[In Press] Long-term efficacy and safety of ExPress implantation for treatment of open angle glaucoma

AIM: To compare the long-term efficacy and safety of ExPress implantation and standard trabeculectomy in patients with primary open angle glaucoma (POAG). METHODS: In this retrospective study, we compared 17 eyes treated by ExPress implantation with 23 eyes treated by trabeculectomy. Efficacy was assessed according to the relevant intraocular pressure (IOP) values and success rates during the first year of follow up. Postoperative corneal endothelial cell loss was also compared. RESULTS: The number of antiglaucoma medications and the IOP reduction were similar between the 2 groups during the follow-up period. Although the mean IOP was similar, the IOP-fluctuation rate during the early postoperative period was significantly lower in the ExPress group than in the trabeculectomy group (P=0.038). A Kaplan-Meier survival curve analysis showed no significant success-rate difference between the groups (P=0.810). The corneal endothelial cell loss rate, moreover, was significantly lower in the ExPress group (P=0.05). CONCLUSION: ExPress implantation compared with trabeculectomy showed similar IOP-reduction and success rates along with lower IOP fluctuation and endothelial cell loss rates. For this reason, it can be considered to be the treatment of choice for patients with advanced glaucoma or low corneal endothelial cell density.     

Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study

PURPOSE: To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. METHODS: The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. RESULTS: Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. CONCLUSION: Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.     

Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

AIM: To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve (AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review. Main outcome measures were surgical failure and complications. Failure was defined as intraocular pressure (IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo, reoperation for glaucoma, or loss of light perception. Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy. RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group. The mean follow-up time was 2.6±1.1y and 3.3±1.6y, respectively. Patients in the AGV group had significantly higher baseline mean IOP (P=0.005), lower baseline mean visual acuity (VA) (P=0.02), and higher proportion of patients with history of previous trabeculectomy (P<0.0001). Crude failure rates were 16.1%, n=5/31 in the Ex-PRESS group and 24.2%, n=8/33 in the AGV group. The cumulative proportion of failure was similar between the groups, P=0.696. The proportion of eyes that experienced postoperative complications was 32.3% in the Ex-PRESS group and 60.1% in the AGV group (P=0.0229). CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates. The AGV group had more post-operative complications, but also included more complex cases with higher baseline mean IOP, worse baseline mean VA, and more previous glaucoma surgeries. Therefore, the results are limited to the cohort included in this study.     

外伤性青光眼引流阀植入术与小梁切除术的疗效对比

目的:比较Ahmed引流阀植入术与小梁切除术治疗外伤性青光眼的效果。方法:前瞻性研究。选取2014年3月至2019年3月杭州市余杭第一人民医院外伤性青光眼120例(124眼),随机分为两组,A组60例(62眼),进行小梁切除术;B组60例(62眼),进行Ahmed引流阀植入术。术后随访12个月,比较两组手术疗效。结果:...     

Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap

PURPOSE: To evaluate the Ex-PRESS miniature implant (Model R 50) placed under partial-thickness scleral flap compared with standard trabeculectomy. METHODS: In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) > or =5 mm Hg and < or =21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week. RESULTS: The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001). CONCLUSIONS: The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.     

三种手术方式治疗青光眼合并白内障疗效的比较

目的 探讨治疗青光眼合并白内障3种手术方式的适应证和临床疗效.方法 对青光眼合并白内障患者135例152只眼进行手术分组:其中30例36只眼先行抗青光眼手术,待白内障发展到一定程度再行白内障手术,即所谓的两阶段手术(A组);87例98只眼行-白联合手术-复合式小梁切除联合小切口白内障晶体吸除+人工晶状体植入术(B组);18例18只眼行单纯白内障手术+人工晶状体植入术(C组).比较不同适应证下3种手术方式的临床疗效,包括眼压控制情况、角膜内皮细胞、视力以及术后并发症等.随访时间(12±1)月.结果 均经统计学处理.结果 手术前后视力≥0.2的眼数3组比较,差异有统计学意义(x~2=16.00,P<0.01).A组与B组手术前后眼压有显著性差异(t_1=1.89,P_1=0.01:t_2=2.87,P_2=0.03),C组手术前后无显著性差异(t=0.43,P=0.78).术前术后角膜内皮细胞数量无显著性差异(P>0.05),3组均未见严重术中并发症,其个A组滤泡形成良好,眼压控制满意,B组术后角膜水肿17例,未特殊处理,1周后全部消退;有2只眼出现瞳孔区纤维膜,滤泡形成欠理想.C组术后视力均显著捉高,有2只眼轻度角膜水肿,有2只眼需加用药物控制眼压,其中1只眼最后接受抗青光眼手术.结论 青光眼合并白内障患者应根据具体情况选择适当的手术方式,以获得较好的视力和眼压控制.     

