Comparison of visual performance between diffractive bifocal and diffractive trifocal intraocular lenses.

To evaluate the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00) and a diffractive trifocal IOL with + 2.17 D and + 3.25 D near addition (AcrySof IQ PanOptix TFNT00), we investigated the 10-week postoperative parameters after cataract surgery in which ZMB00 or TFNT00 lenses were implanted bilaterally from 2011 to 2020 (with a 3-month interval between implantation of the right and left lenses). The study included 1448 eyes of 724 patients. The diffractive bifocal group comprised 1326 eyes of 663 patients (aged 67.0 ± 7.8 years; females/males, 518/145), and the diffractive trifocal group comprised 122 eyes of 61 patients (aged 66.6 ± 7.3 years; females/males, 35/26). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Uncorrected near visual acuity and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm) (Wavefront_4mm_postoperative_Ocular/Internal_Spherical) were significantly better in the bifocal group (p < 0.00068, Wald test). Uncorrected intermediate visual acuity, contrast sensitivity (6.3/4.0/2.5/1.6/1.0/0.7 degrees), and contrast sensitivity with glare (4.0/1.6/1.0/0.7 degrees) were significantly better in the trifocal group (p < 0.00068, Wald test).

Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses.

We compared the visual performance of a bifocal intraocular lens (IOL) (ZMB00) and an extended-depth-of-focus (EDOF) IOL (ZXR00V) by evaluating postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZMB00 or ZXR00V implantation between 2011 and 2020. The right and left lenses were implanted within 3 months of each other. The study enrolled 1536 eyes of 768 patients; the ZMB00 group comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; female/male, 518/145), and the ZXR00V group comprised 210 eyes of 105 patients (age: 67.8 ± 6.9 years; female/male, 39/66). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations and pupil diameter, ensured statistical validity. Uncorrected near visual acuity, corrected near visual acuity, and near spectacle independence were significantly better in the ZMB00 group (p<0.00068, Wald test) than in the ZXR00V group. Contrast sensitivity (visual angle of the test target: 4.0°/2.5°/1.6°/1.0°/0.7°) and contrast sensitivity with glare (4.0°/2.5°/1.6°/1.0°/0.7°) were significantly better in the ZXR00V group (p<0.00068, Wald test) than in the ZMB00 group. Uncorrected intermediate visual acuity, contrast sensitivity with glare (6.3°), and 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) scores for General Vision were slightly but significantly better in the ZXR00V group than in the ZMB00 group (p<0.05, Wald test). At high-performance levels, the two IOL groups had different characteristics regarding various visual performance parameters.

Randomized Multicenter Clinical Trial Comparing 0.1% Brimonidine/0.5% Timolol Versus 1% Dorzolamide/0.5% Timolol as Adjuncts to Prostaglandin Analogues: Aibeta Crossover Study.

INTRODUCTION: This multicenter, randomized, comparative, and investigator-masked crossover clinical trial sought to compare the efficacy and tolerability of fixed combinations of 0.1% brimonidine/0.5% timolol (BTFC) versus 1% dorzolamide/0.5% timolol (DTFC) as adjunctive therapies to prostaglandin analogues. METHODS: A total of 110 patients with open-angle glaucoma or ocular hypertension previously treated with prostaglandin analogue monotherapy were randomized to receive either BTFC or DTFC as adjunctive therapy for 8 weeks. These patients were then crossed over to the alternative treatment arm for another 8 weeks. The reduction in intraocular pressure (IOP) (primary outcome), occurrence of adverse events, ocular discomfort after instillation, and patient preference (secondary outcomes) were recorded through patient interviews. RESULTS: BTFC instillation for 8 weeks reduced IOP by 3.55 mmHg, demonstrating non-inferiority to DTFC instillation (3.60 mmHg; P < 0.0001, mixed-effects model). Although adverse events were rare with both combinations, patients reported greater discomfort with DTFC than with BTFC (P < 0.0001). More patients preferred BTFC (P < 0.0001) over DTFC, as BTFC caused minimal or no eye irritation. CONCLUSION: As BTFC offered better tolerability than DTFC with comparable reduction in IOP, we recommend it as an alternative for patients who experience ocular discomfort with DTFC-prostaglandin analogue combination therapy. TRIAL REGISTRATION NUMBER: jRCTs051190125.

