Visante OCT Research Articles

Improving the technique of antiglaucomatous surgery by using absorbable suture material in patients with primary open-angle glaucoma

Background. Surgical treatment of glaucoma is aimed at achieving target intraocular pressure and obtaining a sustained hypotensive effect. Fibrosis of the filtering bleb in the early and late postoperative period leads to the search for new techniques to improve surgeries. The purpose was to assess the effectiveness of an improved surgical technique using absorbable suture material in patients with primary open-angle glaucoma. Materials and methods. Work with patients was carried out in compliance with the general requirements and provisions of bioethics, which were approved by the First National Congress on Bioethics (Kyiv, 2001). Informed consent was obtained from each patient. Forty-nine individuals (47 eyes) with primary open-angle glaucoma took part in the study. The main group included 25 patients (27 eyes) with uncompensated open-angle glaucoma who underwent antiglaucomatous surgery using absorbable suture material. Control group consisted of 24 patients (20 eyes), in whom antiglaucomatous surgery was performed in a classical way without using of polyglycolide. Examinations were performed before surgery, each week after it for a month and then at 3, 6, 12, 18 and 24 weeks. In addition to standard methods, ophthalmic examination included tonography on an electronic Model 30 Pneumatonometr (Reichert, USA), control of the morphological state of the filtering bleb was carried out by computer tomography using DRI OCT Triton (Topcon, Japan) and Visante OCT (Carl Zeiss, Germany). Results. In the main group in the postoperative period, the intraocular pressure stabilized, its level did not exceed 22 mm Hg, while in the control group, there was an increase in the average indicator to 28.1 mm Hg six months after surgery. The coefficient of the outflow facility in the postoperative period in the main group was more stable and amounted to 0.26 ± 0.06 mm3/min/mm Hg, and in the control group, there was a decrease to 0.19 ± 0.08 mm3/min/mm Hg, which indicated destabilization of hydrodynamic processes. Conclusions. The technique of antiglaucomatous surgeries improved by using absorbable suture material is more effective in patients with primary open-angle glaucoma compared to classic antiglaucomatous surgery.

Comparing meibomian gland visibility on optical coherence tomography and Keratograph 5M images using objective and subjective grading methods

PurposeTo investigate if there is a visible difference in meibomian gland (MG) length between images captured with the Visante optical coherence tomography (OCT; wavelength = 1,310 nm) and the OCULUS Keratograph 5M (K5M; wavelength = 880 nm). MethodsAdults between 18 and 40 years were recruited. Baseline dry eye disease was evaluated with the Standard Patient Evaluation of Eye Dryness (SPEED) and tear meniscus height and tear breakup time with the K5M. Right upper and lower eyelid MGs were imaged with the K5M and Visante OCT. Each image was graded with the 0 to 3 meiboscore scale. The central 5 MGs were evaluated with ImageJ for percent gland length visibility. ResultsThirty participants were analyzed with a median (interquartile range [IQR]) age of 23.0 (5.0) years (53.3 % female). Overall, participants were asymptomatic and had normal tear films. Meiboscores based on K5M and Visante OCT was significantly different for the lower eyelid (0[1] vs 1[2]; p = 0.007) but not the upper eyelid (0[1] vs 0[1]; p = 1.00). The mean percent gland visibility of the upper eyelid (82.7[9.6] vs 75.2[13.5]; p < 0.001) and the lower eyelid (81.2[12.7] vs 64.1[17.6]; p < 0.001) were significantly greater on the Visante OCT than the K5M images, respectively. ConclusionOCT images had significantly greater percent visible MG lengths than the K5M images. This suggests viable segments of the MGs may be missed with typical imaging, which may explain how it is possible that studies have found less post-treatment MG atrophy.

Bleb Morphology on Anterior-Segment Optical Coherence Tomography after XEN Gel Stent Implantation.

