Clinical efficacy of Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma with proliferative diabetic retinopathy

AIM:To describe the clinical results of combined Ahmed valve implantation and 23-gauge vitrectomy for medically uncontrolled neovascular glaucoma(NVG)secondary to proliferative diabetic retinopathy(PDR).METHODS:The medical records of medically uncontrolled NVG patients with PDR who underwent Ahmed valve implantation and 23-gauge vitrectomy between March 2016 and December 2018 were reviewed.Enrolled patients had at least 6-month follow-up.Panretinal photocoagulation(PRP),anti-vascular endothelial growth factor,surgery and medication history were documented.RESULTS:Eleven eyes of 11 patients were included in our study.The visual acuity improved in 8 eyes and remained unchanged in 3 eyes.The preoperative intraocular pressure(IOP)was significantly decreased at the last follow-up(48.8±4.3 to 17.0±1.5 mm Hg,P<0.001).All eyes needed three topical anti-glaucomatous medications before surgery,but the number was significantly reduced to 0.72±0.19 at the last visit(P<0.001).Four eyes had choroidal detachment and 3 eyes had minor hyphemia,all of which gradually resolved without treatments in one week.CONCLUSION:Ahmed glaucoma valve implantation combined with 23-gauge vitrectomy might be a safe and alternative treatment for NVG with PDR.

Comparison of canaloplasty and trabeculectomy for open angle glaucoma：a Meta-analysis

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.

Evaluation of retinal and choroidal changes in patients with Alzheimer’s type dementia using optical coherence tomography angiography

AIM:To evaluate the changes in fundus parameters in patients with Alzheimer’s type dementia(ATD)using optical coherence tomography angiography(OCTA),to record flash electroretinograms(ERG)using the RETeval system and to explore changes in retinal function.METHODS:Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled.All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area,including the vessel length density,the vessel perfusion density and the area of foveal avascular zone(FAZ),as well as the choroidal thickness.The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters.We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD.RESULTS:The vessel parameters[Pvessel length density=0.005 and Pvessel perfusion density=0.006]and average choroid thickness(P<0.001)in the macular area of the ATD group was less than the control group.The FAZ area was statistically significantly enlarged in the ATD group(P<0.001).These parameters were correlated with the Mini-Mental State Examination(MMSE)score and the Montreal Cognitive Assessment(MoCA).CONCLUSION:Patients with ATD exhibit decreases in the parameters associated with fundus.In addition,these indicators significantly correlate with the MMSE score and the MoCA score.OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.