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1.
PURPOSE: To evaluate the safety and efficacy of mini-trabeculectomy in comparison to conventional trabeculectomy in primary open angle glaucoma (POAG). METHODS: A prospective interventional study of mini-trabeculectomy versus conventional trabeculectomy was undertaken on 60 eyes of 54 medically uncontrolled POAG patients requiring glaucoma surgery. They were divided into two groups: Group I underwent mini-trabeculectomy (30 eyes of 26 patients) and Group II underwent conventional trabeculectomy (30 eyes of 28 patients). All patients were followed up for at least 15 months. Statistical analysis was carried using Student's t test and paired t test for quantitative data and Pearson's chi-square test for qualitative data. RESULTS: The mean intraocular pressures (IOP) at the end of 15 months of follow-up in Groups I and II were 15.80+/-4.3 mmHg and 16.13+/-3.3 mmHg versus mean preoperative IOP of 28.63+/-2.74 and 28.60+/-2.44, p<0.0001, respectively. The difference in IOP control was significant only at 6 months of follow up (13.65+/-3.45 versus 15.98+/-4.05, p=0.041). The complications and failure were comparatively less in Group I. CONCLUSIONS: Mini-trabeculectomy is a safe and effective alternative to conventional trabeculectomy in terms of IOP control. A modified tunnel incision employed in mini-trabeculectomy may be responsible for avoiding some of the complications.  相似文献   

2.
PURPOSE: To determine the long-term intraocular pressure (IOP) control and postoperative complications after initial trabeculectomy with use of mitomycin C (MMC) in patients with primary open-angle glaucoma (POAG). PATIENTS AND METHODS: A retrospective review was conducted of a consecutive series of 123 eyes (87 patients) with POAG who underwent initial trabeculectomy with MMC and had at least 4 years of follow-up. All patients underwent standard trabeculectomy with 0.04% MMC applied intraoperatively for 3 minutes. The long-term outcomes (IOP control and bleb leak, long-standing hypotony, bleb-related infections) were analyzed with the Kaplan-Meier life-table method on the basis of three definitions of successful IOP control (defined as IOP <18 mmHg (definition 1), IOP <16 mmHg (definition 2), and IOP decrease of by > or =30% and <21 mmHg (definition 3)). RESULTS: The mean follow-up time was 6.8+/-1.4 (mean+/-SD) years. The cumulative survival rates were 67.0+/-4.6%, 44.5+/-5.4%, and 74.1+/-4.2%, respectively, based on definitions 1, 2, and 3, 8 years postoperatively by life-table analysis. At 8 years, bleb leak occurred in 7.9+/-2.6% of eyes, long-standing hypotony in 8.3+/-2.5%, and bleb-related infections in 5.9+/-2.4%. CONCLUSION: Long-term outcome after initial trabeculectomy with MMC in Japanese POAG patients is comparable with that reported in other populations and with that after trabeculectomy with 5-fluorouracil.  相似文献   

3.
目的观察改良的黏弹剂Schlemm管切开术(VCO)和小梁切除术(TE)治疗原发性开角型青光眼的疗效和安全性。方法采用前瞻性随机对照方法,对100例(100只眼)药物控制眼压不理想的原发性开角型青光眼患者,随机分为改良VCO组50例(50只眼),TE组50例(50只眼),术后平均随访28个月。结果手术后1个月,改良VCO组和TE组患者的平均眼压分别为(11.22±4.34)和(12.35±3.79)mmHg(1mmHg=0.133kPa),手术成功率(术后未用任何降眼压药物眼压〈21mmHg)均为98.0%;手术后12个月,两组的平均眼压分别为(14.50±3.22)和(16.58±4.73)mmHg,手术成功率分别为87.5%和70.0%,两组差异有统计学意义(P〈0.05);手术后24个月,两组的平均眼压分别为16.0和15.4mmHg,手术成功率分别为76.1%和67.3%,两组差异无统计学意义(P〉0.05);早期并发症如浅前房、脉络膜脱离、囊样滤过泡等以TE组明显多于改良VCO组,两组差异有统计学意义(P〈0.01)。结论在治疗原发性开角型青光眼方面,改良VCO组的成功率较TE组高.术后早期并发症相对较少.  相似文献   

