Trabeculectomy with Ologen implant versus perfluoropropane gas bubble for open angle glaucoma in pseudophakic eyes.

AIM: To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma. METHODS: This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma (OAG). Twenty-nine patients were allocated in group I (trabeculectomy with Ologen; trab-ologen group), while 28 patients were assigned in group II (trabeculectomy with perfluoropropane gas bubble; trab-C3F8 gas bubble group). RESULTS: The intraocular pressure (IOP) was significantly reduced in both study groups at all postoperative follow up intervals (1wk, 3, 6, 12, 18, 24, 30 and 36mo, P<0.001). The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up. However, the trab-ologen group achieved a statistically significant reduction over the trab-C3F8 gas bubble group during the last 24 months of follow up. CONCLUSION: Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.

Sites of highest predictability for neurodegeneration in patients with type 2 diabetes mellitus without diabetic retinopathy.

PURPOSE: Identifying earlier retinal thickness affection and predictability for diabetic retinal neurodegeneration (DRN) in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy (DR). PATIENTS AND METHODS: This is a comparative cross-sectional study. Thirty-eight eyes of 19 patients with DM2 without any signs of DR and 38 eyes of 19 controls underwent retinal evaluation using optical coherence tomography. Macular ganglion cell layer (GCL), macular retinal nerve fiber layer (mRNFL), inner plexiform layer (IPL), total macular thickness, peripapillary retinal nerve fiber layer (pRNFL) and Bruch's membrane opening-minimum rim width (BMO-MRW) were evaluated. RESULTS: GCL showed significant thickness reduction in the total, superior and inferior halves as well as the 9 ETDRS regions (except the nasal and lower outer regions). The mRNFL showed a significant reduction in the total, superior and inferior halves as well as the lower and nasal outer regions. The IPL showed significant reduction in the 4 inner regions only. The pRNFL showed significant reduction in the total, superotemporal and inferotemporal sectors values. The BMO-MRW did not show any significant thickness change. CONCLUSION: The total, superior and inferior GCL and mRNFL, in addition to the global pRNFL were the most affected and predictive layers for DRN in patients with DM type 2 without DR. It appears that the GCL is the primary site of DRN and the rest of the changes represented a degeneration of the axonal path between the optic disk and the macular GCL.

Supine positioning after vitrectomy for rhegmatogenous retinal detachments with inferior retinal breaks.

BACKGROUND: To evaluate the effectiveness of face up position (FUP) following pars plana vitrectomy (PPV) and silicone oil injection in cases of rhegmatogenous retinal detachment (RRD) with multiple peripheral and inferior breaks. METHOD: Thirty-two eyes of 32 patients with RRD due to multiple peripheral breaks were managed with PPV and silicone oil as endotamponade. Postoperatively, all patients were instructed to assume face up (supine) position for at least 10 days. Silicone oil was removed 3 to 6 months postoperatively in eyes with attached retina and the patients were followed up for 6 months. RESULTS: Thirty eyes (94%) got a successful attachment of the retina and remained attached after silicone oil removal. One case showed lower redetachment under silicone oil while the other case showed recurrent RRD after silicone oil removal. CONCLUSION: Although postoperative FUP is not a popular one, it is effective in the treatment of RRD with peripheral breaks whatever the number or the distribution of these breaks. This may in some way or another change the traditional trends of postoperative positioning after vitrectomy for RRD.

Does the scleral encircling band provide a protective effect against the progression of diabetic retinopathy?

AIM: To evaluate the effect of scleral encircling bands on the development and progression of diabetic retinopathy (DR) in diabetic patients. METHODS: The medical records of diabetic patients who underwent unilateral retinal detachment (RD) surgery using scleral buckle and encircling band were reviewed retrospectively. Both eyes of patients were included in the study: one eye in each patient had a scleral buckle with encircling band (the operated eye) and the other one is the non-operated eye. The demographic characters, duration of diabetes and period between surgery and the last recall visit were retrieved from each patient. All the cases underwent fundus photo and fluorescein angiography (when indicated) to confirm the DR staging. RESULTS: Totally 25 patients fulfilled the inclusion and the exclusion criteria were become eligible for the study. A total of 50 eyes of 25 patients were enrolled in this analysis. The mean period of time passed from surgery with encircling band and the last reassessment visit was 12.5±2y. Even though DR could develop in the operated eyes, it was at a less degree of severity compared to the non-operated eyes of same patients (P=0.027). CONCLUSION: Scleral encircling bands have protective effects against the development and progression of DR.

