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14 pages, 1528 KiB  
Article
Surgical Outcomes of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in Primary and Secondary Open- and Closed-Angle Glaucoma
by Liron Naftali Ben Haim, Veronika Yehezkeli, Assaf Kratz, Nimrod Dar, Tal Sharon, Gal Harel, Zvia Burganski-Eliash and Avner Belkin
Diagnostics 2025, 15(10), 1226; https://doi.org/10.3390/diagnostics15101226 - 13 May 2025
Viewed by 586
Abstract
Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group [...] Read more.
Background: Gonioscopy-assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival-sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open- and closed-angle glaucomas with or without cataract extraction and to report on risk factors for failure. Methods: A retrospective chart review of consecutive patients with primary or secondary open- or closed-angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics, and postoperative outcomes were collected from patients’ medical records. Primary outcomes were success rates (IOP of 18 mmHg or lower and one of the following: IOP reduction > 30% from baseline on the same or fewer medications or an IOP ≤ baseline with fewer medications as compared to baseline) and complication rates. Intraocular pressure (IOP) and the number of glaucoma medications were secondary outcome measures. Results: GATT was performed on 126 eyes of 121 patients. Mean follow-up was 583 ± 266 days. Cumulative success at 1Y was 0.88 for GATT combined with cataract extraction, 0.96 for GATT alone, 0.88 for primary open-angle glaucoma (POAG), 0.89 for secondary open-angle glaucoma (SOAG), and 0.76 for primary angle-closure glaucoma (PACG). IOP decreased from a mean of 20.65 mmHg to 14.1 mmHg, and medication decreased from a mean of 3.47 to 1.4 at the last follow-up. Forty-four eyes (34%) were classified as failures. Factors associated with an increased risk of failure were worse preoperative corrected visual acuity (OR = 2.46, p = 0.024) and a postoperative IOP spike (OR = 2.62, p = 0.028). Twelve eyes (9.5%) required further surgery for IOP control. Risk factors for requiring further surgery for IOP control were preoperative maximal IOP (OR = 1.066, p = 0.047) and a postoperative IOP spike (OR = 4.531, p = 0.036). Conclusions: GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. GATT should be considered early in the treatment paradigm of medically uncontrolled glaucoma. Full article
(This article belongs to the Special Issue Diagnosis and Management of Ophthalmic Disorders)
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10 pages, 426 KiB  
Article
Affordable Sinskey Hook Goniotomy and Cataract Surgery in Black and Afro-Latino Patients Diagnosed with Glaucoma: Retrospective Real-World One-Year Results
by Idaima Calderon and Daniel Laroche
J. Clin. Med. 2025, 14(10), 3266; https://doi.org/10.3390/jcm14103266 - 8 May 2025
Viewed by 559
Abstract
Background/Objectives: This study aimed to evaluate the effectiveness of early phacoemulsification cataract surgery combined with goniotomy using a Sinskey hook in patients with glaucoma. Methods: This was a retrospective study conducted at Advanced Eye Care of New York; a private practice located [...] Read more.
