The Ex-PRESS glaucoma shunt versus trabeculectomy in open-angle glaucoma: a prospective randomized study

Introduction  The purpose of this study was to establish the efficacy and safety of the Ex-PRESS (Optonol Ltd., Neve Ilan, Israel) mini glaucoma shunt in open-angle glaucoma. Methods  This was a prospective, randomized trial. Eyes from enrolled patients were randomly assigned to either Ex-PRESS implantation under a scleral flap, or trabeculectomy. The main outcome measures were: mean intraocular pressure (IOP), postoperative medication use, visual acuity, and incidence of complications. Complete success was defined as an IOP of >4 mmHg and ≤18 mmHg without the use of antiglaucoma medications. A more stringent target of IOP >4 mmHg and ≤15 mmHg was also noted. Results  There were 78 patients (80 eyes) with primary open-angle, pseudoexfoliative, or pigmentary glaucoma enrolled in the study. A total of 84.6% of patients receiving Ex-PRESS and 60.0% of patients receiving trabeculectomy (P=0.0230) achieved complete success. The respective proportions of patients achieving an IOP >4 mmHg and ≤15 mmHg were 76.9% and 50.0% (P=0.0193). At 1-year follow-up, complete success rates were 81.8% for Ex-PRESS and 47.5% for trabeculectomy (P=0.0020), and 71.7% and 37.5% (P=0.0070), respectively, for the more stringent target. There was a similar level of postoperative interventions and complications for each group. Conclusions  In open-angle glaucoma, the Ex-PRESS mini glaucoma shunt implanted under a superficial scleral flap produces significantly higher success rates, and a similar complication rate, compared with trabeculectomy. The Ex-PRESS is a safe and effective device for treating open-angle glaucoma.     

青光眼滤过术疗效观察

目的观察青光眼滤过术的疗效。方法对 5 0例 (60眼 )不同类型青光眼患者采用小梁切除术联合术中前房预置穿刺、使用丝裂霉素、巩膜瓣及结膜牢固缝合、术毕形成前房的治疗方法 ;术后随访 1年。结果术后 5 4眼眼压 <2 1mmHg,6眼需用降眼压药将眼压控制在 3 0mmHg以下 ;仅有 2眼术后视力低于术前 ,其余均达到或超过术前视力 ;2眼发生结膜瓣创漏 ,2眼发生脉络膜脱离 ,经处理后恢复。结论青光眼滤过术可减少术后常见并发症 ,提高患者早期视力并使眼压恢复正常     

超声乳化联合复合式小梁切除术治疗青光眼合并白内障的临床研究

目的观察超声乳化联合小梁切除术，术中应用丝裂霉素（MMC）及经角膜的调整缝线治疗青光眼合并白内障的临床效果。方法69例（72眼）术中做以角膜缘为基底的结膜瓣，再以角膜缘为基底做5mm×4mm 1／2板层厚巩膜瓣，0．2—0．4mg／ml MMC棉片置于结膜和巩膜瓣下3—5min，再以大量BSS冲洗，继之进行超声乳化及人工晶体植入术，切除小梁2mm×2．5mm，剪除周边虹膜少许。巩膜瓣顶端间断缝合2针，侧面缝经角膜的调整缝线。间断缝合Tenon’s囊，结膜连续缝合。结果平均随访（7．36±4．64）个月，术后视力提高者46眼（63．89％），不变19眼（26．39％），下降7眼（9．27％）。术前平均眼压（28．67±10．69）／mm Hg（1mm Hg=0．133KPa）。术后随访期末眼压21mmHg以下66眼（91．67％），功能性滤过泡91．67％，非功能滤过泡6眼（8．33％）。并发症包括角膜水肿，浅前房、前房渗出等。结论超声乳化联合小梁切除及术中应用丝裂霉素、调整缝线是治疗青光眼合并白内障的有效方法。     

