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Purpose: To investigate the risk factors for Ex-Press® (EXP) surgery failure.Patients and Methods: This was a retrospective non-randomized study of 98 patients who had undergone EXP and were followed-up >5 years. We investigated the following nine risk factors: age, gender, hypertension, diabetes mellitus (DM), previous glaucoma surgery, type of glaucoma (primary open angle glaucoma vs. pseudo-exfoliation glaucoma), surgical methods (EXP alone vs. EXP+cataract surgery simultaneously), central corneal thickness (CCT), and preoperative intraocular pressure (IOP). We defined a successful surgery as a post-operative reduction in the IOP >20% from the preoperative IOP and Results: Performing EXP significantly decreased the IOP (pre-operative: 25.2 ± 8.7, at 5 years: 11.1 ± 4.1). The success ratio of EXP was 67.4% at 5 years. We found no significant risk factors for EXP surgery failure. The p-values of the factors were age (p=0.936), gender (p=0.0587), hypertension (p=0.409), DM (p=0.967), previous glaucoma surgery (p=0.940), type of glaucoma (p=0.435) surgical methods (p=0.521), CCT (p=0.091), and preoperative IOP (p=0.082).Conclusions: No preoperative factors that could be used to predict the failure of EXP surgery were identified. EXP can be safely performed for various types of glaucoma.

Twenty-four-hour IOP measurements with a CLS showed that among IOP indicators studied, the range of IOP fluctuation was most important and significantly larger in NTG eyes compared with nonglaucoma eyes.We conducted the present study to determine (1) the best factor for distinguishing normal tension glaucoma (NTG) and nonglaucoma subjects based on the intraocular pressure (IOP) values measured by a CLS and (2) the optimal cutoff values of that factor.The eyes of 18 nonglaucoma subjects and 26 NTG patients were examined. We evaluated 5 indicators: maximum IOP value, SD, IOP fluctuation range, the cosine-fit curve amplitude, and the amplitude of dual-harmonic regression values. We determined the indicators' cutoff values to distinguish between nonglaucoma subjects and NTG patients with the area under the curve.The mean IOP values were 12.3±2.7 mm Hg in the nonglaucoma eyes and 12.5±3.1 mm Hg in the NTG eyes ( P =0.824). All 5 indicators were significantly higher in the NTG group. The best factor to distinguish the nonglaucoma subjects and NTG patients was the IOP fluctuation range ( P0.0001, area under the curve=0.844); the cutoff level value was 436.5 millivolt equivalents.Twenty-four-hour IOP measurements with a CLS showed that among IOP indicators studied, the range of IOP fluctuation was most important and significantly larger in NTG eyes compared with nonglaucoma eyes.

Purpose: It has been reported that corneal endothelial cells (CEC) decrease faster when the tip of the Baerveldt glaucoma implant (BGI) tube is inserted into the anterior chamber than into the vitreous cavity. We investigated whether surgically relocating the tip of the BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss.Patients and Methods: The subjects were 11 consecutive patients (11 eyes) that could be followed >12 months after relocation surgery. We compared the intraocular pressure (IOP), reduction slope of CEC density and annual reduction rate of CEC density before and after relocation surgery. Results: The relocation surgery did not significantly change IOP (p=0.974). The mean preoperative and postoperative IOP were 13.1 ± 4.5 and 13.6 ± 4.3 mmHg. The reduction ratio of the CEC density was 15.4 ± 6.7 cells/mm2/year before relocation surgery and significantly slower at 8.3 ± 6.5 cells/mm2/year after relocation surgery (p=0.024). Two patients resulted in bullous keratopathy after relocation surgery.Conclusions: Relocating the tip of BGI tube from the anterior chamber to the vitreous cavity could reduce CEC loss.

Despite an expansion of production, pangasius farmers have experienced economic challenges in Vietnam. The aim of this study was to identify optimum economic alternatives for pangasius farmers. A single-stage stochastic frontier analysis was used to estimate the economic efficiency of pangasius farms and investigate the farm size–economic efficiency relationship using cross-sectional data collected on Vietnamese pangasius farms. The study found a nonlinear relationship between farm size and economic efficiency, with economic efficiency increasing until the farm area reached a threshold of 26.9 ha, then falling due to transaction and agency costs under asymmetric information. The farming experience of the decision-makers negatively affected efficiency. Similar to previous studies, we found feed and fingerling costs were essential input factors for farms. Based on these results, we recommend three strategies for improving the economic efficiency of farms are: providing timely market information to farmers; determining the optimal farming scale depending upon the specific farmer’s available resources; and using a good quality of fingerlings and feed.

Purpose Previously, we reported that the Ex-press® shunt (EXP) was associated with more rapid reduction of corneal endothelial cells when inserted into the cornea rather than the trabecular meshwork (TM). We compared the reduction rate of corneal endothelial cells between the corneal insertion group and TM insertion group. Methods This was a retrospective study. We included patients who had undergone EXP surgery and were followed for > 5 years. We analyzed the corneal endothelial cell density (ECD) before and after EXP implantation. Results We included 25 patients in the corneal insertion group and 53 patients in the TM insertion group. One patient in the corneal insertion group developed bullous keratopathy. The ECD decreased significantly more rapidly in the corneal insertion group (p 2 at 5 years with a mean 5-year survival rate of 64.9 ± 21.9%. By contrast, in the TM insertion group, the mean ECD decreased from 2356 ± 364 to 2124 ± 579 cells/mm2 at 5 years, and the mean 5-year survival rate was 89.3 ± 18.0%. The decrease rate of ECD was calculated as 8.3%/year in the corneal insertion group and 2.2%/year in the TM insertion group. Conclusions Insertion into cornea is a risk factor for rapid ECD loss. The EXP should be inserted into the TM to preserve the corneal endothelial cells.

