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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.

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These findings support an association of narrower retinal arteriolar and venular caliber changes with glaucomatous optic neuropathy, independent of intraocular pressure.

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In this Malay population, angle width measured by AS-OCT was smaller in women than in men, and in eyes with shorter axial length and shallower ACD.

Objective: To describe the distribution and determinants of the optic cup to disc ratio (CDR) in Malay adults in Singapore.Methods: This population-based, age-stratified study examined 3280 Malay people aged 40 to 80 years in Singapore. Participants underwent a standardized interview and an ocular examination. A slitlamp examination measured the vertical dimensions of the disc and cup, excluding areas of peripapillary atrophy and the Elschnig scleral ring.Results: Vertical CDR was recorded for 3228 right eyes and 3237 left eyes. The mean (SD) CDR was 0.40 (0.15) in both eyes. The CDR in the right eye increased with age (PϽ .001) and was greater in men vs women (age-adjusted CDR, 0.42 vs 0.39; PϽ .001). In multiple linear regression, significant determinants of greater CDR were increasing age, male sex, higher intraocular pressure (IOP), lower diastolic blood pressure, lower body mass index, and previous cataract surgery. Of these, higher IOP was the most important determinant of the CDR. After excluding 149 persons with glaucoma, male sex, higher IOP, lower diastolic blood pressure, lower body mass index, and diabetes mellitus were significant predictors of greater CDR. Conclusion:Greater vertical CDR was related to male sex, higher IOP, lower diastolic blood pressure, and lower body mass index.