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Purpose To study the predisposing factors for late in-the-bag intraocular lens (IOL) dislocation and to analyze the outcomes after explantation surgery. Methods In this retrospective multicentre study, 61 eyes were enrolled. The main inclusion criterion was in-the-bag spontaneous IOL dislocation after uneventful phacoemulsification cataract extraction. Only eyes with serious dislocation that required IOL explantation were eligible. Follow-up after explantation surgery of at least 3 months was required. Exclusion criteria were complicated cataract surgery, out-of-the-bag IOL dislocation, and dislocations that occurred in the first year after the cataract surgery. The main outcome measures were predisposing factors for dislocation, interval between cataract surgery and dislocation, surgical treatment at the time of explantation, preoperative and postoperative corrected distance visual acuity (CDVA), and postoperative complications. Results High myopia was detected in 12 cases (19.7%) and it was the main predisposing factor. Mean time interval from cataract surgery to dislocation was 7.5 (SD 5.2) years. The dislocated in-the-bag IOL was replaced with a scleral fixated IOL (36.1%), angle-supported anterior chamber IOL (31.1%), sulcus repositioning (18%), or posterior chamber iris sutured IOL (4.9%). Finally, 9.8% of the patients were left aphakic. Mean CDVA improved significantly after surgery ( P =0.005). Final CDVA of 20/40 or better was achieved in 29 cases (47.5%). Conclusions High myopia was the main risk factor for late in-the-bag IOL dislocation. Surgical treatment significantly improved the CDVA in our sample and was associated with a low complication rate.

PurposeTo evaluate acute and chronic changes in optic nerve head (ONH) structures and intraocular pressure (IOP) in patients receiving intravitreal injections (IVIs) of anti-VEGF.MethodsTwenty-nine eyes receiving IVIs for the first time were studied. IOP, retinal nerve fiber layer (RNFL) thickness, and ONH structures were evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology. Structures were measured before and 5 min after each one of the three monthly injections of a loading dose treatment. In 13 eyes (44.8%) with more than six IVIs, another evaluation pre and immediately postinjection was performed after 1 year.ResultsA significant acute and transient IOP increase (all p ≤ 0.001), Bruch’s membrane opening (BMO) enlargement (p ≤ 0.001), cup widening (p < 0.05) and deepening (p ≤ 0.001), and prelaminar tissue thinning (p ≤ 0.001) were observed 5 min after each injection. Compared with baseline values, a significant BMO expansion (p = 0.001) and RNFL thinning (p < 0.001) were observed in the third month. In eyes with more than six IVIs, similar immediate postinjection changes, including IOP increase (p = 0.001), prelaminar tissue thinning (p = 0.007), and cup deepening (p = 0.012) were observed at 1 year, while BMO expansion was not significant (p = 0.556). Compared with baseline preinjection values, a significant BMO expansion (p = 0.003), prelaminar tissue thinning (p = 0.011), and cup deepening (p = 0.006) in the inferior region of the ONH occurred. No change in IOP was observed at the end of follow-up.ConclusionsRepeated IVIs could lead to irreversible changes in ONH structures. Large-scale, prospective studies are required to determine the long-term effects of anti-VEGF treatments in ONH tissues.

