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Romano V, Passaro ML, Airaldi M, Ancona C, Pagano L, Semeraro F, Pineda R. Double trouble in DMEK surgery: Learning experience and review of the literature. Eur J Ophthalmol 2024; 34:NP22-NP28. [PMID: 38387873 DOI: 10.1177/11206721241228346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE To report a challenging Descemet Membrane Endothelial Keratoplasty (DMEK) case, complicated by intraoperative aqueous misdirection and spontaneous anterior chamber fibrin reaction. METHODS A 70-year-old female affected by corneal edema due to Fuchs endothelial dystrophy underwent a triple procedure (cataract extraction - IOL implantation - DMEK surgery) in her left eye. This report illustrates the management of the intraoperative complications of aqueous misdirection syndrome and anterior chamber fibrin reaction. RESULTS Despite the optimal management of the posterior pressure and the thorough removal of the fibrinous reaction during the case, the DMEK graft was not completely unfolded and centred at the end of the surgical procedure. Nonetheless, the patient showed good long-term anatomical and functional recovery: at the last follow-up (2 years after surgery), central corneal thickness was 526 µm with a best corrected visual acuity of 20/25 and an endothelial cell density of 1112 cell/mm2. CONCLUSION Early recognition and prompt management of intraoperative aqueous misdirection syndrome and anterior chamber fibrin reaction during DMEK surgery is essential to ensure good functional and anatomical outcomes.
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Affiliation(s)
- Vito Romano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Ophthalmic Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italia
| | - Maria Laura Passaro
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
| | - Matteo Airaldi
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Chiara Ancona
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Luca Pagano
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Francesco Semeraro
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Ophthalmic Unit, ASST Spedali Civili di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italia
| | - Roberto Pineda
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
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Liu X, Hu Y, Yang T, Wang Z, Wang Z. Impact of improved minimally invasive anterior vitrectomy on the prognosis of patients with malignant glaucoma. BMC Ophthalmol 2024; 24:39. [PMID: 38267918 PMCID: PMC10809461 DOI: 10.1186/s12886-024-03310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND The importance of communicating the anterior chamber and vitreous cavity for managing malignant glaucoma (MG) is widely recognized. This study investigated the impact of improved minimally invasive anterior vitrectomy (IAV) on the prognosis of MG. METHODS This retrospective interventional study included patients with MG who underwent conventional surgery or improved minimally IAV in Nanchang Aier Eye Hospital between January 2011 and April 2021. For the improved step, a small amount of triamcinolone acetonide was injected into the vicinity of the iris. Then, the residual vitreous body adhering to triamcinolone acetonide was excised. Comparisons were made using repeated measures ANOVA, t-test, and chi-squared test. RESULTS Thirty-one eyes from 26 patients were included: 15 eyes from 13 patients in the conventional group and 16 eyes from 13 patients in the IAV group. The 1-week, 1-month, and 3-month intraocular pressure (IOP) and the 3-month mean central anterior chamber depth were comparable between the two groups (all P > 0.05). The conventional group showed one eye with intraoperative vitreous hemorrhage and two eyes with postoperative re-shallowing of the anterior chamber; such events did not occur in the IAV group, and none developed corneal endothelial decompensation, IOL deviation, suprachoroidal hemorrhage, or retinal detachment during treatment and follow-up. CONCLUSION Patients with MG who undergo improved minimally IAV might have similar postoperative IOP and central anterior chamber depth compared with conventional surgery but with reduced complications such as intraoperative vitreous hemorrhage and postoperative re-shallowing of the anterior chamber. Improved minimally IAV might be an alternative surgery for MG.
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Affiliation(s)
- Xuequn Liu
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China.
| | - Yan Hu
- Nanyang Eye Hospital of Henan Province, 473000, Nanyang, China
| | - Tian Yang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
| | - Zhong Wang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
| | - Zhen Wang
- Aier Eye Hospital of Nanchang, 330002, Nangchang, China
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Wu X, Liu X, Xiao S, Cai Y, Yu M, Xu B, Wang Y, Wu W. Efficacy and safety of primary customized phacoemulsification combined with goniosynechialysis for refractory acute primary angle closure. Int Ophthalmol 2023; 43:4515-4525. [PMID: 37572168 DOI: 10.1007/s10792-023-02852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/03/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE To assess the safety, efficacy, and long-term clinical outcomes of primary customized phacoemulsification (phaco) combined with goniosynechialysis (GSL; phaco-GSL) in refractory acute primary angle closure (APAC) eyes with uncontrolled high intraocular pressure (IOP). METHODS This retrospective case series comprised 51 eyes of 42 consecutive patients with refractory APAC and high IOP who were treated using primary customized phaco-GSL at 3 hospitals in China, from 2014 to 2021. Preoperative and postoperative IOP, corrected distant visual acuity (CDVA), corneal endothelial cell density (CECD), intraoperative and postoperative complications were recorded. The safety, efficacy and subsequent long-term clinical outcomes were analyzed. RESULTS The mean CDVA (LogMAR) was improved from 1.67 ± 0.94 preoperatively to 0.23 ± 0.26 postoperatively (P < 0.001). Preoperative CECD was 2309.39 ± 541.03 cells/mm2 in 33 eyes and inaccessible in 18 eyes due to severe corneal edema; at the final follow-up, the mean CECD of all patients was 1823.50 ± 533.40 cells/mm2 (P < 0.001). The mean IOP decreased from 48.51 ± 6.25 mmHg preoperatively to 15.66 ± 2.27 mmHg at the final follow-up (P < 0.001). Among 51 eyes, additional customized procedures performed were corneal indentation in 42 eyes, epithelial debridement in 9 eyes, giant epithelial bullae view in 4 eyes, pars-plana fluid aspiration in 3 eyes, and secondary intraocular lens implantation in 7 eyes. The IOP of all eyes was well controlled eventually and 47 eyes (92.16%) were successfully treated by phaco-GSL alone. No significant intraoperative or postoperative complications were observed. CONCLUSIONS Primary customized phaco-GSL is a safe and effective surgical management strategy for patients with refractory APAC and high IOP.