新型弹性开放襻前房型人工晶状体的长期疗效观察

目的探讨新型弹性开放襻前房型人工晶状体(ACIOL)植入的手术方法,评价其长期疗效和安全性。方法对34只眼行白内障摘除联合前段玻璃体切除及Ⅰ期ACIOL植入术、49只术后无晶状体眼行Ⅱ期ACIOL植入术。年龄16～80岁,平均43.5岁。检查视力、眼压、角膜内皮细胞、房角和手术并发症等情况。随访3～7年,平均4.8年。结果65只眼(78.3%)术后最佳矫正视力≥0.5,Ⅱ期植入者裸眼或矫正视力均达到术前最佳矫正视力。眼压术前平均为(13.55±3.21)mmHg(1mmHg=0.133kPa),末次随访时(13.40±4.29)mmHg(t=0.5427,P=0.5888)。角膜内皮细胞密度:Ⅰ期植入组术前平均为(2497±629)个/mm2,末次随访时(1995±648)个/mm2,细胞损失率为(20.6±14.1)%;Ⅱ期植入组分别为(2459±681)个/mm2,(2238±817)个/mm2和(10.0±17.4)%。两组比较,Ⅰ期植入组损失率较高(P=0.023)。人工晶状体(IOL)支点多位于房角隐窝或巩膜突,少数位于虹膜根部或小梁网,未见有触及角膜内皮细胞者。小梁网色素较术前有不同程度地增加。术后早期并发症:高眼压7只眼(8.4%)、低眼压5只眼(6.0%)、前房出血2只眼(2.4%)、IOL旋转及移位3只眼(3.6%);晚期并发症有继发性青光眼2只眼(2.4%)、瞳孔变形1只眼(1.2%)、视网膜脱离2只眼(2.4%)和角膜内皮功能失代偿2只眼(2.4%)。结论新型弹性开放襻前房型人工晶状体植入术对于无囊膜支撑的无晶状体眼是一种可选择的手术方式,术后需长期随访以及时发现和处理并发症。严格掌握手术适应证并注重手术技巧,可以减少手术并发症。     

Deep sclerectomy with a nonabsorbable implant (T-Flux): preliminary results

BACKGROUND: Deep sclerectomy is one of the two main types of nonpenetrating surgical methods of treating open-angle glaucoma. We aimed to determine, in a prospective study, the efficacy, success rate and complications of deep sclerectomy with implantation of a nonabsorbable drain made of highly hydrophilic acrylic (T-Flux). METHODS: Twenty-five patients (25 eyes) with medically uncontrolled open-angle glaucoma were treated by deep sclerectomy with implantation of the T-Flux drain. We determined the rates of intraocular pressure (IOP) reduction, surgical success (four categories) and complications. To evaluate the efficacy of this new implant in detail, we compared the success rates with those in a group of patients matched for age, sex, diagnosis, preoperative IOP, number of preoperative antiglaucoma medications and previous ocular surgery who underwent successful viscocanalostomy. RESULTS: For two eyes in the deep-sclerectomy group, surgery was converted to standard trabeculectomy owing to perforation of the trabeculo-Descemet's membrane during dissection of the corneal stroma. The following results apply to the remaining 23 eyes. After a mean follow-up period of 16.21 (standard deviation [SD] 3.93) months, the mean IOP had fallen from 26.26 (SD 4.3) mm Hg preoperatively to 17.60 (SD 4.35) mm Hg at the last postoperative visit (p = 0.000). The rate of complete success (IOP < 21 mm Hg without medication) was 86.9% at 1 month, 56.5% at 12 months and 39.1% at the last visit. The rates of qualified success (IOP < 21 mm Hg with or without medication) were 95.6%, 91.3% and 82.6%, respectively. No postoperative complications of the type that might occur after trabeculectomy were observed. Three eyes with an insufficient reduction in IOP underwent goniopuncture with a neodymium:YAG laser. Statistical analysis of the success rates revealed that deep sclerectomy with T-Flux implantation was comparable to viscocanalostomy at all postoperative visits (p > 0.05). INTERPRETATION: A statistically significant drop of IOP with few postoperative complications over the short term was achieved with deep sclerectomy and T-Flux implantation. The success rates were comparable to, and not significantly better than, those of viscocanalostomy.     

