Canaloplasty versus Nonpenetrating Deep Sclerectomy: 2-Year Results and Quality of Life Assessment

Purpose. To compare phacocanaloplasty (PC) and phaco-non-penetrating deep sclerectomy (PDS). Methods. 75 patients with uncontrolled glaucoma and cataract were randomized for PC (37 eyes) or PDS (38 eyes). Intraocular pressure (IOP) and number of medications (meds) were prospectively evaluated. Follow-up examinations were performed on days 1 and 7 and after 1, 3, 6, 12, 18, and 24 months. Surgical success was calculated. Complications and postoperative interventions were noted. Quality of life (QoL) was analyzed. Results. Preoperatively, mean IOP and meds were comparable (P>0.05). After 24 months, IOP significantly decreased in PC from 19.4 ± 5.9 mmHg (2.6 ± 0.9 meds) to 13.8 ± 3.3 mmHg (0.5 ± 0.9 meds) and in PDS from 19.7 ± 5.4 mmHg (2.9 ± 0.9 meds) to 15.1 ± 2.9 mmHg (1.1 ± 1.2 meds). Statistically lower IOP was observed in PC in the 6th month and persisted until 24 months (P0.05). The most frequent complication in PC was transient hyphema (46%), in PDS bleb fibrosis (24%). PC patients during postoperative period required only goniopuncture (22% of subjects), whereas PDS patients required, in order to maintain subconjuctival outflow, subconjunctival 5-fluorouracil injections in 95% of cases (median = 3), suture lysis (34%), needling (24%), and goniopuncture (37%). NEI VFQ-25 mean composite score for PC was 78.04 ± 24.36 points and for PDS 74.29 ± 24.45 (P=0.136). α Cronbach’s correlation coefficient was 0.913. Conclusions. PC leads to a more effective decrease in IOP than PDS in midterm observation with similar safety profiles. PDS patients required a vast number of additional procedures in contrast to PC patients, but this fact did not influence QoL

Zapalenie tęczówki w chorobach reumatycznych – postępowanie terapeutyczne

Leczenie zapalenia błony naczyniowej oka wymaga szczególnego podejścia, z uwagi na ryzyko istotnych powikłań, włącznie z utratą wzroku. Przyczyny choroby nie zawsze zostają ustalone, jednak znacząca część przypadków ma silny związek z układowymi chorobami tkanki łącznej, w szczególności spondyloartropatiami. Wskazuje to na potrzebę współpracy między okulistą i reumatologiem w celu zapewnienia choremu należytej opieki. W przebiegu leczenia można wyróżnić fazy w zależności od czasu trwania terapii i utrzymywania się objawów choroby. Aktualne dane badawcze uzasadniają zastosowanie miejscowe oraz ogólne glikokortykosteroidów, a także leków immunosupresyjnych w kolejnych liniach leczenia. Artykuł stanowi podsumowanie aktualnych rekomendacji oraz obserwacji klinicznych, jak również przedstawia oparty na nich schemat postępowania terapeutycznego.Treatment of uveitis requires a special approach because of the risk of significant complications, including loss of vision. The causes of the disease cannot always be determined, but a significant proportion of cases have a strong association with systemic connective tissue disorders, particularly spondyloarthropathies. This indicates the need for cooperation between an ophthalmologist and a rheumatologist in order to provide the patient with proper care. Several stages can be distinguished in the course of treatment, depending on the duration of therapy and the persistence of symptoms. Current research data justify the use of topical and systemic corticosteroids, as well as immunosuppressive drugs in subsequent lines of therapy. The article summarizes current recommendations and clinical observations, and presents a therapeutic regimen based on them

Assessing Efficacy of Canaloplasty Using Continuous 24- Hour Monitoring of Ocular Dimensional Changes

Citation: Rękas M, Danielewska ME, Byszewska A, et al. Assessing efficacy of canaloplasty using continuous 24-hour monitoring of ocular dimensional changes. Invest Ophthalmol Vis Sci. 2016;57:253357: -254257: . DOI:10.1167 PURPOSE. We investigated whether 24-hour monitoring of corneoscleral limbus area (CSLA) with the Sensimed Triggerfish contact lens sensor (CLS) can be used clinically to assess midterm efficacy of canaloplasty and to assess the relationships of CSLA changes with the heart rhythm. METHODS. Ten eyes of 10 patients, with POAG, which were qualified either to canaloplasty or canaloplasty and phacoemulsification, were included in this study. Eyes were washed out before the surgery and control visits were done at days 1, 7, and 3, 6, 12 months postoperatively, at which subjects were examined. We performed 24-hour monitoring of CSLA changes and Holter ECG at washout, and at 3-and 12-month postop visits. Raw CLS signals were processed to lead two parameters describing short-term 24-hour variability of CSLA (VAR,â). Heart activity parameters from CLS were compared to those acquired from Holter ECG. RESULTS. Mean post washout IOP was 20.6 6 4.7 and decreased to 14.2 6 3.0 mm Hg 1 year after surgery (P < 0.01). A decreasing trend in VAR andâ parameters were noted. Statistically significant differences were found between the washout and 3-month postop visit for VAR andâ (P ¼ 0.014 and P ¼ 0.027, respectively) as well as between the washout and 12-month postop result for the parameterâ (P ¼ 0.031). No statistically significant differences were found between the 3-and 12-month postop results for both considered parameters. CONCLUSIONS. Canaloplasty alone or combined with cataract surgery is a successful surgical method of lowering IOP in glaucoma patients. Canaloplasty decreases 24-hour CSLA fluctuation pattern measured with CLS

The Light Sword Lens - A novel method of presbyopia compensation: Pilot clinical study.

PURPOSE:Clinical assessment of a new optical element for presbyopia correction-the Light Sword Lens. METHODS:Healthy dominant eyes of 34 presbyopes were examined for visual performance in 3 trials: reference (with lens for distance correction); stenopeic (distance correction with a pinhole ϕ = 1.25 mm) and Light Sword Lens (distance correction with a Light Sword Lens). In each trial, visual acuity was assessed in 7 tasks for defocus from 0.2D to 3.0D while contrast sensitivity in 2 tasks for defocus 0.3D and 2.5D. The Early Treatment Diabetic Retinopathy Study protocol and Pelli-Robson method were applied. Within visual acuity and contrast sensitivity results degree of homogeneity through defocus was determined. Reference and stenopeic trials were compared to Light Sword Lens results. Friedman analysis of variance, Nemenyi post-hoc, Wilcoxon tests were used, p-value < 0.05 was considered significant. RESULTS:In Light Sword Lens trial visual acuity was stable in tested defocus range [20/25-20/32], Stenopeic trial exhibited a limited range of degradation [20/25-20/40]. Light Sword Lens and reference trials contrast sensitivity was high [1.9-2.0 logCS] for both defocus cases, but low in stenopeic condition [1.5-1.7 logCS]. Between-trials comparisons of visual acuity results showed significant differences only for Light Sword Lens versus reference trials and in contrast sensitivity only for Light Sword Lens versus stenopeic trials. CONCLUSIONS:Visual acuity achieved with Light Sword Lens correction in presbyopic eye is comparable to stenopeic but exhibits none significant loss in contrast sensitivity. Such correction method seems to be very promising for novel contact lenses and intraocular lenses design