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Background While ptosis is a well-known consequence of glaucoma surgery, some isolated case reports point to the possibility of upper eyelid retraction occurring after glaucoma surgery. This study aims to analyze the occurrence of ptosis and eyelid retraction after glaucoma surgery and to evaluate factors contributing to these palpebral fissure changes. Methods Cross-sectional study including 100 eyes of 100 patients that had undergone unilateral glaucoma surgery. Upper eyelid height in the operated eye was measured by digital photography and compared with the fellow, non-operated eye. The main outcome was to determine if ptosis or retraction occurred in the operated eye in comparison with the fellow eye. The secondary outcome was to determine if any variable was associated with ptosis or retraction. A clinically significant difference (either toward ptosis or retraction) was defined as a difference ≥1 mm between both eyes. Results Of 100 eyes included 81 (81%) showed no change in eyelid height (−0.133 mm ± 0.496), 11 (11%) showed ptosis (−1.348 mm ± 0.387) and 8 eyes (8%) showed retraction (1.705 ± 0.634). A statistically significant relation was found between ptosis and pseudoexfoliation glaucoma (p = 0.003). A trend toward lower postoperative IOP and higher conjunctival blebs was found in eyes with postoperative eyelid retraction. Conclusions Eyelid retraction was present in 8% of patients and ptosis in 11%. Patients with eyelid retraction showed around a 3 mmHg lower postoperative IOP than eyes without retraction. The presence of pseudoexfoliation may be a risk factor for this complication. A prospective study with a large number of patients would be required to confirm these results.

Aniridia is a congenital bilateral ocular disorder with dominant autosomal inheritance. More than 50% of patients will develop aniridic glaucoma (AG) during their lives. Open angle glaucoma is more common in aniridia, but a closed angle mechanism has been described in relation with anterior rotation of the rudimentary iris, occluding trabecular meshwork. Diagnosis and follow-up of AG is difficult in relation with the presence of keratopathy, nystagmus and foveal hypoplasia. Central corneal thickness usually measures more than 600 microns, which prevents achieving a reliable value of intraocular pressure. Medical treatment of AG is not different from the rest of glaucoma. It is recommended to use preservative free formulations, and combined therapy is often required. Surgical treatment is needed in many cases. There is no consensus on the first line surgery for AG, but in open angle AG, angle surgery is usually first choice, and glaucoma drainage devices are the next preferred surgical technique. In closed angle AG glaucoma drainage devices are usually the first choice, with trabeculectomy as the second preferred surgical technique.

Resumen La aniridia es un trastorno ocular bilateral congenito de herencia habitualmente autosomica dominante, mas infrecuentemente recesiva asociada al sindrome de Gillespie. Mas de un 50% de pacientes con este trastorno van a presentar glaucoma aniridico (GA) a lo largo de su vida. En la mayoria de los casos es de angulo abierto, pero tambien puede producirse un mecanismo de cierre angular por rotacion progresiva del munon de iris que ocluye la malla trabecular. El diagnostico y seguimiento de glaucoma se ve complicado por la presencia de alteraciones asociadas como queratopatia, nistagmo e hipoplasia foveal. El espesor corneal central frecuentemente es mayor de 600 micras, lo que dificulta aun mas disponer de un valor fiable de tension ocular. El tratamiento medico del GA no difiere del resto de glaucomas, recomendandose evitar conservantes y siendo frecuente la necesidad de terapia combinada. Es muy comun que los pacientes con GA precisen cirugia. Aunque no existe consenso sobre la cirugia de primera linea, en el GA de angulo abierto suele ser indicada como primera linea la cirugia angular, seguida por los dispositivos de drenaje, y en el GA por cierre angular suelen ser indicados preferentemente los dispositivos de drenaje seguidos por la trabeculectomia.

Resumen Objetivo Describir los efectos de la inyeccion de cefuroxima intracameral a una dosis mas alta de la recomendada en cirugia de catarata. Metodos Estudio retrospectivo de 8 ojos de 8 pacientes operados de catarata en un mismo dia que recibieron 12,5 mg/0,1 ml de cefuroxima intracameral de forma inadvertida al finalizar la cirugia, por un error en la dilucion. A todos los pacientes se les realizo un seguimiento oftalmologico estrecho durante 6 meses. Resultados Todos los pacientes presentaron una inflamacion marcada del segmento anterior con edema corneal que se resolvio en todos los casos (entre 5 dias y 3 meses). A los 6 meses de seguimiento se constato una diferencia significativa en el recuento endotelial corneal de dichos ojos al compararlo con el ojo contralateral (p = 0,038), siendo Conclusiones Aunque la inyeccion de cefuroxima en camara anterior a dosis de 1 mg/0,1 ml ha demostrado disminuir la incidencia de endoftalmitis, su sobredosificacion puede tener efectos oculares potencialmente perjudiciales tanto en el segmento anterior como en el posterior.

To report outcomes of strabismus surgery in thyroid eye disease using intraoperative bow-knot adjustable sutures under topical anaesthesia and calculate prediction models for surgical correction and postoperative drift depending on surgical dose-response.We retrospectively reviewed patients operated on from 2016 to 2021. A satisfactory outcome was defined as no diplopia with maintenance of vertical (5 PD) and horizontal (10 PD) stable alignment at primary gaze. Subjective diplopia corrected with prisms within successful motor alignment was defined as a fair result. Otherwise, the result was considered to be poor.A total of 73 patients were included (60 females, 82%). Mean preoperative horizontal and vertical deviations were 26.9 PD (19.1 SD), and 11.8 PD (7.6 SD), respectively. Mean horizontal drift was -3.2 PD (5.2 SD), whereas mean vertical drift was -3.4 PD (3.3 SD). A linear regression established a dose-response of 2.37 PD/mm for each medial rectus recession (p0.0001; rMuscle recession with intraoperative adjustable sutures is effective for the treatment of thyroid eye disease strabismus. Predictable dose-responses could be achieved with a drift toward overcorrection. Undercorrection proportional to the planned surgical dose should be the immediate postoperative target of choice. Other variables such as orbital decompression and concurrent vertical and horizontal surgery do not correlate with dose-response and postoperative drift. However, further studies are necessary to validate our findings.

