Suturas transconjuntivales del tapete escleral en maculopatía hipotónica tardía tras esclerectomía profunda no perforante

Clinical case

A 63-year-old man presents with late hypotony maculopathy after non-penetrating deep sclerectomy. Hypotonia and visual acuity are improved after transconjunctival suturing of the scleral flap.

Efficacy and safety of a steel drainage device implanted under a scleral flap

Objective: To evaluate the efficacy and safety of a stainless steel miniature glaucoma drainage device (Ex-PRESS X200) implanted under a scleral flap for the surgical treatment of primary open-angle glaucoma (POAG).Study Design: Clinical, prospective, noncomparative, nonrandomized study. The efficacy and safety were evaluated on the full sample, with a minimum follow-up of 12 months (maximum 24, mean 18).Participants: Thirty-seven eyes of 35 patients.Methods: The Ex-PRESS device was implanted under a scleral flap in patients with POAG.Results: Preoperative intraocular pressure (IOP) was 27.6 (SD 8.7) mm Hg; at last follow-up, IOP was 12.4 (SD 3.4) mm Hg (55.1% reduction). The success rates (IOP < 18 mm Hg and < 15 mm Hg at last visit without medications) were 78.4% (29/37) and 70.3% (26/37), respectively. Kaplan-Meier analyses (probability of IOP < 18 mm Hg and < 15 mm Hg without medications) at last follow-up were 72.6% and 47.9%, respectively. Early postoperative complications were clinically mild and included postoperative IOP < 5 mm Hg: 12 cases at 1 day, 8 cases at 1 week, 3 cases at 1 month, 1 case at 3 months; serous choroidal detachment: 9 cases, of which 3 spontaneously resolved, whereas in 6 cases, hypotony and flat chamber were treated with viscoelastic injection in the anterior chamber. At last follow-up, 6 patients were treated with 2 IOP-lowering medications. No sight-threatening consequences of surgery were observed. There were 8 cases (21.6%, n = 37) of bleb needling.Conclusions: Our data support the efficacy and safety of the implantation of this device under a scleral flap. The IOP reduction obtained was significant and long standing and complications were mild.     

Transconjunctival flap sutures: A novel technique to combat hypotony

Background:Hypotony secondary to overfiltration is a recognized complication following trabeculectomy. Persistent hypotony requires intervention .Purpose:We describe a modified version of placing conjunctival compression sutures directly over the scleral flap.Synopsis:A 70-year-old male patient diagnosed with primary open angle glaucoma in both eyes underwent combined surgery in the right eye. On the tenth post-operative day, the patient presented with severe hypotony with 360° choroidal detachment. He was treated with corticosteroids and cycloplegics but developed hypotony maculopathy on the subsequent follow-up. Hence, he was further managed surgically by trans-conjunctival flap sutures to which he responded favorably with resolution of choroidal detachment and improvement in intraocular pressure and visual acuity.Highlights:Transconjunctival suturing of the scleral flap is an effective and minimally invasive treatment to prevent visual loss from hypotony maculopathy for an overfiltering bleb following trabeculectomy.Online Video Link: https://youtu.be/BJtUZcyQZ-w     

Effect of axial length reduction after trabeculectomy on the development of hypotony maculopathy

Purpose

To measure changes in axial length before and after trabeculectomy with noncontact, partial coherence laser interferometry and identify patient factors that lead to the development of hypotony maculopathy and axial length shortening in 25 eyes with intraocular pressure (IOP) ≤6 mmHg at 4 weeks after mitomycin C-augmented trabeculectomy.

Methods

A retrospective comparative case series. Hypotony maculopathy was identified with both ophthalmoscopy and spectral-domain optical coherence tomography. Axial length and IOP were serially measured pre- and postoperatively. Logistic regression analysis was performed to identify factors associated with the presence of hypotony maculopathy at 4 weeks after trabeculectomy and multiple regression analysis to identify factors associated with axial length changes.

