Malignant glaucoma treated by low-dose laser cycloplasty: a 1-year multicenter prospective non-comparative study.

AIM: To report a one-year clinical outcomes of low-dose laser cycloplasty (LCP) among malignant glaucoma patients. METHODS: In this prospective, multicenter, non-comparative clinical study, participants with malignant glaucoma were recruited and underwent LCP at eight ophthalmic centers in China. Patients were followed up at 1wk, 1, 3, 6, and 12mo. Intraocular pressure (IOP), number of glaucoma medications, anterior chamber depth (ACD), and complications were recorded. Anatomical success was defined as the reformation of the anterior chamber based on slit-lamp biomicroscopy. Recurrence was defined by the presence of a shallow or flat anterior chamber after initial recovery from treatment. RESULTS: A total of 34 eyes received LCP. Mean IOP and medications decreased from 36.1±11.5 mm Hg with 3.3±1.5 glaucoma medications pre-treatment to 20.9±9.8 mm Hg (P<0.001) with 2.9±1.6 medications (P=0.046) at 1d, and 17.4±6.7 mm Hg (P<0.001) with 1.3±1.7 medications (P<0.001) at 12mo. The ACD increased from 1.1±0.8 mm at baseline to 1.7±1.0 mm and to 2.0±0.5 mm at 1d and 12mo, respectively. A total of 32 (94.1%) eyes achieved initial anatomical success. During follow-up, 2 (5.9%) eyes failed and 8 (23.5%) eyes relapsed, yielding a 12-month anatomical success rate of 64.3%. Complications including anterior synechia (8.82%), choroidal/ciliary detachment (5.88%) and hypopyon (2.94%) were observed within 1wk. CONCLUSION: LCP is simple, safe, and effective in reforming the anterior chamber in malignant glaucoma.

Clinical features of asthma with comorbid bronchiectasis: A systematic review and meta-analysis.

BACKGROUND: This meta-analysis aimed to systematically estimate the prevalence of comorbid bronchiectasis in patients with asthma and to summarize its clinical impact. METHODS: Embase, PubMed, and Cochrane Library electronic databases were searched to identify relevant studies published from inception until March 2020. STUDY SELECTION: Studies were included if bronchiectasis was identified by high-resolution computed tomography. Outcomes included the prevalence of bronchiectasis and its association with demographic characteristics and indicators of asthma severity, including results of lung function tests and the number of exacerbations. RESULTS: Five observational studies with 839 patients were included. Overall, the mean prevalence of bronchiectasis in patients with asthma was 36.6% (307/839). Patients with comorbid bronchiectasis had lower forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) (MD: -2.71; 95% CI: -3.72 to -1.69) and more frequent exacerbations (MD: 0.68; 95% CI: 0.03 to 1.33) than those with asthma alone, and there was no significant difference of sex, duration of asthma and serum levels of immunoglobulin(Ig)Es between asthmatic patients with or without bronchiectasis. CONCLUSION: The presence of bronchiectasis in patients with asthma was associated with greater asthma severity. There are important therapeutic implications of identifying bronchiectasis in asthmatic patients.

Management strategies in malignant glaucoma secondary to antiglaucoma surgery.

