New suture probe canaloplasty combined with suprachoroidal collagen implantation.

PURPOSE: To present the modified surgery technique of new suture probe canaloplasty with a specially prepared monofilament 4.0 polypropylene suture combined with suprachoroidal drainage (ScD) and collagen sheet implantation for non-penetrating glaucoma surgery. METHODS: Prospective study with a twelve months follow-up. A standard 4/0 polypropylene suture (ProleneTM by Ethicon; thickness: approximately 250 m) is cut and shaped with an ophthalmic knife (MANI® Crescent Knife, Mani Inc 8-3 Kiyohara Industrial Park, Utsunomiya, Tochigi 321-3231, Japan) to create a blunt end without sharp or compressed edges. This improves suture probe canaloplasty by providing a more stable and smoother probing device. Schlemm's canal is prepared using the standard technique of canaloplasty with suprachoroidal drainage. Then, instead of using the canaloplasty microcatheter or the previously published 6/0 double-helix suture, Schlemm's canal is probed with the blunt ending of the 4/0 Prolene suture. After successful 360-degree probing, a doubled 10/0 polypropylene tension suture is threaded through the tip of the 4/0 suture. The 4/0 suture is then pulled back and the 10/0 tension sutures are tied at both ends to tension Schlemm's canal. A special collagen sheet (Ologen®) is placed in suprachoroidal space, and the scleral flap is firmly sewed. RESULTS: 115 eyes were included in this prospective study. In 113 cases the Schlemm's canal could completely be probed with the suture probe and canaloplasty with ScD and collagen sheet implantation succeeded. In two cases the intervention was transformed to 360-degree suture trabeculotomy due to an intraoperative cheese-wiring. Twelve months after successful new suture probe canaloplasty with ScD and Collagen Implantation the IOP had decreased by 37.1% (from 21.6 ± 6.0 mmHg with 3.3 different IOP lowering eye drops to 13.5 ± 3.5 mmHg with 1.0 eye drops). 16 Patients did not achieve sufficient IOP levels and underwent 360-degree suture trabeculotomy during the follow-up. One patient had to be treated with further glaucoma surgery to achieve a sufficient IOP level. Complications were hyphema, postoperative IOP elevation and transient hypotony. No serious or sight-threatening complications occurred. CONCLUSION: New suture probe canaloplasty with ScD and collagen sheet implantation yields the opportunity to conduct a cost-effective canaloplasty easier and less complicated than with the previously described method with the twisted 6/0 suture. The safety profile and IOP lowering effect is comparable. In cases where complete probing fails, there is still the opportunity to switch to suture trabeculotomy over the majorly probed part of Schlemm's canal. The pressure lowering effect of the deep sclerectomy with ScD and suprachoroidal collagen sheet implant seems to have an additional impact on the sufficient pressure lowering procedure.

One Year Results of the Preserflo MicroShunt Implantation for Refractory Glaucoma.

PRCIS: The Preserflo MicroShunt is an effective method to achieve a satisfying intraocular pressure (IOP) reduction in patients with complicated forms of glaucoma. PURPOSE: To evaluate the efficacy and safety of the Preserflo MicroShunt with mitomycin C in patients with complicated glaucoma. METHODS: This prospective interventional study included all patients that underwent Preserflo MicroShunt Implantation between April 2019 and January 2021 to treat severe and therapy refractory glaucoma. The patients either suffered from primary open angle glaucoma with already failed incisional glaucoma surgery or presented severe forms of secondary glaucoma (eg, after penetrating keratoplasty or globe penetrating injury). Primary endpoint was the IOP-lowering effect and the success rate after 12 months. Secondary endpoint was the occurrence of intraoperative or postoperative complications. Complete success was defined as reaching the target IOP (>6 mm Hg and <14 mm Hg) without additional IOP-lowering medication whereas qualified success was attained with the same IOP target regardless of the medication. RESULTS: A total of 40 eyes of 38 patients were enrolled. After 12 months 85.7% of the eyes achieved complete success with an average IOP of 10.5 ± 2.0 mm Hg, without the use of glaucoma eye drops. The average IOP reduction was 58.4% from baseline. In 5 cases (12.5%) failure occurred as revisional surgery was required. CONCLUSION: The Preserflo MicroShunt for refractory glaucoma cases achieved a high complete success rate without additional medication at 1 year. Revisional surgery was needed in some cases and long-term studies are needed.

