Prognostic Significance of Early Postoperative Choroidal Detachment in Patients with Congenital Glaucoma Operated with Nonpenetrating Deep Sclerectomy.

Objective: To assess the association between early postoperative choroidal detachment and intraocular pressure (IOP) following nonpenetrating deep sclerectomy in pediatric primary congenital glaucoma. Design: Retrospective double-arm cohort study. Setting. Single center in Saudi Arabia. Patients. Seventy-two eyes of 45 patients were evaluated. Primary congenital glaucoma patients aged 0-3 years undergoing nonpenetrating deep sclerectomy as the first procedure from 2014 to 2021 were divided into groups with (n = 20) and without (n = 52) postoperative choroidal detachment. Main Outcome Measures. The primary outcome was complete surgical success, defined as an intraocular pressure below 21 mmHg without medication or additional surgery at 24 months. The intraocular pressure was evaluated in the first 72 hours after surgery and at 1, 3, 6, 12, 18, and 24 months. Kaplan-Meier survival analysis over 24 months was used to evaluate this outcome in both cohorts. The secondary outcome was the time to choroidal detachment resolution. Results: There was no significant difference in surgical success between choroidal detachment and nonchoroidal detachment groups (P = 0.12). Preoperative and 2-year postoperative intraocular pressure was similar between groups, with a significant decrease in intraocular pressure from baseline (P < 0.001) in both the groups. The median time to choroidal detachment resolution was 27 days, and 90% of choroidal detachment cases were resolved with medical therapy. Conclusions: Postoperative choroidal detachment does not appear to significantly impact intraocular pressure or surgical success at 24 months following nonpenetrating deep sclerectomy for primary congenital glaucoma. Choroidal detachment typically resolves within one month of treatment. These findings suggest that transient choroidal detachment has a benign course in patients with primary congenital glaucoma undergoing deep sclerectomies.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma.

INTRODUCTION: Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. METHODS: This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15 months. The secondary outcomes included surgical success and complications. RESULTS: The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14 mmHg in the perforation group and 35 to 12 mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. CONCLUSIONS: An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15 months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

Phacoemulsification after trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease: intermediate-term visual outcome, IOP control and trabeculectomy survival.

PURPOSE: To evaluate the visual outcome, intraocular pressure control and trabeculectomy survival after phacoemulsification in eyes with prior trabeculectomy in uveitis associated with Vogt-Koyanagi-Harada disease (VKH). DESIGN: Retrospective comparative study. METHODS: Eyes with uveitic glaucoma associated with VKH who underwent mitomycin C (MMC)-enhanced trabeculectomy were included. Eyes were divided into two groups: the first study group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second control group included eyes that did not have cataract surgery. The main outcome measures were changes in the visual acuity, intraocular pressure (IOP), the number of antiglaucoma medications, IOP control and trabeculectomy survival. RESULTS: There were no significant differences in the final visual acuity (0.78 (±0.9) and 0.92 (±1.1), p = 0.80)) nor IOP (14.21 mmHg (±5.8) and 12.16 mmHg (±6.1), p = 0.29), but there was a difference in the antiglaucoma medications (1.58 (±1.5) and 0.53 (±1.0), p = 0.02) between the study and control group, respectively. There was no difference in the overall trabeculectomy survival (p = 0.381, Log Rank), but more eyes in the study group converted to qualified success after phacoemulsification and required more medications to control the IOP. CONCLUSION: Phacoemulsification after trabeculectomy seems to be a safe procedure in eyes with combined vision threatening complications of VKH, although the visual improvement was limited. Nevertheless, more medications were required to control the IOP, resulting in less absolute and more qualified trabeculectomy success. Therefore, patient counseling before surgery is essential.

Long-term outcomes of initial trabeculectomy in glaucoma associated with granulomatous and non-granulomatous uveitis.

