Statistical agreement of gonioscopy performed as a puppy and as an adult in the Samoyed dog.

OBJECTIVE: To assess whether gonioscopy performed on Samoyed puppies (6-14 weeks of age) is a reliable predictor of their gonioscopy results as adults (>11 months of age). PROCEDURE: A retrospective medical record search was performed to identify Samoyed dogs that had undergone gonioscopy as a puppy (6-14 weeks of age). A second prospective gonioscopy examination was performed as an adult (>11 months of age) and the results were compared. Gonioscopy was assessed on two characteristics: percent of iridocorneal angle (ICA) unaffected by pectinate ligament abnormalities (PLA) and ICA width, with PLA results categorized into unaffected ( ≥ $$ \ge $$ 75% open), moderately affected (50%-74% open), and severely affected (<50% open) and the width categorized into wide, moderate, narrow, and closed groups. A multivariate model was created that considered factors such as PLA, angle width, sex, puppy age, neuter status, and time between examinations. RESULTS: The eyes of 77 Samoyed dogs (154 eyes) met inclusion criteria. When assessing PLA, 90% of dogs had the same categorization as a puppy and as an adult. When assessing ICA width, 53.2% of dogs had the same width classification as a puppy and as an adult. There is strong evidence that variation between puppy and adult results increases with time between examination (p = .03). CONCLUSION: Puppies unaffected by PLA and with a wide ICA angle, are likely to retain these features as adults. Selection of puppies with desirable gonioscopic traits may help breeders to choose dogs likely to retain these traits as adults for breeding. This may reduce the incidence of glaucoma in the breed. Puppy examinations should be performed in both eyes. Examination of adults prior to breeding remains prudent.

Vision outcomes in dogs with primary glaucoma surgically treated with lensectomy and endolaser cyclophotocoagulation after an Ahmed valve gonioimplantation failure.

OBJECTIVE: The aim of this study was to retrospectively evaluate vision outcomes of dogs with primary angle closure glaucoma (PACG) that underwent Ahmed valve gonioimplantation (AVG) followed by lensectomy and endolaser cyclophotocoagulation (ECP) with or without bleb resection after AVG failure. PROCEDURE: Medical records from 2008 to April 2022 were reviewed. All patients selected had an AVG performed first. Following valve failure, lensectomy-ECP was performed in addition to bleb resection as indicated. Additional ECP and AVG replacement surgeries were performed as deemed medically necessary. Main outcomes evaluated included vision preservation, average IOP reduction, and the number of glaucoma medications (both oral and topical) at 6, 12, 24, and 36 months. RESULTS: Fourteen eyes from 13 patients were included in the study. Females were predominant (n = 9) compared with males (n = 4). Mean age at initial glaucoma diagnosis was 6.82 years. Following AVG and lensectomy-ECP, vision was preserved in 93%, 84%, 60%, and 48% of eyes at 1, 2, 3, and 4 years respectively. Following lensectomy-ECP, there was a significant reduction in mean IOP of 9.64 mmHg (p = .015) and 9.71 mmHg (p = .016) at 2 and 6 months, respectively. There was a reduction in mean IOP of 2.45, 7.25, and 12.25 mmHg at 12, 24, and 36 months, respectively, which was not statistically significant. There was a significant decrease in the number of glaucoma medications at all evaluated time points except 24 months. CONCLUSIONS: Combined AVG and lensectomy-ECP is successful in maintaining vision long term as well as decreasing IOP, and the number of glaucoma medications administered.

Visual field progression in Malay patients with primary glaucoma: survival analysis and prognostic factors.

