Laser trabeculoplasty as primary therapy in chronic open angle glaucoma

Sixty-three phakic eyes of 54 patients with early simple (21 eyes) or capsular (42 eyes) glaucoma treated with laser trabeculoplasty (LTP) as the primary therapy were followed retrospectively 12 to 18 months after LTP. In 59 of 63 eyes followed up for 12 months and 46 of 52 eyes followed up for 18 months the intraocular pressure (IOP) was constantly maintained below 22 mmHg with no medication. After a good initial response for 6 to 12 months, 6 eyes required medical therapy because of uncontrolled pressure or progression in the damage of the optic disc or visual fields. The mean pressure reduction of all eyes 18 months after LTP was 28% in simple and 37% in capsular glaucoma. No severe complications were seen. LTP seems to be an effective and safe procedure as the primary therapy for open angle glaucoma.     

One- and two-session laser trabeculoplasty. A randomized, prospective study

Seventy-seven eyes with primary open angle glaucoma and exfoliation glaucoma were subjected to laser trabeculoplasty and followed in a prospective way. The full 360 degrees circumference was treated, but the patients were randomized in two groups: In group 1 the full treatment was given in one session, and in group 2 it was divided into two sessions one month apart. During the follow-up time of 3 to 18 (mean: 12) months both methods of treatment gave the same reduction of IOP. The only three cases with high post-operative transient pressure spike-occurred in group 1. Although this difference of course not is statistically significant it is in agreement with other studies suggesting that a two-session approach might be safer than treating the full circumference in one session. One month after the laser treatment the eyes of group 1, where the full circumference of the trabecular meshwork had been treated, showed only a slightly larger pressure reduction (not statistically significant) than the eyes of group 2 one month after treating 180 degrees of the meshwork.     

Surgical management of chronic glaucoma in aphakia

The surgical management of glaucoma in aphakia has been limited by poor success in the control of intraocular pressure and serious postoperative complications that threaten vision. A consecutive series of trabeculectomy filtering procedures in aphakic eyes with a mean preoperative intraocular pressure of 38 mmHg was followed for an average of 26 months and revealed a 62% control of intraocular pressure at 21 mmHg or less. Five additional patients (24%) had pressures lower than 21 mmHg following digital massage. The complication of decreased visual acuity following surgery was significant but not directly related to the surgical procedure. Another patient population with glaucoma and aphakia with a mean preoperative pressure of 25 mmHg was treated with laser trabeculoplasty. In 12 of 15 patients (80%) intraocular pressure was lower than 22 mmHg for an average of eight months and did not require glaucoma surgery. There were no significant complications following this therapy and all patients retained preoperative level of visual acuity. In aphakic patients who have uncontrolled glaucoma on maximal medical therapy, surgery is indicated. We recommend the following approach to surgical management: (1) Laser treatment to the trabecular meshwork if the angle is open; (2) if this fails, or the angle is extensively closed, a trabeculectomy filtering procedure is suggested; (3) cyclocryotherapy has been effective in controlling pressure but the unpredictable loss of vision has prompted caution in seeing eyes; (4) cyclodialysis; and (5) transpupillary or transscleral treatment of the ciliary processes are additional modes of therapy. Improved results of surgical treatment for glaucoma and aphakia have been encouraging and should be used when maximal medical therapy is ineffective.     

Incidence and prognosis of childhood glaucoma. A study of 63 cases

Sixty-three consecutive cases (95 eyes) of glaucoma in children were studied. Glaucoma associated with congenital anomalies (group II) formed the largest group in this study. This accounted for 46% of the cases compared to primary congenital glaucoma (group I) that accounted for 22.2%. Secondary glaucoma (group III) occurred in 31.8%. The presenting signs and symptoms in group I were tearing and corneal edema. In 50% of the cases in groups II and III, diagnosis was made on a routine ophthalmologic examination. Surgery was performed in 95.8% of eyes in group I, 53.2% in group II, and 54.2% in group III. The best visual prognosis occurred in group I where 77.3% of affected eyes had visual acuity equal to or better than 20/50 with good pressure control in all. This was followed by group II where 41.5% had vision equal to or better than 20/50 and 41.4% had 20/200 vision or less. Intraocular pressure remained uncontrolled in 19.1% of this group. The worst prognosis and morbidity was found in group III where 30.5% of eyes had 20/50 vision or better and 47.8% had 20/200 vision or less. In group III, 33.3% had uncontrolled intraocular pressure.     