To compare surgical outcomes between Ex-Press® (EXP) and Baerveldt glaucoma implant (BGI) surgeries for primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEXG) patients. This was a retrospective single-facility study. The inclusion criteria were that the patient's preoperative intraocular pressure (IOP) was > 21 mmHg and the post-surgery follow-up was > 1 year. We recruited 161 patients who had undergone a trabeculectomy with EXP (89 eyes) or BGI surgery (72 eyes). We compared these groups' postoperative IOP values and postoperative glaucoma medications, the reduction rate of corneal endothelial cell density (ECD), surgical outcomes, complications, the hospital stay duration, and the number of visits within 3 months post-surgery. Both the EXP and BGI surgeries could significantly decrease the IOP. When the surgical success was defined postoperative IOP ≤ 21 mmHg, the surgical outcome of BGI was significantly better than EXP (p = 0.0148). When the surgical success was defined postoperative IOP ≤ 18, 15 , and 12 mmHg, the surgical outcomes between BGI and EXP surgeries were not significantly different (p = 0.0815, p = 0.331, and p = 0.910). The mean ECD reduction rate was significantly faster in the EXP group. The BGI patients had significantly shorter stays in the hospital and fewer visits within 3 months post-surgery (p

Background We compared the efficiency of trabectome surgery for patients with differing preoperative intraocular pressure (IOP) values in a single-facility retrospective study. We evaluated surgical outcomes based on three grades of preoperative IOP: high (hi-IOP, >26 mmHg), middle (mid-IOP, 18-26 mmHg), and low (lo-IOP, Patients and methods We analyzed the cases of 204 eyes that underwent trabectome surgery and were followed >2 years. We defined failure as a reduction of IOP 21, >18, >15, and >12 mmHg. Other factors that may affect surgical outcomes were also investigated: age, central corneal thickness (CCT), history of selective laser trabeculotrabculoplasty (SLT), preoperative visual field, and simultaneous cataract surgery. Results Trabectome surgeries significantly decreased the IOP values from 23.0 ± 7.2 mmHg to 13.6 ± 3.6 mmHg at 2 years post-surgery. The mid-IOP group achieved significantly better surgical outcomes than the lo-IOP and hi-IOP groups with cutoff values 21, 18, and 15 mmHg. A thin CCT and simultaneous cataract surgery were significantly related to better surgical outcomes with cutoff value 21.18 and 15 mmHg. Conclusion For the patients with preoperative IOP 20% with trabectome surgery. Patients with preoperative IOP values >26 mmHg often required additional glaucoma surgery.

Several methods can be applied for a trabeculotomy, including the uses of thread, a blade, cauterization, and a hook. We compared the outcomes of trabectome surgery and microhook surgery. We analyzed the cases of 133 eyes that underwent trabectome (72 eyes) or microhook (61 eyes) surgery and were followed for > 1 year. We defined failure as a

Background: We report the results of Baerveldt glaucoma implant (BGI) surgery performed with the scleral flap and patch technique. Patients and methods: This was a retrospective analysis of 97 consecutive patients (107 eyes) who underwent BGI surgery with the scleral flap and patch, and were followed up for >1 year. We evaluated the patients’ post-operative intraocular pressure (IOP), corneal endothelial cell density, and complications (corneal edema, Hoffmann elbow exposure). Results: The preoperative IOP was 32.9 ± 8.6 mmHg. BGI surgery significantly decreased the IOP to 11.1 ± 3.8, 11.3 ± 3.6, 11.3 ± 4.2, 10.7 ± 3.8, and 11.4 ± 3.2 mmHg at 1, 2, 3, 4, and 5 years post-surgery ( p Conclusion: BGI surgery performed with the scleral flap and patch significantly decreased the IOP, and no case of Hoffmann elbow erosion was observed over the 5-year post-operative period.

Purpose: To compare surgical outcomes between Ex-PRESS® surgery (EXP) and trabeculectomy (Trab) for primary open angle glaucoma (POAG) with low preoperative intraocular pressure (IOP).Patients and Methods: This was a retrospective non-randomized study. We included POAG patients with preoperative IOP ≤16 mmHg who were taking tolerance glaucoma medications. We compared the surgical outcomes, postoperative IOP, number of glaucoma medications, reduction rate of corneal endothelial cell density (ECD), visual acuity, and postoperative complications between POAG patients who underwent EXP (34 eyes) or Trab (38 eyes) and could be followed for >2 years.Results: Both surgeries significantly decreased the IOP (pConclusions: Both surgeries significantly decreased IOP and were useful surgical methods for low-IOP glaucoma. Our results suggest that trabeculectomy can decrease IOP more than Ex-PRESS surgery but might have more complications.

