Pneumatic trabeculoplasty a new method to treat primary open-angle glaucoma and reduce the number of concomitant medications

Pneumatic trabeculoplasty (PNT), when used in combination with antiglaucoma medication, was evaluated in two studies: a feasibility study involving 177 patients, and a separate efficacy study involving 317 eyes. Both studies were nonblinded, single-armed, and nonrandomized; the primary efficacy end point in each study was a decrease in intraocular pressure (IOP) compared with baseline. The first study reported a mean drop in IOP of 6.3 mmHg across the entire group. The second study showed a mean IOP after PNT treatment level at least 1 mmHg less than the pretreatment mean; except at 3, 6, 9, and 12 months, when it was at least 2 mmHg less than the initial mean IOP. The lesser reduction observed in the second study can be explained by the fact that a number of the patients were at least partially controlled by antiglaucoma medications at enrollment, and, as a result, the group had a lower starting IOP than those enrolled in the first study. In both studies, a clear trend to less medication was observed when PNT was added to a patient’s treatment regime. The ability of PNT to reduce IOP and medication requirements, along with its relatively benign safety profile, supports the use of PNT as part of a glaucoma patient’s treatment regimen. Drs. Leo D. Bores and John T. LiVecchi have stated that they do have significant financial interest or other relationship with a product manufacturer or for Ophthalmic International and (Dr. LiVecchi is Medical Director and a member of the Board of Directors of Coronado Industries). Dr. Guillermo Avalos Urzúa has no financial interest the device. The authors also do discuss the use of off-label products, which includes unlabeled, unapproved, or investigative devices.     

巩膜炎治疗的一种新方法:干扰素的应用

目的:用干扰素治疗巩膜炎。方法:无对照11例巩膜炎患者用干扰素2×105U结膜下注射,按巩膜炎记分来评价干扰素治疗效果。结果:11例患者治疗前巩膜炎平均记分为9.36±3.23分,采用干扰素治疗2wk后平均记分为2.82±3.15分。治疗效果明显,未发现有任何毒副作用。结论:干扰素可以用于巩膜炎的治疗,特别是巩膜炎记分较低的巩膜炎的治疗,无副作用,为巩膜炎的治疗开辟了一个新的途径。     

抗青光眼新藥研究展望

近幾年來,青光眼的藥物治療有了較大發展,許多新藥物的研制與開發正在試驗階段,本文就一些新的降眼壓及視神經保護藥作一簡要叙述.     

Efficacy and safety of a systematic switch from latanoprost to travoprost in patients with glaucoma

PURPOSE: To assess the efficacy and safety of systematically switching a large number of hospital-based glaucoma patients from latanoprost to travoprost therapy. MATERIALS AND METHODS: In this prospective observational study, patients on latanoprost were systematically switched to travoprost without washout and followed-up for 12 weeks. The main outcome measures were control of intraocular pressure (IOP), rate of switching back, and tolerability. IOP was measured at baseline (while on latanoprost), and at weeks 6 and 12 after switching to travoprost. Adverse effects were assessed and conjunctival hyperemia was graded using a standardized scale. RESULTS: Ninety-three consecutive patients (mean age 63.3 +/- 12.1 y) were enrolled. Nine patients were lost to follow-up. Four patients (4.3%) were switched back to latanoprost after 6 weeks due to travoprost intolerance. There was no significant difference between mean IOP at baseline [16.4 +/- 3.4 mm Hg, 95% confidence interval (CI) 15.6-17.2] and that at week 6 (15.9 +/- 4.2 mm Hg, 95% CI 14.9-16.8) (P=0.2) and week 12 (16.4 +/- 5.7 mm Hg, 95% CI 15.1-17.7) (P=0.99). There was no significant difference in the mean hyperemia score at week 12 compared with baseline (P=0.09). The majority of patients (86.9%) felt that both medications were comparable in terms of degree of comfort; 5 felt that travoprost caused more redness. CONCLUSIONS: In this study, when glaucoma patients were systematically switched from latanoprost to travoprost, the efficacy and safety of the 2 medications were found to be comparable. A high switch rate (95.2%) was achieved with average hyperemia scores being comparable.     

