Long-Term Clinical and Safety Outcomes of Canaloplasty Performed across All Grades of Glaucoma Severity.

Purpose: To investigate the clinical effectiveness of canaloplasty performed with an ab interno technique using the iTrack microcatheter (Nova Eye Medical) in patients with mild-moderate glaucoma as compared to severe glaucoma. Methods: This is a retrospective single-center case series. Patients were preoperatively categorized as mild/moderate vs. severe glaucoma assessed using the mean deviation (MD) score and controlled group (baseline intraocular pressure (IOP) ≤18 mmHg) vs. uncontrolled group (>18 mmHg). All patients with glaucoma were eligible for recruitment except those who had undergone previous glaucoma surgery (with the exception of selective laser trabeculoplasty or SLT). Patients underwent canaloplasty via an ab interno surgical technique with or without phacoemulsification and were monitored for IOP, glaucoma medication usage, and surgical complications. Results: In total, 72 eyes were followed for 3.4 ± 0.5 years. Mean pre-op IOP (mmHg) was 19.3 ± 7.7 in the standalone group (n = 9) and 18.5 ± 5.6 in the combined group (n = 63) (p=0.38). At the last follow-up, mean IOP reduced by 36% to 12.4 ± 4.4 (p=0.02) in the standalone group and by 26% to 13.7 ± 4.8 in the combined group (p < 0.001). Mean pre-op IOP (mmHg) was 18.6 ± 5.2 in the severe group (n = 24) and 18.6 ± 6.2 in the mild-moderate group (n = 48) (p=0.48). Mean IOP was 14.1 ± 6.3 (-24%; p < 0.001) and 13.3 ± 3.7 (-29%; p < 0.001), respectively, at the last follow-up. Mean glaucoma medication usage decreased from 2.5 ± 0.9 to 2.1 ± 0.9 (-15%; p=0.083) in the severe group and 2.3 ± 1.0 to 1.4 ± 1.3 (-40%; p < 0.001) in the mild/moderate group. There was one localized Descemet's membrane detachment in the moderate group. Conclusion: iTrack canaloplasty achieved a statistically significant IOP reduction in mild-moderate and severe eyes and was found to be an effective option for reducing IOP and medications in patients with mild-moderate primary open-angle glaucoma (POAG). In severe eyes, it has reduced IOP while the medications remained stable.

Cypass Supraciliary Stent in Eye With Chronic Angle Closure and Postvitrectomy With Silicone Oil.

PURPOSE: To report a case of successful intraocular pressure (IOP) reduction following Cypass supraciliary stent implantation in a postvitrectomized eye filled with silicone oil and chronic angle-closure glaucoma. MATERIALS AND METHODS: This is a case report. RESULTS: A 19-year-old female with chronic angle-closure glaucoma underwent combined cataract extraction, goniosynechiolysis and Cypass supraciliary shunt implantation. Patient had a history of proliferative diabetic retinopathy and a tractional retinal detachment, which required pars plana vitretomy and silicone oil implantation, and was subsequently complicated by neovascular glaucoma requiring implantation of an inferior glaucoma drainage device. Approximately 6 months later, the patient's IOP increased to 36 mm Hg on maximum tolerable medical therapy. The patient underwent combined cataract extraction and Cypass implantation and is now controlled with an IOP of 16 mm Hg on 3 classes of medications 6 months postoperatively. CONCLUSIONS: Implantation of a Cypass supraciliary shunt can be an effective means for controlling IOP in patients with chronic angle-closure glaucoma in a postvitrectomized eye with silicone oil implantation and failed glaucoma drainage device.

Menicon Z rigid gas permeable lenses for keratoconus and irregular corneas: a retrospective case series.

PURPOSE: The tisilfocon A (Menicon Z) rigid gas permeable (RGP) contact lens polymer has the highest oxygen permeability (Dk) value of any RGP lens material. To our knowledge there is no published literature documenting the success of this material in fitting contact lenses to highly irregular and diseased corneas. METHODS: A retrospective medical record review of 40 consecutive patients (64 eyes) who had worn lenses made in the Menicon Z RGP material was performed. All patients had some form of corneal pathology and were fitted in a single tertiary care hospital-based contact lens service. RESULTS: Menicon Z contact lenses were fit to 33 eyes of 20 patients with keratoconus (KC) and 31 eyes of 23 patients with irregular corneas. The irregular cornea group comprised 28 eyes of 21 patients after corneal surgery, 1 eye with ocular cicatricial pemphigoid and 2 eyes of 1 patient with chronic staphylococcal blepharo-keratoconjuncitivitis. Treatment goals included acceptable corneal physiology, comfort, and visual acuity. In the KC group, there was an 82% (27/33 eyes) success rate as measured by the treatment goals. Mean duration of wear for successful patients was 2.5 years (0.5-5 years). Only 12% (4/33 eyes) failed directly due to inability of the Menicon Z material to perform adequately while another material was acceptable. In the irregular surface group (surgical and ocular surface disease), there was a 74% (23/31 eyes) success rate. Mean duration of wear for successful patients in this group is 2.79 years (3 months-7 years). Only 3% (1/31 eyes) failed directly due to inability of the Menicon Z material to perform adequately while another material was acceptable. CONCLUSIONS: The tisilfocon A hyper Dk lens material maintains clinically acceptable corneal health and clinically acceptable visual acuity for patients with KC and irregular corneal surfaces. In this series of patients with complicated corneal disease, the most failures were due to design issues and discomfort not related to the Menicon Z material. The Menicon Z material was inadequate in only 8% of eyes, whereas another RGP material was successful. Most patients with irregular corneas in a tertiary care center can be successfully fit with the tisilfocon A RGP material for visual rehabilitation.