Treatment outcomes in the neovascular glaucoma tube versus trabeculectomy study.

PURPOSE: To compare surgical outcomes between patients who underwent Baerveldt glaucoma implantation versus trabeculectomy (TLE) for the treatment of neovascular glaucoma. METHODS: We performed a prospective, randomized, controlled clinical trial at Hiroshima University and Tsukazaki Hospital, Japan. Patients were randomized to Baerveldt glaucoma implantation (23 patients) or TLE (27 patients). The primary outcome measure was the rate of intraocular-pressure control. Secondary outcome measures included complications and interventions. We defined "failure" as intraocular pressure ≥ 22 mmHg or < 20% reduction from baseline pressure, on two consecutive follow-up visits; need for additional glaucoma surgery; vision-threatening complications; or loss of light perception. Kaplan-Meier analysis was used to determine surgical success rates. Postoperative complications and interventions were compared between the two groups with Pearson Chi-square tests. RESULTS: There were no significant differences in demographic or ocular characteristics between the treatment groups at baseline. The postoperative follow-up was 26.6 ± 19.4 months in the Baerveldt group and 27.3 ± 20.1 months in the TLE group. There were no statistical differences (Mann-Whitney nonparametric tests with Bonferroni correction) in postoperative intraocular pressure measured at 6-month intervals. Success rates were 59.1 and 61.6% at 1-year after Baerveldt glaucoma implantation and TLE, respectively. Kaplan-Meier analysis showed no significant difference in success between groups (P = 0.71, log-rank test). Medication use, visual acuity, and interventions were similar between groups. Thirteen late postoperative complications developed in the Baerveldt glaucoma implantation group and four complications developed in the TLE group. Tube exposure was the most common late complication. CONCLUSION: These two procedures produced similar surgical success, intraocular-pressure reductions, visual acuity, and number of medications at the last visit. The TLE group showed smaller numbers of late complications and patients who lost more than two lines of visual acuity. Therefore, TLE might be a safer and better way to treat patients with neovascular glaucoma.

Association between optic nerve head morphology in open-angle glaucoma and corneal biomechanical parameters measured with Corvis ST.

PURPOSES: To investigate associations between Corvis ST-measured corneal biomechanical parameters and glaucomatous optic nerve head (ONH) morphology. METHODS: In total, 118 eyes of 70 patients with open-angle glaucoma were examined in this retrospective cross-sectional study. We measured Heidelberg retina tomograph and Corvis ST values in all eyes. We used the linear mixed model in four sectors (temporal superior, TS; temporal inferior, TI; nasal superior, NS; and nasal inferior, NI) to detect associations between six ONH-related parameters and 14 Corvis ST-related parameters, controlling for age, intraocular pressure, axial length, and central corneal thickness. We calculated the ONH temporal and nasal sector vertical asymmetries (TS-TI and NS-NI asymmetries) and identified the optimal linear mixed models to describe them using model selection with the second-order bias corrected Akaike Information Criterion. RESULTS: The Corvis ST A2 velocity was negatively associated with the rim volume in the NS sector (p < 0.05). The optimal model for TS-TI asymmetry was TS-TI asymmetry = - 3.22 + 0.15 × HC time + 0.88 × HC deflection amplitude, whereas that for NS-NI asymmetry was 0.49-0.048 × axial length - 2.45 × A2 velocity. CONCLUSION: Glaucomatous ONH superior-inferior asymmetries were associated with biomechanical properties measured with Corvis ST. Eyes with superior-dominant rim volume reduction of ONH were associated with small deformations and slow recovery of the cornea.

Effect of Manual Upper Eyelid Elevation on Intraocular Pressure Measurement by Four Different Tonometers.

