scholarly journals Short-Term Observation of Ultrasonic Cyclocoagulation in Chinese Patients with End-Stage Refractory Glaucoma: A Retrospective Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Dongpeng Hu ◽  
Shu Tu ◽  
Chengguo Zuo ◽  
Jian Ge

Purpose. To assess the efficacy and safety of HIFU-based ultrasonic cyclocoagulation in Chinese patients with end-stage refractory glaucoma. Method. Patients were recruited consecutively from May 2016 to May 2017 in the Zhongshan Ophthalmic Center. Ultrasonic cyclocoagulation was performed on every patient, using the EyeOP1 ultrasound emitting device. Return visits were set at 1 day, 7 days, 1 month, and 3 months after the treatment. An intraocular pressure (IOP) reduction of ≥20% while IOP ≥ 5 mmHg was deemed as success. Mean IOP change was assessed. Efficacy of two modes (6 sectors and 8 sectors) was also compared. Complications were recorded for safety evaluation. Results. 61 eyes were treated in this study. The baseline IOP (mean ± SD) was 41.11 ± 10.65 mmHg. The percentage of IOP reduction after treatment was 29.2%, 43.2%, 34.8%, and 23.1% at 1 day, 7 days, 1 month, and 3 months, respectively. Overall success rate at 3 months was 50.0% (26/52). No significant difference was found between the 6 sectors group and the 8 sectors group in terms of the success rate (48.6% vs. 52.9%, p=0.768) as well as IOP reduction (p=0.417) at 3 months. Primary angle-closure glaucoma (PACG) had the highest success rate (80.0%, 12/15). Scleral thinning existed in 12 eyes, among which 2 developed hypotony (2 mmHg and 3 mmHg). Average pain score decreased massively compared with baseline data. Conclusion. With high percentage of IOP reduction and a good safety profile observed in our study, HIFU-based ultrasonic cyclocoagulation might become a promising alternative to cyclodestructive methods. Long-term efficacy and safety need further assessment. The study was registered with Chinese Clinical Trial Registry (http://www.chictr.org.cn; Registration number: ChiCTR-OOC-17014028).

2020 ◽  
pp. 112067212097360
Author(s):  
Zhou Longfang ◽  
Hu Die ◽  
Lan Jie ◽  
Liu Yameng ◽  
Lv Mingyuan ◽  
...  

Purpose: To evaluate clinical efficacy and safety of single Ultrasound Cyclo-Plasty (UCP) in the treatment of advanced refractory glaucoma. Methods: From January 2018 to August 2018, 25 patients (25 eyes) with refractory glaucoma and intraocular pressure (IOP) not controlled by drugs or conventional filtering surgery were included in the study. All subjects (neovascular glaucoma [ n = 12], secondary glaucoma [ n = 6], angle closure glaucoma [ n = 6], and primary open angle glaucoma [ n = 1]) underwent 8-sector Ultrasound Cyclo-Plasty. Patients were followed-up at Day 1, Week 1, and at 1, 3, 6, and 12 months, during which the IOP, the number of IOP lowering drugs and the occurrence of ocular complications were recorded. Clinical outcomes were IOP reduction, success rate, and ocular complications. According to the glaucoma type, patients were divided into a neovascular group (NVG) and a non-NVG group for sub-analysis. Results: All patients underwent a single UCP procedure and mean IOP reduced significantly from 39.7 ± 6.1 mmHg before UCP to 27.1 ± 11.0 mmHg at 1 year ( p < 0.01) corresponding to a mean IOP reduction of 29.6%. The mean number of IOP-lowering drugs used was 2.4 ± 1.2 at baseline and 2.3 ± 1.0 at 12 months. Success rate after a single UCP procedure was achieved in 41.7% patients at 1 year, with a higher success rate in non-NVG than in the NVG group. No major postoperative complications were reported. The main complication was conjunctival congestion, anterior chamber inflammation, scleral ring congestion, and scleral inprint. Of these, scleral ring congestion and scleral imprint are relatively rare complications, which can still be observed 12 months after UCP treatment. Conclusion: UCP for refractory glaucoma is effective in reducing IOP and has a good safety profile. Success rate is lower after a single UCP in NVG than for other types of glaucoma.


Author(s):  
Ying Zhang ◽  
Xu Hao ◽  
Kelu Hou ◽  
Lei Hu ◽  
Jingyuan Shang ◽  
...  

