Mid-term real world outcomes of the Hydrus® Microstent in open angle glaucoma.

PURPOSE: To evaluate the mid-term clinical results and the safety aspects of the Hydrus® Microstent (Ivantis, Inc, Irvine, CA) in a real-life setting. DESIGN: Retrospective case series. METHODS: Hydrus® Microstent was implanted in phakic eyes (88 eyes, 87.1%) and in pseudophakic eyes (13 eyes, 12.9%), respectively. Mean follow-up time was 16 ± 9 months with 27 eyes having a follow-up time of more than 24 months. MAIN OUTCOME MEASURES: The primary endpoint was reduction in IOP compared to baseline. Target IOP levels were set at ≤20 mmHg, ≤18 mmHg and ≤15 mmHg. Kaplan-Meier survival was defined as a reduction in IOP of ≥20% compared to baseline. Secondary endpoints were reduction in number of glaucoma medications and safety assessments addressing visual acuity, adverse events, re-surgery rate and identification of factors that made the implantation more difficult. RESULT: 101 eyes underwent Hydrus® implantation. The mean preoperative IOP was 21.60 mmHg (SD 6.6) on 2.18 (SD 1.3) medications. After a mean follow up time of 16 months, the mean IOP was reduced to 14.61 ± 3.7 mmHg on 1.12 (SD 1.1) medication classes (p < 0.001). Mean decrease in IOP was 26.7%. Analysis of the target IOP levels showed that in 29%, 34% and 35% of cases an IOP of ≤15 mmHg, ≤18 mmHg and ≤20 mmHg respectively could be achieved. BCVA improved from 0.56 ± 0.3 at baseline to 0.85 ± 0.3 more than 24 months after surgery (p < 0.001). The rate of re-operation was low at <3%. Adverse events occurred in 4 eyes (<4%). CONCLUSION: This study underlines the effectiveness and the safety of the Hydrus® Microstent in an elective setting, but it also demonstrates certain limits and risk factors of this procedure.

Associations of cardiovascular risk factors and retinal vessel dimensions at present and their evolution over time in a healthy working population.

PURPOSE: The aim of this study was to investigate whether an association between retinal vessel diameters with blood pressure and other risk factors exists in a healthy working population and whether current risk factors can be used as predictors for retinal vessel changes over time. METHODS: Retinal photographs and medical data were obtained during a voluntary work health check in 2010 and 2013. The central retinal arterial equivalent (CRAE) and central retinal venular equivalent (CRVE) were assessed using a semi-automated software. Linear regression analysis was carried out to determine associations with systemic parameters and cardiovascular risk factors. RESULTS: A total of 1685 participants had gradable photographs and full medical data with a mean age of 44.8 years (SD: 10.2) and 80.8% being male; full data were obtained in both 2010 and 2013 for 365 participants allowing for longitudinal analysis. In the cross-sectional analysis, a mean CRAE of 171.2 ±18.3 µm and a mean CRVE 215.8 ± 18.6 µm were found. A significant negative association for CRAE was seen for age, mean arterial blood pressure (MABP), body mass index (BMI) and high-density lipoprotein (HDL), while triglycerides, spherical equivalent (SAE) and being a current smoker were positively associated. For CRVE age, MABP, HbA1c and HDL were negatively associated, while being female, low-density lipoprotein, white blood cell count, SAE and being a current smoker showed a positive association. The linear regression model for the cross-sectional analysis explained 31% and 21% of the variance of CRAE and CRVE, respectively. The longitudinal analysis showed a mean decrease of -1.6 µm (p = 0.04) for CRAE and -2.0 (p = 0.005) for CRVE within the three-year time frame. Linear regression analysis with longitudinal data showed a significant association for HDL and CRAE, while for other factors no statistically significant association between current risk factors and changes in CRAE and CRVE was observed. CONCLUSION: The width of both arterial and venous retinal vessels shows associations not only with arterial blood pressure but also with biochemical markers of cardiovascular risk. While such effects are partially established for elderly persons, our study results indicate that they apply also in a young population in working age with seemingly unimpaired health.

Total retinal detachment caused by a KIF11 mutation.

