XEN‐45 collagen implant for the treatment of uveitic glaucoma

Importance

The XEN‐45 implant, a hydrophilic collagen implant which drains aqueous to the subconjunctival space, has not been investigated in the context of uveitic glaucoma.

Background

To determine the safety and efficacy of the XEN‐45 collagen implant in eyes with uveitic glaucoma.

Design

Exploratory prospective case series.

Participants

patients with medically uncontrolled uveitic glaucoma.

Methods

Twenty‐four consecutive patients (mean age ± standard deviation [SD] = 45.3 ± 18.1 years) were implanted with the XEN‐45 implant.

Main Outcome Measures

The primary outcome measure was intraocular pressure (IOP) reduction at 12 months as compared to baseline. Secondary outcome measures included ocular hypotensive medication use at 12 months, the requirement for further glaucoma surgery and failure. Intraoperative and postoperative complications were documented.

Results

The baseline mean ± SD IOP was 30.5 ± 9.8 mmHg and the mean ± SD number of glaucoma medications required was 3.3 ± 0.8. In 20 eyes (83.3%) in whom conventional glaucoma surgery was originally perceived to be inevitable, further surgery was not required after XEN‐45 implantation. The mean IOP was reduced by 60.2% from baseline to 12.2 ± 3.1 mmHg and mean medication usage was reduced to 0.4 ± 0.9 at 12 months (both P < 0.001). One patient had hypotony persisting beyond 2 months that required surgical revision and one patient developed blebitis. The 12‐month cumulative Kaplan–Meier survival probability was 79.2%.

Conclusions and Relevance

The XEN‐45 implant is effective for the treatment of patients with medically uncontrolled uveitic glaucoma. Potentially sight‐threatening complications, including bleb‐related ocular infection and persistent hypotony, may occur.     

Ahmed valve implantation in glaucoma secondary to chronic uveitis

PURPOSE: To evaluate the efficacy of Ahmed valve (AV) implantation in patients with uveitic glaucoma. METHODS: In total, 18 patients (19 eyes) with glaucoma secondary to chronic uveitis, who underwent AV implantation were retrospectively reviewed. Visual acuity, intraocular pressure (IOP), and glaucoma medications at the most recent examination prior to surgery, were compared with those of last postoperative examination. The surgical success was defined as IOP less than 21 mmHg and greater than 4 mmHg without loss of light perception and visually devastating complications at the last postoperative examination. Decrease in the number of glaucoma medications was also a criterion for surgical success. RESULTS: The mean follow-up period was 26+/-9.7 months. The mean preoperative and postoperative IOPs were 33.3+/-9.7 (range, 20-57) mmHg and 17.3+/-10.8 (range, 6-40) mmHg respectively (P<0.0001). The mean number of antiglaucoma medications was 3.5+/-0.8 (range, 2-5) preoperatively and 1.4+/-1.3 (range, 0-4) postoperatively (P<0.0001). Valve occlusion (five eyes, 26.3%) was the most commonly observed complication. Surgical success was achieved in 13 eyes (68.4%). The cumulative probability of success was 94.4% at 1 year and 60% at 2 years. Five eyes (26.3%) with IOP greater than 21 mmHg and one (5.3%) with corneal decompensation requiring penetrating keratoplasty were considered as failures. CONCLUSIONS: The implantation of AV is an effective surgical procedure for the management of uveitic glaucoma. The inflammatory background might contribute to the occurrence of valve occlusion, which is the most common complication. Prevention of this complication is an essential factor for improving the surgical outcome.     

