Nonpenetrating Glaucoma Surgery: Meta-analysis of Recent Results

Hondur, Ahmet; Önol, Merih; Hasanreısoğlu, Berati

doi:10.1097/ijg.0b013e31814b98f7

Cited by 77 publications

(71 citation statements)

References 56 publications

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“…The postoperative IOP in the 10-0 Prolene group was similar to the mean IOP of a recent meta-analysis of viscocanalostomy (16.4 mm Hg; range 13-20 mm Hg), 25 and possibly less than one might expect from the additional step of the tensioning suture in canaloplasty. However, the rate of goniopuncture in the reported studies was between 9 and 56%.…”

Section: Discussionmentioning

confidence: 57%

Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Grieshaber

Pienaar

Olivier

et al. 2010

Eye

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Purpose To compare the safety and efficacy of two polypropylene (Prolene) sutures for tensioning of the inner wall of Schlemm's canal (SC) in black African patients with primary open-angle glaucoma (POAG) undergoing canaloplasty. Methods In a prospective randomised trial of 90 patients, canaloplasty was performed with a flexible microcatheter (iTrack-250A) and sodium hyaluronidate 1.4% (Healon GV). After complete circumferential dilatation of the SC, a Prolene suture, either 6-0 Prolene (group 1) or 10-0 Prolene (group 2), was retracted through the SC and tightened leaving tension on the canal and trabecular meshwork. Nd:YAG laser goniopuncture was not performed postoperatively. Results The mean preoperative intraocular pressure (IOP) was 42.7 mm Hg±12.5 (SD) in group 1 and 45.0 mm Hg ± 12.1 (SD) in group 2 (P ¼ 0.70). The mean postoperative IOP without medications was 18.4 mm Hg ± 7.1 (SD) in group 1 and 16.4 mm Hg ± 6.6 (SD) in group 2 at 1 month (P ¼ 0.10), 19.2 mm Hg±6.4 (SD) in group 1 and 16.4 mm Hg±4.9 (SD) at 15 months (P ¼ 0.04). Pressures equal or less than 21, 18, and 16 mm Hg without medications (complete success) at 12 months were 51.0% (95% confidence interval (CI) 0.35-0.73), 34.1% (95% CI 0.21-0.56), and 21.2% (95% CI 0.11-0.42) in group 1, and 76.9% (95% CI 0.62-0.96), 68.8% (95% CI 0.54-0.89), and 53.6% (95% CI 0.38-0.76) in group 2, respectively. In the Cox regression analysis, IOP o18 mm Hg without medications depended significantly on the type of Prolene (hazard ratio (HR) 2.60, 95% CI 1.24-5.46, P ¼ 0.01) and age (HR 1.3, 95% CI 1.03-1.86, P ¼ 0.03), but not on preoperative IOP (HR 1.01, 95% CI 0.99-1.04, P ¼ 0.16) and gender (HR 0.67, 95% CI 0.34-1.33, P ¼ 0.26). No filtering bleb was observed. Intra-and postoperative complications were similarly rare in the two groups and included partial 'cheese-wiring' (2), Descemet's rupture (2), and hyphaema (3). Conclusions In this clinical trial, IOP reduction was substantial in canaloplasty and slightly greater in combination with 10-0 Prolene than 6-0 Prolene sutures at an equally low complication rate. Younger age, but not the level of IOP at surgery, had a positive effect on the amount of IOP reduction, thus suggesting that an early surgical intervention to re-establish physiological outflow offers the best prognosis.

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Section: Discussionmentioning

confidence: 57%

Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Grieshaber

Pienaar

Olivier

et al. 2010

Eye

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“…(15) . Hondur et al found a success rate of 67.1% for NPDS with antimetabolite (16) . Our study showed a success rate (IOP < 21 mmHg without medication) slightly above those found in the literature (70.76%), but within the limits for the 95% CI found by Cheng et al (15) .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

Guedes

Chaoubah

2012

Arq. Bras. Oftalmol.

