目的对比内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术治疗合并白内障的原发性开角型青光眼(primary open angle glaucoma,POAG)的早期手术效果和并发症。设计病例对照研究。研究对象2018年3月至2019年3月在北京同仁眼科...目的对比内路小梁切开联合白内障超声乳化吸除术和单纯内路小梁切开术治疗合并白内障的原发性开角型青光眼(primary open angle glaucoma,POAG)的早期手术效果和并发症。设计病例对照研究。研究对象2018年3月至2019年3月在北京同仁眼科中心住院手术治疗的合并白内障的POAG患者36例(36眼)。方法根据患者选择的手术方式,将患者分为两组:行内路小梁切开联合白内障超声乳化吸除术的POAG患者12例(12眼)为观察组,行内路小梁切开术的POAG患者24例(24眼)为对照组。记录并比较两组患眼术前、术后1、2、3、5天、1周、1个月时眼压、视力、并发症和使用降眼压药的种类。主要指标眼压、视力、并发症和降眼压药物种类。结果观察组和对照组术前最高眼压分别为(34.08±8.21)mmHg和(37.75±8.61)mmHg(P=0.46),观察组术后第1天、1周、1个月的平均眼压分别为(20.75±11.89)mmHg、(21.23±8.72)mmHg、(15.00±2.22) mmHg,对照组术前、术后第1天、1周、1个月的平均眼压分别为(16.08±5.63)mm Hg、(22.08±11.48)mmHg、(16.05±5.25)mmHg,两组术后眼压整体变化趋势随时间降低(P<0.001),两组间术后眼压波动虽然存在差异,但是无统计学意义(P=0.77)。观察组和对照组术后1个月降眼压幅度分别为53.09%±15.19%和55.68%±15.63%(P=0.64)。观察组和对照组术前降眼压药物使用种类分别为(2.67±0.99)种和(3.08±0.72)种(P=0.16),术后1个月时分别下降至(0.17±0.58)种和(0.96±1.33)种(P=0.06)。观察组和对照组组术后眼压反跳发生率分别为16.67%和54.17%(P=0.03)。前房积血为术后最常见的并发症,观察组发生率为83.3%,对照组为62.5%(P=0.21)。观察组和对照组睫状体脱离发生率分别为25.0%和75.0%(P=0.004)。观察组中,8眼(66.7%)术后生活视力提高,4眼(33.3%)视力恢复至术前水平,0眼视力降低;对照组中,20眼(83.3%)术后生活视力恢复至术前水平,4眼(16.7%)视力降低(P<0.001)。结论展开更多
Background： Early surgical intervention is required for the primary congenital glaucoma （PCG）. There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy...Background： Early surgical intervention is required for the primary congenital glaucoma （PCG）. There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety oftrabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth. Methods： A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure （lOP）, corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates. Results： The mean follow-up time was 46.9 ~ 34.4 months （range： 12-122 months）. The postoperative lOP was significantly lower than the preoperative lOP at all of the follow-up visits （P 〈 0.001 ）. The complete success rates for all eyes at 1,2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The lOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly （P = 0.01） although the horizontal corneal diameter did not change significantly （P = 0.11 ）. Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications. Conclusions： Trabeculotomy proves to be a safe and effective treatment in reducing lOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.展开更多
●AIM:To systematically review and Meta-analyze studies of managing open angle glaucoma(OAG)with gonioscopyassisted transluminal trabeculotomy(GATT)and to evaluate its effectiveness and safety.●METHODS:Eligible studi...●AIM:To systematically review and Meta-analyze studies of managing open angle glaucoma(OAG)with gonioscopyassisted transluminal trabeculotomy(GATT)and to evaluate its effectiveness and safety.●METHODS:Eligible studies were retrieved and screened from five main electronic databases.Mean difference(MD)was hired to show the pooled effectiveness of intraocular pressure(IOP)and medication decrease achieved by GATT.In addition,combined surgical success and reoperation rates were calculated,and complications were also summarized.●RESULTS:Ten studies were included for systematic review,but one study was not pooled for Meta-analysis due to the repeated data.The combined IOP decrease after GATT was 9.81 mm Hg(95%CI:7.98-11.63 mm Hg)which showed significant reduction from the baselines(Z=10.52,P<0.0001).Similarly,the number of medications after GATT also decreased distinctly compared with that of medication before the surgery(Z=9.09,P<0.0001),and the pooled medication decrease was 1.68(95%CI:1.31-2.04).In addition,the combined surgical success rate was 85%,while the pooled reoperation rate was 20%.Sightthreatening complications occurred scarcely,whereas the pooled occurrence rate of hyphemia was as high as 36.0%.●CONCLUSION:GATT could effectively lower IOP and decrease medications for patients with OAG.Moreover,the procedure appears to be a safe and promising treatment for OAG due to its minimally-invasive and conjunctiva-sparing nature.展开更多
