Intraocular Pressure Peaks After Suprachoroidal Stent Implantation.

PRéCIS:: Retrospective analysis of 38 suprachoroidal glaucoma stent implantations showed sudden intraocular pressure (IOP) elevations to >30 mm Hg in 37% of eyes, 39% needing additional glaucoma surgery, and a success rate at 12 months of 24%. PURPOSE: To study the efficacy and safety of suprachoroidal stent in everyday clinical practice at a tertiary glaucoma center. MATERIALS AND METHODS: This retrospective single-center consecutive case series involved patients treated at Helsinki University Hospital with the CyPass Micro-Stent. Preoperative IOP was ≥18 mm Hg. Success was IOP between 6 and 18 mm Hg and lowering of IOP at least 20% from baseline without an increase in glaucoma medications over baseline or use of oral acetazolamide, and no subsequent glaucoma surgery. RESULTS: Of the total 38 eyes of 33 patients, 17 had primary open-angle glaucoma, 16 had exfoliative glaucoma, 2 each had uveitic glaucoma or steroid-induced glaucoma, and 1 had pigmentary glaucoma. Median preoperative IOP was 25.8 [interquartile range (IQR), 9.7] mm Hg with a median of 3 (IQR, 2) glaucoma medications. Kaplan-Meier estimate of median survival time was 79 days (95% confidence interval, 37-121 d). Success rate at 12-month follow-up was 24%. Sudden IOP elevation to over 30 mm Hg occurred in 14 eyes (37%). Highest IOP was 68 mm Hg. IOP peaks occurred between 1 week and 8 months after the surgery. In total, 43% of those with IOP elevation to >30 mm Hg had no symptoms. After the CyPass implantation, 15 eyes (39%) needed additional glaucoma surgery within a median of 167 (IQR, 109) days. CONCLUSIONS: Suprachoroidal stenting in a heterogenous clinical population resulted in a high incidence of sudden IOP peaks with a low success rate.

Ab Interno Trabeculotomy: Key Prognostic Factors.

PRéCIS:: The preoperative factors associated with a decreased survival rate of ab interno trabeculotomy (AbIT) perfomed using a Trabectome in open-angle glaucoma were selective laser trabeculoplasty (SLT) performed previously and axial length (AL) over 23.82 mm. PURPOSE: The purpose of this study was to find preoperative factors that predict outcomes of AbIT by a Trabectome. MATERIALS AND METHODS: This retrospective single-center cohort study involved consecutive patients with primary open-angle glaucoma and exfoliation glaucoma treated at Helsinki University Hospital with AbIT with preoperative intraocular pressure (IOP) ≥18 mm Hg and follow-up of at least 1 year. Success was defined as lowering of their IOP by at least 20% from baseline or reduction in glaucoma medications without any rise in IOP above baseline, and no subsequent glaucoma surgery. RESULTS: Of the total 72 eyes of 67 patients, 51 eyes had exfoliation glaucoma and 21 had primary open-angle glaucoma. Mean preoperative IOP was 25.2±5.3 mm Hg, with a mean of 3.2±1.2 glaucoma medications. In the multivariable model, a history of preoperative SLT and higher preoperative AL had hazard ratios of 2.99 [95% confidence interval (CI): 1.26-7.10] and 1.53 (95% CI: 1.12-2.09) with statistical significance (P=0.013 and 0.007). The statistically significant cutoff point was 23.82 mm in AL in relation to the success rate, with success times taken into account (P<0.001). AL over 23.82 mm had hazard ratio of 5.75 (95% CI: 2.57-12.87, P<0.001). CONCLUSION: Previous SLT and AL over 23.82 mm reduce survival after AbIT.

Intravenous hypertonic saline to reduce intraocular pressure.

