Primary Viscocanalostomy for Juvenile Open-angle Glaucoma

Stangos, Alexandros N.; Whatham, Andrew; Sunaric-Mégevand, Gordana

doi:10.1016/j.ajo.2005.04.038

Cited by 38 publications

(10 citation statements)

References 27 publications

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“…Studies have shown that viscocanalostomy, goniotomy and external trabeculotomy can also be performed in eyes with juvenile-onset open angle glaucoma [20,21,22]. However, these studies have small numbers, are mostly retrospective and do not take into account the long-term structural and functional changes associated with IOP control in these patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

Gupta¹,

Ov²,

Rao³

et al. 2011

Ophthalmologica

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Objective: To evaluate long-term structural and functional changes of the optic nerve head in medically and surgically treated juvenile-onset primary open-angle glaucoma (JOAG). Methods: Forty-two eyes of 42 consecutive primary JOAG patients presenting between January 2000 and January 2003. Results were analysed for long-term intra-ocular pressure (IOP) control, IOP fluctuation, disc characteristics on a Heidelberg Retinal Tomograph II and for visual field changes over a 5-year period. The parameters were compared between medically and surgically treated eyes. Results: The average age of the patients was 26.8 ± 6.1 years. The average baseline IOP was 35.3 ± 14.9 mm Hg. An IOP control <18 mm Hg was achieved in 84% of eyes that underwent filtering surgery (n = 17), compared to 63% on medical therapy alone (n = 25) at the end of 5 years; log rank test p = 0.38. Over 5 years, 4 eyes showed progression (9.5%) of which 3 had been medically treated and 1 had failed surgery (p = 0.45). Conclusion: A tenth of JOAG eyes showed progression over 5 years, and this was more common in those treated medically. Aggressive IOP lowering may thus be needed in eyes with JOAG.

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Section: Discussionmentioning

confidence: 99%

Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

Gupta¹,

Ov²,

Rao³

et al. 2011

Ophthalmologica

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“…4,5,8,10,12,26,32,33,38 Some suggested that previous experience of more than 50 viscocanalostomy cases is required before mastering this technique. 12 In the current retrospective study, comparison of early versus late experience showed a significant improvement in overall and complete success as surgeons gained experience.…”

Section: Discussionmentioning

confidence: 97%

“…The most cited intraoperative complication is the perforation of TDM with an incidence around 10%. [3][4][5]8,10,26,33,34 Surgeon's individual experience on nonpenetrating glaucoma surgery is important as intraoperative complications are mainly observed during the first 10 procedures. 32,35,36 Lower incidence of TDM perforation is indicative of improved surgical performance in nonpenetrating glaucoma surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Viscocanalostomy, a nonpenetrating filtration procedure, has reported to efficiently and safely reduce intraocular pressure (IOP) in various types of open-angle glaucoma (OAG). [3][4][5][6][7][8][9][10] As expected in clinical practice, a time-related period is required to master any given surgical procedure, 11 which is particularly true for microsurgical procedures such as viscocanalostomy. [12][13][14] Some postulated that previous experience of more than 50 viscocanalostomy cases is required for mastering this technique.…”

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confidence: 99%

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The Effect of Learning Curve on the Surgical Outcome of Viscocanalostomy

Stangos

Mavropoulos

Leuenberger

et al. 2012

Journal of Glaucoma

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“…However, eyes with hypertension or glaucoma owing to trabecular meshwork impairment should respond the best to viscocanalostomy. This has been shown, for example, in glaucomas secondary to uveitis (with well-controlled inflammation), 23 in juvenile glaucomas 24 and in congenital glaucomas. …”

Section: Mechanism Of Actionmentioning

confidence: 99%

Comparing Viscocanalostomy with Trabeculectomy

Carassa¹

2011

US Ophthalmic Review

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In recent years, non-penetrating glaucoma surgery has been seen as a safer alternative to trabeculectomy. This class of procedures is mainly represented by 'deep sclerectomy', 'viscocanalostomy,' and 'canaloplasty' (a recent and more reproducible variation of viscocanalostomy). The aim of all these procedures is to allow drainage of the aqueous humor from the anterior chamber, not through a patent scleral opening but by slow percolation through the inner trabecular meshwork and/or Descemet's membrane ('sclerodescemetic membrane'). This avoids sudden drops in intraocular pressure (IOP), hypotony, and flat chambers. The absence of anterior chamber opening and iridectomy limits the risk of cataract and infection. The advantages of viscocanalostomy and canaloplasty are that not only are they non-penetrating, like deep sclerectomy, but also, most importantly, they restore the physiologic outflow pathway, thus avoiding external filtration in the majority of eyes. This makes the success of the procedure partly independent of conjunctival or episcleral scarring, a leading cause of failure in trabeculectomy, with fewer indications for wound healing modulation. Moreover, the absence of an elevated filtering bleb avoids related ocular discomfort, and the procedures can be carried out in any quadrant. Operative TechniqueViscocanalostomy is a demanding surgical technique that requires a long learning curve. As soon as the window is completed, the inner scleral flap is excised.The next step is the sealing of the lake, which is obtained by tightly suturing the outer scleral flap with seven 10-0 nylon stitches.High-molecular-weight sodium hyaluronate is then injected underneath the flap to fill the intrascleral space temporarily, preventing it from collapsing and scarring in the early post-operative period. Finally, the conjunctiva is sutured in place. Mechanism of ActionViscocanalostomy increases the aqueous outflow through different paths. Injection of viscoelastic into the canal not only dilates the canal and associated collectors but also disrupts the internal and external walls of Schlemm's canal and adjacent trabecular layers, thus increasing the trabecular outflow facility and making the procedure act as a 'micro-trabeculotomy' (see Figure 5).

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Primary Viscocanalostomy for Juvenile Open-angle Glaucoma

Cited by 38 publications

References 27 publications

Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

Long-Term Structural and Functional Outcomes of Therapy in Juvenile-Onset Primary Open-Angle Glaucoma : A Five-Year Follow-Up

The Effect of Learning Curve on the Surgical Outcome of Viscocanalostomy

Comparing Viscocanalostomy with Trabeculectomy

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