ГЛИКОЗАМИНОГЛИКАНОВЫЙ МАТРИКС В ПРОФИЛАКТИКЕ КОНЪЮНКТИВАЛЬНО-СКЛЕРАЛЬНОГО РУБЦЕВАНИЯ ПРИ СИНУСТРАБЕКУЛЭКТОМИИ

To compare the accuracy of IOPen rebound tonometer with Goldmann applanation tonometer (GAT) in individuals with low, normal and high intraocular pressure (IOP) and to evaluate the effect of central corneal thickness (CCT) on IOP measurements. This cross-sectional study consisted of 159 participants. IOP of one eye of each subject was measured consecutively with IOPen and GAT. Then CCT was measured using an ultrasonic pachymeter. Based on GAT IOP readings, participants were divided into low, normal and high IOP groups. Correlation between tonometers and CCT was calculated by spearman's correlation coefficient. Agreement between tonometers was evaluated using Bland-Altman method. Non-significant underestimation of IOP by IOPen was observed in low IOP group (Mean difference: 0.20mmHg; P=0.454) and also in normal IOP group (Mean difference: 0.56mmHg; P=0.065). However, IOPen significantly overestimated IOP in high IOP group (Mean difference: 1.06mmHg; P=0.038). The 95% limits of agreement (LoA) width between IOPen and GAT IOPs were 7.84, 8.57 and 14.27mmHg in low, normal and high IOP groups, respectively. Low IOP group had thinner corneas compared to high IOP group (P=0.034). IOP measurements taken by IOPen were not influenced by CCT (P=0.099) while poor correlation between CCT and GAT was found (R=0.17, P=0.032). Using receiver operating characteristic (ROC) curve, cutoff value of 18.75mmHg was determined for IOPen with sensitivity of 98.1 and specificity of 97.2%. Accuracy of IOPen is comparable to GAT in patients with low or normal IOP but IOPen overestimates IOP at high IOP levels. CCT does not affect IOP readings with IOPen.

Objective To investigate the change of optic axial length after glaucoma surgery so as to provide reference for the accurate measurement of the intraocular lens in intraocular hypertension state.Methods The changes of intraocular pressure and optic axial length after glaucoma surgery in 19 patients were analysed.Results In 19 patients with glaucoma treated with glaucoma surgery,postoperative average intraocular pressure ( 15.20 ± 2.66mmHg),comparing with the average intraocular pressure (60.27 ± 10.60 mmHg) before surgery,there was significant difference (t =19.15,P =0.000),and the postoperative average optic axial length (21.86 ± 0.80) mm,comparing with the average optic axial length (22.28 ±0.81 mm) before surgery,there was significant difference ( t =49.19,P =0.000).The average intraocular pressure difference was (45.07 ± 10.26) mmHg and average optic axial length difference was (0.42 ± 0.04) mm before and after surgery.Conclusion High intraocular pressure can cause the increase in opticaxial length.For patients suffered from secondary glaucoma due to intumescent cataract whose preoperative intraocular pressure is uncontrollable,intraocular pressure factors should be taken into account when measuring optic axial length,in order to avoid the refractive accident of intraocular lens after operation. Key words: Intraocular pressure ; Glaucoma ; Surgery ; Optic axial length

To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3years were included. Patients with a preoperative IOP of ≦ 16mmHg and > 16mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ≦15mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3years (p = 0.0008). Success rates compared using the Kaplan-Meier survival curve were not significantly different (p = 0.449). EXP surgery was useful for POAG patients with a low preoperative IOP.

