Search

Background: Non-penetrating trabeculectomy is used as the surgical intervention for open angle glaucoma. It has advantage of creating gradual filtration through the thin trabeculo-Descemet membrane to reduce markedly the postoperative complications typical for penetrating operation. We described our experience of the non-penetrating trabeculectomy for open angle glaucoma., Methods: This is a retrospective study of 28 eyes of 28 patients with primary open glaucoma (POAG). Non-penetrating trabeculectomy was performed by one surgeon from July 1998 to March 2000. Examinations were performed preoperatively and postoperatively in 1 and 7 days and 1, 3, 6, 12 and 21 months., Results: The mean follow-up was 12.5 +/- 6.3 months (S.D.). The mean preoperative intraocular pressure (IOP) was 27.8 +/- 6.7 mmHg. The mean postoperative IOP was 11.5 +/- 6.2 mmHg in 1 day and 15.7 +/- 5.8 mmHg in 1 week, and it remained stable in the following 12 months. IOP of 71.3% (20/28) of the eyes could be controlled below or equal to 21 mmHg with no or only topical antiglaucoma medication. There were only few postoperative complications., Conclusions: Non-penetrating trabeculectomy is efficient in controlling intraocular pressure of open angle glaucoma. No entering the anterior chamber diminishes the postoperative complications typical of the penetrating trabeculectomy.

Background: To evaluate the efficacy and safety of intraoperative mitomycin C (MMC) for trabeculectomy combined with phacoemulsification (phacotrab) in patients with coexisting glaucoma and cataract., Methods: We retrospectively reviewed the charts of consecutive patients who underwent phacotrab from July, 1996, to March, 1998. The pre- and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity (VA), and postoperative complications were compared among 22 patients (22 eyes) who received intraoperative MMC and 18 patients (18 eyes) who did not receive MMC, served as the control group. Data of age, gender, type of glaucoma, number of glaucoma medications, cup-to-disc ratio of the optic nerve and the extent of visual field defects were also evaluated. Kaplan-Meier survival analysis was used to compare the surgical success rates between two groups., Results: The mean IOP decreased from 16.1 +/- 4.2 mmHg to 10.94 +/- 3.6 mmHg in the MMC group, and from 18.7 +/- 6.9 mmHg to 14.6 +/- 1.9 mmHg in the control group at one year of follow-up. The mean postoperative IOPs were significantly lower in the MMC group than in the control group at one week, two weeks, and one, two, nine and 12 months. Postoperative mean VA log10 minimum angle of resolution (MAR) improved significantly in both groups. The mean number of medications decreased from 1.91 +/- 0.75 to 0.18 +/- 0.50 in the MMC group, and from 1.89 +/- 0.47 to 0.72 +/- 0.75 in the control group (p < 0.001 for both). The one-year complete success rate was significantly higher in the MMC group (p = 0.0038) than in the control group. No major complication was found throughout the study., Conclusions: Intraoperative MMC in phacotrab may improve postoperative filtration with less dependence on glaucoma medication. No significant adverse effects were associated with MMC application.

Background: This study was designed to determine the efficacy and safety of latanoprost 50 micrograms/ml in Chinese patients with primary open-angle glaucoma (POAG) and ocular hypertension (OH)., Methods: A 14-day randomized, double-masked, parallel-group study comparing topical latanoprost with placebo was followed by a 10-week, one-armed, open-labeled latanoprost treatment study. Intraocular pressure (IOP), visual function, ocular manifestations and miscellaneous adverse effects were evaluated at baseline, and days 1, 7, 14, 15, week 6 and week 12 visits., Results: Twenty-six eligible patients were enrolled in the study. The mean IOP was significantly reduced from baseline only in the latanoprost-treated eyes during the first study period (p = 0.003 on day 1; p = 0.004 on day 7; p < 0.001 on day 14). Meanwhile, the mean IOP was significantly lower in the latanoprost-treated eyes than that in the placebo-treated eyes (p = 0.03 on day 1; p = 0.001 on days 7 and 14). Eyes in both groups showed significantly reduced IOP at each visit of the secondary 10-week latanoprost treatment period, with a mean decrease of 6.12 mmHg. The IOP-lowering effect showed no diminution throughout the study course. Conjunctival hyperemia occurred in 16 of all patients who underwent latanoprost treatment and was the most frequent adverse effect observed. No patient withdrew from the study because of intolerable side-effects., Conclusions: Topical latanoprost is effective in reducing IOP for patients with POAG and OH. The pressure-lowering effect lasts for at least 24 hours after 1 drop instillation and no drift of effect is noted during this 12-week study. Conjunctival hyperemia was the most common side-effect, which was mild in degree and recovered after discontinuation of the medication.

