Two-way adjustable double-knots intrascleral fixation and single sclerotomy looping technique: a novel minimal invasive adjustable intraocular lens fixation technique.

BACKGROUND: IOL fixation without capsular support presents challenges for surgeons. Although innovative techniques were developed to address subluxated IOLs, adjustable IOL fixation methods are seldom reported. We introduce a novel two-way adjustable double-knots intrascleral fixation combined with single sclerotomy looping technique for fixing intraocular lenses (IOL) or IOL-capsular bags. METHODS: A bent 30-gauge needle threaded with 8 - 0 polypropylene was introduced into the eye. A gripping forceps assisted the haptic looping. Two overhand knots were made with 8 - 0 polypropylene thread. The knots were incarcerated into a scleral tunnel made by a 30-gauge needle, with two ends of the thread left at each side of the tunnel. The IOL was adjusted to the premium position with adequate tension by pulling either end of the threads. The study included 19 eyes with aphakia, subluxated IOL-capsular bags, or subluxated crystalline lenses. The mean followed up period was 18.9 ± 7.1 months with evaluations of uncorrected visual acuity (UCVA), intraocular pressure, slit-lamp examination, and swept-source optical coherence tomography of the anterior segment. RESULTS: UCVA increased from 1.28 ± 0.74 at baseline to 0.44 ± 0.51 (logMAR) at final visit (P < 0.001). All IOLs were fixed well-centered. The mean IOL tilt was 3.5°±1.1°. Postoperative complications included transient IOP elevation (15.8%), hypotony (10.5%), and cystoid edema (5.3%) which resolved within 4 weeks. CONCLUSIONS: We presented a novel adjustable technique for IOL fixation, which stabilize IOLs by using an intrascleral double-knots structure. This technique minimized surgical manipulations by using a single sclerotomy looping technique without large conjunctival dissection and scleral flap creation. The technique offers a reliable and optimal IOL positioning and improved visual outcomes in patients undergoing scleral fixed IOL implantation.

Corneal Biomechanical Properties of Various Types of Glaucoma and Their Impact on Measurement of Intraocular Pressure.

INTRODUCTION: Corneal biomechanical properties could affect intraocular pressure (IOP) measurement. The aim of this study was to evaluate the differences in corneal biomechanical properties of various types of glaucoma, assess their effect on IOP measurements. METHODS: This is an observational clinical study of 486 subjects including 102 normal subjects, 104 ocular hypertension (OHT), 89 normal tension glaucoma (NTG), and 191 high tension glaucoma (HTG). Corneal biomechanical parameters were measured using an ocular response analyzer. The main parameters assessed were corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated pressure measurement (IOPg), and corneal-compensated intraocular pressure (IOPcc). Ultrasound pachymetry was used to measure central corneal thickness (CCT). IOP was measured by a Goldmann applanation tonometer (GAT) and a noncontact tonometer (NCT). Visual field (VF) and refractive status were also recorded. Results were analyzed by one-way analysis of variance, univariate and multivariate linear regression analyses, and Bland-Altman plots. RESULTS: Multiple comparison by analysis of variance showed significantly lower CH and CRF in NTG compared to HTG, OHT, and normal subjects (CH: 0.011, 0.015, and 0.033; CRF: 0.001, <0.001, and 0.042, respectively). CRF and CH associated with IOP were measured using either GAT, NCT and IOPcc-GAT, IOPcc-NCT, yet CCT was not. GAT correlated strongly with IOPg (r = 0.79; p < 0.001) and IOPcc (r = 0.77; p < 0.001), but limits of agreement between the measurements were poor. CH and CRF were both negatively correlated with VF change (p < 0.01). CONCLUSION: CH and CRF affect the measurement of IOP and were related to types of glaucoma or severity of glaucoma. Pure CCT should not be used to correct IOP values or estimate the risk of disease.

Iridociliary Body Metastasis of Atypical Carcinoid: Case Management with Intravitreal Anti-Vascular Endothelial Growth Factor Injections.

We report a rare case involving a 52-year-old female diagnosed with an atypical bronchial carcinoid tumor with metastases to the mediastinum, hilar lymph nodes, breast, and pancreas. In additional, the patient had metastases to the iris and ciliary body, resulting in progressive vision loss in her left eye. Treatment was successful by intravitreal injections of anti-vascular endothelial growth factor.

