Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Purpose

We conducted a retrospective study to evaluate the intraocular pressure (IOP) lowering effect, the success rates, and the risk of bleeding events of patients receiving an iStent inject combined with phacoemulsification under anticoagulation therapy compared with a matched control group.

Methods

In this retrospective study, sixty-four eyes underwent an iStent inject implantation combined with phacoemulsification at two centers. Thirty-two eyes received surgery while under anticoagulation therapy, and another thirty-two eyes served as a control group matched for visual acuity, IOP, and medication score. Success was defined as criteria A and B (IOP < 18/21 mmHg, > 20% IOP reduction, no resurgery) and criteria C (IOP ≤ 15 mmHg, IOP reduction ≥ 40%, no resurgery). The clinical goal of the study was to determine the difference between the study and control groups with respect to IOP, medication score, and the frequency of intraoperative and postoperative bleeding events.

Results

After a mean follow-up time of 1 year, the IOP lowered 28% from 20.1 ± 4.8 to 14.5 ± 3.7 mmHg in the group of 64 eyes. The medication score lowered 38% from 2.1 ± 1.1 to 1.3 ± 1.2. The two groups with and without anticoagulant agents did not significantly differ in postoperative IOP, medication score, success rates, or number of bleeding events.

Conclusion

We conclude that in cataract surgery combined with the iStent inject a discontinuation of anticoagulant agents might not be necessary. It might be a good option in glaucoma surgery when anticoagulation treatment should not be interrupted and the target pressure is not very low.

     

iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma

Purpose:To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification.Methods:This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure.Results:One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan–Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure.Conclusion:Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.     

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Background

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)-lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG).

Methods

This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either ‘success’ or ‘failure’ based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C).

Results

The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C.

Conclusions

In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.     

白内障超声乳化术后感染性眼内炎的治疗体会

目的 探讨白内障超声乳化术后感染性眼内炎的治疗方法。方法 对1996年6月-2001年10月，白内障超声乳化术后感染性眼内炎6例的临床表现，治疗情况，及发生原因进行分析。结果 保守疗法1例。最终眼球摘除，玻璃体切除手术治疗5例。炎症治愈。结论 感染性眼内炎预后主要与实施玻璃体切除术的时间有关。主张及早手术。     

青光眼术后晶状体超声乳化人工晶状体植入术

目的 探讨抗青光眼术后晶状体超声乳化摘出和人口晶状体植入术的技巧并评价其疗效。方法 对25例（28眼）青光眼术后发生白内障者施行晶状体超声乳化或合并小梁切除术。手术切口根据结膜滤过泡及眼压的情况选择巩膜隧道及透明角膜缘2种，随访3～12月。结果 术后视力明显提高，67．86％术后矫正视力达0．3～0．8，所有患者眼压控制在正常范围。结论 晶状体超声乳化吸出合并人工晶状体植入术是治疗青光跟术后白内障的有效方法，同时强调保护角膜内皮对减少术后并发症的重要性。     

白内障超声乳化联合人工晶状体植入术后泪膜功能变化

目的 探讨白内障超声乳化联合人工晶状体植入术对泪膜功能的影响.方法 随机抽取2007年1月至2008年1月行白内障超声乳化联合人工晶状体植入术的患者75例(75眼),术前、术后1 d、1周、2周及1个月行干眼症状评分、角膜荧光素染色、泪膜破裂时间(breaking-up time,BUT)和基础泪液分泌实验(Schier-met test,STT)检查.利用统计学软件SPSS 16.0进行数据分析.结果 与术前相比,术后1 d、1周及2周的BUT明显缩短,干眼症状评分及角膜荧光素染色等级明显增高,差异有统计学意义(P<0.05),而SIT仅在术后1 d差异有统计学意义.术后1个月上述指标恢复至术前水平,与术前比较差异无统计学意义(P>0.05).结论 白内障超声乳化联合人工晶状体植入术后短期内影响患者的泪膜功能,1个月后基本恢复正常.     

