AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated en...AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.展开更多
AIM：To evaluate the intraocular pressure（IOP）control of an artificial trabeculum drainage system（ATDS）,a newly designed glaucoma drainage device,and postoperative complications in normal rabbit eyes.METHODS：Pres...AIM：To evaluate the intraocular pressure（IOP）control of an artificial trabeculum drainage system（ATDS）,a newly designed glaucoma drainage device,and postoperative complications in normal rabbit eyes.METHODS：Pressure drops in air and fluid of 30 ATDS were measured after being connected to a closed manometric system.Twenty of them were then chosen and implanted randomly into the eyes of 20 rabbits.Postoperative slitlamp,gonioscopic examination and IOP measurements were recorded periodically.Ultrasound biomicroscopy and B-scan ultrasonography were also used to observe the complications.Eyes were enucleated on day 60.RESULTS：Pressure drops of 4.6-9.4 mm Hg were obtained at physiological aqueous flow rates in the tests in vitro.The average postoperative IOP of the experimental eyes（11.6-12.8 mm Hg）was lower than the controls significantly（P〈0.05）at each time point.Complications of hemorrhage（n=1）,cellulosic exudation（two cases）and local iris congestion（two cases）were observed.The lumina of the devices were devoid of obstructions in all specimens examined and a thin fibrous capsule was found around the endplate.CONCLUSION：ATDS reduce IOP effectively.However,further studies on the structure are needed to reduce complications.展开更多
To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry ey...To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.展开更多
Objective:To make up a portable,economic drainage device to prevent the development of pocket hematoma and avoid the additional therapies of pocket hematoma.Methods:Between 2003 and 2006,a total of 265 devices were im...Objective:To make up a portable,economic drainage device to prevent the development of pocket hematoma and avoid the additional therapies of pocket hematoma.Methods:Between 2003 and 2006,a total of 265 devices were implanted at our institution.The 89 high-risk patients were determined by the predictors of hematoma occurrence(marasmatic elder,inevitable oral antiplatelet/anticoagulation therapy,venous pressure increased by other comorbidity,the deficiency of the clotting mechanism for hepatic diseases,or incognizable severe intraoperative bleeding),and other 186 patients were included in non-high-risk group.The 89 high-risk patients were randomized into treatment and control subgroups by sortition.Surgical procedures differed only by the application of the portable,economic drainage device prior to wound closure in treatment subgroup.Results:The incidence of pocket hematoma was 4.3% in treatment subgroup,18.6% in control subgroup and 2.7% in non-high-risk group,leading to 2,6 and 3 patients' prolonged hospitalization,respectively.The additional cost due to pocket hematoma was lower(1.5 times) in the treatment group compared to the control group.There wasn't antidromic infection and delayed cure of the skin incision with the use of our drainage device within 6 months.Conclusion:Our portable drainage device was made up easily and quickly.It could decrease the total cost of hospitalization,did not increase the other adverse events and seemed to be suitable for such patients with a tendency to develop pocket hematoma undergoing the implantation of pectoral pacemakers,implantable cardioverter defibrillator,or cardiac resynchronization therapy.展开更多
Binocular vision disturbance is a well-described complication of glaucoma drainage device(GDD) implantation. The pathophysiology is not well-understood, but may involve bulk effects from the implant and surrounding bl...Binocular vision disturbance is a well-described complication of glaucoma drainage device(GDD) implantation. The pathophysiology is not well-understood, but may involve bulk effects from the implant and surrounding bleb, as well as modulation of muscle function due to surgical trauma and post-operative inflammation, resulting in a combined resection/posterior fixation effect. Retrospective studies have found the risks of motility disorder and diplopia vary widely, estimated to be 56%-86% and 57%-75%, respectively. More recently, cross-sectional studies and prospective trials estimate post-GDD incidence to be approximately 1%-44%, with the incidence in newer generation of implants designed to limit bleb size likely lower at 1%-5%. Suggested methods of management strategies include prismatic spectacles, monocular occlusion, extreme monovision, and strabismus surgery.展开更多
AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective st...AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.展开更多
Glaucoma drainage devices have traditionally been reserved for refractory glaucoma.However,there is an increasing body of evidence to suggest the use of these implants at an earlier stage in the surgical management of...Glaucoma drainage devices have traditionally been reserved for refractory glaucoma.However,there is an increasing body of evidence to suggest the use of these implants at an earlier stage in the surgical management of glaucoma.We describe the mechanics behind their function as well as the various implants available.The implants vary in size,surface area and composition and hence the surgical implantation of these devices are described in detail.The knowledge of such devices and their potential complications is fundamental for the successful management of patients who undergo aqueous-shunt surgery.Careful patient selection and optimal postoperative management is critical to the successful patient outcomes.展开更多
Purpose:To evaluate the long-term outcomes of a non-valved,.Chinese-made Hunan aqueous drainage device(HAD) in patients with refractory glaucoma,.compared to trabeculectomy.Methods:This was a retrospective observation...Purpose:To evaluate the long-term outcomes of a non-valved,.Chinese-made Hunan aqueous drainage device(HAD) in patients with refractory glaucoma,.compared to trabeculectomy.Methods:This was a retrospective observational case series,including 27 patients with refractory glaucoma who either underwent HAD implantation (n=11) or trabeculectomy (n=16).The mean follow-up was 27.9±13.5 (mean±SD) months.Intraocular pressure(IOP),visual acuity and postoperative complications were measured.Results:IOP was significantly lower at the last follow-up in both two groups compared with the baseline IOP (HAD:58.4 to 19.0 mmHg,P<0.001;trabeculectomy:58.4 to 23.7 mmHg,P<0.001).One week,1 month and 1 year after the operation,the average IOP of the HAD group was significantly lower than that of trabeculectomy group(P<0.05 at all time points).However,the IOP did not differ significantly between the two groups at the time of last follow-up.Conclusion:HAD implantation serves as a good option to control IOP in refractory glaucoma.展开更多
文摘AIM:To compare the surgical outcomes of glaucoma drainage device implantation(GDI)and trans-scleral neodymium:YAG cyclophotocoagulation(CPC)in the management of refractory glaucoma after Descemetstripping automated endothelial keratoplasty(DSAEK).METHODS:This retrospective study on observational case series enrolled 29 patients who underwent DSAEK and posterior anti-glaucoma surgery(15 with GDI and 14 with CPC).The main outcome measures were intraocular pressure(IOP),glaucoma surgery success rate(defined as IOP of 6–21 mm Hg without additional anti-glaucoma operation),number of glaucoma medications,endothelial graft status,and best-corrected visual acuity(BCVA).RESULTS:The mean follow-up time was 34.1 and 21.0mo for DSAEK or glaucoma surgeries,both for the GDI and CPC groups.Both groups showed significant IOP reduction after glaucoma surgery.The GDI group presented a significantly higher success rate in IOP control than the CPC group(60%vs 21.4%,P=0.03).Both procedures significantly decreased the number of glaucoma medications(P=0.03).Forty percent and 57%of cases in the GDI and the CPC group,respectively,experienced endothelial graft failure during follow-up(P=0.36).Significantly worse BCVA after surgery was observed in the CPC group but not in the GDI group.CONCLUSION:Both GDI and CPC significantly decrease IOP in eyes with glaucoma after DSAEK.GDI is preferable to CPC in refractory glaucoma cases after DSAEK,as it manifests a significantly higher success rate for IOP control,similar endothelial graft failure rate,and relatively preserves BCVA than CPC.
