The gonio scratch study: methodology of a multicenter clinical trial establishing a new minimally invasive glaucoma surgery.

There are numerous surgical procedures for glaucoma. Minimally invasive glaucoma surgery is becoming popular; however, the disadvantage is the high incidence of anterior chamber hemorrhage. Heavy bleeding can also lead to increased intraocular pressure (IOP) postoperatively. Gonio scratch is a surgical procedure that improves aqueous humor outflow by rubbing off deposits on the trabecular meshwork with a Diamond Dusted Sweeper. As the conjunctiva and trabecular meshwork are not incised, no postoperative bleeding is expected, and the IOP spike will be minimal. We designed this study to determine the efficacy and safety of gonio scratch. This is an on-going multicenter, prospective, clinical trial. Patients who are scheduled for glaucoma surgery with or without cataract surgery are being enrolled. A total of 80 eyes will be recruited in the Hiroshima University Hospital, Miyoshi Eye Clinic, Yokoyama Retina Clinic, and Kusatsu Eye Clinic. All patients will undergo gonio scratch. When combined with cataract surgery, gonio scratch is performed after the intraocular lens is inserted. The primary study endpoint is the change in IOP from baseline to 1 year after surgery. The secondary endpoints are complications, number of glaucoma medications, surgical time, and changes in visual acuity and the visual field. This study protocol was approved by the institutional review board of Hiroshima University. The trial results will be shared with the scientific community at international conferences and by publication in a peer-reviewed journal. Trial registration number is jRCTs062200003.

Surgical Outcomes of Ab Interno Trabeculotomy Without Phacoemulsification.

Purpose: The aim of this study was to evaluate ab interno trabeculotomy outcomes without phacoemulsification. Methods: This retrospective study evaluated 118 eyes of patients aged 18 and above who underwent ab interno trabeculotomy between December 2017 and August 2022. When surgeries were performed in both eyes, only the eye undergoing the initial surgery was evaluated. Prior to and after surgery, the intraocular pressure (IOP) and mean number of IOP-lowering medications were compared. An IOP of ≤21 mmHg (A) and ≤18 mmHg (B) along with a ≥20% reduction in the preoperative IOP was defined as survival. Cases that required reoperation for glaucoma were defined as surgical failure. The Kaplan-Meier method was used to evaluate the survival rates. A Cox proportional hazards model was used to analyze the preoperative factors that influenced survival rates. Results: At 36 months postoperatively, the 13.4 ± 2.8 mmHg average IOP was significantly decreased from the preoperative 23.5 ± 9.8 mmHg value (P < 0.0001). Moreover, a significant decrease in the mean number of the IOP-lowering medications to 2.3 ± 1.4 at 36 months was found versus the initial 3.9 ± 1.1 preoperative value (P < 0.0001). The survival rates for criteria A and B at 36 months postoperatively were 28% and 25%, respectively. Only the preoperative IOP was identified by multivariate analysis as a factor influencing survival rates (P < 0.0001). Hyphema in 36 eyes (30.5%) and an IOP spike in 20 eyes (16.9%) were the only observed complications. Additional glaucoma surgery was required in 27 eyes (22.9%) during the follow-up period. Conclusion: Utilization of ab interno trabeculotomy effectively lowered the IOP and reduced the number of IOP-lowering medications. Patients with higher preoperative IOP exhibited better postoperative outcomes.

A Retrospective Study of Risk Factors Affecting Long-Term Outcomes Following Ab Interno Trabeculotomy and Goniotomy Concomitant with Phacoemulsification.

