The benefit of early trabeculectomy versus conventional management in primary open angle glaucoma relative to severity of disease

Jay, J L; Allan, Donald

doi:10.1038/eye.1989.84

Cited by 135 publications

(43 citation statements)

References 7 publications

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“…Elevated intraocular pressure is the only commutable risk factor for glaucoma. However, despite the effective control of intraocular pressure (IOP), the progression of visual field loss suggests that IOP-independent mechanisms may also play a role in glaucomatous degeneration in patients having normal-tension glaucoma (NTG) (1,2).…”

Section: Introductionmentioning

confidence: 99%

Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease*

Eraslan¹,

Çerman²,

Çekıç³

et al. 2015

Turk J Med Sci

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IntroductionGlaucoma is among the leading causes of blindness worldwide. As an optic neuropathy, glaucoma is characterized by progressive retinal ganglion cell death. Elevated intraocular pressure is the only commutable risk factor for glaucoma. However, despite the effective control of intraocular pressure (IOP), the progression of visual field loss suggests that IOP-independent mechanisms may also play a role in glaucomatous degeneration in patients having normal-tension glaucoma (NTG) (1,2).Based on the similarities between glaucoma and neurodegenerative diseases, including the selective loss of neuron populations and common mechanisms of cell injury and death, a contemporary hypothesis has implicated glaucoma as a neurodegenerative disease (3). The IOP-independent mechanisms that cause degeneration in NTG may be similar to the mechanisms at work in neurodegenerative diseases. Some studies have Background/aim: To evaluate, in vivo, the optical coherence tomography (OCT) of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) in patients with normal-tension glaucoma (NTG) and those with Alzheimer disease (AD) in comparison with healthy subjects. Materials and methods:This cross-sectional study included 18 patients with NTG, 20 with AD, and 20 control subjects. An ophthalmologic examination and OCT scans of both eyes were performed in all patients.Results: There was a significant reduction in peripapillary RNFL thickness and macular GCC thickness and a significant increase in the global loss volume (GLV) rate in both the NTG and AD patients when compared to the control subjects (P = 0.004, P = 0.006, P < 0.001, respectively). The statistical evaluation showed no difference in any RNFL or GCC parameters between the AD and NTG groups (P > 0.05). There was a negative correlation between disease duration and average RNFL and GCC thicknesses (r = −0.350, P = 0.027 and r = −0.471, P = 0.002, respectively) and a positive correlation between duration and GLV (r = 0.427, P = 0.006) in the AD group. Conclusion:The average RNFL thickness, GCC thickness, and GLV rates may help in the diagnosis of AD as an additional examination and may provide some important clues about the duration of the disease.

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Section: Introductionmentioning

confidence: 99%

Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease*

Eraslan¹,

Çerman²,

Çekıç³

et al. 2015

Turk J Med Sci

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“…Although there are many retrospective studies on the outcome of trabeculectomies from the developing world, there is a paucity of data comparing early surgery and medical management in POAG [6][7][8][9][10][11][12][13][14] (Table 1). The lack of large comparative studies makes it difficult to draw any definite conclusions.…”

Section: Introductionmentioning

confidence: 99%

Role of early trabeculectomy in primary open-angle glaucoma in the developing world

Anand

Negi

Khokhar

et al. 2005

Eye

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Background The lack of prospective data comparing early surgery and medical management in primary open-angle glaucoma (POAG) in the developing world led us to conduct a small randomised controlled clinical trial to evaluate acceptance and effectiveness of early trabeculectomy in these patients. Methods A total of 60 patients with moderately advanced POAG were randomised into three groups (Group IFConventional medical management, Group IIFOption for early trabeculectomy, Group IIIFReceived an educational package about their disease before an option for early trabeculectomy). The patients were followed up for a period of 6 months for visual acuity, intraocular pressures (IOP), and subjective satisfaction. Results The three study groups were statistically similar with respect to mean IOP, demographic, and socio-economic profile. 35% of the patients accepted early surgery when offered a choice between early surgery and medical management in one of the groups. 65% of patients in another group expressed willingness for an early surgery after receiving health education on glaucoma. The mean IOP in the operated eyes was lower than the medically treated eyes at 2 weeks (16.6 vs 23.0 mmHg), 6 months (18.5 vs 22.8 mmHg), and 1-year review (17.9 vs 22.3 mmHg) (Po0.001). No significant difference was seen among the groups with regard to visual acuity and subjective satisfaction. Conclusion There is a reasonable acceptance of early surgery in POAG patients in the developing world and increases on educating patients about their disease. Early surgery offers better IOP control with no long-term subjective adverse effects.

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“…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.…”

Section: Trabeculectomy (Te) As It Is Performed Today Was Introduced mentioning

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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The benefit of early trabeculectomy versus conventional management in primary open angle glaucoma relative to severity of disease

Cited by 135 publications

References 7 publications

Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease*

Neurodegeneration in ocular and central nervous systems: optical coherence tomography study in normal-tension glaucoma and Alzheimer disease*

Role of early trabeculectomy in primary open-angle glaucoma in the developing world

Endoscopic Goniotomy

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