Compatibility and durability of the gel stent material.

INTRODUCTION: The XEN Gel Stent (AbbVie Pharmaceuticals) is a device made from Gelatin; a well-known material in the medical field that is firm enough to hold its shape and soft enough to conform to tissues and reduce the risk of erosion. The Gel Stent creates a permanent outflow connection between the anterior chamber and subconjunctival space. AREAS COVERED: Validation testing done on the Gel Stent to evaluate biocompatibility and durability of the material as well as real-world experience are included and discussed in this paper. EXPERT OPINION: Correlating the results of the preclinical testing, study outcomes available in the published literature, and the surgeons' experiences, the device and materials have shown to have an acceptable biocompatibility and durability profile, with a stable, nondegradable, and permanent implant.

Trabeculectomy with intraoperative retrobulbar triamcinolone acetonide.

Use of topical steroids is an important component of postoperative care after filtration surgery. Efficacy of postoperative medications is affected by patient adherence and physical limitations in the elderly population often prohibit proper dosing of ophthalmic drops. We describe a technique for the use of intraoperative retrobulbar triamcinolone acetonide in trabeculectomy surgery and report on postoperative outcomes. This technique appears safe and may be an attractive method of delivering a steroid depot at the time of trabeculectomy.

Intracameral dexamethasone reduces inflammation on the first postoperative day after cataract surgery in eyes with and without glaucoma.

PURPOSE: To evaluate whether dexamethasone injected intracamerally at the conclusion of surgery can safely and effectively reduce postoperative inflammation and improve surgical outcomes in eyes with and without glaucoma. METHODS: Retrospective chart review of 176 consecutive eyes from 146 patients receiving uncomplicated phacoemulsification (PE) (n = 118 total, 82 with glaucoma), glaucoma drainage device (GDD) (n = 35), combined PE/GDD (n = 11) and combined PE/endoscopic cyclophotocoagulation (n = 12). Ninety-one eyes from 76 patients were injected with 0.4 mg dexamethasone intracamerally at the conclusion of surgery. All eyes received standard postoperative prednisolone and ketorolac eyedrops. Outcomes were measured for four to eight weeks by subjective complaints, visual acuity (VA), slit-lamp biomicroscopy, intraocular pressure (IOP) and postoperative complications. RESULTS: Dexamethasone significantly reduced the odds of having an increased anterior chamber (AC) cell score after PE (p = 0.0013). Mean AC cell score +/- SD in nonglaucomatous eyes was 1.3 +/- 0.8 in control and 0.8 +/- 0.7 with dexamethasone; scores in glaucomatous eyes were 1.3 +/- 0.7 in control and 0.9 +/- 0.8 with dexamethasone. Treated nonglaucomatous eyes had significantly fewer subjective complaints after PE (22.2% vs 64.7% in control; p = 0.0083). Dexamethasone had no significant effects on VA, corneal changes, IOP one day and one month after surgery, or long-term complications. CONCLUSIONS: Intracameral dexamethasone given at the end of cataract surgery significantly reduces postoperative AC cells in eyes with and without glaucoma, and improves subjective reports of recovery in nonglaucomatous eyes. There were no statistically significant risks of IOP elevation or other complications in glaucomatous eyes.

Ab interno sulcus placement of glaucoma tube implants.

A modified technique for sulcus placement of glaucoma silicone tubes is described. Sulcus placement can be useful in patients with penetrating keratoplasty or in those who are at risk for corneal endothelial decompensation. However, correct placement can be difficult to confirm with a traditional ab externo approach. An ab interno technique for sulcus placement of glaucoma tube implants that both offers an easier approach and facilitates accurate positioning is described.

Effect of audible and visual reminders on adherence in glaucoma patients using a commercially available dosing aid.

