超声睫状体成形术治疗难治性青光眼半年随访效果的临床研究

目的探讨超声睫状体成形术(UCP)治疗难治性青光眼的有效性及安全性。 方法收集首都医科大学附属北京同仁医院眼科中心确诊的难治性青光眼患者11例(11只眼)的临床资料。其中,男性6例(6只眼),女性5例(5只眼),年龄28~68岁,平均年龄(48.0±20.4)岁。11例患者中1例为原发性闭角型青光眼术后眼压失控,5例为玻璃体切除术后或其它疾病引起的继发性青光眼,3例为新生血管性青光眼,2例为原发性开角型青光眼术后眼压失控。所有患者术前均经最佳矫正视力检查、裂隙灯显微镜眼底检查、眼压测量、光学生物测量及超声生物显微镜检查。行UCP术后,以平均眼压降低幅度和6个月后的手术成功率来评估UCP治疗的有效性。数据以平均值±标准差( ±s)表示。数据缺失时,采用混合效应模型比较不同时间点的眼压变化;采用Wilcoxon检验比较术前与术后降眼压药物使用数量的变化;采用线性回归分析比较术前及其与术后眼压降低差值的关系。 结果11例患者(11只眼)全部接受UCP手术治疗,术后3个月的手术成功率为54%(6/11),术后6个月的手术成功率为36%(4/11)。术前、术后7 d、3个月及6个月的平均眼压分别为(40.82±3.47)mmHg(1 mmHg＝0.133 kPa)、(20.26± 3.43)mmHg、(19.89± 4.35)mmHg及(22.06±5.15)mmHg。与术前比较,差异均有统计学意义(t＝-4.23,-3.80,-3.05;P<0.05)。术后6个月,每日降眼压药的使用数量明显降低,平均降压药物由(3.09±0.3)种降至(2.3±0.2)种,且两者差异有统计学意义(Z＝7.27,P<0.05)。 结论UCP术后6个月能有效地降低眼压,但其术后效果的长期评价仍需观察。     

玻璃体腔注射甲氨蝶呤治疗原发性眼内淋巴瘤的临床研究

目的观察玻璃体腔注射甲氨蝶呤(MTX)个体化治疗原发性眼内淋巴瘤(PIOL)的疗效和安全性。 方法收集2013年4月至2019年12月于首都医科大学附属北京朝阳医院眼科就诊的PIOL患者20例(30只眼)的临床资料进行研究。其中，男性6例(6只眼)，女性14例(24只眼)。患者年龄34~81岁，平均年龄(55.9±12.4)岁。所有患者肿瘤性质均为弥漫性大B细胞淋巴瘤。治疗方案为"根据淋巴瘤临床表现"的个体化治疗，所有患眼均接受单次玻璃体腔注射MTX(400 μg：0.1ml)治疗。如出现玻璃体混浊加重、眼底病灶范围扩大或IL-10/IL-6比值增高行再次注射。自治疗开始随访12~30个月。所有患眼均行最佳矫正视力(BCVA)、眼压、裂隙灯显微镜、彩色眼底照相、光学相干断层扫描(OCT)及荧光素眼底血管造影(FFA)检查并行房水或玻璃体IL-10/IL-6浓度检测。BCVA转换为LogMAR视力和眼压的检查数据先行正态性检验。眼压符合正态分布采用±s表示，治疗前后眼压的比较采用配对t检验；BCVA不符合正态分布，采用中位数和上下四分位数表示，治疗前后BCVA的比较采用Wilcoxon配对秩和检验。裂隙灯显微镜检查、彩色眼底照相、OCT、FFA及IL-10/IL-6的比值采用文字形式进行描述。 结果治疗前后LogMAR视力中位数为0.75(0.47，1.43)和0.4(0.2，0.57)，差异具有统计学意义(Z＝3.43，P<0.05)。治疗前后眼压分别为(16.56±4.31)mmHg(1 mmHg＝0.133 kPa)和(16.13±3.87)mmHg，差异无统计学意义(t＝0.40，P>0.05)。所有患者经玻璃体腔注射MTX治疗后玻璃体混浊程度较治疗前好转者有12例(19只眼)，占63%(19/30)；视网膜下黄白色奶油样浸润灶减轻或消失者有15例(20只眼)，占66%(20/30)；视网膜色素上皮下的高反射病灶减轻或消失的为13例(18只眼)，占60%(18/30)。注射次数为1~8次，平均(3.00±2.37)次。 结论"根据淋巴瘤临床表现"进行个体化玻璃体腔注射MTX治疗PIOL安全有效，可达到临床缓解。     

