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Purpose: To assess and compare the risk for development of cystoid macula edema (CME) after glaucoma drainage device (GDD) implantation versus conventional trabeculectomy with mitomycin (trab) for glaucoma., Methods: Retrospective review of consecutive patients receiving trab or GDD implantation between 2016 and 2018. Inclusion criteria were availability of pre- and postoperative spectral domain optical coherence tomography (SD-OCT) of the macula. SD-OCT images were evaluated for presence of CME qualitatively, central subfield thickness (CST) and macular volume (MV)., Results: 73 eyes could be included, 42 received trab and 31 GDD surgery. Eyes receiving trab on average had 0.8 ± 0.8 previous intraocular operations, while eyes with GDD implantation had 3.1 ± 1.9 (p < 0.001). Occurrence of postoperative CME was significantly more frequent after GDD implantation (6 out of 31 (19.4%)) than after trab (2 out of 42 eyes = 4.8%), (p = 0.049). Mean preoperative CST as well as MV was comparable in both groups (CST before trab: 282.7 ± 23.0 µm, CST before GDD 284.2 ± 27.3 µm, p = 0.287; MV before trab: 7.8 ± 1.1 mm 3 , MV before GDD: 8.0 ± 0.8mm 3 , p = 0.305). Mean postoperative CST and MV were significantly higher after GDD (CST 338.5 ± 129.3 µm, MV 8.8 ± 2.6 mm 3 ) than after trabeculectomy (CST 290.6 ± 60.2 µm, p = 0.038; MV 7.8 ± 1.2mm 3 , p = 0.039)., Conclusions: In real-life conditions, GDD surgery seems to be associated with a higher risk to develop CME when compared to conventional trabeculectomy. This information may be helpful for glaucoma surgeons to advise the patients on postoperative risks of surgery., (© 2024. The Author(s).)

Bleb failure after implantation of filtering stents (e.g. Preserflo Stent) is a frequent challenge in glaucoma surgery that has occurred in recent years. In the following, a technique for open bleb revision with mitomycin C (0.2 mg/ml) and ologen implantation is presented, which is intended to re-establish the filtration volume lost due to fibrosis and a long-term preservation., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Purpose: To evaluate the dynamics of Bruch's membrane opening-based morphometrics of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT) during the first week after glaucoma surgery by trabeculectomy with mitomycin C., Methods: Prospective, longitudinal analysis of 25 eyes of 25 patients treated by trabeculectomy. Twenty-four eyes had evaluable postoperative SD-OCT examinations. Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed at baseline before surgery, 1 day, 2 to 3 days, and 1 week after surgery. Changes compared to baseline were correlated to intraocular pressure (IOP)., Results: One day after surgery, the mean BMO-MRW changed by + 26.17 µm, p = 0.001 (mean IOP reduction by 17.01 mmHg). This increase persisted on day 2-3 with a mean increase of BMO-MRW of + 25.33 µm, p = 0.001 (mean IOP reduction by 20.46 mmHg) and by week 1 with a mean BMO-MRW increase of + 33.17 µm, p < 0.001 (mean IOP reduction by 22.55 mmHg). The increase in BMO-MRW correlated significantly with the reduction of IOP on day 1 (Spearman's rho ρ = 0.656, p = 0.003) and d2-3 (Spearman's rho ρ = 0.479, p = 0.038). There was no statistically significant correlation found between the IOP and the increase in BMO-MRW in week 1. RNFL thickness showed no significant changes at day 1 as well as days 2-3 (p ≥ 0.078, respectively). It showed a small but significant increase in week 1 by 3.94 µm, p = 0.015., Conclusions: Structural reversal of disc cupping in BMO-MRW occurs as early as 1 day after trabeculectomy and correlates to the extent of the IOP reduction. During the whole first week after surgery, a strong increase in BMO-MRW can be noted. The changes in BMO-based parameters need to be considered when evaluating patients' longitudinal follow-up., (© 2022. The Author(s).)

