[Long-term follow-up after deep sclerectomy]. / Langzeitverlauf nach tiefer Sklerektomie.

BACKGROUND: The aim of this study was to evaluate the long-term outcome of deep sclerectomy (DS) with a follow-up of up to 8 years. PATIENTS AND METHODS: All patients who underwent a deep sclerectomy between February 2004 and October 2005 and who attended a follow-up visit between August 2009 and October 2011 were included in this study. RESULTS: This study evaluated 74 eyes of 65 patients with a mean postoperative follow-up of 76.28 ± 10.6 (53.65-92.02) months. Preoperative IOP was 18.37 ± 6.36 mmHg, postoperative IOP at the last follow-up was 12.85 ± 3.5 mmHg, corresponding a 30 % reduction. The number of IOP-lowering eye drops was reduced from 2.36 ± 1.24 to 1.66 ± 1.21 after more than 6 years (p < 0.05). The visual fields showed a mean deviation of - 9.16 ± 8.48 dB initially and - 9.43 ± 8.07 dB at the last follow-up (p > 0.05). Complete success (IOP ≤ 15 mmHg without eye drops or additional surgery) was achieved in 5 % of patients. Qualified success (IOP ≤ 15 mmHg with eye drops or additional surgery) was achieved in 81 %. 53 % (n = 39) underwent cyclophotocoagulation and 20 % (n = 15) needed revision surgery during the follow-up period. CONCLUSION: DS is an effective long-term IOP-lowering procedure leading to visual field stabilisation.

[Canaloplasty : a new alternative in non-penetrating glaucoma surgery]. / Kanaloplastik : Eine neue Alternative in der nicht penetrierenden Glaukomchirurgie.

BACKGROUND: Canaloplasty provides a new option in non-penetrating glaucoma surgery. The aim of this study is to examine its early postsurgical safety and efficacy. PATIENTS AND METHODS: This was a retrospective study of canaloplasties performed at our institution in 2009 (n=46, 13 of which were combined with cataract surgery). The mean follow-up was 6.0±3.4 months. The most important parameters examined were intraocular pressure (IOP), number of topical medications, postoperative complications, and required additional surgery. RESULTS: Mean presurgical IOP: 18.2±5.8 mmHg on a mean of 2.3±1.2 applied topical medications. Mean postsurgical IOP: 12.3±5.1 mmHg at 3 months, 11.7±3.0 mmHg at 6 months, and 12.6±2.4 mmHg at 12 months. Number of postsurgical medications: 0.8±1.1 at 3 months, 1.2±1.3 at 6 months, and 1.0±1.1 at 12 months. The most frequent postoperative complications were transient hypotension (32.6%), bleb leakage (26.1%), and microhyphema (23.9%). Revision surgery was required in 8.7% of all patients. CONCLUSIONS: Canaloplasty showed a good IOP-reducing effect. Complications occurred mostly temporarily and were of a controllable nature.

[Retrobulbar haemodynamics in normal and high tension glaucoma patients: the diagnostic importance of tinnitus, migraine and Raynaud-like symptoms]. / Retrobulbäre Hämodynamik bei Hochdruck- und Normaldruckglaukompatienten: Diagnostische Bedeutung von Tinnitus, Migräne und raynaudartigen Beschwerden.

BACKGROUND: In the pathophysiology of open-angle glaucoma altered perfusion of the optic nerve head is of importance. Up to now these disturbances were presumed to be the chief cause of glaucomatous damage in patients with normal tension glaucoma showing other vascular disturbances like migraine or tinnitus. PATIENTS AND METHODS: Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured and the resistive index (RI) was calculated by colour Doppler imaging (CDI) in the ophthalmic artery (OA), central retinal artery (CRA) and in the short and long posterior ciliary arteries (SPCA, LPCA) in 18 patients with normal tension glaucoma (NTG), in 18 patients with high tension glaucoma (HTG) and in 18 normal control subjects. RESULTS: In an upright sitting position both glaucoma groups showed statistically significant decreases in PSV and EDV in CRA and SPCA compared to the control subjects. HTG when compared to NTG and normal subjects showed statistically significant decreases of EDV and statistically significant increases of RI in LPCA. In addition, compared to normal subjects, HTG patients showed statistically significant increases of RI in both OA and SPCA. DISCUSSION: Both glaucoma groups showed decreased blood flow velocities in the small retrobulbar vessels in an upright sitting position. Normal tension glaucoma patients with symptoms of vasospasms compared to patients with high tension glaucoma showed only small differences in ocular haemodynamics.

