Trabeculectomy with Ologen implant versus mitomycin C in congenital glaucoma secondary to Sturge Weber Syndrome

AIM： To compare the efficacy and safety of collagen matrix implant [Ologen（OLO） implant] versus mitomycin C（MMC） with subscleral trabeculectomy（SST） for the surgical treatment of congenital glaucoma（CG） in SturgeWeber Syndrome（SWS）.METHODS： A prospective comparative randomized study of 20 eyes of 16 patients with CG associated with SWS was divided into two groups. The first group（MMC Group） included 10 eyes that were subjected to SST with MMC. The second group（OLO Group） included 10 eyes that were subjected to trabeculectomy with a collagen matrix implant（OLO implant）. Postoperative evaluation included intraocular pressure（IOP） level, bleb evaluation, complications, and the need for further medication or surgical intervention. RESULTS： The mean preoperative IOP was 29±3.16 mm Hg in MMC and 29.8±3.08 mm Hg in OLO eyes. Mean 12-month percentage reduction in IOP was significant in both groups（57.9% and 56.3%）. At the end of the 12 postoperative follow-up month, in the MMC Group, 80% of eyes achieved the complete success, 20% of eyes had qualified success with no failed surgery in comparison to OLO Group which 70% of eyes achieved the complete success, 20% of eyes had qualified success with 10% failed surgery. In terms of complications, the MMC Group had a higher rate of complications than the OLO Group in the form of thin polycystic bleb in 6 eyes（60%）, blebitis in only one eye（10%） treated with topical antibiotics, shallow anterior chamber in two eyes（20%）.CONCLUSION： This study proves that the use of a collagen matrix implant yields equally effective results as MMC when combined with trabeculectomy for the treatment of CG in SWS. Furthermore, OLO implantation is safe and has low incidences of complications.

Therapeutic effect analysis on the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy

AIM： To evaluate the therapeutic effect and the safety of the treatment of congenital glaucoma through modified combined trabeculotomy-trabeculectomy. METHODS： The clinical data of 27 cases （altogether 42 eyes）, which included 7 cases of infants （10 eyes） and 20 cases of teenagers （32 eyes）, of congenital glaucoma undertook modified combined trabeculotomy trabeculectomy were analyzed retrospectively. The parameters evaluated included the post operation visual acuity, the anterior chamber, the filtering bleb, the intraocular pressure, the C/D ratio, visual field, the retinal nerve fiber layer changes and the complications. RESULTS： The follow-up period was 1 to 29mo, averaging 13.3 ±7.7mo. Upon the last visit after the operation, functional filtering blebs developed in all the involved eyes. The intraocular pressure was controlled under 21 mm Hg, which was decreased by 60% when compared with that before the operation, without using any medication. There were no significant changes in the post operation visual acuity and the retinal nerve fiber layer thickness before and after the operation in teenager group （P〉0.05）, and both the post operation C/D ratio and the visual field mean defect （MD） were reduced compared with those before the operation （P〈0.05）. There were no severe complications in any of the patients. CONCLUSION： The modified combined trabeculotomy- trabeculectomy can effectively reduce the intraocular pressure and control the development of glaucoma in cases of congenital glaucoma. It is a safe and effective operative method for the treatment of congenital glaucoma

A retrospective and consecutive study of viscocanalostomy versus trabeculectomy for primary congenital glaucoma

Background Surgical interventions are the main treatment for primary congenital glaucoma （PCG）. This study aimed to compare the efficacy and safety between viscocanalostomy and mitomycin C （MMC）-trabeculectomy in patients with PCG. Methods A total number of 43 patients with PCG who underwent either viscocanalostomy （group 1） or MMC- trabeculectomy （group 2） between June 2003 and June 2008 were retrospectively reviewed. The patients＇ intraocular pressures （lOPs） were examined before surgery and on day 1, week 1, month 1, month 6, and month 12 post-operative. Mean horizontal corneal diameters, success rates, intra- and post-operative complications were compared between the two groups. Results Pre-operative lOPs were （31.96±3.90） mmHg in group 1 and （32.56±4.00） mmHg in group 2. At the last visit, lOPs were （16.78±2.20） mmHg and （15.77±2.60） mmHg, respectively （P 〈0.001）; the complete success rates of group 1 and group 2 were 45.9% and 67.4%, respectively, and the difference was not statistically significant （P=0.158）. There were no major complications occurred in the two groups. Conclusions Both viscocanalostomy and trabeculectomy can lower lOP in PCG patients effectively. Although there was no major complications occurred in both groups, viscocanlostomy may decrease the probability of postoperative haemorrhage, hypotony, cataract, or choroid effusion.