Background: To determine whether the outcome of the first eye may serve as a predictor for intraocular pressure (IOP)-lowering effectiveness in the second eye following bilateral ab interno trabeculectomy., Methods: This retrospective single-centre study included 168 eyes from 84 participants, who underwent combined Trabectome surgery with phacoemulsification cataract surgery in a hospital setting. The clinical endpoint was defined as either 'success' or 'failure' based on four separate scores at the longest follow-up time point: IOP at follow-up <21 mm Hg (Score A) or IOP < 18 mm Hg (Score B), without re-surgery and IOP reduction >20%; IOP ≤15 mm Hg without re-surgery and IOP reduction ≥40% (Score C); and the sole absence of re-surgery according to the discretion of the surgeon (Score D)., Results: No significant difference was observed between the outcomes of first and second eyes. The frequency of success in the second eye after effective surgery in the first eye significantly exceeded that after prior failure. Within our analysis, the probability calculations determined a 75% chance of success following prior success for Score A. If surgery in the first eye failed, the chance of success in the subsequent eye was 37%. The corresponding probabilities were 79% and 32% for Score B, 56% and 9% for Score C, and 99% and 50% for Score D., Conclusion: The results of our study offer a useful tool to assess the success of subsequent eye surgeries based on the outcome in the initial eye, owing to the high predictive potential., (© 2021 The Authors. Clinical & Experimental Ophthalmology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Ophthalmologists.)

Precis: The XEN45 Gel Stent can be implanted after failed trabeculectomy without disadvantages compared with primary implantation., Purpose: We aimed to compare the outcomes of XEN45 Gel Stent implantation in pseudophakic eyes after failed trabeculectomy and in pseudophakic eyes without other previous surgeries., Patients and Methods: In this retrospective study, we included 30 pseudophakic eyes of 30 patients who underwent XEN45 Gel Stent implantation after failed trabeculectomy (trabeculectomy group) and 60 eyes of 60 patients with primary XEN45 Gel Stent implantation (control group). The groups were matched for preoperative intraocular pressure (IOP), preoperative medication score, cup-to-disc ratio, follow-up time, visual acuity, and age at a ratio of 1:2. Eyes with concomitant eye diseases, those who had undergone previous surgery, and those with a follow-up duration <6 months were excluded. We compared the success rates on the basis of different criteria: Criteria A (IOP<21 mm Hg, IOP reduction>20%, no repeat surgery); Criteria B (IOP<18 mm Hg, IOP reduction>20%, no repeat surgery); and Criteria C (IOP≤15 mm Hg, IOP reduction≥40%, no repeat surgery)., Results: After an average follow-up period of 20 months, the mean IOP was reduced from 24.4±5.7 to 14.0±4.1 mm Hg in all the study subjects (90 patients). There were no significant differences between the 2 groups in postoperative IOP, postoperative medication score, revision rate, and repeat surgery rate or success rate., Conclusions: XEN45 Gel Stent implantation is a viable option after failed trabeculectomy. According to our results, it has no disadvantage compared with primary XEN45 Gel Stent implantation.

Many clinical studies have demonstrated the benefit of topical anti-inflammatory medication before and after glaucoma surgery, especially for trabeculectomy, and that they improve the long term outcome. Pre- and postoperative topical steroids improve the outcome of trabeculectomy, but duration and intensity of treatment should be adapted individually. Systemic steroid or oral immunomodulation have significant impact on the outcome in uveitic glaucoma, but not in other glaucoma subtypes. Additional topical treatment with non-steroidal anti-inflammatories is an option in combined cataract-glaucoma surgery. Anti-inflammatory treatment after selective laser trabeculoplasty is not necessary, but relieves pain after argon laser trabeculoplasty and laser cyclophotocoagulation. Intravitreal application of steroids in glaucoma surgery must be critically evaluated and must consider the risk of a rise in secondary intraocular pressure., Competing Interests: Vortrags-/Beratertätigkeit: Dietlein: Alcon, Bayer, Theapharma, Santen; Erb: Alcon, Allergan, Bausch u. Lomb, Bayer, Glaukos, Haag-Streit, Novartis, Omnivision, Santen, Theapharma, Zeiss; Hoffmann: Alcon, Allergan, Santen., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To analyze the longitudinal change in Bruch's membrane opening minimal rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) after glaucoma surgery via ab-interno trabeculectomy in adult glaucoma patients., Methods: Retrospective audit of 65 eyes of 65 participants undergoing ab-interno trabeculectomy using electroablation of the trabecular meshwork. In 53 eyes, surgery was combined with phacoemulsification and posterior chamber lens implantation. Pre- and postoperative SD-OCT examinations of the optic nerve head (ONH), intraocular pressure (IOP), and visual field data were analyzed. Longitudinal change in morphometric SD-OCT parameters of the ONH was compared and correlated to change in IOP and visual field function., Results: BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first 6 months after surgery (BL = 167.85 ± 90 μm; FU = 175.59 ± 89 μm; p = 0.034). This increase correlated with postoperative lowering of IOP (rho = - 0.41; p = 0.016). Nine months after surgery (range, 7-12 months), there was no significant change in BMO-MRW (BL = 196.79 ± 79; FU = 196.47 ± 85 μm; p = 0.95), while in later follow-up, a decrease of BMO-MRW was found (BL = 175.18 ± 78; FU = 168.65 ± 72; p = 0.05). RNFL thickness was unchanged in early (p > 0.16) and significantly decreased in later follow-up (p = 0.009). Mean deviation (MD) of visual field function did not show a significant change before and after surgery., Conclusion: Electroablative ab-interno trabeculectomy leads to a significant transient mild increase in BMO-MRW. This increase was shown to correlate with IOP lowering. Significant loss of BMO-MRW in later follow-up may reflect insufficient IOP reduction by surgery. The parameters RNFL thickness and MD seem less impacted directly by surgery.

