Analysis of surgical treatment on acute angle closure glaucoma with persistent high intraocular pressure (original) (raw)
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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.
Surgical management of closed angle glaucoma: our experience
International Ophthalmology, 1992
In this paper we present our experience of the last three years in the surgical treatment of eyes with closed angle glaucoma. We have performed an extracapsular lens extraction and posterior chamber intraocular lens implantation on 34 eyes of 34 patients. All of them were affected by closed angle glaucoma with variable control after a Yag laser iridotomy: 6 eyes had high I.O.P. notwithstanding maximal therapy, 11 eyes had I.O.P. under control (less than 21 mmHg) without therapy, 9 with I.O.P. controlled with topical therapy, 8 with I.O.P. controlled with maximal therapy (C.A.I. included). The cases with well controlled glaucoma were operated on because of the presence of a more or less significant lens opacities. After a follow-up of up to 40 months (mean = 20.3, range = 1-40), all eyes show satisfactory intraocular pressure and no eye needed a filtering procedure. The results of our studies are as follows (values are mean + SD). In the group of 6 eyes with high I.O.P., the mean pre-operative intraocular pressure was 29.7 + 5.6mmHg and the mean post-operative I.O.P. was 15.1 + 1.4mmHg. The mean reduction was 14.5 + 6.6 mmHg (p < 0.005). In the 28 eyes with pre-operative I.O.P. under control (17.5 _+ 1.6), the mean post-operative I.O.P. was 14.4 + 2.3 mmHg, with a mean reduction of 3.1 + 3.1 mmHg (p < 0.005). Before the E.C.C.E., 11 eyes had I.O.P. less than 21mmHg without anti-glaucoma medication, whereas after the E.C.C.E. 28 eyes did not need such a medication. No significant correlation was found between pre-operative and post-operative extension of peripheral anterior synechiae (when assessable) and post-operative intraocular pressure control. The difference between pre-and post-operative anterior chamber depth measured by ultrasonic biometry was remarkable, i.e. M = 1.93 + 0.36mm and 3.42 + 0.2mm (pre-operative and post-operative, respectively; p < 0.005).
Vojnosanitetski pregled
Background/Aim. Trabeculectomy is a safe procedure which effectively reduces the intraocular pressure (IOP). IOP is the most frequent indicator of success after glaucoma surgery. The aim of this work was to evaluate the long-term pressure control in primary open-angle glaucoma (POAG) and in pseudoexfoliative glaucoma (XFG) after primary trabeculectomy without the use of mitomycin-C (MMC), 3 to 5 years after trabeculectomy. Methods. This study involved a retrospective evaluation of 332 consecutive patients (352 eyes), 174 patients (188 eyes) with POAG (mean age of 64.0 ? 8.6 years) and 158 patients (164 eyes) with XFG (mean age of 70.7 ? 8.9 years) who underwent primary trabeculectomy between January 2007 and December 2009 at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. A successful control of IOP was defined as achieving IOP ? 21 mmHg without medication (complete success), or with a single topical medication (qualified success). Results. According to the type ...
Managing Primary Angle Closure Glaucoma – The Role of Lens Extraction in this Era
The Open Ophthalmology Journal, 2016
Trabeculectomy has been the gold standard in reducing intraocular pressure (IOP) in glaucoma patients, no matter it is angle closure or open angle glaucoma. However in primary angle closure glaucoma, no matter the lens is cataractous or not, it is likely to be pathological, this thicker than usual lens, with or without a more anterior position, is often regarded as a strong contributing factor to angle closure. Lens extraction, no matter it is cataractous or clear, can theoretically eliminate this anatomical predisposing factor of angle closure, and thus IOP can be reduced. Based on recent results of a number of clinical trials, lens extraction alone or in combination with other IOP-lowering surgeries, may therefore play a more important role in the treating primary angle closure glaucoma. In cases when greater IOP-lowering effect is needed or if drug dependency has to be minimized, combined procedures, such as phacotrabeculectomy, can be considered, but the surgical risk can be hig...
Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction
Indian Journal of Ophthalmology, 2019
The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/ surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in
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...
