Success and Failure Factors for Trabeculectomy in Glaucomatous Patients in Southwest China: A 325 Eyes Analysis

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.

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MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00021 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0002

Author(s):

Brendon C. Mitchell ◽

Matthew Y. Siow ◽

Alyssa Carrol ◽

Andrew T. Pennock ◽

Eric W. Edmonds

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Shoulder Instability ◽

Surgical Intervention ◽

Operation Time ◽

Demographic Variables ◽

Return To Sports ◽

Suture Anchors ◽

Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

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P720 Recurrent rectovaginal fistula in patients with Crohn’s disease: How can we improve the success rate of graciloplasty? A bi-centric European study in 30 patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.848 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S579-S580

Author(s):

A Frontali ◽

M Rottoli ◽

A Chierici ◽

G Poggioli ◽

Y Panis

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Antibiotic Prophylaxis ◽

Success Rate ◽

Rectovaginal Fistula ◽

Univariate Analysis ◽

Diverting Stoma ◽

Prospective Database

Abstract Background Graciloplasty (GP) is indicated in case of recurrent rectovaginal fistula (RVF), even in patients with Crohn’s disease, after failure of previous local treatments. The aim of this study was to evaluate risk factors for GP failure performed for recurrent RVF in these patients. Methods We realised a retrospective study based on a prospective database of GP, realised in two Tertiary expert Centers in Italy (Bologna) and France (Clichy). Results Thirty-two patients undergoing 34 GP (2 patients have undergone 2 GP for failure of first GP): we excluded second GP and 2 patients without available follow-up: 30 patients undergoing a first GP for RVF (n = 29) or ileal-vaginal fistula after ileal-pouch-anal-anastomosis (IPAA) (n = 1) with a mean age of 41 ± 10 years (range, 25–64) were analysed. After a mean follow-up of 65 ± 52 months (2–183), a success of GP (considered as absence of diverting stoma and RVF healing) was noted in 17/30 patients (57%). We evaluated risk factors for failure of the procedure and we found only 2 risk factors on univariate analysis: (1) absence of a postoperative prophylactic antibiotherapy: only 2/13 (15%) patients with a GP failure had a postoperative antibiotic-prophylaxis vs. 9/15 (60%) patients with success of GP (p = 0.0238); (2) a postoperative perineal infection: 7/13 (54%) with a GP failure developed a postoperative perineal infection vs. 2/17 (12%) patients (p = 0.0196). Conclusion Graciloplasty for recurrent rectovaginal fistula in patients with Crohn’s disease is effective in 57% of patients. Our study underlines the possible benefit of a postoperative antibiotic-prophylaxis because it seems to increase significantly the success rate of the procedure.

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The effect of community hypertension management on blood pressure control and its determinants in southwest China

International Health ◽

10.1093/inthealth/ihaa002 ◽

2020 ◽

Vol 12 (3) ◽

pp. 203-212 ◽

Cited By ~ 2

Author(s):

Xiaohua Liang ◽

Haiying Zhong ◽

Lun Xiao

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Kidney Disease ◽

Southwest China ◽

Antihypertensive Agents ◽

Pressure Control ◽

Community Healthcare ◽

Related Risk ◽

Clinical Centre

Abstract Background Hypertension is a leading cause of cardiovascular disease (CVD). The purpose of this study was to examine the effectiveness of community healthcare in controlling blood pressure (BP) and mitigating related risk factors after 5 y of follow-up. Methods Hierarchical clustering sampling was employed to choose a representative sample of 10 rural and 10 urban community populations (N=4235). The 5y prospective cohort study was completed by the medical group in the community clinical centre. Results The study included 4235 patients, median age 69 y (range 61–76), with hypertension in 2009; 2533 (59.81%) were female. The rate of BP control increased from 28.33% in 2009 to 64.05% in 2014. The BP control rate was higher in patients with CVD and kidney disease and lower in those with obesity than in those without. Comparing 2009 and 2014 values, the intervention resulted in median systolic BP and diastolic BP reductions of 7.0 mmHg and 6.5 mmHg, respectively. Age, medication treatment, antihypertensive agents, BP at baseline and follow-up, complications of diabetes, CVD, obesity and kidney disease, the aspartate aminotransferase:aminotransferase ratio and smoking were identified as risk factors for BP control. Conclusions Community management of hypertension by general practitioners achieved significant BP control over 5 y of intervention.

