The Long-term Outcomes of Mitomycin C Trabeculectomy of Phakic versus Pseudophakic Eyes of Patients with Exfoliative Glaucoma

Purpose@#To determine whether previous cataract surgery affected the surgical prognosis of primary trabeculectomy with mitomycin- C (MMC) to treat exfoliative glaucoma (XFG). @*Methods@#This retrospective, consecutive study included 51 phakic eyes and 40 pseudophakic eyes of XFG patients that had previously undergone phacoemulsification via a temporal, clear corneal incision. All patients underwent primary trabeculectomy with MMC. Complete success was defined by an intraocular pressure (IOP) <18 mmHg and an IOP reduction ≥ 20% without any glaucoma medication. The cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors for surgical failure were analyzed using the Cox’s proportional hazards model. @*Results@#The mean follow-up period was 44.7 ± 28.0 months. The IOP had decreased by 4.5 mmHg in phakic eyes and 11.1 mmHg in pseudophakic eyes at the last visits after surgery (p = 0.005). The cumulative complete success rates were 78.4% at 1 year and 15.0% at 5 years for phakic eyes, and 85.0% and 31.5% for pseudophakic eyes. The complete success rates thus tended to be lower for phakic than pseudophakic eyes (p = 0.068). The risk factors associated with surgical failure were early postoperative hypotony (hazard ratio = 2.81, p = 0.016, complete success) and phakic status (hazard ratio = 1.97, p = 0.040, complete success). @*Conclusions@#The long-term outcomes of XFG patients whose pseudophakic eyes had undergone phacoemulsification prior to primary trabeculectomy with MMC were comparable to or better than those of patients with phakic eyes. Therefore, performing phacoemulsification first, followed by trabeculectomy, may be the better option if trabeculectomy is required by XFG patients with cataracts.

The Long-term Outcomes of Mitomycin C Trabeculectomy of Phakic versus Pseudophakic Eyes of Patients with Exfoliative Glaucoma

Purpose@#To determine whether previous cataract surgery affected the surgical prognosis of primary trabeculectomy with mitomycin- C (MMC) to treat exfoliative glaucoma (XFG). @*Methods@#This retrospective, consecutive study included 51 phakic eyes and 40 pseudophakic eyes of XFG patients that had previously undergone phacoemulsification via a temporal, clear corneal incision. All patients underwent primary trabeculectomy with MMC. Complete success was defined by an intraocular pressure (IOP) <18 mmHg and an IOP reduction ≥ 20% without any glaucoma medication. The cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors for surgical failure were analyzed using the Cox’s proportional hazards model. @*Results@#The mean follow-up period was 44.7 ± 28.0 months. The IOP had decreased by 4.5 mmHg in phakic eyes and 11.1 mmHg in pseudophakic eyes at the last visits after surgery (p = 0.005). The cumulative complete success rates were 78.4% at 1 year and 15.0% at 5 years for phakic eyes, and 85.0% and 31.5% for pseudophakic eyes. The complete success rates thus tended to be lower for phakic than pseudophakic eyes (p = 0.068). The risk factors associated with surgical failure were early postoperative hypotony (hazard ratio = 2.81, p = 0.016, complete success) and phakic status (hazard ratio = 1.97, p = 0.040, complete success). @*Conclusions@#The long-term outcomes of XFG patients whose pseudophakic eyes had undergone phacoemulsification prior to primary trabeculectomy with MMC were comparable to or better than those of patients with phakic eyes. Therefore, performing phacoemulsification first, followed by trabeculectomy, may be the better option if trabeculectomy is required by XFG patients with cataracts.

