Argon laser trabeculoplasty for congenital ectropion uveae: Case report and review of the literature.

A 18-year-old woman with unilateral glaucoma secondary to congenital ectropion uveae (CEU) in the right eye, without other systemic and ocular associations. Intraocular pressure (IOP) was uncontrolled under topical therapy. The visual field (VF) was within normal limits; retinal nerve fiber layer (RNFL) thickness, as evaluated by Optical Coherence Tomography (OCT), was reduced. The patient refused surgical intervention. After evaluation of the iridocorneal angle, ALT was performed as follows: 95 spots were applied for the 270 ° of visible trabecular meshwork using a laser beam diameter of 50 µm, an exposure time of 0.1 s and a power of 750 mw). Mean IOP in the right eye, as evaluated by diurnal tonometric curve, was 10 mmHg, 16 mmHg and 20 mmHg respectively one month, four months and eight months after ALT, with no additional topical therapy, and 18 mmHg twelve months after ALT with topical therapy. CEU is a rare, non-progressive anomaly characterized by the proliferation of iris pigment epithelium on anterior surface of iris; glaucoma, in this disorder, is often poorly controlled with medical therapy alone. In a phase of initial glaucomatous damage and with a not particularly high IOP, as in this case, ALT could be an alternative therapeutic option at least in the short-term, when surgery is not feasible immediately. In fact, given its limited effectiveness over time, ALT can be used as a temporary control measure of IOP, pending surgery to become feasible.

Ex-Press Mini-Implant in the Management of Ocular Hypertension Secondary to Silicone Oil Tamponed.

This study was designed to compare the success of patients with ocular hypertension, secondary to pars plana vitrectomy and silicone oil tamponade, who received an Ex-PRESS Glaucoma Filtration Device P50 (Alcon Laboratories, Inc. Fort Worth, Texas, USA) to those who had conventional trabeculectomy. The records of 10 eyes of 10 consecutive subjects who had Ex-press implants and 9 eyes of 9 consecutive controls who had trabeculectomy procedures were reviewed. Success was defined as the reduction of intraocular pressure (IOP) in patients who did not require further glaucoma surgery in the eye of note during the entire follow-up. IOP was reduced by 10.3 ± 9.7 mmHg (range -31 to 3) in the Ex-PRESS group and by 13.9 ± 11.4 mmHg (range -35 to -4) in the trabeculectomy group. The difference in the percentage of IOP reduction between the standard trabeculectomy group (42.7%) and the Ex-PRESS group (35.9%) was not statistically significant (P = 0.72). The Ex-PRESS device seems to be at least as effective as the standard trabeculectomy in lowering the IOP of patients with hypertension secondary to pars plana vitrectomy and silicone oil tamponade. Even though the data suggested that the Ex-PRESS device did not result in an overall greater reduction in IOP than trabeculectomy, this does not reach statistical significance.

Surgical reposition of a dislocated Ex-PRESS miniature device.

PURPOSE: To present a technique of surgical reposition of the Ex-PRESS miniature glaucoma device when dislocated in corneal limbus. METHODS: A 54-year-old woman diagnosed with glaucoma, with a 3-month history of Ex-PRESS miniature implant, was referred to our department because of progressive intraocular pressure (IOP) rise. Slit-lamp biomicroscopy showed the posterior flange of the implant located in the corneal limbus; IOP was 34 mmHg. Surgical technique consisted of reopening of the conjunctiva and the scleral flap, excision of the corneal tissue covering the flange, and stitching the implant to the sclera with polyprolene suture. RESULTS: Postoperatively, IOP rapidly reduced to 5 mmHg and was balanced to 10 mmHg in the follow-up. CONCLUSIONS: Corneal dislocation of the Ex-PRESS implant, when associated with ocular hypertension, needs surgical treatment. Before considering a trabeculectomy, it could be valuable to attempt an implant reposition.

Ex-PRESS miniature glaucoma device in vitrectomized eyes.

