Peripapillary and macular vascular densities in healthy, ocular hypertensive, and different stages of glaucomatous eyes.

AIM: To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography (OCTA) in the early diagnosis of glaucoma. METHODS: Glaucoma patients and healthy controls (n=29 eyes) were investigated in this cross-sectional comparative study. Glaucoma patients were grouped as ocular hypertension (n=44 eyes), preperimetric glaucoma (PPG; n=32 eyes), early glaucoma (EG; n=35 eyes), moderate stage glaucoma (MG; n=36 eyes), and advanced glaucoma (AG; n=35 eyes). Peripapillary and macular vascular densities (VDs) of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness (RNFLT), ganglion cell analysis (GCA), and visual field (VF) tests were evaluated. Area under the receiver operation characteristic curves (AUC) of the peripapillary and macular VD parameters were obtained. RESULTS: VD values decreased with the progression of glaucoma. Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls (P<0.001). There was no significant difference in RNFLT between the PPG and EG groups, but most peripapillary and macular VDs were found to be lower in EG group than in PPG group (P<0.05). In most disease group, VDs were significantly correlated with OCT parameters (P<0.001) and VF index (P<0.05). There were no significant correlations between VF and RNFLT indices in the AG group, but significant correlations were found between VF and VD values (P<0.05). AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD (AUC: 0.865, 0.929, and 0.986, respectively in EG, MG, and AG groups). CONCLUSION: OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease. In cases where limitations or suspicions in structural and functional tests are present, OCTA can be used as a supportive diagnostic test, both in EG and AG.

Macular and Peripapillary Vascular Densities in Non-Glaucomatous Eyes of Patients with Unilateral Glaucoma.

Objectives: Our purpose was to investigate vascular alterations in the non-glaucomatous eyes of patients with unilateral primary open angle glaucoma using optical coherence tomography angiography and to evaluate the role of vascular damage in glaucoma pathogenesis. Materials and Methods: This cross-sectional study included 60 eyes of 30 patients with unilateral glaucoma (63.4±8.8 years) and 30 eyes of 30 healthy subjects (65.6±9.1 years). Three groups were formed: group A, affected eyes of unilateral glaucoma patients; Group B, non-glaucomatous eyes of unilateral glaucoma patients; and group C, healthy controls. Results: When group A was compared with groups B and C, significant differences were detected in rim area, cup volume, mean cup/disc ratio, and retinal nerve fiber layer thickness parameters (p<0.001 for all). No significant difference was detected between groups B and C (p>0.05 for all). In peripapillary and macular vessel density (VD) comparisons, all parameters except intradisc VD were found to be lower in group A (p<0.0167 for all). No statistically significant difference was detected between groups B and C (p>0.05 for all). Conclusion: The VD values in eyes with glaucoma were found to be lower than in the other two groups. However, no difference was observed between the non-glaucomatous eyes of glaucoma patients and those of healthy individuals. Thus, the results did not support our hypothesis that VD alterations would be observed in the fellow eyes of patients with unilateral glaucoma if the vascular pathway were responsible in the pathogenesis of glaucoma.

Scleral Flap Wound Dehiscence with Valsalva Maneuver After Trabeculectomy with Mitomycin C.

Incisional surgeries such as trabeculectomy reduce the resistance of the eye to trauma. Trabeculectomy is often performed together with mitomycin C, and late onset hypotony is already an expected complication in these eyes. This case report presents a patient who developed dehiscence of the scleral flap and hypotony maculopathy after Valsalva maneuver after 5.5 years of trabeculectomy. In a 6-month period, the patient's hypotonic maculopathy became evident, and vision was affected after this period. Thereupon, the wound site was explored, and dehiscence of the scleral flap at the temporal wound site and increased aqueous outflow were detected. Repair was done with sterile pericardium patch. Post-operative vision, intraocular pressure, and hypotony maculopathy recovered very quickly. After incisional surgeries, patients should be warned against both external trauma and minor traumas such as eye rubbing and Valsalva maneuver.

Optical Coherence Tomography Angiography Findings in Primary Open-Angle and Pseudoexfoliation Glaucoma.

