Combined Phacoemulsification and Goniosynechialysis under an Endoscope for Chronic Primary Angle-Closure Glaucoma

Nie, Li; Pan, Weihua; Fang, Aiwu; Li, Zhangliang; Qian, Zhenbin; Фу, Лин; Chan, Yau Kei

doi:10.1155/2018/8160184

Cited by 18 publications

(21 citation statements)

References 27 publications

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“…However, it had more postoperative complications (8 complications vs 0 complication) like "wipe out", ocular hypotony and poor IOP control [17,27]. Compared with trabeculectomy, GSL was reported to be safe with mild complications including intraoperative hyphema, mild zonulysis and postoperative IOP spikes [28,29]. Medically uncontrolled glaucomatous eyes warrant surgeries to decease IOP since elevated IOP increases the risk of glaucoma progression.…”

Section: Discussionmentioning

confidence: 99%

Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

Фу

Chan

et al. 2020

BMC Ophthalmol

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Background: To investigate the long term surgical outcomes of cataract surgery in severe and end stage glaucoma patients with preoperative intraocular pressure less than 21 mmHg, and to detect the associated factors. Methods: A retrospective study of primary angle closure glaucoma patients was conducted on who underwent cataract surgery or combined with goniosynechialysis from March 2015 to April 2018. Main outcome measures were visual acuity, intraocular pressure, number of glaucoma medications and complications. Results: Sixteen patients (19 eyes) were included. The mean age was 64.89 ± 11.68 years and the mean followed up duration was 21.89 ± 7.85 months. The final visual acuity was significantly improved from 0.69 ± 0.55 to 0.46 ± 0.52 logMAR, within 12 (63.2%) eyes improved, 4 (21.1%) eyes kept unchanged, and 3 (15.8%) eyes reduced. Linear regression analysis indicated that higher mean deviation, higher visual field index and lower glaucoma stage associated with better final visual acuity (r = − 0.511, r = − 0.493, r = 0.537 respectively). Moreover, the final number of medications were reduced from 1.26 ± 0.99 to 0.26 ± 0.56 (p < 0.01). The mean intraocular pressure was not significantly reduced with the final IOP of 14.48 ± 3.74 mmHg (p = 0.97). While the eyes with intraocular pressure above 15 mmHg was decreased to 6 (31.6%) eyes compared to 10 (52.6%) eyes at baseline. Moreover, the number of eyes free of medications was increased from 4 (21.1%) preoperatively to 15 (78.9%) eyes postoperatively. Conclusions: Final visual acuity was significantly improved in the severe and end stage primary angle closure glaucoma patients and the number of eyes came off medications increased by 57.8% after cataract surgery. Preoperatively, the glaucoma stage, mean deviation and visual field index are important parameters to predict the final visual acuity after cataract surgery.

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Section: Discussionmentioning

confidence: 99%

Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

Фу

Chan

et al. 2020

BMC Ophthalmol

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“…Permanent closure of the angle due to peripheral anterior synechiae (PAS) is the main cause of chronic angle-closure glaucoma and induces an increase in IOP [17]. Goniosynechialysis (GSL) can separate peripheral anterior synechia (PAS) from the angle, expose the functional TM, and therefore restoring its filtering function [18, 19]. TM physiology related study shows that this tissue has unique morphologic and functional properties involved in the regulation of aqueous humour outflow [20].…”

Section: Discussionmentioning

confidence: 99%

Expression of matrix Metalloproteinases-2 and aquaporin-1 in corneoscleral junction after angle-closure in rabbits

Jiang

Zhang

et al. 2019

BMC Ophthalmol

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BackgroundTo investigate the expression of Matrix Metalloproteinases 2 and aquaporin-1 in corneoscleral junction and explore the mechanism of trabecular damageafter angle-closure.MethodsThirty New Zealand white rabbits were randomly assigned into 2 groups, theexperimental group (Group 1) including twenty five rabbits and the control group (Group 2) including 5 rabbits. The rabbits in the experimental group were used to establish angle-closure models, and the rabbits in the control group were not subjected to any operation. All the rabbits were followed by slit lamp microscopy, Tonopen tonometer, and anterior segment optical coherent tomography (AS-OCT). The expressions of metalloproteinase MMP-2, aquaporin-1, and tissue inhibitors of metalloproteinase-2 in corneoscleral junctionwere evaluatedin both groups byimmunofluorescence, quantitative reverse-transcription polymerase chain reaction (qRT-PCR), and enzyme-linked immunosorbent assay (ELISA).ResultsSlit-lamp examination showed that angle-closure model was successfully established in twenty rabbits. The extent of angle-closure was about 2 to 4 clock hours in all the rabbit models, but the intraocular pressure (IOP) of the rabbits distributed from 8.57 to 15.25 mmHg and no significant high IOP was found in the follow-up period. The AQP-1-positive cells mainly located in Schlemm’s canal, the inner surface of trabecular meshwork (TM), and the surface of iris, which began to decline on 1 month after angle-closure. MMP2 staining was diffuse in trabecular meshwork and iris. Immunofluorescence signal of MMP2 was strong within 1 month after angle-closure, and subsequently became weak. qRT-PCR and ELISA showed that the expression of MMP-2 and TIMP-2 increased within 1 month after angle-closure and then declined gradually. The AQP-1 levels showed slightly declined on 1 month after angle-closure.ConclusionsAltered levels of MMPs, TIMPs, and AQP-1 were found in the area of angle-closure, which may be involved in the damage of TM and Schlemm’s canal after angle-closure.

