جستجوی مقالات مرتبط با کلیدواژه "minimally invasive glaucoma surgery" در نشریات گروه "پزشکی"

To compare the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) combined with phacoemulsification to PreserFlo™ MicroShunt as a standalone procedure in eyes with moderate to advanced open‑angle glaucoma.

In an observatory, prospective, clinical study, 30 patients (30 eyes) with moderate to advanced angle glaucoma were allocated to either PreserFlo™ MicroShunt combined with phacoemulsification (15 eyes; GroupA) or PreserFlo™ MicroShunt as a standalone procedure (15 eyes; Group B). The follow‑up time of the study was 12 months.

Average intraocular pressure (IOP) at 12 months was 11.62 ± 1.6 mmHg in Group A and 13.8 ± 3.6 mmHg in Group B, which was significantly lower than baseline IOP (Group A: 23.47 ± 8.99 mmHg, P < 0.001; Group B: 23.4 ± 8.68 mmHg, P < 0.001). The absolute reduction of IOP within the 12 postoperative months was not significantly different between the two groups (P = 0.056). The number of the topical medications that were administered 12 months after ocular surgery was 0 in Group A and 0.6 ± 0.8 in Group B, compared to 3.13 ± 1.02 in Group A (P < 0.001) and 2.4 ± 1.45 in Group B (P = 0.004) at baseline. Phacoemulsification combined with PreserFlo™ MicroShunt significantly reduced the number of antiglaucoma agents after 12 months compared to the standalone procedure (P = 0.026). One eye in Group A was referred for bleb revision due to bleb fibrosis and a consequent acute postoperative rise in IOP. One eye in Group A required transscleral cyclophotocoagulation with MicroPulse® laser. One bleb revision was also necessary in Group B at the 4th postoperative week. Endothelial cell density did not significantly change over 12 months in either group (Group A: baseline, 2017.3 ± 346.8 cells/mm2 ; 12 months, 1968.5 ± 385.6 cells/mm2 ; P = 0.38; Group B: baseline, 2134.1 ± 382.6 cells/mm2 ; 12 months, 2094.4 ± 373.3 cells/mm2 , P = 0.42). The PreserFlo™ MicroShunt combined with phacoemulsification produced higher absolute success rates after 12 months in patients with moderate to advanced open‑angle glaucoma than the PreserFlo™ MicroShunt as standalone procedure (Group A: 80% and Group B: 60%, P = 0.022).

In eyes with moderate to advanced open‑angle glaucoma, PreserFlo™ MicroShunt with or without phacoemulsification is effective in reducing IOP and the number of the antiglaucoma agents with a very small incidence of complications and subsequent glaucoma surgeries. However, adding phacoemulsification to PreserFlo™ MicroShunt successfully reduces IOP without the need for ongoing topical medications as are needed after the standalone procedure.

There is a growing interest in targeting minimally invasive surgery devices to the aqueous outflow system to optimize treatment outcomes. However, methods to visualize functioning, large-caliber aqueous and episcleral veins in-vivo are lacking. This pilot study establishes an ex-vivo system to evaluate the use of a confocal laser microendoscope to noninvasively image episcleral vessels and quantify regional flow variation along the limbal circumference.

A fiber-optic confocal laser endomicroscopy (CLE) system with lateral and axial resolution of 3.5 𝜇m and 15 𝜇m, respectively, was used on three porcine and four human eyes. Diluted fluorescein (0.04%) was injected into eyes kept under constant infusion. The microprobe was applied to the sclera 1 mm behind the limbus to acquire real-time video. Image acquisition was performed at 15-degree intervals along the limbal circumference to quantify regional flow variation in human eyes.

Vascular structures were visualized in whole human eyes without processing. Schlemm’s canal was visualized only after a scleral flap was created. Fluorescent signal intensity and vessel diameter variation were observed along the limbal circumference, with the inferior quadrant having a statistically higher fluorescein signal compared to the other quadrants in human eyes (𝑃 < 0.05).

This study demonstrates for the first time that the fiber-optic CLE platform can visualize the episcleral vasculature with high resolution ex-vivo with minimal tissue manipulation. Intravascular signal intensities and vessel diameters were acquired in real-time; such information can help select target areas for minimally invasive glaucoma surgery (MIGS) to achieve greater intraocular pressure reduction.