Xen-DS: a novel technique of ab externo Xen implantation augmented with a modified deep sclerectomy for surgical treatment of glaucoma.

PURPOSE: The Xen gel stent is a surgical glaucoma device which creates a subconjunctival filtering bleb, which has demonstrated good intraocular pressure (IOP) lowering and safety. Nonetheless, bleb-related problems have been reported. We present a case series of ab externo Xen procedures augmented with a deep intra-scleral lake, aiming to improve both IOP-lowering and post-operative management. METHODS: A retrospective review of 20 patients who underwent combined Xen gel stent implantation with modified deep sclerectomy at our institution from June to November 2022, with a 6-month follow-up period. We reviewed demographics, past ocular history, visual acuity (VA), IOP, visual fields, glaucoma medication use, complications, and perioperative information. RESULTS: 20 eyes of 20 patients, with a mean age of 67.45 ± 14.38 underwent surgery. Pre-operative initial IOP was 24.5 ± 7.96 mmHg, improving to 11.50 ± 2.96 mmHg at 6 months; a change of -12.89 ± 8.34 mmHg and a mean decrease of 51.13 ± 20.15% (p < 0.0001) Patients were on 3.1 ± 0.72 glaucoma medications pre-operatively, improving to 0.72 ± 1.27 at 6 months (p < 0.0001). Visual field mean deviation was -13.99 ± 9.98 dB pre-operatively and -10.27 ± 9.06 dB at 6 months, with VA of 0.287 ± 0.69 pre-operatively and 0.31 ± 0.76 LogMAR post-operatively. No patients required bleb needling. 2 patients underwent subsequent bleb revision surgery. 2 patients developed choroidal effusions, which were managed conservatively with good visual outcomes. CONCLUSION: In this preliminary study, we have found the modification of Xen gel stent implant surgery with a modified deep sclerectomy to offer good IOP lowering, with low rates of bleb needling and a good safety profile.

Exploring pharmacists' opinions regarding PHARMAC's interventions in promoting brand changes.

BACKGROUND: In New Zealand, the use of generic medicines is advocated by the Pharmaceutical Management Agency of New Zealand (PHARMAC). Among other interventions, PHARMAC uses educational awareness campaigns to educate pharmacists to promote the uptake of generic medicines. However, the opinion of pharmacists regarding these interventions has not yet been evaluated. OBJECTIVES: The objective of this study was to explore pharmacists' opinions regarding PHARMAC's interventions in promoting medicine brand changes. METHOD: A cross-sectional study design was employed to explore pharmacists' opinions regarding brand changes. A questionnaire was sent to 500 randomly selected pharmacists in New Zealand. In second component of the study, five community pharmacies in the Auckland region were selected through convenience sampling, and a semi-structured interview was conducted with a pharmacist in each site. RESULTS: One-hundred and eighty seven questionnaires were returned and analyzed (response rate of 37.4%). Sixty-eight percent of pharmacists supported brand changes and 98.4% mentioned that PHARMAC is responsible for informing them of brand changes. Over half (51.3%) of pharmacists found the current interventions effective, and 39.6% were satisfied with the current brand change information provided by PHARMAC. The majority (94.7%) of pharmacists currently receive faxed information but many indicated (70.8%) that they prefer email notifications. Cilazapril was considered the least difficult medicine to substitute in the past 10 years and omeprazole the most difficult. Patient acceptance and claims about effectiveness were the main factors in determining the difficulty of brand substitution. Fewer than half of the respondents felt that interventions were implemented with enough preparation time for a brand change. The ideal lead-in time was in the range of three to six months. Pharmacists expressed a number of concerns about brand changes such as the frequency at which they occur and the lack of generic stock availability when a brand change occurs. CONCLUSION: Over one-third of respondents were satisfied with brand change information provided by PHARMAC. Cilazapril was the least difficult medicine to substitute, while omeprazole and salbutamol changes were the most difficult. Claims about effectiveness, quality and side effects were the main factors identified as barriers to generic substitution.

Management challenges arising from a traumatic 360 degree cyclodialysis cleft.

We describe the case of a 28-year-old naval officer who attended the ophthalmology service following blunt ocular trauma to the left eye. Clinical examination revealed a shallow anterior chamber, hypotony, and a 360° cyclodialysis cleft. We discuss the management options in this case, with an overview of the current literature.

Increased iris thickness and association with primary angle closure glaucoma.

AIMS: To investigate the relationship between quantitative iris parameters and angle closure disease. methods: Participants with angle closure were recruited prospectively from glaucoma clinics. Anterior segment optical coherence tomography (AS-OCT) was performed under standardised dark conditions. Customised software was used on horizontal AS-OCT scans to measure iris thickness at 750 um (IT750) and 2000 um (IT2000) from the sclera spur, maximal iris thickness (ITM) and cross-sectional area of the iris (I-Area). RESULTS: 167 Angle closure (consisting of 50 primary angle-closure (PAC), 73 primary angle closure glaucoma (PACG) and 44 fellow eyes of acute PAC) and 1153 normal participants were examined. After adjusting for age, sex, pupil size and anterior chamber depth, mean IT750 (0.499 vs 0.451 mm, p<0.001), IT2000 (0.543 vs 0.479 mm, p<0.001), ITM (0.660 vs 0.602 mm, p<0.001) and I-Area (1.645 vs 1.570 mm(2), p=0.014) were significantly greater in angle closure (combined groups) versus normal eyes. Multivariate adjusted odd ratios (OR) of each parameter for the angle closure as compared with normal eyes were: IT750 OR1.7 (95% CI 1.1 to 2.7, p=0.032); IT2000 OR2.2 (95% CI 1.3 to 3.8, p=0.006) and ITM OR2.2 (95% CI 1.3 to 3.6, p=0.003), respectively, per 0.1 unit increase. CONCLUSIONS: Increased iris thickness is associated with angle closure.