SIGNIFICANCE: This study is the first to show that the manual upper eyelid elevation (manual UEE) that is commonly used to prevent disruption of the IOP measurement due to blinking or upper eyelid contact with the tip of the tonometer does not affect the IOP values. PURPOSE: We investigated whether manual UEE affects the IOP readings using three rebound tonometers (Icare TA01i, Icare PRO, and Icare ic100) and Goldmann applanation tonometry (GAT). METHODS: One eye was measured for 101 patients (56 eyes of primary open-angle glaucoma patients and 45 healthy subjects). The IOPs were measured without and with manual UEE. Each IOP was measured twice; the measurement order using the tonometers was randomly selected. In addition, palpebral fissure height (distance between the upper and lower eyelids) was measured. RESULTS: The IOPs without manual UEE were 12.1 ± 2.9, 13.3 ± 2.7, 11.7 ± 2.9, and 16.0 ± 3.2 mmHg (Icare TA01i, Icare PRO, Icare ic100, and GAT), and those with manual UEE were 12.3 ± 3.0, 13.3 ± 2.8, 11.7 ± 2.9, and 16.0 ± 3.3, respectively. No significant difference was found between the IOP without and with manual UEE (IOP difference; all, P > .50; paired t test). Multiple linear regression analyses revealed that palpebral fissure height did not affect IOP difference for any of the tonometers. CONCLUSIONS: Simple manual UEE when measuring the IOP has little effect on the IOP obtained using all current rebound tonometers and GAT.

Usability and reproducibility of tear meniscus values generated via swept-source optical coherence tomography and the slit lamp with a graticule method.

PURPOSE: To investigate the usability and the reproducibility of the tear meniscus values via swept-source optical coherence tomography (SS-OCT) and the conventional slit lamp microscope method with a graticule. METHODS: The right eye was examined in 90 healthy adult subjects who were grouped according to age (group 1: 20-39 years; group 2: 40-59 years; group 3: ≥60 years). The tear meniscus height (TMH) and tear meniscus area were measured using SS-OCT and TMH by the slit lamp microscope method. The reproducibility of each method was calculated using intraclass correlation coefficients (ICCs) in additionally enrolled 30 healthy young subjects. We also evaluated TMH at 3 mm from the corneal center in both temporal and nasal directions using SS-OCT. RESULTS: The mean of the TMH values measured by SS-OCT was significantly higher than those measured by the slit lamp method (328 vs. 212 µm, P < 0.001, respectively). High reproducibility was observed for each method (ICC > 0.75 for both). No statistically significant differences were found in TMH among the age groups using both SS-OCT and slit lamp methods (P = 0.985, 0.380, respectively). TMH values at both sides of the corneal center were significantly smaller than those at the corneal center (P < 0.0001). CONCLUSIONS: TMH values obtained by the slit lamp method were lower than those obtained by SS-OCT. However, both methods yielded highly reproducible TMH measurements, suggesting that they are clinically useful. Tear meniscus values did not vary by age but by measurement points in our cohort.

Agreement among Goldmann applanation tonometer, iCare, and Icare PRO rebound tonometers; non-contact tonometer; and Tonopen XL in healthy elderly subjects.

PURPOSE: To evaluate the inter-device agreement among the Goldmann applanation tonometer (GAT), iCare and Icare PRO rebound tonometers, non-contact tonometer (NCT), and Tonopen XL tonometer. METHODS: Sixty healthy elderly subjects were enrolled. The intraocular pressure (IOP) in each subject's right eye was measured thrice using each of the five tonometers. Intra-device agreement was evaluated by calculating intraclass correlation coefficients (ICCs). Inter-device agreement was evaluated by ICC and Bland-Altman analyses. RESULTS: ICCs for intra-device agreement for each tonometer were >0.8. IOP as measured by iCare (mean ± SD, 11.6 ± 2.5 mmHg) was significantly lower (p < 0.05) than that measured by GAT (14.0 ± 2.8 mmHg), NCT (13.6 ± 2.5 mmHg), Tonopen XL (13.7 ± 4.1 mmHg), and Icare PRO (12.6 ± 2.2 mmHg; Bonferroni test). There was no significant difference in mean IOP among GAT, NCT, and Tonopen XL. Regarding inter-device agreement, ICC was lower between Tonopen XL and other tonometers (all ICCs < 0.4). However, ICCs of GAT, iCare, Icare PRO, and NCT showed good agreement (0.576-0.700). The Bland-Altman analysis revealed that the width of the 95% limits of agreement was larger between the Tonopen XL and the other tonometers ranged from 14.94 to 16.47 mmHg. Among the other tonometers, however, the widths of 95% limits of agreement ranged from 7.91 to 9.24 mmHg. CONCLUSION: There was good inter-device agreement among GAT, rebound tonometers, and NCT. Tonopen XL shows the worst agreement with the other tonometers; therefore, we should pay attention to its' respective IOP. CLINICAL TRIAL REGISTRATION: Japan Clinical Trials Register; number: UMIN000011544.

