Asia-Pacific Journal of Ophthalmology最新文献

Purpose: To report the 24-month efficacy and safety of ab externo penetrating canaloplasty compared with trabeculectomy in the treatment of primary angle-closure glaucoma (PACG).

Methods: This is a prospective, randomized, controlled trial. Patients with PACG and inadequately controlled intraocular pressure (IOP) were recruited. Patients enrolled were randomized to either ab externo penetrating canaloplasty (PCP group) or trabeculectomy (TRAB group). The main outcome measures were intraocular pressure (IOP), number of glaucoma medications, success rate and ocular surface disease index (OSDI) questionnaire. Surgical success (definition 1) was defined as 6 mm Hg ≤ IOP ≤ 21 mm Hg with an IOP reduction of ≥ 20 % without glaucoma medications (complete success) or regardless of glaucoma medications (qualified success).

Results: A total of 52 eyes (44 patients) were finally enrolled with 25 eyes in PCP group and 27 eyes in TRAB group. PCP group (85.0 %) had a similar qualified success rate compared with TRAB group (87.0 %) with definition 1 at 24 months in intention to treat (ITT) analysis (P = 1.000). In per protocol (PP) analysis, the qualified success with definition 1 were 81.3 % in PCP group and 87.0 % in TRAB group (P = 0.972). But PCP group had a lower success rate in postoperative IOP ≤ 15 mm Hg with an IOP reduction of ≥ 20 % than in TRAB group, in ITT analysis with complete success (PCP 35.0 % vs TRAB 65.2 %, P = 0.048) and PP analysis with qualified success (PCP 31.3 % vs. TRAB 69.6 %, P = 0.025). The mean OSDI score was equal in PCP group (11.9 ± 8.5) and TRAB group (16.6 ± 14.3) (P = 0.302). Hypotony-associated complications were the main complications in PCP group and TRAB group (24.0 % vs. 33.3 %, P = 0.458).

Conclusions: Compared with trabeculectomy, ab externo penetrating canaloplasty had a similar qualified success rate and comparable complications at 24 months. Without frequent bleb interventions, penetrating canaloplasty may be a promising surgery for PACG patients especially with early or mild stages.

Purpose: To assess the efficacy and safety of a novel non-inverted, free single-layer internal limiting membrane (ILM) flap technique for treating large full-thickness macular holes (FTMHs).

Methods: Patients with FTMHs underwent a standard 3-port pars plana vitrectomy using the 23-gauge vitrectomy system. Unique to this technique, a "tongue-shaped" ILM flap was initially created, followed by the formation of two "handles" and the bottom of "plastic bag" ILM flaps. Under perfluoro-n-octane (PFO), the two-point fixed "plastic bag" ILM flap was transferred to the free flap and dragged to cover MH using the ocular viscoelastic device (OVD) to cover the margin of the ILM flap, followed by gas tamponade. Preoperative and postoperative assessments included best-corrected visual acuity (BCVA) and spectral domain optical coherence tomography (SD-OCT).

Results: The 13 patients (mean age 64.38 ± 8.08 years, macular diameter 664.85 ± 153.38μm) demonstrated a significant improvement in BCVA from 1.03 ± 0.22 logMAR preoperatively to 0.78 ± 0.26 logMAR postoperatively (P = 0.0004). In all cases, successful closure of the MH was accomplished, including 10 (76.92%) U-shaped closure, 1 (7.69%) flat closure, 1 (7.69%) W-shaped closure, 1 (7.69%) flap closure, with no ILM flap dislocations.

Conclusions: The non-inverted single-layer "plastic bag" ILM flap technique has been demonstrated to be both a safe and effective method for managing large FTMHs, offering a promising alternative to traditional methods with improved anatomical restorations and stable visual outcomes.

Myopia stands as a prevalent ocular condition with global implications, impacting individuals at various life stages. In school-age children and adolescents, uncorrected myopia impedes reading and academic performance. Among middle-aged and elderly populations, myopia poses severe risks such as macular degeneration, macular holes and retinal detachment, leading to irreversible visual impairment. The term "myopia management" is widely embraced by ophthalmic practitioners and optometry associations worldwide, encompassing strategies to correct refractive errors and ongoing assessment of disease progression, aiming to reduce the progression of myopia and axial elongation. To date, current management strategies for myopia include public health policies, optical solutions, medical interventions and surgical options, but these interventions are general and lack age specificity. Despite existing interventions, we propose the concept of "Whole Life Cycle Myopia Management" in this review. This approach outlined major risk factors of myopia through the whole life cycle, discussed current interventions for myopia and provided age-specific management strategies for myopia of eight different life stages-infancies, toddlers, preschoolers, school-age children, adolescents, young adults, middle-age and old-age, including the prevention of myopia onset, slowing of myopia progression and monitoring of myopia complications. Achieving the "Whole Life Cycle Myopia Management" requires collaborations efforts from government, schools, hospitals and families, to restore vision and enhance the quality of life for those individuals affected by myopia.