Surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma.

BACKGROUND AND OBJECTIVE: To evaluate the surgical results and complications of mitomycin C-augmented trabeculectomy in refractory developmental glaucoma. PATIENTS AND METHODS: The authors reviewed the charts of all patients of refractory developmental glaucoma who underwent mitomycin C-augmented trabeculectomy (0.4 mg/ml for 3 minutes) between September 1990 and August 1995. Thirty-eight eyes of 29 patients were included in the study; 34 eyes (89.5%) had refractory primary congenital glaucoma with documented failure of primary surgery, 2 eyes (5.3%) had Axenfeld-Rieger syndrome and 2 eyes (5.3%) had aniridia. The main outcome measures in this study were preoperative and postoperative intraocular pressures (IOPs),visual acuities, bleb characteristics, success rate, time of surgical failure, and complications. RESULTS: The IOP (mean +/- SD) reduced from a preoperative level of 32.6 +/- 11.8 mm Hg to 12.3 +/- 7.3 mm Hg (P <0.0001) with the percentage reduction in IOP being 56%. Kaplan-Meier survival analysis showed that the success probability at 18 months was 65%, which was maintained till 30 months of follow-up. The bleb was characterized by its large, elevated, avascular, transparent appearance in all the eyes. There were no intraoperative complications. The postoperative complications included hyphema (absorbed one week) in 8 eyes (21%), uncontrolled IOP in 8 eyes (21%), shallow anterior chamber in 3 eyes (7.9%), hypotony without visual loss in one eye (2.6%) and retinal detachment in 2 eyes (5.2%) which was surgically repaired successfully. Visual acuity was maintained in all cases after surgery. None of the patients developed mitomycin-C related late bleb-leakage or endophthalmitis. CONCLUSION: Treatment of refractory developmental glaucoma with mitomycin C-augmented trabeculectomy is effective and safe with an acceptable rate of complications.     

小切口白内障摘除联合小梁切除术治疗PACG合并白内障

目的：观察小切口白内障摘除人工晶状体植入联合小梁切除术治疗原发性闭角型青光眼(primary angle-closure glaucoma,PACG)合并白内障的疗效。

方法：选取44例52眼PACG合并白内障病例,均采用小切口白内障摘除人工晶状体植入联合小梁切除术,观察患者手术前后的视力、眼压及术后并发症情况。

结果：术后与术前相比,术后视力显著改善,眼压明显降低,结果具有统计学意义(P<0.05)。52眼手术均由同一术者完成,手术过程顺利,术后出现前房炎症细胞反应6眼,前房纤维素样渗出物3眼,经过散瞳、糖皮质激素及非甾体类眼药水滴眼治疗后吸收,浅前房2眼,经散瞳、加压包扎后恢复,未出现恶性青光眼、睫状体脱离等并发症。

结论：小切口白内障摘除人工晶状体植入联合小梁切除术治疗PACG合并白内障可靠性高,治疗效果好,手术方法简单易学,适合在基层推广应用。     

Comparison of trabeculectomy with mitomycin C with or without phacoemulsification and lens implantation

PURPOSE: To compare the results of combined trabeculectomy with phacoemulsification and posterior chamber intraocular lens (IOL) implantation to those of trabeculectomy alone using mitomycin C (MMC) application intraoperatively in all cases. PATIENTS AND METHODS: A retrospective comparative study of consecutive patients was conducted on two groups: 102 eyes of 90 patients studied in the combined procedure group, and 33 eyes of 30 patients in the trabeculectomy alone group. RESULTS: Both groups showed a significant decrease in IOP. The combined group had a change from 21.5+/-5.8 mm HG preoperative to 14.73+/-3.44 mm HG postoperative, P=0.0001; the trabeculectomy group changed from 24.2+/-7.5 mm HG preoperative to 12.46+/-3.86 mm HG postoperative, P=0.0001. This represents a 31.5% reduction in IOP in the combined group versus a 48.5% reduction in the trabeculectomy alone group (P=0.0001). The follow-up time was longer in the trabeculectomy group (trabeculectomy group, 22.6+/-13.3 months; combined group, 14.2+/-8.0 months), P=0.0014. There were 97 eyes in the combined group (95%) and 32 eyes (97%) in the trabeculectomy group that had an IOP of less than 20 mm HG at the end of follow up. Postoperatively, the two groups showed similar significant reductions in the number of antiglaucomatous medications used (combined group, 0.82+/-1.0 compared with 2.65+/-0.84 preoperatively, P=0.0001; trabeculectomy group, 0.76+/-1.2 compared with 2.7+/-0.95 preoperatively, P=0.0001). There were no cases of bleb leakage in the combined group and two cases (6%) in the trabeculectomy group. CONCLUSION: The reduction of IOP is significantly larger after trabeculectomy alone than after the combined procedure; however, the functional and anatomical results of the combined procedure of phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with MMC application were as good as those of trabeculectomy alone with MMC.     

