青光眼黏弹剂小管扩张术的临床疗效观察及Schlemm管直径测量

目的 评价青光眼黏弹剂小管扩张术的安全性和有效性,探讨Schlemm管直径的测量方法.方法 收集21例31眼青光眼(开角和慢闭)行黏弹剂小管扩张术及Schlemm管直径测量(NPTS组)的临床资料,总结和分析患者的眼压、视力、眼内反应、滤过泡及手术并发症的发生情况,以及Schlemm管直径测量情况,并与青光眼经典小梁切除手术(PTS组)20例33眼青光眼(开角和慢闭)进行比较.术后随访时间至少6月.结果 术后6月,NPTS组平均眼压为(10.44±3.88)mmHg(1mmHg=0.133 kpa),较术前降低(24±15.78)mmHg,差异有显著意义(P=0.000);术后1周、1月、6月两组降眼压效果比较,差异无显著意义(P=0.959,0.986,0.884).Schlemm管直径测量结果为0.39～0.63 mm,平均(0.50±0.07)mm.NPTS组术后视力均无下降;PTS组术后视力8眼下降.NPTS组术中并发症包括小梁网Descement膜小穿孔5眼,术后滤过泡漏1眼,3只眼有轻微房水闪辉2～3d消失外无任何眼内反应.PTS组术后并发症包括浅前房、前房出血各4只眼,前房出血3-7d消失;术后15眼有轻微房水闪辉,2-6d消失;脉脱2眼,滤过泡漏1眼,并发性白内障2眼.结论 青光眼黏弹剂小管扩张术效果好、并发症少,可安全、有效治疗开角性和部分慢性闭角型青光眼.Schlemm管直径测量方法可行.     

黏弹物质小管切开术联合薇乔缝线植入治疗开角型青光眼

目的 探讨黏弹物质小管切开术联合薇乔缝线植入治疗开角型青光眼的可行性及疗效评价.方法 对17例(27只眼)药物不能控制的中、晚期开角型青光眼患者进行黏弹物质小管切开术联合薇乔缝线植入,随访12个月,术后观察视力、眼压、眼内反应及超声生物显微镜(UBM)检查.结果 (1)术前患者的眼压平均为(30.91±14.06)mmHg;术后第1天、1周、1个月、6个月和12个月平均眼压分别为(7.09±4.78)、(8.38±3.81)、(14.84±6.51)、(13.38±3.40)和(16.08±3.24)mmHg,均较术前有显著性差异(均P<0.01),至术后1个月以后患者眼压基本趋于稳定.(2)术后12个月,需要和不需要药物治疗,眼压<21mmHg的成功率为95.7%(22/23),无需药物治疗眼压<21mmHg的完全成功率为56.5%(13/23).结论 黏弹物质小管切开术联合薇乔缝线植入可有效地降低眼压,术后并发症少,对视力无明显影响,且薇乔缝线易于获取,价格便宜,是一种具有良好应用前景的抗青光眼新方法.     

