One-year outcomes of combined phacoemulsification and viscogoniosynechialysis with and without endoscopic cyclophotocoagulation in primary angle-closure glaucoma.

PURPOSE: To compare the outcomes of combined phacoemulsification and viscogoniosynechialysis (VGSL) with and without endoscopic cyclophtocoagulation (ECP) in primary angle-closure glaucoma (PACG). METHODS: In this prospective interventional case series 52 eyes of 50 patients were enrolled. Twenty-seven eyes underwent combined phacoemulsification and VGSL (PV group) and 25 eyes underwent the same procedure plus circumferential ECP (PVE group). All eyes were followed 1 day, 1 week, 3 months, 6 months, and 1 year after the procedure. Intraocular pressure and antiglaucoma medications were compared between and within groups using generalized estimating equations. Kaplan-Meier survival analysis was carried out to compare intensity to failure between groups. RESULTS: The mean ± SD age was 63.23 ± 6.87 years and 50% of the cases were male in the entire group. Intraocular pressure (IOP) and antiglaucoma medications were significantly reduced at all time points in comparison with the baseline in both groups (p < 0.05). There was no significant difference between groups in either IOP or medications at specific time points (p > 0.05). One eye in each group developed a fibrinous reaction in the postoperative period. There was no statistically significant difference between groups regarding the intensity to failure (P = 0.169). CONCLUSION: There were no significant differences in IOP and medication reduction between groups. Also, the complications were comparable between groups.

The thickness of the outer retina in the macula and circumpapillary area in patients with unilateral advanced glaucoma.

PURPOSE: To compare outer macular and retinal thickness in the circumpapillary area in unilateral advanced glaucomatous eyes to the normal or mild glaucomatous fellow eyes. METHODS: Seventy-eight eyes of 39 patients with unilateral advanced glaucoma (mean deviation (MD) worse than -12.00 dB based on visual field 24-2) were included in this cross-sectional study as the cases. The healthy or mild glaucomatous fellow eyes were enrolled as the control group. All eyes underwent optical coherence tomography of the macula and circumpapillary retina by Topcon DRI Triton (Topcon, Tokyo, Japan). Ganglion cell layer 2+ was considered as the inner retina. Total retinal thickness minus the thickness of the inner retina was considered as the outer retina. Comparison between groups was done by paired-sample sign test. The correlation between structural and functional parameters was evaluated by a partial correlation coefficient. RESULTS: Seventeen (43.6%), 15 (38.5%), and 7 (17.9%) patients had pseudoexfoliation, primary angle-closure, and primary open-angle glaucoma, respectively. The mean age was 62.69 ± 12.00 years. Thirty-three (84.6%) patients were male. The outer retinal thickness in the circumpapillary area was higher in temporal, superior, and inferior quadrants (p < 0.05). The outer macula in different parafoveal and perifoveal quadrants was also thicker (p < 0.05). Average outer parafoveal thickness in the case group had a significant negative correlation with MD (r = -0.339; p = 0.035). CONCLUSION: Advanced glaucomatous eyes had a thicker outer retina in the macula and circumpapillary area. There was a significant negative correlation between outer perifoveal thickness and MD.

Intraocular pressure trend following myopic photorefractive keratectomy.

PURPOSE: To evaluate the intraocular pressure (IOP) trend and risk factors for IOP rise after myopic photorefractive keratectomy (PRK). PATIENTS AND METHODS: One eye of each patient undergone PRK for myopia was randomly assigned to this study. All eyes underwent tonometry by CorVis Scheimpflug Technology (CST) tonometer (Oculus Optikgeräte GmbH, Wetzlar, Germany) 1 week, 2 weeks, 1 month, 2 months, 3 months and 4 months after surgery. The eyes with IOP rise more than 5 mmHg and the risk factors were evaluated by Kaplan-Meier graph and multiple Cox regression analysis. RESULTS: A total of 348 eyes of 348 patients were enrolled in this study. Forty-three eyes (12.35%) experienced a steroid-induced IOP rise of more than 5 mmHg. Eyes with IOP rise had higher baseline IOP (Median 19 mmHg (IQR 18-22) versus Median 15 mmHg (IQR 14-16); p < 0.001). Baseline central corneal thickness (CCT) was higher in eyes without IOP rise (Median 520 µm (IQR 509-541) versus Median 535 µm (IQR 518-547); p = 0.009). In multivariate Cox regression analysis, higher baseline IOP was a risk factor for IOP rise (Hazard Ratio (HR) 1.59 (95% CI 1.43-1.77); p < 0.001) while higher baseline CCT was protective (HR 0.97 (95% CI 0.95-0.98); p < 0.001). CONCLUSION: Eyes with higher baseline IOP and lower baseline CCT are at increased risk of IOP rise after PRK and should be monitored more frequently.