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Affiliation(s)
- Xinna Wu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Ophthalmology, Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China
| | - Xiaobao Liu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Suzhen Xiao
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yajing Cai
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Mengting Yu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong, China
| | - Binqiang Xu
- Department of Ophthalmology, Guangze County Hospital, Nanping, China
| | - Yanling Wang
- Department of Ophthalmology, Funing County Hospital, Ningde, China
| | - Wenjie Wu
- Department of Ophthalmology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
- Department of Ophthalmology, Fujian Provincial Hospital, 134.Dongjie Rd, Fuzhou, 350001, Fujian Province, China.
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Ning J. Early Ciliovitreal Block following Ab Externo XEN Gel Implantation. Case Rep Ophthalmol Med 2023; 2023:9775780. [PMID: 37841340 PMCID: PMC10575743 DOI: 10.1155/2023/9775780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 08/27/2023] [Accepted: 09/05/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose To report a case of ciliovitreal block following ab externo implantation of a XEN gel stent for glaucoma. Methods Case report. Results An 84-year-old African American male underwent ab externo implantation of a XEN gel stent for elevated intraocular pressure. Several days after the surgery, the patient developed severe eye pain and reduced vision. Examination revealed ciliovitreal block (also called aqueous misdirection or malignant glaucoma) which was unresponsive to medical and laser treatment. Pars plana vitrectomy with anterior and posterior synechialysis and anterior chamber reformation were performed. The ciliovitreal block was resolved, and intraocular pressure brought to acceptable levels, but vision in that eye remained poor, likely due to the period of elevated pressure prior to treatment. Conclusion Ciliovitreal block is a rare postsurgical (typically) form of secondary angle closure characterized by narrow or flat central and peripheral anterior chamber, anterior displacement of the lens-iris diaphragm, anterior rotation of ciliary processes, and (usually) elevated intraocular pressure. To our knowledge, this is the first reported case of ciliovitreal block occurring after ab externo XEN implantation. Early diagnosis and treatment are essential for preventing vision loss.
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Affiliation(s)
- Jason Ning
- Omni Eye Services, 485 US Rt. 1 South, Building A, Iselin, NJ 08830, USA
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Liu Y, Wang T. Exploration on surgery of malignant glaucoma with prolonged absence of the anterior chamber: a retrospective consecutive case series. BMC Ophthalmol 2023; 23:304. [PMID: 37420223 DOI: 10.1186/s12886-023-03053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/20/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVE To evaluate the surgical outcomes of anterior chamber restoration in patients with malignant glaucoma and a prolonged absence of the anterior chamber. METHODS Five patients with malignant glaucoma and a long-term absence of the anterior chamber underwent a combination of anterior pars plana vitrectomy (aPPV), phacoemulsification cataract excision, intraocular lens implantation, peripheral iridotomy (PI), goniosynechialysis (GSL) (referred to aPPV + P + I + PI + GSL) at Beijing Tongren Hospital from October 2018 to June 2021. The study compared the changes in their visual acuity, intraocular pressure (IOP) and medication requirements between the pre-surgery period and their most recent follow-up visit. RESULTS The five patients did not report any discomfort, such as pain, tearing, swelling, etc., in their affected eyes, and maintained a stable restoration of the anterior chamber. Among the affected eyes, only one eye demonstrated improved vision during the follow-up visit, while the remaining four eyes did not show any significant improvement. One eye underwent transscleral cyclophotocoagulation as an additional procedure, while the other four eyes did not require any further surgical intervention. In all cases, the intraocular pressure (IOP) was successfully controlled below 30 mmHg. Post-surgery, four eyes still required cycloplegia treatment, and three eyes continued to rely on eye drops to manage their IOP. CONCLUSION Despite minimal improvement in vision, surgical intervention successfully restored the anterior chamber in malignant glaucoma patients with a prolonged absence of anterior chamber. This restoration contributed to alleviating subjective complaints of discomfort and delaying eyeball atrophy.
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Affiliation(s)
- Yan Liu
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical Universit, No.1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China
| | - Tao Wang
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical Universit, No.1 Dongjiaomin Lane, Dongcheng District, Beijing, 100730, China.