Primary single-plate Molteno tube implantation for management of glaucoma in children with Sturge-Weber syndrome

Purpose To evaluate the safety and efficacy of primary single-plate Molteno tube implantation in the management of childhood glaucoma associated with Sturge-Weber syndrome. Patients and methods Nine eyes of seven patients were included in this prospective case series. Success was defined as intraocular pressure (IOP) ≤22 mmHg with (relative success) or without (absolute success) glaucoma medications. Intra- and postoperative complications were also evaluated. Results Mean age at the time of the surgery was 9.6 ± 3.7 years (range: 5–17 years) and mean follow-up duration was 32 ± 4.7 months (range: 20–36 months). Mean IOP was reduced from 34.2 ± 8.3 mmHg preoperatively to 21.2 ± 7.3 mmHg at the final follow-up (P = 0.012). The number of anti-glaucoma medications was reduced from 3.4 ± 0.5 preoperatively to 2.2 ± 1.3 at the final follow-up (P = 0.058). The cumulative probability of relative success was 97.2% [95% confidence interval (CI): 91.85–100%] at 12 months, 78.02% (95% CI: 60.36–95.67%) at 24 months and 43.34% (95% CI: 16.18–70.5%) at the final follow-up. During the first 6 months after surgery, two patients had controlled IOP without the use of medications (absolute success); however, 6 months and later no eye had achieved absolute success. There were no intraoperative complications. Postoperative complications included choroidal effusion necessitating drainage in three eyes (33.3%), cataract formation in one eye (11%) and retinal detachment in one eye (11%). At the final follow-up, visual acuity was unchanged from preoperative values in five eyes (55.5%); no eye demonstrated visual improvement. Conclusion Outcomes of this small case study reveal that primary single-plate Molteno tube implantation appears to be associated with a limited success rate and a relatively high complication rate in eyes of children with glaucoma resulting from Sturge-Weber syndrome.     

Ex-press引流钉联合羊膜植入术中应用丝裂霉素C治疗外伤性青光眼

目的:观察外伤性开角型青光眼患者进行Ex-press引流钉联合羊膜植入术中应用丝裂霉素C后眼压及视力的变化.方法:前瞻性系列病例研究.连续收集行Ex-press引流钉联合羊膜植入术中应用丝裂霉素C治疗外伤性开角型青光眼患者18例18眼,分别记录眼压(IOP)、最佳矫正视力(BCVA)、抗青光眼药物数量及并发症.所有患者随访24mo.结果:术后24mo,15眼取得了绝对成功(未使用抗青光眼药物时IOP<21 mmHg),成功率为88.2%(15/17).术前IOP为36.9±4.8 mmHg,术后12mo为15.4±3.5 mmHg,术后24mo为15.5±3.5 mmHg.术后早期有2例患者(11.1%)由于滤过泡纤维化出现了高眼压.大多数患者最后一次复查时BCVA较术前有提高.2例患者(11.1%)术后出现一过性低眼压.术后无前房出血、脉络膜脱离、浅前房、引流器触碰虹膜或引流器脱位等并发症.结论:Ex-press引流钉联合羊膜植入术中应用丝裂霉素C治疗外伤性开角型青光眼是安全的、有效的,可以作为这类患者的选择.     

Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Outcome of Baerveldt glaucoma drainage implants for the treatment of uveitic glaucoma

OBJECTIVE: To evaluate the efficacy and safety of Baerveldt glaucoma drainage devices in the management of uveitic glaucoma. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-four eyes of 24 patients who underwent implantation of Baerveldt glaucoma drainage devices between 1996 and 2000 for the treatment of uveitic glaucoma refractory to medical therapy. INTERVENTION: Implantation of Baerveldt glaucoma drainage device. MAIN OUTCOME MEASURES: Control of intraocular pressure (IOP), number of glaucoma medications needed for adequate IOP control, visual acuity, complications associated with the surgery, and the effect of subsequent surgery on the ability of the device to control IOP. Success was defined as IOP >/=5 and 相似文献   