Phacoemulsification, Intraocular Lens Implantation, Goniosynechialysis, and Pseudo-Pupilloplasty for Refractory Acute Primary Angle Closure with Atonic Dilated Pupil.

Objective To evaluate the efficacy and safety of prompt phacoemulsification, intraocular lens implantation, visco-goniosynechialysis, combined with pseudo-pupilloplasty for refractory acute primary angle closure (APAC) with atonic dilated pupil and to describe a feasible method of pupilloplasty. Methods A consecutive series of refractory APAC patients who had atonic dilated pupil and undergone prompt phacoemulsification combined with pseudo-pupilloplasty at our center were retrospectively analyzed. Pseudo-pupilloplasty referred to a method of pupilloplasty which included 4.5-mm capsulorhexis, postoperative opacification of anterior capsule residue, and ultimate pseudo-pupil formation. Preoperative and postoperative measurements included intraocular pressure (IOP), best corrected visual acuity (BCVA), and anterior chamber depth (ACD). Intraoperative and postoperative complications were documented. The process of pseudo-pupil formation was also observed. Results A total of 20 eyes of 19 APAC patients were followed up for 19.7 ± 9.8 months. IOP was lowered from preoperative 44.0 ± 9.8 mmHg to 15.5 ± 2.6 mmHg at final visit (t=11.945, P< 0.001). ACD was deepened from preoperative 1.77 ± 0.21 mm to 3.40 ± 0.20 mm at final visit (t=-27.711, P< 0.001). Twelve of 20 eyes had residual angle synechiae, whereas only 3 eyes needed anti-glaucoma medications. No severe complication was observed. All eyes had pseudo-pupil gradually formed within 3 months, accompanied with the gradual improvement of BCVA from preoperative 1.18 ± 0.55 to 0.58 ± 0.22, 0.26 ± 0.09, 0.11 ± 0.09, and 0.11 ± 0.09 at postoperative day 1, month 1, month 3, and last visit. Conclusions Prompt phacoemulsification-goniosynechialysis is effective and safe for refractory APAC with atonic dilated pupil. Pseudo-pupilloplasty is a feasible procedure for pupil reconstruction.

A Case of Refractory Childhood Glaucoma Secondary to Weill-Marchesani Syndrome: Management with Combined CO2 Laser-Assisted Sclerectomy Surgery and Trabeculectomy.

A 2-year-old girl was diagnosed as Weill-Marchesani syndrome with typical systemic features of short stature, short and stubby hands and feet, language disorders and mental retardation. He developed bilateral angle closure glaucoma, ectopia lentis and suffered visual loss from the ocular features of Weill-Marchesani syndrome. The child was successfully treated by combined CO2 laser-assisted sclerectomy surgery and trabeculectomy.

Ring lymphoma: highly indicative ultrasound biomicroscopy findings of ciliary body lymphoma.

BACKGROUND: To describe the ultrasound biomicroscopy (UBM) findings of extremely rare ciliary body lymphoma. METHODS: This was a retrospective noncomparative case series study. Five patients (8 affected eyes) diagnosed with ciliary body lymphoma at Peking Union Medical College Hospital from 2008 to 2019 were included. The UBM findings, including the location, height, and acoustic features, were documented to assess the tumour characteristics. RESULTS: UBM in all 8 (100%) affected eyes revealed 360° ring-like, solid infiltration of the ciliary body with low and homogeneous internal reflectivity. The continuity of the tumours could be most vividly demonstrated by transverse sections. CONCLUSIONS: Ciliary body lymphoma tends to grow in a characteristic circumferential 360° pattern, and the name "ring lymphoma of the ciliary body" is proposed.

Prediction of effective Lens position using anterior segment optical coherence tomography in Chinese subjects with angle closure.

