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Gao X, Lin F, Lu P, Xie L, Tang L, Zhu X, Zhang Y, Lv A, Tang G, Zhang H, Yan X, Song Y, Xu J, Huang J, Zhang Y, Hu K, Peng Y, Wang Z, Li X, Chen W, Wang N, Barton K, Park KH, Aung T, Weinreb RN, Lam DSC, Fan S, Tham CC, Zhang X. Efficacy and Safety of Surgical Peripheral Iridectomy, Goniosynechialysis, and Goniotomy for Advanced Primary Angle Closure Glaucoma Without Cataract: 1-Year Results of a Multicenter Study. J Glaucoma 2024; 33:632-639. [PMID: 38780279 DOI: 10.1097/ijg.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024]
Abstract
PRCIS The combination of surgical peripheral iridectomy, goniosynechialysis, and goniotomy is a safe and effective surgical approach for advanced primary angle closure glaucoma without cataract. PURPOSE To evaluate the efficacy and safety of surgical peripheral iridectomy (SPI), goniosynechialysis (GSL), and goniotomy (GT) in advanced primary angle closure glaucoma (PACG) eyes without cataract. PATIENTS AND METHODS A prospective multicenter observational study was performed for patients who underwent combined SPI, GSL, and GT for advanced PACG without cataract. Patients were assessed before and after the operation. Complete success was defined as achieving intraocular pressure (IOP) between 6 and 18 mm Hg with at least a 20% reduction compared with baseline, without the use of ocular hypotensive medications or reoperation. Qualified success adopted the same criteria but allowed medication use. Factors associated with surgical success were analyzed using logistic regression. RESULTS A total of 61 eyes of 50 advanced PACGs were included. All participants completed 12 months of follow-up. Thirty-six eyes (59.0%) achieved complete success, and 56 eyes (91.8%) achieved qualified success. Preoperative and postsurgical at 12 months mean IOPs were 29.7±7.7 and 16.1±4.8 mm Hg, respectively. The average number of ocular hypotensive medications decreased from 1.9 to 0.9 over 12 months. The primary complications included IOP spike (n=9), hyphema (n=7), and shallow anterior chamber (n=3). Regression analysis indicated that older age (odds ratio [OR]=1.09; P =0.043) was positively associated with complete success, while a mixed angle closure mechanism (OR=0.17; P =0.036) reduced success rate. CONCLUSIONS The combination of SPI, GSL, and GT is a safe and effective surgical approach for advanced PACG without cataract. It has great potential as a first-line treatment option for these patients.
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Affiliation(s)
- Xinbo Gao
- 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
| | - Fengbin 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
| | - Ping Lu
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Lin Xie
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Li Tang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Xiaomin Zhu
- Department of Ophthalmology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yao Zhang
- Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - Aiguo Lv
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Guangxian Tang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Hengli Zhang
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Xiaowei Yan
- Department of Ophthalmology, Shijiazhuang People's Hospital, Hebei Province
| | - Yunhe Song
- 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
| | - Jiangang Xu
- 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
| | - Jingjing Huang
- 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
| | - Yingzhe Zhang
- 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
| | - Kun Hu
- 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
| | - Yuying Peng
- 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
| | - Zhenyu 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
| | - Xiaoyan Li
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Weirong 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
| | - Ningli Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing
| | - Keith Barton
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, UCL Institute of Ophthalmology, London, UK
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Viterbi Family Department of Ophthalmology, and Shiley Eye Institute, University of California San Diego, CA
| | - Dennis S C Lam
- International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen
| | - Sujie Fan
- Handan City Eye Hospital (The Third Hospital of Handan), Handan
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Kowloon, Hong Kong Special Administrative Region, China
| | - Xiulan Zhang
- 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
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Chen J, Du J, Xing X, Liu D, Jia Z, Zheng Y, Wang D, Guo W, Jiang J, Duan G, Tang L, Wu Z, Lv P, Ma J, Zhu Y, Liang Y, Sun X, He M. China Glaucoma Treatment Pattern Study I-Primary Angle-Closure Glaucoma: protocol for a multicentre, retrospective, observational study. BMJ Open 2023; 13:e068048. [PMID: 37015785 PMCID: PMC10083785 DOI: 10.1136/bmjopen-2022-068048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
INTRODUCTION Primary angle-closure glaucoma (PACG) is a leading cause of irreversible blindness globally, and the number of patients with PACG rises every year. Yet, there is a lack of knowledge about the clinical characteristics, therapeutic options and profile of patients with PACG in China. Hence, we design the China Glaucoma Treatment Pattern Study Ⅰ-Primary Angle-Closure Glaucoma (Ch-GTPⅠ). The objective of this paper is to describe the design and methodology of Ch-GTP. The aim of this study is to characterise the profile and trend associated with initial PACG treatment for the last 10 years in China. METHODS Ch-GTPⅠ is a national multicentre retrospective observational study that will randomly sample from 50 hospitals throughout China. Over 7000 patient records hospitalised for initial PACG treatment from 2011 to 2020 will be selected randomly. The data from electronic medical records will be uploaded to an encrypted online platform that will receive and collate data from all collaborating hospitals. Data abstraction and monitoring will be performed in a standardised manner by trained statisticians to ensure consistency. Systematic data cleaning will also be conducted by statisticians to ensure data integrity before final data storage. The outcomes will include four broad categories: (1) demographics, (2) clinical characteristics, (3) therapeutic strategies and procedures and (4) early outcomes at discharge. The demographic characteristics and early outcomes will be summarised using descriptive statistics. Comparative analyses of characteristics and treatment pattern changing trends for different regions and years will be used to test for significant differences (t-test or Mann-Whitney U test). ETHICS AND DISSEMINATION The collaborating hospitals obtained local approval based on a standard ethics application from internal ethics committees or acknowledged an existent ethics approval of the leading institution with approval from internal ethics committees. Due to the retrospective nature, written informed consent from patients was waived by the ethics committee. The results will be published in academic journals and presented at national and international academic conferences. TRIAL REGISTRATION NUMBER ChiCTR2100054643.
