Primary Eyes Research Articles

Corneal Biomechanical Changes Caused by Acute Elevation of IOP in Eyes with and without Glaucoma.

Although corneal biomechanical parameters are well linked with glaucoma, their clinical utility has not yet been fully elucidated. This study was designed to provide unique evidence about the dynamic nature of corneal biomechanical parameters and their potential prognostic ability for glaucoma. This study aimed to evaluate the effect of acute intraocular pressure (IOP) elevation on corneal hysteresis (CH) and corneal resistance factor (CRF) and the associations of these biomechanical parameters with glaucomatous disease. Subjects participating in a prospective, longitudinal glaucoma research study had CH and CRF measured before and during ophthalmodynamometry during visits in the years 2011 to 2012. All participants were diagnosed with primary open-angle glaucoma, ocular hypertension, glaucoma suspect, or normal eyes and had a minimum of 3 years of study participation with at least five reliable visual field (VF) tests. Changes in CH, CRF, and IOP induced by ophthalmodynamometry were compared between diagnostic groups and evaluated for relationships with existing and future glaucomatous VF loss. In 248 eyes of 248 subjects followed up for 7.7 ± 2.3 years, ophthalmodynamometry induced a mean IOP increase from 15.1 to 29.9 mmHg, causing a mean 34 ± 28% increase in CRF and 21 ± 25% decrease in CH. Magnitude of CH change did not differ between diagnostic groups or between eyes that did (n = 20) and did not (n = 95) develop new VF loss during the study period, nor was it related to rate of future VF progression. Ophthalmodynamometry-induced IOP elevation resulted in significant acute changes in CH and CRF in this study; this suggests accounting for IOP may be important in clinical interpretation of these parameters. However, because the degree of CH change was not related to glaucoma or its progression, acute changes in CH and CRF do not seem to have a prognostic value for glaucoma.

Rate of central corneal thickness changes in primary angle closure eyes: long-term follow-up results

BackgroundCentral corneal thickness (CCT) and its association with intraocular pressure, which is a pivotal parameter in glaucoma management, has previously been reported. In this study, we intended to investigate the long-term change of CCT in terms of rate in eyes with primary angle-closure (PAC). Additionally, we aimed to analyze events that could affect CCT.MethodsIn this retrospective study, 26 patients with PAC who had a follow-up period of more than 5 years were analyzed. The rate of CCT changes from baseline was evaluated from the serial CCT measurements over the average follow-up period. The pattern of CCT change rate according to modes of treatment and history of angle-closure attack was analyzed using the repeated linear mixed model analysis.ResultsA total of 52 eyes were enrolled. The CCT reduction rate of the entire study population was − 0.72 ± 0.22 μm/yr (P = 0.001) with statistical significance. The CCT thinning rate of the laser peripheral iridotomy (PI) group was − 0.53 ± 0.25 μm/yr (P = 0.034) and that of the surgical trabeculectomy group was − 1.32 ± 0.43 μm/yr (P = 0.002), and it was not statistically significant (P = 0.112). The rate of CCT thinning in patients with a history of acute angle-closure attack was − 0.81 ± 0.31 μm/yr (P = 0.009) and that in patients without an attack was − 0.63 ± 0.30 μm/yr (P = 0.001), and it was not statistically significant (P = 0.680). Baseline CCT appeared to be the only significant factor affecting the rate of CCT changes (P < 0.001).ConclusionsWe found a significant reduction in CCT over a long observation period in PAC eyes. We also found that the rates of CCT reduction were not affected by different treatment modalities or acute angle-closure attacks. The analysis of long-term CCT changes in conjunction with baseline CCT would also be helpful in the clinical evaluation of the PAC patients.

Secondary Endothelial Keratoplasty-A Narrative Review of the Outcomes of Secondary Corneal Endothelial Allografts.

