Laser peripheral iridotomy with iridoplasty in primary angle closure suspect: anterior chamber analysis by pentacam.

PURPOSE: To compare conventional laser peripheral iridotomy (LPI) and LPI combined with laser peripheral iridoplasty in eyes with primary angle closure suspect (PACS) by assessment of anterior chamber dimensional changes using a Pentacam. METHODS: Forty-eight eyes of 24 subjects with bilateral PACS were recruited consecutively. Each eye was randomly allocated to treatment with conventional LPI, argon LPI only, or LPI plus iridoplasty, which consisted of simultaneous argon LPI and peripheral iridoplasty. Anterior chamber measurements were performed on each eye using a Pentacam, both before and after treatment. Mean anterior chamber depth (ACD), anterior chamber volume (ACV), and anterior chamber angle were measured, and topographic ACD analysis was performed. Results were compared between the two treatment groups. RESULTS: After treatment with either conventional LPI or LPI plus iridoplasty, the mean ACD and ACV increased significantly. Topographic ACD analysis revealed that the mid-to-peripheral ACD increase was significantly greater in the LPI plus iridoplasty group than in eyes treated with conventional LPI. Intraocular pressure changes and post-LPI complications did not differ between the groups. CONCLUSIONS: Compared with conventional LPI, our study showed that LPI plus iridoplasty improved the mid-to-peripheral ACD increase. This procedure may have a role as an adjunct for reducing angle closure by simultaneously eliminating pupillary and non-pupillary block components.

Structure-function relationships in normal and glaucomatous eyes determined by time- and spectral-domain optical coherence tomography.

PURPOSE: To compare the relationships between retinal mean sensitivity (MS) and retinal nerve fiber layer (RNFL) thickness, as measured by time-domain (TD) and spectral-domain (SD) optical coherence tomography (OCT). METHODS: Recruited subjects were divided into normal, glaucoma suspect, and glaucoma groups. RNFL thickness was measured with TD- and SD-OCT, and MS was assessed with visual field perimetry and expressed in decibels and 1/L, where L is luminance in lamberts. The relationship between SUPERIOR MS and INFERIOR RNFL thickness (clock-hour segments 5, 6, 7, and 8) and that between INFERIOR MS and SUPERIOR RNFL thickness (clock-hour segments 10, 11, 12, 1, 2, and 3) were correlated by linear and logarithmic regression analyses. Pearson's correlation coefficients (R), for both OCTs were compared by using Hotelling's t-test. RESULTS: Ninety-five eyes of 76 subjects were prospectively included. Twenty-five eyes were classified as normal, 25 with glaucoma suspect, and 45 with glaucoma. In normal and glaucoma suspect eyes, there were no significant relationships between MS and RNFL thickness. In glaucomatous eyes, the associations between MS and RNFL thickness were R = 0.31 to 0.57 with TD-OCT and R = 0.47 to 0.66 with SD-OCT, and the correlation of SUPERIOR RNFL thickness with INFERIOR MS was significantly better with SD-OCT than with TD-OCT in both linear and logarithmic regression models. CONCLUSIONS: The results showed that, in mild-to-moderate glaucoma, SD-OCT offers an improved structure-function correlation compared with TD-OCT, when applied to the detection of INFERIOR MS and SUPERIOR RNFL defects.

Subconjunctival bevacizumab as an adjunct to trabeculectomy in eyes with refractory glaucoma: a case series.

This prospective observational case series study included 6 eyes of 6 consecutive glaucomatous patients. Each patient underwent trabeculectomy with mitomycin C, and received a 1.25 mg of subconjunctival bevacizumab injection at completion of the trabeculectomy. Study eyes included two with neovascular glaucoma, three with uveitic glaucoma, and one with secondary glaucoma following vitrectomy. All eyes had undergone failed glaucoma laser/surgical treatment or an intraocular surgical procedure. Intraocular pressure (IOP) at the following postoperative visits: preoperative, 1 week, 1 month, 2 months, 3 months, and 6 months, was measured. We also evaluated postoperative bleb findings and complications. IOP measured at each visit was 37.5+/-14.4 mmHg, 6.2+/-3.4 mmHg, 8.3+/-7.2 mmHg, 12.0+/-4.4 mmHg, 10.8+/-3.1 mmHg, and 12.2+/-3.3 mmHg, respectively, for each visit. All eyes had functioning blebs with normal IOP at postoperative 6 months with no additional IOP-lowering medication.

Correlation between disc damage likelihood scale and optical coherence tomography in the diagnosis of glaucoma.

PURPOSE: To investigate the relationship between the Disc Damage Likelihood Scale (DDLS), visual field and various optical coherence tomography (OCT) parameters for glaucoma diagnosis. METHODS: The study comprised 149 eyes from 149 patients. The patients were categorized as normal, glaucoma suspect or with glaucoma. They were clinically examined and graded according to the DDLS system. OCT was performed to acquire both a retinal nerve fibre layer analysis and an optic nerve head analysis. The relationships between DDLS score, visual field and OCT parameters were analysed using multiple correlation analysis. RESULTS: The normal, glaucoma suspect and glaucoma groups had average DDLS scores of 1.58 +/- 1.40, 2.55 +/- 1.93 and 5.33 +/- 1.39, respectively. Evaluating the area under the receiver operator characteristic curve, the DDLS had the best predictive power (0.917), followed by corrected pattern standard deviation. CONCLUSION: The DDLS is a useful parameter in the diagnosis of glaucoma and it showed a close correlation with visual field, cup/disc ratio and OCT parameters.

A prospective audit on the validity of written informed consent prior to glaucoma surgery: an Asian perspective.

PURPOSE: To assess the validity of written informed consent taken from patients prior to undergoing glaucoma surgery by testing their ability to understand the information offered to them during the consent-taking process. METHODS: Seventy-three patients were asked to complete a standardised confidential questionnaire after giving a written informed consent. Surgeons who were taking the consent were also requested to submit their self-evaluation form. Patients' understanding of the information they were given was evaluated using a standardised point scoring system. RESULTS: Fifty patients (68.5%) agreed that they were given enough time to make an informed decision, while 67 doctors (91.8%) claimed that they had allocated enough time to explain the procedures. Fifty-two patients (71.2%) reported that they were given adequate information on the details or diagnosis of their problems, 65 patients (89.0%) on the details of the procedure and 69 patients (94.5%) on the risks and complications. Thirty-four patients (46.6%) were not sure, or refused information on the risks and complications of the procedure. Only half of the patients (57.5%) had overall moderate understanding of their surgical problem, and only 13 patients (17.8%) were able to demonstrate a good overall understanding of their surgical problem. CONCLUSIONS: Although most patients acknowledged that they received sufficient information to give consent, few could objectively recall the information given to them. This study thus raises some doubts on the validity and quality of written informed consent, and highlights the importance of giving clear information to patients undergoing glaucoma surgery.