Objectives: To compare the optical disc and macular vascular density values of patients with glaucoma and healthy individuals by using optical coherence tomography angiography and evaluate the relationship between structural and functional test results and vascular density. Materials and Methods: The study included 128 eyes in total: 31 with pseudoexfoliation glaucoma (PEG), 55 with primary open-angle glaucoma (POAG) and similar visual field defects, and 42 healthy eyes. Whole image peripapillary vessel density (wpVD), intradisc vessel density (idVD), peripapillary vessel density (pVD), whole image macular vessel density (wmVD), and parafoveal vessel density (pfVD) values were compared between the groups. Correlations between visual field findings, retinal nerve fiber layer (RNFL) and optic nerve head measurements and peripapillary and macular vascular density were analyzed. Results: In the PEG and POAG groups, wpVD, idVD, wmVD, and pfVD values were significantly lower in than the control group. In the PEG group, wpVD was found to be significantly lower than the POAG group (p<0.001). There was no significant difference between the PEG and POAG groups in wmVD and pfVD except for nasal pfVD. There were strong positive correlations between RNFL thickness and pVD in the glaucoma groups (p<0.001). Significant correlations were found between visual field mean deviation and pattern standard deviation values and peripapillary and macular vessel density values in the glaucoma groups. Conclusion: Vascular density values were lower in glaucoma patients compared to normal individuals, and there is a strong correlation between structural and functional tests and vessel density values. The lower vascular density in the PEG group compared to the POAG group indicates that vascular damage may be more common in PEG patients.

Factors affecting the surgical success of trabeculectomy performed as the first surgery in primary pediatric glaucoma.

PURPOSE: To present the outcomes and factors affecting the success of trabeculectomy performed as the first surgery in primary pediatric glaucoma. METHODS: Pediatric patients with primary glaucoma who underwent trabeculectomy as the first surgery were retrospectively reviewed. Age, gender, preoperative intraocular pressure (IOP), operation age, axial length, corneal diameter, anterior segment findings, antimetabolite used, complications, and 1-month, 3-months, 1-year, and most recent postoperative findings were recorded. Postoperative IOP with/without medication of 18 mmHg or less was considered successful. Factors that may have affected surgical success were also evaluated using multivariate analysis. RESULTS: Included in the study were 48 patients, of whom 30 had primary congenital glaucoma and 18 had juvenile glaucoma. The mean preoperative IOP was 36.84 ± 6.30 mmHg, and the mean follow-up time was 7.95 ± 6.93 years. The median operation age value was 100.00 ± 100.83 (median: 60; IQR: 153) months. The postoperative IOP at the 1-month, 3-months, 1-year, and most recent follow-ups were 15.39 ± 6.88, 15.70 ± 7.36, 16.28 ± 7.86, and 17.48 ± 8.44 mmHg, respectively (p = 0.565). While there were no postoperative complications in 24 of the patients (50.0%), the most common complications were choroidal detachment and hypotony. Postoperative complication development was found to be significant as a factor affecting surgical success in the multivariate logistic regression analysis. Surgical success rates for all of the patients were 71.7%, 65.9%, 65.0%, and 61.4% at the 1-month, 3-months, 1-year, and most recent follow-ups, respectively. A significant difference was found between the congenital and juvenile groups in terms of surgical success only at 3 months (p = 0.953, p = 0.042, p = 0.191, p = 0.218; respectively). DISCUSSION/CONCLUSION: The fact that surgical success was partially higher in the juvenile group confirmed the idea that the results of trabeculectomy will be more favorable in patients of older age and without anterior segment anomalies.

Assessing risk factors for postoperative hypotony in Ahmed glaucoma valve implantation surgery.

