Search

Purpose of review To summarize the reports of both transient and sustained elevation in intraocular pressure (IOP) associated with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) agents and to review the possible mechanisms for these findings. Recent findings Transient elevation in IOP is common after intravitreal injection of anti-VEGF agents. Sustained IOP elevation is less commonly seen but can require medical and/or surgical intervention. The mechanism for sustained IOP elevation is not well understood but has been attributed to trabecular meshwork injury from repeated injections, a potential toxic or inflammatory reaction after exposure to the biologic agents and/or vehicle, or mechanical blockade of the trabecular meshwork by protein aggregates or contaminant particles associated with packaging and injection techniques, among other potential causes. Summary Intravitreal anti-VEGF injections are commonly used to treat neovascular diseases of the eye. Although they have a favorable side-effect profile, their use can be associated with both transient and sustained elevation in IOP. Further research is necessary to determine the cause of these findings.

Purpose: To compare the efficacy of different surgical strategies for intraocular pressure (IOP) control in Hispanic glaucoma patients with and without visually significant cataracts. Design: Comparative retrospective consecutive case series. Methods: The charts of 153 consecutive patients with primary open angle glaucoma who underwent either trabeculectomy alone (n = 51), phacotrabeculectomy (n = 51), or phacoemulsification alone (n = 51) were reviewed to compare IOP control, the number of glaucoma medications required postoperatively, and the inci dence of surgical complications. Results: Preoperative IOP was 17.5 ± 5.2 mm Hg in the trabe-culectomy group, 15.4 ± 4.5 mm Hg in the phacotrabeculectomy group and 13.9 ± 2.9 mm Hg in the phacoemulsification group (p < 0.001 for all comparisons). Mean IOP reduction from baseline was 4.2 ± 6.9 (24.6%) for the trabeculectomy group, 2.9 ± 5.0 (20.8%) for the phacotrabeculectomy group, and 0.9 ± 3.4 (6.5%) for the phacoemulsification group (p = 0.009). The number of IOP-lowering medications required postoperatively decreased significantly in all three groups (p = 0.001). The rate of early and late postoperative complications was similar between the trabeculectomy and phacotrabeculectomy groups and less for the phacoemulsification group. Conclusion: Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glau coma. Both resulted in similar rates of success, IOP reduction, decrease in use of IOP-lowering medications and post operative complication rates. Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy. Phacoemulsification alone may be a reasonable option for patients with visually significant cataract and lower baseline IOP. How to cite this article: Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY. Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phaco-emulsification in a Hispanic Population. J Curr Glaucoma Pract 2014;8(2):67-74.

Congenital blepharoptosis presents within the first year of life either in isolation or as a part of many different ocular or systemic disorders. Surgical repair is challenging, and recurrence necessitating more than one operation is not uncommon. Not all patients with congenital ptosis require surgery, but children with amblyopia due to astigmatic anisometropia or deprivation may benefit from early surgical correction. A variety of surgical procedures to correct congenital ptosis have been described. The choice of procedure depends on a number of patient-specific factors, such as degree of ptosis and levator function, as well as surgeon preference and resource availability. We review the genetics, associated syndromes, and surgical treatments of congenital ptosis.

To evaluate the effects of a novel ab interno trabeculectomy device on human trabecular meshwork (TM).Laboratory evaluation.The TM from human cadaveric corneal rim tissue was incised using 3 instruments: (1) novel dual-blade device; (2) microvitreoretinal (MVR) blade; and (3) Trabectome. Tissue samples underwent histologic processing and comparative analyses. Subsequently, human eye perfusion studies were performed to evaluate intraocular pressure (IOP)-lowering effects of each device. Main outcome measures were degree of TM removal by histology and IOP in a perfusion model.The MVR blade exhibited minimal removal of TM and obvious injury to the adjacent sclera. The Trabectome removed a large portion of the central TM, but leaflets of residual tissue remained and thermal injury was noted in all samples. The dual-blade device achieved a more complete removal of TM without injury to surrounding tissues. All devices resulted in statistically significant lowering of IOP during perfusion model studies. MVR blade treatment across 170.0 ± 14.1 degrees of TM resulted in a decrease of IOP from 18.5 ± 1.9 mm Hg to 12.8 ± 2.2 mm Hg (P.01). Trabectome treatment across 117.5 ± 12.6 degrees resulted in a decrease of IOP from 18.8 ± 1.7 mm Hg to 11.3 ± 1.0 mm Hg (P.01). Dual-blade device treatment across 157.5 ± 26.3 degrees resulted in a decrease of IOP from 18.3 ± 3.0 mm Hg to 11.0 ± 2.2 mm Hg (P.01).The novel dual-blade device demonstrated a more complete removal of TM without residual TM leaflets or damage to surrounding tissues and significantly reduced IOP in a human eye perfusion model.

