Search Results (349)

Combined trabeculectomy–phacoemulsification is known to provoke more inflammation and yield a poorer long-term efficacy than trabeculectomy alone. This study evaluates whether a similar trend exists for Ahmed glaucoma valve implantation when performed with or without concurrent phacoemulsification. We retrospectively analyzed 51 eyes from patients who underwent either Ahmed-Alone (n = 25) or PhacoAhmed (n = 26) surgery over a 5-year period. The primary outcomes included intraocular pressure (IOP), the use of IOP-lowering medications, and the need for further surgical intervention. Absolute success was defined as IOP reduction > 20% and IOP < 21 mmHg without medication; relative success allowed for continued pharmacologic therapy. Both groups showed a significant IOP reduction, with similar final mean IOP values (Ahmed-Alone: 14.02 ± 4.76 mmHg; PhacoAhmed: 13.89 ± 4.17 mmHg; p = 0.99) and comparable reductions in medication use (p = 0.52). Reinterventions occurred less frequently and later in the PhacoAhmed group (12% vs. 27.3%; median time: 27.1 vs. 12 months). Absolute success was not achieved in any PhacoAhmed case but occurred in 9.3% of Ahmed-Alone cases; relative success rates were similar (83.3% vs. 81.4%; p = 0.291). These findings suggest that combining phacoemulsification with Ahmed valve implantation does not significantly alter efficacy or safety profiles. Additional prospective studies are warranted to assess long-term outcomes. Full article

Background: Patients with primary angle-closure disease (PACD), those with no history of acute angle-closure glaucoma or laser iridotomy, rarely present with prominent corneal endothelial cell density (CECD) loss. To identify factors associated with decreased CECD in PACD, anterior segment parameters were compared in patients with PACD and normal CECD and patients with PACD and decreased CECD, using anterior segment optical coherence tomography (AS-OCT). Patients and Methods: Ten patients with PACD and CECD of less than 1500/mm² without a history of cataract surgery, acute angle-closure glaucoma, or prior laser glaucoma procedures were identified at the Kyorin Eye Center from January 2018 to July 2023. Patients with an obvious corneal guttata or apparent corneal edema were also excluded. Seventeen patients with PACD and normal CECD (normal CECD group) were used as the control. Simultaneous biometry of all anterior segment structures, including the cornea, anterior chamber, and iris, were assessed using a swept-source AS-OCT system. Results: Corneal curvature radius was significantly larger in the decreased CECD group compared with the corneal refractive power in the normal CECD group (p = 0.022, Mann–Whitney test). However, no significant differences were detected in other anterior segment morphology parameters. Multiple regression analysis with CECD as the dependent variable revealed that a large corneal curvature radius was a significant explanatory variable associated with corneal endothelial loss. Conclusions: Flattened corneal curvature may be a risk factor for corneal endothelial loss in patients with PACD. Full article

We report a case of herpes simplex virus type 1 (HSV-1) anterior uveitis evolving into an acute iris transillumination-like syndrome with secondary pigmentary glaucoma, highlighting diagnostic challenges and treatment considerations. A 61-year-old immunocompetent woman presented with unilateral anterior uveitis characterized by keratic precipitates and mild anterior chamber inflammation. The condition was initially treated with topical and subconjunctival corticosteroids without antiviral therapy. After an initial resolution of symptoms, upon the cessation of treatment, the patient developed features resembling unilateral acute iris transillumination (UAIT) syndrome with elevated intraocular pressure, diffuse pigment dispersion, and progressive iris transillumination defects. Aqueous polymerase chain reaction (PCR) testing confirmed the presence of HSV-1. Despite the initiation of antiviral therapy, the condition progressed to severe pigmentary glaucoma, with unreliable intraocular pressure measurements due to prior LASIK surgery. Cataract extraction, pars plana vitrectomy, and Ahmed valve implantation were performed, with only partial recovery of visual acuity. This case illustrates that HSV-1 uveitis can mimic or transition into a UAIT-like syndrome, possibly due to steroid use without concurrent antiviral treatment, which may exacerbate viral replication and damage to the iris pigment epithelium. Aqueous PCR testing aids in differential diagnosis, but indicative medical history and clinical findings should remain instrumental. Clinicians should maintain a high index of suspicion for herpetic etiology in anterior uveitis cases and initiate prompt antiviral treatment to prevent potentially sight-threatening complications. Full article

