Purpose: To describe the efficacy and safety of open versus closed conjunctival implantation of the XEN45 Gel Stent (Allergan Inc). Design: Retrospective, multicenter study. Participants: A total of 137 patients with glaucoma who underwent XEN45 implantation via open or closed conjunctival methods. The XEN45 was implanted as a stand-alone procedure or at the time of cataract surgery by 5 surgeons. Methods: Patient demographics, diagnoses, preoperative and postoperative clinical data, outcome measures including intraocular pressure (IOP), use of glaucoma medications, visual acuity, and complications were collected. Statistical analyses were performed with P < 0.05 as significant. Main Outcome Measures: Failure was defined as less than 20% reduction of IOP from medicated baseline or IOP >21 mmHg at 2 consecutive visits at postoperative month 1 and beyond, the need for subsequent operative intervention or additional glaucoma surgery, or a catastrophic event such as loss of light perception. Eyes that had not failed by these criteria and were not on glaucoma medications were considered complete successes. Eyes that had not failed but required glaucoma medications were defined as qualified successes. Results: Complete success was achieved in 31% and 56% of the closed and open groups, respectively ( P = 0.01). Qualified success was achieved in 53% and 71% of the closed and open groups, respectively ( P = 0.06). At postoperative month 12, the open conjunctiva group was using fewer glaucoma medications than the closed group (0.9 vs. 1.8, respectively; P = 0.02). At postoperative month 12, the open group had a significantly greater percentage of IOP reduction compared with the closed group (43.1% vs. 24.8%, respectively; P = 0.02). Postoperative needling rates were higher in the closed group compared with the open group (36.1% vs. 11.8%, P = 0.001). Conclusions: Implantation of the XEN45 with opening of the conjunctiva is a safe and efficacious procedure to lower IOP with comparable success rate and lower needling rate compared with the closed conjunctiva technique. Prospective evaluation of the various methods for XEN45 implantation will allow for further comparison.
Video games supplemental to occlusion may be considered favorable for visual development in amblyopic children, and the study encourages further research on this subject.
Précis: Sub-Tenon's implantation of the Xen Gel stent resulted in significant intraocular pressure (IOP) lowering along with a low rate of postoperative bleb needling, and a favorable bleb morphology on anterior segment optical coherence tomography (AS-OCT).Purpose: The aim was to assess clinical outcomes and bleb morphology following sub-Tenon's implantation of the Xen Gel Stent. Methods:The medical records of patients who underwent sub-Tenon's Xen Gel Stent implantation with intraoperative mitomycin-C through an open conjunctival approach were reviewed. Postoperative IOP and number of glaucoma medications at 1, 3, 6, 9, and 12 months were assessed. Bleb morphology was analyzed at various timepoints using AS-OCT (Topcon DRI OCT version 1.1.1).Results: Twenty-six eyes were included in the study. Mean age was 69.4 ± 8.0 years. Mean preoperative IOP was 28.1 ± 7.8 mm Hg on an average of 3.5 ± 0.9 glaucoma medications. Mean IOP at postoperative month 12 (n = 23 eyes) was 12.9 ± 4.0 mm Hg (P < 0.01) on an average of 0.3 ± 0.6 (P < 0.01) glaucoma medications. Three eyes (12%) required postoperative needle revision. Bleb morphology in the early postoperative period ( ≤ 3 mo) was characterized by multiple small subconjunctival microcysts on AS-OCT. At the intermediate (6 to 12 mo) and long-term ( > 12 mo) timepoints, reduction in microcysts with multiple internal parallel layers of aqueous flow and a uniform pattern were more frequently noted. All functional blebs were characterized by the presence of a posterior episcleral fluid lake. Failed blebs showed absence of aqueous humor around the distal end of the microshunt. Conclusion:Following an open conjunctival approach, sub-Tenon's placement of the Xen Gel Stent with significant IOP lowering was achieved. In eyes with good shunt function, bleb morphology by AS-OCT showed a posterior episcleral fluid lake similar to findings following trabeculectomy.
P urpose: To study the aetiology, epidemiological profile of patients presenting with ocular trauma and compare visual outcomes of early versus late presentatiod. Design: Prospective observational study performed over fifteen month interval. Methods: Patients' epidemiological characteristics were evaluated along with cause of trauma, place of injury, time lag post injury, and postoperative management. Injuries were classified by Birmingham Eye Trauma Terminology (BETT). Final visual and anatomical outcome after providing tailored surgical management was evaluated. All patients had a minimum follow up of 6 months. Statistical Analysis: All the data collected was analysed using SPSS version 17.0 software. Results: One hundred and three cases of incident ocular injury were included in the study. Open globe: closed globe injuries were 78:22% respectively with intraocular foreign body present in 9% of cases. Actively working adults younger than 25 years of age were the commonest age group affected (64%). The commonest place of injury was at home (32%) followed by workplace environment (29%). Good outcome (vision of > 6/60 Snellen) could be achieved in 50% cases, of which 53% had purely anterior segment injury and 20% concomitant retinal injury. Good outcome had a direct correlation with early presentation in 57% and poor outcome with late presentation seen in 64% cases. Conclusion: Serious ocular trauma frequently occurs at home with the younger population maximum at risk. Good visual acuity is associated with early intervention and purely anterior segment injuries.
Despite no statistically significant change in objective parameters of lens fit, a tendency for flatter lens fit along with contact lens induced further flattening of the ectatic cornea which resulted in marked improvement in both objective and subjective contact lens fit.
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