Results

Ten eyes exhibited hypotony maculopathy, whereas the remaining 15 did not. Patients with hypotony maculopathy were significantly younger (47.7 ± 6.2 years) compared with those without it (63.3 ± 9.6 years, P = 0.0002, unpaired t test). The percent reduction of axial length after trabeculectomy was significantly larger in the former group (5.91 ± 2.76 %) compared with the latter group (1.51 ± 0.91 %) (P = 0.0001, Mann–Whitney U test). Multivariate analyses showed that only age was associated with the presence of hypotony maculopathy, with an odds ratio of 0.82 (P = 0.0075), when age, sex, type of glaucoma, lens status, percent changes in axial length and IOP before and after trabeculectomy, and central corneal thickness were included as independent variables (R ² = 0.543, P = 0.003).

Conclusions

Age-dependent axial length reduction is a risk factor for the development of hypotony maculopathy after trabeculectomy.     

Outcome of intravitreal bevacizumab for idiopathic choroidal neovascularization in a Chinese population

Objective: To assess the long-term visual and anatomical outcomes and safety of intravitreal injection of bevacizumab for idiopathic choroidal neovascularization (ICNV) in Chinese patients.Design: Retrospective interventional case series.Participants: Seventy-seven eyes of 77 patients with ICNV.Methods: Patients were given intravitreal injection of bevacizumab (1.25 mg/0.05 mL) for ICNV between March 2006 and May 2008. Main outcome measures were changes in best-corrected visual acuity (BCVA), central foveal thickness, which was measured by optical coherence tomography, and fluorescein angiography findings.Results: Mean follow-up was 14.3 (SD 2.4, range 10∼20) months. Mean BCVA improved from 0.66 (SD 0.36) logMAR at baseline to 0.25 (SD 0.28) logMAR at final follow-up (p < 0.001). Sixty-one patients (79%) gained BCVA of ≥2 Snellen lines, and 1 eye (1%) lost BCVA of ≥2 Snellen lines. Mean central foveal thickness decreased from 365 (SD 124) μm at baseline to 211 (SD 94) μm at final visit (p < 0.001). Sixty-two eyes (81%) needed reinjection. Both BCVA improvement and the change in central foveal thickness between the 1 — time injection group and the multi-injections group were not statistically significant (p = 0.45 and p = 0.19, respectively). No significant ocular or systemic adverse effects were observed.Conclusions: The long-term results suggest an encouraging efficacy and safety of intravitreal bevacizumab for ICNV in Chinese patients.     

Can preoperative anterior chamber angle width predict magnitude of intraocular pressure change after cataract surgery?

Objective: To determine whether preoperative anterior chamberangle width,capturedbyanteriorsegment optical coherence tomography (AS-OCT), can be a predictor of intraocular pressure (IOP) change following cataract surgery.Design: Prospective comparative observational study.Participants: Fifty-three eyes of 53 patients awaiting cataract surgery were included.Methods: Measurement of anterior chamber angle width and IOP using AS-OCT and Goldmann’s applanation tonometry, respectively, were performed before and 6 months after phacoemulsification and intraocular lens implantation. Preoperative and postoperative measurements were compared using paired t test. The prediction rule defined success as ≥20% IOP reduction from the baseline preoperative IOP measurement. Multivariate regression analysis was performed to assess the association of postoperative IOP with independent variables, including age, sex, systemic hypertension, diabetes mellitus, glaucoma, and preoperative anterior chamber angle width.Results: Data were collected from 32 females and 21 males with visually significant cataract. Mean age was 73.3 (SD 8.2) years. Mean IOP dropped from 15.1 (SD 3.l)mm Hg to 12.8 (SD 2.5) mm Hg (p < 0.0001) after cataract extraction. Mean anterior chamber angle width increased from 24.7° (SD 7.1°) to 38.1° (SD 6.0°) after surgery (p < 0.001). Multivariate regression analysis did not identify preoperative variables to be significantly associated with ≥20% postoperative IOP reduction.Conclusions: Cataract surgery results in significant and sustained mean reductions in IOP and concurrent increases in anterior chamber angle width for a period of at least 6 months after surgery. However, measurements of the preoperative anterior chamber angle width did not predict the IOP-lowering effect of cataract surgery.     

