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1. Solving STODS—Surgical Temporary Ocular Discomfort Syndrome

Author

Matthew T. Hirabayashi and Brad P. Barnett

Subjects
LASIK, Keratopathy, dry eye, STODS, LALEX, SMILE, Medicine (General), R5-920
Abstract

The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS’ deleterious effect on preoperative imaging and postoperative healing.

Published
2023
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2. Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons

Author

Eli L. Pratte, James R. Landreneau, Matthew T. Hirabayashi, and Jella A. An

Subjects
glaucoma, goniotomy, kahook dual blade, kdb, attending, resident, outcomes, Ophthalmology, RE1-994
Abstract

Objective Kahook Dual Blade goniotomy (KDB) has proven effective in lowering intraocular pressure (IOP) and reducing the medication burden in patients with glaucoma. This study compares outcomes up to 12 months postoperatively after KDB combined with phacoemulsification (phaco-KDB) between an ophthalmology attending and residents. Methods A retrospective analysis was performed on 160 eyes of 113 patients who received a phaco-KDB performed by either an ophthalmology attending or a resident under direct guidance of the attending. Data for each patient was collected preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The primary outcome measure was surgical success, defined as 20% IOP reduction or at least 1 medication reduction at 12 months. The secondary outcome measures included mean IOP and medication reduction at each postoperative time point, adverse events, operating time, and survival time, defined as time to failure to meet the criteria for surgical success or requiring a secondary IOP-lowering procedure. Results Preoperative mean IOP was comparable between the two groups (p = 0.585), while baseline medications were higher in the attending group (p = 0.040). Rate of successful outcomes was similar in both groups at 12 months (73.3% attending vs. 87.5% residents, p = 0.708). Mean IOP reduction (1.7 vs. 4.3%, p = 0.278) and medication reduction (0.7 vs. 0.6, p = 0.537) also did not differ at 12 months. Presence of adverse events was similar between the groups (21.6 vs. 27.3%, p = 0.938). The survival time was significantly longer in the attending group (356.3 ± 20.2 days vs. 247.1 ± 26.8 days, p = 0.003). Resident cases took ∼10 minutes longer compared with attending cases (p

Published
2020
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3. Comparison of Outcomes for Laser Trabeculoplasty after Kahook Dual Blade Goniotomy Versus in Goniotomy-Naive Eyes

Author

Jella A An, Joshua King, Junsang Cho, Matthew T Hirabayashi, Muhammad Salim, Daniel W. Hogan, Eli L. Pratte, and Riley Bylund

Subjects
Intraocular pressure, medicine.medical_specialty, genetic structures, business.industry, musculoskeletal, neural, and ocular physiology, medicine.medical_treatment, Kahook Dual Blade, MIGS, Glaucoma, Phacoemulsification, medicine.disease, Laser trabeculoplasty, eye diseases, Ophthalmology, Primary outcome, Baseline characteristics, Cohort, medicine, sense organs, business, Original Research
Abstract

Introduction This was a comparison of laser trabeculoplasty (LTP) outcomes in eyes with prior Kahook Dual Blade (KDB) goniotomy versus in goniotomy-naive control eyes. Methods This was a retrospective matched comparative case series. We identified a cohort of patients undergoing LTP between February 2017 and July 2020 at University of Missouri. Patients were grouped by history of KDB goniotomy versus goniotomy-naivety as a control group. Inclusion criteria included age at least 18 years, minimum of 6 months follow-up after LTP, and minimum period of 6 months between KDB goniotomy and LTP. All KDB procedures were combined with uncomplicated phacoemulsification. Patients who had any additional intraocular pressure (IOP)-lowering procedures between KDB goniotomy and LTP were excluded. Patients in the control group received a single LTP procedure. Primary outcome consisted of the comparison of LTP success, defined as IOP reduction of at least 20% or reduction of glaucoma medications from pre-LTP baseline. Secondary outcomes included IOP and medication reduction from pre-LTP baseline. Results Twenty-one eyes of 19 patients with history of KDB goniotomy and 42 eyes of 36 control patients without previous angle or laser procedures were included. Baseline characteristics including age, gender, ethnicity, type and severity of glaucoma, baseline IOP, and baseline medications were matched between groups. The LTP success rate was higher in the control group, but was not statistically significant (64% vs 57%, p = 0.58). IOP reduction was only significant in the control eyes (2.50 ± 4.0 mmHg, p = 0.01 vs 2.35 ± 4.7 mmHg, p = 0.08). The number of glaucoma medications was not significantly reduced in either group. Conclusion LTP may have a limited IOP- and medication-lowering effect in eyes with a history of KDB goniotomy compared to goniotomy-naive eyes. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00378-7.

Published
2021

4. Predictive Factors for Outcomes of Selective Laser Trabeculoplasty

Author

Matthew T Hirabayashi, Vikram Ponnusamy, and Jella A An

Subjects
Male, Intraocular pressure, medicine.medical_specialty, Selective laser trabeculoplasty, genetic structures, Glaucoma, lcsh:Medicine, Trabeculectomy, Article, 03 medical and health sciences, Tonometry, Ocular, 0302 clinical medicine, Primary outcome, Trabecular Meshwork, Ophthalmology, Medicine, Humans, Total energy, lcsh:Science, Eye diseases, Intraocular Pressure, Aged, Aged, 80 and over, Multidisciplinary, Adult patients, business.industry, lcsh:R, Middle Aged, medicine.disease, Prognosis, eye diseases, Treatment Outcome, Baseline characteristics, 030221 ophthalmology & optometry, Female, lcsh:Q, Laser Therapy, sense organs, business, 030217 neurology & neurosurgery, Glaucoma, Open-Angle, Month follow up
Abstract

We sought to determine predictive factors for selective laser trabeculoplasty (SLT) outcome. 252 eyes from 198 adult patients with open-angle glaucoma who underwent SLT between July 2016 and February 2018 with a minimum 6 month follow up were reviewed. We defined success as ≥20% IOP reduction or ≥1 medication reduction without an IOP lowering procedure. We also evaluated the relationship of these factors to postoperative IOP elevation >5 mmHg (IOP spikes). Our primary outcome measure was association between age, type and severity of glaucoma, pigmentation of the trabecular meshwork (PTM), total energy delivered, and baseline intraocular pressure (IOP) with success. At 2 and 6 months, 33.6% (76/226) and 38.5% (97/252) of eyes met success criteria respectively. Baseline IOP > 18 mmHg was significantly associated with success both at 2 and 6 months, reducing IOP by 5.4 ± 5.3 mmHg (23.7% reduction), whereas those with lower baseline remained at −0.7 ± 4.6 mmHg (4.9% increase) at 6 months (P

Published
2020
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