Microcatheter Circumferential Trabeculotomy versus Conventional Trabeculotomy in Congenital Glaucoma

Microcatheter, Trabeculotomy, Congenital Glaucoma

2017 Jun 14. pii: S0002-9394(17)30242-8. doi: 10.1016/j.ajo.2017.06.004. [Epub ahead of print]

Randomized Trial on Illuminated Microcatheter Circumferential Trabeculotomy versus Conventional Trabeculotomy in Congenital Glaucoma.

Abstract

PURPOSE:

To compare one year outcomes of illuminated microcatheter-assisted circumferential trabeculotomy(IMCT) vs conventional partial trabeculotomy(CPT) for Primary Congenital Glaucom (PCG).

DESIGN:

Randomized clinical trial METHODS: Forty eyes of 31 patients with unilateral or bilateral primary congenital glaucoma aged less than two years were randomized to undergo IMCT (20 eyes) or CPT (20 eyes). Primary outcome measure was IOP reduction. The success criterion was defined as intraocular pressure (IOP) ≤ 12 mm Hg without and with anti-glaucoma medications (absolute success and qualified success respectively).

RESULTS:

The mean age of our study population was 8.35 ± 1.2 months. The mean pre-operative IOP was 24.70± 3.90 mm Hg in the IMCT group and 24.60± 3.31 mm Hg in the CPT group. Both groups were comparable with respect to pre-operative IOP, corneal clarity, corneal diameter, vertical cup-disc ratio and refractive error. In IMCT group, 360 degree cannulation was achieved in 80% (16/20) eyes. For the IMCT group and CPT groups respectively, the absolute success rates were 80%(16/20) and 60%(12/20) (p< 0.001); and qualified success rates were 90% (18/20) and 70% (14/20) (p< 0.001). Both procedures produced a statistically significant reduction in IOP, and eyes undergoing IMCT achieved a lower IOP than CPT group at 12 months follow-up (9.5 + 2.4 mm and 11.7 + 2.1 mm Hg respectively, p< 0.001).

CONCLUSION:

In primary congential glaucoma, illuminated microcatheter assisted 360 degree circumferential trabeculotomy performed better than conventional partial trabeculotomy at one year follow-up, and resulted in significantly lower IOP measurements.

PMID:
28624326
DOI:
10.1016/j.ajo.2017.06.004
Microcatheter, Trabeculotomy, Congenital Glaucoma

Baerveldt glaucoma implant

Risk factors for Rapid Glaucoma Disease Progression

Risk Factor, Glaucoma, Progression

2017 Jun 14. pii: S0002-9394(17)30241-6. doi: 10.1016/j.ajo.2017.06.003. [Epub ahead of print]

Risk factors for Rapid Glaucoma Disease Progression.

Abstract

PURPOSE:

To determine the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors and non-rapid disease progressors.

DESIGN:

Retrospective case control study Methods SETTING: Five private ophthalmology clinics STUDY POPULATION: 48 rapidly progressing eyes (progression ≥1dB mean deviation (MD)/year) and 486 non-rapidly progressing eyes (progression <1dB MD/year). Patients were eligible if they had a diagnosis of glaucoma from their ophthalmologist and if they had greater than or equal to 5 Humphrey visual fields (24-2) conducted. Patients were excluded if their sequential visual fields showed an improvement in MD or if they had greater than 5dB MD variation in between visits. Patients with obvious neurological fields were excluded.

OBSERVATION PROCEDURE:

Clinical and demographic data (age, gender, CCT, IOP, refraction, medications) as well as medical, surgical and ocular histories were collected.

MAIN OUTCOME MEASURES:

Risk factor differences between the cohorts were measured using the independent t-test, Wald chi-squared and binomial regression analysis.

RESULTS:

Rapid progressors were older, had significantly lower CCT and baseline IOPs and were more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes and IOP lowering surgery. They also had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs.

CONCLUSION:

Cardiovascular disease is an important risk factor for rapid glaucoma disease progression irrespective of IOP control.

PMID:
28624324
DOI:
10.1016/j.ajo.2017.06.003
Risk Factor, Glaucoma, Progression

Optic nerves damaged by glaucoma. Not from article

Evaluating structural progression of retinitis pigmentosa after cataract surgery

cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity

2017 Jun 7. pii: S0002-9394(17)30238-6. doi: 10.1016/j.ajo.2017.05.026. [Epub ahead of print]

Evaluating structural progression of retinitis pigmentosa after cataract surgery.

