Journal of Current Glaucoma Practice

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Volume 16, Number 1, January-April 2022

EDITORIAL

Tanuj Dada, Saurabh Verma, Anand N Bukke, Clemens A Strohmaier, Alex S Huang

Aqueous Angiography-guided Minimally Invasive Glaucoma Surgery

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:3] [Pages No:1 - 3]

   DOI: 10.5005/jp-journals-10078-1367  |  Open Access |  How to cite  | 

RETROSPECTIVE COHORT STUDY

Richard L Ford, O\'Rese J Knight, Meredith R Klifto, Alice Yang Zhang, Christopher A Wiesen, David Fleischman

A Pilot Study Assessing Treatment Outcomes in Neovascular Glaucoma Using Ahmed Glaucoma Valve with and without Cyclophotocoagulation

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:7] [Pages No:4 - 10]

Keywords: Ahmed glaucoma valve, Cyclophotocoagulation, Hypertensive phase, Intraocular pressure, Neovascular glaucoma, Retrospective pilot cohort study

   DOI: 10.5005/jp-journals-10078-1358  |  Open Access |  How to cite  | 

Abstract

Purpose: The purpose of this retrospective pilot study was to examine the short-term effect of simultaneous Ahmed Glaucoma Valve implantation and cyclophotocoagulation on postoperative outcomes in patients with neovascular glaucoma. Methods and materials: Patient charts were selected for inclusion in this study if they carried a diagnosis of neovascular glaucoma and underwent Ahmed glaucoma valve implantation only, Ahmed glaucoma valve implantation with cyclophotocoagulation, or cyclophotocoagulation only. A total of 55 eyes of 54 patients were selected for data collection and analysis. Main outcome measures included 1-, 3-, and 6-month intraocular pressure and occurrence of the hypertensive phase. Other outcomes included visual acuity, surgical complication rate, and a number of 6-month postoperative ophthalmic medications. Results: A significantly lower intraocular pressure was seen in the group that received Ahmed glaucoma valve implantation + cyclophotocoagulation compared to the Ahmed glaucoma valve-only group at 3 and 6 months (p = 0.03 and <0.001, respectively). The difference in the occurrence of the hypertensive phase between the Ahmed glaucoma valve-only group and the Ahmed glaucoma valve + cyclophotocoagulation group approached but did not reach significance (p = 0.052). A significantly lower intraocular pressure was also seen in the cyclophotocoagulation-only group compared to the Ahmed glaucoma valve-only group at 3 months (p = 0.006). Conclusion: Simultaneous Ahmed glaucoma valve implantation and cyclophotocoagulation significantly lowered intraocular pressure at 3 and 6 months compared to Ahmed glaucoma valve implantation alone in patients with neovascular glaucoma. Clinical significance: Neovascular glaucoma is difficult to manage medically and surgically. When surgery is performed, intraocular pressure often remains elevated postoperatively despite aggressive medical management. This study examines a novel method to lower intraocular pressure after Ahmed glaucoma valve implantation in patients with neovascular glaucoma.

ORIGINAL RESEARCH

Nariman Nassiri, Shibandri Das, Vaama Patel, Aravindh Nirmalan, Dhir Patwa, Alexandra Heriford, Chaesik Kim, Haoxing Chen, Faisal Ridha, Justin Tannir, Anju Goyal, Mark S Juzych, Bret A Hughes

Factors Associated with 5-year Glaucomatous Progression in Glaucoma Suspect Eyes: A Retrospective Longitudinal Study

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:11 - 16]

Keywords: Glaucomatous progression, Glaucoma suspect, Ocular hypertension, Optical coherence tomography (OCT), Retinal nerve fiber layer (RNFL), Risk factors, Visual field index, Visual field

