Swiss Multicenter Ab Interno XEN45 Gel Stent Study: 2-Year Real-World Data.

INTRODUCTION: The aim of this study was to investigate the 2-year postoperative efficacy of the XEN45 Gel Stent by evaluating the reduction of intraocular pressure (IOP) and the need for eye pressure-lowering medications in a multicenter setting in Switzerland. METHODS: Patients with various types of glaucoma who received a XEN45 Gel Stent with or without combined phacoemulsification cataract surgery at five hospitals in Switzerland were retrospectively enrolled. Pre- and postoperative IOP, the number of antiglaucoma medications, and the need of subsequent interventions to control IOP were assessed. The success rate was defined as a ≥ 20% reduction of IOP 2 years postoperatively without the need for subsequent glaucoma surgery. RESULTS: A total of 345 eyes were included: 44.3% with primary open-angle, 42.0% pseudoexfoliation, and 13.7% with other types of glaucoma. Of these, 206 patients were followed for 2 years. Preoperatively, the mean IOP was 26.3 ± 8.9 mmHg and the mean number of antiglaucoma medications administered was 3.0 ± 1.3. Two years postoperatively, the success rate was 66.0% (95% confidence interval 59.3-72.1%), the IOP had dropped by 43.8% to 14.8 ± 5.7 mmHg, and the number of medications was reduced by a mean of 2.0 ± 1.7 per day. Postoperative complications and the need for interventions remained low. CONCLUSION: The XEN45 Gel Stent successfully reduced IOP and the number of antiglaucoma drugs in most patients at 2 years postoperatively.

Vitreoretinal Surgery in Glaucoma. / Netzhaut-Glaskörper-Chirurgie bei Glaukom.

Glaucoma is associated with the demise of retinal ganglion cells and their axons, primarily located in the retina. Vitreoretinal and glaucoma surgery overlap to a not inconsiderable extent in certain diseases. This overview article aims to present these diseases and highlight treatment strategies and the respective modes of action collectively. This article describes malignant glaucoma or aqueous misdirection syndrome, retinal surgery for choroidal detachment and expulsive choroidal hemorrhage, postoperative blebitis and endophthalmitis after glaucoma surgery, and vitrectomy after glaucoma surgery, along with the therapeutic paths for managing complications. The areas of glaucoma and vitreoretinal surgery are tightly linked. Colleagues from both subspecialties should be familiar with a certain overview of diseases concerning both subject areas.

Long-term outcome of macular shift after retinal detachment repair.

BACKGROUND: This study aimed to evaluate the long-term change of postoperative retinal shift after pars plana vitrectomy for macular off retinal detachment. METHODS: In this retrospective study, patients with retinal shift after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment (RRD) were examined at 3 weeks and 12 months postoperatively. Fundus autofluorescence images were obtained to visualize retinal rotation. Best-corrected visual acuity was measured and metamorphopsia assessed using the Amsler grid. RESULTS: Nine patients with postoperative retinal shift were included in the study. Retinal shift decreased significantly in these patients, on average by 1.07° (range 0.52-1.62, p = 0.002) after 12 months. However, more patients complained of distorted vision after 12 months (odds ratio for change = 3.0, 95% CI: 0.24 to 157.49). The main reason was the new formation of an epiretinal membrane (odds ratio for change = infinity, 95% CI: 0.41 to infinity). There was no change in visual acuity observed (p = 0.16). CONCLUSION: Postoperative retinal shift after RRD repair decreases over a 1-year span. While retinal shift is the main cause for metamorphopsia in the early postoperative period, formation of an ERM is the main reason for distorted vision long term.

Correction to: Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

The original article can be found online.

Multimodal imaging for detecting metamorphopsia after successful retinal detachment repair.

PURPOSE: To investigate the etiologies of metamorphopsia after successful retinal detachment repair. METHODS: In this retrospective study, we included patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD). Patients were reviewed after 3 to 6 weeks. Best-corrected visual acuity (BCVA), fundus biomicroscopy, Amsler grid test, spectral-domain optical coherence tomography (SD-OCT), and fundus autofluorescence images (FAF) were obtained from all patients to visualize abnormalities in retinal layers and retinal rotation. RESULTS: A total of 50 eyes from 49 consecutive patients were included, of whom 12 (24%) complained of postoperative metamorphopsia. The main cause of metamorphopsia was retinal shift after RRD repair (p < 0.001). CONCLUSION: Distorted vision after macula-off RRD is a common and retinal shift was found to be the main reason patients experience metamorphopsia after a successful macula-off RRD repair.