This multicenter study evaluated the effectiveness and safety of third-generation trabecular micro-bypass implantation (iStent^® infinite) combined with phacoemulsification (n = 233 eyes). Key outcomes through 12 months included the mean change in intraocular pressure (IOP) and the number of topical medications, as well as proportions achieving IOPs ≤ 18/15/12 mmHg or using 0/1/2/ ≥ 3 medications. In all eyes with 12-month follow-up data (n = 96, consistent cohort), the mean IOP reduced from 17.2 ± 4.2 mmHg preoperatively to 13.8 ± 3.0 mmHg at Month 12 (p = 0.001), while the mean number of medications reduced from 1.24 ± 0.91 preoperatively to 0.61 ± 0.96 at Month 12 (p = 0.001). The proportions of eyes achieving IOP ≤ 18/15/12 mmHg increased from 63.5%, 34.4%, and 14.6% preoperatively to 92.7%, 71.9%, and 37.5%, respectively at Month 12, (all p = 0.001). The proportions of eyes off medication increased from 16.7% preoperatively to 62.5% at Month 12 (p = 0.001). This study provides clinically relevant, real-world results that demonstrate significant reductions in IOP and the number of topical glaucoma medications required following iStent infinite trabecular micro-bypass and phacoemulsification. Full article

Corneal sensitivity is an important indicator of corneal health and innervation. Corneal hypoesthesia may be an early indicator of corneal diseases such as neurotrophic keratopathy. Various instruments have been used to measure corneal sensitivity, the first being the Cochet–Bonnet aesthesiometer. Over the years, new devices employing different stimuli have been developed, such as the gas-based Belmonte aesthesiometer, the Swiss liquid-jet aesthesiometer, and the most recently released corneal Brill aesthesiometer. In this review, the progress and advancement of aesthesiometers since their introduction is described. The mechanism, advantages, and disadvantages of these aesthesiometers are discussed and compared. We also report the relationship between corneal sensitivity and corneal innervation in various conditions, including diabetes mellitus, Fuchs’ endothelial dystrophy, dry eye disease, glaucoma, keratoconus, herpes simplex keratitis, post-refractive surgery, and ocular graft-versus-host disease. Through this review, we aim to highlight the importance of the assessment of corneal sensitivity and innervation in the diagnosis, treatment, and monitoring of anterior and posterior segment ocular disorders. Full article

Background/Objectives: This study aims to evaluate the long-term efficacy and safety of ab interno techniques using minimally invasive glaucoma surgery (MIGS), specifically XEN gel stent implantation, by evaluating its 2-year outcomes in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). Methods: This retrospective single-center study consecutively included 31 eyes of 31 patients with POAG or PXG who underwent XEN gel stent implantation. Patients were followed for 24 months, with assessments at multiple time points. Success was defined as achieving an IOP of less than 14 mmHg and a reduction of more than 20% from preoperative IOP without additional glaucoma surgery. Bleb morphology was evaluated using anterior segment optical coherence tomography (AS-OCT) and slit-lamp photographs. Postoperative interventions and complications were also recorded. Results: At 24 months, complete success and qualified success rates were 35.5% (11/31) and 51.6% (16/31), respectively. There was no difference in surgical success rates at 2 years based on the tip location (intraconjunctiva, intratenon, and uviform) on the 1st postoperative day. Patients with high sparse wall on AS-OCT imaging or avascular bleb morphology via slit-lamp photography at 6 months postoperatively had higher complete success rates at 2 years than those without (p = 0.007, p = 0.009, respectively). Patients with avascular bleb types at 6 months postoperatively had higher qualified success rates at 2 years compared with the vascular types (p = 0.038). Needling was performed in 32.3% of eyes, with secondary surgical procedures required in 16.1% of eyes. The most common adverse event was hypotony, occurring in 67.7% of eyes on the 1st postoperative day but resolving within 6 months. Conclusions: The ab interno XEN gel stent is an effective and minimally invasive option for managing POAG and PXG, with long-term success predicted by the AS-OCT assessment of bleb morphology at 6 months. Proactive postoperative management, emphasizing early intervention and monitoring, is crucial for maintaining optimal outcomes. Full article

