Anti-glaucoma Surgery Research Articles

Comparative assessment of the potential impact of chronic herpesvirus infection on intra- and postoperative complications in patients with glaucoma

PURPOSE. To evaluate the potential impact of herpesvirus infection (carriage) on early postoperative outcomes of antiglaucoma surgeries.MATERIAL AND METHODS. The study included 95 patients with stage I, II and III primary open-angle glaucoma (POAG), with indications for surgical treatment. The patients were divided into the main group (group 1, 31 patient) and the control group (group 2, 64 patients). The groups were formed on the basis of information obtained from the anamnesis about a transferred herpes simplex virus of any localization (as a rule, it was labial, oral-facial herpes and its skin manifestation). The indication for surgical treatment was the absence of persistent normalization of intraocular pressure and a decrease in visual functions. Depending on the clinical situation, patients underwent one of the two types of surgical interventions: trabeculectomy and non-penetrating deep sclerectomy. Analysis of postoperative complications was performed on day 7 after surgery.RESULTS. The most frequent complications in the early postoperative period were ciliochoroidal detachment, hyphema, increased intraocular pressure, shallow anterior chamber syndrome, excessive vascularization in the surgery site, clinical signs of conjunctival-scleral and sclerascleral scarring. On day 7 after antiglaucoma surgery, the IOP level was 9.1±0.8 mm Hg on average in the groups. IOP was 1–2 mm Hg higher in case of non-penetrating surgery. In the same patients, normalization of IOP by the same date was obtained in 63.15% of cases, which required goniopuncture; needling was indicated and performed in 84.2% of patients. Ciliochoroidal detachment was diagnosed in both groups with the same frequency: 9.7 and 9.4%, respectively. Presence of minor hyphema was observed only after trabeculectomy, in 16.1 and 10.9% of cases, respectively.CONCLUSION. Results of this study, firstly, do not indicate that HSV activates in response to surgical intervention; secondly, in patients who had been infected with it previously, only a tendency for the number of most common intra- and postoperative complications to increase was noted. The obtained results are insufficient for an unambiguous answer to the question posed in this study, which indicates the need for further research.

Ultrastructural analysis of explanted CyPass microstents and correlation with clinical findings

PurposeThe purpose of this study was to obtain insight into cellular processes after CyPass microstent implantation into the supraciliary space. With this knowledge, we expected to find some reason for surgical failure.MethodsNine CyPass microstents of 8 patients with primary open-angle glaucoma (n = 1), pseudoexfoliation glaucoma (n = 5), uveitic glaucoma (n = 1), and posttraumatic open-angle glaucoma (n = 1) were explanted due to recurrence of IOP elevation, corneal decompensation, or persistent hypotony. The explants were processed for light and transmission electron microscopy.ResultsFibrotic material, consisting of collagen fibrils, microfibrils, pseudoexfoliation fibrils produced by activated fibroblasts, was detected in the stent lumen of 4/5 pseudoexfoliation glaucoma patients and also in posttraumatic open-angle glaucoma. Fibrotic material was also present on the outer surface and within fenestrations of the majority of stents. Complete absence of fibrotic reaction was noticed in 3 of 9 microstents.ConclusionAlthough MIGS is known to be less invasive than conventional surgery, implants placed in the suprachoroidal space may be adversely affected by a fibrotic tissue reaction resulting in implant failure. Understanding mechanisms and risk factors leading to fibrotic scarring following antiglaucomatous surgery may help to develop novel strategies that improve surgical outcome.

The Efficacy of Simultaneous Injection of Dexamethasone Implant and Ranibizumab Into Vitreous Cavity on Macular Edema Secondary to Central Retinal Vein Occlusion.

