Changes in choroidal thickness,axial length,and ocular perfusion pressure accompanying successful glaucoma filtration surgery

Purpose

To investigate the changes in choroidal thickness (CT), axial length (AL), and ocular perfusion pressure (OPP) accompanying intraocular pressure (IOP) reduction after trabeculectomy.

Methods

Thirty-nine eyes of 39 patients with primary open-angle glaucoma uncontrolled by medical therapy were included in this prospective and interventional study. All patients underwent a fornix-based trabeculectomy. The CT was measured by enhanced depth imaging-optical coherence tomography. IOP, AL, and systolic/diastolic blood pressure were also measured, and OPP was calculated. All measurements were performed at baseline and 1 month after surgery.

Results

The mean IOP was 25.0±5.8 mm Hg at baseline and 11.7±2.6 mm Hg after trabeculectomy (P<0.001), and the mean subfoveal CT was 295±84 mm Hg at baseline and 331±82 mm Hg after trabeculectomy (P<0.001). The mean AL was 23.64±0.98 mm at baseline and 23.54±0.96 mm after trabeculectomy (P<0.001), whereas the mean OPP was 38.8±6.2 mm Hg preoperatively, and 51.1±7.3 mm Hg postoperatively (P<0.001). The change in CT negatively correlated with the change in IOP (r=−0.785, P<0.001) and AL (r=−0.693, P<0.001), whereas it positively correlated with the change in OPP (r=0.418, P=0.008).

Conclusion

These results suggest that the large IOP decrease following trabeculectomy causes choroidal thickening. In addition, CT changes are associated with IOP and AL reduction as well as OPP increase.     

Effects of body mass index on intraocular pressure and ocular pulse amplitude

AIM: To investigate the effects of body mass index (BMI) on intraocular pressure (IOP) and ocular pulse amplitude (OPA).METHODS: Totally 140 healthy individuals without any systemic diseases were included in the study. BMI (kg/m²) was calculated for every individual. IOP and OPA were measured with Pascal Dynamic contour tonometer (DCT). Blood pressure was also measured along with the DCT. The patients were divided into three groups according to BMI as: Group1, BMI<25; Group2, 25≤BMI<30; Group3, BMI≥30. Mean values of IOP, OPA, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were used in statistical analysis.RESULTS: In Group1, the means of IOP, OPA, were 16.8±2.3mmHg, 2.7±0.7mmHg respectively; and SBP, DBP were 120.0±6.1mmHg, and 77.4±5.6mmHg respectively. In group2, the mean IOP, OPA, SBP, and DBP were found to be 16.6±2.1mmHg, 2.4±0.7mmHg, 121.7±5.3mmHg, and 79.5±4.9mmHg respectively. In group3, the mean IOP, OPA, SBP, and DBP were found to be 17.3±1.7mmHg, 2.1±0.7mmHg, 122.4±5.7mmHg, and 79.7±5.2mmHg respectively. There were no statistically significant difference between groups in terms of IOP, SBP and DBP, while OPA values were significantly lower in group3 (P=0.001).CONCLUSION: Decreased OPA values in individuals with higher BMI may indicate that subjects with higher BMI have lower choroidal perfusion and lower ocular blood flow.     

Factors associated with topographic changes of the optic nerve head induced by acute intraocular pressure reduction in glaucoma patients

Purpose

To investigate factors associated with changes in optic nerve head (ONH) topography after acute intraocular pressure (IOP) reduction in patients with primary open-angle glaucoma (POAG).

Methods

Untreated POAG patients (IOP >21 mm Hg) were prospectively enrolled. Systemic and ocular information were collected, including central corneal thickness (CCT) and corneal hysteresis (CH). All patients underwent confocal scanning laser ophthalmoscopy and tonometry (Goldmann) before and 1 h after pharmacological IOP reduction. The mean of three measurements was considered for analysis. Changes in each ONH topographic parameter were assessed (one eye was randomly selected), and those that changed significantly were correlated with patient''s systemic and ocular characteristics.

