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Purpose: The purpose of this study was to develop deep learning models for surgical video analysis, capable of identifying minimally invasive glaucoma surgery (MIGS) and locating the trabecular meshwork (TM)., Methods: For classification of surgical steps, we had 313 video files (265 for cataract surgery and 48 for MIGS procedures), and for TM segmentation, we had 1743 frames (1110 for TM and 633 for no TM). We used transfer learning to update a classification model pretrained to recognize standard cataract surgical steps, enabling it to also identify MIGS procedures. For TM localization, we developed three different models: U-Net, Y-Net, and Cascaded. Segmentation accuracy for TM was measured by calculating the average pixel error between the predicted and ground truth TM locations., Results: Using transfer learning, we developed a model which achieved 87% accuracy for MIGS frame classification, with area under the receiver operating characteristic curve (AUROC) of 0.99. This model maintained a 79% accuracy for identifying 14 standard cataract surgery steps. The overall micro-averaged AUROC was 0.98. The U-Net model excelled in TM segmentation with an Intersection over union (IoU) score of 0.9988 and an average pixel error of 1.47., Conclusions: Building on prior work developing computer vision models for cataract surgical video, we developed models that recognize MIGS procedures and precisely localize the TM with superior performance. Our work demonstrates the potential of transfer learning for extending our computer vision models to new surgeries without the need for extensive additional data collection., Translational Relevance: Computer vision models in surgical videos can underpin the development of systems offering automated feedback for trainees, improving surgical training and patient care.

To investigate biomarkers of intra-ocular pressure (IOP) decrease after cataract surgery with trabecular washout in pseudo-exfoliative (PEX) glaucoma. A single-center observational prospective study in PEX glaucoma patients undergoing cataract surgery with trabecular washout (Goniowash) was performed from 2018 to 2021. Age, gender, visual acuity, IOP, endothelial cell count, central corneal thickness, medications, were collected over 16-month follow-up. Multivariable binomial regression models were implemented. 54 eyes (35 subjects) were included. Mean preoperative IOP (IOP BL ) was 15.9 ± 3.5 mmHg. Postoperative IOP reduction was significant at 1-month and throughout follow-up (p < 0.01, respectively). IOP BL was a predictive biomarker inversely correlated to IOP decrease throughout follow-up (p < 0.001). At 1 and 12 months of follow-up, IOP decrease concerned 31 (57.4%) and 34 (63.0%) eyes with an average IOP decrease of 17.5% (from 17.6 ± 3.1 to 14.3 ± 2.2 mmHg) and 23.0% (from 17.7 ± 2.8 to 13.5 ± 2.6 mmHg), respectively. Performance (AUC) of IOP BL was 0.85 and 0.94 (p < 0.0001, respectively), with IOP BL threshold ≥ 15 mmHg for 82.1% and 96.8% sensitivity, 84.2% and 75.0% specificity, 1.84 and 3.91 IOP decrease odds-ratio, respectively. All PEX glaucoma patients with IOP BL greater than or equal to the average general population IOP were likely to achieve a significant sustainable postoperative IOP decrease., (© 2024. The Author(s).)

Competing Interests: Competing interests: None declared.

Purpose: To report the histopathologic correlates of trabecular meshwork (TM) specimens procured by microincisional trabeculectomy (MIT) for different severities of glaucoma (early glaucoma: visual field mean deviation [MD] <-6 dB, moderate glaucoma: MD from - 6 to - 12 dB, and advanced glaucoma: MD <-12 dB)., Methods: TM specimens from four patients undergoing MIT with or without cataract surgery were analyzed by routine histopathology for structural changes. The number of cells, the number of cells with spindle-shaped nuclei suggestive of epithelial-mesenchymal transformation (EMT), and the distance between the trabecular beams were calculated using different tools on freely available ImageJ software using the line or pint/count tool., Results: The TM specimens procured from two early and two advanced glaucoma cases showed decreasing cellularity and decreased compact arrangement of the trabecular beams in severe disease stages. The number of cells and preserved architecture in all four specimens were evident, with > 50 cells being present per section in all four cases despite the glaucoma being of advanced disease stage in two patients., Conclusion: The TM specimens obtained from MIT can be utilized for downstream analysis using different molecular methods for studying the molecular events in the tissue from early to severe glaucoma., (Copyright © 2023 Copyright: © 2023 Indian Journal of Ophthalmology.)

