Effect of intracameral injection of fibrin tissue sealant on the rabbit anterior segment

Molecular Vision161087-1097MVEP

Visual field progression 8 years after trabeculectomy in Asian eyes: results from The Singapore 5-Fluorouracil Study

Background/Aims: This work aimed to study the effect of long-term intraocular pressure (IOP) fluctuation on visual field (VF) progression 8 years post-trabeculectomy in Asian eyes. / Methods: This was a retrospective analysis of 8-year post-trabeculectomy data from The Singapore 5-Fluorouracil (5-FU) Study. VFs were analysed using Progressor software (Medisoft, Leeds, UK). Outcome measures included mean slope for VF per year, number of progressing points and mean slope for progressing points per year. Multivariate regression analyses were performed adjusting for age, gender, ethnicity, glaucoma type, intraoperative 5-FU, diabetes mellitus, hypertension, best pre-trabeculectomy VF mean deviation, post-trabeculectomy mean IOP, IOP reduction and IOP fluctuation (SD of IOPs at 6-monthly timepoints). / Results: 127 (52.3%) subjects completed 8-year follow-up with ≥5 reliable VFs and ≥8 6-monthly IOP measurements. Mean age was 61.8±9.6 years. Post-operatively, mean IOP was 14.2±2.8 mm Hg and mean IOP fluctuation was 2.53±1.20 mm Hg. Higher IOP fluctuation was associated with greater mean slope for field (B=−0.071; p=0.013), number of progressing points (B=0.963; p=0.014) and VF progression as defined by ≥1 progressing point (OR=1.585; p=0.029). There was also a trend towards eyes with higher IOP fluctuation having ≥3 adjacent progressing points in the same hemifield (OR=1.489; p=0.055). Greater mean IOP reduction post-trabeculectomy was associated only with a lower mean slope for progressing points per year (B=−0.026; p=0.028). There was no significant effect of intra-operative 5-FU compared with placebo for all outcome measures. / Conclusion: In post-trabeculectomy Asian eyes with well-controlled IOP, higher long-term IOP fluctuation may be associated with greater VF progression

Comparison of outcomes of conventional WaveLight® Allegretto Wave® and Technolas® excimer lasers in myopic laser in situ keratomileusis

Daphne CY Han,1,2 Jean Chen,3 Hla Myint Htoon,2 Donald TH Tan,1,2,4 Jodhbir S Mehta1,21Singapore National Eye Centre, 2Singapore Eye Research Institute, 3Yong Loo Lin School of Medicine, National University of Singapore, 4Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, SingaporeObjective: To compare the results of laser in situ keratomileusis for myopia using WaveLight® Allegretto Wave® Eye-Q® and Technolas® 217z excimer lasers.Method: A retrospective, comparative case series of 442 eyes matched for age and myopia: half each were treated with Allegretto's wavefront-optimized algorithm and Technolas PlanoScan. Outcome measures were postoperative mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA), manifest refraction spherical equivalent (MRSE), cylinder, safety and efficacy indices, refractive predictability, and optical zone size selection. Refractive predictability of a subgroup treated for –2.50 to –4.0 diopter (D) was analyzed separately.Results: At mean follow-up of 80.5 days, mean logMAR UCVA, mean MRSE and mean postoperative cylinder were 0.02 ± 0.07 (range –0.12 to 0.30), 0.27 ± 0.36 D (range –1.25 to 1.50 D) and –0.33 ± 0.30 D (range 0.00 to –1.50 D) for Allegretto versus 0.02 ± 0.08 (range –0.12 to 0.40), 0.095 ± 0.47 D (range –1.25 to 1.13 D) and –0.44 ± 0.5 2 D (range 0.00 to –2.25 D) for Technolas (P = 0.98, 0.80 and 0.006). Mean safety and efficacy indices were 1.05 ± 0.13 (0.75–1.33) and 0.97 ± 0.13 (0.50–1.33) for Allegretto and 1.07 ± 0.14 (0.75–1.49) and 0.97 ± 0.17 (0.40–1.49) for Technolas (P = 0.23 and 0.69). Proportions of eyes achieving postoperative MRSE within ±1.0 D, ±0.5 D, and ±0.25 D were 98.2%, 91.9% and 75.6% for Allegretto and 99.1%, 97.8% and 72.4% for Technolas (P = 0.68, 0.20 and 0.51). Mean optical zone size selected was 6.48 ± 0.10 mm (range 6.0–6.5 mm) for Allegretto and 6.38 ± 0.19 mm (range 5.6–6.6 mm) for Technolas (P < 0.001). Of the subgroup with treatment between –2.5 and –4.0 D, 86.8% and 58.5% of eyes treated with Allegretto achieved postoperative MRSE within ±0.50 D and ±0.25 D versus 70.4% and 44.4% for Technolas (P = 0.006 and 0.057).Conclusion: No differences were seen in postoperative mean logMAR UCVA, MRSE, safety and efficacy indices between the two lasers. Allegretto produced less residual astigmatism, possibly improved refractive predictability, and required smaller optical zone selection.Keywords: LASIK, myopia, laser vision correction, conventional laser algorith

