Clinical presentation and treatment outcomes of an algorithmic approach to uveal effusion syndrome

Purpose: To describe the clinical features and treatment outcomes in spontaneous uveal effusion syndrome (UES). Methods: A 10?year retrospective chart review of UES patients from a tertiary eye center was carried out. Optical coherence tomography (OCT), fundus fluorescein angiography, and ultrasound biomicroscopy (UBM) scans were performed. UES was managed based on presenting best?corrected visual acuity (BCVA), symptoms, and fundus findings. Patients with secondary causes of uveal effusion were excluded. Results: Twenty?five eyes of 16 patients were included. Of the 16 patients, 14 (88%) were male and 9 (56%) had bilateral disease. Fifteen of 25 affected eyes had nanophthalmos (axial length (AL) <20.5 mm) and 6 had hyperopia with AL >20.5 mm. The presenting mean distance BCVA was 0.74 ± 0.64 logMAR (mean Snellen: 20/100). Eleven eyes had exudative retinal detachment, and 4 also had exudative choroidal detachment (CD). Choroidal thickness (CT) was increased in 11 eyes on B?scan ultrasonography, and the mean CT was 1.74 ± 0.38 mm. Sub?retinal fluid (SRF) and retinal folds were the most common OCT findings. UBM findings included shallow angles, peripheral CD, and supra?ciliary effusion. A combination of local and systemic corticosteroids was used to successfully treat 12 eyes, 6 needed surgery, and 7 were observed. Partial sclerectomy with anterior chamber maintainer?assisted SRF drainage was the favored surgery. The median period of follow?up was 6.5 months (0.1–76 months), and the mean distance BCVA at the last follow?up was 0.58 ± 0.42 logMAR (mean Snellen: 20/80). Conclusion: UES can be suitably managed both medically and surgically based on clinical presentation

Changes in ocular surface after withdrawal of anti-glaucoma medications following non-penetrating deep sclerectomy

Purpose: To analyze the ocular surface changes in eyes after the withdrawal of anti?glaucomatous drugs when non?penetrating deep sclerectomy (NPDS) is performed. Methods: Thirty?one patients (33 eyes) diagnosed with glaucoma that underwent NPDS were included in this prospective study. The control group included 33 eyes. Four variables were studied using Keratograph 5M (K5M): ocular hyperemia (OH), non?invasive tear film break?up time (NI?BUT), lower tear meniscus height (LTMH), and meibography. LTMH was also measured using the anterior segment module of a Spectralis Fourier?domain optical coherence tomography (FD?OCT) instrument. Moreover, an evaluation of corneal and conjunctival staining was performed. In the glaucoma group, five visits were carried out: pre?surgery, 1 week after surgery, and 1 month, 3 months, and 6 months after surgery. In control groups, examinations were performed in only one visit. In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ?25) before and 6 months after surgery. Results: Before NPDS, eyes showed worse objective data than healthy control subjects (P ? 0.049). In this group, a significant improvement was observed in questionnaire responses (P < 0.001), LTMH?FD?OCT (P = 0.037), LTMH?K5M (P = 0.025), K5M?OH (P = 0.003), NI?BUT (P = 0.022), and conjunctival and corneal staining (P < 0.001). No significant differences were observed between groups in FD?OCT and K5M LTMH, NI?BUT, corneal?conjunctival staining, nor in the most OH sector values at 6 months (P ? 0.62). Conclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawal of the topical anti?glaucomatous treatment had a beneficial effect on the subjects

Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO / 中国医学科学院学报

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO

Esclerectomía profunda no penetrante en el glaucoma avanzado / Non-penetrating deep sclerectomy in advanced glaucoma

