Efficacy of anti-vascular endothelial growth factor and mitomycin C on wound healing after trabeculectomy in glaucoma patients: A meta-analysis.

Trabeculectomy is the main surgical treatment for glaucoma, but scar formation during wound healing may lead to surgical failure. In this study, we evaluated the efficacy of anti-vascular endothelial growth factor (anti-VEGF) and mitomycin C (MMC) on wound healing after glaucoma surgery. We have been looking for Pubmed, Embase and other databases. The last time we looked at an electronic database was August 2023. A case control study was conducted to compare the use of anti-VEGF and mitomycin C for the treatment of glaucoma. We used the Cochrane standard methodology for collecting and analysing the data. Based on the criteria of inclusion, we have determined 369 related papers and selected seven eligible trials for data analysis. Three hundred and twenty-six cases were treated with trabeculectomy, of which 166 were injected with anti-VEGF and 160 were given MMC for trabeculectomy. In six trials, anti-VEGF and MMC were not found to have any statistical significance on postoperative wound leakage after surgery (OR, 1.55; 95% CI, 0.71, 3.35 p = 0.27). The three trials showed that anti-VEGF and MMC did not differ in terms of reducing postoperative wound hypotony after surgery (OR, 0.78; 95% CI, 0.20, 3.11 p = 0.73). Five trials demonstrated that anti-VEGF and MMC were not associated with a lower incidence of shallow anterior chamber (OR, 1.17; 95% CI, 0.5, 2.76 p = 0.71). There is no significant difference in the effect of anti-VEGF and MMC on wound healing after glaucoma surgery. A multicentre randomized controlled trial with a larger sample size is needed to confirm this study.

Exploration on surgery of malignant glaucoma with prolonged absence of the anterior chamber: a retrospective consecutive case series.

OBJECTIVE: To evaluate the surgical outcomes of anterior chamber restoration in patients with malignant glaucoma and a prolonged absence of the anterior chamber. METHODS: Five patients with malignant glaucoma and a long-term absence of the anterior chamber underwent a combination of anterior pars plana vitrectomy (aPPV), phacoemulsification cataract excision, intraocular lens implantation, peripheral iridotomy (PI), goniosynechialysis (GSL) (referred to aPPV + P + I + PI + GSL) at Beijing Tongren Hospital from October 2018 to June 2021. The study compared the changes in their visual acuity, intraocular pressure (IOP) and medication requirements between the pre-surgery period and their most recent follow-up visit. RESULTS: The five patients did not report any discomfort, such as pain, tearing, swelling, etc., in their affected eyes, and maintained a stable restoration of the anterior chamber. Among the affected eyes, only one eye demonstrated improved vision during the follow-up visit, while the remaining four eyes did not show any significant improvement. One eye underwent transscleral cyclophotocoagulation as an additional procedure, while the other four eyes did not require any further surgical intervention. In all cases, the intraocular pressure (IOP) was successfully controlled below 30 mmHg. Post-surgery, four eyes still required cycloplegia treatment, and three eyes continued to rely on eye drops to manage their IOP. CONCLUSION: Despite minimal improvement in vision, surgical intervention successfully restored the anterior chamber in malignant glaucoma patients with a prolonged absence of anterior chamber. This restoration contributed to alleviating subjective complaints of discomfort and delaying eyeball atrophy.

Early postoperative visual acuity changes after trabeculectomy and factors affecting visual acuity.

