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1.  RESEARCH ARTICLE
A New Provocative Test for Glaucoma
Fabio N Kanadani, TCA Moreira, LF Campos, MP Vianello, J Corradi, SK Dorairaj, ALA Freitas, R Ritch
[Year:2016] [Month:January-April] [Volume:10 ] [Number:1] [Pages:37] [Pages No:1-3] [No of Hits : 850]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1194 | FREE

ABSTRACT

Purpose: To compare the effects of the water-drinking test (WDT) with the 30° inverted body position test on intraocular pressure (IOP) in normal patients, suspected glaucoma patients and glaucoma patients.

Materials and methods: Based on clinical evaluation of the optic disk, IOP, and standard achromatic perimetry (SAP) of 71 eyes, 18 were “normal” (normal SAP and optic disk evaluation, and IOP < 21 mm Hg), 30 were “glaucoma suspect” (GS; normal SAP, cup/disk (C/D) ratio > 0.5 or asymmetry > 0.2 and/or ocular hypertension), and 31 had “early glaucoma” (MD < -6 dB, glaucomatous optic neuropathy). Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Patients fasted before the WDT, and four measurements were performed at basal, 15´, 30, and 45´ after drinking 1 liter of water (WDT) in 5 minutes. In the 30° inverted position, IOP measurement with Perkins applanation tonometer was taken after 5 minutes lying down.

Results: There was a statistical difference in all groups between the basal IOP and peak IOP during the WDT (p < 0.001) and in the inverted position IOP (p < 0.001). Controls (p = 0.50), suspects (p = 0.41) and glaucoma patients (p = 1.0) did not exhibit a difference between WDT-IOP and inverted position IOP.

Conclusion: The 30° inverted position test was as efficient as WDT in detecting peak IOP. This new provocative test is easier, faster and more comfortable for both patients and doctors.

Keywords: Glaucoma, Provocative test, Water drinking test.

How to cite this article: Kanadani FN, Moreira TCA, Campos LF, Vianello MP, Corradi J, Dorairaj SK, Freitas ALA, Ritch R. A New Provocative Test for Glaucoma. J Curr Glaucoma Pract 2016;10(1): 1-3.

Source of support: Nil

Conflict of interest: None

 
2.  EDITORIAL
The Business of Glaucoma Surgery and the Era of Mega-interest
Tarek Shaarawy
[Year:2016] [Month:May-August] [Volume:10 ] [Number:2] [Pages:40] [Pages No:iv] [No of Hits : 785]
Full Text PDF | Abstract | FREE

ABSTRACT

The Business of Glaucoma Surgery and the Era of Mega-interest

For decades, glaucoma therapy innovations have been a strategic goal for many pharmaceutical industry giants. A chronic disease that spans a lifetime, with most patients destined to eye drops applied on a daily basis, glaucoma was and still is a disease from which profits can be made. Glaucoma surgery, on the contrary, was but a small part of this immense business, estimated to be in the range of 5% of the whole glaucoma diagnosis and treatment market. To this day, trabeculectomy remains the gold standard procedure for surgical management of glaucoma. A procedure that requires only a few instruments, wherein one corner of a shaving blade mounted on a razor fragment holder can still be the only knife needed.

 
3.  CASE REPORT
New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case
Tamara L Berezina, Robert D Fechtner, Amir Cohen, Eliott E Kim, David S Chu
[Year:2015] [Month:May-August] [Volume:9 ] [Number:2] [Pages:31] [Pages No:62-64] [No of Hits : 1412]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1185 | FREE

ABSTRACT

We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency.

Keywords: Conjunctiva deficiency, Corneal patch graft, Glaucoma drainage device, Keratoglobus, Wound healing.

How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64.