激光瞳孔成形术与激光周边虹膜成形术治疗急性原发性前房角关闭的临床研究

目的比较激光周边虹膜成形术(LPIP)和(或)激光瞳孔成形术(LPP)对急性原发性前房角关闭(APAC)的临床效果。 方法回顾性分析2020年1月至2020年12月于邯郸市眼科医院(邯郸市第三医院)行LPIP和(或LPP)治疗的APAC患者81例(81只眼)。其中,男性15例(15只眼),女性66例(66只眼);年龄41~94岁,平均年龄(66.7±10.6)岁。按照激光治疗的方式分为联合组和LPIP组。联合组患者先后给予LPIP和LPP;LPIP组只行LPIP。以术后眼压≤30 mmHg(1 mmHg＝0.133 kPa)为治疗初步有效。年龄和眼压经单样本Kolmogorov-Smirnov检验,符合正态分布,以±s表示,组间比较采用独立样本t检验;视力、疾病发作持续时间及既往发作次数不符合正态分布,以中位数和四分位数表示,将Snellen视力换算成logMAR视力以便于统计学处理,组间比较采用Mann-Whitney U秩和检验。激光治疗的初步有效率和性别以例数和百分比表示,组间比较采用χ²检验。两组患者术前、术后1 h及术后2 h视力和眼压的比较采用单因素方差分析。两组患者术前与术后2 h眼压变化幅度的影响因素采用广义线性回归模型分析。 结果联合组患者42例(42只眼)。其中,男性6例(6只眼),女性36例(36只眼)。LPIP组患者39例(39只眼)。其中,男性9例(9只眼),女性30例(30只眼)。两组患者性别比较的差异无统计学意义(χ²＝1.04,P>0.05)。联合组和LPIP组患者术前眼压分别为(50.95±7.22)mmHg和(48.08±8.05)mmHg。两组患者术前眼压比较的差异无统计学意义(t＝1.69,P>0.05)。两组患者术前logMAR视力分别为1.70(0.68,2.00)和1.70(0.90,2.00);发作持续时间分别为16.0(12.0,39.0)h和24.0(15.0,48.0)h;既往发作次数分别为0(0,3.5)次和0(0,1.0)次。经Mann-Whitney U秩和检验,术前两组患者视力、发作持续时间及既往发作次数比较的差异均无统计学意义(Z＝-0.51,-0.99,-1.30;P>0.05)。联合组患者术后1 h和术后2 h的logMAR视力分别为0.50(0.20,0.80)和0.35(0.10,0.93);LPIP组术后1 h和术后2 h的logMAR视力分别为0.90(0.40,1.90)和0.90(0.40,1.90)。两组患者术后1 h和术后2 h的视力均提高。两组术后1 h和术后2 h患者视力比较的差异均有统计学意义(Z＝-2.16,-2.42;P<0.05)。联合组术后1 h和术后2 h患者的眼压分别为(30.83±13.49)mmHg和20.0(14.0,35.5)mmHg;LPIP组术后1 h和术后2 h患者的眼压分别为(34.79±1.70)mmHg和38.0(15.0,45.0)mmHg。两组患者术后1 h比较的差异无统计学意义(Z＝-1.31,P>0.05);术后2 h比较的差异有统计学意义(Z＝-2.14,P<0.05)。联合组与LPIP组术后1 h的初步有效率分别为52.4%和35.9%,比较的差异无统计学意义(χ²＝2.23,P>0.05);术后2 h初步有效率分别为71.4%和41.0%,比较的差异有统计学意义(χ²＝7.62,P<0.05)。经广义线性回归模型分析,APAC患者眼压变化幅度与术前眼压呈正相关,其相关性有统计学意义(β＝0.392,P<0.05);与组别、年龄及发作持续时间呈负相关,其相关性有统计学意义(β＝-9.157,-0.432,-0.115;P<0.05)。 结论LPIP和LPP联合治疗APAC患者,能通过解除瞳孔阻滞和周边前房角开放,快速降低眼压,是一种有效的APAC治疗手段,值得临床推广。     