EYEMATE-SC Trial: Twelve-Month Safety, Performance, and Accuracy of a Suprachoroidal Sensor for Telemetric Measurement of Intraocular Pressure.

PURPOSE: Measuring and controlling intraocular pressure (IOP) provide the foundation for glaucoma treatment. Self-tonometry has been proposed as an alternative to measure IOP throughout the entire day better. The novel EYEMATE-SC sensor (Implandata) is implanted in the suprachoroidal space to enable contactless continual IOP monitoring. The aim of the present study was to investigate the 1-year safety, performance, and accuracy of the EYEMATE-SC in patients with primary open-angle glaucoma undergoing simultaneous nonpenetrating glaucoma surgery (NPGS). DESIGN: Prospective, multicenter, open-label, single-arm, interventional clinical trial. PARTICIPANTS: Twenty-four eyes of 24 patients with primary open-angle glaucoma who were due to undergo NPGS (canaloplasty or deep sclerectomy). METHODS: An EYEMATE-SC sensor was implanted during NPGS. Goldmann applanation tonometry (GAT) measurements were compared with the sensors' IOP measurements at all postoperative visits through 12 months. MAIN OUTCOME MEASURES: Device position and adverse events. RESULTS: Fifteen eyes underwent canaloplasty, and 9 underwent deep sclerectomy. Successful implantation of the sensor was achieved in all eyes with no reported intraoperative difficulties. Through the 12-month follow-up, no device migration, dislocation, or serious device-related complications were recorded. A total of 536 EYEMATE-SC measurements were pairwise included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 0.8 mmHg (95% confidence interval [CI] of the limits of agreement [LoA], -5.1 to 6.7 mmHg). The agreement gradually improved, and from 3 months after surgery until the end of the follow-up, the mean difference was -0.2 mmHg (95% CI of LoA, -4.6 to 4.2 mmHg) over a total of 264 EYEMATE-SC measurements, and 100% of measurements were within ±5 mmHg of GAT. CONCLUSIONS: The EYEMATE-SC sensor was safe and well tolerated through 12 months. Moreover, it allowed accurate, continuous IOP monitoring. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Safety and performance of a suprachoroidal sensor for telemetric measurement of intraocular pressure in the EYEMATE-SC trial.

AIM: To investigate the safety and performance of a telemetric suprachoroidal intraocular pressure (IOP) sensor (EYEMATE-SC) and the accuracy of its IOP measurements in open angle glaucoma (OAG) patients undergoing simultaneous non-penetrating glaucoma surgery (NPGS). METHODS: Prospective, multicentre, open-label, single-arm, interventional clinical trial. Twenty-four eyes of 24 patients with OAG regularly scheduled for NPGS (canaloplasty or deep sclerectomy) were simultaneously implanted with an EYEMATE-SC sensor. Six-month follow-up on the sensor's safety and performance as well as on the level of agreement between the EYEMATE-SC measurements and IOP measurements with Goldmann applanation tonometry (GAT). RESULTS: The eyes underwent canaloplasty (n=15) or deep sclerectomy (n=9) and achieved successful implantation of the sensor. No device migration, dislocation or serious device-related complications occurred. A total of 367 comparisons were included in the IOP agreement analysis. The overall mean difference between GAT and EYEMATE-SC measurements was 1.31 mm Hg (lower limit of agreement (LoA) 7.55 mm Hg; upper LoA -4.92 mm Hg). The maximum difference of 2.5 mm Hg ±3.96 (LoA 0.30-2.29) was reached on day 10 and continuously improved to an agreement of -0.15 mm Hg ±2.28 (LoA -1.24 to 0.89) after 6 months. Accordingly, the percentage of eyes within an IOP difference of ±5 mm Hg improved from 78% (day 3) to 100% (6 months). CONCLUSIONS: After 6 months, the EYEMATE-SC sensor was safe and well tolerated, and allowed continual IOP monitoring. TRIAL REGISTRATION NUMBER: NCT03756662.

