Suture guided gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification in the treatment of primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the clinical efficacy of suture-guided gonioscopy-assisted transluminal trabeculotomy(GATT)combined with phacoemulsification in the treatment of primary open angle glaucoma(POAG).METHODS: A total of 84 patients(84 eyes)with POAG and cataract who underwent surgery in our hospital from January 2021 to July 2022 were selected and randomly divided into two groups. There were 43 cases(43 eyes)in the combined group who underwent suture-guided GATT combined with phacoemulsification, and 41 cases(41 eyes)in the simple group who underwent suture-guided GATT. The two groups were followed up for 3mo to compare the surgical success rate, intraocular pressure, topical intraocular pressure-lowering drugs, visual acuity and postoperative complications.RESULTS: There was no significant difference in overall success rate between the combination and simple groups at 3 mo after surgery(88% vs. 85%, P>0.05). The intraocular pressure levels and topical intraocular pressure-lowering drugs at 1wk, 1 and 3mo after surgery in the two groups were significantly lower than those before surgery(all P<0.05), but there was no significant difference between the two groups(all P>0.05). The visual acuity at 1wk, 1 and 3mo after surgery of patients in the combined group was significantly better than that in the simple group(P<0.01). During the follow-up period, the incidence of anterior chamber hemorrhage and transient hypertension in the combined group was significantly lower than that in the simple group(P<0.05).CONCLUSION: Both suture-guided GATT combined with cataract phacoemulsification and suture-guided GATT are effective treatment for POAG, however, suture-guided GATT combined with phacoemulsification has a lower incidence of anterior chamber hemorrhage and transient ocular hypertension.

Outcomes of ab-interno irrigating goniectomy with trabectome in primary and secondary glaucoma from a single center in India

Purpose: This study was done to report intermediate?term outcomes of irrigating goniectomy with trabectome (trabectome) surgery among different types of glaucoma eyes from a single center in India using a cross?sectional, longitudinal, observational study design. Methods: Fifty?three patients (58 eyes) with glaucoma who underwent irrigating goniectomy with trabectome between January 2019 and February 2020 were included. Pre?operative data included age, gender, eye laterality, specific diagnosis, number of anti?glaucoma medications (AGMs), prior glaucoma surgeries, visual acuity, and intraocular pressure (IOP) on medical treatment. Post?operative data included IOP changes during the follow?up till 1?year, number of AGMs, any complications, or additional surgical intervention required. Success was defined as IOP ? 21 mmHg and ? 20% reduction of IOP from pre?operative IOP with no additional glaucoma surgery. Results: The cohort included 58 eyes (male 53.4% and female 46.6%) ranging from 0.6 to 81 years of age. The average baseline IOP was 23.4 ± 10.2 mmHg and reduced significantly with surgery to 14.1 ± 5.3 mmHg at 1?year follow?up. The AGMs reduced from 2.4 ± 1.4 pre?surgery to 1.6 ± 1.4 at 1?year follow?up. Four eyes required additional glaucoma surgeries for IOP control. The success rate of trabectome with phacoemulsification (88%) was discernibly higher than with trabectome alone (67%). Intra?operatively, significant blood reflux was noticed in 27 eyes, of which only one required tamponading with a viscoelastic agent. Conclusion: This study concludes that irrigating goniectomy with trabectome has good efficacy and safety in both pediatric and adult cases of glaucoma in terms of IOP control, reduction in AGMs, and low incidence of complications in the Indian population.

EX-PRESS drainage device implantation combined with phacoemulsification for chronic primary angle-closure glaucoma complicated with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Facotrabeculectomía por dos vías como tratamiento combinado de pacientes con glaucoma y catarata / Two-site phacotrabeculectomy as combined therapy for patients with glaucoma and cataract

RESUMEN Objetivo: Determinar los resultados de la facotrabeculectomía por dos vías como tratamiento combinado de pacientes cubanos con glaucoma y catarata. Métodos: Se realizó un estudio observacional descriptivo longitudinal prospectivo en pacientes adultos cubanos tratados con facotrabeculectomía en el Servicio de Glaucoma del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre junio del año 2016 y abril de 2017. El universo estuvo constituido por todos los pacientes operados con facotrabeculectomía por dos vías. La muestra la integraron pacientes operados por un mismo cirujano, quienes estuvieron de acuerdo con participar en la investigación. Se excluyeron aquellos con cirugía intraocular previa. Salieron del estudio los que no pudieron mantener el seguimiento en la institución. Se estudiaron las variables edad, sexo, color de la piel, agudeza visual mejor corregida, presión intraocular, número de medicamentos hipotensores oculares y complicaciones presentadas. El seguimiento fue por dos años con consultas al día siguiente, a los siete y a los treinta días; a los tres y a los seis meses; al año y a los dos años. Resultados: Se observaron 31 pacientes. La edad promedio fue de 70 años, con predominio del sexo femenino y el color de la piel no blanco; la agudeza visual mejor corregida preoperatoria media 0,58 y la posoperatoria 0,73. La presión intraocular media preoperatoria 22,04 mmHg y a los dos años 16,37 mmHg. La media de los medicamentos hipotensores preoperatorios fue 3,0 y 0,3 a los dos años. Las complicaciones más frecuentes resultaron la ruptura transquirúrgica de la cápsula posterior y la opacidad posquirúrgica de la cápsula posterior. Conclusiones: Con la facotrabeculectomía por dos vías disminuye la presión intraocular; mejora la agudeza visual mejor corregida y se reduce el número de fármacos hipotensores oculares al menos durante dos años. Las complicaciones asociadas a la técnica son mínimas(AU)

