Anterior Chamber Hemorrhage Research Articles

A modified trabeculectomy technique with direct filtration into the Tenon's capsule

ObjectiveTo report the surgical outcomes of a modified trabeculectomy technique involving implanting the Tenon's layer under the scleral flap. DesignProspective, interventional case series. Participants51 eyes with medically uncontrolled glaucoma were enrolled for this study. A new trabeculectomy technique, the Tenon's filtration technique for trabeculectomy (TFT-LEC) was used in 26 eyes, while a conventional procedure, normal trabeculectomy (N-LEC), was used for 25 eyes. MethodsIntraocular pressure (IOP) control, the number of glaucoma medications, the need for additional interventions, and postoperative complications were assessed. ResultsTwelve months postoperatively, the mean IOP was 13.5 ± 0.5 mmHg in the TFT-LEC group and 15.4 ± 0.5 mmHg in the N-LEC group (p = 0.13). The TFT-LEC group required an average of 1.3 ± 1.0 additional glaucoma medications (21 cases required only ripasudil) postoperatively, with no cases of bleb needling revision or reoperation. The N-LEC group required an average of 1.7 ± 1.5 glaucoma medications (p = 0.43) compared to TFT-LEC group, eight cases (32%) required bleb needling revision (p = 0.002), and one case (4%) of reoperation (p = 0.49). The complications in the TFT-LEC group included shallow anterior chamber in six (23 %) cases (p = 1.00) compared to N-LEC group, choroidal detachment in two (8%) cases (p = 0.42), and anterior chamber hemorrhage in seven (27%) cases (p = 0.29). None of these complications affected visual function. ConclusionsThis new technique involving implanting the Tenon's layer under the scleral flap may improve the postoperative outcomes of trabeculectomy.

Consequences of Clot Formation and Hyphema Post-Internal Trabeculotomy for Glaucoma.

Clot formation and hyphema following internal trabeculotomy represent distinct clinical entities. The eyes with clot formation exhibited a more pronounced postsurgical intraocular pressure spike, longer residual intracameral bleeding, and a higher risk of reoperation. The aim of this study was to investigate the consequences of clot formation and hyphema in the anterior chamber after internal trabeculotomy. In this retrospective interventional comparative study, we investigated the surgical outcomes of internal trabeculotomy in 142 eyes of 142 patients at Sensho-kai Eye Institute. Concurrent clot formation and L≥2 hyphema (height of hyphema ≥1mm) was observed in 22 eyes. In these cases, the postsurgical IOP was 29.3mmHg at 1 week, significantly higher than the 16.1mmHg in eyes that had L≥2 hyphema but without clot formation ( P =0.0002). However, the 1-week postsurgical IOP in L≥2 hyphema and clot (-) eyes, which measured 16.1mmHg was not significantly greater than that in L<2 hyphema and clot (-) eyes, which measured 18.7mmHg ( P =0.162). Thus, clot formation was identified as a significant factor contributing to high postsurgical IOP at 1 week. The resolution time for anterior chamber bleeding in eyes with concurrent clot formation and L≥2 hyphema was 12.3 days, longer than the 5.8 days observed in L≥2 hyphema eyes without clot formation ( P =0.016). Among the 22 eyes with concurrent L≥2 hyphema and clot formation, 8 required anterior chamber washout. Three of the 10 eyes that underwent washout necessitated additional trabeculectomy, a rate significantly higher than that in nonwashout eyes ( P <0.001). After internal trabeculotomy, the sequelae of concurrent clot formation and L≥2 hyphema in the anterior chamber were more severe than those of simple hyphema without clots. Clot formation negatively affected postoperative IOP.

Should Ocular Hemorrhage Screening Be Conducted in Newborns with Acidosis?

Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic-ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis. Neonates >34 weeks are included if pH < 7.10 and BE < -12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed. Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = - 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4-17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9-41.7]) were found to increase the risk of RH. Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation. · One-third of neonates with moderate to severe acidosis exhibited RH.. · Stage 3 RH was identified as the most prevalent.. · Advanced resuscitation was identified as an independent risk factor for RH..

