|Year : 2020 | Volume
| Issue : 4 | Page : 329-331
Vijayalakshmi A Senthilkumar
Glaucoma Consultant, Aravind Eye Hospital and Postgraduate, Institute of Ophthalmology, Madurai, Tamil Nadu, India
|Date of Submission||31-Mar-2020|
|Date of Acceptance||07-Aug-2020|
|Date of Web Publication||16-Dec-2020|
Dr. Vijayalakshmi A Senthilkumar
Glaucoma Consultant, Aravind Eye Hospital and Postgraduate, Institute of Ophthalmology, Anna Nagar, Madurai - 625 020, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Senthilkumar VA. Journal Review. TNOA J Ophthalmic Sci Res 2020;58:329-31
| Deep Sclerectomy versus Subscleral Trabeculectomy in Glaucomatous Eyes with Advanced Visual Field Loss|| |
Elewa LS, Hamid MA. Deep sclerectomy versus subscleral trabeculectomy in glaucomatous eyes with advanced visual field loss. J Egypt Ophthalmol Soc 2014;107:277-82.
Purpose: The aim of the study was to determine the efficacy and safety of deep sclerectomy (DS) compared with subscleral trabeculectomy (SST) in patients with medically uncontrolled primary open-angle glaucoma (POAG) and advanced visual field (VF) loss. Methodology: The study was designed as a prospective, interventional, comparative trial. Forty eyes of thirty patients with medically uncontrolled POAG with advanced field loss underwent either DS or SST under topical anesthesia. Preoperative assessment included best-corrected visual acuity (BCVA), anterior segment slit-lamp biomicroscopy, gonioscopy, applanation tonometry, VF testing using HFA central 24°-2 and 10°-2 threshold test, and fundus examination including optic nerve head evaluation. The main outcome measures were BCVA, intraocular pressure (IOP), VF, lens status, and postoperative complications. The follow-up period was 24 months. Results: Preoperatively, VF was constricted to less than central 10°, the mean deviation was worse than −12 dB, cup–disc ratio was >0.7, and neural rim thinness was found in all eyes. The preoperative IOP was 28.2 ± 2.5 (range 28–35 mmHg) and 27.8 ± 4.2 mmHg (range 24–36 mmHg) in Groups I and II, respectively. The postoperative IOP was 17 ± 5.5 (range 12–20 mmHg) (P = 0.0066) and 18.2 ± 2.2 mmHg (range 12–22 mmHg) (P = 0.0077) at 24 months in Groups I and II, respectively. Complete success rate was 60 and 65%, and the qualitative success was 95 and 85% in Groups I and II, respectively. Reported complications were hyphema (two eyes) and anterior uveitis (three eyes) in Group II and self-limited shallow choroidal detachment (two eyes in Group I and three eyes in Group II). Only one eye in Group II developed more VF defects, and cortical cataract progressed in two eyes in Group II.
The study concluded that DS could be a valuable alternative to SST, especially in eyes with medically uncontrolled POAG and advanced field loss. The two major advantages of DS over trabeculectomy are the slow decrease in IOP during the entire surgical procedure, which prevents wipeout/snuff-out phenomenon and hypotony-related complications, and the nonpenetration of the anterior chamber with avoidance of iridectomy, reducing the postoperative inflammatory reaction.
| Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients|| |
1. Zaarour K, Abdelmassih Y, Arej N, Cherfan G, Tomey KF, Khoueir Z. Outcomes of micropulse transscleral cyclophotocoagulation in uncontrolled glaucoma patients. J Glaucoma 2019;28:270-5.
