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Purpose: The XEN gel stent was developed to reduce the risks of filtration surgery by standardizing the outflow of aqueous humor into the subconjunctival space. Recently, a modified version of the XEN63 gel stent was introduced. The goal of this study was to assess its efficacy and safety.Methods: This is a prospective, nonrandomized, observational, consecutive case series study at a single tertiary centre. Patients with open-angle glaucoma with above target intraocular pressure (IOP) despite maximal tolerated medication were included. The primary outcome was a change of median IOP. Secondary outcomes included a change in the number of medications, complete success, needling and complication rates. Success was defined as a lowering of IOP > 20% from baseline and IOP ≤ 14 mmHg. Complete success indicated that the target IOP was reached without medications.Results: Six patients were included. The median IOP decreased from 35.5 mmHg (25.0– 40.0 mmHg) at baseline to 11.5 mmHg (4.0– 15.0 mmHg, p = 0.03), and median IOP-lowering medication was reduced from 4.0 (3.0– 4.0) at baseline to 0 (0– 1.0, p = 0.03) after two years. Five patients (83.0%) had a complete success after two years. Two patients (33.0%) required a needling procedure. Three patients (50.0%) required an intervention due to symptomatic hypotony within the first three weeks postoperatively. Hypotony resolved completely or was asymptomatic after three months.Conclusion: Our study demonstrated a statistically significant reduction in both IOP and number of IOP-lowering medications. Complications were well manageable and had no long-term sequelae. [ABSTRACT FROM AUTHOR]

Purpose: To compare changes in central retinal arterial equivalent (CRAE), central retinal vein equivalent (CRVE), arteriovenous ratio (AVR), tortuosity and fractal dimension in primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and in a control group (CG) on fundus photographs. Further, to provide further evidence of vascular change in glaucoma patients using a novel method of tortuosity. Patients and Methods: The primary endpoint was the change in CRAE, CRVE, AVR, fractal dimension and tortuosity of the retinal vasculature from baseline, retrospectively analyzed from 2011 to 2017 at the University Eye Hospital Tuebingen. Fundus photos of POAG (N = 49), NTG (N = 38) and CG (N = 18) were computer evaluated and analyzed in the quantities mentioned above. Results: CRAE in NTG and POAG and CRVE in NTG significantly decreased (P = 0.02, P = 0.01; P = 0.03) whereas CRVE in POAG increased insignificantly (P = 0.72). In NTG, AVR decreased significantly (P = 0.05), but to a lesser extent than in POAG (P < 0.001). In CG, CRAE decreased insignificantly (P = 0.10), CRVE decreased significantly (P = 0.03) and AVR increased insignificantly (P = 0.77). In POAG tortuosity calculated using standard methods as well as our novel method, increased significantly (P = 0.015– 0.04), whereas it did not occur in NTG (P = 0.18– 0.57) and CG (P = 0.11– 0.21). Fractal dimensions in POAG decreased significantly (P = 0.001– 0.002), whereas in NTG and CG changes were insignificant (P = 0.33– 0.92). Conclusion: Based on a retrospective analysis of fundus photographs, specific retinal vasculature features of the retinal vasculature display significant alterations associated with NTG and POAG. The assessment of tortuosity using our novel method was consistent with previously established methods for analyzing tortuosity. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare the long-term outcomes of ab externo trabeculotomy in primary open-angle glaucoma (POAG) and uveitic glaucoma (UG). Design: This was a retrospective single-center case series study. Participants: Twenty eyes of 17 patients with POAG and 22 eyes of 18 patients with UG were included in this study. Patients and methods: The medical records of all consecutive patients with POAG and UG who underwent ab externo trabeculotomy since 2004 were reviewed. Main outcome measure: The main outcome measure was change in median intraocular pressure (IOP). Success was defined as IOP #21 mmHg (success 1) and IOP #21 mmHg and at least 25% reduction from baseline (success 2). Results: In the POAG group, the median IOP decreased significantly from 22 mmHg (95% CI 21-25 mmHg; n=20) at baseline to 14 mmHg (95% CI 12-16; n=13) after 4 years, P<0.001. In the UG group, the median