We review the literature on the efficacy and safety outcomes of secondary Descemet stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). Literature search of English-written publications up to September 27, 2020 in PubMed database, using the terms "endothelial keratoplasty" in combination with keywords "secondary" or "repeat." In addition, we manually searched the references of the primary articles. Twenty-seven studies (n = 651 eyes) were retained and reviewed, including 10 studies on repeat DSEK, 8 studies on repeat DMEK, 6 studies of DMEK following DSEK, and 3 studies of DSEK after failed DMEK. All studies reported significant improvement in visual acuity after secondary endothelial keratoplasty (EK). Twelve studies compared visual outcomes between primary and secondary EK, reporting conflicting findings. Sixteen studies reported endothelial cell loss rates after secondary EK, and only 1 study reported significantly increased endothelial cell loss rates compared with primary EK. Allograft rejection episodes occurred in 1.8% of eyes (range, 0%-50%). Six studies compared complication rates between primary and secondary EK eyes, and only 1 study found a higher median number of complications. However, 2 studies reported higher regraft failure rates compared with primary EK eyes. Secondary EK is surgically feasible and renders significant visual improvement after failed primary EK, although it is not clear whether visual outcomes and allograft survival are comparable with primary EK, raising the question of whether secondary EK eyes are "low risk" as primary EK eyes. Further larger, prospective studies are encouraged to obtain additional quality data on secondary corneal endothelial allotransplantation.

Progressive Thinning of Retinal Nerve Fiber Layer and Ganglion Cell–Inner Plexiform Layer in Glaucoma Eyes with Disc Hemorrhage

To evaluate the thinning of the circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) in primary open-angle glaucoma eyes with and without a history of disc hemorrhage (DH). Observational cohort study. Thirty-nine 39 eyes (34 participants) with DH and 117 eyes (104 participants) without DH from the Diagnostic Innovations in Glaucoma Study and the African Decent and Glaucoma Evaluation Study. Participants had at least 1.5 years of follow-up, with a minimum of 3 visits with biannual spectral-domain OCT cpRNFL and mGCIPL thickness measurements and visual fields (VFs). The rates of cpRNFL and mGCIPL thinning were calculated using mixed-effects models. The dynamic range-based normalized rates of cpRNFL and mGCIPL thinning were calculated and compared between the DH and non-DH groups. Rates of cpRNFL and mGCIPL thinning. The rate of mGCIPL thinning was significantly faster in the DH group compared with the non-DH group (-0.62 μm/year vs. -0.38 μm/year; P= 0.024). The rate of cpRNFL thinning in the DH quadrant and rate of mGCIPL thinning in the inferotemporal sector in the DH group were faster than the corresponding regions in the non-DH group after adjusting for intraocular pressure (-1.33 μm/year vs. -0.58 μm/year; P= 0.053) and race (-0.82 μm/year vs. -0.44 μm/year; P= 0.048). In the DH group, percent rate of loss was significantly faster for the mGCIPL than the cpRNFL (-1.59 %/year vs. -1.31 %/year; P= 0.046). Rates of mGCIPL thinning were associated weakly with mean deviation slope, VF index slope, and guided progression analysis (GPA). The areas under the receiver operating characteristic curve for VF progression were 0.75 for mGCIPL and 0.56 for cpRNFL in the DH group. The rate of mGCIPL and cpRNFL thinning was faster in DH eyes than non-DH eyes. Compared with cpRNFL, mGCIPL showed higher proportional rates of thinning and greater association with functional progression. In addition to cpRNFL, clinicians should consider incorporating mGCIPL imaging to monitor glaucoma progression, especially in glaucoma eyes with DH.

Vessel density in early-stage primary open angle glaucoma and pseudoexfoliation glaucoma: a comparative controlled optical coherence tomography angiography study.

