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.     

Accommodation-induced intraocular pressure changes in progressing myopes and emmetropes

Purpose

To investigate the changes of intraocular pressure (IOP) and anterior eye segment biometric parameters under different accommodative statuses in progressing myopes and emmetropes.

Methods

Forty-six progressing myopes and 40 emmetropes participated in this study. All the subjects had their IOP and anterior eye segment biometric parameters (including corneal thickness, anterior chamber depth, anterior chamber angle width, and lens thickness) measured using iCare rebound tonometer and VisanteTM anterior segment-optical coherence tomography while accommodative stimuli of 0, 3, and 6D were presented.

Results

There was no significant difference in IOP between progressing myopes and emmetropes when no accommodation was induced (16.22±4.11 vs 17.01±3.72, respectively, t=−0.93, P>0.05). However, IOP significantly increased with accommodation in progressing myopes (mean change +1.02±2.07 mm Hg from 0D to 6D, F=5.35, P<0.01), but remained unchanged (mean change −0.76±3.22 mm Hg from 0D to 6D, F=1.46, P>0.05) in emmetropes. Meanwhile, we found that their anterior chamber depth decreased (P<0.01), anterior chamber angle narrowed (P<0.01), and lens thickened (P<0.01) significantly with accommodation, both in progressing myopes and emmetropes.

Conclusions

Although no difference was detected between the IOPs of progressing myopes and emmetropes without accommodation, accommodation could induce transient IOP elevation in progressing myopes. Simultaneously, we found that their anterior chamber depth decreased, anterior chamber angle narrowed, and lens thickened with accommodation. Although emmetropes showed the similar anterior eye segment structure changes, their IOPs did not increase with accommodation. Our study indicated that IOP elevation with accommodation in progressing myopes might be related to myopia progression.     

Long-term effect of phacoemulsification on trabeculectomy function

Purpose

To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in trabeculectomized eyes and to identify the factors affecting the IOP changes.

Methods

In consecutive patients with previous trabeculectomy (TE) who underwent uncomplicated clear cornea phacoemulsification we evaluated intraocular pressure, need of antiglaucomatous medical therapy or glaucoma surgery, and length of glaucoma control without therapy. Glaucoma therapy was prescribed in the presence of IOP >18 mm Hg or worsening of the visual field. A group of trabeculectomized eyes that did not receive cataract surgery was retrospectively selected as a control. Multivariate analysis was used to test factors related to final outcome of the treatment.

Results

One hundred and eight eyes with previous TE that received phacoemulsification and 108 controls were included in the study. Phacoemulsification was performed 60±21 months after TE. After a mean follow-up of 66±28 months, mean IOP was significantly increased in the cataract surgery group (by 1.7±4.3 mm Hg) and in the control group (by 2.3±4.3 mm Hg)(both P<0.001); in two groups, respectively, 31 eyes (28.7%) and 17 eyes (15.7%) had received glaucoma therapy (chi-square P=0.030). Factors related to success (no need of therapy) were use of mitomycin-C (MMC) in previous TE (P<0.001), longer time from TE to cataract surgery (P=0.007), higher preoperative bleb score (P=0.021), and lower baseline IOP (P=0.042).

Conclusions

Cataract surgery reduces the function of filtering bleb in some eyes. Factors related to low rate of failure are the previous use of MMC during TE, longer time from TE to cataract surgery, and good preoperative aspect of the bleb.     

Insertion of sequential glaucoma drainage implant in a piggyback manner

Purpose

This pilot study, the first of its type, was conducted to determine the clinical outcome of a sequential glaucoma drainage implant (GDI) inserted in piggyback manner, that is into the bleb of a primary GDI.

Methods

This was a retrospective chart study with a minimum 1-year follow-up involving 16 eyes of 14 uncontrolled glaucoma patients who had previously undergone sequential GDI performed using a technique to convert a one-plate into a two-plate implant system. Surgical success was defined as intraocular pressure (IOP) <21 mm Hg with at least a 30% reduction in IOP from baseline on two consecutive follow-up visits, IOP >5 mm Hg on two consecutive follow-up visits, and neither reoperation of glaucoma nor loss of light perception vision.

