Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma

Pantalon, Anca; Feraru, Crenguța; Târcoveanu, Filip; Chiseliţă, D

doi:10.2147/opth.s308228

Cited by 12 publications

(7 citation statements)

References 43 publications

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“…Its diagnosis and treatment are challenging. Although surgery is the standard therapy for congenital glaucoma, antiglaucoma medications have a minor and temporary preoperative role in controlling IOP and clearing corneal edema [16,[21][22][23]. Goniotomy and trabeculotomy are effective in treating early congenital glaucoma with clear corneas; however, primary trabeculotomy-trabeculectomy is optimal for advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Hassan Elabd,

Elsayed,

Fekry Elgazzar

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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Background: The primary mode of therapy in children with primary congenital glaucoma (PCG) and mild or no corneal edema is goniotomy, which has a high success rate. However, in developing countries, the diagnosis of PCG is usually delayed, and corneal cloudiness interferes with goniotomy. Therefore, trabeculotomy may be the best choice in such eyes. We compared the short-term efficacy and safety of primary combined trabeculotomy–trabeculectomy (primary CTT) with that of non-penetrating deep sclerectomy (NPDS) in managing PCG. Methods: This prospective, randomized, comparative study included patients with PCG referred to Al-Azhar University Hospitals within a 1-year period. Eyes were randomly allocated to one of two groups: eyes in NPDS group underwent NPDS, and those in primary CTT group underwent primary CTT. Baseline and frequent postoperative assessments of intraocular pressure (IOP), cup-to-disc ratio (C/D ratio), corneal diameter, and axial length were performed for up to 6 months. The success rates were recorded in both groups. Results: Forty eyes of 26 patients were included, with 20 eyes allocated to each group. The mean (standard deviation) age of all patients was 12.9 (9.5) months, with comparable ages and sex ratios between groups (both P > 0.05). Both groups demonstrated a significant reduction in IOP and C/D ratio at each postoperative visit compared to the baseline visit (all P < 0.001), with no significant difference detected between the groups (all P > 0.05), except for a significantly lower IOP in NPDS group at 1 month (P < 0.05). The corneal diameter and axial length were comparable between groups at baseline and remained unchanged at all postoperative visits (all P > 0.05). The groups had comparable success rates (P > 0.05). No serious complications were detected. Conclusions: CTT and NPDS both yielded reasonable IOP control and reversal of cupping in eyes with PCG. We observed equal effectiveness of the surgical procedures without major safety concerns. Further large-scale clinical trials with longer follow-up periods are needed to verify our preliminary findings.

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Section: Discussionmentioning

confidence: 99%

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Hassan Elabd,

Elsayed,

Fekry Elgazzar

et al. 2024

Med Hypothesis Discov Innov Ophthalmol

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“…The complication rates of about 25% are reported by all authors. The value is relatively high, but the complications predominantly include hyphema, shallow anterior chamber, and hypotony [20‒23]. Based on the previous findings, it safe to conclude that HFDS can easily find its place in the glaucoma surgical treatment as a very quick and simple method.…”

Section: Discussionmentioning

confidence: 99%

High-Frequency Deep Sclerotomy as Adjunctive Therapy in Open-Angle Glaucoma Patients

Kontic¹,

Todorović

Zecevic³

et al. 2022

Ophthalmic Res

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Introduction: Glaucoma is a chronic, progressive disease of the optic nerve that can cause vision loss and blindness. High-frequency deep sclerotomy (HFDS) is a novel ab interno procedure used to lower intraocular pressure (IOP). This study aims at examining hypotensive effects of HFDS in patients with medically uncontrolled primary open-angle glaucoma (POAG). Methods: 23 patients (23 eyes) participated in this study. They were all affected by primary open-angle glaucoma and used maximum prescribed medical therapy. It is important to note that the target intraocular pressure (IOP) was not detected in any study participant. The target intraocular pressure is the highest IOP value at which no new damages of the optic nerve occur. The procedure was performed with a custom-made, high-frequency dissection probe by applying bipolar current of 500 kHz. Six pockets (1mm deep, 0.3mm high, and 6mm wide) were made ab interno in nasal sclera (through trabecular meshwork and Schlemm's canal). Tobramycin/dexamethasone and pilocarpine eye drops were administered postoperatively for a month. Results: The mean value of the base intraocular pressure had been 25.6mmHg before the procedure. Significant complications were not recorded either during the surgery or in a post-operative follow-up period. The average IOP for our patients reduced by 8.6mmHG (33.6%) after a year. The mean value of the instilled anti-glaucoma eye drops had been 2.78 (SD=0.45) before the HFDS and 0.61 (SD=1.04) at the end of the research. The target IOP was not achieved in five cases (21.7% of our sample). Discussion/Conclusion: This study presents the data on our first surgical experience with high-frequency deep sclerotomy that was conducted on 23 patients who had medically-uncontrolled, primary, open-angle glaucoma. The results indicate that HFDS is safe and efficient in reducing IOP.

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“…Ultrasound cycloplasty is another treatment option that has been applied in the clinic in recent years. The aim of the latter is to achieve the best therapeutic outcome by reducing the IOP slowly to the maximum extent ( 36 – 38 ). It is difficult to effectively improve the preoperative axial length and visual field MS, but it can prompt doctors and patients that the operation effect may be poor to allow them to choose other treatment methods or make psychological preparation for the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Predicting a reduction in intraocular pressure in glaucoma patients in the early period after a trabeculectomy: Development and assessment of a new predictive nomogram

Li¹,

Tan²,

Chen³

2022

Front. Ophthalmol.

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PurposeTo identify the factors associated with a reduction in intraocular pressure (IOP) in the early postoperative period after a trabeculectomy and to develop a predictive nomogram to guide clinical care.MethodsThis study included clinical data on 588 glaucoma patients (N = 588 eyes) who underwent a trabeculectomy in our hospital between January 2016 and December 2021. There were 412 eyes in a training cohort and 176 eyes in a validation cohort. We used logistic regression analysis to evaluate whether these factors were related to a decrease in IOP in the early period postsurgery and established a predictive model by combining features selected in a univariate analysis. We used external validation for evaluation. The standard for IOP reduction was that the IOP decreased to the normal range (10−21 mmHg) 1 month after the trabeculectomy.ResultsAmong the patients in the training cohort, 82.8% met the standard for IOP lowering. There were 11 meaningful differences among the enrolled predictors, but the logistic regression analysis only showed significant differences with anterior chamber angle closed, age, preoperative IOP, axial length, and visual field mean sensitivity (MS). The C-index of the model was 0.910 (95% confidence interval [CI]: 0.869-0.951). The C-index was 0.956 for external validation of the model.ConclusionThis new nomogram can be used to predict whether the IOP will reach the standard in the early stages after a trabeculectomy. The anterior chamber angle closed, age, preoperative IOP, axial length, and visual field MS are independent risk factors.

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Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma

Cited by 12 publications

References 43 publications

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

Non-penetrating deep sclerectomy versus combined trabeculotomy–trabeculectomy in primary congenital glaucoma

High-Frequency Deep Sclerotomy as Adjunctive Therapy in Open-Angle Glaucoma Patients

Predicting a reduction in intraocular pressure in glaucoma patients in the early period after a trabeculectomy: Development and assessment of a new predictive nomogram

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