Carl Erb,1 Ingeborg Stalmans,2 Milko Iliev,3 Francisco José Muñoz-Negrete4 1Eye Clinic Wittenbergplatz, Berlin, Germany; 2Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; 3Ophthalmology Department, University of Bern, Inselspital, Bern, Switzerland; 4Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, EspañaCorrespondence: Francisco José Muñoz-NegreteServicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, EspañaTel +34 913 36 80 00Email franciscojmunoz@telefonica.netPurpose: Patient satisfaction is important in the treatment of glaucoma. Suboptimal compliance and impaired long-term outcome are a likely result of poor tolerability. The present multicentre, international, transverse, epidemiological survey was conducted to assess the satisfaction of patients who had received preservative-free latanoprost (PFL) for at least 3 months.Patients and Methods: A total of 1872 patients from 6 European countries, treated with PFL for at least 3 months, were included in this survey. Prior to PFL treatment, patients were to be treatment naïve or currently treated for their glaucoma. During a single routine consultation, patients completed a questionnaire concerning global satisfaction and satisfaction based on tolerability.Results: In total, 76.2% had been previously treated; 69.4% had received preserved and 6.8% preservative-free (PF) topical treatment. After 3 months of PFL treatment, a large majority of patients (95.3%) were satisfied or very satisfied with their PFL treatment and were, overall, significantly (p< 0.0001) more satisfied with PFL than with their previous treatment; 4.2% were either unsatisfied or very unsatisfied. Overall, 97.3% of originally treatment-naïve patients were satisfied (50.1%) or very satisfied (47.2%) with their PFL. Ocular surface disease was diagnosed in 9.2% of patients (n=173) and was mainly mild (76.9%). Patient satisfaction with PFL was very high.Conclusion: PFL may be considered a valuable first-choice treatment in glaucoma patients.Keywords: glaucoma, prostaglandin, preservative-free latanoprost, patient satisfaction, tolerability, tear substitutes, intra-ocular pressure, ocular surface disease, conjunctival hyperaemia

Purpose To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. Methods The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). Results A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1−4 points, and R and V between 0−3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. Conclusions The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures.

Resumen Objetivo Elaborar un nuevo nomenclator de actos y procedimientos medicos en oftalmologia, basado en la Clasificacion Internacional de Enfermedades CIE-9-MC. Establecer los principios generales y definir los criterios de baremacion, indicadores cuantitativos y escalas de valoracion. Determinar los algoritmos necesarios para el computo de las tarifas retributivas por acto medico. Metodos Sobre el nomenclator vigente, se eliminaron los procesos obsoletos, anadieron otros nuevos, modificaron descriptores, agruparon procedimientos con descripciones similares y trasladaron de grupo otros, por razones de complejidad quirurgica. Se definieron los criterios de baremacion para el calculo de las retribuciones medicas: formacion y complejidad (U), responsabilidad profesional (R) y valor salud (V), con sus indicadores cuantitativos, respectivamente: periodo de formacion necesario para dominar una tecnica, frecuencia de complicaciones que agravan la situacion preoperatoria, y dias de incapacidad laboral que ocasiona el proceso. Se definieron las Unidades Relativas de Valor (URV) como la suma de puntos de U, R y V. La tarifa final por acto medico se calculara como el producto del numero de URV por su coste unitario y por el coeficiente de ponderacion (CP). Resultados Se elaboro un nuevo nomenclator con 161 actos medicos agrupados en consultas, procedimientos diagnosticos (PR.DX), procedimientos terapeuticos (PR.TX) e intervenciones quirurgicas (IQ) crecientes en complejidad desde el grupo 0 hasta el grupo 8. Para cada uno de los actos se describieron los siguientes caracteres: codigos OMC y CIE-9-MC, termino descriptor, grupo, modificacion propuesta: sin cambios o minimos en los descriptores, agrupacion de actos por definiciones similares, cambio de grupo de origen, actos eliminados y nuevos procedimientos. Asimismo, fueron puntuados los tres criterios de baremacion: U entre 1-4, R entre 0-3 y V entre 0-3. Mediante su suma se calcularon el numero de URV por acto medico (entre 1 y 10), que junto con el coste unitario de la URV y el CP (entre 0,05 y 1) determinaran la tarifa final. Conclusiones El nuevo nomenclator de oftalmologia actualiza y mejora el catalogo antiguo, adecuando los procedimientos a los descriptores recogidos en la CIE-9-MC e incorporando todas las tecnicas actuales. Adicionalmente, la declaracion de los principios generales permite definir nuevos criterios de baremacion, indicadores cuantitativos, escalas de valoracion y algoritmos de computo de las tarifas por acto medico.

BACKGROUND Optic disc drusen (ODD) are a dynamic phenomenon, and their appearance, size, and relative location may change. The purpose of this study is to evaluate and quantify the longitudinal changes of buried ODD with enhanced depth imaging (EDI) optical coherence tomography (OCT) over time. METHODS ODD were analyzed with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany) and EDI technology. The peripapillary retinal nerve fiber layer (RNFL) thickness was also measured. The size and depth of ODD were compared between the baseline and study visit (at least 2 years of follow-up), and the changes were correlated with mean RNFL thickness. The repeatability, coefficient of variation, and cutoff values for size and depth on EDI-OCT were calculated. RESULTS Of 21 previously identified patients with ODD, only 12 patients (21 eyes) met the most recent diagnostic criteria according to the ODD Studies Consortium recommendations for using OCT-EDI technology. The 21 eyes were reanalyzed after a mean period of 44.7 ± 13.2 months (range: 24-71 months). Overall, 132 ODD were evaluated with a mean of 6.1 ± 2.5 ODD per eye and 1.9 ± 1.1 ODD per scan. Overall, we found a significant forward movement of the drusen between visits (P = 0.01). Most drusen (67.4%) moved anteriorly, and in approximately one-third (35.6%), this displacement exceeded the cutoff value (64.28 µm). Furthermore, we found a significant correlation between ODD shallowing and RNFL thinning during the follow-up (P ≤ 0.03; R ≥ 0.370). We did not find any significant changes in size measurements (P = 0.10) over time. CONCLUSIONS In approximately one-third of buried ODD, a significant anterior movement occurred over 2 years of follow-up, and this movement was associated with significant RNFL thinning. By contrast, no significant change was detected in the size of the buried ODD.