We investigated the internal morphology of filtration blebs after XEN gel stent implantation using anterior segment optical coherence tomography (AS-OCT) and identified factors related to intraocular pressure (IOP) postoperatively. Eighteen eyes of 18 patients who had undergone XEN gel stent implantation were analyzed. Blebs were imaged using Visante OCT (Carl Zeiss Meditec AG, Germany) at 6 months and 1 year after surgery and evaluated for quantitative parameters including bleb height, maximum height of internal cavity, maximum bleb wall thickness, and maximum bleb epithelial thickness. Subjects were classified into two groups according to the presence or absence of a definite internal cavity between the conjunctiva and sclera using AS-OCT imaging. Nine eyes (50%) were assigned to the internal cavity group and 9 (50%) to the uniform group. Postoperative IOP was significantly lower in the internal cavity group than in the uniform group both at 6 months and 1 year after surgery (p = 0.024 and p = 0.040). Postoperative IOP showed statistically significant negative correlations with bleb height and the height of the internal cavity (Spearman correlation coefficient r = -0.518, p = 0.028 and r = -0.453, p = 0.034, respectively). AS-OCT facilitates analysis of bleb morphology after XEN gel stent implantation. A larger height of the internal cavity of the bleb appeared to correlate with lower IOP after XEN implantation.

Effect of conventional and orthokeratological hard contact lenses on anatomical and functional characteristics of the cornea

This study evaluated the potential effects of conventional hard contact lenses (HCL) and orthokeratological contact lenses (OKL) on anatomical and functional condition of the cornea in myopia correction. The study included 80 patients (159 eyes) with low, moderate and high myopia. Group 1 consisted of 40 patients (79 eyes) who used conventional HCL; group 2 included 40 patients (80 eyes) who used OKL. All patients underwent topographic keratometry, corneal pachymetry mapping (Pentacam, Oculus, Germany; Visante OCT, Carl Zeiss, Germany), high-order aberrometry (OPD Scan, Nidek, Japan), confocal microscopy (Confoscan 4, Nidek, Japan), evaluation of corneal biomechanical properties (ORA, Reichert Technologies, USA) and corneal light scattering (Pentacam, Oculus, Germany). Examinations were taken before the treatment started and after 8-12 months of contact lens wear. Group 1 showed corneal thickness increase in all zones (by 0.9-1.1%), no significant changes in corneal refraction, and increase in corneal hysteresis and corneal resistance factor. OKL wear led to a significant flattening of anterior surface of the cornea and steepening of its paracentral area, decrease in central corneal thickness (by 2.8%) and increase in mid-peripheral thickness (by 2.2%). No significant changes in posterior corneal surface were observed in the study patients. More significant increase in higher-order aberrations and the degree of light scattering was observed in group 2, while changes in subepithelial nerve plexus and stromal structure were more significant in group 1. Long-term OKL wear shows more significant morphological and functional corneal changes compared to RGP lens.

Comparison of corneal, endothelial, and anterior segment parameters in eyes with and without pigment dispersion

BackgroundTo evaluate the differences of central corneal thickness (CCT), corneal endothelial cell morphology, and biometric parameters of the anterior chamber and iridocorneal angle in pigment dispersion syndrome (PDS), pigmentary glaucoma (PG), primary open-angle glaucoma (POAG), and healthy group. MethodsTwenty- three eyes in the PDS group, 39 eyes in the PG group, 33 eyes in the POAG group, and 45 eyes in the healthy control group were included in this cross-sectional retrospective study. Corneal endothelial cell density, the coefficient of variation in the cell area, hexagonality, and central corneal thickness (CCT) were obtained by specular microscopy (CEM 530, NIDEK, Japan). Anterior chamber depth (ACD), iridocorneal angle parameters and CCT were measured by anterior segment optical coherence tomography (AS-OCT) (Visante OCT, Carl Zeiss AG, Germany). ResultsThe mean CCT via specular microscopy (SM-CCT) was measured at the thinnest value in the PG group (531.20 ± 34.91 µm) and the thickest in the control group (569.13 ± 37.52 µm). CV value was higher in PG (34.65 ± 6.84) and POAG group (34.27 ± 9.93) and lower in control group (28.82 ± 5.18) (p = 0,005). The mean AS-OCT-CCT was the thinnest in the PG group (513.61 ± 39.94 µm), and the thickest in the control group (547.04 ± 36.72 µm) (p = 0.001). All parameters of the iridocorneal angle were larger in the PDS and PG groups (p < 0.001). In the correlation analysis of the glaucomatous eyes, a negative correlation between the C/D ratio and SM-CCT and AS-OCT-CCT (p = 0.037, p = 0.017, respectively) and a positive correlation between the pRNFL thickness and AS-OCT- CCT (p = 0.002). ConclusionCCT values obtained with both SM and AS-OCT were found to be significantly thinner in PG cases. CV, which is the measure of polymegatism, was found to be significantly higher in PG cases.