Efficacy and safety of deep sclerectomy in uveitic glaucoma

Purpose To evaluate the safety and efficacy of deep sclerectomy with implant and mitomycin C in uveitic glaucoma. Design Prospective, noncomparative case study. Patients and methods Nine patients (13 eyes) with uncontrolled uveitic glaucoma underwent deep sclerectomy with implant from 2002 to 2006. All patients had their uveitis controlled before and after surgery with anti-inflammatory therapy. Main outcome measures Control of intraocular pressure. A secondary outcome measure was the number of antiglaucoma medications required to achieve the desired intraocular pressure. Visual acuity and complication associated with the surgery were monitored. Results Mean follow-up was 21 months (range 12–54 months). Intraocular pressure (IOP) was reduced from a mean preoperative value of 28.7 mmHg to a mean postoperative value of 13.85 mmHg (Wilcoxon signed rank test P = 0.005). At the most recent visit, complete success was obtained in 84.6%, qualified success was obtained in 7.7%, and complete failure in 7.7%. Mean number of antiglaucoma medications was reduced from 3.07 to 0.2 (Wilcoxon signed rank test P = 0.001). Neodymium:YAG goniopuncture was performed in two eyes. Postoperative complications included transient hypotony with maculopathy in one eye, shallow choroidal effusions in two eyes, and progression of cataract in four eyes. Conclusion Deep sclerectomy with implant in uveitic glaucoma appeared to be effective in controlling the IOP at short-term follow-up with no serious postoperative side-effects.     

Surgical therapy of chronic glaucoma in aphakia and pseudophakia

Most glaucoma surgical procedures are less successful in aphakic or pseudophakic eyes. The authors reviewed 91 consecutive initial glaucoma procedures in aphakic patients from 1979 to 1986 to determine successful outcomes and complications. Success was defined as an intraocular pressure (IOP) of at least 30% below the preoperative value and less than 21 mmHg, less than 2 lines of Snellen acuity loss, and no further surgical intervention. At 9 months, success rates were: trabeculectomy, 4 of 15 patients; cyclodialysis, 3 of 20 patients; neodymium:YAG (Nd:YAG) cyclophotocoagulation, 1 of 8 patients; cyclocryotherapy, 9 of 22 patients; anterior chamber tube shunt (Schocket procedure), 3 of 6 patients; and argon laser trabeculoplasty, 2 of 20 patients. Severe complications included phthisis bulbi in 11% of cyclocryotherapy and severe visual loss in 20% with cyclodialysis and 14% with cyclocryotherapy. Results confirm the difficulty of surgical therapy in these patients.     

Efficacy and safety of latanoprost in eyes with uveitic glaucoma

Background  To compare the efficacy and safety of latanoprost against a fixed combination of dorzolamide and timolol in eyes with elevated intraocular pressure (IOP) or glaucoma and anterior or intermediate uveitis. Methods  Fifty-eight patients with anterior or intermediate uveitis and elevated IOP or glaucoma presented or followed up in the Ocular Inflammation and Immunology Service of General Hospital of Athens were randomly assigned to receive treatment either with latanoprost (30) or with dorzolamide/timolol (28). The main outcome measures were inflammatory relapses and IOP response to treatment. Results  Ten patients (34%) in the latanoprost group and sixteen patients (57%) in the dorzolamide/timolol group experienced relapses of anterior uveitis (p = 0.93). There was no statistical difference between the two groups in respect of inflammatory relapses (p = 0.21). Twenty-one patients were followed up before starting latanoprost. The number of recurrences of anterior uveitis per patient per year before treatment with latanoprost was 0.82 ± 1.2. The rate of relapses per patient per year after starting latanoprost was 0.39 ±0.7 for these patients (p = 0.038). After 1 year of treatment, intraocular pressure was dropped from 27.8 ± 8.4 mmHg to 18.6 ± 5.3 mmHg (p < 0.001) in the latanoprost group and from 28.2 ±8.1 mmHg to 22.6 ±10.1 mmHg (p < 0.001) in the dorzolamide/timolol group. Four patients during treatment with latanoprost and five patients during treatment with dorzolamide/timolol developed macular edema. Conclusion  Latanoprost is safe and equally effective to a fixed combination of dorzolamide and timolol in the treatment of uveitic glaucoma. The authors have no proprietary interest in any aspect of this study.     

Selective trabeculectomy. A report of a new surgical method for open angle glaucoma

A new instrument, the trabeculectome, and an new surgical method for treating open angle glaucoma is described. The double-edged instrument makes 2 cuts through the trabecular meshwork while being pulled through Schlemm's canal, thus cutting free a strip of the trabecular meshwork and the inner wall of Schlemm's canal. The results of the 21 first operations are presented. The observation time is 9-19 months. The characteristic post-operative pressure pattern is an immediate fall to 10-20 mmHg followed by a period of higher pressures which then converge to the range of 8-16 mmHg with most eyes in the 10-14 mmHg range. Four patients need timolol treatment to obtain this, the remaining 17 have no medication. The therapeutic results and additional observations are discussed with special interest to possible physiological mechanisms.     

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD= -0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.     

