Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy.

PURPOSE: This study reports on the combination of excisional goniotomy and cataract extraction in the management of glaucoma in terms of intraocular pressure (IOP) and glaucoma medication reduction. METHODS: This is a retrospective case series. Twenty-eight eyes of 22 patients with the diagnosis of cataract and ocular hypertension or glaucoma of any stage underwent combined phacoemulsification and Kahook Dual Blade (KDB) goniotomy, between March 2019 and September 2020. The parameters evaluated were postoperative best-corrected visual acuity, mean IOP reduction, number of IOP-lowering medications, and the surgical success rate defined as IOP reduction >20% and/or reduction in glaucoma medications >1. RESULTS: The mean IOP reduction at 6 months was 4.5 mmHg (P = 0.0007), which translates to 24.9% reduction from preoperative IOP. The mean preoperative number of glaucoma medications was 2.9 ± 1.0 (median of 3). It was reduced to 1.1 ± 1.1 (median of 1.5), 1.46 ± 1.17 (median of 2), 1.44 ± 1.28 (median of 2), and 1.56 ± 1.28 (median of 2) at 1 week, 1 month, 3 months, and 6 months, respectively. Twenty-nine percent (8/28) of the patients were off glaucoma medications at 6 months and 46% (13/28) had a reduction of more than 50% of their glaucoma medications. CONCLUSION: Combined phacoemulsification-KDB excisional goniotomy may be an effective and safe alternative to more invasive filtering surgery in glaucoma patients of any stage.

Micropulse Transscleral Cyclophotocoagulation.

How to cite this article: Abdelmassih Y, Tomey K, Khoueir Z. Micropulse Transscleral Cyclophotocoagulation. J Curr Glaucoma Pract 2021;15(1):1-7.

Spontaneous Trabeculectomy Bleb Reformation and Regain of Function Following Phacoemulsification.

Phacoemulsification and cataract surgery in general often lead to trabeculectomy bleb failure. We herein describe an unusual occurrence in a 79-year-old female who had a failed trabeculectomy bleb for one year prior to presentation, and whose failed bleb became reformed, and she regained function on the first day post-phacoemulsification, manifesting as a decrease in intraocular pressure. Topical corticosteroids were used for one month postoperatively and the bleb remained functional over more than six months of follow-up. It is most likely that the intraocular pressure elevation that occurs during phacoemulsification was responsible for the reformation of the bleb, even after having been a failed bleb for a whole year.

Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial.

AIM AND OBJECTIVE: Evaluate the short-term safety and efficacy of dexmedetomidine (0.0055%) drops on intraocular pressure (IOP) in healthy eyes. MATERIALS AND METHODS: In this randomized controlled trial, patients with normal eye exams were randomly assigned to receive, in a randomly selected eye, one drop of either balanced salt solution (BSS) or dexmedetomidine (0.0055%). Goldmann applanation tonometry was performed at baseline and then 30 minutes, 4 hours, and 24 hours after drop instillation. RESULTS: Forty-nine eyes of 49 normal volunteers were enrolled in the study, with 21 eyes (group I) receiving BSS and 28 (group II) dexmedetomidine. Both groups were comparable at baseline as far as age and IOP (p = 0.55 for both parameters). Intraocular pressure significantly decreased from baseline in group II at 30 minutes and 4 hours (p = 0.001 and 0.05, respectively). Maximum IOP decrease was obtained at 30 minutes after dexmedetomidine instillation, with a 9% decrease from baseline (mean decrease: 1.15 mm Hg). The percentage of IOP decrease was significantly higher in group II at 30 minutes compared with group I (9 vs 1.1%; p = 0.05). No side effects were recorded. CONCLUSION: In this pilot study, dexmedetomidine 0.0055% drops have shown good safety and efficacy in lowering IOP in normal healthy volunteers with no history of glaucoma. This medication has a short onset of action, with a 10% reduction of IOP occurring 30 minutes post-instillation. TRIAL REGISTRATION NUMBER: NCT03690622. HOW TO CITE THIS ARTICLE: Fakhoury H, Abdelmassih Y, El-Khoury S, et al. The Effect of Topical Dexmedetomidine (0.0055%) on Intraocular Pressure in Healthy Eyes: A Randomized Controlled Trial. J Curr Glaucoma Pract 2021;15(2):58-63.

Outcomes of Micropulse Transscleral Cyclophotocoagulation in Uncontrolled Glaucoma Patients.