Long-term Longitudinal Changes in Choroidal Thickness with Intraocular Pressure Reduction after Glaucoma Surgery

PURPOSE: We investigated the long-term longitudinal changes in axial length (AL), mean ocular perfusion pressure (MOPP), and choroidal thickness (CT) according to the reduction of intraocular pressure (IOP) after glaucoma surgery. The potential variables associated with CT changes were also evaluated.METHODS: This was a prospective study for 1 year after glaucoma surgery, which included 71 eyes of 71 patients with primary open-angle glaucoma. The subfoveal CT (SFCT) and peripapillary CT (PPCT) were measured using spectral-domain optical coherence tomography preoperatively and 1 week, 1 month, 2 months, 6 months, and 1 year postoperatively. MOPP was calculated from the IOP and blood pressure. The AL was measured using partial coherence interferometry. Regression analysis was conducted to assess the possible association of variables.RESULTS: The AL decreased and the MOPP, SFCT, and PPCT increased significantly with IOP reduction at 1 year post-operatively (all, p < 0.001). The changes in SFCT and PPCT were significantly associated with IOP reduction at 1 year postoperatively (r = −0.519 and r = −0.528, respectively). Importantly, greater increases in SFCT and PPCT were found in patients with IOP reduction more than 30% from baseline, when compared with those with less than 30% reduction (p = 0.001 and p = 0.002, respectively). The SFCT increased more significantly in patients with AL ≤ 24 mm, compared with patients with AL > 24 mm (p = 0.044).CONCLUSIONS: Reduction in the IOP, increase in the MOPP, decrease in the AL, and increase in the CT after glaucoma surgery persisted for 1 year during a long-term follow-up. These results suggested that glaucoma surgery reduced mechanical compression on the optic nerve fiber and increased intraocular blood flow.

Clinical Analysis of Candida Species Keratitis: Predisposing Factors, Clinical Characteristics, and Treatment Outcomes

Purpose@#To investigate the epidemiology, predisposing factors, clinical characteristics, and treatment results of Candida species keratitis. @*Methods@#Eighteen eyes of 18 patients who were diagnosed with Candida species keratitis (C. albicans [CA], 9 eyes; non-CA [NCA], 9 eyes) via corneal culture and hospitalized at Yeungnam University Hospital were included. The epidemiology, predisposing factors, initial clinical characteristics, and treatment outcomes were analyzed retrospectively. Treatment success was defined as the successful healing of corneal lesions after medical intervention. @*Results@#The mean age was 67.5 ± 15.4 years and polymicrobial infection was observed in seven eyes (39%). The mean duration of symptoms was 23.9 days. The common predisposing factors were previous ocular surface disease (8 eyes, 44%), corneal trauma (8 eyes, 44%), and previous topical steroid use (7 eyes, 39%). Common initial clinical characteristics were round infiltration (13 eyes, 72%), hypopyon (8 eyes, 44%), and an initial best corrected visual acuity (BCVA) of less than 0.1 (13 eyes, 72%).In terms of treatment outcomes, we recorded a mean corneal epithelial healing time of 23.5 ± 18.9 days, a final BCVA <0.1 in 12 eyes (75%), and treatment success in 6 eyes (35%). Surgical treatments were performed in 11 eyes (61%), five of which experienced evisceration or enucleation. There were no significant differences in clinical characteristics or treatment outcomes between the CA and NCA groups. In the treatment failure group, previous topical steroid use (64% vs. 0%, p = 0.04) was more common and symptom durations were relatively longer than in the treatment success group (31.3 vs. 13.5 days, p = 0.08). @*Conclusions@#Our results showed that Candida keratitis is associated with old age, previous ocular disease, and surgical treatment. Compared with the group in which successful outcomes were achieved, the treatment failure group was associated with previous topical steroid use and longer symptom duration.

Risk Factors for Early Postoperative Intraocular Pressure Elevation after Phacoemulsification in Trabeculectomized Eyes

