Aristeidis Konstantinidis

Efficacy of autologous platelets in macular hole surgery

The introduction of optical coherence tomography has allowed accurate measurement of the size of macular holes. A retrospective consecutive review was performed of 21 patients undergoing macular hole repair with vitrectomy, gas tamponade, and autologous platelet injection and we assessed the effect of macular hole parameters on anatomic and functional outcomes. We looked at the demographic features, final visual outcome, and anatomical closure. Twenty-one patients were included in the study. They underwent routine vitrectomy with gas tamponade (C3F8) and injection of autologous platelets. All patients were advised to maintain a facedown posture for 2 weeks. Anatomical closure was confirmed in all cases and 20 out of 21 of patients had improved postoperative visual acuity by two or more lines. In our series, the macular hole dimensions did not have much effect on the final results. The use of autologous platelets and strict facedown posture seems to be the deciding factor in good anatomical and visual outcome irrespective of macular hole dimensions.

Effect of Tafluprost 0.0015% on Central Corneal Thickness in Patients With Primary Open-angle Glaucoma

Abstract Purpose: To evaluate the effect of tafluprost on the central corneal thickness (CCT) in patients with primary open-angle glaucoma (POAG). Methods: This was a prospective study and included 100 eyes of 54 patients with POAG. All patients received tafluprost 0.0015% (Saflutan®) once daily in one or both eyes. CCT was measured by using noncontact pachymetry prior to the treatment and after 6 and 12 months. Results: Mean CCT of all treated eyes (n = 100) was 547.79 ± 29.48 μm at baseline, 535.61 ± 26.54 μm after 6 months and 533.55 ± 26.45 μm after 12 months (Student’s t test, p < 0.0001). Ninety-three percent of all treated eyes showed a decrease of CCT. CCT reduction was more significant within the first six months of the treatment period (Student’s t test, p < 0.0001). After 12 months, a CCT reduction >25 μm occurred in 5% of all treated eyes. There was a significant positive correlation between the magnitude of corneal thinning and the initial CCT (Pearson, r = 0.49, p < 0.0001) but not between the magnitude of corneal thinning and intraocular pressure (IOP) reduction (Pearson, r = 0.145, p = 0.15). Discussion: Long-term use of tafluprost may decrease the CCT in patients with POAG. Consequently, clinicians must be aware of prolongated CCT variations that may arise throughout the follow-up period for proper IOP targeting and management.

Changes in anterior segment morphology after intravitreal injection of bevacizumab and bevacizumab-triamcinolone acetate combination.

Purpose To evaluate the effects of 2 different amounts of commonly used intravitreal agents on anterior segment morphology in conjunction with intraocular pressure (IOP) changes. Methods Two groups of 46 patients who received intravitreal injection of bevacizumab (group 1, 0.05 mL) or bevacizumab–triamcinolone acetate (TA) combination (group 2, 0.1 mL) were included in this prospective study. All patients underwent anterior segment optical coherence tomography (AS-OCT) imaging with Visante OCT and IOP measurement before and at 5 minutes, 1 hour, and 3 hours after injection. Anterior chamber depth (ACD), angle-opening distance (AOD 500-750), trabecular–iris space area (TISA 500-750), and anterior chamber angle (ACA) were measured. Results were compared between groups and measurement time points. Results The mean change in IOP showed significant difference between baseline and first measurements after the injection in group 1 and group 2 (p = 0.012, p = 0.008, respectively). There was a statistically significant difference from baseline in ACD at the first and second measurements in group 2 (p = 0.005, p = 0.018, respectively). All angle parameters showed insignificant decrease from baseline at all measurement time points in both groups (p>0.05 for each). The difference of angle parameters after injection was not statistically significant between the groups (p>0.05 for each). Conclusions Intravitreal injection of bevacizumab (0.05 mL) or bevacizumab-TA combination (0.1 mL) caused a change in anterior segment configuration determined by AS-OCT. The changes in anterior chamber parameters returned to baseline values with the normalization of IOP values after the first few minutes of injection.

The Effect of Corneal Refractive Surgery on Glaucoma

Laser-assisted refractive procedures have become very popular in the last two decades. As a result, a “generation” of patients with altered corneal properties is emerging. These patients will require both cataract extraction and glaucoma follow-up in the future. Since the glaucoma examination largely depends on the corneal properties, the reshaped postrefractive surgery cornea poses a challenge in the diagnosis, follow-up, and management of the glaucomatous patient. In order to overcome this problem, every patient who is planned to undergo corneal refractive surgery must have a thorough glaucoma examination in order for the ophthalmologist to be able to monitor their patients for possible glaucoma development and/or progression. Some examinations such as tonometry are largely affected by the corneal properties, while others such as the evaluation of the structures of the posterior pole remain unaffected. However, the new imaging modalities of the anterior segment in combination with the most recent advances in tonometry can accurately assess the risk for glaucoma and the need for treatment.

