Advertisement

Outcome of viscodilation and tensioning of Schlemm’s canal for uveitic glaucoma

      Abstract

      Objective

      To evaluate the safety and efficacy of circumferential viscodilation and tensioning of Schlemm’s canal (canaloplasty) in the treatment of uveitic glaucoma (UG).

      Design

      Pilot, retrospective, noncomparative case series.

      Participants

      Nineteen uveitic eyes of 15 patients with UG.

      Methods

      The main outcome measure was surgical success. Secondary outcome measures included intraocular pressure, usage of ocular hypotensive medication, visual acuity, and sight-threatening complications. Patients were included when UG could not be controlled despite maximum tolerated medical therapy. Exclusion criteria were peripheral anterior synechiae and previous glaucoma surgery.

      Results

      Mean follow-up time from canaloplasty was 2.6 ± 1.1 years. Mean intraocular pressure decreased from 30.4 ± 8.4 mm Hg preoperatively to 13.8 ± 5.0 mm Hg at last follow-up (p < 0.001). The mean number of ocular hypotensive medications decreased from 3.7 ± 0.8 preoperatively to 0.4 ± 1.0 at last follow-up (p < 0.001). At last follow-up, the complete success, qualified success, and failure rates were 73.7%, 10.5%, and 15.8%, respectively. No canaloplasty-related permanent sight-reducing complications occurred. Preoperative best corrected visual acuity decreased more than 1 Snellen line in 1 eye due to exacerbation of uveitis 18 months postoperatively.

      Conclusions

      Canaloplasty appears to be a relatively safe and effective initial surgical intervention in UG.

      Résumé

      Objet

      Évaluation de la sécurité et de l’efficacité de la viscolidation circonférentielle et de la tension du canal de Schlemm (canaloplastie) dans le traitement du glaucome uvéitique (GU).

      Nature

      Série de cas pilotes, rétrospectifs, non comparatifs.

      Participants

      19 yeux ayant une uvéite chez 15 patients ayant un GU.

      Méthodes

      Le principal résultat était la réussite chirurgicale. Les résultats secondaires comprenaient la pression intraoculaire (PIO), l’utilisation de médicaments oculaires hypotensifs, l’acuité visuelle et les complications menaçant la vue. Les patients étaient inclus lorsque le GU ne pouvait pas être contrôlé malgré la thérapie médicale maximale tolérée de la (TMMT). Les critères d’exclusion étaient les synéchies périphériques antérieures (SPA) et la chirurgie précédente du glaucome.

      Résultats

      La durée moyenne du suivi de la canaloplastie était de 2,6 ± 1,1 ans. La moyenne de PIO a baissé, passant de 30,4 ± 8,4 mmHg avant la chirurgie à 13,8 ± 5,0 mmHg au dernier suivi (p < 0,001). Au dernier suivi, la moyenne du nombre de médications hypotensives oculaires avait baissé de 3,7 ± 0,8 avant la chirurgie à 0,4 ± 1,0 au dernier suivi (p < 0,001). Au dernier suivi, les taux réussite entière, de réussite qualifiée, et de faillite étaient de 73,7, 10,5 et 15,8 % respectivement. Aucune complication réduisant la vue de façon permanente due à la canaloplastie n’est survenue. L’acuité visuelle préopératoire (AVPO) la mieux corrigée a baissé de plus d’une ligne Snellen dans un œil, dû à l’exacerbation de l’uvéite 18 moins après la chirurgie.

