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Minimal invasive glaucoma surgery

Anthony J King, Anupa Shah, Eleni Nikita, Kuang Hu, Caroline A Mulvaney, Richard Stead, Augusto Azuara-Blanco
BACKGROUND: Glaucoma is a leading cause of irreversible blindness. Subconjunctival draining minimally-invasive glaucoma devices such as the Xen gelatin implant and InnFocus stent have been introduced as a treatment to prevent glaucoma progressing.These implants provide a channel to allow aqueous humour from the anterior chamber of the eye to drain into the subconjunctival space on the surface of the eye thus reducing intraocular pressure (IOP) and mimicking the mechanism of the most commonly undertaken glaucoma surgery, trabeculectomy...
December 16, 2018: Cochrane Database of Systematic Reviews
Henry B Wallace, Stuti L Misra, Sunny S Li, James McKelvie
IMPORTANCE: Intraocular pressure is often reduced following cataract surgery. Postoperative changes in corneal stiffness are likely to be at least partly responsible for any reduction in IOP measured with applanation tonometry. BACKGROUND: To determine the effect of cataract surgery and corneal incision size on corneal biomechanics. DESIGN: Prospective randomised trial PARTICIPANTS: One-hundred prospectively enrolled patients qualifying for cataract surgery METHODS: Participants were randomised to clear corneal incisions with a 2...
November 25, 2018: Clinical & Experimental Ophthalmology
Morgan M Harvey, Joseph W Schmitz
INTRODUCTION: Primary congenital glaucoma is a rare ocular disorder that is responsible for 0.01%-0.04% of total blindness worldwide.1 The goal of congenital glaucoma management is to allow for proper development of the immature visual system by controlling intraocular pressure. Medical therapy usually provides a supportive role to temporarily reduce intraocular pressure, but patients typically require iridocorneal angle surgery to facilitate aqueous humor outflow. In this report, we describe the use of minimally invasive ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma...
October 14, 2018: European Journal of Ophthalmology
Juan Francisco Santamaría-Álvarez, Juan Lillo-Sopena, Silvia Sanz-Moreno, Josep Maria Caminal-Mitjana
In recent years, minimally-invasive glaucoma surgery has emerged as a novel approach to lowering intraocular pressure (IOP). This technique, which is usually reserved for mild to moderate cases, is less invasive than classic filtration surgery and potentially offers a better safety profile. The XEN Gel Stent is implanted through a minimally-invasive, ab interno procedure to create a subconjunctival pathway. Conjunctival tissue disruption is minimal and flow is restricted to avoid hypotony. Data on the optimal approach to managing complications associated with this procedure are limited due to the relatively recent commercialization of this device...
October 11, 2018: Journal of Glaucoma
Raquel Esteves Marques, Nuno Pinto Ferreira, David Cordeiro Sousa, Joana Pinto, André Barata, Paula Sens, Luís Abegão Pinto
PURPOSE: XEN® gel stent is a minimally invasive surgical device aimed at creating a subconjunctival drainage of aqueous humor, thereby reducing intraocular pressure (IOP). Being a novel device, doubts remain regarding the efficacy and safety of its implantation in the early stage of new users. This paper illustrates the XEN® implantation learning curve, assessed through several surgeons of different expertise. METHODS: Retrospective study on the first 6 XEN® implants performed by each of 10 certified ophthalmic surgeons...
October 11, 2018: Journal of Glaucoma
Zeynep Aktas, Bektas Caglar, Murat Hasanreisoglu
PURPOSE: To report a case of panscleritis after gonioscopy-assisted transluminal trabeculotomy (GATT). METHODS: We describe the case of a 33-year-old man with a history of unilateral anterior uveitis and glaucoma, who developed panscleritis after GATT surgery. RESULTS: Uneventful GATT surgery was performed in a glaucomatous left eye. On the second postoperative day, the patient developed tenderness on palpation of the eye. Ophthalmic examination revealed significant diffuse hyperemia, elongated and tortuous upper bulbar conjunctival/scleral vessels, and exudative retinal detachment at the superior nasal quadrant, with diffuse scleral thickening...
