Journal of Current Glaucoma Practice

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2013 | January-April | Volume 7 | Issue 1

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Tarek Shaarawy


[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/jocgp-7-1-v  |  Open Access |  How to cite  | 


Original Article

Emma Jones, Pouya Alaghband, Jason Cheng, Laura Beltran-Agullo, Kin Sheng Lim

Preimplantation Flow Testing of Ahmed Glaucoma Valve and the Early Postoperative Clinical Outcome

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Glaucoma, Aqueous shunt, Methods, Adverse effects, Ahmed implant

   DOI: 10.5005/jp-journals-10008-1128  |  Open Access |  How to cite  | 


Purpose: The Ahmed glaucoma valve (AGV) implant is designed to prevent early postoperative hypotony. There is evidence of variation in hypotony rates in clinical trials which may be due to surgical technique variation, entry site leakage or valve defects from ‘over priming’. We describe a simple preimplantation gravity driven test to assess valve function after priming that may reduce hypotony rates. Materials and methods: Retrospective case note review. An in vivo flow test of AGVs, based on the gravity driven test was introduced prior to implantation. The onset and offset of flow through the valve was measured by altering the height of a bottle of balanced saline solution. We rejected the AGV, if there was fluid still flowing at 10 cm (7 mm Hg) or if there was no flow at 17 cm of water (12 mm Hg). The AGV implantation surgery was without mitomycin C, with a 25G needle entry tract, a corneal or scleral patch graft tube cover and without intracameral viscoelastic. Results: Twenty Ahmed valves were implanted in 16 patients between July 2008 and October 2009. Test failure resulted in four AGV being rejected. The mean preoperative pressure was 29 mm Hg (range, 10-57 mm Hg) and the intraocular pressure (IOP) at 7 days postoperatively was 15 mm Hg (range, 3-52 mm Hg). Hypotony, defined as an IOP of less than 5 mm Hg on two consecutive assessments, was present in two eyes (10%). Conclusion: In vivo flow testing is an important safety check for the AGV. There are also other mechanisms after implantation that can cause an unexpected high or low IOP.


Original Article

Roseline Duke, Ayodele Akinye, Soter Ameh

Presenting Visual Acuity and Ocular Comorbidity in Patients with Primary Open Angle Glaucoma in a Private Tertiary Eye Center in Nigeria

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Ocular comorbidity, Visual acuity, Primary open angle glaucoma

   DOI: 10.5005/jp-journals-10008-1129  |  Open Access |  How to cite  | 


Purpose: To determine the presenting visual acuity (VA) of patients with primary open angle glaucoma (POAG) and the relationship to ocular comorbidity. Materials and methods: A retrospective case note audit was undertaken in Eye Foundation Hospital, Calabar, between 1st January 2010 and 31st June 2011. The case notes of all newly presenting patients diagnosed with POAG were retrieved and data were extracted for analysis. Inclusion criteria for glaucoma was defined. Results: Out of a total of 320 new patients, 88 patients were diagnosed with POAG, with a prevalence of 27.5% (95% CI: 22.7-32.7). The mean age for males is 57.1 ± 8.8 while that of females is 52.6 ± 11.2 and the total mean of 55.8 ± 9.7. Of the 88 patients, there were 84 self referrals [95.5% (95% CI: 88.8-98.7)], of these, 45, 53.6% (95% CI: 42.4-64.5) were for second opinion. There was no statistical significance between the gender, education and occupation and the level of VA seen on presentation. The best corrected visual acuity (BCVA) in the right and left eye respectively, was significantly (p < 0.0001) related to the cup disk ratio. Ocular comorbid conditions were seen in 19 (22%) patients in the study. The presenting BCVA was significantly related to the presence of ocular comorbidity in the best eye. Comorbidity was not strongly related to the age of the patients. Conclusion: The course of glaucomatous progression is highly variable, identifying factors that not only predict progression but influence the VA and ocular health of the eye can help to guide clinical practice and patient treatment and monitoring.


Original Article

William C Stewart, Jeffrey C Oehler, Neil T Choplin, Joseph I Markoff, Marlene R Moster, Parul Ichhpujani, Lindsay A Nelson

A Comfort Survey of Timolol Hemihydrate 0.5% Solution Once or Twice Daily vs Timolol Maleate in Sorbate

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:6] [Pages No:11 - 16]

Keywords: Betimol, Comfort, Glaucoma, Istalol, Timolol hemihydrate, Timolol maleate with potassium sorbate

   DOI: 10.5005/jp-journals-10008-1130  |  Open Access |  How to cite  | 


Objective: To evaluate by survey the comfort upon instillation of timolol hemihydrate compared to timolol maleate with potassium sorbate. Design: A prospective, multicenter, observational, non-interventional study. Participants: One hundred and three patients of open-angle glaucoma or ocular hypertension who were ≥21 years old and were currently prescribed timolol hemihydrate (once or twice daily) or timolol maleate with potassium sorbate once daily as monotherapy or as a part of two-drug therapy. Materials and methods: Study was performed at seven clinical sites in the United States. Patients were surveyed on comfort upon instillation of timolol hemihydrate compared to timolol maleate with potassium sorbate. Results: A difference between timolol hemihydrate and timolol maleate with potassium sorbate for questions 1 (burning/stinging on instillation, p < 0.001) and 4 (tearing on instillation, p = 0.024) was noted. There were no differences between treatment groups for any other question (p > 0.05). Conclusion: This survey suggests that timolol hemihydrate is associated with less stinging/burning and tearing than timolol maleate with potassium sorbate.