The role of optical coherence tomography angiography in moderate and advanced primary open-angle glaucoma.

PURPOSE: To evaluate the relationship between structure and function in moderate and advanced primary open-angle glaucoma (POAG) and to determine the accuracy of structure and vasculature for discriminating moderate from advanced POAG. METHODS: In this cross-sectional study, 25 eyes with moderate and 40 eyes with advanced POAG were enrolled. All eyes underwent measurement of the thickness of circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell complex (GCC), and optical coherence tomography angiography (OCTA) of the optic nerve head (ONH) and macula. Visual field (VF) was evaluated by Swedish interactive threshold algorithm and 24-2 and 10-2 patterns. The correlation between structure and vasculature and the mean deviation (MD) of the VFs was evaluated by a partial correlation coefficient. The area under the receiver operating characteristic curve (AUC) was applied for assessing the power of variables for discrimination moderate from advanced POAG. RESULTS: Including all eyes, whole image vessel density (wiVD) of the ONH area, and vessel density (VD) in the inferior quadrant of perifovea were the parameters with significant correlation with the mean deviation (MD) of the VF 24-2 in OCTA of the ONH and macula (r = .649 and .397; p < .05). The greatest AUCs for discriminating moderate and advanced POAG belonged to VD of the inferior hemifield of ONH area (.886; 95% CI (.805, .967)), and VD in the inferior quadrant of perifovea (.833; 95% CI (.736, .930)) without statistically significant difference (.886 Versus .833; p = .601). CONCLUSION: Among vascular parameters of the ONH area, wiVD had the strongest correlation with the MD of the VF 24-2 while VD of the inferior hemifield of the ONH area had the greatest AUC for discriminating moderate and advanced POAG. Vessel density in the inferior quadrant of perifovea had a significant correlation with the MD of VF 24-2 and also the greatest AUC for discriminating moderate and advanced POAG.

Changes in the morphology of the hyperemic blebs in eyes undergone trabeculectomy with mitomycin C after injection of triamcinolone acetonide during one-year follow-up.

PURPOSE: To track changes in the morphology of hyperemic blebs in eyes undergone trabeculectomy with mitomycin C 0.02% (MMC) after triamcinolone acetonide (TA) injection. METHODS: A total of 30 eyes of 30 patients with localized or diffuse hyperemia after trabeculectomy with MMC were enrolled in this prospective interventional case series. Two milligrams of TA were injected at the site of maximal injection. Bleb morphology was graded using Indiana Bleb Appearance Grading Scale (IBAGS), and the Moorfields Bleb Grading System (MBGS) 1 week, 1 month, 3 months, 6 months, and 1 year after injection. Failure was defined as intraocular pressure (IOP) more than predefined target IOP for each eye, need for an additional surgical procedure, IOP less than 6 mmHg, and loss of Light Perception (LP) vision. RESULTS: A total of 27 patients completed a 1-year follow-up period and were included in the final analysis. The mean time interval from trabeculectomy to injection of TA was 5.98 ± 2.57 weeks. The bleb height and vascularity in the IBAGS system decreased significantly after the intervention (p < 0.05), with an increase in bleb extension (p = 0.006). Using MBGS, the bleb area did not change significantly following TA injection (p = 0.056) but its height and vascularity significantly decreased in both central and peripheral areas and the surrounding conjunctiva (p = 0.032). The development of a mature cataract was the only complication that could be attributed to TA injection. CONCLUSION: Injection of TA in hyperemic failing blebs improves bleb morphology by decreasing vascularity and height while increasing the extent with an acceptable safety profile.