Aim: To compare the three-year surgical outcomes among the Kahook dual blade (KDB), Tanito microhook (TMH), T-hook, and 360° suture trabeculotomy (S-lot) cohorts. Study design: Retrospective interventional comparative study conducted at a single eye center. Subjects and Methods: A total of 224 eyes that underwent combined cataract surgery with either KDB, TMH, T-hook, or S-lot procedures were retrospectively analyzed over the three-year period. Results: According to Tukey’s multiple comparison test, postoperative intraocular pressure (IOP) in the S-lot cohort was significantly lower than in the TMH cohort from 1 month to 3 years (p = 0.01 to <0.001), lower than in the KDB cohort between 6 months and 1 year (p = 0.026 to <0.001), and lower than in the T-hook cohort at 1 month (p = 0.012) and from 6 to 12 months (p < 0.001). The survival probability of achieving ≤15 mmHg and ≤18 mmHg in the S-lot cohort was significantly better than in others by p < 0.001 and 0.005, respectively. At 3 months, the T-hook cohort showed significantly lower IOP than the TMH cohort (p = 0.029), and at 1 week, IOP was marginally lower than in the KDB (p = 0.063) and TMH (p = 0.052) cohorts, based on Dunnett’s test. However, no significant differences in postoperative IOP were observed among the three sectorial canal-opening surgery (COS) groups beyond 6 months. Conclusions: Among the four MIGS cohorts, S-lot provided the most substantial mid-term postoperative IOP reduction. The T-hook cohort showed marginally superior IOP reduction at 1 week compared to the KDB and TMH groups. Full article

Purpose: To review the current literature on the combined use of cataract surgery (or lensectomy) and vitrectomy in pediatric patients, with a focus on clinical indications, surgical techniques, outcomes, and complications across various pediatric ocular pathologies. Methods: A narrative review of published studies addressing the use of combined lensectomy and vitrectomy (LV) in pediatric patients was conducted. Conditions discussed include congenital cataracts, ectopia lentis, retinopathy of prematurity (ROP), retinal detachment (RD), and persistent fetal vasculature (PFV). Key surgical considerations, visual and anatomical outcomes, and postoperative complications were examined. Results: The literature search yielded a total of 160 articles, of which 43 met the inclusion criteria and were included in this review. Although lens-sparing vitrectomy (LSV) is preferred in many pediatric cases to preserve accommodation and reduce complications, combined LV is often necessary in advanced or complex diseases. Studies have shown that combined LV can achieve favorable anatomical outcomes, but functional visual recovery remains variable and is affected by factors such as patient age, baseline ocular anatomy, and disease severity. Postoperative complications such as glaucoma, visual axis opacification (VAO), and intraocular lens (IOL) dislocation are more frequent with combined procedures and require long-term follow-up and rehabilitation. Conclusions: Combined cataract surgery (or lensectomy) and vitrectomy may represent a valuable strategy in the management of complex pediatric ocular conditions, particularly when individualized to the clinical context. Tailored surgical approaches are essential to optimize anatomic and functional outcomes. Further prospective studies and harmonized multicenter registries are needed to develop evidence-based principles that can guide individualized surgical decision-making in this unique patient population. Full article

Purpose: To investigate the role of the kynurenine pathway (KP) in ocular diseases by evaluating the activity of key enzymes—kynurenine aminotransferase (KAT) and kynurenine monooxygenase (KMO)—and the 3-hydroxykynurenine to kynurenic acid (3-HK/KYNA) ratio in relation to cataract severity, diabetes, glaucoma, and pseudoexfoliation syndrome (PEXS). Methods: Tryptophan metabolite levels were measured in patients undergoing cataract surgery and stratified by SPONCS grading and comorbid conditions. KAT and KMO activities were estimated using metabolite ratios (KYNA/KYN and 3-HK/KYN, respectively). Statistical analyses included Kruskal–Wallis tests with post hoc comparisons and Mann–Whitney U tests. Results: KAT activity declined significantly with increasing SPONCS grade (p = 0.014), suggesting a progressive loss of KYNA production and antioxidative capacity in advanced cataracts. Diabetic patients exhibited higher KMO activity (p = 0.039) and elevated 3-HK/KYNA ratios (p = 0.013), indicating a metabolic shift toward oxidative stress and neurotoxicity. Similarly, glaucoma patients had significantly increased KMO activity (p = 0.032), consistent with enhanced 3-HK-mediated retinal ganglion cell damage. In contrast, PEXS showed no significant alterations in KP markers. Conclusions: The kynurenine pathway is differentially modulated in ocular diseases. A decline in KAT activity correlates with cataract severity, while upregulation of KMO is prominent in diabetes and glaucoma, revealing disease-specific metabolic dysregulation. Targeting KMO to reduce toxic metabolite accumulation or enhancing KYNA synthesis may offer novel therapeutic avenues. These findings also support the potential of KP metabolites as biomarkers for disease monitoring and progression. Full article

