Global cross-cultural validation of a brief measure for identifying potential suicide risk in 42 countries

OBJECTIVES

This study aimed to examine the psychometric properties of the P4 suicide screener in a multinational sample. The primary goal was to evaluate the reliability and validity of the scale and investigate its convergent validity by analyzing its correlation with depression, anxiety, and substance use.

STUDY DESIGN

The study design is a cross-sectional self-report study conducted across 42 countries.

METHODS

A cross-sectional, self-report study was conducted in 42 countries, with a total of 82,243 participants included in the final data set.

RESULTS

The study provides an overview of suicide ideation rates across 42 countries and confirms the structural validity of the P4 screener. The findings indicated that sexual and gender minority individuals exhibited higher rates of suicidal ideation. The P4 screener showed adequate reliability, convergence, and discriminant validity, and a cutoff score of 1 is recommended to identify individuals at risk of suicidal behavior.

CONCLUSIONS

The study supports the reliability and validity of the P4 suicide screener across 42 diverse countries, highlighting the importance of using a cross-cultural suicide risk assessment to standardize the identification of high-risk individuals and tailoring culturally sensitive suicide prevention strategies.

Comparison of Safety and Efficacy of Hydrus and iStent Combined with Phacoemulsyfication in Open Angle Glaucoma Patients: 24-Month Follow-Up

The paper presents the results of a 24-month-long observation comparing the effectiveness and safety of two micro-invasive glaucoma surgery (MIGS) devices: Hydrus Microstent and iStent Trabecular Bypass in combination with cataract phacoemulsification in the treatment of open-angle glaucoma. We also analyzed the impact of preoperative factors on achieving surgical success in both surgical methods. The prospective, comparative, non-randomized study included 65 glaucoma surgeries. In 35 patients (53.8%), an iStent implant procedure was performed, while 30 patients (46.2%) underwent a Hydrus implant procedure. The demographic data was similar in both treatment groups. At 24 months after surgery, the mean IOP in the iStent group was 15.9 ± 3.0 mmHg and in the Hydrus group 16.2 ± 1.8 mmHg. The difference between the mean iStent vs Hydrus after two years of treatment was -0.3 (p = 0.683). At the 24 month follow-up, the average change in the number of antiglaucoma medications used was 71.7% in the iStent group and 79.6% in the Hydrus group. The difference in mean percentage change between groups was 7.9% in favor of Hydrus. Patients under the age of 70 may benefit from a greater risk reduction in the Hydrus group (HR = 0.81), while those over the age of 70 may benefit from a risk reduction in the iStent group (HR = 1.33). IOP cases with >18 mmHg before the surgery have a better chance of surgical success with the Hydrus method (HR = 0.28), and with IOP < 18 mmHg in the iStent group (HR = 1.93). Cases with more drugs (≥3 drugs) are more favorable in the Hydrus group (HR = 0.23), while those with a maximum of two drugs have a better prognosis in the iStent group (HR = 2.23). The most common postoperative complication was the presence of erythrocytes in the anterior chamber (AC), found in 40.0% of operated eyes in the Hydrus group. The profile of observed complications and significant improvement in visual acuity allows us to consider both implants as a safe way of treating patients with early or moderate glaucoma and co-existing cataracts.

Schlemm's canal: the outflow 'vessel'

In a healthy eye, the aqueous humour (AH) flows via the ciliary body and trabecular meshwork into the collector channels, which carry it to the episcleral veins. In glaucoma, a heterogeneous group of eye disorders affecting approximately 60 million individuals worldwide, the juxtacanalicular meshwork offers greater resistance to the outflow of the AH, leading to an increase in outflow resistance that gradually results in elevated intraocular pressure (IOP). The present review comprehensively covers the morphology of Schlemm’s canal (SC) and AH pathways. The path of the AH from the anterior chamber through the trabeculum into suprascleral and conjunctival veins via collector channels is described, and the role of SC in the development of glaucoma and outflow resistance is discussed. Finally, channelography is presented as a precise method of assessing the conventional drainage pathway and facilitating localization of an uncollapsed collector and aqueous veins. Attention is also given to the relationship between aqueous and episcleral veins and heartbeat. Possible directions of future research are proposed.

