Effect of cataract surgery on intraocular pressure control in glaucoma patients.

PURPOSE: To examine the effect of cataract surgery on intraocular pressure (IOP) control in eyes with angle-closure glaucoma (ACG) and open-angle glaucoma (OAG). SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: This study included 74 eyes with ACG and 68 eyes with OAG having cataract surgery. The IOP was measured and the number of glaucoma medications recorded preoperatively, 1 month postoperatively, and then every 3 months. The IOP control in the 2 groups was compared using survival analysis, with failure criteria being an IOP greater than 21 mm Hg, addition of medications, or the need for additional glaucoma surgery. RESULTS: The mean IOP and number of medications decreased significantly after surgery in both groups (P <.0001). However, the mean decrease in IOP and percentage of IOP reduction in the ACG group were greater than in the OAG group, and fewer medications were required in the ACG group. The cumulative survival probability of IOP control at 24 months was 91.9% in the ACG group and 72.1% in the OAG group. The survival curve in the ACG group was significantly better than in the OAG group (P =.0012). The IOP was controlled without medication in 30 eyes (40.5%) in the ACG group and 13 (19.1%) in the OAG group; the difference between groups was significant (P =.0055). CONCLUSIONS: Cataract surgery substantially reduced IOP and the number of medications required for IOP control in glaucomatous eyes. Specifically, cataract extraction normalized the IOP in most eyes with ACG.     

Efficacy and safety of micropulse laser trabeculoplasty for primary open angle glaucoma

AIM: To evaluate the efficiency and safety of micropulse laser trabeculoplasty (MLT) for primary open angle glaucoma (POAG) patients. METHODS: Retrospective study. POAG patients undergoing MLT in Peking University Third Hospital from June 2016 to November 2017. Seventy-two eyes of 72 POAG patients were enrolled. Only one eye of each patient was treated by MLT. The intraocular pressure (IOP) before MLT and at 1d, 1, 4, 12 and 24wk and glaucoma medication before and after treatment were compared. RESULTS: The IOP was 20.6±5.9 mm Hg before MLT and 20.8±6.8 mm Hg at 2h after MTL. The IOP at 1d, 1, 4, 12 and 24wk was 17.9±4.4, 18.0±4.3, 17.5±3.4, 17.0±2.7, and 16.5±2.9 mm Hg, respectively. The IOP before and after MLT demonstrated a statistically significant difference by ANOVA analyses (F=5.797, P<0.001). Least significant difference t-tests showed there was no statistically significant difference between pre-MLT IOP within 2h after MLT (P=0.207). The statistically significant difference was confirmed between the pre-MLT IOP at 1d, 1, 4, 12 and 24wk after MLT (P=0.006, 0.009, 0.001, <0.001, <0.001, respectively). The number of glaucoma medications before MLT was 1.7±1.4 and 1.5±1.4 24wk after MLT with a significantly statistical difference (t=2.219, P=0.031) CONCLUSION: MLT is effective and safe for POAG patients. No patient experienced IOP spikes after MLT. The IOP 6mo after treatment decreased significantly with less glaucoma medication.     

生物羊膜在青光眼小梁切除术中应用的临床观察

目的:探讨生物羊膜在青光眼小梁切除术中应用的疗效。方法:对16例(16眼)进行滤过性小梁切除手术,术中用生物羊膜填充在巩膜瓣下层间,进行临床观察。结果:I型、II型滤过泡13眼;Ⅲ型滤过泡3眼。在术后1mo眼压16眼均在正常范围内;术后6mo,14眼眼压≤21mmHg,有2眼需用药物控制在正常范围。结论:生物羊膜在青光眼小梁切除术中应用,提高了滤过性小梁切除手术成功率。     

下方小梁切除术治疗青光眼滤过术后眼压失控的疗效和安全性

目的：观察下方小梁切除术治疗青光眼滤过术后眼压失控的疗效和安全性。

方法：回顾性分析51例61眼青光眼滤过术后眼压失控行下方小梁切除术患者的资料,统计术前、术后眼压、视力和降眼压药物的数量,以及术中、术后并发症。采用Kaplan-Meier生存分析计算手术成功率。

