Comparison of surgical outcomes of combined viscocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery

PURPOSE: To compare the outcomes of combined viscocanalostomy, phacoemulsification, and intraocular lens (IOL) implantation with combined trabeculotomy, phacoemulsification, and IOL implantation in patients with primary open-angle glaucoma (POAG).DESIGN: Nonrandomized clinical trial.METHODS: Fifty-seven eyes (57 POAG patients) that underwent viscocanalostomy, phacoemulsification, and intraocular lens (IOL) implantation between March 2000 and April 2001 and were followed for over 6 months postoperatively comprised the viscocanalostomy (VCS) group. Fifty-seven of 105 eyes (105 POAG patients) that underwent trabeculotomy, phacoemulsification, and IOL implantation between April 1995 and February 2000 and were followed for over 6 months and < 2 years comprised the trabeculotomy (LOT) group. The reductions of postoperative intraocular pressure (IOP) and antiglaucoma medication use in both groups were compared. Best-corrected visual acuity (VA) and complication rates were secondary outcomes. The success probabilities related to postoperative IOP level in both groups were evaluated by Kaplan-Meier life-table analysis with log-rank test.RESULTS: Significant reductions of IOP and antiglaucoma medication use occurred in both groups up to 1 year postoperatively, but were not significantly different between the two groups. The success probabilities of the VCS group for IOP control under 21, 17, and 15 mm Hg were 95%, 74%, and 44%, respectively, at 6 months, 95%, 67%, and 32% at 1 year, and not significantly different from the LOT group. All eyes in the VCS group had VA equal to or better than baseline 3 months postoperatively. The incidences of postoperative fibrin reaction (14 eyes, 25%) and microperforations of the Descemet membrane (14 eyes, 25%) in the VCS group were higher than in the LOT group (P =.0004 and P <.0001, respectively).CONCLUSIONS: Intraocular pressure reduction and VA improvement after the two procedures were similar in Japanese patients with POAG and cataract.     

Relation between office intraocular pressure and 24-hour intraocular pressure in patients with primary open-angle glaucoma treated with a combination of topical antiglaucoma eye drops

PURPOSE: To determine the relation between office intraocular pressure (IOP) and 24-hour IOP in patients with primary open-angle glaucoma (POAG) treated with 3 kinds of antiglaucoma eye drops. PATIENTS AND METHODS: Subjects were 42 patients with POAG (71 eyes). All were being treated with 3 different topical antiglaucoma eye drops (latanoprost, beta-blocker, and carbonic anhydrase inhibitor). Twenty-four-hour IOP values were obtained in the sitting position with a Goldmann applanation tonometer at 3-hour intervals. RESULTS: Maximum 24-hour IOP (mean+/-SD) was 19.76+/-5.65 mm Hg, minimum 24-hour IOP was 13.06+/-4.75 mm Hg, mean 24-hour IOP was 16.30+/-4.90 mm Hg, and 24-hour IOP fluctuation was 6.70+/-2.81 mm Hg. Office IOP was 16.23+/-4.58 mm Hg, and office IOP fluctuation was 2.75+/-1.68 mm Hg. There was no significant difference between office IOP and mean 24-hour IOP (P=0.93). There was no correlation between office IOP and 24-hour IOP fluctuation (r=0.15; P=0.25) or between office IOP fluctuation and 24-hour IOP fluctuation (r=0.19; P=0.17). Maximum 24-hour IOP occurred during office hours in 22 eyes (33.8%). The frequency of maximum 24-hour IOP occurring during office hours was significantly less than that of minimum 24-hour IOP (P<0.001). CONCLUSIONS: In POAG patients treated with 3 kinds of antiglaucoma eye drops, office IOP was similar to mean 24-hour IOP. However, it was difficult to estimate 24-hour IOP fluctuation and maximum 24-hour IOP on the basis of office IOP.     

Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery

PURPOSE: To determine the factors that control intraocular pressure (IOP) after trabeculotomy combined with phacoemulsification and intraocular lens implantation as an initial procedure in adults with primary open-angle glaucoma (POAG). METHODS: A consecutive series of 141 eyes with POAG or ocular hypertension was prospectively recruited. One hundred five eyes were treated by combined trabeculotomy and cataract surgery (TPI group) and 36 eyes were treated by cataract surgery alone (PI group). The prognostic factors that correlate with successful IOP control after surgery were screened using the Cox multivariate analyses based on three definitions of success: IOP <21 mm Hg, <17 mm Hg, and <15 mm Hg, with or without eye drops. The factors examined were types of procedure (TPI or PI), age, sex, preoperative IOP level, number of preoperative antiglaucoma medications, eyes with high myopia (>-10 diopters), postoperative hyphema lasting longer than 4 days, and postoperative transient IOP spike (>30 mm Hg). RESULTS: TPI was a significant factor for IOP reduction in the three definition-based multivariate analyses. Other factors included patient age, preoperative IOP level, and postoperative IOP spike. The statistical significance of age was further confirmed using linear regression analysis and the Spearman correlation coefficient (Rs) between age and IOP level 3 months after surgery (R(2)=0.13, P = 0.0002 and Rs=-0.44, P < 0.0001, respectively in the TPI group). The success rates for IOP control <17 mm Hg and <15 mm Hg were significantly higher in patients 70 years and older than in younger patients, as determined using the Kaplan-Meier life table analysis with the Mantel-Cox logrank test in both TPI and PI groups. IOP reduction was significantly greater in older patients than in younger patients at every follow-up visit for up to 1.5 years for the TPI group and up to 1 year for the PI group. CONCLUSION: Advanced age is a favorable prognostic factor for successful control of IOP after combined trabeculotomy and cataract surgery. Older patients with POAG and visually significant cataract are good candidates for combined trabeculotomy and cataract surgery.     

Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation

PURPOSE: To evaluate intraocular pressure (IOP) after phacoemulsification and intraocular lens (IOL) implantation in nonglaucomatous eyes with and without exfoliation. SETTING: Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. METHODS: One hundred ninety-six eyes that had phacoemulsification with IOL implantation were examined. Eyes with a history of intraocular disease or surgery that could affect IOP were excluded. The study comprised the remaining 160 eyes: 23 with exfoliation (EXF group) and 137 without exfoliation (non-EXF group). Follow-up data were available for 136 eyes. The same surgeon performed all surgeries. Patients were examined on the first postoperative day and after 1 week, 4 months, and 1.0 to 2.7 years. RESULTS: One day postoperatively, IOP rose in the EXF group from a mean preoperative level of 16.3 mm Hg +/- 2.7 (SD) to 21.0 +/- 8.5 mm Hg, a 28.4% increase (P =.0061). In the non-EXF group, mean IOP rose from 16.2 +/- 3.4 mm Hg to 20.5 +/- 5.7 mm Hg, a 29.9% increase (P =.001). In 4 eyes (17.4%) in the EXF group and 8 eyes (5.8%) in the non-EXF group, IOP increased to 30 mm Hg or higher at 1 day. After this, significant IOP decreases occurred in both the EXF and non-EXF group, respectively, as follows: 14.2 +/- 3.0 mm Hg (12.0% decrease from preoperative value; P =.001) and 15.0 +/- 2.9 mm Hg (5.9%; P =.001) 1 week postoperatively; 12.8 +/- 2.7 mm Hg (20.2%; P =.0002) and 13.8 +/- 2.7 mm Hg (13.2%; P =.001) after 4 months; and 12.3 +/- 2.6 mm Hg (23.2%; P =.0001) and 12.7 +/- 2.7 mm Hg (21.2%; P =.001) after 1.0 to 2.7 years. There was no significant difference between the 2 groups. CONCLUSION: After phacoemulsification with IOL implantation, IOP decreased significantly and remained lower than preoperatively in eyes with and without exfoliation. One day postoperatively, transient pressure peaks were more common in eyes with exfoliation. One eye without exfoliation developed glaucoma.     

Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome

PURPOSE: To determine the intraocular pressure (IOP) response to phacoemulsification cataract extraction with posterior chamber intraocular lens (PC IOL) implantation in patients with pseudoexfoliation syndrome. SETTING: Eye clinics at the University of Ottawa Eye Institute, Ottawa, Ontario, Canada. METHODS: A retrospective cohort study design assigned patients to 1 of 3 subgroups: pseudoexfoliation syndrome (PEX) (n = 21), primary open-angle glaucoma (POAG) control (n = 23), and cataract control (n = 23). Inclusion criteria consisted of age older than 50 years, open angle by gonioscopy, and a cataract requiring phacoemulsification. The IOP response was determined at intervals up to 18 months. RESULTS: Postoperative IOP changes from baseline in the PEX group were -1.81, -4.52, and -2.31 mm Hg at 3, 6, and 12 months, respectively. The changes in the POAG control group were -2.22, -2.32, and -1.88 mm Hg, respectively, and in the cataract control group, -2.49, +0.45, and +0.28 mm Hg. Patients in the PEX group had a reduction in IOP from baseline at all postoperative measurements. That reduction was significantly greater than in the POAG and cataract control groups at 6 months (P =.012 and P =.002, respectively) and 12 months (P =.001 and P =.050, respectively). CONCLUSIONS: Patients with pseudoexfoliation syndrome had a postoperative IOP reduction from baseline at all measurements and a significantly greater reduction than patients in the POAG and cataract control groups at 6 and 12 months. Phacoemulsification cataract surgery with PC IOL implantation may be effective in managing patients with pseudoexfoliation syndrome who have elevated IOP and visually significant cataract but no advanced optic nerve damage.     

Incidence of disc hemorrhages in open-angle glaucoma before and after trabeculectomy

PURPOSE: To investigate the effects of reduction of intraocular pressure (IOP) by surgical intervention on the frequency of disc hemorrhages in eyes with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). DESIGN: Retrospective study. METHODS: We studied 99 eyes of 99 patients with POAG and 50 eyes of 50 patients with NTG, who underwent trabeculectomy with adjunctive mitomycin C (MMC) and were followed regularly at 1 to 3-month intervals at the Glaucoma Service of Gifu University Hospital. We applied Kaplan-Meier life-table analysis for the detection of disc hemorrhages before and after trabeculectomy. RESULTS: Trabeculectomy significantly reduced IOP (in POAG: 19.6 +/- 4.4 down to 11.1 +/- 4.2 mm Hg; in NTG: 15.3 +/- 1.5 down to 11.3 +/- 4.5 mm Hg; mean +/- SD). Life-table analysis revealed that the final cumulative probability of detecting a disc hemorrhage after surgery in POAG was 5.5 +/- 2.2% (calculated probability +/- SE) and was significantly lower than that (33.4 +/- 7.8%) before surgery (P < 0.0001, log-rank test). Likewise, the final probability after surgery in NTG was 23.1 +/- 6.3% and was significantly lower than that (42.1 +/- 8.8%) before surgery (P = 0.0063, log-rank test). CONCLUSIONS: IOP reduction via surgical intervention significantly decreases the frequency of disc hemorrhages in open-angle glaucoma patients.     

白内障超声乳化人工晶状体植入术对早期原发性青光眼眼压控制效果分析

目的 观察早期原发性青光眼行超声乳化联合人工晶状体植入术后眼内压(IOP)控制情况,分析与术后IOP控制效果相关的影响因素.方法 回顾性选择原发性闭角型青光眼(PACG)43例(43只眼)和原发性开角型青光眼(POAG)早期患者32例(32只眼),均行标准3.2mm透明角膜切口白内障超声乳化联合折叠人工晶状体植入术,术后2年定期随访.手术成功标准为:术后IOP保持在6～21mmHg,青光眼神经病变及相应视野缺损无明显进展,无需再行抗青光眼手术治疗.结果 白内障超声乳化联合人工晶状体植入术后,PACG组有28例(65.1%)、POAG组有12例(37.5%)术后IOP控制良好,2年累计生存率之间存在差异(P＜0.05).PACG组成功与失败病例在术前IOP(33.0±5.3)mmHg vs(40.1±3.6)mmHg,P＜0.01、抗青光眼药物数量(2.9±0.9vs4.1±0.4,P＜0.01)、房角粘连范围(2.9±0.5)钟点vs(4.2±0.8)钟点,P＜0.01)之间的差异具有统计学意义,而POAG组成功与失败病例在术前IOP(25.3±3.4)mmHgvs(35.4±3.6)mmHg,P＜0.01、抗青光眼药物数量(1.2±0.4vs2.8±0.9,P＜0.01)之间的差异具有统计学意义.Cox逐步回归分析发现,在PACG组中术前IOP(P＜0.05,RR=1.17)、PAS(P＜0.01,RR=3.971),在POAG组中术前IOP(P＜0.01,RR=1.284),与相应两组术后生存时间具有相关性.结论 在术前PACG患者考虑到IOP和房角粘连范围、POAG患者考虑到IOP的条件下,超声乳化联合人工晶状体植入术对于伴有白内障的早期原发性青光眼,是一种可供选择的有效的控制眼内压的治疗方法.