El tratamiento del glaucoma se realiza con el objetivo de disminuir los niveles de presión intraocular, único factor tratable hasta el momento, y debe ser individualizado. Se presenta un paciente masculino de 54 años de edad, de piel mestiza, intelectual, con antecedentes de aparente salud y diagnóstico de glaucoma desde hace 10 años. Se realizó trabeculectomía con antimetabolito (mitomicina C) en el ojo izquierdo en el año 2012 por daño glaucomatoso avanzado. En el año 2016 acudió a nuestra consulta y refirió mala visión y descontrol de la presión intraocular de ambos ojos. Se constataron cifras muy elevadas de presión intraocular en ambos ojos, superiores a 30 mmHg; en el ojo derecho la unidad de visión con su mejor corrección y un daño campimétrico muy avanzado limitado a una isla de visión central con caída hasta los 5° centrales, y el ojo izquierdo no alcanzaba la percepción luminosa. Después de combinar 3 líneas farmacológicas con la dosis máxima, los valores de la presión intraocular no eran protectores. Surgió la disyuntiva entre realizar una cirugía filtrante, temiendo al riesgo quirúrgico elevado y tratándose de un ojo único, o no practicar cirugía alguna y solo continuar con el tratamiento farmacológico a pesar de no conseguirse valores de presión intraocular meta. Se decidió realizar esclerectomía profunda no penetrante con antimetabolito (mitomicina C al 0,02 por ciento). No se presentaron complicaciones asociadas y se consiguió el descenso de la presión intraocular a 24 mmHg, por lo que al mes de la cirugía se realizó goniopuntura. Se obtuvo la presión intraocular objetivo, sin progresión del daño glaucomatoso y hubo conservación de la agudeza visual(AU)

Treatment for glaucoma is aimed at reducing the levels of intraocular pressure. This is the only factor that may be treated so far, and it should be individualized. A case is presented of a male 54-year-old mulatto patient, intellectual, with a history of apparently good health who was diagnosed with glaucoma ten years ago. Trabeculectomy with antimetabolite (mitomycin C) was performed on the patient's left eye in the year 2012 due to advanced glaucomatous damage. In the year 2016 the patient attended our service and reported poor vision and uncontrolled intraocular pressure in both eyes. Very high intraocular pressure values above 30 mmHg were confirmed in both eyes. In the right eye the vision unit with its best correction, and very advanced campimetric damage limited to a central vision island with a fall to 5° central, whereas the left eye did not achieve light perception. After combining 3 drug lines at their maximum dosage, intraocular pressure values were not protective. The dilemma arose whether to perform filtration surgery, fearing the high surgical risk, being as it was a single eye, or not to perform any surgery and just go on with the drug treatment despite not having achieved target intraocular pressure values. It was decided to perform non-penetrating deep sclerectomy with antimetabolite (0.02 percent mitomycin C). No associated complications occurred and intraocular pressured fell to 24 mmHg. Therefore, goniopuncture was performed one month after surgery. The target intraocular pressure was obtained without glaucomatous damage progression and visual acuity was preserved(AU)

Study of changes in higher-order aberrations following non-penetrating deep sclerectomy surgery augmented with sub-Tenon injection of MMC in patients with open-angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the changes in higher-order aberrations following non-penetrating deep sclerectomy surgery augmented with sub-Tenon injection of mitomycin C(MMC)in patients with open angle glaucoma<p>METHODS: Twenty eyes from 20 patients were enrolled in the study. There were 10 eyes with primary open angle glaucoma(POAG)and 10 eyes with secondary open angle(SOAG; pseudoexfoliation). Patients underwent non-penetrating deep sclerectomy surgery augmented with sub-Tenon injections(0.2 mL of MMC 0.02%)before surgery. All patients were evaluated in terms of corneal total higher-order aberrations <i>via</i> i-Trace analyzer before surgery and 1mo and 3mo after surgery. The intraocular pressure(IOP), best corrected visual acuity(BCVA), and bleb morphology were evaluated at each visit. The success rate of surgery was categorized as complete, relative, or failure.<p>RESULTS: The IOP before surgery was 24.05±3.07 mmHg with a mean of 2.85±0.67 medication, which reached to 12.30±3.32 mmHg with 0.70±0.98 medication at the 3mo follow-up. The reduction in IOP was significant at all periods of the follow-up(<i>P</i><0.001). The values of total higher-order total(HOT)root mean square(RMS)and total ocular spherical-like aberrations significantly increased at 1mo follow-up after surgery and decreased over the course of 3mo. Trefoil and total ocular coma-like aberration changes were not statistically significant at all periods after surgery. The HOT RMS, coma-like and spherical-like corneal increased significantly 1mo after surgery and decreased at the 3mo follow-up. Corneal trefoil changes were not statistically significant after surgery compared to preoperative state. Patients age and IOP did not have a significant effect on changes in HOT and corneal HOT aberrations.<p>CONCLUSION: Corneal and ocular higher-order aberrations increased within 1mo after deep sclerectomy surgery and then decreased over a 3mo period, which showed no statistically significant change compared to preoperative state. The BCVA and spherical equivalent(SE)of the patients shown no statistically significant differences compared to the preoperative state at the 3mo follow-up.