Orbital apex syndrome secondary to myocysticercosis: a rare case report

AIM: To compare surgical outcomes of phacoemulsification combined with glaucoma surgical techniques performed with either Kahook Dual Blade (KDB) or iStent for Japanese patients with either primary open-angle glaucoma or exfoliation glaucoma.METHODS: We retrospectively evaluated the surgical outcomes of 129 eyes of 84 Japanese patients with glaucoma who underwent KDB or 44 eyes of 34 patients who underwent phacoemulsification with iStent procedures combined with cataract surgery. The primary outcome was surgical success or failure [with surgical failure being indicated by <20% reduction from preoperative intraocular pressure (IOP) or IOP >18 mm Hg, criterion A; IOP >14 mm Hg, criterion B; or reoperation requirement]. In addition, we assessed the number of postoperative glaucoma medications and the resulting complications. RESULTS: The probability of success was significantly higher in the KDB group than in the iStent group for criterion A (60.2% vs 46.4%, P=0.019). In the KDB group, the mean preoperative IOP of 19.7±7.2 mm Hg decreased significantly to 13.0±3.1 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.5±1.4 decreased significantly to 1.6±1.6 (P<0.01) 12mo postoperatively. In the iStent group, the mean preoperative IOP of 17.8±2.9 mm Hg significantly decreased to 14.3±2.3 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.2±1.1 decreased significantly to 0.9±1.4 (P<0.01) 12mo postoperatively. The overall IOP reduction percentage was higher in the KDB group (26.2%) than in the iStent group (19.0%) 12mo postoperatively (P=0.03). Hyphema occurred significantly more frequently in the KDB group (16.3%) than in the iStent group (2.3%; P=0.017).CONCLUSION: KDB and iStent procedures combine with cataract surgery both resulted in significant IOP and glaucoma medication reductions after the 12-month follow-up. The patients in the KDB group have a higher success rate for the target IOP of less than 18 mm Hg and a higher complication rate than those in the iStent group.     

复合式小梁切除术联合醛化脐带静脉管植入治疗难治性青光眼

目的:评价醛化脐带静脉管(human umbilical vein,HUV)在复合式小梁切除术中治疗难治性青光眼的临床疗效。方法:具有高危因素如新生血管、葡萄膜炎、无晶状体、人工晶状体和发育性的难治性青光眼28例28眼。15例行复合式小梁切除术联合巩膜瓣下HUV植入,13例行复合式小梁切除术。术后观察、比较的指标包括:手术成功率、术后眼内压(intraocular pressure,IOP)、抗青光眼药物使用数量以及术后并发症。所有研究对象随访12mo。结果:术后6mo,手术完全成功:HUV组12/15(80.0%),对照组8/13(61.5%);术后12mo,手术完全成功:HUV组11/15(73.3%),对照组6/13(46.2%)。术后12mo,HUV组和对照组IOP分别从术前50.9±12.2,49.7±11.7mmHg降至17.3±1.1,20.9±2.2mmHg(P=0.00)。由于滤过过强,对照组术后早期出现低眼压2例,HUV组无低眼压;对照组出现包裹性滤过泡4例,HUV组仅出现1例。结论:复合式小梁切除术联合HUV治疗难治性青光眼与复合式小梁切除术相比,具有手术成功率高,术后IOP控制良好、平稳,术后并发症发生率低的特点。     

小切口白内障摘除联合小梁切除术治疗开角型青光眼

目的:观察小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术治疗合并白内障的开角型青光眼的疗效。方法:回顾分析2004-01/2010-06在我院住院行小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术且资料完整的32例56眼开角型青光眼的疗效,根据患者年龄、眼球筋膜情况、视神经受损程度及术后要求达到的靶眼压确定术中用或不用丝裂霉素C(MMC),其中29眼术中使用MMC,27眼不使用MMC,患者均有明显的晶状体混浊。随访6～24(平均14.2±6.7)mo。结果:术中使用MMC组29眼,术前眼压(39.2±10.6)mmHg,术后眼压(13.2±5.5)mmHg,仅1眼需辅助1种局部降眼压药。不使用MMC组27眼,术前眼压(30.1±9.2)mmHg,术后眼压(17.5±8.1)mmHg,有4眼需辅助1种局部降眼压药,1眼需辅助2种局部降眼压药,1眼再手术。术后不需使用降眼压药者49眼(88%)。术后47眼(84%)最佳矫正视力提高。结论:小切口白内障囊外摘除、后房型人工晶状体植入联合小梁切除术可有效治疗合并白内障的开角型青光眼。     