REVISED PREDICTIVE BIOMARKER FOR OCRIPLASMIN THERAPY IN VITREOMACULAR TRACTION DISORDERS.

PURPOSE: To determine a statistically optimal limit of adhesion size in vitreomacular traction (VMT) syndrome for ocriplasmin treatment. METHODS: In this retrospective, consecutive, interventional study, we included 106 patients treated with ocriplasmin injection because of VMT between July 2013 and January 2018. A univariate and multivariate risk analysis was performed with grouped factors and continuous factors. We used a receiver operating characteristic curve to measure the prognostic relevance of each continuous factor for therapy success and determined the statistically optimal cutoff value at which specificity and sensitivity are simultaneously maximized. RESULTS: Among the grouped factors, only a phakic lens status showed a highly significant positive influence on the resolution of the VMT. For the continuous factors, only the adhesion diameter before injection was a good predictor of anatomical success. The statistically optimal threshold value for the adhesion size was calculated to be 480 µm. Eyes below this limit had a 6.84-fold better chance of VMT resolution compared with eyes with a larger adhesion diameter. CONCLUSION: The threshold value of the VMT diameter for ocriplasmin therapy could be statistically defined as 480 µm and may thus be a new quantitative biomarker to predict treatment success.

New optical coherence tomography grading system for macula-off rhegmatogenous retinal detachment: how off is off?

BACKGROUND/AIMS: The classification of retinal detachment is currently still based on many objective criteria such as duration of symptoms and funduscopic macular status, which leaves some important questions unanswered. The most important factor is the macular status, which is determined using direct or indirect ophthalmoscopy. Optical coherence tomography (OCT) has become a standard tool in clinical practice and enables detecting the exact extent of subretinal fluid in macula-off/on retinal detachment. We introduce a new and simple OCT-based grading system for macular detachment to provide a basis for further investigations to determine the optimal timing for surgery. METHODS: We retrospectively included 155 patients who were treated for retinal detachment. We defined the extent of the macular detachment in six stages based on the Early Treatment Diabetic Retinopathy Study (ETDRS) grid of the OCT scan.The outermost ring of the ETDRS grid was defined as zone 1, the middle ring as zone 2 and the inner ring as zone 3. Only zone 3 differed in the retinal detachment height grades (grade a <250 µm vs grade b >250 µm). Retinal detachment heights that could not be measured were considered grade 4 (ungradable) detachments. RESULTS: Forty-seven patients had no macular involvement (grade 0). Regarding macular detachment, 14 patients had grade 1, 20 had grade 2, 9 had grade 3a, 29 had grade 3b and 36 had grade 4. CONCLUSION: The newly developed OCT grading system for macular involvement following retinal detachment is a crucial tool to objectively classify a retinal detachment in order to be able to make better statements in the future, like for defining the optimal time for surgical intervention. A secondary benefit of this grading system would be that it improves predicting postoperative visual acuity.

Canaloplasty with Suprachoroidal Drainage in Patients with Pseudoexfoliation Glaucoma - Four Years Results.

Purpose: To evaluate the long-term efficacy and safety of the modified canaloplasty technique with additional suprachoroidal drainage in patients with pseudoexfoliation glaucoma. Methods: This retrospective clinical trial included 131 patients with pseudoexfoliation glaucoma who underwent canaloplasty with suprachoroidal drainage (scD). One hundred and eleven of 131 patients underwent the follow-up examination after 48 months. Primary endpoints were the pressure-lowering and drug-sparing effect as well as the success rates. Secondary endpoints were intra- and postoperative complications and the occurrence of secondary surgical interventions. Results: The IOP was reduced by 45.8% after 12 months (from baseline 23.4 ± 5.1 mmHg to 12.7 ± 2.2 mmHg) and by 45.1% after four years (12.8 ± 2.2 mmHg) (p < .001). The mean number of IOP-lowering medication decreased significantly from 3.4 at baseline to 0.6 after 12 months and to 1.0 after four years. The IOP-reducing effect was even stronger in those cases in whom canaloplasty+ scD was combined with cataract surgery (49.4% after 12 months and 47.6% after four years). No serious complications were observed. Conclusions: The modified surgery technique of canaloplasty with suprachoroidal drainage is a safe and effective way of reducing IOP in patients with pseudoexfoliation glaucoma.

