Outcomes of Descemet-Stripping Endothelial Keratoplasty in 52 Eyes With Iridocorneal Endothelial Syndrome.

PURPOSE: To evaluate the long-term outcomes of Descemet-stripping endothelial keratoplasty (DSEK) in 52 eyes with iridocorneal endothelial (ICE) syndrome. METHODS: Retrospective study of 52 eyes of 52 patients who were diagnosed with ICE syndrome and underwent DSEK between January 2010 and December 2019 with a follow-up of at least 6 months. RESULTS: The mean age was 48.8 ± 10.8 years. Female patients (n = 33) constituted 63.5%. The median duration of follow-up was 2.4 years (range, 0.5-9.1 yrs). The mean best-corrected visual acuity improved significantly after surgery and remained stable (∼20/50) through 5 years. The mean endothelial cell loss was 28%, 37.9%, 43.6%, and 56.9% at 6 months and at 1, 2, and 3 years, respectively. Graft rejection was noted in 5 eyes (9.6%). Postoperatively, increased intraocular pressure (IOP) was seen in 17 eyes (32.7%), and 10 eyes (19.2%) underwent glaucoma surgeries. Fourteen eyes (26.9%) had secondary graft failures. The estimates of graft success were 93.6% ± 3.6% at 1 year, 85.6% ± 5.5% at 2 years, 79.3% ± 6.7% at 3 years, 69.0% ± 8.9% at 4 years, and 59.1% ± 11.9% at 5 years. Postoperative increased IOP was found to be the only significant (P = 0.05) risk factor (hazard ratio 8.92) associated with graft failure. The clinical variant of ICE syndrome did not seem to influence the graft survival (P = 0.68). CONCLUSIONS: In this study, DSEK had a success rate of ∼60% at 5 years. Increased IOP post-DSEK is a significant risk factor for graft failure. Graft survival is not affected by the clinical variant of ICE syndrome.

Modifications to Combined Trabeculectomy and Manual Small Incision Cataract Surgery: Outcomes and Adaptability in Resource-constrained Areas.

PRECIS: We describe standardization and simplification of classic trabeculectomy combined with manual small incision cataract surgery (MSICS) to effectively manage the 2 leading and often coexisting causes of blindness and vision impairment in resource-constrained areas. PURPOSE: The purpose of this study was to describe modifications to trabeculectomy combined with MSICS and report on the outcomes of this technique. The modifications consist of standardization and simplification of the surgical steps. METHODS: Data obtained from adult patients who underwent described surgical technique at rural eye care centers across 3 Indian states between January 2018 and May 2019 were analyzed retrospectively. Complete success was intraocular pressure between 6 and 18 mm Hg without supplementary medication. Qualified success allowed up to 3 topical medication(s). Data are presented as median (first and third quartiles). RESULTS: We analyzed data of 70 eyes of 70 patients. Ophthalmology fellows performed 27 (38.5%) surgeries, whereas an experienced glaucoma specialist performed 43 (61.4%) surgeries. Patients were 63 (56, 67) years old. The preoperative intraocular pressure was 20 (16, 26) mm Hg on treatment with 3 (2, 3) antiglaucoma medications. Glaucoma was advanced by optic disc structural criteria in 58 (82.8%) eyes. Intraoperative mitomycin C was used in 5 (7.1%) eyes. Follow-up was 12.5 (6, 18) months. At 1 year, complete success (95% confidence interval) achieved was 55% (41-67), whereas qualified success was 83% (68-92) with 0 (0, 1) topical medications. The complete and qualified success rates did not differ between ophthalmology fellows and the glaucoma specialist (P=0.75 and 0.44, respectively). CONCLUSIONS: We present a straightforward, yet effective technique of combined cataract and glaucoma surgery. The technique has a potential for wider applicability, especially in the underserved regions of the world.

LVPEI Glaucoma Epidemiology and Molecular Genetic Study: teleophthalmology screening for angle-closure disease in an underserved region.

