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Khan OA, Sesma G, Alawi A, AlWazae M. Outcomes of Non-Penetrating Deep Sclerectomy for Primary Congenital Glaucoma Performed by Experienced versus Trainee Surgeons: A Cohort Study. Clin Ophthalmol 2023; 17:897-906. [PMID: 36960324 PMCID: PMC10028302 DOI: 10.2147/opth.s403016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
Purpose To compare the outcomes of non-penetrating deep sclerectomy (NPDS) for primary congenital glaucoma (PCG) performed by experienced vs trainee surgeons. Patients and Methods This retrospective cohort study was conducted in 2022 in Saudi Arabia. Consultants (Gr-1) and trainee pediatric ophthalmologists (Gr-2) performed NPDS on pediatric patients with PCG. Success was defined as an intraocular pressure (IOP) less than 21 mmHg at 6 months after surgery. Complications, glaucoma medications, and additional procedures were also observed in the two groups. Results Gr-1 and Gr-2 operated on 14 and 39 eyes with PCG, respectively. The absolute success rates were 90.9% (95% confidence interval [CI]: 73.9, 100) in Gr-1 and 96.7% (95% CI: 90.2, 100) in Gr-2 (odds Ratio=1.1; 95% CI: 0.87, 1.3; P=0.54). Survival analysis suggested that the failure rate in the first 6 months after NPDS was not significantly different between the two groups (hazard ratio=1.45; 95% CI: 0.13, 16.0; P=0.767). The complications included hypotony (2 cases), vitreous hemorrhage (1 case), and total flap penetration (1 case). Only one eye in Gr-2 needed glaucoma medication after surgery. There was no significant difference in the success rates of one surgeon before and after training (P=0.43). The age (P=0.59) and sex (P=0.77) of patients, type of surgeon (P=0.94), and preoperative IOP (P=0.59) were not significant predictors of a stable IOP at 6 months after NPDS. Conclusion At 6 months after NPDS surgery performed by experienced and trainee pediatric ophthalmologists, the outcomes (stabilization of IOP) were similar between the two groups.
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Affiliation(s)
- Omar Abdallah Khan
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Gorka Sesma
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Correspondence: Gorka Sesma, Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia, Tel +966114849700, Fax +966114821908, Email
| | - Abeer Alawi
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Manal AlWazae
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Vahedian Z, Fakhraie G, Ahmed AH. Viscocanalostomy combined with trabeculotomy for management of refractory primary congenital glaucoma. J AAPOS 2022; 26:121.e1-121.e6. [PMID: 35430385 DOI: 10.1016/j.jaapos.2021.12.010] [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: 03/04/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the outcome of viscocanalostomy combined with trabeculotomy (VCO+tbo) in primary congenital glaucoma (PCG) with history of failed trabeculotomy. METHODS In this prospective study, VCO+tbo was performed in 75 eyes of 46 patients with PCG who had not responded adequately to one angle surgery. Success was defined as intraocular pressure (IOP) of 6-21 mm Hg and at least 20% IOP drop at the last postoperative visit with (qualified) or without (complete) glaucoma medications. RESULTS Patients completed a mean follow-up of 31 ± 11 months. Complete success was achieved in 6 eyes (8%); qualified success, in 38 eyes (51%). In the 44 successfully treated eyes, IOP was reduced from a preoperative mean of 29.0 ± 5.8 to 15.7 ± 2.6 mm Hg, and the number of medications dropped from 2.6 ± 0.9 to 2.0 ± 1.0 (P < 0.001). In univariate analysis, the success rate was lower in patients with neonatal onset disease than subjects whose age at onset was 1-12 months (HR = 0.22; 95% CI, 0.05-0.93; P = 0.039). Children whose disease was first diagnosed after 1 year of age responded better than neonatal onset patients but worse than those with age of onset of 1-12 months; however, the difference was not statistically significant. Hyphema occurred in 27 eyes (36%) on day 1 and resolved spontaneously. Iatrogenic cyclodialysis occurred in one eye, which was surgically repaired after 1 month of treatment with cycloplegic agents. CONCLUSIONS In our study cohort, VCO+tbo was associated with successful outcomes in the majority of treated eyes.
