Ocular decompression retinopathy following post-trabeculectomy suture lysis and management with triamcinolone acetonide

Ocular decompression retinopathy (ODR) is a rare complication of sudden lowering of intraocular pressure (IOP) in glaucoma and ocular hypertension. An 80-year-male, a known case of chronic open-angle glaucoma for 13 years, had his IOP controlled by multiple topical antiglaucoma medications. There was an increase in IOP, progression of optic disc cupping and visual field loss along with cataract over the past 6 months. The patient underwent uneventful phacoemulsification with posterior chamber intraocular lens (PCIOL) and penetrating trabeculectomy. Postoperatively, the trabeculectomy bleb was flat and IOP was 44 mmHg and was not controlled by bleb massage. Bleb needling and suture lysis were performed after 2 weeks. The IOP dropped from 44 to 6 mmHg. Three days later the patient presented with a sudden decline in visual acuity (VA) from 0.5 to 1.225 logMAR. The fundus showed multiple retinal haemorrhages resembling ODR. Choroidal detachment also occurred after 3 weeks. Optical coherence tomography confirmed the presence of macular oedema which was treated with an orbital floor triamcinolone acetonide injection (OFTA). The haemorrhages, choroidal detachment and macular oedema resolved and VA improved in 6 months. This is the first case report of ODR following suture lysis and needling after an uneventful combined phacoemulsification with PCIOL implant and trabeculectomy. It also highlights the role of OFTA injections in the management of ODR.     

Acute retinal ischemia caused by controlled low ocular perfusion pressure in a porcine model. Electrophysiological and histological characterisation

The purpose of this study was to establish, and characterize a porcine model of acute, controlled retinal ischemia. The controlled retinal ischemia was produced by clamping the ocular perfusion pressure (OPP) in the left eye to 5 mm Hg for 2 h. The OPP was defined as mean arterial blood pressure (MAP) minus the intraocular pressure (IOP). It was clamped to 0–30 mm Hg by continuous monitoring of MAP and adjustment of the IOP, which was controlled by cannulation of the anterior chamber. Inner retinal function was assessed by induced multifocal electroretinography (mfERG) with comparisons of the amplitudes obtained in the experimental, left eye, and the control, right eye. Quantitative histology was performed to measure the survival of ganglion cells, amacrine cells and horizontal cells 2–6 weeks after the ischemic insult. An OPP of 5 mm Hg for 2 h induced significant reductions in the amplitudes of iN1 to 20% (CI: 13–30%), and iP2 to 14% (95% CI: 8–22%) of their baseline values. No signs of recovery were found within the 6-week observation period. Quantitative histology revealed a highly significant reduction in the number of ganglion cells, amacrine cells and horizontal cells after the ischemic insult. This model seems to be suitable for investigations of therapeutic initiatives in diseases involving acute retinal ischemia.     

Five-year results of non-penetrating deep sclerectomy with demineralized cancellous bone xenogenically derived collagen glaucoma implant

Purpose

To investigate the long-term effectiveness of non-penetrating deep sclerectomy (NPDS) with xenogenically derived cancellous bone collagen glaucoma implant (XCB-CGI) implantation in patients with primary open-angle glaucoma (POAG).

Materials and methods

Retrospective chart review of patients with POAG stages 2 and 3 was treated with NPDS and XCB-CGI. Follow-up was at 6 months, 1, 2, 3, 4 and 5 years after surgery. Main outcomes were intraocular pressure (IOP) and medication burden. Secondary outcomes were visual acuity, corneal hysteresis (CH), visual field (VF) and optical coherence tomography (OCT) parameter analysis.

Results

Among 71 patients (71 eyes), the mean age was 72.7?±?9.8. Average initial IOP was 27.7?±?7.9 and average initial med load was 2.36?±?0.99. At 6 months, 1, 2, 3, 4 and 5 years, the average IOP was 14.9?±?3.3 mm Hg (46.2% reduction), 15.3?±?4.0 mm Hg (44.7% reduction), 14.2?±?3.8 mm Hg (48.7% reduction), 15.2?±?3.3 mm Hg (45.0% reduction), 15.5?±?3.3 mm Hg (44.0% reduction) and 14.2?±?2.8 mm Hg (48.7% reduction), respectively. In 5 years, the success rate was 34% and 67%, without, and with medications (1.8?±?0.8 meds required), respectively. Visual acuity was not significantly different (P?>?.05) at all follow-up visits from baseline. Mean CH increased by 2.1?±?0.8 (P?=?.05). No glaucomatous deterioration of the VF and OCT parameters was detected in 56 eyes at the 5-year follow-up.

