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Indian Journal of Ophthalmology Jun 2023Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative...
BACKGROUND
Trabeculectomy is the gold standard filtration surgery for diverting aqueous from anterior chamber to the subconjunctival space. More than the surgery, postoperative follow-ups and management of the blebs play a critical role in the long-term success. This video is aimed at showing the real-world management of blebs postoperatively.
PURPOSE
This video will serve as a practical guide to the postoperative management of trabeculectomy blebs with specific focus on the suture manipulation.
SYNOPSIS
This video will demonstrate various suturing techniques of trabeculectomy and their manipulation in the postoperative period. Complications related to each will be discussed.
HIGHLIGHTS
We demonstrate how to place and remove, releasable, and fixed sutures. We also address the practical points on why and when to remove the sutures. Suture-related complications and their management have been shown along with practical examples.
VIDEO LINK
https://youtu.be/2WFQJAPyOvY.
Topics: Humans; Anterior Chamber; Filtering Surgery; Intraocular Pressure; Postoperative Complications; Suture Techniques; Sutures; Trabeculectomy
PubMed: 37322725
DOI: 10.4103/IJO.IJO_336_23 -
The Journal of the American Osteopathic... Feb 2015
Topics: Aged; Anterior Chamber; Eye Foreign Bodies; Eyelashes; Female; Humans; Phacoemulsification; Postoperative Complications
PubMed: 25637618
DOI: 10.7556/jaoa.2015.023 -
Sensors (Basel, Switzerland) Feb 2021This study assessed the anterior chamber depth (ACD) and iridocorneal angle using a portable smart eye camera (SEC) compared to the conventional slit-lamp microscope and...
This study assessed the anterior chamber depth (ACD) and iridocorneal angle using a portable smart eye camera (SEC) compared to the conventional slit-lamp microscope and anterior-segment optical coherence tomography (AS-OCT). This retrospective case-control study included 170 eyes from 85 Japanese patients. The correlation between the ACD evaluations conducted with the SEC and conventional slit-lamp was high (r = 0.814). The correlation between the Van-Herick Plus grade obtained using two devices was also high (r = 0.919). A high kappa value was observed for the Van-Herick Plus grading (Kappa = 0.757). A moderate correlation was observed between the ACD measured using AS-OCT and the slit-lamp image acquired with the conventional slit-lamp microscope and SEC (r = 0.609 and 0.641). A strong correlation was observed between the trabecular-iris angle (TIA) measured using AS-OCT and Van-Herick Plus grade obtained with the conventional slit-lamp microscope and SEC (r = 0.702 and 0.764). Strong correlations of ACD evaluation and high kappa value of the Van-Herick Plus grading indicated the adequate subjective assessment function of the SEC. Moderate correlations between the ACD objective measurement and evaluation and strong correlation between the TIA and Van-Herick Plus grade suggested the good objective assessment function of the SEC. The SEC demonstrated adequate performance for ACD evaluation and angle estimation.
Topics: Anterior Chamber; Case-Control Studies; Female; Humans; Iris; Male; Microscopy; Retrospective Studies; Tomography, Optical Coherence
PubMed: 33669487
DOI: 10.3390/s21041436 -
Translational Vision Science &... Jan 2023The anterior chamber angle (ACA) is a critical factor in posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens [ICL]) implantation. Herein, we...
PURPOSE
The anterior chamber angle (ACA) is a critical factor in posterior chamber phakic intraocular lens (EVO Implantable Collamer Lens [ICL]) implantation. Herein, we predicted postoperative ACAs to select the optimal ICL size to reduce narrow ACA-related complications.
METHODS
Regression models were constructed using pre-operative anterior segment optical coherence tomography metrics to predict postoperative ACAs, including trabecular-iris angles (TIAs) and scleral-spur angles (SSAs) at 500 µm and 750 µm from the scleral spur (TIA500, TIA750, SSA500, and SSA750). Data from three expert surgeons were assigned to the development (N = 430 eyes) and internal validation (N = 108 eyes) datasets. Additionally, data from a novice surgeon (N = 42 eyes) were used for external validation.
