Journal of Current Glaucoma Practice

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2023 | April-June | Volume 17 | Issue 2

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EDITORIAL

Leon Au

Can We Ever Win with a Suprachoroidal Implant?

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:3] [Pages No:55 - 57]

   DOI: 10.5005/jp-journals-10078-1410  |  Open Access |  How to cite  | 

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RESEARCH ARTICLE

Naveen K Challa

Optic Nerve Head Parameters in Saudi Male Young Adults Using Swept-source Optical Coherence Tomography

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:5] [Pages No:58 - 62]

Keywords: Cup to disk ratio, Optic nerve head parameters, Retinal nerve fiber layer thickness, Swept-source optical coherence tomography

   DOI: 10.5005/jp-journals-10078-1405  |  Open Access |  How to cite  | 

Abstract

Purpose: To assess the optic nerve head (ONH) parameters in normal male Saudi eyes using swept-source optical coherence tomography (SS-OCT). Materials and methods: The study included 86 healthy men with a mean age of 23.6 ± 4.82 years. The metrics collected using SS-OCT from each individual was disk area (DA), rim area (RA), cup volume (CV), linear cup–disk ratio (LCDR), vertical cup–disk ratio (VCDR), and total retinal nerve fiber layer (RNFL) thickness, superior RNFL thickness, and inferior RNFL thickness. All the metrics were correlated with the DA. The right eye data were used for the correlation analysis. Results: The mean DA in OD was 1.78 mm2 (range 1.09–2.70 mm2). The mean RA was 1.28 mm2 (range 0.72–2.47 mm2). The DA showed a significant positive correlation (p < 0.05) with RA, cup area (CA), CV, VCDR, LCDR, and total RNFL thickness. Conclusion: For the first time, using sweeping source OCT (DRI OCT Triton, Topcon Corporation), a normative database of ONH parameters was made accessible to the Saudi male population. While assessing the optic disk for progressive optic neuropathies like glaucoma, disk size should be taken into consideration since the optic DA affects ONH topography, especially in Saudi eyes.

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ORIGINAL RESEARCH

Sunil Ruparelia, Mohammed Sharif, Nir Shoham-Hazon

Efficacy and Safety Outcomes of XEN Implantation and Gonioscopy-assisted Transluminal Trabeculotomy for the Management of Advanced Open-angle Glaucoma

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:5] [Pages No:63 - 67]

Keywords: Glaucoma, Gonioscopy-assisted transluminal trabeculotomy, Minimally invasive glaucoma surgery, Open-angle glaucoma, XEN

   DOI: 10.5005/jp-journals-10078-1394  |  Open Access |  How to cite  | 

Abstract

Aim: Minimally invasive glaucoma surgery (MIGS) is not typically used in patients with advanced-stage glaucoma. This study describes the outcomes and complications of patients with advanced open-angle glaucoma (OAG) who underwent XEN implantation with cataract surgery or gonioscopy-assisted transluminal trabeculotomy (GATT) with cataract surgery. Methods: This retrospective study identified patients who had undergone XEN implantation or GATT for the management of advanced OAG. Outcomes included surgical success, intraocular pressure (IOP) reduction, number of topical IOP-lowering drops, visual field mean deviation (MD), best-corrected visual acuity (BCVA), and complications. Surgical success was defined as an IOP of <14 mm Hg and a 20% reduction at 12 months without topical IOP-lowering drops (complete success) or with topical IOP-lowering drops (qualified success). Results: Exactly 70 eyes were enrolled in this study, including 35 who had undergone XEN implantation and 35 who had undergone GATT. The overall surgical success rate was 74.3% (26 of 35) for eyes that underwent XEN implantation and 71.4% (25 of 35) for eyes that underwent GATT. Percent IOP reduction from baseline to 12 months postoperatively was 48% in the XEN cohort and 32% in the GATT cohort. Significant reduction in the use of topical IOP-lowering drops was demonstrated for both XEN (3.26 ± 1.15–1.23 ± 1.28) (p < 0.001) and GATT (2.46 ± 1.12–0.43 ± 0.78) (p < 0.001) cohorts at 12 months postoperatively. The only complication reported was transient hyphema, which occurred in three patients from the XEN group and four from the GATT group, and resolved spontaneously. Conclusions: Both XEN implantation and GATT may be safe and effective management options when treating patients with advanced OAG. However, larger sample sizes are required to make direct statistical comparisons between these techniques. Clinical significance: In this study, XEN implantation and GATT combined with cataract surgery were each associated with favorable outcomes in patients with advanced OAG.

