Included Intraocular Pressure Research Articles

Comparison of the Outcome of Silicone Ahmed Glaucoma Valve Implantation with a Surface Area between 96 and 184 mm2in Adult Eyes

PurposeTo compare the success rates, complications, and visual outcomes between silicone Ahmed glaucoma valve (AGV) implantation with 96 mm2 (FP8) or 184 mm2 (FP7) surface areas.MethodsThis study is a retrospective review of the records from 132 adult patients (134 eyes) that underwent silicone AGV implant surgery. Among them, the outcomes of 24 eyes from 24 patients with refractory glaucoma who underwent FP8 AGV implantation were compared with 76 eyes from 76 patients who underwent FP7 AGV implantation. Preoperative and postoperative data, including intraocular pressure (IOP), visual acuity, number of medications, and complications were compared between the 2 groups.ResultsThere were no significant differences in baseline characteristics between the 2 groups (p > 0.05). The postoperative visual acuity of the patients in the FP8 group was better than that of the patients in the FP7 group in some early postoperative periods (p < 0.05); however, after 10 postoperative months, visual acuity was not significantly different through the 3-year follow-up period (p > 0.05). Postoperative IOP was not significantly different between the 2 groups (p > 0.05) except for IOP on postoperative day 1 (11.42 mmHg for the FP7 group and 7.42 mmHg for the FP8 group; p = 0.031). There was no statistical difference in success rates, final IOP, number of medications, or complication rates between the 2 groups (p > 0.05).ConclusionsThe FP7 and FP8 AGV implants showed no difference in terms of vision preservation, IOP reduction, and number of glaucoma medications required.

QUANTITATIVE ANALYSIS OF RHEGMATOGENOUS RETINAL DETACHMENT ASSOCIATED WITH CHOROIDAL DETACHMENT IN CHINESE USING UBM

To investigate the characteristics of rhegmatogenous retinal detachment associated with choroidal detachment (RRDCD) in a Chinese population by using ultrasound biomicroscope (UBM). A random prospective study was used to assess 1,389 patients (1,408 eyes) with rhegmatogenous retinal detachment. Comprehensive standardized ophthalmic examinations included intraocular pressure (IOP) by Goldmann applanation tonometer and the entire ocular fundus by Goldmann three-mirror lens, B-type ultrasound, and UBM. A total of 1,389 patients with rhegmatogenous retinal detachment participated in the study, including 906 men and 483 women. Two hundred and sixty-three eyes (18.79%) had RRDCD and the age of patients ranged from 9 to 82 years (median, 50.8 ± 17.7 years). Patients with high myopia (-6.00 diopters or more) represented 31.94% and more frequently experienced low intraocular pressure and multiple retinal breaks. In 263 RRDCD eyes, the results of UBM showed that ranges of choroidal detachment (CD) were <1 quadrant in 9 (3.42%) eyes, from 1 to 2 quadrants in 37 (14.07%) eyes, from 2 to 3 quadrants in 13 (4.94%) eyes, and from 3 to 4 quadrants in 204 (77.57%) eyes. ultrasound biomicroscope also showed that the angular ranges of CD were between 3.31° and 45.65° (mean, 15.98 ± 9.29°). In addition, UBM showed the mean values of CD angle for the superior (15.42 ± 9.40°), nasal (14.08 ± 8.66°), inferior (15.03 ± 9.05°), and temporal (15.96 ± 9.22°) sides. No statistically significant differences were found among any of these comparisons (F value = 2.011, P > 0.05). Retinal detachment associated with CD occurs more frequently in older people or in patients with high myopia, who usually present with low intraocular pressure and multiple retinal breaks. UBM examination can reduce false-negative rate of RRDCD, determine CD degree quantitatively, and guide classification and treatment. UBM combined with B ultrasound testing can provide a precise diagnosis of rhegmatogenous retinal detachment degree and may have important clinical significance for preoperative diagnosis of anterior proliferative vitreoretinopathy and determining operative strategy and postoperative prognosis.

