High mean IOP may be associated with poor blood reflux and filling of SC. A collapsed canal, probably secondary to high IOP, may be an underestimated sign in black African patients with POAG. The quality of blood reflux and episcleral venous egress may both be predictive of the level of IOP after surgery. Provocative gonioscopy and channelography may reflect the function of the outflow pathway and may be helpful in assessing the surgical outcome of canaloplasty.

Canaloplasty produced a sustained long-term reduction of IOP in black Africans with POAG independent of preoperative IOP. As a bleb-independent procedure, canaloplasty may be a true alternative to classic filtering surgery, in particular in patients with enhanced wound healing and scar formation.

This qualitative in-vivo method was simple, safe, and enabled us to visualize the details of the aqueous outflow system during canaloplasty. Filling characteristics of episcleral venous network as well as trans-trabecular diffusion may reflect the clinical status of the outflow pathway in glaucoma patients, and may be helpful in the prediction of the surgical outcome in canaloplasty.

Purpose To compare the safety and efficacy of two polypropylene (Prolene) sutures for tensioning of the inner wall of Schlemm's canal (SC) in black African patients with primary open-angle glaucoma (POAG) undergoing canaloplasty. Methods In a prospective randomised trial of 90 patients, canaloplasty was performed with a flexible microcatheter (iTrack-250A) and sodium hyaluronidate 1.4% (Healon GV). After complete circumferential dilatation of the SC, a Prolene suture, either 6-0 Prolene (group 1) or 10-0 Prolene (group 2), was retracted through the SC and tightened leaving tension on the canal and trabecular meshwork. Nd:YAG laser goniopuncture was not performed postoperatively. Results The mean preoperative intraocular pressure (IOP) was 42.7 mm Hg±12.5 (SD) in group 1 and 45.0 mm Hg ± 12.1 (SD) in group 2 (P ¼ 0.70). The mean postoperative IOP without medications was 18.4 mm Hg ± 7.1 (SD) in group 1 and 16.4 mm Hg ± 6.6 (SD) in group 2 at 1 month (P ¼ 0.10), 19.2 mm Hg±6.4 (SD) in group 1 and 16.4 mm Hg±4.9 (SD) at 15 months (P ¼ 0.04). Pressures equal or less than 21, 18, and 16 mm Hg without medications (complete success) at 12 months were 51.0% (95% confidence interval (CI) 0.35-0.73), 34.1% (95% CI 0.21-0.56), and 21.2% (95% CI 0.11-0.42) in group 1, and 76.9% (95% CI 0.62-0.96), 68.8% (95% CI 0.54-0.89), and 53.6% (95% CI 0.38-0.76) in group 2, respectively. In the Cox regression analysis, IOP o18 mm Hg without medications depended significantly on the type of Prolene (hazard ratio (HR) 2.60, 95% CI 1.24-5.46, P ¼ 0.01) and age (HR 1.3, 95% CI 1.03-1.86, P ¼ 0.03), but not on preoperative IOP (HR 1.01, 95% CI 0.99-1.04, P ¼ 0.16) and gender (HR 0.67, 95% CI 0.34-1.33, P ¼ 0.26). No filtering bleb was observed. Intra-and postoperative complications were similarly rare in the two groups and included partial 'cheese-wiring' (2), Descemet's rupture (2), and hyphaema (3). Conclusions In this clinical trial, IOP reduction was substantial in canaloplasty and slightly greater in combination with 10-0 Prolene than 6-0 Prolene sutures at an equally low complication rate. Younger age, but not the level of IOP at surgery, had a positive effect on the amount of IOP reduction, thus suggesting that an early surgical intervention to re-establish physiological outflow offers the best prognosis.

ABSTRACT.Purpose: To study the safety and long-term efficacy of classic viscocanalostomy in patients with open-angle glaucoma (OAG) in different populations. Methods: A total of 726 eyes of 726 patients from Europe or South Africa with primary OAG (POAG) and pseudoexfoliative glaucoma (PXFG) were included in this retrospective multicentre study. Complete (qualified) success was defined as an intraocular pressure (IOP) equal to or lower than 21, 18 and 16 mmHg without (with or without) medications, respectively. A failed procedure was defined if IOP was above 21 mmHg, not controllable by laser goniopuncture or medications. Results: The mean IOP before surgery was 42.6 AE 14.2 mmHg for all patients, 29.6 AE 6.6 mmHg for European patients and 48.1 AE 12.9 mmHg for African patients. The follow-up time was 86.2 AE 43.1 months. Mean IOP was 15.4 AE 3.6 mmHg at 5 years, 15.5 AE 4.4 mmHg at 10 years and 16.8 AE 4.2 mmHg at 15 years. The qualified success rate for an IOP of 21, 18 or 16 mmHg or less after 5 years was 92% [95% confidence interval (CI) 0.88-0.96], 70% (95% CI 0.63-0.77) and 43% (95% CI 0.36-0.51) in European patients, and 90% (95% CI 0.87-0.93), 77% (95% CI 0.74-0.81) and 67% (95% CI 0.63-0.72) in African patients, respectively. There was no difference between the success rate for POAG and PXFG for an IOP of 21, 18 or 16 mmHg or less at 5 years (p = 0.64, p = 0.20, p = 0.22, respectively). Laser goniopuncture was performed postoperatively on a total of 127 eyes (17.7%), lowering the pressure from 23.1 AE 1.9 mmHg to 15.0 AE 2.2 mmHg. There were no significant complications, in particular, no blebitis or endophthalmitis. Conclusion: Viscocanalostomy produced a sustained long-term reduction of IOP with a low-risk profile in European and African patients with OAG over 12 years.

Posterior capsulotomy with optic entrapment of the IOL proved to be a safe and efficient surgical procedure for preventing PCO in children with congenital cataracts. Uniting the anterior and posterior capsule in front of the IOL limits the proliferation and migration of Elschnig pearls. An intact anterior hyaloid does not induce capsule opacification in association with optic entrapment; therefore, a vitrectomy is not indicated even in infants under age 5 years. Clear visual axis, centered IOL, and intact vitreous were achieved in this series; this enables a promising long-term prognosis for binocular visual development, especially because surgery was performed early.

Adnexal torsion is an uncommon cause of severe lower abdominal pain in women and is often difficult to distinguish from other acute abdominal conditions. However, adnexal torsion should be considered in premenarcheal girls admitted with acute abdominal pain and evidence of an ovarian mass. Accurate and early radiological diagnosis is mandatory immediately after onset of clinical symptoms in order to preserve the viability of the ovary. Ultrasound (US) is usually the first line examination performed in an emergency setting, but computed tomography (CT) and magnetic resonance imaging (MRI) can be useful in case of ambiguous US findings, especially in patients with sub-acute symptoms and a suspected adnexal mass. This case report describes the additional value of MRI in a premenarcheal girl with sub-acute right fossa pain.

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