OBJECTIVES: To assess the ability of teleophthalmoscopic grading of peripheral anterior chamber depth (PACD) using the van Herick (vH) technique in detecting gonioscopically occludable angle; and to determine whether combining results from vH grading and ocular biometry can improve the accuracy to diagnose gonioscopically occludable angle METHODS: This cross-sectional study was an offshoot of a rural population-based study, Glaucoma Epidemiology and Molecular Genetic Study (GLEAMS). A masked urban ophthalmologist graded digital slit lamp photographs of PACD by vH technique. Sussman four-mirror lens was used to perform dark room indentation gonioscopy. Cutoff values of the tests were, vH technique: grade ≤ 2, central anterior chamber depth (ACD), as well as axial length: ≤ 25th percentile and lens thickness ≥ 75th percentile value of the study population. RESULTS: We studied 1965 eyes of 1029 adult participants. The vH grade was ≤2 in 188 (9.5%) eyes. The angle was occludable by gonioscopy in 101 (5.1%) eyes. The performance of the vH test to rule out gonioscopically occludable angle was good [negative predictive value (NPV): 97.3%], despite low sensitivity (52.5%), while its efficacy to rule in the condition was low [positive predictive value (PPV): 28.2%] despite high specificity (92.8%). However, test combination strategy increased the PPV nearly twofold (53.8%). The calculated PPV at 10% prevalence of gonioscopically occludable angle was even higher (70.5%). CONCLUSIONS: Van Herick technique can be incorporated into a teleophthalmology program by means of slit lamp photographs of PACD. Combined vH grading and ocular biometry improved the predictability of a gonioscopically occludable angle.

New superior modified fornix-based twin-site phacotrabeculectomy.

Phacotrabeculectomy is the preferred surgical management of coexisting visually significant cataract and moderate to advanced glaucoma. We report the surgical technique of a new modified fornix-based separate-site phacotrabeculectomy, with mitomycin C (MMC) application, in both primary open angle and angle closure glaucoma. In this new separate-site technique, both phaco and filtration are accommodated superiorly, side by side, hence called twin-site. This was achieved in an efficacious and safe manner with sparing of limbal stem cells without compromising safety. It is not only MMC-compatible but also has a low incidence of wound leak. The technique has no adverse consequence on the survival of the bleb, and we achieved complete success in 79.2% and total success in 93.1% in 130 eyes of 117 patients, in the intermediate term. Furthermore, the time taken for this separate-site surgical technique is comparable to published one-site procedures.

Toward Better Health Outcomes in Rural and Under-served Areas: L. V. Prasad Eye Institute's Diagonal Model of Glaucoma Care.

Purpose: L. V. Prasad Eye Institute has adopted horizontal approach of eye care delivery for the past 22 years at one of its rural secondary centers. The recent implementation of a diagonal model for enhancing glaucoma care at this center and its outcomes are reported.Methods: This was a retrospective case-control study. We included newly and consecutively diagnosed adult glaucoma patients. A comprehensive ophthalmologist provided glaucoma care. During the study period, an experienced glaucoma specialist supported the care for 2 days every month in a structured format that consisted of triaging glaucoma patients for defined protocols of therapy along with hands-on and remote online guidance to the comprehensive ophthalmologist. The data from the worst or single eye were analyzed.Results: We have included 231 patients (151 study and 80 historical controls). Sixty (75%) control patients were managed at the study center and 20 (25%) were referred. The comprehensive ophthalmologist managed 70 (48.2%) study patients and co-managed 75 (51.7%) with the glaucoma specialist. The latter changed the diagnosis in 15 eyes and altered the treatment plan in 44 eyes. Six were excluded. Successful outcome was achieved in 52 (65%) eyes in the control group and 120 (84.5%) eyes in the study group (P < .01). Additionally, study group did better in terms of case detection rate, compliance to treatment and saving on expenses for patients.Conclusion: The new model has shown better clinical outcomes of glaucoma care in an under-served geographic area. The model has the potential for wider applicability.

The Outcomes of a Comprehensive Program for Maintenance of Goldmann Applanation Tonometer.

