Modified small-incision cataract surgery for combined extraction � A comparative study of two techniques

Purpose: To explore straight incision technique in terms of efficacy for intraocular pressure (IOP) lowering by small-incision cataract surgery (SICS) trab versus modified 揻rown� incision with triangular scleral flap technique. Methods: This study was done at a tertiary health center. It included 44 eyes diagnosed with cataract and coexisting primary glaucoma that underwent SICS with trabeculectomy using modified 揻rown� incision with triangular scleral flap technique and straight incision in group A (n = 22) and B (n = 22), respectively. Postoperative evaluation was done at first postoperative day, then at the end of first week, third week, and 6 weeks; at the end of third month and finally at the end of sixth months. Data were entered and analyzed via Microsoft Excel sheet and SPSS software using Mann朩hitney U test for averages and Chi-square test for categorical values. Results: Mean preoperative IOP in groups A and B were 38.6 and 29.1 mm Hg respectively, by applanation tonometry. After 6-month follow-up, mean of difference in IOP (preoperative � postoperative) for group A was 20.8 � 8.3 mm Hg and that for group B was 17.2 � 13.5 mm Hg. Conclusion: Capacity of IOP reduction of both techniques was found to be comparable and did not show much difference up to the end of 6 months. Mastering technique of group A (modified 揻rown� incision with triangular scleral flap technique) requires more expertise; the simpler straight incision technique provided in group B may be effectively used by the novice and current era Ophthalmologists to combat glaucoma coexistant with cataract.

Efficacy of ciliary sulcus suture fixation of intraocular lens through reverse partial-thickness scleral flap / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To assess the application of ciliary sulcus suture fixation of intraocular lens(IOL)through reverse partial-thickness scleral flap.<p>METHODS: The clinical data of 14 patients(14 eyes )who needed secondary IOL implantations due to different reasons in our department were retrospectively analyzed. All cases underwent ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap. One or two reverse partial-thickness scleral flap were made during the surgery. Preoperative and postoperative visual acuity, intraoperative and postoperative complications and the stability of the IOLs were observed.<p>RESULTS: The mean follow-up time was 3.5-6mo. The preoperative best-corrected visual acuity(BCVA)(LogMAR)was 0.50±0.54, and the uncorrected visual acuity(UCVA)at 1mo after surgery was 0.46±0.39(<i>P</i>>0.05). The BCVA at 1mo after surgery was 0.36±0.35, which was improved compared with the preoperative one, but the difference was not statistically significant(<i>P</i>>0.05). Three cases had transient intraocular hypertension postoperatively. One case had vetrious hemorrhage. One case had moderate anterior chamber inflammatory response. There were serious complications, such as cystoid macular edema, choroidal detachment, retinal detachment during the follow-up period.<p>CONCLUSION: Ciliary sulcus suture fixation of IOL through reverse partial-thickness scleral flap is a effective and safe method for aphakia.

Safety and efficacy of fibrin glue versus infinity suture in SICS with extended scleral flap

Purpose: To study the safety and efficacy of biologic fibrin glue (FG) in comparison with infinity suture in SICS with compromised scleral flap. Methods: A retrospective comparative study of patients who were treated with FG (Group A) with 10�nylon (Group B) as sealing agent for intraoperative compromised tunnels in SICS. Parameters noted were postoperative inflammation, wound integrity, anterior chamber (AC) depth, intraocular pressure (IOP), and surgically induced astigmatism (SIA) at postoperative day 1, 4 weeks, 6 weeks, and 6 months, respectively. Epi Info 7 software and SIA calculator, Version 2.1 were used to analyze the result. Results: We reviewed the two groups of 18 patients each and noted that there was no statistically significant difference in postoperative inflammation (P > 0.05), AC depth (P > 0.05), and IOP (P > 0.05) between both groups at each postoperative visit. One patient in Group A showed postoperative shallow AC and subconjunctival bleb. Exposed sutures causing foreign body sensation had to be removed in five patients in Group B. At the end of 6-month postoperative period, no statistically significant difference was found in SIA (P = 0.92) between the two groups. Conclusion: Biologic FG can be safely used in securing the compromised scleral incisions in SICS. It also avoids suture-related complications.

