Long-Term Efficacy of Selective Laser Trabeculoplasty in Primary Angle-Closure Disease After Laser Peripheral Iridotomy.

PURPOSE: To evaluate the long-term efficacy of selective laser trabeculoplasty (SLT) in eyes with primary angle-closure (PAC) and primary angle-closure glaucoma (PACG) following a laser peripheral iridotomy (LPI). METHOD: In this prospective cross-sectional study, 45 eyes of 34 patients with PAC/PACG diagnosis, uncontrolled intraocular pressure (IOP), and visible pigmented trabecular-meshwork (TM) at least 180° on gonioscopy following a LPI were recruited. Following a detailed baseline ophthalmic evaluation, all eligible eyes underwent SLT, and the patients were examined on day1, at 1 week, 1-, 3-, and 6-months, and 1-, 2-, 3-, 4-, and 5-year subsequently. The main outcomes measured were IOP, number of IOP-lowering agents, and complications. RESULTS: The mean age of the cohort was 57.80 ± 6.44 years, the male-female ratio was 8:26, and 17 eyes were PACG, and 28 were PAC. The baseline IOP was 23.81 ± 1.78 mm Hg, and was significantly declined at all follow-ups (p < .0001). The cumulative probability of overall success was 91% and 84% at 2-, and 5-year, respectively. At 5-year SLT provided drug-freedom in 80% of PAC and 23% of PACG eyes. Six eyes had IOP spike at 1-week and two patients underwent repeat SLT after 1-year. No other complications, such as pain/discomfort, inflammation, an increase in peripheral anterior synechiae and cystoid-macular-edema, were noted. CONCLUSIONS: SLT appears a safe and cost-effective procedure in PAC/mild- moderate PACG eyes with uncontrolled IOP after laser iridotomy. The long-term effectiveness of SLT as adjuvant treatment was good, but need large sized randomized studies for more validation.

Unilateral advanced glaucoma in isolated congenital ectropion uveae with ipsilateral ptosis: A pictorial description of five children.

Aim: To report the cases of five children with unilateral advanced glaucoma in isolated congenital ectropion uveae (CEU) with ipsilateral ptosis and myopia. Methods: This is an ambispective observational case series. After diagnosing one patient with CEU and glaucoma, consecutive patients presenting with unilateral ptosis, congenital iris anomaly, and glaucoma between 2014 to 2020, and had completed a minimum one-year postoperative follow-up, were analyzed. Results: Of the 1421 newly registered pediatric glaucoma patients in the period under review, five children were diagnosed with CEU. All patients presented with gradual painless diminution of vision in the left eye in early adolescence. The left eye of all patients had peculiar clinical features: mild congenital ptosis, high iris insertion, crypt-less smooth iris surface, congenital ectropion uveae, pigments over anterior lens capsule, high myopia, advanced glaucomatous optic disc cupping, and very high intraocular pressure (IOP), which was > 45 mmHg in all cases. The right eye showed signs of angle dysgenesis with mild anterior iris insertion and numerous fine iris processes. Antiglaucoma medications and angle surgery failed to control the IOP, and all children required glaucoma filtration surgery, resulting in reasonable IOP control. Despite the older age, postoperative strict amblyopia treatment resulted in significant improvement in vision. Conclusions: Although ectropion uveae and ptosis have been present since birth, unilaterality, and the asymptomatic nature of the disease led to the late presentation with irreversible damage. Early surgical management and amblyopia therapy are the cornerstones of management. Abbreviations: CEU = Congenital ectropion uvea, CIES = Congenital Iris Ectropion Syndrome, ASD = Anterior segment dysgenesis syndrome, BCVA = Best-corrected visual acuity, IOP = Intraocular pressure.

Efficacy of 0.01% low dose atropine and its correlation with various factors in myopia control in the Indian population.

