Journal of Current Glaucoma Practice

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2013 | May-August | Volume 7 | Issue 2

EDITORIAL

Shibal Bhartiya, Tarek Shaarawy, Tanuj Dada

Editorial

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/jocgp-7-2-vii  |  Open Access |  How to cite  | 

Original Article

Sunil Ganekal, Syril Dorairaj, Vishal Jhanji

Pattern Electroretinography Changes in Patients with Established or Suspected Primary Open Angle Glaucoma

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:4] [Pages No:39 - 42]

Keywords: Pattern ERG, Primary open angle glaucoma, Glaucoma suspects

PDF  |  DOI: 10.5005/jp-journals-10008-1135  |  Open Access |  How to cite  | 

Abstract

Purpose: To assess pattern electroretinogram (PERG) changes in patients with established or suspected primary open angle glaucoma (POAG). Materials and methods: Transient PERG using LV Prasad eye electrodes were performed in 76 normal, 32 glaucomatous and 22 glaucoma suspect eyes. The P50 amplitude, N95 amplitude and P50 latency were analyzed. The results were further analyzed with receiver operating characteristic (ROC) curves and discriminant function analysis (DFA). Results: The P50 and N95 amplitude of the POAG and glaucoma suspect groups were significantly reduced. There was significant shortening in the P50 latency in the POAG and glaucoma suspect groups. DFA using the P50 amplitude, N95 amplitude and P50 latency waveform parameters showed a sensitivity and specificity of 76.67 and 88.57% respectively. Conclusion: Pattern ERG demonstrated significant changes in POAG patients and suspects. ROC curves for the three wave parameters demonstrated that N95 amplitude was the better indicator for diagnosis of POAG when used individually.

Original Article

Vidyarani Rajkumari, Khongbantabam Singh Kaminibabu, Rajkumari Devi Bhabanisana, Rajkumar Victor

Manual Small Incision Cataract Surgery in Phacomorphic Glaucoma: Surgical Technique and Outcome in North-eastern India

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:6] [Pages No:43 - 48]

Keywords: Phacomorphic glaucoma, Intraocular pressure, Intraocular lens implantation, Manual small incision cataract surgery

PDF  |  DOI: 10.5005/jp-journals-10008-1136  |  Open Access |  How to cite  | 

Abstract

Background: North-eastern region of India continue to suffer from limited resources, added upon by Mongoloid racial similarity and poor cataract surgery rate has contributed to the increase incidence of advanced cataract like phacomorphic glaucoma. Objective: To evaluate the visual prognosis and related complications of phacomorphic glaucoma cases by manual small incision cataract surgeries in North-eastern region of India. Materials and methods: This retrospective case series study includes 65 phacomorphic glaucoma cases diagnosed between June 2009 to December 2011 in Jawaharlal Nehru Institute of Medical Sciences, Manipur. Preoperative routine evaluation includes slit-lamp biomicroscopy, measurement of IOP, gonioscopy of fellow eye, axial length measurement, AC depth and lens thickness by A-scan. Manual small incision cataract surgery with intraocular lens implantation was performed in all the 65 eyes. Complete ophthalmic examination was done at each follow-up visit. Results: The mean preoperative IOP was 35.14 (±6.35) mm Hg and IOP at the 3rd month follow-up was 18.65 (±1.3) mm Hg with a statistically significant lowering of IOP (p < 0.0001) at the last follow-up. Intraoperative complications were minimal. Corneal edema, fibrinous exudates in AC was seen in few cases. Postoperative best corrected visual acuity was 6/6-6/12 in 46 eyes, 6/18-6/36 in 12 eyes, 6/60-3/60 in 4 eyes and less than 3/60 in three eyes. Antiglaucoma medication was discontinued immediately after each surgery. Conclusion: Manual small incision cataract surgery being inexpensive play a key role in management of poor outreach program marker like phacomorphic glaucoma in effectively controlling the IOP and achieving good visual acuity with minimal complications.

