Long term effect of latanoprost on intraocular pressure in normal tension glaucoma

AIM: To determine the long term effect of latanoprost on the intraocular pressure (IOP) of patients with normal tension glaucoma (NTG). METHODS: Newly diagnosed patients with NTG were recruited into the study and had their baseline IOPs measured hourly between 8 am and 5 pm using a handheld electronic Tonopen. Patients with fixation threatening field defects were placed immediately into the treatment group while those with non-fixation threatening field defects were randomised into either the treatment group or the control group (no treatment). Treatment consisted of once daily topical latanoprost 0.005%. After a minimum period of 6 months, the patients underwent a second period of IOP phasing. RESULTS: 76 newly diagnosed patients with NTG were recruited-26 had fixation threatening disease, 25 were randomised to treatment, and 25 randomised to the control group. The average duration of treatment was 11 months. The average and maximum diurnal IOP for the patients randomised to treatment were statistically significantly lower than for the control patients at follow up (p<0.05). The treated group as a whole demonstrated a 17% decrease in the average diurnal IOP and a 19% decrease in the maximum diurnal IOP when compared to baseline IOP. 41% of those treated achieved a decrease of at least 20%, but only 10% of patients achieved a decrease of at least 30%. CONCLUSION: Latanoprost had a sustained hypotensive effect in eyes with NTG and 41% of treated patients achieved a reasonable response. However, in the majority of eyes with NTG, latanoprost monotherapy may be insufficient in producing a desirable 30% reduction in IOP.     

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.     

非穿透小梁手术与小梁切除术远期疗效比较

目的 比较非穿透小梁手术和改良小梁切除术治疗原发性开角青光眼(POAG)的远期效果及并发症.设计回顾性队列研究.研究对象非穿透小梁手术患者69例,改良小梁切除手术患者53例.方法 对2000年1月-2001年12月间因POAG在中山眼科中心行非穿透小梁手术或改良小梁切除术(小梁切除术联合可拆除缝线、丝裂霉素C)的广东省内患者,于2004年7-10月以电话或信件方式通知复诊;复诊时详细记录病史、历次复诊和处理情况、当前用药种类,并进行视力、眼压、眼底检查,运用Kaplan-Meier生存分析法比较两种术式的成功率.主要指标眼压、手术成功率及并发症情况.结果 83例126眼POAG患者复查,其中非穿透小梁手术57例84眼,改良小梁切除术26例42眼.非穿透小梁手术组、改良小梁切除术组平均年龄分别为(43.7±21.2)岁、(39.6±19.5)岁.平均随访时间42.3±7.9月.非穿透小梁手术组、改良小梁切除术组术前眼压分别为(24.7±8.9)mmHg、(28.9±11.2).mmHg;术前用药种数分别为(1.89±1.1)种、(2.4±0.63)种;术后终点眼压分别为(16.7±6.7)mmHg、(12.2±4.8)mmHg(P=0.000);术后用药种数分别为(0.68±0.9)种、(0.17±0.4)种(P=0.001);完全成功率分别为52.38%、76.2%(P=0.032).在非穿透小梁手术组中,透明质酸钠凝胶植人物组、生物胶原植人物组完全成功率分别为66.7%、34.6%.结论 非穿透小梁手术治疗POAG的远期成功率低于改良式小梁切除术.术中植入人工支撑材料可提高非穿透小梁手术的远期成功率,且透明质酸钠凝胶植入材料比胶原效果好.(眼科,2008,17:278-282)     

Control of intraocular pressure after trabeculectomy

Control of intraocular pressure (IOP) is the goal of trabeculectomy, and pursuit of this goal does not end with the completion of the surgical procedure. Proper postoperative management of the trabeculectomy patient requires an understanding of possible events that alter IOP and knowledge of the treatments to control IOP. Recent changes in surgical technique, including the use of antimetabolites, have provided new challenges in the postoperative management of trabeculectomy patients. Interventions are described to restore the flow of aqueous to the filtering bleb in the early postoperative period, to manage flat anterior chambers with both high and low intraocular pressures, to manage a failing filtering bleb, and to manage hypotony. Herein we discuss current methods for controlling IOP in the postoperative period.     