Phacoemulsification in eyes with functioning filtering blebs: a prospective study

OBJECTIVE: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. INTERVENTION: Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year. MAIN OUTCOME MEASURES: Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. RESULTS: The mean (+/- standard deviation) IOP before phacoemulsification was 12.24 (+/- 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (P < 0.005). Bleb size decreased after phacoemulsification (P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. CONCLUSIONS: Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.     

小梁切除联合超声乳化白内障吸除术与分阶段手术的对比分析

目的:比较小梁切除联合超声乳化白内障吸除术和分阶段手术治疗青光眼合并白内障的临床疗效。方法:青光眼合并白内障患者施行小梁切除联合超声乳化白内障吸除术82例(82眼)为联合手术组,先施行小梁切除术后施行超声乳化白内障吸除术38例(38眼)为分阶段手术组。比较两组术后视力、眼压、手术并发症和角膜内皮细胞丢失率等。结果:两组术后均随访3mo以上。视力:≥0.5联合手术组56眼(68.3%),分阶段手术组30眼(78.9%);≥1.0联合手术组26眼(31.7%),分阶段手术组6眼(15.8%),两组比较差异无显著性(χ2=1.452和3.364,P>0.05)。眼压:两组术后随访平均眼压分别为(11.08±4.68)mmHg和(11.57±3.25)mmHg,两组比较差异无显著性(t=0.587,P>0.05)。手术并发症:联合手术组多于且重于分阶段手术组,但均经常规治疗后恢复正常。角膜内皮细胞丢失率:联合手术组平均为(20.06±18.03)%,分阶段手术组为(15.07±15.22)%,两组比较差异无显著性(t=0.996,P>0.05)。结论:小梁切除联合超声乳化白内障吸除术和分阶段手术均是治疗青光眼合并白内障的安全、有效方法。     

小梁切除术与Ahmed植入术治疗穿透性角膜移植术后继发青光眼的疗效比较

目的 探讨小梁切除(TRA)术与Ahmed 阀(AGV)植入术治疗穿透性角膜移植术后继发青光眼(post-penetrating keratoplasty glaucoma,PKG)的临床疗效与角膜植片安全性.方法 回顾分析我院2015 年4 月至2018年4 月PKG患者47例47 眼,按手术方式分TRA组与AGV组...     

Efficacy and safety of adjunctive mitomycin C during Ahmed Glaucoma Valve implantation: a prospective randomized clinical trial

PURPOSE: To evaluate the efficacy and safety of intraoperative mitomycin C (MMC) in eyes undergoing Ahmed Glaucoma Valve implantation. DESIGN: Randomized controlled clinical trial. PARTICIPANTS: Sixty patients with refractory glaucoma. INTERVENTION: Sixty eyes of 60 patients with refractory glaucoma were randomized to receive intraoperative MMC (0.5 mg/ml for 5 minutes) (n = 34) or balanced salt solution (n = 26) during Ahmed Glaucoma Valve implantation. MAIN OUTCOME MEASURES: Surgical success was defined according to 2 different criteria: (1) postoperative intraocular pressure (IOP) between 6 and 21 mmHg, with or without antiglaucoma medications, and (2) IOP reduction of at least 30% relative to preoperative values. Eyes requiring additional glaucoma surgery, developing phthisis, or showing loss of light perception were classified as failures. Success rates in both groups were compared using Kaplan-Meier survival curves and the log rank test. Other outcome measures were mean IOP, number of glaucoma medications, and complications. RESULTS: After a mean follow-up of 12.3 months, Kaplan-Meier survival analysis showed a probability of success of 59% at 18 months for the MMC group and 61% for the control group when the first criterion for success was used (IOP between 6 and 21 mmHg). When an IOP reduction of at least 30% was used as the criterion to define success, the Kaplan-Meier survival analysis demonstrated a probability of success at 18 months of 62% for the MMC group and 67% for the control group. There were no significant differences in survival rates between the 2 groups with either criterion (P = 0.75 and P = 0.37, respectively). After 15 days postoperatively, the mean IOP did not significantly differ for both MMC and control eyes. Mean numbers of postoperative antiglaucoma medications were similar in MMC-treated eyes and controls. There was no significant difference between the incidences of postoperative complications in both groups. CONCLUSION: Mitomycin C did not increase the short- or intermediate-term success rates of Ahmed Glaucoma Valve implantation.     

