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Background Gonioscopy assisted transluminal trabeculotomy (GATT) is a minimally invasive, ab interno conjunctival sparing glaucoma surgery aimed at the trabecular meshwork and the inner wall of Schlemm’s canal. The goal of this study is to report on the success of GATT in a large group of patients with a wide variety of open and closed angle glaucomas with or without cataract extraction, and to search for risk factors for failure. Methods A retrospective chart review of consecutive patients with primary or secondary open or closed angle glaucoma who underwent GATT, with or without concomitant phacoemulsification. Demographics, baseline clinical characteristics and postoperative outcomes were collected from patients' medical records. Primary outcomes were success and complication rates. IOP and the number of glaucoma medications were secondary outcome measures. Results GATT was performed on 127 eyes of 121 patients. Mean follow up was 8.7 ± 4.6 months (Range 3–23 months). Cumulative success at 6 months was 0.85 for GATT combined with cataract extraction, 0.92 for GATT alone, 0.9 for both POAG and SOAG and 0.73 for PACG. IOP decreased from a mean of 20.65 mmHg to 13 mmHg and 13.7 mmHg at 12 and 18 months, respectively. Medication decreased from a mean of 3.47 to 1.47 and 1.44 at 12 and 18 months, respectively. Twenty-five eyes (19.5%) were classified as failures. Pre-operative factors associated with an increased risk of failure requiring further surgery for pressure control were: preoperative maximal IOP (p = 0.001, OR: 1.177), post-operative IOP spike (p = 0.012, OR: 16.25), and prior incisional glaucoma surgery (p = 0.002, OR: 0.016). Conclusion GATT achieved good surgical success with good IOP and medication reduction across a wide range of glaucomas, in combination with lens extraction or as a standalone procedure. Gatt should be considered early in the treatment paradigm of medically uncontrolled glaucoma.

The study aims to review the efficacy, safety, and technique of Nd:YAG laser vitreolysis for the management of malignant glaucoma (MG).We performed a search of electronic databases for all published studies which included technical specifications of Nd:YAG laser application for MG. Individual patient data was extracted and evaluated in a weighted pooled analysis.Thirty eyes were reported on from seven studies worldwide. Age of affected patients ranged between 37 and 82 years. Nd:YAG vitreolysis was performed either through an iritodomy (66.7%, 18/27 eyes), transpupillary (18.5%, 5/27 eyes), or through both simultaneously (14.8%, 4/27 eyes). Treatment intensity ranged between 1.0 and 11.00 mJ with 75.9% (22/29 eyes) of treatments being 3.0 mJ or lower. Between 1 and 41 pulses per session were applied. Rates of both anatomical and intraocular pressure resolution were examined. Overall, in a pooled analysis, 77% of eyes demonstrated MG resolution with no further treatment required after Nd:YAG vitreolysis (95% CI: 58.1 to 91.4%). A trend for lower need of additional interventions was seen with transpupillary application (11.1% versus 42.1%). No complications were reported.Nd:YAG laser vitreolysis is a safe procedure, associated with MG resolution in the majority of reported cases, regardless of treatment intensity. Transpupillary treatment may be associated with lower risk of re-intervention.

PURPOSE: To evaluate the optical performance and quality of vision of a novel optical design of a new trifocal intraocular lens (IOL) using a proprietary modified algorithm. METHODS: In this prospective, non-randomized, single-armed, single-center, open-label study, a total of 20 patients (40 eyes) who were candidates for multifocal lens implantation were recruited for implantation with the multifocal Intensity SL IOL (Hanita Lenses). Evaluation performed at 1 and 7 to 10 days and 1 and 3 months after implantation included corrected and uncorrected distance visual acuities at far, intermediate (80 cm), and near (40 cm). Monocular and binocular visual acuities, defocus curves, and contrast sensitivity were measured and questionnaires for grading subjective visual quality, satisfaction, and visual function were provided. RESULTS: Three months postoperatively, monocular uncorrected visual acuity for distance, intermediate, and near averaged 0.03 ± 0.11, 0.09 ± 0.09, and −0.22 ± 0.09 logMAR, respectively (Snellen 20/21.4, 20/24.6, and 20/12). Corrected monocular visual acuity for distance, intermediate, and near averaged −0.07 ± 0.06, 0.03 ± 0.09, and −0.25 ± 0.07 logMAR (20/17, 20/21.4, and 20/11.2), respectively. Binocular corrected visual acuity for distance, intermediate, and near was −0.1 ± 0.06, −0.02 ± 0.09, and −0.28 ± 0.04 logMAR (20/15.8, 20/19, and 20/10.5), respectively. Contrast sensitivity was similar to the normal population in photopic and mesopic conditions. Defocus curves showed that this IOL provided visual acuity of 20/28.9 or better between a defocus of +1.00 and −3.50 diopters. The Visual Function Index-14 questionnaire showed that patients reported high satisfaction. Patients specifically noted good quality of vision at near and intermediate distances. CONCLUSIONS: The Intensity SL IOL can provide good quality distance, intermediate, and particularly strong near vision after cataract surgery and independence from spectacles with good patient satisfaction. [ J Refract Surg . 2022;38(3):150–157.]

