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Kandarakis SA, Filippopoulos T, Doumazos L, Petrou P, Georgalas I. Letter to the Editor: Comparison of Repeat Trabeculectomy Versus Ahmed Valve Implantation After Initial Failed Trabeculectomy Surgery. J Glaucoma 2024; 33:e19-e20. [PMID: 37851982 DOI: 10.1097/ijg.0000000000002316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Affiliation(s)
- Stylianos A Kandarakis
- First Department of Ophthalmology G. Gennimatas Hospital National and Kapodistrian University of Athens
| | | | - Leonidas Doumazos
- First Department of Ophthalmology G. Gennimatas Hospital National and Kapodistrian University of Athens
| | - Petros Petrou
- First Department of Ophthalmology G. Gennimatas Hospital National and Kapodistrian University of Athens
| | - Ilias Georgalas
- First Department of Ophthalmology G. Gennimatas Hospital National and Kapodistrian University of Athens
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Kandarakis SA, Doumazos L, Timpilis M, Karageorgiou G, Petrou P, Georgalas I. Limbal reconstruction in uveitic glaucoma patient with exposed Ahmed valve coincident with corneal melting and iris prolapse using multiple corneoscleral allografts. Rom J Ophthalmol 2024; 68:60-64. [PMID: 38617728 PMCID: PMC11007568 DOI: 10.22336/rjo.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2024] [Indexed: 04/16/2024] Open
Abstract
Aim: To present a complex case of Ahmed tube exposure 6 months after the implantation associated with corneal melting and iris prolapse, and the surgical reposition that required multiple allografts and limbal reconstruction. Methods: A 60-year-old patient arrived at the emergency room with tube exposure combined with corneal melting and iris prolapse from a previously placed Ahmed valve 6 months prior. Our approach was to use one corneoscleral graft to repair the melted cornea and avoid further iris prolapse and a second scleral graft to cover the repositioned tube. Upon completion of conjunctival dissection, cleaning and deepithelization of the melted cornea and the tube by application of alcohol 100% followed. A new entry point was made for the tube and was covered using an alcohol-preserved scleral allograft and the previous entry point was repaired using a corneoscleral allograft with the corneal aspect restoring the limbus and avoiding further iris protrusion. Results: 6 months follow-up of the patient showed excellent recovery, anatomical restoration, and IOP normalization. Conclusion: Surgical repair of these cases can be very demanding, and requires surgical improvisation and prolonged surgical time. The literature remains very limited on how a surgeon should approach similar cases, which are the crucial tips, and which are the missteps that should be avoided. In this case, we used multiple scleral/corneoscleral allografts in a specific orientation and different sutures to reconstruct the damaged limbal area and restore the anatomy. Abbreviations: VA = Visual Acuity, GDD = Glaucoma Drainage Device, IOP = Intra Ocular Pressure.
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Affiliation(s)
- Stylianos Artemios Kandarakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Leonidas Doumazos
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Marios Timpilis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Georgia Karageorgiou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Petros Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Ilias Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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Kandarakis SA, Petrou P, Doumazos S, Chronopoulou K, Doumazos L, Halkiadakis I, Georgalas I. Combining Perfluorobutylpentane (F 4H 5) with Glaucoma Drainage Device Implantation for Silicone Oil-Induced Glaucoma: A Pilot Study. Turk J Ophthalmol 2023; 53:281-288. [PMID: 37867479 PMCID: PMC10599334 DOI: 10.4274/tjo.galenos.2023.95825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/14/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device (GDD) placement in patients with silicone oil (SO)-induced glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the SO and the safety of the procedure. Materials and Methods Eight patients who previously underwent pars plana vitrectomy with SO tamponade due to retinal detachment were selected. Removal of SO was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of SO remnants in the anterior chamber (AC) and angle. Removal of the remaining SO with F4H5 washout was performed in all cases with concomitant insertion of a GDD to treat the refractory glaucoma. Intraocular pressure (IOP), SO remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure. Results All patients had uneventful surgery with no major complications 12 months postoperatively. A marked reduction of SO remnants in the AC and angle was observed in all cases after surgery. There was a 60.9% decrease in mean IOP 12 months postoperatively (p<0.05) and the need for glaucoma medication was lower in all patients (mean topical medicines: 4 preoperatively vs. 0.75±0.89 postoperatively; p<0.05). Endothelial cell density showed no significant change (mean 2012±129 cells/mm2 preoperatively vs. 1985±134 cells/mm2 postoperatively; p>0.05), and there were no signs of corneal edema. Conclusion F4H5 is an effective emulsifier for removing SO remnants and may be safely used in conjunction with GDD placement in order to control IOP in eyes with silicone oil-induced glaucoma.
