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1.
Transl Vis Sci Technol ; 13(10): 7, 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39361316

RESUMO

Purpose: To investigate the usefulness of intraocular pressure (IOP) using the ocular response analyzer to predict the occurrence of hypotony complications following trabeculectomy or bleb needling revision with mitomycin C. Methods: This study included 66 eyes of 66 patients who underwent trabeculectomy (58 eyes of 58 patients) or bleb needling (8 eyes of 8 patients) with mitomycin C. A significant predictor of hypotony complications was identified from (1) operation (trabeculectomy or bleb needling), (2) age, (3) sex, (4) disease type (primary open-angle glaucoma, primary angle closure glaucoma, or exfoliation glaucoma), (5) lens status (phakia or pseudophakia), (6) preoperative Goldmann applanation tonometry IOP, (7) preoperative central corneal thickness, (8) preoperative axial length, (9) preoperative anterior chamber depth, (10) preoperative corneal hysteresis, (11) preoperative corneal resistance factor, (12) preoperative corneal compensated IOP (IOPcc), and (13) minimum IOP (IOP value when hypotony complications occurred, otherwise the minimum IOP during 3 months from trabeculectomy or bleb needling) using multivariate logistic regression. Results: The probability of the occurrence of hypotony complications tended to increase by applying higher cutoff values to preoperative Goldmann applanation tonometry IOP and IOPcc, but not lower cutoff values to the minimum IOP. Multivariate logistic regression suggested that higher preoperative IOPcc and pseudophakia were significant predictors of the occurrence of hypotony complications (P = 0.0062 and 0.0069, respectively). Conclusions: Higher preoperative IOPcc and pseudophakia were significant predictors of the occurrence of hypotony complications. Translational Relevance: It is useful to measure IOP using the ocular response analyzer before trabeculectomy.


Assuntos
Pressão Intraocular , Hipotensão Ocular , Complicações Pós-Operatórias , Tonometria Ocular , Trabeculectomia , Humanos , Feminino , Pressão Intraocular/fisiologia , Masculino , Trabeculectomia/efeitos adversos , Idoso , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico , Tonometria Ocular/instrumentação , Tonometria Ocular/métodos , Hipotensão Ocular/etiologia , Idoso de 80 Anos ou mais , Glaucoma/cirurgia , Glaucoma/fisiopatologia , Adulto , Estudos Retrospectivos , Glaucoma de Ângulo Aberto/cirurgia
2.
J Clin Med ; 13(20)2024 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-39458082

RESUMO

Objectives: This study aimed to evaluate the postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma. Methods: We used the Kaplan-Meier method to analyze 29 eyes of 29 patients with exfoliation glaucoma (mean age: 80.7 ± 8.3 years; 16 males; 24 eyes with intraocular lens implants; preoperative intraocular pressure [IOP]: 32.5 ± 9.3 mmHg; preoperative antiglaucoma medications: 3.4 ± 1.0; Asian ethnicity: 100%) who underwent PreserFlo MicroShunt surgery alone at Saneikai Tsukazaki Hospital from November 2022 to November 2023. The criteria for survival were a reduction in IOP of ≥20%, no additional glaucoma surgery, and IOP of 5-21 mmHg (condition 1), 5-18 mmHg (condition 2), and 5-15 mmHg (condition 3). Needling and glaucoma eye drops were considered qualified successes. Results: The mean follow-up period was 27.9 weeks, with a reoperation rate of 31% (9 cases). The complete and qualified success survival rates at 24 weeks were 56%, 52%, and 49%, and 67%, 59%, and 53% for conditions 1-3, respectively. The complete and qualified success survival rates at 48 weeks were 47%, 43%, and 45%, and 52%, 46%, and 48% for conditions 1-3, respectively. Conclusions: The postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma demonstrated an approximate 50% success rate at both 24 and 48 weeks, with a reoperation rate of approximately 30%. Caution is warranted when performing PreserFlo MicroShunt in patients with exfoliation glaucoma.