Tonography assessment using quantitative and qualitative analysis of the aqueous humor outflow mechanism

Purpose To perform qualitative evaluation of the aqueous humor (AH) outflow mechanism in glaucoma and nonglaucoma patients by means of tonography assessment and mathematical analysis. Methods Sixty-two primary open angle and 58 pseudoexfoliation glaucoma patients were recruited in a non-interventional, observational study between 2004 and 2007. Qualitative and quantitative outflow assessment was acquired by means of a digital tonographer and mathematical analysis. Qualitative results were represented using slope analysis of the change of the AH outflow rate over the tonography study. The results were compared to the control group (CG; n=100) as well as to a pseudoexfoliation group (PEX; n=46). Results Regarding quantitative analysis, glaucoma groups exhibited significantly lower outflow facility compared to nonglaucoma ones (p<0.001). Outflow facility value was significantly correlated to cup to disc ratio (Pearson correlation r=–0.3, p<0.001). Regarding qualitative analysis, the primary open-angle glaucoma (POAG) group presented a significant profile variation at the beginning of the tonography, expressed as an increased resistance of the AH outflow. Both glaucoma groups exhibited profile stabilization at the end of the measurement, suggesting that the outflow rate remained constant, while nonglaucoma groups followed a continuous reduction of the AH outflow rate throughout the study. Conclusions The POAG, PXG, PEX, and CG groups demonstrated both qualitative and quantitative tonographic profile differences. The observed differences in the glaucoma groups suggest a distinct pathomechanism between POAG and PXG. It is suggested that POAG patients have a temporary disruption of the AH flow pathway, while PXG patients have a generalized increased flow resistance.

Comparison of dorzolamide/timolol vs brinzolamide/brimonidine fixed combination therapy in the management of primary open-angle glaucoma

Purpose To compare the efficiency of brinzolamide/brimonidine fixed combination vs the dorzolamide/timolol fixed combination. Methods Forty-four eyes of 44 patients were divided in 2 groups treated either with dorzolamide/timolol twice a day (group A) or with brinzolamide/brimonidine twice a day (group B). Complete ophthalmic examination including Goldmann applanation tonometry was performed before treatment administration and 1, 4, 8, and 12 weeks afterwards. The intraocular pressure (IOP) was measured twice a day (morning at 9 AM and afternoon at 4 PM). Results At the end of the follow-up period (12 weeks), mean morning IOP reduction was 7.0 ± 2.8 mm Hg in group A and 8.4 ± 1.9 mm Hg in group B. A significant difference was found (p = 0.0343). In contrast, mean afternoon IOP reduction was 8.6 ± 2.7 mm Hg in group A and 7.9 ± 1.6 mm Hg in group B and no significant difference was found (p = 0.3413). No significant adverse effects were observed in either group. Conclusions Brinzolamide/brimonidine seems to be an effective and safe alternative β-blocker free fixed combination, especially for patients with comorbidities, having its own antihypertensive profile.

Helicoid peripapillary chorioretinal degeneration complicated by choroidal neovascularization

Purpose Helicoid peripapillary chorioretinal degeneration (HPCD) is a hereditary disease of the fundus that is characterized by atrophic chorioretinal areas that appear early in life and expand gradually from the optic disc towards the macula and the periphery. Methods We describe the case of an elderly man with a known diagnosis of HPCD who developed choroidal neovascular membrane (CNV) in both eyes during the course of the disease. Results The patient was treated with intravitreal injection of ranibizumab, to which he had excellent response. The CNV subsided with 2 injections in the right eye and 1 in the left. Two years after the initial diagnosis of CNV in the right eye, visual acuity was 5/10 OD and 9/10 OS. Conclusions Helicoid peripapillary chorioretinal degeneration is rarely complicated by CNV as the fundus lacks the trigger factors that would sustain this process. Although rare, HPCD complicated by CNV can be seen bilaterally, but responds well to few ranibizumab injections.

Imaging of filtering blebs after implantation of the Ex-PRESS shunt with the use of the Visante optical coherence tomography

AIM To analyze the features of the filtering blebs following implantation of the Ex-PRESS glaucoma device (model P-50) with the aid of the Visante anterior segment optical coherence tomography (AS-OCT). METHODS Five patients with open angle glaucomas were included in the study. They all underwent implantation of the Ex-PRESS device under a scleral flap. The surgical procedure was augmented with the use of mitomycin C subconjunctivally. The filtering blebs were analyzed with the Visante AS-OCT with the scans taken along the axis of the implantation of the glaucoma device. RESULTS All filtering blebs were graded as diffuse functioning. The morphological characteristics of the blebs were similar to those of the trabeculectomy. However the use of the Ex-PRESS implant tend to form a characteristic episcleral lake at the site of the plate of the implant. CONCLUSION The use of the Ex-PRESS implant produces filtering blebs similar to those of the trabeculectomy with the formation of a characteristic episcleral lake at the site of the plate of the implant.

Recognizing a Glaucomatous Optic Disc

Glaucoma is an optic neuropathy with its hallmark being a characteristic loss of the ganglion cell axons which in turn leads to an excavation of the optic disc. Although optic disc cupping occurs in many other ocular diseases [1] the assessment of the optic nerve head with either optic disc photography or the newer modalities remains of utmost importance in the diagnosis and follow up of the glaucomatous process. The digital stereophotographs allow storage of optic disc photos for future comparison and offer qualitative assessment of the optic nerve head. The new imaging modalities can quantitatively and objectively analyze various param‐ eters of the optic nerve head and the retinal nerve fiber layer in order to discriminate between glaucomatous and nonglaucomatous optic discs. They can also compare scans of the same patient overtime and detect any changes. As glaucoma is a progressive optic neuropathy patient’s assessment overtime is of paramount importance in order to tract changes and monitor the progression of the disease.

Combined Cataract-Glaucoma Surgery

Glaucoma is an optic neuropathy which causes a characteristic loss of optic nerve fibers. The loss of the nerve fibers leads to an increase of the optic disc cupping with subsequent visual field defects [1]. It is estimated that around 60 million people suffer from open angle and closed angle glaucoma with the majority of the patients being female and 47% living in Asia. Another 6 million people suffer from various forms of secondary glaucoma. The patients blind from glaucoma are around 8 million [2,3]. The glaucoma is the second cause of blindness worldwide following cataract.