12-Month Outcomes of Combined Phacoemulsification and iStent Inject in Asian Eyes with Normal Tension Glaucoma: A Single-Centre Experience.

PURPOSE: To evaluate efficacy and safety of the iStent inject combined with phacoemulsification in Asian eyes with normal-tension glaucoma (NTG) up to 12 months after surgery. STUDY DESIGN: Retrospective case series. METHODS: Retrospective case series of eyes undergoing surgery from April 2017 to August 2019. Outcome measures included intraocular pressure (IOP), number of topical glaucoma medications and adverse outcomes. Data were retrieved from the post-operative day 1 (POD1), week 1 (POW1), month 1 (POM1), month 3 (POM3), month 6 (POM6) and month 12 (POM12) timepoints. Data were analysed at each timepoint for eyes with available clinical data at that visit. Subgroup analysis was performed for a consistent cohort which included only eyes with data at all six follow-up timepoints. RESULTS: Data from 91 eyes in the collective subject group was analysed. Majority of subjects were male (53, 58.2%) and Chinese (79, 86.8%). Mean age was 73.2 ± 7.2 years. Pre-operatively, mean IOP was 14.3 ± 3.0 mmHg and mean number of medications was 1.5 ± 0.8. Significant IOP reduction was observed at all timepoints except POW1 and POM12. The number of medications was reduced at all timepoints (p < 0.001). By POM12, there was reduction of 1.2 ± 1.0 medications (p < 0.001). Both the collective and consistent cohorts demonstrated a trend towards decreasing surgical efficacy with time, in IOP reduction and decrease in medications. None of the eyes experienced sight-threatening complications. CONCLUSIONS: Asian eyes with NTG undergoing combined phacoemulsification and iStent inject surgery demonstrated significant and sustained reduction in number of glaucoma medications up to 12 months post-operatively.

Anterior segment imaging in minimally invasive glaucoma surgery - A systematic review.

Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri-operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st-generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS-OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle-based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post-implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.

Intelligent Electromagnetic Sensors for Non-Invasive Trojan Detection.

Rapid growth of sensors and the Internet of Things is transforming society, the economy and the quality of life. Many devices at the extreme edge collect and transmit sensitive information wirelessly for remote computing. The device behavior can be monitored through side-channel emissions, including power consumption and electromagnetic (EM) emissions. This study presents a holistic self-testing approach incorporating nanoscale EM sensing devices and an energy-efficient learning module to detect security threats and malicious attacks directly at the front-end sensors. The built-in threat detection approach using the intelligent EM sensors distributed on the power lines is developed to detect abnormal data activities without degrading the performance while achieving good energy efficiency. The minimal usage of energy and space can allow the energy-constrained wireless devices to have an on-chip detection system to predict malicious attacks rapidly in the front line.

Patterns of pre-crash behaviour in railway suicides and the effect of corridor fencing: a natural experiment in New South Wales.

Suicides on railway systems remain a significant concern world-wide. Understanding patterns of pre-crash behaviour, whether jumping, lying or wandering on tracks, is important for the design of preventative measures, yet prior studies have reported divergent patterns of behaviour. This study tested the hypothesis that higher standards of corridor fencing reduce the proportion of train suicides in the non-jumping category. Data was analyzed as a natural experiment for 171 cases of apparent railway suicides in New South Wales (NSW) for the period 2011-2018. Results were congruent with the hypothesis. A higher level of corridor fencing in metropolitan Sydney was associated with a lower proportion in the non-jumping category (33%) compared with regional areas (74%). The article contributes by showing that: (i) fencing appears to lead to a reduction in some types of rail suicides and thus; (ii) contributes to a lower overall rate of suicide by train; and (iii) even with fencing, the non-jumping incidents warrant attention for appropriate countermeasures.