Intracameral Triamcinolone Acetonide in Glaucoma Surgery: A Prospective Randomized Controlled Trial (original) (raw)
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PLOS ONE, 2022
This unicentric randomized clinical trial was designed to compare the surgical outcomes of mitomycin C-enhanced trabeculectomy (MMC-TRAB) with and without subtenon triamcinolone acetonide (TAAC) injection in patients with non-inflammatory glaucomas. This trial is registered at the Brazilian Registry of Clinical Trials (ReBEC) under the register number RBR-53f8nh. Consecutive non-inflammatory glaucoma patients requiring surgical intervention were randomized into two groups. In the control group, eyes underwent standard MMC-TRAB, while in the intervention group, besides the standard MMC-TRAB, these eyes also received a subtenon TAAC injection (4mg) close to the bleb site at the end of the surgery. The main outcomes of the study were surgical success rates, intraocular pressure (IOP) and number of medications at all timepoints. Success was defined as IOP � 15 mmHg and subdivided in complete or qualified according to the need of medication. A total of 75 eyes of 63 different patients were included (intervention group = 39 eyes; control group = 36 eyes). There was no difference between groups at baseline (p>0.11). Multivariable regression analysis indicated that IOP levels were significantly lower in the intervention group at 18 and 24 months of follow-up when number of medications was considered as a covariate (P<0.001). Complete success rates were higher in the intervention group at 06 (90.9% vs 68.7%; p = 0.03), 12 (87.2% vs 66.7%; p = 0.02) and 18 months (87.2% vs 66.7%; p = 0.02). Additionally, although success rates at 24 months were higher in the intervention group (82.0% vs 66.7%; p = 0.09), this difference did not reach statistical significance. Qualified success rates did not significantly differ between groups at all timepoints. In conclusion, this study found significantly lower IOPs levels at 18 and 24 months of follow-up and higher complete success rates until 18 months of follow-up, with the use of subtenon TAAC as an adjuvant to standard MMC-TRABs in non-inflammatory glaucoma patients.
2017
Objective The aim of this study was to evaluate the efficacy and safety of preoperative posterior subtenon injection of triamcinolone acetonide (PSTA) in noninfectious uveitic patients with secondary glaucoma undergoing primary trabeculectomy with mitomycin C. Design This was a retrospective study. Patients and methods We reviewed the medical records of 10 noninfectious uveitic patients, who had received a single preoperative PSTA 40 mg/1 mL, with secondary glaucoma undergoing primary trabeculectomy with mitomycin C. We collected data before and after surgery on intraocular pressure (IOP), anterior chamber (AC) cells, best-corrected visual acuity (BCVA), morphologic characteristics of the filtering bleb and complications. Results The mean time between injection and surgery was 7.8±3.88 days. Postoperative IOP level was significantly lower than preoperative level (31.3±11.44 mmHg) at all visits (P<0.02). Antiglaucoma medications were decreased from preoperative (4.9±0.88) to 12-mo...
Mosaed S, Dustin L, Minckler DS .Comparative outcomes between newer and older surgeries for glaucoma
Transactions of the American Ophthalmological Society
To compare outcomes across Trabectome, iScience (canaloplasty), trabeculectomy, and aqueous shunts regarding intraocular pressure (IOP), adjunctive medications, and complications after glaucoma-only and combined glaucoma-phacoemulsification surgeries for open-angle glaucomas. A literature review compares success rates, complications, efficacy, and limitations of traditional and novel glaucoma surgical procedures. Trabectome and canaloplasty provide modest IOP reduction with minimal intraoperative or postoperative complications. Results of Baerveldt glaucoma implant IOP reduction are comparable to trabeculectomy, but typically this shunt requires more postoperative IOP-lowering medication to achieve a success rate comparable to trabeculectomy. Trabeculectomy is still the most effective IOP-lowering procedure performed today but continues to have the highest serious complication rates. Trabectome and canaloplasty are reasonable surgical therapy choices for patients in which IOPs in th...
