Search

Ahmed Samir,1,2 Ayman M Abdelrahman Elsayed,1 Yasmine A Deiaeldin,1 Mohammed A Al-Naimy1 1Department of Ophthalmology, Zagazig University, Zagazig, Sharkia, Egypt; 2Magrabi Eye Hospital, Jeddah, Kingdom Saudi ArabiaCorrespondence: Ahmed Samir, Tel +966 594988779, Email ahmedsamir74@gmail.comPurpose: To evaluate the role of automated peripheral iridectomy as an adjunctive tool combined with phacoemulsification and ExPRESS shunt implantation in management of cases with chronic angle closure glaucoma.Setting: Magrabi eye hospital.Methods: This prospective study included 22 eyes of 22 patients with chronic angle closure glaucoma and cataract who underwent Ex-PRESS shunt implantation, cataract extraction and surgical peripheral iridectomy at the site of shunt implantation in the period between January 2018 and April 2020.Results: After surgery, the mean IOP was 11.3± 1.2 mm Hg, 14.5± 1.6 mm Hg, 14.8± 2.1 mm Hg, 15.3± 1.9 mm Hg and 17.4± 1.8 mm Hg at 7 days, 1 month, 3 months, 6 months and 12 months, respectively. All postoperative IOP was significantly lower compared with preoperative IOP (P = 0.001). There was a significant decrease in the number of medications required after surgery. The baseline mean number of medications was 3.4± 0.02 (range from 1 to 4), while postoperatively the mean number of medications decreased to 0.7± 0.01 at 12 months (P < 0.01). The qualified success rate was 6/22 eyes, and the complete success rate was 16/22 (72.7%) at 12 months, respectively.Conclusion: The combined phacoemulsification and Ex-PRESS shunt implantation with automated peripheral iridectomy is an effective and safe procedure to treat chronic angle closure glaucoma.Keywords: Ex-PRESS shunt, chronic angle closure glaucoma, iridectomy

Importance: Trabeculectomy is very effective in lowering intraocular pressure for the treatment of glaucoma, but it carries with it possible complications and failure. The ExPress shunt (Alcon Laboratories, Fort Worth, TX, USA) is an adjunctive device that can be used at the time of trabeculectomy to create an external fistuliztion. An alternative established and highly efficacious technique is the implantation of a glaucoma drainage device for sustained intraocular pressure (IOP) lowering. Specifically, evidence has established the Baerveldt 101-350 glaucoma implant (BGI) to have the best sustained IOP lowering in long-term follow-up amongst the many options for glaucoma drainage devices. Objective: To compare outcomes in eyes that underwent Baerveldt 101-350 glaucoma implant (BGI) and trabeculectomy with ExPress shunt (Trab) in primary open angle glaucoma without any prior incisional glaucoma surgery. Design, Setting, and Participants: This was a retrospective study of outcomes in patients identified by CPT codes as having undergone glaucoma implantation or trabeculectomy (with ExPress shunt) for the treatment of Primary Open Angle Glaucoma between 2012 and 2015 at a single institution by 2 fellowship trained glaucoma surgeons. A total of 57 eyes that underwent Baerveldt 101-350 glaucoma implant and 38 eyes that underwent trabeculectomy cases with ExPress™ shunt were included in the study. All patients were diagnosed with primary open angle glaucoma. Cases were included into the study if the patient underwent BGI or trabeculectomy with ExPress shunt without any prior incisional glaucoma surgery. Main Outcomes and Measures: Main outcomes included IOP, medications, visual acuity (VA), and secondary glaucoma surgery, if any. Results: Survival rate at 12 months was 85% in the BGI group and 80% in trabeculectomy with ExPress Shunt. A statistically significant difference was not found in the survival distributions between surgery groups using the log-rank test. A total of 12 trabeculectomy and 9 BGI cases failed by our definition of success. These cases were included in the analysis of IOP, number of glaucoma medications, and VA. The mean IOP was reduced from 20.6 ± 5.6 mmHg to 12.4 ± 3.2 mmHg and from 20.7 ± 5.5 mmHg to 11.3 ± 4.8 mmHg at one year post-operation in the BGI group and the trabeculectomy with ExPress shunt group, respectively. On average, the BGI group showed an IOP reduction of 7.7 ± 6.1 mmHg, while trabeculectomy with ExPress shunt experienced a decrease of 7.9 ± 5.2 mmHg at one year post-operation. Medications were reduced from 3.5 ± 0.8 to 2.6 ± 1.3 at one year in the BGI group and from 3.7 ± 0.5 to 0.6 ± 1.8 in the trabeculectomy with ExPress shunt group. At one year post-operation, the BGI group had an average of 0.9 ± 1.1 medication reduction, while trabeculectomy with ExPress shunt cases had a reduction of 3.2 ± 1.3 medications. VA was compared in logMar. At baseline, the average for BGI logMar was 0.5 ± 0.7 and the average for trabeculectomy was 0.2 ± 0.3. At one year post-operation, the BGI groups VA was 0.4 ± 0.4 while the trabeculectomy with ExPress shunt groups VA was 0.1 ± 0.1. Conclusions and Relevance: The Baerveldt 101-350 glaucoma implant and trabeculectomy (with ExPress™ shunt) may have similar rates of success in the surgical treatment of primary open angle glaucoma in eyes that are naïve to prior incisional glaucoma surgery, with a higher dependence on topical medications post-operation in patients undergoing Baerveldt glaucoma implantation.