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Affiliation(s)
- Stylianos A. Kandarakis
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
| | - Petros Petrou
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
| | - Spyridon Doumazos
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
| | - Konstantina Chronopoulou
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
| | - Leonidas Doumazos
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
| | | | - Ilias Georgalas
- National and Kapodistrian University of Athens, G. Gennimatasgeneral Hospital, 1st Department of Ophthalmology, Athens, Greece
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Kandarakis S, Papadopoulos AP, Roussopoulos G, Georgopoulos E, Chung Y, Doumazos L, Baek A, Paizi NI, Shin H, Papadopoulos PA. COMfort Eye Trial (COMET) results - a non-inferiority, randomized, investigator-masked, two-parallel group, phase III clinical trial, to evaluate the efficacy and safety of a preservative free formulation of latanoprost versus a reference drug (Xalatan®) in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Expert Opin Drug Saf 2023:1-12. [PMID: 37674345 DOI: 10.1080/14740338.2023.2252341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
AIM To prove non-inferiority of preservative-free (PF) latanoprost versus benzalkonium chloride (BAK) containing latanoprost in lowering intraocular pressure (IOP) in primary open-angle glaucoma (POAG) or ocular hypertension (OHT) patients. DESIGN AND METHODS This phase III, randomized, investigator-masked trial primarily aimed to demonstrate non-inferiority of YSLT PF latanoprost 50 μg/ml (Yonsung GmbH) to latanoprost (Xalatan®) 50 μg/ml (Pfizer) in reducing IOP from Baseline to Week 12. Secondary aims included conjunctival hyperemia evaluation and difference in ocular comfort levels. Total 130 patients with POAG or OHT were enrolled and randomized (1:1 ratio) to receive YSLT or latanoprost, instilling eye drops daily for 12 weeks. RESULTS At Week 12, mean diurnal IOP reduction was -7.67 ± 2.104 mmHg for YSLT PF latanoprost and -7.77 ± 2.500 for latanoprost. The 97.5% confidence interval of between-treatment group difference in IOP reduction from Baseline to Week 12 was [-0.846, +∞), not crossing the non-inferiority margin of -1.5 mmHg. A low incidence of mild topical treatment emergent adverse events (TEAEs) was observed in both groups, while no serious TEAEs were reported. CONCLUSIONS YSLT eye drops demonstrated non-inferiority to latanoprost in reducing IOP. Both products were well tolerated without serious TEAEs reported.
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Affiliation(s)
- Stylianos Kandarakis
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Youngsik Chung
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
| | - Leonidas Doumazos
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Areum Baek
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
| | | | - Hyunik Shin
- R&D center, Yonsung Fine Chemicals Co., Ltd. / YS Life Science Co., Ltd, Suwon-si, South Korea
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Doumazos S, Kandarakis SA, Petrou P, Karagiannis D, Doumazos L, Georgalas I. Posterior Scleritis in a Patient with Psoriasis Masquerading as Acute Angle Closure Glaucoma. Case Rep Ophthalmol 2022; 13:717-723. [PMID: 36845449 PMCID: PMC9944587 DOI: 10.1159/000526714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Posterior scleritis is a relatively uncommon form of scleral inflammation of the posterior segment of the eye. Clinical manifestations include ocular pain, headache, pain with ocular movements, and loss of vision. A rare presentation of the disease is acute angle closure crisis (AACC) with elevated intraocular pressure (IOP) secondary to anterior displacement of the ciliary body. Various systemic diseases have been described to co-exist with posterior scleritis; however, psoriasis has not been associated with posterior scleritis. Here, we present a case of posterior scleritis which initially presented as AACC in a patient with pre-existing psoriasis. A 50-year-old male with a history of psoriasis under treatment presented to the emergency department with intense sudden ocular pain and loss of vision on the left eye as well as headache and nausea. A thorough medical and ocular history was taken, and a detailed examination of the anterior and posterior segment was completed including visual acuity and IOP. Initial diagnosis of AACC was made, and appropriate actions were taken with partial resolution of his symptoms. However, upon further work-up including ultrasound (B-scan) of the left eye a final diagnosis of posterior scleritis was made. The patient was treated with steroids and nonsteroidal anti-inflammatory drugs which dramatically improved his condition. Photographic evidence of initial presentation and post-treatment condition was obtained and presented in this report. Posterior scleritis is a potentially vision-threatening condition which is usually challenging to diagnose. In this report, we highlight the challenges one might come into when dealing with different manifestations of the same disease, increasing awareness. This case of posterior scleritis presenting as AACC in a patient with a history of psoriasis enhances what we already know from the literature as well as provides some new insights in the clinical manifestations of posterior scleritis in the setting of psoriasis without arthritis.