高眼压下青光眼的手术治疗

目的探讨高眼压下行青光眼复合式小梁切除术的疗效.方法对33例(33只眼)应用药物不能控制眼压的青光眼患者,采取术中先缓慢降压的方法,进行复合式小梁切除术.结果术后视力提高20只眼,占60.61%,视力不变8只眼,占24.24%;术后眼压控制≤21mmHg21只眼,占66.67%,局部用药可控制者9只眼,占27.27%.结论对药物不能有效控制眼压的青光眼患者,在高眼压下采取必要措施,进行复合式小梁切除术是可行的.     

持续性高眼压青光眼小梁切除术的临床疗效评价

目的 探讨持续性高眼压状态下原发性急性闭角型青光眼(PACG)手术特点、手术时机、手术安全性、可行性及治疗效果.方法 回顾分析36例(41眼)(眼压≥40 mmHg)高眼压下PACG行小梁切除术(治疗组),38例(43眼)(眼压＜40 mmHg)行小梁切除术(对照组),并对两组术前后视力、眼压、滤过泡、前房、手术并发症和手术成功率进行比较.结果 两组病例手术均取得成功,无明显严重并发症,术后近期手术成功率对照组明显高于治疗组,差异有统计学意义(P＜0.05),但术后调整巩膜瓣缝线,眼球按摩和滤过泡针刺分离术联合5-Fu球结膜下注射等技术应用,两组成功率均获得提高,术后6月复诊两组的手术成功率差异无统计学意义(P＞0.05),术前有视功能者术后视力均有不同程度提高.结论 青光眼持续性高眼压下行手术治疗,不仅可缩短病程和减少并发症,而且还能取得与正常眼压下行青光眼手术治疗同样的疗效,持续性高眼压状态下的小梁切除术是完全有效的,应积极采用手术治疗,以避免视功能的进一步损害.     

Evaluation of phacotrabeculectomy versus trabeculectomy alone

Our purpose was to evaluate phacotrabeculectomy (PT) versus trabeculectomy alone (TA). 161 eyes with primary open angle or pseudoexfoliative glaucoma operated on consecutively by one surgeon were followed prospectively. 1 year follow-up was available for 70 eyes with PT and 54 with TA (77% of all eyes). Intraocular pressure (IOP) in PT dropped from 23.4 +/- 8.9 to 13.3 +/- 3.4 mm Hg and in TA from 24.8 +/- 7.5 to 14.2 +/- 3.9 mm Hg. IOP difference between PT and TA at 1 year was nonsignificant (p > 0.1). The average number of medications in PT dropped from 1.9 +/- 0.9 to 0.1 +/- 0.5 and in TA from 2.2 +/- 0.9 to 0.3 +/- 0.6 (p > 0.1). We conclude that additional phacoemulsification does not influence intraocular pressure control at 1 years. Copyright Copyright 1999 S.Karger AG, Basel     

The effect of trabeculectomy on the intraocular pressure of the unoperated fellow eye

