Trabeculectomy with versus without releasable sutures for glaucoma: a meta-analysis of randomized controlled trials

Factors Correlated With Mid-Term Morphology of Functional Blebs Following Implantation of Preserflo MicroShunt Using AS-OCT

Purpose

Evaluating bleb morphology is crucial after glaucoma filtering surgery. Advances in anterior segment optical coherence tomography (AS-OCT) allow for objective assessment. While various parameters differentiate functional from failed blebs, limited information exists regarding variations within functional blebs. This study aimed to identify factors influencing morphology of functional blebs following implantation of Preserflo MicroShunt.

Methods

Eyes with functional blebs after Preserflo were retrospectively included. Age, gender, lens status, preoperative intraocular pressure (pre-IOP) and number of glaucoma medications were documented along with biometric measurements as axial length (AL), white-to-white distance, and anterior chamber depth. Postoperative data included time elapsed since surgery (TaS) and postoperative IOP (post-IOP). Bleb dimensions were measured using AS-OCT including maximal bleb height (MBH), width, length (MBL), bleb wall thickness (BWT), and bleb distance to limbus (DtL) along with dimensions of episcleral lake (maximal height, width [MLW], and length). Linear regression models were applied to correlate these parameters with bleb dimensions.

Results

Included were 50 eyes from 50 patients. Mean IOP decreased from 25.3 ± 10.0 to 11.9 ± 3.0 mm Hg after 278.5 ± 221.9 days after surgery. MBH correlated negatively with age (unstandardized coefficients [uSC] = -0.012) and TaS (uSC = -0.001, P = 0.008 for both). BWT correlated negatively with age (uSC = -0.013, P = 0.02), MBL with AL (uSC = -0.566, P = 0.01) and MLW with pre-IOP (uSC = -0.073, P = 0.02). DtL exhibited a positive correlation with post-IOP (uCS = 0.136, P = 0.02).

Conclusions

Morphology of functional blebs might be influenced by multiple factors such as age, TaS, AL, and pre- and post-IOP.

Translational Relevance

Age, time after surgery, axial length, and preoperative and postoperative IOP could affect the morphology of a functional bleb; hence, these factors should be taken into consideration when making treatment decisions.

Parallel Suture: A Simple Approach to Enable Early Laser Suture Lysis and Prevent Hypotony after Trabeculectomy

PURPOSE

To define a modified flap suture approach and evaluate its effectiveness.

METHODS

Clinical data of patients undergoing trabeculectomy with modified parallel suture technique (Group 1, N = 38 eyes) were compared to patients operated with classical flap suture technique (Group 2, N = 42 eyes). In the modified technique, two parallel sutures (one tight and one loose) are placed simultaneously in one of the flap corners with the aim of obtaining a safety stitch when the tight one needs to be cut. Data from preoperative and postoperative visits at day 1, week 1, months 1, 3, 6 and year 1 were recorded from patient charts and compared between the groups.

RESULTS

In Group 1, seven eyes underwent laser suture lysis (LSL) between postoperative days 2 to 8 and in Group 2 two eyes at days 29 and 37. No complication related to LSL was observed. Rate of postoperative hypotony decreased with the parallel suture approach (P= .002). Number of eyes experiencing any of the complications related to hypotony was lower in Group 1 (P= .004). No significant difference was noted in the mean IOP between the groups (P> .05 for all).

CONCLUSION

The modified approach with parallel suture technique was found to be effective and safe. By enabling early LSL, it provided more precise IOP modulation in the early postoperative period. Thus, in our series, the rate of hypotony and hypotony-related complications decreased, while the success of the surgery was preserved.