Changes in choroidal thickness in patients with diabetic retinopathy.

PURPOSE: To investigate the changes in choroidal thickness (ChT) following panretinal photocoagulation (PRP) for diabetic retinopathy (DR) and compare ChT in relation to DR severity. METHODS: Thirty-two eyes [19 eyes with proliferative DR (PDR) and 13 eyes with severe nonproliferative DR (NPDR)] for which PRP was necessary were analyzed. ChT was measured before PRP and at 1, 3, and 6 months after PRP using the swept-source optical coherence tomography. ChT of the 61 eyes matched with the PDR patients for the mean age and axial length was also measured and statistically compared in relation to severity. RESULTS: The central field ChT before PRP treatment was 268.6 ± 104.5 µm (mean ± standard deviation) and was significantly decreased at 1, 3, and 6 months after PRP (254.5 ± 105.3, 254.2 ± 108.2, and 248.1 ± 101.8 µm, respectively, P < 0.0001). The central field ChT of severe NPDR (323.2 ± 61.3 µm) was significantly thicker than that of normal (248.3 ± 70.7 µm) and mild to moderate NPDR (230.0 ± 70.3 µm, P = 0.0455 and 0.0099, respectively). Moreover, the central field ChT of PDR (307.3 ± 84.1 µm) was significantly thicker than of mild to moderate NPDR (P = 0.0169). CONCLUSION: ChT significantly decreased after PRP, which continued for at least 6 months after treatment. ChT of severe NPDR and PDR was significantly thicker than that of mild to moderate NPDR. ChT of patients with DR was changed according to the treatment and severity of DR.

Comparison of semi-automated center-dot and fully automated endothelial cell analyses from specular microscopy images.

PURPOSE: To evaluate two specular microscopy analysis methods across different endothelial cell densities (ECDs). METHODS: Endothelial images of one eye from each of 45 patients were taken by using three different specular microscopes (three replicates each). To determine the consistency of the center-dot method, we compared SP-6000 and SP-2000P images. CME-530 and SP-6000 images were compared to assess the consistency of the fully automated method. The SP-6000 images from the two methods were compared. Intraclass correlation coefficients (ICCs) for the three measurements were calculated, and parametric multiple comparisons tests and Bland-Altman analysis were performed. RESULTS: The ECD mean value was 2425 ± 883 (range 516-3707) cells/mm2. ICC values were > 0.9 for all three microscopes for ECD, but the coefficients of variation (CVs) were 0.3-0.6. For ECD measurements, Bland-Altman analysis revealed that the mean difference was 42 cells/mm2 between the SP-2000P and SP-6000 for the center-dot method; 57 cells/mm2 between the SP-6000 measurements from both methods; and -5 cells/mm2 between the SP-6000 and CME-530 for the fully automated method (95% limits of agreement: - 201 to 284 cell/mm2, - 410 to 522 cells/mm2, and - 327 to 318 cells/mm2, respectively). For CV measurements, the mean differences were - 3, - 12, and 13% (95% limits of agreement - 18 to 11, - 26 to 2, and - 5 to 32%, respectively). CONCLUSIONS: Despite using three replicate measurements, the precision of the center-dot method with the SP-2000P and SP-6000 software was only ± 10% for ECD data and was even worse for the fully automated method. CLINICAL TRIAL REGISTRATION: Japan Clinical Trials Register ( http://www.umin.ac.jp/ctr/index/htm9 ) number UMIN 000015236.