Five-year results of viscocanalostomy

PURPOSE. To prospectively study the success rates and complications of viscocanalostomy. METHODS. Prospective nonrandomized case series of 46 eyes (46 patients) with medically uncontrolled primary and secondary open angle glaucoma. All patients in the study underwent viscocanalostomy. Control of intraocular pressure was used to measure success. Pre and postoperative glaucoma medications, visual acuity, complications, and adjunctive procedures were recorded. RESULTS. At 60 months, qualified success (intraocular pressure below 21 mmHg with glaucoma medication) was achieved in 37 (82%) patients and complete success (intraocular pressure below 21 mmHg without medication) in 25 (54%) patients. Nd:YAG laser goniopuncture was performed in 33 (72%) patients with significant post laser reduction of intraocular pressure. No sight threatening complications were observed in this series. Visual acuity remained unchanged in 33 patients (72%). CONCLUSIONS. Viscocanalostomy appears to be a safe and effective intraocular pressure lowering procedure in eyes with primary open angle glaucoma and certain types of secondary open angle glaucoma.     

正念减压疗法对开角型青光眼患者药物治疗依从性的影响

目的:探讨正念减压疗法对青光眼患者焦虑情绪、依从性及视功能的影响.方法:选取64例我院门诊确诊为原发性开角型青光眼(primary open angle glaucoma,POAG)并长期局部用药控制眼压的患者,随机分为观察组与对照组,各32例.对照组给予药物治疗和常规心理干预;观察组在药物治疗和常规心理干预的同时进行正念减压疗法.评估两组患者焦虑情绪评分、治疗依从性以及平均视敏度缺损情况.结果:观察组治疗后焦虑情绪评分显著低于对照组(P<0.01);观察组治疗后依从性显著高于对照组(P<0.01).结论:正念减压疗法能有效改善POAG患者的焦虑情绪,提高其治疗依从性.     

Ultrasonic treatment of hypertonia caused by intraocular silicone oil]

The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.     

持续高眼压状态下抗青光眼手术的疗效观察

目的:探讨高眼压状态下行复合小梁切除术的特点,安全性及疗效观察。方法:对36例40眼青光眼患者,持续高眼压状态下行复合小梁切除术,观察术后眼压,视力,滤过泡,并发症等。结果:手术顺利40眼,患者术后随访2～12mo,术后1mo眼压控制<21mmHg者34眼(85%),局部用药方可控制者5眼(12%),1眼再行手术,术后1mo视力提高者21眼,保持不变者10眼,下降者9眼,术中术后未发生脉络膜大出血,眼底出血等并发症,恶性青光眼发生1眼。结论:持续高眼压状态下行复合小梁切除术是安全的,对持续高眼压状态下的病例应积极手术,可以避免视功能进一步损害。     

术前应用康柏西普以不同手术方法治疗新生血管性青光眼

目的 比较术前应用康柏西普两种手术方法治疗糖尿病继发新生血管性青光眼(NVG)的效果.方法 前瞻性随机临床对照研究.以菏泽市中医医院眼科2018年2月至2019年8月诊治的糖尿病所致NVG61例(62眼)为研究对象.患者按随机数字表法分为两组,两组患者手术前均进行康柏西普玻璃体内注射.试验组,31例(32眼),采取玻璃...     

Surgical outcome of combined trabeculotomy and cataract surgery

PURPOSE: To evaluate the efficacy of combined trabeculotomy and cataract surgery in lowering intraocular pressure and improving visual acuity in adults with primary open-angle glaucoma. PATIENTS AND METHODS: A consecutive series of 141 eyes with primary open-angle glaucoma or ocular hypertension was prospectively recruited. One hundred five eyes with visual field defects were treated by trabeculotomy combined with phacoemulsification and intraocular lens implantation (TPI group), and 36 eyes without visual field defects underwent cataract surgery (PI group). Patients in the TPI and PI groups were followed for more than 6 months after surgery (578.1 +/- 35.8 days and 616.0 +/- 58.5 days, respectively). The intraocular pressure reductions after surgery were compared between the groups to evaluate the effect of combined trabeculotomy and cataract surgery. Visual acuity and the complication rate in the two groups were secondary outcomes. The success probabilities of both groups were evaluated by Kaplan-Meier life table analysis with log rank test. RESULTS: A significant intraocular pressure reduction was observed in the TPI and PI groups up to 3 years and up to 1 year and 6 months after surgery, respectively; the magnitude of the reduction was significantly larger in the TPI group up to 3 years after surgery. The success probabilities of TPI group for intraocular pressure control under 21, 17, and 15 mm Hg were 95.8%, 58.7%, and 30.0%, respectively, 1 year after surgery, and 84.9%, 29.5%, and 13.5%, respectively, 3 years after surgery; the success probabilities were significantly higher than those of the PI group. Of 105 eyes, 104 (99.0%) had visual acuity equal to or better than the baseline acuity 3 months after combined trabeculotomy and cataract surgery. CONCLUSION: Combined trabeculotomy and cataract surgery normalizes intraocular pressure and improves visual acuity in adults with glaucoma and coexisting cataract.     