微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼的临床研究

目的探讨微导管辅助360°小梁切开术治疗先天性白内障术后继发青光眼患者的效果及安全性。 方法收集2015年4月至2022年2月于首都医科大学附属北京同仁医院眼科中心接受微导管辅助360°小梁切开术的先天性白内障术后继发青光眼患者27例(30只眼)。其中,男性18例(20只眼),女性9例(10只眼),年龄8月龄至20岁,平均(6.9±5.9)岁。全部患者行微导管辅助的360°小梁切开术治疗。记录术前及术后1 d、术后1周、术后1个月、术后3个月及术后6个月患者的眼压和需用不同药物的眼数。其中,各时间点患者眼压的检测结果符合正态分布,以(±s)表示,需用药物的眼数以频数和百分比表示。各时间点患者眼压的比较使用单因素重复测量方差分析,各时间点需用药物眼数的比较使用广义估计方程法。计算各时间点的手术总成功率及完全成功率并采用广义估计方程法进行比较。 结果术前、术后1 d、术后1周、术后1个月、术后3个月及术后6个月的眼压分别为(35.97±7.67)mmHg(1 mmHg＝0.133 kPa)、(14.83±6.54)mmHg、(16.40±5.01)mmHg、(17.90±4.97)mmHg、(17.53±4.13)mmHg及(18.00±3.34)mmHg。术前与术后各时间点患者眼压的总体差异具有统计学意义(F＝92.75,P<0.05),术前与术后各时间点眼压的差异具有统计学意义(t＝11.49,10.08,9.52,9.87,8.54;P<0.05),术后各时间点间患者眼压的差异无统计学意义(t＝0.54,1.56,1.21,1.62,0.85,0.78,0.90,0.62,0.47,0.65;P>0.05)。术后1周、术后1个月、术后3个月及术后6个月需用药物0种、1种、2种、3种、4种及5种者分别为19例(22只眼)、3例(3只眼)、1例(1只眼)、2例(2只眼)、2例(2只眼)及0例(0只眼),18例(20只眼)、3例(3只眼)、2例(2只眼)、3例(3只眼)、2例(2只眼)及0例(0只眼),18例(20只眼)、4例(4只眼)、2例(2只眼)、3例(3只眼)、1例(1只眼)及0例(0只眼),17例(19只眼)、4例(4只眼)、1例(1只眼)、5例(5只眼)、1例(1只眼)及0例(0只眼);分别占73.33%、10.00%、3.33%、6.67%、6.67%及0.00%,66.67%、10.00%、6.67%、10.00%、6.67%及0.00%,66.67%、13.33%、6.67%、10.00%、3.33%及0.00%,63.33%、13.33%、3.33%、16.67%、3.33%及0.00%。术后1周与术后1 d、术后1个月、术后3个月及术后6个月需用药物者的差异具有统计学意义(χ²＝30.26,61.05,55.36,48.86;P<0.05)。术后1个月与术后3个月及术后6个月需用药物者的差异具有统计学意义(χ²＝72.08,76.05;P<0.05)。术后3个月与术后6个月需用药物者的差异具有统计学意义(χ²＝94.80,P<0.05)。全部患者27例(30只眼)中,术后1周、术后1个月、术后3个月及术后6个月的手术基本成功者分别为3例(3只眼)、4例(4只眼)、4例(4只眼)及4例(4只眼),分别占10.00%、13.33%、13.33%及13.33%;手术完全成功者分别为19例(22只眼)、17例(19只眼)、17例(19只眼)及16例(18只眼),分别占73.33%、63.33%、63.33%及60.00%。术后各时间点手术完全成功率的差异无统计学意义(χ²＝2.90,P>0.05)。术后1周、术后1个月、术后3个月及术后6个月的手术总成功率分别为83.33%、76.67%、76.67%及73.33%,术后各时间点手术总成功率的差异无统计学意义(χ²＝1.42,P>0.05)。 结论微导管辅助360°小梁切开术对先天性白内障术后继发青光眼有较好的治疗效果及安全性。     

