Gas Tamponade Improved Cilio-Choroidal Effusion Induced by an Ab Interno Trabeculotomy with a Microhook: Two Cases.

Purpose: We treated two patients with ciliary detachment due to an ab interno trabeculotomy. The ciliary detachment was improved by the use of sulfur hexafluoride (SF6) gas or octafluoro propane (C3F8) tamponade. Patients and Methods: Patient 1 was a 52-year-old Brazilian man with primary open angle glaucoma (POAG). His preoperative intraocular pressure (IOP) was 29 mmHg. Patient 2 was a 57-year-old Japanese woman with POAG. Her preoperative IOP was 35 mmHg. Both patients underwent an ab interno trabeculotomy with a microhook. They caused ciliary detachment as a postoperative complication. We could observe their ciliary detachment with anterior segment optical coherence tomography (AS-OCT). Hypotony persisted for 2 months and the patients' ciliary detachment had not improved. They each underwent a pars plana vitrectomy (PPV) with simultaneous 20% SF6 filling. Results: In Patient 1, the use of the SF6 gas tamponade successfully attached the ciliary body. His IOP was increased to 30 mmHg after this resolution of the ciliary detachment. He underwent additional tube shunt surgery. For Patient 2, the SF6 gas tamponade improved the ciliary detachment but the ciliary body could not be attached. We injected 0.6 cc of 100% C3F8 gas into the vitreous cavity, and this gas tamponade was able to attach the ciliary body. Conclusion: AS-OCT is very useful to evaluate ciliary detachment. PPV+Gas tamponade can be a treatment option for ciliary detachment.

Corneal endothelial cell loss after EX-PRESS surgery depends on site of insertion, cornea or trabecular meshwork.

PURPOSE: Previously, we reported that the Ex-press® shunt (EXP) was associated with more rapid reduction in corneal endothelial cells when inserted into the cornea rather than the trabecular meshwork (TM). We compared the reduction rate of corneal endothelial cells between the corneal insertion group and TM insertion group. METHODS: This was a retrospective study. We included patients who had undergone EXP surgery and were followed for > 5 years. We analyzed the corneal endothelial cell density (ECD) before and after EXP implantation. RESULTS: We included 25 patients in the corneal insertion group and 53 patients in the TM insertion group. One patient in the corneal insertion group developed bullous keratopathy. The ECD decreased significantly more rapidly in the corneal insertion group (p < 0.0001), in whom the mean ECD decreased from 2227 ± 443 to 1415 ± 573 cells/mm2 at 5 years with a mean 5-year survival rate of 64.9 ± 21.9%. By contrast, in the TM insertion group, the mean ECD decreased from 2356 ± 364 to 2124 ± 579 cells/mm2 at 5 years, and the mean 5-year survival rate was 89.3 ± 18.0%. The decrease rate of ECD was calculated as 8.3%/year in the corneal insertion group and 2.2%/year in the TM insertion group. CONCLUSIONS: Insertion into cornea is a risk factor for rapid ECD loss. The EXP should be inserted into the TM to preserve the corneal endothelial cells.

Improvement of the loss of corneal endothelial cells by relocating the tip of the Baerveldt® implant tube from the anterior chamber to the vitreous cavity.

PURPOSE: It has been reported that corneal endothelial cells (CEC) decrease faster when the tip of the Baerveldt glaucoma implant (BGI) tube is inserted into the anterior chamber than into the vitreous cavity. We investigated whether surgically relocating the tip of the BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss. PATIENTS AND METHODS: This was a single facility retrospective cohort study. The inclusion criteria were the CEC density less than 1500 cells/mm2 and the CEC reduction ratio was greater than 10%/year. The subjects were 11 consecutive patients that could be followed > 12 months after relocation surgery. All patients were undergone vitrectomy, and the tip of tube was inserted into the vitreous cavity from the anterior chamber. We compared the intraocular pressure (IOP), reduction slope of CEC density and annual reduction rate of CEC density before and after relocation surgery. We calculated the annual reduction ratio in comparison with the preoperative CEC density (%/year). RESULTS: The mean of period between the Baeveldt with anterior chamber insertion surgery and the relocation surgery was 33.8 ± 15.0 months. The mean of follow-up after relocation surgery was 21.8 ± 9.8 months. The relocation surgery did not significantly change IOP (p = 0.974). The mean preoperative and postoperative IOP were 13.1 ± 4.5 and 13.6 ± 4.3 mmHg. The reduction ratio of the CEC density was 15.4 ± 6.7 (%/year) before relocation surgery and significantly slower at 8.3 ± 6.5 (%/year) after relocation surgery (p = 0.024). Two patients resulted in bullous keratopathy after relocation surgery. CONCLUSIONS: Relocating the tip of BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss.

