Takashi Shigeeda

Long-term follow-up of visual field progression after trabeculectomy in progressive normal-tension glaucoma.

OBJECTIVE To evaluate the long-term effects of trabeculectomy on the progression of visual field damage in patients with progressive normal-tension glaucoma (NTG). DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Twenty-three patients with NTG who had significant progression of visual field damage preoperatively and underwent trabeculectomy using antimetabolites. METHODS Visual field testing using the Humphrey Visual Field Analyzer was periodically performed before and for at least 5 years after surgery (mean, 6 years). The time course of the mean deviation (MD) and mean of total deviations (TD(mean)) in four separate subfields, superior and inferior cecocentral and superior and inferior arcuate fields, were analyzed using a linear mixed effects model. MAIN OUTCOME MEASURES Intraocular pressure (IOP), preoperative and postoperative regression coefficients of the time course of MD or TD(mean) in the four subfields, corresponding to the rate of progression of visual field damage. RESULTS IOP significantly decreased from 16.2 +/- 1.8 mmHg preoperatively to approximately 11 mmHg during the postoperative follow-up period (P < 0.001). The preoperative regression coefficient of MD change was significantly negative (-1.05 [95% confidence interval, -1.28 to -0.82] dB/year, P < 0.001). After surgery, it increased significantly to -0.44 (95% confidence interval, -0.64 to -0.24) dB/year (P < 0.001), but the postoperative value was still significantly negative (P < 0.001). In the superior cecocentral, superior and inferior arcuate fields, preoperative regression coefficients of TD(mean) change were significantly negative (P < 0.001) and significantly increased after surgery (P < 0.01). In the inferior cecocentral field, the preoperative regression coefficient was not significantly different from 0 (P = 0.72) and did not change significantly after surgery (P = 0.15). CONCLUSIONS Trabeculectomy was statistically associated with slowing further progression of visual field damage in patients with progressive NTG. The progression, however, did not completely stop over the 6-year postoperative follow-up period.

Long-term follow-up of initial trabeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients.

PurposeTo determine the long-term intraocular pressure (IOP) control and postoperative complications after initial trabeculectomy with use of mitomycin C (MMC) in patients with primary open-angle glaucoma (POAG). Patients and MethodsA retrospective review was conducted of a consecutive series of 123 eyes (87 patients) with POAG who underwent initial trabeculectomy with MMC and had at least 4 years of follow-up. All patients underwent standard trabeculectomy with 0.04% MMC applied intraoperatively for 3 minutes. The long-term outcomes (IOP control and bleb leak, long-standing hypotony, bleb-related infections) were analyzed with the Kaplan-Meier life-table method on the basis of three definitions of successful IOP control (defined as IOP <18 mmHg (definition 1), IOP <16 mmHg (definition 2), and IOP decrease of by ≥30% and <21 mmHg (definition 3)). ResultsThe mean follow-up time was 6.8±1.4 (mean±SD) years. The cumulative survival rates were 67.0±4.6%, 44.5±5.4%, and 74.1±4.2%, respectively, based on definitions 1, 2, and 3, 8 years postoperatively by life-table analysis. At 8 years, bleb leak occurred in 7.9±2.6% of eyes, long-standing hypotony in 8.3±2.5%, and bleb-related infections in 5.9±2.4%. ConclusionLong-term outcome after initial trabeculectomy with MMC in Japanese POAG patients is comparable with that reported in other populations and with that after trabeculectomy with 5-fluorouracil.

Spontaneous posterior dislocation of intraocular lenses fixated in the capsular bag

We report 4 cases of complete posterior dislocation of an intraocular lens (IOL) in the capsular bag occurring a mean of 5.5 years after uneventful cataract surgery. In all 4 cases, posterior chamber IOLs were fixated within the capsulorhexis. The patients experienced sudden loss of vision without an episode of trauma or ocular disease. Using a 3-port pars plana vitrectomy, the IOLs were explanted through a limbal incision and a new IOL was sutured to the ciliary sulcus. Histological examination indicated that zonular fibers were severed at the site of insertion in the capsule.

Long-term follow-up of initial 5-fluorouracil trabeculectomy in primary open-angle glaucoma in Japanese patients.

