Postoperative Intraocular Pressure Rise Research Articles

Investigation of subclinical ocular inflammation in the aqueous humor of patients with myopia following bilateral sequential collamer lens implantation

BackgroundThe aqueous humor, a transparent fluid secreted by the ciliary body, supports the lens of the eyeball. In this study, we analyzed the cytokine and chemokine profiles within the aqueous humor of the contralateral eye post-implantation of an implantable collamer lens (ICL) to evaluate potential subclinical inflammation in the second eye subsequent to ICL implantation in the first eye. MethodsAqueous humor samples were procured from both eyes of 40 patients (totaling 80 eyes) prior to bilateral ICL insertion. Subsequently, a comprehensive statistical analysis was conducted using the Luminex assay to quantify 30 different cytokines in these samples. ResultsCompared to the first eye, the aqueous humor of the second eye demonstrated decreased concentrations of IFN-γ (P = 0.038), IL-13 (P = 0.027), IL-17/IL-17 A (P = 0.012), and IL-4 (P = 0.025). No significant differences were observed in other cytokine levels between the two groups. Patients were then categorized based on the postoperative rise in intraocular pressure (IOP) in the first eye. The group with elevated IOP displayed elevated levels of EGF in the aqueous humor of the first eye (P = 0.013) and higher levels of PDGF-AB/BB in the aqueous humor of the second eye (P = 0.032) compared to the group with normal IOP. Within the elevated IOP group, the levels of EGF (P = 0.013) and IL-17/IL-17 A (P = 0.016) in the aqueous humor were lower in the second eye than in the first eye. In the normal IOP group, cytokine levels did not differ notably between eyes. ConclusionFollowing sequential ICL implantation, it appears that a protective response may be activated to mitigate subclinical inflammation in the second eye induced by the initial implantation in the first eye. Additionally, the increase in IOP subsequent to surgery in the first eye may correlate with the presence of inflammatory mediators in the aqueous humor.

Raised Intraocular Pressure Secondary to Vitreoretinal Procedures: A Literature Review

The anatomical proximity of anterior and posterior segment structures and the familiar microcirculatory milieu make both susceptible to arduous complications when either is surgically handled. Because of the complex haemodynamic reciprocity between vitreous, retina, choroid, and aqueous humour, any trivial alteration in one can present a catastrophic consequence in the other. A good number of evidence.based studies have already substantiated that postoperative rise in intraocular pressure (IOP) is a well-recognised complication after vitreoretinal surgeries like scleral buckling, pars plana vitrectomy (PPV), intravitreal gas and silicon oil injection as well as intravitreal steroid and antivascular endothelial growth factor (VEGF) injection. The cause is multifactorial. Determining the cardinal pathophysiological mechanism is very decisive as it provides the ultimate guide to opting for the suitable treatment modality. The superimposing clinical features mystify the diagnosis, and pre.existing conjunctival scars and episcleral explants make any further surgical management very tough. In many cases, anti-glaucoma medications are beneficial for managing the temporary rise in IOP. However, the options of laser treatment and filtration surgeries can be considered in resistant cases, and glaucoma drainage devices are the last resort for refractory patients where filtration surgeries fail. In this review, we provide fundamental insight into the possible pathogenic mechanisms, specifically focusing on how to discriminate among them and strategically approach the management with secondary elevation in IOP following vitreoretinal surgeries.

EyeCee One preloaded intraocular lens: are patients with glaucoma more at risk?

ObjectiveThe Medicine and Healthcare products Regulatory Agency reported links of raised intraocular pressure (IOP) with recently implanted EyeCee One intraocular lens (IOL). This work investigates if glaucomatous eyes were more...

Diluting 2.5% Viscoadaptive Sodium Hyaluronate to Prevent Postoperative Intraocular Pressure Rise After Phacoemulsification: A Pilot Study.