Ciliary Muscle Dimension Changes With Accommodation Vary in Myopia and Emmetropia.

PurposeThe purpose of this study was to determine whether accommodation-induced changes in ciliary muscle dimensions vary between emmetropes and myopes, and the effect of the image analysis method.MethodsSeventy adults aged 18 to 27 years consisted of 25 people with emmetropia (spherical equivalent refraction [SER] +0.21 ± 0.36 diopters [D]) and 45 people with myopia (−2.84 ± 1.72 D). There were 23 people with low myopia (>−3 D) and 22 people with moderate myopia (−3 to −6 D). Right eye ciliary muscles were imaged (Visante OCT; Carl Zeiss Meditec) at 0 D and 6 D demands. Measures included ciliary muscle length (CML), ciliary muscle curved length (CMLarc), maximum ciliary muscle thickness (CMTmax), CMT1, CMT2, and CMT3 (fixed distances 1–3 mm from the scleral spur), CM25, CM50, and CM75 (proportional distances 25%–75%). Linear mixed model analysis determined effects of refractive groups, race, and demand on dimensions. Significance was set at P < 0.05.ResultsMyopic eyes had greater CML and CMLarc nasally than emmetropic eyes. Myopic eyes had thicker muscles than emmetropic eyes at nasal positions, except CM25 and CMT3, and at CM75 temporally. During accommodation and only nasally, CML reduced in emmetropic and myopic eyes, and CMLarc reduced in myopic eyes only. During accommodation, both nasally and temporally, muscles thickened anteriorly (CMT1 and CM25) and thinned posteriorly (CMT3 and CM75) except for temporal CM75. Moderate myopic eyes had greater temporal CMLarc than low myopic eyes, and the moderate myopes had thicker muscles both nasally and temporally using fixed and proportional distances.ConclusionsPeople with myopia had longer and thicker ciliary muscles than people with emmetropia. During accommodation, the anterior muscle thickened and the curved nasal muscle length shortened, more in myopic than in emmetropic eyes. The fixed distance method is recommended for repeat measures in the same individual. The proportional distance method is recommended for comparisons between refractive groups.

The double injection technique to improve visualization of severe coronary lesions with optical coherence tomography.

Optical coherence tomography (OCT) is a high-resolution imaging modality that provides a precise evaluation of coronary anatomy. However, the presence of severe coronary lesions can prevent the required adequate distal contrast flushing resultting in inadequate blood clearance and poor image quality or complete blood shadowing of the underlying vessel wall. The aim of this prospective study was to evaluate the feasibility and safety of a novel "double injection technique" (DIT) to overcome the limitations of the conventional technique (CT) in patients with severely stenotic lesions. Twenty-three patients with severe angiographic lesions were sequentially imaged before intervention with OCT with the CT and then with DIT. A total of 5125 OCT frames were carefully matched and analyzed by an independent central core lab. A semiquantitative image quality score was used to grade the number of quadrants (0-4) with vessel wall visualization. Optimal OCT visualization (Grades 3-4) significantly improved by the DIT (68% vs. 38% of frames, p < 0.001). The DIT also improved the mean score (3.1 ± 0.6 vs. 2.0 ± 0.8; p < 0.05; mean improvement of 1.1 ± 0.5 per patient). There were no complications associated with the DIT. The DIT significantly improved preintervention image quality of OCT in severe coronary lesions.

DIAMondback Atherectomy With OCT Visualization for Calcified PAD Lesions (DIAMOCT-PAD Study).

