人工角膜在治疗严重化学烧伤眼中的研究

目的探讨严重化学烧伤性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择2000年10月至2006年3月于解放军总医院眼科就治的28例因严重化学烧伤导致双眼盲目患者的单侧眼,术前视力14只眼为手动,14只眼为光感,并且角膜混浊病变无法采用常规角膜移植手术达到复明目的。其中严重碱烧伤20只眼,严重酸烧伤8只眼。人工角膜植入术分两期：Ⅰ期手术将人工角膜支架植入角膜层间,所选患眼行角膜表面或层间加固性手术。3个月后行Ⅱ期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果Ⅱ期术后观察3—65个月,平均22．6个月,28只眼中有21只眼裸眼视力≥0．05（75％）,其中2只眼裸眼视力≥1．0。经镜片矫正后,11只眼（39％）视力为0．6—1．2;1只眼（4％）0．3～0．5;5只眼（18％）0．05—0．25;3只眼（11％）手动;3只眼（11％）光感;1只眼（4％）无光感。手术并发症包括分离角膜板层时穿人前房,晶状体皮质残留,继发性青光眼,镜柱前表面组织或上皮增生遮盖,镜柱后壁沉着物,角膜溶解,眼内炎,视网膜脱离。结论人工角膜是目前对严重角膜瘢痕、血管化的双眼化学烧伤患者有效的复明手段。该术式结合自体结膜遮盖、自体骨膜移植加固及睑裂部分缝合等,有利于人工角膜的长期存留。术后定期复查、积极预防并发症是保持视力的有效手段。     

人工角膜植入术的临床研究

评价复杂性角膜混浊患者行人工角膜植入术的临床效果和并发症等。方法选择15例双眼盲目患者的单侧眼15只,术前视力均为光感,角膜混浊病变无法用常规角膜移植手术达到复明目的。其中严重碱烧伤6只眼,严重酸烧伤3只眼,铝水烧伤2只眼,爆炸伤1只眼,严重实质性眼干燥症1只眼,多次穿透性角膜移植失败角膜严重血管化2只眼。人工角膜(MICOF)由俄罗斯费德洛夫眼外科中心制造。手术分两期：一期手术将人工角膜支架植入角膜层问,选择病例行角膜表面或层问加固性手术。约3个月后行二期手术,植入带螺纹的人工角膜光学部。常规行晶状体、部分虹膜及前部玻璃体切除术,将外1／3上、下睑缘做永久性缝合。对完全睑球粘连者,用上、下睑皮肤覆盖角膜表面,仅暴露人工角膜光学部。结果二期术后观察4～26个月,平均9．5个月,除1只眼视力光感外,其余眼裸眼视力0．12～1．0。手术并发症包括分离角膜板层时穿入前房,晶状体皮质残留,柱镜前表面结膜上皮遮盖,柱镜前表面纤维增生组织遮盖,柱镜后壁沉着物,角膜溶解。结论人工角膜特别适合于穿透性角膜移植难于成功的双眼盲目者,而且是对目前严重角膜瘢痕血管化、严重眼睑或泪液功能不良患者有效的复明手段。该术式结合自体结膜遮盖、骨膜层问移植及睑裂部分缝合等,有利于人工角膜的长期存留。     

Forty-five years of keratoprosthesis study and application at the Filatov Institute:a retrospective analysis of 1 060 cases

