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Nandzik M, Wylęgała A, Szkodny D, Wróblewska-Czajka E, Wylęgała E, Orzechowska-Wylęgała B. Risk Factors for Glaucoma and Ocular Hypertension and Post-Transplant Complications in Keratoconus: A Multivariable Analysis. J Clin Med 2024; 13:5407. [PMID: 39336894 PMCID: PMC11432017 DOI: 10.3390/jcm13185407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Background: The purpose of this study was to investigate the risk factors for glaucoma in patients with keratoconus following keratoplasty and to identify potential factors that could affect post-transplant complications. Methods: A retrospective analysis was conducted on the medical records of 192 keratoconus patients who underwent keratoplasty. Data on treatment history, perioperative information, tissue bank data, postoperative regimens, complications, and infections were collected and analyzed. Statistical analysis was performed to identify risk factors associated with glaucoma and transplant complications. Results: There was a 41.6% incidence of glaucoma (high IOP) (p < 0.001), with the median time to glaucoma development being 314 ± 67 days post-transplant. A significant number of patients required surgical intervention, accounting for 48.05%. Our analysis revealed a 14% graft failure rate. On univariable Cox proportional hazard analysis, the following factors demonstrated statistically significant associations with the risk of glaucoma after transplantation: donor endothelial cell density, the use of a single continuous suture type, and the surgeon (performing the surgery). For many variables, the only factor that remained significant was the surgeon. Among the factors analyzed for risks of failure post-transplantation, significant associations were observed for the donor age, the time from harvest to transplant, and the surgeon. In the multivariable analysis, donor age emerged as a significant predictor of post-transplant complications. Conclusions: Risk factors such as donor endothelial cell density, suture type, surgeon, host and donor size, and host gender were found to increase the risk of developing glaucoma post-keratoplasty. Surgeon type was identified as a significant risk factor, while donor age was predictive of post-transplant complications.
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Affiliation(s)
- Magdalena Nandzik
- Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Adam Wylęgała
- Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Dominika Szkodny
- Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Ewa Wróblewska-Czajka
- Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Edward Wylęgała
- Department of Ophthalmology, Faculty of Medical Sciences, Zabrze Medical University of Silesia, 40-760 Katowice, Poland
- Department of Ophthalmology, District Railway Hospital in Katowice, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland
| | - Bogusława Orzechowska-Wylęgała
- Department of Pediatric Otolaryngology, Head and Neck Surgery, Medical University of Silesia (SUM), 40-055 Katowice, Poland
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Paschalis EI, Zhou C, Sharma J, Dohlman TH, Kim S, Lei F, Chodosh J, Vavvas D, Urtti A, Papaliodis G, Dohlman CH. The prophylactic value of TNF-α inhibitors against retinal cell apoptosis and optic nerve axon loss after corneal surgery or trauma. Acta Ophthalmol 2024; 102:e381-e394. [PMID: 37803488 PMCID: PMC10997738 DOI: 10.1111/aos.15786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND AND PURPOSE Late secondary glaucoma is an often-severe complication after acute events like anterior segment surgery, trauma and infection. TNF-α is a major mediator that is rapidly upregulated, diffusing also to the retina and causes apoptosis of the ganglion cells and degeneration of their optic nerve axons (mediating steps to glaucomatous damage). Anti-TNF-α antibodies are in animals very effective in protecting the retinal cells and the optic nerve-and might therefore be useful prophylactically against secondary glaucoma in future such patients. Here we evaluate (1) toxicity and (2) efficacy of two TNF-α inhibitors (adalimumab and infliximab), in rabbits by subconjunctival administration. METHODS For drug toxicity, animals with normal, unburned corneas were injected with adalimumab (0.4, 4, or 40 mg), or infliximab (1, 10, or 100 mg). For drug efficacy, other animals were subjected to alkali burn before such injection, or steroids (for control). The rabbits were evaluated clinically with slit lamp and photography, electroretinography, optical coherence tomography, and intraocular pressure manometry. A sub-set of eyes were stained ex vivo after 3 days for retinal cell apoptosis (TUNEL). In other experiments the optic nerves were evaluated by paraphenylenediamine staining after 50 or 90 days. Loss of retinal cells and optic nerve degeneration were quantified. RESULTS Subconjunctival administration of 0.4 mg or 4.0 mg adalimumab were well tolerated, whereas 40.0 mg was toxic to the retina. 