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。     

黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼

目的：评价黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼( prilary congenital glaucola, PCG)的临床疗效。
　　方法：采用前瞻性随机对照临床试验研究,将37例50眼首次行手术治疗的原发性婴幼儿型青光眼患者分为两组,试验组25眼行黏弹物质小管扩张术联合90°小梁切开术;对照组25眼行180°小梁切开术。观察比较的指标包括：术前及术后眼内压( intraocular pressure,IOP)、角膜直径、杯/盘比(C/D),随访时间点为1wk,1、3、6lo。患儿均在水合氯醛灌肠下用Schiots眼压计测量眼压、用双脚圆规测量角膜的横径,用检眼镜记录眼底杯盘比值。
　　结果：术后随访6lo,黏弹物质小管扩张术联合90°小梁切开术组术后1wk,1、3、6lo的平均眼压分别为7.51±3.68、11.79±1.84、13.97±2.76、14.51±0.97llHg,180°小梁切开术组分别为8.47±2.66、13.88±6.32、15.74±3.20、16.51±2.44llHg,均较术前眼压30.74±4.68、31.96±5.15 llHg 明显降低,差异均有显著统计学意义( P<0.01);黏弹物质小管扩张术联合90°小梁切开术组术后3 lo平均角膜横径较术前明显减少,差异有统计学意义( P<0.05);术后22眼的杯盘比减小,28眼的杯盘比不进展。手术成功者其杯/盘比值明显减小(术前0.72±0.19,术后0.60±0.24,P=0.007);患者50眼中,术中前房出血11眼(22%),前房是否出血与术后眼压降低情况无关。余患者术后均未出现无浅前房、低眼压、角膜后弹力膜脱离、脉络膜脱离、玻璃体脱出、虹膜粘连及眼内感染等并发症。
　　结论：黏弹物质小管扩张术联合90°小梁切开术治疗原发性婴幼儿型青光眼,具有术后眼压控制效果好,术后并发症发生率低,安全性高的特点。     

穿透性Schlemm管成形联合晶状体摘出术治疗闭角型青光眼

目的:评价穿透性Schlemm管成形术联合晶状体摘出术治疗闭角型青光眼的效果。方法:回顾性分析安阳市眼科医院2020年1月至2021年5月穿透性Schlemm管成形联合晶状体摘出术治疗闭角型青光眼34例(34眼)的临床资料。观察术前、术后眼压及视力、手术成功率及并发症。随访时间为6个月。结果:术前眼压为(38.21±1...     

改良黏性小管切开术联合激光虹膜切除术治疗混合型青光眼疗效观察

目的探讨改良黏性小管切开术联合Nd:YAG激光虹膜切除术治疗混合型青光眼的疗效。方法对混合型青光眼的一种类型窄角性原发性开角型青光眼患者15例(18只眼)行改良黏性小管切开术,术前或术后予以YAG激光虹膜切除术。观察患者手术前后的视力、眼压、并发症等情况。术后随访3-24个月,平均18个月。结果视力无一例下降,其中1例视力由术前0.25提高至0.5。术前眼压平均为(23.74±6.01)mmHg,术后3个月平均为(13.85±4.13)mmHg,术后12个月平均为(16.37±3.77)mmHg,术后24个月平均为(15.44±4.10) mmHg,术前与术后眼压比较,均有显著性差异(P<0.05)。术中术后无任何严重并发症出现。结论改良黏性小管切开术联合YAG激光虹膜切除术治疗窄角性原发性开角型青光眼效果好,术中、术后并发症少,是一种有前景的方法。     

缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性闭角型青光眼临床疗效观察

目的探讨缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性闭角型青光眼患者的有效性和安全性。方法对33例41眼原发性闭角型青光眼患者施行了缝线植入Schlemm管开口部成形联合小梁切除术。手术方法是做二层巩膜瓣并切除深层巩膜瓣,剪除Schlemm管外壁,并从管断端口分别植入Schlemm管内6-0尼龙线,穿透性小梁切除及相应虹膜剪除,水密缝合浅层巩膜瓣。术后观察眼压、前房形成、眼内炎性反应、视力、术后并发症以及滤过泡形成等情况。结果随访6m～48m,平均(24.98±14.41)m。术后末次随访平均眼压(16.35±4.88)mmHg(1mmHg=0.133kPa),较术前平均眼压(24.17±12.85)mmHg,差异有非常显著意义(t=3.674,P=0.001)。33例41眼原发性闭角型青光眼患者术后随访眼压经局部降眼压药物治疗,眼压≥22mmHg者3例3眼占7.32%,有效率达92.68%。术前与术后不同时间随访平均眼压值比较,经配对t检验法分析结果显示差异有显著意义。对15例19眼术后随访≥36m青光眼患者,术前、术后眼压差值(12.66±12.72)mmHg,术后眼压与术前眼压比较,差异有非常显著的意义(t=3.446,P=0.005)。41眼青光眼患者中术后形成滤过泡9例10眼占24.39%,其中眼压≥22mmHg者2眼占20%。术后有滤过泡与无滤过泡青光眼患者术前与术后末次随访平均眼压差值的均值比较,经成组t检验法分析结果显示无显著性意义(t=-1.824,P=0.076)。1例双眼术后均出现前房形成迟缓,经阿托品眼药水散瞳后前房形成良好。除8眼术后第1天前房形成不良外,余例术后第1天均前房形成良好。有12眼(29.27%)术后出现前房积血。术后一过性眼压升高(眼压≥22mmHg)4眼。术后一过性低眼压(眼压≤6mmHg)10眼。术后随访早期(术后1m内)一过性眼压升高2眼。术后2眼出现前房内纤维蛋白渗出,其他病例术后均无明显的前房炎性反应。术后均无脉络膜脱离等并发症发生。结论缝线植入Schlemm管开口部成形联合小梁切除术治疗原发性闭角型青光眼降眼压效果肯定、安全,术后并发症少,适应症广,术后管理容易,为一种具有良好应用前景的抗青光眼新手术。     

