Journal of Current Glaucoma Practice

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2020 | January-April | Volume 14 | Issue 1

EDITORIAL

Shibal Bhartiya

Current Glaucoma Practice: The Covid-19 Impact

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:2] [Pages No:1 - 2]

PDF  |  DOI: 10.5005/jp-journals-10078-1275  |  Open Access |  How to cite  | 

Original Article

Grant Slagle, Sylvia L Groth, Mario Montelongo, William E Sponsel

Nonpenetrating Deep Sclerectomy for Progressive Glaucoma: Long-term (5-year) Follow-up of Intraocular Pressure Control and Visual Field Survival

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:7] [Pages No:3 - 9]

Keywords: Antiglaucoma, Cohort study, Glaucoma, Intraocular pressure, Medication, Mitomycin C, Nonpenetrating deep sclerectomy

PDF  |  DOI: 10.5005/jp-journals-10078-1273  |  Open Access |  How to cite  | 

Abstract

Purpose: To monitor 5-year outcomes of nonpenetrating deep sclerectomy (NPDS) with mitomycin C (MMC) in a new consecutive patient cohort. Materials and methods: All eyes undergoing NPDS surgery between 1/08 and 6/12 were monitored for intraocular pressure (IOP), number of antiglaucoma medications (meds), and visual field indices [mean deviation (MD) and corrected pattern standard deviation (CPSD)], relative to the preoperative baseline using the two-tailed paired Student\'s t test. Results: Of 106 eyes undergoing NPDS with MMC, mean IOP was 19.7 ± 0.5 [sem] mm Hg preoperatively, 11.9 ± 0.5 at 3 months, 12.5 ± 0.6 at 6 months, 12.4 ± 0.5 at 12 months, 12.6 ± 0.6 at 18 months, 11.1 ± 0.6 at 2 years, 11.8 ± 0.5 at 2.5 years, 11.0 ± 0.5 at 3 years, 11.7 ± 0.5 at 3.5 years, 10.7 ± 0.7 at 4 years, 11.6 ± 0.5 at 4.5 years, and 12.4 ± 0.7 at 5 years (average IOP reduction of 7.8 mm Hg or 37%; p < 106) at 5 years. About 92% of eyes had stable IOP ≥5 and ≤21 mm Hg at 5 years. Mean preoperative meds 2.7 ± 0.1 was reduced to 0.40 ±0.09 at 3 months, 0.51 ± 0.1 at 6 months, 0.38 ± 0.08 at 12 months, 0.49 ± 0.09 at 18 months, 0.41 ± 0.09 at 2 years, 0.39 ± 0.09 at 2.5 years, 0.49 ± 0.1 at 3 years, 0.58 ± 0.1 at 3.5 years, 0.49 ± 0.1 at 4 years, 0.64 ± 0.1 at 4.5 years, and 0.52 ± 0.1 at 5 years, corresponding to mean reduction of 2.2 meds (81%; p < 1022) at 5 years. Mean deviation and CPSD were stable relative to baseline at all time intervals (R = 0.83–0.94; p < 0.0001). Conclusion: With appropriate postoperative management, eyes undergoing NPDS can maintain excellent IOP control with minimal medication use and maintain very stable visual fields over an extended time frame.

Original Article

Catalina Saavedra, Hernan A Rios, Sandra Belalcazar, Shirley M Rosenstiehl

Characteristics of Pediatric Glaucoma in a Latin American Reference Center

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:6] [Pages No:10 - 15]

Keywords: Retrospective study, Surgical management, Treatment and follow-up of glaucoma,Pediatric glaucoma