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Carrabba N, Zhaver D, Blieden LS. Surgical Management of Secondary Pediatric Glaucoma. Int Ophthalmol Clin 2022; 62:111-130. [PMID: 34965230 DOI: 10.1097/iio.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barke M, Dhoot R, Feldman R. Pediatric Glaucoma: Diagnosis, Management, Treatment. Int Ophthalmol Clin 2022; 62:95-109. [PMID: 34965229 DOI: 10.1097/iio.0000000000000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kessel L, Pedersen KB, Siersma V, Kappelgaard P, Bach‐Holm D. Long-term success after trabeculotomy in primary congenital glaucoma - a study with up to 35 years follow-up. Acta Ophthalmol 2021; 99:362-368. [PMID: 32914564 DOI: 10.1111/aos.14619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/17/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the surgical success after trabeculotomy for primary congenital glaucoma (PCG) in Denmark in the last 40 years. METHODS Retrospective review of medical files on children who all underwent trabeculotomy as the first surgical intervention between January 1rst, 1977 and December 31, 2016. Information on diagnosis and surgical procedures were extracted. Primary outcome was surgical success was defined as intraocular pressure (IOP) < 21 mmHg without medications one year after surgery. Secondary outcome was the number of reoperations needed. RESULTS Out of 118 children with PCG, 96 children (144 eyes) had an ab externo trabeculotomy as primary IOP lowering procedure opening Schlemm's channel 4 clock hours into the anterior chamber. Complete surgical success at one year was achieved in 73% (106 of 144 eyes). On the long term, IOP could be controlled by one surgical procedure in 2/3 of children, eight eyes required >5 surgical procedures to control IOP. In 12.1% of children the second glaucoma procedure was performed >5 years after the initial trabeculotomy. There was a tendency towards greater risk of needing a second procedure in patients < 3 months of age at primary trabeculotomy (hazard ratio, HR, 2.01, 95% CI 0.96-4.22) and in boys (HR 2.02, 95% CI 0.97-4.18) and a lower risk of requiring a third surgery if the second surgery was trabeculectomy with MMC. CONCLUSION Dedicated follow-up of patients with PCG is essential as the disease may continue to progress even after years of quiescence and some children need multiple surgeries to control IOP. Additional glaucoma procedures are required in 1/3 of children and boys and younger patients seem to be at greater risk.
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Affiliation(s)
- Line Kessel
- Department of Ophthalmology University Hospital of Copenhagen Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Karen Bjerg Pedersen
- Department of Ophthalmology University Hospital of Copenhagen Rigshospitalet‐Glostrup Glostrup Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice Department of Public Health University of Copenhagen Copenhagen Denmark
| | - Per Kappelgaard
- Department of Ophthalmology University Hospital of Copenhagen Rigshospitalet‐Glostrup Glostrup Denmark
| | - Daniella Bach‐Holm
- Department of Ophthalmology University Hospital of Copenhagen Rigshospitalet‐Glostrup Glostrup Denmark
- Department of Clinical Medicine Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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Chan JCH, Chow SC, Lai JSM. Retrospective analysis of paediatric glaucoma at a tertiary referral centre in Hong Kong. Jpn J Ophthalmol 2020; 65:115-121. [PMID: 33104957 DOI: 10.1007/s10384-020-00779-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the epidemiological features, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. STUDY DESIGN Retrospective chart review. METHODS Clinical data from the medical records of all patients under 18 years of age diagnosed with glaucoma from January 2008 to December 2017 at a university-affiliated, tertiary referral centre were collected. The patients' demographics, etiological distribution, clinical interventions, and outcomes were analysed. RESULTS A total of 33 subjects (53 eyes) were identified, 30 (49 eyes) of whom were Chinese. Primary glaucoma accounted for 21.2% of subjects, while 78.8% were diagnosed with secondary glaucoma. The most common subtype was juvenile-onset open angle glaucoma, followed by Sturge-Weber Syndrome related glaucoma. The most commonly performed surgical interventions were tube-shunt surgery (Ahmed Glaucoma Valve) and transscleral cyclophotocoagulation. Most eyes had significant reduction in intraocular pressure after medical or surgical intervention, but deterioration of visual acuity remained common. CONCLUSION Most cases of childhood glaucoma in Hong Kong are secondary rather than primary, similar to other regions with low incidence of parental consanguinity. The large proportion of secondary glaucoma which generally has poorer prognosis, is reflected by the frequency of multiple surgery, and a high incidence of visual deterioration despite significant intraocular pressure reduction in most eyes.