AIM: To assess the outcomes of various interventions for malignant glaucoma (MG). METHODS: A retrospective, comparative analysis of case series were performed on 38 eyes of 35 MG patients treated in Aier Eye Hospital of Wuhan between Jan. 2009 and Dec. 2012. Numerous treatments were administered including medical therapy, neodymium: yttrium- aluminium-garnet (Nd:YAG) laser posterior capsulotomy and hyaloidotomy as well as 3 surgical options. The characteristic, treatment option and outcome of MG in every individual patient were reviewed and analyzed among all patients who were followed up for an average of 27.1±9.1mo. RESULTS: Four eyes of 3 patients achieved complete resolution with medical therapy. Nd:YAG laser posterior capsulotomy and hyaloidotomy were performed on 2 eyes, both of which achieved resolution after initial intervention. Thirty-two eyes were given surgical treatments with anterior vitrectomy- reformation of anterior chamber in 13 eyes, phacoemulsification- intraocular lens implantation in 10 eyes and phacoemulsification- intraocular lens implantation- anterior vitrectomy in 9 eyes. Resolution of MG was seen in almost all patients. The mean intraocular pressure decreased from 41.87±9.44 mm Hg at presentation to 15.84±3.73 mm Hg at the last visit. The mean anterior chamber depth improved from 0.28±0.27 mm to 2.28±0.19 mm. Twenty eyes with preoperative visual acuity better than counting figure/ 50 cm had various visual improvements. Complications occurred in 3 eyes of 3 patients including bleeding at the entry site of vitrectomy into vitreous cavity, corneal endothelial decompensation and allergic to atropine respectively. CONCLUSION: MG occurs as a result of multiple mechanisms involved simultaneously or sequentially.Medical therapy is advocated as the initial treatment, laser therapy is beneficial in pseudophakic eyes, and different surgical regimen is recommended based on different pathogenesis of MG when non-response occurs to nonsurgical management. MG can be managed successfully by appropriate and timely interventions with good visual outcome.

[The early postoperative complications and cost-effectiveness analysis of non-penetrating trabecular surgery in patients with primary open angle glaucoma].

OBJECTIVE: To compare the early postoperative complications of non-penetrating trabecular surgery (NPTS) and modified trabeculectomy (MT) in patients with primary open angle glaucoma, and to analyze the cost-effectiveness of NPTS to prevent adverse events as well. METHODS: One hundred and forty seven consecutive cases (215 eyes) with primary open angle glaucoma from the glaucoma division, Zhongshan Ophthalmic Center, were involved. One hundred and four eyes underwent NPTS; while 111 eyes underwent MT. Visual acuity, intraocular pressure and complications occurred while staying in the hospital, were recorded. Number of need to treat (NNT) was used to analyze the cost-effective for NPTS. RESULTS: (1) Visual acuity decrease over 2 lines occurred in 25 eyes (24.0%) in NPTS group and 26 eyes (23.4%) in MT group. The difference of visual changes between these two groups was not statistically significant (P > 0.05). (2) One day after the operation, hypotension [IOP less or equal to 5 mm Hg (1 mm Hg = 0.133 kPa)] occurred in 39 eyes in NPTS group (38.2%), and 10 eyes in MT group (9.2%). The difference was significant (P < 0.01). On the day of discharge, the incidence of hypotension was 27.5% in NPTS group and 17.3% in MT group, respectively. The difference was still significant (P < 0.05). (3) Hyphema was found in 20 eyes (19.2%) in NPTS group and ten eyes (9.0%) in MT group. In either group, a surgical procedure was needed in two eyes to evacuate the blood. (4) Two eyes of grade II degrees and five eyes of grade I degrees shallow chamber were found in NPTS group. Five eyes of grade II degrees and five eyes of grade I shallow chamber were found in MT group. The difference of incidence of shallow chamber between these two groups was not statistically significant (P > 0.05). (5) Other complications: In the NPTS group, trabeculo-descemetic membrane rupture occurred in one eye, pupil dilated to 7 mm observed in six eyes; in the MT group, acute elevated IOP occurred in one eye, peripheral anterior synechia at inner incision occurred in one eye, hypotensive macular edema occurred in one eye. (6) The absolute risk ratio (ARR) of NPTS for adverse event was 3.0%, (NNT = 33.2), it costs additional RMB yen 116, 100 for preventing one adverse event. For serious adverse event, ARR = 1.8% (NNT = 55.5), and it costs additional RMB yen 194, 000 to prevent one serious adverse event. CONCLUSIONS: Although the NPTS may reduce the incidence of serious adverse event in comparing with MT, the cost of NPTS is very high, therefore, it is not an optimal procedure in China. Ophthalmologists in the general hospital should familiar with the MT procedure to save the medical expenses.