Refractive astigmatism in phaco-canaloplasty vs phaco-non-penetrating deep sclerectomy.

This study aimed to assess refractive astigmatism, in phaco-canaloplasty (PC) vs phaco-non-penetrating deep sclerectomy (PDS) in a randomized, prospective study within 24 months. Patients were randomized pre-operatively, 37 underwent PC and 38 PDS. The following data was collected: BCVA, IOP, number of antiglaucoma medications, refraction with autokeratorefractometry. The assessment of astigmatism was simple arithmetic and vector analysis (calculations included cylinder with axis in form of centroids) and included double angle plots and cumulative refractive astigmatism graphs. Pre-operative mean BCVA in PC was 0.40 ± 0.43 and was comparable to BCVA in PDS 0.30 ± 0.32logMAR (P = 0.314). In the sixth month follow-up, mean BCVA showed no difference (P = 0.708) and was 0.07 ± 0.13 and 0.05 ± 0.11, respectively. However, 2 years after the intervention mean BCVA was better in PC 0.05 ± 0.12 than in PDS 0.12 ± 0.23 and it was statistically significant (P = 0.039). Mean astigmatism in PC at baseline was 1.13 ± 0.73Dcyl, at 6 months it was 1.09 ± 0.61 and at 2 years 1.17 ± 0.51. In PDS at baseline 1.35 ± 0.91 at 6 months 1.24 ± 0.86 and at 2 years 1.24 ± 0.82. There were no differences between the groups in mean astigmatism throughout the study. Centroids (mean of a cylinder with axis) in PC were pre-operatively 0.79D@172˚ ± 1.10Dcyl, at 6 months 0.75D@166˚ ± 1.01 and at 24-months 0.64D@164˚ ± 1.11 and in PDS pre-operatively 0.28D@10˚ ± 1.63D at 6 months 0.26D@11˚ ± 1.5 and at 24-months 0.47D@20˚ ± 1.43. The direction of mean astigmatism was against the rule in all analyzed time points. The mean baseline IOP in PC was 19.4 ± 5.8 mmHg and 19.7 ± 5.4 mmHg in PDS(P = 0.639). From the 6-month IOP was lower in PC, at 24-months it was 13.8 ± 3.3 mmHg in PC and 15.1 ± 2.9 mmHg in PDS(P = 0.048). In both groups preoperatively patients used median(Me) of three antiglaucoma medications(P = 0.197), at 24-months in PC mean 0.5 ± 0.9 Me = 0.0 and 1.1 ± 1.2 Me = 1.0 in PDS(P = 0.058). Both surgeries in mid-term observation are safe and effective. They do not generate vision-threatening astigmatism and do not even change the preoperative direction of mean astigmatism. Refractive astigmatism is stable throughout the observation.

XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery.

This retrospective study analyzed the surgical and refractive outcomes of a XEN Gel Implant (Allergan, Abbvie Company, Irvine, CA, USA) in naïve patients versus those with previous glaucoma surgery. We evaluated the efficacy of XEN implantation in 86 glaucoma patients during a long-term follow-up period. Patients were divided into two groups: naïve patients (Group 1) and patients with previous glaucoma surgery (Group 2). Eyes that received a XEN Gel Stent placement from December 2014 to October 2019 were included. Intraocular pressure (IOP) change, corrected distance visual acuity (CDVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. In Group 1, the mean IOP before surgery was decreased significantly from 25.00 ± 7.52 mmHg to 16.83 ± 5.12 mmHg by the end of the study. In Group 2, the mean IOP decreased significantly from 25.35 ± 7.81 mmHg to 17.54 ± 5.34 mmHg. The mean IOP decrease from baseline was 29% in Group 1 and 27% in Group 2 (p = 0.567). There were no significant differences between the groups in the IOP baseline level, the final level, or the change between preoperative and final levels. The qualified success rate for Group 2 was 68.7% versus 76.5% for Group 1 for the initial procedure and 15.4% vs. 20.2%, respectively, for complete success rate (p > 0.05). However, at the end of the follow-up, more patients achieved an IOP < 18 mmHg in Group 1 than in Group 2. Despite the need for more anti-glaucoma medications, repeat XEN Gel implantation appears to show promising results in patients with previously failed anti-glaucoma procedures, owing to its minimal invasiveness.

XEN Glaucoma Implant for the Management of Operated Uncontrolled Glaucoma: Results and Complications during a Long-Term Follow-Up.

This study aimed to analyze the surgical and refractive outcomes of XEN glaucoma implant (Allergan, an Abbvie company, Irvine, CA, USA), a minimally invasive surgical device for the treatment of operated uncontrolled glaucoma. Eyes that received XEN Gel Stent placement from December 2014 to October 2019 were retrospectively investigated. Intraocular pressure (IOP) change, best-corrected visual acuity (BCVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. Seventy-two eyes of 72 subjects were included in the study: 32 (44%) men and 40 (56%) women. The follow-up period ranged from 1 to 50 months (median, 26.13 months). The mean IOP before surgery was 24.82 ± 8.03 mmHg and decreased to 17.45 ± 5.84 mmHg at the end of the study (mean difference [MD] = -7.48, 95% confidence interval [CI]: -10.04, -4.93; p < 0.001). The mean decrease from baseline was 23%. BCVA before surgery was 0.38 ± 0.30, and that at the end of the follow-up period improved to 0.47 ± 0.37, MD = 0.09, 95% CI: 0.04, 0.13; p < 0.001. Additional procedures (fluorouracil injection and bleb needling) were performed in 11/72 patients (15%). Further glaucoma surgery was necessary for 23.9% of the patients. XEN Gel Stent implantation is both safe and reasonably effective for lowering IOP in operated uncontrolled glaucoma patients.