白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障

目的：观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。

方法：急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。

结果：术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05); 慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6～21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22～30mmHg)2眼(6%); 术后视力提高者32眼(89%),没有发生严重并发症。

结论：白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少; 其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。     

The outcome of initial mitomycin C-augmented trabeculectomy with subconjunctival bevacizumab in the management of secondary glaucoma associated with Fuchs heterochromic iridocyclitis

International Ophthalmology - To investigate the outcome of mitomycin C (MMC)-augmented trabeculectomy with subconjunctival bevacizumab in the management of Fuchs heterochromic iridocyclitis...     

Comparison between results of trabeculectomy in primary congenital glaucoma with and without the use of mitomycin C

PURPOSE: To evaluate the results of trabeculectomy with and without the use of mitomycin C in children with primary congenital glaucoma. METHODS: The authors retrospectively studied the data of 91 patients who underwent the first trabeculectomy for primary congenital glaucoma, with 19 years of follow-up. Success criteria were set with two distinct values of intraocular pressure: lower or equal to 15 mm Hg or lower than 21 mm Hg and separately analyzed. RESULTS: Among the studied patients, 61 had undergone trabeculectomy without mitomycin C and 30 with mitomycin C. The comparison between the groups of patients showed age homogeneity (P = 0.152) and did not demonstrate any difference in preoperative (P = 0.234) and postoperative (P = 0.907) intraocular pressure. Success rates through time, for both pressure limits was not different between the groups. Both age and the presence of previous trabeculotomy did not influence the success of trabeculectomy through time, for the two pressure limits considered. The complication rate was higher among the patients who received mitomycin C (P = 0.010). CONCLUSIONS: The success of trabeculectomy for primary congenital glaucoma with mitomycin C was not different than that of trabeculectomy with mitomycin C in the studied patients. Mitomycin C was associated with a higher incidence of complications.     

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.     

Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma

We reviewed 75 consecutive cases of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in 69 patients with glaucoma. The mean preoperative intraocular pressure was 19.3 mm Hg on an average of 2.3 glaucoma medications. Visual acuity improved in 58 eyes (77%) at two months, with an average improvement of 3.3 and 3.6 lines at two and 12 months, respectively. Of the 75 eyes, 49 (65%) achieved a visual acuity of 20/40 or better; three patients (4%) had further deterioration in vision at the completion of follow-up because of progressive glaucoma or macular disease. Postoperatively, the average intraocular pressure was 3.8 and 3.0 mm Hg lower than the preoperative level at two and 12 months (P less than .001) on 0.63 and 0.79 glaucoma medications, respectively. However, 27 (36%) of the 75 eyes had a recorded intraocular pressure greater than 30 mm Hg and 30 (40%) had a pressure 7 mm Hg or more above their preoperative level during the first six months after surgery. Despite improved long-term control of intraocular pressure, detectable conjunctival filtering blebs were present in only 31 (41%) of 75 eyes at two months and in seven (12%) of 56 eyes at 12 months. Hyphema occurred in 34 (45%) of the cases.     

