微导管辅助的内路部分黏小管成形联合内路部分小梁切开术与内路全周小梁切开术的早期疗效对比

目的 评估微导管辅助的内路部分小梁切开术联合内路部分黏小管成形术（简称GABiC）治疗原发性开角型青光眼（POAG）的疗效。设计 回顾性比较性病例系列。研究对象 2018年6月至2019年1月北京同仁医院18岁以上既往无其他抗青光眼手术史POAG患者30例（30眼）。方法 回顾行GABiC术与微导管辅助的内路360°小梁切开术（GATT）患者的病例资料,术后随访3个月。主要指标 眼压、降眼压药物用药情况、并发症、条件成功率、完全成功率。结果GABiC组7眼;GATT组23眼。术后3个月,GABiC组和GATT组眼压分别为17.0 ± 2.2 mmHg和14.7 ± 3.0 mmHg（P=0.081）;用降眼压药物分别为（0.3±0.8）种、（0.1±0.4）种（P=0.865）;绝对成功率分别为86% （6/7例）和83% （19/23例）（P=1.000）;条件成功率分别为100% （7/7例）和96% （22/23例）（P=1.000）。术后眼压反弹分别为14%、48%（P=0.193）,睫状体脱离分别为100%、100%,前房出血分别为57%、87%（P=0.120）。结论 短期随访结果显示,GABiC治疗POAG的效果和安全性与GATT无显著性差异。（眼科,2020,29： 304-308）     

Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook (μLOT) or a single iStent® trabecular bypass implantation (iStent) in eyes with cataract and mild-to-moderate glaucoma.METHODS: This study enrolled subjects with mild-to-moderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90y of age. Patients underwent cataract surgery cooperated with either implantation of an iStent (iStent-phaco) or excisional goniotomy with the μLOT (μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while iStent-phaco was carried out on the other eye. Intraocular pressure (IOP) pre- and post-surgery, alterations in anterior chamber flare (ACF), and corneal endothelial cell density (ECD) were estimated.RESULTS: Twenty subjects were enrolled (mean age: 73.6±7.3y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the iStent eyes. The mean final IOP at 12mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the iStent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30d postoperatively, with a value of 11.4 pc/ms. In the iStent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7d postoperatively (11.2 pc/ms at day 7), demonstrating that postoperative inflammation was less in the iStent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, iStent and μLOT are both effective through 12mo of follow-up. Safety is more favorable in the iStent eyes, based on early anterior chamber inflammation.     

内路Schlemm管成形术治疗原发性开角型青光眼疗效及安全性观察

目的观察内路Schlemm管成形术治疗原发性开角型青光眼的疗效及安全性。设计回顾性病例系列。研究对象2018年10月-2019年3月青岛眼科医院诊治的原发性开角型青光眼30例30眼。方法所有研究对象均行内路Schlemm管成形术,经透明角膜切口进入前房,在前房内水平切开小梁网和Schlemm管内壁,切口宽约1mm,将iTrack微导管尖端对齐切口并插入Schlemm管内,进行360°扩张。术后随访3个月。Schlemm管开放情况采用海德堡前段OCT进行检查。Image J进行OCT图像分析,测量Schlemm管宽度、长度。主要指标眼压、降眼压药物数量、Schlemm管开放程度。结果30例原发性开角型青光眼患者360°穿行成功率83.33%。术前平均眼压(30.43±8.65)mmHg,术后1天、1周、1个月、3个月平均眼压分别为(14.33±3.88)mmHg、(18.21±7.52)mmHg、(16.55±4.92)mmHg、(16.61±3.99)mmHg,术后各时间点眼压较术前明显下降(P<0.001)。术前降眼压药物数量平均为(2.73±0.91)种,术后1周、1个月、3个月分别为(0.84±1.25)种、(0.75±0.91)种、(0.92±0.95)种,术后降眼压药物数量明显减少(P<0.001)。术前Schlemm管平均横径、纵径分别为(255.22±59.67)μm、(37.89±12.00)μm,术后分别为(306.11±59.44)μm、(64.22±34.62)μm(P=0.02、0.04)。术后1周、1个月、3个月的手术成功率分别为69.23%、85.00%、84.61%。术后发生前房积血者46.67%,出血性后弹力膜分离者3.33%。结论内路Schlemm管成形术对原发性开角型青光眼有较好的短期疗效,严重并发症低,是一种安全有效的微创青光眼手术。     

