Journal of Current Glaucoma Practice

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2024 | January-March | Volume 18 | Issue 1

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EDITORIAL

Tanuj Dada, Nitika Beri

Analyzing the Shortcomings of Trabecular Micro-bypass Stents for Surgical Management of Glaucoma

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:3] [Pages No:1 - 3]

   DOI: 10.5005/jp-journals-10078-1439  |  Open Access |  How to cite  | 

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Original Article

Jeffrey M Griffin, Grant T Slagle, Truong A Vu, Ainsley Eis, William E Sponsel

Prospective Comparison of VisuALL Virtual Reality Perimetry and Humphrey Automated Perimetry in Glaucoma

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:6] [Pages No:4 - 9]

Keywords: Glaucoma, Humphrey visual field, Perimetry, Virtual reality perimetry, Visual field analysis

   DOI: 10.5005/jp-journals-10078-1434  |  Open Access |  How to cite  | 

Abstract

Aim and background: Automated perimetry plays an important role in the diagnosis and monitoring of glaucoma patients. The purpose of this study is to prospectively determine parity between Humphrey visual field analyzer (HVFA) perimetry (the current gold standard) and the VisuALL virtual reality perimeter (VRP). Materials and methods: In this prospective fully paired diagnostic accuracy study, patients with stable, long-term HVFA visual fields (horizontal dots for ≥4 consecutive visits on progression analysis) with preperimetric, mild, moderate, or severe visual field loss were familiarized with the VRP and then tested using its proprietary software. These results were used for point-by-point comparison with a contemporaneous HVFA test. This study was approved by the Institutional Review Board (IRB) of the University of the Incarnate Word, San Antonio, Texas, United States of America (IRB approval #20-06-002). Results: The prospective study analyzed 43 eyes of 24 glaucoma patients. Spearman's correlation of mean deviation (MD) revealed a strong correlation between HVFA and VRP with rs(41) = 0.871, p < 0.001. The overall mean difference in locus–locus sensitivity between the devices was −0.4 ± 1.5 dB but varied for different visual field locations and glaucoma severity. Conclusion: The parity between the VRP and HVFA was remarkably strong for mild and moderate glaucoma. Given its portability, ease of use, space efficiency, and low cost, the VRP presents a viable alternative. Clinical significance: Automated perimetry, specifically the HVFA, has been the gold standard for visual field assessment since its introduction. The recent COVID-19 pandemic has illuminated the advantages of the VRP, allowing for safer visual assessment for both patient and clinician alike. Our study hopes to establish parity between these systems, allowing for the efficient integration of a novel head-mounted perimetry system that can safely diagnose and monitor glaucomatous progression in clinical practice. Precis: Investigation of parity between Olleyes VisuALL virtual reality perimetry (VRP) and existing standard HVFA perimetry is essential to the diagnosis and management of glaucoma. Linear correlations between the two were established from 43 glaucomatous eyes. Parity was strong for mild and moderate glaucoma, presenting VRP as a viable alternative.

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Original Article

Leticia A Checo, Syril Dorairaj, Isabella V Wagner, Abhimanyu S Ahuja

Clinical Outcomes of MicroPulse Transscleral Laser Therapy with the Revised P3 Delivery Device

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:6] [Pages No:10 - 15]

Keywords: Cohort, Glaucoma, Laser, MicroPulse transscleral cyclophotocoagulation, MicroPulse transscleral laser therapy

   DOI: 10.5005/jp-journals-10078-1427  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the success and safety of MicroPulse transscleral laser therapy (TLT) on intraocular pressure (IOP) reduction in adults with uncontrolled glaucoma using different total treatment durations, sweep velocities, and a number of sweeps utilizing the revised MicroPulse P3 delivery device. Materials and methods: A single-center Institutional Review Board (IRB) approved multiple cohort studies of MicroPulse TLT with the revised MicroPulse P3 delivery device, which was conducted in 61 eyes from 40 adults with uncontrolled glaucoma. Eyes that received 50-second (GI, GII, and GIII) and 60-second (GIV, GV, and GVI) treatment applications between May and October 2020 were reviewed. Each hemisphere received a total of five, four, or three sweeps. The patient's IOP and glaucoma medications were monitored over 12 months follow-up. Qualified success was defined as an IOP of ≤21 mm Hg and/or reduction of ≥20% from baseline at 12 months, with no secondary glaucoma reinterventions. Complete success was defined as meeting the above criteria with no increase in glaucoma medications at 12 months. All eyes requiring a glaucoma surgical intervention were considered a failure. Results: Qualified success was achieved in 83.6% of eyes, while complete success was achieved in 75.4% of eyes. In eyes receiving 50-second applications of five, four, or three sweeps (GI, GII, and GIII), 70, 90, and 91% achieved qualified success, respectively; in eyes receiving 60-second applications of five, four, or three sweeps (GIV, GV, and GVI), 78, 82, and 90% achieved qualified success, respectively. Within each subgroup, mean IOP reductions ranged from 32.8 to 49.4% and were statistically significant (p < 0.008). The failure rate was 16.4%, and at least one eye failed in each subgroup. Conclusions: MicroPulse TLT with the revised MicroPulse P3 delivery device and relatively low total energy levels is safe and effective at lowering IOP. Efficacy appears to increase with longer treatment durations and slower sweep velocities, but statistical differences between age and clinical differences between baseline IOP measurements limit comparison between subgroups. Clinical significance: There is a lack of literature evaluating the safety and IOP-lowering success of the revised MicroPulse P3 delivery device using different total treatment durations, sweep velocities, and number of sweeps.

