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Objective:To evaluate the preliminary effectiveness and safety of surgical peripheral iridectomy (SPI) combined with goniosynechilysis (GSL) and goniotomy (GT) in the treatment of advanced primary angle-closure glaucoma (PACG).Methods:A multicenter observational case series study was performed.Thirty-five eyes of 27 patients with advanced PACG, who underwent SPI+ GSL+ GT with a follow-up of at least 6 months, were included from August 2021 to January 2022 at Zhongshan Ophthalmic Center, Handan City Eye Hospital, Shijiazhuang People's Hospital, West China Hospital of Sichuan University, and the Third Affiliated Hospital of Chongqing Medical University.The mean follow-up time was 9(7, 10) months.Pre- and post-operative best corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured with an ETDRS chart and a Goldmann applanation tonometer, respectively.The number of anti-glaucoma medications applied before and after surgery was recorded, and the complications after surgery were analyzed.Success rate of surgery was calculated.Complete surgical success was defined as an IOP of 5-18 mmHg (1 mmHg=0.133 kPa) and 20% reduction from baseline without anti-glaucoma medication or reoperation.Qualified success was defined as achieving criterion of complete success under anti-glaucoma medications.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Zhongshan Ophthalmic Center, Sun Yat-sen University (No.2021KYPJ177). Written informed consent was obtained from each subject.Results:The mean preoperative IOP was (30.83±8.87)mmHg, which was significantly decreased to (15.69±3.70)mmHg at 6 months after the surgery ( t=8.588, P<0.001), with a 44.00% (34.78%, 60.00%) decline of 13.00(8.00, 21.00)mmHg.The median number of anti-glaucoma medications was significantly reduced from 2(0, 3) preoperatively to 0 (0, 1) postoperatively ( Z=-3.659, P<0.001). The mean preoperative and postoperative 6-month BCVA were 0.80(0.63, 1.00) and 0.80(0.60, 1.00), respectively, showing no significant difference ( Z=-0.283, P=0.777). Complete surgical success rate was 62.86%(22/35), and the qualified success rate was 91.43%(32/35). Surgical complications mainly included hyphema (6/35), IOP spike (3/35), and shallow anterior chamber (4/35). There was no vision-threatening complication. Conclusions:SPI+ GSL+ GT is preliminarily effective and safe in the treatment of advanced PACG, which provides a new option for PACG.
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Minimally invasive glaucoma surgery (MIGS) has been successfully incorporated in clinical practice in recent years.Increasing evidence shows that MIGS also plays an increasingly important role in the treatment of primary angle-closure glaucoma (PACG). Surgical peripheral iridectomy (SPI) plus goniosynechialysis (GSL) and goniotomy (GT), as a new procedure, has been proven to be safe and effective in the treatment of PACG with no or mild cataracts.However, there is still a lack of uniform standards for indications, surgical procedures, and perioperative medication.Therefore, it is necessary to formulate a detailed and complete expert recommendations on surgical procedures to standardize the application of combined SPI+ GSL+ GT in the treatment.Some experts in glaucoma treatment and management in China have discussed the current problems and developing trend in MIGS for PACG and put forward the expert recommendations of standard process, including indications, anaesthetic methods, surgical site, operating procedure and rational administration of drugs in perioperation, in order to standardize the medical process of clinicians using combined SPI+ GSL+ GT in PACG treatment and lay a foundation for better evaluation of the efficacy of MIGS.
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Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.