PURPOSE: This is a case report of bilateral retinal detachment associated with KIF11 mutation. METHODS: In our university hospital, an 8-week-old patient presented with a potential bilateral congenital cataract, iris atrophy, and iridocorneal contact in the left eye. An examination revealed microcephaly and edema of the dorsa of the feet. The eye examination showed a clear lens in both eyes with a dislodged anterior chamber in the left eye with vessels drawn from the iris to the lens. A retrolental white bilateral mass with vessels was also observed. The MRI and the ultrasound revealed a potential peritoneal hyperplastic glass body. Bilateral retinal detachment was diagnosed during surgery. RESULTS: Due to the external appearance of the eyes (microcephaly and edema) and the bilateral retinal detachments, a test for KIF11 mutations was requested, and the results were positive. CONCLUSIONS: There is a known association between KIF11 mutation and chorioretinopathy. The bilateral retinal detachment in the present case study has not been previously reported in the literature.

Femtosecond lenticule extraction (ReLEx) for correction of hyperopia - first results.

BACKGROUND: This prospective study focused on the results of a novel method for refractive correction, femtosecond lenticule extraction (ReLEx®) in hyperopia, and reports the first 47 eyes. METHODS: In 47 hyperopic eyes (26 patients), both a flap and a lenticule of intrastromal corneal tissue were simultaneously cut utilizing the Carl Zeiss Meditec AG (CZM) 200 kHz VisuMax femtosecond laser system. Thereafter, the lenticule was manually removed and the flap repositioned. Forty two out of 47 hyperopic eyes of the treatment group completed the final 9-month follow-up. The patients mean age was 42.3 (±9.0) years. Their mean preoperative spherical equivalent (SE) was +2.8 (±1.3) D. UCVA and BSCVA after 9 months, objective and manifest refraction, as well as slit-lamp examination and side-effects were evaluated. RESULTS: Nine months postoperatively, 64 % of eyes treated were within ±1.0 D, and 38 % of eyes within ±0.5 D of intended correction. One of 47 eyes (2.1 %) lost more than 2 Snellen lines; none of the eyes had a UCVA less than 0.5. However, stability was less impressive when compared to ReLEx for the correction of myopia. CONCLUSIONS: First data suggest that ReLEx is a feasible and effective procedure for treatment of hyperopia. Further research is needed to improve predictability and effectiveness of the procedure for the correction of hyperopia.

Modulation of central corneal thickness by various riboflavin eyedrop compositions in porcine corneas.

PURPOSE: To evaluate the modulatory effect of various riboflavin 0.1% and 0.2% compositions on the central corneal thickness (CCT) in fresh porcine corneas. SETTING: Department of Ophthalmology, Johannes Gutenberg University of Mainz, Mainz, Germany. DESIGN: Experimental study. METHODS: The CCT in freshly enucleated porcine globes was measured by ultrasound pachymetry before and after (if applicable) deepithelialization and every 10 minutes thereafter during 120 minutes of eyedrop application. In Groups 1 and 2 (controls), no eyedrops were applied. In Groups 3 and 4, isotonic riboflavin eyedrops were used. In Groups 5 to 9, hypotonic riboflavin eyedrops were given. In Groups 10 and 11, preparations for transepithelial crosslinking were applied. In Groups 2 to 9, deepithelialization was performed. The final CCT in the groups was compared by analysis of variance. RESULTS: One hundred ten freshly enucleated porcine globes were used. The mean final CCT compared with preoperative values was 97% ± 4% (SD) in Group 1, 91% ± 4% in Group 2, 66% ± 5% in Group 3, 151% ± 13% in Group 4, 65% ± 2% in Group 5, 105% ± 3% in Group 6, 120% ± 4% in Group 7, 130% ± 4% in Group 8, 132% ± 4% in Group 9, 114% ± 2% in Group 10, and 114% ± 4% in Group 11. The differences between Group 1 and each of Groups 3, 4, 5, 7, 8, and 9 were statistically significant (P<.05). CONCLUSION: There was considerable variation in the final CCT as a result of varying riboflavin eyedrop compositions. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Warty skin changes, chronic scrotal lymphoedema, and facial dysmorphism.

We present the case of a 49-year-old Caucasian man whose main complaints were wart-like skin changes and scrotal lymphoedema. Furthermore, our patient showed signs of a common hereditary disease: lymphoedema, short stature, webbed neck, low frontal and posterior hairline, downslanting palpebral fissures, pale blue iris, broad nose, flat philtrum, and prominent nasolabial folds. His ears were low set and retroverted with a thick helix. However, no diagnosis was made for 49 years. The interdisciplinary dialogue of various specialists to make the final diagnosis is presented and discussed.