Conclusion

NPDS with XCB-CGI implantation is an effective procedure to normalize the level of IOP, stabilize glaucomatous changes and decrease the number of meds needed for glaucoma control.

     

Long term outcome of secondary glaucoma following vitreoretinal surgery

PURPOSE: To determine the long term outcome of secondary glaucoma following retinal reattachment surgery. METHOD: A longitudinal retrospective study was undertaken of the medical records of patients referred to the Glaucoma Service at Moorfields Eye Hospital following retinal reattachment surgery. The main outcome measures were final intraocular pressure (IOP), progression in cup:disc ratio, and final visual acuity outcome. RESULTS: A total of 70 eyes of 70 patients (41 males and 29 females) were identified and included in the analysis. Mean increase of IOP 2-3 weeks following the first vitreoretinal procedure was 6 (SD 3) mm Hg. After a mean follow up of approximately 4 years the mean IOP had significantly decreased from 33 (SD 10) to 16 (SD 8) mm Hg (p<0.001). The visual outcome of eyes with final IOP less than 6 or greater than 21 mm Hg was significantly worse compared with those eyes with a normal (6-21 mm Hg) range of pressure (p = 0.022 and p = 0.009 respectively). Despite the effective control of IOP in the majority of patients during the follow up period, there was mild progression of the mean vertical cup:disc ratio from 0.6 (SD 0.2) to 0.7 (SD 0.2) (p<0.001). CONCLUSION: Secondary glaucoma is a major complication following retinal reattachment surgery. Medical treatment is successful in lowering IOP in most patients. In persisting cases surgical treatment is very effective, however it can be associated with an increased risk of postoperative hypotony. Despite apparently adequate IOP control there may be progressive cupping of the optic disc.     

玻璃体腔注射曲安奈德后的眼压改变

目的观察玻璃体腔注射曲安奈德（TA）后眼压变化规律及其影响因素。方法回顾分析在我院接受TA玻璃体腔注射治疗的125例患者125只眼的临床资料。其中，男性52例，女性73例；年龄17~83岁，平均年龄56.5岁。糖尿病视网膜病变（DR）49例，占39.20%；视网膜静脉阻塞（RVO）56例，占44.80%；渗出型老年性黄斑变性（AMD）20例，占16.00%。治疗前1 d Goldmann眼压计测量的基础眼压为7.00~31 mm Hg（1 mm Hg=0.133 kPa），平均眼压为(14.69±3.72) mm Hg。根据眼压检查结果将患者分为基础眼压偏低（＜15.00 mm Hg）、偏高（≥15.00 mm Hg）2组，分别为 64、61例。所有患者均接受4 mg TA常规玻璃体腔注射治疗。治疗后1、3 d，1、2周，1个月同样方法测量眼压，以后每一个月复查眼压1次。随诊3~21个月，平均随诊时间5个月。以眼压≥21.00 mm Hg为眼压升高。对比分析患者治疗前后、不同病种以及不同年龄的眼压变化规律。结果治疗后36例患者眼压升高，占28.8%。97.2%的患者眼压升高发生在治疗后3个月内，治疗后7个月恢复到基础水平。其中，基础眼压偏低组11例，占17.19%；基础眼压偏高组25例，占40.98%，两组差异有统计学意义（P＜0.01）。治疗后随访期峰值平均眼压（20.09±7.58）mm Hg，较治疗前平均眼压升高5.43 mm Hg，差异有统计学意义（P＜0.001）；53例治疗后峰值眼压比治疗前眼压高5.00 mm Hg，占42.4%。随访期峰值平均眼压DR组为（18.19±4.73）mm Hg，RVO组为（22.50±9.30）mm Hg，AMD组为（18.12±6.09）mm Hg。RVO组眼压升高发生率显著高于DR组和AMD组。3组间差异有统计学意义(P＜0.01)。以年龄为自变量，治疗后峰值眼压为因变量的回归分析显示：年龄与治疗后眼压升高有关，年龄小，治疗后发生高眼压的风险大，差异有统计学意义（P=0.000）。结论TA玻璃体腔注射后眼压升高较常见，治疗后眼压升高与治疗前基础眼压、年龄、病因相关，治疗前基础眼压偏高、患者年龄较小以及RVO患者TA玻璃体注射后容易发生眼压升高。(中华眼底病杂志, 2007, 23: 115-117)     

