Association of Rare CYP39A1 Variants With Exfoliation Syndrome Involving the Anterior Chamber of the Eye.

Importance: Exfoliation syndrome is a systemic disorder characterized by progressive accumulation of abnormal fibrillar protein aggregates manifesting clinically in the anterior chamber of the eye. This disorder is the most commonly known cause of glaucoma and a major cause of irreversible blindness. Objective: To determine if exfoliation syndrome is associated with rare, protein-changing variants predicted to impair protein function. Design, Setting, and Participants: A 2-stage, case-control, whole-exome sequencing association study with a discovery cohort and 2 independently ascertained validation cohorts. Study participants from 14 countries were enrolled between February 1999 and December 2019. The date of last clinical follow-up was December 2019. Affected individuals had exfoliation material on anterior segment structures of at least 1 eye as visualized by slit lamp examination. Unaffected individuals had no signs of exfoliation syndrome. Exposures: Rare, coding-sequence genetic variants predicted to be damaging by bioinformatic algorithms trained to recognize alterations that impair protein function. Main Outcomes and Measures: The primary outcome was the presence of exfoliation syndrome. Exome-wide significance for detected variants was defined as P < 2.5 × 10-6. The secondary outcomes included biochemical enzymatic assays and gene expression analyses. Results: The discovery cohort included 4028 participants with exfoliation syndrome (median age, 78 years [interquartile range, 73-83 years]; 2377 [59.0%] women) and 5638 participants without exfoliation syndrome (median age, 72 years [interquartile range, 65-78 years]; 3159 [56.0%] women). In the discovery cohort, persons with exfoliation syndrome, compared with those without exfoliation syndrome, were significantly more likely to carry damaging CYP39A1 variants (1.3% vs 0.30%, respectively; odds ratio, 3.55 [95% CI, 2.07-6.10]; P = 6.1 × 10-7). This outcome was validated in 2 independent cohorts. The first validation cohort included 2337 individuals with exfoliation syndrome (median age, 74 years; 1132 women; n = 1934 with demographic data) and 2813 individuals without exfoliation syndrome (median age, 72 years; 1287 women; n = 2421 with demographic data). The second validation cohort included 1663 individuals with exfoliation syndrome (median age, 75 years; 587 women; n = 1064 with demographic data) and 3962 individuals without exfoliation syndrome (median age, 74 years; 951 women; n = 1555 with demographic data). Of the individuals from both validation cohorts, 5.2% with exfoliation syndrome carried CYP39A1 damaging alleles vs 3.1% without exfoliation syndrome (odds ratio, 1.82 [95% CI, 1.47-2.26]; P < .001). Biochemical assays classified 34 of 42 damaging CYP39A1 alleles as functionally deficient (median reduction in enzymatic activity compared with wild-type CYP39A1, 94.4% [interquartile range, 78.7%-98.2%] for the 34 deficient variants). CYP39A1 transcript expression was 47% lower (95% CI, 30%-64% lower; P < .001) in ciliary body tissues from individuals with exfoliation syndrome compared with individuals without exfoliation syndrome. Conclusions and Relevance: In this whole-exome sequencing case-control study, presence of exfoliation syndrome was significantly associated with carriage of functionally deficient CYP39A1 sequence variants. Further research is needed to understand the clinical implications of these findings.

Anatomical and functional changes in paravascular abnormalities after epiretinal membrane removal.