The purpose of this study was to determine the safety and effectiveness of simultaneous vitreous injection of dexamethasone implant and ranibizumab on macular edema secondary to central retinal vein occlusion (CRVO). We conducted a 6-month retrospective self-control study. Twenty-five patients diagnosed with macular edema secondary to CRVO were enrolled in this study. The patients received intravitreal injection of dexamethasone implant and ranibizumab. The changes in best corrected visual acuity (BCVA), central retinal thickness (CRT) and interocular pressure (IOP) before and at 2w, 1, 2, 3, 4, 5, 6 m after injection were recorded and compared. The adverse reactions in eyes and whole body were observed. The BCVA of all patients at 2 w (61.8 ± 5.42), 1 m (68.68 ± 5.23), 2 m (70.8 ± 5.8), 3 m (68.44 ± 5.61), 4 m (65.76 ± 5.76), 5 m (67.08 ± 5.57), and 6 m (70.12 ± 5.46) after surgery were significantly higher than that before surgery (52.2 ± 5.06,p < 0.01), and CRT of all patients at 2w (393.36 ± 52.66 um), 1 m (334.52 ± 32.95 um), 2 m (298.800 ± 29.97 um), 3 m (309.080 ± 28.78 um), 4 m (345.48 ± 39.81 um), 5 m (349.080 ± 29.88 um), and 6 m (309.76 ± 30.41 um) after surgery were significantly reduced than that before surgery (583.76 ± 121.09 um, p < 0.01). Macular edema recurred in an average of 4.44 ± 0.51 months after treatment, and those patients received combined treatment again. During follow-up, the most common adverse reactions were subconjunctival hemorrhage and increased intraocular pressure, with the incidence of 22% (11/50) and 18% (9/50) respectively. In all cases, the increased intraocular pressure could be controlled by a single intraocular pressure reducing drug. No patient needed to receive anti-glaucoma surgery. The overall incidence of lens opacity was 4% (2/50). After the first injection, no case showed lens opacity. After re-injection, 2 patients (2 eyes) (8%) developed lens opacity. None of the patients showed serious ocular adverse reactions or systemic complications such as vitreous hemorrhage, retinal detachment, endophthalmitis, uveitis or ocular toxicity. The simultaneous vitreous injection of dexamethasone implant and ranibizumab can significantly improve the visual acuity and anatomical prognosis in macular edema secondary to central retinal vein occlusion (CRVO-ME) patients, exhibiting good safety and effectiveness.

Changing Trends in Glaucoma Surgery Over the Past 5 Years in China.

To analyze the trends of glaucoma surgery procedures over the past 5 years among hospitals across major provinces in China. This was a retrospective observational study based on medical records. We obtained the annual numbers of commonly performed glaucoma incisional surgeries from 57 hospitals of 30 provincial regions in the Chinese Glaucoma Study Consortium (CGSC) from January 2015 to September 2019. The trend of glaucoma surgery was analyzed by Cochrane-Armitage trend test. Trabeculectomy, cataract extraction combined with goniosynechialysis, cataract extraction combined with trabeculectomy, and surgical peripheral iridotomy (SPI) were the top 4 surgical procedures percentages of which have the most substantial change over the course of 2015 to 2019 (all Ptrend <0.001). Numbers of trabeculectomies decreased significantly from 47.59% in 2015 to 31.21% in 2019; cataract extraction combined with goniosynechialysis increased from 12.12% to 28.48%; cataract extraction combined with trabeculectomy increased from 13.11% to 15.97%; and SPI decreased from 9.03% to 6.34%. The proportion of internal drainage surgery increased from 24.31% in 2015 to 39.29% in 2019 while external drainage surgery decreased from 69.20% to 54.64% (All Ptrend <0.001). The microinvasive glaucoma surgeries including AB-interno Canaloplasty, gonioscopy-assisted transluminal trabeculotomy, and Trabectome, increased from 0.62% to 1.40% (Ptrend<0.001). Across all study hospitals, the trends were similar, except for the Tibet Autonomous Region Eye Center, where SPI and trabeculectomy remained the most common anti-glaucoma surgeries. In the past 5 years, we observed substantial reduction in trabeculectomy, and increase in combination cataract-glaucoma procedures across major hospitals in China. The proportion of internal drainage surgery increased, while external drainage surgery decreased significantly. Detailed understanding of shifting trends in glaucoma surgeries can facilitate better health care resource allocation and training of glaucoma subspecialists in China.

Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury.

To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.

Histopathology, matrix metalloproteinase-2 and alpha smooth muscle actin expression in Tenon's capsule of eyes with congenital glaucoma.

