Outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with advanced glaucoma.

PURPOSE: To determine the medium-term outcomes for patients with advanced glaucoma undergoing viscocanalostomy. METHODS: All patients with advanced glaucoma (mean deviation (MD) - 12.00 dB or above) and patients with poor visual acuity secondary to advanced glaucoma which precluded formal visual field assessment undergoing viscocanalostomy (VC) and phaco-viscocanalostomy between 2010 and 2014 under the care of a single surgical team were included. Intraocular pressure (IOP), visual acuity (VA) and visual field outcomes were assessed from data prospectively collected into a surgical outcome database. Success was defined at two IOP cut-off points: IOP ≤ 21 and ≤ 16 mmHg with (qualified) or without (complete) medications. RESULTS: One hundred thirty-five patients were included. Mean IOP changed from 23.6 ± 6.4 mmHg pre-operatively to 15.3, 15.8 and 14.8 mmHg at 1, 2 and 3 years, a change of 35, 33.5 and 39% respectively. Qualified success for an IOP ≤ 21 mmHg was achieved in 95.66, 90.6 and 80% and complete success in 52.5, 48.6 and 30.6% at year 1, 2 and 3. Qualified success for an IOP ≤ 16 mmHg was achieved in 66.6, 66.05 and 60% and complete success in 44.8, 37.6 and 30.6% at year 1, 2 and 3. The cumulative probability for achieving an IOP ≤ 21 mmHg with or without drops was 86.1, 81.4 and 81.4% at 12, 24 and 36 months. Eleven patients (8.1%) failed to achieve adequate IOP control and needed further surgical intervention. Eleven (8.1%) patients needed an intervention (Yag goniopuncture) following VC. Four patients (2.9%) had some post-operative complications, which resolved within 2 weeks following surgery. Nine patients (6.7%) lost more than 2 Snellen lines. There was no significant change in the MD across time points. CONCLUSION: Viscocanalostomy and viscocanalostomy combined with phacoemulsification is a safe and effective method of controlling IOP in the medium term in patients with advanced glaucoma.

The Influence of Donor and Recipient Gender Incompatibility on Corneal Transplant Rejection and Failure.

In vascularized organ transplants, gender mismatches have higher rates of immunological rejection. We investigated the influence of gender incompatibility, including H-Y incompatibility, on corneal transplant graft rejection and failure. Patients were included who had undergone a first corneal transplant for keratoconus (KC), Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK), infection and other indications. A Cox regression model was fitted for each indication to determine factors affecting graft failure and rejection at 5 years. The impact of gender, including H-Y, matching was analyzed after accounting for other factors, including known risk factors. Of 18 171 patients, 4314 had undergone a transplant for FED, 4783 for KC, 3669 for PBK, 1903 for infection and 3502 for other disorders. H-Y mismatched (male [M]→female [F]) corneas were at greater risk of graft failure or rejection. For FED, F→F were 40% less likely to fail (p < 0.0001) and 30% less likely to reject (p = 0.01); M→M were 20% less likely to fail (p = 0.04) and 30% less likely to reject (p = 0.01). For KC, M→M matched corneas were 30% less likely to fail (p = 0.05) and 20% less likely to reject (p = 0.01) compared with H-Y mismatches. H-Y antigen mismatched (M→F) patients were at greater risk of rejection or graft failure.

Twenty-Four-Month Results of Intravitreal Bevacizumab in Macular Edema Secondary to Branch Retinal Vein Occlusion.

PURPOSE: The aim of this study is to evaluate the long-term efficacy of intravitreal bevacizumab (IVB) in macular edema (ME) due to branch retinal vein occlusion (BRVO) in a real clinical practice setting at a tertiary referral center. METHODS: A retrospective analysis of a final total number of 35 eyes of 35 patients with a 24-month follow-up was performed. RESULTS: At 24 months, mean best-corrected visual acuity improved by 0.09 LogMAR units from baseline (95% CI: -0.03-0.24, p = 0.0674). The mean CFT decreased by 75 microns (95% CI: 27-123, p = 0.0026). The median number of injections was 6 (IQR: 3-9). Macular edema showed complete resolution in 12 eyes (34.3%), responded partially in six eyes (17%), recurred in eight eyes (23%), and remained persistent in nine eyes (25.7%, three eyes at six months, one eye at 12 months, three eyes at 18 months and two eyes at 24 months). CONCLUSION: Our study shows that treatment with IVB in patients with ME due to BRVO during a period of 24 months provided complete resolution of the ME in more than one-third of patients. In one-third of the cases, ME resolved partially or recurred and in less than one-third of patients ME remained persistent. Visual acuity increased significantly in 23% of patients and remained stable in the majority of patients. However, a median number of six injections was necessary to maintain a lasting beneficial effect. Further long-term prospective studies are required comparing intravitreal bevacizumab with other treatment modalities.