PURPOSE: This study aimed at evaluating the intermediate-term efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in cases of uncontrolled glaucoma. METHODS: Patients with moderate to advanced glaucoma and uncontrolled intraocular pressure (IOP) despite maximally tolerable antiglaucoma medications were selected to undergo MP-TSCPC using the MP3 handpiece with the Iridex Cyclo G6 (IRIDEX Laser Systems). Follow-up examinations took place on a regular basis until 15 months postoperatively. RESULTS: Seventy-five eyes of 69 patients (53.6% male patients) were included. Mean age was 55.5±22.9 years. Primary open-angle glaucoma was the most common diagnosis. Corrected distance visual acuity at baseline ranged between 0 and 2.1 logMAR. Mean prelaser IOP was 26.0±7.91 mm Hg. This was reduced significantly to 13.8±5.6 mm Hg (44.0% reduction, P<0.001) at week 1, and to 18.0±7.7, 18.4±7.1, 16.7±6.2, 15.1±4.1, 15.7±5.32, and 14.8±5.50 mm Hg at months 1, 3, 6, 9, 12, and 15, respectively. The mean number of antiglaucoma drops decreased significantly up to 12 months of follow-up (P=0.008) and that of oral acetazolamide tablets decreased significantly up to 15 months (P<0.001). The success rate decreased progressively with time, reaching 81.4% at 6 months and 73.3% at 1 year. No major postoperative complications were encountered, and no eye lost vision completely. CONCLUSIONS: MP-TSCPC is an efficient noninvasive glaucoma treatment that achieves sustained IOP reduction and reduced need for ocular antihypertensive medications for up to 15 months. The optimal laser parameters to achieve the best success rate with the least side effects still need to be determined.

Acute Angle-closure Glaucoma as a First Presentation of Coats' Disease: A Case Report.

PURPOSE: The purpose of this study was to report an unusual first manifestation of Coats' disease presenting as an acute angle-closure glaucoma attack in an adult patient. PATIENTS AND METHODS: A 37-year-old African woman presented to the emergency department with severe headache, ocular pain, and no light perception in the left eye. The left pupil was middilated and nonreactive, and the intraocular pressure (IOP) by applanation tonometry was 47 mm Hg. Slit-lamp examination revealed anterior subcapsular opacification (glaukomflecken), posterior synechiae, and total angle closure with iris bombé. A fundus examination revealed macular exudation, inferior vascular dilation, and tortuosity with peripheral telangiectasia and macroaneurysms, in addition to partial exudative retinal detachment involving the macula. On the basis of these findings, Coats' disease was diagnosed. RESULTS: The patient was treated with antiglaucoma medications and laser peripheral iridotomy to control the IOP, which had decreased to 21 mm Hg the following day. Diode laser transscleral cyclophotocoagulation was performed to further decrease the IOP. After completing a 360 degree laser, the IOP decreased to 8 mm Hg and then stabilized around 12 mm Hg. The vision remained no light perception; however, the patient felt major symptomatic relief. CONCLUSIONS: The present case describes acute angle-closure glaucoma as an initial presentation of Coats' disease in adults. Clinicians should be aware that this unique presentation in Coats' disease can occur even without retinal detachment.

Spontaneous simultaneous bilateral malignant glaucoma of a patient with no antecedent history of medical or surgical eye diseases.

PURPOSE: Malignant glaucoma, or aqueous misdirection syndrome, is a condition characterized by sudden intraocular pressure (IOP) elevation, and it is usually unilateral and induced by ocular surgical intervention or by medical therapy. Here, we report a case of simultaneous bilateral malignant glaucoma in a young patient with no history of any ocular diseases. CASE REPORT: A case of a 24-year-old female with no apparent previous history of ocular medical or surgical conditions was referred to our hospital because of recent bilateral IOP elevation associated with a severe drop in vision and shallow anterior chamber with no posterior segment anomalies detected by ocular ultrasound in both eyes. Yttrium aluminum garnet (YAG) laser iridotomy dropped the IOP only temporarily and the patient received topical atropine treatment with combined trabeculectomy and anterior vitrectomy. RESULTS: In this case, the patient had a typical presentation of bilateral malignant glaucoma and her IOP dropped only temporarily following laser iridotomy to rise again shortly thereafter. Also, deepening of the anterior chamber and IOP decrease after topical atropine was very supportive of the diagnosis of malignant glaucoma. Successful management with trabeculectomy and limited vitrectomy also affirmed the diagnosis of malignant glaucoma. CONCLUSION: This is a very rare case of bilateral malignant glaucoma in a young adult without any prior eye conditions; only one similar case has been reported in the literature. We propose our own theory regarding this simultaneous occurrence of the pathology based on previously published studies about the presence of communication between the two eyes along the cerebrospinal fluid pathways.