超声乳化白内障吸除联合青光眼黏弹剂小管扩张术的临床疗效观察

目的　评价超声乳化白内障吸除折叠式人工晶状体 (IOL)植入联合黏弹剂小管扩张术(V P术 )的安全性和有效性。方法　收集 2 8例 (30只眼 )因白内障合并原发性开角型青光眼行V P术患者 (V P组 )的临床资料 ,总结和分析患者的视力、眼压及手术并发症的发生情况 ,并与行超声乳化白内障吸除折叠式IOL植入联合小梁切除术 (T P术 )的 2 7例 (2 8只眼 )白内障合并青光眼患者 (T P组 )进行比较。术后随访时间 6个月。结果　术后 6个月 ,V P组平均眼压为 (14 6 5± 2 70 )mmHg(1mmHg=0 133kPa) ,较术前降低 10 33mmHg ,差异有显著意义 (P =0 0 0 0 ) ;术后 1周、1个月、6个月两组降眼压效果比较 ,差异均无显著意义 (P =0 6 6 1,0 381,0 5 2 6 )。V P组术后 1周、1个月、6个月最佳矫正视力≥ 0 5的眼数占随访眼数的百分比分别为 6 2 1% (18/ 2 9)、71 4 % (2 0 / 2 8)及 80 0 % (2 4 /30 ) ,与T P组比较 ,差异均无显著意义 (P =0 6 2 1,0 70 2 ,0 893)。V P组术中并发症包括小梁网Descemet膜穿破和Schlemm管刺破 (各 2只眼 ) ,术后 2 4h一过性眼压升高 (4只眼 ) ,无其他严重并发症。T P组术后并发症包括前房明显炎性反应 (6只眼 ) ,少量前房出血和脉络膜脱离 (各 1只眼 )。结论　V P术疗效好、并发症     

Outcome of trabeculectomy with mitomycin-C in the iridocorneal endothelial syndrome

PURPOSE: Eyes with iridocorneal endothelial (ICE) syndrome have a high risk of failure in glaucoma filtering surgery failing. We investigated the efficacy of trabeculectomy with intraoperative mitomycin-C application in these patients. DESIGN: Retrospective nonrandomized comparative trial with historical controls. PARTICIPANTS AND CONTROLS: Ten patients with unilateral iridocorneal endothelial (ICE) syndrome were reviewed. Their intraocular pressures could not be controlled medically. In five eyes, this was the primary surgery performed. Five of the patients had undergone prior intraocular pressure-(IOP) lowering surgery that had failed at the time enrolled. Results were compared with previously published case series of similar patients treated with trabeculectomy alone or trabeculectomy and subconjunctival 5-fluorouracil injections. INTERVENTION: Intervention consisted of trabeculectomy with a limbus-based conjunctival flap and mitomycin-C application. The dosage of mitomycin-C was 0.4 mg/ml for 1 to 4 minutes (mean, 1.9 min). MAIN OUTCOME MEASURES: Adequate control of IOP (without medication lower than 21 mm Hg). RESULTS: In eight eyes the IOP remained well controlled (mean IOP, 12.1 mm Hg) over the entire length of available of follow-up (mean, 14.9 months). Two eyes required implantation of an aqueous tube shunt at 4 and 11 months, respectively, after trabeculectomy with mitomycin-C. One eye experienced visual loss of 3 Snellen lines because of hypotony maculopathy. CONCLUSIONS: Trabeculectomy with mitomycin-C application offers a reasonable intermediate-term success rate in ICE patients, who are otherwise at high risk for failure of filtering surgery.     