PURPOSE: To investigate the anatomical and functional changes in areas containing paravascular abnormalities (PVA) in eyes with epiretinal membrane (ERM) after surgery. METHODS: Twenty-eight eyes with concurrent idiopathic ERM and PVA were enrolled in this prospective study. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and areas of PVA in the superficial and deep capillary levels detected on en face optical coherence tomography were measured preoperatively and 1, 3, and 6 months postoperatively. Retinal sensitivity in selected PVA lesions was evaluated by microperimetry preoperatively and 1 and 6 months postoperatively. RESULTS: The areas of PVA at the superficial capillary level before and 1, 3, and 6 months after surgery measured 1.65 ± 1.27, 0.44 ± 0.62, 0.40 ± 0.64, and 0.38 ± 0.62 mm2, respectively, while those at the deep capillary level measured 0.27 ± 0.57, 0.10 ± 0.26, 0.09 ± 0.29, and 0.05 ± 0.15 mm2, respectively. The areas of PVA in the superficial and deep capillary levels were significantly smaller postoperatively (all p < 0.001 at the superficial capillary level and p = 0.010 at the deep capillary level). Average retinal sensitivity values in the PVA lesions before and 1 and 6 months after surgery were 11.2 ± 3.5, 12.9 ± 3.2, and 13.2 ± 2.7 dB, respectively; the values at postoperative months 1 and 6 were significantly improved (p = 0.045 and p < 0.001, respectively). BCVA and CMT were significantly improved postoperatively. CONCLUSION: PVA not only improves anatomically but also functionally after ERM surgery. Vitrectomy can improve not only central vision but also retinal sensitivity in areas of PVA.

Genetic variants and cellular stressors associated with exfoliation syndrome modulate promoter activity of a lncRNA within the LOXL1 locus.

Exfoliation syndrome (XFS) is a common, age-related, systemic fibrillinopathy. It greatly increases risk of exfoliation glaucoma (XFG), a major worldwide cause of irreversible blindness. Coding variants in the lysyl oxidase-like 1 (LOXL1) gene are strongly associated with XFS in all studied populations, but a functional role for these variants has not been established. To identify additional candidate functional variants, we sequenced the entire LOXL1 genomic locus (∼40 kb) in 50 indigenous, black South African XFS cases and 50 matched controls. The variants with the strongest evidence of association were located in a well-defined 7-kb region bounded by the 3'-end of exon 1 and the adjacent region of intron 1 of LOXL1. We replicated this finding in US Caucasian (91 cases/1031 controls), German (771 cases/1365 controls) and Japanese (1484 cases/1188 controls) populations. The region of peak association lies upstream of LOXL1-AS1, a long non-coding RNA (lncRNA) encoded on the opposite strand of LOXL1. We show that this region contains a promoter and, importantly, that the strongly associated XFS risk alleles in the South African population are functional variants that significantly modulate the activity of this promoter. LOXL1-AS1 expression is also significantly altered in response to oxidative stress in human lens epithelial cells and in response to cyclic mechanical stress in human Schlemm's canal endothelial cells. Taken together, these findings support a functional role for the LOXL1-AS1 lncRNA in cellular stress response and suggest that dysregulation of its expression by genetic risk variants plays a key role in XFS pathogenesis.

Prophylactic Effect of Oral Acetazolamide against Intraocular Pressure Elevation after Cataract Surgery in Eyes with Glaucoma.

PURPOSE: To confirm the prophylactic effect of oral acetazolamide against increased intraocular pressure (IOP) in the period immediately after cataract surgery in eyes with primary open-angle glaucoma (POAG) and to evaluate the appropriate administration time of oral acetazolamide to prevent IOP elevation. DESIGN: Randomized clinical study. PARTICIPANTS: Ninety eyes of 90 patients with well-controlled POAG scheduled for phacoemulsification. METHODS: Eyes were assigned randomly to 1 of 3 groups: (1) oral acetazolamide (500 mg) administration 1 hour preoperatively, (2) oral acetazolamide (500 mg) administration 3 hours postoperatively, or (3) no acetazolamide administration. Intraocular pressure was measured using a rebound tonometer 1 hour preoperatively, at the conclusion of surgery (adjusted in the range between 15 and 25 mmHg), and 1, 3, 5, 7, and 24 hours postoperatively. The incidence of eyes with IOP elevation more than 100% above the preoperative IOP was compared. MAIN OUTCOME MEASURES: Postoperative IOP and incidence of eyes with marked IOP elevation. RESULTS: Mean IOP 1 hour preoperatively and that at the conclusion of surgery did not differ significantly among groups. In all groups, mean IOP was significantly elevated from 3 to 7 hours postoperatively, and then decreased at 24 hours. At 1 and 3 hours postoperatively, mean IOP was significantly lower in the group receiving oral acetazolamide preoperatively than in the other 2 groups (postoperative administration or no administration; P ≤ 0.0031). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in both the preoperative and postoperative administration groups than in the nonadministration group (P ≤ 0.0224). Intraocular pressure elevation of more than 100% occurred in 1 eye (3.3%) in the preoperative administration group, 7 eyes (23.3%) in the postoperative administration group, and 8 eyes (26.6%) in the nonadministration group; the incidence was significantly lower in the preoperative administration group (P = 0.0459). CONCLUSIONS: Eyes with POAG experienced short-term IOP elevation from 3 to 7 hours after phacoemulsification. Oral acetazolamide administration 1 hour preoperatively significantly reduced the IOP elevation from 1 to 24 hours, while administration 3 hours postoperatively reduced the IOP elevation at 5 hours or more after surgery.

