2021 ASCRS Annual Meeting

Authors

Presenting Author
Cathleen M. McCabe, MD    Email the author

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Paper Abstract

Purpose
The purpose of this study was to assess 5-year outcomes in patients who underwent cataract surgery alone compared to those who underwent cataract surgery combined with a Hydrus Microstent.

Methods
Subjects with primary open angle glaucoma (POAG) and visually significant cataract with washed-out diurnal IOP 22 - 34 mmHg were randomized 2:1 to undergo cataract surgery + or - a Hydrus Microstent. Study data was collected through 60 months postoperative. 556 eyes were randomized after cataract surgery to Hydrus (HS, N=369) or no further treatement (CS, N=187). Baseline demographics and ocular characteristics did not differ between groups. Baseline washout diurnal IOP was 25.5 ± 3.0 in HS vs 25.4 ± 2.9 mmHg in CS (p=0.9) and visual field mean deviation was -3.61 ± 2.49 dB in HS vs -3.61 ± 2.60 dB in CS (p=1.0). Medication wash out was conducted at 2 years but discontinued thereafter.

Results
2-year results were reported previously. At 5 years, the proportion of eyes requiring medications was significantly lower in the HS group (34% vs. 64%, p<0.001). Among eyes that were medication free, the mean unmedicated IOP was unchanged vs 2 years (16.6 vs. 16.6 HS group and 17.6 vs. 17.4 CS group). There was a significant reduction in the cumulative risk of incisional glaucoma surgery at 5 years in the HS group (2.5% vs. 6.4%, logrank p=0.022). From 2 years to 5 years, mean central endothelial cell count fell by 93 cells/mm2 in the HS group (2060±480 vs. 1967± 522) and 66 cells/mm2 in the CS group (2183±425 vs. 2117±442). There were no significant adverse events compared to 2 years.

Conclusion
Hydrus combined with phacoemulsification results in sustained IOP and medication reduction from year 2 to year 5, and a significant reduction in secondary incisional glaucoma surgery (trabeculectomy or tube shunt). There were no significant changes in safety findings from 2 years, including no abnormal increase in endothelial cell loss.

Authors

Presenting Author
Brian O Wogu    Email the author
Authors
Allen Y. Ganjei, Wesam Shamseldin Shalaby, MD, Marlene R. Moster, MD, Jonathan S. Myers, MD, ABO, Aakriti Garg Shukla, MD, ABO

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Paper Abstract

Purpose
To compare the outcomes of Baerveldt glaucoma implant (BGI) surgery and transscleral cyclophotocoagulation (CPC) in the setting of neovascular glaucoma (NVG).

Methods
Retrospective case series at a single tertiary care center. Charts of consecutive NVG patients who underwent BGI or CPC surgery for NVG with ≥ 6 months follow-up were reviewed. Exclusion criteria included baseline visual acuity (VA) of no light perception (NLP) and intraocular pressure (IOP) < 21 mmHg. Main outcome measures were progression to NLP vision by the final visit and 6-month surgical failure defined as: IOP > 21 mmHg with medications, or < 5 mmHg with hypotony-related maculopathy on 2 consecutive visits, progression to NLP, or glaucoma reoperation.

Results
113 eyes (61 BGI and 52 CPC) of 106 patients were included with a mean follow-up duration of 24.5±22.5 months. Age, sex, race, NVG etiology, preoperative IOP, and medications were similar between groups. BGI eyes had better VA at baseline (P=0.011), more instances of bilateral retinal pathology (P=0.014), and perioperative retinal treatment (P<0.001). At postoperative month 6, comparison of CPC vs. BGI revealed significantly higher reoperations in CPC eyes (11.5% vs. 0%, P=0.008), while difference in failure (42.3% vs. 25.9%; P=0.074) or progression to NLP (19.2% vs. 14.8%; P=0.617) was not detected. At month 6 and the most recent visit, BGI eyes had better VA and required fewer medications.

Conclusion
In the setting of NVG, CPC may be associated with a greater need for reoperations, more glaucoma medications, and worse VA as compared to BGI. However, the results of this retrospective case series may be influenced by surgeon choice to do CPC in eyes with worse visual prognosis.