内路黏小管成形术研究进展

黏小管成形术是在黏小管切开术基础上发展起来的一种新型Schlemm管手术,通过扩张Schlemm管重建自然房水外流通道,增加房水外流来降低眼压,避免了结膜瘢痕化及滤过泡相关并发症问题.黏小管成形术从最初的外路手术到近来改良的内路黏小管成形术(ab-interno canaloplasty,ABiC)变得更加微创、简单、标准化,在临床应用中取得了一定的效果;同时,不论是单独手术或是联合白内障手术,均显示出较好的安全性和有效性,具有较好的应用前景.本文对ABiC在临床应用的最新进展作一综述.     

新型经脉络膜上腔引流房水植入装置Suprajet的疗效观察

目的:评估一种由睫状体前和脉络膜上腔引流房水的新型植入装置Suprajet的有效性和安全性.方法:该项研究使用5只兔子.每只兔子的一眼植入Suprajet.引流器通过位于上方的透明角膜切口,经由前房置入脉络膜上腔.引流器近端位于睫状体根部,远端位于脉络膜上腔.兔子饲养、观察4 wk.使用Tonopen AVIA测量术前和术后的眼压.最后一次随访观察时,兔子被牺牲处死,眼球摘除,进行大体上和组织学的观察评估.结果:术前眼压为18.6±6.1mmHg.术后1wk眼压为8.4±1.1 mmHg.术后2 wk 1只兔子死亡.因此,仅有4只兔子进行了后续观察.术后2wk眼压为11.0±2.8mmHg,术后3wk为9.50±3.1mmHg,术后4wk为11.3±3.3mmHg.与术前平均眼压相比,仅第1周的平均眼压显著降低(P=0.042),术后2 wk、3 wk和术后4 wk的平均眼压无明显变化(P=0.66,P=0.66,P=0.102).术中并发症包括3眼少量出血.术后2d出血已经完全吸收.对摘除眼球的大体观察发现,1眼中引流器的远端位于玻璃体内,而不是位于脉络膜上腔;其它3眼引流器的远端位于脉络膜上腔.所有眼中,近端都位于前房角.对摘除眼的组织学检查发现:不规则的胶原蛋白束和纤维沉积,包括引流器周围大量的成纤维细胞和组织细胞.结论:这一项初始动物研究显示,青光眼中Suprajet植入是一项有前景的术式.需要进行更进一步的研究以评估其有效性和安全性.     

微创青光眼手术的新进展

微创青光眼手术(micro invasive glaucoma surgery,MIGS)是新兴的一类青光眼手术,与传统小梁切除术相比,手术并发症相对少。MIGS按降眼压原理分为三类：减少房水生成术(如内窥镜下激光睫状体光凝术,高强度聚焦超声睫状体成形术),外引流手术(如 EX-PRESS 微型引流钉植入术,Schlemm管成形术),内引流手术(如小梁网微分流支架iStent植入术,内路小梁消融术)。本文将对近年MIGS的优缺点及适应证进行简单综述。     

One-year outcomes and predictable factors for microhook ab interno trabeculotomy

AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy (μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT (including combination of μLOT and cataract surgery) between February 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure (IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using Kaplan-Meier survival analysis. A multivariate Cox proportional-hazards regression model was used to investigate the factors associated with surgical failure. RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma (POAG) and 31 with secondary open angle glaucoma (SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg (P<0.01) and 2.1±1.8 (P<0.01), respectively, 12mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes (80.0% vs 48.0%; P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio (aHR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike (IOP>25 mm Hg within 2wk post-surgery; P<0.001, aHR: 5.382, 95%CI: 2.113-13.707) as independent factors associated with surgical failure. CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.     