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“…All the 9 patients underwent phaco-IOL-GSL with a wide range of peripheral anterior synechiae (PAS, over 180 degrees) ( Table 1). Phaco-IOL-GSL was performed by Dr. Weihua Pan as previously described [4]. ree kinds of IOLs, including AcrySof SA60AT (Alcon Surgical Inc, Fort Worth, Texas, USA), Tecnis ZCB00 (Abbott Medical Optics Inc, Santa Ana, California, USA) and Softec HD (Lenstec Inc., St. Petersburg, FL, USA) were implanted during surgery.…”

Section: Patientsmentioning

confidence: 99%

“…In the past few years, phacoemulsification with intraocular lens implantation combined with goniosynechialysis (phaco-IOL-GSL) has become significantly popular in the treatment of PACG due to its effectiveness and safety [1][2][3][4]. Fluid misdirection syndrome (FMS) is a rare but severe complication observed after phaco-IOL-GSL due to its rapid progression and poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Two Different Anterior Vitrectomies for Fluid Misdirection Syndrome Secondary to Cataract Surgery Combined with Goniosynechialysis

Qian

Chan

Wei

et al. 2020

Journal of Ophthalmology

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Purpose. To evaluate two different approaches of anterior vitrectomy combined with hyaloidotomy, zonulectomy, and iridectomy (VHZI) for fluid misdirection syndrome (FMS) secondary to phacoemulsification with intraocular lens implantation combined with goniosynechialysis (phaco-IOL-GSL). Methods. Nine patients with FMS who developed after a phaco-IOL-GSL procedure, were retrospectively studied from May 2015 to February 2018. They were treated with VHZI, in which 5 cases underwent local anterior vitrectomy via anterior chamber approach, and the others underwent comprehensive vitrectomy via pars plana approach. Main outcome measures were pre- and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and relapse rate. Results. Incidence of FMS secondary to phaco-IOL-GSL was 1.4% (9 in 652 eyes), which was promptly resolved in all affected cases. VHZI via anterior chamber approach resulted in a significant decrease in the mean IOP from 40.2 ± 9.7 mm Hg at presentation to 15.2 ± 4.8 mm Hg postoperatively (P=0.01). The median number of antiglaucoma medications reduced from 3 to 2 (P=0.066). Meanwhile, VHZI via pars plana approach also resulted in the reduction of the mean IOP values from 26.0 ± 5.7 mm Hg at presentation to 15.2 ± 3.3 mm Hg postoperatively (P=0.092). The median number of antiglaucoma medications also reduced from 3.5 to 1.5 (P=0.059). Relapse rate of the treatment through pars plana approach (0%, 0/4) was much lower than that through anterior chamber approach (40%, 2/5), although the difference was not statistically significant (P=0.444). Conclusions. FMS is a rare but severe complication secondary to phaco-IOL-GSL. Compared to VHZI with local anterior vitrectomy via anterior chamber approach, VHZI with comprehensive anterior vitrectomy via pars plana approach might be a more effective procedure to treat FMS. The study has been registered in Contact ClinicalTrials.gov PRS Identifier: NCT04172857.

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Combined Phacoemulsification and Goniosynechialysis under an Endoscope for Chronic Primary Angle-Closure Glaucoma

Cited by 18 publications

References 27 publications

Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

Long term outcomes of cataract surgery in severe and end stage primary angle closure glaucoma with controlled IOP: a retrospective study

Expression of matrix Metalloproteinases-2 and aquaporin-1 in corneoscleral junction after angle-closure in rabbits

Evaluation of Two Different Anterior Vitrectomies for Fluid Misdirection Syndrome Secondary to Cataract Surgery Combined with Goniosynechialysis

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