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AIM: To evaluate the effect of ab-externo circumferential suture trabeculotomy(CST)on the 24 h pattern of intraocular pressure(IOP)in primary open angle glaucoma(POAG).METHODS: This retrospective study included 18 POAG patients who had poor control of IOP from March 2021 to May 2022. The ab-externo CST was performed, and IOP was tested preoperatively and 1 a postoperatively(9:00 a.m., 12:00 a.m., 3:00 p.m., 6:00 p.m., 9:00 p.m., 12:00 p.m., 3 a.m., and 6:00 a.m.). The mean, peak, trough, and range of IOP, as well as the average diurnal-nocturnal IOP change were calculated and compared.RESULTS: The 24 h IOP curves exhibited a decreasing trend during the diurnal period and an increasing trend during the nocturnal period, reaching a trough in the afternoon and peaking at night; the time of trough and peak IOP occurred several hours earlier compared to preoperative eyes. Postoperatively, the mean, peak, and trough IOP values were significantly lower compared to preoperative levels. The range of fluctuation showed no significant difference, while the average diurnal-nocturnal IOP change increased significantly.CONCLUSION: CST could reduce IOP of patients with POAG, but could not change the range of IOP fluctuation. However, an increase in the average diurnal-nocturnal IOP change was observed, indicating that CST might not necessarily reduce diurnal-nocturnal IOP fluctuations.
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Purpose: To evaluate the efficacy and safety of gonioscopy?assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Methods: Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single?center chart review. The main outcome measure was surgical success; intra?ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ? of baseline on fewer medications as compared to baseline. Results: Forty?seven eyes were included in the analysis. The average mean deviation was ?17.5 ± 7.2 dB (range ?8.0 to ?33.0). The average follow?up was 6.8 months (range 3.2–22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12–40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post?operative month (P < 0.001 for both IOP and medications). At the last follow?up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. Conclusions: GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post?operative management are imperative.
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AIM: To investigate the clinical efficacy of gonioscopy-assisted transluminal trabeculotomy(GATT)for secondary high intraocular pressure after vitrectomy.METHODS: A retrospective study was conducted on 10 patients(15 eyes)with secondary high intraocular pressure(IOP)after vitrectomy treated with GATT in Department of Ophthalmology, Chengdu First People's Hospital from January 2019 to May 2022. The best-corrected visual acuity(BCVA), IOP, number of IOP-lowering drugs, and complications before operation and at 1d, 1wk, 1, 3 and 6mo after operation were recorded, and the surgical success rate was analyzed.RESULTS:There was no difference in BCVA before and 6mo after operation(Z=0, P=1). The mean IOP decreased from 28.33±9.48mmHg to 17.47±3.78(1d), 18.8±3.29(1wk), 19.13±3.62(1mo), 20.31±3.66(3mo)and 18.03±3.23mmHg(6mo; all P<0.05). The average medication used before surgery was 2(2, 4), and the average medication used 6mo after surgery was 1(0, 2), which was significantly decreased(P<0.001). The total success rate of surgery at 1d, 1wk, 1, 3 and 6mo after surgery was 87%(13 eyes), 93%(14 eyes), 87%(13 eyes), 73%(11 eyes)and 93%(14 eyes)respectively. The main postoperative complications were transient hyphema(10 eyes, 67%)and transient elevated IOP(5 eyes, 33%). No complications seriously affecting the vision occurred.CONCLUSION: GATT is safe and effective in the treatment of secondary high intraocular pressure after vitrectomy.