Results

The mean ±SD baseline IOP was 29.2±5.2 mm Hg, and the mean postoperative IOP was 17.3±3.4 mm Hg, with a mean pressure drop of 39.4±10.4% (P<0.001). Life-table analysis showed an 88% success rate after 12 months of follow-up. The mean preoperative best corrected visual acuity (BCVA) was 0.2±0.2 logMAR (Snellen equivalent 6/9.5), compared with 0.3±0.3 logMAR postoperatively (Snellen equivalent 6/12; P=0.497). Postoperative complications included a flat anterior chamber and choroidal detachment (one eye), uveitis and cataract (one eye), diplopia (one eye), and worsening of pre-existing pseudophakic bullous keratopathy (one eye).

Conclusions

In glaucoma eyes with useful vision the piggyback GDI seems to provide a significant IOP lowering with minimal complications in patients in whom an initial GDI had failed to control the IOP.     

Short-term intraocular pressure trends following intravitreal ranibizumab injections for neovascular age-related macular degeneration—the role of oral acetazolamide in protecting glaucoma patients

Purpose

To determine the effect of oral acetazolamide on lowering the peak and duration of intraocular pressure (IOP) rise in glaucoma and glaucoma suspect patients, following intravitreal injection of ranibizumab for neovascular age-related macular degeneration.

Methods

The study was an open-label, parallel, randomised, controlled trial (EudraCT Number: 2010-023037-35). Twenty-four glaucoma or glaucoma suspect patients received either 500 mg acetazolamide or no treatment 60–90 min before 0.5 mg ranibizumab. The primary outcome measure was the difference in IOP immediately after injection (T0) and 5, 10, and 30 min following injection. ANCOVA was used to compare groups, adjusting for baseline IOP. The study was powered to detect a 9-mm Hg difference at T0.

Results

The IOP at T0 was 2.3 mm Hg higher in the non-treated group (mean 44.5 mm Hg, range (19–86 mm Hg)) compared with the treated group (mean 42.2 mm Hg, range (25–58 mm Hg)), but was not statistically significant after adjusting for baseline IOP (P=0.440). At 30 min, IOP was 4.9 mm Hg higher in the non-treated group (mean 20.6 mm Hg, range (11–46 mm Hg)) compared with the treated group (mean 15.7 mm Hg, range (8–21 mm Hg)). This was statistically significant after adjusting for baseline IOP (P=0.013).

Conclusions

Although the primary end points were not reached, 500 mg oral acetazolamide, 60–90 min before intravitreal injection, results in a statistically significant reduction in IOP at 3O min post injection. Prophylactic treatment may be considered as an option to minimise neuro-retinal rim damage in high-risk glaucoma patients who are most vulnerable to IOP spikes and undergoing repeated intravitreal injections of ranibizumab.     

Comparation of the new rebound tonometer IOPen and the Goldmann tonometer, and their relationship to corneal properties

Purpose

To compare the intraocular pressures (IOPs) obtained with the IOPen rebound tonometer, Goldmann applanation tonometer (GAT) and the ocular response analyzer (ORA) and investigate the effects of corneal biomechanical properties on IOPen measurements.

Methods

A total of 198 normal eyes were included in this cross-sectional and randomized study. Three measurements were taken using IOPen. Agreement between tonometers was calculated using the Bland and Altman limits of agreement (LoA) analysis.

Results

The median IOPen IOP was 3 mm Hg below the GAT (P<0.001), 3 mm Hg below the ORA IOP similar to Goldmann (IOPg), and 3 mm Hg below the ORA IOP corrected using corneal parameters (IOPcc)(P<0.01). The LoA width between the IOPen and GAT IOPs varied between 13.92 (mean IOPen IOP) and 15.99 mm Hg (third IOPen measurement). The central corneal thickness (CCT) was unrelated to IOPen measurements (P>0.05). Corneal hysteresis (CH) and corneal rigidity factor (CRF) were correlated with IOPen and GAT.