Schlemm管为基础的青光眼内引流手术术后眼压分布特征

目的：分析以Schlemm管为基础的各类型青光眼内引流手术术后眼压分布特征。方法：回顾性系列病例研究。选取2015年6月至2019年1月于温州医科大学附属眼视光医院行以Schlemm管为基础的青光眼内引流手术（黏小管成形术和穿透性黏小管成形术）的患者资料,入选其中随访时间≥6个月, 且末次随访在未用药情况下眼压≤21 mmHg（1 mmHg=0.133 kPa）患者,分析患者的眼压分布特征。各类型青光眼的眼压比较采用单因素方差分析。结果：共纳入患者204例（236眼）,术前眼压为 （33.4±12.1）mmHg,用药（2.7±1.2）种。术后末次随访时（6个月及以上）眼压为（13.9±3.3）mmHg。 其中眼压分布在5～10 mmHg有37眼（15.7%）,分布在>10～12 mmHg有43眼（18.2%）,分布在 >12～15 mmHg有78眼（33.1%）,分布在>15～18 mmHg有56眼（23.7%）,分布在>18～21 mmHg有 22眼（9.3%）。原发性开角型青光眼（85眼）、原发性闭角型青光眼（30眼）、继发性青光眼（76眼）和先天性青光眼（45眼）的末次随访眼压分别为（13.9±3.2）（14.5±3.0）（14.0±3.3）（13.2±3.7）mmHg, 各类型青光眼总体眼压差异无统计学意义（F=1.011,P=0.289）。对于原发性开角型青光眼,早、中、 晚期青光眼的目标眼压达标率分别为82.4%、81.8%、36.8%。结论：以Schlemm管为基础的青光眼内引流手术术后平均眼压为14 mmHg,80%的早、中期以及1/3的晚期原发性开角型青光眼患者可以达到目标眼压。     

视觉诱发电位对青光眼和高眼压的意义

用图象视觉诱发电位(P-VEP)检测了414眼,分成3组:Ⅰ组为164眼原发性开角型青光眼,眼压超过22mmHg,伴有青光眼性视野缺损和病理性视盘凹陷,平均年龄58.69±9.6岁,Ⅱ组为168眼高眼压,眼压超过22mmHg,但不伴有视野和视盘的改变,平均年龄50.64±13.2岁;Ⅲ组为82只正常眼,平均年龄48.5±     

眼压不对称性与原发性开角型青光眼的关系

目的 :评价眼压不对称性在 40岁以上人群横断面研究中的发生率及其与原发性开角型青光眼 (primaryopen angleglaucoma ,POAG)的关系。方法 :在参加北京城乡限定区域人群眼流行病学调查的 4451例 (40～ 10 1岁 )受试者中 ,在散瞳前用非接触式眼压计测量双眼眼压。眼压不对称性的定义是双眼之间的眼压差别≥ 3mmHg。POAG诊断根据为存在典型的青光眼性视神经、视野改变及前房角开放。结果 :眼压被可靠测量者 43 89例。右眼压平均 (16 0 3± 3 2 5)mmHg ,左眼压平均 (16 0 8± 3 17)mmHg。总人群的不对称性眼压发生率为 2 0 0 1% (878/ 43 89) ,且随着年龄的增长而增大 ,在 40～ 49岁年龄组不对称性眼压的发生率为 18 4% ,而在 70岁以上年龄组达 2 6 6% (P =0 0 0 0 )。此外 ,不对称性眼压的发生率随着眼压水平 (以双眼的眼压较高眼为准 )增大而增高 ,在眼压≤ 16mmHg的受试者不对称性眼压发生率 9 7% ,17～ 2 1mmHg者 2 6 1% ,大于 2 1mmHg者 50 7% (χ2 检验 ,Ρ =0 0 0 0 )。在POAG患者不对称性眼压者占 3 5 4% ,正常人则占 18 2 % (P =0 0 0 0 )。结论 :在 40岁以上的人群中 ,无论其眼压水平如何 ,眼压不对称性是POAG的一个非常重要的危险因素     

