Deep sclerectomy in patients with capsular glaucoma

PURPOSE: To compare the results of deep sclerectomy in capsular glaucoma (CG) with those in primary open-angle glaucoma (POAG). METHODS: This consecutive, prospective study comprised 24 CG patients (28 eyes) and 25 POAG patients (29 eyes) who underwent deep sclerectomy. Two different implants were used: either an absorbable collagen implant (Aqua-Flow) or a non-absorbable hydrophilic acrylic implant (T-Flux). The number of glaucoma medications, intraocular pressure (IOP) and complications were compared postoperatively. The definition of complete success was IOP below 19 mmHg without therapy. RESULTS: After a mean follow-up of 19.9 +/- 10.9 months (range 6-36 months) in the CG group and 16.2 +/- 10.0 months (range 6-36 months) in the POAG group, complete success was seen in 60.7% and in 37.9% of eyes, respectively (p=0.085). After adjustments for disparities in baseline characteristics, survival analysis demonstrated that success rates were better over time in CG eyes than in POAG eyes (p=0.038). At all time-points, except at 24 months, the IOP was lower in the CG group than in the POAG group. This difference was statistically significant at 1 week (p=0.050) and 3 months (p=0.006). At 18 months, the mean decrease in number of medications was 77.3% in the CG group and 65.9% in the POAG group (not statistically significant). Levelled hyphema occurred more frequently in CG eyes (35.7%) than in POAG eyes (13.8%). CONCLUSION: Capsular glaucoma patients had significantly higher success rates over time than POAG patients following deep sclerectomy with implant.     

Comparative evaluation of bimatoprost monotherapy in primary chronic angle closure and primary open angle glaucoma eyes: a three-year study.

AIMS: The aim of this study was to compare the long-term efficacy of bimatoprost 0.03% monotherapy in primary open angle glaucoma (POAG) versus primary chronic angle closure glaucoma (PCACG) eyes. METHODS: A total of 55 consecutive primary adult glaucoma patients on bimatoprost monotherapy were prospectively evaluated in this 3-year, open-labeled, uncontrolled study. The primary outcome was the evaluation of a difference in the response to therapy of POAG eyes, as compared to PCACG eyes over a follow-up of 3 years. RESULTS: In the POAG group, the mean intraocular pressure (IOP) at the 36-month followup was found to be increased by 2.10 (+/-3.90) mmHg (confidence interval [CI], 0.975-4.185), compared to the mean IOP at 1 month (P = 0.047). In the PCACG group, the mean IOP at the 36-month follow-up was increased by 3.66) (+/- 3.34) mmHg (CI, 6.241-1.092), compared to the mean IOP at 1 month (P = 0.011). This upward drift in IOP was higher in the PCACG group, compared to the POAG group, but this was not statistically significant (P = 0.54). Patients with POAG and PCACG showed a 50% and 40% chance of having an IOP of <18 mmHg with bimatoprost monotherapy (P = 0.23), respectively, at the 3-year follow-up. CONCLUSIONS: This study showed that bimatoprost 0.03% monotherapy significantly lowers IOP in both POAG and PCACG eyes over a period of 3 years, though its efficacy appeared to decrease over time, to a similar extent, in both groups.     