Conclusions

IOPen underestimated the IOP compared with GAT and ORA. The effect of measurement quality or measurement order on IOPen was low. CCT did not affect the IOPen, but the CH and CRF did. The LoA width between the IOPen and GAT IOPs was higher than between the ORA IOPg or ORA IOPcc and GAT IOPs.     

Analysis of long-term outcomes for combined pars plana vitrectomy (PPV) and glaucoma tube shunt surgery in eyes with advanced glaucoma

Purpose

To analyze 12- and 24-month visual acuity, intraocular pressure, and complications associated with combined pars plana vitrectomy (PPV) and glaucoma tube shunt placement in eyes with glaucoma.

Patients and methods

A retrospective chart review was performed of patients with advanced glaucoma who underwent combined PPV and tube shunt surgery from 2006 to 2010. A minimum of 12 months of follow-up was required for their inclusion in the study. Visual acuity, intraocular pressure, complications, and number of glaucoma medications at 1 and 2 years postoperatively were analyzed.

Results

Twenty-eight eyes met the inclusion and exclusion criteria. Baseline visual acuity was 20/200 or worse in 14/28 eyes (50.0%) and 20/40 or better in 2/28 eyes (7.1%). Visual acuity remained 20/200 or worse in 50.0% (P=0.921) and 44.4% (P=0.973) of eyes after 1 and 2 years postoperatively, respectively. At baseline, the mean intraocular pressure was 30.4 mm Hg. There was significant improvement in mean IOP at 1 year (14.7 mm Hg, P=0.001) and at 2 years (15.2 mm Hg, P=0.001) postoperatively. Baseline number of glaucoma medications averaged 3.0±1.09 (SD), and improved to 1.8±1.28 (SD) at 1 year (P=0.0002) and to 1.4±1.33 at 2 years (P<0.0001) postoperatively.

Conclusion

In this retrospective interventional case series, surgical management of advanced glaucoma with a combination of PPV and glaucoma tube shunt resulted in significantly reduced IOP and glaucoma medications at 1 and 2 years postoperatively.     

Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device

Purpose

To report on the long-term outcomes and risk factors for failure with the EX-PRESS shunt implanted under a scleral flap.

Settings

Eye Department, University of Ancona, Ancona, Italy and the Oxford Eye Center, University of Witwatersrand, Johannesburg, South Africa.

Methods

The medical records of glaucoma patients who underwent consecutive EX-PRESS implantations under a scleral flap between 2000 and 2009 were reviewed. The operations were performed by two experienced surgeons using an identical surgical technique. The potential risk factors for failure that were analysed included age, sex, race, glaucoma type, previous antiglaucoma medications, previous glaucoma surgeries, diabetes, and smoking. Complete success was defined as postoperative intraocular pressure (IOP) 5 mm Hg>IOP<18 mm Hg without antiglaucoma medications. Qualified success was defined as 5 mm Hg>IOP<18 mm Hg with or without antiglaucoma medications.

Results

Two hundred and forty-eight eyes of 211 consecutive patients were included. The mean IOP was reduced from 27.63±8.26 mm Hg preoperatively (n=248) to 13.95±2.70 mm Hg at 5 years (n=95). The mean follow-up was 3.46±1.76 years. Complete and qualified success rates decreased gradually from 83% and 85% at 1 year to 57% and 63% at 5 years follow-up, respectively. The risk factors for failure were diabetes, non-Caucasian race, and previous glaucoma surgery. Complete success rates of diabetic patients and non-Caucasian patients decreased from 63% and 75% at 1 year to 42% and 40% at 5 years follow-up, respectively.

Conclusions

EX-PRESS success rates decrease over time but compare favourably with trabeculectomy literature data. The main identifiable risk factors for failure are diabetes, non-Caucasian race, and previous glaucoma surgery.     