Purpose Persistent corneal edema is a serious potential complication of Baerveldt glaucoma implant (BGI) surgery. A trabeculectomy reduces the density of corneal endothelial cells. We investigated the effect of BGI surgery on corneal endothelial cells of patients with no history of trabeculectomy. Methods We retrospectively analyzed 85 eyes of 85 patients who underwent BGI surgery and were followed-up for ≥12 months. We used new criteria for surgical failure. We defined persistent corneal edema or needed additional surgery for changing the tube position due to remarkable reduction in corneal endothelial cells as failure. We compared surgical outcomes with new criteria and the rates of corneal endothelial cell density (ECD) loss after BGI surgery between the anterior chamber insertion (AC) group (n=23) and vitreous cavity insertion (VC) group (n=63). Results The mean pre-operative ECD values of the AC and VC groups were not significantly different at 2309 ± 498 and 2204 ± 556 (p=0.426). The ECD reduction rate in the AC group was significantly faster than in the VC group. The mean post-operative IOP values significantly decreased in both groups. However, the VC group's surgical outcomes were significantly better than the AC group's (p=0.0241) with the new criteria. Conclusion The mean of ECD did not decrease significantly after BGI surgery in VC group patients with no history of trabeculectomy. BGI surgery insertion to the vitreous cavity was safe and had much less effect on the ECD decrease compared to insertion to the anterior chamber.

To compare surgical outcomes between Ex-PressThis was a retrospective single-facility study. The inclusion criteria were that the patient's preoperative intraocular pressure (IOP) was 21 mmHg and the post-surgery follow-up was 1 year. We recruited 161 patients who had undergone a trabeculectomy with EXP (89 eyes) or BGI surgery (72 eyes). We compared these groups' postoperative IOP values and postoperative glaucoma medications, the reduction rate of corneal endothelial cell density (ECD), surgical outcomes, complications, the hospital stay duration, and the number of visits within 3 months post-surgery.Both the EXP and BGI surgeries could significantly decrease the IOP. When the surgical success was defined postoperative IOP ≤ 21 mmHg, the surgical outcome of BGI was significantly better than EXP (p = 0.0148). When the surgical success was defined postoperative IOP ≤ 18, 15 , and 12 mmHg, the surgical outcomes between BGI and EXP surgeries were not significantly different (p = 0.0815, p = 0.331, and p = 0.910). The mean ECD reduction rate was significantly faster in the EXP group. The BGI patients had significantly shorter stays in the hospital and fewer visits within 3 months post-surgery (p 0.0001).BGI surgery could provide comparable surgical outcomes as EXP surgery for POAG or PEXG patients with high preoperative IOP. BGI surgery has some advantages: fewer post-surgery visits, less postoperative interventions, and a lower ECD reduction rate.

The purpose of this retrospective study was to evaluate the effectiveness of blepharoptosis surgery in patients with deepening of the upper eyelid sulcus (DUES). This case series included 10 consecutive patients (19 eyes) with DUES associated with use of a prostaglandin analog for glaucoma. Patients who had used bimatoprost and developed DUES were changed to an alternative prostaglandin analog and observed for ≥3 months. If there was no improvement, they underwent levator resection for blepharoptosis and were followed up for ≥6 months postoperatively. Improvement in margin reflex distance-1 and surgical complications was evaluated. After discontinuation of bimatoprost in 3 cases (6 eyes), mild subjective and objective improvement in DUES was seen in 2 cases (4 eyes) but without improvement in blepharoptosis. The prostaglandin analog used before surgery was travoprost in 4 eyes (21.0%), tafluprost in 7 eyes (36.9%; including 4 eyes switched from bimatoprost), and latanoprost in 8 eyes (42.1%; including 2 eyes switched from bimatoprost). The mean margin reflex distance-1 value was 1.11 ± 0.96 mm before surgery and 3.72 ± 0.81 mm at the final postoperative follow-up; the difference was significant (P = 3.32 × -10). There were no intraoperative or postoperative complications. Levator resection is a useful and safe procedure for blepharoptosis with DUES.

Purpose The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESS® surgery. Methods This was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESS® surgeries and were followed up for >2 years were analyzed. We used anterior segment optical coherence tomography to measure the bleb volume, and compared the volume at 1 year with that at 2 years after surgery. We also examined potential influencing factors, including age, number of medications, central corneal thickness, type of glaucoma, preoperative intraocular pressure (IOP), postoperative IOP, reduction ratio of IOP, history of trabeculotomy, and operation method (Ex-PRESS® surgery only or simultaneous cataract surgery). Results Ex-PRESS® surgeries significantly decreased the IOP from 26.3±9.7 mmHg to 11.6±3.7 mmHg after 24 months (P

