Efficacy and safety at 6 months of the XEN implant for the management of open angle glaucoma.

The purpose of this study is to evaluate the efficacy and complications of the XEN implant as a solo procedure or in association with cataract surgery in patients with open angle glaucoma (OAG). All patients who received a XEN implant between June 2017 and June 2018 were included in the study. The primary and secondary outcomes were: the reduction of the intraocular pressure (IOP) at 6 months postoperatively, the decrease of the glaucoma medications 6 months after surgery, the clinical success rate (eyes (%) achieving ≥20% IOP reduction on the same or fewer medications without secondary surgical intervention), the frequency and type of postoperative interventions as well as the complication rate. We included one hundred and seven eyes from 97 patients with primary OAG (79%), or secondary OAG (21%). Seventy-seven patients (72%) received a standalone XEN implantation and 30 (28%) underwent XEN implantation combined with phacoemusification. The IOP decreased from 20.4 mm Hg ± 6.4 preoperatively to 15.4 mm Hg ± 5.3 six months after the surgery, which represented a reduction of 24.5% (P = 1.4.10-7). It was associated with a lowering of glaucoma medications from 2.8 ± 1.0 preoperatively to 0.6 ± 1.0 six months postoperatively (P = 3.6.10-34). The clinical success rate was 67.2% six months after the surgery. The most frequent complications were: IOP spikes >30 mmHg (16.8%), improper position or angled drain (14.0%) and transient minimal hyphema (<1 week) (11.2%). During the follow-up, the needling was required in 34.6% of cases and a total of 10 eyes (9.4%) required a new glaucoma surgery. To conclude XEN implantation appears to be an effective short- and mid-term surgical technique to control IOP in OAG with a low risk of complication. However postoperative maneuvers were frequently required to maintain efficiency.

Increased choroidal thickness in primary angle closure measured by swept-source optical coherence tomography in Caucasian population.

PURPOSE: A role of the choroid has been suggested in the pathophysiology of angle closure. We assessed the choroidal thickness (CT) in Caucasian patients with primary angle closure (PAC) and in a subgroup of patients with plateau iris using swept-source optical coherence tomography (SS-OCT) compared to normal eyes. METHODS: This prospective cohort study in a hospital-based population in a tertiary center compared consecutive patients with PAC to healthy controls. A subgroup analysis of patients with plateau iris was also performed. Choroidal thickness was measured by SS-OCT in the subfoveal area (SFCT) and at 1- and 3-mm eccentricity superiorly, inferiorly, nasally and temporally from the fovea. RESULTS: Compared to the 25 eyes of 13 control patients [7 women, mean (SD) age, 56.6 (15.7) years], the 45 eyes of 25 patients with PAC [15 women, mean (SD) age, 55.7 (10.7) years] had a significantly increased SFCT. SFCT was 355.36 µm (SD 85.97) in PAC eyes versus 286.08 µm (SD 98.09) in control eyes (p = 0.009). The CT was also significantly increased compared to control eyes in other macular areas (p < 0.05), except at 3 mm temporal to the fovea. In the plateau iris subgroup, a not significant (except 3 mm nasal to the fovea) trend toward an increased CT was observed in all studied macular areas compared to control eyes. CONCLUSION: In eyes of Caucasian patients with PAC, the CT is increased compared to controls. Increased CT could contribute to the pathophysiology of PAC with a possible choroidal expansion and dysfunction of choroidal ganglion cells.

Comparative Effectiveness and Tolerance of Subliminal Subthreshold Transscleral Cyclophotocoagulation With a Duty Factor of 25% Versus 31.3% for Advanced Glaucoma.