Measures of socioeconomic status and self-reported glaucoma in the UK Biobank cohort

Purpose

To determine ocular, demographic, and socioeconomic associations with self-reported glaucoma in the UK Biobank.

Methods

Biobank is a study of UK residents aged 40–69 years registered with the National Health Service. Data were collected on visual acuity, intraocular pressure (IOP), corneal biomechanics, and questionnaire from 112 690 participants. Relationships between ocular, demographic, and socioeconomic variables with reported diagnosis of glaucoma were examined.

Results

In all, 1916 (1.7%) people in UK Biobank reported glaucoma diagnosis. Participants reporting glaucoma were more likely to be older (mean 61.4 vs 56.7 years, P<0.001) and male (2.1% vs 1.4%, P=0.001). The rate of reported glaucoma was significantly higher in Black (3.28%, P<0.001) and Asian (2.14%, P=0.009) participants compared with White participants (1.62%, reference). Cases of reported glaucoma had a higher mean IOP (18 mm Hg both eyes, P<0.001), lower corneal hysteresis (9.96 right eye, 9.89 left eye, P<0.001), and lower visual acuity (0.09 logMAR right eye, 0.08 logMAR left eye, P<0.001) compared with those without (16 mm Hg both eyes, hysteresis 10.67 right eye, 10.63 left eye, 0.03 logMAR right eye, 0.02 logMAR left eye). The mean Townsend deprivation index was −0.72 for those reporting glaucoma and −0.95 for those without (P<0.001), indicating greater relative deprivation in those reporting glaucoma. Multivariable logistic regression showed that people in the lowest income group (<£18 000/year) were significantly more likely to report a diagnosis of glaucoma compared with any other income level (P<0.01). We observed increasing glaucoma risk across the full range of income categories, with highest risk among those of lowest income, and no evidence of a threshold effect.

Conclusions

In a large UK cohort, individuals reporting glaucoma had more adverse socioeconomic characteristics. Study of the mechanisms explaining these effects may aid our understanding of health inequality and will help inform public health interventions.     

Intraoperative testing of opening and closing pressure predicts risk of low intraocular pressure after Ahmed glaucoma valve implantation

Purpose

The aim of this study was to assess whether intraoperative testing of silicone Ahmed glaucoma valves (AGVs) would identify valves with an increased risk of low postoperative intraocular pressure (IOP).

Methods

In 30 consecutive cases of glaucoma surgery with AGV implantation, after priming the AGV, we intraoperatively measured the opening pressure A, closing pressure B, and re-opening pressure C using the active infusion pump of a phako-machine. IOP was checked postoperatively on the same day. Low IOP was defined as <5 mm Hg. Intraoperatively measured pressure characteristics of the valve function were analysed for their ability to predict postoperative IOP outcomes.

Results

Opening A, closing B, and re-opening C pressures (mean, (SD)) were 18.4 (5.1), 8.3 (4.7), and 11.7 (4.8)mm Hg, respectively. Ten patients (33.3%) had low IOP. An opening pressure of ≤18 mm Hg predicted low postoperative IOP with a sensitivity (10/10) of 100% (95% CI, 69.2–100) and a specificity (13/20) of 65.0% (95% CI, 40.8–84.6).

Conclusions

AGVs have a high variability of opening, closing, and re-opening pressures. An opening pressure of ≤18 mm Hg, a closing pressure of ≤10 mm Hg, or a re-opening pressure of ≤11 mm Hg identified all patients with low postoperative IOP.     

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Purpose

To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period.

Methods

Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline.

Results

Mean follow-up was 63.5±35.3 months. MMC was applied in 145 eyes (49%). Kaplan–Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P=0.002). Cox''s proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P=0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%.

Conclusions

This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.     

Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab

Aims

To compare the outcomes of neovascular glaucoma (NVG) treated with and without intravitreal bevacizumab in a large case comparison study.

Methods

The study is a retrospective, comparative, case series of 163 eyes of 151 patients with NVG, including 99 treated without and 64 treated with intravitreal bevacizumab. Medical and surgical treatments for NVG were assessed. The main outcome measures were visual acuity (VA) and intraocular pressure (IOP).

