查看更多>>摘要：Background:To compare the efficacy of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification.Methods:A retrospective 12-month study on patients with coincident primary open-angle glaucoma(POAG)and cataract.The patients underwent combined phacoemulsification and Ex-PRESS implant(Phaco-ExPRESS,n=35)or phacotrabeculectomy(Phaco-Trab,n=35).The morphological structures of the filtering bleb were examined by slit-lamp,anterior segment optical coherence tomography(AS-OCT)and in vivo confocal microscopy(IVCM).Complete success was defined as postoperative intraocular pressure(IOP)＜18 mmHg without the use of anti-glaucoma medi-cation.Qualified success was defined as postoperative IOP＜18 mmHg with or without anti-glaucoma medications.The data were collected preoperatively and postoperatively at 2 weeks,1 month,3 months,6 months,and 12 months.Results:No significant difference in the variables such as age,IOP and perimetry was found between the groups of Phaco-ExPRESS and Phaco-Trab.At the one-year postoperative visit for filtering blebs,Phaco-ExPRESS increased the mean area of epithelial microcysts significantly from 0.10±0.05 to 0.20±0.09 μm2 per μm2,while Phaco-Trab decreased the mean area significantly from 0.08±0.04 to 0.04±0.06 μm2 per μm2.Notably,the hyperreflective dots detected by IVCM decreased by 84.9％in Phaco-ExPRESS but increased by 36.3％in Phaco-Trab.The hyperreflective dots were further identified as neutrophil-and monocyte-like cells.The number of these cells were negatively corre-lated with the microcysts area(r=-0.7,P＜0.01)but positively associated with the grade of connective tissue(r=0.5,P＜0.01).By creating different microstructural changes in the filtering blebs,Phaco-ExPRESS produced a higher com-plete success rate(84.9％vs.41.2％,P＜0.01)and significant decrease in the number of anti-glaucoma medications(P＜0.01)when compared with those in Phaco-Trab.However,the qualified success showed no significant difference between the two groups(100.0％vs.91.2％,P=0.24).Conclusions:At the one-year follow-up,Phaco-ExPRESS generated better filtering bleb with larger area of micro-cysts,looser connective tissues,and less inflammation than that of Phaco-Trab,providing adequate IOP control and less IOP-lowering medications.These findings indicate that Phaco-ExPRESS could be more preferred than Phaco-Trab for the treatment of patients with coincident POAG and cataract.
Jose Maria Martinez-de-la-CasaCarlos Oribio-QuintoAlmudena Milans-del-BoschPilar Perez-Garcia...
12-21页
查看更多>>摘要：Background:Ocular surface disease in glaucoma patients is a significant ocular co-morbidity that can affect 40％to 59％of these patients worldwide.The current study was aimed at evaluating the potential clinical benefit of an intense pulsed light(IPL)-based treatment in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop treatments.To our knowledge,this is the first series analyzing the therapeutic effect of this treat-ment option in this type of patients.Methods:This non-comparative prospective case series study enrolled a total of 30 glaucoma patients ranging in age from 57 to 94 years old and treated with hypotensive eyedrops for years with dry eye symptomatology.All patients received four sessions of IPL treatment using the Optima IPL system(Lumenis,Yokneam,Israel)adjusted to the official optimized Lumenis setting.Changes in symptomatology,corneal staining,conjunctival hyperemia,non-invasive break-up time(NIBUT),tear osmolarity,tear meniscus height(TMH),meiboscore and meibomian gland expressibility was analyzed after treatment.Results:Statistically significant reductions were observed after IPL treatment in the symptomatology scores meas-ured with different questionnaires[ocular surface disease index(OSDI),standard patient evaluation of eye dryness(SPEED)and symptom assessment questionnaire in dry eye(SANDE)]as well as with the visual analogue scale(P＜0.001).Mean change in OSDI was-15.0±11.3.A significant reduction was found after treatment in the corneal staining score(P＜0.001),tear film meniscus height(P=0.012),as well as in tear film osmolarity(P=0.001).A significant reduction was also found in meibomian gland expressibility(P=0.003),changing the percentage of grade 3 eyes from 44.4％before IPL to 17.2％after treatment.Conclusions:IPL therapy combined with meibomian gland expression(MGX)seems to be an effective option to improve symptomatology in glaucomatous patients with ocular surface disease due to prolonged hypotensive eye-drop treatments,with an additional improvement in clinical signs,such as tear osmolarity and corneal staining.
