Sensitivity and specificity of the uniform field electroretinogram in glaucoma detection in comparison to the pattern electroretinogram.

PURPOSE: To determine the ability of the photopic negative response (PhNR) of the uniform field electroretinogram (UF-ERG) to identify early glaucomatous changes in comparison to the checkerboard and bar stimuli of the pattern electroretinogram (PERG). METHODS: Forty-nine glaucoma patients were classified into two groups: glaucoma-suspect (23 eyes) and early to moderate glaucoma (30 eyes), based on their clinical examination and the results of standard automated perimetry. Thirty patients (30 eyes) with intraocular pressures (IOP) of 21 mmHg or less, with no history of reported high IOP, were included as controls. PERG and UF-ERG recordings were obtained on a Diagnosys D-341 Attaché-Envoy System. Visual field testing was done only for glaucoma-suspect and glaucoma patients. RESULTS: All three tests (PERG bar stimulus, PERG checkerboard stimulus and PhNR) displayed significantly prolonged peak times for glaucoma and glaucoma-suspect patients, with delays ranging from 7.8 to 14.8%, depending on the test. The PERG bar stimulus also showed a significantly lower N95 amplitude for both glaucoma groups (with reductions of 26.0% and 33.0% for glaucoma-suspect and glaucoma groups, respectively). The PERG checkerboard N95 amplitude component had high sensitivity for detecting glaucoma patients but a low specificity (97% and 37%, respectively; AUC = 0.61). Overall, the PhNR peak time showed the highest sensitivity and specificity (77% and 90%, respectively; AUC = 0.87). CONCLUSIONS: PERG bar stimuli and the PhNR of the UF-ERG can be used in the clinical setting to detect glaucoma-related changes in glaucoma-suspect and glaucoma patients. However, our data confirm that the PhNR peak time has the best combined sensitivity and specificity.

Effect of tobacco smoking on outcomes of trabeculectomy / Efeito do tabagismo nos desfechos da trabeculectomia

ABSTRACT Purpose: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. Methods: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. Results: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). Conclusion: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

RESUMO Objetivo: Avaliar o efeito do tabagismo nos desfechos da trabeculectomia. Métodos: Uma revisão retrospectiva do gráfico de pacientes com glaucoma submetidos à trabeculectomia foi realizada por um único cirurgião entre 2007 e 2016. Os gráficos foram examinados para uma história documentada de condição de fumante antes da cirurgia. Variáveis pré-operatórias clínicas e demográficas e clínicas foram registradas. Os pacientes foram divididos em dois grupos de acordo com sua história de tabagismo em fumantes e não fumantes. Quaisquer Intervenções relacionadas à bolha, por exemplo, injeções de 5-fluorouracil + lise de sutura com laser, ou revisão da bolha realizada durante o período pós-operatório foram observadas. O sucesso foi definido como pressão intraocular > 5 mmHg e < 21 mm Hg sem (sucesso completo) ou com (sucesso qualificado) medicamentos hipotensores oculares. A falha foi identificada como violação dos critérios mencionados acima. Resultados: O estudo incluiu 98 olhos de 83 pacientes com idade média de 70,7 ± 11,09 anos, sendo 53% (44/83) dos pacientes do sexo feminino. O diagnóstico mais comum foi o glaucoma de ângulo aberto primário com 47 casos (47,9%). O Grupo de fumantes incluiu 30 olhos de 30 pacientes. Os fumantes, quando comparados aos não fumantes, apresentaram uma melhor acuidade visual pré-operatória significativamente pior (p=0,038), maior espessura central da córnea (p=0,047) e maior pressão intraocular pré-operatória (p=0,011). A taxa de sucesso de um ano para a cirurgia de trabeculectomia foi de 56,7% no Grupo de fumantes contra 79,4% no Grupo de não fumantes (p=0,020). O tabagismo apresentou razão de chances para falha de 2,95 95% de IC (1,6-7,84). Conclusão: Os fumantes demonstraram uma taxa de sucesso significativamente menor em um ano após a trabeculectomia em comparação com os não fumantes e uma maior necessidade de intervenções relacionadas à bolha.

Effect of tobacco smoking on outcomes of trabeculectomy.

