Primary outcomes of Baerveldt glaucoma implants with a modified technique to control intraocular pressure in different cases of glaucoma.

INTRODUCTION: To describe the outcomes of Baerveldt glaucoma implants implanted via a modified technique with regard to early intraocular pressure (IOP) reduction in cases of uncontrolled glaucoma. METHODS: The medical records of patients who had Baerveldt glaucoma implants of 350 or 250 mm2 implanted via a modified technique and were followed up for a period of at least 6 months were reviewed. The primary outcome measures were the mean IOP and number of glaucoma medications at each visit. We evaluated complete success rates at 1 day, 1 week and 1 month, defined as IOP values [Formula: see text] 5 mmHg and ≤ 21 mmHg prior to ligature rupture. RESULTS: A total of 42 eyes had Baerveldt glaucoma implants and met the inclusion criteria. The mean preoperative intraocular pressure (IOP) was 34.2 ± 11.2 mmHg. The postoperative mean IOP values were 15.1 mmHg ± 8.8 (p < 0.05), 17.7 ± 7.1 mmHg (p < 0.05), 12.3 ± 4.0 mm Hg (p < 0.05) at 1 day, 1 month, and 6 months, respectively. The rate of complete success on the first day was 78%, at the first month was 69%, and at 6 months was 95.2%. The number of glaucoma medications used was significantly lower at 6 months (P = < 0.001). CONCLUSION: The modified surgical technique using Baerveldt implants enables a safe, effective, and reliable IOP control in early postoperative patients with uncontrolled glaucomas.

Modification of the Intrastromal Ring Position according to Postimplant Visual and Refractive Failure: Report of Two Cases.

OBJECTIVE: The following report presents the adaptation of an existing technique of intrastromal corneal ring (ICRS) implantation enabling repositioning of the ring position postoperatively to manage a refractive failure in two patients with keratoconus. METHODS: In two cases, KeraRing and Ferrara nomograms had suggested different ring positions. To manage with the differences between the two nomograms, a longer corneal tunnel was created followed by the classic intervention to move the ring through the initial intrastromal corneal tunnel according to the topographic values. Once the first ring position has failed, the ring segment was repositioned along the longer corneal tunnel according to the postoperative outcome. RESULTS: Significant improvement in both cases was observed in the best corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), and root mean square (RMS) measured with Scheimpflug imaging (Pentacam; Oculus GmBH, Wetzlar, Germany). The participants were followed for one year. CONCLUSION: In patients with keratoconus which exhibit significant differences between KeraRing and Ferrara nomograms, a longer tunnel should be created to enable repositioning of the ring postoperatively if necessary, to avoid extracting the ring or changing it.

Hemorrhagic Descemet Membrane Detachment during Ab Interno Canaloplasty.

PURPOSE: To describe a Descemet membrane detachment in peripheral cornea after canaloplasty with ab interno approach in glaucoma. CASE REPORT: A 60-year-old male with uncontrolled primary open-angle glaucoma (POAG) underwent ab interno canaloplasty in the left eye. The previous corrected visual acuity was 20/400 and intraocular pressure 26 mmHg with maximum medical therapy. There was evidence of minor intrastromal bleeding and limited Descemet membrane detachment during the introduction of intracanalicular viscoelastic. Speculate that the Descemet detachment occurred owing to the excessive pressure while injecting the viscoelastic. A conservative management was decided due to the size of the detachment outside the visual axis. On the first postsurgical day, the slit lamp biomicroscopy confirmed that the paralimbal extension of the pre-Descemet hemorrhage was 3mm and the radial extension was 2mm. Moreover the initial thickness of the pre-Descemet hemorrhage measurement with anterior segment OCT was 0.6mm. The follow-up was done weekly. At 3 months postoperatively, cornea recovered its transparency and morphology and intraocular pressure was 18mmHg with maximum medical therapy. CONCLUSION: Descemet membrane detachment by viscoelastic with partial intrastromal hematoma is a rare complication of the ab interno canaloplasty, which can be managed conservatively if it has not compromised the visual axis and has a limited extension.

Effectiveness of Intrastromal Corneal Ring Implantation in the Treatment of Adult Patients With Keratoconus: A Systematic Review.

PURPOSE: To evaluate the available evidence on the effectiveness of intrastromal corneal rings (ICRs) in the treatment of adults with keratoconus. METHODS: A systematic review of electronic databases was completed through July 30, 2017. All primary research articles in which adults with keratoconus were treated with ICRs were included. Two independent reviewers assessed methodological quality and classified the studies into high, low, or undefined risk of bias. The measured variables assessed were visual acuity, refraction, keratometry, ring type, and complications. RESULTS: The initial search yielded 442 scientific articles, 62 articles were read extensively, and 18 articles were assessed for eligibility and included for statistical analysis and quality assessment. A total of 1,325 eyes were analyzed, and the results were evaluated preoperatively and at 12 months of follow-up. Uncorrected distance visual acuity (UDVA) improved 0.23 ± 0.28 logMAR and corrected distance visual acuity (CDVA) improved 0.06 ± 0.21 logMAR. Sphere improved 2.81 ± 1.54 diopters (D), cylinder improved 1.49 ± 0.83 D, and mean keratometry improved 3.41 ± 2.13 D within 12 months of follow-up. ICR implantation combined with corneal crosslinking improved UDVA, refraction, and keratometry to a greater degree than ICR implantation alone. CONCLUSIONS: The studies analyzed demonstrate refractive and visual improvement of patients treated with the ICR implantation technique. However, description of the methodological process necessary to evaluate the bias effectively is insufficient. [J Refract Surg. 2019;35(3):191-200.].