Optical Coherence Tomography Angiography Changes in Patients Diagnosed With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

We conducted a systematic review and meta-analysis to assess the association between optical coherence tomography angiography (OCTA) parameters and acute coronary syndrome (ACS). Two independent reviewers searched the electronic databases (MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, Embase (Excerpta Medica Database), Cochrane Library, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform) from inception until April 2023. According to the inclusion criteria of this review, eligible were observational studies, randomized control trials, and registry/database studies that included the eyes of adult ACS patients and assessed OCTA parameters within the macula. The pooled standardized mean differences (SMD) between patients diagnosed with ACS and healthy controls with a confidence interval (CI) of 95% were calculated using the Hartung-Knapp-Sidik-Jonkman random-effects method. The heterogeneity was assessed by I2 and the Cochran Q and a random effects model was applied. Seven studies were eligible and included in our systematic review (n = 898), of which three were included in the meta-analysis (n = 341). The pooled SMD in the superficial vascular plexus (SVP), deep vascular plexus (DVP), and foveal avascular zone (FAZ) were -0.46 (95% CI: -0.94 to 0.01, p = 0.05, I2 = 0%, three studies), -0.10 (95% CI: -3.20 to 3.00, p = 0.75, I2 = 67%, two studies), and 0.43 (95% CI: -1.22 to 2.09, p = 0.38, I2 = 92%, three studies), respectively. Our findings suggest that there are no differences in OCTA metrics between ACS patients and healthy individuals.

Corneal tomography changes following major (6 mm) medial rectus muscle recession: a prospective cohort study using Pentacam®.

INTRODUCTION: The aim of this study is to evaluate changes in corneal astigmatism, axial anterior corneal curvature, as well as changes in the anterior chamber depth and central corneal thickness, 2 months following the unilateral recession of medial rectus muscle in children. METHODS: Thirty-three children with esotropia were prospectively evaluated following unilateral medial rectus muscle recession, using Pentacam®. Comparisons were made between the operated and fellow unoperated eyes, pre, and postoperatively. The assessment was made for changes in the radius of axial curvature on major meridians at 3 and 3.5 mm from the optical corneal center in the mid-peripheral zone. Astigmatism changes of the anterior and posterior corneal surface were calculated using vector analysis software (astigMATIC®). ANOVA model was used to examine the interaction between age or central corneal thickness and postoperative changes in anterior and posterior surface corneal astigmatism. RESULTS: In the intervention group, changes in anterior and posterior corneal surface astigmatism were statistically significant, with a mean increase of 0.59Dx92 and 0.08Dx91, respectively. In the mid-peripheral corneal zone, there is an increase in the radius of anterior corneal axial curvature more evident nasally 3.5 mm from the corneal center on the horizontal meridian, with corresponding decrease superiorly and inferiorly at 3 and 3.5 mm from the corneal center on the vertical meridian. DISCUSSION: The changes in total astigmatism of the operated eyes are mainly attributed to the anterior corneal surface. These changes are associated with flattening in the 180 meridian of the cornea, leading to a shift to "with-the-rule" astigmatism.

The TsiogkaSpaeth grid for detection of neurological visual field defects: a validation study.

BACKGROUND: The TsiogkaSpaeth (TS) grid is a new, low-cost, and easy to access portable test for visual field (VF) screening which could be used by clinicians in everyday clinical practice. Our study aimed to determine the validity of an innovative screening grid test for identifying neurological disease-associated VF defects. METHODS: We enrolled two groups of participants: We assessed the one eye of ten consecutive adult patients with different types of neurological disease associated VF defects and ten eyes of controls in each group. The TS grid test was performed in each group. Sensitivity, specificity, and positive and negative predictive values of the TS grid scotoma area were assessed using the 24-2 VF Humphrey field analyzer (HFA) as the reference standard. RESULTS: Sensitivity and specificity of the TS grid test were 100% and 90.91%, respectively. The area under curve was 0.9545 with 95% CI 0.87-1.00. There was a significant correlation between the number of missed locations on the TS grid test and the visual field index of the HFA 24-2 (r = 0.9436, P < .0001). CONCLUSION: The sensitivity and specificity of the TS grid test were high in detecting VF defects in neurological disease. The TS grid test appears to be a reliable, low-cost, and easily accessed alternative to traditional VF tests in diagnosing typical neurological patterns of visual field defects. It would be useful in screening subjects for neurologically derived ocular morbidity in everyday clinical practice and in remote areas deprived of specialized health care services.

