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Abdelrahman M Elhusseiny,1,2,* Mohamed M Khodeiry,3,4,* Richard K Lee,4 Tarek Shaarawy,5 Salman Waqar,6 Mohamed S Sayed6 1Department of Ophthalmology, Harvey and Bernice Jones Eye Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Department of Ophthalmology, Boston Children’s Hospital, Boston, MA, USA; 3Department of Ophthalmology, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA; 4Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 5Department of Ophthalmology, Hôpitaux Universitaires de Genève, University of Geneva, Geneva, Switzerland; 6Glaucoma Division, Moorfields Eye Hospitals, Dubai, United Arab Emirates*These authors contributed equally to this workCorrespondence: Mohamed S Sayed, Glaucoma Division, Moorfields Eye Hospitals, Dubai, United Arab Emirates, Tel +97144297888, Email msayed82@hotmail.comPurpose: The Paul glaucoma implant (PGI, Advanced Ophthalmic Innovations, Singapore, Republic of Singapore) is a recently developed novel non-valved glaucoma drainage device (GDD) designed to effectively reduce the intraocular pressure (IOP) in glaucoma patients with a theoretically reduced risk of postoperative complications such as hypotony, endothelial cell loss, strabismus, and diplopia. Limited literature has evaluated its use in adult glaucoma; however, its use in pediatric glaucoma has not been reported to date. We present our early experience with PGI in refractory childhood glaucoma.Patients and Methods: This study was retrospective single-surgeon case series in a single tertiary center.Results: Three eyes of 3 patients with childhood glaucoma were enrolled in the study. During nine months of follow-up, postoperative IOP and number of glaucoma medications were significantly lower than preoperative values in all the enrolled patients. None of the patients developed postoperative complications including postoperative hypotony, choroidal detachment, endophthalmitis, or corneal decompensation.Conclusion: PGI is an efficient and relatively safe surgical treatment option in patients with refractory childhood glaucoma. Further studies with larger number of participants and longer follow-up period are required to confirm our encouraging results.Keywords: glaucoma, pediatric, intraocular pressure, tube, Paul glaucoma implant

Br J Ophthalmol 2004;88:95-98 Aim: To identify the value of using collagen implant in deep sclerectomy. Methods: A prospective randomised trial of 104 eyes (104 patients) with medically uncontrolled primary [...]

Br J Ophthalmol 2003;87:1340-1344 Aim: The use of an animal model to study the aqueous dynamic and the histological findings after deep sclerectomy with (DSCI) and without collagen implant. Methods: [...]

Aim: To prospectively study the success rate and complications of viscocanalostomy, a non-penetrating glaucoma surgery. Methods: Prospective non-randomised consecutive case series of 57 eyes (57 patients) with medically uncontrolled primary [...]

PurposeTo compare the accuracy in measurement of the anterior chamber (AC) angle by anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) in European patients with suspected primary angle closure (PACS), primary angle closure (PAC), or primary angle-closure glaucoma (PACG).DesignCross-sectional study.MethodsIn all, 55 eyes of 33 consecutive patients presenting with PACS, PAC, or PACG were examined with AS-OCT, followed by UBM. The trabecular-iris angle (TIA) was measured in all four quadrants. The angle-opening distance (AOD) was measured at 500 μm from the scleral spur. The Bland–Altman method was used for assessing agreement between the two methods.ResultsThe mean (±SD) superior TIA was 19.3±15.8° in AS-OCT and 15.7±15.0° in UBM (P=0.50) and inferior TIA was 17.9±12.9° (AS-OCT) and 16.7±14.1° (UBM) (P=0.71). The superior AOD500 was 0.17±0.16 mm in UBM and 0.21±0.16 mm in AS-OCT (P=0.06). Bland–Altman analysis showed a mean SD of±9.4° for superior and inferior TIA and a mean SD of ±0.10 mm for superior and inferior AOD500.ConclusionsThis comparative study shows that AS-OCT measurements are significantly correlated with UBM measurements but show poor agreement with each other. We do not believe that AS-OCT can replace UBM for the quantitative assessment of the AC angle. [ABSTRACT FROM AUTHOR]

AimsTo report corneal endothelial cell loss and in vivo visualization of the Ahmed glaucoma valve implant in eyes with refractory glaucoma.MethodsTen eyes underwent Ahmed valve implant surgery and were followed-up for 12 months. Data collected included intraocular pressure (IOP), number of antiglaucoma medications and surgery-related complications. At 6 and 12 months postoperatively, the intracameral length of the drainage tube (ICL) and the distance between the tube and the cornea (T–C distance), and the iris (T–I distance) were assessed using anterior segment optical coherence tomography (AS-OCT). Heidelberg cornea tomograph II (HRT II) was used to measure the corneal endothelial cell density.ResultsMean (±SEM) preoperative IOP was 29.5±4 mmHg. Mean postoperative IOP was 11.6±2 at 12 months (P<0.01). Over a 6-month period, mean corneal endothelial loss was 7.9%±2.5 in the central and 7.5%±2.4 in the peripheral cornea (P<0.01). There was no correlation between central or peripheral corneal endothelial cell loss and the T–C, T–I distance or the ICL of the tube.ConclusionsCorneal endothelial cell loss occurs following Ahmed valve implant surgery, this appears to be multifactorial. AS-OCT and HRT II are promising methods for the follow-up of patients with a glaucoma drainage device. [ABSTRACT FROM AUTHOR]