PURPOSE: This study aims to determine the 5-year visual field progression and identify the prognostic factors for progression in Malay patients with primary glaucoma. METHODS: A retrospective cohort record review study was conducted among 222 patients (222 eyes) with primary glaucoma who were selected from a glaucoma research database of a tertiary center in Malaysia. The patients were Malays and diagnosed with primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Patients who were followed up regularly for at least 6 months between 1 January 2009 and 31 December 2014 and completed another 1-year follow-up after recruitment (between 1 January 2015 and 31 December 2015) were selected. Multiple prognostic factors that influence visual field progression were identified. Progression of visual field loss was based on the Advanced Glaucoma Intervention Study and Hodapp-Parrish-Anderson scores. Kaplan-Meier survival and Cox proportional hazard regression analyses were performed. RESULTS: Sixty-three patients (28.4%) developed visual field progression after a mean (SD) follow-up of 6.9 (3.3) years. Those with POAG progressed faster (mean time, 10.6 years; 95% confidence interval [CI], 9.3, 11.9) than those with PACG (17.3 years; 95% CI, 14.8, 19.9) but not statistically significant. Disc hemorrhage and history of eye pain increased the risk of progression by 2.8-folds (95% CI, 1.6, 4.8) and 2.5-folds (1.4, 4.4), respectively. CONCLUSION: The 5-year survival of the Malay primary glaucoma patients with visual field progression was similar with that of other Asian populations. However, aggressive management is required for those with disc hemorrhages and eye pain related to increased intraocular pressure.

Association of TGFB -509C>T promoter polymorphism with primary angle closure glaucoma in a North Indian Punjabi cohort.

PURPOSE: Transforming growth factor beta (TGFB) is an important candidate gene implicated in glaucoma pathogenesis because it affects retinal ganglionic cell survival. The present study assessed the genetic association of -509C > T variant in the TGFB promoter region with primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) in a North Indian Punjabi population. METHOD: A total of 867 subjects (307 POAG, 133 PACG cases and 427 controls) were recruited from the targeted population. Genotyping was done by PCR-RFLP method and the data was analyzed using PLINK software (v1.07). Logistic regression under different genetic models was applied and genotype phenotype correlation was assessed by one-way ANOVA. RESULT: A statistically significant difference in the frequency of heterozygotes among PACG cases (53.16%) and controls (30.07%) (p = 0.0002) was observed. Genetic model analysis revealed that mutant "TT" genotype conferred 2-fold risk towards PACG development under recessive model (p = 0.0019) while dominant model and co-dominant model provided 0.62 and 0.37 fold protection against PACG (p = 0.025 and p = 0.0001, respectively). Data segregation based on sex revealed a strong protective effect of heterozygous 'CT' genotype against progression of PACG among females (p = 0.002, OR = 0.37, 95% CI = 0.19-0.70), but conferred 2.14-fold risk among female POAG subjects (p = 0.013). CONCLUSION: The study revealed a strong genetic association of -509C > T variant in TGFB with PACG in females. There is a need to replicate the results in a larger PACG cohort in other populations and further assess the contribution of sex specific factors in modifying genetic susceptibility to PACG.

Prophylactic anti-glaucoma therapy in dogs with primary glaucoma: A practitioner survey of current medical protocols.

AIM: To examine the use of prophylactic anti-glaucoma medications in the normotensive fellow eye in dogs with unilateral overt primary glaucoma by veterinary ophthalmology clinicians. METHODS: A survey of veterinary ophthalmology clinicians was distributed over two international list serves servicing veterinary ophthalmologists, trainees, and individuals whose practice consisted primarily of ophthalmic patients. The survey was developed following analysis of historical and currently available medical options for control of intraocular pressure and for neuroprotection. RESULTS: Responses from 199 veterinary ophthalmology clinicians were evaluated. While a large variety of topical anti-hypertensive drugs and protocols were used, the most commonly used medications were aqueous humor production suppressors such as dorzolamide 2.0% ophthalmic solution, timolol 0.5% ophthalmic solution, and a combination product containing both drugs. Latanoprost 0.005% ophthalmic solution was used infrequently for prophylaxis by comparison. The majority of respondents do not use concurrent anti-inflammatory medications (61.22%), although a sizeable minority used prednisolone acetate, dexamethasone, or ketorolac as prophylactic treatment. Systemically administered ocular anti-hypertensive agents were rarely used. Only 40% of respondents used neuroprotectant agents; the most commonly prescribed were the calcium channel blocker amlodipine and the nutraceutical Ocu-Glo™. Recommended intervals between re-examination by the clinician ranged from one month to one year, with most re-evaluations occurring every 3 to 6 months. The majority of respondents recommended more frequent assessments of IOP at intervals between once monthly and once every 3 months. CONCLUSIONS: Data analysis of medical therapy for the normotensive fellow eye of dogs previously diagnosed with primary glaucoma suggests that there is a great need for well-designed, prospective, controlled, multi-center studies to determine which protocols have the greatest efficacy in delaying an overt attack in the previously normotensive eye in dogs with a genetic predisposition to glaucoma. Prospective studies utilizing a carbonic anhydrase inhibitor such as dorzolamide and a prostaglandin analogue such as latanoprost would be reasonable as these two drugs are widely used in the treatment of overt glaucoma and would allow for an exploration of the impact of different mechanisms of action of lowering IOP on the pathophysiology of primary glaucoma.