Ahmed glaucoma valve implantation with and without subconjunctival bevacizumab in refractory glaucoma.

PURPOSE: To evaluate the effects of subconjunctival bevacizumab injection on intraocular pressure (IOP), hypertensive phase, and failure and success rates of Ahmed Glaucoma Valve (AGV) implantation. METHODS: A total of 63 eyes of 63 patients (30 cases in control and 33 cases in bevacizumab group) were included in this randomized masked prospective clinical trial. Pre- and postoperative BCVA, IOP, number of medications, complications and success rates were compared between AGV + bevacizumab and AGV alone group. RESULTS: Both groups showed statistically significant reductions in IOP in all their follow-up visits (P < 0.05). The mean IOP was lower in the AGV + Bevacizumab group than AGV group in all follow-up visits. However, the difference was only significant at the 3rd month (17.3 ± 6.2 vs. 20.7 ± 4.6, p = 0.04). The number of medications was not differed significantly between the two groups at their last visit (p value = 0.84) Complete success rate was higher in AGV + Bevacizumab. However, the difference was not significant (p = 0.73). The qualified and overall success rate, failure rate and the need for second tube were not statistically different between the two groups. The hypertensive phase was not statistically significant between the 2 groups (33.3% in AGV + Bevacizumab group and 50% in AGV group, p = 0.06) CONCLUSION: Adjunctive use of Bevacizumab during AGV implantation is beneficial in controlling hypertensive phase and IOP control and may lead to higher success rates and lower failure rates after AGV implantation. However, whether it's clearly beneficial or its exact role remains to be investigated.

Association of IL-10 gene promoter polymorphisms with susceptibility to pseudoexfoliation syndrome, pseudoexfoliative and primary open-angle glaucoma.

BACKGROUND: The involvement of cytokines in pathogenesis of pseudoexfoliation syndrome and glaucoma has been demonstrated in several studies. The aim of the present study was to explore the association between three promoter polymorphisms -592C/A (rs1800872), - 819C/T (rs1800871) and -1082A/G (rs1800896) of interleukin 10 (IL-10) gene with susceptibility to pseudoexfoliation syndrome (PEX), pseudoexfoliative glaucoma (PEXG), and primary open-angle glaucoma (POAG). METHODS: In this study, 114 PEX, 118 PEXG, 114 POAG patients and 126 healthy individuals from Iranian population were participated. Detailed ophthalmic examinations by an ophthalmologist including slit-lamp bio-microscopic examination, dilated examination of the lens, gonioscopy, and funduscopy were carried out on patients and controls. Genomic DNA was extracted from the blood samples and ARMS-PCR was performed to detect promoter polymorphisms of IL-10. RESULTS: In all three SNPs studied, there was a significant difference in the genotype distribution between patients and control subjects. Results revealed that the AA genotype of IL-10 -592C/A SNP is associated with PEX. However, TT genotype of -819C/T and AA genotype of -1082A/G SNP are significantly associated with susceptibility to either PEX or PEXG and POAG disorders. Furthermore, the ACC haplotype containing the IL-10 -1082A allele was associated with PEX (P = 0.02, OR = 5.76, 95% CI = 5.17-24.49), PEXG (P = 0.006, OR = 7.54, 95% CI = 6.62-30.76) and POAG (P = 0.003, OR = 8.11, 95% CI = 7.13-33.15). CONCLUSIONS: Our results demonstrated that IL-10 gene promoter polymorphisms are associated with susceptibility to PEX, PEXG and POAG in Iranian population. Considering the fact that IL-10 polymorphisms are associated with various IL-10 expressions, further research is needed to explain its involvement in these disorders and the formation of extracellular fibrillar amyloid deposits in PEX and PEXG.

