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Zhou WS, Lin WX, Geng YY, Wang T. Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract. Int J Ophthalmol 2020; 13:1385-1390. [PMID: 32953576 DOI: 10.18240/ijo.2020.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts. METHODS The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups. RESULTS The mean IOP in PGE group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P<0.001) and at the last visit 16.2 mm Hg (P<0.001). Meanwhile PG group also showed significant decrease, from 24.1 mm Hg preoperatively to 13.0 mm Hg at 1mo after operation (P<0.001) and 15.3 mm Hg at the last visit (P=0.004). The mean medications reliance reduced in both groups, in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit (P<0.001), in PG group from 0.87 to 0.10 (P<0.001). At the last visit, BCVA increased from 0.21 to 0.60 in PGE group (P<0.001) and from 0.24 to 0.67 in PG group (P<0.001). The success rate of PGE group at 1mo was 95.2%, then decreased to 70.7% at the last visit, whereas in PG group, the success rate at 1mo was 100%, at the last visit was 73.4%. CONCLUSION PGE shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and PG still has its value in specific patients.
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Affiliation(s)
- Wan-Shu Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen-Xiang Lin
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yun-Yun Geng
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Tao Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Luo Q, Xue W, Yuan Y, Fu C, He J, Zou H, Tong X, Lee RK, Ge L. Peripheral anterior chamber depth and screening techniques for primary angle closure disease in community elderly Chinese. BMC Ophthalmol 2020; 20:353. [PMID: 32859174 PMCID: PMC7456037 DOI: 10.1186/s12886-020-01618-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the distribution of peripheral anterior chamber depth (ACD) and the relationship between peripheral ACD and gonioscopy compared to other ocular parameters for primary angle closure disease (PACD) screening. We performed a population-based survey in Pudong New District of Shanghai, China, in 2011. Methods Cross-sectional study. Adults 50 and older were enrolled from a population-based study using cluster random sampling in Pudong New District, Shanghai. Remote ocular screening was performed with digital anterior eye structure photography. Van Herrick measurements were used to evaluate the peripheral ACD, the depth of the peripheral anterior chamber, and corneal thickness (CT), and the ACD to CT ratio was calculated. Subjects with peripheral ACD less than 0.5 CT were made follow-up appointments for clinical examination with gonioscopy. Receiver operating characteristic curves (ROC) were generated to show the performance of different tests in screening for primary angle closure disease (PACD). Results Two thousand five hundred twenty-eight adults participated in the study with 91 patients diagnosed with PACD. Two thousand four hundred sixty-three subjects had valid data in the right eye available for analysis. The mean peripheral ACD values for men and women were significantly different: 1.04 ± 0.46 (range 0.11–2.93) CT and 0.87 ± 0.41 (range 0.12–2.96) CT respectively (t = − 4.18; P<0.0001). Multivariate logistic regression analysis reveals that peripheral ACD declined by 0.31 CT (P < 0.0001) per diopter of SE and was 0.19 CT (P < 0.0001) shallower in women than in men (r2 = 0.1304, P < 0.0001). Peripheral ACD performed best in screening for PACD. Conclusions Peripheral ACD measurement is recommended for PACD screening in community elderly Chinese.
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Affiliation(s)
- Qin Luo
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200040, China
| | - Wenwen Xue
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China
| | - Yin Yuan
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China
| | - Chaowei Fu
- Department of Social Medicine, School of Public Health, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200032, China
| | - Jiangnan He
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200040, China
| | - Xiaowei Tong
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China
| | - Richard K Lee
- Bascom Palmer Eye Institute, 900 N.W. 17th Street, Miami, FL, 33136, USA
| | - Ling Ge
- Department of Ophthalmology, Shanghai Eye Disease Prevention & Treatment Center/ Shanghai Eye Hospital, No. 380 Kangding Road, Shanghai, 200040, China. .,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100, Haining Road, Shanghai, 200040, China.