PURPOSE: To evaluate the effect of tobacco smoking on trabeculectomy outcomes. METHODS: Charts of patients with glaucoma who underwent trabeculectomy performed by a single surgeon between 2007 and 2016 were retrospectively reviewed. Charts were screened for a documented history of smoking status before surgery. Demographic and clinical preoperative variables were recorded. Based on smoking history, subjects were divided into two groups: smokers and nonsmokers. Any bleb-related interventions (e.g., 5-flourouracil injections ± laser suture lysis) or bleb revision performed during the postoperative period were noted. Success was defined as an intraocular pressure >5 mmHg and <21 mm Hg without (complete success) or with (qualified success) the use of ocular hypotensive medications. Failure was identified as a violation of the criteria mentioned above. RESULTS: A total of 98 eyes from 83 subjects were included. The mean age of the subjects was 70.7 ± 11.09 years, and 53% (44/83) were female. The most common diagnosis was primary open-angle glaucoma in 47 cases (47.9%). The smokers Group included 30 eyes from 30 subjects. When compared with nonsmokers, smokers had a significantly worse preoperative best-corrected visual acuity (p=0.038), greater central corneal thickness (p=0.047), and higher preoperative intraocular pressure (p=0.011). The success rate of trabeculectomy surgery at 1 year was 56.7% in the smokers Group compared with 79.4% in the Group nonsmokers (p=0.020). Smoking presented an odds ratio for failure of 2.95 (95% confidence interval, 1.6-7.84). CONCLUSION: Smokers demonstrated a significantly lower success rate 1 year after trabeculectomy compared with nonsmokers and a higher requirement for bleb-related interventions.

Randomized Trial on Illuminated-Microcatheter Circumferential Trabeculotomy Versus Conventional Trabeculotomy in Congenital Glaucoma.

PURPOSE: To compare 1-year outcomes of illuminated microcatheter-assisted circumferential trabeculotomy (IMCT) vs conventional partial trabeculotomy (CPT) for primary congenital glaucoma (PCG). DESIGN: Randomized clinical trial. METHODS: Forty eyes of 31 patients with unilateral or bilateral primary congenital glaucoma aged less than 2 years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was intraocular pressure (IOP) reduction. The success criterion was defined as IOP ≤ 12 mm Hg without and with antiglaucoma medications (absolute success and qualified success, respectively). RESULTS: The mean age of our study population was 8.35 ± 1.2 months. The mean preoperative IOP was 24.70 ± 3.90 mm Hg in the IMCT group and 24.60 ± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to preoperative IOP, corneal clarity, corneal diameter, vertical cup-to-disc ratio, and refractive error. In the IMCT group, 360-degree cannulation was achieved in 80% (16/20) of eyes. For the IMCT group and CPT groups, respectively, the absolute success rates were 80% (16/20) and 60% (12/20) (P < .001) and qualified success rates were 90% (18/20) and 70% (14/20) (P < .001). Both procedures produced a statistically significant reduction in IOP, and eyes undergoing IMCT achieved a lower IOP than CPT group eyes at 12 months follow-up (9.5 ± 2.4 mm Hg and 11.7 ± 2.1 mm Hg, respectively, P < .001). CONCLUSION: In primary congential glaucoma, illuminated microcatheter-assisted 360-degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at 1 year follow-up and resulted in significantly lower IOP measurements.

Systemic Immunosuppression in High-Risk Penetrating Keratoplasty: A Systematic Review.

Cornea transplantation has a high success rate and typically only requires topical immunomodulation. However, in high-risk cases, systemic immunosuppression can be used. We conducted a systematic review on the efficacy and side effects of systemic immunosuppression for high-risk cornea transplantation. The study population was 18 years old or older with a high-risk transplant (two or more clock hours of cornea vascularization or a previous failed graft or a graft needed because of herpes simplex keratitis). A comprehensive search strategy was performed with the help of an information specialist and content experts from ophthalmology. All study designs were accepted for assessment. Level 1 and level 2 screening was performed by two reviewers followed by data abstraction. Forest plots were created whenever possible to synthesize treatment effects. Quality assessment was done with a Downs and Blacks score. From 1,150 articles, 29 were ultimately used for data abstraction. The odds ratios (ORs) for clear graft survival in cyclosporine and controls were 2.43 (95% CI: 1.00 - 5.88) and 3.64 (95% CI: 1.48 - 8.91) for rejection free episodes. Mycophenolate mofetil (MMF) significantly improved the rejection free graft survival rates at 1 year (OR: 4.05, 95% CI: 1.83 - 8.96). The overall results suggested that both systemic cyclosporine and MMF improved 1-year rejection free graft survival in high-risk keratoplasty. Cyclosporine also significantly improved clear graft survival rates at 1 year; however, there were insufficient data to analyze the same in the MMF group. Higher quality studies are needed to understand this issue better.