PURPOSE: To assess the accuracy of biometric parameters measured by anterior segment optical coherence tomography (AS-OCT) and partial coherence interferometry (PCI) in prediction of effective lens position (ELP) compared with previous formulas in PACG patients. METHODS: 121 PACG eyes were randomly divided into training set (85 eyes) and validation set (36 eyes) with same procedure including AS-OCT, PCI, phacoemulsification and IOL implantation surgery. Preoperative anterior chamber depth (pre-ACD), scleral spur depth (SSD), scleral spur width (SSW), lens vault (LV) and cornea thickness (CT) were measured from AS-OCT image. Axial length (AL) and corneal power (K) were measured by PCI. All the 7 parameters were analyzed by multiple linear regression in training set and a statistic regression formula was developed. In validation set, one-way ANOVA was applied to compare the new regression formula with Sanders-Retzlaff-Kraff theoretic (SRK/T), Holladay 1, Haigis, and a regression formula developed in previous study. RESULTS: The coefficient of determination (R2) of different parameter combinations are 0.19 (pre-ACD, AL), 0.25 (AL, K) and 0.49 (SSD, AL, SSW) in training set. In validation set, the correlation between predicted and measured ELP are: new formula (R2 = 0.50, P = 0.9947) Holladay 1 (R2 = 0.12, P < 0.0001), SRK/T (R2 = 0.11, P < 0.0001) and Haigis (R2 = 0.06, P < 0.0001). CONCLUSION: Among 7 tested parameters, pre-ACD contribute little in ELP prediction. Formula consist of SSD, AL and SSW showed better accuracy than other formulas tested.

Optical Quality Assessed by Optical Quality Analysis System in Chinese Primary Open-Angle Glaucoma Patients and Its Correlations with Psychological Disturbances and Vision-Related Quality of Life.

PURPOSE: To investigate if optical quality assessed by Optical Quality Analysis System (OQAS) is a new factor for psychological disturbance and vision-related quality of life (QoL) in Chinese patients with primary open-angle glaucoma (POAG). METHODS: This is a cross-sectional study. OQAS, automated static perimetry, the Hospital Anxiety and Depression Scale (HADS) Questionnaire, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) were used to assess optical quality, visual field, psychological health, and QoL in 64 POAG patients. Correlation between the OQAS parameters and QoL or psychological health was analyzed by linear regression model. RESULTS: OQAS parameters, the modulation transfer function cutoff frequency (MTF cutoff) and the mean OQAS values (mean OV) were significantly related to mean deviation (MD). Statistically significant correlation was also found between MTF cutoff, the mean OV, and QoL in more than half of the NEI VFQ-25 subscale scores and the composite. The correlation coefficients between OQAS parameters and QoL were similar to those between MD and QoL in most of the subscale scores. HADS-Depression and HADS-Anxiety scores significantly correlated with MD in the worse eye, the composite and 3 subscales of NEI VFQ-25, general health, social function, and mental health, but were not correlated with optical quality parameters measured by OQAS. CONCLUSIONS: OQAS-assessed optical quality is negatively related to MD and is a valid indicator for vision-related QoL, but not for psychological health in our study group. OQAS might be an alternative or supplement to perimeter in POAG patients.

Optical Coherence Tomography Angiography of the Macula in Patients with Primary Angle-Closure Glaucoma.

BACKGROUND: The retinal microvasculature within the macula in glaucomatous eyes is not clear. OBJECTIVES: To detect macular vessel density (MVD) changes in primary angle-closure glaucoma (PACG). METHODS: Twenty-two PACG patients who had an episode of acute primary angle closure were included. Structural optical coherence tomography (OCT) scans were conducted to measure the thickness of the peripapillary retinal nerve fiber layer and macular ganglion cell complex (GCC). The MVD was measured with OCT angiography. RESULTS: A weakened macular microvascular network that had an expanded fovea avascular zone was observed in the case group. Compared with the control group, the case group had a lower MVD (p < 0.001). Single correlation analysis revealed a significant correlation of the MVD with best-corrected visual acuity (BCVA) (r = -0.65, p = 0.001), GCC (r = 0.50, p = 0.018), and the visual field mean deviation (r = -0.54, p = 0.009) in the case group. Moreover, in the mixed-effect models, the MVD was found to be positively correlated with GCC (p = 0.017) and negatively correlated with LogMar BCVA (p < 0.001). CONCLUSIONS: After an acute angle-closure attack, the macular microvascular network is attenuated, and the MVD decreases significantly.

[Application of Ultrasound Biomicroscopy in Longterm Follow-up Post Modified CO2 Laser-assisted Sclerectomy Surgery].