This study aimed to compare the vessel density of the optic nerve head and radial peripapillary capillary in the eyes with early-stage primary open angle glaucoma and pseudoexfoliation glaucoma and control eyes. With visual field mean deviation scores >-6.0 dB, 54 eyes from 37 patients diagnosed with primary open angle glaucoma (n=18) and pseudoexfoliation glaucoma (n=18) and healthy controls (n=18) were enrolled in this cross-sectional observational study. Retrieved from optical coherence tomography angiography, vessel density for the optic nerve head and radial peripapillary capillary were analyzed according to the distribution of the data and appropriate tests. The diagnostic accuracy of vessel density parameters was also assessed. The whole-image vessel density of the radial peripapillary capillary and inside-disc vessel density of the optic nerve head were significantly lower in eyes with primary open angle glaucoma and pseudoexfoliation glaucoma compared to those in the control eyes (p<0.05). Compared to that in pseudoexfoliation glaucoma, the inside-disc vessel density of the optic nerve head was significantly lower in primary open angle glaucoma (p<0.05). Inferotemporal sector vessel density of the optic nerve head for both primary open angle glaucoma and pseudoexfoliation glaucoma was significantly lower than that of the controls (p=0.009). In discrimination of primary open angle glaucoma vs. control and pseudoexfoliation glaucoma vs. control, area under the receiver operating characteristic curve values for inside-disc vessel density of the optic nerve head were 0.855 and 0.731, respectively (p<0.001, p=0.018). However, in discrimination of primary open angle glaucoma vs. pseudoexfoliation glaucoma, area under the receiver operating characteristic curve values for whole-image and inside-disc vessel densities of the optic nerve head were 0.707 and 0.722 (p=0.034, p=0.023). Vessel densities of the optic nerve head and radial peripapillary capillary were significantly lower in eyes with primary open angle glaucoma and pseudoexfoliation glaucoma compared to healthy control eyes. In the early stage of glaucoma, the inside-disc vessel density of the optic nerve head slab may be lower in eyes with primary open angle glaucoma eyes compared to eyes with pseudoexfoliation glaucoma.

Automated iris volume analysis and trabecular meshwork length using anterior segment optical coherence tomography - Application in pseudoexfoliation and pseudoexfoliation glaucoma.

Purpose:The aim of this study was to evaluate differences in the iris and angle parameters in psuedoexfoliation syndrome (PXF) and pseudoexfoliation glaucoma (PXG) using anterior segment optical coherence tomography (ASOCT).Methods:Patients with PXF or PXG were compared using ASOCT with primary open-angle glaucoma POAG eyes as controls in this noninterventional comparative study conducted at a tertiary eye care center in East India. All angle parameters, TM length, and iris thickness were analyzed from the enhanced depth imaging (EDI) single scans obtained. Quadrant scans were used for the calculation of iris volume using a custom-built in-house software. In particular, the software performs multiple operations including edge detection, connected components, and thresholding to localize and segment the iris. Differences in the iris volume/thickness and TM length in PXF and PXG with POAG were analyzed.Results:A total of 225 eyes were included, which included 75 PXG and 98 PXF cases and 52 POAG with a mean age of 67 ± 9.7 years at presentation. The algorithm repeatability and reproducibility was also established with correlation coefficients more than 99% which was substantiated with Bland-Altman plots. The iris volume (calculated in 197 images of 225 eyes) did not differ significantly in PXF and PXG eyes, although both had significantly greater volume compared to POAG eyes. The iris volume or other angle parameters including TM length did not correlate with clinical variables such as IOP, age, or visual field indices.Conclusion:Iris parameters or TM length do not explain pathogenesis of glaucoma in pseudoexfoliation.

Aerobic exercise reduces intraocular pressure and expands Schlemm's canal dimensions in healthy and primary open-angle glaucoma eyes.

