[Trabeculectomy with Collagen Matrix Implant as Bevacizumab Depot: Clinical Results on Efficacy and Safety]. / Trabekulektomie mit Kollagen-Matrix-Implantat als Bevacizumabdepot: klinische Ergebnisse zur Effektivität und Sicherheit.

BACKGROUND: Trabeculectomy for the surgical reduction of internal eye pressure is an established procedure, but the principle limitations are in postoperative wound healing. Various antimetabolites are regularly used to avoid postoperative subconjunctival scarring. The present study investigates whether the combination of an Ologen implant with bevacizumab can modify the rates of success and/or complications during trabeculectomy. METHODS: Three different groups of patients were evaluated in which trabeculectomy was performed with mitomycin C, either alone (group 1) or in combination with an Ologen implant (group 2) or with an Ologen implant with bevacizumab (group 3). The success and failure rates, changes in tension, postoperative complications and postoperative revision for pressure regulation were evaluated. The follow-up was 12 months for all eyes. RESULTS: A total of 130 eyes in 130 patients (mean age 67.74 ± 12.16 years). The number of substances applied preoperatively to reduce intraocular pressure was 2.89 ± 0.98 and the internal ocular pressure was 21.74 ± 5.49 mmHg. Twelve months postoperatively; the mean pressure was 13.14 ± 3.71 mmHg. The greatest absolute success rate (= IOD ≤ 15 mmHg without antiglaucoma medication) was in the group with exclusive goniotrepanation + mitomycin C (MMC; 72.5%), followed by the groups with Ologen (67.5%) and Ologen + bevacizumab (63.6%). The greatest failure rate (= IOD > 15 mmHg) was in the Ologen bevacizumab group (17.3%), followed by the pure Ologen group with 22.5% and the pure trabeculectomy group (12.3%). There were no significant differences in the success and failure rates. There were no serious intra- or postoperative complications in any group. The number of patients for whom it was necessary to loosen the traction thread was significantly lower in the sole Ologen group (p = 0.02). There were also no significant differences between the groups with respect to revisions. CONCLUSION: Using Ologen as drug depot for bevacizumab in a trabeculectomy (TE) with MMC is a safe and active surgical method without an increased risk of complications in comparison to pure TE with MMC or TE with MMC and Ologen implant. After 12 months, this treatment exhibited no significant advantages.

Multiplex Cytokine Analysis of Aqueous Humor in Juvenile Idiopathic Arthritis-Associated Anterior Uveitis With or Without Secondary Glaucoma.

Patients with juvenile idiopathic arthritis often develop chronic anterior uveitis (JIAU). JIAU patients possess a particularly high risk for developing secondary glaucoma when inflammatory inactivity has been achieved. By using multiplex bead assay analysis, we assessed levels of pro- and anti-inflammatory cytokines, chemokines, or metalloproteinases in the aqueous humor (AH) of patients with clinically inactive JIAU with (JIAUwG) or without secondary glaucoma (JIAUwoG), or from patients with senile cataract as controls. Laser-flare photometry analysis prior to surgery showed no significant differences between JIAUwG or JIAUwoG. Compared with the control group, levels of interleukin-8, matrix metalloproteinase-2, -3, -9, serum amyloid A (SAA), transforming growth factor beta-1, -2, -3 (TGFß-1, -2, -3), and tumor necrosis factor-alpha in the AH were significantly higher in patients with clinically inactive JIAUwG or JIAUwoG. Samples from JIAwoG patients displayed significantly higher levels of SAA (P < 0.0116) than JIAUwG patients. JIAUwG patients showed an increased level of TGFß-2 in AH samples compared with JIAUwoG (P < 0.0009). These molecules may contribute to the clinical development of glaucoma in patients with JIAU.

Mitomycin-C assisted photorefractive keratectomy in the treatment of buttonholed laser in situ keratomileusis flaps associated with epithelial ingrowth.