Results

A total of 42 patients were included (mean age, 66.7±11.8 years). After a mean IOP reduction of 47.3±11.9%, significant changes were observed in cup area and volume, and in rim area and volume (P<0.01), but not in mean cup depth (P=0.80). Multiple regression analysis (controlling for baseline IOP and magnitude of IOP reduction) showed that CH (r²=0.17, P<0.01) and diabetes diagnosis (r²⩾0.21, P<0.01) were negatively correlated with the magnitude of changes in ONH parameters, whereas the cup-to-disc ratio was positively correlated (r²=0.30, P<0.01). Age, race, disc area, and CCT were not significant (P⩾0.12). Including all significant factors in a multivariable model, only the presence of diabetes remained significantly associated with all ONH parameters evaluated (P<0.01).

Conclusions

Different systemic and ocular factors, such as diabetes, CH, and the relative size of the cup, seem to be associated with the magnitude of changes in ONH topography after acute IOP reduction in POAG patients. These associations partially explain the ONH changes observed in these patients and suggest that other factors are possibly implicated in an individual susceptibility to IOP.     

Bimatoprost/timolol fixed combination (BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

AIM: To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03% and timolol 0.5% (BTFC) in patients in Greece with primary open angle glaucoma (POAG) or ocular hypertension (OHT) whose previous therapy provided insufficient lowering of intraocular pressure (IOP). METHODS: A multicenter, prospective, open-label, non-interventional, observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece. The primary endpoint was the reduction in IOP from baseline at study end, approximately 12wk after initiation of BTFC therapy. RESULTS: A total of 785 eligible patients were enrolled in the study and 97.6% completed the study. The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg (n=764; P<0.001). In patients (n=680) who replaced their previous IOP-lowering monotherapy (a single drug, or a fixed combination of 2 drugs in a single ophthalmic drop) with once-daily BTFC, the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg (P<0.001). IOP was reduced from baseline in 99.2% of patients, and 58.0% of patients reached or exceeded their target IOP. Substantial mean IOP reductions were observed regardless of the previous therapy. BTFC was well tolerated, with 96.0% of patients who completed the study rating the tolerability of BTFC as “good” or “very good.” Adverse events were reported in 8.3% of patients; only 0.6% of patients discontinued the study due to adverse events. CONCLUSION: In clinical practice in Greece, BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy.     

Comparison of trabeculectomy and Ex-PRESS implantation in fellow eyes of the same patient: a prospective, randomised study

Purpose

To compare intraocular pressure (IOP) over time after standard trabeculectomy vsEx-PRESS implantation in patients with bilateral primary open-angle glaucoma (POAG).

Design

Prospective, randomised study.

Patients and methods

This study included adult patients with bilateral POAG necessitating surgery. Each patient underwent trabeculectomy in one eye and Ex-PRESS implantation under a scleral flap in the other eye according to randomised contralateral allocations. Efficacy was assessed by IOP values and success rates (IOP threshold and/or need for topical glaucoma medication) during 30 months. Statistical analysis included Generalised Estimate Equation and Cox Survival models, and paired t-tests.

Results

Thirty eyes of 15 patients were studied for a mean of 23.6 months (SD, ±6.9). At the last follow-up visit, mean pre-operative IOP decreased from 31.1 (±14.2) to 16.2 (±1.5) mm Hg after trabeculectomy, and from 28.1 (±9.0) to 15.7 (±1.8) mm Hg after Ex-PRESS implantation (P=0.001). The mean number of anti-glaucoma medicines prescribed at the last follow-up decreased from 3.7 pre-operatively (both groups) to 0.9 after trabeculectomy vs0.3 after Ex-PRESS implantation (P=0.001). Complete success rates (5P=0.0024). Postoperative complications were more frequent after trabeculectomy (33%) compared with Ex-PRESS (20%), with four trabeculectomy eyes (27%) needing postoperative interventions, compared with none with Ex-PRESS.

Conclusions

Trabeculectomy and Ex-PRESS implantation provided similar IOP control, but the Ex-PRESS group had a lower rate of complications, fewer postoperative interventions, and needed less glaucoma medications.     