Longterm follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma

PURPOSE: To compare the longterm results in pseudoexfoliative glaucoma and primary open-angle glaucoma (POAG) following deep sclerectomy with implant. METHODS: A total of 28 pseudoexfoliative glaucoma eyes and 27 POAG eyes were consecutively included in the study. Intraocular pressure (IOP) and number of glaucoma medications were compared before surgery and at every postoperative visit. Most patients included had very advanced glaucoma and were using multiple therapies (mean 3.3 and 3.6 in the pseudoexfoliative glaucoma and POAG groups, respectively) and the duration of the disease was more than 8 years in both groups. The definition of complete success was the achievement of IOP < 19 mmHg without therapy. RESULTS: After a mean follow-up time of 45 months in the pseudoexfoliative glaucoma group and 43 months in the POAG group, 50.0% of the pseudoexfoliative glaucoma group were considered to represent complete success compared with 33.3% of the POAG group (NS). In survival analyses controlling for covariates, it was found that patients with pseudoexfoliative glaucoma had a higher rate of success over time than POAG patients (p = 0.014). Furthermore, the duration of glaucoma prior to surgery had a negative influence on the success rate (p = 0.034). Four years after surgery, the mean IOP was 15.5 +/- 5.3 mmHg in the pseudoexfoliative glaucoma group and 13.6 +/- 3.5 mmHg in the POAG group (NS). The mean number of medications used by each group at that time was 1.7 +/- 1.5 and 1.2 +/- 1.1, respectively (NS). CONCLUSION: The present study suggests that deep sclerectomy is a safe procedure in pseudoexfoliative glaucoma. Half of the patients were regulated without therapy after 45 months.     

Comparative evaluation of diode laser trabeculoplasty vs frequency doubled Nd : YAG laser trabeculoplasty in primary open angle glaucoma

AIMS: To evaluate the efficacy of diode laser trabeculoplasty (DLT) and frequency doubled Nd : YAG laser trabeculoplasty (YLT) in primary open angle glaucoma (POAG). METHODS: A total of 52 eyes of 35 patients with POAG were included. In all, 25 eyes underwent DLT (Group I) and 27 eyes underwent YLT (Group II). IOP, gonioscopy and visual fields were evaluated before and 3, 6, and 9 months and 1 year after the laser. An IOP<21 mmHg without medications or a decrease in the number of glaucoma medications with no progression of disc and field changes was considered a success. RESULTS: The mean age of patients in Group I was 57.72+/-8.1 years and the patients in Group II had a mean age of 59.85+/-7.76 years. The mean prelaser IOP was 24.93+/-1.49 mmHg and 25.36+/-1.57 mmHg. The mean IOP after DLT at 12 months follow-up was 18.0+/-0.93 mmHg and after YLT was 18.6+/-1.52 mmHg. The reduction of IOP was statistically significant in both the groups at 3, 6, 9, and 12 months (P<0.001), however there was no significant difference between the two groups. Success rates in both groups were similar, 92% in Group I and 92.6% in Group II. CONCLUSIONS: DLT and Fd YLT are equally effective in controlling IOP in eyes with POAG.     

Mini-trabeculectomy in comparison to conventional trabeculectomy in primary open angle glaucoma

PURPOSE: To evaluate the safety and efficacy of mini-trabeculectomy in comparison to conventional trabeculectomy in primary open angle glaucoma (POAG). METHODS: A prospective interventional study of mini-trabeculectomy versus conventional trabeculectomy was undertaken on 60 eyes of 54 medically uncontrolled POAG patients requiring glaucoma surgery. They were divided into two groups: Group I underwent mini-trabeculectomy (30 eyes of 26 patients) and Group II underwent conventional trabeculectomy (30 eyes of 28 patients). All patients were followed up for at least 15 months. Statistical analysis was carried using Student's t test and paired t test for quantitative data and Pearson's chi-square test for qualitative data. RESULTS: The mean intraocular pressures (IOP) at the end of 15 months of follow-up in Groups I and II were 15.80+/-4.3 mmHg and 16.13+/-3.3 mmHg versus mean preoperative IOP of 28.63+/-2.74 and 28.60+/-2.44, p<0.0001, respectively. The difference in IOP control was significant only at 6 months of follow up (13.65+/-3.45 versus 15.98+/-4.05, p=0.041). The complications and failure were comparatively less in Group I. CONCLUSIONS: Mini-trabeculectomy is a safe and effective alternative to conventional trabeculectomy in terms of IOP control. A modified tunnel incision employed in mini-trabeculectomy may be responsible for avoiding some of the complications.     