Purpose: To examine the potential risk factors affecting the long-term outcomes following a combination of phacoemulsification with ab interno trabeculotomy with the microhook (µLOT-Phaco) and goniotomy with the Kahook Dual Blade (KDB-Phaco). Methods: For 12 months, we retrospectively examined a total of 100 eyes of 100 patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EG) who had previously undergone surgery between December 2016 and December 2020. Patients with a preoperative intraocular pressure (IOP) ˂12 mmHg were excluded. Probability of success was calculated using the Kaplan-Meier method, with surgical failure defined as an IOP >18 mmHg, <20% IOP reduction or additional glaucoma surgery. The Cox proportional hazards model was used to examine the potential risk factors for failure, which included age, gender, type of glaucoma, surgical techniques, preoperative IOP, number and type of preoperative IOP-lowering medications, preoperative visual field mean deviation (MD) value, and axial length. Results: For the 51 males and 49 females, mean preoperative age was 74.4 ± 9.0 years, with µLOT-Phaco performed in 44 and KDB-Phaco in 56 subjects. The type of glaucoma was POAG in 68 and EG in 32 eyes. Preoperative IOP was 20.5 ± 6.7 mmHg, while postoperative IOPs were 14.4 ± 4.2 mmHg, 13.7 ± 2.8 mmHg, and 14.6 ± 3.9 mmHg, respectively (P < 0.001). Significant decreases from the preoperative number of IOP-lowering medications (3.1 ± 1.2) were observed at 12, 24, and 36 months, respectively (1.2 ± 1.3, 1.6 ± 1.3, and 2.1 ± 1.4 (P < 0.001)). Probability of success at 12, 24, and 36 months postoperatively was 52.0%, 49.6%, and 47.7%, respectively. Lower preoperative IOP was shown to be a potential risk factor for surgical failure. Conclusion: Long-term follow-ups showed IOP decreased in µLOT-Phaco and KDB-Phaco patients. Results suggest that patients with higher preoperative IOP may have better postoperative outcomes.

Comparison of surgical outcomes between iStent inject W implantation and microhook ab interno trabeculotomy in combination with phacoemulsification in primary open-angle glaucoma patients.

Purpose: To examine primary open-angle glaucoma patients after undergoing combined cataract surgery with microhook ab interno trabeculotomy (µLOT-Phaco) or iStent inject W implantation (iStent-Phaco), and then evaluate the surgical outcomes after a minimum of 6 months of follow-up. Methods: Between October 2020 and July 2022, 39 µLOT-Phaco eyes and 55 iStent-Phaco eyes that underwent surgery were evaluated in this retrospective, multicenter comparative case series. Data that included preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, and occurrence of complications were collected from medical records and then examined. Surgical failure was defined as patients exhibiting a < 20% reduction in the preoperative IOP or an IOP > 18 mmHg on two consecutive follow-up visits, or when patients were required to undergo reoperation. Success rates were determined based on a Kaplan-Meier survival analysis. Results: At 3, 6 and 12 months postoperatively, there was a significant postoperative reduction in the IOP (p < 0.001) and in the medications scores (p < 0.001) for both of the groups. In the µLOT-Phaco and iStent-Phaco groups, the probabilities of success at 6 and 12 months were 55.3 and 45.5%, and 48.4 and 45.5% (p = 0.38; log-rank test), respectively. In the iStent-Phaco group, there was a significant decrease in the hyphema. Conclusion: Comparable surgical outcomes occurred for both the µLOT and iStent inject W procedures.

Ex-PRESS Implantation versus Trabeculectomy for Long-Term Maintenance in Patients with Open-Angle Glaucoma.

Purpose: To compare the efficacy of Ex-PRESS implantation (EXP) with that of trabeculectomy (TLE) with mitomycin C for maintaining low target intraocular pressure (IOP) in patients with open-angle glaucoma. Patients and Methods: Patients were randomly assigned to receive EXP or TLE. Surgical success was defined according to three target mean IOP ranges (5 mmHg ≤ IOP ≤ 18 mmHg [criterion A], 5 mmHg ≤ IOP ≤ 15 mmHg [criterion B], and 5 mmHg ≤ IOP ≤ 12 mmHg [criterion C]) representing reductions of at least 20% below the baseline on two consecutive follow-up visits 3 months post-surgery, with or without antiglaucoma medication and without further glaucoma surgery. Participants were divided into three subgroups based on baseline mean deviation (MD) values: early (MD ≥ -6 dB), moderate (-6 dB > MD ≥ -12 dB), and advanced (-12 dB > MD). Survival rates were calculated by subgroup. Results: A total of 73 patients, including 30 in the EXP group and 43 in the TLE group, were included in the study. No significant differences in baseline ocular or demographic characteristics were found between the two groups. No significant difference in IOP was noted every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the EXP and TLE groups, respectively. Moreover, there was no difference in success rate based on glaucoma level. Many glaucoma medications administered before surgery were associated with a higher failure rate in the TLE group but not in the EXP group. Conclusion: Both procedures resulted in similar IOP reductions and success rates for a low target IOP. The number of preoperative glaucoma medications was a risk factor for TLE failure.

