Glaucoma is one of the most common optic neuropathies, featuring progressive retinal ganglion cell damage and visual field loss (Tham et al., 2014; Xu et al., 2020). Currently, the only effective treatment for this condition is the reduction of intraocular pressure (IOP) (Palmberg, 2001; Heijl et al., 2002). Canaloplasty is a proven bleb-independent surgery with good efficacy and safety profiles in primary open-angle glaucoma (POAG) (Gołaszewska et al., 2021). However, early transient postoperative IOP elevation has been reported in up to 30% of cases (Riva et al., 2019), similar to that commonly observed in other internal drainage glaucoma surgeries such as implantation using iStent (0%-21.0%), CyPass (10.8%), and Hydrus (4.8%-6.5%) (Lavia et al., 2017). This complication may be a predictor of poor reserve in the outflow system and is potentially associated with surgical failure. Nonetheless, the exact pathophysiology of glaucoma remains unknown, and studies clarifying the risk factors for postoperative IOP elevation have been scarce.
Humans ; Intraocular Pressure ; Glaucoma, Open-Angle/surgery* ; Incidence ; Treatment Outcome ; Risk Factors

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO
Carbon Dioxide ; Follow-Up Studies ; Glaucoma, Open-Angle/surgery* ; Humans ; Microscopy, Acoustic ; Sclera/diagnostic imaging* ; Treatment Outcome

PURPOSE: To evaluate the influence of biometric variables on refractive outcomes after cataract surgery in angle-closure glaucoma (ACG) patients. METHODS: In this case-control study, 42 ACG patients, 40 open-angle glaucoma (OAG) patients, and 35 controls without glaucoma who had undergone conventional cataract surgery were enrolled consecutively. Electronic medical records, including preoperative biometric variables (keratometric diopter, axial length, anterior chamber depth, and lens thickness), the refractive change (RC), and the absolute value of refractive change (ARC) were reviewed. RESULTS: In the control and OAG patients, the anterior chamber depth was negatively correlated with the ARC (r = -0.344, p = 0.043 and r = -0.431, p = 0.006, respectively), whereas there was no correlation in the ACG patients. Lens thickness was positively correlated with the RC, but not with the ARC, in the control and OAG groups (r = 0.391, p = 0.020 and r = 0.501, p = 0.001, respectively). In contrast, lens thickness in the ACG group was not correlated with the RC but was positively correlated with the ARC (r = 0.331, p = 0.032). CONCLUSIONS: In contrast with the anterior chamber depth, preoperatively measured lens thickness may be a useful predictor of the direction of the RC after cataract surgery in control and OAG patients. However, in ACG patients, a thicker lens was correlated with a larger RC, regardless of the direction of the shift (hyperopic or myopic).
Aged ; Anterior Chamber/*diagnostic imaging ; Biometry/*methods ; Female ; Follow-Up Studies ; Glaucoma, Angle-Closure/*complications/diagnosis/surgery ; Glaucoma, Open-Angle/*complications/diagnosis/surgery ; Humans ; *Intraocular Pressure ; Male ; Middle Aged ; *Phacoemulsification ; Refraction, Ocular/*physiology ; Retrospective Studies ; Tomography, Optical Coherence

BACKGROUNDThough trabeculectomy is often performed on patients with medically refractive pigmentary glaucoma (PG), the clinical outcomes of surgical treatment on PG remain unknown. The aim of this study was to summarize the long-term efficacy and safety of trabeculectomy on PG.

METHODSThis was a prospective case series observational study. Eighteen consecutive PG patients were followed up for 8 years after trabeculectomy from May 2006 to April 2007. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, intraocular pressure (IOP) measurement, Humphrey visual field analysis (VFA), and stereoscopic funduscopy were performed on admission and every 6 months after the surgery. Postoperative IOP, VA, BCVA, VFA, adjunctive anti-glaucoma medication, treatment-related side-effects, changes in blebs, and main clinical findings in the anterior segment of PG were recorded and compared with the baseline.

RESULTSEighteen PG eyes from 18 patients, with average preoperative IOP of 34.5 ± 4.7 mmHg (range: 21-47 mmHg, 1 mmHg=0.133 kPa) were enrolled in this study. All enrolled patients completed the follow-up visits and required examinations. Eight years after trabeculectomy, all surgical eyes (18/18) had satisfactory IOP control with an average of 13.7 ± 2.5 mmHg (range: 9-19 mmHg), which was significantly lower than baseline (P = 0.001). Majority (15/18) of the PG eyes had stable VA, BCVA, VFA, and optic disc cupping parameters. Functional blebs still existed in 12/18 of the PG eyes at the last follow-up visit. Unanimously, pigmentation in the anterior segment attenuated with time after surgical treatment. No severe side-effects were recorded in any of the surgical eyes.

CONCLUSIONSAll surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.

Adult ; Female ; Glaucoma ; surgery ; Glaucoma, Open-Angle ; surgery ; Humans ; Male ; Middle Aged ; Prospective Studies ; Time Factors ; Trabeculectomy ; Treatment Outcome ; Young Adult