ABSTRACT Objective: Determine the results of two-site phacotrabeculectomy as combined therapy for Cuban patients with glaucoma and cataract. Methods: An observational prospective longitudinal descriptive study was conducted of Cuban patients undergoing phacotrabeculectomy at the Glaucoma Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from June 2016 to April 2017. The study universe was all the patients undergoing two-site phacotrabeculectomy. The sample was patients operated on by the same surgeon who consented to participate in the research. Patients with a history of intraocular surgery were excluded, as well as those who could not be followed up at the institution. The variables considered were age, sex, skin color, best corrected visual acuity, intraocular pressure, number of ocular hypotensive drugs, and complications developed. Follow-up extended for two years with visits on the next day, at seven and thirty days, at three and six months, and at one and two years. Results: Thirty-one patients were observed. Mean age was 70 years, with a predominance of the female sex and non-white skin color. Best corrected visual acuity was 0.58 preoperative and 0.73 postoperative. Mean preoperative intraocular pressure was 22.04 mmHg, whereas at two years it was 16.37 mmHg. Hypotensive drugs averaged 3.0 preoperative and 0.3 at two years. The most common complications were intraoperative posterior capsule rupture and postsurgical posterior capsule opacity. Conclusions: Two-site phacotrabeculectomy reduces intraocular pressure, improves best corrected visual acuity and lowers the number of ocular hypotensive drugs for at least two years. The complications associated to the technique are minimum(AU)

Surgically induced astigmatism and refractive outcomes following phacotrabeculectomy

Purpose: To objectively evaluate surgically induced astigmatism (SIA) after phacotrabeculectomy using keratometry and topography and to compare the magnitude of SIA and the refractive outcomes of single-site and twin-site phacotrabeculectomies. Methods: Forty prospective subjects were enrolled in the study and were randomized into single-site and twin-site cohorts. SIA was objectively assessed using keratometry and Orbscan before and at three months after surgery. For both cohorts, the changes in SIA were assessed using power vector analysis compared at the third month after surgery. Results: Each cohort consisted of 20 eyes. The preoperative parameters and postoperative IOP were comparable and similar, respectively, in both the cohorts (P = 0.1). Majority of the patients in both the cohorts had preoperative against-the-rule (ATR) astigmatism. The median change in SIA at the three-month postoperative visit was similar in both the cohorts, with a small increase in ATR astigmatism. Although the SIA change measured by keratometry in the J0 component was similar in both the groups (P = 0.54), that of J45 was significantly different (P = 0.01). However, the median change in SIA was similar in both the groups for both the J0 (P = 0.52) and J45 components (P = 0.94) when measured by Orbscan. The SIA in both the groups measured with keratometry (P = 0.62) and topography (P = 0.52) were clinically and statistically similar. In both the groups, the refraction was similar at 1 month and 3 months. Conclusion: The SIA as measured with keratometry and topography was similar in the single-site and twin-site phacotrabeculectomy cohorts at the end of 3-months. The postoperative refraction was stabilized in 1-month in both the groups.

Changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the changes of anterior chamber structure in patients after combined surgery of glaucoma and cataract with viscoelastics injection under the sclera valve by OCT. <p>METHODS: The cataract with acute glaucoma patients who underwent combined surgery of glaucoma and cataract from 2016 to 2018 were enrolled. The patients were divided into the viscoelastics group and the control group. The anterior chamber depth(ACD), the angle opening distance(AOD₅₀₀)and the trabecular iris angle(TIA)were examined to compare the changes of the anterior chamber structure between the two groups. <p>RESULTS: At 1 and 3d after surgery, the ACD(3.82±0.51,3.71±0.63, 3.78±0.33mm), the angle opening distance(AOD₅₀₀: 0.25±0.04, 0.24±0.04, 0.25±0.05mm)and the TIA(25.13°±8.06°, 26.18°±8.06°, 29.25°±6.22°)were statistically different between two groups. There was no significant difference on the ACD, the AOD₅₀₀ and the TIA of the two groups 7d after surgery(<i>P</i><0.05).<p>CONCLUSION: Viscoelastics injection under the sclera valve can deepen the anterior chamber effectively after combined surgery of glaucoma and cataract. It avoids the occurrence of shallow anterior chamber in the early postoperation and maintains the opening of anterior chamber.

