ObjectiveTo evaluate the efficacy and safety of phacoemulsification cataract extraction combined with 180° trabeculotomy assisted by gonioscopy (GT) and combined glaucoma filtration surgery (GFS) in the treatment of primary open angle glaucoma (POAG) with cataract. MethodsThe patients with POAG and cataract in the ophthalmology center of the People’s Hospital of Leshan from June 2021 to March 2022 were included. The patients were divided into GT group and GFS group according to surgical methods. Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR, number of anti-glaucoma drugs used, success rate, and complications were compared between the two groups after 1-year followed-up. ResultsA total of 27 patients (43 eyes) in the GT group and 26 patients (34 eyes) in the GFS group were included. There was no significant difference in baseline between the two groups (P>0.05). BCVA logMAR in the GT group was lower than that in the GFS group at 1 year after surgery, the difference was statistically significant (P<0.01). The postoperative IOP in GT group was lower than that in GFS group, the difference was statistically significant (P<0.05). The difference in total effective rate, the number of anti-glaucoma drugs and the incidence of complications between the two groups were not statistically significant (P>0.05). ConclusionPhacoemulsification cataract extraction combined with GT is safe and effective in the treatment of POAG with cataract and has a good effect on reducing IOP.
Objective To evaluate the efficacy and safety of latanoprost versus travoprost for primary open-angle glaucoma (OAG) and ocular hypertension (OH). Methods All the randomized controlled trials (RCTs) about treating primary open-angle glaucoma and ocular hypertension with latanoprost and travoprost were collected by searching MEDLINE, EMbase, OVID and CNKI. The assessment of methodological quality and data extraction of the included studies were performed independently by two reviewers, and the meta-analysis was conducted with RevMan 5.0 software. Results A total of 13 RCTs involving 1 433 patients were included. The results of meta-analyses showed that, a) At the second week, travoprost showed greater intraocular pressure (IOP) lowering efficacy compared with latanoprost (WMD= –1.47, 95%CI –2.62 to –0.33). At the first month (WMD= –0.50, 95%CI –1.52 to 0.52) and the sixth month (WMD= –0.12, 95%CI –0.85 to 0.61), the difference of IOP reduction between latanoprost and travoprost group was not significant; and b) The latanoprost-treated group showed fewer reported conjunctival congestion than the travoprost-treated group (OR=0.47, 95%CI 0.35 to 0.63). The difference in adverse events of eye pain (OR=0.55, 95%CI 0.27 to 1.12) and iris or skin depigmentation (OR=1.25, 95%CI 0.53 to 2.92) between latanoprost and travoprost group was not significant. Conclusion Latanoprost and travoprost are comparable in lowering IOP for OAG and OH patients. Latanoprost shows greater ocular tolerability with lower incidence of side effects as conjunctival congestion. This conclusion is not powerful enough in proof due to the medium methodology quality of the included studies, so a large number of high-quality RCTs with large sample are needed for objectively, entirely and precisely evaluating the efficacy.
Objective Methods of evidence-based medicine were used to make an individualized treatment plan concerning newly diagnosed open-angle glaucoma patient. Methods After clinical problems were put forward, evidence was collected from Cochrane Library (Issue 4, 2009), PubMed (1990 -2009), MEDLINE (1990-2009), EMbase (1990-2009), CBM (1990-2009), and CNKI (1990-2009) according to the search strategy. Subject words were open-angle glaucoma, timolol, latanoprost, trabeculectomy, intraocular pressure, randomized controlled trials, human, meta-analysis, systematic review. Results A total of 221 randomized controlled trials, and 19 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusion The treatment efficacy in newly diagnosed open-angle glaucoma has been improved by determining an individualized treatment plan according to evidence-based methods.
At present, there are few in vivo experimental studies on anterior chamber flow field, and the relevant technologies are not mature. This study explores the experimental method and key techniques of particle image velocimetry (PIV) for the in vivo measurement of anterior chamber flow field with slow flow velocity in the rabbit with acute intraocular hypertension. The experimental process can be divided into three parts: model construction of rabbit eye with acute intraocular hypertension, in vivo eyeball preparation, and PIV setup. The following key techniques were mainly investigated: the optimal injection strategy of fluorescent particles and the correction strategy for image acquisition errors caused by the effects of image refraction and respiration. The results showed that the best injection method was that 15 μL of fluorescent particles solution was slowly injected into the anterior chamber through the lower part of iris and then the rabbit was released and waited for 13 h. In this way particles were completely distributed in the anterior chamber with the help of the aqueous humor circulation, and then in vivo PIV experiment could be performed. The eyeball should be covered with a square flume filled with ultrasonic coupling gel for the sake of imaging during the experiment. The Maximal Information Coefficient algorithm could be applied to correct the measured results before post-processing calculation. The results indicated that feasible injection strategy of fluorescent particles and the correction strategy for image acquisition are critical to obtain nice experiment effects for the in vivo PIV measurement of anterior chamber flow field in the rabbit with acute intraocular hypertension.