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

A 50-year-old woman, who had undergone extensive removal of conjunctiva on the right eye for cosmetic purposes at a local clinic 8 months prior to presentation, was referred for uncontrolled intraocular pressure (IOP) elevation (up to 38 mmHg) despite maximal medical treatment. The superior and inferior conjunctival and episcleral vessels were severely engorged and the nasal and temporal bulbar conjunctival areas were covered with an avascular epithelium. Gonioscopic examination revealed an open angle with Schlemm's canal filled with blood to 360 degrees in the right eye. Brain and orbital magnetic resonance imaging and angiography results were normal. With the maximum tolerable anti-glaucoma medications, the IOP gradually decreased to 25 mmHg over 4 months of treatment. Extensive removal of conjunctiva and Tenon's capsule, leaving bare sclera, may lead to an elevation of the episcleral venous pressure because intrascleral and episcleral veins may no longer drain properly due to a lack of connection to Tenon's capsule and the conjunctival vasculature. This rare case suggests one possible mechanism of secondary glaucoma following ocular surgery.
Adult ; Conjunctiva/*blood supply/*surgery ; Female ; Glaucoma, Open-Angle/*etiology/pathology ; Gonioscopy ; Humans ; *Intraocular Pressure ; Postoperative Complications/*etiology/pathology ; Surgery, Plastic/adverse effects

PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.
Adult ; Anterior Chamber/*surgery ; Collagen/*administration & dosage ; Drug Implants/*administration & dosage ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle/physiopathology/*surgery ; Humans ; Incidence ; Intraocular Pressure ; Male ; Postoperative Complications/epidemiology ; Postoperative Period ; Republic of Korea/epidemiology ; Retrospective Studies ; Sclera/*surgery ; Sclerostomy/*methods ; Time Factors ; Treatment Outcome ; Visual Acuity

PURPOSE: To evaluate changes in anterior chamber depth (ACD) and angle width induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with glaucoma, using anterior segment optical coherence tomography (AS-OCT). METHODS: Eleven eyes of 11 patients with angle-closure glaucoma (ACG) and 12 eyes of 12 patients with open-angle glaucoma (OAG) underwent phacoemulsification and IOL implantation. Using AS-OCT, ACD and angle parameters were measured before and 2 days after surgery. Change in intraocular pressure (IOP) and number of ocular hypotensive drugs were evaluated. RESULTS: After surgery, central ACD and angle parameters increased significantly in eyes with glaucoma (p < 0.05). Prior to surgery, mean central ACD in the ACG group was approximately 1.0 mm smaller than that in the OAG group (p < 0.001). Post surgery, mean ACD of the ACG group was still significantly smaller than that of the OAG group. No significant differences were found in angle parameters between the ACG and OAG groups. In the ACG group, postoperative IOP at the final visit was significantly lower than preoperative IOP (p = 0.018) and there was no significant change in the number of ocular hypotensive medications used, although clinically, patients required fewer medications. In the OAG group, the IOP and number of ocular hypotensive drugs were almost unchanged after surgery. CONCLUSIONS: The ACD and angle width in eyes with glaucoma increased significantly after phacoemulsification and IOL implantation. Postoperative ACD significantly differed between the ACG and OAG groups, whereas angle parameters did not differ.
Aged ; Aged, 80 and over ; Anterior Chamber/anatomy & histology/*surgery ; Female ; Glaucoma, Angle-Closure/drug therapy/pathology/*surgery ; Glaucoma, Open-Angle/drug therapy/pathology/*surgery ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular/*adverse effects ; Male ; Middle Aged ; Phacoemulsification/*adverse effects ; Postoperative Period ; Preoperative Period ; Tomography, Optical Coherence

To report acute onset lens particle glaucoma associated with a spontaneous anterior capsular dehiscence. A 66-year-old man presented with spontaneous anterior lens capsule dehiscence with an acute onset of right eye pain that was associated with white particles in the anterior chamber angle and intraocular pressure (IOP) of 55 mmHg. No trauma or other inflammatory antecedents were reported. A hypermature cataract was observed at slit lamp exam. After medical treatment without IOP control, we performed extracapsular cataract extraction and anterior vitrectomy. Anterior chamber aspirate confirmed the presence of macrophages. The postoperative IOP at one month was 16 mmHg OD without medication. Spontaneous dehiscence of the anterior lens capsule in a patient with a hypermature cataract may release lens cortical material, resulting in lens particle glaucoma. Prompt surgical removal of the lens material usually controls the high IOP, and the need for additional glaucoma surgery is not common.
Aged ; Cataract ; Cataract Extraction ; Eye Injuries/*complications/surgery ; Glaucoma, Open-Angle/*diagnosis/*etiology/surgery ; Humans ; Male

OBJECTIVE: To evaluate the mid-term and long-term clinical effect and complication of micro-perforating trabecular surgery (MPTS) with amniotic membrane implants on open angle glaucoma (OAG). METHODS: Thirty OAG patients (49 eyes) were treated with MPTS with amniotic membrane implants. Visual acuity, intraocular pressure, visual field, type of blebs, and complications were recorded pre-and post-operatively. RESULTS: Patients were followed up for 6~24(15.93+/-2.35) months. The mean IOPs before the operation and 24 months after the operation were (36.84+/-11.02) mmHg and (18.24+/-1.34) mmHg, respectively (P=0.000). The mean numbers of anti-glaucoma drugs used before and after the operation were (2.76+/-0.69) and (0.59+/-0.89), respectively (P<0.05). The global index of the early to moderate glaucomatous visual field loss was significantly improved postoperatively (P<0.05), and no significant difference was found in aggressive glaucoma pre- and postoperatively. Functional filter bleb was formed in 70.8% patients 24 months after the operation. The complete success rate and quality success rate were 75.5% (37/49) and 93.9% (46/49), respectively. There was no significant change in visual acuity pre- and postoperatively and no severe complication was found. CONCLUSION Micro-perforating trabecular surgery with amniotic membrane implants is effective and safe for OAG, with reliable effect on lowering IOP in the mid-term and long-term.
Adolescent ; Adult ; Aged ; Amnion ; transplantation ; Female ; Follow-Up Studies ; Glaucoma, Open-Angle ; surgery ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Trabeculectomy ; methods ; Treatment Outcome ; Visual Acuity ; Visual Fields ; Young Adult