The purpose is to report on the safety and efficacy of Ahmed Glaucoma Valve
(AGV, New World Medical, Inc., Rancho Cucamonga, CA, USA) implantation for the management
of refractory pediatric glaucoma ...observed during one-year follow up period. A retrospective chart
review was conducted on 10 eyes, all younger than 11 years, with pediatric glaucoma that underwent
AGV implantation for medicamentously uncontrolled intraocular pressure (IOP) between 2010 and
2014. Outcome measures were control of IOP below 23 mm Hg (with or without antiglaucoma
medications) and changes in visual acuity. Complications were recorded. After AGV implantation,
IOP values ranged from 18 mm Hg to 23 mm Hg (except for one eye with postoperative hypotonia
due to suprachoroid hemorrhage, where the postoperative IOP value was 4 mm Hg). The number of
antiglaucoma medications was reduced, i.e. four patients had two medications, one patient had one
medication, and the others did not need antiglaucoma medication on the last follow-up visit. One eye
had suprachoroid hemorrhage, one eye had long-term persistent uveitic membrane, and two eyes had
tube-cornea touch. In conclusion, AGV implantation appears to be a viable option for the management
of refractory pediatric glaucoma and shows success in IOP control. However, there was a relatively
high complication rate limiting the overall success rate.
The purpose of this study was to investigate the frequency of asymptomatic left ventricular dysfunction in patients with pseudoexfoliation syndrome.
Two-dimensional and pulsed Doppler ...echocardiography of transmitral flow was performed on 27 patients with pseudoexfoliation syndrome, aged 66.9+/-5.6 years, and 24 healthy volunteers aged 63.9+/-6.5 years. Left ventricular (LV) systolic contraction and ejection were assessed by LV ejection fraction (EF) and fractional shortening (FS). LV diastolic filling parameters tested were: early fast diastolic filling (E wave), late diastolic filling (A wave), ratio E/A, velocity time integral E wave (VTIE) and A wave (VTIA), their ratio (VTIE/VTIA), pressure at the end of filling (LVEDP) and a pulmonary capillary wedge pressure (PCWP).
Systolic parameters EF and FS, diastolic filling parameters such as A, LVEDP and PCWP were not significantly different between patients with pseudoexfoliation syndrome and controls (P>0.05). A significant difference (P<0.05) was found with regard to the diastolic filling parameters: E (61.6+/-15.1 vs 83.7+/-21.4), ratio E/A (0.8+/-0.1 vs 1.1+/-0.2), VTIE (8.6+/-1.8 vs 9.8+/-1.9), VTIA (10.3+/-2.4 vs 7.8+/-1.6) and ratio VTIA/VTIE (1.2+/-0.2 vs 0.8+/-0.2).
Our study suggests the possibility of an association between patients with pseudoexfoliation syndrome and a discrete asymptomatic myocardial diastolic dysfunction.
The aim of this study was to evaluate macular thickness parameters in glaucoma patients and to compare them to normal subjects using Optical Coherence Tomography (OCT). This prospective, ...observational study included 20 primary open angle glaucoma patients (POAG) and 20 healthy subjects in control group. Exclusion criteria were diabetes and other macular pathology, like age-related macular degeneration, macular oedema, central serous retinopathy and high myopia >4.00 dsph. OCT imaging of peripapillar retina and macular area were performed using Cirrus HD OCT In these two groups of patients we analyzed changes of macular thickness parameters (central subfield thickness, macular volume, and average macular thickness). The group of glaucoma patients had decreased values of the two macular thickness parameters: macular volume and average macular thickness, compared to control group. There was no difference in central macular thickness, presumably because of the absence of the ganglion cells in this layer. Macular imaging can be a useful additional method to determine glaucoma status and has a potential for tracking glaucoma progression.