A multicenter phase II study on the safety of rho-kinase inhibitor (ripasudil) with needling for the patients after trabeculectomy.

Background: There is no established method of maintaining or reducing intra ocular pressure after the needling procedure for failing blebs post trabeculectomy. Regarding newer antihypertensive medications, ripasudil, which is a rho-associated protein kinase inhibitor ophthalmic solution, was able to prevent excessive scarring in vitro. This study aims to evaluate the safety of glaucoma patients submitted to the needling procedure and administered ripasudil for preventing scarring after the procedure. We also investigate the efficacy of ripasudil after needling for bleb failure through suppression of fibrosis to the bleb. Methods: This study is a multicenter, open-label, single-arm, phase II trial to evaluate the safety and efficacy of ripasudil in glaucoma patients after the needling procedure. Forty patients who will undergo needling at least 3 months after trabeculectomy will be recruited in Hiroshima university hospital and Hiroshima eye clinic. All the patients will instill ripasudil two times per day for three months after the needling procedure. The primary endpoint is the safety of ripasudil. Conclusions: We plan to establish the safety of ripasudil and to collect information involving the efficacy of ripasudil widely in this study.

Vision-Related Quality of Life following Combined Cataract and Minimally Invasive Glaucoma Surgery or Cataract Surgery Alone in Glaucoma Patients.

This study examined glaucoma patients after undergoing combined cataract and minimally invasive glaucoma surgery (MIGS), microhook ab interno trabeculotomy and goniotomy with the Kahook Dual Blade (KDB), or cataract surgery alone, and it then evaluates their vision-related quality of life (VR-QOL) following the procedure. A total of 75 eyes of 75 consecutive glaucoma patients in this prospective cohort study underwent phacoemulsification (Phaco) or phaco and MIGS (Phaco-TLO) between October 2019 and March 2022. In all cases, the National Eye Institute Visual Function Questionnaire (VFQ-25) was used to evaluate the 20 eyes in the Phaco group and the 55 eyes in the Phaco-TLO group before and at 2 months after surgery. There was a significant increase in the visual acuity (logMAR) at 2 months post-operatively (Phaco group; 0.34 ± 0.10 to -0.07 ± 0.1, p < 0.0001, Phaco-TLO group; 0.37 ± 0.43 to 0.09 ± 0.32, p < 0.0001). The median (25-75th percentile) total VFQ scores in the Phaco group before and at 2 months after surgery were 71.1 (62.4-80.6) and 79.4 (69.0-84.0), respectively. (p = 0.006). The median (25-75th percentile) total VFQ scores in the Phaco-TLO group before and at 2 months after surgery were 69.8 (55.3-78.6) and 74.7 (65.1-83.3), respectively. (p = 0.005). Glaucoma patients who underwent not only cataract surgery alone but also combined cataract surgery and MIGS exhibited significant improvement in the VR-QOL.

Effects of Ripasudil, a Rho-Kinase Inhibitor, on Scar Formation in a Mouse Model of Filtration Surgery.