Retinal Vessel Caliber Is Associated with the 10-year Incidence of Glaucoma: The Blue Mountains Eye Study

To examine associations between quantitatively measured retinal vessel caliber and the 10-year incidence of primary open-angle glaucoma (OAG).Population-based cohort study.The Blue Mountains Eye Study examined 3654 persons at baseline and 2461 persons at either 5 years, 10 years, or both times. After excluding 44 subjects with OAG at baseline, 2417 participants at risk of OAG at the 5- or 10-year examinations were included.Retinal vessel calibers of baseline retinal photographs were measured using a computer-based program and summarized as central retinal artery and vein equivalents (CRAE, CRVE). Incident OAG was defined as the development of typical glaucomatous visual field loss combined with matching optic disc rim thinning and an enlarged cup-to-disc (C:D) ratio of >0.7 or C:D asymmetry between the 2 eyes (≥0.3) at either the 5- or 10-year examination. Generalized estimating equation models were used to account for correlation between eyes while adjusting for glaucoma risk characteristics including intraocular pressure (IOP) or ocular perfusion pressure (OPP).We assessed the 10-year incidence of OAG.There were 82 persons (104 eyes) who developed incident OAG over the 10-year follow-up. After adjusting for age, sex, family history of glaucoma, smoking, diabetes, hypertension, hypercholesterolemia, body mass index, spherical equivalent refraction, and C:D ratio, narrower CRAE was associated with higher risk of incident OAG (adjusted odds ratio [OR], 1.77; 95% confidence interval [CI], 1.12-2.79, per standard deviation decrease in CRAE). This association persisted after further adjustment for IOP (adjusted OR, 1.87; 95% CI, 1.14-3.05) or OPP (adjusted OR, 1.76; 95% CI, 1.11-2.78), and remained significant when analyses were confined to eyes with IOP<20 mmHg and C:D ratio<0.6 at baseline. There were no independent associations between CRVE and incident OAG.Retinal arteriolar narrowing, quantitatively measured from retinal photographs, was associated with long-term risk of OAG. These data support the concept that early vascular changes are involved in the pathogenesis of OAG and suggest that computer-based measurements of retinal vessel caliber may be useful to identify people with an increased risk of developing the clinical stage of glaucoma.The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Sutureless tunnel trabeculectomy without peripheral iridectomy: a new modification of the conventional trabeculectomy

The purpose of this study was to describe the results of a new modification of the trabeculectomy technique, sutureless tunnel trabeculectomy without peripheral iridectomy (PI), in a group of patients with chronic open-angle glaucoma (COAG). Patients with uncontrolled COAG who were candidates for trabeculectomy underwent sutureless tunnel trabeculectomy without PI. Patients were examined before surgery and at 1, 3, 6 and 12 months after surgery. Pre- and post-operative data including intraocular pressure (IOP), visual acuity, number of anti-glaucoma medications and intraoperative and post-operative complications were recorded. Surgical success was defined as final IOP < 21 mmHg and > 20 % reduction from baseline (criterion A) and as final IOP < 18 mmHg and > 25 % reduction from baseline (criterion B), without further glaucoma surgery or complications that required returning the patient to the operating room. Success was further classified as complete when these criteria were obtained without medications and qualified with or without medical therapy. Eighteen eyes of 18 patients were recruited into the study. All patients had 6 months of follow-up and 15 patients (83.3 %) completed 12 months of follow-up. Mean (SD) age of the patients was 57.2 (5.7) years. Mean (SD) IOP decreased from 23.7 (4.5) mmHg pre-operatively to 14.7 (3.4) mmHg at final follow-up visit (p < 0.001), and the mean (SD) number of glaucoma medications decreased from 2.89 (0.32) pre-operatively to 1 (0.84) at last visit (p < 0.001). Post-operatively, IOP and number of glaucoma medications were decreased in comparison with baseline at all follow-up visits (p < 0.001 for all visits). Qualified and complete surgical success rates were 78 and 50 % for criterion A, and 72 and 50 % for criterion B. Sutureless tunnel trabeculectomy without PI effectively reduced IOP and number of medications in COAG patients during 6-12 months of follow-up. Further controlled studies are needed to better characterize the safety and efficacy of this technique.

