RESUMEN
PURPOSE: To evaluate in glaucoma patients the feasibility and use of remote monitoring of intraocular pressure (IOP) with an implanted telemetry sensor during the coronavirus disease 2019 (COVID-19) lockdown. DESIGN: Cross-sectional study. PARTICIPANTS: Patients previously implanted with a telemetric IOP sensor (Eyemate; Implandata GmbH) were included. METHODS: Intraocular pressure measurements acquired by the patients during the lockdown were collected by physicians who were located remotely. A questionnaire was sent to 10 participating study centers to evaluate the clinical impact of remote monitoring of IOP via the IOP sensor system. MAIN OUTCOME MEASURES: Number of patients who obtained home IOP measurements. RESULTS: Data were available from all centers and from 37 eyes of 37 patients (16 patients with a sulcus-based sensor and 21 patients with a suprachoroidal sensor). Thirty-four patients obtained IOP measurements during the lockdown. Mean age of the patients was 69.3 ± 9.6 years, and 48.6% were women. A total of 8415 IOP measurements from 370 measurement days were obtained. Based on remote IOP measurements, treatment was changed in 5 patients. In another 5 patients, treatment change was considered when physicians received the IOP measurements after the lockdown. Nine of the 10 study centers judged remote IOP measurements to have a clinical impact. CONCLUSIONS: These results show the feasibility of patient-acquired measurement of IOP in conjunction with remote IOP monitoring by physicians with an implantable sensor. The data obtained impacted clinical decision making, including adjustment of ocular hypotensive therapy and avoiding unnecessary office visits during the COVID-19 pandemic.
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COVID-19/epidemiología , Transmisión de Enfermedad Infecciosa/prevención & control , Glaucoma/diagnóstico , Presión Intraocular/fisiología , Pandemias , Telemetría/métodos , Tonometría Ocular/métodos , Comorbilidad , Estudios Transversales , Diseño de Equipo , Femenino , Estudios de Seguimiento , Glaucoma/epidemiología , Glaucoma/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2 , Suiza/epidemiología , Reino Unido/epidemiologíaRESUMEN
A new microinvasive glaucoma surgery device, the Beacon Aqueous Microshunt (BAM), drains aqueous humor directly from the anterior chamber to the surface of the eye vs draining to enclosed spaces within the eye, where outflow resistance, including the episcleral venous pressure, might limit drainage effectiveness. The BAM has a 0.030 mm × 0.048 mm channel and provides a fixed resistance. For implantation, a 1.40 mm wide transcorneal incision into the anterior chamber was created with a posterolimbal outer placement under topical anesthesia. The surgery was easy to execute and had a flat learning curve. Preliminary and early experience have shown success with lowering intraocular pressure immediately postoperatively. In conclusion, the BAM offers a promising minimally invasive surgical procedure.
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Implantes de Drenaje de Glaucoma , Glaucoma , Trabeculectomía , Cámara Anterior/cirugía , Humor Acuoso , Glaucoma/cirugía , Humanos , Presión IntraocularRESUMEN
IMPORTANCE: The transscleral XEN Glaucoma Gel Microstent (XEN-GGM, Allergan Plc., Parsippany, New Jersey) is implanted by a minimally invasive ab interno technique. BACKGROUND: The present study aims to assess the long-term clinical outcomes in patients after XEN-GGM implantation. DESIGN: This prospective, non-randomized, multi-centred study was conducted in three countries (Austria, Canada and Germany). PARTICIPANTS: Sixty-four consecutive eyes of 64 patients with open angle glaucoma received the XEN-GGM (63 µm) without Mitomycin C. Thirty-five (55%) were solo procedures, and 29 (45%) were combined with cataract surgery. METHODS: Visits were planned at baseline, 6 months, 1, 2, 3 and 4 years postoperatively. MAIN OUTCOME MEASURES: The main outcome measures were mean intraocular pressure (IOP), mean number of IOP lowering medication. Secondary outcome parameters were: visual acuity, visual fields and complete surgical failure (defined as presence of a secondary IOP lowering procedure or loss of light perception) at 4 years, postoperatively. RESULTS: Mean best-medicated baseline IOP was 22.5 ± 4.2 mmHg and decreased significantly to 13.4 ± 3.1 mmHg 4 years postoperatively (-40%, n = 34, P < 0.001). Mean number of IOP lowering medication decreased significantly from 2.4 ± 1.3 preoperatively to 1.2 ± 1.3 (-50%, n = 34, P < 0.001) postoperatively. Visual field mean deviation showed no significant change between preoperative and postoperative examinations. Complete surgical failure rate per year was 10%. CONCLUSIONS AND RELEVANCE: The XEN-GGM resulted in lower IOP and a reduction in medications from baseline over 4 years of follow-up. There was no detectable decrease in visual fields over the study. The surgical failure rate is comparable to other filtration surgeries.
