松解性视网膜切开及切除联合硅油填充术治疗复杂性视网膜脱离

目的探讨一种行之有效的治疗复杂视网膜脱离的手术方法。方法增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａ－ｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ＰＶＲ）Ｄ３级患者１８例，行闭合式玻璃体切割，环扎，松解性视网膜切开及切除联合硅油填充术，个别病例同时行前节再造，人工晶体取出及穿透性角膜移植术。结果视网膜完全复位１３例（７２．２％）；视力较术前增加９例（５０．０％），矫正视力低于０．０２者６例（３３．３％），０．０２～０．０５者９例（５０．０％），高于０．０５者３例（１６．７％）；大于１８０°视网膜切开７例，视力在０．０５以上者２例（２８．６％），３６０°切开及切除３例，视网膜复位２例，视力均低于０．０２。结论松解性视网膜切开及切除联合硅油填充可以作为治疗复杂性视网膜脱离的一种手术方法。     

后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离

目的　探讨后巩膜加固术治疗硅油填充术后复发性超高度近视黄斑裂孔性视网膜脱离（ｍａｃｕｌａｒｈｏｌｅｒｅｔｉｎａｌｄｅｔａｃｈｍｅｎｔ,ＭＨＲＤ）的可行性及疗效。方法　选取２０１１年６月至２０１４年６月硅油填充术后的复发性超高度近视性ＭＨＲＤ患者３６例（３６眼）,所有患者均由同一术者行黄斑区改良后巩膜加固术,术后３个月取出硅油。术后随访１２个月,观察记录术后并发症、视网膜脱离复位情况、黄斑裂孔闭合情况、术后视力、眼轴长度等指标。结果　３６眼视网膜完全复位,视网膜复位率为１００％;末次随访ＳＤ-ＯＣＴ示２２眼黄斑裂孔完全闭合,占６１．１％,１１眼黄斑部分闭合,占３０．６％,３眼仍未闭合,占８．３％;３１眼术后最佳矫正视力（ｂｅｓｔｃｏｒｒｅｃｔｖｉｓｕａｌａｃｕｉｔｙ,ＢＣＶＡ）较术前提高,占８６．１％,５眼ＢＣＶＡ较术前无明显改变,占１３．９％;术前患者ＢＣＶＡ为（１．４８±０．９２）ｌｏｇＭＡＲ,术后ＢＣＶＡ为（０．９３±０．３８）ｌｏｇＭＡＲ,差异有统计学意义（Ｐ＜０．０５）;术前患者眼轴长度为（３０．９５±１．１６）ｍｍ,术后为（２８．４６±１．３４）ｍｍ,差异有统计学意义（Ｐ＜０．００１）。所有患眼均未发生眼底出血、眼内炎、涡静脉回流障碍、眼前部缺血综合征等并发症。结论　改良后巩膜加固术是治疗硅油填充术后复发性超高度近视ＭＨＲＤ安全有效的手术方法,能提高视网膜解剖复位率、黄斑裂孔闭合率、视力及减少并发症。     

复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因初步探讨

目的探讨复杂性孔源性视网膜脱离的玻璃体视网膜手术失败原因。方法对４７７例（４７９只眼）复杂性孔源性视网膜脱离采用玻璃体视网膜手术（ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ,ＶＲ术）,即玻璃体切除、膜剥离、气液交换、惰性气体（ＳＦ６,Ｃ３Ｆ８）及硅油眼内填充。结果近期有效者３４７例（３４９只眼,７２．９％）,失败者１３０例（１３０只眼,２７．１％）。结论多因素逐步回归分析显示影响ＶＲ术近期效果的显著因素为眼内填充硅油、巨大裂孔、眼内填充ＳＦ６、医源性裂孔、前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ,ＰＶＲ）、严重视网膜下增殖、ＰＶＲ、眼内填充Ｃ３Ｆ８、手术频次及脉络膜脱离     