In this study, we aimed to describe the immediate and long-term vascular effects of OAS in patients with peripheral arterial disease (PAD) and moderate to severely calcified lesions. Debulking the calcified atherosclerotic plaque with the orbital atherectomy system (OAS) can potentially enhance vessel compliance and increase the chance of reaching a desirable angioplasty result. A total of 7 patients were evaluated both at baseline and at 6-month follow-up. Following a diagnostic peripheral angiogram, patients with significant SFA disease had a baseline intravascular optical coherence tomography (IV-OCT) and the lesion was treated with OAS. Repeat IV-OCT was performed after atherectomy and after drug-coated balloon, if used. Patients were also evaluated with angiography and IV-OCT imaging at their 6-month follow-up. The majority of tissue removed was fibrous tissue. During follow-up, luminal volume increased for 4 of the 7 patients from baseline to 6-month follow-up and decreased in 3 patients. On average there was a 6% increase of luminal volume (P<.01 compared with baseline). A recent virtual histology algorithm was used for automatic classification of IV-OCT images unaided by any reader. The algorithm used convolutional neural networks to identify regions as either calcium, fibrous, or lipid plaque, and it agreed with an expert reader 82% of the time. To the best of our knowledge, the current report is the first to describe vascular effects of OAS in medial calcified lesions immediately after and at follow-up using IV-OCT in patients with severe PAD.

Predictibility of the efficacy of peripheral iridotomy in primary angle closure: Utility of UBM

To assess the utility of UBM in the management of primary angle closure (PAC) and assessing the predictability of peripheral iridotomy (PI) in re-opening the closed angle. Retrospective clinical study. Patients with suspicion of PAC. This study obtained the consent of all patients and adhered to the Declaration of Helsinki. It was conducted in two ocular imaging centers and based on patients with suspected PAC. Each patient underwent UBM and Visante OCT at each visit, before and after PI when PAC was confirmed. Irido-corneal angle. Out of 202 eyes (101 patients) with a mean age of 62 years and 69.3% female predominance, we found 186 eyes with PAC. In most cases (77.4%), the iridocorneal angle was open after a single PI at the second visit, and only 14% eyes remained closed at the third visit, regardless of any additional treatment performed (complementary PI, iridoplasty, surgical lens extraction). Mechanisms involved in persistent angle closure after PI were: imperforate PI (45.2% of eyes), iris plateau syndrome (8.6% of eyes), significant lens vaulting (30.9% of eyes) and mixed mechanisms (2.3% of eyes). PI remains effective as a first-line treatment in most cases of PAC, even when associated with mechanisms other than pupillary block. Nevertheless, the PI must be completely patent, and UBM can help in understanding underlying mechanisms, hence guiding the treatment in these eyes.

Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism.

Эффективность методов LASIK и LASЕK в достижении прогнозированного результата при эксимерлазерной коррекции миопии и миопического астигматизма