We aimed to evaluate the efficacy and safety of low-dose atropine compared to placebo in the Indian population and also to study the impact of various modifiable and non-modifiable factors on myopia progression (MP) and drug efficacy (DE). It was a single-centre prospective placebo-controlled interventional study. 43 participants aged 6-16 years with progressive myopia received 0.01% atropine in the right eyes (treatment) and placebo in the left eyes (control) for 1-year. The main outcome measures were annual MP and axial length elongation (ALE) in treatment and control eyes and their percentage difference between two eyes (drug efficacy). Secondary outcome measures were the occurrence of any adverse events and the correlation of MP, ALE, and DE with various factors. 40 participants (80 eyes) completed the follow-up. After 1-year, MP was 0.25 D (IQR 0.13-0.44) and 0.69 D (IQR 0.50-1.0) (p < 0.001) in treatment and control respectively (63.89% reduction) with respective ALE of 0.14 mm (IQR 0.05-0.35) and 0.32 mm (IQR 0.19-0.46) (p < 0.001) (44.44% reduction). No adverse events were noted. Reduction in MP and ALE was statistically significant in all children irrespective of age-group, baseline MP, family history, screen-time, near and outdoor-time. The strongest determinants of annual MP were age (Treatment: r = - 0.418, p = 0.007; Control: r = - 0.452, p = 0.003) and baseline MP (Treatment: r = 0.64, p = 0.000; Control: r = 0.79, p = 0.000). Screen-time in control eyes was associated with greater ALE (r = 0.620, p = 0.042). DE was higher when outdoor time exceeded 2 h/day (p = 0.035) while the efficacy was lower with prolonged near activities (p = 0.03), baseline fast-progressors (p < 0.05) and history of parental myopia (p < 0.05). 0.01% atropine is effective and safe in retarding MP and ALE in Indian eyes.

Causes and Outcomes of Patients Presenting with Diplopia: A Hospital-based Study.

Diplopia or double vision has various aetiologies and often presents to the ophthalmologist. The purpose of our study was to study in detail the aetiology, progression, and outcome in patients of diplopia presenting to the ophthalmology department of a tertiary care centre. In a prospective observational study, all patients presenting to the emergency services and the outpatient department of a tertiary care centre over a period of 1 year were recruited. One hundred and sixty patients who presented with diplopia with a mean age of 40 (range 7-76) years were included. There were 112 (70%) males and 48 (30%) females. The most common cause for binocular diplopia was vasculopathy in 43 (28.66%) followed by trauma in 37 (24.66%). In those less than 20 years decompensating heterophorias were most common and had the best prognosis. Traumatic causes were common in the age group 20-40 years and vascular in the >40 years age group. For all other aetiologies, elderly patients had more resolution than young patients (p = .04). Larger deviation at presentation, younger age group, and a history of trauma were associated with late recovery (p = .03. p = .04 and p = .04, respectively).

Goniotomy for initial and re-surgery for childhood glaucoma in Northern India.

Purpose: The aim of this study was to describe the effectiveness of goniotomy for childhood glaucoma in Indian eyes. Methods: Consecutive patients with pediatric glaucoma who underwent goniotomy between July 2017 and June 2020, in a single center in Northwest India were prospectively analyzed. Goniotomy was done as a primary procedure or a re-do surgery of the untreated angle in failed filtering surgery. Success was defined as intraocular pressure (IOP) ≦18 mm Hg with or without 2 topical medications. Results: A total of 172 eyes of 126 children underwent goniotomy during this period (37.9% of all pediatric glaucoma surgeries). Goniotomy comprised 132 of 211 (62.5%) primary pediatric glaucoma surgeries and 40 of 243 (16.5%) re-do surgeries. 145, 112, and 54 eyes had a six months, 1-year and 2-year follow-up, respectively. At 1 year, success rates in Primary Congenital Glaucoma (PCG) were 79.7% for primary surgery and 68.4% for re-do surgery. For non-PCG eyes, the success rate was 62% at 1 year. Among PCG subgroups, infantile and newborn glaucoma had 87.5% and 57.1% success rates, respectively. On logistic regression analysis, lower baseline IOP and lesser axial length at presentation were significantly predictive of successful outcomes (P = 0.03 and P = 0.02, respectively). At 1 year, in the primary surgery group, 50% had good vision (better than logMAR 0.5), 28.9% had moderate (better than LOGMAR 1.0) and 20% had severe visual impairment. There were no significant intraoperative or post-operative complications. Conclusion: Goniotomy appears to be an effective surgery for childhood glaucoma in Indian eyes. Being minimally invasive, it obviates the need for conjunctival and scleral dissection and antifibrotic agents.