AIM: To present results of the keratoprosthesis method used at The Filatov Institute of Eye Diseases and Tissue Therapy.METHODS:A retrospective case series analysis was used to describe the development of new types of keratoprostheses and methods of implantation as well as different ways of leukoma strengthening.RESULTS:Keratoprosthesis was performed in 1 060 eyes of 1 040 patients with leukomas of different etiology:burns, 725 eyes (68.4%); trauma, 120 eyes (11.3%); keratitis and ocular pemphigoid, 108 eyes (10.2%); and bullous keratopathy, 107 eyes (10.1%). Visual acuity before keratoprosthesis consisted of light perception in 962 eyes (92%), and 98 eyes (8%) had minimal visual acuity (1/200-1/50). Both eyes were blind (visual acuity less than 1/200) in 955 patients (91.8%). The period of blindness varied from 1 to 52 years. As a result of keratoprosthesis, visual acuity of ≥1/200 was restored in 1 023 of 1 060 eyes (96.5%). Visual acuity of 20/200-20/20 was achieved in 716 eyes (67.5%). At the last follow-up visit visual acuity of ≥1/200 was preserved in 806 eyes (76%), visual acuity of 20/200-20/20 was measured in 583 of 1 060 eyes (55%) and good keratoprosthesis fixation in the cornea was achieved in 986 of 1 060 eyes (93%). The minimal follow-up was 12 months (range, 12 months to 37 years, median 5 years).CONCLUSION: Our techniques of keratoprosthesis effectively restore vision in patients with leukomas that cannot be treated by optical corneal grafting.     

Boston type 1 keratoprosthesis: the CHUM experience

Objective: To describe the characteristics, indications, complications, and outcomes of the patients who underwent Boston type 1 keratoprosthesis (KPro) surgery at the Université de Montreal affiliated Notre-Dame Hospital.Design: Retrospective case series.Participants: Forty-seven eyes of 43 patients who underwent KPro surgery.Methods: The charts of all patients who underwent KPro surgery at Notre-Dame Hospital between October 2008 and February 2010 were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were collected and analyzed.Results: The indication for Boston type 1 KPro was corneal graft failure in 27 eyes; 20 eyes had KPro as a primary procedure. Preoperative diagnoses included aniridia (34%), mechanical trauma (11%), infections (9%), surgery-related bullous keratopathy (9%), chemical burns (9%), corneal dystrophies (9%), and Stevens-Johnson syndrome (2%). A known history of glaucoma was present in 36 eyes (77%). Median preoperative best-corrected visual acuity (BCVA) was hand motion (range, 20/100 to light perception). The assembly of the KPro and surgery were uneventful in all cases. Mean follow-up was 10 ± 5 months. Median BCVA at last follow-up was 20/150 (range, 20/30 to no light perception). The device retention rate was 100% at the end of the follow-up period. Postoperative complications included retroprosthetic membrane in 12 eyes (26%) and glaucoma progression in 11 eyes (23%).Conclusions: Our study demonstrates an excellent retention rate of the Boston type 1 KPro and an improvement of BCVA in the majority of patients. Many patients undergoing KPro surgery have ocular comorbidities that require ongoing care to prevent further vision loss following KPro surgery.     

Experience with Boston keratoprosthesis type 1 in the developing world

Objective

To report the experience of the Federal University of São Paulo, Brazil, in performing Boston keratoprosthesis type 1 implantation in the developing world.

Methods

We analyzed 30 eyes of 30 patients who underwent Boston type 1 keratoprosthesis surgery between 2008 and 2012 in a prospective interventional study. Preoperative, perioperative, and postoperative parameters were analyzed, including visual acuity (VA), keratoprosthesis stability, and postoperative complications.

Results

Preoperative diagnoses were failed grafts in 16 eyes (53.33%), chemical injury in 10 eyes (33.33%) and Stevens–Johnson syndrome in 4 eyes (13.33%). Also, 16 eyes (53.33%) had preoperative glaucoma. Preoperative best corrected VA ranged from 20/400 to light perception. With an average follow-up of 32 months (range 1–55 months), postoperative vision improved to >20/200 in 24 eyes (80%). Postoperative VA was statistically improved compared with the preoperative measurement during all postoperative follow-ups (up to 36 months). During the follow-up period (32 months), retention of the initial keratoprosthesis was 93.3%. The incidence of retroprosthetic membrane was 26.66%. Progression of glaucoma occurred in 7 of 16 eyes (43%). Three patients experienced development of glaucoma after keratoprosthesis implantation. One eye experienced development of infectious keratitis, and 2 eyes had retinal detachment.

