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.

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.

Evaluation of New and Preexisting Epiretinal Membranes Following Glaucoma Filtration Surgery.

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.

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.

Which is More Effective and Safer? Comparison of Propensity Score-Matched Microhook Ab Interno Trabeculotomy and iStent Inject.

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.

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.

Insertion of Ahmed Implant With Partial Buckle Resection: A Case Report.

This report describes a case of poor intraocular pressure control after the encircling procedure for traumatic retinal detachment. We inserted an Ahmed Glaucoma Valve Implant® (AGVI) with partial sponge resection and obtained good results. The results are reported here. An 11-year-old boy had a traumatic globe rupture in the right eye (OD). Corneo-scleral repair and lens extraction were performed on the injured eye. About one month after the injury, the intraocular pressure (IOP) of OD had increased to 25 mmHg. Glaucoma eye drops were started, and the IOP was subsequently controlled at 11-19 mmHg. Five months after the injury, the total retinal detachment was observed, and the encircling procedure with a silicone sponge was performed. Soon, right IOP control deteriorated, increasing to over 30 mmHg despite the maximum eye drops dosage. Given the poor condition of the cornea and iris after the trauma and the limited surgical space after the encircling procedure, we chose to partially cut the sponge and insert the AGVI. Intraoperatively, the adhesions between the conjunctiva and the Tenon's capsule were dissected. The sponge was partially cut at the 10 o'clock position, and both ends were sutured to the sclera. The AGVI was subsequently inserted into the space obtained. The plate was placed posterior to the sponge, and the tube was placed between the cut sponges and inserted into the anterior chamber. The right IOP was 8 mmHg on the day after the surgery and remained at 15-20 mmHg until nine months after surgery postoperatively under two medications. No recurrence of retinal detachment was further observed. In our case of post-traumatic glaucoma, the partial removal of the sponge along with the insertion of an AGVI has shown beneficial results in terms of IOP control.

Accuracy of pattern deviation in estimating the glaucomatous damage in the central 10° visual field in eyes with glaucoma and cataract.

BACKGROUND/AIMS: The accuracy of pattern deviation (PD) in estimating the damage to the glaucomatous visual field (VF) in the central 10° in eyes with glaucoma and cataract is unclear. METHODS: This retrospective study includes 63 eyes of 52 glaucoma patients who successfully underwent cataract surgery or cataract surgery plus iStent implantation. Using the Humphrey Field Analyser 10-2 test, VF was measured within 6 months preoperatively and postoperatively (VFpre and VFpost, respectively). The mean total deviation values in VFpost (mTDpost) indicates glaucomatous damage without cataract and the difference between this value and mean PD values in VFpre (mPDpre) was evaluated (εmPD). The effect of cataract was then evaluated as the difference between mTDpost and mTDpre (ΔmTD), while the effects of mTDpost and ΔmTD on εmPD were also assessed. In addition, based on preoperative visual acuity (VApre) and VFpre, the optimal model for predicting mTDpost was identified. The error of this method (εOptimalModel) was estimated as the difference against mTDpost, which was compared with εmPD. RESULTS: Compared with mTDpre, there was a significant improvement in mTDpost (p=0.028). A significant difference was observed between mPDpre and mTDpost (p<0.001). Further, εmPD significantly increased with the increase of mTDpost or ΔmTD (p<0.001 and p=0.0444, respectively). The absolute εOptimalModel was significantly smaller than the absolute εmPD (p<0.001). CONCLUSIONS: This study warns clinicians that PD of the central 10° VF might underestimate the glaucomatous VF damage with the progression of glaucoma and overestimate it as a cataract progresses.

Persistent corneal blood staining after microhook trabeculotomy: A case report.

