Effect of rigid gas permeable contact lens on keratoconus progression: a review

The prevalence of keratoconus is 1/2000 in the general population and is high in adolescents. Keratoconus is a progressive disease, which has a great impact on patients’ quality of life and mental health. It can be managed by surgical and non-surgical means, rigid gas permeable (RGP) contact lens as its main non-surgical method is widely used in clinic. The efficacy of wearing RGP contact lens has been confirmed to some extent, but some studies have found that wearing RGP contact lens has adverse effects, which may promote disease progression. In this paper, the advantages and disadvantages of RGP contact lens in controlling keratoconus were reviewed to provide more suggestions and references for the clinical application of RGP contact lens.     

前房穿刺与调节缝线联合丝裂霉素在青光眼小梁切除术中的应用

目的 探讨前房穿刺与调节缝线在青光眼小梁切除术中的应用及疗效。方法采用前房穿刺与调节缝线小梁切除术对26例急性闭角型青光眼、18例慢性闭角型青光眼、6例开角型青光眼、7例难治性青光眼共57例77眼进行了6个月至18个月的随访观察。结果术后视力较术前提高1～2行者4眼，术后视力不变67眼，下降1～2行6眼；出院时眼压平均在12．26mmHg左右，两周平均眼压为13．26mmHg左右，6～18个月眼压平均为15．69mmHg左右。无一例术后出现持续性浅前房。结论前房穿刺与调节缝线联合丝裂霉素行小梁切除术能有效地降低眼压，控制术后浅前房，提高了手术成功率，是一种安全有效的青光眼滤过手术方法。     

Keratograph 5M眼表综合分析仪观察小梁切除术后泪膜的早期变化

目的：运用Keratograph 5 M眼表综合分析仪观察小梁切除术后泪膜的早期变化。方法：收集青光眼患者41例46眼,分别于小梁切除术前1d,术后1d;1wk;1mo 行第一次泪膜破裂时间( first tear break up time,FTBUT)、平均泪膜破裂时间( average tear break up time,ATBUT)、非侵入式泪河高度( non-invasive tear meniscus height,NITMH)、脂质层厚度分级及睑板腺完整度评分检查。结果：与术前1 d 相比,术后1 d;1 wk;1 mo 的 FTBUT、ATBUT缩短(P<0.05),脂质层变薄(P<0.017)。术后1d的NITMH高于术前1d,而术后1wk和1mo的NITMH低于术前1d(P<0.05)。睑板腺完整度评分手术前后差异无统计学意义(P>0.05)。结论：Keratograph 5 M眼表综合分析仪可以快速、精确地评估泪膜的功能。青光眼小梁切除术在术后短期内可对泪膜的稳定性及泪液的分泌量产生不良影响。     

隧道刀制作双层巩膜瓣的青光眼小梁切除术后疗效观察

目的：：探讨隧道刀制作双层巩膜瓣并切除层间巩膜瓣的青光眼小梁切除术的临床疗效。方法：采用随机分组方法,将46例60眼青光眼患者分为治疗组24例32眼和对照组22例28眼。前者用隧道刀制作双层巩膜瓣,浅层巩膜瓣大小约为5mm×5.5mm,1/3巩膜厚度,瓣下再做一大小约3.5mm×4mm的巩膜瓣,1/3巩膜厚度,切除中间层的巩膜瓣,切除2mm×2mm小梁组织,常规行虹膜周边切除,可调节缝线缝合浅层巩膜瓣,缝合球筋膜、球结膜;后者行常规青光眼小梁切除术。结果：术后随访1a,治疗组视力明显优于对照组,两组比较差异有统计学意义(P<0.05)。两组患者术后眼压均明显低于术前眼压。术后1,3 mo时,两组患者的眼压比较差异无统计学意义(P>0.05),但术后6,12mo检查发现,治疗组患者的眼压明显低于对照组,差异有统计学意义(P<0.05)。术后1a治疗组和对照组的累积完全成功率分别为90.63％和75％,两组的累积条件成功率分别为96.88％和89.29％,两组比较差异有统计学意义(均P<0.05)。结论：隧道刀制作双层巩膜瓣并切除层间巩膜瓣的小梁切除术降眼压效果好,巩膜瓣厚薄均匀、表面光滑,滤过泡功能维持时间长,术后并发症少,适用于多种类型的青光眼,值得临床推广。     

两种术式治疗早期慢性闭角型青光眼的远期疗效

目的：评价激光周边虹膜切除术和小梁切除术在治疗早期慢性闭角型青光眼的远期疗效。
　　方法：对98例102眼早期慢性闭角型青光眼患者,随机分为A组50例54眼行周边虹膜切除术和B组48例48眼行小梁切除术。追踪观察3~8a,比较两组术后视力、眼压、前房角、视野及杯/盘比值的变化情况。
　　结果：A 组视力下降24眼,眼压>21 mmHg (1 mmHg=0.133kPa)者22眼,房角粘连>180°21眼,视野缩小21眼,C/D扩大21眼;B组依次为10眼,5眼,4眼,4眼和4眼,两组比较差异有统计学意义(P<0.05)。
　　结论：早期慢性闭角型青光眼手术治疗,可取得良好的疗效,远期疗效小梁切除术明显优于虹膜周边切除术。     

Evaluation of ExPress glaucoma filtration device in Indian patients with advanced glaucoma

ExPress glaucoma filtration device (GFD) has recently become available in India as a surgical option for glaucoma patients. We retrospectively evaluated the outcome of ExPress GFD in 12 eyes with advanced glaucoma with intraocular pressures (IOPs) not controlled on maximal tolerable medical therapy. The mean preoperative IOP of 29.58 ± 7.13 mmHg decreased to 17.0 ± 2.67 and 17.40 ± 0.89 mmHg at 6 and 12 months after surgery. Absolute success (IOP ≤ 18 mmHg, with no additional glaucoma medications) was achieved in eight cases (66.7%) and qualified success (IOP ≤ 18 mmHg, with additional glaucoma medications) in two cases (16.7%) at 1-year after surgery. Early intervention was needed in 4 patients; two underwent anterior chamber reformation while the other two required needling. Two patients required resurgery. There was no significant change in the best corrected visual acuity postoperatively (P = 0.37). ExPress GFD does not seem to offer a benefit over standard trabeculectomy in patients with advanced glaucomatous disease in terms of IOP control or complication rate. However, due to the small sample size with a heterogeneous mixture of primary and secondary glaucoma''s, we await further studies with a larger sample size and long-term follow-up, to see how the device performs.     

