AIM:To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C(MMC)in Southwest Chinese patients.METHODS:A retrospective correlational study was conducted on the glaucomatous patien...AIM:To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C(MMC)in Southwest Chinese patients.METHODS:A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)>5 and≤21 mm Hg and 20%reduction of IOP compared to preoperative,without IOP-lowering medications.A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications.The primary outcomes were IOP,the number of IOP-lowering medications,and cumulative success rate.The secondary outcomes included best corrected visual acuity(BCVA),mean deviation(MD)of visual field,major complications,and risk factors for surgical failure.RESULTS:A total of 325 eyes of 261 glaucomatous patients had been included in our study.Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg(P<0.0001)and 3.0±0.9 to 0.9±1.0(P<0.0001),respectively,at the last visit.The cumulative complete success rate and qualified success rate were 77.8%and 92.0%at 1-year follow-up,and 47.2%and 77.7%at 3-year follow up.There were no significant differences in surgical outcomes between primary angle-closure glaucoma(PACG)and primary open angle glaucoma(POAG).In PACG patients,the success rates of trabeculectomy were comparable with those of phacotrabeculectomy.Hypertension(HR=1.904,P=0.011),encapsulated bleb(HR=2.756,P<0.001),and more preoperative topical medications(HR=2.475,P=0.008)were risk factors for surgical failure.CONCLUSION:The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0%at 1-year,and 77.7%at 3-year follow up.Hypertension,encapsulated bleb,and more preoperative topical medications are associated with surgical failure.展开更多
AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective stud...AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.展开更多
Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1,...Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.展开更多
Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1,...Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.展开更多
AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eye...AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma(OAG).Twentynine patients were allocated in group I(trabeculectomy with Ologen;trab-ologen group),while 28 patients were assigned in group II(trabeculectomy with perfluoropropane gas bubble;trab-C3 F8 gas bubble group).RESULTS:The intraocular pressure(IOP)was significantly reduced in both study groups at all postoperative follow up intervals(1 wk,3,6,12,18,24,30 and 36 mo,P<0.001).The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up.However,the trab-ologen group achieved a statistically significant reduction over the trab-C3 F8 gas bubble group during the last 24 months of follow up.CONCLUSION:Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.展开更多
AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG)....AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG).METHODS:This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included:diabetic retinopathy(25 eyes),and retinal vein occlusion(20 eyes).All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities(BCVA)were converted to the logarithms of the minimum angle of resolution(log MAR)for the statisitical analyses.Intraocular pressure(IOP),the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS:A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery(F=545.468,P<0.05),and the mean postoperative log MAR BCVA was also significantly improved(F=10.964,P<0.05)with no significant difference between two groups.CONCLUSION:It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.展开更多
●AIM:To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0 mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.●METHODS:Ninety-s...●AIM:To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0 mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.●METHODS:Ninety-six patients(96 eyes)with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017.Group A(3.0 mm incision),B(2.2 mm incision),and C(1.8 mm incision)comprised 30,34 and 32 eyes respectively.All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy.Data including best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell counts(CECC),intraocular pressure(IOP),and complications were collected before the operation,and at postoperative 1 d,1 and 3 mo.●RESULTS:All the patients were successfully treated with surgery.The BCVA of groups B and C were significantly improved as compared to group A at postoperative 1 d,1 and 3 mo(all P<0.05),but there was no difference between groups B and C at each time interval(all P>0.05).The corneal astigmatism of group A was statistically higher than that of group B(P=0.026);corneal astigmatism of group B was statistically higher than that of group C at postoperative 1 d(P=0.006).The corneal astigmatism of group A at postoperative 3 mo was significantly higher than that before operation(P=0.003).At postoperative 1 and 3 mo,corneal astigmatism of groups B and C were significantly lower than that of group A(all P<0.05).The CECC in group B was significantly higher than that of group A(P=0.020),and CECC in group C was significantly higher than that of group B(P=0.034)at postoperative 1 d.At postoperative 1 and 3 mo,CECC of groups B and C were significantly higher than that of group A(all P<0.05).In each group,postoperative mean IOP at each time interval was significantly lower than preoperative IOP(all P<0.05).●CONCLUSION:Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery,and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.展开更多
AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C(MMC) application as a first line treatment in advanced glaucoma. ·METHODS: The records of 55 patients with severe visual field defects u...AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C(MMC) application as a first line treatment in advanced glaucoma. ·METHODS: The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy(initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy(primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure(IOP) values,visual acuities,mean deviations,morphology and function of the blebs,necessity for anti-glaucomatous medications and surgical complications were reported. ·RESULTS: There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg(27-68mmHg) and 29.0±4.4mmHg(21-41mmHg),respectively(P=0.001). Average preoperative mean deviations(MD) in Groups 1 and 2 were 17.4±2.8dB(13.3-23dB) and 17.9± 2.4dB(13.7-23.2dB),respectively(P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2(P =0.005). No cystic bleb formation was observed in Group 1,whereas 4 patients from Group 2(10.8%) developed cystic bleb(P =0.040). No visually devastating complication has occurred in both Groups. ·CONCLUSION: Initial trabeculectomy with large areaMMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.展开更多
