To assess the efficacy of collagen cross-linking in the treatment of late-onset bleb leakage.
A retrospective, interventional case-series. Cross-linking was performed for late-onset bleb leakage ...after failure of standard medical therapy. Primary outcome is measured by complete resolution of bleb leakage. Secondary outcomes including intraocular pressure and corrected distance visual acuity (CDVA) were documented over 1 year and were analyzed using repeated measure ANOVA.
Seven patients underwent cross-linking for bleb leakage between 2012 and 2013. Five (71%) had complete resolution of bleb leakage. Intraocular pressure improved from 3.9±1.0 to 7.4±1.1 mm Hg at 1 to 2 months (P=0.0003) and remained at 9.6±3.0 mm Hg at final visit (P=0.06). The corresponding CDVA also improved from 0.6±0.2 to 0.38±0.37 logMAR (P=0.0069) at 1 to 2 months before stabilizing at 0.38±0.44 (P=0.0021) at 1 year. Two cases (29%) had persistent bleb leakage after treatment. Four patients (57%) had resolved hypotony (≥6 mm Hg) at final visit. No adverse event was reported.
Collagen cross-linking is a noninvasive treatment offering reasonable success rate for filtering bleb leakage, and may spare patients invasive surgical bleb revisions.
Gather epidemiological data pertaining to the prevalence of suspected glaucoma in rural and urban areas of Haiti.
Cross-sectional pilot study.
Haitians of African ancestry.
We conducted a ...cross-sectional study on 211 Haitians of African ancestry (76 males and 135 females) aged 40 years and over. The mean age was 54.6 ± 10.9 years. The data were collected in glaucoma screening clinics at health fairs held in urban Port-au-Prince (57 people) and three rural regions (154 people) during a two-week medical mission to Haiti in November 2014. An ophthalmic exam with intraocular pressure measurement (with Tonopen) and dilated fundus exam were conducted.
The average C/D was 0.41 ± 0.18. The prevalence of suspected glaucoma, defined as C/D ≥ 0.7, asymmetry of ≥0.2 or significant rim notching, was 14.2%. The average IOP was 18.4 ± 5.4. Ocular hypertension (IOP ≥ 24mmHg) was found in 19.0% of participants.
The prevalence of ocular hypertension and glaucoma based on suspect optic nerves in our sample population was high, indicating a strong need for access to ophthalmologic care in the Haitian population.
Rassembler des données épidémiologiques sur la prévalence de suspicion de glaucome dans des zones rurales et urbaines d'Haïti.
Étude pilote transversale.
Haïtiens d'ascendance africaine.
Nous avons réalisé une étude transversale auprès de 211 Haïtiens d'ascendance africaine (76 hommes et 135 femmes) d'au moins 40 ans. L’âge moyen des sujets s’élevait à 54,6 ± 10,9 ans. Les données ont été recueillies dans des cliniques de dépistage du glaucome lors de foires sur la santé en milieu urbain (Port-au-Prince; 57 personnes) et dans 3 zones rurales (154 personnes) dans le cadre d'une mission médicale de 2 semaines à Haïti en novembre 2014. Pour ce faire, nous avons réalisé un examen ophtalmique qui comprenait la mesure de la pression intraoculaire (PIO) avec un tonomètre Tono-Pen et un examen du fond d'œil après dilatation.
Le rapport cupule/disque (C/D) moyen était de 0,41 ± 0,18. La prévalence de suspicion de glaucome, qui se définissait comme un rapport C/D ≥ 0,7, une asymétrie de ≥ 0,2 ou une encoche significative de l'anneau neurorétinien, était de l'ordre de 14,2 %. La PIO moyenne s’élevait à 18,4 ± 5,4. Quelque 19,0 % des participants présentaient une hypertension oculaire (PIO ≥ 24 mm Hg).
La prévalence d'hypertension oculaire et de glaucome est élevée si l'on en croit les anomalies des nerfs optiques que nous avons observées dans notre échantillonnage. Voilà qui donne à penser que la population haïtienne profiterait grandement d'avoir accès à des soins ophtalmologiques.
HORIZON trials have reported the medium- and long-term outcomes of the Hydrus microstent. However, outside of randomized clinical trials, outcomes beyond 24 months have not been previously reported. ...Here, we examine the 3-year outcomes of the Hydrus microstent with cataract surgery outside of a randomized clinical trial setting.
Single-surgeon consecutive case series.
Glaucomatous eyes that underwent implantation of a Hydrus microstent with concomitant cataract surgery at a single ophthalmology center in Montreal, Canada.
