In vivo confocal microscopy: qualitative investigation of the conjunctival and corneal surface in open angle glaucomatous patients undergoing the XEN-Gel implant, trabeculectomy or medical therapy

Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open angle glaucoma(POAG)patients treated by Xen 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the Xen 45 Gel Stent procedure,Group 2 eyes were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRT II IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The Xen 45 Gel stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with micro-cysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon’s implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare micro-cysts.Post-trabeculectomy inflammatory reaction is more evident than Xen 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel stents.

In vivo confocal microscopy:qualitative investigation of the conjunctival and corneal surface in open-angle glaucomatous patients undergoing the XEN-Gel implant,trabeculectomy or medical therapy

Purpose:Assessing the quality of the ocular surface by in vivo scanning laser confocal microscopy(IVCM)in primary open-angle glaucoma(POAG)patients treated by XEN 45 Gel Stent,medical therapy and trabeculectomy.Methods:Retrospective,single-center,single-masked,comparative study including 60 eyes of 30 patients(mean age 61.16±10 years)affected by POAG.Eyes were divided into 3 groups:Group 1 eyes underwent the XEN 45 Gel Stent procedure,Group 2 eyes^were under medical therapy,Group 3 eyes were surgically treated by trabeculectomy.All patients underwent HRTII IVCM analysis of cornea,limbus,conjunctiva,sub-tenionian space and sclera.Results:The XEN 45 Gel Stent,if properly positioned in the sub-conjunctival space preserves goblet cells and limits ocular surface inflammation.Regular corneal epithelial cells with microcysts,and normo-reflective sub-epithelial nerve plexus are documented by IVCM.In sub Tenon's implants an alternative lamellar intra-scleral filtration is detectable.Combined surgical procedures show a noticeable number of inflammatory cells with rare microcysts.Post-trabeculectomy inflammatory reaction is more evident than XEN 45 Gel Stent associated surgical procedures,but less than medical therapy where a conspicuous presence of Langerhans cells,peri-neural infiltrates,marked loss of goblet cells and fibrosis is visible.Conclusion:Ocular surface inflammation was more notable in topical therapy than after trabeculectomy,which itself causes more inflammation than XEN Gel Stents.

Long term results of accelerated 9mW corneal crosslinking for early progressive keratoconus:the Siena Eye-Cross Study 2

Purpose:To assess clinical results of the 9 mW/5.4 J/cm^(2) accelerated crosslinking(ACXL)in the treatment of progressive keratoconus(KC)over a span of 5 years.Methods:The prospective open non-randomized interventional study(Siena Eye-Cross Study 2)included 156 eyes of 112 patients with early progressive KC undergoing the Epi-Off 9 mW/5.4 J/cm^(2) ACXL at the Siena Crosslinking Centre,Italy.The mean age was 18.05±5.6 years.The 20-min treatments were performed using the New KXL I(Avedro,Waltham,USA),10 min of 0.1%HPMC Riboflavin soaking(VibeX Rapid,Avedro,Waltham,USA)and 10 min of continuous-light UV-A irradiation.Uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),Kmax,coma,minimum corneal thickness(MCT),surface asymmetry index(SAI),endothelial cell count(ECC)were measured,and corneal OCT performed.Results:UDVA and CDVA improved significantly at the 3rd(P=0.028),Δ+0.17 Snellen lines and 6th postoperative month,respectively(P<0.001),Δ+0.23 Snellen lines.Kmax improved at the 6th postoperative month(P=0.03),Δ−1.49 diopters from the baseline value.Also,coma aberration value improved significantly(P=0.004).A mild temporary haze was recorded in 14.77%of patients without affecting visual acuity and without persistent complications.Corneal OCT revealed a mean demarcation line depth at 332.6±33.6μm.Conclusion:The 5-year results of Epi-Off 9 mW/5.4 J/cm^(2) ACXL demonstrated statistically significant improvements in UCVA and CDVA,corneal curvature and corneal higher-order aberrations which confers a long-term stability for progressive ectasia.Based on the results of the Siena Eye-Cross Study 2,the 9 mW/5.4 J/cm^(2) ACXL is a candidate to be the natural evolution of Epi-Off CXL treatment for the management of early progressive corneal ectasia,and thus optimize clinic workflow.