Anterior chamber tube shunt to an encircling band in the treatment of neovascular glaucoma and other refractory glaucomas. A long-term study

Long-term follow-up results of the anterior chamber tube shunt to an encircling band (ACTSEB) procedure are reported. Thirty eyes of 28 patients with neovascular glaucoma (Group I) and five eyes with non-neovascular refractory glaucoma (Group II) underwent this procedure. In Group I, the average preoperative intraocular pressure (IOP) was 57.1 mmHg. After surgery and average followup of 25 months 96% of eyes had a successful outcome with an average IOP of 15.8 mmHg (P less than 0.001). In Group II, despite multiple glaucoma surgical procedures, the average preoperative IOP was 54 mmHg. After surgery and average followup of 20 months 80% of eyes had a successful outcome with an average IOP of 19.8 mmHg (P less than 0.01). Revisions in our surgical technique utilizing a small entry with a 25-gauge needle into the anterior chamber and use of Healon resulted in a fully formed anterior chamber by two days. Clinical and experimental evidence is presented which suggest that aqueous filters through the tube to a reservoir around the encircling band.     

The efficacy of a modified ACTSEB (anterior chamber tube shunt to an encircling band) procedure

PURPOSE: To evaluate the efficacy of a modified anterior chamber tube shunt to an encircling band (ACTSEB) procedure for treating intractable glaucoma after scleral buckling procedure. METHODS: A retrospective review of medical records was performed on 7 eyes of 5 patients who underwent a modified ACTSEB procedure to treat intractable glaucoma after an encircling procedure. The modified ACTSEB procedure was performed using a silicone tube with its distal end inserted into the fibrous capsule around a scleral buckle and its proximal end inserted into the anterior chamber. Preoperative and postoperative intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and complications were recorded. Success was defined as a final IOP of >6 mm Hg and <21 mm Hg with or without medication. Among them qualified success was defined as a final IOP of <22 mm Hg with antiglaucoma medication, and complete success as the same IOP without medication. RESULTS: The overall success rate was 86% (6/7). Qualified success rate was 71% (5/7), and the complete success rate 14% (1/7). No case of hypotony, shallow anterior chamber, fibrous tube occlusion, tube obstruction by lens or iris, conjunctival wound leak, hyphema, or epithelial ingrowth occurred. The only complication was of inferior migration of the silicone tube into the anterior chamber in 2 cases. One of these led to corneal decompensation and subsequent tube removal due to tube migration, and the other underwent tube repositioning at 14 months postoperatively. CONCLUSIONS: The modified ACTSEB procedure provides an efficient means of treating intractable glaucoma after scleral buckling procedure.     

Retinectomy for treatment of intractable glaucoma: long term results

AIM: To report long term efficacy and complications of retinectomy as an intraocular pressure lowering procedure for intractable glaucoma. METHODS: This was a consecutive interventional case series. In 44 consecutive eyes (39 patients, 22 men and 17 women) retinectomy was performed to lower the intraocular pressure (IOP) in patients with uncontrolled IOP (>35 mm Hg for more than 4 months) despite conventional filtering surgery and drug treatment. Pars plana vitrectomy was performed and the peripheral retina was surgically excised to various degrees. The procedure was concluded by an intraocular gas tamponade of 20% C(3)F(8). Included were patients with neovascular glaucoma (12 eyes), infantile and juvenile glaucoma (three eyes), secondary glaucoma due to aphakia (13 eyes), severe ocular trauma (seven eyes), uveitis (seven eyes), and glaucoma in Ehlers-Danlos syndrome (two). RESULTS: All patients underwent successful surgical retinectomy. All patients were followed for 5 years. Mean postoperative IOP after 4 years was 15.7 (SD 9.4) mm Hg, representing a decrease of IOP by 61% compared to the preoperative level (41.2 (9.4) mm Hg). In 52.3% of eyes long term regulation of IOP could be achieved without complications. Retinectomy was least effective in neovascular glaucoma because of central retinal vein occlusion (CRVO). Eyes with glaucoma secondary to uveitis showed a tendency towards low IOP levels with subsequent phthisis bulbi. The initial visual acuity of all patients was lower than 20/50 (mean 1.8 (0.8) logMAR) in the treated eye. Final visual acuity was 2.3 (0.6) logMAR. 21 out of 44 cases developed retinal complications (retinal detachment or proliferative vitreoretinopathy (PVR)) after surgery, requiring silicone tamponade in 11 eyes (52%) either for persistent low IOP or for PVR. Nine eyes developed phthisis, seven of which were enucleated during the follow up. CONCLUSIONS: Long term results after retinectomy demonstrate its efficacy in otherwise intractable glaucoma. Efficacy and safety of retinectomy are dependent on the underlying disease.     