Retrospective study on outcomes of terminal chop technique of nuclear fragmentation in phacoemulsification and combined surgery: An observational study

Purpose: Terminal chop, a new technique of nuclear segmentation, has been recently described in literature. The technique is considered to be a safe and effective option. Methods: We did a retrospective study to evaluate the outcome of terminal chop. Patients operated for terminal chop (phacoemulsification with or without trabeculectomy) from October 2016 to July 2018 were included in the study. Results: In all, 933 patients were included in the study. The grade of nuclear sclerosis ranged from 2 to 5. All the patients had a significant visual improvement at 1 month postop. Around 3.4% had pseudoexfoliation and 8.89% of the eyes underwent combined surgery. Cumulative dissipated energy showed a proportionate relation with the grade of nucleus. Intraoperative complication rate was 0.08%. Postoperative complication rate was 3.50%. Conclusion: Terminal chop proved to be a safe, reproducible, and effective technique of nuclear segmentation in different grades of cataract.

Clinical application of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi / 中华泌尿外科杂志

Objective@#To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.@*Methods@#The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed. A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019. According to different surgical methods, 56 cases were divided into the modified prone split-leg position group (observation group) and the traditional pre-lithotomy position followed by prone position group (control group). In observation group, the average age of 11 males and 17 females was (54.1±10.2)years. The mean body mass index was (23.8±2.9) kg/m2. The location of stones were left in 14 cases and right in 14 cases. The average kidney involvement calyces number was 2.4±0.7.The mean kidney stones maximum cross-sectional area was (870.9±157.7)m2. According to the Guy′s classification system, there were 3 cases of grade Ⅰ, 11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group. The kidney stones S. T.O.N.E scores was 8.7±1.3 and ureteral calculi S. T.O.N.E scores were 13.1± 1.6.In the control group, the average age was (57.0±8.3)years old. The mean body mass index was (24.4±2.9)kg/m2. The average kidney involvement calyces number was 2.1±0.7 and the mean kidney stones maximum cross-sectional area was (808.8±189.6)mm2. To the kidney stones Guy′s classification, there were 5 cases of grade Ⅰ, 15 case of grade Ⅱ, 7 case of grade Ⅲ and 1case of grade Ⅳ in the control group. The kidney stones S. T.O.N.E scores were 8.5±0.6 and the ureteral calculi S. T.O.N.E scores were 12.4±1.7. The operation time, calculus clearance rate, postoperative hospitalization days, reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.@*Results@#The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8±27.3)min vs.(94.4±22.8)min](P<0.05). In the observation group, 23 patients had complete removal of renal and ureteral calculi, and 3 patients need reoperation. While in the control group, 16 patients had complete removal and 10 patients had reoperation. There were significant differences between the two groups (P<0.05). According to the complication severity of Clavien-Dindo, there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group, 4 cases of grade Ⅰ, 2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group. There were no serious complications of grade Ⅳ and Ⅴ in both groups (P>0.05). In observation group, one case accepted the DSA embolization therapy due to the severe bleeding. One case accepted the puncture drainage due to the perinephric effusion. There was no difference in average postoperative hospital stay between the two groups [(6.5±1.2)d vs.(7.0±2.1)d, P>0.05].@*Conclusions@#It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position. One position can solve many problems simultaneously, which can significantly reduce the operation time, increase the stone free rates, reduce the reoperation rate and improve the effectiveness of the operation.

Clinical application of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi / 中华泌尿外科杂志

