Journal of Current Glaucoma Practice

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2023 | October-December | Volume 17 | Issue 4

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EDITORIAL

Shibal Bhartiya, Zeynep Aktas, Parul Ichhpujani

Is GATT the Answer?

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:2] [Pages No:167 - 168]

   DOI: 10.5005/jp-journals-10078-1425  |  Open Access |  How to cite  | 

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ORIGINAL RESEARCH

Faith Birnbaum, Susan Wakil, Daniel M Vu, Shan McBurney-Lin, Mohammed ElMallah, Henry Tseng

Postoperative Management of Kahook Dual Blade Goniotomy with Phacoemulsification Cataract Extraction

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:6] [Pages No:169 - 174]

Keywords: Cohort study, Kahook Dual Blade, Minimally invasive glaucoma surgery

   DOI: 10.5005/jp-journals-10078-1419  |  Open Access |  How to cite  | 

Abstract

Aim: To review the efficacy and safety of two common postoperative regimens following Kahook Dual Blade goniotomy with phacoemulsification cataract extraction (KDB-CE). Materials and methods: This is a retrospective review of eyes undergoing KDB-CE from May 2016 to 2018 by a single surgeon. Almost 12-month follow-up data were assessed for two common postop regimens—treatment with (1) topical prednisolone acetate 1% with pilocarpine 1% (pred-pilo) or (2) difluprednate 0.05% postoperatively. Postoperative results were compared to each respective baseline intraocular pressure (IOP) levels. Results: There were 53 eyes in the difluprednate group and 25 eyes in the pred-pilo group. In the difluprednate group, the IOP decreased at postoperative day 1 (POD1) [16 ± 5 baseline vs 15 ± 5 POD1, mean ± standard deviation (SD) in mm Hg, and p = 0.321], but increased at postoperative week 1 (POW1) due to a 15% rate of IOP-spikes (19 ± 9, p = 0.099). The number of IOP-lowering drops decreased from baseline (2 ± 1 drops) to 1 ± 1 drops at POD1 (p < 0.0001), and remained at 1 ± 1 drops through postoperative month 12 (POM12) (p < 0.0001). In the pred-pilo group, there was a statistically significant decrease in mean IOP at POW1 (16 ± 4 POW1 vs 18 ± 6 baseline, p = 0.044), which persisted through POM6. The number of IOP-lowering drops was not statistically significantly lower from baseline at POM3 (2 ± 1 at POM3, p = 0.188). Spikes in IOP, corneal edema, and hyphema were the most common complications. Conclusion: Both postoperative regimens were effective following KDB-CE at reducing IOP at 12 months. The difluprednate group was likely to experience an IOP-spike at POW1 but used fewer IOP-lowering drops 12 months after KDB goniotomy. In the pred-pilo group, the number of IOP-lowering drops was equivalent to baseline levels at POM3. Aside from IOP spikes, there were similar complication rates observed between the two postoperative regimens. Due to demographic differences, it was not possible to compare relative IOP-lowering efficacy between the two postoperative regimens. Clinical significance: It is efficacious and safe to use either postoperative regimen following KBD-CE. Postoperative trajectories may differ with respect to the postoperative regimen, but further randomized controlled trials are needed to compare various topical steroid medications for postoperative regimens following KDB-CE.

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ORIGINAL RESEARCH

Matthew Hirabayashi, Elizabeth Mellencamp, Sabrina Duong, Jayce Simoncic, Carlton Homan, Joshua King, Jella An

Effect of Selective Laser Trabeculoplasty on the Fellow Eye

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:3] [Pages No:175 - 177]

Keywords: Fellow eye, Retrospective chart review, Selective laser trabeculoplasty