COMPARISON OF ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY PARAMETERS BETWEEN CENTRAL RETINAL VEIN OCCLUSION AND NORMAL EYES: Is Primary Angle Closure a Risk Factor for Central Retinal Vein Occlusion?

PURPOSE: To compare anterior segment parameters in patients with central retinal vein occlusion (CRVO) with normal control subjects by anterior segment optical coherence tomography (AS-OCT). METHODS: In this coss-sectional case-control study, 42 eyes from 21 patients with unilateral CRVO and 21 eyes from 21 age- and sex-matched healthy control subjects were recruited. Study eyes were divided into three groups: involved eyes of CRVO patients (CRVO eyes), fellow eyes of CRVO patients (fellow eyes), and control eyes. Complete ocular examination and AS-OCT were performed for each eye. The AS-OCT parameters (anterior chamber depth, scleral spur angle, angle opening distance [AOD] at 500 and 750 µm from scleral spur [AOD500 and 750] and trabecular-iris space area [TISA] at 500 and 750 µm from scleral spur [TISA500 and 750]) and the rate of narrow angles (based on gonioscopy) in CRVO and fellow eyes were compared with control eyes. RESULTS: The mean (SD) age of the patients and the control group were 60.09 (9.43) and 59.52 (6.66), respectively. The mean intraocular pressure in both eyes of the patients was significantly higher than the control eyes (P < 0.05). All AS-OCT parameters were significantly different among the three groups (P < 0.05). Comparing with the control eyes, CRVO eyes had shallower anterior chamber depth (2.53 vs. 2.85 mm; P = 0.002) and narrower AS-OCT angle parameters (scleral spur angle, AOD500 and 750, TISA500 and 750). Fellow eyes had also shallower anterior chamber depth (2.56 vs. 2.85 mm; P = 0.005) than control eyes and smaller scleral spur angle, AOD500 and AOD750. Five CRVO patients (23.8%) were diagnosed with narrow angles in both eyes based on gonioscopy, whereas no eye in the control group had narrow angles (P = 0.05). CONCLUSION: Imaging with AS-OCT showed that CRVO patients had shallower anterior chamber depth and narrower angle parameters in both eyes in comparison with control eyes. Furthermore, CRVO patients had higher rates of narrow angles on gonioscopic examination.

Acute angle closure: qualitative and quantitative evaluation of the anterior segment using anterior segment optical coherence tomography.

BACKGROUND: To evaluate different mechanisms of acute angle closure and to compare it with unaffected fellow eyes and primary angle closure suspects using anterior segment optical coherence tomography. DESIGN: Prospective, cross-sectional. PARTICIPANTS: 116 eyes (76 patients) with angle closure disease were included. METHODS: Eyes were categorized into three groups: (i) acute angle closure (40 eyes); (ii) fellow eyes of acute angle closure (40 eyes); and (iii) primary angle closure suspect (36 eyes). Complete ophthalmic examinations including gonioscopy, A-scan biometry and anterior segment optical coherence tomography were performed. MAIN OUTCOME MEASURE: Based on the anterior segment optical coherence tomography images, four mechanisms of primary angle closure including pupil block, plateau iris configuration, thick peripheral iris roll and exaggerated lens vault were evaluated among the three subtypes of angle closure disease. RESULTS: There was a statistically significant difference in the mechanism of angle closure disease among the three groups (P < 0.001). Although the majority of fellow and primary angle closure suspect eyes had pupil block mechanism (77.5% and 75%, respectively), only 37.5% of acute angle closure eyes had dominant pupil block mechanism. The percentage because of exaggerated lens vault was greatest in acute angle closure eyes (50%). Acute angle closure eyes had the shallowest anterior chamber depth (P < 0.001), least iris curvature (P < 0.001) and greatest lens vault (P = 0.003) compared with the other two groups. CONCLUSIONS: A statistically significant difference in the underlying primary angle closure mechanisms among acute angle closure eyes as compared with their fellow eyes and primary angle closure suspect may exist.

Outcomes of same-site re-operation with minimal use of mitomycin in failed trabeculectomy.

