Incidence and Risk Factors for Developing Glaucoma Among Patients with Uveitis in a University-based Tertiary Referral Center in Riyadh,Saudi Arabia

Purpose: To investigate the incidence and risk factors of secondary glaucoma among uveitis patients.

Methods: Retrospective review of medical records of 642 patients (1220 eyes).

Results: Glaucoma was diagnosed in 169 (13.9%) eyes and was most common in eyes with anterior uveitis (19.1%) (p?p?Conclusions: Incidence of glaucoma differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of glaucoma.     

Juvenile Idiopathic Arthritis-associated Uveitis at an Italian Tertiary Referral Center: Clinical Features and Complications

Abstract

Purpose: To describe the frequencies and risk factors of ocular complications and poor visual outcomes in children with juvenile idiopathic arthritis (JIA).

Methods: Retrospective cohort study, including 69 consecutive children (116 eyes) affected by JIA-associated uveitis managed at a tertiary uveitis clinic.

Results: The incidence of visual loss to the 20/50 or worse threshold was 0.04/eye-year (EY) and to the 20/200 or worse threshold was 0.02/EY. The most common complications at baseline were posterior synechiae (52%), band keratopathy (38%), and cataract (12%). Risk factor for a visual acuity threshold of 20/50 or worse included hypotony (p?=?0.01; hazard ratio [HR] 3.7; 95% CI 1.3–10.4); anterior chamber flare >1 (p?=?0.04; HR 1.3; 95% CI 0.5–3.4); a positive antinuclear antibody (ANA) (p?=?0.02; HR1.4; 95% CI 0.8–2.4). Hypotony and positive ANA are also associated to the 20/200 or worse threshold (p?=?0.03; HR 5.1; 95% CI 1.1–23.9 and p?=?0.04; HR 1.0; 95% CI 0.4–2.3; respectively). Use of immunosuppressive drugs was associated with a reduced risk of visual loss of 20/200 or worse (odds ratio 0.14, 95% CI, 0.02–1.29; p?=?0.04).

Conclusions: Loss of vision and ocular complications still occur among children with JIA-related uveitis. Prompt diagnosis and a strict follow up associated to immunosuppressive therapy may decrease the poor visual outcome.     

复合式小梁切除术后眼压不降的病因分析

目的：探讨复合式小梁切除术后眼压不降的病因。

方法：记录患者第一次手术前、术中及术后的各种情况,发生眼压不降时眼部专科检查(眼压、视力、房角等)及UBM检查等,回顾分析2009-09/2010-12复合式小梁切除术后眼压不降30例34眼的病因。

结果：复合式小梁切除术后眼压不降的病因：滤过泡扁平瘢痕化12例15眼,恶性青光眼倾向5例6眼,术后前房出血3例3眼,巩膜瓣内切口欠通畅2例2眼,术前高眼压持续时间长2例2眼,包裹性滤过泡2例2眼,术前葡萄膜炎1例1眼,术后膨胀期白内障1例1眼,手术操作不良1例1眼,手术方式选择欠妥1例1眼。

结论：复合式小梁切除术后眼压不降主要原因是术后滤过泡扁平瘢痕化。     

Surgery for Hypotony in Patients with Juvenile Idiopathic Arthritis-Associated Uveitis

Purpose: To describe the clinical response to cyclitic membrane excision of eyes with juvenile idiopathic arthritis (JIA)-associated uveitis and hypotony. Methods: The clinical records of patients with JIA-associated uveitis in a tertiary referral center were reviewed. Those patients with JIA-associated uveitis and hypotony who underwent cyclitic membrane excision were included in the study. Patients with hypotony secondary to active inflammation, retinal detachment, and surgical intervention (filtering, cyclo-destructive procedures, and glaucoma valve implantation) were excluded. Results: Two pediatric and two adult patients (4 eyes) were identified. The range of pre-operative intraocular pressure (IOP) was 0–5 mmHg. The two adult patients were noted to have atrophic ciliary processes intra-operatively, while the two pediatric patients had normal ciliary processes. At six months follow-up, the adult patients had IOPs of 5 mmHg, while the two pediatric patients had IOPs of 16 mmHg. At last consultation (mean duration of follow-up: 3.6 years), IOP was normal in all eyes. None of the eyes had a decrease in vision. Conclusions: Release of traction on the ciliary body by inflammatory membranes may play a role in the management of hypotony in patients with JIA-associated uveitis. However, even though the IOP was successfully elevated, preventing phthisis, vision remained poor due to the long-standing complications secondary to chronic uveitis. This emphasizes the critical importance of early diagnosis and appropriate treatment of the inflammation before vision-robbing complications occur.     