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Lin H, Li J, Zheng X, Wan R, Zhou M, Ding Y, Ji Y, Xie Y, Tham CC, Zhang S, Liang Y. Incidence and characteristics of aqueous misdirection after glaucoma surgery in Chinese patients with primary angle-closure glaucoma. EYE AND VISION (LONDON, ENGLAND) 2023; 10:28. [PMID: 37391810 DOI: 10.1186/s40662-023-00346-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/21/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND To report the incidence and clinical characteristics of aqueous misdirection (AM) after glaucoma surgery in Chinese patients with primary angle-closure glaucoma. METHODS Medical records of all patients diagnosed with primary angle-closure glaucoma who underwent glaucoma surgery in the Eye Hospital of Wenzhou Medical University between January 2012 and December 2021 were retrospectively reviewed. Cases of AM were identified through a keyword-based search. The incidence of AM was calculated. Demographic and clinical characteristics of the AM patients were also described. RESULTS A total of 5044 eyes with primary angle-closure glaucoma were included (mean age 65.81 ± 9.96 years, 68.11% women). Thirty-eight eyes developed AM, presenting an overall incidence of 0.75%. The mean time interval between surgery and first record of AM diagnosis was 2.57 ± 5.24 months (range, 0 day to 24 months). The incidence of AM was significantly higher in patients aged ≤ 40 years (21.28%) and those aged 40-50 years (3.32%), compared to those > 50 years (0.42%) (P < 0.001). AM developed much more frequently among patients with chronic angle-closure glaucoma (1.30%), compared to those with acute angle-closure glaucoma (0.32%, P < 0.001). Eleven eyes (0.37%) developed AM following non-filtering surgery compared to 24 eyes (2.27%) after filtering surgery (P < 0.001). CONCLUSION The incidence of AM after glaucoma surgery was 0.75% in Chinese patients with primary angle closure glaucoma. Younger age, chronic angle-closure glaucoma, and undergoing filtering surgery, were identified as associated risk factors for developing AM. Phacoemulsification may have less risk of developing AM compared to filtering surgery.
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Affiliation(s)
| | - Jiaqian Li
- Wenzhou Medical University, Wenzhou, 325027, China
| | - Xuanli Zheng
- Wenzhou Medical University, Wenzhou, 325027, China
| | - Rui Wan
- Wenzhou Medical University, Wenzhou, 325027, China
| | | | - Yutong Ding
- Wenzhou Medical University, Wenzhou, 325027, China
| | - Yiting Ji
- Wenzhou Medical University, Wenzhou, 325027, China
| | - Yanqian Xie
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270, Xue Yuan Xi Road, Wenzhou, 325027, Zhejiang, China
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, 325027, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Shaodan Zhang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270, Xue Yuan Xi Road, Wenzhou, 325027, Zhejiang, China.
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Yuanbo Liang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, No. 270, Xue Yuan Xi Road, Wenzhou, 325027, Zhejiang, China.
- Glaucoma Research Institute, Wenzhou Medical University, Wenzhou, 325027, China.
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Cheng Y, Ren T, Wang N. Biomechanical homeostasis in ocular diseases: A mini-review. Front Public Health 2023; 11:1106728. [PMID: 36733902 PMCID: PMC9886686 DOI: 10.3389/fpubh.2023.1106728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
Diabetes mellitus-induced hyperglycemia is responsible for multiple pathological ocular alternations from vasculopathy to biomechanical dyshomeostasis. Biomechanical homeostasis is crucial to maintain the normal physiological condition of the eyes. Biomechanical features vary in eye tissues regarding different anatomical positions, tissue components, and cellular functions. The disturbance in biomechanical homeostasis may result in different ocular diseases. In this review, we provide a preliminary sketch of the latest evidence on the mechano-environment of the eyeball and its possible influencing factors, thereby underscoring the relationship between the dyshomeostasis of ocular biomechanics and common eye diseases (e.g., diabetic retinopathy, keratoconus, glaucoma, spaceflight-associated neuro-ocular syndrome, retinal vein occlusion and myopia, etc.). Together with the reported evidence, we further discuss and postulate the potential role of biomechanical homeostasis in ophthalmic pathology. Some latest strategies to investigate the biomechanical properties in ocular diseases help unveil the pathological changes at multiple scales, offering references for making new diagnostic and treatment strategies targeting mechanobiology.
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Affiliation(s)
- Ying Cheng
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tianmin Ren
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ningli Wang
- Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China,Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China,*Correspondence: Ningli Wang ✉
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García‐Lorente M, Rocha‐de‐Lossada C, Borroni D, Romano V, Urbinati F, Zamorano‐Martin F, Peraza‐Nieves J, Rodríguez‐Calvo‐de‐Mora M. Fluid misdirection syndrome associated with endothelial keratoplasty: A multicenter case series. Clin Exp Ophthalmol 2022; 50:801-803. [DOI: 10.1111/ceo.14117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Carlos Rocha‐de‐Lossada
- Department of Ophthalmology (Qvision) Vithas Virgen del Mar Hospital Almería Spain
- Virgen de las Nieves University Hospital Granada Spain
- Department of Surgery, area of Ophthalmology University of Sevilla Seville Spain
| | - Davide Borroni
- Department of Doctoral Studies Riga Stradins University Riga Latvia
- Advalia Vision, Cornea Research Unit Milan Italy
| | - Vito Romano
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences University of Liverpool Liverpool UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Ophthalmology Clinic University of Brescia Brescia Italy
| | | | | | | | - Marina Rodríguez‐Calvo‐de‐Mora
- Regional University Hospital of Malaga Málaga Spain
- Department of Ophthalmology (Qvision) Vithas Virgen del Mar Hospital Almería Spain
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9
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Wang QW, Zuo CG, Li J, Lin XS, Chen W, Zhu QL, Zhou FQ, Lin HT, Chen WR. Effectiveness of surgical management of malignant glaucoma in phakic eyes. Int J Ophthalmol 2022; 15:65-70. [PMID: 35047358 DOI: 10.18240/ijo.2022.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/08/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the effectiveness of core vitrectomy-phacoemulsification-intraocular lens (IOL) implantation-capsulo-hyaloidotomy in treating phakic eye at least 1mo 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-capsulo-hyaloidotomy 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.
