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@#AIM: To evaluate the efficacy of EX-PRESS drainage device implantation combined with phacoemulsification for chronic primary angle-closure glaucoma(CPACG)with cataract and compare with trabeculectomy combined with phacoemulsification. METHODS: A retrospective case control design was used in this study. The patients underwent combined operation of glaucoma and cataract in the ophthalmology department of our hospital from January 1st, 2017 to January 1st, 2019 were collected and divided into two groups according to different operation methods. The study group(13 cases, 16 eyes)was treated with EX-PRESS drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group(16 cases, 20 eyes)was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The best corrected visual acuity(BCVA)and intraocular pressure(IOP)at 1wk, 1, 3, 6mo after surgery, central anterior chamber depth(ACD)at before surgery, 1, 6mo after surgery, central corneal endothelial cell count, the duration of operation, length of hospital stays after surgery were compared between the two groups. RESULTS:The demography was matched between the two groups(all <i>P</i> >0.05). The number of eyes with visual improvement was significantly raised 6mo after treatment in study group(<i>Z</i>=-2.066,<i>P</i>=0.039). There were no significant differences in BCVA between two groups 6mo after treatment(<i>Z</i>=-0.319,<i>P</i>=0.765). The IOP of study group at 1wk, 1, 3 and 6mo was significantly lower than that before operation(all <i>P</i><0.001). There were no significant differences in IOP between the two groups(<i>F</i>=0.003, <i>P</i>=0.956). The anterior chamber significantly deepened at 1 and 6mo after operation in two groups respectively(all <i>P</i><0.001). There were no significant differences in ACD and central corneal endothelial cells count between two groups(all <i>P</i>>0.05). The duration of operation was 26.1±4.5min in study group and 31.5±5.1min in control group, which showed significant differences(<i>t</i>=-3.307, <i>P</i>=0.002). The length of stays after surgery was 7.2±1.6d in study group and 7.7±1.5d in control group, and there was no significant difference between the two groups(<i>t</i>=-0.880, <i>P</i>=0.388). One eye EX-PRESS touched the iris in study group. Since the IOP was normal, it didn't receive therapy. In control group, the anterior chamber of 2 eyes was 2 degrees shallow after surgery, which recovered in 1wk by pupil dilation and pressurized bandage. At 6mo point after operation, one eye in each group was treated with one IOP drop to maintain normal IOP. In control group, one case received EX-PRESS drainage device implantation again 12mo later for recurrent glaucoma, another case underwent ciliary body photocoagulation 8mo later. CONCLUSION: EX-PRESS drainage device combined with phacoemulsification is effective in improving visual acuity and controlling IOP for CPACG, and it takes shorten operation time compared with trabeculectomy combined with phacoemulsification.
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La cirugía filtrante es una opción de tratamiento encaminada a disminuir la presión intraocular una vez que no hay respuesta a las alternativas no quirúrgicas. En los últimos años ha experimentado una evolución sorprendente. Aparecen nuevos dispositivos que buscan obtener un control tensional con las mínimas complicaciones; entre estos, el implante Ex-PRESS ha demostrado una efectividad similar a la trabeculectomía, mientras que la variante técnica para su implantación, descrita por Richard Hoffmann, posibilita excelentes resultados con menos dificultades. Se presenta un paciente masculino de 51 años de edad, de raza blanca, con antecedente de glaucoma, con agudeza visual mejor corregida de 100 VAR y presión intraocular de 32 mmHg. Se realizó implante de dispositivo Ex-PRESS (modelo P-50) mediante la técnica modificada de Richard Hoffmann, asociada al uso de mitomicina C al 0,2 por ciento en el transoperatorio. A los dos años se lograron tensiones oculares de 17 mmHg y agudeza visual mejor corregida de 100 VAR(AU)