The efficacy of Ahmed glaucoma valve implantation in the management of early stage of glaucoma secondary to blunt ocular trauma

To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in the early stage of glaucoma secondary to contusion injuries. A retrospective case series study. The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 months after the trauma. The duration from injury to IOP elevation was 1 to 30 (6.10 ± 1.13) days. The time from injury to AGV implantation was 16 to 60 (40.03 ± 2.97) days. The patients were followed-up for a period of 6 to 42 (20.75 ± 1.66) months. The main outcome measures included intraocular pressure (IOP), visual acuity (VA), number of glaucomatous medications, intra- and postoperative complications. IOPs were analyzed by repeated measures analysis of variance, numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test, and VA comparison was performed using paired Student t-test. The absolute success rate was 86.21% and the conditional success rate was 13.79% after AGV implantation. Compared with pre-operation, the IOP was significantly(F = 124.09, P < 0.05) lowered at the last following-up of post-operation(42.59 ± 1.82)vs (15.12 ± 0.56) mm Hg(1 mm Hg = 0.133 kPa), the numbers of glaucomatous medications were significantly (H = 131.73, P < 0.05) reduced post-operatively (3.93 ± 0.15) vs (0.21 ± 0.12) species, and the VA was significantly (t = -3.466, P < 0.05) improved post-operatively (logMAR 0.40 vs logMAR 0.70). Two cases with shallow anterior chamber and three cases with hyphema were observed in the early stage after the surgery. No persistent hypotony, tube exposure or other serious complications were noted. AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

Long-term changes in endothelial cell counts after early phacoemulsification versus laser peripheral iridotomy using sequential argon:YAG laser technique in acute primary angle closure

To compare the change in endothelial cell counts (ECC) after early phacoemulsification and laser peripheral iridotomy (LPI) using sequential argon:yttrium-aluminum-garnet (YAG) laser technique for the treatment of acute primary angle closure (APAC). This was a retrospective chart review, case-control study; 86 APAC patients were enrolled. Sixteen patients who underwent early phacoemulsification with intraocular lens implantation and 32 patients who underwent LPI were matched by propensity score analysis. All subjects underwent a complete ophthalmic examination, including intraocular pressure (IOP) measurements, optic disc examinations, and gonioscopy. ECC were acquired at the center of the cornea with a noncontact specular microscope before treatment, and at 1, 6, 12, and 24months following phacoemulsification or LPI. The mean follow-up was 26.1 ± 4.7months in the phacoemulsification group and 26.3 ± 4.5months in the LPI group. After intervention, the changes in anterior chamber depth and Shaffer grading by gonioscopy were significantly different between groups. ECC were not different before treatment; however, after phacoemulsification or LPI at 12months (2280 ± 320 vs 1993 ± 380cells/mm(2)) and 24months (2113 ± 333 vs 1880 ± 422cells/mm(2)), there was a significant difference between the two groups (P = 0.040 and P = 0.032 respectively). Regression analysis showed that anterior chamber depth at baseline (P = 0.041) and intervention modality (phacoemulsification vs LPI; P < 0.001) were significantly related to the change in ECC. Early phacoemulsification showed lower endothelial cell loss than did LPI in the treatment of APAC after a 2-year follow-up. In terms of ECC, early phacoemulsification could be a better intervention modality for APAC.

Ab interno trabeculectomy: Outcomes in exfoliation versus primary open-angle glaucoma