We studied the effects of audible and visual alarms on adherence with a recommended dosing regimen in the management of glaucoma. Forty-two patients were begun on therapy with the Travatan((R)) Dosing Aid (TDA) and randomly divided into two observation groups - one with visual and audible alarm functions turned on and the other with alarms off. Dosing information was analyzed for mean rates of adherence, missed days, and dosing at the wrong time. Twenty patients were randomized to the TDA alarm on group and 22 to the alarm off group. The rates of adherence were 87.9% and 79.7% (p = 0.02), rates of missed dosing were 7.6% and 14.4% (p = 0.03), and rates of dosing at the incorrect times were 7.1% and 9.8% (p = 0.19), respectively for alarm on versus alarm off groups. In the alarm on group, the adherence rate was significantly higher and proportion of missed dosing was significantly lower. It is still yet to be determined whether there is a relationship between adherence and progression of glaucoma.

Parent-administered visual acuity testing: is it reliable and can it improve office efficiency?

PURPOSE: To evaluate the accuracy of a parent-administered visual acuity test, using the electronic visual acuity tester (EVA) (JAEB Center, Tampa, FL) and evaluate its use as a means to improve efficiency of office acuity testing. METHODS: This was a prospective experimental study. Part I: Sixty-four children had their visual acuity determined using the EVA, first by their parents and then by an ophthalmic technician. Acuity scores were compared. Part II: Forty-four other children were randomly assigned to one of 2 groups. Group A (parent-prescreen) children had their visual acuity determined first by the parents using the EVA. The visual acuity result in that child was then rechecked by the technician using the Reinforcement Phase and Phase 2 of the Amblyopia Treatment Study (ATS) visual acuity testing protocol. Group B (full ATS protocol) children had their acuity determined by the technician using the full ATS protocol. The number of optotypes presented by the technician in order to determine the acuity in each group was compared. RESULTS: Part I: Reliability of parent-determined visual acuity scores was high (r = 0.91 and 0.81 for right eyes (OD) and left eyes (OS), respectively), with 93% of right eye parent scores and 85% of left eye parent scores within 0.11 logarithm of minimal angle of resolution (logMAR) units (ie, within one line of vision) of the technician score. Part II: The parent prescreen group (Group A) required presentation of 66% fewer optotypes to the OD and 68% fewer optotypes to the OS than the full ATS protocol group (Group B) (OD: P = 5.4 x 10(-18); OS: P = 6.5 x 10(-18)). CONCLUSIONS: Visual acuity testing results by parents using the EVA are reliable. Electronic visual acuity prescreening by parents reduces the number of optotype presentations required to be shown by the technician to accurately determine acuity. Use of a parent-assisted screening system in the waiting room may translate to increased office efficiency.

Neumatonómetro versus tonométro de Goldmann en una población pediátrica / Pneumatonometer versus Goldman tonometry a pediatrics population

Determinar la correspondencia de la neumatonometría comparada con el tonómetro de aplanación de Goldmann en niños. Estudio prospectivo comparativo de la tensión intraocular medida con neumatonómetro computarizado (Topcon CT20, Nueva York, EE.UU) y con tonometría de aplanación de Goldmann (Haag-Streit; Berna, Suiza), en 44 niños (88 ojos) entre 5 y 15 años que asistieron a consulta de Oftalmología Pediátrica del Centro Médico Docente la Trinidad entre el 7 de febrero y el 7 de abril de 2000. La tensión intraocular con neumatonometría arrojó un promedio de 14,21 mmHg (DE 4,51) versus 14,15 mmHg (DE 3,30) cuando fue registrada con tonómetro de aplanación. La diferencia entre estos dos promedios no resultó estadísticamente significativa (p=0,894). Respecto a la colaboración de los pacientes, ésta fué mayor para la neumatonometría (39 pacientes, 97,5 por ciento) comparado con la tonometría de aplanación (30 pacientes, 75 por ciento). Con base en la correspondencia observada y considerando que el neumatonómetro resulta en mayor colaboración del paciente que con el método de goldmann, recomendamos su uso para mediciones de tensión intraocular en consulta de oftalmología pediátrica