AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated en...AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.展开更多
AIM: To report on the efficacy of combined endoscopic cyclophotocoagulation(ECP) and phacoemulsification cataract extraction(PCE) with intraocular lens placement for reduction of intraocular pressure(IOP) and medicati...AIM: To report on the efficacy of combined endoscopic cyclophotocoagulation(ECP) and phacoemulsification cataract extraction(PCE) with intraocular lens placement for reduction of intraocular pressure(IOP) and medication burden in glaucoma.·METHODS: A retrospective case review of 91 eyes(73patients) with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded,as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits(at 1, 3, 6, or 12 mo postoperatively),IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within12 mo after PCE/ECP.·RESULTS: Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo(P <0.0001). Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo(P =0.0003). At 3mo postoperatively,the success rate was 73.6%(95%CI: 63.3, 81.5), 57.1% at6mo(95% CI: 46.3, 66.6), and 49.7% at 12mo(95% CI:38.9, 59.6). Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.· CONCLUSION: Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients withhigher baseline IOP levels are most likely to benefit from this procedure.展开更多
AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting p...AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.展开更多
As cataract occurs frequently in patients with glaucoma, combining phacoemulsification and endoscopic cyclophotocoagulation has been gaining attention recently due to its minimally invasive nature. A variety of studie...As cataract occurs frequently in patients with glaucoma, combining phacoemulsification and endoscopic cyclophotocoagulation has been gaining attention recently due to its minimally invasive nature. A variety of studies had evaluated the efficacy and safety of this procedure and had shown extremely promising results. This review article has shown here that combined phacoemulsification and endoscopic cyclophotocoagulation procedure could effectively reduce intraocular pressure in medically uncontrolled glaucoma patients while avoiding serious complications associated with traditional cyclophotocoagulation procedure and adverse effects related to filtering surgery such as trabeculectomy.展开更多
To compare the histological effects of trans-scleral cyclophotocoagulation(TCP) performed with two different probes, the G-probe(IRIDEX Medical Instruments, Mountain View, CA, USA) and the Ciliprobe(Katalyst Surgical,...To compare the histological effects of trans-scleral cyclophotocoagulation(TCP) performed with two different probes, the G-probe(IRIDEX Medical Instruments, Mountain View, CA, USA) and the Ciliprobe(Katalyst Surgical, Chesterfield, MO, USA). TCP was performed on two human cadaver eyes from the same corpse. The vertical meridian was marked and opposite sides were treated using either the G-probe or Ciliprobe. The first eye was treated with each probe at 2000 ms/2000 mW and the second eye at 3000 ms/1500 mW. Histological examination revealed separation and loss of the non-pigmented ciliary epithelium as well as vacuolization in all sections for both probes and settings. Changes to the non-pigmented ciliary epithelium treated at 3000 ms/1500 mW were similar between the two probes. A slightly more complete separation of the non-pigmented epithelium was noted on the Ciliprobe treated sections as compared to the G-probe treated sections in the eye treated at 2000 ms/2000 mW. Therefore, in human cadaver eyes, both the G-probe and Ciliprobe produced separation, vacuolization, and loss of the non-pigmented ciliary epithelium at two different, clinically utilized settings.展开更多
Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective s...Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.展开更多
Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagula...Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagulation(PRP),and endoscopic cyclophotocoagulation(ECP)surgery for neovascular glaucoma(NVG)patients.Methods:This retrospective study included 30 patients(30 eyes)who were suffering from NVG and treated with PPV&PRP&ECP(ECP group,16 eyes),or Ahmed glaucoma valve implantation(Ahmed group,14 eyes).The intraocular pressure(IOP),number of postoperative anti-glaucoma medications,best-corrected visual acuity(BCVA),successful rate of surgery,and postoperative complications were recorded and statistically analyzed at the time points of preoperative,1-day,1-month,3-months,6-months,and 12-months after operation.Results:An obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation(P<0.05),and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months(P=0.014)and 12-months(P=0.047)postoperative time