Journal of Current Glaucoma Practice最新文献

Aim: "Consensual ophthalmotonic reaction" refers to changes in intraocular pressure (IOP) in one eye, which is accompanied by a corresponding change in IOP in the contralateral eye. This study evaluates whether monocular administration of selective laser trabeculoplasty (SLT) leads to a consensual ophthalmotonic reaction and how long this effect lasts.

Materials and methods: A retrospective chart review was performed on patients receiving SLT at Kresge Eye Institute in Detroit, MI, from January 2015 to August 2016. Patients were excluded if they had previous history of glaucoma incisional and/or laser procedures; required additional laser trabeculoplasty; had glaucoma medication changes during the follow-up period; experienced no decrease in IOP during the follow-up period; or had a diagnosis of angle closure on gonioscopy. Various demographic, clinical, and surgical data were collected. IOP measurements were collected at baseline and postoperatively at 1-3 months, 4-9 months, and 12-15 months.

Results: At all follow-up periods, the IOP of the treated eye was decreased from baseline IOP (p ≤ 0.05, paired t-test). For the fellow eye, there was a statistically significantly decrease from baseline up to the 4-9 months follow-up period (p ≤ 0.05, paired t-test). Linear regression analysis of the percent reduction in IOP from baseline in the SLT-treated eye with the fellow eye shows a mild correlation at all-time points: R² = 0.284 (p < 0.001) at 1-3 months; R² = 0.348 (p < 0.001) at 4-9 months; R² = 0.118 (p = 0.054) at 12-15 months.

Conclusion: This study showed that monocular administration of SLT results in a consensual ophthalmotonic reaction. The consensual ophthalmotonic reaction appears to last for up to 4-9 months.

Clinical significance: Therefore, although SLT does lead to a consensual ophthalmotonic reaction, monocular administration of SLT is not a reliable method of long-term IOP control for the contralateral non-SLT-treated eye.

How to cite this article: Nassiri N, Mei F, Tokko H, et al. Consensual Ophthalmotonic Reaction Following Selective Laser Trabeculoplasty. J Curr Glaucoma Pract 2022;16(1):36-40.

Aim and background: The present case report describes a novel surgical technique combining XEN gel stent implantation and deep sclerectomy: XEN-augmented deep sclerectomy (XEN-DS).

Case description: An active 96-year-old Caucasian woman suffering from pseudoexfoliative glaucoma (PEXG) presented with intraocular pressure (IOP) of 24 mm Hg and a double arcuate visual field defect [mean deviation (MD) -9.6 dB] in her only functional eye despite maximal medical therapy. Considering (1) the magnitude of IOP reduction sought, (2) the risk of complications associated with trabeculectomies and glaucoma drainage devices, and (3) the risk of missed appointments due to the patient's personal and social circumstances, it was decided to tailor the surgical treatment to this patient's specific characteristics combining two existing surgical techniques. Following conjunctival dissection, a superficial scleral flap was lifted 2 mm more posteriorly than in conventional DS, and a XEN gel stent was implanted ab externo through the anterior wall of the deep sclerectomy, into the anterior chamber. A mitomycin C-soaked autologous space maintainer was used. No peri- or postoperative complications were observed. Following XEN-DS, her IOP stabilized between 5 mm Hg and 8 mm Hg through 6 months, and her visual field MD improved to -1.5 dB.

Discussion: The present case report is a proof of concept for this novel surgical technique, confirming that XEN-DS has the potential to achieve substantial and persistent IOP reductions in PEXG with a satisfactory safety profile. Clinical studies are warranted to confirm these results.

How to cite this article: Niegowski LJ, Gillmann K, Baumgartner JM. XEN-Augmented Deep Sclerectomy: Step-by-step Description of a Novel Surgical Technique for the Management of Open-angle Glaucoma. J Curr Glaucoma Pract 2021;15(3):144-148.

Aim and objective: Developing improved methods for early detection of visual field defects is pivotal to reducing glaucoma-related vision loss. The Melbourne Rapid Fields screening module (MRF-S) is an iPad-based test, which allows suprathreshold screening with zone-based analysis to rapidly assess the risk of manifest glaucoma. The versatility of MRF-S has potential utility in rural areas and during infectious pandemics. This study evaluates the utility of MRF-S for detecting field defects in non-metropolitan settings.

