Purpose: To compare the efficacy and safety of collagen matrix implant (Ologen â ; OLO) with mitomycin C (MMC) in phacotrabeculectomy. Methods: Prospective, single-centre, nonblinded, randomized controlled trial. A total of 53 eyes of 45 patients were enrolled in the study protocol with 27 eyes randomly assigned to OLO and 26 to MMC. The follow-up was 12 months. The primary outcome measure was mean change from baseline intraocular pressure (IOP) in both groups after 12 months. The secondary outcome measures were cumulative success rates at 12 months with Kaplan-Meier analysis, change in number of medications, change in best corrected visual acuity (BCVA), and bleb morphology assessed using Moorfields Bleb Grading System and anterior segment swept-source optical coherence tomography. Results: The mean IOP decreased from 26.4 AE 6.1 mmHg to 13.7 AE 3.8 in the OLO group and from 23.4 AE 3.6 mmHg to 13.3 AE 2.8 in the MMC group at 1 year without significant intergroup differences. At 1 year, the overall success rates were 92.6% and 92.3% in the OLO and MMC groups, respectively. There were no significant differences in the overall success rates, BCVA, number of medications, morphology of the filtering blebs and rate of complications at the end of the follow-up. Conclusion: Ologen (OLO) provides similar surgical outcomes in phacotrabeculectomy compared with adjunctive MMC. It may be a new, safe and effective alternative to MMC for combined phacoemulsification and trabeculectomy surgery.
To compare refractive outcomes after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes and to investigate the accuracy of 3 intraocular lens (IOL) calculation formulas in these eyes. In this prospective comparative study 42 eyes (PEX group) and 38 eyes (control group) of 80 patients were included. The follow-up was 3 months. The refractive prediction error (RPE), mean absolute error (MAE), median absolute error (MedAE) and the percentages of eyes within ± 0.25 D, ± 0.5 D, ± 1.0 D and ± 2.0 D of prediction error were calculated. Three IOL calculation formulas (SRK/T, Barrett Universal II and Hill-RBF) were evaluated. PEX produced statistically significantly higher mean absolute errors and lower percentages of eyes within ± 0.5 D than control eyes in all investigated IOL calculation formulas. There were no statistically significant differences in the median absolute errors between the 3 formulas in either PEX or control eyes. Refractive outcomes after cataract surgery are statistically significantly worse in PEX than in control eyes. All three IOL calculation formulas produced similar results in both PEX and control eyes.Trial registration: ClinicalTrials.gov registration number NCT04783909.
introduCtion. The purpose of the study was to evaluate the intraocular pressure (IOP) lowering effect of lens removal in eyes with primary angle closure glaucoma (PACG) and primary angle closure (PAC). MATERIALS AND METHODS. This study was a retrospective analysis of 114 eyes of 97 patients (83 women, 14 men; mean age 69.9 years) with PACG and PAC treated with lens extraction. Outcome measures: age, gender, visual acuity, IOP reduction over time, preoperative and postoperative number of IOP-lowering medications, axial length, intraocular lens (IOL) power, requirement for additional anti-glaucoma operations, and complications. Patients were divided into three groups: 1) patients with PAC (22 eyes) with mean follow-up 12.2 months; 2) patients with PACG with a history of previous acute angle closure (AAC) (39 eyes) with mean follow-up 15.4 months; and 3) patients with PACG without a history of previous AAC (53 eyes), with mean follow-up 13.5 months. Laser iridotomy was performed in all treated eyes prior to the surgery. RESULTS. In the group with PAC mean IOP was reduced from 42.2 ± 15.4 mm Hg (mean ± SD) under 2.6 IOP-lowering medications to 20.2 ± 10.4 mm Hg under 1.1 IOP-lowering medications (mean IOP reduction 52.1%). In the group with PACG with a history of previous AAC mean IOP was reduced from 29.0 ± 15.7 mm Hg under 2.1 IOP-lowering medications to 17.0 ± 7.5 mm Hg under 0.7 IOP-lowering medications (mean IOP reduction 41.3%). In the group with PACG without a history of previous AAC (53 eyes) mean IOP was reduced from 22.8 ± 8.0 mm Hg under 1.75 IOP-lowering medications to 18.8 ± 7.4 mm Hg under 1.5 IOP-lowering medications (mean IOP reduction 17.5%). In all three groups statistically significant improvement of visual acuity as a result of surgery was observed. There were no statistically significant differences between the three groups with regard to AXL or IOL power. Intraoperative complications were noticed in eight cases, and postoperative complications were noticed in four cases. The number of anti-glaucoma medications was reduced, but 17 eyes needed additional anti-glaucoma procedures. CONCLUSIONS. Lens extraction in eyes with PACG and PAC resulted in significant IOP reduction in all groups. The most pronounced IOP reduction was achieved in the group with PAC, where lens extraction was performed up to 60 days from AAC. Visual acuity was significantly improved as a result of surgery in all three study groups.