Witrektomia 23 G z podaniem iniekcji inhibitora czynnika wzrostu śródbłonka naczyniowego u chorego na jaskrę neowaskularną, z całkowitym odwarstwieniem siatkówki, krwotokiem do komory przedniej i komory ciała szklistego oka prawego – opis przypadku

IntroductionNeovascular glaucoma is a serious eye disease characterized by neovascularization of their is and anterior chamber angle. The most important risk factors for the development of neovascular glaucoma include retinal ischemia including that caused by proliferative diabetic retinopathy, central retinal vein occlusion, or retinal detachment.Material and MethodsA 61-year-old man with anterior chamber and vitreous chamber hemorrhage, recurrent total retinal detachment and advanced neovascular glaucoma in the right eye.ResultsVisual acuity recorded as hand motion, intraocular pressure measured by applanation tonometry 16 mmHg. The anterior segment showed massive anterior chamber hemorrhage and iris neovascularization. Ultrasound examination of the right eyeball in the B projection showed multiple diffuse extra echoes consistent with hemorrhage into the vitreous chamber and flat total retinal detachment. The patient was scheduled for anterior chamber washout, 23 G posterior vitrectomy with retinal endolaser, silicone oil endotamponade and injection of ranibizumab into the vitreous chamber of the right eye. During the first follow-up, an improvement in visual acuity to a level of 1/50 using Snellen arrays, stabilization of intraocular pressure to a level of 11 mmHg, and retinal adhesion was achieved.ConclusionsPars plana vitrectomy in patients with anterior chamber and vitreous chamber hemorrhage, retinal detachment and neovascular glaucoma is an effective surgical procedure for restoring useful visual acuity. In addition, ranibizumab injection has a direct effect on reducing the level of intraocular vascular endothelial growth factor and causes regression of neovascularization in the retina, angle and iris.

Multimodal Imaging Assessment of Typical Sympathetic Ophthalmia: A Case Report

Purpose: Despite the relatively low incidence of sympathetic ophthalmia, prompt diagnosis is essential to prevent visual impairment in both eyes. Here, we present a case of sympathetic ophthalmia, emphasizing distinctive imaging findings.Case summary: A 64-year-old male patient presented with complaints of right ocular pain and visual disturbances occurring 3 weeks after blunt trauma. The patient had a history of ophthalmologic surgeries, including cataract surgery in both eyes and intraocular lens trans-scleral fixation in the right eye. A primary suture was performed in the right eye due to iris prolapse through the scleral incision site and anterior chamber hemorrhage. At 1 week post-surgery, the patient reported diminished visual acuity in the left eye. Further assessment using wide-field fundus photography, optical coherence tomography, and fluorescein angiography revealed multiple focal hyperfluorescence leakage and serous retinal detachment. Consequently, sympathetic ophthalmia was diagnosed. Intravenous administration of high-dose steroids led to significant symptom improvement.Conclusions: We present a patient with a history of multiple ophthalmic surgeries and contralateral eye trauma indicative of sympathetic ophthalmia. Imaging modalities revealed typical findings for this condition. This case report emphasizes the importance of early diagnosis and treatment of sympathetic ophthalmia.

Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients.

The evaluation of ab interno trabeculectomy, referred to as trabectome®, among Japanese patients is insufficient. Japanese patients who underwent trabectome® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. A total of 250 eyes from 197 patients were enrolled. The trabectome® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with the success rate. The trabectome® alone did not show a significant reduction in corneal endothelial cells. Eyes with postoperative transient IOP elevation and removal of anterior chamber hemorrhage were 11.2% and 1.2%, respectively. Twenty-four eyes (9.6%) underwent additional glaucoma surgeries. The trabectome® could be considered an effective and safe surgery. Compared to trabectome® alone, combined cataract surgery was superior in lowering IOP and reducing glaucoma medications.

