Trabeculotomy in a Behçet's Disease Patient One Week after Infliximab Administration

Purpose: To describe a patient with Behçet’s disease and anterior uveitis, which was not cured by local and systemic corticosteroid treatments, who underwent trabeculotomy one week after infliximab administration. Methods: The patient received preoperative antibiotic therapy followed by trabeculotomy one week after infliximab administration. We observed ocular findings before and after surgery. Results: Anterior uveitis improved after infliximab administration. The elevated intraocular pressure improved after surgery and there were no intraoperative complications. Neither ocular inflammatory attacks nor infectious complications were found in the operated eye of the patient during follow-up. Conclusion: Trabeculotomy one week after administration of infliximab appears to be safe and effective in treating secondary glaucoma associated with Behçet’s disease

Inferior displacement of the lower eyelid during intraoperative quantification in blepharoptosis surgery

Hirohiko Kakizaki, Yasuhiro Takahashi, Masahiro Zako, Masayoshi IwakiDepartment of Ophthalmology, Aichi Medical University, Nagakute, Aichi, JapanPurpose: To examine inferior displacement of the lower eyelid during eye closing in intraoperative quantification of blepharoptosis surgery.Methods: A series of lower eyelid movements during eye closing in intraoperative quantification of blepharoptosis surgery were examined in 30 eyelids of 15 patients (6 males and 9 females; mean age 70.0 years; range 43–81 years) with bilateral aponeurotic blepharoptosis.Results: Inferior displacement of the lower eyelid was observed in all eyelids examined, although the extent varied in each patient (range 2.0–4.5 mm; mean 3.2 mm). Inferior displacement occurred with upward eye movement caused by Bell's phenomenon. Many wrinkles were simultaneously observed as a result of contraction of the orbicularis oculi muscle. After maintaining the inferiorly displaced state for several seconds, 20 lower eyelids in 10 patients naturally moved superiorly to a resting position. On the other hand, 10 lower eyelids in 5 patients remained in the same inferior position for more than 5 seconds, after which we had to manually elevate them to a resting position. The eyes then moved inferiorly to their resting position with a decrease in the number of lower eyelid wrinkles. Once the patients opened their eyes, inferior displacement of the lower eyelid completely disappeared.Conclusions: Inferior displacement of the lower eyelid during eye closing increases the amount of lagophthalmos. This phenomenon needs to be considered for quantifying the intraoperative lagophthalmos level during blepharoptosis surgery.Keywords: blepharoptosis surgery, eye closing, inferior displacement, intraoperative quantification, lower eyelid&nbsp

Effect of oral tranexamic acid on macular edema associated with retinal vein occlusion or diabetes

Purpose: Tranexamic acid (TXA) is a widely used antifibrinolytic agent that can also cause a decrease in vascular permeability. We hypothesized that TXA could improve macular edema (ME) that is caused by an increase in retinal vascular permeability. The aim of this study is to evaluate the efficacy of oral TXA for ME associated with retinal vein occlusion (RVO) or diabetic ME (DME).Patients and methods: Oral TXA (1,500 mg daily for 2 weeks) was administered to patients with persistent ME secondary to RVO (7 eyes) and DME (7 eyes). After 2 weeks (ie, the final day of administration) and 6 weeks (ie, 4 weeks after the final administration), best-corrected visual acuity and central macular thickness (CMT) were measured and compared with baseline. Analyses were performed for RVO and DME cases. No other treatment was performed during the study period.Results: In RVO cases, significant improvement in CMT was found between baseline (467.7±121.4 µm) and 2-week measurements after treatment (428.7±110.5 µm, p=0.024). No significant change was found in CMT between measurements taken at baseline and 6 weeks after treatment. In DME cases, no significant change was found in CMT between measurements taken at baseline and 2 or 6 weeks after treatment. In all analyses of best-corrected visual acuity, no significant change was observed.Conclusion: The results support the hypothesis that plasmin plays a role in the development of ME associated with RVO, and oral TXA administration may be useful as an adjuvant treatment when combined with other agents such as anti-vascular endothelial growth factor

Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy

Purpose: Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery.Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Peri­operative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery.Results: The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly.Conclusion: No significant disorders in ocular structural and functional parameters were found until long after RALP

Adalimumab in Active and Inactive, Non-Infectious Uveitis:Global Results from the VISUAL I and VISUAL II Trials

Purpose: Report global adalimumab safety and efficacy outcomes in patients with non-infectious uveitis. Methods: Adults with non-infectious intermediate, posterior, or panuveitis were randomized 1:1 to receive placebo or adalimumab in the VISUAL I (active uveitis) or VISUAL II (inactive uveitis) trials. Integrated global and Japan substudy results are reported. The primary endpoint was time to treatment failure (TF). Results: In the integrated studies, TF risk was significantly reduced (hazard ratio [95% CI]) with adalimumab versus placebo (VISUAL I: HR = 0.56 [0.40-0.76], p < 0.001; VISUAL II: HR = 0.52 [0.37-0.74], p < 0.001). In Japan substudies, no consistent trends were observed between groups (VISUAL I: HR = 1.20 [0.41-3.54]; VISUAL II: HR = 0.45 [0.20-1.03]). Adverse event rates were similar between treatment groups in both studies (854 to 1063 events/100 participant-years). Conclusions: Adalimumab lowered time to TF versus placebo in the integrated population; no consistent trends were observed in Japan substudies. Safety results were consistent between studies

A useful technique of starting internal limiting membrane peeling from the edge of the internal limiting membrane defect in epiretinal membrane surgery

Key Clinical Message Clinicians should be aware that internal limiting membrane (ILM) defects may occur concurrently with epiretinal membrane, and starting ILM peeling at the ILM defect margin may be useful in such cases. Abstract We describe a useful surgical technique for the treatment of idiopathic epiretinal membrane with concurrent internal limiting membrane (ILM) defect, in which ILM peeling was started from the ILM defect margin. A dissociated optic nerve fiber layer‐like appearance on fundus examination and optical coherence tomography may suggest an ILM defect