Patients with glaucoma who require further reduction in intraocular pressure while undergoing monotherapy with prostaglandin analogue ophthalmic solution have been prescribed two enhanced treatment options: 0.1% brimonidine/0.5% timolol fixed combination ophthalmic solution (BTFC) and 1% dorzolamide/0.5% timolol fixed combination ophthalmic solution (DTFC). The Aibeta Crossover Study Group in Japan compared the efficacy and tolerability of fixed combinations of BTFC versus DTFC when an additional fixed combination ophthalmic solution was prescribed in patients with open-angle glaucoma or ocular hypertension who had been treated with prostaglandin analogue monotherapy. We recruited 110 patients previously treated with prostaglandin analogue monotherapy at 20 clinical centers in Japan, then randomly assigned them to two alternative treatment groups: the BTFC to DTFC group or the DTFC to BTFC group, as an adjunctive therapy to prostaglandin analogues for total of 16 weeks. We compared the reduction in intraocular pressure, occurrence of side effects, eye discomfort after instillation, and patient preference between BTFC versus DTFC instillations. The intraocular pressure reduction of BTFC instillation was comparable to that of DTFC instillation, showing non-inferiority to DTFC (3.55 mmHg vs. 3.60 mmHg; P < 0.0001, mixed-effects model). Both eye drops caused few side effects; however, patients felt greater eye discomfort with DTFC than with BTFC (P < 0.0001). Because of less eye irritation, more patients preferred BTFC (P < 0.0001) over DTFC. We can recommend using BTFC for patients who feel eye discomfort with DTFC­prostaglandin analogue combination therapy.

Comparative visual performance of diffractive bifocal and rotationally asymmetric refractive intraocular lenses.

We compared the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00 [Johnson & Johnson Surgical Vision]) and a rotationally asymmetric refractive IOL with + 1.5 D near addition (LS-313 MF15 [Teleon Surgical BV]) 10 weeks after cataract patients' last surgery for bilateral ZMB00 or LS-313 MF15 implantation between 2011 and 2020, with the lenses of each eye implanted within 3 months of each other. The ZMB00 and LS-313 MF15 groups comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; females/males, 518/145) and 448 eyes of 224 patients (73.6 ± 7.0 years; females/males, 125/99), respectively. A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Compared to LS-313 MF15, ZMB00 achieved significantly superior uncorrected near visual acuity, reduced higher-order aberrations (ocular/internal, scaled to a 4-mm pupil; Wavefront_4_post_Ocular_Total Higher-Order Aberration/Third/Fourth/Trefoil/Coma/Tetrafoil/Spherical, Wavefront_4_post_Internal_Astigmatism/Total Higher-Order Aberration/Third/Trefoil/Coma/Tetrafoil/Spherical), and superior distance and near spectacle independence (p < 0.00068, Wald test). Contrast sensitivity, measured without (visual angle of the test target: 6.3°/4.0°/2.5°/1.6°/1.0°/0.7°) or with glare (4.0°/2.5°/1.6°/1.0°/0.7°), was significantly better in the LS-313 MF15 than the ZMB00 group (p < 0.00068, Wald test).

Very Challenging Cases to Diagnose: Concealed Foreign Bodies in the Upper Palpebral Conjunctiva Should Always Be Kept in Mind in Unresolved, Long-Lasting Chronic Ocular Pain.

Ocular pain is a common complaint, and anything that stimulates the sensory nerve terminals innervating the eye, the peripheral axons of neurons located in the trigeminal ganglion, can cause it. An undetected ocular foreign body sometimes masquerades as a common condition such as dry eye or other frequencies, which can misguide both the doctor and the patient into an endless cycle of ineffective therapies and incomplete diagnoses. In recent years, as the concept of neuropathic pain has become more widely recognized, cases of idiopathic ocular pain in which the actual cause of the discomfort is a foreign body seem to be increasingly misdiagnosed as neuropathy. This report reviews cases in which hidden foreign bodies were responsible for unresolved, long-lasting chronic ocular pain. All records referencing the phrase "foreign body removal" were extracted from the outpatient clinic notes recorded by the author (H.T.) between 2016 and 2018 at Ashikaga Red Cross Hospital using the search engine of the computerized record system. There were 3 cases that were very difficult to diagnose: (1) a very minute iron shard in a 72-year-old female cataract surgery patient, (2) a deeply hidden eyelash in a 60-year-old female with varicella-zoster virus-related keratoconjunctivitis, and (3) an extremely small grain of sand in an 83-year-old female diagnosed with dry eye. In all cases, the foreign body was detected in an area of the upper palpebral conjunctiva without typical pathognomonic signs. Removing the foreign bodies led to immediate and dramatic relief of long-lasting, previously unresolved chronic ocular pain.