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Background: Primary congenital glaucoma is the most common type of glaucoma in infancy. It manifests within the first few years of life and is not associated with any other systemic or ocular abnormalities. This study aimed to evaluate a protocol for diagnosis and treatment of primary congenital glaucoma at Tanta University Eye Hospital.Methods: The study was prospective interventional on 60 eyes of 36 infants and children who presented between December 2018 to March 2021 at Tanta University Eye Hospital in Egypt. All patients were presented with primary congenital glaucoma and were managed according to specific diagnostic, therapeutic and follow up regimen. Pre- and Post-operative clinical data were recorded, and results were studied.Results: The mean of age±SD (range) at first presentation was 11.33±21.76 (0.5-120) months and of follow-up period was 7.85±2.71 (4-13) months. The mean of pre-operative IOP, corneal diameter, C/D ratio and AxL was 24.1±5.9 (12–41.5) mmHg, 12.97±0.69 (11–14.5) mm, 0.57±0.18 (0.2–0.9) and 21.87±1.28 (19.1–26.8) mm respectively, and post-operatively was 14.4±3.09 (8.5–20.5) mmHg, 12.71±0.89 (11–14.5) mm, 0.48±0.22 (0.2–1) and 22.16±1.53 (19–25.9) mm respectively. Surgical interventions included 1ry surgeries (trabeculotomy in 21 eyes and CTT with MMC in 39 eyes), 2ry surgeries (CTT with MMC in four eyes) and 3ry surgery (Ahmed valve implantation in one eye). Complete success was achieved in 38 eyes (63.3%) and qualified success in 22 eyes (36.7%).Conclusions: The current protocol applied at Tanta University Eye Hospital for diagnosis and treatment of primary congenital glaucoma proved efficacy and safety. Primary surgical intervention in the form of trabeculotomy (for mild cases) and combined trabeculotomy-trabeculectomy with MMC (for moderate to advanced cases) is a successful regimen for management of these eyes.
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Background: Trabeculectomy is still the most frequently performed glaucoma surgery. But being an invasive procedure, it has numerous vision?threatening complications along with bleb?related complications like cystic bleb, overhanging bleb blebitis, or endophthalmitis. The choice of therapy between medical laser and filtering surgery is now bridged by minimally invasive glaucoma surgeries (MIGS), which are conjunctiva?sparing procedures with adequate intraocular pressure (IOP)?lowering effects and good safety profiles. Among the armamentarium of MIGS procedures, gonioscopy?assisted transluminal trabeculotomy (GATT) is a frontrunner safe procedure. The procedure is a blebless and sutureless procedure in which a readily available Prolene suture is used to cleave the entire trabecular meshwork. An ab interno approach also allows direct visualization of a so?called trabecular shelf that, when present, indicates an open, cleaved collector system commonly associated with a positive postoperative outcome. Thus, it not only saves the eye from various postoperative complications of other previous penetrating procedures, but is also an effective glaucoma surgery that can be performed with very low costs, which would have big economic implications for glaucoma carein developing countries. Purpose: The purpose of this video is to illustrate transluminal novel trabeculotomy technique and video?based skill transfer to a novice surgeon. Synopsis: This video depicts detailed steps of GATT surgery in a patient with primary open angle glaucoma and in a case of silicon oil induced secondary open angle glaucoma. The authors also share their experience regarding possible intraoperative problems and solutions with some tips and tricks to make the surgery easy. Highlights: GATT can be performed with cataract surgery with minimal patient morbidity and a short recovery time with preserving healthy conjunctiva. There is no risk of post op hypotony or bleb related complications, with a short surgical learning curve
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RESUMO Objetivo Avaliar a eficácia da trabeculotomia transluminal assistida por gonioscopia correlacionada com a gravidade do glaucoma. Métodos Análise restrospectiva de prontuários de pacientes que foram submetidos à trabeculotomia transluminal assistida por gonioscopia no período de 2019 a 2021 em um hospital privado. Resultados Vinte olhos foram submetidos à trabeculotomia transluminal assistida por gonioscopia (dois olhos) ou facectomia e trabeculotomia transluminal assistida por gonioscopia (18 olhos). Pacientes portadores da doença avançada obtiveram redução de 5mmHg (26,5%) na pressão intraocular, com redução de 2,3 drogas, e olhos com glaucoma leve ou moderado apresentaram redução de 8mmHg (40%) na pressão intraocular média e 2,1 drogas. Metade dos olhos operados teve hifema nos primeiros dias como principal complicação cirúrgica. Conclusão A trabeculotomia transluminal assistida por gonioscopia é um procedimento eficaz na redução da pressão intraocular e na redução da quantidade de drogas em uso, apresentando maior redução da pressão intraocular em olhos com glaucoma leve/moderado.