Background/Objectives: This study aimed to evaluate the effectiveness of early phacoemulsification cataract surgery combined with goniotomy using a Sinskey hook in patients with glaucoma. Methods: This was a retrospective study conducted at Advanced Eye Care of New York; a private practice located in New York City. Most patients carried diagnoses of mild to moderate glaucoma and were mainly Black and Afro-Latino in origin. The patients included in this study were those who underwent early phacoemulsification cataract surgery combined with goniotomy performed with a reusable Sinskey hook (Ambler 200 μm tip) between January 2022 and August 2023 and completed 1 year of follow-up. The primary outcome measures were intraocular pressure, number of medications used, visual acuity, visual field indices, pre-/post-operative spherical refractive error, and adverse events. Results: A total of 121 eyes were identified with a 1-year follow-up that underwent this combined surgery. The mean age was 65. The mean medically treated pre-operative intraocular pressure ± standard deviation (SD) was lowered from 16.40 ± 4.5 mmHg at baseline to 14.66 ± 3.1 mmHg at 1 year, a statistically significant reduction of 10.6%. There was an 82% reduction in the mean ± SD number of intraocular pressure-lowering medications used, from 1.67 ± 1.2 at baseline to 0.30 ± 0.8 at 1 year. Out of the 121 eyes, 83% (103 eyes) remained medication-free at 1-year post-operation. Post-operatively, there were five IOP spikes (IOP ≥ 30 mmHg) and eight hyphemas that were noted, addressed, and resolved. Conclusions: Early cataract surgery combined with Sinskey hook goniotomy microinvasive surgery effectively reduced intraocular pressure and medication burden in this cohort of predominantly Black and Afro-Latino patients diagnosed with glaucoma with 1-year follow-up. Full article
(This article belongs to the Special Issue New Insights into Glaucoma)
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11 pages, 865 KiB  
Article
Kahook Dual Blade Goniotomy Outcomes in the Underserved Dominican Republic Black and Afro-Latinx Population
by Cristos Ifantides, Hernan Bejar, Jennifer Patnaik, Erin Sieck, Mina Pantcheva, Cara Capitena Young, Margarita Arbaje and William McCollum
J. Clin. Med. 2025, 14(7), 2201; https://doi.org/10.3390/jcm14072201 - 24 Mar 2025
Viewed by 741
Abstract
Background/Objectives: Black and Afro-Latinx communities have a higher propensity for more-severe glaucoma at a younger age. This study aimed to use the Kahook Dual Blade (KDB) to treat all glaucoma subtypes and severity levels in this historically underserved community. Materials and Methods: This [...] Read more.
Background/Objectives: Black and Afro-Latinx communities have a higher propensity for more-severe glaucoma at a younger age. This study aimed to use the Kahook Dual Blade (KDB) to treat all glaucoma subtypes and severity levels in this historically underserved community. Materials and Methods: This study involved a retrospective analysis of surgical case records, with follow-up through 20 months. The subjects were glaucoma patients at Hospital Elias Santana in Santo Domingo, Dominican Republic. Inclusion criteria were age >18 years and a minimum follow-up of 1 year after surgery. All glaucoma subtypes and disease severities were included, including previous glaucoma procedures. Sequential patients undergoing KDB goniotomy alone or in combination with phacoemulsification cataract surgery were assessed. IOP data and number of medications were collected at specific time points: baseline, postoperative day 1, postoperative week 1, and postoperative months 1, 3, 6, 12, 16, and 20. Surgical outcome was determined using IOP and number of medications. Success was defined as either a 20% or more reduction in IOP or a decrease in at least one topical therapy. Recorded postoperative complications were hyphema, ocular hypertension, and need for additional glaucoma surgery. Results: A total of 90 eyes from 90 patients were included. A total of 100% of the patient population was Black or Afro-Latinx. The most common glaucoma subtype was primary open-angle (76.7%). Most of the eyes had severe glaucoma (53.3%). The mean preoperative baseline IOP was 20.5 mmHg. The mean postoperative IOP from all time points ranged from 12.9 to 13.5 mmHg (all time points were significantly lower than baseline IOP, p < 0.0001). A mean reduction in IOP percent of at least 31.5% was seen at every time point. There was a mean reduction of two medications by postoperative month 20. Surgical success was achieved in 95.6% of patients at postoperative month 1 and remained high throughout the study period (95.4% at month 20). Conclusions: KDB goniotomy achieved successful IOP and medication reduction across all levels of glaucoma severity. Surgical success rates were maintained to 20 months. While MIGS has historically been used as an intervention in mild-to-moderate glaucoma, our study results show that the KDB can play a significant role in all stages of glaucoma, including severe. MIGS should be considered as a favorable intervention in all disease severities in Black and Afro-Latinx communities around the world. Full article
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16 pages, 683 KiB  
Article
Comparison of Standalone Tanito Microhook Trabeculotomy Between Unilateral and Bilateral Incision Groups
by Kazunobu Sugihara, Chisako Ida, Hinako Ohtani and Masaki Tanito
J. Clin. Med. 2025, 14(6), 1976; https://doi.org/10.3390/jcm14061976 - 14 Mar 2025
Cited by 1 | Viewed by 732
Abstract
Background/Objectives: Trabeculotomy using the Tanito microhook (TMH) is a minimally invasive glaucoma surgery (MIGS) technique that effectively reduces intraocular pressure (IOP). The optimal incision extent for standalone TMH remains unclear. This study aimed to compare the surgical efficacy and safety of unilateral (120-degree) [...] Read more.
