Outcomes of laser suture lysis after initial trabeculectomy with adjunctive mitomycin C

PURPOSE: To evaluate and compare outcomes of eyes that underwent laser suture lysis (LSL) after initial trabeculectomy with mitomycin C (MMC) to those that did not require such an intervention. METHODS: We reviewed the charts of consecutive patients with open-angle glaucoma who underwent initial trabeculectomy with mitomycin C at the Jules Stein Eye Institute between 1998 and 2003. Primary outcome measures were intraocular pressure (IOP) control at 1 year and success rate of trabeculectomy according to following criteria: criteria A, IOP < 21 mm Hg with >or=20% IOP reduction and criteria B, IOP < 15 mm Hg with >or=30% IOP reduction. Kaplan-Meier survival analysis and Cox's proportional hazards regression analysis were used to estimate and determine influence of laser suture lysis on success rates after trabeculectomy. RESULTS: Laser suture lysis was performed in 95 eyes (84 patients) whereas 146 eyes (121 patients) did not require it. IOP was significantly higher at 12 months in laser suture lysis eyes compared with non-laser suture lysis eyes (12.9 +/- 5.2 mm Hg versus 11.0 +/- 4.1 mm Hg; P = 0.04). Laser suture lysis eyes also had decreased success rates with criteria B (57% compared with 73% at 1 year for non-LSL eyes; P = 0.005). However, only late laser suture lysis (last LSL session >10 days after trabeculectomy) was associated with worse outcome in Cox's proportional hazards model using criteria B (HR = 2.26; P = 0.004). Late hypotony occurred in 4% and 1% of non-LSL and LSL eyes, respectively. CONCLUSIONS: Eyes that undergo laser suture lysis >10 days after initial trabeculectomy with mitomycin C are more likely to have poorer long-term IOP control than eyes not requiring laser suture lysis or eyes undergoing laser suture lysis 相似文献   

Combined Baerveldt glaucoma drainage implant and trabeculectomy with mitomycin C for refractory glaucoma

PURPOSE: To describe the surgical technique and clinical outcomes of a procedure for refractory glaucoma, concurrent Baerveldt glaucoma implant (BGI) and trabeculectomy with mitomycin C. MATERIALS AND METHODS: Medical records of all patients who underwent combined Prolene-ligated BGI and trabeculectomy with mitomycin C were retrospectively reviewed. Main outcome measures were intraocular pressure (IOP), number of glaucoma medications, visual acuity, and complications. Kaplan-Meier survival analysis was used to determine success, defined as IOP < 22 mm Hg, no reoperation for glaucoma, and no loss of light perception vision. RESULTS: The mean +/- SD follow-up period for 38 eyes of 36 patients was 34 +/- 36 months (range, 3-121 months), during which 18 of 38 eyes (47%) required laser suture lysis of the Prolene suture. Intraocular pressure was reduced from a mean (+/- SD) preoperative value of 35.7 +/- 12.8 to 12.7 +/- 4.7 mm Hg at 1-year follow-up and 11.9 +/- 5.5 mm Hg at the last follow-up visit ( < 0.001). Number of medicines used for glaucoma was reduced from a mean +/- SD preoperative value of 2.5 +/- 0.9 to 0.5 +/- 0.6 at 1-year follow-up and 0.6 +/- 0.8 at the last follow-up visit ( < 0.001). LogMar visual acuity remained stable at mean of 1.15 +/- 0.85 preoperatively, compared with 1.14 +/- 1.05 at 1-year follow-up, but declined to 1.61 +/- 1.01 at the last follow-up visit, a loss of an average of four lines of vision ( = 0.004). Cumulative success was 91% at year 1, 86% at year 2, and 81% at year 3. Three eyes (8%) had suprachoroidal hemorrhages, one eye (3%) needed reoperation for an extruded implant, one (3%) eye had poor vision due to chronic hypotony, three eyes (8%) required additional glaucoma surgery during the postoperative period, and one eye (3%) needed revision of the implant for pressure control. CONCLUSIONS: Combined BGI and mitomycin C trabeculectomy provides excellent postoperative IOP control in patients with refractory glaucoma.     

