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Akai R, Yunoki T, Otsuka M, Hayashi A. Incidence of Blepharoptosis After Pars Plana Baerveldt 350 Glaucoma Implant Surgery by a Single Surgeon. Ophthalmic Plast Reconstr Surg 2023; 39:357-360. [PMID: 36735298 DOI: 10.1097/iop.0000000000002319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To investigate the incidence of postoperative blepharoptosis and clinical risk factors for blepharoptosis after pars plana Baerveldt 350 glaucoma implantation (BGI) by a single surgeon for refractory glaucoma. METHODS Twenty-four patients (30 eyes) who underwent pars plana BGI for refractory glaucoma at Toyama University Hospital between November 2019 and February 2021 were included. Patients with a preoperative margin reflex distance-1 (MRD-1) of ≥2 mm were included in the study, and a decrease in MRD-1 of ≥2 mm at 6 months postoperatively was defined as blepharoptosis. RESULTS The mean MRD-1 decreased significantly from 3.2 ± 0.6 mm preoperatively to 2.4 ± 1.1 postoperatively ( p < 0.01). Postoperative ptosis developed in 8 eyes (26.7%). A comparison of the ptosis (n = 8) and nonptosis (n = 22) groups showed a significant difference in the history and number of previous filtration surgeries ( p = 0.02 and p = 0.03, respectively). Those with previous filtration surgery had a higher risk of blepharoptosis after pars plana BGI compared with those without previous filtration surgery (OR: 6.43; 95% confidence interval: 1.03-40.26; p = 0.04). CONCLUSION Pars plana BGI is a risk factor for postoperative blepharoptosis. Particular attention should be paid to eyes that have undergone previous filtration surgery.
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Affiliation(s)
- Ryota Akai
- Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Chan AX, Chang A, Do JL, Koo SJ, Lin G, Welsbie DS. Polymorphous low-grade adenocarcinoma with cavernous sinus involvement presenting as third nerve palsy. Am J Ophthalmol Case Rep 2022; 26:101460. [PMID: 35313474 PMCID: PMC8933825 DOI: 10.1016/j.ajoc.2022.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose Polymorphous low-grade adenocarcinoma is a tumor of the salivary glands that typically localizes within the oral cavity. We present a case of isolated third cranial nerve palsy as the initial presentation of polymorphous low-grade adenocarcinoma involving the left cavernous sinus in a patient status post glaucoma surgery. Observations A 68-year-old woman status post glaucoma drainage device implantation in her left eye presented with an isolated left third nerve palsy ten weeks postoperatively. Differential diagnoses included microvascular ischemic neuropathy, postoperative ptosis, and compressive mass. MRI revealed a left cavernous sinus mass, and subsequent excisional biopsy revealed a diagnosis of polymorphous low-grade adenocarcinoma. Conclusions There are few cases reporting polymorphous low-grade adenocarcinoma originating from and extending beyond the nasopharynx. This report emphasizes an unexpected neuro-ophthalmic manifestation of this salivary gland tumor.
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Taniguchi A, Yunoki T, Otsuka M, Hayashi A. Visual field changes in glaucoma patients after blepharoptosis surgery. Eur J Ophthalmol 2022; 32:3353-3357. [PMID: 35001702 DOI: 10.1177/11206721211073254] [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: 11/15/2022]
Abstract
PURPOSE To examine changes in parameters of the visual field test before and after blepharoptosis surgery in patients with glaucoma. METHODS Twenty-three eyes of 14 glaucoma patients who underwent blepharoptosis surgery at Toyama University Hospital between July 2015 and September 2020 were included in this study. Pre- and post-operative values for the mean deviation (MD), pattern standard deviation (PSD) and total deviation (TD) of the upper or lower hemi-visual field in the Humphrey visual field test, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and margin reflex distance (MRD)-1 were compared. RESULTS MRD-1 showed a significant improvement after blepharoptosis surgery (preoperative MRD-1: 1.0 ± 0.82 mm, postoperative MRD-1: 3.26 ± 0.66 mm, p < 0.001). There were no significant differences in BCVA, IOP, MD and PSD values before and after surgery. On the other hand, there was a significant improvement in the superior TD (preoperative: -11.29 ± 6.57 dB, postoperative: -9.88 ± 7.31 dB, p = 0.044) although no significant difference was detected in the inferior TD postoperatively. The preoperative parameters of 2 groups (improvement and non-improvement groups of postoperative superior TD) were compared. Preoperative MD and superior TD were significantly lower in the improvement group (p = 0.03, p = 0.004, respectively), although there was no significant difference in preoperative PSD and inferior TD between the two groups. CONCLUSION In glaucoma patients, blepharoptosis may interfere with accurate visual field assessment, especially of superior TD.