PURPOSE: To investigate the intraocular pressure (IOP) changes in the unoperated fellow eye in patients who underwent trabeculectomy. MATERIALS AND METHODS: IOP changes in the unoperated fellow eyes of 107 patients who underwent trabeculectomy in 1 eye for high-tension glaucoma (48 primary open-angle glaucoma, 43 pseudoexfoliative glaucoma, and 16 narrow-angle glaucoma) were evaluated during the early postoperative period. All IOP measurements were recorded during the postoperative first 3 months and compared with preoperative values. RESULTS: Mean preoperative IOP levels were 37.0 +/- 10.0 mm Hg in the operated eyes and 15.1 +/- 3.1 mm Hg in the fellow eyes. Mean IOPs in the unoperated eyes on the postoperative first-day, first- and second-week, and first- and third-month visits (17.1 +/- 5.7, 17.5 +/- 5.1, 18.5 +/- 5.4, 18.6 +/- 5.1, and 19.0 +/- 5.9 mm Hg, respectively) were significantly different compared with the preoperative levels for each period of time (P < 0.01). Eight fellow eyes underwent operations for uncontrolled glaucoma before month 3. Among the remaining 99 eyes, higher postoperative IOP values were measured in 33 (33%) eyes at all postoperative visits compared with the preoperative IOP levels. A consistent IOP rise equal to or higher than 5 mm Hg was detected in 12 eyes (12%) and a consistent IOP elevation of 30% or more was found in 14 eyes (14%) during the postoperative first 3 months. Contralateral IOP elevation was not correlated with patient age, type of glaucoma, or preoperative antiglaucomatous medications prescribed to the operated or fellow eyes. CONCLUSION: After filtration surgery, IOP of the unoperated fellow eye should also be monitored closely in order not to overlook a possible insidious rise, especially in glaucomatous eyes that were previously under good medical control.     

复合式小梁切除术治疗非穿透小梁切除术后眼压失控

目的：探讨复合式小梁切除术治疗原发性开角型青光眼行非穿透小梁切除术后眼压失控（眼压升高）的长期疗效与安全性。方法：回顾分析了2006-03/2011-07非穿透小梁切除术治疗原发性开角型青光眼术后眼压失控（眼压升高）再次行小梁切除术的连续随访患者13例25眼。青光眼术后再次眼压异常升高,均属于难治性青光眼,我们采取复合式小梁切除术,对于仅存中心视岛及管状视野患眼,手术在表面麻醉联合球筋膜浸润麻醉下实施。主要检查指标：手术前后眼压、视力、角膜水肿情况、滤过泡特征、前房深浅及其它并发症。结果：随访3mo～5a,非接触眼压测定术前眼压28～52mmHg,术后眼压11.7～18mmHg,术后3mo,眼压为145mmHg,眼压以≤21mmHg为成功标准。术后3mo,视力提高3眼（12%）,视力不变17眼（68%）,视力下降5眼（20%）;术后21眼角膜均变清亮;功能性滤过泡22眼（80%）,有3眼为非功能性滤过泡,眼压再次高于21mmHg,二次进行复合式小梁切除术后眼压控制在21mmHg以下;术后有15眼（60%）出现前房轴深在1.5～2CT间,均自行恢复;术中、术后有10眼（40%）出现不同程度的前房出血,经对症治疗后均已吸收;术后有5例5眼（20%）出现房水闪辉,经散瞳及典必殊滴眼液进行眼局部频点后房水闪辉完全消失,未发生眼内炎等并发症。结论：小梁切除术目前仍是可挽救有视力眼的青光眼最经典、最有效的方法;复合式小梁切除术是原经典手术方式的进一步发展;青光眼术后眼压再次异常升高均属于难治性青光眼,原发性开角型青光眼行非穿透小梁切除术后眼压失控应用复合式小梁切除术再次治疗,证实安全有效,长期疗效满意,是弥补非穿透小梁切除术眼压失控（升高）后有效的治疗措施,并且可以一眼多次手术;有效地保护仅存的视力,维持了一定的视功能;晚期原发性开角型青光眼不适合非透性小梁手术。     

The effect of scleral flap edge apposition on intraocular pressure control in experimental trabeculectomy

