Effect of peripheral iridectomy on VEGF-A and TGF-β levels in rabbit aqueous humour

Background Peripheral iridectomy (PI), routinely performed during glaucoma filtration surgery, may contribute to scarring. This study aims to determine whether PI alters the concentrations of VEGF-A and TGF-β isoforms in the rabbit aqueous humour. Methods Anterior chamber paracentesis (ACP) was performed in both eyes of six New Zealand white rabbits, with additional surgical PI performed in the right eyes. Eyes were examined on postoperative days (PODs) 1, 7, 30 and 60 by means of the tonopen, slit-lamp biomicroscopy, and bead-based cytokine assays for TGF-β and VEGF-A concentrations in the aqueous humor. Results ACP caused a significant reduction in intraocular pressure (IOP) from mean preoperative 11.47 ± 1.01 mmHg to 5.67 ± 1.63 mmHg on POD 1 while PI did not cause further IOP reduction. Limbal conjunctival vasculature appeared slightly increased on POD 1 in both ACP and PI eyes with PI also causing mild bleeding from damaged iris vessels. Two PI eyes developed fibrinous anterior chamber reaction and/ or peripheral anterior synechiae. Aqueous VEGF-A levels were not significantly different between eyes treated with ACP and PI. Aqueous TGF-β concentrations distributed in the ratio of 4:800:1 for TGF-β1:TGF-β2:TGF-β3 respectively. While aqueous TGF-β2 was not significantly induced by either procedure at any time point, TGF-β1 and TGF-β3 were significantly induced above baseline levels by PI on POD 1. Conclusion PI increases the risk of inflammation. The combined induction of aqueous TGF-β1 and TGF-β3 by PI in glaucoma surgery may impact surgery success in glaucoma subtypes sensitive to these isoforms.

The Clinical Guiding Role of the Distribution of Corneal Nerves in the Selection of Incision for Penetrating Corneal Surgery in Canines

The cornea is one of the regions with the highest density of nerve terminals in the animal body and it bears such functions as nourishing the cornea and maintaining corneal sensation. In veterinary clinical practice, the corneoscleral limbus incision is frequently applied in cataract surgery, peripheral iridectomy, and other procedures for glaucoma. Inevitably, it would cause damage to the nerve roots that enter the cornea from the corneal limbus, thus inducing a series of complications. In this paper, the in vitro cornea (39 corneas from 23 canines, with ages ranging from 8 months old to 3 years old, including 12 male canines and 11 female canines) was divided into 6 zones, and the whole cornea was stained with gold chloride. After staining, corneal nerves formed neural networks at different levels of cornea. There was no significant difference in the number of nerve roots at the corneoscleral limbus between different zones (F = 1.983, p = 0.082), and the nerve roots at the corneoscleral limbus (mean value, 24.43; 95% CI, 23.43–25.42) were evenly distributed. Additionally, there was no significant difference in the number of corneal nerve roots between male and female canines (p = 0.143). There was also no significant difference in the number of corneal nerve roots between adult canines and puppies (p = 0.324). The results of the above analysis will provide a reasonable anatomical basis for selecting the incision location and orientation of penetrating surgery for the canine cornea in veterinary practice.

Complicated corneal ulceration in cats: diagnosis and treatment outcomes of 80 cases (2014-2018)

The study describes the most common clinical and endoscopic findings associated with complicated corneal ulcers in cats and evaluates the short-term outcomes after surgical interventions. Eighty client-owned cats of different breeds with corneal ulcers were included. Cats were clinically evaluated to initially determine corneal abnormalities. Endoscopic examination of the corneas was performed to determine anterior and posterior segments’ abnormalities. Non-healing superficial ulcer was treated by superficial keratectomy and deep stromal ulcers were treated using conjunctival flaps. Corneal sequestrum were treated by partial keratectomies and conjunctival flaps. Anterior synechiae were treated via peripheral iridectomy and separation of the adhesion between the iris and the inner cornea. Symblepharon were treated by removal of the adhered conjunctival membrane from the cornea. Unresponsive endophthalmitis was treated surgically by exenteration. Outcomes after surgical managements of selected corneal abnormalities were assessed clinically and endoscopically. Non-healing superficial ulcer, deep stromal ulcer with descemetocele, endophthalmitis, symblepharon, corneal sequestration and anterior synechiae with secondary glaucoma and corneal scarring were the recorded complications of corneal ulcer. FHV-1 was a common etiologic factor of corneal ulceration. Persistent corneal scars of varying shape and size developed in cats with deep stromal ulcer, anterior synechiae, and corneal sequestration. Domestic shorthaired and Persian cats were the most predisposed breeds to FHV-1 infection and subsequent corneal ulceration. Management of patients with corneal ulcer would prevent serious complications. No age or sex predisposition to complicated corneal ulceration in cats was noticed.