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Affiliation(s)
- Qi-Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China.,New England College of Optometry, Boston, MA 02115, USA
| | - Cheng-Guo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China.,New England College of Optometry, Boston, MA 02115, USA
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
| | - Xiao-Shan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
| | - Qiao-Lin Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
| | - Feng-Qi Zhou
- New England College of Optometry, Boston, MA 02115, USA
| | - Hao-Tian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
| | - Wei-Rong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, Guangdong Province, China
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El Matri K, Gouider D, Limaiem R, Chebil A, Henchiri M, Falfoul Y, El Matri L. Management of a bilateral post-uveitic complex glaucoma with pupillary block, rupture of the anterior lens capsule, and malignant glaucoma following laser peripheral iridotomies: Case report and literature review. J Curr Ophthalmol 2022; 34:260-263. [PMID: 36147276 PMCID: PMC9487004 DOI: 10.4103/joco.joco_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/15/2022] [Indexed: 11/04/2022] Open
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Zuo C, Wang D, Guo X, Xiao H, Zheng S, Lin M, Fang L, Liu X. Associations Between the Choroidal Vascularity Index and Malignant Glaucoma After Trabeculectomy for Primary Angle Closure Glaucoma. Front Med (Lausanne) 2021; 8:747720. [PMID: 34957140 PMCID: PMC8692757 DOI: 10.3389/fmed.2021.747720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To compare the choroidal vasculature characteristics by using the choroidal vascularity index (CVI) in eyes with malignant glaucoma (MG), fellow eyes with non-MG, and eyes with uncomplicated primary angle-closure glaucoma (PACG) after trabeculectomy by spectral-domain optical coherence tomography (SD-OCT). Methods: This case-control study included 53 patients diagnosed with MG after trabeculectomy. Eyes with MG (n = 53) and the fellow eyes with non-MG (n = 50) were included. Eyes with PACG without MG after trabeculectomy (n = 60) were also enrolled as controls. The choroidal parameters, including CVI and the subfoveal choroidal thickness (SFCT), were measured by using SD-OCT images. Results: Eyes with MG and the fellow eyes showed a significantly lower CVI than eyes with PACG controls (p < 0.001). After adjusting for age, sex, axial length (AL), and intraocular pressure (IOP), eyes with the greater CVI [odds ratio (OR), 0.44] were significantly related to MG. The area under the receiver operating characteristic curve of the CVI was greater than that of the SFCT in the diagnosis of MG (0.911 vs. 0.840, p = 0.034). Conclusion: Eyes with MG showed a significantly lower macular CVI than eyes with PACG controls. A higher macular CVI was an associated factor of eyes with MG. The CVI serves as a more stable and sensitive indicator for MG than the SFCT in this group of patients with PACG.
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Affiliation(s)
- Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dingqiao Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xinxing Guo
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shaoyang Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Mingkai Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Fang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Silva Cayatopa F, González Méndez AL, Barrientos Ortiz R, Silva Diaz A, Godin Estrada F. Central Pars Plana Vitrectomy + Phacoemulsification + Intraocular Lens Implantation in Patients with Small Eyes, Cataract, and Narrow Anterior Chambers. Clin Ophthalmol 2021; 15:4181-4187. [PMID: 34703205 PMCID: PMC8541767 DOI: 10.2147/opth.s336929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the results of central pars plana vitrectomy + phacoemulsification + intraocular lens implantation in patients with small eyes, cataract, and narrow chambers. Methods This prospective study was carried out in 89 eyes of 58 patients undergoing central pars plana vitrectomy + phacoemulsification + IOL implantation in small eyes with cataract at Clínica La Luz Eye Institute in Lima, Peru. Results The mean best corrected visual acuity (BCVA) was 0.8±0.6 preoperatively, 0.5±0.6 at 1 month, 0.3±0.3 at 6 months, 0.1±0.1 at 9 months, and 0.05±0.1 at 1 year, which was statistically significant from the preoperative period to 1 year of follow-up. Mean intraocular pressure was 22.09±2.4 mmHg preoperatively, 14.55±2.9 mmHg at 1 day, 12.94±2.04 mmHg at 1 month, 12.01±1.2 mmHg at 6 months, 12.20±1.9 mmHg at 9 months, and 11.34±1.1 mmHg at 1 year. The reduction in the intraocular pressure from the preoperative control period to the follow-up at 1 year was statistically significant. There was only one complication, a rupture of the posterior capsule, which was quickly resolved. Conclusion Central pars plana vitrectomy with phacoemulsification is a safe and effective technique to perform in narrow chambers with all types of cataracts, in experienced hands, which can avoid intraoperative complications.
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Rothman AL, Townsend JH, Chang TC. Pediatric intraoperative ciliary block. J AAPOS 2021; 25:242-245. [PMID: 33989795 DOI: 10.1016/j.jaapos.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
Pediatric patients who undergo intraocular surgery are at risk for many of the same perioperative complications as adults. The same methodical approach to assessing perioperative shallowing of the anterior chamber that presents in the adult population should be followed for children. We present a rare case of intraoperative ciliary block in a 3-year-old boy undergoing a second glaucoma drainage device implantation that was successfully treated with pars plana vitrectomy and hyaloid-zonulo-iridectomy.
