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JAYPEE JOURNALS
International Scientific Journals from Jaypee
 
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Journal of Current Glaucoma Practice
Current Issue : Volume 11, Issue 3, September-December 2017
 
 
1.  EDITORIAL
Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type IV?
Tanuj Dada
[Pages No:77-79]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1228 | FREE

ABSTRACT

Glaucoma is an acquired multifactorial progressive neurodegenerative syndrome with complex pathogenesis. It is characterized by accelerated retinal ganglion cell (RGC) apoptosis and leads to optic neuropathy with visual field defects, the intraocular pressure (IOP) being a major risk factor.

How to cite this ar ticle: Dada T. Is Glaucoma a Neurodegeneration caused by Central Insulin Resistance: Diabetes Type 4? J Curr Glaucoma Pract 2017;11(3):77-79.

Source of support: Nil

Conflict of interest: None

 
2.  ORIGINAL ARTICLE
Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study
Ghada I Gawdat, Maha M Youssef, Nermeen M Bahgat, Dina M Elfayoumi, Mohamed AS Eddin
[Pages No:80-85]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1229 | FREE

ABSTRACT

Aim: To study the incidence and risk factors of glaucoma occurring within 1 year following pediatric cataract surgery in Egyptian children.

Materials and methods: This is a prospective nonrandomized study conducted at Aburich Children’s Hospital, over a period of 1 year on a cohort of Egyptian patients with congenital and infantile cataract. One hundred and fifty eyes of 88 patients were enrolled in this study. All the patients underwent anterior approach removal of lens matter, whereas primary intraocular lens (IOL) implantation was carried at the age of 1 and 2 years for unilateral and bilateral cases respectively. Intraocular pressure (IOP) was measured at 1 week, 1 month, 3 months, 6 months, 9 months, and 1 year. For those who developed glaucoma, time of diagnosis and associated risk factors were reported.

Results: The incidence of glaucoma was 11.33% (17 of 150 eyes), while incidence of glaucoma suspect was 0.67% (1 of 150 eyes) in the first year following cataract surgery. The majority of the cases (66.7%) were discovered in the first 3 months postcataract surgery. Age at time of cataract surgery, the state of aphakia/pseudophakia, persistent fetal vasculature (PFV), and microphthalmia were not found to be significant predictors of early-onset glaucoma in our study.

Conclusion: Aphakic glaucoma continues to be a devastating condition with high incidence during first year following cataract surgery.

Clinical significance: Regular follow-up should start as early as possible following cataract surgery. Further prospective studies with larger study population are required.

Keywords: Aphakic glaucoma, Congenital cataract, Incidence, Prospective, Risk factors.

How to cite this article: Gawdat GI, Youssef MM, Bahgat NM, Elfayoumi DM, Eddin MAS. Incidence and Risk Factors of Early-onset Glaucoma following Pediatric Cataract Surgery in Egyptian Children: One-year Study. J Curr Glaucoma Pract 2017;11(3):80-85.

Source of support: Nil

Conflict of interest: None

 
3.  ORIGINAL ARTICLE
Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy
Tarannum Mansoori, Nagalla Balakrishna
[Pages No:86-91]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1230 | FREE

ABSTRACT

Aim: To evaluate the configuration of the anterior chamber angle quantitatively and study the morphological changes in the eye with ultrasound biomicroscopy (UBM) in primary angle closure glaucoma (PACG) patients after laser peripheral iridotomy (LPI).

Materials and methods: A total of 185 eyes of 185 PACG patients post-LPI and 126 eyes of 126 normal subjects were included in this prospective study. All subjects underwent complete ophthalmic evaluation, A-scan biometry, and UBM. The anterior segment and angle parameters were measured quantitatively and compared in both groups using Student’s t-test.

Results: The PACG patients had shorter axial length, shallower central anterior chamber depth anterior chamber depth (ACD), and anteriorly located lens when compared with normal subjects. Trabecular iris angle (TIA) was significantly narrow (5.73 ± 7.76°) in patients with PACG when compared with normal subjects (23.75 ± 9.38°). The angle opening distance at 500 μm from scleral spur (AOD 500), trabecular-ciliary process distance (TCPD), iris-ciliary process distance (ICPD), and iris-zonule distance (IZD) were significantly shorter in patients with PACG than in normal subjects (p < 0.0001). The iris lens angle (ILA), scleral-iris angle (SIA), and scleral-ciliary process angle (SCPA) were significantly narrower in patients with PACG than in normal subjects (p < 0.0001). The iris-lens contact distance (ILCD) was greater in PACG group than in normal (p = 0.001). Plateau iris was seen in 57/185 (30.8%) of the eyes. Anterior positioned ciliary processes were seen in 130/185 eyes (70.3%) of eyes.