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Affiliation(s)
- Jinyuan Chen
- Department of Ophthalmology, Fujian Medical University, Fuzhou, Fujian, China
| | - Jie Du
- Department of Ophthalmology, Wenzhou Medical University Eye Hospital, Wenzhou, Zhejiang, China
| | - Xiaoli Xing
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, Tianjin, China
| | - Danyan Liu
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhiyang Jia
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yajuan Zheng
- Department of Ophthalmology, Jilin University Second Hospital, Changchun, Jilin, China
| | - Dan Wang
- Department of Ophthalmology, Jilin Province Hospital of Chinese Medicine, Changchun, Jilin, China
| | - Wenyi Guo
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, Shanghai, China
| | - Jian Jiang
- Eye Center, Xiangya Hospital Central South University, Changsha, Hunan, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan, China
| | - Guoping Duan
- Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Li Tang
- Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Zhengzheng Wu
- Department of Ophthalmology, Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
| | - Peng Lv
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Jianjun Ma
- Department of Ophthalmology, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Yihua Zhu
- Department of Ophthalmology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yuanbo Liang
- Wenzhou Medical University Eye Hospital, Wenzhou, Zhejiang, China
| | - Xin Sun
- Sichuan University West China Hospital, Wuhou, Sichuan, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Zhou L, Wu S, Wang Y, Bao X, Peng T, Luo W, Ortega-Usobiaga J. Clinical presentation of acute primary angle closure during the COVID-19 epidemic lockdown. Front Med (Lausanne) 2022; 9:1078237. [PMID: 36590933 PMCID: PMC9802666 DOI: 10.3389/fmed.2022.1078237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose This study aimed to investigate the clinical presentation of acute primary angle closure (APAC) during the COVID-19 epidemic lockdown in Wuhan. Methods Consecutive patients seeking APAC treatment at the Wuhan Aier Eye Hospital during the 76 days (January 23-April 8, 2020) when the lockdown policy was implemented due to the COVID-19 pandemic were compared to those during the same period the following year (January 23-April 8, 2021), when the lockdown policy was not implemented. The cohorts were compared to assess demographic variables and clinical presentations. Results A total of 54 patients (64 eyes) were included in the 2020, compared with 46 patients (51 eyes) in the 2021. Demographic factors were similar between the groups. Significantly more patients developed blindness in the 2020 cohort (21.87%) than in the 2021 cohort (7.84%). Patients in the 2020 showed a longer time from symptom to treatment (241.84 ± 211.95 h in 2020 vs. 121.53 ± 96.12 h in 2021; P = 0.001), higher intraocular pressure at presentation (52.63 ± 12.45 mmHg in 2020 vs. 45.16 ± 9.79 mmHg in 2021; P = 0.001), larger pupil diameter (5.47 ± 1.62 mm in 2020 vs. 4.33 ± 1.27 mm in 2021; P = 0.001), and more glaucomatous optic neuropathy diagnoses [20/64 eyes (31.25%) in 2020 vs. 7/51 eyes (13.73%) in 2021; P = 0.03]. Conclusion The time between the onset of APAC symptoms and its treatment during the COVID-19 epidemic lockdown was significantly prolonged, which increased the blindness rate of APAC patients.