Conjunctival Marginal Zone Lymphoma in a Patient With Neurofibromatosis Type 1: A Case Report.

We present a case of painless bulbar conjunctival mass due to B-cell non-Hodgkin lymphoma (NHL), without systemic involvement, in a 76-year-old man. Following an excision biopsy, histopathologic examination and immunohistochemistry confirmed the diagnosis, prompting a referral for hemato-oncological assessment. The patient underwent comprehensive laboratory and imaging scans, subsequently receiving combined chemo-immunotherapy that resulted in complete remission to date. This case is reported as it is crucial to recognize that a conjunctival insult might emerge in neurofibromatosis type 1 (NF1) patients.

Evaluation of Macular Thickness Changes Following Large Horizontal Rectus Muscle Recession: A Prospective Cohort Study.

Aim The aim of the study was to evaluate the long-term effect of large horizontal rectus muscle recession on macula thickness using spectral domain optical coherence tomography (SD-OCT). Material and methods Forty-two children were included in the study. The intervention groups were the medial rectus (MR) group (=20 eyes ) and the lateral rectus (LR) group (=22 eyes), including the eyes that underwent large medial and lateral rectus muscle recession, respectively. The control group included the fellow 42 unoperated eyes of the same children. Each eye was scanned using Topcon Maestro2 OCT-Angiography (OCTA; Topcon, Tokyo, Japan) preoperatively and then two months following surgery. A paired t-test was used to compare the mean difference in macular thickness between the intervention and control groups using the statistical program R (R Foundation for Statistical Computing, Vienna, Austria). Results The mean change in central, parafoveal, and perifoveal macular thickness of the intervention group was not statistically significant. Conclusion The long-term changes in macular thickness, as evaluated using SD-OCT both for the central and peripheral regions of the fovea, following large horizontal rectus muscle recession surgery, are not statistically significant.

Early Postoperative Changes in Macular Choroidal Thickness After Uncomplicated Phacoemulsification in Patients With and Without Glaucoma: A Swept-Source Optical Coherence Tomography Study.

Purpose The objective of this study was to examine the impact of uncomplicated phacoemulsification on macular choroidal thickness (CT) within the first three postoperative months and to investigate its relationship with postoperative cystoid macular edema (CME) in both glaucomatous and healthy subjects, utilizing swept-source optical coherence tomography (SS-OCT). Methods The non-randomized prospective study involved 82 patients, selected via convenience sampling from the First Department of Ophthalmology, Medical School of Athens, "G. Gennimatas" Hospital, Athens, Greece, between May 2018 and May 2022, undergoing phacoemulsification and intraocular lens (IOL) implantation. The inclusion criteria encompassed patients aged 50 years or above, with or without glaucoma. Patients with ocular pathologies that could influence macula or CT measurements were excluded. Data collection focused on retinal and CT variables of the macular area, measured using SS-OCT. Baseline measurements were established preoperatively, with follow-up assessments at one week, one month, and three months postoperatively to monitor CT and macular edema onset. Results A total of 82 eyes from 82 patients with a mean age of 79.1±8.3 years were included. The study population was divided into a glaucoma group (n=28 eyes) and a control group (n=54 eyes). Our findings indicate a consistently significant increase in macular CT measurements one month after cataract surgery, observed in both glaucomatous and non-glaucomatous eyes. In the first postoperative week, statistically significant changes in CT were observed only in patients with CME. Subsequently, at one-month interval, both patient groups, those with and without CME, exhibited statistically significant changes in CT across all macular sectors. CME was detected in 10 out of 28 eyes in the glaucoma group and in 16 out of 54 eyes in the control group. When evaluating the impact of postoperative CME on groups of glaucomatous and non-glaucomatous eyes, it was observed that glaucomatous eyes exhibited a significantly larger magnitude of change in subfoveal CT (SFCT) (p=0.03) at one month (relative to baseline) compared to non-glaucomatous eyes. There was also a 31% increase in the odds of developing CME for glaucoma patients; this result was not statistically significant (odds ratio {OR}, 1.31; 95% confidence interval {CI}, 0.50-3.47; p=0.57). Conclusions During the early postoperative period, the study revealed a significant increase in CT at one month after phacoemulsification in both glaucomatous and non-glaucomatous eyes. When CME was present, a significantly more pronounced magnitude of change in SFCT was observed at one month in glaucomatous eyes, as opposed to non-glaucomatous eyes. This observation suggests a possible selective susceptibility of glaucomatous eyes in the early postoperative period that requires further research.