Conclusion: In PACG patients, persistent apposition angle closure is common even after LPI, which could be due to anterior rotation of ciliary body and plateau iris and overcrowding of anterior segment due to shorter axial length and relative anterior lens position.

Keywords: Anterior chamber angle, A-scan biometry, Primary angle closure glaucoma, Ultrasound biomicroscopy.

How to cite this article: Mansoori T, Balakrishna N. Anterior Segment Morphology in Primary Angle Closure Glaucoma using Ultrasound Biomicroscopy. J Curr Glaucoma Pract 2017;11(3):86-91.

Source of support: Nil

Conflict of interest: None

 
4.  ORIGINAL ARTICLE
Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant
Ilya Sluch, Brett Gudgel, Justin Dvorak, Mary Anne Ahluwalia, Kai Ding, Steve Vold, Steven Sarkisian
[Pages No:92-96]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1231 | FREE

ABSTRACT

Aim: To evaluate the safety and efficacy of the M4 (porous polyethylene plate) Ahmed Glaucoma Valve (AGV) drainage implant in a multicenter retrospective study.

Materials and methods: A retrospective chart review of medical records of patients who had undergone the M4 Ahmed valve was performed from January 2013 to April 2015. The primary outcome measure was surgical failure defined as: Less than a 20% reduction in baseline intraocular pressure (IOP) to last follow-up visit, final IOP less than 5 mm Hg or greater than 18 mm Hg, reoperation for glaucoma, or loss of light perception vision. All eyes not meeting the above criteria were defined as success.

Results: A total of 291 eyes met all study inclusion criteria. The average follow-up in the study was 6 months (±7.6 months) with 112 patients achieving 12-month follow-up (38.5%). 208 eyes (71.5%) met the study success criteria at final follow-up. No statistically significant spikes in postoperative IOP at 1 and 4 months were detected. The average preoperative IOP was 26.0 on an average of 2.8 medications. At 6 months, the average IOP dropped to 16.7 on 0.9 medications and stayed relatively stable at 15.8 on 1.2 medications at 12-month follow-up.

Conclusion: The M4 valve appears to have less of a hypertensive phase compared with the other Ahmed class valves with a similar safety profile. While 71.5% success rate was achieved at final follow-up, the failure rate steadily increased over time.

Clinical significance: While the M4 production has been discontinued, the porous design of the M4 may avoid a pressure spike in the Ahmed valve class and warrants future investigation for valve design.

Keywords: Ahmed valve, Drainage device, M4.

How to cite this article: Sluch I, Gudgel B, Dvorak J, Ahluwalia MA, Ding K, Vold S, Sarkisian S. Clinical Experience with the M4 Ahmed Glaucoma Drainage Implant. J Curr Glaucoma Pract 2017;11(3):92-96.

Source of support: Nil

Conflict of interest: None

 
5.  ORIGINAL ARTICLE
Glaucoma Medication Preferences among Glaucoma Specialists in Mexico
Gabriel Lazcano-Gomez, Daniela Alvarez-Ascencio, Cindy Haro-Zuno, Mauricio Turati-Acosta, Magdalena Garcia-Huerta, Jesus Jimenez-Arroyo, Rafael Castañeda-Diez, Armando Castillejos-Chevez, Roberto Gonzalez-Salinas, Francisca Dominguez-Dueñas, Jesus Jimenez-Roman
[Pages No:97-100]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1232 | FREE

ABSTRACT

Aim: To determine the glaucoma specialists’ preferences for the different brands of topical glaucoma medications available in Mexico.

Materials and methods: A web-based survey was sent to 150 board-certified glaucoma specialists in Mexico, with 14 questions related to brand preferences for all glaucoma medications available in Mexico. Participants were asked to select each glaucoma medication class by brand and to state the factors leading to their choice.

Results: Data from 111 (74%) glaucoma specialists were collected. Imot (timolol 0.5%; Sophia, Mexico) was the preferred brand for the beta-blockers (BB) class by 71% (n = 79) of the participants. Azopt (brinzolamide 1%; Alcon Lab, US) was the preferred carbonic anhydrase inhibitor (CAI) by 54% (n = 60) of the glaucoma specialists. Lumigan (bimatoprost 0.01% and 0.03%; Allergan Inc., U.S.) was the first choice for the prostaglandin analogues (PGAs) in 62% (n = 70) of the answers. The most frequently prescribed alpha-agonist (AA) was Agglad (brimonidine 0.2%; Sophia Lab, Mexico) in 44% (n = 49) of the answers. Medication accessibility (31%), cost (29%), and recommended dose (23%) were the three main factors influencing the glaucoma specialists’ preferences.

