LONG term results of non-penetrati̇ng glaucoma surgery

Amaç: Açık açılı glokomlu (AAG) gözlerde mitomisin-C'li (MMC) viskokanalostomi ameliyatının sonuçlarını değerlendirmek. Gereç ve Yöntem: Aralık 2007- Mart 2014 tarihleri arasında MMC-viskokanalostomi ameliyatı olan 104 hastanın (41 kadın, 63 erkek; ortalama yaş: 60.7±16.2 yıl; yaş aralığı: 19-87 yıl) 122 gözü retrospektif olarak değerlendirildi. Ameliyattan önce ve sonraki göziçi basıncı (GİB), kullanılan ilaç sayısı ve görme keskinliği değerleri, ameliyattan sonra ek tedavi (anti-glokomatöz ilaç ve/veya 'lazer goniopuncture') ihtiyacı, cerrahi komplikasyonlar ve izlem süresi kaydedildi. Ameliyattan sonra GİB'nın ilaçla veya ilaçsız 21 mm Hg altında olması kısmi cerrahi başarı, ilaçsız 21 mm Hg altında olması ise tam cerrahi başarı olarak kabul edildi. Bulgular: Ortalama GİB ameliyat öncesi 27.5±9.2 mmHg iken, ameliyattan sonra son muayenede 14.5±6.6 mm Hg idi (p<0.001). Ameliyattan önce ve son muayenede, ortalama Snellen görme keskinliği, sırasıyla 0.48±0,3 ve 0.50±0.3 idi (p= 0.726). Kısmi cerrahi başarı oranı %86.9 (n=106), tam cerrahi başarı oranı %50.8 (n=62) idi. Ek tedavi olarak lazer 'goniopuncture' uygulanma oranı %35.2, anti-glokomatöz ilaç kullanma oranı %49.1 idi. Ortalama takip süresi 27.3 ay (veri aralığı:1-79 ay) idi. Sonuç: Bu çalışma MMC-viskokanalostominin, AAG'lu gözlerde, uzun süreli, stabil, etkin ve güvenli bir GİB düşüşü sağladığını desteklemektedir.Purpose: To evaluate the results of MMC-viscocanalostomy in patients with open angle glaucoma. Methods: This retrospective study included 122 eyes of 104 (41 women, 67 men; mean age: 60.73±16.22 year; range between: 19-87 year) patients who underwent viscocanalostomy surgery between December 2007-March 2014. Pre and postoperative IOP, number of glaucoma medication, visual acuity, complications, adjunctive procedure (laser goniopuncture with/or glaucoma medication) and success rate were recorded Complete success rate was defined as an IOP of lower than 21 mm Hg without additional medication and qualified success rate was defined as an IOP of less than or equal to 21 mm Hg with or without glaucoma mediacation.. Results: The mean preoperative IOP was 27.5±9.2 mm Hg; while the mean postoperative IOP was 14.5±6.6 mm Hg at last visit (p<0.001). The mean visual acuity before and after surgery were 0.48±0.3 and 0.50±0.3, respectively (p= 0,726). Qualified success was achieved in 106 (86.9%) patients, complete success in 62 (50.8%) patients. Laser goniopuncture was performed in 43 (35.2%) patients and the glaucoma medication usage was %49.1. The mean postoperative follow-up period was 27.3±16,7 months (1-79 months). Conclusion: This study supports that MMC-viscocanalostomy appears to be a safe and effective intraocular pressure lowering procedure in eyes with open angle glaucoma

Results of mitomycin-C-augmented viscocanalostomy for open-angle glaucoma

AIM: To evaluate the results of mitomycin-C(MMC)-augmented viscocanalostomy in patients with open-angle glaucoma.METHODS: This retrospective study included 104 patients who underwent viscocanalostomy surgery between December 2007 and March 2014. Pre- and postoperative intraocular pressure(IOP), number of glaucoma medications, visual acuity, complications, adjunctive procedure(laser goniopuncture and/or glaucoma medication), and success rate were recorded. Complete success was defined as IOP≤21 mmHg without additional medication, and qualified success was defined as IOP≤21 mmHg with or without glaucoma medication.RESULTS: Mean preoperative IOP was 27.5±9.2 mmHg and mean postoperative IOP was 14.5±6.6 mmHg at the last visit(PP=0.726). Qualified success was achieved in 106(86.9%)eyes and complete success was achieved in 62(50.8%)eyes. Laser goniopuncture was performed in 43(35.2%)eyes and glaucoma medication usage rate was 49.1%. The mean postoperative followup period was 27.29±16.78(1-79)mo.CONCLUSION:Although viscocanalostomy is a safer option due to low complication rates and stable visual acuity, without laser goniopuncture(LGP), surgical success rate is still very low. Further comparative studies are necessary to evaluate the contribution of MMC to viscocanalostomy surgery

Laser intervention on trabeculo-Descemet′s membrane after resistant viscocanalostomy: Selective 532 nm gonioreconditioning or conventional 1064 nm neodymium-doped yttrium aluminum garnet laser goniopuncture?