Abstract

PURPOSE:

To determine whether cataract surgery accelerates disease progression in retinitis pigmentosa (RP).

DESIGN:

Retrospective cohort study.

METHODS:

Seventy eyes of 40 patients with RP were categorized as having had phacoemulsification with intraocular lens implantation versus no cataract surgery at a single tertiary-level institution. Spectral domain optical coherence tomography (SD-OCT) was used to measure the ellipsoid zone (EZ) width, which has been demonstrated to be a reliable marker of RP severity, at baseline and throughout follow-up (median 768 days). RP progression was calculated as the loss of EZ width over time for all patients. Additional post-operative data was collected for the cataract surgery group, including pre- and post-operative best-corrected visual acuity, incidence of macular edema, posterior capsular opacification, epiretinal membrane, and intraocular lens subluxation.

RESULTS:

Multivariable analysis including age, baseline EZ width, mode of inheritance, and cataract surgery status showed that there was no significant difference in RP progression between the cataract surgery and control groups (P=0.23). Mode of inheritance was associated with RP progression, with autosomal recessive RP progressing at 148 microns/year and autosomal dominant RP progressing at 91 microns/year (P=0.003). Visual acuity improved in almost all eyes that underwent surgery (17/19, 89%), and remained stable in remaining eyes (2/19, 11%). There was a high incidence of post-surgical posterior capsular opacification (18/19, 95%). There were no serious complications such as lens subluxation or endophthalmitis.

CONCLUSIONS:

Our findings suggest that cataract surgery is a safe and effective means of improving visual acuity in RP patients and that it does not seem to be associated with faster disease progression as measured using SD-OCT.

KEYWORDS:

IS/OS; cataract surgery; ellipsoid zone; optical coherence tomography; phacoemulsification; posterior subcapsular cataract; retinitis pigmentosa; visual acuity

PMID:
28601586
DOI:
10.1016/j.ajo.2017.05.026
cataract surgery, ellipsoid zone, optical coherence tomography, phacoemulsification, posterior subcapsular cataract, retinitis pigmentosa, visual acuity

Retinitis pigmentosa example not from article

outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration

AMD, Aflibercept, Anti-VEGF, Bevacizumab, Choroidal neovascularization, Ranibizumab, Ziv-aflibercept

2017 Jun 8. pii: bjophthalmol-2017-310318. doi: 10.1136/bjophthalmol-2017-310318. [Epub ahead of print]

One-year outcome of intravitreal ziv-aflibercept therapy for non-responsive neovascular age-related macular degeneration.

Abstract

AIM:

To evaluate 12-month outcome of intravitreal ziv-aflibercept (IVZ) therapy in eyes with neovascular age-related macular degeneration (nAMD) that are non-responsive to bevacizumab and ranibizumab.

METHODS:

This retrospective study included 16 eyes (14 patients) with nAMD who were on prior treatment with bevacizumab and ranibizumab and were treated with as-needed IVZ (1.25 mg/0.05 mL) for 12 months. The primary outcome measure was the mean change in best corrected visual acuity (BCVA) and secondary outcome measures included mean change in central macular thickness (CMT), retinal pigment epithelial detachment (RPED) heights, longest treatment free interval, presence of subretinal fluid (SRF) and intraretinal fluid (IRF) and adverse events.

RESULTS:

There was no change in the mean logarithm of minimum angle of resolution (logMAR) BCVA at baseline and following treatment with IVZ therapy (p=0.978). The mean number of IVZ injections during 12 months was 5.9±3.3, and the mean number of antivascular endothelial growth factors (VEGFs) injections prior to switching to IVZ was 8.4±4.7. The mean treatment free interval was longer during IVZ therapy (114.4±67.1 days) compared with 76.3±54.6 days before IVZ therapy (p=0.03). Five (31.25%) eyes had visual gains of at least 0.1 logMAR, 3 (18.75%) eyes had stable BCVA (within 0.1 logMAR) and 8 (50%) eyes had BCVA decline of at least 0.1 logMAR. There was no significant difference in the mean CMT, RPED heights and presence of IRF and SRF at 12 months compared with baseline. No adverse events were noted.