To evaluate the ultrastructural features of collagen fibrils, matrix metalloproteinase (MMP) and alpha-smooth muscle actin (α-SMA) expression in the Tenon's capsule of buphthalmic eyes. A prospective comparative case series study was conducted on 35 buphthalmic eyes vs 25 control eyes. Children with congenital glaucoma (CG) who underwent a combined trabeculectomy-trabeculotomy procedure with mitomycin C (CTTM); the Tenon's capsule was obtained during the surgical procedure. The control group included children with strabismus, the Tenon's capsule was obtained in the course of strabismus surgery. Both H&E and Masson's trichrome staining were done. The Metalloprotenease-2 (MMP-2), alpha smooth muscle actin (α-SMA) immunohistochemical staining was performed. Mean collagen percentage area by Masson trichrome stain in Tenons capsule was significantly higher in buphthalmic eyes (54.76% ± 0.32 vs 33.71% ± 1.4; P < 0.001).The percentage area of αSMA expression in Tenons capsule was significantly higher in buphthalmic eyes (4.93% ± 0.7 vs 2.00% ± 0.5; P < 0.001). However, MMP2 expression in Tenons capsule of the buphthalmic group was significantly lower than that of the control group (12.88% ± 2.95 vs 27.91% ± 0.2 respectively) P = 0.02. Tenon capsule of buphthalmic eyes have their own histopathological features and properties making them more liable for fibrosis with high rate of failure following antiglaucoma surgeries. Such detailed information has not been published before which may aid in the identification of new antifibrotic therapies in management of glaucoma.

Epidemiological Characteristics of Inpatients Undergoing Surgery for Glaucoma at Tianjin Eye Hospital from 2013 to 2017.

Purpose To analyze the epidemiological characteristics of inpatients who underwent surgery for glaucoma at Tianjin Eye Hospital from 2013 to 2017. Methods All glaucoma inpatients who underwent surgery at Tianjin Eye Hospital from 2013 to 2017 were evaluated. The relationships of age and sex with different types of glaucoma were analyzed. The differences in the prevalence and family history of glaucoma among patients with different systemic diseases were compared. Additionally, the effects of different surgical methods for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) were compared. Results A total of 4539 patients with glaucoma were retrospectively analyzed. The most prevalent type was PACG (60.15%), followed by secondary glaucoma (SG, 25.53%), POAG (7.6%), uncontrollable intraocular pressure (IOP) after antiglaucoma surgery (4.71%), mixed glaucoma (MG, 10%), and congenital glaucoma (CG, 0.9%). The main surgical methods were phacoemulsification (phaco), phacotrabeculectomy (phaco-trab), and trabeculectomy (trab). The rate of phaco-trab increased, while that of trab decreased. The proportion of women in the PACG group was higher than those in the POAG and SG groups, and there was a pronounced tendency for family clustering (P < 0.001), while in the POAG and SG groups, the proportions of men and those with diabetes were higher (P < 0.05). Conclusions In Tianjin Eye Hospital from 2013 to 2017, the main type of glaucoma was PACG. Female sex and a family history of glaucoma were risk factors for PACG, while male sex and hyperglycemia were risk factors for POAG and SG. Among the antiglaucoma surgery methods, the proportion of phaco-trab increased, while the proportion of trab decreased.

Efficacy of the XEN gel stent on intraocular pressure lowering in glaucoma patients

Objective: To evaluate the efficacy and safety of the XEN gel implant in the treatment of glaucoma. Methods: It was a retrospective case series study. Eight patients (8 eyes) in the First Affiliated Hospital of Fujian Medical University from January 2020 to September 2020 were included, including six males and two females, aged 29 to 74 years. The patients treated with the XEN gel implanting for glaucoma. After detailed ophthalmic examination, all the patients met the surgical indications for the XEN gel implanting. Preoperative and postoperative intraocular pressure (IOP), anterior segment and fundus examination results, medication, and surgical complications were evaluated. Results: There were seven patients with primary open-angle glaucoma and one patient with glaucomatocyclitic syndrome. Five patients had received anti-glaucoma surgeries, and the remaining three patients had not received surgical treatment. All XEN gel stents were implanted successfully. All patients were followed up for 4 to 12 months. The preoperative maximum IOP ranged from 11 to 44 mmHg (median, 28 mmHg, 1 mmHg=0.133 kPa), and the IOP was 10 to 18 mmHg (median, 13 mmHg) at the last follow-up. Two to 4 types of medication were used for glaucoma preoperatively (median, 3), while 0 to 2 types (median, 0) were used at the last follow-up. During the follow-up, 7 cases were completely successful and only one case failed. Intraoperative hemorrhage occurred in two patients, and after effective treatment, the IOP decreased to below 20 mmHg. One patient was found to have an increased IOP with the XEN luminal obstruction, and the XEN drainage tube was recanalized. The IOP was about 10 mmHg at the last follow-up, and no anti-glaucoma drugs were used, but the surgery was assessed as failure by standard. The remaining patients had no other serious complications. Conclusion: This preliminary study shows that the XEN gel drainage may be a safe and effective treatment for patients with glaucoma. (Chin J Ophthalmol, 2021, 57: 679-684).

