Short-term Efficacy and Safety of XEN Stent Implantation with or without a Conjunctival Incision

Purpose@#Comparison of the 6-month outcomes of ab externo XEN 45 gel stent implantation with conjunctival resection in Korean glaucoma patients. @*Methods@#From January to May 2021, 43 open-angle glaucoma patients who underwent ab externo XEN stent insertion alone and were followed for more than 6 months were classified into incision (n = 23) and non-incision (n = 20) groups according to the presence or absence of a conjunctival incision and analyzed retrospectively. Qualified or complete success was defined as achieving the personal target intraocular pressure (IOP) with or without medication, respectively. @*Results@#The IOP measured 6 months after surgery decreased significantly in both groups. The number of IOP-lowering drugs required was also reduced. The decrease in IOP after surgery was greater in the non-incision group. Six months after surgery, the qualified success rate was 55% in the non-incision group and 52.2% in the incision group, while the complete success rate was 40% and 8.7%, respectively. During follow-up, 58.1% of the patients underwent bleb needling more than once, and 20.9% underwent additional IOP-lowering surgery, but there was no difference between the two groups. @*Conclusions@#XEN stent insertion helped to reduce IOP and the number of IOP-lowering agents after 6 months regardless of a conjunctival incision. However, to maintain the target IOP, bleb manipulation was required in many cases.

Efficacy of 0.15% Sodium Hyaluronate Eye Drops in Patients’ Ocular Surface after Upper Eyelid Surgery

Purpose@#To evaluate the clinical efficacy of preservative-free 0.15% sodium hyaluronate eye drops on the ocular surface after upper eyelid surgery. @*Methods@#This study included 43 patients who underwent upper eyelid surgery between December 2018 and May 2019. Patients were randomly assigned to group A (those treated with preservative-free 0.15% sodium hyaluronate eye drops) and group B (the control group). Ocular surface disease index score (OSDI), tear break up time (TBUT), Schirmer’s test, corneal staining score (CSS), meibomian gland (MG) quality, MG expressibility, and meiboscore were evaluated before surgery and at 1 week, 1 month, and 2 months after surgery. @*Results@#In group A, OSDI and TBUT showed a significant increase at 1 week after surgery compared with baseline values (all p < 0.05). In group B, OSDI, TBUT, and CSS were significantly higher at 1 week and 1 month after surgery (all p < 0.05), whereas there were no significant changes at 2 months after surgery compared with baseline values. At 1 month after surgery, OSDI (p = 0.03) and CSS (p < 0.01) showed significant changes between group A and group B; however, there was no significant change in the TBUT. There were no significant within-group differences in Schirmer’s test values, MG quality, MG expressibility, or meiboscore, and there were no significant between-group differences over time. @*Conclusions@#Preservative-free 0.15% sodium hyaluronate eye drops were shown to be an effective treatment for early dry-eye symptoms and ocular surface damage after upper eyelid surgery.

Clinical Manifestations of Fungal Keratitis Following Penetrating Keratoplasty

Purpose@#We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). @*Methods@#Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were included in this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration, visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon, use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into the treatment success or failure group, and the risk factors were evaluated accordingly. @*Results@#The mean age at diagnosis was 63.94 ± 15.53 years. Fungal infection occurred a mean of 55.31 ± 44.72 months after PKP. The mean symptom duration was 10.33 ± 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatment success and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgical management. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations with treatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatment failure. @*Conclusions@#Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis of fungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.

Clinical Evaluation of Unilateral Open-Angle Glaucoma: A Two-Year Follow-Up Study / 전남의대학술지

To evaluate the clinical characteristics of unilateral open-angle glaucoma, patients diagnosed with unilateral open-angle glaucoma from January 2017 to October 2018 were divided into primary open-angle glaucoma and normal-tension glaucoma groups according to the type of glaucoma diagnosed. The glaucoma and the contralateral eyes were compared, and the contralateral eye was analyzed for conversion to glaucoma and its risk factors were assessed during the 2-year follow-up period. Among 99 patients, 36 were diagnosed with primary open-angle glaucoma and 63 with normal-tension glaucoma. When comparing the glaucoma eye with the contralateral eye, the visual field mean deviation value (all p<0.001), peripapillary retinal nerve fiber layer thickness (all p<0.001), macular ganglion cell layer-inner plexiform layer thickness (p< 0.001, p=0.003), and optic nerve cup-disc ratio (p=0.005, p<0.001) were significantly different in both the primary open-angle glaucoma and normal-tension glaucoma groups. In normal-tension glaucoma, peripapillary retinal nerve fiber layer thickness was significantly thinner in the glaucoma conversion group than in the glaucoma non-conversion group (p=0.008). It was significantly associated with glaucoma conversion (odds ratio=0.97, p=0.023). In conclusion, in patients with unilateral open-angle glaucoma, the contralateral eye may develop glaucoma. In particular, if the peripapillary retinal nerve fiber layer thickness is decreased in normal-tension glaucoma, the possibility of glaucoma conversion is high; hence, careful examination is required.

