Elizabeth A. Vanner

Treatment Outcomes in the Primary Tube Versus Trabeculectomy Study after 1 Year of Follow-up

PURPOSEnTo report 1-year treatment outcomes in the Primary Tube Versus Trabeculectomy (PTVT) Study.nnnDESIGNnMulticenter, randomized clinical trial.nnnPARTICIPANTSnTwo hundred forty-two eyes of 242 patients with medically uncontrolled glaucoma and no previous incisional ocular surgery, including 125 in the tube group and 117 in the trabeculectomy group.nnnMETHODSnPatients were enrolled at 16 clinical centers and assigned randomly to treatment with a tube shunt (350-mm2 Baerveldt glaucoma implant) or trabeculectomy with mitomycin C (MMC; 0.4 mg/ml for 2 minutes).nnnMAIN OUTCOME MEASURESnIntraocular pressure (IOP), glaucoma medical therapy, visual acuity, visual fields, surgical complications, and failure (IOP of more than 21 mmHg or reduced by less than 20% from baseline, IOP of 5 mmHg or less, reoperation for glaucoma, or loss of light perception vision).nnnRESULTSnThe cumulative probability of failure during the first year of follow-up was 17.3% in the tube group and 7.9% in the trabeculectomy group (Pxa0= 0.01; hazard ratio, 2.59; 95% confidence interval, 1.20-5.60). Meanxa0± standard deviation IOP was 13.8±4.1 mmHg in the tube group and 12.4±4.4 mmHg in the trabeculectomy group at 1 year (Pxa0= 0.01), and the number of glaucoma medications was 2.1±1.4 in the tube group and 0.9±1.4 in the trabeculectomy group (P < 0.001). Postoperative complications developed in 36 patients (29%) in the tube group and 48 patients (41%) in the trabeculectomy group (Pxa0= 0.06). Serious complications requiring reoperation or producing a loss of 2 Snellen lines or more occurred in 1 patient (1%) in the tube group and 8 patients (7%) in the trabeculectomy group (Pxa0= 0.03).nnnCONCLUSIONSnTrabeculectomy with MMC had a higher surgical success rate than tube shunt implantation after 1 year in the PTVT Study. Lower IOP with use of fewer glaucoma medications was achieved after trabeculectomy with MMC compared with tube shunt surgery during the first year of follow-up. The frequency of serious complications producing vision loss or requiring reoperation was lower after tube shunt surgery relative to trabeculectomy with MMC.

Visualization of Focal Thinning of the Ganglion Cell–Inner Plexiform Layer in Patients with Mild Cognitive Impairment and Alzheimer’s Disease

BACKGROUNDnA detailed analysis of the tomographic thickness of intraretinal layers may provide more information on neurodegeneration in patients with mild cognitive impairment (MCI) and Alzheimers disease (AD).nnnOBJECTIVEnThe goal was to analyze tomographic thickness patterns of intraretinal layers in patients with AD andMCI.nnnMETHODnForty-nine patients (25 AD and 24 MCI) and 21 cognitively normal (CN) controls were imaged using ultra-high-resolution optical coherence tomography to obtain volumetric data centered on the fovea. The segmented intraretinal layers were retinal nerve fiber layer (RNFL), ganglion cell- inner plexiform layer (GCIPL), inner nuclear layer (INL), outer nuclear layer (ONL), outer plexiform layer (OPL), and retinal photoreceptor (PR), in addition to the total retinal thickness(TRT).nnnRESULTSnThe thickness differences were negative (thinning) mainly in TRT, RNFL, and GCIPL in both AD and MCI groups in comparison to CN, while the thickness differences were positive (thickening) mainly in ONL and PR in AD. GCIPL of AD and MCI was thinner in superior, nasal superior, and temporal superior quadrants, compared to CN (p < 0.05). GCIPL of the inner superior, inner nasal superior, inner temporal superior, and outer nasal superior sectors was significantly thinner in AD than CN (p < 0.05). GCIPL of the outer superior, inner temporal superior, outer nasal, and temporal superior sectors was significantly thinner in MCI than CN (p < 0.05).nnnCONCLUSIONnFocal thinning of the GCIPL was visualized and quantified by detailed partitions in AD and MCI, which provides specific information about neurodegeneration in MCI and AD.

Strabismus surgery outcomes without removal of scleral buckle in patients with previous retinal detachment repair

PURPOSEnTo report the motor and sensory outcomes of strabismus surgery following scleral buckle procedure for retinal detachment (RD) without removal of the scleral buckle.nnnMETHODSnThe medical records of patients who underwent strabismus surgery without removal of scleral buckle following RD surgical repair at a tertiary referral center between 2002 and 2015 were reviewed retrospectively. Demographic data were recorded, and rates of surgical motor success (defined as horizontal deviation of ≤10Δ and vertical deviation of ≤4Δ) and sensory success (resolution of diplopia) were calculated.nnnRESULTSnA total of 23 patients (mean age, 58.4xa0±xa024.4xa0years; 12 males) were included. The average time between the RD surgery and onset of strabismus was 11.05xa0±xa010.95xa0months (range, 1-42xa0months). The strabismus was horizontal in 6 patients, vertical in 2, and combined in 15. Eighteen patients (78%) presented with diplopia. Adjustable sutures were used in 18 patients. Final motor surgical success was achieved in 17 of 23 patients (74%), and diplopia improved in 17 of 18 patients (94%) who had preoperative fusional capability. There was no statistically significant difference in age, number of RD surgeries, macular status, time to strabismus surgery, visual acuity in the worse eye, or magnitude of preoperative horizontal and vertical deviation with regard to motor success rate and with persistence of diplopia postoperatively.nnnCONCLUSIONSnIn our study cohort, strabismus surgery without removal of the scleral buckle resulted inxa0motor success and alleviated diplopia in the majority of patients with prior RD repair.

Association between congenital nasolacrimal duct obstruction and mode of delivery at birth

PURPOSEnTo investigate the association between mode of delivery, incidence of congenital nasolacrimal duct obstruction (CNLDO), and treatment outcomes.nnnMETHODSnThe medical records of children diagnosed with CNLDO at a tertiary referral center between 2012 and 2017 were analyzed retrospectively. Patient demographics, pregnancy and birth history, clinical characteristics of CNLDO, and treatment outcomes were compared in patients delivered via Cesarean section (CS) versus vaginal delivery (VD). The rates of CS, as well as full-term and premature births, were also compared to Miami-Dade County normative values to eliminate the confounding effects of prematurity.nnnRESULTSnA total of 104 patients were included. A significantly higher percentage of patients with CNLDO (61%) were delivered via CS (Pxa0<xa00.0001). Among full-term babies, there was 55% greater risk (ORxa0=xa01.55; 95% CI, 0.98-2.43; Pxa0=xa00.067) of CNLDO for CS birth compared to all other babies. Among preterm babies, there were no significantly greater odds of CNLDO for CS compared to VD births (Pxa0=xa00.575). CNLDO did not resolve spontaneously in 50 patients, including 37 CS (74%) and 13 VD (26%) patients (Pxa0=xa00.007). Among those patients who failed first-line probing, 86.2% were born via CS, whereas 13.8% were born via VD (Pxa0=xa00.0009).nnnCONCLUSIONSnCS is a risk factor for CNLDO, independent of gestational age. Children born via CS also tend to have a more complicated clinical course requiring additional surgical interventions.