Abstract Background To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb. Methods A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling. Results At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32). Conclusion Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR.

Background: To compare 6 month outcomes of bleb needling performed in the clinic vs. the operating room (OR) in adult glaucoma patients with failed bleb.Methods: A retrospective case series of 47 eyes from 41 glaucoma patients who received needling with mitomycin C (MMC) of scarred bleb from prior bleb-forming procedures in clinic (32 eyes) vs. the OR (15 eyes), including trabeculectomy (14 eyes), ExPress shunt (16 eyes), and ab-interno XEN gel stent (17 eyes). The primary outcome was needling success, defined as IOP ≤ 18 mmHg on 0 glaucoma medications without requiring an additional IOP lowering procedure within 6 months after needling.Results: At 6 months, bleb needling success rate was similar when performed in the clinic vs. in the OR (28% vs. 20%, P = 0.54). Success rate was not statistically different in patients with prior trabeculectomy, ExPress shunt, and XEN gel stent (29% vs. 38% vs. 12%, P = 0.26). When comparing clinic vs. the OR needling procedures at 6 months, there was no difference in mean IOP (14.2 vs. 14.9 mmHg, P = 0.73), mean glaucoma medications (1.4 vs. 1.7, P = 0.69), additional IOP-lowering procedure rate (16% vs. 27%, P = 0.37), or complication rate (0% vs. 7%, P = 0.32).Conclusion: Bleb needling with MMC in clinic may be a safe and effective way to revise failed bleb after trabeculectomy, ExPress shunt, and XEN gel stent procedures when compared to needling in the OR. [ABSTRACT FROM AUTHOR]

