Stanley Eye Unit, Abergele Hospital, Llanfair Road, Abergele, Conwy, Wales, UK.
Section of Academic Ophthalmology, School of Life Course Sciences, FoLSM, King's College London, London, UK.
BMC Surg. 2021 Apr 19;21(1):200. doi: 10.1186/s12893-021-01176-5.
Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC).
Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure.
A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries.
There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.
葡萄膜炎性青光眼通常比其他类型的青光眼导致更严重的视神经损伤，引起青光眼视神经和视野缺损。前葡萄膜炎是最常见的相关危险因素。当所有的药物治疗都失败时，通常需要手术干预。我们报告了 16 只患有葡萄膜炎性青光眼的眼睛，通过黏弹剂巩膜切开术（VC）/超声乳化黏弹剂巩膜切开术（PVC）进行治疗的五年结果。
对所有符合五年随访的葡萄膜炎性青光眼病例进行回顾性分析。所有患者均接受 VC 或 PVC 手术治疗。评估的结果包括术前、术后第 1 天、第 1 年至第 5 年的眼压测量。完全成功定义为眼压（IOP）低于 21mmHg 或药物治疗降低 30%，而合格成功定义为 IOP 低于 21mmHg 或药物治疗降低 30%和（或）激光房角切开术（LGP）。如果由于青光眼进展需要进一步手术降低眼压，则将其归类为失败。
共对 16 例葡萄膜炎性青光眼患者进行了回顾。第 1 年完全成功的患者占 75%，第 3 年为 50%，第 5 年为 19%。相反，第 1 年有 94%的患者获得了合格成功，第 3 年为 86%，第 5 年为 75%。在需要进一步手术的患者组中，50%的患者之前进行过手术，包括白内障手术、小梁切除术和黏弹剂巩膜切开术。在初次手术前，他们平均使用了 4 种术前滴眼剂，在 5 年随访时，平均减少了 1.1 种眼部药物。成功率与较低的平均干预次数和较低的既往手术比例相关。
在葡萄膜炎性青光眼患者中，PVC 的应用信息仍然非常有限。非穿透性青光眼手术（NPGS）的优点包括无需进入前房和避免虹膜切除术，这可能减少眼内炎症和术后并发症。我们的研究表明，非穿透性手术在治疗晚期葡萄膜炎性青光眼方面是成功的。
