Phakic Eyes Research Articles

Efficacy of pars plana vitrectomy (PPV) for visually significant vitreous opacities.

Objective: To study the efficacy of pars plana vitrectomy (PPV) for visually significant vitreous opacities in improving visual function and quality of life. Study Design: Interventional study. Setting: Department of Vitreoretinal Clinic of Ophthalmology, Nishtar University Hospital Multan. Period: May 2017 to August 2019. Material & Methods: A total of 50 patients of both genders, aged 35 to 65 years having lenticular status (Phakic or pseudophakic patients) and planned for PPV were enrolled for this study. All patients were examined on slit lamp bio microscope. Dilated fundus examination was performed with indirect ophthalmoscope using scleral indentation. Intraocular pressure was measured pre and postoperatively with Goldmann’s applanation tonometer under topical anaesthesia. Diagnosis was made on through clinical examination. All patients underwent 23 gauge PPV with or without silicon oil with endo laser. Best spectacle corrected visual acuity was recorded with help of Snellen chart. Results: There were 50 eyes of 50 patients in two groups, 40 phakic eyes (80%) and 10 pseudophakic eyes (20%) that underwent 3 PPV for visually significant opacities. There were 38 (76.0%) male and 12 (24.0%) female patients. Thirty four (68.0%) out of 50 patients showed improved best spectacle corrected visual acuity (BSCVA) and visual function while 18% had BCVA 6/24 – 6/18. Forty three (86.0%) patients reported quality of life and psychological feel improvement. Conclusion: Pars plana vitrectomy is a safe, effective and viable option for annoying vitreous floaters. There are risks of retinal breaks, rhegmatogenous retinal detachment and cataract. Surgeon must be ready for prompt handling of patient.

Intraocular Pressure and Its Relation to Ocular Geometry: Results From the Gutenberg Health Study.

PurposeThe purpose of this study was to investigate the association between intraocular pressure (IOP) and ocular geometry.MethodsThe Gutenberg Health Study is a population-based cohort study in Mainz, Germany. Study participants underwent a comprehensive ophthalmologic examination including noncontact tonometry, objective refraction, optical biometry, and Scheimpflug imaging of the anterior segment at the first 5-year follow-up examination (in 2012–2017). Multivariable linear regression analysis was carried out to determine associations of IOP and geometric parameter of the human phakic eye, namely central corneal thickness (CCT), corneal curvature, anterior chamber depth (ACD), lens thickness, and axial length. In addition, the relationship of IOP and the anterior chamber angle (ACA) width was analyzed.ResultsThere were 6640 participants with phakia (age 57.3 ± 10.2 years, 49.1% women) that were included in this cross-sectional analysis. Mean IOP was 14.8 ± 2.9 mm Hg in the right eyes and 14.9 ± 2.9 mm Hg in the left eyes. IOP increased with higher CCT, greater posterior segment length, higher age (all P < 0.001), thicker lens (P = 0.003), and female sex (P = 0.05), whereas the ACD was not associated with higher IOP. The IOP increased with a narrower ACA in univariable analysis (P < 0.001), but not in adjusted analysis in subjects with an open angle.ConclusionsIOP values are related to ocular geometry, as shown in this population-based study on Caucasian subjects. Thus, knowledge of the architecture of the eye is an important factor when measuring IOP. Longitudinal evaluation will analyze whether some of these parameters are also risk factors for the development of glaucoma.

Effectiveness of surgical management of malignant glaucoma in phakic eyes.

To assess the effectiveness of core vitrectomy-phacoemulsification-intraocular lens (IOL) implantation-capsulo-hyaloidotomy in treating phakic eye at least 1mo after the onset of malignant glaucoma. A retrospective analysis were performed on malignant glaucoma patients treated in Zhongshan Ophthalmic Center between 2016 and 2018. Demographic and clinical data were described. The preoperative and postoperative visual acuity (VA), intraocular pressure (IOP), number of IOP-lowering medications used, and anterior chamber depth (ACD) of the case series were compared by Wilcoxon signed-rank test. Thirteen phakic eyes with long time intervals between onset and surgery were identified in this case series. Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy reduced the IOP (P=0.046) and the number of IOP-lowering medications used (P=0.004), deepened the ACD (P=0.005). Complete success was achieved in 38.5% of the eyes, and anatomical success was achieved in 100% of the eyes without any recurrence. The only postoperative complication observed is corneal endothelial decompensation. It occurred in two cases. Core vitrectomy-phacoemulsification-IOL implantation-capsulo-hyaloidotomy is safe and effective for treatment of long onset phakic malignant glaucoma.