小梁切除术后白内障超声乳化手术分析

目的:探讨分析抗青光眼小梁切除术后白内障超声乳化摘除联合人工晶状体植入术的手术方法、技巧及效果分析。方法:我院2007-01/2010-12对87例87眼抗青光眼小梁切除术后发生白内障的病例行白内障超声乳化摘除联合人工晶状体植入术,随访6mo,分析术后视力、眼压、并发症等情况。结果:术后随访6mo,87眼术后视力均有不同程度的提高,其中78眼（90％）视力≥0.3;术后眼压均较术前下降;术后并发症主要有角膜水肿（15眼,17％）、虹膜反应（11眼,13％）、前房出血（5眼,6％）、后囊膜混浊（10眼,11％）。结论:对抗青光眼小梁切除术后出现的白内障,行透明角膜切口的白内障超声乳化摘除联合人工晶状体植入术可显著提高视力,保持滤过泡和眼压的稳定,恢复眼前节的组织结构。     

白内障超声乳化联合人工晶状体植入术后眼高阶像差的多因素研究

目的 观察白内障超声乳化并人工晶状体植入术后眼高阶像差与人工晶状体各参数的关系,探讨改善白内障术后眼高阶像差的途径.方法 采用Zywave波前像差仪,检测白内障超声乳化并人工晶状体植入术后129例(129眼)患者的术眼总高阶像差、球差、彗差等各高阶像差的均方根值,常规检查裸眼视力、最佳矫正视力、人工晶状体位置、前后囊混浊情况、眼压、眼底,并记录术眼的人工晶状体类型、人工晶状体度数、眼轴长度、瞳孔直径、白内障分级、泪膜破裂时间等影响波前像差的多种临床因素资料,进行多元逐步回归分析.结果 术后3个月,平均裸眼视力(LogMAR视力)为0.29±0.09,最佳矫正视力(LogMAR视力)为0.02±0.06.所有患者的术眼除Z310、Z420、Z530外,其余高阶像差与多种临床因素存在线性回归关系(均为P<0.05).其中,人工晶状体类型是术后眼高阶像差的主要影响因素,白内障分级与眼轴长度等对其也有一定影响.总高阶像差的回归方程中,眼轴长度与人工晶状体类型的标准化线性回归系数分别为0.25和-0.38,后者对总高阶像差的影响较大.结论 白内障超声乳化并人工晶状体植入术后患眼高阶像差受多种临床因素影响,非球面人工晶状体可以降低术眼高阶像差.     

玻璃体切割术后超声乳化联合人工晶状体植入术的屈光误差分析

目的：探讨玻璃体切割术后白内障患者Ⅱ期行白内障超声乳化抽吸联合人工晶状体(IOL)植入的屈光误差。

方法：回顾性分析。选取既往行玻璃体切割术现发生白内障需行手术治疗的患者38例40眼。按既往玻璃体腔填充物分为2组,A组(22眼)为既往单纯行玻璃体切割组,B组(18眼)为既往行玻璃体切割联合惰性气体(C₃F₈)填充组。另设置无玻璃体切割手术史现需行白内障超声乳化抽吸手术的正常对照组C组(20眼)。术前应用IOL Master 500测量眼轴长度(AL)、角膜曲率(K)、前房深度(ACD),角膜横径(W-W),带入Barrett Universal Ⅱ公式计算IOL屈光度。A组、B组采用虹膜拉钩辅助的超声乳化抽吸联合IOL植入术,C组为单纯超声乳化抽吸联合IOL植入术。术中均无后囊膜破裂等并发症。术后3mo验光获得实测屈光度。比较3组的预测误差、绝对预测误差、绝对误差中位数。

结果：三组间AL、K、植入IOL屈光度数均无差异(P>0.05)。A组、B组ACD均较C组显著加深(P<0.01)。三组间预测误差有差异(P=0.042),B组较C组有显著的远视漂移。绝对预测误差、绝对误差中位数在组间无差异。

结论：单纯玻璃体切割术后Ⅱ期白内障超声乳化联合IOL植入,与正常对照组相比,术后屈光结果无显著差异; 但在玻璃体切割联合惰性气体填充术后患者,Ⅱ期白内障超声乳化抽吸术后会产生远视漂移,在选择IOL时应避免欠矫,适当过矫。     