基金Supported by National Natural Science Foundation of China(No.81300765)
文摘AIM：To evaluate the intraocular pressure（IOP）control of an artificial trabeculum drainage system（ATDS）,a newly designed glaucoma drainage device,and postoperative complications in normal rabbit eyes.METHODS：Pressure drops in air and fluid of 30 ATDS were measured after being connected to a closed manometric system.Twenty of them were then chosen and implanted randomly into the eyes of 20 rabbits.Postoperative slitlamp,gonioscopic examination and IOP measurements were recorded periodically.Ultrasound biomicroscopy and B-scan ultrasonography were also used to observe the complications.Eyes were enucleated on day 60.RESULTS：Pressure drops of 4.6-9.4 mm Hg were obtained at physiological aqueous flow rates in the tests in vitro.The average postoperative IOP of the experimental eyes（11.6-12.8 mm Hg）was lower than the controls significantly（P〈0.05）at each time point.Complications of hemorrhage（n=1）,cellulosic exudation（two cases）and local iris congestion（two cases）were observed.The lumina of the devices were devoid of obstructions in all specimens examined and a thin fibrous capsule was found around the endplate.CONCLUSION：ATDS reduce IOP effectively.However,further studies on the structure are needed to reduce complications.
文摘To report the first case of dellen-like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. A 70-year-old male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. Prior to placement, minimal refractive error was noted on manifest refraction. Several years later, the patient was referred for decreased vision and corneal irregularity. Examination showed pathologic corneal curvature, superior corneal thinning, and epithelial demarcation lines immediately anterior to the glaucoma drainage devices in both eyes. The epithelium remained intact with no evidence of limbal stem cell deficiency. Manifest refraction revealed a large change in both eyes. Topography was used to confirm the presence of irregular corneal curvature anterior to the glaucoma drainage devices. Dellen-like keratopathy with superior thinning is a rare sequela after implantation of a glaucoma drainage device that must be considered in elderly patients who undergo glaucoma surgery. It is likely related to a combination of tear film alteration related to previously large anterior blebs, antimetabolite application, and aqueous humor flow patterns around the drainage devices. Treatment should focus on lubrication.
文摘Objective:To make up a portable,economic drainage device to prevent the development of pocket hematoma and avoid the additional therapies of pocket hematoma.Methods:Between 2003 and 2006,a total of 265 devices were implanted at our institution.The 89 high-risk patients were determined by the predictors of hematoma occurrence(marasmatic elder,inevitable oral antiplatelet/anticoagulation therapy,venous pressure increased by other comorbidity,the deficiency of the clotting mechanism for hepatic diseases,or incognizable severe intraoperative bleeding),and other 186 patients were included in non-high-risk group.The 89 high-risk patients were randomized into treatment and control subgroups by sortition.Surgical procedures differed only by the application of the portable,economic drainage device prior to wound closure in treatment subgroup.Results:The incidence of pocket hematoma was 4.3% in treatment subgroup,18.6% in control subgroup and 2.7% in non-high-risk group,leading to 2,6 and 3 patients' prolonged hospitalization,respectively.The additional cost due to pocket hematoma was lower(1.5 times) in the treatment group compared to the control group.There wasn't antidromic infection and delayed cure of the skin incision with the use of our drainage device within 6 months.Conclusion:Our portable drainage device was made up easily and quickly.It could decrease the total cost of hospitalization,did not increase the other adverse events and seemed to be suitable for such patients with a tendency to develop pocket hematoma undergoing the implantation of pectoral pacemakers,implantable cardioverter defibrillator,or cardiac resynchronization therapy.
文摘Binocular vision disturbance is a well-described complication of glaucoma drainage device(GDD) implantation. The pathophysiology is not well-understood, but may involve bulk effects from the implant and surrounding bleb, as well as modulation of muscle function due to surgical trauma and post-operative inflammation, resulting in a combined resection/posterior fixation effect. Retrospective studies have found the risks of motility disorder and diplopia vary widely, estimated to be 56%-86% and 57%-75%, respectively. More recently, cross-sectional studies and prospective trials estimate post-GDD incidence to be approximately 1%-44%, with the incidence in newer generation of implants designed to limit bleb size likely lower at 1%-5%. Suggested methods of management strategies include prismatic spectacles, monocular occlusion, extreme monovision, and strabismus surgery.
