Human recombinant nerve growth factor (Cenegermin) in a patient affected by primary congenital glaucoma with neurotrophic keratopathy.

PURPOSE: To report a case of neurotrophic keratopathy (NK) in a patient affected by primary congenital glaucoma (PCG) who undergone glaucoma drainage implant surgery. NK was successfully treated with human recombinant Nerve Growth Factor (Cenegermin) eye drops. CASE REPORT DESCRIPTION: A 46-years-old patient affected by primary congenital glaucoma underwent Ahmed glaucoma valve implantation in the right eye, after several unsuccessful surgeries to control intraocular pressure (IOP) since the age of three. Surgical intervention was performed without complications, and IOP was well-controlled post-operatively. However, 1 month after surgery, he developed NK with stromal ulceration, initially treated with a topical combination of preservative-free artificial tears and antibiotic ointment. As NK did not resolve, a new treatment with Cenegermin 20 µg/ml eye drops, 6 times daily, was started. OUTCOME: NK completely resolved after 8 weeks of Cenegermin treatment, with complete restoration of corneal integrity and improvement of corneal sensitivity and transparency. Visual acuity in the operated eye reverted to the pre-operative value. CONCLUSION: Cenegermin was extremely effective in restoring corneal integrity in this PCG patient with NK.

Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review.

Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.

Efficacy and Safety of PreserFlo® MicroShunt After a Failed Trabeculectomy in Eyes with Primary Open-Angle Glaucoma: A Retrospective Study.

INTRODUCTION: To evaluate the efficacy and safety of PreserFlo® MicroShunt in primary open angle glaucoma (POAG) eyes after a single failed trabeculectomy. METHODS: Retrospective review of POAG eyes with a failed trabeculectomy that underwent PreserFlo® MicroShunt implantation from March 2019 to November 2019, in two Italian glaucoma centers. Pre- and postoperative data were collected and compared. RESULTS: A total of 31 surgeries in 31 patients were reviewed. Mean preoperative IOP and mean preoperative number of medications were 24.12 ± 3.14 mmHg and 3.29 ± 0.64, respectively, and decreased to 12.56 ± 2.64 mmHg and 0.46 ± 0.77 at the 12-month postoperative follow-up visit (p < 0.01). The most frequent adverse events were transient hypotony (6 eyes, 19.3%) and choroidal effusion (3 eyes, 9.6%). In all cases spontaneous resolution was observed, with no intervention. CONCLUSION: In POAG eyes with a single failed trabeculectomy, the PreserFlo® MicroShunt was safe and effective in reducing the IOP after a 12-month follow-up. The PreserFlo® MicroShunt may represent a viable choice as a second surgery.

Worsening of gas exchange parameters at high FiO2 in COVID-19: misleading or informative?

BACKGROUND: In COVID-19, higher than expected level of intrapulmonary shunt has been described, in association with a discrepancy between the initial relatively preserved lung mechanics and the hypoxia severity. This study aim was to measure the shunt fraction and variations of PaO2/FiO2 ratio and oxygen alveolar-arterial gradient (A-a O2) at different FiO2. METHODS: Shunt was measured by a non-invasive system during spontaneous breathing in 12 patients hospitalized at COVID-19 Semi-Intensive Care Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, between October 22 and November 23, 2020. RESULTS: Nine patients were men, mean age (±SD) 62±15 years, mean BMI 27.5±4.8 Kg/m2. Systemic hypertension, diabetes type 2 and previous myocardial infarction were referred in 33%, 17%, and 7%, respectively. Mean PaO2/FiO2 ratio was 234±66 and 11 patients presented a bilateral chest X-ray involvement. Mean shunt was 21±6%. Mainly in patients with a more severe respiratory failure, we found a progressive decrease of PaO2/FiO2 ratio with higher FiO2. Considering (A-a O2), we found a uniform tendency to increase with FiO2 increasing. Even in this case, the more severe were the patients, the higher was the slope, suggesting FiO2 insensitiveness due to a shunt effect, as strengthened by our measurements. CONCLUSION: Relying on a single evaluation of PaO2/FiO2 ratio, especially at high FiO2, could be misleading in COVID-19. We propose a two steps evaluation, the first at low SpO2 value (e.g., 92-94%) and the second one at high FiO2 (i.e., >0.7), allowing to characterize both the amendable (ventilation/perfusion mismatch), and the fixed (shunt) contribution quote of respiratory impairment, respectively.

