Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

Esfandiari, Hamed; Hassanpour, Kiana; Yaseri, Mehdi; Loewen, Nils A.

doi:10.12688/f1000research.13756.1

Cited by 7 publications

(5 citation statements)

References 35 publications

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“…To our knowledge, there are no published reports comparing postoperative steroids following goniotomy procedures. A study evaluating postoperative use of pilocarpine following standalone Trabectome surgery (NeoMedix, Tustin, California, United States of America) found no significant difference in IOP at any postoperative visit with or without pilocarpine, 8 suggesting that pilocarpine might not be superior in IOP-lowering after angle surgery. Our study supports the Trabectome study in that we found early postoperative pilocarpine use did not lead to fewer IOP-lowering drops long-term, although IOP was significantly lowered.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction

Birnbaum,

Wakil,

et al. 2024

Journal of Current Glaucoma Practice

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A bstract Aim To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). Materials and methods This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens—treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. Results There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 ( p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) ( p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Conclusion Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. Clinical significance It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE. How to cite this article Birnbaum F, Wakil S, Vu DM, et al. Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction. J Curr Glaucoma Pract 2023;17(4):169–174.

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Section: Discussionmentioning

confidence: 99%

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction

Birnbaum,

Wakil,

et al. 2024

Journal of Current Glaucoma Practice

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“…For most surgeons, this includes intracameral and/or topical antibiotic therapy, a topical steroid taper, and possibly a topical nonsteroidal anti-inflammatory eye drop. There is no clear evidence that procedures to excise, ablate, open, or stent the trabecular meshwork do better with postoperative miotics [61], and it is not our practice to use them. Following ECP, we often lengthen the duration of the steroid taper to 2 or more months, tailored to the individual's anterior chamber inflammation.…”

Section: Postoperative Managementmentioning

confidence: 99%

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

Tassel

Chen

2019

Curr Ophthalmol Rep

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Purpose of Review In this article, we review the current options for microinvasive glaucoma surgery (MIGS) combined with cataract extraction in the USA and the efficacy of the various approaches. Recent Findings MIGS is a rapidly growing area of research and clinical interest. Available surgeries aim to reduce intraocular pressure by improving aqueous outflow through the trabecular or subconjunctival pathways or by reducing aqueous production. Summary Multiple approaches to MIGS are utilized in clinical practice. On average, these surgeries are safe and modestly effective in reducing intraocular pressure. Future research will demonstrate which surgical approaches are most efficacious, whether and how to combine MIGS, and the role of MIGS in improving patient quality of life.

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“…In AIT, pilocarpine was used four times a day for one month followed by three times a day for a second month, a practice only recently found to be unnecessary. 20 Glaucoma medications were stopped at the day of surgery and restarted postoperatively as needed.…”

Section: Surgical Techniquementioning

confidence: 99%

Two-Year Data Comparison of Ab Interno Trabeculectomy and Trabecular Bypass Stenting Using Exact Matching

Esfandiari¹,

Taubenslag²,

Shah³

et al. 2018

Preprint

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Purpose: To create a highly balanced comparison of ab interno trabeculectomy (Trabectome, AIT) and trabecular bypass stenting (iStent, TBS).Setting: Eye and Ear Institute, Pittsburgh, Ross Eye Institute, Buffalo, and Glaucoma Associates of Texas, Dallas, USA.Design: Retrospective Exact Matching analysis.Methods: AIT and TBS patients were included from three large glaucoma practices. The primary outcome measure was the unmedicated IOP ≤ 21 mmHg at 2-year follow-up visit. A secondary measure was unmedicated IOP reduction ≥ 20% at 2 years. Patients were matched by baseline IOP, the number of glaucoma medications and glaucoma type using Exact Matching and by age using Nearest Neighbor matching. Patients without a close match were excluded. All surgeries were combined with phacoemulsification. Results: 154 AIT and 110 TBS eyes were analyzed. 48 AIT patients were exactly matched to 48 TBS patients. Both groups had a baseline IOP of 15.3±3.1 mmHg. At 24 months, the mean IOP was 13.9±3.3 for AIT versus 16.8±2.8 mmHg for TBS (p=0.04), while the number of medications was 0.7±1.0 for AIT versus 1.7±1.2 for TBS (p=0.04). The proportion of subjects achieving IOP ≤ 21 mmHg without medications at 24 months was 53% in AIT versus 16.6% in TBS (P < 0.05). At 24-month follow up 17.6% of patients in AIT had ≥ 20% IOP reduction without medication versus no patient in TBS. Conclusions: An Exact Matching comparison of AIT and TBS demonstrated greater IOP reduction with fewer medications in AIT.

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Extended pharmacological miosis is superfluous after glaucoma angle surgery: A retrospective study

Cited by 7 publications

References 35 publications

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

Two-Year Data Comparison of Ab Interno Trabeculectomy and Trabecular Bypass Stenting Using Exact Matching

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