   DOI: 10.5005/jp-journals-10078-1350  |  Open Access |  How to cite  | 

Abstract

Purpose: Using demographic, clinical, visual field, and optical coherence tomography (OCT) variables to study the association of 5-year glaucomatous progression in glaucoma suspect eyes. Patients and methods: This is a retrospective longitudinal clinical study. Inclusion criteria consisted of glaucoma suspect eyes (i.e., concerning cup-to-disk ratio and/or intraocular pressure (IOP) >21 mm Hg), age ≥ 30 years old, follow-up time of 5 years, best-corrected visual acuity (BCVA) of 20/100 or better, spherical equivalent (SE) higher than 8 diopters and an astigmatism less than 3 diopters. Eyes with glaucoma—determined by two consecutive, reliable visual field tests—were excluded, as well as any eyes with any clinically significant retinal or neurological disease. The percentage of glaucoma suspect eyes, which progressed to glaucoma within a 5-year period, was calculated. Study subjects were divided into the following groups: eyes that progressed to glaucoma and those that did not. Results: In the 288 patients which we looked at, 365 total eyes, 323 eyes had concerning cup-to-disk ratio and 42 had ocular hypertension. Bivariate analysis showed that the eyes which progressed to glaucoma had significantly worse mean deviation, increased pattern standard deviation (PSD), and less visual field index (VFI). Our bivariate analysis also showed a thinner average, superior and inferior retinal nerve fiber layer thickness (RNFL), and more severe average, superior, and inferior RNFL damages (i.e., color grading scale) at baseline. Logistic regression analysis showed that only PSD and severe inferior RNFL damage (i.e., red color) to be significantly associated with 5-year glaucomatous progression. Conclusion: Segmental RNFL damage and pattern standard deviation are associated with 5-year glaucomatous progression in glaucoma suspect eyes.

ORIGINAL RESEARCH

Rafael AG López, Nora LO Castillo

Trabeculectomy Efficacy in a Latin American Ophthalmology Training Institution

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:3] [Pages No:17 - 19]

Keywords: Glaucoma therapy, Latin America, Residents, Trabeculectomy efficacy

   DOI: 10.5005/jp-journals-10078-1366  |  Open Access |  How to cite  | 

Abstract

Aim: To report trabeculectomy efficacy in a Latin American Ophthalmology Training Institution. Materials and methods: Retrospective study between March 2015 and March 2019, Medical records of 77 patients (96 eyes) that underwent trabeculectomy were reviewed. Collected data included glaucoma type, pre- and post-trabeculectomy intraocular pressure (IOP) and glaucoma therapy and assigned surgeon. Data analysis included descriptive statistics, Paired T student double tailed, and Welch-Satterthwaite test. Results: Ninety-six eyes (77 patients) that underwent trabeculectomy were included in the analysis. 44.79% were male and 55.20% female. Median age was 54.04 ± 18.92 years. Median IOP pretrabeculectomy was 27.86 ± 10 mm Hg. More commonly found diagnoses were narrow angle glaucoma (36.46%), primary open-angle glaucoma (18.75%), and secondary to chronic steroid use glaucoma (14.58%). Median IOP reduction from basal IOP at 6 weeks, 6 months, and 12 months after trabeculectomy was 15.87 mm Hg, 14.42 mm Hg and 14.55 mm Hg, respectively, p < 0.05. Cumulative success was 66.66% at 12 months follow-up. General decrease of antiglaucomatous topical therapy was 1.9 ± 1.09 (p > 0.05) eye drops. Trabeculectomy success rate was 69.23% for attendants and 65.71% for residents (p = 0.85). Conclusion: Trabeculectomy continues to be a successful and effective therapy to obtain significant and stable IOP decrease. Success trabeculectomy rates are comparable between residents and attendants.