Scleral Buckling: A Review of Clinical Aspects and Current Concepts.

Scleral buckling represents a valuable treatment option for rhegmatogenous retinal detachment repair. The surgery is based on two main principles: the closure of retinal breaks and the creation of a long-lasting chorioretinal adhesion. Buckles are placed onto the sclera with the purpose of sealing retinal breaks. Cryopexy is usually performed to ensure a long-lasting chorioretinal adhesion. Clinical outcomes of scleral buckling have been shown to be more favorable in phakic eyes with uncomplicated or medium complexity retinal detachment, yielding better anatomical and functional results compared with vitrectomy. Several complications have been described following scleral buckling surgery, some of which are sight-threatening. Expertise in indirect ophthalmoscopy is required to perform this type of surgery. A great experience is necessary to prevent complications and to deal with them. The use of scleral buckling surgery has declined over the years due to increasing interest in vitrectomy. Lack of confidence in indirect ophthalmoscopy and difficulties in teaching this surgery have contributed to limiting its diffusion among young ophthalmologists. The aim of this review is to provide a comprehensive guide on technical and clinical aspects of scleral buckling, focusing also on complications and their management.

Intravitreal dexamethasone implant for noninfectious uveitis in Chinese patients

To evaluate the effectiveness and safety of the dexamethasone intravitreal implant (DEX-I) in Non-Infectious Uveitis (NIU) in Chinese patients. Ninety-one eyes of 77 patients (56 men, 21 women) receiving 130 implant injections for NIU were included. Treatment indication, uveitis diagnosis, best-corrected visual acuity (BCVA), central retinal thickness (CRT), vitreous haze score, intraocular pressure, phakic status, number of injections, time to reinjection, and systemic treatments were collected at baseline, 1week, 1month, 3 and 6months after treatment. All patients were followed for at least 12weeks and had a mean follow-up period of 5.1months (range, 3-14months) after the first implant. The main treatment indications were macular edema (ME), retinal vasculitis, retinal vasculitis with ME. Sixty-one eyes (67.03%) received only one injection, while 31 eyes (32.97%) received two or more. In eyes that received 2 injections, the mean time to the second injection was 3.83months and in those that received 3 injections, the mean time to the third injection was 7.5months. BCVA and CRT significantly improved at 1week, 1month, 3months, and 6months after treatment. When compared to baseline, the mean prednisone (or equivalent) dosage significantly decreased at 3- and 6-month follow-up evaluations after DEX implantation.14.29% of eyes developed a transient increase in intraocular pressure, and a cataract was removed from 1 phakic eye. DEX implants, either alone or in combination with common adjunctive NIU treatments, is safe and effective in the treatment of NIU in Chinese patients.