Comparison of the results of Ex-PRESS® surgery for primary open-angle glaucoma between high and low preoperative intraocular pressure.

PURPOSE: To compare surgical outcomes of Ex-PRESS® (EXP) surgery for primary open-angle glaucoma (POAG) between low preoperative intraocular pressure (IOP) and high preoperative IOP. METHODS: This was a retrospective non-randomized study. Seventy-nine POAG patients who underwent EXP surgery and were followed for > 3 years were included. Patients with a preoperative IOP of ≦ 16 mmHg and > 16 mmHg with tolerant glaucoma medications were defined as the low IOP group and the high IOP group, respectively. We compared the surgical outcomes, postoperative IOP and number of glaucoma medications. Success was defined as a postoperative IOP of ≦ 15 mmHg and a reduction of > 20% from the preoperative IOP to the postoperative IOP. RESULTS: EXP surgeries significantly decreased IOPs from 13.2 ± 2.0 to 9.1 ± 2.9 mmHg in the low IOP group (p < 0.001), and from 22.5 ± 4.8 to 12.5 ± 4.0 mmHg in the high IOP group (p < 0.001). The mean postoperative IOP was significantly low in the low IOP group at 3 years (p = 0.0008). Success rates compared using the Kaplan-Meier survival curve were not significantly different (p = 0.449). CONCLUSIONS: EXP surgery was useful for POAG patients with a low preoperative IOP.

Risk factors for Ex-Press® surgery failure.

PURPOSE: To investigate the risk factors for Ex-Press® (EXP) surgery failure. PATIENTS AND METHODS: This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed up ≥ 5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open-angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP + cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a postoperative reduction in the IOP ≥ 20% from the preoperative IOP and ≤ 18 mmHg. We determined the risk factors using multivariate cox regression models. RESULTS: Performing EXP significantly decreased the IOP (preoperative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p values of the factors were age (p = 0.936), gender (p = 0.0587), hypertension (p = 0.409), DM (p = 0.967), previous glaucoma surgery (p = 0.940), type of glaucoma (p = 0.435) surgical methods (p = 0.521), CCT (p = 0.091), and preoperative IOP (p = 0.082). CONCLUSIONS: No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for primary open-angle glaucoma and pseudo-exfoliation glaucoma.

Twenty-Four-Hour Intraocular Pressure Indicators Distinguish Normal Tension Glaucoma From Healthy Eyes Measured With a Contact Lens Sensor.

PRCIS: Twenty-four-hour IOP measurements with a CLS showed that among IOP indicators studied, the range of IOP fluctuation was most important and significantly larger in NTG eyes compared with nonglaucoma eyes. PURPOSE: We conducted the present study to determine (1) the best factor for distinguishing normal tension glaucoma (NTG) and nonglaucoma subjects based on the intraocular pressure (IOP) values measured by a CLS and (2) the optimal cutoff values of that factor. SUBJECTS AND METHODS: The eyes of 18 nonglaucoma subjects and 26 NTG patients were examined. We evaluated 5 indicators: maximum IOP value, SD, IOP fluctuation range, the cosine-fit curve amplitude, and the amplitude of dual-harmonic regression values. We determined the indicators' cutoff values to distinguish between nonglaucoma subjects and NTG patients with the area under the curve. RESULTS: The mean IOP values were 12.3±2.7 mm Hg in the nonglaucoma eyes and 12.5±3.1 mm Hg in the NTG eyes ( P =0.824). All 5 indicators were significantly higher in the NTG group. The best factor to distinguish the nonglaucoma subjects and NTG patients was the IOP fluctuation range ( P <0.0001, area under the curve=0.844); the cutoff level value was 436.5 millivolt equivalents. CONCLUSIONS: Twenty-four-hour IOP measurements with a CLS showed that among IOP indicators studied, the range of IOP fluctuation was most important and significantly larger in NTG eyes compared with nonglaucoma eyes.

Ex-PRESS® surgery versus trabeculectomy for primary open-angle glaucoma with low preoperative intraocular pressure.