Comparative Analysis of Surgical Durations and Fees Across Eight Types of Glaucoma Surgery Performed by a Single Surgeon.

The duration of several types of glaucoma surgery and reimbursement amounts per minute of surgery remain unknown. This study compared the surgical duration of glaucoma procedures (ab interno trabeculotomy, PreserFlo, ab externo trabeculotomy, bleb revision, EXPRESS, trabeculectomy, Ahmed, and the Baerveldt implant) and their reimbursement amounts in Japan. We retrospectively analyzed 30 consecutive surgeries of each type of glaucoma surgery. The reimbursement amount per surgical hour was calculated by subtracting the implant cost from the total medical fees. Amounts were converted to dollars based on an exchange rate of 1 USD = 133 JPY. The average surgical time was as follows: ab interno trabeculotomy, 7.8 ± 2.1; PreserFlo, 13.5 ± 4.0; ab externo trabeculotomy, 15.2 ± 4.1; bleb revision, 15.6 ± 2.3; EXPRESS, 16.9 ± 2.7; trabeculectomy, 18.5 ± 3.1; Ahmed, 35.8 ± 8.2; and Baerveldt, 39.2 ± 6.2. The reimbursement amounts after implant deduction were as follows: ab interno trabeculotomy, $1,089; PreserFlo, $1,538; ab externo trabeculotomy, $1,430; bleb revision, $259; EXPRESS, $1,600; trabeculectomy, $1,774; Ahmed, $1,600; and Baerveldt, $1,765. Reimbursement amounts per minute varied, with the highest and lowest for ab interno trabeculotomy and bleb revision at $140 per minute and $17 per minute, respectively. Reimbursement amounts per minute of surgery for eight types of glaucoma surgery vary by up to eightfold.

Scleral bridging technique for preventing PreserFlo microshunt exposure: A case report.

INTRODUCTION: The use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy. PATIENT CONCERNS: However, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery. DIAGNOSIS: Exfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva. INTERVENTIONS: We performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge. OUTCOMES: The patient had better intraocular pressure control with positive cosmetic appearance using this technique. CONCLUSION: This technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.

Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps.

Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.

Changes in Ocular Biometry Following PreserFlo MicroShunt Implantation and Trabeculectomy: A Prospective Observational Study.

Background This study aimed to evaluate postoperative changes in ocular biometry following initial PreserFlo MicroShunt implantation and trabeculectomy. Methodology This prospective, observational study analyzed 27 cases of PreserFlo MicroShunt implantation and 29 cases of trabeculectomy performed by a single surgeon. Visual acuity, intraocular pressure, corneal curvature, central corneal thickness, anterior chamber depth, and axial length were assessed at baseline and postoperatively at one day, one week, two weeks, one month, two months, three months, and six months. Patients requiring additional surgery and those with missing data were excluded. Consecutive data were compared with the baseline values using multiple comparisons. Results In both groups, intraocular pressure was significantly decreased from baseline at all postoperative time points (all p < 0.01). Visual acuity decreased in both groups at one day and one week postoperatively. Corneal curvature remained unchanged in both groups throughout the six-month follow-up. Central corneal thickness increased at one day and one week postoperatively in the PreserFlo group, but not in the trabeculectomy group. Anterior chamber depth exhibited a significant decrease at one week postoperatively in both groups. Axial length significantly decreased postoperatively until three months in the PreserFlo group and at all postoperative time points in the trabeculectomy group. Conclusions Ocular biometry following PreserFlo and trabeculectomy had a similar tendency postoperatively.

Effect of ripasudil after trabeculectomy with mitomycin C: a multicentre, randomised, prospective clinical study.

