RELAY INTRASCLERAL 6-0 POLYPROPYLENE-ASSISTED INTRAOCULAR LENS FIXATION: A Retrospective Comparison With Modified Yamane Technique.

PURPOSE: To describe a new surgical technique that uses a relay suture to optimize sutureless scleral fixation of intraocular lens in eyes with capsular insufficiency and to evaluate the outcomes of this technique versus Flanged, double needle-guided, scleral fixation of intraocular lens with haptic trimming (modified Yamane approach). METHODS: Relay intrascleral 6-0 polypropylene sutures with flanges generated at the intraocular ends were used to fixate and securely hold a rigid intraocular lens with haptic eyelets against the inner scleral wall. The results were analyzed at 3-, 6-, and 12-month follow-up. RESULTS: This retrospective cohort study found that compared with the control group (n = 27), the relay-sutured group (n = 26) had greater mean changes in corneal astigmatism (0.44 vs. -0.52 diopters [D]) and fewer mean degrees of intraocular lens astigmatism (0.62 vs. 1.1 D). The mean intraocular lens decentration was comparable between both the groups; however, in the control group, there was a significant increase in intraocular lens tilt degrees from 3 to 12 months. Moreover, significantly higher proportions of patients with persistent macular edema and iris-optic capture were seen in the control group. CONCLUSION: The relay-sutured technique may be an alternative to flapless scleral fixation of intraocular lens and provides a stable intraocular lens position with acceptable complication rates.

24-month outcomes of XEN45 gel implant versus trabeculectomy in primary glaucoma.

PURPOSE: To compare the efficacy and safety profiles of XEN implant versus trabeculectomy as a surgical intervention for primary glaucoma. METHODS: A retrospective cohort study of mild to moderate stage glaucoma patients, who had undergone either XEN implantation or trabeculectomy with adjunctive mitomycin C, was performed in a tertiary eye center. RESULTS: Fifty-seven eyes for XEN implant and 57 eyes for trabeculectomy with medically uncontrolled glaucoma were included. Preoperative IOP was 16-33 mmHg. Visual field mean deviation was -9.11±6.93 dB in XEN group, and -9.67±5.06 dB in trabeculectomy group (p = 0.195). At the 24-month timepoint, mean IOP was reduced from 21.6±4.0 to 14.6±3.5 mmHg (32.4% reduction) in the XEN group (p<0.001), and from 22.5±5.8 to 12.5±4.1 mmHg (44.4% reduction) in the trabeculectomy group (p<0.001). Final IOP in XEN was significantly higher than trabeculectomy (p = 0.008) with lesser mean IOP percentage reduction at month 24 (p = 0.045). Mean number of medications was reduced from 2.2±1.4 to 0.5±0.7 in XEN group (p<0.001), and from 2.4±0.7 to 0.8±1.3 in trabeculectomy group (p<0.001). Final number of medications was not different between the groups (p = 0.225). Surgical success was comparable between XEN and trabeculectomy group. Overall success was 71.4% vs. 73.3% (p = 0.850), and complete success was 62.9% vs. 62.2% (p = 0.954), respectively. XEN had lower rate of numerical hypotony than trabeculectomy. No serious complication occurred in either procedure group. CONCLUSION: At 24 months, XEN showed a rate of success comparable to that of trabeculectomy. Although XEN had a higher final IOP than trabeculectomy, XEN achieved 32% IOP reduction, and achieved final IOP in mid-teen level. No serious complication occurred in either group. XEN can be applied for treatment of mild to moderate stages of glaucoma in Southeast Asian patients.

Comparison of Corneal Biomechanical Properties among Axial Myopic, Nonaxial Myopic, and Nonmyopic Eyes.

PURPOSE: To compare corneal deformation characteristics using ultra-high-speed Scheimpflug camera (Corvis ST) in patients with nonmyopic (NM), mild-to-moderate nonaxial myopic (MM), and high axial myopic (HM) eyes. METHODS: In this cross-sectional study, normal subjects aged >40 years with no history of ocular laser/surgery were classified according to axial length (AL) and spherical equivalence (SE) into three groups: (1) NM (SE > -0.50 D and AL < 26 mm), (2) MM (SE -6.00 D to -0.50 D and AL < 26 mm), and (3) HM (SE ≤ -6.00 D and AL ≥ 26 mm). Seven parameters including corneal deformation amplitude (CDA), inward/outward corneal applanation length, inward/outward corneal velocity (ICV and OCV), peak distance, and radius were measured. Pearson correlation and linear mixed-effects model were done. RESULTS: A total of 180 eyes were recruited. 98 eyes were NM, 30 eyes were MM, and 52 eyes were HM. There were significant correlations of OCV to the degree of refractive error (r = 0.203, p < 0.001) and AL (r = -0.242, p < 0.001). After adjusting for age, sex, intraocular pressure, and corneal thickness, there was significantly higher CDA (ß = 0.07, p < 0.001), faster OCV (ß = -0.08, p < 0.001), and smaller radius (ß = -0.39, p=0.01) in the HM group compared to the NM group. CONCLUSION: The higher CDA, faster OCV, and smaller radius found in the HM may suggest that these eyes have reduced ocular stiffness and may be less stable and more prone to stress.

Stability and Sterility of Extemporaneously Prepared Nonpreserved Cefazolin, Ceftazidime, Vancomycin, Amphotericin B, and Methylprednisolone Eye Drops.

PURPOSE: To determine in-use stability and sterility of fortified cefazolin, ceftazidime, vancomycin, amphotericin B, and methylprednisolone eye drops in a simulated inpatient setting with and without a mobile refrigerated container (MR). METHODS: Each drug was prepared and divided into 4 groups: 1) simulated patient use with the MR group: stored at 4°C and kept in the MR during drug administration, 2) simulated patient use without the MR (NoMR) group: stored at 4°C and no MR, 3) refrigerated control group: stored at 4°C, and 4) room temperature control group: stored at room temperature. Stability and sterility data were evaluated at days 0, 4, 7, 14, 21, and 28. Linear mixed-effects model and survival analysis were performed. RESULTS: Median time to 10% loss of concentration for in-use medications (MR/NoMR groups) was >28/27.9, 22.2/22.2, 19.4/19.4, 10.18/<4, and >28/>28 days for cefazolin, ceftazidime, vancomycin, amphotericin B, and methylprednisolone, respectively. There was no significant difference in the predicted concentration loss per day among all groups for vancomycin and methylprednisolone (all P > 0.05). For the other study medications, all room temperature control groups, the cefazolin NoMR group, and the ceftazidime NoMR group had significantly greater predicted concentration loss per day compared with the refrigerated control groups (all P ≤ 0.02). Culture results were negative for all drugs throughout the study. CONCLUSIONS: The NoMR group showed that the drug significantly degraded rapidly for cefazolin, ceftazidime, and amphotericin B. Implementation of MR could decrease the predicted loss of concentration per day for cefazolin and ceftazidime. In vitro antimicrobial activity and sterility were retained for 28 days.