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      Intermediate outcomes of ab externo circumferential trabeculotomy and canaloplasty in POAG patients with prior incisional glaucoma surgery

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          Abstract

          Background

          To compare the efficacy and safety of ab externo circumferential trabeculotomy (ECT) and canaloplasty on primary open angle glaucoma (POAG) patients with failed filtering surgery and intact schlemm’s canal (SC).

          Methods

          We conducted a retrospective chart review of POAG patients with failed filtering surgery and intact SC, who further received ECT and canaloplasty. The primary outcome measures were intraocular pressure (IOP) and the number of topical medications at each follow-up point. The secondary outcome compared the quantified success rate at1-year follow-up between the groups.

          Results

          Twenty-nine eyes were recruited in the ECT group and 19 eyes in canaloplasty group. The postoperative IOP and the number of topical medications decreased significantly in both groups ( p < 0.001). The IOP at 3-month and 6-monthwas significantly lower in the ECT group ( p = 0.039, p = 0.001) than in the canaloplasty group. Although the IOP at 12-mon was similar between the two groups, the number of topical medications was less in the ECT group ( p = 0.040). Hyphema (72.4%) and ciliary body detachment (27.6%), which mainly resolve spontaneously, were two leading complications in the ECT group. The prevalence of hyphema was higher in ECT than in canaloplasty group ( p < 0.001).

          Conclusion

          For POAG with failed filtering surgery and intact SC, canaloplasty may be safer, whereas ECT presented better IOP control.

          Translational Relevance: Suggestions for surgical choice for POAG with failed filtering surgery.

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          Most cited references20

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          Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis.

          Irene Floriani, Luciano Quaranta, Ivano Riva … (2013)
          To date, only a few studies have directly compared nonpenetrating surgery (NPS) and trabeculectomy (TE). Therefore, there is no strong evidence as to which surgical technique leads to the best results in terms of ocular hypotensive effect and safety. To compare the hypotensive effect and safety of NPS and TE in terms of intraocular pressure (IOP) reduction and incidence of complications. The MEDLINE and EMBASE databases were searched for studies potentially eligible in any language published up to March 31, 2013. Systematic review and meta-analysis of comparative studies of 2 or more surgical techniques (1 of which had to be TE), including patients with open-angle glaucoma. The considered interventions were TE, deep sclerectomy (DS), viscocanalostomy, and canaloplasty. The primary outcome was the mean between-group difference in the reduction in diurnal IOP from baseline to the 6- or 12-month follow-up evaluation. We also considered the incidence of complications, expressed as relative risk. Eighteen articles, accounting for 20 comparisons, were selected for data extraction and analysis. Analysis of the 6-month follow-up data showed that the pooled estimate of the mean between-group difference was -2.15 mm Hg (95% CI, -2.85 to -1.44) in favor of TE. There was no difference between the NPS subgroups. In the subgroup antimetabolite analysis, the addition of mitomycin C to TE and DS decreased the difference in the reduction in IOP (TE and DS without mitomycin C: -2.65 mm Hg [95% CI, -3.90 to -1.39]; TE and DS with mitomycin C: -0.83 mm Hg [95% CI, -2.40 to 0.74]). In the subgroup analysis by implant addition, no significant difference induced by DS with or without drainage devices was detected (test for subgroup differences: χ(2)(1) = 0.24; P = .62). The absolute risk of hypotony, choroidal effusion, cataract, and flat or shallow anterior chamber was higher in the TE group than in the NPS group. Trabeculectomy seems to be the most effective surgical procedure for reducing IOP in patients with open-angle glaucoma. However, as expected, it was associated with a higher incidence of complications when compared with NPS.
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            National and subnational prevalence and burden of glaucoma in China: A systematic analysis