Abstract：

Objective To assess and find associated factors for favorable postoperative intraocular pressure (IOP) after cataract phacoemulsification with intraocular lens implantation in patients with primary glaucoma on early stage.Methods Forty-five patients (43 eyes) with primary angle closure glaucoma (PACG) and 32 patients with primary open angle glaucoma (POAG) were retrospectively selected.All patients had undergone standard 3.2mm limbal incision phacoemulsification,and 2 years of routine follow-up after cataract surgery.Success was defined as an IOP between 6-21mmHg,with fewer antiglaucoma medications needed than those during pre-operation,no obvious progressions of glaucomatous neuropathy and its coincident visual field loss,and no need of additional glaucoma surgery.Results After phacoemulsification with intraocular lens implantation,there were 28 cases (65.1%) in PACG group and 12 cases (37.5%) in POAG group with well controlled postoperative IOP,and the different of 2-year survival rate was statistically significant (P ＜0.05).There were significant different in the pre-IOP (33.0± 5.3mmHg vs 40.1 ± 3.6mmHg,P ＜0.01),the number ofantiglaucoma medications (2.9± 0.9 vs 4.1± 0.4,P＜0.01) and the extent of peripheral anterior synechiae (PAS) (2.9±0.5 clock hours vs 4.2± 0.8 clock hours,P ＜0.01) between success and failure cases in PACG group.The pre-IOP (25.3±3.4 mmHg vs 35.4±3.6 mmHg,P＜0.01),the number of antiglaucoma medications (1.2± 0.4 vs 2.8± 0.9,P ＜0.01) were significant different between the success and failure cases in POAG group.Cox stepwise regression analysis found that pre-IOP (P ＜0.05,RR=1.17) and the extent of PAS (P ＜0.01,RR=3.971) in PACG group and the pre-IOP (P＜0.01,RR=1.284) in the POAG group was significant associated with the corresponding survival time after cataract surgery.Conclusions Phacoemulsification with intraocular lens implantation may be an alternative procedure for effective IOP control of the patients with primary glaucoma on early stage coexisting with cataract on considering pre-IOP and the extent of PAS in PACG and pre-IOP in POAG.     

Ultrasound biomicroscopy of intrascleral lake after viscocanalostomy and cataract surgery

PURPOSE: To assess anatomic changes at the sclerectomy site after combined viscocanalostomy and cataract surgery associated with POAG or OH and cataract. METHODS: In a prospective, noncomparative, longitudinal study, we performed ultrasound biomicroscopy (UBM) of the sclerectomy site in 84 eyes at 3, 6, and 12 months after the surgery. Four parameters in UBM findings (area, radial longitudinal length, height of intrascleral space, and meridional length of window) were measured and the IOP level, the number of antiglaucoma medications, and bleb formation were observed for 12 months. RESULTS: Intraocular pressure decreased from 19.8 +/- 3.5 (+/- SD) mm Hg preoperatively to 15.5 +/- 3.0 mm Hg 12 months postoperatively (P < 0.0001). Blebs were formed in 2 of 84 eyes (2.4%) at 1 month, and 1 of 84 eyes (1.2%) after 3 months. The IOP decreased at 3, 6, and 12 months postoperatively by 5.8, 4.8, and 4.3 mm Hg, respectively (P = 0.0016). A significant difference was observed between 3 months and 12 months in area (0.17 and 0.13 mm, respectively, P = 0.0127 using the Bonferroni/Dunn test), longitudinal length (0.89 and 0.72 mm, P = 0.0059), and height (0.21 and 0.15 mm, P < 0.0001), but not in meridional length (0.41 and 0.33 mm). The lake was present in 66.7% of cases at 12 months. CONCLUSION: Combined viscocanalostomy and cataract surgery lowered IOP without bleb formation. Postoperatively, the size of the lake and IOP decreased, suggesting parallel reduction of the two. The lake was undetected ultrasonographically in one third of the cases 1 year postoperatively.     