The most common complication with intraoperative viscoelastic use is an immediate elevation of intraocular pressure, particularly if the viscoelastic agent remains in the eye, which can cause serious effects. Complications may include severe ocular pain, corneal epithelial edema, and increased risk of anterior ischemic optic neuropathy and retinal artery occlusion. This study aims to find an efficient and safe adjunctive method to decrease the incidence of postoperative intraocular pressure rise. When cohesive viscoelastic agents were unavailable due to the pandemic, we diluted Microvisc 2.5% sodium hyaluronate ophthalmic viscosurgical device by 50% prior to intraocular lens implantation. Twelve eyes are included in this study, which are divided into two groups. The study followed a double-blinded methodology in which the physician and the patient were unaware of what group they were in. The first group (seven patients, seven eyes) was treated using the diluted Microvisc 2.5%, and the second group (five patients, five eyes) was controlled with the undiluted Microvisc 2.5%. The primary variable was intraocular pressure, measured at four different timeline points (baseline, day 1, week 1, and month 1). We found that the technique used had easier irrigation and aspiration with minimal viscoelastic agent left in the bag, leading to a lower postoperative intraocular pressure spike. Analysis was conducted using the Wilcoxon signed rank test, and significance was noted between the two groups on postoperative day 1 (p=0.042). The analysis also included the populations' comorbidities (hypertension and diabetes) and postoperative outcomes (pain, corneal edema, and visual acuity).

PreserFlo™ MicroShunt Versus Trabeculectomy in Patients With Moderate to Advanced Open-Angle Glaucoma: 12-Month Follow-Up of a Single-Center Prospective Study.

Purpose: The study compares the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) and trabeculectomy in eyes with moderate to advanced open-angle glaucoma.Methods: In this prospective study, 300 patients (300 eyes) with moderate to advanced open-angle glaucoma were treated with either PreserFlo MicroShunt or trabeculectomy. The implantation of the PreserFlo MicroShunt was performed in 150 eyes (group A) and trabeculectomy was performed in 150 eyes (group B). The efficacy was evaluated by estimating the absolute and qualified success rates using the Kaplan-Meier survival analysis. Results: During the 12-month follow-up period, 81.33% of eyes in group A and 94% in group B reduced intraocular pressure (IOP) >20% without glaucoma eye drops. The average IOP 12 months after surgery was 12.89±3.4 mmHg in group A and 11.39±4.5 mmHg in group B, which was significantly lower than the baseline intraocular pressure (group A: 23.47±8.36 mmHg, p=0.00053; group B: 22.03±5.2 mmHg, p= 0.0006). The number of topical medications administered 12 months after ocular surgery was 0.4±0.8 in group A and 0 in group B, compared to 2.5±1.2 in group A and 2.7±0.9 in group B at baseline (group A: p= 0.00091; group B: p= 0.00072). Ten eyes (6.67%) in group A and four eyes (2.67%) in group B were referred for bleb revision due to bleb fibrosis and consequent acute postoperative rise in IOP. Four eyes of group A and two eyes of group B were treated with transscleral cyclophotocoagulation. Five eyes in group B received re-trabeculectomy because of dysfunction of the primary bleb.Conclusion: PreserFlo MicroShunt reduced the number of antiglaucoma agents compared to baseline, but was inferior to trabeculectomy at reducing IOP after 12 months. Additionally, trabeculectomy produced better absolute success rates after 12 months than PreserFlo MicroShunt in the treatment of moderate to advanced open-angle glaucoma.

Anterior staphyloma repair following trauma and surgery – A retrospective review of techniques and outcomes over 25 years

To review surgical options, techniques, and outcomes of anterior staphyloma repair done following trauma and surgery. This was a retrospective case study of patients who underwent staphyloma repair with scleral or tibial periosteal patch grafts following trauma and surgery with a minimum follow-up of 3 months postoperatively. Preoperative risk factors, choice of graft materials, surgical details, and outcomes in terms of graft uptake and tectonic integrity were analyzed. Seventeen eyes of 17 patients underwent successful staphyloma repair (scleral 15, tibial periosteal two). Mean follow-up was 47.1 months (3-159 months). Postoperative intraocular pressure rise noted in four eyes was controlled medically or surgically. Three patients underwent successful repeat patch grafting (graft melt one and recurrent ectasia two). Tectonic integrity of the eyeball was restored and maintained in all patients at the final follow-up. Comprehensive evaluation of the risk factors, control of ocular comorbid conditions, and early and meticulous surgery can optimize results.