青光眼引流器植入联合小梁切除术治疗难治性青光眼的临床观察

目的：观察青光眼引流器植入联合小梁切除术治疗难治性青光眼的疗效。方法对34例（46只眼）难治性青光眼行青光眼引流器植入联合小梁切除术治疗,观察术后视力、眼压、滤过泡及并发症等情况。结果34例难治性青光眼中,新生血管性青光眼12例（17只眼）,无晶状体眼4例（4只眼）,人工晶状体眼1例（1只眼）,外伤性青光眼2例（2只眼）,发育性青光眼9例（12只眼）,色素播散性青光眼2例（2只眼）。术前平均眼压（42．15±2．32）mmHg,术后眼压控制30只眼,眼压部分控制7只眼,眼压失控9只眼,术后平均眼压（18．34±3.55）mmHg,眼压有效控制率为80．43％。功能性滤过泡形成率67．39％,手术并发症较少。结论新型国产青光眼引流器植入联合小梁切除术治疗难治性青光眼疗效好,安全性高,术后并发症少,可以推广使用。     

Amniotic membrane transplantation in trabeculectomy with mitomycin C for refractory glaucoma

PURPOSE: To compare outcomes of trabeculectomy combined with mitomycin C (MMC) and amniotic membrane transplantation (AMT) with those of trabeculectomy with MMC alone in refractory glaucoma. METHODS: This prospective, randomized study included 37 eyes with refractory glaucoma at such high risks as neovascular, pseudophakic, and prior failure. Trabeculectomy with MMC and single-layer AMT under the scleral flap was performed in 19 eyes and trabeculectomy with MMC alone in 18 eyes. The outcome measures included intraocular pressure (IOP), number of antiglaucoma medications, and complications. All patients were followed for 12 months. RESULTS: Complete success (IOP <22 mm Hg without glaucoma medications) was seen in 15/16 (93.7%) study eyes and 9/15 (60%) control eyes at 6 months postoperatively (P=0.03), and in 12/15 (80%) and 6/15 (40%) at 12 months after surgery, respectively (P=0.03). IOP decreased from 45.6+/-12.7 mm Hg and 44.9+/-10.7 mm Hg preoperatively in study and control groups to 15.3+/-2.3 mm Hg and 21.3+/-3.8 mm Hg, respectively, at 12 months (P<0.0001). Early postoperative hypotony developed in 3 (16.7%) control eyes owing to excessive filtration but none of study eyes (P=0.1). Encapsulated bleb occurred in 7 (38.9%) control eyes but in 1 (5.3%) study eye (P=0.02). CONCLUSIONS: In refractory glaucoma, trabeculectomy combined with MMC and AMT compared to trabeculectomy with MMC alone has higher success rates, lower postoperative mean IOPs, and less complication rates.     

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.     

Long term results of glaucoma surgery among participants in an east African population survey

AIM: To evaluate the long term results of glaucoma surgery among people in East Africa. METHODS: Participants in a population based survey of eye disease prevalence were offered glaucoma surgery using standardised criteria. Either surgical iridectomy or trabeculectomy was carried out as indicated by a medical officer or by one of two ophthalmologists. Trabeculectomy methods included releasable sutures and mitomycin C in the majority of eyes. Subjects were examined during the first week and 2 months after surgery. Nearly 3 years later, re-examination was carried out in those who were still resident in the region. RESULTS: Among 46 people who were offered iridectomy, trabeculectomy, or combined cataract extraction/lens implant/trabeculectomy, 21 people underwent surgery (46%). Of the 21, 19 were re-examined at 3 years (90%), including 16/18 eyes after trabeculectomy. Among these, intraocular pressure (IOP) declined from 29.9 (SD 9.4) mm Hg to 14.7 (5.9) mm Hg, with 16 of 18 eyes (89%) achieving a reduction > 25%. Hypotony maculopathy, late bleb leak, and late endophthalmitis were not detected. Visually significant cataract developed in 5/15 re-examined eyes that underwent trabeculectomy alone (33%), possibly associated with pre-existing cataract and diagnosis of angle closure glaucoma, but not with mitomycin C use. CONCLUSIONS: Nearly half of those with glaucoma among residents of rural African villages accepted the offer of surgical therapy. While technical success was achieved at satisfactory levels, the development of cataract must be considered an important issue for application of glaucoma surgical therapy programmes.     