白内障超声乳化吸除联合小梁切除术与白内障囊外摘除联合小梁切除术的疗效分析

目的 观察白内障超声乳化吸除联合小梁切除术治疗青光眼合并白内障的临床疗效。方法 回顾分析患青光眼白内障在我院行超声乳化白内障吸除人工晶体植入联合小梁切除术的患者82例（82眼）和行白内障囊外摘除人工晶体植入联合小梁切除术的患者52例（54眼），记录手术前、后的视力和眼压，记录手术并发症和滤过泡情况。术后随访至少3个月。结果 两组术后1周和3个月矫正视力较术前明显提高，眼压较术前明显降低（P均〈0．05）。两组间术后视力和眼压比较，差异无显著性（P〉0．05）。术后3个月随访，眼压≥21mmHg者，超乳三联术组2眼，囊外三联术组4眼，两组比较差异无显著性（P〉0．05）。手术并发症超乳三联术组明显低于囊外三联术组，差异有非常显著性（P〈0．01）。两组术后均无严重并发症发生。结论 超声乳化白内障吸除人工晶体植入联合小梁切除术，可安全有效治疗青光眼合并白内障，且效果优于白内障囊外摘除人工晶体植入联合小梁切除术。     

MMC在青光眼小梁切除联合白内障囊外摘除术中的应用效果

目的:探讨丝裂霉素C(MMC)在青光眼小梁切除联合白内障囊外摘除人工晶状体植入术中的应用效果。方法:选择32例合并有青光眼的硬核白内障患者,随机分为MMC组及对照组,行小梁切除联合白内障囊外摘除人工晶状体植入术。其中MMC组术中使用0.2g/LMMC3min。比较两组在术后12mo内的并发症、手术效果及术后视力。结果:术后两组发生浅前房的几率无显著性差异。术后12mo时MMC组的功能性滤过泡为对照组的2倍,且有显著性差异。术后12mo,MMC组手术失败显著少于对照组,两组最佳矫正视力无显著性差异,且需行Nd:YAG后囊膜激光截开术的患者比例也无显著性差异。两组在随访期均未发生滤过泡渗漏、恶性青光眼以及眼内炎等并发症。结论:MMC可在一定程度上增加青光眼滤过联合白内障囊外摘除人工晶状体植入三联手术的成功率,且没有增加并发症的发生率。     

超声乳化联合小梁切除治疗白内障合并青光眼

目的　探讨超声乳化联合小梁切除治疗白内障合并青光眼的方法。方法　白内障合并闭角型青光眼15例 (15只眼 ) ,经巩膜隧道切口进行白内障超声乳化及人工晶状体植入 ,然后垂直剪开切口一侧 ,使之呈三角形巩膜瓣 ,在同一切口进行小梁切除及周边虹膜切除。结果　手术后随访 3～ 6月 ,矫正视力≥ 0 .5者 9例 ,6例视力较差的主要原因为青光眼性视神经萎缩。平均眼压 (14.2 1± 2 .74) mm Hg,14例为 、 型功能滤泡。结论　在同一切口施行白内障超声乳化、人工晶状体植入联合小梁切除治疗白内障合并闭角型青光眼 ,方法简单、安全、有效。     

丝裂霉素C在慢性闭角型青光眼合并白内障手术中的价值

目的:探讨丝裂霉素C(MMC)在慢性闭角型青光眼患者行青光眼白内障联合手术中的价值,为青光眼合并白内障的临床治疗提供参考。方法:将40例慢性闭角型青光眼合并白内障患者随机分为观察组(使用MMC组)和对照组(未使用MMC组),均行晶状体超声乳化联合小梁切除术治疗,比较治疗效果。结果:观察组治疗后患者远视力(矫正)、周围前房深度、眼压及降眼压药物使用数量与种类均优于对照组,且与对照组比较,均P<0.05,具有统计学差异。观察组功能性滤过泡的比例与对照组比较,两组差异无统计学意义(P>0.05)。两组治疗主要并发症为术后浅前房,其中,观察组1例(5%),对照组2例(10%),两组比较差异无统计学意义(P>0.05)。结论:MMC能改善慢性闭角型青光眼患者行青光眼白内障联合手术后的眼压、视力,建议推广使用。     