Conclusions

Performing Boston type 1 keratoprosthesis in a developing country is a viable option after multiple keratoplasty failures and conditions with a poor prognosis for keratoplasty. Our experience appears similar to major reports in the field from investigators in developed countries. Adjustments to postoperative management must be considered according to the particular location.     

Ahmed valve implantation for neovascular glaucoma after 23-gauge vitrectomy in eyes with proliferative diabetic retinopathy

AIM:To report on the outcome of Ahmed glaucoma valve (AGV) implantation for the management of neovascular glaucoma (NVG) after 23-gauge vitrectomy for proliferative diabetic retinopathy (PDR).METHODS: Twelve medically uncontrolled NVG with earlier 23-gauge vitrectomy for PDR underwent AGV implantation. The control of intraocular pressure (IOP), preoperative and postoperative best-corrected visual acuity, the development of intraoperative and postoperative complications were evaluated during the follow-up.RESULTS: The mean follow-up was 15.4±4.3 months (9-23 months). Mean preoperative IOP was 49.4±5.1mmHg and mean postoperative IOP at the last visit was 17.5±1.6mmHg. The control of IOP was achieved at the final follow-up visits in all patients, however, 8 of 12 patients still needed anti-glaucoma medication (mean number of medications, 0.8±0.7). The visual acuity improved in nine eyes, and the visual acuity unchanged in three eyes at the final follow-up visits. The complications that occurred were minor hyphema in three eyes, choroid detachment in two eyes, and the minor hyphema and choroid detachments were reabsorbed without any surgical intervention.CONCLUSION: AGV implantation is a safe and effective procedure that enables successful IOP control and vision preservation in the NVG patients with the history of earlier 23-gauge vitrectomy for PDR.     

Ahmed青光眼阀植入治疗难治性青光眼

目的：探讨Ahmed青光眼阀植入治疗难治性青光眼的临床疗效。 方法：回顾性研究我院Ahmed青光眼阀植入术治疗21例21眼难治性青光眼的临床疗效并进行总结分析。 结果：术前平均眼压为44.6±7.2mmHg,术后6mo末次随访平均眼压15.4±5.3mmHg;视力提高4眼,无改变14眼,降低3眼;手术并发症主要包括术后前房形成迟缓2眼、持续高眼压1眼、引流管暴露1眼、角膜失代偿1眼、引流盘纤维包裹3眼;手术成功率为86％。 结论：Ahmed青光眼阀植入术是治疗难治性青光眼有效和安全的方法。     

Contributing ocular comorbidity to end-of-life visual acuity in medically treated glaucoma patients,ocular hypertension and glaucoma suspect patients

AimTo assess the visual acuity at the end of life in glaucoma suspect patients, ocular hypertension, and patients treated for glaucoma and to find factors contributing to a reduced visual acuity in this cohort of deceased patients.MethodsIn a cohort of 3883 medically treated glaucoma patients, glaucoma suspect, or patients with ocular hypertension assembled in 2001–2004, 1639 were deceased. Patient data were collected from electronic and paper patient files. The files of 1378 patients were studied and the last measured visual acuity and ocular comorbidities influencing the visual acuity were extracted.ResultsOur results show that only 37.2% of patients had no visual impairment in either eye, 30.5% was visually impaired or blind in both eyes and 4.1% was blind in both eyes, all based on VA. The most common contributing factors for severe visual impairment or blindness (prevalence ≥ 1%) were: glaucoma, retinal vein occlusion, dry and exudative age-related macular degeneration, past retinal detachment, amblyopia, diabetic retinopathy, anterior ischemic optic neuropathy, trauma, decompensated cornea, past keratitis, enucleation, corneal transplantation, and macular hole.ConclusionsDespite the current advanced treatment modalities for glaucoma, 30.5% of patients had a VA < 0.5 in both eyes and 4.1% was blind in both eyes. However, this disability cannot be confidently attributed only to glaucoma. Besides glaucoma, most common contributing factors were among others retinal and macular diseases. Patient management in glaucoma should be based on more than lowering the intraocular pressure to prevent blindness at the end of life.Subject terms: Optic nerve diseases, Pattern vision     

