AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients wit...AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.展开更多
With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has broadened.Despite its novelty however,there has been a ...With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has broadened.Despite its novelty however,there has been a rapid evolution in the development of a multitude of devices,each targeting a structure along the aqueous drainage pathway.A growing body of evidence has demonstrated IOP and medication burden reduction,and a more favorable safety profile with MIGS procedures in contrast to traditional incisional surgeries.Among the array of MIGS,the Hydrus®Microstent(Ivantis,Inc.,Irvine,CA)is a recent FDA approved device,designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s canal.The objective of this article is to review the Hydrus from conception to clinical use,and present data on its efficacy and safety to date.The available literature has shown promise,however inherent to all novel devices,only longterm monitoring will ensure sustained IOP control and an acceptable safety profile.Surgical advancements in glaucoma have revolutionized the field,and continued research and development will establish these approaches in clinical treatment algorithms.展开更多
文摘AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.
基金support for the research,authorship,and/or publication of this article:this study was supported by Ivantis,Inc.,(Irvine,CA).
文摘With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has broadened.Despite its novelty however,there has been a rapid evolution in the development of a multitude of devices,each targeting a structure along the aqueous drainage pathway.A growing body of evidence has demonstrated IOP and medication burden reduction,and a more favorable safety profile with MIGS procedures in contrast to traditional incisional surgeries.Among the array of MIGS,the Hydrus®Microstent(Ivantis,Inc.,Irvine,CA)is a recent FDA approved device,designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s canal.The objective of this article is to review the Hydrus from conception to clinical use,and present data on its efficacy and safety to date.The available literature has shown promise,however inherent to all novel devices,only longterm monitoring will ensure sustained IOP control and an acceptable safety profile.Surgical advancements in glaucoma have revolutionized the field,and continued research and development will establish these approaches in clinical treatment algorithms.
