Cutting the subconjunctival fragment of the XEN gel implant during needling procedure.

PURPOSE: To describe the case and the follow-up of an inadvertently damaged XEN gel implant during needling procedure. METHODS: Case report. RESULTS: A 60-year-old African American patient underwent an uncomplicated combined phacoemulsification with the insertion of a XEN gel implant. Two months postoperatively, a needling procedure was required. During the needling procedure, a fragment of the XEN gel implant was inadvertently damaged. One month postoperatively, the intraocular pressure was still controlled and the bleb was functioning well. CONCLUSION: This case report reveals a previously unreported complication concerning XEN gel implant. It is important for the surgeon to pay attention during needling procedure, especially if there is a subconjunctival hemorrhage impairing the view, to defer the procedure until good visibility exists.

Changes in the Anterior Lamina Cribrosa Morphology with Glaucoma Severity.

This study was designed to evaluate if primary open angle glaucoma (POAG) and its severity are associated with the shape of the lamina cribrosa (LC) as measured by a global shape index (LC-GSI), or other indices of LC curvature or depth. Optical coherence tomography (OCT) scans of the optic nerve head (OHN) were obtained from subjects with POAG (n = 99) and non-glaucomatous controls (n = 76). ONH structures were delineated, the anterior LC morphology reconstructed in 3D, and the LC-GSI calculated (more negative values denote greater posterior concavity). Anterior LC depth and 2D-curvature were also measured. Severity of glaucoma was defined by the extent of visual field loss, based on the Hodapp-Parrish-Anderson grading. Linear regression analyses compared LC characteristics between controls, mild-moderate, and advanced POAG groups. After adjusting for age, gender, ethnicity, intraocular pressure, axial length and corneal curvature, the LC-GSI was most negative in the advanced POAG group (mean [standard error] = -0.34 [0.05]), followed by the mild-moderate POAG group (-0.31 [0.02]) and then controls (-0.23 [0.02], PTrend = 0.01). There was also a significant trend of increasing LC depth and greater LC horizontal curvature with increasing severity of glaucoma (PTrend = 0.04 and 0.02, respectively). Therefore, with more severe glaucoma, the LC-GSI was increasingly more negative, and the anterior LC depth and curvature greater. These observations collectively correspond to greater cupping of the ONH at the level of the LC. As the LC-GSI describes the 3D anterior LC morphology, its potential usage may be complementary to existing ONH parameters measured on OCT.

Optic nerve head cupping in glaucomatous and non-glaucomatous optic neuropathy.

BACKGROUND: Enlargement of optic disc cupping is seen both in glaucoma and in neurological disorders. We used enhanced depth imaging with spectral-domain optical coherence tomography to differentiate glaucoma from non-glaucomatous optic neuropathy. METHODS: The optic discs were scanned in this prospective comparative study, and the lamina cribrosa (LC) thickness and anterior laminar depth (ALD) in the central, superior and inferior optic nerve head, and peripapillary choroidal thicknesses, were measured. RESULTS: There were 31 eyes of 31 patients with severe glaucoma and 33 eyes of 19 patients with non-glaucomatous cupping. Eyes of 29 healthy controls were also enrolled. There was no significant difference in the cup-to-disc ratio and in the average peripapillary nerve fibre layer thickness between the glaucoma and non-glaucomatous cupping groups (p>0.99). The average peripapillary choroidal thickness was thinner in glaucoma eyes than in the control eyes after adjusting for age and axial length. Glaucomatous and non-glaucomatous eyes had greater ALD and thinner LC than the control eyes (p<0.001 for both). ALDs of glaucoma eyes were deeper than non-glaucomatous eyes (p=0.01 for central ALD) when age, axial length and peripapillary choroidal thickness were included in the linear mixed model. Prelaminar thickness and LC thickness of glaucoma eyes were not different from non-glaucomatous eyes after adjusting. CONCLUSION: Deeper ALD was observed in glaucoma than non-glaucomatous cupping after adjusting for choroidal thickness.

Cross-Sectional Imaging Analysis of Epiretinal Membrane Involvement in Unilateral Open-Angle Glaucoma Severity.