PreserFlo™ MicroShunt Combined with Phacoemulsification versus PreserFlo™ MicroShunt as a Standalone Procedure in Patients with Medically Resistant Open-Angle Glaucoma.

Purpose:To compare the efficacy and safety of PreserFlo™ MicroShunt (Santen, Osaka, Japan) combined with phacoemulsification to PreserFlo™ MicroShunt as a standalone procedure in eyes with moderate to advanced open-angle glaucoma.Methods:In an observatory, prospective, clinical study, 30 patients (30 eyes) with moderate to advanced angle glaucoma were allocated to either PreserFlo™ MicroShunt combined with phacoemulsification (15 eyes; Group A) or PreserFlo™ MicroShunt as a standalone procedure (15 eyes; Group B). The follow-up time of the study was 12 months.Results:Average intraocular pressure (IOP) at 12 months was 11.62 ± 1.6 mmHg in Group A and 13.8 ± 3.6 mmHg in Group B, which was significantly lower than baseline IOP (Group A: 23.47 ± 8.99 mmHg, P < 0.001; Group B: 23.4 ± 8.68 mmHg, P < 0.001). The absolute reduction of IOP within the 12 postoperative months was not significantly different between the two groups (P = 0.056). The number of the topical medications that were administered 12 months after ocular surgery was 0 in Group A and 0.6 ± 0.8 in Group B, compared to 3.13 ± 1.02 in Group A (P < 0.001) and 2.4 ± 1.45 in Group B (P = 0.004) at baseline. Phacoemulsification combined with PreserFlo™ MicroShunt significantly reduced the number of antiglaucoma agents after 12 months compared to the standalone procedure (P = 0.026). One eye in Group A was referred for bleb revision due to bleb fibrosis and a consequent acute postoperative rise in IOP. One eye in Group A required transscleral cyclophotocoagulation with MicroPulse® laser. One bleb revision was also necessary in Group B at the 4th postoperative week. Endothelial cell density did not significantly change over 12 months in either group (Group A: baseline, 2017.3 ± 346.8 cells/mm[2]; 12 months, 1968.5 ± 385.6 cells/mm[2]; P = 0.38; Group B: baseline, 2134.1 ± 382.6 cells/mm[2]; 12 months, 2094.4 ± 373.3 cells/mm[2], P = 0.42). The PreserFlo™ MicroShunt combined with phacoemulsification produced higher absolute success rates after 12 months in patients with moderate to advanced open-angle glaucoma than the PreserFlo™ MicroShunt as standalone procedure (Group A: 80% and Group B: 60%, P = 0.022).Conclusions:In eyes with moderate to advanced open-angle glaucoma, PreserFlo™ MicroShunt with or without phacoemulsification is effective in reducing IOP and the number of the antiglaucoma agents with a very small incidence of complications and subsequent glaucoma surgeries. However, adding phacoemulsification to PreserFlo™ MicroShunt successfully reduces IOP without the need for ongoing topical medications as are needed after the standalone procedure.

Multipiece posterior chamber intraocular lens as sutureless, glueless scleral fixated intraocular lens.

PURPOSE:The purpose of the study is to report the outcomes of sutureless, glueless multipiece posterior chamber intraocular lens (PCIOL) as scleral fixated intraocular lens (SFIOL) implantation in patients with poor or no posterior capsular support.METHODS:Medical records of 45 eyes of 42 patients who underwent SFIOL implantation where no suture or glue was used to fixate intraocular lens (IOL) to the sclera from November 2016 to October 2017, with minimum 18 months of follow-up were retrospectively analyzed. The best-corrected visual acuity, indication of surgery, other significant eye examination findings, and complications were analyzed.RESULTS:Out of 42 patients, 62% were males and 38% were females. Mean age of subjects was 48.5 ± 16.5 years (range 13–79 years). Mean preoperative and postoperative visual acuity was 1.48 ± 0.6 Logarithm of the Minimum Angle of Resolution (logMAR) units and 0.6 ± 0.3 logMAR units, respectively. Most common complication was vitreous hemorrhage six eyes (13.3%) followed by postoperative hypotony in five eyes (11.11%). Other complications such as transient postoperative intraocular pressure rise, hyphema, tilted IOL, cystoid macular edema, retinal detachment were also noted.CONCLUSION:Multipiece PCIOL used as SFIOL without any sutures and glue is a viable, cost-effective method of IOL implantation in eyes with aphakia following surgical complication or trauma, with comparable outcome to other techniques of SFIOL implantation.