The biomechanical properties of the cornea in patients with systemic lupus erythematosus

Pupose:

The purpose of this study was to compare the biomechanical properties of the cornea and intraocular pressure (IOP) between patients with systemic lupus erythematosis (SLE) and age-matched controls.

Patients and Methods:

In this prospective study, 30 healthy individuals (control group) and 30 patients with SLE (study group) underwent Reichert ocular response analyzer (ORA) measurements. In the right eye of each participant, the corneal hysteresis (CH), corneal resistance factor (CRF), and Goldman-related IOP (IOPg) were recorded using the ORA.

Results:

Mean CH, CRF, IOPg were significantly different between groups. Mean CH was 10.2±0.6 mm Hg in the study group and 11.3±1.3 in the control group (P=0.02); mean CRF was 9.7±1.1 mm Hg and 11.9±1.5 mm Hg, respectively (P=0.001). Mean IOP_g was 13.9±2.9 mm Hg in the study group and 16.9±2.6 mm Hg in the control group (P=0.001).

Conclusion:

The biomechanical properties of the cornea are altered in patients with SLE compared with normal controls. These findings should be taken into account when measuring IOP values in patients with SLE as IOP readings may be underestimated in SLE eyes.     

The influence of soft contact lenses on the intraocular pressure measurement

Purpose

To evaluate the influence of silicone hydrogel contact lenses on the intraocular pressure (IOP) measurement using Goldmann applanation tonometry (GAT), non-contact tonometry (NCT), and Pascal dynamic contour tonometry (DCT).

Methods

We included in the study 40 eyes of 40 patients who did not have any ocular or systemic diseases or contraindications to contact lens use. We measured and recorded the IOP values of each patient using NCT without and with contact lenses (groups 1 and 2, respectively), using DCT without and with contact lenses (groups 3 and 4, respectively), and using GAT without contact lenses (group 5).

Results

The mean IOP value of group 1 was 14.55±2.95 mm Hg and 13.92±2.58 mm Hg in group 2. We detected no statistically significant difference between group 1 and group 2 (P=0.053). The mean IOP values for group 3 and group 4 were 16.26±2.33 mm Hg and 15.19±2.40 mm Hg, respectively. We detected a statistically significant difference between groups 3 and 4 (P=0.005). Group 5''s mean IOP value was 12.97±2.65 mm Hg. IOP values measured with DCT were statistically significantly higher compared with IOP values measured with NCT and GAT (P<0.0001 and P<0.0001, respectively). Additionally, IOP values measured with NCT were statistically significantly higher compared with IOP values measured with GAT (P<0.0001).

Conclusion

According to the results of our study, silicone hydrogel soft contact lens use does not significantly affect IOP values measured with NCT, but it affects IOP values measured with DCT.     

Evaluation of ocular pulse amplitude and choroidal thickness in diabetic macular edema

Purpose

The aim of this study is to evaluate the ocular pulse amplitude (OPA) and choroidal thickness (CT) measurements in patients with diabetic macular edema (DME) and healthy subjects.

Methods

A total of 34 patients (12 male and 22 female) who had type 2 diabetes mellitus with DME and 34 sex-matched healthy subjects (13 male and 21 female) were included in this prospective study. The intraocular pressure (IOP) and OPA were measured with Dynamic contour tonometer (Pascal DCT, Switzerland). The subfoveal CT was measured using the Cirrus HD-OCT (Carl Zeiss Meditec). The CT at 1500 μm and 3000 μm nasal and temporal to the central fovea was also measured.

Results

The mean IOP values were 18.4±3.5 and 17.1±2.1 mm Hg in DME patients and healthy controls, respectively (P= 0.091). The mean OPA values in patients with DME (2.58±0.96) and controls (3.52±1.03) were statistically different (P<0.001). The mean subfoveal CT value was 273.5±30.2 μm in the eyes with DME and 321.4±36.5 μm in the control group (P< 0.001). In both groups, linear regression analysis showed no significant association between OPA and CT measurements. The IOP showed a significantly positive correlation with OPA in both DME (P=0.002, r=0.526) and controls (P=0.004, r=0.483).