Authors

Presenting Author
Elias F. Jarade, MD    Email the author

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Paper Abstract

Purpose
Glaucoma is one of the most common complications post-penetrating keratoplasty(PK). In this study we report the Incidence, risk factors and treatment outcomes of intraocular hypertension(IOH) or/and Glaucoma Post-Penetrating Keratoplasty(PKG).

Methods
A 5-year descriptive retrospective study, Lebanese patients who underwent PK at Beirut Eye & ENT Specialist Hospital, between 2012 and 2017, were included. Patients with history of glaucoma were excluded. IOH/PKG cases that necessitate treatment where identified and analyzed for the incidence, risk factors and treatments outcomes

Results
189 eyes of 159 patients were included, male/female ratio 1.6, the mean age 47.2±21.3 years.34.9% of eyes developed high IOP within a mean of 25 months of follow-up distributed between sub-groups of patient with corneal ectasia(22.5%), redo-PK(51.2%), bullous keratopathy(BK)(50%), keratitis(24.9%), and others(dystrophy, trauma…)(21.4%). High IOP developed in 67.4% of the diabetic patients. In those refractory to medical treatment, trabeculectomy as a glaucoma surgery was effective in lowering the IOP. Combining procedures with PK were not a risk factor for glaucoma. Interrupted sutures and higher number of suturing were associated with increased IOP levels

Conclusion
IOH developed in one out of three patients who underwent penetrating keratoplasty. DM, bullous keratopathy, infectious keratitis and redo-PK were highly associated with PKG; whereas high IOP was less likely to develop in cases with keratoconus. glaucoma is considered a poor prognostic factor in patients post-PK

★ This paper won Best Paper of Session (BPOS) at the 2021 ASCRS Annual Meeting

Authors

Presenting Author
Lorena Wheelock-Gutierrez, MD    Email the author
Authors
Carolina F Prado Larrea, MD, Jose A Oyervides-Alvarado, MD, Gabriel Lazcano Sr., MD, Jesus Jimenez-Roman, MD, Roberto Gonzalez-Salinas, MD, PhD

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Paper Abstract

Purpose
To compare long-term effects of phacoemulsification on intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG).

Methods
The study enrolled consecutive patients having phacoemulsification with IOL implantation and a diagnosis of POAG or PXG. Data about IOP values, best-corrected visual acuity (BCVA), number of glaucoma medications used, and Visual fields (mean deviation and visual field index) were collected preoperatively and at month 1, 3, 6 and 12 post-operatively.

Results
102 patients underwent phacoemulsification surgery, 51 (50%) had POAG. Most patients were female (n=35, 69% vs n=27, 53% in the PXG group). POAG patients were younger with a mean age of 72.92 ± 8.2 years than PXG ones (78.82 ± 7.3) (p=0.002); had a lower baseline IOP with a mean of 17.5 ± 3.8 mmHg vs 20.8± 5.6 mmHg (p=0.003), and had lesser extent of glaucoma damage with a mean Mean Deviation of -6.2 ± 4.8 dB vs -11.6 ± 9.9 dB (p=0.036). Statistically significant changes in BCVA (p=0.001) were observed 12 months after phacoemulsification in both groups. A reduction in IOP values was found in PXG group (p=0.001) and a significant reduction in glaucoma medication in the POAG group (p=0.001).

Conclusion
Hispanic patients with PXG have a significant IOP reduction after phacoemulsification and behave in a similar way as reported for other ethnic groups with this condition. Patient selection is of utmost importance, cataract surgery may be an additional benefit in glaucoma control in POAG patients that want less ocular hypotensive of medications.

Authors

Presenting Author
Mordechai Goldenfeld, MD    Email the author

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Paper Abstract

Purpose
Translimbal direct selective laser trabeculoplasty(DSLT),is fast,noncontact & user friendly automated procedure for selective laser trabeculoplasty(SLT)directly through the limbus withoutgonioscopy. In this first-in-human clinical trial we assessed its safety & ability to reduce intraocular pressure (IOP) in patients with open-angle glaucoma (OAG).