3.
J Clin Med ; 13(15)2024 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-39124830

RESUMO

Background/Objectives: This study aimed to examine the postoperative changes in the corneal biomechanical properties between solo cataract surgery and solo microhook ab interno trabeculotomy (LOT). Methods: This retrospective case-control study included 37 eyes belonging to 26 patients who underwent solo cataract surgery and 37 eyes belonging to 31 patients who underwent solo µLOT. These two groups were matched according to their preoperative intraocular pressure (IOP), axial length (AL), and age. Corneal Visualization Scheimpflug Technology (Corvis ST) was used to obtain four biomechanical parameters representing the corneal stiffness or corneal deformation at the highest concavity, including stiffness parameter A1 (SP-A1), stress-strain index (SSI), peak distance (PD), and deflection amplitude max (DefAmpMax). These parameters were compared preoperatively and 6 months postoperatively, and between the two surgical groups. Results: Preoperatively, the patients' IOP, age, and AL, as well as their results in four Corvis ST parameters, were similar between the two groups (p > 0.05). No significant difference was observed in SP-A1; however, PD and DefAmpMax were significantly larger, and SSI was significantly smaller postoperatively in the LOT group than in the cataract group. Conclusions: Corneal stiffness was reduced, and the cornea was more deformed with LOT than cataract surgery.

4.
Retina ; 2024 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-39094115

RESUMO

PURPOSE: This study aims to evaluate the efficacy and safety of vitrectomy with vitreous gas replacement using low-concentration nitrous oxide (N2O) gas anesthesia, focusing on intraocular pressure (IOP) changes, pain, anxiety, and safety outcomes. METHODS: This retrospective study analyzed 133 patients undergoing fluid-air exchange without use of such as SF6 or C3F8, at Saneikai Tsukazaki Hospital, Japan, from April 2019 to March 2022. Participants were divided into two groups: those receiving low-concentration nitrous oxide gas anesthesia (N2O group) and those receiving local anesthesia with room air inhalation (Air group). IOP, pain, anxiety levels, and intraoperative complications were assessed. RESULTS: No significant differences were found in IOP changes postoperatively between the N2O and Air groups. The N2O group reported significantly lower pain scores and had lower intraoperative systolic blood pressure and heart rate changes compared with the Air group. No significant intraoperative or postoperative complications were observed in either group. CONCLUSION: Vitrectomy with fluid-air exchange using low-concentration nitrous oxide gas anesthesia is safe, does not increase IOP, and may offer benefits in reducing intraoperative pain and stabilizing vital signs compared with traditional local anesthesia methods. This approach could be considered a viable option for vitreous surgery requiring fluid-air exchange.

5.
Am J Ophthalmol ; 268: 66-75, 2024 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-39089353

RESUMO

PURPOSE: This study aimed to investigate the usefulness of measuring biomechanical parameters using the Corvis ST to predict the occurrence of hypotony maculopathy and choroidal detachment (CD) following trabeculectomy or bleb needling revision with mitomycin C. DESIGN: Clinical cohort study. METHODS: This study included 100 eyes of 100 patients who underwent trabeculectomy (88 eyes of 88 patients) or bleb needling (12 eyes of 12 patients) with mitomycin C. A significant predictor of hypotony complications was identified from (1) operation (trabeculectomy or bleb needling), (2) age, (3) sex, (4) disease type (primary open-angle glaucoma, exfoliation glaucoma or other), (5) lens status (phakia or pseudophakia), (6) preoperative Goldmann applanation tonometry (GAT) intraocular pressure (IOP), (7) preoperative central corneal thickness (CCT), (8) preoperative axial length (AL), (9) preoperative anterior chamber depth, (10) "Min IOP" (IOP value when hypotony complications occurred, otherwise the minimum IOP during 3 months from trabeculectomy or bleb needling), (11) preoperative corneal curvature, and (12-24) 12 Corvis ST parameters using multivariate logistic regression. RESULTS: There were 13 and 21 eyes developed hypotony maculopathy and CD, respectively. Male gender, greater preoperative GAT IOP, and greater highest concavity deflection Amplitude were significant predictors of the occurrence of hypotony maculopathy (P < .05). On the other hand, shorter AL, thinner CCT, greater preoperative GAT IOP and pseudophakia were significant predictors of the occurrence of CD (P < .05). CONCLUSIONS: A careful attention should be paid to the occurrence of hypotony maculopathy with male gender and greater highest concavity deflection Amplitude despite higher preoperative GAT IOP. Different risk factors were identified; shorter AL, thinner CCT, greater preoperative GAT IOP, and pseudophakia.

6.
Medicine (Baltimore) ; 103(27): e38847, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38968453

RESUMO

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.