强的松龙所致类固醇性青光眼

类固醇的局部及全身应用均可致高眼压、视神经损伤及视野缺损,已有文献报道[1]。本文报告1998年元月至2004年12月所遇到的强的松龙结膜下注射所发生的类固醇性青光眼的临床表现,以引起足够的重视。一、一般资料:本组报告强的松龙0.5(25mg/ml)结膜下注射所致青光眼共12例,18眼;男7例,女5例。右眼10眼,左眼8眼。年龄12至68岁,平均38岁,用激素治疗的原发眼病是结膜炎2眼,巩膜炎8眼,葡萄膜炎8眼。二、临床表现:①高眼压:本组18眼结膜下一次注射强的松龙后均出现顽固高眼压,眼压波动在38-62mmHg,平均50.5mmHg,这时用抗青光眼药,如甘露醇、醋氮酰…     

高眼压的处理

“高眼压”是指眼压升高超过正常或平均值而没有视野和视盘的损害。Grant和chandler称之为“无损害的原发性开角青光眼”,也有称“疑似青光眼”或“前期青光眼”者。高眼压涉及40岁以上人群的6-10%。而有视神经和视野损害的青光眼仅占0.3-0.5%。正常人平均眼压为15±3mmHg,未经治疗的青光眼病人平均眼压为24±5mmHg。正常人、高眼压和青光眼的眼压存在交叉重迭的情况。用“高眼压”而不用“青光眼”一词,可以避免引起许多潜在问题。对眼压增高而无症状的病人首先要进行全面的检查,包括病史、屈光、裂隙灯检查、压平眼压计测量眼压、眼底检查、视盘照相、前房角镜及视野检查,作出最初的判断:是高眼压还是青光眼,是否应着手治疗?如眼压高于20mmHg,视盘和视野正常,则初诊为“高眼压”,要作定期检查。     

非穿透小梁切除透明质酸钠凝胶植入术治疗开角型青光眼疗效观察

目的观察非穿透小梁切除术(NPTS)联合透明质酸钠凝胶植入术治疗开角型青光眼的疗效.方法对9例(10眼)开角型青光眼施行非穿透小梁切除术,术中植入透明质酸钠凝胶.观察手术前后视力、眼压及手术并发症,并行超生生物显微镜(BUN)观察.结果 10眼术后眼压均得到控制.术前眼压最低24.38 mmHg,最高61.75 mmHg,平均(39.45±11.98)mmHg.术后5天拆线时眼压最低测不出,最高7.10 mmHg.1个月后复查,眼压最低4.85 mmHg,最高20.55 mmHg,平均(14.18±4.26)mmHg.手术前后眼压对比有非常显著性差异(t＝8.026,P<0.01).术后6个月、8个月各有1眼眼压升高,加用一种抗青光眼药物治疗后眼压即恢复正常.与术前需用1～3种降眼压药物相比,有非常显著性差异(t＝6.530,P<0.01).视力较术前提高.患者术后均无明显的前房炎症反应、浅前房以及脉络膜脱离等并发症.结论非穿透小梁切除透明质酸钠凝胶植入术是治疗开角型青光眼的有效方法.其最大特点是手术不穿透前房,术后视力迅速恢复,并发症极少.     