ABSTRACT Objective To evaluate efficacy of gonioscopy-assisted transluminal trabeculotomy and relate to severity of glaucoma. Methods A retrospective analysis of medical records of patients submitted to gonioscopy-assisted transluminal trabeculotomy, at a private hospital, from 2019 to 2021. Results A total of 20 were submitted to gonioscopy-assisted transluminal trabeculotomy (2 eyes) or facectomy and gonioscopy-assisted transluminal trabeculotomy (18 eyes). Patients with advanced-stage disease achieved a decrease by 5 mmHg (26.5%) in IOP, with a reduction of 2.3 drugs, and eyes with mild or moderate glaucoma showed a drop by 8 mmHg (40%) in mean IOP and of 2.1 drugs. Half of the operated eyes had hyphema in the first days as the main surgical complication. Conclusion Gonioscopy-assisted transluminal trabeculotomy is an effective procedure to reduce IOP and the number of drugs being used, with greater IOP decrease in eyes with mild/moderate glaucoma.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Trabeculectomia , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/diagnóstico , Prontuários Médicos , Estudos Retrospectivos , Resultado do Tratamento , Gonioscopia/métodos , Pressão IntraocularRESUMO
ABSTRACT The aim of this study is to present the results of ab-interno trabeculotomy using Kahook Dual Blade in patients with primary congenital glaucoma. An ab-interno trabeculotomy using a dual blade device was performed in three eyes of two patients with the diagnosis of primary congenital glaucoma. One of them in the left eye and the other patient in both eyes. In the first patient, an adequate response was achieved after the intraocular pressure reduced from 36 mmHg to 14 mmHg. The second patient did not respond adequately to the procedure, and high intraocular pressure levels persisted in both eyes after the procedure. The indication of Kahook Dual Blade ab-interno trabeculotomy in primary congenital glaucoma must be cautious and more studies are needed to establish its efficacy and the best indications. Seems that this procedure should not be indicated for primary congenital glaucoma treatment.
RESUMO O objetivo deste estudo é apresentar os resultados da trabeculotomia ab-interno com Kahook Dual Blade em pacientes com glaucoma congênito primário. Foi realizada trabeculotomia ab-interno com dispositivo de lâmina dupla em 3 olhos de 2 pacientes com diagnóstico de glaucoma congênito primário. Um deles no olho esquerdo e o outro paciente nos dois olhos. No primeiro paciente, houve resposta adequada uma vez que a pressão intraocular diminuiu de 36 mmHg para 14mmHg. O segundo paciente não respondeu adequadamente ao procedimento, mantendo altos níveis de pressão intraocular em ambos os olhos após o procedimento. A indicação da trabeculotomia ab-interno com o Kahook Dual Blade no glaucoma congênito primário deve ser cautelosa e são necessários mais estudos para estabelecer a eficácia e as melhores indicações. Parece que esse procedimento não deve ser indicado no tratamento do glaucoma congênito primário.
