Indian Journal of Ophthalmology最新文献

Purpose: To evaluate the safety and efficacy of a combined surgical approach involving intraocular lens (IOL) explantation, flanged intrascleral IOL fixation using the Yamane technique, and gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with dislocated IOLs and pseudoexfoliative glaucoma.

Design: Retrospective observational study.

Methods: This single-center study included 15 patients (15 eyes) with dislocated IOLs and pseudoexfoliative glaucoma who underwent combined IOL exchange (Yamane technique) and GATT, with a minimum 3-month follow-up. Inclusion criteria were uncontrolled IOP (>21 mmHg) or progressive glaucomatous damage. Main outcome measures included changes in IOP and antiglaucomatous medications (AGMs), surgical success, and complications.

Results: The mean preoperative IOP decreased from 29.40 ± 3.40 mmHg to 14.80 ± 1.52 mmHg (P < 0.001), and the mean number of AGMs reduced from 3.47 ± 0.83 to 1.13 ± 0.83 (P < 0.001) at a mean follow-up of 14.67 ± 6.10 months. The best corrected visual acuity improved significantly (P < 0.001), while ganglion cell layer and retinal nerve fiber layer thicknesses remained stable. Complete surgical success was achieved in 26.7% of eyes, and qualified success in all cases. The overall complication rate was 60%; the most common complications were microhyphema and mild vitreous hemorrhage, occurring in four patients each (26.7%), all of which resolved spontaneously.

Conclusions: Combined flanged intrascleral IOL fixation and GATT is an effective, minimally invasive strategy with an acceptable safety profile for IOP reduction and IOL exchange in patients with dislocated IOLs and pseudoexfoliative glaucoma, with the advantage of preserving the conjunctiva for future interventions.

Primary angle closure disease (PACD) though less prevalent than primary open angle glaucoma contributes to fifty percent of glaucoma blindness, particularly in the Asian population. Pupillary block is the most common pathology associated with PACD. The definitive treatment to relieve pupillary block and to prevent disease progression is laser peripheral iridotomy (LPI). The most commonly employed laser for performing laser peripheral iridotomy is Neodymium: Yttrium Aluminium Garnet (Nd:YAG). LPI is routinely performed as an outpatient procedure. Though it is often considered as a safe procedure, it is not without limitations. Apart from widening the angle it can influence the intraocular pressure, corneal endothelial cells and can lead to newer visual disturbances/dysphotopsias. Additionally, it can cause or accelerate cataract formation. This narrative review discusses the indications, procedural considerations, structural and functional outcomes, and the changes associated with LPI in eyes with PACD.

Purpose: The purpose of this study was to compare surgical outcomes and safety profiles of gonioscopy-assisted transluminal trabeculotomy (GATT) versus combined trabeculectomy and trabeculotomy (CTT) in primary congenital glaucoma (PCG) at 12 months.

Design: Retrospective comparative analysis.

Methods: Children with mild-to-moderate PCG who underwent either GATT or CTT between December 2021 and June 2023 were included. Patients' data recorded at baseline and at postoperative periods of 1st, 3rd, 6th, and 12th months were analyzed. Intraocular pressure (IOP) reduction, incidence of complications, and the need for repeat examinations under anesthesia (EUA) were analyzed. Surgical success was defined as absolute when IOP ≤18 (criterion A) and ≤15 mmHg (criterion B) was achieved without medications and qualified, when achieved with medications. Failure was defined as IOP >18 mmHg on maximal medical therapy, IOP <6 mmHg, or the need for additional IOP-lowering surgery. Multivariate regression analysis was used to assess baseline predictors for binary outcomes (surgical success and any complication).

Results: Ninety-eight eyes from 68 children diagnosed with PCG were analyzed, having undergone either CTT (58 eyes) or GATT (40 eyes) with 12-month follow-up, which showed similar success rates (P = 0.6, Log Rank test). Multivariate analysis did not identify any significant baseline predictors of surgical success. Postoperative complications (34% vs 20%; adjusted P = 0.02) and need for repeat EUAs (0 vs 1.27/eye; P = 0.05) were significantly higher in the CTT group.

Conclusions: In mild-moderate PCG eyes, GATT demonstrated similar surgical success with a better safety profile than CTT and can be preferred as the first-line surgical modality.

Purpose: To analyze early outcomes and safety profiles of combined phacoemulsification and suture gonioscopy-assisted transluminal trabeculotomy (phaco-GATT) in Indian eyes with primary and secondary (pseudoexfoliative) glaucoma coexisting with cataract.

Methods: In this retrospective interventional analysis, 42 eyes with primary and secondary (pseudoexfoliative) glaucoma, all with coexisting cataract having follow-up of 6 months to 1 year, were included. Phacoemulsification with suture GATT was performed. Outcome measures included surgical success rate (complete and qualified), intraocular pressure (IOP) reduction post surgery, change in antiglaucoma medications (AGMs) post surgery, change in best corrected visual acuity, and surgical complications. IOP reduction <18 mmHg or ≥30% from baseline without AGM was defined as complete success. IOP reduction <18 mmHg or ≥30% from baseline with AGM was considered as qualified success.

Results: Mean baseline IOP reduced significantly from 23.05+- 7.42 mmHg to 13.4+- 3.20 mmHg at 1 year ( P < 0.001, n = 30), with a 44% IOP reduction. Mean AGM use decreased from 1.93+- 0.52 to 0.13+-0.43 at 1 year ( P < 0.001, n = 30). The complete and qualified success rates at 1 year were 90% and 93%, respectively. BCVA improved from 0.533+- 0.36 logMAR to 0.013+-0.050 logMAR ( P < 0.001). Common complications were IOP spikes (19%) and transient hyphema (16%), all resolving without major intervention.

Conclusion: Combined phaco-GATT is a cost-effective and safe surgery with favorable early outcomes, providing significant IOP reduction, reduced medication burden, and minimal complications in patients with primary and secondary (pseudoexfoliative) glaucoma. As a conjunctiva sparing technique, it preserves future surgical options and may delay or avoid need for trabeculectomy.