Exacerbation of branch retinal vein occlusion post SARS-CoV2 vaccination: Case reports.

RATIONALE: In this paper, we report on 2 patients who developed branch retinal vein occlusion (BRVO) exacerbation 1 day after administration of the BNT162b2 (Pfizer-BioNTech) SARS-CoV-2 vaccine. PATIENT CONCERNS: Case 1: A 71 year-old female developed vision loss in her left eye 1 day after receiving a second dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal inferior BRVO and secondary macular edema (ME) in her left eye. ME resolved after 3 doses of intravitreal aflibercept (IVA). After treatment, no recurrence of ME was observed.Case 2: A 72 year-old man developed vision loss in his right eye 1 day after receiving the first dose of the SARS-CoV-2 mRNA vaccine. This patient was diagnosed with temporal superior BRVO in the right eye without ME. The patient was followed up and did not undergo any additional treatment. DIAGNOSES: Case1: Temporal superior BRVO and secondary ME were observed in the left eye. Her best-corrected visual acuity (BCVA) was 20/30.Case2: Temporal superior BRVO recurrence and secondary ME were observed in the right eye. BCVA was 20/25. INTERVENTIONS: Case1: Additional dose of IVA was administered. Case2: Two times of Intravitreal ranibizumab was administered twice. OUTCOMES: Case1: Subsequently, ME resolved BCVA was 20/20. Case2: Subsequently, ME resolved BCVA was 20/25. LESSONS: Both cases showed a possible association between SARS-CoV-2 vaccination and the exacerbation of BRVO.

Heart rhythm-synchronized fibrin flap in a glaucoma tube shunt: The heartbeat acts as a drainage pump for the aqueous humor: A case report.

RATIONALE: The amount of aqueous humor that is constantly produced by the ciliary processes and the equal amount that flows out through the trabecular meshwork via the drainage angle or through the uveoscleral route is very small (2-3 µg/min each), representing approximately 1% of the content of the anterior chamber; therefore, it is challenging to visualize its flow. PATIENT CONCERNS: A 69-year-old man who had high intraocular pressure (IOP) (>20 mm Hg) with the maximum glaucoma eyedrop dose and presented with severe visual field loss (Humphrey Field Analyzer 30-2: -26.32 dB) had been implanted with a 350-mm2 Baerveldt tube of the aqueous chamber type for refractory open-angle glaucoma. The IOP ultimately decreased (<15 mm Hg) with no need for glaucoma eyedrops. DIAGNOSES: After the procedures, a fibrin membrane repeatedly formed on the anterior surface of the intraocular lens. INTERVENTIONS: This issue was resolved by two rounds of neodymium-doped yttrium aluminum granet (Nd:YAG) laser surgery and prescription steroidal eyedrops. OUTCOMES: During the laser surgery, an unusual and unintended fibrin flap appeared at the opening of the Baerveldt tube; this flap moved synchronously with the heartbeat, as verified by checking the pulse at the radial artery of the wrist. The fibrin flap mimicked the behavior of a cardiac valve, and the aqueous humor and stray fibrin particles mimicked the blood in the chambers of the heart. Although the Baerveldt tube itself is an artificial instrument that is not present in normal human eyes, we hypothesize that our observation shows the fundamental mechanism of aqueous humor drainage. LESSONS: This novel, vividly descriptive observation highlights the important role of the heartbeat as a drainage pump in aqueous humor flow dynamics and IOP homeostasis, which are treatment targets for glaucoma, the leading cause of blindness.

A Novel Lid Hygiene Detergent Successfully Eliminated Demodex Mites, a Common Pathogen of Refractory Obstructive Meibomian Gland Dysfunction.

