Purpose Several new implant devices have recently been introduced to glaucoma surgery using various techniques for reducing intraocular pressure (IOP). Two implants introduced during the past couple of years, XEN45 and PreserFlo Microshunt, are both designed to control subconjunctival filtration. There are two Swiss multicenter studies that collected the data retrospectively to analyze the efficacy and safety of these two devices separately. In this study, we report the analysis of the combined data subset from the University Hospital of Basel. Subjects and Methods The XEN45 implantation technique was introduced to Basel University Hospital in 2016 and PreserFlo Microshunt in 2018. Sixty operated patients, thirty in each group, were operated on by one surgeon, clinically followed up, and their data retrospectively analyzed from medical records. Only standalone procedures, without combined phacoemulsification, were considered in this analysis; the lens status, however, was neither an inclusion nor an exclusion criterion. Further inclusion criteria were the diagnosis of open-angle glaucoma, no previous glaucoma surgery, other than laser trabeculoplasty, and complete medical records during the 12 months of follow-up. IOP reduction during a 12-month postoperative period was the primary outcome measure as well as the number of IOP reducing drugs. The number of subsequent surgical interventions and complications/adverse events are descriptively reported. Results Patient age, gender, ophthalmological diagnosis, and initial preoperative IOP were well balanced between the two groups. Postoperative IOP course was comparable between the two methods for the first 12 months. IOP measurements were taken preoperatively and then on the first postop day, week 1, month 1, and months 3, 6, and 12 for the PreserFlo Microshunt vs. XEN45 (mmHg): 23.6 vs. 24.9, 9.0 vs. 8.9, 11.4 vs. 10.6, 13.0 vs.18.3, 16.8 vs.15.1, 15.9 vs.15.0, and 15.4 vs.14.5, respectively. IOP reducing medications were also comparable between the two groups. The study showed that subsequent interventions were more frequent in the XEN45 (13) than in the PreserFlo Microshunt group (7). Conclusion Both methods demonstrate satisfactory IOP control within a 12-month postoperative period with practically no serious adverse events/complications, but with relatively high numbers of subsequent interventions (needlings), particularly in the XEN45 group.

2016-12-23T18:47:23

PurposeSpontaneous corneal perforation is a rare complication of systemic diseases with ocular involvement such as Sjögren's syndrome, rheumatoid arthritis, graft‐versus‐host disease or ocular rosacea. There are few cases of spontaneous perforations in adult patients described in the literature associated with keratoconus (KC) or pellucid marginal degeneration (PMD). This case describes a spontaneous corneal perforation in a young patient with vernal keratoconjunctivitis.MethodsCase report.ResultsA 14‐year‐old male patient presented at the Department of Ophthalmology accompanied by his parents due to one day existing redness and hazy vision of the left eye (OS). Additionally, he noticed a sudden “water outflow from the left eye.” The patient's medical history includes vernal keratoconjunctivitis, systemic prediabetes, obesity and steatohepatitis. Slit‐lamp examination of the left eye revealed a spontaneous corneal perforation of 1.4 × 1.8 mm inferonasal with iris tamponade and a surrounding corneal melting of 4 mm. The anterior chamber had been totally flattened. The right eye was diagnosed by slit‐lamp examination with central corneal thinning and inferior peripheral vascularization. The corneal perforation was primarily treated with histoacrylic tissue glue. Antibiotic treatment with Ceftazidime and Moxifloxacin eye drops alternating every hour has been established. After one week, a progressive corneal melting in the area of the primary corneal perforation was observed. Therefore, a patch “keratoplasty à chaud” had to be performed. The postoperative course was devoid of complications. The patient was initially treated with Pred forte eye drops 4 times daily. An optical penetrating keratoplasty is planned.ConclusionsSpontaneous corneal perforation is an extremely rare but severe complication of vernal keratoconjunctivitis, which can also occur in young patients. Ophthalmologists should be aware of this rare complication and inform and treat their patients accordingly.

Corneal crosslinking (CXL) has been proven to inhibit the progression of keratoconus and corneal ectatic disease. Over the last years, new treatment protocols have emerged, aiming to increase efficacy and safety of the procedure. Nowadays, a plethora of different modalities are available, such as ‘epi‐on’ and ‘epi‐off’ procedures, ‘accelerated’ CXL, ‘pulsed’ CXL, ‘customized’ CXL, etc. At the same time, riboflavin solutions have also evolved in order to provide improved outcomes. This talk will highlight the above mentioned innovations and evaluate their clinical relevance and importance, emphasizing on the ‘gold standard’ in CXL therapies, in an evidence‐based manner.

Purpose To report the use of corneal crosslinking (Dresden protocol) as adjuvant treatment in a patient with advanced therapy‐resistant keratitis complicated with corneal melting. Methods Case report and literature review. Results A 52‐year‐old female patient, who presented with an extended central corneal ulcer and hypopyon, was treated with fortified antibiotic eye drops (Ceftazidin 5% and Moxifloxacin alternating hourly). Corneal cultures were positive for Streptococcus dysgalactiae. On clinical suspicion of fungal co‐infection, treatment was supplemented with Voriconazole eye drops 8 times/day. Two weeks later, Alternaria spp. was detected in corneal cultures. Despite broad‐spectrum therapy, the corneal ulcer progressed and corneal melting occurred. After discussion with the patient we decided to proceed to a corneal crosslinking, before considering therapeutic corneal transplantation. Postoperatively, the corneal melting was reversed and the infection was adequately controlled with formation of corneal scarring. Conclusion Corneal crosslinking was successfully implemented to manage corneal melting and control infection in a patient with advanced therapy‐resistant keratitis. Physicians should not ignore the clinical signs of mycotic co‐infection in their clinical assessment, even in the absence of initial positive cultures, and they should consider corneal crosslinking even in advanced corneal ulceration with melting.