Microinvasive glaucoma surgery: a review and classification of implant-dependent procedures and techniques

The aim of this article is to discuss how physiology and anatomical background affect the effectiveness of implant‐dependent microinvasive glaucoma surgery (MIGS). First, we provide a micro view of aqueous outflow and tissue behaviour. Second, we review studies exploring the mechanisms of the pressure‐lowering effect of MIGS, as well as tissue behaviour during aqueous flow and tissue motion. We also describe and classify microinvasive surgical procedures and the most important types of implants, as well as their mechanisms of action, implantation techniques and efficacy. Further, we summarize the indications and surgical results presented in recent studies, providing an evidence‐based update on novel and emerging MIGS techniques for the treatment of open‐angle glaucoma. These data can help surgeons to personalize the management of glaucoma and to choose the best MIGS option for individual glaucoma patients.

XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery

This retrospective study analyzed the surgical and refractive outcomes of a XEN Gel Implant (Allergan, Abbvie Company, Irvine, CA, USA) in naïve patients versus those with previous glaucoma surgery. We evaluated the efficacy of XEN implantation in 86 glaucoma patients during a long-term follow-up period. Patients were divided into two groups: naïve patients (Group 1) and patients with previous glaucoma surgery (Group 2). Eyes that received a XEN Gel Stent placement from December 2014 to October 2019 were included. Intraocular pressure (IOP) change, corrected distance visual acuity (CDVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. In Group 1, the mean IOP before surgery was decreased significantly from 25.00 ± 7.52 mmHg to 16.83 ± 5.12 mmHg by the end of the study. In Group 2, the mean IOP decreased significantly from 25.35 ± 7.81 mmHg to 17.54 ± 5.34 mmHg. The mean IOP decrease from baseline was 29% in Group 1 and 27% in Group 2 (p = 0.567). There were no significant differences between the groups in the IOP baseline level, the final level, or the change between preoperative and final levels. The qualified success rate for Group 2 was 68.7% versus 76.5% for Group 1 for the initial procedure and 15.4% vs. 20.2%, respectively, for complete success rate (p > 0.05). However, at the end of the follow-up, more patients achieved an IOP < 18 mmHg in Group 1 than in Group 2. Despite the need for more anti-glaucoma medications, repeat XEN Gel implantation appears to show promising results in patients with previously failed anti-glaucoma procedures, owing to its minimal invasiveness.

Microinvasive Glaucoma Surgery: A Review of Schlemm's Canal-Based Procedures

Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm’s canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome^®, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.

Changes in spectral parameters of corneal pulse following canaloplasty

PURPOSE

To ascertain whether changes in the spectral content of the corneal pulse (CP) signal, measured in vivo in primary open-angle glaucoma (POAG) patients, indirectly reflect changes in corneal biomechanics after canaloplasty.

METHODS

Fifteen eyes of 15 POAG patients who underwent canaloplasty combined with phacoemulsification were enrolled. Standard ophthalmic examinations were conducted before washout, pre-operatively, at days 1, 7, and 1, 3, 6, and 12 months after surgery. Non-contact measurements of the CP signal were performed at pre-washout, pre-operatively, and at 3, 6, and 12 months post-operatively. Then, amplitudes of the CP first five harmonics associated with the heart rate were estimated. Temporal changes of all considered parameters were tested at a Bonferroni-adjusted significance level set to 0.005.

RESULTS

A decrease in the amplitude of the first harmonic and an increase in the normalized amplitude of the third harmonic (A_CP3n) of the CP signal were noticed between the pre-washout and the pre-operative stages (p = 0.003 and p = 0.004, respectively). This corresponds to an increase in median intraocular pressure (IOP) values by 6.0 mmHg (p = 0.0045). After surgery, A_CP3n reached the highest value at 3 months post-operatively, compared with pre-washout level (p = 0.0045).

CONCLUSIONS

Alterations in corneoscleral stiffness caused by surgery are reflected in changes in the A_CP3n value. Hence, post-operative corneal biomechanics could be monitored indirectly by this supporting indicator that can be used to estimate the time at which measures of IOP are no longer biased by the changed cornea boundary conditions caused by canaloplasty.