Evaluation of the hypertensive phase after insertion of the Ahmed Glaucoma Valve

PURPOSE: To investigate the postoperative hypertensive phase (HP) in patients undergoing glaucoma drainage implant surgery. DESIGN: Interventional case series. METHODS: A retrospective chart review of 156 consecutive eyes (139 patients) who underwent placement of an Ahmed Glaucoma Valve (AGV) with a follow-up of >or=3 months was performed. Main outcome measures were occurrence and resolution of the HP and intraocular pressure (IOP) control. The HP was defined as IOP > 21 mm Hg during the first 3 months after surgery. Resolution of the HP was defined as an IOP < 22 mm Hg and an IOP reduction of 3 mm Hg with the same or fewer number of glaucoma medications. RESULTS: An HP was observed in 88 eyes (56%). It occurred after a mean of 5.0 weeks (median, 4 weeks; range, 1-13 weeks) with an average (+/- standard deviation) peak IOP of 30.1 (+/- 7.5) mm Hg. Resolution of the HP occurred in 19 of 68 eyes (28%) with available data. Eyes with an HP had a higher mean IOP and needed more medications 6 to 12 months after surgery than eyes without an HP (17.2 +/- 5.6 vs 14.3 +/- 5.8 mm Hg; P =.012 and 1.7 +/- 1.2 vs 0.3 +/- 0.6 medications; P <.001, respectively). CONCLUSION: A hypertensive phase occurs frequently after implantation of the AGV. However, it resolves in only a minority of eyes. The majority of eyes with an HP have no significant improvement of IOP control and continue to require the same number of glaucoma medications as they did during the HP.     

小切口小梁切除联合超声乳化白内障吸除术治疗青光眼合并白内障

目的　探讨 3 5mm小切口小梁切除联合超声乳化白内障吸除后房型人工晶状体植入术 (三联手术 )治疗青光眼合并白内障患者的效果。方法　应用小切口三联手术对 2 0例 (2 6只眼 )青光眼合并白内障患者进行手术治疗。术后随访 3～ 41个月 ,平均 16 1个月。结果　术前平均眼压(2 3 0 1± 2 6 3)mmHg(1mmHg =0 133kPa) ,术后随访最终平均眼压降至 (13 93± 1 85 )mmHg(P <0 0 0 1)。术后随访最终矫正视力范围 0 0 5～ 1 0 ,其中≥ 0 6者 17只眼 (6 5 % ) ,术后平均散光度0 81D ,其中 4只眼无散光度。术后早期 2只眼使用降眼压药物 ,随访后期无使用者。术后早期并发症角膜水肿 5只眼 (19% ) ,浅前房 3只眼 (12 % ) ;晚期并发症后发性白内障 6只眼 (2 3% )。结论　小切口三联手术治疗青光眼合并白内障患者 ,具有恢复有用视力、稳定眼压、减少术后用药、并发症少等理想效果。     

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.     

Long-term relationship between intraocular pressure and visual field loss in primary open-angle glaucoma

PURPOSE: To investigate the dependence upon intraocular pressure (IOP) of the progression of visual field defects in eyes with primary open-angle glaucoma (POAG), in which the mean IOP was maintained at < or =21 mm Hg. METHODS: This study involved 100 eyes with POAG, which were followed up for > or =5 years. The mean IOP levels were maintained at < or =21 mm Hg during the follow-up period. The relationship between the IOP and the progression of visual field defects, which was scored using the Advanced Glaucoma Intervention Study criteria, was investigated retrospectively. RESULTS: Compared with the baseline scores, the visual field defect scores had significantly worsened by the end of the follow-up period (P<0.0001, Wilcoxon paired signed rank test). The change in the visual field defect score (2.5+/-0.5) in eyes with average IOP levels of > or =16 mm Hg (n=36) was significantly greater (P=0.031, Mann-Whitney U test) than the change (1.3+/-0.3) in eyes with average IOP levels of <16 mm Hg (n=64). Moreover, IOP of > or =18 mm Hg made a major contribution to the aggravation of visual field defects in eyes with POAG. CONCLUSIONS: Eyes with POAG and with mean IOP levels maintained at < or =21 mm Hg underwent IOP-dependent progression of their visual field defects. Our results suggest that further IOP lowering would be beneficial in such cases.     