全周小梁切开术治疗发育性青光眼

目的 评评估微导管引导下全周小梁、Schlemm管切开术治疗发育性青光眼的临床疗效。方法 回顾2014年6月至2018年6月郑州市第二人民医院收治的发育性青光眼患儿21例(37眼),行微导管引导下全周小梁、Schlemm管切开术。对患儿手术前后眼压、角膜横径、杯盘比、降眼压药物使用情况及术后并发症进行分析。结果 患儿眼压术前术后对比差异有统计学意义(t=17.91,16.25,15.92,15.87,15.58,13.49;P<0.05),64.86%患儿角膜横径、51.35%患儿杯盘比术后较术前减小,术后用药种类显著减少。术中患儿均出现少量前房出血,术后1～3d吸收。术后少量患儿出现虹膜点状黏连、脉络膜脱离,用药后均痊愈。结论 微导管引导下全周小梁、Schlemm管切开术是有效治疗发育性青光眼的手术方式,而且术后没有滤过泡,护理简便,无需常年行眼球按摩     

改良黏小管切开术治疗继发性青光眼的临床研究

目的观察改良黏小管切开术治疗不同类型继发性青光眼的有效性及安全性。并探讨黏小管切开术的适应证。方法临床病例系列研究。对2008年7月至2012年12月接受改良黏小管切开术的继发性青光眼18例(20只眼)患者进行回顾性分析。比较术前及术后的视力、视野、眼压、杯盘比,并记录继发性青光眼的病因、滤过泡形态、是否行激光房角穿孔术及有无并发症发生。对术前及术后1、3 d,1、3、6个月,1、2年的眼压进行比较,采用成组t检验的方法进行统计学分析。结果患者均有轻度到中度隆起的弥散滤过泡,术前眼压为(38.815±2.387)mm Hg,术后各随访时间点的眼压分别为(8.305±0.562)mm Hg、(9.490±0.846)mm Hg、(12.775±2.029)mm Hg、(13.184±1.143)mm Hg、(13.694±1.162)mm Hg、(14.108±1.432)mm Hg、(13.563±1.090)mmHg、(13.710±0.921)mm Hg。术前及术后各时间点眼压的差异有统计学意义(P<0.05)。3例(3只眼,15%)患者因术后眼压升高≥21 mm Hg,行激光房角穿孔术。少数患者存在视力、视野及眼底杯盘比的变化。结论改良黏小管切开术能够有效并安全的降低继发性青光眼的眼压,对炎症相关继发性青光眼的治疗效果好。     

