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Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of open angle glaucoma

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2011年第2期31卷 264-270页

作者：柯敏郭敬钱志刚 Department of Ophthalmology Zhongnan Hospital Wuhan University

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED （1966 to 2009）, Embase （1980 to 2009） and CMB-disk （1979 to 2009） for the randomized clinical trials （RCT） concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration＇s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure （IOP） between non-penetrating trabecular surgery and trabeculectomy （Z=6.05 P0.00001）. There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures （Z=4.92, P0.00001）. Difference in the success rate was also found between the two surgeries （Z=3.82, P=0.0001）. It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

关键词： open angle glaucoma non-penetrating trabecular surgery sclerectomy viscocanalostomy trabeculectomy

Comparison of canaloplasty and trabeculectomy for open angle glaucoma：a Meta-analysis

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International Journal of Ophthalmology(English edition) 2016年第12期9卷 1814-1819页

作者： Zhong-Jing Lin Shuo Xu Shou-Yue Huang Xiao-Bin Zhang Yi-Sheng Zhong Department of Ophthalmology Ruijin Hospital Affiliated Medical School Shanghai Jiao Tong University Shanghai 200025 China Department of Ophthalmology Hubei University of Science and Technology Xialming 437100 Hubei Province China

AIM： To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle ***： Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction （IOPR）, postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse ***： We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference （WMD） of IOPR between canaloplasty and trabeculectomy from baseline to 12mo was -2.33 （95%CI： -4.00, -0.66）. There was not significant improvement in the complete or qualified success rate （OR： 0.58, 95%CI： 0.26, 1.31; OR： 0.50, 95%CI： 0.10, 2.44, respectively）. Similarly, no statistically significance was observed in anti-glaucoma mediations reduction （WMD： -0.54, 95%CI： -1.18, 0.09）. Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis ***： Trabeculectomy seems to be more effective in lowering IOP up to 12mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.

关键词： canaloplasty trabeculectomy open angle glaucoma Meta-analysis

Head trauma can cause transient elevation of intraocular pressure in patients with open angle glaucoma

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International Journal of Ophthalmology(English edition) 2011年第3期4卷 298-302页

作者： George L.Spaeth glaucoma Research Center Wills Eye InstituteJefferson Medical College

AIM: To describe a newly-recognized entity, illustrated by five cases of glaucoma in whom trauma to the head, but not the eye, resulted in marked, transient elevation of intraocular pressure (IOP). METHODS: Retrospective case series. Chart review. RESULTS: All five cases had a diagnosis of primary open-angle glaucoma prior to the experience of trauma to the head. All cases had an unusual elevation of IOP (around 70 percent) for days to weeks following the trauma, after which the IOP fell to pre-accident levels. No cause other than the trauma could be determined. CONCLUSION: The relationship between head trauma and elevation of IOP appears real.

关键词： head trauma open angle glaucoma intraocular pressure

Efficacy and Safety of Travoprost and Timolol Fixed Combination Compared to Travoprost in Patients with Primary open angle glaucoma and Ocular Hypertension

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open Journal of Ophthalmology 2017年第3期7卷 176-183页

作者： Gentian Hoxha Kelmend Spahiu Gazmend Kacaniku Mimoza Ismaili Fellanza Ismajli-Hoxha Department of Ophthalmology Faculty of MedicineUniversity Clinical Center of KosovoPrishtinaKosovo Department of Dermatovenerology Faculty of MedicineUniversity Clinical Center of KosovoPrishtinaKosovo

Purpose: To compare intraocular pressure (IOP)-lowering efficacy and safety of travoprost 0.004% and travoprost 0.004% and beta-blocker 0.5% fixed combination ophthalmic solution in patients with open-angle glaucoma and ocular hypertension. Methods: In this prospective, multicentre clinical trial, 62 patients received travoprost 0.004% (n = 31) or travoprost 0.004% and beta-blocker 0.5% fixed combination (n = 31). Efficacy and safety were compared across treatment groups over 2 years. IOP reduction and adverse events were examined at 3, 6, 12 and 24 months for each group. Results: Mean IOP at the first visit in the travoprost 0.004% group was 26.4 (SD ± 2.1), and travoprost 0.004%/timolol 0.5% group was 26.3 (SD ± 2.1). Mean IOP after 24 months in the travoprost 0.004% group was 20.5 (SD ± 1.5) and travoprost 0.004%/timolol 0.5% group was 18.5 (SD ± 1.5). There were statistically significant differences in IOP in both eyes after third visit (after 1 year) and fourth visit (after 2 years). Conclusion: After 2 year of treatment, travoprost 0.004%/timolol 0.5% produced clinically relevant IOP reductions in patients with open-angle glaucoma or ocular hypertension that were greater than those produced by travoprost 0.004% alone.

