Long-term outcomes of canaloplasty and phaco-canaloplasty in the treatment of open angle glaucoma: a single-surgeon experience.

PURPOSE: To evaluate and compare the long-term outcomes of canaloplasty and phaco-canaloplasty in the treatment of open angle glaucoma and assess the prognostic factors associated with surgical outcome. METHODS: A 48-month retrospective analysis was performed on n = 133 open angle glaucoma eyes treated with canaloplasty and n = 57 open angle glaucoma eyes treated with phaco-canaloplasty by a single surgeon. Surgical success was defined according to six criteria, achieving a target intraocular pressure (IOP) ≤ 21, 18 or 15 mmHg on glaucoma medications (qualified success) or without any further treatment (complete success), including laser therapy or surgery. Kaplan-Meier survival analysis and Cox regression analysis were performed to evaluate surgical success and preoperative factors associated with surgical outcome. Surgical complications in the early postoperative period were compared between canaloplasty and phaco-canaloplasty. RESULTS: Canaloplasty and phaco-canaloplasty significantly reduced postoperative IOP and number of glaucoma medications (p = 0.001 for both). Phaco-canaloplasty showed higher rates of cumulative surgical success over canaloplasty, but only for target IOP ≤ 21 and ≤ 18 (p = 0.018 and p = 0.011, respectively). A preoperative number of > 4 glaucoma medications predicted surgical failure. Phaco-canaloplasty was associated with a higher rate of IOP peaks in the first month compared with canaloplasty (40.4% vs 12.7%, p = 0.000). CONCLUSION: Canaloplasty and phaco-canaloplasty demonstrated long-term efficacy in the treatment of open angle glaucoma, with phaco-canaloplasty showing higher rates of surgical success compared to canaloplasty, but not for target IOPs lower than 16 mmHg. Patients on more than 4 preoperative glaucoma medications may not be good candidates for canaloplasty and may benefit from other surgical options.

Long-term functional outcome between Yamane technique and retropupillary iris-claw technique in a large study cohort.

PURPOSE: To evaluate which secondary intraocular lens (IOL) implantation technique was more successful in achieving the best postoperative results and refractive outcomes between retropupillary iris-claw IOL (ICIOL) and flanged intrascleral IOL (FIIOL) fixation with the Yamane technique. SETTING: Eye Clinic of the University of Trieste, Trieste, Italy. DESIGN: Retrospective observational study. METHODS: 116 eyes of 110 patients who underwent ICIOL or FIIOL were analyzed. Patients with follow-up shorter than 6 months or with incomplete clinical data were excluded. Collected data included demographics, ocular comorbidity, indication of surgery, intraocular pressure, early (≤1 month) and late (>1 month) postoperative complications, corrected distance visual acuity (CDVA), and manifest refraction at the last follow-up visit. RESULTS: 50% (n = 58) of eyes underwent FIIOL and 50% (n = 58) ICIOL implantation for aphakia (n = 44, 38%) and IOL dislocation (n = 72, 62%). No statistically significant differences in demographics, comorbidity, follow-up duration, postoperative complications, and surgical indications were found. The refractive prediction error (RPE) was 0.69 ± 0.94 diopter (D) in the FIIOL group and 0.21 ± 0.75 D in the ICIOL group ( P = .03), indicating residual hyperopia after both techniques. RPE, mean absolute error, and median absolute error were higher in the FIIOL group ( P = .003). ICIOL implantation was more successful in obtaining a RPE between -0.50 D and +0.50 D (52% of ICIOL, n = 30, and 31% of FIIOL, n = 18). CONCLUSIONS: Both techniques were effective in increasing preoperative CDVA with no statistical difference between them. Although complication rates did not significantly differ, the FIIOL group exhibited less predictable refractive outcomes. Adjusting the dioptric power of the 3-piece IOL, as performed in ciliary sulcus implantation, to prevent myopic shift, is not recommended.

Reproducibility and Reliability of Spectralis II OCT Angiography Vascular Measurements.

Purpose: to investigate the reproducibility and reliability of OCT-A vascular measurements using Heidelberg Spectralis II OCT-A. Methods: a prospective study involving a single eye of patients aged 18 or older with no ocular disease. In order to investigate the reliability of the first and second OCT-A scans, the coefficient of variation of the foveal avascular zone (FAZ) and the vessel density (VD) in the superficial (SCP), intermediate (ICP) and deep capillary plexus (DCP) were calculated. Results: A total of 75 eyes were included in the study. The mean FAZ in the first and second scan was 0.36 × 0.13 mm2 and 0.37 × 0.12 mm2, respectively, in the SCP, 0.23 × 0.10 mm2 and 0.23 × 0.09 mm2 in the ICP, and 0.42 × 0.11 mm2 and 0.43 × 0.12 mm2 in the DCP. The overall VD was 36.05 × 9.01 and 35.33 × 9.92 at the first and second scan, respectively, in the SCP, 21.87 × 5.00 and 21.32 × 5.56 in the ICP, and 23.84 × 6.53 and 23.20 × 6.83 in the DCP. No statistically significant differences in FAZ measurements and VD in all sectors of each capillary plexus were observed between the first and second scan (p > 0.05). Conclusion: our study demonstrated the good reproducibility and reliability of OCT-A vascular measurements in the analysis of the FAZ and the quantification of VD in each capillary plexus of the retina.