   DOI: 10.5005/jp-journals-10078-1420  |  Open Access |  How to cite  | 

Abstract

Aim: Determine if selective laser trabeculoplasty (SLT) affects the fellow eye's intraocular pressure (IOP). Materials and methods: A retrospective review of 76 pairs of eyes from 76 adult glaucoma patients who underwent SLT in one eye with at least 2 months between treatments were evaluated for IOP and medication reduction in the untreated fellow eye. Success was defined as ≥20% IOP reduction or ≥1 medication reduction without any additional IOP lowering procedures or medication. The primary outcome measures were success, IOP, and medication reduction in the untreated fellow eye at 6 months. Results: At 6 months after SLT treatment, 48.7% (38/76) treated eyes and 36.8% (28/76) untreated fellow eyes met success criteria. IOP reduction in the treated eye was 2.6 ± 5.8 (14.1%; p < 0.002) and 0.8 ± 4.3 (5.1%, p = 0.122) in the fellow eye. The fellow eye was significantly more likely to meet success criteria if the treated eye was successful [odds ratio (OR): 6.00, 95% confidence interval (CI) (2.11–17.06), p < 0.002]. Conclusion: After a unilateral treatment with SLT, over one-third of the fellow eyes experienced either ≥20% IOP reduction or medication reduction. Additionally, fellow eyes were six times as likely to meet success criteria if this was observed in the treated eye. These findings may support the proposed biochemical mechanism for the therapeutic action of SLT. Clinical significance: The implication for clinicians is that SLT treatment in one eye may allow the fellow eye to benefit and provide a prediction on the fellow eye's response without subjecting both eyes to the rare but present complications of SLT.

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ORIGINAL RESEARCH

Andrew Tirsi, Vasiliki Gliagias, Hosam Sheha, Bhakti Patel, Julie Moehringer, Joby Tsai, Rohun Gupta, Stephen A Obstbaum, Celso Tello

Retinal Ganglion Cell Functional Recovery after Intraocular Pressure Lowering Treatment Using Prostaglandin Analogs in Glaucoma Suspects: A Prospective Pilot Study

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:13] [Pages No:178 - 190]

Keywords: Ganglion cell layer + inner plexiform layer, Glaucoma suspects, Intraocular pressure treatment, Pattern electroretinogram, Retinal ganglion cells, Retinal nerve fiber layer thickness

   DOI: 10.5005/jp-journals-10078-1423  |  Open Access |  How to cite  | 

Abstract

Aim and background: To evaluate the ability of pattern electroretinogram (PERG) to detect improvement of retinal ganglion cell (RGC) function in glaucoma suspects (GS) after medically reducing intraocular pressure (IOP) using prostaglandin analog drops. Materials and methods: Six subjects (eight eyes) received topical IOP lowering treatment based on their clinical examination and were observed at Manhattan Eye, Ear & Throat Hospital over an average of 3.1 ± 2.2 months. During this time, participants underwent a full ophthalmologic exam and were evaluated with a Humphrey visual field analyzer (HFA) 24–2 [24–2 mean deviation (MD), 24–2 pattern standard deviation (PSD), and 24–2 visual field indices (VFI)], Diopsys NOVA PERG optimized for glaucoma [magnitude (Mag), magnitudeD (MagD), and magnitudeD/magnitude ratio (MagD/Mag ratio)] and optical coherence tomography (OCT)-derived average retinal nerve fiber layer thickness (avRNFLT) and average ganglion cell layer + inner plexiform layer (avGCL + IPL) thicknesses at baseline visit (pretreatment) and 3 months later (posttreatment). Goldman applanation tonometry was used to measure IOP at each visit. Paired sample t-tests were conducted to determine the statistical significance of the change in IOP, HFA indices, PERG parameters, and OCT thickness measurements between the two visits. Results: Lowering IOP by 22.29% resulted in a significant increase (32.98 and 15.49%) in MagD [t (7) = −3.174, 95% confidence interval (CI) = −0.53, −0.08, p = 0.016] and MagD/Mag ratio [t (7) = −3.233, 95% CI = −0.20, −0.03, p = 0.014], respectively. There was a positive percentage change for all variables of interest, however, 24–2 MD, Mag, avRNFLT, and GCL+ IPLT did not reach statistical significance. Conclusion: After reducing IOP by 22.29% for a duration of 3.1 months, the PERG parameters, MagD and MagD/Mag ratio, significantly improved by 32.98 and 15.49%, respectively. Clinical significance: Pattern electroretinogram (PERG) may be a crucial tool for clinicians to locate a window of opportunity in which degenerating yet viable RGCs could be rescued from irreversible damage. We suggest consideration of PERG as a tool in early retinal ganglion cell (RGC) dysfunction detection as well as for monitoring IOP lowering treatment.

