Effects of Argon Laser Iridotomy on the Corneal Endothelium of Pigmented Rabbit Eyes

Purpose

In Asian countries, laser iridotomy for the treatment of angle-closure glaucoma is a common cause of bullous keratopathy, which may be associated with a shallow anterior chamber and dark iris pigmentation in Asians. Several cases of corneal decompensation after argon laser iridotomy have been reported. In the present study, we evaluated the harmful effects of argon laser iridotomy on the corneal endothelium.

Methods

Argon laser iridotomy was performed on the right eyes of pigmented rabbits. Changes in corneal thickness and endothelial cell density after laser iridotomy were evaluated. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was performed for assessment of corneal endothelial cell apoptosis. Combined staining with alizarin red and trypan blue, as well as a live/dead cell assay, were performed for evaluation of damage to the corneal endothelium induced by laser iridotomy.

Results

Corneal thickness did not change immediately after laser iridotomy; however, a significant increase was observed 24 hours after iridotomy (p = 0.001). The endothelial cell density of laser-treated eyes four days after laser iridotomy was significantly decreased compared with control eyes (p < 0.001). TUNEL staining showed many TUNEL-positive cells in the corneal endothelium and corneal stroma. No endothelial trypan blue-stained cell nuclei were observed after laser iridotomy; however, several large endothelial cells with damaged membrane integrity were observed. The live/dead cell assay clearly showed a large number of dead cells stained red in several areas throughout the entire corneal button 24 hours after iridotomy.

Conclusions

Argon laser iridotomy induces corneal endothelial cell apoptosis in pigmented rabbit eyes, resulting in decreased endothelial cell density.     

Diurnal intraocular pressure fluctuation and its risk factors in angle-closure and open-angle glaucoma

Purpose

To evaluate intraocular pressure (IOP) fluctuation during office hours and its predictive factors in untreated primary angle-closure suspects (PACS); post-iridotomy primary angle closure (PAC) and primary angle-closure glaucoma (PACG) eyes with or without IOP-lowering medication(s) as appropriate and medically treated primary open-angle glaucoma (POAG) eyes.

Methods

One-hundred seventeen eyes (29 PACS, 30 PAC, 28 PACG, and 30 POAG) of 117 patients were included in this cross-sectional study. The subjects underwent hourly IOP measurements with Goldmann tonometer from 0800 to 1700 hours. Subjects with PAC and PACG had laser peripheral iridotomy at least 2 weeks prior to the inclusion. SD of office-hour IOP readings was the main outcome measure.

Results

IOP fluctuation differed between the groups (P=0.01; Kruskal–Wallis Test). Post hoc Mann–Whitney U-tests showed significantly less IOP fluctuation in PACS compared with PACG (P<0.01). Peak office-hour IOP was observed in the morning in untreated subjects and in the early afternoon in treated subjects. A stepwise linear regression model identified the presence of peripheral anterior synechiae (PAS), thickness of lens, large vertical cup-to-disc ratio (VCDR), and PAC category as significant predictive factors associated with office-hour IOP fluctuation.

Conclusions

Diurnal IOP fluctuation in asymptomatic PACSs was less than that in treated PACG subjects and was at least comparable to that in treated PAC and POAG subjects. The greater the amount of PAS, the thicker the lens, the larger the VCDR, the greater was the IOP fluctuation during office hours.     

Nd:Yag laser iridotomy in Shaffer-Etienne grade 1 and 2:angle widening in our case studies

AIM:To obtain widening of a potentially occludable angle, in according to Kanski’s indications, through preventive Nd:Yag laser iridotomy. The observational study was performed by using gonioscopy for the selection and follow-up of 1165 treated eyes and exploiting Shaffer-Etienne gonioscopic classification as a quality/quantity test of the angle recession.METHODS:Between September 2000 and July 2012, 586 patients were selected at the Outpatients’ Ophthalmological Clinic of the Policlinico Umberto I of Rome in order to undergo Nd:Yag laser iridotomy. A Goldmann type contact lens, Q-switched mode, 2-3 defocus, and 7-9 mJ intensity with 2-3 impulse discharges were used for surgery.RESULTS:From as early as the first week, a whole 360° angle widening were evident in the patients, thus showing the success of Nd:Yag laser iridotomy in solving relative pupil block. The angle remained narrow by 270° in 14 eyes only, despite repetitions of further treatment with laser iridotomy in a different part of the iris, twice in 10 eyes and three times in 4 eyes.CONCLUSION:Nd:Yag laser iridotomy revealed itself as being a safe and effective treatment in widening those critical Shaffer-Etienne grade 1 and 2 potentially occludable angles.     