Efficacy and Safety of the Intraoperative Application of Mitomycin in Glaucoma Patients with Trabeculectomy: A Systematic Review and Meta-Analysis

What Is Known and Objective. The primary cause of trabeculectomy failure in glaucoma surgery is the imperfect formation of the filter bubble, which blocks the filtration effect. This systematic review and meta-analysis aimed to compare the effects and safety of mitomycin C (MMC) or no antimetabolite in trabeculectomies cases that require needling revision. Methods. We searched PubMed, Cochrane, and EMBASE to identify randomized trials published between the time the databases were built and May 31, 2022. To compare the effectiveness and safety of mitomycin with or without mitomycin in trabeculectomy, intraocular pressure (IOP), the surgical failure rate, and functional follicle formation were used as efficacy indicators, and the occurrence of postoperative complications was used as a safety indicator. Meta-analyses were performed for comparisons. Results and Discussion. After trabeculectomy, MMC was significantly better than a placebo at lowering postoperative IOP (MD = −11.31 mmHg, 95% CI −19.73 to −2.88 mmHg). MMC outperformed the control group in terms of filtering blebs formation (relative risk (RR) = 1.18, 95% CI: 1.09 to 1.27). The surgical failure rate was significantly lower with MMC compared to placebo (RR = 0.35, 95% CI: 0.22 to 0.58). No significant difference was observed between MMC and placebo in terms of hypotony, anterior chamber bleeding, filter bubble leakage, and endophthalmitis, apart from the shallow anterior chamber (RR: 1.51, 95% CI: 1.02 to 2.25). What Is New and Conclusion. The use of MMC in glaucoma trabeculectomy can increase the success rate of the procedure and provide significant patient benefits. However, it is important to be extremely careful and aware of complications such as shallow anterior chambers.

Incidence and Risk Factors for Secondary Glaucoma in Eyes with Uveal Melanoma

To estimate incidence of and analyze risk factors for developing secondary glaucoma in eyes with uveal melanoma before and after diagnosis. A cross-sectional, population-based cohort study. Seven hundred eighty-one patients (median age, 64 years; range, 14-93) consecutively diagnosed with uveal melanoma from 1997 to 2012 in a national ocular oncology service, 708 (91%) of whom received ruthenium (50%) or iodine (50%) brachytherapy. Patient, tumor, treatment, and follow-up data were collected prospectively. Frequency and associations of melanoma-related glaucoma at tumor diagnosis were assessed. Incidence of developing secondary glaucoma after diagnosis was estimated by Kaplan-Meier analysis. Independent risk factors were modeled using Cox regression. Melanoma-related glaucoma and related risk factors. Forty-five patients (5.8%; 95% confidence interval [CI], 4.2-7.6) had tumor-related secondary glaucoma at diagnosis, 34 (76%) from a narrow-to-closed angle (25 had direct angle invasion) and 10 (22%) from anterior neovascularization. Synchronous metastases were common in patients with initial secondary glaucoma (11% vs. 1.2% with incident glaucoma, P= 0.005). Patients with secondary glaucoma were often male (58% vs. 48% without glaucoma; P= 0.010) and had larger tumors (median thickness, 9.1 vs. 4.0 mm; P < 0.001) involving the ciliary body (43% vs. 21%; P < 0.001) with retinal detachment (53% vs. 30%; P < 0.001). One hundred and sixty-eight patients 165 of which were treated with brachytherapy developed incident tumor- or treatment-related secondary glaucoma a median of 1.7 years (range, 0.1-13.6) after tumor diagnosis. Cumulative proportion of developing secondary glaucoma was 23% (95% CI, 20-27) at 5 years. The most common mechanism was neovascularization in 119 patients (71%; 95% CI, 63-78). By multivariable regression, initial retinal detachment 3 to 4 quadrants (hazard ratio [HR], 2.18; P < 0.001), initial intraocular pressure 17 mmHg or higher (HR, 1.64; P= 0.01), and tumor thickness predicted incident secondary glaucoma. Secondary glaucoma at initial uveal melanoma diagnosis predicts high risk of synchronous metastases. Although anterior neovascularization is the most common mechanism for secondary glaucoma after diagnosis, other mechanisms such as angle narrowing and anterior chamber hemorrhage are not infrequent. Initial retinal detachment and intraocular pressure with tumor thickness could inform interim assessments of intraocular pressure and neovascularization.