Objective To observe the role of ultrasound biomicroscopy(UBM)in two-year post-operative follow-up for primary open-angle glaucoma patients with modified CO2 laser-assisted sclerectomy surgery(CLASS).Methods This was a case series study.A combination of modified CLASS and preoperative laser iris management was administered to 28 eyes.Visual acuity,intraocular pressure(IOP),and slit-lamp examinations,visual field testing,and gonioscopy were carried out at baseline and until 24 months postoperatively.UBM examination was performed at 1,3,12 and 24 months postoperatively.Results Compared with the mean preoperative IOP [(30.61±10.59)mmHg],the IOP at each time point after operation was significantly lowered [(15.15±5.87),(12.56±3.24),(13.15±2.73),(13.75±2.55)and(13.75±2.46)mmHg at 1,3,6,12 and 24 months,respectively;all P<0.001].Complete success rates and qualified success rates at 12 months and 24 months were 60.71%,89.29% and 53.57%,85.71%,respectively.UBM images can present "dolphin head sign" after successful CLASS.The thickness of trabeculo-Descemet's window was(0.13±0.03)mm,which had no significant correlation with postoperative IOP at 12(r=-0.278,P=0.144)and 24 months(r=0.026,P=0.895).UBM examination revealed a severe scleral lake diminution(a change > 50%)in 1 eye(3.57%)at 12 months and 3 eyes(10.71%)at 24 months.There was no statistical significance detected between the size of the scleral lake and IOP after CLASS.Non-founctional blebs were found in 16 eyes(57.14%)at 12 months and 25 eyes(89.28%)at 24 months.Two eyes(7.14%)demonstrated severe peripheral anterior synechiae at 24 months,requiring surgical intervention.Conclusions UBM can effectively observe the morphology of the scleral lake,anterior chamber angle and filtering blebs in post-operative follow-up after modified CLASS,and give early warning of complications.It plays an important role in ensuring the success of CLASS.

Iris lens distance to predict the risk of intraocular pressure elevation after dark room provocative test.

PURPOSE: To investigate if a new ultrasound biomicroscopy (UBM) parameter, iris lens distance (ILD), and its model could predict clinically significant intraocular pressure (IOP) elevation after darkroom provocative test (DRPT). METHODS: Cases with a peripheral anterior chamber depth less than one-fourth corneal thickness were enrolled. All subjects underwent UBM examination and DRPT if possible. Anterior chamber depth (ACD) and ILD were measured in the central axis at different positions in dark (ACDD, ILDD) and bright (ACDB, ILDB). An IOP elevation over 5 mmHg and 8 mmHg was set as cutoffs for a positive DRPT result (positive-5 and positive-8). SAS 9.3 statistical software was used to manage and analyze data and calculate the linear probability model (LPM). Another 17 patients (34 eyes) were included to validate the model. RESULTS: Two hundred and ten (210) UBM images qualified for analysis. ILD was significantly less in the dark than in the bright and in patients with a positive DRPT result (p < 0.001). The LPM for positive-5 and positive-8 were P = 1.14 + (- 0.49*ILDD) + (- 0.41*ACDD) (n = 210, R2 = 0.1079, AUC = 0.715), and P = 0.87 + (- 0.44*ILDD) + (- 0.35*ACDD) (n = 210, R2 = 0.1358, AUC = 0.807), respectively. CONCLUSIONS: LPMs based on ILD could predict the risk of an IOP elevation over 5 mmHg or 8 mmHg. The LPM for positive-8 reached a good level of diagnostic accuracy.

IOP measurement in silicone oil tamponade eyes by Corvis ST tonometer, Goldmann applanation tonometry and non-contact tonometry.

PURPOSE: To compare the postoperative intraocular pressure (IOP) of eyes following pars plana vitrectomy (PPV) combined with intravitreal silicone oil (SO) tamponade by Corneal Visualization Scheimpflug Technology (CST), Goldmann applanation tonometry (GAT) and non-contact tonometry (NCT). METHODS: Thirty-eight participants who had undergone PPV combined with SO tamponade to treat vitreoretinal diseases were enrolled. Postoperative IOP measurements were obtained using CST, NCT and GAT. Inter-device agreement was assessed by Bland-Altman analysis. The correlation coefficient was used to describe the potential postoperative factors affecting the postoperative IOP differences between each device. RESULTS: Bland-Altman analysis revealed the bias between CST and GAT, between CST and NCT, and between GAT and NCT to be -0.2, 2.1 and 2.4 mmHg, respectively. CST and GAT correlated well with each other. NCT values were lower than those of GAT and CST (all p < 0.05), whereas CST values did not differ from the GAT readings. Central corneal thickness, corneal biomechanical properties and age showed significant correlation with the differences of CST-NCT and GAT-NCT. CONCLUSIONS: In SO tamponade eyes, NCT obtains lower IOP than other tonometry techniques, and CST is highly consistent with GAT. CST offers an optional non-contact method for measuring postoperative IOP in SO tamponade eyes.