Age-related macular degeneration and especially neovascular age-related macular degeneration is the leading cause of low vision in developed countries. Even though the introduction of anti-VEGF drugs in recent years completely changed the management of this condition, its cost, the need for repeated intravitreal injections, and loss of efficacy in the long term are still issues to deal with. Currently, a new generation of novel therapies under development is attempting to address some of these limitations. Some of the most prominent among them are new anti-VEGFs such as brolucizumab or abicipar, drugs against angiopoietin-2 receptor such as faricimab, sustained-release systems, or tyrosine kinase inhibitors. As regards dry age-related macular degeneration, neuroprotection, the complement pathway, and stem cell therapy are the most promising targets currently under investigation.

Objective: To analyse the ocular surface changes in eyes after the withdraw of anti-glaucomatous drugs when non-penetrating deep sclerectomy (NPDS) is performed.Methods: 31 patients (33 eyes) diagnosed of glaucoma that underwent NPDS, were included in this prospective study. Control group included 33 eyes of 33 age and sex-matched volunteers. Five variables were studied with Keratograph 5M (K5M): ocular hyperaemia (OH), non-invasive tear film break-up time (NI-BUT), lower tear meniscus height (LTMH) and meibography. LTMH was also measured using the anterior segment module of Spectralis Fourier-Domain Optical Coherence Tomography (FD-OCT). Also, an evaluation of corneal and conjunctival staining was performed.In addition, patients were asked to answer two questionnaires: Ocular Surface Disease Index (OSDI) and National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) before and 6-months after surgery.Results: Before NPDS, treated eyes, showed worse objective data than healthy controls (p ≤0.049). In this group, a significant improvement was observed in the questionnaires (p< 0.001), LTMH FD-OCT (p=0.037) and LTMH K5M (p=0.025), K5M OH (p=0.003), NI-BUT (=0.022) and conjunctival and corneal staining (pConclusion: A significant improvement in the ocular surface was observed 6 months after NPDS, suggesting that the withdrawn of the topical anti-glaucomatous treatment has a beneficial effect.

Background Retrograde transsynaptic degeneration (RTSD) of the retinal ganglion cells and retinal nerve fiber layer after postgeniculate injury has been well documented, but to the best of our knowledge, associated retinal microvascular changes have not been examined. The purpose of our study was to assess vessel density (VD) at macular and peripapillary regions in patients with RTSD. Methods Cross-sectional study including 16 patients with homonymous visual field defects secondary to unilateral postgeniculate visual pathway injury and 18 age-matched controls. All participants were examined with AngioVue optical coherence tomography angiography to measure the peripapillary vessel density and macular vessel density (pVD/mVD) as well as the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell complex (GCC) thicknesses. The pRNFL and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses also were evaluated using Cirrus OCT. A normalized asymmetry score (NAS) was calculated for GCIPL and GCC thickness, and mVD. Results Average pRNFL and macular GCIPL/GCC thicknesses were significantly thinner in both eyes of patients compared with control eyes (all P ≤ 0.05). Eight patients (50%), who showed a RTSD of the GCIPL map, had a relative thinning of the GCIPL/GCC ipsilateral to the brain lesion in both eyes (represented by a positive GCIPL-NAS/GCC-NAS). The mean pVD and mVD also were significantly reduced in patients (all P ≤ 0.05). There was a strong correlation between GCIPL-NAS/GCC-NAS and mVD-NAS index in both eyes (all r > 0.7, P = 0.001). Furthermore, there was a similar spatial pattern of damage for the macular GCC thickness and VD values. Conclusions We demonstrated a significant VD decrease in peripapillary and macular areas of patients with RTSD because of postgeniculate lesions. The structural and microvascular asymmetry indexes were significantly correlated. These findings provide new insights regarding transsynaptic degeneration of the visual system.

Objective Smoking is an important risk factor for Graves orbitopathy (GO) and it is modifiable. The advice to stop smoking has been included in all the clinical practice guidelines of GO. However, the effectiveness of this practice remains unknown. The purpose of this study is to assess the change in the smoking habit in patients affected with GO after an oral counselling for smoking cessation. Material and methods A retrospective cohort of GO patients was studied. The patients received a significant oral counsel during the first consultation with the ophthalmologist. 33 GO patients were explored in the ophthalmology clinic during 2013 and 2014 and the study was done throughout a telephone questionnaire in 2015. The main outcome was the number of cigarettes smoked daily before and after consultation with the endocrinologist and the ophthalmologist. Other medical and socioeconomic factors were recorded. Results The mean number of cigarettes that were smoked was 13.6 (SD 9.66) and 6.3 (SD 7.73) before and after the consultation done at the ophthalmology office (T-test paired, p = 0.0006). 42.42% achieved smoking cessation and 30.3% decreased their smoking habit. Patients who stopped smoking suffered usually from active and severe GO, had more stable jobs and received greater support from their relatives and friends. Conclusion A firm and strong oral counsel held for smoke cessation was effective in GO patients. This disease deeply affects patients’ quality of life, making them more prone to change their habits.

Resumen Objetivo El tabaco es un factor de riesgo en la orbitopatia de Graves (GO) y es modificable. El consejo medico para dejar de fumar se ha incluido en todas las guias de practica clinica de esta enfermedad, aunque su efectividad no ha sido evaluada. El objetivo de este estudio es conocer el cambio producido en el habito tabaquico en pacientes con GO tras una recomendacion verbal para dejar de fumar. Material y metodos Se estudio una cohorte retrospectiva de pacientes con GO. Todos los pacientes recibieron consejo medico sobre la importancia de dejar de fumar en la primera consulta del oftalmologo. Entre 2013 y 2014 se atendio a 33 pacientes en la consulta, que fueron preguntados sobre el cambio en su habito tabaquico en 2015. La variable principal de estudio fue el numero de cigarros fumados al dia antes y despues de las consultas en endocrinologia y oftalmologia. Aparte, se recogieron otros datos personales medicos y socioeconomicos. Resultados El numero medio de cigarros fumados fue de 13,6 (DE 9,66) y 6,3 (DE 7,73) antes y despues de la primera consulta en oftalmologia, respectivamente (test t pareado, p Conclusion Un consejo fuerte y firme recomendando dejar de fumar es efectivo en pacientes con GO. Esta enfermedad afecta seriamente la calidad de vida de los pacientes, lo que hace que sean mas susceptibles de cambiar a la hora de modificar sus habitos.