INTRODUCTION: Demodex mites are microscopic arthropods that have been shown to be responsible for chronic blepharitis. Although many reports have demonstrated positive effects of lid hygiene on demodicosis, some have produced conflicting results. We retrospectively evaluated the effect of lid margin cleansing with a novel lid hygiene detergent, Eye Shampoo, in patients with ocular demodicosis. METHODS: Outpatient clinic notes recorded over a 24-month period between June 30, 2016, and June 29, 2018, at Keio University Hospital in Japan were reviewed to identify patients diagnosed with ocular demodicosis who started cleansing their lid margins with Eye Shampoo at least once daily as a lid hygiene therapy. RESULTS: Five patients diagnosed with ocular demodicosis who started cleansing their lid margins using Eye Shampoo for lid hygiene were identified. In four cases, Demodex mites were successfully eliminated, and ocular conditions were ultimately improved with no recurrence. Active Demodex mites were still noted after 3 months of lid hygiene therapy in one case; further observation of this case was not available. There were no adverse effects of Eye Shampoo in any of these cases. CONCLUSION: Lid hygiene therapy using Eye Shampoo successfully eliminated Demodex mites, a common pathogen of refractory obstructive meibomian gland dysfunction.

Real-Time Surgical Problem Detection and Instrument Tracking in Cataract Surgery.

Surgical skill levels of young ophthalmologists tend to be instinctively judged by ophthalmologists in practice, and hence a stable evaluation is not always made for a single ophthalmologist. Although it has been said that standardizing skill levels presents difficulty as surgical methods vary greatly, approaches based on machine learning seem to be promising for this objective. In this study, we propose a method for displaying the information necessary to quantify the surgical techniques of cataract surgery in real-time. The proposed method consists of two steps. First, we use InceptionV3, an image classification network, to extract important surgical phases and to detect surgical problems. Next, one of the segmentation networks, scSE-FC-DenseNet, is used to detect the cornea and the tip of the surgical instrument and the incisional site in the continuous curvilinear capsulorrhexis, a particularly important phase in cataract surgery. The first and second steps are evaluated in terms of the area under curve (i.e., AUC) of the figure of the true positive rate versus (1-false positive rate) and the intersection over union (i.e., IoU) obtained by the ground truth and prediction associated with the region of interest. As a result, in the first step, the network was able to detect surgical problems with an AUC of 0.97. In the second step, the detection rate of the cornea was 99.7% when the IoU was 0.8 or more, and the detection rates of the tips of the forceps and the incisional site were 86.9% and 94.9% when the IoU was 0.1 or more, respectively. It was thus expected that the proposed method is one of the basic techniques to achieve the standardization of surgical skill levels.

Author Correction: Comparison of visual performance between monofocal and multifocal intraocular lenses of the same material and basic design.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Comparison of visual performance between monofocal and multifocal intraocular lenses of the same material and basic design.

To compare the visual performance of a monofocal intraocular lens (IOL) (ZCB00) and a multifocal IOL (ZMB00) of the same material and basic design, we evaluated postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZCB00 or ZMB00 implantation from December 13, 2010, to July 29, 2019, with the right and left lenses implanted within 3 months of each other. The study enrolled 2,230 eyes of 1,115 patients. The monofocal group comprised 904 eyes of 452 patients (72.3 ± 6.8 years; females/males, 268/184), and the multifocal group comprised 1,326 eyes of 663 patients (67.0 ± 7.8 years; females/males, 518/145). Contrast sensitivity (4.0/2.5/1.6/1.0/0.7 degrees), contrast sensitivity with glare (1.6/1.0/0.7 degrees), and the VFQ-25 score for driving at night were significantly better in the monofocal group (p < 0.00068, Wald test). Uncorrected intermediate/near visual acuity and near spectacle independence were significantly better in the multifocal group (p < 0.00068, Wald test). The two IOL groups had different characteristics in terms of contrast sensitivity, night-time driving, uncorrected intermediate/near visual acuity and near spectacle independence.

Potential roles of MNREAD acuity charts and contrast/glare sensitivity in Ranibizumab treatment of branch retinal vein occlusion.

