Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a longterm follow-up

PURPOSE: To study the outcome of viscocanalostomy (VC) and deep sclerectomy (DS) for the surgical management of medically uncontrolled glaucoma. PATIENTS AND METHODS: A non-randomized, prospective study of all consecutive non-penetrating glaucoma filtering procedures was carried out in two centres. In the first centre, one surgeon (MSW) performed VC in 105 eyes (27 VC and 78 phaco VC). In the second centre, one surgeon (PKW) performed DS in 87 eyes (52 DS and 35 phaco DS). RESULTS: The mean follow-up was 36 months (range 9-60 months). At final follow-up the complete success rate (intraocular pressure < or = 21 Hg without medication) was 92.6% for VC eyes, 96% for phaco VC eyes, 77% for DS eyes and 94% for phaco DS eyes. Kaplan-Meier survival analysis for complete success showed no significant difference between DS and VC nor between phaco VC and phaco DS (p > 0.05). By 36 months postoperatively, mean IOP was 16.8 mmHg (SD 3) in VC eyes, 16.6 mmHg (SD 3.1) in phaco VC eyes, 16.7 mmHg (SD 5.7) in DS eyes and 15 mmHg (SD 3.2) in phaco DS eyes. Postoperative Nd:YAG laser goniopuncture was necessary in 10 eyes in the DS group. Large or cystic drainage blebs occurred only in the DS eyes. CONCLUSIONS: Viscocanalostomy and DS are effective and safe methods of achieving sustained IOP reduction in glaucomatous eyes and both techniques can be successfully combined with cataract extraction.     

Mitomycin C‐augmented deep sclerectomy in primary open‐angle glaucoma and exfoliation glaucoma: a three‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36‐ month follow‐up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Results: Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). Conclusions: DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications.     

Mitomycin‐C‐augmented deep sclerectomy in patients with primary open‐angle glaucoma and exfoliation glaucoma: a 1‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in patients with primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Results: Preoperatively, the mean IOPs were 23.1 ± 5.8 and 25.4 ± 8.3 mmHg, and 13.8 ± 6.1 and 11.2 ± 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. Conclusion: DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.     

Combined phacoemulsification and goniotrephination in primary open-angle glaucoma and pseudoexfoliation glaucoma - a retrospective analysis

BACKGROUND: During the last few years combined cataract and glaucoma surgery is an established method to control intraocular pressure (IOP) and visual rehabilitation in patients with cataract and glaucoma. Despite this, there are currently only few data concerning the results of combined surgery for primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS: To study the course of PEXG and POAG with respect to IOP regulation and visual acuity, 100 eyes with POAG (72 patients) and 22 with PEXG (19 patients) were evaluated which underwent a combined phacoemulsification and goniotrephination between 1993 and 1997. All patients had no glaucoma or other ocular surgery before. The mean follow up after operation was 39.5 (range 16 - 72) months. RESULTS: The mean preoperative IOP in PEXG (31.8 +/- 10.3 mm Hg) was significantly higher than in the POAG group (25.3 +/- 6.4 mm Hg) (p=0.0004). At follow up IOP decreased to 16.7 +/- 2.8 mm Hg (POAG) and 15.1 +/- 4.0 mm Hg (PEXG) (p < 0.0001). The absolute IOP lowering effect was significantly better for PEXG than for POAG (p=0.0003). All patients received medical treatment before surgery, whereas at follow up 59.0 % (POAG) and 81.8 % (PEXG) were untreated. The median preoperative visual acuity for the POAG was 0.32 (PEXG 0.25), visual outcome 0,63 (PEXG 0.5). CONCLUSION: The combined cataract and glaucoma surgery is a successful method of IOP control and visual rehabilitation. It seems that there is a tendency for a better efficiency and an untreated IOP regulation after surgery for PEXG. Thereby early surgical intervention could be an advantage for this glaucoma entity.     

Efficacy of laser trabeculoplasty in phakic and pseudophakic patients with primary open-angle glaucoma.

