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AIM: To evaluate the application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve(AGV)implantation.METHODS: A total of 78 patients(78 eyes)with refractory glaucoma who underwent AGV implantation in the People's Hospital of Leshan from May 2020 to January 2022 were retrospectively analyzed. According to the treatment, the patients were divided into the modified AGV implantation group, with 43 patients(43 eyes)treated by modified AGV implantation, ligating the drainage tube with single-pass four-throw releasable suture, and the traditional AGV implantation group, with 35 patients(35 eyes)treated by traditional AGV implantation. Followed-up for 6mo, the intraocular pressure(IOP), success rate and complications were observed at 1d, 1 and 2wk and 1 and 6mo after operation.RESULTS: Postoperative IOP at all follow-up visits was significantly lower than that before surgery in both groups(all P<0.05). There was no significant difference in IOP between groups at all follow-up visits(all P>0.05). The incidence of shallow anterior chamber was 5% in the modified AGV implantation group and 23% in the traditional AGV implantation group at 1wk after surgery(P<0.05). At 6mo after operation, the overall success rate was 98% in modified AGV implantation group and 89% in the traditional AGV implantation group(P>0.05).CONCLUSION:During AGV implantation, ligation of drainage tube with single-pass four-throw releasable suture can effectively reduce IOP and reduce the incidence of shallow anterior chamber in early postoperative stage. Furthermore, the technique is safe and efficacious.
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Purpose: To evaluate the incidence of shallow anterior chamber in the early postoperative period following Ahmed glaucoma valve (AGV) implantation and its effect on the hypertensive phase (HP), intermediate-term intraocular pressure (IOP) control, and success rate. Methods: A retrospective analysis of 369 eyes of 360 patients who underwent AGV implantation between January 2005 and January 2020 with a minimum follow-up of 2 months was performed. Twenty-six patients developed shallow anterior chamber (AC) within 8 weeks following surgery (cases). They were compared with 39 randomly selected controls (no shallow AC post AGV). HP (IOP spike >21 mmHg), use of ocular hypotensive medications, and other associations were compared. Results: Incidence of shallow AC post AGV was 7% (95% confidence interval [CI] 4, 9). The onset of shallow AC was 3 ± 2.1 days and resolved within 6 ± 4.7 days. Hypotony (12 [47%] vs. 1 [2.5%], P 0.0001) and choroidal detachment (CD; 7 [27%] vs. 3 [8%], P 0.03) were more common in cases compared to controls. The HP occurred in 11 (43%) cases versus 13 (34%) controls (P 0.4). Cases required more ocular hypotensive medications than controls at the end of 8 weeks (1.1 ± 1 vs. 0.5 ± 0.5, P 0.01). There was no significant difference in the qualified success between the groups at 1 year. Conclusion: The development of postoperative shallow AC post AGV implantation was not detrimental to IOP control at 1 year. However, there is a need to monitor the occurrence of HP in these eyes.
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@#AIM: To observe the clinical effect of femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract.<p>METHODS:Retrospective study. From March 2019 to April 2021, 34 eyes of 29 acute angle-closure glaucoma with cataract patients were performed femtosecond laser-assisted phacoemulsification combined with goniosynechialysis. Best corrected visual acuity(BCVA), intraocular pressure(IOP), grading of chamber angle, central anterior chamber depth, corneal endothelial cell count and central corneal thickness were mesaured and analyzed preoperatively and at 1d, 1wk, 1mo.The postoperative complications were analyzed.<p>RESULTS: There was a statistically significant difference between preoperative and postoperative BCVA at 1mo(<i>Z</i>= -5.126, <i>P</i><0.01). IOP at 1d, 1wk and 1mo were 16.72±2.12mmHg, 13.73±1.68mmHg and 12.87±3.54mmHg respectively, which were different from 28.67±4.13mmHg before surgery(all<i> P</i><0.01). The range of atrial angle adhesion at 1mo after the surgery was significantly reduced compared with preoperative(<i>t</i>=21.32, <i>P</i><0.01). The depth of central anterior chamber, the open distance of atrial angle and the included angle of trabecular iris at 1mo after the surgery were significantly greater than preoperative(<i>t</i>= -3.37,-3.68, -5.61, all <i>P</i><0.01). There were no significant differences in corneal endothelial cell count and central corneal thickness(<i>P></i>0.05). Postoperative satisfaction was high without serious complications.<p>CONCLUSION:Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis may be an effective treatment option for acute angle-closure glaucoma complicated with cataract, is safe, effective and has fewer complications.