PURPOSE: To investigate the early visual acuity (VA) changes that occur after trabeculectomy and their reversal with recovery. METHOD: Two hundred ninety-two eyes of 292 patients after initial trabeculectomy as a standalone procedure fulfilling the following conditions were included: 1) patients with a postoperative follow-up of at least 3 months; 2) patients with preoperative corrected VA less than 0.5 logMAR equivalent; 3) patients with reliable results of visual field; and 4) patients who had open angle glaucoma. VA and intraocular pressure (IOP) changes during the first 3 months after surgery and factors affecting VA postoperatively at 3 months were investigated. RESULTS: The mean IOPs (mmHg) after trabeculectomy were significantly lower than preoperatively during the entire period (P < 0.0001). The mean corrected VA for all patients was 0.06 ± 0.17, 0.24 ± 0.38, 0.19 ± 0.26, and 0.14 ± 0.27 preoperatively and at 1 week, 1 month, and 3 months postoperatively, respectively, showing a significant decrease from the preoperative period at all time points (P < 0.0001). VA loss of two or more levels was observed in 13 eyes (4.45%) at 3 months postoperatively. Foveal threshold (FT), shallow anterior chamber (SAC), and choroidal detachment (CD) affected the change in VA before and at 3 months after surgery (P < 0.0001, P = 0.0002, P = 0.0004, respectively). The factors that had significant effects on VA change were FT, SAC, and CD in POAG, FT and hypotonic maculopathy in NTG, and FT in XFG (p < 0.05). CONCLUSION: The frequency of serious vision loss was 4.45% for two or more levels of vision loss, and early postoperative VA changes after trabeculectomy may not be reversed even 3 months later. VA loss is influenced by preoperative FT, postoperative SAC and CD, but the impact of postoperative complications vary with disease type.

Vault-Correlated Efficacy and Safety of Implantable Collamer Lens V4c Implantation for Myopia in Patients with Shallow Anterior Chamber Depth.

INTRODUCTION: The aim of the study was to evaluate efficacy and safety outcomes after implantation of the Visian Implantable Collamer Lens (ICL V4c) in myopia patients with shallow anterior chamber depth (ACD). METHODS: This retrospective study followed 163 eyes of 94 patients for at least 24 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, intraocular pressure (IOP), manifest refraction, vault, endothelial cell density (ECD), anterior chamber angle (ACA), anterior chamber volume, and the distance from the corneal endothelium to the central ICL (C-ICL) were measured during follow-ups. Spearman's correlation and logistic regression were used to identify variables correlated with changes in ECD and potential risk factors for ineffective outcomes, respectively. RESULTS: All surgeries were performed safely. High IOP of 9 eyes and anterior capsular opacity of 5 eyes were observed. The last follow-up ACA had a significant difference between the high and normal IOP groups (p = 0.0003). The mean ECD and vault were 2,855.76 ± 270.82 cells/mm2 and 388.01 ± 135.28 µm at the last follow-up, respectively. The vault and C-ICL were significantly associated with ΔECD (all p < 0.05). Furthermore, the vault was most responsible for the ECD loss. Twenty-two eyes had unsatisfactory postoperative UDVA, and the low vault at the last follow-up was a significant risk factor for this ineffective outcome (p < 0.001, OR = 14.739). CONCLUSIONS: ICL V4c implantation in patients with shallow ACD achieved stable visual outcomes. The vault is related to postoperative visual acuity and ECD loss, which needs to be paid attention during follow-up.

Application of single-pass four-throw releasable suture drainage tube ligation technique in Ahmed glaucoma valve implantation / 国际眼科杂志(Guoji Yanke Zazhi)

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&#x003C;0.05). There was no significant difference in IOP between groups at all follow-up visits(all P&#x003E;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&#x003C;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&#x003E;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.

Effect of immediate shallow anterior chamber after Ahmed glaucoma valve implantation on intermediate-term intraocular pressure control.

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.

A deep learning approach for detection of shallow anterior chamber depth based on the hidden features of fundus photographs.