Results

At the time of NVG diagnosis, the median VA was count fingers (CF) in the non-bevacizumab group and 2/300 in the bevacizumab group. IOP (mean±SD) was 43.1±13.0 mm Hg in the non-bevacizumab group and 40.8±11.5 mm Hg in the bevacizumab group. IOP (mean±SD) decreased to 18.3±13.8 mm Hg in the non-bevacizumab group and 15.3±8.0 mm Hg in the bevacizumab group, and the median VA was CF in both treatment groups at a mean follow-up of 12 months. Panretinal photocoagulation (PRP) substantially reduced the need for glaucoma surgery (P<0.001) in bevacizumab treated NVG eyes.

Conclusions

Although bevacizumab delayed the need for glaucoma surgery, PRP was the most important factor that reduced the need for surgery. Vision and IOP in eyes with NVG treated with bevacizumab showed no long-term differences when compared with eyes that were not treated with bevacizumab. Thus, intravitreal bevacizumab serves as an effective temporizing treatment, but is not a replacement for close monitoring and definitive treatment of NVG. PRP remains the treatment modality that affects the course of NVG in terms of decreasing the need for surgery to control IOP.     

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.     

Longitudinal analysis of age-related changes in intraocular pressure in South Korea

Purpose

To assess the changes in intraocular pressure (IOP) with age in South Korea

Methods

Subjects aged 20–79 who had been receiving health examinations at a university hospital were enrolled. They completed physical and ophthalmic examinations. Subjects with ocular disease that could possibly affect their IOP were excluded. The relationships between IOP and age, blood pressure, heart rate, body mass index, blood chemistry, and electrolyte were analyzed using a linear mixed model.

Results

Of the 33 712 subjects, 31 857 participants were enrolled. In a cross-sectional analysis, IOP also showed a negative correlation in all age groups (respectively, P<0.001). In particular, patients in their 60s~80s had a less steep decreasing slope of IOP with age than patients in their 20s~30s (correlation coefficient −0.260 and −0.168, respectively). In longitudinal analysis, negative trend was shown in the slope of tendency in total subjects. When analyzing the effect of gender on the relationship between age and IOP, females had a less steep decreasing slope of IOP with age than males by 0.05 mm Hg. With regard to systemic parameters, systolic blood pressure and heart rate were positively correlated with IOP (P<0.001).

Conclusion

IOP was significantly decreased with age, although the amount of change was small. In women and older age groups, IOP was less decreased than that of men and young age groups. In addition, IOP was positively associated with systolic blood pressure and heart rate.     

Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

Purpose

To assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner–Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP).

Patients/Methods

Trabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months.

Results

Mean IOP before trabectome surgery was 40±10 mm Hg (range 33–58 mm Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1 mm Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred.

Discussion

In addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.     

Changes in lamina cribrosa and prelaminar tissue after deep sclerectomy

Aim

To determine the response of the lamina cribrosa (LC) and prelaminar tissue to a reduction of intraocular pressure (IOP) after nonpenetrating deep sclerectomy (NPDS) using enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT).

Methods

A total of 28 eyes from 28 patients presenting with primary open angle glaucoma who underwent NPDS were studied. SD-OCT scans using EDI technology were obtained before surgery and 1 week, 1 month, and 3 months postoperatively. The OCT device was set to image a 15 × 10° vertical rectangle centred on the optic disc. The scan closest to the optic nerve head (ONH) centre was selected for analysis. The vertical distances from three equidistant points on the reference line (Bruch''s membrane opening) to the anterior prelaminar tissue surface and the anterior and posterior surfaces of the LC were measured.

