Purpose: Myopic macular degeneration (MMD) can cause irreversible vision loss. Thinner choroid is associated with increased MMD severity. This cross-sectional study analyzed choriocapillaris (CC) alterations in MMD. Methods: Axial length (AL), best-corrected visual acuity (BCVA), fundus photography, and swept-source optical coherence tomography angiography (SS-OCTA) were assessed in controls and high myopes (spherical equivalent ≤ −6 diopters). Myopic patients with grade 2 MMD (macular diffuse chorioretinal atrophy [MDCA]), high axial myopia (AL ≥ 26.5 mm), and BCVA ≥ 20/40 were compared with controls without MMD. CC mean thickness was measured from 3 × 3-mm SS-OCTA scans by identifying CC peaks in A-scan intensity profiles. CC flow deficit percent (CC FD%) was quantified using a fuzzy C-mean local thresholding method on en face OCTA images. Multivariate regressions compared CC thickness and CC FD% between myopic patients and controls, correcting for age and other confounders. Results: Sixteen eyes with MDCA (AL, 26.96–33.93 mm; ages, 40–78 years) were compared with 51 control eyes (AL, 21.65–25.84 mm; ages, 19–88 years). CC thickness in patients with MDCA was 66% lower than that in controls (5.23 ± 0.68 µm [mean ± SD] vs. 15.46 ± 1.82 µm; P < 0.001). CC FD% in patients with MDCA was 237% greater than in controls (26.5 ± 4.3 vs. 11.2 ± 4.6; P < 0.001). Conclusions: Patients with MDCA with good visual acuity had thinner CC and increased CC FD%, or reduced CC flow, compared with controls. Patients with grade 2 MMD and good visual acuity demonstrated significant choriocapillaris alterations, suggesting that choriocapillaris perfusion defects contribute to the pathogenesis of MMD. Translational Relevance: Given the potential vascular etiology for MMD, current research about revascularization of ischemic retina likely has implications for the treatment of MMD.

Purpose To compare the macroscopic and microscopic histologic changes in eyes treated with micropulse transscleral cyclophotocoagulation (MP-TCP) versus continuous wave transscleral cyclophotocoagulation (CW-TCP). Methods Twelve halves of globes from three pairs of adult cadaveric eyes were randomly assigned to nontreated control, CW-TCP, single MP-TCP treatment, or double MP-TCP treatments, and then sectioned for histologic analysis. Presence or absence of the following four unique histologic changes was recorded: splitting within the ciliary process epithelium (splitting), separation of the pigmented ciliary process epithelium from the stroma (separation), coagulation of collagen and destruction of ciliary process stroma (coagulation), and full-thickness destruction of ciliary process epithelium (destruction). Results A total of 498 slides were analyzed, and laser scars in all treated specimens were located in the pars plana. Logistic regression analysis showed that compared with controls, CW-TCP-treated specimens were significantly more likely to experience separation (odds ratio [OR] = 11.1, P = 0.02), coagulation (OR = 24.3, P = 0.002), and destruction (OR = 11.1, P = 0.03). Destruction of the ciliary process epithelium was observed exclusively in CW-TCP-treated sections. No significant differences in histologic features were observed between controls and MP-TCP. Conclusions MP-TCP does not produce significant histologic changes in cadaveric eyes, whereas CW-TCP treatment does. Translational Relevance These findings improve understanding of the mechanism of MP-TCP, help explain the increased rates of adverse effects following CW-TCP treatment compared with MP-TCP, and describe effects of MP-TCP at various doses.

IMPORTANCE:This is the first study to compare the efficacy and safety of endocyclophotocoagulation (ECP) via pars plana (ECP-plus) with ECP via limbus (anterior ECP) for treating glaucoma. BACKGROUND:There is no direct comparison of treatment outcomes between ECP-plus and anterior ECP. DESIGN:Retrospective study. PARTICIPANTS:Fifty-four consecutive patients. METHODS:Fifty-eight eyes from 54 consecutive patients underwent anterior ECP (33 eyes) or ECP-plus (25 eyes) with 2-year follow-up. Linear mixed model was used to analyse the surgical outcomes. MAIN OUTCOME MEASURES:Intraocular Pressure (IOP) was the primary outcome. Secondary outcomes were best-corrected visual acuity, number of glaucoma medications, complications and success rate. RESULTS:Compared to anterior ECP, patients in the ECP-plus group had lower IOP (estimate of effect size [EES] = -3.7 mmHg, P = 0.023) and used fewer number of glaucoma medications (EES = -1.11, P = 0.003), after adjusting for degrees of treatment, preoperative IOP, and presence of combined ECP and phacoemulsification procedure. Patients with ECP-plus achieved a higher success rate at 2 years postoperatively (80% vs 33.3%, P < 0.001). The decrease in IOP between the preoperative and last follow-up visit was greater in the ECP-plus group compared to the anterior ECP group (14.3 mmHg (52%) vs 5.2 mmHg (24%), P = 0.001). There was no significant difference in complication rates between the two groups (28% vs 33%, P = 0.561). CONCLUSIONS AND RELEVANCE:Anterior ECP and ECP-plus have a similar safety profile, and ECP-plus may offer superior IOP control for the management of glaucoma.