PRéCIS:: Subliminal subthreshold transscleral cyclophotocoagulation (SS-TSCPC) with duty cycles 25% and 31.3% seems to be an effective approach to reduce intraocular pressure (IOP) in glaucoma that is refractory to medical management. OBJECTIVE: The objective of this study was to compare the effectiveness and the tolerance of SS-TSCPC with a duty cycle of 25% versus 31.3% with Supra 810 nm Subliminal Quantel Medical laser stimulation for advanced glaucoma. MATERIALS AND METHODS: This was a retrospective, single-center, comparative case series of patients treated by SS-TSCPC between January 2017 and July 2017. The diagnostic and inclusion criteria were patients with advanced and refractory glaucoma, defined as IOP >21 mm Hg on maximal tolerated medical therapy with or without previous glaucoma surgical procedures, a minimum follow-up of 12 months, and patients who refused or were poor candidates for additional filtering surgery or implantation of glaucoma drainage devices. The primary endpoint was surgical success defined as an IOP of 6 to 21 mm Hg or a reduction of IOP by 20% from baseline without an increase in glaucoma medication from baseline. The secondary endpoints were the mean IOP and best visual corrected acuity best-corrected visual acuity at 12 months after surgery, retreatment outcomes, glaucoma medications, and complications such as inflammation, uveitis, cataract, mydriasis, and phthisis. RESULTS: Forty eyes of 32 patients were included: 20 eyes were subjected to SS-TSCPC with 31.3% duty cycle and 20 eyes with a 25% duty cycle. The surgical success of the TSCPC 12 months after the first procedure was better in the 31.3% duty cycle group (83.5%) than in the 25% duty cycle group (65%). The most common complications were inflammation (50%, 1 mo after surgery) and IOP spikes (increase in IOP of >25% from baseline within 1 mo of laser) in both groups. Inflammation was higher in the 31.3% duty cycle group. CONCLUSIONS: SS-TSCPC at 31.3% and 25% duty cycle seems to be an effective approach to reduce IOP in glaucoma that is refractory to medical management. SS-TSCPC at 31.3% duty cycle is more effective than the 25% duty cycle SS-TSCPC. However, the 31.3% duty cycle SS-TSCPC induces more inflammation than the 25% duty cycle SS-TSCPC. Each procedure should be considered on a case by case basis.

[Glaucoma screening and prevention]. / Dépistage et prévention des glaucomes.

Glaucoma Screening And Prevention. Glaucoma screening is a very important health problem, as it is a frequent desease, and can lead to blindness when not treated (3rd cause of blindness worldwide). When diagnosed early, glaucoma can be treated, allowing to avoid blindness in a majority of patients. Screnning depends on ophthalmologic examination of all people above 40, even earlier in subjects whith strong risk factors. Intraocular pressure and pachymetry should be measured, optic nerve and irido-corneal angle should be carefully assessed. Various exams can confirm the diagnosis (OCT, perimetry), and also be usefull for follow-up.

Dépistage Et Prévention. Des Glaucomes Le dépistage du glaucome est fondamental car cette maladie est asymptomatique et potentiellement cécitante (3e cause de cécité dans le monde). Il peut déboucher sur un traitement adapté, permettant dans la majorité des cas de prévenir la cécité. Le dépistage repose sur l'examen ophtalmologique de la population générale dès 40 ans, et plus tôt chez les sujets prédisposés. L'examen comprend la mesure de la pression intra-oculaire, mais également celle de la pachymétrie, l'examen de l'angle irido-cornéen et du nerf optique. Il peut être complété par divers examens complémentaires dont le champ visuel et la tomographie en cohérence optique, qui serviront également pour le suivi.

Assessment of corneal biomechanical properties in normal tension glaucoma and comparison with open-angle glaucoma, ocular hypertension, and normal eyes.

PURPOSE: To assess the biomechanical properties of corneas in patients with normal tension glaucoma (NTG) and to compare them with those of patients with primary open-angle glaucoma (POAG), ocular hypertension (OHT), and normal controls (N). METHODS: Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann intraocular pressure (IOPg), and corneal compensated IOP (IOPcc) were obtained using an ocular response analyzer for 28 eyes in 14 patients with NTG, 75 eyes in 38 patients with chronic POAG, 53 eyes of 27 patients with OHT, and 44 eyes of 22 N controls. IOP using Goldmann applanation tonometry (IOPGA) and ultrasonic central corneal thickness (CCT) were also measured for each eye. Analysis of variance test was used for statistical analysis. RESULTS: CH was significantly lower in the NTG group (9.88±2.02 mm Hg) compared with the N group (11.05±1.53 mm Hg; P<0.01). CRF was significantly lower in the NTG group (9.5±1.89 mm Hg) compared with the POAG group (11.15±2.35 mm Hg; P<0.01) and to the N group (11.00±1.75 mm Hg; P<0.01). CCT was not considered significantly different between the 4 groups. However, IOPcc was found to be significantly lower in NTG group compared with the POAG group and OHT group (P<0.001). CONCLUSION: NTG was associated with significantly lower CRF than chronic POAG and N patients. CH and CRF could be a useful tool in early diagnosis of NTG.

Corneal hysteresis measured with the Ocular Response Analyzer in normal and glaucomatous eyes.