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Affiliation(s)
- Jonathan Cheuk-Hung Chan
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China.
| | - Shing Chuen Chow
- LKS Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Jimmy Shiu-Ming Lai
- Department of Ophthalmology, LKS Faculty of Medicine, University of Hong Kong, Room 301, Block B, Cyberport 4, Hong Kong, People's Republic of China
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Soh YQ, Kocaba V, Weiss JS, Jurkunas UV, Kinoshita S, Aldave AJ, Mehta JS. Corneal dystrophies. Nat Rev Dis Primers 2020; 6:46. [PMID: 32528047 DOI: 10.1038/s41572-020-0178-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 12/21/2022]
Abstract
Corneal dystrophies are broadly defined as inherited disorders that affect any layer of the cornea and are usually progressive, bilateral conditions that do not have systemic effects. The 2015 International Classification of Corneal Dystrophies classifies corneal dystrophies into four classes: epithelial and subepithelial dystrophies, epithelial-stromal TGFBI dystrophies, stromal dystrophies and endothelial dystrophies. Whereas some corneal dystrophies may result in few or mild symptoms and morbidity throughout a patient's lifetime, others may progress and eventually result in substantial visual and ocular disturbances that require medical or surgical intervention. Corneal transplantation, either with full-thickness or partial-thickness donor tissue, may be indicated for patients with advanced corneal dystrophies. Although corneal transplantation techniques have improved considerably over the past two decades, these surgeries are still associated with postoperative risks of disease recurrence, graft failure and other complications that may result in blindness. In addition, a global shortage of cadaveric corneal graft tissue critically limits accessibility to corneal transplantation in some parts of the world. Ongoing advances in gene therapy, regenerative therapy and cell augmentation therapy may eventually result in the development of alternative, novel treatments for corneal dystrophies, which may substantially improve the quality of life of patients with these disorders.
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Affiliation(s)
- Yu Qiang Soh
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Viridiana Kocaba
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore.,Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands
| | - Jayne S Weiss
- Department of Ophthalmology, Pathology and Pharmacology, Louisiana State University, School of Medicine, New Orleans, USA
| | - Ula V Jurkunas
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Schepens Eye Research Institute, Boston, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore, Singapore. .,Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore, Singapore. .,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore.
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Gonioscopy-assisted transluminal trabeculotomy using an illuminated catheter for infantile primary congenital glaucoma. Case series. Am J Ophthalmol Case Rep 2020; 19:100733. [PMID: 32462099 PMCID: PMC7240732 DOI: 10.1016/j.ajoc.2020.100733] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To describe our experience of Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) in four eyes with infantile primary congenital glaucoma (PCG). Observations We report the first two GATT procedures performed in six-month-old infants with PCG. We also report the same procedure in two eyes of a two-year-old boy with PCG who had previous goniotomies with subsequent peripheral anterior synechiae formation. In all four eyes, the IOP remained under 20 mmHg at years three and four postoperatively, without glaucoma medication or conjunctival surgery. Conclusions and importance Our cases confirm that GATT is an alternative to traditional ab externo glaucoma surgery in PCG and can be successfully performed within the first months of life, or in infants with failed or partially functioning goniotomies, avoiding the need for invasive conjunctival or scleral surgery.