A classification system of intraocular lens dislocation sites under operating microscopy, and the surgical techniques and outcomes of exchange surgery.

PURPOSE: The aim of this study was to examine the recent status of intraocular lens (IOL) dislocation according to a classification system based on vertical dislocation position, as well as the surgical techniques and outcomes of IOL exchange surgery. METHODS: The medical records of 230 eyes from 214 consecutive patients who experienced IOL dislocation and underwent exchange surgery between 2006 and 2014 were reviewed. Vertical dislocation sites observed preoperatively under operating microscopy were examined, along with the surgical techniques and outcomes of IOL exchange. RESULTS: Dislocation sites included (1) the anterior chamber (12.2 %), (2) pseudophakodonesis (19.1 %), (3) the anterior vitreous cavity (47.4 %), (4) trap door-like dislocation (dangling in the peripheral vitreous cavity; 16.1 %), and (5) the retinal surface (5.2 %). The IOL retained in the anterior segment was moved onto the iris by pulling it up through the limbal side ports with an anterior vitrectomy (67.8 %), or by pushing it up from the pars plana with an anterior vitrectomy (26.5 %), while the IOL dropped on the retina was lifting it up from the retina after pars plana vitrectomy (5.7 %). Mean uncorrected and distance-corrected visual acuity significantly improved postoperatively (p < 0.0001). Major complications included a marked elevation in intraocular pressure (7.8 %), pupillary capture (6.5 %), and vitreous hemorrhage (2.6 %). CONCLUSIONS: Based on the classification system, approximately 95 % of dislocated IOLs were retained in the anterior segment, and these IOLs were exchanged using an anterior approach through limbal incisions with an anterior vitrectomy. Visual acuity improved significantly, and serious complications were uncommon, probably because the IOL exchange techniques were standardized and simplified without pars plana vitrectomy.

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome.

AIMS: To predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome. METHODS: 315 eyes of 315 consecutive patients with PXF scheduled for phacoemulsification surgery underwent preoperative examination of various ocular parameters using an anterior segment-optical coherence tomography and other devices. When zonular complications occurred during surgery due to zonular dehiscence, scleral fixation of the intraocular lens (IOL) or implantation of a capsular tension ring (CTR) was performed. High-risk factors for these intraoperative zonular complications were examined using classification-tree and logistic regression analyses. RESULTS: Of the 315 eyes, 31 (9.84%) underwent scleral IOL fixation or CTR implantation. High-risk factors identified by classification-tree analysis were a small pupillary diameter after mydriasis <6.30 mm, a shallow anterior chamber depth <2.074 mm and lens decentration >0.260 mm. Based on exact logistic regression analysis, the OR was 4.81-fold higher for eyes with poor mydriasis than for eyes without poor mydriasis (p=0.006, 95% CI 1.49 to 18.23), 23.99-fold higher for eyes with poor mydriasis and a shallow anterior chamber (p<0.001, 5.92 to 109.02) and 287.39-fold higher for eyes with poor mydriasis, a shallow chamber and great lens decentration (p<0.001, 50.46 to infinity). CONCLUSION: In eyes with PXF, high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence were poor mydriasis, shallow anterior chamber and large lens decentration, suggesting the importance of evaluating these conditions preoperatively.

Surgical safety and efficacy of a multi-stent system, the comet stent, in Baerveldt glaucoma implant surgery: a prospective pilot study.

