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Minimal invasive glaucoma surgery

Tanya Karaconji, Salman Naqvi, Karl Mercieca
Low intraocular pressure and hypotony secondary to overfiltration is a recognized complication after trabeculectomy, particularly when augmented with antimetabolites such as 5-fluorouracil and mitomycin C. The relatively recent introduction of minimally invasive glaucoma surgery such as the ab interno XEN 45 (Allergan, Ireland) subconjunctival gel implant has heralded a new era of glaucoma drainage surgery where postoperative complications may be less and surgical recovery quicker. However, any effective glaucoma filtering procedure will always carry the risk of inducing hypotony...
March 2019: Journal of Glaucoma
Jed Lusthaus, Ivan Goldberg
Glaucoma is an irreversible progressive optic neuropathy, for which the major proven treatment is to lower the intraocular pressure (IOP). Five groups of IOP-lowering eye drops have varying mechanisms of action. Some drops, such as β-blockers and α-2 agonists, have potentially serious systemic side effects. Acetazolamide is the only available oral agent; it is effective at lowering IOP, but significant side effects relegate its use usually to refractory glaucoma. Two new eye drops, netarsudil and latanoprostene bunod, have recently been approved by the United States Food and Drug Administration...
February 14, 2019: Medical Journal of Australia
H Burkhard Dick, Tim Schultz, Ronald D Gerste
In the management of glaucoma, recent and upcoming innovations have the potential to contribute to both the efficacy of intraocular pressure (IOP) monitoring and the number of available treatment options. These new devices and procedures have two things in common: they are part of the trend in medicine towards miniaturization, and they require a limited surgical procedure to become effective. This review focuses on the Eyemate (Argos) intraocular sensor, which offers a new way to reliably measure 24 h IOP, and on intraocular sustained release systems for pharmacological glaucoma therapy...
February 6, 2019: Ophthalmology and Therapy
S N Onwubiko, N N Udeh, O Nkwegu, D O Ukwu, N Z Nwachukwu
PURPOSE: To investigate the current practice on glaucoma care with the aim of highlighting its poise to tackle this emerging sight-threatening disease in Nigeria. METHODS: This was a cross-sectional, descriptive, population-based survey involving 88 ophthalmologists. Information on their demographic characteristics, practice profile, challenges and prospects on glaucoma care was collected using a semi-structured, self-administered questionnaire in August 2016. Data were analysed using SPSS 20...
February 1, 2019: International Ophthalmology
Louis Arnould, Vincent Theillac, Sarah Moran, Damien Gatinel, Alice Grise-Dulac
PURPOSE: The purpose of this study was to report a case of recurrent conjunctival erosion and XEN Gel Stent exposure after implantation in a primary open-angle glaucoma patient. Minimally invasive glaucoma surgery (MIGS) is a new approach in glaucoma surgery, and there is a lack of published data with regard to the management of postoperative ocular surface complications. METHODS: This is a case report of a patient with a persistent corneal erosion after XEN Gel Stent implantation...
March 2019: Journal of Glaucoma
Adi Orbach, Gerardo Lopez, Eran Berkowitz, Beatrice Tiosano
The goal of all glaucoma surgery is to lower eye pressure to prevent or reduce damage to the optic nerve. Standard glaucoma surgeries - trabeculectomy, ExPRESS shunts and external tube-shunts like the Ahmed and Baerveldt valves - are major surgeries. While they are very often effective at lowering eye pressure and preventing progression of glaucoma, they have a long list of potential complications. Minimal invasive glaucoma surgery (MIGS) is a group of operations that have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries...
January 2019: Harefuah
Renato Menezes Palácios, André Corrêa Maia de Carvalho, Maurício Maia, Rafael Ramos Caiado, Danilo Aedo Gardim Camilo, Michel Eid Farah
PURPOSE: To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results...
January 15, 2019: Graefe's Archive for Clinical and Experimental Ophthalmology
Francesco Stringa, Zaria Ali, Savvas Christou, Sumita Karandikar, Vikas Shankar
A 78 old male with angle closure glaucoma and on treatment with oral anticoagulants, underwent phacoemulsification. An early acute suprachoroidal hemorrhage (SCH) occurred and the surgical wound was rapidly sutured without complete soft lens matter (SLM) removal, nor insertion of intraocular lens (IOL). The SCH was managed conservatively and it resolved in 5 weeks; the intraocular pressure was 35▒mm Hg despite maximal medical treatment. Secondary SLM removal followed by IOL implantation combined with XEN45 was then performed...
December 24, 2018: Journal of Glaucoma
S Montolío Marzo, A Lanzagorta Aresti, J M Davó Cabrera, E A Alfonso Muñóz, J V Piá Ludeña, E Palacios Pozo
Minimally invasive glaucoma surgery for chronic open-angle glaucoma treatment tries to reduce the amount of chronic topical drug treatment, delaying invasive glaucoma surgery and diminishing the number of surgical complications. XEN45 uses subconjunctival drainage in order to reduce intraocular pressure. The report is presented of a patient following phacoemulsification, intraocular lens implantation and XEN45 implant. After four days acute malignant glaucoma was observed, with stage 3 athalamia requiring pars plana vitrectomy and secondary Ahmed valve implantation...
December 18, 2018: Archivos de la Sociedad Española de Oftalmología
Sabita M Ittoop, Leonard K Seibold, Malik Y Kahook
PURPOSE OF REVIEW: Adherence to chronic use of topical intraocular pressure (IOP) lowering medications is a fundamental barrier to successful, long-term control in patients suffering from glaucoma. This has fueled innovation to create new vehicles for drug administration, new drug formulations with enhanced bioavailability, and minimally invasive glaucoma surgeries (MIGS) with improved risk-benefit profiles to enhance sustained IOP control. The present article is an overview of novel devices in the pipeline...
March 2019: Current Opinion in Ophthalmology
David A Camp, Prashant Yadav, Lauren A Dalvin, Carol L Shields
PURPOSE OF REVIEW: Glaucoma secondary to intraocular tumors is important to consider in eyes with a known tumor and those with unilateral or refractory glaucoma. The purpose of this review is to discuss the mechanisms and management of intraocular tumors with related secondary glaucoma. RECENT FINDINGS: Several intraocular tumors can lead to glaucoma, including iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma, and medulloepithelioma...
December 12, 2018: Current Opinion in Ophthalmology
Frances Meier-Gibbons, Michael S Berlin, Marc Töteberg-Harms
PURPOSE OF REVIEW: It is well known that glaucoma patients are not adherent to their therapeutic regimens. The issue of nonadherence is multifactorial and includes inadequate communication between doctors and patients, resulting in significant costs associated with enhanced disease progression. Therapeutic regimens are risk factors which often influences adherence rates. Thus, alternative treatment modalities, especially those risk factors that do not rely on patients' cooperation, may enable improvements in long-term outcomes of glaucoma in patient...
March 2019: Current Opinion in Ophthalmology
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: The 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 with regard to 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: This was a retrospective study on the first 6 XEN implants performed by each of the 10 certified ophthalmic surgeons...
January 2019: 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
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