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@#AIM: To investigate the therapeutic effect of femtosecond laser-assisted cataract surgery(FLACS)in eyes with shallow anterior chamber depth.<p>METHODS: Totally 60 eyes of 55 cataract patients with shallow anterior chamber who received cataract phacoemulsification in Tangshan eye hospital from November 2020 to February 2021 were selected, and divided into two groups according to the surgical methods on patient's subjective willingness: Patients who received FLACS were assigned to the FLACS group(28 patients, 30 eyes), and patients who received conventional Phaco(27 patients, 30 eyes)were assigned to the Phaco group. Preoperative general conditions, cumulative dissipated energy(CDE), effective phacoemulsification time(EPT), postoperative best corrected visual acuity(BCVA), uncorrected visual acuity(UCVA), endothelial cell loss rate(ECL), central macular thickness(CMT)and complications were compared and analyzed.<p>RESULTS:There was no significant difference in preoperative general data between the two groups(<i>P</i>>0.05). In both groups, UCVA at 1d, 1wk and 1mo after surgery and BCVA at 1wk and 1mo after surgery were better than those before surgery, and at 1d after surgery, UCVA in FLACS group was better than that in Phaco group, the difference was statistically significant(<i>P</i><0.05). In the FLACS group, CDE, EPT, ECL at 1wk and 1mo after surgery, and the incidence of corneal edema at 1d and 1wk after surgery were all lower than those in the Phaco group(all <i>P</i><0.05). There was no significant change in CMT in either the intragroup comparison or the intergroup comparison(<i>P</i>>0.05).<p>CONCLUSION:FLACS is safe and effective in patients with shallow anterior chamber cataract, which can significantly reduce the rate of endothelial cell loss, quickly restore vision, reduce the incidence of complications, and has no significant effect on macula.
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@#AIM: To explore the characteristics of refractive changes in patients with age-related cataract and shallow anterior chamber after phacoemulsification.<p>METHODS: A retrospective study was conducted. 96 patients(112 affected eyes)with age-related cataract who were admitted to the hospital between March 2018 and June 2019 were divided into the shallow anterior chamber group(ACD≤2.20mm, 52 patients with 62 affected eyes)and the control group(ACD between 2.21 and 2.90 mm, 44 cases with 50 affected eyes)according to the anterior chamber depth(ACD). All subjects were treated with phacoemulsification. The diopter, ACD and anterior chamber volume(ACV)were measured before surgery, at 1d and 3mo after surgery. Pearson linear correlation analysis was performed to analyze the relationship between the refractive status and anterior chamber parameters in patients with age-related cataract and shallow anterior chamber after phacoemulsification.<p>RESULTS: The diopter error in the shallow anterior chamber group was higher than that in the control group at 3mo after surgery(<i>P</i><0.001). The variations of ACD and ACV in the shallow anterior chamber group before surgery, at 1d and 3mo after surgery were higher than those in the control group(<i>P</i><0.001). In the control group, there was no obvious correlation between the diopter error at 1d, 3mo after surgery and preoperative ACD, preoperative ACV, variations of ACD or ACV at different time after surgery(<i>P</i>>0.05). In the shallow anterior chamber group, the diopter error at 3mo after surgery was negatively correlated with preoperative ACD(<i>P</i><0.05). The diopter error of at 3mo after surgery was positively correlated with variations of ACD at 1d and 3mo after surgery(<i>P</i><0.05), but there was no obvious correlation with variations of ACV(<i>P</i>>0.05).<p>CONCLUSION: There is hyperopic shift in patients with age-related cataract and shallow anterior chamber after phacoemulsification. The degree of hyperopic shift is negatively correlated with preoperative ACD and positively correlated with postoperative ACD, namely, the smaller the preoperative ACD, the larger the postoperative ACD, the severer hyperopic shift.
