Journal of Current Glaucoma Practice

Register      Login

Table of Content

2017 | September-December | Volume 11 | Issue 3

EDITORIAL

Tanuj Dada

Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4?

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:3] [Pages No:77 - 79]

PDF  |  DOI: 10.5005/jp-journals-10028-1228  |  Open Access |  How to cite  | 

Abstract

How to cite this article: Dada T. Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4? J Curr Glaucoma Pract 2017;11(3):77-79.

ORIGINAL ARTICLE

Ghada I Gawdat, Maha M Youssef, Nermeen M Bahgat, Dina M Elfayoumi, Mohamed AS Eddin

Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: A One-year Study

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:6] [Pages No:80 - 85]

PDF  |  DOI: 10.5005/jp-journals-10028-1229  |  Open Access |  How to cite  | 

Abstract

Aim

To study the incidence and risk factors of glaucoma occurring within 1 year following pediatric cataract surgery in Egyptian children.

Materials and methods

This is a prospective nonrandomized study conducted at Aburich Children's Hospital, over a period of 1 year on a cohort of Egyptian patients with congenital and infantile cataract. One hundred and fifty eyes of 88 patients were enrolled in this study. All the patients underwent anterior approach removal of lens matter, whereas primary intraocular lens (IOL) implantation was carried at the age of 1 and 2 years for unilateral and bilateral cases respectively. Intraocular pressure (IOP) was measured at 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year. For those who developed glaucoma, time of diagnosis and associated risk factors were reported.

Results

The incidence of glaucoma was 11.33% (17 of 150 eyes), while incidence of glaucoma suspect was 0.67% (1 of 150 eyes) in the first year following cataract surgery. The majority of the cases (66.7%) were discovered in the first 3 months postcataract surgery. Age at time of cataract surgery, the state of aphakia/pseudophakia, persistent fetal vasculature (PFV), and microphthalmia were not found to be significant predictors of early-onset glaucoma in our study.

Conclusion

Aphakic glaucoma continues to be a devastating condition with high incidence during first year following cataract surgery.

Clinical significance

Regular follow-up should start as early as possible following cataract surgery. Further prospective studies with larger study population are required.

How to cite this article

Gawdat GI, Youssef MM, Bahgat NM, Elfayoumi DM, Eddin MAS. Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: A One-year Study. J Curr Glaucoma Pract 2017;11(3):80-85.

ORIGINAL ARTICLE

Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:6] [Pages No:86 - 91]

PDF  |  DOI: 10.5005/jp-journals-10028-1230  |  Open Access |  How to cite  | 

Abstract

Aim

To evaluate the configuration of the anterior chamber angle quantitatively and study the morphological changes in the eye with ultrasound biomicroscopy (UBM) in primary angle closure glaucoma (PACG) patients after laser peripheral iridotomy (LPI).

Materials and methods

A total of 185 eyes of 185 PACG patients post-LPI and 126 eyes of 126 normal subjects were included in this prospective study. All subjects underwent complete ophthalmic evaluation, A-scan biometry, and UBM. The anterior segment and angle parameters were measured quantitatively and compared in both groups using Student's t-test.

Results

The PACG patients had shorter axial length, shallower central anterior chamber depth anterior chamber depth (ACD), and anteriorly located lens when compared with normal subjects. Trabecular iris angle (TIA) was significantly narrow (5.73 ± 7.76°) in patients with PACG when compared with normal subjects (23.75 ± 9.38°). The angle opening distance at 500 μm from scleral spur (AOD 500), trabecular—ciliary process distance (TCPD), iris—ciliary process distance (ICPD), and iris—zonule distance (IZD) were significantly shorter in patients with PACG than in normal subjects (p < 0.0001). The iris lens angle (ILA), scleral—iris angle (SIA), and scleral—ciliary process angle (SCPA) were significantly narrower in patients with PACG than in normal subjects (p < 0.0001). The iris—lens contact distance (ILCD) was greater in PACG group than in normal (p = 0.001). Plateau iris was seen in 57/185 (30.8%) of the eyes. Anterior positioned ciliary processes were seen in 130/185 eyes (70.3%) of eyes.

Conclusion

In PACG patients, persistent apposition angle closure is common even after LPI, which could be due to anterior rotation of ciliary body and plateau iris and overcrowding of anterior segment due to shorter axial length and relative anterior lens position.

How to cite this article

Mansoori T, Balakrishna N. Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy. J Curr Glaucoma Pract 2017;11(3):86-91.

ORIGINAL ARTICLE

Ilya Sluch, Brett Gudgel, Justin Dvorak, Mary Anne Ahluwalia, Kai Ding, Steve Vold, Steven Sarkisian

Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:5] [Pages No:92 - 96]

PDF  |  DOI: 10.5005/jp-journals-10028-1231  |  Open Access |  How to cite  | 

Abstract

Aim

To evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study.

