Full title: Acute Exudative Polymorphous Vitelliform Maculopathy as the initial presentation of Human Immunodeficiency Virus Infection.

PURPOSE: To describe the occurrence of acute exudative polymorphous vitelliform maculopathy (AEPVM) as the initial presentation in a human immunodeficiency virus (HIV) positive patient. METHODS: Observational case report of one patient and literature review. RESULTS: An active 21-year-old Caucasian woman presented at our emergency department with anterior segment complaints. Her best corrected visual acuity (BCVA) was 20/20 in both eyes. Fundus examination revealed numerous, polymorphous bleb-like lesions at the posterior pole, corresponding, on structural imaging (optical coherence tomography, OCT) to subretinal detachments (SRD). The bleb-like lesions on infrared imaging were slightly autofluorescent on fundus autofluorescence (FAF). Swept source OCT Angiography showed signal attenuation due to the presence of subretinal fluid in the choriocapillaris segmentation. Multimodal imaging findings were suggestive for AEPVM. Hence, a systemic blood workup was performed. The workup returned positive for HIV and an antiviral therapy was introduced. CONCLUSION: The fortuitous diagnosis of HIV having as the initial presentation AEPVM in an asymptomatic patient highlights the value of a thorough clinical examination and multimodal imaging in correctly diagnosing this rare disorder and its cause. This case report could prove helpful to clinicians faced with this rare scenario.

Posterior Corneal Asphericity Effect on Postoperative Astigmatism after EDOF Intraocular Lens Implantation in Cataract Patients.

AIM: To assess the impact of posterior corneal asphericity on postoperative astigmatism. METHODS: We included retrospectively 70 eyes of 70 patients that underwent cataract surgery. We included data of the Q value, K max, K1, K2, astigmatism AL, and ACD. We performed a vectorial analysis to calculate the astigmatic vectors. RESULTS: Seventy eyes were evaluated. 40 eyes were of females (58%) and 30 of males (42%). The average cohort age was 73 ± 8.9 years. Axial length (AL) was 23.5 ± 0.9, anterior chamber depth (ACD) was 3.13 ± 0.3, and the average posterior Q value was -0.35 ± 0.2. The only significant predictive variable for the correction index (CI) was the posterior Q value (r = 0.24, p < 0.05) and for the surgically induced astigmatism (SIA) (ß = 0.34, r = 0.58, p < 0.05). CONCLUSION: Posterior corneal surface asphericity significantly influences the surgically induced astigmatism and the overcorrection for cataract patients after Lucidis EDOF IOL implantation.

Combined Ab interno viscocanaloplasty (ABiC) in open-angle glaucoma: 12-month outcomes.

PURPOSE: The aim of this study was to analyse the safety profile and efficacy of ab interno viscocanaloplasty (ABiC) through to 12 months post-operatively. METHODS: In this retrospective study, the medical records of all patients who underwent ABiC between September 2015 and December 2019 were analysed. Complete success was defined as a 12-month reduction in intraocular pressure (IOP) ≥ 20% from baseline with no concomitant medications. Qualified success criteria were identical, with no more medications than at baseline. RESULTS: In all, 54 eyes of 41 patients were analysed. Mean IOP decreased from 23.6 ± 7.4 mmHg preoperatively to 14.2 ± 2.9 mmHg (-39.8%; p < 0.001) after 12 months. Concomitantly, the number of anti-glaucoma treatment dropped from 2.9 ± 1.0 to 0.6 ± 1.1 (-79.3%; p < 0.001). Amongst patients with a baseline MD < -12.0 dBs, mean IOP decreased from 22.8 ± 9.8 mmHg to 13.8 ± 4.4 mmHg (p = 0.049), with a concomitant reduction of medications from 2.8 ± 1.3 to 1.2 ± 1.3 (p < 0.001). Complete success at 12 months was achieved in 46% of eyes, and qualified success was achieved in 65% of eyes. Amongst eyes with a baseline MD < -12.0 dBs, 50% achieved complete success, and 83.3% achieved qualified success. A total of 19 eyes (35.2%) were considered surgical failure, all due to uncontrolled IOP. Of them, 7 eyes (13.0%) required further filtering surgery. Twelve post-operative adverse events were observed, with early post-operative IOP spikes being the most common (22.2%). CONCLUSIONS: ABIC achieved a statistically significant reduction in IOP and anti-glaucoma medications through 12 months, while maintaining a favourable safety profile in mild-to-severe open-angle glaucoma.

XEN-Augmented Deep Sclerectomy: Step-by-step Description of a Novel Surgical Technique for the Management of Open-angle Glaucoma.