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Original Article

Suneeta Dubey, Kanika Jain, Julie Pegu, Saptarshi Mukherjee

Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:7] [Pages No:68 - 74]

Keywords: Childhood glaucoma, Childhood Glaucoma Research Network classification, Primary congenital glaucoma, Primary glaucoma, Secondary glaucoma

   DOI: 10.5005/jp-journals-10078-1400  |  Open Access |  How to cite  | 

Abstract

Purpose: To ascertain the prevalence and clinical features of the various types of childhood glaucoma at a tertiary eye care hospital in Northern India. Materials and methods: Retrospective chart review of all children less than 16 years of age with childhood glaucoma who presented from 1st April 2014 to 31st March 2019, who was diagnosed to have any subtype of childhood glaucoma as per Childhood Glaucoma Research Network (CGRN) classification and advised appropriate management. Results: Out of 405 children with childhood glaucoma, 36% had primary glaucoma, whereas the rest had secondary glaucoma. Primary congenital glaucoma (PCG) was the most common form of primary glaucoma. Glaucoma associated with acquired conditions was the most common cause of secondary glaucoma. Primary glaucoma was mostly bilateral in contrast to secondary glaucoma. The most common age of presentation with primary glaucoma was <1 year of age, and in children with secondary glaucoma was 11–16 years. On presentation, 80% of eyes had intraocular pressure (IOP) of >20 mm Hg and 70% had cupping of >0.7. Eyes with PCG were primarily managed surgically. Conclusion: In our cohort, PCG was the most common primary childhood glaucoma. Traumatic glaucoma was the most common secondary glaucoma. Since childhood glaucoma is an important cause of visual morbidity in children, its timely diagnosis and prompt management are essential to prevent irreversible visual loss. Clinical significance: Understanding the disease pattern, their presenting features, and the proportion of different types of childhood glaucoma can help in planning appropriate eye care services, create awareness and better allocate resources to plan appropriate management strategies. Screening programs and counseling of parents should also be strengthened.

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Original Article

Pedro Henrique Alves Soares, Rafael de Oliveira Santos, Celso Ribeiro Angelo De Menezes Filho, Sebastião Pimenta Moraes Neto, João Antonio Prata Junior

Goldmann Applanation Tonometry: Comparison of Intraocular Pressure Values Obtained with Disposable Tip and Conventional Applanation Prism in the Population without Clinical Signs of Glaucoma

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:4] [Pages No:75 - 78]

Keywords: Cross-sectional studies, Disposable tip, Intraocular pressure, Tonometry

   DOI: 10.5005/jp-journals-10078-1401  |  Open Access |  How to cite  | 

Abstract

Aim: Comparing intraocular pressure (IOP) measurements using Goldmann applanation prism and TonoSafe® in the population without signs of glaucoma. Material and methods: Patients with no ocular pathologies, except ametropia (until ± 4 D) or IOP of <30 mm Hg without signs of glaucoma by optic disc structural analysis by fundus biomicroscopy. The IOP was measured sequentially using the traditional cone and the TonoSafe®, according to a randomization list to determine which device would be used first. The measurements from the right and left eyes were compared separately. Since there was no statistical difference, both eyes were considered in this study. Results: A total of 385 eyes of 194 patients with a mean age of 66.4 ± 11.2 years old were included. The mean IOP with conventional prism was 14.2 ± 3.6 and 14.3 ± 3.6 mm Hg with TonoSafe®. Differences were not statistically significant by the Wilcoxon test (p = 0.3). The median was 14.0 mm Hg for both groups. The mean difference between measurements was 0.04 mm Hg, with the median equal to zero. There was no statistical difference in IOP readings according to which device was the first measurement. Conclusion: No statistical difference was found in IOP was measured with conventional prism or TonoSafe® in the population without signs of glaucoma. Clinical significance: The data provided by our study support the efficacy and safety of the disposable tonometer compared to the Goldman tonometer in measuring IOP in patients without glaucoma.