青光眼引流器植入联合小梁切除术治疗难治性青光眼的临床观察

目的：观察青光眼引流器植入联合小梁切除术治疗难治性青光眼的疗效。方法对34例（46只眼）难治性青光眼行青光眼引流器植入联合小梁切除术治疗,观察术后视力、眼压、滤过泡及并发症等情况。结果34例难治性青光眼中,新生血管性青光眼12例（17只眼）,无晶状体眼4例（4只眼）,人工晶状体眼1例（1只眼）,外伤性青光眼2例（2只眼）,发育性青光眼9例（12只眼）,色素播散性青光眼2例（2只眼）。术前平均眼压（42．15±2．32）mmHg,术后眼压控制30只眼,眼压部分控制7只眼,眼压失控9只眼,术后平均眼压（18．34±3.55）mmHg,眼压有效控制率为80．43％。功能性滤过泡形成率67．39％,手术并发症较少。结论新型国产青光眼引流器植入联合小梁切除术治疗难治性青光眼疗效好,安全性高,术后并发症少,可以推广使用。     

Results of viscocanalostomy for primary open-angle glaucoma

PURPOSE: Viscocanalostomy is a nonperforating filtering surgical procedure that may avoid postoperative complications common with standard trabeculectomy. This study was conducted to determine the surgical outcome of this procedure after a postoperative observation period of 12 to 36 months. METHODS: Interventional consecutive case series. In a prospective study, a consecutive series of 67 eyes of 67 patients with chronic primary open-angle glaucoma underwent VCS. Excluded were patients with angle closure glaucoma, post-traumatic, uveitic, neovascular, or dysgenetic glaucoma, as well as patients who needed combined cataract-glaucoma procedures. The patients were examined postoperatively on the first day, first week, at 1 month, and then at 3-month intervals through 36 months. At each visit, best-corrected visual acuity, intraocular pressure (IOP), and the appearance of the surgical wound, anterior chamber, and indirect funduscopy were recorded. RESULTS: Complete success was defined as IOP less than or equal to 20 mm Hg and greater than or equal to 30% IOP reduction without medical or additional surgical treatment compared with the IOP from a preoperative level with maximum tolerated medical therapy; qualified success IOP less than or equal to 20 mm Hg with treatment or an IOP reduction less than 30% from preoperative level with maximum tolerated medical therapy; and qualified failure of an IOP greater than 20 mm Hg with glaucoma medication, but no optic nerve or visual field deterioration and complete failure as an eye requiring further glaucoma surgery or lost visual function. The overall success rate was 88% at 1 year, 90% at 2 years, and 88% at 3 years, with a complete success of 68% at 1 year, 60% at 2 and 59% at 3 years. Four eyes had a perforation of the Descemet membrane, three of those needed peripheral iridectomy; six eyes had a microperforation not needing a peripheral iridectomy. Five eyes presented hyphema. Eight eyes presented deterioration of visual function after surgery: three eyes because of corneal astigmatism, one eye because of cataract, and four presented glaucomatous deterioration of the visual field despite pressures under 20 mm Hg. Four eyes had progressive cataract formation judged as independent from surgery. CONCLUSION: VCS provides an overall success rate of 88% and a complete success of 59% 3 years after surgery. The major immediate complication is perforation of the Descemet membrane with a need for peripheral iridectomy. No serious long-term complications were noted in our small series. Visual function remained stable in 55 eyes (82%).     