Incidence,Risk Factors and Surgical Outcomes of Cataract among Patients with Uveitis in a University Referral Hospital in Riyadh,Saudi Arabia

Purpose: To investigate incidence, risk factors, and surgical outcomes of cataract among uveitis patients.

Methods: Retrospective review of 1000 patients (1582 eyes).

Results: At initial presentation, cataract was diagnosed in 290 (18.3%) eyes and was most common in eyes with anterior uveitis. Fuchs’ uveitis, herpetic uveitis, and presumed tuberculous uveitis were leading clinical entities associated with cataract at presentation. During follow-up, cataract developed in additional 200 (12.6%) eyes and was most common in eyes with anterior uveitis. Significant risk factors at presentation included age >18 years, female gender, presence of keratic precipitates, hypopyon, and posterior synechiae. Among the 490 eyes with cataract, 204 underwent cataract extraction during follow-up period. Best corrected vision of ≥20/40 was achieved in 122 (60.1%) eyes.

Conclusions: Incidence of cataract differed depending on anatomic and etiologic diagnoses of uveitis. There is a significant association between severity of inflammation at presentation and development of cataract.     

葡萄膜炎继发性青光眼治疗探讨

目的:探讨葡萄膜炎继发性青光眼的治疗疗效。方法:对本院1999-01/2005-12收治的36例葡萄膜炎继发性青光眼患者,进行回顾性研究。结果:葡萄膜炎继发性青光眼患者36例(42眼),其中前葡萄膜炎28例,全葡萄膜炎7例,Fuchs综合征1例。非手术治疗组(12例)中2例眼压控制不良5mo后行小梁切除术。手术治疗组(24例)中22例眼压控制满意。结论:非手术以首次发作或反复发作治疗及时,虹膜粘连时间短者疗效显著,小梁切除术或青光眼阀植入术对葡萄膜炎继发性青光眼均有效,但要注意控制葡萄膜炎炎症。     

Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients

PURPOSE: To describe the clinical presentation of cytomegalovirus (CMV) anterior uveitis in human immunodeficiency virus (HIV)-negative patients. DESIGN: Retrospective, interventional case series. METHODS: HIV-negative patients with anterior uveitis associated with elevated intraocular pressure (hypertensive anterior uveitis) seen at the Singapore National Eye Centre had their aqueous analyzed for viral deoxyribonucleic acid by polymerase chain reaction, and their records were reviewed for demographic data, ocular findings, laboratory results, and treatment. RESULTS: Aqueous was obtained from 105 of 106 eligible eyes. Twenty-four eyes demonstrated positive results for CMV (22.8%). Eighteen eyes had Posner-Schlossman syndrome (PSS; 75%) at presentation, five eyesba had Fuchs heterochromic iridocyclitis (FHI; 20.8%), and one eye had a presumed herpetic anterior uveitis. Twelve of the 24 eyes were treated with ganciclovir. Of the 12 who completed treatment, all responded clinically, and their aqueous demonstrated negative results for CMV on repeat testing. However, nine had recurrences within eight months of stopping treatment and required further courses of ganciclovir. The 81 CMV-negative eyes included 30 with PSS, 11 with FHI, 27 with uveitic glaucomas of unknown cause, and 13 with presumed herpetic anterior uveitis. CONCLUSIONS: CMV anterior uveitis is not uncommon in our immunocompetent patients and it may present as a recurrent acute or chronic inflammation, resembling PSS, herpetic anterior uveitis, or FHI.     

