Outcomes of iStent versus endocyclophotocoagulation (ECP) as adjunct to cataract surgery by phacoemulsification for glaucoma patients.

PURPOSE: To compare the efficacy and safety of iStent versus Endocyclophotocoagulation (ECP) as an adjunct to cataract surgery by Phacoemulsification for treating glaucoma patients in a tertiary eye center. METHODS: Retrospective study of 67 eyes of 61 patients with glaucoma and cataract who underwent either phaco-ECP or phaco-iStent. Primary efficacy endpoint is the Intraocular pressure (IOP) reduction, while reduction of glaucoma medications is the secondary outcome. In addition to IOP and number of glaucoma medications; visual acuity, degree of disc cupping, safety profiles were all assessed at different intervals up to 12 months. RESULTS: A total of 40 eyes underwent phaco-ECP, and 27 eyes underwent phaco-iStent. Both groups were associated with a significant reduction in the number of glaucoma medications; however phaco-iStent group achieved slightly lower IOP levels than the phaco-ECP group. Furthermore, iStent inject had better control of IOP at the last follow-up compared to first-generation stents. Moreover; 2 or more stents significantly reduced IOP than single stent (p = 0.009 vs. p = 0.618, respectively). Phaco-iStent achieved a better reduction in the number of glaucoma medications for primary open-angle glaucoma (p = 0.007) compared to pseudoexfoliation glaucoma patients (p = 0.084). Complications were seen in 12 eyes (18%), of which five eyes in phaco-ECP (7.4%) and 7 eyes in phaco-iStent (10.4%), majority were mild and treated conservatively. CONCLUSIONS: Both groups had equal efficacy in reducing the IOP. However, phaco-iStent seems superior in reducing the number of glaucoma medications after 1 year of follow-up compared to phaco-ECP, particularly when 2 or more stents are used. Both groups showed an overall good safety profile.

Effect of Trabeculodescemetic Window Perforation in Deep Sclerectomy on Intraocular Pressure in Primary Congenital Glaucoma.

INTRODUCTION: Primary congenital glaucoma causes vision loss if intraocular pressure is uncontrolled. Nonpenetrating deep sclerectomy is effective in treating primary congenital glaucoma. However, the effects of inadvertent trabeculodescemetic window perforation remain unclear. METHODS: This retrospective cohort study included patients with primary congenital glaucoma who underwent nonpenetrating deep sclerectomy between 2014 and 2021. The perforation group had intraoperative trabeculodescemetic window perforations; the non-perforation group did not. The primary outcome was intraocular pressure between the groups over 15 months. The secondary outcomes included surgical success and complications. RESULTS: The study included 74 eyes of 44 patients. The cohort comprised 31 perforated and 43 non-perforated eyes. Both groups showed significant intraocular pressure reduction without significant between-group differences in complete (68 vs. 77%), qualified (19 vs. 9%), or failed (13 vs. 14%) treatments. The median intraocular pressure decreased from 39 to 14 mmHg in the perforation group and 35 to 12 mmHg in the non-perforation group. Of the 74 treated eyes, 68 (92%) showed no complications. CONCLUSIONS: An inadvertent trabeculodescemetic window perforation during nonpenetrating deep sclerectomy for primary congenital glaucoma did not significantly affect intraocular pressure outcomes compared to non-perforated cases over 15 months. Nonpenetrating deep sclerectomy reduced intraocular pressure regardless of intraoperative perforation in patients with primary congenital glaucoma. Perforation of the trabeculodescemetic window was associated with a low incidence of postoperative complications.

Uncommon Complication Post-deep Sclerectomy: Giant Retinal Tear.

Glaucoma is a prevalent neurodegenerative disease. It causes progressive visual loss and is one of the most common causes of blindness worldwide. It can be categorized into open-angle or closed-angle glaucoma. Primary congenital glaucoma (PCG) is a subdivision of open-angle glaucoma. Non-penetrating deep sclerectomy (NPDS) is a surgical method for managing open-angle and primary congenital glaucoma, which was first introduced in 1990. During NPDS, a sclera flap is raised but not completely removed, and the outer part of Schlemm's canal and trabecular meshwork, along with the juxtacanalicular tissue, are excised without completely penetrating the eye. Therefore, it is considered a safe and efficient option for controlling intraocular pressure. This report shows a unique case of uncommon complication post-deep sclerectomy, a giant retinal tear, after undergoing non-penetrating deep sclerectomy for primary congenital glaucoma.