PURPOSE: To compare prospectively the results of deep sclerectomy (DS) vs deep sclerectomy with collagen implant (DSCI) METHODS: Randomized prospective trial involving 26 eyes (13 patients) with medically uncontrolled primary and secondary open angle glaucoma. Collagen implant was randomly assigned to one eye of each patient. RESULTS:: The mean follow-up period was 49.5 (SD 20) months for the DS-treated eyes, and 56.5 (SD 14) months for the DSCI-treated eyes (P=0.4). The mean preoperative intraocular pressure (IOP) was 24.1 (SD 7)?mmHg for the DS-treated eyes, and 25.3 (SD 6)?mmHg for the DSCI-treated eyes (P=0.5). The mean IOP at the first postoperative day was 6.4 (SD 3)?mmHg for the DS-treated eyes, and 3.7 (SD 2)?mmHg for the DSCI-treated eyes (P=0.05). The mean IOP at 12 months postoperative day was 15.4 (SD 3)?mmHg for the DS group, and 10.4 (SD 4)?mmHg for the DSCI-treated eyes (P=0.04), while at 48 months it was 16 (SD 3)?mmHg for the DS group, and 10 (SD 4)?mmHg for the DSCI-treated eyes (P=0.005). Complete success rate, defined as an IOP lower than 21?mmHg without medication, was 38%(5/13 patients) at 48 months for the DS-treated eyes, and 69%(9/13 patients) for the DSCI-treated eyes. Qualified success rate: patients who achieved IOP below 21?mmHg with or without medication, was 69%(9/13 patients) at 48 months and 100%(13/13 patients) for the DSCI group. The mean number of medications was reduced from 2.4 (SD 0.8) to 1.1 (SD 1) after DS, and was reduced from 2.2 (SD 0.7) to 0.4 (SD 0.6) in the DSCI group (P=0.001). For those eyes treated with DSCI, IOP was 3.21?mmHg lower than for those treated with DS (P<0.0001). CONCLUSION: The use of a collagen implant in DS seems to enhance the success rates, provides significantly lower IOP levels, and lowers the need for postoperative medications.Eye (2005) 19, 298-302. doi:10.1038/sj.eye.6701469 Published online 16 July 2004 [ABSTRACT FROM AUTHOR]

