Journal of Current Glaucoma Practice

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2021 | January-April | Volume 15 | Issue 1

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Youssef Abdelmassih, Karim Tomey, Ziad Khoueir

Micropulse Transscleral Cyclophotocoagulation

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:7] [Pages No:1 - 7]

   DOI: 10.5005/jp-journals-10078-1298  |  Open Access |  How to cite  | 


Original Article

Mohamad Dakroub, Diana Khair, Bahaa Noureddine, Christiane Al-Haddad

Pediatric Glaucoma in a University Hospital

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:6] [Pages No:8 - 13]

   DOI: 10.5005/jp-journals-10078-1291  |  Open Access |  How to cite  | 


Aims and objectives: This study aimed at describing the characteristics and outcomes of pediatric glaucoma patients in a university hospital in Lebanon and comparing them between primary congenital glaucoma (PCG) and secondary glaucoma. Materials and methods: Sixty-four eyes of 40 pediatric glaucoma patients with a follow-up of 1 year or more were reviewed. Parameters were studied for both PCG and secondary glaucoma groups. Three major outcomes were considered: intraocular pressure (IOP) control, final best-corrected visual acuity (BCVA), and the proportion of failed angle surgeries. Results: Sixty-four eyes were included divided into 29 PCG and 35 secondary glaucoma eyes, followed up for a mean of 6.6 ± 4.7 years. Eyes with PCG presented earlier, with a higher initial IOP and underwent earlier surgery than their secondary glaucoma counterparts. Although 85.9% of all eyes achieved good IOP control, 44.4% of them had a BCVA ≥20/50 with PCG having a better visual prognosis. Secondary glaucoma eyes needed more medications at the end of their follow-up. In this group, it was shown that a later age at first surgery, unilateral disease, and multiple surgeries were associated with a BCVA < 20/50. Conclusion: Patients with PCG presented earlier and with a higher IOP than secondary glaucoma; they were also operated on earlier. Both groups demonstrated good IOP control at the end of the follow-up period with PCG eyes having a superior visual outcome. Secondary glaucoma eyes required a higher number of medications at their final visit. In this population, multiple surgeries, unilateral disease, and a delayed first surgery conferred a poorer visual prognosis. Clinical significance: Data regarding the characteristics of pediatric glaucoma, especially in the Middle East, are scarce. Our study sheds the light on the presentation of different types of pediatric glaucoma and their outcomes namely IOP control and visual acuity.


Original Article

Shruti Aggarwal, Candice Kremer, Stephanie Engelhard, Sandra Johnson

Comparison of Locally Sourced Pericardium and Other Conventional Patch Graft Materials in a Glaucoma Drainage Device Surgery

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:5] [Pages No:14 - 18]

   DOI: 10.5005/jp-journals-10078-1294  |  Open Access |  How to cite  | 


Purpose: Our study aimed to compare the outcomes and costs of various patch graft materials used in the setting of glaucoma drainage device (GDD) surgeries: conventional Tutoplast® pericardium (TP), locally-obtained Lifenet® pericardium (LP), and tissue-banked corneal (CP) and scleral (SP) patches. Design: Retrospective observational study. Subjects: One hundred and ninety-five eyes of 185 patients who underwent glaucoma device surgery with patch grafts were included. Materials and methods: Patient records were reviewed for demographics and surgical data including age at the time of GDD surgery, race, sex, eye, history of diabetes or immunologic disease, glaucoma diagnosis, length of follow-up, pre- and postoperative intraocular pressure (IOP), type and location of GDD, patch type, and tube-related complications. Main outcome measures: The primary outcome measures were rates of patch graft-related complications including conjunctival dehiscence with and without tube exposure. Secondary outcome measures were IOP control achieved and cost of patch graft materials. Results: Mean follow-up for all eyes was 17.1 months. Overall, conjunctival dehiscence without tube exposure occurred in four eyes (2.1%); tube exposure was seen in six eyes (3.1%). The mean time to exposure was 3.3 months (range 1–8 months). The rate of tube exposure was 2.3% of eyes with TP grafts, 10.7% of eyes with CP grafts, 2.8% of eyes with SP grafts, and 0% of eyes with LP grafts. There was no significant difference in rates of tube exposure rates by graft material (p = 0.26). Multivariate logistic regression analysis with adjustment for patch type, age, sex, implant type, and location revealed no significant risk factors for tube exposure. Univariate logistic regression was then performed on the same risk factors as well as diabetes, prior and concurrent ocular surgery, and showed no significance. Conclusion: Our preliminary, short-term results show that locally sourced patch graft material can be a cost-effective alternative to traditionally used patch grafts without an increase in tube exposure rates. To further determine the efficacy of the different patch graft materials, longer-term comparative prospective trials are needed. Longer prospective studies are needed to compare the long-term safety and rate of tube exposures in these locally obtained patch graft materials.