We compared the outcomes of Baerveldt glaucoma implant (BGI) surgery between vitreous cavity and anterior chamber insertion. We retrospectively analyzed a total of 105 consecutive eyes that underwent BGI surgery and were followed up for ≥ 12 months. BGI surgery was performed via the anterior chamber (AC group 48 eyes) or the pars plana into the vitreous cavity (VC group 57 eyes). Patients’ data were examined at 3, 6, and 12 months, and then every 6 months after surgery. We compared the groups’ intraocular pressure (IOP), success ratio, visual acuity, number of glaucoma medications, central corneal endothelial cell density (CCECD), reduction ratio of CCECD, and postoperative complications. The mean preoperative and postoperative IOP values were not significantly different between the two groups. In the Kaplan-Meier survival plots, there was no significant between-group difference in the success rate (p = 0.333). The postoperative mean CCECD decreased significantly faster in the AC group than the VC group at all time points. The cases of postoperative corneal edema were 12.5% in AC group and 1.8% in VC group. The risk of postoperative corneal edema was significantly higher in the AC group (p = 0.0136). Risk factors for the rapid reduction of CCECD were “history of trabeculectomy” (p = 0.00283), “insertion into the anterior chamber” (p = 0.001), and “shorter distance between the tube and corneal endothelium” (p = 0.0137). There was no significant between-group difference in postoperative IOP, medications, or success rate. Considering the reduction of corneal endothelial cells, insertion into the vitreous cavity seems safer than insertion into the anterior chamber.

Purpose To compare the postoperative interventions and outcomes between conventional trabeculectomy and trabeculectomy with the Ex-PRESS® mini-glaucoma shunt device (Ex-Press). Methods This was a retrospective, comparative, single-facility study. We analyzed the cases of 108 glaucoma patients who underwent trabeculectomy and were followed for >1 year. Thirty-nine eyes underwent a conventional trabeculectomy (conventional group) and 69 eyes underwent a trabeculectomy with an Ex-Press (Ex-Press group). As evaluation items, we examined postoperative intraocular pressure (IOP), the surgical success rate, postoperative complications, the number of days to laser suture lysis, and needling. Results Trabeculectomy significantly decreased the patients' IOP values from 27.8±7.9 to 11.1±3.9 mmHg in the conventional group (p

We investigated glaucoma patients' complications, subjective symptoms, and side effects of continuous 24-h measurement of intraocular pressure (IOP)-related patterns with a contact lens sensor (CLS). We asked the patients to complete a questionnaire about their subjective symptoms after wearing the CLS. This was an observational single-facility study. We analyzed 56 patients (35 men, 21 women) who underwent 24-h continuous measurement of their IOP-related patterns with a Triggerfish® CLS. The four questionnaire items asked whether blurred vision, ocular pain, conjunctival hyperemia, and sleep disorder were present/absent. All questionnaire items were answered subjectively. We examined the relationship between the patients' questionnaire results and their visual acuity and visual field. The rate of blurred vision was 55%; ocular pain, 30%; conjunctival hyperemia, 14%; sleeping disorder, 29%. Patients with good visual acuity tended to report experiencing blurred vision. When 24-h continuous measurement of IOP-related patterns with a CLS is considered, clinicians should tell the patient about the possibility of blurred vision, ocular pain, conjunctival hyperemia, and/or sleeping disorder.

We investigated the factors that influence the reduction in corneal endothelial cells after Ex-Press® surgery. This was a retrospective study. We included patients who had undergone Ex-Press surgery and were followed up for > 2. We analyzed the corneal endothelial cell density (ECD) before and after Ex-Press surgery. We investigated the insertion position (Ex-Press device was inserted into cornea or trabecular meshwork (TM)), Ex-Press–iris touch, cornea–iris touch, peripheral anterior synechiae, history of trabeculotomy, history of selective laser trabeculoplasty, type of glaucoma, and simultaneous cataract surgery as influencing factors. We used multivariate analysis to determine the factors influencing the reduction rate of ECD. We included 129 eyes. The mean of ECD had decreased 7.0% at 2 years. Ex-Press surgeries significantly decreased the ECD after 2 years (p = 0.0118). As a result of the multivariate analysis, the factor that led to a significantly faster reduction in ECD was the insertion position of the Ex-Press (p

PURPOSE To evaluate the effectiveness and safety of aponeurotic blepharoptosis surgery and the morphology of filtering bleb in patients with filtrating bleb. METHODS This retrospective case series included 7 consecutive patients (9 eyes) with filtering bleb after trabeculectomy. They underwent transcutaneous levator aponeurotic advancement from May 2018 to April 2019. The authors evaluated margin reflex distance-1 and intraocular pressure and analyzed filtering bleb morphology, such as filtering bleb volume, filtering bleb height, and filtering bleb wall thickness, using anterior segment optical coherence tomography before and after aponeurotic advancement. The authors also evaluated intra and postoperative complications. RESULTS The mean age was 75.6 ± 7.8 years; the mean duration from glaucoma surgery to blepharoptosis surgery was 36.9 ± 26.8 months; the mean follow-up after blepharoptosis surgery was 6.1 ± 2.9 months. The mean margin reflex distance-1 value changed significantly from 0.7 ± 0.8 mm before surgery to 3.3 ± 0.4 mm after surgery (p < 0.0001). The mean intraocular pressure showed no significant change from 12.9 ± 2.6 mm Hg before surgery to 12.7 ± 3.3 after surgery. In the filtering bleb analysis using anterior segment optical coherence tomography no significant differences were found, such as in bleb volume, height and wall thickness, before and after blepharoptosis surgery. There were no intraoperative complications in any of the cases. A postoperative corneal disorder was seen in 1 eye, but there was no infection of or damage to filtering bleb in any of the cases during the postoperative follow-up period. CONCLUSIONS In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.In patients with glaucoma filtering bleb, transcutaneous levator aponeurotic ptosis surgery is considered to be highly safe and unlikely to affect the morphology of the filtering bleb or intraocular pressure in the short term.