Transconjunctival suture adjustment for initial intraocular pressure control after trabeculectomy

PURPOSE: In an experimental human eye model of trabeculectomy, scleral flap suture adjustment allows predictable control of intraocular pressure (IOP). This approach had not previously been described in clinical use; we present a case series with the application of this technique. METHODS: A prospective, non-comparative interventional case series of consecutive patients undergoing trabeculectomy. Forty trabeculectomies were performed using a 3 mm x 4 mm scleral flap with two apical adjustable 10-0 nylon sutures under a fornix-based conjunctival flap. Intraoperatively the scleral flap sutures were tied tightly to appose the edges of the flap. All trabeculectomies were augmented with antimetabolite intraoperatively. On day one, patients with an IOP greater than 15 mm Hg had their suture tension adjusted to lower their IOP to a target range (10 to 15 mm Hg). Major outcome measures were IOP before and after adjustment and success at last follow-up (IOP < or = 15 mm Hg on no glaucoma medication and no clinically significant complications) without and with adjunctive needling. Other outcomes measured were postoperative complications, bleb needling, final bleb morphology, and visual acuity change from pre-operation to final follow-up. RESULTS: Average day one IOP was 14.8 mm Hg (standard deviation (SD) 7.8). Fourteen patients had a day one IOP over 15 mm Hg and underwent suture adjustment, lowering IOP to between 10 and 15 mm Hg. (Mean post adjustment IOP was 10.7 mm Hg (SD 3.6)). One patient had a conjunctival tear intraoperatively. Four patients had transient wound leaks. No patients had shallow anterior chambers. All but four had diffuse blebs at last follow-up. Success rate without any further surgical intervention was 75%, and success rate with adjunctive needling was 100%. The mean duration of follow-up was 6.3 months (range 1-12 months). CONCLUSION: The approach of tying scleral flap sutures tightly with transconjunctival adjustment of sutures if the IOP is greater than 15 mm Hg on day one allows excellent control of early postoperative IOP.     

Laser suture lysis after trabeculectomy

PURPOSE: The author attempted to avoid ocular hypotony following a mitomycin-C trabeculectomy by controlling the interval between surgery and laser suture lysis. METHODS: When 10 seconds of digital pressure on the eye following a mitomycin-C trabeculectomy produced a 20% drop of the intraocular pressure, the decision of whether or not to perform laser suture lysis was delayed until the following examination. RESULTS: Twenty-nine consecutive eyes (27 patients) with primary open-angle glaucoma underwent mitomycin-C trabeculectomy in which laser suture lysis was required during the postoperative period to reach the target intraocular pressure. The eyes were classified by the severity of the glaucoma: mild, moderate, and severe. For moderate and severe glaucoma, an unqualified success was defined as an intraocular pressure of 10 +/- 2 mm Hg. A qualified success had an intraocular pressure of 5 to 7 mm Hg or 13 to 15 mm Hg. Failure was defined as an intraocular pressure less than 5 mm Hg or greater than 15 mm Hg. Fifteen eyes were called success, 7 eyes qualified success, and 7 eyes failure. When the final laser suture lysis was carried out within the first two postoperative months, two of the failure eyes sustained hypotony. If the final laser suture lysis had been carried out after the first two postoperative months, there were no eyes with hypotony. There was no statistical difference in the final intraocular pressure between the early laser suture lysis and late laser suture lysis groups. CONCLUSIONS: From this pilot study it would appear that delaying the final laser suture lysis following trabeculectomy (MMC) until after the second postoperative month may reduce the risk of hypotony without adversely affecting the final intraocular pressure.     

Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.     