Launching a paradigm for first and redo-surgery in primary congenital glaucoma: institutional experience

AIM: To evaluate the outcome of the initial and the redo-surgeries for primary congenital glaucoma(PCG) correlated to its degree of severity. METHODS: A retrospective study involved patients with PCG presented between 2010 and 2018. Medical records were reviewed to assess the degree of the preoperative severity according to the intraocular pressure(IOP), corneal diameter and corneal edema. Success and failure rates were calculated for both first and redo-surgeries at 6 and 12 mo respectively then correlated to the severity of the cases. RESULTS: Complete records were retrieved for 272 eyes(153 patients) with PCG: 43 eyes were mild, 136 moderate and 93 severe. Combined trabeculotomy and trabeculectomy(CTT) had the highest success rate in moderate(96.4%) and severe cases(59.3%) while trabeculotomy had the highest success rate in mild cases(96.3%). Medical records of 88 eyes(63 patients) with recurrent PCG were analyzed, most with severe presentation(59 eyes). Ahmed glaucoma valve(AGV) was used in 67(76%) eyes and augmented trabeculectomy in 21(24%) eyes. At 12 mo, there was no statistically significant difference between both surgeries in total success rate(P=0.256). For mild cases, success rate was 100% for both surgeries. Severe cases had higher success rates following AGV(87%) than augmented trabeculectomy(20%). Preoperative severity of the disease was an independent factor affecting the failure rate in secondary trabeculectomy but not in AGV. Patients younger than 24 mo had higher probabilities of failure following both redo-surgeries with hazard ratio =1.325 and 0.37 for augmented trabeculectomy and AGV respectively. CONCLUSION: Preoperative assessment of the severity of eyes with PCG helps in the selecting the optimal primary and secondary surgery. For first surgery, trabeculotomy is more effective in mild cases whereas; CTT and augmented subscleral trabeculectomy(SST) are appropriate for moderate and severe cases. AGV proved to be superior to augmented SST in severe recurrent cases.

Novel CYP1B1 mutations and a possible prognostic use for surgical management of congenital glaucoma

AIM: To identify CYP1B1 gene mutations and evaluate their possible role as a prognostic factor for success rates in the surgical management of Egyptian congenital glaucoma patients.METHODS: Totally 42 eyes of 29 primary congenital glaucoma patients were operated on with combined trabeculotomy/trabeculectomy with mitomycin-C and followed up at 1 d, 1 wk, 1, 6 and 12 mo postoperatively. Genomic DNA was extracted from peripheral blood leukocytes. Coding regions of CYP1B1 gene were amplified using 13 pairs of primers, screened for mutations using single-strand conformation polymorphism followed by sequencing of both strands. Efficacy of the operation was graded as either a success [maintaining intraocular pressure(IOP) less than 21 mm Hg with or without antiglaucoma medication], or a failure(IOP more than 21 mm Hg with topical antiglaucoma medications). RESULTS: Seven novel mutations out of a total of 15 different mutations were found in the CYP1B1 genes of 14 patients(48.2%). The presence of CYP1B1 gene mutations did not correlate with the failure of the surgery(P=0.156, odds ratio=3.611, 95%CI, 0.56 to 22.89); while the positive consanguinity strongly correlated with failure of the initial procedure(P=0.016, odds ratio=11.25, 95%CI, 1.57 to 80.30). However, the Kaplan-Meier survival analysis revealed a significantly lower time of IOP control in the subgroup with mutations in CYP1B1 versus the congenital primary glaucoma group without mutations(log rank test, P=0.015).CONCLUSION: Seven new CYP1B1 mutations are identified in Egyptian patients. Patients harboring confirmed mutations suffered from early failure of the initial surgery. CYP1B1 mutations could be considered as a prognostic factor for surgery in primary congenital glaucoma.