The Profile of Secondary Glaucoma in China: A Study of Over 10,000 Patients.

Few studies have investigated the epidemiology of secondary glaucoma (SG) in China. This study analyzed the current profile of admitted patients with SG at the largest ophthalmic center in China. SG cases were retrieved retrospectively by International Classification of Disease-10 clinical coding data from January 2010 to December 2019. Demographic data, etiologies, and the management of SG were analyzed. The ratios of the etiologies were compared with previously reported data from other regions. The etiologies and management between the 2010 to 2014 group and the 2015 to 2019 group were compared. A total of 11,730 cases were enrolled. The mean age of the patients with SG was 44.45±19.45 years old. Men (66.94%) were more vulnerable than women (33.06%). The etiologies of SG in 2010 to 2019 were trauma (28%), vascular disease (18%), lens-induced (9%), inflammation (11%), drug-induced (2%), anterior segment surgery (7%), posterior segment surgery (11%), syndrome-associated (4%), and tumors (1%). Compared with other regions, our data have a higher proportion of trauma and vascular disease-associated SG. Compared with 2010 to 2014, trauma-induced SG declined, and drug-induced SG, anterior segment surgery, and syndrome-associated SG increased in 2015 to 2019 (P<0.001). Vascular disease-associated SG cases were older than trauma-induced SCs and had a higher percentage in retired patients (P<0.001), whereas trauma-induced SGs were more prevalent in pediatric patients than vascular disease-related SGs (P<0.001). In addition, the application of drainage device implantation, cataract surgery, and cyclophotocoagulation increased, whereas trabeculectomy and anterior chamber paracentesis and cyclocryotherapy decreased in 2015 to 2019 (P<0.005). Although the etiology spectrum has changed during the last 10 years, trauma and vascular disease are still common causes of SG in southern China. Traditional antiglaucoma surgery decreased gradually, and more advanced treatments emerged for its treatment. Up-to-date knowledge of SGs reflects the impact of economic development and ophthalmic service improvement on SGs and is of great value for ophthalmologists to detect SGs early and manage them in a timely manner.

Гипотензивный эффект микроимпульсной лазерной циклофотокоагуляции при гемофтальме с высоким внутриглазным давлением

Purpose. To study the effectiveness of micropulse laser cyclophotocoagulation (CPC) use in the treatment of hemophthalmos with ophthalmic hypertension. Materials and methods. Examination and treatment of 11 patients (11 eyes) with fresh hemophthalmos with secondary uncompensated ophthalmic hypertension were carried out. Antiglaucoma surgery was considered inappropriate due to the high threat of serious hemorrhagic complications. To normalize intraocular pressure (IOP), patients underwent micropulse laser CPС. Results. After microimpulse CPС, all patients on the first day showed a decrease in IOP to an average of 26.6 mm Hg, after 7 days - up to 20.1 mm Hg. After 1 month, 7 patients (7 eyes), against the background of conservative treatment of hemophthalmos with a normalized IOP level (15-20 mm Hg), showed positive dynamics: the hemophthalmos was practically resorbed, an increase in visual acuity was achieved (from 0.3 to 0.8). In 4 patients (4 eyes) there was a decrease in the IOP level to 18-25 mm Hg. All patients underwent a successful vitrectomy with a high functional result, visual acuity ranged from 0.4 to 0.8. Conclusion. The use of micropulse laser CPС is pathogenetically justified and safe in patients with hemophthalmos in combination with high IOP. The use of this approach made it possible to achieve stable normalization of ophthalmotonus, increase the effectiveness of conservative therapy for hemophthalmos, and achieve restoration of visual functions in the examined patients. Key words: hemophthalmos, micropulse laser cyclophotocoagulation, intraocular pressure, ophthalmic hypertension.