The filtering, clear-cornea diathermal keratostomy: a minor Danish multicenter study

PURPOSE: Is the new micropenetrating, clear-cornea procedure, intrastromal diathermal keratostomy (IDK), an alternative to the intricate "modern trabeculectomy"? METHODS: Prospective multicenter study. Four surgeons from 4 Danish eye departments attended an IDK course and subsequently decided when to start their consecutive IDK series. The data were analyzed centrally. Injection of preoperative, subconjunctival doses of mitomycin C (MMC) was recommended according to risk-of-failure. A total of 54 eyes from 48 patients with advanced and complicated glaucomas (mean age 65 y) and preoperative mean intraocular pressure (IOP) of 29 mm Hg were studied. RESULTS: At 10 months (range: 3 to 34 mo) the total success rate, employing traditional IOP success criteria (IOP< or =18 mm Hg and postoperative IOP decrease > or =30%), was 87% (47 of 54 eyes). In the 69% (37 of 54 eyes) without medication, the final IOP+/-SD was 11+/-3.5 mm Hg. Employing new IOP success criteria (IOP< or =15 mm Hg and postoperative IOP decrease> or =30%) for severe glaucoma (cup/disc ratio> or =0.8) and traditional criteria for moderate glaucoma (cup/disc ratio< or =0.7) the success rates were 76% and 80% and the mean postoperative IOP+/-SD were 10+/-2.5 mm Hg and 13+/-2.5 mm Hg, respectively. No serious complications (malignant glaucoma, endophthalmitis) were seen. The success rate for the most experienced and the less experienced surgeons, with risk-of-failure factors per eye of 1.3 and 1.2, was similar at 88% and 86%, respectively. The "knife time" for the experienced surgeon averaged 15 minutes (range: 10 to 20 min). The success rate (traditional criteria) after IDK revision with internal needling was 69%. CONCLUSIONS: MMC IDK seems to be simpler and quicker than the modern trabeculectomy, and with similar success rate and safety. Revision by internal needling is easy and efficient. Thus, MMC IDK may be a valid alternative and may also be recommended after failed MMC trabeculectomy, replacing shunting. Randomized, controlled studies are indicated.     

复合式小梁切除术治疗原发性闭角型青光眼的临床观察

目的 了解复合式小梁切除术治疗原发性闭角型青光眼(PACG)的眼压控制情况及并发症.方法 回顺性系列病例研究.将PACG分为原发性急性闭角型青光眼(APACG)急性发作期、慢性期及原发性慢性闭角型青光眼(CPACG)慢性期和晚期,分别对复合式小梁切除术患者手术前后眼压、最佳矫正视力、手术并发症等指标进行观察,分析复合式小梁切除术治疗APACG与CPACG的眼压控制情况.采用SPSS 12.0统计学软件进行数据处理.手术后患者视力变化及转归情况的等级资料分析采用秩和检验,组间年龄、眼压等定量资料比较采用独立样本的t检验,手术前后不同时期眼压值的比较采用单因素重复测量资料的方差分析.结果 接受复合式小梁切除术的PACG患者共82例(96只眼).其中APACG患者37例(40只眼),CPACG患者45例(56只眼);术后随访时间(中位数)分别是24个月和25个月,APACG与CPACG患者术后随访时间差异无统计学意义(Z=-0.146,P=0.886).APACG患者术前眼压(53.6±17.9)mm Hg(1 mm Hg=0.133 kPa),术后出院时眼压(10.5±4.9)mm Hg,最终随访时眼压降至(14.0±10.3)mm Hg.CPACG患者的术前眼压(36.8±13.8)mm Hg,术后出院时眼压(11.7±4.2)mm Hg,最终随访时眼压(13.8±4.5)mm Hg.APACG患者(F=100.783)和CPACG患者(F=54.383)手术前与手术后眼压差异均有统计学意义(P<0.01).APACG患者中,有38只眼(95.0%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中急性发作期33只眼,慢性期5只眼.CPACG患者中有50只眼(89.3%)手术后无需使用降眼压药物,眼压即可控制在21 mm Hg以下;其中进展期45只眼,晚期6只眼.所有PACG患者在小梁切除术后均以视力下降比例为高,手术后最常见的并发症为浅前房.结论 复合式小梁切除术后,APACG急性发作期和慢性期及CPACG进展期和晚期的眼压控制均较好,表明小梁切除术是治疗PACG和控制眼压的有效方式之一.但是复合式小梁切除术后视力降低比例较高是不可忽视的重要问题.     

Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma

OBJECTIVE: To establish the efficacy and safety of nonpenetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma. DESIGN: Prospective randomized trial. PARTICIPANTS: Thirty-nine patients (78 eyes) with bilateral primary open angle glaucoma were included in the study. INTERVENTION: Eyes were randomly assigned to receive deep sclerectomy in one eye and trabeculectomy in the other eye. MAIN OUTCOME MEASURES: Mean intraocular pressure (IOP), postoperative medications, visual acuity, success rate, and complications. RESULTS: At 12 months, mean IOP reduction was 12.3 +/- 4.2 (sclerectomy) versus 14.1 +/- 6.4 mmHg (trabeculectomy) (P = 0.15), and an IOP 相似文献   

Trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma: outcomes and risk factors for failure

PURPOSE: To evaluate tonometric outcomes of trabeculectomy with mitomycin C in pseudophakic patients with open-angle glaucoma and associated risk factors for failure. DESIGN: Retrospective cohort study. METHODS: Seventy-three pseudophakic patients (89 eyes) with primary open-angle, normal-tension, exfoliative, or pigmentary glaucoma were recruited. Success rates were defined according to three criteria: (A) intraocular pressure (IOP) < or = 18 mm Hg and IOP reduction > or = 20%; (B) IOP < or = 15 mm Hg and IOP reduction > or = 25%; and (C) IOP < or = 12 mm Hg and IOP reduction > or = 30%. IOP, visual acuity, complications, and additional interventions were documented after surgery. Cox's proportional hazard regression analysis was used to identify risk factors for failure. RESULTS: Mean IOP (+/-SD) decreased from a preoperative value of 18.8 +/- 6.6 mm Hg to 10.2 +/- 5.1 mm Hg at one year and to 10.0 +/- 4.2 at two years (P < .001 for both). Average number of preoperative medications decreased from 3.0 +/- 1.1 to 0.5 +/- 1.0 at one year and to 0.5 +/- 0.9 at two years (P < .001 for both). For criteria A, B, and C, success rates (+/-SE) were 87% +/- 4%, 83% +/- 5%, and 76% +/- 5% at 1 year and 67% +/- 4%, 58% +/- 8%, and 50% +/- 7 at two years. Laser suture lysis was performed in 30 eyes, and 11% of those required a second glaucoma procedure. CONCLUSION: Increasing age, use of a limbus-based conjunctival flap, and performance of laser suture lysis were factors that were associated with a smaller risk of failure. Present findings indicate that trabeculectomy with mitomycin C provides acceptable long-term success rates in pseudophakic patients, with a low incidence of complications.     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.     

A pilot study of deep sclerectomy with implantation of chromic suture material as a collagen implant: medium-term results

AIMS: A pilot study of the safety and efficacy of deep sclerectomy with a chromic suture implant (DSCI) for open angle glaucoma. METHODS: This prospective trial involved 23 eyes of 16 consecutive patients with uncontrolled open angle glaucoma. The DSCI procedure involved radial suturing of a 2 mm piece of 1/0 chromic suture as an implant. Intraocular pressure (IOP) measurements and eye examinations were performed preoperatively and regularly postoperatively for up to 66 months. RESULTS: The mean follow-up period was 36.3 (SD 19.9) months. The mean preoperative IOP was 26.3 (SD 8.5) mmHg. The mean postoperative IOP was 14.1 (SD 2.8) mmHg at month 12, and 16.5 (SD 2.3) mmHg at 36 months. Complete success rate, defined as an IOP lower than 21 mmHg without medication was 77% of eyes at 36 months. Qualified success rate, defined as an IOP lower than 21 mmHg with medication, was 100% at 36 months. Paired t-test and Wilcoxon test analysis of preoperative vs postoperative IOP at 36 months indicated a significant reduction in IOP. Intraoperative complications included rupture of the trabecular meshwork in seven eyes. Exclusion of these patients from the results analysis revealed a mean follow-up of 37.1 months (SD 9), preoperative mean IOP was 25.9 mmHg (SD 4.1), 12-month mean IOP was 13.4 mmHg (SD 2.8), and 36-month mean IOP 16.6 mmHg (SD 2.1). Early postoperative complications included hyphaema in two eyes and dislocation of implant in one eye. One eye developed a central retinal vein occlusion and cataract progression occurred in one eye. The mean postoperative duration of use of topical dexamethasone was 5.4 months (SD 2). CONCLUSIONS: DSCI using a chromic suture implant provides good control of IOP at medium-term follow-up with few postoperative complications. Prolonged use of postoperative anti-inflammatory medication was necessary.     