Case Report: Intraocular Hemorrhage in a Primary Vitreoretinal Lymphoma Patient Treated With Zanubrutinib

PurposeTo report a case of primary vitreoretinal lymphoma (PVRL) treated with oral zanubrutinib, who had bilateral intraocular hemorrhage after intravitreal injection of methotrexate (MTX).Case reportA 69-year-old Chinese female presented with vision decrease in both eyes. After diagnostic vitrectomy, the patient was diagnosed as PVRL in both eyes, and was treated with intravenous rituximab, oral zanubrutinib and bilateral intravitreal MTX. There were bilateral anterior chamber and vitreous hemorrhage after the fourth intravitreal MTX combined with paracentesis. After discontinuation of zanubrutinib, vitrectomy and silicon oil tamponade were performed on the left eye, and the blood in the right eye was absorbed.ConclusionBleeding is a major concern in the use of zanubrutinib. It is suggested that drugs be held for a few days prior to procedures and surgeries.

Clinical Practice of Cataract Special Care Standards in Nonophthalmic Wards

Cataract is a lens metabolism disease, which is caused by various factors, and leads to metamorphic lens proteins turbidity. Cataract commonly occurs in elderly patients, and majority of these patients have clinical manifestations of blurred vision and other symptoms. In this study, we explored the clinical practice and observations of cataract care criteria in nonophthalmic wards. To realize this, a total of one hundred and twenty (120) cataract patients, admitted to the East Department of Ophthalmology, Shanghai Sixth People's Hospital, particularly from April 2019-2020, were divided into the control and observation groups, where 60 cases were added to each group. The control group received routine nursing, and observation group was treated with cataract care criteria based on the control group. The complication rate, health cognition, and patient's satisfaction were compared with existing approaches. The incidence of corneal edema, anterior chamber hemorrhage, endophthalmitis, and incision infection, specifically in the observation group, was lower than that in the control group (P < 0.05). Likewise, the number of hospitalization days and expenses, specifically in the observation group, were lower than those in the control group (P < 0.05). Health knowledge and satisfaction scores of the observation group were higher than the control group (P < 0.05). Active service, service attitude, psychological support, caring patients, and health education dissatisfaction rate of the observation group were lower than the control group (P < 0.05). Finally, the standard of cataract care in nonophthalmic wards reduces the incidence of complications, improve health awareness of patients, and help to improve satisfaction of patients with nurses. Furthermore, it is worthy of promotion and application particularly in traditional hospitals.

Microcatheter-Assisted Trabeculotomy Combined With Deep Sclerectomy and Trabeculectomy in Young to Middle-Aged Adults With Advanced Primary Open-Angle Glaucoma: 1-Year Result.

Objective: We aimed to evaluate the safety and clinical efficacy of ab externo microcatheter-assisted trabeculotomy combined with deep sclerectomy and trabeculectomy (MATT-DS-Trab) in the surgical management of advanced primary open-angle glaucoma (POAG).Methods: According to the inclusion criteria, we retrospectively collected and analyzed 37 POAG cases in advanced stage who received MATT-DS-Trab. The intraocular pressure (IOP), best corrected visual acuity (BCVA), use of anti-glaucoma drugs, shape of the filtering bleb, size of the scleral lake, complications, and the surgical success rate were recorded.Results: The mean IOP was 37.50 ± 8.11 mmHg before the operation, while it depleted to 10.08 ± 2.01 and 11.43 ± 2.07 mmHg at 1 week and 12 months after the operation, respectively (both P < 0.001 compared to preoperative IOP). From none to two kinds of anti-glaucoma drugs were used 12 months after surgery on the patients, which were significantly reduced compared with that preoperatively (P < 0.001). An L-type filtering bleb was the main form at all time points after the operation. At 12 months following surgery, an F-type filtering bleb accounted for 5.41% and no E-type filtering bleb was recorded. The length and height of the scleral lake shrunk with time, but there was no statistical significance (P > 0.05). Also, there was no correlation between the size of the scleral pool and the IOP (P > 0.05). At 12 months after the operation, the complete success rates were 94.59, 83.78, and 72.97% according to standards A (≤18 mmHg), B (≤15 mmHg), and C (≤12 mmHg), respectively. Intraoperative complications were mainly anterior chamber hemorrhage, and no complications related to the filtration bleb were observed after the operation.Conclusion: Based on multichannel mechanisms, MATT-DS-Trab is able to effectively reduce IOP in advanced POAG patients, with few serious complications and a high success rate.

A Systematic Review on Three Major Types of Scleral-Fixated Intraocular Lens Implantation.