PDF  |  DOI: 10.5005/jp-journals-10078-1267  |  Open Access |  How to cite  | 

Abstract

Aim: To describe the clinical and epidemiological characteristics of children with pediatric glaucoma (PG) treated in an ophthalmologic national reference center. Materials and methods: A retrospective study of patients diagnosed with PG in a national ophthalmologic reference center was made, between 2005 and 2015. Clinical findings, type of treatment, and the follow-up were evaluated. Results: A total of 89 patients (145 eyes) were included. The median age of diagnosis was 2.0 years. The most frequent type of glaucoma was primary PG with 67.4% of affected patients, primary congenital glaucoma (PCG) being more frequent (69 eyes) than juvenile open-angle glaucoma (JOAG 36 eyes). Secondary PG accounted for 32.6% of the cases (40 eyes). At least one surgical procedure was needed in 56.6% of all studied eyes, and 10.7% of eyes had more than two surgical procedures. Even more, eyes with PCG had surgery in 88.4% of cases. On the contrary, eyes with JOAG did not require surgery. In the last assessment, the distribution of cases according visual acuity did not show differences. However, it is important to note that patients with secondary PG maintained a good vision only in 17.9% of cases. Conclusion: Pediatric glaucoma is a heterogeneous group of diseases, and due to its low incidence, descriptive reports of large cohorts are not available. This study has a well-detailed report of PG characteristics in a national reference center. The frequency of JOAG in the present study was significantly higher than that reported in other studies. Also, clinical characteristics of all glaucoma described have some differences from data published. Clinical significance: There are few studies that describe characteristics of PG. This study is an important tool to analyze the characteristics of PG in an effort to better know the disease.

Original Article

Hend Safwat, Elaraby Nassar, Afaf Rashwan

Early Glaucoma Discrimination Index

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:9] [Pages No:16 - 24]

Keywords: Glaucoma, Optical coherence tomography, Retinal nerve fiber layer

PDF  |  DOI: 10.5005/jp-journals-10078-1271  |  Open Access |  How to cite  | 

Abstract

Purpose: To develop a new structural algorithm derived from optical coherence tomography (OCT) retinal nerve fiber layer (RNFL) thickness and asymmetry and validate it as a discriminate among normal, suspect, and early primary open-angle glaucoma (POAG). Study design: A case-controlled observational clinical study. Materials and methods: In total, 150 subjects (299 eyes) were selected, 61 normal, 46 suspect, and 43 early glaucoma, from Al-Azhar University Hospitals. They were in fifth decade and free from any ocular or systemic diseases affecting the retinal nerve fiber layer. They were investigated by two consecutive perimetry (1 month apart), and three scans of circumpapillary retinal nerve fiber layer (cpRNFL) by using Nidek spectral domain (SD)-OCT 3000 Lite. The cpRNFL thickness (cpRNFLT) and inter-eye asymmetry parameters were analyzed among the three groups. Then some selected parameters were selected and analyzed using a binary logistic regression analysis for developing the new algorithm. The new algorithm was tested for the best fitting, accuracy, and diagnostic ability among the three groups and was validated in the suspect group. Results: The new algorithm model [early glaucoma discrimination index (EGDI)] works well with only four variables; whole cpRNFLT, inferior quadrant cpRNFLT, inferotemporal clock hour (CH) cpRNFLT, and absolute inter-eye inferior quadrants asymmetry. The highest area under the curve (AUC) obtained from the EGDI among the three groups was 0.854. The validation analysis in the suspect group revealed a higher diagnostic ability in discrimination of early glaucoma with AUC of 0.989 (0.976–1.003). Conclusion: The EGDI showed better diagnostic ability for diagnosis of glaucoma in the pre-perimetric stage. The new OCT algorithm is simple and can be run in any SD-OCT device without dependence on normative data.

Original Article

Tarannum Mansoori, Appidi Abhinav Reddy, Nagalla Balakrishna

Identification and Quantitative Assessment of Schlemm's Canal in the Eyes with 360° Angle Recession Glaucoma

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:5] [Pages No:25 - 29]

Keywords: Schlemm\'s canal,Angle recession glaucoma, Anterior segment optical coherence tomography