INTRAOCULAR PRESSURE DECREASE IN SURGICAL TREATMENT FOR CONGENI-TAL GLAUCOMA

Purpose: To evaluate results of intraocular pressure decrease in surgical procedures for congenital glaucoma We reviewed our experience with goniotomy, trabeculotomy, trabeculectomy and the combined procedure during the last 23 years. Methods: Pre-operative and postoperative intraocular pressures concerning 104 eyes (64 patients) that underwent goniotomy (45 eyes), trabeeu-lotoray (25 eyes), trabeculectomy alone (15 eyes) or a combined trabeculotomy-trabeculectomy (19 eyes) as a primary surgical procedure for congenital glaucoma were recorded. Follow up ranged from 1 month to 77 months (mean: 6.4 months). Intraocular pressure was measured by Schiotz or hand-held applanation tonometry with the patient under anesthesia Results: Mean pre-treatment intraocular pressure in 104 eyes was 27.3 (SD 5.3) mmHg, decreasing to 19.9 (SD 7.5) mmHg following treatment with a single surgical procedure. Combined trabeculotomy-trabeculectomy and trabeculectomy alone were the most successful as the initial operation, decreasing mean intraocular pressure to 15.2 (SD 6.4) and 16.7 (SD 9.2)mmHg, respectively. Surgical results with goniotomy and trabeculotomy, decreased mean intraocular pressure to 21.0 (SD 6.2) and 23.6 (SD 7.1) mmHg, respectively. Conclusion: Our results indicate that trabeculectomy (either alone or combined with trabeculotomy) is an efficient surgical procedure to control of intraocular pressure in primary congenital glaucoma. With goniotomy or trabeculotomy we had disappointing surgical results.

外路小梁切开联合小梁切除术治疗先天性青光眼

目的:评价外路小梁切开联合小梁切除术治疗先天性青光眼的疗效。方法:应用外路小梁切开联合小梁切除术治疗先天性青光眼7例(14眼)。结果:术后7d,14眼眼压降至正常。术后随访平均18mo,13眼眼压控制正常,手术成功率92%,术中常见并发症为少量前房出血,一般在术后1～4d完全吸收,对手术效果无影响。结论:外路小梁切开联合小梁切除术治疗先天性青光眼安全有效。

非穿透性小梁切除术联合小梁切开术治疗先天性婴幼儿型青光眼(英文)

目的:探讨非穿透性小梁切除术联合90度小梁切开术(non-penetrating trabeculectomyc ombined with 90 degrees trabeculotomy,NPTST)对治疗先天性婴儿型青光眼的手术方法及治疗效果,提高临床治疗效率。方法:回顾性分析2010-01/2012-01我院15例30眼原发性婴幼儿型青光眼的患者行NPTST。并分析术后眼压(intraocular pressure,IOP)改变,角膜横径以及并发症的情况。结果:本组术后1wk;1,3,6,12moIOP控制较术前下降,角膜横径保持原来大小或稍有减小,术后并发症发生率低。结论:NPTST对治疗先天性婴幼儿型青光眼成功率高,并发症少,是一种安全有效的治疗术式。

先天性青光眼小梁切除术中玻璃酸钠的应用

目的:观察玻璃酸钠(sodium hyaluranate,SH)在先天性青光眼小梁切除术中的作用。方法:选择先天性青光眼患者40例69眼,随机分为两组行常规小梁切除术,术中巩膜瓣下放置0.3mg/mL的丝裂霉素C(mitomycin C,MMC)棉片3min,在间断缝合巩膜瓣2针后,观察组向巩膜瓣下及前房内注入SH0.2mL,两侧边作可调节缝线;对照组前房内注入平衡盐溶液,其余操作相同。术后监测并记录视力、眼压、前房深度、滤过泡及并发症发生情况,随访6mo。结果:术后1wk内对照组眼压比观察组低,差异有显著性;末次复诊时两组眼压、视力无统计学差异。术后早期观察组浅前房、前房积血、脉络膜脱离、低眼压性黄斑病变发生率均低于对照组,差异具有显著性(P<0.05)。结论:先天性青光眼小梁切除术中应用SH,可明显减少术后早期滤过过强所致并发症。