Intraocular pressure adjusted for central corneal thickness as a screening tool for open-angle glaucoma in an at-risk population

Objective: Evaluation of intraocular pressure (IOP) adjusted for central corneal thickness (CCT) screening for open-angle glaucoma (OAG) in an at-risk population.Study Design: Community-based screening clinic.Participants: Three hundred and forty-nine persons of black race, or >50 years of age, or with a positive family history of glaucoma.Methods: Ophthalmological examination including Goldmann applanation tonometry, ultrasonographic corneal pa-chymetry, and visual field testing. Glaucomatous optic nerve damage with visual field loss was the gold standard. IOP was adjusted for CCT based on 3 nomograms. Results were compared with screening using unadjusted IOP. Outcome measures included sensitivity, specificity, areas under the receiver operating characteristic (ROC) curves, positive and negative predictive values (PPVs and NPVs), as well as positive and negative likelihood ratios.Results: No significant difference in CCT was found between those with glaucoma (560 [SD 37] µm, n = 31) and those without (557 [SD 35] um, n = 233). Screening adjusted IOPs for glaucoma with an IOP > 21 mm Hg resulted in PPVs of 23.8% to 25% and NPVs of 89.3% to 89.6%, similar to preadjustment values. Areas under the ROC curves varied from 0.544 to 0.571 post adjustment from the initial value of 0.574.Conclusions: IOP adjusted for CCT is unlikely to improve tonometry as a screening tool for OAG in an at-risk population.     

Comparison of dynamic contour tonometry and Goldmann applanation tonometry following penetrating keratoplasty

Objective: To evaluate dynamic contour tonometry (DCT) versus Goldmann applanation tonometry (GAT) intraocular pressure (IOP) measurements in eyes that underwent penetrating keratoplasty (PKP).Design: Prospective, cross-sectional, observational study.Participants: Thirty-one eyes of 28 patients were examined after PKP.Methods: All eyes had undergone PKP with interrupted sutures. The postoperative period was more than 1 year for 25 eyes and less than 1 year for 6. Sutures were removed based on corneal topography and refraction. IOP was measured by both DCT and GAT methods and was correlated to the number of remaining sutures.Results: IOP readings were successfully obtained in 25/31 (80.6%) with DTC and in 21/31 (67.7%) with GAT (p = 0.25). In eyes with fewer than 4 remaining sutures, both methods were successful. In eyes with more than 4 sutures, the success rates of DCT and GAT were 66.7% and 44.4%, respectively (p = 0.18). In PKPs with a postoperative period of more than 1 year, the success rates of DCT and GAT were 96% and 84%, respectively (p = 0.16). In 20 eyes, both methods measured the IOP. The mean IOP obtained by DCT (16.6 [SD 2.8] mm Hg) was higher than the mean IOP obtained from GAT (15.1 [SD 3.6] mm Hg). The IOPs from the 2 instruments correlated significantly (p < 0.05) and the mean difference was 1.5 mm Hg.Conclusions: The success rate in measuring IOP with DCT and GAT did not show any statistically significant difference. Both methods were less effective measuring the IOP after recent PKPs and regrafts. However, DCT seemed to be superior to GAT in corneas with more than 4 remaining sutures and in PKPs performed more than 1 year earlier. The absolute values of IOP were higher with DCT than with GAT.     

Efficacy and safety of transconjunctival scleral flap resuturing for hypotony after glaucoma filtering surgery

