Comparison of Ab Externo and Ab Interno 360-degree Suture Trabeculotomy in Adult Open-angle Glaucoma.

PRECIS: Ab interno (gonioscopy-assisted transluminal trabeculotomy) and ab externo 360-degree suture trabeculotomy (ST) achieved similar success rates for reducing intraocular pressure (IOP) without serious complications threatening visual acuity. PURPOSE: We aimed to compare the efficacy of ab externo and ab interno 360-degree ST in reducing IOP, decreasing the number of antiglaucoma medications required, and decreasing the rates of intraoperative/postoperative complications in adults with open-angle glaucoma (OAG). PATIENTS AND METHODS: This retrospective study included 33 eyes of 33 patients who underwent ab externo 360-degree ST (group 1) and 23 eyes of 23 patients who underwent ab interno 360-degree ST for OAG (group 2). We analyzed demographics as well as preoperative and postoperative (1, 3, 6, and 12 mo) data related to IOP, the number of antiglaucoma medications, complications, and surgical success rates. RESULTS: In group 1, the mean IOP was 26.2±10.4 mm Hg, and the mean number of antiglaucoma medications was 3.2±1.0 preoperatively, decreasing to 11.2±3.0 mm Hg and 0.1±0.4 at 12 months, respectively (P<0.001, <0.001). In group 2, the mean IOP was 28.3±10.4 mm Hg, and the mean number of antiglaucoma medications was 3.5±0.9 preoperatively, decreasing to 13.3±6.5 mm Hg and 0.8±1.0 at 12 months, respectively (P<0.001, <0.001). Decreases in IOP at 6 and 12 months were similar in groups 1 and 2 (50% vs. 47%, P=0.6; and 51% vs. 49%, P=0.7, respectively). At 12 months, complete and qualified success rates were 88% and 97% for group 1 and 57% and 87% for group 2, respectively. The most common complications in both groups were hyphema and transient IOP spikes. CONCLUSION: Ab interno 360-degree ST is similar to ab externo 360-degree ST in terms of safety and efficacy in patients with OAG.

Comparison of a new optical biometry with an optical low-coherence reflectometry for ocular biometry.

OBJECTIVE: To evaluate the repeatability and agreement of a new partial coherence interferometry optical biometer (AL-Scan, Nidek CO, Aichi, Japan) with optical low-coherence reflectometry device (Lenstar LS 900, Haag-Streit AG, Köniz, Switzerland). METHODS: Three consecutive measurements with the 2 devices were performed by the same examiner in 65 eyes of 65 patients with cataract. Patients were divided into 2 groups: axial length (AL) between 22 and 26mm (Group 1) and more than 26mm (Group 2). Comparisons were performed for AL, anterior chamber depth (ACD), keratometry (K, over 2.4mm diameter for AL-Scan and 2.3mm diameter for Lenstar) and corneal diameter (CD). Repeatability was analyzed using the intraclass correlation coefficient (ICC) and the agreement was by the Bland-Altman method. RESULTS: The repeatability of both devices was high for all biometry measurements (ICC over 0.970) in Group 1 and 2. The best repeatability was achieved for AL in each group. In both groups, the differences were statistically significant for all parameters (p<0.05) except for the measurement of AL and CCT (p>0.05). The Bland-Altman analysis showed good agreement between devices for all measurements in both groups. The closest agreement was for the AL measurements (ranged from -0.06 to 0.08mm in Group 1 and -0.05-0.07mm in Group 2). CONCLUSIONS: The new biometer provided excellent repeatability for all ocular biometry. In addition, there was good agreement between AL-Scan and Lenstar biometers for all parameters in cataractous patients with medium and long ALs.

Comparison of Anterior Segment Measurements With a Dual Scheimpflug Placido Corneal Topographer and a New Partial Coherence Interferometer in Keratoconic Eyes.