Akutes Winkelblockglaukom trotz vorhandener Nd:YAG-Laser-Iridotomie

BACKGROUND: Nd:YAG laser iridotomy is routinely used as a procedure for primary acute angle-closure glaucoma (AACG). The clear advantage of Nd:YAG laser iridotomy is to resolve pupillary block without opening the eye. Nevertheless it remains unclear whether Nd:YAG laser iridotomy is equally effective as surgical iridectomy. In this context cases in which AACG recurred despite patent Nd:YAG laser iridotomy are of interest. PATIENTS AND METHODS: In a retrospective study, we analyzed the charts of 90 patients who presented with unilateral primary AACG in our department over 3 years and were treated with a surgical iridectomy. Surgical iridectomy at the 12 o'clock position was performed using a self-sealing corneal incision. RESULTS: Of the 90 patients with primary AACG, 13 (14.4%) had already been treated with Nd:YAG laser iridotomy. Despite the laser iridotomy, these eyes developed recurrent AACG. The presenting intraocular pressure (IOP) of these 13 eyes was 49.07+/-12.65 mmHg. In 4 eyes, continuous medical glaucoma therapy was used prior to AACG, 8 eyes showed signs of glaucoma damage at the optic disk or/and the visual field. In 2 eyes, the presenting high IOP at AACG could be lowered by medication. All other eyes were operated at high IOP. The average interval between the Nd:YAG laser iridotomy and the AACG was 24.5 weeks. After surgical iridectomy, the IOP was reduced to 12.69+/-4.11 mmHg and was 16.62+/-3.86 mmHg at the end of the observation period. CONCLUSIONS: In spite of Nd:YAG laser iridotomy recurrent AACG can occur. Surgical iridectomy is capable of permanently resolving the pupillar block in these cases.     

Outcomes of Ahmed valve surgery for refractory glaucoma in Dhahran, Saudi Arabia

AIM:To evaluate the outcomes of Ahmed glaucoma valve (AGV) implantation surgery for refractory glaucoma.METHODS:This one-armed historical cohort study was conducted in 2011. Refractory glaucoma was defined as eyes with an intraocular pressure (IOP) greater than 21 mm Hg with maximally tolerated glaucoma medications, failed surgeries, or both. For all eyes with refractory glaucoma that underwent AGV implantation, data were collected on IOP, the best corrected visual acuity (BCVA) and glaucoma medications preoperatively and 4, 6, 12, 24 and 56wk postoperatively. Logarithm values of IOP were calculated and compared.RESULTS: The study group was comprised of 30 patients (30 eyes, 16 males and 14 females) with refractory glaucoma. Mean preoperative IOP was 39.3±13.8 mm Hg. Postoperative mean IOP was 15.7±7.1 mm Hg, 19.6±12.8 mm Hg and 13.9±14.2 mm Hg at 12, 24 and 56wk respectively. BCVA was ≥ 6/60 in 11 eyes preoperatively, and five eyes had BCVA≥6/60 at 56wk postoperatively. Preoperatively, more than four medications were used to treat glaucoma in 21 eyes. At 12wk postoperatively, no medications were required to control IOP in 20 eyes. At 56wk postoperatively, at least one medication was required to control IOP in 10 eyes. Over the entire follow up period, four eyes were treated with yttrium aluminium garnet (YAG) laser and 14 eyes required a second surgery. The AGV was removed in four eyes.CONCLUSION: AGV implantation reduced IOP and the number of medications required to control refractory glaucoma. However, there was a higher risk of decreased vision. Long-term follow up and prompt intervention are recommended.     