PDF  |  DOI: 10.5005/jp-journals-10078-1272  |  Open Access |  How to cite  | 

Abstract

Synopsis: Angle recession, trabecular meshwork injury, increased trabecular pigmentation, and reduced Schlemm\'s canal dimensions can cause reduced aqueous outflow and unilateral glaucoma in an eye, following blunt trauma. Also, these patients are possibly at a risk to develop raised intraocular pressure (IOP) in the normal fellow eye due to reduced Schlemm\'s canal area. Aim: To identify and quantitatively evaluate Schlemm\'s canal (SC) parameters by anterior segment optical coherence tomography (AS-OCT) in the patients with unilateral 360° angle recession glaucoma (ARG) and compare with the fellow normal eyes and age-related normal control. Materials and methods: Six patients with a history of unilateral ocular blunt trauma and unilateral 360° ARG, normal fellow eyes and 34 age-matched normal controls underwent anterior chamber angle imaging with corneal line scan protocol using AS-OCT. Schlemm\'s canal cross-sectional area (SC-CSA) and meridional and coronal diameters were measured on temporal and nasal sections at 3 and 9 o\'clock positions. Results: In the AS-OCT cross-sectional images, SC was observed as a horizontally oval or ellipsoidal translucent space. The mean SC-CSA (1,710 ± 376.1 μm2 vs 6,100 ± 2,700 μm2, p < 0.0001), mean meridional diameter (243.6 ± 55.47 μm vs 474 ± 125.6 μm, p < 0.0001), and mean coronal diameter (32.68 ± 6.27 μm vs 57.42 ± 16.27 μm, p < 0.0001) of the SC were smaller in ARG eyes when compared with the normal eyes. The SC dimensions were reduced in the untraumatized fellow eyes of ARG patients when compared with the normal eyes (SC-SCA: 2350 ± 602.1 μm2, p = 0.001, meridional diameter: 341.8 ± 88.8 μm, p = 0.012 and coronal diameter: 31.67 ± 3.8 μm, p < 0.0001). There was no difference in the measured SC dimensions between the ARG eyes and the normal fellow eyes. Conclusion: The reduced SC parameters in the eyes with unilateral 360° ARG and the normal fellow eyes could mean that these patients probably have an underlying structural abnormality in the SC. Trabecular meshwork injury, angle recession, and increased trabecular pigmentation are probably the predisposing factors in the ARG eyes for the increase in IOP. Whether the normal fellow eyes develop IOP rise in the future needs to be seen during regular follow-up.

Original Article

Nermien SM El-Haddad

Anterior Chamber Angle, Intraocular Pressure, and Globe Biometric Parameters in the Children with β-Thalassemia Major

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:7] [Pages No:30 - 36]

Keywords: Anterior chamber angle, Corneal curvature, Effective lens position, Globe biometric parameters and intraocular pressure, β-Thalassemia

PDF  |  DOI: 10.5005/jp-journals-10078-1274  |  Open Access |  How to cite  | 

Abstract

Background: To evaluate the intraocular pressure (IOP), anterior chamber angle (ACA), and globe biometric parameters in β-thalassemia major children and the correlations of these changes. Materials and methods: Eighty-four eyes were included (42 eyes of thalassemia patients and 42 eyes of control). All participates underwent head circumference and height measurements, full ophthalmic examination, anterior segment optical coherence tomography (AS-OCT), and A-scan biometry. Results: The temporal angle of anterior chamber (T-ACA) was significantly narrower in thalassemia patients with p value = 0.008. While the nasal angle showed a nonsignificant narrowing with p value = 0.153. This narrowing was positively correlated with the height, and negatively correlated with the head circumference. Intraocular pressure was statistically higher in thalassemia patients with p value = 0.000. The increased IOP was positively correlated with the head circumference and the lens thickness (LT) and negatively correlated with T-ACA, axial length (AL), vitreous chamber depth (VCD), and anterior chamber depth (ACD). Axial length, ACD, and VCD significantly decreased with p value = 0.000 for all with a positive correlation with the height and a negative correlation with the head circumference. The LT increased in thalassemia group with p value = 0.000. This increase was positively correlated with the head circumference and negatively with the height. Also, there was steeper corneal curvature in thalassemia group with p value = 0.023 and 0.015 (for K1 and K2, respectively). No significant change was observed in corneal thickness in both groups with p value = 0.810. Conclusion: Narrower T-ACA, increased IOP, shorter (AL, VCD, and ACD), steeper corneal curvature, and thicker lens were found in thalassemia patients.