Effects of topical dorzolamide on IOP after phacoemulsification with different types of ophthalmic viscosurgical devices

PURPOSE: To evaluate the effect of topical dorzolamide on postoperative intraocular pressure (IOP) after routine phacoemulsification surgery with different type of ophthalmic viscosurgical device (OVD). METHODS: Patients who were scheduled for phacoemulsification with intraocular lens (IOL) implantation were evenly divided into four groups. Group I (83 eyes) received one drop of topical dorzolamide immediately after surgery and 1.4% NaHa (BD Visc) was used as a cohesive OVD during IOL implantation. Group II (83 eyes) did not receive any topical antiglaucoma medication after operation and 1.4% NaHa was used as a cohesive OVD. Group III (83 eyes) received topical dorzolamide and 1% NaHa (Healon) was used, and Group IV (83 eyes) did not receive any topical and 1% NaHa was used in operation. Mean postoperative IOPs were compared between groups. RESULTS: Eyes with 1.4% NaHa usage (18.2+/-9.2 mmHg) had higher mean postoperative IOPs than eyes with 1% NaHa usage (15.5+/-5.3 mmHg) (p=0.002). Mean postoperative IOPs were lower in eyes with dorzolamide application (15.6+/-7.2 mmHg) than in eyes without any medication (18.1+/-8.5 mmHg) both in eyes with 1.4% NaHa and 1% NaHa usage (p=0.003). Dorzolamide application caused an average 2.5 mm decrease in mean postoperative IOPs in both groups. CONCLUSIONS: Effects of OVDs on IOP rises after phacoemulsification surgery are closely related to their molecular structure. Increase in viscosity rendered higher postoperative IOP increments. However, topical dorzolamide application effectively reduced postoperative IOP increments in eyes with both Healon and BD Visc use.     

非穿透小梁手术中应用丝裂霉素C的疗效

目的　评价非穿透小梁手术中应用丝裂霉素C治疗原发性开角型青光眼的临床疗效。方法　对 18例 (2 5只眼 )原发性开角型青光眼患者行非穿透小梁手术 ,术中联合应用丝裂霉素C。术后随访 6～ 2 8个月 ,平均 16个月。结果　患者术前平均眼压 (2 7 93± 7 6 2 )mmHg(1mmHg =0 133kPa) ;术后 3个月 ,平均眼压降至 (14 6 2± 3 5 3)mmHg ;差异有显著意义 (t=11 82 ,P <0 0 0 1)。术后2 5只眼均形成明显的弥散滤过泡。术后 3个月 ,2 1只眼有功能性滤过泡 ,4只眼功能性滤过泡消失。术后前房反应轻 ,1只眼发生前房出血 ;4只眼术中发现小梁网处有小穿孔 ,但无虹膜膨出 ,术后前房角镜检查均可见小穿孔 ;2只眼术中未发现小穿孔 ,而前房角镜下观察有小裂隙。结论　非穿透小梁手术中应用丝裂霉素C ,能有效降低开角型青光眼的眼压。术后患者视力恢复快 ,并发症少而轻。     