结果：术后随访时间为6～76(平均30.15±14.10)mo。61眼术前眼压35.98±10.01mmHg,术后1wk,1、3、6mo,1a及末次随诊眼压分别为9.62±4.90、13.15±4.51、16.05±7.37、16.48±6.81、16.68±6.42、16.77±7.56mmHg,与术前眼压相比,均有差异(P<0.001)。术后6mo,1、2a的完全成功率分别是62%、49%、36%,部分成功率分别是93%、85%、81%,34眼(56%)形成功能性滤过泡,术前采用降眼压滴眼液3.33±0.77种,术后3mo降至1.41±1.44种(t=9.86,P<0.001)。术后未出现滤过泡感染、眼内炎等严重并发症。

结论：下方小梁切除术操作难度相对较大,但对于青光眼滤过术后眼压控制不佳的患者,仍可以作为一种安全有效的治疗方案。     

Neodymium: YAG laser trabeculopuncture in open-angle glaucoma

Ten eyes of eight patients with open-angle glaucoma (OAG) had neodymium (Nd):YAG trabeculopuncture performed in an investigational protocol as an alternative to surgical intervention. In each, at four to six sites in the mid-trabecular meshwork, three to six superimposed applications were made (2 to 6 mJ). In four of six patients with adult OAG, a small decrease in intraocular pressure (IOP) was noted (from a mean of 25.5 to 20.0 mmHg after 3-4 weeks in the treated eyes, compared to no change at 21 mmHg in the fellow eyes). There appeared to be further attenuation of this IOP effect over the subsequent 2 to 11 months, and all patients demonstrated gonioscopic closure of all the puncture sites with time. One patient demonstrated an acute IOP elevation to 58 mmHg after the procedure, necessitating emergency filtration surgery. In contrast, in four eyes of two patients with juvenile open angle glaucoma, a dramatic lowering of IOP and improvement in tonographic outflow facility was demonstrated, although the effects were only temporary in one patient. YAG laser treatment to the trabecular meshwork may have its greatest potential usefulness when abnormalities in the uveal meshwork are involved, such as in certain cases of juvenile or congenital glaucoma, and may help identify the need for a surgical goniotomy. With more usual forms of OAG, however, widespread use of this technique should be avoided until greater efficacy can be achieved.     

Ahmed glaucoma valve implantation in uveitic glaucoma versus open-angle glaucoma patients

Background: The poor long-term success rate of repeat trabeculectomies in refractory uveitic glaucoma (UG) patients has led to the use of glaucoma drainage devices (GDDs). However, the success and complication rates of GDDs in UG patients utilizing a control group with standard demographic data, design, and surgical technique have never been evaluated. Methods: Fifteen patients (15 eyes) with chronic uveitis and 53 patients (53 eyes) with uncontrolled open-angle glaucoma (OAG) who underwent Ahmed glaucoma valve (AGV) implantation were included in a retrospective, comparative, case-controlled study. Postoperative intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and complications were compared. Results: There was a significant difference between the UG versus the OAG group with respect to age only (59.3 years vs 68.4 years, p = 0.006). Regression analysis of the postoperative IOP controlled for age and glaucoma type, and preoperative IOP revealed significantly lower IOP in the UG group at 1 month (p = 0.04; 95% confidence interval [CI] -5.9 to 0.15) and 2 months (p = 0.008; 95% CI -6.0 to 0.97). No significant differences were found at 3, 6, 12, 24, and 30 months. The cumulative success rates at 3 to 30 months for the UG and OAG groups were 80% to 66.6% versus 84.9% to 57% (p = 0.713), respectively. The only complication between the 2 groups that was significantly different was tube removal, which occurred more often in the UG group (p = 0.018). Interpretation: AGV implantation is an effective and safe procedure in the management of UG, similar to primary OAG.     

Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma

PURPOSE: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. METHODS: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1-3.7 (mean 2.8) years after the operation. RESULTS: The mean preoperative IOP was 18.4+/-3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2 +/- 12.5 mmHg. IOP > or = 30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1 +/- 3.8 mmHg (p = 0.0027). After a mean follow-up of 1-3.7 (mean 2.8) years, the average postoperative IOP was 15.1 +/- 2.9 mmHg, being significantly (p = 0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. CONCLUSIONS: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1-3.7 (mean 2.8) years.     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.     