            Peige Song, Jiawen Wang, Kajo Bucan … (2017)
            Background Glaucoma, the second leading cause of blindness, affects approximately 64.3 million individuals worldwide. In China, demographic ageing is in rapid progress. Yet detailed and up–to–date estimates of the scale of glaucoma are rare. We aimed to quantify and understand the prevalence and burden of glaucoma in China from 1990 to 2015, with projections until 2050. Methods For this systematic review and meta–analysis, we searched China National Knowledge Infrastructure (CNKI), Wanfang, Chinese Biomedicine Literature Database (CBM–SinoMed), PubMed, Embase and Medline using comprehensive search strategies to identify all relevant articles that have reported the prevalence of glaucoma in the general Chinese population. We used a multilevel mixed–effect meta–regression to estimate the prevalence rates of primary open–angle glaucoma (POAG) and primary angle–closure glaucoma (PACG), and a random–effects meta–analysis to pool the overall prevalence of secondary glaucoma. United Nations population data were used to estimate and project the number of people with glaucoma from 1990 to 2050. Univariable and multivariable meta–regressions were conducted to assess the association between the prevalence of POAG and PACG and relevant demographic and geographic factors. The national burden of POAG and PACG in the years 2000 and 2010 were distributed to six geographic regions accordingly. Results From 1990 to 2015, the prevalence of all glaucoma ranged from 2.59% (95% CI = 1.96–3.49) to 2.58% (95% CI = 1.94–3.47). For different subtypes of glaucoma, the overall prevalence of POAG ranged from 1.03% (95% CI = 0.67–1.58) in 1990 to 1.02% (95% CI = 0.67–1.57) in 2015, PACG from 1.41% (95% CI = 1.18–1.68) to 1.40% (95% CI = 1.17–1.68). The overall prevalence of secondary glaucoma was 0.15% (95% CI = 0.10–0.23) during this period. The number of people with all glaucoma in China was 5.92 million (95% CI = 4.47–7.97) in 1990, and 13.12 million (95% CI = 9.88–17.68) in 2015. This increasing trend was also witnessed in different subtypes of glaucoma. The number of people affected by POAG increased from 2.35 million (95% CI = 1.54–3.60) in 1990 to 5.22 million (95% CI = 3.40–7.98) in 2015, PACG from 3.22 million (95% CI = 2.70–3.84) to 7.14 million (95% CI = 5.97–8.53), and secondary glaucoma from 0.34 million (95% CI = 0.23–0.53) to 0.76 million (95% CI = 0.51–1.17). In 2015, more than half (54.42%) of the glaucoma cases were PACG, followed by POAG (39.79%) and secondary glaucoma (5.79%). By 2050, the number of all glaucoma cases in China will be 25.16 million (95% CI = 18.96–33.86). In the multivariable meta–regressions, the odds ratio (OR) for each decade’s increase in age was 1.43 (95% CI = 1.33–1.55) for POAG, and 1.65 (95% CI = 1.51–1.80) for PACG; males were more likely to have POAG (OR 1.36, 95% CI = 1.17–1.59), but less likely to have PACG (OR 0.53, 95% CI = 0.46–0.60) compared with females. After adjustment of age and gender, people living in urban areas were more likely to have POAG compared with those in rural areas (OR 1.54, 95% CI = 1.02–2.35). People in Northeast China were at a higher risk (OR 1.77, 95% CI = 1.07–2.94) of having PACG than people in East China. Among the six regions, East China owed the most POAG and PACG cases, whereas Northwest China owed the least. Conclusions This systematic review and meta–analysis suggests a substantial burden of glaucoma in China, with great variances among the different age groups, genders, settings and geographic regions. With the dramatic ageing trend in the next three decades, the prevalence and burden of glaucoma will continue to increase. More elaborate epidemiological studies are needed to optimise public health strategies for mitigating this important health problem.
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              The inner wall of Schlemm's canal.

              C. Ross Ethier (2002)
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                Author and article information

                Contributors
                Ningli Wang:
                ORCID: http://orcid.org/0000-0002-8933-4482
                wningli@vip.163.com
                Journal
                Journal ID (nlm-ta): BMC Ophthalmol
                Title: BMC Ophthalmology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2415
                Publication date (Electronic): 2 October 2020
                Publication date PMC-release: 2 October 2020
                Publication date Collection: 2020
                Volume: 20
                Electronic Location Identifier: 389
                Affiliations
                [1 ]GRID grid.24696.3f, ISNI 0000 0004 0369 153X, Beijing Tongren Eye center, Beijing Tongren Hospital, , Capital medical university, ; Beijing, China
                [2 ]GRID grid.266102.1, ISNI 0000 0001 2297 6811, Department of Ophthalmology, , University of California, San Francisco School of Medicine, ; San Francisco, California USA
                Author information
                http://orcid.org/0000-0002-8933-4482
                Article
                Publisher ID: 1645
                DOI: 10.1186/s12886-020-01645-0
                PMC ID: 7531087
                PubMed ID: 33008405
                SO-VID: 080cb800-a9ba-400e-9791-d6ec57779f55
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 14 May 2020
                Date accepted : 14 September 2020
                Funding
                Funded by: Beijing Municipal Administration of Hospitals’ Youth Programme
                Award ID: QML20180202
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: U1713220
                Award Recipient :
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: ab externo circumferential trabeculotomy,canaloplasty,primary open angle glaucoma,failed filtering glaucoma surgery
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: ab externo circumferential trabeculotomy, canaloplasty, primary open angle glaucoma, failed filtering glaucoma surgery

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