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Implantes de Drenaje de Glaucoma , Glaucoma de Ángulo Abierto/cirugía , Stents , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Extracción de Catarata , Femenino , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Estudios Prospectivos , Implantación de Prótesis , Tonometría Ocular , Resultado del Tratamiento , Agudeza Visual/fisiología , Campos Visuales/fisiología , Adulto JovenRESUMEN
PURPOSE: To assess the long-term effectiveness and safety of photorefractive intrastromal corneal crosslinking (CXL) in patients with low myopia. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective case series. METHODS: Healthy eyes with myopia were treated with photorefractive intrastromal CXL using the Mosaic System. Riboflavin 0.1% solution (VibeX Rapid) was topically administered, followed by 365 nm ultraviolet-A (30 mW/cm2) irradiance. Efficacy was assessed by the uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent (MRSE), and keratometry. Safety was assessed by corrected distance visual acuity (CDVA), slitlamp biomicroscopy, endothelial cell count, and adverse event rates. RESULTS: Fourteen patients (24 eyes) with a mean age of 35.7 years were included. At all follow-ups, a statistically significant improvement in UDVA was observed (all P < .001). The CDVA progressively improved from 1 month postoperatively and a statistically significant improvement was achieved at 12 months (P < .001). The average reduction in manifest sphere was 0.90 diopter (D) ± 0.40 (SD) by 12 months. There were no significant differences in mean manifest sphere and MRSE at 3, 6, or 12 months. Compared with baseline, significant reductions in corneal curvature were also observed at all follow-ups (all P < .05). There were no significant changes in endothelial cell density (P = 1.00) or number of cells (P = .95) at 12 months postoperatively, and no adverse events were reported. CONCLUSION: Photorefractive intrastromal CXL was a safe and efficacious treatment of refractive error in patients with low myopia.
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Colágeno/administración & dosificación , Reactivos de Enlaces Cruzados/administración & dosificación , Epitelio Corneal/diagnóstico por imagen , Miopía/tratamiento farmacológico , Fotoquimioterapia/métodos , Refracción Ocular/fisiología , Riboflavina/administración & dosificación , Adulto , Paquimetría Corneal , Sustancia Propia , Topografía de la Córnea , Femenino , Estudios de Seguimiento , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Miopía/diagnóstico , Miopía/fisiopatología , Fármacos Fotosensibilizantes/administración & dosificación , Estudios Prospectivos , Factores de Tiempo , Resultado del Tratamiento , Agudeza Visual , Adulto JovenRESUMEN
PURPOSE: To evaluate the safety and efficacy of photorefractive intrastromal corneal crosslinking (CXL) in low myopia. SETTING: Ruhr University Eye Hospital, Bochum, Germany. DESIGN: Prospective case series. METHODS: Healthy eyes with myopia or myopic astigmatism had photorefractive intrastromal CXL using the Mosaic system to apply ultraviolet-A (UVA) 365 nm (30 mW/cm2) irradiance (total calculated UVA dose of 10 J/cm2 or 15 J/cm2) with riboflavin 0.1% solution. Efficacy was determined by the change in the manifest refraction spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), and corneal curvature. Safety was determined by the corrected distance visual acuity (CDVA), slitlamp biomicroscopy, endothelial cell count, and adverse events. RESULTS: Twenty-six eyes of 14 patients with a mean age of 30.8 years ± 9.3 (SD) were included. There were statistically significant improvements in UDVA 1, 3, and 6 months postoperatively (all P < .001). A significant improvement in CDVA was observed (P = .02). Improvements in the mean manifest sphere and MRSE versus baseline were noted at all visits (P < .001), with a mean change of 0.99 ± 0.47 diopter (D) and 0.97 ± 0.48 D, respectively, by 6 months postoperatively. Significant reductions in corneal curvature versus baseline occurred at all follow-up visits (all P < .05). At 1 month, there were no significant changes in the endothelial cell density (P = .282) or number of cells (P = .069). No safety issues or complications were reported. CONCLUSION: The findings show that patterned CXL using a custom CXL system is safe and effective for reducing myopic refractive error.