Objective To evaluate the predictive factors of refractory glaucoma treated with diode laser transscleral cyclophotocoagulation(TSCP) in a midterm observation.Methods Fifty-four consecutive patients(54 eyes) with refr...Objective To evaluate the predictive factors of refractory glaucoma treated with diode laser transscleral cyclophotocoagulation(TSCP) in a midterm observation.Methods Fifty-four consecutive patients(54 eyes) with refractory glaucoma were enrolled and underwent TSCP(power of 1.5-2.0 W,exposure time of 2 seconds and 20-50 applications).Patients were regularly followed up for 12 months.Intraocular pressure(IOP) was measured before TSCP treatment and at each follow-up visit.Patients were divided into the sensitive and insensitive groups according to the effect of a single treatment of TSCP on IOP.The success rate was defined as the percentage of eyes achieving an IOP between 5 and 21 mm Hg following TSCP therapy at their final follow up visit.Difference of age between the sensitive and insensitive groups was evaluated with Independent-samples T test and that of gender distribution of two groups was evaluated with Fisher's exact test.The success rate of different types of glaucoma to TSCP was calculated.Results A total of 32 patients were sensitive to TSCP(sensitive group) and 22 patients were insensitive to TSCP(insensitive group).The success rates of female(77.8%,14/18) and cases being over 50 years(71.4%,20/28) were higher than those of male(50.0%,18/36) and ones being under 50 years(46.2%,12/26)(all P>0.05).The age of the sensitive and insensitive groups was 56.0±15.5 and 46.4±15.4 years,respectively(P=0.029).The age(P=0.029) and gender distribution(P=0.046) of the two groups had significant difference.The success rate of neovascular glaucoma,primary angle-closure glaucoma,primary open angle glaucoma,traumatic glaucoma,uveitic glaucoma,and secondary glaucoma after silicone oil injection to TSCP was 57.1%,100.0%,50.0%,20.0%,81.8%,and 0%,respectively.Conclusion Age,gender,and type of glaucoma appear to be associated with effect of TSCP on IOP control.展开更多
Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective s...Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.展开更多
AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting p...AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.展开更多
Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation（EVLA） is a frequently used method. A newly developed alternative, based on thermal th...Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation（EVLA） is a frequently used method. A newly developed alternative, based on thermal therapy, is endovenous microwave ablation（EMA）. This study evaluated the effect of the two procedures, in terms of coagulation and histological changes, in occluding lateral veins in goats. Twelve animals were randomized into two group, with 6 treated with EMA（EMA group）, and the rest 6 with EVLA（EVLA group）. Results of coagulation, including coagulation, fibrinolysis and platelet activation, were assessed at three or four different time points： before, immediately after, 24 h（and 48 h） after ablation. The diameter change, a measure of efficacy, was ultrasonographically measured before and 1 month after the ablation. Histological changes were grossly and microscopically evaluated immediately, 1 and 3 month（s） after the ablation. The length of the ablated vein and preoperative average diameter were comparable between the two groups. In both EMA and EVLA groups, several coagulation parameters, fibrinolysis and platelet activation parameters only underwent slight changes. Ultrasound imaging displayed that the diameter reduction of the veins treated by EMA was significantly larger than by EVLA, in consistent with the results of macroscopic examination. Microscopic examination revealed necrosis and thickening of the vein wall, and occlusion of the lumen within 3 months after ablation in both EMA and EVLA groups. It is concluded that EMA is a minimally invasive therapy, which appears to be safe and effective for treatment of lateral veins in goats.展开更多
Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopat...Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema,subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma.Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques,including subthreshold selective laser trabeculoplasty(SSLT),micropulse laser trabeculoplasty(MLT),pattern-scanning laser trabeculoplasty(PSLT),titanium laser trabeculoplasty(TLT),and micropulse transscleral cyclophotocoagulation(MP-TSCPC).Methods:This was a narrative review compiled from literature of PubMed and Google Scholar.The review was performed from March 2021 to October 2021 and included publications in English.We also included information from web pages to cover details of relevant laser systems.We discuss the history of subthreshold laser,recent advancements in subthreshold techniques,and commercially available systems that provide subthreshold capabilities for glaucoma.We highlight basic science and clinical studies that deepen the understanding of treatment mechanisms and treatment effectiveness in the clinical setting respectively.We review commonly used parameters for each technique and provide comparisons to conventional treatments.Key Content and Findings:We found five distinct types of subthreshold laser used in the management of glaucoma.Numerous subthreshold laser systems are commercially available and can provide this treatment.Therefore,understanding the differences between subthreshold techniques and laser systems will be critical in utilizing subthreshold laser in the clinical setting.Conclusions:Traditional laser trabeculoplasty(LT)and cyclophotocoagulation(CPC)have shown effectiveness in the treatment of various types of glaucoma but are associated with visible damage to the underlying tissue and adverse effects.Subthreshold laser systems aim to provide the therapeutic effect found in traditional lasers,while minimizing unwanted treatment related effects.Further clinical studies are needed to evaluate the role of subthreshold lasers in the management of glaucoma.展开更多