PURPOSE: To assess the risk factors associated with the development of hypotony after Ahmed glaucoma valve (AGV) implantation. METHODS: One hundred and ninety-three eyes of 177 patients with various types of glaucoma that were treated with AGV implantation were retrospectively evaluated. Intraocular pressure lower than 6 mmHg related to the surgery is defined as postoperative hypotony. Patients' demographic characteristics, type of glaucoma, preoperative and postoperative visual acuity, necessity of antiglaucoma treatments, lens status, previous ocular surgeries, intraocular pressure (IOP) measurements before and after surgeries, the need for additional procedures and postoperative complications were recorded from the patients' charts. RESULTS: Hypotony was seen in 68 of 193 eyes (35.2%) postoperatively. In 45 eyes (23.3%), it has occurred in first postoperative day and in 23 eyes (11.9%) after the first day within the first week. There was no difference in intraocular pressures between two groups in the first year follow-up. Pre- and postoperative best-corrected visual acuities, age and gender were not statistically different between hypotony and no hypotony groups (p > 0.05). Also, lens status, history of previous ocular surgery, type of glaucoma and number of preoperative glaucoma medication usage were not found to be different between groups (p > 0.05). CONCLUSIONS: Potential risk factors such as age, sex, lens status, history of previous ocular surgeries, preoperative glaucoma medication usage or glaucoma type are not found to influence upon postoperative hypotony prevalence for AGV surgery. Surgery type and personal ocular factors, which could not be determined beforehand, could be more important than demographic features.

Factors affecting the early and mid-term success of needling for early failure of filtering bleb.

Purpose: The purpose of this study is to evaluate the factors affecting the success of needling surgery for early filtering bleb failure after trabeculectomy. Methods: Patients who underwent a single needling surgery within 3 months after trabeculectomy were retrospectively evaluated. Glaucoma type, intraocular pressure (IOP), and medical treatments before trabeculectomy; the presence of hypotony after trabeculectomy; bleb type; IOP before needling; lens status; complications; IOP after 1, 6, and 12 months; and medical treatments after needling were recorded. Risk factors were evaluated for complete success at 1, 6, and 12 months after needling. Results: Thirty-three eyes of 33 patients were analyzed. The mean IOP after needling at 1, 6, and 12 months was 16.09 ± 3.70, 15.64 ± 2.68, and 15.79 ± 2.61 mmHg, respectively. The mean age of the patients was 53.97 (25-79) years. The mean IOP after needling at 1, 6, and 12 months was 16.09 ± 3.70, 15.64 ± 2.68, and 15.79 ± 2.61 mmHg, respectively. The pre-needling IOP and IOP decrease on the first day affected the complete and qualified success at 1, 6, and 12 months, but the glaucoma type, presence of hypotony after trabeculectomy, lens status, interval between trabeculectomy and needling, and bleb type were not found to affect success. In the receiver operating curve analysis, the pre-needling IOP value was found to be significant in determining complete success. Complete success at 1 month was more likely when the pre-needling IOP cutoff value was <24.5 mmHg. Conclusion: According to the results of single needling surgery performed within 3 months after trabeculectomy, the pre-needling IOP and IOP decrease with needling were found to be factors affecting success. Regardless of the time between the primary trabeculectomy and needling, effective needling will be successful before the IOP rises to high levels. Keeping the IOP at low values with medical treatment until the needling process is performed will have a positive effect on success.

The Effect of Long-Term Usage of Single-Agent Antiglaucomatous Drops with Different Preservatives on Cornea Biomechanics.

OBJECTIVES: This study examined the effect of antiglaucomatous drops with different preservatives on corneal biomechanics using the ocular response analyzer (ORA) (Reichert Technologies, Inc., Depew, NY, USA). METHODS: Patients using antiglaucomatous medical treatment containing a single agent combined with a preservative for at least 1 year who underwent a control examination between January and December 2017 at a glaucoma unit were included in this retrospective study. The patients were divided into 5 groups according to the antiglaucomatous agent and preservative ingredients. Measurements were taken with the ORA and compared with a control group. RESULTS: A total of 83 eyes treated eyes were included and analyzed. Thirty-three eyes of 33 patients were treated with latanoprost+benzalkonium chloride (BAC), 17 eyes of 17 patients were treated with travoprost+polyquad, 7 eyes of 7 patients were treated with bimatoprost+BAC, 18 eyes of 18 patients were treated with brimonidine+purite, 8 eyes of 8 patients were treated with brimonidine+BAC. A control group of 23 eyes of 23 healthy patients was also assessed for comparison. A significant decrease in corneal hysteresis (CH) and corneal resistance factor (CRF) was seen in the patients using bimatoprost+BAC and brimonidine+BAC when compared with the control group. Evaluation of the bimatoprost+BAC group and the latanoprost+BAC group revealed that the CH and the CRF was significantly lower in the group using bimatoprost+BAC (p<0.01). CONCLUSION: It has been reported that CH is a more important prognostic marker than central corneal thickness in glaucoma patients. Loss of visual field progresses faster in eyes with a low CH. Both preservatives and the active antiglaucomatous agents in medications can affect CH. Variation in CH in patients using antiglaucomatous drops over a long period is important in both the progression and follow-up of the disease.