Materials and methods: This was a prospective, multicenter, cross-sectional validation study. Two hundred and fifty-two eyes of 142 participants were recruited from rural sites through two outreach eye services in Australia. Participants were tested using MRF-S and compared with a reference standard; either Zeiss Humphrey Field Analyzer or Haag-Streit Octopus performed at the same visit. Standardized questionnaires were used to assess user acceptability. Major outcome measures were the area under the curve (AUC) for detecting mild and moderate field defects defined by the reference tests, along with corresponding performance characteristics (sensitivity, specificity).

Results: The mean test duration for MRF-S was 1.88 minutes compared with 5.92 minutes for reference tests. The AUCs for mild and moderate field defects were 0.81 [95% confidence interval (CI): 0.75-0.87] and 0.87 (95% CI: 0.83-0.92), respectively, indicating very good diagnostic accuracy. Using a risk criterion of 55%, MRF-S identified moderate field defects with a sensitivity and specificity of 88.4 and 81.0%, respectively.

Conclusion and clinical significance: The MRF-S iPad module can identify patients with mild and moderate field defects while delivering favorable user acceptability and short test duration. This has potential application within rural locations and amidst infectious pandemics.

How to cite this article: Chia MA, Trang E, Agar A, et al. Screening for Glaucomatous Visual Field Defects in Rural Australia with an iPad. J Curr Glaucoma Pract 2021;15(3):125-131.

Aim and objective: To evaluate repeat selective laser trabeculoplasty (SLT) for treating primary open-angle glaucoma (POAG).

Materials and methods: PubMed, CINAHL, and EMBASE were systematically searched along with grey literature. All English articles that measured intraocular pressure (IOP) before and after repeat SLT on adult patients with POAG were included. Studies were not filtered by location or publication date. Covidence was used to screen imported articles. Risk of bias assessment and data extraction was performed after screening. Meta-analysis was performed using STATA 16.0. Fixed-effect or random-effects models were developed depending on the presence of heterogeneity.

Results: Database and grey literature search identified 512 unique studies. After duplicate removal and screening, 12 articles were included and data from included studies were synthesized. Nine articles were included in the meta-analysis. Three studies were prospective observational studies, and nine studies were retrospective chart reviews. Due to the presence of heterogeneity, a random-effects model has been utilized that suggested significant IOP reduction (IOPR) by repeat SLT at 24 months follow-up.

Conclusion: Based on our results, repeat SLT could be an effective procedure in reducing IOP for patients with glaucoma for up to 24 months. Efficacy of third, fourth, or further SLT remains to be verified. More data from long-term, high-quality randomized-controlled trials (RCTs) are required to make conclusions.

Clinical significance: Repeat SLT may be an effective treatment for lowering IOP with minimal complications or safety issues. This may allow the use of SLT as a primary treatment for POGA, allowing the discontinuation of medications or eye drops and lead to additional benefits.

How to cite this article: Jang HJ, Yu B, Hodge W, et al. Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-analysis. J Curr Glaucoma Pract 2021;15(3):117-124.

Aim and objective: To report the incidence of late-onset endophthalmitis following XEN45^® stent implantation.

Background: Long-term safety profile and efficacy in relation to the so-called microinvasive glaucoma surgery (MIGS) techniques are still under evaluation. The XEN45^® gel stent entails a bleb formation and often requires postoperative conjunctival management, differing from the current reviewed concept of minimally invasive procedures. Endophthalmitis has been described among the complications, triggered in the majority of cases by tube extrusion.

