Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

INTRODUCTION

A first-generation iStent was used, which is a single-piece titanium stent. Using the gonioprism lens to observe the nasal angle, the iStent was put into the anterior chamber approaching the corneal port. For iStent implantation, the iStent was passed through the trabecular meshwork to stay within Schlemm’s canal, at which point it was delivered from its inserter, which was then used to gently press on the implant to seat its heel firmly in the canal (Figure 2).

亞伯是牧羊的，該隱是種地的。有一日，該隱拿地里的出產為供物獻給耶和華，亞伯也將他羊群中頭生的羊的脂油獻上。耶和華看中了亞伯和他的供物，只是看不中該隱和他的供物。該隱就大大發怒，變了臉色。后來殺了亞伯。(《創世紀·第四章》)

The effectuality and safety of the iStent-phaco and of μLOT cooperated with cataract surgery (μLOT-phaco) have been reported separately

, but there has been no report comparing the effects of μLOT-phaco and iStent-phaco. Comparison of the iStent-phaco and μLOT-phaco in the right and left eyes of the same patient would allow more detailed examination.In addition, there has been no report regarding to the anterior chamber inflammation in comparison between these surgeries.Therefore, in this study, we performed iStent-phaco in one eye and μLOT-phaco in the other eye of the same patient and evaluated the anterior chamber inflammation and compared the effects and complications of these two MIGS procedures.

SUBJECTS AND METHODS

Ethical Approval This retrospective clinical cohort study was approved by the local ethics committee (St Marianna University School of Medicine Ethics Committee, certificate approval number: 4029) and adhered to the regulations of good clinical practice and the tenets of the Declaration of Helsinki. All patients provided written informed consent for participation in the study.

Study Design Patients underwent cataract surgery (Constellation Vison System: Alcon) cooperated with implantation of an iStent (iStent-phaco) in one eye and excisional goniotomy with the μLOT (μLOT-phaco) in other eye by a single surgeon (Tokuda N) at the St Marianna University School of Medicine, between June 2017 and June 2019. The eye with lower the mean deviation (MD) was chosen for μLOT-phaco.Patients were evaluated preoperatively and again at 1 and 3d,1 and 2wk, and every month up to 1y postoperatively. Each investigation contained assessment of best-corrected visual acuity (BCVA), IOP, and number of ophthalmic antiglaucoma agents used. We delineated failure conforming to the postoperation IOP levels with or without ophthalmic antiglaucoma agents after surgery: ＜20% reduction from the baseline IOP, or IOP＞18 mm Hg.

Patients underwent measurement of the corrected visual acuity using Landolt vision charts. IOP was estimated by Goldmann applanation tonometry. Inflammation in the anterior chamber was evaluated by using the anterior chamber flare (ACF; FC-2000

laser flare meter, Kowa, Japan). Corneal endothelial cell density (ECD) was measured by noncontact specular microscopy (Noncon Robo SP-8000; Konan Medical, Japan).Gonioscopy was carried out before operation and at every postoperative visit to estimate the angle and stent positioning.Data were analyzed using IBM SPSS Statistics 21 (IBM Corporation, Poughkeepsie, NY, USA). Parameters were analyzed using 2-tailed Student’s

-tests and Chi-squared tests,and

＜0.05 were considered statistically significant.

藝術高校的管理人員要提升對安全管理工作的認識，引導教師參與到學生安全監管過程中，定期開展相關內容的教育培訓活動，構建長久而穩定的管理機制，依照法律文件和管理制度落實工作內容，還要加入心理教育的課程，設立心理咨詢室。安保人員是維護校園穩定的主要組成部分，學校要加大安保人員培訓的投入力度，創建專業化的安保隊伍，在校園內定期巡邏，尤其要加強夜間的防控，要具備突發事故處理的素質，對于校園門口和周邊環境要加強管理力度，還要與當地的公安部門配合，避免校園內部出現任何違法活動［4］。除此之外，宿舍是學生安全事故的高發地點，舍務老師要有安全管理意識，運用柔性手段來代替強制性管理，使學生自覺遵守、自我監督。

Participants The trial enrolled subjects with mild-to-moderate(the Hodapp-Parrish-Anderson visual field criteria:MD≥-6.0 dB, mild; -6.0＞MD≥-12.0 dB, moderate)

open angle glaucoma [containing primary open angle glaucoma (POAG),pseudo-exfoliative glaucoma (PXG), combined-mechanism glaucoma (CMG)] with visually significant cataract who were treated with two or more ophthalmic antiglaucoma agents.The diagnosis of open angle glaucoma was determined by a glaucoma specialist (Tokuda N) conforming to the Japan Glaucoma Society Guidelines for Glaucoma (4

edition)

criteria. Preoperative visual fields were measured using the Swedish interactive threshold algorithm standard 30-2 program of the Humphrey field analyzer (Carl Zeiss-Meditec,Jena, Germany). Eyes were required to have anterior chamber angle grades II-IV (Shaffer classification), where at least the trabecular meshwork was observable by a gonioscope.Additionally, patients had to be aged between 60 and 90y for inclusion in the study. Exclusion criteria included recent(within 12mo) intraocular incisional glaucoma surgery or laser trabeculoplasty and active ocular inflammation, neovascular,traumatic, or angle-closure glaucoma.

截至2016年底，安徽陸續在省內糧棉油主產區建成投產秸稈直燃發電項目23個（凱迪9個，國能4個，光大4個，華電、中節能、理昂、大唐等企業各1個），其中4個為新投產發電項目（理昂郎溪電廠、光大懷遠電廠、光大定遠電廠、齊耀阜南電廠），年運行總裝機容量660MW,累計發電量約38億kWh，同比增長31%，發電設備年利用小時數超過6300h，處于全國領先水平，建成規模居全國第二。……