Construction and validation of logMAR visual acuity charts in seven Indian languages.

Purpose: The evaluation of visual impairment requires the measurement of visual acuity with a validated and standard logMAR visual acuity chart. We aimed to construct and validate new logMAR visual acuity chart in Indian languages (Hindi, Bengali, Telugu, Urdu, Kannada, Malayalam, and Assamese). Methods: The commonly used font in each language was chosen as the reference and designed to fit the 5 × 5 grid (Adobe Photoshop). Ten letters (easiest to difficult) around median legibility score calculated for each language based on the results of legibility experiment and differing by 10% were selected. The chart was constructed based on the standard recommendations. The repeatability of charts was tested and also compared with a standard English Early Treatment Diabetic Retinopathy Study (ETDRS) logMAR chart for validation. Results: A total of 14 rows (1.0 to -0.3 logMAR) with five letters in each line were designed with the range of row legibility between 4.7 and 5.3 for all the language charts. Each chart showed good repeatability, and a maximum difference of four letters was noted. The median difference in visual acuity was 0.16 logMAR for Urdu and Assamese chart compared to ETDRS English chart. Hindi and Malayalam chart had a median difference of 0.12 logMAR. When compared to the English chart a median difference of 0.14 logMAR was noted in Telugu, Kannada, and Bengali chart. Conclusion: The newly developed Indian language visual acuity charts are designed based on the standard recommendations and will help to assess visual impairment in people of these languages across the country.

Fibrin sealant-assisted revision of the exposed Ahmed tube.

Tube exposure is a known complication of Ahmed glaucoma valve (AGV) implantation. Repair of the exposed tube is not easy. A 42-year-old monocular aphakic male had undergone retinal detachment repair with placement of an episcleral-encircling band followed by implantation of AGV. He presented to the clinic on routine review with exposure of the shunt tube. The complication was managed by placing scleral and conjunctival grafts over the exposed tube using a fibrin adhesive (Tisseel kit; Baxter AG, Vienna, Austria). The novel use of the fibrin sealant in the repair of AGV tube exposure was for better graft-integration.

Ahmed glaucoma valve in eyes with preexisting episcleral encircling element.

BACKGROUND: To describe the use of Ahmed glaucoma valve (AGV) in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element. MATERIALS AND METHODS: This is a retrospective, consecutive, noncomparative study. The study included 12 eyes of 12 patients with a preexisting episcleral encircling element that underwent implantation of silicone AGV to treat intractable glaucoma during January 2009 to September 2010. RESULTS: The mean patient age was 25.6 (standard deviation 17.1) years. Five (41.6%) patients were monocular. The indications for AGV were varied. The mean duration between placement of episcleral encircling element and implantation of AGV was 30.5 (33.8) months. The mean follow-up was 37.4 (22.9) weeks. Preoperatively, the mean intraocular pressure (IOP) was 31.4 (7.9) mmHg and the mean antiglaucoma medications were 2.8. At the final postoperative follow-up, the mean IOP was 12.5 (3.5) mmHg and the mean number of antiglaucoma medications was 0.8 (P < 0.001). The complications observed over the follow-up period did include corneal graft failure in three eyes, tube erosion in two eyes and rhegmatogenous retinal detachment in one eye. CONCLUSION: AGV is an effective option in the management of intractable glaucoma in eyes with a preexisting episcleral encircling element keeping in mind the possibility of significant postoperative complications.

Prospective evaluation of early visual loss following glaucoma-filtering surgery in eyes with split fixation.

PURPOSE: The aim of this study was to evaluate the incidence and etiology of loss of vision in the early postoperative period after glaucoma-filtration surgery in eyes with split fixation. METHODS: This was a prospective, interventional cohort study. Sixty-five eyes of 65 patients with advanced glaucomatous optic nerve damage with split fixation were included. Thirty-four eyes underwent trabeculectomy (group A) and 31 eyes underwent combined cataract and glaucoma surgery (group B). Main outcome measures included the incidence and etiology of visual loss and changes in intraocular pressure, visual acuity, and visual field indices during the first 2 months after surgery. RESULTS: No significant changes were seen in the mean deviation in group A [mean difference, -0.53±2.23; 95% confidence interval (CI): -1.32, 0.25; P=0.59] and in group B (mean difference, -0.75±2.9; 95% CI: -1.81, 0.31; P=0.16). There was a significant drop in the intraocular pressure from a baseline of 36.87±2.86 to 10.2±3.47 mm Hg (P<0.001) in group A, and from a baseline of 27.74±15.5 to 13.41±5.5 mm Hg in group B (P<0.001). At the end of 2 months, visual loss of 2 lines or more occurred in 2 eyes (3%; 95% CI: 0%, 7%) because of choroidal detachment with increase in lens changes in one eye (group A) and no apparent cause in the other (group B). None of the eyes developed a loss of central vision ("0" dB sensitivity in 4 test points abutting fixation). CONCLUSIONS: Visual loss after surgery in advanced glaucoma is rare and most often because of reversible causes.

Inadvertent rupture of iridociliary cyst following transscleral Diode laser.