Source of support: Nil

Conflict of interest: None

 
4.  REVIEW ARTICLE
Biodegradable Collagen Implants in Trabeculectomy
Parul Ichhpujani, Tanuj Dada, Shibal Bhartiya
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:24-27] [No of Hits : 1208]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1179 | FREE

ABSTRACT

Subconjunctival and subscleral fibrosis are the major causes of failure of filtering surgery. Antiproliferative agents have been successfully used to improve the long-term success of this surgery. Recent advancement in the field of glaucoma surgery has been the use of bioengineered, biodegradable, porous collagen-glycosaminoglycan matrix implant in the subconjunctival and/or subscleral space to modify the woundhealing process and reduce scar formation, hence improving the surgical success without the need for anti-fibrotic agents.
Biodegradable, collagen implants have shown favorable results when used with deep sclerectomy. There have been variable results regarding the success of trabeculectomy when combined with these implants. These implants also decrease the dose of mitomycin C required with trabeculectomy and hence, decrease the side effect associated with these drugs.
The use of the biodegradable implants in glaucoma surgery is still evolving and further studies are needed to find the appropriate surgical technique, the ideal size and site of placement and determine their long-term impact on trabeculectomy outcomes and complications.

Keywords: Collagen implants, Subconjunctival fibrosis, Trabeculectomy.

How to cite this article: Ichhpujani P, Dada T, Bhartiya S. Biodegradable Collagen Implants in Trabeculectomy. J Curr Glaucoma Pract 2015;9(1):24-27.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Does Chronic Hypotony following Trabeculectomy Represent Treatment Failure?
Steven Yun, Brian Chua, Colin I Clement
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:12-15] [No of Hits : 1006]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1176 | FREE

ABSTRACT

Purpose: To measure the rate of complications from chronic hypotony following trabeculectomy and clarify the definition of postoperative hypotony.

Materials and methods: In this retrospective case-control study, the rate of complications was compared between 34 eyes with chronic hypotony and 34 eyes without hypotony. Chronic hypotony was defined as those eyes with an intraocular pressure (IOP) of less than 6 mm Hg on two consecutive clinic visits at least 3 months after trabeculectomy. Cases were identified from a database of two glaucoma surgeons between 2010 and 2013. Outcomes measured included visual acuity, presence of choroidal effusion, hypotensive maculopathy and cataract development/progression. Factors associated with the development of hypotony were considered using analysis of variance (ANOVA) multivariate regression.

Results: Maculopathy was seen in 23.5% of hypotony eyes but not in controls (p < 0.01). No significant difference in the rate of choroidal effusion or cataract was documented between groups. Control eyes were more likely to remain complication free (58.8 vs 32.4%, p < 0.03). Spontaneous recovery from hypotony occurred in 32.4% of hypotony eyes.

Conclusion: Sight threatening complications occur more frequently in eyes with chronic hypotony following glaucoma surgery. However, not all eyes with chronic hypotony develop sight threatening complications. A definition of hypotony that combines IOP criteria with the presence of structural and/or functional changes is recommended.

Keywords: Intraocular pressure, Glaucoma, Filtration surgery, Choroidal effusion, Hypotensive maculopathy, Cataract.

How to cite this article: Yun S, Chua B, I Clement C. Does Chronic Hypotony following Trabeculectomy Represent Treatment Failure? J Curr Glaucoma Pract 2015;9(1):12-15.

Source of support: Nil

Conflict of interest: None

 
6.  REVIEW ARTICLE
Surgery on the Trabecular Meshwork: Histopathological Evidence
Shibal Bhartiya, Parul Ichhpujani, Tarek Shaarawy
[Year:2015] [Month:May-August] [Volume:9 ] [Number:2] [Pages:31] [Pages No:51-61] [No of Hits : 755]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1184 | FREE

ABSTRACT

Juxtacanalicular (JXT) trabecular meshwork and endothelial lining of Schlemm’s canal have been cited as the loci of aqueous outflow resistance, both in a normal as well as a glaucomatous eye. In this review, we attempt to understand the currently available surgical modalities in light of the available histopathological evidence, regarding localization of outflow resistance.

Keywords: Aqueous outflow and resistance, Histopathological basis of glaucoma surgery, Outflow facility, Trabecular meshwork.

