Modified Viscotrabeculotomy with Microcatheter: Our Technique and Experience in the Surgical management of Glaucoma.

AIMS: To present the results of our case series with a technique we defined as "modified viscotrabeculotomy" which incorporates the benefits of 360° of trabeculotomy and viscodilation and viscodissection of canal of Schlemm using a microcatheter. MATERIALS AND METHODS: This study was designed as a prospective interventional case series and was conducted in Cerrahpasa Medical School Ophthalmology Clinic. Forty-one eyes of 30 patients diagnosed with congenital glaucoma (CG) underwent modified viscotrabeculotomy surgery following initial preoperative examination. The main outcome measure was the surgical success of the procedure, which is determined by an intraocular pressure (IOP) of <18 mm Hg without medication or resurgery; qualified success is defined as an IOP of <18 mm Hg under general anesthesia with an additional need for medications. The differences in IOP measurements were analyzed using paired analysis of variance (ANOVA) with repeated measures. RESULTS: The mean preoperative IOP of the patients was 32.27 ± 4.89 mm Hg. The IOP values at the 1st, 3rd, 6th postoperative months, and at the last visit were 13.41 ± 2.25 mm Hg, 13.70 ± 1.78 mm Hg, 12.47 ± 1.57 mm Hg, and 12.26 ± 1.81 mm Hg, respectively. The difference between the preoperative IOP values and postoperative IOP values was statistically significant (p < 0.001). The qualified surgical success rate was 94.4% after a mean follow-up of 27.95 ± 8.25 months (range 15-45 months). CONCLUSION: Modified viscotrabeculotomy is a safe and effective treatment in the management of CG. HOW TO CITE THIS ARTICLE: Tamçelik N, Capar O, Atalay E. Modified Viscotrabeculotomy with Microcatheter: Our Technique and Experience in the Surgical management of Glaucoma. J Curr Glaucoma Pract 2019;13(3):88-93.

Demographic features of subjects with congenital glaucoma.

CONTEXT: Congenital glaucoma is a potentially blinding ocular disease of the childhood. Identification of the possible associated risk factors and may be helpful for prevention or early detection of this public health problem. AIMS: To demonstrate the demographic features of congenital glaucoma subjects. SETTING AND DESIGN: The charts of congenital glaucoma patients referred to Tamcelik Glaucoma Center were retrospectively reviewed through the dates of 2000 and 2013. MATERIALS AND METHODS: Analyzed data included diagnosis, age at first presentation, symptoms at first presentation, laterality of the disease, sex, presence of consanguinity, family history of congenital glaucoma, maturity of the fetus at delivery, and maternal age at conception. STATISTICAL ANALYSIS USED: Statistical Package for Social Sciences (SPSS) version 19.0 by IBM (SPSS Inc, Chicago, Illinois, USA) was used to compare the mean of continuous variables with Student's t-test and analysis of variance (ANOVA) and χ2 test was used to test differences in proportions of categorical variables. RESULTS: The data of 600 eyes of 311 patients were analyzed. The distribution of primary and secondary congenital glaucoma among the patients were 63.3% (n = 197) and 36.7% (n = 114), respectively. Of the 311 patients, 57.2% (n = 178) were male and 42.8% (n = 133) were female. The overall frequency of bilateral disease was 92.3% (n = 287). Overall rate of consanguinity and positive family history was 45.3% (n = 141) and 21.2% (n = 66), respectively. CONCLUSIONS: Bilateral disease in this study was more common than previously reported studies. Positive family history was more frequent in primary congenital glaucoma although not statistically significant.

Posture-induced changes in intraocular pressure: comparison of pseudoexfoliation glaucoma and primary open-angle glaucoma.

PURPOSE: The objective of this study was to evaluate and compare the IOP values in the sitting and supine positions in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) patients. We also investigated possible relationships between the level of visual field damage and postural IOP change. METHODS: Twenty-nine patients with POAG and 32 patients with PXG were recruited to the study. An Icare PRO tonometer was used to measure IOP in the sitting and supine positions. Intraocular pressure in the sitting position was also measured with a Goldmann applanation tonometer (GAT). Humphrey field analyzer 750 data taken within the previous 3 months were obtained and analyzed. RESULTS: The mean difference between the GAT and the Icare PRO tonometer readings was 0.12 ± 0.8 mmHg, and the tonometers were in close agreement (r = 0.964; P < 0.0001). The mean Icare PRO IOP in the sitting position was 16.6 ± 3.3 mmHg in the POAG group and 14.9 ± 2.7 mmHg in the PXG group. The average rise was 1.7 ± 1.2 mmHg in the POAG group and 2.9 ± 1.9 mmHg in the PXG group. The difference in IOP between the sitting and supine positions was significant between the groups (P = 0.001). The ∆IOP was negatively correlated with both the mean deviation and the visual field index (P < 0.0001 for both). The ∆IOP and pattern standard deviation were positively correlated (P < 0.0001). CONCLUSIONS: A higher increase in IOP was observed in PXG patients from the sitting to the supine position than in POAG patients. Postural variation in IOP was found to be associated with the severity of visual field damage.

High intraocular pressure after carbamazepine and gabapentin intake in a pseudoexfoliative patient.

INTRODUCTION: Psychotropic agents may frequently be associated with ocular adverse effects, which include angle-closure glaucoma. We report a case of pseudoexfoliation glaucoma in which intraocular pressure (IOP) increased within hours after carbamazepine and gabapentin intake, with no observable evidence of any angle closure. CASE REPORT: A 67-year-old woman with pseudoexfoliation glaucoma presented with high IOP in her right eye after carbamazepine and gabapentin intake. To investigate which psychotropic medicine was the cause of this fluctuation, the patient was called for 2 subsequent visits and the order of the medicines she took was changed in each examination. Baseline IOP was recorded in each examination, and the IOP was monitored hourly after the intake of medicines. Baseline and hourly Pentacam measurements were also made to demonstrate changes in anterior segment parameters. DISCUSSION: Gabapentin and carbamazepine resulted in deepening of the anterior chamber, widening of the iridocorneal angle, and mild pupillary dilation in 2 visits. Carbamazepine was associated with a significant increase in IOP independent of gabapentin use. The absence of angle closure and plateau iris configuration suggested other mechanisms that might be related to high IOP after carbamazepine intake. CONCLUSION: This is the first reported case of a large increase in IOP within hours after carbamazepine and gabapentin intake in a pseudoexfoliative eye.