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
Our study retrospectively reviewed the surgical outcomes up to 3 mo of 38 consecutive Chinese glaucoma patients who underwent trabeculectomy(n=18) or phacotrabeculectomy(n=20).Baseline age,visual acuity,and intrao...Our study retrospectively reviewed the surgical outcomes up to 3 mo of 38 consecutive Chinese glaucoma patients who underwent trabeculectomy(n=18) or phacotrabeculectomy(n=20).Baseline age,visual acuity,and intraocular pressure were comparable.Intraocular pressure from post-operative 1 d to 3 mo were similar between 2 groups.Complete success was achieved in 65% of phacotrabeculectomy,and 66.7% of trabeculectomy cases;while failure occurred in 16.7% of phacotrabeculectomy,and 10% of trabeculectomy cases at 3 mo.Phacotrabeculectomy group consistently showed better improvement in visual acuity.Diffuse blebs occurred in 65% of phacotrabeculectomy and 83% of trabeculectomy eyes;and flat blebs in 35% of phacotrabeculectomy,but none after trabeculectomy.There was more hypotony(5% vs 0) after phacotrabeculectomy.To conclude,phacotrabeculectomy and trabeculectomy demonstrated comparable intraocular pressure control up to 3 mo post-operatively.However,phacotrabeculectomy patients had better visual acuity improvement.Nonetheless,more diffuse bleb and less hypotony were present following trabeculectomy.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 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, T-bis-(2-carboxyethyl) -5-(and-6)-carboxyfluorescein, acetoxymethyl ester mixed isomersl as a method to control postoperative ...AIM: To evaluate the safety and efficacy of cellular photoablation using BCECF-AM [2, T-bis-(2-carboxyethyl) -5-(and-6)-carboxyfluorescein, acetoxymethyl ester mixed isomersl 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 intraoperaUve 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 subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. Clinical response was assessed by measuring intraocular pressure (lOP) at day 1, 3, 5, 7, 14, 21 postoperatively, Success was defined by 〉20.0% reduction in lOP from the preoperative values without anti-glaucoma medications. RESULTS: The mean percentage of reduction was 35.0% in the study group I with only one eye (14.3%) had 12.5% reduction. The mean percentage of reduction was 28.0% in the study group U with two eyes (28.6%) in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3% 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 lOP 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 sub- epithelial 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 electron...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;=0.50 and WMD:2.89;95%CI:-8.05-13.83;=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;=0.02 and OR:1.74;95%CI:1.06-2.86;=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;=0.003 and OR:0.27;95%CI:0.10-0.69;=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION: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 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 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 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 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 se...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 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 incepti...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 12mo 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 12mo 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 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...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 alpha -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, immunohistochemistry 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
This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) an...This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration's RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P0.00001). There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92, P0.00001). Difference in the success rate was also found between the two surgeries (Z=3.82, P=0.0001). It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.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
Descemet's membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resu...Descemet's membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resulting from trabeculectomy by presenting a case of extensive DMD after trabeculectomy which was successfully repaired.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 glaucom...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 the efficacy of modified deep sclerectomy combined with Ex-PRESS shunt versus trabeculectomy in primary open angle glaucoma. METHODS:This is a prospective cohort comparative single-center study. Forty...AIM:To compare the efficacy of modified deep sclerectomy combined with Ex-PRESS shunt versus trabeculectomy in primary open angle glaucoma. METHODS:This is a prospective cohort comparative single-center study. Forty-nine eyes of 49 patients were enrolled in the study. Patients were randomly divided into two groups. Group A(22 patients) underwent classic trabeculectomy and group B(27 patients) underwent modified deep sclerectomy combined with insertion of Ex-PRESS model P50 drainage device. RESULTS:Mean age was 69±7y in group A and 64±8y in group B(P=0.03). The mean reduction was 11.1±5.7 mm Hg in group A compared to 15.8±5.7 mm Hg in group B at 6mo(P=0.006), and 9.8±4.9 mm Hg and 15.4±4.7 mm Hg respectively at 1y(P=0.0001). Regarding the postoperative glaucoma medication, significant difference was observed between the two groups(in favour of group B) only at 6mo(P=0.017). At the end of the follow-up period complete success rate in group A was 68.2% compared to 92.6% in group B(χ^2 test, P=0.07) and qualified success rate was 100% in both groups.CONCLUSION:Modified deep sclerectomy combined with Ex-PRESS shunt may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.展开更多
AIMTo 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...AIMTo 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.展开更多
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Our study retrospectively reviewed the surgical outcomes up to 3 mo of 38 consecutive Chinese glaucoma patients who underwent trabeculectomy(n=18) or phacotrabeculectomy(n=20).Baseline age,visual acuity,and intraocular pressure were comparable.Intraocular pressure from post-operative 1 d to 3 mo were similar between 2 groups.Complete success was achieved in 65% of phacotrabeculectomy,and 66.7% of trabeculectomy cases;while failure occurred in 16.7% of phacotrabeculectomy,and 10% of trabeculectomy cases at 3 mo.Phacotrabeculectomy group consistently showed better improvement in visual acuity.Diffuse blebs occurred in 65% of phacotrabeculectomy and 83% of trabeculectomy eyes;and flat blebs in 35% of phacotrabeculectomy,but none after trabeculectomy.There was more hypotony(5% vs 0) after phacotrabeculectomy.To conclude,phacotrabeculectomy and trabeculectomy demonstrated comparable intraocular pressure control up to 3 mo post-operatively.However,phacotrabeculectomy patients had better visual acuity improvement.Nonetheless,more diffuse bleb and less hypotony were present following trabeculectomy.