How to cite this article: Bhartiya S, Ichhpujani P, Shaarawy T. Surgery on the Trabecular Meshwork: Histopathological Evidence. J Curr Glaucoma Pract 2015;9(2):51-61.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients
Fabio N Kanadani, Carlos R Figueiredo, Rafaela Morais Miranda, Patricia LT Cunha, Tereza Cristina M Kanadani, Syril Dorairaj
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:16-19] [No of Hits : 712]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1177 | FREE

ABSTRACT

Purpose: Glaucomatous neuropathy can be a consequence of insufficient blood supply, increase in intraocular pressure (IOP), or other risk factors that diminish the ocular blood flow. To determine the ocular perfusion pressure (OPP) in normal and systemic hypertensive patients.

Materials and methods: One hundred and twenty-one patients were enrolled in this prospective and comparative study and underwent a complete ophthalmologic examination including slit lamp examination, Goldmann applanation tonometry, stereoscopic fundus examination, and pulsatile ocular blood flow (POBF) measurements. The OPP was calculated as being the medium systemic arterial pressure (MAP) less the IOP. Only right eye values were considered for calculations using Student’s t-test.

Results: The mean age of the patients was 57.5 years (36-78), and 68.5% were women. There was a statistically significant difference in the OPP of the normal and systemic hypertensive patients (p < 0.05). The difference in the OPP between these groups varied between 8.84 and 17.9 mm Hg.

Conclusion: The results of this study suggest that although the systemic hypertensive patients have a higher OPP in comparison to normal patients, this increase does not mean that they also have a higher OBF (as measured by POBF tonograph). This may be caused by chronic changes in the vascular network and in the blood hemodynamics in patients with systemic hypertension.

Keywords: Ocular perfusion pressure, Pulsatile ocular blood flow, Glaucoma.

How to cite this article: Kanadani FN, Figueiredo CR, Miranda RM, Cunha PLT, Kanadani TCM, Dorairaj S. Ocular Perfusion Pressure and Pulsatile Ocular Blood Flow in Normal and Systemic Hypertensive Patients. J Curr Glaucoma Pract 2015;9(1):16-19.

Source of support: Nil

Conflict of interest: None

 
8.  CASE SERIES
Surgical Management of Iatrogenic Pigment Dispersion Glaucoma
Camille Van Mierlo, Luis Abegão Pinto, Ingeborg Stalmans
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:28-32] [No of Hits : 700]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1180 | FREE

ABSTRACT

Introduction: Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear.

Methods: Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion.

Results: Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcusbased single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention.

Conclusion: IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met.

Keywords: Pigment dispersion glaucoma, Iris chafing, IOLexchange.

How to cite this article: Van Mierlo C, Abegão Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32.

Source of support: Nil

Conflict of interest: None

 
9.  ORIGINAL ARTICLE
How ‘Drug Aware’ are our Glaucoma Patients?
Chirayu Mohindroo, Parul Ichhpujani, Suresh Kumar
[Year:2015] [Month:May-August] [Volume:9 ] [Number:2] [Pages:31] [Pages No:33-37] [No of Hits : 607]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1181 | FREE

ABSTRACT

Background: Poor knowledge, attitude and self-care practices (KAP) as regards medication compliance is a major concern in the management of glaucoma. This study aims to evaluate the knowledge, attitude regarding eyedrop instillation and selfcare practices pertaining to eyedrops in diagnosed glaucoma patients.

Methods: In this cross-sectional, open-ended questionnairebased study, 101 consecutive glaucoma patients on medication were recruited from an urban tertiary care hospital of North India. A self-designed 10-point KAP questionnaire that addressed patient-, medication-, environment- and physicians related factors was used.
For each desirable answer, the participant gives a score of 1 was given and for each undesirable answer a score of ‘0’ was given for each question. The total scores for each domain were calculated separately along with the total score. The association between the individual domain scores, the total score and various sociodemographic parameters were compared using unpaired t-test. Analysis of variance (ANOVA) test was used to compare the means, where the exposure variable had more than two categories.