PURPOSE: This study aimed to introduce a new technique for lowering intraocular pressure (IOP) using a multi-stent system after the implantation of a Baerveldt glaucoma implant (BGI) and evaluate its clinical effectiveness. STUDY DESIGN: Prospective case series. METHODS: Six patients with uncontrolled refractory glaucoma were enrolled between December 2021 and May 2022. Six 6-0 nylon sutures were preoperatively inserted into the tube of a BGI. These sutures were named "comet stents" (CSs). BGI implantation was performed, and the CSs were removed one-by-one whenever the IOP rose during the follow-up period. IOP was measured 30-60 min after the removal of each CS, and the reduction in IOP was recorded to assess the effect of CS removal. IOP reduction and the effect of CS removal on IOP reduction were evaluated for 6 months. The cut and trimmed stented tubes were examined with scanning electron microscopy, and the ratio of the patent cross-sectional area to the total luminal area (PCSA, %) and the luminal area occupation rate per stent (%) were calculated. RESULTS: The mean (±standard deviation) IOP decreased from 31.5 ± 2.8 mmHg at the baseline to 14.8 ± 8.3 mmHg at 1 month, 8.8 ± 4.7 mmHg at 3 months, and 9.2 ± 3.4 mmHg at 6 months. The IOP reduction induced by CS removal ranged from 0 to 19 mmHg. The mean PCSA was 52.7 ± 1.7%, and the mean luminal area occupation rate per stent was 7.9 ± 0.3%. CONCLUSION: The use of CSs is an effective technique for controlling IOP in a step-by-step manner after BGI surgery.

Prevalence and characteristics of oblique astigmatism.

OBJECTIVE: To examine the incidence and characteristics of eyes with oblique astigmatism stratified by meridian, age, sex, and eye side (left to right). METHODS: One thousand eyes of 1000 patients with oblique corneal astigmatism underwent videokeratographic examination and was classified into 4 meridian categories: (1) 31°-45°, (2) 46°-59°, (3) 121°-135°, and (4) 136°-149°. Amounts of regular and irregular astigmatism, and the vertical/horizontal (Rx) and oblique astigmatism components (Ry) decomposed using vector analysis were compared among the 4 categories and age groups, and between sexes and eye sides. RESULTS: Incidences of the 4 meridian categories were similar and did not differ significantly among age groups or between sexes. The incidence was significantly greater in eyes in meridian categories 1 and 2 in the left eye and categories 3 and 4 in the right eye, and significantly greater in men in their 40 s and 50 s and in women in their 70 s and 80 s (P < 0.0001). The mean regular astigmatism, asymmetry and higher-order irregularity components, and Rx and absolute Ry significantly increased with age (P ≤ 0.0372). The mean regular and irregular astigmatism, and absolute Rx and Ry did not differ significantly among the 4 categories, or between sexes or left and right eyes. CONCLUSIONS: The incidence of oblique astigmatism was significantly greater in the temporal side meridians, and the incidence in women increased with age. The degree of oblique astigmatism increased with age, with an increase in irregular astigmatism.

Age-Related Changes in Total Corneal Astigmatism in Eyes With High Myopia.

PURPOSE: The purpose of this study was to compare age-related changes in corneal astigmatism in eyes with and without high myopia. METHODS: Eight-hundred eyes with high myopia (axial length ≥26.0 mm) and 800 eyes without high myopia (200 eyes each from patients in their 40s, 50s, 60s, and ≥70s) underwent videokeratographic examination. The amounts of vertical/horizontal (Rx) and oblique astigmatism (Ry) components, irregular astigmatism, and corneal shape were compared between eyes with and without high myopia and among age categories. RESULTS: In both groups, the mean Rx significantly changed to more positive with age (P < 0.001), whereas the Ry did not change significantly. The Rx was significantly more negative in the high myopia group than in the control group in all age categories (P ≤ 0.003), whereas the Ry did not differ significantly. The mean changes in the Rx and Ry during each 2 consecutive decades did not differ significantly between groups. The asymmetry and higher-order irregularity components increased with age (P ≤ 0.001) but did not differ significantly between groups, except for the higher-order irregularity in patients in their 60s (P = 0.018). In the averaged map, the corneal shape changed from with-the-rule to against-the-rule astigmatism with age in both groups, but the changes occurred later in the high myopia group. CONCLUSIONS: Age-related changes from with-the-rule to against-the-rule astigmatism occurred later in eyes with high myopia compared with eyes without high myopia in middle or older aged patients, but this change in each age decade was comparable between eyes with and without high myopia.