晶体玻璃体视网膜联合手术治疗复杂性视网膜脱离

目的探讨玻璃体视网膜手术（ｖｉｔｒｅｒｅｔｉｎａｌｓｕｒｇｅｒｙ，ＶＲ术）联合晶体切除／超声粉碎的效果。方法对８１例（８１只眼）应用晶体玻璃体视网膜联合手术（ｌｅｎｔｉｃｕｌａｒ－ｖｉｔｒｅｏｒｅｔｉｎａｌｓｕｒｇｅｒｙ，ＬＶＲ术）治疗的复杂性视网膜脱离进行回顾性分析。结果解剖性成功者６４只眼（７９．０１％），功能性成功者４５只眼（５５．５６％）；手术成功率显著降低的原因是前部增殖性玻璃体视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏ－ｒｅｔｉｎｏｐａｔｈｙ，ＰＶＲ）（成功率４２．８６％，Ｐ＜０．０１）和术中／术后眼内出血（成功率５８．８２％，Ｐ＜０．０２５）。结论ＬＶＲ术是治疗复杂性视网膜脱离的主要方法；显著影响手术预后的因素是前部ＰＶＲ和术中／术后眼内出血。     

硅油在复杂性视网膜脱离复位术中的应用

报告玻璃体切除联合硅油填充治疗复杂性视网膜脱离６０例（６０只眼），包括增殖性玻璃体现网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｖｉｔｒｅｏｒｅｔｉｎｏｐａｔｈｙ，ＰＶＲ）Ｄ级２７只眼，后瓣翻转的巨大裂孔视网膜脱离１５只眼，后极或黄斑裂孔１３只眼，外伤性ＰＶＲ５只眼。经３～２４个月随访，４８只眼获得解剖学复位，成功率为８０％。４３只眼术后视力进步，其中３２只眼视力≥０．０５。玻璃体切除、膜剥离为硅油填充创造了条件并充分发挥了硅油填充的作用，而硅油填充完善了玻璃体手术并提高了成功率。作者对硅油手术的原理、适应证、优缺点及并发症也进行了扼要讨论。     

增殖性玻璃体视网膜病变的玻璃体手术治疗

目的 评估玻璃体手术治疗增殖性玻璃体视网膜病变的疗效。方法 Ｃ２级以上ＰＶＲ合并视网膜脱离２１眼，特发性ＰＶＲ１４眼，外伤性ＰＶＲ７组，Ｃ级９眼，Ｄ级１２眼，均作常规玻璃体切除术联合环扎、膜剥离、视网膜切开、气体或硅油填充等附加术式。结果随访２～９个月，视网膜复位１５眼（７８．９％），视力提高２０眼（９５．２％）。４眼手术失败，均系ＰＶＲ再次复发所致。结论 现代玻璃体手术是治疗严重ＰＶＲ的理想术     

增殖性玻璃体视网膜病变的玻璃体手术治疗

目的 评估玻璃体手术治疗增殖性玻璃体视网膜病变（ＰＶＲ）的疗效。方法 Ｃ２级以上ＰＶＲ合并视网膜脱离２１眼,其中特发性ＰＶＲ１４眼,外伤性ＰＶＲ７眼;Ｃ级９眼,Ｄ级１２眼,均作常规玻璃体切除术联合巩膜环扎、膜剥离、松解性视网膜切开、气体或硅油填充等附加术式。结果 出院时２１眼视网膜全部复位（１００％）,１９眼随访２～９个月,视网膜复位成功率为７８．９％（１５／１９）、术后视力提高９５．２％（２０／     

玻璃体切除术治疗人工晶状体眼视网膜脱离

目的 探讨玻璃体切除术治疗人工晶状体眼视网膜脱离（ｔｒｔｉｎａｌ ｄｅｔａｃｈｍｅｎｔ,ＲＤ）的效果。方法 对３２例（３２只眼）植入人工晶状体后ＲＤ患眼行玻璃体除术,其中首次治疗采用玻璃体切除术１１只眼（３４．４％）,巩膜扣带术失败后再行玻璃体切除术２１只眼（６５．６％）,玻璃体切除术中联合硅油充填１０只眼（３１．３％）,玻璃体切除术同时行人工晶状体取出１２只眼（３７．５％）。术后随诊６个月至５年     

玻璃体视网膜手术治疗外伤性视网膜脱离合并增生性玻璃体视网膜病变的临床观察

目的：探讨玻璃体视网膜手术（ VRS）治疗合并增生性玻璃体视网膜病变（ PVR）的外伤性视网膜脱离（RD）患者的临床疗效。方法对2007年6月至2013年3月50例（51只眼）合并PVR的外伤性RD患者行VRS治疗,术后随访5～26个月,平均10．8个月。结果视网膜完全解剖复位47只眼,部分复位3只眼,未复位1只眼,总有效率98．4％。视力提高者41只眼（80．39％）;视力不变者7只眼（13．73％）,视力下降者4只眼（7.84％）。51只眼均行硅油填充术,继发性青光眼14只眼（27．45％）;8只眼因术后硅油进入前房行前房冲洗术（15．69％）;5只眼视网膜复位后Ⅱ期硅油取出术后低眼压或多次复发RD,长期硅油高粘度填充（9．80％）。结论通过VRS手术能有效解除外伤性PVR引起的视网膜牵拉,复位视网膜,提高视力。     

