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Herein, we report two clinical cases with acute temporary filtering bleb obstruction by gas tamponade after Descemet membrane endothelial keratoplasty (DMEK) surgery and postoperative intraocular pressure (IOP) peaks. Both patients underwent uncomplicated DMEK surgery with 20% sulfur hexafluoride (SF6) anterior chamber tamponade and had previous trabeculectomy for glaucoma. Prior to surgery, both patients showed patent bleb function with low to normal IOP without antiglaucomatous medication. After uneventful DMEK surgery, both patients showed postoperative IOP peaks of up to 50 mm Hg despite patent inferior iridotomy and no sign of a pupillary block. In both cases, SF6 gas bubbles could be visualized obstructing the bleb. Both patients were treated with IOP-lowering agents topically as well as systemically. In addition, anterior chamber paracenteses were performed to reduce the SF6 volume within the anterior chamber. Under this treatment, IOP normalized within the first 18 h after surgery. We hypothesize that the SF6 gas tamponade from the anterior chamber migrates into the ostium and below the bleb, leading to an acute temporary insufficiency of bleb function and to a consecutive IOP peak after surgery. In contrast to a pupillary block, this mechanism cannot be antagonized by preoperative iridotomy and needs to be taken into account for every glaucoma patient with functional bleb undergoing DMEK surgery. (C) 2019 The Author(s) Published by S. Karger AG, Basel

Many clinical studies have demonstrated the benefit of topical anti-inflammatory medication before and after glaucoma surgery, especially for trabeculectomy, and that they improve the long term outcome. Pre- and postoperative topical steroids improve the outcome of trabeculectomy, but duration and intensity of treatment should be adapted individually. Systemic steroid or oral immunomodulation have significant impact on the outcome in uveitic glaucoma, but not in other glaucoma subtypes. Additional topical treatment with nonsteroidal anti-inflammatories is an option in combined cataract-glaucoma surgery. Anti-inflammatory treatment after selective laser trabeculoplasty is not necessary, but relieves pain after argon laser trabeculoplasty and laser cyclophotocoagulation. Intravitreal application of steroids in glaucoma surgery must be critically evaluated and must consider the risk of a rise in secondary intraocular pressure.

During the last few years, there has been a considerable capacity of innovations in glaucoma surgery owing to new micro-stents increasing the aqueous outflow via transscleral routes, via the trabecular meshwork or the suprachoroidal space. These interventions can be easily performed in combination with small-incision cataract surgery. Even the well-known filtering procedures, trabeculectomy and drainage device surgery, formerly perceived as being outdated, re-achieve better reputation owing to refinements in surgical technique and improved surgical experience. Although enthusiasm is understandable, considering the technical advances, we must wait for clinical long-term results and compare the new procedures with the established ones.

Purpose: To evaluate the accuracy of intraocular pressure (IOP) measurements obtained with the newly available iCare HOME (RTHOME) rebound tonometer compared with the iCare ONE (RTONE) tonometer and Goldmann applanation tonometry (GAT), and possible correlation with central corneal thickness (CCT). Materials and Methods: IOP measurements were obtained from 154 patients by an ophthalmologist (doc) using each of the above-mentioned tonometers. In addition, patients (pat) measured their own IOP with the RTHOME and RTONE. The means and SD of results obtained with the different tonometers were compared. Agreement between the tonometers was calculated using the Bland-Altman method. Results: Mean IOPs for the right eyes only were 15.9 +/- 6.4 mm Hg (RTONEdoc), 15.8 +/- 6.4 mm Hg (RTONEpat), 15.0 +/- 5.9 mm Hg (RTHOMEdoc), 14.9 +/- 6.3 mm Hg (RTHOMEpat), and 15.8 +/- 4.4 mm Hg (GAT). Bland-Altman analysis revealed mean differences (bias) between RTONEdoc and RTHOMEdoc, between RTHOMEdoc and RTHOMEpat, and between RTHOMEdoc and GAT of 0.8, 0.1, and -0.8 mm Hg, respectively, with 95% limits of agreement of -3.5 to 5.2, -4.9 to 5.1, and -7.2 to 5.6 mm Hg, respectively. Linear regression of the comparisons revealed a proportional error over the range of pressures examined in the case of RTHOMEdoc versus GAT (slope = 0.32, P < 0.001). Considering the data from all eyes, the difference between RTHOMEdoc and GAT correlated significantly with the CCT (P = 0.01). Conclusion: RTHOME readings correlate well with the GAT results although some limitations such as dependency of readings on CCT and increasing differences at lower and higher IOP levels need to be taken into account.

Purpose: To assess the efficacy of trabeculectomy with a biodegradable Ologen (TM) implant (OLO) versus mitomycin C (MMC) in patients in a prospective randomized clinical trial. Methods: In the MMC group (15 patients), trabeculectomy was performed according to standard protocols. In the OLO group (15 patients) after standard trabeculectomy, the implant was positioned on top of the scleral flap, and no MMC was applied. Results: Mean preoperative intraocular pressure (IOP) levels (OLO: 28.0 +/- 9.4; MMC: 23.9 +/- 5.0 mm Hg; p = 0.21) and medication score (OLO: 3.4 +/- 1.6; MMC: 3.6 +/- 1.5; p = 0.56) were comparable in both groups. One year after surgery, the mean IOP was 15.9 +/- 4.5 mm Hg in the OLO group (p < 0.01, 43% reduction) and 11.0 +/- 2.6 mm Hg in the MMC group (p < 0.01, 54% reduction). The surgical success rate 12 months after surgery was 93.3% in the MMC group and 40% in the OLO group (p = 0.01). Conclusions: With the atelocollagen-glycosaminoglycan matrix OLO it was not possible to reach the surgical success rate and pressure reduction achieved in the MMC group. (C) 2013 S. Karger AG, Basel