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Humanos , Trabeculectomia , Doenças do Nervo Óptico , Glaucoma , Tonometria Ocular , Glaucoma/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Pressão IntraocularRESUMO
Objective:To explore the nursing cooperation of gonioscope assisted transluminal trabeculectomy (GATT).Methods:From February 2019 to August 2020, preoperative visits, preoperative equipment debugging and surgical instrument preparation were conducted for 30 patients (30 eyes) undergoing GATT for open-angle glaucoma in Zhongshan Ophthalmic Center of Sun Yat-sen University. Nurses closely attended the patients and expertly cooperated with doctors in the intraoperative management of patients. The incidence of complications was observed. The intraocular pressure (IOP) and medication were compared before and after operation.Results:Totally 30 cases (30 eyes) completed the operation successfully without serious complications and nursing adverse events. Twenty-six patients (86.7%) completed 360° total incision, and four patients (13.3%) completed 270° total incision. The mean preoperative IOP was (27.43±6.46) mmHg (1 mmHg= 0.133 kPa), the mean postoperative IOP was (13.67±3.01)mmHg. The difference between preoperative and postoperative IOP and the use of anti-glaucoma drugs were of statistical significance ( t value was 10.67, Z value was 4.18, P<0.05). Conclusions:The implementation of fine nursing for patients with GATT can ensure the smooth operation, reduce the incidence of complications and improve the postoperative rehabilitation effect.
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Objective:To investigate the efficacy and safety of non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy for the treatment of primary congenital glaucoma (PCG).Methods:An observational case series study was conducted.A total of 29 cases (50 eyes) with PCG, including 21 males (35 eyes) and 8 females (15 eyes), were enrolled in Jiangsu Province Hospital and Nanjing Children's Hospital from January to November, 2019.The age of subjects ranged from 1 month to 4 years, and the median age was 6 months.Non-penetrating trabecular surgery was first performed in order to open the Schlemm canal.The cannulation and nearly 360-degree suture trabeculotomy were then performed with the twisted 6-0 polypropylene suture.Intraocular pressure (IOP), corneal diameter, cup-to-disc ratio (c/d) and complications were recorded preoperatively and 1 week, 1 month, 3 months, 6 months, 9 months, 12 months, and 24 months postoperatively, and the proportion of sutures successfully passed through the Schlemm canal and the success rate of operation were recorded.This study followed the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (No.2019-SR-198). Written informed consent was obtained from the guardian of each subject prior to entering the study cohort.Results:Circumferential cannulation by suture was successfully performed in 90% of the subjects.The Harms trabeculotomy probe was applied in failed cases.Mean IOP was significantly lowered from preoperative (35.0±9.5) mmHg (1 mmHg=0.133 kPa) to (9.9±4.4), (10.0±4.2), (9.7±4.4), (9.0±2.9), (9.4±4.2), (9.3±3.3) and (9.5±3.8) mmHg at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=141.56, P<0.01). Mean corneal diameter was significantly reduced from preoperative (13.7±1.4) mm to (13.3±1.4), (12.9±1.4), (12.8±1.3), (12.7±1.2), (12.6±1.1), (12.6±1.1) and (12.8±0.4) mm at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=4.55, P<0.01). Mean c/d was significantly reduced from preoperative 0.81±0.15 to 0.55±0.22, 0.48±0.23, 0.45±0.22, 0.43±0.21, 0.41±0.20, 0.40±0.21 and 0.31±0.19 at postoperative 1 week, 1 month, 3 months, 6 months, 9 months, 12 months and 24 months, respectively ( F=21.07, P<0.01). Forty-two eyes (93.3%) achieved complete success and 45 eyes (100%) achieved qualified success at postoperative 12 months.No severe complications were observed during or after surgery. Conclusions:Non-penetrating trabecular surgery combined with nearly 360-degree suture trabeculotomy can effectively treat patients with PCG without any severe complications.
