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American Journal of Ophthalmology Case... Dec 2023To report a case of XEN45 gel stent implantation in a pediatric patient with WAGR syndrome as a successful surgical intervention in the management of multifactorial...
PURPOSE
To report a case of XEN45 gel stent implantation in a pediatric patient with WAGR syndrome as a successful surgical intervention in the management of multifactorial secondary open-angle glaucoma.
OBSERVATIONS
A 6-year-old female with a history of WAGR syndrome, bilateral congenital aniridia, pseudophakia OD and glaucoma OD, was referred for a XEN45 gel stent OD. IOP was persistently elevated at 24 mm Hg despite two glaucoma medications. Implantation of the XEN45 gel stent was performed using a transconjunctival ab externo approach. There were no significant intra-or-postoperative adverse events associated with the stent. The patient achieved good IOP-lowering control without glaucoma medications across the 18-month follow-up period.
CONCLUSIONS
A XEN45 stent through a transconjunctival ab externo approach may be an effective surgical intervention in pediatric patients with secondary open-angle glaucoma associated with aniridia and aphakia.
PubMed: 37533700
DOI: 10.1016/j.ajoc.2023.101888 -
Case Reports in Ophthalmology 2023The purpose of the present case is to report the visual outcomes of a pseudophakic patient with high post-penetrating keratoplasty astigmatism treated with implantation...
The purpose of the present case is to report the visual outcomes of a pseudophakic patient with high post-penetrating keratoplasty astigmatism treated with implantation of toric AddOn intraocular lens (IOL) in the sulcus. A 79-year-old man with a ophthalmologic history of pseudoexfoliative glaucoma and Fuchs endothelial dystrophy had a graft failure after Descemet's stripping automated endothelial keratoplasty procedure on his right eye. Consequently, a penetrating keratoplasty was performed, and a high corneal astigmatism of -9.8 D to 140° resulted in that eye after selective suture removal. A secondary AddOn toric IOL customized for the patient with a manufacturer-calculated power of +11.0 D was implanted to 50° in sulcus of the right eye. Subjective refraction was used for IOL calculation. Final refraction was +1.0 D of sphere and -2.0 D of cylinder power to 105°, with spherical equivalent of 0.0 D. Best corrected visual acuity was logMAR 0.1 (20/25, 0.8 decimal) 1 year after the IOL implant. Our case report demonstrates that the toric AddOn secondary IOL can be effective and safe in correcting residual refractive error of high regular astigmatism after keratoplasty in pseudophakic eyes.
PubMed: 37485245
DOI: 10.1159/000530281 -
Medicina (Kaunas, Lithuania) May 2023: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to...
: The main cause of the vision loss in diabetics is the development of diabetic macular edema, regardless of the stage of diabetic retinopathy. The paper aimed to examine whether the additional intravitreal application of triamcinolone acetonide to continuous anti-vascular endothelial growth factor therapy could improve therapeutic outcomes for pseudophakic eyes with persistent diabetic macular edema. : twenty-four pseudophakic eyes with refractory diabetic macular edema, that had appeared despite three previously administered intravitreal injections of aflibercept, were divided into two groups (twelve eyes in each group). The first group continued to have aflibercept administered according to a fixed dosing regimen (once in two months). Triamcinolone acetonide 10 mg/0.1 mL (administered once per four months) was included for the second group, i.e., their treatment continued with a combination of aflibercept + triamcinolone acetonide. : The reduction in central macular thickness was higher in the eyes treated with combined therapy (aflibercept + triamcinolone acetonide) compared with the use of aflibercept alone during the entire 12-month follow-up period (3rd month = 0.019; 6th month = 0.023; 9th month = 0.027; 12th month = 0.031). As was evident from the -values, the differences were statistically significant. No statistically significant difference was recorded for visual acuity: 3rd month = 0.423; 6th month = 0.392; 9th month = 0.413; 12th month = 0.418. : Combined anti-vascular endothelial growth factor and steroid therapy leads to a better anatomical outcome of persistent diabetic macular edema in pseudophakic eyes, but does not lead to a more significant improvement in visual acuity than continuous anti-VEGF therapy alone.
Topics: Humans; Triamcinolone Acetonide; Macular Edema; Diabetic Retinopathy; Glucocorticoids; Endothelial Growth Factors; Tomography, Optical Coherence; Treatment Outcome; Diabetes Mellitus
PubMed: 37241214
DOI: 10.3390/medicina59050982 -
Journal of Personalized Medicine May 2023The study aimed to examine the effect of cataract extraction on ophthalmologists' ability to detect pseudoexfoliation (PXF) syndrome. A total of 31 patients admitted for...