The effect of scleral flap edge apposition on intraocular pressure control in experimental trabeculectomy

Background: To assess the contribution of scleral flap edge apposition to intraocular pressure (IOP) control in trabeculectomy, using a previously described and validated experimental model of guarded filtration surgery. Materials and methods: Twelve rectangular‐flap trabeculectomy operations each with two apical adjustable sutures were performed on six donor human eyes connected to a constant flow infusion with real‐time IOP monitoring. Three sizes of scleral flap were created: 4 × 4 mm, 16 mm² (n = 4), 3 × 3 mm, 9 mm² (n = 4) or 3 × 2 mm, 6 mm² (n = 4). Sutures were tied tightly to produce high aqueous outflow resistance, and equilibrium IOP established. The lateral and posterior edges of the scleral flap were removed, the sutures tightened again, and the new equilibrium IOP measured. Results: Following flap closure and with intact flap edges, the mean absolute IOP for all flaps (n = 12) was 19.5 ± 3.9 mm Hg (mean ± SD, range 12.4–27 mm Hg) and following flap edge excision 18.7 ± 4.4 mm Hg (range 5.6–27.9 mm Hg), demonstrating no significant difference between flaps with edge apposition compared with those without (P = 0.33). Mean relative IOP (% of baseline) was 68.4 ± 12.1% (range 40.9–94%) with intact flap edges and 65.4 ± 14.5% (range 18.5–97.2%) following flap edge excision (P = 0.31). Flaps measuring 4 × 4 mm and 3 × 3 mm behaved in a similar manner with minimal change in equilibrium IOP following excision of flap edges. Conclusions: In this experimental model, scleral flap edge apposition is not required for generating outflow resistance. Suture tension generated during tight flap closure produces apposition of the underside of the scleral trapdoor to the underlying bed, and it is this apposition, which determines IOP.     

Effects of early postfiltration ocular hypotony on visual acuity, long-term intraocular pressure control, and posterior segment morphology

PURPOSE: To determine whether hypotony after filtration surgery has any influence on visual acuity and intraocular pressure (IOP) lowering. PATIENTS AND METHODS: We prospectively investigated 43 eyes of 43 patients undergoing trabeculectomy without the use of antimetabolites for 12 months. RESULTS: The lowest postoperative IOP valued 4.9 +/- 3.6 mm Hg (range, 0-14 mm Hg). It correlated statistically significant with the IOP 6 weeks (P = 0.016), 6 months (P = 0.009), and 1 year after surgery (P = 0.027). Eyes with a deterioration of visual acuity 6 weeks after surgery had undergone a stronger postoperative hypotony (correlation with lowest postoperative IOP, P = 0.035). The mean period with an IOP less than 5 mm Hg was 3.5 +/- 8.0 days, and the mean period with an IOP less than 10 mm Hg lasted 45.4 +/- 68.8 days (range, 0-276 days). A hypotony score based on IOP and duration of hypotony was introduced. A correlation was detected between morphologic signs of hypotony, such as tiny retinal folds, at the 6-month follow-up and the duration of hypotony (P = 0.029) and hypotony score (P = 0.001). CONCLUSIONS: Hypotony after filtration surgery may decrease visual acuity in the early postoperative period. Conversely, early postoperative hypotony correlated with better long term IOP control. There was no deleterious effect on visual acuity after 6 months.     