Conclusions

The current study suggests that both pulsatile choroidal blood flow and CT are decreased in patients with DME.     

Increased intraocular pressure on the first postoperative day following resident-performed cataract surgery

Purpose

The aim of this study was to investigate the incidence of intraocular pressure (IOP) elevation after resident-performed cataract surgery and to determine variables, which influence postoperative day 1 (POD1) IOP.

Methods

In all, 1111 consecutive cataract surgeries performed only by training residents between 1 July 2001 and 30 June 2006 were included. Elevated IOP was defined as ≥23 mm Hg. Surgeries were classified according to the presence of POD1-IOP elevation. Fisher''s exact test and Student t-test were used to compare both groups. Multivariate analyses using generalized estimating equations were performed to investigate predictor variables associated with POD1-IOP elevation.

Results

The average preoperative IOP was 16.0±3.2 mm Hg and the average POD1-IOP was 19.3±7.1 mm Hg, reflecting a significant increase in IOP (P<0.001, paired t-test). The incidence of POD1-IOP elevation ≥23 mm Hg was 22.0% (244/1111). Presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length were frequently encountered variables in the POD1-IOP elevation group (all P<0.05). Using a multivariate analysis, presence of glaucoma (P=0.004, OR=2.38; 95% confidence interval (95% CI)=1.31–4.30), presence of ocular hypertension (P=0.003, OR=6.09; 95% CI=1.81–20.47), higher preoperative IOP (P<0.001, OR=3.73; 95% CI=1.92–7.25), and longer axial length (P=0.01, OR=1.15; 95% CI=1.03–1.29) were significant predictive factors for POD1-IOP elevation.

Conclusions

IOP elevation on the first postoperative day following resident-performed cataract surgery occurred frequently (22.0%). Increased early postoperative IOP was associated with presence of glaucoma and ocular hypertension, higher preoperative IOP, and longer axial length.     

Corneal hysteresis in patients with dry eye

Purpose

To measure corneal hysteresis and intraocular pressure (IOP) in patients with dry eye and to compare with normal subjects.

Methods

This cross-sectional study consists of 70 eyes of 40 patients with dry eye (group 1) and 75 eyes of 40 normal subjects (group 2). Eyes were diagnosed as dry eye or normal according to the clinical symptoms, biomicroscopical evaluation, and Schirmer test. Corneal hysteresis (CH), corneal resistance factor (CRF), and cornea-compensated intraocular pressure (IOPcc) were measured by the Ocular Response Analyser (ORA).

Results

Mean CH values were 10.56±0.25 mm Hg and 10.34±0.26 mm Hg, mean CRF values were 10.75±0.28 mm Hg and 10.70±0.28 mm Hg, mean CCT values were 542±3.20 μm and 543±3.89 μm in group 1 and group 2, respectively. There was no statistically significant difference between the groups for these three parameters. IOPcc values measured with ORA were 15.73±0.36 mm Hg in group 1 and 16.60±0.33 mm Hg in group 2, and there was no statistically significant difference between the two groups.

Conclusions

Corneal biomechanical parameters such as CH and CRF are not influenced in dry eye. Also statistical difference was not found between the two groups according to CCT and IOPcc values.     

Comparison of postoperative intraocular pressure changes between 23-gauge transconjunctival sutureless vitrectomy and conventional 20-gauge vitrectomy

Purpose

To compare the intraocular pressure (IOP) after 23-gauge transconjunctival sutureless vitrectomy (TSV) and conventional 20-gauge vitrectomy for various vitreoretinal diseases.

Methods

This was a retrospective interventional case series including 338 cases of 23-gauge TSV and 476 cases of 20-gauge vitrectomy with minimum follow-up period of 1 month. Postoperative 1 day, 1 week and 1 month IOPs were compared. Multiple regression analysis to assess the actual effect of gauge of vitrectomy on postoperative IOP was performed including intraoperative and postoperative factors influencing postoperative IOP as covariates.