Filtration surgery is a therapeutic option aimed at reducing intraocular pressure when there is no response to non-surgical alternatives. Filtration surgery has developed remarkably in recent years. New devices have emerged geared to achieving pressure control with minimum complications. Among them, Ex-PRESS implantation has shown to be as effective as trabeculectomy, and the technique described by Richard Hoffman provides excellent results with fewer difficulties. A case is presented of a male white 51-year-old patient with a history of glaucoma, best corrected visual acuity 100 VAR, and intraocular pressure 32 mmHg. Implantation was performed of an Ex-PRESS (model P-50) device by modified Richard Hoffman's technique associated to 0.2 percent mitomycin C in the perioperative period. Two years after surgery, ocular tensions of 17 mmHg and a best corrected visual acuity of 100 VAR had been achieved(AU)
Subject(s)
Humans , Male , Middle Aged , Trabeculectomy/methods , Glaucoma/diagnosis , Mitomycin/adverse effects , Filtering Surgery/adverse effects , Intraocular PressureABSTRACT
@#AIM:To evaluate the clinical efficacy of EX-PRESS aqueous humor drainage nail implantation combined with intravitreous injection of conbercept universal panretinal photocoagulation(PRP)in the treatment of neovascular glaucoma.<p>METHODS: Totally 21 patients(21 eyes)with neovascular glaucoma who met the inclusion criteria in our hospital from January 2015 to May 2018 were analyzed retrospectively. They were treated with intravitreal injection of conbercept before operation, EX-PRESS aqueous humor drainage nail was implanted after iris neovascularization disappeared 5-10d, and panretinal photocoagulation 2-3wk later. Intraocular pressure(IOP), visual acuity, recurrence rate of iris neovascularization and postoperative complications were observed after 12mo follow-up. <p>RESULTS: There were significant differences in intraocular pressure at different time before and after EX-PRESS aqueous drainage nail implantation(<i>F</i>=18.513,<i>P</i><0.05). There was significant difference between preoperative and postoperative visual acuity of EX-PRESS(<i>P</i>=0.008). At the last follow-up, the operation was completely successful in 18 eyes(86%), the condition was successful in 2 eyes(9%), and the total success rate of operation was 95%. Recurrence of iris neovascularization occurred in 1 eye(5%), shallow anterior chamber in 1 eye(5%)and high IOP in 5 eyes(24%). <p>CONCLUSION: Implantation of EX-PRESS aqueous humor drainage nail combined with PRP can effectively reduce the intraocular pressure of neovascular glaucoma and can be widely used in clinical treatment.
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@#AIM:To study the effect of EX-PRESS miniature glaucoma device implantation on corneal endothelial cell density and intraocular pressure for primary open angle glaucoma(POAG). <p>METHODS:This was a prospective clinical study of 38 eyes in 32 POAG patients who underwent EX-PRESS miniature glaucoma device implantation in our hospital from May 2016 to December 2017. The central, nasal, temporal,superior, inferior endothelium cell density, intraocular pressure(IOP), best corrected visual acuity(BCVA)were observed at 24mo after operation. Anterior chamber depth and the position of drainage nail with iris and cornea were also observed. <p>RESULTS: There was no significant difference of the corneal endothelium density in five sites and BCVA between preoperation and postoperation(<i>P</i>>0.05). There was significant difference in IOP between pre-operation and postoperation(<i>P</i><0.05). The complete success rate was 66% and conditional success rate was 21%, the failure rate was 13%. The main cause of failure was filtering bleb scarring. There was no complete disappearance of anterior chamber during the operation and follow-up period. There were 1 eye of shallow anterior chamber, 5 eyes of EX-PRESS contact with iris surface. The position of drainage nail with iris and cornea endothelium was good in the other 32 eyes.<p>CONCLUSION: The EX-PRESS miniature glaucoma device implantation has no effect on corneal endothelial cells in five directions and can effectively control intraocular pressure. It is a safe and effective method for primary open-angle glaucoma.
