Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma

Purpose: To compare efficacy and safety results of an ab interno gel implant in patients with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG). Methods: Retrospective analysis of the medical records of 110 consecutive eyes with open angle glaucoma who had received a XEN45 gel implant between March 2014 and June 2015. Intraocular pressure course, number of glaucoma medications, the need for additional intervention (including needling) and complications were evaluated until 12 months postoperatively. Results: Data of 67 eyes with POAG and 43 eyes with PXG were analyzed. At 12 months postoperatively, the mean IOP had significantly decreased by 54.0% from preoperatively 31.85 ± 8.5 mmHg to 13.99 ± 2.6 mmHg in the POAG group, (p = 0.000; Wilcoxon test), and by 55.2% from 31.63 ± 9.0 mmHg to 13.28 ± 3.1 mmHg in the PXG group (p = 0.000; Wilcoxon test). The mean number of anti-glaucoma medications had significantly decreased from 3.25 ± 0.8 at baseline to 0.3 ± 0.7 medications at 12 months postoperatively in POAG eyes (p = 0.000; Wilcoxon test), and from 3.05 ± 1.0 to 0.3 ± 0.6 medications in PXG eyes (p = 0.000; Wilcoxon test). Hypotony (IOP ≤ 6 mmHg) was observed in 2 POAG eyes (3.0%) and in 5 PXG eyes (11.7%) at 1 month but normalized in all eyes at 12 months postoperatively. Severe complications were not observed. No statistically significant differences were found between PXG eyes and POAG eyes. Conclusion: Our data indicate that the XEN45 gel implant provides significant and comparable reduction in IOP and anti-glaucoma medication during the one-year follow-up period in POAG as well as PXG eyes. This suggests that it may be a noteworthy alternative to traditional filtering procedures in patients with POAG and PXG respectively

Cell Death and Ultrastructural Morphology of Femtosecond Laser-Assisted Anterior Capsulotomy

PURPOSE. To evaluate cell death and ultrastructural effects on capsulotomy specimens derived from femtosecond laser-assisted cataract surgery. METHODS. In 26 eyes, an anterior capsulotomy was performed using a femtosecond laser. In 10 eyes (group 1), the laser-pulse energy was set to 15 lJ using a rigid curved interface and in another 10 eyes (group 2) to 5 lJ using a curved interface combined with a soft contact lens. The control group (6 eyes, group 3) underwent manual anterior capsulorhexis using forceps. All extracted capsule specimens underwent cell death analysis using the TUNEL kit, ultrastructural analyses using atomic force microscopy (AFM), and scanning electron microscopy (SEM). Counterstaining was performed with 4 0 ,6-diamidino-2-phenylindol (DAPI) and hematoxylin-eosin (HE). RESULTS. Cell death was found in all capsule specimens along the cutting edge but was significantly more pronounced in group 1. DAPI and HE staining showed regular epithelial cell distribution with a demarcation line along the cutting edge of both laser groups, which was more pronounced in group 1. In AFM analysis, laser spot size in the femtosecond laser groups were in accordance with the preoperative planned size (P < 0.01). Cutting edges in SEM observations were smoother and more roundly shaped using 5 lJ (group 2). CONCLUSIONS. Cutting edges of femtosecond laser-performed capsulotomies are precise and laser spot lesions are within planned size. Cell death reaction depends on the laser pulse energy settings and can be reduced to the level observed in a manual capsulorhexis. Keywords: femtosecond laser, capsulotomy, capsulorhexis, laser energy, cell death, apoptosis, atomic force microscopy, scanning electron microscopy A precise and well-performed capsulorhexis is crucial to perform an uncomplicated cataract extraction, intraocular lens implantation, and centration. 1-3 This main step in cataract surgery and refractive lens exchange surgery is commonly performed manually. Femtosecond lasers are now changing how lens surgery is performed by becoming involved in the main steps of the surgical process: corneal incisions, capsulotomy, and lens fragmentation. Dick et al. 2 recently suggested a new terminology for opening the anterior lens capsule with a femtosecond laser: capsulotomy instead of capsulorhexis, as the femtosecond laser operates as a cutting knife by using focal photodisruption. Recent studies have already demonstrated that femtosecond laser-performed capsulotomies allow repeatable and precise sizing and centration; furthermore, they improve the safety of hydrodissection, nuclear fragmentation, and cortical cleanup. 10 During capsulotomy, the anterior capsule is being injured and epithelial cell death is induced. This effect might be stronger with the assistance of femtosecond lasers. Therefore, the purpose of this study was to investigate cell death reaction after anterior capsulotomy either performed by a femtosecond laser using different energy levels or manually by using forceps. Furthermore, laser spot lesions and cutting edge of all capsulotomy specimens were investigated on the ultrastructural level. METHODS The experimental study was approved by the ethics committee of the Goethe-University, Frankfurt am Main, Germany, and was performed in accordance with the Declaration of Helsinki at the Department of Ophthalmology, Goethe-University. In 26 eyes of 26 patients diagnosed with corticonuclear cataract formation anterior femtosecond laser-assisted capsulotomy (n ¼ 20) or manual capsulorhexis (n ¼ 6) using forceps was performed. In 10 eyes (group 1) that underwent femtosecond laser capsulotomy, the laser pulse energy was set to 15 lJ and applanation to the ocular surface was performed using a rigid curved interface. For another 10 eye

