Purpose: To investigate through a case-matched analysis whether failed ab interno XEN45 Gel Stent implantation exerts an influence on the outcome after subsequent implantation of a Preserflo MicroShunt. Methods: In this retrospective study, 70 eyes from 70 participants who underwent Preserflo MicroShunt implantation were included. Thirty-five eyes each underwent primary stent implantation (control group) or had previously undergone failed XEN45 Gel Stent implantation (post-XEN group). The two groups were matched at a 1:1 ratio based on the following criteria: preoperative and maximum intraocular pressure (IOP), preoperative medication score, cup/disc-ratio, follow-up time, and age. Surgery was defined as either “success” or “failure” based on the following three scores: an IOP reduction of >20% and IOP at the longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B) or IOP ≤15 mmHg and an IOP reduction ≥40% (Score C). In all scores, revision surgery was considered a failure. Furthermore, we compared postoperative IOP and medication score, side effects, and revision rate between both groups. Results: Mean IOP decreased from 28.9 to 12.2 mmHg in the post-XEN group and from 27.7 to 12.9 mmHg in the control group, while the mean medication score decreased from 2.1 in the post-XEN group and from 2.6 in the control group to 0.3, respectively. Comparative analyses between the two groups did not reveal a significant difference in postoperative IOP, medication score, side effects, revision, or success rate. Conclusion: Preserflo MicroShunt implantation can be considered a viable option for repeat surgery in patients with bleb failure after prior XEN45 Gel Stent implantation.

To investigate, whether postoperative cystoid macular edema (CME) after combined XEN45 Gel Stent implantation with phacoemulsification has a predictive potential for the occurrence of bleb failure and subsequent conjunctival revision surgery. This retrospective study involved 45 eyes of 45 participants being treated via combined XEN45 Gel Stent implantation with phacoemulsification and who received optical coherence tomography- (OCT) scans after surgery. In 15 eyes OCT detected a postoperative CME (CME group), the remaining 30 eyes did not show a postoperative CME (Control group). The occurrence of bleb failure and subsequent conjunctival revision surgery was compared among the two groups via a Kaplan-Meier survival analysis. A predictive potential was assessed via a Cox proportional hazards regression model. Postoperative intraocular pressure (IOP), medication scores, success and revision rates were compared. Bleb failure requiring conjunctival revision surgery occurred significantly more frequently in the CME group than in the Control group (87

Purpose:To determine differing outcomes among pseudophakic patients with exfoliation glaucoma who underwent combined trabectome surgery and trabecular aspiration and phakic patients treated by a triple procedure with additional phacoemulsification. Methods:This retrospective study involved 75 eyes of 75 participants, of which 25 eyes received combined ab-interno trabeculectomy and trabecular aspiration (Trabectome + TA group), and 50 eyes underwent a triple procedure with additional phacoemulsification (triple group). The groups were matched at a 1:2 ratio, based on the following criteria: preoperative intraocular pressure (IOP), maximum known preoperative IOP, preoperative medication score, cup/disc ratio, follow-up time, and age. Successful surgery was defined by three scores: IOP at longest follow-up <21 mmHg (Score A) or <18 mmHg (Score B), without re-surgery and an IOP reduction >20% or IOP ≤15 mmHg without re-surgery and an IOP reduction ≥40% (Score C). Results:The preoperative IOP was 23.7 ± 5 mmHg, respectively, and decreased to 15.2 ± 4 mmHg in the triple group, which is significantly lower than postoperative IOP in the Trabectome + TA group, being 18.6 ± 8 mmHg during an average follow-up period of 33.4 ± 26 months (P = 0.02). The success rate in the triple group was significantly higher than in the Trabectome + TA group, according to Score A (78% vs. 40%) and Score B (70% vs. 36%). When aiming at a lower target IOP (Score C), the success rates did not differ significantly (36% vs. 24%). Conclusions:Cataract extraction, as a part of a triple procedure, seems to contribute to more effective IOP-lowering than trabectome surgery and trabecular aspiration alone in patients who underwent standalone phacoemulsification previously.