PURPOSE: To quantitate the effect of intravenous hypertonic saline (IVHTS) injection on elevated intraocular pressure (IOP). METHODS: Nineteen patients (median age, 65 years; range, 41-84 years) with glaucoma and an IOP 30 mmHg or higher were recruited. A bolus of IVHTS (sodium chloride concentration 23.4%) was injected in an antecubital vein over 10-20 seconds. The IOP and systolic and diastolic blood pressure (BP) were measured frequently for 2 hr. The dosage was 0.5 mmol/kg sodium in 11 patients (Group 1) and 1.0 mmol/kg in eight patients (Group 2). RESULTS: In both groups, a median absolute IOP reduction of 7 mmHg was achieved in 5 min. The maximum median reduction was 7 mmHg (range, 4-16) and 9 mmHg (range, 3-14) at 5 and 16 min after IVHTS in Group 1 and 2, respectively, at which point the median IOP had reduced from 38 and 35 mmHg to 31 and 27 mmHg (p < 0.001), respectively. In both groups, the IOP remained 7 mmHg reduced 2 hr after IVHTS. Systolic BP increased a median of 14.5 mmHg at 3 min and was comparable with baseline after 6 min. CONCLUSION: Intravenous hypertonic saline solution reduces IOP moderately within minutes for up to 2 hr.

[Acanthamoebal keratitis]. / Akantamebakeratiitti.

Acanthamoebae are protists causing opportunistic infections to immunocompromised patients, and refractory keratitis also to others. Factors predisposing to Acanthamoebae keratitis include conditions that impair corneal defence mechanisms, such as traumas or use of contact lenses combined with exposure to contaminated water, for example. Delays in diagnosis and therapy will worsen the prognosis of acanthamoebal keratitis. In recent years, noninvasive in vivo confocal microscopy that enables an early diagnosis and is quicker than before, has become more common alongside conventional diagnostic methods, i.e. culture and smears made from corneal specimens.

LASIK for myopia of -9.00 to -17.00 D with the VISX STAR S2: 2- to 5-year follow-up.

PURPOSE: To evaluate long-term results of LASIK in the correction of high myopia. METHODS: Preoperative and early postoperative data, including uncorrected and best spectacle-corrected visual acuity and refraction, were collected retrospectively from 77 eyes of 47 patients who underwent LASIK for myopia of at least -9.00 diopters (D) performed with the VISX STAR S2 excimer laser in our hospital from 1999 to 2003. An additional examination with a satisfaction query was performed 2 to 5 years postoperatively. RESULTS: After 2- to 5-year follow-up, 40% of eyes has a spherical equivalent refraction within 1.00 D of the original intended refraction, 70% within 2.00 D, and 91% within 3.00 D. Only one eye lost two Snellen lines of visual acuity, whereas three eyes gained two lines and the remainder had no significant change. Regression was mild but significant in the long-term, with mean spherical equivalent refraction being -1.21 D at 1 month, -1.82 D at 6 months, and -1.95 D at 2 to 5 years. Stability was similar in a subgroup of eyes followed for at least 4 years. Nine eyes had mild postoperative complications, which resolved without permanent consequences. All patients, except one, were very satisfied with the results and would have chosen the surgery again. CONCLUSIONS: With careful patient selection and safety precautions, LASIK is a safe alternative with moderate stability but limited predictability in the treatment of myopia of -9.00 to -17.00 D.

Dry eye and corneal sensitivity after high myopic LASIK.