Efficacy of 0.15% Sodium Hyaluronate Eye Drops in Patients’ Ocular Surface after Upper Eyelid Surgery

Purpose@#To evaluate the clinical efficacy of preservative-free 0.15% sodium hyaluronate eye drops on the ocular surface after upper eyelid surgery. @*Methods@#This study included 43 patients who underwent upper eyelid surgery between December 2018 and May 2019. Patients were randomly assigned to group A (those treated with preservative-free 0.15% sodium hyaluronate eye drops) and group B (the control group). Ocular surface disease index score (OSDI), tear break up time (TBUT), Schirmer’s test, corneal staining score (CSS), meibomian gland (MG) quality, MG expressibility, and meiboscore were evaluated before surgery and at 1 week, 1 month, and 2 months after surgery. @*Results@#In group A, OSDI and TBUT showed a significant increase at 1 week after surgery compared with baseline values (all p < 0.05). In group B, OSDI, TBUT, and CSS were significantly higher at 1 week and 1 month after surgery (all p < 0.05), whereas there were no significant changes at 2 months after surgery compared with baseline values. At 1 month after surgery, OSDI (p = 0.03) and CSS (p < 0.01) showed significant changes between group A and group B; however, there was no significant change in the TBUT. There were no significant within-group differences in Schirmer’s test values, MG quality, MG expressibility, or meiboscore, and there were no significant between-group differences over time. @*Conclusions@#Preservative-free 0.15% sodium hyaluronate eye drops were shown to be an effective treatment for early dry-eye symptoms and ocular surface damage after upper eyelid surgery.

Clinical Manifestations of Fungal Keratitis Following Penetrating Keratoplasty

Purpose@#We evaluated the clinical manifestations and risk factors of fungal keratitis after penetrating keratoplasty (PKP). @*Methods@#Eighteen patients who experienced fungal keratitis after PKP between January 2005 and January 2020 were included in this retrospective study. Clinical characteristics including sex, age, underlying disease, indication for PKP, symptom duration, visual acuity, graft state before infection, suture-related problems, size of epithelial defect, depth of infiltration, presence of hypopyon, use of eyedrops before infection, and the results of microbiological tests were analyzed. Patients were classified into the treatment success or failure group, and the risk factors were evaluated accordingly. @*Results@#The mean age at diagnosis was 63.94 ± 15.53 years. Fungal infection occurred a mean of 55.31 ± 44.72 months after PKP. The mean symptom duration was 10.33 ± 7.36 days. Of the 18 patients, 5 (27.8%) and 13 (72.2%) were in the treatment success and failure groups, respectively. Of the treatment failure group, seven patients (38.9%) underwent surgical management. The graft state before infection, symptom duration, and size of epithelial defects had significant correlations with treatment failure (all p < 0.05). Multivariate analysis identified graft state (p = 0.046) as a significant risk factor for treatment failure. @*Conclusions@#Graft state before infection, symptom duration, and size of epithelial defects were associated with the prognosis of fungal keratitis after PKP. Graft state before infection was a significant risk factor for treatment failure.

Clinical Evaluation of Unilateral Open-Angle Glaucoma: A Two-Year Follow-Up Study / 전남의대학술지

To evaluate the clinical characteristics of unilateral open-angle glaucoma, patients diagnosed with unilateral open-angle glaucoma from January 2017 to October 2018 were divided into primary open-angle glaucoma and normal-tension glaucoma groups according to the type of glaucoma diagnosed. The glaucoma and the contralateral eyes were compared, and the contralateral eye was analyzed for conversion to glaucoma and its risk factors were assessed during the 2-year follow-up period. Among 99 patients, 36 were diagnosed with primary open-angle glaucoma and 63 with normal-tension glaucoma. When comparing the glaucoma eye with the contralateral eye, the visual field mean deviation value (all p<0.001), peripapillary retinal nerve fiber layer thickness (all p<0.001), macular ganglion cell layer-inner plexiform layer thickness (p< 0.001, p=0.003), and optic nerve cup-disc ratio (p=0.005, p<0.001) were significantly different in both the primary open-angle glaucoma and normal-tension glaucoma groups. In normal-tension glaucoma, peripapillary retinal nerve fiber layer thickness was significantly thinner in the glaucoma conversion group than in the glaucoma non-conversion group (p=0.008). It was significantly associated with glaucoma conversion (odds ratio=0.97, p=0.023). In conclusion, in patients with unilateral open-angle glaucoma, the contralateral eye may develop glaucoma. In particular, if the peripapillary retinal nerve fiber layer thickness is decreased in normal-tension glaucoma, the possibility of glaucoma conversion is high; hence, careful examination is required.

Effects of Amniotic Membrane Extract Eye Drops on Persistent Epithelial Defects of the Cornea

Purpose@#To evaluate the clinical efficacy of amniotic membrane extract eye drops (AMEEDs) in patients with persistent epithelial defects (PEDs) of the cornea. @*Methods@#Sixteen patients with PEDs refractory to the conventional treatment were further treated with AMEEDs six times a day. Visual acuity, visual analog scale (VAS), esthesiometer score, and areas of the epithelial defects before and after 1 and 2 months of treatment were evaluated. After 2 months, AMEEDs were considered effective if all epithelial defects were healed, partially effective if the epithelial defects decreased in size compared with the baseline, and ineffective if the epithelial defects increased in size and required additional treatment. @*Results@#After 2 months of treatment with AMEEDs, there was a reduction in the area of epithelial defects (5.2 ± 3.1 mm2 vs. 0.1 ± 0.1 mm2, respectively, p = 0.01), as well as a significant improvement in best-corrected visual acuity (0.8 ± 0.5 logarithm of minimal angle of resolution [LogMAR] vs. 0.6 ± 0.3 LogMAR, respectively, p = 0.03), and VAS scores (4.3 ± 1.0 vs. 2.8 ± 0.7, respectively, p = 0.04) compared with the baseline values. Treatment with AMEEDs was effective in 13 (81.3%) patients and partially effective in three (18.8%) patients. @*Conclusions@#AMEEDs could stimulate epithelial wound healing and improve ocular symptoms in patients with refractory PED. Therefore, AMEEDs could be considered an effective treatment option for refractory PEDs.