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ORIGINAL RESEARCH

Christiane Al-Haddad, Anita Barikian, Zeinab El Moussawi, Nour A Nasser, Bahaa Noureddine, Ziad Bashshur

Success of Endoscopic Laser Cyclophotocoagulation vs Repeat Transscleral Treatment after Prior Transscleral Cycloablation

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:6] [Pages No:191 - 196]

Keywords: Endoscopic cyclophotocoagulation, Glaucoma, Transscleral cycloablation, Treatment

   DOI: 10.5005/jp-journals-10078-1426  |  Open Access |  How to cite  | 

Abstract

Aim: To compare the efficacy of endoscopic cyclophotocoagulation (ECP) vs repeat transscleral cyclophotocoagulation (TCP) in eyes with persistent glaucoma despite prior treatment with TCP. Materials and methods: This was a retrospective chart review of glaucoma patients at the American University of Beirut Medical Center over 10 years who underwent ECP or repeat TCP. We reported qualified and complete success; success was defined as postoperative intraocular pressure (IOP) ≤21 mm Hg, with (qualified) or without medications (complete) and without procedure-related complications. Results: This study included 23 eyes of 21 patients with various forms of uncontrolled glaucoma who had failed TCP. A total of 13 eyes of 12 patients underwent ECP with a mean age of 39.9 ± 23.2 years, and 10 eyes of nine patients underwent repeat TCP with a mean age of 27.2 ± 22.6 years. A significant decrease in IOP was observed from 38.5 ± 7.9 mm Hg preoperatively to 25.2 ± 8.8 mm Hg postrepeat TCP (p = 0.006) and from 33.0 ± 9.5 to 12.8 ± 3.9 mm Hg post-ECP (p < 0.001), noted at a mean follow-up time of 39.2 ± 44.4 and 41.5 ± 37.4 months, respectively. The mean number of antiglaucoma medications decreased in the two groups (from 3.8 ± 1.0 preoperatively to 1.8 ± 0.9 postoperatively for ECP and from 3.5 ± 1.3 to 3.1 ± 0.9 postoperatively for TCP); however, the drop was only statistically significant post-ECP. Qualified success was significantly higher after ECP vs repeat TCP (91.7 vs 40%, respectively). Complete success was achieved only in 1/12 (8.3%) eyes in the ECP group. Conclusion: Endoscopic cyclophotocoagulation (ECP) performed in glaucomatous eyes previously treated with transscleral cycloablation provided more IOP control as compared to repeat TCP by directly treating viable tissue in previously skipped ciliary processes and in between processes. Clinical significance: In glaucomatous eyes previously treated with transscleral cycloablation, ECP attained better IOP control than repeat transscleral cycloablation.

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Original Article

Federico Di Staso, Paul A Gaudio

Aqueous Outflow Facility after Periocular Triamcinolone Injection: A Preliminary Evaluation of the Falck Medical Applanation Tonometer

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:8] [Pages No:197 - 204]

Keywords: Glaucoma, Goldmann, Outflow facility, Tonography, Triamcinolone, Uveitis

   DOI: 10.5005/jp-journals-10078-1421  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the Falck Medical Applanation Tonometer 1 (FMAT-1) as a device for measuring intraocular pressure (IOP) and outflow facility (OF) in patients with uveitis after periocular triamcinolone injection in one eye. Materials and methods: Retrospective observational comparison. IOP and OF measurements were recorded and analyzed, comparing Goldmann tonometry and FMAT-1 readings. Records were reviewed for adult patients with uveitis who had undergone recent periocular triamcinolone injection in one eye. Results: A total of 19 patients’ records were evaluated. In treated eyes, median IOPs (in mm Hg) by Goldmann and FMAT-1 were 21 and 21.0, respectively, and mean IOPs were 22.21 and 21.15, respectively. In untreated eyes, median IOPs by Goldmann and FMAT-1 were 15 and 15.7, respectively, and mean IOPs were 15.52 and 15.31, respectively. Median OF (in µL/mm Hg) in treated and untreated eyes was 0.17 and 0.22, respectively, and mean values were 0.17 and 0.23, respectively. Pearson correlation showed an inverse relationship between IOP and OF in treated eyes, and linear regression analysis showed that IOP strongly predicted outflow in this group. Conclusion: The FMAT-1 generates IOP results substantially similar to Goldmann and OF readings with greater ease than prior tonography devices. Clinical significance: The mechanism of corticosteroid-induced IOP elevation appears to be a reduction in aqueous OF, and its measurement is tonography. This technique has traditionally been cumbersome. FMAT-1 is a newly launched instrument that measures IOP and OF at the slit lamp simultaneously in a few seconds.