Diode laser trans-scleral cyclophotocoagulation for glaucoma following silicone oil removal

Purpose : To evaluate the effect of trans‐scleral cyclophotocoagulation (TSCP) on intraocular pressure (IOP) in eyes with medically uncontrolled secondary glaucoma persisting after intravitreal silicone oil removal. Methods : Clinical records of 21 eyes of 21 patients who underwent TSCP for medically uncontrolled glaucoma persisting after the removal of intravitreal silicone oil, injected during vitreoretinal surgery for proliferative vitreoretinopathy (PVR), were reviewed retrospectively. Diode laser contact TSCP was applied at a power setting of 1.5–2.5 W, for a maximum duration of 2 s, and a total of 40 spots (10 spots each quadrant). All the patients were evaluated for visual acuity, IOP and number of medications used. Results : The patients were followed up for a mean ± SD period of 39.9 ± 4.27 weeks (range 36–48 weeks). The IOP was found to have decreased significantly from a pretreatment value of 34.5 ± 5.37 mmHg (range 24–44 mmHg) to 20.47 ± 4.49 mmHg at 6 months of follow up (range 12–30 mmHg, P < 0.01, Student’s paired t‐test). The total number of glaucoma medications being used reduced from 3.38 ± 0.5 to 1.08 ± 0.80 postoperatively (P < 0.01, Wilcoxon’s rank sum test). There was no significant difference in the visual acuity before and after the procedure. Thirteen eyes required a second sitting of TSCP, and five of these required a third sitting. For a successful outcome (IOP < 24 mmHg), a mean of 1.56 sittings (range 1–3 sittings) per eye were needed. Conclusion : Patients with medically uncontrolled glaucoma persisting after intravitreal silicone oil removal can be treated with TSCP; however, the reduction of IOP is variable. The IOP usually falls after a mean of 2–3 sittings of TSCP.     

Surgical management of secondary glaucoma in Fuchs’ heterochromic iridocyclitis

Purpose

To access surgical effects in patients with secondary glaucoma in Fuchs’ heterochromic iridocyclitis.

Methods

We had employed medical or surgical treatment for 22 patients who had been diagnosed as secondary glaucoma and Fuchs’ heterochromic iridocyclitis. Thirteen patients had undergone trabeculectomy with intraoperative applications of mitomycin C (MMC), of whom 11 patients had been followed up postoperatively for 25.09?±?14.4 months (range 6–48 months).

Results

Intraocular pressure (IOP) were controlled medically in 17 of 22 (77.3 %) patients. In 11 patients who had surgical therapy, mean IOP fell from a preoperative initial value of 38.05?±?7.26 mmHg to 20.63?±?6.15 mmHg (P?=?0.000), and mean number of lowering IOP medications fell from preoperative value of 2.27?±?0.78 to 1.09?±?1.22 at postoperative final follow-up time (P?=?0.014). The result of Kaplan–Meier analysis showed a total success of 90.9 % was achieved at 1 year, 62.3 % success at 4 years and 63.6 % complete success was achieved at 1 year and 31.8 % at 4 years. Exacerbations of intraocular inflammation with transient IOP rise at the early postoperative period occurred in six patients (23 %), and were controlled with topical corticosteroid. No frequent postoperative uveitic relapses were observed.

Conclusion

Fuchs’ heterochromic iridocyclitis has high morbidity of secondary glaucoma. Regular follow-up and close observation should be carried out. Trabeculectomy with MMC is a moderately effective procedure for patients with secondary glaucoma.     

Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

Purpose

To compare efficacy and safety results of an ab interno gel implant in patients with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG).