Comparison of postoperative recovery after trabeculectomy for pseudoexfoliation glaucoma and chronic primary open angle glaucoma

BACKGROUND: A former study showed an increased biochemical and tyndallometrical concentration of proteins in the anterior chamber in eyes with pseudoexfoliation glaucoma (PEX). This may induce an increased healing process, which may reduce the effectiveness of a trabeculectomy. To evaluate the intraocular pressure (IOP) lowering effect of trabeculectomy over time in eyes with PEX and primary open angle glaucoma (POAG) a retrospective study was conducted. METHODS: Thirty eyes of 30 patients with PEX were matched to 30 eyes of 30 patients with POAG in terms of age, glaucoma medication, and visual field loss. All patients underwent primary trabeculectomy by one surgeon without the use of antimetabolites. Maximum IOP and the duration of antiglaucomatous therapy before trabeculectomy was evaluated. IOP readings were analyzed before and 1 day, 1, and 2 years after trabeculectomy. Statistical evaluation was performed by Mann and Whitney's U-test. RESULTS: Patients with PEX showed a significant higher maximum IOP and a significant shorter duration of antiglaucomatous therapy before trabeculectomy. Both groups showed no significant differences in IOP before and after trabeculectomy. In the group with PEX a tendency to a lower IOP was found 1 year (p(U) = 0.13) and 2 years (p(U) = 0.16) after trabeculectomy. There was no significant difference in antiglaucomatous therapy after trabeculectomy. CONCLUSIONS: This study did not find a reduced IOP lowering effect of trabeculectomy in eyes with PEX in comparison to eyes with POAG over time.     

Trabeculectomy with Ologen implant versus perfluoropropane gas bubble for open angle glaucoma in pseudophakic eyes

AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma(OAG).Twentynine patients were allocated in group I(trabeculectomy with Ologen;trab-ologen group),while 28 patients were assigned in group II(trabeculectomy with perfluoropropane gas bubble;trab-C3 F8 gas bubble group).RESULTS:The intraocular pressure(IOP)was significantly reduced in both study groups at all postoperative follow up intervals(1 wk,3,6,12,18,24,30 and 36 mo,P<0.001).The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up.However,the trab-ologen group achieved a statistically significant reduction over the trab-C3 F8 gas bubble group during the last 24 months of follow up.CONCLUSION:Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.     

Selective laser trabeculoplasty

The introduction of selective laser trabeculoplasty (SLT) provided a new choice for the reduction of intraocular pressure (IOP) in eyes with open angle glaucoma (OAG) and ocular hypertension (OHT). SLT was demonstrated equally as effective as topical medical therapy and argon laser trabeculoplasty (ALT) to lower IOP. It is a potentially repeatable procedure because of the lack of coagulation damage to the trabecular meshwork (TM) and also effect in patients with previously failed ALT. SLT can be used to treat patients with OAG, pseudoexfoliation glaucoma, pigmentary glaucoma, normal-tension glaucoma, OHT, juvenile glaucoma, pseudophakic and aphakic glaucoma. Furthermore, SLT can be considered as a primary treatment option in patients who cannot tolerate or are noncompliant with medications, while not interfering with the success of future surgery. Its safety profiles include mild and transient inflammation, ocular pain and a small risk of moderate IOP elevations after the procedure. SLT is a safe and effective means of IOP reduction in eyes with OAG and OHT.     

三种途径植入房水引流物治疗难治性青光眼的疗效观察

目的观察3种途径(经角膜缘植入前房、经角膜缘后植入后房及经睫状体平坦部植入玻璃体腔)植入房水引流物治疗难治性青光眼的效果.方法对99例(99只眼)难治性青光眼患者行房水引流物植入术.根据植入途径分为3组经角膜缘植入前房组58例(58只眼),经角膜缘后植入后房组16例(16只眼),经睫状体平坦部植入玻璃体腔组25例(25只眼).结果术后随访6～34个月,平均19.6个月.引流物经角膜缘植入前房组眼压＜21 mm Hg(1 mm Hg=0.133 kPa)者46例(79.3%),其中需加用局部降眼压药物者6例(10.3%);经角膜缘后植入后房组眼压＜21 mm Hg者12例(75.0%),其中需加用局部降眼压药物者1例(6.2%);经睫状体平坦部植入玻璃体腔组眼压＜21 mm Hg者13例(52.0%),其中需加用局部降眼压药物者3例(12.0%).3组的手术成功率差异有显著性(χ2=6.525, P<0.05).经睫状体平坦部植入玻璃体腔组成功率较低.但经除外新生血管性青光眼患者后,3组的手术成功率分别为83.3%、75.0% 及58.8%,差异无显著性(χ2=4.231, P>0.05).结论通过3种途径植入房水引流物治疗难治性青光眼的效果基本相同,可根据患者具体情况选择合适的植入途径.     