Purpose:Aerobic exercise (AE) has been reported to decrease intraocular pressure (IOP) in healthy subjects and there are concomitant morphological changes in the anterior segment of the eye including the Schlemm’s canal (SC). However, its effects on IOP and SC morphology in glaucoma patients had not been studied before. We aim to investigate the effect of AE on the IOP and SC dimension in both healthy and primary open-angle glaucoma (POAG) eyes.Methods:The area and diameter of SC and IOP were measured in 35 primary open-angle glaucoma (POAG) patients (59 eyes) and 36 healthy subjects (72 eyes) before and after performing moderate intensity of AE by running on a treadmill for 30 min. SC was imaged by swept-source optical coherence tomography (SS-OCT) for evaluation.Results:In comparison with baseline values, mean IOP decreased significantly following AE in both POAG and healthy eyes (both P < 0.001), in which POAG eyes showed a greater degree of reduction compared to healthy eyes (P = 0.002). In comparison with baseline values, in both POAG and healthy eyes, the average cross-sectional area (POAG: 80.48 +/- 59.54 vs. 99.20 +/- 54.87 pixels; healthy: 151.84 +/- 52.76 vs. 198.23 +/- 53.70 pixels; both P < 0.001) and diameter (POAG: 3.73 +/- 1.69 vs. 4.33 +/- 1.74 pixels; healthy: 5.61 +/- 1.02 vs. 6.47 +/- 1.20 pixels; both P < 0.001) of SC significantly increased after AE. In POAG, both treated and untreated with IOP-lowering medications, a significant reduction in mean IOP and increase in SC dimensions following AE were observed (all P < 0.05), and there were no significant differences of such measurements between the two subgroups (all P > 0.05).Conclusion:AE-induced reduction in IOP and an increase in SC dimensions in POAG eyes as in healthy eyes. Further studies to evaluate the long-term effect of AE on IOP control and SC morphology in POAG seem warranted.

Anterior and posterior segment structural features of acute primary angle-closure eyes: date based on AS-OCT and SS-OCT

Anterior and posterior segment structural features of acute primary angle-closure eyes: date based on AS-OCT and SS-OCT

Role of Surgeon Experience in Pterygium Surgical Outcomes: A Comparative Study Between Ophthalmology Resident and Consultant.

PurposeAlthough surgical technique and patient variables are responsible for the recurrence of pterygium, the surgeon's experience has been sparsely studied. This retrospective study was designed to compare the surgical time, complications, and rates of recurrence after primary pterygium excision between consultant ophthalmologists and trainee residents.Material and methodsIn this retrospective study, we collected the data of 176 primary pterygium eyes, who were operated on with excision and sutureless/glueless conjunctival autograft either by the consultant (group A) or by the trainee (group B). The demographic profile, surgical time, complications, and recurrences between both groups were analyzed.ResultsBoth the groups were comparable with regards to age, gender, religion, side of the eye, size of the pterygium, and duration of follow-up. The mean operative time was longer in group B (26.5+/-3.8 minutes) than group A (14.2+/-1.6 minutes). Though a relatively higher percentage of complications was observed in group B (12% vs. 9%), the difference was statistically not significant (Mann-Whitney U test, p-value 0.271). There was no statically significant difference in recurrence rate (6.8% vs 9.4%) between the groups.ConclusionWith regards to the role of surgeon experience in primary pterygium excision using the sutureless and glueless conjunctival autografting technique, the residents did not have any statistically significant differences in their postoperative complications and recurrence rates. However, the surgical time was significantly higher in the resident group owing to the learning curve.

Pterygium excision with modified bare sclera technique combined with mitomycin C.