Purpose To assess the capability of ganglion cell–inner plexiform layer (GCIPL) thickness analysis by optical coherence tomography (OCT) to detect early neuronal loss in nonarteritic anterior ischemic optic neuropathy (NAION). Methods Sixteen patients with unilateral NAION participated in this prospective study. Complete ophthalmologic evaluation including visual acuity, visual field (VF) test, and spectral domain optical coherence tomography (SD-OCT) of peripapillary retinal nerve fiber layer (pRNFL) and GCIPL thickness were performed in the acute phase (within 1 week: 2.7 ± 2.1 days) and at 2 weeks, 1 month, 3 and 6 months after diagnosis. The mean time elapsed from acute episode to irreversible damage detection by GCIPL and pRNFL analysis was registered. Correlations between the GCIPL thinning and functional parameters such as best-corrected visual acuity (BCVA) and visual field indices [mean deviation (MD) and visual field index (VFI)] in acute and chronic phase were also analyzed. Results NAION eyes showed a significant thinning of the mean GCIPLminimum (min) compared to the unaffected eyes as early as 2.2 days after symptoms onset ( p  = 0.017) and at each follow-up visit. ( p  ≤ 0.003). The mean GCIPL average (av) was also thinner in NAION eyes compared to uninvolved eyes at 1 ( p  = 0.003), 3 ( p  = 0.002) and 6 months ( p  < 0.001). At the acute phase, 100 % of NAION eyes showed significant pRNFL thickening, while abnormal thinning was evident in GCIPLav, GCIPLmin, and GCIPL deviation map analysis in 31.3, 56.3, and 62.5 % of NAION eyes. The abnormal thinning rates increased to 43.8, 75, and 81.3 % at 2 weeks and to 62.5, 100, and 100 % at 1 month, respectively. At 2 weeks, GCIPLmin thickness significantly correlated with both acute and chronic BCVA, MD, and VFI. Furthermore, the mean superior and inferior GCIPL thicknesses at 2 weeks associated with corresponding mean inferior and superior hemifield MD at 6 months. Conclusions GCIPL analysis by SD-OCT can be considered as a useful biomarker to establish ganglion cell damage. GCIPL min and GCIPL deviation map are abnormally thinner in 56.3 % and 62.5 % of eyes at presentation, respectively. Therefore, both parameters are abnormally thinned in more than 50 % of eyes at presentation. At 2 weeks, GCIPL min thickness significantly correlated with chronic BCVA, MD and VFI; therefore, GCIPL min thickness can predict final visual dysfunction.

Aim To determine the response of the lamina cribrosa (LC) and prelaminar tissue to a reduction of intraocular pressure (IOP) after nonpenetrating deep sclerectomy (NPDS) using enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT). Methods A total of 28 eyes from 28 patients presenting with primary open angle glaucoma who underwent NPDS were studied. SD-OCT scans using EDI technology were obtained before surgery and 1 week, 1 month, and 3 months postoperatively. The OCT device was set to image a 15 × 10° vertical rectangle centred on the optic disc. The scan closest to the optic nerve head (ONH) centre was selected for analysis. The vertical distances from three equidistant points on the reference line (Bruch’s membrane opening) to the anterior prelaminar tissue surface and the anterior and posterior surfaces of the LC were measured. Results The IOP decreased from 18.7±4.3 to 9.1±4.0 at the first week, 11.4±3.7 at 1 month, and 13.1±3.6 mm Hg at 3 months postoperatively ( P <0.001). There was a significant reduction of the ONH cupping at 1 week (22.3%, P <0.001), 1 month (13.7%, P <0.001), and 3 months (9.8%, P =0.001) after surgery. Anterior displacement of the LC was slight but statistically significant at 1 week (4.5%, P =0.003), 1 month (3.8%, P =0.014), and 3 months postoperatively (3.3%, P =0.010). IOP reduction was significantly correlated with a reduction of ONH cupping and anterior displacement of LC at the first week and first month ( P <0.05). Conclusions Cupping reversal after NPDS is mainly due to changes in prelaminar tissue thickness, whereas the LC changes in position are less pronounced.

Purpose To compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography. Methods This is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 45°, 90°, and 135° and the bleb height was measured. Results Sk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles ( p 25 8.25; p 75 20). The median IOP was 13 mm Hg ( p 25 10; p 75 15), with no significant differences among implants ( P =0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 45° ( r =−0.359; P =0.004), 90° ( r =−0.410; P =0.001), and 135° ( r =−0.417; P =0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants. Conclusion There was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

Aims:The aim of the study was to compare event-based glaucoma progression analysis (GPA) I with new GPA II software and pattern deviation-based trend analyses (visual field index [VFI]) to detect progression in a glaucoma population.Methods:This was a retrospective study that included 90 eyes of 90 patients with a minimum of five reliable visual field tests and a follow-up period of at least 2 years.Results:Event-based GPA II detected progression in 16.7% of eyes in which trend analysis VFI failed. GPA detected progression 6.8 months earlier than VFI. GPA I and II showed excellent agreement (k = 0.94). Agreement between VFI and mean deviation (MD) linear analysis and with GPA criteria was k = 0.52 and k = 0.48, respectively. Mean rates of progression of MD and VFI were −0.41 dB and −1.30% annually, respectively (rho = 0.824; p<0.0001). Using VFI, mean follow-up time was 6.12 and 4.89 years (p = 0.004) and the mean number of visual field tests was 7.33 and 6.01 (p = 0.023) in eyes with and without progression, respectively.Conclusions:Event-based software GPA I and II had excellent agreement. Event analysis showed earlier and greater sensitivity for detecting progression than VFI analysis and both had only moderate agreement. Trend analysis VFI is likely to detect progression in patients with a greater number of visual field tests and a longer follow-up time. The VFI analysis seems to be more accurate than MD analysis for determining rate of progression.