Purpose: To evaluate 12 month surgical outcome of Kahook Dual Blade (KDB) goniotomy in combination with cataract surgery in Latino patients with open angle glaucoma (OAG) and ocular hypertension (OHT)., Methods: This retrospective study included 45 eyes of 40 patients who underwent KDB goniotomy combined with cataract extraction from January 2016 to September 2020 at two centers in South America. Primary outcome was surgical success defined as ≥ 20% intraocular pressure (IOP) reduction or ≥ 1 medication reduction from preoperative without additional IOP-lowering procedures and an IOP ≥ 5 mmHg or ≤ 21 mmHg. Additionally, we used 2 cutoffs values for success of IOP ≤ 18 and ≤ 15 mmHg. Secondary outcomes included: IOP, medication use, best corrected visual acuity, complications and failure-associated factors., Results: Success rates at 12 months with cutoff limits of 21, 18 and 15 mmHg were 84.3%, 75.6% and 58.7%, respectively. At 12 months, mean preoperative IOP significantly decreased from 19.23 ± 0.65 mmHg on 2.3 ± 1.0 medications to 14.33 ± 0.66 mmHg on 0.6 ± 0.9 medications (p < 0.001) , with 62% of eyes free of hypotensive medication. Eyes that developed postoperative IOP spikes showed a higher risk for failure using the cutoff limit of IOP ≤ 18 mmHg with a hazard ratio of 3.6 (95% confidence interval [CI], 1.80-7.13; p < 0.001). There were no serious ocular adverse events., Conclusions: KDB combined with cataract extraction showed safety and efficacy for decreasing IOP in OAG and OHT Latino patients. Additionally, dependence on medications was reduced significantly after surgery., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To compare IOP and ocular hypotensive medication reduction of using one trabecular microbypass stent versus two in patients with open-angle glaucoma. Setting . Palo Alto Veterans Affairs (VA) Hospital and the Byers Eye Institute at Stanford University, Palo Alto, California, USA., Design: Retrospective case series., Methods: A chart review included patients who underwent trabecular microbypass implantation with cataract surgery in 2015-2017, with at least one-year follow-up. Subjects were divided into two groups by location (always one stent at Stanford versus two stents at the VA). Primary outcome measures included IOP and medication reduction at baseline and 12-month follow-up., Results: 132 subjects (166 eyes) were included. The preoperative IOP was 16.3 ± 3.4 mmHg on 2.6 ± 1.1 medications in the one-stent group ( N = 85) and 17.5 ± 3.1 mmHg on 2.7 ± 0.6 medications in the two-stent group ( N = 81). There was no significant difference between the two groups ( p = 0.06). At the 12-month visit, there was a 13.37% ± 2.93 reduction in IOP in the 1-stent group ( p ≤ 0.001) and 13.49% ± 2.69 in the 2-stent group ( p ≤ 0.001); both were not significantly different from each other ( p = 0.074). At 12 months, there was also a 14.5% reduction in medication use for the 1-stent group and 15.3% reduction in the 2-stent group, both statistically significant from baseline, ( p = 0.022 and p = 0.037, respectively)., Conclusions: Implantation with either one or two stents during cataract surgery in patients with glaucoma demonstrated similar IOP and med reduction in both groups between the two sites., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Shuo Yang et al.)

Introduction: This retrospective consecutive case series assessed 12-month effectiveness and safety of iStent ® or iStent inject ® trabecular micro-bypass implants with cataract surgery in patients with open-angle glaucoma (OAG) in a real-world clinical setting., Methods: Effectiveness outcomes consisted of intraocular pressure (IOP) reduction; glaucoma medication reduction; proportions of eyes achieving IOP < 18, < 15, or < 12 mmHg; and proportional analysis of medication usage. Safety outcomes included adverse events, secondary surgeries, and best-corrected visual acuity (BCVA)., Results: This evaluation included 58 eyes with OAG (35 iStent, 23 iStent inject), with 96.6% of eyes having mild or moderate glaucoma. Diagnoses included primary open-angle glaucoma (the majority; 72.4%), pseudoexfoliative glaucoma, and pigmentary glaucoma. Baseline mean IOP and medications were statistically comparable between groups: 16.1 ± 3.6 mmHg on a mean of 1.8 ± 0.8 medications in the iStent group, and 16.2 ± 3.1 mmHg on a mean of 1.7 ± 0.8 medications in the iStent inject group. Twelve months after stent-cataract surgery, mean IOP was significantly lower in the iStent inject group than in the iStent group (13.1 mmHg vs. 15.4 mmHg, respectively; p < 0.001), and the percent reduction in IOP from baseline was significantly greater in iStent inject eyes than in iStent eyes (19.1% vs. 4.3% reduction, respectively; p < 0.001). At 12 months postoperative, significantly greater proportions of iStent inject eyes than iStent eyes achieved IOP < 18 mmHg (100% vs. 80.0% of eyes, respectively; p = 0.035), IOP < 15 mmHg (73.9% vs. 34.3% of eyes, respectively; p = 0.003), and IOP < 12 mmHg (26.1% vs. 0% of eyes, respectively; p = 0.002). Meanwhile, both groups achieved significant medication reductions at 12 months vs. baseline (94.1% reduction in iStent inject eyes, p < 0.0001; and 72.2% reduction in iStent eyes, p < 0.0001), with the percent reduction being significantly greater in iStent inject eyes than in iStent eyes (p = 0.023). At 12 months, mean number of medications was significantly lower in iStent inject eyes than iStent eyes (0.1 vs. 0.5 medications, respectively; p = 0.021), and significantly more iStent inject eyes (95.7%) than iStent eyes (71.4%) were off medications entirely (p = 0.021). A similarly high safety profile was observed in both groups., Conclusion: iStent or iStent inject implantation with cataract surgery resulted in substantial and safe reductions in IOP and medications through 12 months postoperative. Consistent with prior observations, greater efficacy was observed with iStent inject than with iStent., Funding: The Rapid Service Fees were funded by Glaukos Corporation.