Efficacy and safety of once-daily levobunolol for glaucoma therapy

We studied the ocular hypotensive efficacy and safety of 0.5% levobunolol hydrochloride and 0.5% timolol maleate administered topically once daily for 3 months in 91 patients (46 in the levobunolol group and 45 in the timolol group) with primary or secondary open-angle glaucoma or ocular hypertension. In this randomized double-masked parallel clinical study, intraocular pressure (IOP) was successfully controlled in 78% of the patients who received levobunolol and 89% of those who received timolol. The overall mean decrease in IOP was 5.6 mm Hg (decrease of 23%) in the levobunolol group and 6.7 mm Hg (26%) in the timolol group, a nonsignificant difference. In both groups the overall mean IOP during treatment was significantly lower than the pretreatment value (p less than 0.001). For both treatment groups changes in heart rate and blood pressure were minimal. We conclude that both 0.5% levobunolol and 0.5% timolol administered once daily are effective and safe in lowering IOP in most patients with ocular hypertension or open-angle glaucoma.     

Efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucoma

AIMS: To evaluate the efficacy and safety of the Ahmed glaucoma valve implant in Chinese eyes with complicated glaucomas. METHODS: This retrospective study reviewed the final intraocular pressure, visual outcome, and incidence of complications in all patients with the Ahmed glaucoma valve implant performed at the Prince of Wales Hospital, Hong Kong, between June 1996 and November 1998. RESULTS: A total of 65 eyes from 60 patients were treated with the Ahmed glaucoma implant. At a mean follow up (SD, median) of 21.8 (9.2, 28. 0) months (range 6-37 months), the mean intraocular pressure was reduced from 37.0 (SD 12.1) mm Hg before the implant surgery to 16.1 (12.4) mm Hg at the last follow up after surgery. The success rate of intraocular pressure control of <22 mm Hg was achieved in 73.8% of operated eyes. Transient postoperative hypotony with shallow anterior chamber occurred in 10.8% of cases. The most common postoperative complication was the formation of encapsulated bleb (24.6%). CONCLUSIONS: The Ahmed glaucoma valve implant appears to be effective and relatively safe for treating complicated glaucomas in Chinese eyes. The success rate is comparable with those reported in non-Asian eyes. Formation of postoperative encapsulated bleb is, however, more commonly encountered.     

New surgical approach in the management of pseudophakic malignant glaucoma

PURPOSE: To describe a new surgical approach in the management of pseudophakic malignant glaucoma. DESIGN: Noncomparative case series. PARTICIPANTS: Five consecutive patients with pseudophakic malignant glaucoma. METHODS: All patients underwent zonulo-hyaloido-vitrectomy. The procedure involves the performance of zonulectomy, hyaloidectomy, and anterior vitrectomy (zonulo-hyaloido-vitrectomy) through a peripheral iridectomy or iridotomy via the anterior chamber. MAIN OUTCOME MEASURES: Medications, visual acuity, intraocular pressure, and anterior and posterior segment findings were recorded before and after surgery. RESULTS: Resolution of the malignant glaucoma was achieved in all cases. No recurrences were observed after a median follow-up of 5.5 months (range, 1-9 months). In one patient with extensive anterior synechiae, bleb failure occurred after the resolution of the malignant glaucoma. This patient was treated successfully with a guarded filtration procedure supplemented with 5-fluorouracil. No other complications were observed. CONCLUSIONS: Zonulo-hyaloido-vitrectomy via the anterior segment appears to be an alternative option in the treatment of patients with pseudophakic malignant glaucoma.     

Effectiveness of surgical management of malignant glaucoma in phakic eyes

AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.     

Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma

AIM: To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty (UCP) for the treatment of refractory glaucoma in Chinese patients. METHODS: In this 6-month retrospective study, 37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure (IOP) of ≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements. A complete ophthalmic examination was performed before and at 1d, 1, 3, 6mo after UCP. Therapeutic success was defined as IOP reduction from baseline ≥20% and IOP ≥5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit. In addition to mean IOP at each follow-up visit, medications used and complications were also detected and compared to baseline. RESULTS: After UCP procedure, the mean IOP was significantly reduced (P<0.01) from the preoperative 44.1±11.9 mm Hg to postoperative 26.7±11.8 mm Hg at 3mo, and 30.4±14.5 mm Hg at 6mo. The overall mean IOP reductions achieved at 3 and 6mo were 39% and 31% compared to baseline IOP. Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48% at 3mo and 42% at 6mo. Ocular pain in most of patients were alleviated. No serious intraoperative or postoperative complications occurred. CONCLUSION: High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.     

Efficacy and safety of ab interno trabeculectomy in juvenile open-angle glaucoma

Objective

To determine the efficacy and safety of ab interno trabeculectomy with Trabectome in juvenile open-angle glaucoma (JOAG) patients.

