Surgical intervention for dynamic movement of a glaucoma drainage device with shifting tube position associated with corneal edema and cataract.
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ABSTRACT:
SUBMITTER: Plotnik J
PROVIDER: S-EPMC7575847 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Surgical intervention for dynamic movement of a glaucoma drainage device with shifting tube position associated with corneal edema and cataract.
American journal of ophthalmology case reports 20200709
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Project description:PrcisKaplan-Meier analysis was used to compare the rate of corneal grafting after glaucoma drainage device (GDD) placement in pediatric and adult patients. Adults were at an increased risk of receiving a corneal graft after device placement.PurposeThe goal of this study was to compare the rate of corneal graft implantation after GDD placement in pediatric and adult patients.PatientsPatients receiving a GDD between January 1, 1985 and December 31, 2017 were selected from the medical records. Patients receiving their first device while <18 years of age were considered children for the extent of the study.MethodsWe compared the rate of receiving a corneal graft after GDD implantation using Kaplan-Meier analysis. Baseline patient characteristics and surgical characteristics were compared using a generalized estimating equation.ResultsCorneal grafting occurred in 8.6% of adults and 4.7% of children from the original cohort. The rate of receiving a corneal graft at 5, 10, and 15 years was 9.4%, 16.8%, 39.4% and 1.6%, 1.6%, 12.5% for adults and children, respectively. However, certain characteristics were different between the 2 groups.ConclusionAdult patients were more likely to receive a corneal graft after GDD placement. However, pediatric and adult patients differed in the prevalence of preexisting corneal disease, glaucoma type, GDD type used, and types of previous surgeries. Elucidation of the impact of these factors on corneal graft rate requires a larger cohort size.
| S-EPMC8043241 | biostudies-literature
Project description:IntroductionThe Aurolab aqueous drainage implant (AADI) is a low-cost glaucoma drainage device that is modelled on the Baerveldt glaucoma implant. Studies on AADI have reported absolute success rates of 41.8-93.1% at 1 year. Most studies report on tube placement in the anterior chamber. We report on results of tube insertion in the sulcus/pars plana.Material and methodsA retrospective chart review of all patients who had undergone AADI implantation (with insertion of tube in the sulcus/posterior segment) between June 2015 and November 2018 was done. Patients were asked to stop anti-glaucoma medications on the 40th post-operative day.ResultsThe mean age was 57.4 ± 13.8 years (n = 30). The mean IOP prior to surgery was 34.4 ± 6.1 mmHg which reduced to 15.4 ± 8.6 mmHg on the 45th post-operative day (p < 0.001). The absolute success at last review was 10% and the qualified success was 80%. The complication rate was 26.7%. Three patients had hypotony related complications noted at/after the 45th day review (none before 40th day). The incidence of ocular motility disturbances was 26.7% though none of the patients reported diplopia. One patient had sideways rotation of the scleral patch graft resulting in tube exposure. This complication was not seen after we shifted to using 9-0 nylon sutures to anchor the graft. Six patients had loss of best corrected visual acuity and one patient developed endophthalmitis. The endophthalmitis was preceded by conjunctival retraction and sloughing off of the scleral patch graft.DiscussionAADI implantation results in a substantial drop in IOP. However, many patients continue to require anti-glaucoma medications. Allowing overlap of scleral/corneal patch graft onto the scleral flap may be effective in preventing peritubular leak. It may be advisable to use 9-0 nylon sutures to secure the scleral patch graft anti-glaucoma medications can be temporarily suspended after the 40th post-operative day to minimize hypotony related complications. Melting of the scleral patch graft may be an early sign of endophthalmitis. It would be prudent to specifically look for ocular motility problems in patients undergoing AADI implantation.
| S-EPMC8026980 | biostudies-literature
Project description:For patients who are unresponsive to pharmacological treatments of glaucoma, an implantable glaucoma drainage devices (GDD) are often used to manage the intraocular pressure. However, the microscale channel that removes excess aqueous humor from the anterior chamber often gets obstructed due to biofouling, which necessitates additional surgical intervention. Here we demonstrate the proof-of-concept for smart self-clearing GDD by integrating magnetic microactuators inside the drainage tube of GDD. The magnetic microactuators can be controlled using externally applied magnetic fields to mechanically clear biofouling-based obstruction, thereby eliminating the need for surgical intervention. In this work, our prototype magnetic microactuators were fabricated using low-cost maskless photolithography to expedite design iteration. The fabricated devices were evaluated for their static and dynamic mechanical responses. Using transient numerical analysis, the fluid-structure interaction of our microactuator inside a microtube was characterized to better understand the amount of shear force generated by the device motion. Finally, the anti-biofouling performance of our device was evaluated using fluorescein isothiocyanate labeled bovine serum albumin. The microactuators were effective in removing proteinaceous film deposited on device surface as well as on the inner surface of the microchannel, which supports our hypothesis that a smart self-clearing GDD may be possible by integrating microfabricated magnetic actuators in chronically implanted microtubes.
