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JAYPEE JOURNALS
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1.  ORIGINAL REASEARCH
Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia
Divya Singh, Sanjay K Mishra, Esha Agarwal, Reetika Sharma, Shibal Bhartiya, Tanuj Dada
[Year:2017] [Month:May-August] [Volume:11 ] [Number:2] [Pages:40] [Pages No:52-57] [No of Hits : 671]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10028-1223 | FREE

ABSTRACT

Introduction: To evaluate the relationship between retinal nerve fiber layer (RNFL) thickness measured by Cirrus highdefinition (HD) optical coherence tomography (OCT) and the axial length and refractive error of the eye.

Materials and methods: A total of 100 eyes of 100 healthy subjects (age 20-34 years with M/F ratio of 57/43), comprising 50 eyes with emmetropia [spherical equivalent (SE) 0 D], 25 eyes with moderate myopia (SE between -4 D and -8 D), and 25 eyes with high myopia (SE between -8 D and -12 D) were analyzed in this cross-sectional study. Average and mean clock hour RNFL thicknesses were measured by cirrus HD-OCT and compared between the three groups. Associations between RNFL measurements and axial length and SE were evaluated by linear regression analysis.

Results: The average RNFL measurements were significantly lower in high myopia (78.68 +/- 5.67) and moderate myopia (83.76 +/- 3.44) group compared with emmetropia group (91.26 +/- 2.99), also in the superior and inferior mean clock hours. Significant correlations were evident between RNFL measurements and the SE and axial length. The average RNFL thickness decreased with increasing axial length (r = -0.8115) and negative refractive power (r = 0.8397). Myopia also affected the RNFL thickness distribution. As the axial length increased and the SE decreased, the thickness of the superior, inferior, and nasal peripapillary RNFL decreased.

Conclusion: The axial length/refractive error of the eye affected the average RNFL thickness and the RNFL thickness distribution. Analysis of RNFL thickness in the evaluation of glaucoma should always be interpreted with reference to the refractive status. When interpreting the RNFL thickness of highly myopic patients by OCT, careful attention must be given to the inherently thinner RNFL to avoid a false diagnosis of glaucoma.

Keywords: Emmetropia, Retinal Ner ve Fiber Layer, Spearman’s rho.

How to cite this article: Singh D , Mishra S K, Agarwal E, Sharma R, Bhartiya S, Dada T. Assessment of Retinal Nerve Fiber Layer Changes by Cirrus High-definition Optical Coherence Tomography in Myopia. J Curr Glaucoma Pract 2017;11(2):52-57.

Source of support: Nil

Conflict of interest: None

 
2.  INVITED EDITORIAL
Relationship between Glaucoma Drainage Device Size and Intraocular Pressure Control: Does Size Matter?
Cooper D Rodgers, Alissa M Meyer, Mark B Sherwood
[Year:2017] [Month:January-April] [Volume:11 ] [Number:1] [Pages:34] [Pages No:1-2] [No of Hits : 590]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1212 | FREE

ABSTRACT

There is ambiguity in the literature regarding whether a larger glaucoma drainage device (GDD) achieves a lower long-term intraocular pressure (IOP). There is some evidence on both sides, but overall there seems to be an optimal surface area of approximately 200–250 mm2 beyond which there may be little advantage to increasing the plate size for most patients.

Keywords: Baerveldt, Glaucoma, Glaucoma drainage device, Intraocular pressure, Molteno, Retrospective study, Visual acuity.

How to cite this article: Rodgers CD, Meyer AM, Sherwood MB. Relationship between Glaucoma Drainage Device Size and Intraocular Pressure Control: Does Size Matter? J Curr Glaucoma Pract 2017;11(1):1-2.

Source of support: Nil

Conflict of interest: None

 
3.  RESEARCH ARTICLE
A New Provocative Test for Glaucoma
Fabio N Kanadani, TCA Moreira, LF Campos, MP Vianello, J Corradi, SK Dorairaj, ALA Freitas, R Ritch
[Year:2016] [Month:January-April] [Volume:10 ] [Number:1] [Pages:37] [Pages No:1-3] [No of Hits : 1109]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1194 | FREE

ABSTRACT

Purpose: To compare the effects of the water-drinking test (WDT) with the 30° inverted body position test on intraocular pressure (IOP) in normal patients, suspected glaucoma patients and glaucoma patients.

