Cornea thinning in two cases of ICE syndrome.

We present two patients with a new finding of symmetrical corneal thinning early in the clinical course of iridocorneal endothelial syndrome. Patient 1 was evaluated for uncontrolled angle closure glaucoma of the left eye (OS) status post laser peripheral iridotomy (LPI). After placement of an Ahmed glaucomatous valve and trabeculectomy with mitomycin C were performed, the patient was diagnosed with Chandler syndrome. The patient's pachymetry at the time of diagnosis revealed stable central corneal thickness (CCT) of 481 µm of the right eye (OD) (baseline 494 µm) and central cornea thinning with CCT of 407 µm OS (baseline 486 µm). Patient 2 was evaluated for ocular hypertension and Chandler syndrome OS was diagnosed. The patient had a good short-term response to LPI and ocular hypotensive medications. This patient was also found to have thinning of his affected cornea with CCT 523 µm OD and 476 µm OS.

Use of ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma.

INTRODUCTION: Primary congenital glaucoma is a rare ocular disorder that is responsible for 0.01%-0.04% of total blindness worldwide.1 The goal of congenital glaucoma management is to allow for proper development of the immature visual system by controlling intraocular pressure. Medical therapy usually provides a supportive role to temporarily reduce intraocular pressure, but patients typically require iridocorneal angle surgery to facilitate aqueous humor outflow. In this report, we describe the use of minimally invasive ab interno Kahook Dual Blade trabeculectomy for treatment of primary congenital glaucoma. CASE DESCRIPTION: A 13-month-old male with bilateral primary congenital glaucoma due to a loss of function TEK mutation. He had bilateral findings of elevated intraocular pressures, buphthalmos, Haab's striae, photophobia, and myopia. Over the course of 6 weeks, three ab interno trabeculectomies with a Kahook Dual Blade were performed in the patient's left eye and one in the patient's right eye. After 3 months, intraocular pressures while receiving pressure reducing ophthalmic drops bilaterally reduced from 43 to 21 mmHg in the right eye after a single surgery and from 44 to 34 mmHg in the left eye after three surgeries, eventually requiring glaucoma drainage implant placement. There were no complications. CONCLUSION: Ab interno Kahook Dual Blade Trabeculectomy is a minimally invasive and potentially successful procedure for the treatment of congenital glaucoma. The safety profile of minimally invasive glaucoma surgery warrants consideration for congenital glaucoma patients, as they usually require iridocorneal angle surgery because pharmacologic therapy is typically inadequate.

Combining Ab Interno Kahook Trabeculectomy with Gonioscopy-Assisted Transluminal Trabeculotomy Reduces Intraocular Pressure.

Minimally invasive glaucoma surgery (MIGS) provides a safe option for individuals with mild to moderate open-angle glaucoma to reduce their need for pharmacologic therapy or more extensive ab externo surgeries. In this report, we describe a surgical technique using both the Kahook Dual Blade and Gonioscopy-assisted transluminal trabeculotomy (GATT), to treat a 23-year-old active duty female with idiopathic uveitis and subsequent corticosteroid-induced glaucoma who presented with consistently elevated intraocular pressure (IOP) measurements despite maximal pharmacologic interventions. This combination was effective in consistently lowering intraocular pressure for at least 12 months in a young, phakic, active duty patient with uveitis and steroid-responsive open-angle glaucoma.

Intraocular Pressure During Robotic-assisted Laparoscopic Procedures Utilizing Steep Trendelenburg Positioning.