The purpose of this retrospective study was to compare the outcomes after combined phacoemulsification and ab-interno trabeculectomy via Kahook Dual Blade (KDB) and Trabectome, being represented in two groups of patients of Caucasian ethnicity with matched baseline criteria. We included 60 eyes of 49 participants being treated for cataract, of which 30 eyes underwent additional ab-interno trabeculectomy via KDB (Kahook group) and 30 eyes received additional Trabectome surgery (Trabectome group). For this comparative analysis, the Kahook group and Trabectome group were matched at a 1:1-ratio, based on the following criteria: preoperative IOP, maximum known preoperative IOP, preoperative medication score, cup/disc-ratio, follow-up time, best-corrected visual acuity and age. Successful surgery was defined by three scores: IOP at longest follow-up < 21 mmHg (Score A) or < 18 mmHg (Score B) without re-surgery and an IOP reduction > 20% or IOP ≤ 15 mmHg without re-surgery and an IOP reduction ≥ 40% (Score C). Furthermore, we compared postoperative IOP, as well as medication score, and side effects between both groups. Both surgical techniques led to a relative IOP reduction of 29% within their respective groups. Specifically, preoperative IOP decreased from 19.5 ± 5.0 mmHg to 13.8 ± 3.9 mmHg in the Kahook group, and from 19.8 ± 4.5 mmHg to 14.0 ± 3.9 mmHg in the Trabectome group during an average follow-up period of 23–24 months. There was no statistical significant difference noted. Both the KDB and Trabectome yielded similar success rates, according to Score A (67% vs. 70%), Score B (63% vs. 67%) and Score C (33% vs. 23%). There were no severe side effects notes in either group. In conclusion, the KDB and Trabectome showed similar IOP-lowering properties and safety profiles within our two matched groups of Caucasian patients.

To determine the accuracy of two axis-marking methods for toric intraocular lens (IOL) implantation, one picture-assisted approach based on scleral vessel vectors, and the other based on a self-leveling device for manual marking. This retrospective single-center study involved 60 eyes of 51 participants, who underwent phacoemulsification with toric IOL implantation. In all eyes, preoperative markings were made in a seated position both manually via a self-leveling corneal marker (RoboMarker), and digitally on slit-lamp photographs, defining scleral vessels as landmarks, aiding to find the correct intraoperative orientation for an angular graduation instrument. The axis of IOL alignment at the end of surgery was determined from high resolution, intraoperative footage from a microscope-integrated camera and the axis-marking error served as an outcome measurement for both marking techniques. The endpoint was the alignment of the lens at the end of surgery. The average axis-marking error was 2.5 ± 1.9 degrees for picture-assisted marking, which was significantly less than that of the self-leveling corneal marker, being 5.4 ± 4.4 degrees. Our results indicate that scleral vessel vector marking leads to highly accurate toric IOL alignments, while being an inexpensive technique, as solely a slit-lamp camera is required for preoperative preparation.

To assess the practicality of two novel perimetry devices for glaucoma in daily clinical practice: a head-mounted virtual reality headset and a tablet-based perimeter. Both were compared to conventional bowl perimetry and glaucoma experts qualitatively assessed the results. The study included 363 eyes from 199 patients. All patients performed two perimetry examinations with one or both eyes: standard automated perimetry on a conventional bowl perimeter (CBP; Octopus 900, Haag-Streit) and subsequently one of two novel perimetry methods: virtual reality perimetry (VRP; n=100 patients; “PalmScan VF2000” MicroMedicalDevice) or tablet-based perimetry using the Melbourne Rapid Fields application (MRF; n=99 patients; Glance Optical Pty.Ltd.). Additionally, a panel of 10 glaucoma experts was asked to evaluate the new methods. There was a very high correlation between VRP and CBP for mean deviation and pattern standard deviation (ICC 0.956 and 0.825, respectively). The correlation was moderate to high with the tablet-based perimetry using the MRF application (0.832 for mean deviation and 0.566 for pattern standard deviation). 74.6

This report covers a case of bilateral choroidal detachment due to routine use of systemic acetazolamide after cataract surgery. A 67-year-old woman was referred with a presumed rhegmatogenous retinal detachment in the left eye, complaining about the acute onset of a grayish veil at the temporal margin of the left visual field. The asymptomatic right eye had undergone cataract surgery elsewhere 3 days prior. Dilated fundus exam showed both a bullous choroidal detachment in the nasal mid-periphery of the left eye and in the lower nasal periphery of the right eye. The anterior chamber was deep; there was no angle closure and no myopic shift. Later, it was revealed that 500 mg of intravenous acetazolamide were prophylactically administered after cataract surgery, unbeknownst to the patient. Uveal effusion due to systemic acetazolamide use can manifest posteriorly without angle closure or myopic shift. The respective symptoms, if present at all, can resemble those of a rhegmatogenous retinal detachment.