INTRODUCTION: Hyphema, that is, massive anterior chamber hemorrhage, is one of the major complications after a recent minimally invasive glaucoma surgery. Hyphema along with high intraocular pressure increases the risk of corneal bloodstaining. PATIENT CONCERNS: A 71-year-old female was receiving 0.1% fluorometholone drops in both eyes for severe dry eye. She was also receiving antiplatelet agents for platelet aggregation hyperactivity and prednisolone for interstitial pneumonia internally. Her right eye was suffering from increased intraocular pressure. DIAGNOSIS: We diagnosed her right eye as steroid-induced glaucoma. INTERVENTIONS: We performed microhook trabeculotomy. OUTCOMES: At postoperative day 10, she had total anterior chamber hemorrhage and high intraocular pressure, and subsequently developed corneal blood staining at postoperative day 15, for which we performed anterior chamber cleaning. After that, we did not perform additional anterior chamber cleaning, and during the 1-year follow-up, a gradual improvement was noted in the entire cornea with reddish-brown opacity, from the periphery to the center. However, almost the entire pupil was still covered with opacity, and her visual acuity was at the light perception at the final visit. LESSONS: Corneal bloodstaining takes a considerable time to resolve and causes severe vision loss. Special attention should be given to persistent corneal blood staining when hyphema and high intraocular pressure are observed after minimally invasive glaucoma surgeries.

Comparison of surgical outcomes between initial trabeculectomy and Ex-PRESS in terms of achieving an intraocular pressure below 15 and 18 mmHg: a retrospective comparative study.

BACKGROUND: To evaluate the postoperative outcomes of initial trabeculectomy (Trab) and Ex-PRESS (EX) in terms of achieving an intraocular pressure (IOP) below 15 and 18 mmHg. METHODS: This study retrospectively analyzed 64 and 54 cases of Trab and EX, respectively, performed by the same surgeon with uniform management from April 2018 to March 2019. Surgical success was defined as 5 < IOP < 15 mmHg (criterion 1) and 5 < IOP < 18 mmHg (criterion 2) without additional glaucoma medication, needling, and bleb reconstruction 2 months after surgery. Survival analysis with Cox regression was performed to identify factors associated with postoperative outcomes. RESULTS: The Trab and EX groups had an IOP of 22.6 ± 6.2 vs. 21.8 ± 6.0 mmHg before surgery (P = 0.507), 12.6 ± 2.6 vs. 14.0 ± 4.4 mmHg (P = 0.06) at 6 months, 12.7 ± 2.3 vs. 12.9 ± 2.8 mmHg (P = 0.678) at 12 months, 13.3 ± 2.6 vs. 12.6 ± 2.8 mmHg (P = 0.260) at 18 months, and 13.2 ± 2.3 vs. 13.6 ± 2.8 mmHg (P = 0.444) at 24 months, respectively. The proportion of those with an IOP < 15 mmHg in the Trab and EX groups was 82% vs. 81% at 6 months, 68% vs. 62% at 12 months, 63% vs. 61% at 18 months, and 57% vs. 53% at 24 months, respectively. The log-rank test showed no significant difference between the groups for Criteria 1 (P = 0.755) and 2 (P = 0.138). The results of the multivariate logistic analysis identified only a high preoperative IOP as a risk factor for surgical failure (odds ratio for Criteria 1: 1.076, P = 0.009 and Criteria 2: 1.068, P = 0.048). CONCLUSION: Postoperative outcomes of Trab and EX suggested similar ability for achieving an IOP below 15 and 18 mmHg without medications and interventions.

Case Report: Microincision Vitreous Surgery Induces Bleb Failure in Eyes With Functional Filtering Bleb.