AIM:To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy(MAT).METHODS:Totally 10 eyes of 10 patients with primary open angle glaucoma(POAG)who underwen...AIM:To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy(MAT).METHODS:Totally 10 eyes of 10 patients with primary open angle glaucoma(POAG)who underwent MAT facilitated by Usights UC100(5 eyes)or iTrack(5 eyes)were reviewed.The success of this surgery was defined as intraocular pressure(IOP)<22 mm Hg with>30%reduction,without oral glaucoma medications,or additional glaucoma surgery.RESULTS:The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group.MAT was achieved in all eyes in both groups.The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes,respectively.Both microcatheters produced a statistically significant reduction in IOP,and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo followup(12.58±1.52 and 14.84±1.89 mm Hg,respectively),but no statistical significance was there.No severe side effects were observed in either group.CONCLUSION:MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG,and Usights UC100 is as safe as iTrack.展开更多
In traditional trabeculotomy,a radial incision is performed at the corneoscleral transition zone to locate the Schlemm＇s canal.However,in some conditions,finding the Schlemm＇s canal is difficult because of the enlar...In traditional trabeculotomy,a radial incision is performed at the corneoscleral transition zone to locate the Schlemm＇s canal.However,in some conditions,finding the Schlemm＇s canal is difficult because of the enlargement of the comea,developmental anomalies of the angle,etc.In our study,we performed a modified trabeculotomy,to locate the Schlemm＇s canal easily and accurately and evaluated the outcomes.展开更多
AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwe...AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.展开更多
AIM： To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy. METHODS： The clinical data of 27 cases （altogether 42 eyes）, ...AIM： To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy. METHODS： The clinical data of 27 cases （altogether 42 eyes）, which included 7 cases of infants （10 eyes） and 20 cases of teenagers （32 eyes）, of congenital glaucoma undertook modified combined trabeculotomy trabeculectomy were analyzed retrospectively. The parameters evaluated included the post operation visual acuity, the anterior chamber, the filtering bleb, the intraocular pressure, the C/D ratio, visual field, the retinal nerve fiber layer changes and the complications. RESULTS： The follow-up period was 1 to 29mo, averaging 13.3 ±7.7mo. Upon the last visit after the operation, functional filtering blebs developed in all the involved eyes. The intraocular pressure was controlled under 21 mm Hg, which was decreased by 60% when compared with that before the operation, without using any medication. There were no significant changes in the post operation visual acuity and the retinal nerve fiber layer thickness before and after the operation in teenager group （P〉0.05）, and both the post operation C/D ratio and the visual field mean defect （MD） were reduced compared with those before the operation （P〈0.05）. There were no severe complications in any of the patients. CONCLUSION： The modified combined trabeculotomy- trabeculectomy can effectively reduce the intraocular pressure and control the development of glaucoma in cases of congenital glaucoma. It is a safe and effective operative method for the treatment of congenital glaucoma展开更多
AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract...AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.展开更多
文摘Background： Early surgical intervention is required for the primary congenital glaucoma （PCG）. There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety oftrabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth. Methods： A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure （lOP）, corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates. Results： The mean follow-up time was 46.9 ~ 34.4 months （range： 12-122 months）. The postoperative lOP was significantly lower than the preoperative lOP at all of the follow-up visits （P 〈 0.001 ）. The complete success rates for all eyes at 1,2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The lOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly （P = 0.01） although the horizontal corneal diameter did not change significantly （P = 0.11 ）. Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications. Conclusions： Trabeculotomy proves to be a safe and effective treatment in reducing lOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.