Changes in Subfoveal Choroidal Thickness Following Uncomplicated Cataract Surgery: A Scoping Review.

This scoping review investigates the relationship between subfoveal choroidal thickness (SFCT) and cataract surgery. We synthesized existing research to clarify SFCT changes following surgery and identify contributing factors. Our aim was to enhance understanding of the ocular changes associated with cataract surgery. A comprehensive database search identified studies on SFCT changes after uncomplicated cataract surgery, categorized as "SFCT changes after cataract surgery," "Factors influencing SFCT," "Macular thickness changes," and "Long-term changes." Quantitative data and findings were extracted from a total of 13 research articles. Studies on SFCT changes after cataract surgery provided valuable insights for the subject under review. Factors influencing SFCT changes included age, axial length, and cataract surgery. Macular thickness increased at various time points. Long-term SFCT changes varied among studies. The present research provides valuable insights into SFCT changes after cataract surgery. Factors including age, axial length, and cataract surgery consistently influence SFCT. The clinical relevance of macular thickness changes remains uncertain, and the influence of age, ocular pathologies, and patient populations is highlighted. Long-term changes in SFCT vary, suggesting a need for further research. Standardized measurement techniques and larger cohort studies are recommended to enhance comparability and generalizability. This review enhances understanding of ocular changes associated with cataract surgery and informs future research.

Effect of silicone oil on retinal microcirculation after vitrectomy for rhegmatogenous retinal detachment evaluated by OCT angiography: a literature review.

Silicone oil (SO) has been widely used as intravitreal tamponade agent for rhegmatogenous retinal detachment (RRD) and has been occasionally associated with incomplete retinal structural and functional recovery. The use of Optical Coherence Tomography Angiography (OCT-A) has recently attracted significant attention for detailed analysis of retinal capillary plexus and blood flow changes as predicting factors for postoperative outcomes. A detailed literature search was performed in PubMed database until October 2022. The following keywords were used: rhegmatogenous retinal detachment, silicone oil, optical coherence tomography angiography, macular microvasculature, peripapillary capillary plexus, vessel density, and foveal avascular zone. We identified and reviewed 19 studies referring to microcirculation alterations of the retinal capillary plexus as seen on OCT-A in eyes treated by vitrectomy with intravitreal SO for RRD. A comprehensive update revealed variability of microcirculation characteristics of the retinal capillary plexus including the macular and the peripapillary capillaries. Further studies are warranted to clarify the OCT-A values in an attempt to identify the potential effect of SO on retinal tissue in clinical practice. A review of the existing literature sheds light on the effect of SO on retinal capillary plexus and the potential impact on functional outcomes after vitrectomy for RRD. This article discusses important aspects of key publications on the topic, highlights the importance to identify distinct alterations of the microvasculature status, and proposes the need for further future research in this field.

Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI.