Purpose: To investigate the effect of microincision vitreous surgery (MIVS) on intraocular pressure (IOP) control in glaucomatous eyes with functional filtering bleb. Methods: We enrolled 18 patients (15 males; median age, 73 years) who previously had filtering surgery and underwent MIVS with functional filtering bleb. Kaplan-Meier method was used to calculate the survival rate with defined the failure as when more number of preoperative antiglaucoma medication was started or additional glaucoma surgery including bleb revisions were performed, and IOP increase of 20% (criteria 1) and 30% (criteria 2) from preoperative levels after 2 weeks of MIVS. Results: The median follow-up duration was 970 days. Preoperative IOP was 13.3 ± 3.8 mmHg (mean ± SD). Postoperative IOP were 14.7 ± 4.9 (P=0.365), 15.2 ± 3.5 (P=0.137), 16.4 ± 5.6 (P = 0.073), 17.6 ± 6.1(P = 0.020), and 14.5 ± 4.0 (P = 0.402) mmHg at 3, 6, 12, and 15 months and final visit, respectively (compared to preoperative IOP). The number of antiglaucoma medications was a median of 1.0 (range 0-4) preoperatively and 0 (0-4) at the final visit (P = 0.238). The survival rates were 55%/61% at 3 months, 50%/61% at 6 months, and 38%/55% at 12 months with criteria 1 and 2, respectively. Four eyes (22%) received additional glaucoma surgery during follow-up. Conclusion: After several months of MIVS, IOP was likely to increase. We should focus on IOP control by conducting long-term follow-ups.

Examination of the safety and effectiveness of low-concentration nitrous oxide anesthesia in cataract surgery.

PURPOSE: To investigate the effects in cataract surgery using local anesthesia along with a 30% low-concentration nitrous oxide (N2O) anesthesia compared with local anesthesia only. SETTING: Saneikai Tsukazaki Hospital. DESIGN: Retrospective, consecutive study. METHODS: Patients who underwent bilateral cataract surgery were enrolled. 37 patients using room air inhalation (Air group) and 45 patients using 30% low-concentration N2O anesthesia (70% oxygen, total 6 L/min) at surgery start (N2O group) were retrospectively reviewed. Systolic blood pressure (BPs), diastolic blood pressure (BPd), and heart rate (HR) at surgery start and end, and mean intraoperative oxygen saturation (% SpO2) were examined. Immediately following surgery, a questionnaire using the Visual Analog Scale score was done to determine intraoperative pain, anxiety, memory, and nausea. RESULTS: No systemic symptoms in all patients and ocular complications requiring treatment were observed. For the N2O and air groups, changes in BPs were -5.38 ± 11.07(P = .01) and 1.27 ± 13.61 mm Hg, and HR were -2.24 ± 6.76 and 0.89 ± 5.18 bpm (P = .001), respectively; intraoperative SpO2 was 99.05% ± 0.74% and 97.44% ± 1.31% (P < .001), intraoperative anxiety was 21.76 ± 23.2 and 37.17 ± 32.79 (P = .002), and intraoperative memory was 55.24 ± 36.8 and 68.91 ± 33.81 (P = .01), respectively. No patients experienced intraoperative nausea. There was no statistically difference in BPd (P = .47) and intraoperative pain (P = .62). CONCLUSIONS: Low-concentration N2O anesthesia may not cause respiratory depression, abnormal vital signs, or nausea in cataract surgery. It can suppress intraoperative anxiety and memory and decrease and stabilize vital signs.

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports.

RATIONALE: In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. PATIENT CONCERNS: Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment. DIAGNOSES: Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25. INTERVENTIONS: Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice. OUTCOMES: Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25. LESSONS: Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.

Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report.

RATIONALE: The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2-3 µg/min each), representing approximately 1% of the content of the anterior chamber; therefore, it is challenging to visualize its flow. PATIENT CONCERNS: A 69-year-old man who had high intraocular pressure (IOP) (>20 mm Hg) with the maximum glaucoma eyedrop dose and presented with severe visual field loss (Humphrey Field Analyzer 30-2: -26.32 dB) had been implanted with a 350-mm2 Baerveldt tube of the aqueous chamber type for refractory open-angle glaucoma. The IOP ultimately decreased (<15 mm Hg) with no need for glaucoma eyedrops. DIAGNOSES: After the procedures, a fibrin membrane repeatedly formed on the anterior surface of the intraocular lens. INTERVENTIONS: This issue was resolved by two rounds of neodymium-doped yttrium aluminum granet (Nd:YAG) laser surgery and prescription steroidal eyedrops. OUTCOMES: During the laser surgery, an unusual and unintended fibrin flap appeared at the opening of the Baerveldt tube; this flap moved synchronously with the heartbeat, as verified by checking the pulse at the radial artery of the wrist. The fibrin flap mimicked the behavior of a cardiac valve, and the aqueous humor and stray fibrin particles mimicked the blood in the chambers of the heart. Although the Baerveldt tube itself is an artificial instrument that is not present in normal human eyes, we hypothesize that our observation shows the fundamental mechanism of aqueous humor drainage. LESSONS: This novel, vividly descriptive observation highlights the important role of the heartbeat as a drainage pump in aqueous humor flow dynamics and IOP homeostasis, which are treatment targets for glaucoma, the leading cause of blindness.