PurposeTo evaluate the long-term efficacy and safety of initial trabeculectomy with subconjunctival 5-fluorouracil in Japanese patients with primary open-angle glaucoma. Subjects and MethodsClinical records of 117 eyes from 117 patients with records of up to 14 years were retrospectively analyzed using the appropriate statistical methods. ResultsThe mean follow-up period was 6.2 ± 3.6 years. Criteria for successful intraocular pressure control and success probability by Kaplan-Meier method at 12 years were intraocular pressure < 21 mm Hg without medication plus a 30% or more reduction in intraocular pressure, 50.4 ± 5.2% (SE) 38.2 ± 5.3%; and intraocular pressure < 16 mm Hg without medication plus a 30% or more reduction in intraocular pressure, 45.9 ± 5.1% (36.5 ± 5.2%). Cox multiple regression analysis showed that a younger age was associated with a higher success probability (P <0.01). Eyes with lower postoperative intraocular pressure tended to show more positive value of the MD slope (P = 0.0669), whereas 7% of successfully treated eyes showed a negative postoperative MD slope (P < 0.1). The probabilities for developing bleb leaks and bleb-related infections in eyes with a functioning bleb were 28.9 ± 12.5% and 13.0 ± 10.4% at 12 years. ConclusionTrabeculectomy with 5-fluorouracil as an initial surgery in Japanese patients with primary open-angle glaucoma was effective for long-term control of glaucoma. However, the probability of late-onset bleb-related complications was not low in eyes with a functioning bleb, stressing the importance of constant care regarding bleb status.

Effects of Aromatherapy Massage on Face-Down Posture-Related Pain After Vitrectomy: A Randomized Controlled Trial

Postoperative face-down posturing (FDP) is recommended to optimize the effects of intraocular gas tamponade after vitrectomy. However, patients undergoing FDP usually experience physical and psychological burdens. This 3-armed, randomized, single-center trial investigated the effects of aromatherapy on FDP-related physical pain. Sixty-three patients under FDP were randomly allocated to one of three treatment groups: aromatherapy massage with essential oil (AT), oil massage without essential oil (OT), and a control group. The AT and OT groups received 10 minutes of massage by ward nurses trained by an aromatherapist, while the control group received usual care. Outcomes were assessed as short-term (pre- to post-intervention) and long-term (first to third postoperative day) changes in physical pain in five body regions using face-scale. The AT and OT groups both revealed similar short-term pain reductions after intervention, compared with the control group. Regarding long-term effects, neither group experienced significant effects until the second day. Significantly more pain reduction compared with usual care occurred on the third day, mainly in the AT group, though there were few significant differences between the AT and OT groups. In conclusion, this study suggests that simple oil massage is an effective strategy for immediate pain reduction in patients undergoing FDP, while aromatherapy may have a long-term effect on pain reduction.

Influence of cataract surgery on pupil size in patients with diabetes mellitus

Editor, A spiration of residual cortical matter, especially if located in the subincisional area, can pose a challenge to the cataract surgeon. Various methods have been described to aid the aspiration of residual cortical matter, including use of bimanual IA systems, J-shaped cannulas (Dewey 2002) and transparent irrigation cannulas (Shimada et al. 2002). We describe a hybrid bimanual technique of aspiration of residual cortical matter that uses a combination of the coaxial and bimanual IA hand pieces and averts the requirement of an additional side port. An informed consent was obtained from all the patients undergoing cataract surgery. The study followed the tenets of the Declaration of Helsinki. Two incisions are made at the start of cataract surgery. A 2.75-mm main port is made using a 2.75-mm blade (Alcon Labs, Fort Worth, TX, USA) for the coaxial phacoemulsification probe (Infiniti System, Alcon Labs, USA) and a side port made two clock hours away from the main port with a 20G MVR blade (Alcon Labs). Following the completion of nuclear and epinuclear phacoemulsification, aspiration of cortical matter is begun using the traditional coaxial hand piece. The hybrid bimanual technique may be used if the surgeon is unable to completely aspirate the cortical matter. The coaxial IA probe connected only to the irrigation tubing is introduced into the anterior chamber through the 2.75-mm main incision. The aspiration hand piece of the bimanual system (Appasamy, India) is inserted in the anterior chamber through the 20G side port. The bimanual aspirating hand piece is used to aspirate the remaining cortical matter (Fig. 1). The tip of the coaxial hand piece is kept just below the interior lip of the valve. This allows for better visualization of the aspiration port of the aspirating hand piece. We used this technique in 27 eyes of 27 patients with residual cortex. Cortex could be successfully aspirated in 26 of 27 eyes with the use of the modified technique. One eye that had extensive cortex under the area where the side port was made required conversion to the standard technique of bimanual irrigation and aspiration (IA). No posterior capsular rupture occurred in any of the cases. Residual cortex, especially located in the subincisional area, can pose challenges to the surgeon. Bimanual irrigation and aspiration can greatly ease the removal of residual cortical matter. However, if the surgeon uses a single side port for phacoemulsification, an additional side port needs to be created during the surgery to enable bimanual IA. Our technique obviates the requirement for an additional side port. When the traditional bimanual IA system is used through the two side ports, the larger, main port tends to leak during IA, as it is not occluded by the hand piece. This may lead to surge and instability of the anterior chamber. As the main port is effectively occluded by the coaxial hand piece during IA using our technique, the anterior chamber is more stable during irrigation and aspiration. The only drawback that we experienced with our technique is the occasional inadequate visualization of subincisional cortical matter in the area below the side port as compared to the use of a traditional bimanual IA technique. In such cases, one can make a second side port and shift to the standard bimanual IA technique. In conclusion, the hybrid bimanual technique is a useful modification that can be safely used for aspirating the residual cortical matter during cataract surgery. It combines the benefits of the traditional bimanual IA system with that of the coaxial IA system and at the same time circumvents the need for creation of the second side port.