Pars plana filtration with multiple laser perforation of the uvea for neovascular glaucoma following proliferative diabetic retinopathy

PURPOSE: To evaluate the effect of pars plana filtration with multiple laser perforation of the uvea in neovascular glaucoma patients following proliferative diabetic retinopathy. METHODS: In 18 eyes of 13 patients, after a fornix-based conjunctival incision, two 9 x 3 mm, thin, rectangular scleral flaps were created 3-6 mm posterior to the limbus. The remaining layers of sclera under each flap were removed. The exposed uvea was irradiated at a mean of 60.6 spots with an argon laser just to the point of perforation. After the posterior chamber fluid escaped, the flaps were sutured. RESULTS: The mean preoperative intraocular pressure (IOP) was 36.4 +/- 9.0 mm Hg. After an average follow-up of 16.6 +/- 5.9 months, the mean final postoperative IOP was 16.6 +/- 4.4 mm Hg. The postoperative IOP was below 21 mm Hg in 3 (16.7%) of the 18 eyes without medication, in 14 (77.8%) on anti-glaucoma eye drops, and in 16 (88. 9%) on anti-glaucoma eye drops and an oral carbonic anhydrase inhibitor. Snellen visual acuity improved by more than 2 lines in 7 of the 18 eyes, worsened by this amount in 3, and remained within baseline +/- 2 lines in 8. CONCLUSION: This procedure is an effective treatment for neovascular glaucoma patients following proliferative diabetic retinopathy.     

眼内窥镜下睫状体光凝对角膜植片存活的影响

目的探讨对穿透性角膜移植术（PKP）后眼压升高且药物不能控制的患者,采用眼内窥镜直视下睫状体光凝术（ECP）进行治疗的疗效和对角膜植片存活的影响。方法选择2000年3月至2004年4月期间,于中山大学中山眼科中心就诊的34例（34只眼）PKP术后眼压升高且药物不能控制患者,在眼内窥镜直视下,行半导体激光睫状体光凝术（12例）或联合玻璃体切除术（22例）（ECP组）。选择26例（26只眼）患者作为对照,采用经巩膜面半导体激光睫状体光凝术（TCP）（TCP组）。术前、术后随访观察视力、眼压、植片透明度、内皮细胞密度及前房反应,超声活体显微镜（UBM）检查睫状突和房角情况,注意术后并发症等。结果ECP组术后3个月和6个月时,分别有13例（38．2％）和23例（67．7％）眼压低于21mmHg。TCP组术后3个月和6个月时,分别有10例（38．5％）和8例（30．8％）眼压低于21mmHg。两组之间术后眼压控制率比较,在3个月时差异无统计学意义（X^2=0．0003,P=0．986）,但6个月时差异有统计学意义（X^2=8．024,P=0．005）。ECP组和TCP组术后植片内皮细胞密度分别为（1013±170）个／mm^2和（847±136）个/mm^2,差异有统计学意义（t=-0．009,P=0．033）。ECP组和TCP组术后分别有9例（26．5％）和21例（80．8％）出现反应性虹膜炎,两组之间比较差异有统计学意义（x^2=17．376,P=0．001）。结论ECP对降低PKP术后青光眼患者眼压的远期疗效优于TCP。ECP对角膜植片内皮细胞的损伤和引起术后葡萄膜炎的程度均较TCP轻,相对提高了PKP术后角膜植片的生存质量。     

玻璃体切割联合术治疗伴有玻璃体积血的 新生血管性青光眼

目的探讨玻璃体切割联合术治疗伴有玻璃体积血新生血管性青光眼的效果。方法7例患者7只眼因玻璃体积血新生血管性青光眼接受玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除术。手术前视力光感～0.2，眼压平均 54 mm Hg(38～64 mm Hg )(1 mm Hg=0.133 kPa)。平均随访8个月(6～15个月)。结果手术后视力光感～0.4；眼压平均17 mm Hg(10～30 mm Hg)，显著低于手术前眼压(P＜0.05)；并发症主要包括前房炎性渗出(7只眼)，手术后1～2周内高眼压(2只眼)，手术后脉络膜上腔出血(2只眼)。结论玻璃体切割联合白内障摘除、全视网膜光凝及小梁切除手术可能是治疗某些伴有玻璃体积血新生血管性青光眼的有效方法。(中华眼底病杂志,2005,21:148-149)     

Long-term results of anterior chamber tube shunt to an encircling band in the treatment of refractory glaucomas.