RESULTS
Postoperative ACAs were highly predictable using the machine-learning (ML) technique (extreme gradient boosting regression [XGBoost]), with mean absolute errors (MAEs) of 4.42 degrees, 3.77 degrees, 5.25 degrees, and 4.30 degrees for TIA500, TIA750, SSA500, and SSA750, respectively, in internal validation. External validation also showed MAEs of 3.93 degrees, 3.86 degrees, 5.02 degrees, and 4.74 degrees for TIA500, TIA750, SSA500, and SSA750, respectively. Linear regression using the pre-operative anterior chamber depth, anterior chamber width, crystalline lens rise, TIA, and ICL size also exhibited good performance, with no significant difference compared with XGBoost in the validation sets.
CONCLUSIONS
We developed linear regression and ML models to predict postoperative ACAs for ICL surgery anterior segment metrics. These will prevent surgeons from overlooking the risks associated with the narrowing of the ACA.
TRANSLATIONAL RELEVANCE
Using the proposed algorithms, surgeons can consider the postoperative ACAs to increase surgical accuracy and safety.
Topics: Humans; Phakic Intraocular Lenses; Lens Implantation, Intraocular; Myopia; Lens, Crystalline; Anterior Chamber
PubMed: 36607625
DOI: 10.1167/tvst.12.1.10 -
Indian Journal of Ophthalmology Dec 2021The tuck-and-pull technique was developed for practical and safe explantations of posterior chamber phakic intraocular lenses (PCPIOLs). In this technique, after the...
The tuck-and-pull technique was developed for practical and safe explantations of posterior chamber phakic intraocular lenses (PCPIOLs). In this technique, after the creation of a side port, viscoelastic (or OVD [ophthalmic viscosurgical device]) is initially injected behind the PCPIOL to widen the space between PCPIOL and the crystalline lens. The old incisions can be used after recent implantations rendering the enlargement of the main incision unnecessary. After additional OVD over and under the PCPIOL, the haptic is tucked by a chopper and pulled through the main incision with a single maneuver. The haptic is grasped by two suture forceps and explanted with a "hand-to-hand" maneuver. The tuck-and-pull technique provided high protection of the corneal endothelium, crystalline lens, anterior chamber structures, and the PCPIOL itself. This technique is a practical, easy, and safe approach for explantations of all PCPIOL types, whatever the reason for its explantation may be.
Topics: Anterior Chamber; Humans; Lens Implantation, Intraocular; Lens, Crystalline; Lenses, Intraocular; Myopia; Phakic Intraocular Lenses
PubMed: 34827034
DOI: 10.4103/ijo.IJO_652_21 -
BMC Ophthalmology Aug 2018The purpose of this study was to compare the efficacy and safety of pars plana glaucoma drainage device (PP GDD) with anterior chamber glaucoma drainage device (AC GDD)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The purpose of this study was to compare the efficacy and safety of pars plana glaucoma drainage device (PP GDD) with anterior chamber glaucoma drainage device (AC GDD) for the treatment of glaucoma.
METHODS
We comprehensively searched three databases, including PubMed, EMBASE, and the Cochrane Library databases, selecting the relevant studies. The continuous variables, namely, intraocular pressure (IOP) and glaucoma medications, were pooled by the weighted mean differences (WMDs), and the dichotomous outcomes, including corneal failure incidence and overall complications incidence, were pooled by the odds ratio (ORs).
RESULTS
Four retrospective studies involving 275 eyes were evaluated, with 135 in the PP GDD group and 140 in the AC GDD group. The WMDs of the IOP reduction between the PP GDD group and the AC GDD group were - 1.01 mmHg (95% CI -4.05 to 2.03, p = 0.52). The WMDs of the glaucoma medications reduction between the PP GDD group and the AC GDD group were 0.23 (95% CI -0.11 to 0.56, p = 0.19). The pooled ORs comparing PP GDD group with AC GDD group were 1.01 (95% CI 0.03 to 40.76, p = 0.99) for corneal failure incidence and 1.19 (95% CI 0.68 to 2.09, p = 0.54) for overall complication incidence. There were no significant differences between PP GDD group and AC GDD group on these aspects.