Predictive factors for the IOP reduction in phacocanaloplasty with suprachoroidal drainage.

PURPOSE: Although the pressure-reducing effect of cataract surgery alone is not very high, it is often cited in the literature. Some authors describe predictive factors correlated with the IOP (intraocular pressure) reduction: in particular noteworthy are age, axial length, preoperative pressure level and the ratio of preoperative pressure/anterior chamber depth. The aim of this study was to determine the applicability of these predictive factors to phacocanaloplasty with suprachoroidal drainage. Setting Eye Clinic Sulzbach Germany. DESIGN: Retrospective study with a 12-month follow-up, including patients that underwent phacocanaloplasty with suprachoroidal drainage between 2012 and 2014. METHODS: Preoperatively, baseline information was collected (including age, diagnosis, medication), and the patients underwent a basic examination and optical biometry. To investigate the relationship between preoperative parameters and the IOP reduction, Pearson's correlation analysis and linear regression were used. Patients with missing data pre- or postoperatively were excluded from the analysis. RESULTS: The study comprised 89 patients. Mean preoperative IOP was 23.0 ± 5.3 mmHg with 4.0 different antiglaucomatous eye drops. After 12 months, IOP was reduced to 12.1 ± 1.4 mmHg with a median medication of 0.0. The preoperative IOP and the ratio of preoperative IOP/anterior chamber depth were identified as predictive factors. There was no influence of axial length and anterior chamber depth. CONCLUSION: Unlike in cataract surgery, anterior chamber depth and axial length have no influence on the pressure reduction caused by phacocanaloplasty. However, a strong predictive factor is the preoperative pressure level. The higher the preoperative IOP, the greater the postoperative pressure reduction.

Impact of Patient Interface Diameter and Vacuum Level on Suction Stability Using a Flat Applanating Interface for Femtosecond Laser-Assisted LASIK.

PURPOSE: To investigate the impact of different patient interface (PI) diameters and different vacuum levels on the suction stability during vacuum application for femtosecond laser-assisted LASIK. METHODS: Break-away forces as a marker for suction stability were measured by an automated test bench set-up. The test bench was based on a customized stamp connected to a digital load cell. Three flat applanating PI with different diameters (8.5, 9.5 and 10.0 mm) and four different vacuum levels (500, 600, 700 and 800 mbar) were investigated using the FEMTO LDV Z8 (Ziemer Ophthalmic Systems AG, Switzerland). RESULTS: Mean break-away force was 5.23N (±0.99N) using the 8.5 mm PI and 500 mbar vacuum, 8.18N (±1.39N) using the 8.5 mm PI and 800 mbar, 3.37N (±0.56N) using the 10.0 mm PI and 500 mbar, and 6.14N (±0.68N) using the 10.0 mm PI and 800 mbar vacuum (p < .001; CI95%). Increasing the PI diameter from 8.5 to 10.0 mm resulted in a 28.89% (+1.97 ± 1.02N) lower break-away force (p < .001) when using default vacuum settings (700 mbar) compared to increasing vacuum from 500 to 800 mbar, which resulted in a 60.37% (+1.95 ± 1.40N) higher mean break away force (p < .001). CONCLUSION: The vacuum level and the diameter of the PI showed significant impact on suction stability measured as break-away force during flat applanating docking for corneal and refractive surgery. Break-away forces were inversely related to the PI diameter and directly to the vacuum level. Increasing the PI diameter by one step or reducing vacuum by 100 mbar resulted in a comparable decrease of break-away forces. Therefore, the surgeon could potentially maintain stabile suction by increasing vacuum when choosing a larger PI diameter to obtain a larger treatment zone. Furthermore, reduction of the PI diameter and/or increasing vacuum could help improving suction stability in situations of poor suction and in situations with increased risk of suction loss during LASIK.