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@#AIM: To investigate the clinical effect of combined laser peripheral iridectomy for primary angle-closure glaucoma.<p>METHODS: A total of 82 eyes were included in 82 patients with primary angle-closure glaucoma who visited our hospital from August 2015 to October 2017. They were randomly divided into two groups. Patients in the simple laser group were performed Nd:YAG laser only. In the combined laser group, 532 semiconductor laser combined with Nd: YAG laser were used for laser peripheral iridectomy. Intraocular pressure(IOP)was measured preoperative and postoperative. Laser energy was recorded. Iridemia were observed.<p>RESULTS: Postoperative IOP increased significantly in the simple laser group compared with the combined laser group, and the differences between the two groups 1h, 1d and 1wk after operation were statistical significances(<i>P</i><0.01). The IOP of the two groups was basically restored to the preoperative level at 1mo postoperatively. The success rate of single laser surgery was significantly lower than that of combined laser surgery(73% <i>vs </i>100%, <i>P</i><0.05). The total energy of Nd:YAG laser was significantly higher than that of the combined laser group(40.16±13.43mJ <i>vs</i> 23.23±6.70mJ, <i>P</i><0.05). There was no significant difference in intraoperative iris bleeding rate between the two groups(33% <i>vs</i> 26%, <i>P</i>>0.05).<p>CONCLUSION: Totally 532 semiconductor laser combined with Nd: YAG laser for peripheral iridectomy has a high rate of penetration, especially for patients without iris recess. It can significantly decreases laser energy, reduces the difficulty of laser operation and relieves intraocular inflammation.
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AIM:To observe related biological parameters of 3 minutes dark-room provocative test in patients with laser peripheral iridectomy(LPI) in the fellow eyes of acute primary angle-closure (APAC) by ultrasound biomicroscopy (UBM).To explore the risk factors in primary angle closure suspect(PACS) patients with progressive angle closure after LPI.METHODS: Seventy-eight eyes of APAC patients without peripheral anterior synechia were selected.Each eye underwent 3 minutes dark-room provocative test after LPI.Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber angle open distance500 (AOD500), peripheral iris thickness (PIT), iris convex (IC), the position of iris insertion and trabecular-ciliary process distance (TCPD), and the number of positional angle closure(NPAC) were observed and analyzed by statistic methods.RESULTS:Patients with APAC were examined by UBM after LPI and 26 eyes(33%) occurs at least one positional angle closure,19 eyes(24%)were positive in 3 minutes dark-room provocative test among them.It occurs a positive relationship between the elevation intraocular pressure and the number of positional angle closure in dark-room provocative test(r=0.84, P<0.01).AOD500, IT and IC were significantly changed from normal light to darkroom between positional angle closure positive group and positional angle closure negative group(all P<0.01).In single factor analysis, AOD500(P=0.003), IT(P=0.012), IC(P=0.043), TPCD(P=0.015), the position of iris insertion(P=0.024) were correlative factors of positive results.In multiple-factor analysis, only IT(P=0.011), TPCD(P=0.009), iris root attachment points(P=0.02) were independent risk factors of positive results.CONCLUSION:A certain proportion of patients with PACS after LPI appeared positional angle closure in a dark room.Peripheral iris hypertrophy, anterior displacement of the ciliary body and iris root attachment points are vital risk factors.Long-term follow-up study and intervention treatment are required in these patients after LPI.
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Objective To investigate the complications and outcomes of the treatments in the early time of posterior chamber phakic in-traocular contact lens ( ICL) implantation for the treatment of high myopia, and to analyze the causes. Methods Forty-six patients ( 92 eyes) who underwent ICL/TICL implantations were enrolled in this study. The intraoperative and the postoperative complications in 6 months were observed,at the same time also the treatments and the outcomes were observed. Results None of the patients had a pupillary block. Only 8 eyes in all the patients had an elevated IOP after peripheral iridectomy ( PI) ,and 7 eyes after the ICL implantation,the highest IOP in which was 28 mmHg. No medication was given for treatment. In the YAG PI group,the incidence rate of iris bleeding and pigment dispersion were all higher than that in the YAG PI group (P<0. 05);2 crystalline lens of different patient were damaged intraoperation. Rotation of TICL was observed in 2 eyes. Only 2 individuals of all the patients in this study had complained visual disturbances,which was shadows and glare. Visual psychological change occurred in 1 patient. Conclusion The complications in the early time after ICL implantation for treat-ment of high myopia can prevent and control,the satisfaction of the patients is high.