Results of modified CO2 laser-assisted sclerectomy monotherapy versus trabeculectomy combination therapy in the eyes with uveitic glaucoma

This study compared the efficacy of modified CO₂ laser-assisted sclerectomy surgery (CLASS) with combined CLASS and trabeculectomy (CLASS-TRAB) in patients with uveitic glaucoma (UG). UG patients who underwent CLASS-TRAB between August 2015 and April 2019 were retrospectively compared with a control group who underwent a modified CLASS standalone procedure during the same period. Visual acuity, intraocular pressure (IOP), use of supplemental medical therapy and postoperative complications were recorded at baseline, 1 week, 3 months, 6 months and 12 months. Forty patients (40 eyes) were enrolled, and each group had 20 patients (20 eyes). The age and sex distribution were matched between groups (P > 0.05). Both the preoperative IOP (CLASS: 34.9 ± 9.3 mmHg, CLASS-TRAB: 36.8 ± 8.7 mmHg; P > 0.05) and number of glaucoma medications (CLASS: 3.3 ± 0.4, CLASS-TRAB: 3.5 ± 0.5; P > 0.05) were relatively higher in the CLASS-TRAB group than in the CLASS group. At the final follow-up, the IOP (CLASS: 12.9 ± 3.4 mmHg, CLASS-TRAB: 11.2 ± 2.5 mmHg) and number of glaucoma medications (CLASS: 0.4 ± 0.7 and CLASS-TRAB: 0.2 ± 0.5) significantly decreased in both groups (P < 0.01). Both the complete success rate and qualified success rate were comparable between the two groups (CLASS versus CLASS-TRAB: 55% versus 80%, P = 0.09; 80% versus 95%, P = 0.34). CLASS-TRAB is as efficient as modified CLASS in terms of the IOP-lowering effect, providing a new option for patients with UG that is severe and ineligible for other treatments.

Trabeculectomy: is releasable suture trabeculectomy a cause of better bleb?

Purpose: To compare the outcome of fixed suture trabeculectomy with releasable suture trabeculectomy in terms of IOP control, bleb morphology, complications and need of antiglaucoma medication post-surgery.

Methods: This study enlisted 200 cases of open angle glaucoma, whose IOP was uncontrolled despite maximal medication. Trabeculectomy was performed using releasable suture in one group of 100 patients and fixed suture in another group of 100 with mitomycin 0.02% in both groups. The study was randomized, the method being the simple randomization. Fornix based trabeculectomy was done in both groups. Two 10-0 nylon releasable sutures were used at two corners of the rectangular flap and one fixed 10-0 vicryl suture was used in the center of the flap. Two mattress sutures (conjunctiva cornea) were also used. Essentially, all the sutures were removed postoperatively over a period of 2-4 weeks depending upon the level of IOP. Mitomycin c 0.02% was used in both groups.

Results: The mean preoperative intraocular pressure was 33 ± 12 mmHg in the single suture group and 39 ± 13 mmHg in the releasable suture group (p). We observed a highly significant reduction of intraocular pressure at all times in both groups compared with the preoperative intraocular pressure (P, 0.0001). There was an obvious difference between the bleb morphology between conventional trabeculectomy and releasable suture trabeculectomy. Blebs in releasable suture trabeculectomy were more diffuse, low lying and presented a more ideal vascularity.

Conclusion: Releasable suture trabeculectomy is a far much better technique than conventional trabeculectomy. Results are very good in terms of IOP control, post-operative complications, and bleb morphology. They may possibly have a role in wound modulation thereby achieving an ideal bleb, though more large sample studies need to be done.

Secondary epiretinal membrane after Ex-Press glaucoma filtration device implant

Purpose

To estimate the frequency of epiretinal membrane (ERM) in eyes with primary open-angle glaucoma (POAG) treated with Ex-Press shunt implant. Secondarily, we aimed to assess the role of concomitant cataract surgery and the impact of the ERM on central foveal thickness and macular volume.

Methods

In this prospective, consecutive, case-control study, we enrolled 54 patients affected by PAOG and scheduled for Ex-Press device implant with or without contemporary phacoemulsification. Contralateral eyes affected by POAG and receiving anti-glaucomatous eyedrops constituted the control group. Complete ophthalmologic evaluation and spectral-domain optical coherence tomography (OCT) were performed before and 1, 3 and 6 months after surgery.