ORIGINAL RESEARCH

Francesco Stringa, Ruth Chen, Pavi Agrawal

One-year Outcomes Following Internal Ligation Suture Removal in 350 mm2 Baerveldt Tube Implant Surgery

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:4] [Pages No:20 - 23]

Keywords: Baerveldt implant, Glaucoma surgery, Glaucoma drainage devices

   DOI: 10.5005/jp-journals-10078-1351  |  Open Access |  How to cite  | 

Abstract

Aim: Long-term data of the postoperative management following Baerveldt tube surgery (BVT) is currently limited. This study aims to evaluate the outcome and the safety profile of internal ligation suture removal after BVT surgery for refractory glaucoma. Materials and methods: A prospective, consecutive, non-comparative case series of patients previously undergoing BVT 350 mm2 surgery with 0.4 mg/mL mitomycin C (MMC), 3/0 intraluminal suture (Supramid) insertion, and 10/0 nylon external ligation suture(s). For each patient, data was collected over 12 months after internal ligation suture removal. Follow-up assessments looked at intraocular pressure (IOP), complication rate, and postoperative number of glaucoma medications. Definition of success was adopted as per the World Glaucoma Association recommendations. Results: Twenty-four patients were included. On average, Supramid was removed at 22 ± 18.2 weeks following BVT surgery. Preoperatively, the mean IOP was 30.9 ± 12.6 mm Hg and the average antiglaucoma medications were 1.95 ± 1.13. At 12 months, the mean IOP was 15.2 ± 5.3 mm Hg and the mean number of glaucoma medications was 1.3 ± 0.2. Qualified success with IOP ≤ 21 mm Hg and IOP ≤ 15 mm Hg was achieved in 62.5% and 33.3%, respectively. Only two patients developed hypotony following Supramid removal; both resolved spontaneously within 1 month. Conclusion: Our results show a good IOP reduction and safety profile at 1 year from internal ligation suture removal following BVT. A drop in IOP of approximately 50% from the preoperative IOP can be expected.

ORIGINAL RESEARCH

Isis K Kapinga, David L Kayembe, Jean-Claude Mwanza

Vision-related Quality of Life in Congolese Patients with Glaucoma

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:7] [Pages No:24 - 30]

Keywords: Congolese, Glaucoma, NEI VFQ-25, Quality of life

   DOI: 10.5005/jp-journals-10078-1360  |  Open Access |  How to cite  | 

Abstract

Purpose: To assess the vision-related quality of life (QoL) in Congolese patients with glaucoma and its associated factors.
Methods: Ninety-four patients with open-angle glaucoma and 42 age-matched controls were included in the study. QoL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). QoL scores were compared between patients and controls. Correlation analysis was run to assess the association of QoL scores with visual function measures. Multivariate linear regression analyses were used to identify demographic and clinical factors that independently predict the overall QoL and its subdomains.
Results: The QoL composite score (QoL-CS) of glaucoma patients (60.2 ± 30.5) was 31.7% lower than that of controls (87.9 ± 9.5), p < 0.001. QoL subdomain scores were also significantly lower in glaucoma patients than controls (all p < 0.001), with a reduction rate oscillating between 16.5% for color vision and 61.1% for general health. Best-corrected visual acuity (BCVA) of both better seeing eye (BSE) and worst seeing eye (WSE) correlated significantly with QoL-CS (variance: 50.4% and 42.3%, respectively). The correlations of QoL-CS with BSE (variance: 12.9%) and WSE (variance: 16.8%) visual field MD were also significant, but the strengths were weaker than those of BCVA. Every increase of BSE's BCVA by one line improved QoL-CS by 43.4.
Conclusion: Vision-related quality of life in glaucoma patients is significantly impaired in Congolese patients with glaucoma, starting in the early stage of the disease. BCVA of the BSE emerged as an independent significant predictor of overall QoL and most of its components.

ORIGINAL RESEARCH

Alessandro de Paula, Andrea Perdicchi, Augusto Pocobelli, Serena Fragiotta, Gianluca Scuderi

The “Topography” of Glaucomatous Defect Using OCT and Visual Field Examination

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:5] [Pages No:31 - 35]