BACKGROUND: To investigate if there are improvements in trabeculectomy outcomes supporting filtration bleb formation caused by Rho-associated protein kinase (ROCK) inhibitors. METHODS: This prospective, multicentre, randomised, open-label clinical study examined open-angle glaucoma patients who underwent trabeculectomy or trabeculectomy combined with cataract surgery followed by 3-month postoperative ripasudil treatments. After randomly allocating patients to ripasudil-ROCK inhibitor (ripasudil) or without ripasudil (non-ripasudil) groups. Mean intraocular pressure (IOP) changes, success rate, and number of eyedrops were compared for both groups. RESULTS: A total of 17 and 15 subjects dropped out in the ripasudil group and non-ripasudil group, respectively. At baseline, the mean IOP was 16.8±5.0 mm Hg in the ripasudil group (38 patients) and 16.2±4.4 in the non-ripasudil group (52 patients). The IOP decreased to 11.4±3.2 mm Hg, 10.9±3.9 mm Hg and 10.6±3.5 mm Hg at 12, 24 and 36 months in the ripasudil group, while it decreased to 11.2±4.1 mm Hg, 10.5±3.1 mm Hg and 10.9±3.2 mm Hg at 12, 24 and 36 months in the non-ripasudil group, respectively. There was a significant decrease in the number of IOP-lowering medications after trabeculectomy in the ripasudil group versus the non-ripasudil group at 24 (p=0.010) and 36 months (p=0.016). There was no statistically significant difference between the groups for the 3-year cumulative probability of success. CONCLUSION: Although ripasudil application did not increase the primary trabeculectomy success rate, it did reduce IOP-lowering medications after trabeculectomy with mitomycin C.

Intraocular pressure of supine patients using four portable tonometers.

PURPOSE: To evaluate the congruity of intraocular pressure (IOP) measurements from supine patients, which were obtained using four portable tonometers. METHODS: Intraocular pressure measurements were obtained from the right eye of 72 supine patients. We used the iCare (Tiolat Oy, Helsinki, Finland) rebound tonometer, the Diaton (BICOM Inc., Long Beach, NY) transpalpebral tonometer, the Tonopen XL (Reichert inc., Depew, NY), and a Kowa hand-held applanation tonometer (HAT; Kowa Company, Ltd., Nagoya, Japan). Relationships between mean IOPs were evaluated using Pearson correlation coefficients, and the mean differences between tonometers, using one-way analysis of variance followed by Tukey-Kramer post-hoc analysis. Levels of agreement were evaluated using Bland-Altman analysis. RESULTS: The mean IOPs (mean ± SD) were 18.2 ± 3.5 mm Hg for iCare, 14.8 ± 3.4 mm Hg for Diaton, 16.7 ± 3.7 mm Hg for Tonopen XL, and 16.8 ± 2.8 mm Hg for Kowa HAT. Pearson correlation coefficients between iCare, Tonopen XL, and Kowa HAT ranged from 0.382 to 0.577, whereas those between Diaton and other tonometers ranged from 0.041 to 0.286. Post-hoc analysis indicated significant differences between all pairs except Tonopen XL and Kowa HAT. The mean difference between measurements from iCare and Diaton was 3.39 ± 3.39 mm Hg; iCare and Tonopen XL, 1.47 ± 3.52 mm Hg; iCare and Kowa HAT, 1.49 ± 2.90 mm Hg; Diaton and Tonopen XL, -1.93 ± 4.90 mm Hg; Diaton and Kowa HAT, -1.90 ± 4.15 mm Hg; and Tonopen XL and Kowa HAT, 0.02 ± 3.61 mm Hg. Computation of the width of the 95% limits of agreement resulted in a wide bias range when comparing Diaton with all tonometers. Relatively good agreements were observed between iCare, Tonopen XL, and HAT. CONCLUSIONS: Intraocular pressure measurements obtained in a supine position by four portable tonometers were not interchangeable. Although iCare and Tonopen XL significantly overestimated IOP values in eyes with a higher IOP when compared with Kowa HAT, the agreements between iCare, Tonopen XL, and Kowa HAT were at clinically acceptable levels.