Five-year follow up of selective laser trabeculoplasty in Chinese eyes

PURPOSE: To study the effectiveness and safety of selective laser trabeculoplasty (SLT) on primary open-angle glaucoma and ocular hypertension in Chinese eyes. METHODS: This was a prospective randomized controlled clinical study in which 58 eyes of 29 patients with primary open-angle glaucoma or ocular hypertension were included. One eye of each patient was randomized to receive SLT (Group 1) and the fellow eyes received medical treatment (Group 2). Patients were evaluated after laser treatment at 2 h, 1 day, 1 week, 2 weeks, 1 month, 3 months, 6 months, and then yearly. RESULTS: All patients (13 male, 16 female) were Chinese. The mean age was 51.9 +/- 14.7 years. The mean baseline intraocular pressure was 26.8 +/- 5.6 mmHg in group 1 and 26.2 +/- 4.2 mmHg in group 2 (P = 0.62). The failure rate, defined as intraocular pressure >21 mmHg with maximal medications, was 17.2% in group 1 and 27.6% in group 2 at 5-year follow-up (P = 0.53). Eight eyes (27.6%) in group 1 required medications to control the intraocular pressure to below 21 mmHg. There was no statistically significant difference in the intraocular pressure reductions between the two groups at all time intervals (P > 0.05). The mean number of antiglaucoma medications was significantly lower in the SLT than the medical treatment group up to 5 years of follow up (P < 0.001). Transient post-SLT intraocular pressure spike >5 mmHg was observed in three eyes (10.3%). CONCLUSION: With fewer medications, SLT gives similar intraocular pressure reduction to medical therapy alone in Chinese patients with primary open-angle glaucoma or ocular hypertension.     

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations

PURPOSE: Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation. MATERIAL AND METHODS: 67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test. RESULTS: After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05). CONCLUSIONS: DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.     

The efficacy of timolol in gel-forming solution after morning or evening dosing in Asian glaucomatous patients.

AIMS: The aim of this study was to determine the effectiveness of timolol gel-forming solution as a monotherapy and to compare the efficacy of timolol gel-forming solution morning instillation versus at night application in Asians with newly diagnosed open-angle glaucoma. METHODS: A retrospective, comparative, parallel group study was conducted on 78 eligible patients diagnosed with open-angle glaucoma who received topical timolol gel-forming solution either on morning (AM dosing group; 39 patients) or evening (PM dosing group; 39 patients) as monotherapy treatment. Intraocular pressure was taken at baseline, 1, 3, 6, and 12 months post-treatment. RESULTS: Mean baseline intraocular pressure (IOP) for timolol gel-forming solution in general was 22.7 +/- 6.6 mmHg with the mean IOP reduction of 5.7 +/- 5.3 mmHg (23.1% reduction). The mean IOP reduction of the AM dosing group was 7.5 +/- 5.2 mmHg (31.0% reduction) and 3.9 +/- 4.9 mmHg (15.1% reduction) in the PM dosing group (P = 0.0002). There was a statistically significant difference of IOP reductions between AM and PM dosing group at 1 month (P = 0.041), 3 months (P = 0.037) and 12 months (P = 0.015) post-treatment. Seventy-five percent (24) of good responders was in the AM group and 67.4% (31) of poor responders were patients in the PM group. CONCLUSION: Timolol gel-forming solution is effective in reducing IOP in Asian eyes. Morning dosing was more effective in lowering the IOP compared to evening dosing.     

Postoperative intraocular pressure rise in open-angle glaucoma patients after cataract or combined cataract-filtration surgery

Postoperative intraocular pressure (IOP) was measured in patients with open-angle glaucoma undergoing extracapsular cataract extraction with a posterior chamber lens implant (ECCE-PC IOL). Patients considered to be under adequate medical glaucoma control had cataract surgery alone or combined with a posterior lip sclerectomy. Patients with medically uncontrolled glaucoma had cataract surgery combined with either a posterior lip sclerectomy or a trabeculectomy. Cataract surgery alone (n = 26) was associated with a significantly (P less than 0.001) increased IOP on postoperative day 1: preoperative IOP, 18.9 +/- 3.6 mmHg; postoperative IOP, 34.2 +/- 12 mmHg. An IOP rise of 10 mmHg or more occurred in 69% of the eyes, whereas 77% of the eyes had an absolute IOP over 25 mmHg. Eyes undergoing combined surgery (n = 42) had a preoperative IOP of 21.3 +/- 4.8 mmHg. On postoperative day 1, the mean IOP was 14.9 +/- 12.0 mmHg. An IOP rise of 10 mmHg or more was observed in 14%, and an IOP over 25 mmHg in 21% of combined surgery eyes. Cataract surgery in eyes with open-angle glaucoma requires careful monitoring and therapy for early postoperative increases in IOP. Combined surgery reduces the frequency and magnitude of, but does not eliminate, this complication.     