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Affiliation(s)
- Li Zhou
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China
| | - Shaoqun Wu
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China
| | - Yong Wang
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China,*Correspondence: Yong Wang ✉
| | - Xianyi Bao
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China
| | - Tingting Peng
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China
| | - Wenjing Luo
- Aier Eye Hospital of Wuhan University (Wuhan Aier Eye Hosptial), Wuhan, China
| | - Julio Ortega-Usobiaga
- Department of Cataract and Refractive Surgery, Clínica Baviera, Aier Eye Hospital, Bilbao, Spain
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Angle Closure Glaucoma—Update on Treatment Paradigms. CURRENT OPHTHALMOLOGY REPORTS 2022. [DOI: 10.1007/s40135-022-00290-8] [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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Wang R, Chen B, Wei H, Yan W, Wu Y, Wang C, Zhang B, Liu F, Tian H, Chen X, Tian W. Collecting and deactivating TGF-β1 hydrogel for anti-scarring therapy in post-glaucoma filtration surgery. Mater Today Bio 2022; 14:100260. [PMID: 35514434 PMCID: PMC9061788 DOI: 10.1016/j.mtbio.2022.100260] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/09/2022] [Accepted: 04/10/2022] [Indexed: 11/26/2022] Open
Abstract
Scar formation can lead to glaucoma filtration surgery (GFS) failure, wherein transforming growth factor (TGF)-β is the core regulator. To reducing scar formation, this paper presents our study on the design of hydrogels to deactivate TGF-β1. We hypothesized that excess TGF-β1 can be removed from aqueous humor through the addition of oxidized hyaluronic acid (O-HA) hydrogels that are seeded with decorin (O-HA + D). Immunohistochemistry and enzyme-linked immunosorbent assay (ELISA) were performed to demonstrate the adsorption properties of O-HA + D hydrogel, thus reducing the TGF-β1 concentration in aqueous humor. In the light that collagen contraction in human Tenon's capsule fibroblasts (HTFs) and the angiogenesis of human umbilical vein endothelial cells (HUVECs) can be activated by TGF-β1 and β2, we performed the quantitative analysis of polymerase chain reaction to determine the effect of O-HA + D on the type I collagen, fibronectin, and angiogenesis. Our results illustrate that O-HA + D can inhibit the increase of α-SMA expression in HTF induced by TGF-β1 and that O-HA + D can inhibit the production of collagen I and fibronectin in HTF treated with TGF-β1. Furthermore, we performed in vivo studies by employing a rabbit model, where rabbits were treated with hydrogels post GFS. Our results demonstrate that, as compared with other groups, the rabbits treated with O-HA + D had the greatest reduction in inflammatory cells with reduced level of collagen in wounds. Taken together, the present study paves the way toward the treatment of post-glaucoma fibrosis following surgery.
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Affiliation(s)
- Ruiqi Wang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
| | - Boyang Chen
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
| | - Haiying Wei
- The First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Harbin, 150001, Heilongjiang Province, PR China
| | - Wei Yan
- The First Affiliated Hospital, Harbin Medical University, 23 Youzheng Street, Harbin, 150001, Heilongjiang Province, PR China
| | - Yuping Wu
- Chiping People's Hospital, Liaocheng, 252100, PR China
| | - Cao Wang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
| | - Bosong Zhang
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
| | - Fengzhen Liu
- Liaocheng People's Hospital, Medical College of Liaocheng University, Liaocheng, 252000, PR China
- Department of Materials Science and Engineering, Liaocheng University, Liaocheng, 252000, PR China
| | - Hui Tian
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
| | - Xiongbiao Chen
- Department of Mechanical Engineering, University of Saskatchewan, SK, S7N5A9, Canada
| | - Weiming Tian
- School of Life Science and Technology, Harbin Institute of Technology, Harbin, 150080, Heilongjiang Province, People's Republic of China
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Lin H, Wang J, Fan S, Wu Z, Xu X, Cai Q, Zhao L, Cheng S, Zhang S, Liang Y. Design and Methodology of a Multi-Centre Clinical Trial of Low Dose Laser Cycloplasty for the Treatment of Malignant Glaucoma in China. Ophthalmic Epidemiol 2021; 29:523-530. [PMID: 34429011 DOI: 10.1080/09286586.2021.1966809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To summarize the design and methodology of a trial designed to evaluate the efficacy and safety of low dose laser cycloplasty (LCP) in treating malignant glaucoma. METHODS Prospective, multicentre, non-controlled clinical trial. Subjects were recruited from eight ophthalmic centers in China. The target sample size was 34. Patients aged >18 years with a clinical diagnosis of malignant glaucoma inadequately controlled on medical therapy or malignant glaucoma recurrence after topical cycloplegics withdrawal were enrolled. All patients underwent LCP under retrobulbar anesthesia or sub-Tenon anesthesia. LCP is a treatment adopting few laser points (1100-2000 mW energy, 2000 milliseconds duration) that cauterizes and remodels the ciliary body over two clock hour-positions, which may relieve the ciliary ring block. Follow-up is planned for a period of 12 months. The primary outcome is the resolution of malignant glaucoma which is defined as central anterior chamber deepening after LCP. CONCLUSION The Malignant Glaucoma Treatment trial (MGTT) will be the first prospective trial providing evidence of a treatment for malignant glaucoma. It intends to provide clinicians an optional, easy and convenient treatment for malignant glaucoma patients. Detailed morphological and biometric information collected during the study period will also help provide experience for the outcomes of malignant glaucoma. TRIAL REGISTRATION NUMBER ChiCTR1800017960.