Results

The IOP decreased from 18.7±4.3 to 9.1±4.0 at the first week, 11.4±3.7 at 1 month, and 13.1±3.6 mm Hg at 3 months postoperatively (P<0.001). There was a significant reduction of the ONH cupping at 1 week (22.3%, P<0.001), 1 month (13.7%, P<0.001), and 3 months (9.8%, P=0.001) after surgery. Anterior displacement of the LC was slight but statistically significant at 1 week (4.5%, P=0.003), 1 month (3.8%, P=0.014), and 3 months postoperatively (3.3%, P=0.010). IOP reduction was significantly correlated with a reduction of ONH cupping and anterior displacement of LC at the first week and first month (P<0.05).

Conclusions

Cupping reversal after NPDS is mainly due to changes in prelaminar tissue thickness, whereas the LC changes in position are less pronounced.     

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.     

Is the 1-day postoperative IOP check needed post uncomplicated phacoemulsification in patients with glaucoma and ocular hypertension?

Purpose

To determine whether the 1-day postoperative intraocular pressure (IOP) check following routine uncomplicated phacoemulsification is necessary in patients with pre-existing glaucoma and ocular hypertension (OHT), if acetazolamide prophylaxis is used. To investigate the practice of UK glaucoma specialists in IOP rise prophylaxis and follow-up regimes.

Patients and methods

The IOP 1-day postoperatively was analysed against the last recorded IOP before phacoemulsification in a cohort of patients with glaucoma or OHT who underwent uncomplicated phacoemulsification cataract surgery between December 2009 and September 2012, where it was routine practice to give acetazolamide postoperatively. UK and Eire Glaucoma Society members were surveyed via an online questionnaire to analyse practice among UK glaucoma specialists.

Results

One hundred and seven eyes were studied: 99 with glaucoma and 8 with OHT. The mean IOP change was −0.8 mm Hg with only two eyes measuring >30 mm Hg postoperatively (2%). Both these eyes received 750 mg acetazolamide. Eighteen (17%) eyes had an IOP rise of at least 30%. In the survey of practice there were 65 respondents. Twenty-one (32%) respondents did not use IOP prophylaxis. Only 17 (26%) of respondents routinely reviewed their patients 1-day postoperatively.

Conclusion

Our prophylactic acetazolamide regime does not completely eliminate the risk of an IOP >30 mm Hg on day 1 post routine phacoemulsification in glaucoma/OHT patients. Patients with pre-existing glaucoma, despite acetazolamide prophylaxis, will require IOP management decisions on the first postoperative day after uncomplicated phacoemulsification surgery. UK expert practice is non-uniform with regard to IOP prophylaxis, and the 1-day review, and further discussion and formulation of consensus appears necessary.     

Effect of laser suture lysis on filtration openings: a prospective three-dimensional anterior segment optical coherence tomography study

Purpose

To investigate the effects of laser suture lysis (LSL) on filtration openings after trabeculectomy.

Methods

Prospective study analyzing the changes in the location and width of filtration openings, fluid cavity height, total bleb height, bleb wall thickness, and bleb wall intensity before and after LSL using three-dimensional anterior segment optical coherence tomography (3D AS-OCT).

Results

Fourteen patients had clear scleral flap image analysis. As five patients underwent LSL twice and two patients underwent LSL thrice, 23 comparison studies were possible. After LSL the intraocular pressure (IOP) decreased (P=0.0015) from 20.5±5.3 to 14.9±6.4 mm Hg, and the fluid cavity height increased significantly from 0.2±0.2 mm to 0.3±0.1 mm (P=0.0094). Other bleb parameters were not significantly different when comparing before and after LSL. When the IOP reduction ratio was >25% following LSL, the width of the filtration openings on the LSL side, the total bleb height, and the fluid cavity height increased (P=0.0273, 0.0342, and 0.0024, respectively). In multiple regression analysis the changes in fluid cavity height, the wall thickness, the wall intensity, and the width of the filtration opening were positively associated with the IOP reduction rate (P=0.0428, 0.0226, 0.0420, and 0.0356, respectively).

Conclusions

3D AS-OCT allowed a detailed examination of the internal morphology of filtration blebs and openings before and after LSL. The changes in the internal morphology were closely associated with the success of LSL to decrease IOP.