Trabeculectomy: a prospective study of complications and results of long-term follow-up

A total of 50 trabeculectomies were carried out with pre- and postoperative medications using steroids and indomethacin, and also with the use of sodium hyaluronate during surgery. The postoperative course was followed by the prospective study protocol adopted by Shirato et al and the results were compared with the Shirato series of 145 trabeculectomies where the surgery was performed without the above medications and without the use of sodium hyaluronate. The shallow anterior chamber and choroidal detachment were less frequent, and the complication-free postoperative course was more frequent in the present than in the Shirato series. The state of the intraocular pressure control of the Shirato series was analyzed by the life-table method for the follow-up period of about 5 years. The final success rate in maintaining the intraocular pressure at or below 20 mmHg after the first trabeculectomy was 60.8 +/- 7.2 (SE) % in primary open-angle glaucoma, 64.2 +/- 12.1% in primary angle-closure glaucoma and 31.1 +/- 9.9% in secondary glaucoma. There were several cases where argon laser trabeculoplasty had been carried out before trabeculectomy. The success rate in these cases appeared to be no different from the rate in the rest of the eyes. In primary open-angle glaucoma, the second surgery after failed first trabeculectomy gave a similar success rate as the first surgery, but the third surgery after two failed trabeculectomies gave a very low success rate. The intraocular pressure distribution after one year showed a frequency of visual field deterioration was high in the order of the eyes with the intraocular pressure higher than 20 mmHg, those with 15-20 mmHg and those with lower than 15 mmHg.     

Long-term progression at individual mean intraocular pressure levels in primary open-angle and exfoliative glaucoma

PURPOSE: To describe progression and non-progression rates at individual mean intraocular pressure (IOP) levels for patients with primary open-angle and exfoliative glaucoma. METHODS: A meta-analysis of five previously published retrospective studies describing progression and non-progression rates at individual intraocular pressure levels over 5 or more years of follow-up. All patients had primary open-angle (four studies) or exfoliative glaucoma (one study). RESULTS: This meta-analysis included 822 patients of whom 655 (80%) had primary openangle glaucoma and 167 (20%) had exfoliative glaucoma. In total, 220 patients progressed (27%), while 602 (73%) remained stable over 5 years. The mean IOP was 20.0 for progressed and 17.1 mmHg for stable patients (p=0.0004). The peak IOP was 29.1 for progressed and 23.6 mmHg for stable patients (p=0.0014). At an IOP level >18 mmHg, 49% of patients remained stable; at 18 mmHg, 78%; between 13 and 17 mmHg, 82%; and <13 mmHg, 96%.Additional factors associated with progression were older age (p=0.0004) and exfoliative glaucoma (p=0.0001). However, multivariant regression analysis identified only mean IOP as a risk factor for progression (p=0.039). CONCLUSIONS: This study suggests that maintaining an IOP well within the normal range over 5 years in patients with primary open-angle or exfoliative glaucoma helps to prevent glaucomatousprogression.     

Twenty-four-hour diurnal curve comparison of commercially available latanoprost 0.005% versus the timolol and dorzolamide fixed combination