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Affiliation(s)
- Haishuang Lin
- Department of Glaucoma, The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital, Wenzhou, Zhejiang Province, China
| | - Jibing Wang
- Department ofGlaucoma, Weifang Eye Hospital, Weifang, Shandong Province, China
| | - Sujie Fan
- Department of Ophthalmology, Handan City Eye Hospital, Handan, Hebei Province, China
| | - Zuohong Wu
- Department ofGlaucoma, Aier Eye Hospital (Wuhan), Wuhan, Hubei Province, China
| | - Xiaoping Xu
- Department ofGlaucoma, Ningbo Eye Hospital, Ningbo, Zhejiang Province, China
| | - Qinhua Cai
- Department of Ophthalmology, First Affiliated Hospital of Suzhou University, Suzhou, Jiangsu Province, China
| | - Lijun Zhao
- Department of Ophthalmology, The Third People's Hospital of Dalian, Dalian, Liaoning Province, China
| | - Sumian Cheng
- Department ofGlaucoma, HeiBei Eye Hospital, Xingtai, Hebei Province, China
| | - Shaodan Zhang
- Department of Glaucoma, The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital, Wenzhou, Zhejiang Province, China.,Glaucoma Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Yuanbo Liang
- Department of Glaucoma, The Eye Hospital of Wenzhou Medical University, Zhejiang Eye Hospital, Wenzhou, Zhejiang Province, China.,Glaucoma Institute of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Effect of Phacoemulsification on Anterior Chamber Angle in Eyes with Medically Uncontrolled Filtered Primary Angle-Closure Glaucoma. J Ophthalmol 2020; 2020:8720450. [PMID: 32377424 PMCID: PMC7191372 DOI: 10.1155/2020/8720450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the effect of phacoemulsification and intraocular lens (IOLs) implantation in eyes with medically uncontrolled primary angle-closure glaucoma (PACG) previously treated with trabeculectomy and to quantify the anatomical changes in the anterior chamber angle by ultrasound biomicroscopy (UBM). Methods Forty-four eyes of 37 consecutive patients with medically uncontrolled PACG coexisting cataracts with a surgical history of trabeculectomy were included in this study. Each patient underwent phacoemulsification and IOL implantation. Indentation gonioscopy and UBM were performed preoperatively and then again 3 months after surgery. The main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP), number of antiglaucoma medications and anatomical changes in the anterior chamber angle. Results The mean logarithm of the minimum angle of resolution BCVA significantly improved from 0.52 ± 0.30 preoperatively to 0.26 ± 0.23 postoperatively (p < 0.001). The mean IOP significantly decreased from 24.33 ± 9.65 mmHg preoperatively to 18.04 ± 7.86 mmHg postoperatively (p < 0.05). 001). The median number of antiglaucoma medications decreased from 2 preoperatively to 1 postoperatively (p < 0.001). There was no significant difference in the extent of peripheral anterior synechia after the surgery (p > 0.05). Some parameters, including anterior central chamber depth, angle opening distance at 500 μm, trabecular-iris angle, and scleral ciliary process angle, were significantly higher after than before surgery (p < 0.001). However, the crystalline lens rise was significantly smaller following the surgery (p < 0.001). Conclusions Phacoemulsification and IOL implantation reduced the IOP and improved vision in eyes with medically uncontrolled filtered PACG. The mechanism underlying the outcomes observed following surgery might be related to the anterior chamber deepening, widened drainage angle, and improved aqueous fluid flow to the trabecular meshwork.
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Tang J, Liang Y, O'Neill C, Kee F, Jiang J, Congdon N. Cost-effectiveness and cost-utility of population-based glaucoma screening in China: a decision-analytic Markov model. Lancet Glob Health 2019; 7:e968-e978. [PMID: 31122906 DOI: 10.1016/s2214-109x(19)30201-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of global blindness. Nearly half of all people with PACG are of Chinese descent. Population-level glaucoma screening has generally not been found to be cost-effective in high-income countries; however, this assessment has rarely been done in low-income or middle-income countries. We aimed to assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. METHODS We developed decision-analytic Markov models for separate and combined screening for PACG and primary open angle glaucoma (POAG) to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. A cohort of individuals was followed in the model from age 50 years through a total of 30 1-year Markov cycles. Analyses were done separately for rural and urban settings. We did a meta-analysis of glaucoma prevalence studies in China to obtain prevalence estimates for PACG and POAG. Screening costs were taken from a Chinese screening programme and treatment costs from a tertiary Chinese eye hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. We did one-way deterministic and simulated probabilistic sensitivity analyses to reflect uncertainty around ICURs and ICERs. FINDINGS Compared with no screening, combined screening of POAG and PACG in rural China is predicted to result in an ICUR of US$569 (95% CI 17 to 4180) and an ICER of $1280 (-58 to 7940), both of which are below the WHO cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening is predicted to result in fewer net costs and greater gain in health benefits than no screening. Findings were robust in all sensitivity analyses. Over 30 years, a total of 246 (95% CI 63 to 628) and 1325 (510 to 2828) years of blindness are predicted to be avoided for every 100 000 rural and urban residents screened, respectively. INTERPRETATION Population screening for glaucoma (POAG and PACG combined) is likely to be cost-effective in both urban and rural China. Future studies should investigate the effectiveness of interventions to improve acceptance of definitive care among people screened. FUNDING Ulverscroft Foundation, Wenzhou Medical University Research Fund, Zhejiang Province Health Innovation Talents Project, and Wenzhou's Ten Major Livelihood Issues 2015.
