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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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Qu J, Tian Z, Li X, Zhang Y. Anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification and trabeculectomy in treatment of medically uncontrolled acute primary angle-closure glaucoma: A retrospective study. Medicine (Baltimore) 2022; 101:e30946. [PMID: 36221410 PMCID: PMC9542570 DOI: 10.1097/md.0000000000030946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
To explore the clinical efficacy of quadruple surgery (anterior segment pars plana vitrectomy + phacoemulsification + posterior capsulorhexis + intraocular lens (IOL) implantation + trabeculectomy) and dual surgery (phacoemulsification + IOL implantation + trabeculectomy) to treat medically uncontrolled acute primary angle-closure glaucoma (APACG). The clinical data of 44 patients (45 eyes) with APACG treated in the Department of Ophthalmology of Taihe Hospital were retrospectively analyzed. They were divided into 2 groups based on quadruple surgery and dual surgery. There were 20 patients (20 eyes) underwent quadruple surgery in group A. And there were 24 patients (25 eyes) dual surgery in group B. The changes in intraocular pressure (IOP), visual improvement, and complications were observed between the 2 groups preoperatively and 1 month, 3 months, and 6 months postoperatively. Preoperative best corrected visual acuity (BCVA) was the influencing factor of postoperative BCVA at 1 month, 3 months and 6 months. Before surgery, the mean IOP of group A was significantly higher than that of group B (P < .001), and no significant difference was found in the BCVA, age, gender, eyes, axial length (AL), anterior chamber depth (ACD) (PBCVA = 0.12, Page = 0.76, Peyes = 0.20, Pgender = 0.37, PAL = 0.94, PACD = 0.08). On comparison at postoperative 1week, there was no significant difference in the IOP and BCVA between the 2 groups (PIOP = 0.64, PBCVA = 0.66). The mean IOP of group A was significantly lower than that of group B 1 month, 3 months, and 6 months postoperatively (P1month = 0.002, P3months < 0.001, P6months < 0.001). The degree of visual acuity recovery was significantly higher in group A at 1 month, 3 months, and 6 months postoperatively (P1month = 0.03, P3months = 0.02, P6months = 0.02). During treatment, the incidence of complications in group B was significantly higher than that in group A (P < .01). The clinical efficacy of anterior segment pars plana vitrectomy combined with posterior capsulorhexis, phacoemulsification, and trabeculectomy elicits clinical safety in treating medically uncontrolled APACG. It has remarkable effects and leads to a significant decrease in the occurrence of complications.
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Affiliation(s)
- Jie Qu
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
- Jinzhou Medical University
| | - Zhen Tian
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
| | - Xin Li
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
| | - Yong Zhang
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medicine
- Jinzhou Medical University
- *Correspondence: Yong Zhang, Master Supervisor of Hubei University of Medicine, Chief Physician of Taihe Hospital in Shiyan City of Hubei Province in China (e-mail: )
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Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure. J Ophthalmol 2022; 2022:6959479. [PMID: 35677621 PMCID: PMC9170445 DOI: 10.1155/2022/6959479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/28/2022] [Accepted: 05/18/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). Methods We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. Results The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann–Whitney U test, p=0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm2 (p=0.735) in the LI and lensectomy groups, respectively. Conclusions Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.