Nature-derived bionanomaterials for sustained release of 5-fluorouracil to inhibit subconjunctival fibrosis

Effectively inhibiting subconjunctival fibrosis remains a challenge in pterygium and antiglaucoma surgery. As one of the superior first-line clinical drugs, 5-fluorouracil (5-FU) possesses certain disadvantages, such as fast drug metabolism and poor dose controllability. The emergence of appropriate pharmaceutical formulation and administration routes provides attractive solutions. In this work, we report the development of a multilevel drug release strategy using two types of nature-derived biomaterials (biocompatible chitosan and silk protein) processed into nanofibers of different size ranges, which was shown to achieve sustained release of 5-FU, toward the unique application of inhibiting subconjunctival fibrosis. In vitro data demonstrated that this system achieved fast 5-FU release during the first 25 days, where the release became relatively stable and lengthy (3 months) afterward. More importantly, the in vivo outcomes also suggested a continuous long-lasting inhibitory effect on subconjunctival myofibroblasts. These results indicated that our nature-derived bionanomaterials served as a promising drug-carrying platform for inhibiting subconjunctival fibrosis by providing sustained release of pharmaceutical compounds thus reducing the administration frequency, which may find broad utility in the treatment of ocular diseases and possibly other biomedical applications.

To evaluate effect of intraocular pressure control on central corneal thickness, horizontal corneal diameter and axial length in primary congenital glaucoma

To evaluate the effect of intraocular pressure (IOP) on central corneal thickness (CCT), horizontal corneal diameter (HCD), axial length (AL) in patients with primary congenital glaucoma (PCG) after antiglaucoma surgery. In this hospital based interventional study 36 patients (66 eyes) of PCG who underwent antiglaucoma surgery were included in the study. For each patient visual acuity, anterior and posterior segment examination, IOP, AL, CCT, HCD and refraction (in clear media) were recorded pre and post operatively (3 weeks, 3 months, 6 months). B scan ultrasonography was done to measure AL and to rule out posterior segment pathology. Surgery was performed by a glaucoma expert (by a single surgeon). Bilateral involvement was present in 83.33% with the most common symptom being photophobia and watering (30.56% each). The mean IOP, CCT, HCD, VCD and AL before surgery were 26.88+/-2.78 mmHg, 614.38+/-89.41 µ, 14.41+/-1.26mm, 13.19+/-1.46mm and 24.78+/-2.21mm and at 6 months were 13.85+/-1.93 mmHg, 548.56+/-63.13 µ, 14.62+/-0.49 mm, 13.34+/-1.10 mm and 25.73+/-1.36mm respectively. 59.1% of the patients had corneal clearing at 6 months. Control of IOP affects various parameters of eye like CCT, HCD and AL. Early surgery is the definitive line of management for controlling IOP in PCG patients.

Эффективность комбинированной хирургии глаукомы и катаракты с применением модифицированной антиглаукомной операции

Purpose. To evaluate the clinical and functional results of a combined intervention – simultaneous cataract phacoemulsification (femtolaser assisted in some cases) and a developed partially fistulizing anti-glaucoma surgery in patients with primary open-angle glaucoma (POAG). Material and methods. 15 patients (45 eyes) aged 65-73 years with stage I-III POAG. The frequency of complications, dynamics of visual acuity's visual functions, and ophthalmotonus were analyzed before, during, and 6 months after surgery. Results. By the end of observation, the level of normalized IOP was defined in all patients, while in 78.6% of cases without drug correction and in 21.4% with the help of antihypertensive drugs (on average, 1.1±0.5). At the day of discharge from the hospital visual acuity after a simultaneous combined operation averaged 0.53±0.05, in the long term-0.77±0.06, while stabilization of glaucoma optical neuropathy after surgery occurred in 92.9%. Conclusion. A simultaneous combined intervention, including cataract phacoemulsification with a developed partially fistulizing anti-glaucoma operation, is an effective way to increase visual acuity, normalize ophthalmotonus and stabilize glaucoma optical neuropathy as well as reduce the drug load. Key words: cataract, glaucoma, surgical treatment, phacoemulsification, anti-glaucoma surgeries.