Materials and methods

A retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success.

Results

A total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up.

Conclusion

The M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time.

Clinical significance

While the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design.

How to cite this article

Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

ORIGINAL ARTICLE

Rafael Castaneda-Diez, Gabriel Lazcano-Gómez, Roberto Gonzalez-Salinas, Jesus Jimenez-Roman, Daniela Alvarez-Ascencio, Cindy Haro-Zuno, Mauricio Turati-Acosta, Magdalena Garcia-Huerta, Jesus Jimenez-Arroyo, Armando Castillejos-Chevez, Francisca Dominguez-Dueñas

Glaucoma Medication Preferences among Glaucoma Specialists in Mexico

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:4] [Pages No:97 - 100]

PDF  |  DOI: 10.5005/jp-journals-10028-1232  |  Open Access |  How to cite  | 

Abstract

Aim

To determine the glaucoma specialists' preferences for the different brands of topical glaucoma medications available in Mexico.

Materials and methods

A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice.

Results

Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists' preferences.

Conclusion

Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option.

Clinical significance

This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition.

How to cite this article

Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez-Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez-Salinas R, Dominguez-Dueñas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.

ORIGINAL ARTICLE

Albert S Khouri, Grace Huang, Linda Y Huang

Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: A One-year Study

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:6] [Pages No:101 - 106]

PDF  |  DOI: 10.5005/jp-journals-10028-1233  |  Open Access |  How to cite  | 

Abstract

Aim

To determine the safety and efficacy of intraoperative injection of mitomycin C (MMC) against conventional sponge-applied MMC during trabeculectomy.

Materials and methods

This study was a retrospective, comparative case series. Thirty eyes with primary open-angle glaucoma underwent consecutive trabeculectomies with MMC injection (injection group), and thirty eyes with sponge-applied MMC were as controls (sponge group). Data were collected preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Demographic data, applanation intraocular pressure (IOP), best-corrected visual acuity (VA), number of glaucoma medications, postoperative interventions, postoperative complications, and number of visits within 3 months were recorded. In order to stratify data, proportion of eyes achieving >30% IOP reduction from baseline with or without glaucoma medications was calculated and defined as surgical success.

Results

Mean IOP reduction at 1 year was significant in both the injection and sponge groups from baseline (46.8 and 37.8% respectively). The injection group had overall lower postoperative IOP and comparable complete treatment success, defined as achieving >30% IOP reduction without glaucoma medications (p = 0.941). The number of postoperative visits within 3 months and the proportion of eyes needing 5-fluorouracil (5-FU) intervention were significantly lower in the injection group (p = 0.03, p = 0.04 respectively).

Conclusion

Injection of MMC was as safe and effective as sponge application with comparable estimated complete treatment success, less need for visits within 3 months, and 5-FU intervention.

Clinical significance

Surgeons may consider intraoperative injection of MMC in appropriate patient cohorts given comparable safety and efficacy and several advantages over traditional sponge application. Further study in a prospective, larger, long-term manner is necessary to assess this modality.

How to cite this article

Khouri AS, Huang G, Huang LY. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: A One-year Study. J Curr Glaucoma Pract 2017;11(3):101-106.

ORIGINAL ARTICLE

Georgios Bontzos, Michail Agiorgiotakis, Efstathios T Detorakis

Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case—control Study

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:6] [Pages No:107 - 112]

PDF  |  DOI: 10.5005/jp-journals-10028-1234  |  Open Access |  How to cite  | 

Abstract

Aim

In this study, we reviewed demographics and biometric characteristics among patients receiving chronic β-blockers and prostaglandins (PGs) for primary open-angle glaucoma. We compared the age at the time of cataract surgery in different patient groups and in a control group which was not under any medication.

Materials and methods

Retrospective chart review of glaucomatous patients who underwent cataract extraction at the Department of Ophthalmology of the University Hospital of Heraklion, Crete, Greece, between January 1998 and December 2016 was done. Age at cataract surgery, axial length (AL), and preoperative and postoperative best-corrected visual acuities (BCVAs) were recorded. A cohort of patients without glaucoma who were operated for cataract extraction was also evaluated.

Results

In all, 320 patients were reviewed. There were significant results in mean age difference between the beta-antagonist and the PG group [3.05 years, 95% confidence interval (CI) 1.54-4.57] and between the beta-antagonist group with the patients receiving a combined therapy (3.02 years, 95% CI 1.14-4.91). No significant difference was found between the PG and the combination group. All the three treated groups had a significant lower mean age than the control group at the time of cataract surgery.