Results

Twenty-six eyes received the Ex-Press implant alone, and 28 eyes underwent the combined procedure. Six months postoperatively, we observed 18 (33%) cases of ERM: 15 (28%) of cellophane macular reflex (CMR) and 3 (6%) of pre-macular fibrosis (PMF). In the control group, 9 (17%) eyes developed an ERM: 8 (15%) were CMR, and 1 (2%) was PMF. The frequency of ERM statistically differs between treated and contralateral eyes (P = 0.032, χ² test). The ERM frequency did not statically differ between eyes subjected to simple or combined surgery (P = 0.846, χ² test). Mean central foveal thickness and mean macular volume did not significantly differ between groups.

Conclusion

The Ex-Press glaucoma shunt may increase the risk of ERM onset regardless of the concomitant cataract surgery; however, most cases were cellophane macular reflex with limited functional and anatomical impact.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00417-020-05025-8.

Stab incision mitomycin C-assisted rapid trabeculectomy: A 'SMART' trabeculectomy alternative

The aim of the present study was to introduce a new modified trabeculectomy technique, stab incision mitomycin C (MMC)-assisted rapid trabeculectomy (SMART), which requires less surgical time and tissue manipulation. A total of 41 eyes with indication for trabeculectomy underwent glaucoma surgery with the SMART technique; superior subconjunctival injection of 0.005 mg MMC mixed with 0.1 ml lidocaine, followed by small, fornix base conjunctival opening. A stab incision was made to enter the anterior chamber 1.5 mm post-limbus using a 2.4 mm cataract knife. Double 0.75 mm punch and peripheral iridectomy were performed. A releasable suture was placed in the scleral opening, and matrix sutures to close conjunctiva. The preoperative mean intraocular pressure (IOP) was 23.8 mmHg, with a mean number of medications of 3.3. The mean follow-up duration was 27.6 months, with a range of 12-46 months. A year post-surgery, the mean IOP was 11 mmHg, with a mean number of medications of 0.7, corresponding to a reduction of 12.8 mmHg in IOP and 2.6 in the number of medications. During follow-up, additional 5-fluorouracil injections were administered when needed. In conclusion, SMART with wound modulation appears to be a safe and quick alternative to classic trabeculectomy. Few minor and no major complications were observed during the first 2.5 years of follow-up, with all eyes maintaining an IOP <15 mmHg.

[Treatment success of canaloplasty and trabeculectomy by the same surgeon with the same level of experience in the long-term course]

BACKGROUND

Trabeculectomy (TE) with the use of antimetabolites is the standard procedure in glaucoma surgery, whereas canaloplasty (CP) is a nonpenetrating and potentially less invasive alternative.

OBJECTIVE

The aim of this retrospective case series was to compare the long-term success of CP and TE under the same conditions and with the same levels of experience of the surgeon as well as to investigate whether preoperative intraocular pressure (IOP) and postoperative IOP correlate with eachother.

METHODS

The study included 57 eyes that underwent either CP or TE (CP n = 27; male = 50.0% age 60.7 ± 13.2 years; TE n = 30; male = 55.6% age 68.0 ± 9.1 years). Each of the procedures was performed by the same surgeon with comparable levels of experience. The comparison included preoperative and postoperative visual field damage, preoperative and postoperative IOP (mm Hg) after 1 and 6 weeks, 6 and 12 months as well as in the long-term course (1-3 years) and the necessary local treatment at the corresponding times.

RESULTS

With both methods no worsening of the visual field could be detected and the patient groups showed comparable preoperative and postoperative mean deviations (MD). The CP showed a positive correlation between preoperative and postoperative 1‑year IOP (r = 0.4; p = 0.022), whereas TE showed no significant correlation between preoperative and postoperative IOP. The count of local antiglaucoma medication in long-term comparison (1-3 years after surgery) was higher after CP than after TE (1.5 ± 1.6 vs. 0.5 ± 0.8; p = 0.003). In both groups there were no severe postoperative complications. The overall success rates (without treatment) were higher at all time points after TE.

