5-Fluorouracil and glaucoma filtering surgery. III. Intermediate follow-up of a pilot study

Ninety-five patients (104 eyes) were enrolled in a pilot study of subconjunctival 5-fluorouracil (5-FU) injections after filtering surgery in eyes with poor surgical prognoses. At least a six-month follow-up was available on 84 patients, of whom four were excluded from the analysis of surgical outcome because they suffered retinal detachments within six months of their filtering surgery. The initial 5-FU procedures on the remaining 80 patients were successful (no further glaucoma surgical procedures were either performed or recommended, and the intraocular pressures [IOPs] were either 21 mmHg or lower with ocular hypotensive medication[s] or 25 mmHg or lower without ocular hypotensive medication) in 33 (68%) of the 48 aphakic eyes with non-neovascular glaucomas, 13 (81%) of the 16 phakic eyes with non-neovascular glaucomas after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with neovascular glaucoma (NVG). The follow-up on the successful eyes ranged from 6 to 34 months (mean +/- SD = 18.5 +/- 7.5). The visual acuities remained within one line of their preoperative levels or improved in 38 (79%) of the 48 aphakic eyes with non-neovascular glaucoma, 11 (69%) of the 16 phakic eyes with non-neovascular glaucoma after unsuccessful filtering surgery, and 12 (75%) of the 16 eyes with NVG. The initial 5-FU procedures on the 104 eyes were complicated by the following: corneal epithelial defects (50%); conjunctival wound and suture tract leaks (36%; 2% underwent surgical repair); suprachoroidal hemorrhages (9%); retinal detachments (3%); subepithelial corneal scarring (3%); endophthalmitis (2%); and malignant glaucoma (1%). It is the authors' impression that postoperative subconjunctival 5-FU increases the likelihood of achieving IOP control after filtering surgery in eyes with poor surgical prognoses; however, a randomized clinical trial is necessary to confirm this impression.     

Trabeculectomy in aphakic eyes

One hundred twenty-seven trabeculectomies performed on aphakic eyes at the Bascom Palmer Eye Institute (BPEI) between 1972 and 1982 were reviewed. Forty-five cases were excluded from data analysis: 28 in eyes with confounding conditions, such as neovascular glaucoma; ten with follow-up of less than six months; and seven that were the second or third trabeculectomy performed at the BPEI in six eyes. Of the remaining 82 trabeculectomies in 82 eyes: 32 (39%) were categorized as successes (eyes that achieved an intraocular pressure of less than or equal to 21 mmHg with medication or less than or equal to 25 mmHg without medication); eight (10%) were categorized as qualified failures (eyes that had an intraocular pressure of greater than 21 mmHg despite medication or greater than 25 mmHg without medication); and 42 (51%) were categorized as complete failures (eyes that underwent further glaucoma surgery, had further glaucoma surgery recommended, or lost light perception). In the 20 eyes of the patients younger than 50 years of age, only one (5%) was categorized as a success; while in the 62 eyes of the patients 50 years of age or older, 31 (50%) were categorized as successes.     

Filtration procedures supplemented with mitomycin C in the management of childhood glaucoma

AIMS: To evaluate the outcome of filtering procedures supplemented with mitomycin C in children with glaucoma. METHODS: All patients aged 17 or younger with glaucoma who underwent filtering surgery supplemented with mitomycin C at a tertiary care centre (n = 21) during a 5 year interval (1992 and 1996) were included. One eye for each patient was entered into the analysis. The postoperative intraocular pressure (IOP), use of antiglaucoma medications, clinical stability of glaucoma, complications, and visual acuity were retrospectively evaluated. Kaplan-Meier survival curves were used to estimate the probability of success. RESULTS: At the time of surgery mean age was 5.7 (SD 5.0) years. The most common diagnoses were trabeculodysgenesis (n = 6) and aphakic glaucoma (n = 8). Mean IOP before surgery was 35.7 (10.5) mm Hg. Average length of follow up was 18.6 (14.7) months. The probability of having IOP less than 21 mm Hg with no antiglaucoma medications and with clinically stable glaucoma 1 year after surgery was 76.9% in phakic eyes (n = 13) and 0% in aphakic eyes (n = 8). A phakic patient with Sturge-Weber's syndrome had choroidal effusion after surgery that resolved spontaneously. In the aphakic group one patient had retinal detachment and another developed an encapsulated bleb. Visual acuity deteriorated in one patient. CONCLUSION: A guarded filtration procedure with mitomycin C is relatively successful in phakic children with glaucoma, but unsuccessful in aphakic ones.     

