AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glauc...AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.展开更多
AIM:To report the one-year surgical outcome Kahook Dual Blade goniotomy combined with phacoemulsification(KDB-Phaco)in Chinese patients with primary open angle glaucoma(POAG).METHODS:This is a retrospective study incl...AIM:To report the one-year surgical outcome Kahook Dual Blade goniotomy combined with phacoemulsification(KDB-Phaco)in Chinese patients with primary open angle glaucoma(POAG).METHODS:This is a retrospective study included 43 eyes of 28 Chinese POAG patients with cataract who accepted KDB-Phaco and followed-up for 12mo.Intraocular pressure(IOP),glaucoma medications and surgical complications were recorded.Success 1 and success 2 was defined as 5-21 mm Hg and 5-18 mm Hg,and success plus was determined if additional criteria of IOP reduction≥20%from baseline was reached.A corrected IOP by adding 3 mm Hg for each medication was used to do correlation test.Cox’s proportional hazards regression model was used to test the hazard ratio for factors associated with surgical success.RESULTS:After a 12-month follow up,the IOP decreased from 28.1±6.3 to 13.8±3.0 mm Hg(47.92%reduction,P<0.001),and the medications used decreased from 2.0(1.0)to 0.0(0.0)(95%reduction,P<0.001).The mean IOP of all postoperative visits were lower than preoperative IOP(all P<0.001),so as the number of glaucoma medications(all P<0.001).Complete success 1 and qualified success 1 were 87.80%and 100.00%respectively.The complete success 1 plus and qualified success 1 plus were 85.37%and 97.56%,respectively.Totally 82.93%and 90.24%of patients got complete success 2 and qualified success 2 while 80.49%and 87.80%of patients satisfied complete success 2 plus and qualified success 2 plus.Age(r=-0.511,P=0.001)and visual acuity(VA;r=-0.321,P=0.041)were negatively correlated with postoperative corrected IOP at 12mo,while anterior chamber depth(r=0.432,P=0.005),mean deviation(r=0.617,P<0.001)and visual field index(r=0.524,P<0.001)were positively correlated with it.Preoperative VA(OR=33.092,P=0.004)and MD(OR=1.481,P=0.018)were hazard factors associated with failure based on qualified success as 18 mm Hg.The main complications of KDB were hyphema(9.30%),IOP spike(11.63%)and peripheral anterior synechia(6.98%).CONCLUSION:KDB goniotomy is a safe and effective in the treatment for Chinese POAG patients.Preoperative VA and mean deviation may predict the surgical success.展开更多
AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually s...AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually significant cataracts that underwent combined excisional goniotomy and MSICS with one-year follow-up. The medical history, demographic information, and clinical characteristics of each case were recorded. Data regarding changes in vision, intraocular pressure(IOP), the number of glaucoma medications, and the evolution of the disease after surgery were reported. RESULTS: Three patients, with open angle glaucoma and cataracts underwent combined excisional goniotomy and MSICS without adverse events. All patients had improvement in vision compared to baseline measurements. The range of IOP at baseline was from 14 to 18 mm Hg and decrease to a range of 10 to 14 mm Hg after one year of follow-up. Additionally, two patients also decreased their dependence on IOP-lowering medications at the last follow up visit with one patient maintaining baseline level of medication use.CONCLUSION: A combination of excisional goniotomy and MSICS illustrates both the safety and efficacy to treat patients with visually significant cataract and glaucoma. This procedure allows for a more cost-effective surgical approach that matches the needs of resource strained territories around the globe.展开更多
Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased r...Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels.The trabecular meshwork(TM)is a multi-layer spongy tissue that filters aqueous humor.Its structure changes and the filtering capacity decreases,leading to an increase in intraocular pressure.Surgical methods for TM are constantly updated.Compared with traditional glaucoma surgical techniques,such as external trabeculectomy,the development of a new surgical technique-minimally invasive glaucoma surgery(MIGS)-enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye.MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway,uveoscleral outflow pathway,and subconjunctival outflow pathway.A new surgical instrument,the Kahook Dual Blade,appears to optimize the TM outflow pathway in the surgical technique.The Kahook Dual Blade is a new type of angle incision instrument.Because of its unique double-edged design,in the process of goniotomy,it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly.Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants.The operation time is relatively short,the surgical technique is easy to master,and the TM resection scope can be determined based on the patient’s condition.It can be used to treat some clinically meaningful glaucoma.This article is organized as follows.We present the following article following the Narrative Review reporting checklist.展开更多