British Journal of Ophthalmology, 2004
Aims: To compare trabeculectomy with viscocanalostomy for the control of intraocular pressure (IOP) in open angle glaucoma (OAG) uncontrolled by medical therapy. Methods: 48 patients (50 eyes) with uncontrolled OAG were randomised to either trabeculectomy (25 eyes) or a viscocanalostomy technique (25 eyes). Preoperatively, eyes were graded in terms of risk factors for drainage failure. Those undergoing trabeculectomy were given intraoperative antimetabolites (5-fluorouracil 25 mg/ml (5-FU), mitomycin C (MMC) 0.2 mg/ml and 0.4 mg/ml) according to a standard protocol. Antimetabolites were not used intraoperatively in eyes undergoing viscocanalostomy, but they were randomised to the use of viscoelastic (Healonid GV) for intraoperative intracanalicular injection. Results: There were no significant differences between the groups in age, sex, type of OAG, preoperative medications, risk factors for drainage failure, and preoperative IOP. Mean follow up was 19 months (range 6-24 months). It was 12 months or longer in all eyes, except one lost to follow up at 6 months. At 12 months, complete success (IOP <21 mm Hg without antiglaucoma medications) was seen in all eyes undergoing trabeculectomy (100%), but in only 64% of eyes undergoing viscocanalostomy (p<0.001). The mean IOP was lower at 12 months (p<0.001) with trabeculectomy and the number of eyes with IOPs of 15 mm Hg or less was greater (p<0.05). The mean IOP at 12 months was lower in eyes that had undergone viscocanalostomy using intraoperative intracanalicular Healonid GV injection compared to those where only balanced saline solution had been used (p<0.01). However, in terms of complete success there was no difference between the viscocanalostomy groups (p<0.1). With the exception of measurements at 1 week, visual recovery (logMAR acuity) was similar and laser flare and cell values showed little differences between the groups. Corneal topography and keratometry at 12 months were little different from preoperative values. Postoperative interventions (subconjunctival 5-FU and needling procedures) were similar between the groups. Transient complications such as early bleb leak and hyphaema were more common in the trabeculectomy group (p<0.05). Postoperative cataract formation was more common after trabeculectomy (p<0.05). Conclusions: IOP control appears to be better with trabeculectomy. Viscocanalostomy is associated with fewer postoperative complications, although significant complications permanently impairing vision did not occur with either technique.
Focus on triamcinolone acetonide as an adjunct to glaucoma filtration surgery
Medical Hypotheses, 2007
Glaucoma is one of the most common causes of irreversible blindness worldwide. Despite continued advances in medical and laser therapy, incisional surgery still appears to be an important and for many cases the only option by which intraocular pressure is controlled. Unlike many other types of surgery in which complete healing of tissue would be a desirable outcome, glaucoma surgery seeks to achieve incomplete healing to allow aqueous humor to escape the eye. Pharmacologic modulation of wound healing is a hot topic in glaucoma filtration surgery. Although routine antifibrotic medications are associated with good results in modulating wound healing in glaucoma surgery, they carry with them the possibility for significant morbidity due to the adverse effects of treatment. Challenge continues to be to find a safe and effective agent for this purpose. Because of beneficial effects of triamcinolone acetonide in some conditions which are associated with secondary glaucoma and also potential effects of this agent in modulating wound healing process, we propose it as a useful adjunct to glaucoma filtration surgery. This approach may allow modulation of wound healing with less of the toxicity associated with commonly used antifibrotics (5-FU and mitomycin C).
Trials, 2015
Glaucoma is the leading cause of irreversible blindness in the world. Estimated to affect 60 million people worldwide, this figure is expected to rise to 80 million by 2020. Untreated, glaucoma leads to visual decay and eventually to blindness, and can significantly reduce quality of life. First-line treatment in patients with primary open-angle glaucoma and exfoliative glaucoma is topical medical therapy with ocular hypotensives as eye drops. However, eye drops have several disadvantages including cost, possible local and systemic side effects, and adherence and perseverance issues. Randomised controlled trials have demonstrated that selective laser trabeculoplasty is equally as effective in lowering intraocular pressure as eye drops. However, the impact of these two treatment modalities from the patient and economic perspectives has not been adequately determined. Thus, it remains unclear whether topical medical therapy or selective laser trabeculoplasty should be recommended as first-line treatment for glaucoma. This protocol describes an international, multi-centre, randomised controlled trial to determine the optimum first-line therapy for people with primary open-angle glaucoma and exfoliative glaucoma. This study will compare the effect of selective laser trabeculoplasty and topical medication with respect to patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; generic and glaucoma-specific quality of life. The trial will also provide a detailed cost-effectiveness analysis and compare the clinical effectiveness with respect to the degree of intraocular pressure lowering and rates of treatment failure. Research coordinators in each centre will identify and recruit previously untreated patients with primary open-angle glaucoma and exfoliative glaucoma. Those who meet the eligibility criteria will be invited to enter a randomised controlled trial with either selective laser trabeculoplasty or topical ocular hypotensive therapy, according to a stepped regimen. Outcome assessment will be measured at 6 weeks and at 6, 12, and 24 months post-treatment. Regular clinic follow-ups will continue as clinically indicated between study outcome visits. The Glaucoma Initial Treatment Study is the first multi-centred RCT to determine the optimum first-line therapy for people with glaucoma. Our trial will have an unprecedented capacity to meaningfully transform the treatment and management of glaucoma in Australia and overseas. ACTRN12611000720910 ; Date registered: 11 July 2011.
