AIM:To compare surgical efficacy based on residual peripheral anterior synechiae(PAS)extent af ter viscogonioplasty(VGP)combined with phacoemulsification and intraocular lens implantation(PEI)in patients with primary ...AIM:To compare surgical efficacy based on residual peripheral anterior synechiae(PAS)extent af ter viscogonioplasty(VGP)combined with phacoemulsification and intraocular lens implantation(PEI)in patients with primary angle-closure disease(PACD)and identify risk factors for extensive postoperative PAS.METHODS:This prospective cohort study included 73 eyes of 61 patients with PACD undergoing PEI with VGP.Patients were divided into Group A(PAS<90°,n=39)and Group B(90°≤PAS≤180°,n=34)based on PAS extent at the end of surgery.PAS progression rates were assessed using a linear mixed-effects model.Logistic regression analyzed risk factors for PAS≥180°at 12mo postoperatively.RESULTS:Both groups showed significant PAS progression at 12mo(P<0.001).Group A had smaller PAS extent than Group B at all time points(P<0.001).PAS progression rates were similar between groups(P=0.335).No significant differences were found in intraocular pressure(IOP),IOP-lowering medications,or surgical success rates(P>0.05).Female[odds ratio(OR)=0.211,P=0.046],preoperative medication number(OR=1.017,P=0.029),and PAS extent at the end of surgery(OR=1.017,P=0.018)were risk factors for PAS≥180°at 12mo.CONCLUSION:Residual PAS extent at the end of surgery predicts postoperative extensive PAS formation but has limited effect on PAS progression rate and IOP control.Female,multiple preoperative IOP-lowering medications,and larger residual PAS extent are independent risk factors for extensive PAS at 12mo postoperatively.展开更多
AIM:To investigate the association of peripheral anterior synechiae(PAS)with intraocular pressure(IOP)and glaucomatous optic neuropathy(GON)in primary angle closure(PAC)and primary angle-closure glaucoma(PACG).METHODS...AIM:To investigate the association of peripheral anterior synechiae(PAS)with intraocular pressure(IOP)and glaucomatous optic neuropathy(GON)in primary angle closure(PAC)and primary angle-closure glaucoma(PACG).METHODS:Totally 355 eyes(238 PAC and 117 PACG)of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial.All patients had undergone a comprehensive ophthalmic examination.The extent of PAS in clock hours as determined on gonioscopy was documented.The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation(GEE)models.RESULTS:The frequency of GON increased with the extent of PAS and a higher IOP.PAS were more extensive(8 vs 1 clock hour,P<0.001)and IOP higher(28.01 vs 18.00 mm Hg,P<0.001)in PACG compared to PAC.The prevalence of GON among the PAS quartiles were 10.2%(PAS<0.5 clock hours),16.9%(PAS≥0.5 and PAS<3 clock hours),29.6%(PAS≥3 and PAS<7 clock hours),and 74.4%(PAS≥7 clock hours),respectively.After adjusting for IOP,age,gender,spherical equivalent,average Shaffer score and number of medications,the odds ratio(OR)for GON was 4.4(95%CI:1.5-13.0;P=0.007)with PAS≥3 clock hours and 13.8(95%CI:4.3-43.6;P<0.001)with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours.The frequency of GON increased linearly with the extent of PAS.Extent of PAS was also associated with higher IOP.Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg(OR=18.0,95%CI:7.5-43.4;P<0.001).CONCLUSION:The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP,suggesting other factors related to PAS formation may be involved in the development of GON in PACG.展开更多
Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and t...Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.展开更多
Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients...Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients and 35 normal eyes(21.0≤AL≤24.5 mm)in 35 controls who had undergone uneventful cataract surgery were included.Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups.The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure(IOP)were also investigated.Results:The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes.Peripheral anterior synechiae(PAS)were observed in 56%(18/32)of nanophthalmic eyes,and a characteristic boomerangshaped iris was observed in 28%(9/32).The anterior surface of the iris seemed"smoother"in nanophthalmic eyes than in normal eyes.Schlemm's canal(SC)diameter,SC area,trabecular meshwork(TM)thickness,TM width,and TM area were generally smaller in the nanophthalmic eyes.Younger age,higher preoperative IOP,broader PAS,and smaller SC area were main contributors to higher postoperative IOP.AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.Conclusions:The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes.Influencing factors such as age,AL,preoperative IOP,extent of PAS,SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.Trial registration:ClinicalTrails.gov,Trial registration number:NCT02182921,Registered 8 July 2014.展开更多