This work aimed to investigate changes in optic nerve head (ONH) morphometry based on Bruch membrane opening in children with extensive nocturnal intraocular pressure (IOP) elevations. The course of Bruch membrane opening-based optic nerve head (ONH) morphometry was analysed in thirty-two patients younger than 18 years with evaluable SD-OCT examinations of the ONH and nocturnal posture-dependent IOP elevation above 25 mmHg. Longitudinal changes in neuroretinal rim tissue, as measured by Bruch Membrane opening minimum rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness, were assessed. One year after the 24 h IOP measurement, global BMO-MRW (− 1.61 ± 16.8 µm, n.s.; p = 0.611) and RNFL (+ 0.64 ± 3.17 µm; n.s.; p = 0.292) measurements were not significantly different from the baseline. No significant BMO-MRW reduction (− 3.91 ± 24.3 µm; n.s. p = 0.458) or deviation in RNFL thickness (+ 1.10 ± 3.52 µm) was observed at the four-year follow-up. Absolute IOP values measured in the supine position did not correlate with changes in global BMO-MRW or RNFL thickness. Posture-dependent IOP elevations do not seem to influence retinal nerve fibre layer thickness or Bruch membrane opening-based morphometric data in childhood.

BackgroundThe aim of this study was to compare the outcome of implantation of a XEN45 Gel Stent with the outcome of implantation of a Preserflo MicroShunt in a matched-pair analysis in eyes being na & iuml;ve to filtering surgery. MethodsIn this comparative, retrospective study, 50 eyes that had undergone XEN45 Gel Stent implantation were compared with 50 eyes after Preserflo implantation. Follow-up was at least 6 months, and surgical success was measured by criteria A (IOP < 21 mmHg, IOP reduction >20%, no repeat surgery); criteria B (IOP < 18 mmHg, IOP reduction >20%, no repeat surgery); and criteria C (IOP <= 15 mmHg, IOP reduction >= 40%, no repeat surgery). ResultsAfter a follow-up period of 12 months, mean IOP had decreased from preoperative 25.2 +/- 4.8 mmHg in the XEN group to 14.5 +/- 4.0 (n = 35) and from 25.3 +/- 6.8 mmHg to 11.9 +/- 2.9 (n = 41) in the Preserflo group, respectively. The IOP at the last follow-up of the two groups differed significantly (p < 0.01). The probability of surgical success did not differ concerning Criteria A and B, but surgical success was significantly higher in the Preserflo group for Criteria C (60%, p < 0.01). ConclusionBoth the Preserflo and XEN45 Gel Stent provide an effective and safe treatment option for advanced glaucoma and have a high potential to reduce intraocular pressure. Absolute IOP levels of <16 mmHg after 12 months were significantly more frequent in the Preserflo group.

PURPOSE:To determine differing outcomes among either phakic or pseudophakic patients who received standalone XEN45 Gel Stent (Allergan, an AbbVie Company, CA, USA) implantation and patients who underwent combined surgery with phacoemulsification. METHODS:This retrospective single-center study involved 180 eyes of 180 participants who underwent XEN45 Gel Stent implantation, of which 60 eyes received combined surgery with phacoemulsification (combined group). Standalone stent implantation was performed on 60 phakic (phakic group) and on 60 pseudophakic eyes (pseudophakic group). The groups were matched in a ratio of 1:1:1 based on multiple criteria. Successful surgery was defined by three scores: IOP at the longest follow-up of < 21 mmHg (Score A) or < 18 mmHg (Score B) and an IOP reduction > 20% or IOP ≤ 15 mmHg and an IOP reduction ≥ 40% (Score C). In all scores, one open conjunctival revision was allowed, and additional repeat surgery was considered a failure. RESULTS:After an average follow-up time interval of 20.6 ± 12.6 months, there was a mean IOP-reduction by 37% among the entire cohort. Comparative analysis between the three groups did not show significant differences regarding postoperative IOP, postoperative medication score, side effects, revision rate, repeat surgery rate or success rate. A dysfunctional stent was detected in eight eyes (4%) during open conjunctival revision in 76 eyes. CONCLUSION:The clinical endpoints investigated did not differ significantly among either phakic or pseudophakic patients who received standalone stent implantation and patients who underwent combined surgery. However mean latency between primary stent implantation and first revision surgery after combined surgery was markedly shorter.

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)‐lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open‐angle glaucoma (POAG).

