The last 11 years of Molteno implantation at the University of Cape Town. Refining our indications and surgical technique

Analysis aqueous humor lipid profile of neovascular glaucoma secondary to diabetic retinopathy and lipidomic alteration response to anti-VEGF treatment

The objective of this study was to examine the lipid spectrum of aqueous humor (AH) in patients with neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy and to investigate the lipid alteration response to anti-vascular endothelial growth factor (anti-VEGF) treatment. Lipidomic analysis using ultra-high performance liquid chromatography-tandem mass spectrometry was conducted to compare the lipid profiles of the AH in NVG patients with those of a control group. Lipid changes in the AH of NVG patients before and after intravitreal conbercept injections were also evaluated. The identification of lipids showing differential expression was accomplished through both multivariate and univariate analyses. This study included 13 NVG patients and 20 control subjects. Based on LipidSearch software, 639 lipid species across 33 lipid classes were detected in the participants' AH. The combination of univariate and multivariate statistical analyses yielded 53 differentially expressed lipids (VIP >1 and P < 0.05). In addition, 9 lipids were found to be differentially expressed before and after the intravitreal conbercept injections in the NVG patients. Significant alterations in the metabolic pathways of glycerophospholipid and glycerolipid exhibited notable changes. Our results highlighted the lipid changes in patients' AH in relation to the progression of NVG, and indicated that the modified lipids could potentially be utilized as therapeutic targets for NVG.

Intraocular Pressure Fluctuation during Aerobic Exercise at Different Exercise Intensities

Few studies have examined the effects of different aerobic-exercise intensities on intraocular-pressure (IOP) changes. This may be important for eye diseases that are impacted by IOP or its fluctuation, including glaucoma, and diabetes that is complicated by diabetic retinopathy. We investigated the effects of low-, moderate-, and high-intensity exercise on IOP in healthy subjects. A submaximal cardiopulmonary exercise test was performed in 18 healthy male subjects, and the maximal oxygen uptake was calculated. The subjects then exercised for 20 min at 30%, 50%, and 70% ·VO₂ of maximal oxygen uptake, and their IOP was measured at rest and every 5 min during exercise. Oxygen uptake was monitored using an expiratory gas analyzer during exercise to maintain accurate exercise intensity and adjust exercise load. Oxygen uptake during exercise was significantly higher at all intensities from 5 to 20 min than at rest. IOP was significantly lower at 70% exercise intensity from 5 to 20 min than at rest. A negative correlation existed between IOP and ·VO₂. IOP remained unchanged during low- and moderate-intensity exercise but significantly declined during high-intensity exercise compared with that at rest. Although various factors, such as β-blockers, are involved in IOP decline at rest, a different mechanism is involved in IOP decline during exercise.

Ahmed Glaucoma Valve Implantation: Graft-Free Short Tunnel Small Flap versus Scleral Patch Graft after 1-Year Follow-up: A Randomized Clinical Trial

PURPOSE

To compare the efficacy and safety of the graft-free short tunnel small flap (STSF) technique with that of the scleral patch graft (SPG) in Ahmed glaucoma valve (AGV) (New World Medical Inc, Rancho Cucamonga, CA) implantation.

DESIGN

Randomized clinical trial.

PARTICIPANTS

A total of 203 eyes of 203 patients with medically uncontrolled glaucoma, including 102 in the STSF group and 101 in the SPG group.

METHODS

Patients were enrolled and assigned randomly to STSF or SPG.

MAIN OUTCOME MEASURES

Tube exposure, intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity, surgical complications, and success rate (defined as IOP >5 mmHg, ≤21 mmHg, and IOP reduction ≥20% from baseline at 2 consecutive visits after 3 months, no reoperation for glaucoma).

RESULTS

Only 1 patient in the SPG group developed tube exposure at 1-year follow-up. The cumulative probability of success during the first year of follow-up was 70% in the STSF group and 65% in the SPG group (P = 0.36). The IOP decreased significantly from 29.6±8.6 mmHg at baseline to 16.4±3.6 mmHg at the final follow-up in the STSF group (P = 0.001). The corresponding numbers for the SPG group were 30.9±11.2 and 15.8±4.7, respectively (P = 0.001). The final IOP was comparable between both groups (P = 0.65). Mean ± standard deviation of the number of glaucoma medications was 1.8±0.9 in the STSF group and 1.6±0.9 in the SPG group at final follow-up (P = 0.32). Postoperative complications developed in 8 patients (19%) in the STSF group and 9 patients (23%) in the SPG group (P = 0.81).

CONCLUSIONS

The STSF and SPG techniques had a comparable complication rate at the 1-year follow-up. Both techniques were comparable in terms of success rate, postoperative IOP, and glaucoma medications.

Neovascular glaucoma: Handling in the future

Neovascular glaucoma (NVG), which is refractory to both medical management and surgical intervention, is a disastrous ocular disease for it always ends up with intolerable pain and extinguishing patients' residual visual function. Since insufficient acknowledge of the pathophysiological and molecular mechanisms of NVG, it has been laying a challenging dilemma of managing NVG in clinical practice for a long time. Along with the progression on some new agents and surgical options targeting certain possible roles in the NVG process, there seems having been some new sights but still much unknown and to be revealed. This review discusses the underlying etiologic diseases of NVG, molecular findings and characteristics of its pathogenic process, as well as the management of NVG in detail. In addition, here represents some of our hypothesis regarding the interesting findings about NVG in clinical practice, aiming to provide some new enlightenment for future research.

Neovascular glaucoma: a retrospective review from a tertiary center in China

Background

The purpose of this study is to report the prevalence, etiology, treatment and outcomes of neovascular glaucoma (NVG) in a tertiary care ophthalmic center in China.

Methods

Medical records of patients diagnosed as NVG at the Wenzhou Medical University between 2003 and 2014 were reviewed. Success was defined as IOP between 6 and 21 mmHg without topical or systemic glaucoma medications with retention of presenting visual acuity (VA).

Results

NVG was diagnosed in 483 of 8306 (5.8 %) of all glaucoma patients. Etiology is reported for all 310 eyes of 284 patients managed in the department. Interventions depended on insurance as well as personal finances; outcomes are reported for the 149 eyes of 138 patients with complete data that met follow up requirements. Diabetic retinopathy (DR,39.7 %) was the major cause of NVG. Kaplan Meier survival analysis showed a success rate of 84.8 % at 1 year, 47.5 % at 3 years and 21.9 % at 5 years. Major interventions included glaucoma drainage device (GDD) in 103 eyes and trans-scleral cyclophotocoagulation (TSCPC) in 22 eyes. Complications were more common in the GDD group.

Conclusions

NVG comprised 5.8 % of glaucoma patients seen in a tertiary Chinese hospital. DR was identified as the commonest cause and probably reflects the increasing prevalence of diabetes in China. Surgical interventions were partly determined by insurance status and personal finances. GDD was the commonest surgical intervention used and also had the most complications.