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Affiliation(s)
- Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida.
| | - Justin H Townsend
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
| | - Ta C Chang
- Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida
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Yu X, Zhao Z, Zhang D, Yang X, Sun N, Lin Y, Zhang J, Fan Z. Anterior vitrectomy, phacoemulsification cataract extraction and irido-zonulo-hyaloid-vitrectomy in protracted acute angle closure crisis. Int Ophthalmol 2021; 41:3087-3097. [PMID: 33905050 PMCID: PMC8076881 DOI: 10.1007/s10792-021-01874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/19/2021] [Indexed: 11/05/2022]
Abstract
Purpose To describe a modified surgical approach with anterior vitrectomy, phacoemulsification (phaco) cataract extraction and irido-zonulo-hyaloid-vitrectomy (IZHV) in protracted acute angle closure crisis (AACC). Patients and methods Non-comparative, retrospective case series including 21 eyes in 19 consecutive cases of protracted AACC, which persists for at least 7 days despite maximal medical and laser therapies, were included in this study. All patients underwent a modified surgical procedure with anterior vitrectomy, phaco cataract extraction, IOL implantation, goniosynechialysis (GSL) and IZHV, using modest phaco dynamic parameters with intraocular pressure (IOP) set at 30 mmHg through the procedure using Centurion® Vision System equipped with active fluidics while the anterior vitrectomy was set at 4000 or 5000 rpm. IOP and anterior chamber space were maintained through the procedure using ophthalmic viscosurgical device (OVD) injected through paracentesis whenever the Phaco or I/A probe was withdrawn from within the anterior chamber. Medical history, visual acuity (VA), IOP and anterior and posterior segment findings were recorded and compared before and after surgical treatment. Results The average age of all patients was 60.05 years old, while the average period of persistent AACC was 20.05 days. Preoperatively, the average IOP of all included eyes was 44.40 ± 8.42 mmHg despite maximal topical and systemic anti-glaucoma medications and/or laser surgeries, while the average VA was 1.46 ± 0.88 (log MAR). Postoperatively, IOP was well controlled in all patients with an average IOP at 12.06 ± 3.07 mmHg without any anti-glaucoma medications at follow-ups, which was decreased significantly from that in preoperative measurements (P < 0.001). Visual acuity was improved significantly at final follow-up with an average postoperative VA at 0.74 ± 0.77 (log MAR, P < 0.001). Anterior segment inflammation was surprisingly mild with no or minimal inflammatory cells or exudates. Anterior segment configuration was resolved in all the cases. There was no recurrent IOP spike, anterior chamber shallowing or severe complications during an average follow-up of 5.38 months (ranging from 3 to 6 months). Conclusions Protracted AACC is a complex situation while a modified surgical strategy of anterior vitrectomy, phaco cataract extraction and IZHV provides a safe and efficient solution.
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Affiliation(s)
- Xiaowei Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Zhenni Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Dandan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Xue Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Nannan Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yixiu Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Jiamin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Zhigang Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China. .,Tongren Eye Center, Beijing Tongren Hospital, Capital Medical School, Beijing, 100730, China.
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Petpiroon P, Suwan Y, Teekhasaenee C, Supakontanasan W. Pseudophakic Angle Closure Due to Vitreous Block Following Ureteroscopic Lithotripsy. Int Med Case Rep J 2021; 14:21-24. [PMID: 33536795 PMCID: PMC7850374 DOI: 10.2147/imcrj.s285701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background Here, we describe a patient who exhibited pseudophakic angle closure due to vitreous block following ureteroscopic lithotripsy under general anesthesia. Case Presentation A 57-year-old Thai man presented with sudden eye pain and blurring of vision in the left eye following ureteroscopic lithotripsy under general anesthesia. The patient had a history of coconut hit into his left eye which resulted in traumatic anterior lens subluxation, for which he had undergone phacoemulsification and scleral-fixated intraocular lens implantation in the left eye. Prior scleral fixation procedure, anterior vitrectomy was not performed. Clinical examination showed mushroom-shaped vitreous in the anterior chamber with absolute pupillary block, which had resulted in acute angle closure. Thus, topical and oral antiglaucoma medications were administered to achieve normal intraocular pressure in the left eye, followed by laser peripheral iridotomy in that eye. The anterior chamber depth was successfully increased. Limited anterior vitrectomy by a pars plana approach was performed to prevent recurrent angle closure. The patient’s vision improved and his intraocular pressure remained controlled without any antiglaucoma medication. Conclusion Vitreous block can occur in patients with pseudophakia, especially in the presence of a ruptured posterior capsule. Cautious intraoperative anterior vitrectomy and surgical iridectomy are warranted. General anesthesia may contribute to the onset of vitreous block in susceptible patients.
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Affiliation(s)
- Purit Petpiroon
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanin Suwan
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Teekhasaenee
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Supakontanasan
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Hynnekleiv L, Thrane AS, Krohn J. Simultaneous bilateral aqueous misdirection following certolizumab therapy for rheumatoid arthritis. BMJ Case Rep 2020; 13:13/10/e235194. [PMID: 33012711 PMCID: PMC7536770 DOI: 10.1136/bcr-2020-235194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Aqueous misdirection syndrome is a rare, incompletely understood, sight-threatening eye condition that is difficult to diagnose and treat. We present a case of simultaneous bilateral aqueous misdirection following the administration of certolizumab in a 41-year-old women with rheumatoid arthritis and no known risk factors. To our knowledge, aqueous misdirection has not previously been associated with the use of tumour necrosis factor-alpha inhibitors.
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Affiliation(s)
- Leif Hynnekleiv
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | | | - Jørgen Krohn
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway
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Slit-lamp Pars Plana Needle Hyaloidotomy-Zonulotomy-Iridotomy for the Treatment of Spontaneous Malignant Glaucoma. J Glaucoma 2020; 29:e31-e32. [PMID: 32097257 DOI: 10.1097/ijg.0000000000001473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An 88-year-old woman with a history of recent complicated pacemaker insertion presented with acute-onset malignant glaucoma recalcitrant to conservative medical therapy. Surgical intervention was discussed; however, given her complex cardiac history and recent postoperative state, the risk of anesthesia-related systemic adverse events was deemed unacceptably high. As such, a slit-lamp procedure was recommended to break the attack of malignant glaucoma. Here within, we report a novel technique of breaking an attack of malignant glaucoma by needling the anterior hyaloid face at the slit lamp. With this technique, a 25-G needle was entered through the pars plana and was advanced through the anterior hyaloid face, zonules, and peripheral iridotomy to create a unicameral eye and successfully break the malignant closure attack.