PURPOSE: To assess subjective symptoms and objective clinical signs of dry eye and investigate corneal sensitivity after high myopic LASIK. METHODS: Twenty eyes of 20 patients with a mean age of 34 +/- 7.5 years who had undergone high myopic LASIK 2 to 5 years previously and 10 eyes of 10 controls with a mean age of 39.8 +/- 10.4 years were enrolled in the study. Clinical signs of dry eye and subjective dry eye symptoms were determined. The corneal sensitivity was assessed using non-contact esthesiometer. RESULTS: The preoperative spherical equivalent refraction was -11.40 +/- 1.40 diopters (D) (range: -9.10 to -14.00 D) and the intended spherical equivalent refraction correction was -10.40 +/- 1.10 D (range: -8.30 to -12.50 D). Schirmer's test score was 14.4 +/- 8.9 mm in patients and 9.0 +/- 4.2 mm in controls (P = .066). The break-up time was 15.9 +/- 11.2 seconds in patients and 14.0 +/- 10.0 seconds in controls (P = .505). The mean corneal sensitivity was 73.5 +/- 29.6 mL/min in patients and 78.0 +/- 18.7 mL/min in controls (P = .666). The majority (55%) of patients still reported dry eye symptoms. Ocular surface disease index indicating degree of dry eye symptoms was significantly higher in LASIK patients (18.6 +/- 13.4%) compared to controls (7.5 +/- 5.7%; P = .022). CONCLUSIONS: The majority of patients who received LASIK for high myopia reported ongoing dry eye symptoms, although objective clinical signs of tear insufficiency and hypoesthesia were not demonstrable. We assume that symptoms represent a form of corneal neuropathy rather than dry eye syndrome.

Acinetobacter and Staphylococcus aureus ulcerative keratitis after laser in situ keratomileusis treated with antibiotics and phototherapeutic keratectomy.

PURPOSE: To report a method of treatment for through-the-flap multibacterial ulcerative keratitis after laser in situ keratomileusis (LASIK). METHODS: Bacterial ulcerative keratitis after LASIK was treated with topical and systemic antibiotics followed by flap lifting, cleaning, and phototherapeutic keratectomy (PTK). Follow-up examinations included in vivo confocal microscopy, corneal topography, and wavefront analysis. RESULTS: Rapid recovery of the ulcerative keratitis was observed after flap lifting and cleaning of the interface and PTK combined with topical and systemic antibiotics. Two years postoperatively, corneal topography showed a slight depression of the ulcer area and decentration of the photoablation. Wavefront analysis revealed an irregular scan with a pronounced coma-like aberration, which with a wavefront-guided custom test lens correction provided 20/16 visual acuity. CONCLUSIONS: Ulcerative bacterial keratitis is a possible sight-threatening complication of LASIK refractive surgery. Lifting and rinsing the flap combined with cleaning of the flap interface with PTK may be helpful in these conditions when regression of the ulcer does not occur with topical and oral antibiotic treatment.

Serum noncholesterol sterols during inhibition of cholesterol synthesis by statins.

We studied changes in serum cholestanol and plant sterols (indexes of cholesterol absorption) and cholesterol precursors (indexes of cholesterol synthesis) in response to cholesterol reduction by way of 1 year's treatment with atorvastatin (n = 102) and simvastatin (n = 105) treatments in patients with coronary heart disease. Serum cholesterol levels and ratios of the precursor sterols to cholesterol after 1 year of treatment were reduced in proportion to the pretreatment values (33% +/- 1% by simvastatin and 36% +/- 1% by atorvastatin; P <.01 for difference between groups) for cholesterol; the respective reductions in the precursor sterol:cholesterol ratios were also higher with atorvastatin (50% +/- 2% for lathosterol) than with simvastatin (42% +/- 1%; P <.01 between groups), but the ratio of squalene to cholesterol was increased (17% +/- 5%, P <.001) by atorvastatin. Plant sterol concentrations were gradually increased by atorvastatin but decreased initially by simvastatin. However, their ratios with respect to cholesterol were increased by as much as 82% with atorvastatin and by as much as 39% with simvastatin. In conclusion, effective inhibition of cholesterol synthesis and subsequent reduction in serum cholesterol levels by statins lead to increases in serum plant-sterol levels, probably as a result of reduced biliary secretion and enhanced absorption of these sterols. Because serum plant sterols have been claimed to be involved in the early development of atherosclerosis, the question arises whether continuously increasing serum plant sterols during long-term statin treatment should be prevented by cholesterol malabsorption (eg, by plant stanol ester consumption), especially in subjects with high baseline plant sterol values and effective sterol absorption.