{"title":"Glaucoma Drainage Implant Surgery.","authors":"Ahmad A Aref, Steven J Gedde, Donald L Budenz","doi":"10.1159/000458485","DOIUrl":"https://doi.org/10.1159/000458485","url":null,"abstract":"<p><p>Glaucoma drainage implant (GDI) surgery represents a significant advance in the treatment of refractory glaucomas. Recent randomized clinical trials have compared the efficacy and safety of this technique to standard trabeculectomy. Several types of implant are currently available and differ in surface area, shape, composition, and the presence or absence of a flow-restricting valve. Two separate prospective, randomized clinical trials comparing 2 types of GDI have reported results after 5 years of follow-up. GDIs may be placed in the anterior chamber, ciliary sulcus, or pars plana. Several types of patch graft material may be utilized to prevent tube erosion. Potential complications of GDI surgery may relate to immediate or late-onset hypotony, motility disturbances, corneal decompensation, or tube erosion.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"43-52"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ocular Surface and External Filtration Surgery: Mutual Relationships.","authors":"Christophe Baudouin","doi":"10.1159/000458487","DOIUrl":"https://doi.org/10.1159/000458487","url":null,"abstract":"<p><p>There is a large body of evidence from clinical and experimental studies indicating that the long-term use of topical drugs may induce ocular surface changes, causing ocular discomfort, dry eye, conjunctival inflammation, subconjunctival fibrosis, corneal surface impairment, and, as a consequence of chronic ocular surface changes, the potential risk of failure for further glaucoma surgery. Subclinical inflammation has also been widely described in patients receiving antiglaucoma treatments for long periods of time, with inflammatory cell infiltration and fibroblast activation in the conjunctiva and subconjunctival space. Preservatives, especially benzalkonium chloride, which has consistently demonstrated its toxic effects in laboratory, experimental, and clinical studies, could induce or enhance such inflammatory changes, and has been recently confirmed as a direct risk factor of surgical failure. As a quaternary ammonium, this compound causes tear film instability, loss of goblet cells, conjunctival squamous metaplasia and apoptosis, disruption of the corneal epithelium barrier, corneal nerve impairment, chronic inflammation and potential damage to deeper ocular tissues. Drug-induced adverse effects are therefore far from restricted to only allergic reactions, but they are often very difficult to identify because they mostly occur in a delayed or poorly specific manner, and result from complex and multifactorial interactions between the drugs and the ocular surface. Postoperatively, the ocular surface also plays an important role, as the conjunctiva interacts with aqueous humor and subconjunctival fibrosis may block aqueous outflow and cause surgical failure. As preoperative inflammation underlies postoperative fibrosis and therefore surgical outcome, a better knowledge of ocular surface changes with appropriate evaluation and management should thus become a new paradigm in glaucoma care over the long term.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"67-79"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diabetic Macular Edema: Emerging Strategies and Treatment Algorithms.","authors":"Elad Moisseiev, Anat Loewenstein","doi":"10.1159/000459706","DOIUrl":"https://doi.org/10.1159/000459706","url":null,"abstract":"<p><p>Diabetic macular edema (DME) is the most common cause of vision loss in diabetic patients, and its management is often a long process requiring frequent monitoring and therapeutic interventions. During the past several decades, numerous treatments have been developed for the treatment of DME. Although many of them have been found to be effective and safe, there is relatively little comparative data, and no established guidelines for the optimal treatment approach exist. In this chapter, the evolution of DME therapies is reviewed, and the current common practice patterns are discussed. Available data from clinical trials on the commonly used agents, as well as comparative studies and combination therapies are reviewed. Additionally, recent advances and novel treatment options that are currently being investigated are also discussed.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"165-174"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Optical Coherence Tomography Angiography in Diabetic Maculopathy.","authors":"Gabriel Coscas, Marco Lupidi, Florence Coscas","doi":"10.1159/000459688","DOIUrl":"https://doi.org/10.1159/000459688","url":null,"abstract":"<p><p>Fluorescein angiography (FA) and indocyanine green angiography have provided information about the normal retinal and choroidal anatomy, nearly comparable to histological findings. These tests have been fundamental in the evaluation of all retinal and choroidal vascular diseases and have allowed clinicians to define and diagnose several pathological conditions. FA became the \"gold standard\" in retinal imaging due to the capacity to visualize the retinal capillary bed and its changes, both in the macular area and in the periphery. Although the fluorescence of the injected dye enabled improved visualization of retinal capillaries, not all the different layers of the retinal capillary network could be visualized in this bi-dimensional examination, mainly because of the light scattering phenomenon. By calculating the difference between static and non-static tissues, optical coherence tomography angiography (OCT-A) allows a depth-resolved visualization of the retinal and choroidal microvasculature. Given that the main moving elements in the ocular fundus are contained in blood vessels, determining a vascular decorrelation signal enables visualization of the 3-dimensional retinal and choroidal vascular networks without the intravenous dye injection, reducing therefore the risk of potential adverse events. Since OCT-A is perfectly co-registered with its structural OCT, both morphological findings, such as macular edema, and functional ones, like capillary drop-out, may be clearly evaluated on a single dye-free examination. Proficient detection of the different findings in diabetic maculopathy on OCT-A can result in a rapid analysis of the examination, and in the capacity to distinguish truly decorrelated structures (perfused vessels) from artifacts. Moreover, a complete morpho-functional assessment may help in determining both the origin and the clinical activity of a given vascular disease.