Background: To assess the contribution of scleral flap edge apposition to intraocular pressure (IOP) control in trabeculectomy, using a previously described and validated experimental model of guarded filtration surgery. Materials and methods: Twelve rectangular‐flap trabeculectomy operations each with two apical adjustable sutures were performed on six donor human eyes connected to a constant flow infusion with real‐time IOP monitoring. Three sizes of scleral flap were created: 4 × 4 mm, 16 mm² (n = 4), 3 × 3 mm, 9 mm² (n = 4) or 3 × 2 mm, 6 mm² (n = 4). Sutures were tied tightly to produce high aqueous outflow resistance, and equilibrium IOP established. The lateral and posterior edges of the scleral flap were removed, the sutures tightened again, and the new equilibrium IOP measured. Results: Following flap closure and with intact flap edges, the mean absolute IOP for all flaps (n = 12) was 19.5 ± 3.9 mm Hg (mean ± SD, range 12.4–27 mm Hg) and following flap edge excision 18.7 ± 4.4 mm Hg (range 5.6–27.9 mm Hg), demonstrating no significant difference between flaps with edge apposition compared with those without (P = 0.33). Mean relative IOP (% of baseline) was 68.4 ± 12.1% (range 40.9–94%) with intact flap edges and 65.4 ± 14.5% (range 18.5–97.2%) following flap edge excision (P = 0.31). Flaps measuring 4 × 4 mm and 3 × 3 mm behaved in a similar manner with minimal change in equilibrium IOP following excision of flap edges. Conclusions: In this experimental model, scleral flap edge apposition is not required for generating outflow resistance. Suture tension generated during tight flap closure produces apposition of the underside of the scleral trapdoor to the underlying bed, and it is this apposition, which determines IOP.     

取得更低眼压的青光眼复合小梁切除手术方法

目的 探索取得更低眼压水平的安全的青光眼复合小梁切除手术方法.方法 观察接受复合小梁切除手术的65岁以下的原发慢性闭角型青光眼和原发开角型青光眼病人81例(98只眼),随机分为两组,即改良组和标准组.改良组25例患者(31只眼),巩膜瓣为5 mm×3 mm×5 mm长方形,约1/4～1/3厚,缝3针可调节缝线;标准组56例患者(67只眼),巩膜瓣5 mm×4 mm×4mm梯形,约1/2～1/3厚,缝2针可调节缝线,分析两组手术后浅前房发生率和3月时眼压情况.结果 浅前房情况:改良组31只眼,5例5只眼发生浅前房,其发生率为16.1%;标准组67只眼,5例5只眼发生浅前房,其发生率为7.5%.经x2检验分析,两组浅前房发生率的差别无统计学显著性意义(x 2=1.74,P＞0.1).手术后3个月眼压:改良组为8.1～16.5 mm Hg,平均为(12.5±1.9)mm Hg,而标准组为8.9～24.8 mm Hg,平均为(16.4±3.6)mm Hg,经t检验,两组均值的差异有统计学意义(t=2.36,P＜0.05).结论 与普遍采用的标准复合小梁切除手术相比,改良的复合小良切除手术后获得更低的眼压水平,同时浅前房发生率低.

Abstract：

Objective To explore save complex trabeculectomy to achieve lower intraocular pressure in glaucoma. Methods Eighty-one patients (98 eyes) with primary cbronic glaucoma received complex trabeculectomy in our hospital and were reviewed. All of the patients were divided into two groups according to the number of adjustable sutures of the operated eyes. The two groups were the modified and the standard. There were 25 cases (31 eyes) in modified group. All of the eyes had received complex trabeculectomy with 3 adjustable sutures and a scleral flap of 5×3×5mm and 1/4～1/3 sclera thick. There were 56 cases (67 eyes) in standard group. All of the eyes' had received complex trabeculectomy with 2 adjustable sutures and a scleral flap of 5×4×4 mm and 1/2～1/3 sclera thick The incidence rates of shallow anterior chamber and the intraocular pressures 3 months after operation were analyzed retrospectively. Results Shallow anterior chamber: There were 5 cases (5 eyes)occurrence in modified group (3leyes) with incidence rate of 16.1%. Among them 3 were the grade I and 2 were grade II. There were 5 cases (5 eyes) occurrence in standard group (67 eyes) with incidence rate of 7.5%. Among them 2 were the grade 1, 2 were grade Ⅱ and Ⅰ was grade Ⅲ. An alyzed by chi square test, the difference of.the incidence rates of the two groups was no signiificant statisticaUy (X2=1.74, P＞0.1). Intraocular pressures 3 months post-operation: The range of the pressure was 8.1 to 16.5 mmHg with the average of 12.5± 1.9 mmHg in modified group. The other range of the pressure was 8.9 to 24.8 mmHg with the average of 16.4± 3.6 mmHg in standard group. Analyzed by t test, the difference of the averages of the two groups was statistically significant (t=2.36, P ＜0.05). Conclusions Compared with the standard complex trabeculectomy which is common used by eye doctors at present the modified complex trabeculectomy is more effective for glaucoma to get the intraocular pressure at lower level after operation and the incidence of shallow anterior chamber is low.     

