Intraocular Pressure and Safety of Vitrectomy with Vitreous Gas Replacement using Low-concentration Nitrous Oxide Gas Anesthesia.

PURPOSE: This study aims to evaluate the efficacy and safety of vitrectomy with vitreous gas replacement using low-concentration nitrous oxide (N2O) gas anesthesia, focusing on intraocular pressure (IOP) changes, pain, anxiety, and safety outcomes. METHODS: This retrospective study analyzed 133 patients undergoing fluid-air exchange without use of such as SF6 or C3F8, at Saneikai Tsukazaki Hospital, Japan, from April 2019 to March 2022. Participants were divided into two groups: those receiving low-concentration nitrous oxide gas anesthesia (N2O group) and those receiving local anesthesia with room air inhalation (Air group). IOP, pain, anxiety levels, and intraoperative complications were assessed. RESULTS: No significant differences were found in IOP changes postoperatively between the N2O and Air groups. The N2O group reported significantly lower pain scores and had lower intraoperative systolic blood pressure and heart rate changes compared with the Air group. No significant intraoperative or postoperative complications were observed in either group. CONCLUSION: Vitrectomy with fluid-air exchange using low-concentration nitrous oxide gas anesthesia is safe, does not increase IOP, and may offer benefits in reducing intraoperative pain and stabilizing vital signs compared with traditional local anesthesia methods. This approach could be considered a viable option for vitreous surgery requiring fluid-air exchange.

Direct Intraocular Lens Extraction Using a Newly Developed Lens-Grabbing Forceps.

Background: Due to lower age thresholds for cataract surgery and increased longevity, cases with intraocular lens (IOL) dislocation requiring removal have increased. Traditional methods, such as cutting or folding the IOL within the eye, pose a high risk of complications, including corneal endothelial and iris damage. Methods: We developed a new minimally invasive technique for direct IOL removal using specially designed lens-grabbing forceps. These forceps can grasp and remove the IOL through a small incision in a single motion, significantly reducing intraocular manipulations compared to conventional methods. Results: In our test cases, IOL removal through a 2.2 mm corneal incision was completed in approximately 95 s, with minimal incision enlargement (about 0.16 mm) and a slight decrease in corneal endothelial cells. Conclusions: Our findings suggest that this technique is minimally invasive and safe for IOL removal, offering a promising alternative to existing methods.

Visual Performance of a Violet-Filtering Intraocular Lens versus a Blue-Filtering Intraocular Lens of New/Old Manufacturing Processes.

This article compares the visual performance of a violet light-filtering colored lens (ZCB00V) and blue light-filtering intraocular lens (IOL; SN60WF) before and after modifying the manufacturing process for glistening suppression. In this retrospective study, conducted at Saneikai Tsukazaki Hospital, Himeji, Japan, a consecutive sample of 8943 eyes of 5119 patients were included and implanted with blue-filtering IOLs before and after modifying the manufacturing process (SN60WF-J (1318 eyes) and SN60WF-Q,A (1418 eyes), respectively), noncolored UV-cut IOLs (ZCB00 (1418 eyes)), and ZCB00V (3717 eyes). For each patient, the corrected distance visual acuity (CDVA) at 3 months postoperative (3MCDVA) and the area under log contrast sensitivity function (AULCSF) were measured. The 3MCDVA was -0.076 ± 0.1, -0.11 ± 0.13, -0.10 ± 0.17, and -0.11 ± 0.13, for SN60WF-J, SN60WF-Q,A, ZCB00, and ZCB00V, respectively. The SN60WF-J group revealed significant differences as compared to the other three groups (all p < 0.05). The mesopic AULCSF was 2.59 ± 0.20, 2.68 ± 0.19, -2.69 ± 0.18, and 2.76 ± 0.19, respectively, whereas the photopic AULSCF was 2.63 ± 0.23, 2.76 ± 0.25, -2.77 ± 0.25, and 2.88 ± 0.25. The SN60WF-J and ZCB00V groups exhibited significant differences as compared to the other three groups, whereas no significant differences were noted between the SN60WF-Q,A and the ZCB00 groups (all p < 0.05). The violet-filtering lens offers higher visual acuity and contrast sensitivity than the clear and blue-filtering lens. It was also found that the above functions were improved by modifying the manufacturing process.