Diurnal versus office-hour intraocular pressure fluctuation in primary adult onset glaucoma / Comparación de la fluctuación de la presión intraocular diurna y en horario de consulta en pacientes con glaucoma primario de aparición en la edad adulta

Purpose: To evaluates the role of measuring intraocular pressure (IOP) outside office-hour in primary adult onset glaucoma. Methods: This retrospective study included 100 cases of primary adult onset glaucoma. IOP readings obtained with Goldmann applanation tonometry between 7 am and 10 pm were compared to office-hour readings. Results: One hundred patients were enrolled (mean age: 58.64±10.98 years) in the study. Overall, mean diurnal IOP was significantly higher than mean office IOP (p<0.05). Two-thirds of the patients had peak IOP measurements outside office-hour. Mean diurnal IOP fluctuation (7.03±2.69mm Hg) was significantly higher than mean office IOP fluctuation (4.31±2.6mm Hg) (p<0.003). There was a significant correlation between baseline IOP and fluctuation in IOP (r=0.61, p<0.001). Conclusion: The mean diurnal IOP and IOP fluctuations were higher than office-hour readings in patients with primary adult onset glaucoma. Diurnal monitoring may be particularly useful in patients with high baseline IOP (AU)

Objetivo: Evaluar la función de la medición de la presión intraocular (PIO) fuera del horario de consulta en el glaucoma de reciente aparición en edad adulta. Métodos: Este estudio retrospectivo incluyó 100 casos de glaucoma primario en adultos. Se compararon las mediciones de la PIO obtenidas mediante tonometría de aplanación de Goldmann entre las 7:00 y las 22:00, con los valores en horario de consulta. Resultados: Se incluyó a cien pacientes (edad media: 58,64±10,98 años). Globalmente, la PIO media diurna fue significativamente superior que la PIO media en horario de consulta (p<0,05). Dos tercios de los pacientes reflejaron unos valores elevados de la PIO fuera del horario de consulta. La fluctuación de la PIO media diurna (7,03±2,69mm Hg) fue considerablemente superior que la fluctuación de la PIO media en horario de consulta (4,31±2,6mm Hg) (p<0,003). Se produjo una correlación significativa entre la PIO basal y la fluctuación de PIO (r= 0,61, p <0,001). Conclusión: Las fluctuaciones de la PIO media diurna y la PIO fueron superiores a los valores medidos en horario de consulta en pacientes con glaucoma primario de aparición en la edad adulta. La supervisión diurna puede resultar particularmente útil en pacientes con una elevada PIO basal (AU)

Diurnal versus office-hour intraocular pressure fluctuation in primary adult onset glaucoma.

PURPOSE: To evaluates the role of measuring intraocular pressure (IOP) outside office-hour in primary adult onset glaucoma. METHODS: This retrospective study included 100 cases of primary adult onset glaucoma. IOP readings obtained with Goldmann applanation tonometry between 7 am and 10 pm were compared to office-hour readings. RESULTS: One hundred patients were enrolled (mean age: 58.64 ± 10.98 years) in the study. Overall, mean diurnal IOP was significantly higher than mean office IOP (p < 0.05). Two-thirds of the patients had peak IOP measurements outside office-hour. Mean diurnal IOP fluctuation (7.03 ± 2.69 mm Hg) was significantly higher than mean office IOP fluctuation (4.31 ± 2.6 mm Hg) (p < 0.003). There was a significant correlation between baseline IOP and fluctuation in IOP (r = 0.61, p<0.001). CONCLUSION: The mean diurnal IOP and IOP fluctuations were higher than office-hour readings in patients with primary adult onset glaucoma. Diurnal monitoring may be particularly useful in patients with high baseline IOP.

Impact of initial topical medical therapy on short-term quality of life in newly diagnosed patients with primary glaucoma.