BACKGROUND AND OBJECTIVE: To compare the efficacy of laser trabeculoplasty in pseudophakic and phakic patients with primary open-angle glaucoma (POAG). PATIENTS AND METHODS: Retrospective comparative case-control series of 42 eyes (21 pseudophakic eyes and 21 phakic eyes of patients matched for age and gender) with POAG not controlled using medical therapy and treated with laser trabeculoplasty. Success was reduction of intraocular pressure (IOP) of at least 3 mm Hg from baseline and no additional glaucoma surgery or laser treatment. uloplasty, there was no significant difference between pseudophakic and phakic eyes in the mean IOP and change from baseline IOP Success at 12 months was 78% for pseudophakic and 80% for phakic eyes. Kaplan-Meier survival analysis showed no statistically significant difference in success after laser trabeculoplasty comparing phakic to pseudophakic eyes (P = .87). CONCLUSION: In eyes with POAG, laser trabeculoplasty is as effective in pseudophakic eyes as in phakic eyes.     

维吾尔族假性剥脱综合征患者角膜内皮形态学分析

目的：:对比分析维吾尔族假性剥脱综合征（PEX）、剥脱综合征性青光眼（PEXG）、原发性开角型青光眼（POAG）及年龄相关性白内障（ARC）角膜内皮形态学差异。方法：:回顾性病例对照研究。选取2019年7月至2020年8月在中国人民解放军新疆军区总医院全军眼科中心就诊治疗的维吾尔族PEX患者76例（76眼）,PEXG患...     

Phacoviscocanalostomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma

Objective: To compare the outcome of phacoviscocanalostomy in Pseudoexfoliation glaucoma (PEXG) versus that in primary open-angle glaucoma (POAG).Design: Prospective comparative study.Participants: Sixty eyes of 60 patients who underwent phacoviscocanalostomy for cataract and medically uncontrolled PEXG (30 eyes) or POAG (30 eyes).Methods: Success rate was based on intraocular pressure (IOP) reduction and need for antiglaucoma medication. Visual acuity (VA) and complication rates were secondary outcomes.Results: The mean follow-up was 19.7 months (range, 12–36 months). The mean IOP values in both groups were significantly less than the preoperative values at all postoperative intervals (p < 0.001). From 1 month onward, the decrease in IOP was more dramatic in PEXG eyes than in POAG eyes (p < 0.05). At last visit, the mean percentage of IOP reduction was 49.7% in the PEXG group and 30.9% in the POAG group. All study eyes required decreased antiglaucoma medications and showed improved VA postoperatively. Transient complications included Descemet's membrane microperforations, macroperforation, zonular dehiscence, and postoperative IOP spike. No eyes developed trabeculectomy-type bleb, hyphema, fibrin exudation, or bleb-related complications.Conclusions: Phacoviscocanalostomy achieved excellent IOP control and VA improvement in both PEXG and POAG groups. PEXG demonstrated greater IOP reduction and fewer postoperative medications than POAG. The complication rate was low and did not affect surgical outcome. Phacoviscocanalostomy can be an effective and safe surgical alternative to phacotrabeculectomy in both groups of patients.     

Results of combined phacoemulsification and viscocanalostomy in patients with cataract and pseudoexfoliative glaucoma

PURPOSE: Coexisting pseudoexfoliation glaucoma (PEXG) and cataract represents a special challenge. Although phacotrabeculectomy is an effective procedure, it combines the risks of phacoemulsification and trabeculectomy. This study evaluates phacoviscocanalostomy to manage eyes with PEXG and cataract. METHODS: We conducted a prospective noncomparative study that included 30 consecutive eyes of 22 patients with uncontrolled PEXG and cataract. Phacoviscocanalostomy was performed in all. Success rate based on postoperative intraocular pressure (IOP) reduction and requirement for topical antiglaucoma medication was evaluated as the main outcome measure. Visual acuity and complication rates were secondary outcomes. RESULTS: The mean follow-up was 18.6 months +/-6.2 (SD) (range 12 to 36 months). There was statistically significant decrease in mean IOP from 25.3+/-5.2 mmHg preoperatively to 13.5+/-6.0 mmHg 1 day after surgery (p< .05), 12.3+/-3.1 mmHg at the final follow-up (p< .05), and at all evaluations to the last postoperative visit. Only three eyes (10%) required a single antiglaucoma medication to achieve the target IOP. A complete surgical success (IOP <21 mmHg without medication) was achieved in 90%, while a qualified success (IOP <21 mmHg with or without glaucoma medication) was achieved in 100% of cases. Complications included Descemet membrane microperforations (13.3%), macroperforation (3.3%), zonular dehiscence (6.6%), and transient postoperative IOP spike (3.3%). CONCLUSIONS: Phacoviscocanalostomy achieved excellent IOP control and visual acuity improvement in pseudoexfoliation patients with coexisting cataract and glaucoma. Complication rate was low and did not affect the surgical outcome.     