CONCLUSIONS
Both PP GDD and AC GDD procedures had similar efficacy of reduction in the IOP and number of medications. They are also both comparable on the safety with similar incidence of corneal failure and overall complications.
Topics: Anterior Chamber; Glaucoma; Glaucoma Drainage Implants; Humans; Intraocular Pressure; Visual Acuity
PubMed: 30157805
DOI: 10.1186/s12886-018-0896-x -
Ophthalmic Research 2021Evaluating the anterior chamber angle (ACA) is important for the early diagnosis and treatment of primary angle-closure glaucoma. The assessment of ultrasound...
INTRODUCTION
Evaluating the anterior chamber angle (ACA) is important for the early diagnosis and treatment of primary angle-closure glaucoma. The assessment of ultrasound biomicroscopy (UBM) images usually requires well-trained ophthalmologists and screening for patients with narrow ACA is usually time- and labor-intensive. Therefore, the automatic assessment of UBM could be cost-effective and valuable in daily practice.
OBJECTIVE
The objective of this study is to develop an automatic method for localizing and classifying ACA based on UBM images.
METHODS
UBM images were collected and a coarse-to-fine method was used to localize the apex of the angle recess. By analyzing the grayscale features around the angle recess, closed angles were identified, and the rest were then classified as open or narrow angles, based on the degree of ACA. Using manual classification as the reference standard, the overall accuracy (OAcc), sensitivity (Sen), specificity (Spe), and balanced accuracy of the automatic classification method were evaluated.
RESULTS
A total of 540 UBM images from 290 participants were analyzed. Using these UBM images and the proposed method, the ACA was classified as open, narrow, or closed. During processing, the method localized the angle recess with 95% accuracy. The OAcc of the ACA classification was 77.8%, and the Spe and Sen of our method were 85.8 and 81.7% for angle closure; 88.9 and 75.6% for open angles; 91.9 and 76.1% for narrow angles, respectively.
CONCLUSIONS
Our method of automatic angle localization and classification based on UBM images is feasible and reliable. The automatic classification of ACA provides a basis and reference for future studies.
Topics: Anterior Chamber; Glaucoma, Angle-Closure; Gonioscopy; Humans; Microscopy, Acoustic
PubMed: 32810851
DOI: 10.1159/000510924 -
Korean Journal of Ophthalmology : KJO Feb 2024The aim of this study is to investigate changes in intraocular pressure (IOP) and anterior-segment parameters before and after cataract surgery, vitrectomy, and combined...
PURPOSE
The aim of this study is to investigate changes in intraocular pressure (IOP) and anterior-segment parameters before and after cataract surgery, vitrectomy, and combined surgery.
METHODS
The records of patients who had undergone cataract surgery (cataract group), vitrectomy (vitrectomy group), or combined cataract surgery and vitrectomy (combined group) at our hospital were retrospectively examined. The vitrectomy group consisted of pseudophakic eyes. IOP and anterior-segment measurements, including anterior chamber depth (ACD), angle opening distance (AOD), trabecular-iris angle (TIA), and trabecular-iris space area (TISA), were measured using swept-source anterior-segment optical coherence tomography before and 6 months after surgery in 41, 15, and 40 eyes, respectively.
RESULTS
In the cataract and combined groups, there was a decrease in IOP (cataract group: from 15.8 to 13.4 mmHg, p <0.001; combined group: from 15.8 to 14.2 mmHg, p = 0.002) and an increase in the central corneal thickness after surgery (p <0.001). The ACD increased in all groups, with a smaller increase in the vitrectomy group (p <0.03). Postoperative AOD, TIA, and TISA were significantly increased in the cataract and combined groups (p <0.02). Higher preoperative IOP and larger IOP reduction after surgery were correlated with smaller preoperative AOD, TISA, and TIA in cataract and combined groups (p <0.034). A small preoperative ACD was related to smaller preoperative AOD, TISA, TIA (r > 0.649, p <0.001), and postoperative IOP reduction in the cataract and combined groups (r = 0.377, p = 0.018 and r = 0.559, p = 0.001, respectively).