Aim The aim of this study is to identify target levels of early postoperative intraocular pressure (IOP) associated with successful trabeculectomy using an Ex-Press glaucoma shunt. Materials and methods This was a retrospective single-facility study. We enrolled 158 glaucoma patients who underwent trabeculectomy with Ex-Press and were followed for >1 year, and investigated risk factors for the failure of Ex-Press surgery. We examined age, sex, central corneal thickness (CCT), number of preoperative glaucoma medications, simultaneous performance of cataract surgery, history of trabeculotomy, hypertension (HT), diabetes mellitus (DM), subtype of glaucoma, and early postoperative IOP (minimum, 2 weeks, 1 month, and 3 months). Results Ex-Press surgery could significantly decrease IOP. Success rates at 1, 2, 3, and 4 years were 91.1, 86.1, 82.5, and 78.1%, respectively. Factors significantly affecting the success rate included age, the number of preoperative glaucoma medications, and early postoperative IOP. The IOP cutoff values of minimum IOP for the success of Ex-Press surgery was 5 mm Hg. Conclusions Younger age, a high number of preoperative glaucoma medications, and high IOPs in the early postoperative period were found to be the risk factors for failure of Ex-Press surgery. Considering hypotonic complications, it is desirable to control the minimum IOP from 3–5 mm Hg within 2 weeks after surgery. According to our calculations, target IOPs at 2 weeks, 1 month, and 3 months after Ex-Press surgery should be 8 mm Hg, 10 mm Hg, and 14 mm Hg, respectively. Clinical significance We thought that Ex-Press surgery might require lower IOP in the early postoperative period than conventional trabeculectomy. How to cite this article Tojo N, Hayashi A, et al. Evaluation of Early Postoperative Intraocular Pressure for Success after Ex-Press Surgery. J Curr Glaucoma Pract 2019;13(2):55–61.

We examined whether a contact lens sensor (CLS) is useful for the postoperative evaluation of trabectome surgery. We investigated the correlations between the outcomes of trabectome surgery and the output of a CLS. We examined 24 consecutive eyes of patients with pseudo-exfoliation glaucoma. In each eye, the intraocular pressure (IOP) fluctuations over 24 h were measured with the SENSIMED Triggerfish CLS before and at 3 months after the trabectome surgery. We divided the patients into success (n = 12 eyes) and failure (n = 12 eyes) groups; success was defined as a postoperative IOP level ≤ 21 mmHg plus an IOP reduction ≥ 20% relative to the preoperative IOP value with or without anti-glaucoma medications. We investigated CLS parameters that correlate with surgical outcomes by performing a Cox hazard regression analysis. We determined the maximum value, minimum value, and range of IOP fluctuation as CLS parameters. The mean follow-up period was 38.0 ± 3.0 months. The success rate was 50%. The postoperative range of IOP fluctuation during the nocturnal period with the CLS was significantly correlated with the surgical results (p = 0.024). A smaller range of IOP fluctuation was significantly correlated with better surgical outcomes. We were able to predict the surgical success after trabectome surgery at 3 months using the CLS. Thus, CLS results could be a new surgical evaluation parameter.

We sought to determine whether changes in the measurement angle of the Icare TA01i and IcarePRO tonometers led to errors in the measurement of intraocular pressure (IOP). In this prospective, single-facility study, we analyzed 77 patients from November 2017 to September 2019. We measured IOP with the Icare TA01i and IcarePRO while changing the angle of the device with the cornea center and analyzed the associated changes in the measurement. IOP measured with the Icare tilted − 30°, − 15° vertically was significantly higher than that measured with the Icare tilted horizontally (p

We investigated the correlations between 24-h continuous intraocular pressure (IOP) measurement with a contact lens sensor (CLS) and visual field (VF) progression. We examined 69 eyes of glaucoma patients who were followed > 2 years after the measurement of IOP fluctuation with a CLS. All patients underwent VF examinations > 4 times. VF progression was defined as a deterioration of the mean deviation (MD). We evaluated the original 17 parameters from the data obtained from the CLS output and attempted to identify which of them contributed to the VF progression. We then performed multivariate analyses to identify risk factors for rapid VF progression. The mean follow-up period was 4.0 ± 1.6 years. The mean VF progression rate was − 0.37 ± 0.53 dB/year. The multivariate analysis identified the following as-risk factors for VF progression: more advanced baseline MD value (p = 0.0269); high maximum values during the 24-h (p = 0.0131) and nocturnal (p = 0.0466) periods; large standard deviation of IOP fluctuation during the 24-h (p = 0.0404), diurnal (p = 0.0330), and nocturnal (p = 0.0027) periods; and large range of IOP fluctuation during the nocturnal period (0.0431). Our results suggested that the above CLS parameters might be correlated with rapid progression of VF disorder. These CLS parameters could be used to evaluate the results of CLS in the future. Examination with a CLS could be useful for predicting the VF progression rate within a mere 24-h period.