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.
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, T-bis-(2-carboxyethyl) -5-(and-6)-carboxyfluorescein, acetoxymethyl ester mixed isomersl 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 intraoperaUve 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 subconjunctivally 30min before surgery followed by intraoperative illumination with diffuse blue light for 10min. Antifibrotic efficacy was established by clinical response and histological examination. Clinical response was assessed by measuring intraocular pressure (lOP) at day 1, 3, 5, 7, 14, 21 postoperatively, Success was defined by 〉20.0% reduction in lOP from the preoperative values without anti-glaucoma medications. RESULTS: The mean percentage of reduction was 35.0% in the study group I with only one eye (14.3%) had 12.5% reduction. The mean percentage of reduction was 28.0% in the study group U with two eyes (28.6%) in study group II had 14.2% reduction each. Regarding the control group II, the mean percentage of reduction was 14.3% 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 lOP 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 sub- epithelial 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;=0.50 and WMD:2.89;95%CI:-8.05-13.83;=0.60,respectively).Ex-PRESS possessed a significant higher complete and qualified success rate(OR:1.59;95%CI:1.07-2.35;=0.02 and OR:1.74;95%CI:1.06-2.86;=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;=0.003 and OR:0.27;95%CI:0.10-0.69;=0.003,respectively).However,there was no consistent result on the cost between the two groups according to the previous three studies.·C ONCLUSION: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.
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.
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.
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.·
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 12mo 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 12mo 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 alpha -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, immunohistochemistry 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This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED (1966 to 2009), Embase (1980 to 2009) and CMB-disk (1979 to 2009) for the randomized clinical trials (RCT) concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration's RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure (IOP) between non-penetrating trabecular surgery and trabeculectomy (Z=6.05 P0.00001). There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures (Z=4.92, P0.00001). Difference in the success rate was also found between the two surgeries (Z=3.82, P=0.0001). It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.
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.
文摘Descemet's membrane detachment (DMD) can be a potentially serious complication of intraocular surgery or ocular trauma. The cause is not very clear. We are trying to remind an awareness of the spectrum of DMD resulting from trabeculectomy by presenting a case of extensive DMD after trabeculectomy which was successfully repaired.
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 the efficacy of modified deep sclerectomy combined with Ex-PRESS shunt versus trabeculectomy in primary open angle glaucoma. METHODS:This is a prospective cohort comparative single-center study. Forty-nine eyes of 49 patients were enrolled in the study. Patients were randomly divided into two groups. Group A(22 patients) underwent classic trabeculectomy and group B(27 patients) underwent modified deep sclerectomy combined with insertion of Ex-PRESS model P50 drainage device. RESULTS:Mean age was 69±7y in group A and 64±8y in group B(P=0.03). The mean reduction was 11.1±5.7 mm Hg in group A compared to 15.8±5.7 mm Hg in group B at 6mo(P=0.006), and 9.8±4.9 mm Hg and 15.4±4.7 mm Hg respectively at 1y(P=0.0001). Regarding the postoperative glaucoma medication, significant difference was observed between the two groups(in favour of group B) only at 6mo(P=0.017). At the end of the follow-up period complete success rate in group A was 68.2% compared to 92.6% in group B(χ^2 test, P=0.07) and qualified success rate was 100% in both groups.CONCLUSION:Modified deep sclerectomy combined with Ex-PRESS shunt may provide comparable IOP reduction with fewer complications in management of primary open angle glaucoma.
基金Supported by the Natural Science Foundation of Hubei Province,China(No.2007ABA108)
文摘AIMTo 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.