To compare outcomes in exfoliation glaucoma versus primary open-angle glaucoma (POAG) after ab interno trabeculectomy alone (Trabectome) or in combination with cataract surgery and intraocular lens (IOL) implantation. Trabectome Study Group institutions. Prospective nonrandomized cohort study. Outcomes included intraocular pressure (IOP), glaucoma medications, complications, secondary procedures, and success, defined as no secondary surgery and IOP less than 21 mm Hg and a greater than 20% reduction from baseline. In the ab interno trabeculectomy-alone group, the mean preoperative IOP was 29.0 mm Hg ± 7.5 (SD) in exfoliation glaucoma cases and 25.5 ± 7.9 mm Hg in POAG cases (P<.01). At 1 year, the mean decrease in IOP was -12.3 ± 8.0 mm Hg and -7.5 ± 7.4 mm Hg, respectively (P<.01); the secondary procedure rate was 20.9% and 34.9%, respectively (P=.02); and the cumulative probability of success was 79.1% and 62.9%, respectively (P=.004). In the combined ab interno trabeculectomy-IOL group, the mean preoperative IOP was 21.7 ± 8.4 in exfoliation glaucoma cases and 19.9 ± 5.4 mm Hg in POAG cases (P=.06). At 1 year, the mean decrease in IOP was -7.2 ± 7.7 and -4.1 ± 4.6, respectively (P<.01); the secondary procedure rate was 6.7% and 6.1%, respectively (P=.88); and the cumulative probability of success was 86.7% and 91.0% (P=.73), respectively. Ab interno trabeculectomy using this new incisional procedure safely lowered IOP to the mid teens, with an overall greater reduction in exfoliation glaucoma and improved success when combined with cataract surgery.

Effect of dacryocystorhinostomy on systemic adverse effects of topical timolol maleate

Purpose:To evaluate whether transformation of the naso-lacrimal passage as happens after dacryocystorhinostomy (DCR) operation has any effect on the systemic adverse effects of topically administered timolol maleate.Materials and Methods:Fifty otherwise healthy adult patients without any prior history of cardiac or pulmonary problems scheduled for elective DCR surgery received a drop of timolol maleate 0.5% on the healthy eye. This eye served as a control. Six weeks after successful DCR surgery, the operated eye received the same medication. Parameters compared included intraocular pressure (IOP), pulse rate, blood pressure and forced expiratory volume in the first second (FEV1) findings.Observations:Post DCR patients showed an increased incidence of reduced pulse rate and FEV1.Conclusion:Timolol maleate ophthalmic preparation should be used with caution in post-DCR patients.

Prevalence of Primary Open Angle Glaucoma in a Rural Adult Chinese Population: The Handan Eye Study

To estimate the prevalence and associations of primary open angle glaucoma (POAG) in a rural population of northern China. In a rural county in Handan, China, 6716 adults residing in 13 villages were randomly selected and participated in the study. All participants completed a comprehensive eye examination, including intraocular pressure (IOP), slit-lamp examination, and fundus evaluation. Visual fields were obtained with on glaucoma suspects. Sixty-five persons (1.2%) had POAG, with an adjusted prevalence of 1.0% (95% confidence interval [CI], 0.7% -1.3%) in those aged 40 years and older. Sex was not significantly associated with POAG (P > 0.05). Age (odds ratio [OR], 1.9; 95% CI, 1.4-2.5, for each 10-year increase), IOP (OR, 1.5; 95% CI 1.2-2.0 for each 5-mm Hg increase), axial length (OR, 1.3; 95% CI, 1.1-1.6), and moderate myopia (3.1-6.0 D; OR, 4.7; 95% CI, 1.6-13.5) increased the risk for POAG in multivariate analysis. The mean IOP of persons with POAG was 16.3 ± 3.5 mm Hg, and 90% of them presented with an IOP ≤ 21 mm Hg. Of those with POAG, 4.5% were blind from glaucoma in at least one eye. Approximately 1% of adults aged 40 years and older living in rural China have POAG. As seen in other populations, increasing age, higher IOP, greater axial length, and having myopia were associated with POAG. Given the rapid aging and myopic shift (acquired myopia) in China's population, POAG is likely to increase in prevalence in the coming decades.

Heidelberg Retina Tomograph (HRT3) in Population-based Epidemiology: Normative Values and Criteria for Glaucomatous Optic Neuropathy