Methods
Design: Single-arm, non-randomized, masked clinical trial. Participants: Fifteen patients (15 eyes: 10 with OAG, 4 with ocular hypertension, 1 with pseudo exfoliation glaucoma). Patients with IOP ≥22 mmHg, naïve or after adequate hypotensive medications washout, underwent DSLT by irradiation for 1.5 or 2.3 seconds with, respectively, 100 or 120 sequential non-contact 532 nm, Q-switched laser shots (0.8−1.4 mJ), that were automatically applied directly on the limbus, guided by image analysis and monitored by eye tracking. Visual acuity, IOP, numbers of glaucoma medications, and intra- and post-procedure complications were assessed at 1 hour, 3 hours, 1 day, 1 week, and 1, 3, and 6 months.

Results
Mean Pre DSLT IOP(mmHg)was26.7±2.3.By 1,3& 6m F/U,deacrese in IOP was noted: to 21.7±4.2 (18.1%),20.8±2.5 (21.4%),& 21.5±4.1 (18.8%)respectively.A subgroup(n=6) treated with 1 mJ/shot, mean baseline IOP was reduced from 27.3±2.0 to20.0±4.2 (mean reduction 26.4%,P=0.03),to 22.0±2.4 (mean change 18.4%,P=0.06)&to 22.7±5.1(mean reduction 15.2%,P=0.3)respectively.Another subgroup(n=6),treated with 1.4 mJ/shot,significant mean reductions from 26.7±3.2 to 21.2±2.3 (19.9%.P=0.06),to 19.8±2.9 (24.9%, P=0.03),and to 19.3±2.0 (27.1%, P=0.03),respectively. No serious side effects were noted. Minor SC hemorrhages in 4 pt's resolved without treatment within 1 week.

Conclusion
Conclusions: Automated DSLT appears to be an effective, safe, and well-tolerated new modality for reducing IOP in patients with OAG. Higher energy usage led to better-sustained results. Randomized controlled studies with more patients are being conducted to validate these initial promising findings.

Authors

Presenting Author
Kristen Hawthorne, MD    Email the author
Authors
Daniel O Godoy, BSc; Apurva Chavali, MS; Eunice M Bajomo, OSC

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Paper Abstract

Purpose
To evaluate surgical outcomes in chronic glaucoma patients who were treated with endocyclophotocoagulation (ECP) at the time of cataract surgery with or without additional MIGS procedures. Determination of whether ECP is a MIGS tool that offers sustained efficacy with a minimal side effect profile in surgical glaucoma patients.

Methods
A retrospective chart analysis of 98 eyes with glaucoma that were treated by a single surgeon with ECP, ECP + iStent or ECP + goniotomy at the time of CE/IOL. Stage of glaucoma, efficacy of intraocular pressure (IOP) lowering effect, reduction of medication burden, visual acuity changes over time, side effect profile, complications and need for additional procedures were examined. 35 patients had data collected greater than 24 months with a maximum follow up time of 68 months. Paired t-tests were done to determine if IOP lowering effect was sustained years after treatment. Graphical representation of results provided for BCVA, IOP lowering effect and change in medication burden over time.

Results
The level of statistical significance chosen was (α = 0.05). 89% of eyes had moderate or severe glaucoma. All procedures (ECP, ECP + iStent and ECP + goniotomy) showed a significant decrease in IOP at 1 month, 6 months and 1 year. At 1-year, average IOP decreased in ECP from 18.737.55mmHg to 143.07mmHg, in ECP + iStent from 17.873.95mmHg to 15.414.12mmHg and in ECP + goniotomy from 18.534.21mmHg to 12.752.92mmHg. ECP and ECP + iStent showed a significant decrease in IOP at 2 years, 3 years and 4 years. Insufficient data available for ECP + goniotomy at 24 months and beyond. At most time points there was not a significant reduction in medication burden in this cohort of patients.

Conclusion
ECP has few side effects and offers a sustained IOP lowering effect in glaucoma patients with advancing disease. Minimal discontinuation of topical medications may be expected to reach IOP reduction goals in this cohort. ECP with or without combined MIGS procedures may delay conjunctival incisional therapy in advancing glaucoma for years.