Clinical observation of a triple procedure of stimultaneous penetrating keratoplasty combined with extracapsular cataract extraction and intraocular lens implantation / 眼科新进展

Objective To evaluate the operative outcomes of a triple procedure including simultaneous penetration keratoplasty (PKP),extracapsular cataract extraction (ECCE) and intraocular lens (IOL) implantation,and to investigate the relationship between postoperative corneal refractive power and preoperative lens diopter.Methods This retrospective analysis study involved 15 patients who had undergone a triple procedure surgery in Beijing You'an hospital from April to October 2016.Outcomes including the best corrected visual acuity (BCVA),intraocular pressure (IOP),corneal refractive power,axial length,postoperative complications,corneal endothelial cell counts and the survival of corneal graft were determined one year after surgery.Results All corneal grafts were transparent and corneal endothelium were (1974.20 ±472.82) cell · mm-2.The mean postoperative LogMAR visual acuity (0.80 ±0.27) had a significant improvement compared with the mean preoperative LogMAR visual acuity (2.63 ±0.62) (t =13.042,P ＜0.001).There were no statistically significant differences in preoperative IOP (15.27 ± 2.37) mmHg (1 kPa =7.5 mmHg) and postoperative data (14.53 ± 3.04) mmHg (t =0.685,P =0.505),preoperative axial length (23.69 ±2.01) mm and postoperative data (23.62 ±2.12)mm (t =-0.138,P=0.893)and preoperative keratometry (45.01 ± 1.66) D of the control eye and postoperative data (42.56 ± 5.48) D (t =1.202,P =0.260).The postoperative spherical equivalent refractive was (0.40 ±4.65) D,and the target refraction was (0.58 ±0.25)D.Conclusion The triple procedures are safe and effective for the treatment of patients with coexisting corneal pathologies and cataracts.Selection of emmetropia lens diopter may result in the satisfactory postoperative visual acuity.However,unpredictable postoperative corneal curvature changes will still affect the final refractive state.

Double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for glaucoma complicated with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate the effect of double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for the treatment of glaucoma complicated with cataract. <p>METHODS:Selected 36 patients(40 eyes)with acute or chronic angle-closure glaucoma and cataract in our hospital from June 2014 to January 2016 were treated with double incision trabeculectomy combined phacoemulsification and intraocular lens implantation. All patients were followed up for 1mo to observe preoperative and postoperative visual acuity, anterior chamber depth, scope of anterior chamber angle open and intraocular pressure. At the same time, we observed the patients' postoperative filtering bleb and intraoperative and postoperative complications.<p>RESULTS: Intraocular pressure before treatment were between 19-36mmHg, the average was 26.02±2.42 mmHg, and after the treatment intraocular pressure was patients between 11-22mmHg, the average was 13.62±4.38 mmHg, preoperative and postoperative intraocular pressure had the obvious difference(<i>t</i>=33.273, <i>P</i><0.05). Preoperatively 85.0%(32 cases, 34 eyes)was with vision less than 0.3, and 53%(19 cases, 21 eyes)after surgery with eyesight over 0.3. All of the eyes formed good filtering bleb after surgery. Scope of anterior chamber angle open, anterior chamber angle open distance and central anterior chamber depth after operation increased in 36 cases compared with preoperative(<i>t</i>=5.832, 5.924, 33.293, <i>P</i><0.05). There were 7 eyes with mild edema of the cornea, all disappear within 3d after surgery; one eye with bleeding when the iris was cut and absorbed after 2d; 4 eyes with fibrin effusion on lens surface and anterior chamber and absorbed with 6d. There were not any other severe complication in this study.<p>CONCLUSION: Double incision trabeculectomy combined with phacoemulsification and intraocular lens implantation for glaucoma with cataract can effectively improve the patient's vision, and can better control the intraocular pressure after surgery.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

PURPOSE: To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma. METHODS: The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were followed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intraocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared. RESULTS: The IOP at 1 year postoperatively was 13.39 +/- 2.25 mm Hg, 13.41 +/- 2.79 mm Hg (p = 0.981) and IOP reduction was 4.51 +/- 6.35 mm Hg, 9.11 +/- 8.27 mm Hg (p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing postoperative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 +/- 0.88 D and -0.13 +/- 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively. CONCLUSIONS: Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with patients with angle-closure glaucoma.

