To evaluate the outcomes and elucidate the failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients.

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 1-3y. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) >5 and ≤21 mm Hg 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.

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 to 16.4±5.7 mm Hg (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.

The qualified success rate of trabeculectomy with MMC in glaucomatous patients in the cohort is 92.0% at 1-year, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.

To evaluate the postoperative refractive prediction error (PE) and determine the factors that affect the refractive outcomes of combined pars plana vitrectomy (PPV) or silicone oil removal (SOR) with cataract surgery.

The study is a retrospective, case-series study. Totally 301 eyes of 301 patients undergoing combined PPV/SOR with cataract surgery were enrolled. Eligible individuals were separated into four groups according to their preoperative diagnoses: silicone oil-filled eyes after PPV (group 1), epiretinal membrane (group 2), macular hole (group 3), and primary retinal detachment (RD; group 4). The variables affecting postoperative refractive outcomes were analyzed, including age, gender, preoperative best-corrected visual acuity (BCVA), axial length (AL), keratometry average, anterior chamber depth (ACD), intraocular tamponade, and vitreoretinal pathology. The outcome measurements include the mean refractive PE and the proportions of eyes with a PE within ±0.50 diopter (D) and ±1.00 D.

For all patients, the mean PE was -0.04±1.17 D, and 50.17% of patients (eyes) had a PE within ±0.50 D. There was a significant difference in refractive outcomes among the four groups (P=0.028), with RD (group 4) showing the least favorable refractive outcome. In multivariate regression analysis, only AL, vitreoretinal pathology, and ACD were strongly associated with PE (all P<0.01). Univariate analysis revealed that longer eyes (AL>26 mm) and a deeper ACD were correlated with hyperopic PE, and shorter eyes (AL<26 mm) and a shallower ACD were correlated with myopic PE.

RD patients have the least favorable refractive outcome. AL, vitreoretinal pathology, and ACD are strongly associated with PE in the combined surgery. These three factors affect refractive outcomes and thus can be used to predict a better postoperative refractive outcome in clinical practice.

To analyze the accuracy of the new generation intraocular lens (IOL) formula and the Wang-Koch (WK) adjustment in individuals with severe myopia undergoing combined anterior-posterior surgery.

A total of 100 patients (100 eyes) with axial length (AL) >26 mm undergoing combined anterior and posterior segment surgery in our department from June 2015 to June 2021 were enrolled in this study. Totally 13 IOL calculation formulas, such as Barrett Universal Ⅱ (BUⅡ), Emmetropia Verifying Optical (EVO), Kane, Haigis, Hoffer Q, Holladay, and SRK/T as well as the first generation linear WK eye axis optimization formula (Haigis-WK1, SRK/T-WK1, Hoffer Q-WK1, Holladay 1-WK1) and the second generation linear WK eye axis optimization formula (SRK/T-WK2, Holladay 1-WK2), were utilized to determine IOL diopter. The mean prediction error (ME), mean absolute error (MAE), median absolute error (MedAE), and percentage of prediction error within different refractive thresholds were calculated to assess the accuracy of each formula. In order to investigate the impact of AL on accuracy of IOL calculation, the patients were categorized into group A (38 eyes, 26.00 mm<AL≤28.00 mm), group B (28 eyes, 28.00 mm<AL≤30.00 mm), and group C (34 eyes, AL >30.00 mm). Additionally, the patients were also divided into silicone oil (63 eyes) and non-silicone oil (37 eyes) groups based on preoperative intraocular filling to determine the effect of intraocular filling on IOL calculation.

The MedAE values of the new-generation IOL formulas (BUⅡ, EVO, and Kane) were significantly lower (0.34D, 0.31D, 0.35D) than those of traditional formulas (P<0.05). Additionally, the percentage of prediction errors within ±0.25 D, ±0.50 D, ±0.75 D, and ±1.00 D were significantly higher with the new formulas when compared to traditional ones (P<0.05). Traditional formulas exhibited a hyperopic deviation (0.35D~0.65 D), which could be corrected using the WK eye axis adjustment. WK2 was effective in improving the accuracy of calculation in SRK/T and Holladay 1 formulas, and there was no statistical difference in the MedAE values of SRK/T-WK2 and Holladay 1-WK2 formulas with the new-generation IOL formulas. When comparing the formulas across different axial eye length groups in terms of MedAE, the new IOL formulas (BUⅡ, kane and EVO) and WK-corrected formulas (Haigis-WK1, SRK/T-WK1, SRK/T-WK2, Hoffer Q-WK1, Holladay 1-WK1, Holladay 1-WK2) showed no significant differences among the different AL groups. However, there were significant differences in the MedAE values of traditional formulas among the different AL groups (P<0.01), with group C displaying the largest MedAE values (Haigis: 0.84D, SRK/T: 1.10D, Hoffer Q: 1.23D, Holladay 1: 1.20D). Comparing the MedAE values of different formulas in various preoperative intraocular filling groups, it was observed that the MedAE values of the new-generation IOL formulas (BUⅡ, kane and EVO), Haigis, and SRK/T formulas were significantly higher in the silicone oil-filled eye group than the non-silicone oil-filled eye group (P<0.05).

In patients with high myopia undergoing combined anterior and posterior segment surgery, the precision and consistency of the new-generation IOL formulas and the second-generation linear WK axis correction formula exhibit significant improvements when compared to traditional formulas.