Ab-externo canaloplasty with and without suture in highly myopic eyes.

PURPOSE: To evaluate the effectiveness of ab-externo canaloplasty using the iTrack canaloplasty microcatheter (Nova Eye Inc, Fremont, California), with or without suture, in glaucoma patients with high myopia. METHODS: This was a prospective, single-center, single-surgeon, observational study comparing the outcomes of ab-externo canaloplasty performed with a tensioning suture (suture group) and without a tensioning suture (no-suture group) in mild to severe glaucoma patients with high myopia. Twenty-three eyes received canaloplasty as a standalone procedure, 5 in combination with phacoemulsification. Primary efficacy endpoints included intraocular pressure (IOP) and the number of glaucoma medications. Safety was assessed based on reported complications and adverse events. RESULTS: Twenty-nine eyes of 29 patients with a mean age of 61.2 ± 12.3 years; 19 eyes in the no-suture group and 10 eyes in the suture group. All eyes demonstrated a significant reduction in IOP 24 months postoperatively, from 21.9 ± 7.22 to 15.4 ± 4.86 mmHg in the suture group and from 23.8 ± 7.58 to 19.7 ± 3.68 mmHg in the no-suture group. The mean number of anti-glaucoma medications reduced from 3.1 ± 0.6 to 0.4 ± 0.7 in the suture group and 3.3 ± 0.9 to and 0.2 ± 0.6 in the no-suture group at 24 months. IOP was not significantly different at baseline between the 2 groups, but it was statistically different at 12 and 24 months. There was no statistically significant difference in the number of medications between the groups at baseline, 12 and 24 months. No serious complications were reported. CONCLUSION: Ab-externo canaloplasty performed either with or without a tensioning suture demonstrated good effectiveness in highly myopic eyes with a significant reduction in IOP and number of anti-glaucoma medications. The suture group achieved a lower postoperative IOP. However, the no-suture modification provides a similar reduction in medications with reduced tissue handling.

Updates on the utility of anterior segment optical coherence tomography in the assessment of filtration blebs after glaucoma surgery.

The formation of filtration blebs is the main drainage mechanism for reducing intraocular pressure after traditional incisional glaucoma surgery such as trabeculectomy and non-penetrating deep sclerotomy. Early and short-lasting blebs may also occur after canaloplasty. Bleb formation also plays an important role after the implantation of glaucoma drainage devices, including Minimally Invasive Glaucoma Surgery devices. Anterior segment optical coherence tomography (AS-OCT) is a rapid and non-invasive high-resolution imaging technique that has evolved in recent years to become a routine examination. Anterior segment optical coherence tomography (AS-OCT) provides key information in the assessment and follow-up of glaucoma surgery, especially in the assessment of filtration blebs. Thus, bleb morphology can be qualitatively classified into diffuse, cystic, encapsulated and flattened, and AS-OCT imaging can also provide several quantitative parameters of the bleb, such as total bleb height, bleb fluid-filled cavity height, bleb wall thickness, number of microcysts and trabeculectomy opening size. These parameters could have an impact on clinical management during follow-up because they may predict the success or failure of the surgery in the early and late postoperative periods. Additionally, they may also guide the procedures used to increase filtration and reduce intraocular pressure, such as bleb needling and laser suture lysis.

Changes in lipidomic profile of aqueous humour in Fuchs endothelial dystrophy.

PURPOSE: To identify and determine differences in lipid profile of aqueous humour (AH) in patients with Fuchs endothelial corneal dystrophy (FECD). METHODS: Lipidomic profile of eight AH samples of FECD patients and 10 control samples was analysed. Patients with previous history of anterior segment surgery, anterior segment pathology or intraocular injections were excluded. Topical ocular medications within the last 6 months were reported. Aqueous humour (AH) was obtained during the first step of Descemet membrane endothelial keratoplasty in FECD patients and during refractive lensectomy in the control group. Lipidomic ultra-performance liquid chromatography mass spectrometry was used to perform an optimal profiling of glycerolipids, sterol lipids, sphingolipids and glycerophospholipids. Metabolite extraction was accomplished by fractionating the samples into pools of species with similar physicochemical properties. RESULTS: The levels of 27 of 110 lipids change significantly in the AH of FECD eyes when compared to control samples. The concentration of most diacylglycerophosphocholines and 1-ether, 2-acylglycerophosphocholines increases in the AH of FECD eyes when compared to healthy controls. In addition, eight sphingomyelins and up to two long-chain highly unsaturated cholesteryl esters present higher levels in FECD samples when compared to controls. CONCLUSION: The lipid composition of AH in FECD patients differs from that of healthy subjects. Those changes may reflect oxidative stress-related changes in the lipid metabolism of the corneal endothelial cells in FECD.