Vassilios P. Kozobolis

Primary deep sclerectomy versus primary deep sclerectomy with the use of mitomycin C in primary open-angle glaucoma.

PurposeTo prospectively study and compare the effectiveness and the safety of primary deep sclerectomy with and without the use of mitomycin C in eyes with open-angle glaucoma. Patients and MethodsA total of 90 eyes of 90 patients with primary open-angle glaucoma or pseudoexfoliative glaucoma underwent deep sclerectomy. Patients were enrolled consecutively and assigned randomly to undergo deep sclerectomy without the use of mitomycin C (DS group) and deep sclerectomy with the application of mitomycin C (DSMMC group) in a concentration of 0.2 mg/mL for 2.5 minutes, before the superficial scleral flap formation. ResultsThe intraocular pressure was significantly decreased by 7.13 mm Hg or 27.59% in the DS group and by 11.68 mm Hg or 42.25% in the DSMMC group at the end of the follow-up period. The intraocular pressure reduction in the DSMMC group was statistically significant when compared with that in the DS group (P <0.05). The complete (IOP <22 mm Hg without medication) and qualified (IOP < 22 mm Hg with or without medication) success rates at the end of the follow-up period were 42.5% and 72.5% in the DS group and 50% and 95% in the DSMMC group. The qualified success rate in the DSMMC group was statistically significant when compared with that in the DS group. Differences in complications (choroidal detachment, hyphema, leakage) seen between the two groups were statistically nonsignificant. A hemorrhagic detachment of the Descemet membrane was observed in one eye in the DSMMC group. ConclusionsThe use of intraoperative mitomycin C during deep sclerectomy significantly reduced the postoperative IOP and increased the success rate of the procedure.

The intraoperative use of mitomycin-C in excision of ocular surface neoplasia with or without limbal autograft transplantation.

Purpose. To evaluate the efficacy of intraoperative mitomycin-C in excision of ocular surface neoplasia for prevention of recurrence. Methods. Seven patients (eight eyes), three men and four women, aged 56 to 87 years (mean, 73.8 years), with lesions suspicious for corneal or conjunctival neoplasia, were operated on between October 1998 and March 2000. During excision of the lesion, mitomycin-C 0.02% was applied intraoperatively for 5 minutes. In two cases, excision was combined with conjunctival limbal autograft transplantation. All excised lesions were sent for histopathologic evaluation. Results. During the follow-up period ranging from 6 to 28 months (mean, 16 months) one patient (one eye) died of an unrelated cause. Histopathologic study showed four cases of squamous cell carcinoma, one case of carcinoma in situ, two cases of dysplasia, and one case of actinic keratosis. Of the eight eyes, no clinical recurrence of the lesion occurred in seven eyes, whereas one eye with squamous cell carcinoma showed mild recurrence 5 months after surgery and was successfully treated with topical mitomycin-C. Up to the last follow-up of this case 10 months later, the lesion did not recur. Conclusion. The excision of conjunctival and corneal epithelial neoplasia combined with the intraoperative use of mitomycin-C seems to reduce the recurrence rate. The combined use of mitomycin-C and conjunctival limbal autograft transplantation in two cases did not alter the surgical outcome. More cases and a longer follow-up are needed to establish the efficacy of such an approach.

Comparison of the 24-Hour Intraocular Pressure–Lowering Effects of Latanoprost and Dorzolamide/Timolol Fixed Combination after 2 and 6 Months of Treatment

PURPOSE To evaluate the 24-hour intraocular pressure (IOP)-lowering effect of latanoprost and the dorzolamide/timolol fixed combination (DTFC) after 2 and 6 months of treatment. DESIGN Randomized, prospective, crossover comparison. PARTICIPANTS Thirty-nine patients had primary open-angle glaucoma, and 14 patients had ocular hypertension. METHODS After a 6-week washout period, patients were randomized to either 6 months of treatment with the DTFC twice daily or latanoprost every evening and then crossed over to the opposite treatment for an additional 6 months. MAIN OUTCOME MEASURE Mean 24-hour IOP after 2 and 6 months of treatment. RESULTS Fifty-three patients had an average 24-hour baseline IOP of 25.2+/-2.3 mmHg. After 6 months of treatment, 24-hour IOPs were 18.1+/-1.9 mmHg for the DTFC and 18.3+/-1.9 mmHg for latanoprost. Compared with 2 months of therapy, at 6 months the DTFC showed no significant change in mean 24-hour IOP, whereas latanoprost demonstrated a reduction of 0.3 mmHg (P = 0.01). The DTFC had more burning (P<0.001) and bitter taste (P = 0.01), whereas the latanoprost had more hypertrichosis (P = 0.02). CONCLUSIONS After 6 months of therapy, the DTFC and latanoprost have clinically similar 24-hour IOP-lowering efficacies.