Results

The mean IOP of 20-gauge vitrectomy was significantly higher than that of 23-gauge TSV (20.6±8.02 mm Hg vs12.8±4.48 mm Hg, P<0.001) at postoperative day 1, but the differences were not significant at postoperative 1 week and 1 month. The IOP pattern of 23-gauge TSV demonstrated more stable course than that of 20-gauge vitrectomy. At 1 day post vitrectomy, the incidence of hypertony was higher in 20-gauge, whereas that of hypotony was higher in 23-gauge. Among risk factors, the 20-gauge vitrectomy showed the strongest association with postoperative 1 day IOP rise.

Conclusion

Twenty-three-gauge TSV has stable and lower IOP in the early postoperative period than the 20-gauge vitrectomy. In patients whose retina and optic nerves are vulnerable to higher or fluctuating IOP, 23-gauge TSV may be more beneficial.     

The effect of orbital decompression surgery on refraction and intraocular pressure in patients with thyroid orbitopathy

Purpose

To investigate the effect of orbital decompression surgery in thyroid orbitopathy (TO) on both refractive status and intraocular pressure (IOP).

Patients and methods

A prospective, multicentre, consecutive audit of patients undergoing thyroid decompression surgery. Indications for surgery included cosmetically unacceptable proptosis or corneal exposure. Exclusion criteria included the following: previous orbital surgery, glaucoma, corneal disease, steroid use in the preceding 12 months, or an acute optic neuropathy. Automated refraction, keratometry, pachymetry, Hertel exophthalmometry, and IOP were recorded at 1 month pre- and 3 months postoperatively. IOP using the Tono-Pen (mean of three readings) was measured in the primary, upgaze, and downgaze positions.

Results

Data were collected from 52 orbits of 33 patients (East Grinstead, New York, and Adelaide). There was no significant difference between pre- and postoperative data for sphere, cylinder, or central corneal thickness (CCT). The mean spherical equivalent was −0.43±1.49 D pre-operatively and −0.28±1.52 D postoperatively. The steepest meridian of corneal curvature was 93.1 degrees pre- and 94.2 degrees postoperatively, with no significant difference. Mean IOP significantly decreased when measuring by Goldmann applanation tonometry (GAT) (2.28 mm Hg, ^* P=0.001) and Tono-Pen (3.06 mm Hg, ^* P=<0.0001). IOP measured in upgaze was significantly greater than that in the primary position. Regression analysis between change in IOP and either Hertel exophthalmometry or the number of orbital walls decompressed was non-significant (^*Student''s t-test).

Conclusion

Patients with TO undergoing orbital decompression had, on average, with-the-rule astigmatism not affected by orbital decompression surgery. IOP was significantly reduced by decompression surgery although no relationship between IOP and the degree of decompression was observed.     

Assessment of intraocular pressure measured by Reichert Ocular Response Analyzer, Goldmann Applanation Tonometry, and Dynamic Contour Tonometry in healthy individuals