Comparison of the swept-source anterior segment optical coherence tomography and wide-field ultrasound biomicroscopy for imaging previously operated horizontal extraocular muscles.

PURPOSE: To assess the feasibility and accuracy of determining extraocular muscle insertion distance from the limbus of previously operated extraocular muscles with the swept-source anterior segment optical coherence tomography (AS-OCT) compared with wide-field ultrasound biomicroscope (UBM). METHODS: Patients with a history of previous strabismus surgery for whom additional strabismus surgery was planned were enrolled. The insertion distance was measured by AS-OCT and UBM before reoperation and compared to the caliper measurement at the time of surgery. Observers taking measurements were masked to patient data. Patient comfort for both machines was graded on a scale of 1-10 and timing of both imaging procedures was recorded. RESULTS: Thirteen previously operated muscles of 6 subjects (age 20.3 ± 4.4 years; range, 11-25) were imaged. The muscle insertion could be identified in 12 cases on AS-OCT and 10 cases on UBM. The difference between the imaging result and the caliper reading was ≤1 mm in 9 cases on AS-OCT and 5 cases on the UBM (69% vs 38%; P = 0.03). The maximum insertion distance on AS-OCT was 13.8 mm; on UBM, 10.4 mm. AS-OCT had a higher grade than UBM for patient comfort (P = 0.0005) and speed (P = 0.001). CONCLUSIONS: In our cohort, AS-OCT identified the muscle insertion distance more accurately than UBM. AS-OCT measurements were judged more comfortable to the patient, and images were acquired faster. In large recessions, wide-field UBM yields suboptimal results compared with AS-OCT.

Efficacy of part-time occlusion in amblyopia in Indian children.

Purpose: To study the effectiveness of part-time occlusion (PTO) in different types of amblyopia in Indian population. Methods: Prospective case series of consecutive cases of amblyopia from a tertiary care center were subjected to PTO of the better eye and monitored periodically for 6 months. Those who failed to improve by 6 months were shifted to full-time occlusion of the better eye and followed for a further 3 months. Results: 175 eyes of 175 patients with amblyopia underwent PTO for 6 months. The mean age of the patients was 10.47 ± 4.69 years (range: 3-26 years). Major subgroups included 94 eyes with strabismic amblyopia and 70 with anisometropic amblyopia. Overall, 168 (96%) children benefited from PTO (improvement being defined as a gain of at least one line of Snellen's visual acuity). The improvement rates for strabismic amblyopes (97.9%) was significantly more than anisometropia (94.3%); P = 0.027. Of the seven patients not responding to PTO, six did not benefit even after full-time patching. Conclusion: PTO is a viable and effective modality of management of amblyopia in Indian patients. Strabismic amblyopia was the commonest and responded best to the occlusion therapy in our cohort.

A Pilot Nurse-Led Tele-Counseling Intervention to Parents of Children With Cerebral Visual Impairment on Adherence to Eye Activities During COVID-19 Pandemic: A Pre-experimental Study.