Myopia and advanced-stage open-angle glaucoma

OBJECTIVE: To investigate the effect of myopic refraction on the central visual field in patients with advanced open-angle glaucoma (OAG). DESIGN: Multicenter cross-sectional study. PARTICIPANTS: Three hundred thirteen OAG eyes (176 eyes of 176 primary open-angle glaucoma [POAG] patients and 137 eyes of 137 normal-tension glaucoma [NTG] patients) with clear ocular media and a mean deviation (MD) <-15 dB. Patients with a recorded maximum intraocular pressure (IOP) of 22 mmHg or greater were classified as POAG, and those with an IOP of 21 mmHg or less were classified as NTG. METHODS: Multiple regression analysis was used to study the influence of refraction on 12 central test points of the C30-2 Humphrey program, and the differences in visual field defects between POAG and NTG eyes were examined using logistic discriminant analysis. In the multiple regression analysis, total deviation (TD) of the 12 test points was graded and used as the dependent variable, and MD and the spherical equivalent refraction were the explanatory variables. In the logistic discrimination analysis, TD, MD, and refraction were covariants that determined the OAG subtypes. MAIN OUTCOME MEASURES: TD values of the 12 central test points (C30-2 program). RESULTS: Higher myopic refraction was significantly associated with more damage at a point just temporal and inferior to the fixation point in POAG eyes, whereas it was significantly associated with less damage at test points just temporal and superior to the fixation point in NTG eyes. After correcting for the influence of refraction, POAG eyes had significantly more damage at a test point just temporal and inferior to the fixation point, whereas NTG eyes had significantly more damage at those test points nasal and inferior to the fixation point. CONCLUSIONS: High myopia constitutes a threat to the remaining lower cecocentral visual field and is one of the factors that interfere with the quality of vision in advanced OAG with high IOP but not low IOP.     

A prospective longterm study of primary chronic angle closure glaucoma

PURPOSE: To prospectively evaluate the longterm outcome of therapy for chronic primary angle closure glaucoma (PACG) and to assess the efficacy of medical and surgical treatment in terms of intraocular pressure (IOP) and visual field stabilization. METHODS: Seventy consecutive patients with chronic PACG, whose IOP remained > 21 mmHg despite a patent iridotomy, had their IOP controlled by medications or trabeculectomy performed without antimetabolites. They were followed over a 6-year period. Best corrected visual acuity, IOP (mean of annual diurnal variation readings), cup : disc ratio and visual fields were recorded. A trabeculectomy was performed if the IOP was not adequately controlled on maximal tolerable medical therapy or if there was a progression of the glaucomatous defect. Data from one eye of each patient were analysed; if both eyes met the inclusion criteria, one was randomly selected for the analysis. The baseline parameters were compared with those at the end of 6 years. RESULTS: A total of 46 eyes (65%) were controlled medically throughout the 6-year follow-up period, while 24 eyes (35%) required surgery. The mean IOP was 25.4 +/- 4.9 mmHg at baseline and 15.6 +/- 4.6 mmHg at 6 years follow-up (p < 0.001). Stereoscopic evaluation of the cup : disc ratio did not show a significant change from a mean of 0.6 +/- 0.18 at baseline to a mean of 0.64 +/- 0.2 at 6 years (p = 0.12). Progression of visual field defects was seen in seven eyes (10%), which had statistically larger cup : disc ratios (p = 0.04) and more extensive visual field deficits at the initial assessment (p = 0.04), and which also maintained higher levels of IOP (p = 0.03) over the 6 years of follow-up. CONCLUSIONS: Stable visual fields and good longterm IOP control were seen in 90% of chronic primary angle closure glaucoma eyes on medical/surgical therapy over 6 years.     