Background  To evaluate the efficacy and safety of transconjunctival scleral flap resuturing for the management of hypotony-associated excess filtration after glaucoma filtering surgery. Methods  Fifty-six eyes of 55 patients with hypotony maculopathy and/or choroidal detachment caused by excess filtration after glaucoma filtering surgery underwent transconjunctival scleral flap resuturing directly through the conjunctiva, using a 10-0 nylon suture with a round tapered needle. Intraocular pressure (IOP) after suture, best-corrected visual acuity, rate of resolution of hypotony maculopathy and choroidal detachment, rate of complication, and rate of supplemental surgical treatment were assessed. Results  IOP (mean ± SD) was 2.9 ± 1.4 mmHg before suture, and elevated significantly to 7.3 ± 4.5 mmHg at 1 week after suture, 7.2 ± 3.5 mmHg at 1 month, 8.4 ± 4.1 mmHg at 1 year, and 8.1 ± 3.5 mmHg at the last follow-up (mean of 23 months). The best-corrected visual acuity was improved. Hypotony maculopathy was resolved in 92% and choroidal detachment in 100% of the patients. None of the patients required supplemental surgical treatment, because transconjunctival scleral flap resuturing failed to increase IOP. Suture removal was performed in 14 eyes that showed high IOP after suture. Of these eyes, six required needle revision and one required surgical bleb revision. In two eyes, aqueous humor leak after suture was controlled by wearing contact lenses. No bleb-associated infection was observed. Conclusion  Even though additional treatments such as repeated suture, suture removal, and needle revison were necessary in some cases, transconjunctival scleral flap resuturing is a simple and minimally invasive procedure that improves hypotony after glaucoma filtering surgery, with no serious complication. There was no commercial sponsorship or support for this study.     

Influence of topical bimatoprost on macular thickness and volume in glaucoma patients with phakic eyes

Background: In light of concern about the possible relation between the extensive clinical use of prostaglandin analogues and the development of retinal disorders such as cystoid macular edema, this study investigated the influence of topical application of bimatoprost 0.03% on macular thickness and volume in glaucoma patients with phakic eyes.Methods: A total of 40 eyes in 22 patients with primary open-angle glaucoma or normal-tension glaucoma were evaluated in this study. Optical coherence tomography images were taken before initiation of bimatoprost application and after 1, 2, and 3 months of treatment. In addition, best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were measured, and contrast sensitivity tests and fundus examinations were performed. Changes in various parameters, including macular thickness and volume, were analyzed.Results: BCVA and contrast sensitivity did not change from baseline over the treatment period. IOP declined by 20% to 25% from baseline for 1 month before stabilizing. Macular thickness and volume did not increase significantly during the 3 months.Interpretation: Topical application of bimatoprost does not induce clinical or structural changes in the macula, at least in glaucoma patients with phakic eyes. Moreover, bimatoprost effectively lowered IOP without causing macular disorders such as cystoid macular edema.     

Risk factors for a postoperative intraocular pressure spike after phacoemulsification

Background: The aim of our study was to examine several potential risk factors for intraocular pressure (IOP) spikes 2 to 3 hours after phacoemulsification.Methods: 50 eyes of 50 consecutive patients undergoing uncomplicated phacoemulsification under topical anesthesia were included in this prospective study. The following variables were recorded:preoperative IOP, nuclear colour,cortical lens opacity,posterior subcapsular lens opacity,patient age;and presence or absence of preexisting glaucoma.Results: The mean IOP at each time interval was as follows: preoperatively, 14.5 (SD 3.4) mm Hg; 2-3 hours postoperatively, 23.1 (7.0) mm Hg; and 24 hours postoperatively, 17.0 (6.0) mm Hg. The postoperative IOP was significantly higher than baseline at 2-3 hours (p < 0.001) and at 24 hours (p = 0.002). Overall there were 10 cases (20%) of IOP spikes 2-3 hours postoperatively. Higher mean baseline IOP was significantly associated with postoperative IOP spikes (p = 0.013). Patient age, sex, operating surgeon, absolute phacoemulsification time, lens nuclear colour, cortical opacity, and posterior opacity were not significantly different between groups with or without an IOP spike (p > 0.05).Interpretation: Patients with high IOP at the preoperative assessment are more likely to have IOP spikes after surgery and should be scheduled at the start of the operating list. In a day-case setting with restricted opening hours, postoperative checks in those patients at risk of IOP spikes can then coincide with the time IOP reaches its peak.     

