Trabekuläre mikroinvasive Glaukomchirurgie

Jünemann, Anselm; Ręjdak, Robert; Hohberger, Bettina

doi:10.1007/s00347-018-0689-x

Cited by 5 publications

(6 citation statements)

References 38 publications

(32 reference statements)

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“…As glaucoma subtypes did not show any effect on therapeutic success in the present and previous reported cohort [21], Xen45 gel stents can be offered to overall OAG patients with conservative non-regulated IOP. It is an ongoing task to identify criteria for therapeutic success after Xen45 gel stent implantation [22,23]. In previous data, myopic eyes were seen to provide higher levels of inflammatory cytokines and growth factors than emmetrope eyes [10,11].…”

Section: Discussionmentioning

confidence: 99%

Two-Year Follow-Up: Therapeutic Success with Respect to Axial Length of Stand-Alone Xen45 Gel Stent Implantation and Combined Procedures

Gernhart

Hohberger

Laemmer

2021

Klin Monbl Augenheilkd

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Background Up to now, no data have been available on the therapeutic success rate of Xen45 gel stent with respect to axial length (AL). The present study aimed to investigate a potential influence of AL on therapeutic success in stand-alone Xen45 gel stent implantation or combination with cataract surgery in open-angle glaucoma patients (OAG) with a follow-up of 2 years. Materials and Methods In this retrospective observational study, 98 eyes of 87 glaucoma patients of the Department of Ophthalmology, University of Erlangen Nürnberg, and from the Erlangen Glaucoma Registry (NCT00494923; ISSN 2191-5008, CS-2011) underwent stand-alone Xen45 gel stent implantation or a combination with cataract surgery. Therapeutic success was defined as ≥ 20% IOP reduction with the same or fewer anti-glaucomatous eye drops needed compared to baseline, yet without additional glaucoma-related surgery (expect bleb needling). Therapeutic failure was classified as any additional glaucoma-related surgery, IOP reduction < 20% or if more local anti-glaucomatous eye drops were applied compared to baseline. Results The therapeutic success rate was 60.7% (1 year) and 62.5% (2 years). No statistical difference was observed when procedures were combined with cataract surgery (p > 0.05). Subgroup analysis yielded no significantly different therapeutic success when considering glaucoma subtype [1 year: 61.5% (POAG), 60% (SAOG), 2 years: 54.5% (POAG), 69.2% (SOAG); p > 0.05]. Anti-glaucomatous medication use was lowered from 2.72 ± 1.04 at baseline to 0.61 ± 0.99 (1 year) and 0.7 ± 1.04 (2 years). The therapeutic success rate was seen to be independent of axial length for group and subgroup analysis (p > 0.05). Emmetropic eyes (22.0 – 24.5 mm) showed a statistically higher needling rate than myopic eyes (> 24.5 mm, p = 0.02). Conclusion Minimal invasive glaucoma surgery is one therapeutic option in OAG eyes, with good reduction in IOP even after 24 months (with additional bleb needling). Therapeutic success seemed to be independent of axial length in the present study.

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Section: Discussionmentioning

confidence: 99%

Two-Year Follow-Up: Therapeutic Success with Respect to Axial Length of Stand-Alone Xen45 Gel Stent Implantation and Combined Procedures

Gernhart

Hohberger

Laemmer

2021

Klin Monbl Augenheilkd

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“…In addition, the anatomical condition of the eye and the pa-tientʼs therapeutic course can determine the decision for or against micro-invasive stent therapy. In their review of trabecular micro-invasive glaucoma surgical stent procedures, Jünemann et al 2018 refer, for example, to the possible damage to the conjunctiva caused by eye drops, which may also influence the success or failure of an implantation [15].…”

Section: Discussionmentioning

confidence: 99%

“…In concrete terms, it is a question of finding out which patients (could) benefit most from the therapy and what patient characteristics would, in turn, tend to make successful therapy difficult. The study follows the advice to identify risk factors for surgical application and postoperative results [15,23].…”