Relationship between Postoperative Anterior Chamber Depth and Refraction Based on the Haptic Fix Position in Intraocular Lens Intrascleral Fixation.

The aim of this study was to analyze the refraction and iris capture tendency regarding the fixation position with respect to the intrascleral fixation (ISF) of intraocular lenses. Consecutive patients who underwent ISF 1.5 mm (ISF 1.5, 45 eyes) and 2.0 mm (ISF 2.0, 55 eyes) from the corneal limbus with NX60, as well as those who underwent normal phacoemulsification with in-the-bag ZCB00V (ZCB, 50 eyes), were enrolled. The anterior chamber depth (post-op ACD), the estimated ACD when using the SRK/T (post-op ACD-predicted ACD), and the refractive error (post-op MRSE, and the predicted MRSE) were all calculated. In addition, the postoperative iris capture was also investigated. The post-op MRSE-predicted MRSE values were: -0.59, 0.02, and 0.00 D (ISF 1.5, ISF 2.0, and ZCB) (p < 0.05, between ISF 1.5 vs. ISF 2.0 and ZCB); the post-op ACD values were: 4.00, 4.17, and 4.29 mm (p < 0.05, ISF 1.5 vs. ZCB); and the post-op ACD-predicted ACD values were: -2.03, -1.98, and -1.60 mm (p < 0.05, between ZCB vs. ISF 1.5 and ISF 2.0). The iris capture occurred in four eyes with regard to ISF 1.5 and three eyes with ISF 2.0 (p = 0.52). Moreover, ISF 2.0 possessed 0.6D hyperopia and 0.17 mm deeper anterior chamber depth. The refractive error of ISF 2.0 was less than that of ISF 1.5. Lastly, no significant iris capture onset was noted between ISF 1.5 mm and 2.0 mm.

Torsional Power and Tip Shape Greatly Change Irrigation Flow Feeding Rate.

BACKGROUND: It is important to maintain intraocular pressure during cataract surgery. When the intraocular pressure sharply drops during phacoemulsification, it is important to ensure a compensatory maximum fluid supply. To the best of our knowledge, this is the first study presenting the maximum irrigation flow supply using an ultrasonic tip shape and torsional power setting. METHODS: The weight of BSS PLUS 500 ejected during torsional oscillation fitted with a mini-tip or balanced tip and nano sleeve with IOP set at 20 mmHg (IOP20) or 40 mmHg (IOP40) was measured. The weight of the BSS ejected from the sleeve over 3.0 s (15 measurements taken at 200-ms intervals) was measured to calculate the irrigation flow feeding rate. Measurements were made four times at each torsional power setting (TP). RESULTS: With a balanced tip, the irrigation flow rate rose as TP was increased, whereas, at 60% or 90% TP, the irrigation flow rate markedly decreased. With the mini-tip, the irrigation flow rate remained relatively stable, up to 60% or 80% TP but decreased dramatically at higher power settings. Compared with IOP20, the irrigation flow rate increased by 1.21- to 1.28-fold with the balanced tip and by 1.28- to 1.41-fold with the mini-tip at IOP40. At IOP20, the irrigation flow rate was higher with the mini-tip at 0% and 5% TP but equal to or higher with the balanced tip at TP of ≥10%. At IOP40, the irrigation flow rate with the mini-tip was equal to or higher than that with the balanced tip at all TP. CONCLUSIONS: The irrigation flow rate tends to vary with changes in TP and tip shape.

Insertion of Ahmed Implant With Partial Buckle Resection: A Case Report.