Daytime diurnal curve comparison between the fixed combinations of latanoprost 0.005%/timolol maleate 0.5% and dorzolamide 2%/timolol maleate 0.5%.

AbstractPurpose The diurnal efficacy and safety of the fixed combinations of latanoprost/timolol given once daily vsdorzolamide/timolol given twice daily in primary open-angle glaucoma or ocular hypertensive patients.Design A double-masked, two-centre, crossover comparison.Results In 33 patients, the mean diurnal IOP (0800–2000, measured every 2 h) for latanoprost/timolol fixed combination was 17.3±2.2 mmHg and for dorzolamide/timolol, the fixed combination was 17.0±2.0 mmHg (P=0.36). Additionally, there was no statistical difference for individual time points following a Bonferroni correction. A bitter taste was found more frequently with the dorzolamide/timolol fixed combination (n=6) than the latanoprost/timolol fixed combination (n=0) (P=0.040), while the latanoprost/timolol fixed combination demonstrated more conjunctival hyperaemia (n=9) than the dorzolamide/timolol fixed combination (n=2) (P=0.045). One patient was discontinued early from the dorzolamide/timolol fixed combination due to elevated IOP.Conclusion This study suggests that the daytime diurnal IOP is not statistically different between the dorzolamide/timolol fixed combination and latanoprost/timolol fixed combination in primary open-angle glaucoma and ocular hypertensive patients.

Hemorrhagic Descemet's membrane detachment as a complication of deep sclerectomy: a case report.

PurposeTo report a case that developed hemorrhagic Descemets membrane detachment after deep sclerectomy. Patient and MethodsCase report. A 63-year-old diabetic patient suffering from uncontrolled chronic open-angle glaucoma with full medication, underwent an uneventful deep sclerectomy operation combined with intraoperative Mitomycin-C. ResultsOn the second postoperative day, a hemorrhagic Descemets membrane detachment (HDDM) was observed. The hemorrhage showed rapid absorption rate during the first two weeks along with reduction of the HDDM. After this period of time the rate of blood absorption was decreased. The Descemets membrane reattached completely six months after surgery without any intervention but a paracentral corneal scar was present. The bleb was not functionally impaired during the whole postoperative period, and intraocular pressure remained stable at the level between 12 and 15 mmHg without medication. ConclusionHemorrhagic Descemets membrane detachment should be considered as a potential complication of deep sclerectomy.

Corneal collagen cross-linking using riboflavin and ultraviolet-A irradiation: a review of clinical and experimental studies

Corneal collagen cross-linking (CXL) using riboflavin and ultraviolet-A irradiation is a common method of tissue stabilization and has been developed primarily to address the need of treating keratoconus. CXL’s promising results on keratoconus indicated that it might be effective in other corneal diseases as well. This new treatment promises a slowing effect on the progression of these diseases and its initial results show that it is safe and reasonably curative. The purpose of this review is to critically evaluate this treatment, to explore its benefits, to highlight its limitations in terms of efficacy and long-term safety and finally to identify areas for future research in this topic with a significant potential to change the way we treat our patients. In addition, in this unbiased review we try to bring together all the scientific information from both laboratory and clinical trials that have been conducted during recent years and to review the most recent publications regarding the therapeutic indications of CXL.

Biomechanical diagnosis of keratoconus: evaluation of the keratoconus match index and the keratoconus match probability

Purpose:   To evaluate the diagnostic capacity of the Ocular Response Analyser’s keratoconus match index (KMI) and keratoconus match probability (KMP) classification in a sample of keratoconus (KC) patients.