First Simultaneous Explantation and Re-Implantation of an Argus II Retinal Prosthesis System.

A 59-year-old blind woman with retinitis pigmentosa had undergone implantation of an Argus II system without complications and took advantage of the system for 7 months. Due to a technical error of the system, the glasses of the prosthesis developed increased heat generation, making the use of the system unbearable. Because of the initial satisfaction and high motivation of the patient, it was decided to strive for an implant exchange. In a 4-hour surgery session, the implant was removed and a new system was implanted. Hereby, several critical surgery steps could be identified that are important to consider for future surgeries. Besides a strong fibrotic scarring of conjunctiva and tenon aggravating the extraction of the extraocular components, the preparation of the sclerotomy proved to be difficult for achieving water tightness. Furthermore, the extraction of the retinal tack and the repositioning of the new array were challenging steps. During the postoperative course, a severe hemorrhagic choroidal detachment occurred but resolved without surgical intervention. The implant was well-placed and showed good function. The exchange of an Argus II is feasible, however, with the challenge of hypotony and hemorrhage as well as possible fibrosis complicating the repositioning of the chip. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:462-465.].

Effect of Ocriplasmin on objectively assessed retinal function after treatment of vitreomacular diseases.

BACKGROUND: The scope of the study was the functional assessment of possible effects of intravitreally injected ocriplasmin using electroretinographical (ERG) examinations. METHODS: Seven subjects suffered from pathologies within the label of ocriplasmin (Jetrea® ) were examined in the study. An extended international society for clinical electrophysiology of vision ERG protocol was used for baseline recordings (before treatment) and was repeated for comparison 3 months after treatment with intravitreally injected ocriplasmin. All subjects were examined using 6 steps and a 9 Hz flicker protocol as scotopic flicker response under dark-adapted conditions. Under light-adapted conditions, two single-flash responses (standard flash and On/Off protocol) and a 31 Hz flicker response was used for functional assessment. RESULTS: A significant reduction of amplitudes was found for the lowest stimulation intensity (0.0001 cd.s/m²) under dark-adapted conditions after treatment (p = 0.027). All other parameters were not significantly different after treatment including the scotopic flicker response. Under light-adapted state, the a- and b-wave amplitudes were not significantly altered after treatment for single-flash and flicker responses. The On- and Off-responses were not significantly different between baseline and after the treatment. CONCLUSIONS: One single significant difference of all examined parameters mirrors a difference due to chance, even if a negative effect of proteolytic enzymes on laminin and fibronectin of retinal cells cannot be entirely excluded. Nevertheless, this result should be respected in order to ensure a safe use of ocriplasmin for patients with vitreoretinal disorders.

Catheter-independent suture probe canaloplasty with suprachoroidal drainage.

PURPOSE: To introduce the novel technique of suture probe canaloplasty with suprachoroidal drainage (SCD) as a catheter-independent and cost-saving method to perform non-penetrating glaucoma surgery. METHODS: Prospective interventional study with a 12-month follow-up. A standard 6/0 polypropylene suture is twisted in a special manner to create a double helix with a small loop at its end. Then canaloplasty with SCD is performed, but instead of using the standard canaloplasty catheter, Schlemm's canal is probed with the twisted suture. After 360° probing, a 10/0 polypropylene suture is thread through the loop and the twisted 6/0 suture is pulled backwards through Schlemm's canal. The 10/0 suture in Schlemm's canal is tied firmly and hyaluronic acid is injected into the suprachoroidal space. RESULTS: In total, 74 eyes that underwent suture probe canaloplasty with SCD were included. In 57 cases, probing of Schlemm's canal with the twisted 6/0 suture succeeded. Seventeen eyes had adhesions in Schlemm's canal which made probing with the suture impossible so that the surgeon switched in 12 cases to microcatheter-guided canaloplasty with SCD. While this was successful in five further cases, the adhesions seemed surely not be overcome and SCD with collagen sheet implantation was directly performed. In four additional cases after successful probing, the suture cut through trabecular meshwork; hence a 360° suture trabeculotomy was performed. After successful suture probe canaloplasty with SCD, intraocular pressure (IOP) decreased by 39.2% (from 19.8 ± 4.3 mmHg with 3.4 ± 0.7 different IOP-lowering eye drops to 12.0 ± 1.9 mmHg with 0.6 ± 0.9 eye drops). Three patients did not achieve sufficient IOP levels and, therefore, underwent 360° suture trabeculotomy during follow-up. No serious or sight-threatening complications occurred. CONCLUSION: Suture probe canaloplasty + SCD yields the opportunity to conduct canaloplasty with SCD more cost-effectively with a safety profile and IOP-lowering effect comparable to conventional canaloplasty. In cases where probing with the suture fails. there still remains the option to use a conventional microcatheter or to switch to SCD with collagen sheet implantation.