Purpose: To establish normative values for Heidelberg Retina Tomograph (HRT3) variables and to develop HRT3-based criteria for glaucomatous optic neuropathy for epidemiological research in a white population.Methods: Consecutive participants in the Rotterdam Study were examined with HRT and simultaneous stereoscopic fundus photography (ImageNet) in addition to other ophthalmic examinations including intraocular pressure (IOP) measurements and perimetry. Normative values for all HRT3 variables were determined in participants who met all the following criteria: no glaucomatous visual field loss (GVFL), an IOP of 21mmHg or less, no IOP lowering treatment, and a negative family history of glaucoma. Sensitivity was determined in participants with glaucomatous visual field loss at a fixed high specificity of 97.5% − a value commonly used in population-based epidemiology.Results: A total of 2516 participants were included in this study of whom 66 had glaucomatous visual field loss in at least one eye and 1680 fulfilled the criteria for contributing to the normative values. The HRT3 linear cup-disc ratio (LCDR) variable, adjusted for disc area, showed the highest sensitivity, 35%, at the required specificity of 97.5%. The 97.5th percentile of the LCDR was 0.67 for small discs (up to 1.5mm2), 0.73 for medium-sized discs and 0.79 for large discs (above 2.0mm2). The HRT3 Glaucoma Probability Score and previously published linear discriminant functions showed a lower sensitivity than LCDR at this specificity.Conclusions: At the high specificity of 97.5% as is commonly used in population-based epidemiology, the sensitivity of the HRT3 is low − albeit not lower than that of the vertical cup-disc ratio as assessed with simultaneous stereoscopic fundus photography and analyzed with the ImageNet software. The LCDR variable, stratified for disc area, seems to be the most suitable variable to develop criteria for glaucomatous optic neuropathy for epidemiological purposes.

Macular and peripapillary retinal nerve fibre layer thickness in adults with amblyopia

Objective To evaluate macular and peripapillary retinal nerve fiber layer (RNFL) thickness in amblyopic eyes compared to the fellow eye. Design Cross-sectional study. Participants 30 patients (60 eyes) older than 18 years of age with amblyopia. Methods Inclusion criteria included individuals older than 18 years, amblyopia, and best-corrected visual acuity (BCVA) ≤20/40. A complete medical history was taken and an eye examination carried out. Optical coherence tomography (OCT) was carried out on both eyes of all patients. Exclusion criteria included intraocular pressure (IOP) >23 mm Hg and eye pathology that may affect OCT measurements. The primary outcome measures were foveal thickness and average peripapillary RNFL thickness, which were compared using a paired t test. Quadrants in peripapillary scans and concentric rings in macular scans were analyzed. Results The average age was 56 years (range = 33–82 years). Visual acuity ranged from 20/40 to 20/4000 (mean = 20/275). The average peripapillary RNFL thickness was 90.6 μm (SD = 9.6 μm) in the amblyopic eye and 90.1 μm (SD = 12.1 μm) in the fellow eye ( p = 0.64). The average macular thickness in amblyopic eyes was 260.1 μm (SD = 32.0 μm), and 254.7 μm (SD = 32.5 μm) in fellow eyes ( p = 0.10). No statistical difference existed between peripapillary quadrants or macular concentric rings. These differences were smaller when the strabismic amblyopes were isolated. Conclusions There does not seem to be a difference in peripapillary RNFL or macular thickness between the amblyopic eye and fellow eye.

Combined Viscocanalostomy-Trabeculectomy for management of Advanced Glaucoma - A Comparative Study of the Contralateral Eye: A Pilot Study.

Purpose:To compare combined viscocanalostomy-trabeculectomy (VISCO-TRAB) to trabeculectomy (TRAB) for the management of advanced glaucoma.Materials and Methods:The study cohort comprised of 18 subjects with bilateral advanced glaucoma who underwent VISCO-TRAB surgery (VISCO-TRAB group) in the right eye and TRAB (TRAB group) in the left eye. VISCO-TRAB constituted lamellar scleral flap, deep scleral flap dissection with deroofing of Schlemm's canal (SC), viscodilation of SC, penetrating trabeculectomy, peripheral iridectomy, and tight flap closure. All eyes received subconjunctival mitomycin. Success criteria included intraocular pressure (IOP) < 14 mmHg or > 30% lowering of IOP with no devastating complications. A P value less than 0.05 was considered statistically significant.Results:Mean IOP was significantly lower after VISCO-TRAB compared to TRAB at 1 week and 3 months postoperatively (P<0.05). No eyes lost more than two lines of Snellen acuity. There were more hypotony-related complications after TRAB than VISCO-TRAB surgery. Target IOP was achieved in 83.3% in the VISCO-TRAB group compared to 55.6% in the TRAB group.Conclusion:Combined VISCO-TRAB is effective in reducing IOP to the target level for advanced glaucoma with lower postoperative complications.