points,while there was no significant difference of medication number between the two groups except for 1-day after surgery.The BCVA showed no marked difference between the two groups preoperatively and postoperatively(P>0.05),while it was significantly improved in ECP group at 3-months(P=0.001),6-months(P=0.004),and 12-months(P=0.010)time points comparing with preoperative BCVA.The surgical success rates in ECP group were also slightly higher than Ahmed group.And the complications after operation showed no marked differences.Conclusions:The comprehensive treatment of PPV,endoscopic PRP,and ECP surgery for NVG patients after antiVEGF injection can control IOP effectively and be friendly to patients’BCVA without obvious serious complications throughout a 12-months follow-up period.展开更多
Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of o...Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. Methods: The case records of all patients who were managed in the department of ophthalmology from January 2013 to December 2017 for neovascular glaucoma were retrieved. Data collected included, age, sex, causes of neovascular glaucoma, presenting visual acuity, treatment options and outcomes, systemic and ocular comorbidities. Results were analysed using Statistical Package for Social Sciences (SPSS) 20.0 for Windows statistical software. Results: Thirty-two eyes (32) of twenty-eight patients were studied. The hospital prevalence of neovascular glaucoma was 0.3%. There were 4 cases of bilateral neovascular glaucoma (NVG). Retinal vein occlusion 17 (53%) was the commonest cause of NVG followed by proliferative diabetic retinopathy 13 (41%). Uveitis was seen in only 2 (6%) eyes. The commonest form of intervention used was a combination of medical therapy and anti VEGFs. Fifty percent (50%) of the study population had a lowering of their intraocular pressures within the normal limits post treatment and this was statistically significant (p = 0.000). However, only 10% had an improvement in their visual acuity after treatment. Conclusions: Neovascular glaucoma is a potential blinding condition with challenges in control of intraocular pressures and preservation of vision. Early detection and attention to aetiological factors with timely institution of the appropriate mode of treatment may help in preserving vision.展开更多
Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopat...Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema,subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma.Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques,including subthreshold selective laser trabeculoplasty(SSLT),micropulse laser trabeculoplasty(MLT),pattern-scanning laser trabeculoplasty(PSLT),titanium laser trabeculoplasty(TLT),and micropulse transscleral cyclophotocoagulation(MP-TSCPC).Methods:This was a narrative review compiled from literature of PubMed and Google Scholar.The review was performed from March 2021 to October 2021 and included publications in English.We also included information from web pages to cover details of relevant laser systems.We discuss the history of subthreshold laser,recent advancements in subthreshold techniques,and commercially available systems that provide subthreshold capabilities for glaucoma.We highlight basic science and clinical studies that deepen the understanding of treatment mechanisms and treatment effectiveness in the clinical setting respectively.We review commonly used parameters for each technique and provide comparisons to conventional treatments.Key Content and Findings:We found five distinct types of subthreshold laser used in the management of glaucoma.Numerous subthreshold laser systems are commercially available and can provide this treatment.Therefore,understanding the differences between subthreshold techniques and laser systems will be critical in utilizing subthreshold laser in the clinical setting.Conclusions:Traditional laser trabeculoplasty(LT)and cyclophotocoagulation(CPC)have shown effectiveness in the treatment of various types of glaucoma but are associated with visible damage to the underlying tissue and adverse effects.Subthreshold laser systems aim to provide the therapeutic effect found in traditional lasers,while minimizing unwanted treatment related effects.Further clinical studies are needed to evaluate the role of subthreshold lasers in the management of glaucoma.展开更多