Purpose/Aim: To evaluate the best formula to predict intraocular pressure (IOP) reduction after cataract surgery.Materials and methods: In this prospective longitudinal study, we included consecutive patients with or without glaucoma, either with open or with narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Clinical factors and anterior segment parameters measured with optical biometry and optical coherence tomography were evaluated as preoperative predictors for IOP reduction at 6months postoperatively. To find the best combinations of predictors, model selection was conducted using least absolute selection and shrinkage operator regression with cross-validation.Results: A total of 156 eyes from 109 patients were enrolled. The mean age of the patients was 74.89 (8.54) years and the average preoperative IOP was 15.6 (+/- 3.68) mmHg with 0.7 (range 0-4) glaucoma medications. The mean IOP reduction after phaco was 3.1 (+/- 2.49) mmHg at postoperative month 6. After multivariate analysis, preoperative IOP (=0.49 [0.4-0.59] P <.0001), gonioscopy score (=-0.14 [-0.23 to -0.06] P =.0001), anterior chamber depth (=-0.85 [-1.64 to -0.07] P =0.033), lens thickness (LT) (=0.87 [0.12-1.62] P =.024), and angle open distance 750 (=-2.2 [-3.96 to -0.44] P =0.014) were associated with IOP reduction. The best formula to correlate with IOP reduction was -4.76+(0.46xpreoperative IOP) -(0.42xLT) -(0.1xgonioscopy score) -(0.66xglaucoma status).Conclusion: Different formulas were developed and were able to improve the predictive value of the preoperative IOP. When used in combination, these formulas may help the clinician to know how much IOP reduction to expect after cataract surgery at 6months postoperatively.

Purpose: To evaluate a novel gonioscopy score as a potential predictor for intraocular pressure (IOP) reduction after cataract surgery. Materials and Methods: This was a prospective study that included consecutive patients with or without glaucoma, either with open or narrow angles but without peripheral anterior synechiae, who underwent phacoemulsification. Eyes with intraoperative complications and secondary glaucoma were excluded. A preoperative gonioscopy score was created, summing the Shaffer gonioscopy grading in 4 quadrants (range, 0 to 16). To determine variables associated with IOP change at 6 months, univariate and multivariate linear mixed-effects regression analysis was performed adjusting for age, sex, and preoperative IOP. Results: In total, 188 eyes from 137 patients were enrolled. The mean age of the patients was 75.0 (±8.5) years and the average preoperative IOP was 15.6 (±3.6) mm Hg with 0.7 (range, 0 to 4) glaucoma medications. The mean IOP reduction after phacoemulsification was 3.0 (±2.6) mm Hg at postoperative month 6. After multivariate analysis, preoperative IOP [&bgr;=0.49 (0.41-0.58), P<0.0001], gonioscopy score [&bgr;=−0.17 (−0.24 to −0.09), P<0.0001], anterior chamber depth (ACD) [&bgr;=−0.88 (−1.64 to −0.14), P=0.02], and IOP/ACD ratio [&bgr;=0.45 (0.07 to 0.83) P=0.021] were associated with IOP reduction at 6 months. Conclusions: Preoperative predictors for IOP reduction after cataract surgery were preoperative IOP, ACD, gonioscopy score, and IOP/ACD ratio. The IOP/ACD ratio and gonioscopy score can be easy parameters to obtain and may help clinicians to estimate the IOP reduction after phacoemulsification.