PRECIS: We checked 190 tonometers every month and repaired faulty ones. Calibration error (CE) frequency reduced from 23% to 0.6% at 1 year. Tonometers needing one or >1 CE repair differed in survival but not in age. PURPOSE: The purpose of this study was to report the outcomes of a comprehensive program to maintain calibration status of the Goldmann applanation tonometer. METHODS: This prospective cohort study was carried out at 2 tertiary eye care referral centers. We included 190 slit-lamp mounted Goldmann applanation tonometers (Model AT 900 C/M). Health care providers (error checking and reporting) and clinical engineers (maintenance) participated. The team carried out CE check once a month, and repair of faulty tonometers, if any, within 24 hours. Failure of tonometer was defined as development of unacceptable CE beyond the third repair. The main outcome measures were the frequency of CE and survival function of the tonometer over 1 year. RESULTS: The median age of the tonometers was 10.7 (range, 0.2 to 25.1) years. The total number of repairs was 86. The proportion (95% confidence interval) of faulty tonometers reduced from 23.1% (17.7, 29.6) in the first month to 0.6% (0.1, 3.3) at 1 year (P<0.01). The median age of the tonometer did not differ between those needing (n=63, 9.4 y) and not needing (n=127, 10.7 y; P=0.24) repair. All tonometers requiring 1 CE repair (n=49, 25.7%) survived until 1 year. The survival of tonometers requiring >1 CE repair (n=14, 7.3%) was 40% at 1 year. CONCLUSIONS: Our in-house program maintained 92.6% tonometers error free. Number of repairs rather than age determined the need for replacement/sending back the tonometer to the manufacturer. Our simple and easy to follow maintenance program has the potential for wide application.

Etiology and Management of Raised Intraocular Pressure following Posterior Chamber Phakic Intraocular Lens Implantation in Myopic Eyes.

AIM: To evaluate the etiology and management of elevated intraocular pressure (IOP) following posterior chamber phakic implantable collamer lens (ICL) surgery. METHODS: Between 2009 and 2015, 638 eyes of 359 subjects with refractive myopia, underwent V4b and V4c (CentraFLOW) model ICL implantation. Ocular hypertension (OHT) was defined as IOP of ≥ 22 mm Hg on two separate occasions and elevated IOP with corresponding optic disc or visual field damage was defined as glaucoma. RESULTS: Elevated IOP ≥ 22 mm Hg was noted in 33 eyes of 30 subjects (33/638; 5.17%). Median age of subjects with raised IOP was 26 years (Inter quartile range (IQR):22, 29) and median refarctive error was -16 diopters (-19.5, -13). The median follow up was 7.8 months (IQR:0.3, 17.6) and median time for postoperative IOP rise was 12 days, (IQR:2, 24). The various etiologies for elevated IOP were steroid response in 21 eyes (64%; 10 eyes with V4b, 11 eyes with V4c), retained viscoelastic in 5 eyes (15%) (3 with V4b, 2 with V4c), pupillary block in four eyes (12%; 3 with V4b, 1 with V4c), malignant glaucoma in one eye (3%, V4b), and missed pre-existing Juvenile open angle glaucoma (JOAG) in two eyes (6% with V4b). Elevated IOP in 31 eyes resolved with conservative management. One eye (centraFLOW design) with central aquaport block by viscoelastic, needed AC wash and one eye with malignant glaucoma needed parsplana vitrectomy and hyaloidotomy. Ten eyes required longterm (>2 months) antiglaucoma medications (AGM) for IOP control. Except the two eyes with JOAG, none had disc and field damage. CONCLUSION: In our series, OHT was seen in 4.85% and glaucoma in 0.3% eyes that underwent V4b and V4c model ICL implantation. Multiple etiologies were noted and steroid induced ocular hypertension was the most common cause of elevated IOP followed by retained viscoelastic and pupillary block. One third of these eyes required longterm AGM for IOP control.

Six-year incidence of visually significant age-related cataract: the Chennai eye disease incidence study.