Single-Pass Mikrokeratome and Anterior Chamber Pressurizer for the Ultrathin Descemet-Stripping Automated Endothelial Keratoplasty Graft Preparation.

PURPOSE: To compare the reliability of microkeratome dissection with the anterior chamber pressurizer (ACP) system versus conventional pressurization for ultrathin Descemet-stripping automated endothelial keratoplasty (UT-DSAEK) graft preparation. METHODS: A retrospective review of a consecutive series of dissected donor corneas processed at Pavia Eye Bank for UT-DSAEK surgery was performed. Grafts were prepared through single-pass microkeratome dissection with artificial anterior chamber internal pressure regulation through either ACP or the conventional method using a water column with tube clamp. The target central graft thickness (CGT) was ≤100 µm. Cutting predictability was determined as the difference between the microkeratome head size and the thickness actually removed. Graft regularity was investigated as central-to-peripheral thickness increase, central-to-peripheral (CP) ratio, and graft thickness uniformity. Thickness was measured with anterior segment optical coherence tomography (horizontal and vertical meridians). RESULTS: Of the 265 UT-DSAEK grafts, ACP achieved the target "CGT ≤ 100 µm" in 87 of 120 (72.5%), whereas the conventional technique achieved the same in 85 of 145 (58.6%) (P = 0.018). ACP predictability was -3.9 µm (SD: 2.3), whereas predictability of the conventional technique was -54.6 µm (SD: 3.7) (P < 0.001). Thickness increased similarly (P = 0.212); CP ratio was better with ACP for only 2 mm diameter (P = 0.001); graft thickness uniformity was comparable (P > 0.05). CONCLUSIONS: Compared with conventional pressurization, ACP improved microkeratome-assisted preparation reliability of UT-DSAEK grafts, achieving CGT ≤ 100 µm with significantly higher frequency (P = 0.018) and predictability (P < 0.001). ACP improved CP ratio only at 2 mm (P = 0.001); for other graft thickness, the 2 methods proved equivalent.

Pre-operative conjunctival flora in patients with local and/or systemic risk factors for post cataract surgery infection in Northern Italy.

PURPOSE: To investigate the pre-operative conjunctival flora in patients undergoing cataract surgery with major local and/or systemic risk factors for developing post-operative infection. METHODS: A total of 83 patients underwent bacterial culture and sensitivity testing of conjunctival swabs obtained from both eyes because of local risk factors at the pre-operative visit (i.e. chronic blepharitis, conjunctivitis, or lacrimal system disease), and/or systemic risk factors (i.e. autoimmune or skin disorders) for developing post-operative infection. If the swab was found positive, an antimicrobial susceptibility test was performed, and a specific antibiotic therapy was administered. Surgery was performed when a repeat conjunctival swab (after antibiotic treatment) showed negative cultures. RESULTS: Cultures were found positive in 25.3% of patients. Staphylococcus aureus (18%) and Staphylococcus epidermidis (15%) were the most frequently isolated microorganisms. Gram-negative bacteria, including Pseudomonas aeruginosa, were present in nine cases (8%). CONCLUSION: Present results showed a low rate of swab positivity compared to previous published data, and slightly different microbial flora. The differences observed may be caused by geographical factors and/or to the specific characteristics of the subgroup of studied patients. Considering that the surface microbial flora is one of the major causes of endophthalmitis, this information may be useful in selecting antibacterial regimens to prevent serious ocular infections, and restrain the increasing problem of antibiotic resistance.

A rare case of endophthalmitis after bleb needle revision for glaucoma Xen® gel stent.

