Bilateral Nonpenetrating Deep Sclerectomy: Difference in Outcomes Between First- and Second-Operated Eyes at 24 Months.

BACKGROUND/AIM: The aim of this study was to assess the difference in outcome between the first-operated and the second-operated eyes after nonpenetrating deep sclerectomy (DS), and to identify potential success predictors for the second eye. METHODS: This single-surgeon, retrospective study analyzed the outcomes of all bilateral nonsimultaneous DS with at least 24 months of follow-up. Its main outcome measure was surgical success, defined as unmedicated intraocular pressure (IOP) ≤15 mm Hg associated with a relative reduction ≥20%. RESULTS: In all, 104 eyes of 52 patients who underwent bilateral (standalone or combined) DS, within a mean of 344.3±526.3 days of each other, were analyzed. Postoperatively, the mean medicated IOP decreased from 20.7±7.9 (first-operated eyes) and 19.3±6.6 mm Hg (second-operated eyes) at baseline (P=0.107) to 13.8±4.8 [(-33.3%; P<0.001) first-operated eyes) and 12.7±3.8 mm Hg [(-34.2%; P<0.001) second-operated eyes] after 2 years (P=0.619). Postoperative IOP and treatment reduction, respectively, showed fair (r=0.53) and good (r=0.71) levels of correlation between fellow eyes. The rates of complete success were comparable between first-operated and second-operated eyes (32.7% and 40.4%, respectively; P=0.364). At 2 years, among patients whose first-operated eyes were considered a success, 82.4% of surgeries in second eyes were successful (P=0.001). The odds ratio of a second-operated eye experiencing complete success were 6.32 (P=0.011) if the first-operated eye experienced complete success. CONCLUSIONS: The present study demonstrated a strong association between first-operated and second-operated eyes after DS, in terms of surgical outcomes and IOP reduction. In effect, surgical success in the first-operated eye increases the odds of success in the second eye by 6-fold.

Intraocular Pressure Variations After Intravitreal Injections Measured With an Implanted Suprachoroidal Telemetry Sensor.

PURPOSE: Intravitreal injections (IVIs) may create transient intraocular pressure (IOP) elevation. This report describes continuous IOP fluctuations following multiple IVI measured with a permanent implantable sensor. PATIENTS AND METHODS: We report the case of a 49-year-old white glaucomatous male with refractory macular edema secondary to central retinal vein occlusion in his left eye who underwent deep sclerectomy combined with the implantation of a suprachoroidal tonometry sensor. Serial IOP measurements were performed immediately before and after each IVI over a 1-year period. RESULTS: During the first 7 months following deep sclerectomy, IOP remained below 10 mm Hg. During this period, mean IOP before each injection was 2.1±2.6 mm Hg, and each IVI caused a reduction of 1.2±0.8 mm Hg on average, with a maximum reduction of 2.7 mm Hg, before IOP normalized within 50 minutes to 24 hours. From 7 months postoperatively, mean IOP increased to the low teens. During this period, mean IOP before each injection was 9.9±1.8 mm Hg, and each IVI caused an increase of 15.8±11.7 mm Hg on average, with a maximum increase of 44.8 mm Hg, before IOP normalized within 20 minutes to 4 hours. CONCLUSIONS: During the initial postoperative phase, IVI may cause acute reduction in IOP, either through subconjunctival leaks or increased filtration secondary to increased fluid pressure. Several months after surgery, this effect subsides and IOP spikes sharply immediately after each IVI, suggesting the resolution of the initial mechanism, most likely through scarring and fibrosis.

Surgical Management of Pseudoexfoliative Glaucoma: A Review of Current Clinical Considerations and Surgical Outcomes.