Introduction: To report the first case of bilateral ocular decompression retinopathy after uneventful non-perforating deep sclerectomy with mitomycin C in a child with tubulointerstitial nephritis and uveitis syndrome. Case description: An 8-year-old girl affected by tubulointerstitial nephritis and uveitis syndrome developed ocular hypertension (45 mmHg in the right eye and 42 mmHg in the left eye) associated with recurrent episodes of uveitis and chronic use of steroids despite maximum hypotensive medical treatment. Bilateral non-perforating deep sclerectomy with mitomycin C (0.2 mg/mL, 1 min) was performed under general anesthesia without complications. The first postoperative day, the visual acuity was reduced to 0.6 in the right eye and 0.05 in the left eye and the intraocular pressure was 3 mmHg in both eyes. Fundoscopy revealed bilateral optic nerve swelling and diffuse retinal hemorrhages, some of them with scattered-white centers. About 2 months after surgery, the visual acuity was normal and the fundus examination showed complete resolution. Conclusion: The ocular decompression retinopathy is an uncommon complication after non-perforating deep sclerectomy. This is the first case of bilateral ocular decompression retinopathy reported after non-perforating deep sclerectomy in a child with ocular hypertension secondary to recurrent uveitis and chronic use of steroids associated with tubulointerstitial nephritis and uveitis syndrome.

AimsTo define and quantify the upper lid contour by adapting Bézier curves with a newly developed software in normal subjects, assessing their reliability.MethodsFifty eyes of 50 healthy patients with no ocular pathology were included in this study from October 2020 to November 2020. All measurements were performed on Bézier curves adjusted to the upper lid contour. An original software was used to measure the radial and vertical midpupil-to-lid margin distances (MPLD), temporal-to-nasal (T/N) ratios, contour peak location and grade of superposition (GS) and asymmetry (GA) indexes. We calculated differences in the variables measured regarding age, gender or the side of the eye being assessed.ResultsThe mean Bézier curve showed an excellent level of inter-rater reliability (intraclass correlation coefficient of 0.99). The median GS index of each eyelid to the mean Bézier curve was 95.4%, 8.5 IQR, and the median GA index was 3%, 3.4 IQR. The mean contour peak location was −0.35 mm, SD 0.45. Overall, the mean central MPLD was 4.1 mm, SD 0.6. No significant differences were found between male and female patients in variables derived from Bézier curves.ConclusionBézier curves may become a very useful tool for the assessment of upper lid contour, contour peak and symmetry. GS and GA indexes, along with the T/N area ratio are potential outcomes for this purpose. All current variables can be obtained just from one single Bézier curve measurement. Our results offer an in-depth exhaustive description of these variables and their distribution in the normal population.

AimsTo assess visual field (VF) pseudoprogression related to face mask use.MethodsWe reviewed a total of 307 VFs performed with a face mask (FPP2/KN95 or surgical masks) and compared them with prior VFs, performed before the pandemic. VFs with suspected pseudoprogression due to mask artefacts (VF test 1) were repeated with a surgical mask and an adhesive tape on its superior border (VF test 2) to distinguish from true VF loss. Several parameters including reliability indices, test duration, VF index (VFI), mean defect (MD) and pattern deviation probability plots were compared among last pre-COVID VFs, VF tests 1 and VF tests 2, using the Wilcoxon signed-rank test.ResultsWe identified 18 VFs with suspected progression artefact due to masks (5.8%). In all of them, the median VFI and MD significantly improved after fitting the superior border of the mask, showing no significant differences with pre-COVID tests. The median fixation losses were significantly higher when wearing the unfitted mask (13% vs 6%,p=0.047). The inferior hemifield was the most affected, either as a new scotoma or as an enlargement of a prior defect.ConclusionUnfitted masks can simulate VF progression in around 6% of cases, mainly in the inferior hemifield, and increase significantly the rate of fixation losses. A similar rate of artefacts was observed using FPP2/KN95 or surgical masks. The use of a surgical mask with an adhesive tape covering the superior border may reduce mask-related artefacts, although concomitant progression cannot be ruled out in all cases.

Introduction To compare the tolerability and efficacy of a preservative-containing latanoprost (PCL) to a preservative-free formulation of latanoprost (PFL) in patients with open-angle glaucoma or ocular hypertension. Methods A pooled analysis was performed of data from five published studies. The primary outcome was tolerability as evaluated by the severity of hyperemia. The secondary objectives were patient tolerance based on a composite ocular surface disease (OSD) score arising from ocular signs and symptoms, patient and investigator satisfaction, and a comparison of IOP-lowering efficacy. Results There were three randomized controlled trials and two observational studies included in the analysis. Conjunctival hyperemia improved significantly in 25.6% (388) of patients switched to the PFL group versus 11.7% (117) of patients switched to the PCL group (p, Plain Language Summary Preservatives in eye drops for glaucoma can cause side effects such as stinging and eye redness. These side effects can cause some patients to reduce the frequency of the drops as prescribed or stop using the drops. One of the most common drops for glaucoma is latanoprost. This study evaluated whether a preservative-free latanoprost (PFL) is as effective as preservative-containing latanoprost (PCL) for reducing eye pressure and whether PFL is better tolerated in patients with glaucoma. The results of the study indicated that PFL was as effective as PCL for reducing eye pressure. The results also indicated PFL was much better at reducing the side effects related to PCL. For example PFL reduces eye redness up to twofold compared to PCL. By reducing the side effects associated with PCL patients may continue to take their glaucoma drops as directed and thereby reduce the risk of vision loss from glaucoma.