Secondary developmental glaucoma in eyes with congenital aphakia

Purpose:To describe the clinical spectrum and management of glaucoma in congenital aphakia.Methods:The demographics and clinical spectrum of eyes with congenital aphakia with and without glaucoma were compared, and management outcomes of congenital aphakia cases with glaucoma were studied retrospectively between April 2000 and June 2020.Results:There were a total of 168 eyes (84 subjects) with a diagnosis of congenital aphakia, of which 29 eyes of 18 subjects were diagnosed with glaucoma. Corneal opacity was the presenting complaint in 26/29 eyes with glaucoma and 139/139 eyes without glaucoma. The (interquartile range (IQR)) horizontal corneal diameter was 10.5mm (IQR, 9.0-12.5) and 8mm (IQR, 5-10) in eyes with and without glaucoma (P = 0.01), respectively. The median (IQR) axial length was 17.5mm (IQR, 13.5-19.5) and 15mm (IQR, 14-16) mm in eyes with and without glaucoma (P = 0.03), respectively. Nineteen eyes with glaucoma had adequate intraocular pressure (IOP) control with one medication. Three eyes underwent transscleral diode cyclophotocoagulation and maintained IOP without medications. Three eyes underwent trabeculectomy and trabeculotomy, trabeculectomy followed by penetrating keratoplasty, and trabeculectomy, respectively, of which two eyes became phthisical. At the last follow-up, the median (IQR) IOP was 14 mm Hg (IQR, 14-17) Hg. The median (IQR) follow-up duration was 4.53 months (IQR, 2.03- 48.06).Conclusion:One-fifth of the eyes with congenital aphakia had secondary developmental glaucoma. The corneal diameter and axial lengths were higher in the eyes with glaucoma compared to eyes without glaucoma. Medical management is the preferred short-term mode of IOP control. Transscleral cyclophotocoagulation may be preferred over surgical intervention.     

Viscocanalostomy versus trabeculectomy in white adults affected by open-angle glaucoma: a 2-year randomized,controlled trial

PURPOSE: To compare the effectiveness and safety of viscocanalostomy and trabeculectomy in adults with uncontrolled open-angle glaucoma. DESIGN: Single-masked, parallel-group, prospective, randomized 24-month trial, with 90% power to detect a clinically important difference between groups. PARTICIPANTS: Fifty consecutive patients (50 eyes) with primary open-angle or pseudoexfoliative glaucoma. INTERVENTION: Eyes were assigned randomly to either viscocanalostomy (group 1) or trabeculectomy (group 2) with no intraoperative antifibrotics in the study eye. In group 1, no further intervention was allowed, whereas trabeculectomy eyes could receive subconjunctival 5-fluorouracil (5-FU) injections or laser suture lysis after surgery. MAIN OUTCOME MEASURES: Success rate based on intraocular pressure (IOP), visual acuity, discomfort, and other complications. RESULTS: At the end of the 24-month follow-up, IOP of 21 mmHg or less and more than 6 mmHg was achieved in 76% in group 1 (n = 19) and in 80% in group 2 (n = 20; log-rank P = 0.60); an IOP between 6 and 16 mmHg was obtained in 56% in group 1 (n = 14) and in 72% in group 2 (n = 18; log-rank P = 0.17; Kaplan-Meier cumulative probability of success). Complications of viscocanalostomy included one intraoperative conversion into trabeculectomy; microruptures in Descemet's membrane in five eyes; three cases of iris incarceration in the Decemet's window, two of which caused early failure of the procedure requiring reoperation; and a 1-mm to 2-mm transient self-resolving hyphema in three cases. Complications of trabeculectomy included one case of postoperative bleb bleeding with early transient IOP spike; one early hyphema; five cases of postoperative hypotony, two of which had a positive Seidel test from the conjunctival suture; three cases of transient choroidal detachment, two of which had shallow anterior chamber. No patient required reoperation. Two eyes required argon laser suture lysis, and nine underwent one or more 5-FU injections, which caused punctate keratopathy in three eyes. CONCLUSIONS: Viscocanalostomy is an effective IOP-lowering procedure in white adults affected by open-angle glaucoma. Trabeculectomy with postoperative 5-FU can probably provides lower IOPs but, with more numerous complications, greater discomfort, and more intensive postoperative management.     

