Efficacy and safety of high-dose ultrasound cyclo-plasty procedure in refractory glaucoma

AIM:To evaluate the efficacy and safety of high-dose ultrasound cyclo-plasty(UCP)for the treatment of refractory glaucoma in Chinese patients.METHODS:In this 6-month retrospective study,37 eyes of 37 patients suffering from severe glaucoma with uncontrolled intraocular pressure(IOP)of≥21 mm Hg underwent 8-s ultrasonic cyclocoagulation with ten active piezoelectric elements.A complete ophthalmic examination was performed before and at 1 d,1,3,6 mo after UCP.Therapeutic success was defined as IOP reduction from baseline≥20%and IOP≥5 mm Hg without adding new glaucoma medication compare to baseline at the 6-month follow-up visit.In addition to mean IOP at each followup visit,medications used and complications were also detected and compared to baseline.RESULTS:After UCP procedure,the mean IOP was significantly reduced(P<0.01)from the preoperative 44.1±11.9 mm Hgto postoperative 26.7±11.8 mm Hg at 3 mo,and 30.4±14.5 mm Hg at 6 mo.The overall mean IOP reductions achieved at 3 and 6 mo were 39%and 31%compared to baseline IOP.Sixty-one percent of patients responded well to UCP treatment with a mean IOP reduction of 48%at 3 mo and 42%at 6 mo.Ocular pain in most of patients were alleviated.No serious intraoperative or postoperative complications occurred.CONCLUSION:High-dose UCP treatment is an effective and safe procedure to reduce IOP in Chinese patients with severe glaucoma.

The change of anterior segment parameters after cataract surgery in normal-tension glaucoma

AIM： To investigate the change of anterior chamber angle morphology and intraocular pressure （lOP） reduction after cataract surgery in patients with normal-tension glaucoma （NTG） using swept-source optical coherence tomography （SS-OCT）. METHODS： This prospective, comparative, observational study recruited patients into two groups. Group 1 was the control group including normal subjects except those with cataracts （cataract group, n=67 eyes of 67 patients）, and group 2 was NTG group including patients who were diagnosed with NTG and cataracts （n=43 eyes of 43 patients）, which were treated with phacoemulsification and intraocular lens implantation. Before surgery, and at postoperative 1 and 6too, anterior chamber angles were evaluated by SS-OCT under dark conditions using three- dimensional angle analysis scan protocol. Angle opening distance （AOD）, angle recess area （ARA）, and trabecular- iris surface area （TISA） at four quadrants （temporal, nasal, superior, and inferior） were calculated automatically by SS-OGT, after the observer marked scleral spurs. RESULTS： A total of 106 patients （54 males and 52 females） were enrolled in the study. Angle parameters, AOD, ARA, and TISA were increased after surgery in both groups. However, changes of angle parameters were only significant in group 2. In group 2, preoperative lOP was 13.2＋2.9 mm Hg, and postoperative lOP at 1 and 6mo were 10.5＋3.0 and 10.7＋2.8 mm Hg, respectively. In group 1, preoperative lOP was 12.42.8 mm Hg, and postoperative lOP at 1 and 6mo were 11.6＋2.5 and 12.0＋2.8 mm Hg, respectively. After cataract surgery, angle parameters changed significantly while IOP significantly reduced and was maintained in group 2 （P〈0.001）. The changes in angle parameters （＆AOD500, ATISAS00 at temporal; ＆AOD500, S, RA500 at nasal） were linearly correlated with postoperative IOP changes. CONCLUSION： Cataract surgery may have improved antedor chamber angle parameters and decreased lOP in NTG patients.