An illuminated microcatheter for 360-degree trabeculectomy in congenital glaucoma: A retrospective case series

To evaluate the efficacy of achieving a 360° ab externo trabeculotomy [corrected] using an illuminated ophthalmic microcatheter for the treatment of primary congenital glaucoma. This retrospective, consecutive case series included 16 eyes of 10 patients ≤ 3 years of age at the time of surgery and diagnosed with primary congenital glaucoma. All patients underwent a trabeculotomy [corrected] via microcatheter with the intent of catheterizing the full circumference of Schlemm's canal and rupturing the entire canal in a single procedure. The main outcome measure was the success rate of achieving a complete 360° as compared to a partial trabeculotomy. [corrected] Secondary outcome measures included intraocular pressure (IOP), glaucoma medication usage, and adverse events. Clinical examination data are reported up to 12 months postoperatively. Of 16 eyes included, 12 (75%) achieved a complete 360° trabeculotomy [corrected] using the microcatheter; 4 of 16 eyes (25%) achieved a partial trabeculotomy. [corrected] For all treated eyes the postoperative reduction in IOP from baseline was statistically significant at the 1-, 3-, and 6-month follow-up visits (p < 0.001). At 6 months, IOP was significantly lower in the complete as compared to the partial trabeculotomy [corrected] cohort (p = 0.03). A complete or partial trabeculotomy [corrected] was safely completed in eyes with primary congenital glaucoma using a microcatheter with an illuminated, atraumatic tip.

Efficacy and tolerance of systemic ganciclovir as a treatment for cytomegalovirus‐associated anterior uveitis in inmunocompetent patients

Abstract Purpose To assess the utility of systemic, intravitreal or topical ganciclovir, as a treatment for PCR‐proven cytomegalovirus (CMV)‐associated anterior uveitis. Methods Retrospective interventional case series of 39 consecutive patients treated in a single centre between 2002 and 2009. Main outcome measures included intraocular pressure (IOP) and anterior chamber inflammation. Results All 35 patients with at least a 12‐month follow‐up responded to the first treatment regimen. Mean IOP dropped from 32 (SD 7) to 18 (SD 2) mmHg after 1 week and remained within normal values throughout the treatment course, with progressive lowering of antihypertensive therapy. Relapses occurred in 50% of cases within one year. Mean time to relapse was 5.7 months (range: 0.5‐12). Long‐term antivirals were needed in 15% of cases whereas intolerance occurred in 15% of cases. Intravitreal ganciclovir may be proposed in patients with systemic intolerance but multiple injections are required. Long‐term topical ganciclovir was able to control the disease in selected cases. Conclusion Systemic Ganciclovir is effective in controlling CMV‐induced chronic ocular hypertension and anterior chamber inflammation, but even prolonged treatment does not protect from relapses. Repeated short‐course regimens seem to be an appropriate strategy.

Ophthalmic Examination Findings in A Captive Colony of Western Gray Kangaroos (Macropus fuliginosus)

Complete ophthalmic examination of a mob of western gray kangaroos (Macropus fuliginosus) was performed under chemical restraint. Examination included intraocular pressure (IOP) measurement by rebound and applanation tonometry, fluorescein staining, corneal diameter measurement, slit-lamp biomicroscopy and indirect funduscopy. The corneal diameters had a mean of 19.52 mm, SD 2.16 mm, 95% confidence interval (CI) 18.71-20.32 mm. Ocular abnormalities were noted in 4/8 (50%) of examined kangaroos. Intraocular pressure as estimated by rebound tonometry was 9.00 mm Hg with a 25-75% quartile range of 6.5-10.75 mm Hg and a minimum-maximum range of 5.00-23.00 mm Hg. Intraocular pressure as estimated by applanation tonometry was 11.50 mm Hg with a 25-75% quartile range of 10.00-17.00 mm Hg and a minimum-maximum range of 9.00-20.00 mm Hg. This is the first report of ocular examination findings in a mob of captive western gray kangaroos and provides ranges and values for tonometry and corneal diameter.