Numerous surgical methods, with varying rates of recurrence, have been applied for the treatment of pterygium. Adjuvant mitomycin C (MMC) application has shown promising results in the prevention of recurrence. Here we propose and describe modified bare sclera technique combined with the intraoperative application of MMC for pterygium excision. Retrospective study. Primary pterygium patients who underwent pterygium excision via the bare sclera combined with 0.04% MMC technique from January 2014 to December 2016 were reviewed. In all patients, the subconjunctival pterygium strand was exposed and then sufficiently excised in combination with the safe use of MMC; i.e., the prevention of MMC dilution and diffusion to surrounding tissue. Surgical complications, recurrence rates, and recurrence onset were recorded. This study involved 32 primary pterygium eyes (grade T1 = 22 eyes; 68.7%). The mean postoperative follow-up period was 26.4 ± 14.5months (range: 12-60months). MMC was applied for 1-3min. The mean complete epithelialization was 12.6 ± 7.6days and no surgical complications were observed. In 1 patient with double-head primary pterygium, recurrence occurred at 15-months postoperative. The modified bare sclera technique combined with MMC application was found to be safe, effective, and presents good cosmetic appearance for the treatment of primary pterygium when safety points are strictly applied.

Combined thermomechanical and optical simulations of planar-optical polymer waveguides

In this work, we describe a theoretical approach for combined thermal, mechanical and optical simulation and analysis of planar polymer waveguides. We consider a finite element approach for thermal and stress/deformation simulation. Also, a Crank-Nicholson finite difference beam propagation method (CN-BPM) is implemented to perform the optical simulation. The results of the finite element (thermo-mechanical) analysis are coupled with the CN-BPM results to carry out the optical simulation of poly(methyl methacrylate) (PMMA) waveguides as function of temperature. For thermal simulation, a model was designed where a polysilicon microheater was added to the upper cladding of the PMMA waveguides to vary the temperature between 20 °C and 200 °C. Thus, the impact of the induced temperature gradients on the refractive index modulation of the PMMA waveguides and the corresponding change in numerical aperture are obtained. In addition, the temperature gradients influence the beam intensity profiles and the movement of the primary eyes within the optical waveguides, thus, impacting the optical properties. Furthermore, the thermally induced mechanical stress and deformation were calculated for transverse and axial directions. In the next step, validation of the model by systematic experimental studies will be performed. In general, our approach provides a toolbox for more comprehensive multi-physics theoretical analysis of polymer-optical waveguides which, in future, can be extended to more complex and functional structures as required for flexible sensor networks, as example.

Ab interno vs ab externo microcatheter-assisted trabeculotomy for primary congenital glaucoma with clear cornea.

ImportanceThis is the first comprehensive comparison between ab interno approach and ab externo approach for microcatheter‐assisted trabeculotomy in primary congenital glaucoma with clear cornea.BackgroundAb externo microcatheter‐assisted trabeculotomy is considered to be the gold standard for primary congenital glaucoma. The novel ab interno approach would intuitively be similar to ab externo approach for microcatheter‐assisted trabeculotomy in eyes with clear cornea; however, there is no evidence yet.DesignNon‐contemporary comparison of retrospective case series.ParticipantsFifty‐eight and fifty‐seven consecutive primary congenital glaucoma eyes with clear corneas underwent ab interno and ab externo microcatheter‐assisted trabeculotomy, respectively.MethodsRetrospective comparison of clinical outcomes.Main Outcome MeasuresSurgical success was defined as a postoperative intraocular pressure of ≤21 mmHg with at least a 30% reduction from preoperative IOP with or without the use of anti‐glaucoma medication (qualified and complete success, respectively).ResultsThe qualified success rate (87.9% vs 82.2%, P = .40) and complete success rates (81.0% vs 73.3%, P = .32) were comparable between groups. Complications were minimal and comparable. Less than 360° trabeculotomy (P = .009) and a higher number of previous surgeries (P = .03) were both associated with worse surgical outcomes.Conclusions and RelevanceAb interno approach provide good and comparable outcomes as ab externo approach for microcatheter‐assisted trabeculotomy in primary congenital glaucoma eyes with clear cornea. It should be considered as the initial choice in these patients with the benefit of sparing conjunctiva. Successful trabeculotomy with either technique during the first attempt is critical to overall success and underscores the need for proficiency before independent practice.