BACKGROUND: The aim of this study is to report the 6-year incidence of age-related cataract in a population-based study. DESIGN: The design used is a population-based cohort study. PARTICIPANTS: A cohort of 2484 phakic subjects, aged 40 years and above at baseline, from a south Indian population was included in the study. METHODS: Bilateral phakics with visual acuity of 6/12 or better and cataract less than N2, C2 and P2 on the Lens Opacities Classification System II at baseline were included. Subjects with glaucoma and corneal or retinal diseases were excluded. Incident visually significant cataract was defined as visual acuity of less than 6/18 with a corresponding one grade or greater change in Lens Opacities Classification System II or history of having undergone cataract surgery with evidence of pseudophakia or aphakia at the 6-year follow-up. MAIN OUTCOME MEASURES: Six-year incidence of visually significant cataract and associated risk factors data were collected. RESULTS: Incident visually significant cataract at 6 years was seen in 158 subjects (6.36%, 95% CI: 5.40-7.32, phakics:pseudophakics/aphakics 70:88). Incidence was higher in the rural cohort as compared with the urban cohort (P < 0.001). Incidence increased with age and was highest in the ≥70 years age group (odds ratio (OR):31.23, 95% CI: 15.20-64.16, P < 0.001). Other associated risk factors included illiteracy (OR 1.75, 95% CI: 1.17-2.61, P = 0.007) and smoking (OR 1.77, 95% CI: 1.08-2.88, P = 0.02). CONCLUSIONS: A significant proportion of the population developed visually significant age-related cataract at 6 years. Incident visually significant cataract was significantly greater for the rural cohort between 50 and 69 years old.

Comparison of Cataract Surgery Alone Versus Cataract Surgery Combined With Trabeculectomy in the Management of Phacomorphic Glaucoma.

PURPOSE: To compare the outcomes of cataract surgery alone versus combined cataract surgery with trabeculectomy in eyes with phacomorphic glaucoma. MATERIALS AND METHODS: In a retrospective comparative case series, 126 eyes of phacomorphic glaucoma presenting within 4 weeks of onset between 1993 and 2012, with at least 6 months of postoperative follow-up were included. Group 1 included 63 eyes with cataract surgery only and group 2 included 63 eyes with combined cataract surgery and trabeculectomy. Primary outcome measure was intraocular pressure (IOP) ≤21 mm Hg (without antiglaucoma medication) 6 months after surgery. RESULTS: The median (interquartile range) preoperative IOP in group 1 was 36 mm Hg (30 to 50 mm Hg) and group 2 was 40 mm Hg (32 to 48 mm Hg) (P=0.34). The median duration of phacomorphic attack was 7 days (3 to 12 d) in group 1 and 7 days (3 to 15 d) in group 2 (P=0.39). The median duration of postoperative follow-up was 23 months in group 1 and 30 months in group 2 (P=0.89). Six months after surgery, 97% of the eyes in group 1 and 100% in group 2 achieved IOP≤21 mm Hg without antiglaucoma medications with a median postoperative IOP of 12 mm Hg in both the groups (P=0.09). The median Log MAR visual acuity was significantly better in group 1 compared with group 2 (0.2 vs. 0.3, P<0.001). The percentage of eyes that achieved visual acuity better than 20/40 at 3 months was 62% in group 1 versus 19% in group 2 and at 6 months it was 75% in group 1 versus 38% in group 2 (P<0.001). CONCLUSIONS: In our cohort of phacomorphic glaucoma presenting within 4 weeks of onset, cataract surgery and combined surgery resulted in similar IOP control at 6 months. However, cataract surgery alone resulted in better and faster visual recovery.

Outcomes of Primary Trabeculectomy With Mitomycin-C in Glaucoma Secondary to Iridocorneal Endothelial Syndrome.

PURPOSE: To report the outcomes of primary trabeculectomy with mitomycin-C (MMC) in eyes with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. METHODS: We included 16 eyes of 15 subjects with ICE syndrome who underwent primary trabeculectomy with MMC between 1991 and 2013. Surgical success was defined as complete when the intraocular pressure (IOP) was ≥5 and ≤21 mm Hg with no additional antiglaucoma medication (AGM) or surgery and as qualified if IOP was controlled with AGM. RESULTS: The median age (interquartile range) of subjects at the time of trabeculectomy was 41 years (37, 44 y) and the median follow-up period was 23 months (7, 79 mo). Postoperatively, the median IOP significantly reduced from 36 (26, 43) to 14 mm Hg (12, 17 mm Hg) (P<0.001) and median number of AGMs reduced from 3 (2, 4) to 0 (0, 0) (P<0.001). The percentage of complete success was 75% at 6 months, 64% at 12 months, 57% at 36 months, and 33% at 60 months. The percentage of qualified success was 94% at 6 months, 82% at 12 months, 71% at 36 months, and 60% at 60 months. Five eyes failed during the follow-up period. The mean (±SD) number of glaucoma surgeries per eye was 1.3±0.5. Eight eyes developed corneal edema at a median follow-up of 78.5 months and 4 eyes underwent keratoplasty. CONCLUSIONS: Primary trabeculectomy with MMC offers moderate surgical success in patients with ICE syndrome. Maintaining long-term IOP control and corneal clarity in these eyes is a big challenge.