● AIM: To compare the outcomes of Ex-PRESS implantation in one eye versus trabeculectomy with mitomycin C in the fellow eye in Chinese patients with primary open-angle glaucoma(POAG).● METHODS: This was a prospectiv...● AIM: To compare the outcomes of Ex-PRESS implantation in one eye versus trabeculectomy with mitomycin C in the fellow eye in Chinese patients with primary open-angle glaucoma(POAG).● METHODS: This was a prospective, non-randomized comparative study. Forty-eight eyes of 24 patients with bilateral POAG necessitating surgery were included and underwent Ex-PRESS implantation under the scleral flap in one eye and trabeculectomy in the other eye according to patients' choice. Primary outcome measures included mean intraocular pressure(IOP) and success rate. Secondary outcome measures were aqueous flare, postoperative medication use, visual acuity, and incidence of complications. ● RESULTS: All 24 patients finished a 1-year follow-up. Both groups maintained significant reductions in IOP after surgery throughout the follow-up period. At any point in time, the IOP of the two groups did not differ significantly. The Kaplan-Meier survival curve analysis showed no significant differences in success between the two groups(P=0.289). The mean number of anti-glaucoma medicines and visual acuity in both groups were not significantly different. Eyes with Ex-PRESS implantation had lower aqueous flare values on days 1 and 3(both P<0.05). Instances of early postoperative hypotony and choroidal effusion were significantly fewer in frequency after Ex-PRESS implantation under the scleral flap compared with those after trabeculectomy(P <0.001).● CONCLUSION: Ex-PRESS is comparable to trabeculectomy in terms of IOP, success rate, number of glaucoma medications used, and visual acuity. However, Ex-PRESS resulted in fewer cases of inflammation and a lower rate of complications.展开更多
AIM:To evaluate the safety and efficacy of cellular photoablation using BCECF-AM[2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein,acetoxymethyl ester mixed isomers]as a method to control postoperative f...AIM:To evaluate the safety and efficacy of cellular photoablation using BCECF-AM[2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein,acetoxymethyl ester mixed isomers]as a method to control postoperative fibrosis in subscleral trabeculectomy(SST) compared to mitomycin C(MMC) in a rabbit model.· METHODS:A comparative prospective case-control animal study was conducted.Fourteen rabbits were subjected to SST with intraoperative use of wound modulating agents(MMC or BCECF-AM) of the right eye(study groups Ⅰ and Ⅱ respectively) and SST without use of intraoperative wound modulating agents for the left eye(control group Ⅱ).Two rabbits 4 eyes were considered as control group Ⅰ with no surgical intervention.BCECF-AM was injected subconjunctivally30 min before surgery followed by intraoperative illumination with diffuse blue light for 10 min.Antifibrotic efficacy was established by clinical response and histological examination.Clinical response was assessed by measuring intraocular pressure(IOP) at day 1,3,5,7,14,21 postoperatively.Success was defined by >20.0%reduction in IOP from the preoperative values without anti-glaucoma medications.· RESULTS:The mean percentage of reduction was35.0%in the study group Ⅰ with only one eye(14.3%) had12.5%reduction.The mean percentage of reduction was28.0%in the study group Ⅱ with two eyes(28.6%) in study group Ⅱ had 14.2%reduction each.Regarding the control group Ⅱ,the mean percentage of reduction was14.3%with 64.3%eyes had <20.0%reduction.There was a highly statistically significant difference between each of the study groups(right eyes) and the corresponding control group Ⅱ(left eyes) as regards the mean postoperative IOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period.Histologically,MMC treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control.Marked sub-epithelial edema was seen along with variable collagen dispersion.Mild cellularity was noted in sub-epithelial tissue.BCECF-AM treated blebs showed normal conjunctival epithelial thickness with abundant goblet cells.Mild subepithelial edema was noted along with moderate collagen dispersion.No histological abnormality was noted in the ciliary body or the cornea in any of the studied groups.· CONCLUSION:Cellular photoablation using BCECF-AM is a safe and effective wound modulating agent to control postoperative fibrosis in trabeculectomy.However MMC considered as a more potent adjuvant to trabeculectomy than BCECF-AM in promoting IOP reduction.展开更多
AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electronic d...AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electronic databases(Pub Med,EMBASE,ISI Web of science and Cochrane library),and data,such as intraocular pressure(IOP),the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference(WMD),odds ratio(OR)and 95%confidence intervals(CIs)were calculated and were pooled using a randomeffects model.·RESULTS:Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction(IOPR%)at 1,2y(WMD:-2.01;95%CI:-7.92-3.90;P=0.50 and WMD:2.89;95%CI:-8.05-13.83;P=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;P=0.02 and OR:1.74;95%CI:1.06-2.86;P=0.03,respectively).Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab(OR:0.39;95%CI:0.21-0.72;P=0.003 and OR:0.27;95%CI:0.10-0.69;P=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·CONCLUSION:Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.展开更多
AIM:To observe effects of trabeculectomy with amniotic membrane transplantation(AMT) in controlling postoperative intraocular pressure(IOP) in patients with medically uncontrolled glaucoma.·METHODS:This study inc...AIM:To observe effects of trabeculectomy with amniotic membrane transplantation(AMT) in controlling postoperative intraocular pressure(IOP) in patients with medically uncontrolled glaucoma.·METHODS:This study included adult patients with requiring bilateral glaucoma surgery.Each patient underwent trabeculectomy(Non-AMT group) in one eye and with AMT(AMT group) in the other eye according to randomized principle.Success was defined as intraocular pressure(IOP) <21mmHg without any anti-glaucoma medications at 24 months follow-up.The two groups were compared in terms of IOP,complications and success rate.·RESULTS:Thirty-four eyes of 17 patients were investigated in this study.There was no statistically signifcant difference in pre-operative IOP between the two groups.The mean IOP was lower in AMT group compared with Non-AMT group on follow up months 12,18,and 24.Postoperative complications were more frequent in Non-AMT group(35.3%,6/17) compared with AMT group(5.9%,1/17).The success rate of surgery was88.2%(15/17) in Non-AMT group and 100%(17/17) in AMT group.·CONCLUSION:Trabeculectomy with AMT is an effective procedure to reduce IOP and complications,thereby improving surgical success rates.展开更多
