• bleb leak
• bleb revision
• encapsulated bleb
• failing bleb
• needling
• over-filtering bleb
• trabeculectomy

• Humans
• Glaucoma/surgery
• Glaucoma/physiopathology
• Trabeculectomy/adverse effects
• Trabeculectomy/methods
• Intraocular Pressure/physiology
• Postoperative Complications
• Blister/surgery
• Blister/etiology
• Conjunctiva/pathology
• Conjunctiva/surgery

• Amniotic membrane
• Glaucoma treatment
• Macular hole
• Retinal detachment
• Trabeculectomy
• Vitreoretinal procedures

Bleb leakage is a serious complication of glaucoma filtering surgery. This study describes the method and the results of a new repair method for ischemic bleb leaks. The subjects were consecutive eleven eyes of 11 patients with bleb leakage who underwent the bleb plication surgery. The bleb plication surgery consisted of two steps: 1) bleb needle redirection to float the conjunctiva away from the sclera as extensively as possible around the ischemic conjunctiva; and 2) multiple “O-shaped” sutures were applied between the non-ischemic conjunctiva just outside the ischemic conjunctiva and corneal limbus. The ischemic conjunctiva was not removed, but undermined beneath the advanced non-ischemic conjunctiva. This bleb plication method was repeated until the leakage was sealed. All patients were followed up for at least 6 months after final bleb plication. After final bleb plication, no recurrence of bleb leakage was observed. Moreover, ischemic changes were no longer observed in the advanced non-ischemic conjunctiva. Pre-operative and final intraocular pressure was 3.2 ± 4.1 and 11.9 ± 2.8 mmHg, respectively. This new repair method of bleb plication was safe and effective in sealing the leakage. The conjunctiva is not excised, and hence it does not run out.

The aim of this paper is to provide a succinct literature review of the different clinical applications for AMT usage in an ophthalmic setting, ranging from commonly used applications to less mainstream approaches. The hope is that this review enables the reader to have a better understanding of the biological properties of amnion as well as the indications and scenarios in which AMT can be used, whilst presenting relevant evidence from within the literature which may be of interest. We also provide an update on the methods of preservation of amniotic membrane and the application methodologies.

Literature search. A PubMed search was performed using the search terms “amniotic membrane transplant”, “amnion AND cornea”, amnion AND ophthalmology”, “amnion AND ocular surface” and “Amnion AND eye”. A full review of the literature using the PubMed database was conducted up until 01/05/20. The articles used were written in English, with all articles accessed in full. Both review articles and original articles were used for this review. All full publications related to ophthalmology were considered.

• amnion
• amniotic membrane
• amniotic membrane graft
• amniotic membrane transplant

• Atmospheric pressure
• Bias
• Glaucoma
• Tonometry.

• Angle closure
• Cyclophotocoagulation
• Glaucoma
• Goniosynechialysis
• Intraocular pressure.

To compare the early postoperative hypotony rates and intraocular pressure (IOP) in two groups of eyes using either 23-gauge (23G) or 25-gauge (25G) needle in the creation of the anterior chamber entry tract for Baerveldt tube. The primary outcome measure was incidence of hypotony, and secondary outcome measures included comparison of mean IOP and other early complications.

Ours was a retrospective case review of consecutive patients who underwent 350 mm² Baerveldt implantation in two units over a 2-year period. Data including IOP and complications were collected at 1 day, 1 week, and 1 month following surgery from patients’ notes. Statistical analysis between groups was determined using the unpaired 2-tailed f-test for continuous variables and chi-squared test for categorical variables. Statistical significance was defined at the 0.05 level.

A total of 58 eyes of 58 patients were included in this study. Preoperative mean IOP in the 25G group was significantly higher (26.4 ± 6.8 mm Hg) when compared with the 23G group (21.6 ± 4.0 mm Hg) (p = 0.002). The mean postoperative IOP remained significantly higher in the 25G group at day 1 (p=0.004), week 1 (p = 0.008), but not at month 1 (p = 0.744). Four patients in the 23G group had hypotony within 1 month postsurgery compared with no cases in the 25G group (chi-squared test p = 0.038).

There was a significantly higher risk of early hypotony and lower IOP in the larger 23G group at days 1 and 7, although the IOP was similar in both groups by 1 month.

After all glaucoma drainage device (GDD) tube implantation, regardless of which needle is used to create the tract, the entry site should always be checked with 2% fluorescein drop and 10.0 nylon suture is used with or without autologous Tenon’s tissue to close any leakage.

How to cite this article: Lim KS, Garg A, Cheng J, Muthusamy K, Beltran-Agullo L, Barton K. Comparison of Short-term Postoperative Hypotony Rates of 23-gauge vs 25-gauge Needles in Formation of the Scleral Tract for Baerveldt Tube Insertion into the Anterior Chamber. J Curr Glaucoma Pract 2018;12(1):36-39.

• Baerveldt
• Drainage device
• Glaucoma
• Leak
• Needle entry.