PURPOSE: In this study, we investigated the frequency and risk factors for early postoperative intraocular pressure (IOP) elevation after phacoemulsification in patients with a prior trabeculectomy. METHODS: We performed a retrospective chart review of 200 eyes (172 patients, study group) with filtering bleb after previous trabeculectomy and 207 eyes (144 patients, control group) without previous trabeculectomy, who underwent temporal clear corneal phacoemulsification with posterior chamber lens implantation. Twelve possible risk factors including age, gender, glaucoma type, interval from trabeculectomy to phacoemulsification, axial length, preoperative IOP, preoperative bleb morphology (height, vascularity), glaucoma medication, and concomitant intraoperative procedures (iris manipulation, anterior vitrectomy, subconjunctival mitomycin C injection) were analyzed to identify independent risk factors using a multivariate logistic regression method. Early postoperative IOP elevation was defined as IOP value > or = 25 mm Hg or an IOP increase > or = 10 mm Hg the morning after surgery compared to the preoperative IOP. RESULTS: There was a significant difference in the frequency of IOP elevation between the study group (25 eyes, 12.5%) and control group (6 eyes, 2.9%; p < 0.001). The mean early postoperative IOP (15.2 +/- 6.7 mm Hg) was significantly higher than preoperative IOP (12.5 +/- 4.4 mm Hg) in the study group (p < 0.001). Risk factors for early postoperative IOP elevation were low bleb height (odds ratio; OR = 9.995, p = 0.003) and iris manipulation (OR = 4.831, p = 0.026) in the study group while risk factors were preoperative use of glaucoma medication (OR = 3.492, p = 0.004) and iris manipulation (OR = 34.249, p = 0.009) in the control group. CONCLUSIONS: Phacoemulsification increases the risk of IOP spike in prior trabeculectomized eyes, especially those with low bleb height and intraoperative iris manipulation. We suggest intraoperative and postoperative efforts to minimize intraocular inflammation and earlier follow-up examination in these patients.

The Effects of Commodified Growth Factor Products on the Fibrovascularization of Porous Polyethylene Orbital Implants

PURPOSE: To investigate the effects of commodified growth factor products used clinically on fibrovascular ingrowth into porous polyethylene orbital implants. METHODS: Porous polyethylene orbital implant sheets (Medpor(R)) soaked with Nepidermin (Easyef(R)), Trafermin (Fiblast(R)), and normal saline were implanted into the backs of 18 Sprague-Dawley rats. The degree of fibrovascular ingrowth as observed using a light microscope was compared 1 and 2 weeks after implantation and was calculated as a percentage of the fibrovascular ingrowth length. RESULTS: One week after implantation, the percentage of fibrovascular ingrowth length was 25.33 +/- 5.43%, 22.56 +/- 5.30%, and 21.78 +/- 4.66% in the Easyef(R)-, Fiblast(R)- and normal saline-soaked groups. The degree of fibrovascularization was higher in the Easyef(R)-soaked group than in the other groups (p = 0.020, 0.012). Two weeks after implantation, the degree of fibrovascularization was 98.33 +/- 5.00%, 100.00 +/- 0.00%, and 95.89 +/- 4.57%, which was significantly higher in the Easyef(R)-, and Fiblast(R)-soaked groups than in normal saline-soaked group (p = 0.019, <0.001). CONCLUSIONS: Commodified growth factor products used in other areas selectively enhanced fibrovascular ingrowth to a greater degree and earlier in ophthalmic plastic and reconstructive surgery.

Analysis of Risk Factors for the Development of Post-Operative Epidural Hematoma after Intracranial Surgery / 대한신경손상학회지

OBJECTIVE: Patients undergoing intracranial operations often suffer from post-operative epidural hematoma (EDH). The incidence and risk factors for with the occurrence of EDH after intracranial operations are not well described previously. The objective of this study was to identify the risk factors and the incidence of post-operative EDH adjacent and regional to the craniotomy. METHODS: This was a retrospective study of 23 (2.4%) patients, between January 2005 and December 2011, who underwent epidural hematoma evacuation after primary intracranial during this period, 941 intracranial operations were performed. The control group (46 patients) and hematoma group (23 patients) were categorized on the basis of having undergone the same pre-operative diagnosis and treatment within 3 months of their operations. The ages of the hematoma and control group were individually matched to similar ages within 10 years of each other to minimize bias of age. RESULTS: Univariate analysis showed that the significant pre-operative and intra-operative factors associated with post-operative EDH were a pre-operative Glasgow Coma Scale (GCS) scored 1.0 (p=0.014), prothrombin time (PT) >11.3 sec (p=0.008), intra-operative blood loss >650 mL (p=0.003) and craniotomy size >7,420 mm2 (p=0.023). In multivariate analysis, intra-operative blood loss exceeding 650 mL (median of total patients) placed a patient at significantly increased risk for post-operative EDH. CONCLUSION: Recognizing the limitations of the study, large intra-operative blood loss, wide craniotomy area, prolonged PT and a pre-operative GCS <8 are presented implicated with an increased risk of post-operative EDH after intracranial surgery.