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Xiahou L, Liu C, Zhou W, Yang S. Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma. Pak J Med Sci 2020; 36:234-239. [PMID: 32063966 PMCID: PMC6994914 DOI: 10.12669/pjms.36.2.1439] [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] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. Methods: One hundred primary glaucoma patients (120 eyes) in Xinyu People’s Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. Results: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P<0.05). There was 93.33% formation of functional filtering blebs in the study group, which was significantly higher than that in the control group (60.00%, P<0.001). Moreover, normal anterior chamber formation was significantly higher in the study group (91.67%) than in the control group (71.67%, P<0.01). There was 95.00% operation success in the study group, relative to 68.33% success in the control group (P<0.001). Conclusion: Microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique has better curative effect on primary glaucoma than compound trabeculectomy. Moreover, it does not exacerbate complications. Therefore, the combination treatment technique merits clinical application.
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Affiliation(s)
- Li Xiahou
- Li Xiahou Department of Ophthalmology, Xinyu People's Hospital, Xinyu, Jiangxi Province, 338000, China
| | - Chunlan Liu
- Chunlan Liu Department of Ophthalmology, Xinyu People's Hospital, Xinyu, Jiangxi Province, 338000, China
| | - Weihong Zhou
- Weihong Zhou Department of Ophthalmology, Xinyu People's Hospital, Xinyu, Jiangxi Province, 338000, China
| | - Shasha Yang
- Shasha Yang The Second Affiliated Hospital, South China University of Technology, Guangzhou First People's Hospital, Guangzhou, 510180, China
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Tian T, Li M, Pan Y, Cai Y, Fang Y. The effect of phacoemulsification plus goniosynechialysis in acute and chronic angle closure patients with extensive goniosynechiae. BMC Ophthalmol 2019; 19:65. [PMID: 30832600 PMCID: PMC6399882 DOI: 10.1186/s12886-019-1070-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Patients with primary angle closure/glaucoma (PAC/PACG) with extensive peripheral anterior synechiae (PAS), and coexisting cataract, increasingly have been treated with phacoemulsification combined with goniosynechialysis (Phaco-GSL). Since the mechanisms of acute and chronic PAC/PACG may differ, the treatment effect of this procedure also may differ. The purpose of this study was to establish whether there was a difference in the therapeutic effect of Phaco-GSL on these two groups of patients, the results of which could provide clinical evidence for improvement in treatment protocols for patients with PAC/PACG and extensive PAS. Methods This study was a retrospective cohort study. Twenty-seven patients, 13 with acute PAC/PACG and 14 with chronic PAC/PACG, were treated surgically by Phaco-GSL. The intraocular pressure (IOP), surgical success rate, the need of medication, the extent of PAS, the time and the rate of recurrence of PAS (re-PAS) and other indicators were observed post-operatively for at least 3 months. Results After surgery, IOP decreased (preoperative vs postoperative: 29.77 ± 11.55 mmHg vs 14.92 ± 1.66 mmHg in the acute group and 26.00 ± 11.2 mmHg vs 14.93 ± 2.7 mmHg in the chronic group), the extent of PAS reduced (preoperative vs. postoperative: 314.23 ± 49.07° vs 116.54 ± 73.78° in the acute group and 285.00 ± 53.28° vs 156.43 ± 56.35° in the chronic group), the topical and systemic anti-glaucoma drug requirements decreased, in both groups and in the acute group, respectively. Compared with the acute group, the success rate (acute vs chronic: 100% vs 64.3%) was lower in the chronic group, while the incidence of re-PAS (acute vs chronic: 30% vs 83.3%) were higher in the chronic group. All differences mentioned above were statistically significant (p < 0.05). In addition, there were five patients in total who showed re-PAS of more than 90° (4 in chronic group and 1 in acute group) and all these re-PASs formed within 1 week postoperatively. Conclusion Although Phaco-GSL is effective in both groups, there may be differences in the effect between the two groups. Chronic patients are more susceptible to re-PAS. Thus, these patients should be observed closely and treated appropriately in the early post-surgical time period.
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Affiliation(s)
- Tian Tian
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, People's Republic of China
| | - Mei Li
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, People's Republic of China.
| | - Yingzi Pan
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, People's Republic of China
| | - Yu Cai
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, People's Republic of China
| | - Yuan Fang
- Department of Ophthalmology, Peking University First Hospital, 8 Xi Shi Ku Street, Xi Cheng District, Beijing, 100034, People's Republic of China
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