We performed the anterior chamber tube shunt to an encircling band procedure in 34 patients (36 eyes) with refractory glaucoma, and evaluated the long-term outcome. The preoperative mean intraocular pressure (IOP) was 36.8 +/- 9.6 mmHg, the postoperative mean IOP was 21.6 +/- 13.6 mmHg, a statistically significant (p < 0.01) reduction of IOP following this procedure. The final postoperative IOP was under 21 mmHg in 23 (63.9%) of the 36 eyes. The success rate of IOP control 36 months after the operation without any elevation of post-operative IOP was 30.3% (life-table method). Complications of this procedure included flattening of the anterior chamber (61.1%), damage to the corneal endothelium (25%), hyphema (25%), and a transient IOP elevation (25%). As filtering surgery with 5-fluorouracil is more effective and simple to perform, we conclude that the anterior chamber tube shunt to an encircling band procedure should be reserved for those with refractory glaucoma who have had multiple surgical interventions.     

Valve implants of glaucoma pressure regulator for refractory glaucoma: own experience

PURPOSE: To present our experiences in valve implantation for refractory glaucoma. MATERIAL AND METHODS: From October 1993 to December 1996 implantations of Glaucoma Pressure Regulator Optimed were performed in 7 eyes of 7 patients. There were 4 men and 3 women aged from 32 to 65 years. There were 3 eyes with neovascular glaucoma due to diabetes mellitus, 2 eyes with posttraumatic glaucoma, including 1 case after keratoplasty, 1 eye with postkeratoplasty glaucoma and 1 eye with aphakic glaucoma. Preoperative IOPs ranged from 33 to 61 mm Hg (mean 37.6 +/- 7.2 mm Hg). RESULTS: Success was considered an IOP of less than 22 mm Hg without medication (complete success) or with medication (qualified success) without additional filtering surgery. Postoperative success was obtained in 4 out of 7 eyes after follow-up period of 37.4 +/- 17.08 months (range 16-39 months). Early complications were hyphema (1 patient, 14.3%), blockage of intracameral portion of the tube (1 patient, 14.3%), hypertony (1 patient, 14.3%). Late complications were: external conjunctival bleb failure (2 patients, 28.6%), blockage of intracameral portion of tube by fibrovascular tissue (1 patient, 14.3%). CONCLUSION: Our experiences confirm that the valve implant is still today an alternative surgical procedure for controlling IOP in eyes with refractory glaucoma that have visual potential.     

Seven-year follow-up of combined cataract extraction and viscocanalostomy

PURPOSE: To investigate the long-term success and complications of phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in eyes with coexisting cataract and medically uncontrolled glaucoma. SETTING: Department of Ophthalmology, Warrington Hospital, Warrington, United Kingdom. METHODS: A prospective nonrandomized study evaluated 165 consecutive eyes (114 patients) that had phacoviscocanalostomy. The main outcome measures were intraocular pressure (IOP), visual acuity, requirement for topical antiglaucoma medication, and the presence or absence of drainage blebs or bleb complications. RESULTS: The mean follow-up was 38.7 months +/- 19.3 (SD) (range 12 to 90 months). There was a statistically significant decrease in IOP, from 24.1 +/- 5.1 mm Hg preoperatively to 13.8 +/- 8.1 mm Hg 1 day after surgery (P<.001), 16.0 +/- 4.1 mm Hg at 5 years (P<.001), and at all evaluations to the last follow-up. The mean number of medications per eye decreased significantly from 2.5 +/- 0.9 before surgery to 0.1 +/- 0.5 at last follow-up (P<.001). At the final follow-up, IOP was reduced by 33.2% (16.2 mm Hg versus 24.1 mm Hg). Complete success, defined as an IOP reduction of more than 30% from preoperative level without medications, was achieved in 48.5% of eyes, with 42% of eyes having an IOP of less than 16 mm Hg. The percentage fall in IOP was linearly related to the preoperative IOP level (P<.001). No eye developed a trabeculectomy-type bleb, and there were no bleb-related complications. CONCLUSIONS: Phacoviscocanalostomy was safe and effective for the management of eyes with coexisting cataract and medically uncontrolled glaucoma. It provided a stable and sustained reduction in IOP with a minimum requirement for topical medication.     