眼内填充在增生型糖尿病视网膜病变合并玻璃体出血玻璃体切割术中的作用

目的　分析眼内填充在增生型糖尿病视网膜病变（ｐｒｏｌｉｆｅｒａｔｉｖｅｄｉａｂｅｔｉｃｒｅｔｉｎｏｐａｔｈｙ,ＰＤＲ）合并玻璃体出血玻璃体切割术中的作用。方法　回顾性分析２０１３年５月至２０１５年５月西安交通大学第二附属医院眼科收治的ＰＤＲ合并玻璃体出血行玻璃体切割术患者的病例资料。术后随访至少１ａ,记录患者一般资料、术前及术后最佳矫正视力、玻璃体内填充物类型、复发性玻璃体出血和视网膜脱离情况。结果　１３０例（１３０眼）患者分无填充物、空气填充和硅油填充３组分析,其中无填充物组４５例（３４．６％）、空气填充组３５例（２６．９％）和硅油填充组５０例（３８．５％）。三组患者复发性玻璃体出血分别为:１１．１％（５／４５）、８．６％（３／３５）和１０．０％（５／５０）。术后１ａ内,三组分别有９７．８％、９４．３％和９２．０％患者未发生视网膜脱离。结论　ＰＤＲ合并玻璃体出血行玻璃体切割术中应用眼内填充物在减少复发性玻璃体出血和避免视网膜脱离方面并没有优势。术中没有视网膜裂孔时应用眼内填充物是不必要的。     

Long-term prognosis after removal of silicone oil

PURPOSE: To investigate surgical and functional results six or more months after silicone oil (SiO) removal in patients undergoing pars plana vitrectomy (PPV) and tamponade for various reasons. METHODS: Retrospective chart review. Inclusion criteria were recurrent retinal detachment with PVR grade C (R-RD), primary PVR grade C longer than 9 hours, recurrent vitreous hemorrhage in PDR (PDR-RVH) with traction RD, giant retinal tears (GRT) with PVR grade C and total RD with vitreous hemorrhage and hypotony in penetrating traumas (PT). Indications for removal of SiO included attached retina and intra-ocular pressure (IOP) more than 10 mmHg after 60 days or IOP more than 30 mmHg despite medication. RESULTS: Of the 212 patients undergoing PPV and SiO tamponade between 1994-1997, 91 met the inclusion criteria, 8 had incomplete charts so 83 eyes were included in the study. The mean interval between PPV and SiO removal was 163.1 +/- 111.0 days and follow-up was 351.5 +/- 148.6 days. At the time of SiO removal, 30.6% of phakic eyes had cataract, 14.4% keratopathy and 8.4% IOP more than 30 mmHg. At the last visit after SiO removal, 43.5% had cataract, 12.0 keratopathy, 6.0% IOP > 30 mmHg and 3.6% IOP < 5 mmHg. After SiO removal, 6.0% eyes developed R-RD. There was no significant difference in SiO duration for patients with and without R-RD. VA was more than 5/200 in 16.8% of eyes preoperatively, 79.5% at the time of SiO removal (p<0.05) and 78.3% at the last visit (n.s.) and better than 20/400 in respectively 2.4%, 51.8% (p<0.05) and 53% (n.s.). There was a tendency for VA to improve after SiO removal (p = 0.011). CONCLUSIONS: SiO is an effective tamponade for complex RD, although its possible benefits must always be weighted carefully against the complications and the need for further intervention. The present series compares favorably with the current literature in terms of complication rates. The optimal timing of SiO removal and precise screening and decision-making guidelines before removal are still the main issues and need careful consideration.     