Background: Glaucoma is a well known complication that arises after congenital cataract surgery. The purpose of this research was to study eyes that manifested glaucoma after congenital cataract surgery and to identify associated factors., Methods: A retrospective review of patients who received cataract surgery before the age of five was conducted. The chi-squared test for association was used to evaluate risk factors., Results: One hundred and forty eyes of 85 patients were studied. Nineteen eyes of 12 patients had glaucoma, among which 79% was open angle. Patients who underwent secondary membranectomy for visual axis occlusion had a higher risk of glaucoma, especially when secondary membranectomy was performed within one year of primary surgery. Of eight eyes with microcornea, none developed glaucoma after surgery. No significant difference in outcome was found among the surgical methods of cataract removal., Conclusions: Aggressive clearance of lens cortex during surgery is important. Secondary membranectomy for clearing the visual axis occlusion is associated with post operative glaucoma. Frequent and long-term patient follow-up is mandatory since glaucoma may manifest many years after congenital cataract surgery.

Background: To evaluate the long-term intraocular pressure (IOP) reduction effect and safety of adjunctive mitomycin C (MMC) (0.02%) in combined trabeculectomy and extracapsular cataract extraction (ECCE) procedure., Methods: Thirty of forty-one consecutive patients who underwent MMC trabeculectomy and ECCE with a minimum follow-up of 12 months were evaluated., Results: The mean IOP was reduced significantly (p < 0.001) from preoperative 19.2 +/- 3.2 mmHg to postoperative 12.1 +/- 2.7 mmHg, while the mean number of medications decreased from 2.1 to 0.2 at 1-year follow-up. Twenty-seven (90%) patients had IOPs controlled at 15 mmHg or less, and 26 (86.7%) patients required no medication. Net astigmatism and polar value converted from keratometric readings were 1.43 +/- 0.94 diopters and 0.07 +/- 1.38 diopters, respectively, in 1-year follow-up, which were not significantly different from the preoperative values., Conclusions: Intraocular pressure could be maintained in the low teens without the need for medication in a majority of patients even one year after the combined procedure. No adverse effect on corneal endothelium or limbal wound healing was detected with intraoperative application of 0.02% MMC.

Background: Clear cornea incision for phacoemulsification is the current trend of cataract surgery, with the benefits of small incision, quick rehabilitation and stable wound architecture. In our Oriental eyes with small palpebral fissure the cornea curvature is easily affected by the tight lid compression. Evaluation of the postoperative cornea topographic change after this procedure in our patient is thus necessary., Methods: Forty eyes with simple cataract were enrolled in this study. Among them 22 were right eyes and 18 were left eyes. All of them were through temporal clear cornea incision. A 2.65 mm length incision for phacoemulsification then enlarged to 3.5 mm for foldable intraocular lens implantation. The wound remained self-healing without suture. Color topographies were taken before and then one and three months after surgery. Palpebral fissures were measured before surgery., Results: Induced cornea astigmatism measured as 0.30 +/- 0.35 diopter in the first postoperative month, and 0.50 +/- 0.43 diopter in the third postoperative month. All the induced astigmatism was toward the incision axis and with the rule shifting., Conclusions: Tolerable with-the-rule astigmatism shifting around 0.5 diopter was noted postoperatively via temporal clear cornea phacoemulsification with foldable intraocular lens implantation in our patients.