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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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AIM: To study the curative effect for patients with age related cataract and shallow anterior chamber after phacoemulsification.METHODS: Totally 38 patients (38 eyes) with age related cataract and shallow anterior chamber were selected and divided into two groups according to the depth of the anterior chamber, as mild shallow anterior chamber group (2-2.5mm) 23 eyes, high risk shallow anterior chamber group (0.05).The visual acuity improved significantly after operation in both groups (P0.05).Posterior capsular rupture occurred in shallow anterior chamber group in 1 eye, suspensory ligament rupture in 1 eye.Posterior capsular rupture and suspensory ligament rupture occurred none in normal anterior chamber group.Postoperative corneal edema occurred in 10 eyes (26%) in shallow anterior chamber group, which occurred in 3 eyes (8%) in normal anterior chamber group.The difference on the incidence was significant (P <0.05).CONCLUSION: Phacoemulsification should be taken timely for patients with age related cataract and shallow anterior chamber.The postoperative visual acuity can be improved and the anterior chamber depth can increase.The operation is safe and effective for those patients.
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AIM: To study the clinical effects of using sodium hyaluronate in the glaucoma trabeculectomy. ·METHODS: Totally 46 patients were included in our research and they were divided into two groups. In the study group (23 cases 23 eyes), we used slice with MMC of 0. 4mg/mL in trabeculectomy. Before the conjunctiva flap was sewed, a small amount of sodium hyaluronate was injected into the space under scleral flap and the anterior chamber. In control group ( 23 cases 23 eyes ) , we only used MMC. After trabeculetomy, shallow anterior chambe formation, intraocular pressure, corneal endothelial injury and the formation of filter-bubble were observed in long term. ·RESULTS:IOP of study group at 1d after operation was higher than that of control group ( P0. 05). At 3d after operation, visual acuity decreased in 2 eyes (9%) of study group, 8 eyes (35%) in control group with significant different ( P = 0. 035 ). At 6mo after operation, visual acuity decreased in 0 of study group, 5 eyes (22%) in control group with significant different (P=0. 025 ). The differences on the occurrence of shallow anterior chamber at 7d after operation, formation of filter-bubble at 6mo after operation and corneal endothelial count were significant (P<0. 05). There were less postoperative complications in study group than in control group. ·CONCLUSION: Using sodium hyaluronate combined with MMC in trabeculectomy can greatly prevent the formation of shallow anterior chamber, filter-bubble scarring, and corneal endothelium dropout, make it possible to a safer surgery and a better outcome.
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? AIM: To investigate the efficacy and safety of phacoemulsification combined with intraocular lens implantation in the treatment of shallow anterior chamber with cataract.?METHODS: Retrospective case series. From February 2014 to July 2015 in our hospital,65 eyes in 65 patients with cataract were enrolled and divided into mild and high risk of shallow anterior chamber group. Best-corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) , central anterior chamber dept ( CACD ) , angle opening distance ( AOD ) , complications pre- and post treatment, were observed and analyzed as outcome measures.?RESULTS: In this study, the mild shallow anterior chamber group included 34 eyes; postoperative BCVA were improved in 29 eyes, with 4 eyes remaining stable and decreased in 1 eye; BCVA was improved in 16 eyes, with 10 eyes remaining stable and decreased in 5 eyes in high risk of shallow anterior chamber group postoperatively. BCVA had a better prognosis in the mild shallow anterior chamber group than another group ( t=-2. 956, P<0. 05). Meanwhile, IOP decreased by 5. 71± 2. 07mmHg and CACD increased by 1. 37 ± 0. 38mm in the mild shallow anterior chamber group, by 9. 77±4. 04mmHg and 1. 67±0. 43mm respectively in high risk group, and the difference has statistical significance ( t=-5. 02,-3. 04; P<0. 05). The mean preoperative nasal AOD500 was 200. 57± 33. 74μm, and they were 346. 62 ± 101. 37μm and 410. 75 ± 137. 48μm and 398. 69 ± 122. 28μm respectively at postoperative 1d, 1 and 3mo, and all nAOD500 comparing with preoperative were increased obviously, and the difference has statistical significance (F=203. 75, P<0. 01). And AOD500 at temporal, superior and inferior presented similar trends. Complications were corneal edema ( 5 eyes ) , transient intraocular hypertension ( 2 eyes ) , posterior capsular opacification ( 4 eyes ) , and posterior capsular rupture (1 eye).?CONCLUSION:Micro incision cataract surgery is useful, effective and safe in patients with cataract and shallow anterior chamber which can stabilize or improve BCVA, reduce IOP, deepen CACD and open the anterior chamber angle.