Bilateral Choroidal Occlusion in Antiphospholipid Syndrome Associated with Systemic Lupus Erythematosus.

This article reports a rare case of bilateral choroidal occlusion that occurred in a 24-year-old woman with antiphospholipid syndrome (APS) associated with systemic lupus erythematosus (SLE). This young lady concurred with aorta ventralis thrombosis and bilateral iliac artery occlusion when presented, and experienced a rapid deterioration of vision. She also has a history of recurrent miscarriage. Corticosteroid, immunosuppression and anticoagulation therapy were administered. Patients with APS associated with SLE are at risk for thrombotic phenomena, which may affect the ocular vessels of all sizes, including choroidal vessel. Our case alerts ophthalmologists and rheumatologists that bilateral choroidal occlusion may indeed be developed in patients with APS associated with SLE, and is a potential cause of visual morbidity.

Comparison of Long-Term Effects Following Phacoemulsification Combined with Goniosynechialysis and Trabeculectomy in Patients with Primary Angle-Closure Glaucoma and Cataract.

INTRODUCTION: Goniosynechialysis (Phaco-GSL) is a logical therapeutic approach for patients with primary angle-closure glaucoma (PACG) and cataract. The aim of this study was to compare the long-term effectiveness and safety of Phaco-GSL and trabeculectomy (TRB) in the management of PACG with coexisting cataract. METHODS: A review was conducted on 96 Chinese patients (96 eyes) with PACG and cataract from Peking Union Medical College Hospital (PUMCH). Among them, 56 patients underwent Phaco-GSL, while 40 underwent TRB. Intraocular pressure (IOP), best corrected visual acuity (BCVA), use of supplemental antiglaucoma medical therapy, surgery success rates, and complications for both procedures were assessed. RESULTS: The average follow-up period was 50.3 ± 18.7 months in the Phaco-GSL group and 61.2 ± 15.1 months in the TRB group. At the final follow-up, IOP decreased from 27.0 ± 11.1 mmHg to 13.5 ± 2.1 mmHg in the Phaco-GSL group and in the TRB group IOP decreased from 27.1 ± 7.7 mmHg to 16.5 ± 5.5 mmHg. The long-term postoperative IOP in the Phaco-GSL group was significantly lower than that in the TRB group. There was a statistically significant reduction in medication usage in both groups, with the TRB group having a higher number of postoperative medications at the final follow-up. The incidence of postoperative complications was significantly higher in the TRB group compared to the Phaco-GSL group. CONCLUSIONS: Phaco-GSL is the recommended surgical approach for Chinese patients with primary angle-closure glaucoma (PACG) and cataract. Compared to traditional TRB, eyes undergoing Phaco-GSL show a reduced requirement for antiglaucomatous medications, improved management of IOP, decreased risk of complications, and higher long-term cumulative probability of treatment success for patients with PACG.

[Peripapillary choroidal thickness in primary open angle glaucoma and normal subjects measured by enhanced depth imaging optical coherence tomography].

OBJECTIVE: To compare peripapillary choroidal thickness (CT) between primary open angle glaucoma (POAG) and normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS: This research was a cross-sectional study. A 360-degree 3.4 mm diameter peripapillary circle scan was performed for retinal nerve fiber layer (RNFL) assessment by EDI-OCT in one eye of 40 POAG patients and 41 age- and sex-matched normal subjects. The observer used the manual segmentation function to delineate the posterior edge of the retinal pigment epithelium and the sclerochoroidal interface. The RNFL thickness algorithm function was used to automatically generate the CT in corresponding sectors. The intra- and inter-observer reproducibility was evaluated by intraclass correlation coefficient (ICC). Repeated measures ANOVA and LSD-t test were used to analyze differences in CT by peripapillary location. A Pearson correlation was calculated for variation in CT relative to age and RNFL. Spearman rank correlation was calculated to test the strength of the relationship between global mean RNFL and visual field mean deviation (MD) and between CT and MD. Independent-samples t-test was conducted to compare mean RNFL and CT between POAG and normal subjects. RESULTS: The intra- and interobserver ICC values ranged from 0.993 to 0.999 and 0.993 to 0.998 respectively. In both groups, the CT showed a negative correlation with age at each peripapillary location (r = -0.509 to -0.608, -0.549 to -0.668; P = 0.000 to 0.001) but no significant correlation with RNFL for any location (r = -0.186 to 0.273, -0.090 to 0.132; P = 0.092 to 0.869). The peripapillary CT was thickest superotemporally and superonasal, then nasally and temporally, and was thinnest inferotemporally and inferonasal (P = 0.000 to 0.036). Compared to normal subjects, eyes with POAG had significantly thinner RNFL at all locations (t = 6.975 to 16.087, P = 0.000), but CT measurements did not differ between groups for any location (t = -0.474 to 0.367, P = 0.637 to 0.978). In POAG patients, the global mean RNFL (rs = -0.511, P = 0.001) but not CT (rs = -0.285, P = 0.079) was found to significantly correlate with visual field MD. CONCLUSIONS: The peripapillary CT in POAG neither differ from that in normal subjects nor correlate with RNFL and visual field index, which does not support using it as a clinical parameter in glaucoma diagnosis or management.