Purpose:Description of safety and efficacy of micropulse lYanssderal cydophotocoagulation as a treatment option for refractory glaucoma.Mahods:This is a prospective study including 39 eyes of 31 patients foil owed for...Purpose:Description of safety and efficacy of micropulse lYanssderal cydophotocoagulation as a treatment option for refractory glaucoma.Mahods:This is a prospective study including 39 eyes of 31 patients foil owed for refractory glaucoma,who benefited from transsderal cyclophotocoagulation using a mic topi used laser.The main indication for tire procedure was increased ocular pressure refractory to quadri therapy in various types of glaucoma.Ihe patients were tieated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm.The parameter for tire procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an eneigy of 180 J.Both tire upper and lower hemispheres were treated in tire same procedure,sparing tire 3 o'clock and 9 o'clock meridians,and aD tire patients benefited from a single treatment session.The following parameters were evaluated;ocular pain and overall tolerance;visual acuity;and tire evolution of IOP postoperatively up to 9 months.Results:The glaucoma subtypes treated are as follows:primaty open-angle glaucoma(n=05),chronic angle-closure glaucoma(n=13),neovascular glaucoma(n=07),aphakic glaucoma(n=06),malignant glaucoma(n=04),post-traumatic angle recession(n=02),and inflammatoiy glaucoma(n=02).The mean pre-operative intraocular pressure was 42.3±5.2 mmHg and tire mean post operative intraocular pressure at 9 months was 16.9±1.9 mmHg The reduction in IOP was 49.9%.The average number of intraocular pressure-lowering medications used prior to surgery was four,and tire average number of medications used at tire 9-month postoperative visit was 2.0±1.2(703%of patients were on dual therapy).The overall success rate was 60.9%.Conclusions:Micropulse transsderal cydophotocoagulation appears to be a safe and effident treatment for refractory glaucoma.Its indications should therefore be broadened and proposed early in various situations.展开更多
文摘AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.
基金Supported by the Slater Family Endowment (MYK)NIH/NCATS Colorado CTSI Grant Number UL1 TR001082
文摘AIM: To report on the efficacy of combined endoscopic cyclophotocoagulation(ECP) and phacoemulsification cataract extraction(PCE) with intraocular lens placement for reduction of intraocular pressure(IOP) and medication burden in glaucoma.·METHODS: A retrospective case review of 91 eyes(73patients) with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded,as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits(at 1, 3, 6, or 12 mo postoperatively),IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within12 mo after PCE/ECP.·RESULTS: Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo(P <0.0001). Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo(P =0.0003). At 3mo postoperatively,the success rate was 73.6%(95%CI: 63.3, 81.5), 57.1% at6mo(95% CI: 46.3, 66.6), and 49.7% at 12mo(95% CI:38.9, 59.6). Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.· CONCLUSION: Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients withhigher baseline IOP levels are most likely to benefit from this procedure.
文摘AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.
基金Supported by the Science and Technology Foundation of Zhejiang Province, China (No.2015C33191)
文摘As cataract occurs frequently in patients with glaucoma, combining phacoemulsification and endoscopic cyclophotocoagulation has been gaining attention recently due to its minimally invasive nature. A variety of studies had evaluated the efficacy and safety of this procedure and had shown extremely promising results. This review article has shown here that combined phacoemulsification and endoscopic cyclophotocoagulation procedure could effectively reduce intraocular pressure in medically uncontrolled glaucoma patients while avoiding serious complications associated with traditional cyclophotocoagulation procedure and adverse effects related to filtering surgery such as trabeculectomy.
文摘To compare the histological effects of trans-scleral cyclophotocoagulation(TCP) performed with two different probes, the G-probe(IRIDEX Medical Instruments, Mountain View, CA, USA) and the Ciliprobe(Katalyst Surgical, Chesterfield, MO, USA). TCP was performed on two human cadaver eyes from the same corpse. The vertical meridian was marked and opposite sides were treated using either the G-probe or Ciliprobe. The first eye was treated with each probe at 2000 ms/2000 mW and the second eye at 3000 ms/1500 mW. Histological examination revealed separation and loss of the non-pigmented ciliary epithelium as well as vacuolization in all sections for both probes and settings. Changes to the non-pigmented ciliary epithelium treated at 3000 ms/1500 mW were similar between the two probes. A slightly more complete separation of the non-pigmented epithelium was noted on the Ciliprobe treated sections as compared to the G-probe treated sections in the eye treated at 2000 ms/2000 mW. Therefore, in human cadaver eyes, both the G-probe and Ciliprobe produced separation, vacuolization, and loss of the non-pigmented ciliary epithelium at two different, clinically utilized settings.