DISCUSSION

With both methods conducted by the same surgeon with the same levels of experience, an effective reduction of the IOP was achieved. It seems that the higher the preoperative IOP before CP, the higher the achievable pressure after 1 year and in the long term. In contrast, after TE the IOP was effectively reduced in the long term regardless of the initial IOP. The CP seems to be inferior to TE under the same conditions with respect to complete surgical success (without local treatment).

Evaluating glaucoma surgeries in the MIGS context

The challenges of glaucoma management are many: the disease is chronic, progressive, often asymptomatic, and very often, the quality of life and costs of treatment is unacceptable to the patient. This is true for both medical therapy and conventional glaucoma surgery. The choice of therapy, especially the transition from the former to the latter, is now being bridged by Minimally Invasive Glaucoma Surgeries (MIGS). Choosing from the several options now available in the surgical armamentarium requires a deeper understanding of the available modalities. This review aims to provide an overview of the decision-making process, keeping in mind age, type of glaucoma, life expectancy, socioeconomic status, patient expectations, and coexisting cataract.

The prognosis of trabeculectomy in primary angle-closure glaucoma patients

AIM

To evaluate whether the level of thrombospondin-1 (TSP-1) in aqueous humor can predict the prognosis of trabeculectomy in patients with primary angle-closure glaucoma (PACG).

METHODS

This case-control study involved 26 patients with PACG who experienced a failed trabeculectomy (case group) and 78 age- and sex-matched patients with PACG who underwent successful trabeculectomy (control group). Aqueous humor was collected at the time of trabeculectomy and tested for TSP-1 and TGF-β2 levels with an enzyme-linked immunosorbent assay method. Logistic regression modeling was used to assess the risk factors for failed trabeculectomy.

RESULTS

The mean TSP-1 aqueous concentrations were significantly higher in the case group (20.67±9.79 ng/mL) than the control group (5.17±2.29 ng/mL) (P<0.001). The transforming growth factor-β2 (TGF-β2) aqueous concentrations were significantly different between the case and control group, at 3633.25 and 1090.24 pg/mL, respectively (P<0.001). Logistic regression analysis revealed TSP-1 level as an independent risk factor for a failed trabeculectomy (OR=3.540; 95%CI=1.092-11.482).

CONCLUSION

The aqueous humor TSP-1 and TGF-β2 levels are higher in PACG eyes with failed trabeculectomy than with successful trabeculectomy at one year. The aqueous humor TSP-1 level is an independent risk factor associated with failed trabeculectomy.

Revisiting Results of Conventional Surgery: Trabeculectomy, Glaucoma Drainage Devices, and Deep Sclerectomy in the Era of MIGS

How to cite this article: Bhartiya S, Dhingra D, et al. Revisiting Results of Conventional Surgery: Trabeculectomy, Glaucoma Drainage Devices, and Deep Sclerectomy in the Era of MIGS. J Curr Glaucoma Pract 2019;13(2):45–49.

Treatment of Advanced Glaucoma Study: a multicentre randomised controlled trial comparing primary medical treatment with primary trabeculectomy for people with newly diagnosed advanced glaucoma-study protocol

BACKGROUND

Presentation with advanced glaucoma is the major risk factor for lifetime blindness. Effective intervention at diagnosis is expected to minimise risk of further visual loss in this group of patients.

AIM

To compare clinical and cost-effectiveness of primary medical management compared with primary surgery for people presenting with advanced open-angle glaucoma (OAG).

METHODS

Design: A prospective, pragmatic multicentre randomised controlled trial (RCT).

SETTING

Twenty-seven UK hospital eye services.

PARTICIPANTS

Four hundred and forty patients presenting with advanced OAG, according to the Hodapp-Parish-Anderson classification of visual field loss.

INTERVENTION

Participants will be randomised to medical treatment or augmented trabeculectomy (1:1 allocation minimised by centre and presence of advanced disease in both eyes).