Aims: To compare success proportions at 5 years in three surgical groups: group 1, trabeculectomy alone; group 2, trabeculectomy followed by cataract surgery within 2 years; and group 3, trabeculectomy performed on a pseudophakic eye., Methods: A retrospective cohort study. 194 eyes of 194 patients were identified with at least 5 years' follow-up post trabeculectomy (N=85, 60 and 49 in groups 1, 2 and 3, respectively)., Main Outcome Measures: 1., Primary Outcome Measure: intraocular pressure (IOP) at 5 years post-trabeculectomy surgery, 2.Secondary outcome measure: change in visual acuity at 5 years., Results: At 5 years, the mean IOP (SD) was 12.9 (3.5), 12.5 (4.8) and 12.7 (4.8) mm Hg in groups 1, 2 and 3, respectively. Overall success was almost identical, 58%, 57% and 59% in groups 1, 2 and 3, respectively. There was no significant difference between the groups in terms of percentage IOP reduction, number of medications, proportion restarting medication and reoperation rates at 5 years. Logistic regression for an outcome of failure showed men to be at increased risk of failure OR 1.97 (95% CI 1.10 to 3.52, p=0.02). Nearly 80% of patients retained or improved their vision following their initial trabeculectomy., Conclusions: The sequence in which surgery is carried out does not appear to affect trabeculectomy function at 5 years, success being similar to trabeculectomy alone. In our study, men may be at increased risk of failure., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To compare the efficacy and safety of combined cataract extraction and either excisional goniotomy performed with the Kahook Dual Blade (KDB; phaco-KDB group) or single iStent trabecular bypass implantation (phaco-iStent group) in eyes with mild to moderate glaucoma and visually significant cataract., Methods: This was a retrospective analysis of 315 eyes from 230 adults with mild or moderate glaucoma treated with one or more intraocular pressure (IOP)-lowering medications (190 eyes of 134 subjects in the phaco-KDB group and 125 eyes of 96 subjects in the phaco-iStent group) that required no subsequent surgical intervention for IOP control through 12 months of follow-up. Data included best-corrected visual acuity (BCVA), IOP, and IOP-lowering medications, collected preoperatively and at 1 week and 1, 3, 6, and 12 months postoperatively as well as intraoperative and postoperative adverse events. The primary efficacy outcomes were the proportion of subjects in each group achieving ≥ 20% IOP reduction and ≥ 1 medication reduction at month 12. Subgroup analysis by baseline IOP (≤ 18 mmHg vs. > 18 mmHg) was also performed., Results: Mean (standard error) baseline IOP was 18.2 (0.3) mmHg in the phaco-KDB group and 16.7 (0.3) mmHg in the phaco-iStent group (p = 0.001). Statistically significant mean IOP and mean IOP medication reductions from baseline were achieved at all time points in both groups. Mean IOP reductions were significantly greater in the phaco-KDB group than in the phaco-iStent group at all time points including month 12 [- 5.0 (0.3) mmHg vs. - 2.3 (0.4) mmHg, p < 0.001], while mean medication reductions were similar between groups at all time points except week 1, when greater mean medication reduction was seen in the phaco-iStent group (- 1.23 vs. - 0.60 medications, p < 0.001). At month 12, IOP reductions ≥ 20% were achieved by 64.2% and 41.6% (p < 0.001) in the phaco-KDB and phaco-iStent groups, respectively, and IOP medication reductions of ≥ 1 medication were achieved by 80.4% and 77.4% (p = 0.522), respectively. Intraocular pressure subgroup analysis revealed significant reductions in IOP-lowering medications without compromise of IOP control in lower IOP subgroups and significant reductions in both IOP and IOP-lowering medications in the higher IOP subgroups. The most common adverse events were transient IOP elevations and transient anterior chamber inflammation, which occurred with similar frequency in both groups and resolved spontaneously., Conclusion: Goniotomy with the KDB lowered IOP significantly more than iStent implantation, with few adverse events in both groups. In eyes with mild to moderate glaucoma undergoing combined cataract extraction and glaucoma surgery, goniotomy with the KDB can safely deliver statistically significant and clinically meaningful reductions in both IOP and IOP medication burden through 12 months of follow-up., Funding: New World Medical, Inc., provided funding for the study, medical writing assistance, Rapid Service Fees, and the open access fee.