Lens parameters as predictors of intraocular pressure changes after phacoemulsification

Purpose

To evaluate intraocular pressure (IOP) change after cataract surgery in non-glaucomatous eyes with narrow and open angles (OAs) and its relation to novel lens parameters measured by anterior segment optical coherence tomography (AS-OCT).

Setting

University affiliated hospital, Farabi Eye Hospital, Tehran, Iran.

Design

Prospective interventional case series.

Methods

In this prospective study, 85 non-glaucomatous eyes underwent phacoemulsification and lens implantation. Thirty-nine eyes had OAs and 46 eyes had narrow angles (NAs). IOP and biometric parameters were measured by AS-OCT preoperatively and 3 months after surgery. Change in IOP and its relation to biometric parameters, including lens vault (LV), anterior vault (AV), defined as the sum of the LV and the ACD, and relative LV (rLV), defined as the ratio of the LV to the AV, were evaluated. The main outcome measure was degree of IOP change after phacoemulsification.

Results

Of the 85 patients included in the analysis, 35 were male and 50 were female with an overall mean age of 62.2±8.9 years. The average IOP reduction was −4.95±2.26 mm Hg, from a preoperative mean of 17.12±2.47 mm Hg, at 3 months after cataract surgery. The amount of IOP reduction was significantly greater in the NA compared with the OA group. In multivariate linear regression analysis, preoperative IOP and AV were significantly associated with IOP decrease (all ≤0.03).

Conclusion

Cataract surgery results in IOP reduction in both OA and NA eyes. The amount of IOP reduction is related to AV.     

The efficacy of a monocular drug trial in normal-tension glaucoma

Purpose

To evaluate the efficacy of a monocular drug trial in eyes with normal-tension glaucoma (NTG).

Methods

This prospective study enrolled 74 patients with NTG. The monocular drug trial was started using latanoprost 0.005% for one week. If the intraocular pressure (IOP) reduction was greater than 15%, the same medication was administered to both eyes for one month. The unadjusted change and adjusted change (the change in the treated eye minus the change in the contralateral eye) in IOP were evaluated, and the predictors of IOP response were analyzed by multivariate linear regression.

Results

Among the initial 74 patients, 31 (41.9%) were included; others were excluded because they did not meet the requisite conditions. The most significant predictors of IOP response in the initial eye and subsequent eye were the baseline IOPs in both eyes (β = 0.907, 0.771, respectively). The adjusted change in IOP of the initial eye had greater association (β = 0.589) with the IOP after monocular trial in the initial eye than that of unadjusted IOP change (β = 0.279). The adjusted change in IOP also had greater predictability (β = 0.348) for IOP after monocular trial in the subsequent eye than that of the unadjusted IOP change (β = 0.090).

Conclusions

Although the monocular trial in NTG patients had limited efficacy due to its stringent conditions, it was useful for evaluating the IOP response in the initial eye and for predicting the IOP response in the subsequent eye.     

Effect of Excision of Avascular Bleb and Advancement of Adjacent Conjunctiva for Treatment of Hypotony

Purpose

To evaluate the efficacy of excision of avascular bleb and advancement of adjacent conjunctiva (EBAC) for treatment of hypotony after trabeculectomy with mitomycin C (MMC).

Methods

Fifteen patients (17 eyes) who received EBAC for correction of hypotony between September 1996 and October 2008 were reviewed retrospectively. The main outcomes were intraocular pressure (IOP) and postoperative complications.

Results

Hypotony (IOP <6 mmHg) of eight eyes (47.1%, seven patients) was caused by bleb perforation. Of these, two eyes (two patients) had a history of trauma. Hypotony appeared at 33.9±30.8 months, and EBAC was performed at 48.2±35.3 months after trabeculectomy with MMC. The mean follow-up period was 38.3±29.8 months. The qualified success rate of EBAC was 100% at 51 months after EBAC, and the complete success rate of EBAC was 76.5% at six months and 70.6% at 51 months, as determined by Kaplan-Meier analysis. Post-EBAC complications included blepharoptosis in four eyes (23.5%) and bleb perforation in one (5.9%). The blepharoptosis resolved within one month after EBAC in two patients. However, in the other patients, mild blepharoptosis remained at 17 and 22 months postoperatively.