Keywords: Glaucoma, OCT, RNFL, Visual field

   DOI: 10.5005/jp-journals-10078-1353  |  Open Access |  How to cite  | 

Abstract

Aim: To describe the modifications in the superior and inferior retinal nerve fiber layer (RNFL) thickness regarding the distribution of the VF defects for the horizontal meridians in glaucomatous patients and the differences in the RNFL thickness topography between glaucomatous and healthy subjects. Methods: One hundred twenty eyes of 91 patients affected by glaucoma and 94 eyes of 51 normal patients were retrospectively reviewed. Computerized 30°VF (Octopus G1 Dynamic strategy) and optical coherence tomography (OCT) ONH and 3D disk analysis were performed in all cases. The RNFL thickness measures analyzed in both groups were superior-nasal (SN), superior-temporal (ST), inferior-nasal (IN), and inferior temporal (IT) sectors. The VFs were classified according to the distribution of the VF defect as for the horizontal meridian in the pattern deviation plot as superior, inferior, predominantly superior, or predominantly inferior. Result: In the glaucomatous group, 78 eyes (65%) showed a predominantly superior VF defect, while 38 eyes (32%) showed a predominantly inferior VF defect. Fifty-six eyes (46.7%) presented an exclusively superior, and 27/120 eyes (22.5%) presented an exclusively inferior VF defect. In the control group, the thickest RNFL sector was IT. The ST sector showed the thickest RNFL in presence of an exclusive superior VF defect. In case of an exclusive inferior VF defect, the thickest RNFL was the IT sector. VF showing superior defect presented a more altered MD than the VF with an inferior defect. Conclusion: Glaucomatous damage affects both the superior and inferior neural rim almost simultaneously. However, the neural rim loss seems to be asymmetric, involving the inferior or superior rim depending on the predominant involvement of the superior or inferior hemifield at the VF test. Particularly, the IT sector appears to be the most compromised in glaucomatous eyes. Therefore, the asymmetry between superior and inferior RNFL could support the diagnosis of glaucoma.

ORIGINAL RESEARCH

Nariman Nassiri, Frank Mei, Hassan Tokko, John Zeiter, Sarah Syeda, Chaesik Kim, Ronald Swendris, Anju Goyal, Elise In\'T Veld, Alma Mas-Ramirez, Sonia W Rana, Mark S Juzych, Bret A Hughes

Consensual Ophthalmotonic Reaction Following Selective Laser Trabeculoplasty

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:5] [Pages No:36 - 40]

Keywords: Consensual ophthalmotonic reaction, Glaucoma treatment, Intraocular pressure, Retrospective study, Selective laser trabeculoplasty

   DOI: 10.5005/jp-journals-10078-1361  |  Open Access |  How to cite  | 

Abstract

Aim: “Consensual ophthalmotonic reaction” refers to changes in intraocular pressure (IOP) in one eye, which is accompanied by a corresponding change in IOP in the contralateral eye. This study evaluates whether monocular administration of selective laser trabeculoplasty (SLT) leads to a consensual ophthalmotonic reaction and how long this effect lasts. Materials and methods: A retrospective chart review was performed on patients receiving SLT at Kresge Eye Institute in Detroit, MI, from January 2015 to August 2016. Patients were excluded if they had previous history of glaucoma incisional and/or laser procedures; required additional laser trabeculoplasty; had glaucoma medication changes during the follow-up period; experienced no decrease in IOP during the follow-up period; or had a diagnosis of angle closure on gonioscopy. Various demographic, clinical, and surgical data were collected. IOP measurements were collected at baseline and postoperatively at 1–3 months, 4–9 months, and 12–15 months. Results: At all follow-up periods, the IOP of the treated eye was decreased from baseline IOP (p ≤ 0.05, paired t-test). For the fellow eye, there was a statistically significantly decrease from baseline up to the 4–9 months follow-up period (p ≤ 0.05, paired t-test). Linear regression analysis of the percent reduction in IOP from baseline in the SLT-treated eye with the fellow eye shows a mild correlation at all-time points: R2 = 0.284 (p < 0.001) at 1–3 months; R2 = 0.348 (p < 0.001) at 4–9 months; R2 = 0.118 (p = 0.054) at 12–15 months. Conclusion: This study showed that monocular administration of SLT results in a consensual ophthalmotonic reaction. The consensual ophthalmotonic reaction appears to last for up to 4–9 months. Clinical significance: Therefore, although SLT does lead to a consensual ophthalmotonic reaction, monocular administration of SLT is not a reliable method of long-term IOP control for the contralateral non-SLT-treated eye.

