Kutay Andaç

Surgically induced corneal refractive change following glaucoma surgery ☆: Nonpenetrating trabecular surgeries versus trabeculectomy

Purpose: To compare surgically induced corneal refractive change following trabeculectomy with the nonpenetrating trabecular filtering surgeries with and without implant. Setting: Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey. Methods: A consecutive series of 34 patients (34 eyes) with uncontrolled open‐angle glaucoma had trabecular filtering surgery. Patients were assigned randomly to receive viscocanalostomy (12 patients), nonpenetrating deep sclerectomy (NPDS) with T‐flux® implant (10 patients), and trabeculectomy (12 patients). Autokeratometry and computerized corneal videokeratoscopy with the Topcon KR‐7000P autokeratorefractometer were performed preoperatively and 1 day and 1, 3, and 6 months postoperatively to analyze surgically induced keratometric and topographic astigmatism. Results: Thirty patients (11 trabeculectomy, 11 viscocanalostomy, and 8 NPDS with nonabsorbable implant) completed the study. Mean patient age was 61.7 years ± 10.9 (SD) (range 37 to 81) and did not differ among groups. Postoperative intraocular pressure (IOP) levels and visual acuity (logMAR values) did not differ among groups compared with preoperative levels. Average induced astigmatism was lower in the NPDS group than the trabeculectomy group at postoperative month 3 and 6 based on autokeratometry values (P = .023 and .042, respectively). Nonpenetrating surgeries resulted in less induced astigmatism in the early postoperative period and less against‐the‐rule shift over 6 months. Conclusion: Despite larger flap size and surgical area, nonpenetrating trabecular surgeries induced less astigmatism than trabeculectomy.

Deep sclerectomy with a nonabsorbable implant (T -Flux): preliminary results

BACKGROUND Deep sclerectomy is one of the two main types of nonpenetrating surgical methods of treating open-angle glaucoma. We aimed to determine, in a prospective study, the efficacy, success rate and complications of deep sclerectomy with implantation of a nonabsorbable drain made of highly hydrophilic acrylic (T-Flux). METHODS Twenty-five patients (25 eyes) with medically uncontrolled open-angle glaucoma were treated by deep sclerectomy with implantation of the T-Flux drain. We determined the rates of intraocular pressure (IOP) reduction, surgical success (four categories) and complications. To evaluate the efficacy of this new implant in detail, we compared the success rates with those in a group of patients matched for age, sex, diagnosis, preoperative IOP, number of preoperative antiglaucoma medications and previous ocular surgery who underwent successful viscocanalostomy. RESULTS For two eyes in the deep-sclerectomy group, surgery was converted to standard trabeculectomy owing to perforation of the trabeculo-Descemets membrane during dissection of the corneal stroma. The following results apply to the remaining 23 eyes. After a mean follow-up period of 16.21 (standard deviation [SD] 3.93) months, the mean IOP had fallen from 26.26 (SD 4.3) mm Hg preoperatively to 17.60 (SD 4.35) mm Hg at the last postoperative visit (p = 0.000). The rate of complete success (IOP < 21 mm Hg without medication) was 86.9% at 1 month, 56.5% at 12 months and 39.1% at the last visit. The rates of qualified success (IOP < 21 mm Hg with or without medication) were 95.6%, 91.3% and 82.6%, respectively. No postoperative complications of the type that might occur after trabeculectomy were observed. Three eyes with an insufficient reduction in IOP underwent goniopuncture with a neodymium:YAG laser. Statistical analysis of the success rates revealed that deep sclerectomy with T-Flux implantation was comparable to viscocanalostomy at all postoperative visits (p > 0.05). INTERPRETATION A statistically significant drop of IOP with few postoperative complications over the short term was achieved with deep sclerectomy and T-Flux implantation. The success rates were comparable to, and not significantly better than, those of viscocanalostomy.

Bilateral angle closure glaucoma following general anesthesia

Although unilateral angle closure glaucoma is quite common, simultaneous bilateral acute angle closure is very rare and is usually induced by an external cause. General anesthesia is a triggering factor for acute angle closure glaucoma. We report two cases of simultaneous bilateral angle closure glaucoma following non-ocular surgery under general anesthesia. One patient had cholecystectomy, the other craniotomy for tumor resection.In the postoperative period following general anesthesia, any patient at risk for angle closure glaucoma should be followed closely; patients with periorbital pain and visual symptoms should be examined for angle closure glaucoma attack in both eyes.

Non-penetrating deep sclerectomy and collagen implant surgery in glaucoma patients with advanced field loss

Purpose: The aim of the study was to determine the medium term intraocular pressure (IOP) lowering effects and the potential complications of non-penetrating deep sclerectomy and collagen implant (DSCI) surgery in glaucoma patients. Patients and methods: 54 eyes of 52 patients with medically uncontrolled open angle glaucoma with advanced field loss underwent DSCI under topical anaesthesia. Follow-up period was 24 months. Results: The mean preoperative IOP was 24.7 ± 6.2 mmHg and decreased to 15.1 ± 4.0 mmHg at 24 months (p = 0.0068). During the follow- up period, 36 of 54 eyes (66%) received no topical antiglaucomatous medications. In 18 eyes, monotherapy with topical beta blockers (Betaxolol HCl) was added to the regimen. At last visit , only two patients (3.8%) had IOP greater than 18 mmHg. We did not detect any additional optic disc changes, visual field or visual acuity defects postoperatively. Detailed slit-lampexamination revealed no anterior segment complications regarding the probablecomplications of trabeculectomy. None of the patients developed surgery relatedcataract. As a complication, we diagnosed one case of self-limited, shallow choroidal detachment. Conclusion: DSCI appears to provide considerable medium term IOP decrease with few postoperative complications without deteriorating visual acuity. Owing to our medium term results, we believe that DSCI could be a valuable alternative to trabeculectomy especially in cases of advanced medically uncontrolled open angle glaucoma.