Objective To investigate the feasibility and safety of endoscopic combined simultaneous surgery in the modified prone split-leg position for complex renal calculi with ipsilateral ureteral calculi.Methods The clinical data of 56 cases patients with simultaneous renal and ureteral stones admitted to the Second Affiliated Hospital of Anhui Medical University from January 2016 to March 2019 were retrospectively analyzed.A retrospective analysis was performed on 56 cases of patients with simultaneous renal and ureteral stones who received surgical treatment between January 2016 and March 2019.According to different surgical methods,56 cases were divided into the modified prone split-leg position group (observation group)and the traditional pre-lithotomy position followed by prone position group (control group).In observation group,the average age of 11 males and 17 females was (54.1 ± 10.2) years.The mean body mass index was (23.8 ± 2.9) kg/m2.The location of stones were left in 14 cases and right in 14 cases.The average kidney involvement calyces number was 2.4 ± 0.7.The mean kidney stones maximum cross-sectional area was (870.9 ± 157.7) m2.According to the Guy's classification system,there were 3 cases of grade Ⅰ,11 case of grade Ⅱ and 14 case of grade Ⅲ in the observation group.The kidney stones S.T.O.N.E scores was 8.7 ± 1.3 and ureteral calculi S.T.O.N.E scores were 13.1 ± 1.6.In the control group,the average age was (57.0 ± 8.3) years old.The mean body mass index was (24.4 ± 2.9) kg/m2.The average kidney involvement calyces number was 2.1 ± 0.7 and the mean kidney stones maximum cross-sectional area was (808.8 ± 189.6)mm2.To the kidney stones Guy's classification,there were 5 cases of grade Ⅰ,15 case of grade Ⅱ,7 case of grade Ⅲ and 1 case of grade Ⅳ in the control group.The kidney stones S.T.O.N.E scores were 8.5 ±0.6 and the ureteral calculi S.T.O.N.E scores were 12.4 ± 1.7.The operation time,calculus clearance rate,postoperative hospitalization days,reoperation rate and severity of complications of Clavien-Dindo were statistically compared between the two groups.Results The study found that the average operation time in the observation group was significantly shorter than that in the control group [(77.8 ± 27.3) min vs.(94.4 ± 22.8) min] (P ＜ 0.05).In the observation group,23 patients had complete removal of renal and ureteral calculi,and 3 patients need reoperation.While in the control group,16 patients had complete removal and 10 patients had reoperation.There were significant differences between the two groups (P ＜ 0.05).According to the complication severity of Clavien-Dindo,there were 4 cases of grade Ⅰ and 1 case of grade Ⅱ in the observation group,4 cases of grade Ⅰ,2 case of grade Ⅱ and 2 case of grade Ⅲ in the control group.There were no serious complications of grade Ⅳ and Ⅴ in both groups (P ＞0.05).In observation group,one case accepted the DSA embolization therapy due to the severe bleeding.One case accepted the puncture drainage due to the perinephric effusion.There was no difference in average postoperative hospital stay between the two groups [(6.5 ± 1.2) d vs.(7.0 ± 2.1) d,P ＞ 0.05].Conclusions It is safe and feasible to treat complex renal calculi with ipsilateral ureteral calculi by endoscopic combined simultaneous surgery in the modified prone split-leg position.One position can solve many problems simultaneously,which can significantly reduce the operation time,increase the stone free rates,reduce the reoperation rate and improve the effectiveness of the operation.

Angle separation or trabeculectomy combined with phacoemulsification in the treatment of primary angle closure glaucoma with age-related cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the efficacy and safety of goniosynechialysis or trabeculectomy combined with phacoemulsification(Phaco)in the treatment of primary angle-closure glaucoma(PACG)and coexisting cataract.<p>METHODS: A retrospective study. A total of 108 eyes of 96 PACG patients with age-related cataract admitted to our hospital from March 2013 to February 2018 were collected. Goniosynechialysis combined with Phaco(group A)was performed in 50 cases(54 eyes), and trabeculectomy combined with Phaco(group B)in 46 cases(54 eyes). The best corrected visual acuity, intraocular pressure, central anterior chamber depth, corneal endothelial cell count, failure rate, recurrence rate, operation time and average hospitalization days were compared between the two groups.<p>RESULTS: After at least 12mo of follow-up(till February 2019), the best corrected visual acuity of the two groups was significantly improved, and the intraocular pressure was significantly lower than preoperation(<i>P</i><0.01). Intraocular pressure in group B was significantly lower than that in group A postoperatively(<i>P</i>=0.004), while the best corrected visual acuity in group B was lower than that in group A(<i>P</i>=0.012). The central anterior chamber depth of the two groups was significantly deeper than pre-operation(<i>P</i><0.01), but there was no significant difference between the two groups(<i>P</i>=0.231). At the last follow-up, there was no significant difference in the percentage of hexagonal cells(<i>P</i>>0.05). The operation time of group A was shorter(<i>P</i>=0.022), and the average hospitalization days were significantly lower than those of group B(<i>P</i><0.001). There was no significant difference in the failure rate(<i>P</i>=0.243)and recurrence rate(<i>P</i>=0.113)between the two groups.<p>CONCLUSION: Goniosynechialysis combined with Phaco in the treatment of PACG and coexisting cataract has similar efficacy and safety to trabeculectomy combined with Phaco. The former may achieve better visual acuity, shorter operation time and shorter hospitalization time, while the latter has lower failure rate and recurrence rate, which is more suitable for patients with chronic PACG.

Study of transforming growth factor-a as a diagnostic biomarker for systemic-to-pulmonary shunts induced pulmonary arterial hypertension / 中国药理学通报