Aims: To assess the impact of cytochrome P450 (CYP) 2C19 polymorphisms on the clinical efficacy and safety of voriconazole. Methods: We systematically searched PubMed, EMBASE, CENTRAL, ClinicalTrials.gov, and three Chinese databases from their inception to March 18, 2021 using a predefined search algorithm to identify relevant studies. Studies that reported voriconazole-treated patients and information on CYP2C19 polymorphisms were included. The efficacy outcome was success rate. The safety outcomes included overall adverse events, hepatotoxicity and neurotoxicity. Results: A total of 20 studies were included. Intermediate metabolizers (IMs) and Poor metabolizers (PMs) were associated with increased success rates compared with normal metabolizers (NMs) (risk ratio (RR): 1.18, 95% confidence interval (CI): 1.03~1.34, I2=0%, p=0.02; RR: 1.28, 95%CI: 1.06~1.54, I2=0%, p=0.01). PMs were at increased risk of overall adverse events in comparison with NMs and IMs (RR: 2.18, 95%CI: 1.35~3.53, I2=0%, p=0.001; RR: 1.80, 95% CI: 1.23~2.64, I2=0%, p=0.003). PMs demonstrated a trend towards an increased incidence of hepatotoxicity when compared with NMs (RR: 1.60, 95%CI: 0.94~2.74, I2=27%, p=0.08), although there was no statistically significant difference. In addition, there was no significant association between CYP2C19 polymorphisms and neurotoxicity. Conclusions: IMs and PMs were at a significant higher success rate in comparison with NMs. PMs were significantly associated with an increased incidence of all adverse events compared with NMs and IMs. Researches are expected to further confirm these findings. Additionally, the relationship between hepatotoxicity and CYP2C19 polymorphisms deservers clinical attention.


2021 ◽  
Author(s):  
Haoyang Wang ◽  
Wei Wang ◽  
Yongsheng Xu ◽  
Jianan Li ◽  
Kang Liu ◽  
...  

Abstract BackgroundIntra-articular injection of hyaluronic acid (HA) has favorable effects on pain relief and knee function along with the low incidence of serious adverse reactions. Although various HA products are available for the treatment of knee osteoarthritis, it is still controversial whether differences in HA products have any clinically significant difference in efficacy and safety. In light of the above, the efficacy and safety of intra-articular injection of biological fermentation–derived high-molecular-weight HA (NRD101) was investigated in a double-blind comparative manner in Chinese patients with knee osteoarthritis.MethodA multicenter, prospective, randomized, double-blind, parallel, active control, non-inferiority study was conducted in Chinese patients with knee osteoarthritis. Patients were randomized to receive five consecutive weekly injections of either NRD101 or Artz (a non-crosslinked low-molecular-weight HA derived from combs of roosters) followed by 4 weeks follow-up. The primary efficacy endpoint was the change from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) NRS pain subscale score at Week 5. Secondary efficacy endpoints included WOMAC stiffness and physical function subscale score, local pain, range of joint motion, and overall improvement.ResultsAmong 267 randomized patients, 259 patients completed the study. The change from baseline in WOMAC NRS pain subscale score at Week 5 was −2.98 ± 0.193 in the NRD101 group and −2.66 ± 0.194 in the Artz group, and the trial met the non-inferiority criteria. Efficacy in the NRD101 group tended to be consistently higher than in the Artz group for most items of WOMAC. Several subgroup analyses also showed differences between the two groups, tending to favor NRD101. Adverse events were seen in 26.0% (34/131) of patients in the NRD101 group and 38.3% (51/133) in the Artz group.ConclusionsNRD101 improved knee pain in Chinese patients with osteoarthritis after five consecutive weekly injections. NRD101 tended to be somewhat more effective than Artz. No new safety concerns were identified.Trial registration: JapicCTI, JapicCTI-173531. Registered 10 March 2017, https://www.clinicaltrials.jp/cti-user/trial/Search.jsp


2002 ◽  
Vol 30 (3) ◽  
pp. 330-336 ◽  
Author(s):  
CS Liau ◽  
KL Chien ◽  
CL Chao ◽  
TM Lee

The efficacy and safety profiles of barnidipine in the treatment of hypertension were evaluated in an open parallel-group study. Fifty-nine Chinese patients with mild-to-moderate essential hypertension were randomized to receive either barnidipine or felodipine (5 mg once daily, titrated to 10 mg or 15 mg once daily, as indicated) for 12 weeks. Both drugs reduced blood pressures significantly with ≥ 68% of cases obtaining marked or moderate blood pressure reduction. Mean reductions in systolic and diastolic blood pressure for barnidipine treatment were 23.7 ± 13.5 mmHg and 12.7 ± 7.9 mmHg, and for felodipine, 24.3 ± 18.4 mmHg and 14.5 ± 10.0 mmHg, respectively. There was no significant difference between these two drugs in anti-hypertensive effect, heart rate, laboratory measurements or incidence of adverse events. The only difference was that more patients taking felodipine experienced palpitations. We conclude that barnidipine has similar efficacy and a similar safety profile to felodipine in the treatment of mild-to-moderate essential hypertension in Chinese patients.


