Outcomes of trabeculectomy in microspherophakia.

Purpose: To report the outcomes of trabeculectomy in eyes with glaucoma in microspherophakia. Materials and Methods: In a retrospective non-comparative case series, we analyzed 29 eyes of 18 patients with glaucoma in microspherophakia, who underwent primary trabeculectomy between 1998 and 2012. Success was defi ned as complete if the intraocular pressure (IOP) was ≤21 and >5 mm Hg without any antiglaucoma medication and qualifi ed if IOP ≤21 and >5 mm Hg with or without antiglaucoma medications. Eyes not falling into qualifi ed success criteria were labeled as failure. Results: The median age at the time of trabeculectomy was 23 years (inter quartile range: 12, 28). The mean IOP reduced from 31.1 ± 8.6 mm Hg to 14.6 ± 4.4 mm Hg after trabeculectomy over a median follow up of 77 months (P < 0.001). The probability of complete success was 96% (95% CI: 77-99%) at one year, 88% (95% CI: 67-96%) at 2 years, which was maintained till 7 years and decreased to 79% (95% CI: 50-92%) at 8 years. The probability of qualifi ed success was 100% till 7 years and decreased to 90% (95% CI: 47-98%) at 8 years. The median number of postoperative medications reduced from 2 to 0 postoperatively (P < 0.001). Five eyes (21%) developed post-operative shallow anterior chamber (AC) requiring anterior chamber reformation, with 2 of these eyes needing lensectomy for resolution of this complication. Conclusion: Primary trabeculectomy had good success rate in glaucoma associated with microspherophakia. Post-operative shallow AC was a frequent complication needing additional intervention.

Contralateral intraocular pressure lowering effect of prostaglandin analogues.

Background: Though the use of prostaglandin analogues (PGA) for reduction of intraocular pressure (IOP) has shown a marked increase, studies evaluating the contralateral eff ects of PGA are limited. Aims: To evaluate if PGA treatment in one eye has an eff ect on the IOP of the untreated fellow eye. Design: Retrospective study. Materials and Methods: Thirty patients of open-angle glaucoma with no previous antiglaucoma treatment underwent 24-hour diurnal IOP phasing. They subsequently were started on a uniocular trial with PGA, and had offi ce diurnal IOP measurements 6 weeks later. Twenty-four hour diurnal consisted of 8 IOP readings over 24 hours and offi ce diurnal consisted of 4 IOP readings between 8 AM and 6 PM at 3 hourly intervals. Statistical Analysis: IOPs of the fellow eye during the offi ce diurnal were compared with IOPs at similar time points during the 24-hour diurnal using paired t-tests. Results: Mean (± standard deviation) IOP in the treated eye reduced (P < 0.001) from 17.17 ± 3.2 mm Hg at baseline to 13.7 ± 2.4 mm Hg at 6 weeks, while that in the untreated eye reduced from 16.4 ± 3.1 mm Hg to 14.8 ± 2.7 mm Hg (P = 0.01). The decrease in IOP in the untreated fellow eye was statistically signifi cant at 8 AM (2.7 mm Hg, P = 0.003) and 11 AM (2.3 mm Hg, P = 0.01) but not so at 2 PM (1.2 mm Hg, P = 0.10) and 5 PM (0.9 mm Hg, P = 0.19). The amount of IOP reduction in the untreated eye was signifi cantly associated with the magnitude of IOP reduction in the treated eye (β = 0.69, P = 0.008). Conclusion: Uniocular PGA treatment tends to reduce the IOP of the untreated fellow eye.

Scanning the macula for detecting glaucoma.

Background: With the advent of spectral domain optical coherence tomography (SDOCT), there has been a renewed interest in macular region for detection of glaucoma. However, most macular SDOCT parameters currently are thickness parameters which evaluate thinning of the macular layers but do not quantify the extent of area over which the thinning has occurred. We therefore calculated a new macular parameter, “ganglion cell complex surface abnormality ratio (GCC SAR)” that represented the surface area over which the macular thickness was decreased. Purpose: To evaluate the ability of SAR in detecting perimetric and preperimetric glaucoma. Design: Retrospective image analysis. Materials and Methods: 68 eyes with perimetric glaucoma, 62 eyes with preperimetric glaucoma and 165 control eyes underwent GCC imaging with SDOCT. SAR was calculated as the ratio of the abnormal to total area on the GCC signifi cance map. Statistical Analysis: Diagnostic ability of SAR in glaucoma was compared against that of the standard parameters generated by the SDOCT soft ware using area under receiver operating characteristic curves (AUC) and sensitivities at fi xed specifi cities. Results: AUC of SAR (0.91) was statistically signifi cantly bett er than that of GCC average thickness (0.86, P = 0.001) and GCC global loss volume (GLV; 0.88, P = 0.01) in diff erentiating perimetric glaucoma from control eyes. In diff erentiating preperimetric glaucoma from control eyes, AUC of SAR (0.72) was comparable to that of GCC average thickness (0.70, P > 0.05) and GLV (0.72, P > 0.05). Sensitivities at specifi cities of 80% and 95% of SAR were comparable (P > 0.05 for all comparisons) to that of GCC average thickness and GLV in diagnosing perimetric and preperimetric glaucoma. Conclusion: GCC SAR had a bett er ability to diagnose perimetric glaucoma compared to the SDOCT soft ware provided global GCC parameters. However, in diagnosing preperimetric glaucoma, the ability of SAR was similar to that of soft ware provided global GCC parameters.

Evaluation of blotchy pigments in the anterior chamber angle as a sign of angle closure.

Background: Blotchy pigments in the anterior chamber (AC) angle are considered diagnostic of primary angle closure (PAC). But there are no reports either on the prevalence of blotchy pigments in AC angles or the validity of this sign. Aims: To determine the prevalence of blotchy pigments in AC angles and to evaluate their relationship with glaucomatous optic neuropathy (GON) in eyes with occludable angles. Setting and Design: Cross-sectional, comparative study. Materials and Methods: Gonioscopy was performed in 1001 eyes of 526 subjects (245 eyes of 148 consecutive, occludable angle subjects and 756 eyes of 378 non-consecutive, open angle subjects), above 35 years of age. Quadrant-wise location of blotchy pigments was documented. Statistical Analysis: Odds of blotchy pigments in occludable angles against that in open angles were evaluated. Relationship of GON with blotchy pigments in occludable angle eyes was evaluated using a multivariate model. Results: Prevalence of blotchy pigments in occludable angles was 28.6% (95% CI, 22.9-34.3) and in open angles was 4.7% (95% CI, 3.2-6.3). Blotchy pigments were more frequently seen in inferior (16%) and superior quadrants (15%) of occludable angles, and inferior quadrant of open angles (4%). Odds of superior quadrant blotchy pigments in occludable angles were 33 times that in open angles. GON was seen in 107 occludable angle eyes. Blotchy pigments were not significantly associated with GON (odds ratio = 0.5; P = 0.1). Conclusions: Blotchy pigments were seen in 28.6% of occludable angle eyes and 4.7% of open angles eyes. Presence of blotchy pigments in the superior quadrant is more common in occludable angles. Presence of GON in occludable angle eyes was not associated with blotchy pigments.