We performed a systematic review on 3 major types of scleral-fixated intraocular lens (SFIOL) implantations and conducted subgroup analyses on pediatric population and subjects with Marfan syndrome. Systematic review. We performed a search in PubMed, Ovid MEDLINE, and Embase for English language articles with keywords "(sutured intraocular lens) OR (SFIOL) OR (sutureless intraocular lens) OR (glued intraocular lens) OR (intrascleral intraocular lens) OR (SFIOL)" through October 16, 2019. Articles reporting individual outcomes after SFIOL were included in this systematic review. Recorded outcome measures included intraoperative and postoperative complications, endothelial cell changes, and intraocular lens-related outcomes. Our search yielded 217 papers. After removing duplicated and irrelevant reports, we included 57 articles involving 2624 eyes. The mean age at operation was 51.47 ± 25.62 years. Sutured SFIOL was most commonly reported in all subjects with Marfan syndrome and 92.87% of pediatric patients. The pooled intraoperative complication rate was 6.65%. Minor anterior chamber hemorrhage was the most common intraoperative (1.92%) and postoperative complication (13.93%). Optic capture was the top intraocular lens (IOL)-related complication (4.47%). The overall mean endothelial cell loss was 8.95% at 16.77 ± 11.04 months. Overall 11.99% of SFIOLs were decentred with a mean distance of 0.49 ± 0.40 mm and a mean degree of tilt by 4.11 ± 3.03°. Glued SFIOL had the fewest IOL-related complications and the lowest endothelial cell loss. Sutured SFIOL carried the highest IOL-related complications, whereas sutureless, glueless SFIOL was associated with the greatest endothelial cell loss.

Cataract Surgery (Phacoemulsification with Intraocular Lens Implantation) Combined with Endoscopic Goniosynechialysis for Advanced Primary Angle-Closure Glaucoma

To evaluate the efficacy and risk of cataract surgery (phacoemulsification with intraocular lens [IOL] implantation) combined with endoscopic goniosynechialysis (EGSL) for advanced primary angle-closure glaucoma (PACG). Retrospective, continuous case series. A total of 16 patients (18 eyes) with advanced PACG were enrolled in this study between February 2014 and March 2016. Advanced glaucoma inclusion criteria were based on the method proposed in the Advanced Glaucoma Intervention Study, with a visual field score of 18 points or more. All patients underwent cataract surgery with EGSL by the same experienced surgeon. Paired t test and generalized estimating equation analyses were performed. The extent of peripheral anterior synechiae (PAS), number of intraocular pressure (IOP)-lowering drugs, IOP, best-corrected visual acuity (BCVA), and visual fields before and after surgery. The incidence of complications was recorded. The mean follow-up duration was 13.8 months (standard deviation, 2.7 months). The mean difference (preoperative minus postoperative) in PAS was 202.7° (95% confidence interval [CI], 43.5°). The mean difference (preoperative minus postoperative) in the number of IOP-lowering drugs and IOP was 2.0 (95% CI, ±0.5), and 9.4 mmHg (95% CI, ±2.1 mmHg) respectively. The mean improvement in BCVA was 0.29 logMAR (95% CI, ±0.14). A positive correlation was found between the extent of postoperative PAS and postoperative IOP (B= 8.2; P < 0.001) and also between postoperative PAS and postoperative number of IOP-lowering drugs (B= 28.9; P < 0.001). Anterior chamber hemorrhage and exudation occurred in 4 patients and 2 patients, respectively, after surgery. Posterior capsular opacification occurred in 5 patients after surgery. Cataract surgery with EGSL could be an effective surgical method for the treatment of advanced PACG.

Combined aspirin and clopidogrel therapy in phacoemulsification cataract surgery: a risk factor for ocular hemorrhage?