Background/Objectives: Trabeculotomy using the Tanito microhook (TMH) is a minimally invasive glaucoma surgery (MIGS) technique that effectively reduces intraocular pressure (IOP). The optimal incision extent for standalone TMH remains unclear. This study aimed to compare the surgical efficacy and safety of unilateral (120-degree) and bilateral (240-degree) incisions in standalone TMH for primary open-angle glaucoma or late-onset juvenile open-angle glaucoma in patients without a history of intraocular surgery. Methods: This retrospective study analyzed 81 eyes of 48 patients who underwent standalone TMH at Shimane University Hospital. Patients were categorized into unilateral (29 eyes) or bilateral (52 eyes) incision groups. The primary outcomes were IOP reduction and medication score changes over 12 months. Secondary outcomes included best-corrected visual acuity (BCVA), anterior chamber (AC) flare, corneal endothelial cell density (CECD), and postoperative complications, particularly hyphema, assessed using the Shimane University Postoperative Hyphema Scoring System (SU-RLC). Multivariate mixed-effects regression and Kaplan–Meier survival analyses were performed. Results: At 12 months, IOP reduction was comparable between the unilateral (23%) and bilateral (28%) groups (p = 0.29). The unilateral group had a significantly lower medication score at postoperative day 3 (p = 0.0057) and week 2 (p = 0.033). No significant differences were observed in BCVA, AC flare, CECD, or visual field mean deviation (MD). However, the bilateral group had significantly higher hyphema scores (p = 0.017), with more cases of layered hyphema. Conclusions: Unilateral standalone TMH achieved equivalent IOP and medication score reductions compared to bilateral incisions, with a lower risk of early postoperative hyphema. The unilateral approach may be preferable for faster visual recovery. Full article
(This article belongs to the Special Issue Clinical Debates in Minimally Invasive Glaucoma Surgery (MIGS))
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13 pages, 1070 KiB  
Review
Primary Congenital and Childhood Glaucoma—A Complex Clinical Picture and Surgical Management
by Valeria Coviltir, Maria Cristina Marinescu, Bianca Maria Urse and Miruna Gabriela Burcel
Diagnostics 2025, 15(3), 308; https://doi.org/10.3390/diagnostics15030308 - 28 Jan 2025
Cited by 1 | Viewed by 2421
Abstract
Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it [...] Read more.
Childhood glaucoma encompasses a group of rare but severe ocular disorders characterized by increased intraocular pressure (IOP), posing significant risks to vision and quality of life. Primary congenital glaucoma has a prevalence of one in 10,000–68,000 people in Western countries. More worryingly, it is responsible for 5–18% of all childhood blindness cases. According to the Childhood Glaucoma Research Network (CGRN), this spectrum of disease is classified into primary glaucoma (primary congenital glaucoma and juvenile open-angle glaucoma) and secondary glaucomas (associated with non-acquired ocular anomalies, non-acquired systemic disease, acquired conditions, and glaucoma after cataract surgery). They present very specific ocular characteristics, such as buphthalmos or progressive myopic shift, corneal modifications such as Haab striae, corneal edema or increased corneal diameter, and also glaucoma findings including high intraocular pressure, specific visual fields abnormalities, and optic nerve damage such as increased cup-disc ratio, cup-disc ratio asymmetry of at least 0.2 and focal rim thinning. Surgical intervention remains the cornerstone of treatment, and initial surgical options include angle surgeries such as goniotomy and trabeculotomy, aimed at improving aqueous outflow. For refractory cases, trabeculectomy and glaucoma drainage devices (GDDs) serve as second-line therapies. Advanced cases may require cyclodestructive procedures, including transscleral cyclophotocoagulation, reserved for eyes with limited visual potential. All in all, with appropriate management, the prognosis of PCG may be quite favorable: stationary disease has been reported in 90.3% of cases after one year, with a median visual acuity in the better eye of 20/30. Immediate recognition of the specific signs and symptoms by caregivers, primary care providers, and ophthalmologists, followed by prompt diagnosis, comprehensive surgical planning, and involving the caregivers in the follow-up schedule remain critical for optimizing outcomes in childhood glaucoma management. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Management of Eye Diseases, Second Edition)
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8 pages, 227 KiB  
Article
Vision-Related Quality of Life following Combined Cataract and Minimally Invasive Glaucoma Surgery or Cataract Surgery Alone in Glaucoma Patients
by Yuki Yuasa, Kazuyuki Hirooka, Naoki Okada, Hiromitsu Onoe, Yumiko Murakami, Hideaki Okumichi and Yoshiaki Kiuchi
J. Clin. Med. 2023, 12(9), 3279; https://doi.org/10.3390/jcm12093279 - 4 May 2023
Cited by 4 | Viewed by 2114
Abstract
This study examined glaucoma patients after undergoing combined cataract and minimally invasive glaucoma surgery (MIGS), microhook ab interno trabeculotomy and goniotomy with the Kahook Dual Blade (KDB), or cataract surgery alone, and it then evaluates their vision-related quality of life (VR-QOL) following the [...] Read more.
