ABSTRACT
@#【Objective】To evaluate the efficacy of early filtering surgery in newborns with primary congenital glaucoma（NPCG）.【Methods】A total of 70 eyes of 39 patients with NPCG，who underwent trabeculotomy or combined trabeculotomy-trabeculectomy within 3 years old were retrospectively studied. Preoperative and postoperative intraocular pressure（IOP），corneal clarity and diameter，optic disc cupping and visual acuity were evaluated. Kaplan-Meier survival analysis of the success rates were studied. Success rates of the patients who underwent surgery within 1 month old（22 eyes）and older than 1 month old（48 eyes）were compared by Log- Rank.【Results】The postoperative IOP（mmHg；16.9 ± 5.2） were significantly lower than the preoperative IOP（28.7±5.8 ，P<0.001）. At the last visit ，the cornea became clearer ， C/D（cup/disc）ratio decreased significantly，while the horizontal corneal diameter did not change significantly in all the children. The success rates for all eyes at 1，2，3，6 and 9 years after operation were 94.3%（63 eyes），90.6%（52 eyes），85.9%（40 eyes），85.9%（23 eyes），and 85.9%（15 eyes），respectively. The success rates and visual acuity at last visit of patients who underwent surgery within 1 month old were better than those older than 1 month old（P=0.033； P=0.01）. There were no severe intraoperative or postoperative complications.【Conclusions】Early surgery such as trabeculotomy or combined trabeculotomy-trabeculectomy is a safe and effective treatment for NPCG.
ABSTRACT
<p><b>BACKGROUND</b>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 of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth.</p><p><b>METHODS</b>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 (IOP), 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.</p><p><b>RESULTS</b>The mean follow-up time was 46.9 ± 34.4 months (range: 12-122 months). The postoperative IOP was significantly lower than the preoperative IOP 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 IOPs 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.</p><p><b>CONCLUSIONS</b>Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.</p>
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Congenital Abnormalities , General Surgery , Glaucoma , General Surgery , Postoperative Complications , Retrospective Studies , Trabeculectomy , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity. Ocular surface symptoms had a substantial impact on the glaucoma patients' quality of life and compliance. This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment.</p><p><b>METHODS</b>Fifty-eight patients (101 eyes), who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria, were included in the analysis. All patients were maintained the original topical anti-glaucoma treatment. In the SH-treated group (56 eyes), unpreserved 0.3% SH eye drops were administered with 3 times daily for 90 days. In the control group (55 eyes), phosphate-buffered saline were administered with 3 times daily for 90 days. Ocular Surface Disease Index (OSDI) questionnaire, break-up time (BUT) test, corneal fluorescein staining, corneal and conjunctival rose Bengal staining, Schirmer test, and conjunctiva impression cytology were performed sequentially on days 0 and 91.</p><p><b>RESULTS</b>Compared with the control group, SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test: H = 38.668, P < 0.001), fluorescein and rose Bengal scores (Wilcoxon signed-ranks test: z = -3.843, P < 0.001, and z = -3.508, P < 0.001, respectively), increase in tear film BUT (t-test: t = -10.994, P < 0.001) and aqueous tear production (t-test: t = -10.328, P < 0.001) on day 91. The goblet cell density was increased (t-test: t = -9.981, P < 0.001), and the morphology of the conjunctival epithelium were also improved after SH treatment.</p><p><b>CONCLUSIONS</b>SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment. SH could be proposed as a new attempt to reduce ocular surface toxicity, and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.</p>