The effect of canaloplasty with suprachoroidal drainage combined with cataract surgery - 1-year results.

PURPOSE: The purpose of this study was to investigate the safety and efficacy of phacocanaloplasty with suprachoroidal drainage (PCscD) and to compare its intraocular pressure (IOP)-lowering and drug-sparing effect to canaloplasty with suprachoroidal drainage (CscD). METHODS: The study retrospective interventional study included patients with open-angle glaucoma or secondary forms of glaucoma who underwent either CscD or PCscD between the year 2011 and 2014 in Knappschaft Eye Clinic Sulzbach. Primary end-points were IOP reduction and the number of IOP-lowering medication after 12 months. Secondary end-points were intraoperative and postoperative complications. RESULTS: A total of 328 eyes were included, 193 were treated with CscD and 135 underwent PCscD. Canaloplasty with scD achieved an IOP reduction of 37.0% (from 20.9 ± 3.6 mmHg to 13.2 ± 2.6 mmHg) after 1 year, whereas PCscD showed a significant higher reduction of 47.4% (from 23.2 ± 5.1 mmHg to 12.2 ± 1.7 mmHg). Reduction in IOP-lowering medication was higher after PCscD (from 3.6 ± 0.6 to 0.2 ± 0.5) than after CscD (from 3.5 ± 0.8 to 0.7 ± 1.0). Twelve months after surgery 55.5% in the CscD group and 80.2% in the PCscD group were free of IOP-lowering medication. In both groups, no severe or sight-threatening complications occurred. CONCLUSION: Combining cataract surgery and CscD achieves a higher IOP reduction, and patients postoperatively need less IOP-lowering medication than after CscD alone.

Suprachoroidal drainage with collagen sheet implant- a novel technique for non-penetrating glaucoma surgery.

PURPOSE: Our purpose was both to introduce the new technique of suprachoroidal drainage with collagen sheet implantation as a novel technique of non-penetrating glaucoma surgery and to present first results of a prospective pilot study. METHODS: A superficial rectangular sclera flap of half-scleral thickness sized 4 × 4.5 mm is dissected anteriorly until clear cornea. Then, a second scleral flap is created underneath the first one sized 3.5x4mm and is cut down full-thickness to the choroid exposing the suprachoroidal space. The flap is then bluntly prepared until the scleral spur is reached. Sharp dissection above the sclera spur exposes Schlemm's canal, which is located directly anteriorly. Schlemm's canal is unroofed, juxtacanalicular meshwork is peeled and the deep flap is cut off at its base. An absorbable collagen sheet (Ologen®, Dahlhausen, Cologne, Germany) is placed into the suprachoroidal space at the level of the ciliary body, and the superficial sclera flap is sutured tightly to prevent leakage. RESULTS: We prospectively analyzed 65 eyes that underwent suprachoroidal drainage with collagen sheet implantation. Mean reduction of intraocular pressure after 3 months was 35.1% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.4 mmHg)(p < 0.01) and after 12 months 35.6% (from 21.0 ± 4.3 mmHg to 13.5 ± 3.0  mmHg)(p < 0.01). The number of topical IOP-reducing medication decreased significantly from 3.5 ± 0.7 to 0.6 ± 0.9 and to 0.9 ± 1.1 after 3 and 12 months, respectively (p < 0.01). No serious complications occurred. CONCLUSION: Suprachoroidal drainage with collagen sheet implantation seems to be a safe and effective surgical technique for non-penetrating glaucoma surgery that yields the opportunity of a sufficient IOP reduction for eyes unsuitable for canaloplasty.

Comparison of intraocular pressure during the application of a liquid patient interface (FEMTO LDV Z8) for femtosecond laser-assisted cataract surgery using two different vacuum levels.

BACKGROUND: To evaluate intraocular pressure (IOP) using the application of a novel liquid patient interface for femtosecond laser-assisted cataract surgery with the FEMTO LDV Z8. METHODS: IOP was evaluated in enucleated porcine eyes prior, during and after the application of the Femto LDV Z8 liquid patient interface (Ziemer Ophthalmic Systems, Switzerland) using intracameral cannulation (n=20), intravitreal cannulation (n=20), rebound tonometry (n=20) and indentation tonometry (n=20). Pressure was assessed prior vacuum, during vacuum (30 s, 1 min, 2 min, 3 min) and after releasing the vacuum (1 min and 2 min). Two groups with different predefined vacuum levels (350 mbar, 420 mbar) were investigated. RESULTS: Mean intracameral pressure (±SD) increased during vacuum application from 20 mm Hg to 52.00 mm Hg (±6.35mm Hg; p=0.005) and 45.18 mmHg (±4.34 mm Hg; p=0.005) for the 420 mbar and the 350 mbar vacuum levels, respectively. Mean intravitreal pressure increased from 20 mm Hg to 25.60 mm Hg (±9.85 mm Hg; p=0.058) and 28.10 mm Hg (±2.54 mm Hg; p=0.059) for the 420 mbar and the 350 mbar vacuum levels, respectively. Pressure values from indentation and rebound tonometry were in between intracameral and intravitreal values. Mean intracameral IOP was 18.1% higher (p=0.019) in the 420 mbar group compared with the 350 mbar group. CONCLUSION: During vacuum application of the liquid patient interface of the Femto LDV Z8 for femtosecond laser-assisted cataract surgery, IOP values were higher in the anterior chamber compared with the intravitreal pressure measurements. The higher predefined vacuum level (350 mbar vs 420 mbar) resulted in significant higher intracameral IOP.

Femtosecond laser-assisted cataract surgery: First clinical results with special regard to central corneal thickness, endothelial cell count, and aqueous flare levels.

PURPOSE: To evaluate clinical data and outcomes after femtosecond laser-assisted cataract surgery with the recently introduced low-energy Femto LDV Z8 laser during a 3-month follow-up. SETTING: Knappschaft Eye Clinic Sulzbach, Knappschaft Hospital Saar GmbH, Sulzbach, Germany. DESIGN: Consecutive case series. METHODS: Femtosecond laser-assisted cataract surgery was performed using the low-energy femtosecond laser. Clinical data including objective refraction, corrected distance visual acuity, central corneal thickness (CCT), endothelial cell count (ECC), and aqueous flare were evaluated 1 day, 1 week, 4 weeks, and 3 months postoperatively. RESULTS: The median CCT and aqueous flare were statistically significantly elevated during the first day and 4 weeks after surgery, respectively (P < .001). There were no significant differences between CCT preoperatively and 1 week postoperatively (P = .079) and aqueous flare preoperatively and 3 months postoperatively (P = .082). No statistically significant difference was found in the median ECC and spherical equivalent refraction between preoperatively and postoperatively (P > .05). CONCLUSION: Visual outcomes and investigated parameters reflecting corneal integrity indicated safe and atraumatic surgery using a new low-energy femtosecond laser for laser-assisted cataract surgery (including capsulotomy and lens fragmentation). FINANCIAL DISCLOSURE: None of the authors has a financial or proprietary interest in any material or method mentioned.

Modified canaloplasty with suprachoroidal drainage versus conventional canaloplasty-1-year results.

PURPOSE: The aim of this study was to investigate the efficacy and safety of a new and modified canaloplasty technique with suprachoroidal drainage in a large patient cohort, and to compare its IOP-lowering and topical drug-sparing effect to that of conventional canaloplasty. METHODS: This retrospective clinical trial included patients with open-angle glaucoma or secondary forms of glaucoma who underwent either conventional canaloplasty or canaloplasty with suprachoroidal drainage. Primary endpoint was the IOP reduction after 12 months as well as the number of IOP-lowering medications. Secondary endpoints were intra- and postoperative complications and the occurrence of secondary surgical interventions. RESULTS: Four hundred and seventeen eyes were included in the study; 180 of them were treated with conventional canaloplasty, and 237 eyes underwent canaloplasty with suprachoroidal drainage. In both groups, a significant IOP reduction could be observed after 12 months. Mean IOP reduction was stronger after canaloplasty with suprachoroidal drainage (35.9 %) (from baseline 20.9 ± 3.5 mmHg to 13.1 ± 2.5 mmHg) than after conventional canaloplasty (31.2 %) (from baseline 20.8 ± 3.6 mmHg to 14.0 ± 2.6 mmHg) (p < 0.01). The number of IOP-lowering medications decreased significantly in both groups: after canaloplasty with suprachoroidal drainage from 3.5 ± 0.9 to 0.7 ± 1.0, and after conventional canaloplasty from 3.4 ± 0.9 to 0.8 ± 0.9 with different drugs. The percentage of patients who were free of IOP-lowering agents after 1 year was significantly higher in the combined group (56.9 %) than in the group of conventional canaloplasty (45.4 %) (p = 0.0383). No serious complications were observed. CONCLUSIONS: The modified surgery technique of canaloplasty with suprachoroidal drainage yields the opportunity to optimize the IOP-lowering effect of canaloplasty as a non-penetrating surgical procedure while still offering a more favourable safety profile than trabeculectomy. The suprachoroidal access facilitates the most complicated step of the canaloplasty surgery: the localization of Schlemm's canal.

Micro-invasive 360-degree suture trabeculotomy after successful canaloplasty ­ one year results.

PURPOSE: This study was conducted to analyse the intraocular pressure (IOP)-lowering and drug-sparing effect of micro-invasive 360-degree suture trabeculotomy after successfully performed canaloplasty. METHODS: This retrospective interventional study included patients with open angle glaucoma or secondary forms of glaucoma, suffering from insufficient IOP level after previously conducted canaloplasty. To enhance the IOP-lowering canaloplasty effect, all patients underwent micro-invasive 360-degree suture trabeculotomy as a conjunctiva-sparing ab interno approach for circumferential trabeculotomy. This was achieved by introducing end-gripping forceps into the anterior chamber with topical anaesthesia, and grasping and extracting the canaloplasty suture through the trabecular meshwork under gonioscopic visualisation. Main outcome measures were IOP reduction and the number of IOP-lowering medications after 3 and 12 moths. Intraoperative and postoperative complications were documented systematically. RESULTS: In total, 88 eyes of 88 patients were included. Mean IOP reduction after micro-invasive 360-degree suture trabeculotomy at month 3 was 37.5 % (from baseline 22.8 ± 6.7 mmHg to 14.3 ± 3.1 mmHg, p < 0.01) and 41.2 % after 12 months (from 22.8 ± 6.7 mmHg to 13.4 ± 2.3 mmHg, p < 0.01). The number of IOP-lowering medications decreased significantly from a mean of 2.7 ± 1.4 to 1.3 ± 1.4 after 3 months, and 1.6 ± 1.2 after 12 months. No serious complications were observed. However, mild or moderate retrograde bleeding from the collector channels was present in 25 % of eyes that resorbed spontaneously in all cases. CONCLUSIONS: Micro-invasive 360-degree suture trabeculotomy represents a simple and safe minimal invasive ab interno technique to postoperatively enhance the IOP-lowering and drug-sparing effect of canaloplasty.