Presentamos el caso de un varón de 28 años que consultó por pérdida de visión bilateral en el que el examen de fondo de ojo mostró lesiones compatibles con una epiteliopatía placoide multifocal posterior aguda asociada a una inflamación granulomatosa aguda de la cámara anterior. El presente caso sirve para ilustrar el proceso diagnóstico por imagen multimodal a nivel oftalmológico y el despistaje de posibles enfermedades asociadas o síndromes mascarada a nivel sistémico. Asimismo, la presentación del caso se acompaña de una revisión bibliográfica sobre la epiteliopatía en placas., We present the case of a 28-year-old man who consulted for bilateral vision loss in which the fundus examination revealed lesions consistent with acute posterior multifocal placoid pigment epitheliopathy associated with acute granulomatous inflammation of the anterior chamber. This case illustrates the multimodal diagnostic imaging process as well as the screening strategy for possible associated systemic diseases or masquerade syndromes. Likewise, the presentation of the case is accompanied by a bibliographic review on acute posterior multifocal placoid pigment epithelipathy.

Purpose To describe intracameral toxic effects of cefuroxime at a higher dose than recommended in cataract surgery. Methods Retrospective study of 8 eyes of 8 patients who inadvertently received 12.5 mg/0.1 ml of intracameral cefuroxime due to a dilution error, at the end of the cataract surgery. All patients underwent a strict ophthalmology follow-up for 6 months. Results All patients presented with a marked anterior segment inflammation with corneal oedema that resolved completely in all cases (between 5 days and 3 months). At 6 months of follow-up a statistically significant difference was found in the corneal endothelial cell density when compared with the fellow eye (P = .038), being Conclusions Although 1 mg/0.1 ml of intracameral cefuroxime has been shown to reduce the incidence of endophthalmitis, its overdose can have potentially toxic eye effects in both anterior and posterior segments.

Resumen Objetivo Minimizar la exposicion al virus SARS-CoV-2, reducir las posibilidades de transmision cruzada entre pacientes y personal sanitario, y evitar el desarrollo de complicaciones postoperatorias por la atencion a pacientes con enfermedades oculares durante la pandemia de enfermedad por coronavirus 2019 (COVID-19). Metodos Elaboracion de un documento de revision del estado del conocimiento sobre COVID-19 y consenso entre diferentes sociedades oftalmologicas espanolas y afines, al objeto de proporcionar guias y recomendaciones de maximos recursos primariamente condicionadas por el estado de alerta, confinamiento y distanciamiento social que acontece en Espana desde el 16 de marzo de 2020. Resultados Las recomendaciones promoveran la adopcion de medidas de actuacion y proteccion para el desarrollo de la actividad asistencial en consultas externas, area quirurgica y hospitalizacion, tanto para pacientes no confirmados –asintomaticos y sintomaticos– como confirmados de COVID-19. Deberan ser adaptadas a las circunstancias y disponibilidad de equipos de proteccion individual en cada uno de los centros y Comunidades Autonomas, debiendo ser actualizadas en funcion de las fases de la pandemia y de las medidas que adopte el Gobierno de la nacion. Conclusiones Durante la pandemia COVID-19, la atencion a los potenciales riesgos de salud para la poblacion ocasionados por el coronavirus debera prevalecer sobre la posible progresion de enfermedades oculares comunes. Tanto medicos oftalmologos como restantes profesionales de la salud ocular deberan asumir una posible progresion de dichas enfermedades ante la imposibilidad de un seguimiento adecuado de los pacientes.

OBJECTIVES To describe the characteristics and hygiene habits of contact lens (CL) wearers who acquire CLs over the Internet, as well as their awareness of modifiable risk factors (RFs). METHODS A web-based survey was conducted among clients of an online CL sales platform during 6 months. Demographic data, CL hygiene-related awareness, and compliance were collected and analyzed. RESULTS The questionnaire was completed by 1,264 CL wearers: the average age was 40.8 years; most were women (71.1%), had myopia (76.4%), and wore monthly disposable CLs (63.6%). The frequency of eye examination was significantly lower among those buying the CL exclusively online (15.8% vs. 6.6%, P

Objective Minimize exposure to the SARS-CoV-2, reduce the chances of cross-transmission between patients and healthcare personnel, and prevent the development of postoperative complications from the management of patients with eye diseases during the 2019 coronavirus disease pandemic (COVID-19). Methods COVID-19 literature review and consensus establishment between different Spanish ophthalmology societies in order to provide guidelines and recommendations of maximum resources primarily conditioned by the state of alert, confinement and social distancing that occurs in Spain since March 16, 2020. Results The recommendations will promote the adoption of action and protection measures for eye care in outpatient clinics, surgical areas and hospitalization, for unconfirmed (asymptomatic and symptomatic) and confirmed COVID-19 patients. Measures must be adapted to the circumstances and availability of personal protective equipment in each of the centers and Autonomous Communities, which will be updated according to the pandemic phases and the measures adopted by the Spanish Government. Conclusions During the COVID-19 pandemic, attention to the potential health risks to the population caused by coronavirus should prevail over the possible progression of the common eye diseases. Ophthalmologists and other eye care professionals must assume a possible progression of these diseases due to the impossibility of adequate patient follow-up.

Supplemental Digital Content is Available in the Text. Idebenone treatment can result in both stabilization of residual visual acuity and recovery of lost vision, with a treatment duration of at least 2 years needed to maximize the probability of recovery., Background: Leber hereditary optic neuropathy (LHON) leads to bilateral central vision loss. In a clinical trial setting, idebenone has been shown to be safe and to provide a trend toward improved visual acuity, but long-term evidence of effectiveness in real-world clinical practice is sparse. Methods: Open-label, multicenter, retrospective, noncontrolled analysis of long-term visual acuity and safety in 111 LHON patients treated with idebenone (900 mg/day) in an expanded access program. Eligible patients had a confirmed mitochondrial DNA mutation and had experienced the onset of symptoms (most recent eye) within 1 year before enrollment. Data on visual acuity and adverse events were collected as per normal clinical practice. Efficacy was assessed as the proportion of patients with either a clinically relevant recovery (CRR) or a clinically relevant stabilization (CRS) of visual acuity. In the case of CRR, time to and magnitude of recovery over the course of time were also assessed. Results: At time of analysis, 87 patients had provided longitudinal efficacy data. Average treatment duration was 25.6 months. CRR was observed in 46.0% of patients. Analysis of treatment effect by duration showed that the proportion of patients with recovery and the magnitude of recovery increased with treatment duration. Average gain in best-corrected visual acuity for responders was 0.72 logarithm of the minimal angle of resolution (logMAR), equivalent to more than 7 lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Furthermore, 50% of patients who had a visual acuity below 1.0 logMAR in at least one eye at initiation of treatment successfully maintained their vision below this threshold by last observation. Idebenone was well tolerated, with most adverse events classified as minor. Conclusions: These data demonstrate the benefit of idebenone treatment in recovering lost vision and maintaining good residual vision in a real-world setting. Together, these findings indicate that idebenone treatment should be initiated early and be maintained more than 24 months to maximize efficacy. Safety results were consistent with the known safety profile of idebenone.