[Expression of Nogo-A, NgR mRNA and protein in the retina of rats with chronic elevated intraocular pressure].

OBJECTIVE: To investigate the expression of Nogo-A and its receptor NgR mRNA and protein in the retina of rats with chronic elevated intraocular pressure (IOP). METHODS: Experimental study. Rat chronic ocular hypertension (OHT) was induced by obstructing episcleral veins and temporal limber veins. The retinal tissues were collected at day 3, 7, 14 and 28 after the IOP elevated in rats. Each group includes 16 rats and one group served as normal control. Expression of Nogo-A and NgR mRNA was detected by reverse transcription polymerase chain reaction (RT-PCR), while the protein levels of Nogo-A and NgR were expressed by the western blot in rat retinal tissues in different groups. Expression of Nogo-A, NgR mRNA and protein were analysed by one way analysis of variance (ANOV) and multiple comparison ANOV. RESULTS: IOP in rat OHT group was significantly increased after day 3 lasting for 28 day. Compared with control group, the level of Nogo-A mRNA and protein in rat chronic OHT groups were significantly (mRNA: F = 7.464, protein: F = 5.677; P < 0.01) increased at day 7, 14, and 28 (mRNA: 0.661 ± 0.065 vs 0.831 ± 0.055, 0.813 ± 0.063, 0.844 ± 0.077, protein: 1.284 ± 0.043 vs 1.359 ± 0.033, 1.381 ± 0.063, 1.361 ± 0.044), respectively. There is a tendency of increase of Nogo-A mRNA expression at day 3 but did not reach statistical significance. However, the level of NgR in the retina in rats with the chronic OHT was not significantly (mRNA:F = 0.598, protein:F = 0.460; P > 0.01) changed compared with normal group. CONCLUSION: The increased expression of Nogo-A in retina of rat OHT indicates that Nogo-A may play a primary role in obstructing regeneration of optic nerve, which is mediated by other receptors and elements rather than NgR.

[Analysis of fundus fluorescein angiography, indocyanine green angiography and choroidal thickness in central serous chorioretinopathy].

OBJECTIVE: To evaluate the characteristics of choroidal thickness changes and abnormalities in choroidal circulation in cases of central serous chorioretinopathy (CSC). METHODS: This was a case control study, we measured the bilateral choroidal thickness in 21 patients with unilateral CSC and 24 eyes of 24 age- and sex-matched normal subjects using enhanced depth imaging optical coherence tomography (EDI-OCT). The choroid was measured from the posterior edge of the retinal pigment epithelium (RPE) to the choroid-scleral junction at 500 µm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Paired-samples t-test was conducted to compare mean choroidal thicknesses between symptomatic eyes and fellow eyes of patients. The datum between patients and normal subjects were analyzed by independent-samples t-test. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) were performed and the digital images were analyzed in CSC patients. RESULTS: The 21 CSC patients had a mean age of 45.6 years, and 12 patients (57.1%) were male. The choroid in symptomatic eyes was thickest beneath the fovea (519.0 ± 102.5) µm. It was significantly thicker than that in the fellow eyes (439.3 ± 94.1) µm (t = 4.171, P < 0.05). Choroidal thickness in both groups was significantly greater than that in the eyes of age- and sex-matched normal subjects (332.0 ± 67.3) µm (t = 7.125, 4.441; P < 0.05). Choroidal thickness at each of the other 12 points showed a similar tendency (t = 2.544 to 3.819, 4.799 to 7.816, 2.487 to 5.236; P < 0.05). ICGA showed a choroidal filling delay (100%), vessels dilation (90.5%), and focal choroidal hyperfluorescence (100%) surrounding leakage from the RPE in symptomatic eyes. Pigment epithelium detachment with abnormal choroidal circulation was observed in 6 fellow eyes. In 4 symptomatic eyes and 11 fellow eyes, ICGA revealed choroidal hyperfluorescence but FFA showed normal appearance. CONCLUSIONS: CSC seems to be a bilateral eye disease with choroidal focal ischemia followed by vessels congestion and hyperpermeability. EDI OCT is a useful tool for monitoring choroidal thickness changes caused by choroidal vascular hyperpermeability.

