Evaluation and correlation of corneal endothelium parameters with the severity of primary glaucoma

Purpose: To evaluate and correlate corneal endothelium parameters with the severity of primary glaucoma. Methods: This prospective case?control study was conducted on 150 eyes of 80 newly diagnosed primary open?angle glaucoma (POAG), chronic primary angle?closure glaucoma (cPACG), and normal?tension glaucoma (NTG) patients in a tertiary care center. Endothelial parameters including endothelial cell count (ECC), percentage of hexagonal cells, and coefficient of variation of cell size were analyzed. Glaucoma cases were further sub?grouped into early, moderate, and severe glaucoma and compared for endothelial parameters. Chi?square, Fischer’s exact test, independent sample t?test, and analysis of variance were performed using IBM® SPSS® Statistics version 28. Results: The ECC was markedly reduced in cases (2281 cells/mm2) versus controls (2611 cells/mm2) (P < 0.001). The POAG (2251 cells/mm2) and cPACG (2287 cells/mm2) eyes had significantly a lower ECC compared to healthy controls (P < 0.001), whereas NTG eyes had a lower mean ECC (2538 cells/mm2), but it was not statistically significant (P > 0.05) when compared with controls. The ECC decreased with an increase in severity as patients with early glaucoma had an ECC of 2284 cells/mm2, moderate 2261 cells/mm2, and severe 2086 cells/mm2, and the difference was statistically significant. Conclusion: A significant decrease in corneal ECC was observed in POAG and cPACG patients when compared with healthy controls of the same age group. Mechanical damage following an elevated intra?ocular pressure for a longer duration may be attributed to morphological and consequent functional damage to endothelial cells.

A comparison study on goniosynechialysis+ phacoemulsification versus simple phacoemulsification for CPACG with PAS≤180° combined cataract / 中华实验眼科杂志

Objective:To compare the efficacy of phacoemulsification+ goniosynechialysis (Phaco-GSL) and Phaco alone for chronic primary angle-closure glaucoma (CPACG) patients with peripheral anterior synechia (PAS)≤180° combined cataract.Methods:A cohort study was performed.Fifty-two eyes with CPACG in 40 patients who underwent Phaco-GSL and Phaco-alone in Peking Union Medical College Hospital from February 2014 to October 2018 were enrolled.The patients were divided into Phaco-GSL group (22 cases, 29 eyes) and Phaco-alone group (18 cases, 23 eyes) according to different surgeries.Goldmann applanation tonometer was used to measure intraocular pressure (IOP) before operation and 1 day, 1 week and 1, 3, 6, 12, 18 months after operation.Best corrected visual acuity (BCVA) was examined with a standard logarithmic visual acuity chart.The number of anti-glaucoma drugs was calculated in the follow-up duration.The change of PAS was observed by ultrasound biomicroscopy and indentation gonioscopy.The intra- and post-operative complications and their management were analyzed and compared.This research protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Peking Union Medical College Hospital (No.S-K1352). Written informed consent was obtained from each subject prior to any medical examination.Results:There was no significant difference in IOP between the Phaco-GSL group and the Phaco-alone group ( Fgroup=1.569, P=0.223). A significant difference was found in IOP among various time points in different groups ( Ftime=7.762, P<0.01). The IOP of the eyes were significantly reduced at various time points postoperatively in comparison with the preoperative IOP in each group (all at P<0.001). There was no significant intergroup difference in BCVA ( Fgroup=1.996, P=0.172), however, a significant difference was found in BCVA among different time points in both groups ( Ftime=95.737, P<0.01). The postoperative 6- and 18-month BCVA was significantly improved in comparison with before surgery in both groups (all at P<0.001). The number of anti-glaucoma medicines used was significantly decreased at postoperative 1, 6, 12, 18 months in comparison with preoperation in both groups (all at P<0.05), and the anti-glaucoma medicines used in the Phaco-GSL group was less than that in the Phaco-alone group at 6, 12 and 18 months after surgery (all at P<0.05). The ranage of PAS at 18 months after surgery was 45 (0, 90)° and 100 (90, 140)° in the Phaco-GSL group and Phaco-alone group, respectively.The range of PAS in the Phaco-GSL group at postoperative 1, 3, 6, 12, 18 months was significantly smaller than preoperation in the Phaco-alone group (all at P<0.05). The incidence of intra- and post-operative complications in the Phaco-GSL group was significantly higher than that in the Phaco-alone group ( P<0.001). Conclusions:Both Phaco-GSL and Phaco-alone can reduce IOP and improve visual acuity in CPACG with PAS≤180° combined cataract patients.Phaco-GSL can maintain the gonio open and reduce the use of anti-glaucoma medicines and show a good safety.