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。以术后不使用降眼压药物,且眼压≤21 mmHg为完全成功,术后需要使用降眼压药物控制眼压≤21 mmHg为条件成功。分析术前与末次随访眼压情况与药物使用情况。根据患者进行小梁切开术前是否有青光眼手术史将患者分为两组,比较两组小梁切开术后的眼压和降眼压药物使用情况。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症,手术成功率。结果 术前平均眼压为（24.8±9.0）mmHg,术后末次复查的平均眼压为（16.9±4.7）mmHg（P=0.000）。术前用药（2.9±0.9）种,术后用药（0.7±1.0）种（P=0.000）。术后1、3、5年累积完全成功率分别为72.1%、62.7%、41.2%、,累积条件成功率分别为91.8%、88.1%、76.5%。术后早期所有患者均有不同程度的前房积血,部分患者出现一过性眼压波动。无严重远期并发症出现。末次随访时,术前有无抗青光眼手术史患者的眼压分别为(18.1±5.1)mmHg和(15.7±4.0)mmHg,与术前比两组之间无显著差异（P=0.098）。结论 微导管引导的小梁切开术对原发开角型青光眼是一种长期安全有效的降眼压手术方式。术前有无抗青光眼手术史对手术的降眼压效果无显著影响。（眼科,2021, 30： 435-439）     

丝裂霉素C联合粘小管成形术治疗开角型青光眼的疗效

目的:评估丝裂霉素C(MMC)联合粘小管成形术治疗开角型青光眼的效果.方法:回顾性研究.收集2007-12/2014-03接受粘小管成形术患者104例122眼.记录术前术后眼内压(IOP),青光眼用药数量,视力,并发症,辅助治疗(激光前房角穿刺或青光眼用药)和成功率.IOP≤21 mmHg无额外用药为完全成功,IOP≤21 mmHg有或无青光眼用药为部分成功.结果:术前平均IOP为27.5±9.2 mmHg,术后平均IOP为14.5±6.6 mmHg(P<0.001).术前平均视力为0.42±0.4,术后为0.32±0.4 (P=0.726).部分成功106眼(86.9%),完全成功62眼(50.8%).激光前房角穿刺术43眼(35.2%),青光眼药物使用率为49.1%.术后平均随访27.29±16.78 (1~79)mo.结论:粘小管成形术并发症发生率低且术后视力稳定,是一种安全的选择,术后补充进行激光前房角穿刺术可以提高手术成功率.丝裂霉素C对于粘小管成形术的作用还需进行深入的比较研究.     

外路微导管辅助的360度小梁切开术治疗青少年性开角型青光眼和原发性开角型青光眼的临床对照研究

目的 评估微导管辅助小梁切开术治疗青少年性开角型青光眼（JOAG）和原发性开角型青光眼（POAG)的临床效果和安全性。设计 回顾性病例系列。研究对象2017年11月至2018年12月北京同仁医院接受微导管辅助的小梁切开术治疗的JOAG患者22例（26眼）,平均年龄（25.2±4.5）岁;POAG患者11例（14眼）,平均年龄（46.3±5.1）岁。方法 回顾患者的病历资料,记录眼压、抗青光眼药物使用数量、术中及术后并发症等。术后1、3、6、12个月随访。术后不使用降眼压药物眼压≤21 mmHg且眼压下降幅度≥20%为成功。主要指标 眼压、抗青光眼药物使用数量、术中及术后并发症。结果 所有患者均完成了12个月的随访。JOAG组术前平均眼压（30.6±7.5） mmHg,平均应用（3.5±1.0）种药物;术后12个月平均眼压（15.8±3.3 ) mmHg,平均应用（0.5±1.0）种药物,眼压降幅为44.9%±18.0%。POAG组术前平均眼压（25.4±6.2） mmHg,平均应用（3.4±0.9）种药物;术后12个月平均眼压（15.9±3.2） mmHg,平均应用（0.3±0.6）种药物,眼压降幅为35.8%±15.6%。JOAG组、POAG手术成功率分别为76.0%、78.6%。两组降眼压幅度和成功率均无显著性统计学差异（P=0.122、0.855)。均无严重手术并发症发生。结论 微导管辅助小梁切开术治疗JOAG和POAG均具有较好的短期降眼压效果及安全性。（眼科,2021, 30： 20-24）     