Xen45 gel stent ab interno trimming for ostium occlusion: case report

BackgroundDespite the XEN gel stent low-risk profile, various complications following the implant have been described, including internal and external occlusion, with a consequent postoperative rise in intraocular pressure (IOP). In this case report we aimed to present a XEN45 stent internal occlusion successfully treated by trimming in situ its proximal end with a 25 G vitreous scissors using a bimanual technique.Case presentationA 63-year-old male patient affected by primary open angle glaucoma (IOP = 25 mmHg) and a full thickness macular hole in his right eye, underwent ab-interno Xen gel stent implantation and, 1 month later, a 25 G vitrectomy surgery. Despite a significant IOP reduction after stent implant, 6 days after vitrectomy, IOP increased (25 mmHg) and the conjunctival bleb flattened following occlusion of stent internal ostium by a clot of presumed fibrinous material. The Nd:YAG laser failed to remove the clot, so that we decided to snip a small bit of the proximal end of the Xen tube (about 0,5 mm length) with a 25 G vitreous scissors, using a bimanual technique. In the postoperative day 1 and month 1, the IOP was 8 mmHg and 12 mmHg, respectively. The Anterior Segment OCT confirmed a functional, layered, filtering bleb, and the normal appearance and patency of the XEN proximal segment. No side effects from the intervention were observed.ConclusionsAb interno trimming with vitreous scissors of the occluded proximal end of the XEN stent may represent a safe, rapid and efficient method to restore aqueous humor subconjunctival drainage.

Using tropicamide and phenylephrine without cyclopentolate for pupil dilation in cataract surgery reduces postoperative intraocular pressure rise

The aim of this retrospective study was to evaluate whether intraocular (IOP) elevation post-cataract surgery can be reduced by using tropicamide and phenylephrine only, without cyclopentolate. Medical records across two surgical facilities were analyzed. One surgical facility (Cohort A) used a combination of tropicamide, cyclopentolate, and phenylephrine preoperatively, while the other (Cohort B) used tropicamide and phenylephrine only. Of patients in Cohort A, 63.6% (n = 7) had a higher IOP in the operated eye, while it was only 27.3% (n = 3) in Cohort B. Therefore, it is preferable to exclude the use of cyclopentolate in the preoperative dilation regimen of patients undergoing cataract surgery. However, a study with a larger sample population is required to further evaluate the significance of these results.

Descemet membrane endothelial keratoplasty in iridocorneal endothelial syndrome and posterior polymorphous corneal dystrophy

ObjectiveTo report the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) in cases of corneal decompensation secondary to iridocorneal endothelial syndrome (ICE) or posterior polymorphous corneal dystrophy (PPCD). DesignRetrospective interventional case series. ParticipantsEight eyes of 7 patients that underwent DMEK due to corneal decompensation secondary to either ICE syndrome or PPCD, and had at least 6 months of postoperative follow-up. MethodsData were collected on best corrected visual acuity (BCVA), graft attachment and survival, endothelial cell density (ECD), and intraocular pressure (IOP). BCVA change, ECD loss, and IOP elevations were analyzed. ResultsPatients’ age was 51.5 ± 13.3years. Four eyes (4 patients) had ICE syndrome and 4 eyes (3 patients) had PPCD. All procedures were uneventful. Follow-up time was 11.3 ± 7.6 months (range 6–24 months). DMEK was combined with goniosynechiolysis in 3 eyes and iridoplasty in 1 eye.BCVA improved in all eyes. Mean BCVA improved from 0.70 ± 0.34 logMAR (Snellen equivalent ∼20/100; range 20/50−20/400) preoperatively to 0.21 ± 0.14 logMAR (Snellen equivalent ∼20/34; range 20/20−20/40) at the final follow-up (p = 0.008).Donor ECD was 2740 ± 193 cells/mm2 preoperatively and 1967 ± 277 cells/mm2 at 6 months after surgery (p = 0.010)—cell loss rate of 27.8%. There were no graft rejections and no graft failures. Postoperative IOP rise (steroid response) was seen in 2 eyes, and was managed successfully with topical medical treatment. There was no evidence of glaucoma progression in any of the cases. ConclusionsDMEK surgery was effective in treating corneal decompensation secondary to ICE syndrome and PPCD. Adjunct procedures can be simultaneously combined with DMEK to address other disease aspects.