Orbital apex syndrome secondary to myocysticercosis: a rare case report

AIM: To compare surgical outcomes of phacoemulsification combined with glaucoma surgical techniques performed with either Kahook Dual Blade (KDB) or iStent for Japanese patients with either primary open-angle glaucoma or exfoliation glaucoma.METHODS: We retrospectively evaluated the surgical outcomes of 129 eyes of 84 Japanese patients with glaucoma who underwent KDB or 44 eyes of 34 patients who underwent phacoemulsification with iStent procedures combined with cataract surgery. The primary outcome was surgical success or failure [with surgical failure being indicated by <20% reduction from preoperative intraocular pressure (IOP) or IOP >18 mm Hg, criterion A; IOP >14 mm Hg, criterion B; or reoperation requirement]. In addition, we assessed the number of postoperative glaucoma medications and the resulting complications. RESULTS: The probability of success was significantly higher in the KDB group than in the iStent group for criterion A (60.2% vs 46.4%, P=0.019). In the KDB group, the mean preoperative IOP of 19.7±7.2 mm Hg decreased significantly to 13.0±3.1 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.5±1.4 decreased significantly to 1.6±1.6 (P<0.01) 12mo postoperatively. In the iStent group, the mean preoperative IOP of 17.8±2.9 mm Hg significantly decreased to 14.3±2.3 mm Hg (P<0.01), and the mean number of glaucoma medications at 2.2±1.1 decreased significantly to 0.9±1.4 (P<0.01) 12mo postoperatively. The overall IOP reduction percentage was higher in the KDB group (26.2%) than in the iStent group (19.0%) 12mo postoperatively (P=0.03). Hyphema occurred significantly more frequently in the KDB group (16.3%) than in the iStent group (2.3%; P=0.017).CONCLUSION: KDB and iStent procedures combine with cataract surgery both resulted in significant IOP and glaucoma medication reductions after the 12-month follow-up. The patients in the KDB group have a higher success rate for the target IOP of less than 18 mm Hg and a higher complication rate than those in the iStent group.     

Factors affecting changes in the intraocular pressure after phacoemulsification surgery

AIM: To assess the changes in anterior chamber parameters and examine the factors associated with changes in the intraocular pressure (IOP) in individuals who have undergone phacoemulsification surgery. METHODS: It is a longitudinal analysis of secondary clinical data collected from 105 non-glaucomatous eyes (82 patients) undergoing a cataract surgery. We studied the association between anterior chamber parameters, grade of cataract, demographics, and changes in the IOP over a period of three weeks. We also evaluated the association between the pressure-depth (PD) ratio and changes in the IOP during this time. RESULTS: The mean age (SD) of the 82 patients was 60.1±7.8y. The mean±standard deviation (SD) IOP was 15.06±3.36 mm Hg pre-operatively; it increased to 15.75±4.21 mm Hg on day one (P=0.20). In the multifactorial models, the mean IOP was -1.715 (95%CI: -2.795, -0.636) mm Hg on day 21±5 compared with the pre-operative values. The anterior chamber depth (ACD), axial length, age, sex, and grade of cataract were not significantly associated with changes in the IOP. Each unit increase in the PD ratio was associated with an increase in the mean IOP by 1.289 mm Hg (95%CI: 0.906, 1.671). After adjusting for pre-operative PD ratio, none of the other variables (ACD, axial length, temporal angle) were significantly associated with changes in mean IOP. CONCLUSION: The PD ratio was the single most important factor associated with the changes in post-operative IOP over three weeks post-surgery.     