espanolEl objetivo de este estudio fue estimar la mortalidad natural en los estados embrionarios y larvales de la sardina europea Sardina pilchardus a largo de la Costa Atlantica del Noroeste de Africa entre el Cabo Barbas (22°30'N) y el Cabo Bojador (26°N) durante noviembre de 2007. Se utilizaron datos planctonicos seleccionados de un estudio realizado en noviembre 2007 y ajustados a un modelo exponencial; el indice de mortalidad de huevos de sardina (Z) fue estimado en 0,07 (por hora), siendo el indice de mortalidad diario del 83,5%. Por otra parte, para larvas de sardina, Z fue estimada en 0,1 (por hora), correspondiente a un indice de mortalidad diario igual al 21,4%. Migraciones hacia el sur y costa afuera pueden ser consideradas como una causa de la variabilidad en la deriva y condiciones de sobrevivencia de larvas de sardina. Analisis adicionales de serie de tiempo de las primeras etapas del ciclo vital de las sardinas y la futura supervision con programas de monitoreo adaptativo deberian ser conducidos para un mejor manejo de la industria pesquera de esta especie en Marruecos. EnglishThe purpose of this study was to estimate the natural mortality of embryonic and larval stages of European pilchard Sardina pilchardus along the Atlantic Coast of Northwest Africa between Cape Barbas (22°30'N) and Cape Bojador (26°N) during November 2007. Using planktonic data that were fitted to an exponential model, sardine eggs hourly mortality rate (Z) was estimated in 0.07 (per hour) corresponding to 83.5% of daily mortality rate. On the other hand, for sardine larvae, Z was estimated in 0.01 (per hour), corresponding to a daily mortality rate of 21.4%. Southward and offshore transport can be considered as causes of variability in drifting scenario and survival condition of sardine larvae. Additional analyses of time series of the early life history data of sardines and future adaptive monitoring should be conducted to better manage sardine fisheries in Morocco.

Naoki Tojo, Shinya Abe, Mari Miyakoshi, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University ofToyama, Toyama, Japan Purpose: We investigated correlations between short-term and long-term intraocular pressure (IOP) fluctuations. Methods: We examined 50 eyes of glaucoma patients who were followed for >2years. We measured short-term IOP fluctuation using a Triggerfish® contact lens sensor (CLS). The short-term IOP fluctuation (mVeq) was defined as the difference between the maximum value and the minimum value measured during the 24-hour course with CLS. The long-term IOP fluctuation was defined by four parameters: 1) the mean IOP (mmHg) determined during follow-up; 2)the IOP difference, which was defined as the difference between the maximum IOP and the minimum IOP; 3) the standard deviation of IOP; and 4) the peak IOP, which was defined as the maximum IOP. Correlations between these parameters and the short-term IOP fluctuation were examined. Results: The mean follow-up period was 5.4years. The average IOP was 15.0±4.0mmHg. The range of short-term IOP fluctuation identified with CLS was significantly correlated with all the four long-term IOP fluctuation parameters. Conclusion: Short-term IOP fluctuations were found to be associated with long-term IOP fluctuations. Examination of 24-hour IOP fluctuations with the CLS might be useful for predicting the long-term IOP fluctuation. Keywords: intraocular pressure, contact lens sensor, Triggerfish®, fluctuation

Purpose: Cataract surgeries have been shown to reduce intraocular pressure. We used a Sensimed Triggerfish® contact lens sensor to compare intraocular pressure levels and their fluctuation between before and after cataract surgeries in patients with normal-tension glaucoma. Methods: This was a prospective open-label study. Thirteen patients with normal-tension glaucoma were included. All patients underwent a 1-month washout and discontinued glaucoma medications during this study. In each eye, intraocular pressure fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the cataract surgery. We compared intraocular pressure levels and their fluctuation between before and after cataract surgeries. We used two approaches to evaluate the amplitude of intraocular pressure fluctuations: dual-harmonic regression analysis, and measurement of the difference between the maximum and the minimum value. Results: The mean pre-operative intraocular pressure was 14.7 ± 2.2 mm Hg and mean post-operative intraocular pressure was 11.4 ± 2.2 mm Hg. Cataract surgery significantly decreased intraocular pressure (p = 0.0005). In both methods, the post-operative fluctuations in intraocular pressure over 24 h were significantly smaller than their pre-operative counterparts (dual-harmonic regression analysis: p = 0.0171; difference between the maximum and the minimum: p = 0.0398). Conclusion: Cataract surgery decreased both intraocular pressure values and intraocular pressure fluctuations in normal-tension glaucoma patients.

The aim of this study was to investigate the factors influencing the volume of the filtration bleb after Ex-PRESSThis was a retrospective non-randomized study. After excluding patients who had undergone an additional glaucoma surgery, 99 glaucoma patients who underwent Ex-PRESSEx-PRESSAdvanced age, higher postoperative IOP, pseudo-exfoliation glaucoma, and simultaneous cataract surgeries were all found to decrease the volume of the filtration bleb.

