Cyclodialysis cleft repair: A multi-centred, retrospective case series.

IMPORTANCE: There is a paucity of evidence analysing the treatment of cyclodialysis clefts. BACKGROUND: We describe outcomes following the treatment of this rare condition at six centres internationally. DESIGN: Retrospective case series. PARTICIPANTS: Thirty-six patients with a cyclodialysis cleft from 2003 to 2017 were recruited. METHODS: Clefts were treated with cycloplegic agents, laser therapy and/or surgery. MAIN OUTCOME MEASURES: Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure. RESULTS: The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow-up required IOP lowering medication. CONCLUSIONS AND RELEVANCE: There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP.

The Ahmed Versus Baerveldt Study: Five-Year Treatment Outcomes.

PURPOSE: To compare 2 frequently used aqueous shunts for the treatment of glaucoma. DESIGN: International, multicenter, randomized trial. PARTICIPANTS: Patients aged 18 years or older with uncontrolled glaucoma despite maximum tolerated medical therapy, many of whom had failed or were at high risk of failing trabeculectomy. METHODS: Eligible patients were randomized to receive an Ahmed-FP7 valve implant (New World Medical, Inc, Rancho Cucamonga, CA) or a Baerveldt-350 implant (Abbott Medical Optics, Inc, Santa Ana, CA) using a standardized surgical technique. MAIN OUTCOME MEASURES: The primary outcome was failure, defined as intraocular pressure (IOP) outside the target range (5-18 mmHg) or reduced <20% from baseline for 2 consecutive visits after 3 months, severe vision loss, or de novo glaucoma surgery. Secondary outcomes measures included IOP, medication use, visual acuity, complications, and interventions. RESULTS: A total of 238 patients were randomized; 124 received the Ahmed-FP7 implant, and 114 received the Baerveldt-350 implant. Baseline characteristics were similar between groups. Mean preoperative IOP was 31.4±10.8 mmHg on 3.1±1.0 glaucoma medications. At 5 years, the cumulative failure rate was 53% in the Ahmed group and 40% in the Baerveldt group (P = 0.04). The main reason for failure in both groups was high IOP, and the cumulative de novo glaucoma reoperation rate was 18% in the Ahmed group and 11% in the Baerveldt group (P = 0.22). Hypotony resulted in failure in 5 patients (4%) in the Baerveldt group compared with none in the Ahmed group (P = 0.02). Mean IOP was 16.6±5.9 mmHg in the Ahmed group (47% reduction) and 13.6±5.0 mmHg in the Baerveldt group (57% reduction, P = 0.001). Mean medication use was 1.8±1.5 mmHg in the Ahmed group (44% reduction) and 1.2±1.3 mmHg in the Baerveldt group (61% reduction, P = 0.03). The 2 groups had similar complication rates (Ahmed 63%, Baerveldt 69%) and intervention rates (Ahmed 41%, Baerveldt 41%). Most complications were transient, and most interventions were slit-lamp procedures. CONCLUSIONS: Both implants were effective in reducing IOP and the need for glaucoma medications. The Baerveldt group had a lower failure rate and a lower IOP on fewer medications than the Ahmed group, but had a small risk of hypotony that was not seen in the Ahmed group.

Ultrasound biomicroscopic analysis of iris-sutured foldable posterior chamber intraocular lenses.

PURPOSE: To report ultrasound biomicroscopic (UBM) findings of iris-sutured foldable posterior chamber intraocular lenses (PCIOLs). DESIGN: Prospective, noninterventional consecutive case series. METHODS: Fifteen eyes with foldable acrylic IOL implantation using peripheral iris suture fixation in the absence of capsular support were included. UBM was used to determinate the haptic position in relation to the ciliary sulcus and ciliary body in these eyes. Additionally, anterior chamber depth, lens tilt, site of suture fixation, focal iris or angle abnormalities, and relationship of iris to lens were determined. Main outcome measures were haptic position, anterior chamber depth, and iris anatomic changes. RESULTS: Of the 30 haptics imaged, 16 (53.3%) were positioned in the ciliary sulcus. Nine (30%) haptics were found over the ciliary processes, and 5 (16.7%) were over pars plana. No patients were found to have peripheral anterior synechiae present at the haptic position. The mean (+/- standard deviation) depth of the anterior chamber was 3.84 +/- 0.36 mm. The iris profile was altered in all patients at the iris-haptic suture fixation site. No angle abnormalities or tilted lenses were found. CONCLUSIONS: Iris-sutured PCIOL haptics were found to be in the ciliary sulcus or over the ciliary body with no significant tilt on UBM analysis. The procedure respects the angle anatomy, and no evidence of angle closure was found. The anterior chamber was deeper than has been reported previously for scleral sutured PCIOLs and was similar to that of pseudophakic eyes. This may have implications for surgical technique, IOL power calculations, and postoperative complications.

Evaluación de factores pronósticos refractivos en lasik miópico / Evaluation of refractive prognostic factors in myopic lasik

Objetivo: Evaluar resultados y pronóstico de LASIK miópico, según refracción preoperatoria. Método: En 200 casos agrupados por esfera y cilindro preoperatorio, se comparó: esfera, cilindro , cambio astigmático, cilindro refractivo inducido (SIRC), astigmatismo residual, equivalente defocus, predictibilidad de corrección esférica y cilíndrica, agudeza visual (AV), índices de seguridad (IS) y eficacia (IE). Resultados: Ordenados por esfera: La esfera se corrige mejor que el cilindro, subcorrigiéndose las más miopes (p< 0.0171). El astigmatismo residual dio un centroide muy similar. La predictibilidad +/-1D va de 98 a 80 por ciento para la esfera y de 92 a 84 por ciento para el cilindro. Ordenados por cilindro alto se subcorrige (p< 0.05) e hipercorrige la esfera (p= 0.0469). El astigmatismo residual entre los grupos menores y mayores dio una diferencia de û0.32 x 90°. La predictibilidad +/- 1D va de 98 a 94 por ciento para esfera y de 96 a 88 por ciento para cilindro. El por ciento del Equivalente Defocus < 1D fue 74 y 46 por ciento por esfera y 82 y 38 por ciento por cilindro, para grupos menos y más miopes, respectivamente. Las AV pre y postoperatoria disminuyen a menor esfera o cilindro. IS > 1.0 e IE es similar (+/- 0.9), por Esf. y Cil . Preop. Predictibilidad de AV c/c 20/25 por esfera, va de 100 por ciento a 60 por ciento y por cilindro para 20/30 de 100 por ciento a 83 por ciento, de grupos menos a más miopes, respectivamente. Conclusiones: El análisis por grupo refractivos permite determinar su influencia para mejorar pronóstico y tratamiento. Es muy seguro y eficaz, para todos los grupo. Su inexactitud depende fundamentalmente del astigmatismo y menos de esfera preoperatoria. A mayor astigmatismo se debe disminuir ablación esférica y aumentar el cilindro.