Long-term Outcome of Surgical Treatment with Various Reinforcement Material Grafts on Scleromalacia

Purpose@#To investigate the long-term efficacy and stability of the use of various reinforcement material grafts on scleromalacia. @*Methods@#This retrospective study was conducted on scleromalacia patients who underwent surgical treatment with reinforcement material grafts from January 2012 to March 2019. The choice of amniotic membrane, Tenon’s capsule, acellular sclera, or collagen matrix implanted in the area of scleromalacia was made based on disease severity. Amniotic membrane transplantation with a pedicular rotatory inferior conjunctival flap was performed to prevent having a bare sclera. The patient demographics, cause of scleromalacia, best-corrected visual acuity (BCVA), recurrence rate, postoperative complications, and restoration appearance were evaluated. @*Results@#A total of 58 patients (58 eyes) were enrolled in this study. The mean age of patients was 65.7 ± 9.6 years, and 32 patients (55.2%) were women. The mean follow-up period was 28.1 ± 17.3 months. The most common cause of scleromalacia was pterygium operation (53 patients, 91.4%). The reinforcement materials were mainly amniotic membrane (31 patients, 53.4%) and acellular sclera (15 patients, 25.7%). There was no recurrence of scleromalacia or structural instability during the follow-up period. The preoperative and postoperative mean BCVA values were 0.24 ± 0.24 and 0.21 ± 0.23 logMAR, respectively. Wound dehiscence (three patients, 5.2%) and conjunctival cyst (three patients, 5.2%) occurred with the highest frequency. @*Conclusions@#The use of the appropriate reinforcement material graft according to the severity of scleromalacia and amniotic membrane transplantation using a pedicular rotatory inferior conjunctival flap to prevent a bare sclera can be effective for treating scleromalacia, without long-term recurrence.

Efficacy of Preservative-free Latanoprost in Normal-tension Glaucoma with Mild to Moderate Dry Eye

Purpose@#To evaluate the efficacy and safety of preservative-free latanoprost in patients with normal-tension glaucoma who had mild to moderate dry eye after switching from preserved latanoprost. @*Methods@#This retrospective study was conducted in patients with normal-tension glaucoma who had mild to moderate dry eye. All enrolled patients had used preserved latanoprost and switched to preservative-free Latanoprost. The study consisted of a baseline visit (treatment with preserved latanoprost) and four follow-up visits conducted after 1, 3, 6, and 12 months of treatment with preservative-free latanoprost. Intraocular pressure (IOP), mean deviation (MD), ocular surface disease index (OSDI), Shirmer’s test score, tear break-up time (TBUT), corneo-conjunctival fluorescein staining, and adverse drug reactions were evaluated. @*Results@#The mean IOP and MD values during treatment with preserved latanoprost were 14.1 ± 2.6 mmHg and -2.68 ± 0.11 dB, respectively. The mean IOP and MD values at 12 months after switching to preservative-free latanoprost were 13.9 ± 1.9 mmHg and -2.66 ± 0.12 dB, respectively. The OSDI, Shirmer’s test score, BUT, and corneo-conjunctival fluorescein staining during treatment with preserved latanoprost were 53.15 ± 8.86, 4.97 ± 1.71 mm, 4.92 ± 1.72 seconds, and 2.92 ± 1.05, respectively. The OSDI, Shirmer’s test score, TBUT, and corneo-conjunctival fluorescein staining at 12 months after switching to preservative-free latanoprost were 49.07 ± 6.97, 5.51 ± 1.48 mm, 5.49 ± 1.46 seconds, and 2.47 ± 1.09, respectively. There were no serious adverse drug reactions causing ocular damage. @*Conclusions@#Preservative-free latanoprost was effective for improving objective and subjective symptoms compared to preserved latanoprost; it maintained a stable IOP and visual field value in patients with normal-tension glaucoma who had mild to moderate dry eye.