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PURPOSE: To evaluate whether intraocular pressure reduction by intravenous injection of mannitol before phacoemulsification-cataract surgery can have a protective effect on corneal endothelium. METHODS: Patients undergoing sequential bilateral cataract surgery were divided into 2 groups, 36 eyes with anterior chamber depth (ACD) or = 2.50 mm (group B). In each group, preoperative intravenous injection of mannitol was performed in 1 randomly selected eye of the patient. The specular microscopic examination including cell density (ECD), coefficient of variation (CV), hexagonality (HA) of corneal endothelium, and corneal thickness was performed on postoperative 1 day, 2 weeks, and 5 weeks. In each group, the parameters were compared between the eyes with mannitolization and the contralateral eyes without mannitolization. RESULTS: In group A, eyes with preoperative mannitolization showed significantly higher ECD at postoperative 1 day and 5 weeks and showed a significantly thinner cornea at postoperative 1 day than those without mannitolization (all p < 0.05). However, in group B, there was no significant difference of ECD, CV, HA, and corneal thickness between the eyes with and without mannitolization. CONCLUSIONS: Preoperative intraocular pressure reduction by mannitolization before phacoemulsification can protect the corneal endothelial cells and recover the early postoperative period visual acuity in eyes with shallow anterior chamber.
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Humans , Anterior Chamber , Cataract , Cell Count , Cornea , Endothelial Cells , Endothelium, Corneal , Injections, Intravenous , Intraocular Pressure , Mannitol , Microphthalmos , Phacoemulsification , Postoperative Period , Visual AcuityABSTRACT
We present a case report of a 31-year-old female patient who presented to us with a 1 day history of acute bilateral eye pain, blurred vision and headache. She was found to have a myopic shift, raised intraocular pressure (IOP) and shallow anterior chambers in both eyes. She had been commenced on oral topiramate 1 week previously. A number of investigations, including anterior segment optical coherence tomography (AS-OCT) were done and a diagnosis of topiramate induced bilateral acute angle closure (TiAAC) was made. Topiramate was discontinued and she was managed with topical and oral antiglaucoma medications, topical steroids and cyclopegics. Her symptoms subsided dramatically at the next follow-up. The AS-OCT documentation revealed lucidly the improvement in her anterior chamber depth and anterior chamber angle parameters. Her IOP decreased, her myopic shift showed reversal and her AS-OCT fi ndings revealed gross improvement in all the parameters angle opening distance, trabecular iris space area and scleral spur angle. This case report clearly shows with AS OCT documentation the changes which occur in the anterior segment in a case of TiAAC.
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Objective:To analyze the causes and treatment ofshallowanterior chamber in 50 patients(58 eyes)with primary angle closed glaucoma after trabeculectomy.Methods:330 cases(422 eyes)with primary angle closed glaucoma,enrolled from January 2006 to May 2009 in our hospital,were underwent trabeculectomy with application of 0.4 g/L mitomycin C once under and above sclera flap during all filtering surgeries.50 patients(58 eyes)were found with postoperative shallow anterior chamber.Results:The intraocular pressure of all patients were decreased.The incidence of shallow anterior chamber were found 50 patients(58 eyes).The causes were excessive aqueous humor filteration(29 eyes),filter bleb leaks(15 eyes),choroida detachment(5 eyes),malignant glaucoma(3 eyes).Anterior chamber reformed in 8 eyes with surgical procedure and 88 eyes without any surgical procedure.Conclusion:The incidence of shallowanterior chamber is high after trabeculetomy with application of mitomycin C in patients with primary angle closed glaucoma.Most of such cases could be reformed through conservation treatment.