Conclusion

Based on our study, we concluded that there might be a possible association between chronic treatment with beta-antagonist agents and earlier cataract surgical time in the treated eye.

Clinical significance

Intraocular pressure control is often usually achieved using ophthalmic agents. Their topical and systemic effects should be monitored precisely. Earlier cataract formation might be an important side effect which the physician has to keep in mind before choosing the suitable medication.

How to cite this article

Bontzos G, Agiorgiotakis M, Detorakis ET. Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case—control Study. J Curr Glaucoma Pract 2017;11(3):107-112.

RESEARCH ARTICLE

Joobin Hooshmand, James CY Leong, Jeremy O'Connor, Ghee S Ang, Anthony P Wells

Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:7] [Pages No:113 - 119]

PDF  |  DOI: 10.5005/jp-journals-10028-1235  |  Open Access |  How to cite  | 

Abstract

Aim

To evaluate by anterior segment optical coherence tomography (AS-OCT) the medium-term (mean duration 3.2 years) anatomical changes in the anterior chamber angle (ACA) after laser peripheral iridoplasty.

Materials and methods

This is a longitudinal, retrospective case series of 31 eyes of 31 patients with primary angle-closure suspicion, primary angle closure (PAC), or primary angle-closure glaucoma (PACG) who underwent laser peripheral iridoplasty. All patients had persistent iridotrabecular contact (ITC) despite the presence of a patent peripheral iridotomy (PI). An AS-OCT was performed in dark conditions before and after laser iridoplasty. Quadrants of ITC, intraocular pressure (IOP), and the AS-OCT parameters of the temporal and nasal ACAs were measured and analyzed.

Results

Prior to iridoplasty, the average number of quadrants of ITC was 3.3. At the first postiridoplasty visit (mean duration 6.8 weeks), this reduced to 1.7 quadrants but increased to 1.9 by the final follow-up visit (mean duration 3.2 years). Twenty-five patients (80.1%) had less ITC at the first postlaser visit increasing to 27 (87.1%) patients by the final visit. Two (6.5%) required a second iridoplasty, while 3 (9.7%) required cataract surgery. All parameters of angle width showed a statistically significant increase in magnitude. All patients maintained IOP ≤ 21 mm Hg throughout the follow-up period.

Conclusion

Iridoplasty is a useful adjunct in widening the ACA, particularly in those with persistent angle closure after iridotomy but with no cataract. While not successful in all patients, it can act as a temporizing measure to widen the drainage angle until such time that cataract surgery can be performed.

Clinical significance

Laser peripheral iridoplasty can be used as an adjunct in angle-closure glaucoma patients with no cataract.

How to cite this article

Hooshmand J, Leong JCY, O'Connor J, Ang GS, Wells AP. Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study. J Curr Glaucoma Pract 2017;11(3):113-119.

CASE REPORT

David Fleischman, Bryan Kim

Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands

[Year:2017] [Month:September-December] [Volume:11] [Number:3] [Pages:5] [Pages No:120 - 124]

PDF  |  DOI: 10.5005/jp-journals-10028-1236  |  Open Access |  How to cite  | 

Abstract

Schockmed valve

A novel surgical option for uncontrolled glaucoma in eyes with poor conjunctiva and encircling bands.

How to cite this article

Fleischman D, Kim B. Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands. J Curr Glaucoma Pract 2017;11(3):120-124.

journal videos

Baerveldt Implantation

This video demonstrates the technique of insertion of the Baerveldt tube in refractory glaucoma. A conjunctival flap is made and the rectii isolated. The Baerveldt shunt is tucked into position and...

Size: 9 MB

Aniridia: Trabeculectomy with a Glued Aniridia IOL

In this surgical video, fibrin glue assisted posterior chamber intraocular lens implantation (glued IOL) combined with trabeculectomy is performed. An 8-year-old patient is diagnosed as bilateral a...

Size: 21 MB

Minitrab Glaucoma Eye Surgery

The minitrab glaucoma surgery is a small incision evolution of traditional trabeculectomy. The unique wound construction alters the resistance during the postoperative period resulting in a high fl...

Size: 30 MB

Management of Overhanging Bleb

We describe a challenging scenario where an overhanging cystic bleb occluded the visual axis together with mature cataract. We performed simultaneous sequential horizontal bleb transection, phacoem...

Size: 23 MB

I Catheter

This video demonstrates the technique of viscocanaloplasty using an illuminated endo-catheter. After the scleral flap is made, a second flap is made to reveal the angle structures. Then viscoelasti...

Size: 12 MB

MICS with Trabeculectomy

Capsulorhexis is performed after capsular staining. Coaxial 1.8 mm phacoemulsification within the bag PCIOL implantation is performed. Conjunctival and partial thickness scleral flaps are made. Tra...