Histologic, immunohistochemical, and scanning electron microscopic comparison of pre-iridal monocellular and fibrovascular membranes in normal and glaucomatous canine globes.

OBJECTIVES: (i) To evaluate immunohistochemical labeling of pre-iridal monocellular and fibrovascular membranes and (ii) describe the light and scanning electron microscopic (SEM) characteristics of these membranes in glaucomatous and normal/control canine globes. MATERIALS AND METHODS: All globes were evaluated with light microscopy. Immunohistochemical labeling for CD18, Smooth muscle actin (SMA), and CD117 was completed on 40 canine globes with congenital/anterior segment dysgenesis-associated glaucoma (n = 10), primary/goniodysgenesis-associated glaucoma (n = 10), secondary glaucoma (n = 10), and normal/control globes (n = 10). SEM was completed on 10 globes: 5 with monocellular membranes, 3 with fibrovascular membranes, and 2 without a histologically detectable membrane. RESULTS: Monocellular membranes were detected in all normal/control globes with light microscopy and appeared to be morphologically very similar to those in diseased globes. CD18 labeling was detected in 9/10 monocellular membranes in normal/control globes, 15/23 monocellular, and 7/8 fibrovascular membranes in globes with glaucoma. SMA and CD117 labeling was not detected in monocellular membranes of normal/control globes. SMA was expressed in 10/23 monocellular and 7/8 fibrovascular membranes of glaucomatous globes. CD117 was expressed in 7/23 monocellular and 5/8 fibrovascular membranes of glaucomatous globes. SEM of monocellular membranes revealed a continuous sheet of mostly spindle cells and few individual round cells that extended over the anterior iris face in normal/control and all glaucomatous globes. CONCLUSION: Pre-iridal monocellular membranes are a normal component of the anterior iris surface, and CD18 immunoreactivity suggests some cells within these are of leukocytic origin. SMA and CD117 labeling of monocellular membranes in glaucomatous, but not normal/control globes, suggest metaplastic cellular change secondary to intraocular pathology related to glaucoma.

A variant in OLFML3 is associated with pectinate ligament abnormality and primary closed-angle glaucoma in Border Collies from the United Kingdom.

PURPOSE: Canine primary closed-angle glaucoma (PCAG) is a complex disease caused by multiple genetic factors. A c.590G>A variant in OLFML3 was recently reported to be a candidate for pectinate ligament abnormality (PLA) and PCAG in the Border Collie. We investigated the association of this variant with PLA and PCAG in Border Collies from the United Kingdom. METHODS: The OLFML3 variant was genotyped in 106 Border Collies comprising 90 with normal eyes (controls) and 16 with PLA (n = 11) and/or PCAG (n = 5) (cases). Genotyping was performed in an additional 103 Border Collies to estimate variant frequency within the population. To investigate the association of the variant with disease in other breeds, genotyping was performed in 337 non-Border Collies with PLA and/or PCAG. RESULTS: Of the 90 controls, 71 were homozygous for the wild-type allele, two were homozygous for the variant, and 17 were heterozygous. Of the 16 cases, three were homozygous for the wild-type allele, 11 were homozygous for the variant, and two were heterozygous. The association of the variant allele with disease was significant (P = 1.1 x 10-9 ). We estimated the frequency of this variant to be 4.4% within the United Kingdom Border Collie population, and it was not identified in clinically affected dogs of any other breed. CONCLUSIONS: This study confirms the association of the OLFML3 variant with PLA and PCAG in Border Collies from the United Kingdom. DNA testing for the variant and selective breeding can reasonably be expected to result in a reduction of PLA and PCAG prevalence in the breed.

Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma.