Purpose: This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. Methodology: Patients with moderate-to-advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems Iridex Cyclo G6 Laser Systems, Mountain View, CA). Follow-up examinations took place on a regular basis until 15 months postoperatively. Results: Seventy-five eyes of 69 patients (53.6% of male patients) were included in the study. Their mean age was 55.5 ± 22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. The mean prelaser IOP was 26.0 ± 7.91 mmHg and reduced significantly to 13.8 ± 5.6 mmHg (44.0% reduction, P < 0.001) at week 1, and to 18.0 ± 7.7, 18.4 ± 7.1, 16.7 ± 6.2, 15.1 ± 4.1, 15.7 ± 5.32, and 14.8 ± 5.50 mmHg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma medication decreased statistically significantly up to 12 months of follow-up (P = 0.008) and that of oral acetazolamide tablets decreased statistically significantly up to 15 months (P < 0.001). Success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely.
MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.
| Prevalence of Depression and Anxiety among Participants with Glaucoma in a Population-Based Cohort Study: The Gutenberg Health Study|| |
2. Rezapour J, Nickels S, Schuster AK, Michal M, Münzel T, Wild PS, et al. Prevalence of depression and anxiety among participants with glaucoma in a population-based cohort study: The Gutenberg Health Study. BMC Ophthalmol 2018;18:157.
Purpose: The purpose of this study was to investigate the prevalence of depression and anxiety among patients with self-reported glaucoma and the association between self-reported glaucoma and depression and anxiety in a European cohort. Methodology: A study sample of 14,657 participants aged 35–74 years was investigated in a population-based cohort study. All participants reported the presence or absence of glaucoma. Ophthalmological examinations were carried out in all participants, and demographic and disease-related information was obtained by an interview. Depression was assessed with the Patient Health Questionnaire-9 and generalized anxiety was assessed with the two screening items (Generalized Anxiety Disorder [GAD]-2) of the short form of the GAD-7 Scale. The prevalence of depression and generalized anxiety was investigated in the participants with and without self-reported glaucoma. Logistic regression analyses with depression and anxiety as dependent variables and self-reported glaucoma as an independent variable were conducted and adjusted for sociodemographic factors, systemic comorbidities (arterial hypertension, myocardial infarction, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and cancer), ocular diseases (cataract, macular degeneration, corneal diseases, and diabetic retinopathy), visual acuity, intraocular pressure, antiglaucoma eye drops (sympathomimetics, parasympathomimetics, carbonic anhydrase inhibitors, beta-blockers, and prostaglandins), and general health status. Results: Two hundred and ninety-three participants (49.5% of females) reported having glaucoma. The prevalence of depression among the participants with and without self-reported glaucoma was 6.6% (95% confidence interval [CI]: 4.1–10.3) and 7.7% (95% CI: 7.3–8.2), respectively, and for anxiety, it was 5.3% (95% CI: 3.1–8.7) and 6.6% (95% CI: 6.2–7.1), respectively. Glaucoma was not associated with depression (odds ratio: 1.10, 95% CI: 0.50–2.38, P = 0.80) or anxiety (odds ratio: 1.48, 95% CI: 0.63–3.30, P = 0.35) after adjustment for sociodemographic factors, ocular/systemic diseases, ocular parameters, antiglaucoma drugs, and general health status. A restriction to self-reported glaucoma cases either taking topical antiglaucoma medications or having a history of glaucoma surgery did not alter the result.
This is the first study analyzing both depression and anxiety among glaucoma patients in a European cohort. Participants with and without self-reported glaucoma had a similar prevalence of depression and anxiety. The self-reported glaucoma was not associated with depression or anxiety. A lack of a burden of depressive symptoms may result from recruitment from a population-based sample as compared to previous study groups predominantly recruited from tertiary care hospitals.
| Surgical Outcomes of a New Low-Cost Nonvalved Glaucoma Drainage Device in Refractory Glaucoma: Results at 1 Year|| |
3. Pathak Ray V, Rao DP. Surgical outcomes of a new low-cost nonvalved glaucoma drainage device in refractory glaucoma: Results at 1 year. J Glaucoma 2018;27:433-9.
