Microcatheter, Trabeculotomy, Congenital Glaucoma
Am J Ophthalmol.
2017 Jun 14. pii: S0002-9394(17)30242-8. doi: 10.1016/j.ajo.2017.06.004. [Epub ahead of print]
Randomized Trial on Illuminated Microcatheter Circumferential Trabeculotomy versus Conventional Trabeculotomy in Congenital Glaucoma.
To compare one year outcomes of illuminated microcatheter-assisted circumferential trabeculotomy(IMCT) vs conventional partial trabeculotomy(CPT) for Primary Congenital Glaucom (PCG).
Randomized clinical trial METHODS: Forty eyes of 31 patients with unilateral or bilateral primary congenital glaucoma aged less than two years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was IOP reduction. The success criterion was defined as intraocular pressure (IOP) ≤ 12 mm Hg without and with anti-glaucoma medications (absolute success and qualified success respectively).
The mean age of our study population was 8.35 ± 1.2 months. The mean pre-operative IOP was 24.70± 3.90 mm Hg in the IMCT group and 24.60± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to pre-operative IOP, corneal clarity, corneal diameter, vertical cup-disc ratio and refractive error. In IMCT group, 360 degree cannulation was achieved in 80% (16/20) eyes. For the IMCT group and CPT groups respectively, the absolute success rates were 80%(16/20) and 60%(12/20) (p< 0.001); and qualified success rates were 90% (18/20) and 70% (14/20) (p< 0.001). Both procedures produced a statistically significant reduction in IOP, and eyes undergoing IMCT achieved a lower IOP than CPT group at 12 months follow-up (9.5 + 2.4 mm and 11.7 + 2.1 mm Hg respectively, p< 0.001).
In primary congential glaucoma, illuminated microcatheter assisted 360 degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at one year follow-up, and resulted in significantly lower IOP measurements.
Copyright © 2017 Elsevier Inc. All rights reserved.
Risk Factor, Glaucoma, Progression
Am J Ophthalmol.
2017 Jun 14. pii: S0002-9394(17)30241-6. doi: 10.1016/j.ajo.2017.06.003. [Epub ahead of print]
Risk factors for Rapid Glaucoma Disease Progression.
To determine the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors and non-rapid disease progressors.
Retrospective case control study Methods SETTING: Five private ophthalmology clinics STUDY POPULATION: 48 rapidly progressing eyes (progression ≥1dB mean deviation (MD)/year) and 486 non-rapidly progressing eyes (progression <1dB MD/year). Patients were eligible if they had a diagnosis of glaucoma from their ophthalmologist and if they had greater than or equal to 5 Humphrey visual fields (24-2) conducted. Patients were excluded if their sequential visual fields showed an improvement in MD or if they had greater than 5dB MD variation in between visits. Patients with obvious neurological fields were excluded.
Clinical and demographic data (age, gender, CCT, IOP, refraction, medications) as well as medical, surgical and ocular histories were collected.
MAIN OUTCOME MEASURES:
Risk factor differences between the cohorts were measured using the independent t-test, Wald chi-squared and binomial regression analysis.
Rapid progressors were older, had significantly lower CCT and baseline IOPs and were more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes and IOP lowering surgery. They also had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs.
Cardiovascular disease is an important risk factor for rapid glaucoma disease progression irrespective of IOP control.
Copyright © 2017. Published by Elsevier Inc.