Long-term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes

PURPOSE: To evaluate the long-term effect of phacoemulsification with intraocular lens (IOL) implantation alone in normotensive and ocular hypertensive eyes. SETTING: Private practices, Minneapolis, Minnesota, and Savannah, Georgia, USA. METHODS: The IOP before surgery, 1 year after surgery, and at the final chart recording in 588 eyes having phacoemulsification with IOL implantation was retrospectively reviewed. Before surgery, eyes were divided into 5 groups based on IOP at surgery, patient age at surgery, years of postoperative follow-up, and a comparison between IOP at 1 year and IOP at the final check. RESULTS: The final mean IOP reduction was 6.5 mm Hg (27%) in the 31 to 23 mm Hg presurgical IOP group (n = 19), 4.8 mm Hg (22%) in the 22 to 20 mm Hg group (n = 62), 2.5 mm Hg (14%) in the 19 to 18 mm Hg group (n = 86), and 1.6 mm Hg (9%) in the 17 to 15 mm Hg group (n = 223). In the 14 to 9 mm Hg group (n = 198), the mean IOP at the final examination was 0.2 mm Hg higher (0.1% increase). CONCLUSIONS: Stratifying eyes according to presurgical IOP showed greater long-term IOP reductions than previously reported. The reduction was proportional to the presurgical IOP. The decrease was greatest in eyes with the highest presurgical IOP. The IOP remained unchanged in eyes with the lowest presurgical IOP. The IOP reductions at 1 year were sustained over 10 years and were similar in patients of all ages.     

Phacoviscocanalostomy versus cataract surgery only in patients with coexisting normal-tension glaucoma: midterm outcomes

PURPOSE: To compare the midterm efficacy and safety of phacoviscocanalostomy (viscocanalostomy, phacoemulsification, and intraocular lens [IOL] implantation) and cataract surgery (phacoemulsification and IOL implantation) in patients with normal-tension glaucoma (NTG) and cataract. SETTING: Sensho-kai Eye Institute, Kyoto, Japan. METHODS: Thirty-one eyes had phacoviscocanalostomy, and 35 eyes had uncomplicated cataract surgery only. The intraocular pressure (IOP), postoperative antiglaucoma medications, and visual outcomes were compared between groups. RESULTS: The mean follow-up was 34.9 months+/-19.8 (SD) (range 7 to 78 months). At 36 months, the mean preoperative IOP and postoperative IOP were 17.2+/-1.5 mm Hg and 14.1+/-1.6 mm Hg, respectively, in the phacoviscocanalostomy group and 16.7+/-1.4 mm Hg and 15.6+/-3.4 mm Hg, respectively, in the cataract surgery only group. The differences between groups were significant at all time points (P<.05). The success probabilities of the phacoviscocanalostomy group achieving 20% and 30% IOP reductions with (or without) medications were 78.5% (67.4%) and 35.5% (37.4%) at 24 months and 58.0% (44.2%) and 28.0% (26.6%) at 48 months, which were significantly better than the probabilities in the cataract surgery only group, which were 16.0% (9.5%) and 5.7% (2.9%) at 24 months (P<.001 for each comparison, Kaplan-Meier life-table analysis with log-rank test). Based on the modified Aulhorn-Greve classification, the visual acuity and visual fields did not deteriorate in the phacoviscocanalostomy group; the visual fields deteriorated in 6 eyes in the cataract surgery only group during the follow-up (P=.024). CONCLUSION: Phacoviscocanalostomy lowered IOP and maintained postoperative visual outcomes; it was safe and effective in elderly patients with coexisting NTG and cataract.     

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.     

The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series

PURPOSE: To evaluate the clinical outcomes of minimally invasive cataract extraction by phacoemulsification, with primary intraocular lens implantation, in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract. MATERIALS AND METHODS: Consecutive primary angle-closure glaucoma patients with co-existing visually significant cataract were invited to participate in this prospective study. After obtaining informed consent, cataract extraction by phacoemulsification through a clear corneal incision was performed under topical anesthesia. Foldable intraocular lenses were implanted in the same setting. These patients were then followed up for a minimum of 1 year. Outcome measures included intraocular pressure (IOP), requirement for glaucoma drugs, and visual acuity. RESULTS: Twenty-one primary angle-closure glaucoma eyes of 21 patients were recruited. Mean age (+/- SD) was 73.7 +/- 8.1 years (range, 60-87 years). There were 12 female patients and 9 male patients, with 13 right eyes and 8 left eyes. Nine eyes (42.9%) had history of acute primary angle closure. Mean follow-up duration was 20.7 +/- 3.6 months (range, 13-26 months). Intraocular pressure was decreased from a mean preoperative level of 19.7 +/- 6.1 mm Hg (range, 11 mm Hg-40 mm Hg) to 15.5 +/- 3.9 mm Hg (range, 9 mm Hg-26 mm Hg) at final follow-up (P = 0.022) (paired t test). The number of glaucoma eye drops required was decreased from a mean preoperative level of 1.91 +/- 0.77 (range, 1-3) to 0.52 +/- 0.87 (range, 0-3) at final follow-up (P < 0.001) (paired t test). In 10 eyes (47.6%), visual acuity improved significantly after surgery. In 9 eyes (42.9%), visual acuity remained the same. In 2 eyes (9.5%), visual acuity deteriorated significantly after surgery. Mean cup-to-disc ratio was 0.6 +/- 0.2 (range, 0.3-0.9) preoperatively, and 0.7 +/- 0.2 (range, 0.3-0.9) postoperatively (P = 0.047) (paired t test). CONCLUSIONS: In primary angle-closure glaucoma patients with co-existing cataract, cataract extraction alone (by phacoemulsification) can significantly reduce both intraocular pressure and the requirement for glaucoma drugs.     