BACKGROUND AND OBJECTIVES: Patients with angle-closure glaucoma (ACG) are asymptomatic until they experience a painful attack. Shallow anterior chamber depth (ACD) is considered a significant risk factor for ACG. We propose a deep learning approach to detect shallow ACD using fundus photographs and to identify the hidden features of shallow ACD. METHODS: This retrospective study assigned healthy subjects to the training (n = 1188 eyes) and test (n = 594) datasets (prospective validation design). We used a deep learning approach to estimate ACD and build a classification model to identify eyes with a shallow ACD. The proposed method, including subtraction of the input and output images of CycleGAN and a thresholding algorithm, was adopted to visualize the characteristic features of fundus photographs with a shallow ACD. RESULTS: The deep learning model integrating fundus photographs and clinical variables achieved areas under the receiver operating characteristic curve of 0.978 (95% confidence interval [CI], 0.963-0.988) for an ACD ≤ 2.60 mm and 0.895 (95% CI, 0.868-0.919) for an ACD ≤ 2.80 mm, and outperformed the regression model using only clinical variables. However, the difference between shallow and deep ACD classes on fundus photographs was difficult to be detected with the naked eye. We were unable to identify the features of shallow ACD using the Grad-CAM. The CycleGAN-based feature images showed that area around the macula and optic disk significantly contributed to the classification of fundus photographs with a shallow ACD. CONCLUSIONS: We demonstrated the feasibility of a novel deep learning model to detect a shallow ACD as a screening tool for ACG using fundus photographs. The CycleGAN-based feature map showed the hidden characteristic features of shallow ACD that were previously undetectable by conventional techniques and ophthalmologists. This framework will facilitate the early detection of shallow ACD to prevent overlooking the risks associated with ACG.

Femtosecond laser-assisted phacoemulsification combined with goniosynechialysis in the management of acute angle-closure glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Clinical evaluation of femtosecond laser-assisted phacoemulsification in the treatment of cataract with shallow anterior chamber / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

Assessment of anterior chamber angle changes after phacoemulsification with swept-source OCT.

AIM: To assess the changes of anterior chamber angle in patients with shallow anterior chamber after phacoemulsification combined with intraocular lens (IOL) implantation, based on anterior segment swept-source optical coherence tomography (AS-SS-OCT) measurements. METHODS: This was a prospective case control study; sixty eyes of sixty case were scheduled for cataract surgery with normal intraocular pressure (IOP). Based on anterior chamber depth (ACD) and gonioscopy findings, the eyes were divided into two groups: group of shallow anterior chamber and narrow angle (SAC group, 30 eyes); and group of normal anterior chamber group with wide angle (NAC group, 30 eyes). Measurements of ACD, anterior chamber volume (ACV), iris volume (IV), lens vault (LV), angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), and trabecular iris angle (TIA) were conducted in each group before and 3mo after surgery. RESULTS: There was no significant difference in age, axial length (AL), corneal curvature, corneal diameter, intraocular pressure, and IV between two groups before surgery, except for the LV (P=0.000). ACD and ACV were prominently larger in the NAC group than the SAC group 3mo after operation (3.69±0.38 vs 3.85±0.39 mm, P=0.025; 161.37±19.47 vs 178.26±20.30 mm3, P=0.002). AOD750, ARA750 in nasal and inferior quadrants, TISA750 in all quadrants except temporal, and TIA750 in all quadrants in SAC group were significantly smaller than those in NAC group after operation (all P<0.05). CONCLUSION: Cataract surgery can deepen anterior chamber and increase the width of anterior chamber angle in Chinese subjects, but the angle related parameters including AOD750, ARA750, TISA750, TIA, TISA750, and ACV in patients with shallow anterior chamber and narrow angle do not reach the normal level.

Smartphone-Acquired Image Photogrammetry for Detection of Shallow Anterior Chamber.

PURPOSE: This study aimed to explore the role of smartphone imaging of the eye using two perspectives - anterior and temporal - in the detection of a shallow anterior chamber (AC). The AC depth (ACD) of an eye can be used as a surrogate marker for identification of eyes at risk of developing angle-closure disease. METHODS: A prospective observational study was conducted at a university teaching hospital in South India. Each eye was photographed with a smartphone using the two perspectives, followed by quantitative measurement of ACD using optical biometry. The percentage of nasal iris illuminated was measured from the image acquired using the flashlight method (anterior perspective), whereas pupil position relative to the cornea was measured from the image acquired using the temporal perpendicular method (temporal perspective). The receiver-operating characteristic curve and area under the curve (AUC) were studied for both perspectives independently for overall predictive accuracy in detection of shallow AC (ACD <2.7 mm, obtained by IOL Master). RESULTS: A total of 275 eyes were examined, of which 77 (28%) had an ACD <2.7 mm. The accuracy of detection of shallow AC was found to be 95.2% for both perspectives when used alone or in combination. AUC of the anterior perspective was 0.99 (95% CI 0.982-0.997). The AUC for the temporal perspective was 0.993 (95% CI 0.988-0.999). CONCLUSION: Smartphone-acquired image photogrammetry of an eye with anterior and temporal perspectives independently and in combination provided accuracy nearing 95% in the detection of shallow AC (ACD <2.7 mm). REGISTRATION: This trial was registered with the Clinical Trial Registry of India (CTRI/2018/09/015867, September 28, 2018).