Characteristics of uveitic glaucoma in Turkish patients.

PURPOSE: To evaluate the prevalence of uveitic glaucoma (UG) in the Turkish population and investigate the primary underlying diseases. METHODS: This multicenter, cross-sectional, prospective study included patients who presented to the glaucoma units of 10 tertiary ophthalmology departments in Ankara, Turkey from 15th March to 16th May 2015 and fulfilled the criteria of UG. Patients were inspected for age, sex, medical history, best corrected visual acuity, biomicroscopic findings, intraocular pressure values, and visual field results. RESULTS: During the study period, 4604 eyes of 2541 patients with glaucoma were screened and 145 eyes of 104 patients (4.1%) were identified as having UG. One hundred and thirty-four eyes (92.4%) had open-angle glaucoma and 11 eyes (7.6%) had closed-angle glaucoma. The mean patient age was 47 ± 16 (6-90) years. Idiopathic uveitis (54 eyes), Behçet's disease (26 eyes), Fuchs heterochromic cyclitis (21 eyes), Herpes Simplex virus infectious uveitis (14 eyes), and ankylosing spondylitis (six eyes) were the leading types of uveitis associated with glaucoma. Acute anterior uveitis was the most common type of uveitis diagnosed in 72 patients (105 eyes), whereas 21 patients (27 eyes) had panuveitis, eight patients (nine eyes) had intermediate uveitis, and three patients (four eyes) had posterior uveitis. The need for surgical intervention was 37.2% among all cases and the most common surgery was trabeculectomy in 45 eyes. CONCLUSION: UG is a vision-threatening complication commonly seen in patients with uveitis. This study demonstrates the epidemiological features and underlying etiologies of UG in the Turkish population. The most common primary causes of UG were Behçet's disease and Fuchs heterochromic cyclitis.

Effect of trabeculectomy and Ahmed glaucoma valve implantation surgery on corneal biomechanical changes.

PURPOSE: To evaluate alterations in corneal biomechanical properties before and 6 months after conventional trabeculectomy (TRAB) and Ahmed glaucoma valve (AGV) implantation. METHODS: Thirty-nine eyes of 39 patients were evaluated retrospectively. Complete ophthalmological examinations including evaluation of corneal biomechanical properties using the Ocular Response Analyzer were performed before and after 6 months postoperatively. A mean of four measurements for corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann correlated intraocular pressure (IOPg), and corneal compensated intraocular pressure (IOPcc) was recorded. The participants had undergone trabeculectomy or shunt surgery as the first surgical procedure for glaucoma treatment of uncontrolled IOP with maximum antiglaucoma eyedrops. RESULTS: There were 20 eyes of 20 patients in trabeculectomy group and 19 eyes of 19 patients in AGV implantation group. There was no significant difference between two groups in terms of sex, age, eye laterality, lens status, antiglaucoma drug usage, preoperatively measured Mean Deviation of Humphrey Visual Field Analyzer, CH, CRF, IOPcc, and IOPg (p > 0.05). CH and CRF increased significantly after shunt surgery (p < 0.001). CH increased in trabeculectomy group postoperatively (p < 0.001); however, CRF showed a small amount of decrease, but this reduction was not statistically significant (p > 0.05). CH and CRF showed higher increase after AGV surgery than trabeculectomy surgery (p < 0.05). There was no significant correlation between IOP changes and CH-CRF changes in both TRAB and AGV groups (p > 0.05). CONCLUSION: According to our results, surgical technique differences may have an impact on postoperative corneal biomechanical outcomes. AGV surgery offers better corneal biomechanical results than standard trabeculectomy in 6-month follow-up.