Efficacy and safety of intravitreal ranibizumab with panretinal photocoagulation followed by trabeculectomy compared with Ahmed glaucoma valve implantation in neovascular glaucoma

AIM: To evaluate the efficacy and safety of intravitreal ranibizumab (IVR) with panretinal photocoagulation (PRP) followed by trabeculectomy compared with Ahmed glaucoma valve (AGV) implantation in neovascular glaucoma (NVG). METHODS: This was a retrospective comparative study. We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included: diabetic retinopathy (25 eyes), and retinal vein occlusion (20 eyes). All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities (BCVA) were converted to the logarithms of the minimum angle of resolution (logMAR) for the statisitical analyses. Intraocular pressure (IOP), the logMAR BCVA and surgical complications were evaluated before and after surgery. The follow-up period was 12mo. RESULTS: A total of 39 cases showed complete regression of iris neovascularization at 7d after injection, and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12mo after trabeculectomy and AGV implantation, respectively. In the trabeculectomy group, the logMAR BCVA improved at the last follow-up in 14 eyes, remained stable in 6 eyes and decreased in 2 eyes. In 4 cases, slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group, the logMAR BCVA improved in 14 eyes, remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases, and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery (F=545.468, P<0.05), and the mean postoperative logMAR BCVA was also significantly improved (F=10.964, P<0.05) with no significant difference between two groups. CONCLUSION: It is safe and effective to treat NVG with this combined procedure, and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.     

高三尖杉酯碱用于青光眼滤过术的临床随机对照研究

目的研究高三尖杉酯碱（ｈｏｍｏｈａｒｉｎｇｔｏｎｉｎｅ）在青光眼滤过术中的抗增殖作用。方法采用随机对照的临床验证方法,施行同一标准的小梁切除术,将７８例（８８只眼）难治性青光眼分为用药组４２例（４６只眼）和对照组３６例（４２只眼）。用药组术中应用高三尖杉酯碱０４ｍｇ,术后再分次结膜下注射高三尖杉酯碱０６２±０２０ｍｇ（范围０５３～０７５ｍｇ）;对照组未用高三尖杉酯碱。术后随访观察１８～４８个月（平均３６个月）。采用寿命表分析法统计。结果手术成功率：用药组为８４５％,对照组为５０９％（Ｐ＜０．０５）。功能性滤过泡的累计百分率：用药组为８４２％,对照组为５２９％（Ｐ＜０．０５）。并发症：用药组的角膜上皮缺损和结膜伤口渗漏发生率分别为２３９％和６５％,对照组为７１％和２４％（Ｐ＜０．０５）。用药组的角膜内皮细胞数在用药前后差异无显著性（Ｐ＞０．０５）。结论高三尖杉酯碱是安全有效的抗增殖药物,可明显提高青光眼滤过术的成功率,至少可在术后３年内将眼压维持在正常水平。     

Treatment outcomes in the tube versus trabeculectomy study after one year of follow-up

PURPOSE: To report one-year results of the Tube Versus Trabeculectomy (TVT) Study. DESIGN: Multicenter randomized clinical trial. METHODS: Setting: 17 Clinical Centers. Study Population: Patients 18 to 85 years of age who had previous trabeculectomy and/or cataract extraction with intraocular lens implantation and uncontrolled glaucoma with intraocular pressure (IOP) > or =18 mm Hg and < or =40 mm Hg on maximum tolerated medical therapy. Interventions: 350 mm(2) Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC). Main Outcome Measures: IOP, visual acuity, and reoperation for glaucoma. RESULTS: A total of 212 eyes of 212 patients were enrolled, including 107 in the tube group and 105 in the trabeculectomy group. At one year, IOP (mean +/- SD) was 12.4 +/- 3.9 mm Hg in the tube group and 12.7 +/- 5.8 mm Hg in the trabeculectomy group (P = .73). The number of glaucoma medications (mean +/- SD) was 1.3 +/- 1.3 in the tube group and 0.5 +/- 0.9 in the trabeculectomy group (P < .001). The cumulative probability of failure during the first year of follow-up was 3.9% in the tube group and 13.5% in the trabeculectomy group (P = .017). CONCLUSIONS: Nonvalved tube shunt surgery was more likely to maintain IOP control and avoid persistent hypotony or reoperation for glaucoma than trabeculectomy with MMC during the first year of follow-up in the TVT Study. Both surgical procedures produced similar IOP reduction at one year, but there was less need for supplemental medical therapy following trabeculectomy with MMC.     