杜塞酰胺滴眼液降眼压的有效性和安全性临床研究

目的　验证２０ｇ·Ｌ－ １ 杜塞酰胺滴眼液治疗开角型青光眼与高眼压症的有效性和安全性。方法　进行为期４ｗｋ 的开放性临床药理评估。符合入选标准的２３ 例受试者,男１０例,女１３ 例;开角型青光眼５ 例（２１－７ ％）,高眼压症１８ 例（７８－３％） 。使用２０ｇ·Ｌ－ １ 杜塞酰胺滴眼液每日３ 次共４ｗｋ。结果　第１、２、４ 周眼压与第０ 天基线相比眼压下降幅度平均为６－００±３－１０ｍ ｍＨｇ ～７－１７ ±３－９０ｍｍ Ｈｇ,分别平均下降了２２－３８ ％ ±１０－８２％ ～２６－３３％ ±１２－９４％ ;用药后仅有短暂而轻微不良反应。结论　２０ｇ·Ｌ－１ 杜塞酰胺滴眼液可稳定有效降低眼压,且不良反应短暂而轻微。     

内眼手术术中及术后暴发性脉络膜上腔出血的原因、处理和预后

目的　分析与评价内眼手术及术中术后暴发性脉络膜上腔出血的原因、处理和预后。方法　选取暴发性脉络膜上腔出血患者１１例,术前５例合并高度近视,４例合并高眼压,２例有既往内眼手术史,２例患者发生二次出血。出血后采取保守或于出血后１０～１６ｄ（平均１２．１ｄ）手术治疗。手术方法包括单纯后巩膜脉络膜上腔积血穿刺放液术,或联合玻璃体切割及硅油填充术。结果　１１例患者中有７例发生于术中,４例发生在术后１～３ｄ,约占同期我科内眼手术的０．１５％（１１／７２０４）。１１例患者中,２例保守治疗,４例行单纯后巩膜脉络膜上腔积血穿刺放液术,１例行玻璃体切割及后巩膜脉络膜上腔积血穿刺放液术,另外４例行玻璃体切割硅油填充及后巩膜脉络膜上腔积血穿刺放液术。平均随访８．２个月,术后７例患者视力改善,１例无变化,３例恶化。结论　术前高眼压、高度近视及既往内眼手术史是暴发性脉络膜上腔出血的高危因素。通过术中迅速关闭切口,术后采取保守治疗,择机行后巩膜脉络膜上腔积血穿刺放液术,视网膜脱离时联合玻璃体切割术,可保留患者部分视力。     

Complications of surgery in glaucoma. Suprachoroidal expulsive hemorrhage in glaucoma patients undergoing intraocular surgery

A retrospective study of suprachoroidal expulsive hemorrhage in 1638 consecutive cases of intraocular surgery in patients with glaucoma identified 12 cases. A brief summary of each is presented. The pathogenesis of suprachoroidal expulsive hemorrhage is discussed, emphasizing the increased risk of this surgical complication in patients with glaucoma.     

激光房角穿刺对非穿透小梁手术后高眼压的治疗

目的评价激光房角穿刺治疗非穿透小梁手术后眼压升高的临床疗效和安全性。方法以21例（23眼）开角型青光眼患者为研究对象作前瞻性研究，当非穿透小梁手术后眼压〉21mmHg时，即在手术部位行Nd：YAG激光房角穿刺。结果激光前平均眼压（25．1±2．4）mmHg，房角穿刺后1h的平均眼压降至（14．2±3．9）mmHg（P〈0．01）。激光后随访（10．5±4．1）个月，最后一次随访的平均眼压为（16．0±3．6）mmHg（P〈0．01）。并发症为浅前房、脉络膜脱离1眼，虹膜周边前粘连1眼。结论Nd：YAG激光房角穿刺能有效和安全地治疗非穿透小梁手术后小梁网-后弹力膜的房水低滤过状态，降低再次手术率。     

Relationships among systemic blood pressure, intraocular pressure, and open-angle glaucoma

Several vascular factors, including systemic hypertension (or high blood pressure [HBP]), ocular perfusion pressure, and nocturnal hypotension, have been identified as risk factors for the development and progression of glaucoma. The results of epidemiologic studies of these factors and their relationships to intraocular pressure (IOP) and open-angle glaucoma (OAG) have been contradictory. Inconsistent definitions of HBP and OAG, inconsistent design, and differing population characteristics within these studies have obfuscated definitive conclusions. Here, we review the relationships among blood pressure, IOP, and OAG.     