To evaluate the safety of phacoemulsification cataract surgery in the patients undergoing dual antiplatelet therapy with aspirin and clopidogrel. Consecutive patients undergoing phacoemulsification cataract surgery with a clear corneal incision under topical anesthesia were eligible for inclusion in the study. Thirty-eight eyes from 38 patients on combined aspirin and clopidogrel therapy who continued the treatment were classified into the maintenance group, a matched group of 38 eyes from 38 patients on no antiplatelet/anticoagulant therapy as the control group. The best-corrected visual acuity (BCVA) and incidences of complications were compared between the two groups. There was no significant difference in final BCVA between the maintenance group and the control group (p = 0.178). No significant difference existed in the incidences of hemorrhagic or non-hemorrhagic complications between the two groups (p = 0.529 and p = 0.589, respectively). Moreover, no surgery was postponed or cancelled due to hemorrhagic complications in either group, and no cardiovascular events occurred during the follow-up. There was no case of anterior chamber hemorrhage, vitreous hemorrhage, or suprachoroidal hemorrhage. Our outcomes indicated that phacoemulsification cataract surgery using a clear corneal incision with topical anesthesia could be safely done without stopping dual antiplatelet therapy with aspirin and clopidogrel.

Anti-vascular endothelial growth factor for neovascular glaucoma.

Neovascular glaucoma (NVG) is a potentially blinding, secondary glaucoma. It is caused by the formation of abnormal new blood vessels, which prevent normal drainage of aqueous from the anterior segment of the eye. Anti-vascular endothelial growth factor (anti-VEGF) medications are specific inhibitors of the primary mediators of neovascularization. Studies have reportedthe effectiveness of anti-VEGF medications for the control of intraocular pressure (IOP) in NVG. To assess the effectiveness of intraocular anti-VEGF medications, alone or with one or more type of conventional therapy, compared with no anti-VEGF medications for the treatment of NVG. We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register); MEDLINE; Embase; PubMed; and LILACS to 22 March 2019; metaRegister of Controlled Trials to 13 August 2013; and two additional trial registers to 22 March 2019. We did not use any date or language restrictions in the electronic search for trials. We included randomised controlled trials (RCTs) of people treated with anti-VEGF medications for NVG. Two review authors independently assessed the search results for trials, extracted data, and assessed risk of bias, and the certainty of the evidence. We resolved discrepancies through discussion. We included four RCTs (263 participants) and identified one ongoing RCT. Each trial was conducted in a different country: China, Brazil, Egypt, and Japan. We assessed the trials to have an unclear risk of bias for most domains due to insufficient information. Two trials compared intravitreal bevacizumab combined with Ahmed valve implantation and panretinal photocoagulation (PRP) with Ahmed valve implantation and PRP. We did not combine these two trials due to substantial clinical and statistical heterogeneity. One trial randomised participants to receive an injection of either an intravitreal anti-VEGF medication or placebo at the first visit, followed by non-randomised treatment according to clinical findings after one week. The last trial randomised participants to PRP with and without ranibizumab, but details of the study were unavailable for further analysis. Two trials that examined IOP showed inconsistent results. One found inconclusive results for mean IOP between participants who received anti-VEGF medications and those who did not, at one month (mean difference [MD] -1.60 mmHg, 95% confidence interval [CI] -4.98 to 1.78; 40 participants), and at one year (MD 1.40 mmHg, 95% CI -4.04 to 6.84; 30 participants). Sixty-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 60% without anti-VEGF medications. In another trial, those who received anti-VEGF medications were more likely to reduce their IOP than those who did not receive them, at one month (MD -6.50 mmHg, 95% CI -7.93 to -5.07; 40 participants), and at one year (MD -12.00 mmHg, 95% CI -16.79 to -7.21; 40 participants). Ninety-five percent of the participants with anti-VEGF medications achieved IOP ≤ 21 mmHg, versus 50% without anti-VEGF medications. The certainty of a body of evidence was low for this outcome due to limitations in the design and inconsistency of results between studies. Post-operative complications included anterior chamber bleeding (3 eyes) and conjunctival hemorrhage (2 participants) in the anti-VEGF medications group, and retinal detachment and phthisis bulbi (1 participant each) in the control group. The certainty of evidence is low due to imprecision of results and indirectness of evidence. No trial reported the proportion of participants with improvement in visual acuity, proportion of participants with complete regression of new iris vessels, or the proportion of participants with relief of pain and resolution of redness at four- to six-week, or one-year follow-up. Currently available evidence is uncertain regarding the long-term effectiveness of anti-VEGF medications, such as intravitreal ranibizumab or bevacizumab or aflibercept, as an adjunct to conventional treatment in lowering IOP in NVG. More research is needed to investigate the long-term effect of these medications compared with, or in addition to, conventional surgical or medical treatment in lowering IOP in NVG.