BACKGROUND/OBJECTIVES: To investigate the potential utility of MNREAD acuity charts and contrast/glare sensitivity (CGS) assessment for evaluating the efficacy of an initial treatment with ranibizumab (Lucentis®) for branch retinal vein occlusion (BRVO). METHODS: Intravitreal injections of ranibizumab were administered in 43 eyes of 43 treatment-naïve patients with BRVO. Efficacy was assessed 1 month later. Best-corrected far/near visual acuity (BCFVA/BCNVA), MNREAD parameters (reading acuity [RA], maximum reading speed [MRS], critical print size [CPS]), CGS (CS/GS), and central macular thickness (CMT) in optical coherence tomography (OCT) before and after treatment were evaluated. The area (superior/inferior) affected by BRVO was determined by fluorescein angiography. RESULTS: All parameters improved significantly following treatment (p < 0.05), and all MNREAD and CGS parameters were significantly correlated with BCVA in the treated eye before and after treatment (p < 0.01). The changes in BCFVA, BCNVA, MRS, and CS were significantly correlated with the amount of change in CMT (p < 0.007; r = 0.415, 0.528, -0.465, and -0.508, respectively). MRS exhibited a percentage change that was significantly correlated with that in CMT (p < 0.007; r = -0.511). Additionally, MRS exhibited the lowest threshold CMT (397 µm) at which the most significant change in improvement was observed. CMT was less likely to improve if BRVO occurred at a superior site than if it occurred at an inferior site (0.05 < p = 0.07 < 0.1). CONCLUSIONS: MNREAD and CGS testing were useful for evaluating BRVO treatment efficacy. MRS might be a valuable index for evaluating treatment success and making treatment decisions.

CHARGE Syndrome Associated with Angle Closure despite High Myopia: A Case Report with Structural Suggestion.

CHARGE syndrome is associated with multiple malformations, and the main ocular abnormality is coloboma. We describe an unusual case of a 15-year-old girl with CHARGE syndrome having high intraocular pressure and narrow angle closure despite refractive high myopia (-9.0 dpt) in her left eye. Gonioscopy revealed peripheral anterior synechia (approximately 90°) in the superior quadrant of the left eye. Both eyes exhibited similar axial length (about 22 mm) and corneal curvature (about 8 mm). However, microcornea (9 mm), thicker central cornea and iris induced narrower anterior components in the left eye than in the right eye. Preventing the chance of acute primary angle closure attack, the patient underwent laser iridotomy in the left eye; however, long-term follow-up is needed. Additionally, we developed a hypothesis for the mechanism of unilateral angle closure despite high myopia by investigating the ocular structural parameters in detail.

Plate size reduction surgery for the Baerveldt 350-mm2 glaucoma implant for postoperative motor disturbance: A case report.

RATIONALE: Diplopia due to ocular motility disturbance is a common complication after glaucoma drainage device (GDD) surgery. The treatment options include prescription prism glasses, strabismus surgery or GDD removal. However, to the best of our knowledge, GDD size reduction surgery has not been reported. PATIENT CONCERNS AND DIAGNOSES: An 83-year-old woman diagnosed with primary open angle glaucoma was referred to Tsukazaki Hospital due to uncontrolled intraocular pressure (IOP) in December 2015. We performed an EXPRESS shunt surgery on both eyes in January 2016 and a needling procedure on the left eye in May 2017. Thereafter, because IOP in her left eye remained high, we performed Baerveldt 350-mm implantation in her inferotemporal area by placing the tube at the sulcus on December 3, 2017. The next day, 4Δ hypertropia (HT) was detected in the left eye in alternate cover testing in primary gaze, and diplopia in the inferotemporal direction was demonstrated. Although IOP was controlled well between 15 and 20 mmHg in her left eye, diplopia did not improve. INTERVENTIONS: Three weeks later, we performed a plate size reduction surgery for the Baerveldt 350-mm implant. In this procedure, we cut and removed the plates placed beneath the lateral rectus muscle and inferior rectus muscle, which were thought to be responsible for diplopia. OUTCOMES: Diplopia improved subjectively, but there was no drastic objective change. We prescribed prism glasses (3Δ base down for the left eye) for remaining mild diplopia. On January 21, 2019, significant objective improvement (2Δ HT with less ocular motor dysfunction demonstrated in the Hess chart) was finally observed. LESSONS: Early plate size reduction surgery, which was not immediately but ultimately effective in improving motor disturbance in our case, could be a potential option to relieve operation-induced motor disturbance. However, notably, tube shunt surgery has the risk of motility disturbances, which might require additional treatment.