ORIGINAL RESEARCH

Jaya Kaushik, Jitendra KS Parihar, Rakesh Shetty, Ankita Singh, Piyush Chaturvedi

A Long-term Clinical Study to Evaluate AGV with Concurrent Intravitreal Ranibizumab vs Primary AGV Implantation in Cases of Refractory Neovascular Glaucoma

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:41 - 46]

Keywords: Ahmed glaucoma valve, Anti-VEGF with AGV implantation in NVG, Decreased postoperative complications with ranibizumab in AGV implantation for NVG, ranibizumab with AGV implantation in NVG, ranibizumab in NVG

   DOI: 10.5005/jp-journals-10078-1355  |  Open Access |  How to cite  | 

Abstract

Purpose: This study was aimed to gauge the efficacy of primary AGV implantation with concurrent intraoperative intravitreal ranibizumab vs primary AGV implantation alone in the management of neovascular glaucoma (NVG). Methods: This retrospective comparative study was carried out based on the data collected in patients of neovascular glaucoma who underwent Ahmed Glaucoma Valve implantation with or without concurrent intravitreal ranibizumab between the period from Feb 2009 to Feb 2015 involving two groups of 40 patients each, having the clinical diagnosis of neovascular glaucoma, having undergone pan-retinal photocoagulation with minimum 03 intravitreal injections of ranibizumab not less than 4 weeks prior to undergoing primary Ahmed glaucoma valve implantation and allotted randomly to either group to receive concurrent administration of intravitreal ranibizumab with Ahmed glaucoma valve (AGV) implant surgery or AGV implant surgery alone. The minimum qualifying follow-up was 3-years. The functional outcome measures included intraoperative and postoperative complications, intraocular pressure (IOP), and the need for antiglaucoma medication, if any, as well as best corrected visual acuity. Results: Both the groups showed a significant decrease in IOP (p < 0.05). Sight and IOP threatening postoperative complications were significantly low in the study group. NVI regression was higher in the study group and re-emergence was significantly lesser in the study group (p = 0.002). Mean postop IOP had shown an excellent reduction in IOP up to 14.25 ± 2.05 mm Hg with 1.5 ± 1 antiglaucoma drugs in ranibizumab group and 15.25 ± 2.95 mm Hg with 1.7 ± 0.87 antiglaucoma drugs in the control group at the 3-years follow-up period. Surgical success rates were comparable between the two groups at 1 and 3-year. Conclusion: Concurrent intravitreal ranibizumab along with primary AGV implantation minimizes postoperative complications, regresses NVI while accelerating stabilization of IOP and visual functions.

ORIGINAL RESEARCH

Eli L Pratte, Junsang Cho, James R Landreneau, Matthew T Hirabayashi, Jella A An

Predictive Factors of Outcomes in Kahook Dual Blade Excisional Goniotomy Combined with Phacoemulsification

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:47 - 52]