Clinical observation on intravitreal anti-VEGF injection combined with trabeculectomy for neovascular glaucoma

Objective To evaluate the efficacy of intravitreal anti-VEGF injection combined with trabeculectomy in the treatment of neovascular glaucoma. Methods The data of 31 eyes of 30 patients with neovascular glaucoma from Oct. 2015 to May 2017 were analyzed retrospectively. All cases underwent intravitreal anti-VEGF(Conbercept or Lucentis) injection combined with trabeculectomy. Trabeculectomy was performed at 1 week after injection and the follow-up time was 6 months after surgery. Results The post-operative visual acuity(VA) were all significantly increased at 1 week, 1 and 6 months compared with those before surgery (P<0.05). The average intraocular pressure at 1 week, 1 and 6 months were(16.3±1.7)mmHg, (18.2±1.9)mmHg and (18.4±1.6)mmHg (1 mmHg=0.133 kPa) respectively. The difference were statistically significant between before and after surgery (P<0.01). At 1 week after surgery all cases had functional filter bleb. At 6 months after surgery, the functional and non-functional filtering blebs occurred in 25 eyes(80.65%) and 6 eyes(19.35%) respectively. Iris neovascularization and intraocular pressure elevation were found in 1 eye (3.23%)because of poor glycemic control. The IOP returned to normal after intravitreal anti-VEGF injection combined with filter bleb separation. The mainly postoperative complications were hyphema, shallow anterior chamber, anterior uveitis and vitreous hemorrhage. Conclusion Intravitreal anti-VEGF injection combined with trabeculectomy in treatment of neovascular glaucoma is effective. Key words: Glaucoma, neovascular; Injection, intravitreal; Anti-VEGF; Trabeculectomy

Effect of Anticoagulants and Surgeon-Related Factors on Short-term Outcomes of Laser Peripheral Iridotomy

To assess the effects of surgeon-related factors on laser peripheral iridotomy (LPI) outcomes by comparing residents and glaucoma specialists, and to look for demographic and clinical predictive factors associated with LPI complications. Retrospective cohort study. Patients who underwent LPI performed by a resident physician were included as cases, and patients who underwent LPI performed by a glaucoma specialist were included as controls. In patients who underwent multiple sessions of laser therapy, only the information from the first session of each eye was included in the study. Demographic and clinical information were gathered from the pre-LPI, 1-week, 1-month, and 3-month follow-up visits. The following information was recorded from the LPI session: total laser energy, presence of bleeding, and post-laser intraocular pressure (IOP). Information gathered from the follow-up visits included visual acuity (VA), IOP, hyphema, and need to repeat LPI. A logistic regression analysis with modification for rare events was used to examine the relationship between the dependent variables and the group, adjusted for the clinical and demographic characteristics of patients. The LPI procedure parameters (total energy), postoperative VA and IOP, risk for complications, and need for re-treatment were compared between groups using odds ratio (OR) measurements. A total of 333 eyes were included in the study. The residents used statistically significant higher total energy compared with the glaucoma specialists' group (P < 0.001). After adjusting for demographic characteristics, antiplatelet/anticoagulant use, and laser energy parameters, we found that the patients of the residents group had a significantly increased likelihood for re-treatment within 3 months (OR, 3.38; 95% confidence interval [CI], 1.31-8.73) and anterior chamber bleeding (OR, 7.48; 95% CI, 1.07-52.02). Although LPI is an effective and minimally invasive procedure, evidence shows that a higher level of experience leads to clinically and statistically significant better outcomes.