INTRODUCTION: Pseudoexfoliative glaucoma (PEXG) is the most common cause of secondary open-angle glaucoma worldwide. It is more aggressive and often more resistant to conventional treatments than primary open-angle glaucoma, yet there is currently no clear consensus on best management practices. This review explores current literature on PEXG to assess the safety and efficacy of currently available surgical techniques, and discusses clinical considerations on the diagnosis and management of the disease. METHODS: A PubMed and Google Scholar search identified 2271 articles. These were reviewed to exclude irrelevant or duplicate data. A total of 47 studies reporting specifically on PEXG were retained and analyzed. REVIEW: One of the most significant ophthalmic consequences of pseudoexfoliative (PEX) syndrome is the compromising of the blood-aqueous barrier resulting in the leakage of inflammatory cytokines and extracellular matrix material into the anterior chamber. Considering the high risk of developing PEXG and the aggressive nature of this type of glaucoma, accurate and timely diagnosis of PEX is critical. Therefore, systematic attentive examination for PEX deposits is crucial. Patients diagnosed with PEX need frequent glaucoma assessments. Patient information is key to improving compliance. Gonioscopy and diurnal tension curves or 24-hour intraocular pressure (IOP) monitoring are integral part of the diagnostic work-up and risk-assessment of PEXG. Because of the lability of IOP in PEX, clinical decisions on the basis of single IOP measurements should be avoided. Cataract extraction was shown to provide persistent IOP-lowering effect in the order of 10% in PEXG. A number of other surgical options may offer wider IOP reduction, and both XEN 45 gel stents and angle-based glaucoma procedures were suggested to achieve better outcomes in PEXG than in primary open-angle glaucoma. Yet, more significant IOP reductions may be achieved with filtering surgery or glaucoma drainage device. Same day postoperative IOP monitoring is recommended to treat the frequent IOP spikes following surgery, and more aggressive anti-inflammatory therapy may reduce the rates of postoperative adverse events in PEXG. CONCLUSION: Specific studies of the surgical management of PEXG remain scarce in the medical literature, and more long-term and comparative studies are warranted to define more robust recommendations.

Iridocorneal Angle Assessment After Laser Iridotomy With Swept-source Optical Coherence Tomography.

AIM: To investigate the reliability of anterior chamber angle (ACA) measurements in narrow angles and assess the effect of laser peripheral iridotomy (LPI) on these measurements using novel swept-source optical coherence tomography (SS-OCT) technology. MATERIALS AND METHODS: In this prospective observational study, patients with gonioscopically narrow angles were enrolled and scheduled for prophylactic LPI. Twelve ACA sections were obtained in each eye using SS-OCT (ANTERION, Heidelberg Engineering, Germany) before and after Nd:YAG LPI. A built-in algorithm calculated ACA measurements after manual identification of the scleral spur and ACA recess. Eight ACA parameters were evaluated: ACA (ACA 500, ACA 750); scleral spur angle (SSA 500, SSA 750); angle opening distance (AOD 500, AOD 750); and trabecular iris space area (TISA 500, TISA 750). The effect of LPI was assessed for each parameter, both nasally and temporally. RESULTS: Ten patients (18 eyes) were enrolled (mean age, 61.8±13.6 y; 60.0% female individuals). On average, the ACA was wider nasally than temporally (P=0.004). LPI significantly widened the ACA (range, 26.7-29.4%; P<0.05). ACA 500 increased by 29.4% (P<0.001), ACA 750 by 29.2% (P=0.002), SSA 500 by 27.3% (P=0.003), SSA 750 by 28.1% (P=0.001), AOD 500 by 28.6% (P=0.009), AOD 750 by 28.6% (P=0.003), TISA 500 by 27.3% (P=0.004), and TISA 750 by 26.7% (P=0.200). CONCLUSIONS: SS-OCT ANTERION imaging can be used to reliably measure ACA before and after LPI. ACA, AOD, SSA, and TISA are all valid ACA measurement methods.

Effect of the combination of basic fibroblast growth factor and cysteine on corneal epithelial healing after photorefractive keratectomy in patients affected by myopia.

BACKGROUND: This study sought to evaluate the effect of basic fibroblast growth factor eye drops and cysteine oral supplements on corneal healing in patients treated with photorefractive keratectomy (PRK). MATERIALS AND METHODS: One hundred and twenty patients treated bilaterally with PRK for myopia were enrolled at one of two eye centers (Clinica Santa Lucia, Bologna, Italy and Department of Ophthalmology, University of Magna Graecia, Catanzaro, Italy) and were treated at the former center. Sixty patients included in the study group (Group 1) were treated postoperatively with topical basic fibroblast growth factor plus oral L-cysteine supplements, whereas 60 subjects included in the control group (Group 2) received basic fibroblast growth factor eye drops. We recorded the rate of corneal re-epithelialization and patients were followed-up every 30 days for 6 months. Statistical analyses were performed on the collected data. RESULTS: The eyes in Group 1 demonstrated complete re-epithelialization at Day 5, whereas the eyes in Group 2 achieved this status on Day 6. No side-effects were reported. CONCLUSIONS: Patients treated with basic fibroblast growth factor eye drops and L-cysteine oral supplements benefit from more rapid corneal re-epithelialization. In human eyes, this combination treatment appeared to be safe and effective in accelerating corneal surfacing after surgery. FINANCIAL DISCLOSURE: No author has any financial or proprietary interest in any material or method used in this study. TRIAL REGISTRATION: Current Controlled Trials ISRCTN73824458.