Intensive Treat-to-Target Statin Therapy in High-Risk Japanese Patients With Hypercholesterolemia and Diabetic Retinopathy: Report of a Randomized Study

OBJECTIVE Diabetes is associated with high risk of cardiovascular (CV) events, particularly in patients with dyslipidemia and diabetic complications. We investigated the incidence of CV events with intensive or standard lipid-lowering therapy in patients with hypercholesterolemia, diabetic retinopathy, and no history of coronary artery disease (treat-to-target approach). RESEARCH DESIGN AND METHODS In this multicenter, prospective, randomized, open-label, blinded end point study, eligible patients were randomly assigned (1:1) to intensive statin therapy targeting LDL cholesterol (LDL-C) <70 mg/dL (n = 2,518) or standard statin therapy targeting LDL-C 100–120 mg/dL (n = 2,524). RESULTS Mean follow-up was 37 ± 13 months. LDL-C at 36 months was 76.5 ± 21.6 mg/dL in the intensive group and 104.1 ± 22.1 mg/dL in the standard group (P < 0.001). The primary end point events occurred in 129 intensive group patients and 153 standard group patients (hazard ratio [HR] 0.84 [95% CI 0.67–1.07]; P = 0.15). The relationship between the LDL-C difference in the two groups and the event reduction rate was consistent with primary prevention studies in patients with diabetes. Exploratory findings showed significantly fewer cerebral events in the intensive group (HR 0.52 [95% CI 0.31–0.88]; P = 0.01). Safety did not differ significantly between the two groups. CONCLUSIONS We found no significant decrease in CV events or CV-associated deaths with intensive therapy, possibly because our between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment). The potential benefit of achieving LDL-C <70 mg/dL in a treat-to-target strategy in high-risk patients deserves further investigation.

Visual Field Progressive Rate in Normal Tension Glaucoma Before and After Trabeculectomy: A Subfield-Based Analysis.

PurposeTo compare pretrabeculectomy and posttrabeculectomy progression rates in normal-tension glaucoma in 6 subfields of the central 30 visual field. DesignA retrospective study. MethodsClinical records of 34 patients with normal-tension glaucoma (12 males and 22 females) with progressive visual field loss undergoing successful trabeculectomy were studied. The time course of the mean deviation (MD) and mean of total deviation in the superior/inferior arcuate, paracentral, and cecocentral subfields were analyzed using a linear mixed-effects model. ResultsPatients’ age, intraocular pressure (IOP), MD, and pretrabeculectomy and posttrabeculectomy follow-up averaged 57.7 ± 9.6 years, 15.7 ± 1.7 mm Hg, −12.7 ± 5.5 dB, and 4.6 ± 1.5 and 5.7 ± 1.2 years, respectively. Average IOP was lowered by 6.1 ± 3.3 to 10.3 ± 2.7 mm Hg (5–14 mm Hg) over the postoprerative period with MD change rate of −0.25 dB/y (P < 0.003), which was slower (P < 0.001) than the preoperative one (−0.70 dB/y). The preoperative mean of total deviation change rate (−0.31 to −1.35 dB/y) improved postoperatively in the superior and inferior paracentral subfields (P < 0.001), whereas it remained unchanged in the inferior cecocentral/arcuate subfields (P > 0.10). The postoperative rate of progression showed no significant variation in these subfields. ConclusionsThe rate of progression significantly varied among the 6 subfields preoperatively. It was significantly slowed down in the superior subfields by surgical IOP reduction, but not in the inferior cecocentral/arcuate subfields.

Comparison of burn size after retinal photocoagulation by conventional and high‐power short‐duration methods

assessments every 2 months to detect recurrences with shorter delay. Our results point out the need for reinjection every 5 months, with good results on CMT and VA in real life (Fig. 1). Financial disclosures outside the subject of this work: Dr Krivosic received honoraria for board membership, consultancy, lectures and received reimbursement of travel and meeting expenses from Allergan, Bayer and Novartis. Dr Bheekee has no financial disclosure. Dr Mich ee has no financial disclosure. Dr Delyfer has no financial disclosure. Pr Tadayoni received honoraria for board membership, consultancy, lectures and educational presentation, and received reimbursement of travel and meeting expenses from Alcon, Allergan, Alimera, Bausch & Lomb, Bayer, Dorc, FCI, Novartis, Pfizer, Servier and Takeda. Pr Korobelnik received honoraria for board membership, consultancy, lectures and educational presentation, and received reimbursement of travel and meeting expenses from Alcon, Allergan, Bayer, Carl Zeiss Meditec, Novartis, Roche and Thea.

Influence of a yellow-tinted intraocular lens on laser beam transmittance.

Acta Ophthalmol. 2011: 89: 37–39