Journal of Current Glaucoma Practice

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2020 | May-August | Volume 14 | Issue 2

EDITORIAL

Tanuj Dada, Karthikeyan Mahalingam

Allostatic Load and Glaucoma: Are We Missing the Big Picture?

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:47 - 49]

PDF  |  DOI: 10.5005/jp-journals-10078-1280  |  Open Access |  How to cite  | 

Original Article

Luis G Aquino, Norman M Aquino

Evaluation of Macular Ganglion Cell Layer Thickness vs Peripapillary Retinal Nerve Fiber Layer Thickness for Glaucoma Detection Using Spectral-domain Optical Coherence Tomography in a Tertiary Philippine Hospital

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:7] [Pages No:50 - 56]

Keywords: Cross-sectional, Ganglion cell complex, Glaucoma, Macula, Optical coherence tomography, Retinal nerve fiber layer

PDF  |  DOI: 10.5005/jp-journals-10078-1278  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To appraise the validity of measuring macular ganglion cell layer (mGCL) thickness as an indicator of early glaucoma, as compared to measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness. Materials and methods: This was a single-center, single-observer, cross-sectional, retrospective study. Records included Filipino adult patients seen from January 2017 onward. Patients underwent testing of both automated visual field (VF) testing with either Humphrey Visual Field Analyzer (24-2 SITA program) or Octopus 311 (G1 program), and standard Spectral-Domain Optical Coherence Tomography (Cirrus HD-OCT 5000). Modified Hodapp–Anderson–Parrish criteria were used to classify subjects as either healthy, suspect, or early glaucomatous eyes. Thickness changes were directly observed through optical coherence tomography. Area under receiver operating curve (AUC) analysis was used to determine ability of mGCL and pRNFL to discriminate between healthy and early glaucomatous states. Results: A total of 96 eyes were included. Progressive thinning for all parameters was noted for both pRNFL and mGCL from healthy to suspect to early glaucomatous eyes. The highest AUC of 0.744 was seen in average pRNFL of healthy vs early glaucomatous eyes. However, AUC values for both pRNFL and mGCL were all above 0.500. Conclusion: Measurements of mGCL thickness in Filipino patients exhibit comparable performance to pRNFL measurements in detecting early anatomic glaucomatous change. It is a tool that can be utilized for early glaucoma detection in addition to current standard diagnostic tests. Clinical significance: This study, the first to be performed on Filipino patients, validates using mGCL thickness as a good parameter in discriminating between normal and early glaucoma patients for this particular population and Ethnic group.

Original Article

Diane T Siegel, Monica K Ertel, Jennifer L Patnaik, Nida S Awadallah, Cara E Capitena Young, Leonard K Seibold, Malik Y Kahook

Acute Ocular Effects of Sphenopalatine Ganglion Nerve Block

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:57 - 60]

Keywords: Headache, Intraocular pressure, Nerve block, Sphenopalatine ganglion

PDF  |  DOI: 10.5005/jp-journals-10078-1282  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The goal of this study was to measure acute ocular effects in patients undergoing routine sphenopalatine ganglion (SPG) nerve block for headache. Projections from the SPG influence blood flow to the eye which may influence intraocular pressure (IOP). There are limited animal and human studies investigating the relationship between the SPG and its effect on the eye. Materials and methods: This was a single-site, investigator-initiated, single-visit, prospective study. Participants were aged 18–85 years old who had consented to SPG nerve block for headache. The primary outcome measures were change in near visual acuity (NVA) and IOP pre-procedure to immediately post-procedure. Additional data collected included pupil diameter and presence of any ocular or visual complaints. Results: A total of 13 patients were enrolled in the study. Average pre-procedure IOP was 14.2 mm Hg [standard deviation (SD) 3.8] in the right eye and 13.7 mm Hg (SD 3.2) in the left eye. Average post-procedure IOP was 14.8 mm Hg (SD 3.8) in the right eye and 14.2 mm Hg (SD 2.9) in the left eye. Neither the right nor left eye experienced a statistically significant change in IOP after SPG block. There were no statistically significant changes in average NVA or pupil diameter in either eye. There were no adverse events. Conclusion and clinical significance: This pilot study suggests no significant acute changes in IOP or other ocular parameters after SPG block for headache disorders and supports the fact that the procedure is safe as it relates to ocular health. The ocular effects of SPG blockade merit further study in a larger cohort of patients.