Journal of Evolution of Medical and Dental Sciences
Purpose analysis of safety and efficacy of Non-Penetrating Glaucoma Surgery (NPGS) for control and maintenance of intraocular pressure as compared to penetrating glaucoma surgery in Primary Open Angle Glaucoma (POAG) patients. DESIGN A hospital based randomized study. Participants 70, eyes of 70 POAG patients, 35 of which underwent NPGS and the remaining underwent Trabeculectomy surgery. MATERIALS NPGS and trabeculectomy was performed by standard surgical procedures after recording routine preoperative data. Patients were divided into 2 groups depending on the procedure they underwent. All patients were followed up after 1 week, 1 month, 3 months, 6 months and 12 months. Post-operative success was defined as IOP <21 mmHg at 1 month in absence of additional antiglaucoma medication or other treatment. RESULTS A significant reduction in intraocular pressure was observed post-surgery in both groups, changing from a preoperative mean of 31.09±7.37 mmHg and 29.26±7.10 mmHg to a postoperative mean of 15±3.06 mmHg and 14.85±4.22 mmHg respectively (P<0.001) at 12 months for trabeculectomy patients. It was seen that there was approximately constant reduction in all ranges of IOP, while for NPGS patient's best control in IOP was seen between at preoperative IOP between 21 to 30 mmHg. There was a significant difference in complications between two groups and the NPGS group had significantly less number of complications than the trabeculectomy group (p<0.05). However, the trabeculectomy group had a significantly lesser failure rate as compared to the NPGS group (p<0.05). CONCLUSION Trabeculectomy though more effective for higher preoperative IOP, range is associated with greater risk of complications and hence for IOP range between 21 to 30 mmHg, NPGS would be the surgery of choice due to its equivalent efficacy and much greater safety standards.
IP innovative publication pvt. ltd, 2019
Introduction: This study is conducted to evaluate the prevalence and progress after medical and surgical treatment of primary open angle and angle closure glaucoma patients. Materials and Methods: A study conducted at Ophthalmology department of RNT medical college and MB Hospital, Udaipur during the period of 1 year and it included a total of 60 patients of glaucoma. Inclusion criteria: patients above 40 years fulfilling ISGEO criteria of Glaucoma diagnosis. Exclusion criteria: Patients below 40 years and patients having congenital or secondary glaucoma. Results: The prevalence of primary open angle and angle closure glaucoma was 1.37% and 0.42% with overall prevalence of glaucoma in our study was 1.78%. In primary angle closure 18 eyes were given surgical and no medical treatment. In primary open angle glaucoma 14.28% patients were on monodrug therapy, 19.04% were on double drug therapy, 47.62% were on triple drug therapy, 19.04% were on quadruple drug therapy. In primary angle closure glaucoma 27.77% patients had undergone Iridotomy, 27.77% had Trabeculectomy, 22.24% had prophylactic Iridotomy, 11.11% had Cataract surgery and 11.11% had trabeculectomy with cataract surgery. Conclusion: It is concluded that primary open angle glaucoma is more prevalent then angle closure glaucoma. Surgical treatment is preferred for Primary angle closure glaucoma and no patients having primary open angle glaucoma were undergone surgery.
Cataract surgery in eyes with filtered primary angle closure glaucoma
Journal of ophthalmic & vision research, 2013
To evaluate the effect of cataract surgery on intraocular pressure (IOP) in filtered eyes with primary angle closure glaucoma (PACG). In this prospective interventional case series, 37 previously filtered eyes from 37 PACG patients with mean age of 62.1±10.4 years were consecutively enrolled. All patients had visually significant cataracts and phacoemulsification was performed at least 12 months after trabeculectomy. Visual acuity, IOP and the number of glaucoma medications were recorded preoperatively, and 1, 3, 6 and 12 months after surgery. Anterior chamber (AC) depth was measured preoperatively and 3 months after cataract surgery with A-scan ultrasonography. The main outcome measure was IOP at 12 months. IOP was decreased significantly from 18.16±5.91 mmHg at baseline to 15.37±2.90 mmHg at final follow-up (P<0.01). The mean number of glaucoma medications was significantly decreased from 1.81±0.24 to 0.86±1.00 (P=0.001) at 1 year postoperatively. At final follow up, 36 (97.2%)...