Intraoperative use of spectral-domain optical coherence tomography during Descemet’s stripping automated endothelial keratoplasty

Chelvin CA Sng1,2, Federico Luengo Gimeno1, Jodhbir S Mehta1,2, Hla Myint Htoon1, Donald T Tan1,21Singapore Eye Research Institute and Singapore National Eye Center, 2Department of Ophthalmology, National University Health System, SingaporePurpose: To evaluate the intraoperative changes in the donor lenticule, recipient cornea, and the reduction of interface fluid thickness during Descemet’s stripping and automated endothelial keratoplasty with EndoGlide™ (Angiotech Pharmaceuticals Inc, Vancouver, Canada) donor insertion, using intraoperative spectral-domain optical coherence tomography.Methods: Prospective observational case series of patients underwent Descemet’s stripping and automated endothelial keratoplasty using the EndoGlide inserter. Spectral-domain optical coherence tomography (iVue; Optovue Inc, Fremont, CA) with a handheld probe was used to image the cornea and anterior chamber. Standardized software was used to measure interface fluid gap, host cornea, and donor lenticule thicknesses during the following surgical stages of Descemet’s stripping and automated endothelial keratoplasty: (1) after donor insertion and immediately before full air tamponade; (2) after air tamponade and expression of fluid from venting incisions; (3) at 6 minutes of air tamponade; and (4) at 10 minutes of air tamponade.Results: Ten patients with a mean age of 74.9 ± 11.8 years were recruited. Spectral-domain optical coherence tomography measurements of the interface fluid gap after fluid was expressed through the venting incisions (P < 0.001), at 6 minutes of air tamponade (P < 0.001) and at 10 minutes of air tamponade (P < 0.001 and P = 0.001, respectively), were significantly decreased compared to the measurements immediately before air tamponade. Donor thickness increased significantly at 6 minutes of air tamponade (P = 0.004) but reduced by 10 minutes compared to immediately before air tamponade.Conclusion: Significant intraoperative changes in the donor, recipient cornea, and interface fluid thickness occurred following endothelial keratoplasty donor insertion.Keywords: Descemet’s stripping and automated endothelial keratoplasty, spectral-domain optical coherence tomograph

Donor and surgical risk factors for primary graft failure following Descemet's stripping automated endothelial keratoplasty in Asian eyes

Marcus Ang1,2, Hla M Htoon1,2, Howard Y Cajucom-Uy1,2, Donald Tan1–3, Jodhbir S Mehta1–41Singapore National Eye Centre, Bukit Merah, 2Singapore Eye Research Institute, Bukit Merah, 3Department of Ophthalmology, Yong Yoo Lin School of Medicine, National University of Singapore, Queenstown, 4Duke-NUS Graduate Medical School, Outram, SingaporeBackground: Descemet's stripping automated endothelial keratoplasty (DSAEK) has been shown to have superior refractive and visual results compared with penetrating keratoplasty, but higher rates of primary graft failure (PGF). This paper presents donor and surgical risk factors for PGF in DSAEK cases in Asian eyes.Design: Retrospective case-control study.Participants: All consecutive patients who underwent DSAEK at a tertiary referral teaching hospital from March 2006–December 2008.Methods: Donor details analyzed were: age of donor, cause of donor death, death to harvesting time, donor storage time, distribution distance of tissue, preoperative endothelial cell count. Surgical factors analyzed were: donor diameter, donor thickness, and method of donor insertion. These risk factors in cases of PGF were compared with patients with successful DSAEK as the control group.Main outcome measure: PGF.Results: A total of 124 DSAEK procedures were performed. Six DSAEK procedures (five eyes of five patients; one eye with two failures) resulted in PGF (4.8%). Significant risk factors were found for PGF to include graft insertion using a folding technique (odds ratio [OR], 34.03; 95% confidence interval [CI], 3.75–314.32; P = 0.0017) and a small donor diameter (OR, 39.94; 95% CI, 2.18–732.17; P = 0.013).Conclusion: The results of this study suggest that in Asian eyes with shallow anterior chambers, surgical trauma relating to the technique of donor insertion, and the use of a small donor are major risk factors for PGF following DSAEK.Keywords: DSAEK, PGF, penetrating keratoplast

Endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty versus penetrating keratoplasty in Asian eyes