PURPOSE To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS). METHODS In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively. RESULTS Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005). CONCLUSIONS IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.

Purpose – To report on a combined surgical approach of IOL fixation and GATT for the treatment of subluxated IOLs and glaucoma.Methods – In this retrospective cohort, Charts of patients who underwent IOL-fixation combined with GATT between November 2019 and October 2021 were reviewed. Main outcome measure was surgical success, defined as a well-centered IOL and an IOP of 18mmHg or lower and either a 30% IOP reduction or a reduction in medications as compared to baseline. Complications and need for reoperation were recorded.Results – 8 patients who underwent GATT with IOL-fixation were included. Mean age was 80.88 years (range 73-90). The pathomechanism of subluxation for all patients was pseudoexfoliation. 5 cases underwent scleral-fixation, and 3 underwent iris-fixation. Mean follow-up was 6.5 months. The success rate was 100%. Mean baseline IOP was 19.75±6.38 mmHg on 3.38±0.74 medications. 3 patients were on an oral carbonic-anhydrase inhibitor (CAI) prior to surgery. Mean IOP at the end of follow-up was 13.43±4.43 mmHg on 0.63±1.19 medications, and none were on oral CAIs. No intraoperative complications occurred, transient hyphema and vitreous hemorrhage were the most common postoperative complications. All patients had a well-centered IOL. No patients needed any additional surgery. Mean BCVA was 0.62±0.7 at baseline and 0.40±0.31 at the end of follow-up. One patient with advanced glaucoma did not recover her VA, while other patients’ BCVA was either retained or improved.Conclusions – GATT can be combined with IOL-fixation to effectively reduce IOP and medication usage.

To assess the effect of hypotensive drugs on light absorbance, discoloration, opacification and precipitate formation of IOLs.In this laboratory study, four types of IOLs (two hydrophilic-acrylic-L1 and L2, and two hydrophobic-acrylic-B1 and B2) were soaked in solutions containing Timolol-maleate 0.5%, Dorzolamide 2%, Brimonidine-tartrate 0.2%, Latanoprost 0.005%, Brimonidine-tartrate/Timolol-maleate 0.2%/0.5% and Dorzolamide/Timolol-maleate 2%/0.5%. Non-treated IOLs and IOLs soaked in balanced salt solution (BSS) served as controls. All Treated lenses were sealed in containers and placed in an oven at 82 degrees Celsius for 120 days. Each IOL was examined using four different techniques: light microscopy imaging, light absorbance measurements at 550 nanometers through the optic's center, assessment of by a scanning electron microscope (SEM), and energy dispersive Xray spectrometry (EDX).Ninety-eight IOLs were included. All BSS-soaked IOLs appeared clear with no significant discoloration or precipitate-formation. Light absorbance in these lenses was comparable to that of non-soaked, non-heated IOLs. No calcium or phosphate were detected in either of these groups. Light absorbance differed significantly between the four treated IOL types. The drops most affecting light absorbance differed between IOLs. Gross examination revealed brown and yellow discoloration of all IOLs soaked in Dorzolamide and Brimonidine-tartrate solutions, respectively. SEM demonstrated precipitates that differed in size, morphology and distribution, between different IOL-solution combinations. EDX's demonstrated the presence calcium and phosphor in the majority of precipitates and the presence of sulfur in brown discolored IOLs.In vitro, interactions between hypotensive drugs and IOLs induce changes in light absorbance, discoloration and precipitate formation.