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Original Article

Lassina Traoré, Jérôme Sanou, Bélélé S Bakyono, Abdou A Zoure, Théodora M Zohoncon, Hermann K Sombié, Albert T Yonli, Guertrude Meda-Hien, Ezechiel B Tibiri, Florencia W Djigma, Jacques Simpore

Prevalence of Glu323Lys Mutation of the TIGR/MYOC Gene and Risk Factors amongst Primary Open-angle Glaucoma Patients in Ouagadougou, Burkina Faso

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:6] [Pages No:79 - 84]

Keywords: Burkina Faso, Glu323Lys mutation, Risk factors glaucoma

   DOI: 10.5005/jp-journals-10078-1403  |  Open Access |  How to cite  | 

Abstract

Aim: Glaucoma is a group of degenerative diseases of the optic nerve whose predisposing factors may be genetic. The objective of this study was to estimate the frequency of the Glu323Lys mutation as a genetic risk factor for glaucoma. Materials and methods: A cross-sectional study over 6 months from October 2020 to March 2021 in Ouagadougou, Burkina Faso. A total of 89 samples of patients with primary open-angle glaucoma (POAG) were collected. The frequency of the Glu323Lys mutation of the myocilin, trabecular meshwork inducible glucocorticoid response (TIGR/MYOC) gene by polymerase chain reaction (PCR)—restriction fragment length polymorphism. Results: In glaucoma patients, only homozygous nonmutated guanine-guanine (GG) and heterozygous mutated adenine-guanine (AG) genotypes were found in 96.63 and 3.37% of cases, respectively. Around 69.66% of patients had a family history of glaucoma, 28.09% had a history of hypertension, and 7.86% had a history of diabetes. Conclusion: The frequency of the Glu323Lys mutation of the TIGR/MYOC gene was 3.37% in the glaucoma population in Ouagadougou. A case-control study is necessary to know the contribution of the Glu323Lys mutation as a genetic risk factor for glaucoma in our study population. Clinical significance: This study constituted the beginning of genetic investigations of glaucoma in our context and showed a low Glu323Lys mutation.

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Original Article

Angelica M Prada, Alejandro Tello, Carlos M Rangel, Virgilio Galvis, Gustavo Espinoza

Agreement between Two Swept-source Optical Coherence Tomography: Optic Nerve Head, Retinal Nerve Fiber Layer and Ganglion Cell Layers in Healthy Eyes

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:6] [Pages No:85 - 90]

Keywords: Ganglion cell, Glaucoma, Optical coherence tomography, Optic nerve, Repeatability, Reproducibility, Swept source

   DOI: 10.5005/jp-journals-10078-1409  |  Open Access |  How to cite  | 

Abstract

Aim and background: Precision of optical coherence tomography (OCT) measurements of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macular ganglion cell layer (GCL) is essential for the diagnosis and monitoring of glaucoma. The purpose of this research was to evaluate the repeatability and reproducibility of retinal and ONH parameters measured with two identical swept-source optical coherence devices. Methods: A cross-sectional study was conducted. A total of 30 eyes of 15 healthy subjects were included. Two technicians performed four OCT-wide protocol scans in the same visit using two identical Triton swept-source OCT (DRI-OCT) instruments. The interdevice and interobserver reproducibility and the repeatability of both instruments for all ONH, RNFL, and macular GCL parameters were evaluated by the intraclass correlation coefficient (ICC). Additionally, Bland–Altman test analysis was used for repeatability and reproducibility measurements. Results: Intraclass correlation coefficient (ICCs) of the ONH, RNFL, and GCL measurements were excellent for repeatability and interdevice reproducibility (>0.9). Interobserver reproducibility was good for all parameters except for RNFL clock hour 11 (ICC = 0.72). The variability of the average RNFL was from −4.103 to 4.97 µm, with a mean percentage of the difference (PD) of 0.37 ± 2.03%. Among GCL parameters, the greatest variability was found in the inferior sector (PD = −0.88 ± 5.39%, limits of agreement (LoA) = −8.345–7.078 μm). Conclusion: Using two identical swept-source OCT instruments for the evaluation of the structural parameters of the ONH, RNFL, and macular GCL showed high repeatability and reproducibility. This allows the clinician to make a therapeutic decision based on OCT findings coupled with the clinical evaluation of the patient. When evaluating RNFL clock hours measurements, interobserver reproducibility might decrease. Clinical significance: The understanding of measurement variability while using different devices and the impact of the observer capturing the images, is clinically relevant.

