Live outflow imaging in porcine eyes

Purpose: Although outflow of aqueous humor can be estimated using fluorophotometry and tonography, no method exists to assess segmental outflow directly. This has hindered investigations into outflow resistance elements that are downstream of the trabecular meshwork and into causes of failure of canal-based minimally invasive glaucoma surgeries (MIGS). Here, we describe a method to observe and quantify conventional outflow directly in ex vivo whole eyes and an organotypic culture model using standard fluorescence visualization equipment. Results: Aqueous outflow paths could be distinguished from venous and arterial vessels. Intricate vascular tree filling patterns were observed down to estimated 50 micrometer diameter. Whole eyes demonstrated significantly earlier filling of the nasal (SN, IN) than of the temporal quadrants (ST, IT). The fastest, superonasal quadrant filled 1.6 times faster than the slowest, superotemporal quadrant (p≤0.05). The inferotemporal quadrant also filled faster than the superotemporal quadrant. In contrast, perfused anterior segment cultures had lost these characteristic filling time differences (p>0.05). One eye showed no outflow after 20 minutes of pressurization. After three days of culture, the same quadrant that was the fastest in whole eyes (SN), was 2.2 times as fast as the slowest (ST) but this did not reach statistical significance with the number of eyes tested. The eye without flow at 20 minutes did not recuperate during 3 days of culture. Reverse filling was occasionally seen in d3 anterior segments (bottom row, red arrowhead). Whole eyes could not be reliably cultured for 3 days. Discussion: Canalograms using a green fluorescent chromophore can be obtained with standard visualization equipment to estimate the local outflow function. Regionally different outflow patterns and filling times can be observed that match channel size equivalents in human eyes. Outflow is impaired in fresh anterior segment cultures but then normalizes to the pattern seen in whole eyes. The nasally increased flow may have implications for placement and study of MIGS

Stratification of phaco-trabectome surgery results using a glaucoma severity index

The outcomes of phacoemulsification combined with trabectome surgery was analyzed using a glaucoma severity index based on preoperative intraocular pressure (IOP), number of preoperative medications, and visual field damage. Despite a less absolute indication to lower IOP, a substantial pressure reduction was seen in patients with more advanced glaucoma

Soliton Staircases and Standing Strain Waves in Confined Colloidal Crystals

We show by computer simulation of a two-dimensional crystal confined by corrugated walls that confinement can be used to impose a controllable mesoscopic superstructure of predominantly mechanical elastic character. Due to an interplay of the particle density of the system and the width D of the confining channel, "soliton staircases" can be created along both parallel confining boundaries, that give rise to standing strain waves in the entire crystal. The periodicity of these waves is of the same order as D. This mechanism should be useful for structure formation in the self-assembly of various nanoscopic materials.Comment: 22 pages, 5 figure

Trabecular Meshwork Engineering and Live Tracking in Perfused Porcine Anterior Segments

Purpose: To establish a trabecular meshwork ™ engineering model using porcine anterior segments of consistently high quality in a physiological, fixed perfusion system.\ud \ud Discussion: Compared to previously used human donor eyes, this inexpensive porcine anterior segment perfusion model is of sufficient, repeatable high quality to develop strategies to modify genetically, ablate and repopulate the TM. Despite significant anatomic differences, effects of transduction and ablation in the porcine model presented here replicate key aspects of previously explored human, feline and rodent models

Longer-term Baerveldt to Trabectome glaucoma surgery comparison using propensity score matching

Purpose: To apply propensity score matching to compare Baerveldt glaucoma drainage implant (BGI) to Trabectome-mediated ab interno trabeculectomy (AIT). Recent data suggests that AIT can produce results similar to BGI which is traditionally reserved for more severe glaucoma. Methods: BGI and AIT patients with at least 1 year of follow-up were included. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications, and a Glaucoma Index (GI) score. GI reflected glaucoma severity based on visual field, the number of preoperative medications, and preoperative IOP. Score matching used a genetic algorithm consisting of age, gender, type of glaucoma, concurrent phacoemulsification, baseline number of medications, and baseline IOP. Patients with neovascular glaucoma, with prior glaucoma surgery, or without a close match were excluded. Results: Of 353 patients, 30 AIT patients were matched to 29 BGI patients. Baseline characteristics including, IOP, the number of glaucoma medications, type of glaucoma, the degree of VF loss and GI were not significantly different between AIT and BGI. BGI had a preoperative IOP of 21.6 ± 6.3 mmHg compared to 21.5 ± 7.4 for AIT on 2.8 ± 1.1 medications and 2.5 ± 2.3 respectively. At 30 months, the mean IOP was 15.0 ± 3.9 mmHg for AIT versus 15.0 ± 5.7 mmHg for BGI (p > 0.05), while the number of drops was 1.5 ± 1.3 for AIT (change: p = 0.001) versus 2.4 ± 1.2 for BGI (change: p = 0.17; AIT vs BGI: 0.007). Success, defined as IOP  0.05) and 50% versus 52% at 2.5 years. Conclusions: A propensity score matched comparison of AIT and BGI demonstrated a similar IOP reduction through 1 year. AIT required fewer medications

