Combined pars plana vitrectomy and Baerveldt glaucoma implant placement for refractory glaucoma

AIMTo evaluate outcomes of combined pars plana vitrectomy and Baerveldt glaucoma implant (PPV-BGI) placement for refractory glaucoma.METHODSThe medical records of 92 eyes (89 patients) that underwent PPV-BGI were retrospectively reviewed, including 43 eyes with neovascular glaucoma (NVG) and 49 eyes with other types of glaucoma (non-NVG).RESULTSOutcome measures were visual acuity (VA), intraocular pressure (IOP), glaucoma medical therapy, complications, and success [VA>hand motions (HM), IOP≥6 mm Hg and ≤21 mm Hg, no subsequent glaucoma surgery]. Cumulative success rates for the non-NVG group and NVG group were 79% and 40% at 1y, respectively (P=0.038). No difference in the rates of surgical success were found between pars plana and anterior chamber tube placement. Preoperative IOP (mean±SD) was 30.3±11.7 mm Hg in the Non-NVG group and 40.0±10.6 mm Hg in the NVG group, and IOP was reduced to 15±9.5 mm Hg in the non-NVG group and 15±10.5 mm Hg in the NVG at 1y. Number of glaucoma medications (mean±SD) decreased from 2.7±1.3 in the non-NVG group and 2.8±1.3 in the NVG group preoperatively to 0.76±1.18 in the non-NVG group and 0.51±1.00 in the NVG group at 1y. Improvement in VA of ≥2 Snellen lines was observed in 25 (27%) eyes, although only 33% of non-NVG eyes and 2.3% of NVG eyes maintained VA better than 20/200 at 1y. Nonclearing vitreous hemorrhage was the most common postoperative complication occurring in 16 (17%) eyes, and postoperative suprachoroidal hemorrhages developed in 5 (5.4%) eyes.CONCLUSIONPPV-BGI is a viable surgical option for eyes with refractory glaucoma, but visual outcomes are frequently poor because of ocular comorbidities, especially in eyes with NVG. The location of tube placement does not influence surgical outcome and should be left to the discretion of the surgeon.

Exploratory study of non-invasive,high-resolution functional macular imaging in subjects with diabetic retinopathy

AIM:To evaluate a high-resolution functional imaging device that yields quantitative data regarding macular blood flow and capillary network features in eyes with diabetic retinopathy(DR).METHODS:Prospective,cross-sectional comparative case-series in which blood flow velocities(BFVs)and noninvasive capillary perfusion maps(nCPMs)in macular vessels were measured in patients with DR and in healthy controls using the Retinal Functional Imager(RFI)device.RESULTS:A total of 27 eyes of 21 subjects were studied[9 eyes nonproliferative diabetic retinopathy(NPDR),9 eyes proliferative diabetic retinopathy(PDR)and 9 controls].All diabetic patients were type 2.All patients with NPDR and 5 eyes with PDR also had diabetic macular edema(DME).The NPDR group included eyes with severe(n=3)and moderate NPDR(n=6),and were symptomatic.A significant decrease in venular BFVs was observed in the macular region of PDR eyes when compared to controls(2.61±0.6 mm/s and 2.92±0.72 mm/s in PDR and controls,respectively,P=0.019)as well as PDR eyes with DME compared to NPDR eyes(2.36±0.51 mm/s and 2.94±1.09 mm/s in PDR with DME and NPDR,respectively,P=0.01).CONCLUSION:The RFI,a non-invasive imaging tool,provides high-resolution functional imaging of the retinal microvasculature and quantitative measurement of BFVs in visually impaired DR patients.The isolated diminish venular BFVs in PDR eyes compared to healthy eyes and PDR eyes with DME in comparison to NPDR eyes may indicate the possibility of more retinal vein compromise than suspected in advanced DR.