PURPOSE: To evaluate the clinical efficacy and safety of the Ex-PRESS miniature glaucoma device placed under scleral flap for the treatment of ocular hypertension in eyes that underwent vitreoretinal surgery. METHODS: Vitrectomized patients who required glaucoma surgery for persistent ocular hypertension were included. The Ex-PRESS miniature glaucoma device was implanted under scleral flap. Postsurgical clinical outcomes and intraocular pressure (IOP) was monitored for 6 months after surgery. RESULTS: At 6 months, all the patients had an IOP lower than 18 mmHg, 3 of them without topical therapy. CONCLUSIONS: The use of the Ex-PRESS implant under scleral flap in eyes that underwent vitreoretinal surgery was effective for lowering IOP.

One-year clinical results of photorefractive keratectomy with a solid-state laser for refractive surgery.

PURPOSE: To investigate the safety, efficacy, and stability of photorefractive keratectomy (PRK) performed with a newly developed solid-state laser after 1-year follow-up. METHODS: The all-solid-state, Q-switched, frequency-shifted laser (LaserSoft; Katana Technologies, Berlin, Germany) with a Gaussian spot diameter of 0.2 mm and repetition rate of 1 kHz was used. Eleven eyes of six patients were treated with PRK. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, and corneal transparency. All patients were evaluated at 1, 3, 6, and 12 months postoperatively. RESULTS: At 12-month follow-up no eye lost lines of BSCVA and UCVA improved in all eyes. All eyes were within +/- 1.00 diopters (D) and 8 (73%) eyes were within +/- 0.50 D of emmetropia. CONCLUSIONS: Clinical results at 1 year were promising, with good safety, efficacy, and stability of the visual and refractive outcome.

Combined radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion.

To evaluate the efficacy of radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide for central retinal vein occlusion. Eight consecutive eyes with central retinal vein occlusion with a duration of less than 6 months, cystoid macular edema, and best-corrected visual acuity (BCVA) of less than 20/200 were enrolled. BCVA, intraocular pressure, fluorescein angiography, and optical coherence tomography were evaluated. After 4.75 +/- 0.7 months, BCVA significantly improved, intraocular pressure was well controlled, and fluorescein angiography showed perfused state and reduction of the number of retinal hemorrhages in all eyes. Optical coherence tomography revealed significant reduction of macular thickness. Bleeding in the neurotomy site occurred in 3 cases. Radial optic neurotomy, internal limiting membrane peeling, and intravitreal triamcinolone acetonide may be useful in the management of central retinal vein occlusion with macular edema.

Experimental and clinical investigation of efficiency and ablation profiles of new solid-state deep-ultraviolet laser for vision correction.

PURPOSE: To investigate the efficiency and ablation profiles of a newly developed, all-solid-state laser platform. SETTING: Experimental investigations performed at Katana Technologies GmbH, Kleinmachnow, Germany, and clinical study, at the Ophthalmology Clinic, University of Messina, Messina, Italy. METHODS: Experimental studies were performed on poly(methyl methacrylate) (PMMA) and in porcine eyes using an all-solid-state, Q-switched, frequency-shifted laser (LaserSoft, Katana Technologies GmbH) with a Gaussian spot with a diameter of 0.2 mm in the target plane, a peak fluence of 350 mJ/cm2, and a repetition rate of 1 kHz. The ablation profiles were determined using a profile meter (MicroProf, Fries Research and Technology GmbH), corneal topography was analyzed with a TMS 2N (Tomey Inc.), and corneal thickness was measured with an ultrasound pachymeter (DGH Technology). In the clinical study, 9 human eyes were treated with photorefractive keratectomy. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), corneal topography, and corneal transparency. The follow-up was 1 month for all eyes and 3 months for 4 eyes. Safety, efficacy, and predictability were evaluated. RESULTS: Smooth profiles were found in the PMMA and the porcine eyes. The topographic maps showed central steepening after the hyperopic ablation and slight central flattening of the surface after the myopic treatment. No eye lost lines of BSCVA; the UCVA improved in all eyes. All eyes were within +/-1.00 diopter (D) of emmetropia, and 89% were within +/-0.50 D. CONCLUSION: The efficacy of the ablation was good, with the profile meter results confirmed by the topographic measurements.