Clinical features of uveal effusion syndrome and the efficacy of sclerectomy in the treatment of uveal effusion syndrome / 中华眼底病杂志

Objective To observe the clinical features ofuveal effusion syndrome (UES) and the efficacy of sclerectomy in the treatment of UES.Methods A retrospective case series.Twenty patients (36 eyes) of UES with sclerectomy were enrolled in this study from June 2012 to December 2016 in Beijing Tongren Hospital.Among them,there were 12 males (22 eyes) and 8 females (14 eyes),with an average age of 37.8 years.All patients suffered from bilateral diseases,including 4 patients in single eye group and 16 patients in double eye group.Visual acuity,intraocular pressure,indirect ophthalmoscope,UBM,FFA combined with ICGA,A/B ultrasonography,axial length (AL) and scleral thickness were measured.All patients underwent lamellar sclerectomy,and those with exudative retinal detachment underwent four quadrant lamellar sclerectomy,followed by four quadrant full-thickness sclerectomy with the size of 1 mm × 2 mm in the center of the scleral bed.The follow-up time after operation was more than 6 months.Visual acuity,intraocular pressure and fundus examination were performed 1,3 and 6 months after operation with the same equipment and methods before operation.Results There was no obvious inflammation in the anterior chamber of all eyes,and intraocular pressure was 24-28 mmHg (1 mmHg =0.133 kPa) in 4 eyes (11.1％).Axial length of 8 eyes (22.2％) were 16-18 mm (true microphthalmia).12 eyes (33.3％) had scleral thickness ＞ 1.0-1.8 mm.Visual acuity ranged from hand movement to 0.05 in 20 eyes,0.1 to 0.3 in l0 eyes and＞0.3 in 6 eyes.Fundus examination showed peripheral choroidal and ciliary detachment;UBM examination showed annular peripheral ciliary and choroidal detachment.32 eyes (88.9％) were complicated with exudative retinal detachment.FFA examination showed that 14 eyes (38.9％) had leopard spot changes.Compared with preoperative vision,the visual acuity improved in 28 eyes (77.8％) and remained unchanged in 8 eyes (22.2％) after surgery.Thirty-two eyes with different degrees of retinal detachment were found before surgery.After surgery,ciliary body detachment,choroidal detachment and retinal detachment were restored.Six eyes (16.7％) recurred and underwent sclerectomy again.Conclusions The mild symptoms and recurrent attack are the characteristics of UES.Sclerectomy is an effective method to treat UES.

Research advances in surgical management approaches for uveitic glaucoma / 眼科新进展

Uveitic glaucomas (UG) are complex in cause or disease and response to treatment.UG typically is associated with very high intraocular pressure and more intense optic nerve damage than other glaucoma types.This secondary glaucoma requires an early diagnosis and adequate management of both uveitis and glaucoma.Recently,a multitude of novel medical therapies and surgical techniques have been added to the armamentarium of existing therapeutic modalities.This article reviews the surgical treatment of UG,including Trabeculectomy,laser peripheral iridotomy,nonperforating deep sclerectomy,glaucoma drainage implants,minimally invasive glaucoma surgery,and also briefly discusses the application and effect of these surgical treatments.

Diagnosis and a minimum effective management for nanophthalmic uveal effusion syndrome.

A 38‑year‑old male presented with a 2‑week history of sudden blurred vision (best‑corrected visual acuity: 20/200) and pain in his right eye. Spectral domain optical coherence tomography (OCT) revealed focal thickening of the retinal pigment epithelium layer as leopard spots [Fig. 1a]. Fundus examination demonstrated exudative retinal detachment and retinal vascular dilation [Fig. 1c] whereas the contralateral eye remained unremarkable [Fig. 1b and d]. B‑scan ultrasonography showed a short axial length (17.3 mm). Fundus fluorescein angiography and indocyanine green angiography revealed leopard spots of granular hyperfluorescence in the posterior and inferior quadrants [Fig. 1e], which were increased with time and persisted until the late phase [Fig. 1f]. On the basis of clinical findings, we diagnosed him and it revealed to be nanophthalmic uveal effusion syndrome (UES).[1] After 10 mg dexamethasone was applied intravenously, two‑third thickness scleral flaps measuring 4 mm × 5 mm were performed at inferotemporal and inferonasal sites [Fig. 2a]. Under them, the remaining sclerae were excised measuring 1 mm × 2 mm accordingly [Fig. 2b and c]. Biopsy [Fig 2d] and pathologic evaluation revealed fibroblastic proliferation and hyaline degeneration of lamellar sclera [Fig. 2e and f]. The effusion was not detected at least on 6‑month follow‑up [Fig. 3], and the visual acuity was stabled at 20/100.