OBJECTIVE: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. METHODS: One hundred primary glaucoma patients (120 eyes) in Xinyu People's Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. RESULTS: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P<0.05). There was 93.33% formation of functional filtering blebs in the study group, which was significantly higher than that in the control group (60.00%, P<0.001). Moreover, normal anterior chamber formation was significantly higher in the study group (91.67%) than in the control group (71.67%, P<0.01). There was 95.00% operation success in the study group, relative to 68.33% success in the control group (P<0.001). CONCLUSION: Microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique has better curative effect on primary glaucoma than compound trabeculectomy. Moreover, it does not exacerbate complications. Therefore, the combination treatment technique merits clinical application.

[Initial combination therapy for primary open-angle glaucoma]. / 'Startovaia' kombinirovannaia terapiia pervichnoi otkrytougol'noi glaukomy.

PURPOSE: To study the efficacy and safety of initial combination therapy in patients with primary open-angle glaucoma (POAG). MATERIAL AND METHODS: The study included 111 patients (161 eyes) with stages II-III b-c of POAG aged 46 to 89 years (mean age 70.8±8.5 years). In the test group, therapy began with a fixed combination of prostaglandin (PG) (latanoprost) and beta-blocker (BB) (timolol). In patients of the control group, POAG therapy began with administration of the analogue of prostaglandin (latanoprost). When the target IOP was not achieved, a second drug was added to the treatment - instillations of 0.5% solution of timolol maleate 2 times a day. RESULTS: In patients of the test group the treatment started with a combination of BB + PG, the target IOP in the 'worst' eyes was achieved in 33 cases (64%) in 1.5±0.6 visits, and in the 'best' eyes - in 17 cases (81%), in 1.2±0.4 visits. In the control group with a 'step-by-step' selection of antihypertensive therapy, the target IOP in the 'worst' eyes was achieved in 35 cases (59%), in 2.5±0.7 visits, and in the 'best' eyes - in 22 cases (76%), in 2.2±0.5 visits (p<0.05). In both study groups, there were no cases of drug withdrawal attributed to their side effects. Patients noted conjunctival hyperemia in 5% (4 eyes) and 7% (6 eyes) of cases in the test group and the control group, respectively (p>0.05). Hyperemia decreased significantly in 2 weeks of latanoprost administration or fixed combination and did not cause withdrawal. CONCLUSION: Initial combination therapy is possible in patients with newly diagnosed POAG in some clinical situations, namely in stages II-III POAG with high IOP, unavailability of regular observation of patients for various social and economic reasons, absence of somatic and local contraindications to individual components of the combined treatment, etc.

The association between socioeconomic status and visual impairments among primary glaucoma: the results from Nationwide Korean National Health Insurance Cohort from 2004 to 2013.

BACKGROUND: Glaucoma is one of the most leading causes of permanent visual impairments in Korea, and social expenses spent for the glaucoma are increasing. This study is to identify association between socioeconomic status and the visual impairments caused by primary glaucoma in Korea. METHODS: This study is based on a cohort study using stratified representative samples in the National Health Insurance claim data from 2002 to 2013 with 1,025,340 representative subjects. Target subjects were patients who are newly diagnosed with primary glaucoma from 2004 to 2013. We conducted a multiple logistic regression analysis depending on the occurrence of visual impairment and its temporal order compared to the glaucoma diagnosis. RESULTS: Among 1728 patients with primary glaucoma, those with low and middle income shows higher odds ratio (OR) of the visual impairments than those with high income group (low income; OR = 3.42, 95% Confidential Interval (CI):2.06-5.66, middle income; OR = 2.13, 95% CI: 1.28-3.55), in case of the occurrence of the visual impairments preceded the diagnosis of glaucoma. CONCLUSIONS: Glaucoma patients without pre-existing glaucoma history before visual impairment have higher association between socioeconomic status and the occurrence of visual impairments by primary glaucoma. Since glaucoma had not been diagnosed and recognized yet, the differences may have been derived from the disparities of the awareness of the glaucoma. These findings call attention to the correlation between socioeconomic factors and the visual impairments by glaucoma, and raise public health needs over the importance of glaucoma awareness and eye screening for glaucoma, especially for low socioeconomic status.

Survey of the incidence of pectinate ligament dysplasia and glaucoma in the UK Leonberger population.

