Purpose: To evaluate the 3-year efficiency and safety of XEN<sup>®</sup> 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized...Purpose: To evaluate the 3-year efficiency and safety of XEN<sup>®</sup> 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized observational study we identified patients who had undergone either stand-alone XEN<sup>®</sup> implantation (XEN solo) or XEN<sup>®</sup> implantation in combination with phacoemulsification (XEN combi). All patients who had undergone an implantation during the period 01.04.17-31.10.19 at the Department of Ophthalmology, Drammen Hospital, Norway, were asked to participate. Success was defined as IOP between 5 - 18 mmHg and 20% pressure reduction without medications. Qualified success required the same pressure interval and reduction but allowed medications. The procedure was deemed as failure if pressure requirements were not met, vision was reduced to light perception or worse, or if there was a converion to secondary glaucoma surgery. Results: Out of 115 patients and 133 eyes identified, 87 patients and 99 eyes consented to participate. All patients were Caucasians with a mean age of 73.6 years. The study had a mean (range) follow-up of 38.9 (28 - 54) months. The mean medicated baseline (SD) was reduced from 22.6 (7.9) mmHg on 3.2 (1.1) medications to 14.2 (5.6) mmHg on 1.4 (1.6) medications. Success and qualified success were achieved in 22.2% and 21.2%, respectively. Needling was performed in 34 eyes. Conclusion: XEN<sup>®</sup> 45 gel stent implantation is a safe procedure, offering a significantly lower IOP and number of medications in a subset of patients with open angle glaucoma.展开更多
An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of ban...An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.展开更多
We demonstrate that the insertion of a graphene tunnel barrier between Heusler alloy Co_2MnSi and the germanium（Ge） channel modulates the Schottky barrier height and the resistance–area product of the spin diode. W...We demonstrate that the insertion of a graphene tunnel barrier between Heusler alloy Co_2MnSi and the germanium（Ge） channel modulates the Schottky barrier height and the resistance–area product of the spin diode. We confirm that the Fermi level is depinned and a reduction in the electron Schottky barrier height（SBH） occurs following the insertion of the graphene layer between Co_2MnSi and Ge. The electron SBH is modulated in the 0.34 eV–0.61 eV range. Furthermore,the transport mechanism changes from rectifying to symmetric tunneling following the insertion. This behavior provides a pathway for highly efficient spin injection from a Heusler alloy into a Ge channel with high electron and hole mobility.展开更多
Background: The iStent inject is a Micro-Invasive Glaucoma Surgical (MIGS) device that has shown to reduce IOP and to be safe for glaucoma patients with fewer complications than regular surgery. Objective: To investig...Background: The iStent inject is a Micro-Invasive Glaucoma Surgical (MIGS) device that has shown to reduce IOP and to be safe for glaucoma patients with fewer complications than regular surgery. Objective: To investigate, up to 15 - 20 months, the efficacy and safety of implantation of two second-generation trabecular microbypass stents in patients with or without prior glaucoma surgery. Methods: Fifty-seven eyes were implanted with the iStent inject. The population was comprised of eyes with primary open-angle glaucoma (n = 51), pseudoexfoliation glaucoma (n = 5) and ocular hypertension (n = 1). Major outcome parameters included IOP, medication needs and corrected distance visual acuity (CDVA). Follow-up time points were one day, 2 - 4 months, 9 - 14 months and 15 - 20 months. Results: The main reason to perform MIGS was IOP reduction in 68.4%, reduced number of medications due to drug intolerance in 24.6% and reduced medication due to compliance issues in 7.0% of the eyes. IOP decreased by 22.47%, from 19.40 ± 3.83 mmHg preoperatively (preop) to 15.04 ± 1.67 mmHg at 15-20 months postoperatively. IOP reduction was achieved at all follow-up time points (p Conclusions: Insertion of the iStent inject in patients with or without prior glaucoma surgery shows effective and sustained improvements in IOP with no safety concerns.展开更多