Purpose: To evaluate the efficacy and safety of the Baerveldt® glaucoma implant (BGI) for eyes with neovascular glaucoma (NVG). Methods: This was a retrospective study. Thirty-five eyes (31 patients) diagnosed with refractory NVG at Toyama University Hospital were enrolled from January 2012 to December 2015. All patients underwent BGI and were followed up for more than 6 months. Results: The mean age of patients was 62.7±13.9 years old. The mean postoperative follow-up periods was 22.0±12.7 months. The mean preoperative IOP was 35.5±9.6 mmHg and the mean postoperative IOP at 6, 12, 24, 36, 48 month were 12.7±5.9, 12.8±3.7, 12.2±3.3, 13.1±3.3, 15.0±1.4 mmHg respectively. Postoperative visual acuity was not significantly improved. Complications were Hoffmann Elbow erosion in 2 patients who needed additional surgery. The success rate at one year was 82.7%. Postoperative intervention was not required. Conclusion: BGI surgery should be considered a useful treatment to lower the IOP for NVG.

Purpose To report a case of corneal decompensation due to the Ex-PRESS(®) mini glaucoma shunt device (Ex-PRESS). Patient and methods A 75-year-old man had pseudoexfoliation glaucoma in his right eye. He underwent filtration surgery with Ex-PRESS. His intraocular pressure was 7 mmHg after 9 months. Results We observed partial decompensation of the corneal endothelium adjacent to the filtering bleb. Specular microscopy revealed a marked decrease in the endothelial cell density at the center of the cornea. Conclusion Anterior segment optical coherence tomography is very useful for evaluating corneal edema and the position of Ex-PRESS. It is important to follow up with an examination of the corneal endothelial cells.

Naoki Tojo, Shinya Abe, Mari Miyakoshi, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan Purpose: Ab interno trabeculectomy (AIT) with the Trabectome has been shown to reduce intraocular pressure (IOP) in eyes with pseudoexfoliation (PEX) glaucoma. Here, we examined the change of IOP fluctuations before and after only AIT or AIT with cataract surgery in PEX patients using the contact lens sensor Triggerfish®.Methods: This was a prospective open-label study. Twenty-four consecutive patients with PEX glaucoma were included. Twelve patients underwent cataract surgery and AIT (triple-surgery group), and 12 patients underwent only AIT (single-surgery group). In each eye, IOP fluctuations over 24 h were measured with the contact lens sensor before and at 3 months after the surgery. We compared the change of IOP fluctuation before and after operation. We also evaluated the difference in IOP changes between the triple- and single-surgery groups.Results: At 3 months after the surgeries, the mean IOP was significantly reduced from 23.5±6.5 mmHg to 14.6±2.8 mmHg in the single-surgery group and from 22.5±3.0 mmHg to 11.5±2.9 mmHg in the triple-surgery group. The mean IOP reduction rate was significantly higher in the triple-surgery group compared to the single-surgery group (p=0.0358). In both groups, the mean range of IOP fluctuations was significantly decreased during nocturnal periods. The mean range of 24 h IOP fluctuations was decreased in the triple-surgery group (p=0.00425), not in the single-surgery group (p=0.970).Conclusion: Triple surgery could decrease IOP value and the IOP fluctuations to a greater extent than single surgery in PEX glaucoma patients. Keywords: pseudoexfoliation, ab interno trabeculectomy, contact lens sensor, fluctuation, intraocular pressure

To compare the efficacy and safety of the Baerveldt® glaucoma implant (BGI) between a preserved donor scleral patch alone and double scleral flaps, comprising a preserved donor scleral patch and an autologous scleral pedicle flap. This was an open-label retrospective study. We analyzed the cases of 52 consecutive patients (56 eyes) who underwent BGI surgery with the Hoffman elbow (#BG 102–350, Abbott) and were followed up for >1 year. Twenty-one eyes underwent BGI surgery with a preserved donor scleral patch alone (donor-patch group), and the other 35 eyes underwent BGI surgery with a preserved donor scleral patch and an autologous scleral pedicle flap (double-flap group). The main outcome was the incidence of Hoffman elbow exposure associated with each surgical approach. Three patients in the donor-patch group (14.3%) developed Hoffman elbow exposure, whereas in the double-flap group, no cases had Hoffman elbow exposure (p = 0.048). The use of the double scleral flaps technique was more efficient in preventing Hoffman elbow exposure.

The subarctic–subtropical transition area of the western North Pacific is an important summer feeding grounds of sei whales. The oceanographic structure and circulation of this area are largely determined by strong oceanic fronts and associated geostrophic currents, namely the Polar Front (PF), Subarctic Front (SAF) and Kuroshio Extension Front (KEF). The relationship between the distribution of sei whales and oceanographic fronts was investigated using a generalized additive model (GAM), and the cetacean sighting survey data and oceanographic observations in July from 2000 to 2007 were used in the analysis. The number of individual sei whales was used as the response variable while the distances from the PF, SAF, and KEF to the whales were used as explanatory variables along with the longitude values. Sei whales were concentrated north and south of the SAF and the areas from 250 to 300 km north and from 100 to 200 km south of the SAF were estimated as high-density areas of sei whales. The entire inter-frontal zone between the PF and SAF featured an elevated concentration of sei whales, and the area south of the PF and along the SAF was identified as an important feeding ground of sei whales in July from 2000 to 2007.