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Five-Year Clinical Outcomes of Trabectome Surgery at a Single Glaucoma Center

10.20944/preprints201804.0248.v1 ◽

2018 ◽

Author(s):

Hamed Esfandiari ◽

Priyal Shah ◽

Pooya Torkian ◽

Ian P. Conner ◽

Joel S. Schuman ◽

...

Keyword(s):

Risk Factors ◽

Success Rate ◽

Retention Rate ◽

Case Series ◽

Series Data ◽

Cumulative Probability ◽

Single Center ◽

Trabectome Surgery ◽

Ab Interno

Purpose: To analyze the five-year results of Trabectome ab interno trabeculectomy of a single glaucoma center. Method: In this retrospective interventional single-center case series, data of 93 patients undergoing ab interno trabeculotomy between September 2010, and December 2012 were included. Kaplan-Meier analysis was performed using success criteria defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, or >20% reduction from preoperative IOP, and no need for further glaucoma surgery. Risk factors for failure were identified using Cox proportional hazards ratio (HR). Results: The retention rate for five years follow-up was 66%. The cumulative probability of success at 1, 2, 3, 4 and 5 years was 82.6%, 76.7%, 73.9%, 72.3%, and 67.5%. Risk factors for failure were lower baseline IOP (HR=0.27, P=0.001), younger age (HR=0.25, P=0.02), and higher central corneal thickness (HR=0.18, P= 0.01). Pseudoexfoliation was associated with a higher success rate (HR= 0.39, P=0.02). IOP was decreased significantly from 20.0±5.6 mmHg at baseline to 15.6±4.6 mmHg at 5-year follow-up (P=0.001). The baseline number of glaucoma medications was 1.8±1.2, which decreased to 1.0±1.2 medications at 5 years. Conclusion: Trabectome surgery was associated with a good long-term efficacy and safety profile in this single-center case series with a high retention rate. A higher baseline IOP, older age, thinner cornea, and pseudoexfoliation glaucoma were associated with a higher success rate.

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Ten-year incidence of primary angle closure in elderly Chinese: the Liwan Eye Study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311808 ◽

2018 ◽

Vol 103 (3) ◽

pp. 355-360 ◽

Cited By ~ 9

Author(s):

Lanhua Wang ◽

Wenyong Huang ◽

Shengsong Huang ◽

Jian Zhang ◽

Xinxing Guo ◽

...

Keyword(s):

Risk Factors ◽

Incident Angle ◽

Significant Risk ◽

Anterior Chamber Depth ◽

Angle Closure ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Study Participants ◽

Angle Width

PurposeTo determine the 10-year incidence of all forms of primary angle closure (PAC) in phakic eyes and its risk factors in an urban Chinese population aged 50 years and older.MethodsSurvivors of 1405 baseline participants were invited to attend the 10-year follow-up visit in the Liwan Eye Study. Participants with established baseline angle closure, including primary angle closure suspects (PACS), PAC and primary angle closure glaucoma (PACG), or those who underwent bilateral cataract surgery during the 10-year period, as well as those who did not tolerate gonioscopic examinations, were excluded from this analysis. Incident PAC was present when those with open angles at baseline developed angle closure in any form in either eye during the 10-year period.ResultsAmong 791 participants who returned during the 10-year follow-up visit, 620 (78.4%) provided data on PAC incidence. The 10-year cumulative incidence of any forms of PAC was 20.5% (127/620, 95% CI 17.4% to 24.9%), including 16.9%, 2.4% and 1.1% with incident PACS, PAC and PACG in either eye, respectively. In multiple logistic regression, significant risk factors for incident angle closure were greater baseline lens thickness (OR=1.82 per mm, p=0.003), shallower anterior chamber depth (OR=3.18 per mm decreased, p=0.010) and narrower angle width (OR=1.63 per decreased angle width, p<0.0001).ConclusionsApproximately one in five people aged 50 years and older developed some form of angle closure over a 10-year period. Small ocular dimensions and hyperopia at baseline were associated with the development of angle closure.