The Prevalence of Pseudoexfoliation and the Long-term Changes in Eyes With Pseudoexfoliation in a South Indian Population.

PURPOSE: To report the prevalence, long-term changes and associated factors for pseudoexfoliation (PEX) in a population aged 40 years and above from rural and urban south India. MATERIALS AND METHODS: At baseline (the Chennai Glaucoma Study), 7774 subjects were examined. After 6 years, as a part of the incidence study, 133 of the 290 subjects diagnosed with PEX at baseline were reexamined for long-term changes. Participants had detailed examination at base hospital. RESULTS: At baseline PEX was noted in 290 [3.73%, 95% confidence interval (CI), 3.3-4.2] subjects. It was associated with glaucoma in 24 (8.3%), ocular hypertension (OHT) in 21 (7.2%), and occludable angles in 24 (8.3%) subjects. The age-adjusted and sex-adjusted prevalence was 3.41% (95% CI, 3.39-3.43). Increasing age was a significant associated factor. Using the 40- to 49-year age group as a reference, the odds ratio increased from 8.4 (95% CI, 4.1-17.1) for the 50- to 59-year age group to 51.2 (95% CI, 25.8-101.6) for the 70 years and above age group. Other associated factors were rural residence (P<0.001), higher intraocular pressure (P<0.001), cataract (P<0.001), being underweight (P=0.01), manual labor (P=0.03), and aphakia (P<0.001). Of the 133 subjects reexamined, 8 (6.0%) subjects developed glaucoma and all had OHT at baseline. Rates of cataract surgery were (P<0.001) higher in subjects with PEX. CONCLUSION: Prevalence of PEX was higher in rural population and baseline OHT was a significant factor for conversion to glaucoma.

Fibrin sealant-assisted revision of the exposed Ahmed tube.

Tube exposure is a known complication of Ahmed glaucoma valve (AGV) implantation. Repair of the exposed tube is not easy. A 42-year-old monocular aphakic male had undergone retinal detachment repair with placement of an episcleral-encircling band followed by implantation of AGV. He presented to the clinic on routine review with exposure of the shunt tube. The complication was managed by placing scleral and conjunctival grafts over the exposed tube using a fibrin adhesive (Tisseel kit; Baxter AG, Vienna, Austria). The novel use of the fibrin sealant in the repair of AGV tube exposure was for better graft-integration.

Six-year incidence of ocular hypertension in a South Indian population: the Chennai eye disease incidence study.

AIMS: To report the 6-year incidence and risk factors for ocular hypertension (OHT) in a population-based study in southern India. METHODS: 6 years after baseline evaluation, 56.9% subjects (participants:non-participants, 4421:3353) were re-examined at the base hospital. Incident OHT was defined as an intraocular pressure above the 97.5th centile for the population with no evidence of glaucoma in the 2852 phakic subjects, 40 years or older. Subjects with trauma, laser or incisional surgery at baseline or follow-up were excluded (total exclusions: 1569). RESULTS: Incidence of OHT at 6 years was 62/2852 subjects (2.17% (95% CI 1.64% to 2.71%, men:women, 36:26)). Incidence was higher in the rural cohort as compared with the urban cohort (80.6% vs 19.4%, p<0.001). A higher baseline intraocular pressure (with increasing OR: 16-18 mm Hg (OR 4.0, 95% CI 2.1 to 7.9), 19-21 mm Hg (OR 11.4, 95% CI 5.7 to 22.9), 22-24 mm Hg (OR 42.6, 95% CI 11.0 to 164.8, in the urban cohort)) and increasing age (50-59 years (OR 1.9, 95% CI 1.1 to 3.3), 70 years and above (OR 3.6, 95% CI 1.2 to 10.6)) were significantly associated risk factors for incident OHT. CONCLUSIONS: A significant proportion of this normal population converted to OHT. A higher incidence of conversion was seen in the rural population.