1, 10, or 100 mg infliximab were also well tolerated. Analysis of the optic nerve axons after 50 days confirmed the safety of 4.0 mg adalimumab and of 100 mg infliximab. For efficacy, 4.0 mg adalimumab subconjunctivally in 0.08 mL provided practically full protection against retinal cell apoptosis 3 days following alkali burn, and infliximab 100 mg only slightly less. At 90 days following burn injury, control optic nerves showed about 50% axon loss as compared to 8% in the adalimumab treatment group. CONCLUSIONS Subconjunctival injection of 4.0 mg adalimumab in rabbits shows no eye toxicity and provides excellent neuroprotection, both short (3 days) and long-term (90 days). Our total. accumulated data from several of our studies, combined with the present paper, suggest that corneal injuries, including surgery, might benefit from routine administration of anti-TNF-α biologics to reduce inflammation and future secondary glaucoma.
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Affiliation(s)
- Eleftherios I. Paschalis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Chengxin Zhou
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jyoti Sharma
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Kim
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Fengyang Lei
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - James Chodosh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Disruptive Technology Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Demetrios Vavvas
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Angiogenesis Laboratory, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Arto Urtti
- Division of Pharmaceutical Biosciences, University of Helsinki, Finland and School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - George Papaliodis
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
| | - Claes H. Dohlman
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
- Schepens Eye Research Institute, Boston Keratoprosthesis Laboratory/Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Felfeli T, Rhee J, Eshtiaghi A, Balas M, Tai F, Kaplan AJ, Christakis PG, Mandelcorn ED, Rubin LA, Bakshi NK, Derzko-Dzulynsky LA. Characteristics of ocular hypertension and uveitic glaucoma among patients with noninfectious uveitis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00035-8. [PMID: 38431271 DOI: 10.1016/j.jcjo.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/13/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Ocular hypertension and uveitic glaucoma are important downstream sequela of noninfectious uveitis (NIU). Herein, we describe the clinical outcomes of NIU cases with ocular hypertension and uveitic glaucoma. DESIGN Retrospective cohort study. PARTICIPANTS All adults (≥18 years) with NIU under the care of uveitis subspecialty tertiary care clinics between 2010 and 2021 were included. METHODS The primary outcomes were baseline and final visual acuity. RESULTS A total of 216 patients out of 914 (23.6%) cases with NIU had ocular hypertension or uveitic glaucoma over the study period. Of all patients with ocular hypertension or uveitic glaucoma, 46% were corticosteroid responders. Baseline and last median visual acuities were better for the ocular hypertension patients compared with patients with uveitic glaucoma (p < 0.001). A higher proportion of patients with uveitic glaucoma than patients with ocular hypertension required glaucoma surgery (p < 0.001). The regression analyses suggested that baseline visual acuity and anatomical classification are significant predictors of last visual acuity, whereas diagnosis of ocular hypertension versus uveitic glaucoma were significant predictors of requirement for glaucoma surgery (p < 0.001). CONCLUSION A quarter of patients with NIU in this study developed ocular hypertension or uveitic glaucoma. Approximately half of the patients with ocular hypertension or uveitic glaucoma were deemed to be corticosteroid responders. Baseline and last visual acuity outcomes are better amongst ocular hypertension patients compared with those with uveitic glaucoma. Poor baseline visual acuity and panuveitis are predictors of worse vision at last follow-up. Additionally, diagnosis of uveitic glaucoma was a significant predictor of requirement for glaucoma surgery.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON.
