Results of mitomycin-C-augmented viscocanalostomy for open-angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To evaluate the results of mitomycin-C (MMC)-augmented viscocanalostomy in patients with open-angle glaucoma.METHODS:This retrospective study included 104 patients who underwent viscocanalostomy surgery between December 2007 and March 2014.Pre-and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity, complications, adjunctive procedure (laser goniopuncture and/or glaucoma medication), and success rate were recorded.Complete success was defined as IOP≤21 mmHg without additional medication, and qualified success was defined as IOP≤21 mmHg with or without glaucoma medication.RESULTS:Mean preoperative IOP was 27.5±9.2 mmHg and mean postoperative IOP was 14.5±6.6 mmHg at the last visit (P<0.001).Mean visual acuity before and after surgery were 0.42±0.4 and 0.32±0.4, respectively (P=0.726).Qualified success was achieved in 106 (86.9%) eyes and complete success was achieved in 62 (50.8%) eyes.Laser goniopuncture was performed in 43 (35.2%) eyes and glaucoma medication usage rate was 49.1%.The mean postoperative followup period was 27.29±16.78 (1-79)mo.CONCLUSION:Although viscocanalostomy is a safer option due to low complication rates and stable visual acuity, without laser goniopuncture(LGP), surgical success rate is still very low.Further comparative studies are necessary to evaluate the contribution of MMC to viscocanalostomy surgery.

Laser intervention on trabeculo‑Descemet’s membrane after resistant viscocanalostomy: Selective 532 nm gonioreconditioning or conventional 1064 nm neodymium‑doped yttrium aluminum garnet laser goniopuncture.

Purpose: To compare the results of conventional 1064 nm neodymium‑doped yttrium‑aluminum garnet laser goniopuncture (Nd:YAG‑GP) and selective 532 nm Nd:YAG laser (selective laser trabeculoplasty [SLT]) gonioreconditioning (GR) on trabeculo‑Descemet’s membrane in eyes resistant to viscocanalostomy surgery. Methods: Thirty‑eight eyes of 35 patients who underwent laser procedure after successful viscocanalostomy surgery were included in the study. When postoperative intraocular pressure (IOP) was above the individual target, the eyes were scheduled for laser procedure. Nineteen eyes underwent 532 nm SLT‑GR (Group 1), and the remaining 19 eyes underwent conventional 1064 nm Nd:YAG‑GP (Group 2). IOPs before and after laser (1 week, 1 month, 3 months, 6 months, 1 year, and last visit), follow‑up periods, number of glaucoma medications, and complications were recorded for both groups. Results: Mean times from surgery to laser procedures were 17.3 ± 9.6 months in Group 1 and 13.0 ± 11.4 months in Group 2. Mean IOPs before laser procedures were 21.2 ± 1.7 mmHg in Group 1 and 22.8 ± 1.9 mmHg in Group 2 (P = 0.454). Postlaser IOP measurements of Group 1 were 12.1 ± 3.4 mmHg and 13.8 ± 1.7 mmHg in the 1st week and last visit, respectively; in Group 2, these measurements were 13.6 ± 3.7 mmHg and 14.9 ± 4.8 mmHg, respectively. There were statistically significant differences (P < 0.001) in IOP reduction at all visits in both groups; the results of the two groups were similar (P > 0.05). Mean follow‑up was 16.6 ± 6.4 months after SLT‑GR and 18.9 ± 11.2 months after Nd:YAG‑GP. Conclusions: While conventional Nd:YAG‑GP and SLT‑GR, a novel procedure, are both effective choices in eyes resistant to viscocanalostomy, there are fewer complications with SLT‑GR. SLT‑GR can be an alternative to conventional Nd:YAG‑GP.

Methylene blue-related corneal edema and iris discoloration / Edema de córnea e descoloração de íris associados ao azul de metileno

ABSTRACT We report the case of a 70-year-old female patient who developed corneal edema and iris discoloration following the inadvertent use of 1% methylene blue instead of 0.025% trypan blue to stain the anterior capsule during cataract phacoemulsification surgery. Copious irrigation was performed upon realization of incorrect dye use. Corneal edema and iris discoloration developed during the early postoperative period and persisted at 24-months follow-up. However, keratoplasty was not required. The intracameral use of 1% methylene blue has a cytotoxic effect on the corneal endothelium and iris epithelium. Copious irrigation for at least 30 min using an anterior chamber maintainer may improve outcomes.

RESUMO Paciente do sexo feminino com 70 anos de idade desenvolveu edema da córnea e descoloração da íris após o uso inadvertido de 1% de azul de metileno em vez de 0,025% de azul tripano para corar a cápsula anterior do cristalino durante a cirurgia de catarata por facoemulsificação. Foi realizada irrigação abundante quando detectou-se que o corante incorreto tinha sido usado. Edema da córnea e descoloração íris que ocorreu no período pós-operatório precoce persistiu durante 24 meses de seguimento; no entanto, a ceratoplastia não foi necessária. O uso intracameral de 1% de azul de metileno tem efeitos citotóxicos sobre o endotélio da córnea e epitélio da íris. A irrigação abundante durante pelo menos 30 minutos, utilizando um mantenedor de câmara anterior pode resultar em um prognóstico melhor.