Precis: Schlemm canal (SC) expands after cataract extraction (CE), both in the area and in volume by 25% as was measured using enhanced-depth imaging optical coherent tomography (EDI-OCT) in patients before and 1 week after CE., Purpose: This study aims to characterize the structural and volume changes on the microstructure of SC in patients before and after uneventful phacoemulsification CE by using EDI-OCT., Materials and Methods: Forty-one serial horizontal EDI-OCT B-scans (interval between B-scans, 69 µm) were obtained in the nasal corneoscleral limbus before and 1 week after CE. The structure of aqueous channels, conjunctival blood vessels and iris anatomy in each scan were used as landmarks to select for overlapping scans taken before and following CE. The SC cross-section area was measured in each of the selected scans and SC volume was determined following a 3-dimensional reconstruction., Results: Eleven eyes (6 females and 5 males) were imaged successfully before and after CE. Mean age was 70.54±11.38 years. The mean axial length was 23.10±0.87 mm. After CE, the mean best-corrected visual acuity in logMAR improved from 0.4±0.13 to 0.2±0.13 (P=0.028). There was no significant change in the mean intraocular pressure before and after CE (15.09±1.33 to 15.0±2.16 mm Hg; P=0.39). The mean SC cross-section area increased by 25%, from 4744±376 to 5941±1048 μm (P<0.001). SC volume in the analyzed region increased by 25% from 6,641,473±585,954 to 8,317,909±1,328,809 μm (P<0.001)., Conclusion: CE expands SC dimensions in healthy eyes. EDI-OCT imaging of SC may prove useful in the evaluation of the SC dimensions in vivo before and after CE.

A propagation of microinvasive glaucoma surgery (MIGS) techniques and devices has resulted in the availability of multiple new modalities for surgical intervention for open-angle glaucoma. As MIGS devices and methods approach a new phase in maturity, midterm failures will inevitably be reported. Although MIGS techniques prioritize safety, an understanding of the potential mechanisms of failure is paramount. In this case of a midterm failure of a trabecular microbypass, clinical findings and pathological correlates allow for a comprehensive understanding of the means by which MIGS devices might fail and offer the opportunity for intervention and potential prevention., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Introduction: Trabecular microbypass stents are effective at lowering intraocular pressure in patients with mild to moderate glaucoma. Corneal hysteresis has been shown to correlate with reduction in intraocular pressure in patients using topical prostaglandin analogues and selective laser trabeculoplasty to treat glaucoma. The purpose of this study was to investigate whether baseline corneal hysteresis measurements were predictive of effectiveness of trabecular microbypass stents in treating glaucoma., Methods: This was a retrospective chart review of 163 eyes from 109 patients with primary open angle glaucoma that underwent simultaneous trabecular microbypass stenting and cataract surgery. This was a single center study with one surgeon performing all procedures., Results: The eyes were grouped into quartiles according to baseline corneal hysteresis measurements. Baseline intraocular pressures among the four quartiles of baseline corneal hysteresis groups were similar (p=0.082, ANOVA). The average intraocular pressure reduction at 3 months post-operative visits were 3.67, 1.51, 2.83, and 2.09 mmHg for the first through fourth quartiles respectively, and these differences are insignificant overall (p=0.34, ANOVA). Likewise, no significant difference was detected in terms of reduction in glaucoma medications among the quartiles three months after surgery (p=0.78, ANOVA)., Conclusion: Baseline corneal hysteresis does not appear to show any value in predicting intraocular pressure reduction in response to placement of a trabecular microbypass stent for treating glaucoma., (Copyright© South Dakota State Medical Association.)

