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Related Concept Videos

Open Angle Glaucoma: Treatment01:27

Open Angle Glaucoma: Treatment

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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Angle Closure Glaucoma: Treatment01:28

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Angle-closure glaucoma, or closed-angle glaucoma, is an eye condition where the iris bulges out and blocks the iridocorneal angle, resulting in a buildup of aqueous humor and increased intraocular pressure. Immediate medical attention is necessary due to the sudden onset of symptoms. The treatment for angle-closure glaucoma includes short-term and long-term approaches. Short-term treatment involves using eye drops like pilocarpine to lower intraocular pressure by increasing aqueous humor...
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Glaucoma: Overview01:25

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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Ab interno supraciliary microstent surgery for open-angle glaucoma.

Amanjeet Sandhu1, Hari Jayaram1,2, Kuang Hu1

  • 1Glaucoma Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.

The Cochrane Database of Systematic Reviews
|May 28, 2021
PubMed
Summary
This summary is machine-generated.

Supraciliary microstent surgery combined with phacoemulsification effectively reduces intraocular pressure (IOP) and medication use in open-angle glaucoma (OAG) patients. However, long-term safety concerns, including endothelial cell loss, led to the device

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Area of Science:

  • Ophthalmology
  • Glaucoma Surgery
  • Minimally Invasive Procedures

Background:

  • Glaucoma is a leading cause of irreversible blindness, often linked to elevated intraocular pressure (IOP).
  • Surgical intervention is considered when medical or laser treatments fail or are not tolerated.
  • Minimally-invasive glaucoma surgery (MIGS) aims to reduce IOP with lower surgical risks.

Purpose of the Study:

  • To evaluate the efficacy and safety of supraciliary microstent surgery for open-angle glaucoma (OAG).
  • To compare supraciliary microstent surgery with standard medical, laser, or surgical treatments for OAG.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) was conducted.
  • Searches included Cochrane CENTRAL, MEDLINE, Embase, ISRCTN, ClinicalTrials.gov, and WHO ICTRP up to August 27, 2020.
  • One RCT met the inclusion criteria, comparing Cypass supraciliary microstent combined with phacoemulsification to phacoemulsification alone over 24 months.

Main Results:

  • Supraciliary microstent surgery combined with phacoemulsification likely increases the proportion of medication-free patients at 24 months (85% vs. 59%).
  • This combined surgery demonstrates a greater reduction in mean IOP (-7.4 mmHg vs. -5.4 mmHg) and medication use (1.2 vs. 0.7 drops).
  • Postoperative complications were similar, but 5-year data showed increased endothelial cell loss; the device has since been withdrawn.

Conclusions:

  • Supraciliary microstent surgery combined with phacoemulsification appears superior for medication-free OAG control but carries long-term safety concerns.
  • The Cypass device has been withdrawn from the market due to safety issues, specifically endothelial cell loss.
  • Further high-quality RCTs with long-term follow-up are needed to establish robust safety data and assess quality of life outcomes.