Background Many studies indicated that short-term and long-term intraocular pressure （IOP） fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evalu...Background Many studies indicated that short-term and long-term intraocular pressure （IOP） fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy （LPI） with or without laser peripheral iridoplasty.Methods A total of 158 patients with primary angle closure suspect （PACS, n=21）, primary angle closure （PAC, n=81） and primary angle closure glaucoma （PACG, n=55） had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation （GEE） regression models was used to evaluate the association of long-term IOP fluctuation （maximum IOP minus minimum IOP） with gender, age, baseline IOP, baseline peripheral anterior synechia （PAS）,baseline vertical cup/disc ratio （VCDR）, baseline mean deviation （MD）, need for IOP-lowering medications.Results IOP fluctuation during follow-up in PACS, PAC and PACG groups were （4.83±2.90）, （5.67±3.35）, and （9.40±7.14）mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP （r=0.356, P 〈0.001）, PAS （r=0.374, P 〈0.001）.IOP fluctuation was higher in patients with higher baseline IOP （0.18 mmHg per unit increase, 95% CI： 0.05-0.31 mmHg）.Conclusions Long-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.展开更多
Objectives:This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery(ESS)for chronic rhinosinusitis(CRS)....Objectives:This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery(ESS)for chronic rhinosinusitis(CRS).Methods:We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was performed on Medline(PubMed),EBSCO CINAHL plus,CENTRAL,and Clinicaltrials.org and included randomized controlled trials in the English language only.We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool(version 2).We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment,Development and Evaluation.Results:Our search identified 390 articles of which four met our eligibility criteria.A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils.At 4 weeks of follow-up,there was no difference in the risk of synechia formation on either the packed side or the unpacked side,with a relative risk(RR)of 0.77(95%confidence interval[CI]:0.48-1.25).Similarly,no difference was seen at either 8-12 weeks of follow-up,with an RR of 0.68(95%CI:0.42-1.20).Nasal congestion was reported to be less on the packed side on the follow-up in one of the trials.Conclusions:Our systematic review,with limited evidence,indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS.Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long-term sequelae.展开更多
基金Supported by the National Natural Science Foundation of China(No.62020106015)the Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes(No.PWD&RPP-MRI,JYY2023-6).
文摘AIM:To compare surgical efficacy based on residual peripheral anterior synechiae(PAS)extent af ter viscogonioplasty(VGP)combined with phacoemulsification and intraocular lens implantation(PEI)in patients with primary angle-closure disease(PACD)and identify risk factors for extensive postoperative PAS.METHODS:This prospective cohort study included 73 eyes of 61 patients with PACD undergoing PEI with VGP.Patients were divided into Group A(PAS<90°,n=39)and Group B(90°≤PAS≤180°,n=34)based on PAS extent at the end of surgery.PAS progression rates were assessed using a linear mixed-effects model.Logistic regression analyzed risk factors for PAS≥180°at 12mo postoperatively.RESULTS:Both groups showed significant PAS progression at 12mo(P<0.001).Group A had smaller PAS extent than Group B at all time points(P<0.001).PAS progression rates were similar between groups(P=0.335).No significant differences were found in intraocular pressure(IOP),IOP-lowering medications,or surgical success rates(P>0.05).Female[odds ratio(OR)=0.211,P=0.046],preoperative medication number(OR=1.017,P=0.029),and PAS extent at the end of surgery(OR=1.017,P=0.018)were risk factors for PAS≥180°at 12mo.CONCLUSION:Residual PAS extent at the end of surgery predicts postoperative extensive PAS formation but has limited effect on PAS progression rate and IOP control.Female,multiple preoperative IOP-lowering medications,and larger residual PAS extent are independent risk factors for extensive PAS at 12mo postoperatively.