Purpose: To evaluate the safety and efficacy of intravitreal administration of a steroid and antibiotics during cataract surgery compared with the typical postoperative topical regimen in preventing postoperative inflammation, pain, cystoid macular edema (CME), and endophthalmitis., Setting: Private practice, Sioux Falls, South Dakota, USA., Design: Retrospective case series., Methods: The study group included eyes that had an intravitreal injection of triamcinolone-moxifloxacin-vancomycin at the time of cataract surgery with concomitant trabecular microbypass stent insertion. The control eyes had the same procedure but were prescribed topical antibiotics, steroids, and nonsteroidal antiinflammatory drugs postoperatively. Data were recorded preoperatively and 1 day, 1 week, 1 month, and 3 months postoperatively. Primary outcomes included the number of glaucoma medications, intraocular pressure (IOP), and IOP spikes of at least 15 mm Hg from baseline., Results: There were 234 eyes in the study group and 249 eyes in the control group. The mean reduction in glaucoma medications was 0.24 drops in the study group and 0.80 drops in the control group 3 months postoperatively, whereas the mean IOP reduction was 2.59 mm Hg in the study group and 3.63 mm Hg in the control group. Pressure spikes were detected at 54 (5.7%) of 936 postoperative visits in the study group and at 37 (3.7%) of 996 visits in the control group. There were no cases of severe inflammation, CME, infection, or retinal detachments., Conclusions: Both groups had similar postoperative pressure reductions and incidence of IOP spikes. The results indicate that intravitreal injections of a steroid and antibiotics might be a safe option for glaucomatous eyes having cataract surgery with trabecular microbypass stent insertion., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the safety and efficacy profile after combined micro-incision cataract surgery (MICS) and micro-invasive glaucoma surgery (MIGS) with the ab interno trabeculectomy (Trabectome®) in one eye versus two iStent® inject devices in the contralateral eye in patients with open-angle glaucoma (OAG) and cataract., Methods: This retrospective, intraindividual eye comparison study included 27 patients (54 eyes) who were treated with combined MICS and ab interno trabeculectomy (group I, Trabectome®) in one eye and two iStent® inject devices (group II, GTS 400) in the fellow eye. Primary outcome measures included intraocular pressure (IOP) and glaucoma medication after 6 weeks, 3, 6, and 12 months follow-up. Secondary outcome measures were number of postoperative interventions, complications, and best-corrected visual acuity (BCVA)., Results: Mean preoperative IOP decreased from 22.3 ± 3.7 mmHg in group I and 21.3 ± 4.1 mmHg in group II to 15.6 ± 3.6 mmHg for Trabectome (p < 0.001) and 14.0 ± 2.3 mmHg for iStent inject (p < 0.001) at 12 months after surgery without a significant difference between the two groups (p > 0.05). No vision-threatening complications such as choroidal effusion, choroidal hemorrhage, or infection occurred. In each group trabeculectomy had to be performed in two eyes due to insufficient IOP lowering effect., Conclusions: Ab interno trabeculectomy and iStent® inject were both effective in lowering IOP with a favourable and comparable safety profile in an intraindividual comparative study over a 12-months follow-up in OAG. However, longer follow-up of these patients will be necessary to determine long-term outcomes and to evaluate significant differences.

Purpose: To evaluate the changes in anterior chamber angle (ACA) parameters in primary angle closure (PAC) spectrum eyes before and after cataract extraction (CE) and compare to the changes after laser peripheral iridotomy (LPI) using anterior segment optical coherence tomography (ASOCT)., Methods: Twenty-eight PAC spectrum eyes of 18 participants who underwent CE and 34 PAC spectrum eyes of 21 participants who underwent LPI were included. ASOCT images with 3-dimensional mode angle analysis scans were taken with the CASIA SS-1000 (Tomey Corp., Nagoya, Japan) before and after CE or LPI. Mixed-effect model analysis was used to 1) compare best-corrected visual acuity, intraocular pressure, and ACA parameters before and after CE; 2) identify and estimate the effects of potential contributing factors affecting changes in ACA parameters; and 3) compare CE and LPI treatment groups., Results: The increase in average angle parameters (TISA750 and TICV750) was significantly greater after CE than LPI. TICV750 increased by 102% (2.114 [±1.203] μL) after LPI and by 174% (4.546 [± 1.582] μL) after CE (P < 0.001). Change of TICV750 in the CE group was significantly affected by age (P = 0.002), race (P = 0.006), and intraocular lens power (P = 0.037)., Conclusions: CE results in greater anatomic changes in the ACA than LPI in PAC spectrum eyes. ASOCT may be used to follow anatomic changes in the angle after intervention., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: The CASIA SS-1000 was loaned to Dr. Feldman by the Tomey Corporation (Nagoya, Japan). Dr. Bell, Dr. Blieden, and Dr. Feldman are members of the Alcon Speaker Bureau and have received research funding from Alcon. Dr. Feldman is also a consultant for Alcon. No other authors declare any relevant conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: The aim of this study was to evaluate the intraocular pressure (IOP)-lowering effect of cataract surgery combined with canaloplasty compared to canaloplasty alone., Methods: A total of 43 patients underwent canaloplasty without cataract surgery (group K) and 20 patients underwent canaloplasty with cataract surgery (group K+P). The IOP-lowering effect was measured 4-6 weeks, 3, 6 and 12 months postoperatively., Results: The mean presurgical IOP was 18.26 ± 6.07 mmHg in group K and 16.95 ± 3.46 mmHg in group K+P. In group K the mean IOP was 13.08 ± 5.67 mmHg (28% reduction) 4-6 weeks postoperatively, 13.25 ± 4.51 mmHg (27%) 3 months postoperatively, 12.4 ± 3.25 mmHg (32%) 6 months postoperatively and 12.5 ± 2.45 mmHg (32%) 12 months postoperatively. The mean IOP in group K+P was 11.41 ± 4.87 mmHg (33%) 4-6 weeks postoperatively, 10.4 ± 4.88 mmHg (39%) 3 months postoperatively, 11.0 ± 2.89 mmHg (35%) 6 months postoperatively and 13.0 ± 1.94 mmHg (23%) 12 months postoperatively (no statistical significant difference between the two groups)., Conclusions: Combined cataract-canaloplasty surgery has no significant additional IOP-lowering effect compared to canaloplasty alone.