Objective: To assess the impact of trabeculectomy for glaucoma on morphometric neuroretinal parameters of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT)., Design: Retrospective, interventional case series., Methods: Participants: Eighty-eight eyes of 88 patients who underwent trabeculectomy with mitomycin C in 2016., Intervention: All patients underwent trabeculectomy in 1 eye (study eye) and had evaluable SD-OCT examinations of the ONH to measure neuroretinal tissue before and at least at 1 of the 3-, 6-, and 12-month follow-up time points after surgery., Main Outcome Measures: Longitudinal change in Bruch membrane opening minimum rim width (BMO-MRW), Bruch membrane opening minimum rim area (BMO-MRA), peripapillary retinal nerve fiber layer (RNFL) thickness, intraocular pressure (IOP), and mean deviation in perimetry., Results: In study eyes, BMO-MRW significantly increased postsurgically comparing baseline and follow-up examinations at 3 months (P = .012), at 6 months (P = .007), and at 1 year (P = .010) after trabeculectomy. The increase in BMO-MRW 6 months after surgery correlated with IOP reduction (r = 0.48; P = .001). BMO-MRA showed an equal increase (P ≤ .034). RNFL thickness remained stable between baseline and follow-up at 3, 6, and 12 months and showed a moderate loss after 18 months (P = .021) of follow-up., Conclusions: Structural reversal of disc cupping after trabeculectomy markedly influences Bruch membrane opening-based parameters for up to more than 1 year. Improvement in morphometry seems to correlate with the reduction of IOP while visual field function appears not to be influenced. In longitudinal follow-up of glaucoma patients by SD-OCT, evaluation of BMO-based parameters necessitates to reflect bias caused by surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)

During the last few years, there has been a considerable capacity of innovations in glaucoma surgery owing to new micro-stents increasing the aqueous outflow via transscleral routes, via the trabecular meshwork or the suprachoroidal space. These interventions can be easily performed in combination with small-incision cataract surgery. Even the well-known filtering procedures, trabeculectomy and drainage device surgery, formerly perceived as being outdated, re-achieve better reputation owing to refinements in surgical technique and improved surgical experience. Although enthusiasm is understandable, considering the technical advances, we must wait for clinical long-term results and compare the new procedures with the established ones., Competing Interests: T. S. Dietlein: Vortragstätigkeit für Alcon, Santen, Theapharma; Beratertätigkeit für Alcon, Bayer., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To assess the risk of pseudophakic cystoid macular edema (PCME) following cataract surgery (bimanual phacoemulsification with posterior chamber lens implantation) combined with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) compared with solely cataract extraction., Patients and Methods: In total, 360 consecutive eyes of 180 patients with age-related cataract, and thereof 162 with coexistent glaucoma, who underwent sole cataract surgery or in combination with ab interno glaucoma surgery (trabecular aspiration or ab interno trabeculotomy) were compared retrospectively regarding PCME development. Patients with known risk factors of PCME were excluded. Macular examination was performed using spectral-domain optical coherence tomography before and at 4, 8, 12, 16, 24, 36, and 48 weeks after surgery. Main outcome measure was the incidence of PCME., Results: In total, 126 eyes (35%) underwent cataract surgery combined with ab interno glaucoma surgery (96 trabecular aspiration (76.2%), 30 ab interno trabeculotomy (23.8%), and 234 eyes (65%) received cataract surgery alone. PCME overall occurred in 23 eyes (6.4%). Following combined trabecular aspiration 5 eyes (5.2%) developed PCME, following ab interno trabeculotomy 2 eyes (6.7%), and following sole cataract surgery 16 eyes (6.8%), reaching no significant difference (P=0.676). Risk of PCME in fellow eye was significantly increased (P=0.025; odds ratio 7.177; 95% confidence interval, 5.667-8.687)., Conclusions: Additional ab interno glaucoma surgery combined with phacoemulsification does not seem to increase the risk of PCME in uncomplicated eyes. However, in patients with history of PCME a significantly increased risk of PCME in fellow eye should be taken into account.

