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Suprachoroidal shunts

This article reviews recent studies evaluating the efficacy and safety of ab externo and ab interno suprachoroidal shunts designed to augment uveoscleral outflow in patients with open angle glaucoma. Recent findings The Gold Shunt and STARflo are placed into the suprachoroidal space via an ab externo approach, while the CyPass Micro-Stent and iStent Supra are inserted ab interno through a clear corneal incision. A small randomized clinical trial suggested similar efficacy among two different models of the Gold Shunt and the Ahmed glaucoma valve. The pivotal multicenter, randomized COMPASS trial showed that the CyPass Micro-Stent combined with cataract surgery is more effective than cataract surgery alone through 2 years. Study results suggest a favorable safety profile for each suprachoroidal device and intraocular pressure-lowering to the mid-to-high teens with an associated reduction in medication burden. Given the relative novelty of these procedures, it is currently unknown whether fibroblastic proliferation within the suprachoroidal space may limit their long-term success. Summary Renewed interest in the suprachoroidal space has led to the development of new biocompatible glaucoma implants. Ab interno devices are easily combined with cataract surgery and preserve conjunctiva for future incisional glaucoma surgery. Additional data regarding the long-term efficacy and late complications of suprachoroidal shunts are needed.
Source: Current Opinion in Ophthalmology - Category: Opthalmology Tags: GLAUCOMA: Edited by Donald L. Budenz Source Type: research

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Abstract Background: The aim of the study was to evaluate the long-term safety and efficacy of the Trabectome for Chinese glaucoma patients. Methods: This was a multicenter, retrospective, observational study. Glaucoma patients, except those with neovascular glaucoma, with/without a visually significant cataract were enrolled. The patients received Trabectome or a combined surgery with phacoemulsification and intraocular lens implantation. The primary outcome evaluation was a reduction in intraocular pressure (IOP), and the secondary outcomes were a reduction in glaucoma medication, the 2-year success percent...
Source: Chinese Medical Journal - Category: General Medicine Authors: Tags: Chin Med J (Engl) Source Type: research
CONCLUSIONS: In this pilot study, a quantitative difference was found in the protein expression of humor among patients with glaucoma, there being 27 proteins unique to patients with glaucomatous disease. PMID: 29439810 [PubMed - as supplied by publisher]
Source: Archivos de la Sociedad Espanola de Oftalmologia - Category: Opthalmology Tags: Arch Soc Esp Oftalmol Source Type: research
ConclusionsThe hooked tube technique seems to provide an effective way to reduce the risk of the IOP spikes after cataract surgery in eyes with GDI.
Source: International Ophthalmology - Category: Opthalmology Source Type: research
Conclusion: These findings suggest that cataract surgery patients with ocular HTN, glaucoma, a preoperative IOP ≥22 mmHg, or significant intraocular complications may benefit from prophylactic ocular anti-hypertensive medication. PMID: 29425312 [PubMed - as supplied by publisher]
Source: Military Medicine - Category: International Medicine & Public Health Tags: Mil Med Source Type: research
ConclusionsBased on our small and limited retrospective study, and under unusual circumstances, urgent tube shunt implantation through the ciliary sulcus may be considered in phakic eyes with severely uncontrolled IOP, shallow anterior chambers and poor view to the posterior segment, and when concomitant lensectomy is not recommended. We advise the use of appropriate surgical modifications by experienced glaucoma surgeons to prevent intraoperative complications. Further and larger studies are needed to evaluate the safety of this surgical option.
Source: International Ophthalmology - Category: Opthalmology Source Type: research
Glaukos (NYSE:GKOS) today released results from a study of its iStent trabecular micro-bypass stent exploring its use during cataract surgery in patients with severe open-angle glaucoma, touting significant reductions in intraocular pressure and medication use. The San Clemente, Calif.-based company’s iStent micro-bypass stents are made from non-ferromagnetic titanium and coated in heparin, is designed to be implanted into multiple trabecular meshwork through a single corneal entry point to reduce IOP. Results were published in the January issue of the Journal of Glaucoma. “Although the iStent&nb...
Source: Mass Device - Category: Medical Devices Authors: Tags: Clinical Trials Optical/Ophthalmic Glaukos Source Type: news
SIGNIFICANCE Noncompliance is a problem affecting glaucoma patients. Approaches to improve adherence include the use of drug-delivery systems and safer forms of surgery. Minimally invasive glaucoma surgery (MIGS) has reduced complications, particularly in combination with cataract surgery, and with its good intraocular pressure (IOP) reduction may reduce or eliminate glaucoma medications. Glaucoma is a progressive disease and a leading cause of irreversible blindness. Elevated IOP is the most important risk factor, but effective medical management is dependent on patient adherence. This review summarizes the adherence p...
Source: Optometry and Vision Science - Category: Opthalmology Tags: Reviews Source Type: research
Purpose: To evaluate the safety and efficacy of XEN gel implant (Allergan Inc., Irvine) as a standalone versus combined XEN-Phacoemulsification surgery (XEN+cataract) in glaucoma patients. Methods: Prospective, interventional study. One-hundred forty-nine eyes (113 patients) with open-angle glaucoma and uncontrolled intraocular pressure (IOP) despite medical treatment were enrolled at a tertiary glaucoma center and followed up for a minimum of 1 year. Approximately two-thirds of patients underwent combined XEN+cataract surgery, while the remainder had XEN alone surgery. Primary outcome was a 20% or more decrease in IO...
Source: Journal of Glaucoma - Category: Opthalmology Tags: Original Studies Source Type: research
This study assessed the success rates, complication rates, final intraocular pressure (IOP), and bleb characteristics between patients receiving subtenon MMC application by sponge versus irrigation. Patients and Methods: A total of 100 patients with glaucoma were enrolled and each was randomized to 1 of the 2 treatment groups. Patients underwent trabeculectomy with Ex-PRESS shunt and MMC placement and were followed for 6 months. Complication rates assessed included bleb failure, bleb leaks, bleb encapsulation, and hypotony, amongst others. Additional factors evaluated included bleb morphology, glaucoma drop usage, Fluor...
Source: Journal of Glaucoma - Category: Opthalmology Tags: Original Studies Source Type: research
Conclusions: The scleral-glued surgery is a good option for fixating an IOL in eyes with PXF and poor zonular integrity or absent capsular support. Special attention should be placed on intraocular pressure control following surgery, which can be less predictable in PXF eyes with or without preexisting glaucoma.
Source: Journal of Glaucoma - Category: Opthalmology Tags: Original Studies Source Type: research
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