Aims To assess the efficacy of Xen in reducing intraocular pressure (IOP) in varying glaucoma subtypes. To assess the effect of combined phacoemulsification. To determine the frequency of complications and explore further bleb management needed. Methods Retrospective case note review of all patients undergoing Xen implantation across four centres from August 2015 to May 2017. Results In total, 259 consecutive surgeries of 226 patients were reviewed. IOP reduced from 19.3 (SD ± 6.0) mmHg preoperatively to 14.2 (SD ± 4.4) at month 12 and 13.5 (SD ± 3.3) at month 18 (p < 0.0001). Medication usage reduced from 2.6 (±1.1) preoperatively to 0.8 (±1.0) at month 12 (p < 0.0001) and 1.1 (±1.3) medications at month 18 (p < 0.0001). Simultaneous phacoemulsification did not alter outcomes as Xen IOP was 14.3 (SD ± 4.7) mmHg and Phaco-Xen was 13.8 (SD ± 2.6) mmHg at month 12 (p = 0.5367). Xen appears to be effective in previous failed filtration surgery. Adverse events included: IOP spikes of ≥30 mmHg in 33 (12.7%) cases, secondary filtration surgery required in 24 (9.3%) cases; implant exposure in 6 (2.3%) cases; persistent hypotonous maculopathy in 5 (1.9%) cases; persistent choroidal effusions in 4 (1.5%) cases; a cyclodialysis cleft secondary to implant insertion in 1 (0.5%) case; and 1 (0.5%) case of endophthalmitis postimplant bleb resuturing. In all, 40.9% of cases required postoperative bleb needling or antimetabolite injection. Conclusions Xen reduces IOP and medications at 18 months. Adverse events are uncommon. Careful postoperative surveillance and low threshold for bleb management is needed. Xen is safe and effective in mild to moderate glaucoma.

ObjectivesDoes phaco–ECP reduce intraocular pressure? Is phaco–ECP safe?DesignRetrospective case note review of all patients undergoing phaco–ECP between June 2008 and June 2009. All glaucoma subtypes were included.SettingSingle District General Hospital Ophthalmology Department within the UK.Participants58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8).InterventionsAll patients received combined cataract surgery and endoscopic cyclophotocoagulation.Outcome measuresFollow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed.ResultsOf the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout.ConclusionsThis study confirms the safety of phaco–ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco–ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.

The intravitreal dexamethasone implant does not last the 6 months implied by the retreatment protocol in the GENEVA trial, and improved results can be achieved with an as-needed retreatment protocol, particularly in CRVO. However, visual outcomes remain similar to those previously seen with triamcinolone in the SCORE study and neovascular complications remain a feature of CRVO.

Xen reduces IOP and number of medications in eyes with failed trabeculectomy. Detailed preoperative conjunctival assessment and targeted stent placement is required. Prospective data and follow-up beyond 12 months are required but Xen seems a viable, effective, and safe option after failed trabeculectomy.

To evaluate motion analysis as a discriminator of ophthalmic plastic surgical skill between surgeons of varying experience. Methods: Thirty subjects were divided into 3 groups based on surgical experience: novice (Ͻ5 performed procedures; n=10), intermediate (5-100 procedures; n=10), and expert (Ͼ100 procedures; n=10). Detailed 3-dimensional motion data from surgeons performing 2 oculoplastic surgical tasks on a wet laboratory skills board were obtained using the Qualisys motion capture system. The first task was a deep 3-1-1 suture. The second was skin closure with a continuous suture. The main outcome measures were time, overall path length, and total number of movements. Kruskal-Wallis analysis was performed to evaluate statistical significance. Results: Highly significant differences were found during the skin closure task between all groups for mean time (P=.002), overall path length (P =.002), and number of movements (P = .001). For the deep stitch, highly significant differences were also found for time (P Ͻ.001), path length (P Ͻ .001), and number of movements (PϽ .001). Conclusions: Motion analysis, using this technology, was able to differentiate between surgeons of varying experience performing oculoplastic tasks, thus demonstrating construct validity. This technique may be useful in the objective quantitative measurement of oculoplastic skill, with potential applications for training and research.

BackgroundGlaucoma services are under unprecedented strain. The UK Healthcare Safety Investigation Branch recently called for new ways to identify glaucoma patients most at risk of developing sight loss, and of filtering-out false-positive referrals. Here, we evaluate the feasibility of one such technology, Eyecatcher: a free, tablet-based ‘triage’ perimeter, designed to be used unsupervised in clinic waiting areas. Eyecatcher does not require a button or headrest: patients are simply required to look at fixed-luminance dots as they appear.MethodsSeventy-seven people were tested twice using Eyecatcher (one eye only) while waiting for a routine appointment in a UK glaucoma clinic. The sample included individuals with an established diagnosis of glaucoma, and false-positive new referrals (no visual field or optic nerve abnormalities). No attempts were made to control the testing environment. Patients wore their own glasses and received minimal task instruction.ResultsEyecatcher was fast (median: 2.5 min), produced results in good agreement with standard automated perimetry (SAP), and was rated as more enjoyable, less tiring and easier to perform than SAP (all p<0.001). It exhibited good separation (area under receiver operating characteristic=0.97) between eyes with advanced field loss (mean deviation (MD) < −6 dB) and those within normal limits (MD > −2 dB). And it was able to flag two thirds of false-positive referrals as functionally normal. However, eight people (10%) failed to complete the test twice, and reasons for this limitation are discussed.ConclusionsTablet-based eye-movement perimetry could potentially provide a pragmatic way of triaging busy glaucoma clinics (ie, flagging high-risk patients and possible false-positive referrals).

The discovery of systemic disease related to raised tissue and serum immunoglobulin G4 (IgG4) is changing diagnostic and therapeutic practice in many medical specialties.

Peripapillary choroidal neovascular membranes (PCNM) are defined as a collection of new choroidal blood vessels, any portion of which lies within one disc diameter of the nerve head. There are two types of PCNM, and correct pre-interventional identification of growth site has been shown to stratify the chance of visual improvement following therapy. Clinical manifestations occur only where the membrane extends over the macula, if the vessels haemorrhage into the subretinal space or fluid exudation occurs within the macula. This review provides an update and overview on the diverse range of current treatment studies and strategies being used in present clinical ophthalmic practice.