Phacoemulsification-deep sclerectomy modified by trabeculum microperforations and implantation of lens anterior capsule as autologous scleral implant.

OBJECTIVE: To evaluate the efficacy and safety of Phacoemulsification-deep sclerectomy modified by trabeculum microperforations and anterior lens capsule as autologous scleral implant (mPDS) for open-angle glaucoma. RESEARCH DESIGN AND METHOD: A case series study comprised 127 patients and 127 eyes after mPDS. The applied modification of deep sclerectomy consisted in creating microperforations within the posterior trabeculum and in fixing the anterior lens capsule, removed during phacoemulsification, in the scleral lake as an autologous intrascleral implant. Primary open-angle glaucoma without satisfying intraocular pressure (IOP) control (>or=21 mmHg) despite maximally tolerated medications or with progression of visual field and cataract was the indication for surgery. For statistical analyses paired Student's t-test, the Wilcoxon signed rank test and one-dimensional ANOVA with repeated measures were used; survival analysis was performed using the Kaplan-Meier method. MAIN OUTCOME MEASURES: IOP, number of medications and best corrected visual acuity (BCVA) were examined. On the basis of the assessment of the anterior and posterior segments of the eye, the character and also the degree of intensification of postoperative complications were established. Follow-up examinations were performed on days 1 and 7, and at 1, 3, 6, 12, 18 and 24 months and thereafter every 6 months. The complete success rate was defined as IOP

Combined surgery for cataract and glaucoma: PDS with absorbable SK-gel implant compared with PDS with non-absorbable T-flux implant - medium-term results.

OBJECTIVE: To compare the efficacy and safety of phacoemulsification - deep sclerectomy (PDS) with absorbable SK-gel or non-absorbable T-flux implantation. RESEARCH DESIGN AND METHOD: The study involved eyes after PDS with SK-gel (32 eyes) and T-flux (20 eyes). Primary open angle glaucoma without satisfying intraocular pressure (IOP) control (> or =21 mmHg) despite maximally tolerated medication or with progression of the visual field and cataract was the indication for surgery. For statistical analyses, the Mann-Whitney U test, Student's t-test, pair sequence Wilcoxon test, and analysis of variance were used. Survival analysis was done using the Kaplan-Meier method. MAIN OUTCOME MEASURES: The best corrected visual acuity (BCVA), IOP, anterior and posterior segments of the eye, and number of antiglaucoma medications were examined. Follow-up examinations were performed on days 1 and 7, and at 1, 3, 6, 12, 18 and 24 months. A complete success rate was defined as IOP < or =18 mmHg without and qualified success as IOP < or =18 mmHg with or without antiglaucoma medications. RESULTS: After a 24-month follow-up, mean IOP decreased in the SK-gel group from 20.9 +/- 6.1 to 13.8 +/- 2.1 mmHg (P = 0.000012) and in the T-flux group from 21.1 +/- 6.2 to 14.1 +/- 1.9 mmHg (P = 0.000006). There was no statistically significant difference between the number of antiglaucoma medications used in either group (P = 0.389). Complete success rates were 69.8% and 61.3%, respectively (P = 0.064) and qualified success rates were 93.2% and 84.1%, respectively (P = 0.034). There were no significant differences in complications between the two groups. LIMITATIONS: Despite the obtained statistical differences between the investigated groups in the scope of the qualified success rate, the result should not be treated as reliable from a clinical point of view. The influence of the kind of implant on the obtained result and the nature of the decompression space would require confirmation by ultrasound biomicroscopy (UBM), and by analysis of histological specimens but these were not performed. It should also be noted that the groups were not numerous. CONCLUSIONS: In the case of SK-gel and T-flux application, PDS demonstrates similar efficacy and safety although the qualified success rate in the case of PDS with T-flux is significantly lower after a 24-month follow-up. The study does not indicate the cause of the observed changes but the nature of the intrascleral lake created by the implants used and its role in IOP regulation may be essential.

[Sealed-capsule irrigation during cataract surgery to prevent posterior capsule opacification]. / Zastosowanie systemu szczelnej irygacji w czasie operacji zacmy w zapobieganiu rozwojowi zmetnienia torebki tylnej.

The possibility of isolated use of pharmacological agents to selectively destroy anterior capsule epithelial cells and avoid toxic side effects on other tissues has become the aim of numerous research studies. Creation of a precise, tight, safe system which would allow delivery of pharmaceutical agents into the lens capsule following cataract extraction seems to be a solution. Thus, the aim of our study is to present a surgical technique preventing the development of posterior capsule opacification (PCO) after cataract surgery with the use of sealed-capsule irrigation system (SCI)--Perfect Capsule device.