Modi Goldenfeld

Efficacy and Safety of Gold Micro Shunt Implantation to the Supraciliary Space in Patients With Glaucoma: A Pilot Study

PURPOSE To evaluate the safety and efficacy of Gold Micro Shunt (GMS) implantation to the supraciliary space in patients with glaucoma. METHODS A total of 38 patients with glaucoma with uncontrolled intraocular pressure (IOP) underwent implantation of the GMS in this prospective 2-center study. MAIN OUTCOME MEASURES Intraocular pressure and surgical complications. RESULTS A total of 38 patients with glaucoma participated. The mean follow-up time was 11.7 months. The IOP decreased a mean (SD) of 9 mm Hg from 27.6 (4.7) to 18.2 (4.6) mm Hg (P < .001). Surgical success was achieved in 30 patients (79%) (IOP >5 and <22 mm Hg, with or without antiglaucoma medication). Eight patients had mild to moderate transient hyphema. CONCLUSIONS Implantation of GMS to the supraciliary space is a safe and effective method of controlling IOP in patients with glaucoma. Use of the GMS resulted in a significant decrease in IOP. APPLICATION TO CLINICAL PRACTICE The GMS could be an alternative surgical device to standard trabeculectomy.

Selective laser trabeculoplasty in uncontrolled pseudoexfoliation glaucoma.

BACKGROUND AND OBJECTIVE To assess the efficacy and safety of selective laser trabeculoplasty (SLT) in uncontrolled pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS Fifty-seven eyes (57 patients) with uncontrolled PEXG and intra-ocular pressure (IOP) greater than 23 mm Hg underwent SLT. All received ophthalmic evaluation preoperatively and at intervals postoperatively. IOP was measured at 1 hour, 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. During follow-up, patients were treated with topical anti-glaucoma medications as necessary. RESULTS One year postoperatively, mean IOP in all patients decreased from 26.01 ± 2.5 to 17.8 ± 2.8 mm Hg (31.5%; P < .001). Mean medications per patient decreased from 2.8 to 2.3. Complications included conjunctival redness and infection within 1 day postoperatively in 30 eyes (67%). One hour after SLT treatment, an increase in IOP greater than 5 mm Hg was detected in two eyes (3.5%) and resolved within 24 hours with topical medication. CONCLUSION SLT is safe and effective in patients with PEXG.

Donor Scleral Patch for Treating Hypotony Due to Leaking and/or Overfiltering Blebs

Objective:To report a modified technique of bleb revision with the use of a donor scleral patch in cases in which scleral melting did not allow effective suturing and closure of the aqueous leak. The suturing technique ensures tight adaptation of the scleral patch over the leaky region, and allows better-controlled aqueous flow with loose suturing of the posterior edge of the scleral patch. Methods:Records of patients who underwent bleb revision with donor scleral graft from 1997 to 2003 were reviewed retrospectively. Chart information including demographic and clinical data was recorded preoperatively and 1 day, 1 week, 1 month, 6 months, and at final follow-up. Results:Fifteen patients underwent this surgical procedure for bleb revision. The mean follow-up time was 22.0 ± 24.0 months (median = 8.0 months). The mean preoperative visual acuity was 20/50 and the mean intraocular pressure (IOP) was 2.9 ± 2.3 mm Hg, which improved to 20/30 and 14.1 ± 3.3 mm Hg respectively, on last follow-up. Conclusions:The scleral patch with 4-nylon sutures should be proposed in cases in which a macerated scleral bed is revealed during the revision. The loose suturing of the scleral patch at its posterior border was found to prevent intraocular pressure spikes.

CO2 laser-assisted deep sclerectomy in glaucoma patients.

Purpose:To evaluate the safety and efficacy of CO2 laser-assisted deep sclerectomy surgery (CLASS) in patients with open angle glaucoma. Design:A prospective single-arm, nonrandomized clinical investigation for the evaluation of technology. Methods:Fifteen eyes of 15 consecutive patients diagnosed with either primary open angle glaucoma or pseudoexfoliation glaucoma who were the candidates for glaucoma filtration surgery were included. Laser-assisted deep sclerectomy using a CO2 laser system was performed in all patients. A half-thickness scleral flap was created, the use of 0.04% mitomycin C for 60 seconds was left at the surgeon’s discretion, and a CO2 laser with a beam-manipulating system was used to achieve deep scleral ablation and unroofing of Schlemm’s canal zone. Visual acuity, complete ophthalmologic examination, and intraocular pressure (IOP) were measured and documented at baseline, 1, 2, 4, and 6 weeks and at 3, 6, and 12 months, respectively. Complete success was defined as 5⩽IOP⩽21 mm Hg and 20% IOP reduction with no medication at the 12-month endpoint visit. Qualified success was defined as a similar IOP reduction with medication. Results:The preoperative IOP of 27.3±4.2 mm Hg (mean±SD) dropped to 15.0±3.7 mm Hg at 6 months and 16.6±3.4 mm Hg at 12 months postoperatively, yielding an average IOP reductions at 6 and 12 months of 13.1±4.3 mm Hg (45.1%; 95% CI, 11, 15.3) and 11.5±5.5 mm Hg (39.2%; 95% CI, 8.8, 14.3), respectively (P<0.001). The complete success rate after 12 months was 45.5%, whereas qualified success was 90.9%. Mitomycin C was used in 76.9% of the CLASS subjects.

Postoperative treatment with topical diclofenac versus topical dexamethasone after combined phacotrabeculectomy with mitomycin C.

Objective:The objective of the study was to compare the efficacy and safety of topical dexamethasone sodium phosphate 0.1% (Sterodex) to diclofenac sodium 0.1% (Voltaren Ophthalmic) after combined phacotrabeculectomy with mitomycin C. Methods:This prospective, randomized, double-masked clinical trial includes 42 patients with glaucoma and cataract who underwent a combined phacotrabeculectomy. Patients were randomly assigned to postoperative treatment with topical diclofenac sodium 0.1% or topical dexamethasone phosphate 0.1%. Follow-up duration was 12 months and all examinations were masked. The main outcome measures were intraocular pressure (IOP), number of glaucoma medications, and bleb morphology. Results:Baseline characteristics of the diclofenac (n=21) and dexamethasone (n=21) patients were similar. Phacotrabeculectomy with both postoperative treatments was effective in reducing IOP, lowering the number of glaucoma medications and improving visual acuity at all follow-up points. The average number of medications taken by the dexamethasone group was significantly greater than the diclofenac group at 8 months (1.2±1.4 and 0.3±0.6, respectively, P=0.03). The mean bleb height of the diclofenac group was significantly higher than the dexamethasone group at 3 weeks (P=0.05), and the mean bleb width was significantly wider at 8 months (P=0.04). No significant group differences in IOP were found at any of the follow-up visits, although there was a clinical trend toward lower IOP values in the diclofenac group. Sixteen patients (76%) in the diclofenac group and 17 patients in the dexamethasone group (81%) completed 1 year of follow-up. Conclusions:In this preliminary study, diclofenac sodium is at least as good as topical dexamethasone phosphate for glaucoma patients undergoing two-site combined phacotrabeculectomy with mitomycin C.