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18
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Current Concepts on Aqueous Misdirection. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Lin H, Zhou G, Zhang S, Huang F, Liang Y. One-year outcome of low dose laser cyclophotocoagulation for capsular tension ring-induced malignant glaucoma: A case report. Medicine (Baltimore) 2020; 99:e18836. [PMID: 32028394 PMCID: PMC7015563 DOI: 10.1097/md.0000000000018836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up. PATIENT CONCERNS A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye. DIAGNOSIS Ciliary block caused by capsular tension ring and malignant glaucoma was observed. INTERVENTIONS Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia. OUTCOMES One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation. LESSONS Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.
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Affiliation(s)
- Haishuang Lin
- The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital
| | - Guangming Zhou
- The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital
| | - Shaodan Zhang
- The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital
- Glaucoma Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Fang Huang
- The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital
| | - Yuanbo Liang
- The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital
- Glaucoma Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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20
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Thompson AC, Vu DM, Postel EA, Challa P. Factors Impacting Outcomes and the Time to Recovery From Malignant Glaucoma. Am J Ophthalmol 2020; 209:141-150. [PMID: 31377283 DOI: 10.1016/j.ajo.2019.07.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 07/28/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To identify factors associated with the successful treatment of malignant glaucoma (MG). DESIGN Retrospective case series. METHODS Setting: single institution; study population: 64 eyes (55 subjects) with MG; observation procedure(s): chart review; main outcome measures: anatomy, intraocular pressure (IOP), best visual acuity (BVA). RESULTS 87.5% (n=56/64) of eyes with MG required surgical intervention. Vitrectomy was more likely to be successful in eyes with a history of <3 incisional surgeries, <3 glaucoma drops, or IOP ≤30 mm Hg (P < .05). If vitrectomy was performed within 30 days, recovery of anatomy, BVA, and IOP occurred sooner (P < .05). IOP reduction was greater in subjects treated with oral carbonic anhydrase inhibitors (P = .016) or Nd:YAG laser hyaloidotomy (P = .007), and without a history of MG (P = .007). Time to maximal improvement was significantly longer for IOP and BVA than anatomy (P < .001). Treatment of MG with an oral carbonic anhydrase inhibitor hastened anatomic recovery (P = .01). Time to improvement in BVA was significantly faster in men and African Americans (P < .05). Time to maximal reduction in IOP occurred sooner in eyes that underwent anterior chamber reformation in clinic (P < .002). Trabeculectomy surgery prior to MG was associated with prolonged recovery of anatomy, BVA, and IOP (P < .05). CONCLUSIONS Earlier vitrectomy may shorten recovery times for MG. Nd:YAG laser hyaloidotomy and oral carbonic anhydrase inhibitors may lead to greater IOP reduction. The time to maximal improvement in IOP and BVA may be longer than the time to anatomic resolution. Although trabeculectomy may impede time to recovery from MG, oral carbonic anhydrase inhibitors may shorten the time to anatomic recovery and anterior chamber reformation may hasten IOP recovery.
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Affiliation(s)
- Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Daniel M Vu
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Eric A Postel
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Pratap Challa
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA.
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21
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Hu JL, Hu CC. Virtual Eye Simulation: An Aid in Evaluation of Capsular Block Syndrome. Open Ophthalmol J 2019. [DOI: 10.2174/1874364101913010051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
To demonstrate the findings of three consecutive cases of postoperative Capsular Block Syndrome (CBS) diagnosed with the aid of Pentacam virtual eye simulation images.
Methods:
Observational case series report. Three patients underwent uneventful cataract removal and presented with blurry vision ranging from 4 days to 5 years after the surgeries were performed.
Results:
In a case of early-onset postoperative CBS, virtual eye simulation images clearly revealed a reduced posterior chamber depth caused by the accumulation of transparent fluid in the area between the intraocular lens and the posterior capsule. In two cases of late-onset postoperative CBS, virtual eye simulation images better visualized the alignment between intraocular lens (IOL) and iris than slit lamp examination and Schiemflug images. All three of the cases underwent neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy, and their capsular bag distensions were resolved immediately. The patients with misalignments between IOL and iris experienced more improvement in best-corrected visual acuity as opposed to the one who did not.
Conclusion:
Virtual eye simulation is found to be a useful way in visualizing misalignment between IOL and iris and assisting diagnoses of both early- and late-onset postoperative capsular block syndrome.
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22
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Shute TS, Varma DK, Tam D, Klein T, Moinul P, Ahmed IIK, Sheybani A. Seasonal Variation in the Incidence of Malignant Glaucoma after Cataract Surgery. J Ophthalmic Vis Res 2019; 14:32-37. [PMID: 30820284 PMCID: PMC6388520 DOI: 10.4103/jovr.jovr_41_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To investigate a potential link between the incidence of malignant glaucoma after cataract surgery and seasonal variations in daylight. Methods: In total, 18,374 uncomplicated cataract surgeries were performed between June 2008 and June 2013 at an ambulatory surgery center in Toronto. Toronto's average monthly daylight over that time period—in hours per day for each month—was determined. The number of malignant glaucoma cases that developed after cataract surgery performed in months with above average daylight was compared to the number of cases that developed after cataract surgery performed in months with below average daylight. Fisher's exact test was used to analyze the relationship between the development of malignant glaucoma and variation in daylight during the month of cataract surgery. Results: Malignant glaucoma developed in 16 eyes. Thirteen cases of malignant glaucoma developed in months with above average daylight and three cases developed in months with below average daylight (P = 0.01). Eyes that developed malignant glaucoma in months with more daylight were slightly longer (21.95 ± 1.23 mm) than those that developed malignant glaucoma in months with less daylight (21.55 ± 0.88 mm). Conclusion: Light-induced choroidal expansion may play a major role in the development of malignant glaucoma following cataract surgery.
