Nd:YAG laser goniopuncture after deep sclerectomy: outcomes

Anand, Nitin; Pilling, Rachel

doi:10.1111/j.1755-3768.2008.01494.x

Cited by 71 publications

(85 citation statements)

References 22 publications

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“…28 Hypotony was observed in 3% of our cohort, which also compares favourably with the hypotonyrate of 7.2% reported by the aforementioned paper by Kirwan et al 25 Over a mean follow-up period of 63.5 months (in 296 eyes), we only observed three serious complications related to hypotony: two eyes required resuturing, whereas one resulted in delayed LGP is considered an important adjunct to DS in achieving low target IOPs. Reported rates vary from 36 to 67% 19,[28][29][30][31] The overall rate of LGP in our cohort was 54.4%. Patients in the phaco-DS with MMC group had a significantly greater chance of undergoing LGP (75.7%) compared with the unaugmented phaco-DS group (51.4%) at 5 years after surgery (P = 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…Detailed techniques for LGP and iridoplasty have already been described in a previous publication. 19 Complete (unqualified) success criteria were defined as follows: (A) IOP o19 mm Hg and/or 20% decrease from baseline off any glaucoma medications. Failure in this group was defined as IOP = 419 mm Hg or IOP not reduced by 20% of preoperative IOP or IOP o6 mm Hg on two consecutive time points after 3 months; (B) IOP o16 mm Hg and/or 30% drop from baseline off any glaucoma medications.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Mercieca

Shevade

Anand

2015

Eye

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Purpose To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. Methods Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre-and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP o19 mm Hg and/or 20% decrease from baseline and (B) IOP o16 mm Hg and/or 30% drop from baseline. Results Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeatedmeasures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. Conclusions This study confirms the longterm safety and efficacy of phaco-DS as a primary glaucoma procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Mercieca

Shevade

Anand

2015

Eye

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“…The techniques for LGP and iridoplasty are described in detail in a previous publication. 21 Definitions were derived from the TVT trial. 28 Reoperation for glaucoma or a complication was defined as additional surgery requiring a return to the operating theatre.…”

Section: Methodsmentioning

confidence: 99%

“…[18][19][20] The IOP after DS can be further lowered by Nd:YAG laser goniopuncture (LGP) of the TDM. 21,22 Like with trabeculectomy, intraoperative mitomycin C (MMC) application results in lower IOPs in the long term 23,24 and bleb rejuvenation techniques like needle revision can be used. 25 DS with MMC has been reported to be a safe and effective procedure for eyes with failed trabeculectomy.…”

Section: Introductionmentioning

confidence: 99%

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

Anand

Wechsler²

2011

Eye

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Purpose To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE). Patients and methods Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) 418 mm Hg. MMC (0.2 mg/ml) was applied for 2-3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure. Results Mean follow-up was 57.7±22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3-25.6, 95% confidence intervals) to 13.4 mm Hg (12.0-14.2) at 3 years after surgery (Po0.001). There was a significant decrease in the number of glaucoma medications from 2.0±1 preoperatively, to 0.3±0.7, 3 years after surgery. Kaplan-Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained o19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP o6 mm Hg) was the commonest complication in five eyes (6.1%). Conclusion DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.

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“…Puncturing the trabecular Descemet membrane leads to success rates similar to those of TE. [52][53][54] Previously, Feltgen et al used an erbium(Er):YAG laser. They reported that goniopuncture in combination with cataract surgery produced an IOP reduction comparable to that of combined TE and cataract surgery.…”

Section: Goniotomymentioning

confidence: 99%

Endoscopic Goniotomy

Töteberg‐Harms¹,

Ciechanowski²,

Funk³

2012

US Ophthalmic Review

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Glaucoma is a leading cause of preventable and irreversible blindness. [1][2][3][4][5] Glaucoma is a chronic and progressive neurodegenerative disorder causing loss of retinal ganglion cells and their axons. 6 Characteristic 'cupping' of the optic disc is seen with corresponding loss of visual field. Elevated intraocular pressure (IOP) is a causative risk factor for the development and progression of glaucoma, and lowering IOP is the mainstay of treatment. Besides IOP, other risk factors are well-known, e.g. age, family history, and race (e.g. African descent). 7 The balance of aqueous humor production (inflow) and drainage (outflow) determines the IOP. The pathophysiology of elevated IOP in primary open-angle glaucoma (POAG) is dysfunctional drainage, specifically through the trabecular meshwork (TM). 8,9 The exact mechanisms that control drainage through the TM are not fully understood, but changes in the extracellular matrix (ECM) are one of the reasons. Furthermore, pathological accumulations of certain ECM structures within the TM have been described as causative in eyes with POAG.In managing glaucoma patients, lowering the IOP is the only available treatment with a significant body of supporting evidence. [10][11][12][13][14][15][16][17][18][19][20] Medical reduction of IOP is the first line of therapy in most cases. 12,21,20 If medical treatment fails, there are several well-established surgical procedures to reduce IOP. Trabeculectomy (TE) as it is performed today was introduced in 1968 byCairns 23 and at the same time by Linner. 24 It is still the gold standard in glaucoma surgery. The aqueous flows via a scleral flap from the anterior chamber into the subconjunctival space. 25 TE is very effective in long-term IOP reduction. 26,27 The use of antimetabolites during surgery provides an even better long-term success. [28][29][30][31][32][33][34] The greatest outflow resistance is at the location of the juxtacanalicular TM (JCT) and inner wall of Schlemm's canal. Schlemm's canal communicates with the episcleral veins. The drainage of aqueous outflow through the TM into Schlemm's canal and later on into the episcleral veins is called the trabecular outflow (83-96 %, 'conventional' pathway), the remaining 5-15 % of the aqueous humor is drained via the uveoscleral pathway ('alternative' pathway). 35,36 The JCT region, which includes the inner wall of Schlemm's canal and the underlying TM, is thought to be the region where regulation of aqueous humor outflow takes place. [37][38][39] The JCT region has the highest resistance to outflow, especially under conditions of elevated IOP. [39][40][41][42] Although TE remains the mainstay of surgical glaucoma treatment, it remains feasible to enhance aqueous outflow through the conventional pathway. Several surgical approaches have been tried, e.g. ab interno TE with the Trabectome™, 43,44 goniotomy, and goniopuncture, which can be performed with or without endoscopy. This paper focuses on another technique, excimer laser trabeculotomy (ELT, also known as excimer laser...

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Nd:YAG laser goniopuncture after deep sclerectomy: outcomes

Cited by 71 publications

References 22 publications

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

Endoscopic Goniotomy

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