4.
PURPOSE: To compare the efficacy and safety of viscocanalostomy and trabeculectomy in patients with primary open-angle glaucoma (POAG). SETTING: Department of Ophthalmology, Ankara Education and Research Hospital, Ankara, Turkey. METHODS: In this prospective randomized trial, 50 eyes of 50 patients with medically uncontrolled POAG were randomized to have a trabeculectomy (25 eyes) or a viscocanalostomy (25 eyes). Visual acuity, intraocular pressure (IOP), and slitlamp examinations were performed before surgery and 1 day, 1 week, 1, 3, and 6 months, and 1, 2, and 3 years postoperatively. RESULTS: At 3 years, the mean IOP was 16.0 mmHg +/- 7.07 (SD) in the trabeculectomy group and 17.8 +/- 4.6 mmHg in the viscocanalostomy group (P=.694). Complete success (IOP 6 to 21 mm Hg without medication) was achieved in 66.2% of eyes at 6 months and 55.1% at 3 years in the trabeculectomy group and in 52.9% and 35.3%, respectively, in the viscocanalostomy group (P>.05). Qualified success (IOP 6 to 21 mmHg with medication) was achieved in 95.8% of eyes at 6 months and 79.2% at 3 years in the trabeculectomy group and in 90.7% and 73.9%, respectively, in the viscocanalostomy group (P>.05). Postoperative hypotony and cataract formation occurred more frequently in the trabeculectomy group than in the viscocanalostomy group (P=.002). CONCLUSIONS: Primary trabeculectomy lowered IOP more than viscocanalostomy in POAG patients. However, the complication rate was lower in the viscocanalostomy group.  相似文献   

5.
Lai JS  Poon AS  Tham CC  Lam DS 《Ophthalmology》2003,110(9):1822-1826
PURPOSE: To evaluate the long-term outcome and complications of trabeculectomy with beta radiation. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Forty-three patients with confirmed primary open-angle glaucoma (POAG), who received trabeculectomy with adjunctive beta radiation at the Prince of Wales Hospital between June 1991 and November 1994. METHODS: Patients fulfilling the preceding criteria were followed up longitudinally. The visual acuity, intraocular pressure (IOP), bleb morphology, and complications were evaluated. MAIN OUTCOME MEASURES: Visual acuity, IOP, bleb morphology, complications. RESULTS: Forty-three eyes of 43 consecutive Chinese patients were recruited and successfully followed up for a minimum of 7 years. The mean age +/- 1 standard deviation (SD) was 60.9 +/- 13.0 years. There were 29 males and 14 females. The mean baseline IOP +/- 1 SD was 28.3 +/- 5.8 mmHg. The mean postoperative IOP +/- 1 SD after the initial trabeculectomy was 11.9 +/- 4.3 mmHg, and the mean number of preoperative IOP-lowering eyedrops +/- 1 SD was reduced from 2.8 +/- 0.5 to 0.7 +/- 1.0 at 7 years follow-up. The qualified success rate at 7 years follow-up, defined as IOP 相似文献   

6.
目的 观察原发性开角型青光眼患者单眼行外路小梁切除术后对侧眼眼压变化趋势.方法 回顾性分析2016年12月至2021年1月于我院行单眼外路小梁切除术的37例原发性开角型青光眼患者资料,随访并记录患者术后1d、2d、3d、1周、2周、1个月和3个月对侧未手术眼眼压,与术前基线眼压比较.结果 术后1d、2d、3d及1周、2...  相似文献   

7.
It has recently become popular to use mitomycin C (MMC) with trabeculectomy. MMC helps to maintain effective filtration and long-term intraocular pressure (IOP) control, while the use of laser suture lysis has improved the safety of this procedure. We evaluated the outcome of trabeculectomy alone and of trabeculectomy plus phacoemulsification (PEA) and intraocular lens (IOL) implantation, each supplemented with MMC. The mean preoperative IOP for the trabeculectomy alone group was 22.4 +/- 3.2 mmHg(bleb+), 25.3 +/- 2.6 mmHg(bleb-), and that of the combined surgery group was 22.4 +/- 2.8 mmHg(bleb+), 21.0 +/- 3.5 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.3 +/- 2.7 mmHg(bleb+), 17.1 +/- 4.4 mmHg(bleb-) and 11.9 +/- 2.7 mmHg(bleb+), 16.4 +/- 3.4 mmHg(bleb-), respectively. After 4.5 years, the success probability for postoperative IOP control was 38%(bleb+), 3%(bleb-) in the trabeculectomy alone group and 53%(bleb+), 10%(bleb-) in the combined surgery group (相似文献   