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"38-49"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intravitreal Aflibercept in Diabetic Macular Edema: Long-Term Outcomes.","authors":"Ugo Introini, Giuseppe Casalino","doi":"10.1159/000460220","DOIUrl":"https://doi.org/10.1159/000460220","url":null,"abstract":"<p><p>For decades, macular laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). With the relatively recent advent of anti-vascular endothelial growth factor (VEGF) agents, DME treatment has entered a new era. VEGF is a well-known pro-angiogenic and pro-permeability factor involved in the pathogenesis of DME. VEGF blockade has proven remarkably effective at reducing DME and improving visual acuity (VA) in eyes with center involved DME causing VA loss in several randomized controlled trials (RCTs). Intravitreal aflibercept, ranibizumab, and bevacizumab (the latter used off-label) are 3 anti-VEGF molecules currently available for DME treatment. Aflibercerpt is a 115-kDA recombinant fusion protein consisting of VEGF binding domains of human VEGF receptors-1 and -2 fused to the Fc domain of human immunoglobulin-G1. The ability to bind placental growth factors 1 and 2 (which is another pro-permeability mediator) and a theoretically long half-life are potential advantages of aflibercept over other anti-VEGF agents. The use of intravitreal aflibercept in DME treatment has been investigated in several RCTs. The aim of this chapter is to briefly report on the current evidence for treating DME with intravitreal aflibercept.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"71-77"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000460220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34928611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Drug Delivery to the Posterior Segment of the Eye.","authors":"Elad Moisseiev, Anat Loewenstein","doi":"10.1159/000455276","DOIUrl":"https://doi.org/10.1159/000455276","url":null,"abstract":"<p><p>Drug delivery into the posterior segment of the eye is complicated by the existence of the blood-ocular barrier. Strategies for delivering drugs to the posterior segment include systemic administration, modification of the barrier, and local drug delivery (including transcorneal, transscleral, and intravitreal). The most commonly used method for drug delivery into the posterior segment is by intravitreal injection. Other routes that can be used to achieve therapeutic drug levels in the posterior segment include topical, iontophoretic, and juxtascleral delivery. Extended-release intravitreal drug delivery systems can achieve sustained therapeutic levels with the goal of providing a prolonged clinical benefit with significantly fewer interventions.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"58 ","pages":"87-101"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000455276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34862034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emerging Insights into Pathogenesis.","authors":"Edoardo Midena, Elisabetta Pilotto","doi":"10.1159/000459687","DOIUrl":"https://doi.org/10.1159/000459687","url":null,"abstract":"<p><p>Diabetic retinopathy (DR) is a frequent complication of diabetes mellitus (DM). Persistent hyperglycemia leads to the activation of multiple cellular pathways involved in the pathogenesis of DR, resulting in increased inflammation, oxidative stress, and vascular dysfunction. DR has been considered a \"chronic, low-grade inflammatory disease of the retina\". However, an increasing body of evidence suggests that inflammation and neurodegeneration both occur in human diabetes even before the development of clinical signs of DR. One of the first signs of inflammation in DM is the activation of retinal glia cells (RGC). RGC include microglia and macroglial cells (Müller cells and astrocytes). Activated RGC release cytotoxic substances responsible for the recruitment of leukocytes, blood-retinal barrier breakdown, direct glial dysfunction, and neuronal cell death. Recently, many inflammatory mediators, growth factors, and other molecules have been investigated in human vitreous and aqueous humor samples to better understand, in vivo, the multiple pathways and mechanisms leading to the pathogenesis of DR and its complications, such as diabetic macular edema, with potential for more tailored treatment. Moreover, non-invasive techniques, like optical coherence tomography, have allowed to detect new findings in the retinal layers, such as the hyperreflective intraretinal spots, which have been hypothesized to represent an in vivo marker of microglial activation, and early neural cell loss, confirming the hypothesis that neurodegeneration occurs early both in type 1 and 2 diabetes. These new emerging insights foster a better understanding of the pathogenesis of DR, which can no longer be considered as a pure retinal vascular complication of DM.