Purpose To compare bleb survival and histology after implantation of the EX-PRESS™ glaucoma filtration device versus silicone tubes in a rabbit model of filtration surgery. Methods Glaucoma filtration surgery was performed on one eye each of twelve New Zealand white rabbits. Eyes were randomized to implantation with the EX-PRESS™ filtration device (n=6) or a silicone tube (n=6). Bleb vascularity was evaluated at three and six weeks using a standard scale. At 6 weeks, eyes were enucleated and a histologic analysis was performed. Bleb survival was also recorded for the two groups. Results Histologically, a thin capsule consisting of mild fibroblast proliferation associated with intercellular collagen was present around both implants. Both groups demonstrated a mild infiltration of plasma cells and polymorphonuclear leukocytes. Bleb vascularity was similar between both groups at three and six weeks post-operatively. Bleb survival between the two groups was not significantly different. Conclusions Similar outcomes were noted after glaucoma filtration surgery using either silicone tubes or the EX-PRESS™ glaucoma filtration device in this rabbit model. Both implants appear to be relatively inert with little difference in biocompatibility and bleb survival.

Leukocytes from a whole blood sample were concentrated using a microfluidic aqueous two phase system (microATPS). Whole blood was simultaneously exposed to polyethylene glycol (PEG) and dextran (Dex) phase streams and cells were partitioned based on their differential affinity for the streams. The laminar flow characteristic of microfluidic devices was used to create zero, one, and two stable interfaces between the polymer streams. Three different patterns of three polymer streams each were evaluated for their effectiveness in concentrating leukocytes: immiscible PEG-PEG-Dex, immiscible Dex-PEG-Dex, and miscible PEG-PBS-Dex. The most effective configuration was the Dex-PEG-Dex stream pattern which on average increased the ratio of leukocytes to erythrocytes by a factor of 9.13 over unconcentrated blood.

A microfluidic device for efficient and gentle leukocyte separation from whole blood is presented. The device is realized by taking advantage of the high specificity of lysing solutions, the collection efficiency of an Aqueous Two Phase System (ATPS), and the laminar flow of microfluidics. A narrow stream of dextran (DEX) containing whole blood is flowed next to a stream of polyethylene glycol (PEG) containing a lysing solution. The lysing solution diffuses across the interface and lyses the erythrocytes. The leukocytes are held in place by the surface tension of the two phase system while the remnants of the lysed erythrocytes, other blood materials and the lysing solution are allowed to diffuse away and then diverted to another channel. The main advantages of this method are the minimization of exposure of leukocytes to the toxic lysing solution and the removal of non-leukocyte components of blood. These steps are critical to allow the device to be used as a preparatory step for accurate quantification of leukocytes and sensitive detection of rare leukocytes.

Lower incidence rates of cancer for all anatomic sites combined were found in male and female Spanish-surnamed residents of Los Angeles County when compared to other whites. These Mexican-Americans were at lower risk for cancer of the buccal cavity, colon, rectum, larynx, lung, breast, bladder, prostate, and testis, and were at higher risk for cancer of the stomach, gallbladder, liver, and cervix. Immigrant Mexican-Americans had incidence rates most divergent from other whites, whereas indigenous Mexican-Americans had rates between the other two groups. The cancer pattern in Mexican-Americans was generally similar to that in American Indians. These data were most consistent with environmental variations in cause.