Deep sclerectomy after DSAEK: A cautionary tale

A 78-year-old pseudophakic women with pseudoexfoliation glaucoma and 6-year history of prior Descemet’s stripping automated endothelial keratoplasty (DSAEK) underwent deep sclerectomy for a poorly controlled glaucoma. Exposure of the trabeculo-Descemet’s window (TDW), showed a very poor drainage. An attempt to dissect the fibrous tissue off the TDW resulted in perforation of the window needing peripheral iridectomy, followed by a white fibrous band which had to be excised to prevent blockade of the filtration channel. Postoperatively, there was complete detachment of the endothelial graft on day 1 with an intraocular pressure of 20 mm Hg. She was commenced on topical steroids and listed for a revisionary DSAEK in 6 weeks but when reviewed in a month postoperatively, a spontaneous reattachment of the endothelial graft was seen.

Angle-closure glaucoma, iris-lens contact, ciliochoroidal effusion, and transient myopia induced by topiramate

Topiramate is a sulphonamide derivative indicated in the treatment of epilepsy and migraine. In foreign scientific literature there are reported cases of topiramate-induced bilateral angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Purpose. To evaluate outcomes of laser iridectomy in a patient with topiramate-induced angle-closure glaucoma and acute myopia with ciliochoroidal effusion. Material and methods. A case is reported of bilateral angle-closure glaucoma, iris-lens contact, ciliochoroidal detachment and acute myopia following topiramate for migraine treatment in a 32-year-old patient. Laser peripheral iridectomy was performed in the both eyes according to the standard technology (Nd:YAG laser Selecta Trio, Lumenis Ltd., Israel) to decrease IOP and restore visual functions. Results. After laser iridectomy, the examination showed normal IOP with no medication, ciliochoroidal effusion and induced myopic shift were relieved. Conclusion. Laser iridectomy is an effective and safe in the treatment of topiramate-induced angle-closure glaucoma, acute myopia, and ciliochoroidal detachment. It contributes to normalization of IOP and improvement of visual acuity. Key words: topiramate, angle-closure glaucoma, ciliochoroidal effusion, transient myopia.

Microperipheral Iridectomy for Troublesome Posterior Synechiolysis in Secondary Intraocular Lens Implantation

Purpose. To introduce an effective method for separating extensive posterior synechiae and those located under or adjacent to surgical incisions. Methods. Pediatric patients who had been subjected to cataract surgery and developed troublesome posterior synechiae requiring secondary intraocular lens (IOL) implantation were recruited. All patients underwent microperipheral iridectomy at the 12 o’clock position. Then, an ophthalmic viscosurgical device was injected into the posterior chamber through the iris fistula to mechanically separate the posterior synechiae, using scissors to cut robust posterior synechiae if necessary. The results of posterior synechiolysis and the position of the implanted IOL were analyzed. Results. Sixteen patients (median age, 51.56 months; range, 28–80 months) were included. The scope of posterior synechia in clock was 4.42 (range, 1–10). All troublesome posterior synechiae were successfully separated using the microperipheral iridectomy method, and all patients underwent IOL implantation in the ciliary sulcus. There was one case of peripheral iridectomy-related early intraoperative bleeding; no bleeding was observed at the end of surgery. Conclusions. Microperipheral iridectomy is a useful method for the management of troublesome posterior synechiae during secondary IOL implantation in pediatric patients, which makes secondary IOL implantation an easier and safer method in some challenging cases.

Peripheral iridectomy in descemet stripping endothelial keratoplasty: to do or not to do

Background: The purpose of the research was to study role of peripheral iridectomy (PI) in alleviating intra ocular pressure (IOP) spike due to retained air in patients of pseudophakic bullous keratopathy (PBK) undergoing descemet stripping endothelial keratoplasty (DSEK).Methods: A retrospective case review was done for patients undergoing DSEK at tertiary care eye centre from January 2017 to December 2018. Patients were divided into two groups based on whether they have undergone PI during DSEK surgery or not. Total 25 patients were included in the study. Group 1 consisted of 15 patients who hadn’t undergone PI and group 2 consisted of 10 patients who had undergone PI. Study of post-operative IOP spike was done in all cases and role of PI was evaluated. The primary outcome measure was role of PI in alleviating IOP rise. Statistical analysis was done using statistical package for social sciences (SPSS) statistical software version 26.0.Results: All patients in group 1 had developed an IOP spike on first post-operative day. The mean IOP on day 1 in group 1 patients were 29±2.9 mm of Hg (range 24-34 mm of Hg) and in group 2 were 19±1.49 mm of Hg (range 17-21 mm of Hg). Almost all patients in group 1 required anti glaucoma medications. Group 2 had better post-operative results as compared to group 1in terms of best corrected visual acuity (BCVA) as well as graft clarity. Three patients in group 1 had to undergo repeat DSEK.Conclusions: DSEK surgery causes increase in IOP post operatively due to retained air in anterior chamber (AC), probably causing pupillary block. PI definitely has some role in alleviating this IOP spike and increasing graft survival in long term.