Short- and Long-term Results of Glaucoma Valve Implantation for Aniridia-related Glaucoma: A Case Series and Literature Review

Objectives: To report the results obtained from glaucoma drainage device (GDD) implantation in patients with aniridia-related glaucoma and to review the literature. Materials and Methods: We retrospectively reviewed 6 patients who underwent GDD implantation for glaucoma secondary to congenital aniridia between April 2001 and February 2015. Data on age at surgery, gender, laterality, surgeries before GDD implantation, GDD model, concomitant ocular disorders, visual acuity, and intraocular pressure (IOP) values before and at 1 and 12 months after GDD implantation, medications, follow-up period, findings during last visit, complications, and course of disease were collected. Results: Mean age at surgery was 16.00±12.31 years (range 5-37 years). Mean IOP was 33.00±12.11 (range 22-50) mmHg just before the GDD implantation with a mean of 3.5±1.2 medications. Mean IOP 1 month after implantation was 16.33±4.22 (range 12-24) mmHg with a mean of 1.5±0.8 medications; at 12 months, mean IOP was 19.50±4.76 (range 15-26) mmHg with 3.0±0.8 medications. At the last follow-up visit, IOP was 21.16±4.07 (range 16-26) mmHg with a mean of 3.33±0.51 medications. Mean follow-up was 19.16±8.8 (range 12-36) months. Surgical success rates were 83.3%, 66.6%, and 50.0% at 1 month, 12 months, and the last visit, respectively. Conclusion: GDD implantation was effective in controlling aniridic glaucoma with a success rate of 83.3% at 1-month follow-up and 66.6% at 1-year follow-up. Therefore, it should be considered as an initial surgical treatment for aniridic glaucoma; the clinician should be alert for concomitant ocular disorders.

Antioxidant effects of vitamin D on lacrimal glands against high dose radioiodine-associated damage in an animal model.

PURPOSE: To evaluate antioxidant effects of active vitamin D (calcitriol) against high-dose radioiodine (RAI) therapy-associated damage of lacrimal gland. MATERIALS AND METHODS: Wistar albino rats were used and divided into three groups randomly (n = 12/group). The first group was appointed as the negative control group and received no RAI or medication. The second group was appointed as the positive control group that only received 3 mCi/kg (111 MBq/kg) RAI via gastric gavage and the last group was the treatment group that received 3 mCi/kg RAI via same method and calcitriol (200 ng/kg/day) via intraperitoneal administration. Seven days after RAI administration, bilateral intraorbital (IG), extraorbital (EG) and Harderian (HG) glands were removed for the evaluations of histopathologic, tissue cytokine, total oxidant status (TOS) and total antioxidant status (TAS). RESULTS: RAI led to significant increase in tissue TOS, TNF-α, IL-6 levels and significant decrease in IL-10 and TAS levels (p < 0.05 for each). Addition of adjunctive calcitriol reversed all these parameters significantly (p < 0.05 for each).The following histopathologic parameters were seen more frequently in positive control group than the other groups: Abnormal lobular pattern, perivascular infiltration, periductal infiltration, lipofuscin-like accumulation, acinar atrophy, periductal and periacinar fibrosis in all lacrimal gland types (p < 0.05), acinar fibrosis in EG (p = 0.049), periductal fibrosis in EG and HG (p = 0.049 and 0.038, respectively), abnormal cell outlines in EG and HG (p = 0.020 and 0.011, respectively) and variation in cell size in the IG and the HG (p = 0.003 and 0.049 respectively). CONCLUSIONS: RAI caused significant oxidative stress and inflammation in lacrimal glands. Vitamin D demonstrated potent anti-inflammatory, antioxidant and radio-protective effects on lacrimal glands in histopathologic, tissue cytokine and oxidant/antioxidant level evaluations.