PURPOSE: To evaluate the impact of initial topical medical therapy on newly diagnosed glaucoma patients using the Indian Vision Function Questionnaire (IND-VFQ33). PATIENTS AND METHODS: The IND-VFQ33 was used to evaluate the quality of life (QoL) in 62 newly diagnosed patients with moderate to severe primary glaucoma and 60 healthy controls. IND-VFQ33 is a 33 item QoL assessment tool with three domains: General functioning, psychosocial impact and visual symptoms. The glaucoma patients were started on medical therapy and the QoL assessment was repeated after 3 months. RESULTS: Glaucoma patients (mean age: 55.6 ± 9.6 years, range 40-77 years) and controls (mean age: 54.9 ± 6.7 years, 42-73 years) were matched with respect to age (P = 0.72), gender (P = 0.91) and literacy (P = 0.18). Glaucoma patients had significantly worse QoL as compared to controls at baseline across all the three domains (P < 0.001). 3 months after initiation of treatment, the overall QoL life significantly worsened from baseline with a decrease in general functioning (P < 0.001) and psychosocial impact (P = 0.041). Visual acuity in better eye significantly co-related to poor QoL at baseline (P < 0.001) and at 3 months (P = 0.04). In addition, the use of >2 topical medications significantly co-related to poor QoL at 3 months (P = 0.01). CONCLUSIONS: Evaluation using the IND-VFQ33 revealed that newly diagnosed glaucoma patients have a significant worsening of QoL after initiation of topical ocular hypotensive therapy. This should be an important consideration when educating patients about the disease and its therapy.

Test-retest variability of retinal nerve fiber layer thickness and macular ganglion cell-inner plexiform layer thickness measurements using spectral-domain optical coherence tomography.

PURPOSE: To evaluate the test-retest variability of spectral-domain optical coherence tomography (OCT) in measurement of retinal nerve fiber layer (RNFL) thickness and macular ganglion cell-inner plexiform layer (GCIPL) thickness. METHODS: A total of 65 eyes of healthy subjects were enrolled in this observational cross-sectional study. RNFL thickness and GCIPL thickness were measured using the repeat scan optic cube and macular cube protocol using Cirrus HD-OCT (software version 6.0). A single operator obtained 3 measurements during 1 session to determine test-retest variability. Intrasession repeatability was defined by intraclass correlation, limits of agreement, and coefficient of variation. RESULTS: The mean age of patients was 37.89±15.11 years (range, 10 to 70 y). The mean RNFL thickness readings as measured during 3 sessions were 93.89±9.73, 93.63±10.00, and 93.55±9.64 µm and average GCIPL thickness measurements were 82.90±4.61, 82.98±4.24, and 83.06±4.36 µm, respectively. Coefficient of variation was 1.2 for average RNFL thickness and 0.82 for average GCIPL thickness. The intraclass correlation coefficient showed a good correlation between repeat measurements for both average RNFL and GCC thicknesses (0.994 and 0.990, respectively). The limits of agreement (95% confidence interval) for the 3 sessions ranged from -3.61 to 4.13 µm for the average RNFL thickness and -2.55 to 2.40 µm for GCIPL thickness measurements. CONCLUSIONS: In healthy eyes, Cirrus HD-OCT shows excellent intrasession repeatability for RNFL and GCIPL thickness measurements.

Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous.

PURPOSE: To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous (PHPV). MATERIALS AND METHODS: In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade (plasma knife) and removed with a vitrector. A foldable posterior chamber intraocular lens (IOL) was implanted in eight eyes and the outcomes were evaluated. RESULTS: The mean age of patients was 16.8 ± 6.37 months (range: 5 to 28 months). The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation (aphakic). None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of ≥20/200 with 50% (4/8) of these eyes with ≥20/60 vision. CONCLUSION: Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV.

Management of intra-Descemet membrane air bubble in big-bubble deep anterior lamellar keratoplasty.

PURPOSE: To report the recognition and management of intra-Descemet membrane air bubble (IDMA) as a complication of big-bubble deep anterior lamellar keratoplasty (DALK). METHODS: IDMA was present intraoperatively in 8 eyes after DALK. Indications for surgery were healed keratitis (n = 4), macular dystrophy (n = 2), and keratoconus (n = 2). The IDMA was present between the anterior banded layer and posterior nonbanded layer of Descemet membrane (DM). They were slid and displaced toward the peripheral cornea using 27-gauge cannula and punctured taking care that underlying DM was not ruptured. RESULTS: DM was bared in all eyes, and DALK was completed in 7 cases. One patient required conversion to penetrating keratoplasty because of macroperforation. No case had double anterior chamber. Mean follow-up was 13.9 ± 4.1 months. A DM fold was noted in 1 eye. Seven cases had postoperative best-corrected visual acuity of 20/60 or better. CONCLUSIONS: Prompt recognition of the IDMA intraoperatively is required, which can be managed successfully.

