Malignant glaucoma treated by low-dose laser cycloplasty: a 1-year multicenter prospective noncomparative study

AIM:To report a one-year clinical outcomes of low-dose laser cycloplasty(LCP)among malignant glaucoma patients.METHODS:In this prospective,multicenter,noncomparative clinical study,participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China.Patients were followed up at 1wk,1,3,6,and 12mo.Intraocular pressure(IOP),number of glaucoma medications,anterior chamber depth(ACD),and complications were recorded.Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy.Recurrence was defined by the presence of a shallow orflat anterior chamber after initial recovery from treatment.RESULTS:A total of 34 eyes received LCP.Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg(P<0.001)with 2.9±1.6 medications(P=0.046)at 1d,and 17.4±6.7 mm Hg(P<0.001)with 1.3±1.7 medications(P<0.001)at 12mo.The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo,respectively.A total of 32(94.1%)eyes achieved initial anatomical success.During follow-up,2(5.9%)eyes failed and 8(23.5%)eyes relapsed,yielding a 12-month anatomical success rate of 64.3%.Complications including anterior synechia(8.82%),choroidal/ciliary detachment(5.88%)and hypopyon(2.94%)were observed within 1wk.CONCLUSION:LCP is simple,safe,and effective in reforming the anterior chamber in malignant glaucoma.

Laparoscopic spleen-preserving total pancreatectomy for the treatment of low-grade malignant pancreatic tumors:Two case reports and review of literature

BACKGROUND Function-preserving pancreatectomy can improve the long-term quality of life of patients with benign or low-grade malignant tumors,such as intraductal papillary mucinous neoplasms(IPMNs)and mucinous cystic neoplasms.However,there is limited literature on laparoscopic spleen-preserving total pancreatectomy(LSpTP)due to technical difficulties.CASE SUMMARY Patient 1 was a 51-year-old male diagnosed with IPMN based on preoperative imaging,showing solid nodules in the pancreatic head and diffuse dilation of the main pancreatic duct with atrophy of the distal pancreas.We performed L-SpTP with preservation of the splenic vessels,and the postoperative pathology report revealed IPMN with invasive carcinoma.Patient 2 was a 60-year-old male with multiple cystic lesions in the pancreatic head and body.L-SpTP was performed,and intraoperatively,the splenic vein was injured and required ligation.Postoperative pathology revealed a mucinous cystic tumor of the pancreas with low-grade dysplasia.Both patients were discharged on postoperative day 7,and there were no major complications during the perioperative period.CONCLUSION We believe that L-SpTP is a safe and feasible treatment for low-grade malignant pancreatic tumors,but more case studies are needed to evaluate its safety,efficacy,and long-term outcomes.

Bilateral malignant glaucoma with bullous keratopathy:A case report

BACKGROUND Malignant glaucoma,caused by aqueous misdirection,is a challenging postsurgical complication presented with normal/high intraocular pressure and shallowing of the central and peripheral anterior chambers.Its incidence is about 0.6%-4.0%.It can be secondary to filtering surgeries,laser iridotomy,and cataract surgery.Short axial length and a history of angle closure glaucoma are its main risk factors.Here,we report a bilateral malignant glaucoma with bullous keratopathy in the patient’s left eye.CASE SUMMARY We present a case of bilateral malignant glaucoma.The cause of malignant glaucoma for each eye of this patient was different.Hence,the management strategy and selection of surgical methods were also different.However,the normal anterior chamber was ultimately maintained,and maximum visual function was preserved.Even though the left eye received multiple surgeries and corneal endothelial decompensation occurred,the formation of a retroendothelial fibrous membrane partially compensated for the function of the corneal endothelium.CONCLUSION The formation of a retroendothelial fibrous membrane partially compensated for the function of the corneal endothelium.

Excision of malignant and pre-malignant rectal lesions by transanal endoscopic microsurgery in patients under 50 years of age