Purpose: To determine the relevance of epiretinal membranes (ERMs) in primary open-angle glaucoma (POAG) and potential risk for glaucoma severity. Methods: Sixty eyes of 30 patients with POAG who had a unilateral ERM were analyzed; 60 nonglaucomatous eyes of 30 patients with a unilateral ERM also were recruited in this institutional cross-sectional study. Patients underwent swept-source (SS) optical coherence tomography (OCT) imaging and visual field testing. Intraindividual differences in the SS-OCT retinal nerve fiber layer (RNFL) disc cupping area measurements and visual field outcomes were analyzed in the two groups. Results: In patients with POAG, the mean circumpapillary RNFL thickness in the eyes with an ERM was 75.6 ± 16.5 µm superiorly and 71.8 ± 26.0 inferiorly compared with the fellow eyes without an ERM (87.2 ± 23.6 µm, P = 0.0061 and 81.3 ± 27.7 µm, P = 0.034, respectively). The areas of disc cupping and cup-to-disc ratio seen on OCT horizontal and vertical B-scans were larger in eyes with an ERM than in the fellow eyes without ERM (P = 0.0004 and P = 0.0011, respectively). The average mean deviations were -11.6 ± 7.5 dB in the ERM group and -8.19 ± 6.4 dB in the group with no ERM (P = 0.029). Eyes with an ERM received more antiglaucoma eye drops (P = 0.018). Those differences were not seen between eyes with an ERM or fellow eyes in patients without glaucoma. Conclusions: The presence of an ERM can be a potential risk factor for unilateral severity in eyes with POAG.

Ultrasound biomicroscopy in nonperforating filtering surgery with intraoperative 5-fluorouracil and no implant: long-term results.

PURPOSE: To evaluate the long-term morphologic changes in the anterior segment structures after nonpenetrating filtering surgery (NPFS) supplemented with 5-fluorouracil (5-FU) and no scleral implant using ultrasound biomicroscopy (UBM). METHODS: Thirteen eyes of 13 consecutive patients who underwent NPFS with intraoperative 5-FU under the conjunctiva and the scleral flap and no implant were evaluated in an observational nonrandomized, consecutive case series study conducted 2 years postoperatively. Patients were assessed for the presence of a subconjunctival filtering bleb, the volume of an intrascleral cavity, and a suprachoroidal hypoechoic area. The intraocular pressure(IOP) was measured preoperatively and postoperatively at the time of UBM. RESULTS: The IOP decreased significantly (p=0.01) from 24-/+7.6 mmHg to 13.7-/+4.1 mmHg. In most patients (69.2%), the postoperative IOP decreased at least 30% from the preoperative value without medications and in 84.6% with medication. UBM showed a subconjunctival empty space in 92.3% of eyes. In 84.6% of patients, an intrascleral cavity was seen, the mean volume of which was 1.68 mm(3) (range, 0-4.07). We found a negative correlation between the height, width, and volume of the intrascleral lake and the IOP. In 92.3% of eyes, a hypoechoic area in the suprachoroidal space also was seen. CONCLUSIONS: UBM showed a filtering intrascleral cavity, subconjunctival filtering bleb, and a suprachoroidal space after NPFS supplemented with 5-FU under the conjunctiva and the scleral flap without an implant.

Relationship between the effect of carbon dioxide inhalation or nilvadipine on orbital blood flow in normal-tension glaucoma.

PURPOSE: To investigate the relationship between the effect of carbon dioxide (CO2) inhalation or oral nilvadipine, a calcium-channel blocker, on orbital blood flow in patients with normal-tension glaucoma, as determined by color Doppler imaging. PATIENTS AND METHODS: Sixteen patients with normal-tension glaucoma (mean age, 55.6+/-9.8 years; male:female ratio, 3:13) underwent color Doppler imaging to measure the resistance index, and peak systolic and end-diastolic blood flow velocities of the ophthalmic artery, central retinal artery, and nasal and temporal short posterior ciliary arteries. Measurements were taken before and during CO2 supplementation sufficient to increase the end-tidal CO2 partial pressure by 10%. The color Doppler imaging measurements were repeated after 2 to 4 weeks of treatment with 2 mg oral nilvadipine, and comparisons were made between the effects of the two treatments. RESULTS: Both CO2 inhalation and nilvadipine treatment significantly reduced the resistance index in the central retinal artery, nasal short posterior ciliary artery, and temporal short posterior ciliary artery. There was a significant correlation between the effects of the two treatments on the difference in the resistance indexes of the ophthalmic artery and central retinal artery, but not on those of the nasal or temporal short posterior ciliary artery. CONCLUSIONS: Both CO2 inhalation and oral nilvadipine significantly reduce the resistance index measured by color Doppler imaging in orbital vessels. The effect of oral nilvadipine might be predicted by CO2 inhalation in patients with normal-tension glaucoma.

Changes in optic nerve head blood flow and retrobular hemodynamics following calcium-channel blocker treatment of normal-tension glaucoma.