选择性激光小梁成形术治疗青光眼的临床观察

目的评价选择性激光小梁成形术(SLT)治疗原发性开角型青光眼(POAG)、正常眼压性青光眼(NTG)的疗效和安全性。方法选择局部用药眼压不能控制的原发性开角型青光眼20例(37眼),正常眼压性青光眼6例(10眼)。观察应用选择性激光小梁成形术后6个月眼压的变化。结果术后眼压平均降低幅度为4.86±2.14mmHg(24.04±10.21%),两组患眼的眼压在激光治疗后均有显著下降:开角型青光眼组术后6个月的眼压较术前平均下降5.44±2.32mmHg(24.90±11.09%);正常眼压性青光眼组平均下降2.71±1.12mmHg(19.06±7.19%)。术后暂时的眼压升高、前房炎症反应为常见的并发症。结论选择性激光小梁成形术具有降眼压效果明显、安全、实用、损伤小、可重复等特点,是治疗青光眼的一种较安全有效的方法。     

Visual loss after transscleral diode laser cyclophotocoagulation for primary open-angle and neovascular glaucoma.

BACKGROUND AND OBJECTIVE: Varying incidences of visual loss after transscleral diode laser cyclophotocoagulation for uncontrolled intraocular pressure (IOP) have been reported. This study compared the treatment response in primary open-angle (POAG) and neovascular (NVG) glaucoma, particularly regarding vision loss. PATIENTS AND METHODS: Case notes of consecutive patients who underwent transscleral diode laser cyclophotocoagulation between March 2001 and September 2005 were retrospectively reviewed. A diagnosis of POAG or NVG and at least 6 months of follow-up were required for inclusion. Conservative laser parameters were used. The treatment response of the POAG and NVG groups was compared. RESULTS: Twenty-five eyes of23 patients with POAG and 14 eyes of 14 patients with NVG were studied. Mean follow-up was 22.4 and 12.9 months in the POAG and NVG groups, respectively. Post-treatment, both groups had significant reduction in mean IOP of 7.3 (29.2%) and 13.2 (36.6%) mm Hg, respectively (between group P = .18). One eye in each group had mild hypotony of 4 mm Hg, and no eyes became phthisical. Oral acetazolamide treatment was significantly reduced in both groups. Visual acuity post-treatment decreased in both groups; the POAG eyes had better initial visual acuity and lost more visual acuity. Nine of 25 (36%) POAG and 4 of 8 (50%) NVG eyes lost 2 or more LogMAR lines. CONCLUSIONS: Transscleral diode laser cyclophotocoagulation reduced IOP and medication requirements in POAG and NVG. Patients should be warned that visual loss may occur, especially in endstage glaucoma.     

Phacoviscocanalostomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma

Objective: To compare the outcome of phacoviscocanalostomy in Pseudoexfoliation glaucoma (PEXG) versus that in primary open-angle glaucoma (POAG).Design: Prospective comparative study.Participants: Sixty eyes of 60 patients who underwent phacoviscocanalostomy for cataract and medically uncontrolled PEXG (30 eyes) or POAG (30 eyes).Methods: Success rate was based on intraocular pressure (IOP) reduction and need for antiglaucoma medication. Visual acuity (VA) and complication rates were secondary outcomes.Results: The mean follow-up was 19.7 months (range, 12–36 months). The mean IOP values in both groups were significantly less than the preoperative values at all postoperative intervals (p < 0.001). From 1 month onward, the decrease in IOP was more dramatic in PEXG eyes than in POAG eyes (p < 0.05). At last visit, the mean percentage of IOP reduction was 49.7% in the PEXG group and 30.9% in the POAG group. All study eyes required decreased antiglaucoma medications and showed improved VA postoperatively. Transient complications included Descemet's membrane microperforations, macroperforation, zonular dehiscence, and postoperative IOP spike. No eyes developed trabeculectomy-type bleb, hyphema, fibrin exudation, or bleb-related complications.Conclusions: Phacoviscocanalostomy achieved excellent IOP control and VA improvement in both PEXG and POAG groups. PEXG demonstrated greater IOP reduction and fewer postoperative medications than POAG. The complication rate was low and did not affect surgical outcome. Phacoviscocanalostomy can be an effective and safe surgical alternative to phacotrabeculectomy in both groups of patients.     

