Importance of multimodal imaging diagnostics in acute angle closure glaucoma: Case report.

To describe the natural history and management of an acute angle closure secondary to choroidal melanoma. A 70-year-old female presented with pain, elevated intraocular pressure, mature cataract, and angle closure in right eye. With further studies she was found to have a choroidal melanoma causing the acute angle closure. Enucleation was performed and the patient is currently in close postoperative surveillance by ophthalmology and oncology. The importance of early identification and treatment of intraocular tumors to decrease incidence of metastasis. In secondary acute angle-closure glaucoma treatment should be targeted towards resolving the triggering factor of glaucoma.

Real-world outcomes of micropulse cyclophotocoagulation in a Latin American population and analysis of the factors associated with the success rate.

OBJECTIVE: To report the outcomes of micropulse cyclophotocoagulation in a Latin American population with refractory glaucoma in a "real-world" setting and to evaluate the factors associated with success after a one-year follow-up. MATERIALS AND METHODS: Retrospective, multicenter study. The medical records of patients who underwent micropulse cyclophotocoagulation between September 2017 and October 2018 were reviewed. Treatment success was defined as an intraocular pressure of 5 to 21 mmHg or a 20% intraocular pressure reduction with or without additional glaucoma medical therapy. RESULTS: Eighty-three eyes from 83 patients were included, with a mean follow-up of 10.1 ± 3.1 months. The intraocular pressure and number of glaucoma medications significantly decreased at all postoperative visits from a mean of 21.9 ± 7.6 mmHg on 3.8 medications to 13.1 ± 3.5 mmHg on 2.8 medications at the 12-month follow-up. The mean intraocular pressure decreased 40.1% from baseline at 12 months. The cumulative success rate was 54.5% (95% CI, 44-67%) at 12-month follow-up. We identified a higher baseline intraocular pressure as a significant independent predictor of treatment success (p = 0.03). Late complications included 1 eye with corneal edema, 1 eye with prolonged anterior chamber inflammation and cystoid macular edema and 9 eyes (11%) with visual loss of 2 Snellen lines or more. CONCLUSIONS: Micropulse cyclophotocoagulation is an effective and safe treatment for Latin American patients and can provide intraocular pressure and medication reductions with a single treatment after a one-year follow-up. A high baseline intraocular pressure was the most significant predictor of treatment success.

Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up. / Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses.

PURPOSE: Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. METHODS: Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. RESULTS: The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (-0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was -0.92 medications (-3.38; +1.54) for the MMC group and -1 medication (-3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917). Both the PVP and MMC groups showed an initial reduction in number of medications until month 12 and a relatively linear increase towards month 36. A longer follow-up may be warranted to reveal differences in the number of medications between the two exposure groups. Postoperative complications were less frequent in the PVP group. CONCLUSIONS: The use of PVP during trabeculectomy achieves and maintains a statistically significant IOP reduction from baseline to 36 months and decreases the number of glaucoma medications. Secondary outcome measures showed a lower incidence of adverse events in the PVP group.

Importancia del diagnóstico por imágenes multimodales en glaucoma agudo de ángulo cerrado: reporte de caso / Importance of multimodal imaging diagnostics in acute angle closure glaucoma: Case report

Describir la historia natural y el manejo de un glaucoma de cierre angular agudo secundario a melanoma coroideo.Mujer de 70 años que presenta dolor agudo con presión intraocular elevada y catarata madura y que fue diagnosticada de glaucoma agudo de ángulo cerrado en el ojo derecho. Mediante estudios adicionales de diagnóstico por imagen se descubrió un melanoma coroideo que causaba el cierre agudo del ángulo. Se realizó enucleación, y actualmente la paciente se encuentra en estrecha vigilancia postoperatoria por parte de oftalmología y oncología.Este caso refleja la importancia del diagnóstico y el tratamiento precoz de los tumores intraoculares en la disminución de la incidencia de metástasis y el aumento de la supervivencia. En el glaucoma de ángulo cerrado agudo secundario, el tratamiento debe estar dirigido a resolver el factor desencadenante del glaucoma. (AU)