Purpose: To analyze the clinical features of pseudoexfoliation syndrome and to determine complications in cataract surgery in eyes with pseudoexfoliation syndrome compared with eyes without this syndrome., Methods: A retrospective, single-center comparative study was conducted on patients who underwent cataract surgery between 2004 and 2006. Demographic parameters (age, sex, ethnicity, medical and ophthalmologic history), clinical features (visual acuity, pupil dilatation, intraocular pressure) before and after surgery, and surgical complications were analyzed and compared to a control group without pseudoexfoliation., Results: Seventy-four eyes of 71 patients were included in the study. The sex ratio of the pseudoexfoliation group was 1.26 with 19 males (56%) and 15 females (44%). Pseudoexfoliation was unilateral in 21 cases (61%). Open-angle glaucoma was associated in 11 cases (32%) in the pseudoexfoliation group versus two cases in the control group (5.4%). Poor pupil dilatation was observed in eight cases (24%) in the pseudoexfoliation group and in one case (2.7%) in the control group. Phacoemulsification with IOL was the surgical technique in all the cases with only one case (2.7%) of anterior chamber IOL in the pseudoexfoliation group. There was no significant difference in the surgical complications between the pseudoexfoliation and control group (5.4%). The mean preoperative intraocular pressure was 16+/-5 mmHg in the pseudoexfoliation group and 14+/-3 mmHg in the control group. The mean postoperative intraocular pressure at 1 month was 14+/-4 mmHg in the pseudoexfoliation group and 14+/-3 in the control group. The mean preoperative visual acuity was 1.0+/-0.7 LogMar in the pseudoexfoliation group and 0.7+/-0.5 LogMar in the control group. The mean postoperative visual acuity was 0.4+/-0.6 LogMar in the pseudoexfoliation group and 0.2+/-0.1 LogMar in the control group. The mean follow-up was 70 days in the pseudoexfoliation group and 30 days in the control group., Conclusion: Pseudoexfoliation syndrome is the most common in its unilateral presentation. It is frequently associated with chronic secondary open-angle glaucoma. Poor pupil dilatation is one of the most common problems faced by cataract surgeons. Nevertheless, pseudoexfoliation syndrome did not confer a statistically higher risk for surgical complication in eyes without marked phacodonesis or lens subluxation.

Purpose: To evaluate the efficacy of a new trabecular aspiration technique on intraocular pressure (IOP) immediately after cataract surgery., Setting: University Eye Hospital of Cologne, Germany., Methods: This prospective, double-masked study comprised 48 of 100 patients having extracapsular cataract extraction (ECCE) who were randomly assigned to a study group. In these patients, 180 degrees of the inferior circumference of the chamber angle was treated with negative suction pressure ranging between 100 and 200 mm Hg. The other 52 patients served as a control group. Intraocular pressure was measured preoperatively and early (5 to 7 hours) and late (12 to 48 hours) postoperatively., Results: There was a significant mean increase in IOP from the preoperative to early postoperative period in both the control group (20.8 mm Hg) and the treatment group (7.4 mm Hg). There was no significant difference between preoperative and late postoperative pressures in either group. A one-way analysis of covariance of the changes in pressure from the preoperative to early postoperative period showed significantly less increase (P = .0041) in the aspiration than in the control group., Conclusion: Trabecular aspiration was effective in reducing the amount of IOP increase in the immediate period after ECCE.

Combined phacoemulsification, foldable lens implantation, and trabeculotomy (12 eyes, LOTOMY group) or trabeculectomy (22 eyes, LECTOMY group) were performed. At 6 months after the operation the visual acuity improvement (over 0.5 improvement, 83.3% in the LOTOMY group, and 95.5% in the LECTOMY group) was not significantly different between the two groups. 9 months postoperatively ocular pressure values (15.6 +/- 3.0 mmHg in the LOTOMY group, and 14.2 +/- 8.0 mmHg in the LECTOMY group) were not significantly different between the two groups. But within 7 days postoperatively average values of the maximal ocular pressure (25.5 +/- 5.9 mmHg in the LOTOMY group, and 11.8 +/- 3.0 mmHg in the LECTOMY group) were significantly higher in the LOTOMY group. The value was higher than the preoperative level. In the follow-up, progressive visual field loss was seen in 17% of the cases in the LOTOMY group. There was no progressive visual field loss in the LECTOMY group. Especially in cases with advanced glaucomatous visual field loss, the occurrence of ocular pressure spikes in the initial postoperative period may be closely related to postoperative progressive visual function loss. Phacotrabeculectomy was effective in avoiding these spikes.