小切口隧道内小梁切除术治疗白内障合并青光眼的疗效

目的：分析小切口隧道内小梁切除术在白内障合并青光眼手术中的应用价值及疗效。
　　方法：选取2013-05/2015-05在本院行手术治疗的青光眼合并白内障患者82例90眼,均行小切口隧道内小梁切除术治疗,比较患者手术前后不同时间点的眼压和屈光度的差异;分析患者术后视力改善情况以及总结手术的并发症发生情况。
　　结果：术后1、7d,1、6mo 时的眼压分别为19.38±3.63、12.96±2.84、11.37±1.05、11.89±0.82mmHg均低于术前眼压32.65±6.42mmHg,差异具有统计学意义(P<0.05);术后患者垂直方向角膜屈光度先上升后下降,且各时间点均高于术前,差异具有统计学意义(P<0.05);术后患者水平方向角膜屈光度先下降后上升,除术后1 mo外术后各时间点的水平方向角膜屈光度与术前的差异均具有统计学意义(P<0.05);患者术后6mo 时视力≤0.1者5眼(6%),>0.1~0.5者48眼(53%),0.6~0.9者29眼(32%),≥1.0者8眼(9%),与术前比较明显提高,差异具有统计学意义(P<0.05)。术后前房积血3眼,角膜水肿5眼,前房纤维样渗出3眼,经对症处理后均在7d内恢复正常。
　　结论：小切口隧道内小梁切除术治疗白内障合并青光眼的疗效显著,安全性高。     

非穿透板层小梁切除术联合丝裂霉素C与改良小梁切除术治疗原发性开角型青光眼的疗效比较

目的比较非穿透板层小梁切除术(nonpenetrating lamellar trabeculectomy,NPT)联合丝裂霉素C(mitomycin C,MMC)与改良小梁切除术治疗原发性开角型青光眼(primary open angle glaucoma,POAG)的有效性和安全性。方法回顾性分析37例(57眼)POAG患者应用NPT联合MMC治疗与30例51眼POAG患者行改良小梁切除术治疗的效果。观察并比较2组患者术后眼压、视力、成功率、并发症等。结果 NPT联合MMC治疗后POAG患者与经改良小梁切除术治疗后眼压在术后早期和中期无明显差异;术后24个月,经NPT联合MMC治疗,良好眼压控制成功率大约为47%,而经改良小梁切除术治疗,良好眼压控制成功率接近70%,术后6个月、12个月、18个月,2组眼压控制成功率比较差异均无统计学意义(均为P>0.05)。2组术后1周视力比较,差异无统计学意义;术后24个月视力比较,NPT联合MMC治疗组优于改良小梁切除术治疗组(P<0.05)。改良小梁切除术治疗组术后浅前房(14眼,27.5%)和白内障(11眼,21.6%)的发展率高于NPT联合MMC治疗组。结论 NPT联合MMC治疗在早期和中期控制眼压方面与改良小梁切除术疗效相当,但改良小梁切除术长期良好眼压控制成功率较高。NPT联合MMC治疗术后并发症少于改良小梁切除术后。     

超乳联合房角分离或小梁切除对PACG合并白内障患者血流动力学的影响

目的：探究超声乳化白内障吸除联合房角分离术或小梁切除术对原发性闭角型青光眼(PACG)合并白内障患者血流动力学的影响。

方法：随机数字表格法将巴中市中心医院2015-01/2017-06收治的94例94眼PACG合并白内障患者分为超声乳化白内障吸除联合房角分离术(观察组)与超声乳化白内障吸除联合小梁切除术(对照组),每组47例,比较两组疗效指标。

结果：观察组术后1、3mo收缩期峰值流速(PSV)、舒张末期流速(EDV)均显著大于对照组,术后3mo阻力指数(RI)明显小于对照组以及前房深度、房角开放程度显著大于对照组(P<0.05)。

结论：房角分离或小梁切除联合超声乳化均能有效降低眼压,促进患者视力恢复,但房角分离术相对能更好地促进房角开放,改善血流动力学。     

Results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma.