PURPOSE: To determine the effect of steep Trendelenburg (sTBURG) surgical positioning on intraocular pressure (IOP) during robotic-assisted laparoscopy (RAL) in subjects without previously identified ocular disease. DESIGN: Prospective cohort study. PARTICIPANTS AND CONTROLS: Eighteen patients undergoing RAL with sTBURG and 21 controls undergoing open and laparoscopic cases in horizontal positioning. MATERIALS AND METHODS: Research data derived from an approved Naval Medical Center, San Diego, CA, IRB protocol. A study group undergoing RAL utilizing sTBURG (group 1) was compared with a control group undergoing open surgery in the horizontal position (group 2), and laparoscopic cases in the horizontal position (group 3). An ophthalmologic examination including Snellen visual acuity, IOP, Humphrey Visual Field (HVF) 24-2 with standard Swedish Interactive Thresholding Algorithm, time domain optical coherence tomography (OCT), retinal nerve fiber layer (RNFL) analysis, pachymetry, and dilated fundus examination was conducted preoperatively and at 1 month postoperatively. IOP was measured intraoperatively at discrete time-points. MAIN OUTCOME MEASURES: IOP values, change in OCT RNFL thickness, HVF mean deviation, and HVF pattern standard deviation. RESULTS: Baseline IOP (mm Hg) was similar, 13.7±3.2 for group 1 versus 15.3±3.2 for group 2 and 14.1±2.4 for group 3 (P=0.55). The IOP plateau from 60 minutes until case conclusion occurred at 29.9 mm Hg (95% confidence interval, 27.4-32.5), 19.9 mm Hg (95% confidence interval, 17.6-22.3), and 22.8 mm Hg (95% confidence interval, 20.2-25.4) for group 1, group 2, and group 3, respectively. There were no significant changes in OCT RNFL thickness, HVF mean deviation, and HVF pattern standard deviation. CONCLUSIONS: Significant elevations of IOP are experienced during robotic surgery utilizing sTBURG positioning in patients with healthy eyes, and we recommend a multidisciplinary approach in determining potential risk to those with known ocular disease who are candidates for these procedures.

Intraocular lens power calculation for humanitarian missions based on partial biometry.

PURPOSE: To determine whether the correlation between corneal power (K) and axial length (AL) can be used for intraocular lens (IOL) power calculation when biometric data are incomplete. SETTING: Developing regions served by United States Navy humanitarian assistance missions. DESIGN: Case series. METHODS: Measurements of K and AL were collected from all adult cataract surgery charts and used to calculate emmetropic IOL powers. A formula for estimating K or AL was derived by Deming regression analysis. The emmetropic IOL powers were calculated by hypothetical scenarios as follows: (1) K estimated from the formula and measured AL, (2) mean population K and measured AL, (3) measured K and estimated AL, and (4) measured K and mean population AL. The mean absolute refractive error (MAE) was calculated for each hypothetical scenario and an additional scenario (scenario 5) using single IOL power for all eyes. The MAEs were compared with a paired t test. RESULTS: The formula derived from Deming regression analysis was K = 74.56 - 1.317 × AL. The MAE for the scenarios were (1) 0.90 diopters (D), (2) 1.11 D, (3) 1.91 D, (4) 1.55 D, and (5) 1.22 D. The MAE for scenario 1 was significantly less (P<.01) than that for scenarios 2 and 5. The MAE for scenario 5 was significantly less than that for scenarios 3 and 4. CONCLUSIONS: The correlation between K and AL can be used to improve accuracy of IOL calculation when K is unavailable. When the AL is unavailable, the mean population IOL power is most accurate. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Delayed presentation of traumatic dislocation of a Visian Implantable Collamer Lens.

PURPOSE: To report traumatic dislocation of a Visian Implantable Collamer Lens (ICL, STAAR Surgical Co) discovered on routine examination. METHODS: A 26-year-old man was found to have ICL subluxation into the anterior chamber with pupillary capture on routine screening examination. The patient reported being punched near the left eye 2 weeks earlier. He noted mild blurry vision, no pain, and uncorrected distance visual acuity (UDVA) was 20/30, which was decreased from his baseline of 20/20 in the affected eye. RESULTS: Surgical repositioning was performed under pupillary dilation without complication. Postoperatively, UDVA was 20/20(-2). Persistent pigment on the ICL, slight pupillary margin peaking, and anterior chamber inflammation were noted. CONCLUSIONS: Traumatic ICL dislocation may occur with minimal signs and symptoms. Education of patients about the necessity for examination after ocular trauma and need to wear eye protection during activities at high risk of ocular trauma are important.