The Profile and Management of Glaucoma in Adult Aphakic Patients Following Complicated Cataract Surgery.

OBJECTIVES: To determine the profile and clinical course of glaucoma in adult aphakic patients following complicated cataract surgery. MATERIALS AND METHODS: Retrospective chart review of 22 adult aphakic patients (29 eyes) with glaucoma. RESULTS: Mean age was 57.69±14.18 years when aphakia occurred. Mean age at time of presentation to our glaucoma clinic was 62.57±12.47 years. Mean follow-up time was 42.83±57.04 months. Changes between the first and last follow-up visits were as follows: mean intraocular pressure decreased from 26.21±13.86 mmHg to 18.14±9.63 mmHg (p=0.003); mean number of glaucoma medications used increased from 1.41±1.27 to 2.07±1.04 (p=0.005); and mean vertical cup/disc ratio increased from 0.69±0.25 to 0.78±0.24 (p=0.024). Glaucoma was managed using medications in 26 eyes (89.7%), whereas 3 eyes underwent surgical treatment. However, surgery alone was not sufficient to control intraocular pressure and additional glaucoma medications were needed. CONCLUSION: Prevention of glaucomatous optic neuropathy in aphakic patients is challenging both medically and surgically. Although a significant decrease in intraocular pressure can be achieved with glaucoma medications, glaucomatous disc changes may progress.

Outcomes of Trabeculectomy and Glaucoma Drainage Devices for Elevated Intraocular Pressure After Penetrating Keratoplasty.

PURPOSE: To assess and compare the outcomes of trabeculectomy with and without antimetabolites (AMs) and glaucoma drainage devices (GDDs) in the management of elevated intraocular pressure (IOP) after penetrating keratoplasty (PK). METHODS: Data of 84 eyes of 81 patients who underwent trabeculectomy (12 eyes without an AM and 42 eyes with an AM) or GDD implantation (30 eyes) after PK were reviewed retrospectively. The main outcome measures were IOP control, corneal graft survival, and postoperative ocular complications. RESULTS: At the final visit, IOP success (<22 mm Hg) was 58.3% in trabeculectomy alone, 64.3% in trabeculectomy with an AM (TrabAM), and 86.7% in GDD groups (P = 0.047). The median time from surgery to IOP failure was 1 month after trabeculectomy alone, 13 months after TrabAM, and 20 months after GDD implantation (P = 0.042). The cumulative probability of IOP success rates at 1 and 3 years postoperatively was as follows: 66.7% and 57.1% in trabeculectomy alone, 80.6% and 64.8% in TrabAM, and 92.3% and 84.6 in GDD groups (P = 0.063). The cumulative probability of corneal graft survival rates at 1 and 3 years postoperatively was as follows: 70.0% and 60.0% in trabeculectomy alone, 76.7% and 67.7% in TrabAM, and 65.8% and 52.6% in GDD groups (P = 0.549). CONCLUSIONS: GDDs are more successful than trabeculectomy in controlling IOP in eyes that have undergone PK, but they tend to have low corneal graft survival rates. Trabeculectomy without an AM has limited success and may be considered in a limited number of patients with a low risk for bleb failure.

Outcomes of Ahmed glaucoma valve implantation for steroid-induced elevated intraocular pressure in patients with retinitis pigmentosa.