CLINICAL TRIALS REGISTRATION

NCT02908633.

Phacoemulsification-deep sclerectomy modified by trabeculum microperforations and implantation of lens anterior capsule as autologous scleral implant

OBJECTIVE

To evaluate the efficacy and safety of Phacoemulsification-deep sclerectomy modified by trabeculum microperforations and anterior lens capsule as autologous scleral implant (mPDS) for open-angle glaucoma.

RESEARCH DESIGN AND METHOD

A case series study comprised 127 patients and 127 eyes after mPDS. The applied modification of deep sclerectomy consisted in creating microperforations within the posterior trabeculum and in fixing the anterior lens capsule, removed during phacoemulsification, in the scleral lake as an autologous intrascleral implant. Primary open-angle glaucoma without satisfying intraocular pressure (IOP) control (>or=21 mmHg) despite maximally tolerated medications or with progression of visual field and cataract was the indication for surgery. For statistical analyses paired Student's t-test, the Wilcoxon signed rank test and one-dimensional ANOVA with repeated measures were used; survival analysis was performed using the Kaplan-Meier method.

MAIN OUTCOME MEASURES

IOP, number of medications and best corrected visual acuity (BCVA) were examined. On the basis of the assessment of the anterior and posterior segments of the eye, the character and also the degree of intensification of postoperative complications were established. Follow-up examinations were performed on days 1 and 7, and at 1, 3, 6, 12, 18 and 24 months and thereafter every 6 months. The complete success rate was defined as IOP <or= 18 mmHg without, and the qualified success rate as IOP <or= 18 mmHg with and without antiglaucoma medications.

RESULTS

The mean follow-up was 32.2 +/- 9.1 months. Mean IOP decreased by 30.4%. Mean IOP decreased from 20.1 +/- 5.1 to 14.0 +/- 2.9 mmHg (p < 0.001). The mean number of medications was reduced from 2.2 +/- 0.7 to 0.6 +/- 0.8 (p < 0.001). Complete and qualified success rates were 74.4 % and 93.3 %, respectively. Mean logMAR of BCVA changed from 0.52 +/- 0.40 to 0.16 +/- 0.16 (p < 0.001). Subconjunctival 5-FU injections together with suturolysis because of bleb fibrosis were performed in 20 eyes, which represented 15.7% of the cases operated on. 5-FU-induced complications involved corneal epitheliopathy in nine eyes (7.1 % of cases) and irregular astigmatism in one eye (0.8% of cases). Among early complications the most frequent was transient hypotony observed in 55 eyes (41.7% of cases).

LIMITATIONS

The explanation of the role of the anterior capsule in the mechanism of mPDS requires inclusion into the study of histological observations of surgeries performed on an animal model as well as prospective ultrasound biomicroscopy (UBM) examinations performed in humans.

CONCLUSIONS

Phacoemulsification-deep sclerectomy modified by trabecular microperforations and anterior capsule as a scleral implant lead to an effective decrease in the IOP in medium-term follow-up. The profile of the observed complications indicates that it can be a safe procedure. However, a larger group of patients should be observed to confirm this.

Combined surgery for cataract and glaucoma: PDS with absorbable SK-gel implant compared with PDS with non-absorbable T-flux implant - medium-term results

OBJECTIVE

To compare the efficacy and safety of phacoemulsification - deep sclerectomy (PDS) with absorbable SK-gel or non-absorbable T-flux implantation.

RESEARCH DESIGN AND METHOD

The study involved eyes after PDS with SK-gel (32 eyes) and T-flux (20 eyes). Primary open angle glaucoma without satisfying intraocular pressure (IOP) control (> or =21 mmHg) despite maximally tolerated medication or with progression of the visual field and cataract was the indication for surgery. For statistical analyses, the Mann-Whitney U test, Student's t-test, pair sequence Wilcoxon test, and analysis of variance were used. Survival analysis was done using the Kaplan-Meier method.