Testing toxicity of multiple intravitreal injections of bevacizumab in rabbit eyes

Objective: To evaluate the potential toxicity of repeated intravitreal injections of bevacizumab in rabbit eyes. Design: Randomized, placebo-controlled experimental animal study. Participants: Fourteen chinchilla rabbits; 12 assigned to the experimental group and 2 assigned to the normal control group. Methods: Three sequential, biweekly, intravitreal injections of bevacizumab in doses of 2.5 mg/0.1 mL or 5.0 mg/0.2 mL were performed on each rabbit. Evaluations included intraocular pressure (IOP), aqueous flare, B-scan ultrasound, fundus photography, ultrasound biomicroscopy, electroretinography (ERG), and visually evoked potentials (VEPs) performed at baseline and during the follow-up period. The eyes were enucleated at 1 week and 4 weeks after the last intravitreal injection, and underwent light and electron microscopic evaluations, as well as testing for apoptotic activity. Results: After intravitreal injections, no changes were found by regular clinical observation and IOP tests. There was no significant difference in the anterior chamber inflammatory activity evaluated by the laserflare meter. No evidence of retinal toxicity was seen after intravitreal bevacizumab at doses of 2.5 and 5.0 mg by either ERG or flash VEPs. Electron microscopy did show the presence of inflammatory cells and some ultrastructural changes in the photo-receptor cells in the 5.0 mg experimental group 1 week after the third injection. Mild to moderate apoptosis of photoreceptors was detected in the 5.0 mg group at the same time. Conclusions: The biweekly, multiple intravitreal injections of bevacizumab did not result in evidence of toxicity in regular clinical and functional observations at both 2.5 mg and 5.0 mg doses. The 5.0 mg dose may induce transient inflammation, ultrastructural abnormalities, and apoptosis.

Ocular hypotony after the use of indocyanine green for epiretinal membrane surgery

Purpose: To report the occurrence of transient ocular hypotony after indocyanine green (ICG)-assisted macular surgery for removal of the epiretinal membrane (ERM).Materials and methods: This was a retrospective review of 122 eyes of 118 patients who underwent vitrectomy for idiopathic ERM. The ICG staining technique was used in 71 eyes without fluid–air exchange (FAX) and in 15 eyes with FAX. Detailed eye examinations, including intraocular pressure (IOP) measurement, were performed before and after surgery.Results: We observed postoperative transient ocular hypotony with choroidal detachment in 8 of 71 eyes (11%) in the ICG (+)/FAX (−) group, and no ocular hypotony was seen in the ICG (+)/FAX (+) group (15 eyes) or in the ICG (−) group (36 eyes). The median best corrected visual acuity (BCVA) in the ICG(−)group was only significantly better than in the ICG (+)/FAX (−) with hypotony at 1 week after surgery (p = 0.046). However, there was no statistically significant difference in BCVA at 3 and 6 months after surgery among the groups (p > 0.05).Conclusion: ICG staining of the internal limiting membrane (ILM) supports complete ERM removal because of enhanced visualization of the border between the ILM and the ERM. However, it should be cautioned that postoperative ocular hypotony may occur in some cases of ICG-assisted macular surgery. Therefore, informed consent with careful follow-up is required when ICG-assisted surgery is performed.

