Considerações sobre o glaucoma facomórfico. Diagnóstico e tratamento / Phacomorphic glaucoma. Diagnose and treatment

RESUMO Os AA fazem considerações sobre clínica, diagnóstico e tratamento do Glaucoma Facomórfico, e ilustram com a apresentação e discussão em quatro pacientes.

ABSTRACT The AA present Phacomorphic Glaucoma discussing the clinic presentation, diagnose and treatment of the disease in four patients.

Comparative study of lens subluxation in patients with angle-closure glaucoma and shallow anterior chamber with different axial lengths / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To investigate whether there is a difference in the probability of partial zonular dehiscence and subluxation in patients with angle-closure glaucoma and shallow anterior chamber combined with cataract. <p>METHODS: A retrospective analysis was performed,for patients with angle-closure glaucoma and patients of shallow anterior chamber with cataract admitted to our hospital from February 2017 to March 2019. The patients underwent cataract surgeries and were divided into two groups: Group A(visual axis <22mm)and Group B(visual axis ≥22mm). Central anterior chamber depth(ACD)was measured with ultrasound biomicroscopy(UBM); Axial length(AL, length of optic axis)was measured with IOL-Master; Calculation of the ratio of AC depth to axial length(ACD/AL)was performed. The consistency of the anterior chamber depth in all directions in UBM images was analyzed. In cataract surgeries, partial zonulysis with or without lens subluxation was recorded.<p>RESULTS: The result indicated that the rate of partial zonular dehiscence in group B was higher than that in group A(8.46%±1.44% <i>vs</i> 7.56%±1.51%, <i>P</i><0.05). <p>CONCLUSION: When performing cataract surgery in patients of angle-closure glaucoma and shallow anterior chamber in group B, attention should be paid to the probability of zonular abnormality.

Outcomes of trabeculectomy in microspherophakia.

Purpose: To report the outcomes of trabeculectomy in eyes with glaucoma in microspherophakia. Materials and Methods: In a retrospective non-comparative case series, we analyzed 29 eyes of 18 patients with glaucoma in microspherophakia, who underwent primary trabeculectomy between 1998 and 2012. Success was defi ned as complete if the intraocular pressure (IOP) was ≤21 and >5 mm Hg without any antiglaucoma medication and qualifi ed if IOP ≤21 and >5 mm Hg with or without antiglaucoma medications. Eyes not falling into qualifi ed success criteria were labeled as failure. Results: The median age at the time of trabeculectomy was 23 years (inter quartile range: 12, 28). The mean IOP reduced from 31.1 ± 8.6 mm Hg to 14.6 ± 4.4 mm Hg after trabeculectomy over a median follow up of 77 months (P < 0.001). The probability of complete success was 96% (95% CI: 77-99%) at one year, 88% (95% CI: 67-96%) at 2 years, which was maintained till 7 years and decreased to 79% (95% CI: 50-92%) at 8 years. The probability of qualifi ed success was 100% till 7 years and decreased to 90% (95% CI: 47-98%) at 8 years. The median number of postoperative medications reduced from 2 to 0 postoperatively (P < 0.001). Five eyes (21%) developed post-operative shallow anterior chamber (AC) requiring anterior chamber reformation, with 2 of these eyes needing lensectomy for resolution of this complication. Conclusion: Primary trabeculectomy had good success rate in glaucoma associated with microspherophakia. Post-operative shallow AC was a frequent complication needing additional intervention.

The Effect of Flat Anterior Chamber on the Success of Ahmed Valve Implantation

PURPOSE: To evaluate the outcome following Ahmed valve implantation in patients who developed flat anterior chamber. METHODS: The authors reviewed 60 eyes of 60 patients who underwent Ahmed valve implantation and divided these patients into the flat anterior chamber group (18 eyes) and the control group (42 eyes). The influence of clinical variables on the development of flat anterior chamber and the effect of flat anterior chamber on the success of Ahmed valve implantation were evaluated. RESULTS: The preoperative intraocular pressure, age, and the incidence of neovascular glaucoma as a preoperative diagnosis were higher in the flat anterior chamber group than in the control group (p0.05). CONCLUSIONS: The development of a flat anterior chamber after Ahmed valve implantation appeared not to affect the outcome of the surgery.

Glaucoma Shell Tamponade for The Flat Anterior Chamber Following Trabeculectomy

Usual managements of flat anterior chamber following filtering surgery are deepening of anterior chamber using cycloplegics and mydriatics, and pressure patch technique compressing the fistula. But the pressure patch technique may worsen chamber depth problem because exact compression on the filtering area is difficult by pressure patching. Prolonged pressure patching may also cause deterioration of filtering function. The tampon with glaucoma shell provides enough resistance to excessive outflow, allows the anterior chamber to reform promptly, and can prevent choroidal separation. We treated the flat anterior chamber following trabeculectomy using glaucoma shell in 7 eyes. The anterior chamber in each eye was restored promptly within 2-4 days after the placement of glaucoma shell. Glaucoma shell is easy to handle, gives minimal discomfort to patient, and may need less time to restore flat anterior chamber than pressure patching.

Treatment of Neovaseular Glaucoma Using Modified Schocket Implant

Seven eyes of 7 patients had undergone modified Schocketimplant surgery for neovascular glaucoma. The mean preoperative intraocular pressure(IOP) was 49.1 +/- 10.1 mmHg(range 38 to 70 mmHg). With a follow up of 6 to 18 monnths, the mean postoperative IOP was 20.3+/-5.1 mmHg(range 16 to 30 mmHg). The author's personal method to make two oblique valve incisions on the obliterated distal end of the draining silicone tube, prevented early postoperative complications(flat anterior chamber and hypo-tony). The one oblique incision on silicone tube turned into a open valve at a pressure between 17.3 and 21.6 mmHg(average 19.3 mmHg) and two oblique incisions opened at a oblique incisions seemed to be more available for pressure sensitive valve. The complications included minimal hyphema(4 eyes) and progression of cataract(1 eye). Modified Schocket implant are an effective and simple technique in the management of neovascular glaucoma.