PURPOSE: To evaluate the outcomes of initial trabeculectomy in granulomatous and non-granulomatous uveitis. METHODS: Retrospective comparative study of 68 eyes that underwent an initial trabeculectomy. RESULTS: The mean follow-up was 74.18 and 74.86 months in both groups (p = 0.95). The intraocular pressure decreased from 40.03 mmHg ( ± 7.2) and 36.48 mmHg ( ± 11.3) to 14.00 mmHg ( ± 6.2) and 13.48 mmHg ( ± 5.7), the number of medications decreased from 3.73 ( ± 0.7) and 3.58 ( ± 0.9) to 1.00 ( ± 1.4) and 1.13 ( ± 1.4) on the last follow-up (p < 0.01) in the granulomatous and non-granulomatous groups, respectively. More eyes in the granulomatous uveitis group developed delayed postoperative complications like cataract, transient hypotony and glaucoma progression. Success rates were 64.9 and 71.0%, while failure rates were 35.1 and 29.0% in both groups (p = 0.84). CONCLUSIONS: Trabeculectomy seems to have comparable IOP control and survival in granulomatous and non-granulomatous uveitis. Nevertheless, more eyes in the granulomatous uveitis group developed late-onset complications.

The Effect of Tube Ligature on the Safety and Efficacy of Ahmed Glaucoma Valve Surgery.

PRECIS: In this matched case-control study, ligature of the Ahmed glaucoma valve (AGV) was associated with a reduction in the rate of postoperative complications without affecting the surgical success rate or the visual outcome following the procedure. PURPOSE: The purpose of this study was to compare the safety and efficacy of AGV surgery with and without tube ligation. MATERIALS AND METHODS: This was a retrospective, matched case-control study. A review was performed of patients who underwent AGV surgery with tube ligation between June 2015 and December 2017 (ligated AGV group). Cases were matched with controls who underwent AGV surgery without tube ligation (nonligated AGV group). Data were compared on postoperative intraocular pressure (IOP), the number of glaucoma medications, surgical success rates, complications, and vision. RESULTS: There were 49 eyes in the ligated AGV group, and 98 eyes in the nonligated AGV group. Baseline characteristics were similar between groups except for the number of glaucoma medications (3.72±0.55 in the ligated AGV group vs. 3.92±0.92 in the nonligated AGV group; P<0.01). At 18 months, IOP was 16.7±6.3 mm Hg in the ligated AGV group and 17.3±8.0 mm Hg in the nonligated AGV group (P=0.76). In addition, the mean number of glaucoma medications was 2.38±1.10 in the ligated AGV group and 1.68±1.51 in the nonligated AGV group (P=0.56). The overall success rate at 12 months was similar between groups (P=0.84). The overall rate of complications was statistically lower in the ligated AGV group (28.6%) compared with the nonligated AGV group (73.5%) (P<0.01). The mean change in logarithm of the minimum angle of resolution acuity was similar between groups (P=0.50). CONCLUSION: Tube ligation in AGV surgery may be an effective measure that reduces the rate of postoperative complications without affecting the success rate or visual outcomes of the surgery.

Spontaneous glaucoma drainage device extrusion after early postoperative orbital cellulitis - Case report and literature review.

A 70-year-old glaucoma patient who underwent Ahmed Glaucoma Valve (AGV) implantation developed orbital cellulitis (OC) 5 days postoperatively. On presentation, the valve was not exposed and no intraocular involvement was noted. After successful treatment of OC with intravenous and oral antibiotics, the patient presented to the clinic with the AGV completely extruded from the eye. There are only 10 previous cases of OC reported in the literature following glaucoma drainage device (GDD) implantation and no previous reports of spontaneous AVG extrusion. Close observation and thorough evaluation of the tube and plate positions are warranted to achieve better outcomes.

The influence of mitomycin C concentration on the outcome of trabeculectomy in uveitic glaucoma.

PURPOSE: To evaluate the influence of mitomycin C (MMC) concentration on the outcome of trabeculectomy in uveitic glaucoma. METHODS: Retrospective comparative study included 50 patients who underwent MMC-enhanced trabeculectomy for uncontrolled uveitic glaucoma. Patients were divided into two groups based on the concentration of MMC used during trabeculectomy (high [0.04%] or low [0.02%]). The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the need for further glaucoma surgeries, and trabeculectomy success. RESULTS: There were no differences in the IOP nor antiglaucoma medications. The success rates were 76.0 and 68.0%, while the failure rates were 24.0 and 32.0% in the 0.02 and 0.04% MMC groups, respectively. CONCLUSION: Trabeculectomy augmented with low (0.02%) MMC concentration seems to have comparable outcomes in uveitic glaucoma compared with high (0.04%) concentration.