Effects of Argon Laser Trabeculoplasty in the Early Manifest Glaucoma Trial
American Journal of Ophthalmology, 2011
Purpose: To analyze reduction of intraocular pressure (IOP) by argon laser trabeculoplasty (ALT) in the Early Manifest Glaucoma Trial, and factors influencing the effect of such treatment. Design: Cohort study based on 127 patients from the treatment group of the Early Manifest Glaucoma Trial (EMGT), a randomized clinical trial. Methods: Patients randomized to the treatment arm of the EMGT received a standard treatment protocol (topical betaxolol hydrochloride followed by 360°ALT) and were then followed prospectively at 3-month intervals for up to 8 years. One eye per patient was included in the analyses. We investigated the relationship between pre-ALT IOP and subsequent IOP reduction, and other factors that might have influenced the effect of ALT, including stage of the disease, trabecular pigmentation, presence of exfoliation syndrome, and treating surgeon. Results: The mean pre-ALT IOP after betaxolol was 18.1 mmHg ± 3.9 (SD), and the mean short-term IOP reduction 3 months after ALT was 2.8 mmHg ± 3.9 (SD) (12.6% ± 20.5 SD). Pre-ALT IOP level strongly affected IOP reduction (p < 0.001); each 3-mmHg higher pre-ALT IOP value was associated with an additional mean IOP reduction of approximately 2 mmHg. The treating surgeons also had a significant impact on IOP reduction (p = 0.001), with mean values ranging from 5.8 to-1.3 mmHg. Conclusions: In this cohort, which included many patients with low IOP levels, pre-ALT IOP markedly influenced the IOP reduction induced by ALT, seen as a much larger decrease in eyes with higher pre-ALT pressures. The treating surgeon also had a significant impact on ALT outcome.
American Journal of Ophthalmology
To evaluate the prophylactic efficacy of selective laser trabeculoplasty for preventing an increase in intraocular pressure (IOP) after intravitreal triamcinolone acetonide injection.Prospective, comparative, interventional case series.We studied 31 eyes with a baseline IOP of 21 mm Hg or more of 31 patients for which intravitreal triamcinolone acetonide injection was planned for diabetic macular edema. The patients were divided into 2 groups, a study group and control group. The study group comprised 15 eyes of 15 patients that underwent selective laser trabeculoplasty a mean of 8.3 ± 4.1 days before intravitreal triamcinolone acetonide injection. The control group comprised 16 eyes of 16 patients who underwent only intravitreal triamcinolone acetonide injection. Main outcomes measures were mean IOP and number of patients requiring antiglaucomatous therapy.Mean baseline IOP was 21.6 ± 0.9 mm Hg in the study group and 21.5 ± 0.8 mm Hg in the control group (P = .98). Mean IOP at 1 day after injection was 17.0 ± 2.0 mm Hg in the study group and 19.5 ± 4.3 mm Hg in the control group (P = .23). Mean IOP at 1 week after injection was 16.9 ± 1.7 mm Hg and 18.4 ± 4.0 mm Hg, respectively (P = .49); mean IOP at 1 month after injection was 16.4 ± 1.5 mm Hg and 20.8 ± 5.6 mm Hg, respectively (P = .003); mean IOP at 3 months after injection was 15.8 ± 2.5 mm Hg and 18.3 ± 5.5 mm Hg, respectively (P = .01); and mean IOP at 6 months after injection was 15.7 ± 1.4 mm Hg and 17.1 ± 1.5 mm Hg, respectively (P = .03). The number of patients requiring antiglaucomatous therapy during follow-up was 0 of 15 eyes in the study group and 8 of 16 eyes in the control group (P = .001).The IOP elevation after intravitreal triamcinolone acetonide injection may be prevented by performing selective laser trabeculoplasty before intravitreal triamcinolone acetonide injection, especially in cases with a baseline IOP of 21 mm Hg or more.
International Ophthalmology, 2021
Purpose To study midterm efficacy and safety of combined Visco-Trab operation for management of advanced glaucoma. Methods 168 eyes of 148 patients with advanced glaucoma had Visco-Trab operation (a merge of both viscocanalostomy and trabeculectomy operations). Mean follow-up was 29.1 ± 22.2 months. Criteria of success were intraocular pressure (IOP) of 14 mmHg or less with or without glaucoma medications, with no devastating complications, loss of light perception, or additional glaucoma surgery. Results IOP, number of glaucoma drops, and visual field mean deviation were significantly reduced (11.9 ± 5.6 mmHg, 0.7 ± 1.2, and 14.2 ± 6.3 dB, compared to preoperative values of 24.4 ± 9.9 mmHg, 2.8 ± 1.4, and 17.3 ± 6.3 dB, respectively). Success was reported in 136 of 168 eyes (81%) without (100 eyes, 59.5%) or with (36 eyes, 21.5%) glaucoma medications. A functioning bleb was seen in 2/3rd of eyes; diffuse (59 eyes, 35%) and thin ischemic (54 eyes, 32%). Predictors for failure to achieve the target IOP included previous ocular (p = 0.01) or glaucoma (p = 0.04) surgery, number of preoperative glaucoma medications (p = 0.029), and severity of glaucoma (p = 0.058).