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 study the success and outcome of trabeculectomy in Hospital Melaka.· METHODS:Medical records of all patients who underwent trabeculectomy between January 1,2007 and October 31,2010 whom were followed up fo...AIM:To study the success and outcome of trabeculectomy in Hospital Melaka.· METHODS:Medical records of all patients who underwent trabeculectomy between January 1,2007 and October 31,2010 whom were followed up for at least 6 months postoperatively in Hospital Melaka were retrospectively reviewed.· RESULTS:A total number of 117 eyes of 91 patients with the age range between 12 to 84 years underwent primary trabeculectomy(n =20,17.1%),combine trabeculectomy with cataract surgery(n =90,76.9%),repeat trabeculectomy(n=5,4.3%),and combine repeat trabeculectomy with cataract surgery(n =2,1.7%).The disease spectrum includes primary open-angle glaucoma(POAG)(54 patients,59.3%),priamry angle-closure glaucoma(PACG)(14 patients,15.4%),secondary glaucomas(19 patients,20.9%) and juvenile glaucomas(4 patients,4.4%).Preoperative mean intraocular pressure(IOP) was(24.69±8.67)mmHg as compared to postoperative mean IOP of(15.81±6.66)mmHg,(15.07±4.72)mmHg and(15.68±3.65)mmHg at 6-month,12-month and 24-month respectively.Eighty-two point one percent of eyes(n =96) achieved complete success(CS),12.8%(n =15) with qualified success(QS) and only 5.1%(n = 6) failed at 6 month with two of them warrant other filtering surgery.At twelve months,trabeculectomy with CS was 71.6%(n =63),QS in 22.7%(n =20) and failure in 5.7%(n = 5).Sixty-seven point five percent(n =27) attained CS,20.0%(n =8) with QS while 12.5%(n =5) failed at 24 month postoperative.· CONCLUSION:As the understanding of the lower the IOP,the better the patients retaining the visual function,trabeculectomy is significantly a choice of treatment in uncontrolled glaucoma.This study concluded that trabeculectomy performed in Hospital Melaka has produced significant success as compared to other studies.展开更多
AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure(IOP) and reduct...AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure(IOP) and reduction of postoperative bleb vascularization and fibrosis.METHODS: A prospective, one center, randomized, placebo-control study. Fifty-nine patients(59 eyes) with uncontrolled IOP under maximal tolerated medical treatment(MTMT) were recruited. A primary trabeculectomy with mitomycin C(MMC) was done and the patients were randomized to either postoperative subconjunctival injection of bevacizumab(1.25 mg/0.05 mL) or balanced salt solution(BSS). Forty-seven patients(47 eyes) completed at least one year of follow up and were included in the study. The main outcome measure was the IOP, and secondary outcome measures include bleb morphology, vascularization, and fibrosis, as well as the need for glaucoma medications and 5-fluorouracil(5-FU) needling.RESULTS: At 1-year follow up, there was no significant difference between groups for IOP(P=0.65), bleb morphology(P=0.65), and the need for glaucoma medications(P=0.65) or 5-FU needling requirements(P=0.11). However, the bevacizumab group had a higher rate of success results, lower use of glaucoma medications after surgery, and optimal bleb aspect in more patients, but more 5-FU needling procedures required. CONCLUSION: A bigger sample size is needed in order to determine whether the differences found in the bevacizumab group are statistically significant.展开更多
AIM: To evaluate the effect of amniotic membrane loaded with 5-fluorouracil poly(lactic-co-glycolic acid)(PLGA) nanoparticles(5-FU-NPs) in the surgical outcomes of experimental trabeculectomy in rabbits.METHODS: Thirt...AIM: To evaluate the effect of amniotic membrane loaded with 5-fluorouracil poly(lactic-co-glycolic acid)(PLGA) nanoparticles(5-FU-NPs) in the surgical outcomes of experimental trabeculectomy in rabbits.METHODS: Thirty-two New Zealand white rabbits were randomly categorized into four groups with 8 rabbits in each group. Group 1, the control group, performed traditional trabeculectomy without adjuvant treatment.While the experimental groups performed compound trabeculectomy with different implantations including amniotic membrane(group 2), 5-FU-NPs(group 3) and amniotic membrane loaded with 5-FU-NPs(group 4).Clinical evaluations including IOP measurement and filtration bleb analysis were performed in all groups postoperatively.RESULTS: There is no significant difference of mean IOP in all groups at first 7d after surgery. While at P14,mean IOPs of experimental group 2(9.8 ±2.1 mm Hg),groups 3(8.9 ±2.8 mm Hg) and group 4(7.6 ±2.3 mm Hg)were significantly reduced compared to control group(12.4 ±2.6 mm Hg; n =8, P <0.05). At P21, mean IOPs of groups 3(11.7±3.2 mm Hg) and group 4(9.9±1.6 mm Hg)were significantly decreased compare to control group(17.9±1.6 mm Hg) and group 2(16.6 ±2.8 mm Hg; n =8,P <0.05). At P28, mean IOPs of groups 3(13.8±3.3 mm Hg)and group 4(10.6 ±2.0 mm Hg) were also significantly reduced compare to control group(19.4±2.3 mm Hg) and group 2(18.5 ±2.4 mm Hg; n =8, P <0.05). Meanwhile mean IOP of group 4 is significantly decreased compared to group 3 at P28(n =8, P <0.05). Survival analysis of functional filtration blub in all groups revealed the longest survival time in group 4(24.9±5.1d) compared to that in group 3(20.6 ±4.3d), group 2(15.0 ±5.2d) and control group(10.1±5.7d).CONCLUSION: Amniotic membrane loaded with 5-FuNPs may function as an effective anti-scarring implant and provides improved long-term surgical outcomes for experimental trabeculectomy in rabbits.展开更多
· AIM: To investigate the antifibrotic effect of freeze-dried bilayered fibrin-binding amniotic membrane on trabeculectomy in a rabbit model. · METHODS: Twenty-four Japanese white rabbits were randomized int...· AIM: To investigate the antifibrotic effect of freeze-dried bilayered fibrin-binding amniotic membrane on trabeculectomy in a rabbit model. · METHODS: Twenty-four Japanese white rabbits were randomized into three groups: the experimental group (ocular trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane transplantation), the control group (ocular trabeculectomy in combination with natural bilayered fibrin-binding amniotic membrane) and the blank group (single trabeculectomy). Clinical observation, hematoxylin-eosin staining, Massion staining, real-time PCR and immunohistochemistry for α-SMA were performed on days 7, 14, 21 and 30 following surgery. · RESULTS: Statistical differences were noted in survival analysis and intraocular pressure(IOP) among groups on days 7, 14, 21 and 30 following surgery. Histology, immunoh- istochemistry and real-time PCR further demonstrated that trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane resulted in good wound healing and no scar formation. · CONCLUSION: Self-made freeze-dried bilayered fibrin- binding amniotic membrane may inhibit the formation of scarring in glaucoma after trabeculectomy. ·展开更多
AIM: To explore the effect of Qingguangan on the expressions of MMP-2 and MMP-9 in filtering bleb scarring area after trabeculectomy in rabbit model. METHODS: Thirty-two New Zealand rabbits were randomized into four g...AIM: To explore the effect of Qingguangan on the expressions of MMP-2 and MMP-9 in filtering bleb scarring area after trabeculectomy in rabbit model. METHODS: Thirty-two New Zealand rabbits were randomized into four groups: control group, experimental group, MMC group (ocular trabeculectomy in combination with MMC), and Qingguangan group. Trabeculectomy was performed on both eyes in each group except control group. Qingguangan group was mouth-fed with Qingguangan (solution). On postoperative day 14, the appearances of MMP-2 and MMP-9 on filtrating blebs were observed by immunohistochemistry. RESULTS: Statistical differences of the expressions of MMP-2 and MMP-9 were noted among groups on day 14 following surgery. Histology immunohistochemistry showed significant differences on the expressions of MMP-2 and MMP-9 between each groups(P <0.05). CONCLUSION: Qingguangan can promote the expressions of MMP-2 and MMP-9.展开更多
