Objectives To describe the 12-month outcomes of the Xen45 glaucoma stent. Methods Non-comparative retrospective study of all cases who underwent Xen glaucoma surgery in April 2017 or earlier and completed 12 months of follow-up. The primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications at 12 months postoperatively. The secondary outcome measures were surgical complications and the success rate of surgery at 1 year. Success rate was defined according to the multiple IOP thresholds of 15 mmHg, 18 mmHg, and 21 mmHg with all requiring a drop of 20% and no additional glaucoma surgery. Revision or needling of the Xen conjunctival bleb was not considered to constitute a surgical failure. Results Sixty-eight eyes were included in the study. Mean IOP dropped from 22.1 mmHg preoperatively to 14.8 mmHg at 12 months, a 33% drop (p < 0.0001). Mean number of glaucoma medications reduced from 2.9 preoperatively to 1.1 at 12 months (p < 0.0001). In total, 54.4% of cases were back on glaucoma medications by 12 months. Success rate varied from 32.4% when defined as IOP ≤ 15 mmHg and ≥ 6 mmHg and ≥ 20% reduction without medications to 70.6% when defined as IOP ≤ 21 mmHg and ≥ 6 mmHg and ≥ 20% reduction with or without medications. Thirty cases (44.1%) required bleb needling or surgical revision. Conclusions The Xen45 is effective at reducing IOP and glaucoma medication use at 12 months postoperatively. Patients considering this procedure should be warned that by 12 months postoperatively there is a significant chance of requiring postoperative bleb intervention and glaucoma drops.

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Purpose To describe and examine the observation that eccentric eye positions may develop under certain general anaesthetic conditions and negatively impact upon operating conditions during ocular surgery. Methods A case series description with historical review followed by a 2-week prospective observational survey examining the general anaesthetic techniques utilized during ocular surgery and the associated development of an eccentric eye position. Results A total of 52 cases were studied, of which four developed eccentric eye positions. 50% of patients received effective muscle relaxation. Without muscle relaxants, the incidence of eccentric eye positioning was 18%. Conclusions Eccentric ocular positions are likely to occur in light planes of general anaesthesia. In the case of ocular surgery, this phenomenon may create surgical difficulty and increase the risk of complication and patient morbidity. Arguments for the planned use of balanced general anaesthesia with non-depolarizing muscle relaxants are presented.

Purpose: Observations made during glaucoma filtering surgery (trabeculectomy) suggest variability in the thickness of the bulbar conjunctiva and Tenon's layers between individuals. We propose that this could infuence the final bleb morphology and function.We designed a pilot study to assess this using optical coherence tomography (OCT) to measure bulbar conjunctival and Tenon's layer thickness.Materials and methods: A total of 67 eyes of 48 individuals were scanned using an optovue Mode RT100 version 2.0 OCT machine. Cross-line CAM-L scans were taken and the com bined bulbar conjunctival and Tenon's layer thickness was measured 3 mm above the superior limbus. Conjunctival and Tenon's layers appeared as a hyper-refective section as opposed to the hypo refective underlying sclera. Measurements were taken using the inbuilt review software.Results: The age ranged from 23 to 91 years. There were 20 mal e s and 28 females. The mean conjunctival and Tenon's layer thick ness was 393 ± 67 microns (mean ± SD) ranging from 194 to 573 microns.Conclusion: Optical coherence tomography conjunctival and Tenon's layer thickness measurements appear to vary significantly between individuals. We postulate that this could infuence the final bleb morphology and may predict the risk of bleb encapsulation and failure or thin avascular blebs. Further assessment could establish cut-offs on which patients should receive intraoperative antimetabolites and/or Tenon's layer excision.How to cite this article: Howlett J, Vahdani K, Rossiter J. Bulbar Conjunctival and Tenon's Layer Thickness Measurement using Optical Coherence Tomography. J Curr Glaucoma Pract 2014;8(2):63-66.

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