Keywords: Kahook dual blade, Outcomes, Retrospective study, Risk factors

   DOI: 10.5005/jp-journals-10078-1313  |  Open Access |  How to cite  | 

Abstract

Aim: To identify factors that were significant predictors of Kahook Dual Blade (KDB) excisional goniotomy outcomes. Materials and methods: One hundred and thirty-two eyes from 99 adult glaucoma patients who underwent combined KDB and phacoemulsification (KDB-phaco) with a minimum 6-month follow-up were assessed for baseline patient characteristics to determine correlation to the success of KDB-phaco at 6 and 12 months postoperatively. Success was defined as ≥20% intraocular pressure (IOP) reduction or ≥1 medication reduction as well as IOP ≤18 mm Hg without any additional IOP-lowering procedures after KDB-phaco. Results: 63.6% (84/132) and 46.1% (41/89) of cases were successful at the 6- and 12-month follow-ups, respectively. KDB-phaco reduced patient\'s preoperative IOP (in mm Hg) from 17.6 ± 4.6 to 14.9 ± 3.2 at 6 months (15.3%, p < 0.001) and 15.4 ± 4.7 at 12 months (12.5%, p = 0.001). KDB-phaco reduced patient\'s preoperative IOP-lowering medications from 2 ± 1.2 to 1.1 ± 1.2 at 6 months (45%, p < 0.001) and 1.32 ± 1.3 at 12 months (34%, p < 0.001). At 6 months, patients on >1 IOP lowering medication had a greater chance of meeting our success criteria (p = 0.037). Visually significant postoperative hyphema was not associated with the use of anticoagulation (p = 0.943) but was significantly associated with postoperative day 1 IOP ≤ 10 mm Hg (p = 0.011). Conclusion: Patients who underwent KDB-phaco significantly reduced their IOP and medication burden at both 6 and 12 months compared with their baseline preoperative values. KDB-phaco outcome was associated with higher baseline IOP-lowering medications and increased rate of hyphema was associated with lower postoperative day 1 IOP, regardless of anticoagulation status. Age, ethnicity, prior laser trabeculoplasty, type and severity of glaucoma, and baseline preoperative IOP were not associated with surgical success. Clinical significance: Patients with a higher number of baseline medications may experience a greater probability of success following KDB-phaco.

ORIGINAL RESEARCH

Bruno LB Esporcatte, Roberto M Vessani, Luiz AS Melo Jr, Norton S Yanagimori, Guilherme H Bufarah, Norma Allemann, Ivan M Tavares

Diagnostic Performance of Optical Coherence Tomography and Nonspecialist Gonioscopy to Detect Angle Closure

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:53 - 58]

Keywords: Angle-closure, Anterior segment optical coherence tomography, Gonioscopy, Primary angle-closure glaucoma

   DOI: 10.5005/jp-journals-10078-1354  |  Open Access |  How to cite  | 

Abstract

Aim: To compare the usefulness of gonioscopy performed by general ophthalmologists (GO) and anterior segment optical coherence tomography (AS-OCT) in detecting angle closure in patients with a shallow anterior chamber. Methods: Forty-four patients with a shallow anterior chamber (defined by a ratio of peripheral anterior chamber depth to peripheral corneal thickness lower than 1/2) were included in this cross-sectional study. Gonioscopy was performed in all subjects by two glaucoma experts (GE1 and GE2) and one GO. Anterior segment imaging was performed using Visante® OCT (Carl Zeiss Meditec Inc.). Agreement between examiners was assessed with first-order agreement coefficients (AC1). Diagnostic accuracies of GO gonioscopy and AS-OCT were evaluated using sensitivity, specificity, and area under the receiver operating characteristic (AROC) curves. Results: For static gonioscopy, the agreement between GE1 and GE2 was substantial (AC1 = 0.65), and that between GE1 and GO was moderate (AC1 = 0.50). For indentation gonioscopy, the agreement between GE1 and GE2 was slightly lower (AC1 = 0.55); however, the agreement between GE1 and GO showed a larger reduction (AC1 = 0.12). GO\'s gonioscopy presented a low specificity (25%) and the AROC to angle closure detection was lower than AS-OCT (0.56–0.73). Combined information of GO gonioscopy and AS-OCT improved specificity (85.7%) and AROC (0.77) of angle closure evaluation. Conclusion: Agreement between GO and glaucoma experts was moderate for static gonioscopy and slight for indentation gonioscopy. AS-OCT performed better than GO gonioscopy in detecting angle closure in patients with a shallow anterior chamber. The addition of AS-OCT to clinical information in patients with GO positive gonioscopy improved the specificity and AROC of gonioscopy test.

