Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and en...Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.展开更多
AIM:To propose a novel glaucoma surgery for rebalancing translaminar pressure difference.METHODS:Three non-human primates with normal eyes and two with laser-induced glaucoma underwent the novel surgical procedure.Can...AIM:To propose a novel glaucoma surgery for rebalancing translaminar pressure difference.METHODS:Three non-human primates with normal eyes and two with laser-induced glaucoma underwent the novel surgical procedure.Cannulation of the subarachnoid space was performed after completion of routine vitrectomy steps.An XEN 45 implant was inserted into the created puncture to communicate between the vitreous body and subarachnoid space.Intraocular pressure(IOP),fundus photography,and spectral-domain optical coherence tomography were assessed at baseline and regular intervals during follow-up.RESULTS:All operated eyes showed IOP reduction in the first postoperative month.Two(2/3)normal eyes and one(1/2)glaucomatous eye maintained lower IOP until 18mo after operation.The XEN 45 implant remained positioned through the lamina cribrosa in all normal eyes but was not detected in two glaucomatous eyes.Complications observed in this study included retinal vascular bleeding in 1/3 normal eyes and XEN implant dislocation in all 2 glaucomatous eyes.CONCLUSION:Subarachnoid space cannulation and mini-shunt implantation may contribute to IOP reduction,possibly by rebalancing translaminar pressure difference and enhancing aqueous humor drainage.The development of a suitable mini-shunt requires further investigation.展开更多
AIM:To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~P-50 for combined cataract surgery and glaucoma.·METHODS:Patients having cataract and open angle glaucoma or patients with open advance...AIM:To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~P-50 for combined cataract surgery and glaucoma.·METHODS:Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included.Combined cataract surgery and glaucoma with Ex-PRESS~P-50 model placed under scleral flap was performed.·RESULTS:Out of 40 eyes of 40 patients(55%male and45%female)completed the study during one-year follow-up.The mean of age was 76.6±11.02 y.The intraocular pressure(IOP)decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg(Wilcoxon signed ranks test,P〈0.001).A 59.5%of patients did not need any topical treatment,10.8%of them needed one active principle,27%needed two active principles,and 2.7%of them needed three active principles for successful IOP control(〈21 mm Hg).·CONCLUSION:Combined surgery of phacoemulsification with Ex PRESS~P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.展开更多
There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)...There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)system and several custom-made OCT-compatible instruments for glaucoma surgery.Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments.After surgery,a subjective feedback survey about the user experience was taken.The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery.The custom-made instruments also solved the shadowing problem in OCT imaging.Surgeons preferred to use the system in their future practice.展开更多
AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for ...AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.展开更多
AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract...AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.展开更多
AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies tha...AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma.Primary outcomes included postoperative intraocular pressure(IOP)and the number of postoperative antiglaucoma medications.Secondary outcomes were the prevalence of complications,incidence of needling or goniopuncture,and surgical success rate.RESULTS:In total,380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included.Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group[weighted mean difference(WMD)=-1.12,95%confidence interval(CI):-2.11 to-0.12,P=0.03;WMD=-0.31,95%CI:-0.53 to-0.09,P=0.006].Moreover,Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone,while no significant difference existed for surgical success.CONCLUSION:Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications.Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy,fewer complications,and postoperative procedures.展开更多
BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medi...BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.展开更多
Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assess...Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness展开更多