Short-Term Result of Triple Procedure in Pterygium Surgery

PURPOSE: To evaluate the success and complication rates of triple procedure, including pterygium excision, marginal amniotic membrane insertion beneath the conjunctiva, and limbal-conjunctival autograft in pterygium surgery. METHODS: We conducted a retrospective study on 45 eyes of 45 patients who underwent pterygium surgery between August 2011 and October 2012. After pterygium excision, amniotic membrane was placed beneath the conjunctiva along the margin of the exposed sclera followed by a limbal conjunctival autograft. Success rates, intraoperative and postoperative complications were evaluated. RESULTS: Forty-three eyes with primary pterygium and 2 eyes with recurrent pterygium were enrolled in the present study. The mean age of the patients was 59.87 +/- 14.30 years with a mean follow-up of 12.9 +/- 4.6 months. There were no complications during surgery. Early postoperative complications included partial wound dehiscence in 1 eye and a simple conjunctival cyst on the autografted conjunctiva in the another eye. No clinically significant recurrence (G2, G3) was noted during the observational periods. Thirty-nine (86.7%) and 6 (13.3%) eyes were graded as G0 and G1, respectively. CONCLUSIONS: Our surgical technique not only has the benefits of the limbal conjunctival autograft acting as a barrier against fibrovascular invasion of the cornea and supplying stem cells to the corneal epithelium but also has antiangiogenic effects of amniotic membrane with minimal use. In addition, this technique is a safe surgical method in primary and recurrent pterygium.

Bee sting of the cornea: case report / Picadura de abeja en la córnea: informe de un caso

Bee stings of the eye are uncommon entities and ocular reactions to the bee venom are wide, ranging from mild conjunctivitis to sudden vision loss. We present the case of a patient who suffered a bee sting of the cornea and the response to the poison components. We go through the bee venom properties, its actual treatment, and propose a new management alternative.

Las picaduras de abeja en el ojo son entidades poco comunes y las reacciones oculares al veneno de abeja son amplias, pues van desde una leve conjuntivitis hasta la pérdida aguda de la visión. Se presenta el caso de un paciente que sufrió la picadura de una abeja en la córnea y la respuesta frente a los componentes de este veneno. Se realizó una revisión de las propiedades del veneno de abeja, su tratamiento actual y se propone una nueva alternativa de manejo.

Clinical Results of Corneal Triple Procedure and Risk Factors for Graft Failure

PURPOSE: To evaluate the clinical results of corneal triple procedure, as well as the causes and the risk factors for graft failure. METHODS: Indications, survival period of graft, causes of graft failure, and risk factors for failure in 29 patients (29 eyes) who had undergone penetrating keratoplasty combined with cataract surgery and intraocular lens (IOL) implantation were retrospectively analyzed. RESULTS: The most common primary indication of corneal triple procedure was bacterial keratitis (24%), followed by corneal trauma, herpes simplex keratitis, and graft failure. The average survival period of corneal graft in corneal triple procedure was 29.2+/-23.2 months. The most common cause of graft failure was allograft rejection (56.3%). The risk factors of graft failure by an univariate analysis were preoperative unfavorable diagnosis (bullous keratopathy, corneal ulcer, and trauma), corneal neovasculization, intraoperative additional procedure (anterior vitrectomy, synechiolysis, and anterior chamber irrigation), immune rejection, and postoperative glaucoma, but were unrelated to methods of cataract surgery, graft size, or IOL position. In a multivariate analysis, graft rejection and corneal neovascularization were identified as risk factors for graft failure in patients undergoing triple procedure. CONCLUSIONS: Corneal graft in corneal triple procedure had various success rates according to the many factors. Risk factors for graft failure included graft rejection and corneal neovascularization.