This report describes a case of poor intraocular pressure control after the encircling procedure for traumatic retinal detachment. We inserted an Ahmed Glaucoma Valve Implant® (AGVI) with partial sponge resection and obtained good results. The results are reported here. An 11-year-old boy had a traumatic globe rupture in the right eye (OD). Corneo-scleral repair and lens extraction were performed on the injured eye. About one month after the injury, the intraocular pressure (IOP) of OD had increased to 25 mmHg. Glaucoma eye drops were started, and the IOP was subsequently controlled at 11-19 mmHg. Five months after the injury, the total retinal detachment was observed, and the encircling procedure with a silicone sponge was performed. Soon, right IOP control deteriorated, increasing to over 30 mmHg despite the maximum eye drops dosage. Given the poor condition of the cornea and iris after the trauma and the limited surgical space after the encircling procedure, we chose to partially cut the sponge and insert the AGVI. Intraoperatively, the adhesions between the conjunctiva and the Tenon's capsule were dissected. The sponge was partially cut at the 10 o'clock position, and both ends were sutured to the sclera. The AGVI was subsequently inserted into the space obtained. The plate was placed posterior to the sponge, and the tube was placed between the cut sponges and inserted into the anterior chamber. The right IOP was 8 mmHg on the day after the surgery and remained at 15-20 mmHg until nine months after surgery postoperatively under two medications. No recurrence of retinal detachment was further observed. In our case of post-traumatic glaucoma, the partial removal of the sponge along with the insertion of an AGVI has shown beneficial results in terms of IOP control.

Examination of the safety and effectiveness of low-concentration nitrous oxide anesthesia in cataract surgery.

PURPOSE: To investigate the effects in cataract surgery using local anesthesia along with a 30% low-concentration nitrous oxide (N2O) anesthesia compared with local anesthesia only. SETTING: Saneikai Tsukazaki Hospital. DESIGN: Retrospective, consecutive study. METHODS: Patients who underwent bilateral cataract surgery were enrolled. 37 patients using room air inhalation (Air group) and 45 patients using 30% low-concentration N2O anesthesia (70% oxygen, total 6 L/min) at surgery start (N2O group) were retrospectively reviewed. Systolic blood pressure (BPs), diastolic blood pressure (BPd), and heart rate (HR) at surgery start and end, and mean intraoperative oxygen saturation (% SpO2) were examined. Immediately following surgery, a questionnaire using the Visual Analog Scale score was done to determine intraoperative pain, anxiety, memory, and nausea. RESULTS: No systemic symptoms in all patients and ocular complications requiring treatment were observed. For the N2O and air groups, changes in BPs were -5.38 ± 11.07(P = .01) and 1.27 ± 13.61 mm Hg, and HR were -2.24 ± 6.76 and 0.89 ± 5.18 bpm (P = .001), respectively; intraoperative SpO2 was 99.05% ± 0.74% and 97.44% ± 1.31% (P < .001), intraoperative anxiety was 21.76 ± 23.2 and 37.17 ± 32.79 (P = .002), and intraoperative memory was 55.24 ± 36.8 and 68.91 ± 33.81 (P = .01), respectively. No patients experienced intraoperative nausea. There was no statistically difference in BPd (P = .47) and intraoperative pain (P = .62). CONCLUSIONS: Low-concentration N2O anesthesia may not cause respiratory depression, abnormal vital signs, or nausea in cataract surgery. It can suppress intraoperative anxiety and memory and decrease and stabilize vital signs.

Utility and safety of low-concentration nitrous oxide anesthesia in ptosis surgery.