Original Article

Egbula N Eni, Winifred Nolan, Bassey Eval, John C Buchan

What Glaucoma Surgical Rate could Serve as a Target for West Africa? A Systematic Review

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:9] [Pages No:19 - 27]

   DOI: 10.5005/jp-journals-10078-1293  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to use the available evidence to model a glaucoma surgical rate (GSR), which could serve as a target for West Africa. Materials and methods: A comprehensive literature search was performed in Medline, Embase, Global Health, and CINAHL, and studies published between January 1, 2000, and June 19, 2020, were retrieved. Study selection, quality appraisal, and data extraction were performed and the results of individual studies aggregated and presented using a narrative synthesis. Using these data, we aimed to construct a target GSR per million population per year that is sufficient to offer trabeculectomy to most patients with glaucoma who are diagnosed, and for whom other treatment options are either ineffective or inappropriate. The findings were then used to develop a trabeculectomy target for West Africa. Results: Initial searches returned 633 references, of which 33 unique studies were eligible for inclusion. The glaucoma prevalence population-based surveys identified, reported a wide range of prevalence of primary open-angle glaucoma (POAG) ranging from 1.0 to 8.4%. The studies on glaucoma medications reported intraocular pressure (IOP)-lowering effects ranging from 12.8% (beta-blockers) to 63.7% (Timolol–Latanoprost combinations). The adherence rate to antiglaucoma medications spanned from 10.3 to 82.3%. Regarding selective laser trabeculoplasty (SLT), only two studies were found. All the studies on trabeculectomy showed a significant reduction in IOPs at different follow-up periods with many reporting the absence of vision-threatening complications. From these available data, a GSR of 50 trabeculectomies was suggested for countries in West Africa. Conclusion: This trabeculectomy target metric is expected to minimize POAG blindness in the West African subregion. Clinical significance: The proposed GSR will enable eye care workers involved in glaucoma care in West Africa to assess their efforts compared with the proposed target. The gap will signal the potential for improvement.


Original Article

Huseyin Mayali, Muhammed Altinisik, Ismail Diri, Sami Ilker, Emin Kurt, Ozcan Kayikcioglu

Comparison of Central Corneal Thickness Measurements by Contact and Non-contact Pachymetry Devices

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:4] [Pages No:28 - 31]

