Surgical Intervention Of Uveitis Secondary Glaucoma And Study On The Concentration Of Cytokines In The Aqueous Humor

Part Ⅰ Efficacy and safety of high-energy selective laser trabeculoplasty for steroid-induced glaucoma in patients with uveitis[Purpose]To evaluate the efficacy and safety of high-energy selective laser trabeculoplasty(SLT)in the treatment of steroid-induced glaucoma in patients with uveitis.[Methods]This study is a case study.A total of 19 patients(20 eyes)with uveitis who underwent high-energy SLT treatment for steroid-induced glaucoma in our hospital from November 2014 to November 2017 were collected.All patients received SLT with stable inflammation control but intraocular pressure still unable to be controlled at the maximum tolerated dose.The study compared changes in intraocular pressure(IOP)and the number of IOP-lowering drugs 1 day before surgery and 1 week,1 month,3 months,6 months,and 12 months after surgery.The definition of successful SLT treatment was that the intraocular pressure was less than 18 mmHg at 12 months after surgery and the reduction in intraocular pressure was>20%lower than that before surgery without the need to increase the number of anti-glaucoma drugs.Data were analyzed using a paired-samples t-test.[Results]The intraocular pressure(mean±SD)was 3 0.61±8.27 mmHg 1 day before SLT and 21.04±7.57 mmHg 1 week,1 month,3 months,6 months,and 12 months after SLT(P<0.001),19.38±9.02mmHg(P<0.001),15.76±4.85mmHg(P<0.001),15.51±2.75mmHg(P<0.001)and 15.09±3.15mmHg(P<0.001).The success rate of SLT at 12 months postoperatively was 65.0%.No serious complications and recurrence of inflammation occurred in all patients during the follow-up period.[Conclusions]High-energy SLT is a safe and effective method for the treatment of steroid-induced glaucoma complicated with uveitis,and more studies are needed to observe its long-term success rate.Part Ⅱ Clinical study of surgical treatment of uveitis secondary glaucoma Section OneStudy on the efficacy analysis and prognostic evaluation of modified non-penetrating deep sclerectomy for uveitis secondary glaucoma[Purpose]To evaluate the clinical safety and efficacy of modified CO2 laserassisted sclerectomy surgery(CLASS)in patients with US G and compare it with POAG patients.[Methods]This study is a retrospective case-comparison study.We collected 23 USG patients and 25 POAG patients who received modified CLASS surgery in the ophthalmology department of our hospital from June 2015 to August 2018.The postoperative intraocular pressure,the number of anti-glaucoma drugs and the success rate of surgery were compared between the two groups to evaluate the surgical effect;the incidence of postoperative complications,the number of postoperative needling procedure and laser goniopuncture,and the morphological changes of intrascleral lake during the follow-up period were compared to assess the safety of surgery.Complete surgical success was defined as 5≤IOP≤18mmHg and a 20%reduction in intraocular pressure without the need for anti-glaucoma drugs.[Results]A total of 40 patients(48 eyes)were included in the study.Mean intraocular pressure and mean the number of anti-glaucoma medications was significantly lower in both groups at 12 months postoperatively compared with baseline.The complete success rates of the USG group and POAG group were 60.9%and 64.0%,respectively(P=0.859).The Kaplan-Meier survival analysis showed that USG patients who received aggressive anti-inflammatory therapy in the perioperative period had no higher risk of postoperative failure after modified CLASS than POAG patients.The incidence of total postoperative complications in the USG group was only slightly higher than that in the POAG group,and there was no significant difference in the morphological changes of the intrascleral lake in the USG group between 3 months and 12 months.[Conclusions]Modified CLASS surgery is safe and effective in the treatment of USG,and the effect is similar to that of POAG.Section Two The efficacy and risk factors of modified non-penetrating deep sclerectomy combined with trabeculectomy for refractory uveitis secondary glaucoma[Purpose]To analyze and compare the difference in efficacy between modified CLASS and combined CLASS and trabeculectomy(CLASS-TRAB)in the treatment of refractory USG.