ABSTRACT
Purpose: We evaluate the reduction of corneal astigmatism and the improvement of visual outcomes of this surgical method in the Indonesian population. We also assess the accuracy and predictability of using femtosecond laser astigmatic keratotomy (FLAK) combined with cataract surgery. Patients and Methods: In a retrospective study, a total of 275 subjects (78 with against-the-rule (ATR) astigmatism, 178 with with-the-rule (WTR) astigmatism, and 19 with oblique (OBL) astigmatism) with preexisting corneal astigmatism ranging from 0.75D to 3.00D underwent FLAK. All subjects completed a 3-month follow-up. The femtosecond laser used for creating paired AK 2.2 mm, primary incision, and paracentesis incision was the FEMTO Z8 NEO from Ziemer Ophthalmic System, Switzerland. The surgical approach was guided by the "NAPA" nomogram. Results: The reduction in postoperative astigmatism was 56.90% for the WTR group, 49.46% for the ATR group, and 47.33% for the oblique group. A significant reduction in astigmatism was observed at the 1-week, 1-month, and 3-month follow-up intervals in both the WTR and ATR groups. The reduction in astigmatism was more favorable in cases of moderate astigmatism within the WTR group, as compared to the ATR and oblique groups. Postoperative astigmatism reduction was found to be more predictable in the right eye than in the left eye. Conclusion: The combination of FLAK can be considered as a potential method for reducing corneal astigmatism ranging from 1.00D to <3.00D. The highest reduction was observed in the WTR group, along with a higher rate of intended correction without astigmatism meridian shift in the right eye for the WTR group. However, factors such as cyclotorsion resulting from the surgical technique, alignment of docking, incision length, and preoperative astigmatism need to be taken into account for further enhancement and predictability of astigmatism reduction with this method.
ABSTRACT
PURPOSE: To study the association between corneal endothelial cell density (ECD) and degree of anterior chamber angle (ACA) opening in eyes with chronic angle closure glaucoma. METHODS: The study was conducted at JEC Eye Hospitals in Indonesia. Treatment-naïve patients aged ≥40 years with IOP >21 mmHg and peripheral anterior chamber depth (ACD) grade 2 or less by Van Herick's technique were recruited. Trabecular iris angle (TIA; degree) was measured using anterior segment optical coherence tomography (AS-OCT) and classified as: grade 1 ≤10°, grade 2 11-20°, and grade 3 >20°. Noncontact specular microscopy was performed, and the following corneal parameters were obtained:ECD (cells/mm2), coefficient of variation (CV; µm2/cell), percentage of hexagonal cells, and central corneal thickness (CCT; µm). RESULTS: A total of 52 eyes from 52 subjects were recruited (16 grade 1 TIA, 24 grade 2 TIA, and 12 grade 3 TIA). Presenting IOP was not significantly different between groups. The median central corneal ECD was 2684.5 (1433-2934), 2587.0 (1902-3103), and 2441.0 (1659-3005) cells/mm2 in grade 1, 2, and 3 TIA, respectively, with no significant differences across the groups (P = 0.67). The CV was lowest in grade 3 TIA (36.4 ± 7.2 µm2/cell), and highest in grade 1 TIA (38.3 ± 9.6 µm2/cell), but the differences were not significant (P = 0.74). Likewise, the percentage of hexagonality and CCT was not significantly different. TIA was not correlated with IOP but was modestly correlated with age. CONCLUSION: The corneal ECD and morphological characteristics such as CV and hexagonality were not significantly different across various TIA grading in chronic angle closure. This may reflect the lack of chronic and gradual IOP insult on corneal endothelial parameters as TIA did not show direct effect towards IOP.
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AIM: To compare surgical results of the Ahmed and Baerveldt implant procedures in glaucoma patients at 1y follow-up at Jakarta Eye Center (JEC) Eye Hospitals. METHODS: This cohort retrospective study was conducted on glaucoma patients aged ≥18y who had undergone Ahmed and Baerveldt implant surgery. Intraocular pressure (IOP), visual acuity, glaucoma medication, success rate, early and late postoperative complications, and the number of resurgeries were analyzed. RESULTS: A total of 351 eyes in the Ahmed group and 94 eyes in the Baerveldt group were included in this study. At 1y follow-up, the mean IOP was found to be significantly lower in the Baerveldt group (13±4.47 mm Hg) compared to the Ahmed group (15.02±5.73 mm Hg; P=0.025). Glaucoma medication was required in both the Ahmed and Baerveldt groups (58.92% vs 71.67%). Comparable success rate was found in both groups. The Ahmed group revealed a complete and qualified success of 86.82%, and failure of 13.17%. Similarly, the Baerveldt group showed complete and qualified success in 87.75% and failure in 12.25% cases. In the Ahmed group, 11.97% early complications, 26.06% late complications and 9.97% resurgeries were observed. In comparison, in the Baerveldt group, 23.40% early complications, 30.95% late complications and 11.70% resurgeries were observed. CONCLUSION: Both groups of glaucoma implants show significant IOP reduction, however, the Baerveldt implant group demonstrates greater IOP reduction with more failure rates and complications than the Ahmed implant group.
ABSTRACT
Secondary glaucoma may develop after vitreoretinal surgery as it is a known risk factor for its development. When the risk factors are more than one, for instance along with neovascular glaucoma (NVG), the secondary glaucoma may become recalcitrant and very difficult to manage. Surgical intervention is often warranted to control intraocular pressure (IOP) and prevent progressive glaucomatous damage in patients with refractory glaucoma, and glaucoma drainage implant may be preferred as the primary choice. We describe a patient who develop secondary glaucoma after vitrectomy and silicone oil (SO) injection due to unresolved vitreous hemorrhage in proliferative diabetic retinopathy (PDR) and subsequent NVG. Baerveldt glaucoma implant (BGI) was carried out and placed in the superotemporal quadrant with longer anterior chamber tube placement to prevent escape of SO through the tube. Qualified success was achieved with additional one fixed-drug combination (FDC). However, 3 years later, the tube was blocked by the iris tissue at the inferior edge of the pupil. Tube trimming was performed efficiently using a simple technique. The distal end of the tube was pulled out of the anterior chamber through a paracentesis just next to the tube entrance and trimmed to the appropriate length. More than a year after the surgery, IOP was still well controlled with the same FDC. Unfortunately, the visual acuity could not be recovered due to advanced PDR.