Purpose: To investigate the morphological and functional correlation between microvascular retinal changes in optical coherence tomography angiography (OCTA) and the microvascular coronary circulation in patients with ST elevation myocardial infarction (STEMI) coronary heart disease (CHD). Methods: A total of 330 eyes from 165 participants (88 cases and 77 controls) were enrolled and imaged. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density was measured in the central (1 mm) and perifoveal (1-3 mm) areas and in the superficial foveal avascular zone (FAZ) and choriocapillaris (3 mm). These parameters were then correlated to the left ventricular ejection fraction (LVEF), and the number of affected coronary arteries. Results: Decreased vessel densities in the SCP and DCP and choriocapillaris were positively correlated to the LVEF values (P = 0.006, P = 0.026, and P = 0.002, respectively). No statistically significant correlation between the SCP and DCP central area or FAZ area was found. Regarding the number of affected vessels, significant negative correlations were revealed for the SCP and DCP central vessel densities (P < 0.001 and P < 0.001, respectively) and the SCP perifoveal vascular density (P = 0.009). Conclusions: OCTA vascular indices are significantly correlated with morphological and functional parameters in patients with STEMI CHD. SCP vascular density especially seems to be a promising biomarker for the extent of both macrovascular damage (number of affected coronary arteries) and microvascular damage, as mirrored in the decreased LVEF at admission. Translational Relevance: OCTA vascular indices offer a valuable insight into the microvascular status of coronary circulation.

Hertel Exophthalmometry Values in a Greek Adult Outpatient Clinic-Based Population: Association With Demographic Factors and Systemic Disease.

PURPOSE: To investigate correlations of exophthalmometry values (EVs) with age, gender, and the presence of diabetes mellitus, arterial hypertension, and dyslipidemia. METHODS: In a cross-sectional, clinic-based study, consecutive adult Greek patients presenting for evaluation at the outpatient general clinic on a scheduled appointment basis at a tertiary care referral center were submitted to Hertel exophthalmometry in both eyes by the same observer. Subjects with signs of history or orbital pathology, including thyroid-associated ophthalmopathy, were excluded. Demographics, as well as a detailed systemic history report, were recorded. Mixed effect linear regression analysis was performed to account for the correlation between the eyes of the same participant. RESULTS: A total of 800 eyes (400 subjects) were included, 194 males and 206 females, with a mean age of 67.82 ± 12 years (range: 18-92 years). The mean exophthalmometry value was 15.7 ± 2.6 mm (range: 11-21 mm). Every one year of increase in age is associated with a decrease in EVs by 0.03 mm (95% CI -0.04, -0.02/p-value<0.001). Female gender was associated with lower EVs by 0.33mm (95% CI-0.56, -0.1/p-value=0.005). Patients with diabetes mellitus had higher EVs by 0.47 mm (95% CI 0.25, 0.70/p-value<0.001) compared to patients without diabetes, and patients with arterial hypertension had lower EVs by 0.26 mm (95% CI -0.5, -0.02/p-value=0.034) compared to patients without hypertension. No association was found between dyslipidemia and systemic history of thyroid dysfunction.  Conclusions: A negative correlation of EVs was noted with increasing age, female gender, as well as history of arterial hypertension and a positive correlation with diabetes mellitus.

Long-term astigmatism changes following horizontal muscle recession: a prospective cohort study.