The chapter is a review enclosed in the volume "Glaucoma: A pancitopatia of the retina and beyond." No cure exists for glaucoma. Knowledge on the molecular and cellular alterations underlying glaucoma neurodegeneration (GL-ND) includes innovative and path-breaking research on neuroinflammation and neuroprotection. A series of events involving immune response (IR), oxidative stress and gene expression are occurring during the glaucoma course. Uveitic glaucoma (UG) is a prevalent acute/chronic complication, in the setting of chronic anterior chamber inflammation. Managing the disease requires a team approach to guarantee better results for eyes and vision. Advances in biomedicine/biotechnology are driving a tremendous revolution in ophthalmology and ophthalmic research. New diagnostic and imaging modalities, constantly refined, enable outstanding criteria for delimiting glaucomatous neurodegeneration. Moreover, biotherapies that may modulate or inhibit the IR must be considered among the first-line for glaucoma neuroprotection. This review offers the readers useful and practical information on the latest updates in this regard.

Importance There is a paucity of evidence analysing the treatment of cyclodialysis clefts. Background We describe outcomes following the treatment of this rare condition at six centres internationally. Design Retrospective case series. Participants Thirty-six patients with a cyclodialysis cleft from 2003 to 2017 were recruited. Methods Clefts were treated with cycloplegic agents, laser therapy and/or surgery. Main outcome measures Postoperative best recorded visual acuity (BRVA), intraocular pressure (IOP) and the rate of cleft closure. Results The mean age was 45 ± 17 years and 29 (80.6%) patients were male. One eye (2.8%) received only medical therapy, 5 (13.9%) received laser, 14 (38.9%) underwent surgery after laser failure and 16 (44.4%) eyes received exclusively surgery. Over 80% of eyes had a BRVA improvement of more than two lines. Closure was attained in 30 eyes (93.8%; n = 32), with postoperative stabilized IOP ≥ 12 mmHg in 29 eyes (80.6%; n = 36) and postoperative BRVA ≤20/50 in 20 eyes (58.8%; n = 34). Improved postoperative BRVA was related to better preoperative BRVA (P = 0.006) and preoperative IOP ≥ 4 mmHg (P = 0.03). There was no significant difference between treatment approach for IOP ≥ 12 mmHg (P = 0.85) or postoperative BRVA ≤20/50 (P = 0.80). Only two eyes at last follow-up required IOP lowering medication. Conclusions and relevance There was a high closure rate with most eyes eventually requiring surgery. Clinically significant improvements in BRVA were found in most eyes. Improved postoperative BRVA was significantly related to better preoperative BRVA and IOP.

Purpose:To compare peripapillary vascular parameters derived from two optical coherence tomography angiography devices in pseudoexfoliation glaucoma, primary open-angle glaucoma, and healthy controls and to evaluate their diagnostic accuracy.Methods:Observational, cross-sectional study. In total, 20 eyes with pseudoexfoliation glaucoma, 20 primary open-angle glaucoma eyes matched by peripapillary retinal nerve fiber layer thickness, and 20 control eyes were recruited. Participants underwent standard automated perimetry and peripapillary retinal nerve fiber layer analysis by Optovue and Cirrus optical coherence tomography. Vascular parameters provided by Angiovue and Angioplex optical coherence tomography angiography were compared. Their diagnostic accuracy and correlation with structural and functional parameters were assessed.Results:All peripapillary optical coherence tomography angiography vascular parameters were significantly different among groups (all p Conclusion:Only Angiovue detected a significantly lower capillary density in pseudoexfoliation glaucoma compared to primary open-angle glaucoma at similar glaucoma damage. Both, Angiovue and Angioplex demonstrated a decreased capillary density in glaucoma eyes compared to healthy eyes. Furthermore, Angiovue-derived vascular parameters showed better correlation with functional and structural parameters and a higher diagnostic capacity to discriminate among groups compared to Angioplex.

Purpose: To assess the changes in peripapillary and macular choroidal thickness, and in the lamina cribrosa position following deep sclerectomy. Methods: Prospective study, including 39 eyes with open-angle glaucoma following deep sclerectomy. Choroidal thickness was automatically measured using swept-source optical coherence tomography at four peripapillary locations (superior, temporal, inferior, and nasal) and at the macular area in nine fields plotted with Early Treatment Diabetic Retinopathy Study grid. Optic nerve head was evaluated by Spectralis optical coherence tomography with enhanced depth imaging technology. All measurements were performed preoperatively and at 1 week and 2 months after surgery. Results: The mean intraocular pressure significantly decreased 1 week and 2 months after surgery ( p Conclusion: There was a significant reversal lamina cribrosa displacement measured from Bruch’s membrane opening reference despite a significant peripapillary choroidal thickening following deep sclerectomy. Both findings were significantly correlated with the change in intraocular pressure

Resumen La respuesta negativa del electrorretinograma de campo completo se define como una disminucion de la onda b con conservacion de la onda a (ratio b/a Este hallazgo puede verse de forma bilateral y simetrica en diferentes enfermedades hereditarias como la ceguera nocturna estacionaria congenita, la retinosquisis juvenil ligada a X y las distrofias musculares de Duchenne y Becker. Por otro lado, tambien se puede encontrar de forma unilateral en enfermedades adquiridas como algunos tipos de retinitis inmunomediadas (retinocoroiditis en perdigonada o Birdshot), retinopatias autoinmunes, retinopatia asociada a cancer/melanoma o toxicidad retiniana. El objetivo de esta revision es resumir las caracteristicas de las afecciones en las que puede observarse este hallazgo, de gran utilidad en el diagnostico diferencial de enfermedades de la retina.