AIM: To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma.· METHODS: Potentially relevant studies were systematically searched using various databases from in...AIM: To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma.· METHODS: Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction(IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events.· RESULTS: We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference(WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12 mo was-2.33(95%CI:-4.00,-0.66). There was not significant improvement in the complete or qualified success rate(OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction(WMD:-0.54, 95% CI:-1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result.· CONCLUSION: Trabeculectomy seems to be more effective in lowering IOP up to 12 mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.展开更多
AIM:To investigate the influence of He-Ne lasers on scar formation in the filtration canal after trabeculectomy in a rabbit model,as well as to explore the mechanisms for preventing scar formation when using He-Ne las...AIM:To investigate the influence of He-Ne lasers on scar formation in the filtration canal after trabeculectomy in a rabbit model,as well as to explore the mechanisms for preventing scar formation when using He-Ne lasers in vivo. METHODS:Experiment 1:Four groups were established （four eyes in each group）.In 12 eyes,the upper nasal limbus area next to the upper rectus muscle received 10 minutes of He-Ne laser irradiation（100,150,200mW/cm<sup>2</sup>;60,90, 120J/cm<sup>2</sup>）every day for three days.Four eyes served as controls.Twenty-four hours after the final irradiation,the rabbits were sacrificed and the irradiated tissue was excised, fixed with paraformaldehyde and tested for proliferating cell nuclear antigen（PCNA）,connective tissue growth factor （CTGF）and apoptosis（TUNEL）.Experiment 2:Forty-two rabbits were randomly divided into two groups and standard trabeculectomy was performed in the right eyes either after 200mW/cm<sup>2</sup> He-Ne laser irradiation or not in the filtration area.The expression of PCNA and CTGF,apoptosis and collagen density in the filtration area were tested on the 7<sup>th</sup>, 14<sup>th</sup>and 28<sup>th</sup>day after surgery. RESULTS:Experiment 1:There were no more PCNA and CTGF positive cells in the He-Ne irradiation group than in the control group.No apoptotic cells were found in either group. Experiment 2:The expression of PCNA and CTGF was lower in the He-Ne irradiation group than in the control group on the 7<sup>th</sup>and 14<sup>th</sup>day after trabeculectomy surgery（P【0.05）; no apoptotic cells were detected in either group.Collagen density was significantly lower in the He-Ne irradiation group than in the control group on the 14<sup>th</sup>and 28<sup>th</sup>day after surgery（P【0.05）. CONCLUSION:Pretreating the filtration area with 200mW/cm<sup>2</sup> （120J/cm<sup>2</sup>）of He-Ne laser irradiation may be helpful in preventing scar formation after trabeculectomy,possibly due to the downregulation of the expression of PCNA,CTGF and collagen synthesis in fibroblasts.展开更多
基金Supported by the National Natural Science Foundation of China(No.81770972)。
文摘AIM:To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C(MMC)in Southwest Chinese patients.METHODS:A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3y.A complete success for surgery is defined as a postoperative intraocular pressure(IOP)>5 and≤21 mm Hg and 20%reduction of IOP compared to preoperative,without IOP-lowering medications.A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications.The primary outcomes were IOP,the number of IOP-lowering medications,and cumulative success rate.The secondary outcomes included best corrected visual acuity(BCVA),mean deviation(MD)of visual field,major complications,and risk factors for surgical failure.RESULTS:A total of 325 eyes of 261 glaucomatous patients had been included in our study.Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9±12.0 to 16.4±5.7 mm Hg(P<0.0001)and 3.0±0.9 to 0.9±1.0(P<0.0001),respectively,at the last visit.The cumulative complete success rate and qualified success rate were 77.8%and 92.0%at 1-year follow-up,and 47.2%and 77.7%at 3-year follow up.There were no significant differences in surgical outcomes between primary angle-closure glaucoma(PACG)and primary open angle glaucoma(POAG).In PACG patients,the success rates of trabeculectomy were comparable with those of phacotrabeculectomy.Hypertension(HR=1.904,P=0.011),encapsulated bleb(HR=2.756,P<0.001),and more preoperative topical medications(HR=2.475,P=0.008)were risk factors for surgical failure.CONCLUSION:The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0%at 1-year,and 77.7%at 3-year follow up.Hypertension,encapsulated bleb,and more preoperative topical medications are associated with surgical failure.
基金Supported by the National Natural Science Foundation of China(No.82070955)the Science and Technology Program of Guangzhou(2022),China(No.202201020362)the High-level Hospital Construction Project,Zhongshan Ophthalmic Center,Sun Yat-sen University(No.303020104)。
文摘AIM:To evaluate the safety and efficacy of posterior scleral application(a modified technique)of an antimetabolite mitomycin C-soaked sponge in trabeculectomy for patients with glaucoma.METHODS:This retrospective study included 101 patients(115 eyes)with glaucoma(aged 12–83y)who underwent trabeculectomy using a modified mitomycin C-soaked sponge placement method.A piece of 3.5×10 mm2 sponge was placed vertically and posteriorly with the long side perpendicular to the limbus.The mitomycin C concentration and exposure time were 0.2–0.5 mg/m L and 1–5min,respectively.Intraocular pressure,bestcorrected visual acuity,and hypotensive medications were recorded at baseline and at the final visit.Complications,interventions required,and bleb morphology were recorded postoperatively.The primary outcome was trabeculectomy safety,including complications and bleb morphology;the secondary outcome was the trabeculectomy success rate.RESULTS:At the final follow-up[median 28mo,range 7–67mo and interquartile range(IQR)13mo],the qualified(cumulative)success rate was 93.0%and the complete success rate was 60.0%.No bleb-related complications were observed.The mean height,extent,and vascularity grades were 0.6±0.9,1.1±0.4,and 2.4±0.9,respectively.All Seidel tests were negative.The mean posteriority grade was 0.8±0.4.CONCLUSION:Trabeculectomy with the long side of a mitomycin C-soaked sponge placed perpendicular to the corneal limbus is safe and effective.
文摘Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.