Results: Out of 101 participants, 98% knew the reason why they were instilling the medicine. Only 61.4% subjects knew that the eyedrops should be stored in cool and dry place. Nearly 30% participants believed that two eyedrops could be instilled back to back. Half of the participants (55.4%) did not consider missing a dose of medicine to be significant. Majority (89.1%) of the participants asked the doctor about the drug dosage and timings and 71.3% of them did not use the eyedrops beyond 40 days after opening the vial. 37.6% participants believed that the medicine could be discontinued without asking the doctor, once the symptoms are relieved. Eighty percent patients checked the vial for correct drug name and expiry date before buying. 57.4% of the participants washed their hands before instilling the eyedrops. Only 23.8% patients asked their doctor for alternate medication name, in case they do not get the primary medication.
There were no statistically significant differences in the mean domain and total scores between males and females and between urban and rural patients.
There were no statistically significant differences in knowledge (p = 0.059) and attitude (p = 0.809) scores in people with different educational qualification. But education had a statistically significant relation with the practice scores (p = 0.004) and total scores (p = 0.047).

Conclusion(s): There exists marked variation in the reported practices, even in the very basic prerequisites of instilling eyedrops like washing of hands, checking the expiry date before the usage of eyedrops.
The findings in our study suggest a need to better educate our patients by providing them detailed information about eyedrop and its administration. This would help to reduce patients’ frustration, improve compliance and increase the efficacy of anti-glaucoma therapy.

Keywords: Eyedrops, Glaucoma, IOP.

How to cite this article: Mohindroo C, Ichhpujani P, Kumar S. How ‘Drug Aware’ are our Glaucoma Patients? J Curr Glaucoma Pract 2015;9(2):33-37.

Source of support: Nil

Conflict of interest: None

 
10.  ORIGINAL ARTICLE
Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy
Oscar Albis-Donado, Carmen C Sánchez-Noguera, Lorena Cárdenas-Gómez, Rafael Castañeda-Diez, Ravi Thomas, Félix Gil-Carrasco
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:6-11] [No of Hits : 605]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1175 | FREE

ABSTRACT

Purpose: To evaluate the ability of phacoemulsification combined with either primary trabeculectomy (PT) or primary Ahmed glaucoma valve implantation (PAVI) to achieve target intraocular pressures (TIOP) in adults with primary open angle glaucoma.

Materials and methods: Chart review of 214 adult patients operated between January 2002 and June 2008 with a minimum follow-up of 6 months. Group 1 comprised 181 eyes of 166 patients undergoing PT while group 2 included 50 eyes of 49 patients in combination with primary AVI. Target IOPs were pre-determined for each patient and success was defined as an IOP at or lower than target with or without medications. An IOP above target, loss of light perception or need for additional procedures to lower IOP were considered a failure.

Results: Mean preoperative IOP was 17.2 mm Hg in group 1 and 17.3 in group 2. Mean postoperative IOPs were 10.2 and 9.2 on day 1, 12.2 and 11.6 at year 1, and 10.7 in both groups at year 5. Survival rates in groups 1 and 2 were 96.7 vs 96% at 6 months, 89 vs 96% at 12 months, 83.5 vs 96% at 24 months and 79.4 vs 89.1% at 36, 48 and 72 months. Transient bleb leaks were more frequent in group 1 (26 eyes, 14.4 vs 0%, p = 0.001) and transient choroidal detachments were more frequent in group 2 (7 eyes, 3.9 vs 6 eyes, 12%, p = 0.038).

Conclusion: Midterm results for achieving target pressures using combined phacoemulsification with either PT or PAVI are comparable. The profile of complications is different for the two procedures.

Keywords: Phacoemulsification, Cataract, Glaucoma, Ahmed valve, Trabeculectomy, Combined surgery, Target pressure.

How to cite this article: Albis-Donado O, Sánchez-Noguera CC, Cárdenas-Gómez L, Castañeda-Diez R, Thomas R, Gil-Carrasco F. Achieving Target Pressures with Combined Surgery: Primary Patchless Ahmed Valve Combined with Phacoemulsification vs Primary Phacotrabeculectomy. J Curr Glaucoma Pract 2015;9(1):6-11.

Source of support: Nil

Conflict of interest: None

 
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