Changing Trends in Glaucoma Surgery Over the Past 5 Years in China

Qiao, Chunyan; Zhang, Hui; Cao, Kai; Tian, Jingkui; Chung, Tham Yih; Shan, Jing; Han, Ying; Wang, Ke

doi:10.1097/ijg.0000000000002004

Cited by 13 publications

(9 citation statements)

References 32 publications

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“…A systematic analysis revealed that the overall prevalence of primary open-angle glaucoma (POAG) in China was 1.02% in 2015 [ 2 ]. Glaucoma filtering surgery is one of the most frequently performed anti-glaucoma procedures in China [ 3 ]. However, bleb failure due to episcleral fibrosis or subconjunctival scarring has always been a challenge, even with the introduction of releasable sutures and the combined use of antimetabolites.…”

Section: Introductionmentioning

confidence: 99%

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

et al. 2023

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Background To evaluate the safety and efficacy of gonioscopy-assisted transluminal trabeculotomy (GATT) in treating patients with open-angle glaucoma (OAG) who had failed prior incisional glaucoma surgery. Methods A consecutive case series of OAG patients aged ≥ 18 who underwent GATT with previous failed glaucoma incision surgery was retrospectively analyzed. Main outcome measures included intraocular pressure (IOP), the number of glaucoma medications, surgical success rate, and occurrence of complications. Success was defined as an IOP of ≤ 21 mmHg and a reduction of IOP by 20% or more from baseline with (qualified success) or without (complete success) glaucoma medications. For eyes with preoperative IOP of < 21 mmHg on 3 or 4 glaucoma medications, postoperative IOP of ≤ 18 mmHg without any glaucoma medications was also defined as complete success. Results Forty-four eyes of 35 patients (21 with juvenile-onset open-angle glaucoma and 14 with adult-onset primary open-angle glaucoma) with a median age of 38 years were included in this study. The proportion of eyes with 1 prior incisional glaucoma surgery was 79.5%, and the others had 2 prior surgeries. IOP decreased from 27.4 ± 8.8 mm Hg on 3.6 ± 0.7 medications preoperatively to 15.3 ± 2.7 mm Hg on 0.5 ± 0.9 medications at the 24-month visit (P < 0.001). The mean IOP and the number of glaucoma medications at each follow-up visit were lower than the baseline (all P < 0.001). At 24 months postoperatively, 82.1% of the eyes had IOP ≤ 18 mmHg (versus 15.9% preoperatively, P < 0.001), 56.4% reached IOP ≤ 15 mmHg (versus 4.6% preoperatively, P < 0.001), and 15.4% achieved IOP ≤ 12 mmHg (compared to none preoperatively, P = 0.009). While 95.5% of eyes took 3 or more medications preoperatively, 66.7% did not take glaucoma medication 24 months after GATT. Thirty-four (77.3%) eyes achieved IOP reduction greater than 20% on fewer medications. The complete and qualified success rates were 60.9% and 84.1%, respectively. No vision-threatening complications occurred. Conclusions GATT was safe and effective in treating refractory OAG patients who failed prior incisional glaucoma surgery.

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Section: Introductionmentioning

confidence: 99%

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

et al. 2023

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“…Trabeculectomy (Trab) remains the gold standard for glaucoma surgery [8]. However, due to the risk of potential complications, there has been a substantial decrease in Trab during the past 5 years in China [9]. Nonpenetrating deep sclerectomy (NPDS) is an alternative filtering surgery, which achieves IOP reduction by increasing aqueous outflow through a thin trabeculo-Descemet window (TDW) into a surgically created scleral lake, without penetrating the anterior chamber [10].…”

Section: Introductionmentioning

confidence: 99%

CO2 Laser-Assisted Sclerectomy Surgery Alone or Combined with Phacoemulsification in Primary Open-Angle Glaucoma: Comparison of 1-Year Outcomes