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Affiliation(s)
- Jianjun Tang
- School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Yuanbo Liang
- The Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China; Glaucoma Institute, Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Ciaran O'Neill
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Belfast, UK; UKCRC Centre of Excellence for Public Health (NI), Queen's University Belfast, Belfast, UK
| | - Junhong Jiang
- The Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Orbis International, New York, NY, USA; Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
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Wang X, Li Z, Bai J, Song W, Zhang F. miR‑17‑5p regulates the proliferation and apoptosis of human trabecular meshwork cells by targeting phosphatase and tensin homolog. Mol Med Rep 2019; 19:3132-3138. [PMID: 30816540 PMCID: PMC6423565 DOI: 10.3892/mmr.2019.9973] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 01/17/2019] [Indexed: 12/23/2022] Open
Abstract
Glaucoma is one of the leading causes of blindness. Previous studies have indicated that the oxidative stress-induced apoptosis of trabecular meshwork cells (TMCs) may serve a key role in the pathogenesis of glaucoma, and that micro RNA(miR)-17-5p may be involved in this process. However, the specific mechanisms require further investigation. The aim of the present study was to investigate the effects of miR-17-5p on the proliferation and apoptosis of human TMCs (HTMCs) in response to oxidative stress. It was observed that exposure to H2O2 induced a significant decrease in the proliferation and a marked increase in the apoptosis of HTMCs. H2O2 exposure also suppressed the expression of miR-17-5p and promoted the expression of phosphatase and tensin homolog (PTEN). Furthermore, transient overexpression of miR-17-5p induced a significant increase in the proliferation and a significant decrease in the apoptosis of HTMCs by affecting the expression of PTEN, and the apoptosis-related proteins B-cell lymphoma-associated X protein (Bax), B-cell lymphoma-extra large (Bcl-xL) and B-cell lymphoma-2 (Bcl-2). However, knockdown of miR-17-5p demonstrated the opposite results. The results of a dual luciferase reporter assay demonstrated that PTEN may be a direct target of miR-17-5p. In conclusion, miR-17-5p was downregulated in HTMCs under oxidative conditions, and miR-17-5p may regulate the apoptosis of HTMCs by targeting PTEN. These results provide a novel theoretical basis and potential therapeutic target for the treatment of glaucoma.
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Affiliation(s)
- Xiaoyuan Wang
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Zhijian Li
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Jie Bai
- Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Wuqi Song
- Department of Microbiology, Harbin Medical University, Heilongjiang Provincial Key Laboratory of Infection and Immunity, Key Laboratory of Pathogenic Biology, Harbin, Heilongjiang 150086, P.R. China
| | - Fengmin Zhang
- Department of Microbiology, Harbin Medical University, Heilongjiang Provincial Key Laboratory of Infection and Immunity, Key Laboratory of Pathogenic Biology, Harbin, Heilongjiang 150086, P.R. China
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10
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Zhu JD, Xie LL, Li ZY, Lu XH. The prognosis of trabeculectomy in primary angle-closure glaucoma patients. Int J Ophthalmol 2019; 12:66-72. [PMID: 30662842 DOI: 10.18240/ijo.2019.01.10] [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: 05/04/2018] [Accepted: 06/03/2018] [Indexed: 01/18/2023] Open
Abstract
AIM To evaluate whether the level of thrombospondin-1 (TSP-1) in aqueous humor can predict the prognosis of trabeculectomy in patients with primary angle-closure glaucoma (PACG). METHODS This case-control study involved 26 patients with PACG who experienced a failed trabeculectomy (case group) and 78 age- and sex-matched patients with PACG who underwent successful trabeculectomy (control group). Aqueous humor was collected at the time of trabeculectomy and tested for TSP-1 and TGF-β2 levels with an enzyme-linked immunosorbent assay method. Logistic regression modeling was used to assess the risk factors for failed trabeculectomy. RESULTS The mean TSP-1 aqueous concentrations were significantly higher in the case group (20.67±9.79 ng/mL) than the control group (5.17±2.29 ng/mL) (P<0.001). The transforming growth factor-β2 (TGF-β2) aqueous concentrations were significantly different between the case and control group, at 3633.25 and 1090.24 pg/mL, respectively (P<0.001). Logistic regression analysis revealed TSP-1 level as an independent risk factor for a failed trabeculectomy (OR=3.540; 95%CI=1.092-11.482). CONCLUSION The aqueous humor TSP-1 and TGF-β2 levels are higher in PACG eyes with failed trabeculectomy than with successful trabeculectomy at one year. The aqueous humor TSP-1 level is an independent risk factor associated with failed trabeculectomy.
