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      Delayed-Onset, Recurrent Hyphema after Microhook ab interno Trabeculotomy

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          Abstract

          Trabeculotomy (LOT) and related goniotomy surgeries can be divided into two classes based on the excision or incision of the trabecular meshwork. Previously, blood reflux from Schlemm’s canal (SC) after long-standing glaucoma surgery was reported in eyes treated with excisional LOT. The current case is one of delayed-onset hyphema after incisional LOT. An 87-year-old woman with bilateral normal-tension glaucoma had undergone microhook ab interno LOT (μLOT) combined with small incisional cataract surgery in both eyes 4 years previously. At the scheduled 4-year follow-up visit, numerous red blood cells floating in the anterior chamber, angle hyphema, and opening of the LOT cleft were observed in the right eye. No possible cause of hyphema such as rubeosis, Swan syndrome, or uveitis-glaucoma-hyphema syndrome was identified. This case suggests that SC can remain open for an extended time even after incisional LOT such as μLOT.

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          Most cited references 20

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          Clinical results with the Trabectome for treatment of open-angle glaucoma.

          To describe clinical results from a pilot study of a novel glaucoma surgical device. Prospective interventional case series. Thirty-seven adult Hispanic and Caucasian patients (17 male, 20 female) with uncontrolled open-angle glaucoma (OAG) in one or both eyes with or without previous surgery or laser treatment were recruited from a clinical practice in Tijuana, Mexico. Surgery was performed with the Trabectome (NeoMedix Corp., San Juan Capistrano, CA) in one eye of each patient. Goldmann applanation intraocular pressures and Snellen visual acuities were measured before and after surgery. Intraoperative and postoperative adverse events were tabulated, and numbers of preoperative and postoperative adjunctive medications were compared before and after surgery. Preoperative pressures after 1 week of medication washout averaged 28.2+/-4.4 mmHg (n = 37). Only 3 patients were not using topical medications preoperatively. Follow-up ranged between 3 months (n = 37) and 13 months (n = 11). Mean postoperative IOPs were 18.4+/-10.9 mmHg (n = 37) at 1 day, 17.5+/-5.9 mmHg (n = 37) at 1 week, 17.4+/-3.5 mmHg (n = 25) at 6 months, and 16.3+/-2.0 mmHg (n = 15) at 12 months. Visions returned to within 2 lines of preoperative levels and remained stable in all patients beyond 3 weeks postoperatively except one, not sutured at surgery, who had a late hyphema probably associated with corneal wound gaping after accidental blunt trauma. The number of adjunctive medications decreased from 1.2+/-0.6 among preoperative patients on medications (n = 34) to 0.4+/-0.6 among all patients at 6 months (n = 25). Blood reflux occurred in all eyes on instrument withdrawal after angle surgery and was present at day 1 in 22 eyes (59%) with clearing by slit-lamp examination at a mean of 6.4+/-4.1 days postoperatively. The Trabectome seems to offer a safe and effective method of lowering IOP in OAG.
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            Canaloplasty: A Minimally Invasive and Maximally Effective Glaucoma Treatment

            Canaloplasty is a highly effective, minimally invasive, surgical technique indicated for the treatment of open-angle glaucoma that works by restoring the function of the eye's natural outflow system. The procedure's excellent safety profile and long-term efficacy make it a viable option for the majority of glaucoma patient types. It can be used in conjunction with existing drug based glaucoma treatments, after laser or other types of incisional surgery, and does not preclude or affect the outcome of future surgery. Numerous scientific studies have shown Canaloplasty to be safe and effective in lowering IOP whilst reducing medication dependence. A recent refinement of Canaloplasty, known as ab-interno Canaloplasty (ABiC), maintains the IOP-lowering and safety benefits of traditional (ab-externo) Canaloplasty using a more efficient, simplified surgical approach. This paper presents a review of Canaloplasty indications, clinical data, and complications, as well as comparisons with traditional incisional glaucoma techniques. It also addresses the early clinical evidence for ABiC.
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              Short-term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series.

              To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT).
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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2021
                January - April 2021
                13 January 2021
                : 12
                : 1
                : 57-61
                Affiliations
                Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo, Japan
                Author notes
                *Masaki Tanito, Department of Ophthalmology, Shimane University Faculty of Medicine, 89-1 Enya, Izumo, Shimane 693-8501 (Japan), tanito-oph@umin.ac.jp
                Article
                510931 PMC7879268 Case Rep Ophthalmol 2021;12:57–61
                10.1159/000510931
                PMC7879268
                33613251
                © 2021 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Pages: 5
                Categories
                Case Report

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