Bevacizumab as adjuvant for neovascular glaucoma

We aimed to evaluate the longterm effects of intraocular bevacizumab (Avastin) injections as adjuvant treatment in patients with neovascular glaucoma. Twenty eyes of 18 consecutive patients with secondary neovascular glaucoma caused by proliferative diabetic retinopathy (n = 7), ischaemic central retinal vein occlusion (n = 7), ischaemic ophthalmopathy (n = 2) and retinal ischaemia resulting from persistent detachment (n = 2) were treated with intraocular bevacizumab injections (1.25 mg/0.05 ml) in addition to other treatments. The main outcome measure was the change in degree of iris rubeosis. Secondary outcomes included intraocular pressure (IOP), best corrected visual acuity (BCVA) and numbers of additional interventions or antiglaucoma medications administered after injection. Mean (+/- standard deviation) follow-up was 67.7 +/- 13.8 weeks (range 50-93 weeks). At the last follow-up, complete regression of rubeosis was detectable in five (20%) eyes, incomplete regression in seven (35%), stabilization in six (30%), and an increase in two (10%) eyes. Mean IOP was 26.0 +/- 8.9 mmHg at baseline and significantly decreased to 14.75 +/- 5.3 mmHg at the last follow-up visit (p = 0.000005). Mean baseline BCVA (logMAR [logarithm of the minimum angle of resolution] 1.43 +/- 0.89) was stabilized during the follow-up period (logMAR 1.5 +/- 0.98). Patients received an average of 2.75 injections. Additional treatments were laser photocoagulation in 13 (65%) eyes, cyclodestructive procedure in 14 (70%), cryopexy in six (30%), drainage procedures in two (10%), and vitrectomy in five (25%) eyes. Bevacizumab may be beneficial as adjuvant treatment in neovascular glaucoma because of its anti-angiogenic properties and its ability to prevent establishment or progression of angular obstruction. The causative disease inducing the angiogenic process requires treatment in all cases. Antiglaucoma treatment is needed in cases of persistent elevated IOP.

Intravitreal bevacizumab for neovascular glaucoma.

To report 6-month and 1 year outcomes of eyes treated for neovascular glaucoma (NVG) with intravitreal bevacizumab injection and panretinal laser (PRP) compared to those receiving PRP alone. retrospective, consecutive case series. Charts of patients with NVG from retinal ischemia and at least 6 months of follow-up were reviewed. Patients were treated with one injection of 1.25 mg intravitreal bevacizumab followed by PRP or with PRP alone. The primary outcome was the long-term angle anatomy. Secondary measures included intraocular pressure (IOP), visual acuity, patient compliance, and control of systemic diseases. Fourteen eyes of 12 patients treated with bevacizumab and PRP and 15 eyes of 11 patients treated with PRP alone were included in the study. Mean sectors of open angle at baseline was 1.31 in the bevacizumab group and 1.47 in the retinal ablation group (P = 0.73). Mean sectors of open angle was 2.14 and 1.18 in the bevacizumab and retinal ablation groups, respectively (P < 0.05) at 6-month follow-up, and 2.27 and 1.18, respectively (P < 0.05) at 1-year follow-up. Mean baseline IOP was 32.3 mmHg (+/-14.8) in the bevacizumab group and 31.8 mmHg (+/-13) in the PRP group (P = 0.75). At 6-month follow-up, the mean IOP was 18.28 mmHg (+/-10) in the bevacizumab group and 23.33 mmHg (+/-14.6) in the PRP group (P = 0.05), and 19.12 mmHg (+/-6.8) and 26.2 mmHg (+/-18) (P = 0.1), respectively at 1-year follow-up. Nineteen patients were judged to be noncompliant, 10 had uncontrolled diabetes and 7 had uncontrolled hypertension. This study documents better long-term preservation of open angle and IOP control in eyes receiving bevacizumab along with PRP. We stress that NVG is still associated with poor visual acuity outcomes.

The effect of filter test in the compound trabeculectomy

Objective To observe the outcome of applicationfilter test combing with adjustable sulure in estimating and control-ling the posioperational filtering outflow in compound trabeeulectomy.Methods 78eyes of 61 cases of primary glaucoma,were randomly divided into 2 groups.All eyes of test group undergo application of filter test combining with ajdustable suture and mitomycin-C in compound trabeculectomy.Eyes in compared group undergo ordinal trabeculectomy.All cascs were observed for 48 weeks,including intraocular pressure（IOP）,filtering blebs,depth of antcrior chamber,visual acuity and other complications.Results In the early term after operation,the shallow anterior chamber and other complication apperared in test group was obviously less than that in compared group.In the far term after operation ,the IOP in test group was lower than that in compared group,visual loss and nonfunctional bulbs apperared in test group was obviously less than that in compared group.Conclusion Filter test combining with adjustable suture and mitomyein-C in compound trabeculectomy is useful for controlling IOP,and less complication. Key words: glaucoma; compound trabeculectomy; mitomycin C; filter test