Deep sclerectomy for the treatment of exfoliation and primary open-angle glaucoma

PURPOSE: To retrospectively compare the efficacy of deep sclerectomy in the treatment of primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG). METHODS: Deep sclerectomy with either collagen or hyaluronate implants was performed in 31 eyes (45%) with POAG and 38 eyes (55%) with ExG. Pre- and postoperative intraocular pressure (IOP) was recorded, as was the number of glaucoma medications used pre- and postoperatively in each group. The follow-up data referred to a mean period of 18 months (range: 2 weeks to 36 months). RESULTS: At 18 months, complete success had been achieved in 56.3% of POAG eyes and 44.9% of ExG eyes. Qualified success had been achieved in 83.1% and 71.6% of POAG and ExG eyes, respectively. The mean IOP was 18.6 mmHg in POAG eyes and 16.3 mmHg in ExG eyes. YAG-descemetotomies were performed in nine eyes in each group. There were no statistically significant differences between the groups in IOP (except at 1 week postoperatively in favour of POAG; p = 0.05), success rates, need for postoperative glaucoma medication or number of complications. Reoperations were required in three (10%) POAG eyes and seven (18%) ExG eyes. CONCLUSIONS: Deep sclerectomy is equally effective in controlling IOP in both POAG and ExG and has low rates of serious complications, even when the surgeon is inexperienced in the technique. Both survival rates and IOP control were similar between the groups, and there were no serious intra- or postoperative complications.     

Matrix metalloproteinases and their inhibitors in aqueous humor of patients with pseudoexfoliation syndrome/glaucoma and primary open-angle glaucoma

PURPOSE: To determine the presence, activity, and quantitative differences of matrix metalloproteinases (MMPs) and their endogenous inhibitors (TIMPs) in aqueous humor and serum samples of patients with pseudoexfoliation (PEX) syndrome, PEX glaucoma (PEXG), primary open-angle glaucoma (POAG), and cataract. METHODS: Aqueous humor and serum samples were collected from 100 patients with PEX syndrome, PEX glaucoma (PEXG), POAG, and cataract, respectively. Levels of MMP-1, -2, -3, -7, -9, and -12 and TIMP-1 and -2 were determined by zymography, Western blot analysis, and specific immunoassays. Activity assay kits were used to quantitate levels of endogenously activated MMP-2 and -9. RESULTS: MMP-2, -3, -7, -9, and -12 and TIMP-1 and -2 were identified in human aqueous humor samples from all groups of patients with a six to sevenfold molar excess of TIMPs over MMPs. Whereas serum samples showed no significant differences, total MMP-2 and -3 and TIMP-1 and -2 were detected at significantly higher concentrations in aqueous samples from PEX eyes with and without glaucoma compared with cataractous eyes. MMP-2 and -3 and TIMP-1 were also detected in higher, but not significantly different, amounts in aqueous samples of POAG eyes. However, levels of endogenously activated MMP-2 were significantly decreased in both PEX and POAG samples. The ratio of MMP-2 to its principal inhibitor TIMP-2 was balanced in cataract samples, but was decreased in samples from patients with PEXG, resulting in an excess of TIMP-2 over MMP-2. CONCLUSIONS: The findings suggest that complex changes in the local MMP-TIMP balance and reduced MMP activity in aqueous humor may promote the abnormal matrix accumulation characteristic of PEX syndrome and may be causally involved in the pathogenesis of both PEX glaucoma and POAG.     

Comparative evaluation of diode laser trabeculoplasty vs frequency doubled Nd : YAG laser trabeculoplasty in primary open angle glaucoma

AIMS: To evaluate the efficacy of diode laser trabeculoplasty (DLT) and frequency doubled Nd : YAG laser trabeculoplasty (YLT) in primary open angle glaucoma (POAG). METHODS: A total of 52 eyes of 35 patients with POAG were included. In all, 25 eyes underwent DLT (Group I) and 27 eyes underwent YLT (Group II). IOP, gonioscopy and visual fields were evaluated before and 3, 6, and 9 months and 1 year after the laser. An IOP<21 mmHg without medications or a decrease in the number of glaucoma medications with no progression of disc and field changes was considered a success. RESULTS: The mean age of patients in Group I was 57.72+/-8.1 years and the patients in Group II had a mean age of 59.85+/-7.76 years. The mean prelaser IOP was 24.93+/-1.49 mmHg and 25.36+/-1.57 mmHg. The mean IOP after DLT at 12 months follow-up was 18.0+/-0.93 mmHg and after YLT was 18.6+/-1.52 mmHg. The reduction of IOP was statistically significant in both the groups at 3, 6, 9, and 12 months (P<0.001), however there was no significant difference between the two groups. Success rates in both groups were similar, 92% in Group I and 92.6% in Group II. CONCLUSIONS: DLT and Fd YLT are equally effective in controlling IOP in eyes with POAG.     