OBJECTIVE: To determine the prevalence of pectinate ligament dysplasia (PLD) in UK Leonbergers and identify cases affected by glaucoma. Also, to define the spectrum of pectinate ligament (PL) appearance in this breed and determine whether gonioscopic monitoring should be recommended. ANIMALS STUDIED: Data were compiled from 78 prospective gonioscopy examinations performed by one author (GF) and retrospective analysis of 233 UK eye scheme certificates (2009-2014). Clinical cases of glaucoma in Leonbergers diagnosed by UK veterinary ophthalmologists, where gonioscopy of the fellow eyes or histology of affected eyes had been performed, were also reviewed. PROCEDURE: In the prospective study, intraocular pressure was recorded prior to gonioscopy using a rebound tonometer. Gonioscopy was performed using a slit-lamp biomicroscope with a Koeppe goniolens. PLD was categorized according to the percentage of the iridocorneal drainage angle affected (grade 0 = <25% affected; grade 1 = 25-50% affected; grade 2 = 51-75% affected; and grade 3 = >75% affected), and the degree of narrowing of the angle was noted. RESULTS: Of 78 dogs examined prospectively, 64/78 (82%) were grade 0, 7/78 (9%) were grade 1, 3/78 (4%) were grade 2, and 4/78 (5%) were grade 3. A large phenotypic variation was observed. Spearman's rank correlation showed a positive correlation between age and severity of PLD (P < 0.0055). 52 (22%) of Leonbergers examined under the UK eye scheme 2009-2014 were affected by PLD. Five clinical cases of glaucoma were reviewed where gonioscopy had been performed and one where histology was performed. All individuals had grade 3 PLD with gonioscopy of the contralateral eye or severe goniodysgenesis with histological sections of the affected eye. CONCLUSION: This survey suggests the prevalence of PLD is sufficient to justify ongoing screening of Leonbergers.

Progression of pectinate ligament dysplasia over time in two populations of Flat-Coated Retrievers.

OBJECTIVE: Two of the authors (DG, BS) independently observed that a number of Flat-Coated Retrievers (FCRs) previously unaffected by pectinate ligament dysplasia (PLD) appeared to develop the condition later in life. This study was instigated to investigate progression of PLD within individual dogs over time. ANIMALS STUDIED: Flat-Coated Retrievers that had previously undergone gonioscopy under the UK/ECVO hereditary eye schemes were included in the study. PROCEDURE: A second gonioscopic examination was performed 1.92-12.58 years later (mean 6, median 5.75 years) and the results compared. 39 FCR (17 males, 22 females) in the UK and 57 FCR (27 males, 30 females) in Switzerland were included. Slit-lamp biomicroscopy, indirect ophthalmoscopy, and gonioscopy were performed in all dogs. Gonioscopy allowed classification as either unaffected or affected; percentage of the iridocorneal drainage angle (ICA) affected by PLD was determined, before calculating progression observed as mild, moderate, or severe. RESULTS: 39 of 96 (40.6%) dogs demonstrated progression of PLD (P < 0.0001). Of these, 13 of 96 (13.5%) were classified as mild progression (from either unaffected to 10-20% or 10-20% to 20-90% ICA affected). Progression was more extensive in 26 of 96 (27.1%) dogs (P < 0.0001), of which 12 of 96 (12.5%) went from unaffected to severe PLD of >90% ICA affected, consistent with a high risk of glaucoma. CONCLUSIONS: To the authors' knowledge, this is the first report describing progression of PLD in individual dogs over time, in a breed affected by primary, angle closure glaucoma.

Prevalence of pre-iridal monocellular and fibrovascular membranes in canine globes affected with congenital glaucoma associated with anterior segment dysgenesis, primary glaucoma associated with goniodysgenesis, and secondary glaucoma.