PURPOSE: To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open-angle glaucoma (POAG) with low preoperative intraocular pressure (IOP). PATIENTS AND METHODS: This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤ 16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed up for > 2 years. RESULTS: Both surgeries significantly decreased the IOP (p < 0.001): At 2 years, EXP provided decreases from 13.4 ± 2.3 to 10.2 ± 3.1 mmHg, and Trab provided decreases from 13.5 ± 2.0 to 8.9 ± 3.2 mmHg. No significant differences were observed in the postoperative IOP (p = 0.076), number of postoperative medications (p = 0.263), success rate (p = 0.900), reduction rate of ECD (p = 0.410), or difference in visual acuity (p = 0.174). The reduction rate of IOP was significantly high in the Trab group (p = 0.047). CONCLUSIONS: Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.

Ex-Press® versus Baerveldt implant surgery for primary open-angle glaucoma and pseudo-exfoliation glaucoma.

PURPOSE: To compare surgical outcomes between Ex-Press® (EXP) and Baerveldt glaucoma implant (BGI) surgeries for primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEXG) patients. PATIENTS AND METHODS: This was a retrospective single-facility study. The inclusion criteria were that the patient's preoperative intraocular pressure (IOP) was > 21 mmHg and the post-surgery follow-up was > 1 year. We recruited 161 patients who had undergone a trabeculectomy with EXP (89 eyes) or BGI surgery (72 eyes). We compared these groups' postoperative IOP values and postoperative glaucoma medications, the reduction rate of corneal endothelial cell density (ECD), surgical outcomes, complications, the hospital stay duration, and the number of visits within 3 months post-surgery. RESULTS: Both the EXP and BGI surgeries could significantly decrease the IOP. When the surgical success was defined postoperative IOP ≤ 21 mmHg, the surgical outcome of BGI was significantly better than EXP (p = 0.0148). When the surgical success was defined postoperative IOP ≤ 18, 15 , and 12 mmHg, the surgical outcomes between BGI and EXP surgeries were not significantly different (p = 0.0815, p = 0.331, and p = 0.910). The mean ECD reduction rate was significantly faster in the EXP group. The BGI patients had significantly shorter stays in the hospital and fewer visits within 3 months post-surgery (p < 0.0001). CONCLUSIONS: BGI surgery could provide comparable surgical outcomes as EXP surgery for POAG or PEXG patients with high preoperative IOP. BGI surgery has some advantages: fewer post-surgery visits, less postoperative interventions, and a lower ECD reduction rate.

Comparison of trabectome and microhook surgical outcomes.

BACKGROUND: Several methods can be applied for a trabeculotomy, including the uses of thread, a blade, cauterization, and a hook. We compared the outcomes of trabectome surgery and microhook surgery. METHODS: We analyzed the cases of 133 eyes that underwent trabectome (72 eyes) or microhook (61 eyes) surgery and were followed for > 1 year. We defined failure as a < 20% reduction in the postoperative intraocular pressure (IOP) value or requiring additional glaucoma surgery. We used three surgical success definitions: ≤ 21, ≤ 18, and ≤ 15 mmHg IOP reduction. A Kaplan-Meier survival analysis was performed for the surgical outcomes. We compared the trabectome and microhook groups' postoperative IOP values, number of glaucoma medications, and postoperative complications. RESULTS: At 1 year postsurgery, the trabectome surgeries decreased the IOP significantly from 24.6 ± 7.3 to 13.3 ± 3.7 mmHg, and the microhook surgeries significantly decreased the IOP from 24.1 ± 9.2 to 12.5 ± 3.9 mmHg. The two groups' 1-year postoperative IOP values were not significantly different (p = 0.310). The surgical outcomes of the trabectome surgeries were significantly better than those of the microhook surgeries (≤ 21 mmHg: p = 0.0049, ≤ 18 mmHg: p = 0.0029, and ≤ 15 mmHg: p = 0.0393). There were three patients with ciliary detachment in the microhook surgery group. CONCLUSIONS: Trabectome surgery provided significantly better surgical outcomes than microhook surgery. The risk of postoperative ciliary detachment should be considered in microhook surgery cases.

The results of Baerveldt glaucoma implant surgery performed with the scleral flap and patch technique.