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Original Article

Shibal Bhartiya, Parul Ichhpujani, Uday Pratap Singh Parmar, Surbhi Kapoor, Sonali Kaundal, Suresh Kumar

Glaucoma Drug Prescription Pattern in North India: Public vs Private Sector Hospitals

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:7] [Pages No:16 - 22]

Keywords: Fixed-dose combinations, Generic drug, Glaucoma, Innovator drug, Prescription, Preservative free

   DOI: 10.5005/jp-journals-10078-1438  |  Open Access |  How to cite  | 

Abstract

Background: Glaucoma is an optic neuropathy associated with characteristic structural damage to the optic nerve and associated visual dysfunction that may be caused by various pathological processes. A number of pharmacological agents are used to reduce the intraocular pressure (IOP), involving the usage of two or three medications concurrently. Literature is sparse regarding prescription patterns of antiglaucoma drugs, especially regarding variability in public sector vs private sector hospitals. Drug utilization studies can add insight for crafting rational, affordable, and ocular surface friendly prescriptions. Aim: This study assessed the prescription pattern in glaucoma patients of a public sector, tertiary care hospital vs a private sector tertiary care hospital. Materials and methods: In this retrospective study, pertinent data of diagnosed and labeled glaucoma patients were reviewed. Data collected included demographic details, type of glaucoma, number and nature of drugs prescribed, whether innovator or generic drugs were prescribed, if fixed-drug combinations (FDCs) and preservative-free formulations were prescribed. The prescription patterns between the two sectors were compared, as were the prescription patterns between primary open-angle glaucoma (POAG) and primary angle-closure disease (PACD). Results: A total of 336 prescriptions were evaluated (216 from public sector, group I; 120 from private sector, group II). Travoprost 0.004% was the most prescribed antiglaucoma medication in both group I (30.09%) and group II (38.33%). Brimonidine and brinzolamide (14.17%) was the most prescribed combination in group II, while Brimonidine with Timolol (7.87%) in group I. In group I, Timolol and Travoprost were the most prescribed medications for both PACD and POAG. Conclusion: This study showed that both public sector as well as private sector tertiary care centers prescribe antiglaucoma medications in tune with current principles of rational drug use. Preservative-free drugs were preferred in both the groups for better adherence.

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CASE SERIES

Nitika Beri, Saurabh Verma, Anand N Bukke, Saloni Une, Ayushi Agarwal, Tanuj Dada

Early Drainage of Suprachoroidal Hemorrhage Combined with Surgical Correction of Hypotony after Trabeculectomy

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:5] [Pages No:23 - 27]

Keywords: Case report, Delayed suprachoroidal hemorrhage, Early drainage, Hypotony, Trabeculectomy, Trocar

   DOI: 10.5005/jp-journals-10078-1429  |  Open Access |  How to cite  | 

Abstract

Aims and background: Delayed suprachoroidal hemorrhage (DSCH) is a vision-threatening complication of intraocular surgeries with a higher prevalence in postglaucoma filtering surgeries. Through these case series of trabeculectomy complicated with DSCH, we aim to emphasize that correction of hypotony (inciting factor) is fundamental for complete resolution and prevention of recurrence. Case description: All three glaucoma patients underwent trabeculectomy surgery followed by DSCH on postoperative day 1. Drainage of DSCH using a 23 gauge trocar cannula within 48 hours of onset was performed along with exploration for the cause of hypotony. All three patients had satisfactory visual and anatomical outcomes. Conclusion: Early drainage using 23 gauge trocar cannulas gives good results in DSCH. The cause of hypotony must simultaneously be corrected during the drainage of DSCH. Preventive measures against hypotony should be taken while doing glaucoma filtering surgery. Clinical significance: Surgical exploration for the cause of hypotony must simultaneously be performed during drainage of DSCH. Primary preventive measures against hypotony and bleeding during glaucoma filtering surgeries, like the use of releasable sutures, viscoelastic in the anterior chamber, and discontinuation of anticoagulants, can be done. Early drainage using trocar cannulas gives satisfactory results in DSCH postglaucoma surgeries.

