Penetrating Keratoplasty in Congenital Glaucoma.

BACKGROUND: Childhood glaucoma is one of the most common causes of corneal opacity in childhood and is associated with various pathological corneal changes, including corneal enlargement, corneal clouding, and edema. Congenital glaucoma (CG) may cause a decrease in vision outcomes due to corneal opacity or clouding, which is often associated with stimulus deprivation amblyopia. Therefore, to create a balance between preventing amblyopia and sustaining corneal clearance, patients with CG can be managed with early penetrating corneal transplantation surgery along with advanced glaucoma management. AIM: To investigate the graft survival rate and factors affecting graft survival in patients with congenital glaucoma who underwent penetrating keratoplasty (PKP). STUDY DESIGN: Cross-sectional. MATERIALS AND METHODS: Patients with congenital glaucoma who underwent PKP were retrospectively evaluated. The associations between age, corneal diameter, presence of ocular comorbidities, concurrent ocular surgeries with corneal graft, and visual outcomes were assessed. RESULTS: Among the 30 eyes enrolled in the study, 6 (20%) had aniridia, 6 (20%) had Axenfeld-Rieger syndrome, and 18 (60%) were diagnosed with primary congenital glaucoma. Graft survival rates were 66.6% and 63.33% at 12 and 24 months, respectively. At the end of the follow-up, the overall graft survival rate was 60%. Statistical significance was observed between patient age at the time of surgery and graft failure (p = 0.02). Graft failure was associated with a younger patient age. Functional vision was achieved in 53.3% of patients. CONCLUSIONS: The management of congenital glaucoma and its corneal complications is a delicate issue that requires great effort. PKP in congenital glaucoma was moderately successful in the present study. To provide functional vision, PKP could be the treatment of choice.

Efficacy comparison of combined trabeculectomy with MMC and gonioscopy-assisted transluminal trabeculotomy.

PURPOSE: To compare the efficacy of gonioscopy-assisted transluminal trabeculotomy combined with cataract surgery (PGATT) and trabeculectomy combined with cataract surgery (PTRAB) in open-angle glaucoma patients. METHODS: A multi-centered, retrospective, non-randomized study included 67 PGATT patients and 70 PTRAB patients. We compared preoperative intraocular pressure (IOP), best-corrected visual acuity (BCVA) compared with early and final IOP, medication numbers, and BCVA levels. Success was determined as IOP reduction > 20% from baseline, IOP between 5 and 21 mmHg, preoperative IOP of higher than 21 mmHg with medication and postoperative IOP of less than 21 mmHg without medication for surgeries performed for intolerance to medication, postoperative IOP < 21 mmHg as well as < 18 mmHg separately without medications, and no need for further glaucoma surgery. RESULTS: Preoperative IOP values were 28.61 ± 6.02 mmHg in PTRAB group and 23.99 ± 8.00 mmHg in PGATT group (P < 0.0001). Early postoperative IOP values were found lower in PTRAB group as 12.19 ± 3.41 mmHg and as 15.69 ± 4.67 mmHg in PGATT group (P < 0.0001). Last follow-up IOP reading were lower in PGATT group (P = 0.009). IOP difference values were found higher both in early and last postoperative periods in PTRAB group (respectively, P < 0.0001, P = 0.018). Success rates were found higher in both at lower than 21 and 18 mmHg levels in PGATT group (respectively, P = 0.014, P = 0.010). CONCLUSION: We found the PGATT combined procedure to be a well-tolerated, effective procedure that can lower IOP both early and late in the postoperative period with different rates of IOP success compared with the combined PTRAB procedure.

Evaluation of Bruch's membrane opening-minimum rim width and retinal nerve fiber layer thickness in adults with anisometropic amblyopia.