Incidence and Management of Cystoid Macular Edema after Corneal Transplantation

In this review, we overview the incidence and management of cystoid macular edema following endothelial keratoplasty (EK) including Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Incidence of CME was 2.0–12.7% following DSAEK and 0.7–15.6% following DMEK. Glaucomatous eyes, in particular, with primary angle closure glaucoma and eyes with severe iris damage and eyes with combined EK with transscleral intraocular lens implantation experienced postoperative CME at a higher incidence. Topical non-steroidal anti-inflammatory (NSAIDs) and intensive topical steroid can effectively treat and prevent CME recurrences. CME is one of the major complications following EK and can be involved in the limitation of the recovery of postoperative visual acuity. Careful attention should be paid to patients with systemic and ocular conditions, as these might trigger postoperative CME. The prophylactic use of NSAIDs and intensive steroid treatment may be a reasonable approach.

Predictive factors of Boston Type I Keratoprosthesis outcomes: A long-term analysis

PurposeTo study the long-term visual- and device retention-related outcomes and complications of the Boston Type I Keratoprosthesis (KPro). MethodsSingle-center, retrospective cohort study of all patients undergoing KPro implantation from February 2007 to April 2014 with at least 5 years of follow-up. Results68 eyes from 65 patients underwent KPro implantation during the study period. At 5 and 10 years, the probability of maintaining or improving visual acuity (VA) was 75.0% and 66.7%, respectively, and the probability of KPro retention was 89.2% and 89.2%, respectively. Initial device retention rate at 10 years was significantly lower in those with underlying ocular surface disease (46.8% [30.6–63.2] vs 75.8% [61.0–90.7], P = 0.03), while other baseline characteristics showed no significant association. Final VA was more likely to be stable or improved in patients with fewer failed grafts (2 [1–6] vs 3 [1–6], P < 0.01), and a final VA of 20/200 or better was more likely in primary KPro eyes (44.8% [26.7–62.9] vs 19.4% [6.5–32.3], P = 0.03). Combined KPro-vitrectomy eyes were more likely to have stable or improved final VA than non-vitrectomy eyes (88.5% [76.2–100.0] vs 64.1% [49.1–79.1], P = 0.04). All complications had increasing incidence beyond 5 years; in particular, corneal melt, surgical glaucoma interventions, and endophthalmitis tended to have late presentations, with 79.0%, 78.6%, and 88.9% of these complications occurring beyond one year, respectively. ConclusionsKPro devices show favorable long-term visual and retention outcomes in select patients. Careful long-term, multidisciplinary follow-up is warranted to address potential complications.

Peripapillary Choroidal Thickness Measurement in Glaucoma Patients Using Spectral Domain Optical Coherence Tomography

Abstract Background: Glaucoma, the leading cause of irreversible blindness worldwide, can adversely impact quality of life for patients with visual field defects even if they are unaware of their diagnosis. In many populations, POAG is the most common form of the disease. Aim of Study: To measure peripapillary choroidal thickness in eyes with primary open angle glaucoma versus normal eyes using spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging mode (EDI). Patients and Methods: The present study involved Ninety eight eyes of fifty adult patients were included in this obser-vational, case control study. These cases were collected from out-patient ophthalmic clinic of Ain Shams University Hospital during the period from March, 2018 till March, 2019. Results: A total 98 eyes of 50 patients were included in this observational study, with mean age of 52.26 years old. 48% of patients were males [24/50], while females were 52% [26/50]. These cases were divided into control group (50 eyes of 25 healthy controls) and glaucoma group (48 eyes of 25 patients). Conclusion: Peripapillary choroidal thickness (PCT) in primary open angle glaucoma cases shows no significant correlation nor in early or sever cases, so PCT has no role in early detection or follow-up of primary open angle glaucoma cases.

Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes.