采用1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障

目的　探讨采用1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障的有效性和安全性。方法　选取2016年4月至2019年3月在我院就诊的难治性青光眼合并白内障患者 61 例 61 眼。随机分为观察组和对照组,观察组31例(31眼),对照组30例(30眼)。观察组患者行1.8 mm同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术;对照组患者行1.8 mm 同轴微切口晶状体超声乳化术联合小梁切除术。所有患者随访时间均大于6个月,观察并记录两组患者的眼压、最佳矫正视力（best corrected visual acuity,BCVA）、功能性滤过泡、中央前房深度、角膜内皮细胞密度、抗青光眼药物种数、手术成功率以及并发症,对两组各指标进行统计学分析。结果　两组患者术后各时间点眼压与术前比较均明显降低,差异均有统计学意义(均为P<0.01)。术后１个月、3个月及６个月时观察组眼压均较对照组低,差异均有统计学意义(均为P<0.05)。术后各时间点两组患者BCVA均较术前提高,差异均有统计学意义(均为P<0.01);在术后随访1周后的各个时间点,观察组的BCVA均较对照组提高,差异均有统计学意义(均为P<0.05)。在术后6个月时,观察组31眼有功能性滤过泡,对照组25眼有功能性滤过泡。两组患者术后6个月时中央前房深度均较术前加深,差异均有统计学意义(均为P<0.01)。两组患者术前、术后6个月时角膜内皮细胞密度相比,差异均无统计学意义(P_术前=0.949,P_术后=0.401)。术后6个月时观察组患者使用的抗青光眼药物种数少于对照组,差异有统计学意义(P<0.05)。无论按照传统标准或优化标准,观察组手术成功率均高于对照组（均为P<0.05）。观察组有1眼术后出现低眼压。对照组有2眼术中出现少许前房出血;术后有3眼出现低眼压、浅前房;有1眼术后出现脉络膜脱离。给予患者对症治疗后均恢复正常。结论　1.8 mm 同轴微切口晶状体超声乳化术联合Ahmed引流阀植入术治疗难治性青光眼合并白内障是一种安全、有效的手术方式。     

Long-term Outcomes of Domestic Hunan Aqueous Drainage Implantation in Refractory Glaucoma

 Purpose:To evaluate the long-term outcomes of a non-valved, Chinese-made Hunan aqueous drainage device (HAD) in patients with refractory glaucoma, compared to trabeculectomy. Methods:This was a retrospective observational case series, including 27 patients with refractory glaucoma who either underwent HAD implantation (n=11) or trabeculectomy (n=16). The mean follow-up was 27.9±13.5 (mean±SD) months. Intraocular pressure (IOP), visual acuity and postoperative complications were measured. Results:IOP was significantly lower at the last follow-up in both two groups compared with the baseline IOP (HAD: 58.4 to 10.0 mmHg, P>0.001; trabeculectomy:58.4 to 23.7 mmHg, P<0.001). One week,1 month and 1 year after the operation, the average IOP of the HAD group was significantly lower than that of trabeculectomy group (P<0.05 at all time points). However, , the IOP did not differ significantly between the two groups at the time of last follow-up. Conclusion:HAD implantation serves as a good option to control IOP in refractory glaucoma.     

青光眼合并白内障患者的围手术期处理

目的:探讨青光眼合并白内障患者进行综合因素处理的临床效果。方法:对65例79眼青光眼合并白内障患者进行耐心的心理疏导和认真的术前准备后于表面麻醉下行小切口手法碎核白内障摘除、人工晶状体植入术联合小梁切除术,观察麻醉效果、眼压、术后视力,角膜内皮细胞等情况。结果:有97.5%患者对麻醉效果满意。术后视力均有所提高。眼压控制良好。术后角膜内皮细胞平均丢失率6.9%。结论:对青光眼合并白内障患者选择表面麻醉下小切口手法碎核白内障摘除、人工晶状体植入术联合小梁切除术是安全、有效的,可以提高患者的生活质量。