Original Article

Ejaz Ansari

IOP Maintenance in SLT-treated Eyes following Subsequent Phacoemulsification and IOL

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:2] [Pages No:17 - 18]

Keywords: Selective laser trabeculoplasty, Cataract Surgery and Glaucoma

   DOI: 10.5005/jp-journals-10008-1131  |  Open Access |  How to cite  | 


To assess whether the intraocular pressure (IOP) in selective laser trabeculoplasty (SLT)-treated eyes is maintained following subsequent phacoemulsification and lens implant (phaco + IOL). Retrospective single center review of 45 eyes of 35 patients who had open angle glaucoma (OAG), successfully treated by SLT by the same surgeon (EA), and then had routine phaco + IOL by same surgeon (EA). The main outcome measures were baseline (SLT-treated) IOP and IOP at 3, 6 and 12 months following subsequent routine phaco + Intraocular lens (IOL). Secondary outcome measures were visual acuity pre- and post (phaco + IOL) and any complications. The study found that IOP reduction with SLT is not significantly affected by subsequent phaco + IOL in patients with OAG.



George Kampougeris, Dimitrios Spyropoulos, Adrianna Mitropoulou

Intraocular Pressure rise after Anti-VEGF Treatment: Prevalence, Possible Mechanisms and Correlations

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:6] [Pages No:19 - 24]

Keywords: Anti-VEGF injections, Neovascular AMD, Intraocular pressure rise

   DOI: 10.5005/jp-journals-10008-1132  |  Open Access |  How to cite  | 


Intraocular pressure (IOP) rise after anti-vascular endothelial growth factor (VEGF) treatment for neovascular age-related macular degeneration (AMD) can be either short-term or long-term and may require medical intervention. Short-term IOP spikes are a fairly common and well recognized complication of anti-VEGF injections. Long-term IOP rise is less well-understood and disputed as a complication by some authors. We try to review current literature on the subject and especially studies focused on the prevalence of this complication, speculate on possible mechanisms of IOP rise and discuss correlations of long-term IOP rise with the nature of the injected agent, average number of injections, previous glaucoma history and other factors.



Muneeb Faiq, Kuldeep Mohanty, Tanuj Dada

Molecular Diagnostics and Genetic Counseling in Primary Congenital Glaucoma

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:11] [Pages No:25 - 35]

Keywords: Primary congenital glaucoma, Molecular diagnostics, Genetics, Genetic counseling

   DOI: 10.5005/jp-journals-10008-1133  |  Open Access |  How to cite  | 


Primary congenital glaucoma (PCG) is a childhood irreversible blinding disorder with onset at birth or in the first year of life. It is characterized by the classical traid of symptoms viz. epiphora (excessive tearing), photophobia (hypersensitivity to light) and blepharospasm (inflammation of eyelids). The only anatomical defect seen in PCG is trabecular meshwork dysgenesis. PCG shows autosomal recessive mode of inheritance with considerable number of sporadic cases. The etiology of this disease has not been fully understood but some genes like CYP1B1, MYOC, FOXC1, LTBP2 have been implicated. Various chromosomal aberrations and mutations in mitochondrial genome have also been reported. Molecular biology has developed novel techniques in order to do genetic and biochemical characterization of many genetic disorders including PCG. Techniques like polymerase chain reaction, single strand conformational polymorphism and sequencing are already in use for diagnosis of PCG and other techniques like protein truncation testing and functional genomics are beginning to find their way into molecular workout of this disorder. In the light of its genetic etiology, it is important to develop methods for genetic counseling for the patients and their families so as to bring down its incidence. In this review, we ought to develop a genetic insight into PCG with possible use of molecular biology and functional genomics in understanding the disease etiology, pathogenesis, pathology and mechanism of inheritance. We will also discuss the possibilities and use of genetic counseling in this disease.



Alfonso Vasquez Perez, Jorge Loscos Arenas, Julio De La Camara Hermoso

Laser Treatment to avoid Trabeculectomy and to recover the Aqueous Outflow after Iris Incarceration in a Patient with NPDS

[Year:2013] [Month:January-April] [Volume:7] [Number:1] [Pages:2] [Pages No:36 - 37]

Keywords: Glaucoma, Gonioscopy, Intraocular pressure, Trabeculectomy

   DOI: 10.5005/jp-journals-10008-1134  |  Open Access |  How to cite  | 


The advantages of the nonpenetrating deep sclerectomy (NPDS) compared with the trabeculectomy are based on faster recovery and lower incidence of complications. The incarceration of the iris at the trabeculo-Descemet's membrane is one complication of NPDS and leads frequently to the reoperation of the patient. We report one case operated of NPDS with iris incarceration post-Nd:YAG goniopuncture in which we also documented spontaneous returning of the prolapsed iris during gonioscopy 3 hours after the onset of symptoms. With an argon laser iridoplasty, the iris returned completely to its position and a wide Nd:YAG laser iridotomy prevented recurrences. After this episode, the patient have always had intraocular pressure measures lower than 15 mm Hg.


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