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Puthuran GV, Palmberg PF, Wijesinghe HK, Pallamparthy S, Krishnadas SR, Robin AL. Intermediate-term outcomes of Aurolab aqueous drainage implant in refractory paediatric glaucoma. Br J Ophthalmol 2019; 104:962-966. [DOI: 10.1136/bjophthalmol-2019-314399] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/11/2019] [Accepted: 09/25/2019] [Indexed: 11/04/2022]
Abstract
AimTo report the intermediate-term outcomes of Aurolab aqueous drainage implant (AADI) surgery in paediatric eyes with refractory glaucoma.MethodsCase records of patients below 18 years, who underwent AADI surgery between 2012 and 2015 with >2 years follow-up, were analysed. The intraocular pressure (IOP), visual acuity, number of antiglaucoma medications, complications and resurgery if any were recorded at baseline, day 1and then at months 1, 3, 6, 9, 12, 18, 24 and at the last visit. Failure was defined as IOP >18 mm Hg or not reduced by at least 30% below baseline, IOP ≤5 mm Hg on two consecutive follow-up visits after 3 months, reoperation for a complication or loss of light perception vision.Results101 eyes of 101 patients were included with a mean age of 10.4±4.7 years at the time of surgery and a mean follow-up of 40.9±15.1 months. Glaucoma following cataract surgery was the most common type of glaucoma (n=31, 30%), followed by primary congenital glaucoma (n=29, 29%). The cumulative probability of failure was 15.8% (95% CI 10.1% to 24.5%) at 1 year, 22.7% (95% CI 15.7% to 32.2%) at 2 years, 42.5% (95% CI 32.6% to 53.9%) at 3 years and 62.1% (95% CI 49.5% to 74.8%) at the 4 years time point.ConclusionThe AADI showed excellent success until 2 years after surgery in paediatric eyes after which failure rates increased. Further prospective studies with longer follow-up are required to evaluate the long-term success of the AADI for paediatric glaucomas.
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Liang Y, Sun H, Shuai J, Xu K, Ji FF, Sucijanti, Yuan ZL. Modified viscocanalostomy in the Chinese population with open angle glaucoma: a 10-year follow-up results. Int J Ophthalmol 2019; 12:429-435. [PMID: 30918812 DOI: 10.18240/ijo.2019.03.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 01/02/2019] [Indexed: 11/23/2022] Open
Abstract
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 5y after surgery, and 15.6±2.8 mm Hg (mean IOP reduction of 49.9%) at 10y after surgery (P<0.001). The number of anti-glaucoma medications dropped from 2.39±0.5 preoperatively to 0.47±0.8 at 5y and 0.67±0.8 at 10y postoperatively (P<0.001). The follow-up period was 104.5±37.0mo. 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 5y, and 80% (95%CI: 0.76-0.84), 69% (95%CI: 0.64-0.74), 51% (95%CI: 0.44-0.58) after 10y, 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 10y in Chinese individuals with OAG.
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Affiliation(s)
- Ya Liang
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Hong Sun
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Jie Shuai
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Kai Xu
- Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai 200031, China
| | - Fang-Fang Ji
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Sucijanti
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
| | - Zhi-Lan Yuan
- Department of Ophthalmology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
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Sieck EG, Epstein RS, Kennedy JB, SooHoo JR, Pantcheva MB, Patnaik JL, Wagner BD, Lynch AM, Kahook MY, Seibold LK. Outcomes of Kahook Dual Blade Goniotomy with and without Phacoemulsification Cataract Extraction. ACTA ACUST UNITED AC 2018; 1:75-81. [DOI: 10.1016/j.ogla.2018.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 02/06/2023]
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12
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Huang JL, Huang JJ, Zhong YM, Guo XX, Chen XX, Xu XY, Liu X. Surgical Outcomes of Trabeculotomy in Newborns with Primary Congenital Glaucoma. Chin Med J (Engl) 2017; 129:2178-83. [PMID: 27625089 PMCID: PMC5022338 DOI: 10.4103/0366-6999.189925] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Early surgical intervention is required for the primary congenital glaucoma (PCG). There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth. Methods: A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates. Results: The mean follow-up time was 46.9 ± 34.4 months (range: 12–122 months). The postoperative IOP was significantly lower than the preoperative IOP at all of the follow-up visits (P < 0.001). The complete success rates for all eyes at 1, 2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The IOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly (P = 0.01) although the horizontal corneal diameter did not change significantly (P = 0.11). Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications. Conclusions: Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.