Ab-interno goniotrabeculotomy versus mitomycin C trabeculectomy for adult open-angle glaucoma: a 2-year randomized clinical trial.

OBJECTIVE: To evaluate the effect of ab-interno goniotrabeculotomy (AIGT) on the intraocular pressure (IOP) in adult patients with primary open-angle glaucoma (POAG), compared with the effects of mitomycin C trabeculectomy (MT). DESIGN: Prospective, randomized, clinical trial. PARTICIPANTS: Thirty-two eyes of 32 patients with medically uncontrolled POAG. INTERVENTION: Standard limbus-based trabeculectomy with adjunct mitomycin C (0.3 mg/mL for 3 minutes) in 16 eyes of 16 patients; AIGT was performed in 16 eyes of 16 patients. The groups were matched for age, preoperative IOP, duration of preoperative antiglaucoma treatment, use of preoperative beta-blockers and parasympathomimetics, and use of beta-blockers in the fellow eye. The IOP (average of the two highest values measured in the diurnal curve, from 8 AM to 6 PM, every 2 hours) and complications were recorded 1, 3, 6, 12, 18, and 24 months after surgery. MAIN OUTCOME MEASURES: Identification of complications and IOP. RESULTS: All patients were followed up for 24 months. More postoperative complications occurred in the MT group during the 2-year follow-up. One month after surgery, IOP was 10 +/- 1.46 mmHg (range, 8-13) in the MT group and 12.12 +/- 1.63 mmHg (range, 8-14) in the AIGT group (Student's t test, P = 0.001). Three months after surgery, IOP was 11.5 +/- 1.59 mmHg (range, 8-14) and 12.75 +/- 1.57 mmHg (range, 10-16) in the MT and AIGT groups, respectively (Student's t test, P = 0.033). From the 6th to the 24th postoperative month, no statistically significant difference in IOP was found between the two groups. At the end of follow-up, 14 of 16 eyes (87.5%) of the AIGT group and 13 of the 16 eyes (81.25%) of the MT group showed an IOP < or = 14 mmHg. CONCLUSION: Ab-interno goniotrabeculotomy appears to be a viable and safe surgical treatment for adult POAG. More extended follow-up, however, and a larger series of patients are needed to ascertain the actual effectiveness of this procedure in adult POAG.     

Deep sclerectomy for the treatment of exfoliation and primary open-angle glaucoma

PURPOSE: To retrospectively compare the efficacy of deep sclerectomy in the treatment of primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG). METHODS: Deep sclerectomy with either collagen or hyaluronate implants was performed in 31 eyes (45%) with POAG and 38 eyes (55%) with ExG. Pre- and postoperative intraocular pressure (IOP) was recorded, as was the number of glaucoma medications used pre- and postoperatively in each group. The follow-up data referred to a mean period of 18 months (range: 2 weeks to 36 months). RESULTS: At 18 months, complete success had been achieved in 56.3% of POAG eyes and 44.9% of ExG eyes. Qualified success had been achieved in 83.1% and 71.6% of POAG and ExG eyes, respectively. The mean IOP was 18.6 mmHg in POAG eyes and 16.3 mmHg in ExG eyes. YAG-descemetotomies were performed in nine eyes in each group. There were no statistically significant differences between the groups in IOP (except at 1 week postoperatively in favour of POAG; p = 0.05), success rates, need for postoperative glaucoma medication or number of complications. Reoperations were required in three (10%) POAG eyes and seven (18%) ExG eyes. CONCLUSIONS: Deep sclerectomy is equally effective in controlling IOP in both POAG and ExG and has low rates of serious complications, even when the surgeon is inexperienced in the technique. Both survival rates and IOP control were similar between the groups, and there were no serious intra- or postoperative complications.     