The Influence of Phacoemulsification on Intraocular Pressure Control and Trabeculectomy Survival in Uveitic Glaucoma.

OBJECTIVES: To evaluate the influence of phacoemulsification on intraocular pressure (IOP) control and survival of mitomycin C (MMC)-enhanced trabeculectomy in uveitic glaucoma (UG). MATERIALS AND METHODS: Retrospective case-control study included 54 eyes from 40 patients with UG who underwent MMC-enhanced trabeculectomy as an initial procedure to treat glaucoma at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 2002 and 2014. Eyes were divided into 2 groups: the first group included eyes that later underwent cataract surgery in the form of phacoemulsification, and the second group included eyes that did not have cataract surgery. The main outcome measures were changes in the IOP, the number of antiglaucoma medications, IOP control, and trabeculectomy survival. RESULTS: There were no differences in the overall trabeculectomy survival of eyes that underwent cataract surgery and those that did not (P=0.681, log-rank) nor the final IOP [15.54 mm Hg (±6.3) in the study group and 13.34 mm Hg (±5.6) in the control group, P=0.247]. However, more antiglaucoma medications were needed to control the IOP after cataract surgery at the last follow-up [1.59 medications (±1.4) in the study group and 0.50 medications (±0.7) in the control group; P=0.009]. CONCLUSIONS: UG eyes that underwent phacoemulsification following MMC-enhanced trabeculectomy required more medications to control the IOP than those that did not undergo cataract surgery and therefore less IOP control. Such changes in IOP control did not affect the overall trabeculectomy survival rate.

Intermediate and Long-term Outcomes of Mitomycin C-enhanced Trabeculectomy as a First Glaucoma Procedure in Uveitic Glaucoma.

OBJECTIVES: To evaluate the intermediate and long-term outcomes of mitomycin C-enhanced trabeculectomy as a first glaucoma procedure in uveitic glaucoma. MATERIALS AND METHODS: Retrospective cohort study included 70 eyes of 50 patients with uveitic glaucoma who underwent mitomycin C-enhanced trabeculectomy as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1996 and 2014. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. Surgical outcome of each eye was classified as an absolute success, qualified success, or failure, based on the main outcome measures. RESULTS: The mean follow-up period was 77.0 months (±40.9). The IOP and number of antiglaucoma medications decreased significantly from a mean of 39.5 mm Hg (±8.9) and 3.7 (±0.8) to 14.4 mm Hg (±6.9) and 1 (±1.3) at the last follow-up, respectively (P<0.001 for both). The cumulative probabilities of success were 60% and 35.7% at 36 and 60 months postoperatively, respectively. The most common complications were cataract development and progression (45.3%), hypotony (IOP ≤5 mm Hg) (30%) and IOP spike≥30 mm Hg (10%). Eighteen eyes (25.7%) needed a second procedure to control the IOP. CONCLUSIONS: Although mitomycin C-enhanced trabeculectomy offers reasonable intermediate and long-term IOP control and safety in uveitic glaucoma, a significant number of patients needed further procedures to control the pressure. Thus, continuous monitoring of the pressure and inflammation are crucial.

Traumatic Ghost Cell Glaucoma with Successful Resolution of Corneal Blood Staining Following Pars Plana Vitrectomy.

Ghost cell glaucoma (GCG) was first described in 1976. It is a type of a secondary open angle glaucoma, which occurs following long-standing vitreous hemorrhage. The ghost cells are rigid and less pliable than fresh red blood cells; therefore, they may cause direct obstruction of the trabecular meshwork and secondary increase in the intraocular pressure (IOP). This case report presents the diagnosis and management of a rare case of traumatic GCG after vitreous hemorrhage in a phakic child. Pars plana vitrectomy was done after unsuccessful medical therapy and the diagnosis was confirmed by cytopathology. Surprisingly, spontaneous resolution of the corneal blood staining occurred. The outcome in this case was favorable with controlled IOP in the affected eye.

Intraocular Pressure Outcomes Following Transscleral Diode Cyclophotocoagulation Using Long and Short Duration Burns.