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AIM: To investigate the effect and safety of laser peripheral iridoplasty combined with iridectomy in the unmanageable acute angle - closure glaucoma by medication. METHODS:Totally 19 cases (21 eyes) with acute angle-closure glaucoma, including 15 cases ( 17 eyes ) with primary glaucoma and 4 cases (4 eyes) with intumescent cataract - induced glaucoma, were recruited into the study. The intraocular pressure ( IOP ) of all cases were still >21mmHg after 24h drug treatment, and then were treated by laser peripheral iridoplasty combined with iridectomy. The visual accurity, IOP, cornea, peripheral anterior chamber depth, anterior chamber angle and complications were observed at 24h after the surgery. RESULTS:The mean IOP of all cases was reduced from 53. 09±11. 01mmHg before the surgery to 14. 98±4. 21mmHg at 24h after the treatment, with significant statistical difference ( P CONCLUSION: Laser peripheral iridoplasty combined with iridectomy is an effective and safe method for the treatment of the unmanageable acute angle - closure glaucoma by medication.
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Background Whether ocular anterior and posterior chamber exist a blood-aqueous barrier is in controversy.Conventional method can not offer a good evidence because it is unable to detect the aqueous component in the posterior chamber.Objective This study was to investigate the distribution of Gadolinium-diethylene triamine pentaacetic acids(Gd-DTPA)after peripheral iridectomy with magnetic resonance imaging(MRI)in rabbit.Methods Monocular peripheral iridectomy was performed on the right eyes in 8 clean New Zealand white rabbits and the fellow eyes were as controls.0.2 ml/kg(0.5 mol/L)Gd-DTPA,a tracer of MRI,was injected into ear vein in vivo to scan the eyes with MRI for the observation of the permeability and distribution.The signal enhanced ratio of interest region associated with time were analyzed.Results The signal in ciliary body of both eyes showed an immediately sharp enhancement within 10 minutes following the injection of Gd-DTPA with a peak intensity at 30-40 minutes,and then the intensity was gradually weaken over time.The signal was stronger in the operative eyes than that in the fellow eyes.The signal in the posterior chamber was gradually increased after operation,however,that in posterior chamber of the control eyes was lower.The interest regions of Gd-DTPA were ciliary,anterior chamber and posterior chamber,and the enhanced signal intensities were consisted in the posterior chamber after operation.However,the increase of the signal was not seen in the posterior chamber in the control eyes.Conclusions The pathway of plasma protein entering into the anterior chamber is very different from that of aqueous secretion.There exists a barrier between the anterior and posterior chamber which might be an integral part of the blood-ocular barrier.
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21 mmHg.The side effects,IOP and application of anti-glaucoma drugs were examined 1 h,1 d,1 week,1 month,3 months and 6 months after SLT. Results The IOP was significantly decreased 1 week,1 month,3 months and 6 months after SLT compared with that before treatment(P21 mmHg using two anti-glaucoma drugs,respectively. Conclusion SLT is a safe and effective method for IOP control in early CPACG after treatment with laser peripheral iridoplasty and laser iridectomy.
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We surveyed fifty patients with the acute angle closure glaucoma from January 1, 1990 to August 31, 1996 retrospectively in order to study the clinical characteristic of disease. The mean age of the patients was 61.9 years, women were larger than men in number, right eye involvement was in nineteen patients(38%), left eye in twelve patients(24%), binocular involvement in nineteen patients(38%). The mean IOP at the first visit was 46.3mmHg. Twenty-nine patients(58%) have unknown predisposing factor, fifteen patients(30%) have known predisposing factor which is the mmature cataract or lens subluxation. In the prophylactic treatment of the fellow eye, close observasion was done in fifteen patients(49%), argon laser iridotomy was done in eight patients(26%). The surgical treatment of choice was trabeculectomy, peripheral iridectomy, laser iridotomy or triple operation. At the last follow-up, fifty-six eyes(96%) had intraocular pressure of 21mmHg or less as complete success and best-corrected visual acuity was better than the preoperative best-corrected visual acuity in all patients.