Non-Self-Sealing (Leaky) Anterior Chamber Paracentesis: A New Technique in Managing Postphacoemulsification Intraocular Pressure Rise in Glaucoma and Normal Eyes.

Phacoemulsification (phaco) for cataract extraction is 1 of the most commonly performed ophthalmic surgeries. With increasing evidence of significant intraocular pressure (IOP) reduction after phaco, the paradigm for glaucoma treatment has been shifting toward more cataract extraction instead of glaucoma surgery; thus, the population of glaucoma patients undergoing phaco is likely to continue to increase in the coming years. Although the safety of surgery has improved over the years with newer technologies and machines, postoperative IOP spike remains an important condition even after an uneventful operation. Glaucoma patients undergoing phacoemulsification are particularly at risk of further glaucomatous optic nerve damage from the transient yet potentially high pressures after phaco. Common treatments include topical, intracameral, oral, and systemic IOP-lowering medications; postoperative anterior chamber paracentesis (ACP); and so on. No single treatment to date can guarantee effective prevention or control IOP rise in the first 24 hours after phaco. Sometimes, the IOP remains high despite all of the above treatments and the risk for further glaucomatous damage may be unavoidable. In this perspective article, we discuss the incidence, causes, and treatments of IOP rise after phaco and introduce a new technique, a non-self-sealing (leaky) ACP that may be of use in regulating postoperative IOP rise, especially for patients with glaucoma.

Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty.

Perioperative medications for preventing temporarily increased intraocular pressure after laser trabeculoplasty.

Correction: Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.

[This corrects the article DOI: 10.1371/journal.pone.0165469.].

Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.

AimTo evaluate the etiology and management of elevated intraocular pressure (IOP) following posterior chamber phakic implantable collamer lens (ICL) surgery.MethodsBetween 2009 and 2015, 638 eyes of 359 subjects with refractive myopia, underwent V4b and V4c (CentraFLOW) model ICL implantation. Ocular hypertension (OHT) was defined as IOP of ≥ 22 mm Hg on two separate occasions and elevated IOP with corresponding optic disc or visual field damage was defined as glaucoma.ResultsElevated IOP ≥ 22 mm Hg was noted in 33 eyes of 30 subjects (33/638; 5.17%). Median age of subjects with raised IOP was 26 years (Inter quartile range (IQR):22, 29) and median refarctive error was -16 diopters (-19.5, -13). The median follow up was 7.8 months (IQR:0.3, 17.6) and median time for postoperative IOP rise was 12 days, (IQR:2, 24). The various etiologies for elevated IOP were steroid response in 21 eyes (64%; 10 eyes with V4b, 11 eyes with V4c), retained viscoelastic in 5 eyes (15%) (3 with V4b, 2 with V4c), pupillary block in four eyes (12%; 3 with V4b, 1 with V4c), malignant glaucoma in one eye (3%, V4b), and missed pre-existing Juvenile open angle glaucoma (JOAG) in two eyes (6% with V4b). Elevated IOP in 31 eyes resolved with conservative management. One eye (centraFLOW design) with central aquaport block by viscoelastic, needed AC wash and one eye with malignant glaucoma needed parsplana vitrectomy and hyaloidotomy. Ten eyes required longterm (>2 months) antiglaucoma medications (AGM) for IOP control. Except the two eyes with JOAG, none had disc and field damage.ConclusionIn our series, OHT was seen in 4.85% and glaucoma in 0.3% eyes that underwent V4b and V4c model ICL implantation. Multiple etiologies were noted and steroid induced ocular hypertension was the most common cause of elevated IOP followed by retained viscoelastic and pupillary block. One third of these eyes required longterm AGM for IOP control.