MAIN OUTCOME MEASURES

The primary outcome is vision-related quality of life measured by the National Eye Institute-Visual Function Questionnaire-25 at 24 months. Secondary outcomes include generic EQ-5D-5L, Health Utility Index-3 and glaucoma-related health status (Glaucoma Utility Index), patient experience, visual field measured by mean deviation value, logarithm of the mean angle of resolution visual acuity, intraocular pressure, adverse events, standards for driving and eligibility for blind certification. Incremental cost per quality-adjusted life-year (QALY) based on EQ-5D-5L and glaucoma profile instrument will be estimated.

RESULTS

The study will report the comparative effectiveness and cost-effectiveness of medical treatment against augmented trabeculectomy in patients presenting with advanced glaucoma in terms of patient-reported health and visual function, clinical outcomes and incremental cost per QALY at 2 years.

CONCLUSIONS

Treatment of Advanced Glaucoma Study will be the first RCT reporting outcomes from the perspective of those with advanced glaucoma.

TRIAL REGISTRATION NUMBER

ISRCTN56878850, Pre-results.

Relationship between epithelial cell adhesion molecule (EpCAM) overexpression and gastric cancer patients: A systematic review and meta-analysis

OBJECTIVES

The epithelial cell adhesion molecule (EpCAM) is one of the most commonly used markers of cancer stem cells (CSCs), but the clinical and prognostic significance of EpCAM in gastric cancer (GC) remains disputable. Motivated by heterogeneous and inconclusive results, we conducted a systematic review and meta-analysis to systematically summarize and elucidate the association between EpCAM overexpression and GC patients.

METHODS

The PubMed, Cochrane Library, Medline, Web of Knowledge and the China National Knowledge Infrastructure (CNKI) databases were searched to identify relevant studies. The RevMan 5.3 software was used for the meta-analysis. Fixed-effects or random-effects models were applied depending on the presence of heterogeneity. The pooled odds ratio (ORs) and 95% confidence intervals (CIs) were applied to estimate the associations between EpCAM and gastric cancer. For the significant heterogeneity studies, sensitivity analyses were applied based on the population to test the robustness of the pooled results and identify possible sources of heterogeneity.

RESULTS

A total of 11 studies including 1960 GC patients met our inclusion criteria. The results of the meta-analyses revealed that there were significant differences in EpCAM overexpression and tumour size (OR = 2.97, 95% CI: 2.13~4.13, P < 0.00001), the nature of the tissue (OR = 80.30, 95% CI: 29.21~220.81, P < 0.00001), lymph node metastasis (OR = 2.78, 95% CI: 1.23~6.27, P = 0.01), and the cumulative 5-year overall survival rate (OR = 0.54, 95% CI:0.29~0.99, P = 0.05). No significant associations were identified between EpCAM overexpression and gender (OR = 0.89, 95% CI: 0.66~1.19, P = 0.43), age (OR = 1.13, 95% CI: 0.58~2.20, P = 0.73), tumour stage (OR = 2.26, 95% CI: 0.79~6.45, P = 0.13), distant metastasis (OR = 2.15, 95% CI: 0.20~22.69, P = 0.52), TNM stage (OR = 5.14, 95% CI: 0.77~34.37, P = 0.09), Lauren type (OR = 1.18, 95% CI: 0.08~16.45, P = 0.9), differentiation (OR = 1.88, 95% CI: 0.65~5.41, P = 0.24). However, due to significant heterogeneity in tumor stage, lymph node metastasis, TNM stage, differentiation and Lauren type, these results should be taken carefully.

CONCLUSIONS

The meta-analysis demonstrated that the expression of EpCAM in the gastric cancer group was greater than that in the control group. Moreover, EpCAM overexpression was associated with larger tumour size, lymphnode metastasis and worse prognosis in gastric cancer. Due to significant heterogeneity, the sensitivity analysis suggests that population factor may be an important source of heterogeneity, and these results should be treated with caution. EpCAM may be useful as a novel prognostic factor, and large-scale and well-designed studies are needed to validate our results in the future.