BACKGROUND: Because calcium channel blockers reduce vascular resistance, they may have a clinical application in the treatment of normal-tension glaucoma (NTG). This study investigates changes in both the optic disc blood flow and the hemodynamics of retrobulbar vessels in NTG patients after the systemic administration of a calcium channel blocker. METHODS: Twelve eyes of 12 NTG patients (mean age 57.6 +/- 15.3 years) were examined before and after a 4-week treatment with 2 mg b.i.d. oral nilvadipine, an L-typc calcium channel blocker. By scanning laser-Doppler flowmetry (SLDF), we obtained the velocity, flow, and volume from within a 10 x 10 pixel window placed on the temporal rim region of the optic disc perfusion map. By ultrasound color Doppler imaging (CDI), we measured the peak systolic velocity (PSV) and the end diastolic velocity (EDV) of the ophthalmic artery (OA), central retinal artery (CRA), nasal posterior ciliary artery (NPCA), and temporal posterior ciliary artery (TPCA). We then calculated a resistance index (RI) for each vessel. RESULTS: After treatment, the flow and velocity of the optic disc blood flow significantly increased (P < 0.05). Nilvadipine also significantly reduced RIs of the CRA, NPCA, and TPCA (P < 0.05), and increased both the PSV of the NPCA and the EDVs of the CRA, NPCA, and TPCA. The percent change in velocity correlated significantly with the percent changes of the CRA RI and NPCA RI. CONCLUSIONS: Oral nilvadipine appears to reduce orbital vascular resistance, which consequently increases the optic disc blood flow.

[Calcium channel blockers in the treatment of primary open-angle glaucoma]. / Blokatory kal'tsievykh kanalov v lechenii pervichnoi otkrytougol'noi glaukomy.

Study of nifedipine effect on the hemodynamics in the orbital and central retinal arteries showed that nifedipine therapy in a dose of 10 mg 3 times a day for 1 month results in decrease of resistance of the orbital and central retinal arteries in patients with stage I primary open-angle glaucoma. No changes in the visual field, arterial pressure, or hydrodynamics were noted.

Evaluation of optic disc cupping using high-resolution ocular ultrasound.

BACKGROUND/PURPOSE: The new Biovision B-Scan Probe has greater resolution than its predecessors because of its posteriorly placed focus (25 mm inside the eye) and the consequent reduction in size of the sound field. We investigated the accuracy, reproducibility and test-retest variability of two-dimensional optic cup measurements using this new-generation B-scanner. METHODS: One randomly selected eye of 20 patients underwent five repeated measurements of vertical (VOCD) and horizontal optic cup diameters (HOCD), and optic cup depth, using confocal scanning laser tomography (Heidelberg Retinal Tomograph) and high-resolution ultrasound (Biovision, Chiron Vision, UK) on two separate occasions. There was one operator per instrument who was masked to all clinical data and previous measurements. Accuracy of ultrasound readings was quantified by comparing the results with those of Heidelberg Retinal Tomography (HRT). RESULTS: The 95% confidence interval for the bias of echographic vertical and horizontal cup diameter measurements was -95 +/- 48 microns and -19 +/- 72 microns respectively, and -87 +/- 328 microns for cup depth readings. The indices of reproducibility (mean coefficient of repeatability +/- SD) were: VOCD: 177 +/- 105 microns [B-scan] 209 +/- 100 microns [HRT]; HOCD: 179 +/- 61 microns [B-scan], 205 +/- 101 microns [HRT]; cup depth: 206 +/- 63 microns [B-scan], 204 +/- 124 microns [HRT]. Ninety-five per cent limits of agreements between initial and retest values for ultrasound were 18 +/- 136 microns [VOCD], 2 +/- 144 microns [HOCD] and 4 +/- 156 microns [cup depth], compared with 1 +/- 104 microns [VOCD], 20 +/- 102 microns [HOCD] and 3 +/- 168 microns [cup depth] for scanning laser tomography. CONCLUSION: The results demonstrate that measurements of optic cup diameter and depth using ultrasound correlate strongly with corresponding HRT readings. These echographic measurements are reproducible, and not subject to clinically meaningful test-retest variability. This technique of measuring two-dimensional cup parameters does not require expensive specialist equipment and has many potential clinical applications which are discussed.

A color Doppler analysis of nifedipine-induced posterior ocular blood flow changes in open-angle glaucoma.

PURPOSE: This pilot study used color Doppler imaging to investigate the effects of nifedipine on the posterior ocular blood flow of patients with glaucoma progression at normal intraocular pressures. PATIENTS AND METHODS: Eighteen patients, 11 men and seven women with a median age of 61.7 years, were imaged before and 6 weeks after the initiation of 30 mg of sustained-release nifedipine (Procardia XL; produced by either Pfizer or Pratt) daily. RESULTS: There was no statistically significant change in the blood velocity of the ophthalmic artery, central retinal artery, and main nasal and temporal short posterior ciliary arteries after treatment with nifedipine. CONCLUSION: The routine use of nifedipine in patients with normal tension glaucoma progression is not supported by this study.