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@#AIM: To investigate the effect on vision and complications of Conbercept combined with EX-PRESS glaucoma drainage device implantation for patients with neovascular glaucoma(NVG). <p>METHODS: Totally 128 cases of patients with NVG admitted to ophthalmology in our hospital from February 2016 to October 2018 were selected and divided into EX-PRESS group(<i>n</i>=66)and Trabeculectomy group(<i>n</i>=62)according to their treatment methods. Patients in both groups received conbercept intravitreal injection, patients in EX-PRESS group were treated with EX-PRESS glaucoma drainage device implantation, and patients in Trabeculectomy group were treated with Trabeculectomy. The surgical efficacy, postoperative intraocular pressure, visual acuity improvement and complications were compared between the two groups. <p>RESULTS: At 12mo postoperatively, the total successful rate of surgery in the EX-PRESS group and Trabeculectomy group were 81.8%(54/66)and 72.6%(45/62), respectively. There was no significant difference on the surgical efficacy between the two groups(<i>P</i>>0.05). At 1d, 7d, 1mo, 3mo, 6mo, 12mo postoperatively, the two group were significantly lower than preoperation(<i>P</i><0.05), but there was no significant difference on intraocular pressure between the two groups(<i>P</i>>0.05). At 6mo, 12mo postoperatively, the vision improvement of EX-PRESS group was significantly better than that of Trabeculectomy group(<i>P</i><0.05). The total postoperative complication rate of EX-PRESS group and Trabeculectomy group were 27.3%(18/66)and 37.1%(23/62), respectively(<i>P</i>>0.05). <p>CONCLUSION: The effectiveness and safety of conbercept intravitreal injection combined with EX-PRESS glaucoma drainage device implantation is similar to combined trabeculectomy for patients with NVG, and the former is more advantageous in improving eyesight.
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@#AIM: To observe the clinical efficacy and safety of new EX-PRESS glaucoma drainage device implantation combined with ranibizumab drugs in the treatment of neovascular glaucoma(NVG).<p>METHODS: A total of 78 patients(78 eyes)who were diagnosed with neovascular glaucoma and underwent intravitreal injection of ranibizumab drugs in our hospital from June 2015 to June 2018 were selected. Sixty patients with complete follow-up data were randomly divided in the experimental group(A), 30 patients(30 eyes)underwent EX-PRESS glaucoma drainage device implantation. Postoperative complications were observed early, visual acuity and intraocular pressure were observed at 1wk, 1mo, 3mo, 6mo and 1a, and the success rate of the operation was evaluated at 6mo and 1a. <p>RESULTS:After 1wk, 1, 3mo, 25 eyes, 25 eyes and 23 eyes with BCVA <0.1 in the experimental group, the average intraocular pressure was 16.76±3.21mmHg, 15.63±2.70mmHg and 16.69±3.29mmHg, the control group was 26 eyes, 26 eyes and 25 eyes, the average IOP was 17.31±2.96mmHg, 14.44±2.53mmHg and 16.56±4.14mmHg(all <i>P</i>>0.05); 6mo after operation, 16 eyes and 16 eyes in the 1a test group with BCVA <0.1 were the average IOP 15.49±3.19mmHg, 18.52±4.03mmHg, the control group was 25 eyes and 25 eyes, the average intraocular pressure was 21.96±2.90mmHg, 28.90±4.33mmHg(all <i>P</i><0.05); the experimental group had low intraocular pressure, shallow The number of cases of anterior chamber, anterior chamber hemorrhage, inflammation, choroidal detachment were 0 eyes, 1 eyes, 2 eyes, 1 eyes, 0 eyes, while the control group were 6 eyes, 6 eyes, 5 eyes, 4 eyes, 2 eyes(<i>P</i><0.05); 6mo after operation in the experimental group, the success rate of 1a operation was 83% and 80%, while that in the control group was 60% and 53%, respectively(<i>P</i><0.05).<p>CONCLUSION: EX-PRESS glaucoma drainage implantation combined with ranibizumab drug treatment in the vitreous cavity can effectively reduce the intraocular pressure in patients with neovascular glaucoma and has the advantages of small surgical incision, simple operation, safety, fewer postoperative complications, and high success rate of surgery.
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Purpose: We investigated the factors influencing the morphology of filtration blebs after Ex-PRESS® surgery. We analyzed the thickness of the bleb wall and the height and the volume of blebs. Methods: This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, we analyzed the cases of 145 consecutive patients (180 eyes) who underwent trabeculectomy with Ex-PRESS® for the first time at Toyama University Hospital and were followed for >1 year. We used anterior segment optical coherence tomography to analyze the morphology of the blebs after Ex-PRESS surgery. We also examined potential influencing factors including age, central corneal thickness, type of glaucoma (primary open-angle glaucoma [POAG] or pseudo-exfoliation glaucoma [PEXG]), preoperative intraocular pressure (IOP), postoperative IOP, history of trabeculotomy, and operation method: Ex-PRESS surgery only, or simultaneous cataract surgery. Results: Ex-PRESS surgeries significantly decreased the IOP from 24.5 ± 8.8 mmHg to 11.1 ± 3.4 mmHg after 1 year (P < 0.001). The cases with higher blebs, larger volume of blebs, and thinner bleb wall had better surgical outcomes. Conclusion: Advanced age, higher postoperative IOP, PEXG, and simultaneous cataract surgeries were found to decrease the volume and height of blebs. Younger age, higher postoperative IOP, POAG, and simultaneous cataract surgeries were found to thicken the wall of blebs. Among the younger patients, there were many cases in which surgery was unsuccessful in spite the large volume of blebs. The reason for this may be that the wall of the bleb is thick.