文摘Objective: This study aims to describe the experience with diode laser cyclophotocoagulation in the control of intraocular pressure and resolution of pain in patients with refractory glaucoma. Methods: Retrospective study. 64 eyes of 60 patients who underwent cyclophotocoagulation between January 2008 and March 2014. Evaluation of the pre- and post-operative intraocular pressure, the control of ocular pain, the number of anti-glaucoma drugs used in pre- and post-intervention, the rate of complications and the success rate. Results: There was an overall success rate of 81.3%, with 9 eyes needing a second intervention. There was a mean reduction of 52.6% of the preoperative mean intraocular pressure of 41.25 to 19.56 mmHg at 12 months observation (p < 0.001). There was also a statistically significant reduction in the number of anti-glaucoma drugs used from 3.19 to 2.01 per eye and the resolution of pain in 75% of patients. Conclusions: cyclophotocoagulation is an effective procedure, with an expected positive impact on quality of life of patients as a result from the decreased number of anti-glaucoma drugs, sustained intraocular pressure reduction and resolution of pain.
基金supported by the Clinical diagnosis and treatment technology and translational application in Beijing (Z211100002921049).
文摘Purpose:To establish a comprehensive treatment strategy and evaluate the efficacy of combination of anti-vascular endothelial growth factor(VEGF)injection,pars plana vitrectomy(PPV),endoscopic pan-retinal photocoagulation(PRP),and endoscopic cyclophotocoagulation(ECP)surgery for neovascular glaucoma(NVG)patients.Methods:This retrospective study included 30 patients(30 eyes)who were suffering from NVG and treated with PPV&PRP&ECP(ECP group,16 eyes),or Ahmed glaucoma valve implantation(Ahmed group,14 eyes).The intraocular pressure(IOP),number of postoperative anti-glaucoma medications,best-corrected visual acuity(BCVA),successful rate of surgery,and postoperative complications were recorded and statistically analyzed at the time points of preoperative,1-day,1-month,3-months,6-months,and 12-months after operation.Results:An obvious reduction in IOP and number of postoperative anti-glaucoma medications were observed in both the ECP group and Ahmed group after operation(P<0.05),and the ECP group showed a significantly lower IOP compared to the Ahmed group at the 6-months(P=0.014)and 12-months(P=0.047)postoperative time points,while there was no significant difference of medication number between the two groups except for 1-day after surgery.The BCVA showed no marked difference between the two groups preoperatively and postoperatively(P>0.05),while it was significantly improved in ECP group at 3-months(P=0.001),6-months(P=0.004),and 12-months(P=0.010)time points comparing with preoperative BCVA.The surgical success rates in ECP group were also slightly higher than Ahmed group.And the complications after operation showed no marked differences.Conclusions:The comprehensive treatment of PPV,endoscopic PRP,and ECP surgery for NVG patients after antiVEGF injection can control IOP effectively and be friendly to patients’BCVA without obvious serious complications throughout a 12-months follow-up period.
文摘Purpose: To determine the prevalence, identify the causes and outline the management options available at our center for the treatment of neovascular glaucoma. Setting: The study was carried out in the department of ophthalmology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria. Methods: The case records of all patients who were managed in the department of ophthalmology from January 2013 to December 2017 for neovascular glaucoma were retrieved. Data collected included, age, sex, causes of neovascular glaucoma, presenting visual acuity, treatment options and outcomes, systemic and ocular comorbidities. Results were analysed using Statistical Package for Social Sciences (SPSS) 20.0 for Windows statistical software. Results: Thirty-two eyes (32) of twenty-eight patients were studied. The hospital prevalence of neovascular glaucoma was 0.3%. There were 4 cases of bilateral neovascular glaucoma (NVG). Retinal vein occlusion 17 (53%) was the commonest cause of NVG followed by proliferative diabetic retinopathy 13 (41%). Uveitis was seen in only 2 (6%) eyes. The commonest form of intervention used was a combination of medical therapy and anti VEGFs. Fifty percent (50%) of the study population had a lowering of their intraocular pressures within the normal limits post treatment and this was statistically significant (p = 0.000). However, only 10% had an improvement in their visual acuity after treatment. Conclusions: Neovascular glaucoma is a potential blinding condition with challenges in control of intraocular pressures and preservation of vision. Early detection and attention to aetiological factors with timely institution of the appropriate mode of treatment may help in preserving vision.