REVIEW ARTICLE

Syed Shoeb Ahmad, Shuaibah Abdul Ghani, Theodora Hemalata Rajagopal

Current Concepts in the Biochemical Mechanisms of Glaucomatous Neurodegeneration

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:5] [Pages No:49 - 53]

Keywords: Glaucoma, Biochemical, Neural, Degeneration

PDF  |  DOI: 10.5005/jp-journals-10008-1137  |  Open Access |  How to cite  | 

Abstract

Glaucoma is now regarded as a neurodegenerative disorder. A number of theories including the mechanical and vascular models have been used to explain the pathogenesis of glaucoma. However, there is now increasing evidence of biochemical molecules which may play a part in it\'s causation. These biochemical mechanisms include the role of excitatory aminoacids, caspases, protein kinases, oxygen free radicals, nitric oxide, TNF-alpha, neurotrophins and metalloproteins. This paper reviews these new developments which form the biochemical basis of glaucomatous neural degeneration.

REVIEW ARTICLE

Parul Ichhpujani, Shibal Bhartiya, Anuj Sharma

Premium IOLs in Glaucoma

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:4] [Pages No:54 - 57]

Keywords: Glaucoma, Intraocular implant, Multifocal IOL, Toric IOL

PDF  |  DOI: 10.5005/jp-journals-10008-1138  |  Open Access |  How to cite  | 

Abstract

Advanced technology or premium intraocular lenses have been developed to meet the patient expectations of perfect distance and near vision without the need for spectacles. Careful patient selection is critical when implanting these implants. This brief review focusses mainly on multifocal and toric IOLs and their application and limitations in patients with glaucoma.

REVIEW ARTICLE

Skaat Alon

Selective Laser Trabeculoplasty: A Clinical Review

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:8] [Pages No:58 - 65]

Keywords: Selective laser trabeculoplasty, Glaucoma, Trabecular meshwork

PDF  |  DOI: 10.5005/jp-journals-10008-1139  |  Open Access |  How to cite  | 

Abstract

Selective laser trabeculoplasty (SLT) is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma. It achieves its results by selective absorption of energy in the trabecular pigmented cells, sparing adjacent cells and tissues from thermal damage, with minimal morphological tissue alteration following treatment. On the basis of the peer-reviewed medical literature, SLT is efficacious in lowering IOP, as initial treatment or when medical therapy is insufficient in all types of open-angle glaucoma in all races. SLT achieves intraocular pressure reduction similar to that of argon laser trabeculoplasty but without the tissue destruction and side effects. Observed side effects following SLT were almost uniformly transient and minor. We review highlights of recently published studies on the mechanisms and clinical outcome of SLT in order to address frequently raised issues pertinent to SLT in the clinical practice. Key messages: Selective laser trabeculoplasty is a safe and effective treatment modality for lowering the intraocular pressure in patients with glaucoma.

REVIEW ARTICLE

Muneeb Faiq, Reetika Sharma, Rima Dada, Kuldeep Mohanty, Daman Saluja, Tanuj Dada

Genetic, Biochemical and Clinical Insights into Primary Congenital Glaucoma

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:19] [Pages No:66 - 84]

Keywords: Glaucoma, Primary congenital glaucoma, Genetics, CYP1B1, Myocilin

PDF  |  DOI: 10.5005/jp-journals-10008-1140  |  Open Access |  How to cite  | 

Abstract

Glaucoma is an irreversible form of optic neuropathy in which the optic nerve suffers damage in a characteristic manner with optic nerve cupping and retinal ganglion cell death. Primary congenital glaucoma (PCG) is an idiopathic irreversible childhood blinding disorder which manifests at birth or within the first year of life. PCG presents with a classical triad of symptoms (viz epiphora, photophobia and blepharospasm) though there are many additional symptoms, including large eye ball and hazy cornea. The only anatomical anomaly found in PCG is trabecular meshwork (TM) dysgenesis. PCG is an inheritable disease with established genetic etiology. It transmits through autosomal recessive mode. A number of cases are sporadic also. Mutations in many genes have been found to be causative in PCG and many are yet to be found. Mutations in cytochrome P4501B1 (CYP1B1) gene have been found to be the predominant cause of PCG. Other genes that have been implicated in PCG etiology are myocilin, Forkhead-related transcription factor C1 (FOXC1) and latent transforming growth factor beta-binding protein 2 (LTBP2). Mutations in these genes have been reported from many parts of the world. In addition to this, mitochondrial genome mutations are also thought to be involved in its pathogenesis. There appears to be some mechanism involving more than one genetic factor. In this review, we will discuss the various clinical, biochemical and genetic aspects of PCG. We emphasize that etiology of PCG does not lie in a single gene or genetic factor. Research needs to be oriented into a direction where gene-gene interactions, ocular embryology, ophthalmic metabolism and systemic oxidative status need to be studied in order to understand this disorder. We also accentuate the need for ophthalmic genetic facilities in all ophthalmology setups.

