Outcomes of 360° suture trabeculotomy with deep sclerectomy combined with cataract surgery for primary open angle glaucoma and coexisting cataract (original) (raw)
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Clinical ophthalmology (Auckland, N.Z.), 2015
In this paper, we describe 360° suture trabeculotomy (360°LOT) ab interno and the short-term course in patients who underwent this procedure. We prospectively studied 12 patients (12 eyes) with open-angle glaucoma who underwent 360°LOT ab interno at the Sato Eye Clinic between February and July 2014. The surgical procedure involved making a 1.7 mm temporal corneal incision, exposing an approximately 15° opening in the inner wall of Schlemm's canal (nasal side) using a Trabectome with a gonioscope, and inserting a 5-0 nylon suture rounded at the tip into Schlemm's canal opened via the anterior chamber. The suture was then threaded around Schlemm's canal, and the tip of the suture that emerged on the other side was then advanced through the opening to make a circumferential incision. Intraocular pressure (IOP), number of anti-glaucoma medications used, complications, and the surgery completion rate were prospectively studied. Mean IOP, which was 19.4 mmHg at baseline, show...
Clinical Ophthalmology
To report the outcome and complications of a combined surgical technique of modified deep sclerectomy and trabeculectomy (mDST) for glaucoma. Patients and Methods: Retrospective study of 44 eyes of 43 patients with open and closed angle glaucoma who underwent mDST. Outcome measures were: Surgical Success with 3 criteria-(i) criterion 1 = intraocular pressure (IOP) ≤21 mmHg or reduced by ≥20% of preoperative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months; (ii) criterion 2 = IOP ≤18 mmHg or reduced by ≥30% of pre-operative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months and (iii) criterion 3 = IOP ≤15 mmHg or reduced by ≥40% of preoperative IOP or IOP ≥6 mmHg on 2 consecutive time points after 3 months; IOP Reduction; Use of Anti-glaucoma Medication; Complications; Visual Acuity and Postoperative Interventions. Results: Median follow-up was 40 months (range 24-77 months). At the final follow-up visit, the mean postoperative IOP was 11.5 ± 4.7 mmHg (p<0.0001). Mean number of antiglaucoma medications decreased from 2.45 ± 1.21 to 0.54 ± 0.95 (p<0.0001). Surgical success in terms of IOP reduction was 50%; 43.2%; 36.4% for the 3 criteria respectively (complete success) and 70.5%; 56.8%; 47.7% for the 3 criteria respectively (qualified success). The complications noted were shallow/flat anterior chamber in 2 (4.54%), hyphema & bleb leak in 3 (6.81%), aqueous misdirection in 1 (2.27%), hypotonic maculopathy in 2 (4.45%) and hypotony requiring intervention in 6 (13.63%) eyes. Conclusion: Combined mDST was found to be an effective surgical procedure in reducing IOP. It was associated with complications commonly encountered in glaucoma filtering surgery. The use of intra-scleral space maintainer may help lower the risk of flat or shallow anterior chamber during the early postoperative period.
IOSR Journals , 2019
Purpose: TO STUDY AND COMPARE THE LONG TERM EFFICACY (INTRA OCULAR PRESSURE REDUCTION) WITH PENETRATING (TRABECULECTOMY) VS NON PENETRATING (DEEP SCLERECTOMY) GLAUCOMA SURGERY Methods: In this study, 35 eyes underwent trabeculectomy (group A)and 35 eyes underwent deep sclerectomy (group B). Applanation tonometry was performed at 1st day, 1 week, 1 month, 3 month, 6 month, 1 year and 7 years postoperatively. The variable included was the intra ocular pressure using goldmann applanation tonometer. Results: Overall, the mean preoperative IOP in group A patients was 28.2 +-2.70 mmHG and in group B it was 26.2+-5.70 mmHG. The mean post operative IOP on day 1 was 9.1 +-2.12mmHG and 8.2+-1.76 mmHG in group A and group B respectively. A reduction of 68.2% in group A and a reduction of 69.6% In group B was observed. Reduction in the mean IOP at 1 year and 7 year was 42.4 % and 38.6 % in group A and 30.2 % and 24.2 % in group B respectively. Out of 35 patients in group A, 3 patients were prescribed one group of anti glaucoma medication post operatively due to marginally high intra ocular pressure Out of 35 patients in group B, 7 patients had to undergo trabeculectomy with the application of MMC due to persistently high intra ocular pressure The mean reduction reduced over time in both the groups compared, which was observed more in the group B patients. Conclusion : Our study observed that although both the penetrating and non-penetrating surgeries significantly lowered the IOP in patients with primary open angle glaucoma, the patients who underwent non-penetrating surgery (deep sclerectomy) provided comparable reduction in the IOP with fewer complications.