Strabismus surgery may cause refractive changes, particularly in astigmatism. The aim of this study is to evaluate those changes in astigmatism two and 12 months following unilateral recession of horizontal rectus muscles in children. The authors prospectively evaluated 66 children with esotropia or exotropia, that would undergo a unilateral recession strabismus surgery. Comparisons were made between the 66 eyes that would undergo strabismus surgery and the fellow unoperated 66 eyes of the same children. The 66 eyes that would undergo strabismus surgery were divided into medial (38 eyes) and lateral (28 eyes) rectus muscle subgroups, and further, into subgroups based on the astigmatism axis preoperatively (with-the-rule astigmatism: 35 eyes, no astigmatism: 20 eyes, oblique astigmatism: 10 eyes, against-the-rule astigmatism: 1 eye). All patients were examined one day preoperatively, and then, two and 12 months postoperatively. Paired tests were conducted, and the significant level was set to 0.05 or was adjusted for subgroups. Mean age of children included was 6.73 years (SD = 3.19). Mean astigmatism values preoperatively, 2 and 12 months postoperatively were 0.92D (SD = 0.95), 1.45D (SD = 1.04) and 1.50D (SD = 1.10), respectively, for the eyes that underwent strabismus surgery. A statistically significant mean increase of 0.58D in astigmatism values in the eyes that underwent strabismus surgery was observed 12 months postoperatively (p < .005). Astigmatism values in the eyes that did not undergo strabismus surgery did not statistically significantly change during the observation period. The increase of the absolute values of astigmatism in medial and lateral rectus muscle subgroups was similar, 0.59D (SD = 0.10) and 0.57D (SD = 0.11), respectively. For the eyes that had with-the-rule astigmatism and no astigmatism preoperatively, a statistically significant increase was shown 12 months postoperatively (0.64D and 0.66D respectively) (p < .005). Changes in astigmatism were observed in the eyes which underwent recession of horizontal rectus muscles compared to the fellow eyes, which did not undergo any intervention. An increase in cylindrical power was noted in the eyes that had with-the-rule and no astigmatism prior to surgery. This increase may be interpreted by the decreased tension of the recessed rectus muscle following strabismus surgery. Decreased forces, caused by the recessed horizontal rectus muscle, acting on the sclera on 180-degree meridian may lead to corneal flattening on this particular meridian and consequently, a corneal steepening on the 90-degree meridian. These changes seem to be stable during the first 12 postoperative months.

Five-year follow-up of corneal morphology and corneal refractive power changes after uneventful DMEK.

PURPOSE: To investigate changes of corneal thickness spatial profile (CTSP), corneal volume (CV) distribution, and total corneal refractive power (TCRP) over a course of 60 months after uneventful Descemet membrane endothelial keratoplasty (DMEK). METHODS: In our prospective, comparative study, sixty DMEK cases without intraoperative and postoperative complications and with complete 60-month follow-up were included (group 1). CTSP at corneal apex (CCT) and at 2 mm, 4 mm, 6 mm, and 8 mm rings, CV in 3 mm, 5 mm, 7 mm, and 10 mm zones, and TCRF in 2 mm, 4 mm 6 mm, and 8 mm zones were evaluated preoperatively and at 3, 6, 12, 24, and 60 months postoperatively. The 60-month results were compared to an age-matched group of uncomplicated pseudophakic eyes (group 2; n = 20). RESULTS: The CCT and CTSP at 2, 4, and 6 mm increased significantly at 60 months compared to 3-month outcomes (P < 0.001). Similarly, CV increased significantly in 3 mm, 5 mm, and 7 mm zones at 60 months compared to 3 months outcomes (P < 0.001). The TCRP showed in all zones a significant decrease at 3 months (P < 0.001) followed by a continuous and significant increase at 60 months (P < 0.001). The 60-month CCT and CTSP at 2 mm were similar to group 2 (P ≥ 0.094). CONCLUSION: Sixty months after uneventful DMEK, CT within the central 2 mm zone and CV at 3 mm zone were similar to uncomplicated pseudophakic eyes. A continuous and statistically significant increase of TCRP was observed in all measured zones after the 3-month examination.

Corneal Remodeling After Myopic SMILE Versus FS-LASIK: A Spatial Analysis of Short- and Mid-Term Corneal Thickness, Volume, and Shape Changes.

