The combination of glaucoma and cataract occurs in 14.6-76% of cases, according to various sources. The goal of surgical treatment for these patients is to improve visual function while simultaneously reducing intraocular pressure. Due to the wide variety of proposed surgical methods, there is no consensus on the optimal management strategy for such patients.
OBJECTIVE: This study evaluates the hypotensive effect and visual function outcomes of combined surgery for complicated cataract and glaucoma using the mesh drain made of digeland the xenocollagen drain.
METHODS: Patients in Group 1 (n=43; 48.3%) underwent combined cataract and glaucoma surgery with implantation of the digel drainage implant, while patients in Group 2 (n=46; 51.7%) underwent an identical operation with the xenocollagen implant. Preoperative tonometric pressure was 27.2±1.7 and 27.3±1.9 mm Hg; best corrected visual acuity was 0.35±0.21 and 0.33±0.18, respectively. The following surgical technique was employed. At 3.0-4.0 mm from the limbus, an intrascleral tunnel was created using a 2.2 mm sclerotome through the conjunctiva in the anteroposterior direction, exiting into the anterior chamber. Capsulorhexis and phacoaspiration were performed. The scleral tunnel was widened to 3 mm, and the intraocular lens was implanted. Penetrating basal coloboma of the iris was formed. The deep flap of the scleral tunnel was dissected from the flat part of the ciliary body and removed. The digel implant was shaped into a T-configuration, while the xenocollagen implant was used without modification. Each drainage was implanted into the intrascleral tunnel (one end directed into the anterior chamber, the other exiting the scleral tunnel). The conjunctiva was sutured with 10/0 stitches, and the paracenteses were hydrated.
RESULTS: Over a 24-month follow-up period, the tonometric intraocular pressure in Groups 1 and 2 was 18.8 and 18.5 mm Hg, respectively, and the best corrected visual acuity was 0.51 and 0.58.
CONCLUSIONS: The use of both drainages in the proposed combined surgery for complicated cataract and glaucoma results in similarly stable hypotensive outcomes and high visual function.
Сочетание глаукомы и катаракты встречается, по разным данным, в 14,6—76% случаев. Улучшение зрительных функций с одновременным снижением внутриглазного давления является целью хирургического лечения таких пациентов. Из-за наличия большого количества предлагаемых методов операций единая тактика ведения этих больных отсутствует.
UNASSIGNED: Изучить гипотензивный эффект и зрительные функции комбинированной хирургии осложненной катаракты и глаукомы с использованием дренажей из ксеноколлагена и дигеля.
UNASSIGNED: Пациентам 1-й группы (n=43; 48,3%) проведена комбинированная хирургия катаракты и глаукомы с имплантацией дренажа из дигеля, пациентам 2-й группы (n=46; 51,7%) выполнена идентичная операция с имплантацией дренажа из ксеноколлагена. Дооперационное тонометрическое давление составило 27,2±1,7 и 27,3±1,9 мм рт.ст.; максимальная корригированная острота зрения — 0,35±0,21 и 0,33±0,18 соответственно. Использована следующая техника операции. В 3,0—4,0 мм от лимба склеротомом (2,2 мм) через конъюнктиву в переднезаднем направлении формируется интрасклеральный тоннель в поверхностных слоях склеры с выходом ножа в переднюю камеру, выполняется капсулорексис и факоаспирация. Склеральный тоннель расширяется до 3 мм, имплантируется линза. Формируется сквозная базальная колобома радужки. Глубокий лоскут склерального тоннеля отделяется шпателем от плоской части цилиарного тела и удаляется. Дренажу из дигеля придают Т-образную форму. Дренаж из ксеноколлагена применяется без коррекции его формы и размеров. Любой из дренажей имплантируется в интрасклеральный тоннель (один конец направляется в переднюю камеру, другой — выходит из склерального тоннеля). На конъюнктиву накладывается шов 10/0, производится гидратация парацентезов.
UNASSIGNED: За 24 мес наблюдения у пациентов 1-й и 2-й групп тонометрическое внутриглазное давление составило 18,8 и 18,5 мм рт.ст. соответственно, а максимальная корригируемая острота зрения — 0,51 и 0,58.
UNASSIGNED: Применение дренажей из дигеля и ксеноколлагена в предложенной комбинированной хирургии осложненной катаракты и глаукомы приводит к одинаковому стабильному гипотензивному результату и высоким зрительным функциям.

