PurposeThe purpose of this study was to evaluate the safety and efficacy of microinvasive glaucoma surgery (MIGS) with 360° ab-interno trabeculotomy using the TRAB360 device as a stand-alone procedure in patients with refractory primary open-angle glaucoma (POAG) and preoperative IOP ≥18 mmHg.SettingThis study evaluated patients treated in a tertiary-referral clinical practice setting.DesignThis study is a retrospective analysis of 81 eyes.MethodsPatients with refractory open-angle glaucoma underwent stand-alone 360° ab-interno trabeculotomy using the TRAB360 device. Effectiveness was determined by reduction in medicated IOP and the use of medications from baseline. Safety was determined by the rate of adverse events and secondary surgical interventions. The time points assessed were baseline and postoperative day 1, week 1, and months 1, 3, 6, and 12. A subgroup analysis was performed on eyes with medicated preoperative IOP values of ≥25 mmHg.ResultsThe reductions in IOP from 1 day to 12 months postoperatively were statistically significant compared to baseline values. The mean reduction in IOP at 12 months was 7.3±6.7 mmHg from baseline. At 12 months, 59% eyes achieved ≥20% reduction in IOP and IOP <18 mmHg with the same or fewer numbers of IOP-lowering medications compared with those at baseline. The mean number of IOP-lowering medications was reduced from 1.7±1.3 at baseline to 1.1±1.0 at 12 months. At 12 months, 67% of eyes with preoperative IOP values of ≥25 mmHg achieved ≥20% reduction in IOP and IOP <18 mmHg with the same or fewer numbers of IOP-lowering medications compared with those at baseline. The most common adverse event for all eyes was mild, transient hyphema (57 eyes). During the first year after the procedure, 20 (25%) eyes were considered failures since they required reinterventions.ConclusionTrabeculotomy using the TRAB360 device resulted in significant IOP reductions up to 1 year with a favorable safety profile. The device is an effective stand-alone MIGS procedure for patients with refractory POAG.

Purpose. To compare two threshold strategies for visual field assessment, ZETA Fast (Optopol Technology) and Humphrey SITA Fast (Carl Zeiss Meditec), in controls and subjects with glaucoma. Patients and Methods. A prospective case-control study was carried out in which the clinical practice study included 26 controls and 26 glaucoma subjects. Testing for each strategy was monocular. Quantitative comparisons of mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and test duration were made using two one-sided t-tests and Wilcoxon signed-rank tests. Confusion matrices were constructed to assess Optopol’s detection as a proxy for Zeiss’s detection of early glaucomatous defects. Receiver operating characteristic (ROC) curves were used to assess MD and PSD’s discriminability. Results. The difference in MD values (Optopol-Zeiss) was within the margin for controls (difference = 0.36, p = 0.06 ), but not for glaucomatous subjects (difference = 2.16, p = 1.0 ). The Optopol strategy took longer than the Zeiss strategy in both controls (difference = 23 seconds, p = 0.001 ) and glaucomatous subjects (difference = 49 seconds, p < 0.001 ). PSD values were higher and VFI values were lower from Optopol in glaucomatous subjects ( p < 0.001 and p = 0.002 ). Optopol was 92% sensitive in capturing early glaucomatous defects with MD <−2 when compared to Zeiss ( p < 0.001 ). ROC analysis shows Optopol yields higher discriminability than Zeiss for MD/PSD indices. Conclusions. Both strategies enable effective identification of glaucomatous defects within 6 minutes; they also offer high sensitivity with a high correlation in global indices between the two strategies. The Optopol strategy is an alternative to the Zeiss counterpart with the limitation of a marginally longer testing protocol but a higher sensitivity of detecting glaucomatous defects.

Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum which is undergoing a global resurgence since its initial decline in the late 1980s. The authors present the case of a 30-year-old Caucasian female who was transferred to our institution for left-sided orbital cellulitis and ultimately diagnosed with ocular syphilis causing panophthalmitis. She was treated with intravenous penicillin and other broad-spectrum antibiotics, topical prednisolone, and cycloplegia, resulting in full recovery. Timely recognition of ocular syphilis by healthcare professionals is key in the prevention of visual sequelae from the infection.

A n 18-year-old boy was accidentally shot with an airgun by a friend while playing at home. He was seen in the casualty unit at Leeds General Infirmary, Leeds, UK. A penetrating ocular injury, with a traumatic cataract and vitreous haemorrhage, was observed. A complex trans-oculofacial injury was confirmed by a computed tomography scan (fig 1). The risks of infection and lead intoxication were not marked with retained intranasal air pellet, and no further endoscopic exploration was undertaken. A primary ocular surgical repair was performed with a lens aspiration, followed by surgery for retinal detachment. Air weapons are an important cause of serious eye injuries in adolescent boys. A survey by the British Ophthalmic Surveillance Unit raised questions regarding airgun use.1 The UK Government has changed the legislation recently to deal with increasing public concerns over airgun misuse. Despite new legislation, airgun pellets remain a cause of sight-threatening ocular injury. An unusual fracture of the scapular body F ractures of the scapula are infrequent; they constitute 3-5% of all shoulder girdle injuries and 1% of all fractures. Fractures of the scapular body/spine make up 50% of scapular fractures. 1A 36-year-old man fell off a horse and sustained a direct injury to the shoulder. On examination, the patient had a prominence over the inferior angle of the scapula with restricted range of movement of the shoulder, especially protraction and retraction of shoulder. Radiographs revealed an unusual fracture of the body of the scapula with an apex anterior angulation of 40˚on the scapular Y view.Scapulothoracic movement is complex and has six movements: elevation, depression, upward rotation, downward rotation, protraction and retraction and they are an important part of the movements of the shoulder girdle. Alhough most scapular body fractures are treated conservatively, fracture malunion can have adverse mechanical and functional effects on shoulder movement.1 Scapular snapping syndrome is one of the problems that could arise from malunion. Accident and emergency staff need to be aware of these complications and the importance of ordering scapular Y views. These fractures would merit an early orthopaedic referral.

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