PURPOSE: To evaluate the repeatability and agreement of the anterior segment measurements obtained using the Galilei dual Scheimpflug analyzer (Galilei DSA; Ziemer) and Nidek AL Scan (Nidek CO, Aichi, Japan) biometry in keratoconic and normal eyes. METHODS: Three consecutive measurements were performed by the same examiner using both devices in 62 healthy and 88 keratoconic eyes. Central corneal thickness (CCT), anterior chamber depth, keratometry readings (K) [in flattest meridian (Kf), in steepest meridian (Ks), and mean (Km)], and white-to-white distance were evaluated. Repeatability was assessed by calculating the within-subject SD and coefficient of variation. The agreement between both devices was assessed using the Bland-Altman method. RESULTS: Both devices achieved excellent repeatability for all parameters in each group. The 95% limits of agreement (LoA) between both devices were also very narrow and acceptable for all parameters in normal corneas. However, the 95% LoA for agreement was large for CCT and measurements related to K (Kf, Ks, and Km) using both 2.4 and 3.3 mm in keratoconic eyes. In addition, compared with the Galilei DSA, K values of the Nidek AL Scan using a diameter of 3.3 mm showed slightly closer 95% LoA than those obtained using a diameter of 2.4 mm. CONCLUSIONS: In normal eyes, the Galilei DSA and Nidek AL Scan can be used interchangeably for anterior segment measurements. In keratoconic eyes, both devices yielded interchangeable anterior chamber depth and white-to-white distance measurements, whereas CCT and keratometry measurements showed clinically significant differences.

Repeatability and reproducibility of a new optical biometer in normal and keratoconic eyes.

PURPOSE: To evaluate the repeatability and reproducibility of measurements obtained by a new optical biometer (Nidek AL-Scan) in normal eyes and keratoconic eyes. SETTING: Department of Ophthalmology, Turgut Özal University, Medical School, Ankara, Turkey. DESIGN: Evaluation of diagnostic technology. METHODS: To assess the repeatability and reproducibility of the optical biometer, 2 independent examiners performed 3 consecutive measurements. The following parameters were evaluated: central corneal thickness (CCT), anterior chamber depth, axial length (AL), corneal dioptric power in the flattest meridian (flat keratometry [K]) and in the steepest meridian (steep K), and white-to-white (WTW) distance. Repeatability was assessed using the within-subject standard deviation (S(w)), repeatability, and precision. Reproducibility was evaluated using the 95% limits of agreement proposed by Bland and Altman. RESULTS: Thirty healthy subjects and 27 patients with keratoconus were evaluated. Both examiners achieved high repeatability for all parameters in each group except for the steep K measurement in keratoconic eyes performed by examiner 2 (S(w) = 3.341). The WTW in normal eyes and the CCT and steep K in keratoconic eyes showed less repeatability. In both groups, the smallest range of agreement was in AL measurements whereas the largest was in CCT measurements. In keratoconic eyes, the range of agreement for steep K was also greater (3.766). CONCLUSIONS: The precision of the measurements obtained by the new optical biometer was high. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Cyclosporin effectively inhibits posterior capsule opacification after phacoemulsification in rabbits: a preliminary study.

PURPOSE: To evaluate whether cyclosporin A prevents or reduce posterior capsule opacification after phacoemulsification surgery in rabbit eyes. METHODS: Twenty rabbits underwent cataract surgery in their right eyes were randomized into two groups. In group 1, 0.1 mL cyclosporin A (0.5 mg/mL) was given into the capsular bag after phacoemulsification and 0.1 mL cyclosporin A (0.5 mg/mL) was injected subconjunctivally once every 3 days for 1 week. Group 2 served as a control group. The development of posterior capsule opacification was assessed weekly, its density was graded clinically, and the proliferation of lens epithelial cells was evaluated histologically. RESULTS: On clinical assessment, cyclosporin A was significantly effective in preventing posterior capsule opacification compared with controls (P = 0.0045). On histological analysis, there was significantly reduced proliferative activity on posterior capsules in the treatment group, in contrast to multilayer lens epithelial cells proliferation in the control group. CONCLUSION: The preliminary results indicate that cyclosporin A is effective in suppressing posterior capsule opacification in rabbits, yet requires further investigation.

Central corneal thickness in individuals with intellectual disabilities.

PURPOSE: To assess central corneal thickness (CCT) values in individuals with intellectual disabilities (ID). METHODS: The study group was made up of 25 participants with ID (mean age, 36.9 +/- 8.7 years). The control group was made up of 25 healthy individuals (mean age, 37.1 +/- 10.1 years) with normal intellectual capacity and without any systemic or intraocular pathology. CCT value was measured by ultrasound pachymetry. Ten consecutive measurements were made at the center of the cornea of each eye. RESULTS: In the ID group, mean CCT value was 554.0 +/- 39.7 microm in the right eye and 556.8 +/- 38.7 microm in the left eye. In the control group, mean CCT value was 535.7 +/- 24.2 microm in the right eye and 536.5 +/- 24.8 microm in the left eye. CCT value in the ID group was significantly greater than in the control group for both right (P < 0.05) and left eyes (P < 0.02). CONCLUSIONS: CCT should be kept in mind during measurements of intraocular pressure (IOP) in individuals with ID because their CCTs may be greater than those in the general population.