文摘Aim: The aim is to evaluate the safety and efficacy of phacoemulsification with goniosynechialysis versus trabeculectomy in the treatment of acute angle closure glaucoma (AACG) systematically. Methods: From January 1, 2000 to August 31, 2022, we searched PubMed, Science Citation Index Database, China National Knowledge Infrastructure, and Wanfang Database for pertinent material about the treatment of AACG with various operations. The imported literature was carefully vetted using the inclusion and exclusion criteria, assessed for quality, and the raw data were retrieved and integrated into EndNoteX9. For the meta-analysis, STATA 16.0 and RevMan 5.3 were used as the tools. Results: The meta-analysis includes 20 clinical investigations in all, involving 1463 eyes. The quality of the literature was rated as excellent and the data homogeneity among the studies was excellent based on the various study types that were included in the literature. According to a meta-analysis, phacoemulsification with goniosynechialysis is superior to trabeculectomy for treating acute angle-closure glaucoma because it results in improved postoperative visual acuity, lower intraocular pressure, a broader anterior chamber depth, and fewer complications. Conclusion: If conditions allow, phacoemulsification in conjunction with goniosynechialysis performs better than trabeculectomy in terms of visual acuity, intraocular pressure, anterior chamber depth, and comorbidities.
文摘AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma(OAG).Twentynine patients were allocated in group I(trabeculectomy with Ologen;trab-ologen group),while 28 patients were assigned in group II(trabeculectomy with perfluoropropane gas bubble;trab-C3 F8 gas bubble group).RESULTS:The intraocular pressure(IOP)was significantly reduced in both study groups at all postoperative follow up intervals(1 wk,3,6,12,18,24,30 and 36 mo,P<0.001).The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up.However,the trab-ologen group achieved a statistically significant reduction over the trab-C3 F8 gas bubble group during the last 24 months of follow up.CONCLUSION:Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.
文摘AIM:To evaluate the efficacy and safety of intravitreal ranibizumab(IVR)with panretinal photocoagulation(PRP)followed by trabeculectomy compared with Ahmed glaucoma valve(AGV)implantation in neovascular glaucoma(NVG).METHODS:This was a retrospective comparative study.We reviewed the cases of a total of 45 eyes from 45 NVG patients among which 23 eyes underwent AGV implantation and the other 22 underwent trabeculectomy. The causes of neovascular glaucoma included:diabetic retinopathy(25 eyes),and retinal vein occlusion(20 eyes).All patients received preoperative IVR combined with postoperative PRP. The mean best-corrected visual acuities(BCVA)were converted to the logarithms of the minimum angle of resolution(log MAR)for the statisitical analyses.Intraocular pressure(IOP),the log MAR BCVA and surgical complications were evaluated before and after surgery.The follow-up period was 12 mo.RESULTS:A total of 39 cases showed complete regression of iris neovascularization at 7d after injection,and 6 cases showed a small amount of residual iris neovascularization. The success rates were 81.8% and 82.6% at 12 mo after trabeculectomy and AGV implantation,respectively. In the trabeculectomy group,the log MAR BCVA improved at the last follow-up in 14 eyes,remained stable in 6 eyes and decreased in 2 eyes. In 4 cases,slight hyphemas developed after trabeculectomy. A shallow anterior chamber developed in 2 cases and 2 vitreous hemorrhages. In the AGV group,the log MAR BCVA improved in 14 eyes,remained stable in 5 eyes and decreased in 4 eyes. Slight hyphemas developed in 3 cases,and a shallow anterior chamber in 3 cases. The mean postoperative IOP was significantly lower in both groups after surgery(F=545.468,P<0.05),and the mean postoperative log MAR BCVA was also significantly improved(F=10.964,P<0.05)with no significant difference between two groups.CONCLUSION:It is safe and effective to treat NVG with this combined procedure,and we found similar results after IVR+AGV implantation+PRP and IVR+trabeculectomy+PRP in eyes with NVG.
文摘●AIM:To compare efficacy of coaxial microincisions(1.8 mm,2.2 mm)and small incisions(3.0 mm)on phacoemulsification combined with trabeculectomy for primary angle-closure glaucoma(PACG)with cataract.●METHODS:Ninety-six patients(96 eyes)with PACG and cataract were recruited and randomly divided into three groups between January 2015 and June 2017.Group A(3.0 mm incision),B(2.2 mm incision),and C(1.8 mm incision)comprised 30,34 and 32 eyes respectively.All cases were treated with clear corneal incision phacoemulsification combined with trabeculectomy.Data including best corrected visual acuity(BCVA),corneal astigmatism,corneal endothelial cell counts(CECC),intraocular pressure(IOP),and complications were collected before the operation,and at postoperative 1 d,1 and 3 mo.●RESULTS:All the patients were successfully treated with surgery.The BCVA of groups B and C were significantly improved as compared to group A at postoperative 1 d,1 and 3 mo(all P<0.05),but there was no difference between groups B and C at each time interval(all P>0.05).The corneal astigmatism of group A was statistically higher than that of group B(P=0.026);corneal astigmatism of group B was statistically higher than that of group C at postoperative 1 d(P=0.006).The corneal astigmatism of group A at postoperative 3 mo was significantly higher than that before operation(P=0.003).At postoperative 1 and 3 mo,corneal astigmatism of groups B and C were significantly lower than that of group A(all P<0.05).The CECC in group B was significantly higher than that of group A(P=0.020),and CECC in group C was significantly higher than that of group B(P=0.034)at postoperative 1 d.At postoperative 1 and 3 mo,CECC of groups B and C were significantly higher than that of group A(all P<0.05).In each group,postoperative mean IOP at each time interval was significantly lower than preoperative IOP(all P<0.05).●CONCLUSION:Coaxial microincision phacoemulsification combined with trabeculectomy for PACG with cataract has better curative efficacy in reducing postoperative corneal astigmatism and corneal endothelial cell injury than traditional small incision combined surgery,and the 1.8 mm microincision has better curative efficacy than 2.2 mm microincision in the early postoperative period.