白内障超声乳化联合人工晶状体植入术后并发眼前节毒性反应综合征

目的 通过评估对23例(23眼)眼前节毒性反应综合征(toxic anterior segment syndrome,TASS)患者的治疗经过,寻找TASS的患者的治疗方法并观察其预后.方法 根据患者临床表现诊断为TASS患者23例(23眼),通过前房水穿刺及玻璃体穿刺培养的方法排除细菌感染性眼内炎,全身及眼局部应用抗菌素和糖皮质激素治疗,部分患者同时使用10 g·L-1阿托品眼膏和5 g·L-1噻吗洛尔眼液.持续观察20 d,随访18个月.结果 23例TASS患者进行前房水穿刺及玻璃体穿刺培养均未见细菌生长.发生TASS第3-5天,5眼前段玻璃体点状混浊,余未见异常,应用抗菌素和激素类药物治疗15 d后炎症稳定,20 d视力恢复到0.64±0.21,眼压为(15.9±2.3)mmHg(1 kPa=7.5 mmHg),与发病前视力0.62±0.14、眼压(14.2±3.1)mmHg相比,差异均无统计学意义(P均>0.05),随访18个月所有患者均未见眼部异常表现.结论 TASS是眼前段手术的一个少见的并发症,正确分析、判断及积极有效的治疗预后良好.     

超声乳化联合IOL植入术后角膜水肿的原因及处理

目的:探讨白内障超声乳化联合人工晶状体(IOL)植入术后角膜发生水肿的原因分析及其预防和处理方法。方法:选取2009-01-01/2011-12-01在我院进行的白内障超声乳化联合IOL植入手术的患者160例190眼为研究对象,对患者的临床基本资料以及手术治疗情况进行总结分析,探讨其发生角膜水肿的原因,并提出针对性的预防及处理方案。结果:患者190眼中,共有67眼出现术后角膜水肿,其中年龄相关性白内障术后发生的角膜水肿为25眼(13.2%);Ⅰ～Ⅱ级核发生的角膜水肿为6眼(3.2%);Ⅲ～Ⅴ级核发生的角膜水肿为56眼(29.5%)。结论:对于白内障超声乳化联合IOL植入术后发生角膜水肿的原因,主要和手术医生的操作熟练程度及手术技巧有关,要采取积极的预防措施,在手术中严格操作,注意细节,从根本上控制角膜水肿的发生原因,以减少患者的痛苦,提高手术成功率。     

白内障超声乳化吸出联合人工晶状体植入术后角膜曲率与散光的变化

目的　超声乳化白内障吸出联合人工晶状体植入术与可植入式角膜接触镜（implantable collamer lens,ICL）植入术后角膜曲率及散光的变化,并进行比较,为屈光性白内障手术视觉质量的提高提供理论指导。方法　收集我院行超声乳化白内障吸出联合人工晶状体植入术的患者34例（52眼）为A组,同期行ICL植入术的患者26例（52眼）为B组,两组患者手术前后使用Pentacam眼前节分析系统检测角膜前后表面曲率、角膜散光。比较两组患者术前和术后3个月的角膜前表面曲率、角膜后表面曲率、角膜前表面散光、角膜后表面散光及角膜总屈光力与总散光,比较两组患者手术前后各数值变化值的差异。结果　A组患者手术前后角膜前表面曲率及散光差异均无统计学意义（P=0.734、0.427）,角膜后表面曲率、角膜后表面散光差异均有统计学意义（P=0.022、0.000）。B组患者手术前后角膜前表面曲率及前表面散光差异均无统计学意义（P=0.475、0.446）,角膜后表面曲率及后表面散光差异均有统计学意义（P<0.001,P=0.016）。A组与B组患者手术前后角膜前表面曲率差值、角膜前表面散光差值差异均无统计学意义（P=0.534、0.841）。A组患者手术前后角膜后表面曲率差值、角膜后表面散光差值均大于B组,差异均有统计学意义（P=0.001、0.022）。A组与B组手术前后角膜总散光差异有统计学意义（P<0.05）。结论　白内障超声乳化术与ICL植入术对角膜前表面曲率及前表面散光的影响较小,但是对角膜后表面曲率及后表面散光的影响较大,且白内障超声乳化术较ICL植入术对角膜后表面曲率及后表面散光的影响更大。     