高眼压下青光眼滤过手术的临床观察

目的 探讨高眼压下青光眼小梁切除术的疗效。方法 对32例（36眼）应用药物治疗不能控制眼压的青光眼患者，采取术中先缓慢降压的方法，进行青光眼小梁切除术。结果 术后矫正视力无光感1眼，光感－数指5眼，0.02-0.05者11眼，≥0.3者19眼。术后眼压≤16mmHg者24眼，17－22mmHg者9眼，23－30mmHg者3眼。结论 对于药物不能有效控制眼压的青光眼患者，在高眼压下采取必要措施，进行小梁切除术是可行的。     

青光眼滤过手术后高眼压的临床分析

目的：探讨青光眼患者行小梁切术后发生高眼压(>21mmHg)的常见原因及处理方法。
　　方法：回顾性研究我院2010-07/2014-09青光眼患者行小梁切除术后出现高眼压的病例24眼,分析其常见原因、处理方法。
　　结果：导致术后早期高眼压的因素有：发生滤过泡瘢痕11眼(46%)、滤过内口阻塞4眼(17%)、恶性青光眼3眼(12%)、虹膜切除不合理2眼(8%)、前房积血2眼(8%)、包裹性囊状滤过泡2眼(8%)。经对症治疗后,患者眼压均控制在21 mmHg以下。
　　结论：青光眼行小梁切除术后高眼压是由多因素造成的,术前、术中尽量避免,术后及早发现给予对症处理是手术成功的关键。     

高眼压状态下青光眼小梁切除术的临床分析

目的：探讨青光眼高眼压状态下小梁切除术的安全性和有效性。

方法：对25例26眼充分降眼压后眼压仍不正常的青光眼患者, 前房穿刺放出房水后行复合小梁切除术,观察疗效及术后并发症。

结果：所有手术均顺利完成, 未出现暴发性脉络膜出血、玻璃体脱出等严重并发症,术后眼压控制≤21mmHg,术后视力提高25眼,总有效率96.2%。

结论：小梁切除术治疗青光眼安全、简便、可靠。对药物不能控制的持续性高眼压状态下的青光眼,放出房水后再行复合小梁切除术仍是最有效的理想术式。     

Effects of trabeculectomy on posture-induced intraocular pressure changes over time

Introduction

To determine whether trabeculectomy affects postural-induced changes in intraocular pressure (IOP), and whether it is maintained.

Methods

Thirty-six eyes of 36 patients with open-angle glaucoma who were scheduled for their initial trabeculectomy with adjunctive mitomycin C were prospectively examined. The IOP was measured in the sitting and the lateral decubitus position with an ICare rebound tonometer before, and 1, 3, and 12?months after trabeculectomy.

Results

Twenty-nine eyes of 29 patients completed this study. The mean baseline IOP measured with the ICare tonometer was 17.4?±?4.9?mmHg in the sitting position and 21.3?±?5.6?mmHg in the lateral decubitus position (p?p?p?=?0.004 respectively). This decrease in the degree of posture-dependent IOP change was maintained at +1.7?±?2.2?mmHg at 1 year postoperatively (p?Conclusions Our results indicate that trabeculectomy not only reduces the IOP but also reduces the degree of posture-induced changes in the IOP. Our findings also speculate that measuring the postural IOP changes after trabeculectomy might provide a clue on the functioning of a filtering bleb.     