Influence of Postoperative Posture on Macular Slippage after Macula-Off Retinal Detachment: A Randomized Controlled Trial.

INTRODUCTION: To evaluate the effect of postoperative posture on the retinal shift after retinal detachment repair. METHODS: Patients who underwent pars plana vitrectomy (PPV) for macula-off rhegmatogenous retinal detachment (RRD) were included prospectively in the current study. Patients were randomized into two groups: group A included patients who did a log roll postoperatively, and group B included patients who had to lie flat on their backs for 6 h postoperatively before moving into the end position. Patients in group A and patients in group B were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence images (FAF) were obtained to visualize the retinal rotation. RESULTS: The sample included 50 eyes from 49 patients. Retinal shift occurred after RRD repair in 17 patients (34%). There was no statistically significant difference between the two groups (p = 0.94). Postoperative macular shift occurred significantly less often (p = 0.049) in participants in whom heavy fluid was used in the procedure. Metamorphopsia was reported postoperatively by 10 of 17 patients with retinal shift (p < 0.001). CONCLUSION: In our study, postoperative posture did not significantly influence postoperative macular slippage after RRD repair. The use of intraoperative heavy liquid appears to be associated with a lower occurrence of retinal shift.

How to Prevent Retinal Shift after Rhegmatogenous Retinal Detachment Repair: A Prospective, Randomized Study.

PURPOSE: To evaluate the effect of intraoperative use of heavy liquid on retinal shift after retinal detachment repair. DESIGN: Prospective, randomized study. PARTICIPANTS: Patients who underwent pars plana vitrectomy for macula-off rhegmatogenous retinal detachment were included in the current study. METHODS: Patients were randomized into 2 groups: group A included patients in whom heavy liquid was used during the procedure and group B included patients in whom no heavy liquid was used. Group A and B patients were reviewed after 3 weeks and after 6 weeks, respectively, and fundus autofluorescence (FAF) images were obtained to visualize the retinal rotation. MAIN OUTCOME MEASURE: Postoperative macular shift, visualized with FAF. RESULTS: A total of 50 eyes from 49 patients were included. Overall, retinal shift was observed in 17 patients (34%). Patients in whom heavy liquid was used during the procedure showed significantly less macular shift after surgery (P = 0.049). There was a strong association between retinal shift and postoperative symptoms of metamorphopsia. Ten of 17 patients with retinal shift reported distorted vision (P < 0.001). CONCLUSIONS: The use of intraoperative heavy liquid seems to be associated with lower occurrence of retinal shift after retinal detachment repair.

Relative indexes of cutaneous blood perfusion measured by real-time laser Doppler imaging (LDI) in healthy volunteers.

We used real-time LDI to study regional variations in microcirculatory perfusion in healthy candidates to establish a new methodology for global perfusion body mapping that is based on intra-individual perfusion index ratios. Our study included 74 (37 female) healthy volunteers aged between 22 and 30 years (mean 24.49). Imaging was performed using a recent microcirculation-imaging camera (EasyLDI) for different body regions of each volunteer. The perfusion values were reported in Arbitrary Perfusion Units (APU). The relative perfusion indexes for each candidate's body region were then obtained by normalization with the perfusion value of the forehead. Basic parameters such as weight, height, and blood pressure were also measured and analyzed. The highest mean perfusion value was reported in the forehead area (259.21APU). Mean perfusion in the measured parts of the body correlated positively with mean forehead value, while there was no significant correlation between forehead blood perfusion values and room temperature, BMI, systolic blood pressure and diastolic blood pressure (p=0.420, 0.623, 0.488, 0.099, respectively). Analysis of the data showed that perfusion indexes were not significantly different between male and female volunteers except for the ventral upper arm area (p=.001). LDI is a non-invasive, fast technique that opens several avenues for clinical applications. The mean perfusion indexes are useful in clinical practice for monitoring patients before and after surgical interventions. Perfusion values can be predicted for different body parts for patients only by taking the forehead perfusion value and using the perfusion index ratios to obtain expected normative perfusion values.