PURPOSE: To evaluate the efficacy and safety of commercially available latanoprost 0.005% given every evening versus timolol 0.5% and dorzolamide 2% fixed combination (TDFC) given twice daily to white Greeks with primary open-angle glaucoma and ocular hypertensive patients. DESIGN: A single-masked, two-center, crossover comparison with two 6-week treatment periods occurring after at least a 3-week medicine-free period. Diurnal curve intraocular pressures were taken at 2:00 AM, 6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, and 10:00 PM. PARTICIPANTS: Thirty-four subjects with primary open-angle glaucoma or ocular hypertension were enrolled. INTERVENTIONS: Latanoprost 0.005% given every evening and TDFC twice daily. MAIN OUTCOME MEASURES: The primary efficacy variable was diurnal intraocular pressure. RESULTS: Thirty-three patients completed the study. On the last day of treatment, the mean diurnal intraocular pressure for latanoprost was 15.9 +/- 2.3 mmHg and for TDFC was 15.3 +/- 2.0 mmHg (P = 0.05). Individual time points for intraocular pressure were not statistically different between groups except at the 10:00 PM time point, when the mean for TDFC was 14.6 +/- 2.7 mmHg and for latanoprost was 16.6 +/- 3.1 mmHg (P < 0.006). Eighteen patients overall preferred latanoprost versus 2 patients for the fixed combination, generally because of the greater convenience of once daily dosing. Adverse events were not significantly different between groups except that a bitter taste was found more frequently with TDFC (n = 9) than with latanoprost (n = 0; P = 0.009). Despite screening to exclude intolerance to beta-blockers, a single patient had to discontinue the TDFC because of new-onset asthma. CONCLUSIONS: This study indicates that the 24-hour diurnal intraocular pressure is lowered more, by a small but statistically significant amount, with TDFC compared with latanoprost in primary open-angle glaucoma and ocular hypertensive patients.     

Characteristics of reduction of intraocular pressure after trabeculectomy.

The change in intraocular pressure achieved after 98 trabeculectomy operations performed on 70 patients with primary open-angle glaucoma was analysed. The reduction was proportional to the untreated preoperative pressure, and the results indicated that a first trabeculectomy reduced the intraocular pressure to between 16 and 20 mmHg irrespective of its initial level. Cases which required medical therapy for final pressure control after surgery showed a distribution of initial intraocular pressure similar to those not requiring such therapy. In addition, these cases were reduced to a level of pressure only slightly above the arbitrary figure of 20 mmHg before medical therapy was added, and were therefore considered almost to have reached the normal physiological range. Cases submitted to a second trabeculectomy are discussed, including 2 cases with unexplained acute open-angle glaucoma some months after the first operation.     

Status of blood supply to the eye in patients with primary open-angle glaucoma depending on the value of systemic arterial pressure and level of ophthalmic tone

Blood supply to the eye was studied in 756 patients aged 40-82 years (1339 eyes) with primary open-angle glaucoma, systemic arterial pressure (AP) 105-170 mm Hg, and various level of intraocular pressure (IOP). Control group consisted of 340 healthy subjects (680 eyes) aged 28-80 years without ophthalmic diseases with the same AP values. Blood supply values in the controls were taken for the norm. They were in high correlation with systemic AP. Ocular blood supply in patients with primary open-angle glaucoma depends on systemic AP and IOP, particularly perfusion pressure (Pperf) which decreases by 3.1 mm Hg in patients with systemic AP of 126-139 mm Hg and moderately (from normal to moderate) increased IOP. If IOP increases in the interval from moderate to high in patients with the same AP, Pperf drops by 12.5 mm Hg. Pperf values indicate deterioration of ocular blood supply in patients with primary open-angle glaucoma and different levels of IOP.     

The effect of trabeculotomy on the day-time variation of intraocular pressure of the primary open-angle glaucoma

We selected 34 eyes with primary open-angle glaucoma cases having glaucomatous visual field loss, but with relatively low base-line intraocular pressure (average intraocular pressure at normal office hour, below 20mmHg) and with one or more episodes of intraocular pressure over 21mmHg in a diurnal fluctuation estimated at 8:30, 9:30, 11:30, 13:30, 15:00 and 17:00. They were treated with trabeculotomy ab externo and we compared the pre- and postoperative diurnal fluctuation pattern of the intraocular pressure. The mean of the base-line intraocular pressure decreased from 18.4 to 16.3mmHg. The mean values of the maximal pressure of the diurnal estimation and of the diurnal difference (maximum minus minimum) also decreased, from 23.4 to 17.9 and from 7.4 to 3.9mmHg, respectively. In 31 eyes (91%) the individual maximal value did not exceed 20mmHg postoperatively. From these findings, it was speculated that trabeculotomy can be effective on primary open-angle glaucoma with relatively low intraocular pressure.