Background:Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma.This risk is further increased with combined filtering procedures.Indee...Background:Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma.This risk is further increased with combined filtering procedures.Indeed,there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery(MIGS).Here,we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade(KDB)goniotomy.Methods:Retrospective chart review of 385 glaucomatous eyes of 281 patients,which underwent either phacoemulsification alone(n=309)or phacoemulsification with KDB goniotomy(n=76,phaco-KDB)at the University of Colorado.The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than±0.5 Diopter(D).Results:Refractive surprise greater than±0.5 D occurred in 26.3%of eyes in the phaco-KDB group and 36.2%in the phacoemulsification group(p=0.11).Refractive surprise greater than±1.0 D occurred in 6.6%for the phacoKDB group and 9.7%for the phacoemulsification group(p=0.08).There was no significant difference in risk of refractive surprise when pre-operative IOP,axial length,keratometry or performance of KDB goniotomy were assessed in univariate analyses.Conclusion:There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.展开更多
Several types of childhood glaucoma exist, and the terminology is based on the time of onset of disease and its potential cause. Though childhood glaucoma occurs less commonly than adults but can lead to permanent vis...Several types of childhood glaucoma exist, and the terminology is based on the time of onset of disease and its potential cause. Though childhood glaucoma occurs less commonly than adults but can lead to permanent visual damage due to amblyopia, optic neuropathy or refractive error. A detailed evaluation should be done to establish diagnosis. Medical therapy has a limited role and surgery remains main modality for treatment. Childhood glaucoma is a treatable disease, if early diagnosis is established and therapeutic intervention done in time. In children with low vision efforts should be there to maintain residual vision and visual rehabilitation with low vision aids should be done.展开更多
文摘AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.
基金Supported by the National Natural Science Foundation of China Youth Science Foundation Project(No.82201176)Zhejiang Provincial Medical&Health Science Technology Program(No.2023KY153).
文摘AIM:To report the one-year surgical outcome Kahook Dual Blade goniotomy combined with phacoemulsification(KDB-Phaco)in Chinese patients with primary open angle glaucoma(POAG).METHODS:This is a retrospective study included 43 eyes of 28 Chinese POAG patients with cataract who accepted KDB-Phaco and followed-up for 12mo.Intraocular pressure(IOP),glaucoma medications and surgical complications were recorded.Success 1 and success 2 was defined as 5-21 mm Hg and 5-18 mm Hg,and success plus was determined if additional criteria of IOP reduction≥20%from baseline was reached.A corrected IOP by adding 3 mm Hg for each medication was used to do correlation test.Cox’s proportional hazards regression model was used to test the hazard ratio for factors associated with surgical success.RESULTS:After a 12-month follow up,the IOP decreased from 28.1±6.3 to 13.8±3.0 mm Hg(47.92%reduction,P<0.001),and the medications used decreased from 2.0(1.0)to 0.0(0.0)(95%reduction,P<0.001).The mean IOP of all postoperative visits were lower than preoperative IOP(all P<0.001),so as the number of glaucoma medications(all P<0.001).Complete success 1 and qualified success 1 were 87.80%and 100.00%respectively.The complete success 1 plus and qualified success 1 plus were 85.37%and 97.56%,respectively.Totally 82.93%and 90.24%of patients got complete success 2 and qualified success 2 while 80.49%and 87.80%of patients satisfied complete success 2 plus and qualified success 2 plus.Age(r=-0.511,P=0.001)and visual acuity(VA;r=-0.321,P=0.041)were negatively correlated with postoperative corrected IOP at 12mo,while anterior chamber depth(r=0.432,P=0.005),mean deviation(r=0.617,P<0.001)and visual field index(r=0.524,P<0.001)were positively correlated with it.Preoperative VA(OR=33.092,P=0.004)and MD(OR=1.481,P=0.018)were hazard factors associated with failure based on qualified success as 18 mm Hg.The main complications of KDB were hyphema(9.30%),IOP spike(11.63%)and peripheral anterior synechia(6.98%).CONCLUSION:KDB goniotomy is a safe and effective in the treatment for Chinese POAG patients.Preoperative VA and mean deviation may predict the surgical success.