文摘AIM: To evaluate the outcomes of trabeculectomy with large area mitomycin-C(MMC) application as a first line treatment in advanced glaucoma. ·METHODS: The records of 55 patients with severe visual field defects undergoing trabeculectomy were retrospectively reviewed. The patients were classified as first-line therapy to either early trabeculectomy(initial trabeculectomy-Group 1) or long term medical therapy followed by trabeculectomy(primary trabeculectomy-Group 2). Trabeculectomy was performed with large-area MMC application. Intraocular pressure(IOP) values,visual acuities,mean deviations,morphology and function of the blebs,necessity for anti-glaucomatous medications and surgical complications were reported. ·RESULTS: There were 20 eyes of 18 patients in Group 1 and 37 eyes of 37 patients in Group 2. The mean preoperative IOPs in Groups 1 and 2 were 40.2±10.0mmHg(27-68mmHg) and 29.0±4.4mmHg(21-41mmHg),respectively(P=0.001). Average preoperative mean deviations(MD) in Groups 1 and 2 were 17.4±2.8dB(13.3-23dB) and 17.9± 2.4dB(13.7-23.2dB),respectively(P=0.441). Postoperative IOPs significantly decreased and were comparable in both Groups. The mean number of medications was significantly higher in Group 2(P =0.005). No cystic bleb formation was observed in Group 1,whereas 4 patients from Group 2(10.8%) developed cystic bleb(P =0.040). No visually devastating complication has occurred in both Groups. ·CONCLUSION: Initial trabeculectomy with large areaMMC application might be applied in patients with advanced glaucoma with low complication rates. Long-term topically applied anti-glaucomatous medications seem to increase the risk of cystic bleb formation.
基金Supported by the National Natural Science Foundation of China(No.81670847No.81600728)the Science and Technology Program of Guangzhou,China(No.15570001)
文摘● AIM: To compare the outcomes of Ex-PRESS implantation in one eye versus trabeculectomy with mitomycin C in the fellow eye in Chinese patients with primary open-angle glaucoma(POAG).● METHODS: This was a prospective, non-randomized comparative study. Forty-eight eyes of 24 patients with bilateral POAG necessitating surgery were included and underwent Ex-PRESS implantation under the scleral flap in one eye and trabeculectomy in the other eye according to patients' choice. Primary outcome measures included mean intraocular pressure(IOP) and success rate. Secondary outcome measures were aqueous flare, postoperative medication use, visual acuity, and incidence of complications. ● RESULTS: All 24 patients finished a 1-year follow-up. Both groups maintained significant reductions in IOP after surgery throughout the follow-up period. At any point in time, the IOP of the two groups did not differ significantly. The Kaplan-Meier survival curve analysis showed no significant differences in success between the two groups(P=0.289). The mean number of anti-glaucoma medicines and visual acuity in both groups were not significantly different. Eyes with Ex-PRESS implantation had lower aqueous flare values on days 1 and 3(both P<0.05). Instances of early postoperative hypotony and choroidal effusion were significantly fewer in frequency after Ex-PRESS implantation under the scleral flap compared with those after trabeculectomy(P <0.001).● CONCLUSION: Ex-PRESS is comparable to trabeculectomy in terms of IOP, success rate, number of glaucoma medications used, and visual acuity. However, Ex-PRESS resulted in fewer cases of inflammation and a lower rate of complications.
文摘AIM:To evaluate the safety and efficacy of cellular photoablation using BCECF-AM[2',7'-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein,acetoxymethyl ester mixed isomers]as a method to control postoperative fibrosis in subscleral trabeculectomy(SST) compared to mitomycin C(MMC) in a rabbit model.· METHODS:A comparative prospective case-control animal study was conducted.Fourteen rabbits were subjected to SST with intraoperative use of wound modulating agents(MMC or BCECF-AM) of the right eye(study groups Ⅰ and Ⅱ respectively) and SST without use of intraoperative wound modulating agents for the left eye(control group Ⅱ).Two rabbits 4 eyes were considered as control group Ⅰ with no surgical intervention.BCECF-AM was injected subconjunctivally30 min before surgery followed by intraoperative illumination with diffuse blue light for 10 min.Antifibrotic efficacy was established by clinical response and histological examination.Clinical response was assessed by measuring intraocular pressure(IOP) at day 1,3,5,7,14,21 postoperatively.Success was defined by >20.0%reduction in IOP from the preoperative values without anti-glaucoma medications.· RESULTS:The mean percentage of reduction was35.0%in the study group Ⅰ with only one eye(14.3%) had12.5%reduction.The mean percentage of reduction was28.0%in the study group Ⅱ with two eyes(28.6%) in study group Ⅱ had 14.2%reduction each.Regarding the control group Ⅱ,the mean percentage of reduction was14.3%with 64.3%eyes had <20.0%reduction.There was a highly statistically significant difference between each of the study groups(right eyes) and the corresponding control group Ⅱ(left eyes) as regards the mean postoperative IOP values started from day 5 in both study groups and this highly significant difference remained so till the end of the follow up period.Histologically,MMC treated blebs showed thinning of conjunctival epithelium with marked reduction of the goblet cells relative to control.Marked sub-epithelial edema was seen along with variable collagen dispersion.Mild cellularity was noted in sub-epithelial tissue.BCECF-AM treated blebs showed normal conjunctival epithelial thickness with abundant goblet cells.Mild subepithelial edema was noted along with moderate collagen dispersion.No histological abnormality was noted in the ciliary body or the cornea in any of the studied groups.· CONCLUSION:Cellular photoablation using BCECF-AM is a safe and effective wound modulating agent to control postoperative fibrosis in trabeculectomy.However MMC considered as a more potent adjuvant to trabeculectomy than BCECF-AM in promoting IOP reduction.
基金Supported by the National Natural Science Foundation of China(No.81373826)
文摘AIM:To systematically review the current evidence based on the efficacy and cost of Ex-PRESS implantation and trabeculectomy(Trab)for uncontrolled glaucoma.·METHODS:Clinical trials were identified by electronic databases(Pub Med,EMBASE,ISI Web of science and Cochrane library),and data,such as intraocular pressure(IOP),the complete and qualified success rate,the postoperative complications and the cost,were exacted from these relevant studies.Weighted mean difference(WMD),odds ratio(OR)and 95%confidence intervals(CIs)were calculated and were pooled using a randomeffects model.·RESULTS:Eleven relevant publications and two abstracts met the inclusion criteria.The efficacy of ExPRESS was similar to that of Trab in the percentage of IOP reduction(IOPR%)at 1,2y(WMD:-2.01;95%CI:-7.92-3.90;P=0.50 and WMD:2.89;95%CI:-8.05-13.83;P=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;P=0.02 and OR:1.74;95%CI:1.06-2.86;P=0.03,respectively).Moreover,Ex-PRESS exerted a significantly lower frequency of hypotony and hyphema than Trab(OR:0.39;95%CI:0.21-0.72;P=0.003 and OR:0.27;95%CI:0.10-0.69;P=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·CONCLUSION:Both Trab and Ex-PRESS have equivalent efficacy in lowering IOP,yet Ex-PRESS had a lower risk of hypotony and hyphema than Trab.Nevertheless,whether the cost of Ex-PRESS was less than that of Trab should be further investigated to ensure evidence-based conclusion in the long run.