Aim To determine the feasibility of transforming growth factor-a ( TGF-a ) as a diagnostic bio-marker for systemic-to-pulmonary shunts induced pulmonary arterial hypertension ( PAH ). Methods Systemic-to-pulmonary shunts induced PAH was built by combined surgery ( right pulmonary artery was ligated and a cervical shunt was established one week later). A total of 49 patients with congenital heart diseases were recruited, including 24 congenital heart disease patients without PAH(CHD) and 25 congenital heart disease patients with pulmonary arterial hypertension (CIID-PAH). Moreover, 20 healthy volunteers matched by age and sex were also included. Enzyme linked immunosorbent assay (EL1SA) was used to test TGF-a concentrations in plasma of systemic-to-pulmonary shunts induced PAH rats and CHD-PAH patients. Results ELISA results showed that TGF-a levels in plasma of systemic-to-pulmonary shunts induced PAH rats were significantly higher than those of sham operated group. Spearman correlation analysis showed that plasma TGF-a concentrations were positively associated with right ventricular systolic pressure, pulmonary arterial systolic pressure, mean pulmonary arterial pressure and right ventricular hypertrophy index. The plasma concentration of TGF-a in CHD-PAH patients was much higher than that of CHD patients and healthy vol- unteers ( CON); however, there was no significant difference between CHD group and CON group; Using 314 ng • L"1 as cutoff value of TGF-a for the diagnosis of CHD-PAH, the sensitivity, specificity and area under the cure was 0. 760, 0. 750 and 0. 895, respectively. Conclusions Plasma concentration of TGF-a increases with the progression of systemic-to-pulmonary shunt induced PAH; the level of TGF-a in plasma may be a potential biomarker for the diagnosis of systemic- to-pulmonary shunt induced PAII.

Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.

Changes in refractive status in high-myopic patients with rhegmatogenous retinal detachment after vitrectomy combined with cataract surgery / 眼科新进展

Objective To evaluate the changes in refractive state in high-myopic patients with rhegmatogenous retinal detachment after vitrectomy combined with cataract surgery.Methods Clinical data of 30 patients of rhegmatogenous retinal detachment in the Affiliated Hospital of Qingdao University from January 2016 to March 2017 was retrospectively analyzed,and these patients were randomly dividedly into two groups:high myopia (15 patients of 15 eyes) and non high myopia group (15 patients of 15 eyes),in which patients firstly underwent vitrectomy combined with phacoemulsification and silicone oil tamponade,followed by intraocular lens (IOL) implantation after the removal of silicone oil 3 months later.The two groups were continuously followedup for 6 months after IOL implantation.Before vitrectomy,the axial length,corneal curvature were measured for calculating the predictive spherical equivalent (SE).Then axial length and corneal curvature at 1 month,3,6 months after IOL implantation were measured for calculating the actual SE.The best corrected visual acuity (BCVA) was recorded before and after operation and the LogMAR was calculated in each groups.The SE,axial length,corneal curvature before vitrectomy and 1 month,3,6 months after IOL implantation were respectively compared in each group.The relationship between the refractive prediction errors and the preoperative axial length in the high myopia group was evaluated.Results The LogMAR visual acuity was improved in both groups,and the difference between before and after treatment was statistically significant (both P ＜0.05).The SE at 1 month,3,6 months after surgery showed significantly myopic shift in the high myopic eyes,and the myopic shift gradually increased with time,with statistically significant at each time point (all P ＜ 0.05),but there was no significant difference in myopic shift between before and after surgery as well as among each time point after surgery in the non-high myopic eyes (P ＞ 0.05).Axial length and corneal curvature at 1 month,3,6 month after surgery in the high myopia group were significantly increased (all P ＜ 0.05),whereas those in the non high myopia group did not change significantly (all P ＞ 0.05).By simple linear regression analysis,the refractive prediction errors had a negative correlation with the preoperative axial length in the high myopia group (R2 =0.580,P =0.001).Conclusion The LogMAR visual acuity after vitrectomy combined with cataract surgery is improved in patients with rhegmatogenous retinal detachment.Postoperative axial length growth and corneal curvature increase are presented in patients with high myopia,and the longer the preoperative axial length is,the more myopic shift the eye shows.

Facoemulsificación en pacientes con glaucoma / Phacoemulsification in patients with glaucoma

La extracción de la catarata produce una significante y sustancial reducción de la presión intraocular en individuos con glaucoma de ángulo abierto, hipertensión ocular y glaucoma por cierre angular. Remover la catarata mejora la interpretación de las pruebas perimétricas. Es recomendable restablecer las imágenes de base del nervio óptico, así como el campo visual después de la extracción de la catarata. La secuencia de cirugía de catarata y cirugía de glaucoma disminuye la probabilidad de complicaciones y aumenta el éxito quirúrgico. Tiene múltiples beneficios realizar la cirugía de catarata antes que la cirugía de glaucoma, mientras que la cirugía de catarata después de la trabeculectomía incrementa el riesgo de fallo de la filtración. Como la cirugía de glaucoma mínimamente invasiva continúa mejorando en términos de eficacia, esta juega un rol importante en la cirugía combinada de glaucoma y catarata en pacientes con glaucoma en estadios inicial y moderado. La combinación de cirugía de catarata con implante valvular o trabeculectomía por uno o dos sitios, también ofrece ventajas en pacientes con glaucoma avanzado. La presente revisión tiene como objetivo resumir el papel de la cirugía de catarata en el tratamiento del glaucoma teniendo en cuenta el efecto en la presión intraocular y las ventajas que ofrece en aquellos pacientes con ambas condiciones(AU)