To describe a case of retinal pigment epithelial tears (RPE tears) and serous retinal detachment (SRD) after Ex-PRESS filtration surgery for primary open-angle glaucoma (POAG) combined with ischemic optic neuropathy. Case Presentation. This case report involved a 69-year-old woman who underwent Ex-PRESS filtration surgery for right POAG. She had a history of systemic arteriosclerotic disease and subacute progressive visual field loss due to suspected ischemic optic neuropathy in her right eye. The right preoperative visual acuity was 0.7, and intraocular pressure (IOP) was 19 mmHg with maximum glaucoma eye drops. RPE detachment was not observed in the fundus. On day 9 after surgery, the IOP was 6 mmHg, and mild choroidal detachment was observed. On day 13, although IOP remained almost unchanged at 7 mmHg, bullous SRD was observed in the inferior retina, including the macula, and RPE tears were observed along the superior arcade vessel. While subretinal fluid gradually decreased with increasing IOP, tractional retinal folds persisted along the superior arcade, accompanied by macular degeneration. We experienced a case of RPE tears after Ex-PRESS filtration surgery. In addition to choroidal detachment in the setting of hypotony, a pathologic condition causing structural fragility of the RPE layer may contribute to the development of RPE tears.

To assess good prognostic factors of Trabectome surgery in primary open-angle glaucoma (POAG), clinical records of patients with POAG who underwent Trabectome surgery with/without cataract surgery as the first additive therapy to eye drops between January 2015 and March 2018 were retrospectively reviewed. Overall, data of 79 eyes (79 patients; 50 men; mean age, 68.0 years) up to postoperative 24 months were analyzed. Their mean intraocular pressure (IOP) was 20.4 ± 6.0 mmHg at baseline. Forty-two eyes (53.2%) achieved an IOP < 15 mmHg and ≥ 20% reduction from baseline without additional treatments. Phakic eyes had a better survival probability than pseudophakic eyes after adjusting for age, sex, baseline IOP, best-corrected visual acuity, and eye drop score (hazard ratio 3.096; 95% confidence interval [95% CI] 1.367–7.013; P = 0.007). Phakic eyes treated with combined Trabectome and cataract surgeries (mean survival time, 22.250 months; 95% CI 17.606–26.894) had a better survival probability than pseudophakic eyes treated with Trabectome surgery only (mean survival time, 12.111 months; 95% CI 8.716–15.506; P = 0.009) after the adjustment. Among the eyes treated with Trabectome surgery only, phakic eyes required significantly less additional treatments than pseudophakic eyes (P = 0.04). Trabectome surgery may be indicated for phakic eyes with POAG in addition to eye-drop therapy.

To evaluate a new canal expander in circumferential viscocanalostomy (canaloplasty) for whites with primary open-angle glaucoma (POAG). Prospective, single-center, noncomparative study. Twenty-two eyes of 22 consecutive patients with medically uncontrolled POAG underwent primary viscocanalostomy and implantation of the Stegmann Canal Expander into Schlemm canal with a follow-up time of at least 1 year. Schlemm canal was unroofed ab externo, and dilated with viscoelastic material and microcatheter. The Stegmann Canal Expander is a flexible, fenestrated hollow implant of 9 mm in length. One expander was implanted into either side of the surgically created of ostium to keep the Schlemm canal permanently open. The superficial scleral flap was closed watertight. Laser goniopuncture of the trabeculo-Descemet membrane window was performed if postoperative intraocular pressure (IOP) exceeded 16 mm Hg. Complete successes were defined as a confirmed IOP≤21, ≤18, and ≤16 mm Hg without medications, respectively, combined with a 30% IOP reduction. Number of antiglaucomatous medications, best-corrected visual acuity, and intraoperative and postoperative complications were recorded. The mean IOP dropped from 27.1±5.3 mm Hg preoperatively to 13.6±1.6 mm Hg at 6 months, 13.0±1.5 mm Hg at 9 months, and 13.1±2.2 mm Hg at 12 months (P<0.001). The complete success rates for an IOP≤21, ≤18, and ≤16 mm Hg combined with a 30% IOP reduction were 91% [95% confidence interval (CI), 0.80-1.0], 91% (95% CI, 0.80-1.0), and 91.0% (95% CI, 0.80-1.0) at 6 months, and 86% (95% CI, 0.73-1.0), 82% (95% CI, 0.67-1.0), and 82.0% (95% CI, 0.67-1.0) at 12 months. The success rate of an IOP≤16 mm Hg without medications did not depend on age [hazard ratios (HR) 1.02; 95% CI, 0.85-1.12; P=0.74], preoperative IOP (HR 0.97; 95% CI, 0.83-1.23; P=0.89), and mean visual defect (HR 1.05; 95% CI, 0.72-1.27; P=0.76). Laser goniopuncture was performed on 2 eyes (9%) 4.1 months postoperatively; the mean IOP was 19.5 mm Hg before and 13.6 mm Hg after goniopuncture. The number of medications dropped from 2.9±0.6 before surgery to 0.05±0.2 after surgery (P<0.001). The postoperative best-corrected visual acuity at last visit (0.12±0.09; range, 0 to 0.39) was comparable to preoperative values (mean±SD, 0.16±0.10; range, 0 to 0.39) (P=0.35). Minor intraoperative or postoperative complications included microhyphema (8 eyes) and transient elevated IOP (steroid responder; 2 eyes). Implantation of the Stegmann Canal Expander in canaloplasty lowered IOP significantly in POAG without complications related to the device in this 1-year observation period.