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@#AIM: To probe into the treatment effects of P50 EX-PRESS drainage nail combined with biological amniotic membrane implantation in primary open angle glaucoma(POAG).<p>METHODS: Totally 96 cases of 96 eyes with POAG and who treated from March 2013 to January 2019 were selected as the research objects, and the patients were divided into the observation group and the control group by the random number table method, with 48 cases in each group. The control group was implanted with P50 EX-PRESS drainage nail only, while the observation group were treated with biological amniotic membrane implantation on the basis of the control group. Then, the changes of intraocular pressure, retinal nerve fiber thickness(RNFLT), complications and success rate of operation before operation and after the operation for 7d, 1mo and 3mo of two groups of patients were observed.<p>RESULTS: The proportion of functional filtering blebs after operation for 3mo in the observation group was significantly higher than that in the control group(<i>P</i><0.05). There was no difference in preoperative intraocular pressure and RNFLT between the two groups(<i>P</i>>0.05). The intraocular pressure and RNFLT after operation for 7d, 1mo and 3mo in the observation group were significantly lower than those in the control group(<i>P</i><0.05). The incidence of complications in the observation group and the control group were 12% and 25% respectively(<i>P</i>>0.05). The success rates of operation in observation group and control group were 96% and 75% respectively(<i>P</i><0.05).<p>CONCLUSION:The application of P50 EX-PRESS drainage nail combined with biological amniotic membrane implantation for POAG, which the clinical effects are satisfactory, and which can improve the condition of filtering blebs, reduce intraocular pressure and RNFLT, thus it has good safety and high success rate.
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@#AIM: To observe the effect of phaco-EX-PRESS for refractory open-angle glaucoma with cataract.<p>METHODS: Totally 66 patients(67 eyes)with refractory open-angle glaucoma and cataract were selected.There were 34 eyes in the phaco-EX-PRESS and 33 eyes in the phacotrabeculectomy. Preoperative best corrected visual acuity(BCVA)and intraocular pressure(IOP), intraoperative complications, operation time, postoperative BCVA and IOP, postoperative complications were observed. The follow-up time were 1d, 1wk, 1mo, 6mo and 1a.<p>RESULTS: The operation time in experimental group was 23.26±2.00min, while the control group was 31.73±2.17min. The difference between the two groups was statistically significant(<i>t</i>=16.68, <i>P</i><0.01). In the experimental group, superficial anterior chamber and filtering bubble scar occurred in 1 eye each. In the control group, low IOP occurred in 3 eyes, anterior chamber hemorrhage and choroid detachment in 1 eye and filtering bubble scar in 5 eyes.There was no statistically significant difference in follicular Kronfeld classification(<i>Z</i>=-0.775, <i>P</i>=0.438). Intervention factors and time in both groups had an effect on postoperative IOP. Intervention factors had no effect on postoperative visual acuity, and the difference in postoperative visual acuity between the two groups was statistically significant.<p>CONCLUSION: Phaco-EX-PRESS for the refractory open-angle glaucoma combined with cataract is safe and effective, and the operation time is shorter, so it can be used as a conventional combination surgery.