The Comparison of Clinical Outcomes between the Triple Procedure and Sequential Procedure in Patients with Corneal Opacity and Cataract

PURPOSE: To compare the differences of clinical results between the triple procedure and the sequential procedure in penetrating keratoplasty and cataract patients. METHODS: Forty-six patients who had undergone a penetrating keratoplasty and cataract extraction simultaneously or sequentially between January 1998 and January 2004 were investigated retrospectively. The uncorrected visual acuity, best corrected visual acuity, spherical equivalent refractive error, average absolute refractive error, corneal endothelial cell counts, average survival period and survival rate were compared between the two groups. RESULTS Seven of 25 eyes (28%) in the sequential procedure group and 3 of 23 eyes (13%) in the triple procedure group had 0.2 or better uncorrected visual acuity (p=0.04). The average absolute refractive error was 3.61+/-2.00 D in the triple procedure group and 2.35+/-1.83 D in the sequential group (p=0.03). There were no statistically significant differences between the two groups in best corrected visual acuity, spherical equivalent refractive error, endothelial cell count, average survival period, or survival rate at final follow-up. CONCLUSIONS: The sequential procedure provides better uncorrected visual acuity and less refractive error. No significant difference was observed in average survival period or survival rate between the triple procedure group and sequential group.

The Comparison of Clinical Outcomes between the Triple Procedure and Sequential Procedure in Patients with Corneal Opacity and Cataract

PURPOSE: To compare the differences of clinical results between the triple procedure and the sequential procedure in penetrating keratoplasty and cataract patients. METHODS: Forty-six patients who had undergone a penetrating keratoplasty and cataract extraction simultaneously or sequentially between January 1998 and January 2004 were investigated retrospectively. The uncorrected visual acuity, best corrected visual acuity, spherical equivalent refractive error, average absolute refractive error, corneal endothelial cell counts, average survival period and survival rate were compared between the two groups. RESULTS Seven of 25 eyes (28%) in the sequential procedure group and 3 of 23 eyes (13%) in the triple procedure group had 0.2 or better uncorrected visual acuity (p=0.04). The average absolute refractive error was 3.61+/-2.00 D in the triple procedure group and 2.35+/-1.83 D in the sequential group (p=0.03). There were no statistically significant differences between the two groups in best corrected visual acuity, spherical equivalent refractive error, endothelial cell count, average survival period, or survival rate at final follow-up. CONCLUSIONS: The sequential procedure provides better uncorrected visual acuity and less refractive error. No significant difference was observed in average survival period or survival rate between the triple procedure group and sequential group.

The Efficacy and Safety of Mitomycin C and Releasable Suture in Glaucoma Triple Procedure

PURPOSE: To evaluate the clinical efficacy and safety of short-term application of mitomycin C and releasable scleral flap sutures. METHODS: The clinical outcome and complications were evaluated in 62 eyes undergone glaucoma triple procedure(Group A: with mitomycin C and releasable suture, Group B: with mitomycin C only, Group C: with releasable suture only, Group D: without mitomycin C and releasable suture). RESULTS: The mean postoperative intraocular pressure was relatively lower in group A and B than that of group C and D(p=0.868). The most common complication was posterior capsular opacity, and other complications were cystoid macular edema, hypotony, choroidal detachment and bleb leakage. CONCLUSIONS: The glaucoma triple procedure using mitomycin C and releasable suture could be recommended to be safe and effective on controlling the early postoperative and long-term intraocular pressure for treating the patients with coexisting cataract and glaucoma, and the use of releasable suture could lower the incidence of postoperative complications such as hypotony.