Marcus Ang1,2, Jodhbir S Mehta1–4, Arundhati Anshu1,2, Hon Kiat Wong5, Hla M Htoon2, Donald Tan1–31Singapore National Eye Centre, 2Singapore Eye Research Institute, 3Department of Ophthalmology, National University Health Systems, 4Department of Clinical Sciences, Duke-NUS Graduate Medical School, 5Department of Ophthalmology, Tan Tock Seng Hospital, SingaporeBackground: The purpose of this study was to compare endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty in Asian eyes.Methods: This was a retrospective study of patients from our prospective Singapore Corneal Transplant Study cohort who received corneal transplantation in 2006–2008. We compared eyes that underwent DSAEK or penetrating keratoplasty for Fuchs’ endothelial dystrophy or pseudophakic and aphakic bullous keratopathy. Clinical data, and donor and recipient characteristics were recorded. Of 241 patients who met our inclusion criteria, 68 underwent DSAEK and 173 underwent penetrating keratoplasty. The main outcome measure was endothelial cell loss at 1 year. Secondary outcome measures were graft survival and visual outcomes at 1-year follow-up.Results: There were no significant differences in baseline characteristics of patients between the treatment groups. Percent endothelial cell loss at 1-year follow-up was greater in penetrating keratoplasty eyes (40.9% ± 2.9%) compared with DSAEK eyes (22.4% ± 2.3%; P < 0.001). DSAEK-treated eyes had significantly superior uncorrected visual acuity (mean difference = 0.42 ± 0.0059; P < 0.001) and best spectacle-corrected visual acuity (mean difference = 0.14 ± 0.032; P < 0.001) as compared with penetrating keratoplasty-treated eyes. Penetrating keratoplasty-treated eyes had worse astigmatism as compared with DSAEK-treated eyes (-3.0 ± 2.1 versus -1.7 ± 0.8; P < 0.001). Graft survival at 1 year was comparable in both groups, ie, 66/68 (97.0%) DSAEK-treated eyes versus 158/173 (92.0%) of penetrating keratoplasty-treated eyes had clear grafts (P = 0.479).Conclusion: We report lower percent endothelial cell loss comparing DSAEK and penetrating keratoplasty at 1-year follow-up in Asian eyes, with comparable graft survival rates in both groups.Keywords: Descemet’s stripping automated endothelial keratoplasty, endothelial cell count, penetrating keratoplast

De novo ocular hypertension after Descemet stripping endothelial keratoplasty: comparative 3-year incidence, risk factors, and outcomes

Errol W Chan,1 Tina T Wong,2,3 Hla M Htoon,3 Ching L Ho,2 Donald T Tan,1,2,3 Jodhbir S Mehta2,3,4 1Department of Ophthalmology, National University Health System, Singapore; 2Singapore National Eye Centre, Singapore; 3Singapore Eye Research Institute, Singapore; 4Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore Objective: To compare the 3-year incidence of de novo ocular hypertension (OHT) after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK). For DSAEK, to evaluate predictors for OHT and 2-year outcomes after OHT development. Methods: This was a review of the prospective Singapore Corneal Transplant Study at a single tertiary referral center. Consecutive DSAEKs and PKs for Fuchs&rsquo; endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK) in eyes without pre-existing glaucoma were analyzed. OHT incidence after DSAEK and PK were compared using Kaplan&ndash;Meier survival analysis, and OHT risk factors identified using Cox proportional regression. OHT was defined: intraocular pressure (IOP) &ge; 24 mmHg or &ge; 10 mmHg from baseline. Secondary outcomes 2 years after OHT development in DSAEK were rates of glaucoma medical therapy failure, IOP success, graft failure and rejection, and best-spectacle corrected visual acuity (BSCVA). Results: There were 108 (96.4%) DSAEKs and 216 (96%) PKs. The 1-, 2- and 3-year de novo OHT incidence was not significantly different between DSAEK (36.1%, 47.2%, 47.2%, respectively) and PK (35.7%, 44.9%, 45.8%, respectively; P = 0.914). OHT incidence did not differ in subgroup analyses of multiple clinical variables (P > 0.1). OHT predictors after DSAEK were: fellow eye glaucoma (hazard ratio [HR] 3.20, P = 0.004), age <60 years (HR 2.41, P = 0.016), concurrent goniosynechiolysis (HR 3.29, P = 0.021), post-graft complications or procedures (HR 2.85, P = 0.006). Two years after OHT onset, 29.7% of DSAEKs failed glaucoma medical therapy requiring trabeculectomy. Complete and qualified IOP success was achieved in 23.5% and 76.5%, respectively. Graft failure developed in 9.8% and graft rejection in 5.9%. At 6 months, 1, and 2 years from OHT onset, 86.3%, 88.3%, and 92.1% achieved BSCVA 20/40, respectively. Conclusion: DSAEK and PK have comparable OHT risks. A significant 30% of DSAEK eyes with OHT require filtration surgery. Effective IOP control and good graft and visual outcomes are achieved with treatment. Keywords: DSAEK, glaucoma, ocular hypertension, risk factor