OBJECTIVE: To evaluate radiographic lacrimal gland (LG) volume and dimensions in Ahmed glaucoma valve (AGV)- versus trabeculectomy-treated eyes and contralateral non-treated eyes.
METHODS: In this retrospective cohort study, 1616 medical records acquired between 2010 and 2020 were examined. In AGV-treated (group 1) eyes, there were 19 patients with records sufficient for radiological LG evaluation, and in trabeculectomy-treated (group 2) eyes, there were 18. The hospital workstation software was used to assess high-resolution computed tomography (HRCT) scans conducted under standard protocol using a 128 SL Optima CT 660 scanner. The software (Vitrea™) was used to perform semi-quantitative volumetric measurements. LG dimensions were obtained in the axial and reformatted coronal planes on each side, and four measures were generated using the widest LG tip-to-tip diameters in two planes: coronal length, coronal width (CW), axial length (AL), and axial width.
RESULTS: The time interval between surgery and HRCT imaging was 50.97 ± 26.25 months. Group 1 had significantly lower LG volume than group 2 (594.11 ± 259.45 vs. 933.67 ± 294.09 mm3, P = 0.001). When compared to non-treated eyes, AGV-treated eyes had lower LG volume (P = 0.065) while trabeculectomy-treated eyes had higher LG volume (P = 0.031). Further, group 1 had decreased length and width in both the axial and coronal planes as compared to group 2, with AL and CW being significantly different (P < 0.05).
CONCLUSIONS: AGV and trabeculectomy had varied impacts on LG volume and dimensions despite being conducted in the same quadrant. HRCT appears to be effective in analysing AGV position, which may be related to LG volumetric and dimensional issues.

OBJECTIVE: Trabeculectomy, a primary surgical treatment for glaucoma, often employs mitomycin C (MMC) to reduce scar formation and improve surgical outcomes. However, the optimal application method of MMC, whether by injection or sponge, remains a subject of debate. This meta-analysis aims to compare injectable and sponge-based MMC application in terms of efficacy and safety, focusing on various clinical outcomes in glaucoma patients.
METHODS: A comprehensive literature search of Scopus, MEDLINE, EMBASE, Ovid, Chinese biomedical literature database, China National Knowledge Infrastructure, and Cochrane Library was done for eligible studies that report data of glaucoma patients who were administered MMC by injection or sponge application during trabeculectomy. Outcomes of interest included intraocular pressure (IOP) reduction, bleb appearance grading (height, extent, vascularity), use of anti-glaucoma medications, and rates of complete success, qualified success, and failure. Data were reported as weighted mean differences (WMD) or odds ratios (OR) with confidence intervals (CI). The random-effects inverse-variance model with DerSimonian-Laird estimate of tau2 was employed, with continuity correction applied where necessary.
RESULTS: A total of 15 studies with 1276 participants were included. The meta-analysis revealed no significant difference in IOP reduction between patients treated by MMC injection and sponge application (WMD = - 0.434). Significant differences were observed in bleb appearance grading scores for height (WMD = - 0.170) and extent (WMD = 0.174), with substantial heterogeneity. The use of anti-glaucoma medications was significantly lower in the injection group (WMD = - 0.274). However, there were no significant differences in the rates of complete success, qualified success, and failure. The study demonstrated moderate to high heterogeneity across various outcomes.
CONCLUSIONS: This meta-analysis indicated that while both injection and sponge methods of MMC application during trabeculectomy were equally effective for IOP reduction, they differ in their impact on bleb morphology and postoperative medication requirement. The findings highlight the need for individualized treatment approaches in glaucoma surgery, taking into account the specific needs and characteristics of each patient.

