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Objective To report a postoperative complication of corneal invasion of filtering bleb (CIFB) and the analysis of its diagnosis and treatment.Methods A retrospective analysis was conducted in 17 patients with CIFB collected from March 2006 to April 2017.They were treated according to the classification standards.Patients suffering the mild type with no obvious conjunctival post-adhesion received conservative observation;but patients with obvious adhesion were given acupuncture separation combined with 5-Fluorouracil filter follicular subconjunctival injection and eye massage.The moderate type with no progress was treated with the mild and mediumpartial filtration and amniotic membrane transplantation.For the severe ones,the conjunctiva filtering bleb was excised with lamellar keratoplasty and filtering bleb reconstruction.Finally,the clinical features,classification standards and the follow-up results were summarized.Results As for the clinical features,17 patients were treated with domeas the basement of the conjunctival incision,and received intraoperative mitomycin administration.For the patients with CIFB growing rapidly,the posterior synechiae of their filtering blebs had occurred and timely actions could slow down or stop its development.As for the classification standards,according to the degree of corneal invasion,there were 11 patients being mild type,5 patients being moderate types,and only 1 patients being severe type.After treatment,the progress stopped in all mild patients,while the moderate and severe types were not relapsed after treatment.Conclusion CIFB is different from overhanging filtering bleb.As a less common kind of filtering bleb complication,timely identification and appropriate treatments can effectively delay or even stop the progress of corneal damage to maintain the filtering surgery effects.
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Objective To investigate the clinical effects of microinvasive revision surgery on the patients of the fibrotic filtering bleb with the guidance of ultrasound biomicroscopy (UBM).Methods A prospective,nonrandomized clinical controlled trial was conducted,which had 2 groups according to the results from UBM during the same period in our hospital,including the patients with the microinvasive revision surgery (28 patients of 28 eyes,group A) and the in-situ traditional revision surgery of larger incision (27 patients of 27 eyes,group B).The clinical data of the patients were collected and the main observation targets were the change of the postoperative visual acuity (VA),intraocular pressure (IOP),the operation success rate and the complications.Results There were no significant differences in the gender,age,glaucoma types,primary operation modes,postoperative follow-up time and preoperative VA (all P ＞0.05).The average duration of hospital stay,postoperative VA and the postoperative complications of group A were better than those of group B and the differences were statistically significant (all P ＜ 0.05).There was no significant difference in IOP at different time points between the two groups (all P ＞ 0.05).The operative successful rates of the two groups were 64.3％ and 66.6％,respectively(P ＞ 0.05).Conclusion The in-situ microinvasive revision surgery on the basis of the UBM examination is a good choice for patients with the fibrotic filtering bleb of the unlocked inner passageway in the filter aisle and a latent liquid dark cavity that is interlinked with the anterior chamber under the scleral flap or the liquid dark cavity of the capsule.
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Abstract?AlM:To investigate the choice of different treatments for malignant glaucoma.? METHODS: ln this retrospective case series, 21 malignant glaucoma patients ( 21 eyes ) admitted in Wuhan General Hospital of Guangzhou Military Command from May 2012 to May 2013 were analyzed. Sixteen eyes ( 76%) developed malignant glaucoma after filtration surgery, 3 eyes ( 14%) after EX - PRESS glaucoma filtration device, 2 eyes ( 10%) after glaucoma filtration Ahmed valve implantation. Main Outcome of corrected visual acuity, intraocular pressure ( lOP ) , anterior chamber depth and complications were detected.?RESULTS: lOP recovered by drug control in 13 eyes, anterior chamber depth. Four eyes were treated by vitreous water- bag aspiration combined with anterior chambers reconstructing. Two eyes were treated by cataract extraction and intraocular lens implantation. Two eyes were treated by posterior capsule excision combined with anterior vitrectomy. lOP before and after treatment was 29. 81±4. 98, 12. 71±3. 77mmHg, respectively (P=0. 00). Anterior chamber depth before and after treatment was 0.41± 0. 34, 2. 13 ± 0. 54mm, respectively (P = 0. 00). Corrected visual acuity before treatment was 0. 19 ± 0. 17, after treatment was 0. 20±0. 16 (P= 0. 36). Except for vitreous hemorrhage in 1 eye, there were no ocular or systemic adverse events observed in all patients.? CONCLUSlON: lt is good to diagnose malignant glaucoma in early period, and treated it step by step. For this can reduce lOP and restore anterior chamber.