查看更多>>摘要：Background:The accuracy of using total keratometry(TK)value in recent IOL power calculation formulas in highly myopic eyes remained unknown.Methods:Highly myopic patients who underwent uneventful cataract surgery were prospectively enrolled in this prospective comparative study.At one month postoperatively,standard deviation(SD)of the prediction errors(PEs),mean and median absolute error(MedAE)of 103 highly myopic eyes were back-calculated and compared among ten formulas,including XGboost,RBF 3.0,Kane,Barrett Universal Ⅱ,Emmetropia Verifying Optical 2.0,Cooke K6,Haigis,SRK/T,and Wang-Koch modifications of Haigis and SRK/T formulas,using either TK or standard keratometry(K)value.Results:In highly myopic eyes,despite good agreement between TK and K(P＞0.05),larger differences between the two were associated with smaller central corneal thickness(P＜0.05).As to the refractive errors,TK method showed no differences compared to K method.The XGBoost,RBF 3.0 and Kane ranked top three when considering SDs of PEs.Using TK value,the XGboost calculator was comparable with the RBF 3.0 formula(P＞0.05),which both presented smaller MedAEs than others(all P＜0.05).As for the percentage of eyes within±0.50 Dor±0.75 D of PE,the XGBoost TK showed comparable percentages with the RBF 3.0 TK formula(74.76％vs.66.99％,or 90.29％vs.87.38％,P＞0.05),and statistically larger percentages than the other eight formulas(P＜0.05).Conclusions:Highly myopic eyes with thinner corneas tend to have larger differences between TK and K.The XGboost enhancement calculator and RBF 3.0 formula using TK showed the most promising outcomes in highly myopic eyes.
查看更多>>摘要：Background:The aim of the study was to investigate the changes in the periarterial capillary-free zone(paCFZ)after anti-vascular endothelial growth factor(VEGF)therapy in patients with branch retinal vein occlusion(BRVO)by wide-field swept-source optical coherence tomography angiography(SS-OCTA)and assess their associations with clinical outcomes.Methods:In this retrospective observational study of 54 treatment-naive BRVO patients with macular edema,we reviewed the findings of 12 × 12 mm2 SS-OCTA at baseline,3,6,and 12 months after intravitreal ranibizumab injec-tions.The paCFZ and major retinal artery areas were measured on SS-OCTA images.The paCFZ area to artery area(P/A)ratio was calculated.Results:The paCFZ areas and P/A ratios of first-and second-order arteries were significantly greater in BRVO eyes than in contralateral eyes(all P＜0.01),but there were no differences in the first-and second-order artery areas(P=0.20 and 0.25,respectively).The paCFZ areas and P/A ratios decreased significantly at 3,6,and 12 months after anti-VEGF therapy(all P＜0.01).The baseline P/A ratio was significantly correlated with the baseline best-corrected visual acuity(BCVA),central retinal thickness,and their improvements at 3,6,and 12 months(all P＜0.05).Baseline BCVA and P/A ratios of first-and second-order arteries were independently associated with the final BCVA in multivari-ate linear regression.Conclusions:Wide-field SS-OCTA shows that anti-VEGF therapy can lead to a significant improvement in the paCFZ parameters in BRVO.Smaller baseline P/A ratios on SS-OCTA tend to predict better visual outcomes at 12 months after anti-VEGF therapy.
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