Comparison between ocular biometry parameters in patients with unilateral congenital glaucoma.

Purpose: To compare the axial length (AL) and corneal diameter between glaucomatous eye (GE) and fellow normal eye (NE) in patients with unilateral congenital glaucoma and to obtain a normative database for ocular growth among Indian children below 3 years of age. Methods: Retrospective longitudinal study. Patients who had a follow-up of 3 years from diagnosis with ocular biometry parameters being recorded at least thrice (once a year) and fellow eye being normal were included. Data collected were age, gender, intraocular pressure (IOP), AL, corneal diameter, optic disc findings, diagnosis, and surgery details. Results: Eleven patients were analyzed. All GE underwent combined trabeculotomy with trabeculectomy. Mean (SD) baseline IOP, AL, and corneal diameter were 17.1 (6.7) mmHg, 18.9 (1.1) mm and 12 (0.91) mm in GE, and 11.1 (3.8) mmHg, 17.8 (0.44) mm, and 10.5 (0.58) mm in NE, respectively. Increase in AL was 3.1 mm in the first year followed by 0.6 mm in second year and 0.4 mm in third year in GE compared to 2.6, 0.6, and 0.5 mm in NE, respectively. Corneal diameter increased by 1.1 mm in GE in the first year and remained stable thereafter compared to 0.7 mm in first year followed by 0.3 mm in second year and stable thereafter in NE. The percentage of success was 73% at 3 years. Conclusion: Axial length and corneal diameter were higher in GE than NE at all-time points. With prompt intervention, the growth curve of the GE was made parallel to that of NE.

Scurvy: a rare cause of haemarthrosis.

A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and upper and lower extremity ecchymoses that had been present for 3 weeks. His initial laboratory results showed a normocytic anaemia, normal platelet count, slightly abnormal coagulation studies and normal inflammatory markers. Arthrocentesis of the left knee revealed haemarthrosis, and additional laboratory workup found an undetectable serum vitamin C (ascorbic acid) level consistent with scurvy. It was determined that scurvy had predisposed the patient to injury, leading to haemarthrosis. Following vitamin C supplementation, dietary and activity modifications, and acetaminophen as needed, the patient's serum vitamin C level normalised and his left knee pain and swelling improved. Scurvy is a rare cause of haemarthrosis, but it should be recognised in at-risk patients since treatment is effective.

Assessment of glaucoma referral letter for quality and accuracy among patients referred to a tertiary eye care center.

Purpose: To assess the quality and accuracy of glaucoma referrals from ophthalmologist. Methods: Retrospective review of patients chart with referral letter to a tertiary glaucoma center between January and December 2017. Patients aged <16 years, lens-induced glaucoma, uveitic glaucoma, and glaucoma following retinal and corneal surgery were excluded. Results: A total of 184 patients referred by 55 ophthalmologists were included. Mean patient age (SD) was 57.8 ± 14 years. Intraocular pressure was not documented in the referral letter in 113 (61%) patients, gonioscopy in 174 (95%) patients, disc findings in 149 (81%) patients, and visual fields in 175 (95%) patients. Thirteen (37%) of the 35 patients referred as open angle glaucoma were found to have angle closure glaucoma. Pseudoexfoliation glaucoma was diagnosed in 29 (16%) patients, of which 18 were missed by the referring ophthalmologist. Conclusion: In our study >90% of referral letter did not have the essential parameters. A standard template for glaucoma referral is suggested, which will help the patient to get better transfer of care.

Comparison of New Visual Disturbances after Superior versus Nasal/Temporal Laser Peripheral Iridotomy: A Prospective Randomized Trial.

PURPOSE: To determine whether laser peripheral iridotomy (LPI) location affects postoperative dysphotopsia symptoms. DESIGN: Multicenter, randomized, prospective, single-masked trial. PARTICIPANTS: Five hundred fifty-nine South Indian patients 30 years of age or older diagnosed as primary angle-closure suspects (PACSs) or with primary angle closure (PAC) or primary angle-closure glaucoma (PACG) in both eyes. METHODS: Patients were randomized to either bilateral superior or bilateral nasal/temporal LPI. Occurrence of new visual disturbances was evaluated before and 2 weeks after LPI using a questionnaire based on the 7-item dysphotopsia symptoms described by Spaeth et al. MAIN OUTCOME MEASURES: New-onset dysphotopsia symptoms. RESULTS: Superior LPI (n = 285) and nasal/temporal LPI (n = 274) patients were matched for age (P = 0.6), gender (P = 0.7), and distribution of PACS versus PAC or PACG (P = 0.7). Similar initial laser energy settings were used in both groups (P = 0.3), although superior LPIs required more shots (P = 0.006) and greater total energy (P < 0.001) than nasal/temporal LPIs. No significant differences in postoperative anterior chamber reaction (P = 0.7) or LPI area (P = 0.9) were noted between the 2 groups. No group differences were noted regarding the proportion of patients demonstrating 1 or more dysphotopsia symptoms before LPI (15.8% for superior vs. 13.9% for nasal/temporal; P = 0.1) or any individual dysphotopsia symptom (P > 0.2 for all). After LPI, 8.9% of all patients reported 1 or more new symptoms, the most common consisting of linear dysphotopsias, glare, and blurring in 2.7%, 4.3%, and 4.3% of patients, respectively. Patients undergoing superior LPI were not more likely to describe the new onset of 1 or more dysphotopsia symptoms as compared with patients undergoing nasal/temporal LPI (8.4% vs. 9.5%; P = 0.7), nor did the frequency of any new individual symptoms differ by group (P ≥ 0.3 for all). In multivariate logistic regression analysis, neither LPI location nor LPI area nor total laser energy predicted higher odds of new postoperative dysphotopsias (P > 0.1 for all). CONCLUSIONS: Laser peripheral iridotomy likely is safe with respect to visual dysphotopsias regardless of location, LPI size, and amount of laser energy used.