The prophylactic intraoperative use of mitomycin-C (MMC) to prevent haze and scarring after excimer laser surface ablation (phototherapeutic/photorefractive keratectomy [PTK/PRK]) in an eye with a previous laser in situ keratomileusis (LASIK) flap buttonhole with epithelial ingrowth is described. A well-centered buttonhole measuring 2.0 mm in diameter was cut within a thin LASIK flap in an amblyopic eye. Over the next 8 weeks, corneal haze and progressive epithelial ingrowth formed centrally. An early transepithelial PTK/PRK approach was chosen to manage the buttonhole together with the epithelial ingrowth and to treat ametropia before the onset of scarring. The approach included epithelial removal with PTK, application of MMC 0.02% for 1 minute, irrigation, a short waiting period to allow for diffusion, PRK correction of -4.0 diopters without nomogram adjustment, and bandage contact lens. A regimen of prednisolone acetate 1% and ofloxacin 0.03% 5 times a day for 1 week (steroid tapered) was prescribed. Epithelial ingrowth was removed successfully. Minimal haze formation was visible 2 weeks after the retreatment but did not reduce best spectacle-corrected visual acuity (BSCVA) and resolved within the next few weeks. After 6 weeks, uncorrected visual acuity was equal to BSCVA preoperatively (20/50). There was no evidence of recurrent epithelial ingrowth or central scarring after 24 months. Transepithelial PTK/PRK was effective in managing central epithelial ingrowth in a buttonholed LASIK flap. Prophylactic intraoperative use of MMC may reduce haze formation and corneal scarring in early treatments and may also prevent recurrent epithelial ingrowth. This approach may offer faster visual recovery and no risk for a repeated buttonhole creation compared with the widespread recutting a new flap after a couple of months. The optimal application time and concentration of MMC need to be established.

Hypermotility of an iris-fixated anterior chamber phakic intraocular lens due to nontraumatic iris laxity.

PURPOSE: Permanent immovability of phakic intraocular lenses (pIOLs) for the correction of high myopia is crucial in avoiding injury to the corneal endothelium and maintaining visual acuity. Unstable position of iris-fixated pIOLs due to traumatic or nontraumatic disenclavation of the haptic has been described previously. METHODS AND RESULTS: We report a different mechanism of repeated excessive implant motility in both eyes of a young woman who developed late nontraumatic elongation of the iris fibers to which an iris-claw pIOL was fixated. This led to increased motility of the pIOLs with blinking causing mild iritis. Subsequent bilateral successful re-enclavation to other iris fibers ameliorated these symptoms. After 2.5 years, these iris fibers, too, were elongated, causing excessive movements of the pIOLs and consecutive endothelial cell loss necessitating removal of the pIOLs. The etiology of this iris fiber laxity remains unclear. CONCLUSIONS: Surgeons should be aware of this rare potential complication.

Trabeculectomy or modified deep sclerectomy in juvenile uveitic glaucoma.

PURPOSE: The purpose of this study is to report the effectiveness of trabeculectomies (TE) and modified deep sclerectomies (mdS) in a group of patients with juvenile uveitic secondary glaucoma. METHODS: This is a retrospective analysis of 16 TE and eight mdS. RESULTS: Postoperatively, an IOP reduction to 11.6 ± 4.7 mmHg was achieved in the TE group and to 18.5 ± 11.4 mmHg in the mdS group (p = 0.045). In the TE group, 14 patients showed postoperative success, one limited success and another was a failure compared to four successes and four failures in the mdS group (p = 0.041). The mean number of complications was 1.25 ± 1.49 in the TE group and 0.38 ± 0.74 after mdS (p = 0.11). In the mdS group, four patients (50%) needed additional glaucoma surgery compared to one TE patient (p = 0.023). CONCLUSION: Both surgical techniques showed a marked reduction of IOP. Trabeculectomy has a higher probability of achieving success and lowering IOP.

Prevalence of uveitic secondary glaucoma and success of nonsurgical treatment in adults and children in a tertiary referral center.

PURPOSE: The aim of this study is to compare treatment strategies, the success of topical and systemic therapy, and the need for glaucoma surgery in children and adults with secondary uveitic glaucoma. METHODS: Retrospective observational case series with 1997 consecutive new uveitis patients. RESULTS: Overall, 176 patients (8.8%) suffered from secondary glaucoma (n = 126) or ocular hypertension (n = 50). All patients received topical therapy, and 107 (62%) patients also received systemic glaucoma therapy. Topical therapy was successful (IOP