A prospective, comparative study between endoscopic cyclophotocoagulation and the Ahmed drainage implant in refractory glaucoma

PURPOSE: To compare endoscopic cyclophotocoagulation (ECP) and the Ahmed drainage implant in the treatment of refractory glaucoma. METHODS: Sixty-eight eyes of 68 patients with refractory glaucoma were prospectively assigned to either ECP or Ahmed tube shunt implantation. All procedures were performed by a single surgeon. Eyes that were included were pseudophakic with a history of at least one trabeculectomy with antimetabolite, an intraocular pressure (IOP) equal to or above 35 mm Hg on maximum tolerated medical therapy, and a visual acuity better than light perception. Exclusion criteria included eyes that had had previous glaucoma drainage device implantation or a cyclodestructive procedure. Success was defined as an IOP more than 6 mm Hg and less than 21 mm Hg, with or without topical anti-hypertensive therapy. RESULTS: The mean follow-up was 19.82 +/- 8.35 months and 21.29 +/- 6.42 months, for the Ahmed and ECP groups, respectively (P = 0.4). The preoperative IOP, 41.32 +/- 3.03 mm Hg (Ahmed) and 41.61 +/- 3.42 mm Hg (ECP) (P = 0.5), and the mean postoperative IOP, at 24 months follow-up, 14.73 +/- 6.44 mm Hg (Ahmed) and 14.07 +/- 7.21 mm Hg (ECP) (P = 0.7), were significantly different from baseline in both groups (P < 0.001). Kaplan-Meier survival curve analysis showed a probability of success at 24 months of 70.59% and 73.53% for the Ahmed and ECP groups, respectively (P = 0.7). Complications included choroidal detachment (Ahmed 17.64%, ECP 2.94%), shallow anterior chamber (Ahmed 17.64%, ECP 0.0%), and hyphema (Ahmed 14.7%, ECP 17.64%). CONCLUSION: There was no difference in the success rate between the Ahmed Glaucoma Valve and ECP in refractory glaucoma. The eyes that underwent Ahmed tube shunt implantation had more complications than those treated with ECP.     

Combined pars plana vitrectomy and glaucoma drainage implant placement for refractory glaucoma

PURPOSE:To report visual acuity and intraocular pressure outcomes among patients who have undergone combined pars plana vitrectomy and placement of a glaucoma drainage implant.METHODS:The medical records of all patients who underwent combined pars plana vitrectomy and placement of a glaucoma drainage implant at the Bascom Palmer Eye Institute by one of the authors between January 1, 1990, and February 28, 1998, were reviewed. Forty patients (40 eyes) were identified, including 14 patients with neovascular glaucoma secondary to proliferative diabetic retinopathy or central retinal vein occlusion, 15 patients with other posterior segment disease, seven patients with secondary angle-closure glaucoma, and four patients with aphakia with ruptured anterior hyaloid face. Main outcome measures included visual acuity and intraocular pressure at 1 year postoperatively.RESULTS:At 1 year postoperatively, 31 (77.5%) of 40 patients had stable or improved visual acuity; three eyes (7. 5%) had a final visual acuity of no light perception and three additional eyes (7.5%) were enucleated (because of chronic pain in two eyes and endophthalmitis in one eye). Mean preoperative intraocular pressure was 34 mm Hg and the median number of preoperative antiglaucoma medications was two. At 1 year postoperatively, mean intraocular pressure was 13 mm Hg and the median number of antiglaucoma medications was zero. Twenty-two patients (55.0%) achieved an intraocular pressure greater than 5 mm Hg and less than or equal to 21 mm Hg without antiglaucoma medication, and an additional seven patients (17.5%) achieved this level of intraocular pressure control with medication. Only one patient (2.5%) underwent further glaucoma surgery for uncontrolled intraocular pressure.CONCLUSIONS:Although combined pars plana vitrectomy and placement of a glaucoma drainage implant is often a successful management option in selected patients with refractory glaucoma, visual outcome may be poor because of severe underlying ocular disease and postoperative complications.     

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma

PURPOSE: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. MATERIALS AND METHODS: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. RESULTS: The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. CONCLUSIONS: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.     

