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Chen M, Yu N, Huang C, Zhang Q, Liu X, Wang K. CO 2 Laser-Assisted Sclerectomy Surgery Alone or Combined with Phacoemulsification in Primary Open-Angle Glaucoma: Comparison of 1-Year Outcomes. Ophthalmol Ther 2022; 11:1719-1733. [PMID: 35773569 PMCID: PMC9437161 DOI: 10.1007/s40123-022-00539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction To compare 1-year outcomes of CO2 laser-assisted sclerectomy surgery (CLASS) alone or combined with phacoemulsification (CLASS + Phaco) in eyes with primary open-angle glaucoma (POAG). Methods This was a prospective, comparative, case series study. A total of 46 eyes with POAG underwent CLASS or CLASS + Phaco were followed up for 1 year. The primary outcomes included changes in intraocular pressure (IOP), medication and best corrected visual acuity (BCVA). The secondary outcomes were success rate, functional bleb, postoperative laser intervention and complications. Results CLASS alone resulted in a greater IOP reduction compared with CLASS + Phaco. BCVA improved remarkably in CLASS + Phaco group, but there was no difference in BCVA before and after CLASS. The number of antiglaucoma medications significantly decreased at 12 months postoperatively in both groups. Functional blebs were more commonly seen in the CLASS than combination group. The overall success rate was higher in the CLASS than CLASS + Phaco group at 1 year after surgery. The incidence of peripheral anterior synechiae (PAS) in CLASS + Phaco group was significantly lower than that of CLASS alone. Conclusion CLASS alone achieved a greater IOP reduction, more common functional bleb formation and a higher success rate compared to CLASS combined with Phaco, while combination surgery yielded a better BCVA improvement and a lower PAS incidence than CLASS alone. Both surgical strategies have favorable safety and efficacy among POAG patients. Combined surgery could be a viable option for patients with co-existing POAG and cataract. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-022-00539-2.
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Affiliation(s)
- Min Chen
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Naiji Yu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Chunlian Huang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China.,Taizhou Central Hospital, Taizhou, Zhejiang, China
| | - Qi Zhang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Xin Liu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China
| | - Kaijun Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 1 Xihu Boulevard, Hangzhou, 310009, Zhejiang, China. .,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, Zhejiang, China.
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Chen M, Li Y, Cheng B, Zhang Q, Liu X, Wang K. CO 2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:902716. [PMID: 35665343 PMCID: PMC9160387 DOI: 10.3389/fmed.2022.902716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Bilateral congenital ectropion uveae (CEU) is rare syndrome, usually accompanied by refractory glaucoma. Proper and timely treatment was very important for the prognosis. The report aims to compare the long-term outcomes and complications between the two eyes after different approaches of surgery in a case of bilateral CEU with advanced glaucoma. Case Presentation The patient was a 20-year-old male with bilateral CEU and glaucoma. The intraocular pressure (IOP) was 48 mm Hg in the right eye (OD) and 52 mm Hg in the left eye (OS). The vertical cup-to-disc (C/D) ratio was nearly 1.0 in both eyes. Despite maximum medical therapy, the target IOP could not be achieved. Therefore, CO2 laser-assisted sclerectomy surgery (CLASS) was performed in OS, and the IOP was remarkably decreased. 1 month after the surgery, the IOP rebounded slightly and was controlled with a fixed-combination anti-glaucoma medicine. 3-month postoperatively, a YAG laser goniopuncture (LGP) was performed to enhance the IOP-lowing effect and the anti-glaucoma agent was discontinued. An ab externo microcatheter-assisted trabeculotomy (MAT) was performed in OD, and the IOP was also significantly decreased. During the follow-up period, the IOP was well controlled for both eyes without any medication. Shallow anterior chamber and complicated cataract developed in OS after CLASS, and there was no obvious late complication in OD after MAT. Conclusions To our knowledge, this was the first attempt to perform two different surgeries, CLASS and MAT, in both eyes of a single patient presented with bilateral CEU with glaucoma. Our results showed that the IOP was lower after CLASS, but there were potential complications such as shallow anterior chamber and complicated cataract. MAT could achieve a moderate IOP-lowing effect but had a higher safety. CLASS and MAT may be considered effective surgical options for the management of such patients.
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Affiliation(s)
- Min Chen
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Yuhang Li
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Bo Cheng
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Department of Ophthalmology, Fenghua People's Hospital, Zhejiang, China
| | - Qi Zhang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Kaijun Wang
- Eye Center, The Second Affiliated Hospital, Medical College of Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
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