CONCLUSIONS
Compared to the vitrectomy group, the cataract and combined groups showed reduced postoperative IOP and increased AOD, TISA, and TIA. In these two groups, patients with shallower preoperative ACDs showed greater changes in IOP after surgery. Changes in IOP after surgery are thought to be related to changes in the anterior segment caused by the removal of the crystalline lens.
Topics: Humans; Intraocular Pressure; Retrospective Studies; Vitrectomy; Anterior Chamber; Lens, Crystalline; Eye Diseases; Cataract; Tomography, Optical Coherence
PubMed: 38104596
DOI: 10.3341/kjo.2023.0072 -
Ophthalmic Surgery, Lasers & Imaging... Jan 2022No consensus exists on the comparative efficacy and safety of sutured scleral-fixated (SSF) and anterior chamber (AC) intraocular lens (IOL) implantation. We aim to... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVE
No consensus exists on the comparative efficacy and safety of sutured scleral-fixated (SSF) and anterior chamber (AC) intraocular lens (IOL) implantation. We aim to compare outcomes of these two techniques.
PATIENTS AND METHODS
A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was conducted (2005 to 2020). Studies comparing SSFIOLs with ACIOLs were included. Outcomes included corrected distance visual acuity and complications. A meta-analysis was conducted with a random effects model. Weighted mean differences and risk ratios with 95% CIs were computed.
RESULTS
Seven hundred eighty-three eyes from nine studies were included. SSFIOLs had a significantly higher absolute postoperative spherical equivalent (weighted mean difference, 0.32; 95% CI, 0.03 to 0.60; = .03; low certainty) and incidence of IOL decentration/subluxation (risk ratio, 2.69; 95% CI, 1.03 to 7.01; = .04; moderate certainty) than ACIOLs. There was no difference in final corrected distance visual acuity ( = .26).
CONCLUSIONS
SSFIOLs have a higher absolute postoperative spherical equivalent and incidence of IOL decentration/subluxation than ACIOLs. Future prospective studies are needed to confirm these findings. .
Topics: Anterior Chamber; Humans; Lens Implantation, Intraocular; Lens Subluxation; Lenses, Intraocular; Postoperative Complications; Retrospective Studies; Sclera; Suture Techniques
PubMed: 34982000
DOI: 10.3928/23258160-20211213-01 -
Progress in Retinal and Eye Research Jan 2013This review traces the evolution of the concept of the blood-aqueous barrier (BAB) during the past 20 years. The Classical model simply stipulated that the tight... (Review)
Review
This review traces the evolution of the concept of the blood-aqueous barrier (BAB) during the past 20 years. The Classical model simply stipulated that the tight junctions of the iris vasculature and ciliary epithelium excluded plasma proteins from the aqueous humor (AH). It failed to reconcile the presence of AH protein levels equal to 1% of that found in plasma. Moreover, models of barrier kinetics assumed that the processes of AH secretion and plasma protein entry were directly linked. Thus, elevations of AH protein levels could only be explained by a pathological breakdown of the BAB. Over the last 20 years it has been shown that the plasma proteins in normal AH by-pass the posterior chamber entirely. Instead, these proteins diffuse from the capillaries of ciliary body stroma, into the iris stroma and then into the anterior chamber. This creates a reservoir of plasma-proteins in the iris stroma that is not derived from the iris vessels. This reservoir is prevented from diffusing posteriorly by tight junctions in the posterior iris epithelium. The one-way valve created by the pupil resting on the anterior lens capsule, combined with the continuous, forward flow of AH through the pupil, prevents protein reflux into the posterior chamber. Importantly, in the new paradigm, secretion of AH and the entry of plasma proteins into AH, are semi-independent events. This opens the possibility that AH protein levels could increase in the absence of breakdown of the BAB. Clinical consequences of this new paradigm of the BAB are discussed.
Topics: Animals; Anterior Chamber; Aqueous Humor; Blood-Aqueous Barrier; Capillary Permeability; Humans
PubMed: 23128417
DOI: 10.1016/j.preteyeres.2012.10.004