The definition of the negative response of the full field electroretinogram is the presence of a b-wave with less amplitude than the a-wave (b/a ratio

Resumen Objetivos El aumento de la calidad y de la esperanza de vida y el hecho de que el glaucoma se diagnostique cada vez mas precozmente hace preguntarse a muchos pacientes si afectan a su enfermedad determinados deportes, actividades o aficiones. El objetivo de este trabajo es establecer unas guias para aconsejar a los pacientes con base en la evidencia cientifica de los trabajos publicados. Metodos Revision de todos los trabajos publicados sobre glaucoma y deportes u otras actividades. Los trabajos fueron clasificados segun el nivel de evidencia cientifica basada en la clasificacion del Oxford Centre for Evidence-Based Medicine. Resultados Las actividades aerobicas son beneficiosas para el paciente. Se han de evitar deportes o tecnicas de relajacion tipo yoga con maniobras de Valsalva o colocacion de la cabeza en posicion inferior. Tambien se deben evitar los cambios bruscos en altura. El calor intenso no parece influir en el glaucoma, pero el frio intenso puede afectar a pacientes con disregulacion vascular. Las actividades de vision proxima disminuyen levemente la presion intraocular. El uso de instrumentos de viento puede elevar la presion intraocular dependiendo de la tecnica utilizada. Conclusiones Ciertos deportes y actividades pueden tener una influencia en la aparicion o la progresion del glaucoma. Los especialistas en glaucoma deben tener informacion adecuada sobre la evidencia cientifica de las publicaciones para poder aconsejar apropiadamente a los pacientes.

Resumen Objetivos Establecer guias para aconsejar a los pacientes respecto a la relacion entre dieta y habitos de vida y glaucoma. Metodos Revision de los trabajos publicados sobre glaucoma y la dieta, la ingesta de suplementos, el consumo de drogas o el tabaco, el sueno, el embarazo y la hipertension. Los trabajos fueron clasificados segun el Oxford Center for Evidence-Based Medicine. Resultados La evidencia sobre la relacion entre la dieta o el uso de suplementos y la incidencia o la progresion del glaucoma es insuficiente para justificar una recomendacion. Si bien algunos estudios en glaucoma de tension normal sugieren que el Ginkgo biloba podria reducir la progresion, no permiten recomendar su uso generalizado. Los estudios sobre tabaco no demuestran claramente una relacion entre consumo de tabaco e incidencia del glaucoma. La marihuana no es un tratamiento util para el glaucoma. Los resultados sobre la relacion entre la apnea del sueno y glaucoma son heterogeneos, pero si parece conveniente que los pacientes con grado moderado o severo de apnea sean evaluados para descartar glaucoma. El embarazo no suele afectar al curso de la enfermedad, pero varios medicamentos hipotensores pueden ser nocivos para el feto. La hipotension nocturna es un factor de riesgo de empeoramiento del glaucoma. Conclusiones Ciertas costumbres, circunstancias o enfermedades pueden tener una influencia en la aparicion o progresion del glaucoma. Es importante conocer la evidencia cientifica existente para poder aconsejar adecuadamente a los pacientes.

Purposes The increase in quality and life expectancy, often leads to many patients asking the glaucoma specialist whether some sports, activities or hobbies would affect their illness. The aim of this article is to establish guidelines for patients, based on the scientific evidence of published papers. Methods Review of all published articles on glaucoma and sports or other activities. The papers were classified according to the level of scientific evidence based on the Oxford Centre for Evidence-Based Medicine classification. Results Aerobic sports are beneficial for the patient. Yoga indoor sports or relaxation techniques should be avoided if Valsalva maneuvers are performed or the head is placed very low. Also, the patients must avoid sudden changes in height. Intense heat does not seem to lead to progression of glaucoma, but intense cold can affect patients with vascular dysregulation. Activities using the near vision slightly reduce the intraocular pressure. The use of wind instruments may raise intraocular pressure, depending on the technique used. Conclusions Certain sports and activities may have an influence on the onset or progression of glaucoma. Glaucoma specialists should have adequate information about the scientific evidence in the publications, in order to properly advise the patients.

Purpose. To study the structure-function relationship in glaucoma and healthy patients assessed with Spectralis OCT and Humphrey perimetry using new statistical approaches. Materials and Methods. Eighty-five eyes were prospectively selected and divided into 2 groups: glaucoma (44) and healthy patients (41). Three different statistical approaches were carried out: (1) factor analysis of the threshold sensitivities (dB) (automated perimetry) and the macular thickness (μm) (Spectralis OCT), subsequently applying Pearson’s correlation to the obtained regions, (2) nonparametric regression analysis relating the values in each pair of regions that showed significant correlation, and (3) nonparametric spatial regressions using three models designed for the purpose of this study. Results. In the glaucoma group, a map that relates structural and functional damage was drawn. The strongest correlation with visual fields was observed in the peripheral nasal region of both superior and inferior hemigrids (r=0.602 and r=0.458, resp.). The estimated functions obtained with the nonparametric regressions provided the mean sensitivity that corresponds to each given macular thickness. These functions allowed for accurate characterization of the structure-function relationship. Conclusions. Both maps and point-to-point functions obtained linking structure and function damage contribute to a better understanding of this relationship and may help in the future to improve glaucoma diagnosis.

Case report A 35-year-old man suffered a severe hypotension maculopathy after being kicked in his left eye. He presented a broad area of iridodialysis. Gonioscopy, ultrasound biomicroscopy and optic coherence tomography were not able to locate the suspected cyclodialysis. Medical treatment was ineffective. Five months later the patient received transcleral diode laser cyclophotocoagulation with clinical resolution. Discussion Transscleral diode laser constitutes an effective treatment, with low iatrogenia, that can solve cases of ocular hypotension, even when the location of the cyclodialysis has not been determined.