Observation of Ex - press miniature implantation with deep sclerectomy surgery for refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM: To evaluate the effect for refractory glaucoma by using Ex - Press miniature implantation with deep sclerectomy.?METHODS: Thirty eyes in 24 patients with refractory glaucoma were treated by Ex- Press miniature ( P50 ) implantation with deep sclerectomy. The patients’ symptom, intraocular pressure ( IOP ) , visual acuity and complications were analyzed in a 12mo follow-up period.?RESULTS: During the follow-up period, all patients’ ocular pain was reduced. The mean IOP before operation and at the last follow-up time were 51. 15 ± 2. 60mmHg (1kPa=7. 5mmHg) and 15. 11 ± 2. 51mmHg, respectively, there was significant difference (P<0. 05). Postoperative visual acuity was improved in 8 eyes, had no significant change in 22 eyes. After operation, hyphema of anterior chamber appeared in 2 eye ( 7%) , which were obsorbed after 1wk.? CONCLUSION: Ex - Press miniature implantation combined with deep sclerectomy surgery is a relatively effective and safe treatment for the patients with refractory glaucoma. This method can significantly degrade the IOP, lessen ocular pain and reduce the complications risk.

Safety and feasibility of the use of a bevacizumab-methylcellulose mixture as an adjunct to glaucoma surgery: a pilot study / Segurança e viabilidade do uso de uma mistura de bevacizumabe-metilcelulose como terapia adjuvante à cirurgia anti-glaucomatosa: um estudo piloto

ABSTRACT Bevacizumab, a monoclonal anti-vascular endothelial growth factor antibody, has been suggested as a potential healing therapeutic following glaucoma surgery. Here, we aimed to improve the bioavailability of bevacizumab when used as an adjunct therapy to non-penetrating deep sclerectomy (DS) by using a bevacizumab-methylcellulose mixture (BMM). Ten previously non-operated eyes in ten patients diagnosed with primary open angle glaucoma underwent DS with a subconjunctival injection of 0.3 ml of BMM (bevacizumab 3.75 mg incorporated into 4% methylcellulose) at the surgical site. Bevacizumab release was evaluated in vitro using size-exclusion high performance liquid chromatography (HPLC). Intraocular pressure (IOP), bleb morphology, corneal endothelial cell count (CECC), and complications were evaluated at 6 months after surgery. Using HPLC, bevacizumab was detected in BMM for up to 72 h. Moreover, all surgical blebs remained expanded with hyaline material during the first week. A significant IOP reduction (mean ± SD= -10.3 ± 5.4 mmHg, P<0.001) and diffuse blebs were observed at the final follow-up period. Although CECC was slightly reduced (-7.4%), no complications were observed. In conclusion, bevacizumab was released from BMM, and the use of this innovative mixture yielded good results following DS with no complications. Further studies are required to determine its efficacy prior to establishing BMM as an adjunct treatment for penetrating and non-penetrating glaucoma surgeries.

RESUMO O bevacizumabe (um agente anti-fator de crescimento endotelial vascular) tem sido sugerido como potencial modulador cicatricial na cirurgia do glaucoma. Este estudo objetivou melhorar a biodisponibilidade do bevacizumabe, investigando a viabilidade de uma nova mistura de bevacizumabe-metilcelulose (BMM) como terapia adjuvante para a esclerectomia profunda não-penetrante (DS). Dez olhos sem cirurgias prévias de 10 pacientes com glaucoma primário de ângulo aberto foram submetidos à DS associada à uma injeção subconjuntival de 0,3 ml da mistura de bevacizumabe-metilcelulose (bevacizumabe 3,75 mg incorporado em metilcelulose 4%) no sítio cirúrgico. A liberação de bevacizumabe foi avaliada in vitro através de cromatografia líquida de alta performance por exclusão de tamanho (HPLC). A pressão intraocular (PIO), a morfologia da ampola de filtração, a contagem de células endoteliais da córnea (CECC) e as complicações foram estudadas aos seis meses de seguimento. O bevacizumabe foi detectado a partir da mistura de bevacizumabe-metilcelulose por meio do HPLC até 72 horas. Além disso, todas as ampolas cirúrgicas permaneceram expandidas com material hialino durante a primeira semana. Uma redução significativa da pressão intraocular (média ± DP= -10,3 ± 5,4 mmHg, P<0,001) e ampolas difusas foram observadas ao final do período de seguimento. Embora a contagem de células endoteliais da córnea se mostrou discretamente diminuída (-7,4%), nenhuma complicação foi observada. Neste estudo, o bevacizumabe foi liberado da mistura de bevacizumabe-metilcelulose e o uso desta nova mistura se associou com bons resultados cirúrgicos e nenhuma complicação. Estudos futuros serão necessários para determinar sua eficácia, antes de se estabelecer a mistura de bevacizumabe-metilcelulose como um tratamento adjuvante às cirurgias penetrantes e não-penetrantes para o glaucoma.