Choroidal thickness in pregnant women: a cross-sectional study

AIM

To investigate choroidal thickness in pregnant women and compare the measurements with those of normal nonpregnant women.

METHODS

Using enhanced depth imaging optical coherence tomography (EDI-OCT), choroidal thickness was measured at the fovea and at 1 mm and 3 mm superior, inferior, temporal, and nasal to the fovea in both healthy pregnant women and nonpregnant women. Pearson correlation analysis was performed to evaluate the relationships between subfoveal choroidal thickness (SFCT) and the demographic and ocular parameters. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed-effects model when Meta-analyses were conducted.

RESULTS

Comparison of choroidal thickness between the groups showed that it was significantly greater in healthy pregnant women's eyes than in normal nonpregnant women's eyes at all locations except at 3 mm superior and 3 mm temporal from the fovea (P<0.05). The mean SFCT was 344.13±50.94 µm in healthy pregnant women's eyes and 315.03±60.57 µm in normal nonpregnant women's eyes, with a statistically significant difference (P=0.008). Pearson correlation analysis showed that age and axial length were significantly related to SFCT in healthy pregnant women, normal nonpregnant women, and all subjects. The results of our cross-sectional study were consistent with the results of the further Meta-analysis, with a pooled weighted mean difference (WMD) of 33.66 µm (95% CI: 26.16 to 41.15) for SFCT.

CONCLUSION

Our results, along with the comprehensive Meta-analysis, suggest that choroidal thickness in healthy pregnant women is greater than that in normal nonpregnant women.

Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

PURPOSE

To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma naïve of previous filtering surgery.

METHODS

Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP) > 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP > 5 mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP > 5 mmHg and IOP < 21 mmHg with possible re-intervention and without hypotensive medication adjunction) at the last follow-up visit and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared with baseline, medication use, complications and re-interventions.

RESULTS

Intra-ocular pressure was significantly reduced (p < 0.05) from a mean pre-operative value of 28.2 ± 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 ± 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Qualified success was achieved in 63% of eyes (19/30) (mean IOP reduction of 37% in these eyes) and complete success in 46.7% of eyes (14/30) (mean IOP reduction of 37% in these eyes) at the last follow-up. No major intra- or post-operative complications occurred.

CONCLUSIONS

The UC(3) procedure seems to be an effective and well-tolerated method to reduce IOP in patients with open-angle glaucoma without previous filtering surgery.

Postoperative management of trabeculectomy and glaucoma drainage implant surgery

PURPOSE OF REVIEW

This article describes important aspects of postoperative management after trabeculectomy and glaucoma drainage implant surgery.

RECENT FINDINGS

Postoperative management of glaucoma drainage implant surgery includes stabilization of intraocular pressure, possible ligature release, and management of complications such as corneal edema, and tube/plate exposure. Postoperative management of trabeculectomy includes evaluation of bleb encapsulation, management of hypotony, and assessment of need for adjuvant therapy. Recent advances in surgical techniques, device/tissue availability, and imaging continue to shape the postoperative course.

SUMMARY

Careful preoperative planning and postoperative care may decrease the likelihood of complications in tube surgery or trabeculectomy.

Comparison of 3 different releasable suture techniques in trabeculectomy

PURPOSE

The use of releasable sutures provides an effective and simple way of titrating intraocular pressure (IOP) postoperatively. The purpose of this study was to compare the surgical outcome of 3 releasable suture techniques for closing scleral flaps in patients undergoing primary trabeculectomy.

METHODS

The Wills Eye Glaucoma Research Center retrospectively reviewed the charts of patients who underwent primary trabeculectomy by 3 surgeons using 3 different releasable suture techniques. Ninety eyes of 90 glaucoma patients were divided into 3 groups by releasable suture technique (n = 30 eyes for each group). Main outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), rate of surgical success, use of supplemental medical therapy, need for additional glaucoma surgery, and complications during suture removal.