Результаты экспериментального исследования гидрогелевого дренажа, содержащего ранибизумаб при антиглаукомных операциях

Purpose. Еxperimental substantiation of the effectiveness of biocompatible biodegradable hydrogels based on hyaluronic acid and chitosan succinate as a carrier of ranibizumab in antiglaucoma operations. Material and methods. Hydrogel drainage (HD) was obtained immediately before surgery. A solution of ranibizumab (0.23 ml) was mixed with a solution of hyaluronic acid dialdehyde (0.5 ml), then a solution of chitosan succinate (0.5 ml) was added. Experimental studies were performed in 12 (12 eyes) healthy rabbits. The first group consisted of 6 eyes – 0.187 ml of ranibizumab per 1 ml of gel. In the control group, HD was used intraoperatively without the addition of ranibizumab (6 eyes). Morphological studies were performed on 7th, 21st, and 42nd days. Results. In experimental studies in vitro and in vivo, it was proved that ranibizumab, administered as a part of 0.1 ml of hydrogel drainage in the antiglaucoma surgery area is released within 3 weeks and suppresses vascularization, scarring of the operating area, and preserves the intrascleral cavity. The optimal concentration of ranibizumab was selected-0.02 ml in 0.1 ml of gel. Conclusion. The safety and effectiveness of the use of hydrogel drainage with ranibizumab based on hyaluronic acid dialdehyde and chitosan succinate in anti-glaucoma operations has been proven. Key words: experimental research, hydrogel drainage, ranibizumab, glaucoma surgery.

Проникающие и непроникающие антиглаукомные операции в комбинированной хирургии глаукомы и катаракты (обзор литературы)

The combination of diseases such as cataract and glaucoma is a very common phenomenon in the practice of an ophthalmologist. The analysis of various surgical approaches to the treatment of this combined pathology indicates the feasibility of a wider and more active use of combined surgery. The anti-glaucoma component in a one-time intervention can be represented by both fistulizing operations (mainly trabeculectomy) and non-penetrating (most often non-GSE). Those and others have their undeniable advantages and disadvantages in the form of a higher hypotensive effect of penetrating interventions and a low number of complications after non-perforating operations. A limitation for the widespread use of implantation of drainage devices and minimally invasive procedures in the Russian Federation is a number of inaccessibility and high cost of some of them. The search for the most optimal anti-glaucoma component, which has the advantage of both non-penetrating and fistulizing operations to improve the hypotensive and visual results of simultaneous surgical treatment of glaucoma and cataracts, remains relevant today. Key words: glaucoma, cataract, combined surgery, anti-glaucoma surgery, antihypertensive effect, complications.

Клинический случай консервативного лечения отслойки сосудистой оболочки, развившейся в отдаленные сроки после факоэмульсификации возрастной катаракты

A clinical case of successful conservative treatment of choroidal detachment (CD), which developed in the long term after phacoemulsification of age-related cataract (PEC), is presented. The patient underwent PEC of the left eye 3 months ago with implantation of a posterior chamber intraocular lens, while an antiglaucoma operation was performed a year earlier. The patient was canceled the hypotensive regimen and conservative treatment was prescribed – instillation of Midrimax drops (Phenylephrine 5.0% + Tropicamide 0.8%) 2 times a day, Dexamethasone 0.1% – 4 times a day, subconjunctival injections of 2 mg Dexamethasone and 0.1 ml of 0.1% solution of Atropine sulfate. The prescribed conservative treatment made it possible to arrest the CD in the pseudophakic eye, which arose in the late postoperative period, and made it possible to avoid the need for posterior sclerectomy. Key words: choroid detachment, phacoemulsification of age-related cataract, conservative treatment.

Corneal transplant survival rate in glaucoma patients with multiple previous antiglaucoma surgeries.

Glaucoma can cause corneal decompensation and accelerate the failure of the graft. Previous antiglaucoma operations are one of the most important risk factors for endothelial failure. In this retrospective study, 40 eyes of 40 glaucoma patients with advanced corneal decompensation after glaucoma surgery were treated with keratoplasty and outcomes were assessed for 24months. 16, 9 and 15 eyes underwent Descemet Membrane Endothelial Keratoplasty (DMEK), Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and penetrating keratoplasty (pKPL), respectively. Visual acuity improved at least 2 lines in 24 of 40 eyes after the three types of keratoplasty. All 40 eyes remained pain free for the follow-up period. The mean intraocular pressure (IOP) difference was not significantly different (p > 0.05) from the preoperative values 12 and 24months after keratoplasty. The endothelial cell density of the donor cornea decreased from 2485.6 ± 165.18 to 1291.4 ± 467.1 and 1180.4 ± 397.2/mm2 (p < 0.001) after 12 and 24months, respectively. Nine eyes (22.5%) had therapy-resistant corneal decompensation in the context of a transplant failure and were treated with a re-keratoplasty (2 re-pKPLs, 3 re-DSAEKs and 3 re-DMEKs). Eyes with previous glaucoma surgery show satisfying results after keratoplasty, mainly DMEK and pKPL.