Cataract extraction produces a significant, substantial reduction in intraocular pressure in people with open-angle glaucoma, ocular hypertension and angle closure glaucoma. Cataract removal improves the interpretation of perimetric tests. After cataract extraction it is advisable to re-establish the base optic nerve images and the visual field. The cataract surgery - glaucoma surgery sequence reduces the chances of complications and increases surgical success. It is very beneficial to perform cataract surgery before glaucoma surgery, whereas cataract surgery following trabeculectomy increases the risk of filtration failure. Minimally invasive glaucoma surgery continues to improve in terms of efficacy, thus playing an important role in combined glaucoma-cataract surgery in patients with early-stage, moderate glaucoma. Combined cataract surgery and valve implant or one- or two-site trabeculectomy is also advantageous in patients with advanced glaucoma. The present review is aimed at summarizing the role of cataract surgery in the treatment of glaucoma in terms of its effect on intraocular pressure and its advantages for patients with both conditions. Key words: phacoemulsification, cataract, glaucoma, trabeculectomy, combined surgery, MIGS(AU)

Resultados a corto plazo de la facotrabeculectomía por una vía en el Instituto Cubano de Oftalmología Ramón Pando Ferrer / Short-term outcomes of one-site phacotrabeculectomy at Ramón Pando Ferrer Cuban Institute of Ophthalmology

Objetivos: describir los resultados a corto plazo de la facotrabeculectomía por una vía. Métodos: se realizó un estudio descriptivo de series de casos en 19 ojos de 18 pacientes tratados con facotrabeculectomía por una vía y por un mismo cirujano del Departamento de Glaucoma del Instituto Cubano de Oftalmología Ramón Pando Ferrer, entre los meses de febrero y octubre del año 2016. Se controlaron las siguientes variables: edad, sexo, color de piel (blanco o negro), número de fármacos hipotensores, agudeza visual mejor corregida, presión intraocular, estadio de daño glaucomatoso, tipo de glaucoma y complicaciones posquirúrgicas con seguimiento durante tres meses. Resultados: la edad promedio de la muestra fue 69 ± 12 años, igual número de masculinos y femeninos. Predominó el glaucoma primario de ángulo abierto y el color de piel negra. En el preoperatorio la presión intraocular media fue 22,5 ± 5,9 mmHg; la agudeza visual mejor corregida 51,77 ± 31,89 VAR y el número de fármacos hipotensores 3,2 ± 0,5. A los tres meses posoperatorios la presión intraocular media fue 15,6 ± 4,3 mmHg (p< 0,05); la agudeza visual mejor corregida 71,15 ± 33,05 VAR y el número de fármacos hipotensores 0,7 ± 1 (p< 0,05). Las complicaciones posquirúrgicas fueron atalamia, desprendimiento coroideo y quiste de Tenon. Conclusiones: la facotrabeculectomía por una vía constituye una alternativa quirúrgica que ofrece a pacientes con glaucoma y catarata el control de la presión intraocular, la recuperación visual, la reducción del número de fármacos hipotensores oculares y mínimas complicaciones(AU)

Objectives: describe the short-term outcomes of one-site phacotrabeculectomy. Methods: a descriptive case-series study was conducted of 19 eyes of 18 patients treated with one-site phacotrabeculectomy by the same surgeon at the Glaucoma Department of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February to October 2016. The variables evaluated were age, sex, skin color (black or white), number of hypotensive drugs, best corrected visual acuity, intraocular pressure, glaucomatous damage, glaucoma type and postsurgical complications during a three-month follow-up. Results: mean age of the sample was 69 ± 12 years, with an equal number of males and females. There was a predominance of primary open-angle glaucoma and black skin color. In the preoperative period mean intraocular pressure was 22.5 ± 5.9 mmHg, best corrected visual acuity was 51.77 ± 31.89 VAR, and the number of hypotensive drugs was 3.2 ± 0.5. Three months after surgery mean intraocular pressure was 15.6 ± 4.3 mmHg (p< 0.05), best corrected visual acuity was 71.15 ± 33.05 VAR and the number of hypotensive drugs was 0.7 ± 1 (p< 0.05). The postoperative complications were athalamia, choroidal detachment and Tenon cyst. Conclusions: one-site phacotrabeculectomy is a surgical alternative offering patients with glaucoma and cataract intraocular pressure control, visual recovery, a reduction in the number of hypotensive drugs, and minimal complications(AU)

Surgical Outcomes of a Combined Surgical Approach for Apical Prolapse Repair / Resultados cirúrgicos de uma abordagem cirúrgica combinada para a correção do prolapso apical