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"60 ","pages":"16-27"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000459687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34930315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Postoperative Management of Penetrating and Nonpenetrating External Filtering Procedures.","authors":"Paolo Bettin, Federico Di Matteo","doi":"10.1159/000458486","DOIUrl":"https://doi.org/10.1159/000458486","url":null,"abstract":"<p><p>Correct postoperative management is fundamental to prevent and treat complications and to optimize the success of filtering surgery. Timely control visits and appropriate actions and prescriptions ensure the best outcomes, allow recovery from a number of untoward events, and can reestablish filtration when failure seems imminent. In contrast, a slack follow-up and wrong interventions or prescriptions can lead to the failure of any surgery, no matter how accurately it was carried out, sometimes jeopardizing vision and even the anatomy of the globe. The purpose of this review is to present a rational approach to postoperative follow-up and to synthetically describe how to prevent, recognize and address the most common complications of filtering surgery, pointing out the most common pitfalls in the management of the operated eye.</p>","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"59 ","pages":"53-66"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000458486","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34941171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Changes in Ocular Growth after Pediatric Cataract Surgery.","authors":"S. Lambert","doi":"10.1159/000442498","DOIUrl":"https://doi.org/10.1159/000442498","url":null,"abstract":"The human eye undergoes extensive changes during early childhood, including axial elongation, corneal flattening and reduced lens power. Animal studies have shown that removing the crystalline lens during infancy retards axial elongation. Axial elongation has been studied in children after cataract extraction both directly and indirectly. Children with a unilateral congenital cataract generally have a shorter axial length in their cataractous eye than in their fellow eye. This difference usually persists after cataract surgery. While some studies have reported a modest reduction in axial elongation after cataract extraction, the magnitude of this effect is much less than what has been reported in animal models. Choosing an intraocular lens (IOL) power for implantation into a child's eye is complicated by continued ocular growth, the inaccuracy of IOL power calculation formulas for small eyes, and the difficulty of accurately measuring the biometrics of a child's eye. In addition, given the fixed position of an IOL in the eye, increasing elongation of the posterior segment of the eye relative to the anterior segment magnifies the myopic shift that occurs with ocular growth. The targeted refractive error in young children undergoing IOL implantation should be an undercorrection in anticipation of a future myopic shift.","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"57 1","pages":"29-39"},"PeriodicalIF":0.0,"publicationDate":"2016-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442498","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64979358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Delphi Process in the Management of Pediatric Cataract.","authors":"M. Serafino, G. Castellucci, G. Banderali","doi":"10.1159/000442508","DOIUrl":"https://doi.org/10.1159/000442508","url":null,"abstract":"In 2013, our group wanted to learn more about worldwide practice styles and preferences for the management of pediatric cataract. Our initial idea was to survey ophthalmologists around the world. However, Alex Levin suggested doing something more accurate and proposed the Delphi process. We approached Edward Wilson and Rupal Trivedi and formed an executive committee. Before describing the research, we will briefly highlight what the Delphi technique is. It is an accepted method to achieve consensus among experts in controversial areas. It is structured to avoid undue influence from any one individual. An expert group is asked to answer questionnaires anonymously in two or more rounds. Questions without consensus are then reviewed face to face with the assistance of a facilitator. Experts can revise earlier questions after hearing the questionnaire responses to analyze those areas where consensus can or cannot be achieved. By using this process, the range of answers decreases, and the group converges toward a consensus. Results may also be used to identify areas for future research based on areas of nonconsensus. The areas of nonconsensus are of particular interest for future research. Our research was published in 2015 in the British Journal of Ophthalmology [1] . We identified a panel of international pediatric cataract surgeons with a publication record in pediatric cataract management and recognized participation in international meetings on this topic. The executive committee created questions to be used for the electronic surveys. The questionnaires included issues related to the preoperative, intraoperative, and postoperative management of pediatric cataract. In our study, we had 3 rounds of anonymous electronic questionnaires, followed by a face-to-face meeting and then a fourth anonymous electronic questionnaire. All questions had unit-based, multiple-choice, or true-or-false answers. Delphi Process in the Management of Pediatric Cataract","PeriodicalId":77107,"journal":{"name":"Developments in ophthalmology","volume":"57 1","pages":"107-8"},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000442508","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64979704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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