PURPOSE: Glaucoma is a leading cause of blindness worldwide. Characteristic changes occur in the optic nerve and visual field of patients with glaucoma; optic nerve damage can be mitigated by lowering intraocular pressure. Treatment modalities include drugs and lasers; filtration surgery is necessary for patients with insufficient intraocular pressure reduction. Scar formation often contributes to glaucoma filtration surgery failure by increasing fibroblast proliferation and activation. Here, we examined the effects of ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, on postoperative scar formation in human Tenon's fibroblasts. METHODS: Collagen gel contraction assays were used to compare contractility activity among ripasudil and other anti-glaucoma drugs. The effect of Ripasudil in combination with other anti-glaucoma drugs and transforming growth factor-ß (TGF-ß), latanoprost and timolol-induce contractions were also tested in this study. Immunofluorescence and Western blotting were used to study the expression of factors relating scarring formation. RESULTS: Ripasudil inhibited contraction in collagen gel assay and reduced α-smooth muscle actin (SMA) and vimentin (scar formation-related factors) expression, which was inversely promoted by latanoprost, timolol or TGF-ß. Ripasudil also inhibited contraction on TGF-ß, latanoprost and timolol-induced contraction. Furthermore, we investigated the effects of ripasudil on postoperative scarring in a mouse model; ripasudil suppressed postoperative scar formation by altering the expression of α-SMA and vimentin. CONCLUSIONS: These results suggest that ripasudil, ROCK inhibitor may inhibit excessive fibrosis after glaucoma filtering surgery vis inhibition the transdifferentiation of tenon fibroblast into myofibroblast and may have a potential effect as anti-scarring for glaucoma filtration surgery.

Comparison of Mid-Term Outcomes between Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade.

This study retrospectively examined the mid-term surgical outcomes between microhook ab interno trabeculotomy (µLOT) and goniotomy when one was using the Kahook Dual Blade (KDB) in combination with phacoemulsification in primary open-angle glaucoma and exfoliation glaucoma patients. Between December 2016 and December 2020, the current study examined 47 µLOT and 52 KDB eyes that underwent surgery. When there was a < 20% reduction in the preoperative intraocular pressure (IOP) or when the IOP was > 18 mmHg (criterion A), the IOP was > 14 mmHg (criterion B) at two consecutive follow-up visits, or when there was a requirement for reoperation, these were all considered to indicate that the surgery failed. A genetic algorithm that used the preoperative IOP was used to determine the score matching. After score matching, a total of 27 eyes were evaluated. In the µLOT and KDB groups, the mean postoperative follow-up periods were 31.2 ± 13.3 and 37.2 ± 16.3 months, respectively. The results for both of the groups show there were significant postoperative reductions in the IOP (p < 0.05) and medication scores (p < 0.05) at 6, 12, 24 and 36 months. At 12, 24, and 36 months, the probabilities of success in the µLOT and KDB groups for criterion A were 70.4% and 48.2%, 61.9% and 48.2%, and 55.0% and 48.2% (p = 0.32; log-rank test), respectively. For criterion B, the results for the two groups were 55.6% and 33.3%, 44.4% and 33.3%, and 44.4% and 33.3% (p = 0.15; log-rank test), respectively. Similar postoperative complications were found between the groups. Comparable mid-term surgical outcomes were found for the uses of µLOT and KDB.

Safety and Efficacy of the Rho-Kinase Inhibitor (Ripasudil) in Bleb Needling after Trabeculectomy: A Prospective Multicenter Study.

Ripasudil, a rho-associated protein kinase inhibitor ophthalmic solution, shows a protective effect in preventing excessive scarring in vitro. This study aims to evaluate the safety and efficacy of ripasudil for glaucoma patients submitted to the needling procedure. In this prospective, multicenter, single-arm study, we included 20 eyes of 20 patients with glaucoma who underwent the needling procedure without antimetabolites. All patients administered ripasudil after needling for three months. The primary endpoint of this study was the safety of ripasudil in patients, and the secondary endpoint was the change in IOP at 12 weeks after the needling procedure. No serious complications were found in the patients. One eye experienced pruritus and conjunctival follicle, while another eye had conjunctival follicle. These complications were transient and resolved quickly after discontinuation of ripasudil. The mean preoperative IOP was 14.6 ± 4.6 mmHg, which decreased to 11.0 ± 4.7 mmHg (p = 0.0062) at 1 week postoperatively. The IOP reduction effect continued to 12 weeks (11.8 ± 3.1 mmHg; p = 0.0448). The administration of the ROCK inhibitor, ripasudil, after the needling procedure is safe and effective in maintaining IOP for 12 weeks.

