ABSTRACT.Purpose: To analyse structural changes in conjunctiva, sclera and Schlemm's canal (SC) following canaloplasty with optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). Methods: Fifteen patients undergoing canaloplasty were included in this prospective study. AS-OCT images were acquired pre-and 1, 7, 30 and 90 days postoperatively. UBM was performed 3 months postoperatively. The surgical site was evaluated for the presence of SC, transscleral filtration, a scleral lake and the visibility of intra-Schlemm-sutures. The height and width of SC were measured at the 3 and 9 o'clock limbus position. Results: After canaloplasty, SC was detectable with AS-OCT in 93% of the patients on day 1. The increase in height was higher than that in width (height: +369%, p = 0.0004, width: +152%, p = 0.002). IOP was negatively correlated to SC's width 1 week postoperatively (r = À0.63, p = 0.04) and to SC's height until 3 months (r = À0.66, p = 0.02) postoperatively. Using UBM, a reflection of the traction sutures indicated SC's position in all patients. Transscleral filtration was found in all patients using AS-OCT, demonstrating a peak 1 week postoperatively. At 3 months, a scleral lake could be visualized in 50% and 83% of patients using AS-OCT and UBM, respectively. Conclusions: AS-OCT offers a high resolution for imaging superficial conjunctival areas and SC after canaloplasty, whereas UBM is capable of detecting deeper structures such as scleral lakes or intra-canal-sutures. The results imply a correlation of the dilation of SC with the IOP-lowering effect and an early pronounced transscleral filtration following canaloplasty.
End-diastolic velocities of the central retinal artery and of the temporal posterior ciliary arteries increased after successful trabeculectomy and remained stable in a longer period - even if IOP rose significantly in the follow-up.
Alterations in BP variability and coupling with heart rate suggest impaired patterns of autonomic cardiovascular regulation in glaucoma patients especially in patients with NTG.
Persisting anatomic changes of SC, a transscleral filtration and a scleral lake can be recorded by AS-OCT and UBM long-term after successful canaloplasty.
Purpose: To evaluate the long-term outcome of trabeculectomy with intra- and postoperative 5-fluorouracil (5-FU) application in glaucoma. Methods: Eighty-six patients with glaucoma planned for primary trabeculectomy with 5-FU and a minimum follow-up of 3 years were retrospectively analyzed. Success rates, postsurgical 5-FU injections, needling procedures, and complications were analyzed. Results: Mean intraocular pressure (IOP) decreased from 27.2 ± 6.7 to 13.2 ± 4.2 mm Hg at 1 year and 13.8 ± 3.7 mm Hg at the 3-year follow-up. The complete success rates (no IOP-lowering medication) were 83, 79, 73, and 45% at 1 year for IOP ≤21, ≤18, ≤16, and ≤12 mm Hg, respectively, and 64, 59, 56, and 20% for these criteria at 3 years. The average number of medications decreased from preoperatively 2.9 ± 1.4 to 0.2 ± 0.5 at 1 year and 0.7 ± 1.1 at 3 years. During the first 6 months, subconjunctival 5-FU injections were performed in 49 cases. Eleven patients underwent bleb needling during the first 6 months and 13 patients underwent the procedure between the 6th month and the 3rd year. Malignant glaucoma and bleb-related endophthalmitis occurred in 1 patient each. Conclusions: Trabeculectomy with 5-FU is an efficient surgical procedure for glaucoma treatment when combined with intensified postsurgical care.
The SLc system agrees more with the designated cutting depth than the CBm. The dissection produced a comparable LSR and a ∼10% ECL independently of the system. Further incubation of the prepared lamellae led to a swelling, but no further ECL.
Purpose:
The purpose of this study was to evaluate ocular hemodynamics in patients with a disease believed to be related to a chronic vascular damage [ie, normal tension glaucoma (NTG)] in comparison with an entity with an acute ischemic impact on the optic nerve [ie, acute nonarteritic anterior ischemic optic neuropathy (NAION)].
Materials and Methods:
Blood-flow velocities [peak systolic velocity (PSV), enddiastolic velocity (EDV)] of the ophthalmic artery (OA), central retinal artery (CRA), and nasal and temporal posterior ciliary arteries were measured using color Doppler imaging. Resistive index (RI) of all vessels was calculated (PSV-EDV/PSV). A total of 41 patients suffering from acute NAION (onset of symptoms <10 d) and 64 age-matched patients suffering from NTG were included in this prospective study.
Results:
No significant differences were recorded for either age or intraocular pressure inbetween the 2 groups. Systolic blood pressure was significantly higher in the NAION group, whereas no significant differences were recorded for the diastolic blood pressure. Only 3 color Doppler imaging parameters were found to differ significantly. The PSV (P<0.005) and EDV (P<0.02) in the CRA were significantly higher in NTG patients. Furthermore, the RI in the OA was significantly higher in the NAION patients (P<0.005).
Conclusions:
Decreased blood-flow velocities in the CRA and a higher RI in the OA can be recorded in NAION patients as compared with NTG. No differences with regard to the posterior ciliary arteries’ velocities were recorded. Ocular hemodynamics are suspected to play a critical role in NAION and NTG, whereas the blood-flow disturbances seem to be more severe in NAION than in NTG.
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