Objectives: The objectives of this study were to (i) evaluate the prevalence of pre-iridal monocellular and fibrovascular membranes in canine globes affected with congenital glaucoma associated with anterior segment dysgenesis (ASD), primary glaucoma associated with goniodysgenesis (GD), and secondary glaucoma, and (ii) examine the associations between monocellular and fibrovascular membranes by breed, gender, age and histopathologic ocular changes on light microscopic examination. Methods: Records of dogs who had eyes enucleated due to blindness and uncontrolled glaucoma were reviewed. Glaucoma was categorized clinically and histologically into three groups: congenital/ASD, primary/GD, and secondary glaucoma. The presence or absence and type of pre-iridal membrane (monocellular or fibrovascular) and other intraocular histologic findings were reviewed and compared statistically for each group. Results: In total, 108 canine globes (101 dogs) were included. Pre-iridal monocellular membranes were identified with light microscopy in 10 out of 19 congenital/ASD, 29 out of 40 primary, and 23 out of 49 secondary glaucoma globes. Fibrovascular membranes were observed in 3 out of 19 congenital/ASD, 9 out of 40 in primary, and 24 out of 49 secondary glaucoma globes. There were no associations between the type of membrane and breed, gender, or age. Peripheral anterior synechiae were more common in globes with fibrovascular membranes, and uveal atrophy was more common in globes with monocellular membranes. Conclusion: Pre-iridal monocellular membranes are common in all types of canine glaucoma. They are identified with light microscopy most easily in cases of primary glaucoma, and they are masked by pre-iridal fibrovascular membranes in other forms of glaucoma.

Five-year incidence of primary glaucoma and related risk factors - The Handan eye study.

PURPOSE: To determine the 5-year incidence of primary glaucoma and its associated risk factors in rural northern China. METHODS: Population-based cohort study. A total of 5184 participants aged 30 years and older, without glaucoma at baseline, were subjected to comprehensive standardized interviews and ophthalmic and systemic examinations at baseline and after a 5-year interval in the Handan Eye Study. Incident glaucoma was diagnosed by a consensus panel of five senior glaucoma specialists. Univariate and multivariable logistic regression analyses were performed to identify the baseline risk factors that could predict the incidence of glaucoma. RESULTS: During the 5-year follow-up, incident primary glaucoma developed in 82 subjects (1.6%; 95% confidence interval [CI], 1.2%-1.9%). The age- and gender-standardized incidence of glaucoma among subjects ≥40 years old was 2.1% (0.4% annually), calculated according to the 2010 Chinese census. A higher age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; p < 0.001), higher intraocular pressure (IOP) (OR, 1.11; 95% CI, 1.02-1.20; p = 0.017), and vertical cup disc ratio (VCDR) ≥ 0.60 (OR, 5.30; 95% CI, 3.22-8.73; p < 0.001) were found to be associated with an increased risk of incident glaucoma. For each year, older age and each mmHg higher IOP, the risks of primary glaucoma increased by 1.2% and 2.0% per year, respectively. CONCLUSION: We reported the 5-year incidence of primary glaucoma in a rural Chinese population and found that older age, higher IOP, and VCDR ≥ 0.60 at baseline could help in identifying those at highest risk of disease development.

Extent of glaucomatous damage on the first presentation.

AIM: The aim is to determine the magnitude of glaucomatous damage in the asymptomatic subjects identified with primary glaucoma for the first time and thus to evaluate the significance and efficacy of screening measures for glaucoma. MATERIALS AND METHODS: An observational retrospective cohort study of 100 asymptomatic patients of age more than 40 years, diagnosed with and under treatment for primary glaucoma was performed. Patients were categorized into having early, moderate, and severe glaucoma, according to standard automated perimetry (SAP) mean deviation (MD) in the worse eye (<-6, -6 to -12 and >-12 dB, respectively). Risk factors were correlated with the severity of glaucoma at presentation and statistically analyzed. RESULTS: About 32%, 33%, and 35% of patients were found to have early, moderate, and severe stages of glaucoma with average MD of -3.51 ±1.53, -8.65 ±1.64, -17.15 ± 5.13 on SAP, respectively. The association of risk factors such as age (P = 0.006) and glaucoma awareness (P = 0.044) with the severity of glaucoma was statistically significant. There was no direct statistical correlation found between gender, history of diabetes mellitus, family history of glaucoma, intraocular pressure, central corneal thickness, the angle width, and the severity of glaucoma in our study. CONCLUSION: Majority of cases with primary glaucoma show no symptoms until advanced irreversible stages. Early screening and proper treatment are the only ways to halt its progression. In spite of available facilities, 68% of patients in our study were found to have moderate-to-severe stages of glaucoma. This indicates that our screening measures should reach the masses at the primary level, with a focus on awareness programs.

Visual Field Progression After Glaucoma Surgery in Pseudoexfoliation versus Primary Glaucoma.