Background:The study aimed to investigate the 24-month safety and efficacy of implantation of two secondgeneration iStent inject trabecular micro-bypass stents with concomitant cataract surgery.Methods:This consecutiv...Background:The study aimed to investigate the 24-month safety and efficacy of implantation of two secondgeneration iStent inject trabecular micro-bypass stents with concomitant cataract surgery.Methods:This consecutive case series included 164 eyes of 109 patients implanted with the iStent inject®device with concomitant cataract surgery.The series was comprised of eyes with primary open-angle glaucoma(n=84),pseudoexfoliation glaucoma(n=42),normal-tension glaucoma(n=18),and ocular hypertension(n=20).All 164 eyes reached 9–14 months of follow-up(“12-month consistent cohort”),with a subset of 88 eyes reaching 21–26 months of follow-up(“24-month consistent cohort”).Performance outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included intra-or postoperative complications,the need for secondary procedures and corrected distance visual acuity.Comparisons of change in continuous(e.g.,IOP)and categorical(e.g.,proportions of eyes on zero medications)measures between baseline and postoperative times were made with the paired t-test and McNemar’s chi-squared test,respectively.Results:At 12 months postoperatively,IOP was reduced by 25.5%(from 20.0±5.5 mmHg to 14.9±2.0 mmHg;p<0.001);at 24 months postoperatively,IOP was reduced by 26.6%(from 20.3±6.1 mmHg to 14.9±1.9 mmHg;p<0.001).At 12 months postoperatively,mean number of glaucoma medications was reduced by 85.0%(from 2.0±1.0 to 0.3±0.8 medications;p<0.001);at 24 months postoperatively,mean number of medications was reduced by 81.0%(from 2.1±1.1 to 0.4±0.8 medications;p<0.001).After 12 months,96.3%of eyes had an IOP≤18 mmHg and 58.5%of eyes had an IOP≤15 mmHg,with 81.1%of eyes free of any medication,compared to 1.8%of eyes medication-free in the 12-month cohort at baseline.After 24 months,98.9%of eyes had an IOP≤18 mmHg and 53.4%of eyes had an IOP≤15 mmHg,with 72.7%free of medication compared to 1.1%of eyes medication-free in the 24-month cohort at baseline.Overall,a high safety profile was ob展开更多
Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents...Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using vis-ual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout eight years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-to-disc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At eight years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved 1OP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success rate was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through eight years postoperative.VF-MD remained stable until postoperative year five and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naive POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical suc-cess,and favorable 展开更多
Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The se...Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.展开更多
Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Method...Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon’s implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts.Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.展开更多
Background:Excimer laser trabeculostomy(ELT)is a microinvasive glaucoma surgery(MIGS)that creates multiple laser channels through the trabecular meshwork using a cold laser system,which minimizes tissue fibrosis and a...Background:Excimer laser trabeculostomy(ELT)is a microinvasive glaucoma surgery(MIGS)that creates multiple laser channels through the trabecular meshwork using a cold laser system,which minimizes tissue fibrosis and aids in bypassing the main area of resistance to aqueous outflow.The purpose of this review is to evaluate the current body of evidence surrounding ELT in terms of efficacy and review the safety profile of the procedure.Main text:Studies screened had to show clear inclusion and exclusion criteria as well as well-defined outcome measures.PubMed,MEDLINE,EMBASE and the Cochrane Controlled Trial Database were searched.Preferred Reporting Items of Systematic Reviews(PRISMA)guidelines were used to assess for study quality and for any bias.Sixty-four articles were initially identified with 18 meeting preliminary screening criteria.Ultimately,8 studies met inclusion criteria and 2 additional non-referenced publications were also included:1 randomized control trial,4 prospective case series and 5 retrospective studies.Overall studies showed moderate intraocular pressure(IOP)lowering of between 20%and 40%from baseline without medication washout and mostly a decrease in glaucoma medications with few complications.Conclusion:Current literature shows a significant IOP-lowering effect of ELT with a favorable safety-profile in standalone cases or combined with cataract surgery.Limitations to these studies are the lack of controls and washout IOP.Overall,ELT is an attractive MIGS option that does not require any residual device remaining in the angle.展开更多
Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open-angle glaucoma(POAG)patients treated by XEN 45 Gel Stent,medical therapy and trabeculectomy.Method...Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open-angle glaucoma(POAG)patients treated by XEN 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the XEN 45 Gel Stent procedure,Group 2 eyes^were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRTII IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The XEN 45 Gel Stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with microcysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare microcysts.Post-trabeculectomy inflammatory reaction is more evident than XEN 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel Stents.展开更多
Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The ...Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.展开更多
Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents...Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throug展开更多
s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were exclud...s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were excluded.Key Content and Findings:Topical glaucoma medications frequently cause adverse effects on the ocular surface,both through direct action of the medications themselves as well as through toxicity from their associated preservatives.Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma,such as trabeculectomy,can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications.Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates,while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability.The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden.It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity.However,more research is needed to directly assess the extent of improvement seen after MIGS.Conclusions:A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.展开更多
Dear Editor,Minimally invasive glaucoma surgery (MIGS) is a lessinvasive surgical alternative to filtering surgery for reducing intraocular pressure (IOP). This technique has been shown to offer long-term outcomes equ...Dear Editor,Minimally invasive glaucoma surgery (MIGS) is a lessinvasive surgical alternative to filtering surgery for reducing intraocular pressure (IOP). This technique has been shown to offer long-term outcomes equivalent to filtering surgery[1]. The XEN gel implant (Allergan Inc., CA, USA) is one of MIGS procedures. This implant consists of a 6-mm tube of collagen-derived gelatin cross-linked with glutaraldehyde, preloaded in an injector.展开更多
Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased r...Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels.The trabecular meshwork(TM)is a multi-layer spongy tissue that filters aqueous humor.Its structure changes and the filtering capacity decreases,leading to an increase in intraocular pressure.Surgical methods for TM are constantly updated.Compared with traditional glaucoma surgical techniques,such as external trabeculectomy,the development of a new surgical technique-minimally invasive glaucoma surgery(MIGS)-enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye.MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway,uveoscleral outflow pathway,and subconjunctival outflow pathway.A new surgical instrument,the Kahook Dual Blade,appears to optimize the TM outflow pathway in the surgical technique.The Kahook Dual Blade is a new type of angle incision instrument.Because of its unique double-edged design,in the process of goniotomy,it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly.Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants.The operation time is relatively short,the surgical technique is easy to master,and the TM resection scope can be determined based on the patient’s condition.It can be used to treat some clinically meaningful glaucoma.This article is organized as follows.We present the following article following the Narrative Review reporting checklist.展开更多
文摘Purpose: To evaluate the 3-year efficiency and safety of XEN<sup>®</sup> 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized observational study we identified patients who had undergone either stand-alone XEN<sup>®</sup> implantation (XEN solo) or XEN<sup>®</sup> implantation in combination with phacoemulsification (XEN combi). All patients who had undergone an implantation during the period 01.04.17-31.10.19 at the Department of Ophthalmology, Drammen Hospital, Norway, were asked to participate. Success was defined as IOP between 5 - 18 mmHg and 20% pressure reduction without medications. Qualified success required the same pressure interval and reduction but allowed medications. The procedure was deemed as failure if pressure requirements were not met, vision was reduced to light perception or worse, or if there was a converion to secondary glaucoma surgery. Results: Out of 115 patients and 133 eyes identified, 87 patients and 99 eyes consented to participate. All patients were Caucasians with a mean age of 73.6 years. The study had a mean (range) follow-up of 38.9 (28 - 54) months. The mean medicated baseline (SD) was reduced from 22.6 (7.9) mmHg on 3.2 (1.1) medications to 14.2 (5.6) mmHg on 1.4 (1.6) medications. Success and qualified success were achieved in 22.2% and 21.2%, respectively. Needling was performed in 34 eyes. Conclusion: XEN<sup>®</sup> 45 gel stent implantation is a safe procedure, offering a significantly lower IOP and number of medications in a subset of patients with open angle glaucoma.
文摘An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD);therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.