UNASSIGNED: This study aimed to evaluate both short-term and long-term changes in the lamina cribrosa curvature index (LCCI) following trabeculectomy and investigate the factors influencing these changes.
UNASSIGNED: In this retrospective, observational study, 40 eyes of 40 patients with glaucoma who underwent trabeculectomy and had a follow-up of at least 2 years were included. Optic nerve head area was scanned by using spectral-domain optical coherence tomography before surgery (Pre_OP), within 6 months postoperatively (Post_OP1), and at the last visit (Post_OP2). LCCI values calculated from B-scan images at six different planes (0°, 30°, 60°, 90°, 120°, and 150°) and their mean values were compared. Univariate and multivariate linear regression analyses were used to identify the clinical factors associated with the amount of LCCI changes.
UNASSIGNED: The mean follow-up time was 38.3 ± 16.8 months. At Post_OP1, the mean LCCI decreased from 9.28 ± 2.58 to 7.91 ± 2.57 (P < 0.001), and the mean intraocular pressure decreased from 22.0 ± 7.6 mm Hg to 12.2 ± 3.8 mm Hg (P = 0.001). At Post_OP2, the mean LCCI was maintained at 7.74 ± 2.49 (P = 0.56 when compared to Post_OP1 and P < 0.001 when compared to Pre_OP). The mean intraocular pressure was 12.6 ± 5.4 mm Hg (P = 0.67 when compared to Post_OP1 and P < 0.001 when compared to Pre_OP). Long-term LCCI changes were associated with baseline age (P = 0.04), spherical equivalent (P = 0.02), mean IOP during follow-ups (P = 0.02), and preoperative LCCI (P = 0.04).
UNASSIGNED: Glaucomatous eyes undergoing trabeculectomy demonstrated reductions in the LCCI after a mean follow-up of over 3 years. Greater long-term LCCI reduction was associated with younger age, lower mean IOP during follow-up period, greater spherical equivalent refractive error, and preoperative LCCI.

OBJECTIVE: To compare surgical results between ab-externo microshunt surgery and trabeculectomy, focusing on postoperative corneal astigmatism.
METHODS: Retrospective study.
METHODS: Subjects were patients with glaucoma who underwent either standalone ab-externo microshunt surgery or trabeculectomy. Data on ophthalmic examinations obtained preoperatively and 1, 3, and 5 months postoperatively were analyzed. To assess corneal astigmatism, two separate data sets measured by anterior segment optical coherence tomography and autorefractometer were evaluated. Multivariate linear mixed model analyses were conducted to identify factors associated with the astigmatism changes.
RESULTS: Sixty eyes were examined: 13 eyes underwent microshunt surgery, and 47 eyes underwent trabeculectomy. The total corneal astigmatism measurements by anterior segment optical coherence tomography (AS-OCT) were: - 1.15 ± 0.85 D and - 1.17 ± 0.81 D for the microshunt and trabeculectomy groups, respectively, preoperatively. At five months postoperatively they were - 0.92 ± 0.47 D and - 1.61 ± 0.83 D, respectively (P = 0.807 for the microshunt group and P = 0.005 for the trabeculectomy group: Wilcoxon signed-rank test). AS-OCT also indicated similar results for posterior corneal astigmatism. Autorefractometry also found the total corneal astigmatism was significantly changed only in the trabeculectomy group. The linear mixed model analysis revealed that trabeculectomy (P = 0.001), older age (P = 0.004), and longer postoperative period (P = 0.015) were correlated with greater astigmatism changes. The intraocular pressures significantly decreased following both surgical treatments.
CONCLUSIONS: Standalone ab-externo microshunt surgery has less effect on corneal astigmatism during a 5 month period than trabeculectomy. Both surgical procedures significantly reduced intraocular pressure.