AIM:To assess the efficacy and safety of non-penetrating deep sclerectomy(NPDS)with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips(modified deep ...AIM:To assess the efficacy and safety of non-penetrating deep sclerectomy(NPDS)with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips(modified deep sclerectomy technique,DS)and minimal use of mitomycin C in glaucoma surgery.METHODS:A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018.Best-corrected visual acuity,intraocular pressure(IOP),post-operative need for glaucoma medications,visual field mean deviation(MD),re-interventions,needling revisions and laser goniopuncture were noted.Absolute success was defined as IOP≤18 mm Hg without topical medication.Relative success was defined as the same criteria but with the addition of any antihypertensive medication.IOP over 18 mm Hg on two consecutive followup visits was considered as a failure.RESULTS:Fifty-two eyes of 47 patients were evaluated.Mean preoperative IOP was 25.37±6.47 mm Hg,and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo(all P<0.0001).Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo(all P<0.0001).No medications were required in 45.5%of patients after 24mo.Relative and absolute success rate at 24mo were 85.5%±5%and 48.5%±7.4%,respectively.CONCLUSION:DS is a safe and effective nonpenetrating glaucoma surgery variation.It aims to retain the patency of all pathways created for aqueous humor drainage:the intrascleral bleb,the supraciliary space and the open communication between intrascleral and subconjunctival compartments.展开更多
Background To report the incidence and clinical characteristics of aqueous misdirection(AM)after glaucoma surgery in Chinese patients with primary angle-closure glaucoma.Methods Medical records of all patients diagnos...Background To report the incidence and clinical characteristics of aqueous misdirection(AM)after glaucoma surgery in Chinese patients with primary angle-closure glaucoma.Methods Medical records of all patients diagnosed with primary angle-closure glaucoma who underwent glaucoma surgery in the Eye Hospital of Wenzhou Medical University between January 2012 and December 2021 were retrospectively reviewed.Cases of AM were identified through a keyword-based search.The incidence of AM was calculated.Demographic and clinical characteristics of the AM patients were also described.Results A total of 5044 eyes with primary angle-closure glaucoma were included(mean age 65.81±9.96 years,68.11%women).Thirty-eight eyes developed AM,presenting an overall incidence of 0.75%.The mean time interval between surgery and first record of AM diagnosis was 2.57±5.24 months(range,0 day to 24 months).The incidence of AM was significantly higher in patients aged≤40 years(21.28%)and those aged 40–50 years(3.32%),compared to those>50 years(0.42%)(P<0.001).AM developed much more frequently among patients with chronic angle-closure glaucoma(1.30%),compared to those with acute angle-closure glaucoma(0.32%,P<0.001).Eleven eyes(0.37%)developed AM following non-filtering surgery compared to 24 eyes(2.27%)after filtering surgery(P<0.001).Conclusion The incidence of AM after glaucoma surgery was 0.75%in Chinese patients with primary angle closure glaucoma.Younger age,chronic angle-closure glaucoma,and undergoing filtering surgery,were identified as associated risk factors for developing AM.Phacoemulsification may have less risk of developing AM compared to filtering surgery.展开更多
Glaucoma filtration surgery(GFS)stands as the most effective intervention for reducing intraocular pressure,a critical component in glaucoma management.Despite its pivotal role,the scarring of the filtration bleb rema...Glaucoma filtration surgery(GFS)stands as the most effective intervention for reducing intraocular pressure,a critical component in glaucoma management.Despite its pivotal role,the scarring of the filtration bleb remains the primary impediment to successful GFS outcomes.Perioperative utilization of antimitotics,while frontline in combating fibrosis and modulating the wound healing process,carries the risk of vision-threatening complications.Given the complexity of the wound healing cascade and the potential insufficiency of targeting a single molecule,there is an imperative to expand therapeutic modalities through combination therapies.This review offers a comprehensive elucidation of the fibrogenesis post-GFS,a synthesis unprecedented in the available literature,and aims to inform the broadening of therapeutic strategies for GFS.展开更多
The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathwa...The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathways or optimize previously utilized glaucoma surgical methods in order to deliver safety,efficacy,and individualized care to the patient.MIGS techniques can be classified based on anatomical location as well as method of intraocular pressure(IOP)reduction.This review will focus on MIGS optimizing the conventional outflow pathway via intervention at Schlemm’s canal,MIGS optimizing the uveoscleral outflow pathway via suprachoroidal shunting,and MIGS optimizing the transscleral or subconjunctival outflow pathway which has long been utilized by glaucoma surgeons performing traditional filtration procedures.The wide array of currently available MIGS modalities can be staggering to the glaucoma care provider,but an understanding of the landscape and the large classes of interventional strategies can allow for clinical decision making based on the specifics of the patient’s needs and the pathophysiology of their disease.展开更多