RESULTS

The BCVA and IOP were similar among the groups for all follow-up visits. As a determinant of success rate of trabeculectomy, mean decrease of IOP after surgery was over 30% in all groups (p = 0.43). The number of postoperative antiglaucomatous medications, number of complications, and need for an additional glaucoma surgery were similar in all groups (p = 0.40, p = 0.87, and p = 0.47, respectively). The differences in suture-related complications, defined as suture break or need for laser suture lysis, were not significant among the groups (p = 0.09).

CONCLUSIONS

We found that the 3 most common surgical techniques had similar mechanisms of action. All techniques were safe and effective, yielding similar outcomes. All 3 techniques can be used for closing scleral flaps in patients undergoing primary trabeculectomy.

Choroidal thickness and high myopia: a cross-sectional study and meta-analysis

Background

The purpose of this study was to examine the choroidal thickness of patients with high myopia using enhanced depth imaging optical coherence tomography (EDI-OCT) and compare them with healthy subjects.

Methods

We first conducted a cross-sectional study and then performed a meta-analysis to address this issue further. Using enhanced depth imaging optical coherence tomography (EDI-OCT), the macular choroidal thickness of high myopic eyes and normal control eyes were measured and compared at each location. Univariate and multivariate linear regression analyses were performed to assess the association between choroidal thickness and clinical factors such as axial length (AL), spherical equivalent (SE), and central corneal thickness. In the high myopic eyes, subgroup analysis of macular choroidal thickness was performed in eyes with or without lacquer cracks and choroidal neovascularization (CNV). The meta-analyses were conducted using the Stata software package.

Results

The high myopic eyes had a thinner choroid than the control eyes at all macular locations (all P < 0.001). Multivariable linear regression analysis showed that the subfoveal choroidal thickness (SFCT) was not significantly thinner in association with the diagnosis. Subgroup analysis showed that the high myopia with CNV and with lacquer cracks had a significantly thinner choroid than without CNV or lacquer crack eyes. The result of our cross-sectional study is consistent with the results of the further meta-analysis with the pooled weighted mean difference (WMD) of −116.30 μm (95 % CI: −145.68, −86.92) for SFCT.

Conclusions

The present study, along with the comprehensive meta-analysis, indicated that in the Chinese population, the choroidal thickness in high myopic eyes was thinner than that of normal control eyes, even across different subgroups. This might be secondary to the longer AL but it is not an independent factor. The presence of CNV and of lacquer cracks is associated strongly with eyes with thinner macular choroids.

Association of TCF4 polymorphisms and Fuchs' endothelial dystrophy: a meta-analysis

Background

Studies investigating the associations between transcription factor 4 (TCF4) genetic polymorphisms and Fuchs’ endothelial dystrophy (FED) have reported controversial results. Therefore, this meta-analysis aims to clarify the effects of TCF4 polymorphisms on FED risk.

Methods

A meta-analysis was conducted to assess the association between four single nucleotide polymorphisms (SNPs) inTCF4 and the risk of FED. Relevant studies were selected through an extensive search of PubMed, EMBASE, and the Web of Science databases. Pooled odds ratio (OR) and 95 % confidence interval (CI) were calculated using the random-effects model.

Results

Thirteen studies were included in this systematic review and meta-analysis. The pooled results showed that there was a strong positive association between the TCF4 rs613872 polymorphism and FED risk in all the genetic models tested (G allele vs. T allele: OR = 4.19, 95 % CI = 3.53–4.97; GG vs. GT/TT: OR = 4.27, 95 % CI = 2.54–7.19; GG/GT vs. TT: OR = 6.29, 95 % CI = 4.23–8.93; GG VS. TT: OR = 10.64, 95 % CI = 5.28–21.41; GT VS. TT: OR = 6.08, 95 % CI = 4.28–8.64). Statistic evidence was also detected for a significant association between three other SNPs and the risk of FED.

Conclusions

This meta-analysis suggested a genetic association between four TCF4 polymorphisms (rs613872, rs2286812, rs17595731, and rs9954153) and the risk of FED.