PURPOSE: The purpose of this study was to compare outcomes of transscleral diode cyclophotocoagulation using short duration (SD) versus longer duration (LD) treatment. PATIENTS AND METHODS: Data were collected retrospectively on patients with glaucoma who underwent cyclophotocoagulation with LD (4000 ms) treatment with variable power ≤1000 mW versus SD using 1500 ms with variable power ≤2000 mW. The outcome measures included: intraocular pressure (IOP) at 12 months, decrease in number of antiglaucoma medications, complications and visual acuity (VA) at the final follow-up visit. RESULTS: There were 71 patients and 70 patients in the SD and LD groups, respectively. The mean IOP±SD pretreatment baseline was 33±10 versus 36±10 mm Hg for SD and LD groups, respectively (P>0.05). At 1 year postoperatively, the IOP decreased significantly in both groups (16.7 vs. 17.4 mm Hg for SD and LD, respectively; P<0.0001). This decrease in IOP was comparable between groups (P=0.5). The average number of IOP lowering medications were 2.5 and 2.9 at baseline in the SD and LD groups, respectively, and decreased to 1.3 in both groups (P=0.83). The mean LogMAR VA decreased significantly from 1.87 at baseline to 1.96 at 1 year in the SD group (P=0.276), and 2.03 to 2.3 (P≤0.001) in the LD group, this change was comparable (0.19; P=0.075) between the 2 groups. Complications were also comparable. CONCLUSIONS: Both LD and SD burns during cyclophotocoagulation effectively lowered IOP at 1 year. Neither treatment resulted in a greater reduction of IOP. LD treatment appeared to result in a decrease in VA and greater postoperative inflammation.

Outcomes of Trabeculectomy With Mitomycin-C in Uveitis Associated With Vogt-Koyanagi-Harada Disease.

OBJECTIVES: To evaluate the outcomes of trabeculectomy with mitomycin-C (MMC) in uveitis associated with Vogt-Koyanagi-Harada disease (VKH). METHODS: Retrospective cohort study included 27 eyes of 15 patients with uveitic glaucoma associated with VKH disease who underwent trabeculectomy with MMC as a first glaucoma procedure at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between 1992 and 2011. The main outcome measures were: the intraocular pressure (IOP), the number of antiglaucoma medications, the presence of visually threatening complications, and the need for further surgeries to control the IOP. RESULTS: The mean follow-up was 78.19 months. The IOP decreased significantly from a mean of 40.15±7.0 to 13.12±6.9 mm Hg on the last follow-up (P<0.01) as well as during the whole follow-up period. The number of medications needed to control the IOP also decreased significantly from 3.89±0.6 to 1.04±1.3. The cumulative probabilities of success were 77.8%, 74.1%, 63.0%, and 51.9% at 12, 24, 36, and 48 months postoperatively, respectively. The most common complications were cataract development and progression (53.8%), hypotony (IOP≤5 mm Hg) (33.3%), choroidal effusion (7.4%), and decompressive retinopathy (7.4%). Eight eyes (29.6%) needed a second procedure to control the IOP. CONCLUSIONS: Trabeculectomy with MMC offers an acceptable intermediate term success and IOP control in uveitic glaucoma associated with VKH. However, significant number of eyes needed further procedures to control the pressure. Therefore, continuous monitoring of the pressure is important.

Postoperative suprachoroidal hemorrhage in a glaucoma patient on low molecular weight heparin.

Suprachoroidal hemorrhage is a complication associated with intraocular surgery that can occur both intraoperatively and postoperatively. Several intraoperative or postoperative risk factors have been identified. The use of low-molecular weight heparin (LMWH) is considered one of the risk factors in surgical cases (ocular or non ocular) and non-surgical cases. Here we present a case of suprachoroidal hemorrhage in a glaucoma patient that occurred after preoperative prophylactic LMWH for deep venous thrombosis. The use of LMWH has been reported to cause suprachoroidal hemorrhage even in patients without any risk factors. The use of LMWH continues to increase, hence it is important to be aware of the possibility of suprachoroidal hemorrhage and to determine the risk/benefit ratio, especially in patients with other risk factors.