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Ichsan AM, Tombe GAF, Launardo AV, Jaury JV, Pratiwi A, Nislawati R, Sumara NMR, Islam IC. Posterior Approach in Management of Phacomorphic Angle Closure. Case Rep Ophthalmol 2021; 12:717-723. [PMID: 34594210 PMCID: PMC8436660 DOI: 10.1159/000518056] [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: 02/15/2021] [Accepted: 06/22/2021] [Indexed: 12/01/2022] Open
Abstract
This article presents a case of posterior lensectomy through 3-port pars plana vitrectomy for the management of phacomorphic angle closure. A 67-year-old man presented to the outpatient department with headache and decreased vision in his left eye for the past 3 days. Visual acuity 2/60, intraocular pressure (IOP) >60 mm Hg, and the anterior chamber (AC) depth Van Herick grade 1. A complete ophthalmologic examination revealed a phacomorphic angle closure. Serial management was performed consisting of mannitol 20% intravenously, laser peripheral iridotomy, and trabeculectomy. However, the depth of the AC became more shallow, and the IOP remained high. Lens extraction as definitive therapy could not be performed because of the adhesion of the iris and anterior lens capsule to the corneal endothelium; thus, posterior lensectomy using 3-port pars plana vitrectomy, and phacofragmatome was performed. Once the corneal thickness was returned to normal, and the AC depth was sufficient, the patient underwent secondary intraocular lens implantation. A significant improvement in visual acuity, normal IOP, and AC depth were achieved after the management of the posterior approach. Thus, this posterior approach should be considered a good option of management technique in cases with phacomorphic angle closure with very shallow AC depth and a fragile cornea.
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Affiliation(s)
- Andi Muhammad Ichsan
- Department of Ophthalmology, Hasanuddin University, Makassar, Indonesia.,Ophthalmology Unit, SILOAM Hospital, Makassar, Indonesia
| | | | | | | | - Andi Pratiwi
- Department of Ophthalmology, Hasanuddin University, Makassar, Indonesia.,Ophthalmology Unit, SILOAM Hospital, Makassar, Indonesia
| | - Ririn Nislawati
- Department of Ophthalmology, Hasanuddin University, Makassar, Indonesia
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Huang X, Zhou Q, Wang S, Zhang J, Niu G, Bi Y. Stepwise Decreasing of Vitreous Pressure by Anterior Vitrectomy: A Novel Method for Preventing Positive Vitreous Pressure During Penetrating Keratoplasty. Adv Ther 2020; 37:617-629. [PMID: 31728826 DOI: 10.1007/s12325-019-01139-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study evaluates the clinical effects of the stepwise anterior vitrectomy on the prevention of positive vitreous pressure (PVP) during penetrating keratoplasty (PKP). METHODS PKP in conjunction with stepwise anterior vitrectomy was performed on 15 eyes of 15 patients under retrobulbar anesthesia. A preset vitrectomy trocar-cannula was inserted into the vitreous cavity before PKP. During the opening of the anterior chamber, intermittent vitrectomy and corneal incision expansion were performed alternately to keep the lens or artificial intraocular lens (IOL) and iris flat until the entirety of the pathological cornea had been dissected. The main outcome measures include visual acuity, crystalline lens rise (CLR), corneal curvature and diopter, and corneal endothelial cell loss. RESULTS All surgical procedures were performed successfully without any PVP-related intraoperative complications. The mean time of the stepwise vitrectomies was 3.1 ± 0.7 s, the duration of each vitrectomy was 8.1 ± 5.3 s, and the duration of the total surgery was 60.5 ± 5.3 min. The anterior segment reaction was mild and the shape of the pupil remained normal 1 day after surgery. The mean preoperative and mean 3-month postoperative CLR values were 0.48 ± 0.09 mm and - 0.16 ± 0.04 mm, respectively (p < 0.0001). The mean preoperative endothelial cell density in donor buttons was 2570 ± 171 cells/mm2, and the mean 6- and 12-month postoperative endothelial cell density in donor buttons was 2207 ± 127 cells/mm2 and 2000 ± 198 cells/mm2, respectively. CONCLUSIONS The novel and stabilized PKP procedure, performed in conjunction with the stepwise anterior vitrectomy, effectively avoided the PVP during open-sky surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR1900021227.
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Affiliation(s)
- Xinyu Huang
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Qi Zhou
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Sangsang Wang
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Juan Zhang
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Guozhen Niu
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China
| | - Yanlong Bi
- Department of Ophthalmology, Tongji Hospital Affiliated with Tongji University School of Medicine, Shanghai, 200065, People's Republic of China.
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