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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Intraocular lens implantation in infants less than 1 year of age is generally a safe procedure. The spread of final refractive error was very wide. Final refraction in the unilateral group was significantly more myopic than the bilateral group. Final acuities were often disappointing especially in the unilateral group.

Purpose To assess the validity and repeatability of partial coherence interferometry (IOLMaster) and A-scan ultrasound measurement of axial length (AL) in children. Methods A prospective comparison of AL measurement made by the IOLMaster optical instrument (Carl Zeiss) and ultrasound A-scan (Alcon) was performed. A total of 20 children (11 male, nine female) were recruited into the study; the mean age of the sample was 11.4 years (range 6.2-15.8). Inclusion criteria comprised individuals o16 years, with no ocular pathology and no previous eye operations or allergy to topical anaesthetics. All measurements were performed by a single examiner. Results Data on validity show that, on average, a small measurement difference existed between these groups with the IOLMaster being 0.017 mm greater than A-scan ultrasonography. The 95% confidence interval for this difference encompasses zero, demonstrating that no significant systematic bias exists between the two-measurement techniques. Overall, IOLMaster reliability exceeded that of A-scan. This is evidenced primarily by the spread of the paired test-retest difference for A-scan compared to IOLMaster. The mean test-retest difference for A-scan was considerably larger than IOLMaster at 0.042 and 0.004 mm, respectively. Conclusion The results show that IOLMaster was more accurate and reproducible than the contact ultrasonographic technique when used in children. Such results indicate that IOLMaster may be a useful tool in studies of eye growth and refractive development in children.