IOP decreased significantly from 27 mmHg (95% CI 24.5-30.5 mmHg; n=22) at baseline to 12 mmHg (95% CI 9-15 mmHg; n=15) after 4 years, P<0.001. Seven eyes in the UG group failed within the first year after surgery compared to none in the POAG group. Of these, four eyes had Fuchs' uveitis syndrome and two had granulomatous uveitis. No sight-threatening complications occurred in both POAG and UG groups. Conclusion: Ab externo trabeculotomy effectively reduced IOP in both UG and POAG groups. However, the success rates in the UG group were significantly lower due to the high failure rate in patients with Fuchs' uveitis syndrome and granulomatous uveitis. The procedure demonstrated a high safety profile in both UG and POAG patients. [ABSTRACT FROM AUTHOR]

Purpose: To report the visual and morphological outcomes following intravitreal bevacizumab in neovascular age-related macular degeneration (nAMD) with submacular, predominantly hemorrhagic, lesions. Methods: Retrospective study of patients with a follow-up after 1 year. All eyes with submacular hemorrhages larger than 50% of the total lesion size and received only anti-VEGF (vascular endothelial growth factor) monotherapy (intravitreous administration of 1.25 mg bevacizumab, PRN). The primary endpoint was the change in hemorrhage size and time to resolution, in association with the mean best-corrected visual acuity (BCVA). The eyes were grouped based on the size of the hemorrhage: group A (≥1 to, 4 disc area [DA]), group B (≥4 to, 9 DA), and group C (≥9 DA). Results: Forty-six consecutive eyes were included. The mean area of the hemorrhage was 6 DA at baseline. Eyes with smaller bleeding (group A) had better chances of stabilized or improved vision. Complete resolution of the hemorrhage was seen in 96% of the eyes within 1 year. The mean BCVA increased from 0.81 logarithm of the minimum angle of resolution (logMAR) (95% confidence interval [CI]: 0.70'0.92) (Snellen 20/125) at baseline to 0.75 logMAR (95% CI: 0.62'0.88) (20/125) after 1 year (P=0.11). BCVA improved (one or more ETDRS [Early Treatment of Diabetic Retinopathy Study] lines) in 57% of the eyes (13/23) in group A; 53% (8/15) in group B; and 38% (3/8) in group C. Conclusion: Many of the eyes with hemorrhagic lesions showed stabilization or improvement of the mean BCVA after treatment within 1 year. Anti-VEGF treatment can be considered as a useful treatment option in eyes with hemorrhages secondary to nAMD. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a digital high-speed camera combined with digital morphometry software for dynamic measurements of phakic intraocular lens movements to observe kinetic influences, particularly in fast direction changes and at lateral end points. Materials and methods: A high-speed camera taking 300 frames per second observed movements of eight iris-claw intraocular lenses and two angle-supported intraocular lenses. Standardized saccades were performed by the patients to trigger mass inertia with lens position changes. Freeze images with maximum deviation were used for digital software-based morphometry analysis with ImageJ. Results: Two eyes from each of five patients (median age 32 years, range 28-45 years) without findings other than refractive errors were included. The high-speed images showed sufficient usability for further morphometric processing. In the primary eye position, the median decentrations downward and in a lateral direction were -0.32 mm (range -0.69 to 0.024) and 0.175 mm (range -0.37 to 0.45), respectively. Despite the small sample size of asymptomatic patients, we found a considerable amount of lens dislocation. The median distance amplitude during eye movements was 0.158 mm (range 0.02-0.84). There was a slight positive correlation (r=0.39, P<0.001) between the grade of deviation in the primary position and the distance increase triggered by movements. Conclusion: With the use of a slit lamp-mounted high-speed camera system and morphometry software, observation and objective measurements of iris-claw intraocular lenses and anglesupported intraocular lenses movements seem to be possible. Slight decentration in the primary position might be an indicator of increased lens mobility during kinetic stress during eye movements. Long-term assessment by high-speed analysis with higher case numbers has to clarify the relationship between progressing motility and endothelial cell damage. [ABSTRACT FROM AUTHOR]