CASE SERIES

Sanjay Asrani, Mei Young, Jing Xu, Marinko V Sarunic

Imaging of Ocular Angle Structures with Fourier Domain Optical Coherence Tomography

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:3] [Pages No:85 - 87]

Keywords: Optical coherence tomography, Anterior eye segment, Trabecular meshwork

PDF  |  DOI: 10.5005/jp-journals-10008-1141  |  Open Access |  How to cite  | 

Abstract

Background: Imaging of the Schlemm\'s Canal is complicated by the small physiological size and the location several hundred microns beneath the sclera. Noninvasive imaging of Schlemm\'s canal and Trabecular Meshwork (TM) in vivo with Fourier Domain Optical Coherence Tomography (FD OCT) can provide clinicians with a powerful tool to visualize ocular angular structures crucial for glaucoma management. Purpose: To investigate the appearance of Schlemm\'s canal and TM on FD OCT images. Methods: FD OCT images of the Schlemm\'s canal and TM were obtained with three different wavelengths using prototype FD OCT systems in a normal volunteer. FD OCT images using the 1310 nm wavelength prototype were obtained in three representative cases of glaucoma surgery performed on angle structures. Results: The longer imaging depth and deeper tissue penetration of the 1310 nm system provided the clearest image of the TM and Schlemm\'s canal in the normal patient. In case 1, images pre- and post-trabectome surgery clearly showed the location and appearance of TM. In case 2, images post-canaloplasty surgery showed the location and appearance of Schlemm\'s canal. In case 3, images pre- and post-trabeculotomy surgery further confirms the appearance and location of the Schlemm\'s canal and TM. Conclusion: Operating wavelength of the FD OCT system and exact location of the scan across different meridians minimally affects the appearance of the ocular anatomy. The postoperative images of three angle glaucoma surgeries confirmed the location of Schlemm\'s canal and TM.

CASE SERIES

Shibal Bhartiya, Tarek Shaarawy

Evaluation of the Van Herick Technique for Screening for Occludable Angles in an African Population

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:3] [Pages No:88 - 90]

Keywords: Van Herick technique, Peripheral anterior chamber depth, Occludable angles, Gonioscopy

PDF  |  DOI: 10.5005/jp-journals-10008-1142  |  Open Access |  How to cite  | 

Abstract

The current gold standard for screening for angle closure and adopting universal approaches to prophylaxis is the assessment of the anterior chamber (AC) angle by gonioscopy, a technique that has substantial interobserver variability and relies on subjective assessment. Slit-lamp estimation of the peripheral anterior chamber depth (ACD) by the Van Herick technique is a noncontact approach for estimating angle width and various authors have commented on its sensitivity and specificity as a screening tool for identifying narrow angles as well as angle closure. This case series draws attention to the fact that as many as 28 out of 36 (77.78%) seemingly open angles on Van Herick test were found to be potentially occludable angles on gonioscopy. Therefore, it may be concluded that gonioscopy is essential even in patients with deep peripheral ACs, before an occludable angle can be ruled out.

CASE REPORT

Tutul Chakravarti, George Spaeth

An Overlap Syndrome of Pigment Dispersion and Pigmentary Glaucoma accompanied by Marfan Syndrome: Case Report with Literature Review

[Year:2013] [Month:May-August] [Volume:7] [Number:2] [Pages:5] [Pages No:91 - 95]

Keywords: Pigmentary glaucoma, Pigment dispersion syndrome, Marfan syndrome, Ectopia lentis, Intraocular pressure fluctuation, Reverse pupillary block, Exfoliation syndrome

PDF  |  DOI: 10.5005/jp-journals-10008-1143  |  Open Access |  How to cite  | 

Abstract

‘Overlap syndrome’ describes the situation in which two or more ‘independent’ conditions are present, either one of which could cause a particular finding. This current presentation reports a case with bilateral pigment dispersion syndrome (PDS), advanced pigmentary glaucoma (PG), and the Marfan syndrome, with bilateral subluxation of the lenses, and large short-term and long-term fluctuations of intraocular pressure. It is interesting to consider whether the associated advanced glaucomatous nerve damage could be a manifestation of just the PDS, just the Marfan syndrome, or rather a combination of these two overlapping independent conditions.

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