flow density of the macular and ONH after cataract surgery with iStent. In the iStent group, the mean IOP was 18.2 ± 3.3 mmHg prior to surgery and 13.2 ± 2.3 at follow-up.…”

Section: Discussionmentioning

confidence: 99%

Peripapillary Vessel Density Reversal after Trabeculectomy in Glaucoma

Lee

Cho

et al. 2018

Journal of Ophthalmology

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Purpose To evaluate the microvascular changes at the peripapillary area and optic disc in glaucomatous eyes after IOP lowering by trabeculectomy using OCT angiography. Methods 25 patients with primary open-angle glaucoma (POAG) who underwent trabeculectomy by a single surgeon were evaluated. Using optical coherence tomography angiography, vessel density was evaluated within the whole image, peripapillary, nasal region, and temporal region. Peripapillary vessel density was measured preoperative, 1 week, 1 month, and 3 months postoperatively in POAG patients. Reversal of vessel density was calculated for all analyzed areas. Results The intraocular pressure (IOP) decreased from 30.92 ± 6.32 mmHg (range, 18–44) to 12.64 ± 3.35 mmHg (range, 8–22) at 3-month postoperatively. Compared with the preoperative baseline value, whole vessel density, peripapillary vessel density (PvD), and PvD in nasal region and temporal region were significantly increased at 3-month postoperatively. The magnitude of the vessel density reversal was significantly associated with higher preoperative IOP and greater IOP reduction. Conclusions A significant increase in the peripapillary vessel density was demonstrated after trabeculectomy using OCT angiography. The reversal of peripapillary vessel density was associated with higher preoperative IOP and greater IOP reduction. Our postoperative results suggest that the ocular perfusion impairment by high intraocular pressure can be improved by IOP reduction, and the reversal of microvasculature may contribute to the rate of glaucoma progression.

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Section: Discussionmentioning

confidence: 99%

Peripapillary Vessel Density Reversal after Trabeculectomy in Glaucoma

Lee

Cho

et al. 2018

Journal of Ophthalmology

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“…Others have shown medical or surgical IOP reduction to have an impact on FD (Holló ; Alnawaiseh et al. ). Likewise, an influence of the systemic circulation on FD has been observed (Alnawaiseh et al.…”

Section: Introductionmentioning

confidence: 99%

Diurnal variations in flow density measured using optical coherence tomography angiography and the impact of heart rate, mean arterial pressure and intraocular pressure on flow density in primary open‐angle glaucoma patients

Müller¹,

Storp²,

Kerschke³

et al. 2019

Acta Ophthalmologica

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Purpose: To determine the diurnal variations in peripapillary and macular flow density (FD), as measured using optical coherence tomography angiography (OCTA) and to elaborate on the relationship between diurnal FD, circulatory parameters and intraocular pressure (IOP) variations in primary open-angle glaucoma (POAG). Methods: Forty eyes of 40 POAG patients were drawn into this cross-sectional study. The retinal microvasculature of the macula (superficial and deep layers) and optic nerve [radial peripapillary capillary (RPC)] was examined by OCTA (AngioVue â , Optovue). Optical coherence tomography angiography (OCTA) measurements were conducted at 08:00, 11:00, 15:00 and 20:00 over the course of two consecutive days. Intraocular pressure (IOP) and circulatory parameters were assessed accordingly. Diurnal variations in FD were analysed using linear mixed models. Results: While superficial macular FD and RPC FD revealed not to be affected by diurnal variations (p = 0.492, p = 0.319), FD in the deep layer of the macula increased throughout the day (p < 0.001). Superficial macular FD was influenced significantly by mean arterial pressure (MAP) (p = 0.006) and heart rate (HR) (p = 0.033), whereas FD in the RPC layer was significantly affected by HR (p = 0.010). No statistically significant effect of IOP fluctuations on FD was observed. Conclusion: This study shows diurnal fluctuations of deep macular FD measured by OCTA and outlines the relationship between FD and hemodynamic parameters (MAP/HR) in POAG patients.Key words: blood pressure -diurnal variations -flow density -heart rate -intraocular pressure -open-angle glaucoma -optical coherence tomography angiography †These authors contributed equally to this study.

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“…This might be further evidence of a synergistic relationship between iSI and phacoemulsification as suggested by several emerging studies. 20,26,27,28,29 IOP outcomes were lower for patients receiving the single procedure at 1 week, 4 weeks, 6 months, and 18 months relative to those receiving iSI. This is best explained by the fact that no patients receiving phacoemulsification alone had POAG and therefore had lower IOPs at baseline.…”

Section: Discussionmentioning

confidence: 90%

Combined iStent® Inject Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma

Salby¹,

Skalicky²

2020

OPTH

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Purpose: This retrospective audit aimed to evaluate the impact of combined iStent ® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields. Patients and Methods: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification. Results: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (-16%; p = 0.012; n = 35) and 12 months (-29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (-8%; p < 0.001; n = 57) and 6 months (-16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups. Conclusion: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

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Changes in Flow Density Measured Using Optical Coherence Tomography Angiography after iStent Insertion in Combination with Phacoemulsification in Patients with Open-Angle Glaucoma

Cited by 30 publications

References 23 publications

Peripapillary Vessel Density Reversal after Trabeculectomy in Glaucoma

Peripapillary Vessel Density Reversal after Trabeculectomy in Glaucoma

Diurnal variations in flow density measured using optical coherence tomography angiography and the impact of heart rate, mean arterial pressure and intraocular pressure on flow density in primary open‐angle glaucoma patients

<p>Combined iStent<sup>®</sup> <em>Inject</em> Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma</p>

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