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Objetivo: Describir los resultados visuales e hipotensores de la trabeculotomía gonioasistida modificada y determinar sus complicaciones. Métodos: Se realizó un estudio analítico de 30 ojos; 15 de ellos (15 pacientes) recibieron trabeculotomía gonioasistida modificada (grupo caso) y 15 ojos (15 pacientes) recibieron trabeculectomía con mitomicina C (control histórico). Resultados: Predominaron los pacientes masculinos. La edad promedio del grupo con trabeculectomía fue 64,2 ± 7,3 años; mientras la del grupo con trabeculotomía gonioasistida modificada fue 69,9 ± 4,8 años. La agudeza visual mejor corregida media preoperatoria fue menor en el grupo con trabeculectomía (95 VAR/100-80 vs. 97 VAR/100-90) y la presión intraocular media fue 26,0 mmHg/24,5-30,0) y 25,0 mmHg/22,5-27,0 respectivamente. Todos los pacientes con trabeculectomía recibieron 3 colirios hipotensores en el preoperatorio, mientras el 53,3 por ciento de los tratados con trabeculotomía gonioasistida modificada requirieron 3 colirios hipotensores. Al año, la agudeza visual mejor corregida media disminuyó en el grupo con trabeculectomía (90VAR/100-75), y se mantuvo en el grupo con trabeculotomía gonioasistida modificada (97VAR/100-90). En ambos grupos se produjo una caída significativa de la PIO promedio y más del 85 por ciento de los casos requirió uno o ningún colirio para su control. Conclusiones: El resultado visual, el poder hipotensor y las complicaciones quirúrgicas al año muestran la trabeculotomía gonioasistida modificada como una técnica útil y segura. Se requieren estudios a largo plazo para evaluar su efectividad futura(AU)
Objective: Describe results one year after modified gonioscopy-assisted trabeculotomy. Methods: An analytical study was conducted of 30 eyes, 15 of which (15 patients) underwent modified gonioscopy-assisted trabeculotomy (GATTm) (case group), and 15 trabeculotomy with mitomycin C (TBT) (historical control). Results: Male patients prevailed. Mean age was 64.2 ± 7.3 years for the TBT group and 69.9 ± 4.8 years for the GATTm group. In the TBT group mean preoperative best corrected visual acuity was lower (95 VAR/100-80 vs. 97VAR/100-90), whereas mean intraocular pressure was 26.0 mmHg/24.5-30.0 and 25.0 mmHg/22.5-27.0, respectively. All TBT patients received 3 hypotensive collyriums preoperative, while 53.3 percent of the GATTm patients required 3 hypotensive collyriums. At one year, mean best corrected visual acuity was lower in the TBT group (90VAR/100-75) and remained the same in the GATTm group (97VAR/100-90). A significant mean intraocular pressure reduction was observed in both groups and more than 85 percent of the cases required either one or no collyrium for their control. Conclusions: Visual result, hypotensive effect and surgical complications at one year are evidence that modified gonioscopy-assisted trabeculotomy is a safe, useful technique. Long-term studies are required to evaluate its future effectiveness(AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Glaucoma/diagnóstico , Mitomicina/uso terapêutico , Pressão Intraocular , Trabeculectomia/métodosRESUMO
El glaucoma congénito primario constituye la forma más común de glaucoma infantil, el cual exige un diagnóstico precoz y un tratamiento quirúrgico relativamente urgente, ya que puede ocasionar graves secuelas morfológicas y funcionales. Se presenta la realización, por primera ocasión, de la trabéculo-trabeculectomía combinada en la República Democrática y Popular de Argelia. Se ejecutó en un paciente árabe, de un año de edad, a quien se le diagnosticó el glaucoma congénito primario II. Se evaluó el seguimiento posoperatorio con resultados satisfactorios, por lo que se consideró la trabéculo-trabeculectomía como el proceder quirúrgico efectivo y suficientemente seguro, el cual debe ser realizado por un personal calificado para poder admitirse como primera opción en el tratamiento quirúrgico del glaucoma congénito primario(AU)
Primary congenital glaucoma is the most common form of childhood glaucoma. This condition requires early diagnosis and relatively urgent surgical treatment, since it may leave serious morphological and functional sequelae. A description is provided of the first combined trabeculotomy-trabeculectomy performed in the People's Democratic Republic of Algeria. The operation was performed on a male one-year-old Arab patient diagnosed with primary congenital glaucoma II. Post-operative follow-up found satisfactory results, and trabeculotomy-trabeculectomy was thus considered to be an effective, sufficiently safe surgical procedure, which should be performed by qualified personnel to be accepted as the first surgical treatment option for primary congenital glaucoma(AU)
