Trabeculectomy Vs Non-penetrating Deep Sclerectomy for the Surgical Treatment of Open-Angle Glaucoma: A Long-Term Report of 201 Eyes.

Introduction: Glaucoma is the second leading cause of vision loss worldwide. The reduction of intraocular pressure remains the backbone of its therapy. Among surgical techniques for its treatment, deep non-penetrating sclerotomy is the most widely practiced non-penetrating surgery. The purpose of this study was to evaluate the long-term efficacy and safety of deep non-penetrating sclerotomy compared to standard trabeculectomy in patients with open-angle glaucoma. Patients and methods: Retrospective study including 201 eyes with open-angle glaucoma. Closed-angle and neovascular cases were excluded. Absolute success was considered when intraocular pressure under 18 mmHg, or a reduction of at least 20% in patients with a baseline intraocular pressure below 22 mmHg, was obtained after 24 months, without the use of medication. Qualified success was considered when those targets were met with or without the use of hypotensive medication. Results: Deep non-penetrating sclerectomy showed a slightly lower long-term hypotensive effect compared to standard trabeculectomy, with significant differences at 12 months, but not at 24 months of follow-up. The absolute and qualified success rates were 51.85% and 65.43% for the trabeculectomy group and 50.83% and 60.83% for the deep non-penetrating sclerectomy, without significant differences. Regarding postoperative complications, mainly due to postoperative hypotonia, or related to the filtration bleb, they were significantly different between groups, with 10.8% and 24.7%, in deep-nonpenetrating sclerectomy and trabeculectomy groups, respectively. Conclusion: Deep non-penetrating sclerectomy seems to be an effective and safe surgical option for patients with open-angle glaucoma unable to be controlled by non-invasive strategies. Data suggests that the intraocular pressure-lowering effect of this technique may be marginally lower than that of trabeculectomy, but the achieved efficacy outcomes were similar, with a significantly lower risk of complications.

Macular Cystoid Edema Induced by Nab-Paclitaxel.

A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and was being treated with gemcitabine+nab-paclitaxel. On examination, the patient presented best corrected visual acuities of 4/20 and 2/20 in the right and left eye, respectively. The optical coherence tomography revealed bilateral severe macular edema. Macular edema was considered secondary to nab-paclitaxel and the drug was discontinued. Three months after drug discontinuation, the patient presented best corrected visual acuities of 20/20 and 16/20 in the right and left eye, respectively, and normal fundoscopy. Macular edema is a very rare side effect of taxanes, and the etiopathology is still unknown. Edema is usually reversible upon discontinuation of the offending agent. Clinicians should be aware of this adverse effect of taxanes, and a high index of clinical suspicion is essential for diagnosis.

Doente do sexo masculino, de 61 anos de idade, foi encaminhado para Oftalmologia por queixas de diminuição da acuidade visual bilateral. Tratava-se de um doente com um adenocarcinoma pancreático metastizado, sob tratamento com gemcitabina+nab-paclitaxel. Ao exame oftalmológico, o doente apresentava melhores acuidades visuais corrigidas de 4/20 e 2/20 do olho direito e esquerdo, respetivamente. A tomografia de coerência ótica revelou a presença de edema macular bilateral grave. O edema macular foi considerado secundário ao uso de nab-paclitaxel, pelo que o fármaco foi suspenso. Três meses após a suspensão do fármaco, o paciente apresentava acuidades visuais de 20/20 e 16/20 do olho direito e esquerdo, respetivamente, e uma fundoscopia normal. O edema macular é um efeito adverso muito raro dos taxanos e a sua etiopatologia ainda não se encontra totalmente esclarecida. O edema é habitualmente reversível após a suspensão do agente causador. Um elevado índice de suspeição é essencial para o diagnóstico desta condição.

A Rare Cause of Optic Neuropathy.

Lyme disease is a multisystem infection caused by Borrelia burgdorferi that mainly affects the joints, the heart, and the nervous system. Neurological complications usually manifest in untreated patients and present as meningitis, cranial neuropathies, and radiculoneuritis. The authors present the case of a 48-year-old male who developed loss of vision in the right eye over a period of two months. On physical examination a relative afferent pupillary defect of the right eye was noted. Visual evoked potential test revealed delayed P100 latency bilaterally, confirming a bilateral optic neuropathy. The analysis of the cerebrospinal fluid (CSF) showed a lymphocytic meningitis. After an extensive work-up, a diagnosis of Lyme neuroborreliosis with meningitis and optic neuritis was made. The patient was treated with antibiotics and showed gradual improvement. The follow-up brain MRI revealed a mild T2 hyperintensity on the right optic nerve with gliosis, sequelae of the inflammatory process. Lyme disease should always be considered in patients from endemic areas with nonspecific symptoms. The diagnosis of neuroborreliosis is challenging, but prompt identification and treatment can prevent the development of complications and sequelae.