Long-term effect of cataract surgery on intraocular pressure after trabeculectomy: extracapsular extraction versus phacoemulsification

PURPOSE: To compare the effect of phacoemulsification with intraocular lens (IOL) implantation on long-term intraocular pressure (IOP) control in glaucoma patients who had previous trabeculectomy with the effect on IOP control in similar patients after extracapsular cataract extraction (ECCE) with IOL implantation. SETTING: Oxford Eye Hospital, Oxford, England. METHODS: Twenty-eight consecutive patients who had phacoemulsification with IOL implantation (phaco group) at least 3 months after trabeculectomy were identified from hospital records, and 28 patients who had ECCE with IOL implantation (ECCE group) were matched retrospectively to the phaco group with respect to age, sex, diagnosis, and IOP. In both groups, the IOP before cataract extraction was compared with the IOP at intervals up to 2 years after cataract extraction. A Kaplan-Meier survival analysis was performed. RESULTS: The mean IOP in the phaco group did not differ significantly from the mean IOP before cataract extraction at any interval. Twelve months after cataract extraction, the mean IOP in the ECCE group was significantly higher than preoperatively (P =.01); however, the mean IOP did not differ between groups over time (P =.704). There was significantly better long-term IOP control in the phaco group as determined by Kaplan-Meier survival analysis and the log-rank test (P =.038). CONCLUSION: After trabeculectomy, phacoemulsification provided better long-term IOP control than ECCE; however, the mean IOP was not significantly lower.     

Raised intraocular pressure with topical steroids after trabeculectomy

A prospective study of 87 eyes of 52 patients with primary open-angle glaucoma showed a significant steroid-induced rise in intraocular pressure in the 4 weeks after trabeculectomy in 23% of eyes. The steroid response rate was lower (17%) in those eyes that had trabeculectomy without a prior trial of medical therapy than in those who had surgery only after failure of medical therapy (36%), but this difference just failed to reach statistical significance. The responders were not significantly different from the non-responders as regards level of intraocular pressure or severity of visual field loss at diagnosis. The frequency of response was lower than that expected in the normal and in the glaucoma population and fell further in the late post-operative period when only 3 of 8 previously responsive eyes submitted to re-challenge with topical steroids showed persisting responsiveness. Topical steroids may be the commonest cause of high intraocular pressure in the first weeks or even days after trabeculectomy. Decisions about long-term supplementary medical therapy should therfore only be taken several weeks after withdrawal of the post-operative steroid drops.     

Medium to long term intraocular pressure control following small flap trabeculectomy (microtrabeculectomy) in relatively low risk eyes

AIM—To determine the long term efficacy of small flap trabeculectomy (microtrabeculectomy) in terms of intraocular pressure (IOP) control in relatively low risk eyes.METHOD—A review of a case series of small flap trabeculectomy procedures performed on 36 eyes from 36 patients with a minimum follow up of 24 months (mean 50.8).RESULTS—The mean (SD) intraocular pressures at presentation and preoperatively were 33.7 (7.5) and 24.6 (4.5) mm Hg. At 6 months, 1, 2, 3, 4, 5, and 6 years the mean (n, SD) IOPs (mm Hg) of those eyes followed to each time point were 11.9 (36, 4.6), 12.6 (36, 4.7), 13.2 (36, 4.6), 13.7 (29, 4.1), 13.2 (22, 4.0), 12.7 (15, 4.8), and 12.3 (8, 4.7) respectively. There was no significant difference in IOP levels at any of the analysis points by one way ANOVA. Kaplan-Meier analysis revealed survival rates of 80% at 4 years and 75% at 5 years when any postoperative IOP >20 mm Hg is considered a failure, and 50% at 6 years when any IOP >15 mm Hg is classed as a failure.CONCLUSION—Small flap trabeculectomy (microtrabeculectomy) is effective at reducing IOP in low risk glaucoma eyes with IOP control similar to previous reports of filtering surgery utilising larger scleral trapdoors.