Conclusions

EBAC was found to be an effective method for treatment of hypotony after trabeculectomy with MMC, and postoperative blepharoptosis was a major complication.     

Cyclodiode laser in the treatment of acute angle closure

Aim

To describe the outcome of using diode laser transscleral cyclophotocoagulation (cyclodiode laser) as a safe technique in managing acute angle closure refractory to conventional treatment.

Methods

This is a retrospective case series from two ophthalmic units in the United Kingdom. Five patients with acute angle closure refractory to medical and laser treatment underwent cyclodiode laser treatment. Demographic information, symptoms, medical and surgical treatment, visual outcomes, and intraocular pressure (IOP) control were recorded.

Case reports

All five patients had symptomatic acute angle closure. Conventional management, including topical and systemic medical treatment, laser iridotomy and laser iridoplasty, did not achieve adequate IOP control or relieve symptoms. Emergency cyclodiode laser treatment was performed within 2–23 days of presentation. All patients subsequently required lensectomy at a later date. At final follow-up (6–14 months), all patients had visual acuity of 6/12 or better with well-controlled IOPs (≤17 mm Hg). Only one patient was on topical treatment. One patient developed a persistent low-grade anterior uveitis.

Discussion

Cyclodiode laser is a safe alternative to emergency lensectomy or trabeculectomy in cases of acute angle closure, which do not respond to treatment.     

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.     

Clinical Characteristics of Glaucomatous Subjects Treated with Refractive Corneal Ablation Surgery

Purpose

To evaluate the clinical characteristics of newly diagnosed glaucomatous subjects who had a history of refractive corneal ablation surgery (RCAS).

Methods

Sixty-eight glaucomatous subjects who had a history of RCAS and 68 age- and visual field (VF) mean deviation-matched glaucomatous subjects with no history of RCAS were included. Intraocular pressure (IOP), central corneal thickness (CCT), VF, and retinal nerve fiber layer thickness determined by optical coherence tomography were assessed. Parameters were compared between patients with and without a history of RCAS. Between-eye comparisons in the same participant (more advanced vs. less-advanced eye, in terms of glaucoma severity) were performed in the RCAS group.

Results

With similar levels of glaucoma severity, those with a history of RCAS showed significantly lower baseline IOP and a thinner CCT than the eyes of individuals without a RCAS history (13.6 vs. 18.7 mmHg, 490.5 vs. 551.7 µm, all p < 0.001). However, the extent of IOP reduction after anti-glaucoma medication did not significantly differ between the two groups (17% vs. 24.3%, p = 0.144). In the between-eye comparisons of individual participants in the RCAS group, the more advanced eyes were more myopic than the less-advanced eyes (-1.84 vs. -0.58 diopter, p = 0.003).

Conclusions

Eyes with a history of RCAS showed a similar level of IOP reduction as eyes without such a history after anti-glaucoma medication. Our finding that the more advanced eyes were more myopic than the less-advanced eyes in the same participant may suggest an association between glaucoma severity and myopic regression.     

Immediate intraocular pressure rise after intravitreal injection of ranibizumab and two doses of triamcinolone acetonide