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Humanos , Lactente , Trabeculectomia/métodos , Glaucoma/diagnóstico por imagem , Diagnóstico PrecoceRESUMO
Purpose: The purpose of this study is to describe the short-term incidence, clinical features, and management of glaucoma in children after successful surgery for stage 4 retinopathy of prematurity (ROP). Methods: The retrospective study included all eyes undergoing successful surgery for stage 4 ROP with good outcomes at a tertiary eye care center between June 2014 and June 2016. Cases developing postoperative glaucoma underwent examination under anesthesia for measurement of intraocular pressures (IOP), corneal diameters, Retcam-assisted fundus imaging, and gonioscopy. Outcomes of glaucoma management were evaluated. Results: Hundred eyes of 70 babies underwent successful surgery for stage 4 ROP (with postoperative attached retina, and minimal sequelae) with minimum follow-up of 15 months. Six eyes (6%) developed postoperative glaucoma. Of these, four eyes had undergone lens-sparing vitrectomy and two were managed with lensectomy and vitrectomy (LV). Median time duration for development of glaucoma after primary vitreous surgery was 17.5 weeks. Two cases could be managed with topical IOP-lowering agents alone, whereas four required filtering surgeries (trabeculotomy with trabeculectomy and 0.04% mitomycin C [MMC] application). Average IOP decreased from 25 ± 2.36 to 12.2 ± 2.05 mmHg at 12 months from glaucoma diagnosis. Conclusion: Glaucoma is a potential adverse event following successful vitreous surgery for stage 4 ROP. A combined trabeculotomy–trabeculectomy along with MMC gives favorable outcome.
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Purpose: To evaluate the success, safety, and complication rates of gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract surgery. Methods: A retrospective study was conducted for 32 patients who underwent GATT combined with phacoemulsification and intraocular lens implantation. Patients with primary open-angle glaucoma were enrolled. The primary outcome measures were visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications used, and complications. Results: The average preoperative visual acuity of the patients was logMAR 1.57 ± 1.2, and the average postoperative visual acuity was logMAR 0.39 ± 0.38. A significant increase in visual acuity was observed post-surgery (P < 0.05). The average preoperative IOP was 34.2 ± 10.6 mmHg. In the 3rd postoperative month, the average IOP was 10.5 ± 2.2 mmHg, and in the 6th postoperative month, the average IOP was 11.2 ± 2.4 mmHg. In all postoperative follow-ups, IOP was significantly lower than that during the preoperative period (P < 0.05). A decrease of 2.7 ± 0.6 on average was detected in the number of glaucoma medications used in the postoperative period compared to the preoperative period, and the average decrease in the number of active ingredients post-surgery was 3.5 ± 0.8. The most frequent complication was hyphaema (31.2%). In only one patient (3.1%), the surgery was considered to have failed due to the development of deep hypotony. Conclusion: Performing GATT in the same session as cataract surgery does not reduce the efficacy of GATT, yet this procedure reduces the incidence of the most frequent complication of GATT, i.e. hyphaema. Therefore, in convenient cases, combined surgery can safely be performed.
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Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma.Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included,and the age ranged from 6 months to 8 years (median 4 years).All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days,1 month and 6 months after surgery,and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01) and Zhengzhou Secord People's Hospital (No.20161202001),and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination.Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy,the success rate was 90.91%.Twelve eyes were operated with full incision (incision range was 360°),8 eyes were performed with subtotal incision (incision range was 180°-330°),while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation,7 days,1 month and 6 months after surgery were (26.55 ±4.38),(20.48 ± 3.62),(13.71 ± 6.35) and (12.67 ± 5.37) mmHg,respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771,P<0.001).At the last follow-up,the intraocular pressures of 18 eyes were controlled.Among them,16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation,and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery,and all the hemorrhages were absorbed within 1 week after surgery.Conclusions For children with glaucoma,microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications.