Ahmed青光眼阀植入治疗难治性青光眼

目的：探讨Ahmed青光眼阀植入治疗难治性青光眼的临床疗效。 方法：回顾性研究我院Ahmed青光眼阀植入术治疗21例21眼难治性青光眼的临床疗效并进行总结分析。 结果：术前平均眼压为44.6±7.2mmHg,术后6mo末次随访平均眼压15.4±5.3mmHg;视力提高4眼,无改变14眼,降低3眼;手术并发症主要包括术后前房形成迟缓2眼、持续高眼压1眼、引流管暴露1眼、角膜失代偿1眼、引流盘纤维包裹3眼;手术成功率为86％。 结论：Ahmed青光眼阀植入术是治疗难治性青光眼有效和安全的方法。     

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...     

Primary viscocanalostomy for juvenile open-angle glaucoma

PURPOSE: To evaluate the efficacy and safety of primary viscocanalostomy for medically uncontrolled juvenile open-angle glaucoma (JOAG). DESIGN: Prospective, noncomparative, interventional case-series study. METHODS: The study included 20 eyes of 20 consecutive patients with medically uncontrolled JOAG who were treated by viscocanalostomy at one institution. No surgical or laser procedure preceded viscocanalostomy. Surgical outcome was defined as an overall success by the following criteria: no visual field deterioration, no optic-neuropathy progression, postoperative intraocular pressure IOP < or =20 mm Hg, and IOP reduction > or =30% compared with baseline values with or without medication. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. RESULTS: Gender distribution was similar. Fourteen eyes belonged to the white race; five eyes belonged to the black race, and one eye belonged to Arab ethnicity. Mean age (+/-SD) at operation was 33.77 +/- 6.16 years, with the mean preoperative IOP (+/-SD) at 22.9 +/- 4.77 mm Hg. Thirty-six months after operation, 16 cases (80%) were considered an overall success. In 11 cases (55%), success was complete. Four cases (20%) were considered failures. No serious complications were documented either during or after operation. In two cases (10%), we documented a spontaneously reabsorbed microhyphema. Trabeculo-Descemet-membrane microperforation occurred in two cases (10%). In two other cases (10%), Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy can efficiently and safely reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to conventional surgical modalities.     

Intraocular pressure control and complications with two-stage insertion of the Baerveldt implant

PURPOSE: To evaluate intraocular pressure (IOP) control and the prevalence of complications associated with the two-stage insertion of the Baerveldt implant. DESIGN: Retrospective, noncomparative, interventional case series. METHODS: We reviewed the medical records of all patients who underwent the two-stage Baerveldt implantation for advanced glaucoma between January 1995 and November 1998 at the Doheny Eye Institute, Los Angeles, California. All eyes with a minimum of 6 months of follow-up were included in the study. Eyes that failed before 6 months after stage II were also included in the study. MAIN OUTCOME MEASURES: The criterion for surgical success was postoperative IOP of 6 mmHg or more and 21 mmHg or less on two or more consecutive measurements with or without the use of glaucoma medications and without loss of light perception or further surgical intervention to lower IOP. RESULTS: Nineteen eyes from 19 patients were included. Median postoperative follow-up was 17 months (range, 3-56 months). The cumulative probability of success was 89% at both 12 and 24 months. The median preoperative IOP of 21 mmHg (range, 12-33 mmHg) was reduced to a median postoperative IOP of 12 mmHg (range, 1-17 mmHg; P < 0.0001). The median number of glaucoma medications before surgery was three and after surgery was one (P < 0.0001). Visual acuity remained the same or improved in 13 eyes (68%). One eye experienced hypotony (5%), and in two eyes (11%) suprachoroidal hemorrhages developed. CONCLUSIONS: The two-stage insertion of the Baerveldt implant effectively reduced IOP, produced few complications, and preserved visual acuity in more than two thirds of eyes with advanced glaucomatous damage.     