原发性先天性青光眼临床治疗研究

目的:观察并分析外路小梁切开联合小梁切除术治疗原发性先天性青光眼的临床疗效。方法:收集原发性先天性青光眼患者51例89眼,应用外路小梁切开联合小梁切除术进行治疗,观察术后眼压、角膜横径、杯/盘比值、滤过泡情况及手术并发症并分析其临床疗效。结果:术后平均随访(15.21±6.50)mo,术后1,6,12mo手术成功率分别为97%,90%,90%。术后平均眼压较术前显著降低(P<0.01);杯/盘比值较术前明显减小(P<0.01);角膜横径手术前后差异无显著意义(P=0.495);手术失败者角膜横径较术前增大(P<0.05)。手术并发症主要有不同程度的前房出血和术后浅前房等。结论:外路小梁切开联合小梁切除术是治疗原发性先天性青光眼安全有效的手术方式之一。

玻璃酸钠在先天性青光眼小梁切除治疗中的应用研究

目的观察玻璃酸钠在先天性青光眼小梁切除术中的作用。方法选择先天性青光眼患者30例48眼,随机分为实验组和对照组,采用常规小梁切除术,术中巩膜瓣下放入丝裂霉素C,实验组向巩膜瓣下及前房内注入玻璃酸钠,对照组前房内注入灭菌生理盐水,其余操作相同。术后监测并记录视力、眼压、浅前房、前房出血、黄斑病变等并发症情况。结果两组患者手术后一周检查眼压,手术后的眼压明显低于手术前,有显著性差异。说明两组手术均有较好的效果(P<0.05)。术后早期实验组浅前房、前房积血、脉络膜脱离、低眼压性黄斑病变发生率均低于对照组,差异具有显著性(P<0.05)。结论先天性青光眼小梁切除术中应用玻璃酸钠,可明显减少术后早期滤过过强所致并发症。

外路Schlemm管切开小梁切除治疗先天性青光眼

目的探讨外路Schlemm管切开联合小梁切除术治疗先天性青光眼的疗效。方法由Schlemm管断端插入切开刀行140°切开;小梁切除包括Schlemm管,大小为1 mm×3 mm,并行周边虹膜切除术。对16例(28眼)先天性青光眼进行手术和观察,其中14例24眼随访8月至2年。结果术后患者症状消失;与术前相比,角膜横径及杯/盘比均未扩大。≥2岁者眼压控制在(14.80±3.30)mmHg;>2岁者眼压控制在(16.68±3.7)mmHg(1 mmHg≈0.133 kPa),均较术前为低(P<0.01)。术后功能型滤泡占89.28%(24眼)。随访眼压控制良好。结论外路Schlemm管切开联合小梁切除术是一种安全有效的治疗先天性青光眼的方法。

小梁切除术联合丝裂霉素C治疗难治性先天性青光眼的临床观察

目的 证实在先天性青光眼常规手术失败的儿童小梁切除术联合丝裂霉素 C(mitomycin- C,MMC)治疗是安全有效的方法。方法 9例 (9眼 )曾行常规手术失败的先天性青光眼儿童在小梁切除术中一次应用 MMC棉片 (0 .2 g· L- 1 )置于手术创面 5 min,平均随访时间 17.6 4mo± 8.41mo(0 .2 5～ 36 mo)。结果 术前平均眼压 4.0 0± 0 .6 3k Pa(3.0 7～4.93k Pa) ,术后平均眼压 1.83± 0 .10 k Pa(1.38～ 2 .0 3k Pa) ,均保持了术前的视力水平 ,成功率 88.89% (8眼 )。基本成功率 11.11% (1眼 )。常见并发症浅前房 8眼 (88.89% )。结论 小梁切除术联合 MMC治疗在常规手术失败的先天性青光眼儿童是安全有效的方法。

小梁切除术联合丝裂霉素C治疗先天性青光眼的临床效果观察

目的探讨小梁切除术联合丝裂霉素C治疗先天性青光眼的临床效果。方法将64例先天性青光眼患者随机分为观察组和对照组,每组各32例,对照组患者采取单纯小梁切除术治疗,观察组患者采取小梁切除术联合丝裂霉素C治疗,随访观察两组患者的临床疗效及并发症。结果观察组患者治疗总有效率为92.7%,显著高于对照组患者的78.9%,组间差异有统计学意义(P<0.05)。两组患者在术后并发症发生率方面的差异无统计学意义(P>0.05)。结论采用小梁切除术联合丝裂霉素C治疗先天性青光眼临床疗效好,手术成功率高,术后并发症少,值得临床进一步推广使用。