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Affiliation(s)
- Thomas S Shute
- Department of Ophthalmology and Visual Sciences, Washington University, St Louis, MO, USA
| | - Devesh K Varma
- Prism Eye Institute, Department of Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada
| | - Diamond Tam
- Prism Eye Institute, Department of Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada
| | - Thomas Klein
- Prism Eye Institute, Department of Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada
| | - Prima Moinul
- Department of Ophthalmology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Iqbal Ike K Ahmed
- Prism Eye Institute, Department of Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada.,Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,Trillium Health Partners, Mississauga, Ontario, Canada
| | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University, St Louis, MO, USA
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Thompson AC, Challa P. Prophylactic anterior vitrectomy during cataract surgery in eyes at increased risk for aqueous misdirection. Am J Ophthalmol Case Rep 2018; 12:24-27. [PMID: 30148233 PMCID: PMC6105756 DOI: 10.1016/j.ajoc.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 08/12/2018] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Patients with chronic narrow angle glaucoma (CNAG) are at increased risk of developing aqueous misdirection (AM) following intraocular surgery. We present a retrospective case series on the use of posterior capsulorrhexis with core vitrectomy by an anterior approach (CAV) at the time of cataract extraction with or without glaucoma surgery as a prophylactic measure for the prevention of AM in CNAG. METHODS Retrospective case series of six phakic eyes in four patients with CNAG and other risk factors for AM who underwent posterior capsulorrhexis and CAV at the time of cataract surgery with or without glaucoma surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), and post-operative complications. RESULTS Six eyes in four subjects underwent posterior capsulorrhexis with CAV at the time of cataract surgery. The case was combined with incisional glaucoma surgery in the five eyes with advanced visual field loss. The mean logMAR BCVA and IOP improved from 0.554 ± 0.398 and 25.2 ± 13 mmHg, respectively, at the pre-operative visit to 0.257 ± 0.218 and 12.2 ± 1.7 mmHg, respectively, at final follow-up. Both eyes with nanophthalmos developed non-appositional serous choroidals that resolved with atropine, but the left eye required additional treatment with synechiolysis, intraocular lens repositioning, limited AV and endocyclophotocoagulation. There were no permanent, vision-threatening complications. CONCLUSIONS AND IMPORTANCE CAV can be safely combined with cataract surgery and glaucoma surgery, and it may be an effective intervention in eyes with CNAG and other risk factors for AM as a prophylactic measure against the development of AM.
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Affiliation(s)
| | - Pratap Challa
- Duke University, Department of Ophthalmology, Durham, NC, USA
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24
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Clinical Characteristics and Outcomes of Malignant Glaucoma after Different Procedures Treated with Pars Plana Vitrectomy: A 10-Year Retrospective Study. ACTA ACUST UNITED AC 2018; 54:medicina54040065. [PMID: 30344296 PMCID: PMC6174344 DOI: 10.3390/medicina54040065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 11/16/2022]
Abstract
Background and objectives: Despite established common risk factors, malignant glaucoma (MG) remains a rare condition with challenging management. We aimed to analyze differences in risk factors for MG after different surgeries and outcomes after pars plana vitrectomy (PPV). Materials and Methods: This retrospective study included cases of MG treated with PPV between January 2005 and December 2015 in the Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas, Lithuania. Results: A total of 39 cases were analyzed: 23 (59%) after cataract surgery, 13 (33.3%) after trabeculectomy, and 3 (7.7%) after other interventions. Characteristics among the groups did not differ. Intraocular lens refractive power was significantly higher in the cataract group, in which intraocular pressure (IOP) before MG was significantly greater in the affected eye. Normotension was achieved in 92.3%, and a normal anterior chamber in 75%. Additional measures included eye drops (n = 24), trabeculectomy (n = 5), bleb revision (n = 2), synechiotomy (n = 4), and cyclophotocoagulation (n = 1). The proportion of drop-free patients significantly increased after PPV compared with that before MG development (38.5% versus 15.4%). Complications were observed in 11 cases: choroidal detachments with spontaneous resolution (n = 2); retinal detachment (n = 1); constant mydriasis (n = 1), neovascular glaucoma (n = 1); obstruction of filtrating zone by iris (n = 1) and by blood clot (n = 1); posterior synechia formation causing IOP rise (n = 4 (all resolved after synechiotomy)). The cataract group experienced significantly fewer complications than the trabeculectomy group (17.4% vs. 53.8%, respectively). Conclusions: There were no differences in the risk of MG among the different surgeries. However, higher IOP in the predisposed eye (versus contra-lateral eye) could indicate additional risk of MG after cataract surgery. PPV afforded reliable treatment for MG and the possibility for glaucoma patients to discontinue topical treatment.
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Kuriakose T, Jasper S, Thomas S. Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries. Indian J Ophthalmol 2018; 66:565-567. [PMID: 29582821 PMCID: PMC5892063 DOI: 10.4103/ijo.ijo_939_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC) before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure. This technique, used in 12 eyes, seems to be effective in patients with angle-closure glaucoma, malignant glaucoma, and per-operative sudden increase in vitreous pressure during surgery. Small-incision surgeries are ideally suited for this procedure. This minimally invasive technique is simple to perform and complications are unlikely to be more than what is seen with intravitreal injections.