AIM: To investigate the accuracy of intraocular pressure (IOP) as measured by a Reichert Ocular Response Analyzer (ORA), as well as the relationship between central corneal thickness (CCT) and IOP as measured by ORA, Goldmann applanation tonometry (GAT), and dynamic contour tonometry (DCT). METHODS: A total of 158 healthy individuals (296 eyes) were chosen randomly for measurement of IOP. After CCT was measured using A-ultrasound (A-US), IOP was measured by ORA, GAT, and DCT devices in a randomized order. The IOP values acquired using each of the three tonometries were compared, and the relationship between CCT and IOP values were analyzed separately. Two IOP values, Goldmann-correlated IOP value (IOPg) and corneal-compensated intraocular pressure (IOPcc), were got using ORA. Three groups were defined according to CCT: 1) thin cornea (CCT<520μm); 2) normal-thickness cornea (CCT: 520–580μm); and 3) thick cornea (CCT>580μm) groups. RESULTS: In normal subjects, IOP measurements were 14.95±2.99mmHg with ORA (IOPg), 15.21±2.77mmHg with ORA (IOPcc), 15.22±2.77mmHg with GAT, and 15.49±2.56mmHg with DCT. Mean differences were 0.01±2.29mmHg between IOPcc and GAT (P>0.05) and 0.28±2.20mmHg between IOPcc and DCT (P>0.05). There was a greater correlation between IOPcc and DCT (r=0.946, P=0.000) than that between IOPcc and GAT (r=0.845, P=0.000). DCT had a significant correlation with GAT (r=0.854, P=0.000). GAT was moderately correlated with CCT (r=0.296, P<0.001), while IOPcc showed a weak but significant correlation with CCT (r=?0.155, P=0.007). There was a strong negative correlation between CCT and the difference between IOPcc and GAT(r=-0.803,P=0.000), with every 10μm increase in CCT resulting in an increase in this difference of 0.35mmHg. The thick cornea group (CCT>580μm) showed the least significant correlation between IOPcc and GAT (r=0.859, P=0.000); while the thin cornea group (CCT＜520μm) had the most significant correlation between IOPcc and GAT (r=0.926, P=0.000). The correlated differences between IOPcc and DCT were not significant in any of the three groups (P>0.05). CONCLUSION: Measurement of IOP by ORA has high repeatability and is largely consistent with GAT measurements. Moreover, the ORA measurements are affected only to a small extent by CCT, and are likely to be much closer to the real IOP value than GAT.     

Twenty-four hour efficacy with the dorzolamide/timolol-fixed combination compared with the brimonidine/timolol-fixed combination in primary open-angle glaucoma

Aim

The aim of this study is to compare the 24-hour efficacy of dorzolamide/timolol-fixed combination (DTFC) and brimonidine/timolol-fixed combination (BTFC) in primary open-angle glaucoma (POAG).

Methods

One eye each of 77 POAG patients was included in this prospective, observer-masked, crossover comparison. Following a 2-month timolol run-in period, patients had three intraocular pressure (IOP) measurements at 1000, 1200 and 1400 h while on timolol treatment. Patients showing at least a 20% IOP reduction on timolol were randomised to 3 months of therapy with DTFC or BTFC, and then were crossed over to the opposite therapy.

Results

Sixty POAG patients completed the study. The mean 24-hour IOP was significantly reduced with both the fixed combinations compared with the timolol-treated diurnal IOP (P<0.001). When the two fixed combinations were compared directly, DTFC demonstrated a lower mean 24-hour IOP level as compared with BTFC (mean difference: −0.7 mm Hg, 95% confidence interval (CI): (−1.0, −0.3), P<0.001). At two individual time points, DTFC significantly reduced IOP more than BTFC: at 1800 h (−1.0 mm Hg, 95% CI (−1.6,−0.5), P=0.001) and at 0200 (−0.9 mm Hg, 95% CI: (−1.4,−0.5), P=0.001). No significant difference existed for the other time points.

Conclusion

Both the fixed combinations significantly reduce 24-hour IOP in POAG. DTFC provided significantly better 24-hour efficacy.     

Choroid thickness and ocular pulse amplitude in migraine during attack

Aim

To compare the choroidal thickness and ocular pulse amplitude (OPA) measurements obtained during the attack period in migraine patients and age and gender matched control group participants using high definition optical coherence tomography (OCT).

Methods

Thirty eyes at the side of the headache of 30 subjects with a diagnosis of migraine with or without aura and unilateral migraine and 29 age and gender matched healthy participants were enrolled in this observational, cross-sectional study. OCT scans were performed to all participants. Choroidal thicknesses were measured at the fovea, 1500 μm nasal and 1500 μm temporal to the fovea. Intraocular pressure (IOP) and OPA were also measured.

Results

The choroidal thickness measurements obtained during the attack period in migraine patients were (mean±SD) 279.82±35.87, 250.05±29.49, and 239.58±27.92 and in control group were 308.20±44.97, 276.95±41.39, and 281.60±41.38 at foveal, nasal, and temporal measurement points, respectively. Choroidal thickness significantly decreased according to the control group (P<0.05) at all measured points in migraine patients during attack. IOP (mean±SD) values were 16.71±3.26 and17.40±3.19 and OPA (mean±SD) values were 2.26±0.81 and 2.64±1.03 in migraine and control groups, respectively, and did not seem to be changed (P>0.05).