AIM: To assess the impact of a culturally appropriate and theoretically driven nurse-led tele-counseling intervention to parents of children with cerebral visual impairment (CVI) on the adherence to visual therapy advised by the ophthalmologists. DESIGN: A pre-experimental design was used. METHODS: Parents of children with CVI aged 2-9 years were enroled telephonically during the coronavirus disease 2019 (COVID-19) pandemic through the Pediatric Ophthalmology Clinic of a tertiary eye care center. Pre-assessment of participants was done telephonically as per the interview schedule. As per the protocol, the trained nurse-delivered tele-counseling intervention two times weekly for the first 2 weeks and weekly for the next 2 weeks via audio and video two-way tele-interaction with parents. A CVI information booklet was shared with parents via WhatsApp interface and individualized visual therapy was reinforced in accordance with the advice of the treating ophthalmologist. It was based on a thorough review of clinical records of the child, such as a detailed CVI questionnaire, history, and findings of clinical examination and neuro-visual behavior of a child. In addition, parents were encouraged to maintain a diary of the daily sessions of visual therapy and share recorded videos of their training exercises which were then evaluated and discussed with the ophthalmologist for any deviation. Outcome measures included adherence to eye activities for 7-8 sessions per day. Data were analyzed by using SPSS statistics for windows, version 20. RESULTS: Overall, improvement of adherence to visual therapy was observed among children with CVI (p < 0.0001). Nearly half (47.6%) of participants adhered to 3-4 sessions/day and only 28.6% were adherent to the recommended 7-8 sessions/day. CONCLUSION: The pilot study demonstrated the potential of the nurse-led tele-counseling intervention to supplement the ongoing health treatment of patients in improving the adherence to eye activities among parents of children with CVI.

Treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma.

AIM: To study the treatment outcomes and efficacy of pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy in malignant glaucoma. METHOD: A retrospective case series study of patients treated for malignant glaucoma between 2005 and 2017. The treatment included medical management as first-line in the form of cycloplegic with anti-glaucoma medications (AGM) or pars plana vitrectomy-hyaloidotomy-zonulectomy-iridotomy as second-line therapy. The resolution was defined as 'deepening of central anterior chamber' with intraocular pressure of ⩽ 21 mm Hg (minimum on two consecutive visits 1 week apart) with or without topical anti-glaucoma medications in the absence (complete success) or presence (qualified success) of systemic medications. RESULTS: Twenty-three eyes of 22 patients were included. At the time of diagnosis of malignant glaucoma preceding surgeries were cataract surgery (13 eyes) and trabeculectomy (4 eyes). One eye each had phacotrabeculectomy, Yag capsulotomy and optical keratoplasty. Eighteen eyes were pseudophakic and two eyes were phakic. At presentation, mean intraocular pressure was 26.25 ± 14.78 mmHg which was decreased to 15.90 ± 8.12 mmHg (p < 0.0001) at final follow-up (median follow-up was 15.50 months). Fifteen (75%) eyes had complete success, 3 (15%) eyes had qualified success and 2 (10%) eyes had treatment failure. Of 15 eyes that had achieved complete success, 3 eyes had undergone medical management and 12 eyes undergone second-line procedure. There was no significant difference in visual acuity or number of anti-glaucoma medication at presentation and final follow-up (p > 0.05). CONCLUSIONS: Though malignant glaucoma is highly refractory to treatment, appropriate management in the form of medical or vitrectomy-hyaloidotomy-zonulectomy-iridotomy could achieve 90% success in this series.

Long-term Outcome of Ahmed Glaucoma Valve Implantation in Eyes With Intractably Raised Intraocular Pressure Following Pars Plana Vitrectomy.

