Trabecular meshwork bypass tube shunt: initial case series

AIMS: This study describes a prospective consecutive case series of the initial six eyes of five patients undergoing implantation of the trabecular bypass tube shunt. METHODS: A prospective consecutive case series. The initial six eyes of five patients with uncontrolled open angle glaucoma who had never previously undergone ocular surgery. Implantation of the trabecular bypass tube shunt measuring 150 micro m outer diameter and 50 micro m inner diameter was performed with the distal end placed in Schlemm's canal and the proximal end in the anterior chamber. The main outcome measures were visual acuity, intraocular pressure, glaucoma medication use. RESULTS: The tube was successfully implanted in five of six eyes. In four eyes longer term follow up of 5-9 months showed no loss of visual acuity with decreased intraocular pressure from preoperative levels (mean 23.4-16.5 mm Hg) and reduced requirement of glaucoma medications (mean 3-0.5). In a subset of two eyes, there was no measured increase in aqueous flare or reduction of endothelial cell count. In one eye the tube was explanted because of presumed misplacement by excessive bleeding during surgery. Two eyes showed a diffuse bleb. CONCLUSIONS: This study reports the initial experience with a novel approach to surgical glaucoma therapy. This very small tube allows a direct communication to be established between the anterior chamber and Schlemm's canal, effecting a trabecular bypass. In this small number of eyes this procedure reduced intraocular pressure and the need for glaucoma medications without appreciable side effects.     

Use of an injector for the Ex-PRESS Mini Glaucoma Shunt.

Using the Ex-PRESS Mini Glaucoma Shunt (Op-tonol Ltd., Neve Ilan, Israel) for the surgical treatment of glaucoma is now possible with the assistance of an injection system. The author believes the procedure is safe and effective in lowering intraocular pressure from baseline. This article discusses the technique and provides pearls for surgical success.     

Combined intraocular lens implantation and glaucoma implant (tube shunt) surgery in pediatric patients: a case series.

PURPOSE: We sought to investigate the outcomes of children who underwent simultaneous intraocular lens (IOL) implant and glaucoma implant surgery. METHODS: Medical records of all patients who underwent simultaneous IOL implant and glaucoma implant surgery from January 1995 through August 2003 by a single surgeon were reviewed. Criteria for success included intraocular pressure 相似文献   

Comparison of trabeculectomy with Ex-PRESS shunt implantation in primary-open-angle-glaucoma patients: A retrospective study

Purpose:

To investigate the efficacy of intraocular pressure (IOP) control and medication use over time after trabeculectomy (TRBC) and Ex-PRESS shunt implantation in primary-open-angle-glaucoma (POAG) patients.

Design:

Retrospective case series.

Patients and methods:

A total of 33 unilateral POAG patients were enrolled, and 17 patients received traditional TRBC and 16 patients received Ex-PRESS device implantation. Data on IOP, reduction of antiglaucoma medication, and major complications were collected and analyzed after 12 months of follow up.

Results:

After 12 months of follow up, both groups showed good IOP control. The mean preoperative IOP decreased from 38.5 (±6.9) to 18.2 (±11) mmHg after TRBC, and from 38.5 (±9.1) to 19.53 (±12.36) mmHg after Ex-PRESS implantation (both p < 0.05). The mean number of antiglaucoma medications prescribed at the last follow up decreased from 3.2 (±0.5) preoperatively to 1.2 (±1.4) after TRBC versus 3.3 (±0.7) preoperatively to 1 (±0.9) after Ex-PRESS implantation (both p < 0.05). Complete success rate (defined as no medication after surgery with IOP >5 and <18 mmHg) and qualified success rate (defined as with or without medication after surgery with IOP >5 and <18 mmHg) were similar (47% vs. 43% and 76.47% vs. 75%) between the two groups without statistical difference (p > 0.05). However, postoperative hypotony rate was more frequent after Ex-PRESS (37.5%) than after TRBC (17.64%).

Discussion:

TRBC and Ex-PRESS implantation provided similar IOP control and reduction of postoperative medication with low incidence of postoperative complications at intermediate-term follow up. However, the Ex-PRESS implantation device may last longer but with extra costs. It is up to the surgeon to decide which procedure to use according to the patient''s situation and economic circumstances.     