Retrolaminar migration as a complication of intraocular silicone oil injection detected on unenhanced CT

AIM: To describe the clinical and radiologic features of retrolaminar migration silicone oil (SiO) and observe the dynamic position of ventricular oil accumulation in supine and prone. METHODS: For this retrospective study, 29 patients who had a history of SiO injection treatment and underwent unenhanced head computed tomography (CT) were included from January 2019 to October 2022. The patients were divided into migration-positive and negative groups. Clinical history and CT features were compared using Whitney U and Fisher''s exact tests. The dynamic position of SiO was observed within the ventricular system in supine and prone. CT images were visually assessed for SiO migration along the retrolaminar involving pathways for vision (optic nerve, chiasm, and tract) and ventricular system. RESULTS: Intraocular SiO migration was found in 5 of the 29 patients (17.24%), with SiO at the optic nerve head (n=1), optic nerve (n=4), optic chiasm (n=1), optic tract (n=1), and within lateral ventricles (n=1). The time interval between SiO injection and CT examination of migration-positive cases was significantly higher than that of migration-negative patients (22.8±16.5mo vs 13.1±2.6mo, P<0.001). The hyperdense lesion located in the frontal horns of the right lateral ventricle migrated to the fourth ventricle when changing the position from supine to prone. CONCLUSION: Although SiO retrolaminar migration is unusual, the clinician and radiologist should be aware of migration routes. The supine combined with prone examination is the first-choice method to confirm the presence of SiO in the ventricular system.     

维甲酸硅油防治实验性增殖性玻璃体视网膜病变

目的：评价维甲酸硅油对免眼实验性增殖性玻璃体视网膜病变的预防作用。 方法：新西兰白兔30只(58只眼)，随机分为三组：对照组(20只眼注入硅油或平衡盐溶液)、维甲酸硅油5μg/ml组(18只眼)、维甲酸硅油10μg/ml组(20只眼)。行气体压迫玻璃手术3天后，所有实验眼玻璃体腔内注入2X10⁵个成纤维细胞，再分别注入硅油或平衡盐溶液0.5ml。以检眼镜观察牵引性视网膜脱离发生情况，共4周。 结果：28天时，对照组、维甲酸硅油5μg/ml组、维甲酸硅油10μg/ml组的牵引性视网膜脱离发生率分别为80.00%、44.44%、30.00%，两组维甲酸硅油组与对照组相比经统计学处理差异均有显著性(χ²检验，P<0.05)。 结论：浓度为5μg/ml及10μg/ml的维甲酸硅油能够有效地预防增殖性玻璃体视网膜病变的发生。 （中华眼底病杂志，1997，13：174-176）     

Visual loss after use of intraocular silicone oil associated with thinning of inner retinal layers

Purpose: To investigate the incidence and cause of severe visual loss following use and removal of intraocular silicone oil (SiO) after uncomplicated vitrectomy and SiO injection for primary rhegmatogenous retinal detachment (RRD). Methods: Consecutive case series of 216 patients operated with vitrectomy for primary RRD in 2004–2005. In 162 eyes, SiO (5500 centiStoke) had been used as intravitreal tamponade and in 54 eyes gas (perflouropropane, C₃F₈) had been used. Following chart review, we identified 16 eyes in 16 patients (nine SiO eyes, seven gas eyes) with macula‐on and documented visual acuity ≥6/12 before surgery, where SiO had been removed, cataract surgery performed and no re‐detachment had occurred. Examinations included best‐corrected visual acuity (BCVA) and high‐definition optical coherence tomography (OCT) of the macular area. Results: Preoperative characteristics were identical between SiO and gas eyes. Postoperative BCVA was significantly worse in SiO eyes (>6/24) compared to gas eyes (>6/7.5), p = 0.005. Three of 9 (33%) SiO eyes had final BCVA ≤6/60 and 67% had final BCVA ≤6/12. No gas eyes had final BCVA <6/9. Macular OCT revealed thinning of inner retinal layers in SiO‐operated eyes (5148 pixels) compared to gas‐operated eyes (6897 pixels), p < 0.002. No other visually significant structural differences were found. Conclusion: Severe visual loss after SiO use was observed in 1/3 of patients with otherwise good visual potential. The visual loss was associated with a significant reduction in inner retinal thickness indicating neuronal cell loss in the macular area as a possible explanation.     