Conclusion: Medication cost and accessibility, as well as posology, remain the main factors influencing brand preferences among glaucoma doctors. In our professional opinion, the therapeutic effect must be the leading factor when prescribing topical medications in the daily practice, so that patients receive the best treatment option.

Clinical significance: This survey provides an understanding of the decision-making process when prescribing glaucoma medications by glaucoma specialists in a Latin American developing country. Ideally, patient treatment should be individualized and aimed to achieve the best results possible for their specific condition.

Keywords: Brands, Generic, Glaucoma medications, Preferences, Survey.

How to cite this article: Lazcano-Gomez G, Alvarez-Ascencio D, Haro-Zuno C, Turati-Acosta M, Garcia-Huerta M, Jimenez- Arroyo J, Castañeda-Diez R, Castillejos-Chevez A, Gonzalez- Salinas R, Dominguez-Dueñas F, Jimenez-Roman J. Glaucoma Medication Preferences among Glaucoma Specialists in Mexico. J Curr Glaucoma Pract 2017;11(3):97-100.

Source of support: Nil

Conflict of interest: None

 
6.  ORIGINAL ARTICLE
Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study
Albert S Khouri, Grace Huang, Linda Y Huang
[Pages No:101-106]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1233 | FREE

ABSTRACT

Aim: To determine the safety and efficacy of intraoperative injection of mitomycin C (MMC) against conventional spongeapplied MMC during trabeculectomy.

Materials and methods: This study was aretrospective, comparative case series. Thirty eyes with primary open-angle glaucoma underwent consecutive trabeculectomies with MMC injection (injection group), and thirty eyes with sponge-applied MMC were as controls (sponge group). Data were collected preoperatively and postoperatively at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Demographic data, applanation intraocular pressure (IOP), best-corrected visual acuity (VA), number of glaucoma medications, postoperative interventions, postoperative complications, and number of visits within 3 months were recorded. In order to stratify data, proportion of eyes achieving >30% IOP reduction from baseline with or without glaucoma medications was calculated and defined as surgical success.

Results: Mean IOP reduction at 1 year was significant in both the injection and sponge groups from baseline (46.8 and 37.8% respectively). The injection group had overall lower postoperative IOP and comparable complete treatment success, defined as achieving >30% IOP reduction without glaucoma medications (p = 0.941). The number of postoperative visits within 3 months and the proportion of eyes needing 5-fluorouracil (5-FU) intervention were significantly lower in the injection group (p = 0.03, p = 0.04 respectively).

Conclusion: Injection of MMC was as safe and effective as sponge application with comparable estimated complete treatment success, less need for visits within 3 months, and 5-FU intervention.

Clinical significance: Surgeons may consider intraoperative injection of MMC in appropriate patient cohorts given comparable safety and efficacy and several advantages over traditional sponge application. Further study in a prospective, larger, long-term manner is necessary to assess this modality.

Keywords: Antimetabolite, Glaucoma filtration surgery, Mitomycin C, Subconjunctival injection, Trabeculectomy.

How to cite this article: Khouri AS, Huang G, Huang LY. Intraoperative Injection vs Sponge-applied Mitomycin C during Trabeculectomy: One-year Study. J Curr Glaucoma Pract 2017;11(3):101-106.

Source of support: Nil

Conflict of interest: None

 
7.  ORIGINAL ARTICLE
Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case–control Study
Georgios Bontzos, Michail Agiorgiotakis, Efstathios T Detorakis
[Pages No:107-112]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1234 | FREE

ABSTRACT

Aim: In this study, we reviewed demographics and biometric characteristics among patients receiving chronic β-blockers and prostaglandins (PGs) for primary open-angle glaucoma. We compared the age at the time of cataract surgery in different patient groups and in a control group which was not under any medication.

Materials and methods: Retrospective chart review of glaucomatous patients who underwent cataract extraction at the Department of Ophthalmology of the University Hospital of Heraklion, Crete, Greece, between January 1998 and December 2016 was done. Age at cataract surgery, axial length (AL), and preoperative and postoperative best-corrected visual acuities (BCVAs) were recorded. A cohort of patients without glaucoma who were operated for cataract extraction was also evaluated.

Results: In all, 320 patients were reviewed. There were significant results in mean age difference between the betaantagonist and the PG group [3.05 years, 95% confidence interval (CI) 1.54-4.57] and between the beta-antagonist group with the patients receiving a combined therapy (3.02 years, 95% CI 1.14-4.91). No significant difference was found between the PG and the combination group. All the three treated groups had a significant lower mean age than the control group at the time of cataract surgery.

Conclusion: Based on our study, we concluded that there might be a possible association between chronic treatment with beta-antagonist agents and earlier cataract surgical time in the treated eye.

