Urgent and emergent glaucoma care during the COVID-19 pandemic: An analysis at a tertiary care hospital in South India.

PURPOSE: To describe the demographic profiles, clinical characteristics, and clinical outcomes of patients presenting with glaucoma emergencies during the COVID-19 lockdown in India. METHODS: This retrospective, cross-sectional, observational case series involved review of medical records of all patients presenting to the glaucoma service during the COVID-19 lockdown period and comparison with the previous year (March 23 to June 23, 2020 Vs 2019) in a tertiary center in India. RESULTS: We found a 78.9% reduction in overall outpatient visits (54,345 vs. 257,339; P < 0.001) and 80.9% reduction in the number of glaucoma outpatient visits (4,788 vs. 25,083; P < 0.001). Additionally, the proportion of true glaucoma emergency visits significantly increased by 62.4% in 2020 Vs 2019 (1,408/4,788 (29.4%) vs. 4,542/25,083 (18.1%); P < 0.001). Lens-induced glaucomas were the most common glaucoma surgical emergency (13.4%) in 2020. Moreover, comparison of procedures demonstrated a proportionate decrease in incisional glaucoma surgeries (70/115 (60.86%) vs. 806/939 (85.83%); P < 0.001) and an increase in the proportion of emergency cataract surgeries (129/475 (27.15%) vs. 170/2715 (6.26%); P < 0.001) and transscleral cyclophotocoagulation (45/115 (39.13%) vs. 133/939 (14.16%); P = 0.0001) during 2020 vs. 2019. CONCLUSION: Our study demonstrated a 62% increase in the proportion of visits that were true glaucoma emergencies. Additionally, the proportions of emergency cataract surgeries increased by 4.3 times and the proportion of transscleral cyclophotocoagulation increased by 2.8 times during the pandemic. More nonincisional procedures and less diagnostic testing were performed to minimize postoperative visits and virus transmission. Further understanding of the profile of emergencies may help in developing novel strategies to anticipate future challenges in managing glaucoma care during subsequent waves of the pandemic.

Outcomes of Glaucoma Drainage Device Implantation and Trabeculectomy With Mitomycin C in Glaucoma Secondary to Aniridia.

PURPOSE: To compare the outcomes of Aurolab aqueous drainage implant (AADI; Aurolab) placement and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to aniridia. DESIGN: Retrospective comparative interventional case series. METHODS: This study included patients with congenital aniridia who underwent AADI implantation or trabeculectomy with MMC. Surgical failure was defined as IOP > 21 mm Hg or reduced <20% from baseline, IOP ≤ 5 mm Hg, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS: A total of 30 eyes of 30 patients underwent surgical treatment, including 18 eyes that received an AADI and 12 eyes that had a trabeculectomy with MMC. The cumulative probability of failure at 2 years was 11.1% (95% CI = 2.9%-37.6%) in the AADI group and 58.3% (95% CI = 33.5%-84.8%) in the trabeculectomy group (P = .05, log-rank). At 2 years, IOP (mean ± SD) was 14.1 ± 2.8 mm Hg in the AADI group and 19.6 ± 6.6 mm Hg in the trabeculectomy group (P = .02), and the number of glaucoma medications was 1.7 ± 0.9 in the AADI group and 2.2 ± 0.8 in the trabeculectomy group (P = .25). Surgical complications developed in 1 patient in each treatment group (P = .65). Cataract surgery was performed in 5 (42%) patients in the trabeculectomy group and no patients in the AADI group (P = .01). CONCLUSIONS: Placement of an AADI resulted in lower IOP and a higher rate of surgical success compared to trabeculectomy with MMC in eyes with glaucoma associated with aniridia. Cataract extraction was more frequently required after trabeculectomy with MMC than AADI implantation.