Deformation of the rodent optic nerve head and peripapillary structures during acute intraocular pressure elevation

PURPOSE. To evaluate the effect of acutely elevated intraocular pressure (IOP) on retinal thickness and optic nerve head (ONH) structure in the rat eye by spectral domain-optical coherence tomography (SD-OCT). METHODS. Fourteen adult male Brown-Norway rats were studied under anesthesia (ketamine/xylazine/acepromazine, 55:5:1 mg/kg intramuscularly). Both eyes were imaged by SD-OCT on two baseline occasions several weeks before and again 2 and 4 weeks after the acute IOP imaging session. During the acute IOP session, SD-OCT imaging was performed 10 minutes after IOP was manometrically set at 15 mm Hg and then at 10, 30, and 60 minutes after IOP had been elevated to 50 mm Hg (n = 8) and again 10 and 30 minutes after IOP had been lowered back to 15 mm Hg (recovery). In two additional groups, IOP elevation was set to 70 mm Hg (n = 4) or 40 mm Hg (n = 2). Acute IOP results are reported for a pattern of 49 horizontal B-scans spanning a 20° square and follow-up results for peripapillary circular B-scans. Retinal and retinal nerve fiber layer (RNFL) thicknesses were measured with custom software by manual image segmentation. Friedman and Dunn's tests were used to assess acute and longer-term effects of acute IOP elevation. RESULTS. Acute IOP elevation to 50 mm Hg caused rapid (within seconds) deformation of the ONH and peripapillary structures, including posterior displacement of the ONH surface and outward bowing of peripapillary tissue; retinal thickness decreased progressively from 10 to 30 to 60 minutes by 16%, 18%, and 20% within the area of Bruch's membrane opening (BMO; P < 0.0001) by 8%, 9%, and 11% within the central 10° (excluding the BMO; P < 0.0001) but only by 1%, 2%, and 2.4% beyond the central 10° (P < 0.0001). Recovery was progressive and nearly complete by 30 minutes. Acute IOP elevation to 40 and 70 mm Hg produced similar structural changes, but 70 mm Hg also interfered with retinal blood flow. There were no changes in peripapillary retinal or RNFL thickness (P = 0.08 and P = 0.16, respectively) measured 2 and 4 weeks after acute elevation to 50 mm Hg. CONCLUSIONS. Acute IOP elevation in the rodent eye causes rapid, reversible posterior deformation of the ONH and thinning of the peripapillary retina, with only minimal retinal thinning beyond 5° of the ONH. No permanent changes in peripapillary retinal or RNFL thickness (for up to 1 month of follow-up) were caused by 60 minutes of IOP elevation to 50 mm Hg.     

Simultaneous pars plana vitrectomy, panretinal photocoagulation, cryotherapy, and Ahmed valve implantation for neovascular glaucoma

AIM: To describe and evaluate the efficacy of Ahmed glaucoma valve implantation (AGV) combined with pars plana vitrectomy (PPV) in a single surgical act for the treatment of advanced neovascular glaucoma (NVG). METHODS: Retrospective observational case series included 51 eyes from 50 patients with severe NVG treated with PPV, AGV, and panretinal photocoagulation and/or cryotherapy in a single surgical act during a 13-year period (2005-2018). Preoperative, intraoperative and postoperative data at day 1 and months 1, 3, 6, 21, and 24 were systematically collected. Definition of surgical success was stablished at IOP between 6 and 21 mm Hg with or without topical treatment. RESULTS: Main indications for surgery were NVG secondary to proliferative diabetic retinopathy (39.2%) and central retinal vein occlusion (37.3%). Mean (±SD) preoperative IOP was 42.0±11.2 mm Hg decreasing to 15.5±7.1 mm Hg at 12mo and 15.8±9.1 mm Hg at 24mo of follow up. Cumulative incidence of success of IOP control was 76.0% at first postoperative month, reaching 88.3% at 6mo. Prevalence of successful IOP control at long term was 74.4% at 12mo and 71.4% at 24mo. Eye evisceration for unsuccessful NVG management was required in 1 case (2.0%). CONCLUSION: Combination of AGV implantation and PPV in a single act may be a suitable option for severe forms of NVG in a case-by-case basis for effective IOP control and a complete panretinal photocoagulation.     

Effect of general inhalational anesthesia on intraocular pressure measurements in normal and glaucomatous children

Purpose

To investigate the agreement between the intraocular pressure (IOP) measurements in the awake condition and under different stages of general inhalational anesthesia using sevoflurane in both glaucomatous and normal children.