Comparison of trabeculectomy with Ex-PRESS miniature glaucoma device implanted under scleral flap

PURPOSE: To evaluate the Ex-PRESS miniature implant (Model R 50) placed under partial-thickness scleral flap compared with standard trabeculectomy. METHODS: In this retrospective comparative series of 100 eyes, we compared 50 eyes in 49 patients treated with the Ex-PRESS miniature glaucoma implant under a scleral flap with 50 matched control eyes in 47 patients treated with trabeculectomy. Success was defined as intraocular pressure (IOP) > or =5 mm Hg and < or =21 mm Hg, with or without glaucoma medications, without further glaucoma surgery or removal of implant. Early postoperative hypotony was defined as IOP <5 mm Hg during the first postoperative week. RESULTS: The average follow-up was 10.8 months (range 3.5 to 18) for the Ex-PRESS group and 11.2 months (range 3 to 15) for the trabeculectomy group. Although the mean IOP was significantly higher in the early postoperative period in the Ex-PRESS group compared with the trabeculectomy group, the reduction of IOP was similar in both groups after 3 months. The number of postoperative glaucoma medications in both groups was not significantly different. Kaplan-Meier survival curve analysis showed no significant difference in success between the 2 groups (P=0.594). Early postoperative hypotony and choroidal effusion were significantly more frequent after trabeculectomy compared with Ex-PRESS implant under scleral flap (P<0.001). CONCLUSIONS: The Ex-PRESS implant under a scleral flap had similar IOP-lowering efficacy with a lower rate of early hypotony compared with trabeculectomy.     

Flap suture - a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C

Background A serious complication following trabeculectomy with mitomycin C (MMC) is intraocular hypotony with hypotony maculopathy, papilledema, flattening of the anterior chamber, corneal decompensation and a decrease in visual acuity. We describe a new simple surgical technique for the treatment of hypotony maculopathy following trabeculectomy with MMC. Methods In a prospective consecutive case study, 16 patients with hypotony maculopathy following trabeculectomy with MMC were included. Through the intact conjunctiva, additional 10.0 nylon sutures were placed through the scleral flaps into the adjacent sclera. Assessment of visual acuity, intraocular pressure (IOP) measurement and fundoscopy were performed on the 1st and 7th day postoperatively and 1, 3 and 6 months postoperatively. Photography of the bleb and the posterior pole and optical coherence tomography imaging of the posterior pole were performed. Results Before surgery (flap suture), the mean IOP was 2.8 mmHg (±1.1; range from 1 to 4 mmHg). It was 24.9 ± 11.7 mmHg (range; 9–48 mmHg) on the 1st postoperative day, 15.7 ±8.1 mmHg (range; 5–35 mmHg) on day 7, 11.1 ±4.1 mmHg (range; 5–20 mmHg) 1 month after surgery, 9.3 ±3.9 mmHg (range; 2–20 mmHg) after 3 months, and 9.6 ±4.2 mmHg (range; 2–20 mmHg) after 6 months. The best corrected mean visual acuity was 20/50 before trabeculectomy and 20/160 before flap suture. It improved to 20/63 at 6 months postoperatively. Clinical signs of hypotony maculopathy disappeared in all patients. No bleb leakage was observed in any patient during follow-up. Conclusion Resuturing the scleral flap through the intact conjunctiva is an effective and minimally invasive method to treat hypotony maculopathy following trabeculectomy with MMC. Thus, opening the conjunctiva can be avoided. The authors have no financial interest in the subject of this paper.     

Delayed in-the-bag implantation of intraocular lens

Objective: To report delayed in-the-bag intraocular lens (IOL) implantation for patients who had undergone simultaneous phacoemulsification and vitreoretinal surgery.Design: Interventional case series.Participants: Delayed IOL implantation surgery was performed for 3 patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.Methods: The medical records of each patient, including the surgical findings and final refraction status, were reviewed retrospectively.Results: Successful in-the-bag IOL implantation surgeries without capsular tear were achieved 3 to 5 months after the initial surgeries. The postoperative refractive error ranged from plano to −1.00 D.Conclusions: Successful in-the-bag IOL implantation and satisfactory refraction were achieved in patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.     