Comparison of Long-Term Effects After Modified CO2 Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

INTRODUCTION: To compare the long-term effect after modified CO2 laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study. METHODS: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively. RESULTS: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group. CONCLUSIONS: MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

Factors related to prognosis of refractory glaucoma with diode laser transscleral cyclophotocoagulation treatment.

OBJECTIVE: To evaluate the predictive factors of refractory glaucoma treated with diode laser transscleral cyclophotocoagulation (TSCP) in a midterm observation. METHODS: Fifty-four consecutive patients (54 eyes) with refractory glaucoma were enrolled and underwent TSCP (power of 1.5-2.0 W, exposure time of 2 seconds and 20-50 applications). Patients were regularly followed up for 12 months. Intraocular pressure (IOP) was measured before TSCP treatment and at each follow-up visit. Patients were divided into the sensitive and insensitive groups according to the effect of a single treatment of TSCP on IOP. The success rate was defined as the percentage of eyes achieving an IOP between 5 and 21 mm Hg following TSCP therapy at their final follow up visit. Difference of age between the sensitive and insensitive groups was evaluated with independent-samples T test and that of gender distribution of two groups was evaluated with Fisher's exact test. The success rate of different types of glaucoma to TSCP was calculated. RESULTS: A total of 32 patients were sensitive to TSCP (sensitive group) and 22 patients were insensitive to TSCP (insensitive group). The success rates of female (77.8%, 14/18) and cases being over 50 years (71.4%, 20/28) were higher than those of male (50.0%, 18/36) and ones being under 50 years (46.2%, 12/26) (all P>0.05). The age of the sensitive and insensitive groups was 56.0+/-15.5 and 46.4+/-15.4 years, respectively (P=0.029). The age (P=0.029) and gender distribution (P=0.046) of the two groups had significant difference. The success rate of neovascular glaucoma, primary angle-closure glaucoma, primary open angle glaucoma, traumatic glaucoma, uveitic glaucoma, and secondary glaucoma after silicone oil injection to TSCP was 57.1%, 100.0%, 50.0%, 20.0%, 81.8%, and 0%, respectively. CONCLUSION: Age, gender, and type of glaucoma appear to be associated with effect of TSCP on IOP control.

[Novel exploration of emergency treatment for ueitic acute angle closure glacuma].

OBJECTIVE: To explore the effects of anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope for the emergency treatment of uveitic acute angle closure glaucoma (ACG). METHODS: In early stage, 14 uveitc acute ACG patients received anterior chamber paracentesis plus pupillary block relief while another 10 uveitc acute ACG patients underwent laser peripheral iridectomy (LPI). The intraocular pressure (IOP), degree of Tyndall, degree of pupillary block and severe adverse events were recorded at each observation timepoint. RESULTS: The IOP values for the paracentesis plus pupillary block relief group were (9.2 ± 2.1) mm Hg, (12.4 ± 3.7) mm Hg and (14.1 ± 2.6) mm Hg at 1, 48 h and 10 d vs (24.5 ± 7.1) mm Hg, (22.2 ± 8.6) mm Hg and (19.3 ± 9.3) mm Hg respectively for the LPI group. The inflammatory reaction of anterior chamber was more relieved in the paracentesis plus pupillary block relief group at Day 10. Pupillary block was observed in 1(1/14) patient from the paracentesis plus pupillary block relief group and 6 (6/10) patients from the LPI group at Day 10. Mild hemorrhage at pupillary margin was observed in 2 cases from the paracentesis plus pupillary block relief group. Both were self-absorbed within 10 days. CONCLUSION: Anterior chamber paracentesis plus pupillary block relief under slit-lamp microscope is the safe and effective emergency treatment for uveitic acute ACG. And it may offer a basis for further therapy.