Materials and methods: Based on clinical evaluation of the optic disk, IOP, and standard achromatic perimetry (SAP) of 71 eyes, 18 were “normal” (normal SAP and optic disk evaluation, and IOP < 21 mm Hg), 30 were “glaucoma suspect” (GS; normal SAP, cup/disk (C/D) ratio > 0.5 or asymmetry > 0.2 and/or ocular hypertension), and 31 had “early glaucoma” (MD < -6 dB, glaucomatous optic neuropathy). Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Patients fasted before the WDT, and four measurements were performed at basal, 15´, 30, and 45´ after drinking 1 liter of water (WDT) in 5 minutes. In the 30° inverted position, IOP measurement with Perkins applanation tonometer was taken after 5 minutes lying down.

Results: There was a statistical difference in all groups between the basal IOP and peak IOP during the WDT (p < 0.001) and in the inverted position IOP (p < 0.001). Controls (p = 0.50), suspects (p = 0.41) and glaucoma patients (p = 1.0) did not exhibit a difference between WDT-IOP and inverted position IOP.

Conclusion: The 30° inverted position test was as efficient as WDT in detecting peak IOP. This new provocative test is easier, faster and more comfortable for both patients and doctors.

Keywords: Glaucoma, Provocative test, Water drinking test.

How to cite this article: Kanadani FN, Moreira TCA, Campos LF, Vianello MP, Corradi J, Dorairaj SK, Freitas ALA, Ritch R. A New Provocative Test for Glaucoma. J Curr Glaucoma Pract 2016;10(1): 1-3.

Source of support: Nil

Conflict of interest: None

 
4.  EDITORIAL
The Business of Glaucoma Surgery and the Era of Mega-interest
Tarek Shaarawy
[Year:2016] [Month:May-August] [Volume:10 ] [Number:2] [Pages:40] [Pages No:iv] [No of Hits : 920]
Full Text PDF | Abstract | FREE

ABSTRACT

The Business of Glaucoma Surgery and the Era of Mega-interest

For decades, glaucoma therapy innovations have been a strategic goal for many pharmaceutical industry giants. A chronic disease that spans a lifetime, with most patients destined to eye drops applied on a daily basis, glaucoma was and still is a disease from which profits can be made. Glaucoma surgery, on the contrary, was but a small part of this immense business, estimated to be in the range of 5% of the whole glaucoma diagnosis and treatment market. To this day, trabeculectomy remains the gold standard procedure for surgical management of glaucoma. A procedure that requires only a few instruments, wherein one corner of a shaving blade mounted on a razor fragment holder can still be the only knife needed.

 
5.  REVIEW ARTICLE
Preoperative Preparation and Anesthesia for Trabeculectomy
Tom Eke
[Year:2016] [Month:January-April] [Volume:10 ] [Number:1] [Pages:37] [Pages No:21-35] [No of Hits : 790]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1198 | FREE

ABSTRACT

Preoperative preparation should improve the likelihood of successful trabeculectomy surgery. The team can reconsider the appropriateness of the proposed surgery, and steps can be taken to maximize the chance of a good outcome. For example, adjustments to anti-hypertensive or anti-coagulant medications may be made, and topical ocular medications adjusted.
Choice of anesthesia technique is of particular relevance to the trabeculectomy patient. Some anesthesia techniques are more likely to have serious complications, and glaucoma patients may be at higher risk of some sight-threatening complications, because the optic nerve is already damaged and vulnerable. Posterior placement of local anesthesia (retrobulbar, peribulbar, posterior sub-Tenon’s techniques) could potentially damage the optic nerve, and thereby cause “wipe-out” of vision. Anesthesia technique may influence the likelihood of vitreous bulge and surgical difficulty. Regarding long-term control of intraocular pressure, there is no good evidence to indicate that any particular anesthesia technique is better than another. There is little high-quality evidence on this topic. The author’s preferred technique for trabeculectomy is subconjunctivalintracameral anesthesia without sedation.

Keywords: Anesthesia, Intracameral anesthesia, Local anesthesia, Peribulbar anesthesia, Retrobulbar anesthesia, Subconjunctival anesthesia, Sub-Tenon’s anesthesia, Topical anesthesia, Trabeculectomy.