Original Article

Saaquib R Bakhsh, David Rooney, Bryan A Goldman, Tom Obertynski, Chirag K Gupta

A Case Series Demonstrating a Novel Technique for Reversal of Trabeculectomy Using Lamellar Sclerectomy and Corneal Graft

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:3] [Pages No:61 - 63]

Keywords: Corneal patch graft, Lamellar sclerotomy, Persistent hypotony, Trabeculectomy reversal

PDF  |  DOI: 10.5005/jp-journals-10078-1277  |  Open Access |  How to cite  | 

Abstract

Aim and objective: We describe two cases demonstrating a new technique to permanently reverse a problematic trabeculectomy. Background: Trabeculectomy-related complications are typically treated in a manner that preserves the initial surgical outcome; however, in certain cases a complete reversal of the trabeculectomy is preferable to revision. Technique: Our technique involves seating a lamellar corneal graft into a partial thickness sclerectomy. Conclusion: This method achieves permanent closure of large ostomies or areas of scleromalacia. Clinical significance: This technique can be used on very anterior ostomies while still providing an excellent seal, patient comfort, and cosmesis without inducing astigmatism.

Original Article

Efstathios T Detorakis, Adan Villamarin, Sylvain Roy, Stephane Bigler, Georgios Bontzos, Constantinos Stergiopulos, Nikos Stergiopulos

eyeWatch™ System Combined with Non-plated Intraorbital Tube Insertion for the Management of Refractory Glaucoma: A Case Series

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:64 - 67]

Keywords: Anti-glaucomatous implant, Anti-glaucomatous tube, Anti-glaucomatous valve, eyeWatch™, Glaucoma

PDF  |  DOI: 10.5005/jp-journals-10078-1276  |  Open Access |  How to cite  | 

Abstract

Introduction: The eyeWatch™ is a novel device in glaucoma surgery aiming at the control of aqueous flow through the use of an external magnetic control unit. We propose the modification of this approach through the use of an injectable perforated tube rather than a plated valve. Materials and methods: Procedures were performed at the Department of Ophthalmology of the University of Crete. Three blind painful eyes of three patients were included. All patients were operated under topical anesthesia. A purpose designed blunt-ended injector was used to insert intraorbitally a perforated 4 cm-long silicone tube. The tube was then connected to an eyeWatch™ device which was placed in a standard fashion along the superior–temporal quadrant of the eyeball. The procedure was uneventful in cases I and II, whereas in case III the tube had to be trimmed by 1.5 cm because of cicatricial changes in the orbit. The eyeWatch™ was left closed (position VI) at the conclusion of surgeries. Patients were examined on the 1-day, 1-week, 2-week, 1-month, 3-month, and 6-month intervals and in one case on the 12-month interval. Results: No major complications were observed. The intraocular pressure (IOP) remained under 15 mm Hg without anti-glaucomatous medications in all postoperative intervals in cases I and 2 with readjustment of eyeWatch™ at position IV. In case III, despite the change of the eyeWatch™ to the open position, the IOP remained high (40 mm Hg). Discussion: The combination of the eyeWatch™ with an insertable perforated tube instead of a standard non-valved plate may prove a valid minimally invasive option. Modifications of the technique, such as an increased number and diameter of tube perforations, increased inserted tube length, perhaps aided by a sharp-ended injector, and selection of the insertion quadrant, may increase the effectiveness of the method. Clinical significance: eyeWatch™ combined with a single tube instead of a plated valve is a feasible, quick, and minimally invasive technique that can be used in glaucoma surgery.