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CASE REPORT

Anny MS Cheng, Geetha G Vedula, Aarup A Kubal, Jillene Moxam, David TY Yang, Shailesh K Gupta

Urrets–Zavalia Syndrome of Unresolving Mydriasis Following Endocyclophotocoagulation Combined with Phacoemulsification

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:3] [Pages No:28 - 30]

Keywords: Case report, Endocyclophotocoagulation, Microinvasive glaucoma surgery, Mydriasis, Phacoemulsification, Urrets–Zavalia syndrome

   DOI: 10.5005/jp-journals-10078-1431  |  Open Access |  How to cite  | 

Abstract

Aim and background: Combined endocyclophotocoagulation and phacoemulsification (ECP/Phaco) are uncommonly associated with complications. We present the first case of a rare complication following ECP/Phaco. Case description: A 72-year-old patient with dense nuclear sclerotic cataracts and primary open-angle glaucoma (POAG) underwent bilateral surgery uneventfully. He experienced a brief episode of postoperative elevated intraocular pressure (IOP), but only one eye with a lower baseline IOP developed a dilated pupil. No pupillary response was observed after applying 4% pilocarpine. The fixed mydriasis persisted without reaction to light or near stimulus, and the best-corrected vision (BCVA) was 20/30 in the affected eye. Conclusion: This case reports a possible rare complication when undergoing ECP/Phaco therapy. The pathogenesis of Urrets–Zavalia syndrome is unknown, but we hypothesized that eyes with more pronounced increases in IOP from baseline may be more susceptible to ischemic injury to the pupillary sphincter, resulting in a chronically dilated pupil. Clinical significance: Even a modest transient rise in postoperative IOP in a glaucomatous eye with normal baseline IOP could result in a chronically dilated pupil.

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CASE REPORT

Prasanna V Ramesh, Sathyan Parthasarathi, Ashik Azad, Aji K Devadas, Tejaswi Ragolu, Shruthy V Ramesh, Meena K Ramesh, Ramesh Rajasekaran

Managing Pigment Dispersion Glaucoma Postbilateral ICL Implantation in High Myopia: A Case Report on the Crucial Role of Gonioscopy in Correcting a Misdiagnosis

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:6] [Pages No:31 - 36]

Keywords: Angle-closure glaucoma, Case report, Glaucoma, Implantable collamer lens, Misdiagnosis, Pigment dispersion syndrome, Secondary open-angle glaucoma

   DOI: 10.5005/jp-journals-10078-1433  |  Open Access |  How to cite  | 

Abstract

Secondary open-angle glaucoma (SOAG) is a rare yet consequential complication following implantable collamer lens (ICL), also known as a phakic intraocular lens insertion, particularly in high myopia patients. This case report emphasizes the importance of recognizing SOAG and details the diagnostic complexities, reevaluation procedures, and successful long-term management of a 24-year-old bilateral high myopia (−7.00 D) patient who initially received an erroneous diagnosis of secondary angle-closure glaucoma (SACG) after ICL insertion at an external medical facility. Persistent visual issues prompted the patient to seek a second opinion, leading to a comprehensive reevaluation that eventually unveiled pigment dispersion syndrome (PDS) as the underlying cause, subsequently resulting in SOAG. This case not only highlights the diagnostic challenges but also elucidates the re-evaluation process and effective 5-year management strategies employed to restore the patient's visual health and quality of life.

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CASE REPORT

Jason Dossantos, Jella An

A Rare Case of Postoperative Uveitis and Obstructive Peripheral Anterior Synechiae Following Combined OMNI Canaloplasty and Hydrus Microstent Implantation

[Year:2024] [Month:January-March] [Volume:18] [Number:1] [Pages:5] [Pages No:37 - 41]

Keywords: Case report, Hydrus microstent, Obstructive peripheral anterior synechiae, OMNI canaloplasty, Phacoemulsification, Psoriatic arthritis, Uveitis

   DOI: 10.5005/jp-journals-10078-1436  |  Open Access |  How to cite  | 

Abstract

Purpose: This study seeks to highlight and explore the occurrence of uveitis with obstructive peripheral anterior synechiae (PAS) after a combined OMNI canaloplasty and Hydrus microstent implantation with phacoemulsification, particularly in a patient with a background of psoriatic arthritis. Observations: A 56-year-old male with a medical history of psoriatic arthritis (in remission for 10 years) and primary open-angle glaucoma (POAG) underwent a combined OMNI canaloplasty and Hydrus microstent with phacoemulsification. The surgical procedure was uncomplicated. However, within 2 weeks postsurgery, the patient presented with severe symptoms, including uveitis, elevated intraocular pressure (IOP), and a significant reduction in best-corrected visual acuity (BCVA). This postoperative response was unexpected, especially given the lack of any past history of uveitis in the patient. The complication, potentially influenced by the patient's history of psoriatic arthritis, led to the need for additional interventions, including the implantation of an Ahmed glaucoma valve. Conclusion: This case underscores the potential for postoperative complications, specifically uveitis with obstructive PAS, following combined OMNI canaloplasty and Hydrus microstent with phacoemulsification, especially in patients with a history of autoimmune diseases. Careful preoperative history, postoperative monitoring, and a nuanced approach to surgical planning are crucial. The association between systemic inflammatory conditions and ocular complications warrants deeper exploration to ensure optimal patient care.

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