The dependence of hydrodynamics on the topography of trabeculectomy performed simultaneously with cataract extraction was checked in 35 eyes with cataract and glaucoma. The eye was opened by a three-surface incision with a broad scleral flap. The specimen were examined in a microscope. In 21 eyes the whole trabeculum together with Schlemm's canal were excised, in 12 eyes the anterior band. In the specimen from 2 eyes no elements of the trabeculum could be found. The dependence of the regulation of the IOP on the geography of the trabeculectomy was established. Accepting the filtering mechanism of the trabeculectomy one may assume that the applied method of incision promotes the formation of the outflow++ ways of the aqueous in a high percentage of cases.

The respective indications are briefly described for: a) trabeculectomy through a scleral flap, b) simple cataract extraction, c) combined operation of lens extraction and fistulation in open-angle glaucoma on the one hand and close-angle glaucoma on the other. The choice of operation is dictated by many considerations. The main considerations are as follows. A Lens extraction alone has no lasting effect on the pressure in open-angle glaucoma, but is a good operation against early closed-angle glaucoma. B. Any fistulising operation predisposes to cataract when performed on old patients whose lenses suffer from senile changes already before the operation. A fistulising operation predisposes more to cataract in close-angle as in open-angle glaucoma. C. Lens extraction removes the risk of post-operative "athalamia" and hence of post-operative malignant glaucoma. D. The combined operation avoids a second surgical intervention and reduces the risks of oedematous dystrophy of the cornea in elderly patients who already have before the operation definite signs of endothelial dystrophy. E. Combining the glaucoma and cataract operations although, having certain peculiar risks, gives in a high percentages of cases efficient and long-lasting fistulation and a satisfactory intracapsular lens extraction.

In this paper we report on a series of 56 eyes which underwent a combined cataract-trabeculotomy operation. After a follow-up of at least 6 months. 63% of the eyes had normal intraocular pressure while 34% of them required further medication to achieve the same. No serious complications were observed.

Seventy-five percent of patients with open-angle glaucoma and cataract will not require medication at the 2-year period after a cyclodialysis canaliculo-trabeculectomy cataract extraction; this is in contrast to simple cataract extraction, which has a success rate of approximately 12 percent. The absence of significant morbidity and the predictability of the procedure recommend it for all patients with open-angle glaucoma needing cataract extraction, not simply those with inadequate glaucoma control.

We describe a simple, rapid technique for creating a filtering bleb in the early postoperative period using the argon or Nd:YAG laser. After cutting a suture, an immediate reduction of the intraocular pressure will result as filtration occurs, thereby safely eliminating the need for and the risk of traditional surgery.

The use of a fornix-based conjuctival flap in trabeculectomy and in the combined trabeculectomy and cataract operation is described. Of 105 eyes subjected to trabeculectomy, the intraocular pressure was maintained at less than 21 mm Hg in 97 (92%). Of these 97 eyes, 58 (60%) required medication following the surgery. There were ten eyes in which combined trabeculectomy and cataract surgery was performed. All ten eyes had normal intraocular pressures postoperation; five (50%) with medication. This method has many advantages when compared with the limbal-based flap and gives excellent surgical results with few complications. The advantages are enumerated and the results are reported on 115 eyes operated on over the past ten years.

Thirty-six patients with significant cataracts and glaucoma had combined extracapsular cataract extraction, posterior chamber lens implantation, and trabeculectomy. Follow-up ranged from three months to four years. Significant visual improvement and reduction in intraocular pressure were noted. This procedure seems to be a viable alternative in patients suffering from combined advanced glaucoma and advanced cataracts.

28 eyes underwent a combined procedure: trabeculectomy, extra-capsular cataract extraction and implantation of a posterior chamber intraocular lens. With a minimum of 9 months follow-up, 23 eyes had intraocular pressure controlled of all antiglaucoma medications, and 4 additional eyes achieved control with only the use of timolol maleate drops. (1 eye was lost to follow-up.) Preoperative near visual acuity was less than Parinaud 5 (Jaeger 7) in all eyes. Post-operative near visual acuity was Parinaud 2 (Jaeger 1) in 17 eyes. Senile macular degeneration was responsible for less than Parinaud 2 visual acuity in 4 additional eyes. An extracapsular extraction has advantages over the intracapsular method, both in terms of less post-operative vitreoretinal complications for the cataract extraction itself, and for the creation of a functional trabeculectomy by keeping the vitreous away from the filtration site. Use of a posterior chamber intraocular lens implant as part of the combined procedure appears to be highly acceptable. Complications and limits of the combined procedure are discussed.