MAIN OUTCOME MEASURES

The best corrected visual acuity (BCVA), IOP, anterior and posterior segments of the eye, and number of antiglaucoma medications were examined. Follow-up examinations were performed on days 1 and 7, and at 1, 3, 6, 12, 18 and 24 months. A complete success rate was defined as IOP < or =18 mmHg without and qualified success as IOP < or =18 mmHg with or without antiglaucoma medications.

RESULTS

After a 24-month follow-up, mean IOP decreased in the SK-gel group from 20.9 +/- 6.1 to 13.8 +/- 2.1 mmHg (P = 0.000012) and in the T-flux group from 21.1 +/- 6.2 to 14.1 +/- 1.9 mmHg (P = 0.000006). There was no statistically significant difference between the number of antiglaucoma medications used in either group (P = 0.389). Complete success rates were 69.8% and 61.3%, respectively (P = 0.064) and qualified success rates were 93.2% and 84.1%, respectively (P = 0.034). There were no significant differences in complications between the two groups.

LIMITATIONS

Despite the obtained statistical differences between the investigated groups in the scope of the qualified success rate, the result should not be treated as reliable from a clinical point of view. The influence of the kind of implant on the obtained result and the nature of the decompression space would require confirmation by ultrasound biomicroscopy (UBM), and by analysis of histological specimens but these were not performed. It should also be noted that the groups were not numerous.

CONCLUSIONS

In the case of SK-gel and T-flux application, PDS demonstrates similar efficacy and safety although the qualified success rate in the case of PDS with T-flux is significantly lower after a 24-month follow-up. The study does not indicate the cause of the observed changes but the nature of the intrascleral lake created by the implants used and its role in IOP regulation may be essential.

The effectiveness of phacodeepsclerectomy performed with implantation sk-gel and T-flux--12 months observations

PURPOSE

The purpose of this work was to present effectiveness and safety of phacodeepsclerectomy with SK-gel and T-flux implant in 12 months observation.

MATERIALS AND METHODS

Retrospective analysis included group I (SK-gel)--40 eyes and group II (T-flux)--23 eyes. At the control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior and posterior segment of the eye were examined. Control testing was done in the first day and 7-th day, and 1, 3, 6, 12 months after surgery. In the case of elevated IOP (>15 mmHg) goniopuncture was performed. IOP (> 15 mmHg) with fibrosis signs of the filtration bleb was an indication to use antimetabolites. Complete and qualified success rate was defined as IOP < or = 18 mmHg. In statistical analysis one-way ANOVA and Kaplan-Meier survival analysis, were used.

RESULTS

After 12 months mean IOP in the SK-gel group was 12.7 +/- 0.6 mmHg and in T-flux group 14.6 +/- 0.7 mmHg. It was a decrease in the mean IOP by 39.1% (p < .001) and 35.7% (p < .001). In both groups fewer medications were used than before surgery. Complete surgical and qualified success rate was reached in group I (81.7% and 91.9%) and in group II (72.7% and 83.8%). Nd:YAG goniopuncture performed in 10 eyes with implant SK-gel (25.0%) and 6 eyes with implant T-flux (26.1%) (p >.05). Subconjunctival injections with 5-FU were done in 5 eyes in the SK-gel group (12.5%) and in 3 eyes in the T-flux group (13.0%) (p > .05).

CONCLUSIONS

Phacodeepsclerectomy (PDS) with SK-gel and T-flux implant are both effective and safe surgical methods in the treatment of POAG in 12 months observation.

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations

PURPOSE

Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation.

MATERIAL AND METHODS

67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test.

RESULTS

After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05).

CONCLUSIONS

DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.

[Surgical treatment of posttraumatic lower canaliculus interruption and results of treatment estimation]

The authors present the method of surgical treatment of posttraumatic lower canaliculus interruption using intubation through upper lacrimal canaliculus. The lacrimal system was intubated through the upper lacrimal canaliculus with a silicone drainage system for 6 weeks. The results were estimated on a base of dacrocystography and scyntygraphy of lacrimal system after 6 month. The presented surgical treatment is both easy for a beginning surgeon and brings good functional results.