ABSTRACT: To evaluate the utility of low-concentration nitrous oxide (N2O) anesthesia in ptosis surgeryThis study was a retrospective consecutive case series that included 54 successive patients with blepharoptosis who underwent bilateral levator aponeurosis advancement and on whom skin resection performed by the same surgeon between August 2016 and July 2017. Among these patients, 27 were operated with a local anesthesia injection (air group) and 27 with a local anesthesia injection and low-concentration N2O anesthesia (N2O group). All N2O cases used a total of 6 L of gas comprising 70% oxygen and 30% N2O. Preoperative and postoperative blood pressure (BP) and heart rate (HR) and intraoperative pain, anxiety, nausea, and memory were measured immediately after surgery using visual analog scale score (VASS). Additionally, perioperative side effects were examined.There was no significant difference in age, sex, and preoperative and postoperative margin reflex distance (MRD) between the 2 groups (all P > .05). The intraoperative mean peripheral oxygen saturation was significantly higher (97.5% ±â€Š1.6% vs 99.5% ±â€Š.6%, P < .001), intraoperative HR was significantly lower (78.2 ±â€Š12.8 vs 70.7 ±â€Š11.6 bpm, P = .02), and operation time was significantly shorter (33.1 ±â€Š8.1 vs 29.4 ±â€Š10.3 minutes, P = .03) in the N2O group than in the air group.Difference between intraoperative and preoperative systolic BP (BPs) (+15.8 ±â€Š18.0 vs + 3.1 ±â€Š21.7 mm Hg, P = .02), diastolic BP (BPd) (+7.0 ±â€Š17.4 vs -2.3 ±â€Š13.6 mm Hg, P = .04), and HR (3.2 ±â€Š8.5 vs -3.9 ±â€Š9.4 bpm, P = .01) was significantly lower in the N2O group than in the air group.VASS of intraoperative pain was significantly lower in the N2O group than in the air group (49.5 ±â€Š24.7 vs 22.6 ±â€Š14.9, P < .001), whereas intraoperative anxiety and memory did not present significant differences between the groups (P = .09 and P = .45, respectively). Intraoperative nausea score was 0 for all cases in both groups. There was no other side effect.Ptosis surgery with anesthesia using 30% N2O may effectively suppress intraoperative BP and HR along with pain and shorten the operation time without side effects such as nausea.

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.

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.

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.

Glaucoma Implant Tube Lumen Obstruction Visualized Using Anterior Segment Optical Coherence Tomography.

We report a case of glaucoma implant tube lumen obstruction visualized with anterior segment optical coherence tomography (ASOCT) and present its surgical management. The patient was a 66-year-old man with refractory glaucoma associated with traumatic aphakia in the right eye after trabeculectomy, several bleb needling procedures, and scleral fixation of the intraocular lens with pars plana vitrectomy. Finally, we performed Baerveldt implantation at the pars plana of the temporal inferior quadrant with a several Sherwood slit. However, his intraocular pressure (IOP) was >30 mm Hg despite maximum medication for several weeks. We attempted second vitrectomy and completely removed vitreous around the tube tip; however, his IOP remained around 40 mm Hg for several days after the surgery. Therefore, we suspected tube obstruction at the extraocular point of the tube lumen and used ASOCT for assessment. ASOCT revealed material in the tube lumen. We pulled out the tube and then crushed and extruded the obstructing material from the tube tip. We then refixed the tube at the same place and achieved good IOP control after the surgery. Our findings indicate that ASOCT is useful for diagnosing glaucoma implant tube lumen obstruction and surgical decision-making.

Bimatoprost-induced late-onset choroidal detachment after trabeculectomy: A case report and review of the literature.

BACKGROUND: Choroidal detachment (CD) is often observed at an early period particularly after trabeculectomy and glaucoma drainage implant surgery. However, topical antiglaucoma eye drop-induced CD is a rare complication. Here, we report a case of topical bimatoprost-induced late-onset CD after trabeculectomy and review the literature. CASE REPORT: A 74-year-old man who suffered from primary open-angle glaucoma underwent his initial trabeculectomy with mitomycin-C in the right eye. Before the surgery, his intraocular pressure (IOP) was 20 to 22 mm Hg with bimatoprost 0.03%, dorzolamide 1%, and brimonidine 0.1% and his best corrected visual acuity (BCVA) was 0.9. The mean deviation in Humphrey Visual Field Analyzer (24-2 program) was -27.83 db. After successful trabeculectomy, IOPs were 11 to 16 mm Hg without any medication. Eight months after the surgery, we restarted bimatoprost to further reduce the IOP in the right eye, which was 15 mm Hg. At a hospital visit 2 months later, he complained of blurred vision that had persisted for the past 1 month; his IOP had decreased to 9 mm Hg. His BCVA was 0.04 and 3 quadrant CD was found. We discontinued bimatoprost and started him on betamethasone 0.1% 4 times per day. However, CD marginally changed after 1 week, with IOP at 7 mm Hg; thus, we performed scleral drainage for CD. After 3 weeks of drainage, CD completely disappeared. IOP increased to 16 mm Hg and BCVA was 0.7. However, 3 months after the drainage, IOP increased to 29 mm Hg, and needling revision was thus performed. After the surgery, IOP remained at 14 to 16 mm Hg without any glaucoma medication and CD recurrence. A review of the literature showed that various antiglaucoma medications induce CD, regardless of the preceding glaucoma surgery and that CD is usually resolved by withdrawing the medication and administering topical steroids. However, most previous studies have shown the recurrence of CD by rechallenging the same drug. CONCLUSION: In our case, topical bimatoprost induced late-onset CD after trabeculectomy. Early scleral drainage may be a good option to quickly resolve drug-induced CD and prevent its recurrence. Therefore, it must be kept in mind that various antiglaucoma medications induce CD.