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Affiliation(s)
- Aya Taniguchi
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, 34823University of Toyama, Toyama, Japan
| | - Tatsuya Yunoki
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, 34823University of Toyama, Toyama, Japan
| | - Mitsuya Otsuka
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, 34823University of Toyama, Toyama, Japan
| | - Atsushi Hayashi
- Departments of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, 34823University of Toyama, Toyama, Japan
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Schulz CB, Fallico M, Rothwell A, Siah WF. Lower eyelid involutional entropion following cataract surgery. Eye (Lond) 2022; 36:175-181. [PMID: 33664509 PMCID: PMC8727584 DOI: 10.1038/s41433-021-01466-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/19/2021] [Accepted: 02/09/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To determine whether cataract surgery is associated with an increased risk of subsequent lower eyelid entropion and evaluate potential associated factors. METHODS This retrospective cohort study included consecutive patients undergoing first eye cataract surgery over a 10-year period at a single institution (n = 14,574). The fellow phakic eye served as control. Patient records were evaluated up until either the time of second eye cataract surgery or any other intraocular or adnexal surgery. The primary outcome was the rate of entropion repair in both the pseudophakic (exposed) group and the phakic control group. Groups were compared using relative risk and Kaplan-Meier analysis. Multivariate logistic regression was used to compare pre-specified characteristics of those patients that underwent entropion repair in their pseudophakic eye with those that did not. RESULTS A fourfold higher relative risk of undergoing entropion repair was observed in eyes that had undergone cataract surgery compared with the fellow unoperated eye (95% confidence interval 1.6-9.8; P < 0.001) with an increased risk at all timepoints between 1 and 12 years according to Kaplan-Meier analysis (P = 0.001). Median time to entropion repair after cataract surgery was 58 months (range 3-124). Documented intraoperative patient factors such as patient or eye movement, eyelid squeezing, pain or anxiety were an independent risk factor for subsequent entropion (P < 0.0001). CONCLUSIONS Cataract surgery is associated with an increased risk of subsequent lower eyelid entropion. Surgeons should be aware of this risk in the pre- and post-operative assessment of patients undergoing cataract surgery.
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Affiliation(s)
- Christopher B. Schulz
- grid.123047.30000000103590315Eye Unit, University Hospital Southampton, Southampton, UK ,grid.415470.30000 0004 0392 0072Eye Unit, Queen Alexandra Hospital, Portsmouth, UK
| | - Matteo Fallico
- grid.123047.30000000103590315Eye Unit, University Hospital Southampton, Southampton, UK ,grid.8158.40000 0004 1757 1969Department of Ophthalmology, University of Catania, Catania, Italy
| | - Alice Rothwell
- grid.123047.30000000103590315Eye Unit, University Hospital Southampton, Southampton, UK
| | - We Fong Siah
- grid.123047.30000000103590315Eye Unit, University Hospital Southampton, Southampton, UK ,grid.411596.e0000 0004 0488 8430Eye Unit, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Treatment of Severe Ptosis by Conjoint Fascial Sheath Suspension. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1837458. [PMID: 34840967 PMCID: PMC8626196 DOI: 10.1155/2021/1837458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
Objective To explore the role of conjoint fascial sheath (CFS) suspension in the treatment of severe ptosis. Methods A total of 110 patients with severe ptosis who were admitted to our hospital from May 2018 to December 2020 were included. Fifty-seven patients treated with frontalis suspension were assigned into group A, and the remaining 53 patients treated with CFS suspension were assigned into group B. The curative effect, ocular surface alterations, complications, and satisfaction in the two groups were compared. Results Patients in group B suffered from severe upper eyelid retraction and lid lag than those in group A, as well as more limited range of motion (ROM) (P < 0.05). The curative effect and patient satisfaction in group B were higher than those in group A (P < 0.05). Postsurgical complications in group B were fewer than those in group A (P < 0.05). Conclusion CFS suspension is effective in the treatment of severe ptosis.