Purpose: To compare visual field progression in severity-matched pseudoexfoliation glaucoma (XFG) and primary glaucoma after intraocular pressure (IOP) reduction by filtering surgery. Methods: Patients with XFG (n=32), primary open-angle glaucoma (POAG, n=33) or primary angle closure glaucoma (PACG, n=28) that underwent routine cataract and glaucoma filtering surgery by the same surgeon (APR) between May 2017 and September 2021, were included for this prospective study. Rate of progression (ROP) was determined using guided progression analysis and compared between XFG and primary glaucoma. Multivariate regression was done to analyse the factors responsible for progression in each group. Results: Visual field progression after surgery was noted in 48 eyes (n=11 XFG, 18 POAG and 19 PACG eyes) at a mean follow-up of 10±5.6 months after surgery with RVI seen in 18 of 48 eyes. The final IOP (p=0.8) and mean ROP (p=0.09) were not significantly different between XFG and primary glaucoma. The XFG eyes had a greater number of eyes (36%) showing an ROP worse than -5dB/yr, with 45% of eyes showing an IOP spike >5mm Hg, and a higher mean IOP spike between visits. The ROP in eyes with RVO and >5mm Hg IOP spikes was greater in XFG than in POAG or PACG. In the multivariate analysis, higher IOP fluctuations >5mm Hg, and associated retinal vein occlusions (RVO) were significant factors for visual progression greater than -5dB/year (R2=53.5%) in POAG and XFG eyes. Age, gender, baseline MD, and number of medications before surgery or at final follow-up did not influence visual progression rates in either group. Conclusion: A higher IOP fluctuation >5mm Hg and associated RVO were the significant factors predicting visual field progression after filtering surgery in XFG and POAG eyes. Control of both IOP-dependent and -independent mechanisms of VF progression is therefore essential in these eyes.

Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India.

Purpose: To ascertain the prevalence and clinical features of the various types of childhood glaucoma at a tertiary eye care hospital in Northern India. Materials and methods: Retrospective chart review of all children less than 16 years of age with childhood glaucoma who presented from 1st April 2014 to 31st March 2019, who was diagnosed to have any subtype of childhood glaucoma as per Childhood Glaucoma Research Network (CGRN) classification and advised appropriate management. Results: Out of 405 children with childhood glaucoma, 36% had primary glaucoma, whereas the rest had secondary glaucoma. Primary congenital glaucoma (PCG) was the most common form of primary glaucoma. Glaucoma associated with acquired conditions was the most common cause of secondary glaucoma. Primary glaucoma was mostly bilateral in contrast to secondary glaucoma. The most common age of presentation with primary glaucoma was <1 year of age, and in children with secondary glaucoma was 11-16 years. On presentation, 80% of eyes had intraocular pressure (IOP) of >20 mm Hg and 70% had cupping of >0.7. Eyes with PCG were primarily managed surgically. Conclusion: In our cohort, PCG was the most common primary childhood glaucoma. Traumatic glaucoma was the most common secondary glaucoma. Since childhood glaucoma is an important cause of visual morbidity in children, its timely diagnosis and prompt management are essential to prevent irreversible visual loss. Clinical significance: Understanding the disease pattern, their presenting features, and the proportion of different types of childhood glaucoma can help in planning appropriate eye care services, create awareness and better allocate resources to plan appropriate management strategies. Screening programs and counseling of parents should also be strengthened. How to cite this article: Dubey S, Jain K, Pegu J, et al. Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India. J Curr Glaucoma Pract 2023;17(2):68-74.

Feline Glaucoma.

Feline glaucoma is best categorized as either secondary, congenital and anterior segment dysgenesis associated, or primary. More than 90% of all feline glaucoma develops secondary to uveitis or intraocular neoplasia. The uveitis is usually idiopathic and assumed to be immune-mediated, whereas lymphosarcoma and diffuse iridal melanoma account for many of the intraocular neoplastic-induced glaucoma in cats. Several topical and systemic therapies are useful in the control of the inflammation and elevated intraocular pressures associated with feline glaucoma. Enucleation remains the recommended therapy for blind glaucomatous feline eyes. Enucleated globes from cats with chronic glaucoma should be submitted to an appropriate laboratory for histologic confirmation of the type of glaucoma.

A Novel Biomarker in Primary Glaucoma: Aqueous Humor and Serum Levels of Ischemia Modified Albumin (IMA).