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@#AIM: To observe the effect of EX-PRESS glaucoma drainage device implantation in treatment of neovascular glaucoma after intravitreal injection of conbercept injection.<p>METHODS: From January 2015 to January 2018, 37 patients(37 eyes)with neovascular glaucoma were randomly divided into experimental group and control group. Both groups were treated with conbercept injection into vitreous cavity before operation. EX-PRESS glaucoma drainage device implantation and trabeculectomy were selected in the experimental group and the control group, respectively. The success rate, best corrected visual acuity(BCVA), intraocular pressure, filtering bleb and complications were compared between the two groups.<p>RESULTS: At 12mo after operation, there was no significant difference in success rate, BCVA and successful filtering bleb between the two groups. There was significant difference in intraocular pressure between the two groups at different time points(<i>F</i><sub>group</sub>=10.0, <i>P</i><sub>group</sub>=0.003; <i>F</i><sub>time </sub>= 496.27, <i>P</i><0.0001). All complications were improved after symptomatic treatment. <p>CONCLUSION: EX-PRESS glaucoma drainage device implantation combined with conbercept vitreous injection in treatment of NVG, which has certain clinical value in reducing intraocular pressure and postoperative complications.
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·AIM: To analyze the curative effect and safety in early stage primary open angle glaucoma (POAG) between simple Ex-PRESS shunt implantation and its combination with biological amniotic membrane implantation. ·METHODS: The clinical data of 53 cases for POAG treated with simple EX-PRESS shunt implantation (22 cases,34 eyes) as control group and its combination with biological amniotic membrane implantation (31 cases,38 eyes) as experimental group were retrospectively analyzed. Intraocular pressure (IOP) preoperatively and postoperatively were statistically evaluated. Filtering bleb and incidences of postoperative complications were observed in our hospital during the period of January of 2015 to April of 2017. ·RESULTS: At each time point after the operation, the mean IOP of the experimental group and the control group decreased distinctly respectively, the difference was statistically significant (P< 0. 05). There was no significant difference on the mean IOP between the experimental group and the control group at 1d and 1wk after operation (P<0.05). The mean IOP in the control group was higher than experimental group at 3 and 6mo (P<0. 05). The rate of functional filtration blebs were different between experimental group and control group during at postoperatively 3mo ( P < 0. 05 ). The complications included shallow anterior chamber, hemorrhage, posterior synechia of the iris, and corneal edema after surgery, and its incidences was not different between two groups (P<0.05). · CONCLUSION: EX - PRESS shunt combined with biological amniotic membrane implantation can effectively and safely reduce intraocular pressure, and improve the condition of filtering bleb after operation, and has long-term effect on IOP.
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·AIM: To investigate the efficacy of Bevacizumab intravitreal injection combined with EX- PRESS in the treatment of refractory glaucoma. ·METHODS: The research objects were 150 cases (150 eyes) of patients with refractory glaucoma from June 2014 to December 2016 in our hospital. All patients were treated with EX - PRESS glaucoma drainage device implantation, and their medicine data were analyzed retrospectively. Totally 70 cases (70 eyes) were treated with EX-PRESS only were set as the control group; 80 cases (80 eyes) received bevacizumab intravitreal injection on the basis of the treatment of the control group were set as the observation group. The successful rate of operation was evaluated, the intraocular pressure was measured before operation and at 7d, 1, 3, 6mo after treatment by non-contact conometer, followed by record of the visual acuity and complications before and after 6mo of treatment. · RESULTS: The observation group's total surgical success rate was 72.5%, which was sharply higher than that of the control group (58. 6%); while the partial success rate was 17. 5%, which was significantly lower than that of the control group (30.0%), with statistical significance (χ2=5.453, P=0.028; χ2=4.213, P=0.047). Two groups'surgical failure rate had no distinct difference (χ2=0.000,P=1.000). There was no significant difference in visual acuity of the two groups before and after operation (P>0.05). There was no significant difference in intraocular pressure between the two groups (Fgroups=982.27,P<0.05; Ftime=941.88, P<0.05). The intraocular pressure of the two groups decreased significantly after treatment, and at the 7d observation group was significantly higher than that of the control group after operation (P<0.05). After 1, 3, 6mo of operation, there was no abvious difference between two groups on IOP (P> 0. 05). The observation group's low intraocular pressure,anterior chamber bleeding and shallow anterior chamber incidence were significantly lower than those of the control group, there was statistical meaning (P<0.05). · CONCLUSION: Intravitreal injection of bevacizumab combined with EX-PRESS in the treatment of refractory glaucoma can improve the complete success rate,as well as perform effective control on complications such as short - term intraocular pressure, hyphema, low intraocular pressure.