To describe the natural history and management of an acute angle closure secondary to choroidal melanoma.A 70-year-old female presented with pain, elevated intraocular pressure, mature cataract, and angle closure in right eye. With further studies she was found to have a choroidal melanoma causing the acute angle closure. Enucleation was performed and the patient is currently in close postoperative surveillance by ophthalmology and oncology.The importance of early identification and treatment of intraocular tumors to decrease incidence of metastasis. In secondary acute angle-closure glaucoma treatment should be targeted towards resolving the triggering factor of glaucoma. (AU)

Resultados del mundo real de la ciclofotocoagulación con láser micropulsado en una población latinoamericana y análisis de los factores asociados con la tasa de éxito / Real-world outcomes of micropulse cyclophotocoagulation in a Latin American population and analysis of the factors associated with the success rate

Objetivo Reportar los resultados de la ciclofotocoagulación transescleral con láser micropulsado en una población latinoamericana con glaucoma refractario en un entorno del «mundo real» y evaluar los factores asociados con éxito a un año de seguimiento. Materiales y métodos Estudio multicéntrico, retrospectivo. Se revisaron los expedientes de pacientes sometidos a ciclofotocoagulación transescleral con láser micropulsado entre septiembre de 2017 y octubre de 2018. El éxito del tratamiento se definió como una presión intraocular de 5 a 21mmHg o una reducción de la presión intraocular del 20% de la basal, con o sin tratamiento médico adicional para glaucoma. Resultados Se incluyeron 83 ojos de 83 pacientes, con un seguimiento promedio de 10,1 ±3,1meses. La presión intraocular y el número de medicamentos para glaucoma disminuyeron significativamente en todas las visitas postoperatorias de una media de 21,9 ±7,6mmHg con 3,8 medicamentos a 13,1 ±3,5mmHg con 2,8 medicamentos a 12meses de seguimiento. La presión intraocular media disminuyó un 40,1% de la basal a los 12meses. La tasa de éxito acumulada fue del 54,5% (IC del 95%: 44-67%) a 12meses de seguimiento. Identificamos una presión intraocular basal más alta como predictor independiente significativo del éxito del tratamiento (p=0,03). Las complicaciones tardías incluyeron 1ojo con edema corneal, 1ojo con inflamación prolongada en cámara anterior y edema macular quístico y 9ojos (11%) con pérdida visual de 2líneas de Snellen o más. Conclusiones La ciclofotocoagulación transescleral con láser micropulsado es un tratamiento eficaz y seguro para pacientes latinoamericanos y puede proporcionar reducciones de la presión intraocular y del número de medicamentos con una sola aplicación a un año de seguimiento. La presión intraocular basal alta fue el predictor más significativo del éxito del tratamiento (AU)

Objective To report the outcomes of micropulse cyclophotocoagulation in a Latin American population with refractory glaucoma in a «real-world» setting and to evaluate the factors associated with success after a one-year follow-up. Materials and methods Retrospective, multicenter study. The medical records of patients who underwent micropulse cyclophotocoagulation between September 2017 and October 2018 were reviewed. Treatment success was defined as an intraocular pressure of 5-21mmHg or a 20% intraocular pressure reduction with or without additional glaucoma medical therapy. Results Eighty-three eyes from 83 patients were included, with a mean follow-up of 10.1 ±3.1months. The intraocular pressure and number of glaucoma medications significantly decreased at all postoperative visits from a mean of 21.9 ±7.6mmHg on 3.8 medications to 13.1 ±3.5mmHg on 2.8 medications at the 12-month follow-up. The mean intraocular pressure decreased 40.1% from baseline at 12months. The cumulative success rate was 54.5% (95% CI: 44%-67%) at 12-month follow-up. We identified a higher baseline intraocular pressure as a significant independent predictor of treatment success (P=.03). Late complications included 1eye with corneal edema, 1eye with prolonged anterior chamber inflammation and cystoid macular edema and 9eyes (11%) with visual loss of 2Snellen lines or more. Conclusions Micropulse cyclophotocoagulation is an effective and safe treatment for Latin American patients and can provide intraocular pressure and medication reductions with a single treatment after a one-year follow-up. A high baseline intraocular pressure was the most significant predictor of treatment success (AU)