To evaluate efficacy and safety of same site re-operation in eyes with failed trabeculectomy. A retrospective, noncomparative, interventional case series. We reviewed the medical records of 35 eyes of 35 patients who underwent same-site re-operation for failed trabeculectomy. The surgery involved a fornix-based peritomy at the same site as the previous trabeculectomy with application of 0.2 mg/mL mitomycin for 1 min. Primary outcome measures were intraocular pressure (IOP) control and number of antiglaucoma medications at last follow-up. Success rates were defined according to criteria (A) IOP ≤ 21 mmHg or (B) IOP ≤ 18 mmHg, with or without antiglaucoma medication. The mean age of the patients was 43.3 ± 18.0 years and 62.9 % were male. The mean follow-up was 13.6 ± 12.0 months (range 6-49 months). At final follow-up, mean baseline IOP was reduced from 27.2 ± 8.0 to 16.6 ± 7.5 mmHg (p < 0001). The mean number of antiglaucoma medications was reduced from 2.8 ± 0.8 to 1.0 ± 1.3 (p < 0001). This study supports the efficacy and safety of same-site re-operation with minimal use of mitomycin C for management of failed filtering blebs following trabeculectomy.

Modified viscotrabeculotomy versus modified trabeculotomy in late-onset primary congenital, juvenile, and secondary open-angle glaucoma.

PURPOSE: To compare modified viscotrabeculotomy (VCO-Tbo) to modified trabeculotomy (Tbo) in late-onset primary congenital, juvenile open-angle, steroid-induced, and pigmentary glaucoma. METHODS: Patients were randomly assigned to VCO-Tbo and Tbo groups in this study. Intraocular pressure (IOP), antiglaucoma medications, and success/failure rates were assessed. A linear mixed model was used to compare the change trend at different follow-up times. Survival time was evaluated using the Kaplan-Meier graph and Log-Rank test. RESULTS: The mean IOP at 1, 3, and 12 months in the VCO-Tbo group was 14.1 ± 3.1, 15.9 ± 3 and 17 ± 3.1 mmHg, respectively. The mean IOP at the same time points in the Tbo group was 15.9 ± 3.3, 17.6 ± 3.5 and 18.4 ± 3.2 mmHg (P = 0.051, 0.058, 0.088, respectively). The VCO-Tbo group had significantly lower IOP after six months (16.5 ± 4.1 mmHg vs. 18.7 ± 3.8 mmHg; p = 0.031) and by the last visit (16.8 ± 2.1 mmHg vs. 18.8 ± 2 mmHg; p = 0.013). The reduction in the number of medications was significant in both groups compared to baseline (P < 0.001), but there was no significant difference between groups (P = 0.450). The complete and qualified success rate was 43.9% and 34.1% in the VCO-Tbo group and 46.8% and 10.6% in the Tbo group at the final follow-up (p = 0.040, and 0.039, respectively). CONCLUSION: Both procedures are effective in IOP and medication reduction. The survival time and efficacy of modified trabeculotomy can be augmented by injecting cohesive viscoelastic in the Schlemm's canal.

Effect of adjunctive viscogonioplasty on drainage angle status in cataract surgery: a randomized clinical trial.