Background: To evaluate the potential of lowering intraocular pressure in pseudoexfoliation glaucoma with combined phacoemulsification, Trabectome, and trabecular aspiration (triple procedure) compared to phacoemulsification and trabecular aspiration alone., Methods: Using a case-matched retrospective study design, 30 patients were included into each group. The main outcome measures were the reduction of intraocular pressure and medication score at the end of follow-up. Clinical data were collected from the patients' medical records., Results: Mean follow-up was 15 months in both groups. Intraocular pressure decreased from 25.3 ± 6.3 mmHg to 14.4 ± 3.7 mmHg (p < 0.0001) in the triple procedure group and from 25.3 ± 4.2 mmHg to 18.1 ± 4.2 mmHg (p < 0.0001) in the control group. The medication score was lowered from 3.4 ± 1.7 to 2.1 ± 1.2 (p = 0.0017) in the triple procedure group and from 3.8 ± 1.8 to 2.3 ± 1.5 (p < 0.008) in the control group. The reduction of intraocular pressure was higher (p < 0.004) in the triple procedure group (38.4 ± 17.3 %) compared to the control group (26.8 ± 19.6 %) The reduction of the medication score did not differ significantly., Conclusions: The triple procedure is more effective in lowering intraocular pressure compared to phacoemulsification and trabecular aspiration alone in pseudoexfoliation glaucoma.

Purpose: To assess the efficacy of trabeculectomy with a biodegradable Ologen™ implant (OLO) versus mitomycin C (MMC) in patients in a prospective randomized clinical trial., Methods: In the MMC group (15 patients), trabeculectomy was performed according to standard protocols. In the OLO group (15 patients) after standard trabeculectomy, the implant was positioned on top of the scleral flap, and no MMC was applied., Results: Mean preoperative intraocular pressure (IOP) levels (OLO: 28.0 ± 9.4; MMC: 23.9 ± 5.0 mm Hg; p = 0.21) and medication score (OLO: 3.4 ± 1.6; MMC: 3.6 ± 1.5; p = 0.56) were comparable in both groups. One year after surgery, the mean IOP was 15.9 ± 4.5 mm Hg in the OLO group (p < 0.01, 43% reduction) and 11.0 ± 2.6 mm Hg in the MMC group (p < 0.01, 54% reduction). The surgical success rate 12 months after surgery was 93.3% in the MMC group and 40% in the OLO group (p = 0.01)., Conclusions: With the atelocollagen-glycosaminoglycan matrix OLO it was not possible to reach the surgical success rate and pressure reduction achieved in the MMC group.

Background: Trabecular aspiration is used for combined glaucoma-cataract surgery in coexisting pseudoexfoliation syndrome (XFS) or glaucoma (XFG). Reports on this technique are limited to a few small-scale studies. In this study, we wanted to elucidate whether the result of combined phacoemulsification with trabecular aspiration in the first operated eye is predictive for outcome in the contralateral eye., Methods: In a retrospective analysis we compared the results from 80 eyes of 40 patients with pseudoexfoliation syndrome or glaucoma, who had undergone bilateral but consecutive phacoemulsification with implantation of a posterior chamber lens combined with trabecular aspiration between 2003 and 2005., Results: The IOP level and medication score after phaco-trabecular aspiration were shown to be significantly lower than the preoperative values after 2 years (p < 0.0001 and p = 0.047). A significant correlation between the first and second eye was detected for reduction of IOP and medication score after 1 year. Kaplan-Meier graphs of the first and second eyes showed an almost parallel trend from 1 day after surgery until 35 months after surgery., Conclusions: The postoperative outcome in an eye after combined phaco-trabecular aspiration is predictive for the second eye. If this procedure succeeded in the first eye, the prognosis for the same strategy in the fellow eye is also good.