BACKGROUND The most common technique for treating benign and early malignant rectal lesions is transanal endoscopic microsurgery(TEM).Local excision is an acceptable technique for high-risk and elderly patients,but there are hardly any data regarding young patients.AIM To describe TEM outcomes in patients under 50 years of age.METHODS We collected demographic,clinical,and pathological data from all patients under the age of 50 years who underwent the TEM procedure at Hasharon Rabin Medical Center from January 2005 to December 2018.RESULTS During the study period,a total of 26 patients under the age of 50 years underwent TEM procedures.Their mean age was 43.3 years.Eleven(42.0%)were male.The mean operative time was 67 min,and the mean tumor size was 2.39 cm,with a mean anal verge distance of 8.50 cm.No major intraoperative or postoperative complications were recorded.The median length of stay was 2 d.Seven(26.9%)lesions were adenomas with low-grade dysplasia,four(15.4%)were high-grade dysplasia adenomas,two were T1 carcinomas(7.8%),and three were T2 carcinomas(11.5%).No residual disease was found following endoscopic polypectomy in two patients(7.8%),but four(15.4%)had other pathologies.Surgical margins were negative in all cases.Local recurrence was detected in one patient 33 mo following surgery.CONCLUSION Among young adult patients,TEM for benign rectal lesions has excellent outcomes.It may also offer a balance between the efficacy of complete oncologic resection and postoperative quality of life in the treatment of rectal cancer.In some cases,it may be considered an alternative to radical surgery.

Management strategies in malignant glaucoma secondary to antiglaucoma surgery

AIM：To assess the outcomes of various interventions for malignant glaucoma（MG）.·M ETHODS：A retrospective,comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan.2009and Dec.2012.Numerous treatments were administered including medical therapy,neodymium：yttriumaluminium-garnet（Nd：YAG）laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options.The characteristic,treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo.·RESULTS：Four eyes of 3 patients achieved complete resolution with medical therapy.Nd：YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes,both of which achieved resolution after initial intervention.Thirty-two eyes were given surgical treatments with anterior vitrectomy-reformation of anterior chamber in13 eyes,phacoemulsification-intraocular lens implantation in 10 eyes and phacoemulsification-intraocular lens implantation-anterior vitrectomy in 9 eyes.Resolution of MG was seen in almost all patients.The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit.The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm.Twenty eyes with preoperative visual acuity better than counting figure/50 cm had various visual improvements.Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity,corneal endothelial decompensation and allergic to atropine respectively.·CONCLUSION：MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment,laser therapy is beneficial in pseudophakic eyes,and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management.MG can be managed successfully by appropriate and timely interventions with good visual outcome.

Comment on “Management strategies in malignant glaucoma secondary to antiglaucoma surgery”

Dear Editor,We read with great interest the article by Wu et al[1]which comprehensively assessed the outcomes of various interventions in 38 eyes of 35 patients with malignant glaucoma（MG）secondary to antiglaucoma surgery whowere followed up for an average of 27.1mo.

Trend of glaucoma internal filtration surgeries in a tertiary hospital in China

AIM:To evaluate the trend of glaucoma internal filtration surgeries for inpatients between 2015 and 2021 at the Eye Hospital of Wenzhou Medical University.METHODS:A review of the medical records of inpatients who had been diagnosed with glaucoma and received antiglaucoma surgery between January 1,2015 and December 31,2021 was conducted.The glaucoma diagnosis in this study included primary open angle glaucoma,primary angleclosure glaucoma,secondary glaucoma,and paediatric glaucoma.The types of surgeries were categorised as internal filtration,external filtration,and cyclodestruction surgery based on the pathway of aqueous humor outflow.The trend of these glaucoma surgeries in the sample of patients with different types of glaucoma was then analysed.RESULTS:The number of patients hospitalised for glaucoma surgery increased yearly,from 752 in 2015 to 1373 in 2021,at the Eye Hospital of Wenzhou Medical University.Regarding the patients diagnosed with primary open angle glaucoma,internal filtration surgery increased from 27.40%of the sample to 54.40%of the sample,while external filtration surgery decreased from 71.50%to 44.20%between 2015 and 2021.For paediatric glaucoma,internal filtration surgery increased from 37.50%in 2015 to 88.20%in 2021.Whilst different types of surgeries were performed on the sample of patients with secondary glaucoma,the proportion of internal filtration surgery also showed an increase from 18.20%in 2015 to 40.90%in 2021.Meanwhile,internal filtration surgery in the patient sample with primary angle-closure glaucoma already accounted for over 70.00%in 2015,and showed a small increase by 2021.CONCLUSION:As surgical technology and surgical experience continue to elevate and improve,the range of glaucoma surgeries are correspondingly evolving.This study find that internal filtration surgeries accounted for an increasing proportion of treatments in the surgical management of glaucoma between 2015 and 2021.

Secondary in-the-bag intraocular lens implantation combined with 120-and 360-degree goniotomy in glaucoma following congenital cataract surgery:a case report

Dear Editor,Glaucoma following cataract surgery(GFCS)is one of the most sight-threatening postoperative complications of pediatric cataract surgery,and often becomes refractory to medical treatment[1].Goniotomy has been an increasingly popular procedure for primary open angle glaucoma and primary angle-closure glaucoma with 120-.

