连续回顾性研究对比粘小管切开术和小梁切除术治疗先天性青光眼的疗效

Background Surgical interventions are the main treatment for primary congenital glaucoma (PCG).This study aimed to compare the efficacy and safety between viscocanalostomy and mitomycin C (MMC)-trabecu...     

Clinical effect of improved viscocanalostomy for the treatment of primary congenital glaucoma

AIM: To evaluate the clinical effect of improved viscocanalostomy in patients with primary congenital glaucoma. METHODS: Retrospective analysis of improved viscocanalostomy was performed on 51 eyes of 42 patients with primary congenital glaucoma. The outcome evaluation included postoperative intraocular pressure(IOP), corneal diameter, cup/disc ratio and complications. All patients were followed up at week 1, month 1, 3, 6 and 12. RESULTS: The results revealed that postoperative IOP was decreased from (38.57±13.61)mmHg to (10.53±3.91)mmHg, (14.89±5.26)mmHg, (15.42±5.11)mmHg, (13.82±3.46)mmHg, (13.16±5.29)mmHg at follow-up time of 1 week, 1, 3, 6, 12 months (P<0.001). The postoperative corneal diameter was decreased significantly (P=0.002); The mean cup/dish ratio wasn’t significantly different (P=0.148) before and after the surgery, the cup/dish ratio of successful surgery was evidently decreased (preoperative 0.7±0.2, postoperative 0.6±0.3, P=0.007), but the complications like as unformed anterior chamber were not observed. The mean follow-up period was 12 months. CONCLUSION: Improved viscocanalostomy improves the clinical effects of the patients with primary congenital glaucoma, such as higher success rates, lower postoperative mean IOP and fewer complications.     

Non-penetrating glaucoma surgery augmented with mitomycin C or 5-fluorouracil in eyes at high risk of failure of filtration surgery: long-term results

PURPOSE: To investigate the long-term efficacy and safety of non-penetrating glaucoma surgery (NPGS) augmented with mitomycin C (MMC) or 5-fluorouracil (5FU) in eyes at high risk of failure of glaucoma filtration surgery. METHODS: Prospective study of all eyes, undergoing NPGS with 0.04% MMC (1 to 2 min topical or 0.04 mL subconjunctival injection into the superior fornix) or 5FU (25 mg/mL topically for 5 min). Complete success was an intraocular pressure (IOP)or=20% drop in IOP or a reduction of at least two medications. RESULTS: Twenty-three eyes of 22 patients with a mean follow up of 41.4 months were reviewed. Fifteen eyes had failed trabeculectomy and seven had uveitic glaucoma. Mean preoperative IOP reduced from 25.8+/-7.8 to 15.4+/-4.9 mmHg at final visit, a mean change of 41%. Median number of preoperative medications decreased from 3 to 0 postoperatively. Cumulative probability of success was 100% at 2 years, 94% at 3 years and 85% at 4 years. No patient developed any long-term complications. Complete success was achieved in 11 eyes and qualified success in 10 eyes. Two eyes failed and required further surgery. CONCLUSION: NPGS augmented with small-volume MMC/5FU provides good long-term IOP control in eyes at high risk of failure with a lower incidence of complications compared with augmented trabeculectomy and eliminates the need for postoperative bleb or suture manipulation.     

Postoperative microhyphema as a positive prognostic indicator in canaloplasty

Purpose: To assess risk factors for failure in canaloplasty. Methods: Nonrandomized prospective study involving 51 eyes of 51 patients with medically uncontrolled primary open‐angle glaucoma undergoing canaloplasty. Visual acuity, intraocular pressure (IOP) and slit‐lamp examinations were performed before and after surgery at 1 and 7 days, and at 1 month and every 3 months thereafter. Factors like age, gender, preoperative IOP and microhyphema on day 1 were evaluated. Results: The mean follow‐up was 20.6 (SD 8.3) months. The mean preoperative IOP was 26.8 (SD 5.2) mmHg; the mean postoperative IOP was 8.4 (4.2) mmHg at day 1 and 12.7 (1.7) mmHg at month 24. Microhyphema was found in 40 patients (85.1%) on day 1 after surgery. The height of microhyphema was 1.8 mm ± 0.4 (SD) (range 1–2.5), and the time of resorption was 6.6 days ± 2.8 (SD) (range 3–14) on average. No recurrence of hyphema has been observed. IOP < 16 mmHg without medications depended significantly on the presence of microhyphema (hazard ratios, HR 0.03, 95% CI 0.01–0.25, p < 0.001), but not on age (HR 1.00, 95% CI 0.91–1.09, p = 0.32), preoperative IOP (HR 0.98, 95% CI 0.85–1.12, p = 0.80), cup‐to‐disc ratio (HR 0.15, 95% CI 0.00–20.01, p = 0.45) and gender (HR 0.24, 95% CI 0.05–1.12, p = 0.07). Factors like preoperative IOP, age, gender, cup‐to‐disc ratio were not associated with microhyphema. There were no significant differences between patients with versus without microhyphema in regard to age, preoperative IOP, morphological and functional glaucomatous damage, number of medications and postoperative day 1 IOP. However, patients with microhyphema had significantly fewer Nd:YAG goniopunctures after surgery than patients without microhyphema (p < 0.001). Conclusion: Microhyphema the first postoperative day seems to be a significant positive prognostic indicator in uneventful canaloplasty in regard to IOP reduction, possibly representing a restored and patent physiologic aqueous outflow system.     