基金Health Innovation Talents in Zhejiang Province(No.2016025)Wenzhou Medical University R&D Fund(No.QTJ13009)。
文摘AIM:To investigate the association of peripheral anterior synechiae(PAS)with intraocular pressure(IOP)and glaucomatous optic neuropathy(GON)in primary angle closure(PAC)and primary angle-closure glaucoma(PACG).METHODS:Totally 355 eyes(238 PAC and 117 PACG)of 181 patients were included in this retrospective analysis of baseline data from a randomized clinical trial.All patients had undergone a comprehensive ophthalmic examination.The extent of PAS in clock hours as determined on gonioscopy was documented.The independent effect of the extent of PAS on IOP and the prevalence of GON were determined using multivariable generalized estimating equation(GEE)models.RESULTS:The frequency of GON increased with the extent of PAS and a higher IOP.PAS were more extensive(8 vs 1 clock hour,P<0.001)and IOP higher(28.01 vs 18.00 mm Hg,P<0.001)in PACG compared to PAC.The prevalence of GON among the PAS quartiles were 10.2%(PAS<0.5 clock hours),16.9%(PAS≥0.5 and PAS<3 clock hours),29.6%(PAS≥3 and PAS<7 clock hours),and 74.4%(PAS≥7 clock hours),respectively.After adjusting for IOP,age,gender,spherical equivalent,average Shaffer score and number of medications,the odds ratio(OR)for GON was 4.4(95%CI:1.5-13.0;P=0.007)with PAS≥3 clock hours and 13.8(95%CI:4.3-43.6;P<0.001)with PAS≥7 clock hours as compared to eyes with PAS<0.5 clock hours.The frequency of GON increased linearly with the extent of PAS.Extent of PAS was also associated with higher IOP.Eyes with both PAS≥6 clock hours and IOP≥21 mm Hg had the highest risk of GON compared to eyes with both PAS<6 clock hours and IOP<21 mm Hg(OR=18.0,95%CI:7.5-43.4;P<0.001).CONCLUSION:The extent of PAS in PAC and PACG is an important predictor of higher IOP and is linearly associated with GON independent of IOP,suggesting other factors related to PAS formation may be involved in the development of GON in PACG.
文摘Background: Goniosynechialysis is a surgical procedure that has been shown to slow the progression of glaucoma in oriental eyes with chronic angle closure glaucoma. This procedure was successful in 80% of cases, and the peripheral anterior syenchiae did not exist until one year later. Nonetheless, there is little evidence of its efficacy in our context. Our study aims to investigate the efficacy of goniosynechialysis during phacoemulsification in patients with primary angle closure disease and concomitant cataract. Methods: This was an observational, prospective study. The intra-ocular pressure, need for anti-glaucoma drugs, visual acuity, the extent of synechiae, anterior chamber depth, surgical success rate, and other indicators were monitored for at least three months following surgery. Results: This study included 114 patients (118 eyes), 61 with chronic angle closure glaucoma (51.69%), 33 with primary angle closure (27.97%), and 24 with acute attack angle closure (20.34%), who were surgically treated with phacoemulsification and goniosynechialysis (Phaco-GSL). The mean intra-ocular pressure had significantly decreased three months after surgery (pre- vs post-op: 22.04 ± 10.86 vs 15.41 ± 6.06 mmHg, p-value p-value p-value p-value p-value Conclusion: Regardless of the type of glaucoma, combined phacoemulsification-goniosynechialysis is effective in lowering pressure, restoring vision, reducing the need for anti-glaucoma drugs, and preventing the synechial recurrence. Success was higher in eyes with less extensive synechiae. Phaco-GSL is safe and effective in the treatment of primary angle closure diseases with co-existing cataract.
基金funded by research grants from the National Natural Science Foundation of China(Grant Nos.81870642,81970780,81470613,81100653,81670835,and 81270989)the National Key R&D Program of China(Grant No.2018YFC0116800)the Outstanding Youth Medical Talents Program of the Shanghai Health and Family Planning Commission(Grant No.2017YQ011).