复合型人工角膜植入治疗重度角膜盲及并发症处理

目的 探讨钛支架复合型人工角膜植入治疗重度角膜盲的临床价值,以及并发症的处理.方法 回顾性系统病例研究.2002年3月至2005年6月期间中山大学中山眼科中心共完成永久性人工角膜植入9例(单侧眼9只),均为男性,年龄28～52岁.所有患者均为双眼损伤,受伤时间为1.5～5.0年.其中碱烧伤6只眼,爆炸伤3只眼,术前视力均为光感,其中2例光定位不准;均为多次角膜移植以及眼表重建手术失败的难治性重度角膜盲患者.手术分两阶段:一期手术显微镜下行钛支架复合型人工角膜植入联合自体耳软骨移植加固,二期行人工角膜前膜剪开,建立镜柱光学通路.术后评价视力恢复情况,分析并发症的发生原因,探讨相应的处理对策.结果 患者随诊时间1～3年.术后7只眼裸眼视力≥0.1,其中2只眼经镜片矫正后达到0.6.术前光定位不准的2例患者术后视力为0.02和0.04.术后并发症的发生情况为复发性人工角膜前膜5例,进行前膜切除,其中1例联合施行自体唇黏膜移植;角膜局限性融解1例,进行脱细胞真皮加固;人工角膜后膜1例,显微镜下施行后膜钩除术.以上并发症经相应处理均得到控制.随访期内所有人工角膜均保持原位,未发生人工角膜排出、房水渗漏.结论 人工角膜移植是使严重角膜盲患者复明的有效手段,联合自体耳软骨加固可减少并发症的发生,提高人工角膜植入的生物相容性.(中华眼科杂志,2009,45:104-109)     

Graft survival and visual outcome after simultaneous penetrating keratoplasty and cataract extraction

AIM:To evaluate the indications, complications, and visual and graft survival outcomes in eyes that had undergone simultaneous cataract extraction and penetrating keratoplasty (PKP).METHODS:We described a retrospective study of 101 patients who had undergone simultaneous cataract extraction and PKP at King Khaled Eye Specialist Hospital between January 1, 2001, and December 31, 2002. All patients were followed up postoperatively with maximum follow-up 68 months.RESULTS:The mean age of patients was 61 years. The mean overall follow-up was 27 months. The most common indications for surgery were corneal scarring (45.5%), previous failed graft (15.8%), corneal ulcer (12.9%), Fuchs endothelial dystrophy (8.9%), stromal dystrophy (2.9%), and other conditions (14.5%). Overall, 69 grafts (68.3%) remained clear at final follow-up. Previous glaucoma or postoperative glaucoma had no statistically significant effects on graft outcome (P>0.05).The graft rejection rate (17.8%) was a significant risk factor for failure (P=0.00). Age, gender, indications for surgery, corneal graft diameter, and intraoperative vitreous loss had no statistically significant effects on the PKP outcome (P>0.05). Postoperative visual acuity was significantly associated with preoperative visual acuity (P<0.01).CONCLUSION: The present study provides evidence that performing a combined procedure results in more rapid visual rehabilitation and good graft clarity.     

