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      Outcomes of 360° suture trabeculotomy with deep sclerectomy combined with cataract surgery for primary open angle glaucoma and coexisting cataract

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          Abstract

          Background

          The purpose of this study was to investigate treatment outcomes in 360° suture trabeculotomy with deep sclerectomy combined with phacoemulsification and aspiration and intraocular lens implantation (360P-LOT + DS)

          Methods

          Thirty-two eyes in 32 consecutive patients treated by 360P-LOT + DS for primary open angle glaucoma with coexisting cataracts at Sato Eye Clinic from March 2011 to April 2013 were retrospectively compared with 23 eyes in 23 consecutive patients treated by cataract surgery and 120° trabeculotomy with deep sclerectomy (120P-LOT + DS) at the same clinic from January 2010 to February 2011. The parameters investigated during the 15 months after surgery were the course of intraocular pressure, number of antiglaucoma medications, best-corrected visual acuity, and complications.

          Results

          Both groups showed a significant decrease in intraocular pressure starting at one month after surgery when compared with values before surgery. At 3, 6, 9, and 15 months after surgery, the intraocular pressure was significantly lower and the survival rate was significantly higher in the 360P-LOT + DS group compared with the 120P-LOT + DS group. The number of antiglaucoma medications, best-corrected visual acuity value, and complications did not differ significantly between the groups.

          Conclusion

          Although the complications are similar to those seen in 120P-LOT + DS, treatment of primary open angle glaucoma and coexisting cataracts using 360P-LOT + DS may yield better outcomes.

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          Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up.

          E. Craven, L. Jay Katz, Jeffrey M. Wells … (2012)
          To assess the long-term safety and efficacy of a single trabecular micro-bypass stent with concomitant cataract surgery versus cataract surgery alone for mild to moderate open-angle glaucoma. Twenty-nine investigational sites, United States. Prospective randomized controlled multicenter clinical trial. Eyes with mild to moderate glaucoma with an unmedicated intraocular pressure (IOP) of 22 mm Hg or higher and 36 mm Hg or lower were randomly assigned to have cataract surgery with iStent trabecular micro-bypass stent implantation (stent group) or cataract surgery alone (control group). Patients were followed for 24 months postoperatively. The incidence of adverse events was low in both groups through 24 months of follow-up. At 24 months, the proportion of patients with an IOP of 21 mm Hg or lower without ocular hypotensive medications was significantly higher in the stent group than in the control group (P=.036). Overall, the mean IOP was stable between 12 months and 24 months (17.0 mm Hg ± 2.8 [SD] and 17.1 ± 2.9 mm Hg, respectively) in the stent group but increased (17.0 ± 3.1 mm Hg to 17.8 ± 3.3 mm Hg, respectively) in the control group. Ocular hypotensive medication was statistically significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant. Patients with combined single trabecular micro-bypass stent and cataract surgery had significantly better IOP control on no medication through 24 months than patients having cataract surgery alone. Both groups had a similar favorable long-term safety profile. Dr. Craven was an investigator in the clinical trial of the iStent. Dr. Katz is a consultant to Glaukos and was the medical monitor for the clinical trial of the iStent. Dr. Katz is a stockholder in Glaukos. Mr. Wells and Ms. Giamporcaro are employees of Glaukos. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.
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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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              Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study.

              Angelo Casa, Julián García-Feijoo, David Valle … (2012)
              To evaluate the long-term efficacy and safety of combined cataract surgery and Glaukos iStent implantation for coexistent open-angle glaucoma and cataract. Prospective, non-comparative, uncontrolled, non-randomised, interventional case series study. Subjects older than 18 years with coexistent uncontrolled mild or moderate open-angle glaucoma (including pseudoexfoliative and pigmentary) and cataract underwent phacoemulsification and intraocular lens implantation along with ab-interno gonioscopically guided implantation of one Glaukos iStent. The variables recorded during a minimum of 3 years of follow-up were: intraocular pressure (IOP), number of antiglaucoma medications and best-corrected visual acuity. The 19 patients enrolled were 58-88 years old (mean age 74.6±8.44 years). Mean follow-up was 53.68±9.26 months. Mean IOP was reduced from 19.42±1.89 mm Hg to 16.26±4.23 mm Hg (p=0.002) at the end of follow up, indicating a 16.33% decrease in IOP. The mean number of pressure-lowering medications used by the patients fell from 1.32±0.48 to 0.84±0.89 (p=0.046). In 42% of patients, no antiglaucoma medications were used at the end of follow-up. Mean best-corrected visual acuity significantly improved from 0.29±0.13 to 0.62±0.3 (p<0.001). No complications of surgery were observed. Combined cataract surgery and Glaukos iStent implantation seems to be an effective and safe procedure to treat coexistent open-angle glaucoma and cataract.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (iso-abbrev): Clin Ophthalmol
                Journal ID (publisher-id): Clinical Ophthalmology
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove Medical Press
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date Collection: 2014
                Publication date (Electronic): 11 July 2014
                Volume: 8
                Pages: 1301-1310
                Affiliations
                [1 ]Sato Eye Clinic, Kumamoto, Japan
                [2 ]Hayashi Eye Hospital, Fukuoka, Japan
                [3 ]Mizoguchi Eye Clinic, Nagasaki, Japan
                Author notes
                Correspondence: Tomoki Sato, Sato Eye Clinic, 4160-270 Arao, Arao City, Kumamoto, 864-0041, Japan, Tel +81 9 6865 5900, Fax +81 9 6865 5902, Email zxsato@ 123456gmail.com
                Article
                Publisher ID: opth-8-1301
                DOI: 10.2147/OPTH.S64264
                PMC ID: 4103920
                PubMed ID: 25050060
                SO-VID: 26377367-0ee4-4b99-8ece-bbb778b63e50
                Copyright © © 2014 Sato et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License
                License:

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                History
                Categories
                Subject: Original Research

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: nonpenetrating surgery,trabeculectomy,iop spike
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: nonpenetrating surgery, trabeculectomy, iop spike

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