Long-term changes in manifest refraction subsequent to cataract surgery.

PURPOSE: To examine the long-term refractive changes after stabilization of surgically induced changes (SICs) subsequent to cataract surgery. SETTING: Private hospital. DESIGN: Case-control study. METHODS: Manifest refraction of 300 eyes of 300 patients who underwent phacoemulsification and 300 eyes of 300 age-matched and sex-matched patients without surgery was examined the day on which SICs stabilized (baseline) and ≥7 years postbaseline using an autorefractometer. Refraction was divided into 3 components: spherical power (M), vertical/horizontal astigmatism (J0), and oblique astigmatism (J45) using power vector analysis, and the components were compared between the 2 timepoints and between groups. RESULTS: Data of All 600 eyes were collected. In the surgery group, the mean M and J45 did not change significantly between baseline and ≥7 years postbaseline, but the J0 significantly decreased between the 2 timepoints (P < .001), indicating an against-the-rule (ATR) shift. In the nonsurgery group, the mean M significantly increased and J0 significantly decreased between the timepoints (P < .001), whereas J45 did not change significantly. The mean change in M between the 2 timepoints was significantly smaller in the surgery group (P < .001), whereas the changes in J0 and J45 did not differ significantly between the timepoints. CONCLUSIONS: Spherical power did not change and refractive astigmatism significantly changed toward ATR astigmatism during the more than 7-year follow-up after stabilization of SICs in pseudophakic eyes, whereas hyperopic and ATR shifts occurred in phakic eyes, and the astigmatic changes were comparable between pseudophakic and phakic eyes.

Optimal amount of anisometropia for pseudophakic monovision.

PURPOSE: To determine the optimal target anisometropia for pseudophakic monovision. METHODS: Thirty-five bilaterally pseudophakic patients who received monofocal intraocular lenses were included in the study. Binocular corrected distance visual acuity (CDVA) and binocular distance-corrected near visual acuity (DCNVA) and stereoacuity were measured after simulating 1.00, 1.50, and 2.00 diopters (D) of monovision by adding the appropriate spherical lens to the nondominant eye. We presumed that mean binocular DCNVA of 20/40, binocular CDVA of 20/25, and stereoacuity <100 seconds of arc (arc sec) were necessary for successful monovision. RESULTS: With no anisometropia, mean binocular DCNVA was 20/97, binocular CDVA was 20/20, and mean stereoacuity was 71 arc sec. With 1.00 D of monovision, mean binocular DCNVA was only 20/60, although binocular CDVA and mean stereoacuity were sufficient. With 1.50 D of monovision, binocular DCNVA was 20/38, binocular CDVA at other distances exceeded 20/21, and stereoacuity was 100 arc sec, which was a 29-arc sec reduction. With 2.00 D of monovision, binocular DCNVA reached 20/31, but stereoacuity was 158 arc sec, which was an 87-arc sec reduction. The number of patients who met the criteria for successful monovision was significantly greater with 1.50 D of monovision than with 1.00 or 2.00 D of monovision (P=.0134). CONCLUSIONS: Pseudophakic monovision with anisometropia of 1.50 or 2.00 D provides useful binocular visual acuity from far to near. However, because stereopsis with 2.00 D of monovision is substantially impaired, approximately 1.50 D of anisometropia is thought to be optimal for successful monovision.

Posterior Vitreous Detachment in Highly Myopic Patients.