The outcomes of trans-scleral cyclophotocoagulation in pediatric glaucoma secondary to Sturge-Weber syndrome.

PURPOSE: To report the outcomes of trans-scleral cyclophotocoagulation (TSCPC) in pediatric glaucoma secondary to Sturge-Weber syndrome (SWS). METHODS: The medical records of all SWS glaucoma cases in the pediatric age group (<18 years of age) that underwent TSCPC at our institute from January 2000 to September 2017. RESULTS: A total of 22 eyes of 22 patients were included. Mean age at the time of TSCPC was 5.9 ± 5 years (range, 0-16 years). Mean postoperative follow-up was 32.2 ± 16.6 months (range, 6-54 months). Intraocular pressure (IOP) was reduced from a preoperative mean of 28 ± 4.5 mm Hg to 20.3 ± 3.7 mm Hg at 36 months (P = 0.02). The mean number of glaucoma medications used was 3.5 ± 0.7 preoperatively and 3.1 ± 1.4 at 36 months (P = 0.70). The overall success rate (complete and qualified) was 72.7% at 12 months, 62.3% at 24 months, and 54.5% at 36 months. One eye developed hypotony and choroidal effusion, which resolved with medical therapy. Of the patients for whom visual acuity was recorded preoperatively, no one experienced a loss of more than 2 lines of Snellen visual acuity. CONCLUSIONS: In our study cohort, TSCPC resulted in mild reduction in IOP, with minimal complications.

Tube Revision Outcomes for Exposure with Different Repair Techniques.

PURPOSE: The aim of this study was to report our experience with eyes that presented with an initial GDD exposure and their subsequent outcome in terms of re-exposure. METHODS: A retrospective review of charts of 42 patients (43 eyes) who presented with a GDD exposure during the period 2008-2015 in a tertiary eye care center was performed. Demographic data, past ocular history, pre-operative and post-operative information including the surgical technique of GDD surgery and exposure repair were recorded. The patients were followed for further exposure to the date of the last follow-up clinic visit. For each type of repair technique, details were collected on risk and timing of GDD exposure. The baseline features of eyes that had further exposure after initial exposure were compared to eyes without further exposure. RESULTS: Forty-three eyes were identified which had repair after an initial exposure. The mean ± SD age was 54 ± 27 years. Of the GDDs, Ahmed FP7 was performed in 31 eyes, Ahmed FP8 in two eyes, Ahmed S2 in five eyes, Krupin valve in two eyes and Baerveldt 350 GDD in three eyes. The methods of repair and the relative risk [95% CI] of re-exposure were: conjunctival closure only (n=4; RR=2.10 [0.84-5.23]); repair with patch graft and conjunctival repair (n=18), RR=1.24 [0.51-3.01]; tube repositioning, use of patch graft and conjunctival repair (n=14), RR=1.0; tube removal with replacement in a different quadrant, patch graft and conjunctival repair (n=3), RR=1.87 [0.64-5.48]. After the first exposure, 18 eyes had a second re-exposure, four eyes had a third re-exposure, and 1 eye had a fourth exposure. CONCLUSIONS: The GDD exposure rates at our institution are consistent with other reports. Lack of a patch graft for repair is associated with a two-fold risk of subsequent re-exposure.

Optical Coherence Tomography in Children With Microtropia.