Risk factors for conjunctival tube erosion in eyes implanted with Ahmed glaucoma valve in a private eye institution in the Philippines

Objective@#To identify the risk factors for conjunctival tube erosion (CTE) in eyes implanted with Ahmed® glaucoma valve (AGV) device@*Method@#This is a retrospective study conducted at a private eye institution. Medical records of patients who underwent AGV implantation surgery from January 2004 to December 2013 were reviewed. Eyes with at least 24 months of follow-up and complete records were included. Several variables from the pre-, intra-, and postoperative periods were collected. The primary outcome was development of CTE after AGV surgery. Univariable logistic regression and multivariable analysis were employed.@*Results@#Forty-six (46) eyes of 45 patients were included in the study. The mean follow-up was 50.2 months (range: 24-140 months). Eight (8) eyes developed CTE (17.4%). Univariable logistic regression analysis identified female gender (P =0.064), presence of diabetes (P =0.083), prior intraocular surgeries (P =0.09), and postoperative use of antiglaucoma medications (P =0.086) to be marginally significant risk factors for CTE. On multivariable analysis, only female gender (OR=15.4, P =0.033) and diabetes (OR=14.1, P =0.031) were found to be significantly associated with CTE.@*Conclusion@#Risk factors for CTE following AGV implantation include female gender and presence of diabetes.

Clinical observation of the glaucoma trabeculectomy with tunnel knife making the double-deck scleral flap / 国际眼科杂志(Guoji Yanke Zazhi)

AlM: To study the trabeculectomy clinical effect of use tunnel knife to make double - deck scleral flap and to cut off the layer scleral flap of glaucoma.METHODS: Using the random grouping method to divide 46 cases (60 eyes) of glaucoma into the treatment group of 24 cases (32 eyes) and control group of 22 cases (28 eyes). The treatment group, tunnel knife was used to make double- deck sclera flap and superficial scleral flap about the size of 5mm×5. 5mm, 1/3 scleral thickness, under the sclera flap made another one about the size of 3. 5mm× 4mm, 1/3 scleral thickness, resected the middle layer of the sclera flap, removed 2mm×2mm trabecular tissue, underwent routine peripheral iridectomy, could adjust suture the superficial scleral flap, sutured Ball fascia and bulbar conjunctiva. ln control group, routine glaucoma trabeculectomy was undergone.RESULTS:Patients were followed up for 1a, the vision in treatment group was obviously better than that in the control group, with a statistically significant difference (P0. 05). But after 6 and 12mo, the intraocular pressure of the treatment group were significantly lower than that of the control group, with statistically significant difference (P<0. 05). Postopeartive 1a, the cumulative complete success rate and conditions for successful rate were 90. 63% and 96. 88% in the treatment group, and those were 75% and 89. 29% in control group. There was significant difference between two groups(P<0. 05).CONCLUSlON:The trabeculectomy have a good effect to lower the intraocular pressure by use tunnel knife to make double-deck scleral flap and to cut off the layer scleral flap. The scleral flap have uniform thickness, smooth surface, and the function of the filtering bleb maintained for a long time, less postoperative complications, suitable for various types of glaucoma, so it is worthy of clinical promotion.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Surgical Outcomes of Different Ahmed Glaucoma Valve Implantation Methods between Scleral Graft and Scleral Flap

PURPOSE: To compare the surgical outcomes of the two different methods used for Ahmed Glaucoma Valve (AGV) implantation between the donor scleral graft method and the partial-thickness scleral flap method. METHODS: We retrospectively reviewed medical records of 28 eyes of 26 patients diagnosed as neovascular glaucoma followed by AGV implantation. Based on the surgical method, the included eyes were divided into two groups. In the graft group (n = 18), the drainage tube was inserted into the anterior chamber, and then covered with preserved donor sclera. In the flap group (n = 10), the drainage tube was inserted under the partial-thickness scleral flap, and then covered with the flap. We compared the postoperative intraocular pressure (IOP), surgical success rates, and postoperative complications between the two groups. RESULTS: Postoperative IOP was not significantly different between the two groups (p = 0.967, 0.495 at 12 months, 24 months, respectively, by the Mann-Whitney U-test). The mean success periods were 53.1 +/- 10.1 months in the graft group versus 50.9 +/- 9.4 months in the flap group (p = 0.882 by log rank test), and cumulative success rates were 77.8% and 80.0% at one year, respectively. However, tube migration occurred more frequently in the flap group than in the graft group (p = 0.037 by Fisher's exact test). CONCLUSIONS: In AGV surgery for neovascular glaucoma, the scleral graft method may be associated with relatively less complication about tube migration than the scleral flap method. The surgical results, however, were not statistically different.