Femtosecond laser-assisted cataract surgery in shallow anterior chamber cases.

PURPOSE: To assess the effectiveness, safety and predictability of femtosecond laser-assisted cataract surgery (FLACS) in eyes with shallow anterior chamber (AC). METHODS: This is a prospective consecutive clinical study. All eyes presented an anterior chamber depth (ACD) ≤ 2.1 mm and were submitted to FLACS with monofocal intraocular lens (mIOL) or trifocal intraocular lens (tIOL) implantation. Uncorrected distance visual acuity (VA) and corrected distance VA values were used to assess efficacy and safety of the surgery. Refraction, intraocular pressure (IOP), endothelial cell density (ECD) and ACD were evaluated before and 6 months post-surgery. RESULTS: Phacoemulsification was carried out successfully in all eyes, without intra- or postoperative complications. Efficacy and safety indexes were 0.96 and 1.26 for the mIOL group, and 0.87 and 1.01 for the tIOL group, respectively. The mean postoperative spherical equivalent was - 0.06 ± 0.28D and - 0.14 ± 0.38D for the mIOL and tIOL groups, respectively. The ECD varied from 2470 ± 483 to 2009 ± 538 cells/mm2 (p < 0.05) and from 2443 ± 319 to 2245 ± 628 cells/mm2 (p = 0.06) for the mIOL and tIOL groups, respectively. IOP significantly decreased (p < 0.05) after the surgery from 14.34 to 12.85 mmHg for the mIOL group and from 14.37 to 11.91 mmHg for the tIOL group, with a general reduction of medical hypotensive treatment in both groups (85% of cases required ≤ number of medications). ACD changed significantly (p < 0.05) from 1.96 ± 0.15 mm to 3.75 ± 0.30 mm after the surgery in the mIOL group and from 1.94 ± 0.15 mm to 3.23 ± 0.21 mm for the tIOL group. CONCLUSION: FLACS with implantation of either mIOL or tIOL may provide good efficacy, safety and predictability in eyes with shallow AC.

Choroidal detachment-induced secondary angle-closure after trabeculectomy in patient with ocular venous congestion: A case report.

PURPOSE: To report a particular circumstance that led to the abnormal complication of choroidal detachment (CD)-induced secondary angle-closure after trabeculectomy with mitomycin C (MMC). OBSERVATIONS: An 82-year-old Japanese male patient with underlying chronic obstructive pulmonary disease and suspicion of ocular venous congestion in both eyes whom diagnosed as primary open-angle glaucoma with uncontrolled intraocular pressure (IOP) of his left eye then underwent an uneventful trabeculectomy with MMC. After the surgery, his left eye had high IOP with a shallow anterior chamber (A/C) but the bleb was hyperfiltration. The high CD was found by B-scan ultrasonography behind the iris and after conservative treatment, the CD was improved, A/C was deepened, and IOP was lower to 16 mmHg. CONCLUSION AND IMPORTANCE: CD-induced secondary angle-closure after trabeculectomy with MMC is a complication to be considered in patients with shallow A/C and high IOP. Fundus examination should be done to rule out this condition before any aggressive treatment as CD can resolve spontaneously with time. Clinicians should be aware of this condition especially in patients with any signs of ocular venous congestion as there have been few reports mentioned about the complication in the patients.

A Case of Idiopathic Orbital Inflammation with Shallow Anterior Chamber and Choroidal Detachment.

