BACKGROUNDNeovascular glaucoma (NVG) is a refractory glaucoma. The management of NVG is very difficult, and it is more difficult when combined with vitreous hemorrhage. The aim of this study was to investigate the effects of ranibizumab plus combined surgery for NVG with vitreous hemorrhage.

METHODSA total of 26 eyes of 26 NVG patients with vitreous hemorrhage were recruited in this study. The patients aged from 36 to 63 years with a mean age of 51.97 ± 7.60 years. The mean intraocular pressure (IOP) was 46.38 ± 5.75 mmHg (1 mmHg = 0.133 kPa) while being treated with the maximum medical therapy. The mean best-corrected visual acuities converted to logarithm of the minimum angle of resolution (logMAR BCVA) was 2.62 ± 0.43. All the patients underwent intravitreal injection of 0.5 mg (0.05 ml) ranibizumab combined with pars plana vitrectomy (PPV), pars plana lensectomy (PPL) with a preserved anterior capsule, panretinal photocoagulation (PRP), and trabeculectomy (intravitreal ranibizumab [IVR] + PPV + PPL + PRP + trabeculectomy). The IOP and logMAR BCVA were the main outcome measures in this study.

RESULTSThe follow-up period was 12 months. The mean postoperative IOPs were 26.38 ± 3.75 mmHg, 21.36 ± 3.32 mmHg, 18.57 ± 3.21 mmHg, and 16.68 ± 2.96 mmHg, respectively at 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy. At the last follow-up, the mean IOP was significantly lower than the preoperative one (t = 6.612, P = 0.001). At 7 days, 1 month, 3 months, and 12 months after PPV + PPL + PRP + trabeculectomy, the mean logMAR BCVA were 1.30 ± 0.36, 1.29 ± 0.37, 1.29 ± 0.39, and 1.26 ± 0.29, respectively. At the last follow-up, the mean logMAR BCVA was significantly improved, and the difference was statistically significant compared with preoperative one (t = 6.133, P = 0.002). The logMAR BCVA improved in 22 eyes (84.62%), and remained stable in 4 eyes (15.38%). The neovascularization in the iris and the angle regressed significantly in all patients 7 days after ranibizumab injection. No serious complications occurred during 12 months of the study.

CONCLUSIONSIVR + PPV + PPL + PRP + trabeculectomy can control IOP well and improve BCVA without severe complication for NVG patients with vitreous hemorrhage.

Adult ; Female ; Glaucoma, Neovascular ; drug therapy ; surgery ; Humans ; Intraocular Pressure ; drug effects ; Male ; Middle Aged ; Postoperative Complications ; Ranibizumab ; therapeutic use ; Trabeculectomy ; adverse effects ; Vitrectomy ; adverse effects ; Vitreous Hemorrhage ; drug therapy ; surgery

OBJECTIVE: To explore the risk factors, the ciliary body anatomy structures, the therapeutic methods and the prognosis for malignant glaucoma through retrospectively collecting the clinical data from primary angle-closure glaucoma (PACG) patients. METHODS: Clinical data in 1183 patients (1456 eyes) with PACG were collected between July, 2010 and May, 2014 from Xiangya Hospital, Central South University. Thirty patients (38 eyes) were diagnosed as malignant glaucoma. According to symptom, these patients were divided into a PACG group (1418 eyes) and a malignant glaucoma group (38 eyes); according to age, they were divided into a 3-40 years old group (171 eyes), a 41-70 years old group (1016 eyes) and a ≥71 years old group (269 eyes); according to therapeutic methods, they were divided into a drug therapy group (5 eyes), a lens extraction group (6 eyes) and a vitrectomy surgery group (27 eyes); according to the different method of surgery, they were divided into a vitrectomy group (27 eyes), a nonvitrectomy group (11 eyes). The age, sex, anterior chamber depth (ACD), axial length (AL), lens thickness (LT), visual acuity, intraocular pressure, therapeutic methods and surgery history were recorded. Meanwhile, the ciliary body thickness (CBT), trabecular ciliary process angle (TCA) and lens diameter were measured by ultrsound biomicroscopy (UBM). RESULTS: Male and female ratio was 1:2 in the malignant glaucoma group. The average age [(51.87±12.92) years] in the malignant glaucoma group was less than that in the PACG group [(57.87±8.78) years](P<0.05). Malignant glaucoma was more likely to occur in the first 3 months after PACG trabeculectomy with a rate of 85.7%. The LT [(4.33±0.67) mm], AL[(21.44±1.18) mm] and ACD [(2.12±0.41) mm] in the malignant glaucoma group were less than those in the PACG group [(4.81±0.50), (22.17±0.97) and (2.49±0.48) mm, respectively](all P<0.05). The CBT0, CBT1, CBTmax, TCA and lens diameter in the malignant glaucoma group were less than those in the PACG group (all P<0.05). CONCLUSION Female PACG patients, with short axial length, shallow anterior chamber, thin lens, thin ciliary body, small trabecular ciliary process angle and short lens diameter, are more likely to suffer from malignant glaucoma. Vitrectomy can significantly reduce intraocular pressure.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Ciliary Body ; anatomy & histology ; Female ; Glaucoma, Angle-Closure ; drug therapy ; surgery ; Humans ; Intraocular Pressure ; Lens, Crystalline ; anatomy & histology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Tonometry, Ocular ; Trabeculectomy ; Visual Acuity ; Vitrectomy ; Young Adult

