Search

Background: To investigate the long-term effect of serous choroidal detachment on the success of trabeculectomy in glaucoma patients.Methods: In this case-control study, 17 patients who underwent trabeculectomy and developed choroidal detachment, and completed at least 3 years of follow-up were included. The controls were matched based on age, sex, preoperative intraocular pressure, and glaucoma type, and lack of choroidal detachment. Surgical success was defined based on two definitions of 5 < IOP < 16 and 20% reduction from the baseline and no need for further glaucoma surgery and all the same but 5 < IOP < 22.Results: The mean estimated duration of survival ±SD was 2.73 ± 0.35 years (CI 95% 2.1, 3.4), which was significantly shorter than 3.98 ± 0.38 years (CI 95% 3.3, 4.7) in the control group. (LogRank = 5.03 p= 0.02). Cumulative probability of success was 76.5%, 52.9%, 29.4%, 17.6%, and 11.8% in year 1, 2, 3, 4, and 5 in the case group, respectively. Corresponding values were 88.2%, 82.4%, 68.6%, 58.8%, and 47.1%. In the control group, respectively. At baseline, average IOP was 22.3 ± 2.7 and 23.8 ± 8.3 mmHg in the case and control groups, respectively (p= 0.17). Mean IOP was significantly higher in the case group than in the control group in years 2, 3, 4, and 5.Conclusion: Serous choroidal detachment affects the long-term surgical success of trabeculectomy, especially in patients with advanced glaucoma when lower target pressure is required.

PURPOSE:To compare refractive outcomes, contrast sensitivity, higher-order aberrations (HOAs), and patient satisfaction after photorefractive keratectomy for correction of moderate myopia with two methods: tissue saving versus wavefront optimized.METHODS:In this prospective, comparative study, 152 eyes (80 patients) with moderate myopia with and without astigmatism were randomly divided into two groups: the tissue-saving group (Technolas 217z Zyoptix laser; Bausch & Lomb, Rochester, NY) (76 eyes of 39 patients) or the wavefront-optimized group (WaveLight Allegretto Wave Eye-Q laser; Alcon Laboratories, Inc., Fort Worth, TX) (76 eyes of 41 patients). Preoperative and 3-month postoperative refractive outcomes, contrast sensitivity, HOAs, and patient satisfaction were compared between the two groups.RESULTS:The mean spherical equivalent was −4.50 ± 1.02 diopters. No statistically significant differences were detected between the groups in terms of uncorrected and corrected distance visual acuity and spherical equivalent preoperatively and 3 months postoperatively. No statistically significant differences were seen in the amount of preoperative to postoperative contrast sensitivity changes between the two groups in photopic and mesopic conditions. HOAs and Q factor increased in both groups postoperatively (The mean spherical equivalent was −4.50 ± 1.02 diopters. No statistically significant differences were detected between the groups in terms of uncorrected and corrected distance visual acuity and spherical equivalent preoperatively and 3 months postoperatively. No statistically significant differences were seen in the amount of preoperative to postoperative contrast sensitivity changes between the two groups in photopic and mesopic conditions. HOAs and Q factor increased in both groups postoperatively (P= .001), with the tissue-saving method causing more increases in HOAs (P= .007) and Q factor (P= .039). Patient satisfaction was comparable between both groups.CONCLUSIONS:Both platforms were effective in correcting moderate myopia with or without astigmatism. No difference in refractive outcome, contrast sensitivity changes, and patient satisfaction between the groups was observed. Postoperatively, the tissue-saving method caused a higher increase in HOAs and Q factor compared to the wavefront-optimized method, which could be due to larger optical zone sizes in the tissue-saving group.[[J Refract Surg.2015;31(10):683–688.]

To compare corneal stromal and endothelial cells after photorefractive keratectomy with intraoperative mitomycin C in alcohol-assisted versus mechanical epithelial debridement using confocal microscopy.