To Evaluate the Surgical Outcome of Epiretinal Membrane Retrospective Study

The epiretinal membrane (ERM) is a common vitreoretinal intersurface disorder in elderly individuals. The objective of the study was to evaluate the outcome of vitreoretinal surgery in patients with epiretinal membrane. We retrospectively reviewed the medical records of thirteen eyes of 12 patients with ERM with mean age group of 63 ± 6.07 (53 – 73) years who underwent vitreoretinal surgery in Tilganga Institute of Ophthalmology and completed at least 3 month postoperative follow up from April 2018 to March 2019. The patients’ pre- and post-operative best corrected visual acuity, slit-lamp examination findings, and optical coherence tomography (OCT) images were evaluated. Three cases were pseudophakic. Out of 10 phakic eyes, 7 had combined surgery and 3 had consecutive surgery (Pars Plana Vitrectomy followed by cataract surgery). The median baseline best corrected visual acuity in Log MAR was was 0.7 (0.6-1.00) which improved to 0.30 (0.25-0.60) in 3 month follow up which was statistically significant (p-0.04).OCT parameters showed decrease in mean CMT from 411.15± 94.52 µm to 318.61 ±118.87µm (p - 0.002). One eye developed inferior retinal detachment at 6 weeks follow up, two eyes had postoperative IOP &gt;30mmHg which was managed with topical anti-glaucoma medication and two had persistent cystoid macular edema. Pars plana vitrectomy with membrane peeling is safe and effective in restoring visual acuity in patients with ERM. Though the study population was small with short duration of follow up, results are encouraging, so need further prospective large multi-centered study to determine the effectiveness of ERM surgery

Repair of progressive retinal detachment complicating degenerative retinoschisis: surgical management and outcomes in phakic eyes

BackgroundDegenerative retinoschisis is a common condition defined by the splitting of the neurosensory retina that may rarely be associated with progressive retinal detachment (RD). Here, we aim to describe the anatomic and functional outcomes of surgical treatment of progressive symptomatic retinal detachment complicating degenerative retinoschisis (PSRDCR) using pars plana vitrectomy (PPV), scleral buckle (SB), or combined PPV/SB procedure.MethodsA retrospective chart review of patients with PSRDCR between Jan 1, 2008 and Dec 31, 2019 was conducted. Data regarding demographics, surgical approach, and anatomic/functional outcomes were collected.ResultsOf the 4973 charts with RD repair during the study period, 36 eyes (0.7%) had retinoschisis with RD. 18 eyes met inclusion criteria (0.4%). The median age was 54 years (range 18–74) and all eyes were phakic. All eyes had outer layer breaks (OLBs) and 16 eyes (89%) had identifiable inner layer breaks. All OLBs were posterior to the equator in charts where position was recorded (16 eyes). The single surgery anatomic success (SSAS) and final anatomical success rates were 66% (12/18) and 100%, respectively. Eyes treated with PPV/SB had an SSAS rate of 75% (9/12), while PPV and SB had SSAS rates of 66% (2/3) and 33% (1/3), respectively.ConclusionsPSRDCR is an exceedingly rare complication of degenerative retinoschisis associated with an SSAS rate lower than for uncomplicated rhegmatogenous RD. The majority of PSRDCR were repaired via combined PPV/SB in our study, and the rarity of this complication limits statistical support of an optimal surgical method in our and prior studies. The role of SB combined with PPV for PSRDCR requires further investigation.

Therapeutic effect of simultaneous intravitreal dexamethasone and aflibercept on diabetic macular edema.

AimsTo report the effect of simultaneous intravitreal dexamethasone (DEX) and aflibercept for the treatment of diabetic macular edema (DME).MethodsThis retrospective analysis of an open-label, multicenter, consecutive case series included 102 eyes of 81 patients with DME. Patients were selected into two groups. The control group consisted of 50 eyes treated with aflibercept alone, and the combination group consisted of 52 eyes treated with simultaneous DEX implant and aflibercept injection. The primary endpoints were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 6. The secondary endpoint was the interval of retreatment.ResultsBaseline BCVA increased and CRT decreased at 6 months in both groups. Pseudophakic eyes in the combination group exhibited significantly greater BCVA improvement compared with phakic eyes (p = 0.031). Fewer intravitreal treatments were required for eyes treated with combination therapy than for those treated with aflibercept alone (1.56 ± 0.54 vs. 4.04 ± 1.26, p < .0001), with a mean retreatment interval of 3.66 ± 0.69 months.ConclusionsSimultaneous intravitreal DEX and aflibercept achieved non-inferior improvement of visual and anatomic outcomes compared with aflibercept alone for DME, but exhibited a significantly longer treatment interval and superior visual outcome in pseudophakic eyes. This therapeutic approach is considered a valid strategy for treating DME in the era of COVID-19.