半导体激光经巩膜睫状体光凝治疗难治性青光眼

目的     

透巩膜睫状体光凝治疗难治性青光眼的疗效观察

目的 评价半导体激光透巩膜睫状体光凝治疗难治性青光眼的临床疗效.方法 取38只眼难治性青光眼,眼压30.9-66.23mmH,平均(45.1±12.98)mmHg,应用激光能量1500～2500mW,脉冲2s,治疗范围270°-300°,观察术后1d、1周、1和3月时患眼的眼压,疼痛情况和并发症.结果 (1)术后1d眼压9.3-33.1mmHg,平均(24.47±8.51)mmHg,术后1周眼压7.5-32.5mmHg,平均(21.67±7.92)mmHg,术后1月眼压5.8～35.5mmHg,平均为(21.02±10.7)mmHg,术后3月眼压4.2-35.8 mmHg,平均(20.03±9.82)mmHg.术后各时间点眼压与术前眼压配对t检验,t值分别为7.11、10.09、8.82和10.03,均P＜0.0001,差异有统计学意义;(2)术后34只眼(89.47%)疼痛明显缓解;(3)并发症有球结膜灼伤水肿2只眼,前房积血23只眼,葡萄膜炎反应18只眼,角膜上皮脱落2只眼.结论 透巩膜睫状体光凝创伤小,早期治疗效果明显,操作简便,能有效降低眼压,缓解难治性青光眼的疼痛.     

Contact transscleral diode cyclophotocoagulation for refractory glaucoma

PURPOSE: To evaluate the effect of contact transscleral diode cyclophotocoagulation on intraocular pressure (IOP), vision, number of medications, and complications in a heterogenous population of patients with refractory glaucoma. METHODS: Clinical data for all patients undergoing contact transscleral diode cyclophotocoagulation for refractory glaucoma at the Medical College of Georgia between November 1994 and November 1996 were reviewed. Forty-seven eyes of forty-seven patients followed for at least one month were included. Visual acuity, IOP, number of medications, and complications were noted for follow-up periods as long as 24 months. RESULTS: At final follow-up examination (range 1-24 months, median 9 months), the average decrease in IOP was 21+/-16 mmHg. Thirty-one (66%) patients had final IOP between 7 and 21 mmHg. Medications were decreased by an average of 1.1. Twenty-six (62%) of 42 patients with vision before surgery had stable or improved visual acuity at the final follow-up visit; 16 (38%) had a deterioration in visual acuity. Neovascular glaucoma was associated with a posttreatment IOP less than 7 mmHg. CONCLUSION: Contact transscleral diode cyclophotocoagulation is effective in lowering IOP in eyes with refractory glaucoma. It also serves to reduce the number of medications required for appropriate IOP control. Loss of visual acuity remains an important concern. Acute complications tend to be transient. Further study is needed to identify patients at risk for markedly reduced IOP after this procedure and for modulation of the protocol to decrease such risk.     

经巩膜睫状体光凝治疗难治性青光眼

目的　评价难治性青光眼行二极管激光巩膜睫状体光凝 (transcleraldiodelasercyclophotocoagulation ,TDLCP)的有效性和安全性。方法　观察 6 6例 6 6眼行TDLCP治疗前后用抗青光眼药物的种类、患者的自觉症状、治疗前后眼压、视力及术后并发症 ,随访 1a。结果　抗青光眼药物种类手术前后分别平均为 2 .6种 (1～ 4种 )和 1.8种 (0～ 3种 ) ,治疗后比治疗前用药明显减少 (P <0 .0 0 1)。术后 5 5例疼痛消失 ,9例疼痛明显减轻 ,2例仍有明显疼痛。治疗前后平均眼压分别为 (35 .2± 7.9)mmHg(18～ 80mmHg) (1kPa =7.5mmHg)及(19.5± 6 .2 )mmHg(4～ 6 8mmHg) ,眼压平均下降 15 .4mmHg ,治疗前后有统计学意义 (P <0 .0 0 1)。术后视力提高10眼 ,视力无变化 4 0眼 ,视力下降 16眼。术后并发症为早期前房炎症反应 4 2眼 ,前房出血 5眼 ,角膜水肿 2 3眼 ,术眼光感丧失 5眼 ,眼球萎缩 3眼。结论　虽然经巩膜睫状体光凝术后会发生前房出血、低眼压、眼球萎缩等并发症 ,但其能显著降低眼压、减少患者痛苦并可减少抗青光眼用药 ,因此仍为目前治疗难治性青光眼的一种有效治疗方法     

