AIM:To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve(AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separa...AIM:To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve(AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure(IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP(P =0.005),lower baseline mean visual acuity(VA)(P =0.02),and higher proportion of patients with history of previous trabeculectomy(P <0.0001).Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group(P =0.0229).CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.展开更多
AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with poste...AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.展开更多
To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar ...To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm(6.0-12.0 mm). Mean visual acuities(in log MAR units) before and after surgery were 1.8 and 1.7, respectively(P=0.29). Spherical equivalents were 1.3 diopter(D) before surgery and 0.7 D after surgery(P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively(P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2(0.56-6.89). No intra-or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.展开更多
文摘AIM:To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve(AGV) implantation. METHODS: Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure(IOP) >21 mm Hg or <5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS: A total of 64 eyes from 57 patients were included: 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP(P =0.005),lower baseline mean visual acuity(VA)(P =0.02),and higher proportion of patients with history of previous trabeculectomy(P <0.0001).Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group(P =0.0229).CONCLUSION: Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.
文摘AIM:To describe the experience with half-width vertical muscles transposition(VRT)augmented with posterior fixation sutures.METHODS:The clinical charts of all patients,who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018,were retrospectively reviewed.For each patient,pre-and post-operatively,the largest measured angle was used for the calculations,usually resulting with the angle for distance,except in young infants,where measurements were made at near fixation using the Krimsky test.RESULTS:Fifteen patients met the inclusion criteria for the study,of them 9(60.0%)had also medial rectus muscle recession at the time of surgery.Mean follow-up period was 21.4±23.2mo(range 1.5-82mo).Preoperative mean esotropia was 51.3±19.7 prism diopter(PD;range 20-90 PD).Postoperative mean deviation on final follow-up was 7.7±20.2 PD(range-40 to 35 PD;P=0.018).In all patients with preoperative abnormal head position,improvement was noted.Ten(66.7%)patients had improvement in abduction and 10(66.7%)patients reported improvement in their diplopia,by final follow-up.The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline(P=0.026).Two(13.3%)patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them.CONCLUSION:Half-width VRT augmented with posterior fixation suture,with or without medial rectus muscle recession,is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy.A major improvement in the angle of deviation is expected.Most patients will have improvement in their abnormal head position and diplopia.
基金Supported by the Research to Prevent Blindness Unrestricted Grant(New York,USA)the National Eye Institute core grant(No.P30-EY14801)(Bethesda,Maryland,USA)
文摘To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients(mean age: 13.0 y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm(6.0-12.0 mm). Mean visual acuities(in log MAR units) before and after surgery were 1.8 and 1.7, respectively(P=0.29). Spherical equivalents were 1.3 diopter(D) before surgery and 0.7 D after surgery(P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively(P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2(0.56-6.89). No intra-or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.