AIM: To evaluate prospectively immediate intraocular pressure (IOP) changes after the intravitreal injection of ranibizumab, 2 and 4mg triamcinolone acetonide. METHODS: Patients who underwent intravitreal injection of 0.1mL (4mg) triamcinolone acetonide (TA, Group T4), 0.05mL (2mg) TA (Group T2) and 0.05mL (0.5mg) ranibizumab (Group R) comprised the study population. Overall, 229 eyes of 205 patients were injected. Fifty-four eyes (23.6%) were in Group T4, 69 eyes (30.1%) in Group T2 and 106 eyes (46.3%) in Group R. If IOP was less than 26mmHg immediately after the injection no further measurement was performed. If IOP was ≥26mmHg, IOP was remeasured till the reading was below 26mmHg at 5, 15 and 30 minutes. RESULTS: Immediately after the injection, the IOP of 28 eyes (51.9%) in Group T4, 22 eyes (31.9%) in Group T2 and 51 eyes (48.1%) in Group R were over 25mmHg. At 30 minutes, IOP of one eye (1.9%) in group T4, two eyes (2.9%) in group T2 and two eyes (1.9 %) in Group R were over 25mmHg. Immediate post-injection IOP was significantly higher in Group T4 and Group R when compared to Group T2 (P<0.001 and P<0.001, respectively). IOP was significantly higher in eyes without vitreous reflux when compared to those with vitreous reflux in all groups (P<0.001). CONCLUSION: IOP may remarkably increase immediately after the intravitreal injection of 2 or 4mg triamcinolone acetonide, and 0.5mg ranibizumab. Absence of vitreous reflux is the most important predicting factor for immediate IOP rise after the injection.     

Selective laser trabeculoplasty for primary open-angle glaucoma patients younger than 40 years

Objective

To evaluate the efficacy of selective laser trabeculoplasty (SLT) among patients with juvenile-onset primary open-angle glaucoma (JOAG).

Five-year follow-up after anterior iris-fixated intraocular lens implantation in phakic eyes to correct high myopia

Purpose

To evaluate the 5-year follow-up of safety, efficacy, predictability, stability, and complications of anterior iris-fixated phakic intraocular lens (pIOL) implantation to correct high myopia, and patients'' satisfaction after implantation.

Design

Prospective, nonrandomized, and comparative (self-controlled) trial.

Methods

A prospective clinical trial of 84 eyes of 43 patients with high myopia was conducted. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refraction, endothelial cell count, intraocular pressure (IOP), anterior chamber depth, slit lamp biomicroscopy, and indirect ophthalmoscope were measured preoperatively and postoperatively.

Results

At the 5-year follow-up, UCVA was significantly improved, with 85.7% of eyes reaching 20/25 or better. No eyes experienced a loss in BSCVA, and 71.4% gained one or more lines of their preoperative BSCVA. There was a significant reduction in spherical errors in all patients after operation. Loss of endothelial cells was observed 3 years after operation and no more loss was observed 4 years after operation in statistical analysis. No increase in IOP was observed 5 years after operation in statistical analysis. No intraoperative complications were observed in this study. However, pigment precipitates of varying intensities on the lens optic were noted in all patients 1 day after operation, and only five eyes were observed to have the pigment residual five years after operation.

Conclusion

At the 5-year follow-up, the implantation of the anterior iris-fixated pIOL was proved to be effective, predictable and capable of reversibility to correct high myopia in phakic eyes. It was a safety addition to the laser refractive surgery. However, longer follow-up with larger numbers of patients is still necessary to evaluate long-term complications.     

Efficacy of bimatoprost 0.03% in reducing intraocular pressure in patients with 360° synechial angle-closure glaucoma: a preliminary study

Context:

Peripheral anterior synechiae (PAS; synechiae anterior to functional trabecular meshwork) formation in primary angle-closure glaucoma (PACG) hampers access to uveoscleral outflow. Thus, the role of bimatoprost in such patients with 360° synechiae was evaluated.

Aims:

To assess efficacy and safety profile of bimatoprost 0.03% in lowering intraocular pressure (IOP) in 360° synechial angle-closure glaucoma patients.

Settings and Design:

This was a prospective, non-randomized, non-comparative, selective analysis, single-center pilot study.

Materials and Methods:

A total of 23 eyes of 20 Indian chronic angle-closure glaucoma (CACG) patients with IOP greater than 21 mmHg, 360° PAS and no visual potential in the study eye underwent detailed eye examination. Baseline IOP was measured and YAG peripheral iridotomy was performed for complete angle-closure reconfirmation. Bimatoprost 0.03% was administered for 8 weeks as once-daily evening dose. IOP reduction within treatment group was determined with “paired t-test”.

