PurposeTo elucidate the learning curve for endoscopic endonasal dacryocystorhinostomy (EE-DCR) based on the results of EE-DCR performed by three surgeons at three different tertiary hospitals.MethodsA retrospective review of the medical records of 386 eyes of 337 patients who had undergone EE-DCR by three surgeons at three tertiary hospitals and who were available for a >6-month postoperative observation period was conducted. The success of a given surgery was determined based on the results of a test performed during the patient's last outpatient visit to the hospital. The learning curve was identified by dividing the patients into four groups (20, 30, 40, and 50 eyes in each respective group) and comparing their success rates.ResultsThe overall success rate of the entire study population was 86.3%. The success rates for each of three surgeons was 83.3%, 85.6%, and 88.1%, respectively. After dividing the patients into groups of 30 eyes each, all three surgeons showed a significant increase in surgery success rates after their first group of 30 eyes (p < 0.05). The overall success rate excluding the first 30 eyes was 92.9%, and all three surgeons exhibited a significantly improved success rate of >90% (A, 94.4%; B, 90.8%; C, 95.4%).ConclusionsA surgeon should be required to perform at least 30 EE-DCR procedures to obtain stable surgical skill for this procedure.

Purpose: We compared the clinical factors, including anterior chamber tube parameters, in patients with and without corneal endothelial cell damage after Ahmed glaucoma valve (AGV) implantation. Methods: In this retrospective and comparative case series, patients who underwent AGV implantation were enrolled consecutively. Serial specular microscopy was performed before and after AGV implantation. Patients were divided into two groups depending on whether there was a significant decrease in corneal endothelial cell density (ECD), which was determined by each patient’s rate of ECD change (%/year), calculated using linear regression analyses. Tube parameters such as the tube-cornea distance (TCD) and tube-cornea angle (TCA) were measured with anterior segment optical coherence tomography. Clinical factors related to the rate of ECD change were evaluated with regression analyses and compared between the two groups. The tipping point at which tube parameters became significantly associated with the rate of ECD change was identified with broken stick regression analyses. Results: There were 30 eyes (32.3%) with ECD damage (group 1) and 63 eyes (67.7%) without damage (group 2). The mean rate of ECD change (%/year) was −18.82 ± 22.97 and 2.14 ± 2.93 in groups 1 and 2, respectively (p < 0.001). The TCA was the only clinical factor associated with the rate of ECD change (regression coefficient, β = 1.254, p < 0.001). The tipping point in the TCA was 26.70° (95% confidence interval, CI: 23.75–29.64°). The mean TCD (mm) was 0.98 ± 0.38 and 1.26 ± 0.39 (p = 0.002), and the mean TCA (degrees) was 28.67 ± 7.79 and 36.35 ± 5.35 (p < 0.001) in groups 1 and 2, respectively. Conclusions: A wider TCA was protectively associated with the rate of ECD change, and the TCA was significantly narrower in patients with ECD damage. When inserting a tube into the anterior chamber, surgeons should therefore try to secure a wide TCA of about 30°. In patients with a narrow TCA after AGV implantation, increased attention should be directed toward whether ECD decreases continuously.

Purpose: To evaluate changes in macular thickness in patients continuing prostaglandin analog (PGA) treatment during the perioperative period involving bromfenac treatment. Methods: Patients with glaucoma who were using a topical PGA were randomly assigned to two groups in this randomized controlled trial: PGA continuing study group and PGA discontinued glaucoma control group. Patients without ocular diseases other than cataract were enrolled into the non-glaucomatous group. After the cataract surgery, the patients used bromfenac twice per day for 4 weeks. Optical coherence tomography was performed in all patients preoperatively and at 1 month postoperatively. Changes in macular thickness were compared among the three groups. Results: There were 32 eyes in the study group, 33 eyes in the glaucoma control group, and 58 eyes in the non-glaucomatous group. We found statistically significant postoperative changes in central macular thickness in all groups (4.30 ± 8.01 μm in the PGA continuing group, 9.20 ± 13.88 μm in the PGA discontinued group, and 7.06 ± 7.02 μm in the non-glaucomatous group, all p < 0.008), but no significant difference among the three groups (p = 0.161). Cystoid macular edema occurred in only one patient in the non-glaucomatous group (p = 0.568). Conclusions: Continuous use of PGAs during the perioperative period was not significantly associated with increased macular thickness after uncomplicated cataract surgery. In the absence of other risk factors (e.g., capsular rupture, uveitis, or diabetic retinopathy), discontinuing PGAs for the prevention of macular edema after cataract surgery with postoperative bromfenac treatment is unnecessary in patients with glaucoma.

Purpose: We hypothesized that the thickness map from macular ganglion cell analysis (GCA) acquired from spectral-domain optical coherence tomography can be used to differentiate retinal vein occlusion (RVO) from glaucoma. Methods: In this retrospective case control study, 37 patients with resolved RVO and 74 patients with primary open-angle glaucoma (POAG) were enrolled. Two independent examiners diagnosed patients with RVO or POAG based on the topographic pattern in the GCA thickness map. Inter-observer agreement for a decision between RVO and POAG was assessed using kappa statistics. Diagnostic specificity and accuracy were calculated. Results: Inter-observer agreement was good, with a kappa value of 0.765 (95% confidence interval, 0.634–0.896, p < 0.001). The diagnostic specificity of RVO from POAG using the GCA thickness map was 93.2% and diagnosis accuracy was 80.4%. Conclusions: An irregular GCA thickness map represents a simple and convenient differential diagnostic clue to distinguish RVO from POAG.

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