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Affiliation(s)
- Jun-Dong Zhu
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China.,Department of Ophthalmology, the First People's Hospital of Chenzhou City, Southern Medical University, Chenzhou 423000, Hunan Province, China
| | - Li-Lian Xie
- Department of Ophthalmology, the First People's Hospital of Chenzhou City, Southern Medical University, Chenzhou 423000, Hunan Province, China
| | - Zhi-Yuan Li
- Department of Ophthalmology, the First People's Hospital of Chenzhou City, Southern Medical University, Chenzhou 423000, Hunan Province, China
| | - Xiao-He Lu
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou 510282, Guangdong Province, China
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11
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Sihota R, Angmo D, Ramaswamy D, Dada T. Simplifying "target" intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian J Ophthalmol 2018; 66:495-505. [PMID: 29582808 PMCID: PMC5892050 DOI: 10.4103/ijo.ijo_1130_17] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/10/2018] [Indexed: 11/25/2022] Open
Abstract
Lowering of intraocular pressure is currently the only therapeutic measure for Glaucoma management. Many longterm, randomized trials have shown the efficacy of lowering IOP, either by a percentage of baseline, or to a specified level. This has lead to the concept of 'Target" IOP, a range of IOP on therapy, that would stabilize the Glaucoma/prevent further visual field loss, without significantly affecting a patient's quality of life. A clinical staging of Glaucoma by optic nerve head evaluation and perimetric parameters, allows a patient's eye to be categorized as having - mild, moderate or severe Glaucomatous damage. An initial attempt should be made to achieve the following IOP range for both POAG or PACG after an iridotomy. In mild glaucoma the initial target IOP range could be kept as 15-17 mmHg, for moderate glaucoma 12-15 mmHg and in the severe stage of glaucomatous damage 10-12 mmHg. Factoring in baseline IOP, age, vascular perfusion parameters, and change on perimetry or imaging during follow up, this range may be reassessed over 6 months to a year. "Target" IOP requires further lowering when the patient continues to progress or develops a systemic disease such as a TIA. Conversely, in the event of a very elderly or sick patient with stable nerve and visual field over time, the target IOP could be raised and medications reduced. An appropriate use of medications/laser/surgery to achieve such a "Target" IOP range in POAG or PACG can maintain visual fields and quality of life, preventing Glaucoma blindness.
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Affiliation(s)
- Ramanjit Sihota
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Dewang Angmo
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Ramaswamy
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Tanuj Dada
- Glaucoma Research Facility & Clinical Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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12
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In vivo Confocal Microscopy of Posner-Schlossman Syndrome: Comparison with herpes simplex keratitis, HLA-B27 anterior uveitis and acute attack of primary angle closure. Sci Rep 2017; 7:9832. [PMID: 28852187 PMCID: PMC5575237 DOI: 10.1038/s41598-017-10496-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/08/2017] [Indexed: 12/17/2022] Open
Abstract
To investigate in vivo confocal microscopy (IVCM) findings in patients with Posner-Schlossman Syndrome (PSS), we compared the IVCM findings from the eyes of patients with: PSS (44 eyes); herpes simplex keratitis (HSK) (45 eyes); HLA-B27 anterior uveitis (B27AU) (45 eyes); and with acute attack of primary angle closure (aPAC) (43 eyes). The central Langerhans cells (LCs) grade at the level of corneal basal epithelial cells of the PSS group (2.33 ± 0.55) was similar to that of the HSK group (2.63 ± 0.67) (χ2 = −1.435, P = 0.174) but was significantly higher than those of the B27AU group (1.80 ± 0.79) (χ2 = 2.311, P = 0.023) and the aPAC group (1.75 ± 0.46) (χ2 = 2.701, P = 0.022). The keratocyte activation grade of the PSS group (1.55 ± 0.76) was similar to that of the HSK group (1.65 ± 0.81) (χ2 = 1.104, P = 0.675) but was significantly higher than those of the B27AU group (1.00 ± 0.71) (χ2 = 2.364, P = 0.025) and aPAC group (1.75 ± 0.46) (χ2 = 2.532, P = 0.027). The LCs and keratocyte activation grades observed by IVCM in patients with PSS were higher than those in patients with B27AU and with aPAC, but they were similar to those in patients with HSK. This implies that PSS might be related to viral infection.
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13
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Flat Anterior Chamber after Trabeculectomy in Secondary Angle-Closure Glaucoma with BEST1 Gene Mutation: Case Series. PLoS One 2017; 12:e0169395. [PMID: 28056057 PMCID: PMC5215797 DOI: 10.1371/journal.pone.0169395] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/12/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose Trabeculectomy has been regarded as a mainstay of initial treatment in eyes of angle closure glaucoma (ACG) with peripheral anterior synechia > 180° in the Chinese population while its efficacy in secondary ACG with BEST1 gene mutation remains unclear. We set out to investigate the treatment outcome of trabeculectomy for secondary ACG in a group of patients with autosomal recessive bestrophinopathy (ARB). Methods In this retrospective case series study, 8 secondary ACG patients with ARB and their 4 recruited family members underwent a thorough ophthalmic examination including best-corrected visual acuity, Goldmann applanation tonometry, gonioscopy, and fundus examinations. Ultrasound biomicroscopy, optical coherence tomography (OCT), ultrasound A-scan, B-scan, electro-oculography (EOG), Humphrey perimetry, fundus photography, fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were also performed. Blood samples were obtained in the patients and their available family members to analyze the variants of the BEST1 gene. Trabeculectomy was performed in the 8 patients (15 eyes). Results The age of onset varied from 13 to 38 years. The average axial length (AL) of the affected eyes was 21.82 ± 0.92 mm and the average anterior chamber depth (ACD) was 2.19 ± 0.29 mm. There was marked axial shallowing of the anterior chamber in all 15 eyes after trabeculectomy, and was not improved with potent mydriatics. The IOP was elevated in 3 eyes. Variable degree of yellowish subretinal deposits was observed in the posterior retina. The FFA showed punctuate or patched hyperfluorescence suggesting retinal pigment epithelium impairment. The ICGA demonstrated dilatation of choroidal vessels. The OCT revealed diffused neuroretinal detachment in the posterior and midperipheral retina, with intraretinal fluid collections, and hyperreflective subretinal accumulations. The average subfoveal choroidal thickness of the patients was 382.36 ± 80.09 μm. All the patients and enrolled family members carried mutation in BEST1 gene. Conclusions ARB is a rare condition with fundus manifestations mimicking various diseases. Careful discrimination should be taken to exclude any secondary causes for ACG before treatment. Concerning the high incidence of postoperative shallow anterior chamber, selection of filtering surgery should be very careful in these patients.