文摘Background and Objective:Subthreshold laser technologies and their applications in ophthalmology have greatly expanded in the past few decades.Initially used for retinal diseases such as central serous chorioretinopathy and diabetic macular edema,subthreshold lasers have recently shown efficacy in the treatment of various types of glaucoma.Our primary objectives are to review the clinical applications of subthreshold laser in the context of glaucoma treatment and discuss the mechanisms of different subthreshold laser techniques,including subthreshold selective laser trabeculoplasty(SSLT),micropulse laser trabeculoplasty(MLT),pattern-scanning laser trabeculoplasty(PSLT),titanium laser trabeculoplasty(TLT),and micropulse transscleral cyclophotocoagulation(MP-TSCPC).Methods:This was a narrative review compiled from literature of PubMed and Google Scholar.The review was performed from March 2021 to October 2021 and included publications in English.We also included information from web pages to cover details of relevant laser systems.We discuss the history of subthreshold laser,recent advancements in subthreshold techniques,and commercially available systems that provide subthreshold capabilities for glaucoma.We highlight basic science and clinical studies that deepen the understanding of treatment mechanisms and treatment effectiveness in the clinical setting respectively.We review commonly used parameters for each technique and provide comparisons to conventional treatments.Key Content and Findings:We found five distinct types of subthreshold laser used in the management of glaucoma.Numerous subthreshold laser systems are commercially available and can provide this treatment.Therefore,understanding the differences between subthreshold techniques and laser systems will be critical in utilizing subthreshold laser in the clinical setting.Conclusions:Traditional laser trabeculoplasty(LT)and cyclophotocoagulation(CPC)have shown effectiveness in the treatment of various types of glaucoma but are associated with visible damage to the underlying tissue and adverse effects.Subthreshold laser systems aim to provide the therapeutic effect found in traditional lasers,while minimizing unwanted treatment related effects.Further clinical studies are needed to evaluate the role of subthreshold lasers in the management of glaucoma.
文摘Purpose:Description of safety and efficacy of micropulse lYanssderal cydophotocoagulation as a treatment option for refractory glaucoma.Mahods:This is a prospective study including 39 eyes of 31 patients foil owed for refractory glaucoma,who benefited from transsderal cyclophotocoagulation using a mic topi used laser.The main indication for tire procedure was increased ocular pressure refractory to quadri therapy in various types of glaucoma.Ihe patients were tieated using iridex Cyclo G6 laser with a Micropulse P3 infrared probe with a wavelength of 810 nm.The parameter for tire procedure were a duration of 90 s per hemisphere with a power of 2000 mW and an eneigy of 180 J.Both tire upper and lower hemispheres were treated in tire same procedure,sparing tire 3 o'clock and 9 o'clock meridians,and aD tire patients benefited from a single treatment session.The following parameters were evaluated;ocular pain and overall tolerance;visual acuity;and tire evolution of IOP postoperatively up to 9 months.Results:The glaucoma subtypes treated are as follows:primaty open-angle glaucoma(n=05),chronic angle-closure glaucoma(n=13),neovascular glaucoma(n=07),aphakic glaucoma(n=06),malignant glaucoma(n=04),post-traumatic angle recession(n=02),and inflammatoiy glaucoma(n=02).The mean pre-operative intraocular pressure was 42.3±5.2 mmHg and tire mean post operative intraocular pressure at 9 months was 16.9±1.9 mmHg The reduction in IOP was 49.9%.The average number of intraocular pressure-lowering medications used prior to surgery was four,and tire average number of medications used at tire 9-month postoperative visit was 2.0±1.2(703%of patients were on dual therapy).The overall success rate was 60.9%.Conclusions:Micropulse transsderal cydophotocoagulation appears to be a safe and effident treatment for refractory glaucoma.Its indications should therefore be broadened and proposed early in various situations.