PURPOSE: To describe the first case of endophthalmitis caused by Sphingobacterium spiritivorum, a glucose non-fermenting Gram-negative rod, in a patient previously implanted with a Xen® gel stent. CASE REPORT DESCRIPTION: An 83-year-old patient, affected by open-angle glaucoma and with a previous surgery of combined cataract extraction and Xen gel stent implantation, developed endophthalmitis 1 month after bleb needle revision with 5-fluorouracil injection. At presentation, best corrected visual acuity was hand movement, hypopyon was evident into the anterior chamber and a flat bleb with no sign of leakage was present over the Xen gel implant. OUTCOME: Immediate pars plana vitrectomy was performed, with intravitreal antibiotic administration and silicon oil tamponade. S. spiritivorum was isolated from vitreous bacterial culture. According to the antibiogram, patient was treated with topical fortified ceftazidime eyedrops and appropriate systemic antibiotics (intravenous meropenem, 500 mg every 8 h for 7 days, followed by oral cotrimoxazole, 160 + 800 mg, twice a day for 10 days). After 2 weeks of treatment, ocular inflammation was resolved, best corrected visual acuity was 0.1 (Snellen chart) and intraocular pressure was 18 mm Hg without topical hypotensive therapy. CONCLUSION: S. spiritivorum was isolated for the first time as a causative agent of endophthalmitis in humans. Bleb needle revision in patients with Xen gel implant is not free of complications, and an attentive follow-up is required.

A case report of pediatric neurotrophic keratopathy in pontine tegmental cap dysplasia treated with cenegermin eye drops.

RATIONALE: To report the management of recalcitrant neurotrophic keratopathy in a pediatric patient affected by pontine tegmental cap dysplasia (PTCD) using topical human recombinant nerve growth factor (hrNGF, Cenegermin 20 µg/ml). To the best of our knowledge the present case is one of the few described in patients with congenital NK treated with Cenegermin, and the first in a patient affected by PTCD. PATIENT CONCERNS: A 9-year-old patient, affected by PTCD with bilateral cranial nerve V1 and VIII palsies, was referred to our hospital for visual disturbances and redness of the right eye due to persistent neurotrophic epithelial defect. The patient presented marked developmental delay, ataxia, bilateral hypoacusia, and bilateral corneal severe hypoaesthesia. Ocular history revealed multiple treatments in order to treat neurotrophic ulcer in the left eye. Four years later, he developed a persistent epithelial defect with corneal anesthesia in the right eye. DIAGNOSES: The impaired trigeminal nerve function, due to the underlying congenital disease, led to the development of moderate NK (stage II) in the right eye and a mild NK (stage I) in the left eye. INTERVENTIONS: Cenegermin 20 µg/ml eye-drop was administered in both eyes. Treatment was continued for 8 weeks. The patient was assessed after 4 and 8 week of treatment. At each follow-up visit, treatment efficacy and adverse events were evaluated. OUTCOMES: The use of Cenegermin eye drops facilitated the remarkable resolution of the neurotrophic keratopathy and the improvement of corneal sensitivity in both eyes. No local or systemic adverse events were observed. LESSONS: Topical Cenegermin 20 µg/ml was well-tolerated and may represent a valuable therapeutic option in the management of pediatric neurotrophic keratopathy.

A Case of Delayed-onset Hemorrhagic Choroidal Detachment After PreserFlo Microshunt Implantation in a Glaucoma Patient Under Anticoagulant Therapy.

PURPOSE: To describe a case of delayed-onset hemorrhagic choroidal detachment (HCD) in a patient affected by primary open-angle glaucoma (POAG) undergone PreserFlo Microshunt implantation. CASE REPORT DESCRIPTION: A 76-year-old patient with POAG, under treatment with Dabigatran (a novel oral anticoagulant), underwent an uncomplicated PreserFlo Microshunt implantation in the left eye. In the first postoperative day, intraocular pressure (IOP) was 6 mm Hg, conjunctival bleb was diffuse, anterior chamber (AC) deep, and device correctly positioned. Twelve days after surgery, the patient had emergency access complaining severe ocular pain and sudden vision loss. Ophthalmological evaluation revealed shallow AC and an IOP of 50 mm Hg. The fundus examination revealed almost kissing HCD. OUTCOME: Immediate topical treatment with atropine, aqueous humor suppressants, and corticosteroids was started. Because of high IOP, ocular pain, and the presence of almost kissing HCD, surgical drainage of suprachoroidal hemorrhage and removal of PreserFlo Microshunt were performed. An improvement of the clinical condition was observed in the following postoperative days, with partial resolution of the HCD and a decrease of the IOP. On the third postoperative day, there was a worsening of the HCD, with a reduction of the AC depth and IOP elevation. HCD was drained through the previously performed sclerotomies, associated with pars-plana vitrectomy and silicone-oil tamponade. HCD completely resolved during the following 6 weeks, with IOP reduction and partial improvement of visual acuity. CONCLUSION: Great attention must be taken in patients with glaucoma under treatment with a novel oral anticoagulant, also when planning PreserFlo Microshunt implantation.