Primary iridociliary cysts can induce plateau iris configuration and angle closure glaucoma. We report a patient with bilateral, primary, ring-shaped, solitary iridociliary cysts. The right eye displayed normal intraocular pressure, oppositional iridocorneal angle closure, and healthy optic nerve head. The left eye had advanced chronic angle closure glaucoma. The management strategy varied between eyes and is discussed. This, to the best of our knowledge, is the first report of transscleral Diode laser application in an eye with a large iridociliary cyst.

Our experience of fibrin sealant-assisted implantation of Ahmed glaucoma valve.

AIM: To report our experience with the fibrin sealant as a suture substitute for securing the human scleral patch graft during implantation of Ahmed glaucoma valve (AGV). MATERIALS AND METHODS: A retrospective, non-comparative study of 12 eyes of 12 patients who underwent an AGV implantation with fibrin sealant for part of the procedure during June 2009 to September 2010. RESULTS: The mean patient age was 21.5 ± 20.6 years. Male: Female ratio was 2 : 1. Seven (58.3%) patients were monocular. The indications for AGV were varied. The mean number of intra-ocular surgeries prior to an implantation of AGV was 1.8. The mean follow-up duration was 24.5 ± 17.9 weeks. There was a statistically significant reduction in the mean IOP and in the mean number of anti-glaucoma medications at the final visit compared to the pre-operative values (P < 0.01, paired t test). Conjunctival retraction was seen in 1 (8.3%) case. The scleral patch graft was retracted posteriorly in another (8.3%) case. There was no case of AGV tube exposure, tube-cornea touch, or conjunctival erosion. Vision threatening complication viz. late post-operative rhegmatogenous retinal detachment, unlikely to be related to the use of the fibrin sealant, occurred in 2 (16.6%) eyes. CONCLUSION: The fibrin sealant offers the advantages of safety and convenience to the placement of a scleral patch graft during an AGV implantation.

Boston keratoprosthesis and Ahmed glaucoma valve for visual rehabilitation in congenital anterior staphyloma.

Congenital anterior staphyloma entails grave visual prognosis. The majority of reported patients have undergone enucleation. We report a promising result of staphylectomy with implantation of a keratoprosthesis and a glaucoma drainage device in a seven-month-old child with a large, congenital anterior staphyloma.

Cupped disc with normal intraocular pressure: the long road to avoid misdiagnosis.

We present a series of six patients who had been receiving treatment for normal tension glaucoma (NTG; five patients) or primary open angle glaucoma (one patient). All of them were found to have optic neuropathy secondary to compression of the anterior visual pathway. Even though uncommon, compression of the anterior visual pathway is an important differential diagnosis of NTG. Diagnosis of NTG should be by exclusion. Here the possible causes of misdiagnosis are discussed. We present an approach to distinguish glaucomatous from nonglaucomatous optic neuropathy. The article also emphasizes how important it is for the clinicians to consider the total clinical picture, and not merely the optic disc morphology, to avoid the mismanagement of glaucoma, especially the NTG.

A randomized, crossover, open label pilot study to evaluate the efficacy and safety of Xalatan in comparison with generic Latanoprost (Latoprost) in subjects with primary open angle glaucoma or ocular hypertension.

AIM: To compare the efficacy and tolerability of Xalatan with generic latanoprost (Latoprost) in subjects with primary open angle glaucoma (POAG) or ocular hypertension (OH). MATERIALS AND METHODS: This was a single-center, randomized, open label, crossover, two period comparative study. At the baseline visit, subjects were randomized to two groups. Group A received Xalatan for weeks 1-12 followed by Latoprost for weeks 13-24. Group B received Latoprost for weeks 1-12 followed by Xalatan for weeks 13-24. RESULTS: 30 subjects were recruited, 12 in Group A and 18 in Group B. In subjects administered Xalatan, intraocular pressure (IOP) showed a greater decrease (P < 0.001) from 23.64 +/- 3.13 mmHg at baseline to 14.29 +/- 1.61 mmHg at week 12 (fall of 9.35 +/- 3.55 mmHg, 38.66% +/- 10.29) than that seen in the Latoprost group (22.74 +/- 2.47 mmHg to 16.98 +/- 2.49 mmHg, fall of 5.76 +/- 1.41 mmHg; 25.42% +/- 5.98). In period 2 when subjects were crossed over to Xalatan from Latoprost, there was a further fall from 16.98 +/- 2.49 mmHg to 16.09 +/- 1.49 at week 24 (fall of 0.89 +/- 1.59 mmHg; 4.3% +/- 8.76). However, when subjects were crossed over to Latoprost from Xalatan, the IOP rose from 14.29 +/- 1.61 mmHg to 15.36 +/- 1.71 mmHg at week 24 (8.86% +/- 17.76). There was no significant difference in incidence of conjunctival hyperemia or any other adverse events in both the groups. CONCLUSION: The magnitude of IOP lowering in patients with POAG and OH with Xalatan and Latoprost is different. In our study, the IOP lowering with Xalatan was higher than that with Latoprost.