IOSR Journals , 2019
Purpose: TO STUDY AND COMPARE THE INTRA-OPERATIVE AND LONG TERM POST-OPERATIVE COMPLICATIONS WITH PENETRATING (TRABECULECTOMY) VS NON PENETRATING (DEEP SCLERECTOMY) GLAUCOMA SURGERY Methods:In this study, 35 eyes underwent trabeculectomy (group A)and 35 eyes underwent deep sclerectomy (group B). The unaided visual acuity, best corrected visual acuity, slit lamp examination to assess the anterior chamber depth, hyphaema, hypotony, blebitis, choroidal detachment, filtering bleb morphology and functioning, cystoid macular oedema, endophthalmitis etc. gonioscopy was performed, fundus evaluation using 78D/90D/20D indirect ophthalmoscopy , visual field examination, Applanation tonometry to evaluate the intra ocular pressure was performed at 1st day, 1 week, 1 month, 3 month, 6 month, 1 year and 7 year postoperatively Results: The complications were divided into intra-operative, early postoperative and late postoperative time. 2 patients from group A suffered intraoperative hyphaema whereas none encountered the same intraoperatively in group B. In the early postoperative period, the most common complication seen with group A patients was shallow anterior chamber and hyphaema and was seen in 25% of the patients whereas the commonest early postoperative complication among group B patients was seen to be severe anterior chamber inflammation which was seen in 15% of them. The late onset complications included loss of >1 line vision on snellen's chartin 25% of group A patients, followed by occurence of cataract in about 20% of them, 3 patients presented with marginal increase in the IOP who were later started on one group anti glaucoma medication. 2 patients from group B had persistently elevated intra ocular pressure for which Nd Yag assisted goniopuncture was performed. Loss of >= 1 line vision on snellen's chart was also noted in 1 patient. Other late onset complications included blebitis, severly vascularised bleb, failure of the filtering bleb and hypotony maculopathy, 7 patients from group B had to undergo conventional trabeculectomy with application of MMC due to very high intra ocular pressure. Conclusion : Our study observed that although both the penetrating and non-penetrating surgeries significantly lowered the IOP in patients with primary open angle glaucoma, the patients who underwent standard penetrating surgery (trabeculectomy), i.e. group A, encountered significantly more number of complications as compared to the patients falling under group B.
Surgical Outcome of Combined Trabeculotomy and Cataract Surgery
Journal of Glaucoma, 2001
To evaluate the efficacy of combined trabeculotomy and cataract surgery in lowering intraocular pressure and improving visual acuity in adults with primary open-angle glaucoma. Patients and Methods: A consecutive series of 141 eyes with primary open-angle glaucoma or ocular hypertension was prospectively recruited. One hundred five eyes with visual field defects were treated by trabeculotomy combined with phacoemulsification and intraocular lens implantation (TPI group), and 36 eyes without visual field defects underwent cataract surgery (PI group). Patients in the TPI and PI groups were followed for more than 6 months after surgery (578.1 ± 35.8 days and 616.0 ± 58.5 days, respectively). The intraocular pressure reductions after surgery were compared between the groups to evaluate the effect of combined trabeculotomy and cataract surgery. Visual acuity and the complication rate in the two groups were secondary outcomes. The success probabilities of both groups were evaluated by Kaplan-Meier life table analysis with log rank test. Results: A significant intraocular pressure reduction was observed in the TPI and PI groups up to 3 years and up to 1 year and 6 months after surgery, respectively; the magnitude of the reduction was significantly larger in the TPI group up to 3 years after surgery. The success probabilities of TPI group for intraocular pressure control under 21, 17, and 15 mm Hg were 95.8%, 58.7%, and 30.0%, respectively, 1 year after surgery, and 84.9%, 29.5%, and 13.5%, respectively, 3 years after surgery; the success probabilities were significantly higher than those of the PI group. Of 105 eyes, 104 (99.0%) had visual acuity equal to or better than the baseline acuity 3 months after combined trabeculotomy and cataract surgery. Conclusion: Combined trabeculotomy and cataract surgery normalizes intraocular pressure and improves visual acuity in adults with glaucoma and coexisting cataract.
Journal of cataract and refractive surgery, 2008
Purpose: To provide efficacy and safety of surgery with Trabectome combined with phacoemulsification in primary open-angle glaucoma. Methods: In this interventional case series, 30 consecutive eyes that have had combined phacoemulsification with Trabectome were included. The main outcome measures were change in intraocular pressure (IOP), glaucoma medication use, and the rate of complications. Results: Mean IOP was 18.25 ± 3.28 mmHg preoperatively which decreased to 13.50 ± 2.53 mmHg at 1 year. (P < 0.05). There was a corresponding drop in glaucoma medications from 2.52 ± 0.60 at baseline to 1.40 ± 0.53 at 12 months (P < 0.01). The preoperative BCVA (Log Mar) was improved from 0.68 ± 0.26 pre-operatively to 0.26 ± 0.19, 0.18 ± 0.13, 0.17 ± 0.13, 0.11 ± 0.12, at 5 days and 2, 6, and 12 months, respectively (P < 0.01). The only frequent complication was transient blood reflux resolving spontaneously within a few days. No visionthreatening complication occurred. Conclusion: Combined phacoemulsification and Trabectome significantly lowered IOP and medication use, with early visual rehabilitation in the majority of patients.
Modified deep sclerectomy for the surgical treatment of glaucoma
Journal of Ophthalmic and Vision Research, 2019
Purpose: To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma. Methods: This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6-15 mmHg and/or a 30% reduction in IOP. Results: All groups showed significant decrease in IOP and number of medications (both Ps < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001). Conclusion: The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.