Methods

A prospective study was performed on 43 glaucomatous children and 30 age-matched controls. Baseline IOP of one eye was measured immediately before general anesthesia using Perkins tonometer and then re-measured under light, intermediate, and deep anesthesia, and then after intubation. Depth of anesthesia was determined using bispectral index pediatric sensor. The agreement between the IOP measurements before and during different stages of anesthesia was analyzed using Bland–Altman plots. Systematic and proportionate deviations between the IOP measurements were analyzed.

Results

The mean age was 58.6?±?41.99 months. The mean IOP was significantly lower at all stages of anesthesia in both groups. The coefficient of variation was over 20% in all measurements under anesthesia. For all IOP measurements during anesthesia, the limits of agreement were?>?7 mmHg difference in the control group and?>?20 mmHg in the glaucomatous group. The best agreement was with the IOP measurement after intubation (mean limit of agreement of -1.4 mmHg, 1.96 s range, ?8.8–6 mm Hg) in the control group and with the IOP measurement under intermediate anesthesia (mean limit of agreement of ?4.2 mmHg, 1.96 s range, ?15.1–6.8 mm Hg) in the glaucomatous group.

Conclusions

Inhalational anesthesia has variable effects on IOP measurement at all stages of anesthesia. Caution should be taken when extrapolating the true IOP from these measurements.

     

Clinical outcomes of amniotic membrane loaded with 5-FU PLGA nanoparticles in experimental trabeculectomy

AIM: To evaluate the effect of amniotic membrane loaded with 5-fluorouracil poly (lactic-co-glycolic acid) (PLGA) nanoparticles (5-FU-NPs) in the surgical outcomes of experimental trabeculectomy in rabbits. METHODS: Thirty-two New Zealand white rabbits were randomly categorized into four groups with 8 rabbits in each group. Group 1, the control group, performed traditional trabeculectomy without adjuvant treatment. While the experimental groups performed compound trabeculectomy with different implantations including amniotic membrane (group 2), 5-FU-NPs (group 3) and amniotic membrane loaded with 5-FU-NPs (group 4). Clinical evaluations including IOP measurement and filtration bleb analysis were performed in all groups postoperatively. RESULTS: There is no significant difference of mean IOP in all groups at first 7d after surgery. While at P14, mean IOPs of experimental group 2 (9.8±2.1 mm Hg), groups 3 (8.9±2.8 mm Hg) and group 4 (7.6±2.3 mm Hg) were significantly reduced compared to control group (12.4±2.6 mm Hg; n=8, P<0.05). At P21, mean IOPs of groups 3 (11.7±3.2 mm Hg) and group 4 (9.9±1.6 mm Hg) were significantly decreased compare to control group (17.9±1.6 mm Hg) and group 2 (16.6±2.8 mm Hg; n=8, P<0.05). At P28, mean IOPs of groups 3 (13.8±3.3 mm Hg) and group 4 (10.6±2.0 mm Hg) were also significantly reduced compare to control group (19.4±2.3 mm Hg) and group 2 (18.5±2.4 mm Hg; n=8, P<0.05). Meanwhile mean IOP of group 4 is significantly decreased compared to group 3 at P28 (n=8, P<0.05). Survival analysis of functional filtration blub in all groups revealed the longest survival time in group 4 (24.9±5.1d) compared to that in group 3 (20.6±4.3d), group 2 (15.0±5.2d) and control group (10.1±5.7d). CONCLUSION: Amniotic membrane loaded with 5-Fu-NPs may function as an effective anti-scarring implant and provides improved long-term surgical outcomes for experimental trabeculectomy in rabbits.     

Intraocular pressure in premature babies in the first month of life.

PURPOSE: The purpose of this work was to study the values of intraocular pressure (IOP) in premature babies during the first month of life. METHODS: Using a hand-held applanation tonometer, IOP was measured in 40 eyes of 20 preterm infants (gestational age ranging from 26 to 32 weeks) shortly after birth and at weekly intervals for the first month of life. RESULTS: IOP values in preterm infants ranged from 7.6 to 18.3 mm Hg. The mean IOP decreased during the study period from 13.25+/-2.86 mm Hg to 10.96+/-2.01 mm Hg (P< .001). CONCLUSIONS: Although the values of IOP found in this study are by no means within the range that is considered to be pathologic for newborns, the possible lack of the decreasing tendency of IOP observed during the first month of life could have, in a given case, some clinical implications. Because systemic blood pressure in preterm infants is already quite low, even a moderately elevated IOP during the first weeks of life might in some cases result in a significant reduction of the ocular perfusion pressure. The latter might play a contributory role in the development of retinopathy of prematurity by decreasing the blood supply to the peripheral retinal tissues.     