This study examined glaucoma patients after undergoing combined cataract and minimally invasive glaucoma surgery (MIGS), microhook ab interno trabeculotomy and goniotomy with the Kahook Dual Blade (KDB), or cataract surgery alone, and it then evaluates their vision-related quality of life (VR-QOL) following the procedure. A total of 75 eyes of 75 consecutive glaucoma patients in this prospective cohort study underwent phacoemulsification (Phaco) or phaco and MIGS (Phaco-TLO) between October 2019 and March 2022. In all cases, the National Eye Institute Visual Function Questionnaire (VFQ-25) was used to evaluate the 20 eyes in the Phaco group and the 55 eyes in the Phaco-TLO group before and at 2 months after surgery. There was a significant increase in the visual acuity (logMAR) at 2 months post-operatively (Phaco group; 0.34 ± 0.10 to −0.07 ± 0.1, p < 0.0001, Phaco-TLO group; 0.37 ± 0.43 to 0.09 ± 0.32, p < 0.0001). The median (25–75th percentile) total VFQ scores in the Phaco group before and at 2 months after surgery were 71.1 (62.4–80.6) and 79.4 (69.0–84.0), respectively. (p = 0.006). The median (25–75th percentile) total VFQ scores in the Phaco-TLO group before and at 2 months after surgery were 69.8 (55.3–78.6) and 74.7 (65.1–83.3), respectively. (p = 0.005). Glaucoma patients who underwent not only cataract surgery alone but also combined cataract surgery and MIGS exhibited significant improvement in the VR-QOL. Full article
(This article belongs to the Section Ophthalmology)
9 pages, 774 KiB  
Article
Goniotomy for Non-Infectious Uveitic Glaucoma in Children
by Charlotte L. L. I. van Meerwijk, Astrid B. Edema, Laurentius J. van Rijn, Leonoor I. Los and Nomdo M. Jansonius
J. Clin. Med. 2023, 12(6), 2200; https://doi.org/10.3390/jcm12062200 - 12 Mar 2023
Cited by 6 | Viewed by 1933
Abstract
Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with [...] Read more.