[Methods]This study is a retrospective case-comparison study.Twenty USG patients(20 eyes)who received CLASS-TRAB treatment in our hospital from August 2015 to April 2019 and 20 USG patients(20 eyes)who received simple modified CLASS treatment during the same period were collected.Baseline IOP before surgery,IOP at 1 week,1 month,3 months,6 months,and 12 months after surgery were compared.Complete surgical success was defined as the intraocular pressure of 6-21 mmHg in the absence of anti-glaucoma drugs at 12 months after surgery,and the intraocular pressure was reduced by more than 20%compared with preoperative.Qualified success was defined as IOP control to the same standard as complete success with or without the aid of anti-glaucoma drugs.[Results]The preoperative intraocular pressure and the number of preoperative anti-glaucoma drugs in the CLASS-TRAB group were higher than those in the CLASS group,but there was no statistical difference(36.8±8.7 mmHg vs.34.9±9.3 mmHg;3.5±0.5 vs 3.3±0.4).At 12 months after surgery,the intraocular pressure and the number of anti-glaucoma drugs in both groups were significantly decreased compared with those before surgery(P<0.01).The complete and qualified success rates of two groups at 1 year were 80%and 95%(CLASS-TRAB group),55%and 80%(CLASS group),respectively.The complete and qualified success rates were both higher in the CLASS-TRAB group(P=0.34;P=0.09).Multivariate Cox regression analysis showed that preoperative cataract surgery history(P=0.045)and postoperative needling procedure(P=0.003)were the risk factors for complete postoperative success.[Conclusions]CLASS-TRAB surgery can achieve a better IOP lowering effect and surgical success rate for advanced USG patients with high baseline IOP,providing a new option for refractory USG patients.Part Ⅲ Correlation between the concentration of cytokines in aqueous humor and uveitis secondary glaucoma[Purpose]To investigate the concentration of cytokines in the aqueous humor of patients with uveitis-secondary glaucoma(USG)and compared them with patients with primary open-angle glaucoma(POAG),uveitis complicated cataract,and agerelated cataract(ARC)in order to observe the effect of inflammation on USG.[Methods]This study is a descriptive experimental study,including a total of 64 patients who underwent surgical treatment in the ophthalmology department of our hospital from September 2021 to January 2022,including anti-glaucoma surgery for USG(n=16),anti-glaucoma surgery for POAG(n=16),cataract surgery for uveitis complicated cataract(n=16),and cataract surgery for ARC(n=16).Aqueous humor was collected at the beginning of the operation and stored in a-80℃ freezer.Luminex xMAP(?) multiplex assays was used to measure the concentrations of MCP-1,MIP-1β,IL-6,IL-8,IL-10,TNF-α,IFN-γ,TGF-β1,TGF-β2,TGF-β3 and RANTES in aqueous humor,and to analyze the correlation between these cytokines and uveitis and intraocular hypertension.[Results]Pro-inflammatory factors MCP-1,MIP-1β,IL-6,IL-8 and transforming growth factors TGF-β1 and TGF-β2 were significantly elevated in the aqueous humor of USG eyes.In the case of enhanced anti-inflammatory in the perioperative period,the pro-inflammatory factors in the USG group were still significantly higher than those in the uveitis complicated cataract group.The concentrations of IL-6,IL-8 and MCP-1 in the aqueous humor of the USG group and POAG group had the same trend,which was significantly higher than those of the ARC group.There was no statistically significant difference in the concentration of cytokines in the aqueous humor of USG eyes with and without 3 months of ocular inflammation control,USG eyes were grouped according to whether the preoperative baseline intraocular pressure was greater than 30 mmHg,and there was no significant difference in cytokine concentrations.[Conclusions]The levels of MCP-1,MIP-1β,IL-6,IL-8,TGF-β1,and TGF-β2 in the aqueous humor of USG patients were generally elevated,suggesting that inflammation is involved in the pathogenesis of uveitis and intraocular hypertension.The results of this study support the safety of early antiglaucoma surgery in USG patients even with baseline high intraocular pressure or mild intraocular inflammation.