PURPOSE:To investigate the effect of blunt foreign body impact on a human cornea after photorefractive keratectomy (PRK) and LASIK using a simulation model.METHODS:Computational simulations were performed using a finite element analysis program (LS-Dyna, Livermore Software Technology Corp). The blunt foreign body was set to impact at the center of the corneal surface models (after PRK and LASIK) with thicknesses of 500, 450, 400, 350, and 300 μm. Corneal rupture was assumed to occur at a peak stress of 9.45 MPa and at a strain of 18%. The foreign body projectile was blunt in shape, made from aluminum, contained plastic-kinematic properties, and had a density of 2700 kg/mComputational simulations were performed using a finite element analysis program (LS-Dyna, Livermore Software Technology Corp). The blunt foreign body was set to impact at the center of the corneal surface models (after PRK and LASIK) with thicknesses of 500, 450, 400, 350, and 300 μm. Corneal rupture was assumed to occur at a peak stress of 9.45 MPa and at a strain of 18%. The foreign body projectile was blunt in shape, made from aluminum, contained plastic-kinematic properties, and had a density of 2700 kg/m3.RESULTS:The projectile was launched at the center of the cornea with velocities ranging from 20 to 60 m/s. The threshold of impact velocities creating rupture in corneal thicknesses of 500, 450, 400, 350, and 300 μm were 33, 32.8, 30.7, 27.9, and 22.8 m/s, respectively, in the PRK model. In the LASIK model, the thresholds creating rupture in the stromal bed of the corneas with thicknesses of 500, 450, 400, 350, and 300 μm were 40, 38.1, 35.6, 31.5, and 26.7 m/s, respectively. The 110-μm corneal flap in the LASIK model ruptured at all velocities.CONCLUSIONS:Ruptures occurred at lower velocities in the PRK cornea model than in the corneal stromal bed of the LASIK model following blunt foreign body impact.

BACKGROUND AND OBJECTIVE:Changes in corneal endothelial cell (CEC) indices 24 months after Ahmed valve (New World Medical, Inc., Rancho Cucamonga, CA) and single-plate Molteno implants (Molteno Ophthalmic Limited, Dunedin, New Zealand) were evaluated.PATIENTS AND METHODS:This cohort included Ahmed valve (29 eyes) or single-plate Molteno (28 eyes) implants. Preoperative and postoperative central CEC indices were compared. Main outcome measure was endothelial cell count.RESULTS:Twenty-four months postoperatively, no difference in visual acuity improvement or decrease in antiglaucoma medications was observed between groups. The Molteno group showed better postoperative intraocular pressure control (Twenty-four months postoperatively, no difference in visual acuity improvement or decrease in antiglaucoma medications was observed between groups. The Molteno group showed better postoperative intraocular pressure control (P< .001). An 11.52% (Ahmed) and 12.37% (Molteno) reduction in CEC density (cells/mm2) and 3.78 (Ahmed) and 2.48 (Molteno) increase in CEC area (mm2) was observed, but no significant between-group difference in CEC density and area or corneal thickness.CONCLUSION:Twenty-four months after Ahmed valve or Molteno implant, statistically significant quantitative (cell density) and minor qualitative (cell area) changes in central CEC were observed. Both groups appeared to have similar CEC damage.

Purpose. To compare 1-site and 2-site phacotrabeculectomies with regard to visual acuity, intraocular pressure (IOP) control, antiglaucoma medication requirements, and postoperative complications.Methods. In a randomized controlled trial, 169 eyes with coexisting visually significant cataract and glaucoma were randomly allocated into 2 groups: eyes that had a trabeculectomy in a superior quadrant combined with phacoemulsification through the same incision (1-site group; n=85) or those with a separate, temporal, clear corneal incision for phacoemulsification (2-site group; n=84). Postoperative evaluation, including visual acuity, intraocular pressure (IOP), glaucoma medication requirements, and surgical complications, was for up to 18 months.Results. After 18 months, there was no significant difference between the 2 groups with respect to visual acuity and antiglaucoma medication requirements. There was a 0.6 to 1.4 mmHg difference in mean IOP, with the 2-site technique demonstrating statistically significant advantage over the 1-site technique in some follow-up visits with nonparametric analysis; however, the difference cannot be clinically significant. Success rates (IOP<21 mmHg with the maximum use of medication) of 1-site and 2-site groups were 85.9% and 92.8%, respectively, which was not statistically significant (p=0.153). Nevertheless, the incidence of failure in the 1-site group was almost twice that of the 2-site group (12 vs 6). Postoperative complications were comparable in both groups.Conclusions. Results for 18-month follow-ups of 1-site and 2-site phacotrabeculectomies were comparable in terms of visual acuity, antiglaucoma medication requirements, and postoperative complications. While lowering of IOP was more pronounced in the 2-site group, this was not clinically significant.