改良的黏弹剂Schlemm管切开术治疗原发性开角型青光眼的临床研究

目的观察改良的黏弹剂Schlemm管切开术（VCO）和小梁切除术（TE）治疗原发性开角型青光眼的疗效和安全性。方法采用前瞻性随机对照方法,对100例（100只眼）药物控制眼压不理想的原发性开角型青光眼患者,随机分为改良VCO组50例（50只眼）,TE组50例（50只眼）,术后平均随访28个月。结果手术后1个月,改良VCO组和TE组患者的平均眼压分别为（11．22±4．34）和（12．35±3．79）mmHg（1mmHg=0．133kPa）,手术成功率（术后未用任何降眼压药物眼压〈21mmHg）均为98．0％;手术后12个月,两组的平均眼压分别为（14．50±3．22）和（16．58±4．73）mmHg,手术成功率分别为87．5％和70．0％,两组差异有统计学意义（P〈0．05）;手术后24个月,两组的平均眼压分别为16．0和15．4mmHg,手术成功率分别为76．1％和67．3％,两组差异无统计学意义（P〉0．05）;早期并发症如浅前房、脉络膜脱离、囊样滤过泡等以TE组明显多于改良VCO组,两组差异有统计学意义（P〈0．01）。结论在治疗原发性开角型青光眼方面,改良VCO组的成功率较TE组高．术后早期并发症相对较少.     

Trans-scleral diode laser cyclophotocoagulation for the treatment of refractory pediatric glaucoma

PURPOSE: To evaluate the success rate of contact diode transscleral cyclophotocoagulation (TSCPC) in pediatric refractory glaucoma. PATIENTS: and method: Twenty-eight eyes of 28 patients (age range 5 months to 26 years) with medical and surgical refractory pediatric glaucoma due to primary congenital glaucoma (group 1, 20 eyes) or aphakic congenital glaucoma (group 2: 8 eyes), were included in this retrospective study. All eyes underwent one or more TSCPC with the diode laser (Oculight SLX, Iris Medical) with a minimal follow-up of 2 months. Success was defined as intraocular pressure (IOP) between 6 and 20 mmHg after one or more procedures, with no increase in medical hypotensive therapy, and no progression to another hypotensive procedure. RESULTS: Mean baseline IOP was 29.4 +/- 7.8 mmHg (range 25 to 60 mmHg) and mean follow-up was 10.3 +/- 6.9 months (range 2 to 26 months). Success rates evaluated at 6 and 12 months (Kaplan Meier survival curves) were 54.4% and 27.7% respectively, with one-third of the eyes retreated once or more. These success rates were similar in both groups with a mean baseline IOP decrease of 38.9 +/- 15.9%. Postoperative uncontrolled hypertony occurred in the first 3 months in 6 (21.4%) eyes, leading to surgical IOP management. Other complications were decrease in visual acuity (14.3%), inflammation (25.5%) and phthisis (3.5%). CONCLUSION: TSCPC with the diode laser is a disappointing procedure for the management of refractory pediatric glaucoma, with poor mid-term IOP control and high incidence of complications including severe uncontrolled IOP increase. For these reasons, this cyclodestructive procedure should be considered as a last resort therapy for patients with refractory pediatric glaucoma.     

Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial

PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.     