二极管激光经巩膜睫状体光凝术治疗难治性青光眼

目的 观察二极管激光经巩膜睫状体光凝术治疗难治性青光眼的临床疗效.方法 回顾性分析北京同仁医院2007年9月至2008年8月107例(110眼)难治性晚期青光眼患者临床资料,均行二极管睫状体光凝,分析术后眼压、疼痛感、视力、并发症等情况.结果 术后第1天平均眼压(15.90±12.30)mmHg(1 kPa=7.5 mmHg),术后1周平均眼压(14.70±5.21)mmHg,术后1个月平均眼压(14.02±9.50)mmHg,术后3个月平均眼压(14.51±11.30)mmHg,术前与术后第1天、1周、1个月及3个月眼压差异均有统计学意义(均为P<0.01).术后89眼(80.9%)视力不变,17眼(15.5%)视力下降,4眼(3.6%)视力提高.83.6%的患者眼痛症状明显缓解或消失.术后发生前房渗出12眼(10.9%),前房积血6眼(5.4%),玻璃体积血2眼(1.8%),巩膜溶解2眼(1.8%),巩膜穿孔1眼(0.9%).结论 二极管激光经巩膜睫状体光凝术是治疗难治性晚期青光眼的有效方法,能显著降低眼压,减少患者痛苦,并发症少,可重复治疗.     

Diode laser transscleral cyclophotocoagulation for refractory glaucoma

PURPOSE: To evaluate the efficacy of contact diode laser transscleral cyclophotocoagulation using different treatment parameters. METHODS: All eyes undergoing contact diode laser transscleral cyclophotocoagulation between April 1991 and September 1997 at our two institutions were enrolled. Success was defined as an intraocular pressure less than or equal to 22 mm Hg or absence of pain for poorly sighted and blind eyes. RESULTS: Two hundred six eyes of 204 patients (Salzburg, 117 eyes; New York, 89 eyes) were enrolled. Mean patient age was 65.8 +/- 18.7 years (range, 4-96 years). Mean follow-up was 9.2 +/- 11.2 months (range, 3-56 months). Mean preoperative and postoperative IOPs were 42.1 +/- 11.0 mm Hg (range, 24-76 mm Hg) and 17.3 +/- 10.9 mm Hg (P < 0.001) and 20.3 +/- 13.2 mm Hg (P < 0.001) at 12 and 24 months, respectively. The number of laser applications (mean, 18.6 +/- 4.2; range, 10-40) and maximal laser power (mean, 2,352 +/- 408.5 mW; range, 1,500-3,000) were not associated with a lower postoperative IOP. An IOP less than or equal to 22 mm Hg was achieved in 72.7% of eyes at the mean follow-up of 9 months. Thirty-three (16.0%) eyes required at least one retreatment. Phthisis occurred in four (1.9%) eyes. CONCLUSION: Contact diode laser transscleral cyclophotocoagulation is useful in eyes with refractory glaucoma in which the risks of outflow surgery are deemed unacceptable.     

国产房水引流物植入术治疗难治性青光眼疗效观察

目的 评价同产房水引流物(HAD)植入术治疗难治性青光眼的临床疗效。 方法 对21例(21眼)难治性青光眼患者施行HAD植入术。新生血管性青光眼7例、虹膜-角膜内皮综合征继发青光眼3例、无晶状体青光眼7例、青少年性青光眼1例及多次行滤过性青光眼手术失败者3例。术前平均眼压(38.71±11.38)mmHg。术后随访平均(13.90±8.99)月。 结果 术后平均眼压(12.71±5.82)mmHg,眼压平均下降26 mmHg。17例获得成功,手术成功率为80.95％。并发症有暂时性前房出血3例(14.29％)、前葡萄膜炎3例(14.29％)、脉络膜脱离8例(38.10％)、引流盘脱出1例(4.76％)、浅前房8例(38.10％)、并发性白内障2例(9.52％)、角膜内皮失代偿1例(4.76％)。 结论 HAD植入术可有效治疗难治性青光眼,其临床疗效及并发症与使用同外同类产品相当,且HAD柔软性好,易于手术操作,价格低于同类进口产品。     

玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼

目的评价玻璃体切除联合眼内镜下睫状体光凝术治疗难治性青光眼的效果。方法对10例（10只眼）难治性青光眼均行玻璃体切除术和晶状体切除后在眼内镜下行激光睫状体光凝,激光能量0．6～0．87／,时间0．5s,光凝下方180°～220°范围,光凝30～40点。结果术后随访6～15个月,10例眼压均控制在〈21mmHg（1mmHg=0．133kPa）。最佳矫正视力提高者7例,不变者1例,不配合者1例,1例睫状体光凝术中出现脉络膜下爆发性出血。结论玻璃体切除联合眼内镜下睫状体光凝治疗难治性青光眼是一种相对有效的方法。     

难治性青光眼睫状体光凝疗效观察

目的:评价激光经巩膜睫状体光凝术(transscleral cyclo-photocoagulation,TSCPC)治疗难治性青光眼的临床疗效。方法:对36眼难治性青光眼采用低能量1.5~2.1W,多点数10~32的TSCPC,术后随访观察并记录眼压,视力,眼部自觉症状以及并发症,随访时间约3mo。结果:术前平均眼压62.89±17.36mmHg,最后随访平均眼压为21.13±7.06mmHg,经配对资料t检验,术前眼压与术后眼压相比,差别具有统计学意义(P<0.05)。手术有效率83%。指数以上视力10眼中术后6眼视力无变化,4眼视力提高。6眼眼压控制欠佳,行睫状体冷冻手术。术前所有眼痛的患者眼痛均消失或缓解,并发症少,程度轻,主要有色素膜炎,前房出血等,无眼球萎缩发生。结论:TSCPC是难治性青光眼的一种简单安全有效的治疗方法。     

经巩膜睫状体光凝术治疗难治性青光眼的效果

目的:评价经巩膜睫状体光凝术(TCP)治疗难治性青光眼的效果。方法:回顾性研究。对北京爱尔英智眼科医院2017年7月至2018年12月行TCP治疗的难治性青光眼73例(81只眼)的临床资料进行分析。观察手术前后眼压、降眼压药物使用种类、术中光凝情况和并发症的发生。术后随访6个月。结果:术前眼压(35.0±8.8)mmH...     

内窥镜下睫状体光凝和减压阀植入术治疗角膜移植术后青光眼的疗效对比

目的:探讨内窥镜下睫状体光凝和减压阀植入术治疗角膜移植术后青光眼的疗效和安全性。方法:设计回顾性研究,对46例46眼角膜移植术后继发青光眼患者分别进行内窥镜下睫状体光凝和减压阀植入术,术后1,7d;1,6mo观察两组病例视力、眼压和角膜内皮以及术后并发症等情况结果:术后两组患者随访眼压在1,7d;1mo时间点进行t检验,均显示无统计学差异,但是在第6mo时间点时ECP组眼压为平均14.1±8.4mmHg,Ahmed组眼压平均18.2±7.6mmHg,两者之间显示有统计学差异。而两组中4个随访时间的眼压值与手术前眼压进行Dunnett-t检验显示均有统计学的差异。术前ECP组平均使用降眼压药物2.3种,术后下降到0.8种,Ahmed组平均使用降眼压药物2.4种,术后下降到0.7种,两者之间显示无统计学差异。ECP组手术后4眼出现渗出膜,5眼出现前房出血。渗出性脉络膜脱离2眼,低眼压2眼。Ahmed组2眼术后出现渗出膜,3眼术后出现前房出血,浅前房5眼,脉络膜脱离6眼,低眼压3眼。结论:ECP和引流阀植入术对于角膜移植术后继发青光眼的治疗均有可靠的疗效。但ECP降眼压的远期效果较引流阀植入术好,同时适应证广,并发症少。     