PRECIS: Ahmed glaucoma valve (AGV) implantation led to a significant reduction in intraocular pressure (IOP) and in antiglaucoma medications in vitrectomized eyes in previously nonglaucomatous eyes. The most common indication for vitrectomy was ocular trauma-related complications. PURPOSE: The purpose of this study was to report the long-term outcomes of AGV implantation in patients of uncontrolled IOP after pars plana vitrectomy (PPV). MATERIALS AND METHODS: Medical records of patients (age 18 y and above) who underwent AGV implantation between January 2006 and December 2017 for uncontrolled IOP following PPV with ≥2 years follow-up were reviewed. The underlying etiology for PPV, IOP, best-corrected visual acuity, and number of antiglaucoma medications (AGMs) were recorded at baseline. The main outcomes measures were IOP, number of AGM, best-corrected visual acuity, and postoperative complications. Postoperative complications were classified as early (≤3 mo)/intermediate (>3 mo to ≤1 y), or late (>1 y). RESULTS: In all, 78 eyes of 78 patients with a mean age of 38.06±17.83 years were included. The mean follow-up was 70.46±36.96 (range: 24 to 180) months. The main underlying etiology for PPV was trauma (38.4%) followed by rhegmatogenous retinal detachment (28.2%). The mean preoperative IOP was 29.33±9.84 mm Hg with an average of 4.07±1.2 AGM. The mean IOP and number of AGM was significantly reduced in all follow-up visits (P<0.0001) following AGV implantation. The cumulative probability of success was 92.3%, 80.7%, and 74% at 2, 5, and 10 years, respectively. Thirty-one complications were observed in 25 (32%) eyes and reoperation (23 procedures) was performed in 22 (28.2%) eyes. CONCLUSIONS: AGV implantation had good outcome in patients with intractably elevated IOP following PPV. Trauma-related pathologies were a major contributor to the indications for PPV and had more chances of failure following AGV implantation.

Mirtazapine-induced bilateral secondary angle closure in a female.

Purpose: To report a case of bilateral secondary angle closure in a female using mirtazapine for 6 months. Patient and method: A 55-year-old female was diagnosed with secondary angle closure in both eyes with raised intraocular pressure, and ultrasound biomicroscopic findings suggestive of ciliary body effusion. It was associated with adjoining cyst presumably because of the use of mirtazapine for depression and sleep disturbances. Results: After the planned discontinuation of mirtazapine, the ocular angle opened, the ciliary body edema decreased, and the cyst regressed in size. The intraocular pressure was controlled with topical timolol (0.5%). Conclusion: Patients with risk factors for angle closure should be prescribed antipsychotic drugs with caution. The peripheral laser iridotomy is not indicated in secondary angle closure due to ciliary body effusion.

Long-term outcome of low-cost glaucoma drainage device (Aurolab aqueous drainage implant) compared with Ahmed glaucoma valve.

PURPOSE: To compare the long-term outcome of Aurolab aqueous drainage device (AADI) and Ahmed glaucoma valve (AGV). METHOD: Retrospective analysis of patients with refractory glaucoma who underwent AGV (AGV-FP7) and AADI (AADI Model 350) implantation. The outcome measures were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs) and re-surgery for IOP control. The postoperative complications were classified as early (≤3 months), intermediate (>3 months to ≤1 year) or late (>1 year). RESULTS: 173 patients (189 eyes) underwent AGV implantation (AGV Group) while 201 patients (206 eyes) underwent AADI implantation (AADI group). The IOP in AADI group was significantly lower than AGV group at all time points till 2 years and comparable at 3 years. AADI group had significantly higher number of AGM in preoperative period and significantly lower number in postoperative period till 3 years compared with AGV group. AADI group had more hypotony-related complications but statistically insignificant (p = 0.07). The surgical interventions were significantly higher in AGV (n = 18) compared with AADI group (n = 5) in late postoperative period (p = 0.01). At 3 years, overall success was seen in 58.18% in AGV and 73.08% in AADI group (p = 0.15). Complete success was seen in 7.27% patients in AGV and 25.00% patients in AADI group (p = 0.02). CONCLUSION: Both AADI and AGV implant had comparable mean IOP at 3 years with lesser requirement of AGM in the AADI group. Both procedures appear to be safe with slight preponderance of hypotony-related complications in AADI group.

Predictors of visual impairment in primary and secondary glaucoma in a tertiary institute in North India.