Purpose: We compared the change in the state of posterior vitreous detachment (PVD) between highly myopic eyes and non-highly myopic eyes using age- and sex-matched patients. Methods: Six hundred eyes of 600 patients with high myopia (axial length > 26.0 mm) or without high myopia were enrolled into each of six age categories with 50 eyes each: (1) 20 to 29 years, (2) 30 to 39 years, (3) 40 to 49 years, (4) 50 to 59 years, (5) 60 to 69 years, and (6) 70 to 79 years. The PVD status was evaluated using swept-source optical coherence tomography and classified into five stages: 0 (no PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (peripapillary PVD), and 4 (complete PVD). Results: In the high myopia and non-high myopia groups, the mean PVD stage increased significantly with the age category (P < 0.0001). The PVD stage was significantly greater in the high myopia group than in the non-high myopia group in all age categories (P ≤ 0.0395). In the age groups of patients 50 to 59 years old and 60 to 69 years old, complete PVD was detected in 54.0% and 73.9% of eyes, respectively, in the high myopia group and in 14.0% and 44.0% of eyes, respectively,in the non-high myopia group. Abnormal PVD characteristics of pathologic myopia were detected in 1.7% of eyes in the high myopia group. Conclusions: We precisely revealed, using age- and sex-matched patients, that partial PVD, including paramacular, perifoveal, and peripapillary PVD, and complete PVD develop at a significantly younger age in highly myopic eyes compared with non-highly myopic eyes, suggesting that PVD-related retinal pathologies occur younger in highly myopic patients.

Posterior vitreous detachment in patients with diabetes mellitus.

PURPOSE: To compare the progression of posterior vitreous detachment (PVD) during aging among eyes of diabetics with diabetic retinopathy (DR), eyes of diabetics without DR, and eyes of nondiabetics. STUDY DESIGN: Prospective cross-sectional study. METHODS: One-hundred thirty-three diabetic eyes with DR (DR group), 254 diabetic eyes without DR (non-DR group), and 577 nondiabetic eyes (nondiabetic group) were divided into four age categories: 1) 40-49 years, 2) 50-59 years, 3) 60-69 years, and 4) 70-79 years. The PVD state was examined using swept source-optical coherence tomography and classified into five stages: 0 (non PVD), 1 (paramacular PVD), 2 (perifoveal PVD), 3 (vitreofoveal separation), and 4 (complete PVD). RESULTS: The PVD stage significantly progressed in the DR, non-DR, and nondiabetic groups (p <0.0001). At 40-49 and 50-59 years, the PVD stage did not differ significantly among the three groups. At 60-69 and 70-79 years, the PVD stage was significantly less progressed in the DR than the non-DR and nondiabetic groups (p ≤0.0027), and did not differ significantly between the non-DR and nondiabetic groups. At 70-79 years, complete PVD was detected in 40.6% of eyes in the DR group, 69.6% in the non-DR group, and 73.5% of eyes in the nondiabetic group. CONCLUSION: PVD progresses later in diabetic eyes with DR than in diabetic eyes without DR and nondiabetics eyes at 60 and 70 years of age, suggesting a stronger vitreomacular adhesion in diabetics with DR.

A case series of endoscopic cyclophotocoagulation with 532-nm laser in Japanese patients with refractory glaucoma.

PURPOSE: To report an initial case series of Japanese patients with refractory glaucoma treated with endoscopic cyclophotocoagulation (ECP) using an ECP device that was equipped with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser. METHODS: This observational case series included 10 consecutive glaucomatous eyes (7 with primary open-angle glaucoma; 3 with secondary glaucoma after cataract surgery) of 10 Japanese subjects (7 men, 3 women; mean age ± standard deviation, 65.7 ± 15.0 years) who underwent ECP to control intraocular pressure (IOP), and preserve visual function. Age, sex, glaucoma type, ocular surgical history, preoperative and postoperative logarithm of the minimum angle of resolution visual acuity (VA), IOP, number of antiglaucoma medications, perioperative complications, and treatments for complications were collected from the medical and surgical records. The IOP and numbers of antiglaucoma medications were compared between preoperative and postoperative values. RESULTS: The mean preoperative IOP (27.3 ± 5.4 mm Hg; range, 19-36) and number of antiglaucoma medications (4.4 ± 0.8; range, 3-6) decreased significantly by 53% and 39% ( p = 0.0005 and p = 0.0043, respectively) to 12.9 ± 5.2 mm Hg (range, 8-20) and 2.7 ± 1.4 (range, 0-4), respectively, at the final visit. Compared with preoperative values, a mixed-effect regression model showed significant decreases in the IOP and numbers of medications at every time point up to 24 months postoperatively. No phthisis bulbi or persistent hypotony was recorded. At the final visit, compared with preoperative values, the VA decreased in three eyes by >0.2 unit because of glaucoma progression. CONCLUSIONS: ECP with Nd:YAG laser is a reasonable option in eyes with refractory glaucoma.

