Oculoplastic considerations in patients with glaucoma

Tan, Puay‐Hoon; Malhotra, Raman

doi:10.1016/j.survophthal.2016.03.008

Cited by 20 publications

(23 citation statements)

References 99 publications

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“…21,22 In addition to the risk of intraoperative bleb damage during ptosis repair, overcorrection could lead to chronic bleb or GDD exposure with increased risk for bleb leak and blebitis or endophthalmitis. 11,23 GDD patients had a greatly increased risk for lagophthalmos compared to both trab and control patients (46.2% vs 9.2% and 11%, respectively) in our study. However, we found no cases of bleb leak, GDD erosion, or infection after ptosis repair.…”

Section: Discussioncontrasting

confidence: 41%

“…6-10 Furthermore, topical prostaglandin-analogs (PGA) have been linked to periorbitopathy and ptosis through Müller muscle degeneration and orbital adipocyte apoptosis. 11 Ptosis can lead to both functional and cosmetic defects across all patient populations, adversely affecting quality of life. 12,13 In addition to restricting the already compromised peripheral vision in glaucoma patients, ptosis may interfere with accurate measurement of intraocular pressure (IOP) and interpretation of visual field (VF) testing.…”

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confidence: 99%

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Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

Song

Khanna

Jamali

et al. 2021

European Journal of Ophthalmology

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Purpose: There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. Methods: A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. Results: Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. Conclusions: Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.

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Section: Discussioncontrasting

confidence: 41%

mentioning

confidence: 99%

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

Song

Khanna

Jamali

et al. 2021

European Journal of Ophthalmology

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“…Moreover, prolonged use of topical PGAs increases the frequency of periocular changes referred to as prostaglandin-associated periorbitopathy (PAP), including deepening of the upper eyelid sulcus (DUES), upper eyelid ptosis/retraction, loss of inferior orbital fat pads and enophthalmos, eyelid pigmentation, and eyelash changes. 41 Notwithstanding these local ADRs, a favorable systemic side-effect profile compared with β-adrenergic antagonists is one of the key reasons for the designation of PGAs as first-line medical therapy. Ripasudil's systemic side-effect profile is equal or superior to that of PGAs because the reported systemic adverse effects are minimal except for allergic reactions, and most of the local adverse events are transient and/or mild in patients treated with ripasudil compared with those in patients treated with PGAs.…”

Section: Patient Selectionmentioning

confidence: 99%

<p>Ripasudil Hydrochloride Hydrate in the Treatment of Glaucoma: Safety, Efficacy, and Patient Selection</p>

Kusuhara¹,

Nakamura²

2020

OPTH

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Reduction of intraocular pressure (IOP) is the only reliable treatment for glaucoma that maintains the patient's visual function throughout life, and IOP-lowering eyedrops are the mainstay of therapy. Ripasudil hydrochloride hydrate (brand name: Glanatec ophthalmic solution 0.4%; Kowa Company, Ltd., Japan) is a Rho-associated coiled-coil-containing protein kinase (ROCK) inhibitor that lowers IOP by increasing conventional aqueous outflow. Since the approval of ripasudil eyedrops in 2014, a large store of clinical data has been amassed in Japan. With regard to safety, conjunctival hyperemia is the most common adverse drug reaction (ADR) and is usually transient and mild. Blepharitis and allergic conjunctivitis are other major local ADRs. Systemic ADRs are rare, but we should be wary of allergic reactions. With regard to efficacy, ripasudil is expected to lower IOP in almost all glaucoma subtypes (including primary open-angle glaucoma, secondary glaucoma, and primary angleclosure glaucoma) and in all patterns of treatment initiation (monotherapy, combination therapy, switching therapy, and add-on therapy). However, the status of the trabecular meshwork may affect the IOP-lowering effect of ripasudil. In patient selection, current evidence-based information on the safety and efficacy of ripasudil should be fully considered. As irreversible damage to the trabecular meshwork would considerably affect efficacy, it may be better to start ripasudil treatment during an early stage of glaucoma.

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“…Six patients had no complications, whereas one patient experienced anterior chamber inflammation and another patient had subjective foreign body sensation for 6 weeks. Tan and Malhotra highlighted issues surrounding the oculoplastic management of glaucoma patients and emphasized the importance of under correcting ptosis in patients who are post‐trabeculectomy in order to avoid post‐trabeculectomy eyelid retraction. In post‐trabeculectomy patients, especially in the setting of a thinned and cystic bleb, some strong advocates of posterior approach ptosis surgery prefer an anterior approach (Malhotra, personal communication, 2019).…”

Section: Can Posterior Approach Ptosis Surgery Be Used In High Risk Pmentioning

confidence: 99%

How far we have come: A review of the evolution of posterior approach ptosis surgery

Ullrich

Malhotra

2019

Clinical Exper Ophthalmology

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We revisit the evolution of posterior approach ptosis surgery. We address the early attempts at ptosis surgery, assess the more modern approach by de Blaskovics, followed by the division into “open sky” and “closed” techniques. The simultaneous developments occurring in America and Europe are described, along with refinement of surgical approaches such as conjunctival‐sparing posterior approach ptosis surgery.

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Oculoplastic considerations in patients with glaucoma

Cited by 20 publications

References 99 publications

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery

<p>Ripasudil Hydrochloride Hydrate in the Treatment of Glaucoma: Safety, Efficacy, and Patient Selection</p>

How far we have come: A review of the evolution of posterior approach ptosis surgery

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