Comparison of Corneal Tissue Profile of Pseudophakic and Phakic Donors.

To compare the endothelial quality of corneas obtained from pseudophakic donors with age-matched phakic controls. Retrospective analysis of 100 corneas each from pseudophakic and phakic eyes with donor age ≥60 years in both the groups was performed. The endothelial cell density, coefficient of variation, and percentage of hexagonal cells obtained by specular microscopy were compared between the two groups. The cut-off level of endothelial cell density (ECD) taken for optical keratoplasty was 2,000 cells/mm2. The male and female donors constituted 60% (n=120) and 40% (n=80), respectively. The mean age of the donors was 66.9±7.3 years in the phakic group and 69.9±7.7 years in pseudophakic group. The mean ECD in the phakic group was 2757.6±328.5 cells/mm2 and that in the pseudophakic group was 2225.5±471.9 cells/mm2 (P<0.0001). The mean coefficient of variation in the phakic group was 37.1±5.0 and that in the pseudophakic group was 38.6±11.1 (P=0.234). The mean percentage of hexagonality in the phakic group and the pseudophakic group was 52.0±6.4% and 51.2±7.2%, respectively (P=0.414). Both in univariate and multivariate linear regression analysis, age of the donor was found to be negatively associated in predicting ECD (P=0.002 and P=0.003, respectively). Sixty-nine and thirty-three corneas from the phakic and pseudophakic donor pool were used respectively. Difference in ECD between the phakic and the pseudophakic donor group was found to be statistically significant. The ECD in the pseudophakic group was found to be above the cut-off limit required for keratoplasty. Hence, pseudophakic corneas may also be used for transplantation.

Comparison of Outcomes Following Glaucoma Drainage Tube Surgery Between Primary and Secondary Glaucomas, and Between Phakic and Pseudophakic eyes.

Purpose:To report outcomes of glaucoma drainage device (GDD) surgery based on primary or secondary glaucoma diagnosis and lens status.Design:Single-center, retrospective, consecutive cohort study.Methods:University of Florida patients aged 18 to 93 years who underwent nonvalved GDD surgery between 1996 and 2015 with a minimum of 1-year follow-up were examined. Of the 186 eyes of 186 patients enrolled, 108 had a primary glaucoma and 78 a secondary glaucoma diagnosis. Excluding 13 aphakic patients, 57 eyes were phakic and 116 pseudophakic. Mean intraocular pressure (IOP), mean number of medications, visual acuity (VA), surgical complications, and failure (IOP ≥18 mm Hg, IOP <6 mm Hg, reoperation for glaucoma, or loss of light perception) were the main outcome measures.Results:No significant difference was noted in mean IOP and mean medication use (12.8 ± 4.5 and 13.0 ± 6.6 mm Hg on 2.0 ± 1.2 and 1.5 ± 1.1 medication classes, respectively), mean VA (1.08 ± 0.98 and 0.94 ± 0.89, respectively), failure, or numbers of complications and reoperations (P > 0.05) between eyes with primary and secondary glaucomas at up to 5 years postoperatively. Comparison of phakic and pseudophakic eyes showed a statistically significant higher success rate for the pseudophakic patient group at the ≥18 mm Hg upper limit and <6 mm Hg lower limit (P = 0.01), and significantly fewer eyes required reoperation to lower IOP (6.9% vs 23%).Conclusions:GDD surgery appears equally effective for secondary glaucomas as for primary glaucomas, and has a better outcome for pseudophakic eyes than phakic eyes.

Single-port transconjunctival vitrectomy for malignant glaucoma.

The management of malignant glaucoma involves either anterior vitrectomy with zonulectomy and iridectomy or 3-port core pars plana vitrectomy (PPV) by retinal surgeons. The proposed modification can be performed with reasonable success rates. In this technique, synechiolysis and anterior chamber irrigation were performed through a limbal incision, and a single-port 23- or 25-gauge vitrector was introduced through PPV superotemporally to perform anterior vitrectomy and central posterior capsulotomy in pseudophakic eyes. The same procedure can be performed after cataract surgery in phakic eyes. Vitrectomy is continued until anterior chamber deepens, ensuring a conduit between anterior and posterior chambers through the posterior capsulotomy alone, bypassing the need for a posterior iridectomy/zonulectomy. In a series on 9 eyes, all achieved optimization of anterior chamber depth with intraocular pressure normalization in 8 of 9 eyes, without showing any signs of recurrence at a mean follow-up of 8.6 months.