Динамика внутриглазного давления и толщины роговицы у больных открытоугольной глаукомой в ближайшие сроки после факоэмульсификации катаракты

A study of IOP and ССТ in patients with open-angle glaucoma in the dynamics after cataract phacoemulsification, the timing of normalization of these indicators was performed. An increase of IOP was noted in 50.0 % of patients, which required increased hypotensive therapy, in 18 % of patients antiglaucoma surgery was performed against persistent decompensation of pressure. Key words: open-angle glaucoma; cataract phacoemulsification; reactive ophthalmic hypertension.

Feasibility of microscope-integrated swept-source optical coherence tomography in canaloplasty.

BackgroundSeveral researchers have used commercial microscope-integrated optical coherence tomography (OCT) systems in glaucoma surgery, including ab interno trabeculectomy and canaloplasty. However, the 840 nm wavelength light source of the OCT systems is not ideal for imaging the anterior chamber angle structures because of its limited penetration. We evaluated the potential value of a microscope-integrated swept-source OCT system with a 1,310 nm center-wavelength light in canaloplasty for glaucoma.MethodsSixteen porcine eyes were used to simulate canaloplasty. The critical surgical steps were monitored using a prototype microscope-integrated OCT system with a 1,310 nm light source and a high axial scan rate of 100 kHz. The images from swept-source OCT and three-dimensional images from the microscope were projected simultaneously onto a liquid crystal display three-dimensional monitor (LMD-4251TD, Sony, Japan). The changes in the collector vessel (aqueous drainage structure in the porcine eye, similar to Schlemm’s canal in humans) were measured using Image J software. Histological sections stained with hematoxylin and eosin were used to assess surgical efficacy.ResultsHigh-resolution real-time images of the anterior segment were acquired during canaloplasty using the microscope-integrated OCT system. With the real-time OCT images, the position of the collector vessel was identified and the scleral flap could be created at the ideal location. The expansion of the collector vessel after viscoelastic injection was also visualized in real time. Compared with baseline, there was a significant increase in the cross-sectional area (from 14,502.98±9,242.55 to 59,499.04±20,506.41 µm2, P<0.001) of the collector vessel.ConclusionsUsing the microscope-integrated OCT system, real-time images of the anterior segment were successfully acquired during the operation. The microscope-integrated OCT system might be useful in future anti-glaucoma surgery.

Evaluation of glaucoma cases with gonioscopy and optical coherence tomography

Glaucoma is the second leading cause of blindness in the adult population of India. Diagnosis and management depends on categorization of Glaucoma into open or closed angle. : To compare the accuracy of Gonioscopy and Anterior Segment Optical Coherence Tomography (ASOCT) in studying the structures of anterior chamber angle of the eye and find out the agreement between them in detecting angle closure. Cross -sectional observational study. The present study is a hospital based cross-sectional study of patients between 20 to 80 years of age with Glaucoma attending the outdoor patient department in a tertiary care government hospital (New civil hospital), Surat. Patients having Corneal Opacity, and anti-Glaucoma surgeries done were excluded. All diagnosed cases of Glaucoma were evaluated by Gonioscopy in the dark with a Goldman 3 mirror lens Gonioscope at high (16x) magnification for static assessment (without indentation). A narrow slit beam, 2mm* 1mm, was cast during Gonioscopy, avoiding direct illumination over the pupil. The angle in each quadrant was graded with the Shaffer grading system. Anterior Segment OCT was done by TOPCON 3D OCT-1 MAESTRO machine. Imaging was performed in dark room conditions. Patients were imaged gazing straight ahead. Imaging of a single meridional section of the Anterior Chamber Angle at superior, inferior, temporal and nasal quadrants were performed. Grading of Anterior Chamber Angles on AS-OCT is termed as Closed if there is no visualization of Scleral Spur and/or any degree of irido-trabecular contact. kappa value, sensitivity &amp; specificity, positive &amp; negative likelihood ratio. Total 50 Glaucoma patients were examined by Gonioscopy and AS OCT. Total number of Angles examined were 400. Total number of Angles closed on Gonioscopy were 136 (34%). Total number of Angles closed on AS OCT were 190 (47.5%). Agreement between Gonioscopy and AS OCT in detecting angle closure in all 4 quadrants was ‘Moderate to Good’ by Kappa Value.