Results:

The mean reduction in IOP from baseline to 8 weeks of bimatoprost therapy was 15.3 ± 9.5 mmHg (P < 0.001). The most commonly observed adverse event was conjunctival hyperemia (35%). Bimatoprost was well tolerated in the study.

Conclusions:

In this study, exclusively involving patients with 360° synechial angle-closure glaucoma and no visual potential, bimatoprost 0.03% treatment demonstrated a statistically significant IOP reduction. Hence, it can be inferred that bimatoprost 0.03% is an efficacious treatment modality in this subgroup of patients for reducing IOP.     

Comparison of brimonidine-timolol and dorzolamide-timolol in the management of intraocular pressure increase after phacoemulsification

AIM: To compare the effectiveness of brimonidine/timolol fixed combination (BTFC) and dorzolamide/timolol fixed combination (DTFC) in the management of short-term intraocular pressure (IOP) increase after phacoemulsi?cation surgery.METHODS: Eighty eyes of 80 patients undergoing phacoemulsi?cation and intraocular lens (IOL) implantation were randomly assigned into three groups. Group 1 consisted of 28 eyes and represented the control group. Group 2 consisted of 25 eyes undergoing phacoemulsi?cation surgery and BTFC was instilled at the end of surgery. Group 3 consisted of 27 eyes undergoing phacoemulsi?cation surgery and DTFC was instilled at the end of surgery. IOP was measured preoperatively and 6, 24h and 1wk postoperatively.RESULTS: There was no statistically signi?cant difference in preoperative baseline IOP among the three groups (P=0.84). However, IOP was significantly lower in groups 2 and 3 compared to the control group (P<0.05 for all comparisons) at all postoperative visits. There was no significant difference between groups 2 and 3 at any visit. Eight eyes (28.6%) in the control group, two (8%) in Group 2 and one (3.7%) in Group 3 had IOP >25 mm Hg at 6h after surgery (P=0.008). However, IOP decreased and was >25 mm Hg in only one eye in each group at 24h after surgery.CONCLUSION: BTFC and DTFC have similar effects in reducing increases in IOP after phacoemulsification surgery and can both be recommended for preventing IOP spikes after such surgery.     

Short-term results of canaloplasty surgery for primary open-angle glaucoma in Japanese patients

Purpose

To report surgical results of canaloplasty surgery for primary open-angle glaucoma (POAG) in Japanese patients.

Methods

Eleven eyes of 9 POAG patients underwent canalopasty surgery at Toyama University Hospital. Three eyes of 3 patients underwent canaloplasty alone and 8 eyes of 6 patients underwent canaloplasty combined with cataract surgery. Canaloplasty was performed with a 10-0 polypropylene tensioning suture and an iTrack™ 250A microcatheter. All patients were followed up for 12 months. Changes in intraocular pressure (IOP) and postoperative complications were examined.

Results

Mean preoperative IOP was 23.4 ± 5.5 mm Hg. Mean number of antiglaucoma drops was 2.8 ± 0.6 before canaloplasty and decreased to 1.2 ± 0.8 at 12 months after canaloplasty (p < 0.01). Mean IOP decreased postoperatively, being 13.7 ± 2.8 mm Hg at 1 month, 12.8 ± 3.5 mm Hg at 3 months, 14.0 ± 4.4 mm Hg at 6 months, and 15.0 ± 4.1 mm Hg at 12 months. The most frequent postoperative complication was mild hyphema (45.5%), which disappeared within 14 days after surgery.

Conclusions

Canaloplasty may be an alternative surgery for POAG patients to reduce IOP to a value of approximately 15 mm Hg.Key Words: Canaloplasty, Primary open-angle glaucoma, Intraocular pressure, Complications     

Gas tamponade combined with laser photocoagulation therapy for congenital optic disc pit maculopathy

Purpose

To evaluate the long-term clinical efficacy and safety of gas tamponade combined with laser photocoagulation for optic disc pit maculopathy.

Methods

Seven consecutive patients with unilateral maculopathy associated with optic disc pit and one patient with bilateral optic disc pit maculopathy were given octafluoropropane (C₃F₈) tamponade combined with focal laser photocoagulation treatment. Patients were followed up for 21–62 months after treatment. Main outcomes were determined by optical coherence tomography (OCT) and best-corrected visual acuity (BCVA).