Abstract Introduction We aimed to evaluate the safety, efficacy and surgical outcomes of combined laparoscopic/vaginal prolapse repair by two surgeons. Material and Methods A retrospective chart review of all patients (n =135) who underwent apical prolapse repair from February 2009 to December 2012 performed in a collaborative manner by a Minimally Invasive Gynecologic Surgeon and a Urogynecologist. Demographic data (age, body mass index [BMI], race, gravidity, parity) and surgical information (estimated blood loss, operative time, intraoperative complications, readmission and reoperation rates, presence of postoperative infection) were collected. Results The majority of patients were postmenopausal (58.91%), multiparous (mean parity =2.49) and overweight (mean BMI =27.71). Nearly 20% had previous prolapse surgery. The most common surgical procedure was laparoscopic supracervical hysterectomy (LSH) with sacrocervicopexy (59.26%), and the most common vaginal repair was of the posterior compartment (78.68%). The median operative time was 149 minutes (82-302), and the estimated blood loss was 100 mL (10-530). Five intraoperative complications, five readmissions and four reoperations were noted. Performance of a concomitant hysterectomy did not affect surgical or anatomical outcomes. Conclusion Combination laparoscopic/vaginal prolapse repair by two separate surgeons seems to be an efficient option for operative management.

Resumo Introdução Objetivamos avaliar a segurança, eficácia e desfechos cirúrgicos da via laparoscópica e vaginal combinadas para a correção do prolapso feitos por dois cirurgiões. Métodos Um estudo retrospectivo com análise de prontuário foi realizado em todos os pacientes (n =135) que foram submetidos a correção de prolapso apical de fevereiro de 2009 a dezembro de 2012 de maneira concomitante por um laparoscopista e um uroginecologista. Dados demográficos (idade, índice de massa corporal [IMC], raça, número de gestações e partos) e cirúrgicos (perda sanguínea estimada, tempo operatório, complicações intraoperatórias, taxas de readmissão e reoperação, e presença de infecção pós-operatória) foram analisados. Resultados Operfil da paciente operada era pertencente à pós-menopausa (58,91%), ser multípara (paridade média =2,49) e com sobrepeso (IMC médio =27,71). Aproximadamente 20% havia feito cirurgia prévia para prolapso. O procedimento cirúrgico mais realizado foi a histerectomia supracervical laparoscópica (HSL) com sacrocervicopexia (59,6%); o reparo vaginal mais encontrado foi o para defeito de compartimento posterior (78,68%). O tempo operatório mediano foi de 149 minutos (82-302), e a perda sanguínea estimada foi de 100 ml (10-530). Cinco complicações pós-operatórias, cinco readmissões e quatro reoperações foram encontradas. A realização de uma histerectomia em concomitância aos demais procedimentos não afetou os desfechos cirúrgicos ou anatômicos. Conclusão O reparo combinado do prolapso pela via laparoscópica e vaginal por dois cirurgiões em concomitância aparenta ser uma opção eficiente para o manejo operatório.

Clinical observation of phacoemulsification and intraocular lens implantation combined with trabeculectomy in cataract and glaucoma patients / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate the clinical effects of dual-incision phacoemulsification and intraocular lens implantation combined with trabeculectomy in cataract and glaucoma patients. METHODS: To observe the visual acuity, intraocular pressure and complications for 3-12mo after surgery as a retrospective study of 65 patients ( 70 eyes ) with cataract and glaucoma. RESULTS: The visual acuity of 2 eyes was lower than 0.1, 6 eyes were ranged from 0. 1 to 0. 3, 60 eyes were from 0. 4 to 0. 8, 2 eyes were over 1. 0. The postoperative intraocular pressure of 26 eyes were effective controlled. The postoperative shallow anterior chamber occurred in 1 eye. CONCLUSION: It is an ideal treatment to take dual-incision phacoemulsification and intraocular lens implantation combined with trabeculectomy in cataract and glaucoma patients and it shows better effects than normal operation method.

Long-Term Outcome of Ahmed Valve Implantation Combined with 23-Gauge Vitrectomy in Eyes with Neovascular Glaucoma

PURPOSE: To investigate the surgical outcome of Ahmed glaucoma valve implantation (AVI) combined with 23-gauge vitrectomy in eyes with medically uncontrolled neovascular glaucoma (NVG). METHODS: Thirty six eyes of 35 NVG patients who underwent AVI combined with 23-gauge vitrectomy and have been followed-up at least 6 months after surgery and were retrospectively reviewed. Surgical success was defined as the control of intraocular pressure (IOP) between 6 and 21 mm Hg, irrespective of the use of topical IOP lowering medications. Surgical failure was defined as the failure of IOP control or visual acuity aggravated to no light perception after the surgery. Overall success rate, median survival time, and clinical factors associated with survival time were investigated. RESULTS: The overall success rate was 63.2% after a mean of 34.0 ± 31.7 months postoperative follow-up. The success rate was 83.3% at postoperative 6 months, 72.7% at postoperative 12 months and 63.2% at postoperative 3 years. The underlying retinal diseases were proliferative diabetic retinopathy (PDR; n = 20, 55.5%), central retinal vein occlusion (CRVO; n = 12, 33.3%), ocular ischemic syndrome (n = 2, 5.6%), and other retinal vascular diseases (n = 2, 5.6%). The survival times were significantly shorter in eyes with CRVO (20.2 ± 30.5 months) compared to PDR (33.1 ± 30.8 months), and in phakic eyes (33.1 ± 30.8 months) compared to pseudophakic eyes (37.7 ± 35.4 months) (p < 0.05). In the multivariate analysis, preoperative phakic eyes were significantly associated with a shorter survival time (hazard ratio = 5.626, p = 0.030). CONCLUSIONS: Combined surgery of Ahmed glaucoma valve implantation and 23-gauge vitrectomy showed favorable outcome in the treatment of medically uncontrolled NVG. Preoperative lens status may affect the long-term success rate in such patients.