Methods

Retrospective analysis of the medical records of 110 consecutive eyes with open angle glaucoma who had received a XEN45 gel implant between March 2014 and June 2015. Intraocular pressure course, number of glaucoma medications, the need for additional intervention (including needling) and complications were evaluated until 12?months postoperatively.

Results

Data of 67 eyes with POAG and 43 eyes with PXG were analyzed. At 12?months postoperatively, the mean IOP had significantly decreased by 54.0% from preoperatively 31.85?±?8.5?mmHg to 13.99?±?2.6?mmHg in the POAG group, (p?=?0.000; Wilcoxon test), and by 55.2% from 31.63?±?9.0?mmHg to 13.28?±?3.1?mmHg in the PXG group (p?=?0.000; Wilcoxon test). The mean number of anti-glaucoma medications had significantly decreased from 3.25?±?0.8 at baseline to 0.3?±?0.7 medications at 12?months postoperatively in POAG eyes (p?=?0.000; Wilcoxon test), and from 3.05?±?1.0 to 0.3?±?0.6 medications in PXG eyes (p?=?0.000; Wilcoxon test). Hypotony (IOP?≤?6?mmHg) was observed in 2 POAG eyes (3.0%) and in 5 PXG eyes (11.7%) at 1?month but normalized in all eyes at 12?months postoperatively. Severe complications were not observed. No statistically significant differences were found between PXG eyes and POAG eyes.

Conclusion

Our data indicate that the XEN45 gel implant provides significant and comparable reduction in IOP and anti-glaucoma medication during the one-year follow-up period in POAG as well as PXG eyes. This suggests that it may be a noteworthy alternative to traditional filtering procedures in patients with POAG and PXG respectively.

     

Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5 (range 48 to 60)mo. The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

【In Press】Long-term outcomes of uveitic glaucoma treated with Ahmed valve implant in a series of Chinese patients

AIM: To report long-term outcomes of secondary glaucoma due to uveitis treated with Ahmed glaucoma valve (AGV) implantation in a series of Chinese patients. METHODS: The retrospective study included 67 eyes from 56 patients with uveitic glaucoma who underwent AGV implantation. Success of the treatment was defined as patients achieving intraocular pressure (IOP) levels between 6 and 21 mm Hg with or without additional anti-glaucoma medications and/or a minimum of 20% reduction from baseline IOP. The main outcome measurements included IOP, the number of glaucoma medications at 1, 3, 6, 12, 24, 36, 48 and 60mo after surgery, surgical complications, final best-corrected vision acuity (BCVA), visual field (VF) and retinal nerve fiber layer (RNFL). RESULTS: The mean follow-up was 53.3±8.5mo (range 48 to 60mo). The cumulative probability of success rate was 98.5%, 95.5%, 89.6%, 83.6%, 76.1%, 70.1%, 65.7% and 61.2% at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively. IOP was reduced from a baseline of 30.8±6.8 to 9.9±4.1, 10.1±4.2, 10.9±3.7, 12.9±4.6, 13.8±3.9, 13.2±4.6, 12.3±3.5 and 13.1±3.7 mm Hg at 1, 3, 6, 12, 24, 36, 48 and 60mo, respectively (P<0.01). The number of postoperative glaucoma medications was significantly decreased compared with baseline at all time points during the study period (P<0.05). There was no significant difference between preoperative and postoperative BCVA. Remarkable surgical complications were not found after surgery. The VF and RNFL of the patients were stable after the surgery. CONCLUSION: AGV implantation is safe and effect in terms of reducing IOP, decreasing the number of glaucoma medications, and preserving vision for patients with uveitic glaucoma.     