Effect of the rho-kinase inhibitor ripasudil in needling with mitomycin C for the failure of filtering bleb after trabeculectomy: a cross-sectional study.

BACKGROUND: Rho-kinase inhibitors can inhibit fibrosis after glaucoma surgery. This study aimed to evaluate the effect of rho-kinase inhibitor after needling procedure with mitomycin C for the failure of filtering bleb with trabeculectomy. METHODS: This retrospective single-center study examined the effects of rho-kinase inhibitor after the needling procedure. We included 27 eyes of 27 patients with glaucoma who underwent needling procedure using mitomycin C and were subsequently treated with ripasudil-a rho-associated protein kinase inhibitor (ripasudil group)-or without ripasudil (control group). The ripasudil and control groups were compared in terms of intraocular pressure (IOP) and the number of antiglaucoma medications. Success at 12 months after the needling procedure was defined as a > 20% decrease in IOP from the preoperative period without surgical reintervention. RESULTS: At 12 months after the needling procedure, the mean IOP decreased from 16.9 ± 4.5 to 12.6 ± 1.1 mmHg in the control group and from 16.0 ± 5.3 to 12.2 ± 1.2 mmHg in the ripasudil group (p = 0.77). The 12-month success rates were 60.00% and 56.25% in the control and ripasudil groups (p = 0.98), respectively. In the preoperative period, the numbers of antiglaucoma drugs were 0.27 ± 0.46 and 0.92 ± 0.91 in the control and ripasudil groups (p = 0.022), respectively, and at 12 months after the needling procedure, they were 1.07 ± 1.44 and 0.73 ± 1.10 (p = 0.52), respectively. CONCLUSIONS: Treatment with ripasudil (a rho-associated protein kinase inhibitor) after the needling procedure with mitomycin C did not show better results than treatment with the mitomycin C needling procedure alone at 12 months after the procedure.

Transient ciliochoroidal detachment after microhook ab interno trabeculotomy: Its frequency and potential risk factors.

Purpose: To investigate ciliochoroidal detachment (CCD) frequency and risk factors after performing microhook ab interno trabeculotomy (µLOT). Methods: A retrospective evaluation of 62 eyes of 62 patients who underwent µLOT and were subsequently examined by anterior-segment optical coherence tomography (AS-OCT) found CCD at 1 day, and 1 and 2 months after surgery. Results: In the 62 patients (mean age 67.3 ± 13.9 years), AS-OCT detected CCD in 18 eyes (29%) at 1 day after surgery, which disappeared within 1 month. Comparisons between the CCD vs. the non-CCD group showed the mean IOPs were 11.7 ± 1.5 mmHg vs. 14.4 ± 1.0 mmHg at day 1 (P = 0.13), 12.2 ± 1.1 mmHg vs. 14.8 ± 0.7 mmHg at day 7 (P = 0.06), 12.2 ± 0.7 mmHg vs. 12.9 ± 0.5 mmHg at 1 month (P = 0.48), and 11.3 ± 0.7 mmHg vs. 12.7 ± 0.5 mmHg at 2 months (P = 0.09). For postoperative IOP, there were no significant differences observed. After undergoing µLOT, multiple regression analysis demonstrated that the CCD development might be influenced by the presence of a thinner central corneal thickness. Conclusion: Approximately one-third of all patients exhibited CCD after µLOT. A thinner central corneal thickness was found to be a risk factor for developing CCD.

A Case of Intraocular Proliferative Changes Caused by a Glaucoma Tube Device.