Background/Objectives: This study evaluated the efficacy and safety of the ab externo open-conjunctiva (AEO) approach with adjunctive Ologen collagen matrix (OCM) compared to ab interno closed-conjunctiva (AIC) techniques for XEN45 gel stent implantation in patients with refractory open-angle glaucoma. The goal was to determine whether the AEO with OCM approach offers advantages in intraocular pressure (IOP) control and postoperative outcomes. Methods: A retrospective, comparative case series was conducted on 76 eyes from 76 patients with open-angle glaucoma who underwent XEN45 implantation between 2017 and 2022 at a single tertiary center. The patients were divided into Group 1 (AEO with OCM, n = 47) and Group 2 (AIC, n = 29). Postoperative IOP, the number of glaucoma medications, surgical complications, bleb revisions, and failure rates were recorded over 12 months. The AEO technique, supported by OCM, was assessed for its potential to reduce postoperative fibrosis and improve long-term outcomes. Results: Both groups experienced significant IOP reductions over time compared to baseline. However, Group 1 had superior outcomes, requiring fewer glaucoma medications postoperatively (p < 0.05), and demonstrated lower rates of complications (10.6% vs. 31.0%, p = 0.026) and bleb revisions (8.5% vs. 34.5%, p = 0.005). Kaplan–Meier survival analysis showed significantly greater cumulative surgical success in Group 1 compared to Group 2 (p < 0.001). Conclusions: The AEO with OCM approach to XEN45 implantation may provide improved safety and efficacy compared to the AIC approach. It appears to be beneficial in minimizing postoperative fibrosis, reducing the medication burden, and lowering complication and failure rates. Prospective randomized trials are needed to validate these findings. Full article

Wipe-out is defined as a sudden, unexplained, and irreversible loss of residual central vision following glaucoma surgery, typically in eyes with advanced visual field damage and severely compromised optic nerves. The purpose of this review is to critically assess the current incidence, risk factors, pathophysiological mechanisms, and clinical relevance of “wipe-out”, a rare but devastating complication of glaucoma surgery characterized by sudden, unexplained central vision loss postoperatively. A comprehensive literature review was conducted, analyzing key peer-reviewed studies from electronic databases (PubMed, Medline, and Google Scholar) published up to 2025. The data from the literature published prior to the year 2000 suggest that wipe-out incidences range broadly from <1% to 13%. Contemporary prospective studies and large-scale reviews indicate a significantly lower current incidence, frequently below 1%. Identified risk factors include severe preoperative visual field loss (especially split fixation), older age, immediate postoperative hypotony, and compromised optic nerve head perfusion. The proposed mechanisms involve acute vascular insults, ischemia–reperfusion injury, and accelerated apoptosis of already vulnerable retinal ganglion cells. Modern MIGS and refined trabeculectomy techniques exhibit notably lower wipe-out risks compared to historical data. The literature emphasizes preventive management, including careful patient selection, incremental intraocular pressure reduction, and minimally invasive anesthetic approaches. Although wipe-out syndrome represents a serious complication, its incidence in modern glaucoma surgery is minimal. The considerable benefits of contemporary surgical approaches—particularly MIGS—in preserving vision clearly outweigh this very low risk. Ophthalmologists should remain vigilant but confident in the safety and efficacy of modern glaucoma surgical techniques, emphasizing proactive intervention to prevent blindness rather than avoiding necessary surgery in consideration of the minimal risk of wipe-out. Full article