Ocular toxicity of low-molecular-weight components of silicone and fluorosilicone oils

Silicone oil (SiO) and fluorosilicone oil (FSiO) are injected into the vitreous cavity in difficult cases of retinal detachment surgery. SiO and FSiO contain linear and cyclic low-molecular-weight components (LMWC) that are thought to cause ocular toxicity. Using the purified oils (without LMWC) and some of the individual LMWC, the authors evaluated the relation of the LMWC to the short-term ocular toxicity of the oils. When octamethylcyclotetrasiloxane or other single small species of linear and cyclic LMWC of SiO were injected into the rabbit anterior chamber, severe inflammation and corneal edema were induced. The ocular responses to the single species of the LMWC of SiO decreased with an increase of the molecular weights. Cyclic LMWC of FSiO (a mixture of trimethyl-3,3,3-trifluoropropylcyclotrisiloxane and tetramethyl-3,3,3-trifluoropropylcyclotetrasiloxane) also induced inflammation and corneal edema. However, unpurified SiO and FSiO, as well as purified oils (via solvent fractionation), did not cause significant adverse ocular response, presumably because the amounts of LMWC (especially the smallest species) in the oils were relatively small. Using gas chromatography, the authors analyzed SiO and FSiO recovered from rabbit and human vitreous cavities up to 2 yr after injection. In most of the cases, the concentrations of LMWC in SiO decreased after injection. This is consistent with the possibility that LMWC diffused from the oils into the ocular tissues. The long-term effect of LMWC in intraocular SiO and FSiO has not been determined. However, diffusion of LMWC into ocular tissues may relate to the chronic ocular toxicity of the oils.     

Factors contributing to the emulsification of intraocular silicone and fluorosilicone oils.

Silicone oil (SiO) and fluorosilicone oil (FSiO) are used as vitreous substitutes during retinal detachment surgery. Emulsification of these oils causes complications in oil-injected eyes. One factor contributing to emulsification is interfacial tension (gamma i) of the oils. In general, the lower the gamma i, the more easily the oils are emulsified. We measured the gamma i of SiO and FSiO by the ring method at 37 degrees C; corrected the measured values by the Harkins-Jordan table or the Zuidema-Waters equation; and found that the gamma i between the oils and liquefied bovine vitreous was low compared with the gamma i between the oils and water (eg, gamma i of 1000 centistokes [cs]SiO against liquefied vitreous and water was 16.0 and 42.8 dyne/cm, and that of 1000 cs FSiO was 14.7 and 38.7 dyne/cm, respectively). When SiO or FSiO and liquefied vitreous were shaken in a partially filled vial, both oils were emulsified regardless of viscosity and purity. However, when the vial was filled completely (a situation in which the hydrodynamic condition of the oils may be similar to that in the eye), SiO of 1000 and 12,500 cs and FSiO of 10,000 cs did not emulsify, although FSiO of 1000 cs did emulsify. SiO was less emulsified than FSiO of the same viscosity, possibly because the smaller density difference between SiO and intraocular fluids makes agitation difficult compared with FSiO. High viscosity of the oils restricted mechanical emulsification, which was not prevented by eliminating low-molecular-weight components of the oils. Residual catalysts may relate to spontaneous emulsification, which was observed occasionally with high-viscosity SiO in water.     

Neuronal complications of intravitreal silicone oil: an updated review

Silicone oil (SiO) has a well‐established role as a long‐term endotamponade agent in the management of complicated retinal detachments. Complications of intraocular SiO include keratopathy, glaucoma, cataract and subretinal migration of the oil droplets. SiO tamponade can also lead to a severe optic neuropathy caused by retrolaminar migration. Nevertheless, intracranial migration of the SiO through the optic nerve posterior to the lamina cribrosa to the optic chiasm and brain is uncommon. The mechanism is still under debate, but it has been suggested elevated intraocular pressure, macrophages or optic nerve head anatomical predispositions as potential explanations. Moreover, central scotoma may develop in eyes with SiO not only at the time of oil removal, but also during the period of tamponade. We performed a PubMed search of neuronal complications of silicone oil over a period of 25 years. This review summarizes our current understanding of the specific pathogenic mechanisms of intraocular SiO neuronal side effects, concluding that pre‐existing glaucoma and optic nerve abnormalities are the main risk factors associated with this damage. In their absence, the risk of extraocular SiO penetration is so low that the use of SiO endotamponade in complex retinal detachment patients does not need to be modified. MRI images to assess extraocular SiO migration are only necessary in very few and special cases, such as patients with optic nerve abnormalities and glaucoma.     