Estimaionof Intraocular Lens Power in Penetration Keratoplasty Combined with Intraocular Lens Implantation

The corneal triple procedure is that penetrating keratoplasty, extracapsular cataract extraction, and posterior chamber intraocular lens implantation are performed simultaneously and preoperative prediction of intraocular lens implant power is necessary to achieve the desired postoperative refractive status in eyes undergoing the triple procedure. Therefore we evaluated the important factors in determining intraocular implant power patients undergoing the triple procedure. A retrospective study was done on 12 eyes of 11 patients who underwent triple procedure between March 1993 and April 1997. Mean age was 52.9 years and mean follow-up period was 26.3 month(range, 4 to 53 months). The Mean postoperative spherical equivalent was -0.98+/-4.05D. Forty-two percents of patients were within +/-2.00D of emmetropia. The important factors in determining intraocular lens power of patients undergoing the triple procedure are axial length, corneal curvature, refractive status of the fellow eye, and donor/recipient size. If these values are unreliable, it is desirable for the corneal srurgeon to use mean axial length and mean corneal curvature to determine the intraocular implant power. The important factors in determining intraocular lens power of patients undergoing the triple procedure are axial length, corneal curvature, refractive status of the fellow eye, and donor/recipient size. If these values are unreliable, it is desirable for the corneal surgeon to use mean axial length and mean corneal curvature to determine the intraocular implant power.

A Comparison between 3.2mm and 5.5mm Incision Phacoemulsification, Intraocular Lens Insertion and Trabeculectomy with Mitomycin C(MMC)

We compared the results of phacoemulsification, intraocular lens(IOL) insertion, and trabeculectomy with mitomycin(MMC) in patients receiving either 3.2mm or 5.5mm incision. Our study revealed that the surgicalresults were comparable between the 3.2 and 5.5mm incision groups in terms of number of glaucoma medicatins, intraocular pressure(IOP) control, visual acuity except visual recovery in early period. The 3.2mm incision group showed stastically significant advantage in early visual recovery than the comparison group(P<0.05, Wilcox rank test). The incidence of anterior capsular opacity was significantly higher in 3.2mm incision group, requiring YAG capsulectomy for better vision than in 5.5mm group. This study suggests that both 3.2 and 5.5mm incision glaucoma triple procedures combined with Mitomycin C(MMC) may provide excellent postoperative IOP control and visual recovery without significant complication I intermediate follow-up period.

Clinical Study on Combined Phacoemulsification and Intraocular Lens Implantation/Trabeculectomy with Mitomycin C

This study was undertaken to evaluate the outcome of combined phacoemulsification, intraocular lens implanation, and trabeculectomy with Mitomycin C. We reviewed 39 eyes in 36 consecutive cases who had been undergone triple procedure for coexisting cataract and glaucoma from January 1993 to October 1995 at Chonnam university hospital. The mean follow-up period was 8. 8 months. Preoperatively, most patients had a visual acuity of worse than 0.4, but the visual acuity improved postoperatively in 20 eyes (51.0%) achieving the visual acuity better than 0.5 at 6 months after the surgery. The mean preoperative intraocular pressure was 31.1 +/- 12.9mmHg, and the mean postoperative IOP was 16.5 +/- 5.4mmHg at 6 months follow-up. The mean number of antiglaucoma medication was 1.87 preoperatively, and 0.28 postoperatively. The postoperative complications were posterior capsular opacity (7 eyes), hyphema (2 eyes), shallow anterior chamber (3 eyes), transient hypotony without macular edema (2 eyes). There was no statistically significant difference in intraocular pressure control at different concentration of Mitomycin C (0.2 and 0.4mg/ml). We conclude that the use of Mitomycin C in combined procedure provides good short-term(6 months) results regarding intraocular pressure control and visual recovery.

The Quadri: Combined Phototherapeutic Keratectomy, Penetrating Keratoplasty, Phacoemulsification and Posterior Chamber Lens Implantation

Combined penetrating keratoplasty, cataract extraction, and lens implantation is the currently accepted treatment of choice for patients with combined corneal and cataract diseases. However, surgeons have met some difficulties and disadvantages of "Open sky" extracapsular cataract extraction during the triple procedure because of open-system approach. Thus, author contrive "Quadri" procedure ; Combined Phototherapeutic Keratectomy, Penetrating Keratoplasty, Phacoemulsification and Posterior Chamber Lens Implantation, for closed-system approach, and performed successfully.

