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Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

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International Journal of Ophthalmology(English edition) 2022年第7期15卷 1082-1088页

作者： Naoto Tokuda Yasushi Kitaoka Ayaka Tsukamoto Yasuhiro Toyoda Yusuke Yamada Kana Sase Hitoshi Takagi Department of Ophthalmology St Marianna University School of Medicine2-16-1 Sugao Miyamae-ku Kawasaki-shiKanagawa 216-8851Japan

AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were ***: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly ***: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.

关键词： minimally invasive glaucoma surgery iStent ab interno trabeculotomy

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Trends in operating room-based glaucoma procedures at a single eye center from 2016–2020

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International Journal of Ophthalmology(English edition) 2023年第2期16卷 208-214页

作者： Di Zhang Jin-Hong Miao Ling-Ge Suo Ya-Nan Li Xu-Hao Chen De-Fu Wu Qian-Ru Wu Chun Zhang Department of Ophthalmology Peking University Third HospitalBeijing 100191China Beijing Key Laboratory of Restoration of Damaged Ocular Nerve Peking University Third HospitalBeijing 100191China Beijing Tongren Eye Center Beijing Tongren HospitalBeijing Institute of OphthalmologyCapital Medical UniversityBeijing 100730China

AIM:To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016–***:A retrospective search of all glaucoma procedures performed at our institution were *** were analyzed by calculating the absolute numbers and relative weightage of each procedure per ***:The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y,and 55%were *** 2016 to 2019,the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460,although it decreased slightly in 2020(n=1393),probably due to the COVID-19 *** number of trabeculectomies did not change significantly in 2016(n=161)to 2018(n=164)but decreased in 2019(n=139)to 2020(n=121),indicating a reduction in its relative weightage among glaucoma procedures(from 21.50%to 8.69%).The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased(50and 58 respectively in 2019),except in *** number of transscleral cyclophotocoagulation procedures was relatively stable,increasing until 2017(n=218)and then *** surgeries with or without glaucoma procedures accounted for a large number of the total surgeries,increasing from 247(32.97%)in 2016 to 967(69.42%),among which cataract extraction combined with goniosynechialysis was the most ***:The overall increase in the number of operating room-based surgical procedures is *** is one of the most commonly performed procedures,despite the relative decline in its *** procedures,including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries,are gaining greater ***,lensrelated surgery plays an important role in glaucoma management.

关键词： glaucoma surgery trends minimally invasive glaucoma surgery

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One-year outcomes and predictable factors for microhook ab interno trabeculotomy

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International Journal of Ophthalmology(English edition) 2022年第4期15卷 598-603页

作者： Daiki Sakai Masashi Fujihara Satoshi Yokota Makoto Nakamura Yasuo Kurimoto Department of Ophthalmology Kobe City Eye HospitalKobe 650-0047Japan Department of Ophthalmology Kobe City Medical Center General HospitalKobe 650-0047Japan Department of surgery Division of OphthalmologyKobe University Graduate School of MedicineKobe 650-0017Japan

AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical ***: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical ***: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.

关键词： microhook ab interno trabeculotomy trabeculotomy ab interno minimally invasive glaucoma surgery survival analysis

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Development and material characteristics of glaucoma surgical implants

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Advances in Ophthalmology Practice and Research 2023年第4期3卷 171-179页

作者： Qiyu Qin Chengshou Zhang Naiji Yu Fan Jia Xin Liu Qi Zhang Min Chen Kaijun Wang Department of Ophthalmology the Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina Zhejiang Provincial Key Lab of Ophthalmology HangzhouChina MOE Key Laboratory of Macromolecule Synthesis and Functionalization of Ministry of Education Department of Polymer Science and EngineeringZhejiang UniversityHangzhouChina Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province Department of CardiologySir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina

Background:glaucoma is the leading cause of irreversible blindness *** reduction of intraocular pressure has proved to be the only factor which can be modified in the treatment,and surgical management is one of the important methods for the treatment of glaucoma *** text:In order to increase aqueous humor outflow and further reduce intraocular pressure,various drainage implants have been designed and applied in clinical *** initial Molteno,Baerveldt and Ahmed glaucoma implants to the Ahmed ClearPath device,Paul glaucoma implant,EX-PRESS and the eyeWatch implant,to iStent,Hydrus,XEN,PreserFlo,Cypass,SOLX Gold Shunt,etc.,glaucoma surgical implants are currently undergoing a massive transformation on their structures and *** materials have been used to produce these implants,from original silicone and porous polyethylene,to gelatin,stainless steel,SIBS,titanium,nitinol and even 24-carat ***,the material geometry,size,rigidity,biocompatibility and mechanism(valved versus nonvalved)among these implants are markedly *** this review,we discussed the development and material characteristics of both conventional glaucoma drainage devices and more recent implants,such as the eyeWatch and the new minimally invasive glaucoma surgery(MIGS)***:Although different in design and materials,these delicate glaucoma surgical implants have widely expanded the glaucoma surgical methods,and improved the success rate and safety of glaucoma surgery ***,all of these glaucoma surgical implants have various limitations and should be used for different glaucoma patients at different conditions.