Central corneal thickness in children—does it help or hinder our evaluation of eyes at risk for glaucoma?

Objective To evaluate the efficiency and safety of micropulse laser trabeculoplasty (MLT) for open angle glaucoma (OAG) patients and ocular hypertension (OHT) patients. Methods A prospective self-controlled study was designed.Fifty-six eyes of 56 OAG and OHT patients in Peking University Third Hospital were recruited from June 2016 to June 2017, including 32 males and 24 females with the age of (50.4±19.0) years old.The diagnosis included 48 eyes of primary open angle glaucoma (POAG), 3 eyes of normal tension glaucoma and 5 eyes of OHT.The best corrected vision acuity (BCVA) was 0.7±0.3 before treatment.The intraocular pressure (IOP) before MLT was (20.4±5.8) mmHg, the average types of antiglaucoma medications was 1.7, including systemic medication and local drug use.The general information, BCVA, IOP and antiglaucoma medication were recorded.Only one eye of each patient was treated by MLT.The IOP at different follow-up time points (2 hours, 1 day, 1 week, 1 month, 3 months post-treatment) and the number of antiglaucoma medication before and after treatment were compared.This study protocol was approved by Ethic Committee of Peking University Third Hospital (No.2014166). Written informed consent was obtained from each subject prior to any medical examination. Results The IOP after MLT was (20.2±6.7), (17.6±4.4), (18.1±4.5), (17.4±3.4) and (17.0±2.1)mmHg at 2 hours, 1 day, 1 week, 1 month and 3 months, respectively, with significant difference among the different time points (F=7.320, P<0.001). Compared with the IOP before treatment, the IOP at 1 day, 1 week, 1 month and 3 months after treatment were significantly decerased, with significant differences between them (all at P<0.05). Three months after treatment, the average number of glaucoma medications used was 1.5, and only local administration was used.Infection, hyphema, cornea injury, burns and other complications were not seen in all the patients. Conclusions MLT is effective and safety for OAG and OHT patients, and reduce the use of glaucoma drugs. Key words: Micropulse laser trabeculoplasty; Intraocular pressure; Open angle glaucoma; Ocular hypertension

To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo(®) ) used to close the conjunctiva in trabeculectomy. A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo(®) group. Two patients in the Tissucol Duo(®) group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. The use of Tissucol Duo(®) seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period.