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@#AIM:To explore the effects of EX-PRESS glaucoma drainage device implantation and trabectome on visual acuity, intraocular pressure, central anterior chamber depth(ACD)and postoperative complications in patients with primary open angle glaucoma(POAG)complicated with cataract. <p>METHODS: The clinical data of 64 patients(64 eyes)with POAG complicated with cataract in our hospital from March 2015 to January 2017 were retrospectively analyzed. Among them, 34 patients(34 eyes)were given EX-PRESS glaucoma drainage device implantation and cataract phacoemulsification(the Group A)and another 30 cases(30 eyes)were given trabectome combined with cataract phacoemulsification(the Group B). The visual acuity \〖best corrected visual acuity(BCVA)\〗, intraocular pressure, ACD and the thickness of macular ganglion cell complex(GCC)were compared between the two groups before operation and at 5mo after operation, and the differences of postoperative complications were also recorded between the two groups. <p>RESULTS: At 5mo after operation, the BCVA, intraocular pressure(IOP)was lower than that before operation(<i>t</i> <sub>Group A</sub>=39.359, 21.045; <i>t</i> <sub>Group B</sub>=23.126, 16.863; <i>P</i><0.01), and the Group A was lower than that in the Group B(<i>t</i>=9.452, 2.761; <i>P</i><0.01). There was no significant difference in the ACD level before and after operation between-groups and within-groups(<i>P</i>>0.05). At 5mo after operation, there was no significant difference in the thickness of macular GCC in the Group A compared with that before operation(<i>P</i>>0.05), but the thickness of macular GCC in the Group B was lower than that before operation(<i>t</i>=3.851, <i>P</i><0.05)and was lower than that in the Group A(<i>t</i>=2.269, <i>P</i><0.05). The incidence rate of postoperative complications in the Group A was significantly lower than that in the Group B(<i>χ</i><sup>2</sup>=7.883, <i>P</i><0.05). <p>CONCLUSION: EX-PRESS glaucoma drainage device implantation or trabectome combined with cataract phacoemulsification can receive good treatment effects in treating POAG patients with cataract, but the former one has better effects on reducing IOP and improving visual acuity than those in the latter one. And EX-PRESS glaucoma drainage device implantation can reduce the incidence rate of postoperative complications, and it is also beneficial to the reduction of retinal ganglion cells(RGCs)damage and the disease prognosis.
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@#AIM:To evaluate the efficacy of EX-PRESS glaucoma filtration device combined with phacoemulsification and intraocular lens implantation for refractory glaucoma complicated with cataract.<p>METHODS: Totally 60 patients(60 eyes)of refractory glaucoma were chosen as the research objects between January 2013 and January 2016 in our hospital, who were divided into research group and the control group according to the operation method. Research group(29 patients 29 eyes)was given EX-PRESS glaucoma drainage device combined with phacoemulsification and intraocular lens implantation; control group(31 patients 31 eyes)was given trabeculectomy combined with phacoemulsification and intraocular lens implantation. The visual acuity, intraocular pressure(IOP), the successful rate and other clinical indicators were observed and analyzed. <p>RESULTS: The surgery of all the 60 patients achieved success.The successful rate of research group was 93%, that of control group was 81%, while the difference was not significant(<i>P</i>=0.26). The best corrected visual acuity(BCVA)of both groups was better than before treatment at 6mo after surgery without statistically significant. The postoperative BCVA was not different between the two groups. The IOP between the two groups was significantly different(<i>P</i><0.05). The IOP of research group at 1d, 1 and 3mo was significantly lower than control group(<i>P</i><0.05). The IOP at 6mo after surgery was not significantly between the two groups. The IOP at different time was significantly different(<i>P</i><0.05). The IOP at 1d after surgery was significantly different compared to that at 6mo(<i>P</i>=0.007). <p>CONCLUSION:It has good clinical effect that EX-PRESS glaucoma filtration device combined with phacoemulsification for refractory glaucoma complicated with cataract. It is a treatment with high feasibility, safety and effectiveness.