Pseudophakic Malignant Glaucoma Treatment Assisted with Anterior Segment Optical Coherence Tomography: A Case Report

PSEUDOPHAKIC malignant glaucoma is diagnosedbased on the presence of a shallow or flat centraland peripheral anterior chamber in the presenceof patent iridectomy, with intraocular pressure（IOP） of 22 mm Hg or more after lens extraction andintraocular lens implantation.1 Pseudophakic malignantglaucoma is one of the most challenging complicationsfaced by surgeons. Initial medication includes topicalcycloplegics, osmotic agents.

Selective laser trabeculoplasty as adjunctive treatment for open-angle glaucoma vs following incisional glaucoma surgery in Chinese eyes

BACKGROUND Selective laser trabeculoplasty(SLT)is a relatively safe and effective therapy in lowering intraocular pressures(IOP)for glaucoma.AIM To study the long-term effects of SLT on IOP and number of glaucoma medications used in Chinese eyes.METHODS This is a retrospective study in which 75 eyes of 70 patients with open-angle glaucoma(OAG,n=36)and eyes with prior glaucoma surgery(PGS,n=39)were included.Changes in mean IOP and number of glaucoma medications used evaluated at 1 d,1 wk,1 mo,3 mo,6 mo,12 mo,and 36 mo after laser treatment.RESULTS All patients(33 male,37 female)were Chinese.The mean age was 44.34±16.14years.Mean pre-SLT IOP was 22.75±2.08 mmHg in OAG and 22.52±2.62 mmHg in PGS.Mean IOP was significantly reduced 1 d,1 wk,1 mo and 3 mo after laser treatment(P<0.05,respectively).Whereas,there were no significant differences between baseline and SLT treated groups at the 6th month both in OAG(P=0.347,P>0.05)and in PGS(P=0.309,P>0.05).Six months after SLT treatment,some patients received retreatment of SLT or were given more topical IOP-lowering medication to control the IOP.By the end of our study,the average IOP decreased to 20.73±1.82 mmHg in OAG and 20.49±1.53 mmHg in PGS groups.The number of glaucoma medications used was significantly reduced until the end of 3 years compared to baseline.CONCLUSION SLT could reduce IOP as adjunctive treatment both in OAG and PGS groups.SLT significantly reduced the number of glaucoma medications used 3-years following treatment in glaucoma patients.

Efficacy and safety of deep sclerectomy with uveoscleral implant plus collagen matrix implant overcoming the superficial scleral flap in glaucoma surgery

AIM:To assess the efficacy and safety of non-penetrating deep sclerectomy(NPDS)with uveoscleral implant plus subconjunctival and intrascleral collagen matrix overcoming the superficial scleral flap lips(modified deep sclerectomy technique,DS)and minimal use of mitomycin C in glaucoma surgery.METHODS:A retrospective review of 47 consecutive glaucoma patients who underwent NPDS with DS between January 2017 and May 2018.Best-corrected visual acuity,intraocular pressure(IOP),post-operative need for glaucoma medications,visual field mean deviation(MD),re-interventions,needling revisions and laser goniopuncture were noted.Absolute success was defined as IOP≤18 mm Hg without topical medication.Relative success was defined as the same criteria but with the addition of any antihypertensive medication.IOP over 18 mm Hg on two consecutive followup visits was considered as a failure.RESULTS:Fifty-two eyes of 47 patients were evaluated.Mean preoperative IOP was 25.37±6.47 mm Hg,and decreased to 15.04±4.73 at 12mo and 12.21±4.1 at 24mo(all P<0.0001).Requirement for topical medications dropped from a mean of 3.06±0.25 per patient to 0.51±0.99 and 1.11±1.23 respectively after 12 and 24mo(all P<0.0001).No medications were required in 45.5%of patients after 24mo.Relative and absolute success rate at 24mo were 85.5%±5%and 48.5%±7.4%,respectively.CONCLUSION:DS is a safe and effective nonpenetrating glaucoma surgery variation.It aims to retain the patency of all pathways created for aqueous humor drainage:the intrascleral bleb,the supraciliary space and the open communication between intrascleral and subconjunctival compartments.