Success was defined according to the absence of specific failure criteria: (A) glaucoma reoperation; (B) selective laser trabeculoplasty; (C) intraocular pressure (IOP) < 5 mmHg, > 18 mmHg, or increase in the number of antiglaucoma medications (AGMs) used (after the first postoperative month), or loss of light perception due to glaucoma; (D) aggregation of criteria A-C. Predictors of treatment failure and postoperative changes in IOP and AGM use were assessed. Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GC-IPL) thickness, visual field mean deviation (VF-MD) and pattern standard deviation (VF-PSD), and adverse events.
Surgical success, predictors of treatment failure, postoperative changes in IOP and AGM use, and structural and functional markers of disease stability.
One hundred six eyes were included. The 3-year surgical success according to Criteria A to D was 86%, 83%, 91%, and 67%, respectively. Intraocular pressure decreased by 26.5% from 18.9 ± 4.8 to 13.9 ± 2.3 mmHg (P < 0.001) and AGM use reduced by 33% from 3.0 ± 1.2 to 2.0 ± 1.2 medications (P < 0.001). The postoperative improvement in BCVA was preserved (P < 0.001). The structural and functional markers of disease stability, including CDR, RNFL, and GC-IPL thickness, as well as VF-MD and VF-PSD, remained stable (P > 0.05). Postoperative adverse events were few and transient.
The 36-month results from this study show that the Hydrus microstent with phacoemulsification is safe and effective in reducing the IOP and AGM among patients with mild to severe open-angle glaucoma and can slow down the disease progression by preserving both structural and functional parameters.
Proprietary or commercial disclosure may be found after the references.
To assess the outcomes and failure risk factors for Kahook Dual Blade (KDB) excisional goniotomy with cataract surgery (phaco-KDB) in eyes with various glaucoma subtypes and severities.
This ...multisurgeon consecutive case series included glaucomatous eyes with cataract that underwent phaco-KDB and had a minimum follow-up of 12 months postoperatively. Efficacy was assessed by absolute and qualified surgical success (defined by different criteria) and changes in intraocular pressure (IOP) and antiglaucoma medication (AGM) at the last postoperative follow-up. Safety included best-corrected visual acuity, cup-to-disc ratio, visual field mean deviation, retinal nerve fibre layer thickness, and adverse events.
A total of 108 eyes of 89 patients with a median follow-up of 18 months (range, 12–47 months) were included. IOP decreased by 26% from 19.1 ± 5.0 mm Hg to 14.1 ± 3.5 mm Hg (p < 0.001), AGM use decreased by 29% from 2.4 ± 1.3 medications to 1.7 ± 1.3 (p < 0.001), and 25% of eyes became free of AGMs (vs 3% at baseline). Qualified success rates achieved for IOP cutoffs of 18, 15, and 12 mm Hg were 87%, 68%, and 46%, respectively. Higher baseline IOP and postoperative incidence of IOP spikes were associated with a higher risk of surgical failure. Best-corrected visual acuity improved postoperatively (p < 0.001), and visual field mean deviation, cup-to-disc ratio, and retinal nerve fibre layer thickness remained stable. Overall, safety was favourable, and adverse events were transient and not sight threatening.
This multicentre Canadian study provides real-world data that support the safety and efficacy of phaco-KDB in reducing IOP and AGM use with no evidence of disease progression during the follow-up period.
To assess the comparative efficacy of latanoprostene bunod (LBN), a novel prostaglandin analogue (PGA), to other medications for open-angle glaucoma and ocular hypertension on lowering intraocular ...pressure (IOP).
A systematic literature review adapted from the Li
(Ophthalmology, 2016) study was conducted. Medline, Embase and PubMed were searched for randomised controlled trials published between 1 January 2014 and 19 March 2020. Studies had to report IOP reduction after 3 months for at least two different treatments among placebo, PGAs (bimatoprost 0.01%, bimatoprost 0.03%, latanoprost, LBN, tafluprost, unoprostone) or apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide, levobunolol, timolol, travoprost. A Bayesian network meta-analysis was performed to provide the relative effect in terms of mean difference (95% credible interval) of IOP reduction and ranking probabilities. Surface under the cumulative ranking curve (SUCRA) was generated.
A total of 106 trials were included with data for 18 523 participants. LBN was significantly more effective than unoprostone (-3.45 (-4.77 to -2.12)). Although relative effect was not significative, compared with other PGAs, LBN numerically outperformed latanoprost (-0.70 (-1.83 to 0.43)) and tafluoprost (-0.41 (-1.87 to 1.07)), was similar to bimatoprost 0.01% (-0.02(-1.59 to 1.55)) and was slightly disadvantaged by bimatoprost 0.03% (-0.17 (-1.42 to 1.07)). LBN was significantly more efficient than the beta-blockers apraclonidine, betaxolol, brimonidine, brinzolamide, carteolol, dorzolamide and timolol. According to SUCRA, LBN was ranked second after bimatoprost 0.03%, followed by bimatoprost 0.01%.