CONCLUSIONS: Long-term success was achievable after GATT. GATT performed at early stage of glaucoma had better surgery outcomes. Trabeculoplasty may compromise surgery success.
OBJECTIVE: To evaluate the long-term effectiveness of prolene suture gonioscopy-assisted transluminal trabeculotomy (GATT) and identify factors that may affect surgical outcomes.
METHODS: This is a retrospective cohort study of adult patients with prolene suture GATT performed by a single surgeon at 1 medical center.
RESULTS: Of the 145 eyes from 124 patients studied, intraocular pressure was reduced from 22.1±7.8 to 15.1±3.2 and 15.1±3.5 mm Hg, and the number of glaucoma medications was reduced from 3.2±1.1 to 1.3±1.4 and 1.4±1.5 at postoperative years 3 and 4, respectively. Ninety-three and 71 eyes completed a 3- and 4-year follow-up, with 44% of the eyes at year 4 remaining medication free. Compared with eyes with combined GATT/cataract extraction (CE), eyes with GATT alone had significantly more preoperative medications and a higher reoperation rate (31% vs. 16.5%). Eyes with prior trabeculoplasty had a higher reoperation rate (28.8%) than those without (16.1%). Kaplan-Meier survival analysis revealed that GATT/CE eyes without trabeculoplasty had a longer median time to failure (48 mo) than GATT/CE eyes with trabeculoplasty (18 mo), and GATT eyes with or without trabeculoplasty (9 and 12 mo, respectively).
CONCLUSIONS: Prolene suture GATT successfully reduced IOP. Eyes with more preoperative medications responded less well to GATT. Prior laser trabeculoplasty was associated with poorer outcomes. Further study is needed to verify these findings.

Glaucoma is one of the primary causes of blindness worldwide. Canal opening surgery, a type of minimally invasive glaucoma surgery (MIGS) applied in cases of mild to moderate glaucoma, has gained increasing popularity in recent years due to its efficacy in reducing the intraocular pressure, its safety profile, the simplicity of its technique, and the reduced likelihood of compromised vision. Nevertheless, the existing body of histopathological studies remains insufficient for a comprehensive understanding of post-surgical wound healing. Consequently, debates persist among researchers regarding the mechanism through which Schlemm\'s canal opening surgery reduces the intraocular pressure, as well as the surgical techniques that may impact the outcomes and the factors influencing surgical success. As the history of MIGS is relatively short and lacks sufficient systemic reviews or meta-analyses evaluating the influence of individual factors, this review was conducted to illuminate the disparities in researchers\' opinions at the current stage of research.

OBJECTIVE: Trabeculectomy and non-penetrating trabecular surgery are common operations for glaucoma. This meta-analysis aims to compare the effect of trabeculectomy and non-penetrating trabecular surgery in postoperative astigmatism of patients with glaucoma.
METHODS: A systematic literature search was performed for studies comparing trabeculectomy and non-penetrating trabecular surgery in patients with glaucoma. The time frame for the search was from the time of construction to April 2024. There were no restrictions regarding study type or type of glaucoma. The endpoint was the surgically induced astigmatism assessed 6 months after operation. We conducted this meta-analysis following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis).
RESULTS: Five eligible studies were included in this meta-analysis and presented data for 359 eyes with various types of glaucoma at different stages. The results revealed an increase in astigmatism in patients with glaucoma after trabeculectomy and non-penetrating trabecular surgery. Trabeculectomy had a higher incidence of astigmatism than in the non-penetrating trabecular surgery group at or around 6 months postoperatively, and the difference was statistically significant. (SMD = 0.40, 95% CI = 0.19 to 0.61, P = 0.02).
CONCLUSIONS: Our results demonstrated that both trabeculectomy and non-penetrating trabecular surgery could increase astigmatism until 6 months after operation. Moreover, non-penetrating trabecular surgery group seems to have less influence on astigmatism.
BACKGROUND: CRD42024517708.