Effect of Topical Hypotensive Medications for Preventing Intraocular Pressure Increase after Cataract Surgery in Eyes with Glaucoma.

PURPOSE: To compare the effects of a topical intraocular pressure (IOP)-lowering medication for preventing an IOP increase after cataract surgery in eyes with glaucoma. DESIGN: Randomized clinical study. METHODS: A total of 165 eyes of 165 patients with primary open-angle glaucoma or pseudoexfoliation glaucoma scheduled for phacoemulsification were randomly assigned to 1 of 3 groups to receive each medication immediately postoperatively: 1) prostaglandin F2α analog (travoprost), 2) ß-blocker (timolol maleate), or 3) carbonic anhydrase inhibitor (brinzolamide). Intraocular pressure (IOP) was measured using a rebound tonometer at 1 hour preoperatively, at the end of surgery, and at 2, 4, 6, 8, and 24 hours postoperatively. The incidence of eyes exhibiting a marked IOP increase to greater than 25 mm Hg was compared among the groups. RESULTS: At 1 hour preoperatively and at the end of surgery, mean IOP did not differ significantly among the groups. Mean IOP increased significantly between 4 and 8 hours postoperatively and then decreased at 24 hours postoperatively in all groups (P < .0001). Mean IOP was significantly lower in the brinzolamide group than in the travoprost or timolol group at 4, 6, and 8 hours postoperatively (P ≤ .0374) and did not differ significantly among groups at 2 and 24 hours postoperatively. The incidence of an IOP spike was significantly lower in the brinzolamide group than in the travoprost and timolol groups (P = .0029). CONCLUSIONS: Brinzolamide reduces the short-term IOP increase after cataract surgery more effectively than travoprost or timolol in eyes with glaucoma, suggesting that brinzolamide is preferable for preventing an IOP spike.

Sex-Related Differences in the Progression of Posterior Vitreous Detachment with Age.

PURPOSE: To compare the difference in the progression of posterior vitreous detachment (PVD) between men and women in relation to age. DESIGN: Observational cross-sectional study. PARTICIPANTS: One hundred eyes of 100 male patients and 100 eyes of 100 female patients in 4 age groups: 40 to 49 years of age, 50 to 59 years of age, 60 to 69 years of age, and 70 years of age or older. METHODS: Using swept-source (SS) OCT, PVD was classified into 5 stages: 0, no PVD; 1, paramacular PVD; 2, perifoveal PVD; 3, vitreofoveal separation; and 4, complete PVD. The PVD stage distribution was compared between men and women in the 4 age groups and among the age groups. MAIN OUTCOME MEASURES: Stage of PVD determined using SS OCT. RESULTS: In both male and female eyes, the stage of PVD progressed significantly in association with the age group (P < 0.0001). The distribution of the PVD stage did not differ significantly between men and women in the 40- to 49- and the 50- to 59-year age groups. The distribution of the PVD stage was significantly more progressed in women than in men, however, in those 60 to 69 years of age and those 70 years of age and older (P ≤ 0.0292). At 40 to 49 years of age, no PVD (stage 0) and paramacular PVD (stage 1) were detected in 92 (92.0%) female eyes and 93 (93.0%) male eyes. At 70 years of age or older, vitreofoveal separation (stage 3) and complete PVD (stage 4) were detected in 93 (93.0%) female eyes and 78 (78.0%) male eyes. CONCLUSIONS: Posterior vitreous detachment significantly progresses with age in both genders, specifically between 40 years of age and 70 years of age or older. Posterior vitreous detachment progression occurs significantly faster in female eyes than in male eyes at 60 years of age or older, suggesting that the macular pathologic features associated with PVD occur at a younger age in women.

Intraocular pressure and wound state immediately after long versus short clear corneal incision cataract surgery.