PURPOSE: To evaluate the short- and mid-term changes of corneal thickness spatial profile (CTSP), corneal volume distribution (CVD), and corneal asphericity after small-incision lenticule extraction (SMILE) for correction of myopia and astigmatism and compare the results with femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). METHOD: Thirty eyes of 18 patients who underwent SMILE were compared with a group of 30 eyes of 16 patients who underwent FS-LASIK. The groups were matched for preoperative central corneal thickness and lenticule thickness/ablation depth. Scheimpflug corneal tomography was performed preoperatively and postoperatively at 2 months and 3 years. The CTSP was evaluated on 4 concentric rings (2, 4, 6, and 8 mm). The CVD was evaluated at 3 concentric zones (3, 5, and 7 mm). Changes in the anterior and posterior asphericity at a 6-mm zone were also evaluated. RESULTS: Between the 2-month and 3-year examination, the CTSP showed a similar increase for both groups at all measured points and rings ( P ≥ 0.168). The CVD also showed a similar increase for both groups at all measured zones ( P ≥ 0.278). The anterior corneal asphericity remained stable after SMILE (2-mo Q = 0.46 ± 0.27; 3-yr Q = 0.45 ± 0.27; P = 0.711) but decreased significantly after FS-LASIK (2-mo Q = 0.52 ± 0.47; 3-yr Q = 0.47 ± 0.44; P = 0.028). Similarly, the posterior corneal asphericity remained stable after SMILE (2-mo Q = -0.11 ± 0.15; 3-yr Q = -0.11 ± 0.13; P = 0.902) but decreased significantly after FS-LASIK (2-mo Q = -0.13 ± 0.14; 3-yr Q = -0.16 ± 0.15; P = 0.034). CONCLUSIONS: CTSP and CVD between the 2-month and 3-year examination showed a similar increase after SMILE and FS-LASIK. During the postoperative course, the anterior and posterior corneal asphericity remained more stable after SMILE compared with FS-LASIK.

Evolution of corneal flattening after repeated corneal cross-linking during a 6-year follow-up.

PURPOSE: To report the evolution of corneal flattening after repeated corneal cross-linking (CXL) in a patient with progressive keratoconus during a 6-year follow-up. METHODS: Case report. RESULTS: A 27-year-old female underwent CXL for progressive keratoconus. Postoperatively, corneal topography revealed keratoconus progression with an increase of 1.20 diopters (D) in maximum keratometry (Kmax) and CXL was repeated. After the second treatment, a continuing significant corneal flattening (up to 16.00 D in Kmax) was observed during the first 5 years followed by stabilization during the last sixth year of follow-up. Both uncorrected and corrected distance visual acuity were improved while corneal thickness was decreased. There were no complications such as corneal opacification or endothelial cells decrease during the follow-up period. CONCLUSION: Repeated CXL can induce an excessive corneal flattening more pronounced during the first years of follow-up followed by stabilization thereafter.

"Corneal Plication" for the Management of Progressive Corneal Graft Protrusion in Patients With Keratoconus: a New Technique.

PURPOSE: The purpose of this study was to present a new surgical technique, namely corneal plication, for the management of high astigmatism and progressive corneal graft protrusion after penetrating keratoplasty (PKP) for keratoconus. METHODS: New surgical approach description. RESULTS: A 61-year-old woman with a history of bilateral keratoconus was referred to our institute for the management of progressive corneal graft protrusion in her left eye 25 years after PKP. On presentation, the uncorrected distance visual acuity in the involved eye was counting fingers, whereas slit-lamp examination revealed a clear graft with a crescentic area of thinning in the inferior host cornea, extending from 4 to 9 o'clock that resulted in significant graft protrusion and astigmatism. We proceeded with a novel surgical approach that included "folding" and suturing the thinned, diseased corneal tissue and thus creating a form of corneal plication. No intraoperative or postoperative complications were observed, and uncorrected distance visual acuity was 0.32 6 months after the operation. CONCLUSIONS: Corneal graft plication may represent a realistic alternative to more invasive procedures, currently used for the management of this long-term post-PKP complication in patients with keratoconus because it is a nonperforating technique that seems to provide satisfactory anatomical and visual outcomes without the need for any tissue excision or regrafting.

Assessing safety and success after using bevacizumab, 5-fluorouracil or placebo in primary trabeculectomy. A prospective randomized placebo controlled 1-year follow-up study.