The Incidence and Risk Factors for Ocular Hypertension in Traumatic Hyphema

PURPOSE: To evaluate the incidence and risk factors for ocular hypertension (OHT) in traumatic hyphema within 7 days after trauma. METHODS: A retrospective case series study of 265 traumatic hyphema inpatients from 2010–2016. OHT was defined as intraocular pressure (IOP) that exceeded 21 mmHg using two consecutive measurements by a Goldmann applanation tonometer within 7 days after trauma. The subjects were divided into two groups (OHT group and non-OHT group). Age, sex, best-corrected visual acuity (BCVA), IOP, hyphema grade, presence of systemic disease, and past history of glaucoma were compared between the two groups. RESULTS: Of the 265 patients, 95 (35.8%) developed OHT after traumatic hyphema. Of those 95 patients, 70 (73.7%) developed OHT within 1 day after trauma; 18 (18.9%) developed OHT 2–3 days after trauma; and 7 (7.4%) developed OHT 4–7 days after trauma. Compared to the non-OHT group, the OHT group had a lower visual acuity (p = 0.018) and higher IOP (p < 0.001). In addition. if the hyphema grade was higher the incidence of OHT was significantly higher (p = 0.017). Using multivariate logistic regression analysis, the BCVA (p = 0.045) and hyphema grade (p = 0.006) were associated with the incidence of OHT in traumatic hyphema within 7 days after trauma. CONCLUSIONS: The incidence of OHT in traumatic hyphema within 7 days after trauma was 35.8%. The BCVA and hyphema grade were associated with the incidence of OHT within 7 days after trauma.

Classification of Lacrimal Punctal Stenosis and Its Related Histopathological Feature in Patients with Epiphora

PURPOSE: To evaluate the classification of punctal stenosis based on the shape of the external punctum, clinical characteristics and histopathologic features. METHODS: Patients who experienced tearing and were diagnosed with punctal stenosis were evaluated in this study. Punctal stenosis was classified according to the shape of the lower external punctum, which included membranous type, slit type, horseshoe type, and pinpoint type. Tear meniscus height, 2% fluorescein dye disappearance test and lacrimal pathway irrigation were measured or performed. For treatment, a punctal snip operation and silicone tube placement were performed, and the peripunctal histopathological findings were evaluated. RESULTS: Punctal stenosis was classified into four types: membranous type (17 eyes, 21.5%), slit type (11 eyes, 13.9%), horseshoe type (25 eyes, 31.6%), and pinpoint type (26 eyes, 32.9%). The tear meniscus was significantly higher, and the 2% fluorescein dye disappeared significantly more slowly in the punctal stenosis group. However, correlation of the tear meniscus height and 2% fluorescein dye disappearance test with the punctum shape was not statistically significant. A history of previous chemotherapy was significantly associated with the occurrence of punctal stenosis, especially the membranous type (p < 0.05). Histopathologic evaluation of the punctum showed differences between the punctum types. Pinpoint puncta exhibited a high density of muscle fibers, while they were faintly visible in the membranous type. CONCLUSIONS: Acquired punctal stenosis has various shapes, and the major types of stenotic puncta exhibited unique histopathologic features. Punctal stenosis and its pathophysiology may be related to multiple factors, such as age and systemic 5-fluorouracil chemotherapy history.

The Efficacy of Brinzolamide 1%/Brimonidine 0.2% Fixed Combination in Normal Tension Glaucoma

PURPOSE: To evaluate the efficacy and safety of brinzolamide 1%/brimonidine 0.2% fixed combination (BBFC) in normal tension glaucoma (NTG) patients. METHODS: This prospective study included patients treated with brinzolamide 1% monotherapy, brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy, as well as newly diagnosed NTG patients. The enrolled patients who used brinzolamide 1% or brimonidine 0.2% switched to BBFC and newly diagnosed NTG patients were treated with BBFC. The patients receiving brinzolamide 1% or brimonidine 0.2% monotherapy or brinzolamide 1% and brimonidine 0.2% concomitant therapy switched antiglaucoma drugs to BBFC. Newly diagnosed NTG patients used BBFC as the first therapy. The study consisted of 1 screening/baseline visit and 3 follow-up visits conducted after 1, 4, 8, 12 and 24 weeks of treatment. Intraocular pressure (IOP), mean deviation value and adverse drug reactions were evaluated before treatment and after treatment with BBFC. RESULTS: The mean IOP in the brinzolamide 1% monotherapy group was 13.5 ± 1.6 mm Hg and the mean IOP after switched from brinzolamide 1% monotherapy to BBFC was 12.1 ± 1.5 mm Hg. The mean IOP in the brimonidine 0.2% monotherapy group was 14.2 ± 1.3 mm Hg and the mean IOP after switched from brimonidine 0.2% monotherapy to BBFC was 11.7 ± 1.5 mm Hg. The mean IOP was 11.9 ± 2.1 mm Hg in the brinzolamide 1% and brimonidine 0.2% concomitant therapy group and the mean IOP after switched from brinzolamide 1% and brimonidine 0.2% concomitant therapy to BBFC was 12.0 ± 1.1 mm Hg. The mean IOP and reduction rate were 10.7 ± 2.1 mm Hg and 35.5%, respectively,in the newly diagnosed NTG patients treated with BBFC. There was no serious adverse drug reaction causing ocular damage. CONCLUSIONS: BBFC provides a significant IOP reduction and is a safe antiglaucoma medication for NTG patients.

Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

PURPOSE: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA). METHODS: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness, mean deviation, nocturnal dip, blood pressure variability) were analyzed. RESULTS: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length. CONCLUSIONS: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thickness were age and axial length.

Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

PURPOSE: To compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA). METHODS: A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thickness, mean deviation, nocturnal dip, blood pressure variability) were analyzed. RESULTS: A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary choroidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length. CONCLUSIONS: Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thickness were age and axial length.

Calculated Brain CT Angiography Volumes of Lacrimal Glands in Normal Korean Orbits

PURPOSE: To determine the size range of lacrimal glands calculated from Brain CT angiography. METHODS: A retrospective review of 107 CT scans of 214 orbits was performed. Aquaris Intuition Viewer software was used to calculate the volumes. RESULTS: The mean volume of the lacrimal gland was 0.655 cm3 in right orbits and 0.595 cm3 in left orbits, 0.616 cm3 in men and 0.625 cm3 in women. There was a significant difference between right and left (p = 0.012) but no difference between men and women (p = 0.725). Linear regression analyses revealed that there was an inverse relationship between gland volume and age (Pearson r = -0.433, p < 0.001). CONCLUSIONS: This is the first study to report the normal volume range of Korean lacrimal glands as measured by CT scans. A difference was detected in the volume between right and left lacrimal glands. The volume of the lacrimal gland decreased with age, and there were no gender differences.

Relationship Between Nocturnal Dip, Carotid Artery Blood Flow, Brain Ischemic Change in Open Angle Glaucoma

PURPOSE: To investigate the effect of nocturnal dip, carotid artery blood flow, and brain ischemic change on the progression of glaucomatous visual field defect in open-angle glaucoma (OAG) when IOP is less than the target pressure. METHODS: We classified OAG patients (74 patients, 148 eyes) who maintained IOP less than the target pressure as normal tension glaucoma (NTG; 52 patients, 104 eyes) or primary OAG (POAG; 22 patients, 44 eyes). Additionally, we performed 24-hr ambulatory blood pressure monitoring (24-hr ABPM), carotid artery color Doppler U/S (CAD), brain MRI, and visual field (V/F) tests on the patients. Nocturnal dips less than 10% were classified as non-dippers, and dips greater than 10% as dippers. The relationships among nocturnal dip, carotid artery blood flow, brain ischemic change, and progression of glaucomatous V/F defect were examined. RESULTS: In the case of dippers, glaucomatous V/F defects were aggravated, with a relative risk of approximately 1.74 (NTG) and 2.91 (POAG) times that of non-dippers. In NTG, decreased carotid artery blood flow and brain ischemic change furthered glaucomatous V/F defects, with a relative risk of approximately 2.40 and 2.54 times that of normal carotid artery blood flow and brain MRI findings, respectively. However, in POAG, decreased carotid artery blood flow and brain ischemic change were not influenced by the progression of glaucomatous V/F defects. CONCLUSIONS: In dippers, decreased carotid artery blood flow and brain ischemic change caused a progression of glaucomatous V/F defects in NTG and POAG patients. Thus, performing 24-hr ABPM, CAD, and brain MRI should be helpful for glaucoma patients with progression of glaucomatous V/F defects even when the IOP is less than the target pressure. In addition, this analysis provides useful information regarding glaucoma diagnosis and treatment.

Long-Term Results of Silicone Tube Intubation in Patients with Common Canalicular Stenosis

PURPOSE: To evaluate the clinical effects of silicone tube intubation in patients with epiphora and a narrow common canaliculus. METHODS: We conducted a retrospective chart review of 107 patients (169 eyes) who underwent silicone tube intubation for treatment of canaliculus between August 2008 and August 2010 and who were followed for more than 12 months. The patients were divided into 3 groups: patients with canalicular stenosis (A), patients with common canalicular stenosis (B), and patients with nasolacrimal duct stenosis (C). Successful treatment was defined as attainment of the predefined requisites, which included improvements in the clinical symptoms following surgery, an adequate passage of tears resulting from post-operative probing and syringing, and continued improvement to the time of the patients' final follow-up visit. In contrast, surgical failure was defined as the lack of post-operative symptom improvement, and recurrence was defined as the appearance of epiphora following the silicone tube extubation. RESULTS: The average follow-up duration for the entire group of patients was 30.5 months. The success rates of Group A, Group B, and Group C were 66%, 75.4%, and 56.3%, respectively, demonstrating that Group B attained the highest success rate. These success rates are similar to rates resulting from other types of surgery such as canaliculodacryocystorhinostomy. CONCLUSIONS: Silicone tube intubation can be considered a relatively simple and effective surgical technology for the long-term treatment of patients with a narrow common canaliculus.