Intraocular Pressure Following Combined Routes of Bevacizumab-augmented Trabeculectomy for Refractory Neovascular Glaucoma

ABSTRACT

Purpose: To evaluate the intraocular pressure (IOP) control following combined routes of adjuvant bevacizumab with trabeculectomy in refractory neovascular glaucoma. Methods: From June 2011 to December 2011, 5 consecutive cases of neovascular glaucoma with persistent raised IOP on maximal medical treatment underwent adjuvant bevacizumab by combined routes (subconjunctival (SC) and/or intracameral (IC), intravitreal (IV) injections) before pan-retinal photocoagulation (PRP). Needs for repeat procedures or medications for IOP control over the postoperative period were assessed. Results: The mean IOP (1 SC, 1 IC?+?IV, 3 SC?+?IC routes) reduced from 40?±?5.5?mm Hg to 17?±?3.7?mm Hg at a mean final follow-up of 4?±?3.7months (range 1–9 months), respectively (p?<?0.001 for each). All eyes had transient IOP spikes 1–3 months after surgery, which normalized spontaneously after PRP, while one eye required topical medications for IOP control. Conclusions: Combined routes of adjuvant bevacizumab augmented trabeculectomy may help in better IOP control (IC?+?IV?>?IC?+?SC?>?SC) in refractory neovascular glaucoma but require additional procedures for sustained effect.     

A comparison of dorzolamide–timolol combination versus the concomitant drugs

PURPOSE: To compare the intraocular pressure (IOP) lowering effect of fixed combination dorzolamide 2% and timolol 0.5% therapy to that of concomitant administration of a topical beta-blocker and dorzolamide.METHODS: Seventy-four consecutive glaucoma patients were changed from a regimen including a topical beta-blocker and dorzolamide to the fixed combination dorzolamide–timolol in 1 eye, with the other eye used as the control. The average IOP readings before and 1 month after the change were compared.RESULTS: The mean baseline IOP in the entire study population was 19.4 ± 4.2 mm Hg in the study eyes and 16.9 ± 4.2 mm Hg in the control eyes. Four weeks after the medication change, the mean IOP was 17.3 ± 3.9 mm Hg in the study eyes (P < .001) and 16.1 ± 4.1 mm Hg in the control eyes (P = .02). The difference between the mean IOP change of 2.1 mm Hg in the study eyes and 0.8 mm Hg in the control eyes was found to be statistically significant (P = .01).CONCLUSION: These findings suggest that the fixed combination dorzolamide–timolol therapy achieves additional lowering of the intraocular pressure compared with the concomitant administration of a beta-blocker and dorzolamide.     

Role of home monitoring with iCare ONE rebound tonometer in glaucoma patients management

AIM: To evaluate intraocular pressure(IOP) measurements and fluctuations using the i Care ONE rebound tonometer(RT-ONE), during home monitoring, in diagnosed and suspected glaucoma patients.METHODS: A retrospective case series of consecutive patients with known glaucoma or glaucoma suspects who were followed-up and treated between January 2016 and January 2017. The study included 80 eyes of 40 patients with a mean age of 59.1±14.6 y(range, 24-78). All patients have undergone 4-5 d of IOP home monitoring with RT-ONE at morning, noon, afternoon, and night time.RESULTS: Baseline mean IOP, as measured in the clinic(8 a.m.-12 p.m.), was 17.4±5.1 mm Hg, compared to RT-ONE home monitoring mean IOP of 15.6±4.1 mm Hg(P=0.002). Mean IOP was significantly lower at noon, afternoon and night times compared to clinic measured IOP and morning measurements(P=0.005). IOP peak measured during home monitoring was significantly higher compared to the clinic measured IOP(21.3±5.6 mm Hg and 17.4±5.1 mm Hg, P<0.001). IOP peaks during home monitoring demonstrated a majority of 47 peaks during morning measurements, compared to 23 at noon, 19 at afternoon and only 12 at night(P<0.001). The home monitoring results led to treatment modification of 44 eyes(55%), treatment regime was insufficient for 40(50%) eyes.CONCLUSION: Home monitoring IOP with RT-ONE can provide good assessment of mean IOP, IOP fluctuations and peaks throughout the hours of the day, which lead to an accurate treatment for glaucoma patients.     