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Affiliation(s)
- Thomas Kuriakose
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Smitha Jasper
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sherina Thomas
- Department of Ophthalmology, Christian Medical College, Vellore, Tamil Nadu, India
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26
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Pakravan M, Esfandiari H, Amouhashemi N, Veisi A, Torkian P, Yazdani S. Mini-vitrectomy; a Simple Solution to a Serious Condition. J Ophthalmic Vis Res 2018; 13:231-235. [PMID: 30090177 PMCID: PMC6058538 DOI: 10.4103/jovr.jovr_192_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To evaluate the safety and efficacy of clear corneal approach irido-zonulo-hyaloido-vitrectomy, which we named "mini-vitrectomy," in the management of pseudophakic aqueous misdirection. Methods In this retrospective, non-comparative interventional case series, 24 eyes with diagnosis of pseudophakic aqueous misdirection were enrolled. Medical therapy with cycloplegics and laser therapy, including posterior capsulotomy and hyaloidotomy, was not effective in the management of the condition. The eyes underwent mini-vitrectomy, a simple technique in which iridotomy, zonulectomy, hyaloidectomy, and limited anterior vitrectomy were performed via a clear cornea incision. The main outcome measure was reformation of the anterior chamber, which was evaluated at day 1 and months 1, 3, 6, and 12. Results The mean age of patients was 75.3 ± 11.3 years (range, 47 to 90), and 13 (54.2%) patients were women. Anterior chamber was deep in 22 patients (91.7%) at the last follow-up visit. The mean intraocular pressure (IOP) was 30.31 ± 1.9 mm Hg at presentation on 2.67 ± 1.09 glaucoma medications. IOP decreased significantly to 14.5 ± 4.6 mm Hg at 12-month follow-up. (P = 0.001). The number of glaucoma medications at final visit was 2.2 ± 0.9 (P = 0.21). Conclusion Mini-vitrectomy is a simple, safe, and effective procedure in the management of pseudophakic aqueous misdirection, and it can be adopted by all ophthalmologists who are involved in glaucoma management and are not comfortable with the pars plana vitrectomy approach.
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Affiliation(s)
- Mohammad Pakravan
- Ophthalmic Epidemiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nassim Amouhashemi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Veisi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooya Torkian
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Yazdani
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hoguet A, Pasquale LR. The best of the best: a review of select glaucoma case reports published in 2015. Digit J Ophthalmol 2017; 22:75-78. [PMID: 28924408 DOI: 10.5693/djo.01.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This review article summarizes four key case reports published in the field of glaucoma in the year 2015. The first article describes a novel technique for draining choroidal fluid in patients with uveal effusion syndrome. The second article describes 2 cases of recurrent vitreous block despite adequate surgical intervention. The third article describes 2 cases of endogenous steroid response glaucoma. The last article describes the treatment of visual phenomena following iridectomy using femtosecond laser assisted keratopigmentation.
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Affiliation(s)
- Ambika Hoguet
- Massachusetts Eye and Ear Infirmary, Harvard Medical School
| | - Louis R Pasquale
- Massachusetts Eye and Ear Infirmary, Harvard Medical School.,Channing Division of Network Medicine, Brigham and Women's Hospital
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28
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Gama I, Rodrigues WM, Filipe HP, Faria MY, Almeida LD. Refractory aqueous misdirection syndrome: A possible complication of penetrating keratoplasty. ACTA ACUST UNITED AC 2017; 92:390-393. [PMID: 28318831 DOI: 10.1016/j.oftal.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
Abstract
CLINICAL CASE An 85 year-old woman presented with a flat anterior chamber of the left eye, severe ocular hypertension, and a normal ultrasound examination in the day following a penetrating keratoplasty (PK). The clinical status did not respond to maximum medical therapy, laser posterior capsulotomy, anterior hyaloidotomy, and complete 23 G vitrectomy. The patient refused further intervention, and light perception was lost after 6 months of follow-up. DISCUSSION This is the first report of refractory aqueous misdirection syndrome following primary PK. Despite maximum medical and surgical management efforts, aqueous misdirection syndrome subsequent to primary PK may have a catastrophic outcome.
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Affiliation(s)
- I Gama
- Servicio de Oftalmología, Hospital Universitario Santa María, Centro Hospitalario Lisboa Norte; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal.
| | - W M Rodrigues
- Servicio de Oftalmología, Hospital Universitario Santa María, Centro Hospitalario Lisboa Norte; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - H P Filipe
- Servicio de Oftalmología, Hospital de las Fuerzas Armadas, Lisboa, Portugal
| | - M Y Faria
- Servicio de Oftalmología, Hospital Universitario Santa María, Centro Hospitalario Lisboa Norte; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
| | - L D Almeida
- Servicio de Oftalmología, Hospital Universitario Santa María, Centro Hospitalario Lisboa Norte; Facultad de Medicina, Universidad de Lisboa, Lisboa, Portugal
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Abstract
PURPOSE OF REVIEW This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery. RECENT FINDINGS Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course. SUMMARY Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.
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Chen H, Zhang SH. Pseudophakic Malignant Glaucoma Treatment Assisted with Anterior Segment Optical Coherence Tomography: A Case Report. ACTA ACUST UNITED AC 2016; 30:266-9. [PMID: 26960309 DOI: 10.1016/s1001-9294(16)30011-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Huan Chen
- College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shun-hua Zhang
- College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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