Secondary glaucoma is still a blinding complication in childhood uveitis, for which most commonly used surgical interventions (trabeculectomy or glaucoma drainage implant) involve multiple re-interventions and/or complications postoperatively. The goniotomy procedure has never been investigated in the current era, in which patients with pediatric uveitis receive biologics as immunosuppressive therapy for a prolonged period, with potential implications for the outcome. The purpose of the study is to evaluate the efficacy and safety of a goniotomy procedure in pediatric non-infectious uveitis in a retrospective, multicenter case series. The primary outcomes were the postoperative intraocular pressure (IOP), number of IOP-lowering medications, and success rate. Postoperative success was defined as 6 ≤ IOP ≤ 21 mmHg, without major complications or re-interventions. Fifteen eyes of ten children were included. Median age of the included patients at goniotomy was 7 years; median follow-up was 59 months. Median (interquartile range) IOP before surgery was 30 (26–34) mmHg with 4 (3–4) IOP-lowering medications. At 1, 2, and 5 years after goniotomy, median IOP was 15, 14, and 15 mmHg with 2 (0–2), 1 (0–2), and 0 (0–2) medications, respectively (p < 0.001 postoperatively versus preoperatively for all timepoints). Success rate was 100%, 93%, and 80% after 1, 2, and 5 years, respectively. There were no significant changes in visual acuity and uveitis activity or its treatment, and there were no major complications. Our results show that the goniotomy is an effective and safe surgery for children with uveitic glaucoma. Full article
(This article belongs to the Special Issue Advances in Glaucoma Management and Intraocular Pressure Physiology)
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8 pages, 449 KiB  
Article
Comparison of Mid-Term Outcomes between Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade
by Naoki Okada, Kazuyuki Hirooka, Hiromitsu Onoe, Hideaki Okumichi and Yoshiaki Kiuchi
J. Clin. Med. 2023, 12(2), 558; https://doi.org/10.3390/jcm12020558 - 10 Jan 2023
Cited by 10 | Viewed by 1634
Abstract
This study retrospectively examined the mid-term surgical outcomes between microhook ab interno trabeculotomy (μLOT) and goniotomy when one was using the Kahook Dual Blade (KDB) in combination with phacoemulsification in primary open-angle glaucoma and exfoliation glaucoma patients. Between December 2016 and December 2020, [...] Read more.
This study retrospectively examined the mid-term surgical outcomes between microhook ab interno trabeculotomy (μLOT) and goniotomy when one was using the Kahook Dual Blade (KDB) in combination with phacoemulsification in primary open-angle glaucoma and exfoliation glaucoma patients. Between December 2016 and December 2020, the current study examined 47 μLOT and 52 KDB eyes that underwent surgery. When there was a < 20% reduction in the preoperative intraocular pressure (IOP) or when the IOP was > 18 mmHg (criterion A), the IOP was > 14 mmHg (criterion B) at two consecutive follow-up visits, or when there was a requirement for reoperation, these were all considered to indicate that the surgery failed. A genetic algorithm that used the preoperative IOP was used to determine the score matching. After score matching, a total of 27 eyes were evaluated. In the μLOT and KDB groups, the mean postoperative follow-up periods were 31.2 ± 13.3 and 37.2 ± 16.3 months, respectively. The results for both of the groups show there were significant postoperative reductions in the IOP (p < 0.05) and medication scores (p < 0.05) at 6, 12, 24 and 36 months. At 12, 24, and 36 months, the probabilities of success in the μLOT and KDB groups for criterion A were 70.4% and 48.2%, 61.9% and 48.2%, and 55.0% and 48.2% (p = 0.32; log-rank test), respectively. For criterion B, the results for the two groups were 55.6% and 33.3%, 44.4% and 33.3%, and 44.4% and 33.3% (p = 0.15; log-rank test), respectively. Similar postoperative complications were found between the groups. Comparable mid-term surgical outcomes were found for the uses of μLOT and KDB. Full article
(This article belongs to the Section General Surgery)
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7 pages, 532 KiB  
Article
Corneal Higher-Order Aberrations after Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade: Preliminary Early 3-Month Results
by Hiromitsu Onoe, Kazuyuki Hirooka, Hideaki Okumichi, Yumiko Murakami and Yoshiaki Kiuchi
J. Clin. Med. 2021, 10(18), 4115; https://doi.org/10.3390/jcm10184115 - 12 Sep 2021
Cited by 7 | Viewed by 1915
Abstract
We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that [...] Read more.