Effect of intraoperative intracameral 2% hydroxypropyl methylcellulose viscoelastic during trabeculectomy.

BACKGROUND AND OBJECTIVE: To evaluate the effect of intraoperative intracameral injection of 2% hydroxypropyl methylcellulose (HPMC) on anterior chamber depth and intraocular pressure (IOP) following trabeculectomy in eyes with uncontrolled primary open-angle glaucoma in a prospective randomized manner. PATIENTS AND METHODS: Thirty consecutive eyes with primary open-angle glaucoma scheduled for trabeculectomy were randomized to conventional trabeculectomy without HPMC injection (group I; n = 15) or to intracameral injection of 2% HPMC during trabeculectomy (group II; n = 15). All patients were observed serially on days 1, 3, 5, 7, and 14 and months 1, 3, and 6 postoperatively. The main outcome measure was restoration of anterior chamber depth to preoperative level with IOP of less than 21 mm Hg with no additional antiglaucoma medication or surgery. RESULTS: The anterior chamber depth decreased from 2.5 +/- 0.53 to 1.5 +/- 0.94 mm on postoperative day 1 in group I and increased slightly from 2.4 +/- 0.43 to 2.5 +/- 0.36 mm on postoperative day 1 in group II (P = .04). Overall, the IOP decreased to 5.0 +/- 2.8 mm Hg in group I (87% reduction) and 9.0 +/- 4.6 mm Hg in group II (70% reduction). Two eyes developed postoperative flat anterior chamber and related complications in group I, whereas none of the eyes in group II developed such complications. CONCLUSIONS: Intracameral injection of 2% HPMC during trabeculectomy helps to maintain anterior chamber depth and reduces incidence of complications related to shallow anterior chamber depth following trabeculectomy.     

Quantitative trabeculectomy.

The technique and results of a trabeculectomy are presented where the desired final intraocular pressure (IOP) is obtained by means of adjusting the thickness of sclerocorneal tissue removed to the initial pressure. The procedure was used in 35 eyes with all types of glaucoma and pre-operative pressures of up to 50 mmHg. In 78.3% of cases one operation was sufficient to control the IOP without additional medication. Two eyes had to be reoperated on, and 7 more needed additional pressure-lowering medication. The overall success rate, therefore, rose to 97.3%. The only failure occurred in an eye with irreducible acute angle-closure glaucoma where malignant glaucoma complicated the trabeculectomy. Complications included hyphaema (3), shallow anterior chamber (7)--with or without choroidal detachment--and transient rise in the IOP. All complications subsided with conservative therapy.     

Laser suture lysis or releasable sutures after trabeculectomy

PURPOSE: To compare the efficacy and complication rates of laser suture lysis (LSL) or releasable sutures techniques after trabeculectomy. MATERIALS AND METHODS: Forty-eight eyes of 43 consecutive patients with uncomplicated glaucoma who were recruited for primary trabeculectomy with mitomycin-C were divided into 2 groups. Group 1 and group 2 comprised 27 and 21 eyes that were randomly assigned to a standard surgery and releasable suture groups, respectively. A target intraocular pressure (IOP) had been determined on the basis of the severity of the glaucoma and was called a complete success, qualified success, or failure. RESULTS: In group 1, the mean change in IOP after LSL was 7.31+/-1.98 mm Hg, 6.1+/-1.1 mm Hg, and 3.9+/-1.5 mm Hg when sutures were lysed on the first, second, and third months. In group 2, the mean change in IOP after releasable suture removed was 8.20+/-2.74 mm Hg, 5.12+/-1.65 mm Hg, and 4.4+/-1.0 mm Hg when sutures were released at the first, second, and third months. At the end of 6 months, the success (complete and qualified success) rates were 92% and 90% for LSL and releasable suture groups, respectively. There was no statistically significant differences in success (P>0.05) and complication (P>0.05) rates between groups. CONCLUSIONS: We observed an effective IOP reduction in eyes that had suture release both in the early and late postoperative periods after LSL and suture release. We believe that both the laserable and releasable suture techniques can be preferred to permanent sutures for closing scleral flaps in primary trabeculectomy with mitomycin-C in uncomplicated glaucoma.