PURPOSE OF THE STUDY:The purpose of the study was to evaluate the safety and efficacy of the iStent Trabecular Micro-Bypass stent in pseudophakic patients with open-angle glaucoma.
...METHODS:Retrospective, consecutive case series from October 2012 to May 2015 with no exclusion criteria. The series comprised 42 pseudophakic eyes with open-angle glaucoma that were implanted with 1 iStent. Data were collected preoperatively, and postoperative data were collected at 1 day, 1 week, 1, 3 and 6 months, 1 year, 18 months and 2 years. Data included intraocular pressure (IOP), number of glaucoma medications, the incidence of postoperative IOP pressure spikes ≥15 mm Hg at any timepoint, and the need for additional surgery.
RESULTS:The mean preoperative IOP was 20.26±6.00 mm Hg. At 1 year postoperatively, the mean IOP was 16.34±3.78 mm Hg (P<0.01). At 2 years postoperatively, the mean IOP was 13.62±4.55 (P<0.01). The mean number of glaucoma medications was 1.95±1.01 preoperative and 1.69±1.28 (P>0.05) at 1 year postoperatively. Postoperatively, 3 eyes (7%) experienced an IOP increase of 15 mm Hg above their baseline IOP that responded to topical therapy. In total, 96% of patients with an IOP≥19 mm Hg achieved a reduction in IOP at their last collected follow-up.
CONCLUSIONS:The insertion of the iStent Trabecular Micro-Bypass stent effectively lowers IOP in pseudophakic patients with open-angle glaucoma. Although medication use was not significantly reduced postoperatively at 1 year, 80% of patients either experienced a reduction or no change in medication use. The safety profile appears favorable with a low rate of IOP spikes and only 1 patient requiring additional surgery.
The diagnosis and management of glaucoma has long been dependent on making decisions based on family history, optic nerve head evaluation, intraocular pressure, visual field testing, and optical ...coherence testing. Other pieces to aid in understanding glaucoma have presented throughout the years, including the role of corneal thickness. The discussion and debate on the mechanism of glaucoma have been attributed to resistance at the level of the conventional outflow pathway, perfusion pressure to the optic nerve head, cerebral spinal fluid pressure, and many more. Another piece that has emerged is corneal hysteresis, an assessmentof the cornea's ability to absorb and dissipate energy. There is abundant published literature supporting corneal hysteresis being associated with the presence and severity of glaucoma, the structural and functional progression of glaucoma, and the conversion to glaucoma. The supported data in these studies add another piece, corneal hysteresis, to consider in the diagnosis and management of glaucoma. Keywords: glaucoma, corneal hysteresis, corneal biomechanics
To evaluate the safety and efficacy of the iStent trabecular microbypass stent in combination with cataract surgery in patients with open-angle glaucoma (OAG).
Retrospective, consecutive case series ...from October 2012 to December 2015 with no exclusion criteria. The series comprised of 350 eyes with OAG and cataract. Data were collected both preoperatively and postoperatively at day 1 week 1, months 1, 3, 6, 12, 18, and 24. Data included intraocular pressure (IOP), number of glaucoma medications, visual acuity, the incidence of postoperative IOP pressure spikes of greater than ≥15 mmHg at any time point, and need for additional surgery.
The mean preoperative IOP was 19.13±6.34 mmHg. At 2 years postoperation, mean IOP was 15.17±3.53 mmHg (
<0.0001). The mean number of glaucoma medications was 1.19±1.00 preoperatively and 0.61±0.96 (
<0.0001) at 2 years postoperation. At 1 day postoperatively, 31 eyes (12.4%) experienced an IOP increase of 15 mmHg above their baseline IOP that responded to topical therapy. Two patients required additional tube shunt surgery.
The insertion of the iStent trabecular microbypass stent in combination with cataract surgery effectively lowers IOP in OAG patients. The magnitude of IOP reduction was more significant in patients with higher preoperative pressure. Medication use was also significantly reduced postoperatively. The safety profile appears favorable with a low rate of IOP spikes and only two eyes (<1%) requiring additional surgery.
The engulfment function of macrophages relies on complex molecular interactions involving both lipids and proteins. In particular, the clearance of apoptotic bodies (efferocytosis) is enabled by ...externalization on the cell target of phosphatidylserine lipids, which activate receptors on macrophages, suggesting that (local) specific lipid-protein interactions are required at least for the initiation of efferocytosis. However, in addition to apoptotic cells, macrophages can engulf foreign bodies that vary substantially in size from a few nanometers to microns, suggesting that nonspecific interactions over a wide range of length scales could be relevant. Here, we use model lipid membranes (made of phosphatidylcholine, phosphatidylserine, and ceramide) and rat alveolar macrophages to show how lipid bilayer properties probed by small-angle x-ray scattering and solid-state 2H NMR correlate with engulfment rates measured by flow cytometry. We find that engulfment of protein-free model lipid vesicles is promoted by the presence of phosphatidylserine lipids but inhibited by ceramide, in accord with a previous study of apoptotic cells. We conclude that the roles of phosphatidylserine and ceramide in phagocytosis is based, at least in part, on lipid-mediated modification of membrane physical properties, including interactions at large length scales as well as local lipid ordering and possible domain formation.