Oral and topical adrenergic beta-receptor blockers in glaucoma treatment. A multicenter study

In a long-term multicenter open randomized study of 103 patients with glaucoma or intraocular hypertension, oral propranolol combined with 2% pilocarpine was compared with 0.5% topical timolol also combined with 2% pilocarpine, with respect to the effects on intraocular pressure and other signs of glaucoma. The results showed that the hypotensive effects were highly significant and equal for both treatments. There were no significant differences between the 2 groups in the amount of cupping of the nerve head or the visual field defects developing during treatment. An additive hypotensive effect was recorded when both propranolol and timolol were combined with pilocarpine, which indicates the development of tolerance to both beta-blockers. Pulse rate and blood pressure were moderately reduced in both groups, both significantly more so in the propranolol group. The investigation indicates that when combined with pilocarpine the 2 adrenergic beta-receptor blockers are equally effective. We believe that oral propranolol can improve drug compliance in the treatment of glaucoma.     

The Collaborative Initial Glaucoma Treatment Study: study design, methods, and baseline characteristics of enrolled patients

OBJECTIVE: The Collaborative Initial Glaucoma Treatment Study (CIGTS) is a randomized, controlled clinical trial designed to determine whether patients with newly diagnosed open-angle glaucoma (primary, pigmentary, or pseudoexfoliative) are better treated by initial treatment with medications or by immediate filtration surgery. DESIGN: Randomized, controlled clinical trial. PARTICIPANTS: A total of 607 patients with open-angle glaucoma were enrolled. INTERVENTION: Patients randomized to initial medications (n=307) received a stepped regimen of medications to lower intraocular pressure. Those randomized to initial surgery (n=300) underwent trabeculectomy to lower intraocular pressure. MAIN OUTCOME MEASURES: Progression in visual field loss constitutes the study's primary outcome variable. Secondary outcomes include health-related quality of life, visual acuity, and intraocular pressure. RESULTS: Randomized assignment resulted in a balanced distribution between treatment groups for most demographic and clinical measures assessed at enrollment. More males than females were enrolled (55% were males), and a substantial percentage (38.1 %) of enrollees were blacks. Most enrollees (90.6%) were diagnosed with primary open-angle glaucoma; the remainder had either pseudoexfoliative (4.8%) or pigmentary (4.6%) forms of open-angle glaucoma. CONCLUSIONS: Follow-up of this well-characterized group of patients should provide well-rounded guidance, based on both traditional ophthalmic measures and patients' perspectives on their health-related quality of life, on how best to initially treat open-angle glaucoma.     

Latanoprost: experience of 2-year treatment in Scandinavia

PURPOSE: The aim of the study was to assess efficacy and side effects of latanoprost during two years of treatment. METHODS: The study was a randomized, parallel group, double-masked, multicenter comparison between latanoprost and timolol in patients with open angle glaucoma or ocular hypertension, followed by an open-label 18-month extension during which all patients were treated with latanoprost. RESULTS: Latanoprost caused a marked and sustained reduction of the intraocular pressure (IOP). IOP was reduced from baseline levels 25.1+/-3.5 mm Hg (mean+/-SD) in 183 patients initially randomized to treatment with latanoprost to 17.4+/-2.9 mm Hg (n=66) after 24 months of treatment. For patients initially randomized to treatment with timolol the corresponding figures were 24.3+/-2.3 mm Hg (n=72) and 17.4+/-2.6 (n=41) mm Hg after 18 months of treatment with latanoprost. Two patients were withdrawn because of uncontrolled IOP and 11 patients required additional timolol treatment to maintain an adequate IOP control. Patients initially treated with timolol and switched to latanoprost had a further reduction of the IOP of 1.0 mm Hg after 6 months of treatment with latanoprost (p<0.005). 46 patients were withdrawn from the study, mostly due to increased iris pigmentation or an iris color with known high risk of developing increased pigmentation. 22 patients developed increased pigmentation of the iris. The follow-up revealed no previously unknown ocular or systemic side effects. CONCLUSION: Once daily applications of latanoprost cause a marked and sustained reduction of the IOP. The only clinically significant side effect noted was the increased pigmentation of the iris, most frequently seen in irides with a mixture of brown and blue/gray or green colors. No systemic side effect was observed.     