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En una enfermedad como el glaucoma, considerada la segunda causa de ceguera en Cuba y en el mundo, el tratamiento quirúrgico ha experimentado una evolución sorprendente y se buscan opciones más sencillas, eficaces y con un posoperatorio tranquilo. En el departamento de Glaucoma del Instituto Cubano de Oftalmología se comenzó a realizar una modificación de la trabeculotomía gonioasistida y es de interés presentarla mediante la evolución posoperatoria a corto plazo de un caso clínico. Se trata de un paciente de 72 años de edad, con catarata y glaucoma descompensado, a pesar del tratamiento médico. Se presenta con 50 VAR de visión y presión intraocular de 26 mmHg. Se realizó cirugía combinada: facoemulsificación y trabeculotomía gonioasistida modificada. Se lograron cifras de presión intraocular de 18 mmHg y agudeza visual mejor corregida de 100 VAR a los 6 meses posoperatorios(AU)
In a disease such as glaucoma, considered the second main cause of blindness both in Cuba and worldwide, surgical treatment has experienced surprising development, and simpler, more effective alternatives as well as a quiet postoperative period are constantly sought. At the glaucoma department of the Cuban Institute of Ophthalmology a modification has started to be performed of gonioscopy-assisted trabeculotomy. It would be interesting to present it by describing the short-term postoperative evolution of the clinical case of a 72-year-old male patient with cataract and decompensated glaucoma despite medical treatment. At presentation, the patient's vision was 50 VAR and intraocular pressure 26 mmHg. Combined surgery was performed: phacoemulsification and modified gonioscopy-assisted trabeculotomy. Six months after surgery, intraocular pressure was 18 mmHg and best corrected visual acuity was 100 VAR(AU)
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Humanos , Masculino , Idoso , Trabeculectomia/métodos , Glaucoma/tratamento farmacológico , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Facoemulsificação/métodosRESUMO
AlM:To compare the efficacy and complication of extra-trabeculotomy in combination with trabeculectomy and trabeculectomy and compound trabeculectomy in the treatment of primary infantile glaucoma. METHODS: Patients with primary infantile glaucoma undergone one of the three procedures from Jan 2006 to Jan 2014 were selected. Among them, group A ( 20 patients, 31 eyes ) underwent extra- trabeculotomy in combination with trabeculectomy, group B ( 20 patients, 32 eyes ) underwent trabeculectomy, while group C ( 20 patients, 30 eyes) underwent compound trabeculectomyRESULTS:The success rates in group A were 96. 8% at the time of discharge and 90. 3% during follow-up (mean 24mo) ; the rates in group B were 96. 9% and 81. 2%( mean 24mo) the rates in group C were 83. 3% and 76. 7%( mean 24mo ) respectively, the differences being significant (P CONCLUSlON: Extra - trabeculotomy in combination with trabeculectomy is more efficacious and safer than trabeculectomy and compound trabeculectomy in the treatment of primary infantile glaucoma. lt should be the first choice for primary infantile glaucoma.
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Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder that causes congenital glaucoma. Previous experiences have shown that drainage procedures are often required to control associated glaucoma. The conventional surgical approach in trabeculectomy carries a significant risk of intraoperative expulsive hemorrhage. Here, we describe a modified approach of the conventional trabeculectomy technique, which may lower the risk of expulsive hemorrhage. A viscoelastic device was employed to maintain a steady intraocular pressure throughout the procedure. Details of the surgical technique and material used are described. One patient with congenital glaucoma associated with SWS underwent a successful trabeculectomy using the modified technique. Postoperative intraocular pressure was successfully reduced and no intraoperative complications occurred. We describe a successful case of trabeculectomy in a SWS case where a modified technique was applied.