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RESUMO Objetivo: A esclerectomia profunda não penetrante (EPNP) é uma opção viável para o tratamento cirúrgico do glaucoma de ângulo aberto. O objetivo deste estudo é avaliar a relação custo-efetividade da EPNP e compará-la com terapia clínica máxima (TCM) em ABSTRACTPurpose: Nonpenetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of openangle glaucoma. Our aim is to assess the cost eff ectiveness of NPDS and to compare it to maximum medical treatment in a 5year followup. Methods: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Costeffectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental costeffectiveness ratio (ICER) was calculated. Results: Direct cost for each percentage of IOP reduction in 5 years (costeffectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better costeffectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. Conclusions: Despite some limitations, NPDS was both less costly and more effective than maximum medical therapy. From the Brazilian public health perspective, it was the most costeffective treatment option when compared to maximum medical the rapy (FCTD and prostaglandin).Keywords: Glaucoma/economy; Filtering surgery/economy; Health care costs; Cost eff ec tiveness evaluation Cost-effeCtiveness Comparison between non-penetrating deep sClereCtomy and maximum-tolerated mediCal therapy for glauComa within the brazilian national health system (sus)

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“…Além disso, o procedimento permite a manutenção da AV no pós-operatório (10) e mostrou-se eficaz na redução pressórica em pacientes portadores de GPAA em vários estudos (11) . A EP porém não é um procedimento desprovido de complicações.…”

Section: Discussionunclassified

“…No presente estudo foi utilizada uma PIO de 21mmhg para as taxas sucesso, seguindo a tendência da maioria dos trabalhos sobre o assunto. Os resultados encontrados pelos autores estão de acordo com os principais estudos encontrados na literatura (11,(21)(22)(23)(24)(25)(26) . Para uma PIO média pré-operatória de 20,50 +/-6,40 mmhg, encontramos após 12 meses de acompanhamento, uma PIO média pós-operatória de 14,00 +/-3,90 mmhg.…”

Section: Discussionunclassified

Estudo pressórico da esclerectomia profunda com implante de SkGel no glaucoma primário de ângulo aberto

Almodin¹,

Picosse²,

Cvintal³

et al. 2010

Rev. bras.oftalmol.

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RESUMOObjetivo: Avaliar a eficácia, em termos de redução da pressão intraocular (PIO) da esclerectomia profunda não penetrante (EP) com uso de implante de SkGel. Métodos: Trata-se de um estudo observacional, retrospectivo através da revisão de prontuários do Instituto de Oftalmologia Tadeu Cvintal. Foram avaliados 45 olhos de 37 pacientes submetidos à EP com implante de Skgel nos últimos 10 anos por glaucoma primário de ângulo aberto (GPAA). O estudo analisou resultados pressóricos após 12 meses de acompanhamento em um período de 10 anos, de 1997-2007. Todos os pacientes apresentavam PIO não controlada com medicação hipotensora ocular máxima tolerada ou PIO controlada, porém com dano glaucomatoso em progressão. Resultados: A população global estudada foi composta de 37 pacientes, sendo 23 (62,16%) mulheres e 14 (37,83%) homens, com um total de 45 olhos. A média de idade da população em estudo foi de 57,4 +/-14,5 anos. A PIO média pré-operatória foi de 20,50 +/-6,40 mmhg, após 12 meses de acompanhamento, a PIO média pós-operatória foi de 14,00 +/-3,90 mmhg. A redução média da PIO foi de -6,50 mmhg +/-7,20 mmhg. As taxas de sucesso absoluto (PIO<21mmhg sem medicação hipotensora) e relativo (PIO<21mmhg com medicação hipotensora) observadas foram de 71,10% e de 26,70% respectivamente. Conclusão: A EP não penetrante com uso de implante mostrou-se no presente estudo ser uma ótima alternativa aos procedimentos cirúrgicos antiglaucomatosos em pacientes com GPAA.Descritores : Pressão intraocular; Glaucoma/cirurgia; Implantes para drenagem de glaucoma; Esclerotomia/métodos; Glaucoma de ângulo aberto

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Nonpenetrating Glaucoma Surgery: Meta-analysis of Recent Results

Abstract: Nonpenetrating glaucoma surgery seems to provide IOP reduction into the high teens. Its potential to achieve lower target IOPs seems to be low. Longer-term studies, with data related to glaucoma severity and proper target IOPs are required.

Cited by 77 publications

References 56 publications

Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Comparing two tensioning suture sizes for 360° viscocanalostomy (canaloplasty): a randomised controlled trial

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

Estudo pressórico da esclerectomia profunda com implante de SkGel no glaucoma primário de ângulo aberto

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