AIM:To confirm whether exosome-mediated delivery of aptamer S58(Exo-S58) has a better antifibrotic effect than naked S58 in human conjunctival fibroblasts(HCon Fs) and a rat glaucoma filtration surgery(GFS) model.METH...AIM:To confirm whether exosome-mediated delivery of aptamer S58(Exo-S58) has a better antifibrotic effect than naked S58 in human conjunctival fibroblasts(HCon Fs) and a rat glaucoma filtration surgery(GFS) model.METHODS:To enhance the effective reaction time of aptamer S58 in vivo, we loaded aptamer S58 into exosomes derived from HEK293 T cells by PEI transfection to determine the effect of Exo-S58 in HCon Fs and a rat GFS model.RESULTS:Exo-S58 can significantly reduce cell proliferation, migration and fibrosis in TGF-β2-induced HCon Fs. In an in vivo experiment, Exo-S58 treatment prolonged filtering bleb retention and reduced fibrosis compared with naked S58 treatment in GFS rats.CONCLUSION:The exosomes are safe and valid carriers to deliver aptamers. Furthermore, Exo-S58 exhibited superior antifibrotic effect than naked S58 both in HCon Fs cells and rat GFS models.展开更多
AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic sear...AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.展开更多
AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity ...AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.展开更多
AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patien...AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patients diagnosed with mild to severe OAG,who underwent canaloplasty with the STREAMLINE®Surgical System combined with CE.The primary outcome was surgical success,defined as achieving≥20%intraocular pressure(IOP)reduction and/or a reduction of≥1 glaucoma medication compared to baseline.Secondary outcomes included mean IOP,average number of glaucoma medications,and best-corrected distance visual acuity(BCDVA).Data was collected preoperatively and at multiple postoperative time points up to one year.RESULTS:A total of 68 eyes of 47 patients were included with mean age was 73.1±7.0y and 60%were females.Surgical success at one year was achieved in 68.8%of eyes,with 67.6%success in mild,80.0%in moderate,and 66.7%in severe OAG cases.IOP was significantly reduced from a baseline of 16.1±0.5 to 14.7±0.4 mm Hg at one year(P=0.0004).The number of medications decreased significantly in all eyes from a baseline of 1.2±0.1 to 0.6±0.1 at one year(P<0.0001).When stratified by glaucoma severity,only the mild group experienced a statistically significant decrease from a baseline of 1.1±0.1 to 0.4±0.1(P<0.0001).BCDVA improved significantly from baseline to one year.No sight-threatening complications were reported.CONCLUSION:Canaloplasty using the STREAMLINE®surgical system combined with CE effectively reduces IOP at one year in mild to severe OAG with minimal complications.IOP lowering efficacy,reduction in IOP lowering medications,and safety in moderate to severe OAG require further study.展开更多
AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes wi...AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure(IOP) greater than21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation,data were collected on IOP, the best corrected visual acuity(BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56 wk postoperatively. Logarithm values of IOP were calculated and compared. RESULTS: The study group was comprised of 30patients(30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3 ±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg,19.6 ±12.8 mm Hg and 13.9 ±14.2 mm Hg at 12, 24 and56 wk respectively. BCVA was ≥6/60 in 11 eyes preoperatively, and five eyes had BCVA ≥6/60 at 56 wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At12 wk postoperatively, no medications were required to control IOP in 20 eyes. At 56 wk postoperatively, at least one medication was required to control IOP in 10 eyes.Over the entire follow up period, four eyes were treated with yttrium aluminium garnet(YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.展开更多