Clinical experience with the single-plate Molteno implant in complicated glaucomas

Ninety patients with medically uncontrollable glaucomas and poor surgical prognoses received single-plate Molteno implants (Optomat Supplies, Dunedin, New Zealand) without postoperative adjunctive systemic antifibrosis therapy. Eleven patients had insufficient follow-up for assessment of intraocular pressure (IOP) or visual acuity outcome. The initial Molteno implant procedures in the remaining 79 patients were successful (IOP less than or equal to 21 mmHg with at least 6 months' follow-up) in 26 (63%) of the 41 patients older than 12 years of age with non-neovascular glaucomas in aphakia/pseudophakia; 7 (70%) of the 10 patients older than 12 years of age with non-neovascular glaucomas in phakic eyes after failed filtering surgery; 7 (47%) of the 15 patients with neovascular glaucomas; and 7 (54%) of the 13 patients younger than 13 years of age with non-neovascular glaucomas. The visual acuities remained within one line of their preoperative levels or improved in 31 (76%) of the 41 aphakic or pseudophakic eyes with non-neovascular glaucomas; 3 (30%) of the 10 phakic eyes with non-neovascular glaucomas after failed filtering surgery; 10 (67%) of the 15 eyes with neovascular glaucomas; and 9 (100%) of the 9 eyes with non-neovascular glaucomas in patients younger than 13 years of age on whom Snellen acuity was available.(ABSTRACT TRUNCATED AT 250 WORDS)     

大节段小梁切除术治疗新生血管性青光眼

目的 评价大节段小梁切除术治疗新生血管性青光眼的临床效果。方法 对23例(23眼)新生血管性青光眼采用大节段小梁切除术，术后给予视网膜光凝或虹膜根部新生血管直接光凝。术后随访6～24月，平均18月。结果 出院时眼压：5～21mmHg者21眼(91．3％)，小于5mmHg者2眼(8．7％)。全部形成功能型滤过泡，2眼视力下降，6眼视力提高。随访眼压：5～21mmHg者19眼(82．6％)，其中5眼须局部滴用降低眼压药物。小于5mmHg者1眼(4．3％)，3眼眼压升高(13．0％)。术后早期并发症主要有前房积血(39．1％)和浅前房(47.8％)，后期主要有滤过区巩膜葡萄肿(30．4％)。结论新生血管性青光眼需要手术、激光、药物等综合治疗，大节段小梁切除术是疗效较好手术方法。     

Glaucoma filtering surgery with postoperative 5-fluorouracil in patients with intraocular inflammatory disease.

Twenty-one eyes of 18 patients with uncontrolled glaucoma and intraocular inflammatory disease had glaucoma filtering surgery with postoperative subconjunctival 5-fluorouracil (5-FU). Follow-up for eyes in which intraocular pressure was controlled ranged from 6 to 53 months (mean, 34 months; median, 35 months). Fifteen of 21 eyes (71%) had controlled intraocular pressure (21 mmHg or less). Control was achieved in 9 of 10 (90%) phakic eyes and in 6 of 11 (55%) aphakic or pseudophakic eyes with or without glaucoma medication. Four of six filter failures had a second filtering procedure with 5-FU, and of these four procedures, three were successful. Cataract progression occurred in 9 of 10 phakic eyes, leading to cataract surgery in 7 eyes. Other complications included corneal epithelial defects in 13 eyes, bleb leaks in 3 eyes, choroidal effusions in 13 eyes, 1 choroidal hemorrhage, 1 serous retinal detachment and macular retinal pigment epithelial disturbance associated with hypotony and choroidal effusion. Filtering surgery with postoperative subconjunctival 5-FU can successfully control intraocular pressure in eyes with ocular inflammatory disease.     

玻璃体切割合并滤过术治疗新生血管性青光眼

目的探讨玻璃体切割合并滤过术治疗新生血管性青光眼的疗效。方法对我院收治的13眼新生血管性青光眼施行了睫状体平坦部三切口闭合式玻璃体切割合并滤过术，其中新生血管性青光眼继发于增生性糖尿病视网膜病变9眼，继发于视网膜中央静脉阻塞4眼。术前视力为LP～0.1，术前眼压在药物控制下为21～70mmHg（1kPa=7．5mmHg），所有患者术后随访6个月。观察术后眼压和视力变化。结果随访期内，12眼眼压≤21mmHg（有／无抗青光眼药液滴眼），10眼视力保持稳定或有增进。结论玻璃体切割合并滤过术可有效地治疗新生血管性青光眼，并在较长时期内维持视觉功能。     

