Mitomycin‐C‐augmented deep sclerectomy in patients with primary open‐angle glaucoma and exfoliation glaucoma: a 1‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in patients with primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG). Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication. Results: Preoperatively, the mean IOPs were 23.1 ± 5.8 and 25.4 ± 8.3 mmHg, and 13.8 ± 6.1 and 11.2 ± 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use. Conclusion: DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.     

Mitomycin C‐augmented deep sclerectomy in primary open‐angle glaucoma and exfoliation glaucoma: a three‐year prospective study

Purpose: To investigate the efficacy and safety of mitomycin C (MMC)‐augmented deep sclerectomy with implant (DSCI) in primary open‐angle glaucoma (POAG) and exfoliation glaucoma (ExG) patients. Methods: A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser goniopuncture treatments and complications were compared postoperatively after 36‐ month follow‐up. Surgery was considered as a complete success when IOP was <18 mmHg without antiglaucoma medication. Results: Preoperatively the mean IOPs were 23 ± 6 mmHg and 25 ± 8 mmHg, and 13 ± 4 mmHg and 11 ± 4 mmHg in the POAG and ExG groups, respectively, at 36 months. At 36 months, 74% and 73% of surgeries were a complete success in the POAG and ExG group, respectively [not significant (NS)]. Two patients (8%) of the POAG group and one of the ExG group (3%) were receiving antiglaucoma medication at 36 months (NS). Nd:YAG laser goniopuncture was performed more often in the ExG group (87%) than in the POAG group (61%, p = 0.024). Postoperatively choroidal detachment occurred in 16% of eyes in the POAG group and in 11% of eyes in the ExG group (NS). Conclusions: DSCI with MMC augmentation appears to be as effective in patients with ExG and POAG in lowering IOP to target levels at medium term with few immediate postoperative complications.     

深层巩膜切除联合Healon GV注入治疗开角型青光眼

目的　观察深层巩膜切除联合玻璃酸钠 (HealonGV)注入对开角型青光眼的近期治疗效果。方法　对 15例 19眼原发性开角型青光眼患者行深层巩膜切除联合浅巩膜瓣下HealonGV注入 ,术后观察视力变化、眼压、前房反应和滤过泡情况。结果　术前眼压为 (2 7 6± 8 1)mmHg ,术后 3个月为 (15 2± 4 7)mmHg ,差异有显著性 (P <0 0 0 1) ,平均眼压下降幅度为 44 9% (12 4mmHg)。术后发生浅前房、前房积血各 1例 1眼 ,未观察到严重并发症。所有病例术前与术后 1d、7d、3个月视力统计学差异无显著性。结论　深层巩膜切除联合HealonGV注入能有效降低开角型青光眼患者眼压 ,且并发症少 ,视力恢复快 ,是一种很有临床应用前景的抗青光眼术式     

Frequency of systemic vascular diseases in patients with primary open‐angle glaucoma and exfoliation glaucoma

Purpose: Abnormal fibrils can be identified by electron microscopy in the heart, lung, liver, kidney, cerebral meninges and other tissues of patients with exfoliation syndrome (ES). However, a clinical association of ES with arterial hypertension (HT), ischaemic heart disease (IHD), cerebrovascular accidents and aneurysm of the abdominal aorta is debated. We conducted a national registry‐based survey to further assess the first two of these associations. Methods: We reviewed the records of 519 consecutive patients to whom the Social Insurance Institution of Finland had granted free medication for glaucoma according to national common criteria. The glaucoma was classified either as primary open‐angle glaucoma (POAG) or exfoliation glaucoma (EG), masked to any systemic diseases; 20 patients with other types of glaucoma were excluded from the survey. Masked to the type of glaucoma, the registry provided data on free medication similarly granted for HT, IHD and diabetes mellitus (DM), a known modifier of risk for cardiovascular disease. Data were analysed by logistic regression, modelling age, gender and DM as confounders. Results: The control group of 344 patients with POAG was comparable as regards gender with the study group of 155 patients with EG, but patients with POAG were both younger (mean 69 versus 73 years; P < 0.0001) and had DM twice as often (10% versus 5%; P = 0.05) compared to those with EG. Adjusting for age, gender and presence of DM, no difference in frequency of HT [odds ratio (OR) 0.80 for presence of EG; 95% confidence interval (CI) 0.52–1.23, P = 0.31] or IHD (OR 0.86 for presence of EG; 95% CI 0.49–1.13, P = 0.66) was detected between the two groups. Conclusion: In this population‐based registry survey, no difference in frequency of HT or IHD was noted between patients with POAG and EG who had been granted free medication for these chronic diseases according to national common criteria. The frequency of DM was lower among patients with EG, in line with several previous reports.     

Choroidal hemodynamic in myopic patients with and without primary open‐angle glaucoma