基金2011 Guangdong Province Natural Science Fund,China (No.S2011010004186)National Basic Research Program of China (973 program,2011CB707501)
文摘AIM:To observe effects of trabeculectomy with amniotic membrane transplantation(AMT) in controlling postoperative intraocular pressure(IOP) in patients with medically uncontrolled glaucoma.·METHODS:This study included adult patients with requiring bilateral glaucoma surgery.Each patient underwent trabeculectomy(Non-AMT group) in one eye and with AMT(AMT group) in the other eye according to randomized principle.Success was defined as intraocular pressure(IOP) <21mmHg without any anti-glaucoma medications at 24 months follow-up.The two groups were compared in terms of IOP,complications and success rate.·RESULTS:Thirty-four eyes of 17 patients were investigated in this study.There was no statistically signifcant difference in pre-operative IOP between the two groups.The mean IOP was lower in AMT group compared with Non-AMT group on follow up months 12,18,and 24.Postoperative complications were more frequent in Non-AMT group(35.3%,6/17) compared with AMT group(5.9%,1/17).The success rate of surgery was88.2%(15/17) in Non-AMT group and 100%(17/17) in AMT group.·CONCLUSION:Trabeculectomy with AMT is an effective procedure to reduce IOP and complications,thereby improving surgical success rates.
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 study the success and outcome of trabeculectomy in Hospital Melaka.· METHODS:Medical records of all patients who underwent trabeculectomy between January 1,2007 and October 31,2010 whom were followed up for at least 6 months postoperatively in Hospital Melaka were retrospectively reviewed.· RESULTS:A total number of 117 eyes of 91 patients with the age range between 12 to 84 years underwent primary trabeculectomy(n =20,17.1%),combine trabeculectomy with cataract surgery(n =90,76.9%),repeat trabeculectomy(n=5,4.3%),and combine repeat trabeculectomy with cataract surgery(n =2,1.7%).The disease spectrum includes primary open-angle glaucoma(POAG)(54 patients,59.3%),priamry angle-closure glaucoma(PACG)(14 patients,15.4%),secondary glaucomas(19 patients,20.9%) and juvenile glaucomas(4 patients,4.4%).Preoperative mean intraocular pressure(IOP) was(24.69±8.67)mmHg as compared to postoperative mean IOP of(15.81±6.66)mmHg,(15.07±4.72)mmHg and(15.68±3.65)mmHg at 6-month,12-month and 24-month respectively.Eighty-two point one percent of eyes(n =96) achieved complete success(CS),12.8%(n =15) with qualified success(QS) and only 5.1%(n = 6) failed at 6 month with two of them warrant other filtering surgery.At twelve months,trabeculectomy with CS was 71.6%(n =63),QS in 22.7%(n =20) and failure in 5.7%(n = 5).Sixty-seven point five percent(n =27) attained CS,20.0%(n =8) with QS while 12.5%(n =5) failed at 24 month postoperative.· CONCLUSION:As the understanding of the lower the IOP,the better the patients retaining the visual function,trabeculectomy is significantly a choice of treatment in uncontrolled glaucoma.This study concluded that trabeculectomy performed in Hospital Melaka has produced significant success as compared to other studies.
基金Supported by the Glaucoma Research Society of Canada
文摘AIM: To compare the effectiveness of postoperative adjunctive use of subconjunctival bevacizumab in altering the outcome of primary trabeculectomy in terms of sustained lowering of intraocular pressure(IOP) and reduction of postoperative bleb vascularization and fibrosis.METHODS: A prospective, one center, randomized, placebo-control study. Fifty-nine patients(59 eyes) with uncontrolled IOP under maximal tolerated medical treatment(MTMT) were recruited. A primary trabeculectomy with mitomycin C(MMC) was done and the patients were randomized to either postoperative subconjunctival injection of bevacizumab(1.25 mg/0.05 mL) or balanced salt solution(BSS). Forty-seven patients(47 eyes) completed at least one year of follow up and were included in the study. The main outcome measure was the IOP, and secondary outcome measures include bleb morphology, vascularization, and fibrosis, as well as the need for glaucoma medications and 5-fluorouracil(5-FU) needling.RESULTS: At 1-year follow up, there was no significant difference between groups for IOP(P=0.65), bleb morphology(P=0.65), and the need for glaucoma medications(P=0.65) or 5-FU needling requirements(P=0.11). However, the bevacizumab group had a higher rate of success results, lower use of glaucoma medications after surgery, and optimal bleb aspect in more patients, but more 5-FU needling procedures required. CONCLUSION: A bigger sample size is needed in order to determine whether the differences found in the bevacizumab group are statistically significant.
基金Supported by National Natural Science Foundation of China(No.81060081,81241124 and 81360155)Jiangxi Provincial Natural Science Foundation(No.2008GZY00123,2010GZY0089,20114BAB205068 and 20114BAB215006)
文摘AIM: To evaluate the effect of amniotic membrane loaded with 5-fluorouracil poly(lactic-co-glycolic acid)(PLGA) nanoparticles(5-FU-NPs) in the surgical outcomes of experimental trabeculectomy in rabbits.METHODS: Thirty-two New Zealand white rabbits were randomly categorized into four groups with 8 rabbits in each group. Group 1, the control group, performed traditional trabeculectomy without adjuvant treatment.While the experimental groups performed compound trabeculectomy with different implantations including amniotic membrane(group 2), 5-FU-NPs(group 3) and amniotic membrane loaded with 5-FU-NPs(group 4).Clinical evaluations including IOP measurement and filtration bleb analysis were performed in all groups postoperatively.RESULTS: There is no significant difference of mean IOP in all groups at first 7d after surgery. While at P14,mean IOPs of experimental group 2(9.8 ±2.1 mm Hg),groups 3(8.9 ±2.8 mm Hg) and group 4(7.6 ±2.3 mm Hg)were significantly reduced compared to control group(12.4 ±2.6 mm Hg; n =8, P <0.05). At P21, mean IOPs of groups 3(11.7±3.2 mm Hg) and group 4(9.9±1.6 mm Hg)were significantly decreased compare to control group(17.9±1.6 mm Hg) and group 2(16.6 ±2.8 mm Hg; n =8,P <0.05). At P28, mean IOPs of groups 3(13.8±3.3 mm Hg)and group 4(10.6 ±2.0 mm Hg) were also significantly reduced compare to control group(19.4±2.3 mm Hg) and group 2(18.5 ±2.4 mm Hg; n =8, P <0.05). Meanwhile mean IOP of group 4 is significantly decreased compared to group 3 at P28(n =8, P <0.05). Survival analysis of functional filtration blub in all groups revealed the longest survival time in group 4(24.9±5.1d) compared to that in group 3(20.6 ±4.3d), group 2(15.0 ±5.2d) and control group(10.1±5.7d).CONCLUSION: Amniotic membrane loaded with 5-FuNPs may function as an effective anti-scarring implant and provides improved long-term surgical outcomes for experimental trabeculectomy in rabbits.