Assuntos
Esclera , Humanos , Esclera/cirurgia , Trabeculectomia/métodos , Pressão Intraocular , Síndrome de Exfoliação/cirurgia , Implantes para Drenagem de Glaucoma/efeitos adversos , Cápsula de Tenon , Retalhos Cirúrgicos , Complicações Pós-Operatórias/prevenção & controle , Feminino , Idoso , Masculino , Túnica Conjuntiva/cirurgia
7.
BMJ Open Ophthalmol ; 9(1)2024 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-38960415

RESUMO

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.


Assuntos
Glaucoma de Ângulo Aberto , Pressão Intraocular , Isoquinolinas , Mitomicina , Sulfonamidas , Trabeculectomia , Humanos , Trabeculectomia/métodos , Masculino , Pressão Intraocular/efeitos dos fármacos , Estudos Prospectivos , Feminino , Glaucoma de Ângulo Aberto/cirurgia , Glaucoma de Ângulo Aberto/tratamento farmacológico , Isoquinolinas/uso terapêutico , Isoquinolinas/administração & dosagem , Idoso , Sulfonamidas/uso terapêutico , Sulfonamidas/administração & dosagem , Mitomicina/uso terapêutico , Mitomicina/administração & dosagem , Pessoa de Meia-Idade , Quinases Associadas a rho/antagonistas & inibidores , Resultado do Tratamento , Alquilantes/administração & dosagem , Alquilantes/uso terapêutico
8.
J Clin Med ; 13(10)2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38792480

RESUMO

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.

10.
Cureus ; 16(3): e56188, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38487650

RESUMO

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.

11.
Cureus ; 16(1): e51675, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38313883

RESUMO

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.

12.
Cureus ; 15(10): e46500, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37927688

RESUMO

PURPOSE: In binocular vision, there is a dominant eye and a nondominant eye, a phenomenon termed ocular dominance. This study determined the differences and associations of the ocular blood flow parameters between dominant and nondominant eyes in healthy Japanese subjects. METHODS: This cross-sectional study included 128 eyes of 64 subjects (13 male and 51 female) aged ≥ 20 years. The ocular blood flow parameters were assessed using laser speckle flowgraphy (LSFG), and software was used to calculate the mean blur rate (MBR), which reflects the blood flow velocity. RESULTS: There were no significant differences in axial length (AL), spherical equivalent (SE), intraocular pressure (IOP), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), or ocular blood flow parameters between the dominant and nondominant eyes. The ocular blood flow parameters of the dominant eye were significantly and positively correlated with those of the nondominant eye (all P < 0.001). CONCLUSIONS: No significant differences in ocular blood flow parameters exist between the dominant and nondominant eyes in healthy subjects. The ocular blood flow parameters in the dominant eye are associated with those in the nondominant eye.

13.
Cureus ; 15(10): e46441, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37927709

RESUMO

Secondary epiretinal membranes (ERMs) can develop from various causes, including those associated with glaucoma treatments such as trabeculectomy (TLE) and EX-PRESS (EXP) insertion surgery. This study aimed to investigate the occurrence of new ERMs and changes in preexisting ERMs following TLE or EXP insertion. Between April 2018 and March 2019, 102 and 74 eyes that underwent primary and standalone TLE and EXP insertion, respectively, were evaluated. Of these, 48 eyes were included in the TLE group and 32 eyes were included in the EXP group. Optical coherence tomography (OCT) was used to assess preoperative and postoperative ERMs. In the TLE group, postoperative ERMs were observed in one (case 1) (3%) out of 34 eyes without preexisting ERMs and in one (case 2) (7%) out of 14 eyes with preexisting ERMs, showing an increase in ERM stage. In the EXP group, postoperative ERMs were observed in one (case 3) (5%) out of 22 eyes without preexisting ERMs and in one (case 4) (10%) out of 10 eyes with preexisting ERMs, showing a decrease in the ERM stage. Case 1 was a 58-year-old man with primary open-angle glaucoma (POAG) in the left eye who underwent TLE. Although no preoperative ERMs were observed, postoperative ERM was noted at the three-month follow-up. Case 2 was a 49-year-old man with POAG in the right eye who underwent TLE. Although ERM was observed preoperatively, ERM progressed at six months postoperatively. Case 3 was a 59-year-old woman with POAG in the right eye who underwent EXP insertion. No preoperative ERMs were observed, but an ERM was noted at the 15-month follow-up. Case 4 was a 72-year-old woman with steroid-induced glaucoma in the right eye who underwent EXP insertion surgery. A preoperative ERM was present, and the foveal pit was absent; however, the foveal pit was observed at the 12-month follow-up. Despite the low incidence of ERMs, filtration surgery may be associated with ERM development and the progression or regression of preexisting ERMs.