Test retest variability of TonoPen AVIA.

The study was conducted to evaluate the intra-session repeatability of Tonopen AVIA (TPA). 180 eyes of 180 patients (50 eyes with glaucoma, 130 eyes of controls) were recruited for this observational study. The mean age of patients enrolled in the study was 43.9 ± 16.7 yrs (84 males, 96 females). Mean IOP recorded with Tonopen AVIA was 19.5 ± 9.5 mmHg, 19.4 ± 9.6 mmHg and 19.3 ± 9.2 mmHg, respectively in the first, second and third instances (P = 0.656). The intraclass correlation coefficient (ICC) ranged from 0.996 (95% CI: 0.956 - 0.998) for glaucoma subjects to 0.958 (95% CI: 0.934 - 0.975) for controls. The coefficient of variation in the study population ranged from 3.47% (glaucoma patients) to 8.10% (healthy controls), being 6.07% overall. The coefficient of repeatability varied between 2.96 (glaucoma patients), 3.35 (healthy controls) to 3.24 (overall). Thus, the Tonopen Avia shows good intrasessional repeatability of IOP in both glaucomatous patients and healthy subjects.

Caregiver burden assessment in primary congenital glaucoma.

PURPOSE: To assess the magnitude of caregiver burden and depression in primary caregivers of patients with primary congenital glaucoma. METHODS: Fifty-five primary caregivers of children diagnosed with primary congenital glaucoma were evaluated. The magnitude of burden on caregivers was assessed using a Caregiver Burden Questionnaire (CBQ). The overall aggregate burden and burden across 3 domains-socioeconomic, emotional, and psychological-was evaluated. Depressive symptomatology was evaluated using a Patient Health Questionnaire-9 (PHQ-9) standard questionnaire and graded from mild to severe. RESULTS: The mean age of the presenting children was 8.11±46.71 months; all of them were male. The mean age of the study participants was 33.6±8.36 years (53 female, 2 male). Thirty-nine (71%) individuals were identified to have moderate aggregate burden and 3 (5%) had severe aggregate burden. Twelve (22%) subjects were noted to have moderate depression, while 6 of them (11%) had either severe or very severe grades of depression. CONCLUSIONS: Caregivers of patients with primary congenital glaucoma have significant emotional and psychological burden. Moderate to severe depression may be present in one-third of individuals giving primary care to children with congenital glaucoma.

Prevalence of diabetes mellitus and hypertension among Indian glaucoma patients and evaluation of systemic therapy.

To study the prevalence and systemic control and evaluate the adequacy of therapy of diabetes mellitus (DM) and hypertension (HT) in glaucoma patients visiting a tertiary care eye facility at a university hospital. Consecutive cases with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG) attending the outpatient services were evaluated for the presence of DM and HT and any systemic/ocular medications being taken were recorded. Of 615 glaucoma cases evaluated, 281 (45.7 %) were POAG and 334 (54.3 %) were PACG. The mean age was 58.19 ± 10.8 years with males comprising 60.5 % of the study group. Two hundred and ninety-two (47.5 %) glaucoma patients had HT and 181 (29.4 %) had DM, including 97 (15.8 %) patients who had both. One hundred and thirty-three (47.3 %) patients with POAG and 159 (47.6 %) patients with PACG had HT. Ninety-seven (34.5 %) POAG patients and 84 (25.1 %) PACG patients were diabetics. One hundred and sixty-one (55.1 %) HT patients had blood pressure above control levels and 88 (48.6 %) diabetics had uncontrolled blood sugars. Twenty-eight (9.6 %) patients with HT were found to be taking combined systemic and topical ß-blocker therapy. A large majority of adult glaucoma patients had concurrent systemic disease, which was not adequately controlled. Patients were using systemic medications with known interactions with ocular hypotensive medications. This study highlights the unmet need for better coordination between ophthalmologists and physicians to improve the overall health of glaucoma patients.

Femtosecond laser cataract surgery: technology and clinical practice.

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience.

A review of corneal melting following kerato-refractive surgery.

Corneal melting is a rare complication that may occur following a number of different types of surgery. Keratolysis may lead to scarring, irregular astigmatism, photophobia and decreased vision. This article reviews the incidence, pathophysiology and treatment of this condition in kerato-refractive surgery.

Surgical outcomes and safety of femtosecond laser cataract surgery: a prospective study of 1500 consecutive cases.

OBJECTIVE: To report the surgical outcomes and safety of femtosecond (FS) laser cataract surgery (LCS) with greater surgeon experience, modified techniques, and improved technology. DESIGN: Prospective, interventional case series. PARTICIPANTS: Fifteen hundred consecutive eyes undergoing FS laser cataract and refractive lens exchange surgery in a single group private practice. INTERVENTION: Femtosecond LCS. METHODS: All eyes undergoing LCS between April 2011 and March 2012 were included in the study. Cases underwent anterior capsulotomy, lens fragmentation, and corneal incisions with the Alcon/LenSx FS laser (Alcon/LenSx, Aliso Viejo, CA). The procedure was completed by phacoemulsification and insertion of an intraocular lens. The cases were divided into 2 groups: Group 1, initial experience consisting of the first 200 cases; and group 2, the subsequent 1300 cases performed by the same surgeons. MAIN OUTCOME MEASURES: Intraoperative complication rates and comparison between groups. RESULTS: Both groups were comparable for baseline demographic parameters. Anterior capsule tears occurred in 4% and 0.31% of eyes, posterior capsule tears in 3.5% and 0.31% of eyes, and posterior lens dislocation in 2% and 0% of eyes in groups 1 group 2, respectively (P<0.001 for all comparisons). Number of docking attempts per case (1.5 vs 1.05), incidence of post-laser pupillary constriction (9.5% vs 1.23%), and anterior capsular tags (10.5% vs 1.61%) were significantly lower in group 2 (P<0.001 for all comparisons). CONCLUSIONS: In the authors' experience, the surgical outcomes and safety of LCS improved significantly with greater surgeon experience, development of modified techniques, and improved technology.

Femtosecond cataract surgery: transitioning to laser cataract.

PURPOSE OF REVIEW: The introduction of the femtosecond laser to the field of cataract surgery offers many potential benefits. The femtosecond laser is able to perform three important steps in cataract surgery: capsulotomy, lens fragmentation and corneal incisions. Although evidence in support of its efficacy is accumulating, there is a surgical learning curve that needs to be addressed. This review outlines key issues to consider when contemplating the transition to laser cataract surgery in clinical practice. RECENT FINDINGS: Laser cataract surgery has been shown to be associated with an initial learning curve. Femtosecond lasers produce a more accurate and precise anterior capsulotomy, improve intraocular lens centration and reduce intraocular lens tilt. Visual and refractive outcomes, although in a limited number of studies, have been shown to be at least as good as those of conventional phacoemulsification. The impact of reduced phacoemulsification energy on the corneal endothelium is still being investigated. SUMMARY: The automation of key steps by the use of femtosecond lasers in cataract surgery has several potential advantages. Emerging literature supports the transition from conventional phacoemulsification to the laser cataract surgery.

Trabeculectomy with combined use of subconjunctival collagen implant and low-dose mitomycin C.

PURPOSE: To evaluate outcomes of trabeculectomy with use of a subconjunctival biodegradable collagen implant (Ologen) combined with mitomycin C (MMC). METHODS: This retrospective study included 33 eyes of 24 patients with primary open-angle glaucoma who underwent fornix-based trabeculectomy with subconjunctival Ologen implant and MMC (0.1 mg/mL×1 min) between October 2008 and April 2010. Data pertaining to the preoperative parameters and postoperative outcomes were recorded. Each patient was followed up for at least 12 months. RESULTS: The mean age of the study participants was 53.03±7.08 years. Mean preoperative intraocular pressure (IOP) was 34.06±6.56 mm Hg, and decreased to 11.87±2.23 mm Hg, 12.27±2.05 mm Hg, and 12.54±1.67 mm Hg at 3, 6, and 12 months, respectively. Mean postoperative IOP readings at all follow-up visits were significantly lower than those at preoperative levels (P<0.001). Two eyes required ocular hypotensive medications to lower the IOP in the postoperative period. All eyes had a diffuse elevated well-formed bleb, with the implant being visible for 6 to 9 months. Two eyes had a shallow anterior chamber with hypotony during the early postoperative period due to wound leak, whereas 1 case developed implant exposure at 1-week follow-up; all these cases were managed by conjunctival resuturing. Two cases developed a Tenon cyst at 8 to 12 weeks and required needling for restoration of bleb function. CONCLUSIONS: Trabeculectomy with implantation of an Ologen implant and use of low-dose MMC appears to offer encouraging short-term results for IOP control in eyes with primary open-angle glaucoma.