Smaller-incision Revision of Trabeculectomy With Mitomycin: Long-term Outcomes and Complications.

PURPOSE: The purpose of this study was to assess long-term outcomes and complications of smaller-incision trabeculectomy revision with mitomycin (MMC) in glaucoma patients. METHODS: Review of patients undergoing trabeculectomy revision with MMC for inadequate intraocular pressure (IOP) control. After dissection of subconjunctival fibrosis through a smaller (median, 5 mm) incision, MMC was topically applied and episcleral fibrosis was incised. Failure was defined as reoperation for glaucoma, or IOP reduction < 20% over 3 follow up visits. RESULTS: Forty eyes (40 patients; mean age, 67±13 y) underwent revision; 9 revisions were combined with other surgery. Mean baseline IOP was 20.6±6.2 mm Hg on 2.6±1.4 glaucoma medications after 2.4±1.3 incisional ocular surgeries. At final follow-up (70±34 mo), 27 successful eyes (67.5%) had IOP of 9.2±2.4 mm Hg on 0.6±0.9 medications. Eleven eyes (27.5%) required reoperation for glaucoma, 7 (63%) within 7 months after revision. The Kaplan-Meier estimate of success at years 1, 2, 3, and 5 postoperatively was 77.5%, 72.2%, 69.5%, and 69.5%, respectively. Recovery of visual acuity to within 2 lines of baseline was 1.7±2.4 weeks (median 1). Complications included sustained hypotony (IOP, ≤5 mm Hg) in 2 eyes (1 also with corneal decompensation), 1 eye with wound leak, and 2 eyes with bleb leak (1 requiring surgical repair). CONCLUSIONS: Smaller-incision trabeculectomy revision with MMC resulted in substantial, sustained IOP reduction in most eyes with poorly functioning filtering blebs, with few serious complications and rapid recovery of baseline visual acuity in most eyes.

Retrograde Ascending Aortic Dissection After Thoracic Endovascular Aortic Repair for Distal Aortic Dissection or With Zone 0 Landing: Association, Risk Factors, and True Incidence.

BACKGROUND: We attempted to determine the true incidence of retrograde ascending aortic dissection (rAAD) and to challenge its reported association with distal aortic dissection or zone 0 deployment. METHODS: From January 2005 to August 2014, 305 patients who were at risk for rAAD underwent thoracic endovascular aortic repair. We excluded patients with prior ascending, hemiarch, or traditional or frozen elephant trunk grafts, or who required concomitant ascending graft placement. Patients in group A (n = 111, 36.4%) had distal aortic dissection or hematoma (n = 75, 67.6%) or required landing of the endograft in zone 0 of the native ascending aorta (n = 36, 32.4%). Patients in group B (n = 194, 63.6%) had nondissected descending or distal arch aneurysm (n = 172), penetrating ulcer (n = 9), coarctation (n = 6), endoleak not caused by dissection (n = 3), aortobronchial fistula (n = 3), or transection (n = 1). RESULTS: The incidence of rAAD was 1.3% overall (n = 4), 0.9% in group A (n = 1, Cook Zenith TX2), and 1.5% in group B (n = 3; 1 Talent Captivia, 2 Cook Zenith TX2; p = 0.64). No zone 0-treated patient had rAAD. Two patients from group B died, and 1 was treated nonoperatively. The median interval between thoracic endovascular aortic repair and rAAD was 11 days (range, 0 to 90 days). CONCLUSIONS: Post-thoracic endovascular aortic repair rAAD is a rare but lethal complication. Operator experience is crucial for prompt recognition and prevention. It does not appear that rAAD is specifically associated with distal aortic dissection or landing in zone 0. To our knowledge, this is one of the few studies to report the true incidence of rAAD in at-risk patients.

Prevalence of self-reported early glaucoma eye drop bottle exhaustion and associated risk factors: a patient survey.

BACKGROUND: One barrier to patient adherence with chronic topical glaucoma treatment is an inadequate amount of medication available between prescription refills. We examined the self-reported prevalence of early exhaustion of glaucoma eye drops prior to a scheduled refill, and associated risk factors. METHODS: This cross-sectional survey was performed at a University-based clinical practice. Glaucoma patients at the University of Washington who were experienced with eye drop application and were on a steady regimen of self-administered glaucoma drops in both eyes took a survey at the time of clinic examination. The main outcome measure was self-reported early eye drop bottle exhaustion. RESULTS: 236 patients were eligible and chose to participate. In general, patients included were relatively healthy (mean 2.3 comorbid medical conditions). Sixty patients (25.4%) reported any problem with early exhaustion of eye drop bottles, and this was associated with visual acuity ≤ 20/70 in the better eye (P = .049). Twelve patients (5.1%) reported that they "often" (5-7 times per year), "usually" (8-11 times per year) or "always" ran out of eye drops prior to a scheduled refill. Patients affected by this higher level (≥ 5 times yearly) of eye drop bottle exhaustion were more likely to have poor visual acuity in their worse eye ≤ 20/70 (P = .015) and had significantly lower worse-eye logMAR (P = .043). CONCLUSIONS: Self-reported early glaucoma bottle exhaustion regularly affected 5% of patients in our population and 25% reported early exhaustion at least once; the main risk factor was poor vision in at least one eye. These results may not be generalizable to a broad patient population, or to those inexperienced with eye drop self-administration. However, this pilot study compels further evaluation and consideration of early eye drop bottle exhaustion in glaucoma patients.

Behçet's disease: comparing 3 decades of treatment response at the National Eye Institute.

BACKGROUND: The goal of the present study was to analyze differences in response to the treatment of ocular Behçet's disease (BD) in the 1960s, 1980s, and 1990s. METHODS: Medical records of 120 patients with uveitis due to BD followed at the National Eye Institute, National Institutes of Health, from 1962 to 2004, were reviewed. RESULTS: The patients were categorized into 3 groups according to the time of follow-up: the first group was followed from 1962 until 1972, the second group from 1983 until 1992, and the third group from 1992 through 2004. Snellen visual acuity was converted to logMAR values. The range of values for inflammation was 0.5 (trace), 1 (mild), 2 (moderate), and 3 (severe). There were 45 patients (89 affected eyes) in the 1960s group, 26 patients (52 eyes) in the 1980s group, and 49 patients (94 eyes) in the most recent group. Statistical analysis showed that the mean logMAR score decreased with each decade. Mean visual acuity in the 1990s group was significantly better than in the previous decades (p < 0.001 for the 1960s group and p = 0.019 for the 1980s). The mean inflammation score was significantly higher in the 1960s than in the subsequent decades (p < 0.001 both for the 1980s and for the 1990s). INTERPRETATION: BD is a severe, blinding disorder. There was a definitive trend toward improvement in clinical outcome from the 1960s to 1990s. We attribute this trend to the introduction of newer, more potent corticosteroid-sparing agents and targeted therapy.