文摘Purpose:To investigate the anterior segment in nanophthalmic eyes and their association with intraocular pressure after cataract surgery.Methods:Thirty-two nanophthalmic eyes(axial length[AL]<18.5 mm)in 18 patients and 35 normal eyes(21.0≤AL≤24.5 mm)in 35 controls who had undergone uneventful cataract surgery were included.Swept-source optical coherence tomography was used to compare the anterior segment structures between the two groups.The associations between the anterior segment characteristics of nanophthalmic eyes and postoperative intraocular pressure(IOP)were also investigated.Results:The IOP-lowering effect of cataract surgery was remarkably insufficient in nanophthalmic eyes.Peripheral anterior synechiae(PAS)were observed in 56%(18/32)of nanophthalmic eyes,and a characteristic boomerangshaped iris was observed in 28%(9/32).The anterior surface of the iris seemed"smoother"in nanophthalmic eyes than in normal eyes.Schlemm's canal(SC)diameter,SC area,trabecular meshwork(TM)thickness,TM width,and TM area were generally smaller in the nanophthalmic eyes.Younger age,higher preoperative IOP,broader PAS,and smaller SC area were main contributors to higher postoperative IOP.AL and SC diameter may also be of great importance in IOP prediction in patients without glaucoma surgery and PAS.Conclusions:The morphological features of the anterior segment in nanophthalmic eyes are significantly different from those of normal eyes.Influencing factors such as age,AL,preoperative IOP,extent of PAS,SC and TM size could all be prognostic for IOP after cataract surgery in nanophthalmic eyes.Trial registration:ClinicalTrails.gov,Trial registration number:NCT02182921,Registered 8 July 2014.
文摘Background Many studies indicated that short-term and long-term intraocular pressure （IOP） fluctuations in primary open angle glaucoma patients might lead to glaucomatous progression. However, seldom study has evaluated the long-term fluctuation of IOP in primary chronic angle closure diseases. The objective of this study was to investigate the long-term IOP fluctuation of primary angle closure diseases and its associations following laser peripheral iridotomy （LPI） with or without laser peripheral iridoplasty.Methods A total of 158 patients with primary angle closure suspect （PACS, n=21）, primary angle closure （PAC, n=81） and primary angle closure glaucoma （PACG, n=55） had been treated by LPI with or without laser peripheral iridoplasty and followed up for more than 12 months. IOP was measured with Goldman applanation tonometer. Multivariate linear regression with generalized estimating equation （GEE） regression models was used to evaluate the association of long-term IOP fluctuation （maximum IOP minus minimum IOP） with gender, age, baseline IOP, baseline peripheral anterior synechia （PAS）,baseline vertical cup/disc ratio （VCDR）, baseline mean deviation （MD）, need for IOP-lowering medications.Results IOP fluctuation during follow-up in PACS, PAC and PACG groups were （4.83±2.90）, （5.67±3.35）, and （9.40±7.14）mmHg, respectively. IOP fluctuation was strongly correlated with baseline IOP （r=0.356, P 〈0.001）, PAS （r=0.374, P 〈0.001）.IOP fluctuation was higher in patients with higher baseline IOP （0.18 mmHg per unit increase, 95% CI： 0.05-0.31 mmHg）.Conclusions Long-term IOP fluctuation in PACG group was larger than that in PACS or PAC group. Eyes with higher baseline IOP were observed to have larger long-term IOP fluctuation.
文摘Objectives:This review aims to evaluate the utility of nonmedicated middle meatal packing compared to no packing on synechia formation up to 12 weeks after endoscopic sinus surgery(ESS)for chronic rhinosinusitis(CRS).Methods:We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search was performed on Medline(PubMed),EBSCO CINAHL plus,CENTRAL,and Clinicaltrials.org and included randomized controlled trials in the English language only.We extracted all relevant data and conducted quality assessment using the Cochrane risk of Bias tool(version 2).We also performed the quality assessment of the outcomes using Grading of Recommendations Assessment,Development and Evaluation.Results:Our search identified 390 articles of which four met our eligibility criteria.A total of 139 patients were randomized to receive middle meatal pack in either of the nostrils.At 4 weeks of follow-up,there was no difference in the risk of synechia formation on either the packed side or the unpacked side,with a relative risk(RR)of 0.77(95%confidence interval[CI]:0.48-1.25).Similarly,no difference was seen at either 8-12 weeks of follow-up,with an RR of 0.68(95%CI:0.42-1.20).Nasal congestion was reported to be less on the packed side on the follow-up in one of the trials.Conclusions:Our systematic review,with limited evidence,indicates no difference in synechia formation between the nonmedicated packed and unpacked middle meatus at four and eight or 12 weeks after ESS for CRS.Further studies are required to ascertain the true effect of packing the middle meatus with different materials and its long-term sequelae.