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Potential effects of angiogenesis-related factors on the severity of APAC and surgical outcomes of trabeculectomy

BMC Ophthalmology ◽

10.1186/s12886-021-02051-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jing Wang ◽

Ming-shui Fu ◽

Min-wen Zhou ◽

Bi-lian Ke ◽

Zhi-hua Zhang ◽

...

Keyword(s):

Intraocular Pressure ◽

Success Rate ◽

Aqueous Humor ◽

Family Members ◽

Angle Closure ◽

Related Factors ◽

Acute Primary Angle Closure ◽

Failure Group ◽

Primary Angle Closure

Abstract Background EPO (erythropoietin) and PDGF (platelet derived growth factor) families are thought to be associated with angiogenesis under hypoxic condition. The sharp rise of intraocular pressure in acute primary angle closure (APAC) results in an inefficient supply of oxygen and nutrients. We aimed to measure the expression of EPO and PDGF family members in APAC eyes and demonstrate their associations with APAC’s surgical success rate. Methods Concentrations of EPO, PDGF-AA, -BB, -CC and -DD collected in aqueous humor samples of 55 patients recruited were measured. Before operations, correlations between target proteins and IOP (intraocular pressure) were detected between APAC (acute primary angle closure) and cataract patients. Based on the post-operative follow-up, the effects of EPO and PDGF family members on the successful rate of trabeculectomy were tested. Results The levels of EPO, PDGF-CC and -DD were significantly elevated in the APAC group compared to the cataract group. During the post-operative follow-up, EPO, PDGF-CC and -DD showed significant differences between the success and failure groups. In multivariable linear regression analyses, failed filtration surgery was more likely in APAC eyes with higher EPO level. The Kaplan-Meier survival plot suggested that the success rate in eyes with low EPO level was significantly higher than that in eyes with high EPO level. Conclusion The levels of EPO, PDGF-CC and -DD were significantly elevated in failure group. EPO level correlated with preoperative IOP and numbers of eyedrops, and higher EPO level in aqueous humor is a risk factor for trabeculectomy failure. It can be a biomarker to estimate the severity of APAC and the success rate of surgery. The investigation of mechanism of EPO in APAC a may have potential clinical applications for the surgical treatment of APAC.

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Appositional angle closure and conversion of primary angle closure into glaucoma after laser peripheral iridotomy

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312956 ◽

2019 ◽

Vol 104 (3) ◽

pp. 386-391

Author(s):

Li Qiu ◽

Yujie Yan ◽

Lingling Wu

Keyword(s):

Ultrasound Biomicroscopy ◽

Chinese Patients ◽

Angle Closure ◽

Glaucomatous Optic Neuropathy ◽

Laser Peripheral Iridotomy ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

The Relationship ◽

Peripheral Iridotomy

PurposeTo determine the relationship between appositional angle closure (AppAC) and the conversion of primary angle closure (PAC) into primary angle closure glaucoma (PACG) after laser peripheral iridotomy (LPI).MethodsConsecutive patients with PAC were included in this prospective cohort study. The eyes of the included patients who had undergone LPI with five or more reliable visual field (VF) tests in at least 5 years were analysed. Baseline AppAC was diagnosed when the trabecular meshwork and iris were located appositionally on the ultrasound biomicroscopy image. The criteria for PAC conversion were based on development of glaucomatous optic neuropathy and corresponding VF defects. Other factors such as age and vertical cup-to-disc ratio (VCDR) were also investigated by univariate and multivariate logistic regression analyses.Results128 patients were assessed at baseline. 80 eyes of 58 patients fulfilled the inclusion criteria. The mean follow-up period was 6.67 ± 1.33 years. PAC conversion was observed in 20 eyes. The frequency of PAC conversion was significantly higher in eyes with AppAC > 2 quadrants at baseline (58.3%, 7/12) than in those with AppAC ≤ 2 quadrants (19.1%, 13/68; p < 0.05). Compared with the non-converting group, the age and VCDR at baseline were both higher in the converting group (p < 0.05). Wider AppAC, older age and higher VCDR were significantly associated with PAC conversion.Conclusions25% of PAC eyes of Chinese patients converted into PACG eyes in more than 5 years after LPI. AppAC > 2 quadrants were related to the PAC conversion. Older baseline age and higher VCDR were also associated with PAC conversion.