In recent years, glaucoma tube surgery has been recommended for refractory cases that have failed to respond to angle surgery. In this study, we described the case of the fibrous proliferative membrane caused in the anterior chamber after Ahmed glaucoma valve implantation in a pediatric glaucoma patient. He was born full term, weighing 3228 g. Corneal opacity in both eyes was seen at birth and he was referred to the Department of Ophthalmology, Hiroshima University Hospital on the 13th day of his life. At the initial examination, the intraocular pressure was 37mmHg right 25mmHg left. Corneal diameter expansion and diffuse corneal opacity were seen in both eyes. Nine days after the initial examination, trabeculotomy was performed in both eyes but they were ineffective, and Ahmed glaucoma tubes were inserted in both eyes two months later. Four months later the intraocular pressure remained 30mmHg range in both eyes and micropulse cyclophotocoagulation was performed. One year after the Ahmed glaucoma valve implantation, the tube of right eye was exposed, and we planned to perform a repair procedure. At this time, ultrasound biomicroscopy (UBM) showed proliferative tissue around both tubes. They were removed next month. Although silicone is a highly biocompatible material, it can cause foreign body reactions such as encapsulation around the silicone plate and proliferative membranes around silicone oil. We speculated that a similar reaction occurred to the silicone tube in this case. We reported a case of fibrous proliferative membrane in the anterior chamber. This might be caused by the silicon tube of the Ahmed glaucoma valve.

Irreversible intraocular pressure elevation as a complication of MIRAgel scleral buckling.

Purpose: To report a case of ocular hypertension due to swelling and degeneration of hydrogel explant (MIRAgel) after retinal detachment surgery. Observations: The patient who had a history of left retinal detachment 23 years prior had been regularly followed up for epiretinal membrane in the left eye at the Department of Ophthalmology, Hiroshima University Hospital. Two years after the first presentation, the patient had symptoms of foreign body sensation and hyperemia, with elevation of the intraocular pressure (IOP) of the left eye to 24 mmHg. Two months later, the patient noticed omnidirectional oculomotor disturbances in the left eye, and magnetic resonance imaging (MRI) revealed swelling of the buckle material, presumably hydrogel explant, surrounding his left eye. His oculomotor disturbances worsened, and the left eye IOP remained high at 40 mmHg, despite the administration of antihypertensive eye drops. Subsequently, the swollen hydrogel explant was surgically removed. After the surgery, there was improvement of the diplopia and foreign body sensation. However, IOP in the left eye remained at 34 mmHg, and a trabeculectomy was performed to normalize the IOP. Conclusions and Importance: As far as we know, there have been no reported cases of irreversible ocular hypertension due to hydrogel explant. Stenosis of the trabecular outflow pathway secondary to compression of the superior scleral vein by long-term swollen hydrogel explant and inflammation around the hydrogel explant may be the cause of irreversible IOP elevation. Trabeculectomy may be effective for treating the intraocular hypertension caused by hydrogel explant.

The Efficacy, Safety and Satisfaction Associated with Switching from Brinzolamide 1% and Brimonidine 0.1% to a Fixed Combination of Brinzolamide 1% and Brimonidine 0.1% in Glaucoma Patients.

We evaluated glaucoma patients for the efficacy, safety and satisfaction associated with switching from brinzolamide 1% and brimonidine 0.1% to a fixed combination of brinzolamide 1% and brimonidine 0.1%. A total of 22 glaucoma patients were enrolled and completed this prospective, nonrandomized study that evaluated patients who underwent treatment with at least brinzolamide 1% and brimonidine 0.1%. Patients on brinzolamide 1% and brimonidine 0.1% were switched to a brinzolamide/brimonidine fixed-combination ophthalmic suspension (BBFC). Evaluations of intraocular pressure (IOP), superficial punctate keratopathy (SPK) and conjunctival hyperemia were conducted at baseline and at 4 and 12 weeks. The Treatment Satisfaction Questionnaire for Medication-9 (TSQM-9) was utilized to assess the change in treatment satisfaction. At baseline and at 4 and 12 weeks, the IOP was 15.0 ± 4.1, 14.8 ± 4.1 and 14.8 ± 4.1 mmHg, respectively. There were no significant differences observed at any of the time points. However, the SPK score significantly decreased at 12 weeks, even though no significant differences were observed for the conjunctival hyperemia incidence at any of the time points. After switching from brinzolamide 1% and brimonidine 0.1% to BBFC, there was a significant increase in the TSQM-9 score for convenience and global satisfaction. Both an improvement in the degree of SPK and an increase in treatment satisfaction occurred after switching from brinzolamide 1% and brimonidine 0.1% to BBFC, even though there were sustained IOP values throughout the 12-week evaluation period.

