Conjunctival bleb tearing by XEN gel stent after conjunctival compression sutures.

PURPOSE: As minimally invasive glaucoma surgery devices emerge, newer complications are reported. XEN gel stent is safer than classic glaucoma surgery but may also lead to severe adverse effects as hypotony. Compression conjunctival sutures are a useful treatment for overfiltration hypotony after XEN gel stent implantation, but might force bleb tearing by the implant as it gets tightly close to the sutured conjunctiva. This complication has not been previously reported. METHODS: We report a patient with overfiltration hypotony after XEN gel implantation. Conjunctival compression sutures and implant relocation ab interno were performed obtaining a good outcome. As conjunctiva got tightly close to the stent, the device eroded the bleb so leakage and implant extrusion were found. RESULTS: Bleb reconstruction by conjunctival autograft was performed in order to avoid hypotony due to continuous conjunctival leakage. CONCLUSION: Conjunctival compression sutures may be used for overfiltration control after XEN gel implantation but we must be aware of potential conjunctival damage due to implant erosion even if it is correctly positioned. Close follow-up and early suture release may be convenient in these patients.

Case Report: Role of Anterior Segment Optical Coherence Tomography in Late-onset Capsular Block Syndrome.

SIGNIFICANCE: We report the use of anterior segment optical coherence tomography (AS-OCT) as a valuable tool for capsular block syndrome diagnosis and follow-up. PURPOSE: The purposes of this study are to report a case of late-onset capsular block syndrome or lacteocrumenasia and to describe differential diagnosis with other more common phacoemulsification complications such as intraocular lens (IOL) or posterior capsule opacification. CASE REPORT: We report the case of a 56-year-old man with a clinical history of cataract surgery in his left eye. Five years after cataract surgery, he complained of blurred vision and was referred for IOL removal to our hospital. After careful slit-lamp examination, we found that the lens was clear, and opacity belonged to the accumulation of a whitish material in the capsular bag behind the lens. AS-OCT gave the definite diagnosis of capsular block syndrome. Intraocular lens removal had been wrongly indicated, and we treated our patient by YAG laser posterior capsulotomy. AS-OCT confirmed the absence of a further accumulated material, so no other interventions were needed. After treatment, best-corrected visual acuity improved from 0.48 to 0.1 logMAR. CONCLUSIONS: Capsular block syndrome is a rare late-onset complication of cataract surgery causing a deep visual acuity decay. A precise slit-lamp examination and AS-OCT, together, avoid misdiagnosis and unnecessary surgical treatment, which may be needed in case of IOL opacity or fibrotic-like lacteocrumenasia. AS-OCT also helps in determining the treatment outcome. Immediate best-corrected visual acuity improvement is reached after a successful intervention.

Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma.

OBJECTIVES: Evaluate the efficacy of transscleral cyclophotocoagulation versus endoscopic cyclophotocoagulation to reduce intraocular pressure. METHODS: A retrospective, non-randomized cohort study with 1 year of follow-up included 62 eyes of 62 refractory glaucoma patients who underwent transscleral cyclophotocoagulation or endoscopic cyclophotocoagulation. RESULTS: Thirty-two patients were enrolled in transscleral cyclophotocoagulation group and 30 patients in endoscopic cyclophotocoagulation group, and the follow-up period was 1 year. The mean preoperative intraocular pressure was 35.6 ± 12.9 mm Hg in the transscleral cyclophotocoagulation group and 31.8 ± 8.8 mm Hg in the endoscopic cyclophotocoagulation group without significant difference (p = 0.18). When we compare both groups, there was no difference at 1 month (p = 0.46) and 3 months (p = 0.21) after surgery. However, there was a statistically significant difference at month 6 (p = 0.0055) and 1 year (p = 0.0019), finding lower intraocular pressure in the transscleral cyclophotocoagulation group. Cumulative success for intraocular pressure <21 mm Hg was 93.8% in transscleral cyclophotocoagulation group and 83.3% in endoscopic cyclophotocoagulation group after 1 year (p = 0.2). For intraocular pressure <18 mm Hg, the success rate was 78.1% in transscleral cyclophotocoagulation group and 63.3% in endoscopic cyclophotocoagulation group (p = 0.06), and for intraocular pressure <16 mm Hg, the success rate was 62.5% in transscleral cyclophotocoagulation group and 43.3% in endoscopic cyclophotocoagulation group (p = 0.02). Hypotony (p = 0.01) and vision loss of two lines (p = 0.01) were statistically significant lower in endoscopic cyclophotocoagulation group. CONCLUSION: This study demonstrates that both transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation are effective at decreasing intraocular pressure. However, transscleral cyclophotocoagulation is related to more complications than endoscopic cyclophotocoagulation, whereas endoscopic cyclophotocoagulation shows lower intraocular pressure decrease than transscleral cyclophotocoagulation.

Prospective pilot study comparing deep sclerectomy outcomes with a long-term and intense corticosteroid treatment versus a standard one.

OBJECTIVE: To compare prospectively intraocular pressure (IOP) results after deep sclerectomy (DS) using a topical short-term corticosteroid treatment (STCT, 1 month) versus a topical long-term and intense corticosteroid treatment (LTCT, 6 months) in a two2 year-follow-up. METHODS: Patients with medically uncontrolled open angle glaucoma were prospectively recruited and underwent a DS. RESULTS: We operated 45 eyes of 45 patients, 22 in STCT group and 23 in LTCT group. Median preoperative IOP was 27 (22-36.75) mm Hg for STCT and for 25 (22-28) mm Hg for LTCT group without significant difference (p=0.195). Median postoperative IOP was 4 (3-6.25) mm Hg in STCT group versus 2 (0-5) mm Hg in LTCT at day 1 (p=0.003); 8.5 (5.75-11.25) mm Hg (STCT) vs 6 (4-9) mm Hg (LTCT) at week 1 (p=0.079); 17.5 (14.75-22.25) mm Hg (STCT) vs 13 (10-14) mm Hg (LTCT) at month 1 (p=0.001); 16 (12-20) mm Hg (STCT) vs 12 (10-15) mm Hg (LTCT) at month 3 (p=0.008); 17 (14-20) mm Hg (STCT) vs 12 (10-14) mm Hg (LTCT) at month 6 (p=0.000); 16 (14-20) mm Hg (STCT) vs 14 (10-16) mm Hg (LTCT) at year 1 (p=0.002) and 17.5 (15-19) mm Hg (STCT) vs 14 (12-16) mm Hg (LTCT) at year 2 (p=0.001). The complete success rate was 54.5 % in STCT and 87 % in LTCT (p=0.018). CONCLUSIONS: A long-term and intensive postoperative treatment enhances success rate in DS compared with a standard protocol.

A Novel Surgical Technique for Ahmed Valves in Refractory Glaucoma With Silicone Oil Endotamponade.

PURPOSE: The purpose of the study is to describe a novel technique to implant Ahmed valves in patients with refractory glaucoma because of silicone oil (SO) endotamponade PATIENTS:: Three patients with glaucoma without SO removal were used as an example for this technique. METHODS: Technique report. RESULTS AND CONCLUSIONS: We introduce a standard technique modification for Ahmed valves in patients with SO. This modification consists on locating the Ahmed valve more tangential to the limbus curvature instead of the usual perpendicular position and inserting the tube in the posterior chamber. The tube can be longer and run parallel to pupil. This technique allows use superotemporal quadrant (fewer complications), avoid corneal touch and decrease SO loss through the tube to subconjunctival space.