PURPOSE: To evaluate the outcomes of Ahmed glaucoma valve (AGV) in the management of elevated intraocular pressure (IOP) secondary to steroid use for macular edema in patients with retinitis pigmentosa (RP). METHODS: A total of nine eyes of five patients were evaluated retrospectively. Complete success was defined as IOP ≤ 21 mmHg without glaucoma medications, while qualified success was defined as IOP ≤ 21 mmHg with glaucoma medications. RESULTS: Mean age at surgery was 25.0 ± 8.3 years, and mean follow-up time was 38.4 ± 13.2 months. Mean IOP was 41.0 ± 8.3 mmHg preoperatively, 9.4 ± 3.5 mmHg at first week (p = 0.008), 13.1 ± 3.6 mmHg at first month (p = 0.008), 14.8 ± 4.1 mmHg at 6th month (p = 0.008), 11.7 ± 2.6 mmHg at 12th month (p = 0.008), 12.4 ± 2.9 mmHg at 24th month (p = 0.008), 12.6 ± 3.6 mmHg at 36th month (p = 0.043) and 12.8 ± 4.2 mmHg at 48th month (p = 0.068) postoperatively. The mean number of topical anti-glaucomatous medications decreased from 2.8 ± 0.4 preoperatively to 0.4 ± 0.9 postoperatively (p = 0.007). Complete success was obtained in 7 (77%) eyes, and qualified success in 2 (23%) eyes. No failure was detected. CONCLUSIONS: AGV implantation can be considered as an alternative and safe option in the management of resistant, elevated IOP secondary to steroid treatment for macular edema in patients with RP.

Coenzyme Q10 for the Protection of Lacrimal Gland against High-Dose Radioiodine Therapy-Associated Oxidative Damage: Histopathologic and Tissue Cytokine Level Assessments in an Animal Model.

PURPOSE: To evaluate protective effect of coenzyme Q10 (CoQ10) in lacrimal glands against high-dose radioactive iodine (RAI)-associated oxidative damage. MATERIALS AND METHODS: Thirty Wistar albino rats were randomly divided into three groups. Group 1 was the control group. Group 2 received 3 mCi/kg RAI via gastric gavage but no medication. Group 3 received 3 mCi/kg RAI via gastric gavage and 30 mg/kg/day CoQ10 intraperitoneally. CoQ10 was started at day one just before RAI administration and continued for five days. Seven days after RAI therapy, the animals were anesthetized and decapitated. Intraorbital (IG), extraorbital (EG), and Harderian (HG) lacrimal glands were removed bilaterally for histopathological and tissue cytokine level assessments. RESULTS: Abnormal lobular pattern, acinar fibrosis, lipofuscin-like accumulations, perivascular infiltration, cell size variation, abnormal cell outlines, irregular nucleus shapes in all lacrimal gland types (p < 0.05 for each), periductal fibrosis, periductal and periacinar fibrosis in EG (p = 0.01, 0.044, respectively) and in HG (p = 0.036, 0.044, respectively), periductal infiltration in HG (p = 0.039) and IG (p = 0.029), acinar atrophy in EG (p = 0.044), and cell shape variation in IG (p = 0.036) were observed more frequently in group 2 than in other groups. RAI caused significant increase in TNF-α, IL-6, nuclear factor kappa B, and total oxidant status, and decrease in IL-2, IL-10, and total antioxidant status levels (p < 0.05 for each). Addition of CoQ10 decreased all cytokine levels, increased nuclear factor kappa B levels more, and increased total antioxidant status levels significantly (p < 0.05 for each). CONCLUSIONS: RAI administration causes prominent inflammatory response in lacrimal glands. Addition of CoQ10 ameliorates the oxidative damage and protects lacrimal glands both in histopathological and tissue cytokine level assessments. Protection of lacrimal glands against oxidative damage may become a new era of CoQ10 use in the future.

Short- to long-term results of Ahmed glaucoma valve in the management of elevated intraocular pressure in patients with pediatric uveitis.

OBJECTIVE: The aim of this study was to evaluate the long-term outcome of Ahmed glaucoma valve (AGV) implant for elevated intraocular pressure (IOP) in pediatric patients with uveitis. DESIGN: This was a retrospective chart review. PARTICIPANTS: The study included 16 eyes (11 children) with uveitis. METHODS: Success was defined as having IOP between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucoma medications and without the need for further glaucoma or tube extraction surgery. RESULTS: Mean age of patients at the time of AGV implantation was 14.19 ± 3.25 years. AGV implantation was the first glaucoma surgical procedure in 12 eyes (75%). Average postoperative follow-up period was 64.46 ± 33.56 months. Mean preoperative IOP was 33.50 ± 7.30 mm Hg versus 12.69 ± 3.20 mm Hg at the last follow-up visit (p < 0.001). Three eyes (18.7%) were determined as cases of "failure" because of tube removal in 2 eyes and a second AGV implantation in 1 eye. The cumulative probability of complete success was 68.8% at 6 months, 56.3% at 12 months, 49.2% at 36 months, 42.2% at 48 months, and 35.2% at 84 months, and the cumulative probability of eyes without complication was 75.0% at 6 months, 66.7% at 24 months, 58.3% at 36 months, 48.6% at 48 months and 24.3% at 108 months based on Kaplan-Meier survival analysis. CONCLUSIONS: Although AGV implant is an effective choice in the management of elevated IOP in pediatric uveitis, antiglaucoma medications are frequently needed for control of IOP. Tube exposure is an important complication in the long term. Differential diagnosis between relapse of uveitis and endophthalmitis is important in patients who received AGV implantation.