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Salvá-Palomeque T, Muñoz-Ramón P, Rebolleda G, Aguado-Casanova V, Ye-Zhu C, Muñoz-Negrete FJ. Changes in eyelid position after glaucoma filtering surgery. Eur J Ophthalmol 2021; 32:2886-2892. [PMID: 34812089 DOI: 10.1177/11206721211063723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes. METHODS Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes. RESULTS Of 100 eyes included 81 (81%) showed no change in eyelid height (-0.133 mm ± 0.496), 11 (11%) showed ptosis (-1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction. CONCLUSIONS Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.
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Affiliation(s)
| | - Pablo Muñoz-Ramón
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
| | - Gema Rebolleda
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Cristina Ye-Zhu
- Ophthalmology Department, IRYCIS, 16507Ramon y Cajal University Hospital, Madrid, Spain
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Song AJ, Khanna CL, Jamali S, Roddy GW, Wagner LH. Efficacy and safety of blepharoptosis repair after incisional glaucoma surgery. Eur J Ophthalmol 2021; 32:122-128. [PMID: 33779340 DOI: 10.1177/11206721211006643] [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: 11/15/2022]
Abstract
PURPOSE There is an increased risk for development of blepharoptosis after incisional glaucoma surgery. Data on safety and efficacy of ptosis repair in this group of patients in limited. The goal of this study is to evaluate outcomes and identify potential risk factors for failure of ptosis repair in eyes with history of incisional glaucoma surgery. METHODS A retrospective chart review was performed of all patients who underwent incisional glaucoma surgery, specifically trabeculectomy or implantation of glaucoma drainage device (GDD), and subsequent ptosis repair at a single institution from 2009 to 2019. Ptosis surgery outcomes were compared to a control group who underwent ptosis repair after cataract surgery. RESULTS Seventy-eight eyes of 64 patients were included in the glaucoma surgery group. The rate of severe ptosis (margin reflex distance 1 ⩽ 0 mm) among glaucoma surgery patients was higher compared to control (35 of 78 (44.9%) vs 23 of 82 (28.6%). Ptosis repair was successful in 59 of 78 eyes (75.6%), which was similar to control. Risk for revision surgery was increased more than five-fold in the GDD group compared to control. There were no cases of early or late bleb-related complications. CONCLUSIONS Ptosis repair can be performed safely in patients after incisional glaucoma surgery. Müller muscle conjunctival resection and external levator advancement are equally effective. Patients with history of GDD should be advised about the potentially increased risk of need for revision surgery.
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Affiliation(s)
- Allisa J Song
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Cheryl L Khanna
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Sepideh Jamali
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Gavin W Roddy
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
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Es'haghi A, Nilforushan N, Jafari S, Abdolalizadeh P, Miraftabi A, Chaibakhsh S, Kashkouli M. Postoperative blepharoptosis after trabeculectomy versus ahmed glaucoma valve implantation. J Curr Ophthalmol 2021; 33:388-393. [PMID: 35128183 PMCID: PMC8772497 DOI: 10.4103/joco.joco_120_21] [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: 04/11/2021] [Revised: 09/18/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: To investigate the frequency of persistent postoperative ptosis (PP) following trabeculectomy or Ahmed glaucoma valve (AGV) implantation and to analyze the associated factors. Methods: It is a prospective observational study on glaucoma patients who underwent trabeculectomy or AGV implantation from October 2015 to June 2017 in a tertiary center. Margin reflex distance 1 and 2 (MRD1 and 2) and levator function were measured before and at least 6 months, postoperatively. Clinically significant ptosis was defined as ≥2 mm drop of MRD1. Results: One hundred and fourteen patients (124 eyelids) including 76 patients (87 eyelids) with trabeculectomy and 35 patients (37 eyelids) with AGV implantation were included. The mean age was 55.50 (standard deviation = 17.54) years. Most of the surgeries were performed under general anesthesia (87.9%, 109/124) between 30 and 60 min (53.2%, 66/124) by residents (39.5%, 49/124). Trabeculectomy and AGV groups did not differ in terms of pre, intra, and postoperative variables (0.1≤ P ≤0.9) except duration of surgery (P = 0.01) and sex (P = 0.04). Clinically significant persistent PP was observed in 12.9% (16/124) in total, 13.7% (12/87) in the trabeculectomy group, and 10.8% (4/37) in the AGV group (P = 0.6). Male gender (ß coefficient = 2.56, 95% confidence interval (CI) = 4.76–0.36, P = 0.02) and a higher preoperative MRD1 (ß coefficient = 1.24, 95% CI = 0.52–1.95, P = 0.001) were the only factors affecting the frequency of clinically significant PP. Conclusions: Postoperative blepharoptosis occurred in 12.9% of eyes after glaucoma procedures. Male gender and higher preoperative MRD1 were significantly associated with a higher frequency of postglaucoma surgery blepharoptosis.