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@#AIM:To compare the effects after two different surgical methods on visual field and retinal nerve fiber layer(RNFL)thickness in patients with glaucoma. <p>METHODS: Clinical data of 69 cases patients(82 eyes )with glaucoma between December 2015 to May 2017 in our hospital for anti-glaucoma surgery were collected. According to operation method, they were divided into EP group(EX-PRESS glaucoma shunt implantation)and XQ group(trabeculectomy). Intraocular pressure, anterior chamber depth(ACD), anterior chamber capacity(ACV), anterior chamber angle width(ACA), optical pupil diameter(PD), visual acuity, visual sensitivity index mean defect(MD), visual correction pattern standard deviation(CPSD), mean sensitivity(MS)and retinal nerve fiber layer thickness(RNFLT)were observed in the preoperative, postoperative 1mo and postoperative 3mo, and the postoperative complications were compared. <p>RESULTS: Hospitalization time of 3.08±0.42d in the EP group was significantly lower than 4.53±1.28d in the XQ group(<i>t</i>=6.124, <i>P</i><0.05). The visual recovery time of 3.26±0.30d in the EP group was significantly lower than 4.96±1.36d in the XQ group(<i>t</i>=6.920, <i>P</i><0.05). The ACA, ACD and ACV after surgery of two groups were significantly higher than those before operation, and the PD after surgery was lower than before operation, and the differences were not statistically significant between two groups after surgery(<i>P</i>>0.05).The postoperative RNFLT, MD and CPSD were all decreased in both groups(<i>P</i><0.05), and postoperative MS increased(<i>P</i><0.05); compared with XQ group, the postoperative CPSD after surgery in EP group was significantly reduced(<i>P</i><0.05).The total incidence of postoperative complications of EP group was 38%, which was significantly lower than 70% in XQ group, the difference was statistically significant(<i>χ</i><sup>2</sup>=8.094, <i>P</i>=0.004). <p>CONCLUSION: Compared with trabeculectomy, EX-PRESS glaucoma shunt implantation is more effective to slow the progress of vision, and it is more conducive to recovery of the patient's vision after surgery with higher security. The improvement of the thickness of the retinal nerve fibers after EX-PRESS glaucoma shunt implantation is consistent with trabeculectomy.
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@#AIM: To investigate the clinical efficacy and safety of EX-PRESS glaucoma drainage combined with phacoemulsification in the treatment of patients with acute angle-closure glaucoma and ocular hypertension with cataract. <p>METHODS: Patients with acute angle-closure glaucoma and cataract sustained high intraocular pressure who were admitted to our hospital from January 2016 to January 2017 were enrolled in this study. All patients were treated with EX-PRESS glaucoma drainage device combined with phacoemulsification. The anterior chamber depth before and after operation, intraocular pressure, corrected visual acuity at 1, 4, 8, 12, 24, and 48wk after surgery were performed. The success rate of surgery and intraoperative and postoperative complications were recorded. <p>RESULTS: The anterior chamber depth of the preoperative patients was 1.974±0.182mm, and that after operation was 2.961±0.175mm. The difference was statistically significant(<i>P</i><0.01). At 1, 4, 8, 12, 24, and 48wk, the intraocular pressure was significantly lower than that before surgery(<i>P</i><0.05). The proportion of successful patients at 12, 24, and 48wk after surgery gradually decreased, but the total success rate was 100%. The corrected visual acuity of the patients was significantly improved compared with the preoperative 48wk after operation, and the difference was statistically significant(<i>P</i><0.05). There were no serious intraoperative and postoperative complications in this group of patients. <p>CONCLUSION: EX-PRESS glaucoma drainage combined with phacoemulsification is safe and effective in cataract patients with acute angle-closure glaucoma with high intraocular pressure.