Purpose: To analyze ischemia-modified albumin (IMA) levels in aqueous humor and serum, and their correlation to RNFL thinning in primary glaucoma patients. Design: Cross-sectional study. Methods: Patients were divided into the control and glaucoma groups. The control group was patients with senile cataracts. The glaucoma group consisted of patients diagnosed for the first time as primary open-angle glaucoma (POAG) or primary angle closure glaucoma (PACG). Exclusion criteria were secondary glaucoma and patients with systemic disease. A complete cataract examination was done for all patients, and glaucoma examinations for the glaucoma group. In both groups, the IMA aqueous humor was obtained during cataract and glaucoma procedure. Serum levels of IMA, malondialdehyde (MDA), and tumor necrosis factor alpha (TNF-α) were examined during preoperative examinations. Results: Control group comprised 33 participants, and glaucoma group 41 patients (21 PACG and 20 POAG). Mean IMA aqueous humor (AQH) levels found in cataract group 6.039±3.16 ng/mL, glaucoma group 14.89±6.08 ng/mL, PACG group 12.69±6.25 ng/mL and POAG group 17.33±4.988 mg/mL. Mean IMA serum levels in cataract group 14.75±6.53 ng/mL, glaucoma group 13.89±6.53 ng/mL, PACG group 12.79±6.46 ng/mL± and POAG group 14.93±10.74 ng/mL. Glaucoma group had significant higher level of IMA in aqueous humor compared to control group, but opposite findings in serum IMA levels between groups. POAG patients had a higher aqueous IMA level compared to PACG group and correlated significantly with IOP. IMA AQH also negatively correlated to the RNFL thickness in both POAG and PACG group. Cut off 9.5 ng/mL was considered as a normal limit value to differentiate between control and glaucoma group. Conclusion: Primary glaucoma patients showed a significantly increased level of IMA AQH as a local ischemic biomarker compared to the control group. Systemic oxidative activity is not a representation of local ocular oxidative stress in both cataract and glaucoma group.

Surgical Outcomes of Glaucoma Drainage Device Implantation in Refractory Glaucoma Patients in Thailand.

Purpose: To study the surgical outcomes of glaucoma drainage device (GDD) implantation in refractory glaucoma patients. Patients and Methods: Retrospective chart review of glaucoma patients undergoing GDD implantation, Ahmed glaucoma valve (AGV), Baerveldt glaucoma implants (BGI), and Aurolab aqueous drainage implantation (AADI) from January 2012 to June 2021. Glaucoma patients were classified into two groups: primary glaucoma including: primary open angle glaucoma (POAG), primary angle closure glaucoma (PACG) and juvenile open angle glaucoma (JOAG) and secondary glaucoma including: neovascular glaucoma (NVG), ocular surgery (vitreoretinal surgery, scleral buckling procedure, postoperative extra capsular cataract extraction, scleral fixation intraocular lens, penetrating keratoplasty), intraocular trauma, uveitis glaucoma, lens-induced glaucoma, pseudoexfoliation glaucoma (PXG), iridocorneal endothelial (ICE) syndromes and Axenfeld Rieger Syndrome. Surgical outcomes were studied. Results: Primary glaucoma included 57 eyes from 49 patients. Secondary glaucoma included 87 eyes from 85 patients. The cumulative probability of complete or qualified success of refractory glaucoma patients at five years were 53.4% (95%CI: 38.4%, 66.3%). Higher success rate was discovered in primary glaucoma at 65.8% (95%CI: 38.4%, 83.3%) than 45.2% (95%CI: 26.9%, 61.9%) in secondary glaucoma group significantly with p=0.003. While the results among success rate, adverse events and complications was not different between types of GDD. Predictors for failure were neovascular glaucoma with unadjusted hazard ratio (HR) 3.62 (95%CI: 1.45, 9.04) with p=0.006, and lens-induced glaucoma with adjusted HR 4.19 (95%CI: 1.10, 15.86) with p=0.035 in multivariable analysis. Tube malposition and occlusion were the most frequent adverse events at 11.11%, corneal decompensation at 5.5%, hypotony at 2% in the nonvalved group, and endophthalmitis at 0.69%. Conclusion: Surgical success in refractory primary glaucoma was superior to secondary glaucoma with no difference between nonvalved and valved GDD implantation. Lens-induced glaucoma was a strong predictor for failure in GDD implantation.