CONCLUSION:

IVZ increased the treatment free interval in non-responders but no significant change in visual and anatomic outcomes.

KEYWORDS:

AMD; Aflibercept; Anti-VEGF; Bevacizumab; Choroidal neovascularization; Ranibizumab; Ziv-aflibercept

Four-year Follow-up of the Changes in Anterior Segment After Phakic Collamer Lens Implantation

Anterior segment, phakic, collamer, lens implantation
Am J Ophthalmol. 2017 Jun;178:140-149. doi: 10.1016/j.ajo.2017.03.020. Epub 2017 Mar 23.

Four-year Follow-up of the Changes in Anterior Segment After Phakic Collamer Lens Implantation.

Author information

 Anterior segment, phakic, collamer, lens implantation

Abstract

PURPOSE:

To assess the changes and relationship in central vaulting, flare intensity, and crystalline lens thickness during a follow-up period of 4 years after implantable collamer lens (ICL) implantation in eyes with high myopia.

DESIGN:

Retrospective observational study.

METHODS:

Ninety-eight eyes of 50 patients were followed up with routine measurements of central vaulting, crystalline lens thickness, endothelial cell density, and aqueous flare postoperatively. Data were analyzed by repeated-measures analysis of variance. The relationship between the annual change in crystal lens thickness after surgery and age was evaluated by Pearson correlation coefficient and linear regression.

RESULTS:

There was a continuous reduction in central vaulting and endothelial cell density as well as an increase in crystalline lens thickness in ICL eyes from 1 month onward to 5 years postoperatively (P < .001). Although the trend of variation during the individual visit period was accentuated, the variation turned out to be smaller between 12 and 36 months or 60 months postoperatively (P = .42, P = .65). Aqueous flare intensity increased significantly after surgery and returned to normal 1 year later. Additionally, a positive correlation between patient age and crystalline lens thickness (r = 0.617, P < .0001) was observed in eyes with ICL implantation.

CONCLUSIONS:

The changes in central vaulting, endothelial cell density, and crystalline lens thickness are more prominent during the first year after ICL implantation, tending to be relatively stable afterwards. The anterior inflammation during the early postoperative period synchronizes with the sharp progression of crystalline lens changes within the first year.

Anterior segment, phakic, collamer, lens implantation

Not from article but Anterior segment, phakic, collamer, lens implantation

Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity

postnatal, hyperglycaemia, risk factor, treatment,retinopathy prematurity

Send to

Br J Ophthalmol. 2017 Jun 2. pii: bjophthalmol-2016-309187. doi: 10.1136/bjophthalmol-2016-309187. [Epub ahead of print]

Early postnatal hyperglycaemia is a risk factor for treatment-demanding retinopathy of prematurity.

Abstract

BACKGROUND:

To investigate whether neonatal hyperglycaemia in the first postnatal week is associated with treatment-demanding retinopathy of prematurity (ROP).

METHODS:

This is a Danish national, retrospective, case-control study of premature infants (birth period 2003-2006). Three national registers were searched, and data were linked through a unique civil registration number. The study sample consisted of 106 cases each matched with two comparison infants. Matching criteria were gestational age (GA) at birth, ROP not registered and born at the same neonatal intensive care unit. Potential ‘new’ risk factors were analysed in a multivariate logistic regression model, while adjusted for previously recognised risk factors (ie, GA at birth, small for gestational age, multiple birth and male sex).

RESULTS:

Hospital records of 310 preterm infants (106 treated; 204 comparison infants) were available. Nutrition in terms of energy (kcal/kg/week) and protein (g/kg/week) given to the preterm infants during the first postnatal week were statistically insignificant between the study groups (Mann-Whitney U test; p=0.165/p=0.163). Early postnatal weight gain between the two study groups was borderline significant (t-test; p=0.047). Hyperglycaemic events (indexed value) were statistically significantly different between the two study groups (Mann-Whitney U test; p<0.001). Hyperglycaemia was a statistically independent risk factor (OR: 1.022; 95% CI 1.002 to 1.042; p=0.031).

CONCLUSION:

An independent association was found between the occurrence of hyperglycaemic events during the first postnatal week and later development of treatment-demanding ROP, when adjusted for known risk factors.

KEYWORDS:

Hyperglycemia.; Preterm birth, Retinopathy of Prematurity; Risk factors