To examine the efficacy of preoperative administration of topical atropine 1% and non-steroidal anti-inflammatory drugs (NSAIDs) for prevention of intraoperative floppy iris syndrome (IFIS).In this retrospective cohort study, patients who underwent cataract surgery by phacoemulsification between July 2019 and February 2020 in two hospitals were included. Both hospitals are located in central Israel, have similar patient demographics and employ similar surgical techniques. They, however, differ in policy of IFIS prevention. In Meir Medical Center no preventive medications are given pre-operatively, while in Shamir Medical Center patients at-risk for IFIS receive topical atropine 1% once daily and non-steroidal anti-inflammatory drugs (NSAIDs) thrice daily for 3 days preoperatively.Overall, 207 eyes of 207 patients with history of alpha-antagonist use were included. Mean age was 74.9 ± 7.8 years and 82.1% (n = 170) were male. Among patients from the pretreating center 86.8% (n = 92/106) were pre-treated with either NSAIDs or atropine preoperatively, while in the non-pretreating center no treatment was prescribed (n = 0/101). IFIS rate among the non-pretreating center was 29.7% (n = 30/101) compared to 15.1% (n = 16/106) in the pretreating center (p = 0.012). When strictly comparing treated to untreated patients, the treated group had an IFIS rate of 12.0% compared to 30.4% among untreated (p = 0.001). Adjusted for age and gender results remain consistent (odds ratio 0.329 for treated patients, 95% confidence interval: 0.150-0.720; p = 0.005).IFIS rates were significantly lower in the pretreating center compared to the non-pretreating center. When comparing strictly treated to untreated patients, differences were even more pronounced.

Purpose: To examine whether Muller’s-muscle-conjunctival-resection (MMCR) changes the position of the lower eyelid.Methods: Retrospective controlled-cohort study. All patients who underwent MMCR (s...

Thorough evaluation of the upper eyelid is essential for diagnosis and management planning in blepharoptosis. In a previous study, our group described a novel force gauge for direct assessment of upper lid force in healthy subjects. In this study, the authors apply the same technique for measuring muscle forces in ptotic eyelids.Patients scheduled to undergo surgical repair of aponeurotic blepharoptosis or dermatochalasis, from July 2017 to August 2018, in a tertiary care medical center, were enrolled in this prospective case series. When the eyelid disorder was unilateral, the normal eye was designated as control. The upward force generated by the eyelid was measured directly using a handheld dynamometer noninvasively attached to the upper eyelid. Measurements were conducted with and without fixation of the frontalis muscle, to differentiate between total lid force, levator force, and frontalis contribution.A total of 56 eyes was included in the study: 34 in the ptosis group, 11 in the dermatochalasis group, and 11 as controls. Both the ptosis group and the dermatochalasis group had significantly lower total muscle force and levator force measurements when compared with control (P

In this paper, we present a model that enables us to calculate the optimal income tax rate, given a specific utility function from leisure and consumption of private and public goods. The main contribution of our paper is presenting a new approach for determining the optimal tax rate: instead of focusing on the social planner’s point of view, we focus on the private agent’s point of view. We assume a given labor supply function and calculate the loss of income which equals increased government supply following tax imposition. Taking into consideration the loss of utility following decreased private consumption as well as increased public utility following increased leisure and public consumption, we calculate the income tax rate that would maximize an agent’s benefit. We examined our model by gradually changing labor supply elasticity, wage per hour, and the parameter of marginal utility from public consumption. We find that as labor supply elasticity increases, the optimal tax rate should be lower. On the other hand, as wage per hour increases, the optimal tax rate should be higher. Finally, as the parameter increasing utility from public consumption is lower, the optimal tax is lower.

In this paper, we suggested a new technique for extracting a technology index time series and calculated the technology index for 26 OECD countries for the years 1990-2011. Assuming that production function is Cobb-Douglas and with constant return to scale and that the labor parameter is equal to the labor share out of the total production, we extracted the technology parameter for each year and for each country. According to our findings, the largest advance in technology occurred in Estonia, Slovenia, Poland, and Ireland while the smallest advance was in Italy, Portugal, Mexico and Japan. A possible explanation for these differences is foreign R&D spillovers.