BACKGROUND: We report the results of Baerveldt glaucoma implant (BGI) surgery performed with the scleral flap and patch technique. PATIENTS AND METHODS: This was a retrospective analysis of 97 consecutive patients (107 eyes) who underwent BGI surgery with the scleral flap and patch, and were followed up for >1 year. We evaluated the patients' post-operative intraocular pressure (IOP), corneal endothelial cell density, and complications (corneal edema, Hoffmann elbow exposure). RESULTS: The preoperative IOP was 32.9 ± 8.6 mmHg. BGI surgery significantly decreased the IOP to 11.1 ± 3.8, 11.3 ± 3.6, 11.3 ± 4.2, 10.7 ± 3.8, and 11.4 ± 3.2 mmHg at 1, 2, 3, 4, and 5 years post-surgery (p < 0.001), respectively. The success rates at 1, 2, 3, 4, and 5 years were 96.3%, 94.8%, 94.8%, 88.5%, and 88.5%, respectively. Failure occurred in six eyes. The reasons for failure were as follows: a postoperative IOP ⩾21 mmHg in one patient, and loss of light sensation in five patients. No patients required additional glaucoma surgery. There were no cases of Hoffmann elbow erosion. Corneal edema occurred in five patients. CONCLUSION: BGI surgery performed with the scleral flap and patch significantly decreased the IOP, and no case of Hoffmann elbow erosion was observed over the 5-year post-operative period.

The Outcomes of Trabectome Surgery in Patients with Low, Middle, and High Preoperative Intraocular Pressure.

BACKGROUND: We compared the efficiency of trabectome surgery for patients with differing preoperative intraocular pressure (IOP) values in a single-facility retrospective study. We evaluated surgical outcomes based on three grades of preoperative IOP: high (hi-IOP, >26 mmHg), middle (mid-IOP, 18-26 mmHg), and low (lo-IOP, <18 mmHg). PATIENTS AND METHODS: We analyzed the cases of 204 eyes that underwent trabectome surgery and were followed >2 years. We defined failure as a reduction of IOP <20% or requiring additional glaucoma surgery. We used 4 cutoff values >21, >18, >15, and >12 mmHg. Other factors that may affect surgical outcomes were also investigated: age, central corneal thickness (CCT), history of selective laser trabeculotrabculoplasty (SLT), preoperative visual field, and simultaneous cataract surgery. RESULTS: Trabectome surgeries significantly decreased the IOP values from 23.0 ± 7.2 mmHg to 13.6 ± 3.6 mmHg at 2 years post-surgery. The mid-IOP group achieved significantly better surgical outcomes than the lo-IOP and hi-IOP groups with cutoff values 21, 18, and 15 mmHg. A thin CCT and simultaneous cataract surgery were significantly related to better surgical outcomes with cutoff value 21.18 and 15 mmHg. CONCLUSION: For the patients with preoperative IOP <18 mmHg, it was difficult to decrease their IOP >20% with trabectome surgery. Patients with preoperative IOP values >26 mmHg often required additional glaucoma surgery.

Effectiveness of Blepharoptosis Surgery in Patients With Deepening of the Upper Eyelid Sulcus.

The purpose of this retrospective study was to evaluate the effectiveness of blepharoptosis surgery in patients with deepening of the upper eyelid sulcus (DUES). This case series included 10 consecutive patients (19 eyes) with DUES associated with use of a prostaglandin analog for glaucoma. Patients who had used bimatoprost and developed DUES were changed to an alternative prostaglandin analog and observed for ≥3 months. If there was no improvement, they underwent levator resection for blepharoptosis and were followed up for ≥6 months postoperatively. Improvement in margin reflex distance-1 and surgical complications was evaluated. After discontinuation of bimatoprost in 3 cases (6 eyes), mild subjective and objective improvement in DUES was seen in 2 cases (4 eyes) but without improvement in blepharoptosis. The prostaglandin analog used before surgery was travoprost in 4 eyes (21.0%), tafluprost in 7 eyes (36.9%; including 4 eyes switched from bimatoprost), and latanoprost in 8 eyes (42.1%; including 2 eyes switched from bimatoprost). The mean margin reflex distance-1 value was 1.11 ±â€Š0.96 mm before surgery and 3.72 ±â€Š0.81 mm at the final postoperative follow-up; the difference was significant (P = 3.32 × -10). There were no intraoperative or postoperative complications. Levator resection is a useful and safe procedure for blepharoptosis with DUES.

Questionnaire survey on complications during 24-h measurement of intraocular pressure-related patterns with a contact lens sensor.