Purpose. To study Mitomycin C Loaded Collagen Implant (CI) pharmacokinetics behaviour In vitro. Methods. The CI were incubated for 15 minutes in different MMC loading solutions with the following concentrations: 0.03mg/mL (n = 9), 0.3mg/mL (n = 10) and 3.0 mg/mL (n = 10), The loaded CI were transferred in l00μL of 0.9% NaCl. Aqueous flow of 5μL/min was simulated. The MMC concentrations of the samples were determined by high performance liquid chromatography (HPLC). Dissolution kinetics were evaluated by a first-order process. The half-life of dissolution and the time of 95% dissolution were determined. Results. The Cl absorbed on average a MMC dose of 0.054, 0.530 and 6.090 μg when incubated in the different MMC loading solutions containing 0.03 mg/mL, 0.3 mg/mL. 3,0 mg/mL of MMC, respectively. In the release experiments, the mean total dose delivered by Cl was 0.0493, 0.585 and 5.291 μg. A linear correlation between loading concentration and the estimated total dose released was demonstrated. The kinetic parameters showed a fast MMC dissolution. The half-life of the 3 series was 8.8, 10.1 and 10.5 min. Conclusions. Commercially available CI can be loaded with MMC, and could provide relatively slower release than sponge delivery of MMC. Clinical implications of these results warrants further studies. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effectiveness and safety of the Paul glaucoma implant (PGI) to the Ahmed glaucoma valve (AGV) in managing refractory childhood glaucoma., Design: Randomized controlled trial., Setting: Two clinical centers., Methods: An ongoing randomized controlled trial including patients ≤ 18 years with refractory childhood glaucoma in whom glaucoma drainage implant surgery was planned. Patients were randomized to receive either PGI or AGV. The primary outcome was the intraocular pressure (IOP) reduction. Secondary outcomes included glaucoma medication reduction, success rate, and complications rate. The success rate was defined as achieving a postoperative IOP between 6-21 mmHg without or with glaucoma medications (up to three topical glaucoma medications), without the need for additional glaucoma surgeries, and without the occurrence of vision-threatening complications or evidence of disease progression. The use of oral glaucoma medications, such as acetazolamide, was considered a failure., Results: The current report included 44 patients (44 eyes) who completed the one-year postoperative follow-up (25 in the PGI group versus 19 in the AGV group). The mean age at the time of surgery was 96.9 ± 59.1 months (90.5 ± 60.04 months in the PGI group and 105.4 ± 58.5 months in the AGV group). Preoperatively, the mean IOP was 32.6 ± 6.1 mmHg with a mean of 3.6 ± 0.6 glaucoma medications in the PGI group, compared with 29.8 ± 6.1 mmHg (P = .1) with a mean of 3.4 ± 0.7 glaucoma medications (P = .35) in the AGV group. At one year, there were no statistically significant differences in the mean IOP (14.9 ± 4.1 mmHg in the PGI group versus 15.5 ± 3.5 in the AGV group, P = .6) and number of glaucoma medications (1.1 ± 1 in the PGI group versus 1.6 ± 1.03 in the AGV group, P = .1). The success rate of PGI was 80% versus 73.6% in the AGV (P = .2). The postoperative complications rate was comparable in both groups (three eyes in each group)., Conclusion/relevance: At one year postoperatively, the IOP reduction, reduction of glaucoma medications, success rates, and rate of complications were comparable between both groups., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Prcis: The effectiveness of Ahmed glaucoma valve (AGV) and Baerveldt glaucoma implant (BGI) was comparable in the management of childhood glaucoma over the long term despite initial better success rate with BGI. There were higher tube block and retraction rates in the BGI group and higher tube exposure rates in the AGV group., Purpose: To evaluate the outcomes and safety of AGV and BGI in childhood glaucoma., Materials and Methods: We performed a systematic literature review of publications from 1990 to 2022 in PubMed, EMBASE, ClinicalTrials.gov, Ovid MEDLINE, Cochrane CENTRAL, and google scholar for studies evaluating AGV and BGI in childhood glaucoma. Primary outcome measures were intraocular pressure (IOP) reduction and glaucoma medication reduction. The secondary outcome measures were the success rates and incidence of postoperative complications. We conducted a meta-analysis using a random effects model., Results: Thirty-two studies met the inclusion criteria. A total of 1480 eyes were included. The mean IOP reduction was 15.08 mm Hg ( P < 0.00001) for AGV and 14.62 ( P < 0.00001) for the BGI group. The mean difference between pre and postoperative glaucoma medications was 1 ( P < 0.00001) fewer medications in the AGV group and 0.95 ( P < 0.0001) fewer medications in the BGI group. There was a lower success rate in the AGV versus BGI groups at 2 years [63% vs 83%, respectively ( P < 0.0001) and 3 years (43% vs 79%, respectively ( P < 0.0001)]; however, the success was higher for AGV at 5 years (63% vs 56% in the BGI group, P < 0.001). The incidence of postoperative complications was comparable in the AGV and BGI groups, with rates of 28% and 27%, respectively., Conclusions: The IOP and glaucoma medication reduction, success rates, and incidence of postoperative complications were comparable in Ahmed and Baerveldt groups. Most literature comes from retrospective low-quality studies on refractory childhood glaucoma. Further larger cohort studies are needed., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Prcis: Deep sclerectomy with intrascleral collagen implant (DSCI) was less effective in lowering intraocular pressure (IOP) than with suprachoroidal implantation. Further studies are needed to establish the potency and safety of deep sclerectomy with suprachoroidal collagen implant (DSSCI)., Purpose: The purpose of this study was to analyze the safety and IOP-lowering effect of DSSCI in comparison with DSCI., Setting: Geneva University Hospitals, Geneva, Switzerland., Methods: This is a prospective, randomized, controlled study involving 13 patients (26 phakic eyes) with bilateral medically uncontrolled primary or secondary open-angle glaucoma. Bilateral deep sclerectomy was performed with each patient being randomly assigned to receive a collagen implant in the intrascleral space in one eye, and a suprachoroidal collagen implant in the other. Follow-up visits were performed at day 1; at week 1; and at months 6, 9, 12, 18, 30, 48, 54, and 60., Results: Mean preoperative IOP was 24.1±4.2 mm Hg for DSCI group and 25.3±5.3 mm Hg for DSSCI group (P=0.1). The mean postoperative IOP was 14.8±4.0 mm Hg (DSCI) versus 9.8±3.7 mm Hg (DSSCI) at month 60 (P=0.01). Mean preoperative best-corrected visual acuity for the DSCI group was 0.76±0.22 and 0.74±0.23 for the DSSCI group (P=0.001), while the mean postoperative best-corrected visual acuity was 0.82±0.17 (DSCI) and 0.80±0.17 (DSSCI) at month 60 (P=0.004)., Conclusions: DSSCI demonstrated a greater IOP-lowering effect than deep sclerectomy with intrascleral implantation. The safety profile of both methods was similar. More patients with a longer follow-up are required to comprehensively assess the safety and efficacy of this new approach., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)