Effect of trabeculectomy and canaloplasty on intra‐ocular pressure modifications after postural changes in open‐angle glaucoma

Quaranta, Luciano; Biagioli, Elena; Riva, Ivano; Tosoni, Claudia; Brusini, Paolo; Centofanti, Marco; Katsanos, Andreas; Floriani, Irene; Konstas, Anastasios G. P.

doi:10.1111/aos.12470

Cited by 22 publications

(11 citation statements)

References 9 publications

(7 reference statements)

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“…As we could show, even little postoperative oedema of the conjunctiva can interfere with the optical imaging of deeper scleral and trabecular structures using AS-OCT. Canaloplasty is believed to re-establish the natural trabeculocanalicular outflow of the eye (Grieshaber et al 2010b). Consequently, eyes after canaloplasty showed postural IOP changes similar to those found in healthy eyes, implying typical functioning outflow pathways (Quaranta et al 2014). Consistent with these results, the SC in our study was significantly dilated during the procedure and could be imaged in almost all patients up to 3 months postoperatively.…”

Section: Discussionmentioning

confidence: 90%

Evaluation of early anatomical changes following canaloplasty with anterior segment spectral‐domain optical coherence tomography and ultrasound biomicroscopy

Fuest

Kuerten

Koch

et al. 2015

Acta Ophthalmologica

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ABSTRACT.Purpose: To analyse structural changes in conjunctiva, sclera and Schlemm's canal (SC) following canaloplasty with optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Methods: Fifteen patients undergoing canaloplasty were included in this prospective study. AS-OCT images were acquired pre-and 1, 7, 30 and 90 days postoperatively. UBM was performed 3 months postoperatively. The surgical site was evaluated for the presence of SC, transscleral filtration, a scleral lake and the visibility of intra-Schlemm-sutures. The height and width of SC were measured at the 3 and 9 o'clock limbus position. Results: After canaloplasty, SC was detectable with AS-OCT in 93% of the patients on day 1. The increase in height was higher than that in width (height: +369%, p = 0.0004, width: +152%, p = 0.002). IOP was negatively correlated to SC's width 1 week postoperatively (r = À0.63, p = 0.04) and to SC's height until 3 months (r = À0.66, p = 0.02) postoperatively. Using UBM, a reflection of the traction sutures indicated SC's position in all patients. Transscleral filtration was found in all patients using AS-OCT, demonstrating a peak 1 week postoperatively. At 3 months, a scleral lake could be visualized in 50% and 83% of patients using AS-OCT and UBM, respectively. Conclusions: AS-OCT offers a high resolution for imaging superficial conjunctival areas and SC after canaloplasty, whereas UBM is capable of detecting deeper structures such as scleral lakes or intra-canal-sutures. The results imply a correlation of the dilation of SC with the IOP-lowering effect and an early pronounced transscleral filtration following canaloplasty.

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Section: Discussionmentioning

confidence: 90%

Evaluation of early anatomical changes following canaloplasty with anterior segment spectral‐domain optical coherence tomography and ultrasound biomicroscopy

Fuest

Kuerten

Koch

et al. 2015

Acta Ophthalmologica

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“…It has been shown that IOP measurements are generally not affected in trabeculectomy-treated eyes, but that canaloplasty-treated eyes have higher IOP measured in a supine position than in a sitting position. 17 Future studies may incorporate multiple centers with multiple measures of IOP, and could also examine the postural effect on IOP measurements. The cost of the implant was not factored into the study design, although this factor would be an important consideration in one’s practice.…”

Section: Discussionmentioning

confidence: 99%

Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication

Katz¹,

Erb²,

Guillamet³

et al. 2015

OPTH

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PurposeTo assess the safety and efficacy of one, two, or three trabecular microbypass stents in eyes with primary open-angle glaucoma (OAG) not controlled on ocular hypotensive medication. A total of 119 subjects were followed for 18 months postoperatively.Materials and methodsSubjects with medicated intraocular pressure (IOP) 18–30 mmHg and postmedication-washout baseline IOP 22–38 mmHg were randomized to implantation of one, two, or three stents. Ocular hypotensive medication was to be used if postoperative IOP exceeded 18 mmHg.ResultsA total of 38 subjects were implanted with one stent, 41 subjects with two stents, and 40 subjects with three stents. Both month 12 IOP reduction ≥20% without ocular hypotensive medication vs baseline unmedicated IOP and month 12 unmedicated IOP ≤18 mmHg were achieved by 89.2%, 90.2%, and 92.1% of one-, two-, and three-stent eyes, respectively. Furthermore, 64.9%, 85.4%, and 92.1% of the three respective groups achieved unmedicated IOP ≤15 mmHg. Over the 18-month follow-up period, medication was required in seven one-stent subjects, four two-stent subjects, and three three-stent subjects. At 18 months, mean unmedicated IOP was 15.9±0.9 mmHg in one-stent subjects, 14.1±1.0 mmHg in two-stent subjects, and 12.2±1.1 mmHg in three-stent subjects. Month 18 IOP reduction was significantly greater (P<0.001) with implantation of each additional stent, with mean differences in reduction of 1.84 mmHg (95% confidence interval 0.96–2.73) for three-stent vs two-stent groups and 1.73 mmHg (95% confidence interval 0.83–2.64) for two-stent vs one-stent groups. Adverse events through 18 months were limited to cataract progression with best-corrected visual acuity loss and subsequent cataract surgery.ConclusionIn this series, implantation of each additional stent resulted in significantly greater IOP reduction with reduced medication use. Titratability of stents as a sole procedure was shown to be effective and safe, with sustained effect through 18 months postoperatively in OAG not controlled with medication.

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“…Der Vergleich von Trabekulektomie und Kanaloplastik in Studien zeigt, dass die Drucksenkung, aber auch die Inzidenz von Komplikationen bei Kanaloplastik geringer und die postoperative Nachsorge weniger intensiv ist [3,6,25,27,30].…”

Section: Vergleich Der Trabekulektomie Und Kanaloplastikunclassified

Trabekulektomie versus Kanaloplastik

Matlach

Klink

2015

Ophthalmologe

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If a higher postoperative IOP is acceptable and additional topical glaucoma medication tolerable, canaloplasty can be considered as an alternative to trabeculectomy as the incidence of complications is low and postoperative care less intensive. Canaloplasty may also be suitable for patients with high risk of bleb failure and early glaucoma with a target IOP not necessarily requiring a filtering procedure. Therefore, canaloplasty offers a treatment option for the management of open-angle glaucoma, especially in combination with cataract surgery.

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Effect of trabeculectomy and canaloplasty on intra‐ocular pressure modifications after postural changes in open‐angle glaucoma

Cited by 22 publications

References 9 publications

Evaluation of early anatomical changes following canaloplasty with anterior segment spectral‐domain optical coherence tomography and ultrasound biomicroscopy

Evaluation of early anatomical changes following canaloplasty with anterior segment spectral‐domain optical coherence tomography and ultrasound biomicroscopy

Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication

Trabekulektomie versus Kanaloplastik

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