How to cite this article: Eke T. Preoperative Preparation and Anesthesia for Trabeculectomy. J Curr Glaucoma Pract 2016; 10(1):21-35.

Source of support: Nil

Conflict of interest: None

 
6.  REVIEW ARTICLE
The Suprachoroidal Route in Glaucoma Surgery
Anthony Gigon, Tarek Shaarawy
[Year:2016] [Month:January-April] [Volume:10 ] [Number:1] [Pages:37] [Pages No:13-20] [No of Hits : 519]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1197 | FREE

ABSTRACT

Glaucoma surgeries targeting the uveoscleral drainage pathways have been drawing more attention lately. Among all the available techniques, procedures focusing on the suprachoroidal space seem particularly promising, by making use of a presumably efficient and secure outflow route and avoiding subconjunctival filtration blebs.
The purpose of this review is to assess the efficacy and the security of the different suprachoroidal drainage implants, namely the CyPass Micro-Stent, the iStent Supra, the SOLX Gold Shunt, the Aquashunt, and the STARflo Glaucoma Implant.
Most clinical studies seem to currently point toward the direction that there are actual benefits in suprachoroidal surgeries by avoiding bleb-related complications. Nevertheless, even suprachoroidal implants may be subject to scarring and failure. More data are still needed, especially concerning longterm effects, although the approach does seem appealing.

Keywords: Glaucoma surgery, Microinvasive, Review, Suprachoroidal.

How to cite this article: Gigon A, Shaarawy T. The Suprachoroidal Route in Glaucoma Surgery. J Curr Glaucoma Pract 2016;10(1): 13-20.

Source of support: Nil

Conflict of interest: None

 
7.  RESEARCH ARTICLE
Diurnal Curve of the Ocular Perfusion Pressure
Fabio N Kanadani, TCA Moreira, BSP Bezerra, MP Vianello, J Corradi, SK Dorairaj, TS Prata
[Year:2016] [Month:January-April] [Volume:10 ] [Number:1] [Pages:37] [Pages No:4-6] [No of Hits : 510]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1195 | FREE

ABSTRACT

Purpose: To describe the diurnal variation of the ocular perfusion pressure (OPP) in normal, suspects and glaucoma patients.

Materials and methods: Seventy-nine subjects were enrolled in a prospective study. The diurnal curve of intraocular pressure (IOP) was performed and blood pressure measurements were obtained. Each participant was grouped into one of the following based upon the clinical evaluation of the optic disk, IOP and standard achromatic perimetry (SAP): 18 eyes were classified as normal (normal SAP, normal optic disk evaluation and IOP < 21 mm Hg in two different measurements), 30 eyes as glaucoma suspect (GS) (normal SAP and mean deviation (MD), C/D ration > 0.5 or asymmetry > 0.2 and/or ocular hypertension), 31 eyes as early glaucoma (MD < -6 dB, glaucomatous optic neuropathy and SAP and MDs on SAP. Standard achromatic perimetry was performed with the Octopus 3.1.1 Dynamic 24-2 program. Intraocular pressure and blood pressure measurements were taken at 6 am, 9 am, 12, 3 and 6 pm. The patients stayed in the seated position for 5 minutes prior to blood pressure measurements.

Results: The mean IOP values in all groups did not follow any regular pattern. The peak IOP was found to be greater in suspect [18.70 ± 3.31 (mm Hg ± SD)] and glaucoma (18.77 ± 4.30 mm Hg) patients as compared to normal subjects (16.11 ± 2.27 mm Hg). In studying the diurnal variation of the OPP, we found lower values at 3 pm in normals (34.21 ± 2.07 mm Hg), at 9 am in suspects (54.35 ± 3.32 mm Hg) and at 12 pm in glaucoma patients (34.84 ± 1.44 mm Hg).

Conclusion: Each group has a specific OPP variation during the day with the most homogeneous group being the suspect one. It is important to keep studying the IOP and OPP variation for increased comprehension of the pathophysiology of glaucomatous optic neuropathy.

Keywords: Diurnal curve, Glaucoma, Ocular perfusion pressure.

How to cite this article: Kanadani FN, Moreira TCA, Bezerra BSP, Vianello MP, Corradi J, Dorairaj SK, Prata TS. Diurnal Curve of the Ocular Perfusion Pressure. J Curr Glaucoma Pract 2016;10(1):4-6.