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Affiliation(s)
- Jie-Lei Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Jing-Jing Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Yi-Min Zhong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Xin-Xing Guo
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Xiang-Xi Chen
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Xiao-Yu Xu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
| | - Xing Liu
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong 510060, China
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Efficacy of Combined Retisert and Ahmed Glaucoma Valve for Medically Uncontrolled Uveitis and Glaucoma. J Glaucoma 2017; 26:683. [PMID: 28333898 DOI: 10.1097/ijg.0000000000000663] [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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14
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Javaid U, Ali MH, Jamal S, Butt NH. Pathophysiology, diagnosis, and management of glaucoma associated with Sturge-Weber syndrome. Int Ophthalmol 2017; 38:409-416. [PMID: 28064423 DOI: 10.1007/s10792-016-0412-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Sturge-Weber syndrome (SWS), also known as encephalotrigeminal angiomatosis, is a condition which includes leptomeningeal hemangioma, facial angiomatosis or nevus flammeus, and ocular changes. SWS can lead to severe complications of anterior segment involving conjunctiva and eyelids, whereas posterior segment of the eye may also be affected by diffuse choroidal hemorrhages. This article was written with the objectives to determine the pathophysiology, diagnosis, and treatment of glaucoma associated with this rare and challenging disorder. METHODS A detailed literature search was conducted on PubMed, EMBASE, Cochrane Library, and Google Scholar using the key words. Forty-five articles matched our inclusion criteria that were included in this systematic review. RESULTS Glaucoma is the one of the commonest ocular manifestations of SWS. It is caused by anterior chamber malformations, increased pressure in the episcleral veins, and changes in ocular hemodynamics. Glaucoma associated with SWS is usually congenital but can develop adults as well. The treatment of glaucoma associated with SWS is quite challenging because of early-onset, severe visual field impairment at the time of diagnosis, and unresponsiveness to standard medical treatment. Several surgical procedures have been devised but the long-term control of the intraocular pressure and visual function remain unsatisfactory. Modifications in the filtration surgery techniques and use of newer anti-fibrotic agents have produced good control of intraocular pressure. CONCLUSION Management of glaucoma associated with SWS is multi-dimensional and needs both medical and surgical interventions for better control. The treatment should be devised on case to case basis depending upon the intraocular pressure, stage of the disease, and type of glaucoma.
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Affiliation(s)
- Usman Javaid
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan.
| | - Samreen Jamal
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Nadeem Hafeez Butt
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
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Fiberoptic Microcatheter-assisted 360-Degree Trabeculotomy Ab Externo After Unsuccessful Trabeculotome Trabeculotomy in Primary Congenital Glaucoma: A Case Report. J Glaucoma 2016; 25:e753-5. [PMID: 27367133 DOI: 10.1097/ijg.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fiberoptic microcatheter-assisted 360-degree trabeculotomy ab externo is a recent technique. Retrospective studies have proved the effectiveness as a first-angle surgery in eyes with primary congenital glaucoma. However, there are no reports in which it is performed after another unsuccessful surgical procedure. We present our case of a monolateral congenital glaucoma. We first performed an ab externo trabeculotomy with poor control of intraocular pressure (IOP). Then, a microcatheter-assisted 360-degree trabeculotomy was performed with IOP lowering. Microcatheter-assisted 360-degree trabeculotomy supplies successful IOP lowering after another angle surgery procedure.
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