Effects of ranibizumab on very low birth weight infants with stage 3 retinopathy of prematurity: A preliminary report

Background/PurposeTo report the effects of ranibizumab on very low birth weight (VLBW) infants with retinopathy of prematurity (ROP).MethodsA retrospective, noncomparative, consecutive, interventional case series was conducted. Patients with stage 3 ROP were identified and evaluated from August 2011 to February 2012. All patients with ROP received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) under topical anesthesia as the initial treatment.Main outcome measures: Regression of ROP and the complications associated with the intravitreal ranibizumab injection.ResultsA total of 23 eyes of 12 patients (four boys and eight girls) were included in this study. All of the patients had a history of supplemental oxygen and mechanical ventilation use. The mean gestational age was 26.33 ± 2.06 weeks (range: 24–30 weeks), and the mean birth weight was 821.58 ± 297.63 g (range: 507–1480 g). The mean postmenstrual age during the intravitreal administration of ranibizumab injection was 35.08 ± 2.07 weeks (range: 32–39 weeks), and the mean follow-up period was 5.83 ± 1.64 months (range: 3–8 months). All eyes received one intravitreal ranibizumab injection (0.25 mg/0.025 mL) as the primary therapy. None of the eyes needed conventional laser photocoagulation or cryotherapy as adjuvant therapy and no systemic complications were noted. No cataracts, endophthalmitis, or retinal detachment occurred postoperatively. Preretinal hemorrhages were found in four eyes of three patients (17.39%), but all were absorbed without sequelae.ConclusionIntravitreal ranibizumab injections seem to be effective and well tolerated in VLBW infants with stage 3 ROP. Only self-limited preretinal hemorrhages were noted, and no short-term systemic or major ocular side effects were identified.     

Acute IOP elevation with scleral suction: effects on retrobulbar haemodynamics.

AIMS/BACKGROUND: Mechanical and vascular factors may both contribute to glaucoma. This study investigated the relation of mechanical to vascular factors by examining how acute IOP elevation altered flow velocities in the central retinal and ophthalmic arteries. METHODS: IOP was elevated from a baseline near 14 to approximately 45 mm Hg using suction ophthalmodynamometry. During recovery from scleral suction, IOP fell to near 8 mm Hg. At each IOP, peak systolic and end diastolic velocities (PSV and EDV) were measured in the central retinal and ophthalmic arteries using colour Doppler imaging (Siemens Quantum 2000). Eleven healthy people served as subjects. RESULTS: Acute elevation in IOP had no effect upon PSV, EDV, or the derived resistance index in the ophthalmic artery: flow velocities in this vessel were identical at IOP of 8 mm Hg or 45 mm Hg. In contrast, in the central retinal artery, PSV and EDV fell, and the resistance index rose, in steady progression as IOP was acutely elevated (each p < 0.01). At IOP of 45 mm Hg, EDV was virtually absent and the resistance index was very nearly 1.0. CONCLUSION: Ophthalmic arterial haemodynamics are unrelated to acute fluctuations of the IOP over a wide range, suggesting that ocular hypertension itself cannot induce vascular dysfunction in this artery. In contrast, flow velocities in the central retinal artery were highly IOP dependent, implying that haemodynamic and mechanical factors are closely linked in this vascular bed.     

Ab interno trabeculectomy with Trabectome: outcomes in African American versus Caucasian patients

Objective

To compare the intraocular pressure–lowering efficacy and complication rate of ab interno trabeculectomy with the Trabectome between African American (AA) and Caucasian patients with open-angle glaucoma.