PURPOSE: We investigated glaucoma patients' complications, subjective symptoms, and side effects of continuous 24-h measurement of intraocular pressure (IOP)-related patterns with a contact lens sensor (CLS). We asked the patients to complete a questionnaire about their subjective symptoms after wearing the CLS. MATERIALS AND METHODS: This was an observational single-facility study. We analyzed 56 patients (35 men, 21 women) who underwent 24-h continuous measurement of their IOP-related patterns with a Triggerfish® CLS. The four questionnaire items asked whether blurred vision, ocular pain, conjunctival hyperemia, and sleep disorder were present/absent. All questionnaire items were answered subjectively. We examined the relationship between the patients' questionnaire results and their visual acuity and visual field. RESULTS: The rate of blurred vision was 55%; ocular pain, 30%; conjunctival hyperemia, 14%; sleeping disorder, 29%. Patients with good visual acuity tended to report experiencing blurred vision. CONCLUSIONS: When 24-h continuous measurement of IOP-related patterns with a CLS is considered, clinicians should tell the patient about the possibility of blurred vision, ocular pain, conjunctival hyperemia, and/or sleeping disorder.

Factors influencing the reduction in corneal endothelial cells after Ex-Press® surgery.

PURPOSE: We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery. METHODS: This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press-iris touch, cornea-iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD. RESULTS: We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p < 0.0001). The reduction rate of ECD after 2 years in cases of insertion into the cornea (27 eyes) was 15.1 ± 3.6%, and in cases of insertion into a TM (102 eyes), it was 5.2 ± 1.4%. CONCLUSIONS: Insertion into the cornea was a risk factor for rapid ECD loss. The Ex-Press should be inserted into a TM for long-term protection of the corneal endothelial cells.

Can a contact lens sensor predict the success of trabectome surgery?

PURPOSE: We examined whether a contact lens sensor (CLS) is useful for the postoperative evaluation of trabectome surgery. We investigated the correlations between the outcomes of trabectome surgery and the output of a CLS. METHODS: We examined 24 consecutive eyes of patients with pseudo-exfoliation glaucoma. In each eye, the intraocular pressure (IOP) fluctuations over 24 h were measured with the SENSIMED Triggerfish CLS before and at 3 months after the trabectome surgery. We divided the patients into success (n = 12 eyes) and failure (n = 12 eyes) groups; success was defined as a postoperative IOP level ≤ 21 mmHg plus an IOP reduction ≥ 20% relative to the preoperative IOP value with or without anti-glaucoma medications. We investigated CLS parameters that correlate with surgical outcomes by performing a Cox hazard regression analysis. We determined the maximum value, minimum value, and range of IOP fluctuation as CLS parameters. RESULTS: The mean follow-up period was 38.0 ± 3.0 months. The success rate was 50%. The postoperative range of IOP fluctuation during the nocturnal period with the CLS was significantly correlated with the surgical results (p = 0.024). CONCLUSIONS: A smaller range of IOP fluctuation was significantly correlated with better surgical outcomes. We were able to predict the surgical success after trabectome surgery at 3 months using the CLS. Thus, CLS results could be a new surgical evaluation parameter.

Glaucoma Filtering Bleb Analysis Before and After Aponeurotic Blepharoptosis Surgery.

PURPOSE: To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb. METHODS: This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications. RESULTS: The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period. CONCLUSIONS: In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.

Correlation between 24-h continuous intraocular pressure measurement with a contact lens sensor and visual field progression.

PURPOSE: We investigated the correlations between 24-h continuous intraocular pressure (IOP) measurement with a contact lens sensor (CLS) and visual field (VF) progression. METHODS: We examined 69 eyes of glaucoma patients who were followed > 2 years after the measurement of IOP fluctuation with a CLS. All patients underwent VF examinations > 4 times. VF progression was defined as a deterioration of the mean deviation (MD). We evaluated the original 17 parameters from the data obtained from the CLS output and attempted to identify which of them contributed to the VF progression. We then performed multivariate analyses to identify risk factors for rapid VF progression. RESULTS: The mean follow-up period was 4.0 ± 1.6 years. The mean VF progression rate was - 0.37 ± 0.53 dB/year. The multivariate analysis identified the following as-risk factors for VF progression: more advanced baseline MD value (p = 0.0269); high maximum values during the 24-h (p = 0.0131) and nocturnal (p = 0.0466) periods; large standard deviation of IOP fluctuation during the 24-h (p = 0.0404), diurnal (p = 0.0330), and nocturnal (p = 0.0027) periods; and large range of IOP fluctuation during the nocturnal period (0.0431). CONCLUSIONS: Our results suggested that the above CLS parameters might be correlated with rapid progression of VF disorder. These CLS parameters could be used to evaluate the results of CLS in the future. Examination with a CLS could be useful for predicting the VF progression rate within a mere 24-h period.