Objective: to determine the specific therapeutic effect of Nd: YAG laser on malignant glaucoma patients after glaucoma filtering surgery, and to determine the correlation between the clinical characteristics of patien...Objective: to determine the specific therapeutic effect of Nd: YAG laser on malignant glaucoma patients after glaucoma filtering surgery, and to determine the correlation between the clinical characteristics of patients and the therapeutic effect of Nd: YAG laser. Methods: this study is a retrospective case series report study. Patients with malignant glaucoma after glaucoma filtering surgery treated by Nd: YAG laser in our hospital were collected retrospectively. The intraocular pressure, anterior chamber depth and uncorrected visual acuity of the patients at different time points before and after operation were compared. To clarify the clinical application effect of Nd: YAG laser in the treatment of malignant glaucoma after Qingguang filtration. Through Spearman correlation analysis of preoperative clinical characteristics of patients with intraocular pressure and anterior chamber depth at 3 months after operation, the correlation between preoperative clinical characteristics of patients and treatment effect was clarified. Results: the study included 35 eyes with malignant glaucoma after glaucoma filtering surgery from January 2015 to July 2021. The results of comparison between preoperative IOP and postoperative IOP at different time points showed that the IOP of the patients at 1 day, 3 days, 1 month and 3 months after operation was lower than that before operation, and the difference was statistically significant (p<0.05). The results of the comparison between preoperative anterior chamber depth and postoperative anterior chamber depth at different time points showed that the anterior chamber depth of the patients increased significantly at 3 days, 1 month and 3 months after operation, and the difference was statistically significant (p<0.05). The comparison of the patients' visual acuity at 3 months after operation and preoperative visual acuity showed that the proportion of patients with visual acuity > 0.8 at 3 months after operation was significantly higher than that before operation, and the proportion of patients with visual acuity < 0.05 was significantly lower than that before operation, and the difference was statistically significant (p<0.05). The results of correlation analysis showed that the age, gender, onset time, preoperative intraocular pressure and axial length of the patients had certain correlation with the intraocular pressure and anterior chamber depth at 3 months after operation (P<0.05). Conclusion: Nd: YAG laser technology has good clinical therapeutic effect on malignant glaucoma patients after glaucoma filtering surgery. The therapeutic effect of Nd: YAG laser technology has certain correlation with patients' age, gender, onset time, preoperative intraocular pressure and axial length.展开更多
Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long...Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long-term ocular hypertension,high myopia,older age,arterial sclerosis,and aphakia have been reported as preoperative risk factors for developing SEH^([1]).The prognosis for the visual acuity is poor without proper management.A suggested time for surgical drainage is said to be 10-14d when the hemorrhagic clot begins to liquefy^([2]).展开更多
基金Supported by Sichuan Provincial Administration of Traditional Chinese Medicine(No.2024MS471)。
文摘Dear Editor,We present the reported case of steroid-induced glaucoma(SIG)treated by trabeculectome tunneling trabeculoplasty(3T).The 3T procedure is a new minimally invasive glaucoma surgery designed to protect and enhance the function of the trabecular meshwork(TM)while reducing resistance to outflow of atrial fluid^([1]).A 20-year-old male patient experienced an elevation in intraocular pressure(IOP)and subsequently progressed to SIG after continuously using tobramycin-dexamethasone eyedrops for one year.Trabeculotomy of the right eye was performed.
文摘AIM:To propose a novel glaucoma surgery for rebalancing translaminar pressure difference.METHODS:Three non-human primates with normal eyes and two with laser-induced glaucoma underwent the novel surgical procedure.Cannulation of the subarachnoid space was performed after completion of routine vitrectomy steps.An XEN 45 implant was inserted into the created puncture to communicate between the vitreous body and subarachnoid space.Intraocular pressure(IOP),fundus photography,and spectral-domain optical coherence tomography were assessed at baseline and regular intervals during follow-up.RESULTS:All operated eyes showed IOP reduction in the first postoperative month.Two(2/3)normal eyes and one(1/2)glaucomatous eye maintained lower IOP until 18mo after operation.The XEN 45 implant remained positioned through the lamina cribrosa in all normal eyes but was not detected in two glaucomatous eyes.Complications observed in this study included retinal vascular bleeding in 1/3 normal eyes and XEN implant dislocation in all 2 glaucomatous eyes.CONCLUSION:Subarachnoid space cannulation and mini-shunt implantation may contribute to IOP reduction,possibly by rebalancing translaminar pressure difference and enhancing aqueous humor drainage.The development of a suitable mini-shunt requires further investigation.