文摘AIM: To report the long-term outcomes of combined excisional goniotomy and manual small incision cataract surgery(MSICS).METHODS: This is a retrospective case series of patients with open angle glaucoma and visually significant cataracts that underwent combined excisional goniotomy and MSICS with one-year follow-up. The medical history, demographic information, and clinical characteristics of each case were recorded. Data regarding changes in vision, intraocular pressure(IOP), the number of glaucoma medications, and the evolution of the disease after surgery were reported. RESULTS: Three patients, with open angle glaucoma and cataracts underwent combined excisional goniotomy and MSICS without adverse events. All patients had improvement in vision compared to baseline measurements. The range of IOP at baseline was from 14 to 18 mm Hg and decrease to a range of 10 to 14 mm Hg after one year of follow-up. Additionally, two patients also decreased their dependence on IOP-lowering medications at the last follow up visit with one patient maintaining baseline level of medication use.CONCLUSION: A combination of excisional goniotomy and MSICS illustrates both the safety and efficacy to treat patients with visually significant cataract and glaucoma. This procedure allows for a more cost-effective surgical approach that matches the needs of resource strained territories around the globe.
基金This work was supported the Natural Nature Science Foundation of China(No.81470633)The Natural Science Grant of the Heilongjiang province of China(H2018035,No.2020H040)+1 种基金The grant of Heilongjiang education committee(11521160,1152G021)The Innovation and Development Foundation of First Affiliated Hospital of Harbin Medical University(2018L002).
文摘Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels.The trabecular meshwork(TM)is a multi-layer spongy tissue that filters aqueous humor.Its structure changes and the filtering capacity decreases,leading to an increase in intraocular pressure.Surgical methods for TM are constantly updated.Compared with traditional glaucoma surgical techniques,such as external trabeculectomy,the development of a new surgical technique-minimally invasive glaucoma surgery(MIGS)-enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye.MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway,uveoscleral outflow pathway,and subconjunctival outflow pathway.A new surgical instrument,the Kahook Dual Blade,appears to optimize the TM outflow pathway in the surgical technique.The Kahook Dual Blade is a new type of angle incision instrument.Because of its unique double-edged design,in the process of goniotomy,it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly.Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants.The operation time is relatively short,the surgical technique is easy to master,and the TM resection scope can be determined based on the patient’s condition.It can be used to treat some clinically meaningful glaucoma.This article is organized as follows.We present the following article following the Narrative Review reporting checklist.
基金Support was received from a challenge grant to the Department of Ophthalmology from Research to Prevent Blindness,Inc.
文摘Background:Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma.This risk is further increased with combined filtering procedures.Indeed,there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery(MIGS).Here,we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade(KDB)goniotomy.Methods:Retrospective chart review of 385 glaucomatous eyes of 281 patients,which underwent either phacoemulsification alone(n=309)or phacoemulsification with KDB goniotomy(n=76,phaco-KDB)at the University of Colorado.The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than±0.5 Diopter(D).Results:Refractive surprise greater than±0.5 D occurred in 26.3%of eyes in the phaco-KDB group and 36.2%in the phacoemulsification group(p=0.11).Refractive surprise greater than±1.0 D occurred in 6.6%for the phacoKDB group and 9.7%for the phacoemulsification group(p=0.08).There was no significant difference in risk of refractive surprise when pre-operative IOP,axial length,keratometry or performance of KDB goniotomy were assessed in univariate analyses.Conclusion:There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.
文摘Several types of childhood glaucoma exist, and the terminology is based on the time of onset of disease and its potential cause. Though childhood glaucoma occurs less commonly than adults but can lead to permanent visual damage due to amblyopia, optic neuropathy or refractive error. A detailed evaluation should be done to establish diagnosis. Medical therapy has a limited role and surgery remains main modality for treatment. Childhood glaucoma is a treatable disease, if early diagnosis is established and therapeutic intervention done in time. In children with low vision efforts should be there to maintain residual vision and visual rehabilitation with low vision aids should be done.