PURPOSE:This prospective study used anterior segment optical coherence tomography (AS-OCT) to determine how phacoemulsification (phaco) changes iris parameters in eyes with glaucoma or glaucoma suspect status. METHODS:Using Visante AS-OCT (Carl Zeiss Meditec AG), the following pre- and post-phaco parameters were measured: IT750 = iris thickness at 750 μm from the scleral spur; IT2000 = iris thickness 2000 μm from the scleral spur; ITCM = the maximum iris thickness at the middle one third of the iris; ICURV = iris curvature; IAREA = iris area; and pupil size = pupil diameter (mm). Only high-quality images with an identifiable scleral spur were included, and only the nasal quadrant was analyzed. A single glaucoma specialist analyzed the parameters according to the Zhongshan Angle Assessment Program (ZAAP, Guangzhou, China). Multivariate analysis was performed using mixed effects regression correcting for age, gender, and ethnicity. RESULTS:89 subjects and 110 eyes were included in this study. The mean age of subjects was 74.83 {+/-} 8.69 years old. Most common diagnoses were POAG and glaucoma suspect (23% and 52%, respectively), and 16% of subjects had an LPI. In multivariate analysis of AS-OCT parameters, decreases in IT750, IT2000, ITCM, ICURV, and pupil size were statistically significant (p<0.05). CONCLUSIONS:After phacoemulsification, eyes with glaucoma as well as glaucoma suspect eyes have thinner irises and smaller pupils. This may lead to less iris-mediated aqueous outflow obstruction, providing support for early phacoemulsification glaucoma treatment. TRANSLATIONAL RELEVANCE:Our AS-OCT imaging findings may guide clinical practice as iris parameters become increasingly relevant in preoperative phaco planning.

Purpose: To report a case of Ahmed glaucoma valve-induced hypotony that was successfully managed with postoperative intraluminal stenting of the aqueous shunt tube. Patient and Methods: We describe a 68-year-old man with advanced uveitic glaucoma with an intraocular pressure (IOP) of 25 mm Hg in the left eye. The patient initially responded well to an Ahmed glaucoma valve implant, but at 10 weeks postimplantation, the patient underwent cataract surgery and developed persistent hypotony, choroidal folds, and decreased vision. Results: Before partial occlusion of the aqueous shunt tube, the patient had an IOP of 3 mm Hg and a best-corrected visual acuity (BCVA) of 20/60. Following intraluminal stenting of the aqueous shunt tube with 4-0 polypropylene suture (Prolene; Ethican), IOP rose from 7 to 10 mm Hg, BCVA improved to 20/30, and the choroidal folds resolved; IOP and BCVA remained stable through 1 year of follow-up and no additional surgical or pharmacological interventions were required. Conclusions: Aqueous shunt-induced hypotony can be successfully managed with intraluminal stenting and should be considered before tubal ligation or shunt removal.

Background: Anterior shoulder instability can be a disabling condition for the young athlete; however, the best surgical treatment remains controversial. Traditionally, anterior shoulder instability was treated with open stabilization. More recently, arthroscopic repair of the Bankart injury with suture anchor fixation has become an accepted technique. Hypothesis: No systematic reviews have compared the rate of return to play following arthroscopic Bankart repair with suture anchor fixation with the Bristow-Latarjet procedure and open stabilization. We hypothesized that the rate of return to play will be similar regardless of surgical technique. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review and meta-analysis focused on return to play following shoulder stabilization. Inclusion criteria included studies in English that reported on rate of return to play and clinical outcomes following primary arthroscopic Bankart repair with suture anchors, the Latarjet procedure, or open stabilization. Statistical analyses included Student t tests and analyses of variance. Results: Sixteen papers reporting on 1036 patients were included. A total of 545 patients underwent arthroscopic Bankart repair with suture anchors, 353 with the Latarjet procedure, and 138 with open repair. No significant difference was found in patient demographic data among the studies. Patients returned to sport at the same level of play (preinjury level) more consistently following arthroscopic Bankart repair (71%) or the Latarjet procedure (73%) than open stabilization (66%) (P < .05). Return to play at any level and postoperative Rowe scores were not significantly different among studies. Recurrent dislocation was significantly less following the Latarjet procedure (3.5%) than after arthroscopic Bankart repair (6.6%) or open stabilization (6.7%) (P < .05). Conclusion: This systematic review demonstrates a greater rate of return to play at the preinjury level following arthroscopic Bankart repair and the Latarjet procedure than open stabilization. Despite this difference, >65% of all treated athletes returned to sport at their preinjury levels, with other outcome measures being similar among the treatment groups. Therefore, arthroscopic Bankart repair, the Latarjet procedure, and open stabilization remain good surgical options in the treatment of the athlete with anterior shoulder instability.