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Five-year Follow-up of Transobturator Sling: 152 Cases with the Same Surgeon

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0038-1670712 ◽

2018 ◽

Vol 40 (10) ◽

pp. 614-619

Author(s):

Mucio Diniz ◽

Luisa Diniz ◽

Gustavo Lopes da Silva ◽

Agnaldo Filho ◽

Zilma Reis ◽

...

Keyword(s):

Risk Factors ◽

Urinary Incontinence ◽

Short Form ◽

Transobturator Sling ◽

Logistic Regression Models ◽

International Consultation ◽

Surgical Failure ◽

The Impact

Objective To evaluate the long-term subjective cure rate of the transobturator sling, including an analysis of the risk factors and of the impact of increased surgical experience on the results. Methods A retrospective cohort study of women who underwent transobturator sling surgery from 2005 to 2011 was conducted. Patients were evaluated by a telephone survey using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and by subjective questions regarding satisfaction. An ICIQ-SF score of 0 was considered a cure. The crude and adjusted odds ratios and 95% confidence intervals were estimated in univariate and multivariate logistic regression models to identify risk factors for surgical failure. Differences with p < 0.05 were considered significant. Results In total, 152 (70.6%) patients answered the questionnaire. The median follow-up period was 87 months. The urodynamic diagnosis was stress urinary incontinence in 144 patients (94.7%), and mixed urinary incontinence in 8 (5.3%) patients. Complications occurred in 25 (16%) patients. The ICQ-SF results indicated that 99 (65.10%) patients could be considered cured (ICIQ-SF score = 0). Regarding the degree of satisfaction, 101 (66%) considered themselves cured, 43 (28%) considered themselves improved, 7 (4.6%) considered themselves unchanged, and one reported worsening of the incontinence. After the univariate and multivariate analyses, the primary risk factor for surgical failure was the presence of urgency (p < 0.001). Conclusion The transobturator sling is effective, with a low rate of complications and a high long-term satisfaction rate. The risk factors for failure were the presence of urgency and patient age. The increased experience of the surgeon was not a factor that influenced the rate of complications.

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Laparoscopic lateral suspension: a single-site and single-surgeon experience

Gynecological Surgery ◽

10.1186/s10397-019-1067-7 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Claudia Mang ◽

Hansjörg Huemer ◽

Ariane Birkenmaier ◽

Jörg Humburg

Keyword(s):

Risk Factors ◽

Success Rate ◽

Mesh Fixation ◽

Operating Time ◽

Estrogen Therapy ◽

Reoperation Rate ◽

Mesh Exposure ◽

Surgeon Experience ◽

Laparoscopic Lateral Suspension

Abstract Background In the reconstructive surgery for pelvic organ prolapse (POP), different newer mesh fixation techniques as an alternative to sacrocolpopexy has been developed. In order to gain more data about the different techniques, it is important to analyze success and recurrence rates of surgical procedures. Methods Collection and analysis of data from patients treated with laparoscopic lateral suspension (LLS). Patients were followed up for 6 weeks after surgery. Consultations were continued, if needed, up to 2.5 years. Main outcome measures were anatomic results, POP recurrence, mesh exposure and reoperation rate, and potential risk factors for relapse. Results Thirty-nine patients were treated between July 2015 and November 2017. In the first visit, one patient was diagnosed with an early relapse (success rate: 95%). Another six women relapsed during follow-up (mean, 13.5 months; success rate, 82%). Patients with recurrence were younger (62 vs. 68 years) and had initially a higher degree of prolapse, a higher parity (3.8 vs. 1.9), more previous surgeries, and longer operating times. Early exposures were seen in 5.3% patients and raised up to 13% during follow-up; all but one were treated successful with local estrogen therapy. Risk factors for exposure were higher age and longer operating time. The whole reoperation rate was 13%. Conclusions LLS might be a valid alternative to the laparoscopic sacrocolpopexy in women with prolapse in the anterior compartment and apical descent. Younger women with higher parity and higher degree of prolapse in the middle compartment had a higher recurrence rate after LLS.

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