Cases description: From our chart of 293 eyes operated on between November 2016 and November 2019, five (1.7%) patients developed endophthalmitis, which took place in the months 3, 4, 5, 11, and 14 after surgery, respectively. Sixty percent had undergone previous needling procedures. All of them showed a previous flat bleb and developed perforation of the conjunctiva caused by the distal portion of the tube. One patient was early eviscerated due to a fateful course. Treatment consisted of intravitreal, oral, and topical antibiotics, as well as topical corticosteroids. Eighty percent underwent device withdrawal, conjunctival gap suturing, anterior chamber washout, aqueous humor (AH) tab extraction (one positive for S. epidermidis and one for Streptococcus agalactiae), and pars plana vitrectomy. A second patient was eviscerated due to phthisis bulbi. Out of three remaining patients, one underwent vitrectomy for retinal detachment, while two patients required glaucoma surgery for intraocular pressure control. The final VA was ≤20/125 in all patients.

Conclusion: The XEN45^® device appears to trigger endophthalmitis by extruding the stent or unnoticed leakage through conjunctival defects. Special attention should be paid to flat and avascular blebs.

Clinical significance: This series shows a higher rate of endophthalmitis (1.7%) compared with previous studies with a significant sample size (0.4-1.4%).

How to cite this article: Burggraaf-Sánchez de las Matas R, Such-Irusta L, Alfonso-Muñoz EA, et al. Late-onset Endophthalmitis after XEN45^® Implantation: A Retrospective Case Series and Literature Review. J Curr Glaucoma Pract 2021;15(3):153-160.

The Xen Gel Stent (Allergan, Irvine, CA, USA) is a hydrophilic collagen-based gelatin tube of 6 mm in length which creates a channel of communication between the anterior chamber and the subconjunctival space allowing aqueous humor outflow. XEN is an ab interno, minimally invasive, glaucoma surgery device which has a better safety profile and offers a less invasive way of lowering intraocular pressure. Unfortunately, one of its weaknesses is that visualization of the implant during surgery is difficult, and this difficulty may be exacerbated, for instance, by a subconjunctival hemorrhage. The purpose of this paper is to describe a simple and effective technique for improving device visualization (XEN 45 μm) during the implantation. How to cite this article: Ramovecchi V, Franco F, Barbera GR. XEN Gel Staining with Trypan Blue: A Simple and Effective Technique to Improve Device Visualization during Implantation. J Curr Glaucoma Pract 2021;15(3):161-163.

Aim and objective: To evaluate the safety of two new generic ophthalmic formulations, Latanost^® (latanoprost) and Latacom^® (latanoprost and timolol) by utilizing the three-dimensional reconstructed human cornea-like epithelium (RhCE) tissue constructs as an in vitro model in the assessment of ocular irritation.

Materials and methods: In vitro irritation test was conducted on Latanost^® (LTN) and Latacom^® (LTC) and their corresponding innovators, Xalatan^® (XLT) and Xalacom^® (XLC), respectively, by using RhCE. According to the OECD guidelines No. 492 on the testing of chemicals, the ophthalmic formulations were assessed via topical exposure of the formulations on in vitro RhCE tissue. Cell viability was measured by MTT assay.

Results: The mean cell viability percentage of LTN and XLT was 70.5 and 75.7%, respectively, whereas, for LTC and XLC, the percentage viability was 95.3 and 85.7%, respectively. The two new generic formulations (LTN and LTC) did not reduce the cell viability of the RhCE tissue to ≤60%. Thus, both can be considered as nonirritant.

Conclusion: Both newly developed generics are nonocular irritants.

Clinical significance: This study informs the safety assessment of new generic antiglaucoma ophthalmic solutions applicable for long-term glaucoma treatment. The formulations aim to keep eye irritation to a minimum level.

How to cite this article: Ng JSC, Tan YX, Alwi NAA, et al. In Vitro Toxicity Evaluation of New Generic Latanost^® and Latacom^® as an Ophthalmic Formulation. J Curr Glaucoma Pract 2021;15(3):139-143.

Aim and objective: To report an unusual and difficult case of malignant glaucoma induced by a traumatic mature cataract that had migrated into the anterior chamber in a developmentally delayed patient.

Background: Malignant glaucoma can present due to multiple mechanisms, including trauma-induced cataract migration into the anterior chamber.