Chen

Huang

et al. 2022

Ophthalmol Ther

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Introduction:To compare 1-year outcomes of CO 2 laser-assisted sclerectomy surgery (CLASS) alone or combined with phacoemulsification (CLASS ? Phaco) in eyes with primary openangle glaucoma (POAG). Methods: This was a prospective, comparative, case series study. A total of 46 eyes with POAG underwent CLASS or CLASS ? Phaco were followed up for 1 year. The primary outcomes included changes in intraocular pressure (IOP), medication and best corrected visual acuity (BCVA). The secondary outcomes were success rate, functional bleb, postoperative laser intervention and complications. Results: CLASS alone resulted in a greater IOP reduction compared with CLASS ? Phaco. BCVA improved remarkably in CLASS ? Phaco group, but there was no difference in BCVA before and after CLASS. The number of antiglaucoma medications significantly decreased at 12 months postoperatively in both groups. Functional blebs were more commonly seen in the CLASS than combination group. The overall success rate was higher in the CLASS than CLASS ? Phaco group at 1 year after surgery. The incidence of peripheral anterior synechiae (PAS) in CLASS ? Phaco group was significantly lower than that of CLASS alone. Conclusion: CLASS alone achieved a greater IOP reduction, more common functional bleb formation and a higher success rate compared to CLASS combined with Phaco, while combination surgery yielded a better BCVA improvement and a lower PAS incidence than CLASS alone. Both surgical strategies have favorable safety and efficacy among POAG patients. Combined surgery could be a viable option for patients with co-existing POAG and cataract.

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“…In recent years, phacoemulsification cataract extraction with intraocular lens (CE + IOL) implantation combined with goniosynechialysis (CEIOL + GSL) has become a first-line surgical treatment for PAC, PACG, and AAC. 8,9 With the increasing volume of CE surgery in PACD, more cases of zonulopathy have been identified during surgery. Our previous study reported that 46.2% of subjects with angle closure glaucoma (ACG) presented with zonulopathy, including zonular laxity and localized zonular dehiscence.…”

mentioning

confidence: 99%

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confidence: 99%

Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease

Zhang

et al. 2023

Journal of Glaucoma

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Précis: The proportion, clinical characteristics, and risk factors of zonulopathy in primary angle closure disease (PACD) were analyzed. Zonulopathy is an underrecognized common finding in PACD, especially in patients with acute angle closure (AAC).Purpose: To examine the proportion and risk factors associated with intraoperative zonulopathy in PACD.Patients and Methods: This is a retrospective analysis of 88 consecutive patients with PACD who underwent bilateral cataract extraction at Beijing Tongren Hospital from August 1, 2020 to August 1, 2022. Zonulopathy was diagnosed based on intraoperative findings including the presence of a lens equator, radial folds of the anterior capsule while making capsulorhexis, and other signs of the unstable capsular bag. The subjects were grouped based on their PACD subtype diagnoses: AAC, primary angle closure glaucoma (PACG), primary angle closure (PAC), or primary angle closure suspect (PACS). Multivariate logistic regression was performed to identify risk factors associated with zonulopathy. The proportion and the risk factors of zonulopathy were estimated in patients with PACD and in PACD subtypes.Results: Of 88 patients with PACD (67.3 ± 6.9 y old, 19 males and 69 females), the overall proportion of zonulopathy was 45.5% of patients (40/88) and 30.1% of eyes (53/176). Among the PACD subtypes, the proportion of zonulopathy was highest (69.0%) in AAC, followed by 39.1% in PACG, and 15.3% in PAC and PACS combined. AAC was an independent risk factor associated with zonulopathy (P = 0.015, AAC vs PACG, PAC, and PACS combined; odds ratio: 0.340, CI: 0.142 -0.814). Shallower anterior chamber depth (P = 0.031) and greater lens thickness (P = 0.036), but not laser iridotomy, were associated with an increased proportion of zonulopathy.Conclusions: Zonulopathy is common in PACD, especially in patients with AAC. Shallow anterior chamber depth and thick lens thickness were associated with an increased proportion of zonulopathy.

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Changing Trends in Glaucoma Surgery Over the Past 5 Years in China

Cited by 13 publications

References 32 publications

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

Gonioscopy-assisted transluminal trabeculotomy for open-angle glaucoma with failed incisional glaucoma surgery: two-year results

CO2 Laser-Assisted Sclerectomy Surgery Alone or Combined with Phacoemulsification in Primary Open-Angle Glaucoma: Comparison of 1-Year Outcomes

Zonulopathy Identified During Cataract Extraction in Patients With Primary Angle Closure Disease

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