Safety and efficacy of intraoperative intravitreal injection of triamcinolone acetonide injection after phacoemulsification in cases of uveitic cataract

PURPOSE: To evaluate the safety and efficacy of a single intraoperative intravitreal injection of triamcinolone acetonide after phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis. SETTING: Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. METHODS: This prospective randomized controlled study included 40 eyes (40 patients) with chronic idiopathic anterior uveitis or intermediate uveitis that had phacoemulsification with intraocular lens implantation. Twenty eyes received an intravitreal injection of triamcinolone acetonide (4 mg/0.1 mL) intraoperatively (triamcinolone acetonide group), and 20 received oral steroids (steroid group) postoperatively. Outcome measures were Early Treatment Diabetic Retinopathy Study best corrected visual acuity (BCVA), anterior chamber reaction, intraocular pressure (IOP) by applanation tonometry, and central macular thickness by optical coherence tomography. RESULTS: The mean BCVA (decimal) improved from a baseline of 0.13 +/- 0.14 to 0.64 +/- 0.32 in the triamcinolone acetonide group and from 0.05 +/- 0.06 to 0.61 +/- 0.36 in the steroid group (P = .74). There were no statistically significant differences between the 2 groups in postoperative anterior chamber reaction, IOP, or central macular thickness. Four patients in the triamcinolone acetonide group and 5 in the steroid group had recurrence of uveitis; 5 patients in the triamcinolone acetonide group had ocular hypertension. One patient in the triamcinolone acetonide group and 3 in the steroid group had cystoid macular edema postoperatively. CONCLUSION: A single intraoperative intravitreal injection of triamcinolone acetonide seemed to be a safe and efficacious route of steroid delivery during phacoemulsification in patients with chronic idiopathic anterior uveitis or intermediate uveitis and is recommended as a substitute for postoperative oral steroid administration.     

后囊撕开联合前段玻璃体切除治疗先天性白内障

目的:探讨后囊膜撕开联合前段玻璃体切除治疗先天性白内障的临床疗效。方法:对40例48眼先天性白内障患者行超声乳化吸除术,并行后囊膜撕开联合前段玻璃体切除,观察术前、术后视力及并发症。结果:患者48眼中有5眼(10%)在术后3mo～1a出现后发性白内障,术后常见并发症有:角膜水肿、前段葡萄膜炎反应、后发性白内障。结论:后囊膜撕开联合前段玻璃体切除能有效降低后发性白内障出现,是一种安全有效的手术方式。     

Real-world comparison between the Tonopen and Goldmann applanation tonometry in a university glaucoma clinic

Purpose

To determine whether Tonopen intraocular pressure (IOP) measurements by Ophthalmic technicians are interchangeable with Goldmann applanation tonometry (GAT) by a specialist in our glaucoma clinic.

Methods

Ophthalmic technician Tonopen and glaucoma specialist GAT IOP measurements were performed on both undilated eyes of 300 consecutive patients during the same visit to our glaucoma clinic.

Results

Among all 600 eyes of 300 patients (age 65.4, range: 23–92 years, male: 44.3%), Tonopen and GAT IOPs were similar (15.5?±?0.6 vs. 15.4?±?0.7 mmHg, respectively, p?=?0.63) and directly correlated (r²?=?0.58, p?<?0.0001). However, among 120 patients with bilateral primary open-angle glaucoma GAT IOP was significantly higher than Tonopen in the right eyes (17.1?±?1.1 vs. 16.2?±?0.9 mmHg, p?=?0.024) and in the left eyes (17.0?±?1.0 vs. 16.3?±?1.0 mmHg, p?=?0.029). In all 300 right eyes, Tonopen underestimated IOP in 48.3% of eyes and overestimated in 39% (difference range: (???)14 to (?+?)12 mmHg), with IOP difference?>??±?3 mmHg in 34% of eyes. In eyes with GAT IOP?≥?22 mmHg, Tonopen IOP was significantly lower (24.7?±?2.6, range: 11–43 mmHg vs. 28.2?±?2.2, range: 22–43 mmHg, p?=?0.0002, mean difference:???3.6?±?1.7 mmHg), and the Tonopen measured IOP?≤?21 mmHg in 33.3% of eyes. In eyes with Tonopen IOP?≤?10 mmHg GAT measured IOP of 11–17 mmHg in 65.7% of eyes.

