ABSTRACT
PURPOSE: To study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations. METHODS: A total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications. RESULTS: The mean IOP before surgery was 42.6 ± 14.2 mmHg for all patients, 29.6 ± 6.6 mmHg for European patients and 48.1 ± 12.9 mmHg for African patients. The follow-up time was 86.2 ± 43.1 months. Mean IOP was 15.4 ± 3.6 mmHg at 5 years, 15.5 ± 4.4 mmHg at 10 years and 16.8 ± 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88-0.96], 70% (95% CI 0.63-0.77) and 43% (95% CI 0.36-0.51) in European patients, and 90% (95% CI 0.87-0.93), 77% (95% CI 0.74-0.81) and 67% (95% CI 0.63-0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 ± 1.9 mmHg to 15.0 ± 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis. CONCLUSION: Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years.
Subject(s)
Filtering Surgery/methods , Glaucoma, Open-Angle/surgery , Limbus Corneae/surgery , Adult , Aged , Aged, 80 and over , Black People , Exfoliation Syndrome/ethnology , Exfoliation Syndrome/physiopathology , Exfoliation Syndrome/surgery , Female , Follow-Up Studies , Glaucoma, Open-Angle/ethnology , Glaucoma, Open-Angle/physiopathology , Humans , Hyaluronic Acid/therapeutic use , Intraocular Pressure/physiology , Male , Middle Aged , Retrospective Studies , Tonometry, Ocular , Viscosupplements/therapeutic use , Visual Acuity/physiology , White People , Young AdultABSTRACT
AIM: To compare the incidences of endophthalmitis after cataract operations before and after introduction of intracameral vancomycin at the end of surgery. METHODS: A retrospective analysis was performed of presumed infectious endophthalmitis after cataract surgery from January 1, 1998 to December 31, 2008. From January 2001, the practice of using intracameral vancomycin at the end of cataract surgery was introduced. The period before introduction of intracameral vancomycin is considered as period A and that after as period B. The incidences of presumed or culture-proven endophthalmitis during periods A and B were compared. RESULTS: A total of 16,606 cataract surgeries were performed during the study period. The incidence of endophthalmitis per 1000 cataract surgeries was 3.0 during period A and 0.08 during period B. This reduction was statistically significantly (Chi-squared test 36.6, P value < 0.0001). The relative risk of developing endophthalmitis without intracameral vancomycin prophylaxis was 38. The absolute risk reduction was 292 cases of endophthalmitis per 100,000 cataract surgeries. CONCLUSIONS: Intracameral vancomycin significantly reduced the incidence of postoperative endophthalmitis after cataract surgery. There is a universal need to adopt this mode of microbial prophylaxis to reduce the burden of endophthalmitis after cataract surgery.