AIM: To find out and compare various predictors of glaucoma-related visual impairments in primary and secondary glaucoma. METHODS: A prospective observational study of patients, who were above 30 years of age. They were diagnosed as primary/secondary glaucoma with visual acuity <20/200 Snellen's/visual field showing less than 20° isopter in at least one eye, with a minimum follow-up of one year at a tertiary center. Patients were classified into advanced and end-stage glaucoma and outcome was assessed according to visual acuity and visual fields to see predictors of visual impairments. RESULTS: There were 169 (99 primary/70 secondary) glaucoma patients with mean age of 62.67 ± 11.9 and 54.65 ± 15.26 years, respectively. Trauma (21.4%), complicated cataract surgery (15.7%), and silicon oil tamponade (14.3%) were common causes of secondary glaucoma. There was significant delay in diagnosis in primary compared to secondary glaucoma (57.57% vs 32.85%) and non-compliance was significantly higher in primary glaucoma (34.3% vs 17.1%, p = 0.01). In univariate analysis, literacy, income status, locality, and delayed or missed diagnosis were found to be significant (p < 0.05) according to visual acuity criteria. Out of the 33 patients who had undergone glaucoma filtration surgery, 18 (54.5%) were in the end-stage group. While 105 (77.2%) of 136 patients who were not subjected to any glaucoma filtration surgery reached end-stage glaucoma as per visual fields criteria (p = 0.011). CONCLUSION: Lack of awareness, delayed diagnosis, low literacy, and income were associated with poor visual outcome. Patients who underwent glaucoma filtration surgery had significantly better visual outcome in comparison to patients managed medically.

Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction.

Purpose: The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in IOP [19.1 ± 18.00% (18.8) in PACS (P < 0.01), 8.55 ± 17.9% (10) in PAC (P = 0.04), 22.82 ± 15.45%(14.3) in PACG (P < 0.01), 18.27 ± 15.99% (14.5) in advanced PACG (P = 0.01) and 36.56 ± 14.58% (28.57) in medically uncontrolled glaucoma (P < 0.01)] and AGM [51.85% (1) in PAC, 32.35% (2) in PACG, 17.71% (2) in advanced PACG, and 40.74% (1.5) in medically uncontrolled PACD] at median follow-up of 1, 2.5, 1, 1.3, and 1 year. Eleven PACG patients, who were on systemic medication preoperatively, were off systemic therapy at final follow-up, while six other PACG eyes (10.9%) required glaucoma surgery. Conclusion: Cataract surgery leads to significant drop in IOP across the spectrum of ACD with visually significant cataract. Cataract surgery may be considered initially for IOP control even in advanced or medically uncontrolled PACG followed by glaucoma surgery later if required.

Iridocorneal endothelial syndrome: Evaluation of patient demographics and endothelial morphology by in vivo confocal microscopy in an Indian cohort.

Purpose: To evaluate the patient demographics and morphological characteristics of corneal endothelium by in vivo confocal microscopy (IVCM), in patients with Iridocorneal Endothelial (ICE) Syndrome. Methods: In this retrospective observational series, IVCM acquired endothelial images of patients with ICE syndrome were evaluated. 'ICE cells' morphology was classified as "-" or "+" if they were larger or smaller than contralateral normal endothelium. It was correlated with patient demographics and clinical manifestations. Results: IVCM was performed on 41 eyes of 21 patients, with 13 males (62%) and 8 females (38%). The disease was unilateral in 19 (90.5%) and bilateral but asymmetric in two (9.5%) patients. Total ICE was seen in 91% eyes. Eighty percent patients (12 out of 15) with ICE-cells were males while 83.3% (5 out of 6) patients with ICE + cells were females. Mean age of patients with ICE- cell type and ICE + cell type was 45.8 ± 17.8 years and 40.3 ± 9.2 years respectively (P = 0.02). Both ICE - and ICE + eyes had similar incidence (33.3%) of corneal edema. ICE + eyes had more severe (grades 2/3) glaucoma (n = 5/6 eyes, 83.3%) compared to ICE - eyes (n = 8/15 eyes, 53.3%). Conclusion: A male preponderance, predilection of ICE - and + cell variants for male and female gender respectively, lack of association of the endothelial cell morphology with corneal edema, and apparent association of ICE + phenotype with more severe glaucoma occurring at a relatively younger age, are some novel findings of the present study. In the clinical setting correlation of patient demographics with these IVCM findings may help in better long-term prognostication of eyes with ICE syndrome.