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Original Article

Virginia Zanutigh, Leila Galetto, Florencia Valvecchia, Celina Logioco

Ocular Surface Evaluation after Switch from Latanoprost 0.005% to Latanoprostene Bunod 0.024%

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:5] [Pages No:205 - 209]

Keywords: Glaucoma, Latanoprost, Latanoprostene bunod, Ocular surface, Ocular surface disease index-score

   DOI: 10.5005/jp-journals-10078-1422  |  Open Access |  How to cite  | 

Abstract

Aim and background: To evaluate the ocular surface of patients treated with latanoprost (LT) 0.005% who switched to latanoprostene bunod (LBN) 0.024%. Materials and methods: A prospective and nonrandomized clinical study of a case series was performed, including patients with chronic open-angle glaucoma who were on previous LT-only treatment and, after a washout period, switched to LBN, with a 3-month follow-up. The main parameter to be evaluated was the ocular surface disease index (OSDI) test. In addition, best-corrected visual acuity (BCVA), intraocular pressure (IOP), biomicroscopic aspect of the ocular surface, measuring tear breakup time, fluorescein staining (grading performed on Oxford scale) and Schirmer I test were evaluated. Results: A total of 36 patients (72 eyes) were included, 21 women (58.3%) and 15 men (41.7%, with a mean age of 65.6 ± 10.9 years (37–86). The initial OSDI score was 17.8 ± 12.1 and improved to 11.1 ± 10.5 (p < 0.01). From the data evaluated at biomicroscopy, an improvement was observed in the Oxford scale from 0.6 ± 0.7 to 0.2 ± 0.8 (p: 0.01), but no statistically significant changes were observed in the break-up time (BUT) and Schirmer. BCVA remained stable, as did IOP, which was initially 13.4 ± 2.1 mm Hg and, after performing the LBN treatment change, went to 13.1 ± 1.7 mm Hg. Conclusion: After the change of treatment from LT 0.005% to LBN 0.024%, the patients had an improvement in the ocular surface, maintaining control of their IOP. The need to investigate possible beneficial mechanisms on the ocular surface in glaucoma patients treated with LBN, potentially related to nitric oxide, is raised. Clinical significance: Patients treated with LT 0.005% who switched to LBN 0.024% had an improvement in ocular surface symptoms and signs, keeping IOP under control. Latanoprostene bunod (LBN) 0.024% may have beneficial effects on the ocular surface, which should be further studied.

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CLINICAL TECHNIQUE

Tanuj Dada, Nitika Beri, Anin Sethi, Namrata Sharma

Viscodilation of Schlemm's Canal Combined with Goniectomy Using a 30 G Needle (Visco-Bent Ab Interno Needle Goniectomy)

[Year:2023] [Month:October-December] [Volume:17] [Number:4] [Pages:4] [Pages No:210 - 213]

Keywords: Minimally invasive glaucoma surgery, Modification of bent ab interno needle goniectomy, Modification of goniectomy, Visco-bent ab interno needle goniectomy, Viscodilation of Schlemm's canal

   DOI: 10.5005/jp-journals-10078-1424  |  Open Access |  How to cite  | 

Abstract

Background and aim: Bent ab interno needle goniectomy (BANG) is a low-cost minimally invasive glaucoma surgery (MIGS) technique that has gained wide popularity in developing nations. However, the risk of injury to surrounding angle structures and especially the outer wall of Schlemm's canal (SC) is the main drawback of this technique. We describe a simple and easy-to-perform modification, “Visco-BANG,” to improve the safety and efficacy of the BANG procedure. Technique: A 30 gauge (G) needle attached to a syringe filled with cohesive viscoelastic is used. The needle is bent at the proximal junction of the bevel with bevel towards the operating surgeon. The needle is then inserted into the SC and viscoelastic injected to dilate the canal, creating a buffer between the inner and outer walls of SC, which is followed by cutting of a trabecular meshwork (TM) strip. Conclusion: The current modification can prevent damage to adjoining angle structures, including the outer wall of SC, which is critical for aqueous outflow. It can potentially increase efficacy of the BANG procedure by incorporating viscodilation of the SC along with removal of the TM. Clinical significance: Injury to surrounding structures causes a fibrotic response, which is the main cause of failure for the BANG procedure. Prevention of injury to adjoining structures and dilatation of the SC can potentially increase the long-term success rates of this procedure.

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