Corneal Higher-Order Aberrations after Microhook ab Interno Trabeculotomy and Goniotomy with the Kahook Dual Blade: Preliminary Early 3-Month Results.

We examined postoperative corneal higher-order aberrations (HOAs) present after combined phacoemulsification with either microhook ab interno trabeculotomy (µLOT-Phaco) or goniotomy, using the Kahook Dual Blade (KDB-Phaco). Retrospective study: A total of 45 eyes underwent µLOT-Phaco and KDB-Phaco (LOT-Phaco) procedures, with 21 eyes that underwent cataract surgery alone used as controls. Visual acuity and corneal HOAs, coma-like aberrations, and spherical-like aberrations were analyzed before and at 1, 2, and 3 months after the surgeries. Risk factors that could potentially influence HOAs were evaluated. No significant postoperative changes were noted for corneal HOAs, coma-like aberrations, and spherical-like aberrations after cataract surgery alone. The mean corneal HOAs, coma-like aberrations, and spherical-like aberrations were 0.222 ± 0.115 µm, 0.203 ± 0.113 µm, and 0.084 ± 0.043 µm at baseline and 0.326 ± 0.195 µm (p < 0.001), 0.302 ± 0.289 µm (p = 0.03), and 0.150 ± 0.115 µm (p < 0.001) at 3 months after LOT-Phaco, respectively. Results of the analysis for risk factors suggested that a longer incision in Schlemm's canal could influence corneal HOAs, coma-like aberrations, and spherical-like aberrations after LOT-Phaco. Although no significant postoperative changes were observed in corneal HOAs and coma-like or spherical-like aberrations after cataract surgery alone, a significant increase in corneal HOAs and coma-like or spherical-like aberrations remained after the LOT-Phaco procedure.

Comparison of Efficacy between 120° and 180° Schlemm's Canal Incision Microhook Ab Interno Trabeculotomy.

We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm's canal microhook ab interno trabeculotomy (µLOT-Phaco). This retrospective comparative case series examined 52 µLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm's canal.

Treatment outcomes in the neovascular glaucoma tube versus trabeculectomy study.

PURPOSE: To compare surgical outcomes between patients who underwent Baerveldt glaucoma implantation versus trabeculectomy (TLE) for the treatment of neovascular glaucoma. METHODS: We performed a prospective, randomized, controlled clinical trial at Hiroshima University and Tsukazaki Hospital, Japan. Patients were randomized to Baerveldt glaucoma implantation (23 patients) or TLE (27 patients). The primary outcome measure was the rate of intraocular-pressure control. Secondary outcome measures included complications and interventions. We defined "failure" as intraocular pressure ≥ 22 mmHg or < 20% reduction from baseline pressure, on two consecutive follow-up visits; need for additional glaucoma surgery; vision-threatening complications; or loss of light perception. Kaplan-Meier analysis was used to determine surgical success rates. Postoperative complications and interventions were compared between the two groups with Pearson Chi-square tests. RESULTS: There were no significant differences in demographic or ocular characteristics between the treatment groups at baseline. The postoperative follow-up was 26.6 ± 19.4 months in the Baerveldt group and 27.3 ± 20.1 months in the TLE group. There were no statistical differences (Mann-Whitney nonparametric tests with Bonferroni correction) in postoperative intraocular pressure measured at 6-month intervals. Success rates were 59.1 and 61.6% at 1-year after Baerveldt glaucoma implantation and TLE, respectively. Kaplan-Meier analysis showed no significant difference in success between groups (P = 0.71, log-rank test). Medication use, visual acuity, and interventions were similar between groups. Thirteen late postoperative complications developed in the Baerveldt glaucoma implantation group and four complications developed in the TLE group. Tube exposure was the most common late complication. CONCLUSION: These two procedures produced similar surgical success, intraocular-pressure reductions, visual acuity, and number of medications at the last visit. The TLE group showed smaller numbers of late complications and patients who lost more than two lines of visual acuity. Therefore, TLE might be a safer and better way to treat patients with neovascular glaucoma.