CASE SERIES

David P Holmes, David K Manning

Intrapalpebral Extending Dysesthetic Bleb Revision with Fibrin Glue

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:6] [Pages No:37 - 42]

Keywords: Fibrin glue, Glaucoma, Intraocular pressure, Surgical technique, Trabeculectomy,Bleb, Dysesthesia

PDF  |  DOI: 10.5005/jp-journals-10078-1270  |  Open Access |  How to cite  | 

Abstract

Aim: This pilot study evaluates the safety and efficacy of a novel surgical technique using fibrin glue to treat bleb dysesthesia post-trabeculectomy due to intrapalpebral extension. Background: Trabeculectomy remains the gold standard for control of intraocular pressure (IOP) in refractory glaucoma. Bleb dysesthesia following antifibrotic-enhanced trabeculectomy is common, resulting in a significant decrease in quality of life. Symptoms include pain, foreign body sensation, and excessive tearing. Treatments include lubrication, topical nonsteroidal anti-inflammatory drugs (NSAIDs), bandage contact lens, bleb needling, compression sutures, Nd:YAG laser treatments, autologous blood injection, and cryopexy. These procedures can be time-consuming, risk bleb function, and may be ineffective at symptom control; thus, a novel technique is required. Technique: This is a retrospective case series of eyes undergoing bleb dissection with scleral cutdown and conjunctival closure with ARTISS fibrin tissue glue. Reported cases have been followed up for 6 months. Outcomes assessed include complications, IOP, medication usage, subjective pain score, visual field, and cup-to-disk (C:D) ratio. Conclusion: This small pilot series demonstrated that patients suffering from bleb dysesthesia due to intrapalpebral bleb extension can be successfully treated with a novel surgical approach combining conjunctival dissection to sclera with fibrin tissue glue closure. There was no significant effect on bleb function and no contribution to glaucoma progression over a 6-month period. A significant reduction in patient discomfort with no new surgical complications was noted. Clinical significance: This demonstrates a safe and effective novel surgical approach to treat patients with this condition. The technique is easily learnt and can be employed in an outpatient setting. The technique is readily accepted by patients in group who are often reticent to undergo further intervention. Most importantly, it does not compromise bleb function or destabilize glaucoma control.

CASE REPORT

Tyler L Junttila, Neville Alberto, Matthew Winkels, Michael D Greenwood

Successful Reduction of Intraocular Pressure in a Patient with Glaucoma Secondary to Sturge–Weber Syndrome Using a Suprachoroidal Shunt

[Year:2020] [Month:January-April] [Volume:14] [Number:1] [Pages:4] [Pages No:43 - 46]

Keywords: Supraciliary,Episcleral venous pressure, Glaucoma, Shunt

PDF  |  DOI: 10.5005/jp-journals-10078-1266  |  Open Access |  How to cite  | 

Abstract

Aim: We present a case of successful reduction of intraocular pressure (IOP) in a patient with Sturge–Weber syndrome (SWS) and moderate open angle glaucoma using a suprachoroidal shunt. Background: Patients with SWS glaucoma often have elevated episcleral venous pressure resulting in elevated IOP. This makes the conventional pathway for aqueous humor outflow a poor target for IOP reduction, yielding it difficult to treat. Medication and procedures that facilitate uveoscleral outflow have been more successful. Case description: We present a case where a suprachoroidal shunt device (CyPass®) was used to reduce IOP in a patient with SWS. The IOP reduction has persisted for 12 months without complication or the requirement for topical prostaglandin analog use. Conclusion: The uveoscleral pathway is a preferred target for IOP reduction in patients with elevated episcleral venous pressure. The CyPass device offers a promising ab interno minimally invasive glaucoma surgery (MIGS) approach to reduce IOP in cases where a pathologic pressure gradient exists in the trabecular meshwork. Clinical significance: Glaucoma in patients with SWS has been historically difficult to treat. Previous surgical procedures that have been successful are more invasive and have required the creation of alternative drainage routes of aqueous humor. The CyPass device offers a promising less invasive option to reduce IOP in these patients.

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