Objective: To evaluate the 24-hour efficacy of tafluprost on the reduction of intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG) and ocular hypertension (OHT). Methods: In this case-series study, a total of 43 eyes of 22 newly diagnosed patients with POAG and OHT from Shengyang Aier Eye Hospital were enrolled. All patients were trained to use an Icare HOME tonometer to measure IOP by themselves. For the certificated patients, aphysician used GAT to measure their IOP three times, and then the patients used Icare HOME to measure 24-hour IOP by themselves. Patients was given tafluprost once a day at 21∶00. Icare HOME was used by the patients themselves to measure 24-hour IOP again one month later. A one-way ANOVA and Bland-Altman analysis were used to compare the consistency of the GAT used by a physician and the Icare HOME used by patients to measure IOP. A paired t test was used to compare IOP at each time point, the mean, the peak, the valley and the fluctuation of 24-hour IOP before and after treatment with tafluprost. Results: The mean IOPs measured with GAT by a physician and Icare HOME by patients were 18.2±3.7 mmHg (1 mmHg=0.133 kPa) and 17.4±4.2 mmHg, respectively, with no statistically significant difference (F=0.837, P=0.363). Bland-Altman analysis showed that there was a good consistency between GAT measured by a physician and Icare HOME measured by patients. IOP decreased at all time points of assessment after 1 month (all P<0.05). The range of IOP reduction at different time points was 1.8 to 5.5 mmHg (all P<0.05). The mean, the peak, the valley, and the fluctuation of IOP at baseline were 19.4±5.0, 25.0±5.8, 14.1±4.5 and 10.9±3.8 mmHg, respectively, and were reduced to 15.6±4.2, 20.4±4.5, 11.3±3.6 and 9.2±2.9 mmHg after treatment (t=9.450, 9.636, 5.939, 3.137, all P<0.05). Conclusions: Tafluprost provides effective 24-hour IOP reduction in newly diagnosed patients with POAG and OHT. Key words: glaucoma, open-angle; ocular hypertension; tonometry, ocular; tafluprost

Background Rabbits are commonly used as animal models for the evaluation of drugs and surgery to lower intraocular pressure (IOP).The accuracy of IOP measurement is therefore critical in the analysis of data and subsequent extrapolation to humans.An accurate method to measure rabbit IOP is intracameral manometry,but it is an invasive way.Schiotz,Perkins and Rebound were often used in clinic.However,their accuracy in measuring rabbit IOP in experimental study is unclear. Objective The purpose of this study was to investigate the accuracy of IOP measured by Schiotz tonometer,Perkins tonometer and Rebound tonometer relative to intracameral manometry in New Zealand white rabbits. Methods The central corneal thickness (CCT),corneal curvature (CC),axial length (AL),anterior chamber depth (ACD), lens thickness (LT) and scleral thickness (ST) were respectively measured in 8 eyes of 8 healthy New Zealand white rabbits with lenstar900 and ultrasound biomicroscopy (UBM).The actual IOP was measured with a 24G needle inserted the anterior chamber and connected to a pressure transducer under the general anesthesia,the IOP gradient was set with a 24G needle inserting the vitreous cavity and connecting to a container with balanced salt solution(BSS).Then,comparative measurements at the same pressures were performed with three types of tonometers.The IOP values from Schiotz tonometer,Perkins tonometer and Rebound tonometer were calibrated based on actual IOP from intracameral manometry and eyeball physiological parameters by multiple regression equation. Results The mean of CCT,CC,AL,ACD,LT and ST was (338.96±21.52) μm,(51.68±1.66) D,(14.63±0.19) mm,(2.22±0.04) mm,(6.15±0.10) mm and (339.80±47.41) μm.Compared with the intracameral manometry value (IMV),the error range was (17.08±11.22) mmHg in the Schiotz tonometer value (STV),(25.81±12.43) mmHg in the Perkins tonometer value (PTV) and (22.50±11.47) mmHg in the Rebound tonometer value (RTV),with significant differences between them(t=10.54,14.39,13.59,all at P<0.05).Compared with IMV,the 95% limits of agreement of three portable tonometer values is larger,and three portable tonometer values had the greater measurement error with elevated IOP gradient.The regression equations was IOP=141.015+1.570×STV+0.122×CCT-3.480×CC between actual IOP and STV (R=0.92,P=0.00),IOP=-33.323+1.914×PTV+0.133×CCT between actual IOP and PTV(R=0.88,P=0.00),IOP=160.395+1.866×RTV+0.201×CCT+34.554×LT-2.649×CC+0.063×ST between actual IOP and RTV (R=0.95,P=0.00). Conclusions The physiological parameters of rabbit eyeball are obviously different from human. The STV, PTV and RTV have a great measuring error in comparson with actual IOP, and therefore it is necessary to correct STV, PTV and RTV based on the ocular physiology parameters in experimental study. Key words: Bio-measurment; Intraocular pressure; Intracameral manometry; Tonometer; Regression equation; Rabbit