文摘AIM:To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~P-50 for combined cataract surgery and glaucoma.·METHODS:Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included.Combined cataract surgery and glaucoma with Ex-PRESS~P-50 model placed under scleral flap was performed.·RESULTS:Out of 40 eyes of 40 patients(55%male and45%female)completed the study during one-year follow-up.The mean of age was 76.6±11.02 y.The intraocular pressure(IOP)decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg(Wilcoxon signed ranks test,P〈0.001).A 59.5%of patients did not need any topical treatment,10.8%of them needed one active principle,27%needed two active principles,and 2.7%of them needed three active principles for successful IOP control(〈21 mm Hg).·CONCLUSION:Combined surgery of phacoemulsification with Ex PRESS~P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.
基金support of the foundations:National Key R&D Program of China,Grant Nos.2022YFC2404201CAS Project for Young Scientists in Basic Research,Grant Nos.YSBR-067+2 种基金The Gusu Innovation and Entrepreneurship Leading Talents in Suzhou City,Grant Nos.ZXL2021425Jiangsu Science and Technology Plan Program,Grant Nos.BK20220263National Key R&D Program of China,Grant Nos.2021YFF0700503.
文摘There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)system and several custom-made OCT-compatible instruments for glaucoma surgery.Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments.After surgery,a subjective feedback survey about the user experience was taken.The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery.The custom-made instruments also solved the shadowing problem in OCT imaging.Surgeons preferred to use the system in their future practice.
文摘AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.
文摘AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.
文摘AIM:To compare the clinical efficacy and safety of non-penetrating glaucoma surgery(NPGS)plus phacoemulsification(Phaco-NPGS)and NPGS-alone.METHODS:We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma.Primary outcomes included postoperative intraocular pressure(IOP)and the number of postoperative antiglaucoma medications.Secondary outcomes were the prevalence of complications,incidence of needling or goniopuncture,and surgical success rate.RESULTS:In total,380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included.Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group[weighted mean difference(WMD)=-1.12,95%confidence interval(CI):-2.11 to-0.12,P=0.03;WMD=-0.31,95%CI:-0.53 to-0.09,P=0.006].Moreover,Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone,while no significant difference existed for surgical success.CONCLUSION:Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications.Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy,fewer complications,and postoperative procedures.
基金Supported by Natural Science Foundation of Sichuan Province of China,No.2022NSFSC1400Youth Innovation Project of Sichuan Medical Association,No.Q15045。
文摘BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.
文摘Dear Sir,Previous reports have illustrated reversible structural changes in optic disc cupping,the lamina cribrosa,and the retinal nerve fiber layer(RNFL)following glaucoma surgery[1-3].However,few studies have assessed changes in macular thickness following such intervention.Our aim was to investigate the impact of intraocular pressure(IOP)reduction after glaucoma surgery on total macular thickness
文摘AIM:To assess the efficacy and safety of non-penetrating deep sclerectomy(NPDS)with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips(modified deep sclerectomy technique,DS)and minimal use of mitomycin C in glaucoma surgery.METHODS:A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018.Best-corrected visual acuity,intraocular pressure(IOP),post-operative need for glaucoma medications,visual field mean deviation(MD),re-interventions,needling revisions and laser goniopuncture were noted.Absolute success was defined as IOP≤18 mm Hg without topical medication.Relative success was defined as the same criteria but with the addition of any antihypertensive medication.IOP over 18 mm Hg on two consecutive followup visits was considered as a failure.RESULTS:Fifty-two eyes of 47 patients were evaluated.Mean preoperative IOP was 25.37±6.47 mm Hg,and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo(all P<0.0001).Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo(all P<0.0001).No medications were required in 45.5%of patients after 24mo.Relative and absolute success rate at 24mo were 85.5%±5%and 48.5%±7.4%,respectively.CONCLUSION:DS is a safe and effective nonpenetrating glaucoma surgery variation.It aims to retain the patency of all pathways created for aqueous humor drainage:the intrascleral bleb,the supraciliary space and the open communication between intrascleral and subconjunctival compartments.