Seventeen cases of open-angle glaucoma requiring cataract extraction underwent intracapsular cataract extraction, trabeculectomy posterior to the scleral spur, and MK9 intraocular lens insertion. Approximately 50 per cent of the patients achieved intraocular pressures of 18 mm Hg or less without medication two years later. Though implantation reduces the surgical success of the combined operation, it is safe, easy to perform and does not worsen pre-operative levels of intraocular pressure and/or control.

In a study of 94 combined cataract and trabeculectomy operations performed for 59 open angle simplex and 35 capsular glaucoma with coexisting cataract, followed up for 1 to 9 years, the overall control of intraocular pressure (less than or equal to 21 mm Hg) without therapy was achieved in 61 eyes (65%). The average follow-up time was 3.4 years. The success rate 76% after 1 year follow-up decreased to 63% after 2 years and went from 45 to 66% over a 3 to 8 years follow-up period. Post-surgical therapy was required in 33 eyes (35%). Of these 31 eyes were controlled with medical therapy alone. In the light of the results the maintenance of filtration was considered the most important factor of success. Most frequent complications, transient hypotony (37%) and hyphaema (30%) had no significant effect on eventual success. As regards the diagnostic categories no significant difference existed in the success rates between the simplex and capsular glaucoma groups. The importance of periodic observation is discussed.

This relatively small series supports the accumulating evidence that a combined cataract extraction and trabeculectomy procedure gives satisfactory results in both respects.

The efficacy and safety of a combined operation for cataract and glaucoma is established. This procedure of combined cataract extraction and trabeculectomy is taken one step further by the simultaneous insertion of the Severin intraocular posterior chamber lens implant. The results of treating 24 eyes in terms of control of glaucoma are discussed. Postoperative miotics may be required to improve stability of the implant, especially after delivery of the lens through a pupil rendered tight by long term preoperative miotic administration.

Combined trabeculectomy and phacoemulsification was performed on 21 eyes with poorly controlled glaucoma (15 open-angle glaucomas, 5 capsular glaucomas, and one secondary glaucoma) and coexisting cataract. In 20 of these eyes there was severe glaucomatous damage of the optic nerve with visual field loss. With the procedure used by the present authors there was a higher incidence of choroidal detachments, whereas other complications occurred at a lower rate than reported by other authors combining cataract extraction and trabeculectomy. Mean IOP was lowered from 25.7 +/- 6.1 to 17.1 +/- 3.2 mmHg after 18 months. Thirteen patients (62%) required no medication, while 5 (24%) required additional therapy for sufficient control of IOP (less than or equal to 21 mmHg). The results indicate that the combined phacoemulsification and trabeculectomy procedure may be a useful approach in eyes with severe glaucomatous damage and cataract.

In 64 eyes the combined procedure (group I) and in 67 aphacic eyes a trabeculotomy (group II) was performed. There were different types of glaucoma. Re-examinations wer done 6 months and 1--10 years postoperatively. No definite differences of operative or postoperative complications existed between the two groups. In eyes suffering from primary open angle glaucoma intraocular pressure was controlled in 65--91% in both groups. In group I visual acuity was slightly better. On the other hand in these eyes more often a deterioration of the visual field was observed inspite of i. o. pressure not exceeding 21 mm Hg with a single exception. In group II further glaucoma surgery was necessary in more eyes than in group I.

Fifty eyes of 40 patients with glaucoma underwent extracapsular cataract extraction with posterior chamber lens implantation. Their visual results and early postoperative complications were compared with those of eyes in an age-matched group of patients without glaucoma after the same procedure. Substantial increases in early postoperative intraocular pressure (IOP) occurred in 62% of the glaucomatous eyes and in only 10% of the normal eyes. The level of best visual acuity was slightly worse (20/40) on average in the glaucomatous eyes than in the nonglaucomatous eyes (20/25). At six months after surgery, 82.5% of the nonfiltered glaucomatous eyes needed the same number of or additional glaucoma medications to maintain an IOP of less than 20 mm Hg. Ten of the glaucomatous eyes underwent trabeculectomy along with cataract surgery due to inadequate IOP control while the patient was receiving maximum medical therapy. Control was substantially improved, with 100% of these patients receiving the same number of or fewer medications at six months. By one year, only 30% of these patients required the same number of medications postoperatively as preoperatively, but all had IOP control.

Combined trepanotrabeculectomy (TTE) and intracapsular cataract extraction for advanced cataract and severe open angle glaucoma proved to be successful in 84% of the operated eyes which were followed for one to 11 years. Complications were infrequent as compared to other combined procedures. The frequency of postoperative flat anterior chamber in particular was much lower. In 77% of the eyes the surgical scars were covered by normal conjunctiva without evidence of extraocular filtration. No avascular cystic blebs formed. The same operation performed as a secondary procedure seems to be equally successful. Eight eyes, which previously had successful trepanotrabeculectomy, developed cataract, which was removed without impinging on the function of the trabeculectomy scars. If the two operations are to be performed in separate sittings, it is advisable to perform the TTE first, followed by cataract extraction.