复合式小梁切除术的护理体会

目的：探讨联合应用抗代谢药物5-氟尿嘧啶（5-FU）和巩膜瓣可调节缝线的复合式小梁切除术的术前、术后护理方法及其效果。方法：通过对58例70眼的复合式小梁切除术患者，术前做好心理护理，加强全身护理与眼部护理，控制眼压，眼部清洁消毒。术后观察术眼视力、眼压、滤过泡、角膜、前房情况，局部用药与眼球按摩以促进功能性滤过泡的形成，有效控制眼压。出院指导与随访给患者提供健康教育。结果：本组58例70眼经有效的护理，均顺利实施手术，术中、术后无严重而持久的并发症，术后恢复理想，平均随访23个月，64眼维持功能性滤过泡，占91．43％，62眼眼压〈21mmHg。眼压控制有效率为88．57％，大部分患者能坚持较长期的随访复查。结论：对复合式小粱切除术患者进行积极的心理护理与青光眼相关的健康知识教育，为手术的顺利实施和术后康复提供了保障。     

虹膜角膜内皮综合征继发青光眼的手术治疗——附12例报告

目的：分析治疗虹膜角膜内皮综合征（ＩＣＥ综合征）继发青光眼的手术方法,以提高远期的手术成功率。方法：对ＩＣＥ综合征继发青光眼的１２例病人均采用滤过性手术治疗,其中７例行复合式小梁切除术,５例行前房引流管植入术,术后随诊观察眼压情况。结果：经过６～３０个月的随访。术后二个月时,眼压低于２．８ｋＰａ者１０例,总成功率为８３％;术后６个月以上,眼压低于２．８ｋＰａ者８例,成功率为７５％,术后并发症为短暂性前房出血、浅前房、脉络膜脱离。结论：尽管复合式小梁切除术及前房引流管植入术出现一些不可避免的并发症,但仍为ＩＣＥ综合症继发青光眼的有效治疗方法。     

可调节缝线及丝裂霉素C在青光眼小梁切除术中的应用与护理

目的:探讨小梁切除术中应用可调节缝线及丝裂霉素C治疗青光眼的疗效和护理方法。方法:将102例原发性闭角型青光眼患者随机分为对照组36例和实验组66例,对照组采用标准小梁切除术,实验组在小梁切除术中应用可调节缝线及丝裂霉素C。结果:实验组术后前房形成情况、滤过泡功能及长期降压效果均明显优于对照组(P<0.05)。结论:小梁切除术中应用可调节缝线及丝裂霉素C,可明显提高抗青光眼手术治疗效果,是治疗青光眼的有效方法。     

Latanoprost and Dorzolamide for the Treatment of Pediatric Glaucoma: The Glaucoma Italian Pediatric Study (Gipsy), Design and Baseline Characteristics

Introduction

To investigate the efficacy of a treatment strategy with latanoprost and dorzolamide in primary pediatric glaucoma patients partially responsive to surgery.

Methods

Single arm, prospective, interventional multicenter study. Primary pediatric glaucoma patients younger than 13 years after a single surgical procedure with IOP between 22 and 26 mmHg were considered eligible. At baseline, patients were allocated to latanoprost monotherapy once daily. Depending on intraocular pressure (IOP) reduction at first visit, the patients were allocated to one of three groups: continuation of latanoprost monotherapy, addition of dorzolamide twice daily, or switch to dorzolamide three times daily. The same approach for allocation in medication groups was used in all subsequent visits. Patients in the dorzolamide monotherapy group with IOP reduction <20% from baseline were considered non-responders and withdrawn. Study treatment and patient follow-up will continue for 3 years or until treatment failure. The primary endpoint is the percentage of responders. Secondary endpoints are time to treatment failure and frequency of adverse events.

