Intermediate-term and long-term outcome of piggyback drainage: connecting glaucoma drainage device to a device in-situ for improved intraocular pressure control.

IMPORTANCE: This study provides results of a treatment option for patients with failed primary glaucoma drainage device. BACKGROUND: The study aimed to describe and evaluate the long-term intraocular pressure control and complications of a new technique joining a second glaucoma drainage device directly to an existing glaucoma drainage device termed 'piggyback drainage'. DESIGN: This is a retrospective, interventional cohort study. PARTICIPANTS: Eighteen eyes of 17 patients who underwent piggyback drainage between 2004 and 2013 inclusive have been studied. All patients had prior glaucoma drainage device with uncontrolled intraocular pressure. METHODS: The piggyback technique involved suturing a Baerveldt (250 or 350 mm) or Molteno3 glaucoma drainage device to an unused scleral quadrant and connecting the silicone tube to the primary plate bleb. MAIN OUTCOME MEASURES: Failure of intraocular pressure control defined as an intraocular pressure greater than 21 mmHg on maximal therapy on two separate occasions or further intervention to control intraocular pressure. RESULTS: The intraocular pressure was controlled in seven eyes (39%) at last follow-up with a mean follow-up time of 74.2 months. The mean preoperative intraocular pressure was 27.1 mmHg (95% confidence interval 23.8-30.3) compared with 18.4 mmHg (95% confidence interval 13.9-22.8) at last follow-up. The mean time to failure was 57.1 months (95% confidence interval 32.2-82), and the mean time to further surgery was 72.3 months (95% confidence interval 49.9-94.7). Lower preoperative intraocular pressure was associated with longer duration of intraocular pressure control (P = 0.048). If the intraocular pressure was controlled over 2 years, it continued to be controlled over the long term. Two eyes (11%) experienced corneal decompensation. CONCLUSIONS: Piggyback drainage represents a viable surgical alternative for the treatment of patients with severe glaucoma with failing primary glaucoma drainage device, particularly in those at high risk of corneal decompensation.

Branch retinal vein occlusion: epidemiology, pathogenesis, risk factors, clinical features, diagnosis, and complications. An update of the literature.

BACKGROUND/PURPOSE: Retinal vein occlusion is the second most common retinal vascular disorder after diabetic retinopathy and is considered to be an important cause of visual loss. In this review, the purpose is to make an update of the literature about the classification, epidemiology, pathogenesis, risk factors, clinical features, and complications of branch retinal vein occlusion (BRVO). METHODS: Eligible articles were identified using a comprehensive literature search of MEDLINE, using the terms "branch retinal vein occlusion," "pathogenesis," "epidemiology," "risk factors," "clinical features," "diagnosis," and "complications." Additional articles were also selected from reference lists of articles identified by the electronic database search. RESULTS: Classification, epidemiology, pathogenesis, risk factors, clinical features, and complications are analyzed. CONCLUSIONS: Branch retinal vein occlusion has an incidence of 0.5% to 1.2%. Several risk factors, such as hypertension, hyperlipidemia, diabetes mellitus, thrombophilia and hypercoagulation, systemic and inflammatory diseases, medications, and ocular conditions, have found to be associated with BRVO. The symptoms depended on the site and severity of the occlusion. The average reduction in visual acuity for ischemic BRVO is 20/50 and for nonischemic BRVO is 20/60. Acute BRVO can be detected by fundoscopy, where flame hemorrhages, dot and blot hemorrhages, cotton wool spots, hard exudates, retinal edema, and dilated tortuous veins can be observed. Chronic BRVO would be more subtle and characterized by the appearance of venous collateral formation and vascular sheathing, in addition to complications previously mentioned. Areas of ischemia can be evaluated using fluorescein angiography. The extent of macular edema and the presence of retinal detachment can be detected by fundoscopic examination or fluorescein angiography, although optical coherence tomography is considered to be the best method. As far as complications, the most common is macular edema, followed by retinal neovascularization, vitreous hemorrhage, or retinal detachment.

Visual outcomes of age-related macular degeneration patients undergoing intravitreal ranibizumab monotherapy in an urban population.

AIM: To compare the visual outcomes of an urban population with age-related macular degeneration (AMD) undergoing ranibizumab monotherapy to the results from major clinical trials. PROCEDURES: Prospective data was collected from 164 wet AMD patients receiving intravitreal ranibizumab. Visual acuities were obtained with the Early Treatment Diabetic Retinopathy Study chart. All patients underwent a loading phase of three monthly treatments of ranibizumab. Patients were monitored monthly using a retreatment criterion. Treatment was further individualized by sequentially lengthening follow-up intervals when stable. RESULTS: At 12 and 24 months, respectively, the percentage of eyes that maintained vision was 91% and 88.6%. We found that 20.3% of eyes had improved vision at 12 months and 20% at 24 months. At 12 months, 8.3% of eyes' vision worsened and 12% worsened at 24 months. CONCLUSION: Individualized ranibizumab monotherapy is effective in preserving vision in wet AMD and follows the same trends as the pivotal trials.

Changes in expression of P2X1 receptors and connexin 43 in the rat myometrium during pregnancy.

OBJECTIVE: To investigate the expression of P2X(1) receptors and connexin 43 in gap junctions between smooth muscle cells. Contraction mediated by P2X receptors is known to occur in the bladder and male reproductive tract, and cell-cell coupling of smooth muscle via gap junctions is essential for synchronized rhythmic activity of these tissues. DESIGN: We selected for this study rat myometrial smooth muscle during pregnancy and at postpartum day l. SETTING: University medical school. ANIMAL(S): Laboratory rats. INTERVENTION(S): Rats were mated and became pregnant. MAIN OUTCOME MEASURE(S): Immunostaining and fluorescence and confocal microscopy. RESULT(S): The level of P2X(1) receptor expression remained low throughout pregnancy (days 4 to 20) but was greatly up-regulated at day 22 (postpartum day 1). Connexin 43 expression showed a pattern of up-regulation, with progression through pregnancy and peaking near labor, but exhibited a rapid down-regulation after parturition. CONCLUSION(S): The functional significance of the changes in connexin 43 and P2X(1) receptor expression that have been observed is discussed in relation to triggering and modulation of uterine contractility during and after pregnancy.