Background: Combined phacoemulsification, intraocular lens implantation, and trabeculectomy (PTE) is currently the standard procedure for most ophthalmic surgeons to treat uncontrolled open-angle glaucoma and cataract at one time. This study was designed to prospectively compare a new technique of phaco-trabeculotomy plus deep sclerectomy (PDSTO) with standard phaco-trabeculectomy (PTE)., Methods: A consecutive series of 43 patients with uncontrolled open-angle glaucoma and cataract underwent combined glaucoma and cataract surgery. The procedure started as a two-site approach with phacoemulsification and IOL implantation through a temporal incision in clear cornea. Trabeculotomy and deep sclerectomy were performed in the superior quadrant. Trabeculectomy was also performed in the superior quadrant as a modified Cairns trabeculectomy. Postoperatively, examinations were performed on a daily base for 1 week. Follow-up visits were applied 1, 3, 6, and 12 months after surgery., Results: The mean preoperative intraocular pressure (IOP) was 26.5 mmHg (SD 7.8) for all patients enrolled. The mean IOP was 12.3 mmHg (SD 5.1) 1 day post surgery for the PTE group (p < 0.001) and 14.4 mmHg (SD 4.0) for the PDSTO group (p < 0.001). At 12 months post surgery the success rate according to the Advanced Glaucoma Intervention Study (AGIS), defined as an IOP lower than 18mmHg without medication, was 20% in the PTE group and 50% in the PDSTO group (p = 0.03). The number of postoperative complications was equally low for both groups. No severe complications, such as bleb infection, endophthalmitis, or choroidal hemorrhage were seen in this series., Conclusions: PDSTO offered significant IOP reduction and a success rate which was higher than that of the current standard, PTE. The specific intra- and postoperative complications of deep sclerectomy, trabeculotomy, and trabeculectomy were seen in our series, although the overall rate of postoperative complications proved low.

Purpose: Combined phacoemulsification, intraocular lens implantation and trabeculectomy (PTE) is currently the standard procedure for most ophthalmic surgeons for treating uncontrolled open-angle glaucoma and cataract at the same time. The present pilot study was designed to prospectively evaluate outcomes in glaucoma patients who underwent a new technique of phaco-trabeculotomy plus deep sclerectomy, with particular attention to the complication profile., Methods: A consecutive series of 15 patients with uncontrolled open-angle glaucoma and cataract underwent combined glaucoma and cataract surgery. The procedure started as a two-site approach with phacoemulsification and intraocular lens (IOL) implantation through a temporal incision in clear cornea. Trabeculotomy and deep sclerectomy were performed in the superior quadrant. Postoperative examinations were performed daily for 1 week. Follow-up visits were carried out at 1, 3, 6 and 12 months after surgery., Results: At 1 day post-surgery, mean intraocular pressure (IOP) was significantly reduced to 14.2 mmHg (SD 4.4). At 12 months post-surgery, the complete success rate, defined as IOP < 22 mmHg without medication, was 60%. Qualified success was achieved in 93.3% of patients. At 12 months post-surgery, the mean number of antiglaucoma medications had fallen to 0.4 (SD 0.6) (p < 0.001). Visual acuity improved by a mean value of 1.6 lines (SD 2.4) over baseline (p = 0.021). Specific complications such as choroidal deroofing, inadvertent perforation of the trabeculo-descemetic membrane, and non-identification of Schlemm's canal were seen among the patients in our trial. The incidence of complications due to overfiltration was low. A relatively high incidence of hyphaemas (53%) was noted in this series. All the hyphaemas were trivial and resolved quickly. No severe complications, such as bleb infection, endophthalmitis or choroidal haemorrhage were seen in this series., Conclusions: Phaco-trabeculotomy plus deep sclerectomy offered significant IOP reduction and a success rate that may be comparable with that of the current standard, PTE. Intra- and postoperative complications specific to deep sclerectomy and trabeculotomy were seen in our series, although the overall rate of postoperative complications proved low. Prospective comparative trials are needed to assess which of PTE and phaco-trabeculotomy plus deep sclerectomy is more successful.