Limbal relaxing incisions are one of the more commonly performed procedures with phacoemulsification to correct preexisting astigmatism during cataract surgery. The aim of the study was to evaluate ...the effect and stability of limbal relaxing incisions in reducing preexisting astigmatism at the time of phacoemulsification. The study included 10 eyes in 12 patients who underwent limbal relaxing incisions during cataract surgery, with preexisting astigmatism of 1-2 diopter (D). Assessments were made preoperatively, and 1 and 3 months postoperatively. Outcome measures included uncorrected distance visual acuity, best corrected distance visual acuity and keratometric astigmatism measures. The mean preoperative and postoperative refractive astigmatism was 1.50 D (+/- 0.75D) and 0.25 D (+/- 0.25 D), respectively. There were no serious postoperative complications. Limbal relaxing incisions provide a viable option for correcting preexisting astigmatism at the time of cataract surgery with mild complications.
The aim of this study was to compare two different refractive surgery approaches in correction of myopia with or without astigmatism. In patients where one eye underwent sub-Bowman keratomileusis ...(SBK) and the other eye photorefractive keratectomy (PRK), the objective and subjective results were retrospectively compared during the six-month follow-up. Eighty four patients (168 eyes) were involved in this retrospective contralateral study. The mean preoperative spherical refraction was -3.88 diopters (D) and the mean cylinder was -0.82 D for all eyes. Each patient underwent SBK on one eye and PRK on the contralateral eye. The eyes in the PRK group underwent mechanical epithelial removal, which was followed by laser treatment. Mitomycin C 0.02% was used for 15 seconds if ablation was deeper than 50 microns. In the SBK group, the intended 100-microm corneal flap was created with IntraLase femtosecond laser. All eyes underwent customized wavefront guided laser ablation using a VISX Star S4 IR excimer laser. Preoperative and postoperative outcome measures included best spectacle-corrected visual acuity, uncorrected visual acuity, corneal topography, contrast visual acuity, and anterior optical coherence tomography imaging. Patients were asked to complete subjective satisfaction questionnaires at each visit. Through the first 3 months of follow up, the SBK eyes demonstrated clinically and statistically better visual results than PRK eyes, between 3 and 6 months the results in the two groups began to equalize, and after 6 months of follow up there were no clinical and statistical differences between the SBK and PRK groups. SBK seems to be more practical for the patient with less pain, faster visual recovery, fewer medications, and overall superior experience.
Astigmatism represents an inability of the cornea and lens to provide a sharp image onto the retina. Correcting astigmatic errors, whether congenital, contact lens induced or surgically induced, is ...now an integral part of modern cataract and refractive procedures. Development of modern technology has enabled accurate diagnosis and perfect opportunities for correction; however, while cataract and keratorefractive surgery have come a long way in the last decade, the treatment and diagnosis of astigmatism continue to challenge ophthalmologists. There are several diagnostic procedures and tools available today, some standard and some contemporary that include keratometry, corneal topography, apparatus using wavefront or Scheimpflug analysis like Orbscan, Pentacam, Wavescan, etc. With the introduction of several new diagnostic tools, measurements of astigmatism have become less of an issue, but in some cases it is still difficult to obtain consistent results. What remains still unanswered is the question of the best diagnostic tool on the market. Further research is needed to evaluate both tools as well as their clinical application for optimal use.
The aim of this study was to evaluate clinical outcomes after toric intraocular lens implantation for astigmatism correction in patients undergoing cataract surgery. This prospective observational ...study included eyes undergoing cataract surgery at Sestre milosrdnice University Hospital Center between February and September 2011. The study enrolled eyes that had visually significant cataract and preexisting regular corneal astigmatism of 1.50 D or greater. Phacoemulsification was performed and all eyes received an AT TORBI 709 M toric foldable intraocular lens. At 3 months, the uncorrected distance visual acuity was 0.8 or better in 9 of 10 eyes. At 3 months postoperatively, the median reduction in refractive cylinder was statistically significant (P < 0.05). The median intraocular lens axis rotation was 3.0 degrees interquartile range (2.0-4.0 degrees). Our results showed AT TORBI 709 IOL to be an effective surgical option to correct preexisting corneal astigmatism and spectacle dependence after cataract surgery.
The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its ...management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.
To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies.
Prospective, open-label, observational, ...multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120).
40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23)).
Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.
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