Baerveldt glaucoma implants in the management of refractory glaucoma after vitreous surgery

Purpose: To examine the effectiveness and safety of Baerveldt glaucoma implants in eyes with refractory glaucoma following vitrectomy. Methods: We performed a retrospective study of a non‐comparative case series of 30 eyes of 30 patients who had undergone the implantation of a Baerveldt glaucoma device. All eyes (30/30) had a minimum follow‐up of 6 months, and 16/30 (53%) had a follow‐up of 24 months. Surgical success was defined as intraocular pressure (IOP) < 22 mmHg on the last two follow‐up visits with or without glaucoma medication and a decrease in IOP of at least 20% compared to preoperative values with or without glaucoma medication. Results: The mean IOP before implantation of a Baerveldt glaucoma device was 30 mmHg [± 11.4 mmHg standard deviation (SD)] with maximally tolerated medical therapy. Six months after implantation of the Baerveldt glaucoma device, the mean IOP was 17.3 mmHg (± 6.7 mmHg SD) and the mean number of glaucoma medications had gone down from 3.0 (± 0.4 SD) to 0.3 (± 0.3 SD). Successful outcomes were found in 24 eyes (80%). Small complications occurred in six eyes (20%): transient postoperative hypotony (17%) and tube retraction (3%). Larger complications occurred in another six eyes (20%): corneal decompensation requiring keratoplasty (7%), suprachoroidal haemorrhage (3%) and persistently high IOP (10%). Conclusion: Baerveldt glaucoma devices are a valid treatment option in eyes with refractory glaucoma after vitreous surgery, although failure occurred in 20% of our patients. Transient complications occurred in 20% and severe complications in another 20%.     

Long-term success of ahmed glaucoma valve in refractory glaucoma

AIM: To evaluate the long-term results and complications of ahmed glaucoma valve (AGV) implantation in refractory glaucoma. METHODS: A retrospective review of 13 patients (13 eyes) with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 18 months was performed. All patients underwent a complete ophthalmologic examination and intraocular pressure (IOP) measurement before surgery and at 1 month, 3 months, 6 months, 1 year after surgery and yearly afterwards. Complications and the number of antiglaucoma medications needed were recorded. RESULTS: Mean age was 27.3±16.0 years. All eyes (100%) had at least one prior incisional surgery. Mean follow-up was 61.3±30.8 months. IOP was reduced from a mean of 35.0 ±7.0mmHg to 18.2±7.9mmHg at 12 months and to 17.0±4.1mmHg at 96 months (P<0.05) with a lower number of medications from baseline, 76.9% patients required additional procedures to achieve the success criteria set by previously published series. The most common complications were encapculated cyst formation in eight eyes (61.5 %) and tube exposure in four eyes (30.8%). CONCLUSION: Encapsulated cyst formation was the most common complication which hindered succesful IOP control after AGV implant insertion for refractory glaucoma. Despite cyst excision with anti-fibrotic agents, successful IOP reduction was not achieved in 76.9% of the patients without antiglaucoma medication.     

Combined Non-Penetrating Deep Sclerectomy with Phacoemulsification Versus Non-Penetrating Deep Sclerectomy Alone

Abstract

Purpose: To compare the results of combined non-penetrating deep sclerectomy with phacoemulsification (Phaco-NPDS) to those of non-penetrating deep sclerectomy (NPDS) alone. Materials and Methods: Fifty-two eyes with cataract and primary open angle glaucoma (POAG) or pseudoexfoliative glaucoma (PXG) were randomly assigned to either Phaco-NPDS or NPDS. Follow-up was performed at regular intervals for up to 36 months. Complete success was defined as intraocular pressure (IOP) <21?mmHg without medication and qualified success was defined as IOP <21?mmHg with medication. Results: Mean IOP in the Phaco-NPDS group decreased from 23.0?±?7.8?mmHg to 14.1?±?2.8?mmHg and in the NPDS group from 23.5?±?5.1 to 14.6?±?2.2?mmHg 24 months after surgery. The decreases of IOP in the postoperative period were statistically significant in both groups (p?<?0.05). There was no significant IOP difference between Phaco-NPDS and NPDS patients postoperatively (p?>?0.05). The mean number of glaucoma medications decreased from 1.8?±?1.3 to 0.15?±?0.4 and from 1.7?±?1.4 to 0.22?±?0.6 in the Phaco-NPDS and NPDS groups, respectively. The decreases in the mean number of the anti-glaucoma medications at the end of the postoperative, 24-month follow-up period were found to be statistically significant for both Phaco-NPDS and NPDS groups (p?<?0.05). Mean BCVA increased significantly in both groups. However, the visual outcome was significantly better for the Phaco-NPDS group (p?<?0.05). The complete and qualified success rates were 65.3% and 88.4% for Phaco-NPDS patients and 73.1% and 92.3% for NPDS patients, respectively (p?>?0.05). Conclusion: Phaco-NPDS surgery achieved excellent IOP control, while also providing immediate visual recovery. The success rate was similar to that of the NPDS procedure alone. It is advisable to consider Phaco-NPDS as a primary surgery for patients with coexisting cataract and open angle glaucoma, including PXG.     