Torsional Power and Tip Shape Greatly Change Irrigation Flow Feeding Rate.

BACKGROUND: It is important to maintain intraocular pressure during cataract surgery. When the intraocular pressure sharply drops during phacoemulsification, it is important to ensure a compensatory maximum fluid supply. To the best of our knowledge, this is the first study presenting the maximum irrigation flow supply using an ultrasonic tip shape and torsional power setting. METHODS: The weight of BSS PLUS 500 ejected during torsional oscillation fitted with a mini-tip or balanced tip and nano sleeve with IOP set at 20 mmHg (IOP20) or 40 mmHg (IOP40) was measured. The weight of the BSS ejected from the sleeve over 3.0 s (15 measurements taken at 200-ms intervals) was measured to calculate the irrigation flow feeding rate. Measurements were made four times at each torsional power setting (TP). RESULTS: With a balanced tip, the irrigation flow rate rose as TP was increased, whereas, at 60% or 90% TP, the irrigation flow rate markedly decreased. With the mini-tip, the irrigation flow rate remained relatively stable, up to 60% or 80% TP but decreased dramatically at higher power settings. Compared with IOP20, the irrigation flow rate increased by 1.21- to 1.28-fold with the balanced tip and by 1.28- to 1.41-fold with the mini-tip at IOP40. At IOP20, the irrigation flow rate was higher with the mini-tip at 0% and 5% TP but equal to or higher with the balanced tip at TP of ≥10%. At IOP40, the irrigation flow rate with the mini-tip was equal to or higher than that with the balanced tip at all TP. CONCLUSIONS: The irrigation flow rate tends to vary with changes in TP and tip shape.

Visual Performance of a Violet-Filtering Intraocular Lens versus a Blue-Filtering Intraocular Lens of New/Old Manufacturing Processes.

This article compares the visual performance of a violet light-filtering colored lens (ZCB00V) and blue light-filtering intraocular lens (IOL; SN60WF) before and after modifying the manufacturing process for glistening suppression. In this retrospective study, conducted at Saneikai Tsukazaki Hospital, Himeji, Japan, a consecutive sample of 8943 eyes of 5119 patients were included and implanted with blue-filtering IOLs before and after modifying the manufacturing process (SN60WF-J (1318 eyes) and SN60WF-Q,A (1418 eyes), respectively), noncolored UV-cut IOLs (ZCB00 (1418 eyes)), and ZCB00V (3717 eyes). For each patient, the corrected distance visual acuity (CDVA) at 3 months postoperative (3MCDVA) and the area under log contrast sensitivity function (AULCSF) were measured. The 3MCDVA was -0.076 ± 0.1, -0.11 ± 0.13, -0.10 ± 0.17, and -0.11 ± 0.13, for SN60WF-J, SN60WF-Q,A, ZCB00, and ZCB00V, respectively. The SN60WF-J group revealed significant differences as compared to the other three groups (all p < 0.05). The mesopic AULCSF was 2.59 ± 0.20, 2.68 ± 0.19, -2.69 ± 0.18, and 2.76 ± 0.19, respectively, whereas the photopic AULSCF was 2.63 ± 0.23, 2.76 ± 0.25, -2.77 ± 0.25, and 2.88 ± 0.25. The SN60WF-J and ZCB00V groups exhibited significant differences as compared to the other three groups, whereas no significant differences were noted between the SN60WF-Q,A and the ZCB00 groups (all p < 0.05). The violet-filtering lens offers higher visual acuity and contrast sensitivity than the clear and blue-filtering lens. It was also found that the above functions were improved by modifying the manufacturing process.

Relationship between Postoperative Anterior Chamber Depth and Refraction Based on the Haptic Fix Position in Intraocular Lens Intrascleral Fixation.