房角手术治疗小儿无晶状体眼青光眼

目的:探讨小梁切开术和房角切开术治疗小儿无晶状体眼青光眼的效果。方法:选择1997/2010年接受先天性白内障手术后进而因无晶状体眼青光眼接受小梁切开术和房角切开术的患儿。手术治疗成功的标准是术后眼压≤24mmHg,无论是否需要局部药物的辅助使用,且避免了小梁切除术或引流阀植入,在随访期间没有明显并发症。排除标准:眼前段发育不全、小角膜、白内障手术时即发生的青光眼、随访<1a。结果:符合纳入标准10例12眼。其中,2眼仅行房角切开术,2眼房角切开术后进而接受了小梁切开术,8眼仅行小梁切开术。房角手术前平均眼压为35±10mmHg,末次随访的平均眼压为22±4mmHg(P=0.0005)。12眼中有7眼获得了成功(58%):5眼(42%)是在单一的小梁切开术后获取成功的,2眼(17%)在接受房角切开术后进而于术后7mo和15mo时接受了引流阀植入。结论:小梁切开术和房角切开术治疗小儿无晶状体眼青光眼的效果满意。     

玻璃体切割联合超全视网膜光凝、白内障摘出术治疗新生血管性青光眼

目的探讨玻璃体切割联合超全视网膜光凝及白内障摘出治疗新生血管性青光眼的疗效。方法对我院收治的15眼新生血管性青光眼施行玻璃体切割联合超全视网膜光凝及白内障摘出术,观察术后眼压、视力、新生血管消退情况,并与文献报道的玻璃体切割联合小梁切除术后眼压结果比较。术后随访6～18个月。结果末次随访时眼压平均18mmHg(13～25mmHg,1kPa=7.5mmHg),13眼(86.7%)眼压≤21mmHg,另2眼(13.3%)眼压(22mmHg、25mmHg)稍高于正常水平,但较术前(50mmHg、65mmHg)明显下降。末次随访时11眼(73.3%)视力提高,4眼(26.7%)视力不变。所有患眼新生血管消退。与文献报道的玻璃体切割联合小梁切除术相比,二者手术前后眼压差类似,差异无统计学意义(P>0.05)。结论玻璃体切割联合超全视网膜光凝及白内障摘出术可较好地治疗新生血管性青光眼,其治疗效果与联合小梁切除术类似。     

不同晶状体状态的硅油眼行Ahmed阀植入术的有效性及安全性

目的 探讨不同晶状体状态下Ahmed阀植入治疗硅油充填术后继发性青光眼的有效性及安全性。设计回顾性病例系列。研究对象2015年6月至2021年12月山东中医药大学附属眼科医院玻璃体切除联合硅油充填术后继发性青光眼Ahmed阀植入患者62例（62眼）。方法回顾患者术前及术后3个月的病历资料。分为有晶状体眼组26例（26眼）、人工晶状体（introcular lens,IOL）眼组16例（16眼）、无晶状体眼组20例（20眼）。手术成功定义为术后使用或不使用抗青光眼药物情况下眼压6～21 mmHg、无严重并发症、不需实施其他抗青光眼手术。主要指标手术成功率、眼压、降眼压药物的数量、硅油是否进入引流管、并发症发生率。结果术后3个月时手术成功率为85.5%,有晶状体眼组、IOL眼组、无晶状体眼组手术成功率分别为96.2%、87.5%、70.0%（P=0.041）。有晶状体眼手术成功率高于无晶状体眼（P=0.033）,其他组间两两比较差异无统计学意义。术后3个月眼压有晶状体眼组（16.93±1.75） mmHg、IOL眼组（18.45±2.78） mmHg均低于无晶状体眼组（22.56±3.10...     

玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼

目的:评价玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼的效果。方法:对30例(30眼)伴玻璃体积血的新生血管性青光眼患者采用玻璃体切割联合Ahmed青光眼引流阀植入术治疗,术后随访10~20(平均12)mo。结果:术后眼压控制在6.0~21.0mmHg25眼(其中3例需加用一种降眼压药物),3例眼压>21.0mmHg,2例长期低眼压,成功率83%。结论:玻璃体切割联合引流阀植入治疗伴玻璃体积血的新生血管性青光眼,术后成功率高,视力有所提高,并发症少。     

Cyclocryotherapy in the treatment of advanced glaucoma

Cyclocryotherapy in the treatment of aphakic open-angle glaucoma (AO), aphakic angle-closure glaucoma (ACL), and neovascular glaucoma (NVG) was evaluated in 96 eyes of 96 patients. All patients had follow-up of greater than 12 months, with a mean of 29.0 +/- 2.1 months (+/- SEM). Intraocular pressure (IOP) was lowered to less than 21 mmHg in 76% of eyes with AO, 68% of eyes with ACL, and 55% of eyes with NVG. Patients with NVG lost vision more frequently (70%) than patients with AO (41%) or ACL (41%). Patients with NVG had a higher incidence of loss of light perception and phthisis bulbi than patients with ACL (P less than 0.015). In patients having visual field examinations (76/96), glaucomatous field loss was arrested in 71% of patients with AO and 65% of patients with ACL, compared to 29% of patients with NVG (P less than 0.025). There was a significant correlation between postoperative IOP less than 21 mmHg and preservation of visual field. Patients receiving initial 360 degrees cryosurgical treatment required fewer repeat treatments than patients receiving initial 180 degrees treatment (P = 0.004); complications were slightly more common in the 360 degrees group.     

Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience

AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.     

小梁切除术联合硅胶片植入治疗难治性青光眼

目的:观察小梁切除术联合巩膜层间硅胶片填充治疗难治性青光眼的效果及并发症。方法:60眼难治性青光眼（包括新生血管性青光眼12眼,无晶体或人工晶体性青光眼14眼,先天性青光眼4眼,滤过性手术失败的青光眼18眼,外伤性青光眼12眼）作小梁切除术联合硅胶片填充于巩膜层间,术后观察其降眼压效果及并发症。结果:术后随访5～34个月（平均18.3个月）,最后一次随访时的眼压范围是17.30～37.19mmHg[平均（23.36±4.06）。Hg],其中38眼（63.3％）术后眼压降至21 mmHg以下,18眼（30％）眼压在21～30 mmHg之间,仅4眼（6.7％）术后眼压高于30 mmHg,术后随访时间内未发现与硅胶片填充有关的严重并发症及硅胶片排斤反应。结论:小梁切除术联合巩膜层间硅胶片植入是治疗难治性青光眼的有效方法,尤其是在我国广大基层医院可以代替昂贵进曰引流性植入物治疗难治性青光眼,因此,值得推广应用。     

【In Press】 Managing high risk glaucomas with the Ahmed valve implant: 20 years of experience

AIM: To evaluate the efficacy and safety of the Ahmed glaucoma valve in patients with refractory glaucoma. METHODS: In 342 eyes of 342 patients with uncontrolled glaucoma despite topical and/or systemic medical treatment, the Ahmed valve implant was placed for intraocular pressure (IOP) control, during the last 20 years. The type of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and failure of previous antiglaucomatic operations (two or more) in 102 eyes. RESULTS: Follow-up time ranged from 18 to 120mo with a mean follow-up of 63.2mo. Preoperative IOP decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (only topical treatment) at the last examination. Comparison of preoperative IOP values using ANOVA demonstrated statistically significant difference (P<0.001). Total success rate was 85.2% the first 6mo, 76.76% at 12mo and 50.3% at the last examination (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in previous failed trabeculectomies. Complications associated with the use of the valve were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSIONS: Although the success of the Ahmed valve implant is similar to that reported for other drainage devices, the complications associated with overfiltration in the immediate postoperative period appear to be less frequent than with other glaucoma valve drainage devices.     

反复针刺分离联合结膜下注射5-FU治疗青光眼术后滤过泡功能不良

目的:评估以反复针刺分离联合结膜下注射5-FU的方法处理青光眼术后功能不良滤过泡的效果。方法:回顾性分析2009-03/2013-02在我院以反复针刺分离联合结膜下注射5-FU的方法处理因青光眼术后滤过泡功能不良而眼压升高的连续病例34例34眼。分析治疗后眼压、滤过泡形态的变化及眼部并发症。结果:治疗后平均眼压从35.51mmHg降至14.43mmHg(P<0.05),成功率达91%。常见并发症包括角膜上皮损伤、结膜撕裂和脉络膜脱离等。结论:反复针刺分离联合结膜下注射5-FU的方法处理青光眼术后滤过泡功能不良安全有效。     