基金supported by the Program for Zhejiang Leading Talent of S&T Innovation(Grant No.2021R52012)the National Key Research and Development Project of China(Grant No.2020YFC2008200)+2 种基金Key Research and Development Projects of Zhejiang Province(Grant No.2022C03112)the Basic Scientific Research Program of Wenzhou(Grant No.Y2020365)Key Innovation and Guidance Program of the Eye Hospital,School of Ophthalmology and Optometry,Wenzhou Medical University(Grant No.YNZD2201903).
文摘Background To report the incidence and clinical characteristics of aqueous misdirection(AM)after glaucoma surgery in Chinese patients with primary angle-closure glaucoma.Methods Medical records of all patients diagnosed with primary angle-closure glaucoma who underwent glaucoma surgery in the Eye Hospital of Wenzhou Medical University between January 2012 and December 2021 were retrospectively reviewed.Cases of AM were identified through a keyword-based search.The incidence of AM was calculated.Demographic and clinical characteristics of the AM patients were also described.Results A total of 5044 eyes with primary angle-closure glaucoma were included(mean age 65.81±9.96 years,68.11%women).Thirty-eight eyes developed AM,presenting an overall incidence of 0.75%.The mean time interval between surgery and first record of AM diagnosis was 2.57±5.24 months(range,0 day to 24 months).The incidence of AM was significantly higher in patients aged≤40 years(21.28%)and those aged 40–50 years(3.32%),compared to those>50 years(0.42%)(P<0.001).AM developed much more frequently among patients with chronic angle-closure glaucoma(1.30%),compared to those with acute angle-closure glaucoma(0.32%,P<0.001).Eleven eyes(0.37%)developed AM following non-filtering surgery compared to 24 eyes(2.27%)after filtering surgery(P<0.001).Conclusion The incidence of AM after glaucoma surgery was 0.75%in Chinese patients with primary angle closure glaucoma.Younger age,chronic angle-closure glaucoma,and undergoing filtering surgery,were identified as associated risk factors for developing AM.Phacoemulsification may have less risk of developing AM compared to filtering surgery.
基金Supported by Hospital Level Project of the Eye Hospital of China Academy of Chinese Medical Sciences(No.GSP5-40)Internal Project of the Eye Hospital of China Academy of Chinese Medical Sciences(No.1011632).
文摘Glaucoma filtration surgery(GFS)stands as the most effective intervention for reducing intraocular pressure,a critical component in glaucoma management.Despite its pivotal role,the scarring of the filtration bleb remains the primary impediment to successful GFS outcomes.Perioperative utilization of antimitotics,while frontline in combating fibrosis and modulating the wound healing process,carries the risk of vision-threatening complications.Given the complexity of the wound healing cascade and the potential insufficiency of targeting a single molecule,there is an imperative to expand therapeutic modalities through combination therapies.This review offers a comprehensive elucidation of the fibrogenesis post-GFS,a synthesis unprecedented in the available literature,and aims to inform the broadening of therapeutic strategies for GFS.
文摘The glaucoma surgical landscape has changed dramatically over the last decade with the introduction and integration of micro-invasive glaucoma surgery(MIGS)techniques.These modalities target physiologic outflow pathways or optimize previously utilized glaucoma surgical methods in order to deliver safety,efficacy,and individualized care to the patient.MIGS techniques can be classified based on anatomical location as well as method of intraocular pressure(IOP)reduction.This review will focus on MIGS optimizing the conventional outflow pathway via intervention at Schlemm’s canal,MIGS optimizing the uveoscleral outflow pathway via suprachoroidal shunting,and MIGS optimizing the transscleral or subconjunctival outflow pathway which has long been utilized by glaucoma surgeons performing traditional filtration procedures.The wide array of currently available MIGS modalities can be staggering to the glaucoma care provider,but an understanding of the landscape and the large classes of interventional strategies can allow for clinical decision making based on the specifics of the patient’s needs and the pathophysiology of their disease.