Effectiveness of surgical management of malignant glaucoma in phakic eyes

AIM:To assess the effectiveness of core vitrectomyphacoemulsification-intraocular lens(IOL)implantationcapsulo-hyaloidotomy in treating phakic eye at least 1 mo after the onset of malignant glaucoma.METHODS:A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018.Demographic and clinical data were described.The preoperative and postoperative visual acuity(VA),intraocular pressure(IOP),number of IOP-lowering medications used,and anterior chamber depth(ACD)of the case series were compared by Wilcoxon signed-rank test.RESULTS:Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series.Core vitrectomy-phacoemulsification-IOL implantation-capsulohyaloidotomy reduced the IOP(P=0.046)and the number of IOP-lowering medications used(P=0.004),deepened the ACD(P=0.005).Complete success was achieved in 38.5%of the eyes,and anatomical success was achieved in 100%of the eyes without any recurrence.The only postoperative complication observed is corneal endothelial decompensation.It occurred in two cases.CONCLUSION:Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.

Malignant pleural mesothelioma mimics thoracic empyema: A case report

BACKGROUND Thoracic empyema and malignant pleural mesothelioma(MPM)are distinct medical conditions with similar symptoms,including cough,chest pain,and breathing difficulty.We present a rare MPM case mimicking thoracic empyema.Physicians must consider MPM risks for patients exposed to building material who exhibit lobulated pleural effusions,indicating thoracic empyema.CASE SUMMARY A 68-year-old retired male construction worker suffered from shortness of breath and chest tightness over 10 d,particularly during physical activity.A poor appetite and 4 kg weight loss over the past 3 wk were also reported.Chest images and laboratory data concluded a tentative impression of empyema thoracis(right).Video-assisted thoracic surgery with decortication and delobulation(right)was conducted.The pathological report yielded an MPM diagnosis.Refractory pleural bilateral effusions and respiratory failure developed postoperatively,and the patient died three weeks after the operation.CONCLUSION Thoracic empyema and MPM are distinct medical conditions that can present similar symptoms,and video-assisted thoracic surgery facilitates an accurate diagnosis.Empyema-mimicking presentations and postoperative refractory pleural effusion may indicate a poor MPM outcome.

Clinicopathological study of malignant peripheral nerve sheath tumors in the head and neck:Case reports and review of literature

BACKGROUND Malignant peripheral nerve sheath tumor(MPNST)is a rare and aggressive soft tissue sarcoma that poses a major diagnostic and therapeutic challenge.CASE SUMMARY We retrospectively reviewed patients with head and neck MPNSTs treated in our hospital from 2000 to 2021.The clinical features,pathological manifestations,treatments,and prognoses were summarized.We also reviewed the literature,focusing on MPNST in the mandible and maxilla.The study population consisted of five women and five men aged 22–75 years(mean age,49 years).Of the 10 patients,7 were initial cases and 3 were recurrent cases.All lesions were sporadic.The most common site was the mandible.The most frequently encountered symptoms were a progressive mass and local swelling.Complete or partial loss of trimethylation at lysine 27 of histone H3(H3K27me3)was evident on staining in four of nine cases(one case was excluded due to lack of tissue for evaluation of loss of H3K27me3).The 2-and 5-year disease-specific survival rates were 86%a nd 43%,respectively.The average survival time was 64 mo.CONCLUSION MPNST is a highly malignant tumor with a poor prognosis,prone to a high risk of recurrence and distant metastasis.Complete surgical resection is the main treatment.

New Management of Malignant Glaucoma by Phacoemulsification with Posterior Chamber Foldable Intraocular Lens Implantation

Objective:To investigate the feasibility of phacoemulsification with posterior chamber foldable intraocular lens implantation in the management of malignant glaucoma. Patients and Methods:Fourteen patients with malignant glaucoma diagnosed in the Department of Glaucoma were enrolled in the study.12 patients developed malignant glaucoma after filtration surgery.1 developed after peripheral iridectomy.1 patient developed malignant glaucoma without any clear cause.Cataract phacoemulsification was performed.Posterior chamber intraocular foldable lens was implanted in 10 cases of patients.Results:All 14 patients were cured wiht normal intraocular pressure,normal anterior chamber depth and increased visual acuity.Conclusion:Phacoemulsification with posterior chamber foldable intraocular lens implantation is a good alternative in treating malignant glaucoma.

Penetrating canaloplasty in corticosteroid-induced glaucoma:a report of two cases

Dear Editor,We have treated two patients of glucocorticoid-induced glaucoma with penetrating canaloplasty(PCP)since 2021.PCP is a new type internal drainage surgery for glaucoma,which is a bleb-independent filtering surgery combined canaloplasty with trabeculectomy,and the surgery shows a great efficacy of intraocular pressure(IOP)reduction with no surgical complication.PCP surgery started with a fornix-based conjunctival flap and double scleral flap,and Schlemm’s canal was opened,a 10-0 prolene suture was positioned and tensioned within Schlemm’s canal,trabucular meshwork segment was excised and peripheral iridectomy was performed,the scleral flap and the conjunctival flap were closed watertight with 10-0 prolene sutures.