Clinical observation of microcatheter assisted trabeculotomy on the treatment of childhood glaucoma

Objective To investigate the clinical efficacy and safety of microcatheter assisted trabeculectomy on the treatment of childhood glaucoma. Methods A prospective case series method was performed.Sixteen childhood glaucoma with 22 eyes were enrolled in Henan Eye Hospital and Zhengzhou Second People's Hospital from December 2016 to August 2017.Nine males with 12 eyes and 7 females with 10 eyes were included, and the age ranged from 6 months to 8 years (median 4 years). All the subjects underwent microcatheter assisted trabeculectomy.The intraocular pressure changes were observed preoperation and 7 days, 1 month and 6 months after surgery, and the postoperative complications were analyzed.This study was approved by the Ethics Committee of Henan Eye Hospital (2018KS-01)and Zhengzhou Secord People's Hospital (No.20161202001), and adhered to the tenets of the Declaration of Helsinki.Written informed consent was obtained from each guardia prior to any medical examination. Results Twenty eyes of 14 patients underwent microcatheter assisted trabeculectomy, the success rate was 90.91%.Twelve eyes were operated with full incision (incision range was 360°), 8 eyes were performed with subtotal incision (incision range was 180°-330°), while the microcatheter could not pass over 90° in 2 eyes and was switch to traditional Harms knife trabeculotomy-trabeculectomy intraoperatively.The intraocular pressures of the 20 eyes that underwent microcatheter assisted trabeculectomy preoperation, 7 days, 1 month and 6 months after surgery were (26.55±4.38), (20.48±3.62), (13.71±6.35) and (12.67±5.37)mmHg, respectively.The intraocular pressures in patients at different time points were statistically significant (F=112.771, P<0.001). At the last follow-up, the intraocular pressures of 18 eyes were controlled.Among them, 16 eyes achieved completely controlled intraocular pressure while 2 eyes returned to normal intraocular pressure after using ocular hypotensive drugs.The intraocular pressure of 2 eyes increased again after operation, and the intraocular pressure could not be controlled after combined use of anti-hypertensive drugs.All patients had no serious complications during and after the operation.Different degrees of anterior chamber hemorrhage occurred in 16 eyes during the surgery, and all the hemorrhages were absorbed within 1 week after surgery. Conclusions For children with glaucoma, microcatheter assisted trabeculectomy can achieve good intraocular pressure reduction effect without serious complications. Key words: Trabeculotomy; Childhood glaucoma; Microcatheter; Intraocular pressure

Application of self-made iris retractors in surgeries of cataract with small pupil

Objective To evaluate the efficacy of application of self-made iris retractors in surgeries of cataract with small pupil. Methods The data of 35 eyes of 32 cases of cataract with miosis due to glaucoma surgery, uveitis and etc from Jan. 2018 to Aug. 2018 were analyzed retrospectively. All cases underwent phacoemulsification and intraocular lens implantation with self-made iris retractors. The patients were followed up for 3-6 months. Results All the 35 eyes achieved square pupils of 5.0-6.0 mm in side length during operation, and the continuous circular capsulorhexis and phacoemulsification were successfully completed. Only 1 eye had minor iris hemorrhage during operation, but it did not affect the surgery. The pupil was nearly circular with diameter of 3.0-4.0 mm after surgery. The pupillary light reaction was normal or sluggish. Visual acuity was significantly improved after surgery. No complication such as posterior capsule rupture, pupil tear, anterior chamber hemorrhage or elevated intraocular pressure occurred. Conclusion Application of self-made iris retractors for the treatment of cataract with small pupil can enlarge the pupil and obtain favorable results. The self-made iris retractors are easy to make and simple and safe to use. Key words: Iris; Miosis; Phacoemulsification

Intracameral Phenylephrine to Arrest Intraoperative Intraocular Bleeding: A New Technique.

Intraoperative intraocular bleeding can present a major challenge during anterior segment operations, such as cataract and glaucoma surgery. In the presence of significant intraocular bleeding, the surgeon may be unable to proceed if the bleeding cannot be controlled. Uncontrolled bleeding may also result in intraoperative or postoperative complications. Intracameral injection of phenylephrine was used in three consecutive cases of intraoperative anterior chamber bleeding during cataract surgery, one of which was combined with CyPass® Micro-Stent insertion. This resulted in complete cessation of bleeding within a minute of the injection. No further intraoperative or postoperative hemorrhage was seen. As far as we know, this is the first report of intracameral phenylephrine use intraoperatively to successfully stop anterior chamber bleeding, enabling safe completion of surgery.Electronic supplementary materialThe online version of this article (10.1007/s40123-019-0165-y) contains supplementary material, which is available to authorized users.