Solitary Free-Floating Iris Cyst Associated With Bilateral Pigment Dispersion Syndrome: Report of a Case.

CASE REPORT: A 27-year-old white man with a 5-year history of pigment dispersion syndrome presented for evaluation. His past ocular history was significant for bilateral intraocular pressure elevation that had required intraocular pressure -lowering medication (beta-blocker-prostaglandin analogue fixed combination). On ophthalmic examination, the visual acuity was 20/20 without correction in both eyes. Anterior chamber slit-lamp examination revealed a pigmented round mass with modest transillumination at 6-o'clock position of the right eye. When asked, the patient reported that he had first noticed a shadow in his right eye during childhood when he was flexing his neck and keeping a face-down position for a few seconds. During a head-flexing test, the mass freely floated in the anterior chamber. When the patient extended the neck, the round mass could be seen in front of the pupil. After a few moments, the mass would slowly fall to the iridocorneal angle at the 6-o'clock position. Ultrasound biomicroscopy and anterior-segment optical coherence tomography confirmed that the lesion was a pigmented cyst without internal reflectivity. Specular microscopy examinations, performed to exclude cyst-induced corneal endothelium compromise, revealed a cell-density of ~3000 cells/mm in both eyes. Gonioscopy showed an open angle with trabecular pigmentation and funduscopy a cup-to-disc ratio of 0.5 bilaterally. Visual fields and optical coherence tomography tests were within normal limits. CONCLUSIONS: The etiology of free-floating iris cysts is unclear, but it is generally agreed that these masses are usually dislodged pigment epithelial cysts. This is the first report of a unilateral free-floating iris cyst associated with bilateral pigment dispersion syndrome.

Screening and Follow-Up of Acute ROP: Reproducibility of Fluorescein Angiography.

INTRODUCTION: Binocular indirect ophthalmoscopy (BIO) is fundamental for screening of retinopathy of prematurity (ROP). Digital retinal imaging devices with fluorescein angiography (FA) proved to be useful in screening and management of ROP. FA provides valuable additional information that is not detectable through ophthalmoscopy. FA images are relatively easy to interpret even by personnel without specific experience in ROP. The aim of this study is to evaluate reproducibility of FA for the screening and follow-up of ROP. METHODS: A total of 106 pairs of FA images of 30 eyes of 15 premature infants with stage II ROP were evaluated by 5 ophthalmologists: 2 experts, 2 non-experts, and 1 expert in reading FA in adult patients. Each operator gave a score to each of following parameters: leakage, ischemic areas, peripheral plus disease and vascular anomalies. The images were reviewed twice. Intra- and inter-concordance between the readers of the FA findings was evaluated by the means of Cohen's kappa coefficient (κ). RESULTS: The intra-operator concordance was very good (κ > 0.81) for all FA findings. Inter-operator concordance was good (κ > 0.41) for all operators and all FA findings. Global concordance was: substantial (intra-inter readers: κ > 0.61) for leakage, ischemic areas, and plus disease; almost perfect (κ > 0.81) for vascular anomalies; and moderate (κ = 0.41-0.60) for continuity/discontinuity of the ischemic areas. Total FA score was directly correlated to the percentage of treatment: a score ≥ 7 was correlated with 100% treatment and a score ≤ 3 with no treatment. Treatment timing was inversely correlated to FA score: a score ≥ 8 was correlated with a timely treatment (≤ 6 days), and a score ≤ 7 was correlated with a delayed treatment (< 10 days). CONCLUSION: This study showed that FA represents a reproducible imaging technique. It is useful for detecting ROP progression, and to define the treatment timing and type.

Surgery for Idiopathic Epimacular Membrane: Morpho-Functional Outcomes Based on the Preoperative Macular Integrity of the Photoreceptoral Junction. A Prospective Pilot Study.