The use of Molteno implant and anterior chamber tube shunt to encircling band for the treatment of glaucoma in keratoplasty patients

This retrospective study reviews the results of 35 keratoplasty patients with complex corneal and glaucoma disease, who received Molteno-type (n = 25) or anterior chamber tube shunt to encircling band (ACTSEB)-type (n = 10) implant for the treatment of difficult glaucomas. The implant was placed before the keratoplasty in 14 eyes, during the keratoplasty procedure in 6 eyes, and subsequent to the corneal surgery in 15 eyes. Mean follow-up for the keratoplasty was 25.46 months (range, 6-58 months) and 24.74 months (range, 7-42 months) for the seton procedure. Graft rejection occurred in 12 (34%) of 35 eyes and was progressive in 9 eyes. Nonimmunologic failure was seen in 9 (26%) of 35 eyes. Grafts were repeated in ten eyes with eight of these (80%) remaining clear at a mean of 14.4 months. Considering the results of the repeat grafts, 25 (71%) of 35 eyes achieved clear transplants. Overall, 46% of patients had final visual acuities of 20/100 or better and 69% had final visual acuities of 20/400 or better. The mean preoperative intraocular pressure (IOP) of 34.54 mmHg (range, 14-68 mmHg; standard deviation [SD], 11.51) was lowered to a mean of 14.65 mmHg (range, 6-30 mmHg; SD, 4.49). In the final analysis, 30 (86%) of 35 eyes were judged successful from a glaucoma standpoint. We conclude that the Molteno- and ACTSEB-type implants are viable treatment alternatives in this difficult glaucoma group.     

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。     

Surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma.

BACKGROUND AND OBJECTIVE: To evaluate the surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma. PATIENTS AND METHODS: The authors reviewed the charts of all patients of refractory developmental glaucoma who underwent mitomycin C-augmented trabeculectomy (0.4 mg/ml for 3 minutes) between September 1990 and August 1995. Thirty-eight eyes of 29 patients were included in the study; 34 eyes (89.5%) had refractory primary congenital glaucoma with documented failure of primary surgery, 2 eyes (5.3%) had Axenfeld-Rieger syndrome and 2 eyes (5.3%) had aniridia. The main outcome measures in this study were preoperative and postoperative intraocular pressures (IOPs),visual acuities, bleb characteristics, success rate, time of surgical failure, and complications. RESULTS: The IOP (mean +/- SD) reduced from a preoperative level of 32.6 +/- 11.8 mm Hg to 12.3 +/- 7.3 mm Hg (P <0.0001) with the percentage reduction in IOP being 56%. Kaplan-Meier survival analysis showed that the success probability at 18 months was 65%, which was maintained till 30 months of follow-up. The bleb was characterized by its large, elevated, avascular, transparent appearance in all the eyes. There were no intraoperative complications. The postoperative complications included hyphema (absorbed one week) in 8 eyes (21%), uncontrolled IOP in 8 eyes (21%), shallow anterior chamber in 3 eyes (7.9%), hypotony without visual loss in one eye (2.6%) and retinal detachment in 2 eyes (5.2%) which was surgically repaired successfully. Visual acuity was maintained in all cases after surgery. None of the patients developed mitomycin-C related late bleb-leakage or endophthalmitis. CONCLUSION: Treatment of refractory developmental glaucoma with mitomycin C-augmented trabeculectomy is effective and safe with an acceptable rate of complications.     