Comparison of outcomes of viscocanalostomy and phacoviscocanalostomy

BACKGROUND Many adults who undergo glaucoma filtering surgery also need surgical treatment of coexisting cataract. Recent reports of the use of new alternative non-penetrating techniques in combination with phacoemulsification have given encouraging results. The purpose of this study was to compare the safety and efficacy of viscocanalostomy and phacoviscocanalostomy in the management of medically uncontrolled open-angle glaucoma. METHODS Twenty patients who underwent phacoviscocanalostomy in one eye each were enrolled in the study. Twenty matching patients who underwent viscocanalostomy in one eye each at our institution were selected as the control group. Postoperative reductions in intraocular pressure (IOP) and number of antiglaucoma medications were compared between the groups. Visual acuity and complications were secondary outcomes. RESULTS Significant reductions of IOP and of use of antiglaucoma medication occurred in both groups (p < 0.05); these results were comparable in the two groups (p > 0.05). The mean IOP reduction was 34% in the eyes that underwent viscocanalostomy alone and 38% in the eyes that underwent phacoviscocanalostomy. The success rates of the two procedures were also comparable (p > 0.05). In the combined-surgery group the best-corrected visual acuity improved by 2 or more lines in 18 eyes (90%). Intraoperative complications did not occur in either group. INTERPRETATION Combining phacoemulsification with viscocanalostomy did not have a negative effect on the IOP control achieved by viscocanalostomy alone and did not increase the complication rate. Phacoviscocanalostomy was safe and effective in the surgical management of eyes with both glaucoma and cataract.

Axial Length Changes Accompanying Successful Nonpenetrating Glaucoma Filtration Surgery

We aimed to evaluate the effect of nonpenetrating glaucoma filtration surgery on axial length (AL). Thirty patients (30 eyes) who underwent successful nonpenetrating glaucoma filtration surgery were prospectively analyzed. AL was measured preoperatively and postoperatively at 1 and 12 months. Associations between change in AL and age, gender, diagnosis, preoperative and postoperative visual acuity, refraction and intraocular pressure (IOP) were analyzed. AL decreased in 22 of 30 eyes postoperatively. The mean change in AL measurement was –0.15 ± 0.27 mm (range –1.37 to +0.12 mm) at 1 month. Regression analysis showed that young age, a high preoperative IOP and a greater change in IOP were associated with a greater decrease in AL (p < 0.02). The mean AL at 12 months was almost the same as the preoperative value (p >0.2), but was significantly greater than the mean AL 1 month postoperatively (p = 0.001). There was no statistically significant difference between the IOP levels obtained postoperatively at 1 and 12 months (p >0.1). Nonpenetrating glaucoma surgery can result in a small decrease in AL which can reverse during the follow-up period.

Erythrocyte deformability in high-tension and normal tension glaucoma.

The exact cause of primary open angle glaucoma is still unknown. Intraocular pressure is a major factor but it is impossible to explain the whole mechanism of glaucomatous optic nerve damage with only increased intraocular pressure. Other factors play important roles in the development of glaucoma. With this point of view, vascular factors have been implicated in the pathogenesis of glaucoma.We tried to determine the etiopathogenetic role of decreased erythhrocyte deformability in normal tension glaucoma and high-tension glaucoma. The study group consisted of 16 patients with the diagnosis of normal tension glaucoma, 17 patients with the diagnosis of high-tension glaucoma, and 24 patients as controls.Independent t-tests were used to compare the three groups two by two for age, hematocrit, mean cell volume, plasma protein level, cardiovascular risk factors, and erythrocyte deformability. There was no statistically significant relationship (p > 0.05) between the groups concerning the erythrocyte deformability. When we consider all of 57 patients, we found that both increasing age (> 60 years) and greater mean cell volume (> 84 fl) had a statistically significant relationship with decreased erythrocyte deformability (p < 0.05). When we performed Pearson correlation analysis, we found that only mean cell volume and erythrocyte deformability had a statistically significant relationship (r=0.31, p=0.02).We conclude that decreased erythrocyte deformability is not a major factor in the ethiopathogenesis of normal tension glaucoma and high-tension glaucoma.

Glaucoma Implant Surgery With Autogenous Fascia Lata in Scleromalacia Perforans

A 51-year-old woman with bilateral scleromalacia perforans and advanced glaucoma in the left eye was evaluated. Glaucoma implant surgery with autogenous fascia lata graft for reinforcement of the underlying sclera and a patch graft overlying the tube to prevent tube erosion was planned because of insufficient response to medical glaucoma therapy. Intraocular pressure decreased from 55 to 15 mm Hg and remained under 20 mm Hg throughout the follow-up period of 24 months. No complication was noted. Glaucoma implant surgery using autogenous fascia lata to form a healthy ground and a patch graft to prevent tube erosion seems to be a safe and effective method when normal sclera is lacking, such as in scleromalacia perforans.

Serum and Aqueous Humor Sialic Acid Levels in Behçet's Disease

Serum and aqueous humor sialic acid (SA) levels were determined in 27 patients with Behçets disease (Bd). Serum SA levels were elevated significantly during the active episode (mean, 113.4 +/- 4.12 mg/dl) and in the remission stages (mean, 85.4 +/- 4.79 mg/dl; P less than 0.001). A significant increase was also detected in active episodes when compared to chronic stages (P less than 0.02). Aqueous humor levels were also evaluated but could only be determined in the six eyes at the end-stage of the disease (mean, 2.65 +/- 0.60 mg/dl; P less than 0.05).