Glaucoma, Neovascular ; drug therapy ; epidemiology ; surgery ; Humans ; Retinal Diseases ; drug therapy ; epidemiology ; surgery

PURPOSE: To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS). METHODS: Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group. RESULTS: With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 micrometer, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003). CONCLUSIONS: Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.
Adult ; Female ; Glaucoma/*complications/drug therapy/pathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Myopia/*complications/pathology/*surgery ; *Refractive Surgical Procedures ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence

PURPOSE: To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS). METHODS: Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group. RESULTS: With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 micrometer, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003). CONCLUSIONS: Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.
Adult ; Female ; Glaucoma/*complications/drug therapy/pathology ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Myopia/*complications/pathology/*surgery ; *Refractive Surgical Procedures ; Retrospective Studies ; Severity of Illness Index ; Tomography, Optical Coherence

BACKGROUNDGlaucoma filtering surgery (GFS) is the most common procedure performed in the treatment of glaucoma. Although antiscarring agents help prevent postsurgical scarring and improve glaucoma surgical outcomes, they may be associated with an increased incidence of severe and potentially blinding complications. Poly(DL-lactide-co-glycolide) (PDLLA/GA) is a bioresorbable polymer, which can be prepared with a large range of physical, mechanical, and biological properties and has been widely used in medicine, including as an absorbable suture and a drug carrier and especially as a scaffold in tissue engineering. This study aimed to evaluate the effect of PDLLA/GA on scar formation after glaucoma filtration surgery (GFS).

METHODSForty-eight New Zealand white rabbits were divided into two groups randomly and GFS was performed on the right eye of each. PDLLA/GA membranes were put under the sclera flap for evaluation. GFS with no membrane inserted served as control. Clinical evaluations of intraocular pressure (IOP) and the presence of a filtration bleb were performed at intervals (3 days, 1, 2, 4, 8, 12, 20, and 24 weeks) postoperatively. At each time point, three eyes per group were excised to observe histological changes such as inflammation and scar formation and the expression of collagen type IV, proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-9 (MMP-9), and tissue inhibitor of metalloproteinase-1 (TIMP-1). The expression of connective tissue growth factor (CTGF) mRNA was determined by reverse transcription-polymerase chain reaction.

RESULTSThe lower IOP level and an effective bleb were maintained for a long time after GFS in the PDLLA/GA group. The histological analysis showed less inflammation and scar formation, weaker expression of collagen type IV and PCNA, more intense MMP-9 and TIMP-1, slightly elevated ratio of MMP-9 and TIMP-1, and a smaller increase in CTGF mRNA postoperatively in the PDLLA/GA group but less than the control group (P < 0.05).

CONCLUSIONPDLLA/GA membranes may be promising for preventing fibrosis after GFS.