关键词： open angle glaucoma Ocular Hypertension Travoprost/Timolol Fixed Combination Adverse Event

Efficacy and safety of XEN 45 gel stent alone or in combination with phacoemulsification in advanced open angle glaucoma patients: 1-year retrospective study

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International Journal of Ophthalmology(English edition) 2020年第8期13卷 1250-1256页

作者： Teresa Laborda-Guirao Juan M Cubero-Parra Antonio Hidalgo-Torres Department of glaucoma Hospital La ArruzafaCordoba 14012Spain

AIM:To assess the effectiveness of the XEN 45 gel stent,either alone or combined with cataract surgery,in advanced stage open angle glaucoma(OAG)***:Retrospective and single-center study conducted on consecutive OAG patients who underwent a XEN 45 gel stent implantation surgery,between July 2017 and September *** primary efficacy end-point was the mean intraocular pressure(IOP)reduction at the end of the follow-up *** was defined as an IOP reduction of at least 20%and an IOP value≤18 mm Hg without(complete)or with(qualified)hypotensive ***:Seventy-four patients(80 eyes)were included in the *** the overall study sample,XEN implant significantly reduced IOP from 21.0(19.8 to 22.1)mm Hg at baseline to 9.3(8.2 to 10.4),10.7(9.6 to 11.9),13.4(12.2 to 14.7),14.5(13.6 to 15.4),14.7(13.8 to 15.6),and 14.7(13.9 to 15.4)mm Hg at 1 d,1 wk,1,3,6,and 12 mo of follow-up,respectively(P<0.0001 each).In the overall study population,at the end of the study the mean IOP reduction was 27.4%(23.3%to 31.5%).Adjusted IOP reduction was similar in XEN and XEN+phacoemulsification groups[30.0(23.4 to 36.4)mm Hg vs 24.8(18.4 to 31.2)mm Hg,respectively,P=0.2939].At the last follow-up visit,52(65.0%)eyes were considered success,29(36.3%)eyes as complete success and 23(28.7%)as qualified *** number of hypotensive medications was significantly reduced from 2.8(2.7 to 3.0)at baseline to 1.1(0.8 to 1.3),P<***-Meier survival analysis did not find any difference in the success rate between XEN and XEN+PHACO,mean hazard ratio 0.56,95%CI 0.26 to 1.23;P=*** was performed in 7(8.8%)eyes at months 1(n=3);3(n=2);4(n=1)and 11(n=1).Eleven(13.8%)eyes presented adverse ***:XEN implant,either alone or in combination with phacoemulsification,significantly reduced the IOP and the number of hypotensive medications in patients with OAG in advanced stage.

关键词： open angle glaucoma advanced stage XEN implant intraocular pressure minimally-invasive glaucoma surgery

Comparison of success rate and intraocular pressure spikes between selective laser trabeculoplasty and micropulse laser trabeculoplasty in African American and Hispanic patients

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International Journal of Ophthalmology(English edition) 2023年第1期16卷 75-80页

作者： Alexander Z Robin Palwasha Syar Dana Darwish Catherine Thomas NMPfahler Agni Kakouri Thomas Patrianakos Michael Giovingo Department of Ophthalmology John H.StrogerJr.Hospital of Cook CountyChicagoIL 60612USA Rosalind Franklin University of Medicine and Science North ChicagoIL 60064USA Department of Ophthalmology and Visual Science University of Illinois at ChicagoChicagoIL 60612USA Department of General Surgery University of Texas at HoustonHoustonTX 77030USA

AIM:To examine the efficacy and safety of micropulse laser trabeculoplasty(MLT)versus selective laser trabeculoplasty(SLT)in a large cohort of primarily African American and Hispanic ***:A single center retrospective comparative cohort review conducted at Cook County Health facilities that included patients with a diagnosis of open angle glaucoma or ocular hypertension who received an SLT or MLT procedure between January 2017 and May ***:Totally 131 eyes of 99 patients were *** 77 eyes received SLT and 54 received *** out of 77 eyes in the SLT group(9.1%)and 1 out of 54 eyes in the MLT group(1.9%)had an IOP spike(defined as>5 mm Hg)at either 1h or 1wk after procedure(P=0.05,Chisquared test with Haldane-Anscombe correction).The procedure failure rate at one year was 50%for SLT and 48%for MLT(P=0.31).CONCLUSION:MLT has a significantly lower incidence of pressure spikes and a similar treatment failure rate at 1-year post-procedure,demonstrating that it is a reasonable alternative compared to SLT.