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14
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Li B, Wang FY, Lv TL, Zhu Y. Effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract. Exp Ther Med 2016; 12:2501-2504. [PMID: 27698750 PMCID: PMC5038496 DOI: 10.3892/etm.2016.3634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/29/2016] [Indexed: 11/15/2022] Open
Abstract
The aim of the present study was to examine the effects of phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly. A total of 68 patients were consecutively selected and divided into the control group with 33 cases (48 eyes) and the observation group with 35 cases (53 eyes). Cataract surgery combined with trabeculectomy was performed on the patients in the control group and phacoemulsification cataract extraction combined with ciliarotomy was performed on the subjects in the observation group, to compare postoperative effects and complications. Following surgery, the visual acuity of patients in the two groups significantly improved, intraocular pressure decreased, and improvement of the observation group was more evident (P<0.05). Following surgery, the depth of central anterior chamber and width of chamber angle of patients in two groups was increased, and improvement of the observation group was significantly more evident (P<0.05). Additionally, the incidence of complications, including corneal swelling, shallow of anterior chamber, fibrinous exudate in iris, and filtering bleb leaking and following cataract removal, of patients in the observation group was significantly reduced compared to the control group (P<0.05). In summary, the results of the present study show that, phacoemulsification and intraocular lens implantation combined with ciliarotomy in the treatment of angle-closure glaucoma with cataract in the elderly is a safe and effective method and should be applied in the clinic.
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Affiliation(s)
- Bo Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China; Department of Ophthalmology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science Technology, Luoyang, Henan 471003, P.R. China
| | - Feng-Yun Wang
- Department of Ophthalmology, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science Technology, Luoyang, Henan 471003, P.R. China
| | - Tai-Liang Lv
- Department of Ophthalmology, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong 250001, P.R. China
| | - Yu Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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15
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Jamali H, Jahanian S, Gharebaghi R. Effects of Laser Peripheral Iridotomy on Corneal Endothelial Cell Density and Cell Morphology in Primary Angle Closure Suspect Subjects. J Ophthalmic Vis Res 2016; 11:258-62. [PMID: 27621781 PMCID: PMC5000526 DOI: 10.4103/2008-322x.188395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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 effects of prophylactic laser peripheral iridotomy on corneal endothelial cell density and cell morphology in subjects with primary angle closure suspect (PACS) within a one-year follow-up period. Methods: In this quasi-experimental prospective study, from June 2012 to November 2013, thirty-five PACS eyes underwent laser peripheral iridotomy at clinics affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. After obtaining informed consent, specular microscopy was performed at baseline and at 3-month, 6-month and 12-month follow-up visits. Central, nasal and temporal endothelial cell counts and cell morphology were evaluated via non-contact specular microscopy. Results: The mean subject age was 53.4 ± 7.9 years, and the majority of subjects were women (88.2%). The mean central corneal endothelial cell count prior to laser peripheral iridotomy was 2528 ± 119.2, and this value changed to 2470 ± 175.9, 2425 ± 150.6, and 2407 ± 69.02 at the 3-month, 6-month, and 12-month follow-up visits, respectively; these differences did not reach statistical significance. Additionally, the changes in the number of cells, the hexagonality of cells, and the coefficient of variation (CV) in the central, nasal, and temporal areas were not significant. Conclusion: In PACS eyes, we did not find a decline in corneal endothelial cell density or a change in cell morphological characteristics, including cell hexagonality and CV, in the central, nasal, and temporal regions of the cornea in any of our subjects over a one-year follow-up period.
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Affiliation(s)
- Hossein Jamali
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Jahanian
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Gharebaghi
- Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Yang K, Jin L, Li L, Zeng S, Dan A, Chen T, Wang X, Li G, Congdon N. Preoperative characteristics and compliance with follow-up after trabeculectomy surgery in rural southern China. Br J Ophthalmol 2016; 101:131-137. [PMID: 27073204 DOI: 10.1136/bjophthalmol-2015-308331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/05/2016] [Accepted: 03/19/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate preoperative characteristics and follow-up in rural China after trabeculectomy, the primary treatment for glaucoma there. METHODS Patients undergoing trabeculectomy at 14 rural hospitals in Guangdong and Guangxi Provinces and their doctors completed questionnaires concerning clinical and sociodemographic information, transportation, and knowledge and attitudes about glaucoma. Follow-up after surgery was assessed as cumulative score (1 week: 10 points, 2 weeks: 7 points, 1 month: 5 points). RESULTS Among 212 eligible patients, mean preoperative presenting acuity in the operative eye was 6/120, with 61.3% (n=130) blind (≤6/60). Follow-up rates were 60.8% (129/212), 75.9% (161/212) and 26.9% (57/212) at 1 week, 2 weeks and 1 month, respectively. Patient predictors of poor follow-up included elementary education or less (OR=0.37, 95% CI 0.20 to 0.70, p=0.002), believing follow-up was not important (OR=0.62, 95% CI 0.41 to 0.94, p=0.02), lack of an accompanying person (OR=0.14, 95% CI 0.07 to 0.29, p<0.001), family annual income <US$800 (OR=0.28, 95% CI 0.11 to 0.72, p=0.008) and not requiring removal of scleral flap sutures postoperatively (OR=0.11, 95% CI 0.06 to 0.22, p<0.001). Age, sex, employment, travel distance/time/costs, patient preoperative clinical factors and physician factors were unassociated with follow-up. CONCLUSIONS Follow-up after 2 weeks was inadequate to provide optimal clinical care, and surgery is being applied too late to avoid blindness in the majority of patients. Earlier surgery, support for return visits and better explanations of the importance of follow-up are needed. Directing all patients to return for possible scleral flap suture removal may be a valid strategy to improve follow-up.