8.
小梁切除联合羊膜移植治疗难治性青光眼   总被引:12,自引:0,他引:12  
陆华文  麦丹 《眼科学报》2003,19(2):89-91
目的:探讨小梁切除联合羊膜移植术治疗难治性青光眼的疗效。方法:对16例(17只眼)难治性青光眼行小梁切除联合羊膜移植术。术后随访 3~24个月,平均11.2个月。结果:术前平均眼压为(39.72±7.26)mmHg(1mmHg=0.133kPa);术后3个月眼压降至(14.62±3.72)mmHg,差异有显著性意义(t=11.73 P<0.001)。术后早期均形成弥散的滤过泡。术后3个月随访中,17只眼有16只眼有功能性滤过泡;术后6个月随访中16只眼有14只眼有功能性滤过泡。术后前房反应轻,无其它并发症。结论:小梁切除联合羊膜移植术是治疗难治性青光眼的一种安全、有效方法。眼科学报2003;19:89-91。  相似文献   

9.
PURPOSE: This study was conducted to evaluate prospectively the surgical outcome in terms of intraocular pressure (IOP) control and safety of trabeculectomy using a sutureless scleral tunnel technique in patients with uncomplicated primary open-angle glaucoma (POAG). METHODS: Patients with POAG whose IOP was more than 21 mmHg with administration of maximally tolerated medications were recruited for this study. All patients underwent the sutureless scleral tunnel trabeculectomy under retrobulbar anesthesia. Intraoperative complications and postoperative visual acuity, IOP, bleb status, and complications were evaluated for a follow-up period of 1 year. RESULTS: Surgery was performed in 18 patients (20 eyes); 17 of the patients (19 eyes) completed the study (one patient was excluded because of defaulted follow-up). Mean IOP was 26.6 +/- 3.6 mmHg before surgery and 15.3 +/- 3.0 mmHg 1 year after surgery. No intraoperative complications were encountered. Mild hyphema (10.5%) and shallow anterior chamber (15.8%) were noted in the immediate postoperative period, but both were managed successfully with conservative treatment. The absolute success rate was 79.0%. CONCLUSION: The preliminary results of this study are encouraging. It appears that sutureless scleral tunnel trabeculectomy is a safe and effective drainage procedure for treating uncomplicated POAG. A larger-scale study with a longer follow-up period seems warranted.  相似文献   

10.
PURPOSE: To investigate the incidence and course of encapsulated filtering blebs (EB) following primary standard trabeculectomy in eyes with non-complicated glaucoma. MATERIALS AND METHODS: Records of patients who were being followed-up in Ankara Numune Hospital, 1st Eye Clinic Glaucoma Department were analyzed and 183 eyes of 183 consecutive patients who underwent primary trabeculectomy without antimetabolites were enrolled in the study. RESULTS: Encapsulation developed in 14 (7.6%) of 183 eyes and identification of bleb encapsulation occurred at a mean follow-up time of 5.1 +/- 5.0 weeks (median = 4 weeks). Mean intraocular pressure (IOP) levels before, during, and after the encapsulated bleb phase were 14.1 +/- 3.6, 23.4 +/- 6.9, and 14.4 +/- 3.9 mm Hg respectively. All eyes responded to conservative medical treatment consisting of aqueous suppressants without digital massage, and encapsulation resolved after a mean duration of 8.3 +/- 4.6 weeks (median = 8 weeks). Patient age, gender, glaucoma diagnosis, and preoperative IOP levels were not significantly related with the occurrence of EB formation. There was no significant difference in the use of topical beta-blockers and miotics in patients that developed EB versus those who did not; however, EB developed only in eyes with prior beta-blocker therapy and no encapsulation occurred in the 16 eyes that had not received topical beta-blockers. Mean duration of follow-up was 45.3 +/- 30.7 months (12 to 127 months) in the group without encapsulation and 44.6 +/- 22.7 months (18 to 84 months) in the EB group. Overall success rates of trabeculectomies in eyes with and without EB were not significantly different (100% and 91.7%, respectively). Complete surgical success, however, without antiglaucomatous medications at the last visit was significantly lower in eyes with prior encapsulation (35.7% with EB, 63.9% without EB) (P = 0.014). CONCLUSION: Filtering bleb encapsulation following primary trabeculectomy responds well to conservative medical IOP-lowering therapy in eyes with glaucoma associated with elevated IOP.  相似文献   