Bilateral idiopathic spontaneous filtering bleb with ectopia lentis: A case report and review of literature.

A 26-year-old male presented with superior filtering bleb with scleral thinning, dislocated lens, and hypotony in both the eyes. His cornea was normal without any sign of ectasia, and there was no history of recurrent redness, trauma, or surgery in either eye. Anterior segment optical coherence tomography did not reveal communicating fistula between the anterior chamber and subconjunctival space. Physical examination and blood investigations did not reveal any systemic association. He was diagnosed to have spontaneous filtering bleb, which is a rare condition observed with ocular or systemic abnormalities.

Predictors of Short-Term Intraocular Pressure Change after Laser Peripheral Iridotomy: A Prospective Randomized Study.

PURPOSE: To describe short-term intraocular pressure (IOP) changes after laser peripheral iridotomy (LPI) and identify factors predicting IOP lowering. DESIGN: Multicenter, prospective randomized study. PARTICIPANTS: Four hundred fifty-five South Indian eyes of 455 participants 30 years of age or older with a diagnosis of primary angle-closure suspect (PACS), primary angle closure (PAC), or PAC glaucoma (PACG). METHODS: Participants were randomized to superior or nasal/temporal LPI. Multivariate regression models were used to determine preoperative features and LPI parameters associated with change in IOP from baseline to the 2-week postoperative examination. MAIN OUTCOME MEASURES: Change in IOP at 2 weeks after LPI compared with baseline. RESULTS: Among all treated eyes, 11.0% of eyes demonstrated a 20% or more decrease in IOP after LPI, whereas 19.6% demonstrated at least a 20% increase in IOP. Intraocular pressure changes occurring after LPI did not differ by LPI location (P > 0.5 for all comparisons). Although the anterior chamber angle widened after LPI (P < 0.001) and was classified as open after laser in most eyes (64% in all 4 quadrants), there was no significant association between gonioscopic angle opening and LPI-induced IOP change (P = 0.7). Linear regression analysis demonstrated more IOP lowering with higher baseline IOP (3.2 mmHg more lowering per 10-mmHg higher baseline IOP; 95% confidence interval [CI], 2.3-4.1 mmHg) and PAC/PACG diagnosis (1.4 mmHg more IOP lowering vs. PACS diagnosis; 95% CI, 0.2-2.6 mmHg) predicted a lower IOP after LPI. After multivariate adjustment, only higher baseline IOP predicted lower IOP after LPI (P < 0.001). Features not associated with IOP lowering included demographic, visual, and A-scan measures; baseline gonioscopic angle width; total laser energy; LPI area; and LPI location (P > 0.08 for all). Eyes with PAC/PACG, as compared with PACS, demonstrated more IOP lowering after LPI (1.2±1.7 mmHg vs. -0.4±1.0 mmHg; P < 0.001) after adjusting for baseline IOP. CONCLUSIONS: Neither LPI location nor degree of gonioscopic angle opening was associated with statistically significant change in IOP after LPI. Although significant IOP lowering after LPI was uncommon in the overall cohort, higher baseline IOP and PAC/PACG diagnosis predicted lower postoperative IOP.

An unusual presentation of Pseudomonas aeruginosa blebitis following combined surgery.

We report a case of blebitis that occurred 3 years later following a combined glaucoma and cataract surgery. It was an atypical presentation, as patient had no classical fiery looking signs of blebitis despite the isolated organism being Pseudomonas aeruginosa. Improvized surgical techniques like use of Mitomycin C, releasable flap sutures though considered as part of the recommended procedure for better surgical outcomes, their role as potential risk factors for visually blinding complications like endophthalmitis are often overlooked. This case report throws light on such risk factors for bleb associated infections and recommends removal or trimming of all releasable sutures and the need for a regular postoperative follow-up.

Suprachoroidal hemorrhage following removal of releasable suture after combined phacoemulsification-trabeculectomy.

We report a case of suprachoroidal hemorrhage following removal of a releasable suture after combined phacoemulsification-trabeculectomy.