BACKGROUND: To compare the anatomic effects of phacoemulsification (Phaco) versus combined phacoemulsification and viscogonioplasty (Phaco-VGP) on drainage angle status in primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). DESIGN: Prospective, randomized clinical trial. PARTICIPANTS: Sixty-seven eyes of 57 patients with the diagnosis of PACG. METHOD: Patients were randomized to undergo Phaco alone (33 eyes) or Phaco-VGP (34 eyes). Patients were examined postoperatively on day 1, week 1 and week 6. Indentation gonioscopy and AS-OCT were performed preoperatively and at 6 weeks after surgery. MAIN OUTCOME MEASURES: Angle and anterior segment parameters by AS-OCT and amount of peripheral anterior synechiae (PAS) by gonioscopy. RESULTS: Sixty-five eyes of 55 patients completed the trial. The mean extent of PAS was significantly reduced from 127.7 to 95.0 degrees (P < 0.001) by Phaco alone, and from 174.0 to 77.3 degrees (P < 0.001) by Phaco-VGP. Phaco-VGP resulted in significantly greater reduction in PAS extent (P = 0.002). Angle-opening distance and trabecular-iris space-area measured by AS-OCT increased significantly after Phaco alone and Phaco-VGP (P < 0.001 for both). Although the change was higher in the Phaco-VGP group, this did not reach statistical significance. Anterior chamber depth (ACD) increased, and lens vault (LV) decreased after both procedures. The amount of change in ACD and LV was not significant between the two groups. CONCLUSION: Both Phaco alone and Phaco-VGP resulted in widening of the drainage angle, deepening of the anterior chamber and reduction of intraocular pressure (IOP) and PAS extent in PACG eyes. Phaco-VGP resulted in significantly more reduction of PAS. However, it seems that additional VGP has no significant effect on short-term IOP.

Plateau Iris: A Review.

Purpose: To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. Methods: This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. Results: This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Conclusions: Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Deep Learning-Based Classification of Subtypes of Primary Angle-Closure Disease With Anterior Segment Optical Coherence Tomography.

PRCIS: We developed a deep learning-based classifier that can discriminate primary angle closure suspects (PACS), primary angle closure (PAC)/primary angle closure glaucoma (PACG), and also control eyes with open angle with acceptable accuracy. PURPOSE: To develop a deep learning-based classifier for differentiating subtypes of primary angle closure disease, including PACS and PAC/PACG, and also normal control eyes. MATERIALS AND METHODS: Anterior segment optical coherence tomography images were used for analysis with 5 different networks including MnasNet, MobileNet, ResNet18, ResNet50, and EfficientNet. The data set was split with randomization performed at the patient level into a training plus validation set (85%), and a test data set (15%). Then 4-fold cross-validation was used to train the model. In each mentioned architecture, the networks were trained with original and cropped images. Also, the analyses were carried out for single images and images grouped on the patient level (case-based). Then majority voting was applied to the determination of the final prediction. RESULTS: A total of 1616 images of normal eyes (87 eyes), 1055 images of PACS (66 eyes), and 1076 images of PAC/PACG (66 eyes) eyes were included in the analysis. The mean ± SD age was 51.76 ± 15.15 years and 48.3% were males. MobileNet had the best performance in the model, in which both original and cropped images were used. The accuracy of MobileNet for detecting normal, PACS, and PAC/PACG eyes was 0.99 ± 0.00, 0.77 ± 0.02, and 0.77 ± 0.03, respectively. By running MobileNet in a case-based classification approach, the accuracy improved and reached 0.95 ± 0.03, 0.83 ± 0.06, and 0.81 ± 0.05, respectively. For detecting the open angle, PACS, and PAC/PACG, the MobileNet classifier achieved an area under the curve of 1, 0.906, and 0.872, respectively, on the test data set. CONCLUSION: The MobileNet-based classifier can detect normal, PACS, and PAC/PACG eyes with acceptable accuracy based on anterior segment optical coherence tomography images.

Sutureless tunnel trabeculectomy without peripheral iridectomy: a new modification of the conventional trabeculectomy.

