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      Evaluating glaucoma surgeries in the MIGS context

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          Abstract

          The challenges of glaucoma management are many: the disease is chronic, progressive, often asymptomatic, and very often, the quality of life and costs of treatment is unacceptable to the patient. This is true for both medical therapy and conventional glaucoma surgery. The choice of therapy, especially the transition from the former to the latter, is now being bridged by Minimally Invasive Glaucoma Surgeries (MIGS). Choosing from the several options now available in the surgical armamentarium requires a deeper understanding of the available modalities. This review aims to provide an overview of the decision-making process, keeping in mind age, type of glaucoma, life expectancy, socioeconomic status, patient expectations, and coexisting cataract.

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          Most cited references77

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          Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract.

          To assess the safety and efficacy of the iStent trabecular micro-bypass stent (Glaukos Corporation, Laguna Hills, CA) in combination with cataract surgery in subjects with mild to moderate open-angle glaucoma. Prospective, randomized, open-label, controlled, multicenter clinical trial. A total of 240 eyes with mild to moderate open-angle glaucoma with intraocular pressure (IOP) ≤24 mmHg controlled on 1 to 3 medications were randomized to undergo cataract surgery with iStent implantation (treatment group) or cataract surgery only (control). Fifty additional subjects were enrolled to undergo cataract surgery with iStent implantation under protocol expansion. Data in this report are based on the first 240 eyes enrolled. Implantation of the iStent trabecular micro-bypass stent in conjunction with cataract surgery or cataract surgery only. The primary efficacy measure was unmedicated IOP ≤21 mmHg at 1 year. A secondary measure was unmedicated IOP reduction ≥20% at 1 year. Safety measures included best-corrected visual acuity (BCVA), slit-lamp observations, complications, and adverse events. The study met the primary outcome, with 72% of treatment eyes versus 50% of control eyes achieving the criterion (P<0.001). At 1 year, IOP in both treatment groups was statistically significantly lower from baseline values. Sixty-six percent of treatment eyes versus 48% of control eyes achieved ≥20% IOP reduction without medication (P = 0.003). The overall incidence of adverse events was similar between groups with no unanticipated adverse device effects. Pressure reduction on fewer medications was clinically and statistically significantly better 1 year after stent plus cataract surgery versus cataract surgery alone, with an overall safety profile similar to that of cataract surgery alone. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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            A twenty-year follow-up study of trabeculectomy: risk factors and outcomes.

            This study was undertaken to determine the performance of trabeculectomy surgery over a 20-year period and examine the associations between outcome and risk factors for trabeculectomy failure. Retrospective cohort study. A total of 234 patients (330 procedures) who had undergone trabeculectomy surgery at Addenbrooke's Hospital, Cambridge, United Kingdom, between January 1988 and December 1990. Patients were identified through surgical logbooks (n = 521 procedures on 380 patients); after this, a case-note review was undertaken, which identified 234 patients (330 procedures) who had available case notes. Surgical success was defined as "complete success" while intraocular pressure (IOP) remained <21 mm Hg with no additional medication and as "qualified success" if those requiring additional topical medication were included. Functional success was defined if patients did not progress to legal blindness (visual acuity <3/60 or visual field <10 degrees). After 20 years, 57% were classified as complete success, 88% were classified as qualified success, and 15% had become blind. Those at risk of trabeculectomy failure were younger or had uveitic glaucoma. Those with pseudoexfoliation or aphakia were more likely to progress to blindness. Furthermore, those using 2 or more topical medications or with advanced visual field loss at the time of surgery were more at risk of both trabeculectomy failure and blindness. This study indicates that trabeculectomy survival at 20 years may be approximately 60% with no topical medication and approximately 90% with additional topical medication. Patient age, preoperative topical medication use, glaucoma type, and glaucoma severity will independently influence this outcome. Trabeculectomy surgery is therefore a long-term solution to IOP control. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
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              Performance and Safety of a New Ab Interno Gelatin Stent in Refractory Glaucoma at 12 Months.

              To evaluate the intraocular pressure (IOP)-lowering performance and safety of an ab interno gelatin stent (XEN 45 Gel Stent, Allergan plc, Irvine, California, USA), a minimally invasive glaucoma surgery device, in refractory glaucoma.
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                Author and article information

                Journal
                Rom J Ophthalmol
                Rom J Ophthalmol
                RomJOphthalmol
                Romanian Journal of Ophthalmology
                Romanian Society of Ophthalmology (Romania )
                2457-4325
                2501-2533
                Apr-Jun 2020
                : 64
                : 2
                : 85-95
                Affiliations
                [* ]CShah Satnam Ji Speciality Hospitals, Sirsa, Haryana, India
                [** ]Glaucoma Services, Fortis Memorial Research Institute, Gurugram, Haryana, India
                Author notes
                Correspondence to: Dr. Deepika Dhingra, MS, DNB, FICO, Consultant, Shah Satnam Ji Speciality Hospitals, Najia Road, Near Shah Satnam Ji Dham, Pin: 125055, Sirsa, Haryana, India, E-mail: dhingradeepika19@gmail.com
                Article
                RomJOphthalmol-64-85
                10.22336/rjo.2020.18
                7339697
                32685772
                56f7f535-67bf-4cac-8ed1-935a0cf0ae12
                ©Romanian Society of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 December 2019
                Categories
                Reviews

                glaucoma,minimally invasive glaucoma surgery,migs,trabeculectomy,glaucoma drainage device

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