Purpose: The purpose of this study was to report the early outcomes in terms of efficacy and safety of a new, low-cost nonvalved drainage device (Aurolab aqueous drainage implant [AADI]) in the management of refractory glaucoma in the Indian population. Methodology: This is a retrospective review of consecutive patients older than 12 years, who underwent glaucoma drainage device (GDD) surgery using AADI, by a single fellowship-trained surgeon, between January 2014 and December 2016, who had at least 3 months of documented postoperative follow-up. The outcome measures were intraocular pressure (IOP) primarily and number of antiglaucoma medications (AGM) secondarily. Complete success was defined as IOP ≥5 mmHg and ≤21 mmHg or reduction of IOP by ≥20% from baseline without AGM; qualified success was defined as achieving these values with AGM. Failure was defined as inability to meet IOP criteria, loss of perception of light, explantation, or any additional glaucoma surgery. Results: A total of 54 eyes of 51 patients were included in the study. The mean follow-up was 12.1 ± 6.3 months. The IOP and number of AGM required were statistically significantly lower at every visit postoperatively (P < 0.001). The median LogMAR best-corrected visual acuity remained unchanged (P = 0.5). Complications occurred in 22 patients (40.7%). Complete success was seen in 66.6%; the overall success rate was 92.6%.
New nonvalved GDD (AADI) surgery is effective in reducing IOP and the need for AGM with a safety profile similar to published reports of prevailing GDDs. It thus has the ability to breach the cost barrier in low- to middle-income countries; further follow-up is required to determine sustainability over time.
| Outcomes of Trabeculectomy Augmented with Subconjunctival and Subscleral Ologen Implantation in Primary Advanced Glaucoma|| |
4. Angmo D, Wadhwani M, Upadhyay AD, Temkar S, Dada T. Outcomes of trabeculectomy augmented with subconjunctival and subscleral ologen implantation in primary advanced glaucoma. J Glaucoma 2017;26:8-14.
Purpose: The purpose of this study was to evaluate the efficacy and safety of trabeculectomy with combined subconjunctival and subscleral ologen implant in eyes with advanced glaucomatous optic neuropathy. Methodology: This is a retrospective, noncomparative case series. Twenty-seven eyes of 23 patients with advanced primary glaucoma who underwent fornix-based trabeculectomy with insertion of ologen both subsclerally and subconjunctivally along with low-dose mitomycin-C (0.1 mg/mL × 1 min) were evaluated. Data recorded included a complete history, demographic profile, and ophthalmic examination including gonioscopy and visual fields. Any complications or secondary procedures performed after trabeculectomy were recorded. Complete success was defined as intraocular pressure (IOP) ≤15 mmHg without ocular hypotensive medication and qualified success as IOP ≤ 15 mmHg with medications. Results: The average age of the patients was 46.2 ± 14.8 years. There were 17 males and six females. Of these, seven patients were diagnosed with juvenile open-angle glaucoma, seven patients with primary open-angle glaucoma, and nine patients with primary angle-closure glaucoma and pseudophakia. The average follow-up time was 23.3 ± 5.6 months, with a minimum of at least 12 months. The mean preoperative IOP was 38.3 ± 6.6 mmHg. Postoperatively, the IOP at 3 months was 12.5 ± 1.9 mmHg; 6 months was 12.6 ± 3.9 mmHg; 12 months was 12.3 ± 2.5 mmHg; and 24 months was 12.5 ± 1.6 mmHg (n = 17) (P < 0.0001). Complete success was noted in 92.6% of eyes, qualified success in 3.7% of eyes, and failure in 3.7% of eyes. The preoperative and postoperative best-corrected visual acuity in logarithm of the minimum angle of resolution was 0.3 ± 0.2 and 0.3 ± 0.1 (P = 0.31), respectively. The average number of ocular hypotensive medications used preoperatively was 4.2 ± 0.5 (median 4), which decreased to 0.07 ± 0.3 (median 0) (P < 0.0001) postoperatively.
Trabeculectomy with low-dose mitomycin-C and with implantation of ologen both subsclerally and subconjunctivally, appears to offer encouraging results in achieving a low-target IOP in eyes with advanced primary adult glaucoma.
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Conflicts of interest
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