The purpose of this study was to describe the results of a new modification of the trabeculectomy technique, sutureless tunnel trabeculectomy without peripheral iridectomy (PI), in a group of patients with chronic open-angle glaucoma (COAG). Patients with uncontrolled COAG who were candidates for trabeculectomy underwent sutureless tunnel trabeculectomy without PI. Patients were examined before surgery and at 1, 3, 6 and 12 months after surgery. Pre- and post-operative data including intraocular pressure (IOP), visual acuity, number of anti-glaucoma medications and intraoperative and post-operative complications were recorded. Surgical success was defined as final IOP < 21 mmHg and > 20 % reduction from baseline (criterion A) and as final IOP < 18 mmHg and > 25 % reduction from baseline (criterion B), without further glaucoma surgery or complications that required returning the patient to the operating room. Success was further classified as complete when these criteria were obtained without medications and qualified with or without medical therapy. Eighteen eyes of 18 patients were recruited into the study. All patients had 6 months of follow-up and 15 patients (83.3 %) completed 12 months of follow-up. Mean (SD) age of the patients was 57.2 (5.7) years. Mean (SD) IOP decreased from 23.7 (4.5) mmHg pre-operatively to 14.7 (3.4) mmHg at final follow-up visit (p < 0.001), and the mean (SD) number of glaucoma medications decreased from 2.89 (0.32) pre-operatively to 1 (0.84) at last visit (p < 0.001). Post-operatively, IOP and number of glaucoma medications were decreased in comparison with baseline at all follow-up visits (p < 0.001 for all visits). Qualified and complete surgical success rates were 78 and 50 % for criterion A, and 72 and 50 % for criterion B. Sutureless tunnel trabeculectomy without PI effectively reduced IOP and number of medications in COAG patients during 6-12 months of follow-up. Further controlled studies are needed to better characterize the safety and efficacy of this technique.

Relationship of central corneal thickness to postural IOP changes in patients with and without glaucoma in southern India.

To evaluate the relationship of central corneal thickness to the changes in intraocular pressure (IOP) in the sitting and supine position. Observational case-control study. The study group included Primary open-angle and chronic angle closure glaucoma patients. The control group consisted of patients without glaucoma seen for their routine eye examination. Central corneal thickness was measured by ultrasound pachymetry. Patients were then randomized to IOP measurement by Tonopen either sitting or supine after maintaining that position for 5 min. The position was then reversed and IOP measurements taken again after 5 min. Main outcome measure was change in IOP. One hundred and eighty-two eyes (90 in cases and 92 in controls) were examined. The mean CCT was 538.11 ± 37.17 µm in the study group and 545.34 ± 36.01 µm in the control group (P = 0.185). The mean IOP in the sitting position was 19.54 ± 5.39 mmHg in cases and 14.82 ± 4.01 in controls (P < 0.001). The mean IOP in the supine position was 20.51 ± 5.48 mmHg in cases and 16.02 ± 3.24 in controls (P < 0.001). Mean IOP change from sitting to supine was statistically significant in both groups (P < 0.001 for both). Postural change was greater in cases than controls (P = 0.020). There was no correlation between postural IOP change and CCT in cases (r = 0.143, P = 0.180) and controls (r = 0.096, P = 0.362). Postural IOP change is greater in glaucoma patients than non-glaucomatous patients. There was no correlation between postural IOP change and CCT.

Viscocanalostomy combined with trabeculotomy for management of refractory primary congenital glaucoma.

PURPOSE: To investigate the outcome of viscocanalostomy combined with trabeculotomy (VCO+tbo) in primary congenital glaucoma (PCG) with history of failed trabeculotomy. METHODS: In this prospective study, VCO+tbo was performed in 75 eyes of 46 patients with PCG who had not responded adequately to one angle surgery. Success was defined as intraocular pressure (IOP) of 6-21 mm Hg and at least 20% IOP drop at the last postoperative visit with (qualified) or without (complete) glaucoma medications. RESULTS: Patients completed a mean follow-up of 31 ± 11 months. Complete success was achieved in 6 eyes (8%); qualified success, in 38 eyes (51%). In the 44 successfully treated eyes, IOP was reduced from a preoperative mean of 29.0 ± 5.8 to 15.7 ± 2.6 mm Hg, and the number of medications dropped from 2.6 ± 0.9 to 2.0 ± 1.0 (P < 0.001). In univariate analysis, the success rate was lower in patients with neonatal onset disease than subjects whose age at onset was 1-12 months (HR = 0.22; 95% CI, 0.05-0.93; P = 0.039). Children whose disease was first diagnosed after 1 year of age responded better than neonatal onset patients but worse than those with age of onset of 1-12 months; however, the difference was not statistically significant. Hyphema occurred in 27 eyes (36%) on day 1 and resolved spontaneously. Iatrogenic cyclodialysis occurred in one eye, which was surgically repaired after 1 month of treatment with cycloplegic agents. CONCLUSIONS: In our study cohort, VCO+tbo was associated with successful outcomes in the majority of treated eyes.