PURPOSE: To investigate the relationship between Bruch's membrane opening-minimum rim width (BMO-MRW) and retinal nerve fiber layer thickness (RNFLT) in adult patients anisometropic amblyopia using spectral domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: In this cross-sectional, observational study, 43 anisometropic eyes with corresponding fellow eyes. BMO-MRW (shortest distance from BMO to the internal limiting membrane) and peripapillary RNFLT were obtained with Spectral Domain Optic Coherence Topography (SD-OCT). Global and six sectors values according to the legacy distribution of the SD-OCT (nasal [N], nasal superior [NS], temporal superior [TS], temporal [T], temporal inferior [TI], and nasal inferior [NI]) for both RNFLT and BMO-MRW were evaluated. RESULTS: Mean RNFLT and BMO-MRW measurements comparison showed no significance between anisometropia and fellow eyes. In correlation analyses ; although all sectors showed significant positive correlations; the global, TS and NI BMO-MRW sectors were significantly correlated with their corresponding RNFLT within both anisometropia and fellow eyes. In subgroup caparison analyses RNFLT and BMO-MRW showed no differences between amblyopia and fellow eyes. On subgroups correlation analyses, there were not a consistent correlation sectors between RNFLT and BMO-MRW. CONCLUSIONS: In the analysis of the BMO-MRW and RNFLT measurements obtained by SD-OCT in adult anisometropic amblyopia patients, both parameters were evaluated not significant on showing structural changes. In correlation analysis within amblyopic and fellow eye groups, while there was positive correlation on all sectors, statistically significant relationships were detected in global, NI, TS sectors for both BMO-MRW and RNFLT measurements.

Evaluation of retinal nerve fibre layer, ganglion cell layer and choroidal thickness with optical coherence tomography in migraine patients: a case-control study.

BACKGROUND: Evaluation of retinal nerve fibre layer (RNFL), ganglion cell layer (GCL) and choroidal thickness (CT) with optical coherence tomography (OCT) in chronic migraine patients, to compare with healthy controls. MATERIAL AND METHOD: Ninety-four eyes of 47 chronic migraine patients (Group 1) and 68 eyes of 34 healthy individuals (Group 2) were included in this prospective case-control study. The right and left eyes were separately evaluated. Mean peripapillary RNFL thicknesses, mean GCL measured from superior and inferior quadrants, and mean CT were measured at three different regions (central, 500 µm nasal and temporal region of the fovea). RESULTS: There was no statistically significant differences in RNFL between the two groups (p > 0.05), while CT values were significantly higher and GCL values were significantly lower in chronic migraine groups (p < 0.05). There were no statistically significant differences between migraine duration, frequency and length of attacks, presence of aura, relation to menstrual cycle, white matter lesions in cranial magnetic resonance imaging and RNFL, GCL and CT (p > 0.05). DISCUSSION: In this study, we observed chronic migraine disease does not have any effect on peripapillary RNFL thickness; however, increases in CT and decreases in GCL thickness were observed in migraine patients.

Evaluation of macular and peripapillary choroidal thickness, macular volume and retinal nerve fiber layer in acromegaly patients.

PURPOSE: To evaluate macular volume, retinal nerve fiber layer, and macular and peripapillary choroidal thickness in acromegaly patients. METHOD: In this prospective, case-control study, 31 patients with acromegaly and 32 healthy subjects were recruited. Only right eyes were evaluated. Macular choroidal thickness (CT) was measured at three points, peripapillary CT was measured at eight points, and macular volume was measured at nine areas in the central 6 mm circle zone by spectraldomain optical coherence tomography (OCT). Retinal nerve fiber layer (RNFL) was measured automatically at six segments by OCT. RESULTS: The mean macular and peripapillary CT at all measuring points were significantly higher in acromegaly group (p < 0.05). RNFL thicknesses were significantly higher in acromegaly except for temporal segment (p < 0.05). The mean total, inferior and superior retinal volume of the macula were significantly higher in acromegaly group (p < 0.001), whereas there was no statistically difference was seen in retinal volume of temporal and nasal macular area between the two groups (p > 0.05). CONCLUSION: The macular and peripapillary choroidal thickness, retinal nerve fiber layer, and total retinal volume of the macula were significantly higher in acromegaly patients. Increased choroidal thickness may cause different macular pathologies such as choroidal neovascularization. RNFL results may be important in acromegaly patients with glaucoma, especially if the progress of glaucoma is monitored by OCT.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case-Control Study.