Short-term to Long-term Results of Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate short-term to long-term outcomes of Ahmed glaucoma valve (AGV) implantation in the management of uveitic glaucoma (UG) secondary to Behçet disease (BD). PATIENTS AND METHODS: A retrospective chart review of 47 eyes of 35 patients with UG secondary to BD who underwent AGV implantation was conducted. Success was defined as having an intraocular pressure (IOP) between 6 and 21 mm Hg with (qualified success) or without (complete success) antiglaucomatous medications and without need for further glaucoma surgery. RESULTS: Mean postoperative follow-up was 57.72±26.13 months. Mean preoperative IOP was 35.40±8.33 mm Hg versus 12.28±2.90 mm Hg at the last follow-up visit (P<0.001). Mean number of preoperative topical antiglaucomatous medications was 2.96±0.29 versus 0.68±1.12 at the last follow-up visit (P<0.001). In all eyes, IOP could be maintained between 6 and 21 mm Hg with or without antiglaucomatous medications during follow-up. The cumulative probability of complete success was 46.8% at 6 months, 40.4% at 12 months, and 35.9% at 36 months, and the cumulative probability of eyes without complication was 53.2% at 6 months, 46.5% at 12 months, and 39.6% at 24 months postoperatively based on Kaplan-Meier survival analysis. No persistent or irreparable complications were observed. CONCLUSIONS: This study includes one of the largest series of AGV implantation in the management of UG with the longest follow-up reported. AGV implantation can be considered as a primary surgical option in the management of UG secondary to BD with 100% total success rate (with or without medications).

Ahmed Glaucoma Valve Implantation for Uveitic Glaucoma Secondary to Behçet Disease.

PURPOSE: To evaluate outcomes of patients with uveitic glaucoma secondary to Behçet disease (BD) who underwent Ahmed glaucoma valve (AGV) implantation. PATIENTS AND METHODS: A retrospective chart review of 14 eyes of 10 patients with uveitic glaucoma associated with BD who underwent AGV implantation at a tertiary referral center. Treatment success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with or without antiglaucoma medication, without further additional glaucoma surgery or loss of light perception. The main outcome measures were IOP, best-corrected visual acuity measured with Snellen charts, and number of glaucoma medications. RESULTS: Mean duration of postoperative follow-up was 18.2±6.6 months (range, 6 to 31 mo). Of the 14 eyes, 10 (71.4%) were pseudophakic and 5 (35.7%) had primary AGV implantation without a history of previous glaucoma surgery. At the most recent follow-up visit, 13 of the 14 eyes had an IOP between 6 and 21 mm Hg. Mean IOP was significantly reduced during follow-up, as compared with preoperative values (P≤0.005). The cumulative probability of surgical success rate was 90.9% at 18 months based on Kaplan-Meier survival analysis. The mean number of antiglaucoma medications required to achieve the desired IOP decreased from 3.4±0.5 preoperatively to 1.0±1.1 postoperatively (P≤0.05). Visual acuity loss of >2 lines occurred in 4 eyes (28.5%) due to optic atrophy associated with retinal vasculitis. Temporary hypotony developed during follow-up in 4 eyes (28.5%) at first postoperative week. CONCLUSIONS: For the management of uveitic glaucoma associated with BD, AGV implantation is a successful method for glaucoma control but requires additional surgical interventions for high early hypotony rates.