AIM AND BACKGROUND: The present case report describes a novel surgical technique combining XEN gel stent implantation and deep sclerectomy: XEN-augmented deep sclerectomy (XEN-DS). CASE DESCRIPTION: An active 96-year-old Caucasian woman suffering from pseudoexfoliative glaucoma (PEXG) presented with intraocular pressure (IOP) of 24 mm Hg and a double arcuate visual field defect [mean deviation (MD) -9.6 dB] in her only functional eye despite maximal medical therapy. Considering (1) the magnitude of IOP reduction sought, (2) the risk of complications associated with trabeculectomies and glaucoma drainage devices, and (3) the risk of missed appointments due to the patient's personal and social circumstances, it was decided to tailor the surgical treatment to this patient's specific characteristics combining two existing surgical techniques. Following conjunctival dissection, a superficial scleral flap was lifted 2 mm more posteriorly than in conventional DS, and a XEN gel stent was implanted ab externo through the anterior wall of the deep sclerectomy, into the anterior chamber. A mitomycin C-soaked autologous space maintainer was used. No peri- or postoperative complications were observed. Following XEN-DS, her IOP stabilized between 5 mm Hg and 8 mm Hg through 6 months, and her visual field MD improved to -1.5 dB. DISCUSSION: The present case report is a proof of concept for this novel surgical technique, confirming that XEN-DS has the potential to achieve substantial and persistent IOP reductions in PEXG with a satisfactory safety profile. Clinical studies are warranted to confirm these results. HOW TO CITE THIS ARTICLE: Niegowski LJ, Gillmann K, Baumgartner JM. XEN-Augmented Deep Sclerectomy: Step-by-step Description of a Novel Surgical Technique for the Management of Open-angle Glaucoma. J Curr Glaucoma Pract 2021;15(3):144-148.

Surgical Management of Pseudoexfoliative Glaucoma: A Review of Current Clinical Considerations and Surgical Outcomes.

INTRODUCTION: Pseudoexfoliative glaucoma (PEXG) is the most common cause of secondary open-angle glaucoma worldwide. It is more aggressive and often more resistant to conventional treatments than primary open-angle glaucoma, yet there is currently no clear consensus on best management practices. This review explores current literature on PEXG to assess the safety and efficacy of currently available surgical techniques, and discusses clinical considerations on the diagnosis and management of the disease. METHODS: A PubMed and Google Scholar search identified 2271 articles. These were reviewed to exclude irrelevant or duplicate data. A total of 47 studies reporting specifically on PEXG were retained and analyzed. REVIEW: One of the most significant ophthalmic consequences of pseudoexfoliative (PEX) syndrome is the compromising of the blood-aqueous barrier resulting in the leakage of inflammatory cytokines and extracellular matrix material into the anterior chamber. Considering the high risk of developing PEXG and the aggressive nature of this type of glaucoma, accurate and timely diagnosis of PEX is critical. Therefore, systematic attentive examination for PEX deposits is crucial. Patients diagnosed with PEX need frequent glaucoma assessments. Patient information is key to improving compliance. Gonioscopy and diurnal tension curves or 24-hour intraocular pressure (IOP) monitoring are integral part of the diagnostic work-up and risk-assessment of PEXG. Because of the lability of IOP in PEX, clinical decisions on the basis of single IOP measurements should be avoided. Cataract extraction was shown to provide persistent IOP-lowering effect in the order of 10% in PEXG. A number of other surgical options may offer wider IOP reduction, and both XEN 45 gel stents and angle-based glaucoma procedures were suggested to achieve better outcomes in PEXG than in primary open-angle glaucoma. Yet, more significant IOP reductions may be achieved with filtering surgery or glaucoma drainage device. Same day postoperative IOP monitoring is recommended to treat the frequent IOP spikes following surgery, and more aggressive anti-inflammatory therapy may reduce the rates of postoperative adverse events in PEXG. CONCLUSION: Specific studies of the surgical management of PEXG remain scarce in the medical literature, and more long-term and comparative studies are warranted to define more robust recommendations.

Pericardium Patch Graft (Tutoplast) for Bleb Repair and Bleb Remodelling After Nonpenetrating Filtering Surgery: 6-Month Outcomes.

PURPOSE: The purpose of this study was to evaluate the outcome of pericardium patch graft (Tutoplast) as an adjuvant to either bleb repair or bleb reduction after nonpenetrating filtering surgery. METHODS: Retrospective study, at a tertiary glaucoma center. Bleb revision with Tutoplast positioning was performed either for bleb repair to treat early leaks or hypotony with maculopathy, either for bleb reduction to improve ocular pain, discomfort, burning, foreign body sensation, tearing, and fluctuations of visual acuity. Intraocular pressure (IOP), best corrected visual acuity, number of antiglaucoma medications, and postoperative complications were analyzed postoperatively at 1 week, 1, 3, 6 months, and compared with the preoperative baseline. Surgical success was defined as achieving an IOP between 8 and 16 mm Hg. RESULTS: Six-month data were available from 15 eyes of 15 patients; mean patient age was 69.6±11.7 (66.7% male). Bleb revision was necessary for 10 patients due to bleb dysesthesia (bleb reduction), and in 5 patients due to leaking filtering bleb (bleb repair). The success rate was 73.3% at 6 months, with a significant IOP increase from 4.9±2.2 mm Hg preoperatively to 12.7±3.5 mm Hg at 6 months (P=0.0001), and a concomitant rise of best corrected visual acuity from 0.5±0.3 to 0.6±0.3 (P=0.2871). To control IOP, antiglaucoma medications were needed for 3 patients (20%) at 6 months. Overall, 3 patients (20%) required additional bleb revision for persistent hypotony, and 1 patient underwent a subsequent glaucoma surgery (transscleral cyclodestruction). CONCLUSION: Pericardium patch graft (Tutoplast) is a safe and effective adjuvant for bleb revision due to bleb dysesthesia of leaking filtering bleb after nonpenetrating filtering surgery.