Long-Term Clinical Results of Trabectome Surgery in Turkish Patients with Primary Open Angle Glaucoma and Pseudoexfoliative Glaucoma.

Objectives: The objectives of the study were to analyze the long-term results of trabectome surgery in Turkish patients with primary open angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG) and to characterize the risk factors for failure. Methods: This single-center retrospective non-comparative study included 60 eyes of 51 patients diagnosed with POAG and PEXG, who underwent trabectome alone or phacotrabeculectomy (TP) surgery between 2012 and 2016. Surgical success was defined as a 20% decrease in intraocular pressure (IOP) or IOP≤21 mmHg and no further glaucoma surgery. Risk factors for further surgery were analyzed with the Cox proportional hazard ratio (HR) models. The cumulative success analysis was undertaken with the Kaplan-Meier method based on the time to further glaucoma surgery. Results: The mean follow-up period was 59.4±14.3 months. During the follow-up period, 12 eyes required additional glaucoma surgery. The mean pre-operative IOP was 26.9±6.8 mmHg. The mean IOP at the last visit was 18.8±4.7 mmHg (p<0.01). IOP decreased 30.1% from the baseline to the last visit. The average number of antiglaucomatous drug molecules used was 3.4±0.7 (range 1-4) preoperatively and 2.5±1.3 (range 0-4) at the last visit (p<0.01). The risk factors for further surgery requirement were determined as a higher baseline IOP value (HR: 1.11, p=0.03] and the use of a higher number of preoperative antiglaucomatous drug molecules (HR: 2.54, p=0.09). The cumulative probability of success was calculated as 94.6%, 90.1%, 85.7%, 82.1%, and 78.6% at three, 12, 24, 36, and 60 months, respectively. Conclusion: The success rate of trabectome was 67.3% at 59 months. A higher baseline IOP value and the use of a higher number of antiglaucomatous drug molecules were associated with an increased risk of further glaucoma surgery requirement.

Relationship between ganglion cell complex thickness and vision in age-related macular degeneration treated with aflibercept.

PURPOSE: This study aimed to analyze the correlation between ganglion cell complex thickness (GCCT) and vision compared with the choroidal thickness (CT) and central retinal thickness (CRT) in relation to the outcomes of intravitreal aflibercept treatment for choroidal neovascular membranes secondary to age-related macular degeneration (AMD). METHODS: This was a prospective, observational study. Forty-three eyes of 38 patients with wet AMD received a monthly loading dose of 2 mg aflibercept by intravitreal injection (IVI) during the first 3 months and were then followed at regular monthly intervals for an average of 10 months by a pro re nata regimen. All patients were examined using spectral domain-optic coherence tomography (OCT) and enhanced depth imaging OCT. According to their response to IVI treatment in the third month, patients were divided into 2 groups, both functionally and anatomically. RESULTS: Three-month GCCT and optic disc retinal nerve fiber layer thickness (ODRNFLT) had the most correlation with the 10-month vision (p = 0.002, p = 0.02, respectively). While baseline GCCT was most correlated with the functional response, baseline CRT was most correlated with the anatomical response (p = 0.01, p = 0.004, respectively). CONCLUSIONS: The results suggest that a reduction in 3-month GCCT indicates a good long-term vision outcome, while a reduction in 3-month ODRNFLT shows a poor long-term vision outcome. The literature suggests that this study is the first to demonstrate that baseline GCCT is more strongly correlated with the functional response than it is with CT and CRT. Hence, GCCT has a prognostic value for vision impairment.

A Rare Ocular Manifestation of Adult Onset Still's Disease: Purtscher's-like Retinopathy.

Adult-onset Still's disease (AOSD) is a rare multisystemic immune-mediated disease of unknown etiology with quotidian spiking fever, evanescent rash, arthralgia, and multiple organ involvement. The few AOSD cases that have been reported developed Purtscher's-like retinopathy associated with thrombotic microangiopathy (TMA). Here, we report Purtscher's-like retinopathy without TMA in a patient with AOSD. A 29-year-old-man who presented for evaluation of blurred vision was diagnosed with AOSD based on Yamaguchi criteria. He had Purtscher's-like retinopathy in his right eye. Lesions improved after steroid treatment. Although almost all reported AOSD cases with Purtscher's-like retinopathy are associated with TMA, in this case such a complication was not encountered.

Evaluation of Aflibercept Treatment Responses in Eyes with Bevacizumab/Ranibizumab-resistant Wet Age-related Macular Degeneration.

OBJECTIVES: To evaluate anatomic and functional results after switching from intravitreal bevacizumab or ranibizumab treatment to aflibercept for wet (neovascular) age-related macular degeneration. MATERIALS AND METHODS: This retrospective study included 22 eyes of 22 patients resistant to treatment with at least 6 injections of bevacizumab or ranibizumab. The first three injections had been applied monthly, the others pro re nata (PRN). Outcome measures were follow-up period, injection number, best corrected visual acuity (BCVA), central retinal thickness (CRT) and pigment epithelial detachment (PED) height. Dosing regimen of aflibercept was determined PRN. The patients were examined monthly. In all visits, BCVA and optical coherence tomography results were assessed together and injections were applied according to these findings. Patients with at least three months of follow-up were included in the study. RESULTS: Twenty-two eyes of 22 patients treated with bevacizumab or ranibizumab were switched to aflibercept therapy. Seven patients had serous PED and 4 patients had fibrovascular PED. The mean follow-up periods for these groups were 20.59±6.76 months and 8.68±3.79 months, respectively. The mean injection numbers were 10.5±3.61 vs 4.54±1.56. Statistically significant reductions were noted in CRT (533.86±164.06 µm vs 412.04±143.86 µm, p<0.05). BCVA levels were almost equal before and after switching (0.18±0.17 vs 0.18±0.14). Serous and fibrovascular PED heights decreased suboptimally from 460±281.51 µm to 282.42±175.76 µm (p>0.05) for serous PEDs and 251.25±43.85 µm to 225.75±73.09 µm (p>0.05) for fibrovascular PEDs. CONCLUSION: Switching to aflibercept resulted in significant improvement in CRT, but not in BCVA or PED heights.