To determine the association of Diopsys® NOVA-LX amplitude and latency abnormality scores with perimetric staging of chronic glaucoma, and to explore potential single-visit short-duration transient visual evoked potential (SD-tVEP) trend detection ability utilizing Humphrey 30-2 field progression data.

Setting: Glaucoma subspecialty clinic. Participants: Treated adult chronic glaucoma patients undergoing SD-tVEP evaluation. Main outcome measures: (1) Proportion of eyes designated as suspect or abnormal by the NOVA-LX multifactorial algorithm were determined as a function of glaucoma severity using the most recent Humphrey visual field analyzer (HVFA) 30-2 field. (2) Association between long-term HVFA-guided progression analysis (GPA) annual slopes and SD-tVEP abnormality was assessed to determine whether a single VEP test might help to identify eyes more prone to progressive visual field (VF) loss.

One hundred and thirty-three eyes of 84 patients (mean age 68 years) were analyzed. The SD-tVEP abnormality increased proportionately with severity of VF loss under high-contrast (Hc) test conditions for both latency (p = 0.001) and amplitude (p < 0.01). The HVFA progression analysis printouts existed for 91 eyes (mean 12.3 fields per eye/range 5-18). Nearly three-quarters (72.5%) of eyes with mean annual HVFA progression >0.7 dB/year (n = 29) had single-visit VEP latency abnormalities. Fewer than half (46.7%) of the remainder (n = 62) showed latency abnormality. Mean progression for eyes with abnormal vs normal VEP latency was -0.87 ± 0.3 dB/year vs -0.32 ± 0.4 dB/year.

Diopsys NOVA-LX Hc latency abnormality shows strong association with VF loss among a diverse population of clinical patients undergoing active treatment for chronic glaucoma, and appears likely to afford clinically useful trend-detecting test.

The SD-tVEP has the potential to serve as a single-visit clinical indicator to identify glaucoma patients at high risk for VF progression.

How to cite this article: Trevino R, Sponsel WE, Majcher CE, Allen J, Rabin J. Association of Diopsys® Short-duration Transient Visual Evoked Potential Latency with Visual Field Progression in Chronic Glaucoma. J Curr Glaucoma Pract 2018;12(1):29-35.

• Cohort study
• Electrophysiology
• Glaucoma
• Perimetry
• Visual evoked potential.

• Adjunct tools
• Amniotic membrane
• Collagen matrix implant
• Fibrin adhesive
• Fibrin glue
• Glaucoma
• Innovations
• Ologen
• Surgery
• Trabeculectomy.

• Cornea
• Human amniotic membrane
• Limbus
• Ocular surface
• Stem cells

• Animals
• Biocompatible Materials
• Cell Line
• Chitosan/chemistry
• Drug Delivery Systems
• Drug Liberation
• Female
• Fibroblasts/cytology
• Magnetic Resonance Spectroscopy
• Membranes, Artificial
• Mice
• Mitomycin/administration & dosage
• Mitomycin/chemistry
• Permeability
• Rabbits
• Rats
• Rats, Wistar
• Spectroscopy, Fourier Transform Infrared
• Water/chemistry

• amniotic membrane
• cryopreservation
• fibrosis
• inflammation
• ocular surface
• reconstruction
• regenerative medicine
• tissue engineering
• wound healing

• R43 EY019785 NEI NIH HHS
• R01 EY006819 NEI NIH HHS
• R44 EY017497 NEI NIH HHS
• R01 EY015735 NEI NIH HHS
• R44 EY019785 NEI NIH HHS
• R43 EY017497 NEI NIH HHS
• R44 EY014768 NEI NIH HHS
• R43 EY014768 NEI NIH HHS

To compare the effectiveness of standard revision surgery using mitomycin C (MMC) with revision using amniotic membrane transplantation and MMC for elevated intraocular pressure (IOP) after trabeculectomy.

A retrospective, nonrandomized comparative study of 36 eyes of 36 patients with a failed trabeculectomy. Patients were divided into two groups, ie, a nonamnion-transplanted group and an amnion-transplanted group. The amniotic membrane was placed on the scleral flap under the conjunctiva in the amnion-transplanted group. Both groups recovered filtration of aqueous humor from the surgical site with the adjunctive use of MMC. The changes in IOP and cumulative survival rate were compared for the two groups. Success was defined as a 30% reduction in IOP from the preoperative IOP and maintenance below 21 mmHg with or without the use of antiglaucomatous agents.

The mean preoperative IOP was not significantly different in the two groups. The mean postoperative IOP in the nonamnion group, 12.1 ± 5.5 mmHg, was significantly lower than the IOP in the amnion group, 16.0 ± 3.7 mmHg. Survival curves in the two groups did not reach significantly different levels.

Conventional surgical bleb revision with MMC can significantly reduce the elevated IOP associated with a failed filtration bleb. The use of an amniotic membrane transplant did not improve the surgical outcome in our cases.

• amniotic membrane
• filtering surgery
• filtration bleb revision
• mitomycin C