Эксимерлазерная коррекция аномалий рефракции вошла в офтальмологическую практику как одна из самых эффективных хирургических методик, позволяющая путем изменения кривизны роговицы корригировать нарушения рефракции, в том числе при миопии и миопическом астигматизме. Как правило, такая коррекция применяется у пациентов молодого трудоспособного возраста, приобретает особую социальную значимость и требует использования наиболее точных и безопасных технологий, которые бы гарантировали достижение быстрого эффекта с минимальным периодом реабилитации. В работе были проанализированы результаты оперативного лечения 60 пациентов (103 глаза) с миопией различной степени и миопическим астигматизмом. Среди пациентов было 28 мужчин (41 %) и 32 женщины (59 %) в возрасте от 18 до 47 лет (средний возраст 25,0 ± 2,5 года). Исследуемые пациенты были распределены на две группы. Первую группу составили 29 пациентов (50 глаз), которым была выполнена коррекция зрения методом laser-assisted in situ keratomileusis (LASIK). Всем пациентам проводились стандартные офтальмологические обследования (визометрия, ауторефрактометрия, биомикроскопия, прямая офтальмоскопия, тонометрия, периметрия) и рефракционная диагностика, включавшая кератотопографию с пахиметрией (Orbscan, Bausch &amp; Lomb Inc., США), аберрометрию (Zуwave, Bausch &amp; Lomb Inc., США), оптическую когерентную томографию переднего отрезка глаза (Visante OCT, Carl Zeiss Meditec, Германия), оптическую биометрию оптическим биометром IOLMaster (Carl Zeiss Meditec, Германия). Достижение рефракционного результата оценивалось на 1-й день, через 1 месяц, через 6 месяцев и через 1 год после операции. Все оперативные вмешательства выполнялись на эксимерном лазере Allegretto WaveLight EX500 (Alcon, США). Через месяц после эксимерлазерной коррекции методом LASIK ожидаемый результат остроты зрения был достигнут на 46 глазах (80,7 %), а при применении методики laser epithelial keratomileusis (LASEK) — на 31 глазу (58,5 %), что свидетельствует о более долгом периоде реабилитации при применении методики LASEK. Через полгода прогнози­руемая острота зрения без коррекции в группе, где оперативное вмешательство выполнялось методом LASЕK, была достигнута на 46 глазах (86,8 %), в то время как в группе, где оперативное вмешательство выполнялось методом LASIK, была достигнута на 50 глазах (100 %) (разница не достоверна, р &gt; 0,05). Через 1 год после проведенной эксимерлазерной коррекции некорригированная острота зрения независимо от степени миопии составила 0,92 ± 0,04 Ед в первой группе при максимальной остроте зрения с коррекцией на этих глазах до операции — 0,86 ± 0,05 Ед (разница не достоверна, р &gt; 0,05) и 0,74 ± 0,10 Ед во второй группе при максимальных показателях корригируемой остроты зрения до операции — 0,92 ± 0,03 Ед (разница достоверна, р &lt; 0,05). Несколько большая разница достигнутых показателей максимальной некорригированной остроты зрения до операции при выполнении эксимерлазерной коррекции по методу LASЕK объясняется развитием субэпителиальной фиброплазии в 3,77 % случаев, что влияло на средние показатели конечного результата.

Comparability of corneal thickness and opacity depth assessed by OCT and UBM.

To compare the measurement of central thickness and depth of involvement of opacity-bearing corneas at different intensities (mild, moderate, and dense) using different instruments: Visante and Optovue OCTs, ultrasound biomicroscopy (UBM), and ultrasound pachymetry (central thickness). Sample of 102 eyes: 70 eyes (68.63 %) with corneal opacity; 32 eyes (31.37%) with normal corneas. Corneal opacity grading included mild (28 eyes, 40.00 %), moderate (27 eyes, 37.57 %), and dense (15 eyes, 21.43 %). Opacity intensity was graded and documented. Central corneal thickness was determined using Optovue and Visante OCTs, ultrasound pachymetry, and UBM VuMax (50 MHz), and depth of corneal opacity, using Optovue and Visante OCTs and UBM. Total corneal thickness of the control group showed differences with a small correction factor using Optovue OCT (534.03 ± 39.88 μm), Visante OCT (523.72±38.70 μm), and ultrasound pachymetry (529.84 ± 39.76 μm), and were higher when compared to UBM (492.06 ± 37.93 μm). In mild opacity, depth measurements were the same with OCT Optovue and Visante and higher than those by UBM. In moderate opacities, there were no differences in measurements by different instruments. In dense opacities, OCT Optovue and Visante measurements were the same and higher than those by UBM. Central corneal thickness measurements were considered higher in corneas with opacity than in normal corneas. We observed that the greatest thicknesses were measured in corneas with dense opacities. There was a difference between the measurements taken by different instruments, both in central thickness and in opacity depth in cases of mild and dense opacity, and no difference in moderate opacity.

Epiretinal Membrane Surgery Using Intraoperative OCT-Guided Membrane Removal in the DISCOVER Study versus Conventional Membrane Removal