INTRODUCTION: This study aimed to evaluate whether the preoperative integrity of the inner segment (IS) and outer segment (OS) photoreceptoral junction may influence the postoperative visual acuity, the macular morphology [assessed by spectral domain optical coherence tomography (SD-OCT)], and macular function (evaluated by multifocal electroretinogram, mfERG) in patients with idiopathic epimacular membrane (EMM) followed up for 6 months. METHODS: In this observational prospective study, 18 patients with EMM (mean age 72.5 ± 6.87 years) were enrolled. They were divided into two groups according to the preoperative integrity of the SD-OCT IS/OS junction: the EMM-I group with an intact IS/OS junction (11 patients, mean age 72.75 ± 3.49 years, providing 11 eyes) and the EMM-D group with a disrupted IS/OS junction (7 patients, mean age 70.86 ± 10.79 years, providing 7 eyes). For each enrolled patient, visual acuity (VA), mfERG, and SD-OCT were assessed at baseline (preoperative) and after 1, 3, and 6 months of follow-up after surgical treatment for EMM (pars plana vitrectomy with EMM removal and internal limiting membrane peeling). RESULTS: During the whole follow-up, VA was significantly increased in EMM-I eyes and unmodified in EMM-D eyes. In both groups, mfERG responses were not significantly different and not related to VA differences. In EMM-I eyes a significant reduction of central retinal thickness (CRT) was observed; however, it was not correlated with VA changes. In EMM-D eyes CTR was not significantly reduced, whereas macular volume was significantly reduced. These changes were significantly related to the corresponding differences in VA. CONCLUSIONS: Our results suggest that the preoperative evaluation of the integrity of the IS/OS junction is relevant for postoperative outcomes. The recovery in VA was higher in EMM-I eyes than in EMM-D eyes. Postoperative recovery was not associated with morphology of the outer retina (photoreceptor and outer nuclear layer) and the function of preganglionic elements.

Human vitreous concentrations of citicoline following topical application of citicoline 2% ophthalmic solution.

PURPOSE: To evaluate the presence and concentration of citicoline and its metabolites (choline, cytidine and uridine) in the vitreous body in human eyes after topical application of an ophthalmic solution of citicoline 2%, in vivo. METHODS: Twenty-one subjects affected by epiretinal membrane with surgical indication for pars-plana vitrectomy underwent treatment with 1 drop 3 times/day of a solution of citicoline 2%, 0.2% high molecular weight hyaluronic acid and 0.01% benzalkonium chloride (OMK1, Omikron Italia s.r.l., Rome, Italy) 14 days before surgery and 2 hours prior to surgery. Five additional patients served as controls and received an OMK1 vehicle solution without citicoline. The vitreous samples were taken at the beginning of the pars-plana vitrectomy and analyzed for qualitative/quantitative determination of vitreous concentration of citicoline and its metabolites by means of high performance liquid chromatography. RESULTS: The overall mean concentration of citicoline in patients treated with citicoline 2% solution was 406.72 ± 52.99 µg/mL, while the mean concentration of choline, cytidine and uridine was 180.88 ± 41.49 µg/mL, 44.45 ± 10.19 µg/mL and 330.41 ± 75.8 µg/mL, respectively. The concentration of citicoline in phakic eyes (n = 13, 366.61 ± 129.61 µg/mL) was lower compared to that found in pseudophakic eyes (n = 8, 435.89 ± 131.42 µg/mL) and the difference was not statistically significant. The concentration of citicoline in the control eyes was 45.66 ± 26.36 µg/mL, while the concentration of choline, cytidine and uridine were 17.21 ± 9.93 µg/mL, 6.24 ± 3.6 µg/mL and 172.80 ± 99.76 µg/mL, respectively. CONCLUSION: Citicoline can reach the human vitreous in high concentration when administered in ophthalmic solution. This evidence contributes to the build-up of the pyramid of the evidences required for determining the role of citicoline administered in ophthalmic formulation in retinal and optic nerve neurodegenerative diseases.

Canaloplasty in the Treatment of Open-Angle Glaucoma: A Review of Patient Selection and Outcomes.

