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Related Concept Videos

Glaucoma: Overview01:25

Glaucoma: Overview

594
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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Angle Closure Glaucoma: Treatment01:28

Angle Closure Glaucoma: Treatment

528
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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Open Angle Glaucoma: Treatment01:27

Open Angle Glaucoma: Treatment

458
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.
Drugs such as carbonic anhydrase inhibitors, α2- and...
458

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Risk Factors for Failure in Glaucoma Patients Undergoing Microshunt Implantation.

Alessandro Rabiolo1, Rebecca Toscani2, Matteo Sacchi3

  • 1From the Department of Ophthalmology (A.R., P.D., A.C., S.D.C.), University Hospital Maggiore della Carità, Novara, Italy; Department of Health Sciences (A.R., S.D.C.), Università del Piemonte Orientale "Amedeo Avogadro", Novara, Italy.

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|November 18, 2023
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Summary

Higher intraoperative mitomycin-C (MMC) concentration and careful patient selection can reduce Microshunt failure in glaucoma patients. This study identified key risk factors for surgical success.

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Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Glaucoma Management

Background:

  • Glaucoma is a leading cause of irreversible blindness.
  • Microshunt surgery offers a potential treatment option for managing intraocular pressure (IOP).
  • Understanding factors influencing Microshunt success is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To identify risk factors associated with Microshunt failure in glaucoma patients.
  • To evaluate the impact of intraoperative mitomycin-C (MMC) concentration on surgical outcomes.
  • To determine patient-specific factors that predict Microshunt success or failure.

Main Methods:

  • A multicenter retrospective cohort study involving 220 glaucoma patients undergoing Microshunt implantation.
  • Defined four distinct IOP success criteria based on target pressure and percentage reduction.
  • Utilized Kaplan-Meier analysis for success rates and multivariable Cox models to identify risk factors for failure.

Main Results:

  • Success rates varied significantly by definition, ranging from 43.3% to 62.5% at 1-year follow-up.
  • Higher intraoperative MMC concentration (0.4 mg/mL vs. 0.2 mg/mL) significantly reduced the risk of Microshunt failure.
  • Specific glaucoma types (pseudoexfoliation/pigmentary, primary angle closure) and prior ocular surgeries were associated with increased failure risk.

Conclusions:

  • Higher intraoperative MMC dosage is a significant protective factor against Microshunt failure.
  • Patient selection is critical, with certain glaucoma subtypes and surgical histories increasing failure risk.
  • Optimizing MMC concentration and considering patient-specific factors can improve Microshunt surgical success rates.