To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG), ocular hypertension (OHT) and normal eyes using optical coherence tomography angiography (OCTA). A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups (aged 68.17±6.30y, 61.11±10.26y, 58.1±8.9y, and 56.9±4.6y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density (VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness (RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic (ROC) curves. The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors (44.35%±6.78% vs 50.47%±1.83%, P<0.001), the superficial (44.08%±5.46% vs 51.28%±2.85%, P<0.001) and the deep (45.13%±8.55% vs 54.20%±5.44%, P<0.001) vascular plexus. There was a significant difference in peripapillary VD between glaucomatous and OHT eyes (44.35%±6.78% vs 49.86%±2.45%, P<0.001). The OHT group featured a lower superficial (48.06%±4.32% vs 51.28%±2.85%, P=0.027) and deep plexus (48.70%±5.99% vs 54.20%±5.44%, P=0.013) whole image vessel density (wiVD) than did the control group. The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG (42.22%±5.36% vs 46.54%±5.56%, P=0.046). OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT, and these results are correlated to functional and structural glaucomatous alterations. Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG. Furthermore, the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.

Association of High-Mobility Group Box-1 with Inflammationrelated Cytokines in the Aqueous Humor with Acute Primary Angle-Closure Eyes.

The aim of this study was to measure the levels of High-mobility group box-1 (HMGB1) and inflammation-related cytokines in the aqueous humor of patients with acute primary angle-closure glaucoma (APAG) and age-related cataract eyes (ARC). Aqueous humor samples were obtained from 59 eyes of 59 Chinese subjects (APAG, 32 eyes; and ARC, 27eyes). The multiplex bead immunoassay technique was used to measure the levels of HMGB1 and IL-8, IL-6, G-CSF, MCP-3, VEGF, sVEGFR- 1, sVEFGR-2, TNF-α, PDGF, and IL-10 in aqueous. The data of Patients' demographics and preoperative intraocular pressure (IOP) were also collected for detailed analysis. The APAG group showed significantly elevated concentrations of HMGB1, IL- 8, IL-6, G-CSF, VEGF, sVEGFR-1, and TNF-α than those in the ARC group. Aqueous HMGB1 level correlated significantly with IOP, IL-8, IL-6, G-CSF and sVEGFR-1 levels but not with age, TNF-α, or VEGF levels. The aqueous level of HMGB1 is elevated in APAG and associated with aqueous level of inflammation-related cytokines, suggesting an association between elevated levels of HMGB1, APAC and certain inflammatory modulators which, of course, should lead to further investigations in order to demonstrate the cause and effect.

Descemet Membrane Endothelial Keratoplasty: Ten-Year Graft Survival and Clinical Outcomes

To evaluate the 10-year graft survival and clinical outcomes of the first case series after Descemet membrane endothelial keratoplasty (DMEK). Retrospective, interventional case series. After excluding the very first 25 DMEK eyes that constitute the technique learning curve, the following 100 consecutive primary DMEK eyes (88 patients) were included. Main outcome parameters (survival, best-corrected visual acuity [BCVA], central endothelial cell density [ECD], and central corneal thickness [CCT]) were evaluated up to 10 years postoperatively, and postoperative complications were documented. At 5 and 10 years after DMEK, 68 and 57 of 100 eyes, respectively, were still available for analysis. Of those eyes, 82% and 89% reached a BCVA of ≥20/25 (decimal VA ≥0.8) at 5- and 10 years postoperatively, respectively. Preoperative donor ECD decreased by 59% at 5 years and 68% at 10 years postoperatively. CCT averaged 668 ±74μm preoperatively and 540 ± 33μm and 553 ± 43μm at 5 and 10 years, respectively, after surgery. Within 10 years, 4% of eyes developed allograft rejection, no primary graft failures occurred, and 6% of the eyes developed secondary graft failure. Graft survival probability was 0.83 (95% confidence interval [CI], 0.75-0.92) and 0.79 (95% CI, 0.70-0.88) at 5 and 10 years postoperatively, respectively. Most eyes that underwent surgery in the pioneering phase of DMEK showed excellent and stable clinical outcomes with low postoperative complication rates and promising graft longevity over the first decade after surgery. This suggests that DMEK may be a safe long-term treatment option for corneal endothelial diseases.