基金Project supported by the National Natural Science Foundation of China(Grant No.61504107)the Fundamental Research Funds for the Central Universities,China(Grant Nos.3102014JCQ01059 and 3102015ZY043)
文摘We demonstrate that the insertion of a graphene tunnel barrier between Heusler alloy Co_2MnSi and the germanium（Ge） channel modulates the Schottky barrier height and the resistance–area product of the spin diode. We confirm that the Fermi level is depinned and a reduction in the electron Schottky barrier height（SBH） occurs following the insertion of the graphene layer between Co_2MnSi and Ge. The electron SBH is modulated in the 0.34 eV–0.61 eV range. Furthermore,the transport mechanism changes from rectifying to symmetric tunneling following the insertion. This behavior provides a pathway for highly efficient spin injection from a Heusler alloy into a Ge channel with high electron and hole mobility.
文摘Background: The iStent inject is a Micro-Invasive Glaucoma Surgical (MIGS) device that has shown to reduce IOP and to be safe for glaucoma patients with fewer complications than regular surgery. Objective: To investigate, up to 15 - 20 months, the efficacy and safety of implantation of two second-generation trabecular microbypass stents in patients with or without prior glaucoma surgery. Methods: Fifty-seven eyes were implanted with the iStent inject. The population was comprised of eyes with primary open-angle glaucoma (n = 51), pseudoexfoliation glaucoma (n = 5) and ocular hypertension (n = 1). Major outcome parameters included IOP, medication needs and corrected distance visual acuity (CDVA). Follow-up time points were one day, 2 - 4 months, 9 - 14 months and 15 - 20 months. Results: The main reason to perform MIGS was IOP reduction in 68.4%, reduced number of medications due to drug intolerance in 24.6% and reduced medication due to compliance issues in 7.0% of the eyes. IOP decreased by 22.47%, from 19.40 ± 3.83 mmHg preoperatively (preop) to 15.04 ± 1.67 mmHg at 15-20 months postoperatively. IOP reduction was achieved at all follow-up time points (p Conclusions: Insertion of the iStent inject in patients with or without prior glaucoma surgery shows effective and sustained improvements in IOP with no safety concerns.
文摘Background:The study aimed to investigate the 24-month safety and efficacy of implantation of two secondgeneration iStent inject trabecular micro-bypass stents with concomitant cataract surgery.Methods:This consecutive case series included 164 eyes of 109 patients implanted with the iStent inject®device with concomitant cataract surgery.The series was comprised of eyes with primary open-angle glaucoma(n=84),pseudoexfoliation glaucoma(n=42),normal-tension glaucoma(n=18),and ocular hypertension(n=20).All 164 eyes reached 9–14 months of follow-up(“12-month consistent cohort”),with a subset of 88 eyes reaching 21–26 months of follow-up(“24-month consistent cohort”).Performance outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included intra-or postoperative complications,the need for secondary procedures and corrected distance visual acuity.Comparisons of change in continuous(e.g.,IOP)and categorical(e.g.,proportions of eyes on zero medications)measures between baseline and postoperative times were made with the paired t-test and McNemar’s chi-squared test,respectively.Results:At 12 months postoperatively,IOP was reduced by 25.5%(from 20.0±5.5 mmHg to 14.9±2.0 mmHg;p<0.001);at 24 months postoperatively,IOP was reduced by 26.6%(from 20.3±6.1 mmHg to 14.9±1.9 mmHg;p<0.001).At 12 months postoperatively,mean number of glaucoma medications was reduced by 85.0%(from 2.0±1.0 to 0.3±0.8 medications;p<0.001);at 24 months postoperatively,mean number of medications was reduced by 81.0%(from 2.1±1.1 to 0.4±0.8 medications;p<0.001).After 12 months,96.3%of eyes had an IOP≤18 mmHg and 58.5%of eyes had an IOP≤15 mmHg,with 81.1%of eyes free of any medication,compared to 1.8%of eyes medication-free in the 12-month cohort at baseline.After 24 months,98.9%of eyes had an IOP≤18 mmHg and 53.4%of eyes had an IOP≤15 mmHg,with 72.7%free of medication compared to 1.1%of eyes medication-free in the 24-month cohort at baseline.Overall,a high safety profile was ob
文摘Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using vis-ual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout eight years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-to-disc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At eight years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved 1OP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success rate was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through eight years postoperative.VF-MD remained stable until postoperative year five and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naive POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical suc-cess,and favorable
基金This study was funded by an investigator-initial trial grant from Glaukos Corp.(San Clemente,CA,USA).