Implantation of second glaucoma drainage devices after failure of primary devices

BACKGROUND AND OBJECTIVE: To evaluate the efficacy and safety of implantation of a second glaucoma drainage device for eyes that have failed a primary device. PATIENTS AND METHODS: Medical records of patients receiving a primary glaucoma drainage device at Bascom Palmer Eye Institute from January 1987 to October 1998 were reviewed, of which 18 eyes of 18 patients were studied. Patients failing a primary glaucoma drainage procedure and receiving a second glaucoma drainage device were included in this study. The second eye in the same patient was excluded if a second drainage implant was required. All patients received a second device in a standardized fashion with the drainage tube inserted in the anterior chamber. Main outcome measures included: visual acuity, intraocular pressure (IOP), antiglaucomatous medication, length of follow up, and surface area of glaucoma drainage device. Success was defined as an IOP less than or equal to 21 mm Hg with or without medications, and at least a 20% reduction in IOP, without the need for additional glaucoma procedures. RESULTS: The mean postoperative IOP (19.6 +/- 9.4 mm Hg; range, 8-50 mm Hg) was significantly (P = 0.006) lower than the mean preoperative IOP (29.5 +/- 8.1 mm Hg; range, 20-52 mm Hg) at last follow up (mean 19.6 +/- 13.6 months; range, 6-47 months). The mean number of postoperative antiglaucomatous medications (2.2 +/- 1.2; range 0-4) was statistically similar (P = 0.2) to mean preoperative number of antiglaucomatous medications (2.6 +/- 1.2, range 1-4). Using Kaplan-Meier estimates, successful IOP reduction was observed in 89%, 83%, 63%, and 37% of eyes at 6 months, 1, 2, and 3 years, respectively. Four patients (21%) had a decline in visual acuity. CONCLUSIONS: Implantation of secondary glaucoma drainage devices may be useful in eyes that have failed primary devices.     

The use of a "cheese-wire" suture in trabeculectomy

AIM: To report a preliminary study on the safety and efficacy of the use of a cheese-wire suture in trabeculectomy. Patients and methods: The case notes of 32 eyes of 25 patients with medically uncontrolled glaucoma who underwent trabeculectomy with cheese-wire suture at Stobhill Hospital, Glasgow, UK, between July 2001 and September 2002 were studied retrospectively. Diagnoses included primary open angle glaucoma (n = 24), normal tension glaucoma (n = 3), angle closure glaucoma (n = 2), ocular hypertension (n = 1), angle recession glaucoma (n = 1) and combined mechanism glaucoma (n = 1). The mean presenting intraocular pressure (IOP) was 29.5 mm Hg and mean intraocular pressure before operation was 23.5 mm Hg OUTCOME MEASURES: Success was defined as lowering of IOP by at least 15% compared with IOP before removal. RESULTS: A total of 20 eyes (62%) underwent removal of the cheese-wire suture. 17 eyes (85%) underwent removal for therapeutic reasons (failing/failed blebs) and three eyes (15%) underwent suture removal as the suture loops were exposed. The timing of removal was between 2 weeks and 12 months following surgery. A successful outcome was seen in 12/17 (70%) eyes in the eyes that had therapeutic suture removal. 15 eyes had undergone previous surgical interventions (trabeculectomy n = 12, extracapsular cataract extraction n = 1 and laser peripheral iridotomies n = 2). Mean IOP before removal was 23.66 mm Hg and mean IOP immediately following removal was 11.33 mm Hg. Of the 32 eyes that underwent trabeculectomy with cheese-wire suture, 24 eyes had intraoperative mitomycin C and one eye had 5-fluorouracil. The remaining seven eyes did not have any antimetabolites. Early complications related to the surgical procedure included conjunctival haematoma in one eye (3%), corneal abrasion in one eye (3%), wound leak in five eyes (15%), shallow anterior chamber in one eye (3%), hyphaema in six eyes (18%), choroidal effusion in six eyes (18%) and raised IOP in two eyes (6%). Late complications of suture exposure occurred in three eyes (9%). Complications related to removal of the cheese-wire suture included suture breakage in two eyes (10%), hypotony in one eye (5%) and transient hyphaema in one eye (5%). CONCLUSION: The use of cheese-wire suture in trabeculectomy appears to be safe and may provide an alternative strategy in the management of bleb failure.     