| S-EPMC6220179 | biostudies-literature
Project description:PurposeThis study examines the incidence of visually significant cystoid macular edema (CME) after glaucoma drainage implant (GDI) surgery and analyses risk factors associated with developing CME and prognosis with treatment.Materials and methodsIn total, 185 eyes from 185 glaucoma patients (mean age, 72.46±13.94 y) who underwent GDI surgery at a tertiary eye institute were recruited. Patients were classified based on the presence (CME) or absence (No-CME) of CME. Pre-GDI and post-GDI best-corrected visual acuity, number of intraocular pressure (IOP)-lowering medications, IOP, standard automated perimetry and post-GDI complications, were recorded and compared between the 2 groups. Optical coherence tomography (OCT) was used to quantify retinal thickness and monitor CME.ResultsIn total, 41 (22.2%) eyes developed visually significant CME after GDI surgery. Patients with CME had a higher incidence of pre-GDI nonsteroidal anti-inflammatory drug (P<0.01) use and higher number of prior glaucoma surgeries (P<0.01). CME patients had a higher (P<0.01) incidence of iritis, epiretinal membrane, and hypotony. CME eyes responded well to steroids, with resolving macular edema (458.4±151.9 vs. 322.0±92.0 µm, P<0.01) and improving visual acuity (0.73±0.48 vs. 0.56±0.56 logarithm of minimum angle of resolution, P<0.01). Both CME and non-CME groups had equivalent lowering of IOP and post-GDI glaucoma medications; with no significant elevation in IOP in the steroid-treated CME group.ConclusionsPost-GDI surgery visually significant CME rates are potentially higher in a real hospital scenario compared with controlled clinical trials. With diligent treatment, CME resolves effectively restoring visual acuity and central macular thickness.
| S-EPMC5790635 | biostudies-literature
Project description:PrcisIn this longitudinal study of patients with open-angle (OAG), pseudoexfoliative (PXE), or neovascular glaucoma (NVG) receiving glaucoma drainage devices (GDD), posttube cumulative rates of reoperation, corneal graft, and visually threatening complications (VT-complications) increased beyond 5 years and were not significantly affected by glaucoma type.PurposeTo study the need for additional glaucoma surgery and development of complications after first GDD surgery in eyes with primary OAG, PXE, or NVG glaucoma.Patients and methodsThere were 306 eyes with OAG (n=185), PXE (n=60), or NVG (n=61) glaucoma who received a first GDD between 1996 and 2017. Outcomes including glaucoma reoperation, corneal graft procedure, and VT-complications after GDD were measured. Kaplan-Meier analysis was used to compare cumulative rate of reaching outcomes over time after GDD placement among the 3 glaucoma groups.ResultsWhen comparing the OAG, PXE, and NVG groups, there were no significant differences in post-GDD cumulative rates of reoperation (P=0.33), corneal graft (P=0.26), or VT-complications (P=0.65) over time. For all eyes, the overall cumulative rates for each outcome measure increased beyond 5 years, and specific Kaplan-Meier rates (5-y, 10-y) included: reoperation (16%, 25%), corneal graft (6%, 12%), VT-complications (9%, 14%). When comparing specific GDDs, the Ahmed FP7 had a higher cumulative reoperation rate over time compared with the Baerveldt 350 (P=0.019).ConclusionGlaucoma type did not significantly affect post-GDD cumulative rates of reoperation, corneal graft, and VT-complication among the OAG, PXE, and NVG groups. For all eyes, cumulative rates of reoperation, corneal graft, and VT-complications increased beyond 5 years. The Ahmed FP7 had a significantly higher cumulative reoperation rate compared with the Baerveldt 350 over time.
| S-EPMC8169530 | biostudies-literature
Project description:PurposeThe optical density of the cornea can be evaluated quantitatively by "densitometry" using a rotating Scheimpflug camera. Densitometry allows evaluation of corneal opacity in the anterior segment of the eye by quantitative measurement of scattering light. In the present investigation, we evaluate quantitatively minimal subclinical corneal edema after cataract surgery using densitometry.MethodsFifty four eyes of 34 patients who underwent cataract surgery were enrolled. Measurement of corneal density was performed using Pentacam® before and on days 1, 3 and 7 after surgery.ResultsDensitometry scores increased from 18.12 ± 1.76 before cataract surgery to 21.03 ± 3.84 on day 1 (P < 0.001) and 19.90 ± 2.46 on day 3 (P = 0.018), but recovered to 19.44 ± 1.58 on day 7 (P = 0.131). Total corneal thickness was 549.1 ± 32.7 μm before surgery and increased to 582.7 ± 46.3 μm on day 1 (P = 0.001), but recovered to 566.4 ± 29.7 μm on day 3 (P = 0.097). Densitometry reading correlated positively with corneal thickness (correlation coefficient = 0.13, P = 0.003).ConclusionsDensitometry is useful to detect corneal edema that is not detectable by slit-lamp examination.