Objectives To assess the clinical effectiveness of non-penetrating trabecular surgery versus trabeculectomy for open angle glaucoma. Methods We searched the Cochrane Central Register of Controlled Trials (issue 2, 2007), MEDLINE (1966 to May 2008), EMbase (1980 to May 2008), and CMB-disk (1979 to May 2008). We also hand searched relevant journals and conference proceedings. Data were extracted by two reviewers independently using an extraction form. The Cochrane Collaboration’s RevMan 5.0 software was used for statistical analysis. Results Three RCTs involving 127 participants (144 eyes) with previously untreated open angle glaucoma were included. Meta-analysis showed that compared with non-penetrating trabecular surgery, trabeculectomy increased the proportion of patients with reduced postoperative intraocular pressure (WMD2.78, 95%CI 1.41 to 4.15), improved the operation success rate (RR 0.53, 95%CI 0.37 to 0.77), and reduced the use of postoperative antiglaucoma medication (WMD 0.96, 95%CI 0.84 to 1.08). Non-penetrating trabecular surgery reduced the incidence of postoperative complications (RR 17.00, 95%CI 8.36 to 26.00). Conclusion Since the sample sizes of the included trials are relatively small, and the two procedures are also related to progressive visual field loss and optic disk damage, more well-designed large-scale RCTs are required.
Objective To explore the current situation and influencing factors of self-management behavior in patients with primary glaucoma, so as to provide a theoretical basis for formulating intervention strategies to improve patients’ self-management ability. Methods Using convenient sampling method, 400 patients with primary glaucoma visiting the Outpatient Department of Ophthalmology, West China Hospital of Sichuan University between September 2019 and March 2020 were selected. Their current situation of self-management behavior was investigated by self-management behavior questionnaire, and the influencing factors of self-management behavior were analyzed. Results A total of 381 valid questionnaires were recovered. The total score of self-management behavior of patients with primary glaucoma was 51.11±6.22, and the mean scores of life debugging dimension, functional health care dimension, and medical management dimension were 2.66±0.67, 3.02±0.81, and 3.13±0.60, respectively. The results of multiple linear regression analysis showed that age [40-59 vs. <40 years old: unstandardized partial regression coefficient (b)=–2.830, 95% confidence interval (CI) (–4.813, –0.847), P=0.005; ≥60 vs. <40 years old: b=–2.660, 95%CI (–4.820, –0.498), P=0.016], occupation [in-service vs. farmers: b=2.639, 95%CI (0.303, 4.976), P=0.027; unemployed or retired vs. farmers: b=2.913, 95%CI (0.995, 4.831), P=0.003], smoking [smoking vs. non-smoking: b=–3.135, 95%CI (–5.196, –1.075), P=0.003], disease type [primary open-angle glaucoma vs. primary angle-closure glaucoma: b=–2.119, 95%CI (–3.317, –0.921), P=0.001], number of follow-up visits [≤2 vs. >2: b=–1.071, 95%CI (–2.118, –0.024), P=0.045], whether fixed doctor follow-up [unfixed vs. fixed: b=–2.619, 95%CI (–3.632, –1.605), P<0.001] were correlated with the total score of self-management behavior of patients with primary glaucoma. Conclusions The self-management behavior of patients with primary glaucoma is in the middle level. The main factors affecting the self-management behavior level of primary glaucoma patients include age, occupation, smoking, disease type, follow-up times, and fixed doctor’s follow-up. Ophthalmologists should pay attention to the current situation and influencing factors of self-management behavior and take feasible intervention measures to improve the self-management behavior of patients with primary glaucoma.
Objective To identify genes associated with juvenile open-angle glaucoma (JOAG) by screening for gene mutation loci and clinical phenotype analysis in a JOAG family. Methods In January 2021, an ophthalmic examination was performed on members of a family with JOAG. Whole-exome sequencing was done on the proband to look for pathogenic genes. Family members were validated using Sanger sequencing, and a long-term follow-up was conducted. Results Three generations of the family comprised eight individuals, including three patients with JOAG. All patients carried a missense mutation in the MYOC gene c.1130C>G (p.Thr377Arg), which showed autosomal dominant inheritance. Other unaffected family members were not found to have the mutation. Conclusion The c.1130C>G (p.Thr377Arg) mutation in the MYOC gene may be responsible for the pathogenesis of this JOAG family.
Neovascular glaucoma (NVG) is a refractory glaucoma secondary to retinal ischemic disease. The ischemic retina produces vascular endothelial growth factor (VEGF) and other cytokines, leading to the formation of neovascularization in the iris and the angle. The neovascularization membrane blocks the angle or pulls and closes the angle, resulting in a sharp increase in intraocular pressure. The combination of anti VEGF drugs, panretinal photocoagulation and surgery to lower intraocular pressure can control the intraocular pressure of some patients and even retain some visual function. However, the treatment of NVG is still challenging and requires long-term follow-up. At present, there is no high-level evidence to guide NVG treatment. To carry out randomized controlled clinical trials comparing different treatment options may provide evidence for guiding the treatment of NVG.
There are so many biomechanical risk factors related with glaucoma and their relationship is much complex. This paper reviewed the state-of-the-art research works on glaucoma related mechanical effects. With regards to the development perspectives of studies on glaucoma biomechanics, a completely novel biomechanical evaluation factor -- Fractional Flow Reserve (FPR) for glaucoma was proposed, and developing clinical application oriented glaucoma risk assessment algorithm and application system by using the new techniques such as artificial intelligence and machine learning were suggested.
ObjectiveTo investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma. MethodsA retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed. ResultsAmong the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred. ConclusionsThe main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.