| | - Jess Rhee
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON
| | - Arshia Eshtiaghi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Michael Balas
- The Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Felicia Tai
- Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Alexander J Kaplan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Panos G Christakis
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Efrem D Mandelcorn
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON
| | - Laurence A Rubin
- Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
| | - Nupura K Bakshi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, ON
| | - Larissa A Derzko-Dzulynsky
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; The Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON
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Bodénès F, Eude Y, Baud'huin M, Vabres B, Weber M, Le Meur G, Orignac I. [Risk factors for failure of pre-cut eye bank UT-DSAEK grafts]. J Fr Ophtalmol 2023; 46:311-321. [PMID: 36804114 DOI: 10.1016/j.jfo.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/26/2022] [Accepted: 08/15/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The main risk factors for graft failure in penetrating keratoplasty are well known. However, few studies have examined donor characteristics or more precise data on endothelial keratoplasty. MATERIALS AND METHODS This was a retrospective, single-center study at the Nantes University Hospital, aiming to identify factors predictive of one-year success or failure of eye bank UT-DSAEK endothelial keratoplasty grafts prepared between May 2016 and October 2018. The outcome measure was success or failure at 12months post keratoplasty. RESULTS One hundred and five grafts were included: 93 successes and 12 failures at 12months. The failure rate was higher in 2016 compared to 2017 and 2018. The characteristics associated with higher failure rate were elderly donor, shorter time between harvesting and grafting, lower endothelial cell density, significant pre-graft endothelial cell loss, re-graft for Fuchs dystrophy, history of corneal transplant. DISCUSSION Our results are consistent with those in the literature. However, some factors, such as the type of corneal harvesting or pre-graft endothelial cell loss, were not found. UT-DSAEK has demonstrated better results than DSAEK, but still appears to be somewhat inferior to DMEK. CONCLUSION The main factor for graft failure in our study was an early re-graft within 12months. However, the low incidence of graft failure limits interpretation of these results.
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Affiliation(s)
- F Bodénès
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France.
| | - Y Eude
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France
| | - M Baud'huin
- Banque multi-tissus, CHU de Nantes, 9, quai Moncousu, 44000 Nantes, France
| | - B Vabres
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France
| | - M Weber
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France
| | - G Le Meur
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France
| | - I Orignac
- Clinique ophtalmologique, CHU de Nantes, 1, place Alexis - Ricordeau, 44000 Nantes, France
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Riaz KM, Gill MS, Murphy DA, Ding K, Khaimi MA. Surgical Management of Intraocular Pressure With Ab Interno Canaloplasty in Postkeratoplasty Patients: 12-Month Results. Cornea 2023; 42:52-59. [PMID: 35249980 DOI: 10.1097/ico.0000000000003009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to report clinical outcomes of ab interno canaloplasty (ABiC) with the iTrack microcatheter (Nova Eye Medical, Fremont, CA) for surgical management of intraocular pressure (IOP) in postkeratoplasty patients. METHODS This study was a single-center retrospective case series of postkeratoplasty eyes undergoing ABiC. Efficacy was evaluated based on graft survivability and mean reduction in IOP at 12 months postoperatively. Secondary end points consisted of visual acuity outcomes, number of topical hypotensive medications, and rate of complications. RESULTS ABiC was successfully performed in 17 eyes after keratoplasty (8 penetrating keratoplasty, 6 DSAEK, 2 penetrating keratoplasty + DSAEK, and 1 DMEK) with elevated IOP refractory to topical hypotensive medications. The baseline mean IOP was 26.2 ± 8.4 mm Hg and reduced significantly to 15.0 ± 4.21 mm Hg at 6 months and 13.0 ± 2.99 mm Hg at 12 months ( P < 0.005). The best-corrected visual acuity improved from 0.61 ± 0.55 logMAR at baseline to 0.47 ± 0.59 and 0.49 ± 0.64 at 6 and 12 months, respectively, following ABiC (not statistically significant: P = 0.6769). The baseline mean number of topical hypotensive medications was 3.7 ± 1.8 and reduced to 2.7 ± 1.4 and 2.9 ± 1.3 at 6 and 12 months, respectively ( P = 0.096). One patient developed a hyphema which required anterior chamber washout. One patient required additional glaucoma surgery 19 months after ABiC. No patients experienced graft failure. CONCLUSIONS ABiC is a clinically safe and effective treatment that can be performed in postkeratoplasty patients to reduce IOP for at least 1 year without any significant complications.