Phacoemulsification in patients with nanophthalmos

Objective: To evaluate phacoemulsification surgery and its possible risks in patients with nanophthalmos.Design: The surgical procedure, corneal diameter, keratometry, axial length, visual acuity, and intraoperative and postoperative complications were reviewed. Scleral thickness was determined by echography.Participants: 5 patients, 8 eyes.Methods: The results of cataract surgery in nanophthalmic eyes were reviewed. Inclusion criteria was based on a clinical diagnosis of nanophthalmos and ocular surgery for cataract. Nanophthalmos was diagnosed according to a shorter than average axial length (usually less than 20.0 mm), typically a shallow anterior chamber, hyperopia, and scleral thickening greater than 1.5 mm. The procedure was planned as phacoemulsification, and foldable acrylic PCIOL implantation via a clear corneal tunnel.Results: The procedure was planned as phacoemulsification. Six eyes had cataract extraction with posterior chamber intraocular lens implantation by phacoemulsification. It was necessary to change the procedure to extraca-psular cataract surgery in 2 cases because of uncontrolled shallowing of the anterior chamber. Postoperative trabeculectomy was needed in 1 eye, and Nd:YAG laser capsulotomy was performed on 4 eyes. No postoperative uveal effusion or infections were seen in any of the eyes. Complications included iritis with posterior synechia (n = 1), transient choroidal hemorrhage (n = 1), vitreous loss (n = 1), posterior capsule opacity (n = 4), and glaucoma (n = 1). In 1 case retinal detachment developed 3 weeks postoperatively. Prophylactic laser iridoplasty or iridotomy was not performed for surgery.Conclusions: Although phacoemulsification seems to be relatively safe in nanophthalmic patients without performing any prophylactic surgical procedure, surgeons need to be attentive of the challenges of working through them when performing phacoemulsification in these high-risk eyes. However, with careful preoperative evaluation and planning, complications can be avoided.     

Biomechanical considerations: evaluating scleral reinforcement materials for pathological myopia

Objective: Scleral biomechanical weakness and thinness are known to be one of the main factors in the pathogenesis of progressive myopia. Posterior scleral reinforcement surgery remains the rational treatment for pathological myopia. We tested the biomechanical properties of 3 types of scleral reinforcement materials (artificial pericardium, human sclera, and all-dermal matrix) in an attempt to select the ideal material for the reinforcement of pathologic sclera.Design: Experimental study.Participants: Forty-five adult Japanese white rabbits.Methods: Animals were equally divided into 3 groups. For each group, 1 type of material was surgically implanted at the back of the globe. We harvested samples after 10 months of implantation, tested the elasticity modulus for both reinforced sclera and unreinforced control sclera, and assessed data by t test methods. Statistically significant differences were considered when p < 0.05.Results: Rabbit sclera reinforced by artificial pericardium or human sclera showed significant increases in the elasticity modulus compared with control eyes. However, the rabbit sclera reinforced by all-dermal matrix showed no significant difference in the elasticity modulus compared with normal controls.Conclusions: The analysis of biomechanical considerations in scleral reinforcement materials presented here is a very helpful method to choose the best materials for treatment of myopia. Of all materials tested, the artificial pericardium and human foreign-body sclera provided the best biomechanical characteristics.     

Posterior capsulectomy using a 25-gauge microincision vitrectomy system for preventing secondary opacification after congenital cataract surgery: outcome up to 4 years

Objective: To assess long-term outcomes of posterior capsulectomy using a 25-gauge microincision vitrectomy system (25-GV) for preventing secondary visual axis opacification after congenital cataract surgery.Study Design: Retrospective noncomparative case series.Participants: Nine eyes of 5 children who underwent posterior capsulectomy carried out with the use of a 25-GV during congenital cataract surgery.Methods: After removal of congenital cataract with phacoemulsification and intraocular lens implantation, the posterior capsulectomy was performed using a 25-GV. Postoperative visual outcomes were analyzed.Results: The mean follow-up period was 43.11 (SD 5.53) months. Eight eyes maintained a clear visual axis, but 1 eye required Nd:YAG capsulotomy to enlarge the opening of the capsulectomy at 7 months postoperatively. Postoperative visual acuity was maintained up to 4 years without any other complications.Conclusions: Posterior capsulectomy using a 25-GV offers an option for preventing secondary visual axis opacifica-tion after congenital cataract surgery.     