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Affiliation(s)
- Spyridon Doumazos
- aFirst Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos A. Kandarakis
- aFirst Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece,*Stylianos A. Kandarakis,
| | - Petros Petrou
- aFirst Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karagiannis
- bSecond Ophthalmology Department, Ophthalmiatreio Eye Hospital of Athens, Athens, Greece
| | - Leonidas Doumazos
- aFirst Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Georgalas
- aFirst Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Doumazos L, Kandarakis SA, Georgalas I. Unexpected Iris Mass Discovery Revealed after Pupil Dilation. Ophthalmol Glaucoma 2022; 5:136. [PMID: 35337651 DOI: 10.1016/j.ogla.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 10/18/2022]
Affiliation(s)
- Leonidas Doumazos
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos A Kandarakis
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Georgalas
- First Department of Ophthalmology, G. Gennimatas Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kandarakis S, Kontaxakis A, Doumazos L, Petrou P, Droutsas K, Papaconstantinou D, Georgalas I. Assessing safety and success after using bevacizumab, 5-fluorouracil or placebo in primary trabeculectomy. A Prospective Randomized placebo controlled 1-Year Follow-up Study. Cutan Ocul Toxicol 2021; 41:25-32. [PMID: 34749555 DOI: 10.1080/15569527.2021.2003376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to determine whether glaucoma patients after trabeculectomy could benefit more from subconjunctival injections of bevacizumab than 5-FU or placebo. METHODS AND RESULTS Fifty-one eyes of 51 patients were recruited for primary MMC (0.2mg/ml for 1 min) augmented trabeculectomy. 17 patients were randomly assigned to receive 1.25mg (0.05ml) of bevacizumab augmentation, 21 patients were assigned to receive 0.1ml of 50mg/ml 5-FU and 13 patients were assigned to a control group receiving a normal saline injection as a placebo. Initial recruitment included 58 patients, but seven patients had to be excluded from the study for various reasons. Postoperative follow up of IOP and bleb characteristics was carried out at 1 day, 1 week, 3 weeks, 6 weeks, 6 months and 1 year after surgery. All analyses where carried out by two masked clinicians. IOP reduction was statistically significant (P < 0.05) across all three groups between baseline visit and final 1-year postoperative visit. There was no significant difference of the final average IOP values between the three groups. Bleb evaluation was made using the Moorfields bleb grading system (MBGS) after 1 year follow up. Central bleb area was statistically greater in the Bevacizumab group when compared with the 5-FU group but not with the placebo group. The vascularity of the central bleb was significantly different between the groups with the Bevacizumab group showing the least vascularity. Vascularity of the peripheral bleb was also decreased in the Bevacizumab group when compared with the placebo group but not with the 5-FU group. CONCLUSION The 12-month IOP results showed no significant differences between the groups of patients after Bevacizumab, 5-FU or placebo to augment primary MMC enhanced trabeculectomy. However, by the analysis of bleb morphology there was a significant difference in terms of central bleb area and vascularity.
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Affiliation(s)
- Stylianos Kandarakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Anastasios Kontaxakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Leonidas Doumazos
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Petros Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Konstantinos Droutsas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Demetrios Papaconstantinou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Ilias Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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