复合式小梁切除术治疗原发性慢性闭角性青光眼效果探讨

目的：探讨和分析采用复合式小梁切除术对原发性慢性闭角性青光眼患者进行临床治疗的情况和效果。方法随机抽选68例原发性慢性闭角性青光眼患者,根据抽签法对他们进行平均分组(对照组和观察组)分方法(传统小梁切除术和复合式小梁切除术)治疗,并对两组患者的治疗效果进行统计、对比以及分析。结果经过一年的治疗后观察组患者的眼压、临床总有效率以及并发症发生率都比对照组的患者要显著,比较差异有统计学意义(P<0.05)。结论对原发性慢性闭角性青光眼患者采用复合式小梁切除术的疗效显著,并发症少,术后恢复好,因而,它是一种科学、有效、理想、安全的临床治疗方法。     

XEN® implant and trabeculectomy medium-term quality of life assessment and comparison of results

AIM: To evaluate and compare the quality of life of patients submitted to XEN® implant or trabeculectomy and the relationship with potentially involved variables. METHODS: A cross-sectional study of patients with advanced open-angle glaucoma who underwent implantation of XEN® (group 1) and trabeculectomy (group 2) between October 2015 and February 2017. The studied variables were: age, gender, follow-up time, need of topical anti-hypertensive therapy, visual acuity and intraocular pressure (IOP). The quantification of the quality of life was attained through the Glaucoma Symptom Scale (GSS) questionnaire. RESULTS: Totally 34 eyes (34 patients) were included, 17 in each group. The mean GSS scores for group 1 were 42.6±6.8 (median, 47; p25, 36.5; p75, 48.5) and for group 2 it was 41.6±7.0 (median, 43; p25, 36.5; p75, 47.0; P=0.34). There was a strong negative correlation between the need for topical anti-hypertensive drugs and the GSS result in both groups (r=-0.88, P<0.01, r=-0.59, P=0.01, respectively) and a moderate negative correlation with IOP in group 1 (r=-0.50, P=0.03). CONCLUSION: The analysis demonstrates the non-inferiority of medium-term quality of life of one group in relation to the other (XEN® implant and trabeculectomy). The number of topical anti-hypertensive drugs and IOP negatively influenced the quality of life.     

Viscoless Manual Small Incision Cataract Surgery with Trabeculectomy

Purpose: To compare the efficacy of combined manual small incision cataract and glaucoma surgery with anterior chamber maintainer (ACM) alone versus that with intraoperative viscoelastics. Methods: Hospital electronic medical records of patients who underwent small incision cataract and trabeculectomy and intraocular lens implantation without Mitomycin-C from 2014 to 2016 were identified from the hospital operation theater database for this retrospective, hospital-based comparative study. All MSICS surgeries were performed by a single surgeon under peribulbar block. Data retrieved from all patients undergoing surgery with viscoelastic (group 2) or under AC maintainer without viscoelastic (group 1) included preoperative visual acuity, preoperative treated intraocular pressure, number of anti-glaucoma medications before surgery, total surgical time, intraoperative complications, postoperative best-corrected visual acuity and IOP at one week and one month, need for additional procedures, and corneal clarity. Differences in surgical time and postoperative course in both groups were compared. Results: Of 268 manual combined cataract and glaucoma surgeries done from 2014–2016, we identified 147 eyes of 130 age-matched patients, which included 51 PACG, 50 POAG, 12 NTG, and 24 PXG eyes with a mean age of 66 ±11.2 years and 64± 10.8 years in group 2 (n=74) and group 1 (n=73), respectively; p=0.9. The surgical time was significantly lower in group 1 (16±4.8 minutes compared to 44±14.6 minutes for group 2; p<0.001) with transient edema seen <1 week after surgery in 24 eyes of group 2 and seven eyes of group 1; p=0.02. The postoperative IOP at all postoperative visits dropped to >50% in both groups with 11 eyes (PXG n=6, PACG n=5) requiring medications for rise in intraocular pressure at a median time of 1.2 months (r=0.2–3 months). The final visual acuity improved >4 snellen lines in all cases with two patients with advanced damage having 1 line improvement in Snellen acuity at final follow-up. Conclusion: The ACM can help completely avoid the use of viscoelastic during surgery, which can be an effective technique for MSICS with trabeculectomy in low resource stings. Training for such procedures should be incorporated into residency training programs.     

青光眼小梁切除术后前房形成延缓的临床观察

目的探讨青光眼复合小梁切除术与单纯小梁切除术后前房形成延缓的原因和对策。方法实验组30眼行复合小梁切除术，对照组28眼行单纯小梁切除术，比较两组术后眼压及前房形成延缓的情况。结果两组术后眼压控制差异无显著性，但实验组术后浅前房的发生率明显低于对照组，差异有显著性垆〈0．05）。结论复合小梁切除术控制前房形成延缓优势明显。