The study aimed to examine the effect of cataract extraction on ophthalmologists' ability to detect pseudoexfoliation (PXF) syndrome. A total of 31 patients admitted for elective cataract surgery were enrolled in this prospective comparative study. Prior to surgery, patients underwent slit-lamp examination and gonioscopy conducted by experienced glaucoma specialists. Subsequently, patients were re-examined by a different glaucoma specialist and comprehensive ophthalmologists. Pre-operatively, 12 patients were diagnosed with PXF on the basis of a Sampaolesi line (100%), anterior capsular deposits (83%), and pupillary ruff deposits (50%). The remaining 19 patients acted as controls. All patients were re-examined 10-46 months post-operatively. Of the 12 patients with PXF, 10 (83%) were correctly diagnosed post-operatively by glaucoma specialists and 8 (66%) by comprehensive ophthalmologists. There was no statistically significant difference in PXF diagnosis. However, detection of anterior capsular deposits ( = 0.02), Sampaolesi lines ( = 0.04), and pupillary ruff deposits ( = 0.01) were significantly lower post-operatively. Diagnosis of PXF is challenging in pseudophakic patients as the anterior capsule is removed during cataract extraction. Therefore, PXF diagnosis in pseudophakic patients relies mainly on the presence of deposits at other anatomical sites, and careful attention to these signs is required. Glaucoma specialists may be more likely than comprehensive ophthalmologists to detect PXF in pseudophakic patients.
PubMed: 37240988
DOI: 10.3390/jpm13050818 -
Vision (Basel, Switzerland) May 2023To analyze the outcomes and complications of Descemet's membrane endothelial keratoplasty (DMEK) performed without prophylactic peripheral iridotomy (PI). : Design:...
UNLABELLED
To analyze the outcomes and complications of Descemet's membrane endothelial keratoplasty (DMEK) performed without prophylactic peripheral iridotomy (PI). : Design: Retrospective study.
SETTING
Institutional, tertiary care eye hospital.
STUDY POPULATION
All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuchs endothelial dystrophy, using a standardized protocol between August 2016 and July 2021, were included. Previous glaucoma surgery, laser PI, aphakia, or complicated pseudophakia were excluded.
MAIN OUTCOME MEASURES
Primary outcomes: Incidence of pupillary block (PB).
SECONDARY OUTCOMES
Graft detachment (GD), rebubbling rates, uncorrected (UCDVA) and best corrected logMAR distance visual acuity (BCDVA), and endothelial cell loss (ECL) at six months. Data were analyzed using the chi-square test and stepwise backward regression analysis. : 104 eyes of 72 patients were included. Four eyes (3.8%) developed PB; in two of these cases, standard protocol was not followed. Overall minor GD occurred in 43.2% (n = 45); significant GD was present only in 7 eyes (6.6%). Overall slit lamp rebubbling rate was 30% (n = 35), though only four patients were rebubbled in theatre (3.8%). PB, GD, and rebubbling rates did not vary with the surgeon, surgery, or tamponade (air or SF6 gas). UCDVA, BCDVA, and ECL at 6 months were 0.29 ± 0.31, 0.20 ± 0.28, and 40.46 ± 20.36%, respectively. : Compared to previously reported outcomes of DMEK with PI, our results of PI less DMEK using a standardized protocol have a similar incidence of pupillary block, graft detachment, and rebubbling, with comparable visual acuity and endothelial cell loss.
PubMed: 37218959
DOI: 10.3390/vision7020041 -
Indian Journal of Ophthalmology May 2023To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk... (Observational Study)
Observational Study
PURPOSE
To evaluate the prevalence of hypertensive phase (HP) and failure in patients who underwent Ahmed Glaucoma Valve (AGV) implantation and identify the possible risk factors for both HP and failure.
METHODS
A cross-sectional, observational study was conducted. Medical records of patients who underwent AGV implantation and had at least 1 year of follow-up were reviewed. HP was defined as an intraocular pressure (IOP) greater than 21 mmHg between the first week and the third postoperative month not attributable to other causes. Success was defined as an IOP between 6 and 21 mmHg, with preservation of light perception and no additional glaucoma surgeries. Statistical analysis was conducted to identify possible risk factors.
RESULTS
A total of 193 eyes of 177 patients were included. HP was present in 58%; a higher preoperative IOP and younger age were associated with HP. Pseudophakic or aphakic eyes had a lower HP rate. Failure was present in 29%; neovascular glaucoma, worse basal best corrected visual acuity (BCVA), higher baseline IOP, and postoperative complications were linked to a higher likelihood of failure. No difference in the HP rate between the failure and success groups was found.
CONCLUSION
A higher baseline IOP and younger age are associated with HP development; pseudophakia and aphakia might be protective factors. Factors for AGV failure are a worse BCVA, neovascular glaucoma, postoperative complications, and a higher baseline IOP. At 1 year, a higher number of medications were needed to achieve IOP control in the HP group.