Results

A total of 37 patients (69 eyes) were enrolled. The mean age was 4.0 ± 3.8 years, the female/male ratio was 1/1.7, and the majority of patients were Caucasian. Eighty percent of patients had bilateral glaucoma. Goniotomy was the most frequently performed surgery (38.6%), followed by trabeculotomy (22.8%), trabeculectomy (21.1%), and trabeculectomy plus trabeculotomy (17.5%). The baseline IOP was 23.6 ± 1.5 mmHg.

Conclusion

The study population is representative of patients frequently encountered after the first surgery for primary pediatric glaucoma. The study will produce evidence on the medium-term efficacy of a defined pharmacological approach.

     

小梁切除术+丝裂霉素C治疗青光眼的临床效果及对包裹囊状泡发生的影响

【目的】观察小梁切除术 丝裂霉素C(MMC)治疗青光眼对包裹囊状泡发生的影响。【方法】对64例均为单眼行抗青光眼手术,随机分为甲组(小梁切除术组)和乙组(小梁切除术 MMC组)各32例,术后随访6～18个月,对两组术后包裹囊状泡发生情况进行观察。【结果】64例青光眼患者中,甲组发生包裹囊状泡8例(25.0%),乙组4例(12.5%)(P<0.01)。【结论】小梁切除术联合应用MMC能有效减少抗青光眼手术包裹囊状泡的发生。     

Prospective,Unmasked Evaluation of the iStent® Inject System for Open-Angle Glaucoma: Synergy Trial

Introduction

Micro-invasive glaucoma surgical implantation of trabecular micro-bypass stents, previously shown to be safe and effective for open-angle glaucoma (OAG) subjects during cataract surgery, was considered for evaluation as a sole procedure. The aim of this study was to evaluate the safety and intraocular pressure (IOP)-lowering efficacy after ab interno implantation of two Glaukos Trabecular Micro-Bypass iStent inject second generation devices in subjects with OAG. This study was performed at sites in France, Germany, Italy, Republic of Armenia, and Spain.

Methods

In this pan-European, multi-center prospective, post-market, unmasked study, 99 patients with OAG on at least two topical ocular hypotensive medications who required additional IOP lowering to control glaucoma disease underwent implantation of two GTS400 stents in a stand-alone procedure. Patients were qualified if they presented with preoperative mean IOP between 22 and 38 mmHg after medication washout. Postoperatively, subjects were assessed at Day 1, Months 1, 3, 6, 7, 9, and 12. IOP, medication use and safety were assessed at each visit.

Results

Sixty-six percent of subjects achieved IOP ≤18 mmHg at 12 months without medication, and 81% of subjects achieved Month 12 IOP ≤ 18 mmHg with either a single medication or no medication. Mean baseline washout IOP values decreased by 10.2 mmHg or 39.7% from 26.3 (SD 3.5) mmHg to 15.7 (SD 3.7) mmHg at Month 12. Mean IOP at 12 months was 14.7 (SD 3.1) mmHg in subjects not using ocular hypotensive medications. Reduction from preoperative medication burden was achieved in 86.9% of patients, including 15.2% with reduction of one medication and 71.7% with reduction of two or more medications. Postoperative complications occurred at a low rate and resolved without persistent effects.

Conclusion

In this series, implantation of two trabecular micro-bypass second generation stents in subjects with OAG resulted in IOP and medication reduction and favorable safety outcomes.     

联合手术治疗晚期新生血管性青光眼的临床观察及护理

目的 回顾性总结复合式小梁切除术联合睫状体冷凝治疗晚期新生血管性青光眼的疗效及护理方法.方法 将58例晚期新生血管性青光眼分为实验组30例,对照组28例,实验组采用复合式小梁切除术联合睫状体冷凝术,并实施全身及眼科护理;对照组采用抗青光眼小梁切除术.结果 实验组的成功率高于对照组,两组比较有显著性差异(P＜0.05).结论 联合手术及抗代谢药物的应用,是一种治疗晚期新生血管性青光眼较有效的方法,而良好的综合护理,在提高治愈率的同时,能有效地减少术后并发症,减轻患者的痛苦,故是可行和值得推广的.