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. Methods: Yearly diurnal measurements of intraocular pressure (IOP), best‐corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti­mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. Results: Sixty‐four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to ≤21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two‐line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. Conclusions: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.     

Pathophysiologic changes in the optic nerves of eyes with primary open angle and pseudoexfoliation glaucoma

PURPOSE: To determine whether differences in the optic nerve occur in eyes with primary versus secondary open-angle glaucoma. METHODS: Optic nerves obtained at autopsy from 36 eyes with primary open-angle glaucoma (POAG) and 15 with pseudoexfoliation glaucoma (PEXG) were studied quantitatively and qualitatively. Axon counts, fibrosis, capillary number and density, and arteriosclerotic changes were assessed in the postlaminar optic nerve and compared to normal age-matched autopsy eyes. Changes in composition of extracellular matrix components were evaluated by immunohistochemistry and electron microscopy. RESULTS: Marked differences were found between POAG and PEXG. Axon loss in eyes with POAG but not in PEXG was associated with increasing connective tissue in the septa and surrounding the central retinal vessels, including increased amounts of type IV and VI collagen. The total number of capillaries decreased with the loss of axons in both POAG and PEXG. POAG nerves, however, had a decrease in the density of capillaries, whereas in PEXG the capillary density did not change with axon loss. Arteriosclerotic changes were more common in glaucomatous eyes than in age-matched control eyes. CONCLUSIONS: The difference in morphology of the optic nerves between POAG and PEXG indicates that in eyes with POAG, elevated IOP cannot be the only pathogenetic factor in glaucomatous optic neuropathy. Additional factors, inducing fibrosis and loss of capillaries, seem to be involved. Such additional factors may also contribute to the clinical finding in POAG that nerves can become damaged without elevation of intraocular pressure.     

Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract

Background: In the present prospective randomized study the effectiveness and safety of trabecular aspiration combined with clear cornea phacoemulsification (phaco) was compared to clear cornea phaco alone in patients with pseudoexfoliation (PEX) glaucoma and visually disabling cataract. Methods: Twenty-seven patients suffering from visually significant cataract (visual acuity <5 Snellen lines) and PEX glaucoma were randomly assigned to either phaco combined with trabecular aspiration (14 eyes of 14 patients) or phaco alone (13 eyes of 13 patients). Inclusion criteria for glaucoma were IOP ≤22 mmHg under treatment with up to two antiglaucomatous agents, excluding pilocarpine 4%, and no previous surgery or laser trabeculoplasty treatment. Clear cornea phaco with foldable acrylic intraocular lens (IOL) implantation was carried out in all patients uneventfully. Trabecular aspiration was performed using a special probe in the inferior 180 deg of the angle after IOL implantation. Results: Follow-up duration ranged from 12 to 18 months. In the combined procedure group there was a statistically significant decrease in postoperative IOP during the whole follow-up period (P<0.01), while in 9 of the 14 patients the IOP was controlled without medications at the last examination. In the phaco alone group a statistically significant decrease in postoperative IOP was recorded at 9 and 12 months after surgery (P<0.05), while in 4 of the 13 patients the IOP was controlled without medications at the last examination. Comparing the two groups, a statistically significantly lower number of medications was being used in the combined procedure group at the last recorded examination (P<0.05). Conclusions: It seems that the combined clear cornea phaco and trabecular aspiration procedure in cases of PEX glaucoma associated with cataract is a safe and effective method. This technique controls IOP more effectively and with fewer postoperative medications than clear cornea phaco alone. Received: 24 February 2000 Revised: 26 April 2000 Accepted: 27 April 2000     