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Affiliation(s)
- Kamran M Riaz
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and
| | - Mohsain S Gill
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and
| | - David A Murphy
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and
| | - Kai Ding
- Hudson College of Public Health, University of Oklahoma, Oklahoma City, OK
| | - Mahmoud A Khaimi
- Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK; and
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Yin L, Liu AQ, Jin X, Jia L, Wang FX. Comparison of outcomes of idiopathic macular holes treated by vitrectomy with air or silicone oil tamponade based on the hole size. Int J Ophthalmol 2022; 15:1305-1309. [PMID: 36017041 DOI: 10.18240/ijo.2022.08.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the efficacy of vitrectomy combined with air or silicone oil in the treatment of idiopathic macular hole (IMH). METHODS According to the results of high-definition optical coherence tomography (HD-OCT), 75 cases (75 eyes) of IMH in stage II-IV (Gass stage) in the General Hospital of Chinese PLA from January 2017 to December 2019 were collected for this retrospective study. The best corrected visual acuity (BCVA) and minimum diameter of IMH (MMHD) were measured. Eyes underwent vitrectomy combined with internal limiting membrane peeling operation, and were divided into disinfection air group (30 eyes) and silicone oil group (45 eyes) according to the intraocular tamponade. For MMHD≤400 µm (MMHD1), there were 23 eyes in air group and 16 eyes in silicone oil group. For MMHD2>400 µm (MMHD2), there were 7 eyes in air group and 29 eyes in silicone oil group. One month after surgery, the closure rates of IMH and BCVA were compared and analyzed. According to HD-OCT, the closure shape was graded with A (bridge closure) and B (good closure). RESULTS The closure rates of air group and silicone oil group were 86.67% and 95.56% respectively with no significant difference (P>0.05); For MMHD1, those of air group and silicone oil group were 95.65% and 100% respectively with no significant difference (P>0.05); For MMHD2, those of air group and silicone oil group were 57.14% and 93.10% respectively, and those of the silicone oil group were higher than the air group (P<0.05). There was no significant difference in the closure shape grade between MMHD1 air group and silicone oil group (P>0.05). The proportion of Grade B in MMHD2 silicone oil group was higher than that in the air group (P<0.05). BCVA of each group after operation was better than that before operation, and there was no significant difference between air group and silicone oil group. While among them, MMHD1 air group was better than silicone oil group (P<0.05), and there was no significant difference between MMHD2 air group and silicone oil group (P>0.05). CONCLUSION For smaller IMH (≤400 µm), the efficacy of vitrectomy combined with air should be considered better than silicone oil; for larger IMH (>400 µm), the efficacy of silicone oil may be better than air.
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Affiliation(s)
- Lan Yin
- Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China
| | - An-Qi Liu
- Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China
| | - Xin Jin
- Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China
| | - Liang Jia
- Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China
| | - Feng-Xiang Wang
- Senior Department of Ophthalmology, the Third Medical Center of Chinese PLA General Hospital, Beijing 100413, China
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Davidson M, Berkowitz E, Roberts H, Wanas A, Myerscough J. Selective laser trabeculoplasty for steroid-induced ocular hypertension following endothelial keratoplasty. Curr Eye Res 2022; 47:1362-1365. [PMID: 35686724 DOI: 10.1080/02713683.2022.2088800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Purpose: To examine the safety and efficacy of selective laser trabeculoplasty (SLT) in patients responding to topical steroids with elevated intraocular pressure following endothelial keratoplasty.Methods: Patients that underwent Descemet Membrane Endothelial Keratoplasty (DMEK) or Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) were offered SLT as first-line therapy if they presented with steroid response and met inclusion criteria. Patient demographics, best-corrected visual acuity (BCVA), steroid and glaucoma regimens were recorded before and after SLT.Results: Twelve eyes of 8 patients were recruited to the study. All patients demonstrated a reduction in IOP and only one patient remained on anti-glaucoma drops after SLT. The mean (±SD) reduction in IOP following SLT was 8.8 (±4.9) mmHg (p < 0.0001). BCVA remained stable and no adverse events following treatment were observed.Conclusions: SLT may be a safe and effective treatment option that reduces topical antihypertensive burden while allowing continuance of corticosteroids in steroid-responsive eyes at high risk of rejection following endothelial keratoplasty. Larger randomized studies are needed to compare SLT efficacy with topical medication in this patient group and to review any impact on graft survival and glaucoma progression.