| S-EPMC6302480 | biostudies-literature
Project description:The key risk factor for glaucoma is increased intraocular pressure (IOP). Glaucoma drainage devices implanted in the eye can reduce IOP and thus stop disease progression. However, most devices currently used in clinical practice are passive and do not allow for postsurgical IOP control, which may result in serious complications such as hypotony (i.e., excessively low IOP). To enable noninvasive IOP control, we demonstrate a novel, miniature glaucoma implant that will enable the repeated adjustment of the hydrodynamic resistance after implantation. This is achieved by integrating a magnetic microvalve containing a micropencil-shaped plug that is moved using an external magnet, thereby opening or closing fluidic channels. The microplug is made from biocompatible poly(styrene-block-isobutylene-block-styrene) (SIBS) containing iron microparticles. The complete implant consists of an SIBS drainage tube and a housing element containing the microvalve and fabricated with hot embossing using femtosecond laser-machined glass molds. Using in vitro and ex vivo microfluidic experiments, we demonstrate that when the microvalve is closed, it can provide sufficient hydrodynamic resistance to overcome hypotony. Valve function is repeatable and stable over time. Due to its small size, our implant is a promising, safe, easy-to-implant, minimally invasive glaucoma surgery device.
| S-EPMC10356933 | biostudies-literature
Project description:Excessive fibrosis is the primary factor for the failure of glaucoma drainage device (GDD) implantation. Thus, strategies to suppress scar formation in GDD implantation are crucial. Although it is known that in implanted medical devices, microscale modification of the implant surface can modulate cell behavior and reduce the incidence of fibrosis, in the field of ophthalmic implants, especially the modification and effects of hydrogel micropatterns have rarely been reported. Here, we designed the patterned gelatin/acrylamide double network hydrogel and developed an innovative GDD with micropattern to suppress inflammatory and fibroblast activation after GDD implantation. Pattern topography suppressed F-actin expression and mitigated actin-dependent nuclear migration of myocardin-related transcription factor A (MRTF-A) during the proliferative phase after GDD implantation. Ultimately, the expression of α-smooth muscle actin (α-SMA), a key fibrosis-related gene product, was suppressed. Moreover, the modified GDD effectively controlled intraocular pressure (IOP), mitigated fibrous formation, and remodeled extracellular matrix (ECM) collagen distribution in vivo. Therefore, the novel GDD with surface patterning interventions provides a promising strategy to inhibit scar formation after GDD implantation and raise the efficacy of GDD implantation.
| S-EPMC11751202 | biostudies-literature
Project description:Anterior segment dysgenesis describes a group of heterogeneous developmental disorders that affect the anterior chamber of the eye and are associated with an increased risk of glaucoma. Here, we report homozygous mutations in peroxidasin (PXDN) in two consanguineous Pakistani families with congenital cataract-microcornea with mild to moderate corneal opacity and in a consanguineous Cambodian family with developmental glaucoma and severe corneal opacification. These results highlight the diverse ocular phenotypes caused by PXDN mutations, which are likely due to differences in genetic background and environmental factors. Peroxidasin is an extracellular matrix-associated protein with peroxidase catalytic activity, and we confirmed localization of the protein to the cornea and lens epithelial layers. Our findings imply that peroxidasin is essential for normal development of the anterior chamber of the eye, where it may have a structural role in supporting cornea and lens architecture as well as an enzymatic role as an antioxidant enzyme in protecting the lens, trabecular meshwork, and cornea against oxidative damage.
| S-EPMC3169830 | biostudies-literature
Project description:BackgroundThe purpose of this study was to compare the efficacy and safety of pars plana glaucoma drainage device (PP GDD) with anterior chamber glaucoma drainage device (AC GDD) for the treatment of glaucoma.MethodsWe comprehensively searched three databases, including PubMed, EMBASE, and the Cochrane Library databases, selecting the relevant studies. The continuous variables, namely, intraocular pressure (IOP) and glaucoma medications, were pooled by the weighted mean differences (WMDs), and the dichotomous outcomes, including corneal failure incidence and overall complications incidence, were pooled by the odds ratio (ORs).ResultsFour retrospective studies involving 275 eyes were evaluated, with 135 in the PP GDD group and 140 in the AC GDD group. The WMDs of the IOP reduction between the PP GDD group and the AC GDD group were - 1.01 mmHg (95% CI -4.05 to 2.03, p = 0.52). The WMDs of the glaucoma medications reduction between the PP GDD group and the AC GDD group were 0.23 (95% CI -0.11 to 0.56, p = 0.19). The pooled ORs comparing PP GDD group with AC GDD group were 1.01 (95% CI 0.03 to 40.76, p = 0.99) for corneal failure incidence and 1.19 (95% CI 0.68 to 2.09, p = 0.54) for overall complication incidence. There were no significant differences between PP GDD group and AC GDD group on these aspects.ConclusionsBoth PP GDD and AC GDD procedures had similar efficacy of reduction in the IOP and number of medications. They are also both comparable on the safety with similar incidence of corneal failure and overall complications.
| S-EPMC6114491 | biostudies-literature