Purpose Currently, there are no specific data on the circadian course of intraocular pressure (IOP) in children, especially for IOP measurements in the supine position. The study aimed to characterize the diurnal and nocturnal IOP fluctuations in supine and sitting positions in patients less than 18 years of age. Methods Seventy-nine eyes of 79 patients under 18 years of age with suspicious optic nerve heads or ocular hypertension could be included in this study. All included patients showed an inconspicuous retinal nerve fiber layer thickness and Bruch’s membrane minimum rim width by coherence tomography. IOP measurements during the 24-h IOP profile were retrospectively evaluated. Measurements were taken at 10:00, 16:00, 20:00, and 23:00 h in the sitting position and at 6:00 h in the morning in the supine position using iCare rebound tonometry on 2 consecutive days. Results Thirty-four of 79 children (43.0%) had peak nocturnal IOP values > 25 mmHg. The mean daily IOP was 18.8 ± 5.6 mmHg, and the mean daily fluctuation was 6.1 ± 4.0 mmHg. At 6 am, supine measurements were elevated to 25.1 ± 8.0 mmHg. Extensive fluctuations with values > 40 mmHg in the nocturnal supine measurement occurred in a relevant share of patients ( n = 5). Conclusion There appear to be relevant diurnal and nocturnal IOP fluctuations in healthy children (< 18 years). Nocturnal IOP measurements in supine patients with risk factors for glaucoma may provide important additional information to identify critical patients for further follow-up.

Background/Purpose: To determine anatomical success and best-corrected visual acuity after secondary surgery with heavy silicone oil tamponade in patients with persistent full-thickness macular holes. Methods: In this retrospective study, 63 eyes with persistent full-thickness macular holes after primary pars plana vitrectomy and internal limiting membrane peeling underwent secondary surgery with heavy silicone oil tamponade. Macular spectral domain optical coherence tomography and best-corrected visual acuity measurements were performed during the follow-up. Results: Fifty of 63 eyes (79.4%) achieved anatomical success. In eyes achieving anatomical success, best-corrected visual acuity before primary vitreoretinal surgery was significantly better (0.77 [∼20/125 Snellen] ± 0.24 [1.3–0.3] logarithm of the minimum angle of resolution) compared with eyes not achieving anatomical success (0.88 [∼20/160 Snellen] ± 0.17 [1.1–0.6] logarithm of the minimum angle of resolution, P = 0.044). Minimum linear diameter of full-thickness macular holes was significantly smaller in eyes achieving anatomical success, both before primary (403.4 ± 128.7 [199.0–707.0] µm vs. 568.1 ± 209.1 [307.0–953.0] µm, P = 0.009) and secondary surgery (464.1 ± 215.0 [178.0–1,521.0] µm vs. 663.3 ± 228.5 [451.0–1,301.0] µm, P = 0.010). Patients remaining phakic during all three surgeries did not benefit from best-corrected visual acuity improvement, although anatomical success was achieved. Conclusion: Heavy silicone oil tamponade in secondary surgery for persistent full-thickness macular holes is a safe and efficient surgical method. Best-corrected visual acuity and minimum linear diameter before surgery may be indicators for anatomical success.

Background To determine whether the outcome of the first eye may serve as a predictor for intraocular pressure (IOP)-lowering effectiveness in the second eye following bilateral ab interno trabeculectomy. Methods This retrospective single-centre study included 168 eyes from 84 participants, who underwent combined Trabectome surgery with phacoemulsification cataract surgery in a hospital setting. The clinical endpoint was defined as either 'success' or 'failure' based on four separate scores at the longest follow-up time point: IOP at follow-up <21 mm Hg (Score A) or IOP < 18 mm Hg (Score B), without re-surgery and IOP reduction >20%; IOP <= 15 mm Hg without re-surgery and IOP reduction >= 40% (Score C); and the sole absence of re-surgery according to the discretion of the surgeon (Score D). Results No significant difference was observed between the outcomes of first and second eyes. The frequency of success in the second eye after effective surgery in the first eye significantly exceeded that after prior failure. Within our analysis, the probability calculations determined a 75% chance of success following prior success for Score A. If surgery in the first eye failed, the chance of success in the subsequent eye was 37%. The corresponding probabilities were 79% and 32% for Score B, 56% and 9% for Score C, and 99% and 50% for Score D. Conclusion The results of our study offer a useful tool to assess the success of subsequent eye surgeries based on the outcome in the initial eye, owing to the high predictive potential.