Section: Materials Und Methodenmentioning

confidence: 99%

Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents

Helbig¹,

Wollny²,

Altiner³

et al. 2020

Klin Monbl Augenheilkd

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Background Primary open-angle glaucoma (POAG) is still one of the most common causes of impaired vision worldwide, despite the further development of therapy options, and can lead to blindness. Micro-invasive glaucoma surgery (MIGS) using stents aims at reducing intraocular pressure (IOP), as it is the main risk factor. With regard to adherence and adverse drug reactions it also aims at reducing the drug burden on patients. The study investigates under everyday conditions the criteria according to which ophthalmologists in Germany select patients for MIGS using stents. In addition, it will be investigated which patients (could) benefit most from the therapy. Material and Methods In this qualitative study, 11 narrative interviews were conducted between May 2017 and July 2018 with ophthalmologists working in the hospital or in a private practice. They were interviewed on their experiences in the treatment of POAG with microstents. The interviews were analysed by an interdisciplinary team using the qualitative content analysis. Results The stages of therapy escalation form the frame of reference for patient selection in MIGS using stents. Only if the IOP cannot be sufficiently reduced by drop therapy or when this causes drug-related side effects that are intolerable for the patients, stents are apparently used as the next higher escalation stage. The intensive post-operative medication and the frequent check-up appointments are perceived as barriers by the interviewees, especially for people with or without disabilities, who are dependent on external help and/or those living in rural areas. The active cooperation of the patients in the demanding aftercare seems to be indispensable for the ophthalmologists. In addition, necessary revisions are sometimes stressful for patients (physical/psychological) and doctors (work organisation/therapy). Against the background of the organisational and economic challenges in the outpatient spectrum of tasks, especially physicians in private practice seem to weigh up carefully for which patients microstent therapy would be reasonable. Conclusion In view of the therapeutic requirements, the current microstent therapy seems to be used in a selected, adherent patient group. Further qualitative and quantitative studies (in other health care regions and structures) are necessary to verify and extend the available results.

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“…Die Vernarbungsprozesse können durch intra-und postoperative Verfahren reguliert werden, um langfristige Drucksenkungen zu erzielen [10]. Die Evaluation von Methoden zur Modulation der Wundheilung ist aus diesem Grund ein Hauptforschungsziel der Glaukomchirurgie [6,14,15].…”

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Trabekulektomie mit Mitomycin C und Ologen®-Implantat im Vergleich zur klassischen Trabekulektomie

et al. 2022

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Zusammenfassung Hintergrund Die Trabekulektomie (TE) mit Mitomycin C (MMC) gilt als Goldstandard der Glaukomchirurgie. Eine neuere Modifikation ist die Verwendung von Ologen®-Implantaten (AEON Astron Europe B.V., Leiden, Niederlande) bei der TE, die in dieser Studie bewertet und mit der klassischen TE verglichen werden soll. Patienten und Methoden In die Studie wurden 98 Augen nach TE mit MMC (Gruppe 1) sowie 70 Augen nach TE mit Ologen® und MMC (Gruppe 2) aufgenommen. Beide Gruppen wurden hinsichtlich des intraokulären Drucks (IOD), der medikamentösen Glaukomtherapie sowie Komplikationen und Nachbehandlungen verglichen. Die Daten wurden präoperativ und bis 2 Jahre postoperativ erhoben. Ergebnisse In Gruppe 1 verringerte sich der IOD von 28,0 mmHg (95 %-Konfidenzintervall: 26,6–29,4 mmHg) präoperativ auf 16,0 mmHg (14,0–18,1) nach 2 Jahren. In Gruppe 2 wurde der IOD von 28,5 mmHg (26,8–30,1) auf 14,3 mmHg (11,7–17) gesenkt. Zu allen Zeitpunkten war die Drucksenkung in beiden Gruppen signifikant (p < 0,001), zwischen den Gruppen bestand kein Unterschied (p > 0,05). Alle glaukomspezifischen Nachbehandlungen waren in Gruppe 1 häufiger, jedoch nicht signifikant. Schlussfolgerung Beide Verfahren zeigten sich gleichwertig effektiv bezüglich der IOD-Reduktion. In unserer Studienpopulation waren nach TE mit Ologen® weniger Nachbehandlungen und folglich seltener Klinikaufenthalte nötig.

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Trabekuläre mikroinvasive Glaukomchirurgie

Cited by 5 publications

References 38 publications

Two-Year Follow-Up: Therapeutic Success with Respect to Axial Length of Stand-Alone Xen45 Gel Stent Implantation and Combined Procedures

Two-Year Follow-Up: Therapeutic Success with Respect to Axial Length of Stand-Alone Xen45 Gel Stent Implantation and Combined Procedures

Treatment Complexity in Primary Open-Angle Glaucoma (POAG): Perspectives on Patient Selection in Micro-Invasive Glaucoma Surgery (MIGS) Using Stents

Trabekulektomie mit Mitomycin C und Ologen®-Implantat im Vergleich zur klassischen Trabekulektomie

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