Micropulse transscleral laser therapy for secondary angle-closure glaucoma in nanophthalmos: a case report

Dear Editor,The choice of surgical intervention for nanophthalmos patients with secondary angle-closure glaucoma poses a challenging decision for ophthalmologists.Because nanophthalmos patients who have undergone filtration surgery or other intraocular procedures are more susceptible to severe complications,including choroidal effusion,malignant glaucoma,and explosive choroidal hemorrhage,all of which can lead to vision loss[1].This dilemma is particularly pronounced in patients with shorter axial lengths.Micropulse transscleral laser therapy(M-TLT),also known as micropulse transscleral cyclophotocoagulation(MP-TSCPC),is a nonincisional laser therapy surgery for glaucoma[2].In 2015,Golan and Kurtz[3]were the first to report four patients with secondary angle-closure glaucoma in nanophthalmos with axial lengths ranging between 17 and 19 mm(mean 18 mm)who were successfully treated with M-TLT,and choroidal detachment was observed in all patients(recovery spontaneously in two patients and recovery after systemic steroid treatment in the other two),of which two had a slight decrease in visual acuity.

Effect of Surgeries on the Prognosis of 100 Patients with Malignant Glioma

objective To observe the effect of surgical therapy on the prognosis of Patients with malignant glioma. Methods Prospective study was performed on 100 cases of malignant glioma: 59 patients were treated with total resection grossly, 7 with subtotal resection, 32 with major excision and 2 with partial excision. Results The mean survival time of patients with total resection was 158.14 weeks, and the five years survival rate was over 24.56％ .The mean survival time of patients with subtotal resection was 149.56 weeks, in which 2 subjects survived over 5 years. Patients with major excision had the mean survival time of 138.54 weeks and the five years survival rate of 22.58％ .The 2 patients with partial excision survived 7 months and 30 months respectively. Conclusion We should perform total resection on patients with malignant glioma and stop partial excision or nonexcision.

Oncology and reproductive outcomes over 16 years of malignant ovarian germ cell tumors treated by fertility sparing surgery

BACKGROUND Malignant ovarian germ cell tumors(MOGCT)are rare and frequently occur in women of young and reproductive age and the oncologic and reproductive outcomes after fertility-sparing surgery(FSS)for this disease are still limited.AIM To evaluate the oncology and reproductive outcomes of MOGCT patients who underwent FSS.METHODS All MOGCT patients who underwent FSS defined as the operation with a preserved uterus and at least one side of the ovary at our institute between January 2005 and December 2020 were retrospectively reviewed.RESULTS Sixty-two patients were recruited for this study.The median age was 22 years old and over 77%were nulliparous.The three most common histology findings were immature teratoma(32.2%),dysgerminoma(24.2%),and yolk sac tumor(24.2%).The distribution of stage was as follows;Stage I,74.8%;stage II,9.7%;stage III,11.3%;and stage IV,4.8%.Forty-three(67.7%)patients received adjuvant chemotherapy.With a median follow-up time of 96.3 mo,the 10-year progressionfree survival and overall survival were 82.4%and 91%,respectively.For reproductive outcomes,of 43 patients who received adjuvant chemotherapy,18(41.9%)had normal menstruation,and 17(39.5%)resumed menstruation with a median time of 4 mo.Of about 14 patients who desired to conceive,four were pregnant and delivered good outcomes.Only one case was aborted.Therefore,the successful pregnancy rate was 28.6%CONCLUSION The oncology and reproductive outcomes of MOGCT treated by FSS are excellent.Many patients show a long survival time with normal menstruation.However,the obstetric outcome is not quite satisfactory.

Role of vascular endothelial growth factor in reconstructive surgery after surgical excision of malignant tumor

As a key mediator of normal physiological angiogenesis, vascular endothelial growth factor(VEGF) has been regarded as an emancipator to plastic surgeon, and yet a misfortune to oncology surgeon, due to its singular biological effect. Therefore in some clinical cases, especially for some malignant tumor patients having endured radical surgery and being craving for a reconstructive surgery, VEGF plays a role full of paradoxes. To make a clinical balance, we should find a point to inhibit tumor cell from utilizing VEGF and make a permission to normal tissues to employ it.