Photodynamic therapy for radiation maculopathy: A case report.

RATIONALE: The best treatment protocol for radiation maculopathy in children has not been determined. The purpose of this study was to determine the effect of photodynamic therapy (PDT) on radiation maculopathy. PATIENT CONCERNS: An 11-year-old boy who was originally diagnosed with orbital rhabdomyosarcoma when he was 1 year old, in October 2008. The lesion improved after peripheral blood stem cell transplantation, chemotherapy and radiation therapy. A cataract was detected in his right eye in May 2011, and he underwent cataract surgery in July 2011. Continuous amblyopia training maintained his visual acuity in his right eye. In January 2017, his visual acuity was reduced and macular edema was detected with optical coherence tomography. DIAGNOSES: We diagnosed radiation maculopathy, from the history of radiation therapy, macular edema by optical coherence tomography, and hyperfluorescent site by fluorescein angiography. INTERVENTIONS: We performed PDT in June 2017. OUTCOMES: Treatment with PDT improved macular edema and his visual acuity. LESSONS: Radiation retinopathy is progressive disorder with poor prognosis. PDT could be considered to treat radiation maculopathy.

Functional analysis of mesencephalic astrocyte-derived neurotrophic factor in retinal ganglion cells under oxidative stress.

Glaucoma is optic neuropathy that is characterized by progressive neurodegeneration of the retinal ganglion cells (RGCs) and axons. This condition will lead to visual impairment and bring glaucoma to become the second cause of blindness globally. Neuroprotection in glaucoma is needed to prevent the progression of optic neuropathy. In this study, we examined the effects of the superior colliculus (SC), and mesencephalic astrocyte-derived neurotrophic factor (MANF) secreted from the SC, on RGC survival after oxidative stress. SC slices and RGCs from rats (3-day old) were co-cultured using a 3D-transwell system. In addition, primary RGCs from 4 to 5-day-old rats were cultured and treated with 100 µM hydrogen peroxide (H2 O2 ), together with stimulation by MANF. Immunoblot and immunofluorescence analyses indicated down-regulated expression levels of several survival markers of RGCs. Extension of neurites was decreased in RGCs treated with 100 µM H2 O2 . Following co-culture with SC slices, or the addition of MANF, we found that both the down-regulated expression of neural markers and extension of neurites caused by oxidative stress in RGCs were blocked. Furthermore, we found a decrease in the expression of neural markers and extension of neurites after co-culture with MANF siRNA-treated SC slices compared with slices treated with mock siRNA, but, RGCs co-cultured with SC slices treated with MANF siRNA displayed no-changed about to apoptosis. These results suggest that MANF secreted from the SC may play an important role in maintenance of function and survival of RGCs. It is also possible that MANF is an important factor in neuroprotection of RGCs. SIGNIFICANCE OF THE STUDY: Glaucoma is a progressive neurodegenerative disease of the retinal ganglion cell (RGC) and their axons. Neuroprotection is aimed at protecting those neurons that are damaged glaucomatous optic neuropathy. We have now examined the effects of superior colliculus, or msencephalic astrocyte-derived neutrophic factor (MANF), secreted from superior colliculus, on RGC survival using co-culture system. Our results suggested that MANF may important key factor in neuroprotection of RGC.