A Novel Sclerectomy Technique for Glaucoma and Ocular Hypertension Treatment.

Purpose: To introduce and evaluate the efficacy and safety of a new surgical scleral technique for treatment of glaucoma based on the concept of scleral biomechanics. Methods: Twelve 3-month-old New Zealand white rabbit eyes were operated under general anesthesia. Single large rectangular full thickness sclerectomy (3 mm limbal x 5 mm) exposing the choroid was performed in each eye. The intraocular pressure (IOP) was measured preoperatively, one day, one week and one month postoperatively. Results: Twelve eyes of 6 New Zealand white rabbits were operated with sector sclerectomy technique. The mean (±SD) intraocular pressure (IOP) was significantly reduced from a preoperative value of 6.0 (±0.0) mmHg to 2.0 (±0.0) mmHg (p = 0.003) in the post-operative assessment. The IOP was quite stable in the following one week and one month follow up assessments at 2.0 (±0.0) mmHg (p = 0.998). Eight out of 12 (66.7%) operated eyes had no postoperative complications. Four (33.3%) eyes faced different complications where: one (8.3%) had corneal perforation by traction suture, 3 (25%) had vitreous loss (one mild and two severe), while one of them (8.3%) had bleeding. Conclusion: Full thickness sector sclerectomy can change the scleral biomechanical behavior leading to highly significant intraocular pressure reduction.

Long-term Results of Deep Sclerectomy with Small Collagen Implant in Korean

PURPOSE: To describe the long-term results of deep sclerectomy with collagen implant (DSCI) with or without adjuvant mitomycin C in Korean patients with primary or secondary open-angle glaucoma (OAG). METHODS: This retrospective review was comprised of 65 Korean patients who received DSCI with or without adjuvant mitomycin C due to primary or secondary OAG. Patients were followed for 72 months after surgery. Complete success was defined as intraocular pressure (IOP) <21 mmHg without medication and qualified success was defined as IOP <21 mmHg with or without medication. RESULTS: Mean postoperative follow-up period was 53.0 +/- 16.2 months. Mean IOP was 30.5 +/- 11.7 mmHg preoperatively, 8.4 +/- 4.3 mmHg at postoperative day one and 13.4 +/- 3.8 mmHg 60 months after surgery. The mean number of glaucoma medications was decreased from 3.6 +/- 1.1 to 1.6 +/- 1.3 at 60 months after the operation. Complete and qualified success rates were 36.7% and 79.6% at postoperative 60 months, respectively (Kaplan-Meier survival curve). No shallow or flat anterior chamber, endophthalmitis, or surgery-induced significant cataract was observed. CONCLUSIONS: The results of DSCI in Korean patients presented here seem reasonably excellent with qualified success rates of over 70% at six years with negligible complications.