Introduction. Cataract surgery is one of the most important surgical procedures in ophthalmology. Aim. The aim of this study is to compare cataract surgeries performed in 1994 and 2014. Material and methods. A retrospective analysis of 100 cataract procedures in 1994, as well as a total of 100 cataract procedures performed in 2014. The authors considered the following factors: age, sex, vision acuity, cataract type, preoperative patient preparation, intra-and postoperative complications, and total hospitalization time.Results. Back in 1994, extracapsular cataract extraction (ECCE) was the most common treatment technique. It caused more intraoperative complications (46) and postoperative complications (38) and longer total hospitalization time (9.25 days±3.25 SD). In 2014, all procedures were performed using phacoemulsification. As a result, the number of intraoperative (20) and postoperative (14) complications has dropped significantly. Total hospitalization time was also reduced (1.53 days±1.08 SD).Conclusions. Phacoemulsification significantly improved cataract treatment. This method is much safer and more effective than ECCE.
Background: To evaluate the relationship between bleb vascularity and surgical outcome one year after mitomycin C (MMC) augmented trabeculectomy. Methods: This was a prospective study of 51 eyes of 44 patients after MMC-augmented primary trabeculectomy with follow-up of 12 months. The total vessel area of a bleb was measured with ImageJ software on color photographs of the bleb on day 1 and 14, then months 1, 3, 6 and 12 after trabeculectomy. Blebs were classified clinically as successful (intraocular pressure (IOP) ≤ 18 mmHg and a >30% reduction in IOP without antiglaucoma medications or additional surgical interventions) or failed. Linear regression analysis was performed to determine the correlation of bleb vascularity with IOP and outcome. Results: At 1 year, 40 eyes (78.4%) were classified as successful and 11 eyes (21.6%) as failed. The mean bleb vascularity at 1, 3 and 12 months after surgery was significantly higher in failed blebs (16.31% vs. 13.01%, p = 0.005, 14.93% vs. 10.15%, p = 0.001, 8.99% vs. 6.37%, p = 0.011, respectively). There were no significant differences in mean bleb vascularity at 1 and 14 days postoperatively in successful and failed blebs. The results revealed a significant association between vessel area at 1 and 3 months after trabeculectomy with IOP at 6 months postoperatively (p = 0.005 and p = 0.009, respectively). Conclusions: In this prospective study, we demonstrated a strong relationship between bleb vascularity and the surgical outcomes of trabeculectomy. Vascularity of the filtering bleb during early postoperative period was not correlated with IOP or success of trabeculectomy at one year. Increased bleb vascularity 1, 3 and 12 months after trabeculectomy appears to predict surgical failure at 1 year after trabeculectomy.
Purpose: To assess preliminarily the efficacy and safety of a relatively new surgical modification of phacovitrectomy in eyes with cataract and visually significant asteroid hyalosis (AH). Materials and methods: Prospective, noncomparative, interventional case series of six eyes of six patients (mean age 75.6 years; 1 woman, 5 men) with cataract and visually significant AH treated with a novel surgical technique—a phacoemulsification with anterior vitrectomy through posterior capsulorhexis and intraocular lens (IOL) implantation. Main outcome measures were: best-corrected visual acuity (BCVA), intraocular pressure (IOP), IOL centration, complications. Mean follow-up was 39.17 ± 4.31 months. Results: The mean BCVA (Snellen) improved from 0.26 ± 0.18 to 0.73 ± 0.33 at the end of the follow-up. IOP was in the normal range, and no problems with IOL fixation were observed at the end of the follow-up. No post-operative complications, retinal detachment, retinal tears, macular edema or prolonged inflammation were observed. Conclusions: The presented new surgical technique seems to be a safe and efficacious method to treat cataract with visually significant asteroid hyalosis.
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