   DOI: 10.5005/jp-journals-10078-1295  |  Open Access |  How to cite  | 


Aim and objective: To compare central corneal thickness (CCT) measurements obtained by handheld contact ultrasound pachymetry (HCUP) and non-contact pachymetry devices. Materials and methods: Ninety eyes of 90 patients (52 male and 38 female) were included in the study. Measurements from two non-contact devices, —specular microscopy (SM, Konan Medical, CA, USA) and Oculus Pentacam (Oculus Inc., Germany)—were compared against HCUP (Pachmate 2, DGH Technology, Inc, PA, USA). Ultrasound measurements were obtained 3 times by the same user and averaged. The differences were calculated by one-way ANOVA. Agreement between measurements were assessed by Bland–Altman plots and intraclass correlation coefficient tests. Coefficient of repeatability (%, CR) was defined as 1.96*standard deviations of the differences between pairs of measurements divided by the average of the means. Results: The mean age was 34.31 ± 14.39 (14–74) years, and the mean intraocular pressure was 16.48 ± 2.63 mm Hg (12–21). Mean CCT measured by HCUP, SM, and Pentacam was 557.76 ± 36.76 μm, 550.29 ± 43.74 μm, and 541.41 ± 35.7 μm, respectively (p < 0.05). In the Bland–Altman plot, 95% limit of agreements were 19.5 and 14.18 μm among HCUP measurements, 34.55 μm between HCUP and Pentacam, 41.49 μm between SM and Pentacam, and 46.98 μm between HCUP and SM. CR values (%) were 3.49, 2.54, 6.28, 7.68, and 8.47, respectively. Conclusion: There were significant differences between the mean CCT values of the measurement devices. Clinical significance: Contact and non-contact devices may not interchangeable in the clinical assessment of CCT.


Original Article

Rita Vieira, Ana Marta, Ana Figueiredo, Rita Reis, Isabel Sampaio, Maria J Menéres

Transscleral Cyclophotocoagulation in Familial Amyloidotic Polyneuropathy Secondary Glaucoma after Ahmed Valve Implantation: A Case Series Study

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:4] [Pages No:32 - 35]

   DOI: 10.5005/jp-journals-10078-1296  |  Open Access |  How to cite  | 


Purpose: To investigate the outcomes of transscleral cyclophotocoagulation (TSCPC) after Ahmed glaucoma valve (AGV) implantation failure in patients with familial amyloidotic polyneuropathy (FAP) secondary glaucoma. Materials and methods: In this retrospective study, all patients with secondary FAP glaucoma who underwent AGV implantation between 2010 and 2019 in our tertiary center were assessed. Among all, those patients who needed TSCPC to control intraocular pressure (IOP) after AGV were selected. Demographic data, value of IOP, best-corrected visual acuity (BCVA), number of antiglaucomatous medications, surgical complications, and need for retreatment were collected. Results: From a total of 124 eyes submitted to AGV implantation, 13 eyes (10.48%) needed TSCPC to control IOP. The median age at TSCPC was 49.50 years (43; 55.75), and the median period between AGV implantation and TSCPC was 1.63 years (1.00; 3.65). There was a significant decrease of IOP after the procedure, from 24.33 ± 4.76 to 11.33 ± 2.90 mm Hg at last visit (p < 0.001). A reduction in the number of antiglaucomatous medications was also noticed, from 3.92 ± 0.29 to 1.25 ± 1.42 (p < 0.001). There was no difference in BCVA (p = 0.502). After the procedure, there was an exuberant anterior chamber (AC) reaction in two eyes (16.7%), and one case developed a neurotrophic ulcer (8.3%). There was no need for re-treatment. Conclusion: Ahmed glaucoma valve implantation is a promising surgical procedure to treat patients with PAF secondary glaucoma, showing good results. For refractory cases, TSCPC seems to be effective and safe to control IOP. Clinical significance: There are only a few studies in current literature that address amyloid secondary glaucoma, maybe because it is a rare pathology worldwide. However, it has a high incidence in certain regions, including the north of Portugal. For the record, this is the first study describing the tool of cycloablative procedures in this type of glaucoma.



Zeynep Aktas, Yavuz K Aribas, Kamil Bïlgïhan, Atike B Tefon

Collagen Crosslinking-assisted Treatment of a Bleb Leak: Enhancement of Vascularization around the Bleb

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:4] [Pages No:36 - 39]