影响原发性先天性青光眼手术后视力的原因分析

目的：探讨影响原发性先天性青光眼术后视力的原因及预防措施。方法：追踪检查５１只接受手术治疗后１０年以上的原发性先天性青光眼的眼压、视力、角膜及杯盘比值等的变化情况。结果：手术不成功的１２只眼视力全部在０．０５以下。手术成功的３９只眼视力在０．１至０．８以上，７只单眼发病者视力都在０．２以下；角膜直径大于１３ｍｍ的２７只眼中２１中眼有Ｈａａｂ线存在；杯盘比值大于０．２以上者１２只眼。结论：手术不成功     

Five year follow up of biocolonisable microporous fluorocarbon haptic (BIOKOP) keratoprosthesis implantation in patients with high risk of corneal graft failure

AIM: To study the anatomical and visual performance following implantation of a model of artificial cornea and to evaluate the postoperative long term complications. METHODS: 11 eyes of 11 patients with bilateral corneal blindness considered as potentially having high risk of failure of penetrating corneal keratoplasty were implanted with biocolonisable Kpro keratoprosthesis (BIOKOP I, FCI, Rantigny, France) in the period between January 1996 and May 1998. Only one eye was implanted in all patients and followed up for a period of 60 months. The visual outcome, anatomical and functional stability, complications, and the general performance of the keratoprosthesis were evaluated. RESULTS: The keratoprosthesis (BIOKOP I) only 36.3% remained in position to date. In the patients' last visit five eyes (45.4%) were blind and one (9.0%) showed a slight improvement in the best corrected visual acuity (BCVA) in comparison to preoperative tests. Six eyes (54.5%) showed improved BCVA before having postoperative complications. Four eyes underwent replacement of a BIOKOP I Kpro with a BIOKOP II as a result of extrusion. The keratoprostheses remained anatomically in situ for a mean of 25.5 months and their functional performance period was limited to a mean of 22 months. CONCLUSION: Corneal keratoprosthesis (BIOKOP I, II) does not provide a stable anatomical relation with the surrounding ocular structures. Its ability to restore vision is limited to a short postoperative period in eyes implanted with severe ocular surface disease.     

Penetrating keratoplasty combined with vitreoretinal surgery for severe ocular injury with blood-stained cornea and no light perception

OBJECTIVE: To evaluate the effects of treatment of severe ocular injury with blood-stained cornea and no light perception by combined penetrating keratoplasty and vitreoretinal surgery, and to analyze the relevant factors. METHODS: Records of 7 severely injured eyes of 7 patients with blood-stained cornea and no light perception who underwent penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis were evaluated retrospectively. The preoperative visual acuity was no light perception in all injured eyes with a mean intraocular pressure of 3 mm Hg and a range from 2 to 5 mm Hg. The average interval from emergency wound closure to vitrectomy was 18 days with a range from 12 to 21 days. The mean follow-up was 28 months with a range from 26 to 30 months. RESULTS: The postoperative visual acuity was better than light perception in 5 eyes with the best corrected visual acuity from light perception to 0.06. The retina was attached in 5 eyes. The postoperative intraocular pressure ranged from 5 to 15 mm Hg with a mean of 12 mm Hg; it was significantly higher than the preoperative one (p < 0.05). The postoperative complications mainly included temporary intraocular elevation (1 eye), corneal neovascularization (4 eyes), corneal rejection (4 eyes), retinal detachment (2 eyes) and ocular atrophy (2 eyes). CONCLUSION: Penetrating keratoplasty combined with vitrectomy using a temporary keratoprosthesis is a safe and effective method in treating severe ocular injury with blood-stained cornea and no light perception.     