Purpose: To assess the intraocular pressure-lowering efficacy and the postoperative complication profile of viscocanalostomy versus trabeculectomy., Patients and Methods: Sixty eyes of 60 patients with medically uncontrolled open-angle glaucoma were randomized either to the viscocanalostomy or to the trabeculectomy group of the trial. Viscocanalostomy was performed according to Stegmann's technique using high-molecular-weight sodium hyaluronate to fill the ostia of the Schlemm canal. For trabeculectomy, a modified Cairns-trabeculectomy was performed. Examinations were performed before surgery and postoperatively daily for 1 week. Follow-up visits were scheduled 1, 6, and 12 months after surgery., Results: The mean (SD) preoperative intraocular pressure was 27.1 (7.1) mm Hg for all patients enrolled. One day after surgery, mean (SD) intraocular pressure was 15.9 (5.2) for the trabeculectomy group (P <0.001) and 15.7 (3.6) for the viscocanalostomy group (P <0.001), respectively. The success rate, defined as an intraocular pressure lower than 22 mm Hg without medication, was 56.7% in the trabeculectomy group and 30% in the viscocanalostomy group at 12 months postoperatively (P = 0.041). The number of postoperative complications was lower in the viscocanalostomy group than in the trabeculectomy group., Conclusions: In eyes with open-angle glaucoma, viscocanalostomy is less effective in reducing intraocular pressure than standard filtering surgery. However, postoperative complications are more frequent after filtering surgery.

Background: Laser-grid trabeculectomy (TE) is a modification of micro-TE designed to enhance the intra- and postoperative safety of filtering surgery by creating several small oval fistulas (max. diameter <200 microm) beneath a scleral flap without peripheral iridectomy., Methods: After dissecting the conjunctiva and a conventional scleral flap, 10 small perforating fistulas were created in five pigmented rabbits in the region of the gray-white border using an erbium:YAG laser with a beveled side-firing 200 microm endoprobe; conventional TE with iridectomy was performed in another five animals. Anterior chamber inspection and IOP measurements of both eyes were conducted on days 1, 4, and 14 after operation. After the last inspection eyes were saved for morphological analysis., Results: Both procedures (laser-grid and conventional TE) led to a reduction of intraocular pressure in the treated eye compared to the control eye. Differences between the outcomes for the two procedures were not statistically significant. Morphology of the eyes treated by laser-grid TE revealed dense scarring of perforations around the center of the ligamenta pectinata and loose tissue refilling of the more peripheral openings., Conclusions: The functional outcome of laser-grid TE in rabbits was similar to that of conventional TE in the short term. Histological examination of microperforations in the area of the trabecular meshwork after 2 weeks indicated that tissue repair was less pronounced than in the more anterior perforations. This morphologic finding may be of importance for non-penetrating glaucoma surgery.