Conclusions

Tonopen may mask a third of eyes with elevated IOP and two third of eyes with potentially above-goal IOP. The Tonopen may not be interchangeable with GAT or sufficiently reliable for patient management or screening in our glaucoma clinic. However, further study is recommended to assess the limitations of the Tonopen IOP measurements in eyes with higher or lower GAT IOPs.

Clinical Trials Registration

The Institutional review board, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY does not require this retrospective study to register.

     

Fuchs’ Uveitis in Iranian Patients: A Review of 89 Eyes

Purpose: To describe clinical and imaging features of Fuchs’ Uveitis (FU) and investigate the rate of misdiagnosis in Iranian patients.

Methods: Records of 82 FU patients (89 eyes) were reviewed retrospectively.

Results: Remarkable findings included iris heterochromia in 14 (17.1%) patients and Fuchs’ keratic precipitates in 97.8%, vitritis in 89.7% and cataract in 69.7% eyes. FU discovered as an incidental finding in 7 patients (10.0%). Imaging revealed disc hyperfluorescence, mild vascular leakage and epiretinal membrane in 72.7%, 32.5% and 19.4% of eyes, respectively. The rate of misdiagnosis was 19.5% (16 patients) with intermediate uveitis being as the most common erroneous diagnosis (10 patients). Patients with the wrong diagnosis were significantly younger (p = 0.045) and more likely to have bilateral involvement (p = 0.004) or no anterior chamber cells (p = 0.039).

Conclusions: Heterochromia is an infrequent clinical feature in Iranian FU patients, however, vitreous involvement is common. Intermediate uveitis is a usual misdiagnosis.     

Toxoplasmosis retinochoroiditis and elevated intraocular pressure: a retrospective study

OBJECTIVES: To report the prevalence of abnormal intraocular pressure (IOP) in patients with toxoplasmosis retinochoroiditis and to determine risk factors for such abnormality. METHODS: In a retrospective clinic-based chart review, the IOP levels of 61 patients with active retinochoroiditis were recorded. Patients were separated into groups with elevated IOP, equal IOP, and lower IOP. The time taken for normalization of IOP was also recorded. Additionally, age, gender, visual acuity, anterior chamber and vitreous inflammatory activity, presence of macular lesions, keratoprecipitates, synechiae, toxoplasmosis antibody titers, and required medical and surgical treatments were noted. The IOP in 61 patients with active retinochoroiditis were also compared with the IOP in 59 age- and gender-matched control patients with unilateral anterior uveitis. RESULTS: Thirty-eight percent of patients (23/61) with active retinochoroiditis had elevated IOP > 21 mm Hg, demonstrated IOP difference > 4 mm Hg between involved and uninvolved eyes, or received on IOP-lowering medications. In the equal IOP category, 55.7% (34/61) of patients had an IOP < or = 21 mm Hg in the actively inflamed eye and had an IOP difference of < or = 3 mm Hg between the active and inactive eyes. Only 6.6% (4/61) of patients with active ocular toxoplasmosis had a decreased IOP in the affected eye. The mean IOP in patients with active retinochoroiditis was 21.2 mm Hg (SD 11.5) and 15.6 mm Hg (SD 2.9) in involved and uninvolved eyes, respectively. A statistically significant average IOP difference of 5.8 mm Hg (SD 11.6) was found between the involved and uninvolved eyes (P < 0.001 by two-tailed student T test). Of the patients with abnormal IOP, 20 patients had IOP > 21 mm Hg, 10 of whom had IOP > 30 mm Hg, 6 of whom had IOP > 40 mm Hg, and 2 of whom had IOP > 50 mm Hg. In the elevated IOP group, the average time from onset of symptoms until presentation for their IOP measurement was 13 days (median: 7 days; range: 1 to 100) with resolution of abnormal IOP occurring in 32 days (median: 28 days; range: 1 to 84 days). The average time of onset of symptoms in the normal to low IOP category was 70 days (median: 17.5 days; range: 2 to 330 days). Elevated IOP was more common in active retinochoroiditis, 23/61 (38%), when compared with anterior uveitis control group, 6/59 (10%) (odds ratio of 5.3; P < 0.001). No statistically significant predictor of elevated IOP was identified, though a trend associating anterior chamber cells with elevated IOP (P = 0.08, r = 0.25 Spearman rank correlation coefficient) was seen. CONCLUSION: Abnormal IOP is a feature in almost half of patients with active toxoplasmosis retinochoroiditis. Elevated IOP occurs in 38% and low IOP occurs in 6.6% of affected eyes. Patients with elevated IOP due to active toxoplasmosis present for earlier evaluation than patients with normal or low IOP. The IOP elevation is generally transient and concurs with the uveitic episode. Medical management of IOP is usually sufficient to treat this generally transient eye pressure rise though chronic administration of eye pressure lowering drops or glaucoma surgery may be necessary in a small proportion of patients.     