Segmentation and removal of fibrovascular membranes with high-speed 23 G transconjunctival sutureless vitrectomy, in severe proliferative diabetic retinopathy

AimTo evaluate the effectiveness and safety of high-speed (5,000 cuts per minute) 23 G transconjunctival sutureless vitrectomy (TSV) in severe diabetic fibrovascular proliferation (DFVP).Patients and methodsIn this retrospective consecutive case series, patients who underwent 23 G TSV for severe DFVP between October 2011 and March 2014 at our institution were evaluated. 23 G TSV was performed with a high-speed (5,000 cuts per minute) cutter without a chandelier light.ResultsThe mean follow-up period was 8 months (range: 4–23 months). Of the 27 eyes of 27 patients, 14 eyes (52%) underwent concomitant phacoemulsification with posterior chamber intraocular lens implantation, nine eyes (33%) were pseudophakic, and four eyes were phakic (15%). DFVP was removed with ease in all, and visual acuity was improved in 18 (67%) eyes. Iatrogenic retinal tear was observed in four eyes (15%) and treated successfully during surgery. Suture placement to a single sclerotomy was performed in eight eyes (30%). Postoperative intraocular hemorrhage was observed in five eyes (18%). Cataract formation was observed in two of the four phakic eyes. Three (11%) patients had postoperative intraocular pressure rise. Postoperative hypotony (≤6 mmHg) and endophthalmitis were not observed in any eye.ConclusionThe segmentation and removal of fibrovascular membranes with high-speed 23 G TSV seems to be a safe and easy method in severe diabetic eye disease.

Fakoemülsifikasyon Cerrahi Sonrası Göziçi Basınç Artışını Önlemede Topikal Dorzolamid-Timolol Maleat ile Oral Asetazolamidin Etkinlik ve Güvenilirlik Yönünden Karşılaştırılması

Objective: To compare the efficacy and safety of topical dorzolamide-timolol maleate combination with oral acetazolamide for prevention of intraocular pressure rise following phacoemulsification surgery. Material and Methods: Sixty-seven eyes of 67 patients with cataracts (33 males, 34 females) who had undergone phacoemulsification and intraocular lens implantation surgery were evaluated retrospectively. Patients were divided into two groups. Group 1 comprised 33 (49%) patients who received oral acetazolamide 250 mg (Diazomid 250 mg tb) 1 hour before the surgery and 1hour after surgery and 125 mg 3 times a day for 3 days following surgery. Group 2 comprised 34 (51%) patients who received topical dorzolamide-timolol maleate combination 1 drop 1 hour before the surgery and twice a day for 3 days following surgery. Results: The mean preoperative intraocular pressure (IOP) of the first group was 14.60±3.21 standard deviation (SD) (range 10-21) mmHg. and that of the second group was 14.67±2.77 (SD) (11-21) mmHg (p=0.924). The mean postoperative IOP(1st day) of the first group was 15.27±2.90 (SD) (11-23) mmHg and that of the second group was 14.82±2.57 (SD) (11-23) mmHg (p=0.505). The mean postoperative IOP (1st week) of the first group was 13.72±2.44 (SD) (10-18) mmHg and that of the second group was 13.64±2.53 (SD) (10-19) mmHg (p=0.895). Conclusion: For prophylaxis of postoperative IOP rise after an uneventful cataract surgery, topical-dorzolamid timolol maleate combination and oral acetazolamide therapy have similar effects, however the adverse effects of systemic acetazolamide should be taken into account. Therefore it is better to prefer topical dorzolamide-timolol maleate combination therapy.

ROLE OF VITREORETINAL SURGERY IN MAXIMIZING TREATMENT OUTCOME FOLLOWING COMPLICATIONS AFTER PROTON THERAPY FOR UVEAL MELANOMA