文摘AIM: To investigate the safety and utility of an electrocautery dilation catheter for endoscopic ultrasonography(EUS)-guided pancreatic fluid collection drainage.METHODS: A single-center, exploratory, retrospective study was conducted between August 2010 and August 2014. This study was approved by the Medical Ethics Committee of our institution. Informed, written consent was obtained from each patient prior to the procedure. The subjects included 28 consecutive patients who underwent EUS-guided transmural drainage(EUS-TD) for symptomatic pancreatic and peripancreatic fluid collections(PFCs) by fine needle aspiration using a 19-gauge needle. These patients were retrospectively divided into two groups based on the use of an electrocautery dilation catheter as a fistula dilation device; 15 patients were treated with an electrocautery dilation catheter(electrocautery group), and 13 patients were treated with a non-electrocautery dilation catheter(non-electrocautery group). We evaluated the technical and clinical successes and the adverse events associated with EUS-TD for the treatment of PFCs between the two groups.RESULTS: There were no significant differences in age, sex, type, location and diameter of PFCs between the groups. Thirteen patients(87%) in the electrocauterygroup and 10 patients(77%) in the non-electrocautery group presented with infected PFCs. The technical success rates of EUS-TD for the treatment of PFCs were 100%(15/15) and 100%(13/13) for the electrocautery and the non-electrocautery groups, respectively. The clinical success rates of EUS-TD for the treatment of PFCs were 67%(10/15) and 69%(9/13) for the electrocautery and the non-electrocautery groups, respectively(P = 0.794). The procedure time of EUS-TD for the treatment of PFCs in the electrocautery group was significantly shorter than that of the non-electrocautery group(mean ± SD: 30 ± 12 min vs 52 ± 20 min, P < 0.001). Adverse events associated with EUS-TD for the treatment of PFCs occurred in 0 patients and 1 patient for the electrocautery and the non-electrocautery groups, respectively(P = 0.942).CONCLUSION: EUS-TD using an electrocautery dilation catheter as a fistula dilation device for the treatment of symptomatic PFCs appears safe and contributes to a shorter procedure time.
文摘Glaucoma drainage devices have traditionally been reserved for refractory glaucoma.However,there is an increasing body of evidence to suggest the use of these implants at an earlier stage in the surgical management of glaucoma.We describe the mechanics behind their function as well as the various implants available.The implants vary in size,surface area and composition and hence the surgical implantation of these devices are described in detail.The knowledge of such devices and their potential complications is fundamental for the successful management of patients who undergo aqueous-shunt surgery.Careful patient selection and optimal postoperative management is critical to the successful patient outcomes.
文摘Purpose:To evaluate the long-term outcomes of a non-valved,.Chinese-made Hunan aqueous drainage device(HAD) in patients with refractory glaucoma,.compared to trabeculectomy.Methods:This was a retrospective observational case series,including 27 patients with refractory glaucoma who either underwent HAD implantation (n=11) or trabeculectomy (n=16).The mean follow-up was 27.9±13.5 (mean±SD) months.Intraocular pressure(IOP),visual acuity and postoperative complications were measured.Results:IOP was significantly lower at the last follow-up in both two groups compared with the baseline IOP (HAD:58.4 to 19.0 mmHg,P<0.001;trabeculectomy:58.4 to 23.7 mmHg,P<0.001).One week,1 month and 1 year after the operation,the average IOP of the HAD group was significantly lower than that of trabeculectomy group(P<0.05 at all time points).However,the IOP did not differ significantly between the two groups at the time of last follow-up.Conclusion:HAD implantation serves as a good option to control IOP in refractory glaucoma.
基金Supported by the Science and Technology Department of Zhejiang Province(No.2014KYB111)Zhejiang Provincial Natural Science Foundation of China(LY13H120002)~~