[A comparison between absorbable and non-resorbable scleral implants in deep sclerectomy (T-Flux and SK-Gel)]. / Vergleich von resorbierbaren und nichtresorbierbaren skleralen Implantaten bei tiefer Sklerektomie (SK-Gel und T-Flux).

BACKGROUND: The intraocular pressure (IOP) lowering effects of deep sclerectomy (partially combined with phacoemulsification) with different scleral implants (T-Flux- or SK-Gel) were investigated. PATIENTS AND METHODS: In a retrospective study, 72 patients with medically uncontrollable glaucoma underwent non-penetrating deep sclerectomy. Of these, 54 patients received T-Flux implants and 18 SK-Gel implants. Examinations were carried out shortly before and after surgery, as well as after 12 months. RESULTS: Prior to surgery IOP was 18.4+/-5.5 mmHg (n=72) and 12 months after surgery it was 13.1+/-3.8 mmHg (n=65). The number of antiglaucomatous eyedrops used prior to surgery was 2.3+/-1.3 (n=72) and 12 months after surgery 0.2+/-0.6 mmHg (n=65). Secondary IOP-lowering surgery after 12 months was carried out on 15.3% of the operated eyes, and consecutive goniopunctures after 12 months were 25%. No significant differences were found between the two groups. CONCLUSIONS: The short- and mid-term IOP lowering effects in deep sclerectomy with scleral implants were quite satisfying no matter which implant was used. There was no difference in deep sclerectomy whether or not combined with cataract surgery.

Glaucoma progression is associated with decreased blood flow velocities in the short posterior ciliary artery.

BACKGROUND: An altered perfusion of the optic nerve head has been proposed as a pathogenic factor in glaucoma. AIM: To investigate potential differences in the ocular haemodynamics of patients having glaucoma with progressive versus stable disease, as well as healthy volunteers. METHODS: Peak-systolic velocity (PSV), end-diastolic velocity (EDV) and resistivity index in the short posterior ciliary artery (SPCA), central retinal artery (CRA) and ophthalmic artery were recorded in 114 consecutive patients having glaucoma with an intraocular pressure (IOP) < or =21 mm Hg, as well as in 40 healthy volunteers, by colour Doppler imaging (CDI). RESULTS: Of the 114 patients with glaucoma, 12 showed glaucoma progression (follow-up period: mean 295 (standard deviation (SD) (18) days). CDI measurements in these patients showed decreased PSV and EDV in the SPCA (p<0.001 and p<0.05, respectively) and decreased PSV in the CRA compared with patients with stable glaucoma and healthy controls (p<0.05). No differences in flow velocities were found for the ophthalmic artery. IOP and systemic blood pressure was similar in all the three groups. CONCLUSIONS: Progressive glaucoma is associated with decreased blood flow velocities in the small retrobulbar vessels supplying the optic nerve head. The detected difference could represent a risk factor for progression of glaucomatous optic neuropathy.

[Ocular hemodynamics in normal tension glaucoma: effect of bimatoprost]. / Okuläre Hämodynamik beim Normaldruckglaukom: Effekte von Bimatoprost.

BACKGROUND: Altered ocular perfusion plays a role in the pathophysiology of normal tension glaucoma. Prostaglandin-like substances are very effective in lowering intraocular pressure. Less data are available regarding the influence of these compounds on ocular perfusion. In the present study the effects of bimatoprost, which has recently been shown to increase the vascular tone of ciliary arteries in vitro, on the blood flow velocity are investigated. PATIENTS AND METHODS: n = 9 eyes from 9 normal tension glaucoma patients were subjected to color Doppler imaging (CDI) before and during a 3 - 5 week therapy with bimatoprost. RESULTS: Bimatoprost reduces intraocular pressure from 14.0 +/- 0.4 to 11.0 +/- 0.5 mmHg (n = 9; P < 0.001). Systolic as well as diastolic blood flow velocities, resistive index (RI) and pulsatility index (PI), measured by CDI, were unaltered in the presence of bimatoprost. DISCUSSION: Bimatoprost does not influence blood flow velocities in the retrobulbar vessels. The in vitro observation of increased vascular tone in the presence of bimatoprost seems not to be relevant for ocular hemodynamics.