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La cirugía del glaucoma es una opción de tratamiento encaminada a disminuir la presión intraocular, una vez que no hay respuesta a las alternativas no quirúrgicas. En los últimos años está experimentando una evolución sorprendente. Aparecen nuevos dispositivos que buscan obtener un control tensional con las mínimas complicaciones. Actualmente se reserva el término minimally invasive glaucoma surgery para el grupo de técnicas quirúrgicas que favorecen el drenaje del humor acuoso vía ab-interno a través de la córnea clara y con las cuales con frecuencia se coloca un dispositivo biocompatible en el ángulo camerular. El Ex-PRESS, el Trabectome, el iStent y recientemente el Cypass (julio, 2016) son los únicos aprobados por la FDA. Pendiente de esto se encuentran el Hydruss y el XEN. Sin embargo, es necesario para la mayoría de ellos mostrar su éxito en el tiempo(AU)
Glaucoma surgery is a therapeutic alternative aimed at reducing the intraocular pressure when there is no response to non-surgical medical treatment. In the last few years, glaucoma surgery has remarkably evolved. New devices, capable of achieving pressure management with minor complications, have emerged. The term MIGS (minimally invasive glaucoma surgery) is reserved only for those techniques that favor aqueous humor drainage ab-interno approach through clear corneal incision and usually a biocompatible device is placed into the anterior chamber angle. The Ex-PRESS, Trabectome, iStent and recently Cypass (July 2016) are the only devices approved by the Food and Drug Enforcement Agency (FDA). Hydrus and Xen are still pending on approval. Nevertheless, it is required that most of them prove their success in the course of time(AU)
Subject(s)
Humans , Glaucoma Drainage Implants/adverse effects , Glaucoma/surgery , Trabeculectomy/methodsABSTRACT
AIM:To compare the short-term and long-term curative effect between two implantation methods for treating refractory glaucoma.METHODS:A total of 150 patients with refractory glaucoma (150 eyes) were divided into Group A (treated by implantation with Ex-press glaucoma drainage device) and Group B (treated by implantation with Ahmed glaucoma valve) according to different implantation methods.Changes of intraocular pressure and anti-glaucoma drugs at different time points, the success rate of surgery, improvement of visual acuity and complications were compared between the two groups.RESULTS:The intraocular pressure of two groups at 1d, 1wk, 3, 6 and 12mo after surgery was significantly lower than that before surgery (P0.05).CONCLUSION:The effects of implantation with Ex-press glaucoma drainage device are similar to those of implantation with Ahmed glaucoma valve in the treatment of refractory glaucoma.However, the intraocular pressure control effect of the former is better than the latter, and used anti-glaucoma drugs are fewer.
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AIM: To evaluate intraocular pressure (IOP) control and visual rehabilitation after placement of the Ex-press(R)miniature glaucoma shunt with adjunctive amniotic membrane transplantation (AMT) and mitomycin C (MMC) in patients with post-traumatic open-angle glaucoma during 2y of follow up.METHODS: This was an interventional,2-year,observational study.Eighteen eyes were prospectively observed (in 18 patients with traumatic secondary open-angle glaucoma) in which Ex-press miniature glaucoma filtration shunts were implanted with AMT and MMC.The outcome measures included intraocular pressure (IOP),best corrected visual acuity (BCVA),number of antiglaucoma medications,and complications.The progress of all patients was monitored for 24mo.RESULTS: Complete success (IOP <21 mmHg without glaucoma medications) was seen in 15 of the 17 (88.2%) eyes enrolled in the study at 24mo after the operation.IOP decreased from 36.9±4.8 mmHg preoperatively to 15.4±3.5 mmHg at 12mo and 15.5±3.5 mmHg at 24mo postoperatively.Early postoperative hypertension developed in two patients (11.1%) due to postoperative fibrosis.Most of the patients had improved postoperative BCVA values at the final follow-up visit compared to their preoperative measurements.Two patients (11.1%) developed transient hypotony.There were no complications such as hyphema,choroidal effusion,shallow anterior chamber,the device touching the iris,or extrusion of the device.CONCLUSION: The Ex-press miniature glaucoma filtration shunt with adjunctive AMT and MMC is effective and safe in cases of traumatic open-angle glaucoma.Surgical management is an appropriate surgical treatment in this series of cases.
ABSTRACT
Refractory glaucoma is one of the main blinding diseases in ophthalmology.Glaucoma drainage device implantation has become one of the main methods of refractory glaucoma.It has been widely used in clinic because of its advantages of safety,effectiveness and less complications.After a large number of clinical applications and innovative development of minimally invasive glaucoma surgery,glaucoma drainage device implantation shows its good treatment prospects.In this paper,the structural features of glaucoma external drainage device (Molteno,Schocket,Baerveldt,Human aqueous drainage,Krupin,Ahmed,Joseph,Whites,Optimed drainage device) and microin vasive glaucoma surgery (MIGS) (Ex-PRESS drainage device,Xen Gel Stent,CyPass Micro-Stent,Ab interno trabeculectomy trabectome,Hydrus Schlemm canal scaffold,iStent trabecular micro-bypass stent,SOLX Gold Shunt) were summarized.The drainage device implantations for glaucoma in the role of the refractory glaucoma were reviewed.