文摘●AIM:To systematically review and Meta-analyze studies of managing open angle glaucoma(OAG)with gonioscopyassisted transluminal trabeculotomy(GATT)and to evaluate its effectiveness and safety.●METHODS:Eligible studies were retrieved and screened from five main electronic databases.Mean difference(MD)was hired to show the pooled effectiveness of intraocular pressure(IOP)and medication decrease achieved by GATT.In addition,combined surgical success and reoperation rates were calculated,and complications were also summarized.●RESULTS:Ten studies were included for systematic review,but one study was not pooled for Meta-analysis due to the repeated data.The combined IOP decrease after GATT was 9.81 mm Hg(95%CI:7.98-11.63 mm Hg)which showed significant reduction from the baselines(Z=10.52,P<0.0001).Similarly,the number of medications after GATT also decreased distinctly compared with that of medication before the surgery(Z=9.09,P<0.0001),and the pooled medication decrease was 1.68(95%CI:1.31-2.04).In addition,the combined surgical success rate was 85%,while the pooled reoperation rate was 20%.Sightthreatening complications occurred scarcely,whereas the pooled occurrence rate of hyphemia was as high as 36.0%.●CONCLUSION:GATT could effectively lower IOP and decrease medications for patients with OAG.Moreover,the procedure appears to be a safe and promising treatment for OAG due to its minimally-invasive and conjunctiva-sparing nature.
基金Supported by the Clinical Medicine Plus X-Young Scholars Project,Peking University(No.PKU2020LCXQ023)National Natural Science Foundation of China(No.82101107).
文摘AIM:To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy(MAT).METHODS:Totally 10 eyes of 10 patients with primary open angle glaucoma(POAG)who underwent MAT facilitated by Usights UC100(5 eyes)or iTrack(5 eyes)were reviewed.The success of this surgery was defined as intraocular pressure(IOP)<22 mm Hg with>30%reduction,without oral glaucoma medications,or additional glaucoma surgery.RESULTS:The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group.MAT was achieved in all eyes in both groups.The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes,respectively.Both microcatheters produced a statistically significant reduction in IOP,and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo followup(12.58±1.52 and 14.84±1.89 mm Hg,respectively),but no statistical significance was there.No severe side effects were observed in either group.CONCLUSION:MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG,and Usights UC100 is as safe as iTrack.
文摘In traditional trabeculotomy,a radial incision is performed at the corneoscleral transition zone to locate the Schlemm＇s canal.However,in some conditions,finding the Schlemm＇s canal is difficult because of the enlargement of the comea,developmental anomalies of the angle,etc.In our study,we performed a modified trabeculotomy,to locate the Schlemm＇s canal easily and accurately and evaluated the outcomes.
文摘AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.
基金Supported by National Scientific Foundation of China (No.81400400)Natural Science Foundation of Hunan Province, China (No.12JJ3120)
文摘AIM： To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy. METHODS： The clinical data of 27 cases （altogether 42 eyes）, which included 7 cases of infants （10 eyes） and 20 cases of teenagers （32 eyes）, of congenital glaucoma undertook modified combined trabeculotomy trabeculectomy were analyzed retrospectively. The parameters evaluated included the post operation visual acuity, the anterior chamber, the filtering bleb, the intraocular pressure, the C/D ratio, visual field, the retinal nerve fiber layer changes and the complications. RESULTS： The follow-up period was 1 to 29mo, averaging 13.3 ±7.7mo. Upon the last visit after the operation, functional filtering blebs developed in all the involved eyes. The intraocular pressure was controlled under 21 mm Hg, which was decreased by 60% when compared with that before the operation, without using any medication. There were no significant changes in the post operation visual acuity and the retinal nerve fiber layer thickness before and after the operation in teenager group （P〉0.05）, and both the post operation C/D ratio and the visual field mean defect （MD） were reduced compared with those before the operation （P〈0.05）. There were no severe complications in any of the patients. CONCLUSION： The modified combined trabeculotomy- trabeculectomy can effectively reduce the intraocular pressure and control the development of glaucoma in cases of congenital glaucoma. It is a safe and effective operative method for the treatment of congenital glaucoma
文摘AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.