Complications of hydroxyapatite pegging: comparison between polycarbonate and titanium peg system

PURPOSE: Polycarbonate peg has been customarily used for pegging of hydroxyapatite for years. For better movement, tissue tolerance, and to decrease the complications of pegging, titanium peg system has been used. This study compares the two systems. METHODS: Complications associated with pegging (polycarbonate: Bio-Eye or titanium: Dr-Perry new P-K) were retrospectively reviewed from the charts of 153 patients admitted to the Labbafinejad Medical Center, Tehran, Iran, for over 5 years from 1997 to 2003. RESULTS: A total of 153 cases were studied. Ninety-six (62.3%) were male and 57 (37.7%) were female, and the mean age was 27.7 years (6-59 years). In 88 cases pegs were poly-carbonate and sleeve system and in 65 cases pegs were titanium. Forty-one (46%) of cases with polycarbonate and 18 (27%) of cases with titanium had at least one or more complications (p=0.018).The most common complications were granulation tissue, discharge, overgrowth of conjunctiva, and peg falling out in 25%, 23%, 13%, and 8% in polycarbonate peg and 15%, 5%, 1.5%, and 0% in titanium peg group. The prevalence of the last three complications was statistically lower in titanium peg compared with polycarbonate. Twenty-five cases (35%) with polycarbonate peg and 5 cases (7.5%) with titanium peg had two or more complications (p=0.03). Peg removal was done in 11 cases of polycarbonate but only two cases of titanium peg in order to treat the complication. CONCLUSIONS: Both pegging systems had some complications, although these were less severe and prevalent in titanium peg. More studies on complications due to titanium pegs are recommended.     

Clinical Observation of 126 Cases of Sutureless Phacoemulsification with PMMA Intraocular Lens Implantation

Objective: To observe the safety and effect of sutureless phacoemulsification with PMMAintraocular lens (IOL) implantation.Methods: One-hundred and twenty-six cases (126 eyes) of suturelessphacoemulsification with PMMA intraocular lens (IOL) implantation were retrospectedand evaluated. The surgeries were performed through a limbal tunnel incision. PMMAIOLs with 5. 5mm or 6. Omm in diameter were implanted.Results: The follow-up was 3 ~ 20 months. Visual acuity of 0. 5 or better was obtained in120 cases (95. 2% ), and that of 1. 0 or better was obtained in 89 cases (70. 6% ) .Intra-operative complications included posterior capsule rupture in 9 cases (7. 1% ) andiris injury in 7 cases(5. 6% ). Postoperative complications included early corneal edemain 96 cases(76. 2% ), transient intraocular pressure elevation in 5 cases(4. 3% ),remnant of cortex in 1 case and leakage of incision in 1 case. All were properly managedwith good results.Conclusion: Sutureless phacoemulsification with PMMA IOL implantation is     

Primary viscocanalostomy for juvenile open-angle glaucoma

PURPOSE: To evaluate the efficacy and safety of primary viscocanalostomy for medically uncontrolled juvenile open-angle glaucoma (JOAG). DESIGN: Prospective, noncomparative, interventional case-series study. METHODS: The study included 20 eyes of 20 consecutive patients with medically uncontrolled JOAG who were treated by viscocanalostomy at one institution. No surgical or laser procedure preceded viscocanalostomy. Surgical outcome was defined as an overall success by the following criteria: no visual field deterioration, no optic-neuropathy progression, postoperative intraocular pressure IOP < or =20 mm Hg, and IOP reduction > or =30% compared with baseline values with or without medication. When medications were not required, success was defined as complete. Cases that did not fulfill the aforementioned criteria and cases in which a surgical revision or further goniopuncture was performed were defined as a failure. RESULTS: Gender distribution was similar. Fourteen eyes belonged to the white race; five eyes belonged to the black race, and one eye belonged to Arab ethnicity. Mean age (+/-SD) at operation was 33.77 +/- 6.16 years, with the mean preoperative IOP (+/-SD) at 22.9 +/- 4.77 mm Hg. Thirty-six months after operation, 16 cases (80%) were considered an overall success. In 11 cases (55%), success was complete. Four cases (20%) were considered failures. No serious complications were documented either during or after operation. In two cases (10%), we documented a spontaneously reabsorbed microhyphema. Trabeculo-Descemet-membrane microperforation occurred in two cases (10%). In two other cases (10%), Trabeculo-Descemet-membrane perforation occurred and was accompanied by iris prolapse that needed peripheral iridectomy. CONCLUSION: Primary viscocanalostomy can efficiently and safely reduce intraocular pressure in cases of medically uncontrolled JOAG and provide a rational alternative to conventional surgical modalities.