Purpose: To compare the results of conventional 1064 nm neodymium-doped yttrium-aluminum garnet laser goniopuncture (Nd:YAG-GP) and selective 532 nm Nd:YAG laser (selective laser trabeculoplasty [SLT])  gonioreconditioning (GR) on trabeculo-Descemet′s membrane in eyes resistant to viscocanalostomy surgery. Methods: Thirty-eight eyes of 35 patients who underwent laser procedure after successful viscocanalostomy surgery were included in the study. When postoperative intraocular pressure (IOP) was above the individual target, the eyes were scheduled for laser procedure. Nineteen eyes underwent 532 nm SLT-GR (Group 1), and the remaining 19 eyes underwent conventional 1064 nm Nd:YAG-GP (Group 2). IOPs before and after laser (1 week, 1 month, 3 months, 6 months, 1 year, and last visit), follow-up periods, number of glaucoma medications, and complications were recorded for both groups. Results: Mean times from surgery to laser procedures were 17.3 ± 9.6 months in Group 1 and 13.0 ± 11.4 months in Group 2. Mean IOPs before laser procedures were 21.2 ± 1.7 mmHg in Group 1 and 22.8 ± 1.9 mmHg in Group 2 (P = 0.454). Postlaser IOP measurements of Group 1 were 12.1 ± 3.4 mmHg and 13.8 ± 1.7 mmHg in the 1 st week and last visit, respectively; in Group 2, these measurements were 13.6 ± 3.7 mmHg and 14.9 ± 4.8 mmHg, respectively. There were statistically significant differences (P 0.05). Mean follow-up was 16.6 ± 6.4 months after SLT-GR and 18.9 ± 11.2 months after Nd:YAG-GP. Conclusions: While conventional Nd:YAG-GP and SLT-GR, a novel procedure, are both effective choices in eyes resistant to viscocanalostomy, there are fewer complications with SLT-GR. SLT-GR can be an alternative to conventional Nd:YAG-GP

Efficacy of balanced torsional phacoemulsification tip for cataract surgery

Purpose: To compare the efficacy of the Intrepid((R)) Balanced torsional phacoemulsification tip to that of the 30 degrees Ozil((R)) and 45 degrees Kelman((R)) tips using Centurion Vision System. Methods: This study included 150 eyes that underwent torsional phacoemulsification surgery using 30 degrees Ozil((R)) tip (Group 1, 48 eyes), Intrepid((R)) Balanced tip (Group 2, 52 eyes), or 45 degrees Kelman((R)) tip (Group 3, 50 eyes). Ultrasound time (UST), cumulative dissipated energy (CDE), average phaco power, average torsional amplitude, balanced salt solution volume, aspiration and operation time, and preoperative, postoperative corrected distance visual acuity, central corneal thickness were recorded. Results: The mean UST, CDE, average phaco power, average torsional amplitude were 49.9 +/- 15.7 s, 10.8 +/- 4.5%-s, 23.9 +/- 4.6%, and 51.4 +/- 5.7% in the Ozil((R)) group and 47.5 +/- 10.6 s, 5.3 +/- 2.2%-s, 12.5 +/- 5.3%, and 28.9 +/- 7.2% in the Intrepid((R)) Balanced group, and 48.1 +/- 12.7 s, 6.9 +/- 3.3%-s, 18.9 +/- 5.9%, and 39.2 +/- 7.9% in the Kelman((R)) group, respectively. The CDE, average phaco power, and average torsional amplitude of the Intrepid((R)) Balanced group were significantly lower than other groups (P 0.05). Conclusion: Intrepid((R)) Balanced tip, by means of its distinctive double bent design and balanced energy distribution, offers more effective phacoemulsification compared to conventional 30 degrees Ozil((R)) and 45 degrees Kelman((R)) tips

A novel suturing technique for filtering glaucoma surgery: the accordion suture

AIM: To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure (IOP). METHODS: Description of ‘the accordion suture’ technique for mitomycin C augmented trabeculectomy. In cases of postoperative high IOP, pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges. By means of this technique, the scleral flap opens up in an ‘‘accordion’’ manner, thus preventing flap obstruction and providing adequate aqueous flow. RESULTS: Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma. Mean age of the subjects was 67.42±8.21y and female/male ratio was 4/4. Mean preoperative IOP was 37±7.48 mm Hg. Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications. The scleral flap closure is performed with three separate sutures; initially, our accordion suture through the center of the flap, and two releasable sutures on both corners. All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture, without any complications. The average traction time was 3.5±0wk postoperatively. The mean postoperative IOP was 11.37±2.72 mm Hg. No suture related complications were observed. CONCLUSION: This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients