Management of Different Subtypes of Primary Angle Closure with Phacoemulsification and Viscogoniosynechialysis.

PURPOSE: To retrospectively assess the effectiveness of combined phacoemulsification with viscogoniosynechialysis for patients with different subtypes of primary angle closure (PAC). METHODS: Forty-three eyes of 37 patients diagnosed with PAC (12 eyes), PAC with glaucoma (PACG, 20 eyes), and acute PAC (11 eyes) were treated with phacoemulsification and viscogoniosynechialysis between November 2010 and October 2012. Main outcome measures were anterior chamber depth (ACD), intraocular pressure (IOP), the number of IOP-lowering medication, extent of peripheral anterior synechia (PAS), and visual acuity preoperatively and one month postoperatively. RESULTS: All operations were successfully accomplished and no intra-operative complications were observed. The ACD, IOP, PAS, and visual acuity were all significantly improved postoperatively, especially in the acute PAC group, which resulted in few glaucoma drugs being needed. The IOP was decreased into equal or less than 21 mmHg in most patients postoperatively, except four patients had IOP slightly higher than 21 mmHg. However, they were restored to normal spontaneously or by medication at last follow-up. The extent of PAS was all reduced to less than 90 or 180°, with the visual acuity restored to more than 0.1. CONCLUSIONS: Combined phacoemulsification with viscogoniosynechialysis seems to be an effective surgical procedure in the treatment of various subtypes of PAC.

Comparative efficacy and safety of the fixed versus unfixed combination of latanoprost and timolol in Chinese patients with open-angle glaucoma or ocular hypertension.

BACKGROUND: A noninferiority trial was conducted to evaluate the efficacy of a single evening dose of fixed-combination latanoprost 50 µg/mL and timolol 0.5 mg/mL (Xalacom®; LTFC), in Chinese patients with primary open-angle glaucoma (POAG) or ocular hypertension (OH) who were insufficiently controlled on ß-blocker monotherapy or ß-blocker-based dual therapy. METHODS: This 8-week, randomized, open-label, parallel-group, noninferiority study compared once-daily evening dosing of LTFC with the unfixed combination of latanoprost, one drop in the evening, and timolol, one drop in the morning (LTuFC). The primary efficacy endpoint was the mean change from baseline to week 8 in diurnal intraocular pressure (IOP; mean of 8 AM, 10 AM, 2 PM, 4 PM IOPs). LTFC was considered noninferior to LTuFC if the upper limit of the 95% confidence interval (CI) of the difference was < 1.5 mmHg (analysis of covariance). RESULTS: Baseline characteristics were similar for LTFC (N = 125; POAG, 70%; mean IOP, 25.8 mmHg) and LTuFC (N = 125; POAG, 69%; mean IOP, 26.0 mmHg). Mean diurnal IOP changes from baseline to week 8 were -8.6 mmHg with LTFC and -8.9 mmHg with LTuFC (between-treatment difference: 0.3 mmHg; 95%-CI, -0.3 to 1.0). Both treatments were well tolerated. CONCLUSIONS: A single evening dose of LTFC was at least as effective as the unfixed combination of latanoprost in the PM and timolol in the AM in reducing IOP in Chinese subjects with POAG or OH whose IOP was insufficiently reduced with ß-blocker monotherapy or ß-blocker-based dual therapy. LTFC is an effective and well tolerated once-daily treatment for POAG and OH.

Practical method to calculate post-LASIK corneal power: the Actual K(a+p) method.

AIM: To evaluate the accuracy of a practical method (the Actual K(a+p) method) of corneal power measurement for post-LASIK eyes undergoing cataract surgery. METHODS: Ten eyes of 7 patients (4 male, 3 female, average age 50.10±4.01 years, with -11.01±3.55D mean refraction before LASIK), underwent post-LASIK phaco+IOL cataract surgery. We used the posterior corneal curvature as measured by the Pentacam in a method we named Actual K(a+p) to calculate the post-LASIK corneal power for IOL calculation. The refractive outcomes after cataract surgery were evaluated. The Actual K(a+p) was compared with the back- calculated corneal power (BCK), which was thought to be the benchmark of true corneal power. The corneal power estimated by other published methods, including Maloney, Shammas, Koch-Maloney, Savini, and McCulley, together with the true net power and equivalent K reading (EKR) as found by the Pentacam were also compared with the BCK. RESULTS: All eyes achieved satisfied refractive status after cataract surgery. The difference between the postoperative refraction and the target refraction was 0.04±0.40D, range from -0.63D and +0.85D. Among all the methods we studied, although the Bonferroni multiple comparison tests did not detect significant differences between any two of them, the Actual K(a+p) yielded the highest agreement with the BCK, with 80% of the eyes falling within ±0.5D and 100% within ±1.0D from the BCK values. CONCLUSION: The Actual K(a+p) method can provide encour- aging results in post-LASIK eyes undergoing cataract surgery.

[The accuracy of posterior curvature method in corneal power calculation after LASIK surgery].

OBJECTIVE: To estimate the accuracy of posterior curvature method in corneal power calculation after LASIK surgery. METHODS: Corneal power calculation in 11 eyes that underwent Intraocular Lens (IOL) implantation after LASIK surgery (10 cases of Phaco + IOL, 1 case of IOL displacement), all of which used posterior curvature method, was analyzed retrospectively. The differences between post-operative stable refraction and target refraction were calculated, the actual corneal powers were deduced, and the expected refractive errors using other corneal power evaluation methods (auto-keratometry, corneal topography, spherical equivalent method, anterior curvature method, Equivalent K Reading method provided by Pentacam) were analyzed. In addition, refraction of 23 eyes underwent LASIK surgery were done on their 6 months follow-up. The theoretical corneal powers were deduced by subtracting the change of refraction before and after LASIK surgery from the pre-operative corneal powers. The differences between calculated corneal powers using posterior curvature method and the theoretical corneal powers were analyzed, and were compared with other corneal power evaluation methods. RESULTS: The mean uncorrected post-operative visual acuity of IOL implantation eyes using posterior curvature method was 0.8 +/- 0.2, with mean absolute refractive error from target of (0.36 +/- 0.36) D (-0.63 to +0.85 D). The ratio of eyes with absolute error within 0.25 D, 0.50 D, and 1.00 D was 55%, 73%, and 91% respectively. This result was significantly lower than that of the auto-keratometry (2.50 +/- 1.08) D, corneal topography (1.90 +/- 0.88) D, and those obtained from spherical equivalent method (2.09 +/- 1.62) D (P < 0.01) or anterior curvature method (1.45 +/- 1.10) D (P < 0.05). It also showed less bias (-1.13 to 0.85 D) when compared to the Equivalent K Reading (-1.10 to 1.80 D), but the difference was not significant (P > 0.05). For the 23 post LASIK eyes, the absolute difference between the corrected corneal power using posterior curvature method and theoretical power was (0.67 +/- 0.45) D, also showed least bias compared with other methods. CONCLUSION: It is a practical and accurate way to calculate the corneal power after LASIK surgery using posterior curvature method.

Triple immune suppression increases short-term survival of porcine fetal retinal pigment epithelium xenografts.

PURPOSE: To determine the effect of triple drug immune suppression on RPE xenograft survival in the fetal pig after transplantation into the albino rabbit subretinal space. METHODS: Primary RPE microaggregates (approximately 40,000 RPE cells) were injected into the subretinal space of 24 albino rabbits, with half the rabbits maintained on triple systemic immune suppression. RPE survival was estimated with a DNA probe (porcine DNA repeat element; PRE) against a porcine-specific repetitive chromosomal marker or a RAM-11 antibody against rabbit macrophages. RESULTS: Numerous pigmented cells were visible in the subretinal space at all time points, but most pigment-containing cells 4 weeks or more after surgery were RAM-11 positive and PRE negative. The number of PRE-positive cells in the immune-suppressed group (4193 +/- 2461, 1184 +/- 1502, and 541 +/- 324 at 4, 8, and 12 weeks, respectively) was greater than in immune-competent control animals (292 +/- 506, 193 +/- 173, and 111 +/- 96), but the difference was only statistically significant at 4 weeks. The time-dependent decrease in PRE-positive cells was more pronounced in immune-suppressed animals. Image analysis performed on serial fundus photographs and fluorescein angiograms did not detect any difference in the appearance of the grafts in immune-suppressed versus immune-competent animals. CONCLUSIONS: Systemic immune suppression increased the 4-week survival of porcine RPE xenografts in the albino rabbit subretinal space, but there was poor survival in immune-suppressed and -competent animals 12 weeks after surgery. Many pigment-containing cells 4 or more weeks after surgery were PRE negative, indicating that they are of host origin.

Identification of transplanted retinal pigment epithelium with a novel chromosomal marker.

PURPOSE: To demonstrate the ability of a novel chromosomal marker to identify retinal pigment epithelium (RPE) after xenotransplantation, and determine the short-term correlation between pigment and this nuclear marker. METHODS: Primary pigmented RPE harvested from third trimester fetal pigs were transplanted as microaggregates into the subretinal space of 3 albino rabbits. We then used an in situ probe for a repetitive segment of the porcine chromosome to identify the transplanted RPE. RESULTS: Pigmented cells were visible in the subretinal space 2 weeks after transplantation. Approximately 70% of pigment-containing cells were also labeled with the porcine chromosomal marker. Labeled cells were predominantly flatter in morphology and close to Bruch's membrane whereas unlabeled cells were rounder and further from Bruch's membrane. The outer nuclear layer thickness was normal above the pigmented monolayer but was decreased over areas containing multiple layers of pigmented cells. CONCLUSIONS: Fetal porcine RPE xenografts can be identified with a nuclear marker for a repetitive segment of the porcine chromosome. The presence of pigment within unlabelled cells suggests that pigment is not a robust marker for transplanted RPE.