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ORIGINAL RESEARCH

Sunidhi Ramesh, Wesam S Shalaby, Jonathan S Myers, Leslie J Katz, Natasha N Kolomeyer, Daniel Lee, Reza Razeghinejad, Marlene R Moster, Aakriti G Shukla

Evaluation of the Hypertensive Phase after Ahmed Glaucoma Valve Implantation in Neovascular Glaucoma

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:7] [Pages No:91 - 97]

Keywords: Ahmed glaucoma valve, Hypertensive phase, Intraocular pressure, Neovascular glaucoma

   DOI: 10.5005/jp-journals-10078-1406  |  Open Access |  How to cite  | 

Abstract

Purpose: To compare Ahmed glaucoma valve (AGV) outcomes in neovascular glaucoma (NVG) eyes with and without a postoperative (PO) hypertensive (HTN) phase. Design: Retrospective study at a single tertiary care center of patients who underwent AGV implantation for NVG treatment with ≥6-month follow-up. Methods: Main outcome measures included intraocular pressure (IOP), number of glaucoma medications (GM), and failure at month 6 or at the most recent visit. Failure was defined as decline to no light perception (NLP) vision, IOP >21 mm Hg, or need for glaucoma reoperations (all with GM). Results: A total of 76 eyes of 74 patients (37 without HTN phase and 39 with HTN phase) with a mean follow-up duration of 28.9 ± 25.7 months (p = 0.602) were included. Both groups had similar demographics, visual acuity (VA), number of GM, etiology of NVG, and retina treatment perioperatively. Baseline IOP was significantly higher in the HTN phase group (p = 0.001). Compared to eyes without an HTN phase, HTN phase eyes more commonly met failure criteria at month 6 (33.3 vs 9.1%; p = 0.01), but both groups had a comparable cumulative failure for the entire follow-up period (p = 0.180). At the most recent visit, the number of GM was higher in the HTN phase group (p = 0.019), but IOP was similar in both groups. PO complications were comparable and uncommon in both groups. Conclusion: Hypertensive (HTN) phase following AGV implantation for NVG is associated with higher preoperative IOP and greater failure by PO month (POM) 6. However, eyes with and without the HTN phase had similar needs for GM and failure rates over the long term.

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Original Article

Kasra Afzali, Dylann K Fujimoto, Seyed Omid Mohammadi, Ken Y Lin

Race and Gender Shift among Academic Glaucoma Specialists in the Last 5 Decades

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:6] [Pages No:98 - 103]

Keywords: Drainage devices, Fenestration, Glaucoma, Glaucoma drainage devices, Glaucoma drainage implants, Glaucoma surgery, Surgical technique, Technique

   DOI: 10.5005/jp-journals-10078-1407  |  Open Access |  How to cite  | 

Abstract

Purpose: To evaluate the demographic composition of academic glaucoma specialists currently practicing in the United States. Design: Retrospective and observational study. Subjects: Academic glaucoma specialists identified from ophthalmology residency programs listed on the Doximity database. Methods: The American Board of Ophthalmology (ABO) membership directory, Doximity database, publicly available data, and direct communications were used to identify academic glaucoma specialists and their demographics. Information collected included—name, gender, race/ethnicity, geographic location, board certification date, academic affiliation, and academic rank. Ophthalmic age was defined as the number of years since ophthalmology board certification. Underrepresented minority (URM) groups were defined as Hispanics, Black or African Americans, Latinos, American Indians, or Alaskan Natives as defined by San Francisco match. In addition, the temporal, geographic, and academic rank distributions among females and URMs were explored. Main outcome measures: Women and URMs representations among academic glaucoma specialists across academic ranks, geographic regions, as well as ophthalmic age. Results: There were 457 active academic glaucoma specialists identified from 110 institutions in 38 states. Among them, 185 (40.5%) were women and 42 (9.2%) were URM. The proportion of women glaucoma specialists in academia had increased significantly with a rate of 1.049 in odds ratio (OR) per year (p < 0.001). However, there were no significant changes in the proportion of URMs over time. The earliest year of certification was 1,964 for males and 1,974 for females. When controlled for ophthalmic age, there were no significant differences in the distribution of women or URMs between the different academic ranks (p = 0.572 and p = 0.762, respectively). Among assistant professors, women had a significantly higher ophthalmic age compared to men (p < 0.001), but there was no significant difference in ophthalmic age in both the associate and full professor groups. There were no significant differences in the geographic distribution of gender (p = 0.516) and URM across United States regions (p = 0.238). Conclusion: The proportion of women among academic glaucoma specialists has significantly increased over the past 5 decades; however, the proportion of URMs has been stagnant in the same period. Enhancing URM representation among academic glaucoma specialists deserves to be a future priority.

