ABSTRACT
Objective:To investigate the efficacy and safety of non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma (PCG).Methods:An observational case series study was conducted.A total of 29 cases (50 eyes) with PCG, including 21 males (35 eyes) and 8 females (15 eyes), were enrolled in Jiangsu Province Hospital and Nanjing Children's Hospital from January to November, 2019.The age of subjects ranged from 1 month to 4 years, and the median age was 6 months.Non-penetrating trabecular surgery was first performed in order to open the Schlemm canal.The cannulation and nearly 360-degree suture trabeculotomy were then performed with the twisted 6-0 polypropylene suture.Intraocular pressure (IOP), corneal diameter, cup-to-disc ratio (c/d) and complications were recorded preoperatively and 1 week, 1 month, 3 months, 6 months, 9 months, 12 months, and 24 months postoperatively, and the proportion of sutures successfully passed through the Schlemm canal and the success rate of operation were recorded.This study followed the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (No.2019-SR-198). Written informed consent was obtained from the guardian of each subject prior to entering the study cohort.Results:Circumferential cannulation by suture was successfully performed in 90% of the subjects.The Harms trabeculotomy probe was applied in failed cases.Mean IOP was significantly lowered from preoperative (35.0±9.5) mmHg (1 mmHg=0.133 kPa) to (9.9±4.4), (10.0±4.2), (9.7±4.4), (9.0±2.9), (9.4±4.2), (9.3±3.3) and (9.5±3.8) mmHg at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=141.56, P<0.01). Mean corneal diameter was significantly reduced from preoperative (13.7±1.4) mm to (13.3±1.4), (12.9±1.4), (12.8±1.3), (12.7±1.2), (12.6±1.1), (12.6±1.1) and (12.8±0.4) mm at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=4.55, P<0.01). Mean c/d was significantly reduced from preoperative 0.81±0.15 to 0.55±0.22, 0.48±0.23, 0.45±0.22, 0.43±0.21, 0.41±0.20, 0.40±0.21 and 0.31±0.19 at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=21.07, P<0.01). Forty-two eyes (93.3%) achieved complete success and 45 eyes (100%) achieved qualified success at postoperative 12 months.No severe complications were observed during or after surgery. Conclusions:Non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy can effectively treat patients with PCG without any severe complications.
ABSTRACT
AIM: To investigate the clinical therapeutic effects of human umbilical vein (HUV)implantation and mitomycin C (MMC) in non-penetrating trabecular surgery (NPTS). METHODS:A total of 32 patients (46 eyes) with uncontrolled primary open angle glaucoma (POAG) were divided into two groups: HUV+MMC group (n=25), SKGEL+MMC group (n=21). The procedure commenced with the creation of a limbus based conjunctival flap. After the dissection of a superficial limbus based rectangular scleral flap, MMC(0.4mg/mL) was used superior and inferior surface of the superficial scleral flap for three minutes. A second limbus based scleral flap was carefully dissected beneath the previous one towards the choroid. Schlemm's canal was deroofed during the extension of the deep scleral flap toits limbal edges. HUV or SKGEL fixed on the bed of sclera in experimental group. Postoperative examinations were performed at 1 week,2,4 weeks;2,6,12 months. IOP,best-corrected visual acuity(BCVA), functional blebs and success rate were examined. RESULTS: There were no statistically differences with postoperative IOP in HUV+MMC group and SKGEL+MMC group (P>0.05) during 1 week to 12 months. There was no difference with postoperative function blebs and the change of BCVA during 1 week to 12 months between HUV+MMC group and SKGEL+MMC group (P>0.05).At 12 months after surgery, the success rate was 84% in HUV+MMC group,86% in SKGEL+MMC group. CONCLUSION: The application of HUV in NPTS can prevent the adhesion of filtering channel and it can improve the success rate of NPTS. Compared with SKGEL, HUV has lower price. So it is a better implant.
ABSTRACT
This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma.We searched the Cochrane Library,PUBMED (1966 to 2009),Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies.The reports,including the papers listed in bibliographies,were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration's RevMan 4.5 software package.A total of nine RCTs were included in the study.The analyses of the reports showed that,12 months after surgery,there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P＜0.00001).There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92,P＜0.00001).Difference in the success rate was also found between the two surgeries (Z=3.82,P=0.0001).It is concluded that,compared with the non-penetrating trabeculectomy,the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.