14.
Eur J Ophthalmol ; : 11206721231214142, 2023 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-37941398

RESUMO

INTRODUCTION: Many adverse occurrences in the eye have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. This is the first report of a patient with an unruptured retinal arterial macroaneurysm (RAM) who developed branch retinal artery occlusion (BRAO) one day after SARS-CoV-2 vaccination (BNT162b2 by Pfizer-BioNTech). PATIENT REPORT: A 75-year-old man with a pertinent history of type-2 diabetes mellitus visited the hospital complaining of sudden visual loss in his right eye 1 day after receiving the fourth dose of the SARS-CoV-2 mRNA vaccine; his best-corrected visual acuity (BCVA) decreased from 1.0 to 0.7 (Snellen decimal). The patient had previously been diagnosed with an unruptured RAM and superior paracentral acute middle maculopathy in the same eye. Fundus examination showed increased sheathing of blood vessels. Indocyanine green showed a hyperfluorescent area suggestive of RAM on the right eye disc. Fluorescein angiography and optical coherence tomography angiography revealed arterial obstruction findings in the upper retinal area. DIAGNOSIS AND INTERVENTION: The patient was diagnosed with BRAO with RAM and was followed up without any additional treatment. Follow-up examination after 4 months did not show any improvement in BCVA value. CONCLUSION: This case suggested that BRAO could develop after SARS-CoV-2 vaccination in patients with unruptured RAM; however, more research is required to investigate the causes.

15.
Sci Rep ; 13(1): 19148, 2023 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-37932377

RESUMO

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.


Assuntos
Catarata , Glaucoma de Ângulo Aberto , Glaucoma , Trabeculectomia , Humanos , Glaucoma de Ângulo Aberto/cirurgia , Estudos Retrospectivos , Estudos de Casos e Controles , Fenômenos Biomecânicos , Trabeculectomia/métodos , Glaucoma/cirurgia , Pressão Intraocular , Córnea
16.
J Clin Med ; 12(15)2023 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-37568510

RESUMO

BACKGROUND: We compared corneal visualization Scheimpflug technology (CST) parameters between eyes with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). METHODS: A retrospective analysis was performed on data from 89 eyes with POAG and 83 eyes with PACG that had CST examinations. CST parameters were compared between eyes with POAG and those with PACG using a linear mixed model (LMM). RESULTS: No differences were observed in age, central corneal thickness, intraocular pressure, or use of antiglaucoma eye drops between the two groups. Patients with PACG had a significantly shorter axial length (AL), a higher proportion of females, CST parameters, longer applanation 2 (A2) time, deeper A2 deformation amplitude, shorter peak distance, longer whole eye movement, and longer whole eye movement time than patients with POAG. The highest concavity (HC) length and PD showed a significant positive correlation with AL. However, A1 length, A1 deformation amplitude, A2 time, A2 velocity, A2 length, A2 deformation amplitude, HC time, whole eye movement, and whole eye movement time were negatively correlated with AL. CONCLUSIONS: The biomechanical properties of the cornea differed between POAG and PACG. In some parts, AL differences between the POAG and PACG groups might contribute to the variation in CST parameters.

17.
Ophthalmol Ther ; 12(5): 2757-2768, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37548906

RESUMO

INTRODUCTION: The purpose of this study was to compare the surgical outcomes between ab interno trabeculotomy (LOT) and iStent inject W implantation (iStent) both combined with cataract surgery, matching the background factors including age, intraocular pressure (IOP), medication score, central corneal thickness (CCT), and axial length. METHODS: A total of 100 eyes from 75/79 patients with primary open-angle glaucoma were included in the LOT/iStent groups. The background factors were matched between the two groups using the propensity score. RESULTS: There were no significant differences in age, IOP, medication score, CCT, and axial length, preoperatively. The postoperative medication scores were 1.3 ± 1.2 and 1.2 ± 1.2 in the LOT and iStent groups. The postoperative IOPs were 12.8 ± 2.8 and 13.1 ± 2.4 mmHg in the LOT and iStent groups, respectively. The changes in the medication score were - 0.64 ± 1.4 and - 0.44 ± 1.6 in the LOT and iStent groups, respectively. The changes in the IOP were - 2.1 ± 3.3 and - 1.5 ± 3.0 mmHg in the LOT and iStent groups, respectively. These values were not significantly different between the two groups. The postoperative IOP and changes in the IOP were significantly associated with preoperative IOP and CCT. There was no significant difference in the occurrence of postoperative complications (hyphema, 11.0% and 6.0%, and transient ocular hypertension, 8.0% and 5.0%, in the LOT and iStent groups, respectively). CONCLUSION: LOT and iStent have similar surgical outcomes with sufficient safety. Postoperative IOP was significantly associated with preoperative IOP and CCT in both groups.