Clinical effects of the implantation of hydroxyapatite orbit after scleral flap / 中华医学美学美容杂志

Objective To investigate the clinical outcomes on implantation of hydroxyapatite orbit after scleral flap especially in the cosmetic results. Methods Implant hydroxyapatite orbital after scleral flap for the treatment of all kinds of patients who should be enucleated, including 14 cases of eyeball atrophy, 5 cases of sclerocorneal staphyloma, 3 cases of absolute glaucoma, 3 cases of neovaseular glaucoma and 7 cases of eyeball rupture. Results We observed that the orbit was full and the orbital movement was smooth in all cases. After 3 to 12 months follow-up we found that no hydroxyapatite exposed or moved. Conclusion Good cosmetic results can be achieved by the implantation of hydroxyapatite orbit after scleral flap.

Experiment of turning scleral flap of self-body over drainage in trabeculectomy of glaucoma / 眼科新进展

Objective　To investigate the effect of turning scleral flap of self-body over drainage in trabeculectomy.Methods　The surgery was performed on one eye of a rabbit while　the other eye of the same rabbit was conducted with the routine trabeculectomy as the control group. The filtering bleb, intraocular pressure and pathology were observed. Results　The intraocular pressure in the experimental eye was much lower than that in the control group 3～12 weeks after the operations (P＜0.05).As it was within 2 weeks after the surgeries, but there was no significant filtering difference (P＞0.05).The rate of eyes with functional bleb in the experimental group was significantly higher than that in the control group at the postoperative 2～7 weeks .Conclusion　This study suggests the turning of self-body over drainage surgery can help to maintain filtering function for a long time and to prevent complication after filtering surgery.

5-Fluorouracil and Scleral Flap Splitting After Trabeculectomy

We introduced a method of splitting the lamellar scleral flap(LSF) after trabeculectomy with 5-fluorouracil(5-FU) to evaluate the postoperative wound strength which may reveal directly th6 antiproliferative effect of 5-FU. An 8-0 nylon sture was placed under the LSF at the time of trabeculectomy and both ends of the suture were drawn out from the conjunctiva. The wound strength was evaluated by pulling out the spitting suture at the end of second week after operation. Seventeen eyes of 16 patients underwent a primary trabeculectomy and placement of a splitting suture. 5-FU was injected subconjunctivally, 5 mg every other day in the eyes during postoperative two weeks. Five(50%) of ten eyes of 5-FU group resulted in LSF splitting(p=0.0407, Fisher's exact test). This result may signify that the LSF splitting suture technique will be a helpful means to investigate the effect of post-trabeculectomy wound healing modulators in the early period postoperatively.

5-Fluorouracil and Scleral Flap Splitting After Trabeculectomy

We introduced a method of splitting the lamellar scleral flap (LSF) after trabeculectomy with 5-fluorouracil (5-FU) to evaluate the postoperative wound strength which may reveal directly the anti proliferative effect of 5-FU. An 8-0 nylon sture was placed under the LSF at the time of trabeculectomy and both ends of the suture were drawn out from the conjunctiva. The wound strength was evaluated by pulling out the spitting suture at the end of second week after operation. Seventeen eyes of 16 patients underwent a primary trabeculectomy and placement of a splitting suture. 5-fU was injected subconjunctivally, 5mg every other day in the eyes during postoperative two weeks. Five (50%) of ten eyes of 5-FU group resulted in LSF splitting (p=0.0407, Fisher's exact test). This result may signify that the LSF splitting suture technique will be a helpful means to investigate the effect of post-trabeculectomy wound healing modulators in the early period postoperatively.

Study of the application of scleral flap made by tunnel knife in trabeculectomy / 重庆医科大学学报

Objective:To study the effect and complication of trabeculectomy with scleral flap made by tunnel knife in prospective randomized clinical trial.Methods:A total of 40 glaucoma eyes were divided into two groups by randomized method,Trabeculectomy was performed with fornix-based flaps,and scleral flaps made by tunnel knife(group A);or limbus-based flaps,and scleral flaps made by general method(group B)respectively.The samples were observed for 6 months after operation and the effect and complication of the two groups were compared.Results:There was no significant difference between group A and B in success rate,which were 75% and 70% respectively;and the conditiong of complication was the same.Conclusion:It can effectively simplify the procedure of fornix-based flaps trabeculectomy with scleral flaps made by tunnel knife.