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Abstract
PURPOSE To describe the frequency of blepharoptosis and factors affecting it after the pars plana vitrectomy (PPV) procedure. METHODS In a prospective study, patients were recruited consecutively from October 2016 to June 2018. Upper eyelid margin reflex distance 1 and 2 (MRD1 and 2), upper eyelid crease height, and levator function were measured before, 1 and at least 6 months after surgery by the same investigator. Clinical and Clinically significant ptosis were defined as ≥0.5 and ≥2 mm drop of MRD1. RESULT There were 60 eyes from 57 patients. The majority of surgeries were performed by the fellows (63.3%, 38/60) and under general anesthesia (95.0%, 57/60). Clinical and clinically significant ptosis following PPV were 47.2% (25/53) and 11.3% (6/53) at the last follow up (at least 6 months), respectively. MRD2 (p = 0.389) and eyelid crease height (p = 0.057) did not significantly change. Surgeons' level, time of the procedure and other variables were not significantly impacting the frequencies. CONCLUSION Persistent clinically significant ptosis was observed in 11% of patients undergoing PPV. No variable was significantly associated with persistent postoperative ptosis after PPV.
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Kwon S, Kim SH, Khang D, Lee JY. Potential Therapeutic Usage of Nanomedicine for Glaucoma Treatment. Int J Nanomedicine 2020; 15:5745-5765. [PMID: 32821099 PMCID: PMC7418176 DOI: 10.2147/ijn.s254792] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
Glaucoma is a group of diseases characterized by progressive degeneration of retinal ganglion cells, leading to irreversible blindness. Currently, intraocular pressure reduction is the only established treatment available for glaucoma. With this treatment, the progression of the disease can only be delayed and there is no recovery. In addition, the commercially available eye drops have the disadvantage of low compliance and short therapeutic time, while glaucoma surgery always has the risk of failure due to wound fibrosis. Nanotechnology can overcome the limitations of the current treatment through the encapsulation and conjugation of drugs used for lowering intraocular pressure and antifibrotic agents using biodegradable or biocompatible nanoparticles for the sustained release of the drugs to protect the damaged ocular cells. Furthermore, using nanotechnology, treatment can be administered in various forms, including eye drops, contact lens, and ocular inserts, according to the convenience of the patients. Despite the promising results of delaying the progression of glaucoma, the regeneration of damaged ocular cells, including trabecular meshwork and retinal ganglion cells, is another critical hurdle to overcome. Bone marrow-derived mesenchymal stem cells and Müller glia cells can secrete neurogenic factors that trigger the regeneration of associated cells, including trabecular meshwork and retinal ganglion cells. In conclusion, this review highlights the potential therapeutic applications of nanotechnology- and stem cell-based methods that can be employed for the protection and regeneration of ocular cells.
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Affiliation(s)
- Song Kwon
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, South Korea
| | - Sung Hyun Kim
- Department of Ophthalmology, Gil Medical Center, Gachon University, College of Medicine, Incheon 21565, South Korea
| | - Dongwoo Khang
- Lee Gil Ya Cancer and Diabetes Institute, Gachon University, Incheon 21999, South Korea.,Department of Gachon Advanced Institute for Health Science & Technology (GAIHST), Gachon University, Incheon 21999, South Korea.,Department of Physiology, School of Medicine, Gachon University, Incheon 21999, South Korea
| | - Jong Yeon Lee
- Department of Ophthalmology, Gil Medical Center, Gachon University, College of Medicine, Incheon 21565, South Korea
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Park HJ, Kim SH, Chi MJ, Lee JY. Incidence and Risk Factors for the Ptosis after Trabeculectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.6.645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Roddy GW, Zhao B, Wang F, Fang C, Khanna SS, Bajric J, Khanna CL. Increased rate of ptosis following glaucoma drainage device placement and other anterior segment surgery: a prospective analysis. Graefes Arch Clin Exp Ophthalmol 2020; 258:1533-1541. [DOI: 10.1007/s00417-020-04630-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022] Open