Changes of choroid thickness in primary angle-closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the changes and related factors of choroidal thickness(CT)in acute primary angle-closure glaucoma(APACG), and chronic primary angle-closure glaucoma(CPACG).<p>METHODS: It was a retrospective study. A total of 35 patients(43 eyes)with APACG, 26 patients(46 eyes)with CPACG and 46 patients(81 eyes)with normal eye condition and used as the control group in the study. EDI-OCT was used to measure and compare the foveal, nasal, temporal, superior and inferior CT of APACG, CPACG and normal control groups. The CT were labeled as subfoveal choroidal thickness(SFCT), nasal 2mm(N 2mm), temporal 2mm(T 2mm), superior 2mm(S 2mm), inferior 2mm(I 2mm).Linear regression analysis was used to explore the related factors of CT. Logistic regression analysis was used to evaluate the association between CT and presence of APACG and CPACG.<p>RESULTS: There was no significant difference in CT of APACG, CPACG and normal control group(<i>P</i>>0.05). CT of all sites was negatively correlated with axial length(AL). N 2 mm and I 2 mm were also negatively correlated with age, anterior chamber depth(ACD), SFCT was negatively correlated with age and AL(<i>P</i><0.05). Multivariate Logistic analysis showed that there was an association between S 2mm and APACG(<i>P</i>=0.029), the odds ratio(<i>OR</i>)and 95% confidence interval(<i>CI</i>)was 0.975(0.953, 0.997). There was no association between CPACG and CT at all locations(<i>P</i>>0.05).<p>CONCLUSION: Age, AL and ACD are the factors that related to choroidal thickness. It is also confirm that there is an association between decreased S 2mm and APACG. However, there is no correlation between CPACG and CT at all locations.

Combined trabeculectomy and injection of filtered air into anterior chamber in the treatment of primary chronic angle closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Combined trabeculectomy and injection of filtered air into anterior chamber in the treatment of primary chronic angle closure glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Change of the thickness of macular inner and outer retina in patients with chronic primary angle-closure glaucoma / 眼科新进展

Objective To measure the thickness of macular inner and outer retina of chronic primary angle-closure glaucoma (CPACG) and observe its features.Methods Together 58 patients (58 eyes) including 14 patients with early CPACG,23 patients with moderate CPACG and 21 patients with severe CPACG were recruited as early CPACG group,moderate CPACG and severe CPACG group,respectively;additional 23 healthy volunteers were chosen as controls.The thickness of macular inner and outer retina at all parts were measured by RTVue-100 SD-OCT.Results The macular inner retinal thicknesses in fovea were (135.62 ± 2.96) μm,(124.21 ± 6.47) μm,(119.74 ± 10.67) μm and (94.95 ± 11.24) μm in the control group,early CPACG,moderate CPACG and severe CPACG group,respectively.The thicknesses of macular inner retina of fovea were significantly decreased in the early CPACG group,moderate CPACG group and severe CPACG group when compared with the control group (all P ＜ 0.05).There were also significant differences between early CPACG group and moderate CPACG group,severe CPACG group and moderate CPACG group and early CPACG group and severe CPACG group (all P ＜ 0.05).The thicknesses of macular outer retina of fovea,parafovea and perifovea were significantly decreased in the severe CPACG group compared with the control group (all P ＜ 0.05).Conclusion The thickness of macular inner and outer retina are decreased at all parts in patients with the severe CPACG.The macular inner retinal thickness only in the fovea is thinner in the patients with the early CPACG.

The reduction of intraocular pressure after instillation of travoprost compared with timolol in chronic primary angle-closure glaucoma.

The objective of this study is to compare the reduction of intraocular pressure (IOP) after instillation of Travoprost compared with timolol in chronic primary angle-closure glaucoma. A prospective randomized, crossover study was conducted from April 2005 to July 2005 at Department of Ophthalmology, National Central General Hospital (RSCM) Jakarta on subjects with chronic primary angle-closure glaucoma. Subjects were randomly divided into 2 groups: those taking Travoprost once daily and those taking timolol twice daily. Two weeks after treatment with the first drug, the second drug was substituted. Intraocular pressure was recorded before therapy, at day 1, day 7, and day 14. There was a wash out period of three weeks prior to initial treatment and after the cross over. Sixteen subjects (32 eyes) met the inclusion criteria and were included in this study. The mean baseline IOP in the Travoprost group was 25.38 ± 3.01 mmHg, while in the timolol group it was 25.88 ± 2.55 mmHg (p=0.354). At day 7, the IOP were consecutively 16.75 + 1.92 mmHg and 21.25 + 3.09 mmHg (p=0.001) and at day 14 IOP were 13.94 + 2.02 mmHg and 19.25 + 2.18 mmHg (p=000). This showed that Travoprost decreased the IOP faster and greater than timolol. The mean baseline IOP was 25.38 ± 3.01 mmHg was decreased to 11.44 ± 1.90 mmHg with Travoprost. In the timolol group, the mean baseline IOP of 25.88 ± 2.55 mmHg was decreased to 6.63 ± 2.25 mmHg. Statistically, Travoprost significantly reduced the IOP faster and greater than timolol (p<0.05). Travoprost eye drops reduced the IOP faster and greater than timolol.