The purpose of this study was to describe morphological changes in lamina cribrosa (LC), prelaminar tissue thickness (PTT) and Bruch’s membrane opening (BMO) in eyes affected by papilledema and correlate them with trans-LC-pressure difference (TLCD). This was a prospective study, including twelve eyes newly diagnosed of papilledema. Eyes underwent scanning with Spectralis-OCT with enhanced depth imaging to compare BMO, anterior LC surface position (LC depth-LCD-) and PTT before and after oedema resolution. Correlation analysis between these parameters and TLCD was performed. TLCD inversely correlated with LCD at baseline and directly with LC reversal movement after lowering cerebrospinal fluid pressure (CSFP) (ρSpearman: −0.739, p = 0.006; ρSpearman: 0.844, p = 0.001 respectively). At onset, RNFL thickening and BMO were significantly larger in eyes with TLCD > −9.2 mmHg (group 2) compared with TLCD < −9.2 mmHg (group 1) [p = 0.007, p = 0.041 respectively]. A significant RNFL and BMO shrinking were observed, but they were significantly larger in group 2. The magnitude of LC displacement following oedema resolution was significantly larger and in the opposite direction in group 2 vs group 1 (−68.7 μm vs 19.5 μm, p = 0.016). TLCD correlated with RNFL thickening at baseline (ρSpearman: 0.667, p = 0.018) and with RNFL thinning at last visit (ρSpearman: 0.673, p = 0.017). TLCD correlated with mean deviation (MD) (ρSpearman: 0.712, p = 0.014) and visual field index (VFI) (ρSpearman: −0.657, p = 0.028) at onset. MD and VFI were worse in group 2. LC position was significantly related to TLCD in papilledema. Eyes with higher TCLD showed significantly larger backward LC movement, BMO shrinking and RNFL thinning after lowering CSFP compared with eyes with lower TLCD, where LC movement occurred in the opposite direction.

Resumen Casos clinicos Mujer de 81 anos y varon de 63, que desarrollan un hematoma pre-descemetico (HPD) tras una esclerectomia profunda no perforante (EPNP), la primera durante la cirugia y el segundo durante el postoperatorio precoz. Se describe la tecnica quirurgica que permite tanto la evacuacion del hematoma como la preservacion de la integridad de la membrana trabeculo-descemetica. Se presentan los hallazgos de OCT de segmento anterior tras la cirugia. Discusion Describimos los primeros casos del HPD tras EPNP, manejados exitosamente con una membranotomia ab interno de Descemet. Se debe estar alerta ante esta rara complicacion, potencialmente amenazadora para la vision.

Case presentation An 81 year-old woman and a 63 year-old man developed a pre-Descemet haematoma after deep sclerectomy (DS), the former during the surgery itself and the latter during the early post-operative period. The surgical technique is described that led to the evacuation of the haematoma and the preservation of the integrity of trabeculo-Descemet membrane. The anterior-segment OCT findings after surgery are also presented. Conclusions These are the first reported cases of pre-Descemet haematoma after DS that have been successfully repaired by an ab interno Descemet membranotomy. Surgeons should be aware of this rare, but potentially sight-threatening, complication.

Purpose To report 1-year treatment outcomes of P50 EX-PRESS implant versus nonpenetrating deep sclerectomy (NPDS) with Esnoper V2000 combined with phacoemulsification. Design Randomized, prospective and multicentre clinical trial. Methods Settings: Six clinical centres. Population Patients 54-89 years of age without previous filtering surgery with cataract and glaucoma who required lower levels of intraocular pressure (IOP). Interventions Phaco-EX-PRESS P50 or Phaco-NPDS with Esnoper V2000, both groups with mitomycin C (0.2 mg/ml for 2 min). Main outcome measures IOP, complete success rate (IOP: ≥6 and ≤18 mmHg), visual acuity, use of medical therapy and systematic assessment of complications and postoperative interventions. Results A total of 98 eyes were enrolled, including 50 in the EX-PRESS group and 48 in the NPDS group. At 12 months, IOP (mean ± SD) was 13.9 ± 3.3 mmHg in EX-PRESS group and 13.3 ± 3.6 mmHg in NPDS group (p = 0.38). Success rate was 75% and 80% in EX-PRESS and NPDS groups, respectively (p = 0.53). The number of glaucoma medications (mean ± SD) was 0.2 ± 0.55 in EX-PRESS group and 0.17 ± 0.44 in NPDS group (p = 1.00). The total number of complications was 66 in 35 subjects in EX-PRESS group and 39 in 23 subjects in NPDS group (p = 0.02). The incidence of more than one complication was n = 13 (26%) versus n = 9 (18.8%) in EX-PRESS and NPDS groups, respectively (p = 0.38). The total number of required postoperative interventions was 59 and 26 in EX-PRESS and NPDS groups, respectively (p = 0.01). Visual acuity was similar in both groups at month 12 (p = 0.13). Surgical time (mean ± SD) was 52.6 ± 13.6 min in EX-PRESS group and 63.3 ± 19.4 min in NPDS group (p = 0.01). Conclusion Phaco-EX-PRESS surgery had similar success rate compared to Phaco-NPDS during 1 year of follow-up. Both procedures were associated with similar IOP reduction and use of additional medical therapy at 12 months. EX-PRESS surgery required more postoperative interventions and had more complications, but needed less surgical time compared to NPDS.

Introduction The preservative benzalkonium chloride (BAK) is used to preserve several topical, intraocular pressure (IOP)-lowering glaucoma medications but can cause tolerability concerns that may lead to decreased adherence to treatment and ultimately diminish the effectiveness of IOP control. The study aimed to determine the efficacy and tolerability of BAK-free travoprost preserved with polyquaternium-1 in glaucoma patients switched from BAK-preserved latanoprost or bimatoprost. Methods This 12-week, open-label study was conducted in Europe between December 2011 and February 2013. We enrolled adult patients with open-angle glaucoma or ocular hypertension who were receiving BAK-preserved latanoprost 0.005% or bimatoprost 0.01% and, in the opinion of the investigator, would benefit from transition to BAK-free travoprost 0.004% preserved with polyquaternium-1 because of tolerability concerns. Assessments included IOP, proportion of patients with IOP ≤18 mmHg, ocular surface status, hyperemia, patient treatment preference, and adherence. Adverse events were recorded throughout the study. Results Of the 202 patients screened, 187 patients were included in the intent-to-treat population (mean age, 66.6 years; range, 19–90 years). The mean IOP significantly reduced from baseline (17.0 mmHg) to week 6 (mean change, −1.17 mmHg; P