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CASE REPORT

Sarah Dawson, Abhijit Mohite

Use of Ocular Response Analyzer Output Data in the Management of Low Intraocular Pressure after Glaucoma Filtration Surgery

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:2] [Pages No:104 - 105]

Keywords: Glaucoma, Glaucoma surgery, Intraocular pressure measurement, Trabeculectomy

   DOI: 10.5005/jp-journals-10078-1402  |  Open Access |  How to cite  | 

Abstract

Aim: To highlight potential benefits of using Reichert's ocular response analyzer (ORA) for intraocular pressure (IOP) measurement following glaucoma filtering surgery (GFS), especially in cases of low IOP. Background: Goldmann applanation tonometry (GAT) is widely regarded as the gold standard of IOP measurement in clinical practice. The ORA also calculates corneal biomechanics, which is used in the calculation of the cornea-compensated IOP (IOPcc).1 This useful, previously unknown information can be used to guide management in challenging clinical cases. Case description: A 78-year-old lady underwent right trabeculectomy with mitomycin C. During the first 9 months postoperatively, IOP's when measured with GAT, were found to be low (ranging between 2 mm Hg and 5 mm Hg). The patient displayed no clinical features of hypotony and visual acuity remained stable throughout. IOP was also measured with Reichert's ORA, which gives readings for corneal hysteresis (CH), corneal resistance factor and corneal corrected IOP. IOPcc measurements obtained with ORA were consistently higher, ranging from 6.7 mm Hg to 9.3 mm Hg and were more in keeping with the clinical features of the case. Conclusion: This case highlights the possibility that GAT can underestimate the true IOP in eyes with low IOP following GFS, as it does not account for corneal biomechanical properties. Clinical significance: Ocular response analyzer (ORA)—measured IOPcc may be a useful adjunct in reassuring surgeons to manage postoperative numerical hypotony conservatively in the absence of any clinical signs of hypotony.

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CASE REPORT

Yi-Wen Su, Shih-Jung Yeh, Mei-Ju Chen

New-onset Glaucoma Following Moderna COVID-19 Vaccination

[Year:2023] [Month:April-June] [Volume:17] [Number:2] [Pages:4] [Pages No:106 - 109]

Keywords: Adverse event, COVID-19 vaccine, Glaucoma, Moderna

   DOI: 10.5005/jp-journals-10078-1408  |  Open Access |  How to cite  | 

Abstract

Aim: To report a case of new-onset glaucoma following administration of the Moderna (mRNA-1273) vaccine. Background: Previous studies have reported a low incidence of ocular adverse events induced by the coronavirus disease 2019 (COVID-19) vaccine. The literature on open-angle glaucoma associated with COVID-19 vaccination is limited. Case description: The patient complained of blurred vision 2 days following the administration of the second dose of the Moderna vaccine in July 2021. At presentation, the ophthalmic examination showed elevated intraocular pressure (IOP) of 30 mm Hg in her right eye (OD) and 18 mm Hg in her left eye (OS). There were no signs of intraocular inflammation or glaucomatous optic neuropathy at the initial presentation. She was treated with a topical β-blocker first. In addition, 1 month later, her IOPs were 28 mm Hg OD and 26 mm Hg OS. Although treated with multiple antiglaucoma medications, her optic cup-to-disc ratios were increased in both eyes (OU) compared to May 2019. She developed a glaucomatous visual field (VF) defect OD in October 2021. Optical coherence tomography (OCT) revealed progressive retinal nerve fiber layer (RNFL) thinning in OU. Conclusion: Glaucoma may be a rare but severe ocular adverse event of the Moderna vaccines. The ophthalmologist should pay attention to the risk of increased IOP following COVID-19 vaccination. Clinical significance: We reported a case of new-onset open-angle glaucoma presumably associated with COVID-19 vaccination.

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