Intraoperative Dexamethasone Implant in Uveitis Patients with Cataract Undergoing Phacoemulsification

Abstract

Purpose: To study the role of intraoperative intravitreal dexamethasone implant in patients of uveitis with cataract undergoing phacoemulsification.

Methods: This prospective study included 20 patients with uveitis and cataract who underwent phacoemulsification with intraocular lens implantation. Ten patients (10 eyes) received an intravitreal dexamethasone implant intraoperatively (implant group), and 10 patients (10 eyes) received oral steroids (steroid group). Outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT).

Results: The logMar BCVA improved from 0.93?±?0.49 to 0.23?±?0.23 and from 1.29?±?0.47 to 0.22?±?0.16 in the implant and steroid groups, respectively. Postoperative IOP and CMT showed no statistically significant differences between the two groups. None of the patients in either group had significant IOP rise requiring any surgical intervention.

Conclusions: A single intraoperative intravitreal dexamethasone implant during phacoemulsification in patients of uveitis with cataract seems to be an effective alternative for postoperative oral steroids.     

Long-term results of cataract surgery in patients with anterior uveitis

Purpose

This study was aimed to assess the long-term results of phacoemulsification and posterior chamber intraocular lens implantation in patients with anterior uveitis.

Methods

Patients with complicated cataract secondary to anterior uveitis who underwent phacoemulsification and posterior chamber intraocular lens implantation were included in this study. Long-term results and all complications were evaluated throughout the postoperative 4 years.

Results

A total of 55 eyes of 48 patients were identified in this study. Cases with anterior uveitis were categorised into four aetiologic groups. Of the 55 eyes, 22 (19 patients) had idiopathic anterior uveitis, 10 (9 patients) had viral anterior uveitis, 10 (9 patients) had Fuchs’ anterior uveitis and 13 (11 patients) had anterior uveitis associated with collagen vascular diseases. Preoperative macular oedema was more frequent (63.6%) in the idiopathic group than in the other groups (p < 0.001). The success rates of the best corrected visual acuity of 20/40 or better ranged from 80.0 to 100.0% in the groups. While postoperative increased intraocular pressure rate was statistically significantly higher in the Fuchs’ group (p = 0.047), there was no statistically significant difference in other complication rates between the groups.

Conclusions

The long-term outcomes of phacoemulsification with intraocular lens implantation in patients with uveitic cataract were satisfactory with excellent visual acuity and relatively low complication rates.