   DOI: 10.5005/jp-journals-10078-1290  |  Open Access |  How to cite  | 


Aim and objective: To present a case with bleb leakage treated with collagen crosslinking (CXL). Background: Bleb-related complications can cause serious problems even a long time after trabeculectomy. In this case report, we present a relatively unknown treatment method for bleb leakage which might be one of the long-term complications of trabeculectomy. Case description: A 60-year-old male patient was admitted to our clinic with a decrease in his left vision. The patient had a history of left trabeculectomy. The bleb leakage was observed. Autologous blood was injected into the bleb area as the first line of treatment. Collagen crosslinking was applied to the bleb area upon the recurrence of the leakage. In the 1st week after the CXL, CXL was repeated in the bleb area upon the observation that the leakage recurred. It was observed that the leakage did not recur and bleb vascularization was triggered after CXL. Conclusion: Conjunctival CXL might be a non-invasive, viable method in the management of bleb leakage. It might be applied in conjunction with bandage contact lenses for the treatment of late bleb leaks as an alternative treatment method before going into surgical intervention. Clinical significance: As a result of conjunctival CXL application, collagen permeability reduction and neovascularization secondary to CXL application might be effective in preventing bleb leakage. However, further studies are needed to prove this.



Zeynep Aktas, Ceyda Erişti Bölük, Gokhan Gurelik

Silicone Oil Droplets in the Schlemm's Canal: A Surprise during Prolene Hemi-gonioscopy-assisted Transluminal Trabeculotomy (Hemi-GATT)

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:4] [Pages No:40 - 43]

   DOI: 10.5005/jp-journals-10078-1297  |  Open Access |  How to cite  | 


Aim and objective: To report a case with emulsified silicone oil (SO) droplets in the Schlemm's canal (SC), encountered during prolene hemi-gonioscopy-assisted transluminal trabeculotomy (hemi-GATT). Background: In cases with a history of previous pars plana vitrectomy (PPV) with SO tamponade and then SO removal; glaucoma might occur secondary to the presence of emulsified SO droplets. Minimal invasive glaucoma surgeries targeting trabecular meshwork such as GATT surgery might be an ideal treatment option in these cases. Case description: A 57-year-old man presented with uncontrolled intraocular pressure (IOP) and topical anti-glaucoma drug intolerance in his left eye. The patient had a history of PPV with SO tamponade and then intravitreal SO removal 5 years ago. He had a history of Ahmed glaucoma valve (AGV) implantation 2 years ago for the treatment of secondary glaucoma but he was still using topical anti-glaucoma medication. However, IOP was measured as 17 in the left eye. Hemi-gonioscopy-assisted transluminal trabeculotomy was performed successfully to get the patient off medication. During the surgery, SC was full of SO droplets. Conclusion: The presence of SO droplets in the SC might contribute to the development of secondary glaucoma after PPV and SO removal. This might be another surgical indication for GATT surgery in these risky eyes.



Surinder S Pandav, Natasha Gautam, Faisal Thattaruthody

Tube-in-tube: A Solution for Retracted Tube

[Year:2021] [Month:January-April] [Volume:15] [Number:1] [Pages:3] [Pages No:44 - 46]

   DOI: 10.5005/jp-journals-10078-1292  |  Open Access |  How to cite  | 


Tube retraction after Ahmed glaucoma valve (AGV) implantation is an infrequent but known complication. The management option includes the use of a commercially available AGV tube extender, 22 G angiocatheter, resisting the existing glaucoma drainage device (GDD), or insertion of a new GDD. Each of the methods described in the literature has its limitations. We describe the successful management of this complication by using a cost-effective technique of connecting the silicone tube segment to the existing tube to lengthen the tube, so that it could be inserted in the anterior chamber again. The silicone tubes used for the technique were the extra length of the GDD tube, which was cut short and leftover during other GDD implantation surgeries. Clinical significance: During any GDD implantation, the tube is cut short before entering the anterior chamber. We retrieved the short segments of the tube immediately after the GDD was opened on the table and sterilized them again using plasma technology, available in our operating room. Hence, it provides a cost-effective alternative since the tube is usually trimmed to the desired length in all cases of GDD implantation (valved/non-valved), which can be subsequently sterilized and reused for lengthening the short tube in cases with tube retraction or inadvertently cut tube.


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