Outcomes of Non-Penetrating versus Penetrating Deep Sclerectomy in Open-Angle Glaucoma.

PRCIS: In this retrospective study, Non-Penetrating-Deep-Sclerectomy and Penetrating-Deep-Sclerectomy interventions showed similar >90% complete success rates at one-year post-surgery. However, Non-Penetrating-Deep-Sclerectomy achieved a superior safety profile in terms of best-corrected visual acuity recovery and rates of post-surgical complications. PURPOSE: Comparing the surgical outcomes of two surgical techniques: non-penetrating deep sclerectomy (NPDS) and penetrating deep sclerectomy (PDS). PATIENTS AND METHODS: This was a retrospective, longitudinal, comparative study including 66 eyes from 57 patients aged 69±9 years who underwent either NPDS or PDS for medically uncontrolled open-angle glaucoma. Outcome measurements included intraocular pressure (IOP), best-corrected visual acuity (BCVA), rates of complications, post-operative corrective interventions and glaucoma medications at baseline and at all post-operative appointments up to 1 year. An exploratory mixed-effects model was used to assess the intergroup differences for IOP and BCVA. RESULTS: One-year post-surgery, similar significant IOP reduction from baseline were observed in NPDS (from 19,9±1.3 to 11.5±0.9 mmHg, P<0.001) and PDS (from 19,5±1,1 to 10.7±0.6 mmHg, P<0.001). A conservative complete success rate (defined as medicated IOP ≤16 mmHg and ≥20% reduction in IOP) was of 87% for NPDS and 97% for PDS. No BCVA changes were observed between baseline and 1-year post-surgery in both groups, and glaucoma medications showed a similar 10-fold reduction in both groups (P<0.001 vs. baseline). However, a significant difference in the speed of post-operative BVCA recovery was observed between NPDS and PDS (P<0.01), NPDS showing a faster recovery. Moreover, lower numbers of post-surgical complication and post-operative interventions were observed following NPDS compared to PDS (NPDS n=30 and 34 vs. PDS n=80 and 48 (P<0.05), respectively). CONCLUSIONS: The present study confirmed that both NPDS and PDS are highly effective surgical interventions for the management of primary open angle glaucoma. However, NPDS had a superior safety profile, in terms of BCVA recovery, complication rates and post-operative interventions.

Trans-scleral plugs scleral fixation IOL and penetrating keratoplasty to restore vision in vitrectomized eyes.

PURPOSE: To report the surgical outcomes of penetrating keratoplasty (PKP) and sutureless scleral fixation (SSF) using Carlevale Lens (Soleko) combined procedure to solve corneal failure and aphakia in vitrectomized eyes and discuss eventual advantages of this new approach. METHODS: Two patients underwent primary wound repair and pars plana vitrectomy after a penetrating ocular trauma and were referred to the author's clinic. The PKP and SSF-Carlevale lens implantation were performed under retrobulbar anesthesia. Intraoperative and postoperative complications were recorded, intraocular lens positioning was evaluated using anterior segment optical coherence tomography (AS-OCT) and endothelial cell density was determined using an endothelial microscope. Both patients completed 12 months follow-up. RESULTS: The surgery was performed without intraoperative complications. After 1 month, the lens was fixed well, and the graft showed no sign of rejection. At the last visit after 12 months, the corneal graft remained transparent with good endothelial cell density in both cases; conjunctival scarring or inflammation and plugs externalization did not occur during follow-ups. Best-corrected visual acuity was 4/10 Snellen in the first case, while in the second case, we witnessed a limited visual recovery of 1/20 Snellen due to retinal issues. CONCLUSION: We report the feasibility of secondary IOL implantation using Carlevale with penetrating keratoplasty. The relative of ease of Carlevale lens implantation through the transscleral plugs reduces the open globe length resulting in a safer procedure, especially for vitrectomized eyes.

Management of submacular massive haemorrhage in age-related macular degeneration: comparison between subretinal transplant of human amniotic membrane and subretinal injection of tissue plasminogen activator.

PURPOSE: Macular neovascularization (MNV) can complicate age-related macular degeneration (AMD) and lead to severe visual acuity reduction. Massive submacular haemorrhage (SMH) is a sight-threatening complication of MNV and a challenge in the management of complications related to MNV in AMD since the effects of anti-vascular endothelial growth factor treatment alone are insufficient. Here, we evaluate the different postoperative outcomes of patients affected by MNV complicated by SMH that underwent subretinal implant of human amniotic membrane (hAM) or subretinal injection of tissue plasminogen activator (tPA). METHODS: This is a retrospective, consecutive, comparative, non-randomized interventional study. We included 44 eyes of 44 patients affected by AMD complicated by MNV and SMH. Twenty-two eyes underwent a pars plana vitrectomy (PPV), SMH and neovascular membrane removal, with a subretinal implant of hAM and silicone oil, and 22 eyes underwent PPV, subretinal injection of tPA, and 20% sulphur hexafluoride. The primary study outcome was visual acuity improvement. Secondary outcomes were postoperative complications, and MNV recurrence and optical coherence tomography (OCT)-Angiography parameters correlated with best-corrected visual acuity (BCVA). RESULTS: Mean preoperative BCVA was 1.9 logarithm of the minimal angle of resolution (logMAR) in the amniotic membrane-group and 2 logMAR in the tPA-group. The mean final BCVA values were 1.25 and 1.4 logMAR, respectively, with a statistically significant difference. Optical coherence tomography (OCT)-Angiography scan was be used to evaluate the retinal vascularization in the treated eye. CONCLUSION: Both techniques report similar VA improvements and postoperative complications. However, transplantation of hAM seems to have a significant benefit in inhibiting MNV recurrence.

Applications of the Amniotic Membrane in Vitreoretinal Surgery.

Recently, the use of the human amniotic membrane (hAM) has been extended to treat retinal disorders, such as macular holes that failed to close and retinal tears. The hAM has demonstrated the induction of a recovery process of the external retinal layers involving the external limiting membrane (ELM) and the ellipsoid zone (EZ). After that, the application of the hAM for retinal pathologies was extended to large macular tears, high myopic retinal detachment associated with MH, paravascular tears, serous macular detachment associated with optic pit, complicated retinal detachment and advanced age-related macular degeneration (AMD). The hAM has shown a potential in repairing retinal tissue through a regeneration process. This review aims to highlight the use of the hAM in various vitreo-retinal surgical fields, and to confront it with other cutting-edge surgical techniques used to treat challenging vitreo-retinal pathologies.