     

Risk factors for elevated intraocular pressure in uveitis

PURPOSE: To determine the prevalence of raised intraocular pressure (IOP) in patients with uveitis and to identify risk factors for raised IOP in patients with uveitis. PATIENTS AND METHODS: Consecutive case notes of 257 patients (402 eyes) attending a specialist uveitis clinic during a three-month period were reviewed. Patients with raised IOP were identified and further evaluated. Risk factors for raised IOP were determined. RESULTS: The prevalence of raised IOP in the study eyes was 41.8%. The prevalence of raised IOP requiring treatment was 29.8%. Raised IOP was found in 26.0% of eyes with acute uveitis and 46.1% of eyes with chronic uveitis. This difference was significant (P = 0.002). Similarly the prevalence of raised IOP requiring treatment in acute and chronic uveitis was 15.1% and 33.8%, respectively. This difference was also significant (P = 0.002). Active inflammation was significantly associated with raised IOP (P = 0.031). Steroid usage, increasing age, and number of years since diagnosis were significantly correlated with raised IOP (P = 0.008, P = 0.022, and P = 0.006, respectively); 9.6% of the study eyes developed glaucoma. The majority of these eyes (69.7%) were treated medically. The remainder (30.3%) required both medical and surgical management. CONCLUSION: Raised IOP is significantly more common in patients with chronic intraocular inflammation than those with acute uveitis. Risk factors for elevated IOP that should enable closer monitoring of 'at-risk' eyes have been identified.     

激光蛋白细胞检测仪在葡萄膜炎中的应用价值

目的:探讨激光蛋白细胞检测仪(laser flare cell meter,LFCM)定量测定葡萄膜炎患者房水闪辉的临床应用价值。方法:选择2009-07/2010-07在我院就诊、复查的葡萄膜炎患者129例171眼,根据其临床特点将其分为前葡萄膜炎组87例87眼,中间葡萄膜炎组10例20眼,后葡萄膜炎组32例64眼;正常对照组50例100眼。应用LFCM(FM-600型)检测各期患者房水闪辉情况,检查前所有患者均经裂隙灯显微镜检查,并进行房水闪辉分级。结果:前葡萄膜炎患者裂隙灯检查前房闪辉48眼(1+),35眼(2+),2眼(3+),2眼(4+);LFCM检测1～2级房水闪辉的平均值分别为28.6±6.7pc/ms,144.3±28.1pc/ms,3～4级房水闪辉由于背景干扰大,检测结果显示警告或无法检测;前葡萄膜炎患者1～2级房水闪辉的裂隙灯显微镜检查与LFCM测定结果呈正相关(r=0.901,P<0.01);与对照组房水闪辉值比较(5.1±1.8pc/ms),差异具有统计学意义(P<0.05)。中间葡萄膜炎患者裂隙灯检查前房闪辉10眼(1+),10眼(2+),LFCM检测1～2级房水闪辉的平均值分别为31.7±5.0pc/ms,130.7±12.9pc/ms;中间葡萄膜炎患者1～2级房水闪辉的裂隙灯显微镜检查与LFCM测定结果呈正相关(r=0.867,P<0.01);与对照组房水闪辉值比较,差异具有统计学意义(P<0.05)。后葡萄膜炎患者裂隙灯检查前房闪辉均为0级,LFCM检测房水闪辉的平均值为9.8±3.1pc/ms,高于对照组,差异具有统计学意义(P<0.05)。结论:LFCM(FM-600型)可确切判断葡萄膜炎患者轻、中度的血-房水屏障破坏,对判断眼前段炎性反应和指导临床治疗有重要意义。     

Serious complications of cosmetic NewColorIris implantation

Acta Ophthalmol. 2010: 88: 700–704

Abstract.

Purpose: This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods: We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results: Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant–iris and implant–endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet’s stripping endothelial keratoplasty. Conclusions: Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists.     

两种联合手术方式治疗急性闭角型青光眼合并白内障的疗效比较

目的：探讨超声乳化白内障吸除人工晶状体植入联合房角分离术治疗原发性急性闭角型青光眼(acute primary angle-closure glaucoma,APACG)合并白内障的临床疗效。

方法：前瞻性随机对照研究。选择符合入组条件的急性闭角型青光眼合并白内障患者60例60眼,随机分为对照组和研究组; 对照组行白内障超声乳化吸除、人工晶状体植入联合小梁切除术(30眼),研究组行白内障超声乳化吸除、人工晶状体植入联合房角分离术(30眼),比较两种术式的临床疗效。