微导管辅助的小梁切开术治疗原发开角型青光眼的远期疗效

目的 评估微导管辅助小梁切开术治疗原发开角型青光眼的远期效果和安全性.设计回顾性病例系列.研究对象2015年10月至2018年5月北京同仁眼科中心接受微导管辅助小梁切开术治疗的原发开角型青光眼患者47例(63眼).方法 所有患者均接受微导管辅助的小梁切开术,术后1、3、6个月,1、2、3、4、5年进行随访.以术后不使用...     

Phaco-microtrabeculectomy: technique and intraocular pressure control in comparison with microtrabeculectomy

Purpose: To describe a modified technique for combined cataract and glaucoma drainage surgery involving a small flap (micro) trabeculectomy combined with phaco‐emulsification (PMT). To assess the level of intraocular pressure (IOP) control achieved by this procedure in comparison with microtrabeculectomy (MT) alone. Methods: In this retrospective controlled case series records were reviewed for 37 consecutive low‐risk patients undergoing PMT augmented with 5‐fluorouracil (5‐FU) and 37 low‐risk subjects undergoing MT with 5‐FU. IOP control was compared by survival analysis using IOP targets ≤21 mmHg and ≤16 mmHg at final follow up and with at least a 25% reduction from the preoperative pressure. Results: Mean follow up was 41.7 months (range 19.0–72.0) in the PMT group and 43.5 months (range 18.0–66.0) in the MT group. A final IOP ≤ 21 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 91.9% patients undergoing PMT (70.3% on no glaucoma drops). IOP <= 16 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 67.6% (56.8% without drops). There were no significant differences in survival rates between PMT and MT for either IOP target. The mean final IOPs were 13.4 and 13.5 mmHg on a mean of 0.6 and 0.8 glaucoma drops in the PMT and MT groups, respectively. In the PMT final visual acuity improved by at least one Snellen line in 81.1% and was worse in a single eye. Conclusions: IOP control following combined surgery by PMT is as good as following MT alone.     

穿透性Schlemm管成形术远期效果的初步观察

目的 观察穿透性Schlemm管成形术治疗青光眼的远期疗效。设计回顾性病例系列。研究对象2015年6～12月于温州眼视光医院行穿透性Schlemm管成形术的连续青光眼病例15例(16眼)。方法 回顾患者术前基本资料、术后眼压及降眼压药物数量等信息。手术成功定义为术后眼压≤21 mmHg;其中未使用任何降眼压药物者为完全成功,无论是否使用降眼压药物则为条件成功。主要指标眼压、抗青光眼药物数量、手术成功率、手术并发症及术后滤过泡形态。结果 15例(16眼)中男性7例,平均年龄(48.9±16.0)岁。术前眼压为(37.9±11.4)mmHg,平均用药3种(2,4种)。术后1个月、3个月、6个月、1年、2年、3年、4年、5年的平均眼压分别为(17.2±6.0)、(15.9±4.5)、(14.4±2.2)、(13.0±1.8)、(13.7±3.2)、(12.9±2.9)、(15.6±3.1)、(14.5±2.7)mmHg,术后各时间点与术前眼压的差异均具有统计学意义。术后1个月的降眼压药物数量的中位数(范围)为0(0,1.5),术后3个月、6个月、1年、2年、3年、4年、5年的降眼压药物数量均...     

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India

Purpose:The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes.Methods:Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications.Results:A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes (P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications.Conclusion:Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.