PURPOSE: The aim of this study was to determine whether glaucoma patients after trabeculectomy could benefit more from subconjunctival injections of bevacizumab than 5-FU or placebo. METHODS AND RESULTS: Fifty-one eyes of 51 patients were recruited for primary MMC (0.2 mg/mL for 1 min) augmented trabeculectomy. 17 patients were randomly assigned to receive 1.25 mg (0.05 mL) of bevacizumab augmentation, 21 patients were assigned to receive 0.1 mL of 50 mg/mL 5-FU and 13 patients were assigned to a control group receiving a normal saline injection as a placebo. Initial recruitment included 58 patients, but seven patients had to be excluded from the study for various reasons. Postoperative follow up of IOP and bleb characteristics was carried out at 1 day, 1 week, 3 weeks, 6 weeks, 6 months and 1 year after surgery. All analyses where carried out by two masked clinicians. IOP reduction was statistically significant (p < 0.05) across all three groups between baseline visit and final 1-year postoperative visit. There was no significant difference of the final average IOP values between the three groups. Bleb evaluation was made using the Moorfields bleb grading system (MBGS) after 1 year follow up. Central bleb area was statistically greater in the Bevacizumab group when compared with the 5-FU group but not with the placebo group. The vascularity of the central bleb was significantly different between the groups with the Bevacizumab group showing the least vascularity. Vascularity of the peripheral bleb was also decreased in the Bevacizumab group when compared with the placebo group but not with the 5-FU group. CONCLUSION: The 12-month IOP results showed no significant differences between the groups of patients after Bevacizumab, 5-FU or placebo to augment primary MMC enhanced trabeculectomy. However, by the analysis of bleb morphology there was a significant difference in terms of central bleb area and vascularity.

Corneal Densitometry After Uneventful Descemet Membrane Endothelial Keratoplasty-5-Year Outcomes.

PURPOSE: The purpose of this study is to analyze the course of corneal densitometry (CD), endothelial cell density (ECD), best-corrected visual acuity (BCVA), and central corneal thickness (CCT) 5 years after uneventful Descemet membrane endothelial keratoplasty (DMEK). METHODS: Sixty uneventful cases (51 patients) with a minimum follow-up of 5 years were included. CD of various corneal layers (anterior, central, posterior, and total layer) and zones (0-2 mm, 2-6 mm, and 6-10 mm) were measured with Scheimpflug tomography. ECD, BCVA, and CCT were also evaluated. RESULTS: Total CD at 0 to 2 mm and 2 to 6 mm zones significantly decreased from 33 ± 10 and 27.8 ± 8 grayscale units (GSU) preoperatively to 21.8 ± 3.1 and 22.2 ± 4.2 GSU at 5 years, respectively ( P < 0.001). On the contrary, total CD at the 6 to 10 mm zone significantly increased from 30 ± 8.3 GSU preoperatively to 34.6 ± 7.8 GSU at 5 years ( P < 0.001). ECD significantly decreased from 2496 ± 267 cells/mm 2 preoperatively to 1063 ± 470 cells/mm 2 at 5 years ( P < 0.001). Similarly, CCT significantly decreased from 686 ± 109 µm preoperatively to 557 ± 37 µm at 5 years ( P < 0.001). Postoperative BCVA was significantly better after DMEK for every examination time point. CONCLUSIONS: Despite a slight CD increase at all layers of all corneal zones from the second to the fifth postoperative year, the excellent visual outcome was maintained throughout 5-year follow-up. Thus, DMEK seems to effectively treat corneal endothelial disease in the long term.

Secondary DMEK following failed primary DMEK.