Comparison of Short-term Outcomes of Aurolab Aqueous Drainage Implant with Ahmed Glaucoma Valve in Post-Penetrating Keratoplasty Glaucoma: A Retrospective Follow-up Study at a Tertiary Care Center.

PURPOSE: Comparison of short-term outcomes of the Aurolab aqueous drainage implant (AADI) with the Ahmed glaucoma valve (AGV) in post-penetrating keratoplasty glaucoma (PPKG). DESIGN: Retrospective study design. PARTICIPANTS: We analyzed the data of patients who underwent glaucoma drainage device (GDD) implantation for PPKG between the time period of 2008 to 2017. A total of 57 eyes of 55 patients were included. METHODS: Parameters including age, sex, corneal graft clarity, duration between the keratoplasty and glaucoma surgery, visual acuity (VA), intraocular pressure (IOP), the number of antiglaucoma drugs (topical and oral) before surgery, and type of GDD were studied. The patients were divided into 2 groups: group I, patients undergoing AADI implantation; and group II, patients undergoing AGV implantation. Patients with at least 6 months follow-up were included. The postoperative VA and IOP were analyzed on day 1 and at 1 week, 4 weeks, 6 weeks, 3 months, and 6 months. The success of GDD was defined as complete success (IOP > 5 mmHg or <21 mmHg without topical antiglaucoma drug) or qualified success (IOP > 5 mmHg or <21 mmHg with up to 2 topical antiglaucoma drugs). Failure was defined as IOP < 5 mmHg or >21 mmHg with or without antiglaucoma medication; IOP < 21 mmHg with 3 or more topical medications or use of systemic medications irrespective of the IOP; loss of perception of light; and/or need for further glaucoma surgery. RESULTS: Nineteen eyes in group I (mean age = 40.16±16.36 years) and 38 eyes in group II (mean age = 56.61±19.35 years) were studied. The mean baseline IOP in group I and group II was not significantly different (28.63±11.21 vs. 30±14.61 mmHg, P = 0.72). Mean postoperative IOP at 6 months was not significantly different in the 2 groups (12.11±4.86 mmHg vs. 14.95±6.35 mmHg, P = 0.2). There was statistically significant fall in IOP at each visit compared to preoperative IOP in both the groups (P = 0.001), but there was no significant difference between the 2 groups at any time point (P > 0.05). At 6 months overall success rate was 84.21% in both groups (P = 1.00), though the complete success was slightly higher in group II, which was nonsignificant (31.58% vs. 39.47%, P = 0.56). There was no significant difference between baseline and final VA in either group. CONCLUSIONS: Both AADI and AGV are equally effective in controlling IOP in post-penetrating glaucoma. The AADI, being a cost-effective implant, may be more suitable for developing countries.

Glaucoma Secondary to Uveitis in Children in a Tertiary Care Referral Center.

Purpose: To study outcome of secondary glaucoma in pediatric uveitis patients. Methods: Retrospective analysis of records of uveitis patients ≤16 years. Results: Of 182 pediatric uveitis patients, secondary glaucoma was seen in 48 patients (75 eyes, 26.23%) with female preponderance (F:M-29:19) . JIA was the most common etiology (35.71%). BCVA of ≥20/40 was seen in 22 eyes at presentation and in 38 eyes at final follow up (p<0.001). Twenty eight children (66.67%) received systemic antiglaucoma therapy while 17 children (21 eyes) required surgery (60.71%). Logistic regression showed pseudophakia could predict the higher use of oral antiglaucoma medication (p=0.03) while anatomical site of involvement was predictive of higher chances of surgery (p=0.003). Overall success was seen in 82.10% and 71.64% using IOP limit of 21 and 18 mmHg respectively at mean follow-up of 3.9 years. Conclusion: Pediatric uveitic glaucoma though require multitude of therapies, can be managed effectively with appropriate therapy.