小梁切开联合小梁切除术治疗先天性青光眼疗效观察

目的探讨小梁切开联合小梁切除术(CTT)治疗先天性青光眼(CG)的疗效。方法回顾性总结我院行CTT的42例(66只眼)CG临床资料。观察眼压、滤过泡及并发症等指标。结果术后平均眼压显著优于治疗前(P<0.05),手术成功率为83.95%,全部患者均未发现玻璃体脱出、虹眼内感染等并发症。结论 CTT治疗CG安全性高,临床效果理想。

小梁切开联合小梁切除术32例围术期护理

目的:探讨小梁切开联合小梁切除术治疗先天性青光眼患儿的围术期护理方法。方法:对32例(61眼)先天性青光眼患儿行小梁切开联合小梁切除术,并给予精心术前、术后护理。结果:本组最后一次随访时平均眼压为(15.2±5.5)mm Hg,眼压控制成功率达94.0%。前房出血发生率为45.0%,均于术后5 d内吸收。术后无浅前房、虹膜粘连、晶状体浑浊及眼内感染发生。结论:加强小梁切开联合小梁切除术治疗先天性青光眼患儿的围术期护理可有效提高手术成功率、减少并发症发生。

先天性青光眼手术疗效观察

目的观察手术治疗先天性青光眼的临床疗效。方法收集初诊年龄≤3岁先天性青光眼患者62例(97只眼),按角膜横径以及眼底杯盘比对患者实施不同手术方式治疗,随访观察手术成功率、眼压、角膜横径以及眼底杯盘比。结果外路小梁切开联合小梁切除术72只眼(占术眼74.2%);单纯小梁切开术12只眼(占12.4%);小梁切除术13只眼(占13.4%)。外路小梁切开联合小梁切除术后1、3、6、12及24个月手术成功率分别为95.83%、90.28%、86.67%、84.31%、82.35%。手术成功者术后平均眼压较术前显著降低(P<0.01),杯盘比较术前减小(P<0.01),角膜横径术前术后差异无显著意义(P=0.259),手术失败者角膜横径与杯盘比继续增大。结论外路小梁切开联合小梁切除术是治疗先天性青光眼常用、安全有效的手术术式;角膜横径可做为判断≤3岁先天性青光眼病情控制与否的指标。

外路小梁切开联合小梁切除术治疗先天性青光眼

目的 评价外路小梁切开联合小梁切除术治疗先天性青光眼的疗效。方法 应用外路小梁切开联合小梁切除术治疗婴儿先天性青光眼6例（11眼）。结果 术后7d，11眼眼压均降至正常。术后随访观察平均20个月。10眼眼压控制正常，手术成功率90．9％．术中常见并发症为小量前房出血，一般在术后1～5d内完全吸收，对手术效果无影响。结论 外路小梁切开联合小梁切除术是治疗婴幼儿先天性青光眼安全而有效的手术方法，可推广应用。

外路小梁切开术联合小梁切除术治疗婴幼儿青光眼

目的探讨小梁切开术联合小梁切除术治疗婴幼儿性青光眼的疗效。方法由外Schlemm管断端插入小梁切开器切开Schlemm管内壁及小梁网,范围120°,并联合小梁切除术。结果术后患者症状消失,角膜横径及杯/盘比无扩大,眼压随访6个月后控制良好,控制在<2.8kPa。结论小梁切开术联合小梁切除术,是一种有效的治疗婴幼儿性青光眼的方法。

外路小梁切开联合小梁切除术治疗原发性先天性青光眼疗效观察

目的评价外路小梁切开联合小梁切除术治疗原发性先天性青光眼的临床疗效。方法随访首次手术行外路小梁切开联合小梁切除术的原发性先天性青光眼患者66例（96只眼），观察术后眼压、角膜横径、杯／盘比值、滤过泡情况及手术并发症，并分析其临床疗效。结果术后平均随访（11．76±8．51）个月，术后1个月、6个月、12个月手术成功率分别为95．83％、92．06％、87．23％。术后平均眼压较术前统计学降低（P〈O．叭）；杯／盘比值较术前明显减小（P〈O．叭）；角膜横径手术前后差异无显著意义（P=0．495）；手术失败者角膜横径较术前增大（P〈O．05）。手术并发症主要有不同程度的前房出血和术后浅前房等。结论外路小梁切开联合小梁切除术是治疗原发性先天性青光眼安全有效的手术方式之一。