BACKGROUND AND OBJECTIVE: To report the results of trabeculectomy with adjunctive intraoperative mitomycin C in Chinese patients with glaucoma. PATIENTS AND METHODS: The medical records of Chinese patients who received trabeculectomy with intraoperative mitomycin C from 1992 to 1998 were retrospectively reviewed. A "successful" trabeculectomy was defined as one after which the intraocular pressure (IOP) could be controlled to between 5 and 21 mm Hg, inclusive, with no more than 3 glaucoma medications. RESULTS: One hundred fourteen trabeculectomies in 105 eyes of 90 patients were retrospectively reviewed. Mean age +/- standard deviation was 48.1 +/- 21.9 years. Primary open-angle glaucoma (43.0%) and angle-closure glaucoma (27.2%) were the most common diagnoses leading to trabeculectomy. The mean follow-up +/- standard deviation was 29.6 +/- 18.6 months (range, 6 to 92 months). The overall success rate at the last follow-up was 73.7% (84 of 114 trabeculectomies). CONCLUSIONS: Trabeculectomy with mitomycin C is a safe and effective procedure for the control of IOP in Chinese patients with glaucoma.     

A comparison of heparin-coated and uncoated intraocular lenses in glaucoma patients undergoing combined cataract extraction and trabeculectomy and in diabetic patients undergoing cataract extraction

The postoperative course of cataract extraction and IOL implantation combined with trabeculectomy in glaucoma patients and of cataract extraction with intraocular lens (IOL) in diabetic patients is more complicated than that of cataract extraction with IOL implantation in otherwise healthy eyes. The main complications are fibrin in the anterior chamber, pigment dispersion, and posterior synechiae. In an attempt to determine whether heparin-coated lenses reduce the rate of these complications, a prospective study was conducted on 19 glaucomatous eyes of 19 patients who underwent a combined procedure of trabeculectomy and extracapsular cataract extraction with IOL and 20 eyes of 20 diabetic patients subjected to extracapsular cataract extraction with IOL. In each category of patients, the early postoperative course in those who received heparin-coated lenses and those who received regular polymethyl methacrylate (PMMA) lenses was compared with respect to the inflammatory reaction, assessed by the amounts of cells and flare, and complications in terms of fibrin, posterior synechiae and pigment dispersion. The results of this preliminary study indicate a slightly higher rate of early postoperative complications with the heparin-coated lenses as compared to PMMA lenses.     

青光眼滤过术联合应用丝裂霉素临床疗效观察

观察青光眼滤过术联合应用丝裂霉素临床疗效，对11例（13眼）青光眼施行青光眼滤过术联合应用丝裂霉素。结果术后随访1～6月，9例（11眼）眼后控制在正常，2例（2眼）术后眼压仍高于正常范围，无1例出现术后低眼压。结论青光眼滤过手术联合丝裂霉素可有效防止滤过泡瘢痕化，提高手术的成功率。作者就术后低眼压进行讨论，认为与手术中操作方法有密切关系。     

小梁切除术联合丝裂霉毒C治疗青光眼的临床疗效

目的:探讨小梁切除联合丝裂霉素C(mitomycin C,MMC)治疗青光眼的临床疗效。方法:原发性青光眼患者57例95眼随机分为两组,为小梁切除术联合MMC(T+MMC)组(31例54眼)和小梁切除术(T)组(26例41眼),术后随访4~6mo,观察其前房、滤过泡、眼压及并发症。结果:T+MMC组术后1d平均眼压为11.24±3.73mmH g,较术前眼压明显降低(P<0.01),与T组比较差异无统计学意义(P>0.05)。而末次随访平均眼压为16.15±3.62mmH g,与T组(18.79±5.27mmH g)比较具有统计学差异(P<0.05)。T+MMC组和T组功能性滤过泡形成率分别为94.44%和80.48%,组间差异具有显著统计学意义(P<0.01)。两组偶发前房出血、角膜水肿,均治愈。结论:采用小梁切除术联合MMC治疗青光眼,术后眼压控制及滤过泡形态维持均良好,并发症少。