To provide a comparative assessment of clinical outcomes between patients undergoing intraoperative OCT (iOCT) and conventional surgery for pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peel. Case-control retrospective, comparative assessment. Patients undergoing PPV with membrane peel for ERM with eyes pooled from the prospective Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) iOCT study and eyes undergoing conventional ERM surgery without iOCT. Visual acuity and OCT assessment before ERM surgery and at 1-, 3-, 6-, and 12-month follow-up after standard small-gauge PPV with iOCT feedback (iOCT DISCOVER group) or PPV with compulsory internal limiting membrane (ILM) peeling (conventional group). Visual acuity, central subfield thickness (CST), reoperation rate, and ERM recurrence were determined by record review and post hoc assessment of clinical OCTs after ERM peel. Visual acuity and ERM recurrence. A total of 262 eyes were included. Visual acuity (VA) improved 11.9 letters in the iOCT group (P<0.0001) and 12.1 letters in the conventional group (P < 0.0001) at 12 months after ERM surgery. Visual acuity improvement did not differ between the iOCT and conventional groups at 1, 3, 6, or 12 months after surgery (P>0.05 for each time point). Preoperative mean CST decreased in the iOCT group (P < 0.0001) and conventional group (P < 0.0001) with no difference between groups in CST reduction at 12 months (P= 0.36). No reoperations or visually significant recurrent ERMs occurred in either cohort. Intraoperative OCT-guided ERM removal without mandated ILM peeling provided similar VA and anatomic results to conventional ILM peeling for ERM. Future randomized prospective studies are needed to assess fully the possible role of iOCT in ERM surgery and to evaluate the potential impact of nonfoveal ERM persistence or recurrence in comparison with conventional surgery.

Experimental evaluation of bacterial corneal ulcer treatment plans using glucocorticosteroid

Purpose : to experimentally evaluate treatment plans for bacterial corneal ulcers involving corticosteroid. Material and methods . We used a previously developed model of bacterial corneal ulcer. 40 rabbits (40 eyes) were divided into 4 groups of 10 rabbits (10 eyes) each. Group 1 received topical antibacterial treatment. Groups 2 and 3 additionally received 0.2–0.3 ml injections of 0.1 % Dexamethasone solution once a day (parabulbar and systemic, respectively). Group 4 (control) was clinically observed after corneal ulcer modeling, with no treatment given. The clinical picture and the dynamics of the course of the disease were assessed by biomicroscopy, a fluorescein test, photoregistration and optical coherence tomography of the anterior eye zone (Visante OCT model 1000, Carl Zeiss, Germany). To analyze inflammatory changes and corneal opacities, a quantitative scoring system has been developed. Results . Corneal opacities emerged in the 1 st group of rabbits on the 14 th day from treatment start: in groups 2 and 3, the 9 th day. In group 4, the ulcerous defect remained by day 14. In group 1, a statistically significant thinning of the cornea (by 148.2 ± 32.6 nm) was noted in the ulceration zone after 7 days. The same effect was noted in group 2 (by 363.3 ± 82.0 nm), in the 3rd group 3 (by 362.8 ± 81.2 nm), and in group 4 (by 135.9 ± 40.0 nm). In 90 % of cases in groups 2 and 3, mild corneal opacities without vascularization were formed. In other cases, corneal opacities of high or moderate degree with vascularization were observed. Conclusion . Treatment of bacterial ulcers of rabbit corneas with dexamethasone glucocorticosteroid drug reduces the recovery time as compared to the results achieved through antibacterial treatment alone, as it brings about a rapid drop in the overall inflammatory response and diameter of the ulcer, significant reduction of the edema and infiltration of the cornea, confirmed by AS-OCT. Additionally, such treatment ensures milder corneal opacity and helps avoid corneal vascularization.

Signs of proliferative process after laser treatment of advanced glaucoma

To evaluate the condition of SFOT in dynamics with Visante OCT after one-step combined laser technique consisting of modified selective laser activation of the trabecula (MSLAT) and DGP in advanced POAG patients with normalized IOP who have pronounced pigmentation of the trabecular meshwork and stage II pseudoexfoliation syndrome (PES). OCT scans of 117 patients (117 eyes) were analyzed before laser treatments and after 1, 3, 6, 12 and 24 months. The study included 62 patients (62 eyes) comprising the main group who underwent MSLAT + DGP, and the control group consisting of 55 patients (55 eyes) who only underwent DGP. Visante OCT scans revealed that parameters of the filtration bleb (FB) and intrascleral cavity (ISC) in the main study group were more stable than in the control group during the whole follow-up. In the main study group there were less incorporations in the ISC and they had lower optical density, compared with the control group where there were denser incorporations in the ISC which gradually increased in count. According to Visante OCT, the growing count and the increase in density of incorporations in the ISC can be defined as adverse signs of an active proliferative process in SFOT. A one-step MSLAT with DGP help achieve both a long-lasting hypotensive effect, and decrease of active proliferative process signs in SFOT.