PURPOSE: To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). METHODS: This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses. RESULTS: The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05). CONCLUSIONS: In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

Macular Choroidal Thickness May Be the Earliest Determiner to Detect the Onset of Diabetic Retinopathy in Patients with Prediabetes: A Prospective and Comparative Study.

PURPOSE: To evaluate the macular and peripapillary choroidal thickness and retinal volume in prediabetes. MATERIAL AND METHODS: This prospective comparative study included 53 patients with prediabetes and 53 age- and sex-matched healthy subjects. Only right eyes were selected. Choroidal thicknesses (CT) and retinal volume were measured by optical coherence tomography. Macular CT was measured at the seven points including macular center, 1, 2, and 3 mm distances along the temporal and nasal scans. Peripapillary CT was measured at the eight points of the optic disk area. Systemic and laboratory findings of the subjects were also recorded. RESULTS: There were no significant differences in blood pressures, ocular findings including intraocular pressure, visual acuity, and refractive powers, and macular volumes between the two groups (p > 0.005). Macular and peripapillary CT at all measuring points, body mass index (BMI), fasting blood glucose (FBG), hemoglobinA1C, and lipid profile were significantly higher in prediabetic patients (p < 0.05). There was a significant positive correlation between all points of macular choroidal thicknesses with BMI, FBG, and hemoglobin A1C (p < 0.05). CONCLUSION: Prediabetic factors including impaired FBG, increased hemoglobinA1C, and BMI are independent risk factors for increase in choroidal thickness. Increased macular choroidal thickness may be the earliest determiner to detect the onset of diabetic retinopathy in prediabetes.

Sutureless Intrascleral Fixated Intraocular Lens Implantation.

PURPOSE: To review sutureless intrascleral intraocular lens (IOL) fixation methods. METHODS: Review of published literature. RESULTS: Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. CONCLUSIONS: Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [J Cataract Refract Surg. 2016;32(9):586-597.].

Corneal hysteresis, corneal resistance factor, and intraocular pressure measurements in eyes implanted with a small aperture corneal inlay.

PURPOSE: To compare the postoperative corneal hysteresis (CH) and corneal resistance factor (CRF) of eyes implanted with a small aperture corneal inlay versus fellow eyes. METHODS: Medical records of patients who underwent small aperture corneal inlay (KAMRA; AcuFocus, Inc., Irvine, CA) implantation were retrospectively reviewed. There were two groups: the implanted and non-implanted. Main outcome measures were CH, CRF, Goldmann-correlated intraocular pressure (IOPg), corneal-compensated IOP (IOPcc), and Goldmann applanation tonometry measurements performed preoperatively and at postoperative week 1 and months 1, 3, and 6. RESULTS: The study included 68 eyes of 34 patients. CH was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (12.2 ± 3.1 vs 10.9 ± 1.7 mm Hg; P = .007) and month 1 (12.3 ± 2.5 vs 10.9 ± 1.8 mm Hg; P = .001). CRF was higher in the implanted group when compared with the non-implanted group at postoperative week 1 (11.9 ± 2.9 vs 10.7 ± 1.6 mm Hg; P = .003) and month 1 (12.5 ± 2.5 vs 10.4 ± 1.8 mm Hg; P < .001). IOPcc was higher in the implanted group when compared with the non-implanted group at only the first postoperative month (17.1 ± 3.5 vs 14.3 ± 2.9 mm Hg; P < .001). There were no statistically significant differences in Goldmann applanation tonometry or IOPg measurements between the two groups (P > .05). At the 3-month postoperative visit, all parameters had returned to baseline and there was no change at the 6-month visit. CONCLUSIONS: Implantation of the KAMRA corneal inlay does not induce a permanent change in CH or CRF. A transient increase in both was seen in the early postoperative period.