Baseline risk factors for incidence of blindness in a South Indian population: the chennai eye disease incidence study.

PURPOSE: To report the baseline risk factors and causes for incident blindness. METHODS: Six years after the baseline study, 4419 subjects from the cohort underwent a detailed examination at the base hospital. Incident blindness was defined by World Health Organization criteria as visual acuity of less than 6/120 (3/60) and/or a visual field of less than 10° in the better-seeing eye at the 6-year follow-up, provided that the eye had a visual acuity of better than or equal to 6/120 (3/60) and visual field greater than 10° at baseline. For incident monocular blindness, both eyes should have visual acuity of more than 6/120 (3/60) at baseline and developed visual acuity of less than 6/120 (3/60) in one eye at 6-year follow-up. RESULTS: For incident blindness, 21 participants (0.48%, 95% confidence interval [CI], 0.3-0.7) became blind; significant baseline risk factors were increasing age (P = 0.001), smokeless tobacco use (P < 0.001), and no history of cataract surgery (P = 0.02). Incident monocular blindness was found in 132 participants (3.8%, 95% CI, 3.7-3.8); it was significantly more (P < 0.001) in the rural population (5.4%, 95% CI, 5.4-5.5) than in the urban population (1.9%, 95% CI, 1.8-1.9). Baseline risk factors (P < 0.001) were increasing age and rural residence, and no history of cataract surgery was a protective factor (P = 0.03). CONCLUSIONS: Increasing age was a significant risk factor for blindness and monocular blindness. No history of cataract surgery was a risk factor for blindness and a protective factor for monocular blindness.

Six-year incidence of angle-closure disease in a South Indian population: the Chennai Eye Disease Incidence Study.

PURPOSE: To estimate the 6-year incidence of primary angle-closure (PAC) disease among adult population aged 40 years and older from rural and urban south India. DESIGN: Population-based longitudinal study. METHODS: A complete ophthalmologic examination, including applanation tonometry, gonioscopy, biometry, stereoscopic fundus examination, and automated perimetry was performed at both baseline and at the 6-year follow up at base hospital. Incident PAC disease was defined as the development of PAC disease during the 6-year follow-up in phakic subjects without PAC disease at baseline. Diagnosis was made using the International Society Geographical and Epidemiological Ophthalmology classification. RESULTS: The data were analyzed for 3350 subjects (mean age, 56.4 ± 8.9 years; 1547 males, 1803 females) for a diagnosis of PAC disease at baseline and at follow-up examinations. The incidence of PAC disease was identified in 134 subjects (6-year incidence rate, 4.0%; 95% confidence interval (CI), 3.3-4.7). Among the 134 subjects, 88 subjects (2.6%, 95% CI, 2.1-3.2) were primary angle-closure suspects; 37 subjects (1.1%, 95% CI, 0.7-1.5) had primary angle closure, and 9 subjects (0.3%, 95% CI, 0.1-0.4) had primary angle-closure glaucoma. There was an inverse relationship between the incidence of PAC disease and the cataract surgery rates. Significant risk factors for PAC disease on logistic regressions were higher intraocular pressure, increased lens thickness, shorter axial length, shallow anterior chamber depth, anteriorly positioned lens, and hyperopia. CONCLUSIONS: The average incidence of PAC disease per year was 0.7%. All biometric parameters were found to be strong predictors for the incidence of PAC disease.

Long-term change in central corneal thickness from a glaucoma perspective.