Error in measurement of intraocular pressure with the Icare and IcarePRO.

PURPOSE: We sought to determine whether changes in the measurement angle of the Icare TA01i and IcarePRO tonometers led to errors in the measurement of intraocular pressure (IOP). METHODS: In this prospective, single-facility study, we analyzed 77 patients from November 2017 to September 2019. We measured IOP with the Icare TA01i and IcarePRO while changing the angle of the device with the cornea center and analyzed the associated changes in the measurement. RESULTS: IOP measured with the Icare tilted - 30°, - 15° vertically was significantly higher than that measured with the Icare tilted horizontally (p < 0.0001, p < 0.0001). The IOP measured with a + 10° vertical tilt was significantly lower than that measured horizontally (p < 0.0001). When the IcarePRO was tilted + 90° vertically, the IOP was significantly lower with the patient in the supine position than in the lateral position (p = 0.00058). CONCLUSIONS: IOP measured with the Icare and IcarePRO is affected by the measurement angle. The study results will direct the clinicians to exercise extra precautions in determining the measurement angle while measuring IOP.

Effects of Baerveldt Glaucoma Implant Surgery on Corneal Endothelial Cells of Patients with No History of Trabeculectomy.

PURPOSE: Persistent corneal edema is a serious potential complication of Baerveldt glaucoma implant (BGI) surgery. A trabeculectomy reduces the density of corneal endothelial cells. We investigated the effect of BGI surgery on corneal endothelial cells of patients with no history of trabeculectomy. METHODS: We retrospectively analyzed 85 eyes of 85 patients who underwent BGI surgery and were followed-up for ≥12 months. We used new criteria for surgical failure. We defined persistent corneal edema or needed additional surgery for changing the tube position due to remarkable reduction in corneal endothelial cells as failure. We compared surgical outcomes with new criteria and the rates of corneal endothelial cell density (ECD) loss after BGI surgery between the anterior chamber insertion (AC) group (n=23) and vitreous cavity insertion (VC) group (n=63). RESULTS: The mean pre-operative ECD values of the AC and VC groups were not significantly different at 2309 ± 498 and 2204 ± 556 (p=0.426). The ECD reduction rate in the AC group was significantly faster than in the VC group. The mean post-operative IOP values significantly decreased in both groups. However, the VC group's surgical outcomes were significantly better than the AC group's (p=0.0241) with the new criteria. CONCLUSION: The mean of ECD did not decrease significantly after BGI surgery in VC group patients with no history of trabeculectomy. BGI surgery insertion to the vitreous cavity was safe and had much less effect on the ECD decrease compared to insertion to the anterior chamber.

Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery.

AIM: The aim of this study is to identify target levels of early postoperative intraocular pressure (IOP) associated with successful trabeculectomy using an Ex-Press glaucoma shunt. MATERIALS AND METHODS: This was a retrospective single-facility study. We enrolled 158 glaucoma patients who underwent trabeculectomy with Ex-Press and were followed for >1 year, and investigated risk factors for the failure of Ex-Press surgery. We examined age, sex, central corneal thickness (CCT), number of preoperative glaucoma medications, simultaneous performance of cataract surgery, history of trabeculotomy, hypertension (HT), diabetes mellitus (DM), subtype of glaucoma, and early postoperative IOP (minimum, 2 weeks, 1 month, and 3 months). RESULTS: Ex-Press surgery could significantly decrease IOP. Success rates at 1, 2, 3, and 4 years were 91.1, 86.1, 82.5, and 78.1%, respectively. Factors significantly affecting the success rate included age, the number of preoperative glaucoma medications, and early postoperative IOP. The IOP cutoff values of minimum IOP for the success of Ex-Press surgery was 5 mm Hg. CONCLUSIONS: Younger age, a high number of preoperative glaucoma medications, and high IOPs in the early postoperative period were found to be the risk factors for failure of Ex-Press surgery. Considering hypotonic complications, it is desirable to control the minimum IOP from 3-5 mm Hg within 2 weeks after surgery. According to our calculations, target IOPs at 2 weeks, 1 month, and 3 months after Ex-Press surgery should be 8 mm Hg, 10 mm Hg, and 14 mm Hg, respectively. CLINICAL SIGNIFICANCE: We thought that Ex-Press surgery might require lower IOP in the early postoperative period than conventional trabeculectomy. HOW TO CITE THIS ARTICLE: Tojo N, Hayashi A, et al. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019;13(2):55-61.