Phacoemulsification with intraocular lens implantation after trabeculectomy

PURPOSE: To determine the effect of phacoemulsification with intraocular lens (IOL) implantation, using a superior clear-corneal incision, on the long-term intraocular pressure (IOP) control in patients who have undergone previous trabeculectomy. METHODS: Twenty-eight consecutive patients who underwent phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified and matched to 28 patients who underwent trabeculectomy only (trabeculectomy-only group) with respect to age, gender, IOP, and duration of follow-up. The mean IOP was compared 1 and 2 years after phacoemulsification, and the surgical success rate in each group was determined by Kaplan-Meier survival analysis. RESULTS: The mean IOP 1 year after cataract surgery was significantly higher ( = 0.025) in the phaco group (15.6 +/- 3.5 mm Hg) than in the trabeculectomy-only group (13.4 +/- 2.5 mm Hg), but at 2 years the difference was not statistically significant (15.3 +/- 3.1 mm Hg in the phaco group compared with 14.3 +/- 3.2 mm Hg in the trabeculectomy-only group; = 0.35). Two years after surgery, 5 of 28 patients in the phaco group and 1 of 28 patients in the trabeculectomy-only group had commenced or were using additional topical medication ( = 0.089). If the introduction of glaucoma medication was considered a "failure," then the IOP control was significantly better in the trabeculectomy-only group using two different criteria for surgical failure. CONCLUSION: Although phacoemulsification and IOL implantation through a superior clear-corneal incision have little effect on mean IOP in a group of patients who have undergone previous trabeculectomy, this procedure may jeopardize the long-term IOP control in individual patients.     

Incidence of anterior intraocular lens precipitates after combined phacotrabeculectomy

PURPOSE: To compare the incidence of anterior intraocular lens (IOL) precipitates on silicone and poly(methyl methacrylate) (PMMA) IOLs after phacotrabeculetomy. SETTING: District general hospital in the United Kingdom. METHODS: Ninety-five consecutive eyes of 77 patients who had combined phacotrabeculectomy between April 1992 and October 1996 were retrospectively studied. A slitlamp biomicroscope was used to look for precipitates. RESULTS: Mean patient age was 75 years (range 51 to 89 years). Preoperatively, mean intraocular pressure (IOP) was 26 mm Hg +/- 5.26 (SD). Thirty plate-haptic silicone IOLs and 65 PMMA IOLs were implanted. Six months postoperatively, median corrected Snellen acuity improved from 6/18 to 6/9. The mean number of antiglaucoma medications dropped from 1.46 preoperatively to 0.29 postoperatively; 73 eyes (76.8%) had an IOP of less than 22 mm Hg with no medication. In 1 surgeon's experience, lens precipitates appeared in 10 of 59 cases (16.9%), with 7 of 14 (50.0%) in the silicone IOL group and 3 of 45 (6.7%) in the PMMA IOL group. The difference was statistically significant (P <.001, chi-square). CONCLUSION: The incidence of anterior IOL precipitates was significantly higher in patients with a silicone IOL than in those with a PMMA IOL, suggesting that use of silicone IOLs may increase the incidence of postoperative IOL precipitates.