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Affiliation(s)
- Ke Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ling Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Li Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Siming Zeng
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Aihua Dan
- Red Cross Hospital of Yunnan Province, Kunming, China
| | - Tingting Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiuqin Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Guirong Li
- Department of Ophthalmology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,ORBIS International, New York, USA.,Queen's University Belfast, Belfast, UK
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17
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Abstract
Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is defined as a glaucomatous optic neuropathy with associated characteristic enlargement of optic disc cupping and visual field loss that is secondary to ocular hypertension caused by closure of the drainage angle. Angle closure is caused by appositional approximation or adhesion between the iris and the trabecular meshwork. The main treatment strategy for PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and possible prevention of further angle closure. There is no universally agreed best surgical treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and cyclodestructive procedures are effective surgical options. Each of them plays an important role in the management of PACG with its own pros and cons. Accumulating evidence is available to show the effectiveness of visually significant and visually nonsignificant cataract extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with cataract extraction, which may offer additional pressure control benefits to patients with PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma surgeries that lower intraocular pressure and also alter the anterior segment and/or drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly reserved for PACG patients who have failed previous filtering operations. Their role as initial surgical treatment for PACG will not be discussed.
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Affiliation(s)
- Jimmy Lai
- From the Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
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18
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Muñoz-Negrete FJ, González-Martín-Moro J, Casas-Llera P, Urcelay-Segura JL, Rebolleda G, Ussa F, Güerri Monclús N, Méndez Hernández C, Moreno-Montañés J, Villegas Pérez MP, Pablo LE, García-Feijoó J. Guidelines for treatment of chronic primary angle-closure glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:119-138. [PMID: 25459683 DOI: 10.1016/j.oftal.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/30/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To present a clinical practice guideline update on the medical, laser, and surgical treatment of primary angle closure glaucoma (PACG) in adults. METHODS Following the formulation of key questions using the PICO scheme (Patient/Problem, Intervention, Comparison, Outcome), a systematic review was performed on the literature published to date, including international clinical practice guidelines. The AMSTAR and Risk of Bias tools were used for evaluating the quality of the information. The level of evidence and grade of recommendation was established following the Scottish Intercollegiate Guidelines Network (SIGN) system. RESULTS Following the above methodology, recommendations of medical, laser and surgical treatment in adult PACG and levels of evidence are presented. CONCLUSIONS Although the level of scientific evidence for many of the questions raised is not very high, a review is presented on updated treatment recommendations for adult PACG. Among the limitations for the implementation of these recommendations is that most studies have been conducted in Asian populations, and that the effectiveness is measured almost exclusively in terms of reducing intraocular pressure, and does not include visual function, quality of life or cost-effectiveness parameters.
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Affiliation(s)
- F J Muñoz-Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, OFTARED, Alcalá de Henares, Madrid, España.
| | - J González-Martín-Moro
- Servicio de Oftalmología, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Coslada, Madrid, España
| | - P Casas-Llera
- Vissum Corporación-Instituto Oftalmológico de Alicante, OFTARED, Alicante, España
| | - J L Urcelay-Segura
- Servicio de Oftalmología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - G Rebolleda
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, OFTARED, Alcalá de Henares, Madrid, España
| | - F Ussa
- IOBA, Universidad de Valladolid, OFTARED, Valladolid, España
| | - N Güerri Monclús
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, IISA, Universidad de Zaragoza, OFTARED, Zaragoza, España
| | - C Méndez Hernández
- Servicio de Oftalmología HCSC, Instituto de Investigación Sanitaria HCSC (IdISSC), Universidad Complutense, OFTARED, Madrid, España
| | - J Moreno-Montañés
- Clínica Universidad de Navarra, Facultad de Medicina, OFTARED, Pamplona, España
| | - M P Villegas Pérez
- Departamento de Oftalmología, Facultad de Medicina, Universidad de Murcia; Hospital General Universitario Reina Sofía, IMIB-Arrixaca, OFTARED, Murcia, España
| | - L E Pablo
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, IISA, Universidad de Zaragoza, OFTARED, Zaragoza, España
| | - J García-Feijoó
- Servicio de Oftalmología HCSC, Instituto de Investigación Sanitaria HCSC (IdISSC), Universidad Complutense, OFTARED, Madrid, España
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