Results

Treatment with C₃F₈ tamponade followed by laser photocoagulation in ODP maculopathy patients resulted in resolution of sub-retinal and/or intra-retinal fluid in six out of eight patients. The remaining two patients had significant reduction in fluid, as determined by OCT, and funduscopy, as well as an improvement in anatomical architecture. Visual acuity improved obviously in seven eyes and remained stable in two eyes. Central visual field loss after photocoagulation was not clinically appreciable by visual field examination. No post-operative complications of maculopathy occurred during the follow-up period.

Conclusions

Although repeated treatment was needed in some patients, C₃F₈ tamponade combined with laser photocoagulation is still a simple, effective, minimally invasive, and economic therapy for optic disc pit maculopathy.     

Evaluation of changes of macular thickness in diabetic retinopathy after cataract surgery

Purpose

To assess the macular thickness changes after cataract surgery in diabetic patients using optical coherence tomography (OCT).

Methods

We retrospectively reviewed the records of 104 diabetic patients who underwent cataract surgery. We examined the changes of macular thickness using OCT before cataract surgery and 1 week, 1-, 2- and 6-months after surgery. The central subfield mean thickness (CSMT) was used to evaluate macular edema which was defined as an increase of CSMT (ΔCSMT) > 30% from the baseline. The association between prior laser treatment or severity of diabetic retinopathy and macular thickness were also analyzed.

Results

Macular edema occurred in 19 eyes (18%) from the diabetic group and 63% of macular edema developed at 1 month after surgery. Thirteen (68%) out of 19 eyes with macular edema showed the resolution of macular edema by 6 months after surgery without treatment. ΔCSMT of eyes without a history of laser treatment was statistically greater compared to eyes with a history of laser treatment in at 1- and 2-months after surgery, but was not different than eyes who had laser treatment at 6-months after surgery. The severity of diabetic retinopathy was not significantly correlated to macular edema, but there was statistical difference when patients who had a history of prior laser treatment were excluded.

Conclusions

The incidence of macular edema after cataract surgery in diabetic patients was 18%. Its peak incidence was at 1 month post surgery and it resolved spontaneously in 68% of patients by 6 months post surgery. Prior laser treatment might prevent postoperative macular edema until 2 months after cataract surgery in diabetic patients. However, macular edema did not affect the severity of diabetic retinopathy.     

Diurnal variation in central corneal thickness and intraocular pressure in eyes with pseudoexfoliation syndrome without glaucoma

Aim:

The aim was to ascertain if any differences exist in diurnal central corneal thickness (CCT) and intra-ocular pressure (IOP) between eyes with pseudoexfoliation (PXF) syndrome without glaucoma and eyes with no ocular pathology. A secondary aim was to determine whether there was a significant relationship between CCT and IOP.

Settings and Design:

This study was a prospective design conducted within a hospital setting.

Materials and Methods:

The experimental group consisted of seven participants with bilateral PXF (14 eyes) and the control group comprised of 15 participants (30 eyes). Testing included CCT and IOP measured at four different times on one given day (8.00 a.m.; 11 a.m.; 2 p.m. and 5 p.m.).

Statistical Analysis:

The data were analyzed with the generalized linear latent mixed model.

Results:

PXF eyes displayed a significantly thinner overall mean CCT (520 μm) compared to controls (530 μm). Furthermore, a significant reduction in CCT and IOP occurred in the PXF group from 8 a.m. to 5 p.m. The mean overall IOP in PXF eyes was significantly lower than the control group. A significant association between IOP and CCT was also found in PXF eyes.

Conclusions:

Displaying a significantly thinner mean CCT highlights the importance of measuring CCT in an ophthalmic clinical setting as to avoid falsely underestimated IOP measurements in such a high-risk glaucoma population. Furthermore, a statistically significant correlation between IOP and CCT in PXF eyes suggests that the reduction in CCT that occurred in PXF eyes between 8 a.m. and 5 p.m. may be partly responsible for the reduction in IOP measurements.