基金Natural Science Foundation of Hubei Province,China (No. 2008cda055)
文摘· AIM: To investigate the antifibrotic effect of freeze-dried bilayered fibrin-binding amniotic membrane on trabeculectomy in a rabbit model. · METHODS: Twenty-four Japanese white rabbits were randomized into three groups: the experimental group (ocular trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane transplantation), the control group (ocular trabeculectomy in combination with natural bilayered fibrin-binding amniotic membrane) and the blank group (single trabeculectomy). Clinical observation, hematoxylin-eosin staining, Massion staining, real-time PCR and immunohistochemistry for α-SMA were performed on days 7, 14, 21 and 30 following surgery. · RESULTS: Statistical differences were noted in survival analysis and intraocular pressure(IOP) among groups on days 7, 14, 21 and 30 following surgery. Histology, immunoh- istochemistry and real-time PCR further demonstrated that trabeculectomy in combination with freeze-dried bilayered fibrin-binding amniotic membrane resulted in good wound healing and no scar formation. · CONCLUSION: Self-made freeze-dried bilayered fibrin- binding amniotic membrane may inhibit the formation of scarring in glaucoma after trabeculectomy. ·
基金National Natural Science Foundation of China (No. 10A094)Natural Science Foundation of Hunan Province, China (No.11JJ2050)
文摘AIM: To explore the effect of Qingguangan on the expressions of MMP-2 and MMP-9 in filtering bleb scarring area after trabeculectomy in rabbit model. METHODS: Thirty-two New Zealand rabbits were randomized into four groups: control group, experimental group, MMC group (ocular trabeculectomy in combination with MMC), and Qingguangan group. Trabeculectomy was performed on both eyes in each group except control group. Qingguangan group was mouth-fed with Qingguangan (solution). On postoperative day 14, the appearances of MMP-2 and MMP-9 on filtrating blebs were observed by immunohistochemistry. RESULTS: Statistical differences of the expressions of MMP-2 and MMP-9 were noted among groups on day 14 following surgery. Histology immunohistochemistry showed significant differences on the expressions of MMP-2 and MMP-9 between each groups(P <0.05). CONCLUSION: Qingguangan can promote the expressions of MMP-2 and MMP-9.
文摘AIM: To evaluate the advantage of canaloplasty compared to trabeculectomy for patients with open angle glaucoma.· METHODS: Potentially relevant studies were systematically searched using various databases from inception until December 2015. The outcome analyses performed automatically using Revman 5.3 included intraocular pressure reduction(IOPR), postoperative success rate, anti-glaucoma medications reduction and the incidence of adverse events.· RESULTS: We included four qualified studies incorporating a total of 215 eyes for quantitative synthesis. The weighted mean difference(WMD) of IOPR between canaloplasty and trabeculectomy from baseline to 12 mo was-2.33(95%CI:-4.00,-0.66). There was not significant improvement in the complete or qualified success rate(OR: 0.58, 95%CI: 0.26, 1.31; OR: 0.50, 95%CI: 0.10, 2.44, respectively). Similarly, no statistically significance was observed in anti-glaucoma mediations reduction(WMD:-0.54, 95% CI:-1.18, 0.09). Sensitivity analysis of the primary outcome estimate confirmed the stability of the Meta-analysis result.· CONCLUSION: Trabeculectomy seems to be more effective in lowering IOP up to 12 mo when comparing with canaloplasty. Canaloplasty does not seem to be inferior to trabeculectomy considering the postoperative success rate or the number of postoperative anti-glaucoma medications. Meanwhile, it has an advantage of less bleb related complications.
基金Supported by the Natural Science Foundation of Hubei Province,China(No.2007ABA108)
文摘AIM:To investigate the influence of He-Ne lasers on scar formation in the filtration canal after trabeculectomy in a rabbit model,as well as to explore the mechanisms for preventing scar formation when using He-Ne lasers in vivo. METHODS:Experiment 1:Four groups were established （four eyes in each group）.In 12 eyes,the upper nasal limbus area next to the upper rectus muscle received 10 minutes of He-Ne laser irradiation（100,150,200mW/cm<sup>2</sup>;60,90, 120J/cm<sup>2</sup>）every day for three days.Four eyes served as controls.Twenty-four hours after the final irradiation,the rabbits were sacrificed and the irradiated tissue was excised, fixed with paraformaldehyde and tested for proliferating cell nuclear antigen（PCNA）,connective tissue growth factor （CTGF）and apoptosis（TUNEL）.Experiment 2:Forty-two rabbits were randomly divided into two groups and standard trabeculectomy was performed in the right eyes either after 200mW/cm<sup>2</sup> He-Ne laser irradiation or not in the filtration area.The expression of PCNA and CTGF,apoptosis and collagen density in the filtration area were tested on the 7<sup>th</sup>, 14<sup>th</sup>and 28<sup>th</sup>day after surgery. RESULTS:Experiment 1:There were no more PCNA and CTGF positive cells in the He-Ne irradiation group than in the control group.No apoptotic cells were found in either group. Experiment 2:The expression of PCNA and CTGF was lower in the He-Ne irradiation group than in the control group on the 7<sup>th</sup>and 14<sup>th</sup>day after trabeculectomy surgery（P【0.05）; no apoptotic cells were detected in either group.Collagen density was significantly lower in the He-Ne irradiation group than in the control group on the 14<sup>th</sup>and 28<sup>th</sup>day after surgery（P【0.05）. CONCLUSION:Pretreating the filtration area with 200mW/cm<sup>2</sup> （120J/cm<sup>2</sup>）of He-Ne laser irradiation may be helpful in preventing scar formation after trabeculectomy,possibly due to the downregulation of the expression of PCNA,CTGF and collagen synthesis in fibroblasts.