Cataract surgery has been shown to reduce intraocular pressure (IOP) in eyes with primary angle closure glaucoma (PACG). In this study, we examined IOP fluctuations and circadian IOP patterns before and after cataract surgery in PACG patients using the contact lens sensor (CLS) Triggerfish.This was a prospective open-label study. Ten consecutive patients with PACG were included. The patients underwent phacoemulsification and intraocular lens implantation (PEA+IOL) surgery. In each eye, IOP fluctuations over 24 h were measured with the CLS before and at three months after the surgery. Changes in corneal curvatures and anatomic parameters of the anterior chamber were measured by anterior segment optical coherence tomography (AS-OCT).The mean IOP was significantly reduced from 14.7 ± 1.5 mmHg to 11.2 ± 2.2 mmHg at three months after the surgery in PACG patients (P = 0.002). Although the mean range of 24-h IOP fluctuations was not significantly changed after the surgery (P = 0.49), the mean range of IOP fluctuations during the nocturnal period was significantly decreased from 246 ± 61 mVeq to 179 ± 64 mVeq after the surgery (P = 0.02). After the surgery, seven eyes of the ten (70%) showed the same circadian IOP patterns. AS-OCT showed significant improvements in the anatomic parameters of the anterior chamber after the surgery.Cataract surgery decreased IOP fluctuations during the nocturnal period in PACG patients. These effects might partly prevent the progression of PACG.

In the Shiretoko Peninsula, a World Natural Heritage site, the sustainable management of kelp forests has drawn public attention because of the economic and ecological importance of kelp. We spatially estimated the distributions of kelp forests in the Shiretoko Peninsula before and after harvest. Field surveys were conducted in coastal waters (23.74 km(2)) at the ends of July and August 2008, immediately before and after harvest. Data on the presence or absence and thickness of the kelp forests were collected via acoustic observation. The data were interpolated using geostatistical methods. Before harvest, the kelp forests were continuously distributed over 5.64 km(2) (thickness 33-132 cm), especially near the north part of the study area. After harvest, they were sparsely distributed over 2.73 km(2) (thickness 35-105 cm). In the southern part of the study area, the influence of harvests was observed as declines in forest area. In addition, relatively thickly forested areas formed the majority of the part most likely to be harvested. Selective harvesting for area and size was confirmed though quantitative mapping of kelp forests. The quantitative mapping of both the distribution and harvest of kelp forests was successful.

Purpose The aim of this study was to examine the effects of selective laser trabeculoplasty (SLT) treatment on habitual intraocular pressure (IOP) fluctuations in patients with normal-tension glaucoma (NTG) using a SENSIMED Triggerfish contact lens sensor (CLS). Materials and methods Ten patients diagnosed with NTG were enrolled in this study. All patients underwent SLT treatment. Habitual 24-hour IOP fluctuations were recorded before and after SLT. The IOP fluctuations were divided into diurnal periods and nocturnal periods and compared before and after SLT. Changes in corneal thickness and curvature were measured before and after the CLS use with anterior segment optical coherence tomography. Results The mean IOP was 13.5±2.5 mm Hg before SLT. The mean IOP at 1, 2, and 3 months after SLT was significantly decreased to 10.1±2.3 mm Hg (P=0.002), 11.2±2.7 mm Hg (P=0.0059), and 11.3±2.4 mm Hg (P=0.018), respectively. The range of IOP fluctuations over 24 hours was not significantly changed between before and after SLT treatment (P=0.77). Although the range of IOP fluctuations during the diurnal periods was not significantly changed between before and after SLT treatment (P=0.92), the range of IOP fluctuations during the nocturnal periods significantly decreased from 290±86 mVEq before SLT to 199±31 mVEq after SLT treatment (P=0.014). With respect to corneal changes, the steeper meridian decreased significantly after the CLS use (P=0.016), although other parameters showed no significant difference between before and after the CLS use. Conclusions SLT treatment was shown to significantly lower IOP and decrease IOP fluctuations during the nocturnal periods in NTG patients. These effects might be important to prevent the progression of NTG.

Purpose To investigate changes in cone photoreceptors with adaptive optics (AO) fundus imaging and spectral domain optical coherence tomography (SD-OCT) in a case of occult macular dystrophy (OMD). Patient and methods Both eyes of a 42-year-old woman diagnosed with OMD were examined. We used an AO fundus camera to obtain images of cone photoreceptors in the macula of the OMD subject and five healthy control subjects. Correlations between the AO images and the SD-OCT images were examined. Cone photoreceptors in eight areas in the macula of OMD and healthy control subjects were analyzed and compared. Results SD-OCT showed a loss of the cone outer-segment tips line outside of the fovea in both eyes of the subject with OMD. The left eye with decreased visual acuity showed a discontinuous photoreceptor inner-segment and outer-segment line and cone outer-segment tips line at the fovea in SD-OCT and loss of cone mosaics as a dark spot in the AO image. In panoramic AO images and cone-density maps, less cone density was observed in a ring-like region outside the fovea than in the peripheral retina. In most of the areas examined, the cone densities were lower in the OMD eyes than in the healthy control eyes. Conclusions Cone densities in the macula of the OMD patient were greatly decreased. AO images were found to be useful to evaluate morphologic changes in cone photoreceptors in patients with OMD.