LBN was significantly more effective than the PGA unoprostone and most of the beta-blockers. Compared with the most widely used PGAs, LBN numerically outperformed latanoprost and travoprost and was similar to bimatoprost 0.01%.
We present the case of a patient who experienced recurrent episodes of blurry vision and eye pain after uneventful cataract extraction and in-the-bag intraocular lens (IOL) implantation. Examination ...revealed a microhyphema and signs of pigment dispersion. Iris transillumination was seen overlying areas where the IOL optic was not covered by the anterior capsule. Anterior segment optical coherence tomography confirmed iris indentation by the IOL optic, which was alleviated by performing laser peripheral iridotomy. This case shows that IOLs in the capsular bag can erode the posterior surface of the iris and that an adequately sized capsulorhexis should be performed to ensure anterior capsule coverage. Laser peripheral iridotomy should be considered when significant posterior iris bowing is observed.
Noninferiority of efficacy was demonstrated for a preservative-free bimatoprost 0.01% compared with BAK-containing bimatoprost 0.01% following a 12-week treatment period in patients with open angle ...glaucoma or ocular hypertension. Improved tolerability, in particular conjunctival hyperemia, was also observed.
To evaluate the intraocular pressure (IOP)-lowering efficacy and safety of a preservative-free bimatoprost 0.01% ophthalmic gel (PFB 0.01% gel) compared with preserved bimatoprost 0.01% (PB 0.01%).
Phase III, international, multicenter, randomized, 2-parallel group, investigator-masked, 3-month treatment duration.
Patients with glaucoma or ocular hypertension were randomized after a 7-week run-in/washout period to receive once-daily PFB 0.01% gel (n=236) or PB 0.01% (n=249) for 3 months. The primary efficacy measure was changed from baseline in IOP at week 12. Safety measures included adverse events (AEs) and assessment of conjunctival hyperemia.
The mean changes from baseline in IOP at week 12 in the PFB 0.01% gel and PB 0.01% were -9.72±2.97 and -9.47±3.06 mm Hg, respectively, at 8 am , -9.41±3.03 and -9.19±3.12 mm Hg at 10 am , and -8.99±3.36 and -8.54±3.44 mm Hg at 4 pm . Noninferiority of PFB 0.01% gel to PB 0.01% was demonstrated at week 12 based on predetermined criteria (upper 95% CI margin of 1.5 mmHg at all time points). The most frequently reported AE was conjunctival hyperemia; 13 (5.5%) patients with PFB 0.01% gel and 17 (6.8%) patients with PB 0.01%. The percentage of patients experiencing a worsening from baseline in conjunctival hyperemia score was lower with PFB 0.01% gel compared to PB 0.01% at week 6 (20.1% vs. 29.3%, respectively) and week 12 (18.3% vs. 30.4%, respectively).
PFB 0.01% ophthalmic gel has the same efficacy in lowering IOP as PB 0.01% and demonstrated less aggravation of conjunctival hyperemia at weeks 6 and 12.
Abstract Objective To determine the utility of combining rim area to disc area asymmetry ratio (RADAAR) and Moorfields regression analysis (MRA) to detect primary open-angle glaucoma (POAG) using ...confocal scanning laser ophthalmoscopy (CSLO) (Heidelberg retina tomograph 3 (HRT3)) in high-risk populations. Design Cross-sectional study. Participants Subjects with high risk for developing POAG. Methods Subjects underwent HRT, frequency doubling technology perimetry (FDT), and complete ophthalmic examination. Based on an ophthalmologic examination and FDT results of the worse eye, subjects were classified into 4 categories: normal, possible glaucoma, probable glaucoma, and definite glaucoma. Main outcome measures included sensitivities (Se), specificities (Sp), positive and negative predictive values (PPV, NPV), and positive and negative likelihood ratios (PLR, NLR) of the MRA, RADAAR, and combined MRA- RADAAR tests. Results Of 375 subjects, 11 were classified as having definite glaucoma. Depending on the reference standard, range results for Se, Sp, PPV, NPV, PLR, and NLR were, respectively, 57.7% to 100%; 55.1% to 85.4%; 6.3% to 39%; 92.6% to 100%; 1.97 to 4.9; 0 to 0.49 for MRA; 11.5% to 27.3%; 98.1% to 98.8%; 30% to 60%; 87.4% to 97.8%; 9.29 to 14.1; and 0.74 to 0.89 for RADAAR; and 57.7% to 90.9%; 81.3% to 85.1%; 12.8% to 38.5%; 92.6% to 99.7%; 3.87 to 4.85; 0.11 to 0.50 for combination MRA-RADAAR. Discussion When using HRT in populations at high risk for glaucoma, RADAAR had a higher specificity than MRA in identifying glaucoma. When patients were classified as borderline on MRA, combining RADAAR values decreased the number of false-positives as well, and may be recommended when high specificity is required.
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