Case description: A developmentally delayed female in her 40s with a history of self-abuse was found to have malignant glaucoma in the setting of a traumatic cataract that had migrated in front of the iris into the anterior chamber. Exam under anesthesia and ultrasound biomicroscopy (UBM) demonstrated complete subluxation of the lens into the anterior chamber. Perioperative techniques included prophylactic pars plana vitrectomy to alleviate posterior pressure as well as the creation of an irido-zonulo-hyaloido-vitrectomy (IZHV), which allowed for reformation of the anterior chamber. These maneuvers allowed for cataract surgery to be performed through a clear corneal incision, with anterior chamber intraocular lens implantation. The patient had improved vision, pressure, and pain.

Conclusion: Malignant glaucoma can present in unique ways and the presence of a flat anterior chamber and increased posterior pressure can make surgery challenging. Initial pars plana vitrectomy in addition to the creation of an IZHV can help relieve posterior pressure and facilitate cataract extraction. It is important to factor in patient-specific situations and goals while selecting an intraocular lens.

Clinical significance: Traumatic cataracts and malignant glaucoma can present in unique scenarios that may prove difficult to treat. Certain techniques can facilitate these challenging surgeries and provide the optimal outcome for patients.

How to cite this article: Sarrafpour S, Davies I, Ahmed O, et al. Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber. J Curr Glaucoma Pract 2021;15(3):164-167.

The iridocorneal endothelial (ICE) syndrome is a sporadic, unilateral condition characterized by abnormalities of the cornea, anterior chamber angle, and iris affecting middle-aged women (3rd to 5th decade). It consists of three variants: progressive iris atrophy, Cogan-Reese syndrome-diffuse nevus or iris nodules, and Chandler syndrome-corneal endothelial abnormalities leading to corneal edema. This syndrome has an abnormal corneal endothelial cell layer (proliferative endotheliopathy), which migrates across the angle and onto the surface of the iris. It is a potentially blinding condition as a result of secondary glaucoma and/or corneal decompensation. Although few case reports have shown an association of ICE syndrome with macular edema; however, our case was unique in the sense that it was associated with neurosensory detachment (NSD). It can be suggested that PG analogs are not a good idea to be prescribed for secondary glaucoma management in patients with ICE syndrome as it can predispose to the development of macular edema with NSD. How to cite this article: Dubey S, Jain K, Singh S, et al. Iridocorneal Endothelial Syndrome with Coexisting Macular Edema and Neurosensory Detachment: An Unusual Case Report. J Curr Glaucoma Pract 2021;15(3):149-152.

Aim and objective: To describe a technique of lens-free gonioscopy that allows the anterior chamber angle to be visualized intraoperatively, without the use of a gonioscopy lens.

Background: Minimally invasive glaucoma surgery (MIGS) is an increasingly popular treatment option for mild to moderate glaucoma. We describe a technique of lens-free gonioscopy that allows visualization of the anterior chamber angle without the use of a lens. This simple intraoperative technique may be used to inspect the placement of MIGS devices within the angle.

Technique: To perform a water gonioscopy, the surgeon sits temporal to the eye. The patient's head is turned 20-45° away from the surgeon, and the operating microscope is tilted 15-30° toward the surgeon. A reservoir of balanced salt solution is allowed to collect in the crater formed by the nose bridge and the bony orbital rim, external to the corneal surface. This body of liquid obliterates the cornea-air interface and hence allows visualization of the anterior chamber. In contrast to gonioscopy using a gonioscopy lens, water gonioscopy offers a lower magnification, ultra-wide field of view for angle visualization.

Conclusion: Water gonioscopy is a useful technique that anterior segment surgeons might use for quick visualization of the anterior chamber angle without the need for additional equipment.

Clinical significance: This is a simple technique that surgeons can use to visualize the anterior chamber angles intraoperatively. It is especially useful for MIGS that are placed within the anterior chamber angle, but this technique may also be used during other anterior segment surgeries, such as visualizing the haptics of an anterior chamber intraocular lens or checking for retained lens fragments in the anterior chamber angles.

How to cite this article: Chiam N, Perara S. Water Gonioscopy: A Technique for Intraoperative Visualization of the Anterior Chamber Angle. J Curr Glaucoma Pract 2021;15(3):106-108.