Achieving low target intraocular pressures in severe glaucoma.

PURPOSE: This study aimed to assess details of therapy required to achieve an intraocular pressure (IOP) of ⩽12 mmHg in patients with severe glaucoma of different etiologies. METHODS: Patients with a follow-up of at least 1 year, who fulfilled inclusion criteria were selected, and data analyzed with respect to baseline IOP, number of medications, and/or surgeries required to achieve an IOP of ⩽12 mmHg and ⩾6 mmHg. Final IOP, visual field status and medications/surgery required were noted. RESULTS: About 127 eyes of 85 patients met all criteria. There were 48 eyes having primary angle closure glaucoma (PACG), 16 eyes with primary open angle glaucoma (POAG), 17 eyes of juvenile open angle glaucoma (JOAG), and 46 eyes of secondary glaucoma. The mean baseline IOP was 33.14 ± 11.07 mmHg and final IOP 10.25 ± 1.81 mmHg. In the age group >40 years, 29.63% of patients were controlled on medication as compared to 9.09% and 5.71% in the age group of <20 years and 20-40 years (p = 0.007). With a baseline IOP of <25 mmHg, 48.65% required a trabeculectomy, whereas for 25-30, and >30 mmHg, 62.5% and 97.29% respectively, required surgery (p < 0.001).66.67% of patients having mean deviation of -12 to -16 dB (decibels) on Humphrey field analyzer (HFA) underwent surgery to achieve target IOP in comparison to 83.52% who had mean deviation greater than -16 dB (p = 0.036). CONCLUSION: Only 21.26% of severe glaucoma eyes could be controlled on medications alone. A baseline IOP of >25 mmHg, age <40 years and mean deviation worse than -16 dB, had a higher frequency of trabeculectomies to achieve an IOP of ⩽12 mmHg.

The Probable Mechanism of Traumatic Angle Recession and Cyclodialysis.

During blunt ocular trauma, the anteroposterior compressive forces confronted lead to consequent equatorial expansion of the globe. This may result in ciliary body trauma, typically manifesting as angle recession or cyclodialysis. The authors hypothesize that a likely asymmetric contraction between the longitudinal and circular ciliary fibers, and an intrinsic weak "oblique buffer zone" creates a plane of separation between the 2, resulting in angle recession. When stronger forces are met with, the equatorial expansion of the sclera may outperform the ability of the ciliary body to follow it, and the taut longitudinal ciliary fibers may subsequently disinsert from the scleral spur causing cyclodialysis. In addition to this, the routinely thought dismembering aqueous jets directed toward the angle may also accentuate ciliary body trauma. Therefore, the vivid distractive external forces along with the complex ciliary muscle anatomy and differential functionality may play a crucial role in causation of post-traumatic angle recession and cyclodialysis.

Subretinal Hypopyon in Presumed Tubercular Uveitis: A Report of Two Cases.

Subretinal hypopyon is an uncommon entity which has been described in ocular infections and inflammations including endophthalmitis, acute retinal necrosis, and sympathetic ophthalmia. The authors report subretinal hypopyon in two cases of presumed tubercular uveitis which responded well to antitubercular therapy (ATT). The first case was a 47-year-old male with bilateral peripapillary chorioretinitis with a subretinal hypopyon. Tuberculosis was confirmed on biopsy of a cervical lymph node which revealed acid-fast bacilli. Case 2 was a 17-year-old male with unilateral involvement in the form of a choroidal granuloma with disc edema and retinitis. In addition, a subretinal hypopyon was evident. Both these cases showed dramatic anatomical improvement with ATT. A novel finding of subretinal hypopyon is described in these cases of presumed ocular tuberculosis. It may be prudent to start empirical ATT early on detection of a subretinal hypopyon along with other manifestations compatible with tubercular etiology.