Efficacy And Safety Of Modified Viscocanalostomy In Treatment With Glaucoma

Purpose:To report 7-year results investigating the safety and efficacy of modified viscocanalostomy(VCS)in adult patients with open-angle glaucoma and primary congenital glaucoma(PCG).To study the clinical effect and safety of Nd:YAG laser goniopuncture(LGP)in patients with high intraocular pressure after modified viscocanalostomy.Methord:Part 1 204 randomly selected eyes of 144 consecutive patients with OAG were included in this prospective study.Follow-up examinations were performed on day 1,week 1,at 1,6,12month and each month after VCS.Corrected distance visual acuity(CDVA),intraocular pressure(IOP),and number of medications were evaluated.Part 2 Laser goniopuncture were performed on the patients with high IOP after modified VCS.The following examinations were carried out and recorded before and affer laser treating:IOP,slit-lamp,gonioseopy,ultrasound biomicroscopy(UBM)and laser time.Part 3 Sixty-four eyes of 41 patients with primary congenital glaucoma were enrolled.IOP,corneal diameter(mm)and cup/disc(C/D)were measured before and after the viscocanalostomy combined with trabeculotomy(VCT)respectively.Result:The mean preoperate IOP was 28.08±10.40,the average postoperate IOP was15.92±2.09 mmHg at 7 years,The mean reduction was 43.3%(P<0.01),the qualified success rate was 88.2%.A total of 53 eyes(25.9%)in 40 patients underwent laser goniopuncture,decreasing the IOP from 23.19±4.33mmHg mmHg to 15.48±3.76 mmHg.The average IOP before VCT was 30.57±7.41mmHg,the mean postoperate IOP was 14.65±3.39mmHg at 5 years.Twenty-seven(42.2%)eyes presented a reduction in corneal diameter,and 40(62.5%)eyes presented a C/D ratio reversal.There was no serious complication in any patients over the follow-up period after the surgery.Conclusion:Modified viscocanalostomy is useful and safe in the management in adults with open-angle glaucoma.Viscocanalostomy combined with trabeculotomy effectuates stable IOP reduction in patients with PCG,rare complications occurred as compared to trabeculoctomy.LGP is a safe and effective treatment and can improve operative achievement ratio of VCS at a long term.