Purpose To determine agreement between slit-lamp indirect ophthalmoscopy and Stratus optical coherence tomography (OCT) when assessing cup-to-disc ratios (CDRs). Methods Twenty-five ocular hypertensive subjects and 56 patients with primary open-angle glaucoma were included. Estimation of vertical (VCDR) and horizontal (HCDR) cup-to-disc ratio with slit-lamp ophthalmoscopy was made by three glaucoma specialists along with OCT scanning of optic nerve head. Agreement between OCT and specialists was measured by intraclass correlation coefficients (ICC), Bland and Altman's scatterplots, and a regression coefficient of the average difference. Results The mean VCDR and HCDR was significantly higher ( P <0.001) with OCT than that estimated by the specialists, with the difference ranging from 0.08 to 0.11, and from 0.13 to 0.18, respectively, depending on the specialist. Difference was higher ( P <0.001) for cuppings below 0.3, and looses significance for larger VCDR cuppings (above 0.7). ICC for VCDR was 0.87 among specialists, and ranges from 0.82 to 0.75 when comparing OCT and specialists. ICC for HCDR was 0.83 among specialists and 0.74 between OCT and specialists. When data were plotted according to the Bland–Altman method, as the cupping increased, the agreement also increased. Conclusions There is very good agreement among the specialists when estimating CDRs by stereoscopic slit-lamp biomicroscopy. OCT shows higher values than the specialists; the greatest differences occurred when assessing small CDRs and the differences diminished as the cupping increased. These two methods of measurement are not interchangeable, and the difference must be considered, especially in discs with smaller CDRs.

Objective To study endothelial injury from a newly designed asymmetric double port Descemet Membrane Endothelial Keratoplasty (DMEK) injector, both ex-vivo and in clinical practice. Design Laboratory investigation with an interventional case series study. Method Sixteen rabbit endothelial rolls were tested for injection using a no-touch technique. For each pair of rolls, one endothelial graft underwent injection with a single port Pasteur pipette twice, wheras the other was injected with a novel asymmetric double port injector with a larger diameter entry port than the exit port also twice. Each graft was stained with 4-6-diamidino-2-phenylinidole dihydrochloride and was counted under a fluorescence-inverted microscope before and after injection. The proportion of graft injury was calculated and the differences were analyzed. Subsequently, six patients requiring DMEK underwent surgery using this novel insertion device and endothelial cell loss was calculated 3 months after the surgery. Results After injection, the mean proportion of endothelial cell survival with the single port pipette was 78.8% ( n =8; SD: ±20.9%), whereas the double port injector yielded a survival rate of 96.8% ( n =8; SD: ±8.4%). This difference was statistically significant ( P =0.008), representing less endothelial injury with the double port device. Early endothelial cell loss after 3 months in the DMEK patients was 26.1% (SD: ±6.1%). Conclusion In our injection model, using a double port injector created significantly less endothelial cell damage than with the single port pipette. Clinically, this device yielded early endothelial cell loss comparable to that of the series performed by experienced DMEK surgeons.

Aim To evaluate the success rate and complications associated with deep sclerectomy with mitomycin C (MMC) and a reticulated hyaluronic acid implant in previously failed trabeculectomy. Methods This prospective study included 20 eyes with a previously failed trabeculectomy, which were treated with deep sclerectomy with 0.2 mg/ml MMC application under the conjunctiva and superficial scleral flap. Intraocular pressure (IOP), glaucoma medications, visual acuity, and complications were recorded preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Results The mean preoperative IOP was 25.8±7.3 mmHg; the IOP significantly decreased to 14.6±3.2 mmHg 1 year postoperative. At each interval, the mean IOP was significantly lower than preoperatively ( P =0.000). At 1 year, the complete success rate (IOP≤21 mmHg untreated) was 65% and the qualified success rate (IOP≤21 mmHg with and without medication) was 100%. 12 patients (60%) achieved an IOP≤15 mmHg with and without medication. No shallow or flat anterior chamber, endophthalmitis, or leakage developed. Conclusions These data suggest that deep sclerectomy augmented with MMC is a safe surgical procedure that decreases IOP in eyes with a previously failed trabeculectomy.