This retrospective review examines whether there is a difference in all-cause mortality in patients who required surgical intervention for neovascular glaucoma (NVG, N = 186) versus primary open-angle glaucoma (POAG, N = 190). Cox proportional hazard models compared mortality across three models: unadjusted, age-adjusted (Model 1), and age-, hypertension-, and diabetes-adjusted (Model 2). In all models, NVG patients who required glaucoma surgery had a higher all-cause mortality rate compared to those with POAG who underwent similar procedures: unadjusted (HR 2.22, (1.59, 3.10), p < 0.0001), Model 1 (HR 2.99, 95% CI (2.12, 4.22), p < 0.0001), and Model 2 (HR 1.88, 95% CI (1.27, 2.80), p < 0.0018). In Model 1, those with NVG due to PDR had a higher all-cause mortality rate after glaucoma surgery than those with NVG secondary to CRVO (HR 2.00, 95% CI (1.19, 3.45), p < 0.0095). Patients treated with CPC had higher all-cause mortality rates than those treated with tube shunt in all models: unadjusted (HR 1.82, 95% CI (1.33, 2.47), p < 0.0001), Model 1 (HR 1.91, 95% CI (1.40, 2.61), p < 0.0001), and Model 2 (HR 1.50, 95% CI (1.04, 2.16), p < 0.03). We observed a higher all-cause mortality rate among patients with NVG requiring glaucoma surgery compared to those with POAG requiring similar surgeries, which could suggest that NVG patients requiring glaucoma surgery had more compromised systemic health. Full article

Background: Postoperative macular edema may limit visual recovery following cataract surgery. Although smoking is recognized as a risk factor for ocular inflammation, its impact on early postoperative macular morphology following cataract surgery has not been investigated. Methods: This prospective cohort study enrolled 88 elderly patients undergoing elective cataract surgery in a single university teaching hospital. The patients were divided into long-term smokers and lifelong non-smokers. Spectral-domain optical coherence tomography (OCT) was used to assess the central subfoveal thickness (CST), cube volume (CV), cube average thickness (CAT), retinal nerve fiber layer (RNFL), and cup-to-disk ratio (CDR) preoperatively and on the 1st, 7th, and 14th postoperative days (PODs). The phacoemulsification time and cumulative dissipated energy were recorded. Linear mixed-effects models were used to assess group-by-time interactions, and multivariable regression, adjusted for baseline covariates, was employed for analyses. Results: Eighty patients were included in the final analysis. Smokers had significantly thinner baseline CST than non-smokers. Both groups showed early postoperative CST increases, but only smokers exhibited sustained and significantly greater increases in CV and CAT on POD 14 (CV Δ +0.30 mm³ vs. +0.04 mm³; p = 0.026; CAT Δ +6.5 µm vs. +1.2 µm; p = 0.037). The RNFL and CDR changes did not differ significantly at earlier timepoints. However, smokers showed a notably greater RNFL thickening on POD 14 (Δ +4.2 µm; p = 0.001). Smoking status remained the strongest independent predictor of these changes (p < 0.001), while phacoemulsification parameters showed no significant interaction effects. Conclusions: Cigarette consumption independently predicts pronounced postoperative macular and RNFL thickening after uncomplicated elective cataract surgery. These transient structural changes could complicate early glaucoma assessment and should be considered when interpreting postoperative OCT findings in smokers. Full article

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan–Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives. Full article

Background: To compare the efficacy and safety of the XEN^® 63 µm and 45 µm devices with the ab externo open conjunctiva with a 30G needle approach. Methods: A retrospective, non-randomized and single-center study was conducted. Consecutive eyes undergoing a XEN^® 63 µm implant were compared with a matched cohort of cases with a XEN^® 45 µm implant. Standalone and combined procedures with phacoemulsification were included. Results: A total of 28 XEN^® 45 µm and 28 XEN^® 63 µm were included. Complete surgical success was achieved in 17 cases (60.7%) in the 45 µm group and in 20 cases (71.4%) in the 63 µm group, with no statistical differences. One year after the surgery, the mean IOP was 13.8 ± 3.3 mmHg for the 45 µm group and 12.4 ± 4.2 mmHg for the 63 µm group (p-value > 0.05). Likewise, the use of glaucoma medication was lowered in the 63 µm device (0.32 ± 0.87) compared to the 45 µm device (0.39 ± 0.86), with no statistical significance. Postoperative hypotony was more frequent in the 63 µm device (39.3%) than in the 45 µm group (28.6%), with no statistical differences. However, hypotony-associated complications (including choroidal detachment, hypotony keratopathy, and hypotony maculopathy) were significantly higher in the 63 µm group (p = 0.011). Conclusions: Although the XEN^® 63 µm may offer a greater IOP-lowering effect with better complete surgical success, no significant differences were detected compared to the 45 µm device. Hypotony-related complications were higher in the XEN 63 µm, although most of them resolved with conservative management. Full article