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.

Long-Term Follow-Up After Successful Trabeculectomy: A Case Report of Reversal of Cupping and Recovery of Visual Field Progression.

Glaucoma is one of the leading causes of blindness worldwide, and reduction of intraocular pressure (IOP) is the only available evidence-based treatment that reduces visual field deterioration in glaucoma. We present a representative case of structural recovery and recovery of visual field progression after successful trabeculectomy (TLE) with long-term follow-up. A 35-year-old woman with glaucoma visited our hospital in 2008. The IOP in her right eye was 11 mmHg at the first visit, and subsequently increased to values in the high teens to 20 mmHg despite treatment with anti-glaucoma eye drops. During this period, the progression of this eye's visual field deterioration was fast (mean deviation [MD] slope = -0.63 dB/year) and the optic disc cupping was advanced. In the seven-year period after successful TLE in 2014, the IOP declined to between 8 and 12 mmHg without any anti-glaucoma medication. During the first two years after TLE, the MD values were poorer than those before TLE. However, by 2020, MD values improved gradually to a state better than that before the surgery (MD slope during this period was +0.75 dB/year). The appearance of the optic disc was monitored using fundus photography, which showed optic disc morphological changes during topical glaucoma medication before and after TLE. In particular, a remarkable reversal of optic disc cupping enlargement started at two weeks after TLE, and the optic disc shape in 2021 was similar to that in 2008. Minimally invasive glaucoma surgeries are often preferred; however, our findings suggest that successful TLE followed by long-term rigorous IOP control can result in structural recoveries. Additionally, despite the deterioration in visual field in the early years after TLE, in the long term, it may settle down to the same level before the surgery with recovery of visual field progression, which may be a part of functional recovery.

Utility and safety of low-concentration nitrous oxide anesthesia in ptosis surgery.

ABSTRACT: To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54 successive patients with blepharoptosis who underwent bilateral levator aponeurosis advancement and on whom skin resection performed by the same surgeon between August 2016 and July 2017. Among these patients, 27 were operated with a local anesthesia injection (air group) and 27 with a local anesthesia injection and low-concentration N2O anesthesia (N2O group). All N2O cases used a total of 6 L of gas comprising 70% oxygen and 30% N2O. Preoperative and postoperative blood pressure (BP) and heart rate (HR) and intraoperative pain, anxiety, nausea, and memory were measured immediately after surgery using visual analog scale score (VASS). Additionally, perioperative side effects were examined.There was no significant difference in age, sex, and preoperative and postoperative margin reflex distance (MRD) between the 2 groups (all P > .05). The intraoperative mean peripheral oxygen saturation was significantly higher (97.5% ±â€Š1.6% vs 99.5% ±â€Š.6%, P < .001), intraoperative HR was significantly lower (78.2 ±â€Š12.8 vs 70.7 ±â€Š11.6 bpm, P = .02), and operation time was significantly shorter (33.1 ±â€Š8.1 vs 29.4 ±â€Š10.3 minutes, P = .03) in the N2O group than in the air group.Difference between intraoperative and preoperative systolic BP (BPs) (+15.8 ±â€Š18.0 vs + 3.1 ±â€Š21.7 mm Hg, P = .02), diastolic BP (BPd) (+7.0 ±â€Š17.4 vs -2.3 ±â€Š13.6 mm Hg, P = .04), and HR (3.2 ±â€Š8.5 vs -3.9 ±â€Š9.4 bpm, P = .01) was significantly lower in the N2O group than in the air group.VASS of intraoperative pain was significantly lower in the N2O group than in the air group (49.5 ±â€Š24.7 vs 22.6 ±â€Š14.9, P < .001), whereas intraoperative anxiety and memory did not present significant differences between the groups (P = .09 and P = .45, respectively). Intraoperative nausea score was 0 for all cases in both groups. There was no other side effect.Ptosis surgery with anesthesia using 30% N2O may effectively suppress intraoperative BP and HR along with pain and shorten the operation time without side effects such as nausea.