Colágeno polivinilpirrolidona versus mitomicina C en trabeculectomía en pacientes con glaucoma primario de ángulo abierto. Seguimiento a 36 meses / Outcomes of trabeculectomy with polyvinylpyrrolidone collagen versus mitomycin in primary open angle glaucoma. 36-month follow-up

Propósito Describir y comparar los efectos de la aplicación intraoperatoria de colágeno polivinilpirrolidona (PVP) versus mitomicina C (MMC) en el patrón de cambio de la presión intraocular (PIO) y del número de medicamentos hipotensores utilizados en un seguimiento a 36 meses en pacientes con glaucoma primario de ángulo abierto (GPAA) operados de trabeculectomía. Métodos Estudio prospectivo, comparativo y aleatorizado. Veintiséis ojos de 26 pacientes con diagnóstico de GPAA, sin cirugías incisionales de glaucoma previas, fueron operados de trabeculectomía y aleatorizados a recibir PVP o MMC durante el procedimiento. Todos los pacientes cumplieron un seguimiento de 36 meses. Los resultados principales medidos fueron cambios en la PIO y el número de medicamentos hipotensores durante el seguimiento. Resultados El análisis multivariado reveló que la reducción de la PIO media del preoperatorio a los 36 meses de seguimiento fue de 7,62mmHg (3,05; 12,18) en el grupo de MMC y de 8,15mmHg (−0,64; 16,95) en el grupo de la PVP. La reducción media porcentual de la PIO fue del 37,09% (15,93; 58,17) en el grupo de MMC y del 36,08% (5,16; 67,20) en el grupo de la PVP. El cambio en el número de medicamentos del preoperatorio a los 36 meses de seguimiento fue de −0,92 medicamentos (-2,38; +1,54) para el grupo de MMC y de −1 medicamentos (−3,12, +1,12) para el grupo de la PVP. Ambos grupos tuvieron una disminución estadísticamente significativa de la PIO durante el seguimiento (p<0,001), pero no hubo una diferencia discernible entre los grupos (p=0,5975). El análisis de sensibilidad mostró que un modelo de tendencia lineal es adecuado para describir la reducción de la PIO durante el seguimiento. Ambos grupos tuvieron una reducción estadísticamente significativa de medicamentos del preoperatorio al final del seguimiento (p<0,05), tampoco hubo una diferencia discernible entre los grupos (p=0,2917)(AU)

Purpose Describe and compare the effects of intraoperative application of Polyvinylpyrrolidone Collagen (PVP) versus Mitomycin C (MMC) on the pattern of change in mean IOP reduction and mean number of medications over 36-months follow-up in patients with primary open angle glaucoma (POAG) undergoing trabeculectomy. Methods Prospective, randomized, comparative study. Twenty-six eyes of 26 patients with POAG and no previous incisional glaucoma surgery underwent trabeculectomy and were randomized to PVP or MMC and completed a 36-month follow-up. Main outcome measures were IOP and number of glaucoma medications. Multivariate longitudinal analysis was performed by fitting a linear trend model adjusting for baseline response for the IOP outcome and a log-linear regression model with within-subject associations for the number of hypotensive medications outcome. Sensitivity analysis was performed to assess lower and higher order polynomial trends over time in IOP. Results The univariate analysis revealed that the mean IOP reduction from baseline to 36 months was 7.62mmHg (3.05; 12.18) in the MMC group and 8.15mmHg (−0.64; 16.95) in the PVP group. Mean percentage IOP reduction from baseline was 37.09% (15.93; 58.17) and 36.08% (5.16; 67.20) in the PVP group. Mean change in number of medications from baseline to 36 months was −0.92 medications (−3.38; +1.54) for the MMC group and −1 medication (−3.12; +1.12) for the PVP group. Both groups had a statistically significant decline in mean IOP over the follow-up period (p<0.001) but there was no discernible difference between the two exposure groups in the rate of change in IOP (p=0.5975). Sensitivity analysis showed that a linear trend model is adequate to describe the IOP reduction over the follow-up period. Both groups had a statistically significant change in the number of hypotensive medications used between baseline and month 36 (p<0.05) but there was no discernible difference between exposure groups (p=0.2917) (AU)