Intraocular pressure changes after vitrectomy with and without combined phacoemulsification and intraocular lens implantation

Purpose

To determine sequential intraocular pressure (IOP) changes after pars plana vitrectomy (PPV) with or without combined phacoemulsification and intraocular lens implantation (PE & IOL).

Methods

Consecutive patients who underwent PPV with PE & IOL (combined group) or without PE & IOL (vitrectomy group) were reviewed for postoperative sequential IOPs and the number of IOP lowering medications used. Of the 68 patients (68 eyes) who underwent simple PPV, 41 eyes were allocated to the vitrectomy group, and 27 eyes to the combined group.

Results

The mean IOPs were higher on postoperative days one and two, as compared to preoperative values, in both groups. The mean IOP changes on postoperative day one (10.0 mmHg vs. 5.3 mmHg, p = 0.02) and day two (3.7 mmHg vs. 1.3 mmHg, p = 0.02) were significantly higher in the combined group.

Conclusions

Phacovitrectomy is associated with a higher risk of IOP elevation during the early postoperative period than PPV alone. Caution should be exercised in patients who are vulnerable to IOP fluctuations when combined surgery is indicated.     

白内障超声乳化及人工晶状体植入联合小梁切除术临床观察

目的 评价白内障超声乳化及折叠式人工晶状体植入联合小梁切除术的疗效。方法 对１６例９１８眼）青光眼合并白内障施行白内障旋转切削亏声乳化摘出及折叠式人工晶状体植 梁切除术。结果 １６例术后３月眼压均控制（７２．２％）。结论 该术式具有视力恢复较好,降眼压效果确实,并发症少的优点。     

白内障超声乳化联合人工晶状体植入术对眼表的影响

目的:观察白内障超声乳化联合人工晶状体植入手术后眼表情况的变化。方法:收集2011-08/2012-10间我院眼科收治的老年性白内障患者78例78眼,经颞侧透明角膜切口行白内障超声乳化联合人工晶状体植入术。分别于术前、术后1d;1wk;1,3,6mo观察眼表情况,记录眼表刺激症状、角膜荧光素染色、泪膜破裂时间、泪液分泌实验(SchirmerⅠtest,SⅠt),并对数据进行统计分析。结果:术后1wk内,患者有明显的干眼症状,术后1d;1wk;1mo,角膜荧光素着色较术前明显增多,而泪液分泌量明显减少,差异具有统计学意义(P<0.05),术后3,6mo与术前无明显差异(P>0.05)。术后1mo内泪膜破裂时间较术前明显缩短(P<0.05),3mo时降至术前水平(P>0.05)并保持至术后6mo。结论:白内障超声乳化联合人工晶状体植入手术对眼表具有一定程度的影响,临床应积极采取措施进行预防和治疗。     

Iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens implantation for proliferative diabetic retinopathy

PURPOSE: To analyze the incidence of iris neovascularization after vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation using a small incision in the treatment of proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: We studied a consecutive series of 46 eyes in which vitrectomy combined with phacoemulsification and IOL implantation had been performed, and compared the surgical results with a prior series of 40 eyes in which vitrectomy alone had been performed. RESULTS: Postoperative iris and angle neovascularization was found in 6 eyes (15%) treated by vitrectomy alone, but in only 1 eye (2%) treated by combined vitrectomy (P<0.05). Final visual acuity improved by two or more lines in 23 eyes (57%) in the vitrectomy alone group, and in 35 eyes (76%) in the combined vitrectomy group. CONCLUSIONS: The incidence of postoperative rubeosis iridis was significantly lower, and the visual results were satisfactory with vitrectomy combined with phacoemulsification and IOL implantation for PDR. These findings suggest that combined vitrectomy for PDR is a useful surgical procedure.