Rescue of an extending capsulorrhexis by creating a midway tangential anterior capsular flap: a novel technique in 22 eyes

Objective: To show how an extending capsulorrhexis can be rescued by a midway tangential capsular flap in order to achieve an uneventful phacoemulsification.Design: Consecutive case series.Participants: Twenty-two eyes of 22 patients with extending capsulorrhexis treated at the Farabi Eye Hospital, Tehran.Methods: First, a tangential capsular opening was created on the border of the presumed continuous curvilinear capsulorrhexis just midway between the beginning of the capsulorrhexis and the edge of the extending capsulor-rhexis, to make a tangential flap of the anterior capsule. Second, the centre of this new flap was grasped and pulled centripetally until the edges of the new flap joined the edges of the extending flap to complete the capsulorrhexis.Results: The technique was successfully performed in all cases, leading to an uneventful phacoemulsification.Conclusions: Midway tangential capsular flap is a safe and effective technique to rescue an extending capsulorrhexis and leads to an uneventful phacoemulsification.     

Intravitreal bevacizumab for the treatment of choroidal neovascularization associated with pathological myopia

Background: The recent discovery of vascular endothelial growth factor and its role in the pathogenesis of ocular neovascularization has led to the development of new pharmacological agents that could block its action. This study was carried out to investigate the effect of intravitreal injections of bevacizumab on choroidal neovascularization (CNV) associated with pathological myopia.Methods: We retrospectively reviewed the charts of all patients who had CNV secondary to pathological myopia and who had been treated with intravitreally administered bevacizumab between November 2005 and April 2007 at Notre-Dame Hospital in Montréal, Québec. Data on best-corrected visual acuity (BCVA), previous treatments, number of injections, fundus photography, and fluorescein angiography were collected.Results: Ten eyes from 9 patients were followed for a mean period of 9.7 (range 2.5-14) months.At baseline the mean (SD) logMAR BCVA was 0.62 (0.25) (Snellen equivalent 6/24). The mean number of injections per eye was 2.6 (range 1-5). At the end of the study the mean (SD) logMAR BCVA had significantly improved to 0.26 (0.16) (Snellen equivalent 6/10.5; p < 0.001).Vision improved by a mean of 3.9 (range 0-7) lines on the Snellen visual acuity chart. Leakage from the CNV on fluorescein angiography had resolved in 7 of the 10 eyes and was reduced in the 3 other eyes. No drug-related side effects or complications were observed during the follow-up period.Interpretation: Intravitreal injection of bevacizumab appears to be a safe and effective treatment alternative for CNV associated with pathological myopia.     

Comparison of the outcome of implantation of hydrophobic acrylic versus silicone intraocular lenses in pediatric cataract: prospective randomized study

Objective: To compare the postoperative performance of hydrophobic acrylic and silicone square-edge intraocular lenses in pediatric cataract.Design: Prospective randomized study.Participants: Forty-one eyes of 41 children (age 1 month to 8 years) with congenital or developmental cataract.Methods: Children were randomly divided into 2 groups. All participants underwent phacoaspiration, primary posterior capsulotomy, and anterior vitrectomy. Group A (n = 21) eyes were implanted with acrylic hydrophobic AcrySof SA60AT intraocular lenses (IOLs), and those of Group B (n = 20) were implanted with silicone Tecnis Z9000 IOLs. The children were evaluated for anterior chamber reaction, IOL position, posterior capsular opacifica-tion (PCO), intraocular pressure, best-corrected visual acuity (BCVA), corneal status, and refractive errors.Results: Postoperatively, 2 eyes in each group had significant anterior chamber reaction with fibrin membrane formation. IOLs were in the capsular bag in all but 1 eye in both groups. Seven eyes in the acrylic group and 6 eyes in the silicone group achieved visual acuity of 20/40 or better. None of the eyes showed glaucoma. BCVA at 1 year was similar in both groups. In the acrylic hydrophobic group, 14 eyes needed hypermetropic correction and 7 eyes were myopic, and in the silicone group 10 eyes had myopia and 10 eyes had hypermetropia at 1 year postoperatively. PCO at 1 yearfollow-up was more common in eyes implanted with acrylic hydrophobic IOLs (5 eyes) than silicone IOLs (2 eyes).Conclusions: Both square-edge hydrophobic acrylic and silicone IOLs were found to be compatible and safe for use in pediatric cataract surgery with similar visual axis clarity and postoperative outcome.