2020 ◽  
pp. 112067212091423 ◽  
Author(s):  
Aitor Lanzagorta-Aresti ◽  
Santiago Montolío-Marzo ◽  
Juan María Davó-Cabrera ◽  
Jose Vicente Piá-Ludeña

Objectives: Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure. Methods: A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation. Results: Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference ( p = 0.18). When we compare both groups, there was no difference at 1 month ( p = 0.46) and 3 months ( p = 0.21) after surgery. However, there was a statistically significant difference at month 6 ( p = 0.0055) and 1 year ( p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure <21 mm Hg was 93.8% in transscleral cyclophotocoagulation group and 83.3% in endoscopic cyclophotocoagulation group after 1 year ( p = 0.2). For intraocular pressure <18 mm Hg, the success rate was 78.1% in transscleral cyclophotocoagulation group and 63.3% in endoscopic cyclophotocoagulation group ( p = 0.06), and for intraocular pressure <16 mm Hg, the success rate was 62.5% in transscleral cyclophotocoagulation group and 43.3% in endoscopic cyclophotocoagulation group ( p = 0.02). Hypotony ( p = 0.01) and vision loss of two lines ( p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group. Conclusion: This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.


2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Bong Ju Moon ◽  
Seong Yi ◽  
Yoon Ha ◽  
Keung Nyun Kim ◽  
Do Heum Yoon ◽  
...  

Percutaneous epidural neuroplasty (PEN) is an effective and safe procedure for herniated lumbar disc (HLD). Although PEN has an advantage of adhesiolysis, this procedure cannot decompress the protruded disc. Recently, trans-sacral epiduroscopic laser decompression (SELD) for HLD has been introduced as a promising alternative methodology. This study evaluated the clinical efficacy and safety of SELD compared to PEN, as well as the change in protruded disc volume after SELD through pre- and postoperative magnetic resonance imaging (MRI), in patients with HLD. Thirty consecutive patients underwent SELD (SELD group), and 45 patients underwent PEN (PEN group). The Visual Analog Scale (VAS) for leg pain; Oswestry Disability Index (ODI); 12-Item Short-Form Health Survey (SF-12); preoperative and postoperative 4-, 12-, and 24-week Macnab criteria; and preoperative and 24-week postoperative lumbar spinal MRIs after SELD were obtained. There was no significant difference in age, sex, duration of symptoms, and the distributions of disc level between the two groups (all P>0.05). Between the SELD and PEN groups, preoperative VAS, ODI, and SF-12 scores had no significant differences. However, the VAS, ODI, and SF-12 scores improved significantly after the procedures by postoperative week 24 in each group (all P<0.05). Furthermore, improvements of VAS, ODI, SF-12, and success rate of Macnab criteria in the SELD group were better than those in the PEN group (all P<0.05). The protruded disc volume after SELD decreased significantly (P=0.034). All clinical and functional outcomes of patients undergoing SELD and PEN for HLD improved following the procedures. Notably, SELD was superior to PEN regarding the degree of improvement in clinical and functional outcomes. Therefore, we suggest that SELD can be used as an effective alternative to PEN to provide improved clinical and functional outcomes in patients with HLD.


Author(s):  
JIANNIS HAJIIOANNOU ◽  
Eleni Gkrinia ◽  
Konstantinos Tzimkas-Dakis ◽  
Effrosyni Palla ◽  
Alexandros Brotis ◽  
...  

Objectives Endoscopic approaches constitute a newly introduced and promising technique in the field of stapes surgery, presenting favorable outcomes, so far. This study aims to compare endoscopic and microscopic stapes surgery based on current literature evidence, in terms of their efficacy and safety characteristics. Design We conducted a systematic literature search of three medical databases (Pubmed, Cochrane Library, and Scopus). We focused on randomized controlled studies or observational studies comparing microscopic to endoscopic stapes surgery. Data related to the efficacy and safety of each technique were extracted. Outcome data were summarized using the pooled mean differences or pooled odds ratio along with their 95% confidence intervals, according to the available data. The quality of evidence was assessed according to the GRADE recommendations. Results Thirteen studies with 705 patients were included in the meta-analysis. Success rate was evaluated by estimating air-bone gap improvement, resulting in comparable outcomes for the two techniques (mean difference: -0.20; 95% CI: -0.53, 0.14). No statistically significant difference was detected concerning postoperative complications, except for dysgeusia that was in favor of the endoscopic approach (OR: -1.46; 95% CI: -2.45, -.047). The overall quality of evidence was assessed to range from “Low” to “Very Low”. Conclusion Endoscopic stapes surgery is an innovative alternative to the microscopic technique, resulting in commensurate outcomes in terms of success rate and complications. Further high-quality studies are needed, to adequately compare the two approaches, particularly in terms of operation time, learning curve, cost-effectiveness, and otology surgical skills acquisition.


PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241886
Author(s):  
Han Min Lee ◽  
Kee Sup Park ◽  
Yoo Young Jeon ◽  
Woo Jin Kim ◽  
Nam Ho Lee ◽  
...  

Objective This study compared surgical outcomes between free plate Ahmed glaucoma valve (FPAGV) implantation without plate fixation and conventional Ahmed glaucoma valve (CAGV) implantation with plate fixation. Methods A retrospective, comparative case series study. Patients with refractory glaucoma who underwent FPAGV or CAGV implantation and were followed >1 year were enrolled consecutively. We reviewed medical records, including data on postoperative intraocular pressure (IOP) and postoperative complications. The success rate and early postoperative hypertensive phase were compared between groups. Results A total of 74 patients with CAGV implantations and 36 patients with FPAGV implantations were studied. The average follow-up periods were 23.3 ± 2.6 months (CAGV) and 22.8 ± 2.8 months (FPAGV; p = 0.424). The surgery time was significantly shorter in the FPAGV group than in the CAGV group (42.6 ± 4.1 vs. 47.3 ± 5.4 min; p < 0.001). Postoperative IOP at 1 week and 1 month were significantly lower in the FPAGV group than in the CAGV group (11.8 ± 3.6 and 14.0 ± 5.3 mmHg vs. 18.7 ± 5.5 and 22.2 ± 5.2 mmHg; p = 0.012 and p = 0.002, respectively). An early postoperative hypertensive phase occurred in 62 eyes, and the frequency was greater in the CAGV group (50 eyes) than the FPAGV group (12 eyes; p = 0.001). There was no significant difference in postoperative complications between the two groups (p = 0.735). The success rate was 84.2% in the FPAGV group and 80.6% in the CAGV group 24 months after surgery (p = 0.367). Conclusion FPAGV implantation was associated with a shorter surgery time, without any change in the extent of IOP reduction or complication rate. This procedure may be considered a good alternative for CAGV implantation in patients with refractory glaucoma.


2021 ◽  
Author(s):  
Zuoxin Qin ◽  
Xi Ying ◽  
Qing Han ◽  
Lu Wang ◽  
Lian Tan ◽  
...  

Abstract Purpose To evaluate the outcomes and elucidate the success and failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. Methods A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3 years. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) > 5 and ≤ 21 mmHg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. Results A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9 ± 12.0 mmHg to 16.4 ± 5.7 mmHg (P<0.0001) and 3.0 ± 0.9 to 0.9 ± 1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. Conclusions The qualified success rate of trabeculectomy with MMC in glaucomatous patients in Southwest China is 92.0% at 1-year follow-up, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.


Angiology ◽  
2016 ◽  
Vol 68 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Kenji Suzuki ◽  
Yukiko Mizutani ◽  
Yoshimitsu Soga ◽  
Osamu Iida ◽  
Daizo Kawasaki ◽  
...  

Background: Although there is increasing evidence of the effectiveness of endovascular therapy for complex aortoiliac (AI) occlusive disease, it is not universally applied to TASC D lesions. Methods: A total of 2096 patients, 2601 limbs with AI occlusive disease, were enrolled. The lesions were categorized as TASC D (395) or TASC A-C (2206), and we compared baseline data, procedure, and follow-up result between the 2 groups. Results: The success rate of the procedure was significantly lower in the TASC D group (91.6% vs 99.3%, P < .01), and more procedure complications occurred in the TASC D group (11.1% vs 5.2%, P < .01). The results of a 5-year follow-up revealed no significant difference in primary patency (77.9% vs 77.1%, P = .17) and major adverse cardiovascular and limb events (MACLE; 30.5% vs 33.4%, P = .42) between the 2 groups. A multivariate analysis revealed complications and critical limb ischemia are independent predictors of MACLE in the TASC D group. Conclusion: The success rate of the procedure was lower in the TASC D group. Complications were more frequent in the TASC D group, and they were related to MACLE.


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