Augmented trabeculectomy-outcomes of first hundred versus second hundred surgeries of a fellowship-trained glaucoma surgeon.

PURPOSE: We aim to compare the outcomes of trabeculectomy with mitomycin-C by a fellowship-trained glaucoma surgeon in the first hundred compared to second hundred surgeries. PATIENTS AND METHODS: Retrospective review of 200 consecutive surgeries from May 2015 to January 2017. Primary outcomes were intraocular pressure (IOP) control and use of IOP-lowering medications. Success between first hundred (Group 1) and second hundred (Group 2) patients were reported using World Glaucoma Association guidelines. Kaplan-Meier survival demonstrated complete success and qualified success. Secondary outcome measures were postoperative complications, bleb interventions and additional procedures. RESULTS: We found no statistical difference between the first hundred and second hundred patient's postoperative IOP at week 4 (p = 0.17), 3 months (p = 0.74), 6 months (p = 0.46), 12 months (p = 0.47), 18 months (p = 0.13) or at final follow up (p = 0.53). The mean final follow up period was 3.6 ± 0.7 years. Mean IOP reduction in Group 1 was from 27.1 ± 10.8 to 12.6 ± 7.1 (p < 0.0001) and Group 2 from 22.8 ± 8.4 to 11.3 ± 4.2 (p < 0.0001). Kaplan-Meier graphs showed no significant difference in complete success (p = 0.0693) or qualified success (p = 0.0866) between Group 1 and Group 2. Bleb interventions were not statistically significant between two groups. There was a significantly higher rate of complications with the first hundred patients (p < 0.0001). CONCLUSION: Both first hundred and second hundred patient groups achieved statistically similar outcomes in long term IOP control. Significant reduction of complications was achieved in the second group of patients.

Ultra-wide-field imaging assessment of small choroidal pigmented lesions using red and green colour channels.

BACKGROUND: Diagnosis of small choroidal melanoma is mainly based on tumour thickness, subretinal fluid, or lipofuscin pigment. Ultra-wide-field imaging (UWF) allows depiction of choroidal lesions through a red (RC) and a green channel (GC). Aim of the study was to determine the utility of this tool in the detection of small choroidal melanoma. METHODS: Retrospective cross-sectional study of patients with small choroidal pigmented lesions up to 3 mm in thickness. All patients underwent clinical and imaging assessment including UWF. Lesions were subcategorized based on thickness and lesion type. A qualitative assessment ensued using the red and green channels feature. RESULTS: A total of 152 patients were included. Melanotic naevi (76/152,50%) and small choroidal melanomas (55/152,36%) were the predominant types. Thickness was <1 mm in 30% (46/152), 1-2 mm in 46% (70/152) and 2-3 mm in 24% (36/152) of cases. Two distinct imaging patterns were noted: dark on RC/undetectable on GC and dark on RC/light on GC. In melanotic naevi the dark on RC/light on GC pattern was significantly associated with increased tumour thickness (p = 0.006) and the presence of lipofuscin (p < 0.001) suggesting a potential prognostic significance. In small melanomas such an association was not established. The majority of small melanomas manifested a dark on RC/undetectable on GC pattern despite the presence of subretinal fluid and lipofuscin. CONCLUSIONS: UWF imaging of choroidal pigmented tumours with red-green channels revealed two distinct patterns. The dark on RC/light on GC pattern was more common in suspicious melanotic naevi, but not in small melanomas. The use of red-green channels is not a reliable diagnostic tool in the early detection of small melanomas.

Diagnostic Performance and Repeatability of a Novel Game-Based Visual Field Test for Children.

Purpose: To demonstrate utility of a game-based test ("Caspar's Castle") for the detection of visual field defects in children. Methods: A validity and reliability study was carried out at Manchester Royal Eye Hospital Pediatric Ophthalmology Outpatients Department. We recruited 108 children with no eye pathology (aged 4-12 years) and examined a single eye with the Caspar's Castle system using either normal thresholds or thresholds artificially adapted to recreate defects to assess diagnostic utility. Number of peripheral stimuli missed was used to determine sensitivity and specificity of artificial defect detection and to plot receiver-operator characteristic curves. A further 21 children (aged 4-16 years) with pathology were recruited and Caspar's fields compared qualitatively with established field testing. A total of 106 of the Caspar's Castle examinations were able to be performed twice and repeatability was determined through coefficient of repeatability and Bland-Altman chart. Results: In diagnostic testing using children with no eye pathology, 45 children completed a test using normal thresholds and 43 with tests using artificial defects. Area under receiver-operator characteristic curves for artificial defect detection was 0.895. Of the 21 children with pathology, seven had completed standard Humphreys field testing and Caspar's Castle fields corresponded with each of these by expert opinion. Coefficient of repeatability for number of points missed across all cohorts of children (106 patients) was 6.9 (95% confidence interval: 6.16-8.07). Conclusions: The Caspar's Castle system of assessing visual fields using novel game-based strategies demonstrates encouraging levels of sensitivity, specificity, and reliability. It could help address current difficulties in perimetry in young children.

Feasibility of Use of a Mobile Application for Nutrition Assessment Pertinent to Age-Related Macular Degeneration (MANAGER2).

PURPOSE: This is a feasibility study assessing use of a mobile phone application (app.) to measure nutrient intake relevant to age-related macular degeneration (AMD). METHODS: Inclusion criteria were age over 40 and ownership of a smartphone. Participants included healthy volunteers and those with ophthalmic conditions. They were asked to record daily food intake for a minimum of 3 days in a paper food diary and the app. A dietician analyzed the food diaries, and an independent researcher analyzed data from the app. Average daily intake of nutrients relevant to AMD (docosahexaenoic acid [DHA], eicosapentaenoic acid [EPA], vitamins E and C, copper, zinc, and lutein + zeaxanthin) were calculated for both and then compared. RESULTS: A total of 54 participants completed the app. and food diary. Male-to-female ratio was 7:20. Median (interquartile range [IQR]) age was 57 years (45.3-68.7 years). More than 90% of all values were within the limits of agreement for all micronutrients. Bland Altman agreement plots demonstrated clinically acceptable agreement between the two systems of analysis. CONCLUSIONS: This study has demonstrated that the app. is a feasible alternative to the food diary for assessing nutrient intake relevant to AMD. Further studies are suggested to assess long-term adherence and effect of the app. on nutrient intake in AMD patients. TRANSLATIONAL RELEVANCE: After smoking, nutritional modification is the key modifiable factor to reduce incidence of AMD. Use of the app. could be an efficient, easy way to monitor and improve dietary intake of required nutrients pertinent to AMD.