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At present, filtration surgery remains an important treatment of glaucoma, and filtering bleb fibrosis is the main cause for treatment failure. Filtering bleb fibrosis is a common fiber hyperplastic disease, and it relates to the activation and proliferation of fibroblasts and the excessive production of extracellular matrix ( ECM) such as collagen protein. The most frequently-used drugs for filtering bleb fibrosis in clinic are 5-fluoro-2,4 (1h, 3h) pyrimidinedione ( 5 - Fu ) and mitomycin ( MMC ) . Although they are effective in some degree, they also have some serious side effects which restrict their clinical use. Triptolide ( TPL) is a major active component of the medicinal plant, tripterygium wilfordii hook. f. ( TWHF) . TPL has multiple pharmacological activities including immunosuppressive, anti- inflammatory, anti- cancer and anti-fertility activity. Reviewing related literatures published in recent ten years, we confirmed that TPL seemed to possess a pharmacological activity in treating filtering bleb fibrosis. Since it has three major functions:1. inhibit the activation and proliferation of fibroblasts and the excessive production of collagen protein; 2. alleviate the inflammatory reaction after surgical wound to suppress fibrous scar formation; 3. TPL has a protective effect on retinal ganglion cells ( RGCs ) . We further find that TPL's anti-fibrosis activity mainly results from that it inhibits TGF-β/Smad,NF-κB and PI3K/AKT signal transduction pathway. This comprehensive analysis about the feasibility of Triptolide's role in treating filtering bleb fibrosis after the filtration surgery of glaucoma can help us develop new drugs for filtering bleb fibrosis and exploit TPL's clinical value on some level.
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Glaucoma is the first leading cause of irreversible blindness and the second leading cause of blindness worldwide. Numerous studies have shown that elevated intraocular pressure ( IOP ) is one of the major risk factors for the development and progression of glaucomatous optic nerve damage. However, there have been 50% of primary open-angle glaucoma ( POAG ) patients with typical glaucomatous optic neuropathy in whom the IOP measurements have always been in the normal range, and some patients develop typical glaucomatous optic neuropathy with the well controlled IOP. These phenomena cannot be explained by the theory of high intraocular pressure. The pathogenesis of glaucomatous optic nerve damage in these patients with normal IOP needs to be further discussed. Numerous studies at home and abroad have shown that: 1. the surrounding anatomy of the optic nerve including the IOP, the anatomy and biomechanics of the lamina cribrosa and retrobulbar orbital cerebrospinal fluid pressure may be of importance for the pathogenesis of the POAG;2. patients with normal tension glaucoma had significantly lower cerebrospinal fluid pressure and a higher trans - lamina cribrosa pressure difference compared with normal subjects; 3. patients with ocular hypertension had significantly higher cerebrospinal fluid pressure, however, there is no difference in trans -lamina cribrosa pressure compared with normal subjects. Based on the above research, now we make a review about the research advance of the relation between intracranial pressure and glaucoma optic nerve damage and the available measurements about noninvasive intracranial pressure in clinical in this paper.
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AIM: To investigate the safety and effect of EX-PRESS glaucoma drainage device on open-angle glaucoma. METHODS: A retrospective review of 40 patients ( 47 eyes ) whose eyes were diagnosed as open angle glaucoma through the best - corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , gonioscope, examination of the ocular fundus, and visual fields et al. Fourty patients 6-73y old ( mean 39. 90±16. 50y old) with the BCVA from 0. 01 to 0. 6 and the IOP from 18mmHg to 65mmHg were treated with EX-PRESS glaucoma drainage device after achieving not well IOP over three drugs. Follow - up of these patients 1d, 3d and 1wk after treatment, IOP, slit lamp examination were retrospectively observed. The changes of the BCVA, IOP were used to evaluate the safety and effect before and after treatmeat. RESULTS: The mean BCVA was 0. 26 ± 0. 29 pre -operatively, while it was 0. 24±0. 22 after treatment one week. The mean BCVA decreased slightly, but there was no statistic difference between pre-treatment and post-treatment (t=1. 56,P=0. 13). The mean IOP was (36. 62 ±14.01)mmHg pre-operatively, (10.04±5.77)mmHg after treatment one day , ( 9. 59±4. 93 ) mmHg after treatment three days, (9. 47±3. 06)mmHg after treatment one week. The IOP was decreased significantly in post-treatment after one day, three days, one week compared with pre-treatment (F=157. 20, P CONCLUSION:EX-PRESS glaucoma drainage device is an effective and safe treatment for the patients with open-angle glaucoma. The risk and complication are low intraoperatively and postoperatively.