Initial experience with phacoemulsification and goniotomy using the Kahook dual blade in advanced open-angle glaucoma: Six-month outcomes in Indian eyes

Purpose:The aim of this study was to report our initial experience on the outcomes of phacoemulsification in combination with goniotomy using the Kahook Dual Blade (KDB) in eyes with advanced open-angle glaucoma (OAG).Methods:The outcomes of phaco-goniotomy with KDB in advanced OAG in Indian eyes were retrospectively analyzed. Based on the Hodapp-Anderson-Parrish criteria of visual field defects, severe glaucoma (mean deviation on standard automated perimetry worse than 12 dB) was considered as advance glaucoma. Preoperative, intraoperative, and postoperative data were collected through 6 months of follow-up. Outcome measures included antiglaucoma medications (AGM), the proportion of eyes achieving >1AGM reduction, intraocular pressure (IOP), and visual acuity.Results:Median (interquartile range) number of AGM in eyes that underwent phaco-KDB goniotomy reduced from 2 (2,3) at baseline to 1 (0,1) at 6 months (P = 0.002). Median IOP reduced from 20 (20,26) mmHg at baseline to 14 (12,15) mmHg at 6 months (P = 0.02). The proportion of eyes achieving >1 medication reduction was 88% eyes (8/9). Adverse events noted were IOP spike (22 mmHg) in 2 eyes and intra-op hyphema in 1 eye on postoperative day-1, both resolved in a week with conservative management. Except one eye with central corneal scar due to prior pterygium surgery, 8 eyes had 20/20 vision at 1 week which was maintained till last follow-up.Conclusion:Phacoemulsification with KDB Goniotomy significantly lowered the need for AGM with moderate IOP reduction in advanced OAG eyes. There were no serious complications and the visual recovery was good and early.     

Outcomes with the Boston Type 1 Keratoprosthesis at Instituto de Microcirugía Ocular IMO

Purpose

To report the outcomes on the Boston Type 1 Keratoprosthesis at our institution.

Design

Retrospective analysis case series.

Participants

We analyzed 54 eyes of 53 patients who previously underwent Boston Type 1 Keratoprosthesis surgery at our institution from July 2006 to March 2011.

Methods

Preoperative and postoperative parameters were collected and analyzed.

Main outcome measures

Visual acuity and keratoprosthesis stability.

Results

Common preoperative diagnoses were penetrating keratoplasty failure in 49 eyes (90.7%), chronic keratitis in 2 eyes (3.7%), ocular cicatricial pemphigoid in 1 eye (1.85%), Stevens Johnson syndrome in 1 eye (1.85%) and corneal vascularization in 1 eye (1.85%). Additionally, 40 eyes (74%) had preoperative glaucoma, and an Ahmed valve was implanted in 55% of them. Preoperative BCVA ranged from 20/200 to light perception. At an average follow-up of 20.15 months ± 12.7 (range, 1–56), postoperative vision improved to ⩾20/200 in 18 eyes (33.3%) and ⩾20/50 in 4 eyes (7.4%). The graft retention was 96%.

Conclusions

The Boston Type 1 keratoprosthesis is a valid option for high-risk patients. The design improvements in the Boston keratoprosthesis, as well as the daily implementation of the therapeutic methods, have notably diminished occurrence of the most serious complications, such as corneal necrosis and endophthalmitis. As such, glaucoma and its subsequent complications now stand as the most prevalent prognostic factor in the long term.     

Boston type I keratoprosthesis: Review

Regardless of significant progress in the field of corneal transplantation to treat corneal opacification, some cases of corneal blindness still present a poor prognosis for conventional penetrating keratoplasty. In patients with repeated graft failure and/or with severe ocular surface disease, the Boston type I keratoprosthesis (type I BKPro) has become a viable option. Modifications in its design and postoperative management have improved the long-term outcomes of visual acuity, retention, and postoperative infection rates. These advances made the type I BKPro be considered a safe alternative for visual rehabilitation in many patients with corneal pathologies. However, postoperative handle of chronic comorbidities, such as glaucoma, is still critical for preserving the visual gains achieved with BKPro.     

Boston keratoprosthesis type 1 for limbal stem cell deficiency after severe chemical corneal injury: A systematic review

Purpose

To systematically review the published literature on outcomes of Boston keratoprosthesis type 1 for the treatment of limbal stem cell deficiency secondary to severe chemical corneal injury.