Intraocular pressure rise after phacoemulsification surgery in glaucoma patients

PURPOSE: To examine the changes in intraocular pressure (IOP) and the incidence of substantial rises in IOP in the early period after cataract surgery in eyes with open-angle glaucoma (OAG). SETTING: Hayashi Eye Hospital, Fukuoka, Japan. METHODS: The study included 32 eyes of 32 patients with OAG and 31 control eyes of 31 age-matched patients scheduled for phacoemulsification surgery. The IOP was measured preoperatively and 1, 2, 3, 5, 7, 14, and 28 days postoperatively. The incidence of a substantial rise in IOP postoperatively was evaluated, with the criterion being an IOP higher than 30 mm Hg. RESULTS: In the OAG group, the mean IOP increased 1, 2, and 3 days postsurgery and then decreased, whereas in the control group, it decreased from day 1 postsurgery. Although no significant differences were found between groups preoperatively, the mean IOP in the OAG group was significantly higher than in the control group postoperatively. Furthermore, the mean IOP decrease was also less in the OAG group than in the control group. A substantial increase in IOP occurred at day 1 postsurgery in 4 eyes (12.5%) in the OAG group, whereas no eyes in the control group showed such an increase; this difference was significant (P =.0419). CONCLUSIONS: A substantial increase in IOP occurred in an approximately 13% of eyes with OAG 1 day after phacoemulsification surgery. The IOP shortly after surgery was significantly greater in the eyes with OAG than in nonglaucomatous eyes.     

Corneal biomechanics predict the outcome of selective laser trabeculoplasty in medically uncontrolled glaucoma

Purpose

To evaluate the predictive value of clinical parameters, including biomechanical properties on the outcome of selective laser trabeculoplasty (SLT) in medically uncontrolled open angle glaucoma (OAG).

Methods

Sixty-eight eyes from 68 patients with OAG and IOP insufficiently regulated by topical medications were enrolled. Patients’ follow-up occurred 6 and 12 months after the procedure. The recorded parameters intraocular pressure (IOP), angle characteristics, central corneal thickness (CCT) and biomechanical properties of the eyes, including corneal hysteresis CH and corneal resistance factor CRF measured with the Ocular Responses Analyzer (ORA, Reichert Ophthalmic Instruments) were tested on their predictive value of SLT-induced IOP lowering effect using correlation analyses and regression models.

Results

Mean IOP reduction 12 months after SLT was 4.2?±?5.7 mmHg (23.2 %, from baseline 18.1?±?5.2 mmHg). The preoperative IOP correlated significantly with IOP reduction (maximum Spearman’s correlation r?=?0.75, p?<?0.001). In linear regression analysis, the corneal biomechanical properties (CH and CRF) together with the baseline IOP revealed good modelling for the IOP lowering effect of SLT (R²?=?0.64, respectively).

Conclusions

In addition to the baseline IOP biomechanical properties (CH and CRF) are significant predictors of SLT induced IOP lowering effect in medically uncontrolled OAG.     

Prospective evaluation of preoperative factors associated with successful mitomycin C needling of failed filtration blebs

PURPOSE: To study the long-term effectiveness and factors involved in successful needling of failed filtration blebs with mitomycin C (MMC). MATERIALS AND METHODS: We conducted a prospective, nonrandomized comparative trial that included 34 consecutive patients (34 eyes) who underwent mitomycin C needling of a failed filtering bleb after trabeculectomy followed by a 0.01 mL injection of mitomycin C (0.2 mg/ml). The success of the needling revision was defined as absolute if the intraocular pressure (IOP) was < 21 mm Hg without antiglaucoma medications and qualified if the IOP was < 21 mm Hg with antiglaucoma medications. Preoperative and perioperative factors were evaluated for an association with postoperative success using Kaplan-Meier survival analysis. RESULTS: The mean follow-up was 14.2 +/- 9.8 months. The mean preoperative IOP was 25.5 +/- 4.4 mm Hg, which decreased to 11.1, 13.4, 15.8, 16.7, 14.9, 14.1, 13.9, and 13 on postoperative day 1, postoperative week 1, and after 1, 3, 6, 9, 12, and 24 months, respectively (P = 0.001 for each comparison). At the final visit, success was absolute in 15 eyes (44.1%) and qualified in 14 eyes (41.2%). The success rates were 90% and 75% at 1 and 2 years, respectively. The success of the needling procedure was highly correlated with glaucoma filtration surgery performed less than 4 months previously (Kaplan-Meier analysis, log-rank test P = 0.006). CONCLUSIONS: Mitomycin C needling revision appears to have a high long-term success rate. Surgery performed less than 4 months previously contributes to the success of the initial mitomycin C needling procedure.     