文摘Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.
文摘Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon’s implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts.Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.
文摘Background:Excimer laser trabeculostomy(ELT)is a microinvasive glaucoma surgery(MIGS)that creates multiple laser channels through the trabecular meshwork using a cold laser system,which minimizes tissue fibrosis and aids in bypassing the main area of resistance to aqueous outflow.The purpose of this review is to evaluate the current body of evidence surrounding ELT in terms of efficacy and review the safety profile of the procedure.Main text:Studies screened had to show clear inclusion and exclusion criteria as well as well-defined outcome measures.PubMed,MEDLINE,EMBASE and the Cochrane Controlled Trial Database were searched.Preferred Reporting Items of Systematic Reviews(PRISMA)guidelines were used to assess for study quality and for any bias.Sixty-four articles were initially identified with 18 meeting preliminary screening criteria.Ultimately,8 studies met inclusion criteria and 2 additional non-referenced publications were also included:1 randomized control trial,4 prospective case series and 5 retrospective studies.Overall studies showed moderate intraocular pressure(IOP)lowering of between 20%and 40%from baseline without medication washout and mostly a decrease in glaucoma medications with few complications.Conclusion:Current literature shows a significant IOP-lowering effect of ELT with a favorable safety-profile in standalone cases or combined with cataract surgery.Limitations to these studies are the lack of controls and washout IOP.Overall,ELT is an attractive MIGS option that does not require any residual device remaining in the angle.
文摘Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open-angle glaucoma(POAG)patients treated by XEN 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the XEN 45 Gel Stent procedure,Group 2 eyes^were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRTII IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The XEN 45 Gel Stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with microcysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare microcysts.Post-trabeculectomy inflammatory reaction is more evident than XEN 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel Stents.
基金funded by an investigator-initial trial grant from Glaukos Corp.(San Clemente,6,USA).
文摘Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.
文摘Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throug
文摘s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were excluded.Key Content and Findings:Topical glaucoma medications frequently cause adverse effects on the ocular surface,both through direct action of the medications themselves as well as through toxicity from their associated preservatives.Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma,such as trabeculectomy,can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications.Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates,while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability.The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden.It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity.However,more research is needed to directly assess the extent of improvement seen after MIGS.Conclusions:A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.
文摘Dear Editor,Minimally invasive glaucoma surgery (MIGS) is a lessinvasive surgical alternative to filtering surgery for reducing intraocular pressure (IOP). This technique has been shown to offer long-term outcomes equivalent to filtering surgery[1]. The XEN gel implant (Allergan Inc., CA, USA) is one of MIGS procedures. This implant consists of a 6-mm tube of collagen-derived gelatin cross-linked with glutaraldehyde, preloaded in an injector.
基金This work was supported the Natural Nature Science Foundation of China(No.81470633)The Natural Science Grant of the Heilongjiang province of China(H2018035,No.2020H040)+1 种基金The grant of Heilongjiang education committee(11521160,1152G021)The Innovation and Development Foundation of First Affiliated Hospital of Harbin Medical University(2018L002).
文摘Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels.The trabecular meshwork(TM)is a multi-layer spongy tissue that filters aqueous humor.Its structure changes and the filtering capacity decreases,leading to an increase in intraocular pressure.Surgical methods for TM are constantly updated.Compared with traditional glaucoma surgical techniques,such as external trabeculectomy,the development of a new surgical technique-minimally invasive glaucoma surgery(MIGS)-enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye.MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway,uveoscleral outflow pathway,and subconjunctival outflow pathway.A new surgical instrument,the Kahook Dual Blade,appears to optimize the TM outflow pathway in the surgical technique.The Kahook Dual Blade is a new type of angle incision instrument.Because of its unique double-edged design,in the process of goniotomy,it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly.Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants.The operation time is relatively short,the surgical technique is easy to master,and the TM resection scope can be determined based on the patient’s condition.It can be used to treat some clinically meaningful glaucoma.This article is organized as follows.We present the following article following the Narrative Review reporting checklist.