Treatment outcomes in the tube versus trabeculectomy study after one year of follow-up

PURPOSE: To report one-year results of the Tube Versus Trabeculectomy (TVT) Study. DESIGN: Multicenter randomized clinical trial. METHODS: Setting: 17 Clinical Centers. Study Population: Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. Interventions: 350 mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). Main Outcome Measures: IOP, visual acuity, and reoperation for glaucoma. RESULTS: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At one year, IOP (mean +/- SD) was 12.4 +/- 3.9 mm Hg in the tube group and 12.7 +/- 5.8 mm Hg in the trabeculectomy group (P = .73). The number of glaucoma medications (mean +/- SD) was 1.3 +/- 1.3 in the tube group and 0.5 +/- 0.9 in the trabeculectomy group (P < .001). The cumulative probability of failure during the first year of follow-up was 3.9% in the tube group and 13.5% in the trabeculectomy group (P = .017). CONCLUSIONS: Nonvalved tube shunt surgery was more likely to maintain IOP control and avoid persistent hypotony or reoperation for glaucoma than trabeculectomy with MMC during the first year of follow-up in the TVT Study. Both surgical procedures produced similar IOP reduction at one year, but there was less need for supplemental medical therapy following trabeculectomy with MMC.     

Early trabeculectomy versus conventional management in primary open angle glaucoma.

The results of a randomised, prospective, multicentre trial of the management of primary open angle glaucoma are presented at up to five years' follow up. Previously undiagnosed cases were selected with intraocular pressure of 26 mmHg or more on two occasions together with field loss characteristic of glaucoma. Analysis was performed on one eye selected at random from each of 99 patients. Conventional medical treatment followed in unsuccessful cases by trabeculectomy (group A) was compared with trabeculectomy at diagnosis followed when necessary by supplementary medical therapy (group B). The life expectancy of these glaucoma patients was found to be similar to that for the local population matched for age and sex. In group A after four years trabeculectomy had been performed in 53% of eyes because medical management had failed to control the disease. The rate of operation was lower in those patients with intraocular pressure less than 31 mmHg and mild relative field loss (17% at three years) than in those with intraocular pressure greater than 30 mmHg and dense scotomas (75% at three years). Early surgery provided much more stable control with fewer changes in treatment than in group A. The group mean intraocular pressure after trabeculectomy was 15.0 mmHg irrespective of the time of operation, and this was significantly lower than the intraocular pressure in those cases thought to be controlled on medical therapy alone at the end of the first year (20.8 mmHg). Early operation provided significantly better protection of visual field, and the extra loss of visual field with delayed operation occurred in the preoperative period. Changes in visual fields were not related to the use of miotics. There was no significant difference in the final visual acuity in the two groups, but six cases in group A lost central fixation because of progressive loss of visual field, and there were no such cases in group B. Cataract occurred in approximately 10% of cases in both groups, but in group A this happened with only half the number of operations and at a shorter postoperative follow-up than in group B. It appears that in cases of primary open angle glaucoma of this severity the risk of delaying operation are significantly greater than those of performing trabeculectomy as the primary treatment.     

灯盏细辛对眼压已控制青光眼患者视野的保护作用

-目的:探讨灯盏细辛对眼压已控制青光眼患者视野的保护作用。方法:选择有青光眼视野缺损,眼压控制在18mmHg以内的原发性青光眼患者24例40眼。按随机、双盲法予药物口服,药物分别为灯盏细辛片和安慰剂。患者每日口服3次,每次2片。2mo为一疗程,连续3个疗程,每2mo随访1次。试验结束由药物提供方拆盲并反馈信息。结果:①用药前后各疗程对照组和治疗组收缩压、舒张压、脉搏、眼压、C/D、视力均无显著性统计学差异(P>0.05),且所有患者用药过程中无明显不良反应。②治疗组用药6mo后的平均缺损(MD)、平均敏感度(MS)与用药前的MD、MS相比,差异有显著性意义(P<0.05)。③中晚期治疗组用药2,4,6mo后的MD、MS分别与用药前MD、MS相比差异均有显著性意义(P<0.05)。结论:降低眼压对部分青光眼患者的视功能有保护作用。灯盏细辛对原发性青光眼患者的视功能有一定的保护作用,且应用疗程越长,视野缺损改善越明显;而对于原发性中晚期青光眼患者,灯盏细辛改善视野更显著。灯盏细辛对血压、脉搏、眼压、视力、C/D比均没有影响。     