Purpose: To investigate the change in subfoveal choroidal blood flow in patients with glaucoma and to assess the effect of myopia, as one of the vascular risk factors for glaucoma on this flow. Methods: Subfoveal choroidal blood flow in groups of 12 myopic and glaucomatous eyes has been investigated by means of the laser Doppler flowmetry (LDF), comparing the results with those of 17 myopic eyes without glaucoma, 34 non‐myopic glaucomatous eyes and of 50 control eyes. The subfoveal choroidal LDF parameters, that is, blood velocity (ChBVel), volume (ChBVol), and flow (ChBF), as well as the vascular resistance were studied in each group. Statistical analysis was performed by means of anova and t‐test according to the Bonferroni procedure for multiple comparisons. Pearson correlation was used to establish the correlations between the hemodynamic parameters and the degree of myopia in dioptres. Results: All LDF parameters (ChBVel, ChBVol and ChBF) were significantly reduced in glaucomatous patients (1.3 ± 0.4, 0.14 ± 0.06 and 4 ± 2 respectively) and myopic patients with primary open‐angle glaucoma (POAG) (1.3 ± 0.4, 0.08 ± 0.04 and 2 ± 0.7 respectively) and without POAG (1.2 ± 0.3, 0.11 ± 0.08 and 2 ± 1 respectively) in comparison with age‐matched controls (1.5 ± 0.4, 0.27 ± 0.1 and 8 ± 2 respectively). On the other hand, the choroidal vascular resistance (Rm) was increased in the previously described studied patients groups (16 ± 7, 26 ± 9 and 24 ± 9 respectively) compared with controls (7 ± 2). The LDF parameters did not differ significantly between myopic subjects without and with POAG (p = 0.09, p = 0.09, p = 0.2, p = 0.08 and p = 0.9 respectively). Compared to patients with emmetropic glaucomatous, significant reduction in the ChBVol and ChBF and increased Rm were recorded in patients with glaucomatous myopia (p = 0.05, p = 0.04 and p = 0.04 respectively). Pearson correlation demonstrated a significant correlation between the degree of myopia in dioptres and the ChBF (p = 0.012). Conclusions: The subfoveal choroidal LDF parameters were reduced in patients with POAG and myopia. Theses alterations are more in glaucomatous patients with myopia in comparison with age‐matched glaucomatous patients without myopia. These data suggest that the impaired choroidal circulation caused by myopia might be an important additional risk factor involved in the glaucomatous damaging process.     

Oxidant/antioxidant balance in the aqueous humor of patients with glaucoma

AIM: To evaluate total antioxidant status (TAS), total oxidant status (TOS), and the oxidative stress index (OSI) of the aqueous humor (AH) in patients with glaucoma. METHODS: The prospective study was composed of a study group (n=31) and a control group (n=31). Fifteen patients in the study group were diagnosed with primary open angle glaucoma (POAG), and 16 patients were diagnosed with pseudoexfoliation glaucoma (PEG). The control group was composed of non-glaucomatous patients with cataracts. AH samples were collected and analyzed for TAS, TOS, and OSI levels. RESULTS: Mean AH TAS level was significantly higher in patients with glaucoma than that in the control group (P<0.01). Mean TOS and OSI levels tended to increase in patients with glaucoma. No significant differences in TAS, TOS, or OSI levels were observed between patients with POAG and PEG. CONCLUSION: High levels of TAS were observed in patients with glaucoma, which was likely a response to the increased oxidative stress observed in these patients.     

非穿透性深层巩膜切除术和小梁切除术的近期疗效比较

目的评价非穿透性深层巩膜切除术的疗效及其术后并发症.方法回顾性对比分析深层巩膜切除术组18例30眼(平均随访9.36个月)和小梁切除术组22例38眼(平均随访12个月)的术后眼压下降、有效率及其并发症.结果非穿透性深层巩膜切除术组术前,术后1周、1、2、3、6、9、12个月眼压分别为(26.39±2.01)mmHg(1kPa=7.5mmHg)、(15.36±5.66)mmHg、(15.70±4.37)mmHg、(15.88±2.57)mmHg、(15.23±2.80)mmHg、(16.37±2.83)mmHg、(18.05±2.43)mmHg、(17.37±3.06)mmHg.小梁切除术组术前,术后1周、1、2、3、6、9、12个月眼压分别为(29.11±7.26)mmHg、(17.33±8.97)mmHg、(17.66±4.78)mmHg、(16.97±4.77)mmHg、(17.42±5.35)mmHg、(18.86±4.66)mmHg、(18.49±4.32)mmHg、(18.29±3.76)mmHg.2组术后12个月的成功率均为75%.深层巩膜切除术组除了3例术后1周内出现前房混浊外无其他并发症.结论非穿透性深层巩膜切除术的疗效与小梁切除术相同,术后并发症的发生率明显低于后者.     

Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification

Purpose:To compare outcomes of laser assisted deep sclerectomy (LADS) and conventional trabeculectomy both combined with phacoemulsification.Methods:We divided 36 eyes into 2 groups, one group with LADS and the other Trabeculectomy. Patients were measured post operatively at 1, 3, 6, 9 months, 1, 2, 3 years for intraocular pressure (IOP), best corrected visual acuity (BCVA) and number of medications.Results:In the trabeculectomy group, after 3 year follow up, IOP was 14.67 ± 3.14, 15.27 ± 4.28 and 17.00 ± 7.79, BCVA improved to 0.17 ± 0.18, 0.24 ± 0.20 and 0.24 ± 0.27 and number of medications reduced to 0.6 ± 0.6, 1.1 ± 1.2, and 1.5 ± 1.5. Complete success rate after 3 years was 100%, 80.0% & 80.0% and Qualified success rate was 100%, 88.9% & 88.9%. In the LADS group, after 3 years follow up, IOP was 14.11 ± 3.91, 16.07 ± 5.51, 15.80 ± 6.07, BCVA improved to 0.13 ± 0.11, 0.10 ± 0.15, 0.11 ± 0.13 and medications reduced to 1 ± 1.1, 1.5 ± 1.0 and 1.8 ± 1.0. Complete success after 3 years was 85.7%, 57.1% & 57.1% whereas qualified success was 92.3%, 84.6% & 84.6%.Conclusion:Main limitations of our study were small sample size and lack of prospective comparison. However we were able to perfom the surgery comfortably due to the relatively shorter learning curve compared to conventional NPDS.