Comparison of semicircular and bent tips regarding regional differences in oscillation amplitude under various torsional power settings.

PURPOSE: To analyze the difference between the behavior of semicircular (balanced) and bent (mini) tips at 20 incremental torsional power settings. SETTING: Tsukazaki Hospital, Himeji, Japan. DESIGN: Experimental study. METHODS: Using an ultra-high-speed video camera HPV-X2, the 2 tips during torsional oscillation were recorded, comparing tip behavior at power settings from 5% to 100% by tracking points 1 to 5 (tip end and at 1325, 2650, 3975, and 5035 µm from the tip end). RESULTS: Both tips increased their amplitude widths, drawing an S-curve at all points as the torsional power setting was increased, reaching their upper limits from 70% to 90% torsional power. At all 20 power settings, both tips showed significantly different amplitudes (all P < .01), and the difference of the amplitude increased as the power setting increased. Although, at points 1 and 3, the balanced tip amplitude was nearly 1.5 times larger than the mini tip amplitude, the amplitude difference was 10 µm or less at points 2 and 4. At point 5, the mini tip amplitude was at least 3 times more than the balanced tip amplitude. CONCLUSIONS: The amplitude does not increase proportionally and varies markedly with the tip shape on reaching the upper limit, suggesting that a higher power setting might not contribute greatly to nuclear fragmentation. The balanced tip might cause greater damage to surrounding tissues if it is inserted at approximately 3 mm from the wound site. To obtain maximum shaft stability using the balanced tip, it is important to insert at least 5 mm.

The Relationship Between Corneal Hysteresis and Progression of Glaucoma After Trabeculectomy.

PURPOSE: The purpose of this study was to investigate the association of corneal hysteresis (CH) measured with Ocular Response Analyzer on the progression of glaucoma after trabeculectomy. MATERIALS AND METHODS: Twenty-four eyes of 19 patients with primary open-angle glaucoma underwent trabeculectomy. A series of visual fields (Humphery Field Analyzer 24-2 SITA-standard) were measured starting after 6 months after trabeculectomy (4.2±5.0 y, mean±SD). The mean total deviation (mTD) of the 52 test points were calculated. In addition, the mTD was divided into the following areas: central area (within central 10 degrees), superior area and inferior area: mTDcentre, mTDsuperior, and mTDinferior, respectively. The relationship between each area's progression rate of mTD and the 7 variables of baseline age, central corneal thickness, baseline mTD, mean intraocular pressure (IOP), SD of IOP divided by the mean IOP, the difference between baseline IOP obtained before the initiation of any treatment, mean IOP, and CH were analyzed using the linear mixed model, and the optimal model was selected using the model selection method with the second ordered Akaike Information Criterion. RESULTS: In the optimal model for mTD progression rate, only CH was selected with the coefficient of 0.11. The optimal model for the mTDcentre progression rate included mean IOP with the coefficient of -0.043 and CH with the coefficient of 0.12, and that for mTDinferior included only CH with the coefficient of 0.089. There was no variable selected in the optimal model for the mTDsuperior progression rate. CONCLUSION: CH is a useful measure in the management of glaucoma after trabeculectomy.