二极管激光经巩膜睫状体光凝术治疗难治性青光眼

目的:研究二极管激光经巩膜睫状体光凝术治疗难治性青光眼的有效性及激光治疗参数。方法:对我院收治的50例50眼晚期难治性青光眼患者行二极管激光经巩膜睫状体光凝术,记录每位患者所用能量,击射范围,光凝点数,爆破点数,观察患者治疗前后的眼压、眼部症状,视力、裂隙灯观察眼前节的改变和并发症等。结果:术后平均眼压(18.50±2.50)mmHg,术后眼压较术前明显下降(P<0.01)。术后46眼疼痛明显减轻,术前术后眼压差值与击射能量的相关性不高;眼压下降值与击射范围、击射点数呈正相关性,眼压下降值与爆破点数显著相关,呈正相关性。结论:二极管激光经巩膜睫状体光凝术治疗难治性青光眼是一种安全有效的方法,激光治疗参数需根据术前眼压、不同类型青光眼进行设计。     

Endoscopic and transscleral cyclophotocoagulation for the treatment of refractory glaucoma

PURPOSE: Cyclophotocoagulation (CPC) is traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this review is to provide an update on the methods, efficacy, complications, indications, and histopathology of transscleral and endoscopic CPC. METHODS: A literature review was conducted for transscleral and endoscopic CPC. Relevant studies were included for evaluation of the procedures. RESULTS: For transscleral CPC (TCP), there is a wide range of success rates reported in the literature, depending on energy settings, follow-up period, and definitions of success. Repeat TCP is often required. Serious complications have included significant vision loss, hypotony, and phthisis. TCP has mostly been performed in very severe forms of glaucoma, in eyes with limited visual potential, or after filtration surgery has failed, although more recently TCP has been used as a primary surgery in eyes with good visual potential. There are more limited published results on endoscopic CPC (ECP), which have demonstrated overall good success. Complication rates are relatively low with ECP, however, large studies with long-term follow-up are lacking. ECP has also been used in difficult, refractory cases, but often used earlier when combined with cataract surgery. CONCLUSIONS: Both TCP and ECP are effective surgeries with potential for serious complications. Recent studies suggest they may be used increasingly as the primary surgery for various stages of glaucoma.     

难治性青光眼半导体激光经巩膜睫状体光凝术

目的　评价半导体激光经巩膜睫状体光凝术治疗难治性青光眼的效果和安全性。方法　 68例 (69眼 )接受治疗 ,术后随访 6～ 17月。分析末次治疗后第 6月的眼压、视力和眼部症状。结果　无光感组 (3 6眼 ) :光凝术前眼压 (61.16± 12 .44 )mmHg(1mmHg =0 .13 3kPa) ,末次光凝术后第 6月后 3 3眼眼压 (2 9.67± 6.79)mmHg。 3眼眼球萎缩 ,12眼需 2次或多次治疗。光感及光感以上组 (3 3眼 ) :光凝术前眼压 (5 1.72± 13 .85 )mmHg ,末次光凝术后第 6月眼压 (2 1.42± 8.2 2 )mmHg。其中 11眼需要 2次或 3次光凝术 ,4眼 3次光凝术后眼压仍高于 2 1mmHg。结论　半导体激光经巩膜睫状体光凝术是一种简单、安全、有效的治疗难治性青光眼的方法 ,但常需要重复治疗。     

810nm激光睫状体光凝治疗难治性青光眼的疗效

目的:探讨810nm激光经巩膜睫状体光凝治疗难治性青光眼的临床疗效。方法:对25例30眼难治性青光眼患者行810nm激光经巩膜睫状体光凝术,术后随访3mo,分析术后眼压、疼痛感、视力、并发症等情况。结果:术后随访期间全部患者眼痛症状均缓解。术前平均眼压为50.42±2.50mmHg,末次随访时平均眼压15.95±4.19mmHg,术后眼压与术前相比,差异有显著统计学意义(P<0.01)。光凝术后2眼(6.7%)视力提高,24眼(80.0%)视力无变化,4眼(13.3%)视力下降。术后前房渗出12眼(40.0%),前房积血3眼(10.0%),玻璃体积血1眼(3.3%),药物治疗后消失。结论:810nm激光经巩膜睫状体光凝术是治疗难治性青光眼的有效方法,能显著降低眼压,减少患者痛苦,并发症少。