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Affiliation(s)
- Max Davidson
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Eran Berkowitz
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Harry Roberts
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Ahmed Wanas
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - James Myerscough
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom.,Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
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Aldarrab A, Alsakran W, Al-Swailem SA, Al-Shahwan SA. Comparison of Glaucoma Therapy Escalation After Penetrating Keratoplasty to Descemet Stripping Automated Endothelial Keratoplasty for the Treatment of Pseudophakic Bullous Keratopathy: A Cohort Study. Middle East Afr J Ophthalmol 2022; 29:72-79. [PMID: 37123424 PMCID: PMC10138129 DOI: 10.4103/meajo.meajo_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 12/01/2022] [Accepted: 01/08/2023] [Indexed: 05/02/2023] Open
Abstract
PURPOSE The purpose of this study was to compare glaucoma therapy escalation (GTE), graft survival, vision, and glaucoma following penetrating keratoplasty (PK group) and Descemet stripping automated endothelial keratoplasty (DSAEK group) to treat pseudophakic bullous keratopathy (PBK). METHODS This cohort included cases of PBK managed with PK from 2009 to 2014. We compared the incidences and determinants of GTE, graft survival, and visual disability. P < 0.05 was statistically significant. RESULTS There were 58 eyes in the PK group and 117 eyes in the DSAEK group. The incidence of GTE in the PK and DSAEK groups at the last follow-up was 34.2% (95% confidence interval [CI]: 19.5-48.9) and 46.6% (95% CI: 27.7-65.4), respectively. The risk of GTE was similar between the groups (relative risk [RR] = 1.36 [95% CI: 0.94-1.98], P = 0.12). GTE was significantly associated with graft survival in the PK group (RR = 3.25 [95% CI: 1.5-7.0], P < 0.001) and the DSAEK group (RR = 3.77 [95% CI: 2.6-5.6], P < 0.001). Glaucoma (P = 0.001) and previous keratoplasty (P < 0.001) were significant predictors for GTE. At the final follow-up visit, severe visual disability was not significantly different between the groups (RR = 0.9 [95% CI: 0.3-2.9], P = 0.88). There was a statistically significant improvement in vision after DSAEK (P < 0.001) but not after PK (P = 0.67). CONCLUSION GTE was similar in eyes with PBK managed by PK or DSAEK. Glaucoma and previous keratoplasty were predictors of GTE post-keratoplasty. DSAEK gave better visual outcomes than PK for managing PBK.