Topics: Humans; Follow-Up Studies; Glaucoma Drainage Implants; Glaucoma, Neovascular; Prevalence; Cross-Sectional Studies; Treatment Outcome; Prosthesis Implantation; Glaucoma; Intraocular Pressure; Postoperative Complications; Risk Factors; Retrospective Studies
PubMed: 37203066
DOI: 10.4103/IJO.IJO_2541_22 -
Journal of Vitreoretinal Diseases 2023To determine the effect of lens status (pseudophakic vs phakic) on diabetic vitreous hemorrhage (VH) resolution time. Medical records were reviewed retrospectively for...
To determine the effect of lens status (pseudophakic vs phakic) on diabetic vitreous hemorrhage (VH) resolution time. Medical records were reviewed retrospectively for each case of diabetic VH until resolution, pars plana vitrectomy (PPV), or loss to follow-up. Univariate and multivariate Cox regression models were used to determine predictors of diabetic VH resolution time through estimated hazard ratios (HRs). Kaplan-Meier survival analysis compared differences in the resolution rate by lens status and other significant factors. Overall, 243 eyes were included. Pseudophakia (HR, 1.76; 95% CI, 1.07-2.90; = .03) and prior PPV (HR, 3.28; 95% CI, 1.77-6.07; < .001) were significant factors for faster resolution. Pseudophakic eyes resolved in 5.5 months (median, 25.1 weeks; 95% CI, 19.3-31.0) and phakic eyes in 10 months (median, 43.0 weeks; 95% CI, 36.0-50.0) ( = .001). More pseudophakic eyes than phakic eyes resolved without PPV (44.2% vs 24.8%) ( = .001). Eyes without prior PPV resolved in 9.5 months (median, 41.0 weeks; 95% CI, 35.7-46.3) compared with 5 months (median, 22.3 weeks; 95% CI, 9.8-34.8) in vitrectomized eyes ( < .001). Age, treatment with antivascular endothelial growth factor injections or panretinal photocoagulation, intraocular pressure medications, and glaucoma history were not significant predictors. Diabetic VH resolved almost twice as fast in pseudophakic eyes than in phakic eyes. Eyes with a history of PPV resolved 3 times quicker than those without PPV. A better understanding of VH resolution can help personalize the decision on when to proceed with PPV.
PubMed: 37188215
DOI: 10.1177/24741264231163394 -
International Journal of Ophthalmology 2023To describe a case of aqueous misdirection complicated by subsequent persistent choroidal effusions following implantation of a Preserflo MicroShunt (PMS) device to...
AIM
To describe a case of aqueous misdirection complicated by subsequent persistent choroidal effusions following implantation of a Preserflo MicroShunt (PMS) device to treat advanced closed angle glaucoma.
METHODS
A 67-year-old caucasian female with advanced primary angle-closure glaucoma on four medications with an intraocular pressure (IOP) of 26 mm Hg was listed for a PMS insertion with mitomycin C (MMC).
RESULTS
Past ocular history was significant for pseudophakia and previous yttrium aluminum garnet (YAG) peripheral iridotomy. Surgery was uneventful but on the first postoperative day, she developed aqueous misdirection complicated by subsequent development of persistent uveal effusions. Conventional treatment strategies including atropine drops, YAG hyaloidotomy and choroidal effusion drainage proved ineffective. A combination of oral steroids and pars plana vitrectomy (PPV) along with an irido-zonulo-hyloidectomy (IZH) proved efficacious.
CONCLUSION
To the best of the author's knowledge, this is the first published case of aqueous misdirection complicated with the presence of significant, unresolving choroidal effusions, highlighting the possibility and sequelae of comorbid pathology in nanophthalmic eyes.
PubMed: 37077484
DOI: 10.18240/ijo.2023.04.21 -
Oman Journal of Ophthalmology 2023The case report of a 68-year-old man with a single-piece hydrophobic intraocular lens (IOL) implanted in the sulcus with posterior capsular rent in the right eye...
The case report of a 68-year-old man with a single-piece hydrophobic intraocular lens (IOL) implanted in the sulcus with posterior capsular rent in the right eye inducing secondary open-angle pigmentary glaucoma without individual hereditary steroid susceptibility. The clinical and diagnostic evaluations of the patient were thoroughly and specifically carried out. The unilateral pseudophakic open-angle pigmentary glaucoma developed in the long course in the context of rubbing of the haptics and optic of a hydrophobic IOL implanted in the sulcus, against the posterior surface of the iris, resulting in pigment dispersion, trabecular inflammation, and aqueous outflow obstruction. Although the clinical findings of our case were very similar to that of pigmentary glaucoma, the distinction between the two conditions was still quite easy, considering that pigmentary glaucoma is a bilateral disorder predominantly affecting young myopic men with Krukenberg's spindle and increased incidence of steroid responsiveness. It has been clearly distinguished from steroid-induced glaucoma based on the pigmented trabecular meshwork.
PubMed: 37007253
DOI: 10.4103/ojo.ojo_391_20