Canaloplasty is a relatively new non-penetrating surgery for the reduction of intraocular pressure in patients affected by glaucoma. The technique uses a microcatheter to perform a 360 º cannulation of Schlemm's canal and leaves in place a tension suture providing an inward distension. It aims to restore the physiological outflow pathways of the aqueous humour and is independent of external wound healing. Several studies have shown that canaloplasty is effective in reducing intraocular pressure and has a low rate of complications, especially compared with trabeculectomy, the gold standard for glaucoma surgery. Currently, canaloplasty is indicated in patients with open-angle glaucoma, having a mild to moderate disease, and the combination with cataract phacoemulsification may provide further intraocular pressure reduction. This article reviews canaloplasty indications, results and complications and analyses its outcomes compared with traditional penetrating and non-penetrating techniques.

The Glaucoma Italian Pediatric Study (GIPSy): 3-Year Results.

PURPOSE: To investigate the efficacy and safety of a treatment strategy with latanoprost and dorzolamide in primary pediatric glaucoma patients partially responsive to surgery. PATIENTS AND METHODS: Children with primary pediatric glaucoma with postsurgical intraocular pressure (IOP) between 22 and 26 mm Hg were eligible. At baseline, patients were administered latanoprost once daily. Depending on IOP reduction, patients were allocated to continuation of latanoprost monotherapy or addition of dorzolamide twice daily, or switch to dorzolamide monotherapy 3 times daily. Patients in the dorzolamide monotherapy group with IOP reduction <20% from baseline were considered nonresponders. The primary endpoint was the percentage of responders. Study treatment continued for 3 years or until treatment failure. RESULTS: A total of 37 patients (61 eyes) were analyzed. The mean age of the patients was 4.1 years (SD: 3.8). In total, 43 eyes were included in the efficacy analysis. A total of 33 eyes (76.7%; 95% confidence interval, 61.4-88.2) were considered responders: 19 on latanoprost monotherapy, 11 on the latanoprost/dorzolamide combination, and only 3 on the dorzolamide monotherapy. The efficacy of pharmacological treatment was inversely related to central corneal thickness at the time of surgery and the age at the time of surgery. IOP reduction was 9.7 mm Hg (SD: 2.6) for latanoprost, 8.4 mm Hg (SD: 1.5) for the latanoprost/dorzolamide combination, and 9.3 mm Hg (SD: 2.5) for the dorzolamide monotherapy. None of the patients was withdrawn because of adverse events. CONCLUSIONS: Latanoprost alone or in combination with dorzolamide is safe and highly effective in lowering IOP in children after surgery. Nonresponders were mainly patients with early presentation of the disease.

The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Hyperfiltration Following Trabeculectomy: A Prospective Study.

INTRODUCTION: The aim of this study was to evaluate the effect of visually non-significant cataract extraction in patients with hypotony maculopathy and reduced visual acuity due to over-filtering blebs after trabeculectomy. METHODS: Patients with intraocular pressure (IOP) < 6 mmHg and documented hypotony maculopathy due to over-filtering blebs after trabeculectomy were prospectively recruited. Eligible patients underwent visually non-significant cataract phacoemulsification, no earlier than 12 weeks from the diagnosis of hypotony maculopathy. IOP and visual acuity before and after phacoemulsification were compared at 1 and 3 months from surgery. Correlations between age, time interval between surgeries, baseline IOP, bleb type and IOP and visual acuity changes at 3 months after phacoemulsification were investigated. RESULTS: From January 2010 to September 2014, 20 consecutive adult patients met the inclusion criteria. Before phacoemulsification, mean IOP was 3.1 ± 1.6 mmHg. Following phacoemulsification, mean IOP increased to 8.6 ± 4.1 mmHg at 1 month (p < 0.01) and to 9.1 ± 4.3 mmHg at 3 months (p < 0.01). IOP elevation following phacoemulsification was observed in 16 of 20 eyes (80%). Mean visual acuity improved from Snellen 0.5 ± 0.1 to 0.6 ± 0.1 at 1 month (p < 0.01) to 0.7 ± 0.2 at 3 months (p < 0.01) after phacoemulsification. In 4 eyes in which the IOP was not elevated, surgical revision of the previous trabeculectomy was performed. No significant correlations between investigated variables, visual acuity and IOP changes at 3 months after phacoemulsification were found. CONCLUSION: Phacoemulsification of visually non-significant cataract appears to be a safe and effective technique for managing chronic ocular hypotony with deep anterior chamber due to over-filtering blebs.