The aim of this study was to analyze the refraction and iris capture tendency regarding the fixation position with respect to the intrascleral fixation (ISF) of intraocular lenses. Consecutive patients who underwent ISF 1.5 mm (ISF 1.5, 45 eyes) and 2.0 mm (ISF 2.0, 55 eyes) from the corneal limbus with NX60, as well as those who underwent normal phacoemulsification with in-the-bag ZCB00V (ZCB, 50 eyes), were enrolled. The anterior chamber depth (post-op ACD), the estimated ACD when using the SRK/T (post-op ACD-predicted ACD), and the refractive error (post-op MRSE, and the predicted MRSE) were all calculated. In addition, the postoperative iris capture was also investigated. The post-op MRSE-predicted MRSE values were: -0.59, 0.02, and 0.00 D (ISF 1.5, ISF 2.0, and ZCB) (p < 0.05, between ISF 1.5 vs. ISF 2.0 and ZCB); the post-op ACD values were: 4.00, 4.17, and 4.29 mm (p < 0.05, ISF 1.5 vs. ZCB); and the post-op ACD-predicted ACD values were: -2.03, -1.98, and -1.60 mm (p < 0.05, between ZCB vs. ISF 1.5 and ISF 2.0). The iris capture occurred in four eyes with regard to ISF 1.5 and three eyes with ISF 2.0 (p = 0.52). Moreover, ISF 2.0 possessed 0.6D hyperopia and 0.17 mm deeper anterior chamber depth. The refractive error of ISF 2.0 was less than that of ISF 1.5. Lastly, no significant iris capture onset was noted between ISF 1.5 mm and 2.0 mm.

Use of multifocal electroretinograms to determine stage of glaucoma.

PURPOSE: To determine whether multifocal electroretinograms (mfERGs) recorded with natural pupils and skin electrodes can be used to determine the stage of open angle glaucoma (OAG). METHODS: Two hundred eighteen eyes of 132 OAG patients and 62 eyes of 62 normal subjects whose best-corrected visual acuity (BCVA) was 0.1 logarithm of the minimum angle of resolution (logMAR) units (20/25) or less were studied. The mean deviations (MDs) obtained by Humphrey Visual Field Analyzer (HFA), optical coherence tomographic (OCT) images, and mfERGs were analyzed. The glaucoma was classified into 4 stages: preperimetric glaucoma (PPG), early stage, moderate stage, and advanced stage glaucoma. The parameters of the mfERGs examined were the amplitudes of the two positive peaks (P1, P2) of the second order kernels in the nasal and temporal fields within the central 15° diameter. RESULTS: The mean age of all participants (patients and normals) was 63.8 ± 10.8 years. With the progression of glaucoma, the amplitudes of P1 in the nasal hemifield increased and the amplitudes of P2 decreased. The nasal to temporal ratio (N/T ratio) of the P1 amplitudes and the negative slope of the line between P1 and P2 (P1P2 Slope) in the nasal field were larger at each glaucoma stage except at the PPG stage. Both the N/T amplitude ratio and P1P2 Slope were weakly but significantly correlated with the MD (r = -0.3139, P<0.0001; r = 0.4501, P<0.0001, respectively), and the OCT parameters (all P<0.0001) except the outer layer thickness. CONCLUSIONS: Our findings indicate that the amplitudes of P1 and P2 of the second order kernel of the mfERGs in the nasal field of the center region can be good markers for the stages of glaucoma.

Comparison of two analyzer measurements focusing on material stiffness among normal, treatment-naïve, and treated glaucoma eyes.