PURPOSE: The aim of this study is to assess the efficacy and safety of ExPress mini shunt in glaucoma patients of Middle Eastern descent. METHODS: This is a prospective cohort study. Uncontrolled glaucoma patients were subjected to ExPress mini-shunt implant. Pre- and post-operative glaucoma clinical indices were measured and compared. Both intra- and postoperative complications and surgical success rates were assessed. In addition to comparing a group of combined ExPress mini-shunt implant with cataract surgery versus ExPress mini-shunt implant alone. RESULTS: A total of 35 eyes of 31 patients were involved. The most common type of glaucoma was primary open-angle glaucoma in 13 eyes (37.1%). Fourteen eyes (40.0%) were combined ExPress device with cataract surgery. The mean intraocular pressure (IOP) (±standard deviation) at the last visit dropped from 24.6 mmHg (±8.3) to 13.9 mmHg (±4.5). There was a significant reduction in the number of postoperative glaucoma medications from 3.0 ± 0.5 to 1.3 (±0.7). In cases combined with cataract extraction, the patients required fewer anti-glaucoma medications. Complete success was achieved in 22 eyes (63%) and qualified success was achieved in 9 eyes (26%), whereas 4 eyes (11%) were considered a failure. The two most common complications encountered were hypotony (28.6%) and hyphema (11.4%). CONCLUSION: Among the studied population of patients, ExPress offers IOP reduction that is comparable to reported rates following standard trabeculectomy. Postoperative hyphema was encountered at a slightly higher rate. [ABSTRACT FROM AUTHOR]

ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications) was achieved in eight cases (66.7%) and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications) in two cases (16.7%) at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37). ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma′s, we await further studies with a larger sample size and long-term follow-up, to see how the device performs.

We describe an innovative technique for performing standardized low cost glaucoma filtration surgery using a polytetrafluoroethylene (PTFE) intravenous cannula. The trocar of a 24 gauge (24G) PTFE intravenous cannula was used to create a trabeculectomy ostium and its tube was inserted under a partial thickness scleral flap in 2 patients with advanced glaucomatous optic neuropathy, in whom intraocular pressure (IOP) was not controlled on maximal tolerable hypotensive therapy. Postoperatively, IOP of the operated eyes at 3, 6 and 9 months′ follow-up ranged from 12 to 15 mmHg with a well formed anterior chamber and a diffuse bleb.

Importance: Trabeculectomy is very effective in lowering intraocular pressure for the treatment of glaucoma, but it carries with it possible complications and failure. The ExPress shunt (Alcon Laboratories, Fort Worth, TX, USA) is an adjunctive device that can be used at the time of trabeculectomy to create an external fistuliztion. An alternative established and highly efficacious technique is the implantation of a glaucoma drainage device for sustained intraocular pressure (IOP) lowering. Specifically, evidence has established the Baerveldt 101-350 glaucoma implant (BGI) to have the best sustained IOP lowering in long-term follow-up amongst the many options for glaucoma drainage devices. Objective: To compare outcomes in eyes that underwent Baerveldt 101-350 glaucoma implant (BGI) and trabeculectomy with ExPress shunt (Trab) in primary open angle glaucoma without any prior incisional glaucoma surgery. Design, Setting, and Participants: This was a retrospective study of outcomes in patients identified by CPT codes as having undergone glaucoma implantation or trabeculectomy (with ExPress shunt) for the treatment of Primary Open Angle Glaucoma between 2012 and 2015 at a single institution by 2 fellowship trained glaucoma surgeons. A total of 57 eyes that underwent Baerveldt 101-350 glaucoma implant and 38 eyes that underwent trabeculectomy cases with ExPress™ shunt were included in the study. All patients were diagnosed with primary open angle glaucoma. Cases were included into the study if the patient underwent BGI or trabeculectomy with ExPress shunt without any prior incisional glaucoma surgery. Main Outcomes and Measures: Main outcomes included IOP, medications, visual acuity (VA), and secondary glaucoma surgery, if any. Results: Survival rate at 12 months was 85% in the BGI group and 80% in trabeculectomy with ExPress Shunt. A statistically significant difference was not found in the survival distributions between surgery groups using the log–rank test. A total of 12 trabeculectomy and 9 BGI cases failed by our definition of success. These cases were included in the analysis of IOP, number of glaucoma medications, and VA. The mean IOP was reduced from 20.6 ± 5.6 mmHg to 12.4 ± 3.2 mmHg and from 20.7 ± 5.5 mmHg to 11.3 ± 4.8 mmHg at one year post-operation in the BGI group and the trabeculectomy with ExPress shunt group, respectively. On average, the BGI group showed an IOP reduction of 7.7 ± 6.1 mmHg, while trabeculectomy with ExPress shunt experienced a decrease of 7.9 ± 5.2 mmHg at one year post-operation. Medications were reduced from 3.5 ± 0.8 to 2.6 ± 1.3 at one year in the BGI group and from 3.7 ± 0.5 to 0.6 ± 1.8 in the trabeculectomy with ExPress shunt group. At one year post-operation, the BGI group had an average of 0.9 ± 1.1 medication reduction, while trabeculectomy with ExPress shunt cases had a reduction of 3.2 ± 1.3 medications. VA was compared in logMar. At baseline, the average for BGI logMar was 0.5 ± 0.7 and the average for trabeculectomy was 0.2 ± 0.3. At one year post-operation, the BGI group’s VA was 0.4 ± 0.4 while the trabeculectomy with ExPress shunt group’s VA was 0.1 ± 0.1. Conclusions and Relevance: The Baerveldt 101-350 glaucoma implant and trabeculectomy (with ExPress™ shunt) may have similar rates of success in the surgical treatment of primary open angle glaucoma in eyes that are naïve to prior incisional glaucoma surgery, with a higher dependence on topical medications post-operation in patients undergoing Baerveldt glaucoma implantation.

ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications) was achieved in eight cases (66.7%) and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications) in two cases (16.7%) at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37). ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma's, we await further studies with a larger sample size and long-term follow-up, to see how the device performs. [ABSTRACT FROM AUTHOR]

Rhinosporidiosis is a rare infection caused by Rhinosporidium seeberi, an organism classified in its own class, mesomycetozoea. It commonly affects mucus membranes namely the nasal mucosa, pharynx and the conjunctiva. We present the case of an 8-year-old female who presented with a flat, red, vascular, fleshy, pedunculated mass arising from the tarsal conjunctiva of the right upper eyelid. The mass was completely excised. On histopathological examination, multiple sporangia were seen in various stages of degeneration, consistent with rhinosporidiosis. The diagnosis of rhinosporidiosis is based solely on its microscopic features, and the treatment is surgical excision. This condition is endemic in the temperate regions of the Indian subcontinent, but it has been known to occur even in the colder regions of North America and Eastern Europe. Although a rare clinical entity, the possibility of rhinosporidiosis must be borne in mind when evaluating any polypoidal conjunctival mass.

Purpose: The aim of this study is to assess the efficacy and safety of ExPress mini shunt in glaucoma patients of Middle Eastern descent., Methods: This is a prospective cohort study. Uncontrolled glaucoma patients were subjected to ExPress mini-shunt implant. Pre- and post-operative glaucoma clinical indices were measured and compared. Both intra- and postoperative complications and surgical success rates were assessed. In addition to comparing a group of combined ExPress mini-shunt implant with cataract surgery versus ExPress mini-shunt implant alone., Results: A total of 35 eyes of 31 patients were involved. The most common type of glaucoma was primary open-angle glaucoma in 13 eyes (37.1%). Fourteen eyes (40.0%) were combined ExPress device with cataract surgery. The mean intraocular pressure (IOP) (±standard deviation) at the last visit dropped from 24.6 mmHg (±8.3) to 13.9 mmHg (±4.5). There was a significant reduction in the number of postoperative glaucoma medications from 3.0 ± 0.5 to 1.3 (±0.7). In cases combined with cataract extraction, the patients required fewer anti-glaucoma medications. Complete success was achieved in 22 eyes (63%) and qualified success was achieved in 9 eyes (26%), whereas 4 eyes (11%) were considered a failure. The two most common complications encountered were hypotony (28.6%) and hyphema (11.4%)., Conclusion: Among the studied population of patients, ExPress offers IOP reduction that is comparable to reported rates following standard trabeculectomy. Postoperative hyphema was encountered at a slightly higher rate., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Saudi Journal of Ophthalmology.)