October 8, 2018: Journal of Glaucoma
Sophia Y Wang, Kuldev Singh, Joshua D Stein, Robert T Chang
Importance: The iStent Trabecular Micro-Bypass (Glaukos Corporation) is a minimally invasive glaucoma implant used in conjunction with cataract surgery to lower intraocular pressure. Objective: To determine whether implantation of the iStent concurrent with cataract surgery is associated with reduced use of ocular antihypertensive medications in a US health care claims database. Design, Setting, and Participants: Retrospective, observational longitudinal cohort study of individuals enrolled in a US managed care network who underwent iStent implantation with cataract surgery (iStent/CEIOL) from 2012 to 2016 (n = 1509 bilateral and n = 1462 unilateral surgery)...
September 27, 2018: JAMA Ophthalmology
Chelvin C A Sng, Keith Barton
No abstract text is available yet for this article.
October 2018: British Journal of Ophthalmology
Xuemin Zhang, Saujanya Vadoothker, Wuqaas M Munir, Osamah Saeedi
OBJECTIVES: Ocular surface disease frequently coexists with glaucoma and may be initiated or exacerbated by topical glaucoma medications. We performed a review of current literature to assess the prevalence, causes, and treatment of ocular surface disease in glaucoma patients, specifically those on topical therapy. METHODS: A Pubmed database search was conducted. A total of 720 articles published from 1972 to 2018 were found in relation with ocular surface disease, glaucoma, and glaucoma medications...
August 30, 2018: Eye & Contact Lens
Markus Lenzhofer, Clemens Strohmaier, Melchior Hohensinn, Wolfgang Hitzl, Philipp Sperl, Matthias Gerner, Veit Steiner, Sarah Moussa, Eva Krall, Herbert A Reitsamer
PURPOSE: Like the classic trabeculectomy, the minimally invasive, ab interno XEN Glaucoma Gel Microstent (XEN-GGM) creates a filtration bleb in the conjunctiva. The goal of this study was to investigate internal bleb morphology over time with anterior segment optical coherence tomography (AS-OCT) after XEN-GGM implantation. METHODS: In a prospective, single-centre, single-armed cohort study, blebs were characterized using AS-OCT in 78 eyes of 60 patients at day 1, at weeks 1 and 2 and at months 1, 3, 6, 9 and 12 after XEN-GGM implantation in patients with open-angle glaucoma...
August 29, 2018: Acta Ophthalmologica
Wen Sun, Chen-Ying Yu, Jian-Ping Tong
As cataract occurs frequently in patients with glaucoma, combining phacoemulsification and endoscopic cyclophotocoagulation has been gaining attention recently due to its minimally invasive nature. A variety of studies had evaluated the efficacy and safety of this procedure and had shown extremely promising results. This review article has shown here that combined phacoemulsification and endoscopic cyclophotocoagulation procedure could effectively reduce intraocular pressure in medically uncontrolled glaucoma patients while avoiding serious complications associated with traditional cyclophotocoagulation procedure and adverse effects related to filtering surgery such as trabeculectomy...
2018: International Journal of Ophthalmology
Laura Bar-David, Eytan Z Blumenthal
Glaucoma is a chronic neurodegenerative optic nerve disease. Treatment is intended to prevent the development and progression of optic nerve damage by lowering intraocular pressure (IOP). Current therapy options include topical/systemic drugs that increase aqueous humor outflow or decrease its production, laser therapy that targets the trabecular meshwork and ciliary body, and incisional surgery. Trabeculectomy as well as glaucoma drainage devices are often performed, given their high efficacy in lowering IOP...
July 30, 2018: Rambam Maimonides Medical Journal
Samir Nazarali, Stephanie L Cote, Patrick Gooi
Glaucoma following penetrating keratoplasty (PKP) remains the leading cause of blindness following PKP. Patients with post-PKP glaucoma can be managed medically and surgically. Evidence studying glaucoma surgical techniques following PKP is limited, but suggests the possibility for high-risk complications, including graft failure. Minimally invasive glaucoma surgeries offer an alternative. We report the first case of post-PKP glaucoma managed with gonioscopy-assisted transluminal trabeculotomy (GATT). The patient was a 33-year-old man with a history of keratoconus who underwent PKP in his right eye...