PURPOSE: To identify differences in corneal hysteresis (CH) and central corneal thickness (CCT) between healthy and glaucomatous patients. METHODS: Retrospective observational study. One hundred and thirty-three eyes of 75 healthy and 58 glaucomatous patients were included. CH was measured in each patient using Ocular Response Analyzer. CCT was determined by ultrasonic pachymetry. For each patient, one eye was randomly selected. We used a Student t-test to search for significant differences between the different groups (p<0.05). RESULTS: In healthy and glaucomatous eyes, mean CH values were 10.46 +/- 1.6 and 8.77 +/- 1.4 mm Hg, respectively. Mean CCT values were 560.2 +/- 36.3 and 535.3 +/- 42.7 microm, respectively. CH and CCT were significantly lower in glaucomatous eyes than in normal eyes, (p<0.05). DISCUSSION: In our series, CH was lower in glaucomatous than in normal eyes. The relationship between glaucoma, IOP, and ocular structures may not be confined to the consideration of CCT. A low CH value could be responsible for under-estimation of IOP. CH could also be a risk factor for glaucoma, independent of IOP. Further studies are needed to support these hypotheses. CONCLUSION: In our investigation, CCT and CH were significantly lower in glaucomatous eyes than in healthy eyes.

Long-term visual outcome of childhood blepharokeratoconjunctivitis.

PURPOSE: To assess the visual outcome of childhood blepharokeratoconjunctivitis. DESIGN: Retrospective noncomparative case series. METHODS: We reviewed visual acuity and corneal examination results for 23 patients (mean age 19 +/- 4 years, range, 11 to 26 years) who had healed more than three years previously (up to 15 years). RESULTS: The disease involved 29 eyes and was unilateral in 17 children. Corneal sequelae (neovascularization or scars) involved 18 eyes (62%) of 15 children (65%). Mean best-corrected visual acuity was 20/25 (range, 20/100 to 20/20). Best-corrected visual acuity was no more than 20/30 in seven eyes (24%) of seven children (30%). Fifteen eyes (52%) of 13 children (45%) had astigmatisms of at least 0.75 diopters attributable to corneal scars. CONCLUSIONS: Corneal and visual sequelae are frequent in childhood blepharokeratoconjunctivitis. Early diagnosis and specific treatment are mandatory.

Non-penetrating deep sclerectomy for glaucoma associated with Sturge-Weber syndrome.

PURPOSE: To report the results of non-penetrating deep sclerectomy (NPDS) in the treatment of glaucoma associated with Sturge-Weber syndrome (SWS). METHODS: We carried out a retrospective case series analysis of patients who underwent NPDS for glaucoma associated with SWS between 1998 and 2003. The control of glaucoma after NPDS, the results of surgery on intraocular pressure, the need for additional medical treatment and surgical complications were studied. RESULTS: Twelve eyes of nine patients, aged 11 days to 24 years, underwent filtering surgery: nine NPDS procedures were performed and three surgical procedures had to be converted to trabeculectomy because NPDS was not technically achievable. The mean follow-up after surgery was 26.3 months (range 6-48 months). Two trabeculectomies were complicated by choroidal effusion, which resolved in both cases. Good control of glaucoma was obtained during follow-up. CONCLUSIONS: Non-penetrating deep sclerectomy is transiently efficient in the treatment of SWS-associated glaucoma. Further studies of NPDS for the treatment of glaucoma associated with SWS are warranted.

Topical cyclosporine A in severe steroid-dependent childhood phlyctenular keratoconjunctivitis.

PURPOSE: To assess the efficacy of topical cyclosporine A (CsA) in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation. DESIGN: Prospective, noncomparative, interventional case series. METHODS: patients: Children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation and not responding to oral antibiotics (cyclines or erythromycin). intervention: Topical CsA 2% four times daily, initially combined with topical dexamethasone for the first week. main outcome measures: Efficacy was judged by the patients (symptoms and ocular redness) and by the ophthalmologist (ocular redness and corneal inflammation). The patients were monitored for adverse effects, and cyclosporinemia was determined every 3 months. RESULTS: We studied 11 children (13 eyes) with a mean age of 9 years (range, 4 to 15 years). Inflammation was controlled in all the eyes within 14 days. Inflammation did not recur during CsA monotherapy, during a mean follow-up of 12 +/- 8 months (range, 6 to 31 months). CsA therapy was stopped in eight patients (10 eyes) after a mean treatment duration of 13 +/- 9 months (range, 6 to 31 months), and no recurrences occurred during 10 +/- 3 months of follow-up (range, 6 to 12 months). Local tolerance of CsA was good. None of the patients had detectable CsA blood levels. CsA was withdrawn in one case after 6 months, because of generalized skin rash. CONCLUSIONS: Long-term topical CsA 2% therapy is safe and effective in children with phlyctenular keratoconjunctivitis associated with severe steroid-dependent corneal inflammation.