To assess the role of vitreoretinal surgery in maximizing treatment outcome following complications after proton therapy for uveal melanoma and to evaluate its safety. Retrospective chart study on 21 patients (2% of a total of 1,005 treated by proton therapy between January 2003 and August 2007) who had developed a complication requiring vitreoretinal surgery. Mean/median total follow-up after irradiation was 43/43 months (range, 12-70 months). Indications for surgery included vitreous hemorrhage (n = 13), epimacular membrane (n = 5), rhegmatogenous retinal detachment (n = 1), combined vitreous hemorrhage with total serous retinal detachment (n = 1), and vitritis (n = 1). Mean/median interval for vitreoretinal surgery after irradiation was 21/20 months (range, 4-45 months), and mean/median follow-up after pars plana vitrectomy was 22/23 months (range, 2-56 months). Pars plana vitrectomy was combined with retinal photocoagulation (n = 5), air/gas (n = 5), or silicone oil tamponade (n = 1). Mean Snellen visual acuity was 20/200 (0-20/40) before and 20/100 (0-20/25) after pars plana vitrectomy. A transient postoperative rise in intraocular pressure was measured in seven patients. Four patients developed phthisis bulbi. Vitreoretinal surgery was efficient in maximizing treatment outcome after proton therapy, as it allowed a better oncologic follow-up. Pars plana vitrectomy permitted panretinal photocoagulation to avoid neovascular glaucoma or retinal detachment repair. Macular surgery improved visual acuity, especially in anterior melanoma, whereas repeated surgery may increase the risk of enucleation.

Effect of intraoperative manipulation during iris-claw phakic IOL implantation on endothelium

ObjectiveTo evaluate the effect of intraoperative complications during iris-claw phakic intraocular lens (pIOL) implantation on endothelial cell survival. DesignRetrospective cohort study. ParticipantsFifty-two eyes of 26 patients with high myopia treated with the iris-claw pIOL. MethodsThe patients were divided as group 1 (no intraoperative events) and 2 (intraoperative events) according to the intraoperative events such as intraoperative bleeding, postoperative intraocular pressure (IOP) rise, and late resolution of the chamber inflammation. Endothelial cell density was compared at 1, 2, 6, 12, and 24 months after the operation prospectively. ResultsGroup 1 showed mean percentage of individual change of –0.04%±7.90% at 1 month, –0.01%±8.67% at 2 months, –0.02%±10.33% at 6 months, 0.05%±9.81% at 12 months, and 0.05%±5.33% at 24 months postoperatively. In group 2, mean percentage individual cell change was –0.17%±8.57% at 1 month, –0.13%±12.14% at 2 months, –0.13%±15.07% at 6 months, –0.17%±11.94% at 12 months, and –0.28%±13.54% at 24 months postoperatively. Two groups showed a significant differences in every visit. ConclusionsEven transient events, such as intraoperative bleeding, postoperative IOP rise, and late resolution of the chamber inflammation, would affect the survival of endothelial cells.

Intraocular pressure after descemet stripping endothelial keratoplasty (DSEK)

To assess the incidence of elevated intraocular pressure (IOP) after descemet stripping endothelial keratoplasty (DSEK). Retrospective case series. From the start of the technique in our hospital in 2003 until the middle of 2010, 73 eyes underwent DSEK, of which 66 (90.5 %) had a clear graft 1 year after surgery. IOP data pre- and postoperatively were analyzed. Follow-up was 1-5 years (mean 3.8, SD 1.3). Mean age was 71 years (SD 11, range 43-89). Three eyes (4.5 %) had a history of glaucoma before DSEK. Mean pre-operative IOP was 12.4 mmHg (SD ± 4.3). Mean IOP 1 day post-operatively was 16.4 mmHg (±9.2). Mean IOP after 1 and 6 months, and 1, 3, and 5 years were, respectively, 13.9 (±5.3), 14.7 (±5.6), 14.2 (±5.4), 13.8 (±3.7), and 12.6 (±3.5). Seventeen percent (11 eyes) had a postoperative rise in IOP which needed medical or surgical intervention: 8 % (5 eyes) had a rise in IOP 1 day after DSEK, of which 1 underwent a trabeculectomy 7 months after DSEK surgery; 6 % (4 eyes) had a rise in IOP later in the postoperative period, which could all be managed medically; and 3 % (2 eyes) had increased IOP 1 day after DSEK and later in the postoperative period, both eyes underwent a trabeculectomy 5 and 24 months, respectively, after DSEK surgery. An increase in IOP was encountered in 17 % of DSEK patients. Checking the IOP in the short and long postoperative period is necessary.