No association between cataract surgery and mitochondrial DNA damage with age-related macular degeneration in human donor eyes.

To determine whether age-related macular degeneration (AMD) severity or the frequency of retinal pigment epithelium mitochondrial DNA lesions differ in human donor eyes that have undergone cataract surgery compared to phakic eyes. Eyes from human donors aged ≥ 55 years were obtained from the Minnesota Lions Eye Bank. Cataract surgery status was obtained from history provided to Eye Bank personnel by family members at the time of tissue procurement. Donor eyes were graded for AMD severity using the Minnesota Grading System. Quantitative PCR was performed on DNA isolated from macular punches of retinal pigment epithelium to quantitate the frequency of mitochondrial DNA lesions in the donor tissue. Univariable and multivariable analyses were performed to evaluate for associations between (1) cataract surgery and AMD severity and (2) cataract surgery and mitochondrial DNA lesion frequency. A total of 157 subjects qualified for study inclusion. Multivariable analysis with age, sex, smoking status, and cataract surgery status showed that only age was associated with AMD grade. Multivariable analysis with age, sex, smoking status, and cataract surgery status showed that none of these factors were associated with retinal pigment epithelium mitochondrial DNA lesion frequency. In this study of human donor eyes, neither retinal pigment epithelium mitochondrial DNA damage nor the stage of AMD severity are independently associated with cataract surgery after adjusting for other AMD risk factors. These new pathologic and molecular findings provide evidence against a relationship between cataract surgery and AMD progression and support the idea that cataract surgery is safe in the setting of AMD.

Endothelial cell loss after pars plana vitrectomy

To analyse the changes in endothelial cell density (ECD) after pars plana vitrectomy (PPV) and to identify the factors implicated. This was a prospective, consecutive, and non-randomised, case-control study. All 23-gauge vitrectomies were performed by a single surgeon at a tertiary centre. ECD was measured at baseline before surgery and on postoperative Days 30, 90, and 180. The fellow eye was used as the control eye. The primary outcome was a change in ECD after PPV. Seventeen patients were included in this study. The mean age of the patients was 65 years. The mean ECD count at baseline was 2340 cells/mm2. The median ECD loss in the vitrectomised eye was 3.6 %, 4.0 %, and 4.7 % at Days 30, 90, and 180, respectively, compared to +1.94 %, +0.75 %, +1.01 %, respectively, in the control eye. The relative risk of ECD loss after PPV was 2.48 (C.I. 1.05-5.85, p = 0.0247). The pseudophakic eyes lost more ECD than the phakic eyes, but this was not statistically significant. There were no significant differences in diagnosis, age, surgical time, or tamponade used after surgery. Routine pars plana vitrectomy had an impact on the corneal endothelial cells until Day 180 post-op. The phakic status was slightly protective against ECD loss after PPV, although it was not statistically significant. The pathophysiology of corneal cell damage after routine PPV remains unclear. Further studies are required to confirm these findings.

Pneumatic retinopexy: an update

Pneumatic retinopexy (PR) is a minimally invasive, non-incisional procedure for repairing uncomplicated rhegmatogenous retinal detachment. It consists of an intravitreal gas injection followed by the maintenance of a postoperative head position and the use of laser or cryopexy to seal the retinal breaks. It was initially indicated for a single or a group of retinal breaks no larger than 1 clock hour involving the superior 8 clock hours in phakic eyes with no proliferative vitreoretinopathy. We aim to perform a narrative review on pneumatic retinopexy since the last major review of 2008, based on a Medline search up to June 20 2021 using multiple search words including pneumatic retinopexy, pneumoretinopexy, retinal detachment, and pars plana vitrectomy. Indications for PR have been expanded and include pseudophakic eyes, eyes with mild PVR, and even breaks in the inferior fundus. Depending on the case selection, PR has a single-operation success rate ranging from 45 to 80%. Despite the lower single operation success rate, the functional outcomes of those eyes repaired successfully by primary PR exceed those of scleral buckling (SB) and pars plana vitrectomy (PPV). Best corrected visual acuity, metamorphopsia scores, mental health scores, and vision-related functioning scores were all better in PR-treated eyes compared to PPV-treated eyes. PR should be strongly considered for eligible patients with a primary uncomplicated rhegmatogenous retinal detachments.