Goniosynechialysis combined with multiple surgeries for secondary glaucoma in nanophthalmos: A case report

Background: Management of secondary glaucoma in nanophthalmos has always been challenging, especially for patients with extremely short axial length and extensive angle synechia. This case report discusses a nanophthalmic patient with secondary glaucoma and extensive angle synechia. Case presentation: A 60-year-old woman was referred to our hospital with uncontrolled intraocular pressure (IOP) in her left eye (LE). Slitlamp examination revealed small cornea and shallow anterior chamber (AC) in both eyes. Extensive angle synechia was seen on gonioscopy, and the IOP and axial length were 36 mmHg/15.79 mm in the left eye. She was diagnosed with nanophthalmos and secondary angle-closure glaucoma LE. Laser peripheral iridectomy (LPI) was performed, but the IOP LE remained elevated and uncontrolled on brinzolamide and brimonidine. The IOP LE was then normalized with the application of 2% pilocarpine. During the follow-up period, the AC of the LE showed progressive shallowing, and 5 months post LPI the IOP became uncontrollable. Goniosynechialysis combined with phacoemulsification, lamellar sclerectomy, sclerostomy, peripheral iridectomy, capsulotomy, and anterior vitrectomy were performed LE. Immediately after surgery, the AC deepened and the IOP stabilized. However, the IOP rose again post-surgically at 1 week and again at 2 months. A generally shallow AC and obstructed capsule hole were present. YAG laser capsulotomy was performed, and the IOP normalized and the AC deepened. Eighteen months after surgery, the IOP LE was 12 mmHg and the AC remained stable. Conclusion: Goniosynechialysis combined with multiple surgical procedures could be considered an alternative treatment regimen for nanophthalmos patients with secondary glaucoma and extensive angle synechia.

Features of Monitoring Patients with Primary and Advanced Stages of Glaucoma in Krasnodar Territory

Purpose: to analyze the monitoring of patients with primary and advanced stages of glaucoma, who applied to the private clinic “Tri-Z” (Krasnodar).Patients and Methods. A total of 3 524 patients underwent screening with a diagnosis of glaucoma for all over 2018 at the clinic, of which 55.6 % were diagnosed with primary and advanced glaucoma. The criterion for inclusion in the study was primary glaucoma of the initial and advanced stages, elimination criteria: high degree of refraction errors, retinal detachment in anamnesis, proliferative diabetic retinopathy, AMD exudative forms, congenital forms of glaucoma, secondary types of glaucoma.Results: The average age of patients was 68.44 ± 8.142 years, women were 71 %, men — 29 %. The average duration of glaucomatous history was 3.48 ± 3.525 years. POAG was found in 85.3 % of cases, PACG in 14.7 % of cases. Glaucoma without concomitant PEX was observed in 44.7 % cases, with signs of PEX in 55.3 % cases. In stage I of glaucoma, the majority of patients (42.7 %) received APG and in 27.1 % cases a fixed combination of ICA + BB. In stage II glaucoma, the majority of patients (26.5 %) received a fixed combination of ICA + BB, in 18.8 % of cases, the combination of APG + ICA + BB and in 17.7 % — APG. The share of laser interventions: LTP — 14.7 %, SLT — 4.1 %, peripheral iridectomy — 10 %, YAG-GP — 0.8 %, SLT + YAG-GP — 0.8 %, peripheral iridectomy + SLT — 0.5 %. The share of surgical interventions: at glaucoma stage I non-penetrating deep sclerectomy (NPDS) — 3.4 %; at stage II NPDS — 10.9 %, repeated NPDS — 0.5 %, deepsclerectomy — 2.2 %; phacoemulsification + IOL — 21.9 % of cases.Conclusion: In the study, we noted the following features: use, including as a starting therapy, effective drugs or their combinations; the preferred use of fixed combinations; prioritization of non-preservative therapy; high frequency of laser interventions in the anterior eye segment; use of peripheral laser iridectomy in the overwhelming majority of cases when PACG is detected; early transition to surgical treatment.