Evaluation of Automatic Monitoring of Instillation Adherence Using Eye Dropper Bottle Sensor and Deep Learning in Patients With Glaucoma.

PURPOSE: We developed and evaluated an eye dropper bottle sensor system comprising motion sensor with automatic motion waveform analysis using deep learning (DL) to accurately measure adherence of patients with antiglaucoma ophthalmic solution therapy. METHODS: We enrolled 20 patients with open-angle glaucoma who were treated with either latanoprost ophthalmic solution 0.005% or latanoprost-timolol maleate fixed combination ophthalmic solution in both eyes. An eye dropper bottle sensor was installed at patients' homes, and they were asked to instill the medication and manually record each instillation time for 3 days. Waveform data were automatically collected from the eye dropper bottle sensor and judged as a complete instillation by the DL instillation assessment model. We compared the instillation times captured on the waveform data with those on each patient's record form. In addition, we also calculated instillation movement duration from Waveform data. RESULTS: The developed eye bottle sensor detected all 60 instillation events (100%). Mean difference between patient and eye bottle sensor recorded time was 1 ± 1.22 (range, 0-3) minutes. Additionally, mean instillation movement duration was 16.1 ± 14.4 (range, 4-43) seconds. Two-way ANOVA revealed a significant difference in instillation movement duration among patients (P < 0.001) and across days (P < 0.001). CONCLUSION: The eye dropper bottle sensor system developed by us can be used for automatic monitoring of instillation adherence in patients with glaucoma. TRANSLATIONAL RELEVANCE: We believe that our eye dropper bottle sensor system will accurately measure adherence of all glaucoma patients as well as help glaucoma treatment.

Corneal Sensory Experience via Transient Receptor Potential Vanilloid 1 Accelerates the Maturation of Neonatal Tearing.

Tearing maturates rapidly after birth, and external environmental challenges play a key role in promoting lacrimal functional maturation. However, little is known about the facilitative factors underlying this developmental process or the potential of application of these factors to treat hypofunction of the lacrimal gland. In this study, eye opening and the subsequent ocular surface sensory experience, which is thought to be involved in postnatal maturation of lacrimal function, were investigated. Our results demonstrated that eye opening after birth is essential for the maturation of neonatal tearing. The maturation process of lacrimal function is dependent on the ocular surface sensory experience via transient receptor potential cation channel subfamily member 1 after birth. This study provides, for the first time, important evidence of the sensory experience of the ocular surface in relation to the maturation of functional tear secretion during the postnatal period.

Outcomes of Wider Area Bleb Revision Using Bleb Knife With Adjunctive Mitomycin C.

PRECIS: Wider area bleb revision using bleb knife with adjunctive mitomycin C (MMC) had a good success rate, according to strict success criteria, except in patients with neovascular glaucoma (NVG). PURPOSE: We determined the efficacy of wider area bleb revision after filtering surgery using bleb knife with adjunctive MMC. PATIENTS AND METHODS: In this retrospective single-center study, we analyzed 86 patients with glaucoma (46 primary open-angle, 18 exfoliations, 13 secondary, and 9 neovascular) after bleb revision using bleb knife with adjunctive MMC after a minimum follow-up of 6 months. A Kaplan-Meier survival analysis with log-rank tests and Cox proportional hazards regression analyses were performed. The main outcome measure was a successful initial bleb revision using bleb knife with adjunctive MMC, arbitrarily defined as intraocular pressure (IOP) control <15 mm Hg without any IOP-lowering medication, additional bleb revision, or glaucoma surgery. RESULTS: The mean time since the initial filtering surgery was 243.8 days, and the mean prebleb revision IOP was 22.0±4.8 mm Hg. The total cumulative success rate of the bleb revision using bleb knife with MMC was 49% at 6 months and 30% at 1 year. Patients with primary open-angle glaucoma had the best success rate (64% at 6 mo and 40% at 1 y). Log-rank tests revealed that patients with NVG had the worst prognosis (P<0.01). NVG was the only significant risk factor identified for short survival time (odds ratio, 167.10; 95% confidence interval, 1.78-15620.44; P=0.027). CONCLUSION: Wider area bleb revision using bleb knife with adjunctive MMC had a good success rate, according to strict success criteria, except in patients with NVG.