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Affiliation(s)
- Abdulrahman Aldarrab
- Department of Surgery, College of Medicine, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Address for correspondence: Dr. Abdulrahman Aldarrab, PO Box 7191, Riyadh 11462, Saudi Arabia. E-mail:
| | - Wael Alsakran
- Retina Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A. Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sami A. Al-Shahwan
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Intraocular Pressure Measurement after Penetrating Keratoplasty. Diagnostics (Basel) 2022; 12:diagnostics12020234. [PMID: 35204325 PMCID: PMC8870783 DOI: 10.3390/diagnostics12020234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/17/2022] Open
Abstract
Assessing the intraocular pressure is a difficult but crucial task in the follow-up of patients that have undergone penetrating keratoplasty. Early recognition of elevated intraocular pressure and/or glaucoma and establishment of the appropriate treatment is essential to ensure the best possible visual outcome for patients dealing with this feared complication. Although Goldmann applanation tonometry is still the gold standard for measuring the intraocular pressure, its limitations in postkeratoplasty eyes, due to postoperative modified corneal morphology, have led to the search for more suitable alternatives. This review is the result of a comprehensive literature search in the MEDLINE database that aims to present glaucoma in the context of perforating keratoplasty, the corneal properties with impact on ocular pressure measurement, and the results achieved with the most important tonometers that have been studied in this pathology. Goldmann applanation tonometry remains the reference for intraocular pressure assessment even in corneas after penetrating keratoplasty. However, some promising alternatives have emerged, the most important of which are the Pascal dynamic contour tonometry, the Tono-Pen XL, the ocular response analyzer, and the iCare. All have advantages and disadvantages but have proved to be appropriate alternatives, especially in cases in which Goldmann applanation tonometry cannot be used.
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Anders LM, Gatzioufas Z, Grieshaber MC. Challenges in the complex management of post-keratoplasty glaucoma. Ther Adv Ophthalmol 2021; 13:25158414211031397. [PMID: 34350382 PMCID: PMC8295943 DOI: 10.1177/25158414211031397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Glaucoma is a serious complication after corneal transplantation and itself a common cause for graft failure and leading cause of vision loss post-keratoplasty due to corneal endothelial decompensation. Endothelial keratoplasty procedures like Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) may be superior to penetrating keratoplasty (PK) regarding the incidence of elevated intraocular pressure (IOP) and development of glaucoma. There are indications that regardless of the method of keratoplasty, some corneal diseases like pseudophakic bullous keratopathy, corneal perforation, and graft rejection have a higher risk for developing post-keratoplasty glaucoma than keratoconus and corneal dystrophies and likewise respond less to IOP lowering therapy. In this review, the pathophysiology of post-keratoplasty glaucoma, the diagnostic tools with focus on different devices, and their limitations with regard to measuring IOP and the treatment modalities are presented.
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Affiliation(s)
- Lisa-Marie Anders
- Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
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Mohammadi Zeidi I, Morshedi H, Shokohi A. Predicting psychological factors affecting regular physical activity in hypertensive patients: Application of health action process approach model. Nurs Open 2021; 8:442-452. [PMID: 33318852 PMCID: PMC7729665 DOI: 10.1002/nop2.645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/12/2020] [Accepted: 09/08/2020] [Indexed: 11/09/2022] Open
Abstract
Aim The aim of this study was to determine the factors affecting the behaviour of regular physical activity in patients with hypertension using the health action process approach (HAPA) model. Design This cross-sectional study was conducted on 176 hypertension patients, in Astaneh-e-Ashrafiyeh, Guilan, Iran, 2018-2019. Methods Data collection tools included demographic characteristics, medical history, the short form of International Physical Activity Questionnaire (IPAQ) and scales related to the HAPA model. The data were analysed using chi-square, independent t test, one-way ANOVA, Pearson's correlation coefficient and path analysis on AMOS, version 23.0. Results Action self-efficacy (β = 0.59), outcome expectancy (β = 0.20) and risk perception (β = 0.18) had a statistically significant effect on intention. Moreover, the path coefficient between intention (β = 0.35) and coping self-efficacy (β = 0.29) with physical activity was statistically significant. The results revealed that HAPA constructs were able to describe 45% of the variance in intention and 31% of the variance in physical activity behaviour. Conclusion The HAPA model is a useful framework for describing the factors affecting physical activity in hypertension patients.
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Affiliation(s)
- Isa Mohammadi Zeidi
- Social Determinants of Health Research CenterResearch Institute for Prevention of Non‐Communicable DiseasesQazvin University of Medical SciencesQazvinIran
| | - Hadi Morshedi
- Social Determinants of Health Research CenterResearch Institute for Prevention of Non‐Communicable DiseasesQazvin University of Medical SciencesQazvinIran
| | - Abdollah Shokohi
- Student Research CommitteeQazvin University of Medical SciencesQazvinIran
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