Background: The aim of this study was to compare the outcome of implantation of a XEN45 Gel Stent with the outcome of implantation of a Preserflo MicroShunt in a matched‐pair analysis in eyes being naïve to filtering surgery. Methods: In this comparative, retrospective study, 50 eyes that had undergone XEN45 Gel Stent implantation were compared with 50 eyes after Preserflo implantation. Follow‐up was at least 6 months, and surgical success was measured by criteria A (IOP < 21 mmHg, IOP reduction >20%, no repeat surgery); criteria B (IOP < 18 mmHg, IOP reduction >20%, no repeat surgery); and criteria C (IOP ≤15 mmHg, IOP reduction ≥40%, no repeat surgery). Results: After a follow‐up period of 12 months, mean IOP had decreased from preoperative 25.2 ± 4.8 mmHg in the XEN group to 14.5 ± 4.0 (n = 35) and from 25.3 ± 6.8 mmHg to 11.9 ± 2.9 (n = 41) in the Preserflo group, respectively. The IOP at the last follow‐up of the two groups differed significantly (p < 0.01). The probability of surgical success did not differ concerning Criteria A and B, but surgical success was significantly higher in the Preserflo group for Criteria C (60%, p < 0.01). Conclusion: Both the Preserflo and XEN45 Gel Stent provide an effective and safe treatment option for advanced glaucoma and have a high potential to reduce intraocular pressure. Absolute IOP levels of <16 mmHg after 12 months were significantly more frequent in the Preserflo group. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the dynamics of Bruch's membrane opening-based morphometrics of the optic nerve head (ONH) using spectral-domain optical coherence tomography (SD-OCT) during the first week after glaucoma surgery by trabeculectomy with mitomycin C. Methods: Prospective, longitudinal analysis of 25 eyes of 25 patients treated by trabeculectomy. Twenty-four eyes had evaluable postoperative SD-OCT examinations. Bruch's membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness were analyzed at baseline before surgery, 1 day, 2 to 3 days, and 1 week after surgery. Changes compared to baseline were correlated to intraocular pressure (IOP). Results: One day after surgery, the mean BMO-MRW changed by + 26.17 µm, p = 0.001 (mean IOP reduction by 17.01 mmHg). This increase persisted on day 2–3 with a mean increase of BMO-MRW of + 25.33 µm, p = 0.001 (mean IOP reduction by 20.46 mmHg) and by week 1 with a mean BMO-MRW increase of + 33.17 µm, p < 0.001 (mean IOP reduction by 22.55 mmHg). The increase in BMO-MRW correlated significantly with the reduction of IOP on day 1 (Spearman's rho ρ = 0.656, p = 0.003) and d2–3 (Spearman's rho ρ = 0.479, p = 0.038). There was no statistically significant correlation found between the IOP and the increase in BMO-MRW in week 1. RNFL thickness showed no significant changes at day 1 as well as days 2–3 (p ≥ 0.078, respectively). It showed a small but significant increase in week 1 by 3.94 µm, p = 0.015. Conclusions: Structural reversal of disc cupping in BMO-MRW occurs as early as 1 day after trabeculectomy and correlates to the extent of the IOP reduction. During the whole first week after surgery, a strong increase in BMO-MRW can be noted. The changes in BMO-based parameters need to be considered when evaluating patients' longitudinal follow-up. [ABSTRACT FROM AUTHOR]

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Purpose: To analyze the longitudinal change in Bruch's membrane opening minimal rim width (BMO-MRW) and circumpapillary retinal nerve fiber layer (RNFL) thickness using spectral domain optical coherence tomography (SD-OCT) after glaucoma surgery via ab-interno trabeculectomy in adult glaucoma patients.Methods: Retrospective audit of 65 eyes of 65 participants undergoing ab-interno trabeculectomy using electroablation of the trabecular meshwork. In 53 eyes, surgery was combined with phacoemulsification and posterior chamber lens implantation. Pre- and postoperative SD-OCT examinations of the optic nerve head (ONH), intraocular pressure (IOP), and visual field data were analyzed. Longitudinal change in morphometric SD-OCT parameters of the ONH was compared and correlated to change in IOP and visual field function.Results: BMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first 6 months after surgery (BL = 167.85 ± 90 μm; FU = 175.59 ± 89 μm; p = 0.034). This increase correlated with postoperative lowering of IOP (rho = − 0.41; p = 0.016). Nine months after surgery (range, 7-12 months), there was no significant change in BMO-MRW (BL = 196.79 ± 79; FU = 196.47 ± 85 μm; p = 0.95), while in later follow-up, a decrease of BMO-MRW was found (BL = 175.18 ± 78; FU = 168.65 ± 72; p = 0.05). RNFL thickness was unchanged in early (p > 0.16) and significantly decreased in later follow-up (p = 0.009). Mean deviation (MD) of visual field function did not show a significant change before and after surgery.Conclusion: Electroablative ab-interno trabeculectomy leads to a significant transient mild increase in BMO-MRW. This increase was shown to correlate with IOP lowering. Significant loss of BMO-MRW in later follow-up may reflect insufficient IOP reduction by surgery. The parameters RNFL thickness and MD seem less impacted directly by surgery. [ABSTRACT FROM AUTHOR]

Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF6) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF6 gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF6 volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF6 gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery. [ABSTRACT FROM AUTHOR]