ОКТ-визуализация плавающих помутнений стекловидного тела для оценки эффективности лазерного витреолизиса

ОКТ-визуализация плавающих помутнений стекловидного тела для оценки эффективности лазерного витреолизиса

Intraoperative OCT-Assisted Retinal Detachment Repair in the DISCOVER Study: Impact and Outcomes

The purpose of this study is to evaluate intraoperative OCT (iOCT) utility and outcomes during retinal detachment (RD) repair. The Determination of Feasibility of Intraoperative Spectral-Domain Microscope Combined/Integrated OCT Visualization during En Face Retinal and Ophthalmic Surgery (DISCOVER) intraoperative OCT study is a prospective Institutional Review Board-approved study. Participants in the DISCOVER study undergoing surgical repair for RD. This was a post hoc analysis of eyes in the DISCOVER study undergoing surgical repair for RDs. Inclusion criteria included iOCT after perfluorocarbon liquid placement and at least 6 months follow-up. Exclusion criteria included severe retinal pathology unrelated to RD. Surgeons completed standardized questionnaires after each case evaluating the iOCT instrument's utility. Functional and surgical outcome data were collected at the latest available time point between 6 and 12 months. Outcomes were evaluated in 2 groups: uncomplicated primary and complex cases. Intraoperative OCT utility, single-surgery success, and visual acuity outcomes. A total of 103 eyes were included in this study: 51 uncomplicated primary and 52 complex cases. Intraoperative OCT provided valuable information in 36% of cases. In 12% of cases, iOCT data directly altered surgical decision making. There was a significantly higher rate of valuable iOCT feedback in complex cases compared with primary cases (50% vs. 22%, P < 0.01). Among primary cases, 48 (94%) had successful single surgery repair with a mean postoperative visual acuity of 20/47 compared with the complex group's 75% single surgery success (n=39) and mean postoperative visual acuity of 20/92. This study affirms the potential impact of iOCT in assisting select cases of RD repair, particularly with complex pathology. The single surgery success rate was good with more than 80% of cases successfully repaired with 1 surgery.

Intraoperative Optical Coherence Tomography–Assisted Descemet Membrane Endothelial Keratoplasty in the DISCOVER Study: First 100 Cases

Intraoperative optical coherence tomography (iOCT) may facilitate successful transition to Descemet membrane endothelial keratoplasty (DMEK) surgery via improved efficiency of tissue orientation. The purpose of this study is to report a large consecutive series of iOCT-assisted DMEK, inclusive of all learning curve cases. Prospective consecutive case series. The Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery (DISCOVER) study is a single-site, multisurgeon, IRB-approved investigational device prospective study. The first 100 consecutive iOCT-assisted DMEK surgeries performed by 1 attending corneal surgeon (JMG) and 6 novice surgeons (cornea fellows under supervision) were reviewed. iOCT was utilized for tissue orientation. Patient demographics, tissue characteristics, intraoperative parameters, and postoperative complications are reported. (1) Utility of iOCT based on surgeon reporting during surgery, (2) intraoperative graft unscrolling efficiency, and (3) frequency of postoperative complications. One hundred eyes of 76 patients were enrolled. Forty-three cases were performed by 1 staff physician and 57 cases were performed by 6 cornea fellows. Concurrent phacoemulsification with lens implantation was performed in 52 cases (52%). Nine eyes (9%) required rebubbling. Two eyes (2.0%) experienced primary graft failure. One graft failure resulted from surgeon error in interpreting the iOCT. Average unscrolling time was 4.4 ± 4.1minutes (range: 0.7-27.6minutes). iOCT facilitates DMEK orientation without the need for external markings. For novice DMEK surgeons, complication rates and unscrolling times compare favorably with alternative tissue orientation methods.