REVIEW ARTICLE

Shibal Bhartiya

Patient Centricity and the Ethics of Glaucoma Care

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:68 - 71]

Keywords: Ethics, Glaucoma practice, Patient centricity, Quality of life, Shared decision-making

PDF  |  DOI: 10.5005/jp-journals-10078-1281  |  Open Access |  How to cite  | 

Abstract

The ultimate goal of glaucoma therapy, as of any other therapeutic intervention, is to achieve superior clinical outcomes, patient satisfaction, and patient adherence to treatment. In a chronic asymptomatic disease, such as, glaucoma, where diagnostic and therapeutic algorithms may have multiple acceptable treatment arms, patient centricity becomes increasingly important. Shared decision-making, patient participation, quality of life (QoL) concerns, and risk–benefit analyzes further complicate this decision-making. In addition, the ethics of research in glaucoma and also that of glaucoma screening may often be in conflict with the ethics of patient care. This article aims to highlight the ethical dilemmas that confound decision-making in current glaucoma practice, and the doctors’ fiduciary duties to the patient.

CASE REPORT

Gustavo Espinoza, Ignacio Rodriguez-Uña, Angelica Pedraza-Concha

A Case of Bilateral Delayed-onset Hyphema Following Pupil Dilation after Gonioscopy-assisted Transluminal Trabeculotomy

[Year:2020] [Month:May-August] [Volume:14] [Number:2] [Pages:4] [Pages No:72 - 75]

Keywords: Glaucoma surgery, Gonioscopy-assisted transluminal trabeculotomy, Hyphema, Minimally invasive glaucoma surgery, Mydriasis

PDF  |  DOI: 10.5005/jp-journals-10078-1279  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To present a case of bilateral delayed-onset hyphema following the administration of a 1% tropicamide and 2.5% phenylephrine fixed combination ophthalmic agent, in the late follow-up period of a gonioscopy-assisted transluminal trabeculotomy (GATT) combined with cataract extraction. Background: Gonioscopy-assisted transluminal trabeculotomy consists on a 360° trabeculotomy through an ab interno approach that may also be combined with cataract surgery. Delayed-onset hyphema has been reported with trabecular minimally invasive glaucoma surgery (MIGS) procedures. Some proposed mechanisms are ocular compression and decompression during sleeping on the surgical side and episcleral venous pressure rise after physical activity. Case description: We describe the case of a 68-year-old female patient with ocular hypertension (OHT) and bilateral cataracts who underwent uncomplicated combined GATT and cataract extraction surgery. Postoperatively, 8 months after the left eye (OS) surgery and 3 months after the right eye (OD) surgery, patient came for routine evaluation. After induced mydriasis, slit-lamp evaluation revealed the presence of 3+ OD and 4+ OS erythrocytes in the anterior chamber (AC). Prednisolone acetate was prescribed q.i.d. and remission of hyphema was achieved after 2 weeks. Subsequently, 4 months later, the pupil dilation was again induced showing 4+ erythrocytes in both eyes (OU), layered hyphema in the inferior quadrant OS, and intraocular pressure (IOP) spike OU. The intraocular pressure was controlled after oral acetazolamide was prescribed. Topic prednisolone was initiated, and after 1 week, the hyphema was resolved in OU. Conclusion: Delayed-onset microhyphema may occur following induced mydriasis even months after the uncomplicated GATT procedure. Ophthalmologists should be aware of the possibility of microhyphema after induced mydriasis and the risks that this might represent with noteworthy and repeated IOP spikes which may eventually require treatment. Clinical significance: Delayed-onset hyphema and IOP spikes may occur following the pupil dilation with fixed combination of phenylephrine and tropicamide ophthalmic agent after the uncomplicated GATT procedure.

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