文摘Objective To evaluate the predictive factors of refractory glaucoma treated with diode laser transscleral cyclophotocoagulation(TSCP) in a midterm observation.Methods Fifty-four consecutive patients(54 eyes) with refractory glaucoma were enrolled and underwent TSCP(power of 1.5-2.0 W,exposure time of 2 seconds and 20-50 applications).Patients were regularly followed up for 12 months.Intraocular pressure(IOP) was measured before TSCP treatment and at each follow-up visit.Patients were divided into the sensitive and insensitive groups according to the effect of a single treatment of TSCP on IOP.The success rate was defined as the percentage of eyes achieving an IOP between 5 and 21 mm Hg following TSCP therapy at their final follow up visit.Difference of age between the sensitive and insensitive groups was evaluated with Independent-samples T test and that of gender distribution of two groups was evaluated with Fisher's exact test.The success rate of different types of glaucoma to TSCP was calculated.Results A total of 32 patients were sensitive to TSCP(sensitive group) and 22 patients were insensitive to TSCP(insensitive group).The success rates of female(77.8%,14/18) and cases being over 50 years(71.4%,20/28) were higher than those of male(50.0%,18/36) and ones being under 50 years(46.2%,12/26)(all P>0.05).The age of the sensitive and insensitive groups was 56.0±15.5 and 46.4±15.4 years,respectively(P=0.029).The age(P=0.029) and gender distribution(P=0.046) of the two groups had significant difference.The success rate of neovascular glaucoma,primary angle-closure glaucoma,primary open angle glaucoma,traumatic glaucoma,uveitic glaucoma,and secondary glaucoma after silicone oil injection to TSCP was 57.1%,100.0%,50.0%,20.0%,81.8%,and 0%,respectively.Conclusion Age,gender,and type of glaucoma appear to be associated with effect of TSCP on IOP control.
文摘Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.
文摘AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.
基金supported by grants from Shanghai Science and Technology Commission(No.13401903900)Municipal Health Bureau of Traditional Chinese Medicine Development Office(No.ZYSNXD-YL-YSZK010 and No.ZXb Z2012-09)Appropriate Technology Project of Shanghai Shenkang Hospital Development Center(No.SHDC12014242)
文摘Increasing number of endovenous techniques are available for the treatment of saphenous vein reflux and endovenous laser ablation（EVLA） is a frequently used method. A newly developed alternative, based on thermal therapy, is endovenous microwave ablation（EMA）. This study evaluated the effect of the two procedures, in terms of coagulation and histological changes, in occluding lateral veins in goats. Twelve animals were randomized into two group, with 6 treated with EMA（EMA group）, and the rest 6 with EVLA（EVLA group）. Results of coagulation, including coagulation, fibrinolysis and platelet activation, were assessed at three or four different time points： before, immediately after, 24 h（and 48 h） after ablation. The diameter change, a measure of efficacy, was ultrasonographically measured before and 1 month after the ablation. Histological changes were grossly and microscopically evaluated immediately, 1 and 3 month（s） after the ablation. The length of the ablated vein and preoperative average diameter were comparable between the two groups. In both EMA and EVLA groups, several coagulation parameters, fibrinolysis and platelet activation parameters only underwent slight changes. Ultrasound imaging displayed that the diameter reduction of the veins treated by EMA was significantly larger than by EVLA, in consistent with the results of macroscopic examination. Microscopic examination revealed necrosis and thickening of the vein wall, and occlusion of the lumen within 3 months after ablation in both EMA and EVLA groups. It is concluded that EMA is a minimally invasive therapy, which appears to be safe and effective for treatment of lateral veins in goats.
文摘Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema,subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma.Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques,including subthreshold selective laser trabeculoplasty(SSLT),micropulse laser trabeculoplasty(MLT),pattern-scanning laser trabeculoplasty(PSLT),titanium laser trabeculoplasty(TLT),and micropulse transscleral cyclophotocoagulation(MP-TSCPC).Methods:This was a narrative review compiled from literature of PubMed and Google Scholar.The review was performed from March 2021 to October 2021 and included publications in English.We also included information from web pages to cover details of relevant laser systems.We discuss the history of subthreshold laser,recent advancements in subthreshold techniques,and commercially available systems that provide subthreshold capabilities for glaucoma.We highlight basic science and clinical studies that deepen the understanding of treatment mechanisms and treatment effectiveness in the clinical setting respectively.We review commonly used parameters for each technique and provide comparisons to conventional treatments.Key Content and Findings:We found five distinct types of subthreshold laser used in the management of glaucoma.Numerous subthreshold laser systems are commercially available and can provide this treatment.Therefore,understanding the differences between subthreshold techniques and laser systems will be critical in utilizing subthreshold laser in the clinical setting.Conclusions:Traditional laser trabeculoplasty(LT)and cyclophotocoagulation(CPC)have shown effectiveness in the treatment of various types of glaucoma but are associated with visible damage to the underlying tissue and adverse effects.Subthreshold laser systems aim to provide the therapeutic effect found in traditional lasers,while minimizing unwanted treatment related effects.Further clinical studies are needed to evaluate the role of subthreshold lasers in the management of glaucoma.