Rates of visual field progression in clinical glaucoma care

Purpose: To investigate rates of visual field progression and factors associated with progression rate in open‐angle glaucoma in clinical glaucoma care. Methods: We performed a retrospective chart review of all patients with manifest primary open‐angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) followed ≥ 5 years with ≥5 SITA Standard fields. Exclusion criteria were minimal. Demographics, intraocular pressure values (IOP), treatment and treatment changes, and visual field (VF) data were recorded. VF progression rates were calculated as slopes of mean deviation (MD) over time. Results: Five hundred and eighty‐three patients were eligible. Three hundred and sixty‐seven (62%) had POAG and 221 (38%) PEXG. Median MD at study start was ?10.0 dB. Mean follow‐up time was 7.8 years (SD ± 1.2); mean number of VF tests was 8.9 (SD ± 2.8). Progression rates varied very much among patients with a mean of ?0.80 dB/year (SD ± 0.82; median rate, ?0.62), and 5.6% of patients progressed at rates worse than ?2.5 dB per year A negative slope of MD values was observed in 89% of patients. Mean IOP of all visits decreased over the study period from 20.15 to 18.10 mmHg. Higher age and mean IOP, and more intensive treatment were associated with more rapid progression, while PEXG and IOP variation were not, if treatment intensity was taken into account. Conclusion: Rates of visual field progression in manifest glaucoma with field loss in ordinary clinical care were highly variable. Progression rates rapid enough to influence quality of life were common.     

Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma

PURPOSE: To compare the longterm results in pseudoexfoliative glaucoma and primary open-angle glaucoma (POAG) following deep sclerectomy with implant. METHODS: A total of 28 pseudoexfoliative glaucoma eyes and 27 POAG eyes were consecutively included in the study. Intraocular pressure (IOP) and number of glaucoma medications were compared before surgery and at every postoperative visit. Most patients included had very advanced glaucoma and were using multiple therapies (mean 3.3 and 3.6 in the pseudoexfoliative glaucoma and POAG groups, respectively) and the duration of the disease was more than 8 years in both groups. The definition of complete success was the achievement of IOP < 19 mmHg without therapy. RESULTS: After a mean follow-up time of 45 months in the pseudoexfoliative glaucoma group and 43 months in the POAG group, 50.0% of the pseudoexfoliative glaucoma group were considered to represent complete success compared with 33.3% of the POAG group (NS). In survival analyses controlling for covariates, it was found that patients with pseudoexfoliative glaucoma had a higher rate of success over time than POAG patients (p = 0.014). Furthermore, the duration of glaucoma prior to surgery had a negative influence on the success rate (p = 0.034). Four years after surgery, the mean IOP was 15.5 +/- 5.3 mmHg in the pseudoexfoliative glaucoma group and 13.6 +/- 3.5 mmHg in the POAG group (NS). The mean number of medications used by each group at that time was 1.7 +/- 1.5 and 1.2 +/- 1.1, respectively (NS). CONCLUSION: The present study suggests that deep sclerectomy is a safe procedure in pseudoexfoliative glaucoma. Half of the patients were regulated without therapy after 45 months.     

改良的黏弹剂Schlemm管切开术治疗原发性开角型青光眼的临床研究

目的观察改良的黏弹剂Schlemm管切开术（VCO）和小梁切除术（TE）治疗原发性开角型青光眼的疗效和安全性。方法采用前瞻性随机对照方法,对100例（100只眼）药物控制眼压不理想的原发性开角型青光眼患者,随机分为改良VCO组50例（50只眼）,TE组50例（50只眼）,术后平均随访28个月。结果手术后1个月,改良VCO组和TE组患者的平均眼压分别为（11．22±4．34）和（12．35±3．79）mmHg（1mmHg=0．133kPa）,手术成功率（术后未用任何降眼压药物眼压〈21mmHg）均为98．0％;手术后12个月,两组的平均眼压分别为（14．50±3．22）和（16．58±4．73）mmHg,手术成功率分别为87．5％和70．0％,两组差异有统计学意义（P〈0．05）;手术后24个月,两组的平均眼压分别为16．0和15．4mmHg,手术成功率分别为76．1％和67．3％,两组差异无统计学意义（P〉0．05）;早期并发症如浅前房、脉络膜脱离、囊样滤过泡等以TE组明显多于改良VCO组,两组差异有统计学意义（P〈0．01）。结论在治疗原发性开角型青光眼方面,改良VCO组的成功率较TE组高．术后早期并发症相对较少.     