Bimodal imaging of proliferative diabetic retinopathy vascular features using swept source optical coherence tomography angiography.

AIM: To categorize neovessels morphology and to detect response to anti-angiogenic therapy by using structural and angiographic modes of swept source optical coherence tomography (SS-OCT). METHODS: Thirty-two eyes with neovessels at disc (NVD) and neovessels elsewhere (NVE) - as diagnosed by fluorescein angiography- were included. Cross sectional OCT images of disc and macular regions were registered to enface OCT angiography (OCTA), B-scan blood flow over lay and density maps. Three eyes received anti-angiogenic treatment. RESULTS: Pin point registration of cross-sectional OCT and OCTA images differentiated active NVD with vascular elements from fibrous or equivalent fibrovascular elements. En face images delineated NVE as vascular tufts or area of filling while cross-sectional images differentiated NVE from microvascular intraretinal abnormality (IRMA). All cases were associated with enlargement of foveal avascular zone and or areas of capillary non perfusion. Regressed NVD appeared as ghost vessel or pruned vascular loops after injection. CONCLUSION: Structural and angiographic modes of SS-OCT can detect, characterize and categorize the pattern of wide spectrum of neovessels based on blood flow data and density maps. It is potentially useful to detect ischemic changes in the vascular bed and regression of NVD after therapeutic regimens providing substitute for invasive techniques.

Fitting Tips and Visual Rehabilitation of Irregular Cornea with a New Design of Corneoscleral Contact Lens: Objective and Subjective Evaluation.

OBJECTIVES: To study the fitting and the visual rehabilitation obtained with a corneoscleral contact lens, namely, Rose K2 XL in patients with irregular cornea. METHODS: This prospective study included 36 eyes of 36 patients with irregular cornea fitted with Rose K2 XL. Refractive and visual outcomes and mesopic and aberrometric parameters of fitted eyes were assessed at 2 weeks, 3 months, and 6 months after the initial lens use. Objective and subjective parameters of patient satisfaction and lens comfort were noted. Causes of lens discontinuation and complications were also recorded. RESULTS: Average logMAR VA improved significantly from 0.95 ± 0.09 without correction to 0.04 ± 0.05 six months after lens wear. Similarly, mesopic and aberrometric measures were significantly improved. Statistical analysis of the subjective patients' responses showed a significant acceptance of the lens by most of them. At the end of follow-up, the mean wearing time was 9.9 ± 2.9 hours per day. The most common cause of wearing discontinuation was persistent discomfort (16.7%) and high lens expenses(16.7%). Self-assessed questionnaire showed statistically significant improvement in nearly all measured subjective parameters. CONCLUSION: Rose K2 XL lenses provide patients with irregular cornea with both quantitative and qualitative optimal visual function with high degree of patient comfort and satisfaction.

Simultaneous versus Sequential Accelerated Corneal Collagen Cross-Linking and Wave Front Guided PRK for Treatment of Keratoconus: Objective and Subjective Evaluation.

Aim. To compare objective and subjective outcome after simultaneous wave front guided (WFG) PRK and accelerated corneal cross-linking (CXL) in patients with progressive keratoconus versus sequential WFG PRK 6 months after CXL. Methods. 62 eyes with progressive keratoconus were divided into two groups; the first including 30 eyes underwent simultaneous WFG PRK with accelerated CXL. The second including 32 eyes underwent subsequent WFG PRK performed 6 months later after accelerated CXL. Visual, refractive, topographic, and aberrometric data were determined preoperatively and during 1-year follow-up period and the results compared in between the 2 studied groups. Results. All evaluated visual, refractive, and aberrometric parameters demonstrated highly significant improvement in both studied groups (all P < 0.001). A significant improvement was observed in keratometric and Q values. The improvement in all parameters was stable till the end of follow-up. Likewise, no significant difference was determined in between the 2 groups in any of recorded parameters. Subjective data revealed similarly significant improvement in both groups. Conclusions. WFG PRK and accelerated CXL is an effective and safe option to improve the vision in mild to moderate keratoconus. In one-year follow-up, there is no statistically significant difference between the simultaneous and sequential procedure.