Prevalent practice patterns in glaucoma: Poll of Indian ophthalmologists at a national conference.

PURPOSE: The aim of this study is to explore and compare the prevailing practice patterns in the diagnosis and management of glaucoma among subspecialists and general ophthalmologists in India. MATERIALS AND METHODS: This is an interactive audience response system (ARS) based poll of ophthalmologists attending the annual conference of the Glaucoma Society of India in 2013. RESULTS: The information was obtained from 379 ophthalmologists (146 glaucoma specialists, 54 nonglaucoma subspecialists, and 179 general ophthalmologists). The majority of polled ophthalmologists (236; 62%) had 10 or more years of experience in ophthalmology. The glaucoma specialists differed from nonglaucomatologists in their preference for Goldmann applanation tonometer (P < 0.01), four-mirror gonioscope (P < 0.01), Humphrey perimeter (P < 0.01), laser peripheral iridotomy in primary angle closure disease (P = 0.03), postiridotomy gonioscopy (P < 0.01), and usage of antifibrotic agents during filtering surgery (P < 0.01). Optical coherence tomography was the most preferred imaging modality and was utilized more often by the subspecialists than general ophthalmologists. The ophthalmologists also differed in their choice of antiglaucoma medications. More glaucoma specialists were performing surgery on children with congenital glaucoma (P < 0.01), implanting glaucoma drainage devices (P < 0.01), and using scientific journals to upgrade knowledge (P = 0.03) than the other ophthalmologists. CONCLUSIONS: This poll is the first of its kind in India, in its usage of the ARS, and in comparing the practice patterns of care for glaucoma among subspecialists and general ophthalmologists. It has revealed substantial diversity in a few areas among those who did and did not receive specialty training in glaucoma.

Recurrence of aqueous misdirection following pars plana vitrectomy in pseudophakic eyes.

We present a retrospective interventional case series of four patients with pseudophakic eye who developed recurrent aqueous misdirection following pars plana vitrectomy (PPV) for malignant glaucoma (MG). The patients were treated with neodymium: YAG (Yttrium Aluminum Garnet) laser hyaloidotomy/membranotomy through the patent peripheral iridectomy. The main outcome measure was resolution of MG. The intervention resulted in resolution of MG in all four cases. The cause for recurrence was an inflammatory membrane covering the hyaloidotomy opening in three eyes and the haptic of intraocular lens blocking the hyaloidotomy opening in one eye. Recurrence of aqueous misdirection even after vitrectomy may be related to obstruction of aqueous flow through the communication created, either by intraocular lens or fibrin. Treatment of this condition involves restoring aqueous flow to the anterior chamber from the anterior vitreous by treating the cause, and most often the YAG laser hyaloidotomy/membranotomy is successful in relieving the condition.

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.

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.

Variability in the calibration error of the goldmann applanation tonometer.

PURPOSE: To investigate the variability in the measured calibration error with continued usage of Goldmann applanation tonometers (GATs) having unacceptable calibration error. METHODS: The study included 132 slit-lamp mounted Goldmann tonometers (Model AT 900 C/M; Haag-Streit, Switzerland). A single observer twice checked a randomly selected set of 25 instruments on 2 consecutive days to determine the intraobserver agreement in the measurement of GAT calibration error. The same observer prospectively checked all the instruments between 8 and 9 AM on any given day at all testing levels namely 0, 20, and 60 mm Hg and rechecked the faulty instruments (calibration error more than ± 2 mm Hg at any testing level) 2 times more on the same day between 12 noon and 1 PM and 4 and 5 PM. RESULTS: The single measures intraclass correlation coefficients for the intraobserver agreement at the 20 mm Hg testing level were 0.78 for positive error and 0.83 for negative error. Twenty-eight (21%) instruments were faulty at any testing level. Nineteen (14%) were faulty at the clinically most important 20 mm Hg testing level. The maximum observed variability in the positive and negative calibration error at any testing level was +4 and -23 mm Hg, respectively. Fifteen (53%) faulty instruments had high variability (≥ 2 mm Hg) in the calibration error at any testing level. CONCLUSIONS: The calibration error of faulty GATs can frequently have a high variability. One should avoid estimating the true intraocular pressure from a faulty GAT by instinct.