Introduction
This study sought to assess ocular surface disease changes following cataract surgery combined with trabecular micro-bypass stent(s) implantation (iStent or iStent
inject
).
Methods
This ...prospective interventional single-arm clinical trial enrolled 47 eyes with mild-to-moderate open-angle glaucoma (OAG) on 1–4 glaucoma medications who underwent phacoemulsification and trabecular micro-bypass stent(s) implantation. Key glaucoma and ocular surface data through 3 months postoperatively included the Ocular Surface Disease Index score (OSDI), corneal/conjunctival staining (Oxford Schema), fluorescein tear break-up time (FTBUT), conjunctival hyperemia (Efron Scale), glaucoma medications, and intraocular pressure (IOP).
Results
Mean OSDI scores improved from 40.1 ± 21.6 (severe) preoperatively to 17.5 ± 15.3 (mild) at 3 months (
p
< 0.0001). While 73% of eyes had moderate or severe OSDI scores preoperatively, 29% had such scores at 3 months, and the OSDI score was normal in 57% of eyes versus 9% preoperatively. Mean FTBUT increased from 4.3 ± 2.4 s preoperatively to 6.4 ± 2.5 s at 3 months (
p
< 0.0001); mean Oxford corneal/conjunctival staining reduced from 1.4 ± 1.0 preoperatively to 0.4 ± 0.6 at 3 months (
p
< 0.0001); mean Efron conjunctival hyperemia score reduced from 1.4 ± 0.7 preoperatively to 1.2 ± 0.6 at 3 months (
p
= 0.118). The number of glaucoma medications decreased from 1.5 ± 0.9 to 0.6 ± 0.8 mean medications (60% reduction,
p
< 0.0001), with all eyes maintaining or reducing medications versus preoperatively and 55% of eyes becoming medication-free (versus 0% preoperatively). Mean IOP reduced from 17.4 ± 4.2 mmHg to 14.5 ± 3.2 mmHg (
p
< 0.0001). The safety profile was excellent.
Conclusion
Implantation of trabecular micro-bypass stent(s) (iStent or iStent
inject
) with cataract surgery produced significant improvements in ocular surface health, alongside significant reductions in IOP and medications.
Trial registration
ClinicalTrials.gov identifier, NCT04452279.
Corneal hysteresis (CH) is used to determine the level of risk of patients developing glaucoma, categorized as suspect, mild, moderate and severe.
This is a retrospective review of 126 consecutive ...eyes presenting, for the first time, at a glaucoma subspecialty clinic. All eyes at initial examination underwent measurement of CH and intraocular pressure using the Goldmann applanation tonometry (IOPgat). Eyes were classified as CH<10 (n=51) or CH≥10 (n=75) and categorized into glaucoma suspect, mild, moderate, or severe glaucoma based on 24-2 Humphrey visual field testing. Additional data included number of topical glaucoma medications.
Of the eyes classified as a CH<10, 45.5% had moderate or severe glaucoma, and 11.8% of eyes with a CH≥10 had moderate or severe glaucoma. In the CH≥10 group, the mean IOPgat was 19.5 mmHg ± 4.72 mmHg (
<0.01) on 1 ± 1.26 (
<0.01) medications in the moderate/severe glaucoma group and 20.13 mmHg ± 4.95 mmHg (
<0.01) on 0.60 ± 0.95 (
<0.01) medications in the glaucoma suspect/mild glaucoma group. In the CH<10 group, mean IOPgat was 20.47 mmHg ± 7.56 mmHg (
<0.01) on 1.79 ± 1.17 (
<0.01) medications in the moderate/severe glaucoma group. Mean IOPgat was 17.54 mmHg ± 5.48 mmHg (
<0.01) on 0.63 ± 0.83 (
<0.01) medications in the glaucoma suspect/mild glaucoma group.
Moderate to severe glaucoma is 2.9 (
<0.01) times more likely to occur in eyes that measure a CH<10 compared to eyes that measure a CH≥10. Although not statistically significant, suspect or mild glaucoma is more common in eyes that measure a CH≥10. Eyes in the CH<10 moderate/severe glaucoma group had statistically significant higher IOPgat (
<0.01) compared to the CH<10 suspect/mild glaucoma group. Measuring CH at initial presentation can help predict the severity of glaucoma.
Defocus Curve of Emerging Presbyopic Patients Shafer, Brian M; Puls-Boever, Keeley; Berdahl, John P ...
Clinical ophthalmology (Auckland, N.Z.),
01/2023, Letnik:
17
Journal Article
Recenzirano
Odprti dostop
To create a defocus curve of emerging presbyopic patients of various age groups.
Single site private practice in Sioux Falls, South Dakota.
This was a non-randomized, prospective study. All subjects ...were enrolled from healthy volunteers.
Subjects aged 37-9, 40-42, 43-45 and 46-48 that have 20/20 best-corrected distance visual acuity (BCDVA) were included. Binocular visual acuity at different defocus steps ranging from +0.5 D to -3 D was measured in each age group. Defocus curves were generated from the mean logMAR visual acuities at each defocus step, by age group.