Purpose: The purpose of this paper is to show the efficacy and safety of controlling intraocular pressure by combining a non-penetrating deep sclerectomy procedure with trabeculotomy, and analyze its results and complications. Design: Surgical cases. Material and Methods: Intraocular pressure equal to or less than 16 mmHg with or without medication was considered a success. Between August 2005 and October 2008, 61 eyes were operated, presenting open-angle glaucoma without intraocular pressure control with maximum medication. 28 patients underwent non-penetrating deep sclerectomy with trabeculotomy and the others received combined phacoemulsification and intraocular lens implant. Average age was 68 years, with a range between 48 and 86. Sex distribution was 22 men and 39 women. Average pre-surgical intraocular pressure was 21.75 mmHg, with standard deviation +- 5.45 and a range between 14 and 45 mmHg. Average follow-up was 22.55 months with a range between 1 and 40 months. No antimetabolites, viscoelastics or devices were employed to improve the results. Results: Average latest post-surgical intraocular pressure was 12.79 mmHg, standard deviation +-4.31 with a range between 9 and 40 mmHg. The difference between pre- and post-surgical measures was 8.96 mmHg. Average success was 88.52% (54 eyes). The failure rate was 11.47% (7 eyes). Intraocular pressure was controlled in 51 eyes (83.60%) without medication and in 10 eyes (16.39%) with medication. 35 cases had hyphema between 1 to 12 days post-surgery, resolved without consequences. Conclusions: Combining non-penetrating deep sclerectomy with trabeculotomy showed better results than each one separately, resulting in an alternative procedure for surgical treatment of open-angle glaucoma.

Objective To explore the surgical techniques, efficacy and the management of complicated ocular trauma with anterior-posterior segment complications such as cyclodialysis. Methods Fifty-five patients (55 eyes) with complicated ocular trauma were enrolled in this study. Among them, there were 35 cases with eyeball contusion and 20 cases of eyeball rupture. Preoperative visual acuity was from no light perception to 0. 15, intraocular pressure (IOP) ranged from one to 10 mm Hg (1 mm Hg=0. 133 kPa).Cyclodialysis, vitreous hemorrhage or retinal detachment were revealed by B-ultrasound and ultrasound biomicroscopy (UBM). Cyclodialysis clefts ranged from one to 12 clock-hours. All patients underwent 3-port pars plana vitrectomy with gas/silicone oil tamponade and ciliary body reattachment by cryotherapy (cyclodialysis clefts ≤ three clock-hours) or suture fixation ( cyclodialysis clefts ＞ three clock-hours).Healing after surgical trauma, visual acuity, intraocular pressure, intraocular hemorrhage, ciliary body and retinal reattachment were followed up. Results In one month after surgery, UBM showed 54 patients out of 55 patients had good ciliary body reattachment. Gonioscopy revealed cyclodialysis still existed in one patient, and this was cured by a second surgical suture fixation. In three months after surgery, ocular trauma healed in all 55 patients, the visual acuity ranged from no light perception to 0. 15, with a best corrected visual acuity of 0.8. The ciliary body and retina had good reattachment. IOP of 52 patients was normal; IOP of three patients was still lower than 10 mm Hg. Three patients had secondary glaucoma which was treated by glaucoma surgery. Conclusions Complicated ocular trauma with cyclodialysis can be treated with vitrectomy and cryotherapy or transscleral sutures. The procedure is safe and effective. Key words: Ciliary body/injuries; Ciliary body/surgery; Vitrectomy