Ex-press青光眼引流钉植入术治疗不同类型青光眼的长期临床观察 △

目的 评价Ex-press青光眼引流钉植入术治疗不同类型青光眼的有效性和安全性。方法 回顾分析于我院行P50型Ex-press青光眼引流钉植入术的不同类型青光眼患者209例(283眼),包括原发性开角型青光眼(POAG)组135眼、原发性闭角型青光眼(PACG)组12眼、发育性青光眼(DG)组94眼、继发性青光眼(SG)组42眼,比较了手术成功率,术后眼压、视力,抗青光眼药物使用数量及并发症。结果 术后平均随访(26.7±10.7)个月。术后36个月,POAG组的完全成功率(68.8%)明显高于PACG组(40.0%)和SG组(47.6%),DG的完全成功率(65.1%)明显高于SG(47.6%),以上P值均<0.05。各组青光眼术后眼压较术前均明显下降(P<0.05),术后不同随访时间各组间平均眼压差异无统计学意义(P>0.05)。各组视力均在术后1周明显下降(P<0.05),术后1个月恢复至术前水平。SG组术后抗青光眼药物使用数量(1.05±1.13)明显高于POAG组(0.51±1.22)、PACG组(0.83±0.84)及DG组(0.63±0.90),P值均<0.05。SG组术后并发症总发生率(40.48%)高于POAG组(15.56%)和DG组(21.28%),P值均<0.05。结论 Ex-press青光眼引流钉植入术治疗POAG和DG有较好的有效性和安全性,对于PACG和SG的治疗则需根据临床情况谨慎选择。     

Combined phacoemulsification and goniotrephination on eyes with primary open-angle glaucoma and classical pseudoexfoliation glaucoma

BACKGROUND: Combined glaucoma and cataract operation has been demonstrated to be effective in controlling IOP and increasing visual acuity. Because of the differences between patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXEG), for cataract and glaucoma surgery alone we evaluated the effects and complications for simultanous surgical management. PATIENTS AND METHODS: In a retrospective study 103 patients were examined who underwent a combined phacoemulsification and goniotrephination between January 1993 and January 1997 and had no surgery before (110 eyes with POWG, 22 eyes with PXEG). RESULTS: The average age in the POAG group (75.1 +/- 8.7 years) was significantly less than in the PXEG group (79.3 +/- 5.9 years) (P < 0.05). The mean preoperative IOP in PXEG (31.8 +/- 10.3 mmHG) was significantly higher than in POAG (25.0 +/- 6.4 mmHg) (P < 0.0005). Due to the combined surgery the mean intraocular pressure decreased in both groups < 10 mmHg (days 1 and 7). PXEG had a significantly higher IOP at day 3 than POAG (12.3 +/- 8.4 mmHg versus 8.5 +/- 5.7 mmHg) (P < 0.05) and developed after combined operation IOP peaks > 25 mmHg into a significantly higher level (P < 0.05). Moreover, zonulolysis, rupture of the posterior capsule, vitreous loss and persistence of inflammatory response occurred more often in PXEG, but there was no significant difference compared to POAG. CONCLUSION: PXEG has an higher incidence of typical problems of phacoemulsification, a temporary increase of IOP and prolonged inflammation after combined cataract and glaucoma surgery than POAG, but there is a similar risk compared to a single procedure.     

Combined phacoemulsification and goniotrephination in primary open-angle glaucoma and pseudoexfoliation glaucoma - a retrospective analysis

BACKGROUND: During the last few years combined cataract and glaucoma surgery is an established method to control intraocular pressure (IOP) and visual rehabilitation in patients with cataract and glaucoma. Despite this, there are currently only few data concerning the results of combined surgery for primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS: To study the course of PEXG and POAG with respect to IOP regulation and visual acuity, 100 eyes with POAG (72 patients) and 22 with PEXG (19 patients) were evaluated which underwent a combined phacoemulsification and goniotrephination between 1993 and 1997. All patients had no glaucoma or other ocular surgery before. The mean follow up after operation was 39.5 (range 16 - 72) months. RESULTS: The mean preoperative IOP in PEXG (31.8 +/- 10.3 mm Hg) was significantly higher than in the POAG group (25.3 +/- 6.4 mm Hg) (p=0.0004). At follow up IOP decreased to 16.7 +/- 2.8 mm Hg (POAG) and 15.1 +/- 4.0 mm Hg (PEXG) (p < 0.0001). The absolute IOP lowering effect was significantly better for PEXG than for POAG (p=0.0003). All patients received medical treatment before surgery, whereas at follow up 59.0 % (POAG) and 81.8 % (PEXG) were untreated. The median preoperative visual acuity for the POAG was 0.32 (PEXG 0.25), visual outcome 0,63 (PEXG 0.5). CONCLUSION: The combined cataract and glaucoma surgery is a successful method of IOP control and visual rehabilitation. It seems that there is a tendency for a better efficiency and an untreated IOP regulation after surgery for PEXG. Thereby early surgical intervention could be an advantage for this glaucoma entity.     