We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (μLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent μLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that underwent cataract surgery alone used as controls. Visual acuity and corneal HOAs, coma-like aberrations, and spherical-like aberrations were analyzed before and at 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence HOAs were evaluated. No significant postoperative changes were noted for corneal HOAs, coma-like aberrations, and spherical-like aberrations after cataract surgery alone. The mean corneal HOAs, coma-like aberrations, and spherical-like aberrations were 0.222 ± 0.115 μm, 0.203 ± 0.113 μm, and 0.084 ± 0.043 μm at baseline and 0.326 ± 0.195 μm (p < 0.001), 0.302 ± 0.289 μm (p = 0.03), and 0.150 ± 0.115 μm (p < 0.001) at 3 months after LOT-Phaco, respectively. Results of the analysis for risk factors suggested that a longer incision in Schlemm’s canal could influence corneal HOAs, coma-like aberrations, and spherical-like aberrations after LOT-Phaco. Although no significant postoperative changes were observed in corneal HOAs and coma-like or spherical-like aberrations after cataract surgery alone, a significant increase in corneal HOAs and coma-like or spherical-like aberrations remained after the LOT-Phaco procedure. Full article
(This article belongs to the Special Issue Intraocular Pressure and Ocular Hypertension)
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12 pages, 1010 KiB  
Article
Effects of Preoperative Intraocular Pressure Level on Surgical Results of Microhook Ab Interno Trabeculotomy
by Masaki Tanito, Kazunobu Sugihara, Aika Tsutsui, Katsunori Hara, Kaoru Manabe and Yotaro Matsuoka
J. Clin. Med. 2021, 10(15), 3327; https://doi.org/10.3390/jcm10153327 - 28 Jul 2021
Cited by 19 | Viewed by 2598
Abstract
To assess the roles of preoperative intraocular pressure (IOP) level on the IOP reducing efficacy of microhook ab interno trabeculotomy (µLOT), 126 consecutive open-angle glaucomatous eyes (90 primary open angle glaucoma, 36 exfoliation glaucoma) of 126 Japanese subjects (60 men, 66 women; mean [...] Read more.
To assess the roles of preoperative intraocular pressure (IOP) level on the IOP reducing efficacy of microhook ab interno trabeculotomy (µLOT), 126 consecutive open-angle glaucomatous eyes (90 primary open angle glaucoma, 36 exfoliation glaucoma) of 126 Japanese subjects (60 men, 66 women; mean age ± standard deviation, 70.5 ± 11.4 years) who underwent µLOT alone (25 eyes, 20%) or combined µLOT and cataract surgery (101 eyes, 80%) were retrospectively included, and subdivided into four groups based on the quartile of preoperative IOP: Q1, ≤15 mmHg; Q2, 15–18 mmHg, Q3, 18–21 mmHg, and Q4, >21 mmHg. Preoperative and 12 months postoperative IOPs and numbers of antiglaucoma medications were compared among IOP groups. Factors associated with postoperative IOP were assessed using multivariate analysis, and the success of IOP control was assessed with various definitions. Postoperatively, IOP was significantly higher in Q3 (p < 0.0146) and Q4 (p = 0.0320) groups than Q1 group, while the number of medications was not significantly different among four IOP groups (p = 0.1966). Older age was associated with lower postoperative IOP, and higher preoperative IOP was associated with higher postoperative IOP, while sex, glaucoma type, surgical procedure, lens status, extent of trabeculotomy incision, and preoperative number of medications were not associated with postoperative IOP. The success rates for IOP ≤ 18 and ≤15 mmHg were higher in lower preoperative IOP groups (i.e., Q1 and Q2) than higher preoperative IOP groups (Q3 and Q4), while the success rate for ≥20% IOP reduction was higher in higher preoperative IOP groups than in lower preoperative IOP groups; the success rate for ≥0% IOP reduction was equivalent among groups. By reviewing the previous studies in ab interno trabeculotomy/goniotomy procedures, positive correlation between preoperative and postoperative IOPs was preserved throughout the studies and surgical procedures. After the µLOT, larger %IOP reduction was achieved in higher preoperative IOP groups than in lower preoperative IOP groups, while postoperative IOP was still lower than in lower preoperative IOP groups. Full article
(This article belongs to the Special Issue Novel Therapeutics in Glaucoma Management)
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11 pages, 257 KiB  
Review
Angle Surgery in Pediatric Glaucoma Following Cataract Surgery
by Emery C. Jamerson, Omar Solyman, Magdi S. Yacoub, Mokhtar Mohamed Ibrahim Abushanab and Abdelrahman M. Elhusseiny
Vision 2021, 5(1), 9; https://doi.org/10.3390/vision5010009 - 5 Feb 2021
Cited by 5 | Viewed by 3160
Abstract
Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of [...] Read more.
Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS. Full article
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