益精补阳还五汤辅治开角型青光眼对其眼压及预后的影响

目的：研究益精补阳还五汤辅治开角型青光眼患者对其眼压控制及预后影响效果。

方法：选取我院2015-07/2017-07收治的开角型青光眼患者93例186眼。按照随机数字表法将所有患者分为两组。观察组47例94眼,给予马来酸噻吗洛尔滴眼液结合益精补阳还五汤辅助治疗; 对照组46例92眼,仅使用马来酸噻吗洛尔滴眼液治疗。观察比较两组患者治疗后临床疗效,治疗前后视力、眼压、视网膜中央动脉血流测定值、平均缺损范围、视野平均光敏度以及图像诱发视觉电位情况。

结果：观察组治疗后总有效率明显高于对照组(85.1% vs 63.0%)(P<0.01)。治疗后,观察组眼压明显低于对照组(P<0.01)。观察组治疗后视网膜中央动脉血流RI测定值明显低于对照组(P<0.01),PSA、EDV测定值明显高于对照组(P=0.011、<0.01)。观察组治疗后视野平均光敏度明显高于对照组(P=0.001),平均缺损范围明显少于对照组(P=0.011)。

结论：使用益精补阳还五汤辅治开角型青光眼临床疗效显著,可有效控制患者眼压水平,扩大视野范围,促进血流循环,改善预后。     

Trabeculectomy with Ologen implant versus perfluoropropane gas bubble for open angle glaucoma in pseudophakic eyes

AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma(OAG).Twentynine patients were allocated in group I(trabeculectomy with Ologen;trab-ologen group),while 28 patients were assigned in group II(trabeculectomy with perfluoropropane gas bubble;trab-C3 F8 gas bubble group).RESULTS:The intraocular pressure(IOP)was significantly reduced in both study groups at all postoperative follow up intervals(1 wk,3,6,12,18,24,30 and 36 mo,P<0.001).The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up.However,the trab-ologen group achieved a statistically significant reduction over the trab-C3 F8 gas bubble group during the last 24 months of follow up.CONCLUSION:Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.     

夜间血压下降对开角型青光眼视神经损伤的影响

目的：探讨夜间血压下降与开角型青光眼和正常眼压性青光眼患者视神经损伤进展的关系。

方法：对我院眼科门诊确诊的开角型青光眼和正常眼压性青光眼患者51例51眼分别进行视野、OCT检查,进行平均视神经纤维层厚度、24h动态血压监测、24h眼压监测等检查,分析夜间血压过度下降与视野进展率的关系。

结果：根据夜间血压下降值(dip)进行分组,三组间有显著性差异的数值为平均缺损(MD)差值(P=0.032)、眼压峰值(P=0.003)、视野缺损计分差值(P=0.041)。在视野缺损进展组、视野缺损改善组、视野缺损不变组间,dip有显著性差异(P=0.028)。视野缺损进展组夜间血压下降值明显高于其他两组。夜间血压过度降低组视野缺损进展率明显高于不过度降低组(视野缺损进展率分别为50%,7%)。影响视神经纤维层(RNFL)厚度的相关因素为夜间最低平均动脉压和dip(P=0.011,P=0.032,R²=0.081); 影响MD值的相关因素为眼压波动(P=0.026,R²=0.115); 影响模式标准差(PSD)值的相关因素为眼压波动和dip(P=0.020,P=0.044,R²=0.141)。

结论：与开角型青光眼相比,正常眼压性青光眼患者中夜间血压过度下降的发生率较高。夜间血压过度降低组中视野损伤进展明显。视野缺损进展组夜间血压降低更明显。眼压波动与dip是正常眼压性青光眼和高眼压开角型青光眼的患者视神经损伤与视野缺损高危因素。     

拉坦前列素联合噻吗心安对开角型青光眼视觉功能、眼压、眼血流的影响

目的：：研究拉坦前列素联合噻吗心安治疗方案对开角型青光眼视觉功能、眼压、眼血流的影响。方法：将2012-01/2014-05期间在我院眼科收治的开角型青光眼患者50例59眼纳入研究对象,采用数字表法随机分为观察组和对照组,观察组患者给予拉坦前列素联合噻吗心安治疗,对照组患者给予噻吗心安治疗,比较两组患者的视觉功能、眼压、眼血流情况。结果：治疗后1,2,3,4wk,观察组患眼白天平均眼压、夜间平均眼压均明显低于对照组,视力水平(0.27±0.03,0.36±0.06,0.44±0.06,0.63±0.13)明显高于对照组;观察组患眼的收缩期峰值血流速度(14.41±1.73cm/s)、舒张末期血流速度(4.18±0.67cm/s)均明显高于对照组,血管阻力指数(0.58±0.07)明显低于对照组。结论：拉坦前列素联合噻吗心安能够更为有效降低眼压,增加视网膜中央动脉的血流量,降低血管阻力,改善视力水平。