The Effect of Mitomycin-C on Postoperative Corneal Astigmatism in Trabeculectomy and Triple Procedure

Mitomycin-C is known to delay wound healing and it may have influence upon the post operative astigmatism changes. We calculated the postoperative induced astigmatism of patients who underwent trabeculectomy or triple procedures with or without the use of mitomycin-C. And the vector analysis method was used. To compare the induced astigmatism between the groups we calculated the induced astigmatism corresponding to the 180degree axis. The patients who underwent triple procedure without and with mitomycin-C showed a mean induced astigmatism of -4.50D, -1.81D, respectively, after 7 days(p<0.05) and -0.13D, 1.73D, respectively, after 12 months (p<0.05). Those who underwent trabeculectomy without mitomycin-C and with mitomycin-C showed a mean induced astigmatism of -2.63D, -1.01D, respectively, after 1 month(p<0.05) and -1.42D, 0.34D, respectively, after 12 months(p<0.05). The use of mitomycin-C reduces the total amount of astigmatism in trabeculectomy patients. However, in the triple procedure patients it increases the total amount of astigmatism. The entire amount of against the rule astigmatic change was similar between the mitomycin-C applied group and non-applied group. The astigmatic shift of the group without mitomycin-C, reached a plateau after 3 months. However, the other group showed continuous against the rule shift until 12 months.

Triple Procedure in Glaucoma Patients

The author reviewed the effectiveness of triple procedure in terms of the visual acuity and the intraocular pressure control after 6 months follow up of twenty-four consecutive glaucoma patients who was treated with triple procedure: trabeculectomy with simultaneous lens extraction and intraocular lens implanation. At 6 months after operation, the mean intraocular pressure was 7.0mmHg lower than the preoperative level, and the kind of glaucoma medication was decreased from 2.1 to 0.6. The visual acuity improved in 67% at two months and 93% at six months after operation, respectively. The several complications such as hyphema, shallow anterior chamber with wound leaking, posterior capsular opacity and uncontrolled intraocular pressure were appeared. Effectiveness of triple procedure in terms of intraocular pressure control and visual acuity improvement seems to be similar to that of the operation done separately.

Clinical Analysis of Glaucoma Triple Procedure of Extracapsular Cataract Extraction and Posterior Chamber Intraocular Lens Implantation Combined with Trabeculectomy

Glaucoma triple procedure of extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy which was undergone in 21 eyes(20 cases) since May 1984, were reviewed. The results as follows. 1. In the distribution of sex and age of 20 patients, 16 patients(75%) were male, and seventies, which were most common, were 9 patients(45.0%); fifties, 5; forties, 1; thirties, 1. The average age was 63.9 years old. 2. In type of glaucoma, chronic open angle glaucoma which was most common, were 14 eyes(66.7%); chronic angle closure glaucoma, 5 eyes(23.8%); aphakic glaucoma, 1 eye(4.8%); secondary glaucoma, 1 eye(4.8%). 3. Visual acuity improved in 20 eyes but unchanged in 1 eye, and 14 eyes(66.7%) achieved visual acuity 0.5 or better. 4. Preoperative mean intraocular pressure(IOP)was 20.9mmHg and postoperative mean IOP was 6.1, 4.5mmHg lower than preoperative level at 2 and 6 months res pectively. 5. 2.1 glaucoma medications was needed preoperatively and 0.7, 0.8 was needed at postoperative 2 and 6 months respectively. 6. There were no serious complications that affected the visual acuity. However minor complications were as follows. Hyphema were 4 eyes(19.0%); mydriasis, 3 eyes(14.3%); flat chamber, 1 eye(14.3%); flat chamber, 1 eye(4.8%); cystoid macular edema, 1 eye(4.8%).