Effectiveness of Combined Surgery Simultaneously Correcting 3 Main Causes of Involutional Entropion

PURPOSE: To evaluate the long-term effectiveness of inferior retractor tightening combined with lateral tarsal strip surgery and anterior lamellar resection for simultaneously correcting the 3 main causes of involutional entropion. METHODS: In this retrospective study we reviewed 80 patients diagnosed with involutional entropion between April 2004 and February 2014 at the Korea University Guro Hospital and Cheonan Chungmu Hospital. The patients were evaluated for the 3 major causes of involutional entropion and were confirmed to have all components. Lateral canthal tendon laxity test and anterior lamellar redundancy test were performed to grade the involutional entropion patients. The patients received inferior retractor tightening, lateral tarsal strip operation and anterior lamellar resection procedure simultaneously. RESULTS: Eighty involutional entropion patients were included in the present study. The patients consisted of 35 males and 45 females with an average age of 71.1 ± 9.3 years. In the lateral canthal tendon laxity test, 52 (61.2%) eyes were grade II, 33 (38.8%) eyes were grade III. In the anterior lamellar redundancy test, 17 (20%) eyes were grade I, 57 (67.1%) eyes were grade II and; 11 (12.9%) eyes were grade III. Among the 80 patients, 85 eyelids received combined surgery, 84 had successful outcomes and 1 case recurred at 5 months following the primary surgery with an average follow up of 26.5 ± 4.6 months. Lateral canthal deformity was observed in 2 eyelids which were corrected successfully. CONCLUSIONS: Simultaneous correction of the 3 main causes of involutional entropion through inferior retractor tightening, lateral tarsal strip surgery and anterior lamellar resection procedure is effective in correcting involutional entropion and safe in avoiding overcorrection.

Comparison of outcomes between phacoemulsification-trabeculectomy and ECCE-trabeculectomy for cataract combined with glaucoma / 中华实验眼科杂志

Background Phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) with trabeculectomy are primary approachs for cataract combined with glaucoma.To compare the efficiency and safety between the two methods is important for the choice of surgeries.Objective This study was to compare the clinical outcomes between ECCE combined with trabeculectomy and Phaco combined with trabeculectomy.Methods A randomized controlled study was designed.Sixty-three eyes of 63 patients with cataract and glaucoma were included from January 2013 to February 2014 in Xinjiang Autonomous District Traditional Chinese Medicine Hospital under the informed consent.The patients were assigned to parallel two groups according to random number table.ECCE+intraocular lens (IOL) implantation with trabeculectomy was performed in 33 eyes of 33 patients in the ECCEteabelectomy group,and Phaco+IOL implantation with trabeculetomy was carried out in 30 eyes of 30 patients in the Phaco-trabeculectomy group.The patients were followed-up for six months.Visual acuity,intraocular pressure (IOP),astigmatic degree and complication after surgery were compared between the two groups.Results The visual acuity was obviously improved after surgery in both groups.The distribution of eyes in different vision acuities was significantly different after operation between the two groups (H =0.125,P =0.032).The IOP was (14.13 ±5.19) mmHg in the Phaco-trabeculectomy group and (15.18 ± 6.04) mmHg in the ECCE-trabeculectomy group,without significantly interclass difference among the two groups (F=3.762,P ＞ 0.05),however,the IOP were lower after surgery (Ftime =14.991,P ＜ 0.05).The postoperative astigmatic power was (1.02-± 0.44) D in the Phacotrabeculectomy group and (3.76 ± 1.53) D in the ECCE-trabeculectomy group,showing a significant reduce in the Phaco-trabeculectomy group (t =3.089,P =0.034).The incidence rates of postoperative complications were 6.67％ and 18.18％ in the Phaco-trabeculectomy group and ECCE-trabeculectomy group,respectively,with a significant difference between them (x2 =6.112,P＜0.05).Conclusions Compared to the ECCE+IOL implantation with trabeculectomy,Phaco + IOL implantation with trabeculectomy for cataract combined with glaucoma shows better clinical effectiveness,less complications and lower astigmatic power.