基金National Natural Science Foundation of China (No.81700836,No.81470629,No.81670860)Chongqing Natural Research Foundation (No.cstc 2018jcyj AX0034)。
文摘AIM:To confirm whether exosome-mediated delivery of aptamer S58(Exo-S58) has a better antifibrotic effect than naked S58 in human conjunctival fibroblasts(HCon Fs) and a rat glaucoma filtration surgery(GFS) model.METHODS:To enhance the effective reaction time of aptamer S58 in vivo, we loaded aptamer S58 into exosomes derived from HEK293 T cells by PEI transfection to determine the effect of Exo-S58 in HCon Fs and a rat GFS model.RESULTS:Exo-S58 can significantly reduce cell proliferation, migration and fibrosis in TGF-β2-induced HCon Fs. In an in vivo experiment, Exo-S58 treatment prolonged filtering bleb retention and reduced fibrosis compared with naked S58 treatment in GFS rats.CONCLUSION:The exosomes are safe and valid carriers to deliver aptamers. Furthermore, Exo-S58 exhibited superior antifibrotic effect than naked S58 both in HCon Fs cells and rat GFS models.
基金Supported by National Natural Science Foundation of China(No.8170080No.81470609)the Natural Science Foundation of Shandong Province(No.ZR2017MH008)
文摘AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.
文摘AIM:To assess the effect of the coronavirus disease 2019(COVID-19)pandemic on the wait times and severity of surgical glaucoma cases in a single tertiary referral center in Quebec,Canada.METHODS:Preoperative severity data included mean visual field(VF)deficit,intraocular pressure(IOP),the number of topical glaucoma medication classes,and preoperative best corrected visual acuity(BCVA).The times from referral to procedure(referral time)and from listing date to procedure(waitlisting time)were calculated.RESULTS:This retrospective cohort study involved 181 eyes of patients undergoing glaucoma surgery from March 1 to June 30,2019(pre-pandemic period),and 201 eyes in the same timeframe in 2021(pandemic period)at Saint-Sacrement Hospital in Quebec City.There was no significant difference in the severity data of surgical glaucoma across both periods(VF deficit:P=0.48;IOP:P=0.14;BCVA:P=0.24;topical medication classes:P=0.27).The number of patients referred with oral glaucoma medication increased slightly from 45 to 70 in 2019 and 2021 respectively(P=0.08).Delay data were also comparable.Mean referral time was 122±120d in 2019 versus 144±136d in 2021(P=0.09),whereas waitlisting time before the pandemic was 43±44.5 versus 39±41.8d in 2021(P=0.13).CONCLUSION:Despite North America’s strictest pandemic restrictions,limited negative impact is observed on waitlisting delays and the severity of glaucoma cases presenting at our center.A larger subset of patients is treated with oral medications indicating a possible increase in advanced glaucoma.
文摘AIM:To evaluate the one-year clinical outcomes of a novel canaloplasty device used in combination with cataract extraction(CE)in patients with mild to severe open angle glaucoma(OAG).METHODS:This study reviewed patients diagnosed with mild to severe OAG,who underwent canaloplasty with the STREAMLINE®Surgical System combined with CE.The primary outcome was surgical success,defined as achieving≥20%intraocular pressure(IOP)reduction and/or a reduction of≥1 glaucoma medication compared to baseline.Secondary outcomes included mean IOP,average number of glaucoma medications,and best-corrected distance visual acuity(BCDVA).Data was collected preoperatively and at multiple postoperative time points up to one year.RESULTS:A total of 68 eyes of 47 patients were included with mean age was 73.1±7.0y and 60%were females.Surgical success at one year was achieved in 68.8%of eyes,with 67.6%success in mild,80.0%in moderate,and 66.7%in severe OAG cases.IOP was significantly reduced from a baseline of 16.1±0.5 to 14.7±0.4 mm Hg at one year(P=0.0004).The number of medications decreased significantly in all eyes from a baseline of 1.2±0.1 to 0.6±0.1 at one year(P<0.0001).When stratified by glaucoma severity,only the mild group experienced a statistically significant decrease from a baseline of 1.1±0.1 to 0.4±0.1(P<0.0001).BCDVA improved significantly from baseline to one year.No sight-threatening complications were reported.CONCLUSION:Canaloplasty using the STREAMLINE®surgical system combined with CE effectively reduces IOP at one year in mild to severe OAG with minimal complications.IOP lowering efficacy,reduction in IOP lowering medications,and safety in moderate to severe OAG require further study.