To investigate differences in biomechanical properties focusing on stiffness parameters between normal, treatment-naïve primary open-angle glaucoma (POAG), and treated POAG eyes. Retrospective case-control study, This study included 46 treatment-naïve POAG eyes, 46 POAG eyes treated with prostaglandin analogues, and 49 normal eyes used as controls; matched in terms of age and axial length. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using an ocular response analyzer (ORA). Fifteen biomechanical parameters were measured with the Corneal Visualization Scheimpflug Technology (Corvis ST), including biomechanical glaucoma factor (BGF) and two stiffness parameters of 'SP A1' and 'stress-strain index (SSI)', which were compared among the three groups. Additionally, the area under the curve (AUC) values of the receiver-operating curve to discriminate control and treatment-naïve POAG eyes were calculated for BGF and CH. Treatment-naïve POAG eyes had higher 'SSI' than normal eyes even after controlling for IOP (p < 0.05, Tukey-Cramer test). Treated POAG eyes had significantly lower CRF, and higher BGF than treatment-naïve POAG eyes. There were also significant differences in CH or SP A1 among the three groups. BGF and CH had similar AUC values (0.61 and 0.59). Treatment-naïve POAG eyes had stiffer corneas compared to normal eyes, which seemed to result from the material/structure of the cornea rather than higher intraocular pressure. Antiglaucoma topical medication alters biomechanical properties measured with Corvis ST. These results are important for understanding the pathogenesis and improving the management of POAG.

Comparing corneal biomechanic changes among solo cataract surgery, microhook ab interno trabeculotomy and iStent implantation.

Minimally invasive glaucoma surgery has expanded the surgical treatment options in glaucoma, particularly when combined with cataract surgery. It is clinically relevant to understand the associated postoperative changes in biomechanical properties because they are influential on the measurement of intraocular pressure (IOP) and play an important role in the pathogenesis of open-angle glaucoma (OAG). This retrospective case-control study included OAG patients who underwent cataract surgery combined with microhook ab interno trabeculotomy (µLOT group: 53 eyes of 36 patients) or iStent implantation (iStent group: 59 eyes of 37 patients) and 62 eyes of 42 solo cataract patients without glaucoma as a control group. Changes in ten biomechanical parameters measured with the Ocular Response Analyzer and Corneal Visualization Scheimpflug Technology (Corvis ST) at 3 and 6 months postoperatively relative to baseline were compared among the 3 groups. In all the groups, IOP significantly decreased postoperatively. In the µLOT and control groups, significant changes in Corvis ST-related parameters, including stiffness parameter A1 and stress‒strain index, indicated that the cornea became softer postoperatively. In contrast, these parameters were unchanged in the iStent group. Apart from IOP reduction, the results show variations in corneal biomechanical changes from minimally invasive glaucoma surgery combined with cataract surgery.

Case report: Medical treatment for limbal epithelial stem cell deficiency in patients treated for glaucoma.

Limbal epithelial stem cell deficiency (LSCD) is an abnormal corneal epithelial lesion with several causes. The patient was diagnosed using fluorescein staining. Bullous keratopathy, multiple surgeries, and drug-related damage can cause LSCD in glaucoma patients. We evaluated the medical treatment course for LSCD in patients with glaucoma. We retrospectively reviewed the electronic medical records of patients diagnosed with LSCD and investigated their background, course of treatment, and classification stages of LSCD before and after treatment. The global consensus classification system (stages IA-C, IIA-B, and III) proposed by Deng et al. (Cornea 2020) was used. Seven patients (two males) and eight eyes were studied. The median age of the patients was 82 years, and the mean duration of glaucoma treatment was 8 years. The patients had open-angle glaucoma (four eyes), exfoliation glaucoma (one eye), neovascular glaucoma (one eye), normal tension glaucoma (one eye), and uveitic glaucoma (one eye). Stage classifications at diagnosis were stage IA in four eyes and stages IC, IIA, IIB, and III in one eye each. All treatments were carried out with dry eye drops, steroid eye drops, and antibiotics. The mean duration of treatment was 1.4 years. The classifications at the time of the final visit were normal corneal epithelium (three eyes), stage IA (two eyes), IIA (one eye), and III (two eyes). Three eyes (37%) improved by more than one stage and one eye deteriorated by more than one stage. LSCD is long-lasting and difficult to treat in a short period; thus, it requires careful medical attention.