Utilization of anterior segment optical coherence tomography (AS-OCT) enhanced high resolution corneal (EHRC) software in measuring Pterygium thickness

Introduction: To propose an objective method of quantifying pterygium thickness using AS-OCT. Methods: Anterior segment imaging was performed using Enhanced High Resolution Corneal (EHRC) of Visante™ OCT in 68 primary pterygium eyes. Prior to imaging, corneal topography assessment was performed on each pterygium eye in order to identify its topographic location. Based on topography mapping, three meridians (in degrees) were selected as close as possible to the pterygium border, which signify the demarcation of pterygium from the cornea. Reliability testing between intra and inter-observer on OCT imaging modality was examined using Intraclass correlation (ICC) and scatter plot. Results: The overall (n = 68) mean and SD of pterygium thickness via OCT modality were 0.48 ± 0.10 mm (CI: 0.45 – 0.50). OCT imaging also showed excellent intra and intergrader reliability in measuring pterygium thickness with ICC of 0.997 (CI: 0.994 – 0.998). Conclusions: We have described and demonstrated the use of EHRC as an objective measurement for pterygium thickness. This tool proved could eliminate the variability of human inter-graders in assessing thickness of pterygium with its promising ICC. This study had proved that anterior segment OCT imaging is a better choice in assessing pterygium compared to traditional slit-lamp biomicroscopy. We suggest that this tool is applicable for future work such as to understand the role thickness in pterygium morphology and its progression. Better understanding of pterygium morphology is important for future clinical decision, especially on prediction of induced corneal astigmatism and visual impairment due to pterygium.

Repeat Descemet Membrane Endothelial Keratoplasty for Failed Primary Descemet Membrane Endothelial Keratoplasty at a Referral Center for Keratoplasty in Spain: DIMOEK Study

To analyze the clinical results of repeat Descemet membrane endothelial keratoplasty (re-DMEK) for failed primary DMEK graft at a referral center for keratoplasty in Spain. Retrospective, interventional, comparative case series. From a single-center, single-surgeon series of 189 consecutive DMEK surgeries, 14 (7.41%) were re-DMEK eyes. The primary outcome was best-corrected visual acuity change (ΔBCVA, logarithm of minimal angle of resolution [logMAR]) from baseline (before first DMEK) to last follow-up. Secondary outcomes were ΔBCVA from baseline at 3, 6, and 12months postoperatively, endothelial cell loss (%ECL), rebubbling rate, and re-DMEK graft failure. Outcomes were compared with an age-matched control group of 18 successful primary DMEK eyes. After re-DMEK (median follow-up time 14.5 [42.5] months), mean BCVA improved from 0.55 (0.42) logMAR (Snellen 20/71 [20/53]) at baseline to 0.09 (0.26) logMAR (Snellen 20/25 [20/36]; P= .037). ΔBCVA from baseline was statistically significant at months 3 (P= .028), 6 (P= .023), and 12 (P= .012), and ΔBCVA was significant observed between months 6 and 12 (P= .028). BCVA differences between patient groups were statistically nonsignificant at 3 (P= .397), 6 (P= .468), and 12months (P= .647). Mean %ECL in re-DMEK eyes with follow-up ≥12months was 48.2 (15.1%), and the rebubbling rate was 28.6%; differences between groups were statistically nonsignificant for both variables (P= .580 and P= .669, respectively). Three re-DMEK eyes developed graft failure, all achieving final BCVA ≤0.30 logMAR (Snellen ≥20/40) after tertiary keratoplasty. Repeat DMEK produces significant, continuous visual improvement after failed primary DMEK. Although visual outcomes and %ECL were comparable to primary DMEK, there was a relatively high rate of graft failure after re-DMEK.