Intracameral Injection of Methotrexate for Treatment of Epithelial Ingrowth.

Purpose: To report a case of intracameral injection of methotrexate (MTX) to treat the epithelial ingrowth that occurred following glaucoma surgery. Methods: A case report of a 40-year-old male with epithelial ingrowth after implantation of Ahmed glaucoma valve. Results: The patient was treated with 11 doses of weekly intracameral MTX (400 mg/0.1 ml). Clinical evidence of recurrence was not observed after 11 months of follow-up. Discussion: Intracameral MTX can be used as an alternative for the treatment of epithelial ingrowth.

Evaluation of Anterior Segment Parameters in Pseudoexfoliation Disease Using Anterior Segment Optical Coherence Tomography.

PURPOSE: To compare anterior segment and angle parameters between pseudoexfoliation syndrome (PEX) and PEX glaucoma (PEXG) and normal control subjects using anterior segment optical coherence tomography (AS-OCT) imaging. DESIGN: Cross-sectional study. METHODS: One hundred and two subjects with PEXG, PEX, and normal eyes as the control group were recruited from an academic referral institution. All subjects underwent a complete ophthalmologic examination, axial length measurement, and AS-OCT imaging. Anterior segment and angle parameters were evaluated. RESULTS: After excluding 4 eyes because of poor imaging of the scleral spur, data from 34 eyes with PEXG, 33 eyes with PEX, and 31 eyes of normal control subjects were analyzed. Anterior chamber depth was significantly shallower in eyes with PEXG compared with eyes of control subjects (P < .001). The differences in anterior chamber angle parameters (AOD500, AOD750, TISA500,and TISA750) were significant among study groups, with lower values in the PEXG group compared with the PEX and control subject groups. Lens vault (mean [mm]±SD) was higher in the PEXG (0.46 ±0.21) and PEX (0.427 +0.28) groups compared with the control group (0.305+ 0.20). CONCLUSIONS: PEXG eyes have the narrowest anterior chamber angle parameters. There is a progressive decrease in angle parameters from control subjects to the PEX group to the PEXG group. Narrow anterior chamber angle and anterior chamber depth may have a role in the progression of PEX to PEXG. Detection of narrow angle in these patients may help clinicians manage the disease more properly.

Comparison of Vascular Density and Structural Patterns Between Primary Open Angle Glaucoma and Primary Angle Closure Glaucoma.

PURPOSE: To compare the pattern of vascular density and structural damage in primary open angle glaucoma (POAG) with primary angle closure glaucoma (PACG) using optical coherence tomography (OCT) and OCT angiography (OCTA) in the optic nerve head, circumpapillary, and macular regions, respectively. MATERIALS AND METHODS: One hundred thirty-one eyes of 82 patients (53 eyes with PACG and 78 eyes with POAG) were enrolled in this study. The patients underwent complete ophthalmic examination, Bruch membrane opening minimum rim width, circumpapillay retinal nerve fiber layer (cpRNFL), and macular ganglion cell complex (GCC) measurements and vascular density determination of the peripapillary and macular area with OCT and OCTA. A linear mixed model was used for the statistical analysis. RESULTS: There was no significant difference between the 2 groups in terms of age ( P =0.94) and visual field mean deviation ( P =0.78). Female-to-male ratio was higher in PACG patients than the POAG group ( P =0.02), and AL was shorter in PACG eyes ( P <0.001). cpRNFL and GCC were not different between the 2 groups (all P values>0.05, except for nasal segment cpRNFL). Vessel densities in the peripapillary and macular areas were comparable between the 2 groups (all P values>0.05). Although Bruch membrane opening minimum rim width was thicker in PACG eyes on univariate analysis, the multivariable analysis showed no significant difference between the 2 groups ( P >0.05). CONCLUSIONS: PACG and POAG eyes with similar visual field damages have comparable structural damage patterns in the peripapillary and inner macular thickness and vessel density measurements.