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Sng CCA, Chew PTK, Htoon HM, Lun K, Jeyabal P, Ang M. Case Series of Combined XEN Implantation and Phacoemulsification in Chinese Eyes: One-Year Outcomes. Adv Ther 2019; 36:3519-3529. [PMID: 31650513 DOI: 10.1007/s12325-019-01127-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The outcome of XEN implantation in Chinese eyes has not been previously reported. The purpose of our study is to evaluate the efficacy and safety of combined cataract surgery and XEN implantation in Chinese eyes with glaucoma. METHODS We conducted a prospective study of 31 consecutive Chinese patients who underwent combined phacoemulsification and XEN implantation at the National University Hospital (Singapore) in this study. Patients were assessed preoperatively and postoperatively on days 1 and 7, and months 1, 3, 6, and 12. The intraocular pressure (IOP), glaucoma medication use, Snellen visual acuity (VA), and complications were assessed at each visit. The Wilcoxon signed rank test for non-parametric data was used for the analysis of IOP and glaucoma medications at baseline versus 12 months after the procedure. RESULTS The mean age of the patients was 70 ± 7.9 years and 48.4% were male. Twelve patients (38.7%) were diagnosed with primary open angle glaucoma and 19 patients (61.3%) were diagnosed with primary angle closure glaucoma. There was a significant decrease in IOP at 12 months (12.1 ± 2.6 mmHg) compared with preoperative medicated (15.6 ± 2.7 mmHg, p < 0.0001) and unmedicated IOP (22.1 ± 3.6 mmHg, p < 0.001). as well as a significant reduction in the number of glaucoma medications (1.4 ± 0.6 vs 0.1 ± 0.4, p < 0.0001). The most common complications were transient hypotony (12.9%) and ptosis (12.9%) and there were no sight-threatening intraoperative or postoperative complications. One patient required additional glaucoma surgery for uncontrolled IOP at 8 months after combined phacoemulsification and XEN implantation. CONCLUSION Combined XEN implantation with cataract surgery was effective in lowering the IOP and the number of glaucoma medications in Chinese eyes for at least 12 months, with a favorable safety profile.
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Affiliation(s)
- Chelvin C A Sng
- Department of Ophthalmology, National University Hospital, Singapore, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
| | - Paul T K Chew
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | | | - Katherine Lun
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Preethi Jeyabal
- Department of Ophthalmology, National University Hospital, Singapore, Singapore
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore, Singapore
- Singapore National Eye Center, Singapore, Singapore
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Wang Y, Lou L, Liu Z, Ye J. Incidence and risk of ptosis following ocular surgery: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2018; 257:397-404. [PMID: 30203103 DOI: 10.1007/s00417-018-4130-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 06/27/2018] [Accepted: 07/12/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the incidence and risk factors of ptosis following ocular surgery. METHODS PubMed, Embase, and Cochrane Library were searched for articles that assessed the incidence or risk factors of ptosis following ocular surgery up to October 2017. We used a fixed effects model to calculate a pooled estimate of incidence, with subgroup analyses to evaluate the effect of different variables. The relative risks (RRs) or odds ratios (ORs) and 95% confidence intervals (CIs) for all available factors were calculated using the fixed effects models. RESULTS A total of 16 studies on 2856 eyes were analyzed, including 3 randomized controlled trials (RCTs) and 13 cohort studies. The overall incidence of ptosis following ocular surgery was 11.4% (95% CI 10.1-12.8%). Subgroup analyses showed that the region and the surgery type were significantly associated with the incidence of postoperative ptosis. Men were less likely to get postoperative ptosis than women (OR 0.62; 95% CI 0.43-0.89). However, age (OR 0.77; 95% CI 0.48-1.23), side (OR 1.37; 95% CI 0.84-2.25), type of anesthesia (OR 0.57; 95% CI 0.16-2.05), prior surgery (OR 1.09; 95% CI 0.64-1.83), bridle suture (OR 2.04; 95% CI 0.94-4.42), or combined surgery (OR 0.95; 95% CI 0.58-1.57) did not significantly change the risk of ptosis following ocular surgery. CONCLUSION More than one in ten patients who undergo ocular surgery will develop ptosis. Different regions and surgery types may influence the occurrence of this abnormality. Female gender is a risk factor for development of postoperative ptosis.
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Affiliation(s)
- Yijie Wang
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Lixia Lou
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Zhifang Liu
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China
| | - Juan Ye
- Department of Ophthalmology, College of Medicine, The Second Affiliated Hospital of Zhejiang University, Jiefang Road 88, Hangzhou, 310009, Zhejiang, China.
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