Size: 18 MB

Deep Sclerectomy with Viscocanaloplasty

This video demonstrates the technique of deep sclerectomy, combined with a viscocanaloplasty. After performing a deep sclerectomy, a guide is then introduced into the Schlemm’s canal and 10’0 prole...

Size: 16 MB

Overhanging Bleb Excision and Compression Suture

This video demonstrates the technique excision of a filtering bleb which is overlying the cornea and application of compression sutures over the bleb. The bleb is peeled off from the cornea and exc...

Size: 14 MB

Argon Laser Suture Lysis

This video demonstrates the technique of argon laser suture lysis using a Ritch lens. The laser beam is aimed at the posttrabeculectomy suture and the suture is lysed. Power used is 300 mW for 0.1 ...

Size: 1022 KB

Surgical Extension of Retracted Glaucoma Drainage Device Tube

This video demonstrates the technique of surgical management of a retracted GDD tube. A conjuctival incision is made after ballooning it in the area of the tube. The tube is freed of adhesions and ...

Size: 42 MB

Deep Sclerectomy

This video demonstrates the technique of deep sclerectomy. A conjunctival and partial thickness scleral flap is made. A deeper scleral flap is then made. A trabeculodescemetic window is created and...

Size: 17 MB

Viscocanaloplasty A Piece of Cake

This video demonstrates the basic principles, surgical technique and postoperative outcome of viscocanaloplasty using an endoilluminator.

Size: 1 MB

AGV through Needle Track

This video demonstrates the techniques of implanting the Ahmed Glaucoma Valve to a 23 G needle track through the sclera without the need for a scleral flap or patch.

Size: 4 MB

Repair of Cyclodialysis Cleft

Surgical repair of cyclodialysis cleft involves intraoperative verification of the presence and extent of the defect by gonioscopy, followed by exposure of the landmarks under a trabeculectomy styl...

Size: 40 MB

Forced Tube Irrigation in AGV

This video demonstrates the technique of tube irrigation of a pars plana Ahmed Glaucoma Valve. A 25 G vitrectomy is performed around the tube to clear the area completely of vitreous. The cannula i...

Size: 8 MB

Express Shunt

This video demonstrates the technique of implantation of the Express shunt. Scleral flap is made after peritomy. AC entry made 2 mm from the limbus. Express shunt is inserted through the entry. Fla...

Size: 12 MB

Pascal Laser Iridoplasty

This video demonstrates the technique of iridoplasty. Modified laser iridoplasty changes a single shot to a row of 3 spots. A simultaneous 3-spot application reduces laser time to half that of conv...

Size: 4 MB

Releasable Suture

Releasable suture is a useful adjunctive step in trabeculectomy. This helps mainly in preventing the immediate postoperative shallow chamber. It is an alternative to argon laser suturolysis. Usuall...

Size: 2 MB

Management of Postoperative Choroidal Detachment

This video demonstrates the technique of drainage of suprachoroidal effusion by making pars plana sclerotomies and reforming the anterior chamber with air.

Size: 38 MB

Forced Tube Irrigation

This video demonstrates the technique of management of the hypertensive phase after AGV implantation. A corneal paracentesis is done and 1-3 ml of BSS are injected through a 28 G cannula which has ...

Size: 43 MB

Video 1 Phacoemulsification with Trabeculectomy

This video demonstrates stepwise technique of combined phacoemulsification and trabeculectomy. We prefer single site technique. Judicious use of MMC for two minutes, good scleral flap and foldable ...

Size: 5 MB

Video 2 Watertight Conjunctival Closure for Fornix-based Trabeculectomy

A simple technique to achieve watertight closure in fornix based trabeculectomy is demonstrated in this video. The key point is to leave 1 to 1.5 mm of limbal conjunctival tissue for suturing. The ...

Size: 49 MB

Video 3 Trabeculectomy with AC Maintainer

This video demonstrates the technique of trabeculectomy. A conjunctival fornix-based incision and a partial thickness scleral flap are made. An AC maintainer is fixed into position via side port in...

Size: 16 MB

Video 4 AGV Implantation through Scleral Tunnel and Flap

This video demonstrates the technique of AGV implantation covering the entire length of the tube with sclera. A conjunctival incision is made, and after priming the AGV, its plate is sutured to the...

Size: 15 MB

Video 5 Triamcinolone Outflow

At the end of AGV implantation, triamcinolone is injected via a side port incision. When the IOP is low, no egress of the suspended particles of triamcinolone is seen. When the IOP is increased by ...

Size: 4 MB

© Jaypee Brothers Medical Publishers (P) LTD.