Conclusions

Choroidal thickness was found to be significantly decreased in unilateral migraine patients during the attack period when compared with the control group, whereas OPA did not change. The possible implications of these findings on the association between migraine and glaucoma are discussed.     

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Aim

To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy.

Methods

This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at ≤21, ≤17, and ≤15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications.

Results

The mean preoperative IOP was 26.5 (±5.2) in MMC and 27.3 (±6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 (±3.5) and 9.2 (±5.5) mm Hg, respectively (P=0.009). The IOP reduction was significant at end point in all groups (P=0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan–Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (P<0.05). SD-OCT analysis of successful/unsuccessful bleb in patients with or without complete success at IOP ≤17 mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted.

Conclusions

Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate.     

Eye rubbing-induced changes in intraocular pressure and corneal thickness measured at five locations, in subjects with ocular allergy

AIM: To assess the effects of eye rubbing on corneal thickness (CT) and intraocular pressure (IOP) measurements obtained 0-30min after habitual eye rubbing in symptomatic patients. METHODS: Measurements of IOP and CT were obtained at five locations (central, temporal, superior, nasal and inferior) before, and every 5min for 30min interval after 30s of eye rubbing, for 25 randomly selected eyes of 14 subjects with ocular allergy and 11 age-matched normals. Differences in measurements were calculated in each group [Baseline measurements minus measurements recorded at each time interval after eye rubbing (for IOP), and for each corneal location (for CT)] and comparison were then made between groups (allergic versus control) for differences in any observed effects. RESULTS: Within groups, baseline mean IOPs in the allergic patient-group (14.2±3.0 mm Hg) and in the control group (13.1±1.9 mm Hg) were similar at all times, after eye rubbing (P >0.05, for all). The maximum reduction in IOP was 0.8 mm Hg in the control subjects and the maximum increase was also 0.8 mm Hg in the allergic subjects. Between groups (allergic versus control), the changes in IOP remained under 1 mm Hg at all times (P=0.2) after 30min of eye rubbing. Between 0 and 30min of CT measurements after eye rubbing, the mean central CT (CCT), inferior CT (ICT), superior CT (SCT), temporal CT (TCT) and nasal CT (NCT) did not vary significantly from baseline values in the control and allergic-subject groups (P>0.05, for both). Between both groups, changes in CT were similar at all locations (P>0.05) except for the TC which was minimally thinner by about 4.4 μm (P=0.001) in the allergic subjects than in the control subjects, 30min following 30s of eye rubbing. CONCLUSION: IOP measured in allergic subjects after 30s of habitual eye rubbing was comparable with that obtained in normal subjects at all times between 0 and 30min. Although, CT in the allergic subjects were similar to those of the control subjects at all times, it varied between +10 and -7.5 μm following eye rubbing, with the temporal cornea showing consistent reductions in thickness in the subjects with allergy. However, this reduction was minimal and was considered to not be clinically relevant.     

Deep sclerectomy with mitomycin C in eyes with failed glaucoma surgery and pseudophakia

Purpose

To report outcomes of deep sclerectomy (DS) with intraoperative mitomycin C (MMC) application in eyes with previous failed glaucoma surgery (GS) and/or cataract extraction (CE).

Patients and methods

Single-surgeon case series of 82 eyes of 82 patients undergoing DS with MMC. The patients had previous CE with IOL and/or conjunctival GS and treated intraocular pressure (IOP) >18 mm Hg. MMC (0.2 mg/ml) was applied for 2–3 min before scleral flap dissection. Complete success was defined as IOP between 6 and 21 mm Hg or a reduction of 20% from baseline without medications. Reoperation for glaucoma or related complications, or loss of light perception vision was considered as failure.