联合手术治疗青光眼合并白内障的临床观察

目的:探讨治疗青光眼合并白内障的手术方法及临床效果。方法:对45例45眼青光眼合并白内障患者施行白内障超声乳化及人工晶状体植入联合隧道内小梁切除术。结果:术前视力<0.1者32眼,0.1～0.3者13眼。术后视力<0.1者6眼(13%),0.1～0.5者22眼(49%),>0.5者17眼(38%)。术前眼压26～60mmHg,术后42例眼压降至正常范围,3例经局部按摩、滴药后降至正常,平均眼压12.78±2.70mmHg。随访6～12mo,无1例眼压再升高。3例视力下降,经戴镜矫正视力提高。并发症主要是角膜水肿和虹膜炎症反应。结论:白内障超声乳化人工晶状体植入联合隧道内小梁切除术是治疗青光眼合并白内障的理想方法。     

板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡

目的：观察板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡的临床效果。

方法：选取2017-01/2018-11在江西医专一附院眼科就诊收住院行板层角膜移植术联合快速角膜胶原交联术治疗的真菌性角膜溃疡的患者18例18眼,对治疗效果进行回顾性分析。观察术后视力、角膜植片透明度的情况及真菌复发、移植片排斥、继发性青光眼、并发性白内障等并发症的发生概率和预后。

结果：术后18例患者全部保全了眼球,术后裸眼视力提高者16眼(89%),视力不变者2眼(11%),角膜移植片发生排斥反应3眼(17%),继发性青光眼2眼(11%),并发性白内障3眼(17%)。植片透明的患者为13眼(72%),植片半透明4眼(22%),植片混浊1眼(6%)。

结论：板层角膜移植术联合快速角膜胶原交联治疗难治性真菌性角膜溃疡能提高真菌性角膜溃疡治愈率,是一种切实可行的治疗方法。     

Time of diagnosis, reoperations and longterm results of goniotomy in the treatment of primary congenital glaucoma: a clinical study

Purpose: The aim of our study was to get information about the development of visual acuity, visual field and cupdisc ratio of patients with primary congenital glaucoma after IOP-regulating goniotomy by means of a katamnestic inquiry. The preoperative conditions of IOP, corneal diameter and corneal opacity were related to postoperative findings of visual acuity, visual field and cup-disc ratio reported by the treating ophthalmologists. Methods: 196 patients were contacted, who had a goniotomy in the period from 1965 to 1983 at the University Eye Hospital Würzburg. Out of the 92 returned replies, the address of the treating ophthalmologists could be ascertained from 77 patients. Sixty of the 77 patients fulfilled the inclusion criteria: (1) primary congenital glaucoma and (2) IOP-regulating goniotomy as last surgery. Results: I. In 76% of 106 eyes childhood glaucoma was diagnosed during the first year of life. II. In 72% of 60 eyes/patients with primary congenital glaucoma one goniotomy was sufficient to reach a normal IOP. In 18% a second and in 10% a third goniotomy was necessary, but without influence on the visual outcome. III. Even in the groups of eyes with a preoperative IOP of more than 40 mmHg, preoperative corneal diameter of more than 13 mm and preoperative severe corneal opacity more than 50% reached a visual acuity of 0.4–1.2 and more than 80% had a normal visual field. Only 9% of the eyes showed a cup-disc ratio of 0.6 or more. Conclusions: In primary congenital glaucoma even eyes with high preoperative IOP, large corneal diameters and severe corneal edemas had a good prognosis of visual outcome after goniotomy.Abbreviations CDR cup-disc ratio - LTG low tension glaucoma - PCG primary congenital glaucoma - PG pigmentary glaucoma - VA visual acuity - VF visual field This study was presented in part at the annual meeting of the Association for Research in Vision and Ophthalmology, ARVO, 1996 Fort Lauderdale, Florida, Poster-No. 1903