Efficacy, Safety, and Risk Factors for Failure of Standalone Ab Interno Gelatin Microstent Implantation versus Standalone Trabeculectomy

To compare the efficacy, safety, and risk factors for failure of standalone ab interno gelatin microstent implantation with mitomycin C (MMC) versus trabeculectomy with MMC.status: publishe

Standalone Ab Interno Gelatin Stent versus Trabeculectomy: Postoperative Interventions, Visual Outcomes, and Visits.

PURPOSE: To evaluate postoperative interventions, visual outcomes, and number of postoperative office visits after standalone ab interno gelatin microstent implantation with mitomycin C (MMC) vs. trabeculectomy with MMC. DESIGN: International, multicenter, retrospective cohort study. PARTICIPANTS: A total of 354 eyes of 293 patients, including 185 microstent eyes and 169 trabeculectomy eyes. METHODS: Consecutive eyes with uncontrolled glaucoma underwent microstent or trabeculectomy surgery from January 1, 2011, through July 31, 2015, at 4 academic ophthalmology centers: Toronto, Canada; Frankfurt, Germany; Salzburg, Austria; and Leuven, Belgium. MAIN OUTCOME MEASURES: Assessed outcomes included (1) in-clinic interventions, (2) transconjunctival needle revision (TCNR), (3) postoperative visits at 1 and 3 months, (4) >2 lines vision loss at last follow-up, (5) complete visual recovery, and (6) >0.5 or >1 diopter (D) of surgically induced astigmatism. RESULTS: Ninety-five (51.4%) of the microstent eyes and 105 (62.1%) of the trabeculectomy eyes underwent an intervention by last follow-up (log-rank P = 0.0004). The most common intervention was TCNR, followed by laser suture lysis. Seventy-eight (42.2%) microstent eyes and 55 (32.5%) trabeculectomy eyes received TCNR (adjusted hazard ratio [HR], 1.73 [95% confidence interval (CI), 1.10-2.71]): 128 total TCNRs in the microstent group and 95 in the trabeculectomy group. Predictors for TCNR included prior laser peripheral iridotomy and diabetes. Microstent eyes had on average 1.00 (standard deviation 2.32) fewer visits compared with trabeculectomy eyes in the first month (P 2 lines of vision at last follow-up or reoperation was 12.4% (95% CI, 8.0%-18.7%) and was 21.9% (95% CI, 15.3%-30.1%) adjusted (P = 0.0383). A higher proportion of microstent eyes regained their baseline preoperative visual acuity compared with trabeculectomy eyes (log-rank P = 0.0250; adjusted HR, 1.46 [95% CI, 1.10-2.00]). Altogether, 25.3% (95% CI, 15.3%-38.9%) of microstent eyes and 40.7% (95% CI, 27.7%-55.3%) of trabeculectomy eyes had > 0.5 D surgically induced astigmatism on an adjusted basis; 8.0% (95% CI, 3.2%-18.6%) vs. 17.3% (95% CI, 8.9%-9.8%) had >1 D. CONCLUSIONS: Microstent eyes had more TCNRs (though fewer in-clinic interventions), fewer postoperative visits, and less vision loss, and experienced less surgically induced astigmatism, than trabeculectomy eyes. Overall, the postoperative course was less intensive for the microstent, except for more TCNRs.status: publishe

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