11.
AIM: To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. METHODS: This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean preoperative IOP was 25.8+/-7.3 mmHg; the IOP significantly decreased to 14.6+/-3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively (P=0.000). At 1 year, the complete success rate (IOP相似文献   

12.
小瓣小梁切除术治疗青光眼   总被引:1,自引:0,他引:1  
方爱武  徐明  李英姿  叶良 《眼科学报》2001,17(4):239-240
目的探讨小瓣小梁切除术治疗青光眼的方法及效果.方法治疗组各型青光眼40例40眼,行小瓣小梁切除术,巩膜瓣2 mm×2 mm,小梁切除1 mm×1 mm.对照组各型青光眼40例40眼,行复合式小梁切除术,巩膜瓣4 mm×3 mm,小梁切除1.0mm×3.0 mm.观察术后眼压及浅前房等并发症,并进行比较.结果治疗组术前眼压44.11±14.86 mmHg(1 mmHg=0.133 kPa),对照组术前眼压为46.45±11.27.随访12~18月,术后最后随访眼压治疗组为12.94±4.13 mmHg,对照组为13.51±3.56mmHg,两组差异无显著意义(t=0.66,P>0.05).浅前房发生率治疗组为16%(6/40),对照组2.6%(1/40),两组差异无显著意义(X2=1.59<3.84,P>0.05).结论小瓣小梁切除术是一种安全、有效的抗青光眼滤过手术.眼科学报2001;17239~240.  相似文献   

13.
PURPOSE: To evaluate the safety and efficacy of fornix-based conjunctival flap versus limbal-based flap in initial trabeculectomy with postoperative 5-fluorouracil. METHODS: 29 patients (58 eyes) with bilateral primary open-angle glaucoma (POAG) were included in the study. Patients were randomly assigned to have a fornix-based conjunctival flap in one eye and a limbal-based flap in the other, followed by subconjunctival injection of 5-fluorouracil. RESULTS: Mean intraocular pressure (IOP) 2 years after treatment was 12.9 +/- 12.25 mmHg in eyes with fornix-based conjunctival flaps and 13.1 +/- 16.81 mmHg in eyes with limbal-based conjunctival flaps. At 4 years, mean IOP was 14.7 +/- 9.61 mmHg in eyes with fornix-based conjunctival flaps and 15.1 +/- 7.29 mmHg in eyes with limbal-based conjunctival flaps. Cumulative success at 4 years (IOP < 21 mmHg) was 89.6% in eyes with fornix-based conjunctival flaps versus 86.2% in eyes with limbal-based conjunctival flaps with medications. Cystic leaking blebs occurred in two cases, both with limbal-based flaps. CONCLUSION: The efficacy of limbal- and fornix-based conjunctival flaps in initial trabeculectomy with postoperative 5-fluorouracil was not significantly different; however, in this study cystic leaking blebs were encountered only in eyes with limbal-based conjunctival flaps.  相似文献   

14.
PURPOSE: To investigate the effects of thick Tenon's capsule on primary trabeculectomy with adjunctive mitomycin-C. METHODS: In this prospective interventional case series of 45 consecutive uncomplicated glaucoma patients, 45 eyes with thick Tenon's capsule underwent primary trabeculectomy with intraoperative mitomycin-C (0.4 mg/ml for 3 min). Success was defined as intraocular pressure (IOP) 相似文献   

15.
BACKGROUND: Combined glaucoma and cataract operation has been demonstrated to be effective in controlling IOP and increasing visual acuity. Because of the differences between patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXEG), for cataract and glaucoma surgery alone we evaluated the effects and complications for simultanous surgical management. PATIENTS AND METHODS: In a retrospective study 103 patients were examined who underwent a combined phacoemulsification and goniotrephination between January 1993 and January 1997 and had no surgery before (110 eyes with POWG, 22 eyes with PXEG). RESULTS: The average age in the POAG group (75.1 +/- 8.7 years) was significantly less than in the PXEG group (79.3 +/- 5.9 years) (P < 0.05). The mean preoperative IOP in PXEG (31.8 +/- 10.3 mmHG) was significantly higher than in POAG (25.0 +/- 6.4 mmHg) (P < 0.0005). Due to the combined surgery the mean intraocular pressure decreased in both groups < 10 mmHg (days 1 and 7). PXEG had a significantly higher IOP at day 3 than POAG (12.3 +/- 8.4 mmHg versus 8.5 +/- 5.7 mmHg) (P < 0.05) and developed after combined operation IOP peaks > 25 mmHg into a significantly higher level (P < 0.05). Moreover, zonulolysis, rupture of the posterior capsule, vitreous loss and persistence of inflammatory response occurred more often in PXEG, but there was no significant difference compared to POAG. CONCLUSION: PXEG has an higher incidence of typical problems of phacoemulsification, a temporary increase of IOP and prolonged inflammation after combined cataract and glaucoma surgery than POAG, but there is a similar risk compared to a single procedure.  相似文献   