Fuchs Heterochromic Iridocyclitis-Associated Glaucoma: A Retrospective Comparison of Primary Ahmed Glaucoma Valve implantation and Trabeculectomy with MMC

Purpose: To compare the safety and efficacy of a primary trabeculectomy with mitomycin C (T) and an Ahmed glaucoma valve (AGV) implantation in patients with Fuchs heterochromic iridocyclitis (FHIC) related glaucoma, a rare complication of an uncommon form of uveitis. Design: Retrospective comparative case series. Method: Twenty-six patients with uncontrolled FHIC-associated glaucoma received T (n=12) or an AGV (n=14). Primary outcome measures were the surgical success defined as IOP ≤ 21 mmHg and decreased ≥ 20% from the baseline and no secondary glaucoma surgery. Secondary outcome measures were the number of glaucoma medications, complications, best corrected visual acuity (BCVA), and intraocular pressure. Results: The follow-up (mean±SD) was 34.0±17.7 in T and 33.4±18.6 months in AGV (p = 0.837). The cumulative probability of success rate at the final follow-up at three years was 41.7% for T and 85.7% for AGV. There was no significant difference in complications between the two groups (P>0.05). The mean preoperative IOP in T was 23.4±3.3 mmHg and 21.6±5.2 mmHg at the final visit (P= 0.041). In AGV, the preoperative IOP was 24±7.8 and 17.1±2.6 mmHg at the final visit (P= 0.003), respectively. AGV had a significantly lower average IOP at the final follow-up visit compared to T (P= 0.018). The number of glaucoma medications at baseline was 3.3±0.5 in T and 3±0.6 in AGV (P= 0.233). This decreased significantly to 2.4±1.0 and 1.7±0.6 at the final follow-up (P= 0.008 and 0.002, respectively). Patients in AGV needed fewer glaucoma medications (P= 0.041). BCVA was equal in both groups and did not change (p>0.05). Conclusion: Primary AGV had a higher success rate than T in the management of FHIC-associated glaucoma. The risk of cataract formation and progression was significantly higher following T in these patients

Glaucoma surgery calculator: limited additive IOP effect of phacoemulsification on Ab Interno Trabeculectomy

Purpose: To compare reduction of intraocular pressure (IOP) after Trabectome in pseudophakic patients and Trabectome combined with phacoemulsification (Trabectome-phaco) in phakic patients. Methods: Cases were excluded if patients were followed for less than 12 months, diagnosed with neovascular glaucoma, or required additional glaucoma surgery within 12 months after Trabectome or Trabectome-phaco. Missing data such as type of glaucoma, gender, or age was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline IOP. Linear regression was used to examine IOP reduction after surgery. Results: A total of 612 cases were included in the study with 248 Trabectome cases and 364 Trabectome-phaco cases. Baseline IOP was found to be statistically significant. An average of 0.73±0.03 mmHg IOP reduction is associated with an increment of 1 mmHg in baseline IOP. Type of surgery was not statistically significant after adjusting for baseline IOP, age, baseline number of glaucoma medications and type of glaucoma. Conclusion: Patients with higher baseline IOP are expected to have a greater IOP reduction

Carbon-enhanced metal-poor stars in the SDSS-APOGEE data base

We identify six new carbon-enhanced metal-poor (CEMP) stars ([C/Fe]>+ 0.7 and [Fe/H] < -1.8) and another seven likely candidates within the APOGEE data base following Data Release 12. These stars have chemical compositions typical of metal-poor halo stars, e.g. mean [a/Fe]=+0.24 +/- 0.24, based on the APOGEE Stellar Parameters and Chemical Abundances Pipeline results. A lack of heavy-element spectral lines impedes further sub-classification of these CEMP stars, however, based on radial velocity (RV) scatter, we predict most are not CEMP-s stars which are typically found in binary systems. Only one object, 2M15312547+4220551, may be in a binary since it exhibits a scatter in its RV of 1.7 +/- 0.6 km s(-1) based on three visits over a 25.98 d baseline. Optical observations are now necessary to confirm the stellar parameters and low metallicities of these stars, to determine the heavy-element abundance ratios and improve the precision in the derived abundances, and to examine their CEMP sub-classifications