Long-term filtration and visual field outcomes after primary glaucoma triple procedure with and without mitomycin-C

OBJECTIVE: To evaluate the long-term effectiveness of glaucoma management in patients undergoing primary glaucoma triple procedure (PGTP) with and without adjunctive subconjunctival mitomycin-C (MMC). DESIGN: Case-controlled study. PARTICIPANTS: Of the 203 eyes of 203 primary open-angle glaucoma (POAG) patients who had undergone PGTP and in whom reliable Humphrey visual fields had been obtained both before and after surgery at 13.5 +/- 8.9 and 27.9 +/- 8.9 months, 124 of the 144 eyes that received MMC during surgery were matched to the other 59 eyes that did not with respect to cup-to-disc ratio and risk factors for filtration failure in addition to other variables. MAIN OUTCOME MEASURES: Both preoperative and postoperative intraocular pressure (IOP), Humphrey visual fields and their global indices, number of glaucoma medications, and best-corrected visual acuity (BCVA). RESULTS: There were no significant differences in demographics between the two groups (P > 0.05 for each). Whereas both the control and the MMC groups attained significant decreases of mean IOP (18.5 +/- 5.7 mmHg-;15.6 +/- 4.6 mmHg, P = 0.0014; 19.3 +/- 7.0 mmHg-13.7 +/- 4.9 mmHg, P = 0.0001) and mean number of medications (2.1 +/- 1.3-1.3 +/- 1.3, P = 0.0001; 2.3 +/- 1.2-1.0 +/- 1.3, P = 0.0001) at 36 months after surgery, the MMC group had significantly lower mean IOP than the control group at all postoperative visits (P < 0.05 for each). The MMC group also tended to have less medical dependency after surgery than the control group. There was no significant difference in postoperative BCVA between the two groups. Patients in both groups had mean visual acuity of 20/30 or better. There was a significant worsening of corrected pattern standard deviation (CPSD) in the control group (3.97 +/- 3.18-5.17 +/- 3.36, P = 0.001) compared with no significant change in the MMC group (5.07 +/- 4.11-5.23 +/- 3.36, P = 0.93). The mean deviation did not change significantly in either group. CONCLUSIONS: The long-term glaucoma management in POAG patients with cataract undergoing PGTP indicates a successful outcome in final IOP, medical dependency, and BCVA. Furthermore, the MMC group had better IOP control and stable visual fields (CPSD), whereas the control group had a significant worsening of CPSD.     

Intraocular pressure response to selective laser trabeculoplasty in the treatment of primary open-angle glaucoma

PURPOSE: To evaluate the intraocular pressure (IOP) response to selective laser trabeculoplasty (SLT) in the treatment of uncontrolled primary open-angle glaucoma (POAG) in a prospective clinical study. SLT is a new laser procedure that selectively targets trabecular meshwork (TM) cells without coagulative damage to the TM. METHODS: 50 eyes with uncontrolled POAG were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). A total of approximately 50 nonoverlapping spots were placed over 180 degrees of the TM at energy levels ranging from 0.40 to 0.92 mJ/pulse. After SLT, the eyes were maintained with the identical hypotensive medical therapy as that before treatment. IOP was estimated before and 1 day, 7 days, 1 month, 3 months and 6 months after treatment. RESULTS: The mean pretreatment IOP was 22.48 mm Hg (SD 1.84). At the end of 1 month of follow-up IOP was reduced with a mean of 4.86 mm Hg (SD 2.38) or 21.6%; after 3 months, IOP was reduced with a mean of 5.66 mm Hg (SD 2.40) or 25.2%; at the end of 6 months of follow-up, IOP was reduced with a mean of 5.06 mm Hg (SD 2.37) or 22.5%. CONCLUSIONS: SLT is an effective method for lowering IOP in the treatment of POAG.     

