Non-penetrating Filtration Surgery Versus Trabeculectomy for Open-angle Glaucoma (Review)

• Editorial
• Published: xviii June 2018

Non-penetrating glaucoma surgery for advanced open-bending glaucoma

Graefe'due south Archive for Clinical and Experimental Ophthalmology volume 256,page 1479 (2018)Cite this commodity

• 922 Accesses

• iv Altmetric

• Metrics details

NICE guidelines (Nov 2017) recommend that patients with advanced chronic open up-angle glaucoma should exist offered surgery with augmentation as indicated. The guidelines stress the demand to offer information on the risks and benefits of surgery [1]. Such information depends of course on the nature of surgery. Eldaly et al. undertook a Cochrane Database Systematic Reviews in 2014 comparing not-penetrating filtration surgery with trabeculectomy for open-angle glaucoma [2]. The authors concluded that there was some limited bear witness that control of IOP is better with trabeculectomy than viscocanalostomy. Therefore, some might think that advanced glaucoma should just be treated with penetrating glaucoma surgery. On the other manus, systematic review and meta-analysis besides showed that trabeculectomy was associated with a higher incidence of complications compared to not-penetrating surgery [3]. Such complications include hypotony, choroidal effusion, cataract, and apartment or shallow anterior chamber and importantly sudden and further visual loss or "wipe out." What evidence do we have of the safety and efficacy of non-penetrating surgery for advanced open-angle glaucoma?

In this issue, we take two complementary papers on non-penetrating glaucoma surgery for avant-garde glaucoma. Tsagkataki et al. reported on viscocanalostomy and phacoviscocanalostomy for advanced glaucoma. Leleu et la reported on the central 10° visual field change post-obit non-penetrating deep sclerectomy in astringent and end-stage glaucoma. The first study from Liverpool was remarkable in that it involved 133 patients, probably the largest number of patients with the longest follow-up of up to 3 years. The authors found that viscocanalostomy and phacoviscocanalostomy were able to accomplish an IOP ≤ 21 mmHg in 80% (three years) to 95% (1 year) patients with a 35–39% drop in IOP from baseline with a good safe profile. The 2d study showed that 28 (82%) eyes had an IOP < 21 mmHg and 19 (56%) an IOP < xvi mmHg. The MD 10-two remained stable (− 19.viii seven.4 to − 19.iv 8.1 dB, non-significant comeback of + 0.four dB, P = 0.1). Every bit with well-nigh serial, the deep sclerectomy involved augmentation with mitomycin in all cases, collagen implant in some and in the postoperative period boosted measures such equally goniopuncture, needling, and iridoplasty. The authors focused on visual complications and stressed that there were no "wipe out" of the visual field, which had been a main concern for penetrating glaucoma surgery in advanced glaucoma [four,5,6].

Potentially, these two papers might influence the way nosotros treat glaucoma cases with severe visual field loss, that is with before surgical rather than medical intervention, with non-penetrating rather than with trabeculectomies.

References

1. Squeamish Guideline NG81 (2017) Glaucoma: diagnosis and management. https://www.nice.org.britain/guidance/ng81. Accessed 18 May 2018

2. Eldaly MA, Bunce C, Due north A, MM G (2014) Non-penetrating filtration surgery versus trabeculectomy for open up angle glaucoma. Cochrane Database Syst Rev (2): https://doi.org/x.1002/14651858.CD007059.pub2

3. Rulli East, Biagioli E, Riva I, Gambirasio Chiliad, De Simone I, Floriani I, Quaranta L (2013) Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol 131:1573–1582

   CAS  Article  Google Scholar

4. Aggarwal SP, Hendeles South (1986) Hazard of sudden visual loss following trabeculectomy in avant-garde primary open angle glaucoma. Br J Ophthalmol lxx(ii):97–99

   CAS  Commodity  Google Scholar

5. Costa VP, Smith Chiliad, Spaeth GL, Gandham South, Markovitz B (1993) Loss of visual acuity later on trabeculectomy. Ophthalmology 100(v):599–612

   CAS  Article  Google Scholar

6. Topouzis F, Tranos P, Koskosas A, Pappas T, Anastasopoulos E, Dimitrakos S et al (2005) Risk of sudden visual loss following filtration surgery in end-stage glaucoma. Am J Ophthalmol 140(4):661–666

   Article  Google Scholar

Download references

Author information

Affiliations

1. Department of Eye and Visual Scientific discipline, University of Liverpool, Liverpool, England

   David Wong

Respective author

Correspondence to David Wong.

Rights and permissions

About this commodity

Cite this article

Wong, D. Non-penetrating glaucoma surgery for advanced open-angle glaucoma. Graefes Curvation Clin Exp Ophthalmol 256, 1479 (2018). https://doi.org/10.1007/s00417-018-4026-5

Download citation

• Received: 21 May 2018

• Accepted: 29 May 2018

• Published: 18 June 2018

• Effect Engagement: August 2018

• DOI : https://doi.org/10.1007/s00417-018-4026-5

quickgimber60.blogspot.com

Source: https://link.springer.com/article/10.1007/s00417-018-4026-5

Share this post