Viscocanalostomy in patients with glaucoma secondary to uveitis: preliminary report

PURPOSE: To assess the efficacy of viscocanalostomy in eyes with uncontrolled glaucoma secondary to uveitis. SETTING: Immunology and Uveitis Service, Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milan, Italy. METHODS: All consecutive patients with glaucoma secondary to uveitis and inadequate intraocular pressure (IOP) control (IOP >21 mm Hg) under maximum-tolerated medical therapy had viscocanalostomy. Patients with active uveitis at the time of surgery, peripheral anterior synechias in the upper quadrant, previous ocular surgery, or sight in only 1 eye were excluded. Eleven eyes of 11 patients with a mean age of 52.2 years +/- 19.9 (SD) were operated on. The etiology of the uveitis was recorded. The ocular variables were IOP, best corrected visual acuity, number of antiglaucoma medications, and complications. Success was defined as an IOP between 6 mm Hg and 21 mm Hg (inclusive) without medication (complete success), or with 1 or more antiglaucoma medications and/or goniopuncture (qualified success). The mean follow-up was 45.9 +/- 11.6 months (range 23 to 56 months). RESULTS: Viscocanalostomy significantly reduced IOP from a mean baseline value of 35.1 +/- 7.0 mm Hg (range 23 to 48 mm Hg) to a mean final value of 18.1 +/- 4.9 mm Hg (range 12 to 30 mm Hg) (P<.0001). Complete success was achieved in 6 eyes (54.5%) and qualified success, in 10 eyes (90.9%). The mean number of preoperative and final antiglaucoma medications was 3.4 +/- 0.8 (range 2 to 4) and 0.7 +/- 1.2 (range 0 to 3), respectively (P =.0004). Complications were minor and included transient hyphema and postoperative IOP spike. CONCLUSION: This preliminary study suggests that viscocanalostomy is a safe, effective surgical alternative for treating glaucoma in patients with uveitis.     

微导管辅助的小梁切开术治疗原发性先天性青光眼的远期疗效观察

目标评估微导管辅助小梁切开术治疗原发性先天性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2014年2月至2016年12月北京同仁眼科中心微导管辅助小梁切开术治疗的原发性先天性青光眼患者65例(86眼),手术时年龄2个月~11岁,平均(3.7±2.8)岁。方法术后3、6、9个月以及1、2、3、4、5、6年进行随访。比较术前、术后末次随访时(或手术失败时)眼压及降眼压药物使用数量的变化。术后不使用降眼压药物,且眼压≤21 mmHg为绝对成功;术后需使用降眼压药物控制眼压≤21 mmHg为条件成功。主要指标眼压、抗青光眼药物使用数量、术中及术后并发症,远期手术干预。结果平均随访(46.3±9.9)个月(36~72个月)。35眼为初次手术,51眼具有抗青光眼手术史。术前平均眼压(32.5±6.4)mmHg,平均应用(2.8±0.6)种药物;末次随访平均眼压(15.6±7.9)mmHg,平均用药(0.4±1.0)种,二者较术前均显著下降(P均<0.001)。术后1、3、5年累积绝对成功率分别为90.7%、86.0%、68.8%,累积条件成功率分别为90.7%、88.3%、76.9%。随访至术后5年,累积绝对成功率既往无手术史者(94.3%)比有手术史者(60.2%)高(P=0.04)。无严重手术并发症发生。结论微导管辅助的小梁切开术治疗原发性先天性青光眼长期安全有效。抗青光眼手术史会影响远期手术成功率。     

Mid-term outcome of trabeculectomy with adjunctive mitomycin C in glaucoma patients