Central Corneal Mechanical Sensitivity in Pseudoexfoliation Syndrome

Purpose: Corneal involvement and disturbances of the tear film have been reported in pseudoexfoliation syndrome (PEX). Tear film deficiencies are correlated with changes in corneal sensitivity. The present study aims at evaluating central corneal mechanical sensitivity (CCMS) in PEX. Methods: Patients with unilateral or bilateral PEX findings constituted the study group (SG). Age- and gender-matched patients without PEX in either eye constituted the control group (CG). Patients with conditions affecting corneal sensitivity were excluded. CCMS and central corneal thickness (CCT) were measured (using a Cochet-Bonnet esthesiometer and an ultrasonic pachymeter, respectively). Schirmer (ST) and break-up time (BUT) tests were also performed. Results: The SG included 40 patients (24 male, 60%). The CG included 38 patients (25 male, 65.78%). ST scores were significantly lower in the SG compared with the CG (11.45 ± 2.52 mm and 14.27 ± 1.18 mm, respectively, P = 0.04). BUT scores were also significantly lower in the SG compared with the CG (7.64 ± 2.37 mm and 12.43 ± 3.14 mm, respectively, P = 0.03). CCMS was significantly (P = 0.02) reduced in the SG compared with CG (4.54 ± 0.23 cm and 5.73 ± 0.44 cm, respectively). Differences in CCT between the SG and the CG were not statistically significant. Conclusions: The decrease in CCMS in PEX eyes may be related to decreased BUT and ST scores in PEX, as previously described. However, a direct involvement of sensory nerves may also participate. The reduction in CCMS may have implications for the clinical management of PEX patients.

Corneal biomechanical properties and anterior segment parameters in forme fruste keratoconus

Purpose. To evaluate the sensitivity and specificity of corneal biomechanical metrics, anterior segment data, and a combination model in differentiating forme fruste keratoconus (FFK) from normal corneas. Methods. A total of 50 FFK eyes were identified by calculation of the KISA index and recruited FFK group. Results were compared with 50 normal eyes (NG group) randomly selected from 50 patients. The following parameters were evaluated for their diagnostic capacity by evaluation of their receiver operating characteristic curves (ROC): corneal hysteresis (CH), corneal resistance factor (CRF), corneal astigmatism (Cyl), anterior chamber depth (ACD), corneal volume (CV) at 3 mm (CV3) and at 5 mm (CV5), maximum posterior elevation value (PEL), central corneal thickness (CCT), thinnest corneal thickness (TCT) and its coordinates (TCTx, TCTy), the ratio TCT/CCT, pachymetric progression indexes (PPImin, PPIavg, and PPImax), and Ambrósios relational thickness (ARTmin, ARTavg, and ARTmax). Logistic regression was attempted for identification of a combined diagnostic model. Results. Significant differences were detected in all studied parameters except the Cyl, ACD, TCTx, and CV. Among individual parameters, the highest predictive accuracy was for ARTavg (area under the curve [AUC] 95.4%, sensitivity 90%, specificity 88.9%) and TCT (AUC 95.3%, sensitivity 90.9%, specificity 89%). Sufficient predictive accuracy (AUC 99.4%, sensitivity 98.8%, specificity 94.6%) was identified in a diagnostic model that combined the CRF, ARTavg, and PEL parameters. Conclusions. None of the individual parameters provide sufficient diagnostic capacity in FFK. However, diagnostic models that combine biomechanical and tomographic data seem to provide high accuracy in differentiating FFK from normal corneas.

Vision-specific quality of life in Greek glaucoma patients.

PurposeThe aim of the study was to assess the vision-specific quality-of-life (VS-QoL) of Greek glaucoma patients, and the impact of potential influencing factors. MethodsThis was a 2-center, cross-sectional study. One hundred twenty-one patients were recruited from the outpatient glaucoma service and 100 successfully responded to the self-administered, Greek version of the National Eye Institute Visual Function Questionnaire 25. The results were quantified in terms of scores (0-100) and correlations with possible modifiers were investigated. The effects of sex, income, education, and comorbidities on VS-QoL scores were examined by analysis of variance. ResultsOur sample consisted of 49 men and 51 women with a mean age of 64.1 years, ranging from 18 to 89 years. The QoL score (mean±SD) was 81.7±14.7, the mean general health subscale score was 57.3±21.0 and the mean general vision subscale score was 72.7±16.3. Men generally presented higher VS-QoL scores (P=0.042). Age had a negative impact on the “General health” (ρ=−0.325, P=0.001) and “General vision” (ρ=−0.265, P=0.008) subscales. Higher educational background contributed to higher scores in General health, “General vision,” and “Central vision” while urban residence correlated with “Distant activities” and “Social functioning”. Cup-to-disc ratio, visual acuity and visual field indices like the Advanced Glaucoma Intervention Study, the Hodapp-Anderson-Parrish, and the Collaborative Initial Glaucoma Treatment Study scores, and pattern standard deviation and mean deviation all correlated with National Eye Institute Visual Function Questionnaire scores (r values ranging from −0.240 to 0.757). ConclusionsIn this first study in a Greek native population, both the structural measure of cup-to-disc ratio and a multitude of functional scores correlated with VS-QoL scores in glaucoma patients.