关键词： glaucoma drainage devices minimally invasive glaucoma surgery Material characteristics

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Long‑term outcomes of two first‑generation trabecular micro‑bypass stents(iStent)with phacoemulsification in primary open‑angle glaucoma:eight‑year results

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Eye and Vision 2021年第4期8卷 431-442页

作者： Ali Salimi Harrison Watt Paul Harasymowycz Department of Ophthalmology Faculty of MedicineMcGill UniversityMontrealQCCanada Montreal glaucoma Institute MontrealQCCanada Faculty of Medicine McGill UniversityMontrealQCCanada Department of Ophthalmology University of Montreal4135 de RouenMontrealQC H1V1G5Canada

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term ***,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of ***:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract ***-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical ***-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse ***:A total of 62 eyes with primary open-angle glaucoma(POAG)were *** 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(Pglaucoma *** measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years ***-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous ***:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success

关键词： minimally invasive glaucoma surgery MIGS Trabecular micro-bypass stent iStent glaucoma Cataract surgery Long-term outcomes

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Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma:a surgery series from surgeon trainees at a tertiary teaching hospital

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Eye and Vision 2020年第1期7卷 47-57页

作者： Karen Hong John Lind Arsham Sheybani Department of Ophthalmology and Visual Sciences Washington University School of MedicineSt.LouisMOUSA Barnes-Jewish Center for Outpatient Health 4901 Forest Park AvenueSt LouisMO 63110USA

Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory ***:A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship *** was collected at baseline and postoperatively at day 1,week 1,and months 1,3,5,and *** outcome was mean IOP *** outcomes included change in number of glaucoma medication classes and visual *** outcomes included needling *** success was defined by achieving≥20%reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent ***:At baseline,28.6%(8/28)of the subjects had prior failed incisional glaucoma surgery in a study population that was 54%African-American,with 78%with severe glaucoma(average mean deviation of−14.58 dB).Thirteen subjects terminated their clinic visits before their 12-month postoperative visit,leaving 15 subjects for end point *** IOP went from 21.6 mmHg(range 12.0–31.0,SD 6.6)at baseline to 12.5 mmHg(range 7.0–19.0,SD 3.6),a 42.1%reduction(p<0.007).All subjects decreased the number of medication classes they were taking with an average reduction of 3.8(range 2–5,SD 0.9)to 1.3(range 0–3,SD 1.0)classes,or a 65.8%decrease(p<0.006).Crude surgical success was 80.0%for the 15 subjects that followed up at 12 *** Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4%(95%CI:44.7–85.8%).Regardless of the length of follow-up,21.4%(6/28)met failure criteria:3 subjects failed because they required secondary surgical intervention,and the other 3 did not have adequate IOP *** bleb needling rate was 28.6%(8/28)and repeat was 17.9%(5/28).Conclusions:Compared to the re

关键词： XEN Investigational devices glaucoma Gelatin stent Ab interno surgery minimally invasive glaucoma surgery Subconjunctival drainage Gelatin microstent

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Hydrus microstent implantation for surgical management of glaucoma: a review of design, efficacy and safety

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Eye and Vision 2019年第1期6卷 271-283页

作者： Saba Samet Jeb A.Ong Iqbal Ike K.Ahmed Department of Ophthalmology and Vision Sciences University of TorontoTorontoONCanada Prism Eye Institute 2201 Bristol CircleSuite 100OakvilleON L6H 0J8Canada

With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has *** its novelty however,there has been a rapid evolution in the development of a multitude of devices,each targeting a structure along the aqueous drainage pathway.A growing body of evidence has demonstrated IOP and medication burden reduction,and a more favorable safety profile with MIGS procedures in contrast to traditional incisional *** the array of MIGS,the Hydrus®Microstent(Ivantis,Inc.,Irvine,CA)is a recent FDA approved device,designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s *** objective of this article is to review the Hydrus from conception to clinical use,and present data on its efficacy and safety to *** available literature has shown promise,however inherent to all novel devices,only longterm monitoring will ensure sustained IOP control and an acceptable safety *** advancements in glaucoma have revolutionized the field,and continued research and development will establish these approaches in clinical treatment algorithms.

关键词： Hydrus Schlemm’s canal minimally invasive glaucoma surgery Drainage device glaucoma

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iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma:early clinical experience

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Eye and Vision 2020年第3期7卷 266-274页

作者： Tanner J.Ferguson Zachary Dockter Adam Bleeker Kayla L.Karpuk Justin Schweitzer Mitch J.Ibach John P.Berdahl Cole Eye Institute Cleveland ClinicClevelandOHUSA University of South Dakota Sanford School of Medicine Sioux FallsSDUSA Cleveland Eye Clinic ClevelandOHUSA Vance Thompson Vision Sioux FallsSDUSA

Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical ***:The series included 56 eyes implanted with the iStent inject device with *** series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma *** outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 ***:IOP was reduced by 21%to 14.7±2.9 mmHg(pglaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(pglaucoma ***:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months *** safety profile is excellent.

关键词： Micro-invasive glaucoma surgery minimally invasive glaucoma surgery MIGS Trabecular microbypass stent Open-angle glaucoma

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