PurposeTo quantify the 2-year success rate and complications of trabeculectomy with adjunctive mitomycin C (MMC).MethodsA retrospective chart review was undertaken of 147 eyes that had undergone trabeculectomy with adjunctive MMC (concentration from 0.1 to 0.27 mg/mL) and at least 2 years' follow-up between January 2001 and March 2010. Demographic and clinical data were collected from all patients at the time of surgery and subsequent follow-up visits. Complete success was defined as intraocular pressure (IOP) ≤ 21 mmHg without any additional medication, whereas qualified success was defined as IOP ≤21 mmHg with or without medication.ResultsAt 24 months, mean IOP was 16.4 ± 10.6 mmHg, with a mean IOP decrease of 19.8 ± 14.2 mmHg. In primary glaucoma patients (n = 66), 60.6% and 95.4% of eyes achieved complete success and qualified success, respectively, at 2-year follow-up. Sub-group analysis of the initial trabeculectomy in primary glaucoma patients (n = 49) showed that complete and qualified success increased to 65.3% and 98.0%, respectively. The success rate was lower in secondary glaucoma patients (n = 74), with complete success at 41.9% and qualified success at 67.6% at 2-year follow-up. Eighty-six eyes (58.5%) developed one or more complications, from mild, such as hyphema, to severe, such as bleb leakage, which could necessitate surgical intervention. Twenty-six eyes developed severe complications, such as wound gap after 5 postoperative days, hypotony, hypotony maculopathy, choroidal detachment, overhanging bleb, bleb leakage, and endophthalmitis. A comparison between eyes with severe complications and other eyes in relation to different MMC amount, defined as MMC concentration multiplied by application duration, revealed no significant difference (p = 0.136). Further glaucoma surgery was performed in 27 eyes (18.4%).ConclusionThe outcome of trabeculectomy with low-dose intraoperative MMC is favorable in primary glaucoma patients at 2-year follow-up. Severe complications are not significantly related to MMC amount. Factors associated with severe complications require further study. Careful selection of MMC concentration and application time based on preoperative and intraoperative risk factors may further improve surgical results.     

Viscocanalostomy and phacoviscocanalostomy: long-term results

PURPOSE: To determine the safety and efficacy of viscocanalostomy and cataract extraction by phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in the management of medically uncontrolled glaucoma. SETTING: Department of Ophthalmic Surgery, Warrington Hospital, Warrington, England. METHODS: This prospective nonrandomized study comprised 101 consecutive eyes of 73 patients with medically uncontrolled glaucoma having viscocanalostomy or phacoviscocanalostomy. Outcomes measured were intraocular pressure (IOP) control, visual acuity, gonioscopy, bleb morphology, and complications associated with surgery. Examinations were performed preoperatively and 1 and 7 days and 1, 3, 6, 9, and 12 months postoperatively and then at 6-month intervals. The mean follow-up was 23.9 months +/- 11 (SD) (range 6 months to 3.5 years). RESULTS: The mean preoperative IOP was 24.9 +/- 5.7 mm Hg on 2.27 +/- 0.8 medications and the mean postoperative IOP at last follow-up, 16.14 +/- 2.9 mm Hg on 0.1 medications. A postoperative IOP of 21 mm Hg or less was achieved in 93% of eyes. In the remaining 7%, an addition of a mean of 1.4 medications achieved an IOP less than 21 mm Hg. No case required further glaucoma surgery. The mean percentage of IOP reduction in eyes having viscocanalostomy alone was 37% and in eyes having phacoviscocanalostomy, 33%. Complications were minor and included 4 small hyphemas, 5 small choroidal detachments, 1 iris prolapse through the phaco incision, and 10 intraoperative microperforations of the trabeculo-Descemet's window. Transient postoperative pressure elevations secondary to topical steroids occurred in 18% of eyes. CONCLUSIONS: Viscocanalostomy and phacoviscocanalostomy were safe and effective in the surgical management of glaucoma and combined glaucoma and cataract. There was a low incidence of complications postoperatively and throughout the long-term follow-up.