&lt;p&gt;The short-term physiological impact of switching reusable silicone hydrogel wearers into a hydrogel daily disposable multifocal&lt;/p&gt;

Purpose: To evaluate ocular physiological responses to etafilcon A multifocal (etMF) daily disposable (DD) lenses after 4 weeks of wear, when switching from habitual silicone hydrogel (SiHy) daily wear.Method: A single-arm, open-label, bilateral dispensing study was conducted in 39 habitual spherical SiHy wearers (14 hyperopes; 25 myopes). Clinical visits occurred with habitual SiHy (control) at baseline and after 4 weeks of etMF DD open-eye lens wear at exit. Objective limbal/bulbar hyperemia using the Oculus K5M (0–4) and subjective grading of lid wiper epitheliopathy (LWE) (0–4) were tested for non-inferiority (NI), using a margin of 1 grade. Corneal thickness along a 10 mm cord was measured using the Visante OCT and tested for NI using a 30 μm margin. Corneal staining area was graded (0–100%).Results: The least-square mean differences (LSMD) and 95% confidence interval (95% CI) between etMF DD and habitual SiHy in central and peripheral corneal thickness (μm) were 3.64 (−2.0, 9.29) and 3.0 (−7.72, 13.72) in hyperopic, and 3.56 (−0.66, 7.78) and 6.40 (−1.62, 14.42) in myopic subjects. The LSMD (95% CI) for bulbar and limbal hyperemia were −0.08 (−0.19, 0.02) and −0.01 (−0.12, 0.09) in hyperopes, and 0.04 (−0.03, 0.12) and 0.04 (−0.04, 0.11) in myopes. The LSMD (95% CI) for LWE were 0.11 (−0.39, 0.60) and 0.30 (−0.07, 0.67) for hyperopes and myopes, respectively.Conclusions: No clinically significant differences in a variety of physiological responses were found when habitual reusable SiHy daily wear subjects were refitted into hydrogel etMF, when the subjects were followed for 4 weeks.

Effect of the outer stent position on efficacy after minimally invasive transscleral glaucoma gel stent implantation.

PurposeThe outer stent lumen can be located either deeper (in or under Tenon's layer) or more superficially in the conjunctival stroma after the transscleral XEN Glaucoma Gel Microstent (XEN‐GGM; Allergan Plc., USA) implantation. The present study aimed to investigate the effect of the postoperative conjunctival implant position on surgical success and intraocular pressure (IOP) after XEN‐GGM.MethodsProspective data from 66 consecutive open‐angle glaucoma eyes of 54 patients were collected preoperatively and 1 and 2 weeks, and 1, 6 and 12 months postoperatively. The layer of implantation was determined in the first month postoperatively as intra‐ and subtenon or intraconjunctival depending on the location of the outer lumen of the stent in OCT (Visante OCT; Zeiss, Germany). Primary outcome measures were differences in relative IOP reduction at 12 months between the two groups. Further, complete and qualified surgical success, number of secondary needlings and number of IOP‐lowering medications and absolute IOP were assessed.ResultsRelative IOP reduction was higher in intra‐ and subtenon group (n = 37/66, 56%) at week 1 (−54% versus −19%, p < 0.001), week 2 (−39% versus −21%, p = 0.02), month 1 (−42% versus −28%, p = 0.035) and month 12 (−39% versus −24%, p = 0.024). The mean absolute IOP was lower in intra‐ and subtenon group at week 1 (10.8 [95%CI, 8.8–14.1] versus 16.6 [95%CI, 14.1–19.0] mmHg, p < 0.001) and months 12 (13.9 [95%CI, 12.4–15.4] versus 16.7 [95%CI, 14.6–18.8] mmHg, p = 0.041). At month 6, a lower burden for IOP‐lowering medication was shown for the intra‐ and subtenon group (0.2 ± 0.5 versus 1.0 ± 1.1, p = 0.034). The mean number of secondary needlings, which were done in 47/66 (71%) of the eyes, was lower in the intra‐ and subtenon group in the first year (1.9 ± 1.7 versus 1.2 ± 1.2, p = 0.03). Qualified surgical success was higher in the intra‐ and subtenon group (90% versus 61%, p = 0.01) after 1 year.ConclusionThe present study demonstrates a higher efficacy achieved with lower secondary needling rates in deeper implant positions in conjunctiva after XEN‐GGM.