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Background Rigid gas permeable (RGP) contact lens,as a kind of new correction of refraction error,has been wildly used,but whether it will cause eye optical system of the change and influence on the visual acuity is unclear.Objective Present study was to evaluate and compare the visual quality of low to moderate myopia following wearing of RGP contact lens and spectacles.Methods Sixty-eight eyes of 35 subjects with low or mediate myopia were included in this study.Wave-front aberrations and visual acuities under the different contrasts (10％,30％,40％,52％,76％,92％) in the light or dark environment were examined before and 3 months after wearing of RGP corneal contact lens.These parameters were compared with those after wearing of spectacles with paired t test.Results The best corrected visual acuity (BCVA) was improved significantly from 0.94±0.10 to 1.26±0.03 3 months after wearing of RGP corneal contact lens (t=-9.266,P=0.000).After fitting of RGP corneal contact lens,the total higher order wave-front aberrations,the 3rd and 4th order aberrations were significantly declined in comparison with those of before fitting (total:t=4.683,P=0.000;RMS3:t=4.656,P=0.000;RMS4:t=3.929,P=0.000).However,no significant differences were detected in the 5th and 6th order aberrations between RGP corneal contact lens fitting and spectacles wearing (RMS5:t=1.766,P=0.083 ;RMS6:t=1.150,P=0.256).In both bright and dark environments,BCVA values were much better in the eyes with RGP corneal contact lens wearing than that in the eyes with spectacles wearing (all P＜0.05).The BCVA was always reduced with the decline of contrast level whether bright or dark backgrounds both in RGP corneal contact lens wearing eyes and spectacles wearing eyes.Conclusions Wearing of RGP corneal contact lens provides better visual quality for low to moderate myopia than the spectacles wearing.
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Background Leber hereditary optic neuropathy (LHON)is a mitochondrial DNA (mtDNA)hereditary disease,so it is significant to understand the influence of DNA mutation on the occurrence of LHON.Objective This survey was to evaluate the role of mtDNA mutation in the development of LHON.Methods This survey study was approved by the Ethic Committee of Wuhan General Hospital of Guangzhou Military Command and written informed consent was obtained from each subject before the relative medial examination.Seventy-two matrilineal relatives from a family with LHON were collected for a pedigree analysis and mutation screening.Regular eye examination was performed on 11 patients,13 mutant gene carriers and 49 individuals with normal phenotype,and the degree of visual damage was graded as follows: ＞0.3 was normal,0.1-0.3 was mild damage,＜0.05-0.1 was moderate damage,＜0.02-0.05 was severe damage and ＜0.01 was very severe damage.Clinical characteristics of LHON was evaluated.The periphery blood sample of 2-4 ml was collected from individuals to separate the mononuclear cells,and the mtDNA was extracted by modified high salt method.MtDNA was amplified by PCR and the mutation loci was sequenced.Results PCR amplification product sequencing of mutant gene showed that both G11778A and T14502C mutations were detected in 24 of 72 matrilineal relatives,but only 11 of 24 carriers developed LHON.No abnormal clinical findings were seen in the 13 carriers,showing a less 50％ penetrance in this family.There was no G11778A or/and T14502C mutation in the normal phenotype individuals of this family.The onset age for vision impairment in 11 affected matrilineal relatives varied from 8 to 50 years old,with the mean age of 24.36 years old,showing a significantly lower age than that of the 13 carriers (5-72 years old,mean 40.38 years old) (t =2.102,P=0.049).Conclusions This study suggests that the Gl1778A and T14502C mutation in mitochondrial DNA is one of causes in the development of LHON.The primary G11778A mutation together with T14502C mutation in mtDNA is a factor for the occurrence of LHON,hut it is not sufficient to the development of LHON.An effective “second hit” process will play an inducing role for LHON.
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Background As a new tonometer,it is necessary to assess the clinical value of Icare rebound tonometer.Objective This study was to compare the intraocular pressure(IOP)values measured by Icare with that measured by GAT,and discuss the clinical value of leare rebound tonometer. Methods IOP measurement was performed on 152 eyes of 78 subjects with suspicious glaucoma,glaucoma,refractive error and normal examinnee by Icare and GAT respectively.The Icare IOP was measured firstly and then the GAT IOP was carried out with the 3-or 5-minute interval.The IOP values were compared between Ieare and GAT.This study was approved by Ethic Committee of Wuhan General Hospital of Chinese PLA.Written informed consent was obtained from each subject prior to this study. Results The mean IOP values of Icare and GAT were(19.16±5.03)mmHg and(18.41±4.52)mmHg respectively.The differences between Icare IOP and CAT IOP were less than or equal to 1 mmHg in 96 of 105 eyes(63.2%).The positive correlation was found between the Icare IOP and GAT IOP(r=0.940,P<0.01).The Ieare IOP was lower than that of GAT when IOPIcare<16 mmHg,however,the IOP of Icare were higher when IOPIcare≥6 mmHg;the IOP of Icare were higher than that of GAT in the total CCT range.The correlation coefficients of IOP of Icare or CAT with CCT were 0.341(P<0.01)and 0.333(P<0.01),respectively. Conclusion Compared with GAT,Icare is more feasible in clinic because it is practicable and reliable.