REVIEW ARTICLE

Syril Dorairaj, Nathan M Radcliffe, Davinder S Grover, Jacob W Brubaker, Blake K Williamson

A Review of Excisional Goniotomy Performed with the Kahook Dual Blade for Glaucoma Management

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:59 - 64]

Keywords: Glaucoma, Glaucoma surgery, Goniotomy, Kahook Dual Blake, Systematic review

   DOI: 10.5005/jp-journals-10078-1352  |  Open Access |  How to cite  | 

Abstract

Aim: To review the published literature describing clinical outcomes of excisional goniotomy using the Kahook Dual Blade (KDB) for the management of glaucoma. Background: A family of less invasive glaucoma procedures—including excisional goniotomy with the KDB—has been developed to provide moderate reductions in intraocular pressure and/or medication burden in eyes with therapeutic needs that may not warrant the risks associated with more traditional procedures such as trabeculectomy and tube-shunt implantation. This review\'s goal is to synthesize the existing literature into a compendium of excisional goniotomy\'s indications, technique, efficacy and safety outcomes, and optimal place in glaucoma management. Review results: Excisional goniotomy with the KDB effectively lowers IOP and reduces the medication burden in eyes with POAG and other forms of glaucoma across the spectrum of both baseline IOP and disease severity. The procedure exhibits a safety profile that is on par with other angle-based surgical interventions and enhanced safety compared to filtration procedures. It can be performed by comprehensive ophthalmologists as well as glaucoma specialists. This procedure as a standalone operation delivers IOP reductions consistent with filtration surgery, and in combination with cataract surgery delivers both IOP and medication reductions at least as great as other minimally invasive procedures. Conclusion: Given the broad base of evidence supporting its use in a wide variety of clinical scenarios, excisional goniotomy with the KDB can play a meaningful role in the achievement of patient-specific glaucoma therapy goals. Clinical significance: These aggregate findings support the efficacy and safety of excisional goniotomy with the KDB and clarify the patient profiles best suited for this procedure.

REVIEW ARTICLE

Priyanka Sudhakar, Meena Menon, Minija CK, Anand Balasubramaniam

Glaucoma in Viral Keratouveitis: A Retrospective Review at a Tertiary Eye Hospital

[Year:2022] [Month:January-April] [Volume:16] [Number:1] [Pages:6] [Pages No:65 - 70]

Keywords: Ahmed glaucoma valve, Antiglaucoma medication, Cytomegalovirus, Herpes simplex virus, Intraocular pressure, Ocular hypertension, Transscleral cyclophotocoagulation, Uveitic glaucoma, Varicella Zoster, Viral keratouveitis

   DOI: 10.5005/jp-journals-10078-1359  |  Open Access |  How to cite  | 

Abstract

Viral keratouveitis (VKU) could be visually debilitating owing to the intraocular inflammation causing collateral damage to the cornea and secondary elevation of intraocular pressure (IOP). In this retrospective, single-center, observational study, we analyze the clinical features and management options for VKU, with a brief review on incidence of glaucoma and its treatment outcomes. We reviewed the outpatient records at our tertiary hospital from 2015 to 2020 and found 53 eyes of 55 patients diagnosed as VKU. The main outcome measures were incidence of clinical signs, elevated IOP and glaucoma, and treatment modalities used. Sixty-four percent were males with a mean age of onset being 45.4 years. Eighty percent of the eyes were clinically diagnosed to have herpes simplex virus (HSV), 16% herpes zoster virus (HZV) and 4% cytomegalovirus (CMV). Ocular presentations most commonly noted were keratic precipitates (70.4%), corneal edema (66.7%). Associated elevation of IOP was seen in 24 eyes (44%), while glaucomatous damage was seen in 20% of the eyes. Those with fewer uveitic episodes (less than two), as opposed to those having more than two episodes (p < 0.09) posed a lesser risk of developing glaucoma. Almost all were treated with topical steroids and oral acyclovir. The need for glaucoma surgery, in our study, was only 7.2%. Majority of patients with glaucoma, as compared to those without, appeared to have a higher number of IOP spikes and uveitic episodes. CMV-associated eyes had higher risk of developing glaucoma and were more intractable, requiring more intense treatment strategies. This review of the clinical profile of an exclusive South Indian cohort of VKU with an attempt to understand the differences in presentation between the herpetic and CMV groups and its implication from a glaucoma perspective makes this study distinctive.

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