BACKGROUND: To investigate the outcomes of trabeculectomy (TRAB) versus repeat Ahmed glaucoma valve (re-AGV) implantation in eyes with Ahmed glaucoma valve (AGV) failure.
METHODS: This quasi-experimental study includes patients with failed AGV implants requiring additional surgical intervention between 2018 and 2022. Patients in the TRAB group underwent a fornix-based procedure with mitomycin C 0.01% injection (0.1 mL). Eyes in the re-AGV group underwent repeat shunt surgery. The choice of the procedure was based on conjunctival condition. The primary outcome measure was surgical success rate based on various intraocular pressure (IOP) targets and percentages of IOP reduction from baseline: IOP ≤ 21 mmHg and 20% reduction (conventional criteria), IOP ≤ 18 and > 20% reduction (criterion A), IOP ≤ 15 and > 25% reduction (criterion B), and IOP ≤ 12 and > 30% reduction (criterion C).
RESULTS: Forty-eight eyes of 48 patients were operated and reported herein, consisting of 22 eyes of 22 patients undergoing TRAB and 26 eyes of 26 subjects undergoing re-AGV. No significant difference was observed between the study groups in terms of initial diagnoses, baseline IOP or the number of prior surgeries. The cumulative probability of survival at one year was significantly higher in the trabeculectomy group using the three stricter success definitions. In both study groups, IOP was significantly reduced from baseline at all postoperative visits, and was significantly lower in the TRAB group at all time points beyond one month. At 12 months, 5% of TRAB versus 48% of re-AGV eyes required glaucoma medications (P < 0.001). The rate of complications was comparable between the study groups (P = 0.76) but there was a trend toward a greater need for repeat surgery in the re-AGV group (4 eyes versus nil, P = 0.07).
CONCLUSIONS: Trabeculectomy can be considered a safe and effective surgical option in eyes with failed AGV leading to significantly lower IOP levels and more favorable success rates than re-AGV in selected patients.

CONCLUSIONS: This study concludes that GATT can be an effective and safe surgical alternative for managing IOP in eyes with prior failed glaucoma surgeries, associated with minimal complications.
OBJECTIVE: To report outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior failed glaucoma surgery.
METHODS: A retrospective study involving 30 eyes of 30 patients, all of whom had open angles on gonioscopy, experienced prior glaucoma surgery failures, and subsequently underwent GATT. The primary outcome measure was success defined as complete when the intraocular pressure (IOP) was >5 and ≤21/16 mm Hg without glaucoma medications and qualified with medications.
RESULTS: The mean age was 51.8±16.1 years. Twenty-one eyes underwent GATT and 9 eyes underwent phaco-GATT. Twenty-seven eyes had failed trabeculectomy and 3 eyes had failed glaucoma drainage device. Post-GATT, the IOP decreased from 27.1±7 to 16.9±6 mm Hg (P<0.001) at the end of 15 months, with a mean drop in AGM from 4.9±1.0 to 2±1.6. At postoperative 1 year, the probability of complete success was 20% (95% CI: 9-43) for an IOP criterion of both 21 and 16 mm Hg. The qualified success probability at 1 year was 82% (67-100) for an IOP criterion of 21 mm Hg and 57% (38-84) for an IOP criterion of 16 mm Hg. Risk factor for failure was older age [hazard ratio (HR): 1.03, 95% CI: 1.01-1.06]. The complications noted were hyphema in 14 eyes (46%), majority resolved within 1 week and all by 2 weeks. None needed any intervention.
CONCLUSIONS: This study concludes that GATT can be an effective and safe surgical alternative for managing IOP in eyes with prior failed glaucoma surgeries, associated with minimal complications.