Of the 60 subjects, 23.3% of subjects were between the ages of 37-39, 26.7% were between the ages of 40-42, 25% of subjects were between ages 43-45, and 25% were between the ages of 46-48. Visual acuity significantly decreased from plano to -3 D defocus steps in all groups (p < 0.0002, p = 0, p = 0 and p = 0). The 46-48-year-old group had worse visual acuity compared to the other three groups from the -1.0 to -2.0 D defocus steps (p = 0.037, p = 0.022 and 0.017, respectively). Starting at a near point of 40cm, the 37-39 group had the best logMAR vision and the 46-48 group had the worst vision (p = 0.001).
The defocus curves of emerging presbyopic individuals demonstrate a decreasing visual acuity at near defocus steps that decreases with age. Defocus curves at different age ranges can help doctors explain various presbyopia treatment options in terms of near point capabilities at various ages.
Acid-catalyzed skeletal C–C bond isomerizations are important benchmark reactions for the petrochemical industries. Among those, o-xylene isomerization/disproportionation is a probe reaction for ...strong Brønsted acid catalysis, and it is also sensitive to the local acid site density and pore topology. Here, we report on the use of phosphotungstic acid (PTA) encapsulated within NU-1000, a Zr-based metal–organic framework (MOF), as a catalyst for o-xylene isomerization at 523 K. Extended X-ray absorption fine structure (EXAFS), 31P NMR, N2 physisorption, and X-ray diffraction (XRD) show that the catalyst is structurally stable with time-on-stream and that WO x clusters are necessary for detectable rates, consistent with conventional catalysts for the reaction. PTA and framework stability under these aggressive conditions requires maximal loading of PTA within the NU-1000 framework; materials with lower PTA loading lost structural integrity under the reaction conditions. Initial reaction rates over the NU-1000-supported catalyst were comparable to a control WO x -ZrO2, but the NU-1000 composite material was unusually active toward the transmethylation pathway that requires two adjacent active sites in a confined pore, as created when PTA is confined in NU-1000. This work shows the promise of metal–organic framework topologies in giving access to unique reactivity, even for aggressive reactions such as hydrocarbon isomerization.
PurposeTo create a defocus curve of emerging presbyopic patients of various age groups. SettingSingle site private practice in Sioux Falls, South Dakota. DesignThis was a non-randomized, prospective ...study. All subjects were enrolled from healthy volunteers. MethodsSubjects aged 37-9, 40-42, 43-45 and 46-48 that have 20/20 best-corrected distance visual acuity (BCDVA) were included. Binocular visual acuity at different defocus steps ranging from +0.5 D to -3 D was measured in each age group. Defocus curves were generated from the mean logMAR visual acuities at each defocus step, by age group. ResultsOf the 60 subjects, 23.3% of subjects were between the ages of 37-39, 26.7% were between the ages of 40-42, 25% of subjects were between ages 43-45, and 25% were between the ages of 46-48. Visual acuity significantly decreased from plano to -3 D defocus steps in all groups (p < 0.0002, p = 0, p = 0 and p = 0). The 46-48-year-old group had worse visual acuity compared to the other three groups from the -1.0 to -2.0 D defocus steps (p = 0.037, p = 0.022 and 0.017, respectively). Starting at a near point of 40cm, the 37-39 group had the best logMAR vision and the 46-48 group had the worst vision (p = 0.001). ConclusionThe defocus curves of emerging presbyopic individuals demonstrate a decreasing visual acuity at near defocus steps that decreases with age. Defocus curves at different age ranges can help doctors explain various presbyopia treatment options in terms of near point capabilities at various ages.
Catalytic oxidation of hydrocarbons with hydrogen peroxide (H2O2) has been of the utmost importance for several decades. The vast majority of studies have been performed in the condensed phase, even ...though condensed phases introduce complex solvent effects and can promote the leaching of active sites. In response, we have built a custom reactor system to understand H2O2 activation and selective oxidation in the vapor-phase. In this report, we study the epoxidation of cyclohexene with H2O2 over four Lewis-acidic metal oxide catalysts: Ti and Nb grafted on SiO2 and on the Zr based metal–organic framework, NU-1000. The M–SiO2 materials are highly selective to the formation of epoxides and diols, as they can be in the condensed phase, while the NU-1000 based materials are far more prone to overoxidation to CO2, which appears to be connected to their strong reactant adsorption. Apparent activation energies are calculated for all materials when operating in the same kinetic regime, and the heats of cyclohexene adsorption into their pores are then used to directly compare intrinsic enthalpies of activation in the vapor vs condensed phase for the M–SiO2 catalysts. Nb–SiO2 catalysts exhibit similar intrinsic enthalpies of activation in the vapor and condensed phases, whereas the condensed phase transition state in Ti–SiO2 is 24 kJ/mol lower in energy than that of the same material in the vapor phase. These experiments establish another methodology for understanding the various roles of solvent in selective oxidation reactions and studying these reactions under conditions that differ significantly from the thousands of prior studies in the condensed phase.
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