Dexamethasone intravitreal implant in treatment-naïve diabetic macular oedema: findings from the prospective, multicentre, AUSSIEDEX study

AimTo evaluate the effectiveness of dexamethasone intravitreal implant 0.7 mg (DEX; Ozurdex) monotherapy in the patient subgroup of the AUSSIEDEX study with treatment-naïve diabetic macular oedema (DME).MethodsThe open-label, prospective, phase...

Five-year change in refractive error and its risk factors: results from the Gutenberg Health Study

Background/AimsTo examine the 5-year change in refractive error in phakic eyes and its risk factors in the general population.MethodsThe Gutenberg Health Study (GHS) is a population-based cohort study including 15...

How to Predict the Suitability for Corneal Donorship?

Background: In Germany, more than one-third of donor corneas harvested are not suitable for transplantation. We evaluated the factors associated with the usability of donor corneas. Method: Data from 2032 consecutive donor corneas harvested at the Rhineland-Palatinate Eye Bank in Mainz, Germany, were retrospectively analyzed. Factors of interest were age, sex, lens status, cause of death, cardiopulmonary resuscitation (CPR), death-to-explantation-interval (DEI), and the influence of these factors on the proportion of discarded donor corneas. Factors associated with endothelial cell density (ECD) were analyzed in a linear regression mixed model. Results: Higher donor age, male gender, pseudophakic lens status, and longer DEI were associated with significantly reduced ECD. With respect to DEI, the estimated cell loss was 7 ± 2 cells/mm2/hour (p < 0.001). Age was associated with a lower ECD of 6 ± 2 cells/mm2 per year (p = 0.001). Female ECD was 189 ± 44 cells/mm2 higher than male ECD (p < 0.001). Pseudophakic eyes had 378 ± 42 cells/mm2 less compared with phakic eyes (p < 0.001). Cause of death did not affect the ECD. Of note, 55% and 38% of corneas harvested on the second and third postmortem day, respectively, and 45% of corneas from donors older than 80 years were still suitable for transplantation. Conclusions: In the context of a growing need for donor corneas, we do not recommend limiting donor age and collection time to 24 h or excluding oncology donors, as is the practice in many countries. Therefore, we propose a mathematical model for better donor preselection.

Computational Fluid Dynamics of Intraocular Silicone Oil Tamponade.

PurposeTo investigate the behavior of silicone oil (SiO) at the steady equilibrium and during saccades and calculate SiO-retina contact, shear stress (SS), and shear rate (SR).MethodsA 24 mm phakic eye mesh model underwent 50°/0.137s saccade. The vitreous chamber compartment was divided into superior and inferior 180° sectors: lens, pre-equator, postequator, and macula. SiO-retina contact was evaluated as a function of fill percentages between 80% and 90% for a standing patient, 45° upward gaze, and supine. SS and SR for 1000 mPa-s (SiO1000) and 5000 mPa-s (SiO5000) silicon oil were calculated.ResultsSiO fill between 80% to 90% allowed 55% to 78% retinal contact. The superior retina always kept better contact with SiO, regardless of the fill percentage (P < 0.01). SiO interface thoroughly contacted the macula only in standing position. SS followed a bimodal behavior and was always significantly higher for SiO5000 compared to SiO1000 (P < 0.01) throughout the saccade. The macula suffered the highest mean SS in standing position, while throughout the saccade the average SS was maximum at the SiO-aqueous interface. SR was significantly higher for SiO1000 compared to SiO5000 (P < 0.001).ConclusionsSS on the retinal surface may instantaneously exceed reported retinal adhesiveness values especially at the SiO-aqueous interface and possibly favor redetachment. Despite 90% SiO fill the inferior retina remains extremely difficult to tamponade.Translational RelevanceAccurate assessment of retina-tamponade interaction may explain recurrent inferior retinal redetachment, silicone oil emulsification, and help to develop better vitreous substitutes.