PURPOSE: To assess whether optical coherence tomography (OCT) could be useful for detecting and documenting fixation in patients with microtropia. METHODS: Retinal fixation observation was performed using spectral-domain OCT on amblyopic children with microtropia. The position between the retinal fixation point and the anatomical fovea was measured, in microns, using the system software tools. Only patients with a high level of cooperation, OCT scan quality signal of 7 or better, and visual acuity of 0.70 logarithm of the minimum angle of resolution (logMAR) or worse in the amblyopic eye were included. RESULTS: A total of 25 patients were included: 15 with microtropia (study group) and 10 without tropia and with foveal fixation and stereopsis (control group). In the study group, microtropia was previously diagnosed in 67% of cases through the cover test, and was predominantly in the left eye (73%). The average visual acuity of the sound eye was 0.03 decimal and 0.18 logMAR in the amblyopic eye. The microtropia was 3.73 ± 3.34 prism diopters and eccentric fixation (387 ± 199 µm) with OCT was observed in all cases except one. Eccentricity was predominantly in the superonasal quadrant (57%). Both eyes in the control group and the contralateral eyes of the study group showed foveal fixation. CONCLUSIONS: OCT can play an important role in the diagnosis and measurement of eccentric fixation in eyes with microtropia, providing high sensitivity. [J Pediatr Ophthalmol Strabismus. 2018;55(3):171-177.].

Patient persistence with first-line antiglaucomatous monotherapy.

PURPOSE: To identify the extent of persistence (period of time of continuous therapy with the drug prescribed) of glaucoma patients treated with prostaglandins (latanoprost, bimatoprost, or travoprost), or beta-blocker (timolol) monotherapy. METHODS: An observational retrospective study of a 24-month follow-up in 191 patients (from four centers) was done to identify the time elapsed until patients discontinued their antiglaucomatous treatment. The relevant information was extracted from patients' medical charts. A descriptive analysis, a Kaplan-Meier survival analysis, and a Cox regression model were used to determine which drug was associated with greater patient persistence and to detect variables significantly influencing persistence. RESULTS: Descriptive analysis and survival curves showed that after 24 months, latanoprost was associated with a higher persistence in glaucoma treatment than the alternative agents: 81.6% versus 22.9% for bimatoprost, 65.4% for travoprost, and 60.5% for timolol (P < 0.0001). Persistence was significantly influenced by the antiglaucoma agent used as monotherapy (with a six-fold higher risk of treatment discontinuation during the follow-up period due to receiving bimatoprost instead of latanoprost; P < 0.0001) and patient age (P = 0.001). Even though comorbidities could not be directly related to persistence, their occurrence was related to patient age. The main reasons for treatment discontinuation were lack of efficacy, development of intolerance and/or adverse events, which were significant in the bimatoprost group, 28.6% (P < 0.001) and 48.6% (P < 0.001), respectively. CONCLUSIONS: Latanoprost shows higher patient persistence compared with travoprost, bimatoprost, and timolol in routine clinical practice, and could lead to better control of intraocular pressure and lower associated economic costs.

Disminución progresiva de agudeza visual en paciente usuario de drogas por vía parenteral / The progressive decrease of visual acuity in patiens who are administered drugs parenterally

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Anestesia parabulbar en procedimientos quirúrgicos oftalmológicos / Parabulbar anesthesia in opthalmologic surgical procedings

La finalidad de este ensayo de la anestesia parabulbar "Flush" utilizando para tomar vías periféricas; de calibre 20 G a través de una incisión en conjuntiva Tenon. Se utilizarón 46 ojos de 44 pacientes con diagnósticos Cataratas (35 ojos) 76 por ciento, glaucoma (5 ojos) 11 por ciento, pterigiones (5 ojos) 11 por ciento y 1 ojo (2,17 por ciento carcinoma epidermoide de conjuntiva. Los procedimientos fueron: EECC, más lente intraocular 73 por ciento (34 ojos), Facoemulsificación (1 ojo) 2,17 por ciento, Cirugía filtrante (4 ojos) 8,69 por ciento, Implante de válvula de Ahmed (1 ojo) 2,17 por ciento, transplante libre de conjuntiva (3 ojos) 6,52 por ciento, Esclera desnuda (2 ojos) 4,34 por ciento y extirpación de tumor de conjuntiva 2,17 por ciento. Al comparar los parámetros como analgesia, aquinesia, blefaroespasmo y quemosis en cada uno de los diagnósticos tomando la diferencia de los porcentajes de muestra independientes se observó que la diferencia de la calidad de analgesia fue buena en 2/3 partes de la muestra siendo estadísticamente significativa mientras que los otros para parámetros no lo fué. Consideramos que es un excelente procedimiento solo o en combinación por lo sencillo de administrar y económico pero requiere experiencia por parte del cirujano por la aquinesia, quemosis, y blefaroespasmo impredecible