Initial experience with phacoemulsification and goniotomy using the Kahook dual blade in advanced open-angle glaucoma: Six-month outcomes in Indian eyes

Purpose:The aim of this study was to report our initial experience on the outcomes of phacoemulsification in combination with goniotomy using the Kahook Dual Blade (KDB) in eyes with advanced open-angle glaucoma (OAG).Methods:The outcomes of phaco-goniotomy with KDB in advanced OAG in Indian eyes were retrospectively analyzed. Based on the Hodapp-Anderson-Parrish criteria of visual field defects, severe glaucoma (mean deviation on standard automated perimetry worse than 12 dB) was considered as advance glaucoma. Preoperative, intraoperative, and postoperative data were collected through 6 months of follow-up. Outcome measures included antiglaucoma medications (AGM), the proportion of eyes achieving >1AGM reduction, intraocular pressure (IOP), and visual acuity.Results:Median (interquartile range) number of AGM in eyes that underwent phaco-KDB goniotomy reduced from 2 (2,3) at baseline to 1 (0,1) at 6 months (P = 0.002). Median IOP reduced from 20 (20,26) mmHg at baseline to 14 (12,15) mmHg at 6 months (P = 0.02). The proportion of eyes achieving >1 medication reduction was 88% eyes (8/9). Adverse events noted were IOP spike (22 mmHg) in 2 eyes and intra-op hyphema in 1 eye on postoperative day-1, both resolved in a week with conservative management. Except one eye with central corneal scar due to prior pterygium surgery, 8 eyes had 20/20 vision at 1 week which was maintained till last follow-up.Conclusion:Phacoemulsification with KDB Goniotomy significantly lowered the need for AGM with moderate IOP reduction in advanced OAG eyes. There were no serious complications and the visual recovery was good and early.     

超声睫状体成形术治疗新生血管性青光眼的疗效及安全性

目的:评价超声睫状体成形术(UCP)治疗新生血管性青光眼(NVG)的有效性与安全性。方法:收集2018-01/12于我院实施UCP治疗的NVG患者30例30眼,分别于术前、术后1、3d,1wk,1、2、3、6mo评估并记录视力、眼压、疼痛程度及降眼压药物使用数量,并观察术后并发症发生情况。结果:本组患者术后各时间点视力均较术前[1.63±0.59(LogMAR)]改善,疼痛程度评分均较术前[2(1,4)分]降低,降眼压药物使用数量均较术前[4,(4,4)种]减少,眼压均较术前(44.19±13.72mmHg)明显降低(均P<0.01),眼压降低率依次为57.32%、56.45%、56.82%、55.64%、52.37%、50.20%、49.18%,且术后6mo时眼压下降值与术前眼压相关(r=0.928,P<0.001)。随访至术后6mo,本组患者手术成功8眼(31%),部分成功7眼(27%),失败11眼(42%),失访4眼,术后未见严重并发症发生。结论:UCP治疗NVG可有效降眼压,减轻患者眼部疼痛,并发症少,安全性高,且术前眼压越高,术后降眼压效果越明显。     

拉坦前列腺素对青光眼的降压效果

目的评价拉坦前列腺素对青光眼降压效果。方法对18例(21眼)局部滴其它降眼压眼液眼压控制不良者,改用0.05g/L拉坦前列腺素点眼1次/d,用药1周,2月用非接触眼压计和Schiotz眼压计测量眼压。结果全部患者用药后降压效果明显,而用药1周和2月降压效果无明显差别(P>0.05)。结论拉坦前列腺素对青光眼,无论是否手术有明显降压效果,没有发现毒副反应。