Results

Mean follow-up was 57.7±22.4 months with 78% of patients completing the 3-year follow-up. Mean IOP decreased from 24.0 mm Hg (22.3–25.6, 95% confidence intervals) to 13.4 mm Hg (12.0–14.2) at 3 years after surgery (P<0.001). There was a significant decrease in the number of glaucoma medications from 2.0±1 preoperatively, to 0.3±0.7, 3 years after surgery. Kaplan–Meier cumulative success rates were 85.6% at 1 year, 80.0% at 2 years, and 76% at 3 years. At 3 years, IOP was maintained <19 and 15 mm Hg in 83 and 70% of eyes, respectively. Fourteen eyes (17.1%) had complications. Delayed hypotony (IOP <6 mm Hg) was the commonest complication in five eyes (6.1%).

Conclusion

DS with MMC appears to be a safe and effective surgical procedure for eyes with previous intraocular surgery.     

POAG患者习惯性体位眼压及眼灌注压昼夜波动趋势的研究

目的：探讨初诊未行治疗的原发性开角型青光眼( prilary open angle glaucola,POAG)患者习惯性体位眼压及眼灌注压(ocular perfusion pressure,OPP)波动趋势,并验证由日间平均坐位及卧位眼压推导夜间峰值眼压的可行性。
　　方法：选取POAG患者19例19眼及正常对照组18例18眼,分别于10：00,14：00,18：00及22：00时行坐位眼压及血压监测,为验证由日间卧位眼压推导夜间峰值眼压的可行性,另对POAG组于卧位5 lin后再行监测。2：00,5：00及7：00行卧位监测,计算出OPP并行数据分析。由已知公式通过日间眼压计算夜间峰值眼压,并与实际值对比。
　　结果：24h习惯性体位下,POAG患者平均眼压及眼压波动均高于正常对照组(P<0.05),POAG组平均眼压峰值出现于凌晨5：00,对照组则为7：00。两组夜间眼压均值均大于日间,差异有统计学意义(P<0.05)。两组内习惯性体位平均眼灌注压( MOPP )均表现为夜间低于日间( P<0.05),而两组间 MOPP 无明显统计学差异( P>0.05)。POAG患者MOPP波动较对照组大,差异有统计学意义( P<0.05)。由两公式推导所得夜间眼压峰值均与所测值无明显统计学差异(P>0.05)。
　　结论：习惯性体位下POAG组及正常人的眼压峰值多出现在凌晨至上午,POAG患者的习惯性体位平均眼压及眼压波动均高于对照组。两组内夜间灌注压均较日间低,且POAG患者有更大的MOPP波动。由日间眼压推导夜间峰值眼压具有一定的可行性。     

Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma

Purpose:

To compare postoperative outcomes and assess factors associated with intraocular pressure (IOP) reduction after phacotrabeculectomy in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).

Methods:

This is a retrospective study of patients who underwent phacotrabeculectomy between 2010 and 2013. Factors including age, gender, visual field (VF), the number of glaucoma medications used, biometric changes, IOP, and surgical success rates were compared between groups.

Results:

There were 27 PACG and 34 POAG patients. The PACG group had a greater mean IOP reduction after phacotrabeculectomy compared to the POAG group (5.5 ± 7.9 mmHg versus 2.0 ± 4.2 mmHg; p = 0.03). However, the final mean IOP was similar between the two groups (PACG: 12.2 ± 4.8 mmHg, POAG: 12.3 ± 3.1 mmHg; p = 0.92). Phacotrabeculectomy resulted in a mean decrease in axial length (AL) of 0.16 ± 0.15 mm in PACG and 0.16 ± 0.11 mm in POAG (p = 0.96), and an increase in anterior chamber depth (ACD) of 1.41 ± 0.91 mm in PACG, and 0.87 ± 0.86 mm in POAG (p = 0.04). At 2 years follow-up, the cumulative success rate of phacotrabeculectomy was 74% in PACG and 62% in POAG. Multivariate analysis found that early glaucoma stage, greater postoperative increase in ACD, and high preoperative IOP were factors associated with greater IOP reduction.

Conclusion:

Postoperative success rates and mean IOP on the final visit after phacotrabeculectomy were similar between the PACG and POAG groups. Factors associated with IOP reduction were greater postoperative increase in ACD, and high preoperative IOP.