PURPOSE: To report the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) performed for failed primary DMEK. METHODS: The medical records of all patients undergoing secondary DMEK due to failure of primary DMEK were reviewed. Reasons for failure were sought and best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications of secondary DMEK were evaluated. RESULTS: A total of 10 cases undergoing secondary DMEK following failed primary DMEK were identified. Presumed reasons for failure included donor ECD ≤ 2300 cells/mm2 (n = 4), difficulty during graft preparation (n = 2), graft detachment (n = 2), acute angle closure due to retroiridal air dislocation (n = 1), inverse graft positioning (n = 1) and phacoemulsification (n = 1). Eyes with low visual potential were not excluded from the study group. We should note that one patient (case no7) had both low ECD and graft detachment as reasons for failure and as a result he is counted twice. Median BCVA (decimal fraction) increased from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at the final follow-up. Mean ECD fell from 2628 ± 284 cells/mm2 to 1391 ± 252cells/mm2 at 6 months (47% reduction) and 959 ± 225cells/mm2 at 24 months (64% reduction) (P ≤ 0.028). Complications included the incomplete removal of the primary graft and mild iris bleeding, decompensation of a preexisting primary open-angle glaucoma and retroiridal air dislocation. CONCLUSIONS: Apart from low donor ECD, surgical challenges, i.e., difficulty with graft preparation, inverse graft positioning, and retroiridal air dislocation, were main reasons for failure of primary DMEK. Secondary DMEK showed a good safety profile and reasonable visual outcomes.

Acute Glaucoma Filtering Surgery Failure following Herpes Zoster Ophthalmicus Infection.

Herein, we report a case of acute failure of a previously successful trabeculectomy, following an infection with herpes zoster ophthalmicus (HZO). HZO remains a common infection, especially among elderly and immunocompromised patients. There is a strong link between HZO infection, the incidence of secondary glaucoma, and the need for glaucoma filtering surgery. Though, to our knowledge, there are no cases reporting on the effect that a concomitant infection may have on a previously successful trabeculectomy. In our case, a 76-year-old immunocompetent male with primary open-angle glaucoma in both eyes and a history of a successful right eye trabeculectomy 1 year earlier presented with acute primary HZO involving the ophthalmic branch of the right trigeminal nerve. Appropriate topical and systemic treatment was immediately initiated. Three days later, the trabeculectomy bleb showed hyperemia and flattening and concomitant rise of intraocular pressure was noted. A week later, the cutaneous signs were improving yet the trabeculectomy had failed and high intraocular pressure was established, requiring both topical and systemic antiglaucoma medications. Our study suggests that a previously successful trabeculectomy may manifest signs of compromise and subsequent failure following a HZO infection.

Reduction of Foveal Avascular Zone After Vitrectomy Demonstrated by Optical Coherence Tomography Angiography.

PURPOSE: To investigate the effect of pars plana vitrectomy on foveal circulation, and in particular the foveal avascular zone (FAZ), using optical coherence tomography angiography (OCTA). METHODS: This was a prospective, non-randomized, comparative case series of patients that underwent vitrectomy. Twenty-six eyes of 26 patients that underwent vitrectomy were studied postoperatively by OCTA. Our patients underwent 23 or 25G pars plana vitrectomy (PPV) for any posterior segment pathology. Three-dimensional OCTAs (DRI Triton Swept Source OCT; Topcon) of the capillary plexus were obtained three months post-operatively. The FAZ measurements of the fellow eyes were used as controls. MAIN OUTCOME MEASURES: Change in FAZ area between vitrectomized eyes and controls. RESULTS: From a total of 26 patients, 17 underwent vitrectomy due to retinal detachment (RD). Almost all patients demonstrated a statistically significant reduction in FAZ size based on the OCTA measurements. Τhe mean difference in FAZ size for the superficial capillary plexus (SCP) was -93.77 ± 71.73 µm and for the deep capillary plexus (DCP) -88.87 ± 75.41 µm, both statistically significant (p=0.000), while the amount of reduction in µm was the same for both SCP and DCP. CONCLUSION: The foveal avascular zone seems to be reduced following vitrectomy as shown by optical coherence tomography angiography. It is postulated that this may be the result of changes in the physiology of the vitrectomized eye, and that this change should be attributed to the removal of the vitreous itself rather than other structures such as the internal limiting membrane.