不同手术方式治疗眼压失控

目的：研究黏弹物质小管切开术和超声黏弹物质小管切开术治疗眼压失控的成功率及并发症。在Nd： YAG前房角穿刺后,检测并发症及结果。

方法：评估1a内进行黏弹物质小管切开术和超声黏弹物质小管切开术时收集预期的数据。除此之外,Nd：YAG激光房角穿孔术(LGP)应用于术后任何时期的眼压失控。

结果：符合纳入条件并能获得随访数据者100眼。76%(76眼)完全成功(未经青光眼治疗眼内压≤18mmHg),88%(88眼)合格成功(眼内压≤18mmHg,伴或者不伴永久性青光眼的治疗)。63%(63眼)在未用药的情况下眼内压下降了30%,67%(67眼)伴或者不伴有永久性青光眼的治疗。Kaplan-Meier生存分析建议超声黏弹物质小管切开术在未用药的情况下把眼压降到18mmHg,时序检验P=0.005。16眼在不同的时间点需要术后激光房角穿孔,大多数在术后6mo发作。平均眼内压术后减少24.8%(P=0.0002)。激光房角穿孔术后第12mo未经治疗的眼内压小于18mmHg的达到94%(15眼)。所有患者在激光房角穿孔术后至少3mo眼内压保持下降趋势,后期将继续进行随访。

结论：我们的数据显示黏弹物质小管切开术和超声黏弹物质小管切开术在这随访1a内能成功控制眼内压。Nd： YAG激光房角穿孔术在降低和保持眼内压方面也很有成效。几乎没有并发症。     

Viscocanalostomy Versus Trabeculectomy in Patients with Bilateral High-tension Glaucoma

Results of trabeculectomy (TE) and viscocanalostomy (VCO) were compared in a prospective randomised study in two fellow eyes of 22 consecutive patients with bilateral symmetrical high-tension glaucoma. Rates of overall surgical success with intraocular pressures (IOP) ≤ 18 mm Hg with or without medications were 91 for the TE, and 95 for the VCO group after a mean follow-up of 18 months. Complete success rates without medications were 64 and 59 for TE and VCO groups, respectively (p=0.750). Both procedures significantly reduced IOP, however, IOP course following trabeculectomy was significantly lower (p=0.026). Rates of complications were not found to be different between the two groups of eyes, except for an apparent – though not significant (p=0.066) – increase in cataract progression with TE. Various types of conjunctival blebs were detected in all eyes with surgical success in both groups, however, diffuse, elevated or multi-cystic functional blebs appeared to be more predominant in eyes with TE, compared to the VCO group in which low-lying, localised blebs had a higher incidence (p=0.015). Viscocanalostomy was found to be a safe and effective filtration technique in patients with uncomplicated high-tension glaucoma, though IOP decrease was more pronounced with trabeculectomy.     

Viscocanalostomía circunferencial con sutura de tensión en el canal de Schlemm (canaloplastia): un año de experiencia

PurposeTo study the efficacy and the safety of ultrasound biomicroscopy assisted canaloplasty in the treatment of open-angle glaucoma (OAG)MethodsA prospective study of uncontrolled open-angle glaucoma patients, or patients with cataracts associated with controlled or uncontrolled OAG under maximal medical therapy who had been subjected to canaloplasty alone or combined with cataract surgery, respectively. Complications, Goldmann intraocular pressure (IOP) and mean number of drugs (ND) were evaluated at 1 day, 1 week, 1 month, and every 3 months.ResultsThirty five surgeries were performed (11 canaloplasties, 24 phaco-canaloplasties). The mean IOP (mmHg) dropped from 24.5 ± 5.1, in canaloplasty, and from 19.8 ± 6.4, in phacocanaloplasty, preoperatively, to medium-low levels at all follow-up periods (13.5 ± 1.0 and 11.0 ± 4.2, at 1 year in canaloplasty and phaco-canaloplasty, respectively). The number of grugs used dropped from 3.3 ± 0.5 before surgery to less than of 1 in all follow-up periods (0.5 ± 0.8 at 1 year). The complications were 2 microruptures of the trabeculodescemetic window, 5 entries in the collector channels, 5 choroidal space/anterior chamber passages, 10 hyphemas, 3 hypotonies, one peripheral Descemet detachment, one intracorneal hematoma, two peripheral anterior synechia, one internal iris prolapse, and two suture extrusions to the anterior chamber.ConclusionsUltrasound biomicroscopy assisted Canaloplasty, alone or combined, provided a sustained IOP reduction to medium-low levels, led to a decrease in the number of drugs and had a good safety profile, making this a good alternative to trabeculectomy.     

改良黏弹剂Schlemm管切开术治疗青少年型青光眼的临床研究

目的:观察改良的黏弹剂Schlemm管切开术治疗青少年型青光眼的疗效及安全性.方法:对被诊断为青少年型青光眼的27例43眼患者施行改良的黏弹剂Schlemm管切开术.记录患者的性别、接受该手术治疗时的年龄、是否有青光眼家族史、术前术后最佳矫正视力、青光眼药物使用情况、眼压及其它手术情况.记录具体手术步骤及术中术后是否发生明显的并发症.结果:改良的黏弹剂Schlemm管切开术治疗青少年型青光眼,术后2a的成功率为74%,术前平均眼压为35.38±7 15mmHg.2a后,患者平均眼压16.50±2.52mmHg,眼压下降值为18.88mmHg(P<0.01).术中及术后均未出现明显并发症.结论:长期随访的数据显示改良的黏弹剂Schlemm管切开术治疗青少年型青光眼有较好的临床效果,结合其术中、术后的并发症较少等优点,该手术有望成为青少年型青光眼的首选治疗术式.