18.
Adv Ther ; 40(9): 4074-4092, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37452961

RESUMO

INTRODUCTION: This multicenter, randomized, comparative, and investigator-masked crossover clinical trial sought to compare the efficacy and tolerability of fixed combinations of 0.1% brimonidine/0.5% timolol (BTFC) versus 1% dorzolamide/0.5% timolol (DTFC) as adjunctive therapies to prostaglandin analogues. METHODS: A total of 110 patients with open-angle glaucoma or ocular hypertension previously treated with prostaglandin analogue monotherapy were randomized to receive either BTFC or DTFC as adjunctive therapy for 8 weeks. These patients were then crossed over to the alternative treatment arm for another 8 weeks. The reduction in intraocular pressure (IOP) (primary outcome), occurrence of adverse events, ocular discomfort after instillation, and patient preference (secondary outcomes) were recorded through patient interviews. RESULTS: BTFC instillation for 8 weeks reduced IOP by 3.55 mmHg, demonstrating non-inferiority to DTFC instillation (3.60 mmHg; P < 0.0001, mixed-effects model). Although adverse events were rare with both combinations, patients reported greater discomfort with DTFC than with BTFC (P < 0.0001). More patients preferred BTFC (P < 0.0001) over DTFC, as BTFC caused minimal or no eye irritation. CONCLUSION: As BTFC offered better tolerability than DTFC with comparable reduction in IOP, we recommend it as an alternative for patients who experience ocular discomfort with DTFC-prostaglandin analogue combination therapy. TRIAL REGISTRATION NUMBER: jRCTs051190125.


Patients with glaucoma who require further reduction in intraocular pressure while undergoing monotherapy with prostaglandin analogue ophthalmic solution have been prescribed two enhanced treatment options: 0.1% brimonidine/0.5% timolol fixed combination ophthalmic solution (BTFC) and 1% dorzolamide/0.5% timolol fixed combination ophthalmic solution (DTFC). The Aibeta Crossover Study Group in Japan compared the efficacy and tolerability of fixed combinations of BTFC versus DTFC when an additional fixed combination ophthalmic solution was prescribed in patients with open-angle glaucoma or ocular hypertension who had been treated with prostaglandin analogue monotherapy. We recruited 110 patients previously treated with prostaglandin analogue monotherapy at 20 clinical centers in Japan, then randomly assigned them to two alternative treatment groups: the BTFC to DTFC group or the DTFC to BTFC group, as an adjunctive therapy to prostaglandin analogues for total of 16 weeks. We compared the reduction in intraocular pressure, occurrence of side effects, eye discomfort after instillation, and patient preference between BTFC versus DTFC instillations. The intraocular pressure reduction of BTFC instillation was comparable to that of DTFC instillation, showing non-inferiority to DTFC (3.55 mmHg vs. 3.60 mmHg; P < 0.0001, mixed-effects model). Both eye drops caused few side effects; however, patients felt greater eye discomfort with DTFC than with BTFC (P < 0.0001). Because of less eye irritation, more patients preferred BTFC (P < 0.0001) over DTFC. We can recommend using BTFC for patients who feel eye discomfort with DTFC­prostaglandin analogue combination therapy.


Assuntos
Glaucoma de Ângulo Aberto , Timolol , Humanos , Timolol/efeitos adversos , Glaucoma de Ângulo Aberto/tratamento farmacológico , Estudos Cross-Over , Anti-Hipertensivos/efeitos adversos , Soluções Oftálmicas/uso terapêutico , Tartarato de Brimonidina/uso terapêutico , Pressão Intraocular , Prostaglandinas Sintéticas/uso terapêutico , Combinação de Medicamentos
19.
Front Med (Lausanne) ; 10: 1161568, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37484863

RESUMO

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.

20.
J Clin Med ; 12(5)2023 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-36902602

RESUMO

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.

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