关键词： selective laser trabeculoplasty micropulse laser trabeculoplasty glaucoma open angle glaucoma ocular hypertension

XEN® Gel Implant for glaucoma;Prospective Cohort Study in a High-Volume Department

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open Journal of Ophthalmology 2023年第2期13卷 208-220页

作者： Hans Wilhelm Meyer Tiril Sandell Department of Ophthalmology Oslo University Hospital Oslo Norway Department of Ophthalmology Vestre Viken Hospital Trust Drammen Norway

Purpose: To evaluate the 3-year efficiency and safety of XEN® 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized observational study we identified patients who had undergone either stand-alone XEN® implantation (XEN solo) or XEN® implantation in combination with phacoemulsification (XEN combi). All patients who had undergone an implantation during the period 01.04.17-31.10.19 at the Department of Ophthalmology, Drammen Hospital, Norway, were asked to participate. Success was defined as IOP between 5 - 18 mmHg and 20% pressure reduction without medications. Qualified success required the same pressure interval and reduction but allowed medications. The procedure was deemed as failure if pressure requirements were not met, vision was reduced to light perception or worse, or if there was a converion to secondary glaucoma surgery. Results: Out of 115 patients and 133 eyes identified, 87 patients and 99 eyes consented to participate. All patients were Caucasians with a mean age of 73.6 years. The study had a mean (range) follow-up of 38.9 (28 - 54) months. The mean medicated baseline (SD) was reduced from 22.6 (7.9) mmHg on 3.2 (1.1) medications to 14.2 (5.6) mmHg on 1.4 (1.6) medications. Success and qualified success were achieved in 22.2% and 21.2%, respectively. Needling was performed in 34 eyes. Conclusion: XEN® 45 gel stent implantation is a safe procedure, offering a significantly lower IOP and number of medications in a subset of patients with open angle glaucoma.

关键词： Long Term Outcome after XEN® Gel Stent open angle glaucoma OAG Pseudoexfoliative glaucoma Minimally Invasive glaucoma Surgeries MIGS

Commentary review on peripapillary morphological characteristics in high myopia eyes with glaucoma:diagnostic challenges and strategies

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International Journal of Ophthalmology(English edition) 2021年第4期14卷 600-605页

作者： Yan-Hui Chen Rui-Hua Wei Yan-Nian Hui Tianjin International Joint Research and Development Centre of Ophthalmology and Vision Science Tianjin 300070China Eye Institute and School of Optometry Tianjin Medical University Eye HospitalTianjin 300384China Department of Ophthalmology Xijing HospitalFourth Military Medical UniversityXi’an 710023Shaanxi ProvinceChina

The incidences of open angle glaucoma(OAG)and high myopia are increasing *** the aging population and concurrent rapid increase in the number of individuals with myopia,the risk of visual defects caused by highly myopic OAG is likely to increase dramatically over the next few ***,precise screening and diagnosis of OAG is challenging because of the tilt and rotation of the optic disc,as well as extensiveβ-zone parapapillary atrophy in highly myopic *** advances in optical coherence tomography(OCT)and OCT angiography(OCTA)technologies imply that both modalities are promising tools for the detection of highly myopic ***,the diagnosis of OAG remains to be determined with the longitudinal changes of functional damages(*** field defect,visual electrophysiological changes).We herein describe some aspects of microvascular and microstructural pathology in patients with highly myopic OAG and proposes a framework for the development of novel diagnostic and therapeutic strategies.

关键词： high myopia open angle glaucoma parapapillary atrophy parapapillary microvasculature optic disc lamina cribrosa optical coherence tomography

Micropulse laser trabeculoplasty under maximal tolerable glaucoma eyedrops:treatment effectiveness and impact of surgical expertise

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International Journal of Ophthalmology(English edition) 2021年第3期14卷 388-392页

作者： Shinji Kakihara Takao Hirano Akira Imai Taihei Kurenuma Yoshiaki Chiku Toshinori Murata Department of Ophthalmology Shinshu University School of MedicineMatsumotoNagano 390-8621Japan

AIM:To evaluate the effectiveness of micropulse laser trabeculoplasty(MLT)for eyes with open angle glaucoma(OAG)under maximal tolerable glaucoma eyedrops and to assess the effect of expertise performing MLT on its clinical ***:Medical records of 42 consecutive eyes of 34 patients diagnosed with OAG who underwent MLT were retrospectively *** effectiveness was determined using the Kaplan-Meier survival *** was defined as an intraocular pressure(IOP)reduction of21 mm Hg during two consecutive follow-up visits,or surgical intervention for *** determine the impact of MLT surgical expertise on clinical effectiveness,the eyes were divided into two groups according to whether the procedure was conducted by an experienced specialist(defined as a glaucoma specialist who had conducted at least ten MLT procedures)or a less experienced glaucoma *** difference in expertise was determined using a log-rank ***:MLT was conducted by three glaucoma *** overall survival rates were 0.76,0.48,and 0.44 at 1,3,and 6 mo,*** survival rates for MLT performed by a less experienced glaucoma specialist were 0.62,0.31,and 0.25(n=21 eyes)at 1,3,and 6 mo,respectively,whereas the survival rates for MLT performed by an experienced glaucoma specialist were 0.90,0.64,and 0.64(n=21 eyes)at 1,3,and 6 mo,*** log-rank test showed a significant difference in the survival curves of the two groups(P=0.0061).CONCLUSION:The 6-month effectiveness of MLT for controlling IOP is relatively limited in eyes with OAG using maximal tolerable glaucoma ***,its effectiveness may be improved if performed by a glaucoma specialist with sufficient MLT experience.

关键词： micropulse laser trabeculoplasty open angle glaucoma inter-operator variability