结果：术前两组视力、眼压、中央前房深度、房角开放程度差异无统计学意义(P>0.05); 术后2mo两组视力、眼压、中央前房深度、房角开放程度均明显比术前改善,差异有统计学意义(P<0.001); 研究组术后视力、中央前房深度、房角开放程度,均优于对照组,差异有统计学意义(P<0.05); 两组术后眼压及并发症相比,研究组优于对照组,但差异无统计学意义(P>0.05)。

结论：白内障超声乳化人工晶状体植入联合房角分离术,对APACG合并白内障患者视力的提高、眼压的控制有着积极的临床效果。     

Comparison of phacotrabeculectomy and sequential surgery in the treatment of chronic angle-closure glaucoma coexisted with cataract

AIM: To compare the safety and effectiveness of phacotrabeculectomy versus sequential surgery in chronic angle-closure glaucoma (CACG) with coexisting cataract. METHODS: One hundred and sixty-two CACG patients (162 eyes) were retrospectively analyzed. Of them, 87 patients (87 eyes) in group A had underwent phacotrabeculectomy with intraocular lens (IOL) implantation, and 75 patients (75 eyes) in group B had underwent sequential surgery with IOL implanted. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), complications and anterior chamber angle (ACA) were measured. RESULTS: Demographic characteristics of the two groups were similar. A mean follow-up period was 15±6mo (range 13 to 24mo), a mean IOP of 16.61±6.43 mm Hg in group A and 15.80±5.35 mm Hg in group B (P=0.84) at the last follow up. The Kaplan-Meier analysis revealed that the cumulative probability of success in both groups was similar (P=0.61). Anterior uveitis and hypotony were the most common complications in group A, whereas group B experienced shallow anterior chamber with trabeculectomy. With the exception of anterior uveitis, no complications occurred to 11 trabeculectomized eyes. All postoperative measurements of anterior chamber showed statistically significant differences in each group according to the preoperative data (P<0.05). However, fewer changes occurred in group B than in group A. CONCLUSION: Phacotrabeculectomy and sequential surgery exhibit similar IOP reduction, visual recovery, and complications when treating CACG patients with cataract. However, for a wider ACA, phacotrabeculectomy has demonstrated higher effectiveness than sequential surgery.     

Safety and Efficacy of Intravitreal Triamcinolone Acetonide for Uveitic Macular Edema

Background: To evaluate the safety and efficacy of intravitreal triamcinolone acetonide (TA) for treating macular edema secondary to non-infectious uveitis. Methods: Retrospective review of sixteen patients (20 eyes) with chronic cystoid macular edema (CME) as a consequence of controlled intermediate uveitis, posterior uveitis, or panuveitis who received at least one intravitreal injection of TA. Main outcome measures were visual acuity (VA), intraocular pressure (IOP), formation or progression of an existing cataract, and CME resolution during the follow-up period. Results: At last follow-up, VA showed improvement (compared to baseline) in 11 eyes (55%), deterioration in three eyes (15%), remained completely unchanged in one eye (5%), and showed improvement initially but returned to baseline levels in five eyes (25%). At last follow-up, CME had relapsed or was still present in 10 of the eyes (50%). The remaining eyes showed complete resolution of the CME, without evidence of recurrence during the follow-up time. Mean VA at last follow-up showed statistically significant improvement (p = 0.02) in nonvitrectomized eyes (mean baseline VA: 1.14 ± 0.58; mean final VA: 0.96 ± 0.66) compared to the almost unaltered mean visual acuity for vitrectomized eyes (mean baseline VA: 0.76 ± 0.41; mean final VA: 0.71 ± 0.48)(p = 0.40, paired samples t-test). Elevation of IOP was transient in all cases and responded well to topical medications, except for one patient who required placement of an Ahmed valve. Preexisting cataract progressed in three of the 15 phakic eyes (20%). One patient developed a retinal detachment and required additional surgery to reattach it. Patients were followed for a mean of 34 weeks (median: 32 weeks; range: 19–56 weeks). Conclusions: Intravitreal TA may play a role in the treatment of uveitis-related CME. Further controlled studies are necessary to test this hypothesis.