PURPOSE: To compare the intraocular pressure (IOP) and wound state immediately after cataract surgery for eyes with a long clear corneal incision (CCI) with those for eyes with a short CCI. STUDY DESIGN: Randomized clinical trial. METHODS: One hundred twenty-eight eyes of 128 patients scheduled for phacoemulsification were randomly assigned to undergo long (≥ 1.75 mm) or short (< 1.75 mm) CCI (2.4-mm wide). IOP was measured using a rebound tonometer preoperatively, at the conclusion of surgery, and at 30 min, 60 min, 120 min, 180 min, and 24 h postoperatively. Wound architecture determined using anterior segment-optical coherence tomography and flare intensity was examined at 60 min postoperatively. RESULTS: The mean incision length was significantly longer in the long CCI group (2.02 ± 0.19 mm) than in the short CCI group (1.50 ± 0.13mm; P < .0001). The mean IOP significantly increased at 120 min and 180 min postoperatively (P ≤ .0005) and returned to the preoperative level within 24 h. The mean IOP did not differ significantly between the long and short CCI groups at any follow-up period. The incidence of IOP lower than 10 mmHg did not differ significantly between the groups. The mean flare intensity was significantly greater in the short CCI group than in the long CCI group (P = .0122). The wound architecture was similar between the groups. CONCLUSION: IOP and wound architecture were comparable between eyes with a long CCI and eyes with a short CCI in the immediate postoperative periods up to 24 h, suggesting that wound stability is equivalent when the CCI is securely closed with wound hydration.

Intraocular pressure elevation after cataract surgery and its prevention by oral acetazolamide in eyes with pseudoexfoliation syndrome.

PURPOSE: To examine whether intraocular pressure (IOP) increases immediately after cataract surgery in eyes with pseudoexfoliation (PXF) syndrome and to assess whether orally administered acetazolamide can prevent the IOP elevation. SETTING: Hayashi Eye Hospital, Fukuoka, Japan. DESIGN: Prospective case series. METHODS: Patients with PXF syndrome scheduled for phacoemulsification were randomly assigned to 1 of 3 groups: (1) oral acetazolamide administered 1 hour preoperatively (preoperative administration group), (2) administered 3 hours postoperatively (postoperative administration group), and (3) not administered (no administration group). The IOP was measured using a rebound tonometer 1 hour preoperatively, upon completion of surgery, and at 1, 3, 5, 7, and 24 hours postoperatively. RESULTS: The study comprised 96 patients (96 eyes). The mean IOP increased at 3, 5, and 7 hours postoperatively in all groups. At 1 hour and 3 hours postoperatively, the IOP was significantly lower in the preoperative administration group than in the postoperative group and no administration group (P ≤ .001). At 5, 7, and 24 hours postoperatively, the IOP was significantly lower in the preoperative group and postoperative administration group than in the no administration group (P ≤. 045). An IOP spike higher than 25 mm Hg occurred less frequently in the preoperative administration group than in the postoperative administration group and the no administration group (P = .038). CONCLUSIONS: Intraocular pressure increased at 3, 5, and 7 hours after cataract surgery in eyes with PXF syndrome. Oral acetazolamide administered 1 hour preoperatively reduced the IOP elevation throughout the 24-hour follow-up; acetazolamide administered 3 hours postoperatively reduced the elevation at 5 hours postoperatively and thereafter.

Retrospective Comparison of Visual Prognosis After Vitrectomy for Idiopathic Epiretinal Membranes With and Without an Ectopic Inner Foveal Layer.

BACKGROUND AND OBJECTIVE: To compare the surgical outcomes of epiretinal membrane (ERM) treatment between eyes with and without an ectopic inner foveal layer (EIFL). PATIENTS AND METHODS: Seventy-seven ERM eyes of 76 consecutive patients were investigated retrospectively. Optical coherence tomography examinations and best-corrected visual acuity (BCVA) measurements were performed before and at 6 and 12 months after vitrectomy. RESULTS: In both eyes with and without an EIFL, the BCVAs at 6 and 12 months after vitrectomy were significantly better than those before vitrectomy (P < .05), whereas the BCVAs 6 and 12 months after vitrectomy were significantly better in eyes without an EIFL than in those with an EIFL (P = .014 and P = .019, respectively). CONCLUSIONS: Vitrectomy may be effective in improving visual acuity in eyes with ERMs with and without an EIFL. However, ERM surgery may be desirable before EIFL development to obtain a better prognosis. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:838-845.].