文摘AIM: To evaluate the outcomes of Ahmed glaucoma valve(AGV) implantation surgery for refractory glaucoma.METHODS: This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure(IOP) greater than21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation,data were collected on IOP, the best corrected visual acuity(BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56 wk postoperatively. Logarithm values of IOP were calculated and compared. RESULTS: The study group was comprised of 30patients(30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3 ±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg,19.6 ±12.8 mm Hg and 13.9 ±14.2 mm Hg at 12, 24 and56 wk respectively. BCVA was ≥6/60 in 11 eyes preoperatively, and five eyes had BCVA ≥6/60 at 56 wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At12 wk postoperatively, no medications were required to control IOP in 20 eyes. At 56 wk postoperatively, at least one medication was required to control IOP in 10 eyes.Over the entire follow up period, four eyes were treated with yttrium aluminium garnet(YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.
文摘Objective: to determine the specific therapeutic effect of Nd: YAG laser on malignant glaucoma patients after glaucoma filtering surgery, and to determine the correlation between the clinical characteristics of patients and the therapeutic effect of Nd: YAG laser. Methods: this study is a retrospective case series report study. Patients with malignant glaucoma after glaucoma filtering surgery treated by Nd: YAG laser in our hospital were collected retrospectively. The intraocular pressure, anterior chamber depth and uncorrected visual acuity of the patients at different time points before and after operation were compared. To clarify the clinical application effect of Nd: YAG laser in the treatment of malignant glaucoma after Qingguang filtration. Through Spearman correlation analysis of preoperative clinical characteristics of patients with intraocular pressure and anterior chamber depth at 3 months after operation, the correlation between preoperative clinical characteristics of patients and treatment effect was clarified. Results: the study included 35 eyes with malignant glaucoma after glaucoma filtering surgery from January 2015 to July 2021. The results of comparison between preoperative IOP and postoperative IOP at different time points showed that the IOP of the patients at 1 day, 3 days, 1 month and 3 months after operation was lower than that before operation, and the difference was statistically significant (p<0.05). The results of the comparison between preoperative anterior chamber depth and postoperative anterior chamber depth at different time points showed that the anterior chamber depth of the patients increased significantly at 3 days, 1 month and 3 months after operation, and the difference was statistically significant (p<0.05). The comparison of the patients' visual acuity at 3 months after operation and preoperative visual acuity showed that the proportion of patients with visual acuity > 0.8 at 3 months after operation was significantly higher than that before operation, and the proportion of patients with visual acuity < 0.05 was significantly lower than that before operation, and the difference was statistically significant (p<0.05). The results of correlation analysis showed that the age, gender, onset time, preoperative intraocular pressure and axial length of the patients had certain correlation with the intraocular pressure and anterior chamber depth at 3 months after operation (P<0.05). Conclusion: Nd: YAG laser technology has good clinical therapeutic effect on malignant glaucoma patients after glaucoma filtering surgery. The therapeutic effect of Nd: YAG laser technology has certain correlation with patients' age, gender, onset time, preoperative intraocular pressure and axial length.
基金Supported by National Natural Science Foundation of China(No.82171087No.82201228)+1 种基金Natural Science Foundation of Hunan Province(No.2024JJ6570)the Scientific Research Launch Project for new employees of the Second Xiangya Hospital of Central South University.
文摘Dear Editor,We present the reported case of repetitive bilateral suprachoroidal expulsive hemorrhage(SEH)after anti-glaucoma surgeries.SEH is a rare but potentially devastating complication of intraocular surgery.Long-term ocular hypertension,high myopia,older age,arterial sclerosis,and aphakia have been reported as preoperative risk factors for developing SEH^([1]).The prognosis for the visual acuity is poor without proper management.A suggested time for surgical drainage is said to be 10-14d when the hemorrhagic clot begins to liquefy^([2]).