Objective To determined the outcome of modified trabeculecotomy (with paracentesis,mitomycin C, scleral flap adjustable suture and formation of anterior chamber at the end of the surgery) in the management of primary acute angle-closure (PAAC) with high intraocular pressure (IOP) and extremely dilated pupil. Methods Twenty-one eyes of 21 successive cases with PAAC with high lOP (IOP ＞ 30mmHg) and large pupil (maximum vertical diameter ＞ 5 mm) were evaluated prospectively. They underwent modified trabeculecotomy between January 2005 and March 2009. The operative success was defined as IOP ≤ 20 mmHg (± medical therapy) without the necessity of further surgery for glaucoma. Results Success was achieved in all of the eyes (100％) at the postoperative first week. The mean preoperative IOP was (48.25 ± 3.14) mmHg under a mean number of 3.35 antiglaucomotous medications, but it reduced to (10.47 ± 1.15,P ＜ 0.01) mmHg without medication at the first week, (13.86 ± 0.93,P ＜ 0.01) mmHg at postoperative 3rd month respectively. Only 1 eye needed 1 kind of antiglaucomotous eye drop from the 2nd month postoperatively. The mean vertical diameter of pupils was (5.81±0.23) mm preoperatively, (5.92 ±0.21 ) mm at the first week(P ＞ 0.05). No case received section iridectomy. No serious complication was observed.Conclusions Modified trabeculectomy provides reduction of IOP and protection of pupil in cases with PAAC with high IOP and large pupil, and the procedures such as releasing aqueous humor gradually,appliance of scleral flap adjustable sutures and formation of anterior chamber at the end of the surgery can effectively reduce the risk of serious complications. Key words: Acute angle-closure; ; High intraocular pressure ; Dilated pupil; Trabeculectomy; Microsurgical operation

Objective To investigate the clinical effects and safety of Ex-Press glaucoma drainage device implantation combined with phacoemulsification (E-P P) for primary acute angle-closure glaucoma (PAACG) with cataract and persistent ocular hypertension. Methods The data of 30 eyes of 26 patients of PAACG with cataract and persistent ocular hypertension were retrospectively analyzed, who received E-P P surgery. The visual acuity, intraocular pressure(IOP) and complications were observed. Results All patients were followed up for 1 year. The complete success rate was 76.67% (23 eyes), the partial success rate was 23.33% (7 eyes), and the total success rate was 100.00%.The IOP before operation and 1 week, 1, 2, 3, 6 and 12 month after operation were (32.19±9.12), (10.30±5.07), (10.28±4.93), (10.87±4.22), (11.32±6.11), (12.12±6.07) and (13.05±5.26)mmHg(1 mmHg=0.133 kPa)respectively. Postoperative IOP was significantly decreased comparing with the preoperative one, and the difference was statistically significant (P<0.05). The visual acuity one week after operation was significantly improved comparing with preoperative one(Z=-4.19, P=0.000). Early postoperative complications included hyphema in 2 eyes, transient low IOP in 4 eyes, and choroidal detachment in 1 eye, and all of those complications healed within 4~14 days. Conclusion Ex-Press glaucoma drainage device implantation combined with phacoemulsification is safe and effective for the treatment of PAACG with cataract and persistent ocular hypertension. Key words: Cataract; Glaucoma, angle-closure, acute; Ocular hypertension, persistent; Phacoemulsification; Glaucoma drainage device, Ex-Press