引流管植入联合羊膜移植和Molteno植入物治疗角膜移植术后青光眼的研究

目的：探讨房水引流管植入联合羊膜移植对角膜移植术后难治性青光眼的治疗作用。方法：应用α－糜蛋白酶行兔眼后房注射制备青光眼动物模型,把它们随机分为照组、单纯引流管植入组、引流管植入加羊膜移植组、引流管加羊膜支架植入联合羊膜移植组,观察眼内压、管周组织学改变、引流管周组织渗透性,并且比较各治疗组对难治性青光眼的疗效。临床上４１例（４２眼）穿透性角膜移植术后青光眼进行了房水引流管植入联合羊膜移植１２眼和     

Causes of elevated intraocular pressure following implantation of phakic intraocular lenses for myopia

The purpose of this study is to present the causes and visual acuity outcomes in patients with elevated intraocular pressure (IOP) following implantable collamer lens (ICL) implantation. A chart review identified patients who developed high IOP at any postoperative examination and a minimum follow-up period of 3 months after ICL implantation. Data are reported out to 6 months postoperatively. Outcome measures included causes of elevated IOP, best-corrected visual acuity (BCVA) at last visit, number of glaucoma medications, other interventions, and glaucomatous damage. Elevated IOP occurred in 58 (10.8 %) of 534 eyes that received ICL. The mean age was 28 ± 7.2 years. The preoperative IOP was 16.3 ± 1.2 mmHg. Elevated IOP most commonly occurred on the first postoperative day (23/58 (39.7 %) eyes) due to retained viscoelastic. This was followed by steroid response in 22/58 (37.9 %) eyes at 2–4 weeks postoperatively. IOP elevation in 6 (10.3 %) eyes was related to high ICL vault and pupillary block, and in 4 (6.9 %) eyes due to synechial angle closure. At last visit, BCVA was 20/40 or better in 56/58 (96.6 %) eyes, and 5/58 (8.6 %) eyes remained on glaucoma medications due to persistent steroid response (2 eyes), synechial angle closure glaucoma (1 eye), and other causes (2 eyes). One eye showed glaucomatous damage. Two eyes with high vault and elevated IOP underwent ICL explantation. There is a moderate risk of transiently developing elevated IOP after ICL implantation. Thorough removal of viscoelastic and use of anti-glaucoma medications during steroid use will reduce the majority of cases with postoperative IOP elevation.     

Glaucoma drainage implants in the treatment of refractory glaucoma in pediatric patients

PURPOSE: The aim of this study is to report the clinical course, effectiveness, and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy. METHODS: This retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9+/-5.3 years (range: 4 months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications, and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, the absence of visually threatening complications, and no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1+/-6.5 years (range: 1.6 to 15.2 years). RESULTS: Mean preoperative and postoperative IOP was 33.6+/-11.4 mmHg and 17.1+/-6.5 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years, and 65% at 6 years. There was no difference between patients with primary (n=31 eyes) and secondary glaucoma (n=45 eyes) in terms of cumulative success (p=0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed: 10 eyes with uncontrolled IOP, 2 eyes with retinal detachment, and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure. CONCLUSIONS: Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractory to the initial surgical procedure and medical therapy.