Animals ; Biocompatible Materials ; therapeutic use ; Cicatrix ; prevention & control ; Filtering Surgery ; Glaucoma ; drug therapy ; surgery ; Lactic Acid ; therapeutic use ; Polyglycolic Acid ; therapeutic use ; Rabbits

PURPOSE: To evaluate changes in anterior chamber depth (ACD) and angle width induced by phacoemulsification and intraocular lens (IOL) implantation in eyes with glaucoma, using anterior segment optical coherence tomography (AS-OCT). METHODS: Eleven eyes of 11 patients with angle-closure glaucoma (ACG) and 12 eyes of 12 patients with open-angle glaucoma (OAG) underwent phacoemulsification and IOL implantation. Using AS-OCT, ACD and angle parameters were measured before and 2 days after surgery. Change in intraocular pressure (IOP) and number of ocular hypotensive drugs were evaluated. RESULTS: After surgery, central ACD and angle parameters increased significantly in eyes with glaucoma (p < 0.05). Prior to surgery, mean central ACD in the ACG group was approximately 1.0 mm smaller than that in the OAG group (p < 0.001). Post surgery, mean ACD of the ACG group was still significantly smaller than that of the OAG group. No significant differences were found in angle parameters between the ACG and OAG groups. In the ACG group, postoperative IOP at the final visit was significantly lower than preoperative IOP (p = 0.018) and there was no significant change in the number of ocular hypotensive medications used, although clinically, patients required fewer medications. In the OAG group, the IOP and number of ocular hypotensive drugs were almost unchanged after surgery. CONCLUSIONS: The ACD and angle width in eyes with glaucoma increased significantly after phacoemulsification and IOL implantation. Postoperative ACD significantly differed between the ACG and OAG groups, whereas angle parameters did not differ.
Aged ; Aged, 80 and over ; Anterior Chamber/anatomy & histology/*surgery ; Female ; Glaucoma, Angle-Closure/drug therapy/pathology/*surgery ; Glaucoma, Open-Angle/drug therapy/pathology/*surgery ; Humans ; Intraocular Pressure ; Lens Implantation, Intraocular/*adverse effects ; Male ; Middle Aged ; Phacoemulsification/*adverse effects ; Postoperative Period ; Preoperative Period ; Tomography, Optical Coherence

Acupuncture Therapy ; Adult ; Aged ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glaucoma ; complications ; surgery ; Humans ; Male ; Middle Aged ; Optic Atrophy ; drug therapy ; etiology ; physiopathology ; therapy ; Vision, Ocular

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.
Adult ; Angiogenesis Inhibitors/therapeutic use ; Anterior Chamber/*metabolism ; Antibodies, Monoclonal, Humanized/*therapeutic use ; *Cholesterol ; Eye Diseases/complications/metabolism ; Follow-Up Studies ; Glaucoma/surgery ; Glaucoma, Neovascular/drug therapy/*etiology/surgery ; Humans ; Intraocular Pressure ; Male ; Vitrectomy/*methods

PURPOSE: To compare the efficacy and safety of repeat and initial trabeculectomy with mitomycine C (MMC). METHODS: Eighty seven patients, who had underwent repeat (repeat group) or initial (initial group) trabeculectomy with MMC, were enrolled in this prospective trial. Postoperative outcome measures included the amount of decrease in intraocular pressure (IOP), the number of anti-glaucoma medications, and the complications. The success of trabeculectomy was defined on the basis of three definitions which were: IOP < or =18 mmHg (definition 1), IOP < or =21 mmHg (definition 2), and the amount of decrease in IOP from baseline > or =30% (definition 3). Success was further defined as "complete" when these criteria were obtained without any anti-glaucoma medications and "qualified" with or without medical therapy and no further surgical procedures. RESULTS: Fifty nine eyes underwent initial and 28 eyes underwent repeat trabeculectomy. The mean follow-up period was 19.1 +/- 5.9 months. Complete success rates were significantly greater in the initial trabeculectomy group (p = 0.02 for definition 1, p = 0.038 for definition 2, p = 0.003 for definition 3). A higher proportion of eyes in the initial group achieved qualified success relative to the group A eyes, but the differences were not statistically significant (p = 0.33 for definition 1, p = 0.99 for definition 2, p = 0.24 for definition 3). The mean number of antiglaucomatous medications at the last examination was 1.2 +/- 1.2 in repeat group and 0.7 +/- 1.1 in initial group (p = 0.01). The number of complications during the follow up period did not differ significantly between the two groups (p = 0.65). CONCLUSIONS: Repeat trabeculectomy with MMC has high success and low complication rates in patients with previously failed trabeculectomy in spite of the need of higher number of anti-glaucoma medications.
Aged ; Alkylating Agents/*administration & dosage ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Glaucoma/*drug therapy/*surgery ; Humans ; Intraocular Pressure/physiology ; Male ; Middle Aged ; Mitomycin/*administration & dosage ; Prospective Studies ; Reoperation ; *Trabeculectomy ; Treatment Outcome