改良viscocanalostomy术中新型植入物的实验研究

目的:探索新型植入物可吸收牛心包补片、不可吸收牛心包补片在改良viscocanalostomy(VCO)中应用的安全性及有效性;方法:将18只新西兰白兔随机分为A、B两个实验组和C对照组,每组6只。在A、B组白兔改良VCO的巩膜腔隙中分别植入不可吸收牛心包补片、可吸收牛心包补片,C组不植入任何植入物。观察术后不同时间巩膜腔隙存留情况及周围组织反应情况。结果:A、B组术后滤过泡形成及存留时间均优于对照组。手术区域周围组织反应轻微,可吸收牛心包补片组反应更为轻微。巩膜滤过空腔的保持与植入物有关,术后12周时A、B组眼巩膜腔隙仍维持较好,C组眼手术区域瘢痕形成明显。结论:植入物有助于改良VCO术后引流道的抗瘢痕化;两种植入物都是安全的,可吸收牛心包组反应更为轻微,远期抗瘢痕化效果可能更好。

Long-term results of viscocanalostomy and phacoviscocanalostomy: a twelve-year follow-up study

AIMTo evaluate the long-term efficacy and safety results of viscocanalostomy and phacoviscocanalostomy.METHODSThe charts of 49 glaucoma patients who underwent viscocanalostomy or phacoviscocanalostomy surgery between February 1999 and August 2004 were reviewed retrospectively. Thirty-one eyes of 21 glaucoma patients who underwent filtering procedure with a postoperative follow-up of at least 5y were included in the study. Results of complete ophthalmologic examinations were recorded and statistically analyzed. Long-term surgical outcome was defined as an overall success when intraocular pressure (IOP) was found as ≤20 mm Hg with or without antiglaucomatous medication at the last follow-up visit, while it was defined as a complete success when IOP was measured ≤20 mm Hg without antiglaucomatous medication.RESULTSMean age was 68.1±9.6y (range: 32-81y). Mean follow-up time was 101.5±27.3mo (range: 60-144mo). Viscocanalostomy was performed in 8 eyes (25.8%) and phacoviscocanalostomy was performed in 23 eyes (74.2%). The mean preoperative IOP was 23.1±7.6 mm Hg with 2.1±1.0 medications, while mean IOP was 16.8±3.8 mm Hg with 0.9±1.1 medication at the last follow-up visit. Both the IOP decrease and the reduction in the antiglaucomatous medication were statistically significant (P<0.001 and P<0.001). No case required further glaucoma surgery. Overall success and complete success were found as 87.1% and 51.6%, respectively. Complete success rate was statistically higher in phacoviscocanalostomy group compared with the viscocanalostomy group (P=0.031), however there was no significant difference in overall success rate between two groups (P=0.072).CONCLUSIONBoth viscocanalostomy and phacoviscocanalostomy provide good IOP reduction in the long-term period.

Modified viscocanalostomy in the Chinese population with open angle glaucoma: a 10-year follow-up results

AIM: To study the long-term efficacy and safety of modified viscocanalostomy in Chinese people with open angle glaucoma(OAG).METHODS: This retrospective study included a total of 100 eyes from 100 Chinese patients with medically uncontrolled OAG. All the patients underwent modified viscocanalostomy with injection of viscoelastic material in the surgically created ostia of Schlemm's canal(SC). The modifications included peeling of the inner wall of SC and the juxtacanalicular meshwork, use of mitomycin C, and loosely suturing the superficial scleral flap. Intraocular pressure(IOP), visual acuity, number of medications, laser goniopuncture data and complications were recorded. The definition of complete(qualified) success was an IOP equal to or lower than 21, 18, 16 mm Hg without(with or without) anti-glaucoma medications. RESULTS: The mean IOP was 33.5±9.9 mm Hg before surgery, 15.2±3.6 mm Hg(mean IOP reduction of 51%) at 5 y after surgery, and 15.6±2.8 mm Hg(mean IOP reduction of 49.9%) at 10 y after surgery(P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5 y and 0.67±0.8 at 10 y postoperatively(P<0.001). The follow-up period was 104.5±37.0 mo. The qualified success rate for an IOP of 21, 18 or 16 mm Hg or less was 84% [95% confidence interval(CI): 0.80-0.88], 73%(95%CI: 0.68-0.78), and 59%(95%CI: 0.52-0.66) after 5 y, and 80%(95%CI: 0.76-0.84), 69%(95%CI: 0.64-0.74), 51%(95%CI: 0.44-0.58) after 10 y, respectively. There was a relationship between age, preoperative IOP and success rate(P<0.01, P<0.05). A total of 31 eyes(31.3%)in 31 patients underwent laser goniopuncture, decreasing the IOP from 22.9±4.3 mm Hg to 16.3±2.5 mm Hg(P<0.01). Neither blebitis nor endophthalmitis occurred.CONCLUSION: Modified viscocanalostomy could be performed to lower IOP, decrease multiple anti-glaucoma drops use as well. It's a safe procedure with less complications over 10 y in Chinese individuals with OAG.

Clinical effect of improved viscocanalostomy for the treatment of primary congenital glaucoma

AIM: To evaluate the clinical effect of improved viscocanalostomy in patients with primary congenital glaucoma. METHODS: Retrospective analysis of improved viscocanalostomy was performed on 51 eyes of 42 patients with primary congenital glaucoma. The outcome evaluation included postoperative intraocular pressure (IOP), corneal diameter, cup/disc ratio and complications. All patients were followed up at week 1, month 1, 3, 6 and 12. RESULTS: The results revealed that postoperative IOP was decreased from (38.57 +/- 13.61)mmHg to (10.53 +/- 3.91)mmHg. (14.89 +/- 5.26)mmHg,(15.42 +/- 5.11)mmHg, (13.82 +/- 3.46)mmHg, (13.16 +/- 5.29)mmHg at follow-up time of 1 week,1, 3, 6, 12 months (P<0.001). The postoperative corneal diameter was decreased significantly (P=0.002); The mean cup/dish ratio wasn't significantly different (P=0.148) before and after the surgery, the cup/dish ratio of successful surgery was evidently decreased (preoperative 0.7 +/- 0.2, postoperative 0.6 +/- 0.3, P = 0.007), but the complications like unformed anterior chamber were not observed. The mean follow-up period was 12 months. CONCUJSION: Improved viscocanalostomy improves the clinical effects of the patients with primary congenital glaucoma, such as higher success rates, lower postoperative mean IOP and fewer complications.

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.

Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of Open Angle Glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED （1966 to 2009）, Embase （1980 to 2009） and CMB-disk （1979 to 2009） for the randomized clinical trials （RCT） concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration＇s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure （IOP） between non-penetrating trabecular surgery and trabeculectomy （Z=6.05 P0.00001）. There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures （Z=4.92, P0.00001）. Difference in the success rate was also found between the two surgeries （Z=3.82, P=0.0001）. It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.