Clinical feature and management of uveal effusion syndrome / 中华实验眼科杂志

Background Uveal effusion syndrome is uncommon in clinic.To understand the clinical characteristics of uveal effusion syndrome is helpful for rescuing visual acuity of patient.Objective This study was to discuss the diagnosis,classification and surgical outcome of uveal effusion syndrome.Methods This was a descriptive study.The clinical data of 14 eys from 10 patients with uveal effusion syndrome,ineluding ophthalmologic examination,B-scan sonography,ultrasound biomicroscopy (UBM),fundus fluorescence angiography (FFA),indocyanine green angiography (ICGA),surgical treatment and prognosis,were retrospectively analyzed.The follow-up period was 6 months.Results The fundus findings of all impacted eyes showed bullous-shape retinal detachment (RD).B-scan sonography revealed retinal and choroidal detachment.A annular peripheral ciliochoroidal detachment was observed in the cases under the UBM.FFA exhibited leopard spots without any leakage from choroid into the subretinal space.ICGA demonstrated diffusely choroidal granular hyperfluorescence in the very early phase,which presented with an increasing intensity as time lapse until the late phase.Full-thickness sclerectomy was performed on 4 eyes of 2 patients and subscleral sclerectomy was performed in 1 eye of 1 patient,achieving a retinal anatomic reattachment after surgery.All of the patients finished the fellow-up.No recurrence of RD was seen during the followup duration.Conclusions Comprehensive preoperative evaluation,including ophthalmologic ultrasonography,MRI and CT,is crucial for accurate classification of uveal effusion syndrome and determine of proper management strategy.

A Case of Paranasal Diffuse Large B-Cell Lymphoma with the Orbital Invasion Masquerading as Chronic Sinusitis

PURPOSE: To compare surgically induced corneal astigmatism following trabeculectomy versus deep sclerectomy and collagen implant (DSCI). METHODS: 37 consecutive eyes of 28 patients having glaucoma surgeries for uncontrolled open-angle glaucoma were retrospectively analyzed. 16 eyes had trabeculectomy and 21 eyes had DSCI. Visual acuity, intraocular pressure (IOP) and autorefractokeratometry of both groups were evaluated preoperatively and 1, 7 days, 1, 3, 6, 12 months postoperatively. Postoperative changes in corneal astigmatism were evaluated using vector analysis. RESULTS: Mean age was 51.63 +/- 12.73 years in the trabeculectomy group and 39.95 +/- 15.09 years in the DSCI group and differed between groups (p = 0.015). Visual acuity was significantly decreased after surgery compared with preoperative values and was improved slowly in both groups. Intraocular pressure was lower in the trabeculectomy group than in the DSCI group at postoperatively 1 and 6 months (p = 0.046 and 0.029, respectively). There was no significant difference in surgically induced corneal astigmatisms (SIA) between both surgeries, which decreased over time in the group with stable postoperative IOP. They showed with-the-rule astigmatism immediate postoperatively. The DSCI group with MMC showed less SIA than the group without MMC. CONCLUSIONS: Surgically induced astigmatisms following trabeculectomy and deep sclerectomy with collagen implant were not differ significantly between two surgeries.

Dilated episcleral veins with secondary open angle glaucoma.

We report a case of dilated episcleral vein with secondary open angle glaucoma. A 65-year-old female presented with redness of both the eyes without any prior systemic history. Her ocular examination revealed dilated episcleral veins and a high intraocular pressure (IOP) of 38 mm Hg in the right eye. Systemic examination was negative for carotid cavernous fistula, low-grade dural arteriovenous fistula, dysthyroid ophthalmopathy, and primary pulmonary hypertension. During follow-up, her IOP remained in high thirties despite maximum medications. She underwent right eye trabeculectomy with partial thickness sclerectomy with sclerotomy. In the beginning, the sclerotomy incision was not deepened into the suprachoroidal space. She developed choroidal effusion during surgery and the sclerotomy was deepened into suprachoroidal space and straw color fluid was drained. Postoperatively, she developed choroidal effusion, which resolved with conservative management. This case highlights the importance of sclerotomy in such cases of high episcleral venous pressure.

Lasers in primary open angle glaucoma.

Lasers have been used in the treatment of primary open angle glaucoma (POAG) over the years, with the hope that they would eventually replace medical and surgical therapy. Laser trabeculoplasty (LT) is an application of argon, diode, or selective laser energy to the surface of the trabecular meshwork to increase the aqueous outflow. The mechanisms by which intraocular pressure (IOP) is lowered could be mechanical, biologic, or by division of adjacent cells. It is commonly used as an adjunct to medical therapy, but is contraindicated if the angle is obstructed, e.g., peripheral anterior synechia (PAS) or developmental glaucomas. About 75% of individuals will show a significant fall in IOP after argon laser trabeculoplasty (ALT), and the response is similar with selective laser trabeculoplasty (SLT). The effects of LT are not always long lasting, with about 10% of individuals showing a rise in IOP with every passing year. Laser thermal sclerostomy, ab interno or externo, is an alternative to other full-thickness filtration procedures. Longer wavelengths in the infrared range have water-absorptive characteristics that facilitate perforation of the sclera. These lasers can be used to avoid intraocular instrumentation and minimize conjunctival trauma.

Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of Open Angle Glaucoma / 华中科技大学学报（医学）（英德文版）

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma.We searched the Cochrane Library,PUBMED (1966 to 2009),Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies.The reports,including the papers listed in bibliographies,were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration's RevMan 4.5 software package.A total of nine RCTs were included in the study.The analyses of the reports showed that,12 months after surgery,there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P＜0.00001).There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92,P＜0.00001).Difference in the success rate was also found between the two surgeries (Z=3.82,P=0.0001).It is concluded that,compared with the non-penetrating trabeculectomy,the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

Two Cases of Uveal Effusion Syndrome

PURPOSE: To report a case of uveal effusion syndrome associated with hypotony and a case of uveal effusion syndrome in nanophthalmos. METHODS: The first case was a 25-year-old man who presented with decreased visual acuity in the left eye and hypotony. Fundus examination revealed choroidal effusion and retinal detachment with a thickened eyeball. Partial thickness sclerotomy and sclerectomy were performed. The second case was a 13-year-old boy who had uveal effusion syndrome with a nanophthalmic eye. RESULTS: In the patient with hypotony, intraocular pressure was well maintained following partial thickness sclerotomy and sclerectomy, and choroidal effusion and retinal detachment were reduced. The visual acuity of the nanophthalmic patient was well maintained during a 3-year follow-up period without treatment. CONCLUSIONS: appropriate treatment modalities should be considered depending on the ophthalmic condition of the individual patient.

Comparison of surgical outcomes between small collagen and chromic catgut implants in deep sclerectomy

In deep sclerectomy, collagen implant has been used to maintain space under the scleral flap. However, the effect of other implants has not been studied. In this retrospective study, we compared surgical outcomes between small collagen and chromic catgut used as implants in deep sclerectomy. Deep sclerectomy was performed on 23 patients (25 eyes) who either had an open angle and a high intraocular pressure (IOP) (> 22 mmHg) in spite of receiving the maximal tolerable medical treatment, or who were intolerant to medications. Our study consisted of 14 patients (15 eyes) in the small collagen group and 8 (9 eyes) in the chromic catgut group. The mean follow-up period was 8.6 +/- 3.3 months in the small collagen group and 4.4 +/- 1.2 months in the chromic catgut group. The mean preoperative IOP was not significantly different between the two groups. The complete success rate of the small collagen group was significantly better than that of the chromic catgut group at the final follow-up when data were analyzed using the Kaplan-Meier survival curve (87% versus 30%; P = .01). As for the qualified success rate, the small collagen group showed significantly better results at the final follow-up (93% versus 80%; P = .046). The mean number of postoperative medications was significantly lower in the small collagen group (0.26 versus 1.10; P < .05). These results confirmed that the use of small collagen implant in deep sclerectomy produced a higher success rate and a lowered need for postoperative medication compared to the use of chromic catgut implant. Because equal sized implants were used, the difference in biochemical properties, particularly the severity of inflammation caused by the implant, is presumed to be the cause of the different surgical outcomes.

Five Cases of Laser Goniopuncture after Deep Sclerectomy with Collagen implant

PURPOSE: To investigate the intraocular pressure-lowering efficacy of laser goniopuncture in 5 cases after hypertrophy of the trabecular-Descemet membrane resulting from deep sclerectomy with collagen implant (DSCI). METHODS: Among the twenty-one patients (26eyes) who received DSCI, laser goniopuncture was performed in 5 patients (19%) by Nd:YAG laser at 5-10 mJ, 3 burst mode, and 2-10 times. RESULTS: Of the 5 cases who received Nd:YAG laser goniopuncture, 2 cases showed a decrease in intraocular pressure after 1 session of treatment while 3 cases resulted in increase of intraocular pressure due to anterior synechiae of the iris. The anterior synechiae were resolved by Argon and Nd:YAG laser in 1 case, peripheral iridectomy and iridoplasty in 1 case but in the third case, patient refused to receive recommended further laser treatment such as peripheral iridectomy and iridoplasty. CONCLUSIONS: In cases of increased intraocular pressure caused by hypertrophy of the trabecular-Descemet membrane after DSCI, laser goniopuncture is an effective method of treatment. However, iris prolapse and anterior synechiae may occur during the follow-up period which can be resolved by peripheral iridectomy and synechiolysis.