Restrictive strabismus following Jones tube insertion: a case series of 8 patients

BACKGROUND: Restrictive strabismus and diplopia are an uncommon complication of conjunctivodacryocystorhinostomy, with insertion of the Lester-Jones tube. A literature review revealed only 4 published reports of this complication with a total of 4 patients affected. METHODS: We report on a series of 8 patients who presented with restrictive strabismus and diplopia following Jones tube insertion. RESULTS: Time to presentation was variable and was found to occur from several months to as long as 6 years after insertion. Treatment included topical steroid therapy initially. Surgery was done to release adhesions and scarring if topical treatment failed. Mitomycin C was used in 2 patients. Only 4 of the 8 patients had successful resolution of their diplopia with either therapy. INTERPRETATION: Diplopia following Jones tube insertion is an infrequent complication of surgery. Medical or surgical therapy can be help resolve symptoms but is often unsuccessful.     

Glaucoma Drainage Devices: A Review of the Past,Present, and Future

Glaucoma drainage devices are more frequently being used for glaucoma filtering surgeries, even those at low risk for failure with trabeculectomy. There are 4 major devices available: the Molteno, Baerveldt, Krupin, and Ahmed. The Molteno and Baerveldt are non-valved implants, while the Krupin and Ahmed are valved. The success rates of the different valves are about equal at approximately 70% with a mean intraocular pressure (IOP) lowering of at least 50% from the pre-operative IOP. Unfortunately, the failure rate is about 10% per year, leading to only 50% functional drainage devices at 5 years. Therefore, research on the biomaterials, shape, and technique of drainage implant surgery is being done in hopes of increasing long term success rates.     

Intravitreal voriconazole for drug-resistant fungal endophthalmitis: case series

PURPOSE: To report the efficacy of intravitreal voriconazole. METHODS: Retrospective analysis of an interventional case series of five cases of culture-proven fungal endophthalmitis treated with intravitreal voriconazole was done. Only cases found to be resistant to conventional antifungal agents were included in the study. The diagnosis of fungal endophthalmitis was established on the basis of clinical as well as microbiological examination. All patients received one or more intravitreal injections of voriconazole. Resolution was determined on the basis of clinical examination. Resolution of infection and final visual acuity were the main outcome measures. RESULTS: Resolution of infection was achieved in all five cases. Visual acuity was better in three cases and was maintained in two. Of the three patients who had improvement, two had vision better than or equal to 20/120. Evisceration was avoided in one case with maximal antifungal treatment including voriconazole. CONCLUSIONS: Voriconazole definitely adds to the available treatment options for fungal endophthalmitis. Because of its broad spectrum of activity, it is efficacious in even amphotericin-B- and fluconazole-resistant fungal endophthalmitis.     

Ranibizumab for idiopathic epiretinal membranes: A retrospective case series

PurposeTo study the effect of intravitreal ranibizumab on idiopathic epiretinal membranes (ERMs).MethodsA retrospective cohort study on a consecutive series of ranibizumab intravitreal injections for epiretinal membranes was performed. Four cases were identified by reviewing a claims database linked to electronic medical records. All patients received a total of three 0.05 mg/0.05 ml ranibizumab intravitreal injections at a monthly interval. The primary outcome measure was the final best-corrected visual acuity (BCVA) at the end of the injection series, and the final central macular thickness (CMT).ResultsAll four patients completed 3 months follow-up after the last ranibizumab injection. The mean baseline CMT was 509 microns (SD = 111). A trend was noticed for reduction in CMT (Δ = 41 microns) P = 0.08. Three patients improved by one line in their BCVA. The remaining patient maintained the same BCVA. No complications were noted.ConclusionIn this study, intravitreal injection of ranibizumab marginally reduced retinal thickness in four patients with minimal improvement in visual acuity. No safety concerns were noticed. Further basic science and clinical studies may be warranted to assess the role of vascular endothelial growth factor and the effect of ranibizumab on idiopathic epiretinal membranes.     

Allergic contact dermatitis: a case series and review for the ophthalmologist

Eyelid dermatitis is most commonly caused by an allergenic response, potentially from exposure at another site, rather than from local toxicity. Yet allergic contact dermatitis is a diagnosis often missed by ophthalmologists. The authors review the literature and detail their experience relating to the causes, clinical features and management of this condition. 14 patients over a 2-year period that were referred to the oculoplastic service for a further opinion were reviewed in a retrospective, non-comparative study. All patients underwent patch testing for diagnosis. 8 of the 14 patients had delays of more than 6 months from symptoms to diagnosis. In six of these, this was greater than 1 year. Similar delays are reported in the literature. 79% of the cases were referred by ophthalmologists. Although two of the patients were biopsied, this did not help in making the diagnosis. 13 patients had disease restricted to the eyelids, though only five of these had direct contact of the allergen with the eyelids. Two patients were also sensitised to topical steroid creams prescribed for their treatment. All patients improved after removal of the allergen. Further clinical features and management options from the literature are reviewed and discussed.