Safety and efficacy of wiping lid margins with lid hygiene shampoo using the "eye brush", a novel lid hygiene item, in healthy subjects: a pilot study.

BACKGROUND: To evaluate the safety and efficacy of using a lid hygiene brush prototype to wipe the lid margins with lid hygiene shampoo in subjects with normal meibomian glands. METHODS: Twelve eyes of 6 subjects were all evaluated just before and after wiping lid margins using 1) tap water alone, 2) Eye Shampoo, 3) Eye Brush, or 4) both products, each during a different week. The results after using both products twice daily for 1 month were also evaluated. Wiping efficacy was determined by post-wiping scores for the remaining fluorescein-stained 0.3% Tarivid ointment fully applied to eyelids and lid margins under microscopic view illuminated by blue light just after performing each of the four lid hygiene methods described above. RESULTS: No significant deterioration in ocular conditions occurred. Eyestrain, eye discharge, and dryness decreased with tap water (P = 0.020), Eye Shampoo (P = 0.036), and Eye Brush (P = 0.014), respectively. Sensations of eye discharge increased after 1 month of using both products (P = 0.042). The wiping efficacy of Eye Brush, Eye Shampoo or both was significantly greater than that of tap water alone (two-sided test, P = 0.003, 0.003, 0.002), and using both significantly increased efficacy above Eye Shampoo use alone (one-sided test, P = 0.009). CONCLUSIONS: Wiping lid margins using Eye Brush enhanced the cleansing power of Eye Shampoo. A daily healthcare routine using both products could be a safe and effective option for daily lid hygiene. TRIAL REGISTRATION: UMIN000016905 . Registration date: March 24, 2015; the study was prospectively registered.

Effect of Eyelid Hygiene Detergent on Obstructive Meibomian Gland Dysfunction.

PURPOSE: To investigate the efficacy of eyelid margin cleansing with lid hygiene detergent in patients with obstructive meibomian gland dysfunction (MGD). METHODS: As a pilot study, we investigated the safety and efficacy of lid hygiene using tap water and/or lid hygiene shampoo in fourteen eyes of 7 normal subjects. All subjects were instructed to cleanse the eyelid margin with tap water and/or lid hygiene shampoo. As a main prospective clinical study, thirty-four eyes of 34 patients with obstructive MGD were enrolled. All subjects were instructed to cleanse the eyelid margin with lid hygiene shampoo at least once daily for 1 month. Ocular surface conditions were observed before and 1 month after study initiation. RESULTS: A significant exacerbating change (p < 0.05) was not detected after either method in the pilot study. In the main study, significant improvements were observed in tear break-up time (TBUT), lid margin lissamine green staining scores, vascular dilatation, and meibum status (p < 0.05). No significant improvements in corneal or conjunctival fluorescein staining scores, the mucocutaneous junction, lid margin deformation, or plugging were observed (p ≥ 0.05). Subjective improvements were observed in 27 subjects. Meibography revealed that 28 subjects had normal meibomian glands, and 6 subjects had meibomian gland atrophy. Significant improvements were observed in TBUT, vascular dilatation, and meibum status only in the group with normal meibomian glands (p < 0.05), but subjective symptoms and lid margin lissamine green staining scores improved in both groups (p < 0.05). No subjects experienced any problems throughout the study. CONCLUSION: Daily routine use of lid hygiene detergent can alleviate the symptoms of MGD regardless of meibomian gland atrophy.

Effects of oral propranolol on a juxtapapillary capillary hemangioma: a single-subject pilot study.

Oral propranolol hydrochloride has been proven effective in treating infantile hemangiomas, and its potential efficacy in choroidal hemangiomas has been suggested. A 57-year-old woman with a juxtapapillary capillary hemangioma was treated with oral propranolol at Nagoya Medical Center in Japan in 2012. Although the condition of this patient partially improved, oral propranolol did not appear to have a critical therapeutic effect. To the authors' knowledge, this is the first pilot study to describe a case in which oral propranolol was used as a therapeutic approach for a retinal hemangioma.