Source of support: Nil

Conflict of interest: None

 
8.  CASE REPORT
New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case
Tamara L Berezina, Robert D Fechtner, Amir Cohen, Eliott E Kim, David S Chu
[Year:2015] [Month:May-August] [Volume:9 ] [Number:2] [Pages:31] [Pages No:62-64] [No of Hits : 1640]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1185 | FREE

ABSTRACT

We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency.

Keywords: Conjunctiva deficiency, Corneal patch graft, Glaucoma drainage device, Keratoglobus, Wound healing.

How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64.

Source of support: Nil

Conflict of interest: None

 
9.  REVIEW ARTICLE
Biodegradable Collagen Implants in Trabeculectomy
Parul Ichhpujani, Tanuj Dada, Shibal Bhartiya
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:24-27] [No of Hits : 1425]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1179 | FREE

ABSTRACT

Subconjunctival and subscleral fibrosis are the major causes of failure of filtering surgery. Antiproliferative agents have been successfully used to improve the long-term success of this surgery. Recent advancement in the field of glaucoma surgery has been the use of bioengineered, biodegradable, porous collagen-glycosaminoglycan matrix implant in the subconjunctival and/or subscleral space to modify the woundhealing process and reduce scar formation, hence improving the surgical success without the need for anti-fibrotic agents.
Biodegradable, collagen implants have shown favorable results when used with deep sclerectomy. There have been variable results regarding the success of trabeculectomy when combined with these implants. These implants also decrease the dose of mitomycin C required with trabeculectomy and hence, decrease the side effect associated with these drugs.
The use of the biodegradable implants in glaucoma surgery is still evolving and further studies are needed to find the appropriate surgical technique, the ideal size and site of placement and determine their long-term impact on trabeculectomy outcomes and complications.

Keywords: Collagen implants, Subconjunctival fibrosis, Trabeculectomy.

How to cite this article: Ichhpujani P, Dada T, Bhartiya S. Biodegradable Collagen Implants in Trabeculectomy. J Curr Glaucoma Pract 2015;9(1):24-27.

Source of support: Nil

Conflict of interest: None

 
10.  ORIGINAL ARTICLE
Does Chronic Hypotony following Trabeculectomy Represent Treatment Failure?
Steven Yun, Brian Chua, Colin I Clement
[Year:2015] [Month:January-April] [Volume:9 ] [Number:1] [Pages:32] [Pages No:12-15] [No of Hits : 1150]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10008-1176 | FREE

ABSTRACT

Purpose: To measure the rate of complications from chronic hypotony following trabeculectomy and clarify the definition of postoperative hypotony.

Materials and methods: In this retrospective case-control study, the rate of complications was compared between 34 eyes with chronic hypotony and 34 eyes without hypotony. Chronic hypotony was defined as those eyes with an intraocular pressure (IOP) of less than 6 mm Hg on two consecutive clinic visits at least 3 months after trabeculectomy. Cases were identified from a database of two glaucoma surgeons between 2010 and 2013. Outcomes measured included visual acuity, presence of choroidal effusion, hypotensive maculopathy and cataract development/progression. Factors associated with the development of hypotony were considered using analysis of variance (ANOVA) multivariate regression.

Results: Maculopathy was seen in 23.5% of hypotony eyes but not in controls (p < 0.01). No significant difference in the rate of choroidal effusion or cataract was documented between groups. Control eyes were more likely to remain complication free (58.8 vs 32.4%, p < 0.03). Spontaneous recovery from hypotony occurred in 32.4% of hypotony eyes.

Conclusion: Sight threatening complications occur more frequently in eyes with chronic hypotony following glaucoma surgery. However, not all eyes with chronic hypotony develop sight threatening complications. A definition of hypotony that combines IOP criteria with the presence of structural and/or functional changes is recommended.

Keywords: Intraocular pressure, Glaucoma, Filtration surgery, Choroidal effusion, Hypotensive maculopathy, Cataract.

How to cite this article: Yun S, Chua B, I Clement C. Does Chronic Hypotony following Trabeculectomy Represent Treatment Failure? J Curr Glaucoma Pract 2015;9(1):12-15.

Source of support: Nil

Conflict of interest: None

 
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