      Conclusion

      La canaloplastie semble être une intervention chirurgicale initiale relativement sûre et efficace pour le GU.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Takahashi T.
        • Ohtani S.
        • Miyata K.
        • et al.
        A clinical evaluation of uveitis associated secondary glaucoma.
        Jpn J Ophthalmol. 2002; 46: 556-562
        • Moorthy R.S.
        • Mermoud A.
        • Baerveldt G.
        Glaucoma associated with uveitis.
        Surv Ophthalmol. 1997; 41: 361-394
        • Herbert H.M.
        • Viswanathan A.
        • Jackson H.
        • et al.
        Risk factors for elevated intraocular pressure in uveitis.
        J Glaucoma. 2004; 13: 96-99
        • Kaburaki T.
        • Koshino T.
        • Kawashima H.
        • et al.
        Initial trabeculectomy with mitomycin C in eyes with uveitic glaucoma with inactive uveitis.
        Eye. 2009; 23: 1509-1517
        • Ceballos E.M.
        • Parrish 2nd, R.K.
        • Schiffman J.C.
        Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma.
        Ophthalmology. 2002; 109: 2256-2260
        • Papadaki T.G.
        • Zacharopoulos I.P.
        • Pasquale L.R.
        • et al.
        Long-term results of Ahmed glaucoma valve implantation for uveitic glaucoma.
        Am J Ophthalmol. 2007; 144: 62-69
        • Molteno A.C.
        • Sayawat N.
        • Herbison P.
        Otago glaucoma surgery outcome study: long-term results of uveitis with secondary glaucoma drained by Molteno implants.
        Ophthalmology. 2001; 108: 605-613
        • Lewis R.A.
        • Von Wolff K.
        • Tetz M.
        • et al.
        Canaloplasty: three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma.
        J Cataract Refract Surg. 2011; 37: 682-690
        • Noble J.
        • Derzko-Dzulynsky L.
        • Rabinovitch T.
        • Birt C.
        Outcome of trabeculectomy with intraoperative mitomycin C for uveitic glaucoma.
        Can J Ophthalmol. 2007; 42: 89-94
        • Prata Jr, J.A.
        • Neves R.A.
        • Minckler D.S.
        • et al.
        Trabeculectomy with mitomycin C in glaucoma associated with uveitis.
        Ophthalmic Surg. 1994; 25: 616-620
        • Wright M.M.
        • McGehee R.F.
        • Pederson J.E.
        Intraoperative mitomycin-C for glaucoma associated with ocular inflammation.
        Ophthalmic Surg Lasers. 1997; 28: 370-376
        • Ceballos E.M.
        • Beck A.D.
        • Lynn M.J.
        Trabeculectomy with antiproliferative agents in uveitic glaucoma.
        J Glaucoma. 2002; 11: 189-196
        • Chawla A.
        • Mercieca K.
        • Fenerty C.
        • Jones N.P.
        Outcomes and complications of trabeculectomy enhanced with 5-fluorouracil in adults with glaucoma secondary to uveitis.
        J Glaucoma. 2013; 22: 663-666
        • Rachmiel R.
        • Trope G.E.
        • Buys Y.M.
        • et al.
        Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients.
        Can J Ophthalmol. 2008; 43: 462-467
        • Wordinger R.J.
        • Clark A.F.
        Effects of glucocorticoids on the trabecular meshwork: towards a better understanding of glaucoma.
        Prog Retin Eye Res. 1999; 18: 629-667
        • Clark A.F.
        • Wilson K.
        • de Kater A.W.
        • et al.
        Dexamethasone- induced ocular hypertension in perfusion cultured human eyes.
        Invest Ophthalmol Vis Sci. 1995; 36: 478-489
        • Tektas O.Y.
        • Heinz C.
        • Heiligenhaus A.
        • et al.
        Morphological changes of trabeculectomy specimens in different kinds of uveitic glaucoma.
        Curr Eye Res. 2011; 36: 442-448
        • Anand N.
        Deep sclerectomy with mitomycin C for glaucoma secondary to uveitis.
        Eur J Ophthalmol. 2011; 21: 708-714
        • Auer C.
        • Mermoud A.
        • Herbort C.P.
        Deep sclerectomy for the management of uncontrolled uveitic glaucoma: preliminary data.
        Klin Monbl Augenheilkd. 2004; 221: 339-342
        • Souissi K.
        • El Afrit M.A.
        • Trojet S.
        • et al.
        Deep sclerectomy for the management of uveitic glaucoma.
        J Fr Ophtalmol. 2006; 29: 265-268
        • Dupas B.
        • Fardeau C.
        • Cassoux N.
        • et al.
        Deep sclerectomy and trabeculectomy in uveitic glaucoma.
        Eye (Lond). 2010; 24: 310-314