A Pilot Evaluation Assessing the Ease of Use and Accuracy of the New Self/Home-Tonometer IcareHOME in Healthy Young Subjects.

PURPOSE: We investigated the ease of use and accuracy of a new self/home-tonometer (IcareHOME) versus Goldmann applanation tonometry (GAT) and the Icare tonometer (Icare) by measuring the diurnal intraocular pressure (IOP). PATIENTS AND METHODS: The right eyes of 43 healthy young subjects were studied. The IOP was measured using the IcareHOME, GAT, and Icare 6 times a day, every 2 hours, from 8:00 to 18:00. The coincidence of the diurnal curves among all tonometers was analyzed using a linear mixed model. The intradevice and interdevice agreement was evaluated using the intraclass correlation coefficients (ICC) and Bland-Altman method. The subjects' perception of the IcareHOME was evaluated using a questionnaire. RESULTS: The liner mixed model showed similar diurnal IOP curves for all tonometers (P=0.543); however, significant differences were observed between the tonometers over time (P<0.001). The intradevice repeatability was ICC>0.8 among all tonometers, although the interdevice agreement was lowest between the IcareHOME and GAT (ICC=0.641). The IOP values were significantly lower for the IcareHOME than for the GAT at 12:00, 16:00, and 18:00 (P<0.05, Tukey-Kramer test). The mean differences between the Icare and IcareHOME and GAT and IcareHOME were 0.83 and 1.03 mm Hg, respectively (95% limit of agreement: -4.17 to 5.84 mm Hg and -3.91 to 5.98 mm Hg, respectively). Regarding the subjects' perception of handling the IcareHOME, 17 (39.5%) subjects answered "easy to use," 20 (46.5%) answered "normal," and six (13.9%) answered "difficult to use." CONCLUSIONS: The IcareHOME can be used as a self/home-tonometer; however, it may result in lower IOP values.

Motor activity and imagery modulate the body-selective region in the occipital-temporal area: a near-infrared spectroscopy study.

The extrastriate body area (EBA) lies in the occipital-temporal cortex and has been described as a "body-selective" region that responds when viewing other people's bodies. Recently, several studies have reported that EBA is also modulated when the subject moves or imagines moving their own body, even without visual feedback. The present study involved 3 experiments, wherein the first experiment was conducted to examine whether near-infrared spectroscopy (NIRS) could capture any activity in the EBA when viewing images of bodies. The second experiment was designed to elucidate whether this region also responds when the subjects move their own body, and the third to observe whether imagining carrying out a movement would activate EBA. Images of human bodies and chairs were used as the stimuli for the first experiment, simple hand movements carried out by the subject were used for the second and the act of imagining hand movements for the third. Our results confirmed that the region we defined as EBA was clearly activated when the subject viewed images of human bodies, carried out movements of their own body and imagined moving parts of their own body, thus demonstrating the usefulness of NIRS as a new brain imaging method. Moreover, we found a gender-based difference when imagining movement; male subjects showed a greater response than female subjects. This may reflect a gender difference in imagery skills; however, further research is needed to verify this hypothesis.