The effect of trabeculectomy on the intraocular pressure of the unoperated fellow eye

PURPOSE: To investigate the intraocular pressure (IOP) changes in the unoperated fellow eye in patients who underwent trabeculectomy. MATERIALS AND METHODS: IOP changes in the unoperated fellow eyes of 107 patients who underwent trabeculectomy in 1 eye for high-tension glaucoma (48 primary open-angle glaucoma, 43 pseudoexfoliative glaucoma, and 16 narrow-angle glaucoma) were evaluated during the early postoperative period. All IOP measurements were recorded during the postoperative first 3 months and compared with preoperative values. RESULTS: Mean preoperative IOP levels were 37.0 +/- 10.0 mm Hg in the operated eyes and 15.1 +/- 3.1 mm Hg in the fellow eyes. Mean IOPs in the unoperated eyes on the postoperative first-day, first- and second-week, and first- and third-month visits (17.1 +/- 5.7, 17.5 +/- 5.1, 18.5 +/- 5.4, 18.6 +/- 5.1, and 19.0 +/- 5.9 mm Hg, respectively) were significantly different compared with the preoperative levels for each period of time (P < 0.01). Eight fellow eyes underwent operations for uncontrolled glaucoma before month 3. Among the remaining 99 eyes, higher postoperative IOP values were measured in 33 (33%) eyes at all postoperative visits compared with the preoperative IOP levels. A consistent IOP rise equal to or higher than 5 mm Hg was detected in 12 eyes (12%) and a consistent IOP elevation of 30% or more was found in 14 eyes (14%) during the postoperative first 3 months. Contralateral IOP elevation was not correlated with patient age, type of glaucoma, or preoperative antiglaucomatous medications prescribed to the operated or fellow eyes. CONCLUSION: After filtration surgery, IOP of the unoperated fellow eye should also be monitored closely in order not to overlook a possible insidious rise, especially in glaucomatous eyes that were previously under good medical control.     

Ex-Press房水引流物植入术治疗新生血管性青光眼临床观察

目的　评价Ex-Press房水引流物植入术治疗新生血管性青光眼的有效性和安全性。方法　2014年5月至2017年6月在北京同仁医院确诊为新生血管性青光眼并行Ex-Press房水引流物植入术的患者23例（23眼）,术后随访12个月,观察术前、术后患者的眼压、降眼压药物种类及术后并发症情况。结果　23例患者术前眼压为（39.0±4.2）mmHg（1 kPa=7.5 mmHg）;术后1个月、3个月、6个月、12个月眼压分别为（12.8±0.7）mmHg、（15.5±0.9）mmHg、（18.4±1.0）mmHg、（20.6±2.5）mmHg,与术前相比差异均有统计学意义（均为P<0.05）。至末次随访时,手术完全成功17眼（73.9%）,条件成功1眼（4.3%）,总手术成功率78.3%。术前使用抗青光眼药物（3.3±0.9）种,术后12个月为（0.2±0.5）种。术后浅前房3眼、前房积血1眼、高眼压7眼。结论　Ex-Press房水引流物植入术安全、有效、并发症少,可作为新生血管性青光眼患者的手术治疗方式之一。     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.     

Draining implant for neovascular glaucoma

We treated 12 eyes with advanced neovascular glaucoma with a modification of drainage implant surgery. All 12 eyes had rubeosis iridis and severe pain and nine had undergone previous glaucoma surgery. After follow-up periods of two to 24 months (mean, 11.3 months), nine of 12 eyes had intraocular pressures of less than 24 mm Hg (mean preoperative value, 49.5 +/- 8.2 mm Hg; mean postoperative value, 22.2 +/- 12.9 mm Hg). Surgery was unsuccessful in three eyes, in two because the anterior chamber remained flat postoperatively and in one because a large hyphema blocked the tube 15 months postoperatively. Our procedure, which uses a Y-shaped Teflon tube, is easy to perform, is well tolerated by the eye, and is associated with a low risk of serious complications.