中药治疗青光眼疗效及安全性的文献系统评价

目的:系统评价分析中药治疗青光眼的有效性和不良反应.方法:检索Medline(1966/2006),EMBASE(1974/2006),中国生物医学文献数据库1978/2006,中文科技期刊全文数据库1977/2006,和中文学术期刊全文数据库1994/2006;并手工检索相关领域杂志.纳入标准以确诊为青光眼患者为研究对象、比较中医药与其它疗法疗效的随机或半随机对照试验,评价纳入研究的质量,并用RevMan4.2.9版软件进行Meta分析.结果:共纳入19篇文献,共1 202例1 651眼.部分中药或中西医结合治疗对改善或恢复青光眼患者的视野损害,可能有一定疗效,但是这种疗效具有选择性.对眼压因研究数较少或文献质量低尚无法确定,对视力有部分研究表明中药对青光眼视力的改善无意义,中药治疗未发现明显的副作用.结论:中药治疗青光眼有一定的疗效,但证据十分有限.     

青光眼减压阀植入治疗无晶体眼和人工晶体眼青光眼的疗效

目的 :评价青光眼减压阀植入术治疗无晶体眼和人工晶体眼青光眼的疗效 ,探讨术后并发症和预防措施。方法 :回顾性分析19例 ( 2 0眼 )无晶体眼和人工晶体眼青光眼患者行青光眼减压阀植入术。其中 13眼行 Ahmed减压阀植入 ,7眼行 Krupin减压阀。结果 :术后一周平均眼压 1.93± 0 .69k Pa,95 %术眼眼压控制正常。平均随访 18.9± 6.9月的 14只术眼平均眼压 2 .4 0± 0 .4 7k Pa,64 .3 %术眼眼压控制正常。术后常见并发症有前房导管口阻塞、导管接触角膜、前房积血、低眼压等。结论 :青光眼减压阀植入术是治疗无晶体眼和人工晶体眼青光眼的较为有效的方法 ,但仍存在一定的并发症     

Trabecular aspiration: a new surgical approach to improve trabecular facility in pseudoexfoliation glaucoma

The main reason for elevation of intraocular pressure in pseudoexfoliation glaucoma is due to secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The aim of the present study was to introduce a new surgical concept to clean trabecular meshwork in pseudoexfoliative glaucoma. Trabecularaspiration was performed under the operating microscope prior to extracapsular cataract extraction in half of the chamber angle circumference using a specially designed irrigation-aspiration device. The hand-held instrument has three outlets, one for aspiration (400m wide and 45 horizontally angulated to meet the slope of the meshwork) and two openings (650m) for irrigation to maintain a deep anterior chamber and to keep the iris away from suction. Trabecular debris and pigment was cleared with a suction force of 100–200 mmHg. The effect oftrabecular aspiration was cross-checked by analysing the aspirate. Pigment granules, fibrillous protein and other forms of trabecular debris were identified in the aspirate using light- and scanning electron microscopy. The morphological analysis of the trabecular aspirate clearly indicates the efficacy oftrabecular aspiration for removing pre- and intratrabecular debris. The clinical relevance of this new procedure looks promising, a clinical trial, recently initiated, is warranted.     

Efficacy and safety of deep sclerectomy in childhood glaucoma in Saudi Arabia

Purpose: To evaluate the efficacy and safety of deep sclerectomy in childhood glaucoma. Methods: A prospective cohort of 120 children presenting with glaucoma to King Abdul Aziz University Hospital (KAUH) was subjected to nonpenetrating deep sclerectomy surgery (NPDS). Eventually, 57 patients had macro perforation and converted to penetrating deep sclerectomy (PDS). Intra‐operative mitomycin C (MMC) 0.2 mg/ml was used in all patients. Pre‐ and postintervention glaucoma indices were assessed. Complete success rate (CSR) was identified as achieving an end‐point of intraocular pressure <21 without any antiglaucoma medications. Data were analysed to compare pre‐ and postintervention changes and to compare both procedures. Results: After follow‐up of 35.8 (34.5) months, NPDS procedure went smooth in 74 eyes of 63 patients. The complete success rate was 79.7%, whereas the overall success rate was 82.4%. Thirteen cases failed. The probability to survive was 74.6% after the 12th month. The mean intraocular pressure (IOP) went down to 11.5 ± 3.0 mmHg compared to 31.9 mmHg preoperatively. Comparing cases with NPDS to those with PDS, the magnitude of IOP reduction (15.8) was higher than that of the PDS (14.8); however, this difference was not statistically significant (p = 0.259). Apart from involuntary perforation of trabeculodescemetic window (TDW), neither intra‐operative nor early postoperative complications were observed. Conclusions: Deep sclerectomy in childhood glaucoma can effectively reduce the IOP, without the occurrence of serious complications that are commonly seen after trabeculotomy or combined trabeculotomy trabeculectomy.