Aerobic exercise reduces intraocular pressure and expands Schlemm’s canal dimensions in healthy and primary open-angle glaucoma eyes

Purpose:Aerobic exercise (AE) has been reported to decrease intraocular pressure (IOP) in healthy subjects and there are concomitant morphological changes in the anterior segment of the eye including the Schlemm’s canal (SC). However, its effects on IOP and SC morphology in glaucoma patients had not been studied before. We aim to investigate the effect of AE on the IOP and SC dimension in both healthy and primary open-angle glaucoma (POAG) eyes.Methods:The area and diameter of SC and IOP were measured in 35 primary open-angle glaucoma (POAG) patients (59 eyes) and 36 healthy subjects (72 eyes) before and after performing moderate intensity of AE by running on a treadmill for 30 min. SC was imaged by swept-source optical coherence tomography (SS-OCT) for evaluation.Results:In comparison with baseline values, mean IOP decreased significantly following AE in both POAG and healthy eyes (both P < 0.001), in which POAG eyes showed a greater degree of reduction compared to healthy eyes (P = 0.002). In comparison with baseline values, in both POAG and healthy eyes, the average cross-sectional area (POAG: 80.48 +/- 59.54 vs. 99.20 +/- 54.87 pixels; healthy: 151.84 +/- 52.76 vs. 198.23 +/- 53.70 pixels; both P < 0.001) and diameter (POAG: 3.73 +/- 1.69 vs. 4.33 +/- 1.74 pixels; healthy: 5.61 +/- 1.02 vs. 6.47 +/- 1.20 pixels; both P < 0.001) of SC significantly increased after AE. In POAG, both treated and untreated with IOP-lowering medications, a significant reduction in mean IOP and increase in SC dimensions following AE were observed (all P < 0.05), and there were no significant differences of such measurements between the two subgroups (all P > 0.05).Conclusion:AE-induced reduction in IOP and an increase in SC dimensions in POAG eyes as in healthy eyes. Further studies to evaluate the long-term effect of AE on IOP control and SC morphology in POAG seem warranted.     

Long-term intraocular pressure fluctuation and visual field progression in glaucoma patients with low intraocular pressure after post-trabeculectomy phacoemulsification.

BACKGROUND: The aim of this study was to evaluate the association of long-term intraocular pressure (IOP) fluctuation and visual field progression in glaucoma patients with low IOP after post-trabeculectomy phacoemulsification. METHODS: A total of 688 eyes with primary open-angle glaucoma (POAG) and chronic primary angle-closure glaucoma (CPACG) were included in this study. The patients always had an IOP below 18 mmHg after post-trabeculectomy phacoemulsification. Visual field testing using the standard automated perimetry was periodically performed at 3 months and for at least 3 years postoperatively. The mean deviation on visual field was compared according to the standard deviation (SD) of the postoperative IOP (SD < or = 2 mmHg group vs. SD > 2 mmHg group). RESULTS: Preoperative and postoperative IOPs during the follow-up period did not differ significantly between the two study groups. Even though the mean deviations on visual field at postoperative 3 months were not different between the two groups, the mean deviations at the last follow-up were significantly worse in the postoperative IOP SD > 2 mmHg group than the postoperative IOP SD < or = 2 mmHg group. CONCLUSIONS: Less postoperative IOP fluctuation was statistically associated with a slower progression of visual field damage in POAG and CPACG patients who kept low IOPs after the post-trabeculectomy phacoemulsification.