October 2018: Journal of Glaucoma
Mohamed S Sayed, Richard K Lee
Surgical and laser procedures traditionally used in the management of exfoliation glaucoma (XFG) include laser trabeculoplasty, trabeculectomy, and glaucoma drainage implant surgery. Having demonstrated similar safety and efficacy in XFG compared with primary open-angle glaucoma, trabeculectomy remains the most commonly performed surgery in XFG. Recent trends in practice patterns in developed nations demonstrate a shift towards glaucoma drainage implant surgery, which is currently the procedure of choice in XFG for many, particularly in developed nations...
July 2018: Journal of Glaucoma
David Cordeiro Sousa, Inês Leal, Luis Abegão Pinto
Steroid-induced ocular hypertension (SIOH) is a challenging entity in paediatric age, with many being refractory to medical therapy. Literature is scarce about surgical options in these cases. A 14-year-old girl with bilateral uveitis and macular oedema had received an intravitreal and subconjunctival triamcinolone injection in the right (OD) and left (OS) eye, respectively. While the steroid was effective in resolving the oedema, intraocular pressure (IOP) increased to about 40 mm Hg OD and 34 mm Hg OS, despite being under maximal IOP-lowering therapy...
June 27, 2018: BMJ Case Reports
Philip Bloom, Leon Au
Surgical treatment for glaucoma has undergone a dramatic change over the last decade. Trabeculectomy has been the main surgical procedure worldwide for almost 50 years. However, there is a growth in development of new novel devices and surgical techniques designed to lower intraocular pressure in a less invasive fashion. The term minimally invasive glaucoma surgery (MIGS) has been coined and is the subject of investment, debate and, increasingly, research. The position of MIGS in the glaucoma treatment paradigm is yet to be clearly defined and its ability to replace conventional filtration surgery remains debatable...
June 22, 2018: Ophthalmology and Therapy
A De Gregorio, E Pedrotti, G Stevan, A Bertoncello, S Morselli
The recent development of new devices that are significantly less invasive, collectively termed minimally invasive glaucoma surgery, offers new perspective of intraocular pressure reduction with less risk, short operating times, and rapid recovery. The aim of this work is to provide a panoramic review of the currently published clinical data to assess the potential role of XEN gel stent (Allergan PLC, Irvine, CA, USA) in the management of glaucoma, which is the only filtering minimally invasive glaucoma surgery device that allows the subconjunctival filtration...
2018: Clinical Ophthalmology
Pavi Agrawal, Steven E Bradshaw
INTRODUCTION: Primary open-angle glaucoma is estimated to affect 3% of the population aged 40-80 years. Trabeculectomy is considered the gold standard in surgical management of glaucoma; however, it is a technically complex procedure that may result in a range of adverse outcomes. Device-augmented, minimally invasive procedures (micro-invasive glaucoma surgeries, MIGS) have been developed aiming for safer and less invasive intraocular pressure (IOP) reduction compared with traditional surgery...
June 2018: Ophthalmology and Therapy
Anja-Maria Davids, Milena Pahlitzsch, Alexander Boeker, Necip Torun, Eckart Bertelmann, Anna-Karina Maier-Wenzel, Annette Hager, Johannes Gonnermann, Matthias Klamann
PURPOSE: The aim of this study is to assess the intraocular pressure lowering effect and the performance of the glaucoma therapy of the iStent inject in glaucoma patients with uncontrolled intraocular pressure after failed trabeculectomy. METHODS: In this retrospective study, iStent inject implantation (Glaukos Corporation, Laguna Hills, CA, USA) was performed in 22 eyes of 21 subjects suffering from glaucoma (n = 18 primary open angle glaucoma, n = 3 pseudoexfoliation glaucoma, and n = 1 for secondary glaucoma) with an intraocular pressure above target pressure after failed trabeculectomy (mean = 9...
November 2018: European Journal of Ophthalmology
Thomas Kuriakose, Smitha Jasper, Sherina Thomas
Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC) before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure...
April 2018: Indian Journal of Ophthalmology
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