AIM: To analyze the therapeutic effect of combined ab-interno trabeculectomy and cataract surgery on intraocular pressure (IOP) levels in supine and sitting postures during a 24-hour IOP profile. METHODS: Twenty-six eyes of twenty-six patients receiving ab-interno trabeculectomy using electroablation of the trabecular meshwork combined with cataract surgery or stand-alone were included in this retrospective analysis. IOP change during 24-hour IOP profiles within two years postoperatively were analyzed for eyes receiving surgery (“study eyes”) and compared to fellow eyes, which had not received surgery. Clinical data including mean sitting IOP (siIOP), mean supine IOP (suIOP) and the number of topical antiglaucomatous medications (TAM) were extracted from patients' files. RESULTS: Preoperatively, siIOP was 17.6±5.3 mm Hg in study and 17.1±4.7 mm Hg in fellow eyes (P=0.347). Patients were treated with an average of 2.8±1.0 TAM. Best corrected visual acuity (BCVA) was significantly worse in study eyes (P<0.001), visual field function was marginally not significantly different (P=0.057). After surgery 9.6±6.8mo, study eyes had a mean siIOP of 14.5±3.6 mm Hg (IOP reduction: -3.2 mm Hg, P=0.009), a mean suIOP of 18.0±3.5 mm Hg, and an average of 1.3±1.34 TAM (P<0.001), while in fellow eyes, mean siIOP was 16.2±3.4 mm Hg and mean suIOP was 20.5±5.1 mm Hg. Postoperatively, the relative IOP increase between sitting and supine postures was approximately 30% in both study and fellow eyes (P=0.99). CONCLUSION: IOP after ab-interno trabeculectomy shows a comparable relative reduction in both supine and sitting position. Classical trabeculectomy is known to lower suIOP overproportionally.

INTRODUCTION:We report a case of endophthalmitis and endocarditis that developed after stent perforation following a XEN45 Gel Stent implantation 10 months ago.CASE REPORT:A 79-year-old man was referred to our hospital because of endophthalmitis of the right eye. The patient had undergone XEN45 Gel Stent implantation in the same eye 10 months ago. On examination, the conjunctiva was perforated by the stent, and it was no longer covered by the conjunctiva. A 27-G pars plana vitrectomy with intravitreal antibiotic injection was performed. Moreover, the patient received intravenous antibiotic treatment and local anti-inflammatory and anti-infectious therapy. Streptococcus gordonii was identified as a bacterial cause of the endophthalmitis. Therefore, transesophageal echocardiography was performed, which revealed aortic valve endocarditis.DISCUSSION:Although not proven, it is possible that the exposed XEN45 Gel Stent served as an entry point for S. gordonii, which caused the exogenous endophthalmitis and subsequent endocarditis. S. gordonii belongs to the viridans group streptococci, which is the etiological agent for endocarditis which is a severe and potentially life-threatening infection. Ophthalmologists should therefore consider the risk of systemic infections as endocarditis after endophthalmitis, particularly caused by the viridans group streptococci, which are known etiological agents of endocarditis.

Purpose: This study investigates the long-term intraocular pressure (IOP) lowering potential, risk profile and success rate of a triple procedure comprising phacoemulsification, trabecular aspiration and trabectome (Microsurgical Technology, Redmond, WA, USA) for treating exfoliation glaucoma. Methods: A total of 117 eyes of 117 patients with exfoliation glaucoma underwent a combination of phacoemulsification, trabectome and trabecular aspiration. They were followed up for up to 7 years. The success rates were designated according to criteria based on the Tube versus Trabeculectomy Study and the World Glaucoma Association guidelines: A (no resurgery); B/C (IOP < 21/18 mmHg, no resurgery, IOP reduction > 20%); D (IOP ⩽ 15 mmHg, no resurgery, IOP reduction ⩾ 40%). Results: The mean follow-up period was 46 months. IOP showed a 38% reduction from 24.5 ± 6.1 to 15.2 ± 3.6 mmHg ( p < 0.0001). The Medication Score decreased by 23% from 2.2 ± 0.9 to 1.7 ±1.0 ( p < 0.0001). The success rates were 87, 76, 74 and 38% according to criteria A, B, C and D. In eyes with an initial IOP of >30 mmHg, a 57% reduction from 34.2 ± 4.4 to 14.8 ± 3.2 mmHg ( p < 0.0001) was observed, and the success rates were 91, 91, 82 and 59% for criteria A, B, C and D, respectively. Discussion: We conclude that the triple procedure may effectively lower IOP in patients with exfoliation glaucoma over a mean follow-up period of 46 months without significant side effects. Therefore, the triple procedure may serve as first-line surgery for patients with exfoliation and cataract, even with a high initial IOP.