AIM: To investigate the longitudinal change in central corneal thickness (CCT) over 3 years in patients with glaucoma. MATERIALS AND METHODS: The Chennai Glaucoma Follow-up Study, an offshoot of the Chennai Glaucoma Study, was designed to evaluate the progression of glaucoma. A cohort of participants in the Chennai Glaucoma Study that were suffering from glaucoma or were at a higher risk for glaucoma underwent comprehensive ophthalmic evaluation at the base hospital at 6-month intervals during the years 2004 to 2007. The CCT (average of 10 readings) was measured between 11 am and 1 pm on any given day using an ultrasonic pachymeter. Patients with a history of ocular surgery, corneal disease and usage of topical carbonic anhydrase inhibitor were excluded. No patient was a contact lens wearer. RESULTS: One hundred and ninety-six patients (84 male, 112 female) met the inclusion criteria. We analyzed data from the right eye. The mean age of the patients was 59.97 ± 9.06 years. Fifty-nine (30.1%) of the patients were diabetic. The mean change in CCT (CCT at first patient visit--CCT at last patient visit) was 3.46 ± 7.63 µm. The mean change in CCT was 0.75 µm per year (R² = 0.00). Age, gender, intraocular pressure at the first patient visit and diabetic status had no significant influence on the magnitude of change in CCT. CONCLUSION: A carefully obtained CCT reading by a trained examiner need not be repeated for at least 3 years as long as the ocular and systemic factors known to affect the measurement of CCT are constant.

Inadvertent rupture of iridociliary cyst following transscleral Diode laser.

Primary iridociliary cysts can induce plateau iris configuration and angle closure glaucoma. We report a patient with bilateral, primary, ring-shaped, solitary iridociliary cysts. The right eye displayed normal intraocular pressure, oppositional iridocorneal angle closure, and healthy optic nerve head. The left eye had advanced chronic angle closure glaucoma. The management strategy varied between eyes and is discussed. This, to the best of our knowledge, is the first report of transscleral Diode laser application in an eye with a large iridociliary cyst.

Can intraocular pressure asymmetry indicate undiagnosed primary glaucoma? The Chennai Glaucoma Study.

AIM: : To investigate the association of intraocular pressure (IOP) asymmetry with undiagnosed primary glaucoma in rural and urban populations of south India. METHODS: Chennai Glaucoma Study is a population-based cross-sectional study. The participants were adults, 40 years or older. The prevalence of primary glaucoma was defined using International Society of Geographical and Epidemiological Ophthalmology classification. IOP asymmetry was diagnosed when the difference in IOP between 2 eyes was >3 mm Hg. Analysis included only bilaterally phakic subjects. We excluded subjects with known glaucoma, secondary glaucoma, pseudoexfoliation, ocular trauma, and ocular surgery. RESULTS: Of 6310 subjects, 3052 (48.4%) were rural residents. The mean age was 52 (standard deviation: 9.5) years. The prevalence of IOP asymmetry increased steadily with increasing patient age. The prevalence of undiagnosed primary glaucoma was 3.4% (95% confidence interval, 2.9-3.8). Undiagnosed primary glaucoma was 3 times more common in subjects with IOP asymmetry than without (odds ratio 3.08, 95% confidence interval, 2.1-4.3). The specificity of IOP asymmetry in detecting undiagnosed primary glaucoma was 92%. CONCLUSIONS: IOP asymmetry of >3 mm Hg has limited accuracy for the detection of undiagnosed primary glaucoma. The criterion should be combined with other indicators of glaucoma to build the pretest probability of the disease.

Cupped disc with normal intraocular pressure: the long road to avoid misdiagnosis.

We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important differential diagnosis of NTG. Diagnosis of NTG should be by exclusion. Here the possible causes of misdiagnosis are discussed. We present an approach to distinguish glaucomatous from nonglaucomatous optic neuropathy. The article also emphasizes how important it is for the clinicians to consider the total clinical picture, and not merely the optic disc morphology, to avoid the mismanagement of glaucoma, especially the NTG.

Intravitreal cysticercosis presenting as neovascular glaucoma.

We report two cases of intraocular cysticercosis which showed a peculiar presentation of neovascular glaucoma which is hitherto unreported. Two young adults presented with symptoms of raised intraocular pressure due to neovascular glaucoma. On dilated fundus examination both were found to have dead intravitreal cysticercosis. The cysts were removed by a three-port vitrectomy and intracameral injection of bevacizumab was given to help in the regression of rubeosis. Trabeculectomy had to be combined in one case. The intraocular pressure returned to normal. No recurrence of rubeosis was seen even after one year.