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Humanos , Recém-Nascido , Masculino , Glaucoma/congênito , Pressão Intraocular , Síndrome de Sturge-Weber/complicações , Trabeculectomia/métodos , Acuidade VisualRESUMO
Congenital glaucoma is a global problem and poses a diagnostic and therapeutic challenge to the ophthalmologist. A detailed evaluation under general anesthesia is advisable to establish the diagnosis and plan for management. Medical therapy has a limited role and surgery remains the primary therapeutic modality. While goniotomy or trabeculotomy ab externo is valuable in the management of congenital glaucoma, primary combined trabeculotomy–trabeculectomy offers the best hope of success in advanced cases. Trabeculectomy with antifibrotic agent and glaucoma drainage devices has a role in the management of refractory cases, and cyclodestructive procedures should be reserved for patients where these procedures have failed. Early diagnosis, prompt therapeutic intervention and proper refractive correction are keys to success. Management of residual vision and visual rehabilitation should be an integral part of the management of children with low vision and lifelong follow-up is a must.
Assuntos
Adrenérgicos/uso terapêutico , Antagonistas Adrenérgicos/uso terapêutico , Inibidores da Anidrase Carbônica/uso terapêutico , Crioterapia/métodos , Glaucoma/congênito , Glaucoma/tratamento farmacológico , Glaucoma/cirurgia , Implantes para Drenagem de Glaucoma , Humanos , Recém-Nascido , Fotocoagulação/métodos , Mitomicina/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos , Prostaglandinas/uso terapêutico , TrabeculectomiaRESUMO
Objetivo: Avaliar os resultados da associação trabeculotomia-trabeculectomia (Tro-Trec) em pacientes de 12 a 50 anos, com glaucoma moderado ou avançado. Métodos: estudo prospectivo de 19 olhos de 13 pacientes, de 12 a 50 anos (média de 33,77 ± 11,43), submetidos à Tro-Trec e seguidos por 21,6 ± 7,2 (5,1 a 29,7) meses. Resultados: A pressão intraocular, (PIO) média inicial de 32,03 ± 10,01 mmHg (variando de 12 a 50), foi reduzida para 9,42 mmHg ± 3,50 (2 e 16), com redução da medicação tópica de 1,47 ± 1,54 (0 a 4) para 0,16 ± 0,37 (0 a 1) medicamentos. A PIO alvo foi atingida em 15 (78,94%) olhos. Houve acentuada redução da PIO mesmo em olhos sem bolhas significativas. O procedimento resultou em hipotonia persistente em três olhos. Conclusão: A cirurgia proposta foi eficaz. A acentuada redução da PIO em olhos sem bolhas significativas sugere que, na faixa etária analisada, a trabeculotomia isolada pode ser suficiente para controle da PIO em alguns pacientes. A incidência de hipotonia foi significativa, porém não superior à relacionada à trabeculectomia isolada, para a mesma faixa etária.
Purpose: To evaluate the results of the trabeculotomy-trabeculectomy combined procedure in 12 to 50 years old patients with moderate and advanced glaucoma. Methods: Nineteen eyes of thirteen patients underwent a trabeculotomy-trabeculectomy procedure and were prospectively analyzed and followed up for 21,6 ± 7,2 (5,1 a 29,7) months. Results: IOP was reduced from 32,03 ± 10,01 (12 to 50) mmHg to 9,42 ± 3,50 (2 e 16) mmHg with the number of topical medications being reduced from 1,47 ± 1,54 (0 a 4) to 0,16 ± 0,37 (0 a 1). The target IOP was obtained in 15 of the eyes (78,94%). A great IOP reduction was obtained in eyes without significant blebs. Three eyes developed persistent hipotony. Conclusion: The procedure proved to be effective. The IOP reduction in eyes without significant blebs make us to infer that isolated trabeculotomy should be sufficient to control IOP for some of these eyes. The occurency of hipotony was similar to that from isolated trabeculectomy for pacients of the same age.