Intraocular pressure response of capsular glaucoma and primary open-angle glaucoma to selective Nd:YAG laser trabeculoplasty: a prospective,comparative clinical trial

PURPOSE: To compare the intraocular pressure (IOP) response of uncontrolled capsular glaucoma (CG) and primary open-angle glaucoma (POAG) to selective laser trabeculoplasty (SLT) in a prospective clinical trial. METHODS: Ten eyes often patients suffering from uncontrolled CG (CG Group) and ten eyes of ten patients with uncontrolled POAG (POAG Group) were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The baseline characteristics were similar in both groups. IOP was measured before and 1 day, 1 week, 1 month and 3, 6, 9, 12, 15 and 18 months after treatment. Success was defined as IOP more than 20% lower than before treatment. Any change of hypotensive medication led to the subjects' exclusion from the study. The two groups were compared using the independent-sample t test for continuous variables and the log-rank test for survival analysis. A value of p<0.05 was considered significant. RESULTS: The mean follow-up was 12.0 months (SD 5.5) for the CG group and 13.5 months (SD 4.3) for POAG (n.s.). No significant difference was found between the two groups for mean pretreatment IOP (23.6 mmHg +/- 5.70 in the CG group and 22.8 mmHg +/- 2.44 in the POAG group) or for mean IOP and mean IOP reductions during the follow-up. At all follow-up visits, IOP was reduced less in the CG group than in the POAG group (24.8% +/- 11.15 vs. 27.7% +/- 9.91 at 6 months, 22.0% +/- 6.66 vs. 30.6% +/- 6.35 at 12 months, and 31.4% +/- 5.55 vs. 35.1% +/- 1.75 at 18 months), but the difference was significant only at 12 months. Kaplan-Meier survival analysis gave an 18-month success rate of 64% in the CG group and 78% in the POAG group, with no significant differences between the groups. CONCLUSIONS: SLTis an effective procedure forlowering IOP in CG and POAG eyes, although the effect seems to last less in CG eyes.     

Crete, Greece glaucoma study

PURPOSE: To investigate the prevalence of primary open-angle glaucoma (POAG) in a randomized sample of the inhabitants of the island of Crete. PATIENTS AND METHODS: In 18 different villages in all four prefectures of the island of Crete, patients were randomly selected from 1993 through 1998, and an in situ study was accomplished. The sampling fraction (covered by the 1991 census) in each village was approximately 5%. Patients were considered to have POAG when the morphologic aspect of a glaucomatous optic disc was present, and/or a nerve fiber layer defect and a visual field defect was present. The presence of Pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (PEXG) was also investigated. RESULTS: The prevalence of glaucoma in Crete was 2.80%. Of those diagnosed with POAG, 9.67% had an intraocular pressure (IOP) under 21 mm Hg, and 25.80% had PEX. The prevalence of simple ocular hypertension without glaucoma was found in 6.58% of the patients. The ratio of subjects with hypertensive glaucoma to those with simple ocular hypertension was 1:2.6. CONCLUSION: The prevalence of POAG and exfoliation glaucoma appears to be quite high in Crete. Further research will be needed to set more accurate criteria for earlier diagnosis and to enable more efficient organization of the health care system.     

Deep sclerectomy in patients with capsular glaucoma

PURPOSE: To compare the results of deep sclerectomy in capsular glaucoma (CG) with those in primary open-angle glaucoma (POAG). METHODS: This consecutive, prospective study comprised 24 CG patients (28 eyes) and 25 POAG patients (29 eyes) who underwent deep sclerectomy. Two different implants were used: either an absorbable collagen implant (Aqua-Flow) or a non-absorbable hydrophilic acrylic implant (T-Flux). The number of glaucoma medications, intraocular pressure (IOP) and complications were compared postoperatively. The definition of complete success was IOP below 19 mmHg without therapy. RESULTS: After a mean follow-up of 19.9 +/- 10.9 months (range 6-36 months) in the CG group and 16.2 +/- 10.0 months (range 6-36 months) in the POAG group, complete success was seen in 60.7% and in 37.9% of eyes, respectively (p=0.085). After adjustments for disparities in baseline characteristics, survival analysis demonstrated that success rates were better over time in CG eyes than in POAG eyes (p=0.038). At all time-points, except at 24 months, the IOP was lower in the CG group than in the POAG group. This difference was statistically significant at 1 week (p=0.050) and 3 months (p=0.006). At 18 months, the mean decrease in number of medications was 77.3% in the CG group and 65.9% in the POAG group (not statistically significant). Levelled hyphema occurred more frequently in CG eyes (35.7%) than in POAG eyes (13.8%). CONCLUSION: Capsular glaucoma patients had significantly higher success rates over time than POAG patients following deep sclerectomy with implant.