Clinical significance: Intraocular pressure control is often usually achieved using ophthalmic agents. Their topical and systemic effects should be monitored precisely. Earlier cataract formation might be an important side effect which the physician has to keep in mind before choosing the suitable medication.

Keywords: Aqueous humor, Beta-antagonists, Cataract, Glaucoma, Prostaglandins.

How to cite this article: Bontzos G, Agiorgiotakis M, Detorakis ET. Long-term Follow-up of Patients receiving Intraocular Pressure-lowering Medications as Cataract Surgery Candidates: A Case-control Study. J Curr Glaucoma Pract 2017;11(3):107-112.

Source of support: Nil

Conflict of interest: None

 
8.  RESEARCH ARTICLE
Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study
Joobin Hooshmand, James CY Leong, Jeremy O’Connor, Ghee S Ang, Anthony P Wells
[Pages No:113-119]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1235 | FREE

ABSTRACT

Aim: To evaluate by anterior segment optical coherence tomography (AS-OCT) the medium-term (mean duration 3.2 years) anatomical changes in the anterior chamber angle (ACA) after laser peripheral iridoplasty.

Materials and methods: This is a longitudinal, retrospective case series of 31 eyes of 31 patients with primary angle-closure suspicion, primary angle closure (PAC), or primary angleclosure glaucoma (PACG) who underwent laser peripheral iridoplasty. All patients had persistent iridotrabecular contact (ITC) despite the presence of a patent peripheral iridotomy (PI). An AS-OCT was performed in dark conditions before and after laser iridoplasty. Quadrants of ITC, intraocular pressure (IOP), and the AS-OCT parameters of the temporal and nasal ACAs were measured and analyzed.

Results: Prior to iridoplasty, the average number of quadrants of ITC was 3.3. At the first postiridoplasty visit (mean duration 6.8 weeks), this reduced to 1.7 quadrants but increased to 1.9 by the final follow-up visit (mean duration 3.2 years). Twentyfive patients (80.1%) had less ITC at the first postlaser visit increasing to 27 (87.1%) patients by the final visit. Two (6.5%) required a second iridoplasty, while 3 (9.7%) required cataract surgery. All parameters of angle width showed a statistically significant increase in magnitude. All patients maintained IOP ≤ 21 mm Hg throughout the follow-up period.

Conclusion: Iridoplasty is a useful adjunct in widening the ACA, particularly in those with persistent angle closure after iridotomy but with no cataract. While not successful in all patients, it can act as a temporizing measure to widen the drainage angle until such time that cataract surgery can be performed.

Clinical significance: Laser peripheral iridoplasty can be used as an adjunct in angle-closure glaucoma patients with no cataract.

Keywords: Iridoplasty, Longitudinal, Optical coherence tomography, Primary angle-closure glaucoma.

How to cite this article: Hooshmand J, Leong JCY, O’Connor J, Ang GS, Wells AP. Medium-term Anatomical Results of Laser Peripheral Iridoplasty: An Anterior Segment Optical Coherence Tomography Study. J Curr Glaucoma Pract 2017;11(3):113-119.

Source of support: Capital Vision Research Trust, Wellington, New Zealand.

Conflict of interest: None

 
9.  CASE REPORT
Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands
David Fleischman, Bryan Kim
[Pages No:120-124]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1236 | FREE

ABSTRACT

Surgical management of elevated intraocular pressure (IOP) in an eye with scarred conjunctiva, an encircling band, and silicone oil has limited options. By combining the flow restrictor of the Ahmed Glaucoma Valve (New World Medical, Rancho Cucamonga, California) and the capsule of the encircling band as a conduit for aqueous flow, immediate pressure reduction could theoretically be achieved in eyes with limited conjunctival mobilization. This is a description of a surgical technique in a case of a patient with multiple ocular surgeries with uncontrolled multimechanism glaucoma despite using all available topical and oral glaucoma medications. A combination of the Ahmed valve with a modification of the Schocket shunt technique was used in this case of an encircling band and poor conjunctiva. At 10-month follow-up, the patient maintains controlled pressures on dorzolamide-timolol drops. The combined Ahmed- Schocket (or Schockmed) technique may be another surgical option for management of uncontrolled IOP in cases of scarred conjunctiva and encircling bands needing immediate pressure reduction.

Keywords: Ahmed valve, Encircling band, Glaucoma surgery, Schocket, Scleral buckle. Schockmed valve A novel surgical option for uncontrolled glaucoma in eyes with poor conjunctiva and encircling bands.

How to cite this article: Fleischman D, Kim B. Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands. J Curr Glaucoma Pract 2017;11(3):120-124.

Source of support: Nil

Conflict of interest: None

 
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