Ex-PRESS青光眼引流器植入术后无功能滤过泡的处理

目的：探讨针刺分离联合结膜下注射5-氟尿嘧啶(5-FU)对Ex-PRESS青光眼引流器植入术后的早期功能不良滤过泡的效果和安全性。

方法：回顾性分析在我院行针刺分离联合结膜下注射5-FU治疗Ex-PRESS青光眼引流器植入术后3mo内因滤过泡功能不良而眼压升高患者18例23眼的病例资料,所有患者均随访至治疗后6mo,统计分析治疗前后眼压和滤过泡形态的变化及治疗的相关并发症。

结果：治疗前眼压平均为(24.13±2.94)mmHg(1mmHg=0.133kPa),治疗后即刻、1、3、6mo的眼压分别为15.13±4.93、14.98±5.12、15.18±3.77、15.54±5.07mmHg,治疗后各时间点眼压与治疗前比较,差异均有统计学意义(P<0.05)。随访至治疗后6mo功能滤过泡形成率和治疗的总成功率均为83%。4眼(18%)治疗失败。治疗后常见并发症主要是滤泡结膜下出血、角膜上皮损伤,无严重并发症发生。

结论：采用针刺分离并结膜下注射5-FU治疗Ex-PRESS青光眼引流器植入术后早期功能不良滤过泡的患者是一种方便、安全、有效的方法。     

Trabeculectomy with anterior vitrectomy in aphakic and pseudophakic glaucoma

In 15 eyes with uncontrolled aphakic/pseudophakic glaucoma, trabeculectomy with anterior vitrectomy was performed. Mean pre-operative intraocular pressure (IOP) was 38.2 ± 6.7 mmHg and mean post operative IOP was 19.3 ± 5.2 mmHg after follow-up of 11.2 2 months. The anterior chamber maintainer technique during vitrectomy has been employed. Success rate (IOP < 21 mmHg with or without glaucoma medication) was 80 %. Visual acuity remained unchanged in 4 eyes, improved in 5 eyes and worsened in 6 eyes. Post-operative complications included: two eyes with cystoid macular edema, two eyes with choroidal effusion and prolonged hypotony, one eye with self-absorbing vitreus hemorrhage and one eye with some opacification of the corneal graft. In aphakic/pseudophakic glaucoma where vitreus is filling the anterior chamber - a combined trabeculectomy with anterior vitrectomy is indicated for removal of vitreus from the sclerostomy site with better aqueous flow through the sclerostomy and adequate control of IOP.     

改良小梁切除术治疗Ⅱ期新生血管性青光眼

目的 探讨改良小梁切除术治疗Ⅱ期新生血管性青光眼的疗效.方法 取30例(30只眼)Ⅱ期新生血管性青光眼行术中应用丝裂霉素C和可拆缝线的小梁切除术.术后早期,术眼眼压≥15mmHg和滤过泡扁平,拆除可拆缝线.术后观察眼压、滤过泡、并发症.随访12～48个月.结果 术前平均眼压(26.1±3.2)mmHg,最后一次随访时平均眼压(18.2 4±2.1)mmHg,两者之间差异有统计学意义(t=7.51,P<0.01).17只眼眼压<21mmHg,眼压控制成功率为56.7%.6只眼眼压>21mmHg,经局部应用降眼压药物后,眼压<21mmHg.17只眼术后有Ⅰ型或Ⅱ型功能性滤过泡.术后4只眼(13.3%)在一周内有Ⅰ度浅前房,未经处理,自行恢复.术后12只眼(40.0%)有前房积血,10只眼前房积血在术后7d内吸收.2只眼在术后15d内吸收.无其他并发症.结论 改良小梁切除术能有效控制Ⅱ期新生血管性青光眼的眼压,术后无严重并发症,是一种安全、有效地Ⅱ期新生血管性青光眼的降眼压方法.     

Use of 5-fluorouracil in the surgery of glaucoma

63 eyes (46 patients) with different types of glaucoma have been operated by filtering surgery with subconjunctival 5 fluoro-uracil (5-FU) injections. The mean follow up is 7 months. Two groups of patients have been studied: In the 33 eyes with previous unsuccessful glaucoma surgery, the result was very good: 73% of complete success (IOP less than or = 20 mmHg without additional therapy) 18% of qualified success (IOP less than or = 20 mmHg with additional therapy) 8% of failure. The other group included 30 eyes without previous glaucoma surgery, but with a bad surgical prognosis. In all the cases, the result was good, only one eye required additional therapy. The corneal complications are the most frequent, but do not last long. The other complications depend upon the indications, there are many in the aphakic patients. The durable flat anterior chamber must also be quoted.