Ocular, Orbital, and Adnexal Toxicity With High-dose Volumetric Modulated Arc Radiation Therapy for Orbital Malignancies.

Conventional modalities of external-beam radiation therapy (EBRT) are associated with high incidences of severe vision-threatening ocular and orbital toxicities when used to treat orbital malignancies. We investigate toxicities associated with high-dose volumetric modulated arc therapy (VMAT), a commonly used contemporary treatment modality for these tumors. Retrospective analysis of malignant orbital tumors managed with adjuvant high-dose VMAT preceded by globe-salvaging surgical therapy (GST) or exenteration. Dosimetric quantitation of target volumes and critical structures was performed. Incidence and severity of ocular, orbital, and adnexal toxicities were evaluated and assessed with regard to conventional EBRT toxicities for orbital malignancies described in the literature. Eighty-four subjects (mean age = 65.9 ± 9.7 years) were included (N = 48 and N = 36 in GST and exenteration subgroups, respectively). Mean dose was 64.8 ± 2.1 Gy to the planning target volume. Dosing to critical structures typically did not surpass known tissue tolerance limits. Median follow up was 18.3 months. Visual acuity in the GST subgroup was not significantly different after VMAT (0.25 ± 0.06) compared with baseline (0.23 ± 0.02; P = 0.302). Whereas severe toxicities reported by major systematic analyses in the literature with older EBRT modalities were relatively common-for example, retinopathy (16-40%), optic neuropathy (16%), and corneal perforation (13%)-toxicities with VMAT were typically mild and less common. The most common toxicities with VMAT were mild dry eye (81.3%; 39/48), cataract (21.1%; 8/38 phakic eyes), and periocular dermatitis (15.5%; 13/84). Vision-threatening toxicities, including severe corneal pathologies, retinopathy, or optic neuropathy, were rare. There were no contralateral ocular or adnexal toxicities. High-dose VMAT for orbital malignancies demonstrated low incidence and severity of eye-related toxicity, in contradistinction to adverse events reported from conventional forms of radiotherapy.

Factors associated with achieving intraocular pressure lower than 15\xa0mmHg by Trabectome surgery in primary open-angle glaucoma

To assess good prognostic factors of Trabectome surgery in primary open-angle glaucoma (POAG), clinical records of patients with POAG who underwent Trabectome surgery with/without cataract surgery as the first additive therapy to eye drops between January 2015 and March 2018 were retrospectively reviewed. Overall, data of 79 eyes (79 patients; 50 men; mean age, 68.0 years) up to postoperative 24 months were analyzed. Their mean intraocular pressure (IOP) was 20.4 ± 6.0 mmHg at baseline. Forty-two eyes (53.2%) achieved an IOP < 15 mmHg and ≥ 20% reduction from baseline without additional treatments. Phakic eyes had a better survival probability than pseudophakic eyes after adjusting for age, sex, baseline IOP, best-corrected visual acuity, and eye drop score (hazard ratio 3.096; 95% confidence interval [95% CI] 1.367–7.013; P = 0.007). Phakic eyes treated with combined Trabectome and cataract surgeries (mean survival time, 22.250 months; 95% CI 17.606–26.894) had a better survival probability than pseudophakic eyes treated with Trabectome surgery only (mean survival time, 12.111 months; 95% CI 8.716–15.506; P = 0.009) after the adjustment. Among the eyes treated with Trabectome surgery only, phakic eyes required significantly less additional treatments than pseudophakic eyes (P = 0.04). Trabectome surgery may be indicated for phakic eyes with POAG in addition to eye-drop therapy.