We report a case of idiopathic orbital inflammation with a shallow anterior chamber and choroidal detachments. This study involved an 87-year-old female patient who presented at our department after becoming aware of the progression of diplopia. Examination of the patient's right eye revealed proptosis, as well as conjunctival edema with dilated and tortuous blood vessels. The right-eye anterior chamber was shallow, and fundus examination revealed marked choroidal detachments. Magnetic resonance imaging revealed enlargement of the right-orbit extraocular muscles and a suspected compression of the right-orbit superior and inferior ophthalmic veins, yet no expansion of the cavernous sinus. We diagnosed the patient as having idiopathic orbital inflammation in her right orbit, and subsequently started corticosteroid therapy. One week after initiating treatment, the anterior chamber was found to be nearing a normal depth, and the choroidal detachments were found to have disappeared. Our findings revealed that the inflammatory swelling of the extraocular muscle due to idiopathic orbital inflammation resulted in compression of the right-orbit superior and inferior ophthalmic veins, thus leading to an apparent choroidal circulation disorder that presented with a shallow anterior chamber and marked choroidal detachments.

Overfiltering Bleb en Route to Annular Ciliochoroidal Effusion.

Annular ciliochoroidal effusion is a rare condition that can complicate trabeculectomy. We report a case of ciliochoroidal effusion mimicking aqueous misdirection after combined glaucoma and cataract surgery. A 75-year-old male with pseudoexfoliation, chronic angle-closure glaucoma, and advanced optic disc damage developed ciliochoroidal effusion after a combined trabeculectomy and phacoemulsification with intraocular lens implantation. The patient presented with overfiltering bleb, hypotony, and a uniformly shallow anterior chamber that mimicked aqueous misdirection in the clinical picture. Reformation of anterior chamber followed by revision of the bleb was performed. Ultrasound biomicroscopy confirmed the diagnosis. Atropine and steroid eye drops improved the condition. Ciliochoroidal effusion should be ruled out in hypotony with shallow anterior chamber post glaucoma surgery.

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.

Analysis of the refractive status in patients with age-related cataract and shallow anterior chamber after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#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.

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.

Endothelial cells loss to the hyperopic pacients during phacoemulsification.

INTRODUCTION: The phacoemulsification cataract surgery is the most frequently performed surgery and it generally improves vision in over 90% of the patients. Hyperopic patients are a challenge during phacoemulsification especially because of their short eyeball and shallow anterior chamber. A shallow anterior chamber is associated with overall reduction of the safe zone, which may lead to difficulty in creating the corneal incisions, harder capsulorhexis performing, or endothelial complications. PURPOSE: The aim of the study was to present the endothelial cells loss after the phacoemulsification procedure in the hyperopic patients. MATERIAL AND METHODS: A number of 1775 patients operated in the Ophthalmology Department of the Clinical Hospital Sibiu from January 11, 2011 to December 20, 2013 have been included in our study; 595 cases with emmetropia and the rest of the 1180 patients had the following refraction errors: 216 - myopia and 964 - hypermetropia. From the total cases of the hypermetropia, we selected 72 patients to measure the endothelial cells density and the corneal thickness by using specular microscopy, one day before and 7-14 days after surgery. RESULTS AND DISCUSSIONS: The preexisting hypermetropia might modify the intraoperative and postoperative cataract surgery evolution. Endothelial cell loss is potentially higher from surgical trauma so that the endothelium must be protected with viscoelastics. The loss of endothelial cells in hyperopic eyes occurred with an average of 267 cell/ mm² and the thickness of the cornea increased by 13 µm. CONCLUSION: The phacoemulsification surgery in the presence of hypermetropia requires more attention. The biometry and the specular microscopy are very important tasks for the preoperative assessment, surgery, and postoperative care. The protection of the corneal endothelium with viscoelastics leads to an insignificant modification of the endothelial cells in hyperopic patients compared to an anterior study of the patients with all ametropies.

Curative effect analysis for patients with age related cataract and shallow anterior chamber after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

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.