16.
Postoperative intraocular pressure (IOP) was measured in patients with open-angle glaucoma undergoing extracapsular cataract extraction with a posterior chamber lens implant (ECCE-PC IOL). Patients considered to be under adequate medical glaucoma control had cataract surgery alone or combined with a posterior lip sclerectomy. Patients with medically uncontrolled glaucoma had cataract surgery combined with either a posterior lip sclerectomy or a trabeculectomy. Cataract surgery alone (n = 26) was associated with a significantly (P less than 0.001) increased IOP on postoperative day 1: preoperative IOP, 18.9 +/- 3.6 mmHg; postoperative IOP, 34.2 +/- 12 mmHg. An IOP rise of 10 mmHg or more occurred in 69% of the eyes, whereas 77% of the eyes had an absolute IOP over 25 mmHg. Eyes undergoing combined surgery (n = 42) had a preoperative IOP of 21.3 +/- 4.8 mmHg. On postoperative day 1, the mean IOP was 14.9 +/- 12.0 mmHg. An IOP rise of 10 mmHg or more was observed in 14%, and an IOP over 25 mmHg in 21% of combined surgery eyes. Cataract surgery in eyes with open-angle glaucoma requires careful monitoring and therapy for early postoperative increases in IOP. Combined surgery reduces the frequency and magnitude of, but does not eliminate, this complication.  相似文献   

17.
PURPOSE: To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg. METHODS: A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21 mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups. RESULTS: Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant. CONCLUSIONS: Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.  相似文献   

18.
A retrospective study was undertaken analysing the results of trabeculectomy without antimetabolites in 33 eyes with uveitis compared to 33 eyes with primary open angle glaucoma (POAG). Both groups were matched for surgeon with a median follow-up of 19 months (range 2-44 months) for the uveitis group and 24 months (range 6-92 months) for the POAG group. The overall one and two year success (IOP ± 21 mmHg with or without medication) was 92% and 83% respectively for the uveitis group and 96% for both years for the POAG group (p = 0.241, Mantel-Haenszel test). These results indicate that the success of trabeculectomy in patients with inflammatory glaucoma compares well with that of the POAG group. In the absence of other risk factors, primary trabeculectomy without the use of antimetabolites should be considered as the first choice of surgical treatment for raised intraocular pressure in patients with intraocular inflammatory disease.  相似文献   

19.
BACKGROUND AND OBJECTIVE: To compare the safety and efficacy of fornix-based trabeculectomy with corneal valve to traditional limbal-based trabeculectomy with mitomycin C (MMC) in eyes with open-angle glaucoma. PATIENTS AND METHODS: In this retrospective, nonrandomized, comparative study, 42 eyes that underwent limbal-based trabeculectomy with MMC were compared with 32 eyes with fornix-based trabeculectomy with corneal valve with MMC. Success was defined as final intraocular pressure (IOP) of at least 20% less than preoperative IOP and between 5 and 22 mm Hg. mean IOPs were 23.5 +/- 12.2 and 11.5 +/- 5.3 mm Hg, respectively, in the limbal-based group and 24.8 +/- 11.1 and 11.7 +/- 2.5 mm Hg, respectively, in the fornix-based group (P < .001 and P = .85, respectively). The fornix-based group had significantly less hypotony (3% vs. 21%, P < .05). CONCLUSIONS: Fornix-based corneal valve trabeculectomy with posterior placement of MMC sponges provides IOP control comparable to limbal-based traditional trabeculectomy, with decreased incidence of hypotony.  相似文献   

20.
PURPOSE: To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of < or = 21 mmHg without medical therapy. RESULTS: Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0+/-10.2 mmHg to 18.2+/-9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1+/-0.5 preoperatively to 0.3+/-0.7 postoperatively (p<0.001; Wilcoxon signedrank test). Twenty-four (80%) eyes were classified as surgical success after a mean followup period of 17.3+/-22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision. CONCLUSIONS: Full PRP followed by trabeculectomy with MMC can effectively reduce the elevatedIOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome.  相似文献   

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